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Williams has served on numerous editorial boards and currently is a member of the boards of Archives of Toxicology discount 10mg tastylia visa mens health france, European Journal of Cancer Prevention order 20 mg tastylia mastercard man health in today, and Drug and Chemical Toxicology order 20 mg tastylia fast delivery prostate ultrasound and biopsy. He has also served on numerous working groups and committees of the National Research Council cheap 20mg tastylia overnight delivery prostate zinc deficiency, U. Environmental Protection Agency, International Agency for Research on Cancer, and World Health Organization. His research focuses in mechanisms of chemical genotoxicity and carcinogenicity. See also individual nutrients 1240-1243 defined, 84, 973 energy metabolism, 33, 54, 108, 116, 289 insufficient evidence of, 102-103, 970extrapolation of data to infants and 971 children, 25, 26-27, 34, 46, 47, 284 nutrient–nutrient interactions, 85, 95 fat (dietary), 459-460, 769, 809, 1234Aerobics Center Longitudinal Study, 912 1237, 1240-1243 African Americans fiber, 354, 358, 366, 387-389, 396, 398, breast cancer, 379 788, 809, 1234-1237, 1240-1243 energy expenditure, 145-146, 179 glucose metabolism, 285-289, 388, 784fiber, 379 785 pubertal development, 33 high fat, low carbohydrate diets, 792-810 Age/aging. See also Physical activity 732, 795 amino acid supplements, 702, 706 Arabinose, 345 endurance training, 660 Arachidonic acid, 425, 426, 433-434, 435, energy balance, 221-223, 452 438, 439, 440, 442, 443, 444, 446-447, high-carbohydrate diet, 452 453-454, 455-456, 465, 469, 472, 476, high-fat diet, 452 478, 824, 838 lipoprotein profile, 61 Arginase, 605 low fat, high carbohydrate diet, 773 Arginine (dispensable), 591, 593, 594, 597, protein, 660-661 605, 608, 697-700, 709, 712, 717, 724, resistance training, 660 736, 994-995 runners, 61, 773 Arginine glutamate, 714 skeletal health, 66 Arginionsuccinic acid synthetase, 697, 700 Autoimmune diseases, 487 Arizona Wheat-bran Fiber Trial, 374 Arteriosclerosis, 130, 842 Asians, obese, 352 B Asparagine (dispensable), 591, 593, 594, 700 Balance studies. See also Thermic effect of food Gastric emptying additives, 90, 350, 366, 391 amino acids, 615 energy density of food and, 795 allergies, 692 amino acid composition, 683-686, 689fat, 438 690 fiber and, 4, 63, 65, 339, 348, 360, 370, 379, 382, 383 energy-dense, nutrient-poor, 302, 312, 794-796 Gastrointestinal distress, fiber intake and, palatability, 425, 795, 808, 809 394-395, 396-397, 398 Gastrointestinal health plantvs. See monounsaturated fatty acid intake and, also Guar gum 817-818 physical exercise and, 60, 61 polyunsaturated fatty acids and, 820, H 821, 822-823, 826, 828, 830-831 protective effect, 560 Hawaiian natives, 798 saturated fatty acids and, 483 Hazard identification. See also individual sugar intake and, 298-301, 302 nutrients trans fatty acids and, 495-503 animal data, 94-95, 96, 696, 697-698, transport, 543, 544 701-702, 707-708, 711-712, 713-714, Health Canada, 349, 481, 883, 979 721-722, 724, 725-726, 727, 729, 730Health Professionals Follow-Up Study, 321, 732, 734-735 363, 364, 368, 371-372, 375-376, 377, asthma, 716-717 387, 562, 563, 827 behavior, 295-296 Healthy People 2000, 882 cancer, 319-321 Heart disease. See also Cardiovascular causality, 94, 96, 102 disease; Coronary heart disease Chinese restaurant syndrome, 715-716 carbohydrate intake and, 59 components of, 87, 94-98 fiber intake and, 59-60 data sources, 96-97 physical activity and, 60-61 defined, 87, 975 protein intake and, 60 dental caries, 296-297 Heat of combustion, 108, 109 developmental studies, 708-710 Height. See also Balance studies intervention studies, 794-796, 798-799, advantages, 91, 98 803-807 amino acids, 608-699, 702-703, 705-706, metabolic syndrome, 802-808 712, 714-715, 720, 722-723, 724-725, and micronutrient inadequacy or excess, 726, 727, 729, 730, 731-733, 735 808-809, 816 controlled, 40 obesity risk, 792-797, 814 dose–response assessment, 98 saturated fatty acid intakes, 799-802 feeding trials, 40-41 sugar inadequacy, 809 limitations of, 40-41, 94 High-fiber diets, 297, 374, 378-379, 383, Hunger, 117, 313, 732, 795, 796 788, 839 Hydrogenated fat, 427-428, 436, 455, 456, High fructose corn syrup, 294, 295 479, 495, 498-504, 836 High glycemic index diets, 302 5-Hydroxyindoleacetic acid, 732 Hippuric acid, 604 Hydroxylysine, 593 Histidine (indispensable), 589, 591, 592, 3-Hydroxy-3-methylglutaryl coenzyme A, 545 593, 597, 604, 662, 663-665, 666, 668, Hydroxyproline, 592-593, 728-729 672-675, 678-682, 686, 687, 689, 709, Hyperactivity, 295 712, 720-723, 736, 1004-1005 Hyperammonemia, 699, 714, 718 Homocysteine, 302, 726 Hypercalciuria, 694, 841 Homovanillic acid, 735 Hyperchloremic acidosis, 698 Honolulu Heart Program, 562 Hypercholesteremia, 276, 352, 355, 356, Human chorionic somatomammotropin, 189 358, 359, 366, 367, 494, 495, 721, Human milk. See also 611, 630, 669, 982 specific indicators, nutrients, and life hyperammonemic, 699 stages language development, 447 methodological considerations, 43 malnutrition, 165, 167, 608-609 risk reduction-based methodological considerations, 44-46 Infants, 0-12 months. See also Diabetes design features, 43 mellitus diabetes mellitus (type 2), 381-382, 785, Insulin Resistance Atherosclerosis Study, 786-787, 806-807, 832-833 803 of dietary patterns, 43 Insulin response. See also Hyperinsulinemia fiber and disease prevention, 344, 351, age/aging and, 62 365-368, 374-377, 378-379, 381-382, amino acids, 696, 701, 705, 710 383-384 and cancer, 320 glucose response, 381-382, 803-807 to carbohydrate intake, 268, 269, 273, high fat, low carbohydrate diets, 794274, 275, 277, 303, 320, 437 796, 798-799, 803-807 and diabetes, type 2, 63, 275, 303, 306hyperlipidemia prevention, 365-368 307, 308-312, 784-785 hypertension prevention, 365-368 epidemiological studies, 380-381 insulin response to fat intake, 803-807 to fat, 62, 303, 430, 437, 438, 484-485, low n-9 monounsaturated fatty acid 802-808 diets, 817-818 fiber intake and, 60, 63, 297, 306-307, meta-analyses, 58, 777, 798 339, 351, 353, 355-356, 360, 380-382, methodological issues, 43, 376-377 388 obesity, 311, 773-776, 794-796, 797 to glucose metabolism, 268, 273, 274 polyunsaturated fatty acids, 821, 828, glycemic index of foods and, 63, 269, 830-831, 832-833 306-307, 308-312, 322 satiety and weight maintenance, 383-384 hazard identification, 303, 306-307 timing of, 376 intervention studies, 381-382 Intestinal absorption. See also Basal metabolic rate; 661, 663-665, 666, 668, 669-670, 671Glucose metabolism; Lipids and lipid 682, 685, 686, 687, 689, 692, 723-725, metabolism; individual nutrients 736, 1010-1011 cellular uptake of nutrients, 273 eiconasanoid, 55 glycogen synthesis and utilization, 274 M insulin, 275 intracellular utilization of sugars, 273Macronutrients. See also Carbohydrate; Fat; 274 Protein physical activity and, 138 brain requirements, 771 splanchnic, 600, 717 defined, 108 Methionine (indispensable), 589, 591, 593, imbalances and chronic diseases, 771 594, 597, 608, 614, 663-665, 666, 668, integrated planning of intakes, 936-966 672-675, 677, 678, 679-682, 685, 686, Magnesium, 394, 789, 790-791, 813, 838, 687, 689, 711, 723, 725-726, 736, 1204-1211, 1214-1221, 1224-1225 1012-1013 Malabsorption syndrome, 30 Methodological issues. See also Data and Malnutrition, 167, 437, 595, 608-610, 704, database issues; Indicators of 839. See also Protein Nuclear peroxisome proliferator activating amino acid utilization through receptors, 425 nonprotein pathways, 607-608, 684 Nurses’ Health Study, 306-307, 363, 368, balance, 275, 279, 287, 594, 611, 694, 376, 377, 387, 563, 827-828, 842 718 Nutrient intakes. See also 357-360, 365, 366, 371, 374-375, 388, individual nutrients 398-399, 693-694 adverse effects, 970-971 Puberty/pubertal development amino acids, 737-738 age at onset, 33, 983 approach to setting, 968 developmental changes, 177 body composition and size, 225, 240 growth spurt, 142 carbohydrates, 323-324 racial/ethnic differences, 33 cholesterol, 574-575, 578 Purine nucleotide cycle, 604, 605 chronic disease relationships to intakes, Pyrimidine nucleotides, 620 970 Pyruvate, 604, 605 data and database issues, 969-971 energy, 225, 240, 323-324 fat (total), 324, 505, 514 R fiber, 399-400 major information gaps and, 18, 44, 969Race/ethnicity. See also Special Risk characterization, 86, 89, 90, 976 considerations Risk management, 87, 89, 104, 976 identification of, 97-98 Septicemia, 609, 705 Serine (dispensable), 591, 593, 594, 597, S 604, 608, 711, 719, 729-730, 736, 1018-1019 Satiety, 65, 313, 348, 382-384, 388, 794, 795, Serotonin, 608, 706, 731, 732, 916 796, 843 Seven Countries Study, 562, 817, 826, 827 Saturated fatty acids. See Thermic effect intestinal absorption, 273 of food intrinsic, 265 Stachyose, 265, 342 lipogenicity, 59, 297-302, 323 Starch. See also Resistant starch in low fat, high carbohydrate diets, 788and cancer risk, 321 789, 790-793 definition, 267-268 maximal intake levels, 16, 810, 816 and dental caries, 296 and micronutrient intake levels, 788-789, digestion and digestibility, 269, 272 790-793, 809, 812, 1203-1225 energy yields, 109 and obesity, 307, 310-313, 314-319, 323 food sources, 265-266, 294 substitutes, 346, 695, 702-703, 727 glycemic index, 323 total, 313, 314-315, 316-317, 789, 792, insulin sensitivity, 303 809, 813-814 lipogenesis, 59, 298-301, 302 uses, 266 slow release vs. See also Obesity and overweight; 266, 294, 344, 346, 391, 479, 771, 882 Reference weights and heights; U. Department of Health, Education, and age/aging and, 143, 167 Welfare, 882 amino acids and, 697, 698, 700, 707, U. The plus (+) symbol indicates a change from the prepublication copy due to a calculation error. This report provides you with information about your heart health based on your recent test results. Talk to your healthcare provider about these results, questions you may have and actions you can take to improve your heart health. On the following pages, you will learn that cholesterol results do not tell the entire story of your heart health. Knowing your risk of heart disease, heart attack, stroke or diabetes is a key step in your heart health journey. The good news is that even small changes can make big improvements to your heart health. Your plan for well being outlines lifestyle, medication and supplement considerations specific to your test results. Schaefer is Board Certified in Internal Medicine, fellowship trained in Endocrinology and is author of over 500 scientific publications. Use this report to learn more about your test results, heart disease risk and your plan for well being. Your healthcare provider combines your test results with other risk factors such as your family history or lifestyle habits to complete the picture and determine the best treatment for you. Your test results will tell you if you have too much cholesterol or fat, whether the kind you have is dangerous, and if you are at risk of forming blockages that can lead to heart attack or stroke. Your test results will tell you if you have the kind of inflammation in your arteries that would increase your near-term risk of heart attack or stroke. While your genes don’t change, this information helps your healthcare provider determine your treatment— the right medication, the right dose, and even the right foods. Here is the summary of your lab test results for each part of your heart health story. Take action to improve your test results by understanding your results and your plan for well being. Your healthcare provider may recommend different types and dosages of medications or supplements, or encourage you to engage in lifestyle changes.

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Analysis of current and historic data may indicate that vaccinaton of an unafected populaton which is at high risk of a severe epidemic and high mortality is potentally more benefcial than vaccinaton of a currently afected populaton that is at less risk of poor outcome best 20mg tastylia prostate 30ml equals. Ideally tastylia 10mg low price prostate cancer signs, then order 10 mg tastylia with mastercard prostate natural remedies, vaccinaton of an afected populaton should occur in the early phase of the outbreak generic 10mg tastylia with mastercard mens health 17 day abs, when the number of cases is stll rising. However, experience to date has demonstrated that rapidly achieving vaccine-induced immunity in a populaton early in an outbreak is challenging. Prompt decision-making, vaccine acquisiton, and campaign implementaton considerably reduces the delay. In this context, vaccinatng populatons stll at risk of outbreak extension is preferable. Vaccinaton of the afected populaton near or afer the peak can be the right strategy in the following scenarios: • Severe epidemic with atack rate and/or mortality rate clearly above the norm; • Epidemic likely to be prolonged. Greater beneft may be realized by vaccinatng populatons which will not have such support, whether currently afected or not. There are no completed feld studies which show strong evidence for prioritzing one target populaton over another. Currently, these recommendatons are made based on observatons of cholera epidemics and the relatvely limited experience of vaccinatng in the outbreak setng. In the end, the guidance here is only a subset of the consideratons that local and natonal health authorites may use in a fnal decision on the strategy of vaccinaton. However, vaccinaton does not lessen the need for protecton against water-borne diseases and should not replace provision of clean water and proper sanitaton. The actual risk of cholera based on the current and historical epidemiological situaton; 2. The capacity to control a possible outbreak and provide adequate care to prevent high mortality; 3. Actual risk of an outbreak the risk of a cholera outbreak in humanitarian emergencies is high when several of the following risk factors are combined. For example: – In a non-endemic area, the risk is high if sanitaton and water conditons have seriously deteriorated and cholera is present in a neighbouring country. Capacity to control a possible outbreak and/or limit cholera mortality Outbreak and/or mortality control is difcult to achieve if some of the following factors are present. The principal targets for vaccinaton are populatons at high risk, as determined by analysis of historical data. These populatons are those living close to natural reservoirs of cholera (lakes, etc. Vaccinaton should be planned at a tme of year where there is litle or no cholera transmission. Re-vaccinaton might be required afer vaccine immunity decreases if defnitve measures to improve access to safe water and sanitaton have not been implemented. With a vaccine given in 2 doses at least 2 weeks apart, and that is in limited supply with respect to needs, a single dose strategy has been employed. In a clinical trial, a single dose protocol demonstrated signifcant protecton (compared to placebo) over a short period (6 months), principally against severe cholera in the adult populaton9. A case-control study performed following a single dose reactve vaccinaton campaign confrmed substantal short term protecton10. Thus, a vaccinaton with a single dose is possible when long term protecton is not the immediate priority. Twice as many people can be vaccinated with the same quantty of vaccines thus herd protecton is enhanced when coverage is high. However, in a context requiring long-term protecton the two-dose regimen is preferable. A rapid tme frame is desirable for each round when vaccinatng in response to an outbreak. A catch-up round may be implemented to vaccinate those who have missed the frst or second dose. Fixed sites Fixed sites are appropriate when an entre village or city is targeted. Mobile teams Mobile teams can be used when small populatons are targeted and the number of expected people can be vaccinated within a few hours. This strategy may be partcularly useful when vaccinatng a specifc sub-populaton. Keeping track of those absent during each round facilitates targetng during catch-up rounds. These studies should be planned from the beginning and conducted by specialized study teams. Efectveness studies require that cholera transmission occurs during the planned period of study. This may not always be the case, partcularly for vaccinaton in humanitarian emergencies. As with other interventons, they target individuals directly afected by, or vulnerable to, cholera. The form and channels of communicaton depend on the context, mainly the type of setng (endemic/epidemic; urban/rural, etc. Household resources and living conditons must be taken into account when implementng health promoton actvites. Strategy, target and/or messages may change according to the evoluton of the epidemic or if the messages are not heeded or the impact of actvites is not satsfactory. They are usually carried out by a dedicated health promoter(s) in large facilites, and by the medical staf in smaller facilites. If the household hygiene kits are given to the person accompanying the patent on admission (Secton 3.

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His past medical history is significant for episodic rate-controlled atrial fibrillation discount 20 mg tastylia prostate cancer biopsy, a stroke at age 72 (from which he recovered fully) order 20mg tastylia with amex prostate oncology kingsport, and uncontrolled hypertension generic 10mg tastylia overnight delivery mens health 300 workout. Last year generic tastylia 10mg with visa prostate 89, an echocardiogram showed he had severe aortic stenosis, but he has elected not to undergo surgical repair. He reports that he is sedentary, and is not able to walk up one flight of steps carrying his groceries without stopping to rest. Which of the described features are clinical predictors of increased perioperative cardiovascular risk for this surgery You are concerned about the cardiac risks of several of your patients undergoing surgical procedures, and are considering further cardiac testing in the preoperative period. Which of the following surgical procedures is considered to have a low surgery-specific risk, and generally does not require additional preoperative cardiac testing, if the patient does not have clinical predictors of increased cardiac risk You are doing a preoperative history and physical examination on a 58-year-old woman who will be undergoing a cholecystectomy later in the month. She is obese, sedentary with type 2 diabetes, hyperlipidemia and a history of congestive heart failure in the past. Which of her historical features is not a risk factor for adverse postoperative outcomes You are doing a routine preoperative clearance for an otherwise healthy 60-year-old man undergoing a knee replacement. A 50-year-old male patient is presenting for preoperative testing before undergoing arthroscopic knee surgery. Which of the following illnesses is the most common seen in international travelers You are counseling a patient who is planning a trip with his wife to celebrate their 30th anniversary. They are going on an African Safari, and wonder about health risks associated with international travel. What would you tell him is the most common cause of death among international travelers You are performing a physical examination on a student traveling to Mexico with her college Spanish class. She is concerned about traveler’s diarrhea, and asks about antibiotic prophylaxis. Due to a significant fear of needles, he is unwilling to obtain any vaccination unless he feels there is significant risk of acquiring the condition. Which of the following vaccine preventable illness is the most common one acquired by travelers One of your patients is a medical student planning a mission trip to equatorial Africa. He is asking about the yellow fever vaccine and the risks of complications from the vaccine. The yellow fever vaccine is a killed vaccine, and therefore has minimal associated side effects b. The yellow fever vaccine is a live vaccine, and does not have clinically significant risks associated with its use c. The complications associated with the vaccine are rarer than the risk of developing yellow fever in equatorial Africa d. The risk of yellow fever vaccine associated encephalitis is higher than the risk of becoming infected with yellow fever, therefore vaccination is not recommended. The risk of developing a syndrome resembling wild-type yellow fever after vaccination is higher than the risk of becoming infected with yellow fever, therefore vaccination is not recommended 29. A 29-year-old obese woman with type 2 diabetes mellitus is asking you about progestin-only pills as a method of contraception. Progestin-only pills should be taken every day of the month, without a hormonefree period 34. She is 36-years-old, she smokes, weighs 145 lb, and has no other medical concerns. A 28-year-old monogamous married woman comes to you for emergency contraception. She and her husband typically use condoms to prevent pregnancy, but when they had sex 2 evenings ago, the condom broke. The vaccine is given in a three-dose schedule, with the timing dependent on the mother’s hepatitis B surface antigen status. If the mother is hepatitis B surface antigen positive, the first dose of vaccine and a dose of hepatitis B immune globulin must be given within 12 hours of birth. The second dose of vaccine is given at 1–2 months, and the third dose is given at 6 months. For mothers with unknown antigen status, the first dose of vaccine should be given within 12 hours, and maternal blood should be drawn to determine status. If the mother’s surface antigen is positive, the child is given immune globulin as soon as possible, but no later than 1 week of age. For mothers with negative antigen status, the first dose of vaccine is given at 0–2 months, the second at 1–4 months, and the third at 6–18 months. Hib meningitis was the most common invasive Hib illness, carried a 2–5% mortality rate, even with appropriate treatment, and up to 30% of survivors developed neurological sequelae.

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If the assessment indicates that a campaign is likely to purchase tastylia 10 mg free shipping mens health trx workouts achieve a reasonable reducton in morbidity and mortality and if this campaign is feasible (Secton 4 tastylia 20 mg mastercard man health daily tip us images. Two groups may be targeted for a vaccinaton campaign: the populaton currently afected by cholera and the populaton highly vulnerable to purchase 20 mg tastylia otc mens health 12 week an expansion of the outbreak order tastylia 10mg online prostate cancer breakthrough. In additon to their routne actvites to prevent cholera and deaths due to cholera, these teams also partcipate in specifc actvites such as distributons. In rural areas where communites are widely dispersed it can be difcult, or even impossible, to set up centralised preventon and treatment. Community or family management of preventon measures and treatment may be the best, or only, strategy possible. In these contexts, key messages on preventon of the illness and patent care also include explanatons, and demonstratons, of measures to be used: home water treatment with or without extra resources. The commitees meet on a regular basis: daily at the start of the outbreak, and then weekly untl operatons are over. Outbreak response requires close coordinaton with other sectors, which may partcipate in specifc meetngs on an as-needed basis. These sectors include: – Laboratories; – Media: radio, newspapers and television disseminate informaton on the existence of an outbreak, the symptoms of the disease, treatment locatons, free care, etc. Natonal commitee the natonal commitee defnes the strategy for surveillance, patent management, vaccinaton, public informaton and health promoton. It must provide appropriate solutons for the implementaton of outbreak response (Table 4. The natonal commitee defnes roles and responsibilites of descending-level commitees (region, district). It also supervises actvites, mobilizes the necessary resources, and coordinates and informs partners at the natonal level. As evaluaton is a component of any operaton, the commitee must ensure regular reviews of implementaton. The aim is to improve operatons by formulatng recommendatons with regard to what is being done in practce. Patent • To shorten the tme between the • Defne and difuse treatment management frst symptoms of cholera and protocols. Public • To provide the public clear, • Determine: informaton practcal informaton on the – message contents; Heath outbreak, patent care and if – target audience; promoton relevant, vaccinaton. Local commitees the other levels (regional and district) are involved in surveillance and alerts, data management, and response implementaton. They transmit informaton to the natonal level daily or weekly according to the phase of the outbreak. Safety and immunogenicity study of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine Shanchol, in Bangladeshi adults and children as young as 1 year of age, Vaccine 29 (2011), 8285-92. Immune responses following one and two doses of the reformulated, bivalent, killed, whole-cell, oral cholera vaccine among adults and children in Kolkata, India: A randomized, placebo-controlled trial, Vaccine (2009), Nov 16;27(49):6887-93. Flexibility of Oral Cholera Vaccine Dosing—A Randomized Controlled Trial Measuring Immune Responses Following Alternatve Vaccinaton Schedules in a Cholera Hyper-Endemic Zone. Efectveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study. Individuals presentng with clinical features not corresponding to this defniton (no diarrhoea, bloody diarrhoea, etc. Inital assessment of hydraton status the objectve of the clinical evaluaton is to determine whether dehydraton is present and if a so, its severity. The frst priority is to correct or prevent dehydraton with the appropriate rehydraton fuids. Complementary therapies (antbiotc, zinc sulfate) are useful in reducing the duraton and severity of diarrhoea but do not replace fuid therapy, which remains indispensable. Cholera is associated with some degree of emesis, anorexia and malabsorpton which can all impact on nutritonal status, especially in children. Once the patent is capable of oral intake, feeding should resume (usually 3 to 4 hours afer startng rehydraton). Clinical signs of “some dehydraton” appear when fuid loss is 5-9% of body weight and signs of severe dehydraton occur when losses equal 10% or more. It is directed at contnuing the systematc oral replacement of ongoing fuid losses as they occur untl diarrhoea ceases. Non-dehydrated patents Patents with no dehydraton do not need rehydraton by defniton, so they begin directly with the maintenance phase (Treatment Plan A) to prevent dehydraton. In these cases, patents and/or atendants must be given clear instructons on treatment administraton and the signs requiring medical atenton. A favourable clinical evoluton allows a reducton in the intensity of treatment: at the end of Plan C, the patent can pass to Plan B (if only signs of some dehydraton remain) or even Plan A (if there are no remaining signs of dehydraton). However, the inital clinical state can rapidly deteriorate (or not improve) if: – the volume of fuid prescribed on admission is insufcient: degree of dehydraton underestmated or error in calculaton. If the patent’s state deteriorates during therapy, a change in protocol must be rapidly considered (switching from Plan A to Plan B; from Plan B to Plan C or re-administering a bolus if necessary) without waitng for the completon of a failing therapy. Surveillance is based on observaton of: 1) Clinical evoluton: – Improvement or the (re-)appearance of signs of dehydraton or danger signs. Surveillance of patent fuid loss has the following objectves: – Reinforce surveillance in the event of profuse diarrhoea or repeated vomitng. They are indicated in patents with some or severe dehydraton and should be administered in the frst 4 hours. The choice of antbiotc should be based on drug-resistance paterns from cholera cultures performed early in an outbreak. While awaitng results of drug sensitvity testng, patents can be given doxycycline.