||Dr. Knutson and Colleagues Reply TO THE EDITOR: We thank Richard Balon, M.D., for reemphasizing some important questions that we touched on in our report i.e., "Is everyone equally affected by antidepressant treatment?" "Are these changes permanent?" ; , but we would like to clarify some of the other issues he raises. An active placebo condition might have provided useful additional data, but we should note that neither our subjects nor those of Dr. Gelfin and colleagues could reliably determine whether they had received an active or placebo compound. While the study we reported cannot address all of these issues, future studies may. A conceptual ambiguity underlying one of the questions concerns us i.e., "Could it be that serotonergic antidepressants just help `normal' and other people tolerate stress better?" ; . This question implies that sensitivity to stress is not relevant to personality. In fact, susceptibility to stress comprises a central facet of one of the most prominent trait dimensions commonly measured by psychologists i.e., neuroticism or negative affect ; 1 ; . This trait has clinical relevance in that it can confer vulnerability to a host of affective disorders 2 ; . Framing personality as a unitary entity rather than as a collection of traits obscures our finding that only one aspect of personality was altered by selective serotonin reuptake inhibitor SSRI ; administration. Indeed, this selective effect led us to conclude that agents such as SSRIs might help elucidate biological substrates for some personality variables. As Dr. Balon implies, our procedures differed from those of Dr. Gelfin and colleagues in a number of ways. These differences may have contributed to an apparent inconsistency of findings. First, we administered SSRI and placebo concurrently to different groups by means of a double-blind procedure ; , rather than sequentially to the same subjects. Second, we mainly used psychometric measures developed for normal rather than clinical samples, which may have reduced our susceptibility to floor effects. Third, we also observed changes in objectively coded interpersonal behavior. Fourth, we measured plasma SSRI levels, which afforded some control for compliance or idiosyncratic malabsorption of the drug. Fifth, we tested a larger number of subjects, which may have boosted our statistical power to detect an effect. Kramer originally observed personality changes in the patients he saw in clinical practice but not in "normal" volunteers. Although behavioral scientists can rarely make definite conclusions, we believe that we have taken the first step toward a testable hypothesis and stand by our original statement: serotonergic mechanisms may selectively modulate an aspect of personality characterized by negative affective experience.|
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Associated with the wrong herb" 2 ; . Albert Leung also alluded to this aspect in his Herbal Gram article "Scientific Studies and Report in the Herbal Literature What are we Studying and Reporting" 3 ; . Most recently Fugh-Berman in her excellent Lancet article drew attention to the difficulty faced by those reporting on and analysing adverse reports on Herbal Medicinal Products, writing: "Perhaps the most serious problem encountered in analyzing such reports is the consistent absence of any effort beyond that of reading the label ; to establish a positive identification of the herb involved, and to exclude the effect of contaminants or adulterants. Unless noted otherwise, the reports mentioned herein did not include chemical analyses" 4 ; . While this paper argues for a knowledgeable, rigorous, precise and hence scientific approach to the reporting of Adverse Reports involving Herbal Medicinal Products, it must also be stressed that clinicians dealing with adverse sequelae in patients who have consumed these medicines and who are trying to prevent additional occurrences should not have to rely on the services of an expert Pharmacognosist to investigate the product and should in fact be able to rely on the product label for accurate information on the contents in the same way that they can rely on the labeling of other medicines. Equally if the information is to be value to others then it must be accurate and meaningful and sometimes it is neither. Even in the Lancet review.
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I also hope the SV will consider implementing a FOOLPROOF height to withers measuring system for the first 20 in each class at the Sieger Show. It is unacceptable for obviously well oversized dogs to be most influential in our breed's gene pool. For too long a blind eye has been turned in this regard, and this practice should end. The SV cannot, on the one hand rigidly refuse to increase the Breed Standard in regard to height to the withers, and on the other hand continue to allow SV Judges and SV Kormeisters to write down false measurements when they choose to. This is two faced, and this is cheating, and it must stop now. The SV sets the breed Standard and the Rules and Regulations; they must also set the standard for integrity in our breed, which is of equal if not higher importance. CHEATING IS WRONG TO CONDONE CHEATING IS EQUALLY WRONG. The SV Krung regulations are very clear as follows: 7.2 Koerklasse 2 Dogs included in the rating of Korklasse-2: b ; with measurement over or under the limits of withers height by up to cm; please note: the breed standard for height to withers are as follows: Males 60cm to 65cm Females 55cm to 60cm. In my opinion this 1cm is far too restrictive to facilitate totally genuine measuring practices, especially in the Krung, and I believe that 2cm at the top end is much more realistic. This becomes very apparent when one looks at the size of many top placed dogs at the German Sieger Show over the years. Not forgetting that most of these males have the greatest influence on our breed. The German `rubber' measuring stick has been an international joke for as long as I can remember. The Korklasse 2 grade is surely preferable than FAILING the Korung and losing otherwise outstanding dogs from our breeding pool. This coupled with honest measuring is surely worth introducing. I would also suggest a double check system for measuring height. It is far too important to leave to a single Kormeister, and measuring dogs using modern sophisticated methods which can eliminate or substantially reduce human error should certainly be explored. With modern technology surely this is possible. I make no apologies for writing about these very serious issues here in my IMPRESSIONS. The Sieger Show is the most globally important and globally influential GSD Show within our breed. We must highlight all the most important issues affecting the breed's present and future for open debate, so that they may be taken seriously by the powerful and influential German Shepherd organisations, especially those within Germany, the homeland.
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A primary activity of Public Citizen's Health Research Group is holding government accountable to the people who depend on it for protection -- in this case, health care workers who depend on government regulation to protect them from dangerous medical devices. Unfortunately, the FDA has once again bowed in response to industry pressure and exposed thousands of workers to needless risks in the process. The statement of Health Research Group Deputy Director Peter Lurie is reprinted below. oday's withdrawal of a rulemaking initiated to protect health care workers from accidental needle sticks shows a profound indifference to the safety of workers and is yet another example of the Food and Drug Administration's FDA ; failure to do its job. In 2000, Public Citizen and the Service Employees International Union SEIU ; petitioned the FDA to ban a variety of unsafe devices used by health care workers, including certain intravenous IV ; catheters, blood collection devices, blood collection needle sets "butterfly syringes" ; , glass capillary tubes and IV infusion equipment. The problem is significant: Each year, U.S. health care workers sustain 590, 000 needle sticks, according to the with needles and began the process of addressing them. Now, the agency has retreated in the face of industry pressure. The agency claims that not enough detailed data exist to warrant action. However, an extensive body of research documents the ability of the safer devices to reduce needle sticks. As the American Medical Association concluded in 2001, "Scientific data now indicate that the appropriate use of needlestick prevention devices, especially in comprehensive prevention programs, significantly reduces the incidence of needlestick injuries." The FDA has increasingly come under fire for its refusal to ensure that prescription drugs are safe before being placed on the market. In most cases where unsafe drugs have had to be removed from the market, safer, equally effective alternatives have existed. Here, again, the agency is eschewing its responsibility to ensure the safety of the products it regulates. By allowing considerably more dangerous devices to stay on the market when equally effective, safer alternatives are available, the FDA has endangered the lives of hundreds of thousands of health care workers in this country. I, for example, imovane tablets.
Gwilym Williams, who is Head of International Programmes at BRI, and National Contact Point for the FP6 `Health' Programme, will head the Dublin RBO. Prof. David McConnell, Department of Genetics, Trinity College Dublin represents Ireland on the EFB Executive Board. Prof. McConnell is also Vice-Chairman of an EFB initiative entitled 'European Action in Global Life Sciences 'EAGLES' ; , which aims to give a European platform to life scientists from Developing Countries, so that support and cooperation may be leveraged in the most appropriate ways and motrin.
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TABLE 3. CLu and unbound fraction values of sulfisoxazole in renal transplant patients CLUR ml min ; CLUACa ml min ; CLUXR ml min ; on day: on day: on day: 1 7 4 pound 13 ; . Additionally, excess N4-acetyl sulfisoxazole appears more difficult than sulfisoxazole to remove by dialysis. In one renal transplant patient not included in this study ; who underwent hemodialysis, the extraction ratio of N4-acetyl sulfisoxazole was 0.066 0.007. The extraction ratio for sulfisoxazole, however, was 0.236 + 0.022. In all patients the unbound concentrations in plasma, as well as those in urine, were at all times after the first dose at levels considered to be active against sulfisoxazole-susceptible microorganisms. The total recovery of sulfisoxazole and N4-acetyl sulfisoxazole over the total study period was 63.5 7.4%, compared with a recovery in normal controls of 80% 9 ; . With the use of the Bratton-Marshall method for total sulfisoxazole 5 ; , 92% of the dose could be accounted for after hydrolysis, which is lower than that observed in healthy controls 109% ; . Part of the lower total recovery is probably related to the difficulty in assuring complete urine collection over the 12- to 21-day study period for the individual patients. During the steady state, when three or more 2-h urine samples were collected, the recovery by the Bratton-Marshall method was 99%. Similarly, the sulfisoxazole and N4-acetyl sulfisoxazole recovery was 36 and 38%, respectively, versus 32% each for the total study period. It therefore appears to be unlikely that total recovery of sulfisoxazole from urine was achieved consistently throughout the study. The total recovery of sulfisoxazole was, on the other hand, only correlated with the daily urine flow in one of the eight patients P 0.05 by the Student t test ; . A correlation was only expected if a large amount of urine was lost on occasions; this indicates that the urine volume lost due to inadequate collection is small. The clearance determination samples were, on the other hand, collected under more controlled conditions and are likely to better represent the ability to eliminate sulfisoxazole. The excretion of sulfisoxazole from urine did not consistently vary with urine pH, urine flow rate, or creatinine levels in serum in individual subjects. Several reasons may account for this phenomenon. The urine pH, urine flow rate, and creatinine levels in serum tended to vary relatively little throughout the study in the individual patients. Only when large changes were seen in urine pH, urine flow rate, and creatinine levels in serum could a correlation be found. In all subjects transplant patients and controls ; , the majority of the variability in the CLUR of sulfisoxazole could be explained by the difference in creatinine clearance values Fig. 3 ; . It is, however, interesting to note that the linear relationship between CLUR and creatinine clearance has a negative intercept on the y axis. Because the four subjects with the lowest CLus were among the subjects with the lowest urine pH, the deviation from a straight line through the origin may be due to higher-than-average reabsorption in these subjects. However, the r2 value for the multiple correlation between CLUR and creatinine clearance, urine flow rate, and urine pH 0.8823 ; was not marginally different from the r2 value for the correlation between CLUR and creatinine clearance alone 0.8597 and phentermine and imovane, for instance, effects 9movane side.
Within the anti-infectives class, which accounts for 11% of reimbursable prescription expenditure, the two largest product groups are systemic antibiotics, which represented 70% of spending in 2000, and antivirals 14% of spending ; . Fluoroquinolones were the fastest growing type of antibiotic, registering a 26% increase in reimbursements. However, it was antivirals which grew at the fastest rate 53% ; , due primarily to the arrival in February 2000 of the hepatitis C antiviral Rebetol on the primary care market, which, together with gains made by the herpes drug Zelitrex + 39% ; , helped boost spending on non-HIV antivirals by 123%. In contrast, spending on HIV antivirals increased by 13% in 2000, although patients can opt to obtain these medications from hospital pharmacies. Within the respiratory class, which represents 9% of reimbursable prescription spending, bronchodilators and anti-asthmatics account for nearly 50% of spending, and this group recorded a growth rate of 19% in 2000. Spending on antihistamines rose by 7%, whilst spending on cough and cold remedies fell by around 5%, due to generic competition and price cuts imposed by CEPS. An analysis of expenditure by product type reveals that drugs to lower cholesterol, anti-asthmatics and analgesics are the top groups by value, with four products to lower cholesterol, four analgesics and three anti-asthmatics featuring among the top 20 products. However, the anti-ulcer drug Mopral holds the number one position, generating reimbursable prescriptions valued at FFr 2 billion in 2000, an increase of 28.6% over 1999. The CNAM notes that the above average rise in spending on Mopral, which has been available for over 10 years, is due to extensions in the product's indications. The 20mg form was recently granted an indication for the prevention of gastric damage from NSAIs, and this explains why the product is the number one drug prescribed by rheumatologists. By volume, the top four products are all paracetamol based analgesics Efferalfan, Doliprane, Di-Antalvic, Dafalgan ; , which generated prescriptions for 150 million boxes in 2000, an average of four boxes per person per year. These products all recorded above average increases in prescription volume during 2000, with the exception of Di-Antalvic, which saw an 11% drop in the number of units prescribed, due to generic competition. Psychotropes represent the second most important group of drugs by volume with 47 million boxes prescribed in 2000. The most frequently prescribed products are the hypnotics Stilnox and Imovane, followed by the antidepressant Prozac, and the tranquillisers Xanax and Lexomil. The five fastest growing products in terms of reimbursement expenditure in 2000 were the antiplatelet Plavix, the statin Tahor, the anti-ulcer Mopral, the organ transplant drug Neoral and the anti-viral Rebetol. With the exception of Mopral, these are either newly available products Neoral, Rebetol ; or recently available products Plavix, Tahor ; . Of the 30 products which recorded a fall in reimbursement expenditure of 7% or more, 17 are products which have come under pressure from generic competition, and the CNAM notes that the combined market for these products originator product plus generics ; has remained stable in most cases. Other products in decline include the vasodilators Fonzylane and Tanakan, which were found to have an insufficient efficacy rating by the Transparency Commission, and whose reimbursement rate has been cut from 65% to 35%. Reimbursable Prescriptions Processed by Rgime Gnral by Prescriber, 2000 Value FFr million Independent Practitioners * Hospital doctors Total 80, 343 8, % of Total 90 10 100.
The way in which we think of medical journals depends an awful lot on where you start. Some academics are obsessed with things called "impact factors" that measure how often papers in a journal are cited Box1 ; . Other people make sweeping assumptions about quality of journals, based on a range of items like peer review, whether they have heard of it or not, where it is published, or whatever. Bandolier has certainly heard some singular definitions of journal quality in its travels. Impact factors cover a wide range. Some journals achieve impact factors of 25 or more, anything over 4 is good, most journals have impact factors of 1 or 2, while many have impact factors well under 1. An impact factor of 0.1, for instance, indicates one citation for every 10 articles published. How do impact factors relate with professionals' attitudes to journals and their quality? A study  tells us they are related, but not that closely and propecia.
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Por su parte, la Agencia Europea de Medicamentos EMEA ; , desde 1995 en que fue creada hasta setiembre de 2004, autoriz la introduccin de 285 medicamentos para uso humano en el mercado comunitario luego retir 13 ; , vale decir, un promedio de 29 productos por ao. De los 272 productos vigentes, en el pas slo se han registrado 160 en promedio 16 por ao ; , hasta la actualidad. Debe tenerse en cuenta que en Europa tambin es posible que las empresas farmacuticas registren sus productos individualmente, en uno o ms pases, sin pasar por la EMEA, for example, imovane for.
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