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25. Bleiberg J, Garmoe W, Cederquist J, et al: Effects of dexedrine on performance consistency following brain injury. Brain Inj 1993; 6: 245248 Kraus MF, Maki P: The combined use of amantadine and L-dopa carbidopa in the treatment of chronic brain injury. Brain Inj 1997; 11: 455460 Taverni JP, Seligei G, Lichtman SW: Donepezil-mediated memory improvement in traumatic brain injury during post-acute rehabilitation. Brain Inj 1998; 12: 7780 Goldberg E, Gerstman LJ, Mattis S, et al: Effects of cholinergic treatment on posttraumatic anterograde amnesia. Arch Neurol 1982; 39: 581 Meyer A: The anatomical facts and clinical varieties of traumatic insanity. J Insanity 1904; 60: 373441 Fedoroff JP, Starkstein SE, Forrester AW, et al: Depression in patients with traumatic brain injury. J Psychiatry 1992; 149: 918 Jorge RE, Robinson RG, Arndt SV, et al: Comparison between acute and delayed-onset depression following traumatic brain injury. J Neuropsychiatry 1993; 5: 4349 Hinkeldy NS, Corrigan JD: The structure of head-injured patients' neurobehavioral complaints: preliminary studies. Brain Inj 1990; 4: 115133 Van Zomeran AH, van den Burg W: Residual complaints of patients two years after severe head injury. J Neurol Neurosurg Psychiatry 1985; 48: 2128 Starksein SE, Robinson RG, Price TR: Comparison of cortical and subcortical lesions in the production of poststroke mood disorders. Brain 1987; 110: 10451059 Bessette RF, Peterson LG: Fluoxetine and organic mood syndrome. Psychosomatics 1992; 33: 224226 Kraus MF: Neuropsychiatric sequelae of stroke and traumatic brain injury: the role of psychostimulants. Int J Psychiatry Med 1995; 25: 3951 Gualtieri CT, Evans RW: Stimulant treatment for the neurobehavioral sequelae of TBI. Brain Inj 1988; 2: 273290 Ruedrich SL, Chu CC, Moore SL: ECT for major depression in a patient with acute brain trauma. J Psychiatry 1983; 140: 928 Jorge RE, Robinson RG, Starksein SE, et al: Secondary mania following traumatic brain injury. J Psychiatry 1993; 150: 916921 Stuart JW, Hemsath RN: Bipolar illness following TBI treatment with lithium and carbamazepine. J Clin Psychiatry 1988; 49: 7475 Robinson RG, Boston JD, Starkstein SE, et al: Comparison of mania and depression after brain injury: causal factors. J Psychiatry 1988; 145: 172178 Klonoff H: Head injuries in children: predisposing factors, accident conditions, accident proneness, and sequelae. J Public Health 1971; 61: 24052417 Lewis A: Discussion on differential diagnosis and treatment of post-concussional states. Proceedings of the Royal Society of Medicine 1942; 35: 607614 Lewis L, Rosenberg SJ: Psychoanalytic psychotherapy with braininjured adult psychiatric patients. J Nerv Ment Dis 1990; 178: 69 Paul SM: Anxiety and depression: a common neurobiological substrate. J Clin Psychiatry 1988; 49 suppl ; : 1316 46. Jorge RE, Robinson RG, Starkstein SE, et al: Depression and anxiety following TBI. J Neuropsychiatry Clin Neurosci 1993; 5: 369 Tennant FS: Naltrexone treatment for PCS. J Psychiatry 1987; 144: 813814 Gualiteri CT: Buspirone: neuropsychiatric effects. J Head Trauma Rehabil 1988; 6: 9092 Preston GC, Ward CE, Broks P, et al: Effects of lorazepam on memory attention and sedation in attention by Ro15-1788. Psychopharmacology 1989; 97: 222227 Feeney DM, Gonzalez A, Law WA: Amphetamine, haloperidol, and experience interact to affect rate of recovery after motor cortex injury. Science 1982; 217: 855857 Davison K, Bagley CK: Schizophrenia-like psychosis associated with organic disorder of the CNS. Br J Psychiatry 1969; 4 suppl ; : 113184 52. Nasrallah HA, Fowler RC, Judd LL: Schizophrenia-like illness following head injury. Psychosomatics 1981; 22: 359361 Brown G, Chadwick O, Shaffer D, et al: A prospective study of children with head injuries: psychiatric sequelae. Psychol Med 1981; 11: 6378 Thompsen C: Late outcome of very severe blunt head trauma: a 1015-year follow-up. J Neurol Neurosurg Psychiatry 1984; 47: 260268 Levine DN, Finkelstein S: Delayed psychosis after right temporal parietal stroke or trauma: relation to epilepsy. Neurology 1982; 32: 267273 Lishman WA: Brain damage in relation to psychiatric disability after head injury. Br J Psychiatry 1968; 114: 373410 Feeney DM, Sutton RL: Pharmacotherapy for recovery of function after brain injury. Crit Rev Neurobiol 1997; 3: 135197 Kant R, Duffy JD, Pivovarnik A: The prevalence of apathy following head injury. Brain Inj 1988; 12: 8792 Duffy JD, Campbell JJ: The regional prefrontal syndromes: a theoretical and clinical overview. J Neuropsychiatry Clin Neurosci 1994; 6: 379387 Gualtieri CT: Neuropsychiatry and Behavioral Pharmacology. New York, Springer-Verlag, 1991 61. Gerring JP: Psychiatric sequelae of severe closed head injury. Pediatric Review 1986; 8: 115121 Campbell JJ, Duffy JD, Salloway SP: Treatment strategies for patients with dysexecutive syndromes. J Neuropsychiatry Clin Neurosci 1994; 6: 411418 Sohlberg KM, Mateer CA: Training use of compensatory memory books: a three-stage behavioral approach. J Clin Exp Neuropsychol 1989; 11: 871891 Epstein NB, Bishop DS: Problem-centered systems therapy of the family, in Handbook of Family Therapy. Edited by Gurman A, Kniskern D. New York, Brunner Mazel, 1981, pp 444482 65. Silver JM, Yudofsky SC: Psychopharmacology, in Neuropsychiatry of Traumatic Brain Injury. Edited by Silver JM, Yudofsky SC, Hales RE. Washington, DC, American Psychiatric Press, 1994, pp 631670 66. Evans RW: The post-concussion syndrome and the sequelae of mild head injury. Neurol Clin 1992; 10: 815847 Levin HS, Mattis S, Ruff RM, et al: Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 1987; 66: 234243 Rutherford WH, Merrett JD, McDonald JR: Symptoms at one year following concussion from minor head injuries. Brain Inj 1978; 10: 225230 McLean A, Temkin NR, Dikmen S, et al: The behavioral sequelae of head injury. J Clin Neuropsychol 1983; 5: 361376 Langfitt TW, Obrist WD, Alavi A, et al: Computerized tomography magnetic resonance imaging and positron emission tomography in the study of brain tumor. J Neurosurg 1988; 64: 760767 Gray BG, Ichise M, Chung DG, et al: Technitium 99m HMPAO SPECT in evaluation of a patient with a remote history of TBI: a comparison with x-ray computed tomography. J Nucl Med 1992; 33: 5258 Evans RW, Gualtieri CT, Patterson DR: Treatment of chronic closed.
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Acknowledgments We thank L6na Barbeau and Lise de Repentigny for typing the manuscript and Knoll Pharmaceuticals for helping us with the measurements of propafenone concentrations. We also thank Richard Cartier, MSc, and Emma Lemire, RN, for technical assistance.
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The procedures adopted to generate sorption data bases SDBs ; for OPA reflecting the changes resulting from the interaction of the host rock mineralogy and groundwater chemistry with the hyperalkaline fluid from the cementitious near-field are essentially similar to those described in a previous report for the case of Palfris marl BRADBURY & BAEYENS, 1997a ; . Only aspects of these procedures essential for understanding will be given here; for more details, justifications and discussions the reader is referred to the above mentioned work. In the case of the OPA pH-plume system, the rock mineralogy and water chemistry are areas of large uncertainty. Normally, such information is a pre-requisite for the construction of SDBs. Nevertheless, and despite all the uncertainties, the procedures outlined below allow reasonable statements concerning the effects of the pH plume to be made and robust sorption values for data bases to be selected. A key question in this respect is whether the influence of the pH plume is likely to lead to better or worse far-field sorption characteristics for the safety relevant radionuclides. A SDB for an undisturbed OPA system is already available, BRADBURY & BAEYENS, 2003 ; . Although many consequences of the interaction between OPA and the high pH plume are uncertain, the fluid emerging from the cementitious near-field will tend to increase the pH of the groundwater in the far-field. How great this increase is, depends on many factors such as the starting pH of the emerging cement porewater NEALL, 1996 ; , dilution by the OPA groundwater, the mineral phases which the fluid "sees" and how rapidly and to what extent reactions can take place etc.
World Bank Group: Data and Statistics. 2005 [ : world bank data countryclass classgroups ]. Egger M, Smith GD: Bias in location and selection of studies. BMJ 1998, 316: 61-66. Thornton A, Lee P: Publication bias in meta-analysis: its causes and consequences. Journal of Clinical Epidemiology 2000, 53: 207-216. Horton R: Medical journals: evidence of bias against the diseases of poverty. Lancet 2003, 361: 713-713. Keiser J, Utzinger J, Tanner M, Singer BH: Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence. BMJ 2004, 328: 1229-1232. Tutarel O: Composition of the editorial boards of leading medical education journals. BMC Med Res Methodol 2004, 4: 3. Olson CM, Rennie D, Cook D, Dickersin K, Flanagin A, Hogan JW, Zhu Q, Reiling J, Pace B: Publication bias in editorial decision making. JAMA 2002, 287: 2825-2828. Garfield E: Journal impact factor: a brief review. CMAJ 1999, 161: 979-980. Lee KP, Schotland M, Bacchetti P, Bero LA: Association of journal quality indicators with methodological quality of clinical research articles. JAMA 2002, 287: 2805-2808. Shields PG: Publication bias is a scientific problem with adverse ethical outcomes: the case for a section for null results. Cancer Epidemiol Biomarkers Prev 2000, 9: 771-772. Mills E, Wu P, Gagnier J, Heels-Ansdell D, Montori VM: An analysis of general medical and specialist journals that endorse CONSORT found that reporting was not enforced consistently. j clin epidemiol 2005, 58: 662-667. Dickersin K, Manheimer E, Wieland S, Robinson KA, Lefebvre C, McDonald S, the CENTRAL Development Group: Development of the Cochrane Collaboration's CENTRAL Register of Controlled Clinical Trials. Evaluation and the Health Professions 2002, 25: 38-64. Nieminen P, Isohanni M: Bias against European journals in medical publication Databases. Lancet 1999, 353: 1592.
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Insert the following new paragraph 1 ; under "Marking": " 1 ; Each package shall be clearly and durably marked with the identification number of the goods to be entered in the transport document, preceded by the letters 'UN'." Paragraphs 1 ; to 4 ; are renumbered 2 ; to 5 ; paragraph 3 ; renumbered 4 , replace "55 ' C by "61 * C". Insert a new paragraph 6 ; " 6 ; New packages containing substances of 13 * carried in deeply refrigerated nitrogen shall also bear a label conforming to model No. 2." Paragraphs 5 ; and 6 ; become paragraphs 7 ; and 8 and dextromethorphan.
Fig. 4. Subcellular fractionation of M21 cells. M21 cells were dispersed with 20 gentle strokes in a Dounce homogenizer and a postnuclear supernatant was layered over a discontinuous sucrose gradient as shown in the bar above. After centrifugation, 0.5 ml fractions were collected from the bottom of the tube. A ; Marker enzyme -glucosidase II was used for ER, and galactosyltransferases was used as Golgi apparatus makers; solid circles, -glucosidase II; open triangles, GalT-I using Xyl-pNP as an acceptor; solid circles, 1, 4GalT using GlcNAc-Bz as an acceptor. B ; -GalNAcT. Inset in B ; represents protein concentration of the fractions. Specific activity of each peak fraction is shown in Table II.
Gay and Lesbian Task Force applauds Equality California EQCA ; and legislative leaders for the record number of pro-equality laws taking effect this month in California. "With eight pro-equality laws going into effect this month, California stands head and shoulders above any other state in treating all its people equally under the law, " said Matt Foreman, executive director of the National Gay and Lesbian Task Force. "Thanks to the extraordinary leadership of Geoff Kors and Equality California and lesbian and gay members of the Legislature -- Senators Sheila Kuehl, Christine Kehoe and Carole Migden and Assemblymember Mark Leno -- tens of thousands will now have greater access to health care, discrimination against LGBT people in housing and state services will be prohibited, and the use of the pernicious `homosexual panic' defense will be limited, among many other advances." One of the most sweeping measures is the Equal Benefits in State Contracting law, which prohibits the state from contracting with businesses that do not offer equal benefits to employees with domestic partners on the same terms that benefits are offered to employees with spouses. The measure, authored by former Assemblymember and current Sen. Christine Kehoe, D-San Diego, passed during the 20032004 legislative session and took effect on Jan. 1. It was modeled after a very successful 1996 equal benefits ordinance enacted in San Francisco. The following pro-equality bills were enacted in California on Jan. 1: Equal Benefits in State Contracting 2003 ; AB 17: Assemblymember Christine Kehoe, D-San Diego. Prohibits the state from contracting with businesses that do not offer equal benefits to employees with domestic partners on the same terms that benefits are offered to employees with spouses. State Income Tax Equity Act SB 1827: Sen. Carole Migden, D-San Francisco. Enables registered domestic partners to file joint state income tax returns and have their earned income treated as community property. Civil Rights Housing Act of 2006 AB 2800: Assemblymember John Laird, D-Santa Cruz. Prohibits discrimination in housing based on race, color, religion, national origin, ancestry, disability and sex including gender identity ; , marital status, sexual orientation, familial status and source of income and diamox.
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If the patient is not agitated, cyanosed nor imminently dying, a trial of methylphenidate Ritalin ; 510mg or dextroamphetamine Dexedrine ; 2.55.0mg once or twice daily in the morning may help. Tolerance develops to these drugs and may limit their role. A newer CNS stimulant, modafinil Alertec ; may be tried. Its mechanism of action is not entirely clear, but it has central 1-adrenergic receptor agonism. It also may have a different site of action in the hypothalamus rather than the cortex as in methylphenidate 5 ; . As such, its adverse effect profile is also different and lower. Although officially approved only for use in narcolepsy, it has been found helpful in cancer-related fatigue, in Alzheimer's disease and as an adjuvant in depression 6 ; . Dosage is 100200mg morning or divided at morning and noon.
With steroid premedication, the incidence of respiratory symptoms in patients who received iodinated contrast media was reduced from 1.4% to 0.4% fig 2 ; , and the incidence of an arbitrary combination of respiratory and haemodynamic symptoms grade 3 ; was reduced from 0.9% to 0.2% fig 3 ; . Thus, to prevent one episode of a potentially life threatening, iodinated contrast medium related reaction, about 100 to 150 patients need to receive steroids prophylactically. Likewise, the clemastinecimetidine combination showed statistically significant efficacy but for prevention of angio-oedema only and in a single trial with a limited number of patients. We found further results in favour of premedication: H1 antihistamines and steroids reduced the risk of cutaneous symptoms, and a double dose methylprednisolone regimen reduced the risk of yet another arbitrary symptom combination including sneezing, nausea, emesis, and vertigo grade 1 ; . For other drugs for example, ephedrine ; or drug combinations for example, steroid-antihistamine ; , we could retrieve no valid data. Disastrous anaphylactic complications after administration of iodinated contrast media seem to be rare. In the analysed trials, more than 10 000 patients received an iodinated contrast medium; we found no reports of death, cardiopulmonary resuscitation, irreversible neurological deficit, or prolonged hospital stay. In a series including more than 6700 patients who received a non-ionic iodinated contrast medium, no life threatening reaction was seen.10 In more than 337 000 patients who received iodinated contrast media, two deaths occurred, but a causal relationship to the contrast medium could not be established.11 Potential limitations Our analysis has some limitations. Firstly, none of the trials included only patients with a history of allergic reactions. It may be argued that premedication is given exclusively to high risk patients, such as those with a history of allergic reaction to iodinated contrast media, and that in these selected patients premedication will certainly be beneficial. However, although three trials excluded patients with a history of a reaction to iodinated contrast media, six did not; we may thus assume that these trials represent daily clinical practice. It is unlikely that conscious selection of low risk patients in the original trials was responsible for the disappointing degree of efficacy of premedication. Also, premedication may not necessarily be efficacious in a patient with a positive history. Indeed, breakthrough reactions after steroid premedication have been observed.12 In a retrospective survey, breakthrough reactions were similar to the patients' initial reactions in 85% of cases and severe or life threatening reactions occurred in 24% of the cases.13 Secondly, a large variety of symptoms were reported. The decision as to whether a symptom was allergy related, and whether a symptom could be regarded as potentially life threatening, had to be made on the basis of clinical features that were described in the original reports; we cannot rule out selection bias. Six trials reported on symptoms that could be regarded as potentially life threatening.w1-w4 w6 w8 Although bronchospasm or laryngeal oedema may represent a certain threat to the patient, most of the reported symptoms were clinically of minor importance. Curiously, grade 1 and grade 3 reactions were significantly reduced but grade 2 reactions were not. However, for composite outcomes to be appropriate the individual symptoms need to be well defined, to be of equal importance, and to occur with similar frequencies; additionally, the active treatment needs to lead to a similar reduction in the risk of all components.14 No evidence and dicloxacillin.
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1529 7. Caimi G, Vaccaro F, Serra A, Picone F, Romano A, Sarno A. Macro and microrheological determinants in chronic renal failure. Clin Hemorheol 1988; 8: 433437 Inauen W, Staubli M, Descoeudres C, Galeazzi RL, Straub PW. Erythrocyte deformability in dialysed and non-dialysed uraemic patients. Eur J Clin Invest 1982; 12: 173176 Guerrero RF, Rodriguez MM, Paniagua SJ, Garcia BG, Salas RM, Amato D. Pentoxifylline reduces proteinuria in insulindependent and non insulin-dependent diabetic patients. Clin Nephrol 1995; 43: 116121 Sharma AK, Gupta R, Chablani P, Sharma P. Progression of renal failure: role of red cell deformability. Contrib Nephrol 1991; 95: 120125 International Committee for Standardization in Haematology. Guidelines for measurement of blood viscosity and erythrocyte deformability. Clin Hemorheol 1986; 6: 439453 Qunibi WY, Barri Y, Devol E, al FO, Sheth K, Taher S. Factors predictive of post-transplant erythrocytosis. Kidney Int 1991; 40: 11531159 Kessler M. Erythropoietin and erythropoiesis in renal transplantation. Nephrol Dial Transplant 1995; 6: 114116 McGonigle RJ, Wallin JD, Shadduck RK, Fisher JW. Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney Int 1984; 25: 437444 Koppensteiner R, Derfler K, Ehringer H. Blood rheology after renal transplantation. Nephron 1996; 74: 328332 Murphy BG, Yong A, Brown JH, McNamee PT. Effect of immunosuppressive drug regime on cardiovascular risk profile following kidney transplantation. Atherosclerosis 1995; 116: 241245 Ditschuneit HH, Flechtner MM, Adler G. Fibrinogen in obesity before and after weight reduction. Obesity Res 1995; 3: 4348 Hohage H, Arlt M, Bruckner D, Dietl KH, Zidek W, Spieker C. Effects of cyclosporin A and FK 506 on lipid metabolism and fibrinogen in kidney transplant recipients. Clin Transplant 1997; 11: 225230 Morishita E, Nakao S, Asakura H et al. Hypercoagulability and high lipoprotein a ; levels in patients with aplastic anemia receiving cyclosporine. Blood Coag Fibrinolysis 1996; 7: 609614 Ziegler O, Guerci B, Muller S et al. Increased erythrocyte aggregation in insulin-dependent diabetes mellitus and its relationship to plasma factors: a multivariate analysis. Metabolism 1994; 43: 11821186 Mohandas N. The red cell membrane. In: Hoffman R, ed. Hematology. Basic Principles and Practice. Churchill Livingstone, New York: 1991: 264268 22. Linde T, Ronquist G, Sandhagen B et al. Treatment of renal anaemia with recombinant human erythropoietin results in decreased red cell uptake of 45Ca. Nephron 1994; 68: 419426 Schut NH, Bilo HJ, Popp SC, Goedhart PT, Wilmink JM. Erythrocyte deformability, endothelin levels, and renal function in cyclosporin-treated renal transplant recipients: effects of intervention with fish oil and corn oil. Scand J Clin Lab Invest 1993; 53: 499506 Baskurt OK, Senturk UK, Dayan N et al. Cyclosporin A affects red blood cell deformability in vivo but not in vitro in guinea pig. J Pharmacol Exp Ther 1995; 274: 14381442 Sloop GD, Garber DW. The effects of low-density lipoprotein and high-density lipoprotein on blood viscosity correlate with their association with risk of atherosclerosis in humans. Clin Sci Colch ; 1997; 92: 473479 Received for publication: 14.10.98 Accepted: 30.1.99.
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Summary: Short immune epitope vaccines are a safe way to immunize against viral disease, but they are often unstable and poorly immunogenic. Linking an immune epitope to a macromolecular structure can increase immunogenicity and stability. We have investigated the possibility of using the insect virus Autographica californica AcNPV ; as a carrier for short vaccine peptides. AcNPV is known to stimulate strong antiviral responses in mammalian dendritic cells that are essential for triggering immunity. These responses are characterized by the production of the cytokine interleukin-12 and the upregulation of activation markers CD40, CD86 and CD80 on the cell surface. We have shown that by and diflunisal
Rious bottleneck. Since I had neither access to the necessary infrastructure nor the know-how for computer-based processing, I started a collaboration with Olaf Kbler at the ETH in Zrich who was in an inverse position: He had the software and the hardware that was needed but no data. In the following years, we made substantial progress in elucidating the molecular architecture of the D. radiodurans cell envelope Baumeister and Kbler 1978; Kbler and Baumeister 1978; Baumeister et al. 1981, 1982 ; . In 1979, I organized a meeting entitled "Electron Microscopy at Molecular Dimensions" held at Burg Gemen near Mnster, Germany, which in retrospect became quite influential see, e.g., Deisenhofer and Michel 1989 ; . Besides state-of-the-art applications, it covered many developments in technology from image recording and processing to lowtemperature electron microscopy EM ; , or strategies for making regular 2-D arrays Baumeister and Vogell 1980 ; . The intrinsic disorder in the 2-D protein arrays limits the resolution one can attain by Fourier filtering, and during the Gemen meeting, I became convinced that there are better ways of dealing with imperfect 2-D crystals. The emerging methods for averaging of single molecules offered an alternative, and I decided to join forces with Joachim Frank. A few months later when I visited him in Albany, we explored the application of correlation-based averaging to the micrographs of the HPI-layer, but to our disappointment we failed to obtain meaningful results during this short period of time. A year later, when I spent several months at the Cavendish Laboratory in Cambridge, England, working with Owen Saxton, we were able to overcome the problems and obtained the first correlation-averaged images of the HPI-layer with a significantly improved resolution. In trying to get this work published, we faced unusual problems; it took several rounds of reviewing and several steps down the ladder of journal ; prestige, until our manuscript was finally published Saxton and Baumeister 1982 ; . In retrospect, however, it is gratifying to see that more than 20 years later, this paper is still cited frequently and, in the guise of "lattice unbending" Baldwin et al. 1988 ; our strategem for overcoming the limitations due to lattice disorder became part of the standard repertoire used for processing images of 2-D crystals. Shortly thereafter, we applied correlation averaging to Scanning Transmission Electron Microscopy STEM ; images of unstained preparations of the HPI-layer and obtained the first quantitative mass maps Engel et al. 1982 ; , the beginning of a long-standing and successful collaboration with Andreas Engel at the Biocenter in Basel, Switzerland. The first decade in Martinsried: Studying protein architecture on prokaryotic cell surfaces At the beginning of 1982, I moved to the Max-PlanckInstitute of Biochemistry where, after a short overlap period, I was appointed successor of Walter Hoppe. Hoppe.
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The majority of patients were satisfied with the effects of treatment. In the IVGC group, 35 patients 85.3% ; reported an improvement of ocular conditions, 4 9.8% ; did not notice substantial changes, and 2 4.9% ; had the impression of a progression of eye signs and symptoms. In the ORGC group, 30 patients 73.2% ; felt that their eye disease had improved, 8 19.5% ; reported no changes, and 3 7.3% ; had a progression of the ophthalmopathy. Differences between the two groups did not reach statistical significance when comparing patients with improved vs. not improved no change or progression ; ocular conditions 2 1.19, P 0.28 ; . In both groups, self-assessment evaluation was in good agreement with the overall clinical evaluation, although few patients in both groups categorized as nonresponders ; considered their ocular conditions to be improved.
| Table 5. Overview of the heat-induced unfolding experiments and dionex.
Overdose risk should be considered. "Because of the rates and severity of side effects in clinical trials and during the early years of clinical use, tcas are not used all that much anymore, " Dr. Ferrando said. "There is much greater interest in the selective serotonin reuptake inhibitors." Early open-label and more recent placebo-controlled trials utilizing standard doses of the ssris fluoxetine Prozac ; , sertraline Zoloft ; , and paroxetine Paxil ; for major depression across hiv illness stages produced encouraging response rates, ranging from 70% to 90%, with relatively few adverse effects, and improvements in both affective and somatic depressive symptoms. Another popular ssri option is escitalopram Lexapro ; . Generally speaking, ssris have relatively low toxicity, even in overdose, and are thus rather safe, easily tolerated medications. Common mild to moderate side effects of ssris can include weight gain; memory impairment; and sexual dysfunction, including anorgasmia and sometimes loss of libido. One issue to beware of is that patients started on ssris or related medicines will occasionally develop severe jitteriness in the first few weeks of treatment; this can be very distressing and calls for dose reduction, or change to another medication if dose reduction does not result in improvement. Once jitteriness ceases, the dose can usually be increased again. Rarely, patients started on an ssri or other antidepressant may develop increased suicidal ideation. The U.S. Food and Drug Administration is in the process of issuing warnings about this in regard to ssris and various other classes of psychotropic medication; this may be part of the jitteriness syndrome just described, or it may indicate underlying bipolar illness, wherein antidepressant treatment without a concomitant mood stabilizer can induce mood cycling or dysphoric mixed-mood states. While this is rare, it is important for clinicians to ask their patients about suicidal ideation prior to initiating antidepressant treatment, in order to have a baseline to compare to. Many depressed patients have suicidal thoughts. If these thoughts worsen upon starting ssri treatment--or at any point-- psychiatric consultation is advisable. Other conventional antidepressants include venlafaxine Effexor ; , mirtazapine Remeron ; , nefazodone Serzone ; , and bupropion Wellbutrin, Zyban ; . The first three listed agents have been studied in small open-label trials in patients with major depression and hiv infection. All were associated with favorable response rates and few adverse effects. While bupropion is less likely to cause sexual side effects, it can increase the risk of seizures in patients with risk factors for seizures. Nefazodone has been associated with extremely rare cases of irreversible hepatotoxicity, which has discouraged its use, although it can be a good second-line medication in patients who fail to respond to a trial of an ssri. Nefazodone, mirtazapine, and trazodone are all sedating, which can be very helpful for patients bothered by insomnia, but may not be useful for patients with fatigue. Psychostimulant and wakefulness agents have also been studied for the treatment of depressed mood, fatigue, and cognitive impairment in the context of hiv infection, usually in advanced illness and where rapid onset of action is desirable. Open-label studies of dextroamphetamine Dexedrine ; , methylphenidate Ritalin ; , and modafinil Provigil ; found them to efficacious in treating depressive symptoms, with relatively few side effects. Modafanil is currently being studied in two placebo-controlled trials at Columbia University Medical Center: one for hiv-infected patients with fatigue and another for hiv infected patients using crystal methamphetamine call Judith Rabkin at 212 5435762 for more information ; . A review of the conventional antidepressants studied in hiv-infected patients and reviewed in Table 3 on page 22 and dextroamphetamine.
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Kenya's membership in regional trading bodies such as COMESA, African Union and the East African Community provides potential investors with a large potential market for their products. As a member of the COMESA Free Trade Area FTA ; , Kenya is allowed duty free exports of sugar to other COMESA FTA countries. Kenya also has an export quota for sugar to the European Union. This offers potential investors with a ready and accessible market for white sugar. Investor friendly arrangements The Kenya government can guarantee investor friendly arrangements such as: the Export Processing Zones EPZ ; program which offers attractive incentives to export-oriented investors and EPZ Authority to provide onestop-shop service for facilitation and aftercare the Investment Promotion Centre IPC ; to promote all other investment in Kenya including in Manufacturing under Bond MUB ; program the Tax Remission for Export Office TREO ; , a program for intermittent imports for export production Generous investment and capital allowances Double taxation, bilateral investment and trade agreements Investment protection and insurance The Constitution of Kenya provides guarantees against expropriation of private property. In addition, capital repatriation, remittance of dividends and interest are guaranteed to foreign investors under the Foreign Investment Protection Act FIPA ; Cap 518 ; . Kenya as a member of MIGA Multilateral Investment Guarantee Agency ; provides investors with an opportunity to insure their investment in Kenya against a wide range of non-commercial risks. Kenya is also a member of the African Trade Insurance Agency ATI ; , a multilateral export credit and political risk agency for COMESA member states as well as the International Council for Settlement of Investment Disputes ICSID ; . Strategic location Located on the East African coast and having the port of Mombasa, Kenya is strategically located for investors wanting to access the East and Central African markets. Kenya is also a regional hub for airlines allowing for easy access from and to any part of the world. Good quality of life Kenya hosts a number of international organizations and foreign embassies and provides very good and up to standard living conditions for foreign investors wishing to reside in Kenya. With recognized international hotels, airports and entertainment centres, Kenya provides as much comfort for foreigners as in any European capital. Stable political climate Kenya has been one of the very stable countries in Africa since independence. The country has had three presidents with smooth transition taking place from one government to the next and peaceful elections held regularly. This is also manifested in the number of international and regional organizations headquartered in Nairobi including the UNEP, IGAD etc. Current divestiture programme in the industry The government is currently divesting its shares from most of the sugar factories. This provides an attractive opportunity for private sector investment. Other incentives for investment include: Potential for adequate raw materials. Existing export quota to the European Union. Existing Regional and International trade protocols offer market opportunities. Existing industry driven strategy to revitalize the industry with the ultimate goal of attaining world-class standards. Strong industry knowledge base. Kenya's Sugar Industry.
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