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Seed: In Guyana infection transmission sumycin 500mg overnight delivery, mixed with Allium cepa, Allium sativum and other plants, to cure Guinea worm infections. Leaf: Warmed leaves are strapped around the affected area as an analgesic or are wrapped around the affected area as an anti arthritic, by the Guyana Patamona. Warmed leaves are used as a poultice for treating muscular aches and pains by the Guyana Patamona. Root and Stem: the stem and crushed root are rubbed on 226 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) teeth and gums as a dental analgesic; stem and crushed roots employed in curare preparation by the French Guiana Palikur and Wayapi. Leaf: the Surinam Tirio place a piece of leaf in cavity in a tooth to relieve toothache pain. Plant is boiled and the water used as an herbal bath or for washing the skin for reducing high fevers, by the Guyana Patamona. Plant is heated and tied or wrapped around the head and forehead for treating headaches, by the Guyana Patamona. Leaf: Infusion is sudorific; in a compress applied to the head for a prolonged period of time as an antineuralgic; macerated leaves and crushed stem are mixed with leaves of Piper amapaense for a headache remedy. Mixed with coconut oil or castor oil and rubbed on painful or swollen joints; ground leaves put on cuts; boiled for grippe and stomach pain; warm poultice is anti-inflammatory. Warmed leaves are tied to the head or forehead to relieve headache, and tied to other areas to relieve hernia pain and arthritis pain. The Tikuna of Colombia use the leaves as an ingredient for a fever and bronchitis remedy (10). Surinam Saramaccan Bush Negro: bosoe pata ahoe, bosoe pata amoe, bosu pata ahu, bosu pata amu. In Guyana, a decoction of boiled leaves is used by women as a "clean-out" for dilation and curettage, and also to aid the expulsion of the afterbirth of women and cows. Boiled with Bambusa vulgaris leaves and Zingiber officinale for a liquid drunk to treat fever and ague. Boiled with leaves of Tripogandra serrulata, Persea americana and Scoparia dulcis for tea to treat jaundice. Decocted with Annona glabra leaves and banana-stalk (Musa x paradisiaca) for an emetic and to rid chest of mucus. As a digestive; decoction to reduce or increase perspiration; for urinary conditions involving painful cramps. Leaves are boiled, and the water drunk as an anti-asthmatic, as an anti-pyretic, as an anti-viral and as a treatment for bronchitis, for colds, for coughing, and for tuberculosis, by the Guyana Patamona. Leaves are boiled, and the water used as a beverage and a tonic, by the Guyana Patamona. Leaves are boiled and the water used as a treatment for influenza, by the Guyana Patamona. Decoction of whole plant used to treat anuria ("stoppage of water"), stomachache, and in baths to prevent itching. Decoction is diuretic, used to treat bladder disorders, relieve pain caused by straining the abdominal muscles, and is applied to open wounds to stop bleeding. In Guyana, the whole plant is boiled with black sage for use in a sitting bath to treat fevers, colds, malaria, and for post-childbirth cleansing of a mother. Flower: Macerated lemmas are used for washing the head to get rid of dandruff, by the Guyana Patamona. Mashed dry leaves are also used as an antimicrobial for the umbilical cord of babies, by the Guyana Patamona. Plant is ground into a powder, dissolved in water, and drunk as an anti-inflammatory, by the Guyana Patamona. Root: Root is ground into a powder, mixed with water and drunk as an antibacterial, as an antidiarrheal, and for coughing or for sore throat, by the Guyana Patamona. Stolon: Stolon is washed and chewed as an antipyretic or as a medication for colds, by the Guyana Patamona. Leaf: Crushed leaves are mixed with red paste from Bixa aril and rubbed on the cheeks by the Surinam Tirio to relieve headache. Yields sugar; finely ground sugar is used for eye diseases in French Guiana by blowing it into a leucoma of the cornea. In Guyana, granulated sugar is sometimes placed on a scald or burn for quick relief. Surinam: karoe-barba, karu-barba, maiskolf-baard (stigma); malata karoe (half-ripe maize); karoe, karu. Flower: Stigmas plucked from corncob are cooked in water as a treatment for rheumatism, urinary complaints, bladder cramps, and to prevent urinary stones. Green corncob is cooked in water, which is drunk for dietary slimming, to reduce fat. Raw sap expressed from the stem is used to soothe a dermatosis characterized by spots on the face and body. A decoction of the grated stem is used as a mouthwash for a dental analgesic by the French Guiana Wayapi. Plant is boiled and the water used for treating arthritis or muscle pains by the Guyana Patamona. Juice from macerated plant is applied as an antiseptic to cuts and bruises to stop bleeding and to heal wounds, by the Guyana Patamona. Leaf: In Surinam, leaves mixed with sugar or soap are applied onto mature abscesses. In French Guiana an infusion of leaves is used as a cholagogue, to treat renal colic, and to prepare the body before taking a purgative. Stem: Cold water infusion of the rasped inner bark is used by the Surinam Wayana as a wash for the treatment of headaches. Species of Protium are said to be used in Surinam for the same purposes as Trattinickia. Stem: In Guyana, a decoction of the boiled bark is drunk to instantly relieve diarrhoea. Fruit: Unripe fruit is employed to relieve diarrhoea, but is less effective than the bark preparation. Rind of fruit in a detersive gargle, or the rind in an infusion drunk for diarrhoea and stomach problems. Leaf: the French Guiana Wayapi grind young leaves in a decoction or maceration as a remedy to combat shortness of breath in pulmonary complaints. Stem: A bark decoction is used to treat frequent dysentery, diarrhea, micturition and bladder diseases in Guyana. Bark is febrifuge, astringent, rich in tannin, used in a decoction in French Guiana for haemorrhages, and in gargles to remedy angina. Root contains emetine; root-bark contains the iridoids daphylloside, asperuloside, feretoside, methyl desacetylasperulosidate, desacetylasperuloside, asperulosidic acid and desacetylasperulosidic acid (115). The French Guiana Palikur treat head injuries and headaches with a cataplasm of grated bark containing the sap. Inner bark is rasped and either a decoction or cold water infusion of it is used as a wash to treat fevers and chills. Juice from the bark is warmed and used for eczema and dermatoses by the Guyana Patamona. Inner bark is scraped, warmed and used as a medicament for sores by the Guyana Patamona. Root is macerated in rum with the roots of Ptychopetalum olacoides and Strychnos erichsonii and drunk as an aphrodisiac by the French Guiana Boni and Creole people. The Surinam Wayana soak the crushed root in rum for three months and drink a tincture of it as an aphrodisiac, said to be extremely effective and sold commercially in Paramaribo, Surinam and Cayenne, French Guiana. Stem and Fruit: Fruit and rasped bark are rubbed by the Surinam Akuriyo on black spots that sometimes develop on the skin. Fruit contains malic acid, genipic acid and genipinic acid; leaf contains geniposidinic acid, an iridoid glucoside; seed 243 Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana) contains caffeine (8, 116,117,118,154). The indoloquinoline alkaloid cryptolepine is an active compound isolated from material collected near Asindopo village, Suriname (244). The Guyana Macushi make reddish paint by mixing this plant with Humiria balsamifera var. Leaf and Fruit: Leaves and young fruits are crushed and used as insecticide by the Guyana Patamona. Young fruit is cut in halves and used for treating ringworm infection or for treating eczema by the Guyana Patamona. Pulp of young fruit is used for making tattoos or for treating sunburn, by the Guyana Patamona.

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If a relapse occurs do antibiotics clear acne for good purchase sumycin online pills, it is very important to try to stop drinking again and to get whatever additonal support is needed to abstain from drinking. Help for Alcohol Abuse Acknowledging you need help for an alcohol problem is difcult. Many alcoholics do not begin to deal with their alcoholism untl a signifcant life-changing or life-threatening event occurs. While it is not necessary to hit botom in order to begin the recovery process, it is ofen the case. Denial is a coping strategy whereby people avoid dealing with difcult situatons by denying that they exist. It is difcult for a person in denial to recognize and understand the efects alcohol has on him or her. This is also true for family members and friends who are frequently in denial with regard to a loved one’s alcoholism. Caring Ambassadors Hepatitis C Choices: 4th Edition Many people fnd the following quiz on drinking helpful. If you answered yes to one or more of these questons, you may have a problem with alcohol. Many people feel uncomfortable discussing their drinking habits even with a healthcare provider or a personal or spiritual advisor. There is a myth in our society that an alcohol problem is a sign of moral weakness. As a result, you may feel that to seek help is to admit a shameful defect in your character. Moving Forward Even if alcohol is taking a signifcant negatve toll on your life, it can be very difcult to begin taking steps to address the problem. Because alcohol has a tremendous impact on the health of people with chronic hepatts C, your healthcare provider will probably ask you several questons about your alcohol use. If your healthcare provider determines that you are not alcohol dependent but are involved in a patern of alcohol abuse, he or she can assist you in the following ways. He or she may recommend that you see a specialist in diagnosing and treatng alcoholism. As hard as this may be to hear, try to understand that your healthcare provider is doing his/her best to help you be well. Studies have proven that interferon-based therapy is much less efectve in people who drink alcohol than in those who do not drink. Treatment for alcoholism may involve one or more of the following components: prescripton medicatons, individual counseling, and group counseling. Promising counseling techniques teach recovering alcoholics to identfy situatons and feelings that trigger the urge to drink. This can help you fnd new ways to cope with stressful 16 Copyright © 2008, Caring Ambassadors Program, Inc. Treatment for alcoholism may be provided in a hospital, residental treatment setng, or on an outpatent basis. Many programs ofer brief marital counseling and family therapy as part of the treatment process. Some programs also link individuals with vital community resources such as legal assistance, job training, childcare, and parentng classes. Treatment for alcoholism may require a combinaton of social support and drug therapy. When faced with the anxiety and fears associated with hepatts C, you may feel the urge to turn to alcohol. A few of the common treatment optons available for eliminatng alcohol from your life are outlined below. Data from a large clinical trial that examined the efcacy of diferent treatment approaches for alcoholism found that the quality of care is more important than the structure of the treatment delivery. It generally consists of straightorward informaton about the negatve consequences of alcohol consumpton. It also gives practcal advice on strategies for eliminatng alcohol from your life. Informaton is provided about community resources to achieve alcohol moderaton or abstnence. Alcohol-dependent people are encouraged to enter specialized treatment programs where the goal is complete abstnence. It typically involves educatonal lectures, group therapy, and one-on-one counseling. Some clients stay for several months depending on individual circumstances and needs. The social setng allows people who are facing a similar challenge to share experiences and support one another. Typically, clients atend lectures, meetngs, group therapy, and individual therapy throughout the day. In a residental facility, a client’s physical and mental status can be closely monitored. The temporary protecton of a residental treatment facility provides clients a safe place to begin rebuilding their lives without the distractons of work 17 Copyright © 2008, Caring Ambassadors Program, Inc. An essental component of residental treatment is making plans for how to maintain sobriety afer leaving the facility. Some facilites ofer part-tme residental treatment for clients who cannot or do not choose to take tme of work. Clients contnue to atend work, but spend the rest of their tme in the treatment facility. Clients who have been through full-tme residental treatment may transiton to a sober-living home afer completng their primary program. Clients live in the facility for an extended period while working on rebuilding their lives. This type of facility is ofen useful for people who have been through treatment in the past, but have relapsed afer returning to their usual environment. This support increases the likelihood that the alcoholic person will change his or her drinking behavior afer treatment ends. Most of these include shared actvites, and learning communicaton and confict resoluton skills. It can be quite difcult for an alcoholic to abstain if his or her partner contnues to drink. It begins with the assumpton that the responsibility and capacity for change lie within the individual. Together, they review treatment optons and design a plan to implement treatment goals. Your healthcare provider will review the drugs available and determine if any are appropriate for you. Many of these skills are similar to those taught in more structured treatment setngs. Chapter 3: Alcohol and Hepatitis C the Final Word no studies have ever determined a safe amount of alcohol to drink. They also provide referrals to Alateen groups, which ofer support to children of alcoholics. Faces & Voices of Recovery is governed by a diverse group of recovery advocates from around the country and supports local recovery advocacy by increasing access to research, policy, organizing and technical support; facilitatng relatonships among local and regional groups; improving access to policymakers and the media; and providing a natonal rallying point for recovery advocates. Impact of alcohol on the histological and clinical progression of hepatts C infecton. Heterogeneous virologic response rates to interferon-based therapy in patents with chronic hepatts C: who responds less well? Consumpton of alcohol in the presence of hepatts C virus is an additve risk for liver damage. Antbody to hepatts C is common among patents with alcoholic liver disease with and without risk factors.

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This Frye standard ensures that scientific evidence is reliable without placing an impossible burden on judges antibiotics for uti diarrhea buy 500 mg sumycin mastercard. The attempted change is unnecessary and it will be detrimental to our system of justice in Florida. The Frye standard is a more objective standard that would help create consistency in qualifying experts for trial. In what can only be viewed as an attempt to overstep the judicial branches refusal to adopt Daubert, the Legislature (through money of special interests groups) has adopted Daubert. This standard requires judges to become scientists in different areas and forces them to evaluate individual "scientific" studies. The Daubert standard is too time-consuming, burdensome, and too costly for under-resourced Florida courts to apply. Trial judges are having to conduct "trials within trials" to apply the multi factorial and flexible Daubert standard thereby providing arbitrary results which cause confusion and inconsistency. The Florida Supreme Court views the Frye standard as the more objective test requiring scientific evidence to be generally accepted in the scientific community. The Frye standard has worked well in Florida for decades and has successfully screened junk science out of Florida courtrooms. The Frye standard ensures that scientific evidence is reliable while at the same time not overburdening our trial judges. Daubert will restrict access to justice and will exponentially increase case costs and delay trials more than they already are. This will further burden our already financially strapped judicial system, whose budget seems to decrease every year. Adding more procedural hoops to our already fragile judicial system will have catastrophic consequences, denying Floridians their right to a jury trial, and significantly increasing the time it takes to get to trial. We need to focus on the real problems of our judiciary, rather than manufacturing false problems. Daubert is being used as a sword to increase the cost and construct barriers to the consumers. Daubert operates as a lock on the courthouse doors to litigants who do not have the financial backing of the insurance industry or other moneyed interests. Daubert has been used as a tool for confusion and the confounding of basic evidentiary presentations, challenging even such basic notions as testimony by treating physicians on causation, diagnosis and prognosis. Daubert, in its original intent to make it easier to present expert testimony, has been perverted and turned on its head. It is seen by trial lawyers almost universally as a tool for exclusion of otherwise valid expert opinions. The need for complicated hearings which force round pegs into square holes is troubling. Importantly, this law is a procedural law, which is solely in the purview of the Supreme Court and outside the power of the Legislative branch. Frye, as recognized by the Florida Supreme Court, is more based in science and principle than Daubert, and Daubert is more likely to produce arbitrary results. Frye, unlike Daubert, requires the principles underlying expert testimony to be "generally accepted in the scientific community" therefore eliminating the subjectivity of experts, lawyers, or judges. Resolution of this issue at the earliest date by the Florida Supreme Court is needed. Despite not being adopted by the Florida Supreme Court, and thus not a rule of evidence, several courts have assumed that the Daubert standard is to be applied. The Daubert standard is time-consuming, burdensome, and costly for under-resourced Florida courts to apply and amounts to an unfunded mandate. Unfortunately, courts are under the impression that Daubert is the standard and is to be applied. As a result, additional motions are necessitated followed by extensive and costly hearings. The amount of time and money being wasted on Daubert is crushing our court system. Additionally, Daubert unfairly forces judges to become judges of science instead of law. Frye is the appropriate standard and has worked to allow valid case, and it provides sufficient protections against "junk science". The only reason to approve Daubert is to limit scientific evidence, and that will not only prevent valid prosecution of civil and criminal cases. Civil cases are important, but there is no question that requiring Daubert will result in allowing criminals to escape culpability for crimes they committed by improperly handcuffing the prosecution. Sacrificing the public safety to protect corporate interests is a horrible idea and thus Daubert should be rejected, and Frye should remain the law of the land. Daubert creates a burden on Plaintiff attorneys and the already burdened Judges to work Daubert hearings into almost ever civil litigation case. Everyone agrees the standard of Daubert is not changing admissibility but is slowing the court system. It is being used as a tool by corporations/defendants to delay litigation, and to significantly increase the expense a plaintiff already bears to pursue a cause of action. Based on my 40 years of trial experience, I can unequivocally say this is a bad evidentiary standard, and should not be implemented. While a majority of the legislature may have disagreed with the learned history steadfast decisions of the Court to reject the Daubert standard in the past, the fact that its members believe that their disagreement alone should change the way the Courts proceed is testament to the impropriety of the standard: it is motivated either by ignorance or overreach, both desiring nothing but to curtail the judicial process. A legislator should not don a black robe any more than a judge should don a white coat. The admissibility of expert opinion evidence is a matter of procedure, subject only to the Court’s authority. The Court adopted the Frye standard after the enactment of the Evidence code, rejecting the argument that the code contradicted the Frye standard. The Court then repeatedly declined requests to replace the Frye standard with the Daubert standard, rejecting the argument that Daubert was a better standard to effectuate the purposes of the code. The Daubert standard may work in other Courts, but that is a decision to made by the Courts and not by the politicians who judge them. The parties will often have to conduct trials within trials just to determine if the Daubert standard has been met. This will cause even greater backlog than already exists, making it even more difficult for the parties to get their day in court. Daubert hearings are hard to schedule due to the massive amount of time required; are very time consuming to prepare for, and are frightfully expensive to conduct. I believe the system should be more simple and the credibility of expert testimony should be a jury decision as they will certainly have the instruction regarding greater weight of the evidence and it should be left to them to discern the credibility and believability, or lack thereof, of an expert and their testimony. The Frye standard has proven to be highly efficient and non detrimental to court cases. The Daubert standard requires Judges to become amateur scientists and will more likely produce arbitrary results and also invade the province of the jury. The Daubert standard is time consuming, burdensome and costly for Florida courts and litigants. The Daubert standard is too time-consuming, burdensome, and costly for under resourced Florida courts to apply and amounts to an unfunded mandate. There is no reason to change the evidentiary standard for expert witness testimony in Florida. Florida’s expert witness opinion standard should not be determined by the legislature. Chapter 2013-107 creates an unworkable standard open to many conflicting rulings and leading to arbitrary and unintended results. As such, the ability to prove cases on their merits (by both sides) is greatly diminished. Even without the formal adoption of chapter 2013-107, civil trial courts in my home circuits are routinely holding multi-hour-and oftentimes multi-day-hearings on expert opinions under the “new standard. We recently had a case which essentially included four days of basically Daubert hearings which is a costly and unnecessary effort for everyone involved. This change is unnecessary for a number of reasons, including that the additional expenses that the change will bring to lawyers and law firms, which flies in the face of the very first rule of civil procedure to ensure the just, speedy and inexpensive resolution of cases. The Daubert standard will likely lead to excessive costs to prosecute civil claims as insurance companies hire experts simply to challenge opposing expert testimony. More importantly, Daubert is more likely to lead to inconsistent rulings from the trial courts. The Daubert standard, however, is fraught with problems, as documented in state and federal courts across the country.

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Eger Innocence Project also maintains a list of these cases and the failure of science at: Twelfth Circuit antibiotic mouthwash over the counter cheap 250 mg sumycin overnight delivery. Howard Finkelstein Seventeenth Circuit First, remember that the Frye test was formulated almost a century ago. Litty Nineteenth Circuit that: “Just when a scientific principle or discovery crosses the line between the Kathleen A. Somewhere in this twilight Twentieth Circuit Vice-President zone the evidential force of the principle must be recognized. Shaken Baby Syndrome is accepted in the relevant scientific community and, therefore, is no longer new or novel. A federal court, after extensive testimony, has called into doubt the validity of that syndrome. Debbie Cenziper, Shaken Science: A Disputed Diagnosis Imprisons Parents, the Washington Post (Mar. That dispute will never be heard in Florida courts under Frye, however, because it is not “new or novel” science and therefore is not subject to Frye testing. Likewise, much “forensic scientific” is not subject to any judicial scrutiny because it is not “new or novel. Bite mark analysis has been admitted in many murder cases in Florida since State v. As Judge Kozinski has noted, however: Spectrographic voice identification error rates are as high as 63%, depending on the type of voice sample tested. Other fields of forensic expertise, long accepted by the courts as largely infallible, such as bloodstain pattern identification, foot and tire print identification and ballistics have been the subject of considerable doubt. Long-time acceptance by courts is no substitute for scientific validity, accuracy and reliability. Second, Frye holds that a methodology is valid if it has “gained general acceptance in the particular field to which it belongs. That makes a certain amount of sense for true scientific endeavors created for and used in the broader world. Frye November 15, 2015 Page 3 “forensic sciences” because most of them have no applicability outside of criminal courtrooms. Much of “forensic science” was created by law enforcement agencies for the sole purpose of helping secure convictions in criminal cases. Thus, “general acceptance” of a forensic science methodology means little more than an agreement by personnel in law enforcement agencies to begin using a technique. And because their jobs and livelihoods depended on it, there was inevitably “general acceptance in the particular field. Most of these techniques were developed in crime laboratories to aid in the investigation of evidence from a particular crime scene, and researching their limitations and foundations was never a top priority. It should come as little surprise that some of these fields are now being revealed as junk science, such as hair sample matching, bullet lead matching and bite mark analysis. David Sheets, “A Study of Multiple Bitemarks Inflicted in Human Skin by a Single Dentition Using Geometric Morphometric Analysis,” 211 Forensic Sci. A 2006 peer-reviewed article lamented the “disturbingly high false-positive error rate” of bite mark matching, as evidenced in part by a 1999 workshop conducted by the American Board of Forensic Odontology, in which experts who “attempted to match four bitemarks to seven dental models found 63. Michael Bowers, “Problem– Based Analysis of Bitemark Misidentifications,” 159S Forensic Sci. Other fields, long “generally accepted” are only now getting any real scientific testing, upending many of their “scientific” principles. Of course, these revelations are too late for defendants convicted using this “scientific evidence. Frye November 15, 2015 Page 4 the problem is that too much of forensic “science” is pure opinion. Similar opinion testimony resulted in the execution of a Texas man for a fire that killed his children. The Texas Forensic Science Commission, Willingham/Willis Investigation (April 15, 2011) (available at. Forensic “science” is rife with examples where a so-called expert, really an adjunct to law enforcement, testifies that X matches the defendant. The examples are endless: bite marks, tool marks, shoe prints, tire marks, handwriting. As the National Research Council noted: “In most forensic science disciplines, no studies have been conducted to establish the uniqueness of marks or features. Yet, despite the lack of a statistical foundation, examiners make probabilistic claims based on their experience. Under Frye, the National Research Council’s recommendation that “research is needed to address the issues of accuracy, reliability, and validity in the forensic science disciplines” will never be implemented. But the Legislature’s adoption of Daubert is at least a step in the right direction towards solving these three problems. Second, rather than “general acceptance,” a kind of popular vote by those experts whose livelihoods depend on that acceptance, Daubert requires that “an inference or assertion must be derived by the scientific method. Respectfully Submitted, Julianne Holt, President, Florida Public Defender Association, Inc. In particular, this memorandum responds to the Majority Report of the Code and Rules 1 Committee of the Florida Bar (the “Majority Report”) which urged the rejection of the Daubert standard in Florida proceedings. As an initial matter, the Majority Report incorrectly asserts that Frye is a more exacting standard then Daubert because it requires that a scientific principle be generally accepted in the scientific community before testimony based upon that principle is admissible, while Daubert is flexible and lacks such a bright line. The “generally accepted” standard articulated by the Circuit Court for the District of Columbia in Frye in 1923 was meant to keep “junk science” out of the court room. If the harm that the Committee seeks to avoid is “arbitrary” results, then the Daubert standard must be adopted simply to ensure that some type of standard is applied to the admissibility of pure opinion testimony. Quoting from a treatise on federal procedure, the Majority Report goes on to assert, incorrectly, that Daubert is “unworkable:” the leading treatise on federal civil procedure, Federal Practice and Procedure, describes the standard as unworkable. The treatise suggests that “‘flexible’ tests of the sort announced in Daubert are more likely to produce arbitrary results than they are to produce nuanced treatment of complex questions of admissibility. Those questions have since been answered over the last twenty two years, and the Florida Bar should not base its recommendation upon dated scholarship from superseded treatises. Wright & Graham no longer considers Daubert “unworkable” because this standard has been used effectively throughout the nation for the last twenty two years. The assertion that Frye is a more exacting standard is flatly inconsistent with another of the Majority Report’s flawed premises, that the Daubert standard undermines the right to a jury trial by keeping expert testimony from the jury. This argument is applicable to the entire Evidence Code, in addition to almost every other rule and limitation on what arguments may be made to a jury. The judge’s role as gatekeeper is merely to ensure that expert testimony meets a minimum standard of reliability: that the testimony is based on reliable principles and methods that have been reliably applied to sufficient facts or data. If expert testimony meets this minimum threshold, it then goes to the jury, who weighs the reliability of the testimony. Yet defense attorneys in Delaware did not complain of frequently encountering proffered ‘junk science. The study went on to state, “Daubert motions are used effectively as leverage in civil disputes. The Study’s conclusion, however, refutes the notion that there is any undue burden on the court system or litigants. The Delaware Superior Court was not affected by excessive or unnecessary cost or delay as a result of Daubert. A case with 12 experts will be long, complicated, and burdensome for the courts under any standard. To claim that Daubert unreasonably restricts the right to a jury where Frye does not is to oversimplify to the point of inaccuracy. To use this case as an example of Daubert motion practice overwhelming the courts when a Frye motion undoubtedly would have been filed is to demonstrate the danger of anecdotal evidence. The Majority Report’s concerns would have been well taken 20 years ago, before Daubert had been widely applied. Florida should not make a decision of this importance based upon ancient fears that have been overtaken by 22 years of case law development. It simply requires expert testimony to be based on reliable principles and methods that have been reliably applied to sufficient facts or data. The federal circuits have evolved different views of the trial court judge’s gatekeeper role in making that assessment. The Eleventh Circuit is arguably stricter than some, and practitioners in Florida are more accustomed to those standards. Other circuits have been more liberal in allowing expert evidence and determining which reliability questions go to the jury.

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Pollutant concentrations must be measured Pediatric Pulmonologist – Clinical Epidemiologist Respiratory Department 7daystodie infection 250 mg sumycin visa, Hospital separately in different houses, and it has been assumed that Nacional de Niños (National Childrens Hospital), San José, Costa Rica Email: msotom@hnn. Globally, Worldwide, environmental pollution is not appreciated, and in nearly 3 billion people use biomass fuels such as coal, wood, dung or most places not quantified as a cause of disease. However, given crop residues for domestic energy production (either cooking, heating that lung disease is a leading cause of morbidity and mortality or lighting) in homes with no chimney ventilation of smoke [1]. Multiple early life factors can adversely affect lung associated with various respiratory diseases, including lower respira function and future respiratory health. Interestingly, the use of biomass fuels a group of infants enrolled in the South African birth cohort to varies by location, culture and socioeconomic status, determining both assess the determinants of early lung function in African infants. There particles exposure) contributes to respiratory disease in children in industrial are commonly known as nanoparticles (<0. Although adecreasing frequencyof daily smokershas been chronic respiratory and systemic disorders (particularly cardiovascu reported during the last three decades in developed countries, in lar). In addition, maternal smoking also encourages children to Biological Pollutants smoke, potentially worsening their health. Also, children who live in these include indoor particles whose importance for health is out of homes with smokers are 50% more likely to become smokers proportion to their concentration. Many of these biological contaminants are small enough to be health problem, as exposure to tobacco smoke often begins inhaled. Sensitization is a key factor for the development of increased prevalence of childhood wheeze and asthma [7]. Formaldehyde Theroleof formaldehydein lower respiratory symptomsand asthmain Oxides of Nitrogen children is controversial. The principal source of formaldehyde in the homes are small amounts occur in tobacco smoke. Their sources include building of indoor particulate matter in developing countries far exceed those materials, furnishing, furniture, adhesives, cleaning agents, cosmetics, in developed countries. The less expensive fuel options are generally the water supply, tobacco smoke and fuel combustion. Global efforts to promote the increased levels of emissions indoors are associated with an open improved programs of pollution control are needed. These specific interventions such as effective cooking solutions (as the use fuels are usually burned in open fires for cooking, heating and lighting of improved fuels, cookstoves), or heaters, and improved ventilation in or near the home environment. In 2016, the World Health Organization estimates that middle-income countries: a systematic review and meta-analysis of 6. Schüepp, the occurrence of ultrafine particles in Air pollution exposures during pregnancy can have a major impact on the specific environment of children. Paediatric Respiratory Reviews, fetal development and the respiratory health of the child. Some pollutants can cross the placental exposure with an increased risk of hospital admissions for pneumonia in barrier such as nicotine, while others may induce inflammation or alter children under 5 years of age in Vietnam. There is a significant association Guatemalan children following a chimney stove intervention. Both lower birth weight and premature birth increase the risk for decreased pulmonary function tests and increased respiratory responsiveness among children with asthma in Costa Rica. Prenatal Exposure to Pollutants and Lung Disease lower respiratory tract infection. With improvements in quantitation, localization and timing of Correspondence: Judith A. The major weeks, increased the risk for asthma in boys, but not girls, at age sources of pollutants are indoor exposures to environmental tobacco 6 years. A pregnancy is a major cause of low birth weight and premature delivery; call for public health action. Ann Am Thorac Soc 2014;11 both factors predispose to increased risk of airflow obstruction. Air pollution exposure there may be therapeutic approaches to mitigate the effect of and markers of placental growth and function: the maternal smoking on the offspring. Environ Health Perspect 2012;120 randomized, double blinded, prospective trial administered Vitamin C (12):1753-1759. This methylation in newborns related to maternal smoking during intervention is currently being investigated in a larger study to pregnancy. Environ Health Perspect 2012;120(10):1425 determine whether Vitamin C has long-lasting effects on protecting 1431. Intrauterine make progress in studying the mechanisms of how prenatal air inflammation and maternal exposure to ambient pm2. First, during preconception and specific periods of pregnancy: the pregnant women may be exposed to mixtures of pollutants with boston birth cohort. Pulmonary effects of maternal satellite-derived aerosol optical depth spectroradiometry have smoking on the fetus and child: Effects on lung development, improved the spatiotemporal accuracy of determining pollution respiratory morbidities, and life long lung health. Proc Am Thorac including socioeconomic status, maternal stress, and the maternal Soc 2010;7(2):116-122. Alveolar development continues through adolescence and therefore interactions between host factors and the child’s #3. Polack development, risk for asthma and lower respiratory tract Professor, Department of Pediatrics at Vanderbilt University Scientific Director of infections. A proposed framework for airway disease genotype, and Th2 polarization influence disease phenotypes. Markers of Severity in Difficult-To-Treat Asthma reviewed elsewhere [3]; this abstract is necessarily selective Andrew Bush A. The differentiation of acute asthma from acute anaphylaxis untreated severe asthma, (2) difficult-to-treat severe asthma, and (3) pathologically may be difficult treatment-resistant severe asthma. Either way, children with care, and will not be discussed further, since the solution largely lies multiple aeroallergen sensitization with big skin prick test outside the hands of pediatricians. They should note the dramatic wheals and/or high specific IgE are a high risk group benefits of making simple, low cost treatments widely available; and 3. Since allergic bronchopulmonary aspergillosis is rarely and middle income settings of markers for a severe outcome in a if ever seen in children with asthma, we do not include in the setting where adequate treatment is not available. Obesity: There is evidence that asthma complicated by factors have been addressed [2]. Environment/Lifestyle Markers of Severity Uncontrolled symptom >3/week use of short-acting β-2ago 1. This airway treatment or deploying the latest monoclonal but by is an area where smart technology is needed. Also, identifying getting the basics right, including adherence and environmental non-adherence is one thing; remedying it is quite another. Uniform definition of asthma severity, control, and exacerbations: document presented for C. Physician Behavior and Asthma Severity the World Health Organization Consultation on Severe Asthma. Asthma plans have guidelines on definition, evaluation and treatment of severe asthma. Previous severe asthma attacks: the roots of these mainly lie a risk factor for life-threatening asthma in childhood: a case-controlled outside the airway, but it is quite clear that severe attacks study. Study of modifiable risk factors for asthma a marker of risk of acute attacks, and there is certainly exacerbations: virus infection and allergen exposure increase the biological plausibility that uncontrolled eosinophilic inflam risk of asthma hospital admissions in children. Absence of airway eosinophilia: We have no add-on characterized by eosinophiliaand remodeling withoutT(H)2cytokines. Absence of intra-epithelial neutrophils: Airway neutro type of severe asthma in children. Intraepithelial of intra-epithelial neutrophils is associated with less severe neutrophils in pediatric severe asthma are associated with better asthma, quite different from what was shown in adults lung function. Allergic Rhinitis and intranasal corticosteroids are the first-line treatment of allergic Adnan Custovic rhinitis, with intranasal corticosteroids having the greatest efficacy. Allergic Rhinitis and Asthma Presence and Severity Allergic rhinitis is one of the most common chronic diseases in Amongst school-age children, allergic rhinitis frequently co-exists with childhood.

Syndromes

• Lung damaged caused by poisonous gas or severe infection
• Pulse: 60 - 100 beats per minute
• General weakness
• The time it was swallowed
• Yellow skin (jaundice)
• Chemotherapy
• After about 2 minutes of CPR, if the child still does not have normal breathing, coughing, or any movement, leave the child if you are alone and call 911. If an AED for children is available, use it now.
• Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
• 4 to 8 years: 500 mg/day
• Muscle aches or stiffness

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In this situation infection 68 buy cheap sumycin 250mg line, transitions occur between burst fring in the delta frequency and regular fring neurons in the theta frequency that are depen dent on prolonged inactivation of sodium channels (Cooper et al. Prolonged or slow inactivation is not that well understood, but likely regulates pyramidal neuron outputs. The investigators describe it as a “switch” from bursting to regular fring neurons that occurs when the voltage-gated sodium channels are inactivated in a frequency-dependent manner. Resonance frequency signifes the frequency at which a nucleus absorbs or emits radiofrequency, and it is the frequency at which it and its network naturally tend to oscillate. Thus, it is easier to get a molecule to vibrate at its resonant frequencies than at any other. Discussion of the elaboration of network oscillations quickly gets very complicated, so simply put, the resonance properties of neurons inform and interact with network oscillation mechanisms; importantly, network oscillations correlate to various behavioral states (Hu et al. Local oscillators of principal cells (in this case, pyramidal cells) are linked to one another via axons, and the discharges of these interlocked cells cause interneurons to create a localized oscillatory system (Traub et al. These local oscillations fos ter synaptic plasticity that, in turn, produces oscillations that have a frequency and timing that optimally foster a specifc behavior, such as learning/memory (Bibbig et al. Thus, cortical neurons in humans are part of behavior-dependent, phy logenetically preserved oscillating networks of various frequencies (frequencies are discussed next). The Stress System 111 Th e T a rh y T h m s in the hi P P o C a m P u s In Chapter 1, we discussed the fact that the theta rhythm occurs during that period of deep relaxation between sleep and wake, sometimes referred to as hypnagogia. However, there are events during which theta is not associated with relaxation, but rather with learning, memory, and receiving information. Individual neurons in the hippocampal formation exhibit oscillatory activity within the theta frequency band, fring rhythmically at high rates (Jinno et al. Therefore, network oscillations are voltage dependent and function separately from synaptic activity. Theta rhythms have been called the fngerprint of the hippocampus, and curiously, neuronal fring that occurs while words are being encoded differs depend ing on whether the words are later retained or forgotten. During alert but moving behaviors, theta oscillations predominate, while during alert but quiet behaviors nontheta oscillations predominate (Anderson and O’Mara, 2003). Similarly, input to the hippocampus generally fows freely during theta fre quency, and output from the subiculum does not reach the frontal lobes (Johnson, 2006). It is believed that the hippocampus integrates these inputs, creating contex tual memory, that is, memory that uses expected, known experiences. Conversely, input to the hippocampus generally is restricted during nontheta frequency; however, output from the subiculum to the frontal lobes and other cortical regions generally fows freely, but it is based on the context memory acquired during the theta fre quency. The outputs create emotional and behavioral contextual memories as well as associations for memory retrieval (Johnson, 2006). In other words, these outputs are the building blocks of our worldview, our personal reality. Not surprisingly, as we leave the childhood years, we rely increasingly on the nontheta, action mode to process much of the information and experiences encountered. The brain also can be in an action mode, which would emphasize frontal lobe functions, or a quieter, receptive mode, each state having corresponding neuromodu lators. One researcher describes the action and receptive modes, stating, “Their alter nation forms a conversation with the environment” (Johnson, 2006). As various types of data are processed through the subiculum, tweaking of the theta-frequency resonance comes into play to integrate or synthesize the infor mation, which likely includes disparate types of sensory input. While the frontal lobes are understood to control executive power, the ability to alternate between receptive and action modes likely occurs in the hippocampus. For instance, glutamate is a pri mary neuromodulator of pyramidal cells, fostering communication between various cortical regions. When hippocampal slices are exposed to prolonged low-frequency stimulation in the delta range, the neuromodulator that stimulates the change in syn aptic strength is β-adrenergic (epinephrine), which as discussed in Chapter 1, is a key modulator of the sympathetic system and is critical to the fght-or-fight response (Huang and Kandel, 2005). In other words, it takes a neuromodulator with some kick to induce synaptic strengthening in the subiculum. Curiously, while it takes a neuromodulator with some kick to enforce synaptic strength ening, it takes a neuromodulator to calm things down for network regulation. Researchers also have found that long-range, fast-spiking interneurons have spe cialized functions that these principal pyramidal cells lack. In the healthy brain, this circuit synchronizes both sensory and thought experiences. Thus, you can see, smell, touch the rose, but you can, at the same moment, have a memory related to it—the experi ences are temporally integrated. Shifts in brain frequency, either increases or decreases, indicate that memory processes are occurring. In fact, some investigators think that theta is like a “tag” for short-term memory (Vertes, 2005). The fact that both the afferent fbers into and the efferent projections out of the subiculum extend widely from or to cortical and subcortical areas, respectively, indi cates that what happens in that small structure has far-reaching network infuence. Recent work supports the budding theory that the subiculum actually has a dorsal/ ventral separation of function, with the dorsal portion involved in processing infor mation that relates not only to memory retrieval, but to spatial orientation/navigation and movement, features already discussed (Esclassan et al. It has been proposed that the “pattern of convergence” of the inputs to subicular neurons. Supporting this hypothesis, researchers demonstrated that in trace conditioning. In fact, it is consid ered an “excitotoxin” and is used to destroy brain tissue in animal studies to assess whether there is an associated behavior defcit. The excitatory/inhibitory actions of these disparate neurotransmitters are simply the body’s efforts toward homeostasis. Actually, this oscillating function not only manages the circadian rhythms of the sleep/wake cycle, but also for temperature, blood pressure, immune cell count, and hormones that impact entire body systems, stemming to and from the central and peripheral systems. Melatonin also is key to temporal ordering—without it cog nitive, behavioral, and memory processes would not synchronously or sequentially be associated or consolidated (Bob and Fedor-Freybergh, 2008). In Chapter 10, we will see that, through the elaboration of melatonin, the pineal gland is the transducer of incoming information and the regulator of endogenous hormonal synthesis. Melatonin, via activity-dependent changes in synaptic strength, may regulate learning and memory. So, when there is a stressful event, melatonin is the mechanism underlying memory dysfunction. While emotional aspects of an event may be remembered (encoded in the amygdala), nonemotional aspects of the episode may be encoded in the hip pocampus in a disorganized fashion, as mentioned, and cannot be retrieved (Bob and Fedor-Freybergh, 2008). It is our contention that one day, details of the oscillating activity in the subiculum will be further elaborated to reveal that the so-called switch from delta (or lower fre quencies) to theta is actually the switch that moves us into relaxation, via melatonin. Meditation is a trainable skill, which might engage the subiculum in switching to a theta mode in the advance practitioners. There are many modalities that offer relaxation techniques to reduce the impact of stress. The topic of spiritual “needs” is very interesting the Stress System 115 because this is the latest area of research in psychoneuroimmunology. There are spiritual leaders, yogis, Tibetan monks, and such who are being studied physiologically. They are wonderful human beings, allowing themselves to be poked, probed, and measured to help us understand the physiological impact on the body of a person who lives a balanced existence. So, rather than calling these individuals the super-healthy, we might refer to them as the super-aware, evidencing the benefts of a tranquil lifestyle. We will closely examine the impact of spiritual awareness and development in the last chapters of the book. Accelerated telomere erosion is associated with a declin ing immune function of caregivers of Alzheimer’s disease patients. Hippocampal place cells, context, and episodic memory, Hippocampus, 16 (9), 716–729, 2006. The Relaxation System 4 Theoretical Construct the concept of total wellness recognizes that every thought, word, and behavior affects our greater health and well-being. And we, in turn, are affected not only emotionally, but also physically and spiritually. Hans Selye introduced us to the stress response and Herb Benson to the relaxation response, both of which, essentially, are epidemiological fndings of various physiological responses to stressed or relaxed patient populations, respectively. It is universally recognized that there is a stress system, including a set pattern of electrical and hormonal responses, varying in sequence and quality between acute and chronic reactions.

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Healthy Eating and Physical Activity Concept Coverage by State from Highest to Lowest Obesity Percentage Table A6 bacteria horizontal gene transfer buy 500mg sumycin with visa. Scope and Sequence of the 62 Healthy Eating Concepts (Standard 1) Across Grade Levels Table A9. Scope and Sequence of the 53 Physical Activity concepts (Standard 1) Across Grade Levels Table A1. Section I: All data in regular font are from the 2007 Youth Risk Behavior Surveillance Survey (high-school aged adolescents). Most data in italicized font are from the National Survey for Children’s Health (n. Oregon had very limited data available in Promoting Physical Activity and Healthy Eating Among Oregon’s Children th th (2007, p. The first recommendation towards achievement of these goals is to gather health-related data. Summary of Healthy Eating Concept Coverage Across All States Grade level Covered by 0–1 state Covered by 9–10 states PreK-2 3 Identify the benefits of drinking plenty of water 1 Explain the importance of (8 concepts) 6 Describe body signals that tell people when they choosing healthy foods and are hungry and when they are full beverages 3–5 7 Summarize the benefits of drinking plenty of None (16 concepts) water 9 Identify foods that are high in fat and low in fat 10 Identify foods that are high in added sugars 11 Describe the benefits of limiting the consumption of fat and added sugar 16 Explain how eating disorders impact proper nutrition 6–8 11 Identify foods that are high in fiber 17 Describe the relationship (23 concepts) 12 Identify food preparation methods that add less between what people eat, their fat to food physical activity levels and 13 Identify examples of whole grain foods their body weight 15 Describe the benefits of eating a variety of foods high in iron 22 Summarize how eating disorders impact proper nutrition 9–12 7 Analyze the benefits of drinking water before, 2 Describe the relationship (15 concepts) during and after physical activity between nutrition and overall 8 Explain how to incorporate foods that are high in health fiber into a healthy daily diet 12 Describe the importance of 10 Explain how to incorporate an adequate healthy eating and physical amount of iron into a healthy daily diet activity in maintaining a healthy 11 Identify how to make a vegetarian diet healthy weight 94 Table A7. Summary of Physical Activity Concept Coverage Across All States Grade level Covered by 0–1 state Covered by 9–10 states PreK-2 1 Describe recommended amount of 4 Describe the benefits of being physically (5 concepts) physical activity for children. Scope and Sequence of the 62 Healthy Eating Concepts (Standard 1) Across Grade Levels Concept PreK-2 (n = 8) Grades 3-5 (n = 16) Grades 6-8 (n = 23) Grades 9-12 (n = 15) 1. Benefits of healthy 1 Explain the 4 Summarize the 4 Analyze the benefits of healthy 4 Analyze the benefits of eating/ consequence importance of benefits of healthy eating healthy eating on poor dietary choosing healthy eating behaviors foods and beverages 6 Describe the 8 Summarize the benefits of benefits of eating eating plenty of fruits and plenty of fruits and vegetables vegetables 2 Describe the relationship between nutrition and overall health 3 Describe the relationship between diet and chronic diseases such as heart disease, cancer, diabetes, hypertension and osteoporosis 2. Food identification/ 2 Identify a variety of 2 Explain the classification healthy snacks importance of eating a variety of foods from all the food groups 1 Name the food 1 Summarize a variety of 6 Describe the importance groups and a variety nutritious food choices for each of eating a variety of the of nutritious food food group appropriate foods to meet choices for each food daily nutrient and caloric group needs Concept PreK-2 (n = 8) Grades 3-5 (n = 16) Grades 6-8 (n = 23) Grades 9-12 (n = 15) 8 Identify nutritious 10 Differentiate between nutritious and non-nutritious and non-nutritious beverages beverages 6 Explain the similarities and 5 Explain food sources that differences among proteins, fats provide key nutrients and carbohydrates regarding nutritional value and food sources 3. Recommended 5 Describe the type of servings & portion foods and beverages control that should be limited 3 Identify the number 2 Classify the number and of servings of food appropriate size of servings of from each food group food from each food group that a that a child needs person needs each day daily 3 Explain why some food groups have a greater number of recommended portions than other food groups 5 Explain the concept 7 Describe the benefits of eating of eating in in moderation moderation 5 Describe the federal dietary 1 Describe the guidelines for teens recommendations of Dietary Guidelines for Americans 13 Explain how the Dietary Guidelines for Americans are useful in planning a healthy diet Concept PreK-2 (n = 8) Grades 3-5 (n = 16) Grades 6-8 (n = 23) Grades 9-12 (n = 15) 4. Water/hydration 3 Identify the benefits 7 Summarize the 9 Analyze the benefits of drinking 7 Analyze the benefits of of drinking plenty of benefits of drinking plenty of water drinking water before, during water plenty of water and after physical activity 5. Breakfast 4 Describe the 12 Conclude that benefits of eating breakfast should be breakfast every day eaten every day 6. Perceptions of hunger 6 Describe body 13 Summarize body signals that tell people signals that tell people when they are hungry when they are hungry and when they are full and when they are full 7. Food preparation & 7 Describe how to 14 Describe methods 23 Summarize food safety safety keep food safe from to keep food safe from strategies that can control germs harmful germs harmful germs that cause food borne illness 8. Weight maintenance 8 Identify eating 15 Explain that both 17 Describe the relationship 12 Describe the importance behaviors that eating habits and between what people eat, their of healthy eating and contribute to level of physical physical activity levels and their physical activity in maintaining a healthy activity can affect a body weight maintaining a healthy weight person’s weight weight 19 Identify healthy and risky 14 Describe healthy and approaches to weight management risky approaches to weight management 18 Explain various methods available to evaluate body weight 9. Nutrient-specific 9 Identify foods that 12 Identify food preparation recommendations are high in fat and methods that add less fat to food low in fat Concept PreK-2 (n = 8) Grades 3-5 (n = 16) Grades 6-8 (n = 23) Grades 9-12 (n = 15) 10 Identify foods that are high in added sugars 11 Describe the 16 Summarize the benefits of benefits of limiting limiting the consumption of fat and the consumption of added sugar fat and added sugar 11 Identify foods that are high in 8 Explain how to incorporate fiber foods that are high in fiber into a healthy daily diet 13 Identify examples of whole grain foods 14 Describe the benefits of 9 Explain how to consuming an adequate amount incorporate an adequate of calcium and a variety of foods amount of calcium into a high in calcium healthy daily diet 15 Describe the benefits of eating 10 Explain how to a variety of foods high in iron incorporate an adequate amount of iron into a healthy daily diet 11 Identify how to make a vegetarian diet healthy 10. Eating disorders & 16 Explain how 22 Summarize how eating 15 Explain the effects of body image eating disorders disorders impact proper nutrition eating disorders on healthy impact proper growth and development nutrition 20 Differentiate between a positive and negative body image and state the importance of a positive body image Concept PreK-2 (n = 8) Grades 3-5 (n = 16) Grades 6-8 (n = 23) Grades 9-12 (n = 15) 21 Describe the signs, symptoms and consequences of common eating disorders Table A9. Scope and Sequence of the 53 Physical Activity Concepts (Standard 1) Across Grade Levels PreK–2 (n = 5) Grades 3–5 (n = 12) Grades 6–8 (n = 19) Grades 9–12 (n = 17) 1. Frequency/ amount 1 Describe 1 Summarize the 5 Describe the recommended 6 Summarize recommended of physical activity recommended recommended amount of amounts and types of moderate amounts and types of physical amount of physical activity for children and vigorous physical activity for activity for adolescents and adults physical activity adolescents and adults for children 2 Explain ways 6 Identify ways to increase 1 Explain that incorporating daily 1 Summarize how a person can to be active daily physical activity moderate or vigorous physical incorporate daily moderate or every day activity into one’s life does not vigorous physical activity into require a structured exercise their life without relying on a plan or special exercise structured exercise plan or equipment special exercise equipment 2. Types of physical 3 Describe 6 Identify ways to increase daily 3 Discuss ways to increase activity (classifica behaviors that physical activity and decrease physical activity and decrease tions of activity, are physically inactivity inactivity components of active and fitness) physically inactive 3 Describe the importance of 2 Differentiate between physical 7 Compare and contrast various choosing a variety of ways to activity, exercise, health-related sports and physical activities in be physically active fitness and skill-related fitness terms of health and skill-related fitness 8 Describe physical activities 8 Summarize physical activities that contribute to maintaining or that contribute to maintaining or improving the components of improving the components of health-related fitness as health-related fitness such as cardiorespiratory fitness, cardiorespiratory fitness, muscular strength, endurance, muscular strength, endurance, flexibility, and body composition flexibility, and body composition PreK–2 (n = 5) Grades 3–5 (n = 12) Grades 6–8 (n = 19) Grades 9–12 (n = 17) 3. Activity outcomes 4 Describe the 4 Identify the short and long 3 Analyze the short-term and 2 Evaluate the short-term and (benefits of activity, benefits of term benefits of moderate long-term physical benefits of long-term physical benefits of consequences of being and vigorous physical moderate and vigorous physical moderate and vigorous physical being sedentary) physically activity, such as improving activity including improving activity including improving active cardiovascular health, cardiovascular health, strength, cardiovascular health, strength, strength, endurance, and endurance, and flexibility and endurance, and flexibility and flexibility and reducing the reducing the risks for chronic reducing the risks for chronic risk for chronic disease diseases diseases 5 Describe how 2 Explain the positive 4 Analyze the mental and social 4 Summarize the mental and being outcomes for being physically benefits of physical activity social benefits of physical activity physically active active can help a person feel better 11 Discuss how an inactive 5 Analyze how an inactive lifestyle contributes to chronic lifestyle contributes to chronic disease diseases 4. Weight 5 Describe that both eating 7 Summarize how physical 12 Describe the importance of a maintenance habits and level of physical activity and eating habits can healthy diet and physical activity activity can affect a person’s contribute to maintaining a in maintaining healthy weight weight healthy body weight 7 Identify behaviors that 15 Identify healthy and risky 13 Summarize healthy and risky contribute to maintaining a approaches to weight approaches to weight healthy weight management management 5. Environmental 8 Identify safety precautions 10 Discuss climate-related 10 Discuss methods for avoiding factors affecting for physical activities in physical conditions that affect and responding to climate-related physical activity different kinds of weather physical activity such as heat physical conditions during and climates exhaustion, sunburn, heat physical activity stroke, and hypothermia PreK–2 (n = 5) Grades 3–5 (n = 12) Grades 6–8 (n = 19) Grades 9–12 (n = 17) 6. Safety & injury 9 Identify basic safety 17 Describe ways to reduce risk 14 Explain ways to reduce the prevention (equip precautions to help prevent of injuries from participation in risk of injuries from participation ment, warm injury during physical activity sports and other physical activities in sports and other physical up/cool down) activities 11 Describe how to ride a 18 Summarize how to safely ride bike, skateboard, scooter a bike and scooter, and use a and inline skate safely skateboard or inline skates 19 Analyze the importance of 15 Determine the necessary using helmets and other safety protective gear for biking, gear for biking, riding a scooter, motorcycling, snowmobiling, skateboarding and inline skating inline skating, riding a scooter, and skateboarding 12 Identify personal 16 Describe the use of safety 16 Describe the use of safety protection equipment equipment for specific physical equipment for specific physical needed for sports and activities activities recreational activities such as mouthpieces, pads and helmets 12 Explain the importance of 17 Summarize the importance of warming up before and cooling warming up before and cooling down after physical activity down after physical activity 7. Hydration 10 Discuss the benefits of 9 Summarize the benefits of 9 Describe effects of hydration drinking water before, during drinking water before, during, and dehydration on physical and after physical activity and after physical activity performance 8. State of Florida Concepts and Skills for Healthy Eating and Physical Activity for Grades K–4 Table B4. State of Florida Benchmarks for Healthy Eating and Physical Activity for Grades 5–12 Table B5. State of Indiana Concepts and Skills for Healthy Eating and Physical Activity for Grades K–5 Table B6. State of Indiana Concepts and Skills for Healthy Eating and Physical Activity for Grades 6–Advanced Table B7. State of Louisiana Benchmarks for Healthy Eating and Physical Activity for Grades K–12 Table B8. State of Maryland Benchmarks for Healthy Eating and Physical Activity for Grades PreK–4 Table B9. State of Maryland Suggested Objectives for Healthy Eating and Physical Activity for Grades 5–12 Table B10. State of Mississippi Suggested Objectives for Physical Activity for Grades K–4 Table B11. State of Mississippi Suggested Objectives for Physical Activity for Grades 5–12 Table B12. State of Mississippi Suggested Objectives for Healthy Eating for Grades K–4 Table B13. State of Mississippi Suggested Objectives for Healthy Eating for Grades 5–12 Table B14. State of North Dakota Concepts and Skills for Physical Activity for Grades K–4 Table B15. State of North Dakota Concepts and Skills for Physical Activity for Grades 5–12 Table B16. State of North Dakota Concepts and Skills for Healthy Eating for Grades K–4 Table B17. State of North Dakota Concepts and Skills for Healthy Eating for Grades 5–12 Table B18. State of Pennsylvania Concepts and Skills for Physical Activity for Grades 3, 6, 9, and 12 Table B19. State of Pennsylvania Concepts and Skills for Healthy Eating for Grades 3, 6, 9, and 12 Table B20. State of Utah Concepts and Skills for Physical Activity for Grades 5–10 Table B22. State of Connecticut Concepts and Skills for Physical Activity Grade K Grade 4 Grade 8 Grade 12 Standard 1. Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors •Identify how families can influence personal •Explore how families can influence •Examine how families and peers can •Evaluate how families, peers and com health personal health influence the health of adolescents munity members can influence the •Discuss their roles in the family and the •Describe how family and culture •Analyze ways in which the environment health of individuals roles of their parents/ guardians influence personal health behaviors and personal health are interrelated •Analyze ways in which the environment •Recognize how media and technology can •Explain how media and technology •Examine the influence of family beliefs influences the health of the community influence their lives influence personal and health behaviors and cultural beliefs on personal health •Analyze how family and cultural diversity •Discuss how families and school influence •Explain how family, school and peers behaviors enriches and affects personal health personal health influence personal health •Analyze how media, technology and behaviors •Identify and explain how the media may other factors influence personal health •Evaluate the effects of media, technol influence messages one may receive behaviors ogy and other factors on personal, family about body image •Analyze how family, school and peers and community health influence personal health •Evaluate how information from family, school, peers and the community influences personal health •Assess how public health policies and government regulations can influence health promotion and disease prevention Standard 3. Students will demonstrate the ability to access valid information and products and services to enhance health •Demonstrate the ability to seek health •Demonstrate the ability to locate valid •Analyze the validity of health information •Evaluate the validity of health information information from trusted adults. Students will demonstrate the ability to use decision-making skills to enhance health •Discuss choices that enhance health •Demonstrate the ability to apply a •Use a decision-making process to •Demonstrate various strategies when Identify adults who can assist in making decision-making process to enhance enhance health making decisions to enhance health health-related decisions health •Describe and analyze how health-related •Demonstrate the ability to make health •Discuss reasons to make and results of •Explain when to ask for assistance in decisions are influenced by using enhancing decisions using the collabor making healthy choices making health-related decisions resources from family, school and ative decision-making process •Apply problem-solving skills in movement •Predict outcomes of positive health community •Predict the immediate and long-term related activities by solving simple decisions •Predict how decisions regarding health impact of health decisions on the indivi movement challenges involving body parts •Explore and adapt fundamental move behaviors have consequences for them dual, family and community in isolation or in combination ment skills in a variety of dynamic selves and others •Use self, peer, teacher and technological •Recognize that some movements, activities environments •Understand, participate in the develop resources as tools to implement perfor and noises are appropriate for •Understand, participate in the ment of, and follow classroom rules; mance improvements in self and others indoors/small spaces, and some for development of, and follow classroom follow activity-specific rules, safety prac •Demonstrate understanding of how outdoors/ large spaces rules; follow activity-specific rules, safety tices and procedures; and apply safe rules, and safety practices and proce practices and procedures; and practices, rules, procedures, etiquette dures need to be adjusted for different demonstrate etiquette and good and good sportsmanship in all physical movement situations sportsmanship in a variety of physical activity settings •Assess and adjust activities to maintain activity settings •Make decisions about participating in or improve personal level of health different physical activities based on related fitness feelings and interests •Use physiological data to adjust levels of exercise and nutrient intake to promote wellness •Use the results of fitness assessments to guide changes in her or his personal programs of physical activity (Standard 6) •Make decisions and implement plans to participate in different physical activities based on interests and positive feelings of accomplishment in daily living (Standard 6) Standard 6. Students will demonstrate the ability to use goal-setting skills to enhance health •Define a healthy goal •Demonstrate the ability to apply the goal •Use the goal-setting process to enhance •Demonstrate various strategies when setting process to enhance health health making goal-setting decisions to •Plan a wellness program demonstrating enhance health an understanding of basic exercise. Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks •Identify healthy behaviors •Identify responsible health behaviors •Explain the importance of assuming •Assess the importance of assuming •Identify personal behaviors that are health •List personal health needs responsibility for personal health responsibility for personal health enhancing •Compare behaviors that are safe to behaviors behaviors •Identify personal health behaviors that need those that are risky or harmful •Examine personal health status to deter •Analyze personal health status to deter to be changed •Demonstrate strategies to improve or mine needs mine needs •Understand and follow rules and routines maintain personal health by examining •Distinguish between safe, risky or harm •Distinguish between safe, risky or harm •Acquire initial gross and fine-motor skills influences and rules that affect decisions ful behaviors involving themselves ful behaviors affecting themselves and needed for engagement in developmentally •Develop and practice safety techniques and/or others others in the community appropriate tasks, activities, creative to avoid and reduce injury and disease •Apply strategies to improve or maintain •Apply and assess strategies to improve movement, dance and play •Participate in a variety of modified personal and family health by examining or maintain personal, family and com •Follow safety and age-appropriate class games, developmentally appropriate influences, rules and legal responsibil munity health by examining influences, room and playground rules and procedures tasks, activities, creative movement, ities that affect decisions rules and legal responsibilities that affect •Engage in physical activities when pre dance and play •Examine and apply safety techniques to decisions sented with opportunities and with teacher •Engage in a variety of moderate to avoid and reduce injury and prevent •Use and evaluate safety techniques to encouragement. Students will demonstrate the ability to advocate for personal, family and community health •Use language to convey healthy behaviors •Describe a variety of methods to convey •Analyze various methods to accurately •Evaluate the effectiveness of methods •Use language to express opinions about accurate health information, concepts express health information, concepts for accurately expressing health infor health topics and skills and skills mation, concepts and skills •Name trusted adults at home, in school and •Express opinions about health issues •Support a healthy position with accurate •Support and defend a position with in the community based on accurate health information information accurate health information •Identify ways to encourage others to make •Identify and describe community •Analyze community agencies that •Engage the support of community positive health choices agencies that advocate for healthy advocate for healthy individuals, families agencies that advocate for healthy •Participate in small and large group individuals, families and communities and communities individuals, families and communities activities, interacting cooperatively with one •Describe ways to encourage and support •Encourage and support others in making •Use the ability to influence and support or more children others in making positive health choices positive health choices others in making positive health choices •Discuss positive ways to show care, •Identify ways to work cooperatively in •Demonstrate the ability to work •Demonstrate the ability to work consideration and concern for others small groups when advocating for cooperatively in small groups when cooperatively in larger, more diverse healthy individuals, families and schools advocating for healthy individuals, groups when advocating for healthy •Promote positive, healthy interpersonal families and schools communities relationships with respect and appreciation for each other Note. Standard 1: Essential concepts get lost in a dizzying array of generic, repetitive and overly specific concepts. Concept coverage is only average despite large number of benchmarks and additional standards pertaining specifically to skill, physical activity and fitness. Standards 2, 3 & 8: Comprehensive coverage of generic sub-skills, no specific applications for physical activity. Standards 4, 5, 6 & 7: Comprehensive coverage of generic sub-skills and at least two examples of specific physical activity applications (some examples are still somewhat vaguely worded). State of Connecticut Concepts and Skills for Healthy Eating Grade K Grade 4 Grade 8 Grade 12 Standard 1. Students will comprehend concepts related to health promotion and disease prevention •List personal health behaviors. Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors •Recognize how media and technology can •Describe how family and culture influence •Examine the influence of family beliefs and •Analyze how family and cultural diversity influence their lives personal health behaviors cultural beliefs on personal health enriches and affects personal health •Discuss how families and school influence •Explain how media and technology influ behaviors behaviors personal health ence personal and health behaviors •Analyze how media, technology and other •Evaluate the effects of media, technology •Identify how families can influence •Explain how family, school and peers factors influence personal health behaviors and other factors on personal, family and personal health influence personal health •Analyze how family, school and peers community health •Identify and explain how the media may influence personal health •Evaluate how information from family, influence messages one may receive •Examine how families and peers can school, peers and the community about body image influence the health of adolescents influences personal health •Explore how families can influence •Evaluate how families, peers and com personal health munity members can influence the health of individuals Standard 3. Students will demonstrate the ability to access valid information and products and services to enhance health •Identify characteristics of a trusted adult •Demonstrate the ability to locate valid •Analyze the validity of health information •Evaluate the validity of health information •Demonstrate the ability to seek health health information, products and services and the cost of products and services and the cost of products and services information from trusted adults. Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks •Practice using words to communicate as a •Practice verbal and nonverbal •Apply effective verbal and nonverbal •Compare and contrast skills for means of enhancing health communication as a means of enhancing communication skills as a means of communicating effectively with family, health enhancing health peers and others Standard 5.

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Over six varieties of cereals and millets and sixteen types of dals and legumes are used in Indian diet infection 8 weeks after c section cheap sumycin 250 mg online. Being a tropical country there are over 150 varieties of leafy and 250 other vegetables to choose from, resulting in nutritionally rich combinations. In the normal Indian diet, cereals are the staple food and dals or legume, milk and vegetable preparations are served with cereal preparations. Clinical Problems Protein Excess: Though protein is a vital need of the body, intake of excess creates stress on the body function. High protein from animal foods carries undesirable saturated fats also along with it. As protein foods are expensive, their increased intake may lead to lesser intake of nutrient rich, foods and thus reduce the quality of the diet. Deficiency of Proteins Latent stage: the deficiency of proteins accompanied by that of energy is one of the most common nutritional deficiencies in India. Research reports indicate that animals on low protein diets tend to be small, but their functioning is not affected. Children tend to have retarded growth but this may not be noticed, if all children from the neighbourhood are of small stature due to protein deficient dietary. Protein deficiency during pregnancy may result in stress, which could give rise to complications such as vomitting, swelling of feet, etc. If these symptoms are commonly prevalent, they are accepted as a normal part of pregnancy. Thus due to ignorance, protein deficiency in pregnancy may not be detected and thus there will be no improvement in the diet. In children, lack of protein in the diet results in stunted growth and low weight. Severe Deficiency: If there is severe deficiency of protein in the first two years of life, it could affect mental development, learning ability and behaviour. When the child is weaned, the diet often does not contain an adequate 6868686868 Fundamentals of Foods, Nutrition and Diet Therapy quantity and quality of protein which results in deficiency diseases. When an infant is fed high carbohydrate low protein foods such as ogi (corn starch porridge) as in West Africa, kwashiorkor, a typical protein deficiency condition occurs. When both protein and calorie are very low in the diet, nutritional marasmus could occur. In other words, kwashiorkor is a deficiency disease due to severe lack of protein but nutritional marasmus is due to sheer starvation (Figure 6. The education of prospective parents about childcare and nutrition can ensure good nutrition of infants and young children and prevent protein-calorie malnutrition. Greater attention is needed to appropriate supplementary nutrition for children in the 0–2 age group, the most critical period in terms of brain and body growth. Write short notes on: protein quality, biological value, special functions of amino acids, deamination, urea cycle, vegetarian diet. Air (oxygen), Water and Food Food supplies the energy components (carbohydrates, fats, proteins), as also nutrients (minerals and vitamins), which ensure their use in the body. In this chapter, we will consider energy, its definition, measurement and balance. In physiology and nutrition, energy is defined as the capacity of a body to do work. Just as a machine needs fuel to keep it operating, the body needs food to provide the energy to perform its various tasks. The energy released in the body from food is measured as a unit of heat the kilocalorie (kcal). By definition, one kilocalorie is the amount of heat required to raise the temperature of one kilogramme of water through one degree centigrade. One joule is equal to the energy expended when one kilogramme is moved through one meter by a force of one newton (N). It must be remembered that the human body uses energy in many forms hence the unit used in measurement is only an indirect indication of the energy available to the body in various forms (chemical, thermal, mechanical, electrical, etc. Two components of food, carbohydrates and fats, supply 85 to 92 per cent of the total energy in the Indian dietary, the rest is provided by proteins. Measurement of Food Energy the energy value of foods is determined in the laboratories by the use of special equipment called the bomb calorimeter. In the bomb calorimeter, the heat given off by a food in direct combustion or burning, is measured under conntrolled conditions. Energy value of a food can also be measured indirectly by measuring the oxygen used in burning a known amount of food. The carbohydrates and fats (after digestion) are completely oxidised in the body, but some partially oxidised end products of proteins are excreted in the urine. This correction is made in calculating energy available from proteins in the body. The averages of coefficients of digestibility1 for the components of a typical dietary were: Carbohydrates 98% Fats 95% Proteins 92% the physiological fuel value. The coefficient of digestibility is a measure of digestion and is calculated as follows (Nutrient intake Nutrient in faeces) ×100 Coefficient of digestibility = Nutrient intake Energy Metabolism 7373737373 Carbohydrates 4 kcals / g Fats 9 kcals / g Proteins 4 kcals / g Please remember that these fuel values refer to the edible portion of the food. Secondly, energy value of food is affected by water or moisture content of food, as it is given in the food composition tables. Therefore foods, which have a large percentage of water, have a low calorie content. As we learnt earlier, fat provides 9 kcals per gramme, therefore foods with high fat content, have a high energy value (Table 7. As rice absorbs water, while cooking, cooked rice has about one-third the number of calories as an equal weight of raw rice. Frying foods such as papad, shev, wafers, invariably increases their energy content. Examples of effect of preparation on energy content of foods is presented in Table 7. Thus any change in the composition during processing or preparation affects the calorie content of the food product. It is important to take these changes into account, while calculating the energy content of food preparations, used in the dietary. Fat or foods containing fat have a higher calorie density than those containing carbohydrate or proteins. Energy Intake the main source of energy for all the body activities is food, along with the energy store in body tissues as reserve. The metabolic products formed by digestion of carbohydrates and fats, which are simple sugars, glycerol and fatty acids, provide most of the energy needs of the body. One can summarise the energy production from foods as: Glucose, fatty acids, glycerol or amino acids + oxygen → → energy + carbon dioxide + water the actual process involves a series of complex reactions, which lead to the common pathway known as Kreb’s cycle or the tricarboxylic acid cycle, its end products being energy, carbon dioxide and water. Energy Metabolism 7575757575 Food Energy Intake: You can calculate your own energy intake by keeping an accurate record of a day’s actual food consumption. Energy Storage in the Body While we may eat two, three or four meals a day, which supply energy to the body at intervals, our body activities (voluntary and involuntary) go on throughout the day, even while we sleep. Glycogen: Glycogen stored in the muscles and liver (about 300–350 g), acts as an energy reserve. Glycogen stores maintain blood glucose at normal levels for use of body functions during hours of sleep. Thus our first meal of the day, which breaks the night long fast, is very important for replenishing glycogen stores. The body draws on these tissues for energy, only when it is under stress due to long periods of fast or starvation. The energy expenditure of adults is decided by three types of needs for energy: basal metabolism, physical activity and use of food in the body. Measurement of Energy Expenditure Energy expended by the human body at rest or in activity can be measured directly by measuring the heat evolved. This is known as direct calorimetry, which is easy in principle, but very cumbersome in practice. It needs a small insulated chamber in which the human subject is kept and all the heat produced is accurately measured. Atwater and Ross about hundred years back, studied human energy metabolism, using such a chamber.

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Today it is recognized that the stress syndrome is not limited to the physically ill antibiotic eye drops for pink eye buy sumycin with amex, but occurs as well in chronically emotionally stressed individuals, such as caregivers of Alzheimer’s patients, as well as numerous people affected by the stress of work, fnancial concern, divorce, or bereavement. Selye believed that some types of stress actually could be advantageous and pleasantly stimulating. Interestingly, the physiological basis for this benefcial low grade stress has now been established. While studies show that glucocorticoids that are secreted in a prolonged manner, as a result of chronic stress, induce apoptosis of thymocytes during the maturation process, recent research indicates that there is actually immune enhancement, via the promotion of T-cell development, when glucocorticoids are secreted in small amounts (Munck and Guyre, 1991; Vacchio et al. Once again, there is an undetermined set point at which glucocorticoids become detrimental to the body’s homeostasis. Several studies have established this set point in number of days for a given proto col (McEwen, 1998; Munck and Guyre, 1991). The conversion to a harmful response after that given number of days is quite consistent. In this chapter, we will discuss the physiological underpinnings of chronic stress in order to understand why it can be so destructive and then review the patterns of behavior that can induce such a 76 the Scientifc Basis of Integrative Medicine response. Memory, which plays a signifcant role in the perpetuation of stress, will also be discussed. We humans are capable of worrying ourselves sick, and as we will see, we actually are capable of worrying ourselves to death. The stress response is designed to empower the gazelle feeing the lion on the savanna; in other words, it is the fght-or-fight response (Figure 3. Release of these adrenal medulla hormones also results in increased arousal and anxiety (Figure 3. The glucocorticoids, epinephrine, and norepinephrine all can inhibit insulin secretion, which results in the conversion of stored protein and fat to useable energy for exertion (the hormone glucagon also helps do this). So, when stress occurs, the stored energy becomes usable glucose and free fatty acids that enter the blood stream for quick energy use. The energy conversion is complemented by increased depth of respiration in the wings, which increases the available oxygen supply. The circulat ing blood directs the oxygen and glucose to the specifc organs and muscles essential figuRe 3. This is how the 110-pound woman is able to lift the family van off of her husband trapped beneath. Hormones related to functions that are nonessential to goals of acute stress, such as reproduction (prolactin, luteinizing hormone, follicle-stimulat ing hormone), appetite (insulin), and vigilant immune system function, are inhibited. Keep in mind that the electrical pathway (which also includes hormones) responds to a stressor immediately, whereas the hormonal response is slower, but more sus tained. While glucocorticoids and epinephrine are the dynamos of the stress response, 78 the Scientifc Basis of Integrative Medicine in this chapter we will cover other molecules that infuence or sustain the stress response in subtler ways. Several summers ago, I was head ing down the Snake River in Wyoming and saw a herd of buffalo. It took about a half a millisecond for my amygdala to say to itself, “Connect, danger, danger! My sympathetic nervous system threw out all sorts of signals, and right after I snapped the picture that you see in Figure 3. I got back to the car (which was across the river) in about 20 seconds, no kidding! The stored sugar and fats were fowing in my bloodstream, providing fuel for my Yellowstone Park marathon. In a well-publicized paper, Shelly Taylor and colleagues at the University of California in Los Angeles discuss their theory of a markedly different pattern of response to stress in women than in men (Taylor et al. While acknowledging that the fght-or-fight response remains the primary physiological hormonal response in both sexes, they tease out a pattern of stress response that is unique to women. They call this pattern “tend-and-befriend” and speculate that it is the female’s counterpart to the infant’s attachment mechanism, which has been so thoroughly examined by child development professionals. Taylor and colleagues cite numerous studies that demonstrate the anxiolytic properties of oxytocin, including mild seda tion, decreased blood pressure, lower sensitivity to pain, and decreased glucocorti coid secretion. Furthermore, they point out that oxytocin levels increase as a response to massage and decrease with sadness. The researchers then go on to make the case that the same properties, which cause the “tend-and-befriend” pattern in response to stress and are present in the mother–infant bond, also are typical of women in vari ous stressful situations—and are marked by a propensity to affliate. What is so remarkable about this theory is that the physiological response results in a hormonal cascade as well as social/emotional behavior that is a healthy response to stress. Oxytocin is essentially a relaxation hormone, which is now known to be secreted in women during stress. In the next chapter, other hormones that produce a relaxation response will be reviewed. While glucocorticoid suppression of the immune system is helpful, if not lifesaving in short-term situations, chronic stress can alter the feedback regulation and cause prolonged glucocorticoid secretion, which can be profoundly detrimental. The stress response was not designed to be a prolonged physiological event, but rather a relatively short sprint away from the buffalo or other ominous critter (angry humans not excluded). The symptoms that occur from chronic stress, of any etiology, correlate to those physiological changes that are induced by and supportive of the fght-or-fight response. In 1993, researcher Bruce McEwen published his views of the complex process of the body’s effort to maintain homeostasis (McEwen and Stellar, 1993). McEwen realized that the concept of a static internal system maintaining a constant homeo static steady state was entirely unrealistic. He recognized that the body is constantly fuctuating in its effort to maintain homeostasis. McEwen used the concept of allosta sis, coined by researchers Sterling and Eyer in the 1980s, to express his premise. Allostasis is defned as the “operating range” of the body or the body’s ability to adjust various vital functions. It is the ability of the body to “achieve stability through change” (McEwen, 1998). McEwen took this concept one step farther and coined the term allostatic load (graphically depicted in Figure 3. He defned allostatic load as the state of an organism in which “the strain on the body produced by repeated ups and downs of physiological response, as well as by the elevated activity of physiological systems under challenge, and the changes in metabolism and the impact of wear and tear on a number of organs and tissues, can predispose the organism to disease” (McEwen and Stellar, 1993). In other words, there comes a point at which the strain of accommodating the stress becomes too much, and the body can no longer handle the load. At that point, the person enters a state of chronic stress, with the accompanying physiological breakdown. Many of us are always feeling rushed, and it is a major cause of stress in our culture. You are handling all of the stress, and then there is just one more thing that happens, but it happens at the wrong time. Or, if you are capable of being calmer in the face of such overload, you are undoubtedly thinking thoughts that you would rather not think. Selye gave us the basics: thymic involution (reduc tion in size and function of the thymus), lymphopenia (decrease in proportion of blood lymphocytes), eosinopenia (decrease in eosinophils in blood), and decreased lymph node size. Yet, in contrast, the acute stress response has been shown to strengthen the immune system and provide an immunological memory (McEwen, 1998). Sometimes I think of acute stress as the body’s way of staying in shape, of exercising the stress aspect of our being. Recent studies, however, have provided more understanding of the extensive implications of allostatic load (McEwen, 1998, 2000c, 2000d). This basic concept of allostatic load 82 the Scientifc Basis of Integrative Medicine is an important one to keep in mind as we proceed to examine different issues that may be supportive during acute stress but maladaptive during chronic stress. There actually are numerous other factors that contribute to the stress–im mune homeostasis, but for the most part, discussion in this section will be limited to what happens physiologically during chronic stress (see Khansari et al. Based on this fnding, physicians decided that glucocorticoids were immune enhancing. That concept should have been dispelled in the mid-twen tieth century, when glucocorticoids were shown to have antiinfammatory properties (Hench et al. Research in the latter part of the twentieth century fully established the cor relation between high doses of glucocorticoids. On the heels of these studies came the work of researchers, such as Hugo Besedovsky, who looked at the actions of the glucocorticoids from a systems interac tion perspective and surmised that the net effect of glucocorticoids was modulatory. Besedovsky felt that the glucocorticoids prevent immune overactivity and permit specifcity.

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The child and all members of his or her immediate family are asked to rate their readiness to take action on a scale from 0 to 100 antibiotic resistance causes buy sumycin master card. Groups with average scores below 50 are encouraged to take some time to reassess their commitment to beginning the program, stressing the importance of readiness for change as essential to success. Participants are also asked to identify benefits and barriers to behavior change, with the suggestion that those who perceive the benefits as outweighing the barriers are more likely to be successful. These are two major constructs of the Health Belief Model conceptualized by Irwin Rosenstock in 1966. There are weekly readings throughout the 12-week curriculum and each lesson is 22 divided into four parts: Time to Stop and Think, Time to Get Active, Time to Dine and Time to Sum Up. Assignments include both reading and writing tasks (included in the book), as well as free-living activities related to eating and activity behaviors. Participants are encouraged to take field trips to locations like the grocery store and local restaurants to learn how to apply their newfound knowledge. Emphasis is placed on providing recognition for positive choices and participants are consistently reminded that “there is no finish line”. Backsliding is a normal part of progress, but healthy choices and changes should gradually become the new norm. Despite the fact that there is no reference to the specific stages of the transtheoretical model, the description of the process of behavior modification sounds very much like an explanation of progress through Prochaska’s stages of change. An internet search revealed Trim Kids chapters operating throughout the United States, but little data are offered to support their effectiveness. Obesity as a significant burden has led people to seek out new treatments for childhood overweight. The ability to distinguish sound programming from opportunistic scam is critical for families seeking to improve a child’s health and wellness. Changes to zoning ordinances, improvements to parks and recreation facilities, creating ways to distribute free or inexpensive fruits and vegetables” (Centers for Disease Control and Prevention, n. Public schools in the United States serve 89% of the nation’s children and adolescents (Collins, 2009), representing 23 unprecedented influence over children’s lives. Based on this unrivaled opportunity to affect children’s lives, schools were challenged to take action in the prevention and treatment of children’s overweight by the Surgeon General in 2001 (Thomas, 2004). Unfortunately, this challenge was not accompanied by resources, and schools continue to struggle to identify the best uses of personnel, time, money, facilities, equipment and materials to achieve that end. Despite the lack of dependable and consistent funding, the literature is inundated with the details of numerous large-scale school initiatives with goals of improving children’s nutrition and/or promoting physical activity. School-health initiatives initially focused on one of three primary components; school health instruction, school health services and the school health environment (Means, 1975). Contemporary initiatives have introduced numerous additional opportunities for intervention, including physical education, counseling services, school food service (meals and vending), school-to-work promotional programs, and integrated school and community programming (Stone, Perry, & Luepker, 1989). The Heart Smart intervention involved changes to the school lunch and physical education programs, as well as measurement of risk factors for cardiovascular disease (anthropometrics, blood pressure, cholesterol). Participants showed increases in cardiovascular knowledge, made healthier food choices at lunch (with corresponding improvements in cholesterol), and improved fitness (Arbeit et al. Participants felt positively about New Moves, but the initiative did not elicit many of the intended results (Neumark-Sztainer, Story, Hannan, Stat, & Rex, 2003). Go For Health reported statistically significant changes among participants in the areas of salt use, diet behavioral capability, exercise behavioral capability, frequency of participation in aerobic activity and self-efficacy (Parcel, Simons-Morton, O’ Hara, Baranowski, & Wilson, 1989; Simons-Morton, Parcel, Baranowski, Forthofer, & O’Hara, 1991). Among the results of the Bogalusa Heart Study were evidence that children who do not have physical education in school are less physically active overall (Myers, Strikmiller, Webber, & Berenson, 1996). Additional initiatives have demonstrated exercise and education programs providing a protective effect against increased systolic and diastolic blood pressure among high-school students (McMurray et al. Numerous review papers have attempted to identify and synthesize the results of these and many other studies (Kahn et al. Despite a shared interest in children’s nutrition and physical activity, consensus on the effectiveness of these initiatives is difficult to reach due to the overwhelming scope of material covered. From a practical perspective, the benefits were generally modest and the costs (in terms of money, time and effort) were significant, suggesting these interventions were not the silver bullet for childhood obesity. The standards are intended to serve as a framework to be used in the development of health education curricula, instructional techniques and assessments. The focus is on health promotion at the individual, family and community levels, and standards are written to 26 explain what the health-promoting child should know and be able to do at various grade levels. Performance indicators are provided at each grade level to track a child’s progress towards achievement of the standard. An effective health education curriculum must clearly identify goals and articulate behaviors which demonstrate progress towards or achievement of said goals. The curriculum must present information 27 that is accurate, complete, and directly contributes to health-promoting behaviors. The curriculum should be able to be individualized to maximize student engagement, and be age, developmentally and culturally appropriate. The curriculum should address personal values as well as group norms, and address the influence (both positive and negative) of peers. There should be a focus on the student’s awareness of both risky and reinforcing behaviors and skills practice to build student competence, confidence and efficacy to handle these challenges. Students should have opportunities to build positive relationships with influential others, including their families, friends and adult role models. There must be adequate time for instruction and learning, including time devoted to the reinforcement of previously learned knowledge, skills and behaviors. Lastly, professional development must be available and training provided to enrich teacher instruction and student learning. Societal Societal or macro-level interventions are those interventions that operate on the grandest scale. Societal variables like ethnicity and socioeconomic status have been identified as significant in the study of childhood overweight. Studies have identified a possible association between low socioeconomic status and increased body fat (Wolfe, Campbell, Frongillo, Haas, & Melnik, 1994) and decreased levels of physical activity (Macera, Croft, Brown, Ferguson & Lane, 1995). Nationwide data have demonstrated significant differences in the prevalence of overweight among children and adolescents. For children ages 12-19, prevalence of overweight was similar for non-Hispanic black (18. Among 12-19 year old females, non Hispanic black girls have the highest prevalence rates (27. Numerous additional studies have identified differences in specific nutrition behaviors and societal variables (Dibsdall, Lambert, Bobbin & Frewer, 2003; Edmonds, Baranowski, Baranowski, Cullen & Myres, 2001; Kirby, Baranowski, Reynolds, Taylor, & Binkley, 1995; Morland, Wing & Diez Roux, 2002), but no clear evidence has demonstrated a direct relationship between macro-level interventions and population overweight and obesity (Faith, Fontaine, Baskin, & Allison, 2007). Intuitively, incompatible environments represent a potentially significant barrier to positive behavior change. The standards individual states have for the health education provided in their schools are another example of a macro-level intervention. The delivery of said programs would take place at the community level, but the mandate must come from above. Most states do require health education in the schools, but the quality and quantity of these programs varies tremendously. Programming differences and lack of consistent structure have made it difficult to address the efficacy of many programs. Trim Kids (Sothern, von Almen, & Schumacher, 2001) is a program aimed at improving the health status of children and includes elements at the individual, interpersonal and organizational levels. Trim Kids and other behavior-change programs would benefit from recording stature data as a critical component in tracking weight status in children. Trim Kids is a program that does not require expert leadership or expensive equipment and may have benefits in engaging families and slowing the progression of obesity. Individuals are influenced by family and friends, the media and many factors that can impact 32 nutrition and physical activity and thereby obesity. The most effective interventions acknowledge and address contributing factors at the individual, interpersonal, organizational, community and social levels. Childhood obesity has become an issue of particular concern because of its potential physiological and psychological consequences. More than 60% of overweight children and adolescents suffer from high cholesterol, high blood pressure and/or type 2 diabetes (Freedman, Dietz, Srinivasan, & Berenson, 1999). Children who are overweight or obese are more likely to have lower self-esteem and to report being targets of discrimination (Dietz, 1998; Strauss, 2000).