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Dermatitis radiation Faint erythema or dry Moderate to brisk erythema; Moist desquamation in areas Life-threatening Death desquamation patchy moist desquamation, other than skin folds and consequences; skin necrosis mostly confined to skin folds creases; bleeding induced by or ulceration of full thickness and creases; moderate minor trauma or abrasion dermis; spontaneous bleeding edema from involved site; skin graft indicated Definition: A finding of cutaneous inflammatory reaction occurring as a result of exposure to biologically effective levels of ionizing radiation. Fall Minor with no resultant Symptomatic; noninvasive Hospitalization indicated injuries; intervention not intervention indicated indicated Definition: A finding of sudden movement downward, usually resulting in injury. Fallopian tube anastomotic Asymptomatic; clinical or Symptomatic; medical Severe symptoms; radiologic, Life-threatening Death leak diagnostic observations only; intervention indicated endoscopic or elective consequences; urgent intervention not indicated operative intervention operative intervention indicated indicated Definition: A finding of leakage due to breakdown of a fallopian tube anastomosis (surgical connection of two separate anatomic structures). Fallopian tube perforation Asymptomatic diagnostic Symptomatic and intervention Severe symptoms; elective Life-threatening Death observations only; intervention not indicated operative intervention consequences; urgent not indicated indicated operative intervention indicated. Gastric anastomotic leak Asymptomatic diagnostic Symptomatic; medical Severe symptoms; radiologic, Life-threatening Death observations only; intervention intervention indicated endoscopic or elective consequences; urgent not indicated operative intervention operative intervention indicated indicated Definition: A finding of leakage due to breakdown of a gastric anastomosis (surgical connection of two separate anatomic structures). Gastrointestinal anastomotic Asymptomatic diagnostic Symptomatic; medical Severe symptoms; radiologic, Life-threatening Death leak observations only; intervention intervention indicated endoscopic or elective consequences; urgent not indicated operative intervention operative intervention indicated indicated Definition: A finding of leakage due to breakdown of a gastrointestinal anastomosis (surgical connection of two separate anatomic structures). Gastrointestinal stoma Superficial necrosis; Severe symptoms; Life-threatening Death necrosis intervention not indicated hospitalization or elective consequences; urgent operative intervention intervention indicated indicated Definition: A finding of a necrotic process occurring in the gastrointestinal tract stoma. Injury to inferior vena cava Life-threatening Death consequences; urgent intervention indicated Definition: A finding of damage to the inferior vena cava. Intestinal stoma leak Asymptomatic diagnostic Symptomatic; medical Severe symptoms; radiologic, Life-threatening Death observations only; intervention intervention indicated endoscopic or elective consequences; urgent not indicated operative intervention operative intervention indicated indicated Definition: A finding of leakage of contents from an intestinal stoma (surgically created opening on the surface of the body). Intestinal stoma site bleeding Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death clinical exam; intervention not intervention indicated indicated; radiologic or consequences; urgent indicated endoscopic intervention intervention indicated indicated Definition: A finding of blood leakage from the intestinal stoma. Intraoperative breast injury Primary repair of injured Partial resection of injured Complete resection or Life-threatening Death organ/structure indicated organ/structure indicated reconstruction of injured consequences; urgent organ/structure indicated; intervention indicated disabling Definition: A finding of damage to the breast parenchyma during a surgical procedure. Intraoperative cardiac injury Primary repair of injured Life-threatening Death organ/structure indicated consequences; urgent intervention indicated Definition: A finding of damage to the heart during a surgical procedure. Intraoperative ear injury Primary repair of injured Partial resection of injured Complete resection of injured Life-threatening Death organ/structure indicated organ/structure indicated organ/structure indicated; consequences; urgent disabling. Intraoperative gastrointestinal Primary repair of injured Partial resection of injured Complete resection or Life-threatening Death injury organ/structure indicated organ/structure indicated reconstruction of injured consequences; urgent organ/structure indicated; intervention indicated disabling Definition: A finding of damage to the gastrointestinal system during a surgical procedure. Intraoperative head and neck Primary repair of injured Partial resection of injured Complete resection or Life-threatening Death injury organ/structure indicated organ/structure indicated reconstruction of injured consequences; urgent organ/structure indicated; intervention indicated disabling Definition: A finding of damage to the head and neck during a surgical procedure. Intraoperative hemorrhage Postoperative radiologic, Life-threatening Death endoscopic, or operative consequences; urgent intervention indicated intervention indicated Definition: A finding of uncontrolled bleeding during a surgical procedure. Intraoperative hepatobiliary Primary repair of injured Partial resection of injured Complete resection or Life-threatening Death injury organ/structure indicated organ/structure indicated reconstruction of injured consequences; urgent organ/structure indicated; intervention indicated disabling Definition: A finding of damage to the hepatic parenchyma and/or biliary tract during a surgical procedure. Intraoperative neurological Primary repair of injured Partial resection of injured Complete resection or Life-threatening Death injury organ/structure indicated organ/structure indicated reconstruction of injured consequences; urgent organ/structure indicated; intervention indicated disabling Definition: A finding of damage to the nervous system during a surgical procedure.

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Check commercially prepared They are often found in sauces and tomato products for hidden sources of onion. Consider Asafetida dressings, marinades, seasoning packets/blends, powder (found in Indian markets) for onion flavor, condiments, deli meat, frozen dinners, and or use other herbs and spices to flavor food. Mind Your Medications Saute whole peeled garlic in oil for 1-2 minutes to Some medications, like liquid pain relievers, cough develop the flavor in the oil, then remove the garlic medicines, and cough drops, may contain lactose clove. In-office or phone appointments are available; call 303-614-1070 to schedule an appointment, or visit kphealthyme. If you have any nutrition question or concerns, please call 303-614-1070 or send an email to your doctor or registered dietitian through kp. Galactans Challenge Lactose Challenge Fructans Challenge Canned, rinsed, and cooked Listed from lowest to highest Banana (>1/3 ripe) beans, will have the lowest lactose content. Polyols: mannitol cup 1 cup 1 cup Ex: mushrooms or mushrooms mushrooms mushrooms X celery or celery or celery or celery Symptoms Fructans 1 slice white 2 slices white 3 slices white Wheat X bread bread bread Symptoms Diagnosis is based on the clinical history, and exclusion of peptic ulcer and cancer by endoscopy. Second line thera Kookaburra Circuit, University py includes administration of a tricyclic antidepressant in low doses, or mirtazap Drive, Callaghan 2308, Australia ine, but not a selective serotonin reuptake inhibitor. The failure of the cri ing an increase in eosinophils that may account for the teria to provide a positive diagnosis is far from surpris symptoms [6,7]. Other data suggest that the systemic and ing and likely refects the limited repertoire of the body psychological symptoms often experienced by patients to respond to injury or pathophysiological disturbances. A pivotal population-based on the presence of one of more of four cardinal gastro study (the Kalixanda study, named after the towns of Ka duodenal symptoms, namely epigastric pain, epigastric lix and Haparanda where the research was conducted) burning, postprandial fullness, and early satiety (inabil obtained a random sample from two northern Swedish ity to fnish a normal sized meal) [9]. However, many patients fnd it difcult, if not im pronounced, and some patients are difcult to place possible, to locate their bloating in the upper abdomen, into subgroups [19]. These data are in contrast with clinical trial more likely to report a delayed peak in pain, suggesting data from Asia, which suggested that H. If risk factors do difer High-fat meals slow gastric emptying and can lead to between Eastern and Western populations, an expla dyspepsia, while moderate-to-fast eating and irregular nation needs to be identifed, as this may provide new meals are also associated with dyspepsia [31,32]. There are conclusive data suggesting that gastric also surprisingly high in the controls [23]. Even if patients failed to recognize a re lationship between eating and their symptoms, nearly 80% had increased symptom intensity 15 minutes after Figure 1. Follow-up of cases after acute bacterial Duodenal perturbations gastroenteritis has shown that those exposed to these More recent research has focused on the duodenum, infections have an approximately 2. These initial observations known but may be altered by dietary changes or possibly have been confrmed in Western and Eastern popula infammation [22]. The best evidence for the and early satiety, and the risk is increased in smokers [6].

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Communicating with your partner can help you both better understand your feelings and desires. Changing hormones cause some women to experience an increased sex drive during pregnancy, while others might not be as interested in sex as they were before they became pregnant. Being intimate during intercourse to decrease the does not require having intercourse. Love and affection can be expressed Women who only feed their babies in many ways. You can take you start having menstrual periods long romantic walks, candlelit again, so remember that you can still dinners, or give each other back become pregnant during this time. Your health care provider might rec ommend that you wait until after your rst postpartum health care ap pointment before having intercourse with your partner. Sexually transmitted diseases are passed on from sexual activity that involves the mouth, anus or vagina. If you have sex with someone who is affected, after your initial screening, you will need to be tested again. If a Chlamydia: Pregnancy seems to be pregnant woman is infected with unaffected by chlamydia infection. In addition, women with hepatitis B Treatment: Mothers with chlamydia are more likely to have premature are treated with antibiotics and all birth delivery. However, early screen newborn babies are given antibiotic ing and vaccination can prevent the eye ointment after birth to prevent worst outcomes of this infection. Treatment: If you have hepatitis B, your doctor will give your newborn Genital herpes: Herpes infection in baby an injection of antibodies and pregnant women is relatively safe a vaccine to prevent the baby from until she gets ready to deliver. If contracted during incurable disease, you can prevent pregnancy, the infection can cause transmitting the virus to your baby mouth sores, fever and blood stream by taking various medications. You might be all of your medicine, even if the less likely to practice safe sex symptoms go away. Regular exercise during pregnancy can improve your posture and decrease some common discomforts such as backaches, constipation, bloating, de creases swelling and fatigue. Being t during pregnancy means safe, mild to moderate exer cise at least three times a week, unless you have been otherwise advised by your physician. If you were physically active before your pregnancy, you should be able to continue your activity in moderation. Stay within 70 percent of your target heart rate (target heart rate can be measured at 220 minus your current age).

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Health benefts of duction but had no efect on insulin-stimulated glucose dietary fber. Dietary fbre: a microbiota and their relevance to the research of dietary roughage guide. The impact of high non-starch polysaccharide intake Fiber-type indication among diferent pathologies. Defnitive demonstration of gluten/wheat-protein and gluten-based products cited as an ofending culprit by sensitivity is by randomized, placebo-controlled, double blind roughly one-in-four. Most patients who beneft can de-restrict the with greater symptom severity in the gluten-treated group. Unfortunately, the study of its epidemiology, other wheat protein sensitivity, multiple food protein sensitiv pathophysiology, and characteristics has been hindered by ity, or none. Furthermore, ies with the ultimate aim of gaining the greatest symptomatic what component(s) of wheat that is/are driving symptoms beneft with the least dietary restriction and of achieving in any individual is difcult to defne. Subjective health com plaints and modern health worries in patients with sub jective food hypersensitivity. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroen Globally, when looking at the evolving literature, a response terol. No efects of gluten in patients with sidered, especially when dietary manipulations are profes self-reported non-celiac gluten sensitivity after dietary sionally unsupervised or purely patient-initiated. Global prevalence of and risk fac tors for irritable bowel syndrome: a meta-analysis. Department of Gastroenterology and Hu the activities of all other disaccharidases remain normal. With the Intolerance to carbohydrates, such as lactose intolerance, is a healing of the intestinal mucosa, the level of lactase improves common type of non-allergic food intolerance. The recovery of lactase patients diagnosed with carbohydrate intolerance has in may take a longer time even when mucosa has healed, which creased during the last few decades mostly as a consequence refects the observation that lactase activity is the last to re of increase in carbohydrate consumption, especially added cover in comparison to other disaccharidases activities. The prevalence of lactase defciency varies widely in the defciency of lactase enzyme and the defciency can occur diferent geographic locations around the world. The absence or defcien the diagnosis of lactose intolerance should be suspected in cy of lactase leads to failure of hydrolysis of lactose, hence patients who have symptoms of bloating and chronic diar unabsorbed lactose remains in the intestinal lumen and fuid rhea.

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Complexity results from the unpredictable inter-relationship and interconnectivity of the elements within a system and between the system and its environment (Chan, 2001). The relationships emerging from interactions in a complex system may result in new patterns that empower the system to structure new changes. For example, the reaction of multiple stakeholders to natural disasters such as hurricanes can be explained by this theory. As the figure shows, the experiences and feedback from patterns formed through interactions and relationships inform the agents and the system(s), and shape the emergence of future patterns, causing them to evolve. These interactions are inevitably complex and will change the context for other agents. Four elements associated with minimum specifications that promote innovative and complex behaviour are: direction pointing, 46 boundaries, resources, and permissions (Baker, 2001). As an example, the Institute of Medicine in the United States used a minimum specification process, in the form of reflecting on innovations presented by various groups of healthcare teams, to transition to a new design of the healthcare system for the 21st century. While coping with anxiety and stresses related to human systems is considered an influence of minimum specification, the significance of emergent phenomena may be downplayed because the control mechanisms generated by organizational hierarchies may have a limiting effect on emergence. Adaptation has been also interpreted as improved performance over time, with different outcomes based on the timeline of adaptation. What appeared to be a hospital infection with a high rate of transmission amongst healthcare workers in initial stages of this outbreak ended up having roots in the community, with a lower potential rate of transmission. In this case, interaction and learning from explorations of different subsystems resulted in adaptation, with the implementation of stronger screening and isolation policies upon hospitalization. In nonlinear systems, outputs are not proportional to inputs; therefore, tallying the parts of the system does not result in a logical 47 combination of its separate parts. An ongoing challenge for public health is to find ways to apply and incorporate the experiences of other academic disciplines to tackle health policies (Clarke et al. Drawing on experiences in other areas of science could result in improvements in the function of the healthcare system. At this time, hospitals and public health departments were dealing with many unknowns. Multiple groups in healthcare organizations at various levels came together to respond to an evolving outbreak.

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