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You have probably heard the facts before - driving while impaired or intoxicated is a serious traffic safety problem in the United States. In New York State, more than 40 percent of all highway deaths involve impaired driving. But the facts and statistics do not tell the whole story. Behind the numbers are thousands of lives cut short, permanent or disabling injuries, and families devastated because someone drove while under the influence of alcohol or other drugs.
Several nonopioid pharmacologic therapies (including acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants) are effective for chronic pain. In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain. Selected anticonvulsants such as pregabalin and gabapentin can improve pain in diabetic neuropathy and post-herpetic neuralgia (contextual evidence review). Pregabalin, gabapentin, and carbamazepine are FDA-approved for treatment of certain neuropathic pain conditions, and pregabalin is FDA approved for fibromyalgia management. In patients with or without depression, tricyclic antidepressants and SNRIs provide effective analgesia for neuropathic pain conditions including diabetic neuropathy and post-herpetic neuralgia, often at lower dosages and with a shorter time to onset of effect than for treatment of depression (see contextual evidence review). Tricyclics and SNRIs can also relieve fibromyalgia symptoms. The SNRI duloxetine is FDA-approved for the treatment of diabetic neuropathy and fibromyalgia. Because patients with chronic pain often suffer from concurrent depression (144), and depression can exacerbate physical symptoms including pain (177), patients with co-occurring pain and depression are especially likely to benefit from antidepressant medication (see Recommendation 8). Nonopioid pharmacologic therapies are not generally associated with substance use disorder, and the numbers of fatal overdoses associated with nonopioid medications are a fraction of those associated with opioid medications (contextual evidence review). For example, acetaminophen, NSAIDs, and opioid pain medication were involved in 881, 228, and 16,651 pharmaceutical overdose deaths in the United States in 2010 (178). However, nonopioid pharmacologic therapies are associated with certain risks, particularly in older patients, pregnant patients, and patients with certain co-morbidities such as cardiovascular, renal, gastrointestinal, and liver disease (see contextual evidence review). For example, acetaminophen can be hepatotoxic at dosages of > 3-4 grams/day and at lower dosages in patients with chronic alcohol use or liver disease (109). NSAID use has been associated with gastritis, peptic ulcer disease, cardiovascular events (111,112), and fluid retention, and most NSAIDs (choline magnesium trilisate and selective COX-2 inhibitors are exceptions) interfere with platelet aggregation (179). Clinicians should review FDA-approved labeling including boxed warnings before initiating treatment with any pharmacologic therapy.
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This publication is designed to help growers make these calculations and conversions and to provide other data useful in the management, planning and operation of horticultural enterprises. A number of formulas for calculating fertilizer application rates on a parts-per-million basis are given. Tables for fertilizer injector calibration using a conductivity meter, as well as pre-plant application rates for various soil mix components and amendments, also are provided. A brief explanation of how each table is used is provided.
As stated in Chapter 1, the translation of human energyrequirements into recommended intakes of food and the assessment of how well theavailable food supplies or diets of populations (or even of individuals) satisfythese requirements require knowledge of the amounts of available energy inindividual foods. Determining the energy content of foods depends on thefollowing: 1) the components of food that provide energy (protein, fat,carbohydrate, alcohol, polyols, organic acids and novel compounds) should bedetermined by appropriate analytical methods; 2) the quantity of each individualcomponent must be converted to food energy using a generally accepted factorthat expresses the amount of available energy per unit of weight; and 3) thefood energies of all components must be added together to represent thenutritional energy value of the food for humans. The energy conversion factorsand the models currently used assume that each component of a food has an energyfactor that is fixed and that does not vary according to the proportions ofother components in the food or diet.
The total combustible energy content (or theoretical maximumenergy content) of a food can be measured using bomb calorimetry. Not allcombustible energy is available to the human for maintaining energy balance(constant weight) and meeting the needs of growth, pregnancy and lactation.First, foods are not completely digested and absorbed, and consequently foodenergy is lost in the faeces. The degree of incomplete absorption is a functionof the food itself (its matrix and the amounts and types of protein, fat andcarbohydrate), how the food has been prepared, and - in some instances (e.g.infancy, illness) - the physiological state of the individual consuming thefood. Second, compounds derived from incomplete catabolism of protein are lostin the urine. Third, the capture of energy (conversion to adenosine triphosphate[ATP]) from food is less than completely efficient in intermediary metabolism(Flatt and Tremblay, 1997). Conceptually, food energy conversion factors shouldreflect the amount of energy in food components (protein, fat, carbohydrate,alcohol, novel compounds, polyols and organic acids) that can ultimately beutilized by the human organism, thereby representing the input factor in theenergy balance equation.
Just as a large number of analytical methods for food analysishave been developed since the late nineteenth century, so have a variety ofdifferent energy conversion factors for foods. In general, three systems are inuse: the Atwater general factor system; a more extensive general factor system;and an Atwater specific factor system. It is important to note that all of thesesystems relate conceptually to (ME) as defined in the previous section. Ageneral factor system based on NME has been proposed by Livesey (2001) as analternative to these systems.
The differences of importance between ME and NME factors arefound primarily in estimating the energy content of protein, fermentable,unavailable carbohydrate, and alcohol (Table 3.3). The NME factor for protein is13 kJ/g (3.2 kcal/g) versus the Atwater general factor of 17 kJ/g (4.0 kcal/g).Use of the NME rather than the Atwater general factor results in a 24 percentdecrease in energy from protein. The recommended ME factor for dietary fibre inordinary diets is 8 kJ/g (2.0 kcal/g); the corresponding NME value is 6 kJ/g(1.4 kcal/g) - a decrease of 25 percent. Values for fermentable fibre arebelieved to vary by 27 percent, i.e. ME 11 kJ/g (2.6 kcal/g) and NME 8 kJ/g (2.0kcal/g). Finally, the values for alcohol are 29 kJ/g (7.0 kcal/g) for ME, and 26kJ/g (6.3 kcal/g) for NME - a difference of 10 percent. The lower NME values fordietary fibre are due to a higher assumed loss of energy through heat offermentation, while those for alcohol seem to be due to thermogenesis followingalcohol consumption. The discrepancy between energy values calculated using MEand those using NME conversion factors will be greatest for diets that are highin protein and dietary fibre, as well as for some novel foodcomponents. 2ff7e9595c
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