Ivan Damjanov, MD
- (University of Kansas Medical Center)
http://www.kumc.edu/school-of-medicine/pathology/faculty-and-staff/clinical-faculty/ivan-damjanov-md-phd.html
All of us know they relate to energy or power medicine cabinets 40 mg strattera mastercard, but we may be a bit unclear about the di erence between the two or about which units refer to energy and which to power treatment 02 quality strattera 18mg. So to clear up confusion at the outset symptoms stomach ulcer order 40mg strattera fast delivery, on one hand we have energy treatment centers cheap 40mg strattera with mastercard, a pure quantity untouched by time. Power, on the other hand, is a rate of change in energy: an amount of energy per unit of time. And in many cases their numerical values are de ned in relation to the speci c heat capacity of liquid water. Despite having "British" in its name, the unit today is used mainly in the United States o en incorrectly as a measure of power. A more common unit is the joule, which is the fundamental unit of energy in the metric system. Named for the physicist James Presco Joule, the joule is de ned as the amount of energy required to accelerate a one-kilogram mass from zero to one meter per second (3. In the world of food, the most commonly used unit of energy is the calorie, which has been the source of endless confusion because two di erent de nitions have been in simultaneous use. For years chemists and other scientists used calorie to mean the amount of energy that will warm one gram of water by 1 °C / 1. But then food scientists, nutritionists, and others took to using calorie to mean the amount of thermal energy necessary to raise the temperature of one kilogram of water by 1 °C 1,000 times as much energy as in the older de nition. Sometimes people capitalize Calorie to make clear that they mean the larger unit, but o en they do not. To avoid misunderstanding, some people distinguish between a "gram-calorie" and a "kilogramcalorie. If you know the power your heat source can deliver (which is less than its electrical rating, as explained on the next page), you can divide that wa age into 210,000 J to estimate how long the water will take to heat. A typical 1,800 W water bath, for example, can actually deliver about 1,200 W to the water. At that rate of 1,200 J/s, the liter of water will reach 55 °C in about three minutes. Of course, your water bath probably holds something closer to 20 liters, in which case it could take an hour to heat. James Prescott Joule, a 19th-century physicist and brewery manager from England, helped to clarify the relationship between mechanical and thermal energy. In a brilliantly simple experiment, he measured the heat produced by paddles churning a vat of water and compared it with the mechanical energy produced by a falling weight that turned the paddle wheel. His work led to the first law of thermodynamics, one of the cornerstones of classical physics. A 500 W induction burner thus sucks 500 J through its electrical cord every second. In the metric system, the pre x kilo- means 1,000, so a kilowa is simply 1,000 wa s. People o en mistake kilowa s as a measure of energy because household electricity meters usually record energy consumption in kilowa -hours. A kilowa -hour (kWh) is the amount of energy expended at a rate of 1,000 W for one hour (3,600 seconds) so 1 kWh equals 3. One of the stranger units of power that still persists is horsepower, which was created as a marketing slogan for steam engines in the 19th century. To this day, car engines, lawnmowers, chain saws, shop tools, and even occasionally vacuum cleaners are rated in horsepower. As you might assume from the name, a horsepower is a big unit, equivalent to about 746 wa s. He advanced the design of the Newcomen steam engine, a vital element of the industrial revolution of the 18th and 19th centuries. In 1948 it became the standard international unit of power in recognition of his numerous contributions to the e ciency of the modern world. You can use the multiplication factors in the table at left to convert almost any quantity of energy into joules then into other units.
Clams symptoms graves disease order strattera 40mg mastercard, clockwise from top left: steamers medications jejunostomy tube buy cheap strattera 40mg line, littlenecks symptoms of pregnancy discount strattera 10mg fast delivery, cherrystones treatment 6th feb 18mg strattera otc, chowder clams. Hard-shell clams are sometimes sandy inside,and soft-shell clams nearly always are. They can be flushed as follows: · Make a salt brine, using 1/3 cup salt per gallon of water (20 mL salt per liter). Like oysters, clams to be cooked may be opened by spreading on sheet pans and placing in a hot oven just until the shells open. Cooking methods: Steaming, poaching, deep-frying, baking on the half-shell with toppings, simmering in soups and chowders. Green mussels, from New Zealand and Southeast Asia, are larger and have a lighter-colored gray or tan shell with a green edge. They may be soaked in brine and flour or cornmeal like clams (see previous section) to rid them of sand. They are usually steamed and served in their cooking broth,in soups,or chilled and served with mayonnaise-type sauces. If live scallops in the shell are available,leave the orange, crescent-shaped coral attached to the adductor muscle when shucking. There are two main kinds of scallops: Bay scallops: Small,with delicate flavor and texture;expensive;32 to 40 per pound (70 to 88 per kilogram) on average. Sea scallops: Larger, not as delicate as bay scallops, but still tender unless overcooked; 10 to 15 per pound (22 to 33 per kilogram) on average. Scallops with roe or coral Checking Freshness A sweet,clean smell is a sign of freshness. They are improved, however, if you pull off the small, tough tendon or sinew on the side of each. The most important cephalopods in the North American kitchen are squid and octopus. A third type, cuttlefish, is similar to squid but is usually seen only in limited markets. They are soft-bodied animals somewhat resembling octopus,but they have 10 tentacles,2 of them longer than the others. Somewhat chewy,squid are cut up and either fried quickly or simmered for about 45 minutes in a seasoned liquid or sauce. All sizes are firm-textured, even chewy, but the larger sizes are usually considered too tough to eat. Because of its texture, octopus requires either mechanical tenderization (such as pounding with a mallet) or long, slow cooking in a court bouillon. Like squid,octopus is cleaned by cutting off the tentacles,discarding the head and beak,and eviscerating the body cavity. Pull the skin off the body pouch and tentacles;it may be necessary to parboil the octopus for a few minutes to loosen the skin. The coral (roe or eggs), which is dark green when raw and red when cooked,and the green tomalley (liver) in the thorax or body portion are also eaten. If it is broiled as shown, the end of the tail should be weighted down to keep it from curling. Yield: A 1-lb lobster yields about 1/4 lb cooked meat, or a 500-g lobster yields about 125 g cooked meat. Sometimes customers request female lobsters in order to get the coral, so you should be able to tell females from males. Pierce the head with a firm thrust of the knife point to kill the lobster quickly. If it is alive, the meat will be firm and the tail will spring back when straightened. Large tails should be cut into more pieces (at least four or five) so that each piece is not too large.
Almost 30 languages were spoken medicine man dispensary buy strattera 10mg amex, including English medications used to treat migraines order strattera 25mg free shipping, Arabic medicine plus generic strattera 18 mg online, Bengali 3 medications that affect urinary elimination buy cheap strattera 18mg on line, Chinese, Creole, French, Greek, Hebrew, Russian, Spanish, Urdu, Vietnamese, Italian and Hindi. Of the 2487 patients referred for colonoscopy for colorectal cancer screening, 1642 (66%) completed the examination within 6 months of referral. Women were more likely to undergo colonoscopy compared to men, 546/985 vs 299/657 (p = 0. Asians (118/321), Middle Eastern (32/78), Indian 41/94) and Caucasians (379/1105) were more likely to undergo colorectal cancer screening compared to African American (59/199) and Hispanic (190/631) patients (p < 0. Language and age of patients did not appear to play a significant role in undergoing colonoscopy (p > 0. Conclusion: We conclude that gender and race are important factors to consider when discussing colorectal cancer screening with patients. These results may explain gender and racial differences in colorectal cancer morbidity and mortality. Male patients, African- Americans and Hispanics may need additional attention from health care professionals when discussing colorectal cancer screening in order to increase compliance. Purpose: Despite increasing age and significant comorbidity, patients over the age of 75 are routinely referred for an initial screening colonoscopy. Patients and physicians often question the utility of a first ever colonoscopy in the elderly when no gastrointestinal symptoms exist. We investigated whether the endoscopic findings in individuals 70-80 and 80 years of age warranted a recommendation to continue initial screening colonoscopies in these elderly populations. Methods: All colonoscopies performed at the Memphis Veterans Affairs Medical Center from January 1, 2006 through April 30, 2008 were retrospectively evaluated. Exclusion criteria included prior colonoscopy, inpatient status, nursing home residence, and any colonoscopy performed for indications other than routine colorectal cancer screening (acute intestinal bleeding, iron deficiency, abdominal pain, constipation, diarrhea, and abnormal imaging findings). Advanced lesions were defined as any polyp containing villous or adenocarcinoma pathology. Results: A total of 621 patients met all selection criteria and were included in the study. When stratified by years of age, 463 patients were age <70, 124 were age 70-80, and 34 were age 80. When compared to the age <70 group, patients age 70-80 had significantly more adenomas (33. Interestingly, 33% of advanced lesions were adenocarcinomas in the age <70 group while 100% of advanced lesions were adenocarcinomas in the age 70 group. Conclusion: Elderly patients undergoing initial screening colonoscopy have significantly higher rates of adenomas and adenocarcinomas when compared to younger patients. Surprisingly, nearly 9% of patients older than 80 years were diagnosed with an adenocarinoma. These findings suggest that it is appropriate to perform an initial screening colonoscopy in elderly patients 70 years and older, provided they are healthy enough to tolerate the procedure. Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2. Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom. Purpose: Achalasia is a disease best defined by abnormalities present during esophageal manometry. These result in failure of esophageal function & may progress to a lifethreatening condition. Presence of short segment (ranging from 3 to 5 cm) peristalsis in the distal 2/3 of the esophagus. Those classified as "achalasia, other" were reviewed, any portion of the report mentioning a short segment of peristalsis, 3 cm or longer, led to inclusion for a detailed and blinded review of the entire motility tracing. Exclusion criteria include all medical or surgical conditions supported by scientific literature as altering motility. Results: Among these 17 original esophageal motility studies that were reported to have intermittent short segments of esophageal peristalsis, 8 studies met the definition of this variant of achalasia (short segment peristalsis). The most common presenting symptoms (with some patients having > 1) were: dysphagia (5); bolus impaction (3); chest pain (3); and heartburn (2). The presence of peristaltic segments similar to that of the presence of aperistaltic segments described by Hirano et al. The purpose of this study is to present a case series of patients with esophageal eosinophilia who underwent fundoplication and were subsequently found to have EoE.
Select the tomatoes: Use 34 varieties of ripe treatment keloid scars purchase 18 mg strattera visa, flavorful tomatoes of varied colors (yellow medications similar to lyrica generic 18mg strattera with mastercard, green treatment 4 pink eye generic 25mg strattera fast delivery, orange medicinenetcom medications generic strattera 40 mg with amex, different shades of red), depending on availability. Prepare the tomatoes: Peel large tomatoes by blanching them for 10 seconds in boiling water, cutting out the core end, and pulling off the skins. Alternate overlapping slices of tomato and fresh mozzarella on a plate or platter. Mix together the tomatoes, lettuce, cheese, avocado, scallions, olives, corn, and beans. A R I A T I O N S Nearly any combination of ingredients, including cooked meats, poultry, and seafood, can be made into a chopped salad. For example, the recipe above can be made into a more substantial maincourse salad by adding chopped, cooked chicken, turkey, or ham, allowing about 2 oz (60 g) per portion. Mixed Bean Salad with Olives and Tomatoes Portions: 12 Portion size: 4 oz (125 g) U. Mixed Bean Salad with Olives and Tomatoes Salads 699 Quinoa Salad with Bell Peppers Portions: 12 Portion size: 41/2 oz (135 g) U. Combine the cooled quinoa, bell peppers, scallions, cucumber, and apricots in a bowl. V A R I A T I O N S this salad can also be made with brown rice, farro, or couscous. Quinoa Salad with Bell Peppers Panzanella Portions: 10 Portion size: 4 oz (125 g) U. If necessary, let it sit out to dry for a few hours, or dry it slightly in an oven. Add either or both of the following ingredients to the mixture: 8 oz (250 g) peeled, seeded cucumber, chopped; 4 oz (125 g) hearts of celery. Bring to a boil, reduce heat, and simmer until the lentils are just tender and not falling apart, about 25 minutes. While the lentils are still warm, add the celery, carrot, onion, parsley, olive oil, and lemon juice. Broccoli, Prosciutto, and Sunflower Salad Portions: 12 Portion size: 41/2 oz (140 g) U. Combine the raisins, broccoli, prosciutto, sunflower seeds, and shallot or onion in a bowl. Broccoli, Prosciutto, and Sunflower Salad Salads 701 Tabouli Portions: 12 Portion size: 4 oz (125 g) U. The bulgur should have absorbed most or all of the water and should be tender enough to eat. Mix together the bulgur, cucumbers, parsley, scallions, tomato, lemon juice, and olive oil. Wheatberry Salad with Mint Portions: 16 Portion size: 3 oz (90 g) wheatberry mixture plus 1/2 oz (15 g) arugula U. Bring to a boil, reduce heat to a simmer, cover loosely, and simmer until tender, about 1 hour. The term bound is used most often for traditional mixtures of cooked protein,starch,and vegetable items with mayonnaise,such as chicken salad, tuna salad, egg salad, and potato salad. As noted in the discussion of vegetable and starch salads on page 690, there is no exact dividing line between that category and bound salads,so you should keep in mind the guidelines for preparing both kinds of salads when preparing bound salads. Some of these salads,mainly those made with protein items, are also used as sandwich fillings. Sandwich filling ingredients must usually be chopped fine or cut into small dice to be practical for this use. Popular choices for cooked salads are the following: Chicken Turkey Ham Tuna Salmon Crab Shrimp Lobster Eggs Potatoes Pastas Rice Mixed vegetables G 1. Mayonnaise-type salads are ideal breeding grounds for bacteria that cause food poisoning. Bound salads are good ways to use leftovers such as chicken, meat, or fish, but the ingredient must have been handled according to the rules of good sanitation and food handling.
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