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Transfer Generally, a hospital may not transfer an unstabilized patient to another facility unless the benefits of transfer outweigh its risks and measures are taken to minimize risk. An ER may transfer an unstabilized patient if the patient or representative requests a transfer in writing after being informed of its risks and of the hospital's obligations under the Act.22 The following excerpts demonstrate HCFA confirmed violations of the Act's transfer provision. 1 ; In Fajardo, Puerto Rico, a patient presented to Hospital San Pablo del Este's ER with severe psychiatric symptoms hallucinations, disorientation and depression ; and lab abnormalities, including an elevated blood sugar indicative of uncontrolled diabetes and a low level of potassium. He or she was diagnosed with low potassium, elevated blood sugar, "rule out" inflammation of the pancreas and transferred to another hospital. The record did not contain a physician evaluation of the benefits and risks of transfer. The transfer certification stated that the patient was transferred because he or she was not insured. As of April 2001, no civil monetary penalty had been imposed in connection with this HCFA-confirmed violation.
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On December 16, 2006, Express Scripts, the third largest PBM, announced a competing bid for Caremark. This horizontal merger of two of the Big 3 PBMs would be competitive if the combined company acted as a "countervailing power" as envisioned by economist John Kenneth Galbraith. PBM countervailing power can be used in the negotiation of rebates with brand name drug manufacturers Pharma ; and in the negotiation of reimbursements with retail pharmacies.
Although age and sex specific reference ranges for body mass index are available, we applied the ranges given to patients aged from late teens to early 60s by Garrow3; these ranges form the basis of acceptable values in widespread use. By these criteria, men had a significantly higher mean body mass index than women, although the two sexes had no obvious clinical differences. Less than a third of women with untreated coeliac disease was underweight and a fifth was overweight, while two thirds of men were overweight. In contrast, Ciacci et al found that, although coeliac symptoms were more severe and of earlier onset in women, body mass index was not significantly different in men and women.4 A milder manifestation of the disease, irrespective of whether this is expressed as symptoms or as higher body mass index, would explain the low proportion of men in most clinical series. Our study suggests that a minority of patients with villous atrophy fit the obviously malnourished stereotype and that the possibility of coeliac disease should not be discounted in overweight patients. Many patients with gluten sensitivity have less severe small bowel damage5 and may be even less likely to be underweight.
Ames, Iowa--Last year's launch of more than 500 new energy drinks created a .3 million business. "Although energy drinks are frequently touted to provide a `burst of energy' consumers need to be careful label readers to know where exactly that burst is coming from, " said Ruth Litchfield, Iowa State University Extension nutrition specialist. Almost one-third of U.S. teenagers 7.6 million ; consume energy drinks. They choose advertised drinks when cramming for exams, participating in athletics or looking for a "buzz." "That buzz comes from stimulants, such as caffeine and guarana, " Litchfield said. "Label ingredient lists may include the names, but consumers have no way to know how much of each is in a product unless the manufacturer chooses to list amounts. Current nutrition labeling laws do not require manufacturers to disclose how much caffeine is in a product. The amount of guarana and other stimulants is also often unlisted." As recent news reports have shown, individuals may not even discover their sensitivity to the effects of stimulants until drinking one or more of the popular products. "The resulting headaches, heart arrhythmias or elevated blood pressure can be frightening and or life-threatening in some circumstances, " Litchfield said. Tests of popular high energy drinks show some having 15 to 93 milligrams per serving more caffeine than carbonated sodas. Others contain more caffeine than a Starbucks Doubleshot 106 mg per serving ; or twice as much caffeine as a can of Coke or Pepsi. "Add in a shot of guarana and you have a drink with a significant amount of stimulant, " Litchfield said. Instead of reaching for a bottle or can when you need an energy boost, Litchfield recommends lacing up a good pair of shoes. "The neurotransmitters, such as endorphins and serotonin, released in response to exercise provide what is commonly referred to as a `runners high, '" Litchfield said. "Take the initiative to create your own natural stimulants." Bottom line on energy drinks Energy drinks have high levels of sugar. When accompanied by inactivity, those extra calories produce stored energy in the form of weight gain. Energy drinks have high levels of caffeine. Caffeine is classified as a drug because it stimulates the central nervous system by increasing heart rate and causing an individual to feel more alert. Too much caffeine can cause anxiety, dizziness, and headaches and can interfere with normal sleep. Energy drinks provide few if any of the needed vitamins and minerals provided by healthier beverage choices, such as low fat milk and 100 percent fruit juice. Even plain water is a better choice for most individuals.
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Acetate, etc. ; , dissociationis almost completelysuppressed, thus precluding detectionwithout chemical eluant suppression. Note: type analysis conducted This of is routinely the mode in ICE after eluant suppression. 2. Ion-: Ion Interac.tlon~.As a ~sul~ of electrosta.ttc a!.tfaction betweenl?nSm sol~uon, 1.Ons, op~~lte of SIgns may temporanly form "lon-paIrs.' These lonpairs" have individually limited lifetime; however, at any instant due to continual interchangeof ions in solution, the total numberof free ions capableof carrying a current is lower than the simple concentrationrelationship. Severalspecies may be then completelyionized, e.g., salts, but not necessarilycompletelydissociated. At high dilutions below 10-4M ; ion-ion interactions becomevirtually negligible and solutesareboth completely ionized and dissociated.Ion-pairing formation or ion association ; favored for small-sizedor highis valenceions in a low dielectric constantmedium.The ionic size referredto is the "effective" size of an ion existin~ in solution ~d ~cludes the solvation sphere. Th~ thicknessof the 10~C~.tmosp~ere approach~s ~o- c~. It decreases v: lth mcreas~g concentratton and mcreasmg valenceof Ions presentm the electroyre. In the concentrationrangeusually analyzedin IC, the ion-pair or ion-associationformation may be neglected and doesnot causedeviationsfrom linearity of response. In this case, the initial concentrationof eluting ions, as a result of completedissociationof salts, is decreased from approximately10-3M standardanion eluant: 0.0018MNa2COjO.0017 M~aHCO3~ to approximately 10-5M dueto suppressor reacuons whichgenerate weakly dissociatedH2CO3 pK. 6.3 ; . In other word~, in this instanceonly, H + HCO - ions in the concentratton rangeof 10-5M contributeto the total ionic contentof the analyteband, thus minimizing interactionswithin the band. Conversely, in single column techniques, at approximately 10-3 M concentrations, presentthroughout are the systemand .contribute~0-3to to.talionic co~tentof the ~ffluen.t.This fact r .tr1cts hnear.operattng the ran~e o~~mgle. col~n. techni9ues be; ca~se mcreased of POSSlbility of Ion-l.onmteracttonswIthm the ~alyzed electrolyre s.eedia~ram ; . P~easerefer to SectIon V for and halcion
That is simply to help others who need help and who generally have to fight an uphill battle against great odds when they are victimized as the result of wrongdoing in Corporate America. After the play, Jean reminded me of the case Greg Allen and I handled against Kubota Tractor Co. several years ago. Durwood Spivey, her father, had been killed when a Kubota tractor rolled over on a very slight incline, pinning Durwood underneath. He was left to slowly die in the hot afternoon sun with ants all over his body.The tractor Durwood was operating wasn't equipped with what is referred to as ROPs protection a roll bar and seat belts ; even though Kubota knew that thousands of people were being killed in tractor rollovers.The Spivey family came to us, but only after Kubota had refused to even discuss the matter with them. We settled the Spivey case for million dollars, but not in the way that Kubota had demanded it be settled.The company had demanded total confidentiality, a return of all damaging company documents that we had obtained during pretrial discovery and a sealing of the court record.We had tried the case for four days before the offer was made on the 5th day of trial. I was fully aware that the trial had gone very well for our side and wasn't surprised that Kubota wanted to settle.We told Ms. Spivey that the offer had been made, but that there were conditions she would have to accept in order for her family to receive that money. This brave lady--who had lost her husband and the father of her children because Kubota had put their.
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THE DIFCO MANUAL, NINTTff EDITION, including d, scriptlons of these media and their use, is available on request. Specify DIFCO t h e trade name of the pioneers in the research and development of Bacto-Peptone and Dehydrated Culture Media and hemocyte.
7. Sampaio, FXR. Diario da Viagem que em Visita, e Correicao, das ~ Povacoes da Capitania de S. Joze do Rio Negro fez o Ouvidor, ~ e Intendente Geral da Mesma, no Anno de 1774 e 1775. Lisbon: Typographia da Academia, 1825. 8. Queiros da Silveira J. Viagem e visita do sertao em o Bispado ~ do Gram-Para em 1762 e 1763. Revista Trimensal de Historia e Geografia 1847; 9: 43527. Henman AR. Guarana Paullinia cupana var. sorbilis ; : ecological and social perspectives on an economic plant of the central Amazon basin. J Ethnopharmacol 1982; 6: 31138. Leacock S. Economic life of the Maue Indians. Boletim do Museu Paraense Emilio Goeldi Nova Serie, Antropologia ; 1964; 19: 130.
P.J Cullagh, Developmental Physiology Group, Division of Molecular Medicine, John Curtin School of Medical Research JCSMR ; , The Australian National University, Canberra, Australia, for the use of his laboratory and animal resources for the conduct of some of the mouse experiments. The support of Hamad Medical Corporation is gratefully acknowledged and heparin.
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Rod Mitchell To Franois Meyer: Will you have a patient or consumer representative in the Transparency Committee? They do exist; and they do have a point of view and integrity. Franois Meyer There is currently no patient representative on the Transparency Committee. The payers are there to listen but not vote. I think patient representatives should be associated to the work of the committee, either as permanent representatives it would be difficult, though, to get one person to talk about the variety of medication the committee deals with ; , or maybe the best way would be to associate a specific organisation when a dossier is submitted dealing with a particular disease. Now is a good time to raise this issue. The composition of the committee can be changed. Some friendly pressure should be exerted on politicians and the Health Ministry. We have a similar thing for the committee that deals with medical devices, and they do have patient representatives when necessary. Catarina Edjfll Speaking from Actelion, a Swiss biopharmaceuticals company with two orphan products on the market, I have a question for Christel Nourissier. First, thank you very much for sharing with us the results of your two surveys. This kind of survey is very important. But coming from one of the companies contributing to your survey, I disagree with the Eurordis graph showing reimbursement time versus price. Since you have new data that do not confirm this slide, I wonder how useful it is to bring the message that the longer the wait, the lower the price as you explained yourself, this is skewed by the fact that those who set the lowest prices are the ones who wait for others to set their price. It would be much more important to bring out the information it is true for Actelion, and I think it is true throughout the industry that the companies are trying to set very similar prices across the EU. I talking about ex-factory prices. We do not want to encourage parallel trade. And large difference in prices may result from national mechanisms, such as retail margins, different VAT rules and so on. Christel Nourissier Actelion is probably a model company in trying to set similar prices. But it is not the case for other companies. The data from the first study were far from perfect, but it was important to publish them at that time we raised some important questions. The trend seems to be better now, but it has to be confirmed with the data we are gathering now. The trend might be improving because we published the first survey, but it is too soon to say. I would prefer to wait until the survey is published. 65 and guarana.
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Puumala hantavirus is the most common human hantavirus infection in Europe.1 2 It is transmitted to humans by inhalation or contamination of skin breaches by urine or faeces of infected bank voles. Infection ranges from subclinical to a severe influenzalike illness progressing to acute renal failure.3 We carried out a case-control study in an endemic area in France and Belgium to estimate knowledge of hantavirus and identify possible risk factors for infection and hms.
On July 11, 1995, Bosnian Serb forces finally overran the town, separating women and children from the men and boys they deemed to be of fighting age. More than 8, 000 men and boys were summarily executed at several locations around Srebrenica. The lightly armed Dutch peacekeepers protecting the enclave failed to act against the onslaught. The victims were initially buried in a dozen mass graves around Srebrenica. But in a bid to cover up a massacre, the Bosnian Serbs moved the remains to other locations. So far the remains of around 6, 000 victims have been exhumed from about 60 mass graves around Srebrenica, while more than 2, 500 have been identified by DNA analysis.
AACE ACE Obesity Statement 327 134. 135. NIH Technology Assessment Conference Panel. Methods for voluntary weight loss and control. Ann Intern Med. 1992; 116: 942-949. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. Very low-calorie diets. JAMA. 1993; 270: 967-974. Life Sciences Research Office. Management of Obesity by Severe Caloric Restriction. Washington, DC: Federation of American Societies for Experimental Biology. Contract #FDA 223-75-2090, 1979. Pi-Sunyer FX. The role of very-low-calorie diets in obesity. J Clin Nutr. 1992; 56 Suppl 1 ; : 240S-243S. Anderson JW, Hamilton CC, Brinkman-Kaplan V. Benefits and risks of an intensive very-low-calorie diet program for severe obesity. J Gastroenterol. 1992; 87: 6-15. Wadden TA, Van Itallie TB, Blackburn GL. Responsible and irresponsible use of very-low-calorie diets in the treatment of obesity. JAMA. 1990; 263: 83-85. Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989; 149: 1750-1753. Donnelly JE, Jakicic J, Gunderson S. Diet and body composition: effect of very low calorie diets and exercise. Sports Med. 1991; 12: 237-249. Prasad N. Very-low-calorie diets: safe treatment for moderate and morbid obesity. Postgrad Med. 1990; 88: 179-182. Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a fiveyear perspective. Int J Obes. 1989; 13 Suppl 2 ; : 39-46. Brownell KD. The LEARN Program for Weight Control. 7th ed. Dallas: American Health Publishing, 1997. Parham ES. Enhancing social support in weight loss management groups. J Diet Assoc. 1993; 93: 1152-1156. Smith IG. Long-term weight loss with sibutramine MERIDIATM ; , a once-daily serotonin and norepinephrine reuptake inhibitor. Abstract presented at the annual conference of the North American Association for the Study of Obesity; November 1997; Cancun, Mexico. Grilo CM. Physical activity and obesity. Biomed Pharmacother. 1994; 48: 127-136. Barlow CE, Kohl HW, Gibbons LW, Blair SN. Physical fitness, mortality and obesity. Int J Obes. 1995; 19 Suppl 4 ; : S41-S44. Desprs JP, Lamarche B, Bouchard C, Tremblay A, Prud'homme D. Exercise and the prevention of dyslipidemia and coronary heart disease. Int J Obes Relat Metab Disord. 1995; 10 19 Suppl 4 ; : S45-S51. Brownell KD. Exercise and obesity treatment: psychological aspects. Int J Obes Relat Metab Disord. 1995; 19 Suppl 4 ; : S122-S125. Hayes D, Ross CE. Body and mind: the effect of exercise, overweight, and physical health on psychological well-being. J Health Soc Behav. 1986; 27: 387-400. Katzel LI, Bleecker ER, Colman EG, Rogus EM, Sorkin JD, Goldberg AP. Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged older men: a randomized controlled trial. JAMA. 1995; 274: 1915-1921. Tremblay A, Desprs JP, Maheux J, et al. Normalization of the metabolic profile in obese women by exercise and a low fat diet. Med Sci Sports Exerc. 1991; 23: 1326-1331. Landau C, Moulton AW. General principles in the primary care of obesity. R I Med. 1992; 75: 527-530. Zelasko CJ. Exercise for weight loss: what are the facts? J Diet Assoc. 1995; 95: 1414-1417. National Task Force on the Prevention and Treatment of Obesity. Long-term pharmacotherapy in the management of obesity. JAMA. 1996; 276: 19071915. Noble RE. A six-month study of the effects of dexfenfluramine on partially successful dieters. Curr Ther Res. 1990; 47: 612-619. Bray GA, Gray DS. Treatment of obesity: an overview. Diabetes Metab Rev. 1988; 4: 653-679. Silverstone T. Appetite suppressants: a review. Drugs. 1992; 43: 820-836. Guy-Grand B, Apfelbaum M, Crepaldi G, Gries A, Lefebvre P, Turner P. International trial of long-term dexfenfluramine in obesity. Lancet. 1989; 2: 1142-1145. Galloway SM, Farquhar DL, Munro JF. The current status of antiobesity drugs. Postgrad Med J. 1984; 60 Suppl 3 ; : 19-26. Scoville BA. Review of amphetamine-like drugs by the Food and Drug Administration: clinical data and value judgments. In: Bray GA, ed. Obesity in Perspective. Bethesda: National Institutes of Health, 1973: 441-443. Spitz AF, Schumacher D, Blank RC, Dhurandhar NV, Atkinson RL. Long-term pharmacologic treatment of morbid obesity in a community practice. Endocr Pract. 1997; 3: 269-275. Lean ME. Sibutramine--a review of clinical efficacy. Int J Obes Relat Metab Disord. 1997; 21 Suppl 1 ; : S30S36. Weintraub M, Hasday JD, Mushlin AI, Lockwood DH. A double-blind clinical trial in weight control: use of fenfluramine and phentermine alone and in combination. Arch Intern Med. 1984; 144: 1143-1148. Bray GA. Use and abuse of appetite-suppressant drugs in the treatment of obesity. Ann Intern Med. 1993; 119 7 Pt 2 ; 707-713. Atkinson RL, Blank RC, Loper JF, Schumacher D, Lutes RA. Combined drug treatment of obesity. Obes Res. 1995; 3 Suppl 4 ; : 497S-500S. Stock MJ. Sibutramine: a review of the pharmacology of a novel anti-obesity agent. Int J Obes Relat Metab Disord. 1997; 21 Suppl 1 ; : S25-S29. Ryan DH, Kaiser P, Bray GA. Sibutramine: a novel new agent for obesity treatment. Obes Res. 1995; 3 Suppl 4 ; : 553S-559S. Seaton TB, Mendel CM, Weinstein SP. Obesity [let ter]. N Engl J Med. 1998; 338: 64. Smith IG, Jones SP, Heath MJ, Kelly F. Categorical outcome analysis of weight loss in long-term sibutramine. Int J Obes Relat Metab Disord. 1996; 20: 157. Jones SP, et al. Long-term weight loss with sibutramine. Int J Obes Relat Metab Disord. 1995; 19 Suppl 2 ; : 41. Bray GA, Ryan DH, Gordon D, Heidingsfelder S, Cerise F, Wilson K. A double-blind randomized placebo-controlled trial of sibutramine. Obes Res. 1996; 4: 263-270. Blackburn GL, Smith IG. Sibutramine MERIDIATM ; produces and maintains long-term weight loss: results of two pivotal studies. Abstract presented at the annual meeting of the American Dietetic Association, October 27, 1997; Boston, MA. Pi-Sunyer FX. Effect of sibutramine MERIDIATM ; on serum lipids: meta-analysis of 11 placebo-controlled trials. Abstract presented at the annual conference of the North American Association for the Study of Obesity; November 1997; Cancun, Mexico and humalog.
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