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Metronidazole familiar brand name: Flagyl ; Name: Often comes in: tablets of 200, 250, or 500 mg. Price: for vaginal inserts, 500 mg. Price: for Metronidazole is useful for gut infections caused by amebas, giardia, and certain bacteria, and sometimes for diarrhea that comes from taking `wide-range' antibiotics such as ampicillin ; . It is also useful for vaginal infections caused by Trichomonas, or by certain bacteria. It can also help to treat the symptoms of guinea worm. CAUTION: Do not drink alcoholic drinks when taking metronidazole, as this causes severe nausea. WARNING: Metronidazole may cause birth defects. Pregnant women should avoid using this medicine if possible, especially during the first 3 months of pregnancy. Breast feeding women using large doses should not give their babies breast milk for 24 hours after taking metronidazole. Persons with liver problems should not use metronidazole. Dosage for giardla infection: Give metronidazole 3 times a day for 5 days. In each dose give: adults: 250 mg. 1 tablet ; children 8 to 12 years: 250 mg. 1 tablet ; children 3 to 7 years: 125 mg. tablet ; children under 3 years: 62 mg. tablet ; Dosage for guinea worm: Give the same dose as for giardia, 3 times a day for 10 days. Dosage for Trichomonas infections of the vagina: The woman should take 8 tablets 2 gm. ; by mouth in one single dose. Or, if the infection is not very severe, she can use a vaginal insert of 2 tablets 500 gm. ; twice a day for 10 days. Both the woman and man should be treated for Trichomonas at the same time. He should do this even if he has no symptoms or he will pass it back to the woman. ; Dosage for stomach ulcers: Give metronidazole 3 times a day for 7 days. In each dose give 400 mg. Side effects: Occasionally causes gas, stomach pain, or nausea. Dosage for diloxanide furoate-- 20 mg. kg. day ; --tablets of 500 mg.-- Give 3 times a day with meals. For complete treatment take for 10 days. In each dose give: adults: 1 tablet 500 mg. ; children 8 to 12 years: tablet 250 mg. ; children 3 to 7 years: tablet 125 mg. ; children under 3 years: 1 8 tablet 62 mg. ; or less, depending on weight Tetracycline see p. 356 ; Chloroquine For treatment of liver abscess caused by amebas, using tablets of 250 mg. chloroquine phosphate or 200 mg. chloroquine sulfate: adults: 3 or 4 tablets twice daily for 2 days, and then 1 or 2 tablets daily for 3 weeks. Give children less, according to age or weight see p. 366 ; . Dosage for bacterial infections of the vagina: The woman should take 2 tablets 500 mg. ; of metronidazole twice a day for 5 days. If the infection returns, both the woman and man should take the same treatment, at the same time. Dosage for amebic dysentery-- 25 to 50 mg. kg. day ; : --using 250 mg. tablets-- Give metronidazole 3 times a day for 5 to 10 days. In each dose give: adults: 750 mg. 3 tablets ; children 8 to 12 years: 500 mg. 2 tablets ; children 4 to 7 years: 375 mg. 1 tablets ; children 2 to 3 years: 250 mg. 1 tablet ; children under 2 years: 80 to 125 mg. 1 3 to tablet ; For amebic dysentery, metronidazole should be taken together with diloxanide furoate or tetracycline. Diloxanide furoate Furamide ; Name: price: for Often comes in: 500 mg. tablets also, syrup with 125 mg. in 5 ml.
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9 61. Rhines, LD, Sampath, P, DiMeco, F, Lawson, HC, Tyler BM, Hanes, J, Pardoll, D, Olivi, A, Brem, H. Local immunotherapy with interleukin-2 delivered via biodegradable polymer microspheres combined with interstitial chemotherapy: A novel treatment for experimental malignant glioma. Neurosurgery 52: 872-880, 2003. Kleinberg, L, Weingart, J, Burger, P, Carson, K, Grossman, SA, Li, K, Olivi, A, Wharam, MD, and Brem, H. Clinical Course and Pathologic Findings After Gliadel R and Radiotherapy for Newly Diagnosed Malignant Glioma: Implications for Patient Management. Cancer Investigation, 22: 1-9, 2004. Komotar RJ, Burger PC, Carson BS, Brem H, Olivi A, and Goldthwaite, PT, Tihan, T. Pilocytic and Pilomyxoid Hypothalamic Chiasmatic Astrocytomas. Neursurgery 54: 72-80, 2004. Wang M, Murphy KM, Kulesza P, Hatanpaa KJ, Olivi A, Tugaro A, Erozan Y, Westra WH, burger PC, and Berg KD. Molecular diagnosis of metastasizing oligodendroglioma: a case report. J Mol Diagn 6: 52-57, 2004. Guerin C, Olivi, A, Weingart JD, Lawson HC and Brem H. Recent advances in brain tumor therapy: local intracerebral drug delivery by polymers. Investigational New Drugs 22: 27-37, 2004 Frazier, J, Garonzik I., Tihan, T., and Olivi, A. Recurrent glioependymal cyst of the posterior fossa: an unusual entity containing mixed glial elements. Case Report. J of Neuro-Oncology, 68: 13-17, 2004. Koenig MA, Geocadin RG, Kulesza P, Olivi A, and Brem H. Rhabdoid meningioma occurring in an unrelated resection cavity with leptomeningeal carcinomatosis. J Neurosurg 102: 371-375, 2005. Amundson EW, McGirt MJ, and Olivi A. A contralateral, transfrontal, extraventricular approach to stereotactic brainstem biopsy procedures. J Neurosurg 102: 565-570, 2005. Raza SM, Pradilla G, Legnani FG, Thai QA, Olivi A, Weingart JD and Brem H. Local delivery of antineoplastic agents by controlled-release polymers for the treatment of malignant brain tumors. Expert Opin. Biol. Ther. 5 4 ; : 477-494, 2005. Book Chapters, Monographs: 1. Olivi A, Waner M, Sawaya R, Wessler T, Cassini P, Liwnicz B, Pensak M, Tew JM Jr: "Photodynamic therapy of brain tumors: Studies on the distribution of DiHematoporphyrin Ether in normal and experimental neoplastic brain tissue in rats." In: Gerosa MA et al Eds. ; Brain Tumors Biopathology and Therapy. Advances in Bioscience, Vol 58 ; . 1987 Pergamon Press, pp. 154-167.
Gliadel is a white, dime-sized wafer made up of a biocompatible polymer that contains the cancer chemotherapeutic drug, carmustine bcnu.
Table 3. Amino acid substitutions identified in the ftsI genes from BLNAR and BLPACR-II H. influenzae strains Amino acid substitutions Resistance class BLNASa Low-BLNARb Low-BLNARc BLNAR BLNAR BLNAR BLNAR BLNAR BLNAR BLNAR BLNAR BLNAR BLPACR-II BLPACR-II BLPACR-II BLPACR-II I II III IV V VI VII VIII IX II III VI IX 1 ; 2.9% ; 10.1% ; 5.8% ; 1.4% ; 8.0% ; 2.9% ; 1.4% ; 66.7% ; Subgroup No. of strains M377 I I I S385 T T T L389 F F F A502 V V V R517 H H H N526 K K K AMP MIC50 mg L ; CTX CRO 0.004 0.008 0.031 MEM 0.031 0.25.
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2004 ; invest new drugs a phase i trial of surgery, gliadel wafer implantation, and immediate postoperative carbop 2005 ; j neurooncol monitoring the effects of bcnu chemotherapy wafers gliadel r ; in glioblastoma multifor 2006 ; j neurooncol phase i study of gliadel wafers plus temozolomide in adults with recurrent supratentorial 2001 ; neuro-oncol risk factors for postcraniotomy surgical site infection after 1, 3-bis 2-chloroethyl ; -1-ni 2003 ; clin infect dis adjuvant chemotherapy for adults with malignant glioma: a systematic review.
Spoofing occurs where the Respondent imitates the Complainant's website and sends emails that appear to be from the Complainant. Where the disputed domain name is used to mimic the Complainant and to attempt to solicit personal data including credit card information from visitors to the website, the practise is known as phishing. This practice is described in Career Builder, LLC .v. Stephen Baker [WIPO Case No. D2005-0251] The domain name in issue was job-careerbuilder . The Complainant, CAREERBUILDER, was a job search and job consultations on-line business. "When entered into a web browser, the disputed domain name resolved to a mirror of Complainant's careerbuilder website. However, when entered through the link provided in the "phish" e-mail obtained by Complainant, the disputed domain name resolved to a page controlled by Respondent that requests credit card information Held, the domain name was confusingly similar to the Complainant's CAREERBUILDER trademark and glucagon.
Breathlessness in the elderly is a common clinical problem but should not be considered an inevitable consequence of the aging process. Because of the diverse causes and the possibility of more than one underlying mechanism, the approach to the breathless patient needs to be comprehensive with investigations guided by specific clinical questions. Once the underlying reversible factors have been identified and treated as far as practicable, management of the chronically breathless patient is based on symptom relief, exercise conditioning, optimisation of breathing patterns and patient education. Interventions should be objectively evaluated using symptom scores or a measure of exercise tolerance rather than a physiological measure alone. As there is the potential for harm including cost ; , treatments offering no benefit should be promptly withdrawn
Study design and loading regime A total of 24 composite femora were used to analyse the influence of active muscle force simulation, load level, patient activity and anchorage principle on the primary stability of cementless hip prostheses in vitro. Six femora were randomly assigned to each of the four groups Table 3 ; . The femora of three of the constituted groups were implanted with the proximal anchoring CLS-stem while the femora of the forth group were implanted with the distal anchoring Alloclassic SL-stem and glucosamine.
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Background Transesophageal echocardiography TEE ; has been used recently to detect atrial thrombi before cardioversion of atrial arrhythmias. It has been assumed that embolic events after cardioversion result from embolism of preexisting atrial thrombi that are accurately detected by TEE. This study examined the clinical and echocardiographic findings in patients with embolism after cardioversion of atrial fibrillation despite exclusion of atrial thrombi by TEE. Methods and Results Clinical and echocardiographic data in 17 patients with embolic events after TEE-guided electrical n 16 ; or pharmacological n 1 ; cardioversion were analyzed. All 17 patients had nonvalvular atrial fibrillation, including four patients with lone atrial fibrillation. TEE before cardioversion showed left atrial spontaneous echo contrast in five patients and did not show atrial thrombus in any patient. Cardioversion resulted in return to sinus rhythm without immediate complication in all patients. Thirteen patients had cerebral embolic events and four patients had peripheral embolism occurring 2 hours to 7 days after cardioversion.
Lz- and Pl-treated boys grew at a similar velocity during the study Fig. 1A ; . During the second year of treatment, those Lz-treated boys who had entered puberty by the 12 month point n 8 ; grew faster than the Lz-treated boys still prepubertal at that point n 8; 6.7 vs. 4.5 cm yr; P 0.04 ; . Correspondingly, those Pl-treated boys who were pubertal at the 12 month point n 5 ; grew faster than the prepubertal Pl-treated boys n 9 ; during the second year of follow-up 7.4 vs. 4.6 cm yr; P 0.004 ; . Growth velocities did not differ between pubertal Lz- and Pl-treated boys 6.7 vs. 7.4 cm yr, respectively; P 0.58 ; or between the prepubertal Lz- and Pl-treated boys 4.5 vs. 4.6 cm yr ; during the second year of treatment. In Lz-treated boys, bone age progressed by only 1.24 yr during the 2-yr treatment, whereas in the Pl-treated boys, bone age progressed by 2.05 yr during the same period change in bone age change in calendar age, 0.62 vs. 1.02; P 0.04; Fig 1B ; . Consequently, height SDS for bone age increased by 0.7 SDS in the Lz group, with no change in the Pl group Fig. 1C ; . In similar fashion, PAH increased by 5.9 cm P 0.0001 ; in Lz-treated boys, but did not change in those treated with Pl during the study. Although PAHs did not differ between groups at the start of the study, at the end of the treatment period, the PAH of the Lz-treated group was higher than the respective measure for the Pl-treated boys 172.8 vs. 166.9 cm; P 0.03; Fig. 1D ; . Lz treatment appeared effective regardless of bone age, because bone age at the start of the study did not correlate in Lz-treated boys with the change in height SDS for bone age r 0.05; P 0.85 ; or with the change in PAH r 0.06; P 0.83 ; . Moreover, the increases in PAH during the 2-yr treatment were similar in prepubertal and pubertal Lztreated boys 7.2 vs. 4.8 cm, respectively; P 0.17 ; . Boys taking Pl and those taking Lz gained weight in a similar fashion during treatment 3.7 vs. 4.2 kg yr; P 0.37 and glycopyrrolate.
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72. PHASE I TRIAL OF GLIADEL PLUS TEMODAR Friedman HS, Quinn JA, Rich JN, Tourt-Uhlig S, McLendon RE, Provenzale JM, Sampson J, Haglund M, Colvin OM, Cokgor I, Gururangan S, Affronti ML, Edwards S, Albergo G, Stewart E, Beason R, Zaknoen S, Bigner DD, Stafford-Fox V, Early M, Friedman AH; Duke University Medical Center, Durham, NC; Schering-Plough Research Institute, Kenilworth, NJ; Pharmacia and Upjohn, Nashville, TN; Aventis, Collegeville, PA Gliadel wafers, an FDA approved regional therapy for recurrent malignant glioma MG ; , are designed to provide tumor control at the primary site. Carmustine, the principal active ingredient in Gliadel wafers, is a nitrosourea approved for use in the treatment of brain cancer, lymphoma, and multiple myeloma. However, MG is an invasive disease, suggesting that a rational strategy would be to combine the Gliadel wafers with systemic chemotherapy. Based on the antiMG activity of Temodar, respectively, we initiated a phase I trial of Gliadel and Temodar in recurrent MG. Gliadel wafers as many as possible, to a maximum of 8 ; are implanted in the resected tumor cavity at the time of surgery. Treatment with Temodar started within 1421 days of surgery at an initial dose of 100 mg m 2 . Patients continue to be treated with Temodar until progressive disease or unacceptable toxicity grade 4 non-hematologic toxicity ; is noted up to a maximum of 12 cycles. We enrolled 10 patients on this trial, 3 patients at 100 mg m 2 , 4 patients at 150 mg m 2 and 3 patients at 200 mg m 2 , respectively. No toxicities were observed in any patients. Four patients continue on therapy at 8 + , and 2 + months since placement of Gliadel. We have now opened a phase 2 trial of Gliadel plus Temodar for patients with recurrent malignant glioma
Gastrointestinal stromal tumors GIST ; are rare mesenchymal tumors most commonly found in the stomach or small intestine of adults. Their incidence ranges from 2.1 to 15 per million people, they are evenly distributed between genders, and 90% are CD-117 positive [1-3]. They usually grow asymptomatically until they are discovered due to appearance of signs and symptoms related to mass effects, bleeding or bowel perforation [4-6]. Other very rare clinical manifestations of GIST include hyperpigmentation or mastocytosis both found in inherited forms of GIST ; [7, 8] and hypoglycemia [9-12]. Expression of CD-117 is the diagnostic marker for GIST and is the transmembrane tyrosine kinase receptor also known as KIT or c-KIT [13]. The ligand for the receptor is stem-cell factor, which is essential for embryonic development and proliferation of a variety of cell types including melanocytes, gonadal cells, and interstitial cells of Cajal GI tract pacemaker cells ; [14]. The latter are thought to be the physiological precursors to gastrointestinal stromal tumors and their proliferation may be due to unregulated activation of KIT [15]. To follow is a unique case associating GIST-induced hypoglycemia due to overproduction of "big" insulin-like growth factor II with an exon 9 mutation and goldenseal.
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Task Force Recommendations Panel Discussion Panel Presenters Left to Right: Fran Brown, Dean, Health Professions, Community College of Southern Nevada and Julie Johnson, Director, Orvis School of Nursing, University of Nevada, Reno; Karla Perez, CEO Desert Springs Hospital; Ron Sparks, Executive Director, Western Institute Commission on Higher Education; Pamela Andres, Director of Operations, Nevada Hospital Association. In a recent Federal report released by The Health Resources and Services Administration HRSA ; Nevada is ranked 50th out of our 50 states in the nurse to population ratio study. Nevada has 520 nurses per 100, 000 population. Second only to Nevada is California, whose ratio is 544 per 100, 000 population. These national statistics only serve to enhance the findings in the report by Dr. Packham. The shortage possesses a quantitative dimension in which the overall demand for registered nurses exceeds the cur.
DEVELOPING A PROPOSAL FOR AN EMERGENCY DEPARTMENT PHARMACIST IN A LEVEL 1 TRAUMA CENTER Katharine A. Adkins * , Niesha L. Griffith The Ohio State University Medical Center, 410 West 10th Ave, Room 368 Doan Hall, Columbus, OH, 43210 katharine.adkins osumc Statement of Purpose: Due to safety concerns with the dispensing of medications, the Emergency Department ED ; , has become a focus area during Joint Commission on Accreditation of Healthcare Organizations surveys. Medication Management Standard 4.10 states that when on-site pharmacy services are available, a pharmacist must review all prescription orders unless a licensed independent practitioner controls the ordering, preparing, and dispensing of the medication; or in urgent situations when the resulting delay would harm the patient. Pharmacist involvement in the ED at The Ohio State University Medical Center is limited to review of medication orders that are not in Pyxis i.e. are dispensed from the pharmacy ; . The purpose of this project is to evaluate the activities that could be performed by a pharmacist, including but not limited to prospective review of medication orders and medication reconciliation. This information, in conjunction with determination of pharmacist resource requirements, will be used to provide workload justification for pharmacy services in a Level 1 Trauma ED. Statement of Methods Used: All Pyxis activity data from July 1, 2005 0000 hours ; to July 31, 2005 2359 ; was collected. Patient specific medication removals were reviewed to assess the number of first and subsequent doses removed. First doses were considered equivalent to a new medication order. Emergency room activity data was extracted from the ED information system IBEX ; . Data regarding potential involvement in cognitive and educational activities was collected via interviews with the nursing and pharmacy staff as well as from the literature. Summary of Preliminary Results: Data collected revealed that out of the 4, 846 patient visits to the ED, 2, 913 patients received medications from Pyxis, resulting in an average of 2.7 medications administered to each patient. Reviewing removal times of first doses revealed the busiest times of the day to be between noon and midnight. Learning Objectives: Discuss current literature describing the impact of an ED pharmacist. Discuss JCAHO Medication Management Standard 4.1, and how an ED pharmacist can help meet the requirements of the standard. Self Assessment Questions: Which JCAHO initiatives can be positively impacted by having an ED pharmacist? a. Medication Management Standard 4.1 b. National Patient Safety Goal 8 c. Core Measures Community Acquired Pneumonia, Myocardial Infarction, Heart Failure, etc. ; d. All of the above Which potential activities of an ED pharmacist could increase patient safety and quality of care? a. Attending level 1 and 2 traumas b. Attending cardiopulmonary resuscitation c. Provide drug information d. Provide in-service sessions for medical staff e. All of the above and gramicidin.
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But in recent succession, guilford has won regulatory approval for the expanded use of its gliadel wafer, used to treat brain cancer tumors.
Genome-wide and chromosome-specific high-density mapping strategies including array-CGH, SNP arrays and fluorescence in situ hybridisation ; and expression microarray analysis to identify key tumour suppressor genes TSGs ; and oncogenes in medulloblastoma Figure 1 ; . Using these strategies, we have made significant insights into mechanisms of chromosomal and granisetron.
Neurologists at The Headache Center are experts in diagnosing and treating headache. Physicians are members of the American Headache Society and the American Academy of Neurology. They conduct ongoing research on headache treatment and gliadel
The right to the exclusive use of the word HEALTHY is disclaimed apart from the trade-mark. WARES: Fluid milk, milk blends, cheese, ice cream and yogurt. Proposed Use in CANADA on wares. Le droit l'usage exclusif du mot HEALTHY en dehors de la marque de commerce n'est pas accord. MARCHANDISES: Lait liquide, mlanges de lait, fromage, crme glace et yogourt. Emploi projet au CANADA en liaison avec les marchandises and grepafloxacin.
Cilitate appropriate remedies. Do many dose-related ADEs occur with initial doses? Some drugs are well known to cause first-dose phenomena, and ADEs with other drugs commonly occur early in treatment. The solution for these problems would be to define and produce the lowest effective doses of medications, thereby facilitating their use in a wide range of clinical situations: 1 ; with medications that are known to cause a high incidence of ADEs and or dropouts at the usual doses eg, antihypertensive and antidepressant agents 2 ; in nonimmediate situations in which dose titration is easily accomplished or in which ADEs may cause compliance problems; 3 ; in initiating treatment with patients known to be slow metabolizers, who have histories of medication intolerances at usual doses, or who are otherwise considered high risk; and 4 ; in initiating treatment with elderly patients, especially the very old 80 years ; or frail or other elderly patients with multiple disorders and or who are taking other medications. In short, the ready accessibility of complete doseresponse information would allow physicians to consider starting with a clearly defined, lowest effective dose of a drug in any therapeutic situation that is not immediate or severe. After all, if a low initial dose is not sufficiently effective for a patient, it can easily be increased. Similarly, studies should also be undertaken on whether many ADEs occur with escalating doses. If so, one solution would be to provide better, more gradual dose-escalation regimens that do not routinely require 100% increases in medication, which are large jumps pharmacologically, yet commonplace in medication therapy. Technically, efficacy and tolerability may be separate variables of drug dynamics, but clinically, there is no opportunity to test these factors separately. Ultimately, it comes down to choosing a specific dose and testing its effect in a patient for efficacy and tolerability. Thus, each new prescription or dose adjustment is an "N experiment of its own. It is a safe assumption that, in general, a lower effective dose is likely to be better tolerated than a higher one. Therefore, complete information about dose-response and the lowest effective doses is essential for physicians and patients. Expediting the Flow of Current and Complete Information to Physicians Even if the origins of dose-related ADEs become better defined and the lowest effective doses are determined, informing physicians of this information would remain a challenge. Despite its popularity, the PDR has never conformed to the requirements of any true drug reference. The PDR was originally developed as a promotional device, not as a source of current and comprehensive drug information. If the PDR were a minor drug reference used infrequently by physicians, its deficiencies might be unimportant. However, the PDR is the leading drug reference among physicians. The availability of the PDR on many hospital floors makes it a common resource for residents and interns. Nurses and other health professionals also rely heavily on the PDR. In addition, the PDR is.
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DISCUSSION There is no clear experimental evidence which mechanism is responsible for either stimulation or sensitization of laryngeal and tracheobronchial nerveendings mediating cough reflex during rhinitis 3 ; . One of the hypothesized mechanisms of sensitization of these nerveendings could be microaspiration of nasal secretion into the lower airways. The aim of the present study was to test the assumption that nasal intensified breathing that could enhance process of creation of aerosol in the nasal cavity and probable microaspiration of nasal content into the lower airways ; could also affect mechanically-induced cough. As we previously reported, sensitivity of the cough reflex in animals with rhinitis is heightened in comparison to controls 3 ; . This phenomenon was tested in awake animals that were coughing after tussive stimuli of chemical origin capsaicin, citric acid ; . To test the hypothesis that we address about intensified nasal breathing and the effect of this phenomenon on coughing, we designed an experiment with the possibility of by passing the nose, for which general anaesthesia was necessary. It is well known that anaesthetized guinea pigs do not cough after administration of tussive substances 10 ; . So should use a model of mechanicallyinduced cough in this study. But first of all, we ensured that experimental animals in our study had significantly heightened cough reflex sensitivity to citric acid, during the period of acute rhinitic symptoms. This finding is consistent with the data reported previously. We have found that animals with rhinitis, nevertheless they were breathing through the tracheotomy or through the intact upper airways, have heightened intensity of cough reflex. The cough response was significantly increased when coughing was provoked both from the larynx and from the trachea, as well, but there are several differences between laryngeal and tracheobronchial cough. Intensity of laryngeal cough could be entirely explained by increased frequency of cough and parallel enhancement of average intensity of cough effort. On the other hand, increased intensity of tracheobronchial cough could be ascribed only to increased cough frequency. Why it is so, we have not convincingly explained. Although there are recent papers concerning central mechanism responsible for generation of cough pattern, they do not explore, either discuss possible differences in regulation of pattern for both the laryngeal or tracheobronchial cough 11 ; . But from our results it is clear that cough response during rhinitis is increased both in awake animals that were coughing to chemical stimuli and in anaesthetized animals that were coughing to mechanical stimuli. There is one possible explanation of such a result. We could suppose that afferent nerveendings in the nasal mucosa were stimulated by the process of allergic inflammation of nasal mucosa, via liberation of a number of mediators responsible for the early phase of allergic response. These mediators are believed to stimulate afferent nerveendings 12, 13 ; . There are recent papers discussing mechanism of plasticity of the cough reflex termed central sensitization 14, 15 ; . It means modulation of cough response by afferent stimuli arising from nasal cavity, esophagus, etc. Although it is well established that coughmediating afferent nerve fibers are supplied by the vagus nerve, the identity and precise central projections of the cough fiber s ; are not known. Even less information is available on central integration and regulation of cough 15 ; . The simplest explanation of the phenomenon described in this study is that some of the central terminals of nasal afferent neurons affect the activity of the secondary sensory neurons of the cough pathways. This may occur either via monosynaptic or polysynaptic connections. Alternatively, that the trigeminal afferents influence the activity of the nucleus tractus solitarii 16 ; . Except central sensitization of the cough reflex, there could be recruited mechanisms responsible for peripheral sensitization. It means, mechanisms affecting neurophysiological characteristics of nerveendings mediating cough in the larynx and more peripheral airways. Especially irritability of these nerve endings and cough threshold levels to standard tussive stimuli. The process of sensitization of nerveendings mediating cough could be caused by transportation of a little amount of nasal content inflammatory mediators, cells, and their products ; into the lower and guaifenesin.
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4.5.6.5 Odours Arising from Mineral Wool Production Technical odour assessment is difficult, expensive and potentially subjective, and there is little information available. However, mineral wool installations can be the source of odour complaints from local residents. This problem has declined in recent years due to improved operation and control, but is still an issue for many installations. This section discusses odours from all parts of the process including melting. Conventional air-gas fired, and oxy-gas fired furnaces do not usually give rise to odour problems, even when recycled material is melted, due to the high temperatures. Cold top electric melters rarely cause odour problems, but can if mineral wool waste is being recycled. Binder materials can undergo partial thermal breakdown during the melting process, and some odorous substances may be emitted. This problem can be minimised by the addition of oxidising agents or pre-treatment of the fibre. Cupola melting gives rise to significant emissions of odorous hydrogen sulphide. The accepted solution to this is combustion in an after burner system, which also deals with any other odorous emissions from recycled material or raw materials. The main sources of odour are from the downstream operations, particularly forming and curing. Odours can also arise from the product cooling, particularly from dense or high binder products, or if a degree of over-curing has taken place. Odour from the individual chemicals used in the process is not considered to be very significant. Odour results predominantly from the chemical and thermal reactions of the organic binder used in the process. The characteristic smell is of `burned Bakelite'. Complaints of formaldehyde or ammonia odours are very rare outside of the plant. Most odours are thought to arise from the curing oven, where the main chemical reactions and thermal processes take place. The drying process will also give rise to a certain amount of steam distillation of binder compounds and intermediates. The inside of most curing ovens shows a build up of fibrous and resinous material which may also give rise to odorous compounds under the influence of the oven temperature. Small fires and localised instances of smouldering are also not uncommon in curing ovens and the smoke and fume emitted can be very odorous. Instances of odour can be greatly reduced by good oven maintenance and cleaning, wet scrubbing systems, adequate dispersion and provision for the rapid extinguishing of any fires. Incineration of curing oven waste gases is a very effective solution to the problem. The forming area activities can also result in the formation of odorous compounds particularly when the binder is sprayed onto the hot fibres. However, the atmosphere is cooler and therefore more moist than the curing oven, and the gas volumes are very much higher and concentrations of any odorous compounds are diluted. Although, a significant mass of odorous compounds can be emitted from the forming area an odour only "exists" if the compound is in a concentration above the odour threshold, and so forming area emissions are generally less odorous than curing oven emissions. If forming area emissions do give rise to odours they can be minimised by wet scrubbing and adequate dispersion. Problematic odours can be addressed by wet scrubbing using an oxidising agent, but this would have to be separate from the process water system. The issues of chemical wet scrubbing are discussed in Section 4.5.6.1.2 and glucagon.
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They fall into this spirit instantly, ' Alan says. `They see it as common to all and don't realise that this ethos isn't in all schools. People leave and come back because there is something about it that they miss, and that is absolute engagement. It's what you want from the children, but you won't get it if the staff aren't giving it.' The inclusive environment, the way that each and every child is valued, encouraged and supported has led to parents taking a greater interest in the school. `When I first came here, you got no support from parents. They weren't interested in their children's education. But who would be interested in a flawed system of education? Who would be interested when their children were going to fail? What I found was that they had every bit as much interest in education as middle-class parents if what you were presenting them with was going to be as effective as the education presented to the middle classes.' The process of changing the parents' perceptions began as soon as he arrived at the school, starting with staff wearing gowns at the school awards ceremony. This sent a clear signal that the aspirations which the school had for students were high and equivalent to those of neighbouring middle-class schools. From that moment parents began to take an interest. On the basis of his experiences, Alan recognised the need for efficient systems to support the vision. Five systems operate alongside each other. The first involves setting targets in consultation with each child. The second monitors how well the child is meeting the targets across the curriculum and, if there are problems, establishes what is preventing the child learning. The child is then referred to professional services, which arrange the interventions necessary either within school or drawing on one of the 35 agencies working with the school. System four is concerned with monitoring and developing the work of the teachers, including classroom observation, and managing the development programme. The fifth system brings together administration, infrastructure, and non-teacher support. This ensures that the right conditions are created for high quality teaching and learning to occur and guanethidine.
Living Goddesses; Research - Nepal; India - Northern India; Bombay; Varanasi; Kathmandu; Lalitpur - Kumari; Kumari Deval; Kumbhecvara; Buddhist Chaitya Call No.: N 954.96072 BEN-J 1991 32. The making of a statue : lost-wax casting in Nepal Eng ; by Michaels, Axel. - Stuttgart : Franz Steiner Verlag Wiesbaden GMBH, 1988 78 p., ill., tables, pictures. - Nepal Research Centre publication, no. 5 ; ISBN: 3-515-05138-4 Keywords: Lost Wax Casting; Precision Casting; Nepalese Sculpture; History; Social Structure; Handicrafts; Technology; Ergology; Newari Lost Wax Casting; Art Metal-Work - Nepal - Nepalese; Newars Call No.: N 731.456 MIC-M 1988 33. Modernity and tradition : contemporary architecture in Pakistan Eng ; by Mumtaz, Kamil Khan. - Karachi : Oxford University Press, 1999 xviii, 132 p. ISBN: 0 19 577853 7 Keywords: Architecture; Contemporary Architecture; Pakistani Architecture; Religion; Culture; Traditional Architecture; Islamic Architecture; Islamic Craftsmen; Creative Ability; Towns; Developing Countries; Housing; Tradition Pakistan - Hussain, Mistree Haji Ghulam Call No.: 720.95491 MUM-M 1999 34. Monuments of Northern Nepal Eng ; by Jest, Corneille. - Paris : UNESCO, 1981 121 p., ill., maps, pictures ISBN: 92-3-101874-4 Keywords: Monuments; Faith; Temples; Nepalese Art Nepal - Northern Nepal; Humla; Mustang; Sindhupalchok; Solukhumbu Call No.: N 725.94 JES-M 1981 35. Monuments of the Kathmandu Valley Eng ; by Sandey, John. - Paris : UNESCO, 1979 129 p., maps, pictures ISBN: 92-3-101644-X Keywords: Monuments; National Monuments; Nepalese Art; Nepalese Architecture; Environment; History; Religion; People; Festivals; Buildings; Handicrafts; Craftsmen; Palaces; Temples; Monasteries - Nepal - Kathmandu Valley; Lalitpur; Bhaktapur; Kathmandu - Hanuman Dhoka Durbar; Patan Durbar Square; Bhaktapur Durbar Square Call No.: N 725.94 SAN-M 1979.
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