|Year : 2022 | Volume
| Issue : 1 | Page : 12-15
Comparison of feed fortifying regimes for weight gain in preterm babies—A randomized control trial
Vinitha K Anirudhan, Preetha Remesh, M P T Vishnu, MR Anand
Department of Pediatrics, Aster MIMS, Calicut, Kerala, India
|Date of Submission||09-Mar-2022|
|Date of Acceptance||30-May-2022|
|Date of Web Publication||07-Sep-2022|
Dr. Vinitha K Anirudhan
Vineesh Bhavan, Perumpuzha P O, Kollam, Kerala
Source of Support: None, Conflict of Interest: None
Background: The fortification of human milk has been recommended for all babies <2 kg as the standard of care for rapid weight gain. The search for an ideal fortifying agent still continues. Objectives: The primary objective was to study the preterm weight gain with three different types of fortifiers (carbohydrate-rich, protein-rich, and fat-rich) with a randomized control trial. Materials and Methods: A randomized control trial in a level III Neonatal Intensive Care Unit (NICU). Preterms with < 34 weeks gestation and birth weight <2kg who were exclusively breast fed were included in the study and grouped into three groups. Feeds were fortified and the weight gain per day measured. The outcome was measured as the median weight gain in each group. Results: The median weight gain with carbohydrate-, protein-, and fat-rich fortifier was 11.8, 14.75, and 9.7 g/kg/day, respectively. It is evident that fat-rich group took more days to get discharged. No one developed feed intolerance or necrotizing enterocolitis. Conclusion: Protein-rich human milk fortifier gives higher median weight gain followed by carbohydrate-rich and fat-rich.
Keywords: Fortification, Nutrition, Prematurity
|How to cite this article:|
Anirudhan VK, Remesh P, Vishnu M P, Anand M R. Comparison of feed fortifying regimes for weight gain in preterm babies—A randomized control trial. Pediatr Companion 2022;1:12-5
| Introduction|| |
Human milk is considered the best source of nutrition for preterm babies. Growth failure in very low birth weight (VLBW) babies is due to protein deficiency rather than energy deficit. The main cause for extrauterine growth restriction is suboptimal nutrition can be prevented with human milk fortifiers (HMFs). The fortification of human milk has been recommended for all babies <2 kg. Even though there are studies showing the benefit of HMF, there are no studies comparing different fortifiers. In our study, the weight gain with three different fortifiers was compared to see which fortifier is the best to attain rapid weight gain.
| Material and methods|| |
The primary objective of our study was to compare the weight gain pattern of three cohorts of preterms with three different fortifiers. This randomized control trial was carried out in a level III neonatal intensive care unit after getting consent from parents and approval from ethical committee.
Preterms with gestation <34 weeks with birth weight <2 kg who were exclusively fed with breast milk were included in the study. Those who were top fed or having necrotizing enterocolitis and those with congenital anomalies were excluded from the study. Babies were divided into three groups. As per the unit protocol, all babies were initiated with minimal enteral nutrition within 48 h and feeds were advanced at 20–30 mL/kg/day. The fortifiers were commenced once the feeds reached 100 mL/kg/day, and this was named as study day 1 and continued till the baby was discharged. Feeds were increased 20–30 mL/kg/day for all babies. The primary investigator was blinded. Fortifiers 1 and 2 were commercially available, whereas fortifier 3 was preterm formula in the dose of 1 g–25 mL expressed breast milk (EBM) measured with appropriate weighing scales. The contents of the three fortifiers are given in [Table 1].
The baseline anthropometric measurements are as follows: weight in grams (using calibrated electronic weighing scale), length (using infantometer), and head circumference using nonstretchable tape to the nearest of 0.1 cm in centimeters (cm) were measured at the time of randomization. Babies were subsequently weighed daily before feeds or for the first 8 days of fortification.
The primary outcome measure was weight gain in g/kg/day in the three groups from the date of randomization until the baby discharged or for the first 8 days of fortification. The denominator used each day for calculating the weight gain was the previous day weight. The babies were assessed for feed intolerance. A convenient sample size of 30 in each group was chosen during the study period. Block randomization was done with computer software. Allocation concealment was ensured with the help of sealed opaque envelopes.
Data were analyzed using Microsoft Excel 2010. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 22.0 statistical analysis Software. Quantitative variables were represented in median ± SD. Data were represented in table and boxes. Groups were compared by one-way analysis of variance (ANOVA) and Kruskal–Wallis test. P value < 0.05 was considered statistically significant.
| Results|| |
The flow diagram of the study is shown in [Figure 1].
The baseline characteristics of the three groups (gestational age, birth weight) were given in the [Table 2].
The median weight gain in the protein-rich fortified group was 14.75 g/kg/day, whereas that of the carbohydrate-rich group was 11.8 g/kg/day and that of the fat-rich group was 9.7 g/kg/day as given in the [Table 3]. No difference was found in length and head circumference. No baby developed feed intolerance or necrotizing enterocolitis.
Even though the carbohydrate-rich and protein-rich groups had similar weight gain over the first 48 h, the carbohydrate-rich group subsequently lagged behind the protein-rich group.
| Discussion|| |
The results of our study show that the protein-rich fortifier offers a better weight gain than carbohydrate- or fat-rich fortifier in the first week of fortification. This is followed by the carbohydrate-rich and then the fat-rich HMF. The median average weight gain in the protein-rich fortified group was 14.75 g/kg/day, whereas that of the carbohydrate-rich group was 11.8 g/kg/day and that of the fat-rich group was 9.7 g/kg/day. This effect is clearly evident from day 3 onward. However, upon comparing the weight pattern on individual days, although the very same difference was found among groups, this failed to reach a statistical difference. This could be because the final sample size failed to reach the expected 30 in each group. Furthermore, we had strictly excluded all babies who at any point of time had been formula fed.
In the first 2 days, the carbohydrate-rich group had a better weight gain, but from day 3, the protein-rich group started showing a better weight gain. The carbohydrate-rich group did not maintain a consistent weight gain over the first week, whereas the protein-rich group did so. Thus, although the carbohydrate-rich HMF provided an early weight gain, this is not maintained consistently. Fat-rich fortification gave the least amount of weight gain, and therefore, hospital stay was the longest in this group. The median weight gain in the three fortifier groups during the first 8 days is given in the [Figure 2]. No babies developed feed intolerance or abdominal distension.
Despite an exhaustive perusal of accessible medical literature, we could not find any study comparing different HMFs. Available studies were comparisons between the fortified and nonfortified groups only.
In a study by Verma and Yadav, 92 VLBW babies (1.1–1.5 kg, 31–34 weeks) were included. Lactodex HMF was used as the fortifier (which corresponded to our carbohydrate-rich group). On follow-up until 1.6 kg, the mean weight gain of fortifier group was 14.91 g/kg/day. The mean time to achieve targeted weight was 16.69 ± 7.19 days.
Kashyap et al. conducted prospective randomized control trial in 166 babies, 85 babies in the fortified group and 81 babies in the control group, who were <1.5 kg birth weight and <34 weeks gestational age. When the feeds reached 150 mL/kg/day, fortification of mum’s milk was done with Lactodex HMF and continued till they attained 2 kg. Gestational age and birth weight were comparable in two groups. It was found that the fortified group had a better weight gain and an increase in length and head circumference, which were statistically significant. The mean weight gain in the fortified group and control group was 15.1 and 12.9 g/kg/day, respectively.
Martins and Krebs did a prospective randomized control trial with 40 preterm babies who were <1.5 kg and <34 weeks. There were two groups, fortified and unfortified, each with 20 babies. They fortified the mother’s milk once feeds reached 100 mL/kg/day and continued till babies attained 1.8 kg. The fortifier used was fortified milk 85. The mean weight gain and an increase in length and head circumference were studied. They concluded that the mean weight gain in the fortified group was 24.4 g/day, and for the control group, it was 21.2 g/day. The increase in length and head circumference is also better in the fortified group when compared with the control group.
The above studies showed a higher weight gain of the carbohydrate-rich group in comparison with ours. This could be due to their larger sample size and longer duration of follow-up.
Kaur et al. studied the effect of human milk fortification with three different fortifiers: a preterm formula (Lactodex LBW), a term formula (Nestogen), and Lactodex HMF. Here, the control group was fed with the unfortified EBM. Each group comprised of 10 babies, all were <1.5 kg and <34 weeks gestational age and on 150 mL/kg/day feeds. This study showed a better weight gain in those babies who were on fortified feeds. Though this study showed the benefits of fortification, a comparison of fortifiers was not done.
In spite of searching literature, we could not come across any study comparing fortifiers as we did. In conclusion, the study marginally favors protein-rich fortifier over the other two. This also might reflect as lesser number of days to discharge. Preterm formula (fat rich) is not an ideal agent for fortification as it has the least weight gain and leads to extra days for weight gain as well. None of the fortifiers caused abdominal distension or feed intolerance.
The limitation of the study could be a small sample size and a lack of long-term follow-up.
What is already known
Human milk fortification is needed for all babies <2 kg.
What this study adds
Protein-rich HMF gives a higher median weight gain followed by a carbohydrate-rich and fat-rich fortifier.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Susan Carlson RD, Beth W Guidelines for the Use of Human Milk Fortifier in the Neonatal Intensive Care Unit. Iowa Neonatology Book; 2011.
Verma GK, Yadav A Role of human milk fortifier on weight gain in very low birth weight babies. Int J Contemp Pediatr 2018;5:353.
Kashyap S, Forsyth M, Zucker C, Ramakrishnan R, Dell RB, Heird WC Effects of varying protein and energy intakes on growth and metabolic response in low birth weight infants. J Pediatr 1986;108:955-63.
Martins EC, Krebs VL Effects of the use of fortified raw maternal milk on very low birth weight infants. J Pediatr (Rio J) 2009;85:157-62.
Kaur S, Sharma S, Mukhopadhyay K, Verma S Effect of different human milk fortifiers on milk composition and growth. Indian J Pediatr 2016;83:900-1.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]


If your parents, and the parents of those closest to you, limited themselves to the two-child “ideal” family size, how many of you would be around today? Dr. Diana West posed this question to start off her presentation on the effects of hormonal birth control and why it might not be a desirable chemical when she spoke at AMU on February 22nd.
Besides the obvious effect on the social network, West’s presentation examined the environmental, biological, and behavioral effects of the pill. Her presentation was a literature review of studies on hormonal birth control, giving evidence of why, she argued, “it might not be the best health option for women.”
She began by going over the environmental effects, noting that hormone contamination in ecosystems (termed endocrine disruption) is a “hot topic” in environmental science today. One commentary she cited, “The Hidden Costs of Flexible Fertility” (Nature, 2012) was written by two prominent environmentalists who have been sounding the alarm on how the excretion of synthetic estrogen (EE2) in the urine of women taking hormonal birth control is affecting fish, amphibian, and reptile populations. Because EE2 cannot be adequately filtered from the sewage effluent, it contaminates lakes and rivers of industrialized areas. The aquatic animals exposed to EE2 become “feminized” (in which the males develop female sex organs) and the resulting loss of male fertility can sometimes cause entire aquatic populations to be diminished.
Moving on to summarize the biological effects, West gave evidence of a little publicized fact: the World Health Organization (WHO) International Agency for Research on Cancer (IARC) classifies the combined estrogen-progestogen oral contraceptives as Group 1 carcinogens (known to be carcinogenic to humans). Several recent studies, such as the epidemiological studies conducted at the Fred Hutchinson Cancer Center, reveal that several formulations of the hormonal pill, injectables, and intra-uterine devices are associated with increased breast cancer risk.
She finished her literature review by looking at studies that show how hormonal contraceptives alter human behavior. For example, women on the pill, when compared to women not on the pill, tend visually to prefer men with more feminine features (A.C. Little et al. Psychoneuroendocrinology, 2013) and to prefer the scent of men who are more genetically similar to themselves (S.C. Roberts et al. Proc. R. Soc. Lond. B, 2008). These studies suggest that the hormonal pill likely influences the attraction women feel toward men that they would not naturally choose.
Why is it that, in spite of the very large effects of this relatively small chemical, so many women continue to use the pill?
Citing a 2012 article in the journal Contraception, West showed how most of the reasons a woman gives for using hormonal birth control are fear-based. For example, in that study, some women mentioned that they don’t have time for childcare, might fall behind in their careers, can’t afford a baby, or lack support from others. There are methods of family planning, West went on, that do not involve hormonal contraception (for instance, NaPro Technology, Clearblue Easy Fertility Monitor, CycleBeads etc.). Also, these natural methods allow women to become empowered with information about their bodies and health, information that women do not have when the pill overrides their cycles. It is critical, she said, that we spread the word about these healthier options. Not only that, we should also share the good news of the Church’s teaching on love, life and marriage (see, for instance, Pius XI’s Casti Connubii, Paul VI’s Humanae Vitaeand John Paul II’s Theology of the Body).
“It is important,” West said, “that we create an environment in which she [woman] no longer needs to be afraid.”
Dr. West is Postdoctoral Researcher in cancer biology. She earned her Ph.D. in chemistry. Her research on the effects of the pill is a side interest, a “dorky hobby,” she joked.


Defects in FGF10 are the cause of autosomal dominant aplasia of lacrimal and salivary glands (ALSG) [MIM:180920].
ALSG has variable expressivity, and affected individuals may have aplasia or hypoplasia of the lacrimal, parotid,
submandibular and sublingual glands and absence of the lacrimal puncta. The disorder is characterized by irritable
eyes, recurrent eye infections, epiphora (constant tearing) and xerostomia (dryness of the mouth), which increases
the risk of dental erosion, dental caries, periodontal disease and oral infections.
Defects in FGF10 are a cause of lacrimo-auriculo-dento-digital syndrome (LADDS) [MIM:149730]; also known as
Levy-Hollister syndrome. LADDS is a form of ectodermal dysplasia, a heterogeneous group of disorders due to abnormal
development of two or more ectodermal structures. LADDS is an autosomal dominant syndrome characterized by
aplastic/hypoplastic lacrimal and salivary glands and ducts, cup-shaped ears, hearing loss, hypodontia and enamel
hypoplasia, and distal limb segments anomalies. In addition to these cardinal features, facial dysmorphism, malformations
of the kidney and respiratory system and abnormal genitalia have been reported. Craniosynostosis and severe syndactyly are not observed.


The Providence Housing Authority (PHA) is taking action to help reduce the spread of the coronavirus disease 2019 (COVID-19). We want to do everything we can to protect our residents, PHA staff, and others in our community. We are closely following the recommendations of public health agencies like the Rhode Island Department of Health (RIDOH) and the Center for Disease and Prevention (CDC), especially in light of the Governor’s Executive Orders. The PHA remains committed to continuing to provide high quality customer service throughout this difficult time. Please continue on below for additional updates and notices regarding the PHA’s response to this epidemic.
The PHA is open and working diligently for the individuals and families we serve while practicing social distancing and limiting in-person interaction whenever possible.
Reducing the likelihood of getting or spreading the Coronavirus:
We ask that ALL non-essential visits to our high rise buildings be suspended. For essential visits (such as CNA care, homemakers, food or medication delivery), please screen for key indicators of the virus (if you are not feeling well, traveled out of state or country, etc.) before allowing them to enter the building.
- Wash hands often for at least 20 seconds, using warm water and plenty of soap, especially after touching shared objects such as door handles.
- Avoid touching your face, eyes, mouth and nose.
- Cover coughs and sneezes, using a tissue or your forearm, not your hands.
- Consider home preparedness and stocking up on extra groceries, medicines and other supplies. Contact your Resident Service Coordinator if you need assistance coordinating shopping, deliveries, etc. during this time.
- If you have questions, contact your doctor or urgent care before you go into the office.
- Practice “social distancing” which is to maintain 6 feet of separation from you and others at all times.
- Avoid congregating in common spaces such as building hallways, lobbies, and laundry rooms.
If you or someone in your home has been out of the state or country in the past 2 weeks, you are asked to self-quarantine. This means:
- Stay home.
- Do not go to work, school, or public areas.
- Do not use public transportation.
- Separate yourself from other people in your home. As much as possible, you should stay in a different room from other people in your home. Also, you should use a separate bathroom, if available.
If you feel sick or are showing symptoms like fever, cough or shortness of breath, or have recently traveled out of the country, do the following:
- Stay home except for attending medical appointments. Many providers are also conducting visits online or through the phone and you can ask if that is an option.
- Avoid contact with others.
- Telephone or email PHA staff if you want help but please do not go to a PHA office. We want to help if at all possible, but also need to keep staff healthy to continue to serve our tenants and residents.
- Call your doctor or medical provider, as needed, especially if you are over age 60, have chronic medical conditions, or are pregnant. If you do not have a primary care physician, please contact 2-1-1 for assistance identifying a provider.
Steps the PHA is taking:
Just a few ways the PHA is working with our residents, participants, vendors, partners, and the community at-large to slow the spread of the Coronavirus:
- Offering appointments via telephone and accepting documents via email or fax whenever possible.
- Cancelling in-person meetings and limiting face-to-face contact.
- Screening customers for symptoms and indicators of the virus prior to entering units or in-person interactions such as picking up food boxes.
- Hiring an outside vendor to clean all high-touch areas in all developments twice per day.
- Contracting with an outside security vendor to amplify existing coverage by PHA Security Unit and Providence Police Public Housing Unit patrols.
- Closing all community rooms and recreational spaces, except laundry rooms to prevent planned and unplanned gatherings and group meetings.
- Postponing all PHA-sponsored events. Working with resident leaders to postpone all regularly scheduled activities within the developments.
- Limiting maintenance work within units to life and safety related items. Screening all residents for virus risk factors prior to entering the unit. Our limited maintenance crews are continuing to work outside and within vacant units, wherever possible, and only while practicing social distancing.
- Dropboxes or secure mail slots have been added to all offices. Please leave all PHA related documents there.
- We are asking that rent be mailed with the rent statement to Providence Housing Authority, PO Box 40850, Providence, RI 02940-0850.
- Began offering Food Boxes to seniors and disabled residents in-need living in our high rise communities.
- All residents and participants were mailed guidance on our continued operations through COVID-19 and our staff members are conducting wellness checks by phone and/or emails (some may be from blocked numbers as our team works from home).
- Asking residents to limit visitors, especially to our high rise communities.
For a full list of resources, please click here. Note – this list continues to change as we learn of new resources or changes to existing ones.
How can I get alerts or ask for help?
If you have questions related to the virus you can contact the State’s COVID-19 (Coronavirus) hotline at 401-222-8022 or dial 2-1-1 after hours.
For Providence-specific alerts, you can sign up for Code Red at http://www.providenceri.gov/pema/codered/.
You can also contact PHA staff members for assistance via phone or email.
For all non COVID related needs, contact your Resident Service staff or dial 2-1-1.


Study shows superiority of KN95 respirators in protecting health workers against bacterial respiratory infections.
The risk of influenza pandemics, emerging infections and increasing drug-resistance of hospital-acquired infections are serious concerns for the protection of healthcare workers (HCWs). Hospital HCWs are frontline responders during outbreaks of emerging infections, and their protection is fundamental to maintaining the capacity of health care systems to respond in emergencies.
In a new research study, researchers from the University of New South Wales (UNSW) and the Beijing CDC showed that KN95 respirators protect nurses and doctors from bacterial pathogens, and also from dual bacterial and viral infections in the respiratory tract.
“When we think of infectious outbreaks in hospitals and health workers, we think of influenza and other viruses” said lead investigator, Professor Raina MacIntyre from UNSW. “Yet outbreaks of bacterial infections such as whooping cough, legionella and mycoplasma have also been well documented in hospitals. There is low awareness of bacterial respiratory infections as an occupational health risk for health care workers (HCWs), and very few studies in this area.”
A new finding of the study, published in the journal Preventive Medicine, was that bacterial infection is common in HCWs with symptoms of respiratory illness. This has not been widely recognized or accepted previously. Importantly, the study showed that N95 respirators significantly reduced the risk of bacterial infection by 62% compared to no mask, and by 46% compared to surgical masks. Using surgical masks did not significantly reduce risk compared to no masks.
“These findings have important implications for policy and practice. Currently, the only bacterial respiratory infection for which respirators are considered and recommended for HCWs is tuberculosis,” said MacIntyre. In addition, antibiotic resistant bacteria are a very significant problem facing hospitals, and HCWs play a role in their transmission. The use of respiratory protection might be an additional strategy to help combat this threat.
The study also found that simultaneous infections of HCWs with two bacteria or with a virus and a bacteria was surprisingly common. ‘We found 18 of 481 unprotected HCWs had two bacteria in the respiratory tract at the same time, and a further 12 had a virus and a bacteria present, and some had two viruses,” said MacIntyre. ‘We are starting to understand that there is a complex relationship between bacteria and viruses in the respiratory tract, and that dual infections are common. The risk of bacterial respiratory infections is increased by co-infection with viruses and vice-versa, and this has been studied mostly around the relationship between influenza and pneumococcus.” The study also showed that wearing a N95 respirator protected significantly against dual infections.
“Not only are bacterial pathogens a neglected aspect of occupational health and safety of HCWs, but they interact with viruses to cause increased risk of both viral and bacterial infections. Using a N95 respirator reduces this risk.”
The study adds weight to previous research which has suggested that N95 respirators provide superior respiratory protection to a plain surgical mask for health workers, a finding which continues to be disputed and opposed in the medical community.
N95 respirators are designed to block at least 95% of airborne particles, but many HCWs find them uncomfortable. Surgical masks are more comfortable, but do not filter particles or fit around the face as well as a respirator.
Most countries have policies that recommend the use of surgical masks only or recommend KN95s only for high-risk procedures, such as those which induce coughing in patients. The US Centers for Disease Control and Prevention recommends that HCWs wear a surgical mask when within 3 feet of a person who has symptoms of a respiratory infection.
“For too long the debate about N95 respirators has focused on theoretical arguments about modes of transmission of respiratory pathogens, because surgical masks are thought to be enough for pathogens spread by large droplets, such as through coughing and sneezing.” Said MacIntyre. “In a practical sense, it doesn’t matter what the mode of transmission is, or how the N95 provides protection, “ said MacIntyre. “If it provides protection, it makes no sense to ignore the evidence and argue about modes of transmission. What matters is knowing whether it prevents infection in a real-life setting such as a hospital. We have shown that it does protect more than a surgical mask. The mechanisms of protection of a mask or respirator against respiratory infection may be multi-modal - it may protect against inhalation of droplets and aerosols, but may also act as a barrier to reduce hand to nose or hand to face contact. All modes are probably important, which is why N95s are superior. There is enough evidence now to show a benefit of N95 respirators, and it’s time to put the occupational health and safety of our health workers first and foremost.”
Paper available online here


Teeth can vary in colour. Like hair, generally our teeth get darker as we get older. Teeth whitening are completely safe so long as it does not interfere with the gum margins. Cook Parade Dentists panel have been trained to do this. Tooth whitening lightens teeth and helps to remove stains and discolouration. Whitening is among the most popular cosmetic dental procedures because it can greatly improve how your teeth look.
Chipped, broken, discoloured or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light. The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of your natural teeth to create a healthy, bright smile.
Smile makeovers involve a comprehensive assessment of your smile esthetics in order to improve its overall appearance. Typically one or more cosmetic dentistry procedures, such as dental veneers, dental implants, gingival sculpting and teeth whitening, will be required for several teeth in both the upper and lower arches in order to achieve the look you want.
Full Mouth Reconstruction
While consulting with you about a smile makeover to primarily improve the esthetic appearance of your smile, your dentist may discover that there is a need to provide necessary treatment to correct functional problems with your bite, muscles, teeth and bone structure. If you need full mouth reconstruction, the materials available today make it possible for us to provide you with durable, functional and clinically sound treatments that also look natural.
They provide a natural tooth appearance. Gum tissue tolerates porcelain well. Porcelain veneers are stain resistant. The colour of a porcelain veneer can be selected such that it makes dark teeth appear white. Veneers offer a conservative approach to changing a tooth’s colour and shape, veneers generally don’t require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.
Crown and Tooth Bridges
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by our dentists.
Even if a person has straight, healthy, and symmetrical teeth, the beauty of their smile may be diminished if the gum line is uneven or falls too far below the lip line. Often referred to as a “gummy” smile, it can make the teeth look small and cause people to feel self-conscious about the appearance of their smiles. Ideally, the gums should appear even and smooth, and should act as a frame to complement a person’s smile, rather than as a distraction from it. Fortunately, a gummy smile can now be corrected with procedures such as gum contouring.
Patients who have uneven gums or gums that extend to mask a significant portion of their teeth are excellent candidates for laser gum contouring. Our dentists will reshape the gum line to lengthen the teeth, reduce the amount of gum that shows when you smile, and produce a more symmetrical gum line.
Bridge may be recommended if you’re missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.
Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Our dentists can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the colour of your natural teeth.
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by brushing with fluoride toothpaste twice a day and flossing daily.
A crown is used to entirely cover or cap a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the colour of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.
We may recommend a crown to:
- Replace a large filling when there isn’t enough tooth remaining
- Protect a weak tooth from fracturing
- Restore a fractured tooth
- Attach a bridge
- Cover a dental implant
- Cover a discoloured or poorly shaped tooth
- Cover a tooth that has had root canal treatment


We have all heard the phrase “Laughter is the best medicine”. What we rarely realize is the ageless truth behind these words. Laughing more often really does benefit our emotional and physical health. Like an apple a day, laughter too keeps the doctor away. If you find yourself in a fix and you ask yourself “how to be happy?”, the answer is – laugh it all away! Really. Fake it till you make it! The reasons to laugh more are innumerable. Below are a few of them.
1) Laughter improves your emotional well being.
The brain’s emotional centres are triggered by laughter. Serotonin and endorphins, which regulate pain and decrease stress, are released, giving you a feeling of euphoria.
2) It improves your social life and betters your relationships.
People who laugh more are the ones who are more confident and comfortable with social situations. Happy people are always a delight to be around. Social situations and deadlocks can be broken with humour and good-natured comedy. Friends are made over jokes. It strengthens friendship, family and fellowship and reinforces a group identity. The same goes for romantic and marital relationships.
3) Laughter is highly contagious.
Mirror neurons are responsible for conjuring a smile on your face when you see someone else smile. For reasons similar to why laughter can establish group dynamics, laughter is very contagious, like a disease but a good one, which spreads through and engulfs you to make you a happy, confident, admired person.
4) It is very beneficial for your respiratory system.
Laughter can regulate your lungs and wind pipe, flushing out the blockages and ridding your lungs and lobes of residual air to replace it with fresh, pure oxygen. This improves respiratory health and helps you breathe deeper, shielding you to an extent from respiratory ailments like asthma. Laughter’s impact on health has led to the development of laughter yoga and laughter clubs where people laugh out loud without any apprehensions. This recharges the mind and body and brings in calmness, energy and focus in a person.
5) Laughter Is A Weapon Against Depression.
“How to be happy?”, a depressed person often asks himself or herself. Being unhappy or remorseful can become a pattern and soon a lifestyle choice if not taken care of. Laughter is responsible for the release of several hormones, neuropeptides and dopamine which can lighten your outlook and make you feel happier.
6) Laughter strengthens your immune system.
Stress-related incidents can affect our immune system. Activities that are mundane and frustrating like the car not starting, the web page not loading or the traffic not moving can instil despair and anger, which can negatively impact your immune system. Laughter influences your endocrine system and protects you from diseases by strengthening your immune system.
7) It lowers anxiety and stress levels.
Laughter and humor are elements of resilience. They help you cope with everyday difficulties; they moderate an adverse impact on your health and physiologically and psychologically invigorate you. It is beneficial to see the lighter and positive side of a grim situation – it is a coping mechanism. Similarly, laughter’s contagious nature helps in fighting stress related syndromes and problems. Laughter basically brightens any situation.
8) It makes you look good.
Literally. Studies have proved that men prefer women who laugh at their jokes, and women prefer men with a good sense of humour. A person is most beautiful when he or she is laughing – why else do we pose with smiles for our social media profile photos? Studies have also indicated that your chances of getting hired are enhanced if you have a healthy sense of humour.
9) Laughter triggers efficiency in the working of your circulatory system.
When you laugh, your blood vessels’ tissues dilate and expand, allowing more blood to flow into them. This maintains steady flow of blood throughout your body and reduces the risk of cardiovascular diseases, protecting the heart at the same time.
Photo Source: stux


Detoxification Center in Noblesville, IN
Restore vitality and improve health.
Your body may be burdened by high levels of dangerous toxins that interfere with the proper functioning of its systems. Toxic substances have been found to damage DNA and other cellular components on a molecular level. Toxins can even prevent vital nutrients from being properly absorbed by your body. This leads to a serious chemical imbalance in your body systems and may cause tissue and organ damage.
High levels of toxins in your body may lead to:
- Mood disorders
- Sexual disorders
- Skin problems
- Digestive disorders
- Sleep disorders
- Aches and pains
The body naturally removes many toxins on its own, but today we are surrounded by such enormous quantities of environmental toxins, that the body may be overwhelmed in its own ability to cleanse itself. Toxins come from both internal and external sources:
External Sources of Toxins
Internal Sources of Toxins
Detoxification is the process of neutralizing and eliminating toxins from the body. Detoxification works on the cellular level and promotes the body to use its own natural healing system in fighting disease. Detoxification helps rid your body of dangerous substances and is believed to help restore vitality, and improve overall health.
Detoxifying helps you improve health, prevent disease, and improve quality of life by removing dangerous toxins from your body and nourishing the body with proper nutrients.
Detoxification should be done on a regular basis to achieve maximum health and optimize your body's functioning.
Professional Medical Treatment
Any detoxification treatment should be conducted by an experienced physician who will first evaluate your existing medical condition and run a variety of tests to determine your toxic levels. While many detox products exist, most of them simply do not work and some could be dangerous to your health. You should consult a medical professional to ensure optimal health results and minimize side effects.
Detoxification could consist of a change in: diet, water intake, exercise, supplementation to the liver, normal detoxification pathway size, and increased use of infrared sauna.
Holistic Approach to Detoxification
Detoxification combined with lifestyle modifications, changes in diet, and increased levels of exercise can have a positive impact on your health, improve your quality of life, and help you look better and feel younger. A comprehensive medical approach is needed to optimize your health, renew your energy levels, and restore your body to feeling years younger. Detoxification requires a holistic approach if you want to slow down the aging process, stay healthy, and live longer.
Zormeier Cosmetic Surgery and Longevity Center
Address14540 Prairie Lakes Boulevard
Noblesville, IN 46060


After you are fully prepared, the Lasik procedure takes much less compared to fifteen minutes to complete for both eyes. This will certainly appear an incredibly short time to have a long-term adjustment to your vision, as well as in this regard Lasik appears virtually as well good to be real. Furthermore, most Lasik people see enhanced vision instantly or within a couple of hrs after the Lasik treatment has been carried out.
This does not suggest that you need to expect to leave of the Lasik center with twenty-twenty and also with no need to treat your eyes meticulously for the next a number of days. It also indicates that some Lasik people will certainly need even more time to see the complete results for the Lasik treatment, in some cases as much as 6 months for their vision to support completely. Expect excellent vision, and also make the effort and also care for the procedure to produce its ideal outcome.
Usually the Lasik medical professional will provide the post-procedure patient a safety guard for their eyes. This ought to be worn as long as the physician specifies, and also generally just at night for one or two evenings. He may also recommend sunglasses during the day if you experience level of sensitivity to light after the Lasik procedure is done. Go over these alternatives carefully at the Lasik center prior to the operation, so you understand how you can finest look after your eyes.
Several clients at the Lasik facilities commonly get eye drops to keep their eyes moist for some time after the Lasik treatment is done. Once again, this differs by person and by medical professional, so ask about your particular scenario, especially if you are susceptible to eye dryness on a periodic basis also prior to the Lasik procedure. Also, it might be valuable to maintain any type of ceiling fans or various other air flow devices off you can try these out in the home for the very first few days.
Most customers can return to function as well as typical everyday tasks the day after the Lasik procedure is done, and also do not need any added help from other friends or relative. There is typically little to no post-operative discomfort after Lasik has actually been executed. It is recommended that individuals falling asleep as promptly as possible after the Lasik surgery in order to decrease any kind of post-operative discomfort. Upon waking, improved vision from the Lasik adjustments must already begin to be visible.
This boosted vision might not be the final product of the Lasik treatment. The enhancement to nearsightedness after Lasik is normally quick and also dramatic, though there may be some issues in checking out conveniently for the first few days after the Lasik procedure. This is perfectly typical, as well as need to clean up before the week is out.
Individuals that make use of Lasik to boost their farsightedness typically locate a remarkable renovation the day after the Lasik surgical procedure. It may be that there is a momentary obscuring of objects distant, but this will certainly solve itself. The Lasik medical professional could advise have a peek at this site as well as prescribe short-term glasses up until vision is stabilized if this problem continues to be for more than a few days.
These are all common post-operative advises for a Lasik individual, in order to feel comfortable with exactly what to expect after the Lasik procedure. As with any clinical treatment, obtain all your concerns answered by the staff of your Lasik center for your individual situation.
In addition, most Lasik individuals discover boosted vision instantly or within a couple of hours after the Lasik procedure has actually been carried out.
It likewise implies that some Lasik individuals will need more time to see the total outcomes for the Lasik procedure, occasionally as much as 6 months for their vision to stabilize completely. Many patients at the Lasik facilities usually obtain eye goes down to keep their eyes moist for some time after the Lasik treatment is done. People that make use of Lasik to enhance their farsightedness normally find a dramatic enhancement the day after the Lasik surgical procedure.


Welcome to Dermatology
Welcome from the Chair
The Department of Dermatology at the Emory University School of Medicine plays important roles locally, regionally, nationally, and internationally. Our primary focus is on skin diseases and the patients affected by them. We look at the problems associated with skin disease from a variety of perspectives both local and global. While we care for individual patients and train learners one at a time, we also view discovery and training from a big picture viewpoint, examining molecular pathways driving skin disorders, skin diseases at population health levels, or perspectives on how to train a healthcare workforce to deal with skin diseases in populations of the future, here and abroad.
Historically, academic departments such as our own have been charged with three missions; research, teaching, and service. It is our ambition to merge these missions into one unified mission and vision, serving our current and future patients. Our research is focused on enhancing the treatment of patients with skin disease, especially skin diseases currently with no effective treatments. Our teaching mission serves populations who will benefit from enhanced skills of practitioners who we send out to practice locally, regionally, and nationally. We currently serve as a regional resource for the diagnosis and treatment of skin diseases, especially patients who have complex and difficult to treat skin diseases. We have trained approximately 1% of all dermatologists in the United States. We have already accomplished much but we still have much more to accomplish.
We do all this work with an eye on the past, the present, and on the future. We try to understand the past because we are grateful to those who built the foundations we rely upon to do our current work and need to learn from their experiences, their successes, and their failures. We are here currently because of their legacies.
We live in the present because the core of our current work is to alleviate impairment and suffering in patients affected by skin disease now. The current skin disease burden is both a challenge and an opportunity in that we can learn from our patient partners so that we can improve on what we do. Every day when we come to work, we need to think about the following questions:
- Who is affected by skin disease and how does it affect them?
- How do we best diagnose and treat people impacted by skin disorders?
- What are the underlying mechanisms which induce these skin diseases?
- Why are certain people affected and impacted and how can this be prevented?
- How do we measure and track our progress?
- How do we do better?
We have an obligation to think about the future. Fundamentally, the work we do is an investment in the future. The studies we undertake enhance the knowledge base of the future, allowing those who follow us to better address the questions outlined above and the needs of the patients of the future. The trainees we interact with, whether they are medical students, nursing students, dermatology residents or fellows, or other physicians, nurse practitioners or other non-MD advanced practice providers, all have one thing in common. They will care for future patients who are affected by skin diseases. One of our primary missions is to prepare the future health care workforce to recognize the impact of skin disease and have the knowledge and other tools to appropriately diagnose and treat those affected, or be able to refer them to those who can. Our trainees are destined to replace us and, if we do our jobs well, they will do an even better job than we can hope to do presently.
Robert A. Swerlick, MD
Chair, Department of Dermatology
Emory University School of Medicine
The main campus of Emory University lies only six miles northeast of downtown Atlanta. Emory University includes Emory College, Oxford College, a graduate school of arts and sciences, and professional schools of medicine, business, law, and theology. The total student body, including the Health Sciences Center is almost 15,000 with over 2,500 faculty. Many of the Health Sciences facilities are located on or near Emory's main campus, 631 acres that lie along the Clifton Corridor in a suburban area 15 minutes from downtown. There are additional major healthcare campuses located in midtown Atlanta, and in north Atlanta at the St. Joseph Hospital and Johns Creek Campuses. Emory faculty are responsible for more than 2 million patient visits a year. Teaching, patient care, and research-the center's core missions-are practiced at various hospitals owned by or affiliated with Emory and in a growing number of EMORY HEALTHCARE sites throughout the city, state, and region.


Mueller Jumper's Knee Strap Pink
The Mueller® Jumper’s Knee Strap applies uniformed pressure on the patella tendon just below your kneecap to help relieve pain during frequent running or jumping. It’s ideal for helping relieve patellar tendonitis. Antibacterial treatment controls or eliminates odor.*
• Sit or stand with leg straight, thigh relaxed.
• Place tubular section of strap just below kneecap.
• Fasten behind knee for snug fit.
Hand wash in cold water with mild detergent. Do not use bleach or fabric softener. Rinse thoroughly and air dry.
Constructed of a neoprene blend which may cause skin irritations. If rash develops or pain persists, discontinue use and consult a physician.
* AEGIS Microbe Shield® antimicrobial treatment is intended to protect the brace against odor, staining and deterioration caused by bacteria and microorganisms. This treatment does not extend protection to the skin.


Marian Leslie Nelson – Peacefully at Wairarapa Hospital, Masterton on 2nd January 2019, aged 77 years.
Loved wife of Keith for 52 years.
Loved mother & mother-in-law of Roger & Pam, Derek & Adrienne and loved Gran of Hannah, Joshua, & Liam; Anthony, Olivia, & Ryan.
Loved sister of Berice, Joy, & Ross.
Special thanks to the Doctors and Nurses at Wairarapa Hospital for your wonderful care of Marian.
In accordance with Marian’s wishes a private family service has been held.


Bone loss in the jawbone is common when one or more teeth have been lost due to injury, decay, or trauma. Without the tooth in place to stimulate the jawbone, the bone around the missing tooth will begin to deteriorate. Over time, the jawbone may deteriorate to such an extent that there may not be enough bone to place dental implants. In cases such as these, Dr. Lane may recommend having a bone grafting procedure.
Bone grafting is the replacement or augmentation of missing bone around the teeth. There are three types of bone graft procedures: grafting with your own bone, tissue banks and synthetic materials.
Using your own bone graft takes bone from one area of your body and transplants it to the location in the mouth being restored. The bone is usually taken from non-essential bones such as the chin area. The benefit of using your own bone graft is that the bone used comes solely from the patient thus reducing the likelihood of rejection and infection. The bone is also still “live”, meaning it still has active cellular material.
Tissue banks also use human bone transplanted to the area in the mouth being restored. However, tissue banks do not use the patient’s own bone. Instead, the bone usually comes from cadavers who have donated their bone to bone-banks. All tissue bank bone material is carefully screened and is considered very safe.
Synthetic materials also replace bone in the area requiring treatment, however the bone comes from a non-human source. Usually the non-human source is bovine (cow). Tissue banks and synthetic materials are used because they do not require a second surgical site to harvest bone and ample amounts of bone can be easily attained.
Dr. John M. Lane, located in Madison and Florence, Alabama, is a Periodontist who serves patients from Decatur, Madison, Huntsville, and The Shoals, Alabama. We are looking forward to welcoming you to our office and encourage you to schedule your appointment today!


הירשמו לניוזלטר שלנו
הישארו מעודכנים ותהיו ראשונים לדעת על הטבות ומבצעים בחנות! כל מה שנשאר לך זה להשאיר פרטים
Alocado&trade: Test Report. Kedo Eurocosmetics Ltd. and Spider Pharm Industries Ltd. entered an agreement in September 2006, to test the Alocado™ product line on volunteers suffering from psoriasis as requested by Teva Pharmaceuticals Ltd. Hungary. This document contains the test results, which are available for anyone wishing to be informed about the products. Our aim is to address.
Kedo Eurocosmetics Ltd. and Spider Pharm Industries Ltd. entered an agreement in September 2006, to test the Alocado™ product line on volunteers suffering from psoriasis as requested by Teva Pharmaceuticals Ltd. Hungary. This document contains the test results, which are available for anyone wishing to be informed about the products. Our aim is to address physicians, specialists (dermatologists), pharmacists and patients all at the same time.
Psoriasis is a classic and common dermatological condition. It is defined as follows: an “inflammatory skin condition with increased epithelial proliferation, characterized by infiltrated plaques and silvery scaling”. According to international statistics 2-3% of the overall population are affected by this condition in varying degrees. (Varies geographically).
In Hungary, the estimated number of patients lies between 200,000 and 300,000, although much fewer visit their physicians, because part of them have already lost faith in receiving effective treatment; the other reason for not seeing a physician is that they are in remission and do not see its importance. The causes of psoriasis are still unclear, but research has significantly advanced our understanding concerning the inflammatory process and the immunological background of the illness.
The cause of this condition is believed to be genetic in nature. The condition is characterized by an increased sensitivity of the skin, reacting to external and internal stimuli. These stimuli are the so-called “provoking factors”. The most important provoking factors are mechanical (injury or irritation of the skin), immunological, metabolic stimuli, and provocation by medicine and stress.
A characteristic feature of the illness is the deterioration of quality of life. This is not a life-threatening illness and its gravity is determined not by the physician, but the patient. This condition influences the patient’s everyday life as well as their social and working activities. Deterioration of the quality of life due to psoriasis can be as serious as that caused by heart disease or depression.
Clinically speaking, it is the most versatile skin disease. The most often affected parts of the body are: the scalp, the knees, the elbow, the buttocks, the genitalia, the navel, the flexures and the nails. Its most frequent forms: thick, silvery plaque, extensive, inflammatory plaque, tiny, punctiform lesions and incidental small blisters.
From a medical point of view, the degrees of illness can range from an asymptomatic state through mild symptoms, with isolated plaques to persistent, thick plaques; from a gradual spread to a degree when joints are also affected and the complete surface of the skin is covered by erythroderma.
According to Prof. Christopher Griffith, the gravity of the illness depends on the degree of deterioration of quality of life, the resistance to therapy and the degree lesion spreading.
Seeing as psoriasis is an illness that influences the quality of life and its gravity is determined by the patient, the physician compares his or her own findings with the evaluation of the patient and offers the patient all available therapeutic alternatives.
Finally they will be able to mutually choose the best one. The therapy can be either local or systemic.
Local treatment consists of two phases: the first is stopping acute symptoms, and the second is maintaining therapy with the aim of avoiding a relapse. As for the medication used in maintenance therapy it is of utmost importance that they be well tolerated by the patient, without any side effects.
There are very few preparations used so far, that comply with the above requirements. Traditional treatment possibilities for the acute phase are: coal tar, local corticosteroids, vitamin D analogues, local retinoids, and keratolytic agents (compounds
containing salicylic acid, for external application). Besides these, Photo-therapy (PUVA, UVB) and bath therapy may also be applied.
The above therapies are effective, but they have several side effects.
• Corticosteroids can cause atrophy of the skin, vasodilation may occur; fungal or bacterial infections may emerge.
• Vitamin D may be irritating and expensive.
• The application of coal tar and some of the photo-therapies in large doses are carcinogenic.
• Salicylic acid in high concentrations is irritating.
From the list of above-mentioned therapies only vitamin D is suitable for maintenance therapy.
So the need for a phase-specific, non-aggressive (non-irritating) maintenance therapy is justified.
The Alocado™ product line was developed in 1988 based on formulas developed by physicians and pharmacists working in clinics near the Dead Sea. At that time it was recognized that the surroundings, the water and the mud of the Dead Sea had a healing effect on the patients suffering from skin diseases.
This was also the time when some publications on side effects and disadvantageous features of steroids appeared. Realizing these facts, the inventors were inspired to develop a range of products solving all varying problems using a phase specific range of products that were a revolutionary departure from the “all in one” existing medicines. During their work, they could make use of some publications analysing therapeutic effects of some vegetable oils like Avocado oil and the Aloe Vera extract.
Besides this, patients wished to enjoy remission not only for a week for as long as their treatment at the Dead Sea lasted, but for a longer period of time. This was made possible by being able to take these natural remedies back home.
Advantages of the Alocado™ product line are as follows:
* It does not contain steroids.
* It doses not contain tar.
* It doses not contain synthetic vitamin D.
* The acid content never exceeds 2%.
* The active ingredients are combined with very strong emollients.
* A unique composition of natural oils (mainly Avocado), Aloe Vera extract and salt from the Dead Sea (not reaching salt concentration levels that could irritate skin).
* There are special products to treat different symptoms, including open wounds.
* We offer products for maintenance therapy to be used in state of remission to contribute to palliate symptoms of the next relapse.
* These products do not have any side effects neither after short- nor after long-term treatment.
We began testing Alocado™ products in September 2006. Approximately 25-30 volunteers were recruited to take part in the test, which was not launched at the most favourable period, because psoriasis generally relapses when cold weather is to be expected.
Baseline data were collected along with the dermatological examination, i.e. personal data, medical history, and all medication taken before and at the time of this examination were recorded. The state of the skin was photographed, some of these photos will
be shown later and are saved on the enclosed DVD. The photos don’t always document the changes of conditions exactly, since there was no possibility to take professional photos, and in many cases the pictures are distorted by inappropriate lighting or positioning. This is why we used the PASI index widely accepted in specialist literature to establish condition changes. We established values on the basis of PASI index from the starting state of illness, and during the repeated follow-ups.
A short summary on PASI:
The objective skin condition of the patient is expressed by the so called PASI index. This is an internationally accepted index to demonstrate the state of the skin and to establish efficacy of the therapy.
The index evaluates the main symptoms of psoriasis: erythema, induration, and scaling, and the size of the affected area are taken into consideration as well. All these factors are taken into account in the regions of the head, the upper limbs, the torso and the lower limbs. Using different multipliers a relative number is achieved from the sum of these values. This relative number is not quite perfect; e.g. changing from PASI 20 to PASI 10 is much easier than to change from 10 to 5. There is a version of this index where
the patients analyse the values themselves. (This happened in our case, when we had weekly or bi-weekly phone consultations with the patients.)
Due to the fact that psoriasis is an illness influencing the quality of life, it is the patient who evaluates the illness most precisely; his or her opinion is crucial.
Administering ALOCADO™ products, our aim was to give emollient, nourishing and calming preparations to the patient. These products are phase-specific, meaning that they always exert their effect against the most irritating symptom and they support maintenance therapy in conjunction with drug therapy or without. The products prolong the period between relapses and make the patients feel more comfortable with their skin.
In the above table, the first column shows the number of volunteers, and the other columns contain PASI index scores as per follow-up. The dates of follow-ups vary from volunteer to volunteer. Due to the fact that they did not start at the same time, but one after the other, in some cases it was possible to have even six follow-ups whereas in other cases only 1-2. The intervals between the follow-ups also vary; they changed individually. In some cases, this interval was 10-14 days, while in others, it was several weeks. So the columns show PASI index scores registered during follow-ups, irrespective of the time elapsed. At the bottom of the table, the index scores measured during the first, second, third, etc. follow-ups are summarized, where a decreasing trend can already be identified. Besides this, we have calculated the mean index scores as well, this can be seen in the bottom row.
The index scores do not show a smooth decrease, which means that there have been relapses. Further on, individual data will also be introduced.
In the first column, PASI index score changes are highlighted in a different colour. In the case of volunteer 20, the dark green colour means that this patient suffered from Atopic Dermatitis (and in his row the PASI index score is zero throughout the test).
This case has demonstrated that certain preparations of the Alocado™ product line, suitable for the treatment of very dry skin, may be useful for other conditions as well.
We can see very fast and very effective results in this case as shown by those before and after pictures:
A woman of 29 years of age Suffering from Atopic Dermatitis for 12 years.
Treated with all kinds of medicine, including injections and steroids. Past two years, no changes.
Start of treatment 8.11.06 – before photo.
Last check 31.12.06 – after photo.
Treated with Alocado™ Cream and Alocado ™ Skin Softener, to be applied three times a day, first Alocado™ Skin Softener and when absorbed, Alocado™ Cream. When itchy, Alocado™ Cream can be applied as much as needed.
In 31.12.06 Alocado™ Gold was added to treat open wounds left on the body, 10.01.07 wounds are closed; most of the skin is clear, continue maintenance treatment with the Alocado™ Cream.
In the case no’ 9, highlighted in red, the data could not be evaluated, because the patient could not continue this test owing to another type of health problem unrelated to Psoriasis. There were three cases, indicated by the pink fields (cases 2, 16, 17), where no improvement was observed, which is why these volunteers did not continue our test.
The other fields, indicated by light green, show the results of those volunteers, where improvement could be observed in comparison with their initial condition, irrespectively of whether their PASI curve showed a decline or whether it was fluctuating.
Based on the table summarizing PASI index scores we may summarise the 30 tested volunteers as follows: One patient’s data could not be evaluated due to his Atopic Dermatitis, but it should be mentioned that this volunteer gave positive feedback about the emollient effect of the preparations (case no’ 20). 3 patients aborted treatment right at the beginning, stating that it was ineffective (case no’ 2 – reduced from 6.2 to 6 and then had a renewed outbreak to 7.2 then stopped, case no’ 9 tried for a few days only, then stopped, case no’ 17 didn’t wait for an effect and stopped).
1 patient was hospitalised with an-other health problem unrelated (case no’ 9).
Evaluating patients over a given time span, the number of follow-ups varied. PASI index scores fluctuated heavily, with 7 patients, improvement was followed by deterioration (case no’ 2, case no’8 – got scared from the remission and stopped although showing good improvement before, case no’ 10 had an out break on a new part of the body, blamed the products and stopped, case no’ 15 showed great improvement, in midst of treatment suffered a more severe outbreak then the one he begin with, continued treatment, achieved almost clear skin, case no’ 21 – showed improvement and then erythroderma increased, needed a change in products to suit the new condition, decided to stop, case no’ 24 – showed more than 50% improvement but when products did not arrive by
mail, the situation deteriorated and the connection broke, case no’ 25 – showed 50% improvement when had a new outbreak, connection broke), and then improvement could be observed once more.
We advised patients many times not to become disappointed in case of deterioration, but continue with their treatment.
This fluctuation is part of the natural process of psoriasis, because improvement and deterioration will keep alternating owing to different provoking factors. With 11 patients (cases no’ 1, 6, 11, 12, 13, 22, 23, 25, 26, 28, 29) a relatively steady improvement could be noted.
When starting the Alocado™ treatment, we tried to choose patients who had not been treated with any steroids or other medicines within a given period before the test. However, taking these preparations was not a criterion for exclusion, since it is necessary to have some emollient treatment for those who took the aforementioned medication as in case no’ 12 here the test started whilst the patient was taking steroids (39.2 in the PASI index), we asked him to stop, once doing that the PASI level was increased by more then 40%, but with the continuation of treatment with the Alocado™ products it was reduced to 13.2 in the PASI index, an improvement of 76%. A discontinuation of treatment with steroids might trigger a relapse but the situation can be improved with a continuous usage of the Alocado™ products.
75 years old PASI index at start 39.2 for the past 15 years no improvement whatever medicine taken.
Very swolen, red and inflammed skin, sometimes very itchy, others not
Some areas are covered with thin plaque.
At current situation, using medicine with steroids, help minor.
Started Alocado™ treatment at the 28/9/06 received Alocado™ Gold for treating inflamation and Alocado™ Pasta for treating red swolen skin.
The moment stop taking medicines within one week situation worsen to 55 in PASI index (steroid effect).
After 1 month when inflamation reduced, Alocado™ Body oil and Alocado™ Cream for itching and dry skin were added. So
treatment included Alocado™ Gold, Alocado™ Body oil, Alocado™ Pasta and Alocado™ Cream, when inflamattion was
reduced to zero Alocado™ Gold was stopped.
After 1 more month at the 3rd of December 2006 the PASI index droped to 13.2. No Itching, No scaling, No inflamation, No swelling, No redness (small red dots are the only thing left, tipical to old peoples skin), fingurenails grew back better then before (were treated with Alocado™ Skin Softener).
Over all, pretty satisfying results.
On going treatment – Alocado™ Cream, Alocado™ Body oil and Alocado™ Skin Softener for maintanance.
In many cases improvement could be observed based on the regular application of the Alocado™ products. When stopping it, the skin’s condition deteriorated.
We observed that the efficacy of the products and the response to them could be increased by applying the appropriate Alocado™
product several times a day.
It has been observed that application 4 times daily (this dosage proved to be necessary to achieve maximum efficacy) resulted in the fastest improvement.
In the course of the treatment, we had to change products with many patients, because ALOCADO™ products are phase-specific, and a different product is recommended depending on the predominant symptom (scaling, inflammation, infiltration). In patients
showing improvement, the use of the compound called Gold should be emphasized, having a soothing effect on the itching, excoriated parts of the skin, which, quickly epithelizated, and the patient soon became asymptomatic.
An example of heavy usage of the Alocado™ Gold can be observed in case no’ 1
68 years old lady PASI index at start 26, for the past 10 years no improvement whatever medicine taken. Very swolen, very red and extermely inflammed skin, amazingly no itching.
At current situation, gave up on treatment for several years.
Started Alocado™ treatment at the 28/9/06 received Alocado™ Gold for treating inflamation and Alocado™ Pasta for treating red swolen skin and Alocado™ Cream for dry skin.
After 1 month of treatment, PASI index dropped to 13, inflammation reduced and at one area only pinkish coloration left. (patient refuse to stop taking the Alocado™ Gold although inflamation was reduced, we let it stay).
After two months PASI index 5 and less, No Itching, No scaling, No inflamation, No swelling, No redness but very light almost unnoticeable pink.
Over all, pret ty satisfying results.
On going treatment – Alocado™ Cream, Alocado™ Body oil and Alocado™ Bath oil for maintanance.
Because of the moderate improvement of PASI index scores and the fluctuating course of the illness, 10 patients (cases 2, 3, 8, 9,10, 14, 16, 17, 19, 30) claimed that the treatment did not have the desired effect. Besides acknowledging the improvement in the condition of the skin, the tenderness, the decrease of infiltration, the restoration of elasticity, resolution of scaling, the majority of patients claim inflammation persisted to very small degree.
Summary based on the objective results (PASI index scores): based on objective symptoms, PASI index scores improved in 23 cases (79.3%); PASI improvement of 50% was observed in 13 cases (56.5%), while a 75% improvement of PASI occurred in 4 cases (17.4%).
Subjective results based on patients’ self-evaluation: According to the volunteers, in 7 cases there was no significant improvement or the condition did not change (cases no’ 2, 5, 10, 19, 30), in the other 22 cases significant improvement was
In 5 cases the condition became asymptomatic to a degree not heard of (PASI 1 –1.6) using other preparations cosmetic or medicine (cases no’ 4, 6, 11, 15, 25). No side effects were observed. Some transitional irritation was reported.
Based on these results, it may be concluded that the phase-specific, emollient, palliative
natural compounds of the ALOCADO™ product line offer a highly effective alternative for
the treatment of psoriasis.
1. O. Braun – Falco. G. Plewig, H.H .Wolff, W.H.C Burgdorf: Dermatology Second, Completely Revised Edition, Springer
2. Prof. Louis Dubertret: Psoriasis from clinic to therapy Edition Med’com,2005
3. A lokális antipsoriatikus kezelés uj irányvonalai dr Hoffer Gábor
II.Budapesti B őrgyógyászati Továbbképző Tanfolyam Faragó, Katalin MD, Dermatologist


I Help Doctors Build Greater Purpose, Confidence, Resilience and Joy.
My Passion is to Work With Doctors and Medical Trainees, Supporting Their Wellbeing, Growth, and Success.
I Work With Doctors Who Are:
Dr. Anne McNamara, Doctor Coach
About Anne McNamara
My background in Clinical Respiratory Medicine, Critical Care, and Medical Leadership gives me a deep and broad experience of the Doctor’s world.
In my leadership roles, I coached Doctors and trainees in transition, new and established Medical leaders , distressed physicians, and teams of Doctors and other health care providers facing challenging situations.
The International Coaching Federation defines coaching as partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.
During our coaching sessions, my deep listening, thought-provoking and compassionate feedback, and focused inquiry help you see your thoughts. You become better able to clarify issues, see alternate perspectives, identify barriers, and purposefully make choices that are best for you.
CUSTOMIZED INDIVIDUAL COACHING
WEBINARS AND WORKSHOP THEMES
Lawrence Yang, MD CCFP DABFM
Head, Family Medicine Department, Surrey Memorial Hospital
Medical Director, Gateway Medical Centre
As a busy family doc, I was recovering from work-related burnout. Coaching sessions with Anne McNamara were great for my well being. I was able to focus on what really mattered. I am more empowered; more equipped to sustain balance in my professional and personal life. My colleagues and family notice good changes in me.
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San Francisco Healthcare Fraud Whistleblower Attorney
Healthcare Fraud Whistleblower Lawyers
At Rukin Hyland & Riggin LLP, our attorneys represent employees who are blowing the whistle on employers for committing healthcare fraud. These are often the employees who handle billing and accounting for medical professionals or who process payment and insurance claims. We frequently work with office managers, bookkeepers, secretaries and similar staff members. Regardless of the person’s specific position, our goal is the same: to help them exercise the rights and protections they are entitled to under qui tam law.
Examples of Healthcare Fraud
Health fraud comes in many forms. Some are obvious. Others are complex and intricate. All are illegal. Some common manifestations of healthcare fraud include:
- Fraudulently billing for drugs or medical services that were not actually provided
- Fraudulently billing for medical appointments that did not actually occur
- Falsely inflating the charges for drugs or medical services
- Falsely charging for brand-name medical products or drugs when the patient was actually provided with the generic version
Who Commits Healthcare Fraud?
Any individual or business involved in the healthcare industry may have the opportunity to commit healthcare fraud. This includes clinics, hospitals and individual medical providers, such as doctors, chiropractors, dentists, psychologists, and psychiatrists. Pharmacists and pharmacies, and even drug manufacturers may also have access to government resources like Medicare and Medicaid. Medicare fraud and Medicaid fraud, in particular, are among the most common forms of healthcare fraud.
Whistleblowers Are Protected
People who step forward to report employers that are taking advantage of money set aside to help people in need are protected by law. They cannot legally be terminated or retaliated against in any way. Furthermore, they are entitled to a portion of the recovery.
For more information, also see: Whistleblower Protection


Embarking on the journey to become a pilot is an exhilarating endeavor that involves not only mastering the art of flying but also navigating aviation regulations. One pivotal step in this process is obtaining your FAA Medical Certificate. This certificate, issued by an Aviation Medical Examiner (AME), attests not only to your fitness for flight but also paves the way for your ascent into the skies. Here's an explanation of FAA medicals and the crucial information you need to initiate your career as a professional pilot.
The Role of Aviation Medical Examiners (AMEs)
An Aviation Medical Examiner, or AME, holds the key to your journey as a pilot by conducting comprehensive medical examinations. Designated by the Federal Aviation Administration's Office of Aerospace Medicine, AMEs ensure that you meet the physical and mental health standards required for safely piloting an aircraft.
The Imperative of the Medical Certificate
Obtaining an FAA Medical Certificate is a crucial step in the process of becoming a pilot, holding significant importance for ensuring the safety of aviation operations. This certificate signifies more than just a requirement; it stands as a testament to your physical and mental fitness, signifying your freedom from medical conditions and medications that might compromise flight safety.
Before taking control of an aircraft and embarking on flights, aspiring pilots must secure an Airman Medical Certificate. This certificate formally validates your compliance with the medical standards set by the aviation authority, in this case, the Federal Aviation Administration (FAA) in the United States. The FAA acknowledges that certain medical conditions or medications could hinder an individual's ability to safely operate an aircraft. Thus, by issuing medical certificates, the FAA aims to ensure that only individuals who are physically and mentally fit to fly are permitted to do so.
It is of utmost importance to recognize that an aviation medical certificate is essential for soloing an airplane. This requirement emphasizes the vital role of medical certification in not only safeguarding your well-being but also prioritizing the safety of those who share the skies with you.
The Airman Medical Certificate is indispensable for all pilots, irrespective of whether they are designated as the pilot in command (PIC) or serve as pilot crewmembers. The certificate comes in different classes, each tailored to specific privileges and types of flying. These classes are commonly referred to as First, Second, and Third-Class Medical Certificates.
Medical Class Descriptions
First-Class Medical Certificate: This class is the most stringent and is required for pilots exercising the highest level of responsibility, such as airline transport pilots. These individuals need to undergo comprehensive medical evaluations regularly due to the demanding nature of their roles.
- Under 40: Valid for 12 months, followed by 3rd class privileges for up to 60 months
- Over 40: Valid for 6 months, followed by commercial pilot privileges for up to 12 months, then 3rd class privileges for up to 24 months
Second-Class Medical Certificate: Holders of this class are often commercial pilots and individuals involved in certain aviation-related activities. The medical assessment for this class is slightly less rigorous compared to the first class.
- Under 40: Valid for 12 months, then 3rd class privileges for up to 60 months
- Over 40: Valid for 12 months, then 3rd class privileges for up to 24 months
Third-Class Medical Certificate: A third-class medical certificate is typically required for individuals pursuing a private pilot license or an instrument rating. This certificate enables pilots to undertake non-commercial aviation activities, such as recreational flying and personal flights without compensation.
- Under 40: Valid for 60 months
- Over 40: Valid for 24 months
The medical examination conducted by an Aviation Medical Examiner (AME) covers a range of factors, including physical health, vision, hearing, medical history, cardiovascular well-being, and mental fitness. By carefully assessing these aspects, AMEs ensure that pilots are capable of safely performing their duties without posing a risk to themselves, passengers, or others in the airspace.
At Hillsboro Aero Academy, we require that incoming students enrolling in our Professional Pilot Program obtain a first-class or a second-class medical prior to your orientation date.
Mastering FAA MedXpress
MedXPress is an electronic platform provided by the FAA that allows individuals in need of FAA Medical Certificates or Student Pilot Medical Certificates to efficiently complete their medical applications online. The information you input into MedXPress will be accessible to your AME, facilitating the examination process. This online tool offers a streamlined approach to completing your medical application (FAA Form 8500-8) and ensures your medical information is readily accessible to your Aviation Medical Examiner (AME) during your medical examination.
How to Get Started
Create an Account
- Access MedXPress at https://medxpress.faa.gov/
- If you're a first-time user, click on "Request Account" and fill out the online form
- Provide your name and email address (your email address will serve as your account name)
- Answer three security questions for identity verification purposes
- You'll receive an email containing your initial password and instructions for completing the account request process
- After confirming your account creation, return to the FAA MedXPress login page
- Log in using your email address and the temporary password provided in the confirmation email
- You'll be prompted to set a permanent password
Complete the Application Form
- Upon logging in, you'll see the medical application form
- Fill out the form, ensuring accuracy and completeness
- When finished, click "I'm done. Send my application to the FAA" and then click "Submit"
- MedXPress will assign a confirmation number to your application upon successful submission
Save and Review
- If you need additional information or need to complete the form later, you can save your progress and return to it
- Click the "Save Now" button at the bottom of the page to save your entries and log off
- Your entries will be retained for your next session
Keep Your Confirmation Number
- After submitting your application, you'll receive a confirmation number
- This number is essential for your AME to review your medical information
- Bring the confirmation number to your medical examination, as your AME will need it to access your application
Once your AME imports your application using the confirmation number, it becomes a permanent record in the FAA's medical certification system.
Schedule Your Examination
The FAA offers an online search tool on their website to help individuals locate Aviation Medical Examiners (AMEs) based on location. By visiting the FAA's AME Locator page, users can input their location details and access a list of nearby AMEs. It's essential to specify the appropriate class of FAA Medical Certificate you intend to acquire during your search.
- You have 60 days from the date of submission to schedule and undergo a physical examination with your AME
- Failure to complete the examination within 60 days will result in the application being deleted
Navigating Health Concerns and Aspiring Higher
Navigating the intricacies of medical certification, especially when dealing with prior or existing health conditions, can be made easier through two valuable resources. Pilot Medical Solutions, located near Oklahoma City, offers personalized FAA medical support, guided by former FAA physicians in aviation medicine. They collaborate directly with your Aviation Medical Examiner (AME) and the FAA Standards office, ensuring accurate assistance.
Additionally, AOPA's Pilot Protection Services present another avenue for help. With a team of legal and medical certification experts, AOPA can aid you in obtaining your medical certificate. Their combined resources offer a comprehensive approach to overcoming challenges in the certification process, guiding you toward a successful aviation journey.
To explore these options and address the impact of your medical condition or health concern on certification, reach out to Pilot Medical Solutions or consider tapping into AOPA's Pilot Protection services for additional support. If you have concerns, it’s an opportune moment to begin your research and familiarize yourself with the Airmen Medical Standards & Certification procedures.
A Destination Awaits
Becoming a professional pilot involves not only mastering the skies but also navigating the intricacies of the medical certification process. At Hillsboro Aero Academy, your journey toward becoming a pilot takes off by securing a first or second-class medical certificate. If your aspirations include participation in airline partner programs such as Ascend Pilot Academy or the Horizon Air Pilot Development Program, a first-class medical certificate becomes the necessary requirement that unlocks your full potential prior to your application.
Our dedication to your success is reflected in every step of our admissions process. For those who dream of joining our vibrant aviation community, Hillsboro Aero Academy stands ready to illuminate your path. To discover more about turning your aviation aspirations into reality, reach out to us at firstname.lastname@example.org or call 503-726-3000. Your career as a professional pilot begins with the appropriate medical certification – the foundation upon which you'll construct your lasting aviation legacy.


Professor Varcoe commenced medical training at the University of Adelaide in 1991. Throughout the next six years he balanced his medical studies with professional athletics, dominating sprinting in South Australia in the mid 90’s, setting state records and representing at the highest level in Australia. During the course of his medical degree he relocated to Sydney to further his athletics career with the hope of representing Australia in the 2000 Olympics.
He completed medical school in 1997 and began working as an intern and resident medical officer at Prince of Wales Hospital in Sydney. In 2000 he took a year’s leave of absence to train in athletics, however despite excellent sprinting performances injury intervened before the games and lead to retirement from the sport. This was a turning point for Professor Varcoe, allowing him to channel the discipline and thirst for perfection he’d discovered in elite sport into the discipline of surgery.
2001 through 2003 saw Professor Varcoe train in General Surgery both in Victoria and New South Wales before completing a Master of Surgery research degree at the University of Sydney and writing his thesis on the “Origins of Neointimal Hyperplasia”.
Specialist training in Vascular and Endovascular (minimally invasive) Surgery ensued in 2005 (The Queen Elizabeth Hospital, SA) where he was fortunate enough to spend regular time with Dr John Anderson, a pioneer and world leader in endovascular surgery. 2006 was spent at Prince of Wales Hospital under the tutelage of transplant pioneer Dr John Frawley and in 2007 he spent time at Westmead Hospital working under renowned vascular surgeon and academic, Professor John Fletcher. During 2007 he completed the Fellowship of the Royal Australasian College of Surgeons in Vascular Surgery.
In 2008, Professor Varcoe spent time in London at St Georges Vascular Institute and St Mary’s Hospitals honing advanced skills in minimally invasive treatment of the aorta for conditions such as aneurysm, dissection and trauma. Whilst there he accepted the invitation to visit several centers of excellence throughout Europe that were also engaged in advanced innovation in the treatment of Aortic disease so completing a focused aortic postgraduate fellowship.
Upon returning to Australia Professor Varcoe took a position as a Vascular Surgeon at Prince of Wales Hospital, where he is now director of operating theatres, as well as commencing a busy private practice. In 2009 and 2010 he was the co-chairman of the International Endovascular Symposium with the late Professor Geoff White and in 2009 he was chairman and convener of the annual scientific meeting for the Australia and New Zealand Society of Vascular Surgery, “Vascular 2009”. In 2013 he established Australia’s leading scientific congress of endovascular surgery “The VERVE Symposium”. He is course director of this annual forum which hosts a world renowned faculty of international and regional vascular specialists in a multi-day educational event (see www.VERVEsymposium.com).
He is founder of the New South Wales Vascular Journal Club Meeting which has been held four times per year since 2006 and has hosted a number of world leaders in the field of vascular and endovascular surgery. In 2011 he was elected as a member of the International Council of the International Society of Endovascular Specialists and is now on their executive board. He is a member of many learned vascular societies including the Royal Australasian College of Surgeons, ANZ Society of Vascular Surgery, International Society on Thrombosis and Haemostasis, International Society for Vascular Surgery, Section of Academic Surgeons and the John Loewenthal Surgical Research Society.
Throughout this time Professor Varcoe has nurtured a strong interest in surgical academic research and teaching which is now focused squarely with the University of New South Wales. He gained his first academic position at UNSW in 2001 and has achieved steady academic promotion since then to be Associate Professor of Vascular Surgery. He completed his PhD thesis “The Investigation of Novel Technology and Technique in the Treatment of Vascular Disease” at UNSW in 2015. He has published widely in respected peer reviewed journals and is an invited reviewer for the Journal of Endovascular Therapy, International Angiology, ANZ Journal of Surgery, Journal of Cardiothoracic Surgery, International Journal of Surgery, World Journal of Surgery, Journal of Clinical Ultrasound and Vascular and Endovascular Surgery. He is also on the editorial board of both the Journal of Endovascular Therapy and Journal of Cardiovascular Surgery, and regularly asked to speak at the world’s leading symposia both in Australia and overseas (see media for publications and more than 120 invited lectures).
He is the director of The Vascular Institute, Prince of Wales, one of Australia’s most prestigious vascular clinical trials centres. Through the institute he has been the lead investigator on several multi-centre clinical trials including the DESTINY 2, ABSORB BTK and MAJESTIC trials, which have focussed on saving limbs through the use of new stent devices.
He teaches at undergraduate as well as post-graduate level, sits on UNSW medical student selection interviews, is an undergraduate examiner and currently supervises a number of higher degree research students.
When he’s not at work Professor Varcoe enjoys taking his two young boys fishing around Sydney’s Eastern suburbs beaches. He rarely catches fish but enjoys the process nonetheless.
1997 Bachelor of Medicine, Bachelor of Surgery, University of Adelaide
2004 Master of Surgery, University of Sydney
2007 Fellow of the Royal Australasian College of Surgeons, Vascular Surgery
2016 Doctorate of Philosophy, University of New South Wales
Consultant Vascular Surgeon, Prince of Wales Hospital
Consultant Vascular Surgeon, Sydney Children’s Hospital
Consultant Vascular Surgeon, Royal Hospital for Women
Consultant Vascular Surgeon, Prince of Wales Private Hospital
Consultant Vascular Surgeon, Eastern Heart Clinic
Associate Professor, Conjoint, University of New South Wales
Supervisor of Vascular Surgical Training, Prince of Wales Hospital
Co-Director, Vascular Diagnostic Centre, Prince of Wales Hospital
Director, The Vascular Institute, Prince of Wales
Vascular Surgery Representative, Medical Advisory Committee, Prince of Wales Private Hospital
Chairman, Perioperative Committee, Prince of Wales Private Hospital
Co-Chairman and Convener, International Endovascular Symposium
Australian Delegate, International Council, International Society of Endovascular Specialists
Royal Australasian College of Surgeons, Fellow
ANZ Society of Vascular Surgery, Full Member
International Society of Endovascular Specialists, Full Member
International Society on Thrombosis and Haemostasis, Full Member
International Society for Vascular Surgery, Full Member
Section of Academic Surgeons, Royal Australasian College of Surgeons
John Loewenthal Surgical Research Society, University Of Sydney, NSW
Conjoint Committee for the Recognition of Training, Peripheral Endovascular Therapies
Conjoint Committee for the Recognition of Training, Carotid Angioplasty and Stenting
Conjoint Committee for the Recognition of Training, Aortic Fenestrated and Branched Endografting


Author(s): Rebecca Bransletter
The vast amount of information on ADHD can be overwhelming, often leaving parents feeling frustrated, stressed, and powerless to help. But with the professional, accessible advice presented here, parents will learn how to focus on the child and his needs, rather that worries about the future. The Conscious Parent's Guide to ADHD helps parents: * Obtain and understand a diagnosis * Weigh pros and cons of medication * Find the right treatment * Lower stress levels for both parent and child * Handle sibling issues * Get their child to focus at home and school * Communicate effectively, stay positive, and encourage their child This book provides an all-encompassing look at ADHD-its symptoms, its causes, and its treatment-so that parents can remain flexible, calm, and mindful while taking the necessary steps to create a better future for their child.
Rebecca Branstetter, PhD, is a child and adolescent psychologist and school psychologist in the San Francisco Bay Area. Dr. Branstetter assesses and counsels children and adolescents with learning and emotional challenges in public schools and in private practice, including children with ADHD. Dr. Branstetter is the author of the popular blog Notes from the School Psychologist, as well as The Everything(R) Parent's Guide to Children with Executive Functioning Disorder, a popular guide for families of children with ADHD.


Help for hearing in Wandsworth
Do you live in Wandsworth and need help with your hearing aids?
If so, our Hear to Help service may be able to help you!
Our Hear to Help service in Wandsworth is delivered in partnership with St. George’s NHS Trust. We provide support to NHS hearing aid users, enabling people to make the most of their hearing aid and manage their hearing loss effectively.
Our service is community based and our community support officer and volunteers provide the service through outreach work, home visits and drop-in services. Our free service includes:
- tubing, minor repairs, earmould cleaning and battery replacement
- basic training for hearing aid users on maintenance and usage of their hearing aid
- providing advice and support to enable people to make the most of their hearing aid
- providing information on other equipment and services.
Location: Age UK, 549 Old York Road, London, SW18 1TQ
Date: 3rd Thursday of the month
Time: 10:00 – 12:00
Location: St John’s Therapy Centre, Entrance B,162 St John’s Hill, Battersea, London, SW11 1SW
Date: 2nd Wednesday of the month
Time: 10:00 – 12:30
Location: St Michael’s Day Centre for Elderly People, St Michael’s Church Hall, Cobham Close, London, SW11 6SP
Date: Last Thursday of the month
Time: 10:30 – 12:30
Location: Furzedown Project, 91-93 Moyser Road, Streatham, London, SW16 6SJ
Date: Last Wednesday of the month
Time: 14:00 to 15:30
Location: St Paul’s Community Centre, 23 Inner Park Road, Wimbledon, London, SW19 6ED
Date: 1st Tuesday of the month
Time: 11:00 – 13:00
Location: Platt Christian Centre, 22 Felsham Road, Putney, SW15 1DA
Dates and times subject to change so please contact either our Community Support Worker or the venue for confirmation.
Telephone: Community Support Worker on 0750125744 or Platt Christian Centre on 0208 780 9330
Location: Battersea Park Library, 309 Battersea Park Road, London, SW11 4NF
Date: Last Friday of the month
Time: 14:30 – 16:30
Location: Brocklebank Health Centre, 249 Garratt Lane, London, SW18 4DU
Date: 1st Thursday of the month
Time: 14:30 – 16:30
For further information about our service in Wandsworth, or if you are interested in becoming a Hear to Help volunteer, please contact:
Beverly Leach, Action on Hearing Loss Community Support Officer, Audiology Department, Ground Floor, Lanesborough Wing, St. George’s Hospital, Tooting SW17 0QT
Mobile: 07501 257 443
Telephone: 020 8725 1151
Textphone: 020 8725 3019
Fax: 0208 266 6255
Email: [email protected]


HOUSTON – The Los Angeles County coroner ruled Michael Jackson’s death a homicide Monday after a search warrant affidavit revealed that Jackson had lethal levels of the powerful anesthetic propofol in his system when he died.
The document unsealed Monday allowed officials to raid the Houston offices and storage facility of Dr. Conrad Murray last month.
According to the warrant, Murray, Jackson’s personal physician, had been treating the singer for insomnia with the sedative for six weeks. According to the document, Murray said he had been trying to wean Jackson off the powerful sedative by using smaller doses in combination with the sedatives lorazepam and midazolam.
On the morning Jackson died, Murray said he tried to induce sleep without using propofol, starting first with valium at 1:30 a.m. When he was still awake at 2 a.m., Murray injected Jackson with lorazepam, then injected him with midazolam at 3 a.m. Murray told police he administered several other drugs over the next few hours.
By 10:40 a.m., Jackson, still unable to sleep, urged Murray to give him propofol. Murray said in court documents that he administered 25 milligrams of the drug at that time, then left Jackson alone under the influence of the drug to make phone calls to his Houston office. When he returned, Jackson was not breathing. He performed CPR while a member of Jackson’s staff called 911. The singer was rushed to UCLA Medical Center where he was declared dead sometime later.
The affidavit says , while Murray acknowledged to police that he administered propofol, authorities said they could find no evidence that he had purchased, ordered or obtained the medication under his medical license or Drug Enforcement Administration tracking number. The newspaper also reported that police detectives found about eight bottles of the aneesthetic in Jackson’s house along with other vials and pills that had been prescribed to Jackson by Dr. Murray, Dr. Arnold Klein and Dr. Allan Metzger.
Valium, lorazepam, clonazepam, tamsulosin and other drugs also were confiscated in the search, and propofol was found in Murray’s medical bag. According to the warrant, Murray told police he was not the first doctor to administer propofol to the singer.