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43 Min, G., Kemper, J. K. and Kemper, B. 2002 ; Glucocorticoid receptor-interacting protein 1 mediates ligand-independent nuclear translocation and activation of constitutive androstane receptor in vivo. J. Biol. Chem. 277, 2635626363 44 Yager, J. D. and Liehr, J. G. 1996 ; Molecular mechanisms of estrogen carcinogenesis. Annu. Rev. Pharmacol. Toxicol. 36, 203232 45 Kawamoto, T., Sueyoshi, T., Zelko, I., Moore, R., Washburn, K. and Negishi, M. 1999 ; Phenobarbital-responsive nuclear translocation of the receptor CAR in induction of the CYP2B gene. Mol. Cell. Biol. 19, 63186322 46 Kakizaki, S., Yamamoto, Y., Ueda, A., Moore, R., Sueyoshi, T. and Negishi, M. 2003 ; Phenobarbital induction of drug steroid-metabolizing enzymes and nuclear receptor CAR. Biochim. Biophys. Acta 1619, 239242 47 Yamamoto, Y., Kawamoto, T. and Negishi, M. 2003 ; The role of the nuclear receptor CAR as a coordinate regulator of hepatic gene expression in defense against chemical toxicity. Arch. Biochem. Biophys. 409, 207211 48 Nemoto, N. and Sakurai, J. 1995 ; Glucocorticoid and sex hormones as activating or modulating factors for expression of Cyp2b-9 and Cyp2b-10 in the mouse liver and hepatocytes. Arch. Biochem. Biophys. 319, 286292 49 Soulez, M. and Parker, M. G. 2001 ; Identification of novel oestrogen receptor target genes in human ZR75-1 breast cancer cells by expression profiling. J. Mol. Endocrinol. 27, 259274 50 Ekins, S., Mirny, L. and Schuetz, E. G. 2002 ; A ligand-based approach to understanding selectivity of nuclear hormone receptors PXR, CAR, FXR, LXR, and LXR. Pharmaceut. Res. 19, 17881800 51 Watkins, R. E., Wisely, G. B., Moore, L. B., Collins, J. L., Lambert, M. H., Williams, S. P., Willson, T. M., Kliewer, S. A. and Redinbo, M. R. 2001 ; The human nuclear xenobiotic receptor PXR: structural determinants of directed promiscuity. Science 292, 23292333 52 Moore, L. B., Parks, D. J., Jones, S. A., Bledsoe, R. K., Consler, T. G., Stimmel, J. B., Goodwin, B., Liddle, C., Blanchard, S. G., Willson, T. M. et al. 2000 ; Orphan nuclear receptors constitutive androstane receptor and pregnane X receptor share xenobiotic and steroid ligands. J. Biol. Chem. 275, 1512215127.
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HENDRICKS, BRIDGES, SAULTER, IRBY, PLUNKETT, MILLER, HOLMES, KOONTZ, and LOOMIS would fail to adequately operate and administer the medical unit and respond appropriately to medical emergencies, violating inmates' Eighth Amendment rights. 47. Defendant CCA maintained a deliberate indifference to the obvious serious medical and
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THORACOSCOPIC TREATMENT OF BRONCHIECTASIS SECONDARY TO RESISTANT ORGANISMS Gary K. Lovelady, MD, MPH; John R. Roberts, MD, MBA * ; The Surgical Clinic; Centennial Hospital; Baptist Hospital, Nashville, TN PURPOSE: Increasingly effective antibiotics have diminished the need for surgical therapy for bronchiectasis. However, drug resistant strains have lessened the impact of antibiotics. Further, rural patients may present with more advanced disease, either because of increased allergen exposure or lesser medical availability. We evaluated our experience with thoracoscopic surgical therapy for bronchiectasis in a predominantly rural community. METHODS: Patients with radiologic evidence of bronchiectasis, recurrent pneumonia, and antibiotic resistant organisms underwent thoracoscopic resection. Data were analyzed for typical demographic features, type of surgery and length of stay, and need for subsequent hospitalization. Patients were considered to have died from surgery if they died during the hospitalization for the surgery, or within 90 days of surgery. RESULTS: Eighteen patients 27-77 years of age ; , underwent nineteen resections. Three patients had FEV1% 35% predictedthe average was 60%. Nine underwent segmentectomy and eight lobectomy one patient underwent two lobectomies ; . Eleven 58% ; underwent thoracoscopic resection. The length of stay was 7.2 days. No patients required intubation nor ICU stay. There was no mortality. While two patients required long-term antibiotics after surgery to clear bronchitis, only one patient with severe emphysema ; required inpatient admission.
Phankingthongkum S, Visitsunthorn N, Vichyanond P IgA deficiency: A report of three cases from Thailand. Asian Pacific Journal of Allergy and Immunology. 20 3 ; : 203-7, 2002. Subclass Deficiency, Blood-Donors, Children, Abnormalities, Recurrent, Arthritis, Frequency. Selective IgA deficiency has been reported to be the most common primary immunodeficiency disease in Western countries. A markedly lower frequency of this condition has been reported in the Japanese population. While most of the IgA deficient cases are healthy, some patients develop significant recurrent sinopulmonary infections, allergic disorders and autoimmune diseases. Herein, we report three cases of IgA deficiency among Thai patients, all of whom suffered from chronic sinopulmonary infections. Two of the three patients had absolute IgA deficiency while the third had a partial IgA deficiency. The associated conditions found in these three patients were deficiencies of an IgG subclass, allergic rhinitis and lupus nephritis. The youngest child 5 years old boy with lupus nephritis ; expired from Pneumocystis carrinii pneumonia complicated with adult respiratory distress syndrome and
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Stafford RS, Radley DC.The Underutilization of Cardiac Medications of Proven Benefit, 1990 to 2002. Journal of the American College of Cardiology, 2003; 41 1 ; : 5661.
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Tolerance to antiepileptic drugs It is unlikely that you could become so used to taking a particular antiepileptic drug that it would no longer work. In some circumstances, such as in pregnancy or where there is a marked increase in weight, the effectiveness of the drug might be reduced and so the dosage will have to be reviewed. drug interactions Antiepileptic drugs can react with other drugs and make them less effective. Your doctor will be aware of these interactions and prescribe medicines for other ailments accordingly. drug withdrawal If you remain free of seizures for three or four years you may be invited by your doctor to consider withdrawing from taking antiepileptic drugs. There are pros and cons to be taken into consideration when deciding whether to stay on drugs or withdraw under medical supervision. An obvious risk is to start having seizures again and lose your driving licence or possibly even your job, whilst on the other hand there could be the joy of being both seizure free and medication free. "illicit drugs" Because they are sometimes thought of as stress relievers and an opportunity to escape from everyday reality, "street drugs" can be perceived as being helpful in controlling seizures. They are not helpful. In fact, they can be the very cause of seizures. Indirectly, narcotic drugs those derived from opium and those manufactured to be chemically similar to opium ; can lead, because of an induced forgetfulness, to a failure to take correct doses of antiepileptic medication. Narcotics, when taken in large doses, can directly lead to the brain being deprived of oxygen an can induce seizures and serevent.
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You are in: emedicine specialties pediatrics cardiology rate this article email to a colleague synonyms and related keywords: ventricular septal defect, vsd, perimembranous, membranous ventricular septal defect, ventricular septum author information author information introduction clinical differentials workup treatment medication follow-up miscellaneous bibliography benjamin w eidem, md, facc, fase, faap, is a member of the following medical societies: alpha omega alpha , american academy of pediatrics , american college of cardiology , american heart association , american society of echocardiography , society for pediatric research , and society of pediatric echocardiography editor s ; : juan carlos alejos, md , assistant clinical professor, department of pediatrics, division of cardiology, university of california at los angeles; mary l windle, pharmd , adjunct assistant professor, university of nebraska medical center college of pharmacy, pharmacy editor, emedicine , inc; hugh d allen, md , professor, departments of pediatrics and medicine, ohio state university college of medicine and public health; gilbert herzberg, md , assistant professor, department of pediatrics, section of pediatric cardiology, new york medical college; and stuart berger, md , professor of pediatrics, division of cardiology, medical college of wisconsin; chief of pediatric cardiology, medical director of pediatric heart transplant program, medical director of the heart center, children's hospital of wisconsin disclosure introduction author information introduction clinical differentials workup treatment medication follow-up miscellaneous bibliography background: normal closure of the ventricular septum occurs through 3 concurrent embryologic mechanisms that help to close the membranous septum: 1 ; downward growth of the conotruncal ridges forming the outlet septum, 2 ; growth of the endocardial cushions forming the inlet septum, and 3 ; growth of the muscular septum forming the apical and mid-muscular portions of the septum, for example, relafen and tylenol.
Focus on Food and Health is written by student participants in SPARK Students Promoting Awareness of Research Knowledge ; , Office of Research, University Centre, Room 437, University of Guelph, Guelph, Ontario N1G 2W1 Phone: 519.824.4120 Ext. 58278 Fax: 519.821.5236 Website: uoguelph research Editor: Owen Roberts Editorial Co-ordination: Marianne Clark Contributors: Marianne Clark, Lisa McLean, Alicia Roberts, Kate Roberts, Heather Scott, Murray Tong Photography: Olivia Brown, Jimmy Chul-Ahn Jeong, Vince Filby, Andre Garneau, Martin Schwalbe Design and Layout: Jay Dart First Printing: November 2004 and singulair.
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Agency Note i ; ii ; Clinical record may include any type of interdisciplinary team documentation, i.e., treatment report, flowsheet, etc. Assessment addresses identification of resident's deficit areas and causes such as medications, mental status, ability to control urine, self-care abilities, mobility, voiding elimination patterns hydration baseline, history of urinary tract infection and the strengths and deficits should be stated in specific terms. Facility protocol should include types of incontinence, assessment, plan, implementation measures, evaluation techniques, staff training and monitoring. Restorative program and approaches should be reflected in the care plan. Restorative programs are limited to residents whose assessment has determined that there is a reasonable likelihood of increasing his or her functional level. If resident, after initial improvement, fails to continue to increase his her functional ability, credit will still be given as long as restorative program continues to be carried out Level 2 Maintenance ; . Progress should be noted by objective documentation indicating increase in resident's functional level as compared to initial baseline and or most recent assessment.
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It is clear from the evaluation that the vast majority of families carers are satisfied with the PLW service as it currently exists. Many respondents used the evaluation to express their gratitude for the service they had received and were currently receiving. However, the survey raises a number of issues regarding the scope of the service and provides a range of suggestions as to how the role of the PLW might be developed in the future. A number of respondents suggested that the PLW service should be better publicised. We know from the survey that the majority of respondents found out about the PLW service from their GP, Paediatrician or Public Health Nurse. This would indicate that more use could be made of health care professionals in promoting the service. Although in general respondents were extremely satisfied with the amount of contact they had with the PLW, a significant number 13% ; were unhappy with the number of visits they received. This would indicate that the PLW should be making more home visits. It also has implications for the running of the service, as home visits are often more time-consuming and costly than telephone contact. Half of respondents indicated that contact with the PLW should continue for as long as the child is receiving therapeutic intervention. This would indicate the high level of satisfaction families carers have with the service, but also has cost implications for the running of the service. We know from the survey that the role of the PLW is a very broad and proactive one, incorporating everything from information provision, arranging appointments, links with service providers, to offering personal and emotional support to parents and carers. This has enormous implications for the training of PLWs and also raises a number of questions in relation to the role of the PLW. Can the service be all things to all people? Are expectations for the service too high among parents carers? Indeed, this high level of expectation was partly responsible for the few negative comments expressed about the service. Almost half of the respondents indicated that the PLW had facilitated links with service providers, health care professionals or parents. Some respondents also commented on the need for the PLW to be present when mother and baby leave hospital. This highlights the importance of fostering linkages between the PLW service and the maternity hospitals in the region. Many of the comments and suggestions to improve the role of the PLW centred on publicising the service and maintaining regular contact with the same PLW, which also came up in other parts of the survey. However, a number of suggestions for improving the service covered the skills and knowledge base of the PLW. This would have implications for staff training programmes.
1 2 Medical Council of India. Directory of postgraduate medical education courses, 2000. New Delhi: Medical Council of India, 2000. Medical Council of India. Guidelines for continuing medical education scheme. New Delhi, Medical Council of India, 2002. mciindia know cme cme accessed 22 Mar 2004 ; . Seneviratne Epa S. Revalidation of Sri Lankan doctors. Ceylon Med J 2003; 48: 65-7. Sri Lanka Medical Association. Minutes of CPD committee meetings. Sri Lanka Medical Association 6, Wijerama Mawatha, Colombo 7, Sri Lanka.
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What exactly does the "and all other mind-altering substances" part mean? I came to Cocaine Anonymous because cocaine had become a problem in my life. We in Cocaine Anonymous, who have been around a while, hear this statement all the time from newcomers. If you read on, we will share with you how we learned that our real problem was not just cocaine or any specific drug; it was the disease of addiction. Some of us never even used cocaine. There were other drugs that got us into trouble. Or, maybe it was the combination of cocaine, alcohol, marijuana, or heroin that had made our lives miserable. Cocaine Anonymous' first step is viewed by our Fellowship as a "blanket" first step. All types of drug users are welcome as long as they have the desire to stop using. In our using days, we rode drug roller coasters. There were drugs to come down with, drugs to go up with, and drugs to mellow out with. In recovery, we had discovered, sometimes the hard way, through relapse, that we could not control our use of any mind-altering substances. If our bodies were not absolutely drug-free, the compulsion to use was always lurking. We inevitably returned to our favorite drug, or went back to an old preference in chemicals. Whatever the drug, the problem of not being able to stop would resurface, usually stronger than before. Here is an example: imagine that you have just run out of cocaine and cannot get any more. What would you use as it's substitute? Alcohol? Speed? Heroin? The list could go on and on. It really wouldn't matter what you'd substitute for cocaine. The point is that you would soon find yourself unable to stop using and would be worrying about when you would run out of your replacement drug. ALCOHOL Alcohol is a mind-altering chemical in liquid form. Many people don't realize that it is no different from cocaine, marijuana, painkillers, or tranquilizers in its ability to lead to addiction. One drink is never enough, just as one hit, fix, pill or snort is never enough. We are masters at combining and substituting one drug for another to get high. Many of us never felt that alcohol was part of our problem. However, take away the drug of choice, substitute another, and eventually it becomes a problem drug.
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Sec. 8. Section 99D.7, Code 2003, is amended by adding the following new subsection: NEW SUBSECTION. 23. To require licensees to establish a process to allow a person to be voluntarily excluded for life from a racetrack enclosure and all other licensed facilities under this chapter and chapter 99F. The process established shall require that a licensee disseminate information regarding persons voluntarily excluded to all licensees under this chapter and chapter 99F. The state and any licensee under this chapter or chapter 99F shall not be liable to any person for any claim which may arise from this process. In addition to any other penalty provided by law, any money or thing of value that has been obtained by, or is owed to, a voluntarily excluded person by a licensee as a result of wagers made by the person after the person has been voluntarily excluded shall not be paid to the person but shall be deposited into the gambling treatment fund created in section 135.150. Sec. 9. Section 99D.9, subsections 1 and 2, Code 2003, are amended to read as follows: 1. If the commission is satisfied that its rules and sections 99D.8 through 99D.25 applicable to licensees have been or will be complied with, it may issue a license for a period of not more than three years. The commission may decide which types of racing it will permit. The commission may permit dog racing, horse racing of various types, or both dog and horse racing. The commission shall decide the number, location, and type of all racetracks licensed under this chapter. The license shall set forth the name of the licensee, the type of license granted, the place where the race meeting is to be held, and the time and number of days during which racing may be conducted by the licensee. The commission shall not approve the licenses for racetracks in Dubuque county and Black Hawk county if the proposed racing schedules of the two tracks conflict. The commission shall not approve a license application if any part of the racetrack is to be constructed on prime farmland outside the city limits of an incorporated city. As used in this subsection, "prime farmland" means as defined by the United States department of agriculture in 7 C.F.R.
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