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By: Z. Thorek, M.A.S., M.D.

Vice Chair, David Geffen School of Medicine at UCLA

Feasts are given at specific stages of life such as birth medicine klonopin buy benemid line, naming ceremony medicine man gallery order benemid us, birthdays medicine examples buy benemid 500mg free shipping, marriages, etc. Most of the religious festivals also call for feasts and feeding of specific segments of the population. It is also used as a symbol of happiness at certain events in life, for example, pedhas are distributed to announce success in examinations, or the birth of a baby; laddus are associated with the celebration of Deepavali and marriages, cakes are associated with Christmas and birthdays and tilgul with sankranti the festival of friendship. As food is an integral part of our social existence, this function is important in daily life. The menu for such get-together should bring the people together, rather than divide them. This basic aspect should be considered in planning menus for such occasions (Figure 1. In addition to satisfying physical and social needs, food must satisfy certain emotional needs. In a friendly gathering we try unfamiliar foods and thus enlarge our food experiences. It must be noted that even a nutritionally balanced meal may not be satisfying to the individual, if the foods included are unfamiliar or distasteful to him/her. With time and repeated experience, strange foods become familiar and new tastes are formed. These aspects are important in food acceptance and must be considered in planning meals, which are not only nutritionally adequate, but also enjoyable for the group for whom they are intended. Functions of Nutrients the foods which we use daily include rice, wheat, dal, vegetables, fruits, milk, eggs, fish, meat, sugar, butter, oils, etc. These different foods are made up of a number of chemical components called nutrients. Each nutrient class has its own function, but the various nutrients must act in unison for effective action. The nutrients found in foods are — carbohydrates, proteins, fats, minerals, vitamins and water. Carbohydrates: Starch found in cereals and sugar in sugarcane and fruits are examples of carbohydrates in foods. Those not used immediately for this purpose are stored as glycogen or converted to fat and stored, to be mobilised for energy supply when needed. Fats: Oils found in seeds, butter from milk, and lard from meat, are examples of fats found in foods. Fats are concentrated sources of energy, carriers of fat soluble vitamins and a source of essential fatty acids. If excess fats are taken in the diet, these are stored as fat reserves in the body. Proteins: Casein from milk, albumin in egg, globulins in legumes and gluten in wheat, are examples of proteins occurring in foods. The main function of protein is the building of new tissues and maintaining and repair of those already built. Synthesis of regulatory and protective substances such as enzymes, hormones and antibodies is also a function of food proteins. Protein, when taken in excess of the body’s need, is converted to carbohydrates and fats and is stored in the body. Minerals: the minerals calcium, phosphorus, iron, iodine, sodium, potassium and others are found in various foods in combination with organic and inorganic compounds. Minerals are necessary for body-building, for building of bones, teeth and structural parts of soft tissues. Vitamins: Fat-soluble vitamins A, D, E and K and also water-soluble vitamins C and B group are found in foods. These are needed for growth, normal function of the body and normal body processes. Water: We get water in foods we eat and a major part from the water we drink as such and as beverages. Water is an essential part of our body structure and it accounts for about 60 per cent of our body weight. Water is essential for the utilisation of food material in the body and also for elimination of food waste. The only variation is in the amounts of each nutrient required according to age, size, activity, etc.

The purpose behind Daubert medications not to take with blood pressure meds buy cheap benemid 500 mg, and its use by federal courts and courts in other jurisdictions is to treatment 02 academy buy discount benemid on line ensure that only reliable expert testimony is allowed into evidence symptoms congestive heart failure purchase benemid visa. Unlike the Frye standard, the Daubert standard helps weed out claims based on “junk science. Litigants know that they can commence an action in Florida state court based on expert testimony that has been excluded as unreliable by other courts that apply the Daubert standard. Seven federal court judges, including a federal judge in Florida, rejected the testimony of the expert at issue in Hood. However, the trial court’s decision was reversed by the Fourth District Court of Appeal and the previously discredited expert was allowed to testify. First, the Supreme Court has specifically addressed whether or not the Florida courts should adopt Daubert, and it has repeatedly said no. Second, the adoption of Daubert would create an immense procedural burden for an already-overburdened court system, resulting in further delays for people who are least able to endure delays—individual civil litigants. Finally, the Frye standard works effectively to weed out so-called “junk science,” and there is no need to inject further procedural hurdles and delays into the justice system. With this change, Florida joined 40 other states and the federal courts in requiring a more stringent standard for expert testimony. Daubert has been the evidentiary standard for the admission of expert testimony in the federal court system since 1993. Daubert is important because the Court must be a gatekeeper when it comes to the introduction of expert witness testimony. Frye, decided nearly 100 years ago, is not sufficient to ensure the gatekeeper role for the Court. The Plaintiff bar has taken the familiar tact that Daubert should not be adopted as a procedural rule because it "benefits the rich and powerful" and reduces access to the courts. Furthermore, there is no empirical support from the 40 other jurisdictions that apply Daubert for the argument that a more rigorous standard for the admission of expert testimony decreases access to the courts or benefits the "rich and powerful. A court room is not an appropriate venue for the introduction of so called expert testimony which would not be accepted in the relevant scientific/expert community. Dave Cannella 606 Several years ago the Supreme Court adopted the "Frye" standard, which has been followed and implemented successfully throughout the State. It is more like a free for all allowing more factors and considerations than were necessary under Frye. It is a boon to those billing by the hourly because it requires seemingly interminable amount of preparation. More experts are required to make determination that the challenged experts are worthy to testify. Suspect experts are allowed to parade into the courtroom under Daubert and only “Vigorous cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence. Frye is still simpler, easier, definitive, saves the Court time, is less costly in time and lawyers fees and experts upon experts and it worked. Daubert is, like the change in Bankruptcy rules is to banruptcy lawyers, a lawyers li f f h billi h l d l b d h l d k d 608 609 It is imperative that the Daubert standard be adopted. There is no reason Florida should not be consistent with the Federal standard and the Daubert standard is the better standard for considering the reliability of expert testimony and avoiding junk science or the introduction of "mere theories" as expert testimony. I am submitting this letter on behalf of my organization, the Florida Justice Reform Institute. The Daubert standard will make it more expensive for litigants to get to the courthouse and is not judicially efficient, putting trial judges in the place of juries to weigh the significance of expert testimony. Daubert hearings have almost doubled the entire cost of the case because we have to fly in our experts to testify for a day long hearing, much like we would for trial. Judges do not like being put in a position of throwing out a catastrophic injury case on an evidentiary issue and would rather let the jury decide. While Judges have to entertain the Daubert hearings they rarely grant the motions. The state court system cannot bear the additional costs and time being imposed by the Daubert standard. I have heard the current Florida Bar president say that legislators want to know why the time to have a matter decided in court is so protracted. Daubert will only increase further protect litigation and the time to resolve cases.

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The Pillar of Clinical Sensitivity is of paramount importance to medicine 66 296 white round pill buy cheap benemid 500mg on-line the personal and professional health and well-being of a physician treatment coordinator buy generic benemid. It is a well-known fact that physicians work long hours and are faced with great challenges xerogenic medications discount 500 mg benemid overnight delivery, both intellectual and emotional. The intellectual challenges are served best by enhancing one’s depth of knowledge through continued education and by developing an excellent referral network, while the emotional trials are well met by understanding one’s limits and spending time in self-refection. As mentioned in the Clinical Sensitivity section, there are two key components to clinical sensitivity: developing self-awareness and effective, compas sionate physician–patient communication. In much of traditional medical education, physicians are not taught how to face emotional challenges, so it is quite refreshing to witness the results of a training program in self-awareness being taught to every freshman medical student at Georgetown University. Such training enhances the abil ity of physicians to face and process the emotional roller coaster encountered on a daily basis. Working toward self-awareness, studies of ethics, spirituality, psychology, and comparative religions all are important components in the education and continu ing education of a physician. In fact, a physician’s communication style and choice of words can impact the health and well-being of his/her patient—a topic touched upon in Chapter 4. Studies in psychoneuroimmunology have shown how our minds can alter hormone and neurotransmitter elaboration, potentially evoking either immune sup pression (nocebo) or healing (placebo). I could write volumes on this topic and cannot over-emphasize its importance in the practice of medicine. The Pillar of Cultural Competence is an outgrowth of the pillars of Clinical Sensitivity and Integrative Collaborative Care. Respect for all humans and selfess service are the key factors to obtaining cultural competence. I have had a great deal of experience with underprivileged and minority populations over three decades of medical practice in the Washington, D. Through experience and exploration, I came to understand that ultimately I am and must be a servant to my patients. Yet, there is an unspoken, in-bred sense of entitlement in the medical profession that must be dispelled and eliminated, if we are to improve as physicians and grow as human beings. When taking care of a patient from a dif ferent race or ethnic background than one’s own, it is incumbent upon the physician to dispel his/her beliefs or prejudices and recognize the value of understanding the beliefs and prejudices of that patient, which in many cases, will be a core issue to their healing. Cultural Competence not only compels an appreciation of and respect for the societal and religious beliefs of others, but it also requires sensitivity to the fact that indigenous remedies and alternative medical systems are a familiar way of life for patients of various ethnic origins. It will become increasingly imperative that physicians are trained in Cultural Competence as globalization expands. State-of-the-art technology, including real-time education via the Internet, archived lectures, and distant education, has brought excellent advances to medical education. Many countries other than the United States, allow these learning formats in basic medical education. The course was oversubscribed; some of us were placed in another location, with access to the lectures via a television monitor. Similarly, when I gave a grand rounds lecture on Integrative Medicine at the Mayo Clinic a few years ago, the real-time lecture was televised in Arizona, Minnesota, and Florida. These two examples involved postgraduate education courses, for which Internet-based education currently is considered acceptable, while M. I fail to understand why some of the basic medical education courses are not allowed in an eLearning format. It is my contention that before long, medical education will have to combine residential and virtual education, as it is a well-known fact that a global physician shortage is looming. A combination of technology-based medical courses and affli ations set up at universities and hospitals local to students in both underdeveloped countries as well as right here in the United States would permit medical education to occur with minimal disruption to family and fnancial matters—both of which are important factors in the decision of whether or not one can feasibly apply to medical school. With innovative planning, such as eLearning coursework, doctors largely could be educated in their local communities. These individuals, ideally, then would provide needed medical care to their native communities, solving the problems eluci dated in the Two Guideposts: (1) serving the underserved of the world, and (2) assist ing physicians to practice in their country of origin, rather than migrating, which can leave medical care defcits in countries most in need of physicians. In summary, the Four Pillars and Two Guideposts affrm the need for a more glob ally equitable system of medical care and ask physicians to increase their self-awareness and clinical compassion. The Four Pillars and Two Guideposts, coupled with a solid scientifc-based program, are my 338 the Scientifc Basis of Integrative Medicine vision of what constitutes optimal medical education and is an ideal that every healthcare provider might strive to obtain. It is imperative that medical education provides far more than scientifc information and also offers a comprehensive approach to treating patients. According to one of our revered mentors, Sir William Osler: “To be of any value, an edu cation should prepare for life’s work” (Osler, 2003).

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Chapter 10: Ayurvedic Medicine In our clinic treatment warts buy genuine benemid on line, the patent’s hepatts C infecton and associated changes in liver biochemistry were treated as an excess of pita humor treatment broken toe cheap benemid 500 mg with amex. However treatment quadriceps tendonitis purchase benemid 500mg otc, because this patent had edema and abdominal discomfort, the involvement of kapha humor was also considered. Afer analyzing the man’s physical consttuton, it was decided that he was a vata prakrut person. The following treatment plan was designed in three stages for fve, one, and 45 days, respectvely. The selecton of herbs for this patent was based on the assessment of his unique conditon. A fat-free diet with sofly cooked old rice, porridge, non-citrus fruits, sugar cane juice, boiled vegetables, lentls, and freshly made butermilk was advised for the patent. The patent was also advised to avoid non-vegetarian foods including fsh, eggs, and ice cream. The patent was told to avoid cold drinks and sleeping for long periods of tme during the day to prevent aggravatng the humors. His alkaline phosphatase (a liver enzyme), which had been high, returned to normal. Reasons for Not Using Ayurvedic Medicine People with acute hepatts C or chronic hepatts C with multple complicatons and a severely cirrhotc liver may not beneft from Ayurvedic medicine. Those who cannot tolerate biter medicines and/or who have reservatons about Ayurvedic medicine are also unlikely to beneft. Ascites (an accumulaton of fuid in the abdomen) is an incurable conditon according to Ayurveda. People presentng with ascites cannot be helped by Ayurvedic medicine, nor can those who are highly debilitated. Anecdotal story of Treatment Failure with Ayurvedic Medicine A 70-year-old male came to our clinic with mild jaundice, elevated liver enzymes, ascites, loss of appette, shortness of breath, and fatgue. He had been treated with rest and polyunsaturated faty acids for the frst two years of his illness, perhaps due to lack of awareness of other treatments. Given this man’s presentng symptoms, partcularly his ascites, the Ayurvedic treatment optons were limited. Detoxifcaton and cleansing procedures, which are mandatory in Ayurveda, could not be used in this patent because of his poor health and nutriton. A symptomatc treatment was planned and he was put on concoctons of liver protectng herbs such as Tinospora cordifolia, Picorrizha curroa, Vits vinifera, and Piper nigrum, and others. Mild laxatves such as avipat choornam were given in small doses, and a pita-pacifying diet and lifestyle were recommended. Caring Ambassadors Hepatitis C Choices: 4th Edition His abdomen became sof and he was able to pass normal stools. Though the patent is contnuing treatment afer more than six months, there has been no signifcant improvement in his liver health. Future Research Possibilities: Prevention and Treatment Chronic hepatts C presents in a number of diferent ways. The liver damage is due to both the direct efect of the virus and the infammatory changes created by actvaton of the immune system. The efectveness and potental liver toxicity of botanicals (herbs and other plant-derived supplements) used to treat chronic hepatts have not been adequately studied. Mult-center trials are needed to determine the role of botanicals in the preventon and treatment of hepatts. Finally, research is needed on the use of the total plant, rather than just what is believed to be the actve ingredient(s). Summary Hepatts C poses unique challenges for both patents and healthcare providers. There is a great deal of historical informaton about the drugs and plants used in Ayurveda. We have descriptons of how these treatments work to improve the health of people with liver disorders. To validate this traditonal knowledge, Ayurveda is undergoing scientfc inquiry to establish its efcacy in the treatment of liver disorders. The natural history of hepatts C virus infecton: host, viral, and environmental factors.