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Percentile benchmark set by ncqa and thus showed that kpnc members were inconsistently advised by clinicians to quit smoking and that work was needed to improve the quality of care for members who smoke figure 2 Extensibility. Extensibility refers to a muscle's ability to extend in length. In our studies of four subjects Table 4 ; , Patient B had an elevated WBC count, probably attributable to the stress of phlebotomy, but without accompanying disorders of cell count differential. All patients had CD4 counts well within normal limits. Review of Endocrine Function Topical reviews of this topic are contained in two recent publications Murphy 2001; Zimmer and Morgan 1997 ; . As with other physiological systems, much data is based on animal studies, and early claims of deleterious effects on acute endocrine function are not necessarily supported by subsequent investigations or chronic use studies. One long held claim is the production of gynecomastia in males associated with cannabis use. A case study or 3 cannabis smokers with this malady was reported by Harmon and Aliapoulios 1972 ; . A more thorough investigation a few years later failed to show any differences in cannabis use in affected males between users and controls Cates and Pope 1977 ; . Similarly, Kolodny et al. 1974 ; reported decreased testosterone levels in chronic marijuana smokers, while no differences in testosterone or luteinizing hormone LH ; levels were identified in a 3-week trial of smokers vs. non-smokers Mendelson et al. 1978 ; . LH levels in menopausal women showed no significant changes after cannabis usage Mendelson et al. 1985 ; , but the next year, a similar group noted a 30% suppression of LH in women by smoking a single cannabis cigarette during the luteal phase Mendelson et al. 1986 ; . Subsequently, a more in-depth study of both sexes was undertaken to assess multiple hormone effects comparing subjects with different levels of cannabis usage vs. controls Block, Farinpour, and Schlechte 1991 ; . No significant effects were noted on testosterone, LH, FSH, prolactin or cortisol in young women and men. Jamaican chronic use studies were confined to examinations of thyroxine and steroid excretion with no significant findings observed due to cannabis use Rubin and Comitas 1975 ; . In the 94-Day Cannabis Study, acute drops in testosterone and LH levels were noted after smoking a cannabis cigarette Cohen 1976 ; . Subsequent drops in testosterone levels were noted after the 5th week of daily usage. LH levels fell after the 4th week and FSH after the 8th week to unspecified degrees. In Costa Rica, no differences were noted in male testosterone levels between abstainers and cannabis smokers stratified according to amount. Editor, --We thank Dr McKenzie for his interest in our article.1 This review encompassed aspiration during all forms of anaesthesia and was intended to highlight the lack of evidence for the increasingly widespread practice of gastric content pH-raising prophylaxis. It was not aimed specifically at obstetric anaesthesia but the point is made in the review for the continued use of such agents in this particular area. It is, however, correct to point out that obstetric anaesthesia has seen a dramatic change in practice with a shift from general to regional anaesthesia, as recent studies in the USA and Germany document.24 The American study4 showed a decrease in maternal mortality from 4.3 per million live births for 19791981 to 1.7 per million live births in 19881990, which was a result mainly of a decrease in mortality in patients who received regional anaesthesia from 8.6 to 1.9 per million regional anaesthetics, respectively. There was, however, an increase in mortality from 20 to 32.2 deaths per million patients receiving obstetric general anaesthesia during that period. The role of aspiration in these cases remains unknown. Physiological changes in pregnancy may alter morbidity and.

109 genes were down-regulated with a ratio 0.5 in at least 28 MDS patients, including Gravin AKAP12, ARPP-21, ELA2, CD24, MME and EBF Table 1 ; . The most represented gene categories for commonly down-regulated genes were `signal transduction' 26 genes e.g. Gravin AKAP12, LEF1 ; , `immune response' 16 genes e.g. CD24, PAX5 ; and `regulation of transcription' 26 genes e.g. EBF, FOSB. To date, with the exception of the work being done by Elders, most of the programs operating within the correctional system have been designed by non-Aboriginal people based on the values and culture of the dominant society. The orientation of many of these programs reflects current trends and developments by the different schools of thought in criminology, sociology, psychology, psychiatry and educational pedagogy, and which do not necessarily encompass Aboriginal realities. Aboriginal offenders are expected to conform to these methods of addressing their negative or antisocial behaviours. The issue of race relations, the oppression of Aboriginal peoples, the role of assimilation, the impact of poverty, the importance of Aboriginal self-determination, the Aboriginal relationship to the land, and the associated social problems in Aboriginal communities are not afforded the same level of significance in providing answers or solutions to the problem of the over-incarceration of Aboriginal people. The so-called professional approach rooted in the culture of non-Aboriginal people is both inadequate and inept not just in assessing individual profiles but in providing the help these same individuals may need to overcome some personal needs or problems towards their recovery or future development. In fact, the assessment models and the language of professionals do nothing to transform lives. In many cases they only contribute to demoralizing individual initiative for personal reformation and retrenching a system that tends to keep Aboriginal offenders serving out their time with no hope for rehabilitation, personal growth or development. Listening to the grievances of Aboriginal people leaves little doubt about their reduced hopes and expectations of a system that adopts the wisdom of professionals who in most cases have little to no contact or relationship to Aboriginal people and their communities in their personal lives. Whether existing programs of CSC are appropriate or not, there is also a significant concern that they are not accessible to all Aboriginal offenders. For those Aboriginal offenders who do complete one or more of these Core Programs, there is also the concern that whenever assessments are being made on requests for transfers or other privileges granted to offenders who complete these Core Programs, they do not get the equal recognition and reward accorded to non-Aboriginal offenders who take these same programs. This is not to suggest that these programs are of no benefit at all and norpramin.

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