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Respondents usually took drugs alone, even though they all had sometimes been rescued by fellow drug users when they had overdosed. Most of them had experienced several overdoses. They could not always explain why this had occurred. But some guesses were tiredness, stress situations, long time without sleep, or long time without food, factors which might have contributed to a greater degree of vulnerability. But it is also mentioned that more people could have been saved in private places, if there had not been so much fear for their dwellings being exposed. Also in public places it happens that people hesitate to call an ambulance because the police might show up at the same time. Most drug users are not suicidal, but there is always a risk for overdose if people mix Rohypnol and heroin to get the "ultimate kick". Some also mention that drinking alcohol enhances the risk for heroin overdose. Several interviewees underscore that alcohol is underestimated as a risk factor for heroin overdoses. The danger of overdoses because of relapses and increased vulnerability after drug-free periods is acknowledged. One 29 years old woman says: "Yes, I've experienced several critical situations, several overdoses. I wonder why it actually happened, since the doses were sometimes smaller than what I normally used. It could have been because I was very tired, extremely stressed or had been awake for a long time on amphetamines, or something like that, maybe I hadn't eaten, but I find it hard to explain why it happened then and there. My overdoses have been on heroin, except for that one time I overdosed on GHB. I've overdosed three to four times when an ambulance was called, and I have been shaken back to life by others on many other occasions. Probably ten times. " One 41 years old male drug user says: "Yes, I've had several overdoses. It has to do with how much nourishment you have in your body, what shape you're in that day. However, the times it happened I had been drinking alcohol. I was lying unaware in a coma, and was saved on at least three occasions by ambulance personnel. Hence, a big issue in health like education is to use randomized interventions, for example, hemophilia.
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Determination of the wage of the lowest paid unskilled government worker nonKuwaiti There is no official minimum wage in Kuwait and the government does not directly employ unskilled labourers. Rather, a competitive out-sourcing procedure is used with companies bidding for cleaning, security and similar contracts. These contracts, which remain confidential between the government and the winning bidder, will specify a sum to be paid to the workers who will be recruited to perform the work. However, the net salary paid to the employees will be less than this amount after deductions for accommodation, health insurance and other fees which vary depending on the company involved. Informal interviews were held with security and cleaning personnel employed by government departments which indicated that they received a disposable income of KWD 22 25 per month, a range that corresponded well with anecdotal accounts of the income of low-paid workers. However, it would not be appropriate to compare these net earnings with salaries for Kuwaiti workers who would still have to pay transport, accommodation, and similar costs from their salary although most single Kuwaiti workers would be expected to live in their parent's house ; . Low-wage workers in the private sector e.g. domestic workers, receive at least KWD 40 per month or more depending on factors such as country of origin, language skills, responsibilities ; out of which they would have to pay accommodation if not live-in workers ; and other expenses. They thus receive a salary more similar in construct to that of government Kuwaiti workers and one which may act as a surrogate for the gross salary a non-Kuwaiti government worker might receive. With the obvious limitations of this data, for the purposes of affordability calculations the wage of the lowest paid non-Kuwaiti government worker was taken to be KWD 40 per month or KWD 1.333 per day. 4. 2004 Cost Recovery For 2004, the Reserve Banks project that the check service will recover 91.9 percent of total costs, including imputed expenses, and targeted ROE. The Reserve Banks expect to recover all direct and indirect operating costs and all imputed costs of providing check services, but only a portion of the targeted return on equity. Total adjusted costs before taxes are projected to decrease approximately $87.1 million, or 9.1 percent, from estimated 2003 expenses. The largest factor contributing to the decline is local operating costs, which are expected to decrease by $64.9 million, or 11.4 percent. This decline reflects significant reductions in personnel costs and partial year savings associated with discontinuing the processing of checks at thirteen Federal Reserve offices. Additional reductions include lower check modernization expenses and the consolidation of some local administrative functions into national support centers and desmopressin.
3 present "stagflation" - the outcome of unlimited demand-side economic policy - makes one realize they might still learn from Mill. W. Stanley Jevons resented the authority accorded to Mill and Ricardo, and attacked them. The drama of personal vendetta, and the neo-classical compulsion to cast out Ricardo and Mill, have spawned a false view that Jevons departed from them. Here, however, is what Jevons actually wrote in his Chapter VII, "Theory of Capital": "The views which I shall endeavour to establish on this subject are in fundamental agreement with those adopted by Ricardo; . The same capital will serve for twice as much industry if it be absorbed or invested for only half the time"4. Jevons develops the last sentence at some length, in a simple mathematical model centered on the concept of a period of investment. Before his premature death, he was trying to turn this into a full explanation of boom-bust cycles. Jevons is the channel between English and Austrian economists. It was a two- way channel: modern Austrians still express one of their major concepts as "Ricardo Effect." Karl Marx, a student of classical political economy, expressed what seems like the same idea in different words. He wrote of the "organic composition of capital, " meaning the degree to which it is fixed rather than circulating. He devotes all of Book II of Das Kapital to treating the turnover of capital. He gets so wound up in it, however, it is hard for this reader, at least, to be sure where he comes out. Modern Marxist writers, not reviewed here, have taken up his views at length. These include Shaikh, Yaffe, Fine and Harris, Bell, and Weisskopf. Sherman 1995 ; remarks the common themes in Marx and the Austrians. This commonality did not abate the Austrians' militant anti- Marxism. Knut Wicksell, who developed these ideas more fully and formally, is cited near the end of this essay. Ludwig Von Mises and Friedrich Hayek, second-generation Austrian-school economists, advanced ideas derived from those cited, and were prominent in the 1920s and early 1930s, before Keynes. However, their variations on the theme modified it and, in my view, muddied it considerably, and I will not cite them here. Smith, Ricardo, Mill, Jevons and Wicksell make enough sense, and represent enough collective wisdom, to attract our attention. In their model, a shortage of job-making capital has two causes, pointing to two different solutions. They direct our attention away from the cause we hear most about today, a simple shortfall in quantity of capital. Let's identify and remember this idea of simple quantity shortage as "Theorem A." If we buy Theorem A, the obvious solution is to get more capital, in whatever form. The classical economists' ideas point, rather, to a "Theorem B." Theorem B says that unsold goods return no capital to meet the next payroll. It says more: the reason goods are unsold is because they are not ready to sell, being fixed in machinery and buildings. They are "unripe." Inadequate demand is not the problem, at least not initially. Unripeness of supply is the initiating problem. Note: class 1a antiarrhythmic agents should not be used to treat cardiotoxicity caused by class 1c drugs and decadron, because nasal sprays. Our results showed the expression of eNOS and TGF- 1 in all the animals. Compared to control young rats, there was approximately a 71% decrease in the estimated eNOS expression in control aged rats Figure 2 ; . These age-related differences in eNOS were restored after losartan treatment. Like the results of apomorphine-induced erection, the densitogram revealed the improved eNOS expression of the losartan-treated aged rats to the level of the control young rats and the losartan-treated young rats. Similar eNOS expressions were observed between the losartan-treated aged rats and the control young rats. In contrast, no age or losartan treatmentrelated differences in TGF- 1 protein expression were observed in the penile tissues of any of the rat groups Figure 3.
Propriate prescribing in the elderly involves psychotropic drugs. In our study, 41% of beneficiaries who filled a prescription for a drug on the Beers list did so for a psychotropic drug. In earlier studies, based on the more extensive criteria, between 23% and 51% of potentially inappropriate prescriptions involved psychotropic agents.10, 14, 15 Given the consistency of findings across data sets and time, why do these drugs continue to be prescribed for the elderly? First, the Beers criteria have never been validated in a research setting. While there is general agreement that these drugs pose risks when used in elderly patients, 19-21 there are legitimate concerns that explicit criteria may be too rigid and cannot take into account all factors that define individualized high-quality health care.22 In the absence of evidence-based guidelines, it may be difficult to convey clear, concise messages to physicians and the public about the risks and benefits of specific drugs.23, 24 Second, the evidence base for appropriate prescribing in the elderly is relatively weak. Elderly patients often are excluded from randomized clinical trials that generate information about adverse effects associated with specific drugs.25 Estimates of adverse effects typically are based on large observational studies in which unmeasured confounders are likely to be present. Third, elderly patients often have multiple chronic diseases26 and, therefore, receive complex drug regimens.27, 28 Physicians may be reluctant to alter a regimen that "works" because there is no perception of harm.23 Fourth, physicians may have evaluated the risks and benefits and believe a given drug to be the best choice for a given patient. In some circumstances, the use of a drug may be clinically justified if the benefits of the drug outweigh the risks to the patient. The lack of diagnostic data on the prescription claims in the present study makes it diffi ARCHINTERNMED and dexamethasone.
LACTIC ACIDOSIS CANNOT BE USED TO EXPLAIN AN OSMOLAL GAP IN PATIENTS WITH POTENTIAL ETHYLENE GLYCOL TOXICITY. A CASE REPORT AND REVIEW OF THE LITERATURE. Joel M. Topf, Sean Jayakar Saint John Hospital and Medical Center, Detroit, Michigan, USA. The finding of an unexplained osmolal gap in the presence of an anion gap metabolic acidosis AGMA ; suggests ethylene glycol or methanol ingestion. In many hospitals specific assays for these toxic alcohols are not available in a timely manner and definitive therapy must be initiated based on clinical suspicion. Separating an explained from unexplained osmolal gap focuses on ruling out sepsis, ketoacidosis and lactic acidosis as the etiology for the osmolal gap. Though lactic acidosis can cause an osmolal gap with an AGMA, the lactic acid assay is unreliable during ethylene glycol intoxication. We report a case where a patient had an elevated osmolal gap 22 mOsm kg ; , severe metabolic acidosis pH 6.9 ; and an elevated anion gap 37 mmol L ; . His osmolal gap was completely explained by a lactic acid level of 27 mmol L. While this should rule out a toxic alcohol as the etiology of his osmolal gap and acidosis, subsequent lab results revealed an admission ethylene glycol level of 11 mg dL. We believe the elevated lactic acidosis was due to a previously documented artifact where the enzymatic lactic acid assay non-specifically mistakes glycolate for lactic acid. Ethylene glycol toxicity can cause artificially elevated lactic acid which can erroneously explain an osmolal gap. Lactic acid should not be used to explain an otherwise suspicious osmolal gap in patients where a toxic alcohol is a consideratio. Received February 12, 2003; revision received May 20, 2003; accepted May 21, 2003. From Mount Sinai School of Medicine H.K., D.S., A.V., M.D.Y. ; , New York, NY; Clinical Neurocardiology Section D.S.G., C.H. ; , National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; and Beth Israel Deaconess Medical Center R.N., R.F. ; , Boston, Mass. Correspondence to Horacio Kaufmann, MD, Mount Sinai School of Medicine, Box 1052, New York, NY 10029. E-mail Horacio.Kaufmann mssm 2003 American Heart Association, Inc. Circulation is available at : circulationaha DOI: 10.1161 01.CIR.0000083721.49847.D7 and divalproex. 1998 ; . Fears are mounting that counterfeit products being sold as antiretroviral drugs in central Africa may set back the treatment of AIDS in serious ways Ahmad 2004 ; . The cost in lives and suffering is inestimable. Newton and colleagues 2002 ; summarised the situation in an editorial in BMJ: `The accumulated evidence, such as it is, suggests that mortality and morbidity arising from this murderous trade are considerable, especially in developing countries.' Counterfeit drugs also pose a danger to public health and safety in developed countries, though the issues are somewhat different. There, many of the counterfeit drugs are not taken for life-threatening illnesses, but as lifestyle medicines. Drugs taken for erectile dysfunction, to control cholesterol levels and to enhance athletic performance make up the bulk of the illicit trade Reuters 2005 ; . However, the problem is growing. In the U.S., the FDA initiated 58 investigations into counterfeit drugs in 2004, compared to thirty in 2003 and six in 2000 Reuters 2005 ; . In 1996 a pharmaceutical distributor admitted that it had for years imported counterfeit drugs into the U.S. from an unapproved source in China CBS 2002 ; . One of these imported drugs caused at least 66 deaths and hundreds of severe reactions. In 2000, Italian authorities seized 24, 000 packs of medicines and 2 tonnes of raw materials worth $1million Farnsworth 2005 ; . In 2002, Ohio police seized 36, 000 bogus Viagra pills that were traced back to China U.S. Army 2002 ; . In 2004, fake bottles of Cialis, used to treat erectile dysfunction, were discovered in the U.K. Gibson 2004b ; . Later that year, British authorities shut down a factory in London that was producing half a million Valium, Viagra and steroid tablets every day Reuters 2005 ; . In 2005, they seized thousands of fake Viagra pills made in India and later discovered packs of counterfeit Lipitor. The convictions reported in November 2005 of a former Co. Clare physician and another man show that illegal trading in pharmaceutical drugs is also occurring in Ireland Lucey 2005 ; . Investigations into the extent of the problem in Ireland are needed. This problem is not limited to `lifestyle' drugs such as Viagra and steroids. In 1982, seven people in the U.S. died after using paracetamol tablets laced with cyanide Cockburn et al 2005 ; . In 2003, the U.S. was flooded with nearly 200, 000 bottles of counterfeit Lipitor, a product widely used to control cholesterol levels ICN 2005 ; . Little is known about the extent of counterfeit drug use and availability in Ireland. Research is urgently needed to investigate the extent of the problem. Financial and other costs The money involved in counterfeit drugs is substantial. The FDA estimates that 10 percent of the market value of medicines globally is used on counterfeit drugs Cockburn et al 2005 ; . The global market in fake drugs is at least a US$35 billion industry. There are also the incalculable financial costs to the reputation of the pharmaceutical companies and public health systems. Some damaging effects of counterfeit drugs are more long-term. One is a breakdown in trust. People will lose faith in the health system if they cannot trust the reliability of medicinal products. For example, effective vaccination programmes require that a high proportion of the population be vaccinated. Yet if the supply of vaccines becomes tainted with.

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To examine the risk of hypospadias after exposure to loratadine and other antihistamines during pregnancy, we conducted a population-based case-control study in four Danish counties, which account for 30% of the Danish population ~1.6 M ; . We obtained data on maternal use of antihistamines from prescription databases, and data on birth outcomes from the Danish Medical Birth Registry MBR ; and the Hospital Discharge Registry HDR ; . A total of 65, 383 male births with a full prescription history of the mother in the study period from 1989-2002 were available for analysis. Within this cohort, we identified cases with a diagnosis of hypospadias, and 10 selected controls per case without such a diagnosis matched on birth month, gender and year of birth ; . We identified 227 cases of hypospadias recorded in the HDR within six months postpartum and 2270 controls. One case 0.4% ; and eight 0.4% ; controls were exposed to loratadine in the first trimester and up to 30 days before the time of conception. The adjusted odds ratio OR ; for hypospadias among users of loratadine relative to non-users was 1.4 95% CI: 0.2-11.2 ; and the corresponding OR for other antihistamines was 1.9 95% CI: 0.7-5.7 ; . In this study, maternal exposure to loratadine did not appear to be associated with an increased risk of hypospadias when compared with other antihistamines, although it should be noted that the statistical precision of the risk estimates might be limited. Key words: Hypospadias, Loratadine, pregnancy, drug safety, case-control studies. 12 weeks resulted in a 19% reduction in LDL particle concentration-NMR. This compared with a 24.9% reduction in LDL cholesterol with pravastatin therapy. Median LDL size-NMR did not change significantly with pravastatin therapy, but the reduction in LDL particle concentration-NMR with pravastatin therapy was most marked among those with smallest LDL size-NMR at baseline. In contrast the change in LDL cholesterol with pravastatin therapy was not related to baseline LDL size-NMR. Apolipoprotein B-100 has been used as an estimate of LDL particle concentration and has been shown previously to correlate strongly with LDL particle concentration-NMR.1 In this regard, the observed reductions in LDL particle concentration-NMR with pravastatin therapy in this study are consistent with previous reports of reductions in apolipoprotein B-100 with statin therapy ranging from 1325% among selected subpopulations.1316 A previous report of the effect of pravastatin therapy on LDL particle concentration-NMR reported a 24% change in LDL particle concentration-NMR after 6 months of 2040 mg of pravastatin among patients with documented coronary artery disease.5 Larger reductions in LDL particle concentration-NMR have been reported with atorvastatin therapy among 101 patients with atherogenic dyslipidemia3 and simvastatin therapy among 20 patients with mixed hyperlipidemia.4 That our data found somewhat smaller reductions may reflect that statins of different potency vary in their effects on LDL particle concentration, but also may reflect that our population was free of known cardiovascular disease and had lower baseline LDL particle concentrations. We observed no change in median LDL size-NMR after 12 weeks of pravastatin therapy. This finding is consistent with the majority of other studies of the effect of statin therapy on LDL size assessed by other and gliclazide. Maybe it has something to do with the enantiomersim of the drug ie levo, left polaring, for example, astelin.
Pulse Check: Trends in Drug Abuse, November 2002. whitehousedrugpolicy.gov publications drugfact pulsechk nov02 U.S. Department of Health and Human Services: Centers for Disease Control and Prevention Public Health Consequences Among First Responders to Emergency Events Associated With Illicit Methamphetamine Laboratories--Selected States, 19961999, November 2000. cdc.gov mmwr preview mmwrhtml mm4945a1 Youth Risk Behavior Surveillance--United States, 2001, June 28, 2002. cdc.gov mmwr preview mmwrhtml ss5104a1 National Institute on Drug Abuse Epidemiologic Trends in Drug Abuse Advance Report, December 2002, January 2003. drugabuse.gov about organization CEWG AdvancedRep 1202adv Monitoring the Future: 2002 Data From In-School Surveys of 8th, 10th, and 12th Grade Students, December 2002. : monitoringthefuture data 02data #2002data-drugs Monitoring the Future: National Survey Results on Drug Use, 19752002, Volume II: College Students and Adults Ages 1940, September 2003. : monitoringthefuture pubs monographs vol2 2002 Research Reports: Methamphetamine Abuse and Addiction, January 2002. drugabuse.gov ResearchReports methamph methamph Substance Abuse and Mental Health Services Administration Emergency Department Trends From the Drug Abuse Warning Network, Final Estimates 19952002, July 2003. : dawninfo.samhsa.gov pubs 94 02 edpubs 2002final files EDTrendFinal02AllText Mortality Data From the Drug Abuse Warning Network, 2001, January 2003. dawninfo.samhsa.gov pubs 94 02 mepubs files DAWN2001 DAWN2001 Results From the 2002 National Survey on Drug Use and Health: National Findings, September 2003. samhsa.gov oas nhsda 2k2nsduh 2k2sofw and dibenzyline. Antiviral medication can reduce the number of outbreaks by 70% to 80. Ketan K. Sheth, MD, MBA, is Head of the Allergy Asthma Section at Arnett Clinic in Lafayette, Indiana. Dr Sheth receives grant research support from, is a consultant for, is on the speakers bureaus of, and is a major stock shareholder of AstraZeneca, Aventis Pharmaceuticals, GlaxoSmithKline, Merck & Co, Inc, Pfizer Inc, and Schering Corporation. Maureen R. George, MSN, RN, CS, is Coordinator, Comprehensive Asthma Care Program, University of Pennsylvania Health System. Ms George receives grant research support from the Merck Foundation; is a consultant for GlaxoSmithKline and Integrated Therapeutics Group; is on the speakers bureaus of AstraZeneca, GlaxoSmithKline, Merck & Co, Inc, and Integrated Therapeutics Group; and receives other financial or material support from the National Institutes of Health and the American Lung Association. H. William Kelly, PharmD, is Professor Emeritus of Pediatrics and Pharmacy, University of New Mexico Health Sciences Center. Dr Kelly receives grant research support from GlaxoSmithKline and AstraZeneca and is on the speakers bureaus of GlaxoSmithKline, AstraZeneca, Schering Corporation, and Merck & Co, Inc and phenoxybenzamine. Ivan montoya of nida's division of pharmacotherapies and medical consequences of drug abuse.

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