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Interventions harnessing social support have emerged as a promising approach to counteract the structural trusted 75mg viagra erectile dysfunction tips, economic purchase discount viagra erectile dysfunction watermelon, service delivery and psychosocial constraints that affect retention in care cheap viagra 100mg on-line erectile dysfunction gnc products. Use fxed-dose combinations to simplify forecasting and supply management systems Lack of a system for Implement systems for patient monitoring across the continuum of monitoring retention in care care, including cohort analysis and patient tracking systems 184 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing hiv infection Table 9. Once people are diagnosed and enrolled in chronic care, follow-up visits should be scheduled and planned. Waiting until people present with symptoms or preventable complications is costly and ineffcient. Compared with the acute care model, planned chronic care models provide opportunities for prevention, early identifcation of issues and timely intervention. A system to keep information on the people receiving care at health facilities is critical for ensuring the continuity of chronic care. Health care teams can use it to identify people’s needs, to follow-up and plan care, to monitor responses to treatment and to assess outcomes for both individuals and for the overall treatment cohort. Information systems can be paper-based or based on an electronic registry, depending on local context. Programmes should develop a systematic strategy for collecting and aggregating key information that supports better management of the patient and ensures high-quality care. A robust patient information system is also critical for high-quality monitoring and evaluation of programmes and for supply management systems. When effective operational solutions such as successful service delivery models and processes of care are identifed in existing systems, programmes need to consider scaling up such models of care. Issues to be considered include mobilizing and allocating resources; training, mentoring and supervising health workers; procuring and managing drugs and other medical supplies; and monitoring and evaluation. In most generalized epidemic settings, maternal and child health services are provided at the primary care level, where pregnant women and children predominantly access health services. The quality of some of these studies was downgraded because of relatively few events (65–70). All these factors increased the satisfaction of the people receiving care and may have contributed to improving the quality of care (66,71). Guidance on operations and service delivery 189 and another showed comparable mortality rates. The quality of evidence was weighed along with programmatic risks and benefits; acceptability; values; preferences; cost implications; feasibility; critical contextual constraints; and contextual relevance. Plans for provider-initiated testing and counselling in such settings should emphasize supportive social, policy and legal frameworks (64). Rationale and supporting evidence In many countries, people who inject drugs are a marginalized population with limited access to and utilization of health care services. Randomized trials found that opioid substitution therapy decreases illicit drug use and increases retention in care relative to placebo (98). Observational studies found that opioid substitution therapy decreases mortality relative to not being in care (100). Some studies observed trends for improved viral suppression and reduced mortality, whereas others found comparable rates of viral suppression and mortality (101–103). In several settings, transport cost is a significant barrier to access and retention in care. Attrition declined after 12 months, resulting largely from significantly reduced losses to follow-up. In this further review, attrition declined after 12 months, due to losses to both follow-up and death. All health workers, including community health workers, need to be regularly trained, mentored and supervised to ensure high-quality care and the implementation of updated national recommendations. The use of new technologies such as computer-based self-learning, distance education, online courses and phone-based consultation may supplement classroom in-service training and support the effcient use of health workers’ time and other resources (116,117). Although volunteers can make a valuable contribution on a short-term or part- time basis, all trained health workers who are providing essential health services, including community health workers, should receive adequate wages and/or other appropriate and commensurate incentives (116). Task shifting involves the rational redistribution of tasks among health workforce teams. With this approach, specifc tasks are reassigned, where appropriate, from highly qualifed health workers to health workers with shorter training and fewer complementary qualifcations to more effciently and effectively use the available human resources. Task shifting should be implemented alongside other strategies designed to increase the total numbers and capacity of all types of health workers. Rationale and supporting evidence The systematic review identifed three randomized trials and six observational studies addressing task shifting. The quality of care in these studies was ensured by (1) providing training, mentoring, supervision and support for nurses, non-physician clinicians and community health workers; (2) ensuring clear indications for patient referral; (3) implementing referral systems and (4) implementing monitoring and evaluation systems. Patient education could help people and their families understand that care provided by nurses and community health workers is not of lower quality than that provided by physicians (106–108,111,113,114,119–121). To ensure that testing services are accurate and reliable, relevant quality assurance systems need to be developed and strengthened. Since an increasing number of new diagnostic tests and point-of-care systems is entering the market, the use of only high-quality diagnostics and equipment needs to be ensured. Strategic planning for properly placing and harmonizing testing platforms should be carried out to ensure appropriate use and cost–effectiveness. The guidelines should include training requirements for specifc tests and the process for certifcation and recertifcation. All health workers assigned to perform point- of-care tests must be trained and profcient on the testing procedure, specimen collection and quality assurance before implementing these services. The quality management system should: be implemented within the laboratory network and all remote testing sites; be incorporated into the routine testing procedures and monitored; ensure that testing sites undertake quality control, as appropriate; ensure that testing sites are enrolled in an external quality assessment scheme (profciency testing programme); ensure the use of standard operating procedures for all processes, including specimen collection and processing, test methods, interpreting results and reporting; ensure the use of standardized logbooks or electronic data management and reporting, including identifying errors and potential misclassifcation; and ensure that equipment and facilities are maintained, both preventive and corrective. This can be achieved only if the procurement and supply management system is strengthened at all levels of the health system. This requires a more effcient and dynamic supply management system to prevent waste and shortages. Since a single health facility may not carry out the dispensing of all needed pharmaceuticals, in some settings clients would need to be able to access services through a referral system. It includes a variety of activities at all levels of the health care delivery system: from the national programme level down to where medicines are dispensed and diagnostics are used. The main activities include managing the information system, ensuring timely information flow between stakeholders at different levels and securing financial and other resources, including the medicines and diagnostics needed for the programme. The following provides broad guidance on key activities at each stages of the supply management cycle. Countries may consider removing less preferred products and aligning paediatric formulations with those of adults, where possible. Health workers need to be trained at different levels in managing pharmaceuticals and diagnostics, including forecasting, procurement and distribution and ensuring adequate supervision throughout the supply system. Procurement should be based on appropriate selection of products and need-based forecasting, considering consumption, expanding services, phasing in and phasing out formulations and implementing new recommendations. Transparent procedures should be adopted to achieve best-value procurement and a quality assurance system implemented to procure, store and distribute high-quality pharmaceuticals, diagnostics and other health products (124,126).

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It also exerts widespread effects on carbohydrates generic viagra 75mg mastercard erectile dysfunction treatment natural medicine, lipid and protein synthesis (or anabolism) cheap viagra 75 mg with amex impotence thesaurus. The cardinal side effects such as excessive potassium excretion and sodium retention order 75mg viagra free shipping impotence nutrition, enhanced gastric acidity, oedema, psychosis and negative nitogen balance are some of the exaggerated manifestations of the normal metabolite functions of cortisol. Most importantly, the determination of cortisol levels is considered useful in the diagnosis and treatment of various ailments, namely : Addison’s Disease i. In the actual radioimmunoassay the cortisol present in the extract competes with Cortisol-H3 (i. Now, the free cortisol is quantitatively removed by adsorption on dextran-coated charcoal from the one bound to the transcortin. Finally, the bound radioactivity (due to Cortisol-H3) is measured which is then employed to calculate exactly the amount of cortisol present in the sample by the help of a Standard Curve (or Calibration Curve). Procedure : The various steps to be followed sequentially for the assay of cortisol in plasma are as follows : (1) The cortisol is usually extracted from the samples drawn from the patients, as follows : Place 100µl of plasma in each of two tubes and add 2. Set tubes 1 and 2 aside until Step-13, Step-6 From this point onwards the various tubes are treated as follows : Step-7 Incubate tubes 3 through 18 and all patient sample tubes in a pre-set constant temperature water-bath at 45°C for exactly 5 minutes, Step-8 Immediately after Step-7 incubate tubes 3 through 18 and all patient tubes in an ice-water bath (0 to 4°C) for 30 minutes. Shake the rack several times at short-intervals to ensure that the tubes attain 0-4°C rapidly, Step-9 Quickly add 0. Shake each vial to solubilize the contents: An emulsion should form, and Step-15 Count the radioactivity in the vials in sequence for 1 to 10 minutes. Now, subtract the blank from all other counts per minute to obtain the actual counts per minute and average the counts per minute for vials 1 to 2 to find the total count per minute. The percent bound may be calculated using the following expression : Counts per minute % Bound = × 100 Total counts per minute Finally, plot the percent bound Vs nanograms (ng) per tube of cortisol standard either on linear or on semilog paper and make use of this Standard Curve to calculate the amount of cortisol present in the unkown samples. The basic principles underlying both automated and unautomated methods of analysis are more or less the same. Out of the broad-spectrum of biological samples blood analysis is the most common one. There exists a number of parameters which may be assayed, and spectrophotometry is ideally suited for nearly all of them, a few typical examples are cited in Table 2. Glucose Glucose reduces Cu2+ to Cu+ ; & Cu+ reduces 420 phosphomolybdic acid (Folin-Wu) 4. To the resulting solution phosphomolybdic acid is added, which is subsequently reduced by Cu2O to give rise to an intensely coloured ‘molybdenum blue’ that is measured at 420 nm accurately. The major component parts com- prise of the various important sections namely : the preparation section, the reaction section and the analysis section which will be discussed briefly here. Preparation section Reaction section Analysis section Flame photo Dialyzer meter Recorder Proportioning heat Sampler or pumps bath Colori computer phaser meter Programmer Figure 2. Preparation Section This particular section of the Auto Analyzer consists mainly of the sampler, proportioning pumps, and programmer. First, the sampler introduces a fixed quantity of serum sample into the ‘analysis train’, which varies from one instrument to another instrument supplied by different manufacturers. The proportioning pump controls the rate of advancement,viz 10 inch/minute, of each sample through the analysis stream. Each analysis stream is made of transparent plastic flexible tubing, and each patient-sample is separated from one another by an air- bubble. Reaction Section The reaction section essentially comprises of the dialyzer, heat bath and phaser, and obviously the reaction takes place in this zone. Evidently, B is added always in excess to ensure : (a) rapid reaction, and (b) complete reaction by forcing the reaction to the right in accordance to the Le Chatelier’s principle. Therefore, in actual experimental operations temperature is increased by the aid of a heat-bath so as to accelerate the reaction which in turn allows the reaction to attain equilibrium state as rapidly as possible. Naturally at a very high temperature there is every possibility for decomposition of either the products or the reactants. Analysis Section The recent advancement in the field ofcomputer technology and anlytical instrumentation it has become very easy and convenient to have the analyical data from a series of biological samples processed at high speed as digital readouts or on computerized recorders. Many hospitals round the globe make extensive use of advanced computer softwares for data processing as stated beiow : • Uptodate listing of various laboratory tests, • Listing of drugs and metabolites that cause interference both biochemically and analytically, • Storing of levels of biologically important compounds for various disease states, and • A tentative diagnosis for a patient based on his serum sample under investiation together with the drugs and dosages being administered and the levels of biologically important compounds. Caution : Nevertheless, the concerned physician or pharmacist must exercise his or her own expertise and knowledge while prescribing drug(s) to a patient along with these computerized data informations. How would you carry out the assay of ‘bilirubin’ or ‘cholesterol’ by colorimetric method? Describe ‘enzymatic assays’ based on colorimetric method of analysis under the following two situations : (i) When ‘substrate’ is in large excess, (ii) When ‘enzyme concentration’ is in large excess. Give a comprehensive account on the various ‘automated methods of clinical analysis’ with an appropriate example. Sawicki, E, Photometric Organic Analysis, Part I, Wiley-Interscience, New York, 1970. In fact, the quantitative pharmaceutical analysis is not merely confined to just taking a random sample, performing a single assay quickly, and finally making a loud claim that the result so obtained cannot be challenged. Truly speaking an ideal analyst must have a total in-depth knowledge of the chemistry involved along with the pros and cons of interferences that may be caused due to the host of compounds, elements and ions besides adequate exposure and hands-on experience of the statistical distribution of values. The terminology ‘error’ invariably refers to the difference in the numerical values between a measured value and the true value. Consequently, the differences thus obtained between the standard values and those by the new analytical methods are then treated as ‘errors’ in the latest procedure. It is pertinent to mention here that it becomes rather difficult at times to place a particular ‘error’ into one of the above mentioned categories ; however, the classification may prove to be beneficial with regard to study of the various analytical errors that crop up in the course of routine analysis. The most important errors belonging to this particular class are : (a) Personal Errors : They are exclusively caused due to ‘personal equation’ of an analyst and have no bearing whatsoever either on the prescribed procedure or methodology involved. These two errors have been duly discussed under the chapter on ‘Pharmaceutical Chemicals : Purity and Management’ (Section 1. It is usually incorporated by a material that directly interferes in an analytical procedure. In this particular instance two things may happen, namely : (i) Presence of ‘Bromate’—another oxidizing agent would give rise to positively higher results, and hence, it must be duly corrected for, and (ii) Absolute error might increase while dealing with large samples, whereas the relative error would remain more or less constant if the sample is perfectly homogenous, (f) Errors due to Methodology : Both improper (incorrect) sampling and incompleteness of a reaction often lead to serious errors. Volatalization of weighing forms on the stoichiometric equivalence point of a ignition, and reaction and the observed end-point. Examples : (i) Errors caused due to weights, and (ii) Loss in weight of a crucible in which a precipitate is incenerated. They are usually manifested due to the minute variations which take place inadvertently in several successive measurements performed by the same analyst, using utmost care, under almost identical experimental parameters. These errors are mostly random in nature and ultimately give rise to high as well as low results with equal probability. They can neither be corrected nor eliminated, and therefore, form the ‘ultimate limitation’ on the specific measurements. It has been observed that by performing repeated measurement of the same variable, the subsequent statistical treatment of the results would have a positive impact of ‘reducing their importance’ to a considerable extent. Here, each vertical line labelled (x1 – xt) designates the absolute deviation of the mean of the set from the true value. Hence, larger indeterminate errors seem to be linked with the performance of ‘analyst-2’ than with that of ‘analyst-1’.

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The same applies to centrifugation best purchase viagra erectile dysfunction more causes risk factors, used for the fragmentation of samples buy 50mg viagra free shipping erectile dysfunction jet lag, since it may occur before or after an experiment purchase discount viagra line erectile dysfunction opiates, depending the search was made using the generic name of the drug. The abstracts and news articles were then placed and classifed in chronological order in an Excel table in accordance with the research setting or institution concerned as recorded in the news item (for the dailies) or to which the primary author was linked (for Medline) (grouping carried out in accordance with emerging institutional categories). Each abstract or press item represented an event, that is, research results (especially for the scientifc feld) or information that marked the pathway of the drug. Thus all the scientifc abstracts reporting results of studies of the medication or substance in question were included in the analyses, but only news items with information that could impact on the future of the drug were considered (by consensus of the analysts) to the exclusion of individual comments. It may go from point 1 to point 6 by looping around within the rooms or just as easily move in a single loop from point 1 to point 6. Point 6 is the computer room and is used to look for scholarly articles on the Internet and to refne the experimentation projects. Different technical aspects are involved in these instruments and bring into play specialized knowledge from outside the realm of pure biology, such as physics, chemistry and information technology. The laboratories also include offces and meeting rooms that are used at all stages of research. The facilities of the northern, regional-university laboratory differ signifcantly from those of the frst two. Much of the activity in this unit involves the description of compounds of essential oils and plant extracts from the boreal forest, so the role of the isolation, extraction and purifcation rooms is crucial. Once the extracts are prepared or the fnal products isolated and purifed, they can be sent on to the biology laboratories where biological activity tests can be conducted. On the biology side, a microbiology room and a tissue culture room are available, but they are separated from each other. These two rooms connect with a central room where the devices and computers for collecting and analyzing data are located. A molecular biology room also adjoins the laboratory so that research can be pursued further and the mechanism of action of the biopharmaceutical agents isolated by the chemists can be elucidated. Animal quarters are also available for in vivo research in a room located just next to the biology laboratories. Close cooperation between the chemistry and biology laboratories is therefore vital, even if they are physically separate. As in the other two laboratories, all these rooms converge on the computer room, indicating the importance of the circulation of knowledge, whether from the outside in or vice versa. The premises and the equipment installed there are apparently not completely standardized, although certain principles in the use of the instruments limit fexibility. They thus refect a degree of diversity stemming from the complexity of different intervening levels. As the examination of these organizations shows, instrumentation affects strategic choices: either a laboratory maximizes its return from the technologies at its disposal, or it tries to acquire the instrumentation to meet its research objectives, in which case the political/fnancial and technical/clinical levels intervene, levels that bring into play concepts representing different disciplines. In fact, the number of pathways increases in accordance with the instrumentation used, the complexity and/or novelty of the substance under study and the unpredictability of its effects. But a more important aspect is the movement back and forth between the different levels. In addition, the knowledge derived from all the operations is not the product of the observation of a direct effect, for it is not possible to observe the behaviour of cells or proteins directly under a microscope. Indeed, staining and coupling with light-emitting particles are used to provide indicators of the effect under study because they are the only way of verifying cell behaviour. Knowledge may therefore follow variable pathways, particularly circular ones regulated by a systemic mode of organization. Through the relationships that emerge from its physical organization, the laboratory delivers the means by which the knowledge wanted and needed to accomplish its mission may be appropriated and may operate. The networks of actors The networks of actors associated with publications produced by the laboratories were reconstructed for the entire scientifc career of the director of the two related Montreal- area laboratories. We found that, over the 8-year period, the great majority of links emerge from the university-hospital community; the linkages with the other three sectors (university, pharmaceuticals and the Institut) are more limited. Most of these links developed in the felds of expertise of cell and molecular biology, biotechnology and bioengineering, and to a lesser extent in neurosurgery, biochemistry and very occasionally pharmacy. A closer examination of the development of this network over time shows a frst network established in the frst six years of the laboratory director’s career (1979–1984) that was drawn mainly from the university area of activities and the felds of expertise of cell and molecular biology and biotechnology and bioengineering. The network of the next six years proved to be somewhat denser with signifcant growth in ties established with the university-hospital area of activities and the same areas of expertise as in the earlier period: cell and molecular biology and biotechnology/bioengineering. On the other hand, in the university area of activities, the biochemistry feld of expertise assumes greater prominence. The last 16 years display a density that has developed exponentially through the proliferation of ties in the university-hospital sector, bringing into play numerous felds of expertise and the emergence of molecular oncology and endocrinology as a new, predominant feld. The links established in the frst six years are dominated by the hospital sector and to a lesser extent by the university sector, mainly in the felds of expertise of cell and molecular biology and to a lesser extent of biotechnology and bioengineering. This trend is reversed in the next six years; the university overtakes the hospital area of activities and the cell and molecular biology feld of expertise expands across the entire network, while there is stability in the biotechnology and bioengineering felds. In the hospital area of activities, chemistry (chemical engineering) comes into play as a new feld of expertise, while in the university sector, oceanography is added. The pharmaceutical and Institute areas do not account for much in this phase of the construction and circulation of knowledge. The “territory” covered by the two networks is permeated more with cell- and molecular-biology knowledge than with biotechnology and bioengineering. The most marked difference remains the signifcant growth in the feld of expertise of molecular oncology- endocrinology for the two Montreal laboratories. This cannot be explained entirely by the stronger presence of the hospital sector, since it is strong in all three laboratories. The increased signifcance 301 Catherine Garnier of this feld in the evolution of the network may however be accounted for by the development over the past few years of direct relations between the head of the two Montreal laboratories with pediatric-hospital oncologists who have to cope with the expectations of desperate parents. This hypothesis was corroborated by interviews conducted with some of members of the laboratories. The analysis thus reveals the great diversity of disciplines and collaborations that is necessary at this stage of drug development. All this serves to confrm the contextualization of the construction and circulation of knowledge in terms of differential principles of action. The Object Analyses of Publications As we pointed out earlier, scholarly papers are of major importance for laboratories, and so we frst systematically analyzed the scientifc articles and left the popular articles for later examination. The analysis dealt with the scientifc articles published by the three laboratories about Neovastat, green tea catechin and essential oils, including balsam fr. For Neovastat, the descending hierarchical cluster analysis produced 6 clusters of discourse grouping together 304 elementary context units (e. Looking at the clusters in terms of their segmentation by hierarchical level, we fnd ffth- and sixth-cluster groupings at the frst level.

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The creaming graph (b)(3) of this section may be mixture shall be pasteurized; however viagra 50mg online erectile dysfunction pump for sale, added during the procedure purchase genuine viagra online impotence lower back pain. The following terial starters purchase generic viagra canada erectile dysfunction at age 30, may be added following safe and suitable ingredients may be pasteurization. I (4–1–10 Edition) (1) The words "cottage cheese" which enzyme that produces equivalent curd shall appear in type of the same size formation, are added and it is held and style. The co- (2) The statement "not less than l agulated mass may be cut; it may be percent milkfat" or "l percent warmed; it may be stirred; it is then milkfat minimum", the blank being drained. The curd may be washed with filled in with the whole number that is water and further drained; it may be closest to, but does not exceed, the ac- pressed, chilled, worked, seasoned with tual fat content of the product. This salt; or statement of fat content shall appear (ii) Food grade phosphoric acid, lac- in letters not less than one-half of the tic acid, citric acid, or hydrochloric height of the letters in the phrase spec- acid, with or without rennet and/or ified in paragraph (c)(1) of this section, other safe and suitable milk-clotting but in no case less than one-eighth of enzyme that produces equivalent curd an inch in height. The curd is on the label so conspicuously as to be washed with water, stirred, and further seen under customary conditions of drained. It may be pressed, chilled, purchase, the statement specified in worked, seasoned with salt. The cept that milk-clotting enzymes may coagulated mass may be cut; it may be be declared by the word "enzymes". It con- centrated skim milk or nonfat dry tains not more than 80 percent of mois- milk is used, water may be added in a ture, as determined by the method pre- quantity not in excess of that removed scribed in §133. The curd may be milkfat" which shall all appear in let- pressed, chilled, and worked and it may ters not less than one-half of the be heated until it becomes fluid. It may height of the letters in the phrase spec- then be homogenized or otherwise ified in paragraph (c)(1) of this section, mixed. One or more of the optional but in no case less than one-eighth of dairy ingredients specified in para- an inch in height. The following bear the statement "Directly set" or safe and suitable ingredients may be "Curd set by direct acidification". Milk, nonfat on the label so conspicuously as to be milk, or cream, as defined in §133. Rennet and/or this paragraph, showing the optional other clotting enzymes of animal, process used, shall immediately and plant, or microbial origin. Each of the in- the procedure set forth in paragraph gredients used in the food shall be de- (a)(2) of this section, or by any other clared on the label as required by the procedure which produces a finished applicable sections of parts 101 and 130 cheese having the same physical and of this chapter, except that: chemical properties. The minimum (1) Enzymes of animal, plant, or mi- milkfat content is 33 percent by weight crobial original may be declared as of the finished food, and the maximum "enzymes"; and moisture content is 55 percent by (2) The dairy ingredients may be de- weight, as determined by the methods clared, in descending order of predomi- described in §133. The dairy ingredi- nance, by the use of the terms "milkfat ents used are pasteurized. Cream cheese with added to coagulate the dairy ingredi- other foods is the class of foods pre- ents. One or (a)(3) of this section or by any other more of the other optional ingredients procedure which produces a finished in paragraph (b)(2) of this section may cheese having the same physical and be used. The minimum tent of the mixture is 60 percent by milkfat content is 50 percent by weight weight. The minimum milkfat is 33 of the solids and the maximum mois- percent by weight of the cream cheese ture content is 42 percent by weight, as and in no case less than 27 percent of determined by the methods described the finished food. If the dairy ingredients used are not pasteurized, the cheese is cured contents will be determined by the at a temperature of not less than 35 °F methods described in §133. The following not more than 3 micrograms as deter- safe and suitable optional ingredients mined by the method described in may be used: §133. Properly prepared fresh, (3) One or more of the dairy ingredi- cooked, canned, or dried fruits or vege- ents specified in paragraph (b)(1) of tables; cooked or canned meats, rel- this section may be warmed, treated ishes, pickles, or other suitable foods. The name of the is drained off, and the curd is matted food is "cream cheese with lll" or, into a cohesive mass. The mass is cut alternatively, "cream cheese and into slabs, which are so piled and han- lll", the blank being filled in with dled as to promote the drainage of the name of the foods used in order of whey and the development of acidity. Each of the in- cooled in water, and soaked therein gredients used in the food shall be de- until the whey is partly extracted and clared on the label as required by the water is absorbed. The curd is drained, applicable sections of parts 101 and 130 salted, stirred, and pressed into forms. The following safe and suitable ingredients may be clared, in descending order of predomi- used: nance, by the use of the terms "milkfat (1) Dairy ingredients. Milk, nonfat and nonfat milk" or "nonfat milk and milk, or cream, as defined in §133. If the (iii) Enzymes of animal, plant, or mi- dairy ingredients used are not crobial origin, used in curing or flavor pasturized, the cheese is cured at a development. The weight of the hydrogen per- this section may be warmed and is sub- oxide shall not exceed 0. One or the weight of the catalase shall not more of the clotting enzymes specified exeed 20 parts per million of the weight in paragraph (b)(2) of this section is of dairy ingredients treated. After coagulation the food is "washed curd cheese" or, alter- mass is cut into small cube-shaped natively, "soaked curd cheese". The mass is stirred gredients used in the food shall be de- and heated to about 90 °F. When the de- crobial origin may be declared as "en- sired curd is obtained, it is transferred zymes"; and to forms permitting drainage of whey. After drainage the curd is re- nance, by the use of the terms "milkfat moved from the forms and is salted and and nonfat milk" or "nonfat milk and cured. Milk, nonfat turing conforms to the definition and milk, or cream, as defined in §133. Rennet and/or that the dairy ingredients are not pas- other clotting enzymes of animal, teurized and curing is not required. I (4–1–10 Edition) (iii) Enzymes of animal, plant, or mi- applicable sections of parts 101 and 130 crobial origin, used in curing or flavor of this chapter. Each of the in- produces a finished cheese having the gredients used in the food shall be de- same physical and chemical properties. The min- (1) Enzymes of animal, plant, or mi- imum milkfat content is 50 percent by crobial origin may be declared as "en- weight of the solids and the maximum zymes"; and moisture content is 42 percent by (2) The dairy ingredients may be de- weight, as determined by the methods clared, in descending order of predomi- described in §133. The dairy ingredi- nance, by the use of the terms "milkfat ents used may be pasteurized. Gorgon- and nonfat milk" or "nonfat milk and zola cheese is at least 90 days old. The mass is cut into set forth in paragraph (a)(2) of this sec- smaller portions and allowed to stand tion, or by any other procedure which for a time. The mixed curd and whey is produces a finished cheese having the placed into forms permitting further same physical and chemical properties. While being placed in forms, The maximum moisture content is 52 spores of the mold Penicillium roque- percent by weight, as determined by fortii are added. When (2) The dairy ingredients are sub- sufficiently drained, the shaped curd is jected to the action of a lactic acid- removed from the forms and salted producing bacterial culture. Perforations are opment of acidity is continued until then made in the shaped curd and it is the dairy ingredients coagulate to a held at a temperature of approximately semisolid mass.

K. Esiel. University of Alaska, Southeast.