However, it is not known whether it has any impact on clinical ou

However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve

disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac surgery alone). The primary efficacy outcome Selleckchem Nutlin3 is the SR presence (without any AF episode) during a 24-hour electrocardiogram after 1 year. The primary safety outcome is the combined end point of death, myocardial infarction, stroke, and renal failure at 30 days. Long-term outcomes are a composite of total mortality, stroke, bleeding, and heart failure at 1 and 5 years. We finished the enrollment with a total of 224

patients from 3 centers in 2 countries in December 2011. Currently, the incomplete 1-year data are available, and the patients who enrolled first will have their 5-year visits shortly. PRAGUE-12 is the largest study to be conducted so far comparing cardiac surgery with surgical ablation of AF to cardiac surgery without ablation in an unselected population of patients who are operated on for coronary and/or valve disease. Its long-term results will lead to a better recognition of ablation’s potential clinical benefits. The PRAGUE-12 trial is partially funded by the Charles University Research Projects MSM0021620817 and UNCE 204010/2012. The authors have no other funding, financial relationships, or conflicts of interest to disclose.”
“Objective: To test the hypothesis that in vivo transgene expression mediated by single intra-articular injection of adeno-associated virus serotype 2 (AAV2) persists within intra-articular tissues 1 year post-injection and can be externally controlled using an AAV2-based tetracycline-inducible gene regulation system containing the tetracycline response element (TRE) promoter.

Methods: Sprague Dawley rats received intra-articular injections of AAV2-cytomegalovirus (CMV)-enhanced green fluorescent protein (GFP) and AAV2-CMV-luciferase (Luc) into their right and

left knees, respectively. Luciferase expression was evaluated over 1 year using bioluminescence imaging. After sacrifice, tissues were analyzed for GFP+ cells by fluorescent microscopy. To study external control of intra-articular AAV-transgene expression, another set of rats was co-injected with AAV2-TRE-Luc and AAV2-CMV-reverse-tetracycline-controlled transactivator (rtTA) into the right knees, and AAV2-CMV-Luc and AAV2-CMV-rtTA into the left knees. Rats received oral doxycycline (Dox), an analog of tetracycline, for 7 days. Luciferase expression was assessed by bioluminescence imaging.

Results: Luciferase expression was localized to the injected joint and persisted throughout the 1-year study period. Abundant GFP+ cells were observed within intra-articular soft tissues.

The largest concentrations are observed in the splanchnic blood r

The largest concentrations are observed in the splanchnic blood rather than in the systemic circulation.

Objective: In contrast with peripheral infusion, oral delivery of sodium N[8-(2-hydroxybenzoyl) amino] caprylate (SNAC) mimics endogenous secretion. We aimed to investigate how this affects food intake.

Design: Twelve healthy male subjects were studied in a

randomized, double-blind, placebo-controlled, 4-way crossover trial. Each subject received in random order 2.0 mg GLP-1, 1.0 mg PYY3-36, or 2.0 mg GLP-1 plus 1.0 mg PYY3-36; the peptides were mixed with SNAC. The placebo treatment was the delivery agent alone. Food intake during an ad libitum test meal was measured.

Results: Both peptides were rapidly absorbed from the gut, leading to plasma concentrations several selleck screening library times higher this website than those in response to a normal meal. GLP-1 alone, but not PYY3-36, reduced total energy intake significantly, with marked effects on glucose homeostasis. Coadministration of both peptides reduced total energy intake by 21.5% and fullness at meal onset (P < 0.05) but not total 24-h energy intake.

Conclusion: The results show a marked effect of orally administered GLP-1 and PYY3-36

on appetite by showing enhanced fullness at meal onset and reduced energy intake. This trial was registered at as NCT00822705. Am J Clin Nutr 2010;92: 810-7.”
“Multivisceral transplantations (MVT) are rarely performed procedures. In this case report, we present a 37-year-old male patient with a large retroperitoneal tumor. After exclusion of malignancy, we performed MVT (distal stomach, liver, pancreas, and small bowel). After a follow-up of 1 year, the patient is in good clinical condition. Histologic examination revealed a chronic sclerosing IgG4-associated disease. Our case shows that MVT can be successfully performed in this rare disease.”
“In a two-dimensional system the quantum spin Hall effect (QSHE) state is characterized by an insulating bulk

and two counter-propagating helical edge states. These edge channels are protected by time reversal symmetry and spin currents propagate without dissipation. It was shown that HgTe-based quantum well structures are the most suitable candidates for its experimental realization. Here, the selleck chemicals llc experimental requirements are discussed which lead to the observation of quantized edge channel transport which is one of the main signatures of the QSHE. Experiments will be presented which demonstrate the stability of the quantized conductance and its nonlocal character. Furthermore, evidence for the spin polarization of the QSHE edge channels is shown in an all-electrical measurement which demonstrates the potential of the QSHE for spin injection and detection applications in spintronics. (C) 2011 American Institute of Physics. [doi:10.1063/1.

Fibrosis, steatosis, homeostatic model assessment-insulin resista

Fibrosis, steatosis, homeostatic model assessment-insulin resistance and HCV RNA were predefined variables to be evaluated in relapse.

An intention-to-treat analysis was performed. SVR rates were 98% and 84% for genotype 2 and 3, respectively. Analysis of genotype 3 patients who had relapse showed a negative selleck chemical correlation with steatosis (P < 0.0001) and HCV RNA (P < 0.015). Multivariate analysis showed that steatosis was the independent predictor of relapse (OR, 0.988; 95% CI, 0.9810.993; P < 0.001). Genotype 3 patients with steatosis had a relapse rate of 36.4% and 15.8% in those with high and low viral load, respectively, whereas there was no relapse in those without steatosis. In conclusion, a 12-week course of therapy is Selleckchem BMS-777607 sufficient for patients without cirrhosis, not obese and infected with HCV genotype 2 achieve a RVR. This is not the case for genotype 3. Steatosis is the independent predictor of relapse. New therapeutic strategies are necessary for this subgroup of HCV genotype 3.”

To emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in significant cervical lymphadenopathy in children.

Study Design

A total

of 336 consecutive children, aged 1 month to 12 years, with significant cervical lymphadenopathy were subjected to FNAC. Children on empirical/specific therapy for lymphadenopathy for > 2 months and children with lymphadenopathy other than cervical region were excluded from this study.


Of 324 cases, the cytomorphologic features observed were reactive lymphadenitis in 58.02% of cases, granulomatous lymphadenitis in 30.55%, suppurative lymphadenitis in 7.10% and malignancies in 5.62%. The remaining 3.57% of cares were excluded because of inadequate aspiration. The most common cause diagnosed was tuberculosis in 29.01% of cases followed by chronic tonsillopharyngitis in 28.39%, suppurative lymphadenitis in 7.10%, human immune deficiency infection

in 5.55% and malignancies in 4.32%.


FNAC is an important diagnostic modality for the etiologic Nepicastat workup in significant. cervical lymphadenopathy in children. It is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes. (Acta Cytol 2009;53:174-178)”
“The dynamics of laser generated plasma plumes expanding within confining surfaces display a two-phase nature. Early phase enhancement due to hydrodynamic containment results in higher temperatures, densities, and average charges states in comparison to freely expanding plasma plumes. Later phase dynamics result in rapid decay of the plasma plume due to lossy plasma-surface interactions.

The initial approach of the CALIBER programme is characterized as

The initial approach of the CALIBER programme is characterized as follows: (i) Linkages of multiple electronic heath record sources: examples include linkages between the longitudinal primary care data from the Clinical Practice Research Datalink, the Givinostat research buy national registry of acute coronary syndromes (Myocardial Ischaemia National Audit Project), hospitalization and procedure data from Hospital Episode Statistics and cause-specific mortality and social deprivation data from the Office of National Statistics. Current cohort analyses involve a million people in initially healthy populations

and disease registries with similar to 10(5) patients. (ii) Linkages of bespoke investigator-led cohort studies (e.g. UK Biobank) to registry data (e.g. Myocardial Ischaemia National Audit Project), providing new means of ascertaining, validating and phenotyping disease. (iii) A common data model in which routine electronic health record data are made research ready, and sharable, by defining and curating with meta-data > 300 variables (categorical, continuous, event) on risk factors, CVDs and non-cardiovascular comorbidities. (iv) Transparency: all CALIBER studies have an analytic protocol registered in the public domain, and data are available (safe haven model)

for use subject to approvals. For more information, e-mail [email protected]
“Objective: To develop and pilot test a generic questionnaire to HKI-272 cost measure continuity

of care from the patient’s perspective across primary and secondary care settings.

Study Design and Setting: We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic CB-839 literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care providers. The questionnaire was distributed among patients with a chronic disease recruited from general practice. We used principal component analysis (PCA) to identify subscales. We refined the factors by excluding several items, for example, items with a high missing rate.

Results: In total, 288 patients filled out the questionnaire (response rate, 72%). PCA yielded three subscales: “”personal continuity: care provider knows me,”" “”personal continuity: care provider shows commitment,”" and “”team/cross-boundary continuity.”" Internal consistency of the subscales ranged from 0.82 to 0.89. Interscale correlations varied between 0.42 and 0.61.

Conclusion: The NCQ shows to be a comprehensive, reliable, and valid instrument. Further testing of reliability, construct validity, and responsiveness is needed before the NCQ can be more widely implemented. (C) 2011 Elsevier Inc. All rights reserved.

Materials and methods: The design of this study was a double-blin

Materials and methods: The design of this study was a double-blind crossover trial. The 90 subjects were divided into three groups: group I used SLS-free (a commercially available SLS-free dentifrice) SB273005 inhibitor and SLS-A (SLS-free + 1.5% SLS), group II used SLS-A and SLS-B

(a commercially available 1.5% SLS-containing dentifrice), and group III used SLS-free and SLS-B. The subjects used one of the two assigned dentifrices for 8 weeks and then the other for the following 8 weeks. The order of the dentifrices used was selected at random, and there was a 2-week washout period between the two phases. The clinical parameters (number of ulcers, number of episodes, duration of ulcers, mean pain score) were compared between the two phases for

each group. Epigenetics inhibitor Results: The number of ulcers and episodes did not differ significantly between SLS-A, SLS-B, and SLS-free. Only duration of ulcers and mean pain score was significantly decreased during the period using SLS-free. Conclusion: Although SLS-free did not reduce the number of ulcers and episodes, it affected the ulcer-healing process and reduces pain in daily lives in patients with RAS.”
“Chemistry of 9,10-anthraquinones is considered as chemistry of isomeric anthraquinones existing in dynamic equilibrium with each other. Diversity of electronic absorption spectra of the same compounds is determined by tautomeric transformations. Alizarin exists as equilibrium mixtures of tautomers and conformers having 9,10- and ARS-1620 2,9-quinoid structures. Qualitatively different compositions are inherent not only to samples of alizarin prepared or purified by different methods but also to different solvates of the same sample.”
“This study examined the baseline characteristics,

racial/ethnic differences, and geographic differences among participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. The SPS3 trial enrolled patients who experienced a symptomatic small subcortical stroke (lacunar stroke) within the previous 6 months and an eligible lesion on detected on magnetic resonance imaging. The patients were randomized, in a factorial design, to antiplatelet therapy (aspirin 325 mg daily plus clopidogrel 75 mg daily vs aspirin 325 mg daily plus placebo) and to one of two levels of systolic blood pressure targets (“”intensive”" [<130 mmHg] or “”usual”" [130-149 mmHg]). A total of 3020 participants were recruited from 81 clinical sites in 8 countries. In this cohort, the mean age was 63 years, 63% were men, 75% had a history of hypertension, and 37% had diabetes. The racial distribution was 51% white, 30% Hispanic, and 16% black. Compared with white subjects, black subjects were younger (mean age, 58 years vs 64 years; P <.001) and had a higher prevalence of hypertension (87% vs 70%; P <.001).

After 3 years, magnesium administration was almost universal amon

After 3 years, magnesium administration was almost universal among patients diagnosed with preeclampsia, preterm labor, or preterm premature rupture of membranes (95.4%), whereas patients delivered preterm for fetal growth restriction were significantly less likely to receive predelivery magnesium (44%, P<.001). No maternal or perinatal magnesium-attributable morbidity was noted. Among patients eligible for the protocol who received magnesium, 84.2% delivered before 32 weeks

of gestation.

CONCLUSION: It is feasible to implement a magnesium sulfate cerebral palsy prevention protocol into clinical practice. (Obstet Gynecol 2013;121:235-40) DOI: http://10.1097/AOG.0b013e31827c5cf8″
“OBJECTIVE: To identify

and analyse the social representations (SRs) of tuberculosis (TB) among three groups of people in Medellin, Colombia, with the purpose of contributing to improvements in TB treatment JNK-IN-8 ic50 and control programme activities.

METHODS: Cross-sectional study using free word association and evocative analysis techniques in 1049 persons within a structural SR framework.

RESULTS: PX-478 concentration The terms ‘cough’, ‘contagion’, ‘illness’ and ‘fear’ were found to be components of the central core in the three groups. In the peripheral system, ‘rejection’ and ‘treatment’ were considered modifiable factors. Text analysis showed that ‘fear’ and ‘compassion’ are associated with evocations among patients and their relatives, ‘contagion’ among lay people and ‘isolation’ among health care personnel.

DISCUSSION: Fear of infection may have a negative effect on relationships with patients, health care activities, treatment surveillance and family support for patients. A better understanding of buy 3-MA patient beliefs and their family environment can improve treatment quality and adherence in the city.”
“OBJECTIVE: To estimate unintended pregnancy

rates among a representative sample of 7,225 active-duty women in the U.S. military in 2008 and to compare these rates with 2005 and with the U.S. population.

METHODS: Cross-sectional data came from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel (Health Related Behaviors Survey). For all women and by key subgroups, unintended pregnancy rates per 1,000 women were calculated and compared with rates reported in the 2005 Health Related Behaviors Survey. Univariable and multivariable logistic regression to test for associations between unintended pregnancy and key subgroups was also performed. Finally, an age-standardized unintended pregnancy rate was calculated to adjust for differences in age composition between the military and U.S. populations for better comparison with the general U.S. rate.

RESULTS: Eleven percent of women reported an unintended pregnancy in the prior 12 months.

Accordingly, the driving mechanism for SA solubility in water-ric

Accordingly, the driving mechanism for SA solubility in water-rich mixtures is the entropy, probably due to water-structure loss around the drug non-polar moieties by propylene glycol, whereas, above 0.20 mass fraction of

propylene glycol the driving mechanism is the enthalpy, probably due to SA solvation increase by the co-solvent molecules.”

Pediatric scoliosis surgery is associated with considerable postoperative pain requiring CA3 opioids for analgesia. Nonsteroidal antiinflammatory drugs (NSAIDs) can be used as adjuvants for analgesia; however, the potential of these agents to affect bone healing raises concerns. No large-scale prospective studies have been performed to evaluate the benefit-to-risk ratio of NSAID use after pediatric scoliosis surgery. Given the lack of evidence in the literature, a survey of practice patterns of anesthesiologists from around the world was conducted with respect to the use of NSAIDs

after pediatric spinal fusion surgery for scoliosis.


One hundred and fourteen anesthesiologists from international academic pediatric hospitals were asked to complete an online survey. After 1 month, nonresponders were sent a second e-mail asking for their participation. All questions were developed specifically for this study.


Out of 80 anesthesiologists who responded 61 were included in the final analysis. Fifty-nine percent routinely use NSAIDs, the most common agents being intravenous ketorolac and oral ibuprofen. The majority of respondents begin to administer NSAIDs Ro-3306 ic50 within the first three postoperative days for a duration of four or more days. The primary reason for not routinely prescribing NSAIDs was the risk of bone nonunion.



survey demonstrates that the practice patterns of pediatric anesthesiologists from around the world with respect to the administration of NSAIDs for the management of postoperative pain after pediatric spinal fusion reflects the conflicting evidence in the literature Selleckchem Dorsomorphin and the lack of high-quality studies in humans.”
“Objectives: To investigate factors in patients with critical limb ischemia (CLI) and isolated infrapopliteal lesions that adversely affect outcomes of endovascular therapy (EVT) with or without angiosome-oriented revascularization.

Methods: This was a retrospective multicenter study. We used a database of 718 consecutive CLI patients (70 +/- 11 years, 75% diabetics, 68% on hemodialysis, 24% Rutherford class 6) with ischemic tissue loss due to isolated infrapopliteal lesions undergoing primary EVT. Primary outcome was MALE (major adverse limb event). Association between indirect EVT (recanalization of a non-angiosome-based artery) and outcome was assessed by Cox proportional hazard regression model.

Results: C-reactive protein (CRP) level was >3 mg/dL in 32% of cases. Indirect EVT (in 307 CLI patients, 43%), was associated with MALE (p = .04, hazard ratio [95% confidence interval] 1.25 [1.01, 1.

The unmet need for mental health care in affected

The unmet need for mental health care in affected PHA-739358 ic50 regions remains an important public health challenge 25 years later. Future research is needed that combines physical and mental health outcome measures to complete the clinical picture. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.”
“The synthesis of 4-(1-adamantyl)-4,4-diarylbutylamines 1, 5-(1-adamantyl)-5,5-diarylpentylamines 2 and 6-(1-adamantyl)-6,6-diarylhexylamines 3 is described and the sigma 1, sigma 2-receptors and sodium channels binding affinity of compounds 1 were investigated. The in vitro activity of compounds 1, 2 and 3 against main cancer cell

lines is significant. One of the most active analogs, 1a, had an interesting in vivo anticancer profile against the ovarian cancer cell line IGROV-1, which was associated with an anagelsic activity against the neuropathic pain induced by the main anticancer drugs.”
“Background: Whether patients with persistent atrial fibrillation (AF) obtain the same degree of benefit with cardiac resynchronization therapy (CRT) as those in sinus rhythm remains unclear.

Methods: We enrolled 93 patients undergoing CRT implantation, 20 (22%) of whom had rate-controlled

persistent AZD1208 purchase AF. The primary end-point was CRT response defined as 1 class improvement in Specific Activity Scale and 15% reduction in left ventricular end-systolic volume (LVESV) during 12 months. Other endpoints included changes in 6-minute walk distance,

quality of life, B-type natriuretic peptide, and survival.

Results: Baseline characteristics were similar in those with and without AF. Response to CRT was observed in 42% vs 54% of those with and without AF, respectively (P = 0.3). Both groups had significant improvements in 6-minute walk distance, quality of life, and LVESV, but the improvement in LVESV was smaller in those with AF (13.7% +/- 14.9% vs 27.7% +/- 23.7%; P = 0.02). During click here 2.8 +/- 1.4 years of follow-up, AF was associated with a 2.2-fold increased risk of death or transplantation (95% confidence interval, 1.2-3.9; P = 0.01).

Conclusions: Compared with patients without rate-controlled persistent AF, those with rate-controlled persistent AF had similar rates of clinical improvement but less left ventricular reverse remodelling in the first year after CRT. AF was associated with a markedly higher risk of death or transplantation in long-term follow-up. Given these findings, randomized studies assessing CRT efficacy in those with AF are warranted.”
“Immunobiochemical status of sheep exposed to periods of experimental protein deficit and realimentation was studied in 12 sheep (15 mo) randomly distributed into 2 equal groups and fed individually 2 different concentrate supplements along with wheat straw to provide 100% (normal protein, NP) or 50% (low protein, LP) of CP requirements.

A consistent prospective follow-up is essential not only for rese

A consistent prospective follow-up is essential not only for research purposes but also for assessing the local results of AF surgery in everyday practice. It may direct and develop the surgical ablation program, guide individual postoperative arrhythmia management and is needed to increase overall quality of surgical AF ablation. (C) 2011 Published by Ruboxistaurin clinical trial European Association

for Cardio-Thoracic Surgery. All rights reserved.”
“Black locust (Robinia pseudoacacia L.) is a pioneer legume for afforestation in soft rock areas of the Loess Plateau, China. Our study aimed to assess the effects of Glomus mosseae and Rhizobium strain NWYC129 on the growth of black locust seedlings and the quality of weathered soft rock soils under pot conditions. Black locust seedlings could form strong symbiotic relationships with arbuscular mycorrhizal (AM) fungi and rhizobia. Dual inoculation with G. mosseae and Rhizobium NWYC129 had the best effects on shoot dry weight, root dry weight, shoot height, root length and stem diameters of black locust seedlings, compared with single and non-inoculation. Inoculation with G. mosseae and/or Rhizobium NWYC129 clearly enhanced the 4SC-202 mw content of organic matter in weathered soft rock soils, and significantly improved the transport rate of soil phosphorus from the rhizosphere soils to plant tissue compared with non-inoculation. Treatments inoculated with Rhizobium had higher available nitrogen concentrations in weathered

soft rock soils than treatments non-inoculated with Rhizobium. Dual inoculation showed the greatest activities of urease, alkaline phosphatase, invertase and catalase among the five treatments. The content of

Bradford-reactive soil proteins (BRSP) was increased by inoculation with G. mosseae, and the highest contents of easily extractable Bradford-reactive soil proteins (EE-BRSP) and total Bradford-reactive soil proteins (T-BRSP) were found in weathered soft rock BAY 63-2521 concentration soils inoculated with G. mosseae and Rhizobium NWYC129 together. We conclude that dual inoculation with G. mosseae and Rhizobium NWYC129 was highly beneficial for improving the growth of black locust seedlings and the quality of weathered soft rock soils of the Loess Plateau.”
“Background: Human and animal studies, albeit not fully consistent, suggest that vitamin D may reduce risk of Parkinson’s disease (PD). Ultraviolet radiation converts vitamin D precursor to the active form. This study examined the hypothesis that working outdoors is associated with a decreased risk of PD.

Methods: PD cases were enrolled from Group Health Cooperative, a health maintenance organization in the Puget Sound region in western Washington State, and the University of Washington Neurology Clinic in Seattle. Participants included 447 non-Hispanic Caucasian newly diagnosed PD cases diagnosed between 1992 and 2008 and 578 unrelated neurologically normal controls enrolled in Group Health Cooperative, frequency matched by race/ethnicity, age and gender.

With the bladder distended to induce large amplitude rhythmic iso

With the bladder distended to induce large amplitude rhythmic isovolumetric bladder contractions, stimulation at a frequency between 5 and 7Hz significantly suppressed the contractions. Stimulation applied during a cystometrogram (CMG) also increased bladder capacity by 44.3 +/- 10.8%. At a frequency between 20 and 40 Hz the inhibitory effect on rhythmic bladder contractions was weak and did not increase bladder capacity during CMG. At low bladder volumes ranging between 60% and 100% of the bladder capacity 20 Hz stimulation-induced small amplitude

(21.2 +/- 14.6cmH(2)O) bladder contractions. However, stimulation at 20 Hz induced large amplitude (111.7 +/- 22.2cmH(2)O) bladder contractions at a bladder volume about 100-110% of the bladder capacity after the rhythmic bladder contractions were completely AC220 datasheet inhibited by the inhibitory 5Hz stimulation. Conclusions: Both inhibitory and excitatory effects on bladder activity can be obtained in cats using the non-invasive neural stimulation approach.

This pre-clinical study warrants a further clinical trial to investigate the ERK inhibitor possibility of using this non-invasive stimulation method to treat incontinence or urinary retention. Neurourol. Urodynam. 30:1686-1694, 2011. (C) 2011 Wiley Periodicals, Inc.”
“Global warming will cause significant harm to the health of persons and their communities by compromising food and water supplies; increasing risks of morbidity and mortality from infectious diseases and heat stress; changing social determinants of health resulting from extreme weather events, rising sea levels, and expanding flood plains; and worsening air quality, resulting in additional morbidity KU-57788 inhibitor and mortality from respiratory and cardiovascular diseases. Vulnerable populations such as children, older persons, persons living at or below the poverty level, and minorities will be affected earliest and greatest, but everyone likely

will be affected at some point. Family physicians can help reduce greenhouse gas emissions, stabilize the climate, and reduce the risks of climate change while also directly improving the health of their patients. Health interventions that have a beneficial effect on climate change include encouraging patients to reduce the amount of red meat in their diets and to replace some vehicular transportation with walking or bicycling. Patients are more likely to make such lifestyle changes if their physician asks them to and leads by example. Medical offices and hospitals can become more energy efficient by recycling, purchasing wind-generated electricity, and turning off appliances, computers, and lights when not in use.