LAC Title (PDF)Last Amended DateMSWordOptionTitle 46:I, Professional and Occupational Standards: ArchitectsNovember 2022Title 46:III, Professional and Occupational Standards: AuctioneersMarch 2022Title 46:V, Professional and Occupational Standards: Automotive IndustryFebruary 2021Title 46:VII, Professional and Occupational Standards: BarbersApril 1991Title 46:VIII, Professional and Occupational Standards: Behavior AnalystsDecember 2022Title 46:XI, Professional and Occupational Standards: Boxing and WrestlingApril 2021Title 46:XIII, Professional and Occupational Standards: Cemetery IndustryNovember 2017Title 46:XIX, Professional and Occupational Standards: Certified Public AccountantsMarch 2020Title 46:XXI, Professional and Occupational Standards: Certified Shorthand ReportersNovember 2020Title 46:XXIII, Professional and Occupational Standards: Certified Solid Waste OperatorsJanuary 2005Title 46:XXV, Professional and Occupational Standards: Certified Social WorkersJune 2020Title 46:XXVII, Professional and Occupational Standards: ChiropractorsApril 2014Title 46:XXIX, Professional and Occupational Standards: ContractorsMarch 2021Title 46:XXXI, Professional and Occupational Standards: CosmetologistsApril 2019Title 46:XXXIII, Professional and Occupational Standards: Dental Health ProfessionsJanuary 2023Title 46:XXXIV, Professional and Occupational Standards: Drug and Device DistributorsJanuary 2017Title 46:XXXV, Professional and Occupational Standards: ElectrologistsApril 2004Title 46:XXXVII, Professional and Occupational Standards: Embalmers and Funeral DirectorsAugust 2017Title 46:XXXVIII, Professional and Occupational Standards: Emergency Medical ServicesSeptember 2003Title 46:XXXIX, Professional and Occupational Standards: Hearing Aid DealersJuly 2012Title 46:XL, Professional and Occupational Standards: Home InspectorsSeptember 2022Title 46:XLI, Professional and Occupational Standards: Horseracing OccupationsFebruary 2017Title 46:XLIII, Professional and Occupational Standards: Interior DesignersDecember 2014Title 46:XLIV, Professional and Occupational Standards: Massage TherapistsJuly 2013Title 46:XLV, Professional and Occupational Standards: Medical ProfessionsJuly 2021Title 46:XLVI, Professional and Occupational Standards: Notaries PublicJanuary 2022Title 46:XLVII, Professional and Occupational Standards: Nurses: Practical Nurses and Registered NursesSeptember 2020Title 46:XLIX, Professional and Occupational Standards: Board of Examiners of Nursing Facility AdministratorsDecember 2015Title 46:LI, Professional and Occupational Standards: OptometristsFebruary 2022Title 46:LIII, Professional and Occupational Standards: PharmacistsJanuary 2023Title 46:LIV, Professional and Occupational Standards: Physical Therapy ExaminersAugust 2021Title 46:LV, Professional and Occupational Standards: PlumbersJune 2022Title 46:LVI, Professional and Occupational Standards: PolygraphAugust 1994Title 46:LVII, Professional and Occupational Standards: Private Investigator ExaminersAugust 2016Title 46:LIX, Professional and Occupational Standards: Private Security ExaminersNovember 2011Title 46:LX, Professional and Occupational Standards: Licensed Professional Counselors Board of ExaminersOctober 2021Title 46:LXI, Professional and Occupational Standards: Professional Engineers and Land SurveyorsSeptember 2022Title 46:LXII, Professional and Occupational Standards: Professional GeoscientistsOctober 2019Title 46:LXIII, Professional and Occupational Standards: PsychologistsAugust 2021Title 46:LXV, Professional and Occupational Standards: Radio and Television TechniciansFebruary 1995Title 46:LXVI, Professional and Occupational Standards: Radiologic TechnologistsDecember 2016Title 46:LXVII, Professional and Occupational Standards: Real EstateSeptember 2020Title 46:LXIX, Professional and Occupational Standards: Registered DietitiansMarch 2019Title 46:LXX, Professional and Occupational Standards: River PilotsJuly 2021Title 46:LXXI, Professional and Occupational Standards: SanitariansDecember 2003Title 46:LXXV, Professional and Occupational Standards: Speech Pathology and AudiologyDecember 2022Title 46:LXXX, Professional and Occupational Standards: Substance Abuse CounselorsMay 2014Title 46:LXXXV, Professional and Occupational Standards: VeterinariansOctober 2022Title 46:LXXXVI, Professional and Occupational Standards: Vocational Rehabilitation CounselorsApril 2019Title 46:LXXXIX, Professional and Occupational Standards: Water Well Contractors (Drillers)October 1985
Almost all (98%) calcium in the body is stored in the bones, and the body uses the bones as a reservoir for, and source of, calcium to maintain calcium homeostasis [1]. More than 99% of calcium in the body is in the form of calcium hydroxyapatite, an inorganic matrix of calcium and phosphate that is stored in the bones and teeth [1,4,5]. Unlike teeth, bone undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone [4]. Bone remodeling is required to change bone size during growth, repair damage, maintain serum calcium levels, and provide a source of other minerals [4].
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At birth, the body contains about 26 to 30 g calcium. This amount rises quickly after birth, reaching about 1,200 g in women and 1,400 g in men by adulthood [1]. These levels remain constant in men, but they start to drop in women as a result of increases in bone remodeling due to decreased estrogen production at the start of menopause [1].
An inverse relationship exists between calcium intake and absorption. Absorption of calcium from food is about 45% at intakes of 200 mg/day but only 15% when intakes are higher than 2,000 mg/day [6]. Age can also affect absorption of dietary calcium [1,4]. Net absorption of dietary calcium is as high as 60% in infants and young children, who need substantial amounts to build bone, but it decreases to about 25% in adulthood and continues to decline with age [1].
Postmenopausal womenMenopause leads to bone loss because decreases in estrogen production reduce calcium absorption and increase urinary calcium loss and calcium resorption from bone [1]. On average, women lose approximately 1% of their bone mineral density (BMD) per year after menopause [25]. Over time, these changes lead to decreased bone mass and fragile bones [1]. About 30% of postmenopausal women in the United States and Europe have osteoporosis, and at least 40% of those with this condition develop at least one fragility fracture (a fracture that occurs after minor trauma, such as a fall from standing height or lower) [26]. The calcium RDA is 1,200 mg for women older than 50 years (vs. 1,000 mg for younger women) to lessen bone loss after menopause [1].
Bone health in older adultsBone is constantly being remodeled. Declining levels of estrogen in women during menopause and for approximately 5 years afterward lead to rates of bone resorption that are higher than rates of bone formation, resulting in a rapid decrease in bone mass [7]. Over time, postmenopausal women can develop osteoporosis, in which bone strength is compromised because of lower BMD and bone quality [1]. Age-related bone loss can also occur in men and lead to osteoporosis, but fracture risk tends to increase in older men about 5 to 10 years later than in older women [1]. Osteoporosis increases the risk of fractures, especially of the hip, vertebrae, and forearms [1,7].
An expert panel convened by the National Osteoporosis Foundation and American Society for Preventive Cardiology determined, on the basis of moderate-quality evidence, that calcium intakes with or without vitamin D from foods or supplements neither increase nor decrease the risk of CVD or CVD mortality [73]. The societies therefore concluded that calcium intakes that do not exceed the UL are safe "from a cardiovascular standpoint."
Clinical trial evidence on the link between calcium and metabolic syndrome is very limited. In one placebo-controlled clinical trial in Iran in 66 adults who were overweight and had type 2 diabetes and coronary heart disease, supplements of 5 mcg (200 IU) vitamin D, 90 mcg vitamin K, and 500 mg calcium for 12 weeks significantly reduced maximum levels of left carotid intima media thickness and improved metabolic status (including improvements in insulin resistance, insulin concentrations, beta-cell function, and quantitative insulin sensitivity check index) [95].
DolutegravirDolutegravir (Dovato, Tivicay) is an HIV integrase inhibitor used in adults and children. Concomitant use of calcium supplements and dolutegravir can reduce blood levels of dolutegravir substantially, apparently through chelation [99,100]. The labels approved by the FDA for dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after taking calcium supplements [101,102].
1. Upon being satisfied, after an examination of information available to it, that the circumstances so warrant, any State Party in whose territory a person alleged to have committed any offence referred to in article 4 is present shall take him into custody or take other legal measures to ensure his presence. The custody and other legal measures shall be as provided in the law of that State but may be continued only for such time as is necessary to enable any criminal or extradition proceedings to be instituted.
4. When a State, pursuant to this article, has taken a person into custody, it shall immediately notify the States referred to in article 5, paragraph 1, of the fact that such person is in custody and of the circumstances which warrant his detention. The State which makes the preliminary inquiry contemplated in paragraph 2 of this article shall promptly report its findings to the said States and shall indicate whether it intends to exercise jurisdiction.
2. These authorities shall take their decision in the same manner as in the case of any ordinary offence of a serious nature under the law of that State. In the cases referred to in article 5, paragraph 2, the standards of evidence required for prosecution and conviction shall in no way be less stringent than those which apply in the cases referred to in article 5, paragraph 1. 2ff7e9595c
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