Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
To understand the difference between using mature specialized cells or stem cells from cloning dutasteride 0.5 mg line hair loss kittens, we need to examine the process of cell replication buy 0.5 mg dutasteride with amex kingsley hair loss cure. As the embryo grows into a more fully functioning organism purchase dutasteride 0.5mg overnight delivery hair loss after weight loss, its cells begin to take on more specialized characteristics, and begin to divide less. As cells become more specialized, cell replication shifts to special precursor cells called stem cells. Mature specialized cells do not replicate easily, probably as a defense against cancer, which is characterized by uncontrolled cell division. Some cells only last for days; others for years, and others for decades, but eventually all cells wear out. The inability of mature cells to replicate themselves limits the body?s ability to repair itself, to heal wounds and to replace aging cells. In mature organisms, undifferentiated cells called stem cells are responsible for replacing old or injured specialized cells. Stem cells are present in all self-repairing tissue, but most stem cells are difficult to detect in a mature living organism. Stem cells in a mature organism are like embryonic cells, in that they can create many different types of specialized cells. But when they are signaled to make new cells of a particular type, they produce typically short-lived intermediate cells called transient amplifying cells, which in turn engage in rapid cell mitosis and create the specialized cells that the organism needs. For a quick review, we?ve learned that cells make up tissue and organs, which make organisms. When an organism needs new specialized cells, stem cells are signaled to create transient amplifying cells, which in turn make the needed specialized cells. Each of these four methods will be described and evaluated as a possible basis for commercial hair follicle cloning. The egg was fooled into thinking it was fertilized, and that it should grow into an organism. The process is much more involved than this summary describes, and there were many failures 195 Chapter Eighteen along the way. But if we just want some hair follicles, cloning an entire living organism from a donor cell is a bit excessive. While a fascinating genetic exercise, the Dolly the Sheep method is too complicated and costly for commercial hair follicle cloning. Another method, which is inadvertently used in almost every micrograft hair transplant procedure, is a lot easier. Surgeons have observed that when a hair follicle is accidentally cut in half, one piece, Cloning follicles by ?splitting hairs 196 Future Hair Loss Treatments and sometimes both pieces of the follicle, will survive and grow a new hair if the follicle is transplanted back into the donor. Micrograft surgeons routinely place cut follicles back into the patient?s scalp, although they don?t generally ?count the cut follicles as ?grafts. If a follicle is cut in half to form top and bottom pieces, and both pieces are placed back in the scalp, the bottom half (with the hair bulb) will sometimes survive and grow a hair. The top half (with the bulge) will sometimes survive and grow a new bottom half containing a new hair bulb, and that half also eventually grows a new hair. This process is similar to the hair follicle creation that occurs at the beginning of the normal hair follicle growth phase. If the follicle is cut lengthwise, two surviving follicles can result, although they may produce finer hairs than the original full-size follicle. Survival rates of transected hair follicles is lower than follicles that are not cut in half, so hair restoration surgeons continue to take great care to avoid cutting follicles. The reason the splitting hairs methods works when the cut follicle pieces are placed back into the scalp, is that other nearby hair follicle stem cells probably help with the cell regeneration process. But with improved methods to signal cell regeneration, and ultimately improved transected follicle survival rates, this crude cloning technique has some promise for the immediate future. Recently the commercialization of cloning mature skin cells has been accomplished. To make an Apligraf patch, human skin cells derived from infant foreskins are cultured in a growth medium and are allowed to differentiate into some of the types of cells that form mature human skin. Apligraf skin does not contain pigment cells, blood vessels, sweat glands, or hair follicles, but it does have the types of cells that are 197 Chapter Eighteen typically found in the upper and lower layers of skin. Replicating skin cells is much less complicated than replicating entire hair follicles. The approval and commercialization of this mature cell cloning process is very encouraging for future hair follicle cloning. Because hair follicles are miniature organs composed of several different types of specialized cells, they are difficult to clone and even more difficult to assemble properly. The trick to hair follicle cloning will be signaling hair follicle stem cells to make and assemble all the cells needed for a hair follicle. In 1993, United Kingdom researchers Jahoda and Reynolds published a paper in the Journal of Investigative Dermatology describing their success in growing a rat whisker in a live rat from cultured rat dermal papilla cells. The dermal papilla cells are found in the hair matrix in the bulb of the hair shaft, and they are the cells that grow hairs. For many years it was believed that the hair follicle bulb contained the stem cells necessary for hair follicle growth. The researchers removed dermal papilla cells from a rat whisker hair follicle bulb, cultured the cells in a growth medium, and created thousands of dermal papilla cell clones.
Oropharyngeal stenosis leading to an unanticipated diffcult airway in a patient after uvulopalatopharyngoplasty: a case report and review of the A case report of a huge tongue mucocele in a child in literature cheap dutasteride generic hair loss in men burning. Learning points: Our case highlights the importance of early recognition of oropharyngeal stenosis a rare complication of upper airway surgery in order to plan 1 2 airway management appropriately generic dutasteride 0.5 mg free shipping hair loss 30 year old woman. Case Report :A case of a huge mucocele affecting the anterior aspect of the Yalcin N generic 0.5 mg dutasteride hair loss in men 4 men. Training Research Hospital,Neurosurgery Clinic Istanbul (Turkey) Airway management was the main concern as fberoptic bronchoscpy and video assisted laryngoscopy were unavailable, elective tracheostomy was not an option Background: Securing the pediatric airway is a critical skill for the anesthetists. In this case the patient had drooling through the nose, inability to feed, diffculty swallowing report, we aim to emphasize successful airway management with Glidescope video and distress. General Anesthesia induced through a T-Piece breathing circuit using laryngoscope in pediatric patient with anatomic defect such as cleft lip and palate, halothane with nasotracheal tube placed and the level of anesthesia deepened with considering the risk of diffcult laryngoscopy and intubation. Discussion: Mucoceles are one of the most common lesions affecting the oral In physical examination, it was observed that the patient had severe cleft lip and cavity that usually result from trauma and most commonly affect the lower lip, foor palate. With the help of Glidescope titanium lopro T3 blade video laryngoscope, of the mouth and ventral surface of the tongue with a peak incidence age between tracheal intubation was performed in the frst attempt and without desaturation in 10-20 years , the treatment involves surgical excision and marcipulization of the the patient by 3. Anesthesiolgists are not usually concerned with was extubated at the end of the operation (Figure 1). Wanderley, ?Mucocele of the lower lip in a 1 year old child, Pediatric Dentistry, vol. He had medical history of severe obstructive sleep apnea and underwent robotic lingual and palatine tonsillectomy. Postoperatively, there was complication of oropharyngeal stenosis with revision pharyngoplasty performed. A nasopharyngeal airway was inserted to maintain airway In the study of pediatric diffcult airways made by Karsl? Nasal fbreoptic bronchoscopy also showed that airway was palate repairs: An audit of 1000 cases under ?Smile Train Project?. Pre-operative in literature as a diffcult airway, has successfully provided airway management in laryngofberscopy will allow assessment of the site and severity of obstruction our case. In event the airway must be secured in a patient with oropharyngeal stenosis, nasal fbreoptic intubation represents a viable option. Unanticipated diffcult airway due to undiagnosed oropharyngeal stenosis: a case report. We decided to do videolaryngoscopy because of the hoarseness and realized a laryngeal web which was narrowing the lumen. At the end of the orthopedic procedure rocuronium was reversed with 2mg/kg sugammadex and patient was extubated successfully. There Safe intubation with videolaryngoscope in a were no respiratory complications. Patients may be misdiagnosed as asthma because of similar symptoms aspiration of gastric contents after several intubation like dyspnea. Incidental laryngeal web simulating intra-operative refractory Universitario de Getafe Madrid (Spain) bronchospasm. Learning points: Laryngeal webs may cause diffcult intubation and if they do, Background: recognition and management of the diffcult airway remain a core use of videolaryngoscopy and small sized endotracheal tubes can make intubation skill in the practice of Anesthesiology. After recording of baseline vital signs, patient received Background: the effcacy of videolaryngoscopy for the management of predictable oxygen (O2) at 3 liters per minute via a nasal cannula. The aim of this of success when performing the intubation, the upper airway was suffciently present case is to discuss the advantages/disadvantages associated with the anesthetized with airway topical anesthesia for the comfort of the patient and use of videolaryngoscopes in management of awake patient in comparison with subsequent successful instrumentation. We used sevofurane to perform a General Anesthesia due to aggravation of dysphonia and dyspnea. We expansive lesion, occupying the posterior laryngeal lumen (only 5 mm of free lumen), deemed an acceptable anesthesia when patient appeared comfortable, and was with 3 cm of extension (fgure 1). Steroid therapy was started, the antiaggregation breathing 10-15 breaths per minute. The patient was lack of reaction to insertion of was suspended and she was admitted for elective biopsy. Because of respiratory the Airtraq blade, and intubation was performed successfully, safety and effectively. But, in some patients we can perform a General Anesthesia wit initial strategy to approach the airway was orotracheal intubation with the awaken spontaneous ventilation maintaining muscle tone. In this patient, we did not suspect patient by fbroscopy, without sedation, only local anesthesia with 2% lidocaine. A a diffcult intubation, and our only concern was to maintain the muscular tone of pediatric fbroscope (3. Fibroscopy intubation was not achieved Topicalization of the oropharynx, spontaneous breathing and seated position by the diffculty in orienting the fbroscope through the lesion. Discussion: Videolaryngoscopy is an effective alternative to fbroscopy in awaken patients, since it allows a global view of the entire glottic structure. The choice of the fbroscopic pediatric, due to its diameter and greater fexibility, made it impossible to overcome the lesion with the available space. The use of fbroscopy in the context of tumor lesions may also be hampered by the possibility of hemorrhage associated with tissue friability. Learning points: It is essential requesting for help and the prior defnition of the strategy to adopt and knowledge of available material. Checking the soundness of nasal structures is recommended, with tracheostomy: Case report when multiple attempts were made even if there is no signs of trauma. Anesthesiologists should always anticipate diffculties in airway management and every patient should Anesthesia for Flexible Bronchoscopy; Intravenous be individually evaluated and prepared. He 1 1 1 1 was diagnosed with adenocarcinoma in right superior lobe and planed for lobectomy Eftekhar N.
Pharmaceutical Considerations regarding chart of Acceptable Combinations of Diabetes Medications purchase cheap dutasteride line hair loss on lower leg. Medical Policy In Pharmaceuticals buy dutasteride cheap hair loss in men 0ver30, revise chart of Acceptable Combinations of Diabetes Medications regarding Bydureon and Beta-Blockers order dutasteride 0.5mg hair loss questions. Administrative In Pharmaceuticals (Therapeutic Medications), Malaria, reorder category content. Medical Policy In Pharmaceuticals, (Therapeutic Medications), Sleep Aids, revise to include warning on eszopiclone. Neurologic, In the dispositions table, change ?Dystonia musculorum deformans" to "Dystonia primary or secondary. Medical Policy In Acceptable Combinations of Diabetes Medications Chart, revise to add alogliptin (Nesina). Medical Policy In Decision Considerations, Disease Protocols Graded Exercise Stress Test Requirements, revise to remove hyperventilation requirement from testing. Medical Policy In Pharmaceuticals (Therapeutic Medications) revise to include chart of Acceptable Combinations of Diabetes Medications. Revise Colitis 463 Guide for Aviation Medical Examiners Dispositions Table and Colitis Special Issuance criteria to reflect the change. Medical Policy In Disease Protocols, Cardiovascular Evaluation, revise to clarify criteria. Medical Policy In Disease Protocols, Coronary Heart Disease, revise to clarify criteria. Medical Policy In Disease Protocols, Graded Exercise Stress Test Requirements, revise to clarify criteria. Medical Policy In Pharmaceuticals (Therapeutic Medications) Anticoagulants and in Disease Protocols Thromboembolic Disease, revise to policy include required wait time after initial start of warfarin (Coumadin) treatment. Medical Policy In Pharmaceutical (Therapeutic Medications), Acne Medications, revise policy to 464 Guide for Aviation Medical Examiners include language on use of topical acne medications, such as Retin A, and oral antibiotics, such as tretracycline. Neurologic, revise the Cerebrovascular Disease dispositions table to expand on criteria for Transient Ischemic Attack, Completed Stroke (ischemic or hemorrhagic), and Subdural, Epidural or Subarachnoid Hemorrhage. Medical Policy In Disease Protocols listing, rename ?Substances of Dependence/Abuse (Drugs and Alcohol) to ?Psychiatric Substances of Dependence/Abuse (Drugs and Alcohol. Administrative Add updated link for the International Standards on Personnel Licensing. Medical Policy In Pharmaceuticals, Malaria Medications, update policy information regarding the use of mefloquine. Medical Policy In Special Issuances, update policy for prednisone usage for treatment of Asthma, Arthritis, Colitis, and/ or Chronic Obstructive Pulmonary Disease. Medical Policy In Special Issuances, revise introductory language to clarify requirements for deferral. Specifically if ?the applicant does not meet the issue criteria in the Aerospace Medicine Dispositions Tables or the Certification Worksheets. G-U System Neoplastic Disorders, revise dispositions table language from ?Any other G-U Neoplastic Disorder to ?All G-U cancers when treatment was completed less than 5 years ago or for which there is a history of metastatic disease. Medical Policy In Pharmaceuticals, add information page on Sleep Aids, including wait times. Heart Syncope, correct typographical error: bilatcarotid Ultrasound to bilateral carotid Ultrasound. G-U System Neoplastic Disorders, revise dispositions table to include criteria for ?All G-U Cancers when treatment was completed more than 5 years ago and there is no history of metastatic disease. Medical Policy Revise language in all Certification Worksheets: (Arthritis, Asthma, Renal Cancer, Glaucoma, Hepatitis C, Hypertension, Hypothyroidism, Migraine Chronic Headaches, and Pre Diabetes) to add ?Applicants for firstor secondclass must provide this information annually; applicants for third-class must provide the information with each required exam. Spine and Other Musculoskeletal, revise Arthritis Worksheet to include link to steroid conversion calculator. General Systemic Pre-Diabetes, Diabetes, Metabolic Syndrome, and/or Insulin Resistance, revise dispositions table to include Polycystic Ovary Syndrome. General Systemic Pre-Diabetes, Diabetes, Metabolic Syndrome, and/or Insulin Resistance, revise PreDiabetes Worksheet to include Polycystic Ovary Syndrome. Administrative In Archives and Modifications, change title to ?Archives and Updates. Spine and Other 468 Guide for Aviation Medical Examiners Musculoskeletal, revise dispositions table for Arthritis. G-U System Neoplastic Disorders, revise dispositions table for Prostatic, Renal, and Testicular Carcinomas. General Systemic Endocrine Disorders, revise dispositions table for Hypothyroidism. Neurologic 469 Guide for Aviation Medical Examiners Headaches, revise dispositions table for Migraine and Chronic Headache. General Systemic Diabetes, Metabolic Syndrome, and/or Insulin Resistance, revise dispositions table to add Pre-Diabetes. In Disease Protocols, delete protocol for Medication Controlled Metabolic Syndrome (Glucose Intolerance, Impaired Glucose Tolerance, Impaired Fasting Glucose, Insulin Resistance, and Pre-Diabetes) 12. In Disease Protocols, revise Diet Controlled Diabetes Mellitus and Metabolic Syndrome. Also, in Pharmaceuticals section, revise name of protocol link to reflect title change. In Pharmaceuticals, Antihypertensives, change name of protocol link from Hypertension Protocol to Hypertension Worksheet. Medical Policy In Disease Protocols, add Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
If large defects are left untreated over many years buy discount dutasteride 0.5mg on line hair loss 8 months after pregnancy, the pressures in the right heart and in the lungs will increase dutasteride 0.5 mg cheap hair loss in men rat, the heart will become enlarged and thickened order dutasteride 0.5 mg otc hair loss gastric bypass, and a severe condition called pulmonary hypertension may occur. X-ray images and a transesophageal or intracardiac echocardiogram are used to guide the delivery of the device. A special sizing balloon can be used to measure the ?stretched diameter of the defect so the most apFigure 10a: Picture in Figure 10b: Two devices propriate size device is selected for the best ft. Once the device is in septum or ventricular nifcant fow left through the proper position, it?s released. The right ventricle on mild blood thinner such as aspirin for about six months while the body *). These holes allow no longer flls from the left for blood to go from the ventricle. This vessel is present in all newborn infants; it should close within a few days after birth. However, in some patients, this vessel remains open and shunts blood away from Figure 11a: Picture in aorta Figure 11b: A coil is imFigure 11c: After delivery of the aorta to the pulmonary artery. Your child won?t need to take additional medications such as aspirin after this procedure. Aorto-Pulmonary Collaterals these are abnormal blood vessels that go from the aorta (the large artery that supplies oxygenated blood to the body) to the pulmonary arteries (which are blood vessels that take used blood from the heart back to the lungs for oxygen). As a result, some oxygen-poor blood gets into the body and mixes with the oxygen-rich blood. These collaterals are mostly found in patients after surgery for a single ventricle. Arterio-Venous Malformations Arteries are vessels that bring oxygenated blood to the body. Arterio-venous malformations are generally a network of abnormal blood vessels that communicate between arteries and veins. After Catheterization When your child arrives in the recovery area, he or she will be monitored closely. If your child was put to sleep using general anesthesia, the breathing tube will be removed as soon as your child is breathing on his own. It?s important to let your child lie quietly to prevent bleeding at the catheterization site. If nausea or vomiting occurs, the oral fuids may be continued for a period of time before your child tries to eat again. Discharge After many therapeutic cardiac catheterizations, patients can be discharged later that same day. Before your child leaves to go home, your doctor or nurse will give you instructions on how to take care of the dressing and the insertion site. Generally, this site should be kept clean and dry and watched for signs of infection such as redness, swelling, tenderness and drainage. There may be bruising and mild discomfort where the catheter was inserted, but this usually goes away in the next few days. It?s not uncommon to have a low-grade fever for the frst 24 hours after a catheterization. You?ll be given instructions about how to take care of the fever or discomfort, when to bathe or swim, and what kinds of activities to avoid. For infants, the diaper should be kept dry for the frst few days after the procedure to avoid contamination at the catheter insertion site. If you have any questions or concerns about your child?s health, feel free to contact your cardiologist. This metal can be bent out of shape (such as by being squeezed into a tiny catheter) and then, when it?s released, it will spring back to its original shape. The device is made of a patch material supported by a fexible nitinol wire with circular shape. It?s made of fexible loops of stainless steel and has a mesh of Dacron fbers attached to it to enhance occlusion. The information in this report is intended to help health care decisionmakers?patients and clinicians, health system leaders, and policymakers, among others?make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. Technical Brief Number 2 Percutaneous Heart Valve Replacement Prepared for: Agency for Healthcare Research and Quality U. None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. A Technical Brief provides an overview of key issues related to a clinical intervention or health care service?for example, current indications for the intervention, relevant patient population and subgroups of interest, outcomes measured, and contextual factors that may affect decisions regarding the intervention. Technical Briefs generally focus on interventions for which there are limited published data and too few completed protocol-driven studies to support definitive conclusions.
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See the Medicare Benefit Policy Manual purchase dutasteride 0.5 mg mastercard hair loss cure exfoliating, chapter 11 purchase dutasteride cheap online hair loss cure quiet, section 90 and chapter 15 order dutasteride 0.5mg free shipping hair loss cure 4 cancer, section 50. General Prostate cancer is the most common non-cutaneous cancer in men in the United States. In 2009, an estimated 192,280 new cases of prostate cancer were diagnosed and an estimated 27,360 deaths were reported. The National Cancer Institute states that prostate cancer is predominantly a cancer of older men; the median age at diagnosis is 72 years. Once the patient has castration-resistant, metastatic prostate cancer the median survival is generally less than two years. The posited mechanism of action, immunotherapy, is different from that of anti-cancer chemotherapy such as docetaxel. This exposure "trains" the white blood cells to target and attack the prostate cancer cells. Clinically, this is expected to result in a decrease in the size and/or number of cancer sites, an increase in the time to cancer progression, and/or an increase in survival of the patient. Most such anti-cancer therapies are manufactured and sold by a biopharmaceutical company and then purchased by and dispensed from a pharmacy. In contrast, once the decision is made to treat with sipuleucel-T, a multi-step process is used to produce sipuleucel-T. Sipuleucel-This made individually for each patient with his own white blood cells. General Stem cell transplantation is a process in which stem cells are harvested from either a patient?s (autologous) or donor?s (allogeneic) bone marrow or peripheral blood for intravenous infusion. Hematopoietic stem cells are multi-potent stem cells that give rise to all the blood cell types; these stem cells form blood and immune cells. A hematopoietic stem cell is a cell isolated from blood or bone marrow that can renew itself, differentiate to a variety of specialized cells, can mobilize out of the bone marrow into circulating blood, and can undergo programmed cell death, called apoptosis a process by which cells that are unneeded or detrimental will self-destruct. When bone marrow or peripheral blood stem cell transplantation is covered, all necessary steps are included in coverage. When bone marrow or peripheral blood stem cell transplantation is non-covered, none of the steps are covered. These disorders are varied with regard to clinical characteristics, cytologic and pathologic features, and cytogenetics. In addition, the clinical study must adhere to the following standards of scientific integrity and relevance to the Medicare population: a. The research study is sponsored by an organization or individual capable of executing the proposed study successfully. All aspects of the research study are conducted according to appropriate standards of scientific integrity (see. The research study protocol specifies the method and timing of public release of all pre-specified outcomes to be measured including release of outcomes if outcomes are negative or study is terminated early. If a report is planned to be published in a peer-reviewed journal, then that initial release may be an abstract that meets the requirements of the International Committee of Medical Journal Editors. However a full report of the outcomes must be made public no later than 3 years after the end of data collection. If the inclusion and exclusion criteria are expected to have a negative effect on the recruitment or retention of underrepresented populations, the protocol must discuss why these criteria are necessary. The rationale for the study is well supported by available scientific and medical evidence. The study results are not anticipated to unjustifiably duplicate existing knowledge. The study design is methodologically appropriate and the anticipated number of enrolled subjects is sufficient to answer the research question(s) being asked in the National Coverage Determination. The study is sponsored by an organization or individual capable of completing it successfully. The research study protocol specifies the method and timing of public release of all prespecified outcomes to be measured including release of outcomes if outcomes are negative or study is terminated early. The results must be made public within 12 months of the study?s primary completion date, which is the date the final subject had final data collection for the primary endpoint, even if the trial does not achieve its primary aim. Final results must be reported in a publicly accessibly manner; either in a peer-reviewed scientific journal (in print or on-line), in an on-line publicly accessible registry dedicated to the dissemination of clinical trial information such as ClinicalTrials. The study protocol explicitly discusses how the results are or are not expected to be generalizable to affected beneficiary subpopulations. This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those in responsive relapse; and. Other All other indications for stem cell transplantation not otherwise noted above as covered or non-covered remain at local Medicare Administrative Contractor discretion. Inpatient Hospital Stay for Alcohol Detoxification Many hospitals provide detoxification services during the more acute stages of alcoholism or alcohol withdrawal. Generally, detoxification can be accomplished within two to three days with an occasional need for up to five days where the patient?s condition dictates. This limit (five days) may be extended in an individual case where there is a need for a longer period for detoxification for a particular patient. In such cases, however, there should be documentation by a physician which substantiates that a longer period of detoxification was reasonable and necessary. When the detoxification needs of an individual no longer require an inpatient hospital setting, coverage should be denied on the basis that inpatient hospital care is not reasonable and necessary as required by ?1862(a)(l) of the Social Security Act (the Act). Following detoxification a patient may be transferred to an inpatient rehabilitation unit or discharged to a residential treatment program or outpatient treatment setting. Inpatient Hospital Stay for Alcohol Rehabilitation Hospitals may also provide structured inpatient alcohol rehabilitation programs to the chronic alcoholic. These programs are composed primarily of coordinated educational and psychotherapeutic services provided on a group basis.