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OTHER RELEVANT GUIDELINES Hypoglycemia, p. S43 Type 1 Diabetes in Children and Adolescents, p. S84 Pre-existing Diabetes and Pregnancy, p. S94 Gestational Diabetes Mellitus, p. S99 Diabetes in the Elderly, p. S106 REFERENCES.
The objective of this study is to evaluate the impact of pharmacist counseling for 10-year coronary heart disease CHD ; risk utilizing the CHD Risk Calculator on statin and or antihypertensive medication adherence. The primary endpoint will be statin and or antihypertensive medication adherence. Secondary endpoints include lipid and or blood pressure goal attainment, 10-year CHD risk based on the CHD Risk Calculator, smoking status, Purdue Pharmacy Directive Guidance Scale scores, modified Morisky Questionnaire scores and Readiness Ruler scores. This will be a prospective randomized controlled trial conducted at the University of New Mexico Hospital Outpatient Pharmacy. Patients e"18 years of age taking antihypertensive medications and or statin therapy will be included in the study. All eligible participants will be required to complete an informed consent form. The primary intervention will be additional counseling from a pharmacist based on their CHD risk analysis using the CHD Risk Calculator, discussion of their healthcare event report and a copy of the report. This study is designed as a pilot trial, therefore a sample size calculation was not performed. The student's t-test will be used to determine differences in mean adherence rates between the two study groups. Categorical variables will be analyzed utilizing Chi-square. Descriptive statistics will be used to describe demographic variables. For the purposes of this study, a p-value of d"0.05 is statistically significant. Preliminary results will be presented. 191 B2 ; Wednesday 3: 00 Dolphin EVALUATION OF THE IMPLEMENTION OF A COMMUNITY PHARMACY-BASED SMOKING CESSATION PROGRAM B2 ; , Marilyn Lavaee, Jeff Goad, Kathy Johnson, Rebecca Cupp, Linh Lee, Peggy Tilbury. University of Southern California, Los Angeles, CA, lavaee usc ; . Despite the evidence demonstrating the devastating health consequences of smoking tobacco, tobacco use still remains the single largest preventable cause of mortality in the United States. It is unclear, however, how likely and to what extent chain pharmacists will participate in smoking cessation activities. A baseline KABP survey was administered to all pharmacists within the supermarket chain. Following the survey period, pharmacists will then be trained on smoking cessation products and counseling using a standard smoking cessation program. Each pharmacy will next receive a smoking cessation toolkit focusing on 3 tiers of participation. Tier 1 will involve advocacy, referral to a quit line and documentation of smoking status; tier 2 has the pharmacist provide comprehensive nonprescription product counseling in addition to tier 1 activities; and tier 3 entails assessment, behavior change counseling sessions, carbon monoxide monitoring in addition to tier 1 and 2 activities. Objective measures of the success of the program will include number of quit line referral cards distributed, quantity and type of non-prescription NRT recommended and counseled, and quantity of patients enrolled in the smoking cessation behavior change program. All data will be collected, documented, analyzed and the results will be discussed. 192 B2 ; Wednesday 3: 30 Dolphin IMPLEMENTATION OF A PHARMACIST- ADMINISTERED INJECTABLE DRUG SERVICE IN A COMMUNITY PHARMACY-GROCERY CHAIN B2 ; , Tara Newton, Kelly Hampton, Safeway Pharmacy70.
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GUIDANCE TO SURVEYORS program has been implemented. Review the facility's program documentation and other records to determine whether patient quality of care and administrative issues that impact on quality have been identified. The ASC should use the results of ongoing quality monitoring to identify processes that need improvement, develop and implement corrective actions and evaluate whether the problems have been eliminated or minimized. Annotate on the survey report form what the ASC considers important processes to patient care that should be evaluated ongoing, and that are not ongoing. Ongoing means that there is continuing or periodic collection and assessment of data concerning all areas that impact on patient care. The program continually identifies processes for improvement and potential problems and indicates the data which should be collected and assessed in order to provide the ASC with routine findings regarding quality of patient care. The monitoring should be comprehensive and take into consideration medical necessity as it relates to the procedure performed by the ASC. The quality assurance or improvement program should also monitor the quality of patient education before procedures are performed and prior to discharge after the procedure. Specifically, are patients given necessary information to prepare for the procedure and to perform self-care and manage complications after discharge? Evaluation of appropriateness of care should include analysis of: o o o Anesthesia recovery; Infection rates; Pathology reports; Nursing services; Completeness of medical records; Complications that have occurred; and Stability at discharge.
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As for Warrigal, Starlight used to knock him down like a log if he didn't please him, but he never offered to turn upon him. He seemed to like it, and looked regular put out once when Starlight hurt his knuckles against his hard skull. Us he didn't like, as I said before -- why, I don't know -- nor we him. Likes and dislikes are curious things. People hardly know the rights of them. But if you take a regular strong down upon a man or woman when you first see 'em it's ten to one that you'll find some day as you've good reason for it. We couldn't say what grounds we had for hating the sight of Warrigal neither, for he was as good a tracker as ever followed man or beasts. He could read all the signs of the bush like a printed book. He could ride any horse in the world, and find his way, day or night, to any place he'd ever once been to in his life. Sometimes we should have been hard pushed when we were making across country at night only for him. Hour after hour he'd ride ahead through scrub or forest, up hill or down dale, with that brute of a horse of his -- he called him `Bilbah' -- ambling away, till our horses, except Rainbow, used to shake and gentian.
Table 3. CMV-specific T-cell reconstitution prior to and after the transfer of polyclonal CMV-specific T-cell lines Proliferation to CMV * Patient no. 1 2 3 Prior to After CMV-specific CD4 T cells Prior to nt 0.22 0.04 nt After nt 1.58 7.93 nt 0.4 4.19 0.98 d 11 ; 0 4.02 A1 ; nt 5 ; CMV peptide-specific CD8 T cells Prior to nt 5.47 A1 ; 3.52 A2 ; After nt 41.58 A1 ; 1.26 A2 ; 13 A2 ; 3.52 A2 ; 4.01 A1 ; A11 ; 1.12 A11 ; d 11 ; Outcome CMV encephalitis d IA d 128 610 492 Alive and well d Alive and well d Alive and well d RSV-IP d 389 42.
Onset GHD. Whereas a number of studies report a decrease in bone mass in patients with GHD 510 ; , our finding of a normal BMD at the lumbar spine is in agreement with more recently published data 13, 18 ; . The reason for this discrepancy in findings may be that some of the studies were performed in patients with childhood-onset GHD, whereas our patients were adult-onset GHD. A decrease in bone mass in adults with childhood-onset GHD is likely to be caused by deficient bone accretion during childhood and or early adulthood, whereas a decrease in bone mass in patients with adult-onset GHD, as reported by some investigators 9, 10 ; , is likely to be caused by an imbalance in bone remodeling as a result of an increase in bone resorption relative to bone formation. Patients with childhood-onset GHD have also significantly lower body height, which may complicate the interpretation of BMD. Adult patients with GHD have an increased body weight, caused by an increase in fat mass especially around the waist ; , and a decrease in fat free mass compared with healthy controls of the same age, gender, and height 19 ; . Holmes et al. 10 ; corrected Z-scores of the lumbar spine for weight, probably because of the known correlation between weight and BMD. In contrast to the patients in Holmes' study, none of our patients had a BMI 32. We therefore believe that correcting Z-scores for weight would not have significantly influenced our results. Moreover, the same group of investigators recently demonstrated normal BMD in patients with GHD older than 60 yr 18 ; and similar results were described by Rosen et al. 9 ; in patients with GHD above the age of 55 yr. In our study group no significant differences were found in Z-scores between younger and older patient groups. Bone histomorphometric data are not available in patients with adult-onset GHD. Our findings, and those of others, show, however, that GH treatment significantly increases bone turnover, as judged by changes in biochemical parameters of bone resorption and formation 1113, 20 ; . BMD of the lumbar spine was normal at baseline and increased statistically significantly, albeit probably not clinically significantly 2% ; during treatment, suggesting a relatively greater increase in bone formation than bone resorption. Concern that the increase in bone turnover may have adverse effects on the skeleton was thus not justified. Despite an increment in the mean dose of rhGH, serum IGF-I levels were lower at 2 yr treatment compared with those after 52 weeks of treatment, but were still greater than baseline values. There are at least two possible explanations for this observation. First, most of the patients changed injecting device between 52 weeks and 2 yr of treatment, with a switch to a Genotropin ; pen with a 16 IU vial instead of a syringe with a 4 IU vial Kabi Mixer ; . Changing to a more concentrated solution may decrease the availability of rhGH and thus result in a decrease in serum IGF-I 21 ; . In addition, changing from syringe to pen may also decrease GH availability as reported by Jrgensen et al. 22 ; , although not confirmed by Blok et al. 21 ; , when both injection volumes and needle length were controlled. A second possibility, although as yet speculative, is that patients became less sensitive to circulating GH concentrations. Actually, one report even mentions an increase in sensitivity to rhGH during treatment 23 ; . It was of note that BMD continued to rise and ginger.
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Society has been revived.19 This also manifests itself in the atmosphere of intensified competition and growing atomization of the assertion of interests. The fear of falling behind in social and economic terms produces an almost atavistic reflex in people to grab what they can and cling to what they already have. At the same time this way of asserting one's interests weakens integrating mechanisms within society and strengthens further this polarization process. The members of more prominent groups are similar to the elite in that they are neither capable nor compelled in themselves to step beyond the state of relative autonomy, while the tensions they experience as a result become stronger than at any time before one of the characteristics of transition is that superiors and institutions change from one moment to the next, which they must conform to. The comparative autonomy of the majority who have fallen behind in society is in truth falling to pieces an increasing section of society are becoming completely helpless. This is the price for the fact that, despite the exhausted possibilities hidden in a relative autonomy, those at the top are able to hold on to their positions and only the external appearance of their opportunities to assert their interests change. Lszl Bruszt and Jnos Simon conducted research with results that showed that from 1985 to 1991 the proportion of citizens who claim that "the ordinary person is always excluded from power" rose from 40 percent to 75 percent. Furthermore, the ratio of those who believe that decisions at the workplace bear no influence grew from 14 percent to 47 percent.20 It transpires from Ferenc Er s' empirical studies that in 1995 looking back on the previous three years ; Hungarian citizens have only felt there have been positive changes in the development of the political transition. They judge the other elements in the quality of life the standard of education and health care, social policies, political stability, solidarity between people, environmental protection, the prospects for the future, public safety, the level of corruption, the standard of living and the country's economic situation ; to have declined considerably on a greater scale in the order listed ; .21 According to Rudolf Andorka`s research work the majority of Hungary's citizens are also unsatisfied with the opportunities available to them to have a say in political decision-making. It also establishes that between 1993 and 1995 the growing general dissatisfaction people felt with regard to the possibilities available to them. Andorka also adds that that the root of this is the actual situation and "not the spreading of a social-psychological dissatisfaction which would be a characteristic prevalent in a longer time span in the cultural life of Hungarian society."22 The system of values and behavior of the ambitious are basically defined in the attitude that they should "become a winner, immediately become distinguished in what they do, beat everything and everyone, because what I can take from others today may be grabbed by someone else tomorrow in this great carve up." By way of strengthening their own circles, it is increasingly difficult to become a winner too unless one resorts to these tactics. This is what Elemr Hankiss called the game which totals naught, which is being played with a tougher and more reckless spirit than ever before. Sooner or later the only goal, one value remaining for the losers will be sheer survival. Mria Vsrhelyi's research also supports this, in that in the years following the political transition the values associated with material and economic stability have risen, to the detriment of values related to social relations ; .23 The ethos of the winners has not become an official social ideology. Apart from what has been mentioned above, the model of behavior reflected by the elite groups has also been an influence. I say "reflected" because society is susceptible not to the declarations of the elite but to the motivation behind their behavior, and this is more true of less educated social groups ; . The desire to win at whatever price and the increasingly short-term approach to the assertion of interests gain considerable weight from these social spheres. In sharp contrast to what has already been stated, the majority of Hungarian citizens would maintain that the development of a multi-faceted social network is necessary, not wishing to shut out the losers in the change of system. In her analysis of the situation, Mria Vsrhelyi claims that.
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Wilkinson and Beckett, 1968 ; . A typical human ephedrine caffeine dosage is ~0.3 mg ephedrine kg body weight 11 mg m2 body surface area ; and ~3 mg caffeine kg body weight 111 mg m2 body surface area ; Table 1 ; . In this study, we evaluated the cardiac pathology of a combined exposure to ephedrine and caffeine. A previous subchronic study in rats, in which ephedrine alone was administered at doses up to approximately 140 mg kg, and a chronic study in which doses as high as 18 mg kg were achieved during the first weeks revealed no evidence of cardiac toxicity National Toxicology Program, 1986 ; . For the current study, the ephedrine dose selected was in the range of the high dose used in the two-year-male-rat chronic study National Toxicology Program, 1986 ; , and the caffeine dosage was approximately equal to the amount of guarana-derived caffeine from a typical human ephedra-supplement dosage based on a mg m2 body surface-area comparison. Thus, the ephedrine exposure given to rats was ~12X and the caffeine dosage ~1.4X that of an average human exposure based on a mg m2 body surface-area comparison Table 1 ; Freireich et al., 1966 ; . To characterize the nature of the morphological manifestation of cardiotoxicity and clarify the pathogenesis of the ephedrine and caffeine-induced myocardial damage, we applied histochemical and immunohistochemical stainings for ischemia and apoptosis. Our work shows the direct relationship between combined ephedrine-and -caffeine exposure and acute myocardial necrosis, acute myocardial hemorrhage, and myocardial inflammation and ginseng.
For agricultural science that inspired young scientists -- such that Dr. Mew still displays in his office an old black-and-white photograph of his mentor. "He told all the scientists, `If something happens in the field, tell me right away, '" recalls Dr. Mew. "`No matter where I am, bring me to the field.'" Two years into Dr. Mew's brief career in Taiwan, a long and frustrating search for diseaseresistant lines of mung bean suddenly yielded a visible result. Relating the story, Dr. Mew's voice becomes excited, almost as if it were 1974 again and he's seeing the result for the first time. He burst into Dr. Chandler's office to find the director general working on the budget with his deputy, who brusquely pointed out that Dr. Chandler was busy. Mung beans could wait until tomorrow. "Chandler told him, `When a scientist comes to your office and says he has something in the field he wants to show you, you should drop what
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A 1719 base-pair bp ; DNA fragment encompassing the region of interest was amplified by PCR 13 ; . Briefly 50 ng of genomic DNA from each subject was amplified by PCR in a final volume of 25 ~1 containing 1 X PCR buffer 50 mmol L KCl, 10 mmol L Tris-HCl, pH 8.3 at 25 C, 1.5 mmol L MgCl 0.01% gelatin ; , 200 pmol L each dNTP, 0.5 pmol L each primer see Table 11, 10% dimethylsulfoxide DMSO ; , and 0.5 units Tuq polymerase Boehringer Mannheim, Indianapolis, IN ; . Forty-five cycles were performed, each consisting of denaturation 95 C, 30 set ; , annealing 58 C, 30 set ; , and extension 72 C, 1 min ; , except in the first cycle, during which the denaturation time was 4 min, and the last cycle, during which the extension time was 10 min. Amplification of the PCR products was confirmed by 1% agarose gel electrophoresis followed by visualization with ethidium bromide and ultraviolet transillumination Fig. 1 and genotropin.
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Pregnancy: pregnancy category b reproduction studies carried out with genotropin at doses of 3, 1, and 3 mg kg day administered sc in the rat and 08, 3, and 3 mg kg day administered intramuscularly in the rabbit highest doses approximately 24 times and 19 times the recommended human therapeutic levels, respectively, based on body surface area ; resulted in decreased maternal body weight gains but were not teratogenic.
MATERIALS AND METHODS Materials. Na125I IMS 30 ; was obtained from Amersham. Osmotic minipumps model 2001 ; were from Alza. Acrylamide, N, N'-methylenebisacrylamide, and SDS were from Bethesda Research Laboratories. Glycerol ultrapure ; was from United States Biochemical. Triton X-100 and CsCl catalogue no. 757306 ; were from Boehringer Mannheim. Bio-Rad protein assay no. 500-0001 ; and high molecular weight standards no. 161-0303 ; were from Bio-Rad. Ethynylestradiol, diethyl pyrocarbonate, N-lauroylsarcosine, bovine serum albumin fraction V, no. A-6003 ; , Trizma base no. T-1503 ; , leupeptin no. L-2884 ; , phenylmethylsulfonyl fluoride no. P-7626 ; , 1, 10-phenanthroline no. P-9375 ; , and L-thyroxine T4; no. T-2501 ; were from Sigma. Dexamethasone Dex ; Decadron ; was from MSD, Haarlem, The Netherlands. Guanidinium thiocyanate, glycine, CaCl2, EDTA, and 2-mercaptoethanol were from Merck. Human GH Somatonorm for rat experiments and Genotropin for human studies ; was kindly provided by R. Gunnarsson, Kabi-Pharmacia, Stockholm. Rats. Forty-eight mature male Sprague-Dawley rats were used. They were kept under standardized conditions with free access to water and commercial rat chow. Lights were on from 6 a.m. to 6 p.m. Hypophysectomy was performed on 200-g rats by the parapharyngeal approach. During the 10 days following the operation, body weight was monitored daily to verify failure of weight gain. Groups of animals four rats per group ; received ethynylestradiol 5 mg kg ; , dissolved in propylene glycol, by daily at 11 a.m. ; subcutaneous injections for 4 days. Hx rats receiving hormonal substitution were in addition given the hormones indicated below through a constant infusion from osmotic minipumps implanted subcutaneously under ether and glucagon.
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