Edward R.M. O'Brien, MD
- Professor of Medicine, Cardiology
- Research Chair, Canadian Institutes of Health Research/Medtronic
- University of Ottawa Heart Institute
- Ottawa, Ontario, Canada
Alcoholic Drink-Equivalents [a] of Select Beverages Drink Description Drink-Equivalents[b] Beer antibiotic resistance vets buy discount keflex 500 mg on line, Beer Coolers antibiotics diabetes buy discount keflex 750mg, & Malt Beverages 12 fl oz at 4 antimicrobial zinc proven keflex 500mg. The following are reference beverages that are one alcoholic drinkequivalent: 12 fluid ounces of regular beer (5% alcohol) antimicrobial properties of garlic purchase keflex 500 mg on-line, 5 fluid ounces of wine (12% alcohol), or 1. Drinkequivalents are not intended to serve as a standard drink definition for regulatory purposes. For [c] Light beer represents a substantial proportion of alcoholic beverages consumed in the United States. Binge drinking is the consumption within about 2 hours of 4 or more drinks for women and 5 or more drinks for men. Excessive alcohol consumption-which includes binge drinking (4 or more drinks for women and 5 or more drinks for men within about 2 hours); heavy drinking (8 or more drinks a week for women and 15 or more drinks a week for men); and any drinking by pregnant women or those under 21 years of age-has no benefits. Excessive drinking is responsible for 88, 000 deaths in the United States each year, including 1 in 10 deaths among working age adults (age 20-64 years). In 2006, the estimated economic cost to the United States of excessive drinking was $224 billion. Binge drinking is associated with a wide range of health and social problems, including sexually transmitted diseases, unintended pregnancy, accidental injuries, and violent crime. Individuals should not drink if they are driving, planning to drive, or are participating in other activities requiring skill, coordination, and alertness. Caffeine does not change blood alcohol content levels, and thus, does not reduce the risk of harms associated with drinking alcohol. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Potassium: Food Sources Ranked by Amounts of Potassium & Energy per Standard Food Portions & per 100 Grams of Foods Food Standard Portion Size Calories in Standard Portion[a] Potassium in Standard Portion (mg)[a] Calories per 100 grams[a] Potassium per 100 grams (mg)[a] Potato, Baked, Flesh & Skin Prune Juice, Canned Carrot Juice, Canned Passion-Fruit Juice, Yellow or Purple Tomato Paste, Canned Beet Greens, Cooked from Fresh Adzuki Beans, Cooked White Beans, Canned Plain Yogurt, Nonfat Tomato Puree Sweet Potato, Baked in Skin Salmon, Atlantic, Wild, Cooked 1 medium 163 941 94 544 1 cup 1 cup 182 94 707 689 71 40 276 292 1 cup 126-148 687 51-60 278 ј cup 54 669 82 1, 014 Ѕ cup 19 654 27 909 Ѕ cup Ѕ cup 1 cup Ѕ cup 147 149 127 48 612 595 579 549 128 114 56 38 532 454 255 439 1 medium 103 542 90 475 3 ounces 155 534 182 628 2015-2020 Dietary Guidelines for Americans - Page 104 Table A10-1. Calcium: Food Sources Ranked by Amounts of Calcium & Energy per Standard Food Portions & per 100 Grams of Foods Food Standard Portion Size Calories in Standard Portion[a] Calcium in Standard Portion (mg)[a] Calories per 100 grams[a] Calcium per 100 grams (mg)[a] Fortified Ready-to-Eat Cereals (Various)[b] Pasteurized Processed American Cheese Parmesan Cheese, Hard Plain Yogurt, Nonfat Romano Cheese Almond Milk (All Flavors)[b] Pasteurized Processed Swiss Cheese Tofu, Raw, Regular, Prepared with Calcium Sulfate Gruyere Cheese Plain Yogurt, Low-Fat Vanilla Yogurt, Low-Fat ѕ-1ј cup 70-197 137-1, 000 234-394 455-3, 333 2 ounces 210 593 371 1, 045 1. Vitamin D: Food Sources Ranked by Amounts of Vitamin D & Energy per Standard Food Portions & per 100 Grams of Foods Food Standard Portion Size Calories in Standard Portion[a] Vitamin D in Standard Portion (g)[a, b] Calories per 100 grams[a] Vitamin D per 100 grams (g)[a, b] Salmon, Sockeye, Canned Trout, Rainbow, Farmed, Cooked Salmon, Chinook, Smoked Swordfish, Cooked Sturgeon, Mixed Species, Smoked Salmon, Pink, Canned Fish Oil, Cod Liver Cisco, Smoked Salmon, Sockeye, Cooked Salmon, Pink, Cooked Sturgeon, Mixed Species, Cooked 3 ounces 142 17. Dietary Fiber: Food Sources Ranked by Amounts of Dietary Fiber & Energy per Standard Food Portions & per 100 Grams of Foods Food Standard Portion Size Calories in Standard Portion[a] Dietary Fiber in Standard Portion (g)[a] Calories per 100 grams[a] Dietary Fiber per 100 grams (g)[a] High Fiber Bran Ready-to-Eat Cereal Navy Beans, Cooked Small White Beans, Cooked Yellow Beans, Cooked Shredded Wheat Readyto-Eat Cereal (Various) Cranberry (Roman) Beans, Cooked Adzuki Beans, Cooked French Beans, Cooked Split Peas, Cooked Chickpeas, Canned Lentils, Cooked Ѕ-ѕ cup 60-81 9. Food Safety Principles & Guidance An important part of healthy eating is keeping foods safe. It is estimated that foodborne illness affects about 1 in 6 Americans (or 48 million people), leading to 128, 000 hospitalizations and 3, 000 deaths every year. Individuals in their own homes can reduce contaminants and help keep food safe to eat by following safe food handling practices. Four basic food safety principles work together to reduce the risk of foodborne illness- Clean, Separate, Cook, and Chill. Alcohol-based (60%), rinse-free hand sanitizers should be used when hand washing with soap is not possible. Wash Hands With Soap & Water Wet hands with clean running water (warm or cold), turn off tap, and apply soap. If you need a timer you can hum the "happy birthday" song from beginning to end twice. A solution of 1 tablespoon of unscented, liquid chlorine bleach per gallon of water can be used to sanitize surfaces. All kitchen surfaces should be kept clean, including tables, countertops, sinks, utensils, cutting boards, and appliances. Keep Appliances Clean At least once a week, throw out refrigerated foods that should no longer be eaten. Pay particular attention to buttons and handles where crosscontamination to hands can occur. Clean Microbes, such as bacteria and viruses, can be spread throughout the kitchen and get onto hands, cutting boards, utensils, countertops, reusable grocery bags, and foods.
Many communities are developing multicomponent initiatives with the understanding that many factors affect health antimicrobial use guidelines order keflex 250mg with amex. For example oral antibiotics for mild acne effective keflex 500 mg, job training programs can have a positive health effect for participants through increased self-esteem and income from a new or better job antibiotics for sinus infection ear infection buy 500mg keflex. We hope that you will join the many others working toward health equity antibiotic cream for acne buy 250 mg keflex, some of whose efforts we have highlighted in this workbook, so we can all learn by doing. Tell us your story about the work your community is doing to achieve health equity. Regional Development and Physical Activity: Issues and Strategies for Promoting Health Equity. Proceedings of Made to Measure: Designing Research, Policy and Action Approaches to Eliminate Gender Inequality, National Symposium; 1999 Oct 36; Halifax, Nova Scotia. Health and social issues associated with racial, ethnic, and cultural disparities. Praeger Handbook of Black American Health: Policies and Issues Behind Disparities in Health. Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation. Proceedings of the Minority Health Conference; 2002 March 1; University of North Carolina. Integrating Public Health Practices: A Position Statement on Community Capacity Development and the Social Determinants of Health for Public Health Services. Proceedings of the American Public Health Association Meeting; 2003 Nov; San Francisco. Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Liverpool, England: Department of Public Health at the University of Liverpool; 2001. Race, socioeconomic status, and health: the added effects of racism and discrimination. Community Based Participatory Research for Health San Francisco: Jossey-Bass; 2003. Findings from a community-based participatory prevention research intervention designed to increase social capital in Latino and African American communities. A community resilience approach to reducing ethnic and racial disparities in health. Collaboration Math: Enhancing the Effectiveness of Multidisciplinary Collaboration. Community-provider partnerships to reduce immunization disparities: field report from northern Manhattan. Review of community-based research: assessing partnership approaches to improve public health. Evaluation results from a community-based participatory research partnership in Detroit. Communities Sustain Public Health Improvement Through Organized Partnership Structures. Implementing communitycampus partnerships in South Carolina: collaborative efforts to improve public health. The East Side Village Worker Partnership: integrating research with action to reduce health disparities. Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. Building community capacity to promote social and public health: challenges for universities. A Guide to Mapping Consumer Expenditures and Mobilizing Consumer Expenditure Capacities.
Between these points of general relations antibiotic bone penetration order 750 mg keflex amex, which we trace on the surface of the trunk of the body antibiotics for scalp acne buy keflex 500 mg cheap, the anatomist includes the entire history of the special relations of the organs within contained antibiotics for uti not sulfa quality 500mg keflex. And not until he is capable of summing together the whole picture of anatomical analysis antimicrobial 1 discount 750 mg keflex overnight delivery, and of viewing this in all its intricate relationary combination-even through and beneath the closed surface of living moving nature, is he prepared to estimate the conditions of disease, or interfere for its removal. When fluid accumulates on either side of the thoracic compartment to such an excess that an opening is required to be made for its exit from the body, the operator, who is best acquainted with the relations of the parts in a state of health, is enabled to judge with most correctness in how far these parts, when in a state of disease, have swerved from these proper relations. In the normal state of the thoracic viscera, the left thoracic space, G A K N, is occupied by the heart and left lung. If the thorax be deeply penetrated at any part of this region, the instrument will wound either the lung or the heart, according to the situation of the wound. But when fluid becomes effused in any considerable quantity within the pleural sac, it occupies space between the lung and the thoracic walls; and the fluid compresses the lung, or displaces the heart from the left side towards the right. This displacement may take place to such an extent, that the heart, instead of occupying the left thoracic angle, A K N, assumes the position of A K* N on the right side. Therefore, as the fluid, whatever be its quantity, intervenes between the thoracic walls, K K*, and the compressed lung, the operation of paracentesis thoracis should be performed at the point K, or between K and the latissimus dorsi muscle, so as to avoid any possibility of wounding the heart. When serous or other fluid accumulates to an excess in the pericardium, so as considerably to distend this sac, it must happen that a greater area of pericardial surface will be exposed and brought into immediate contact with the thoracic walls on the left side of the sternal median line, to the exclusion of the left lung, which now no longer interposes between the heart and the thorax. At this locality, therefore, a puncture may be made through the thoracic walls, directly into the distended pericardium, for the escape of its fluid contents, if such proceeding be in other respects deemed prudent and advisable. The abdominal cavity being very frequently the seat of dropsical effusion, when this takes place to any great extent, despite the continued and free use of the medicinal diuretic and the hydragogue cathartic, the surgeon is required to make an opening with the instrumental hydragogue-viz. The proper locality whereat the puncture is to be made so as to avoid any large bloodvessel or other important organ, is at the middle third of the median line, between P the umbilicus, and Z the symphysis pubis. The anatomist chooses this median line as the safest place in which to perform paracentesis abdominis, well knowing the situation of 2, 3, the epigastric vessels, and of Y, the urinary bladder. All kinds of fluid occupying the cavities of the body gravitate towards the most depending part; and therefore, as in the sitting or standing posture, the fluid of ascites falls upon the line P Z, the propriety of giving the patient this position, and of choosing some point within the line P Z, for the place whereat to make the opening, becomes obvious. In the female, the ovary is frequently the seat of dropsical accumulation to such an extent as to distend the abdomen very considerably. Ovarian dropsy is distinguished from ascites by the particular form and situation of the swelling. In ascites, the abdominal swell is symmetrical, when the body stands or sits erect. In ovarian dropsy, the tumour is greatest on either side of the median line, according as the affected ovary happens to be the right or the left one. The fluid of ascites and that of the ovarian dropsy affect the position of the abdominal viscera variously In ascites, the fluid gravitates to whichever side the body inclines, and it displaces the moveable viscera towards the opposite side. Therefore, to whichever side the abdominal fluid gravitates, we may expect to find it occupying space between the abdominal parietes and the small intestines. The ovarian tumour is, on the contrary, comparatively fixed to either side of the abdominal median line; and whether it be the right or left ovary that is affected, it permanently displaces the intestines on its own side; and the sac lies in contact with the neighbouring abdominal parietes; nor will the intestines and it change position according to the line of gravitation. Now, though the above-mentioned circumstances be anatomically true respecting dropsical effusion within the general peritonaeal sac and that of the ovary, there are many urgent reasons for preferring to all other localities the line P Z, as the only proper one for puncturing the abdomen so as to give exit to the fluid. The caecum and the sigmoid flexure of the colon occupy, R R*, the right and left iliac regions. All these organs continue to hold their proper places, to whatever extent the dropsical effusion may take place, and notwithstanding the various inclinations of the body in this or that direction. On this account, therefore, we avoid performing the operation of paracentesis abdominis at any part except the median line, P Z; and as to this place, we prefer it to all others, for the following cogent reasons-viz. If the ovarian dropsy form a considerable tumour in the abdomen, it may be readily reached by the trocar and cannula penetrating the line P Z. The puncture through the linea alba should never be made below the point, midway between P and Z, lest we wound the urinary bladder, which, when distended, rises considerably above the pubic symphysis. Amongst the many mechanical obstructions which, by impeding the circulation, give rise to dropsical effusion, are the following:-An aneurismal tumour of the aorta, A, or the innominate artery, [Footnote 1] F, may press upon the veins, H or D, and cause an oedematous swelling of the corresponding side of the face and the right arm.
If a haemorrhage therefore take place from either of the palmar vessels antibiotic injection for uti generic 750mg keflex with visa, it will not be sufficient to place a ligature around the radial or the ulnar artery singly antibiotics for uti cause diarrhea keflex 750 mg generic, for if F antibiotics for acne permanent cheap 750 mg keflex visa, Plate 17 antibiotic 45 purchase keflex 250mg overnight delivery, bleeds, and in order to arrest that bleeding we tie the vessel C, Plate 17, still the vessel F will continue to bleed, in consequence of its communication with the vessel E, Plate 18, by the branch 1, Plate 18, and other branches above mentioned. If E, Plate 18, bleeds, a ligature applied to the vessel A, Plate 18, will not stop the flow of blood, because of the fact that E anastomoses with G, by the branch I and other branches, as seen in Plates 17 and 19. Any considerable haemorrhage, therefore, which may be caused by a wound of the superficial or deep palmar arches, or their branches, and which we are unable to arrest by compression, applied directly to the patent orifices of the vessel, will in general require that a ligature be applied to both the radial and ulnar arteries at the wrist; and it occasionally happens that even this proceeding will not stop the flow of blood, for the interosseous arteries, which also communicate with the vessels of the hand, may still maintain the current of circulation through them. These interosseous arteries being branches of the ulnar artery, and being given off from the vessel at the bend of the elbow, if the bleeding be still kept up from the vessel wounded in the hand, after the ligature of the ulnar and radial arteries is accomplished, are in all probability the channels of communication, and in this case the brachial artery must be tied. In addition to these facts he will do well to remember some other arrangements of these vessels, which are liable to occur; and upon these I shall offer a few observations. While I view the normal disposition of the arteries of the arm as a whole, (and this view of the whole great fact is no doubt necessary, if we would take within the span and compass of the reason, all the lesser facts of which the whole is inclusive, ) I find that as one main vessel (the brachial) divides into three lesser branches, (the ulnar, radial and interosseous, ) so, therefore, when either of these three supplies the haemorrhage, and any difficulty arises preventing our having access at once to the open orifices of the wounded vessel, we can command the flow of blood by applying a ligature to the main trunk-the brachial. If this measure fail to command the bleeding, then we may conclude that the wounded vessel (whichever it happen to be, whether the radial, the ulnar, or the interosseous) arises from the brachial artery, higher up in the arm than that place whereat we applied the ligature. To this variety as to the place of origin, the ulnar, radial, and interosseous arteries are individually liable. Again, as the single brachial artery divides into the three arteries of the forearm, and as these latter again unite into what may (practically speaking) be termed a single vessel in the hand, in consequence of their anastomosis, so it is obvious that in order to command a bleeding from any of the palmar arteries, we should apply a ligature upon each of the vessels of the forearm, or upon the single main vessel in the arm. When the former proceeding fails, we have recourse to the latter, and when this latter fails (for fail it will, sometimes, ) we then reasonably arrive at the conclusion that some one of the three vessels of the forearm, springs higher up than the place of the ligature on the main brachial vessel. But however varied as to the normal locality of their origin, at the bend of the elbow, these vessels of the forearm may at times manifest themselves, still one point is quite fixed and certain, viz. Hence, therefore, it becomes evident, that in order to command, at once and effectually, a bleeding, either from the palmar arteries, or those of the forearm, we attain to a more sure and successful result, the nearer we approach the fountain-head and place a ligature on it-the brachial artery. It is true that to stop the circulation through the main vessel of the limb, is always attended with danger, and that such a proceeding is never to be adopted but as the lesser one of two great hazards. It is also true that to tie the main brachial artery for a haemorrhage of anyone of its terminal branches, may be doing too much, while a milder course may serve; or else that even our tying the brachial may not suffice, owing to a high distribution of the vessels of the arm, in the axilla, above the place of the ligature. Whenever this may be done, we need not trouble ourselves concerning the anomaly in vascular distribution. The superficial palmar arch, F, Plate 17, lies beneath the dense palmar fascia; and whenever matter happens to be pent up by this fascia, and it is necessary that an opening be made for its exit, the incision should be conducted at a distance from the locality of the vessel. When matter forms beneath the palmar fascia, it is liable, owing to the unyielding nature of this fibrous structure, to burrow upwards into the forearm, beneath the annular ligament D, Plates 17 and 18. All deep incisions made in the median line of the forepart of the wrist are liable to wound the median nerve B, Plate 17. When the thumb, together with its metacarpal bone, is being amputated, the radial artery E, Plate 19, which winds round near the head of that bone, may be wounded. It is possible, by careful dissection, to perform this operation without dividing the radial vessel. Ulnar nerve; E e e, its continuation branching to the little and ring fingers, &c. Ulnar artery, giving off the branch I to join the deep palmar arch E of the radial artery. Tendons of flexor digitorum sublimis and profundus, and the lumbricales muscles cut and turned down. Tendons of extensor digitorum communis; A*, tendon overlying that of the indicator muscle. End of the radial nerve distributed over the back of the hand, to two of the fingers and the thumb. Dorsal branch of the ulnar nerve supplying the back of the hand and the three outer fingers. On making a section (vertically through the median line) of the cranio-facial and cervico-hyoid apparatus, the relation which these structures bear to each other in the osseous skeleton reminds me strongly of the great fact enunciated by the philosophical anatomists, that the facial apparatus manifests in reference to the cranial structures the same general relations which the hyoid apparatus bears to the cervical vertebrae, and that these relations are similar to those which the thoracic apparatus bears to the dorsal vertebrae. To this anatomical fact I shall not make any further allusions, except in so far as the acknowledgment of it shall serve to illustrate some points of surgical import. The osseous envelope of the brain, called calvarium, Z B, holds serial order with the cervical spinous processes, E I, and these with the dorsal spinous processes. The dura-matral lining membrane, A A A*, of the cranial chamber is continuous with the lining membrane, C, of the spinal canal. The intervertebral foramina of the cervical spine are manifesting serial order with the cranial foramina. The nerves which pass through the spinal region of this series of foramina above and below C are continuous with the nerves which pass through the cranial region.
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