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By Judi Jacobi, PharmD, FCCM The Society of Critical Care Medicine Council met in Chicago in May. The usual business included review of financial reports and reports from committees, sections and chapters. We remain one of the most active sections, and the CPP report detailed the many exciting projects underway. The council also reviewed minutes from the Strategic Planning Committee. A vote on the proposals submitted for strategic planning will be held in September. The Society has launched a program to provide regional training aimed at helping hospitals implement the Surviving Sepsis Campaign and improve patient outcomes. This program is made possible through an unrestricted education grant from Eli Lilly. Visit the SCCM Web site for more information. I will move into the Executive Committee in February as treasurer of SCCM, a position that ultimately leads to the presidency in 2010. This is exciting news for our section and also allows two new candidates to be placed on the ballot for the council's CPP designated seat. Watch for more news later this year about the nominations and election. Upcoming educational events include the Excellence in Quality and Safety in Critical Care conference to be held September 21 to 23, 2006, in Baltimore, Maryland, USA. See : sccm education quality cost summit index for more information. Programs in 2007 will include a consensus conference on acute renal failure and a summer conference on controversies in clinical nutrition to be held in Toronto, Canada. Watch the SCCM Web site for information on these programs. Many of you know that the section formulated a response to the Joint Commission on Accreditation of Healthcare Organizations' draft measures for venous thromboembolism. This was the first time a section attempted this, and unfortunately, our comments did not get final approval. 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Laboratory testing In some settings, screening for gonorrhoea culture ; , chlamydia culture ; , syphilis, and or HIV is done for all children presenting with a history of rape. The presence of these infections may be indicate rape if the infection is not likely perinatally or blood transfusion acquired * ; . Follow your local protocol. In rare cases when the child is highly agitated and examination is vital ONLY if the child cannot be calmed down, AND ONLY IF within 72 hours of a rape, AND evidence collection or treatment is vital should the examination be performed under sedation, using one of the following drugs and ketamine.
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Table 4. Bronchial Responsiveness Assessed by Methacholine Challenge Noonsmokers Current Smokers n 180 109 No. % ; of responders 0 0 ; 27 24.7 ; Baseline Rrs, cmH2O L s 4.0 0.7 ; 4.9 1.0 ; * Baseline Grs, L s cmH2O 0.27 0.06 ; 0.20 0.07 ; * PD35Grs in responders, unit 50 8.9 3.2 ; Cmin in responders, mg ml 25.6 6.7 4.3 and lescol. Would normally do at home. In the words of the Shulchan Aruch3: How [does one perform] the mitzvah of dwelling in the Sukkah? One should eat, drink, sleep, spend time and live in the Sukkah for all seven days [of the holiday], both during the day and during the night, just as he lives in his home the rest of the year. For seven days a person makes his home a temporary dwelling and his Sukkah a permanent one. How so? One should bring into the Sukkah their fine utensils and mats. pitchers and glasses. Orach Chaim 639: 1 The mitzvah is to live in a Sukkah just as you live in your home. This includes more than eating, drinking and sleeping. Even merely "spending time" i.e. doing nothing in particular, should be "done" in a Sukkah, for that too is a home-based activity!4 As the Talmud said, the point of this mitzvah is to move in. We will see that this idea explains several surprising leniencies in the mitzvah of Sukkah. The Talmud teaches that a person who experiences distress in the Sukkah is exempt from dwelling in it Sukkah 26a ; . For example, if flies or bees suddenly invade the Sukkah, making it an uncomfortable place to eat or sleep, one may leave the Sukkah and continue their meal or rest in the house. Similarly, if it rains into the Sukkah, making it an uncomfortable place to be, one may return to their home until the rain stops. This is quite unusual. Nowhere else do we find that distress--as opposed to health or safety--is sufficient grounds for exempting ourselves from mitzvot, for instance, drug hyzaar!


Expenditures to increase dramatically, from $2.16 trillion in 2006, to over $4 trillion in 2015. 29 Per person health spending of $7, 110 in 2006 will rise to $12, 320 by 2015. 30 The analysis of whether health care is too expensive requires more insight into why costs have risen--the same Kaiser ABC USA Today poll that cited concern over rising costs also revealed that the public misapprehends the reason for the increasing costs: according to the public, the drivers of cost increases are things like drug company profits, insurance company profits, overpaid doctors, medical malpractice lawsuits, and fraud. 31 Health care economists generally consider the real reasons for rising health care costs to be issues of demographics, expensive new or improved treatments, and poor health habits among consumers. 32 Thus, the public's perception that drug company profits are driving health care costs affects how Congress will empower the FDA to regulate pharmaceutical advertising. 33 It is one thing to point out that pharmaceutical companies have returns on assets two to three times higher than the average Fortune 500 firm but it is entirely different to make a normative judgment that they are "too profitable" because of their advertising activities. 34 To the extent that DTC advertising helps firms communicate with the public, it is inaccurate to view it merely as a cost to consumers; the and levaquin. Is there a pill to swallow for better libido.

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