lhcqf logo 2016


Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science


The manu spection marks without advance ap facturer shall retain one copy of the proval prohibited; exceptions buy proventil 100 mcg amex asthma symptoms not improving. The management of (1) the certificate is a Food Safety the official establishment or establish and Inspection Service form for signa ment certified under a foreign inspec ture by a Program employee and the tion system cheap 100mcg proventil asthma symptoms and treatments, in accordance with sub official establishment ordering the part T of this part discount 100 mcg proventil asthmatic bronchitis attack, must maintain a marking device, bearing a certificate copy of all labeling used, along with serial number and a letterhead and the the product formulation and processing seal of the United States Department procedure, in accordance with subpart of Agriculture. Such records shall be izes the making of only the devices of made available to any duly authorized the type and quantity listed on the cer representative of the Secretary upon tificate. A teria, have developed since the original parent company for a corporation may temporary approval was granted. Indication of final color field, provided the labeling is in accord may be met by: submission of a color with this section and shows all manda sketch, submission of a sketch which tory features in a prominent manner as indicates by descriptive language the required in subpart N of this part, and final colors, or submission with the is not otherwise false or misleading in sketch of previously approved final la any particular. Any finding of false or mis leading feature shall be used without leading labeling shall institute the pro submission for approval as prescribed ceedings prescribed in 381. Any unau material intended for relabeling in thorized use or disposition of approved spected and passed product shall not be labeling or devices bearing official in transported from an official establish spection marks is prohibited and may ment until permission has been re result in cancellation of the approval. The re (b) Labeling and containers bearing labeling of inspected and passed prod any official inspection marks, with or uct with official labels shall be done without the official establishment under the supervision of an inspector number, may be transported from one pursuant to the regulations in part 362 official establishment to any other of of this chapter. The establishment ficial establishment, only if such ship shall reimburse the Inspection Service ments are made with the prior author for any cost involved in supervising the ization of the inspector in charge at relabeling of such product as provided point of origin, who will notify the in in said regulations. All packaging mate at the establishment to which it is rials must be safe for the intended use shipped unless such use conforms with within the meaning of section 409 of the requirements of this subpart. The guaranty must iden applied pursuant to the regulations, tify the material. The Administrator may extend it shall be considered to have been this time where reasonable grounds for given at the date such article was extension are shown, as, for example, shipped by the person who gives the where data must be obtained from sup guaranty. The file shall be made available to Pro a packaging material is finally denied gram inspectors or other Department by the Administrator, the affected offi officials upon request. While in the of cial establishment and the supplier of ficial establishment, the identity of all the material shall be given notice and packaging materials must be traceable the opportunity to present their views to the applicable guaranty. Official distinguishing brand name or code des establishments and packaging sup ignation, of packaging materials that pliers providing written guaranties to have been reviewed and that fail to those official establishments will be meet the requirements of paragraph (a) permitted an opportunity to provide of this section. Listed materials will information to designated Department not be permitted for use in official es officials as needed to verify the basis tablishments. Materials she determines the material may may continue to be used during the re render products adulterated or inju view period. All poultry with the regulations; and unless the products, and all carcasses, parts container of such product is marked so thereof, meat and meat food products as to identify the product as so in of such animals, which are processed or spected and passed, in accordance with otherwise handled at any official estab 381. Upon age and distribution therefrom without such examination, if any such article repackaging, relabeling, or processing or portion thereof is found to be adul in such establishment. No carcass, part terated, such article or portion shall, thereof, meat or meat food product of in the case of poultry products, be con cattle, sheep, swine, goats, or equines demned and disposed of as prescribed in may be brought into an official estab 381. The inspector spected and passed and is identified as in charge shall designate the type of such in accordance with the require plan and the program employee shall ments of the law and regulations of a select the specific plan to be used in State not designated in 331. These sampling plans are devel articles may enter only under condi oped for individual products by the Wash tions approved by the Administrator in ington staff and will be distributed for field specific cases, including but not lim use as they are developed. This list shall also the Administrator to evaluate it to de identify which part of the system will termine whether or not that system is serve to maintain compliance with the adequate to result in product being in applicable regulations. Such information should in Total Plant Quality Control Establish clude, but not necessarily be limited ment. Such new product tional chart showing that such people shall not be produced at that establish ultimately report to an establishment ment after the 6-month period unless official whose quality control respon approval of the quality control system sibilities are independent of or not pre for that product has been received from dominantly production responsibil the Administrator. In the case of a small establish (d)?(e) [Reserved] ment which does not have full-time (f) Labeling Logo. Owners and opera quality control personnel, information tors of official establishments having a indicating the nature of the duties and total plant quality control system ap responsibilities of the person who will proved under the provisions of para graph (c) of this section, may only use, as a part of any labeling, the following applicable depends on factors such as wheth er the product is in containers, stage of prep logo. Any labeling bearing the logo and aration, and procedures followed by the es any wording of explanation with re tablishment operator. The specific plan ap spect to this logo shall be approved as plicable depends on the kind of product in required by subparts M and N of this volved. In those instances where there is a con flict of facts, a hearing, under applica ble Rules of Practice, will be afforded to the establishment owner or oper ator, if requested, to resolve the con flict. An official estab ministrator under the following condi lishment with an approved total plant tions: quality control system may request ap (i) If adulterated or misbranded poul proval for an operating schedule of up try product is found by the to 12 consecutive hours per shift. Per Adminstrator to have been prepared for missions will be granted provided that: or distributed in commerce by the sub (i) the official establishment has sat ject establishment. In such case, oppor isfactorily operated under a total plant tunity will be provided to the estab quality control system for at least 1 lishment owner or operator to present year. In those instances where there hours of inspection shall only be a con is a conflict of facts, a hearing, under tinuation of the processing monitored applicable Rules of Practice, will be af by the inspector and being conducted forded to the establishment owner or during the last hour of inspection. The form of such code (ii) If the establishment fails to com marks will remain constant from day ply with the quality control system to to day, and a facsimile of the code which it has agreed after being notified marks and their meaning shall be pro by letter from the Administrator or his vided to the inspector. Applications shall be opportunity will be provided to the es submitted to the Regional Director and tablishment owner or operator to shall specify how the conditions in present views to the Administrator 381. In order are prepared, except that, upon written to verify that an establishment is pre request, and under such conditions as paring and shipping product in accord may be prescribed by the Adminis ance with the approved total plant trator in specific cases, such products quality control system and the Act and may be moved from the official estab regulations after the 8 hours of inspec lishment prior to freezing: Provided, tion, the official establishment may be That the official establishment and provided overtime inspectiom services freezer are so located and the necessary at the discretion of the circuit super arrangements are made so that the In visor and charged for such services. The lethality process the Department, such samples as are must include a cooking step. Con necessary of any poultry product, or trolled intermediate step(s) applied to other article for use as an ingredient of raw product may form part of the basis any poultry product, at any official es for the equivalency. There can be no mul complies with the requirements of the tiplication of toxigenic microorga regulations.

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The total water transfer results from a combination of traditional diffusion and capillary flow 100mcg proventil with mastercard asthma definition zionism, and is affected by the porosity or void fraction of the fruit [29 100 mcg proventil fast delivery asthma symptoms throat tightness,94] discount 100mcg proventil amex asthma treatment stages. The reduction in pressure causes the expansion and escape of gas occluded in the pores, and pores can be occupied by osmotic solution, thus increasing mass transfer rate. In addition to vacuum, applications of high hydrostatic pressure [79], centrifugal force [4], high electric pulse [1,80], and ultra sound [98] are used to improve the mass transfer [81]. The increased mass transfer in high electric field and high pressure was due to the irreversible increase in cell wall permeability [79], and the initiation and growth of the pores was time dependent [1]. The acoustic increases the mass transfer by reducing the thickness of boundary layer by generating localized pressure fluctuations [36]. Petrotos and Lazarides [70] reviewed osmotic concentration of liquid foods by applying osmotic membrane tech niques, namely, direct osmosis, membrane distillation, and osmotic distillation. This can be avoided by con trolling the solute diffusion and optimizing the process to improve the sensory assessment of the prod uct. Adequate protective edible coating enriched with specific additives could be developed by osmotic process, which reduces surface microbial growth and provides other barrier (such as moisture, oxygen) properties during storage [41]. Edible semipermeable membrane coatings can also be used to reduce solute uptake and increase water loss [13]. Salting of cod fillets was achieved in osmotic solutions (sucrose and salt, or corn starch syrup and salt) with high molecular solutes allowed better control of salt entrance, thus producing light salted fish [18]. However, microbiological and organoleptic validations need to be carried out for complete process validation. The management of syrup is a major challenge to make the process industrially viable. These include syrup composition and concentration, syrup recycling, solute addi tion, reuse of the syrup, and waste disposal. The compositional changes related to leaching from the fruit or vegetable may influence the product quality (color, acids, sugar, minerals, and vitamins). Microbial contamination can increase with the number of times the syrup is recycled. Depending on the environmental process conditions, the microbial load after several osmotic cycles can range from 2 102 cfu/mL to high levels of yeast and fungi only after the 15th cycle and 105 cfu/mL after 8 h of continuous treatment [83]. Over a 6-day processing period, the microbial load of the brine was kept at a low level (8. The options to reduce microbial contamination are: more care for low-acid foods, avoidance of much dilution of solution, use of air filtering system by process ing environment, and hygienic management of osmotic solution [83]. The control of solute composition in recycling for single solute syrup is easier than mixed solute syrups. During the recycling process, the diluted syrup can be reconcentrated by evaporation, reverse osmosis, membrane filtration, freeze concentration, and treated with active carbon [6,19,83]. The unused syrup needs to be adequately treated before disposal in wastewater [6,83]. The syrup-to-fruit mass ratio should be kept as low as possible to reduce production costs. Torreggiani [101] emphasized that the problems of microbial growth in the syrup and the effects of repeated reconcentration and recycling of syrup on its properties need to be overcome to develop large-scale industrial processes. Acidification of sucrose could happen from the acidic fruits, which could increase the osmotic rate; however, this caused darkening and quality losses during the subsequent drying process. The sucrose hydrolysis at pH range of 6?10 was insignificant and did not depend on temperature and sucrose concentration. Sucrose hydrolysis increased significantly and depended on hydrogen ion and sucrose concentration, temperature, and time when pH values were below 5. Further studies are necessary to get a clear understanding of the variation of equilibrium and rate constants with process variables and charac teristics of the food materials. Most of the osmosis studies have been concerned with the qualitative predic tion of the processing factors, but more quantitative prediction is necessary for industrial use in process design and control. Online measurements of syrup properties can provide continuous control of the process. Fruits and vegetables tend to float on the concentrated syrup due to the higher density of the syrup. Moreover, the viscosity of the syrup exerts considerable mass transfer resistance, causing difficulty in agitation and the syrup tends to adhere to the surface of the food material. Breakage of the fruit or vegetable pieces may occur by flow of syrup in case of continuous process or by mechanical agitation in case of batch process. They provided the following parameters that need to be considered: (i) creating rela tive movement between the solution and the food, characterized by relative speed and homogeneity for all the food, (ii) control of treatment time and equipment used for continuous processing, control of the spread of residence times in the contactor to ensure homogeneous treatment of the food, (iii) ability to accept dif ferent shapes of food (whole or in cubes, slices, or fillets), (iv) reduction of the solution mass/food mass ratio (a low mass ratio is of particular interest if the cost of the solution is high; it also restricts equipment size), avoidance of oxidation in food in contact with air, (v) allowing a system for the solution to be intro duced and removed, (vi) allowing the food to be introduced and its subsequent removal (for continuous pro cessing: continuous introduction, and removal of food when it has reached the required state of treatment), (vii) allowing control of the process control parameters (food and solution temperature, solution concen tration, static pressure of food and solution, agitation), (viii) complying with the appropriate mechanical, electrical, and food-related standards, and (ix) a reasonable cost of equipment manufacture. The equilibrium is the end point of osmosis, but for practical purposes a number of other factors should be considered to ensure the quality of the final product. These include damage to the cells and development of off-flavor due to longer processing time and reuse of the syrup [74]. Finally, adequate packaging systems should be used to make sure that the consumers are getting good quality products. Knorr, Kinetics of osmotic dehydration of red bell peppers as influenced by pulsed electric field pretreatment, Food Res. Gerschenson, Air dehy dration of strawberries: effects of blanching and osmotic pretreatments on the kinetics of moisture transport, J.

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The alarm will sound and the alarm? light will fash if the needle or cannula is blocked buy genuine proventil asthma definition for kids, if the fuid bag is empty or if the sensor is incorrectly placed buy proventil 100mcg asthma treatment non steroidal. Correct the problem and press the start? buton to discount proventil 100mcg otc asthma 6 step plan switch of the alarm and to restart the infusion. If the power fails the controller has its own rechargeable batery that should provide power for a few hours. Mercury thermometers should no longer be used in children due to the risk of mercury poisoning if the thermometer should break in the mouth. If a telethermometer is used, the probe is usually placed over the lef, lower abdomen or the lower back. Similarly, excessive heat production or reduced heat loss causes an increased body temperature (fever or pyrexia). Infected and hypoxic infants, therefore, commonly present with a drop rather than a rise in body temperature. Infection in newborn infants causes a fall rather than a rise in body temperature. Infants rapidly lose heat by conduction when placed naked on a cold table, weighing scale or X-ray plate, or are wrapped in a cold blanket or towel. Many people fnd radiation difcult to understand as the loss of heat from a warm to a distant cold object is not afected by the temperature of the surrounding air. Even if the room and incubator are warm, an infant may still radiate heat to a cold windowpane. The following infants commonly lose too much heat and, therefore, may drop their body temperature: 1. Terefore, preterm and underweight for gestational age infants tend to lose heat rapidly. Terefore, preterm infants are born before they are able to build up stores of white fat. Underweight for gestational age and wasted infants also have litle white fat as they have used up their white fat before delivery. Infants in a cold environment may lose heat by conduction, convection, evaporation or radiation. Tey, therefore, expose a greater area of skin for heat loss than do well, term infants who hold their arms and legs fexed against the body. Terefore, a working defnition of hypothermia (low body temperature) is a body temperature below these values. Infants who produce too litle heat or lose too much heat are at the greatest risk. This includes all infants who are likely to produce too litle heat or lose too much heat. The head of the newborn infant loses a lot of heat by radiation as the surface area of the scalp is large, the brain produces a lot of heat and there is litle hair for insulation. All wet infants must be dried immediately and then wrapped in another, warm, dry towel. Monitor the skin or axillary temperature in all infants who are at an increased risk of hypothermia. The lower the weight and the earlier the gestational age, the higher is the required environmental temperature. Infants that are underweight for gestational age or wasted also need a higher environmental temperature. The environmental temperature for each infant should be adjusted in order to give a normal abdominal skin or axillary temperature. Infants gain weigh fastest when they are kept at the correct environmental temperature. The environmental temperature should be adjusted to give a normal axillary or skin temperature. The infant can be kept warm by covering the body with an insulating layer and, thereby, preventing heat loss by convection to cold air and radiation to cold objects in the room. Never put a cold infant into a thermal blanket or use a thermal blanket in an incubator. A transparent perspex shield can be placed over an infant in an incubator to reduce heat loss by radiation. Tere is no excuse for an infant ever becoming hypothermic because hypothermia is preventable. Skin-to-skin care by the mother, father, family member, nurse, doctor or paramedic is always available. Teir hands and feet are usually pale or blue, but their tongue and cheeks are pink. This is a common cause of death in cold infants and the most important complication of hypothermia. Hypothermia also increases the oxygen needs of the body and this make the hypoxia worse. The resultant anaerobic metabolism of glucose causes an excess lactic acid production. Energy can be given as oral or nasogastric milk, or intravenous maintenance fuid containing 10% dextrose water. A normal oxygen saturation in a cold infant does to exclude tissue hypoxia as oxygen is trapped in the red cells. If intravenous fuid is given, add 10 ml 4% sodium bicarbonate to 100 ml of maintenance fuid (Neonatalyte).

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The statement application buy proventil 100mcg online asthma symptoms joint, either a statement that shall address why the use of the term as pro the investigation was conducted in posed will not be misleading order discount proventil on line asthma treatment crossword clue. The statement shall also specify the level at which the nu view or deny the labeling application purchase proventil pills in toronto asthma definition 90937. This explanation the written notification shall state the shall also state what nutritional benefit to reasons therefor, including why the the public will derive from use of the claim Agency has determined that the pro as proposed and why such benefit is not posed nutrient content claim is false or available through the use of existing terms misleading. The validation Administrator shall file with the Hear data shall include a statistical analysis of ing Clerk of the Department the notifi the analytical and product variability. The proposal shall also summa States Court of Appeals for the District rize the labeling application, including of Columbia Circuit. The notification letter an existing term that has been defined under subpart Y of part 381). The statement shall address why the (A) If the applicant fails to accept use of the synonymous term as proposed will the determination of the Adminis not be misleading. The statement shall pro trator and files an answer and requests vide examples of the nutrient content claim a hearing, and the Administrator, after as it will be used on labels or labeling, as review of the answer, determines the well as the types of products on which the claim will be used. The statement shall also initial determination to be correct, the specify whether any limitations not applica Administrator shall file with the Hear ble to the use of the defined term are in ing Clerk of the Department the notifi tended to apply to the use of the synony cation, answer, and the request for a mous term. The statement and files an answer and requests a shall address why the use of the brand-name hearing, and the Administrator, after as proposed will not be misleading. The review of the answer, determines the statement shall provide examples of the initial determination to be correct, the types of products on which the brand name Administrator shall file with the Hear will appear. It shall also include data show ing that the actual level of the nutrient in ing Clerk of the Department the notifi the food would qualify the label of the prod cation, answer, and the request for a uct to bear the corresponding term defined hearing, which shall constitute the by regulation. Any such determination and scientific data sufficient for such pur by the Secretary shall be conclusive pose. The notice shall also (3) Upon review of the labeling appli summarize the labeling application, in cation and supporting documentation, cluding where the supporting docu the Agency shall notify the applicant, mentation can be reviewed. After the written notification shall state the public comment has been received and reasons therefor, including why the reviewed by the Agency, the Adminis Agency has determined that the pro trator shall make a determination on posed implied nutrient content claim is whether the implied nutrient content false or misleading. The notification claim shall be approved for use on the letter shall inform the applicant that labeling of poultry products. Any product false or misleading, and the product is that purports to be or is represented labeled low calorie? or reduced cal for special dietary use because of use orie? or bears another comparative cal fulness in reducing body weight shall orie claim in compliance with the ap bear: plicable provisions in this subpart. Criteria for the use of the or nutrition information, terms sugar free? and no added (4) Products in small packages that sugar? are provided for in 381. The man size packages of poultry products that ufacturer, packer, or distributor shall have a total area available to bear la provide, on the label of packages that beling of 3 square inches or less may qualify for and use this exemption, an provide all required information in a type size no smaller than 1? The avail ability of records, including electronic questing records or information from records created on or after November 1, the Agency. Similarly, the annual reports to its regulatory responsibilities and will refer to the handbook and how to administrative procedures are pub obtain it. Most of these in a reading area, on business days be publications are available free from the tween the hours of 8: 30 a. The request will be considered the Administrator of the Food Safe as having been received on the date of ty and Inspection Service will make arrival in the office of the Coordinator publicly available the names and loca or designee. Any person whose request tions of retail consignees of recalled for records has been granted may in meat or poultry products that the spect and copy the records (or copies) Agency compiles in connection with a at the office listed in 390. The overtime and holiday rate for in (c) Information disclosed under this spection services provided pursuant to section is not a disclosure of informa 307. For purposes of this part, a peti the rate for laboratory services pro tion? is a written request to issue, vided pursuant to 350. A request to issue, hour per program employee in fiscal amend, or repeal a document that in year 2006, $69. Lighting of good quality sufficient to prevent the creation of in and sufficient intensity to ensure that sanitary conditions and to ensure that sanitary conditions are maintained and product is not adulterated. Plumbing systems must prevent the harborage and breeding of be installed and maintained to: pests on the grounds and within estab (1) Carry sufficient quantities of lishment facilities. Pest control sub water to required locations throughout stances used must be safe and effective the establishment; under the conditions of use and not be (2) Properly convey sewage and liquid applied or stored in a manner that will disposable waste from the establish result in the adulteration of product or ment; the creation of insanitary conditions. Reuse that which has come sewage and piping systems that carry into contact with raw product may not water for product manufacturing; and be used on ready-to-eat product. Sewage must be has been treated by an onsite advanced disposed into a sewage system separate wastewater treatment facility may be from all other drainage lines or dis used on raw product, except in product posed of through other means suffi formulation, and throughout the facil cient to prevent backup of sewage into ity in edible and inedible production areas where product is processed, han areas, provided that measures are dled, or stored. When the sewage dis taken to ensure that this water meets posal system is a private system re the criteria prescribed in paragraph quiring approval by a State or local (g)(1) of this section. For example, such reuse water cleaning rooms and equipment, uten may be used to move heavy solids, to sils, and packaging materials, for em flush the bottom of open evisceration ployee sanitary facilities, etc. They must other physical, chemical, and micro be separate from the rooms and com biological contamination have been re partments in which products are proc duced to prevent adulteration of prod essed, stored, or handled. Such chemicals must structed and maintained in a manner be used, handled, and stored in a man that protects against the creation of ner that will not adulterate product or insanitary conditions and the adultera create insanitary conditions. Clean garments must be worn and construction that their use will at the start of each working day and not result in the adulteration of any garments must be changed during the edible product or in the creation of in day as often as necessary to prevent sanitary conditions. Such receptacles adulteration of product and the cre must not be used for storing any edible ation of insanitary conditions.

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When asked to cheap 100mcg proventil visa asthma definition socialism consume a milkshake before the taste test purchase 100mcg proventil amex asthma from bronchitis, dieters consume a lot more during the taste test than nondieters proventil 100mcg with visa asthma symptoms upper back pain. This efect has been demonstrated and replicated by a number of labs (Heatherton & Baumeister, 1991; Ruderman, 1986). However, increased food consumption in these studies does not necessarily constitute a binge-eating episode, and dieters do not necessarily sufer from eating disorders. Heinberg and T ompson (1995) randomly assigned women to view television commercials containing either appearance related images or non?appearance-related images. Women in the appearance-related condi tion reported signifcantly greater body dissatisfaction afer watching the commercials than did women in the non?appearance-related condition. Stice and Shaw (1994) randomly as signed women to view magazine pictures of very thin models, models with average builds, or no models. Women assigned to view pictures of very thin models reported signifcantly greater body dissatisfaction than did women assigned to the other two conditions. Recently, Mabe, Forney, and Keel (2014) examined the infuence of Facebook use on preoccupation with weight or shape using an experimental design. This study sought to understand how recent changes in media consumption from traditional print magazines to images avail able through social media may or may not infuence body image concerns. College women with Facebook accounts were randomly assigned to spend either 20 minutes on Facebook or 20 minutes in a control condition in which they read about the ocelot on Wikipedia and viewed a brief video clip about this rain-forest animal. Weight/shape preoccupation was mea sured before and afer the experimental manipulation. Compared with women in the con trol condition, women using Facebook reported greater levels of weight/shape preoccupation afer the 20-minute period. This fnding suggests that social media merges widespread cul tural infuences (see Chapter 5) and peer infuences (see Chapter 6) to infuence eating disor der risk by providing women with constant access to viewing friends? favorite celebrities, most fattering photos of themselves, and intentions to diet and exercise. Notably, none of these three studies demonstrated that media images caused eating disorders. However, the studies do provide evidence that media exposure contributes to weight concerns among women. Mills, Polivy, Herman, and Tiggemann (2002) compared the attitudinal and behav ioral responses of dieters and nondieters to exposure to images showing bodies representing the thin ideal. Dieters who were exposed to thin-ideal images described their current and ideal body size as being smaller and increased their food intake; no such changes were seen either in dieters who were not exposed to these images or in nondieters regardless of whether or not they had seen the images. In addition to demonstrating a causal relationship between exposure to media images of idealized bodies and actual eating behaviors, this study sug gested that dieting may increase vulnerability to the efects of media exposure. Clinical Experimental Studies Clinical experimental studies seek to understand the mechanisms that underlie the presence of eating disorders by comparing individuals diagnosed with an eating disorder with indi viduals without eating disorders. As such, they do not experimentally study the new onset of eating disorders but can reveal factors that may contribute to illness maintenance. One example of this type of study involves experimentally manipulating a biological factor and measuring the efects on other variables (including biological and behavioral in dices). Half the women in each group were randomly assigned to complete the trytophan session frst. These and similar fndings support a model for the development of bulimic symptoms in which dieting causes decreased tryptophan levels, which contribute to decreased sero tonin function, which contributes to the emergence of binge-eating episodes (Wurtman & Wurtman, 1986). The frst as sessment involved questionnaires and interviews that would require two to four hours to complete. The second assessment involved having blood drawn once before and twice afer consuming a liquid meal. For participating, she would be paid $150 and she would receive the results of the bone scan. Because her doctor planned to have Emily get a bone scan, Emily decided that she might as well get paid to have the procedure done; in addition, she fgured she would be contributing to science. Clinical treatment trials represent a second experimental study design?one with implica tions for understanding factors that may contribute to the maintenance of eating disorders. Treatment condition is the independent variable, and eating disorder remission is the de pendent variable. If the study fnds that certain factors contribute to remission of eating dis order symptoms, then inferences may be made about the contributions these factors make to eating disorders. These results have been interpreted to support the role of cognitions and behaviors in the development of eating disorders (see Chapter 7). A caveat to using clinical treatment studies to understand the causes of eating disor ders is that curative factors are not necessarily related to causative factors. The classic ex ample is that aspirin may be efective in treating a headache even though the headache was not caused by an aspirin defcit. A drug that had been successful in treating patients with type 2 diabetes was going to be examined in patients with night eating syndrome. George understood that he would be randomly assigned to receive either the active medication or a placebo and that neither he nor the physician managing his medicine would know what he was actually taking. George did not mind these limitations, because he knew that he had a 50/50 chance of getting the active medication and that at the conclusion of the study he would be ofered the medication if it increased remission compared to the placebo. He also knew that the medication would be ofered to all participants if dramatic positive results were seen before the study was meant to be concluded. The medication was associated with some minor side efects that were known to diminish over time. More serious reactions had developed in some instances; however, these severe reactions were very rare, and George would be monitored very closely throughout the study. Unlike most other weight loss programs George was considering, the treatment study was free?and besides, it might work.


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