ACP Medicine, 2006 Edition (Two Volume Set)

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It is worth mentioning that preservation of motility after 24 h of cooling is indicative of sperm quality, considering that these authors reported that this parameter is a good predictor of fertility in the perivitelline membrane binding assays in collared peccary semen. Campos et al. It is necessary that studies addressing the sperm motility parameters that influence sperm binding capacity be conducted with white-lipped peccary, because the success of fertilization is dependent on the meeting of gametes and, to this end, the spermatozoa must move along the genital system of the female and overcome anatomical and physiological barriers Yaniz et al.

Furthermore, knowledge of the correlations between the sperm viability and kinetics parameters and binding tests could provide relevant information about the in vitro fertilizing potential, enabling identification of which sperm quality parameters can effectively impair in vivo fertilization capacity Campos et al.

Leidl et al. It is possible that this also occurs in peccaries. Percentage of GTD, bending and coiling, increased in ACP-cooled samples, indicating that coconut water-based extender were not as effective in controlling the lesions caused by thermal shock. Mitochondrial metabolism plays a crucial role in the regulation of several sperm functions Flores et al.

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According to Cummins et al. Nevertheless, it was also possible to observe that there was preference of the spermatozoa for the BTS extender, because the standard deviation of the means of the parameters sperm motility; percentage of rapid, medium, slow spermatozoa; VCL; VSL; VAP; LIN; STR; percentage of spermatozoa morphologically normal, functionally intact, and with all mitochondria active showed lower values compared with the results of samples processed using the ACP extenders.

Coconut water-based extenders did not show a composition of substances capable of ensuring more homogeneous semen quality responses. This variation observed in the present research can also be attributed to the question of animal individuality in the semen cooling process that has already been observed by other authors Roca et al.

Garcia et al. It is important to note that the white-lipped peccary in this study did not undergo reproductive selection and nevertheless produced spermatozoa with potential to be chilled and stored for 24h with the possibility of use in assisted reproduction techniques such as AI.

Of the five ejaculates diluted and refrigerated, only two ejaculates from two white-lipped peccary remained with viable spermatozoa after 24 h of cooling. There are no reports in the literature on the behavior of white-lipped peccary chilled spermatozoa. It is also known that swine spermatozoa are very sensitive to temperature oscillations, because it is common the occurrence of thermal shock that causes irreversible lesions in cell structure, and loss of sperm motility, selective permeability and plasma membrane integrity, which can lead to cell death Watson It is possible that the spermatozoa of white-lipped peccary that have not resisted the cooling process have suffered the effect of thermal shock, since it is known that spermatozoa stored for a long time in the tail of the epididymis are less resistant to semen manipulation and processing Pellestor et al.

Reduction in the quality of cooled spermatozoa is expected, because the process does not interrupt cellular metabolism, it only reduces the mechanical activity of the cells. Spermatozoa consume the nutrients available in the extracellular environment and excrete toxic products through constant production of substances reactive to the oxygen resulting from this metabolism Johnson et al. In addition, sperm viability and cell osmotic resistance are also reduced by increasing the number of abnormal cells in semen Johnson et al.

Therefore, sperm stored for a long time in animals with long sexual rest may show greater sensitivity to the aforementioned factors. Aiming to minimize the effects of thermal shock, a slow curve with a mean cooling rate of approximately 0. The cooling rate and storage container used were different from those described in the literature for cooling swine and collared peccary semen, namely, cooling rate of In spite of that, it was observed that the semen of the two peccaries behaved quite well during cooling when the sperm viability data were compared with the findings by Garcia et al.

Those authors used the cooling protocol for swine in collared peccary, and reported that the spermatozoa of the latter showed sensitivity to cold very similar to that of the first, which is considered one of the most sensitive to the cooling and freezing protocols compared with spermatozoa of other domestic species Watson such as cattle, goats, and canines. The low resistance of sperm to thermal shock observed in some species of wild and domestic mammals and between ejaculates of the same individual is associated with the chemical and molecular composition of the plasma and mitochondrial membranes, especially with the amount of fatty acids and phospholipids and of seminal plasma Holt et al.

Regarding swine spermatozoa, this sensitivity is closely associated with the cholesterol:phospholipid ratio 0. This characteristic predisposes spermatozoa to several modifications: changes in membrane fluidity and selective permeability, and it can lead to cell death when semen is chilled Leeuw et al.

No reports on the composition of semen plasma and plasma membrane of white-lipped peccary spermatozoa have been found in the literature. During the STT, a sharp decline was observed in the sperm motility parameters of white-lipped peccary 2 - an individual that presented better parameters of sperm quality after cooling and had better viability results regardless of the extender tested. The sperms of white-lipped peccary 1 showed greater resistance in the STT and were longer lived regardless of the extenders used, although when conditioned with the BTS extender - a medium containing glucose, sodium citrate, sodium bicarbonate, potassium chloride, EDTA and streptomycin, there was no sharp decrease in the kinetic parameters of spermatozoa, as observed in samples diluted in ACP extenders.

Sperms of the white-lipped peccary of the present research showed motility results after STT higher than those of swine in the study by Mendez et al. The authors are grateful to Dr. Altrichter M. Range-wide declines of a key Neotropical ecosystem architect, the Near Threatened white-lipped peccary Tayassu pecari. Oryx 46 1 Alvarez J. Spontaneous lipid peroxidation in rabbit epididymal spermatozoa: its effect on sperm motility. Azevedo F.

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Decline of peccaries in a protected subtropical forest of Brazil: toward conservation issues. Mammalia 72 2 Barros T. Beck H. Biondo C. Population genetic structure and dispersal in the white-lipped peccaries Tayassu pecari from the Brazilian Pantanal. Campos L. Estimating the binding ability of collared peccary Pecari tajacu Linnaeus, sperm using heterologous substrates.

Theriogenology Castelo T. Effect of centrifugation and sugar supplementation on the semen cryopreservation of captive collared peccaries Tayassu tajacu. Cryobiology 61 3 CBRA Cummins J. Molecular biology of the human male infertility: links with aging, mitochondrial genetics and oxidative stress. Effect of different storage temperatures on the metabolic activity of spermatozoa following liquid storage of boar semen. Feed Sci. Figueira M.

Revta Bras. Flores E. The degree of resistance to freezing thawing is related to specific changes in the structures of motile sperm subpopulations and mitochondrial activity in boar spermatozoa. Theriogenology 72 6 Fragoso J. A long-term study of white-lipped pecacary Tayassu pecari population fluctuations in northern Amazonia, p. In: Silvius K. Galetti M. Priority areas for the conservation of Atlantic forest large mammals.

Garcia A. Garcia R. Different extenders solutions for tambaqui semen cooling. Halang W. Acta 2 Harrison R. Use of fluorescent probes to assess membrane integrity in mammalian spermatozoa. Holt W. Basic aspects of frozen storage of semen. The significance of cooling rates and animal variability for boar sperm cryopreservation: Insights from the cryomicroscope. Theriogenology 63 2 Hrudka F. Cytochemical and ultracytochemical demonstration of cytochrome C oxidase in spermatozoa and dynamics of its changes accompanying ageing or induced by stress.

Jeyendran R. The bills are currently in the Senate and House Health Policy committees. It was well attended by practicing physicians and by leadership from many of the Specialty boards. In , reporting on MOC was still required, but incentive payments were no longer included. However, because hospitals and payers want a way to show that their physicians are high quality, this is one surrogate they use. We will need the unified physician voice to make a change in the deeply entrenched powers that want to maintain the MOC status quo.

This ACP model provides an evidence-based process with a standardized approach to conversations with patients and their families about end of life care. Final Steps: Discussions with frail, elderly or when a patient may die within next 12 months. As these documents are completed, they will be uploaded to a statewide registry. While community volunteers, clergy and others can participate in First Steps, medical professionals are needed for the Final Steps. Medicare will begin to reimburse for time spent counseling patients on end of life care beginning in Some of the components that make this program successful are the community approach, the availability of information as standard practice and education of healthcare professionals.

Other components include the careful scripting of the conversations and the training of physician and other non-physician advance care planning facilitators. Other states have used their state medical societies to promote ACP programs. More information will be forthcoming! Was this lawsuit filed by the government or a private party? Can you explain what this lawsuit alleged specifically regarding antitrust law violations? I assume the case was either unsuccessful or has not been decided because if MOC was illegal we would not still talking about it.

Can you update us on this? Neither the Federal Trade Commission nor the U. Department of Justice are involved in the case nor is any state antitrust enforcement agency. The other entities include health plan administrators, health insurers, hospitals and other health facilities. The Complaint further alleges that ABMS is acting in concert with The Joint Commission so that the more than 20, healthcare organizations and hospitals accredited by The Joint Commission will require MOC compliance by those physicians on their medical staffs as a condition of renewal of their privileges.

The procedural history of this case is a bit out of the ordinary. The Complaint was filed on April 23, AMBS moved to dismiss the case in May of This motion to dismiss was fully briefed as of July of but the court Federal District Court for the Northern District of Illinois has not yet ruled. MSM legal counsel will continue to monitor the case and report on developments when they occur. He uses a cinnamon flavor. But suddenly, the questions about e-cigarettes that have come to me as matters of policy became quite personal.

Do I think that use of an e-cigarette is healthier than that of a traditional cigarette? Can I say that the use of an e-cigarette is healthy? What do we know about e-cigarettes effects on others exposed to the vapor? What is known is that use of tobacco products are the source of morbidity preventable deaths in the US and across the globe. In fact, e-cigarettes are marketed as smoking cessation devices or alternatives to traditional cigarettes. In FDA issued a proposed rule that will extend its authority to cover additional tobacco products such as e-cigarettes.

Studies such as those are vital to informing public health and healthcare providers about the health effects of aerosolized substances comprising flavored nicotine liquids, and whether use of e-cigarettes definitively decreases the use of traditional cigarettes. Bartter T. Electronic Cigarettes: Aggregate Harm. Annals of Internal Med. Department of Health and Human Services. Atlanta: U. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report ;63 47 — Am J Prev Med 46 4 — Adults, Accessed November 23, MMWR ; 64 14 ; US Federal Drug Administration.

The emergence of e-cigarettes: a triumph of wishful thinking over science [Editorial]. Ann Am Thorac Soc. Electronic nicotine delivery systems: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. The American Academy of Pediatrics. Michigan Department of Health and Humans Services.

Lauren M. JAMA Pediatr. Centers of Disease Control and Prevention. Drummond MB.

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It prevents physicians from providing the highest level of care for their patients. What recourse do physicians have to express their concerns?

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However, physicians want assurances that they are investing in the right EHR systems that will help them improve patient care in an efficient and thoughtful manner. Although initial MU incentives have helped to spur adoption, more than 80 percent of physicians have EHRs in their practices, only 12 percent of physicians have been able to successfully participate in Stage 2 of MU.

This statistic highlights the need to adopt policies that help physicians embrace new technology while eliminating regulations that hold back progress. Over the past several years, physicians have been bringing to the forefront problems with the program and asking for remedies that would support physicians in providing the best care possible for patients.

These remedies need to include the development of innovative EHR technologies that meet the needs of physicians and their practices and that advance the sharing of patient data among the professionals who are providing their care. It includes a website BreaktheRedTape. The premise is that forcing physicians to adopt costly and complicated EHRs on an unrealistic timeline entangles both patients and physicians in problematic red tape. This is actually false.

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Surveys show that physicians and care teams actually embrace new technology that helps to prevent disease, and diagnose and treat patients. Most physicians use tablets, personal and desktop computers and smart phones to streamline their day-to-day work. The complaint tool is designed to ensure your issue or concern gets to the appropriate person at the ONC or other department within the federal government. As challenges and changes arise, physicians are encouraged to contact their vendor as a first step towards resolving any issues. If your issue is related to the products certified capabilities, then you should contact the ONC — Authorized Certification Bodies, who should be able to work with you to find a resolution.

If the issue remains unresolved, submit your complaint to the ONC via the online complaint form. Keep in mind that logging your complaint may not resolve your complaint, but will allow for further conversation between you, your vendor, and the ONC to address the issue and make changes. For more information or to view the complaint form, visit HealthIT. MSMS and organized medicine ongoing activity MSMS, along with the AMA and over other medical societies, recently sent a joint letter to Congressional leaders asking Congress to take immediate action to refocus the Meaningful Use MU program on the goal of achieving a truly interoperable system of electronic health records.

Below are some excerpts from the letter highlighting the importance of program redesign, realistic and appropriate expectations, and evolving technology that truly provides the information sharing and tools necessary to improve patient care. During these meetings, resolutions are one of the vehicles used to debate and determine the policies, priorities, and direction of MSMS and the AMA during the ensuing 12 months and beyond.

The best way to get your idea or recommendation adopted as a Society policy or directive is at the grassroots level.

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To do so, present your suggestion and rationale at your county medical society meeting. If the county agrees, the county will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired Society policy or directive for Society action. If the county does not agree with your idea, you can ask another delegate to submit a resolution on your behalf as an individual delegate.

Email your members of Congress. Share your story. Join your peers in telling your story about how meaningful use regulations are affecting your patient-physician relationships. Conversations About Maintenance of Certification Maintenance of Certification brings up one consistent question among Michigan physicians: Why? Why are we paying thousands of dollars to bring zero value to our patients? Why are we subjected to redundant, non-specialized modules and procedures? Why is MOC continuing to be regulated? In this issue of Michigan Medicine, we talk to three physicians about their frustrations with MOC and how this bureaucratic requirement is affecting their practice and patients.

Patients and Physicians in Michigan have a Right 2 Care Michigan Patients have a right to high quality health care from a physician of their choice. Michigan Physicians have a right and a responsibility to deliver high quality care to their patients. Physicians already maintain education requirements to keep their licenses to practice medicine and have the right to deliver high quality health care to their patients, but:.

What is Maintenance of Certification? The costs of this testing and training are paid by each physician, and are necessary to allow them to practice in Michigan. Defending Michigan Patients Right 2 Care. Patients deserve access to high quality health care. If a patient has irregular menses but no apparent signs of androgen excess, internists still should order tests to try to detect elevated androgen levels.

Azziz recommends ordering high-quality radioimmunoassay and column chromatography, or mass spectrometry, to measure total testosterone. To get free testosterone levels, he advises ordering an equilibrium dialysis or competitive binding test. So are women with hypertriglyceridemia and low HDLs, even if they have no physical signs, she said. In more than half of PCOS cases, the women are obese, which can lead physicians to over- and under-treat patients based on their weight, experts said. Thin or average-weight women may be overlooked, for example, because doctors expect PCOS patients to be obese.

Conversely, physicians who aren't clued in to PCOS may see an obese person and immediately focus their efforts on helping the patient lose weight, rather than digging deeper for a potential cause or consequence of the obesity. Researchers still aren't sure about the causal direction between PCOS and obesity, though most suspect the disease usually comes first. Another issue: It can be difficult to diagnose PCOS in a woman after age 40, because her ovaries shrink and her periods become more regular as she ages, said Corrine Welt, MD, an endocrinologist and assistant professor of medicine at Harvard Medical School in Boston.

Welt said. In order to confirm the diagnosis of PCOS, doctors need to rule out a host of other possibilities. For anovulation, the alternative diagnoses include thyroid dysfunction, prolactin excess and late-onset congenital adrenal hyperplasia. If there are signs of virilization, physicians should consider an androgen-secreting tumor; Cushing's Disease should be ruled out as well, said Richard Legro, MD, professor of obstetrics and gynecology at Penn State University in State College, Pa.

Legro said. The main treatment for women with PCOS is weight loss for those who are overweight and obese, and reducing the degree of insulin resistance, usually with metformin, Dr. Legato said. Some physicians tend to prescribe metformin to every single patient who is diagnosed with PCOS, which is not a responsible use of the drug, Dr.

In fact, the majority of patients will require combination therapy of some sort, including lifestyle changes and cosmetic treatments for appearance. It's particularly helpful for patients who want to reduce their long-term risk of glucose intolerance, but it is not a weight loss medication. Internists will treat most patients for complaints like excess hair growth, irregular periods or obesity, as well, Dr. Treating hirsutism usually requires a combination of hormonal suppression using either birth control pills or metformin plus an antiandrogen like spironolactone or flutamide or finasteride, he added.

If glucose and lipid levels appear normal, they should be re-tested every year and five years, respectively.

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    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)
    ACP Medicine, 2006 Edition (Two Volume Set) ACP Medicine, 2006 Edition (Two Volume Set)

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