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If the index terms used in these large databases meet your purpose medications with weight loss side effect order 10 mg accupril otc, they provide a convenient selection of terms for personal indexing and treatment jock itch generic accupril 10mg with amex, in many cases, can be included in the citation import feature of the software. Consider the high-circulation general journals in your area: Which of these journals provide the highest number of articles that are valid and also relevant to your individual research or practice area? Which specialty journals provide the highest number of valid and relevant articles? Choose general and specialty journals that are most likely to contain articles that will change, expand, or improve your practice or research Р articles that matter to your daily activities. Limit the number of journals to be browsed to only those that you can reasonably get through. Unless ``throwaway' publications (unsolicited, not peer reviewed) oer unique news or reviews by noted specialists, they are probably best thrown away. There are a few elds, such as physics and math, where prepublication copies of research are also available for perusing. Selective dissemination or current awareness search results on specic topics from bibliographical databases oer another method to identify relevant articles from the current literature. A Personal Database Drug information centers have for years devised and maintained ling systems that store and provide future access to answered information questions. Electronic database management systems now provide the structure and retrieval software to eciently save a question=answer database consisting of thousands of records. Life-long learning and professional continuing education needs are well served by the intellectual activities of searching for information, retrieving and evaluating the information, and constructing a solution to the specic clinical or research problem. Pharmaceutical scientists, academicians, and practicing pharmacists all require ever-increasing technological savvy. It is not sucient to know where information resides, to be ecient and successful one must also be skillful in the techniques of acquiring, manipulating, using, saving and retrieving digital information. Acquiring and using informatics skills decreases the time required to acquire, use and re-use information, thus freeing time for the higher level activities of evaluating what is found and applying this new knowledgeР evaluated information Р to solve research problems and improve patient care. Pharmacists for the Future: the Report of the Study Commission on Pharmacy: Commissioned by the American Association of Colleges of Pharmacy. International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use, [Internet]. In: Pharmacists for the future: the report of the Study Commission on Pharmacy: commissioned by the American Association of Colleges of Pharmacy. In: Proceedings/Nineteenth Annual Symposium on Computer Applications in Medical Care. Coping with the Biomedical Literature, A Primer for the Scientist and the Clinician. The New Drug Development Process: Steps from Test Tube to New Drug Application Review, [Internet]. Electronic Orange Book, Approved Drug Products with Therapeutic Equivalence Evaluations, [Internet]. Coping with the Biomedical Literature, a Primer for the Scientist and the Clinician. In: Pharmacists for the Future: the Report of the Study Commission on Pharmacy: Commissioned by the American Association of Colleges of Pharmacy. Doucette University of Iowa, Iowa City, Iowa In the last two decades, managed care has become the dominant model for health care delivery in the United States. Managed care has been especially prevalent in employer-sponsored health insurance, but managed care penetration of government sponsored health benets also has increased in recent years. Given the prevalence of managed care, it is important to understand its role in the delivery of health care and its impact on pharmacotherapy management. In the second part of the chapter we discuss managed care strategies specically related to pharmaceutical therapy. We conclude with a discussion of current and future issues related to managed care and pharmacotherapy management. In 1933, a physician and an insurance agent devised a health care plan where the physician was paid $0. This ``prepayment' plan was dierent from the standard insurance plan, where health care providers were reimbursed based on the number of services provided. Health maintenance organizations, generally dened as organizations that provide comprehensive health care for a prepaid payment, are the most familiar example of managed care. The Managed Care Model To better understand managed care and the reasons for its growth, it is useful to discuss the evolution of payment mechanisms for health care from no insurance, to traditional indemnity insurance, to managed care.

With regard to the remaining large group of non-familial cases symptoms before period buy generic accupril 10mg, a popular theory holds that seizures occurring secondary to other causes symptoms 2dp5dt purchase 10mg accupril with mastercard. First, although certainly not all patients with mesial temporal sclerosis have a history of childhood febrile seizures, such events are more common in these patients than in the general population (Adam et al. Second, among patients with focal cortical dysplasia, a significant minority will also be found to have mesial temporal sclerosis (Fauser et al. Third, there are clearly documented cases wherein patients with normal hippocampi have developed mesial temporal sclerosis after experiencing seizures from other causes (Parmar et al. Traumatic brain injury Seizures occurring after traumatic brain injury may appear early (within the first week) or late (at any time thereafter) (Jennett 1973; Jennett et al. Early seizures are seen in from 2 percent to 15 percent of cases, and late seizures, generally appearing within the first year post injury (Mazzini et al. Several factors increase the likelihood that patients will have late seizures, including the following: the occurrence of an early seizure; the presence of contusions or intracerebral hemorrhages; any intracranial operations; and dural penetration by metal fragments or by bone (Annegers et al. On the T1-weighted scan, atrophy of the hippocampus, indicated by the arrow, is fairly apparent, increased signal intensity being seen in the same area on the T2-weighted scan. In this regard, it may also be noted that acute disseminated encephalomyelitis, occurring in the days or weeks following a viral illness, may also be characterized by seizures (Paskavitz et al. Multi-infarct dementia may be associated with seizures at any point in its evolution (Rosenberg et al. Importantly, the Jarisch­Herxheimer reaction to penicillin treatment may also be characterized by seizures (Hahn et al. Various movement disorders, typically accompanied by dementia, may also cause partial or grand mal seizures, notably the choreiform disorders dentatorubropallidoluysian atrophy (Porter et al. Spinocerebellar ataxia, characterized by a slowly progressive ataxia, in certain of its types, may also cause seizures (Grewal et al. Cerebral amyloid angiopathy, classically causing lobar hematomas and, in some cases, a dementia, may also manifest with simple partial seizures, which may occur before any lobar hemorrhages and either before or concurrent with a dementia (Greenberg et al. Creutzfeldt­Jakob disease, typically characterized by dementia or delirium with myoclonus, may also, albeit uncommonly and late in the course of the disease, cause partial or grand mal seizures (Brown et al. Granulomatous angiitis, or isolated angiitis of the central nervous system, presents subacutely with headache, which is quite prominent, and delirium, and may, in a minority, be accompanied by seizures (Vollmer et al. Certain degenerative disorders of relatively early onset, from childhood to early adult years, may also cause partial or grand mal seizures, including metachromatic leukodystrophy (Alves et al. Various specific congenital disorders, most associated with mental retardation, also cause seizures, with each one being marked by various distinctive features. Fragile X syndrome, seen generally, but not always, in males, is typified by a variable degree of mental retardation, macro-orchidism, and a characteristic dysmorphism, with a long, narrow face, prominent forehead, and large ears. A minority of these patients will also have either partial or grand mal seizures (Finelli et al. Importantly, there is an association between frequent seizures and dementia in this disorder (Lichenstein 1954; Petermann et al. Tuberous sclerosis classically presents in childhood with the triad of seizures, adenoma sebaceum, and mental retardation (Critchley and Early 1932). Seizures generally, but not always, precede the appearance of adenoma sebaceum (Alsen et al. Tuberous sclerosis may rarely present in the adult years: in one case, a 26-yearold developed adenoma sebaceum, followed, at the age of 31, by partial seizures (Kofman and Hyland 1959). Prader­Willi syndrome is characterized by extreme obesity secondary to a ravenous hunger. Dysmorphic features are common, with a narrow head, almond-shaped eyes, a thin upper lip, thin arms, and, in males, micropenis and cryptorchidism. Systemic or autoimmune disorders Various systemic or autoimmune disorders may cause partial or grand mal seizures. Systemic lupus erythematosus may likewise cause partial or grand mal seizures (Devinsky et al. Thrombotic thrombocytopenic purpura should be suspected in cases of seizures occurring in the context of delirium and thrombocytopenia (Blum and Drislane 1996). Hyperthyroidism, rarely, may directly cause seizures, and is suggested by the accompanying autonomic symptoms (Korczyn and Bechar 1976; Jabbari and Huott 1980). Central pontine myelinolysis, suggested by the occurrence of quadriplegia or abnormal movements in the setting of rapid correction of hyponatremia, may also, rarely, cause seizures (Karp and Laureno 1993).

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Liquid and Semi-solid Dosage Forms the development pharmaceutics discussion for liquid and semi-liquid dosage forms may need to pay particular attention to the following points or issues as well as the general points listed above medications with sulfur quality accupril 10mg. The eect of pH within the range specied in the product specication should be considered with respect to possible eects on antimicrobial ecacy and on longterm stability medications osteoporosis purchase 10mg accupril visa. Where appropriate, the inclusion of buer systems may need to be considered to maintain a narrow pH range. Other general aspects to be considered include the ease of dissolution or redispersion, particle size and particle size distribution, aggregation, and rheological properties. For parenteral products specic consideration needs to be included for tonicity adjustment, emulsion globule size, ease of resuspension and sedimentation rate, particle size and particle size distribution, viscosity and syringeability, and crystal form changes. Full consideration should be included of the proposed instructions for dilution or reconstitution of products and of compatibility with the proposed solvents or diluents. This should include a demonstration that the proposed storage temperature and extremes of concentration are suitable. The preservation ecacy aspects of parenteral products are particularly important for those products that are permitted to contain preservatives. This is not allowed for large-volume injections or for any product gaining access to the cerebrospinal Їuid or for intra- or retro-ocular injection (according to the Ph Eur). Solid Dosage Forms Issues relating to chemical incompatibility and instability may be less signicant for solid dosage forms compared with liquid and semi-solid preparations. For modied- and immediate-release solid dosage forms, data are usually expected from appropriate dissolution and disintegration studies. These should be used to justify whether or not stability tests and routine batch testing should include dissolution and=or disintegration tests. This, in turn, will depend on the dosage form, the route of administration, whether the active ingredient is intended for immediate or modied release, etc. Normally it is expected that individually validated limits will be applied to each batch of product for oral solid dosage forms and suppositories, for example. These tests may be applied on the nished product or at some intermediate stage of manufacture Р this to be considered on a case-by case-basis. The omission of disintegration testing may be proposed if a dissolution test of appropriate discriminating power is included in the batch release specication. The test apparatus chosen for disintegration testing and dissolution testing should be one of those described in the Ph Eur unless another pharmacopoeial or a noncompendia method can be justied. The test conditions and the proposed release rates should be justied in terms of batch reproducibility. Appropriate account needs to be taken of in vivo bioavailability data, and, where feasible, an in vivo±in vitro correlation should be established, particularly where the active ingredient has a narrow therapeutic window. It is, however, recognized in the guidelines that the establishment of an in vitro±in vivo correlation is dicult due to a number of factors. It should nonetheless be usual practice to investigate the dissolution characteristics of products during the development process and then to decide on the relevance of the test to the in vivo performance of the product. For immediate-release products development and stability data may provide a justication for not including routine nished product, tests or conrm their need. In the case of modied release products, tests will normally be required and the test conditions and release rates proposed will need to be justied (batch reproducibility) taking into account in vivo study results. Additional studies may be required where there are signicant changes introduced during the product development process into the dosage form. The adequacy of mixing processes should be shown (and conrmed with appropriate process validation data) and potential segregation discussed (as aected by surface properties, crystallinity, particle size, etc. The Ph Eur uniformity of content requirements should apply to the dosage forms and uniformity of distribution needs to be shown between batches and within batches. The need for appropriate routine tests as part of the release specication should be discussed. Where it is possible to justify a half-unit dosage, then additional information will be required for dose uniformity within the halves and on the breakability of the dosage form in patient use conditions. Where the instructions for use of the product involve admixture or dilution with drinks or other materials, appropriate compatibility data will be required. Factors to consider include ease and rate of dissolution, homogeneity, chemical and physical stability over the period of use, particle size, etc.

Not content to leave well enough alone treatment for gout buy accupril no prescription, they go on to provide a rigorous historical analysis of the sources upon which contemporary estimations of deforestation in West Africa rest medicine 219 purchase cheap accupril line, carefully dissecting surveys, remotely sensed analyses, and historical records. Each of these, they demonstrate, rests upon previous sets of statistics and categories, all inherited from earlier researchers, who in turn borrowed from the researchers who came before them, back to shaky imperial foundations and before. Forest cover, and estimates of change that emerge therefrom, are merely projections reflected through a series of colonial funhouse mirrors. Traveling towards an epistemological vanishing point, Fairhead and Leach conclude that, to some degree, "it is turtles all the way down": all claims rest on the backs of previous representations, themselves resting on top of earlier texts, metaphors, and claims. As an inevitable result of such "intertextuality" (Barnes and Duncan 1992), current estimates of deforestation are, at best, grossly exaggerated and, at worst, rest on nothing more than colonial hot air. The human and environmental stakes of claiming local communities either destroy or create forests are enormously high, since the control of local populations, the proliferation of rules that govern livelihoods, and the capacity of working people to reproduce themselves all sit in the crosshairs of forest-cover estimates. Coyote, Raven, Spider this research has been subject to reasonable critique over the years and is by no means the last word on West African forests. The reason it remains so widely recognized and cited, however, and has become such a point-of-pride for the scholarly community associated with political ecology, is that it elegantly weaves together a core contradictory project: to draw into doubt scientific accounts of environmental conditions or change while proliferating them. Conversely, even while they challenge our ability to firmly establish accounts of environmental change outside of ideology and politics, they simultaneously seek to stabilize our understanding of landscapes through rigorous analysis, setting a tone of calm and familiar scientific explanation. In this way, they produce a "moment of chaos," in which the world and our understanding of it are reversed, inverted, and reconstructed. Indeed, having it both ways is one of the principal characteristics of political ecology. The field pronounces explanatory rules that it sometimes violates, nervously cooperates in joint environmental projects while organizing arguments about their limits, and borrows methods prolifically while producing epistemological critiques of the capacity of these methods to explain. As most folk traditions would have it, trickster figures are mischievous subversives, who act in contradictory ways. By turns, Trickster performs as a boastful clown or jester, occasionally acts as a thief, and constantly undermines haughty heroes. But Trickster also protects the weak, transports the seeds of culture, and provides gifts for humanity. Either way, Trickster rarely plays by the rules and is always an agent of often-revolutionary change. Trickster is, in this sense, a relational figure, one always associated with transition or revolution, whose uncanny ability is to reverse roles with other, more powerful, actors. As folklorist Harold Scheub (2012: 31) explains: "This reversal of roles is at the heart of all trickster tales, and of all tales dealing with transitions. We are constantly destroying, being destroyed, and creating, being recreated, reborn. Mimesis, infection, chaos To a great degree, this core Trickster quality is one of the central reasons political ecology has persisted, as a familiar kind of approach, if not a field, despite more than 30 years of ontological and epistemological revolutions, fads, and innovations since the publication of Land Degradation and Society. This is because political ecology, like Trickster, fosters, and thrives within, a critical dialogue with those characters and actors who surround it. For political ecology, these other actors represent allied research fields, foundationally including hazards research (Watts 1983b), conservation (Neumann 1998), and environment and development (Hecht and Cockburn 1989), and more recently including fields like land change science (Turner and Robbins 2008) and environment and health (King 2010). Wherever and whenever such fields establish important beachheads in explanation, political ecology emerges to undermine them, demonstrating the power-laden implications of any such foundational account of human/environment relationships. In that moment of engagement, however, political ecology also practices explanation, proliferating new and alternative environmental accounts, which ironically often mobilize the core elements and categories drawn from the very fields with which political ecology jousts. As political ecological arguments begin to enter the vernacular of these related fields, moreover, they begin to change these fields of study, sometimes in dramatic ways. Political ecologies are mimetic; they tend to reproduce the forms and idioms of the fields with which they are engaged. Political ecologies are infectious; their critical concepts commonly enter the taxonomies and variables of the sciences they engage. Political ecologies are chaotic; founded on a contradictory mandate to advance and undermine explanation, they tend to encourage disorder in other fields. In most accounts, contemporary political ecology began to cohere in the 1980s as a response to other fields and approaches, including classical cultural ecology, a field dedicated to the study and explanation of cultural practices (especially agricultural practices) within an environmental context (Robbins 93 P. Key works of political ecology at the time directed themselves to undermining, politicizing, contextualizing, and deconstructing the core conceptual apparatuses of cultural ecology: adaptation, function, and culture itself (Watts 1983a; Trimbur and Watts 1976). But this did not stop researchers from precisely mimicking and extending cultural ecological methods and ideas in their work, appropriating them for new purpose.