The recognition of this problem is reflected in part by recent changes in FDA recommendations, including more stringent controls on the amount of acetaminophen which may be contained per tablet in combination formulations together with narcotics. Furthermore, an advisory panel to the FDA recommended that the currently widely accepted maximum daily dose of up to four grams daily may be too high.

METHODS: Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis.

RESULTS: The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher than the incidence of candidemia caused by C. albicans (45.6%). The overall, crude 12-week mortality rate was 35.2%. Patients with Candida parapsilosis candidemia had the lowest mortality rate (23.7%; P

CONCLUSIONS: The epidemiology and choice of therapy for candidemia are rapidly changing. Additional study is warranted to differentiate host factors and differences in virulence among Candida species and to determine the best therapeutic regimen.

METHODS: We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer.

RESULTS: The median follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionation radiotherapy (70.3% vs. 64.3%; P=0.18; hazard ratio for death with accelerated-fractionation radiotherapy, 0.90; 95% confidence interval [CI], 0.72 to 1.13), as were the rates of high-grade acute and late toxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients with HPV-negative tumors; P<0.001 by the log-rank test) and, after adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, had a 58% reduction in the risk of death (hazard ratio, 0.42; 95% CI, 0.27 to 0.66). The risk of death significantly increased with each additional pack-year of tobacco smoking. Using recursive-partitioning analysis, we classified our patients as having a low, intermediate, or high risk of death on the basis of four factors: HPV status, pack-years of tobacco smoking, tumor stage, and nodal stage.

CONCLUSIONS: Tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. (ClinicalTrials.gov number, NCT00047008.)

This week’s article will concentrate on home, and the following two articles will go into more depth for work and leisure activities that will involve going green.

The most common of all the energy saving devices that is the easiest and least expensive that all individuals can do is to change from incandescent light bulbs to compact florescent light bulbs as they need replacing. Switching to a compact florescent cost a few dollars more but over the average life-span will save money. For example, by using a 26-watt compact fluorescent light bulb—equivalent to a 100-watt incandescent light bulb—users can save up to $59 on energy costs over the life of the bulb. Many of the home building stores offer 3-pack bulbs to save money. Another way that a household can help develop wind energy is through PECOWIND program there website is www.exeloncorp.com/ourcompanies/peco/pecores/peco_wind/ and how it works is as follow: How it works is a small additional monthly cost covers the added expense of harvesting the wind power. PECO WIND energy is available for purchase in monthly blocks of 100 kilowatt-hours for $2.54 per block. For a typical home, one block is equal to about 15 percent of your average monthly electricity usage. You may choose to sign up for Wind Blocks at $2.54 per block per month or have 100 percent of your actual monthly electric usage charged at 2.54 cents for each kilowatt-hour used. If you sign up for Blocks and choose more blocks than you use, you will not be billed for more than your actual electric usage. The wind energy you support is delivered directly into the Pennsylvania electric grid, reducing the need for energy from fossil fuel sources like oil and coal. The more customers who sign up, the more Pennsylvania wind energy we can buy. This means cleaner air and water for all of us! Although buying wind does not mean that electricity is being delivered straight from the windmill to your home, it does mean that more of the electricity being put into the grid comes from wind, rather than other generation sources. By participating in PECO WIND you are reducing the need to generate electricity from other sources. PECO can be reached at the following: PECO Energy Customer Service Center 2301 Market Street P.O. Box 8699 Philadelphia, PA 19101 Telephone: 1-800-494-4000 I have found a great resource in Oprah recently when I was home sick. I tuned in Oprah for the final 5 minutes but did mange to obtain the information on her website to help green your home. The following website: http://www.oprah.com/tows/pastshows/200704/tows_past_20070420_b.jhtml reviews items such as light bulb replacement as mentioned above, Using a reusable water bottle instead of the buying a one-time usage bottle water at the local convenience store. The reusable water bottles can be used washed thoroughly and used again, and eventually they can be recycled with the other plastics. There are many tips and ideas on her site and one of my favorites is bringing your own bag to the grocery store to save the use of paper and plastic bags. On an interesting note I asked an expert what the answer should be when the checkout clerk asks what type of bags do you prefer “paper or plastic?” I was surprised to learn that if you have a choice paper is the preferable bag as it is a renewable resource and does not require petroleum products in its formation.

The Philadelphia Eagles website has a great resource to help an individual or family calculate savings by changing to green habits and the amount of CO2 produced annually is also calculated. There website is http://philadelphiaeagles.com/gogreen/calculator2.asp. The Philadelphia Eagles even have on their website the ability to purchase a tree in the “Philadelphia Eagles Forest” in Neshaminy State Park http://store.philadelphiaeagles.com/store/item.aspx?ItemId=5201&FID=2006 the price for a single tree is $62.00. I was unable to obtain an address for the Philadelphia Eagles but did mange to obtain a phone number to place an order. Phone Orders Call us toll free at 1-888-247-8833 (Outside of the US & Canada call 412-252-0028), 9:00a.m.- 9:00p.m. E.T. Some household tips that I have encountered and wanted to pass on are as follows:

• Use a clothes line to dry clothes instead of the dryer whenever possible. • Wash clothing in cold or warm water instead of warm and hot water. • Change showerhead to a water saving showerhead. • Keep a water jug near your sink and save the water coming out of the pipes while waiting for the hot water to come out, this water can be used in the washing machine or to water plants. • Save outside rain water to water outdoor plants, tree, and flowers. • During the hot summer months use the outside grill or microwave more then the regular oven and stove, during the cold winter months do the opposite. • Green gift ideas: environmental information and links to eco-friendly products www.wecanlivegreen.com, or green gift guide from the California Dept. of Conservation of gifts made from the states recycling program www.greengiftguide.com, alternative to buying gifts www.buylesscrap.com, and Yahoo’s Green gift guide http://green.yahoo.com/, click on green gift guide. • Caulk around windows and doors inside and out. • When purchasing appliances, buy only eco-friendly and water saving products • When it is time to replace your old water heater, replace it with a tankless on-demand electric or gas water heater. • If possible have solar panels installed • When designing or redesigning your kitchen use eco-friendly products like wheatboard cabinets & wood veneers(Greenbridge Specialties ph# 717-463-3739), Recycled backsplash from Eco-Friendly Flooring ph# 866-250-3273, Earth-friendly countertops by Marblemaster ph#760-607-0903, Natural stone flooring check www.annsacks.com for stores, Sub-zero Fridge www.subzero.com, Viking Range www.vikingrange.com, and Bosch Dishwasher www.boschappliances.com.

I hope some or all of these tips and ideas help us all to get a little bit greener. Even just adopting one idea is better-then doing nothing at all.

To begin I do not claim to be a “green” expert, and I openly welcome feedback as this is a learning process for me as well as a source for information sharing. My background is medical I am a Registered Nurse at Thomas Jefferson U. Hospital. This column actually was developed in part due to my frustration in obtaining information to make my home, office, and leisure activities as green as possible.

Recently I took in the movie “The 11th Hour” a movie about global warming hosted by Leonardo DiCaprio, the most important piece of information I took away from this movie was that each and every consumer has a vote. A vote is cast by the purchasing power of our individual consumer spending. Whether we choose to purchase greener electricity form our electricity supplier or paper plates vs. styrofoam plates for a picnic, or choices made by office supply purchaser. We can all make a difference little by little to hopefully equal a difference that matters.

The first area that everyone can make a difference is to recycle. At home newspaper and post consumer packaging(cereal boxes, envelopes, magazines) should all be bundle in a used paper bag from the supermarket, or tied with string or placed in a plastic recyclable bucket(to be used again and again). Metals cans also make up a large portion of recycling whether aluminum or tin (soda, beer, fruit, and vegetable), old paint cans left open to dry can also be recycled. And finally plastics, according to the thickness of the plastic (all plastic are coded by number of thickness in a triangle located on the package). Each township is different as to the thickness of plastic that it collects. Please refer to your local municipality if there are any questions regarding recycling programs.

At work many employers have separate refuse containers. Cans, bottles, paper, and garbage are sorted into different collection bins in most cafeteria setting dining areas. I have heard of worm farms to help dispose of garbage waste at work. Instead of discarding your food scraps, you can recycle them with the help of worms. Vermicomposting (worm composting) turns many types of kitchen waste into a nutritious soil for plants. When worm compost is added to soil, it boosts the nutrients available to plants and enhances soil structure and drainage. Using worms to decompose food waste offers several advantages: It reduces household garbage disposal costs; • It produces less odor and attracts fewer pests than putting food wastes into a garbage container; • It saves the water and electricity that kitchen sink garbage disposal units consume; • It produces a free, high-quality soil amendment (compost); • It requires little space, labor, or maintenance; • It spawns free worms for fishing. In the work station confidential paperwork can be shredded in the office or collected in a secure container then taken to be shredded and recycled. Everyday paperwork that is no longer needed or is outdated should be collected and recycled, folders and office supplies reused whenever possible.

The following phrase was learned many years ago to help with recycling program: Reduce, Reuse, Recycle it's a matter of waste minimization the idea is that the first priority is to reduce your use or consumption of something second priority; it you can't reduce your use of something, then reuse it if you can, and third, if you can't reuse something, then at least recycle it if you can a good example of this would be water bottles REDUCE your use of water bottles by filling a reusable container from the tap or from your Brita pitcher at home if you do use a water bottle, you can REUSE it a few times (within recommendations for cleanliness) after you have reused it, RECYCLE it. (In some areas where plastics are not picked up at the curbside with other recyclables, look for community groups or churches that may have a periodic drop-off time for other recyclable items)