text:
The Northeastern Buckeye Conferences announces its all-league falls sports teams.
Girls tennis
The Louisville girls tennis team swept all the top awards, as junior Gretchen Groves was named player of the year, while her coach, Rod Hall, received coach of the year. The Leopards finished 10-0 in the league.
First team Julia Dubaj, Sr., Alliance; Tessa Hollinger, Jr., Canton South; Paige Mittas, Sr., Canton South; Gretchen Groves, Jr., Louisville; Alexis Isla, Sr., Louisville; AnnaMae Aufrance, Sr., Marlington; Ashtyn Morris, Fr., Salem
Player of the Year Gretchen Groves, Louisville
Coach of the Year Rod Hall, Louisville
Second team Faryl O'Neil, Sr., Canton South; Hannah Philippi, Fr., Canton South; Ann Marie Trissel, Jr., Canton South; Alexis Pochubay, Fr., Louisville; Kayla Pukys, Fr., Louisville; Sarah Robbins, Jr., Louisville; Michaela Huston, Soph., West Branch
Honorable mention Charli Kelley, Jr., Alliance; Abby Sierravalle, Jr., Alliance; Morgan Iser, Jr., Canton South; Brooke Wyant, Sr., Canton South; Natalie Richards, Fr., Louisville; Jozie Scott, Soph., Louisville; Maria DiRuzza, Sr., Marlington; Valerie Schweizer, Sr., Marlington; Rebecca Linam, Soph., Salem; Brittany Ring, Sr., West Branch; Megan Winters, Soph., West Branch
Boys soccer
West Branch junior Alec Schopfer led the Warriors to an NBC title, earning him player of the year honors. Schopfer's coach, Matt Thomas, was named coach of the year.
First team Ben Draves, Sr., Alliance; Will Draves, Sr., Alliance; Sam McGill, Soph., Canton South; Sam Dowell, Sr., Carrollton; Harrison Raub, Sr., Louisville; Zach Kaplan, Sr., Marlington; Jake Henderson, Sr., Marlington; Justin Campbell, Sr., Minerva; Tyler Stewart, Jr., Minerva; Troy Kuhns, Sr., Salem; Alec Schopfer, Jr., West Branch; Dustin Greenawalt, Sr., West Branch
Player of the Year Alec Schopfer, West Branch
Coach of the Year Matt Thomas, West Branch
Second team Kwaku Amponsah, Fr., Alliance; Bryce Hood, Soph., Alliance; Andrew Wright, Sr., Canton South; Austin Keefer, Jr., Carrollton; Austin Hallas, Sr., Louisville; Zach Zigler, Jr., Marlington; Austin Wade, Jr., Marlington; Alec Mueller, Soph., Minerva; Layn Palmer, Sr., Minerva; Max Righetti, Soph., Salem; Dylan Greenawalt, Sr., West Branch; Jacob Jarvis, Jr., West Branch
Honorable mention Nick Strata, Sr., Alliance; Karl Alvarado, Jr., Alliance; Ryan Giavasis, Jr., Canton South; Kent Ring, Soph., Canton South; Matt Borland, Sr., Carrollton; Cameron Haught, Jr., Carrollton; Austin Haught, Jr., Carrollton; Austin Terra, Jr.., Louisville; Alex Stefanik, Fr.., Louisville; Mitch Ewing, Sr., Marlington; Aric Morian, Sr., Marlington; Kaiya Watauchi, Sr., Minerva; Aaron Stanik, Sr., Minerva; Cody Ewing, Soph., Salem; Andrew Pasco, Soph., Salem; Fritz Schlueter, Sr., West Branch; Parker Zamarelli, Sr., West Branch
Girls soccer
Louisville junior Rachel Baughman was named player of the year, while her coach, Tony Volpe, was voted coach of the year. Baughman and Volpe led the Leopards to a 7-0 record in the NBC and a league title.
First team Casey Greene, Sr., Canton South; Monica Starre, Jr., Carrollton; Rachel Baughman, Jr., Louisville; Sarah Jaroszyk, Sr., Louisville; Kelly Miller, Sr., Louisville; Sierra Mayle, Sr., Marlington; Jordan Sutton, Sr., Marlington; Lauren Haynam, Sr., Minerva; Julia Dundon, Jr., Salem; Marissa Swindell, Jr., Salem; Lauren Martig, Sr., West Branch
Player of Year Rachel Baughman, Louisville
Coach of Year Tony Volpe, Louisville
Second team Miyako Shields, Sr., Alliance; Caige McCabe, Sr., Canton South; Caroline Thompson, Sr., Canton South; Stephanie Donley, Sr., Carrollton; Sami Keefe, Jr., Louisville; Lizzi Mont, Soph., Louisville; Alyana Kennedy, Jr., Marlington; Ali Rodgers, Jr., Marlington; Caitlin Rogers, Jr., Minerva; Anna Wyss, Sr., Salem; Aliza McConnahey, Jr., West Branch; Melinda Trimmer, Jr., West Branch
Honorable mention Za'Nell Dixon, Soph., Alliance; Erin Thompson, Soph., Canton South; Katie Tolbert, Jr., Canton South; Schyler Fennimore, Sr., Carrollton; Morgan Hepner, Sr., Carrollton; Sam Kibler, Sr., Louisville; Devin Kring, Soph., Louisville; Jill Ryan, Jr., Marlington; Katie Wirth, Sr., Marlington; Hannah Burress, Soph., Minerva; Erica McCauley, Sr., Minerva; Raegan Meals, Jr., Salem; Rylee Meals, Jr., Salem; Madison Estock, Sr., West Branch; Bailey Polinori, Fr., West Branch
For the second consecutive year, Minerva's Maddie Fischer was named the player of the year. Fischer also was selected as the District IV's Division II Player of the Year this season. Carrollton's Amanda Tressa was named the NBC Coach of the Year. Tressa guided the Warriors to an NBC title this season.
First Team Anna Morrow, Jr., Canton South; Addie Borland, Jr., Carrollton; Kelsey Voll, Jr., Carrollton; Megan Stocker, Sr., Louisville; Marlee Peck, Soph., Marlington; Maddie Fischer, Sr., Minerva; Camrin Costal, Sr., Salem; Pavin Heath, Jr., West Branch
Player of the Year Maddie Fischer, Sr., Minerva
Coach of the Year Amanda Tressa, Carrollton
Second Team Mary Zurbrugg, Fr., Alliance; Audrey Leahy, Sr., Canton South; Ali Poole, Soph., Carrollton; Nicole Kettlewell, Sr., Louisville; Jordan Diels, Jr., Minerva; Carson Herron, Sr., Salem; Maria Shivers, Soph., Salem; Sydney Townes, Jr., West Branch
Honorable Mention Cheyenne Harris, Sr., Alliance; Samantha Jackson, Jr., Alliance; Savanna Forshey, Jr., Canton South; Joelle Martin, Sr., Canton South; Kady Davis, Soph., Carrollton; Rebecca Grunder, Sr., Carrollton; Emily Hollifield, Soph., Louisville; Grace Jackson, Soph., Louisville; Lindsey Campbell, Sr., Marlington; Kaysee Kerr, Soph., Marlington; Lacy Marshall, Soph., Minerva; Morgan Preston, Sr., Minerva; Megan Lehwald, Sr., Salem; Sarah Smith, Sr., Salem; Taryn Hahn, Sr., West Branch; Bailey McElwain, Sr., West Branch
Boys golf
Carrollton's Cale Pozderac was named the golfer of the year. Pozderac was the co-medalist at the NBC Championships this season. Pozderac tied Marlington's Caleb Hill with a 76. Canton South's Jeremy Noll was named the NBC Coach of the Year.
First Team Bryce Hood, Soph., Alliance; Dan Culberson, Sr., Canton South; Cale Pozderac, Jr., Carrollton; Tyler Shuman, Jr., Carrollton; Caleb Hall, Sr., Marlington; Jordan White, Sr., Marlington; Jordan McGuire, Sr., Salem; Ryan Adams, Sr., West Branch
Player of the Year Cale Pozderac, Jr., Carrollton
Coach of the Year Jeremy Noll, Canton South
Second Team Jacob Dubina, Sr., Canton South; Troy Fairclough, Jr., Carrollton; Matt Eddins, Soph., Louisville; Don Lacerenza, Sr., Louisville; Zach Owen, Soph., Marlington; Ron Worley, Jr., Marlington; Colton Kiko, Sr., Minerva; Jantsen Locke, Sr., Minerva
Honorable Mention Cody Cook, Sr., Alliance; Brenden Lipely, Sr., Alliance; Matt Dworznik, Sr., Canton South; Dakotah Miller, Soph., Canton South; Mason Albrecht, Jr., Carrollton; Luke Cosart, Jr., Carrollton; Mac Hanson, Soph., Louisville; Nick Fawver, Soph., Louisville; Alec Hawley, Jr., Marlington; Mitch Ray, Sr., Marlington; Riley Simpson, Fr., Minerva; Garrett Ring, Sr., Salem; Andrew Robbins, Sr., Salem; Nate Coy, Jr., West Branch; Bobby Parsons, Soph., West Branch
Girls golf
Minerva junior Ellie Chaddock was named the golfer of the year. Chaddock shot an 89 at the NBC Championships to lead Minerva. Louisville's Mary Snode was named coach of the year. Snode guided the Leopards to an NBC title this season.
First Team Olivia Albrecht, Soph., Carrollton; Gina McVey, Sr., Louisville; Sierra Townsend, Fr., Louisville; Ellie Chaddock, Jr., Minerva; Logan Pottorf, Soph., Minerva
Player of the Year Ellie Chaddock, Jr., Minerva
Coach of the Year Mary Snode
Second Team Elizabeth Domer, Soph., Carrollton; Adrienne Metzger, Sr., Louisville; Katie Warga, Sr., Louisville; Hannah Canale, Fr., Marlington; Courtney Halter, Soph., Salem
Honorable Mention Anna Truman, Soph., Carrollton; Bailey Spring, Soph., Louisville; Abby Canale, Jr., Marlington; Sydni Hertel, Soph., Minerva; Carli Hochadel, Sr., Salem
Boys cross country
Louisville swept the top awards. Leopards senior Nick Thomas was named runner of the year after winning the league meet in 17:02.6. Bob Sudomir was named coach of the year, as his Leopards won the NBC team title with a perfect 15 points.
First Team Nick Thomas, Sr., Louisville; Noah Chaplik, Fr., Louisville; Nick Chaplik, Fr., Louisville; Ben Tornow, Soph., Louisville; Zach Fresenko, Fr., Louisville; Andrew Milburn, Sr., Louisville; Jacob Fotheringham, Sr., Alliance; Jakson Knapp, Soph., Marlington
Second Team Sean Gronow, Sr., Louisville; Thomas Mason, Sr., Marlington; Noah Whittington, Soph., Marlington; Kyle Robinson, Jr., Canton South; Mitchell Baxter, Soph., Marlington; Duncan Freeland, Jr., Minerva; Alec Mueller, Soph., Minerva; John Brown, Jr., Carrollton
Honorable Mention Connor O'Brien, Sr., Alliance; Joshua Teel, Soph., Alliance; Curtis Schleappi, Sr., Canton South; Zach Holshu, Soph., Canton South; Cole Lovett, Fr., Carrollton; Joe Knipp, Soph., Carrollton; Sam Gaddis, Sr., Louisville; Jacob Milburn, Soph., Louisville; Dylan Savage, Soph., Marlington; Zach Masterson, Sr., Marlington; John Hartwig, Sr., Minerva; Garrett Spardy, Jr., Minerva; Zachary Morris, Jr., Salem; Jared McClish, Fr., Salem; Max Pigza, Fr., West Branch; Jeremy Truex, Sr., West Branch
Girls cross country
Carrollton's Maddie Dunlap is the runner of the year, as she won the league meet in 19:49.7.
Her coach, Lisa Baker, was named coach of the year. Carrollton won the NBC team championship.
First Team Maddie Dunlap, Fr., Carrollton; Taylar Bennett, Sr., Carrollton; Tori Reeves, Sr., Marlington; Hailey Wells, Fr., Carrollton; Naomi Young, Sr., Carrollton; Sarah Mason, Soph., Marlington; Katie Kennedy, Soph., Marlington; Haley Bradley, Jr., Louisville
Second Team Katelyn Cooley, Sr., Marlington; Haley Davis, Soph., West Branch; Ashley Visi, Jr., Marlington; Isabel Kiko, Soph., Louisville; Emmalee Carver, Jr., Minerva; Sophia Miller, Soph., Marlington; Ashlee Beaver, Fr., Louisville; Caroline Thompson, Sr., Canton South
Honorable Mention Pandora Csanad, Soph., Alliance; Erin Gauze, Fr., Canton South; Tricia Oliver, Fr., Canton South; Janessa Bell, Jr., Carrollton; Maddie Formet, Fr., Carrollton; Adriana Beaver, Soph., Louisville; Spencer Duvall, Sr., Louisville; Breanne Bakan, Jr., Marlington; Casey Bates, Sr., Minerva; Lindsey Brust, Soph., Minerva; Anna Shivers, Jr., Salem; Kelli Little, Sr., Salem; Hannah Sprowl, Soph., West Branch; Emma Bycraft, Jr., West Branch.


text:
Taken by mouth (pill form, oral)
Corticosteroids are similar to natural
hormone substances produced by the body that help to reduce
Corticosteroids are often used to
treat juvenile idiopathic arthritis. Corticosteroids that are taken by mouth or
injected are most often used to control the initial stages of systemic
juvenile idiopathic arthritis (JIA). Corticosteroids may also be used in
children who have
oligoarticular or
polyarticular disease with severe morning stiffness or
night pain.
A short "burst" therapy (initially high doses of
oral corticosteroids that are tapered off) may be useful
when inflammation around the heart (pericarditis) or fever is present in
children with
systemic JIA.
Corticosteroids may also be
used as "bridge" therapy when starting a stronger second-line medicine, such
as methotrexate, to control symptoms while the new medicine takes effect.
After a period of time, the corticosteroid is slowly withdrawn to see whether
the other medicine is effective.
Injections of corticosteroids may be used to treat specific
joints when conservative therapy has controlled symptoms well except in those
specific joints.
Corticosteroid eyedrops
are used in children who develop inflammatory eye disease.
Corticosteroids can provide rapid,
dramatic improvement in some people with JIA.1
Side effects of high or long-term
corticosteroid doses in children include:
Long-term use of corticosteroids causes significant side
effects, including a weakened
immune system and weakened muscles.
can help reduce side effects, including growth problems, by giving your child
this medicine in the morning rather than at night. A low dose at bedtime is
sometimes used to treat severe morning stiffness.1
See Drug Reference for a full list of side
effects. (Drug Reference is not available in all systems.)
Long-term use of corticosteroids
is not advisable due to the significant side effects. Low-dose corticosteroids
have fewer side effects and may be appropriate for longer use in difficult
In some cases the dose of corticosteroids that controls
symptoms is too high for long-term use. The best dose may be a balance between
a higher dose that controls symptoms well but causes significant side effects
and a lower dose that doesn't control all symptoms completely but causes fewer
side effects.
If your child is given corticosteroid treatment for
2 weeks or more, the medicine should be gradually reduced (tapered) rather
than abruptly stopped. Tapering helps the body adjust to the change. But some children have a temporary increase in pain when corticosteroid treatment
is stopped.
After a corticosteroid joint injection, your child
should use the joint as little as possible for a day or two. A cast or splint
may be put on the joint of a young child to protect the joint from excess
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
CitationsGiannini EH, Brunner HI (2005). Treatment of juvenile
rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp.
1301–1318. Philadelphia: Lippincott Williams and Wilkins.
Last Revised:
June 5, 2012
Healthwise Staff
Medical Review:
Susan C. Kim, MD - Pediatrics & John Pope, MD - Pediatrics
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

subset: commoncrawl


text:
Gout is a kind of
arthritis. It can cause an attack of sudden burning
pain, stiffness, and swelling in a joint, usually a big toe. These attacks can
happen over and over unless gout is treated. Over time, they can harm your
joints, tendons, and other tissues. Gout is most common in men.
Gout is caused by
too much
uric acid in the blood. Most of the time, having too
much uric acid isn't harmful. Many people with high levels in their blood
never get gout. But when uric acid levels in your blood are too high, the uric
acid may form hard crystals in your joints.
Your chances of
getting gout are higher if you are overweight, drink too much alcohol, or eat
too much meat and fish that are high in chemicals called purines. Some
medicines, such as water pills (diuretics), can also bring on gout.
The most
common sign of gout is a nighttime attack of swelling, tenderness, redness, and
sharp pain in your
big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The
attacks can last a few days or many weeks before the pain goes away. Another
attack may not happen for months or years.
See your doctor even if
your pain from gout is gone. The buildup of uric acid that led to your gout
attack can still harm your joints.
Your doctor will ask questions about your
symptoms and do a physical exam. Your doctor may also take a sample of fluid
from your joint to look for uric acid crystals. This is the best way to test
for gout. Your doctor may also do a blood test to measure the amount of uric
acid in your blood.
To stop a gout attack, your doctor can give you a
shot of corticosteroids or prescribe a large daily dose of one or more
medicines. The doses will get smaller as your symptoms go away. Relief from a
gout attack often begins within 24 hours if you start treatment right
To ease the pain during a gout attack, rest the joint that
hurts. Taking ibuprofen or another
anti-inflammatory medicine can also help you feel
better. But don't take aspirin. It can make gout worse by raising the uric acid
level in the blood.
To prevent future attacks, your doctor can
prescribe a medicine to reduce uric acid buildup in your blood.
Paying attention to what you eat may help you manage your
gout. Eat moderate amounts of a healthy mix of foods to control your weight and
get the nutrients you need. Limit daily intake of meat, seafood, and
alcohol (especially beer). Drink plenty of water and other fluids.
Learning about gout:
Being diagnosed:
Getting treatment:
Ongoing concerns:
Living with gout:
Health Tools help you make wise health decisions or take action to improve your health.
Gout is caused
by too much
uric acid in the blood (hyperuricemia). The exact cause of hyperuricemia sometimes isn't
known, although inherited factors (genes) seem to
play a role.
Uric acid may
form crystals that build up in the joints. This causes the pain and other symptoms.
Gout can seem to flare up without
specific cause. Or it can be brought on by:
Symptoms of gout include:
How, where, and when the symptoms of gout appear vary.
There are many
other conditions with symptoms similar to gout.
Gout usually
develops after a number of years of buildup of
uric acid crystals in the joints and surrounding
tissues. A gout attack usually starts during the night with moderate pain that
grows worse. A gout attack typically causes pain, swelling, redness, and warmth
(inflammation) in a single joint, most often the big
toe. Then symptoms gradually go away.
There are three stages of gout.1 Many people never experience the third stage.
Certain things can either cause gout or make you more likely to get it.
These include:
Certain other conditions and diseases appear more often in people who
have gout than in people who don't, though studies have not shown a clear
relationship. Gout may share risk factors
(such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:
Call or see your doctor right away if you have:
It's important to see your
doctor even if the pain from gout has stopped. The uric acid buildup that
caused your gout attack may still be irritating your joints and could
eventually cause serious damage. Your doctor can prescribe medicines that can
prevent and even reverse the uric acid buildup.
The following health professionals can diagnose and
prescribe treatment for
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and tests that may help with diagnosis and treatment of gout include:
X-rays of extremities (hands and feet) are sometimes
useful in the late stages of the disease, X-rays aren't usually helpful in the
early diagnosis. Pain often causes people to seek medical attention before any long-term
changes can be seen on an X-ray. But X-rays may help to rule out other causes
of arthritis.
Your doctor may evaluate you for lead poisoning if you
have been exposed to lead in your job or through hobbies.
The goals of treatment for
gout are fast pain relief and prevention of future
gout attacks and long-term complications, such as joint destruction and kidney
damage. Treatment includes medicines and steps you can take at home to prevent
future attacks.
Specific treatment depends on whether you are having an acute attack or are trying to manage long-term gout and prevent future attacks.
If gout symptoms have occurred off and on without
treatment for several years, they may become ongoing (chronic) and may affect
more than one joint.
If the blood uric acid is
high but a person has never had an attack of gout, treatment is rarely needed.
But people with extremely elevated levels may need regular testing for signs of
kidney damage. And they may need long-term treatment to lower their uric acid
levels. Your blood uric acid level may be watched by your doctor until it is
lowered to normal levels.
Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future.
After an acute attack of gout,
talk with your doctor about the causes of the elevated uric acid levels in your
blood. A review of your overall health may reveal diseases, medicines, and
habits that could be raising your uric acid levels.
Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid
levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream
and could make symptoms worse if treatment begins during a gout attack.
If there is swelling that causes pressure in a large joint such as a knee
or ankle, your doctor may relieve the pain and pressure by aspiration. A needle is inserted into the joint and fluid is drawn out (aspirated) with a
syringe connected to the needle.
Gout usually
develops after a number of years of buildup of
uric acid crystals in the joints and surrounding
tissue. You probably won't know that you have an elevated uric acid level in
your blood until you have had your first gout attack.
But you can help prevent
or reduce the severity of future gout attacks. To learn more, see Home Treatment.
If you have been diagnosed with gout, you can do a lot on your own to treat your condition.
In the past, gout was thought to be caused by drinking too
much alcohol and eating too many rich foods. Although eating certain foods and
drinking alcohol may trigger a rise in the level of uric acid in the body,
these habits may not by themselves cause gout. Gout is most often caused by an
overproduction of uric acid (due to
metabolism problems) or decreased elimination of uric
acid by the kidneys.
You use medicine to treat an attack of gout and to reduce the uric acid in the blood. Reducing uric acid helps reduce how often you have attacks.
Medicine treatment for gout usually involves some
combination of short- and long-term medicines.
Short-term medicine relieves pain and reduces inflammation during an acute attack or prevents a
recurrence of an acute attack. These medicines may include:
If treatment is started right away, relief from symptoms often
occurs within 24 hours.
a gout attack, your doctor will prescribe a maximum daily dose of one or more
medicines used for short-term treatment to stop the attack. Doses are then
reduced as the symptoms go away.
Long-term treatment uses medicines to lower
uric acid levels in the blood. This can reduce how often you have gout attacks and how severe they are. These medicines may include:
If your doctor prescribes medicine to lower your uric
acid levels, be sure to take it as directed. Most people will continue to take this
medicine every day. It is also important to know how to take it.
Long-term medicine treatment depends on how high your uric acid levels
are and how likely other gout attacks are. In general, the higher your uric acid
levels and the more often you have attacks, the more likely it is that long-term
medicine treatment will help.
Some people with gout have continuing problems because
they don't take their prescribed medicine. Most people will need treatment every day to keep the uric acid levels in their blood normal. But they may feel perfectly healthy most of the time and wonder why
they should keep taking their medicine. If you stop taking your prescribed
medicine, nothing may happen at first. But after a while, another gout attack is
likely to occur. Without treatment, future attacks are likely to be more severe
and occur more often.
If gout symptoms have occurred off and on without
treatment for more than 10 years, uric acid crystals may have built up in the
joints to form gritty, chalky nodules called
tophi. If tophi are causing infection, pain, pressure,
and deformed joints, your doctor may be able to treat them with medicine. If this doesn't work, your doctor may recommend surgery to remove them.
Complementary therapies may be used by some people to
relieve symptoms caused by
Be sure to talk with your doctor if you are considering
taking vitamins, minerals, or other remedies to help reduce future gout
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
The ACR
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
CitationsWortmann RL (2009). Gout and hyperuricemia.
In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., pp. 1481–1506. Philadelphia: Saunders
Elsevier.Murray MT, Pizzorno JE Jr (2006). Gout. In JE Pizzorno
Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd
ed., vol. 2, pp. 1703–1709. St. Louis: Churchill Livingstone
Elsevier.Other Works Consulted Comeau D, et al. (2011). Rheumatology and musculoskeletal problems. In RE Rakel, DP Rakel, eds., Textbook of Family Medicine, 8th ed., pp. 648–689. Philadelphia: Saunders.Bhole V, et al. (2010). Epidemiology of gout in women. Arthritis and Rheumatism, 62(4): 1069–1076.
Next Section:
Previous Section:
Last Revised:
June 12, 2012
Healthwise Staff
Medical Review:
Anne C. Poinier, MD - Internal Medicine & Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


text:
Burger King, 7UP, Sunkist Join USA Basketball Roster For London Olympics
By Barry Janoff
May 14, 2012: USA Basketball has unveiled two deals tied to the 2012 Olympic Games, one naming Burger King as its official quick service restaurant partner and a second designating Sunkist Soda and 7UP — both brands from USA Basketball partner Dr Pepper Snapple Group — as the official soft drinks.
Financial terms were not disclosed.
"This is a special year for USA Basketball and this partnership with these iconic brands will help pay homage to our rich history," Jerry Colangelo, chairman, USA Basketball, said in a statement. "We look forward to having some of the most storied players in our program's history recognized . . . as we prepare to compete this summer."
The deals follow on the heels of pact last month naming Chrysler's Jeep as the official vehicle of USA Basketball. Other USA Basketball marketing partners include American Express, Cisco, PepsiCo's Gatorade, Las Vegas Events, MetroPCS, Got Milk?, Nike, State Farm and Tiffany & Co.
The alliances come as Burger King, which recently dropped from No. 2 to No. 3 among fast-feeders in the U.S. behind McDonald's and Wendy's, is in the midst of a high-profile menu renovation, supported by marketing featuring the likes of David Beckham, Jay Leno, Salma Hayek and Steven Tyler.
On July 7, USA Basketball will name the roster of players who will represent the U.S. in the Summer Olympics in London. Members of the men's team are expected to include NBA stars LeBron James, Dwyane Wade, Kobe Bryant, Chris Paul, Blake Griffin and Kevin Durant.
(The women's team will largely be populated from the WNBA with such players as Sue Bird, Maya Moore, Candace Parker, Swin Cash and Diana Taurasi.)
Among the marketing support are two activations similar in nature.
Burger King will unveil a five-cup commemorative series that celebrates four of USA Basketball's memorable teams over the last two decades. A 20th anniversary cup honors the 1992 gold medal Dream Team, whose roster included Michael Jordan, Charles Barkley, Magic Johnson, Larry Bird and Patrick Ewing.
Concurrently, Johnson, Bird, Ewing and fellow Dream Team members David Robinson and Scottie Pippen will be featured on Dr Pepper Snapple Group brands Sunkist, 7UP, A&W root beer, Canada Dry and Sun Drop soft drink cans, respectively, during a summer-long promotion.
A Sunkist promotion will offer exclusive opportunities to watch the USA Basketball Men's National team during exhibition games in Las Vegas and Barcelona and meet USA Basketball legends.
Burger King said that marketing support would feature TV spots during and courtside signage at USA Basketball exhibition games prior to the Olympics; ads on USABasketball.com; and a promotion offering such prizes as dinner with a USA Basketball legend, the chance to play against a current USA Basketball player and autographed merchandise.
In addition, Burger King and USA Basketball said they would launch a "Your Team. Your Voice." campaign, which is "intended to "give fans a chance to actively participate in and influence a variety of elements during USA Basketball's summer exhibition tour." Through digital destinations, fans will be able to select which jersey the team will wear during its exhibition game in Las Vegas (July 12), predict which 12 players could make the final team and other elements.
"This is a special year for USA Basketball and this partnership with these iconic brands will help pay homage to our rich history."
Burger King's five-cup commemorative series will also honor the U.S. Olympic gold medal teams from 1996 Atlanta, 2000 Sydney and 2008 Bejing, as well the 2012 USA Basketball team.
"Burger King is a brand with a rich heritage and together we'll give fans new ways to connect with USA Basketball," said Colangelo. "Through our partnership with Burger King we will commemorate some of the most historic moments in USA Basketball history – including the 20th anniversary of the Dream Team – and celebrate this year's men's and women's national teams as they look to represent their country with pride and captivate basketball fans around the world."
According to Alex Macedo, Burger King svp-North America marketing, "We know the passion that America has for USA Basketball and are excited to celebrate the 20th anniversary of the Dream Team. We hope everyone in America gets into the game and get to see all five cups at Burger King restaurants."
Chrysler's Jeep Division Signs As Official Partner With USA Basketball


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Liberty News
LU Chancellor Jerry Falwell Jr. appears on CNN
Liberty University Chancellor Jerry Falwell Jr. appeared on CNN on Wednesday, Jan. 9, discussing the 2008 Presidential race.
It marked the first time Falwell Jr. had been on network television discussing political issues.
"It was pretty exciting," he said.
The CNN report was hosted by correspondent Wolf Blitzer. Blitzer is the host of CNN's "The Situation Room."
Falwell's father, the late Rev. Jerry Falwell, regularly appeared in political discussions on network television.
Falwell Sr. died May 15.
Falwell Jr. has personally endorsed former Arkansas Gov. Mike Huckabee for the 2008 Republican Presidential nomination.
"They asked me to come on the program and discuss who Evangelicals will support," Falwell Jr. said. "I told them that I think Evangelicals are gravitating toward Huckabee because he is so genuine and sincere. You can tell what he says is heartfelt and he means it. I think that's why he's doing so well."
The CNN program included a segment that featured Republican Candidate Sen. John McCain's appearance as the primary speaker at LU's May graduation in 2006.
"They had footage of my father and I welcoming him to Liberty and awarding him an honorary degree," Falwell Jr. said.
"The program gave me a chance to promote Liberty University. That was one of my main objectives."
Falwell Jr. was in a studio on the LU campus for his CNN appearance.
"It was all done by satellite," he said. "It was fun."
He's not ruling out future television appearances.
"I enjoyed doing it," he said. "If I can help people understand how Evangelicals fit into the political world, I'm more than happy to do it."


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Roses are red, violets are blue, some notion's of romance would make a Valentine's date fall through.
Or at least that's seems to be the findings of survey to find out what women would like on Valentine's Day - and what advice to give to men.
Should you propose on Valentine's Day? Go for flowers? Or just ignore the whole event?
The Car People asked 2000 people in its survey and the results were not so unexpected, with the exception of one or two surprises.
On the marriage proposal question, men and women were pretty even in their opinions, with 60 per cent thinking it was a good idea - though for any would-be suitors out there, bear in mind that means that 40 per cent of women would not welcome a proposal on Valentine's Day!
Are we Scots canny or just a little bit mean on romantic gestures? Nearly three out of five Scots asked said they would be spending £30 or less on Valentine's Day - and a quarter of people in relationships said they would not be spending a penny on the celebrations, especially over 55s.
Although 66 per of singleton Scots will be alone and staying in this Valentine's and 35 per cent envy their friends in a relationship, the survey revealed it may not be all its made out to be.
Thirty-four per cent of the Scots surveyed who were in a relationship said they would prefer to be single at Valentine's because it is more fun, 32 per cent would like to be single at Valentine's to have a break, 70 per cent said Valentine's is not important to them and 53 per cent said their partners have stopped snogging them!
Seventy per cent of people in a relationship wanted to go out to mark the day but when it came to just men, a third wanted to stay in and avoid the high prices and busy restaurants.
Based on the answers given by women, The Car People's advice to men is do not make it a double date, go to a drive-through takeaway, ask for half the petrol money or cost of the date - and don't make your present a Valentine's mix tape.
However, it's not all about the money - nearly 90 per cent of women in relationships said they would like to receive a love note.
And when it comes to flowers, they're still a favourite, with nearly three-quarters of women saying they would like to receive flowers at work - and, surprisingly, 64 per cent of men said it would be romantic to receive a bouquet too.
For more details visit The Car People Valentine's Day.


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No question about it, we are witnessing the prime era of Northwestern basketball under the leadership of Bill Carmody. The only problem? The Wildca...
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Web Service Management
Web Services are software systems designed to support interoperable machine-to-machine interaction over a network. This definition encompasses many different systems, but in common usage the term refers to those services that use SOAP-formatted XML envelopes and have their interfaces described by WSDL. For example, WS-I only recognizes Web services in the context of these specifications.


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Fine Arts Foundation debutantes hit the fashion runway
Mariel, the longtime Larimer Square boutique that has just relocated to Cherry Creek North, once again provided the clothing for the Fine Arts Foundation debutantes to model at the FAF's annual luncheon and fashion show.
Three Blind Mice outfitted Alexandra Haymons and Allison Smith, who will serve as tiara mistresses at the June 16 ball.
Denise Plante of KOSI and Colorado & Company was mistress of ceremonies for the event planned by Maureen Hagan, Gwen Lake, Murri Bishop, Lauri Speich, Mary Palms and Kimberly Porter. It was held at Cherry Hills Country Club.
FAF president Lynn Wong welcomed a crowd that included Judi Wolf, the FAF's Citizen of the Arts for 2012; debutante ball chair Gwen Lake and co-chair Murri Bishop; Mary McNicholas, the group's marketing and membership chair; Lynn Cahen, FAF's president-elect; and Dr. David Wong.
Click below to see the members of the FAF's Debutante Class of 2012.


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Tuesday – Saturday 7:30pm Saturday Matinee 2:30pm
The Magic of Neverland has captured imaginations for decaces. Beck and May's new version of Peter Pan emphasizes themes of home, faith, and family. Experience as Wendy and her brothers learn important life lessons. Enjoy as Peter Pan and his clan of lost boys fight off Captain Hook and his crew of silly pirates. This musical's beautiful music, charming lyrics, and dancing priates will leave you wanting to come again and again! Experience the Magic
Guests attending events at the Brigham's Playhouse receive 10% off a full rate for the length of their stay.
Peter Pan: A New Musical
Brigham's Playhouse
25 N. 300 W. Wash. UT
August 8 – September 20, 2014 Tuesday – Saturday 7:30pm Saturdays 2:30
Purchase Tickets at the following Link: http://www.tix2.centerstageticketing.com/sites/brighamsplayhouse/


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Shopping Bag Allowance
Recent changes to the shopping bag allowance at East Midlands Airport mean that with all of our flights, you can indulge in some high street shopping right at the airport.
You can now take one standard sized airport shopping bag on ANY flight in addition to your hand luggage. This now includes Ryanair.
Savvy shoppers already know about the exclusive products and prices available when shopping at the airport. Indulge yourself with airport exclusives from your favourite brands or stock up on last minute essentials for your trip.
Enjoy a host of dining options, from meals for the family to a cosmopolitan cappuccino and cake on the go.


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The purpose of IAS 36 Impairment of Assets is to determine whether any of the assets carried by an entity are being held at too high a value. The result of the impairment testing is not to revalue assets upwards; it is to book an impairment loss, reverse a previously recognised impairment loss, or do nothing.
This course provides an overview of the key requirements and impacts of IAS 36 Impairment of Assets as they relate to reporting entities in all industry sectors. It also covers how to apply the requirements, using practical situations.
Key topics:
This course consists of one online course and one online assessment.
This course is specifically designed for finance professionals who are involved in:
Identifier: 75903988
Subscription Period:365 Days
Language: English
Delivery Language:


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Columbus Crew 2, Chicago Fire 0 | MLS Match Recap
COLUMBUS, Ohio -- Thanks to another multi-point game from Federico Higuain, the Columbus Crew found their first win since March 29 in a 2-0 victory over the Chicago Fire on Saturday.
Gregg Berhalter made a number of changes to his starting lineup, shifting winger Hector Jimenez to right fullback, pairing Eric Gehrig and Tyson Wahl in central defense, and giving Ethan Finlay his first start of the season wide right. Crew captain Michael Parkhurst, who returned from USMNT camp Friday, started on the bench along with usual right back Josh Williams.
Meanwhile, the Fire fielded a starting XI decimated by injuries. Alex (hamstring), Mike Magee (calf), Patrick Nyarko (knee), Lovel Palmer (illness) and Bakary Soumare (calf) were all unavailable for Frank Yallop, who started Patrick Ianni, Dilly Duka and Juan Luis Anangono.
Finlay opened the scoring early, with the Crew's quickest goal of the season coming in the 10th minute. The speedy winger received a pass from Higuain, blew past Chicago defender Greg Cochrane, touched the ball around goalkeeper Sean Johnson, and hit an off-balance shot at a tight angle just past the goalpost and in.
The goal was Finlay's second of his MLS career and second in two weeks, after he scored the Crew's third goal in their 3-3 draw in Portland.
Arrieta stretched the Crew lead to 2-0 in the 25th minute, when the Costa Rican was provided another perfect pass from Higuain. Arrieta just outpaced Ianni, who stumbled and gave Arrieta a one-on-one with Johnson. Arrieta was left with plenty of time, and was able to take a touch, square to the goal and power a shot between the 'keeper's legs.
The first half ended with the 2-0 lead intact, but only after Chicago narrowly missed two golden opportunities to snatch a goal back. First, Quincy Amarikwa beat an out-of-position Steve Clark but couldn't pull back a shot from a similar angle to Finlay's goal. Then Anangono rose to put a curling header on goal, but after arcing over Clark, the ball took an unfriendly bounce off the post, preserving the Columbus lead.
Thanks to a team full of injuries, 19-year-old Tottenham Hotspur academy product Grant Ward made his MLS debut for Chicago in the second half, replacing Duka.
And while the Crew were able to hang onto the lead through the second half, they found themselves handicapped for next weekend's trip to Toronto, after Higuain picked up his fifth yellow card on the season, earning a suspension for next week's match for accumulation.
Perhaps the best reason for the Crew Stadium faithful to cheer in the second half was the return of Parkhurst, who got a standing ovation and chant in the 87th minute when he entered the game.
Neither team could find the net in the second half, as both sides tried to tally, but neither could find a breakthrough.
The win improved the Crew to 4-4-4 on the season, while Columbus snapped Chicago's two-game win streak, dropping them to 2-3-6.
MLSsoccer.com Men of the Match
|What We Saw
|Federico Higuain
|Was far and away the best player on the field, especially in the first 30 minutes, with two sublime assists
|Ethan Finlay
|Is making the most of his opportunities, as he scored his second career goal in as many weeks with a neat finish
|Sean Johnson
|Tried to keep his team in the game, and made some stops, but it wasn't enough to make a difference


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Support Worker - Learning Disabilities
- Recruiter
- Location
- West Yorkshire
- Salary
- £9.20 - £11.00 per hour + Hays Benefits
- Posted
- 24 Sep 2019
- Closing date
- 24 Oct 2019
- Ref
- 2903573
- Contact
- Laura Inman
- Industry
- Social care, Adult care
- Hours
- Full time
- Contract
- Temp
- Listing type
- Job vacancy
Support Worker - Learning Disabilities,Temp-ongoing,£9.20 - £11, West Yorkshire, Shift work
Support Worker - Learning Disabilities
£9.20 - £11
West Yorkshire
Your new company
Hays Social Care are the leading global specialist recruitment company and the market leader in the UK and Ireland. We are currently working with various large care providers who have services across the West Yorkshire area to appoint Support Workers for long term positions and shift work.
Your new role
We are looking for a number of Support Workers to join our team of temporary workers for services across the West Yorkshire area . We deal with both long term roles and shift work including week days, nights and weekend work in Residential, Supported Living and Independent living services.
Within the role of Support Worker you will support adults with disabilities and/or autism in their everyday lives, supporting them to live as full a life as possible and to engage with the community. You will provide physical and emotional support and health care of the highest standard, ensuring that respect, dignity and confidentiality is maintained at all times
What you'll need to succeed
To be suitable for this work you will need to have a minimum of two years experience working with adults with disabilities and either own a car or be able to travel flexibly on public transport.
What you'll get in return
We have a large number of shifts available in various locations. Whilst working through Hays you will benefit from one local point of contact, competitive rates of pay, advice and guidance on CV/application writing and interview technique, and free DBS processing and updates.
What you need to do now
If this sounds of interest to you or anyone you know then please contact Laura Inman on 0113 200 3715 or Hays is pleased to offer a £250 referral bonus to anyone who refers a successful support worker to us.
Hays Specialist Recruitment Limited acts as an employment agency for permanent recruitment and employment business for the supply of temporary workers. By applying for this job you accept the T&C's, Privacy Policy and Disclaimers which can be found at hays.co.uk
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Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
To evaluate whether blue-light-blocking intraocular lens implantation affects the sleep quality of cataract patients.
Pre-test/post-test experiment.
40 patients having bilateral cataracts with level higher than N3 (LOCS II) nucleus hardness, including 26 females (65%) and 14 males (35%).
Cataract phacoemulsification followed by blue-light-blocking intraocular lens (IOLs, SN60WF, Alcon Laboratories, USA) implantation.
Patients were contacted in site before cataract surgery and followed by telephone at least 2 months later after second-eye surgery. Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to evaluate sleep quality. Median age of patients was 74 years (IQR 70 to 78). The median PSQI globe scores were 7 before surgery and 4 after surgery (Z = -2.121, p = 0.037). More specifically, there were significant differences on subjective sleep quality (Z = -2.064, p = 0.045), sleep duration (Z = -2.037, p = 0.047) and daytime dysfunction (Z = -2.142, p = 0.034) when compared between before and after surgeries. The ratio of poor sleepers (PSQI > 5) was reduced significantly after surgery (χ2 = 14.532, p < 0.001).
Blue-light-blocking IOL had a significantly beneficial effect on the sleep quality of cataract patients.
Wei X; She C; Chen D; Yan F; Zeng J; Zeng L; Wang L. Blue-light-blocking intraocular lens implantation improves the sleep quality of cataract patients. J Clin Sleep Med 2013;9(8):741-745.
With aging, the human lens becomes a strong color filter attenuating light transmission, particularly for the short wavelengths.1 However, light of short wavelength is important in the control of the sleep-wake cycle (circadian rhythm), which is well known as photo entrainment of circadian rhythm. Circadian rhythm is regulated by melatonin produced by the pineal gland. Photo entrainment of circadian rhythm is mainly mediated by intrinsically photosensitive retinal ganglion cells (ipRGC) containing melanopsin that allows melatonin suppression via the retinohypothalamic tract.2 Even though the ipRGCs can function in the absence of rods and cones, their output is normally regulated by input from the rod and cone photoreceptors.3,4
Brainard et al.5 reported the influence of various monochromatic lights on melatonin secretion and found that a peak of the action spectrum at 464 nm. Morita and Tokura6 also indicated that a light with more short wavelengths reduced melatonin secretion and decreased the fall of core temperature in the evening and night, causing an inhibitory effect on nocturnal sleep.
In pathological conditions such as cataract, the reduction in light transmission in the eye can be very dramatic. Short wavelength light plays an important role on the inhibition of melatonin secretion. Therefore cataract patients, whose optical systems transmit light poorly (especially short wavelengths), would be likely to experience sleepiness in the daytime because there is not enough short wavelength light to reduce melatonin secretion. Consequently, they commonly have poor sleep in the night and are susceptible to sleep disturbances. For this reason, cataract surgery may improve not only their sight but also the quality of their sleep. Initially, intraocular lenses (IOLs) implanted during cataract surgery allowed the passage of all the visible light.7 However, it was found erythropsia8 (a temporary distortion of color vision where objects appear with an abnormal reddish hue), photic retinopathy (retinal dysfunction which induced by too much light exposure), and cystoid macular edema9–12 (fluid accumulation in the outer plexiform layer and cyst formation, a common cause of decreased vision following cataract surgery) occurred in patients with these IOLs.
Current knowledge/Study Rationale: For cataract patients, blue-light-blocking intraocular lens (IOLs) have beneficial effect on the retina, it can lower the risk of many retina diseases which are caused by too much light exposure. The ophthalmologist's only concern is whether blue-light-blocking IOLs affect the sleep quality of cataract patients because blue light is important in the control of the sleep-wake cycle.
Study Impact: Based on large sample size in Sichuan, China, our data indicate that blue-light-blocking IOL had a significantly beneficial effect on the sleep quality of cataract patients. Thus blue-blocking intraocular implants could be used routinely during cataract phacoemulsification surgery.
Previous works suggest that long time exposure in the blue range (approximately 475 nm) may injure an aging retina and cause photoreceptor damage and possibly lead to the development of other disease processes such as age-related macular degeneration.13–19 Therefore, in recent years, IOLs have been manufactured with a filter that blocks the passage of blue light. Although the filter can protect the posterior segment of the eye in theory, there have been few reports of its advantage, and many researchers still believed that a filter that blocks blue light may have detrimental effects.20–22 Landers and colleagues23 reported that compared to the conventional IOLs, blue-light-blocking IOLs had no detrimental effect on the sleep quality. However, Landers' study lacked assessment of the patient's sleep quality before surgery, and their study was conducted in a geographical region remarkable for its sunny climate. In order to confirm these initial findings in more patients and in a geographical region with less sunshine, we designed a study to evaluate whether cataract phacoemulsification (one kind of cataract extraction surgery, which uses ultrasonic power to emulsify the cataract in to aspirate it from two small incisions) combine blue-light-blocking IOL implantation has an effect on sleep quality based on large sample size in Sichuan, China.
Considering that nucleus hardness is the most important factor for light transmission, 40 bilateral cataract patients with nucleus hardness > level N3 (Lens Opacity Classification System II, LOCS II) were recruited from the outpatient clinic of the Department of Ophthalmology, West China Hospital, Chengdu, China into this study. LOCS II is a grading system for cataract according to the transparency of the lens. Focusing on the nucleus hardness, it can be divided into 4 levels (level N0: transparent nucleus, colorless; N1: soft nucleus, yellow-white color; N2: medium hardness nucleus, yellow color; N3: stiff nucleus, dark brown color). Patients were chosen who required bilateral cataract phacoemulsification followed by blue-light-blocking intraocular lens (SN60WF, Alcon Laboratories, USA) implantation due to visual acuity less than 0.2. To evaluate the nucleus hardness more accurately, 2 doctors provided independent evaluations. If one of these two doctors was not sure the nucleus hardness was > N3, a third doctor provided evaluation. Informed consent was obtained from each patient prior to the beginning of the experiment. Exclusion criteria included: IOL could not implanted during surgery, retinal or optic nerve disorders that might interfere with light perception or color perception (e.g., retinitis pigmentosa, anterior ischemic optic neuropathy, diabetes, glaucoma), color blindness, and inability to complete a questionnaire due to confusion or dementia. Postoperative refractive error and visual acuity were not exclusions.
Study design was a pre-test/post-test experiment.
The transmission curves of the blue-light-blocking intraocular lens (+20.0D SN60WF IOL, Alcon Laboratories, USA) and the typical conventional intraocular lens (+20.0D AR40e IOL, Abbott Medical Optics Inc, USA) were obtained by using an UV/Vis Spectrometer Lambda 14 (Perkin-Elmer Lambda; Shelton, CT). The sources are 2 lamps, one halogen and the other deuterium, which can cover both the UV and the visible lights. The apparatus uses 2 monochromators to select the wavelength (λ) accurately. Light passes through the IOLs and is measured before entering the integrating sphere. A suitable cuvette is used to place the IOLs directly in front and covering the complete entrance hole of the integrating sphere. Spectral of the human lenses were adapted from Boettner and Wolter.24
The questionnaire administered in this study was the Pittsburgh Sleep Quality Index (PSQI; Table 1). This 17-item questionnaire was designed to assess self-rated sleep quality and disturbances over a 1-month time period and to help investigators distinguish between "good" and "poor" sleepers. The PSQI included 7 component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction, and a total global score. Each component was scored 0 to 3, with 3 indicating the worst score. The highest possible global score is 21; and a score > 5 indicates a poor sleeper. The PSQI has been in clinical use for almost 20 years and over that time has consistently shown robust validity and reliability.25–28 The surgeries of this study were carried out between January 2012 to March 2012. All eligible patients completed the questionnaire within 3 days before their cataract surgery. Investigators did not tell subjects the supposed relationship between IOL and sleep quality. This was followed by a telephone call 2 months later after they completed bilateral surgeries. During the call, the same questionnaire was administered.
The Pittsburgh Sleep Quality Index Questionnaire
(more ...)
Given that the data were not normally distributed, Statistical Analysis System software (SigmaPlot 12.2, SYSTAT) was used for statistical analysis, including Wilcoxon's signed rank test, chi-square test. Medians and interquartile ranges (IQR) were recorded. Odds ratios and 95% confidence intervals were also recorded.
Our study confirmed that in visible light, the shorter wave-length (380-480 nm) light's transmittance of the blue-light-blocking lens (SN60WF) was much lower than that of the conventional intraocular lens (AR40e), but interestingly, it is very close to that of the 53-year-old human's natural crystalline lens at short wavelengths range from 350 nm to 465 nm.
Of 40 patients who were eligible, 26 were women (65%) and 14 were men (35%). The data were not normally distributed, the median age of all patients was 74 years (IQR 70 to 78); of female patients, 73 years (IQR 67 to 79) and of male patients, 75 years (IQR 70 to 80). The median PSQI component score before surgery of all patients was 2 (IQR 0 to 3) for subjective sleep quality, 0 (IQR 0 to 1) for sleep latency, 2 (IQR 0 to 3) for sleep duration, 1 (IQR 0 to 1) for habitual sleep efficiency, 1 (IQR 0 to 2) for sleep disturbances, 0 (IQR 0 to 1) for use of sleeping medication, and 1 (IQR 0 to 1) for daytime dysfunction. The median global score of all patients was 7 (IQR 3 to 13); 30 patients (75%) had a global score > 5 and were considered to be poor sleepers (Table 2).
Pittsburgh Sleep Quality Index scores before and after surgery
Two months after patients received bilateral cataract phacoemulsification and blue-light-blocking lens implantation, the median PSQI component score of all patients was 1 (IQR 0 to 2) for subjective sleep quality, 0 (IQR 0 to 1) for sleep latency, 1 (IQR 0 to 3) for sleep duration, 1 (IQR 0 to 1) for habitual sleep efficiency, 1 (IQR 0 to 2) for sleep disturbances, 0 (IQR 0 to 1) for use of sleeping medication, and 0 (IQR 0 to 1) for day-time dysfunction. The median global score of all patients was 4 (IQR 2 to 7); only 13 patients (32.5%) had a global scores > 5 and were considered poor sleepers (Table 1).
Between the two timepoints, there was a significant difference in global score (Z = -2.121, p = 0.037). More specifically, there were significant differences in subjective sleep quality (Z = -2.064, p = 0.045), sleep duration (Z = -2.037, p = 0.047), and daytime dysfunction (Z = -2.142, p = 0.034) before and after surgeries (Table 2). As a result of cataract phacoemulsification with blue-light-blocking intraocular lens implantation, 56.67% of subjects went from having an abnormal PSQI (> 5) to normal < 5 PSQI. The ratio of poor sleepers (PSQI > 5) reduced significantly after surgery (χ2 = 14.532, p = 0.000); the odds ratios were 6.231 and 95% confidence intervals were (2.351, 12.513).
Any medical device must be evaluated to ensure that it has no adverse effects. Our study found there is beneficial effect to cataract patients on sleep quality after cataract surgery and blue-light-blocking IOL implantation. Patients in our study who with the nucleus hardness over than level N3 (LOCS II) typically slept for a median of 5.5 hours per day, and they slept for 6.5 hours per day after cataract surgery combined blue-light-blocking IOL implantation. Very high ratio (75%) patients before surgery were considered to be poor sleepers as their PSQI scores were greater than 5 and their median PSQI scores were similar with those in a previous population-based assessment of patients of the same age.29
The circadian rhythm is controlled by suprachiasmatic nucleus inhypothalamus30,31 whose activity increases and decreases over a period of nearly 24.5 hours.32 One of its target organs is the pineal gland which secretes melatonin in a cyclical fashion. The secretion of melatonin could induce sleep.32 As mentioned above, the lighttriggered melatonin suppression is most sensitive to blue light, and it has also been proved theoretically that short-wavelength light is important in maintaining a balanced circadian rhythm and a regular sleep-wake cycle.33–36 This suggests that the patients with blue-light-blocking IOLs may be susceptible to sleep disturbances, daytime sleepiness, and insomnia or depression because of the blue light-blocking effect.37 However in stark contrast, our results clearly indicate this is not the case, blue-light-blocking IOLs actually improve the sleep quality of cataract patients. One reason for this phenomenon is that blue-light-blocking IOLs block blue lights only partially. Indeed, based on the spectral transmittance spectral curve as shown in Figure 1, though the blue light transmittance of the blue light-blocking IOL is much lower than that of conventional IOL, but it is very close to that of a 53-year-old human natural lens, which still allows 10% to 70% of 400-500 nm light go through. It seems that this amount of blue lights is sufficient to suppress the melatonin production, and thus keep the circadian rhythm. Another possibility is that patients with blue light-blocking IOL may have more rods, cones, and ipRGCs (as this type of IOL can protect retina from light damages), thus are more sensitive to blue light. This will compensate for the lost blue lights by this type of IOL. This conclusion is consistent with Landers' finding that the sleep quality is the same in cataract patients with conventional IOLs and blue-light blocking IOLs.23
Spectral of the human lenses were adapted from Boettner and Wolter.25
Spectral transmittance curves of the human natural lens at age 53 years, a +20.0D blue-light-blocking IOL(SN60WF) and a +20.0D conventional IOL(AR40e)Spectral of the human lenses were adapted from Boettner and Wolter.25
Blue-light-blocking IOLs have beneficial effect on the retina of cataract patients. They could lower the risk of erythropsia,8 photic retinopathy, and cystoid macular edema.9–12 Blue light-blocking IOLs do not reduce visual acuity, contrast sensitivity, color vision,38–41 or scotopic sensitivity42–44 of cataract patients. The ophthalmologist's only concern is whether blue-light-blocking IOLs affect the sleep quality of cataract patients. Based on our data and Landers' results, blue-light-blocking IOL is a good choice for cataract patients because thy have beneficial effects not only on retina, but also on sleep quality.
There are still several limitations of this observation. First, there is no control group, so we cannot compare the sleep quality between conventional IOL and blue-light-blocking IOL implantation. Second, we did not measure other circadian rhythm indicators such as the Horne Ostberg morningness-eveningness questionnaire or core temperatures. While our patients have improved sleep quality, we have no idea if they have a normal circadian rhythm. Third, it is difficult for us to be double-blinded to the treatment, so there might be bias. Nevertheless, our data indicate that blue-light-blocking IOL had a significantly beneficial effect on the sleep quality of cataract patients. Thus blue-blocking intraocular implants could be used routinely during cataract phacoemulsification surgery.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
Author contributions: Xin Wei and Lin Wang were responsible for drafting the manuscript, study concept, data acquisition and manuscript revision; Chunyan She, Fangbing Yan, Jihong Zeng, and Liping Zeng were responsible for data acquisition, analysis, and interpretation; Danian Chen provided comments on the manuscript. This work was supported by grants from Natural Science Foundation of China #81200687, Research Fund of Young Scholars For The Doctoral Program of Higher Education of China #20120181120014, and Science and Technology Support Program of Chengdu #12DXYB058JH-002 to Dr. Wei.
Brainard GC, Rollag MD, Hanifin JP, authors. Photic regulation of melatonin in humans: ocular and neural signal transduction. J Biol Rhythms. 1997;2:537–46.
Hankins MW, Peirson SN, Foster RG, authors. Melanopsin: an exciting photopigment. Trends Neurosci. 2008;31:27–36. [PubMed]
Altimus CM, Guler AD, Alam NM, authors. Rod photoreceptors drive circadian photoen-trainment across a wide range of light intensities. Nat Neurosci. 2010;13:1107–12. [PubMed Central][PubMed]
Dollet A, Albrecht U, Cooper HM, Dkhissi-Benyahya O, authors. Cones are required for normal temporal responses to light of phase shifts and clock gene expression. Chronobiol Int. 2010;27:768–81. [PubMed]
Brainard GC, Hanifin JP, Greeson JM, et al., authors. Action spectrum for melatonin regulation in humans: Evidence for a novel circadian photoreceptor. J Neurosci. 2001;21:6405–12. [PubMed]
Morita T, Tokura H, authors. The influence of different wavelengths of light on human biological rhythms. Appl Hum Sci. 1998;17:91–6.
Mainster MA, author. The spectra, classification and rationale of ultraviolet-protective intraocular lenses. Am J Ophthalmol. 1986;102:727–32. [PubMed]
Mainster MA, author. Solar retinitis, photic maculopathy and the pseudophakic eye. Am Intraoc Implant Soc J. 1978;4:84–6.
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Methamphetamine is a cheap and easy to make drug that offers an intense high, making it highly addictive and corrosive.
Methamphetamine is a cheap and easy to make drug that offers an intense high, making it highly addictive and corrosive.
The drug can quickly hook users and lead to a prolonged and damaging addiction that can cause a myriad of mental and physical health problems.
The caustic nature of meth can be attributed to the common household ingredients used to make it.
"It's common products that you might get at any retail store or pharmacy, and most of us already have them at home. It's just knowing how to put them together," Mark Woodward, spokesperson for the Oklahoma Bureau of Narcotics and Dangerous Drugs said.
The process of manufacturing the drug has changed over the years, due in part to legislation passed to combat production. Where elaborate labs were once necessary and the process took two to three hours, a user can now make a small batch in 45 minutes using little more than a 20-ounce soda bottle, a package of cold medicine, cleaning supplies and a coffee filter.
Users implement this "shake and bake" method, a process Woodward calls an inexact science using volatile material, to produce a small amount of the drug. A successful batch creates around 10 ounces of toxic waste for every quarter gram of meth – roughly one hit – produced.
Some of the ingredients include ether from starting fluid; red phosphorus found on the head of match sticks and in fireworks; ammonium nitrate, the ingredient in cold packs that make them get cold; lithium metal from camera batteries; sodium hydroxide from a drain cleaner; water; and pseudo ephedrine from cold medicine.
The components are measured and combined in the soda bottle, then shaken until the ingredients break down into sludge.
A brownish liquid, like the foam at the top of an icy mug of root beer, rises to the top.
The brown liquid is skimmed from the "gunk," usually with a turkey baster, and then dried out using Hydrogen Chloride Gas made by combining sulfuric acid and salt, or muriatic acid and tinfoil. Muriatic acid is commonly used in swimming pools.
"It is very corrosive, some cooks even use a gas mask while they're powdering that out using that gas," Woodward said.
The volatile combination of chemicals can easily "flashover," or catch fire, during production.
"It is a lot of work for a small amount of meth," Woodward said. "[Users] say it's worth all that work for the high that they get, because that high can last 14 to 24 hours."
That is longer than any other street drug. Because of the low cost of the drug, Oklahoma ranks in the top five states for meth use and production, Woodward said. The shake and bake, or "one pot," method became widespread after a series of laws were passed in Oklahoma in the early 1990s. These laws effectively regulated the purchase of many meth ingredients, resulting in a 95 percent reduction of meth labs in the state from 2004 until 2008.
Around that time, production started ticking up because of the shake and bake method.
One-pot production is strictly used by cooks that plan to use their product, and not used for commercial production. Bigger "super" labs, or "fiesta labs," are used by Mexican drug cartels that set up shop and cook large amounts of the drug to sell.
"They cook pounds and pounds of it and package it and ship it across the country, and some of it is coming through Oklahoma because of our highway system," Woodward said. "They're cooking in 55gallon drums, that's mass production for commercial sale."
Instead of coffee filters, the cartels use bed sheets, he said.
Meth addiction can lead to risky behavior, like cooking the drug, or stealing and other behavior that can have grave consequences at every level of one's health.
The average heart beats around 70 beats per minute (BPM). A heart rate at 100 BPM is considered fast, Dr. Scott Hough, M.D. F.A.C.E.P., an emergency medicine physician at St. Anthony, said. Some meth users go into the emergency room at St. Anthony's with a heart rate of 140 to 150 BPM.
"Most [health problems from meth] stem from malnutrition," Hough said. "You can also get skin disorders, ulcers, a lot of vitamin deficiencies, but the main thing is just behavioral."
Meth causes appetite suppression and severe sleep deprivation that can lead to psychosis like paranoia or depression, which can lead to murder or suicide. The most common health problems Hough has seen are skin ulcers and dental decay (see sidebar).
Pottawatomie County is the worst county for meth use out of the seven counties Hough has worked in, he said. He sees at least one patient with meth related health problems every day.
"But, it's bad everywhere," he said.
Tulsa County has the worst meth problem in the state.
Law enforcement seizes approximately two to three meth labs a day there, compared to one a month in Oklahoma County and one to two a month in Pottawatomie County, Woodward said.


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Orioles knock Rangers out in wild-card playoff
This isn't how the Texas Rangers envisioned following up two World Series runs.
They collapsed down the stretch, blowing their lead in the American League West, and finding themselves in a do-or-die, one-game wild card playoff with the Baltimore Orioles.
Their season died Friday night.
The Rangers completed their season-ending slump with a 5-1 loss to the Orioles, eliminating them from postseason competition. Texas finished its season by losing 10 of its final 14 games.
The Rangers seemed to have a favorable matchup with the Orioles starting left-hander Joe Saunders, who was winless in six starts at Rangers Ballpark. But the veteran held the Rangers to one run on six hits over 5 2/3 innings, handing it off to a dominant bullpen.
Rangers starter Yu Darvish did his job, keeping the Rangers in the game.
With the game tied 1-1 going into the sixth, the Orioles took a 2-1 lead. J.J. Hardy singled, advanced to third on a single by Chris Davis and scored on a sacrifice fly by Adam Jones.
Baltimore extended its lead to 3-1 in the seventh. Ryan Flaherty had a one-out single, and Robert Andino pinch-ran for him. Andino moved to second on a sacrifice bunt by Manny Machado, which ended the night for Darvish.
Darvish had thrown only 91 pitches to that point, allowing five singles, but manager Ron Washington turned to Derek Holland for the lefty-lefty matchup against Nate McLouth. It didn't pay off, as McLouth singled to left to score Andino.
Darvish, in his postseason debut, allowed three runs (two earned) on five hits with no walks and seven strikeouts over 6 2/3 innings.
Trailing 3-1 going into the eighth, the Rangers brought the tying run to the plate. With one out, Ian Kinsler reached on an infield single but Elvis Andrus grounded out and Josh Hamilton struck out on three pitches.
Hamilton ended his night 0 for 4 with two strikeouts, and saw a total of eight pitches. The Rangers faithful booed the soon-to-be free agent outfielder after his final three at-bats.
The Orioles cushioned their lead to 5-1 with a pair of runs in the ninth inning off Rangers closer Joe Nathan.
Orioles closer Jim Johnson worked out of a bases loaded jam in the ninth, ending the game by getting David Murphy to fly out.
-- Drew Davison
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