Waste not want not: Applying an old adage to the modern issue of pharmaceutical waste

Our predecessors taught us, ‘waste not, want not’ – if we did not waste anything we would always have enough. Unfortunately, we did not heed their sage advice. Over the last three centuries, human kind’s wastefulness, or lack of respect for the finite resources of this planet, has contributed to climate change and negatively impacted on ‘ecosystem services’ with a significant, irreversible loss of biodiversity...

Modern diagnosis of Epstein-Barr virus infections and post-transplant lymphoproliferative disease

Infection by Epstein-Barr virus (EBV) occurs in approximately 95% of the world s population. EBV was the first human virus implicated in oncogenesis. Characteristic for EBV primary infection are detectable IgM and IgG antibodies against viral capsid antigen (VCA). During convalescence the VCA IgM disappears while the VCA IgG persists for life. Reactivations of EBV occur both among immunocompromised and immunocompetent individuals. In serological diagnosis, measurement of avidity of VCA IgG separates primary from secondary infections. However, in serodiagnosis of mononucleosis it is quite common to encounter, paradoxically, VCA IgM together with high-avidity VCA IgG, indicating past immunity. We determined the etiology of this phenomenon and found that, among patients with cytomegalovirus (CMV) primary infection a large proportion (23%) showed antibody profiles of EBV reactivation. In contrast, EBV primary infection did not appear to induce immunoreactivation of CMV. EBV-associated post-transplant lymphoproliferative disease (PTLD) is a life threatening complication of allogeneic stem cell or solid organ transplantation. PTLD may present with a diverse spectrum of clinical symptoms and signs. Due to rapidity of PTLD progression especially after stem cell transplantation, the diagnosis must be obtained quickly. Pending timely detection, the evolution of the fatal disease may be halted by reduction of immunosuppression. A promising new PTLD treatment (also in Finland) is based on anti-CD-20 monoclonal antibodies. Diagnosis of PTLD has been demanding because of immunosuppression, blood transfusions and the latent nature of the virus. We set up in 1999 to our knowledge first in Finland for any microbial pathogen a real-time quantitative PCR (qPCR) for detection of EBV DNA in blood serum/plasma. In addition, we set up an in situ hybridisation assay for EBV RNA in tissue sections. In collaboration with a group of haematologists at Helsinki University Central Hospital we retrospectively determined the incidence of PTLD among 257 allogenic stem cell transplantations (SCT) performed during 1994-1999. Post-mortem analysis revealed 18 cases of PTLD. From a subset of PTLD cases (12/18) and a series of corresponding controls (36), consecutive samples of serum were studied by the new EBV-qPCR. All the PTLD patients were positive for EBV-DNA with progressively rising copy numbers. In most PTLD patients EBV DNA became detectable within 70 days of SCT. Of note, the appearance of EBV DNA preceded the PTLD symptoms (fever, lymphadenopathy, atypical lymphocytes). Among the SCT controls, EBV DNA occurred only sporadically, and the EBV-DNA levels remained relatively low. We concluded that EBV qPCR is a highly sensitive (100%) and specific (96%) new diagnostic approach. We also looked for and found risk factors for the development of PTLD. Together with a liver transplantation group at the Transplantation and Liver Surgery Clinic we wanted to clarify how often and how severely do EBV infections occur after liver transplantation. We studied by the EBV qPCR 1284 plasma samples obtained from 105 adult liver transplant recipients. EBV DNA was detected in 14 patients (13%) during the first 12 months. The peak viral loads of 13 asymptomatic patients were relatively low (<6600/ml), and EBV DNA subsided quickly from circulation. Fatal PTLD was diagnosed in one patient. Finally, we wanted to determine the number and clinical significance of EBV infections of various types occurring among a large, retrospective, nonselected cohort of allogenic SCT recipients. We analysed by EBV qPCR 5479 serum samples of 406 SCT recipients obtained during 1988-1999. EBV DNA was seen in 57 (14%) patients, of whom 22 (5%) showed progressively rising and ultimately high levels of EBV DNA (median 54 million /ml). Among the SCT survivors, EBV DNA was transiently detectable in 19 (5%) asymptomatic patients. Thereby, low-level EBV-DNA positivity in serum occurs relatively often after SCT and may subside without specific treatment. However, high molecular copy numbers (>50 000) are diagnostic for life-threatening EBV infection. We furthermore developed a mathematical algorithm for the prediction of development of life-threatening EBV infection.

Synagogue Council of America records 1935-1974

Contains the constitution, by-laws, correspondence, papers, and minutes of the Synagogue Council of America (1935-1958), an incomplete set of the minutes of the Plenum, (1949-1965), the minutes of the Executive Committee (1946-1969), Officers' (Summit) Meetings (1955-1967) and the minutes and reports of the Budget Committee (1946-1966), financial reports and statements for 1942-1965 and fundraising activities (1958-1968).

Constructing the ideal victim in the United States of America's annual trafficking in persons reports

Human trafficking as a global phenomenon continues to elude accurate quantitative measure, and remains a controversial policy domain significantly influenced by anecdotal evidence. Drawing on the policy analysis framework of Bacchi (1999; 2007) the problem representation of trafficking through narratives can be considered a direct antecedent of contemporary anti-human trafficking policy. This article explores the construction of human trafficking within the Trafficking in Persons Reports, published annually by the United States of America’s Department of State. An examination of the victim and offender narratives contained within the reports published between 2001 and 2012 demonstrates that human trafficking is predominantly represented as a crime committed by ideal offenders against idealized victims, consistent with Christie’s (1986) landmark criteria of ideal victimization. This representation of an ideal prototype has the potential to inform policy that diverts focus from the causative role of global socioeconomic injustice towards criminal justice policies targeting individual offenders.

Fishery resources of the United States of America

The term “fishery resources” is used in this book with a broad application. It includes the populations of the fishes and other organisms useful to men, the environment that makes life possible for them, the industry that exploits and utilizes them, and our knowledge about them by which we can conserve their productivity. This book aims to survey the present status of all these aspects of those fishery resources that are used or are available for use by United States anglers and commercial fishermen. It is planned primarily for the Congress, at its request, with the idea of giving to busy people, in condensed fashion, a perspective on its subject. (pdf contains 142 pages)

Statement submitted by the United States of Brazil to the President of the United States of America as arbitrator : under the provisions of the treaty concluded september 7, 1889, between Brazil and the Argentine Republic

Exposição que os Estados Unidos do Brazil apresentam ao Presidente dos Estados Unidos da América como árbitro seguindo as estipulações no Tratado de 7 de setembro de 1889, concluído entre o Brazil e a Republica Argentina.

The History and Literature of America's Oysters

Historically, America's use and enjoyment of the oyster extend far back into prehistoric times. The Native Americans often utilized oysters, more intensively in some areas than in others, and, at least in some areas of the Caribbean and Pacific coast, the invading Spanish sought oysters as eagerly as they did gold-but for the pearls. That was the pearl oyster, Pinctada sp., and signs of its local overexploitation were recorded early in the 16th century. During the 1800's, use of the eastern oyster grew phenomenally and, for a time, it outranked beef as a source of protein in some parts of the nation. Social events grew up around it, as it became an important aspect of culture and myth. Eventually, research on the oyster began to blossom, and scientific literature on the various species likewise bloomed-to the extent that when the late Paul Galtsoff wrote his classic treatise "The American oyster Crassostrea virginica Gmelin" in 1954, he reported compiling an extensive bibliography of over 6,000 subject and author cards on oysters and related subjects which he deposited in the library of the Woods Hole Laboratory of the Bureau of Commercial Fisheries (now NMFS). That large report, volume 64 (480 pages) of the agency's Fishery Bulletin, was a bargain at $2.75, and it has been a standard reference ever since. But the research and the attendant literature have grown greatly since Galtsoff's work was published, and now that has been thoroughly updated.

Modern changes of tidal troughs among the radial sand ridges in northern Jiangsu coastal zone

Using satellite images taken on different dates, GIS analysis of aerial photos, bathymetric maps and other field survey data, tidal troughs and major sand ridges in the northern Jiangsu coastal area were contrasted. The results show that there have been three types of movement or migration of tidal trough in this area: (1) Periodic and restricted, this type of trough usually developed along the beaches with immobile gully head as a result of the artificial dams and the swing range increased from gully head to the low reaches, so they have been obviously impacted by human activity and have longer swing periods; (2) Periodic and actively, this kind of trough, which swung with a fast rate and moved periodically on sand ridges, were mainly controlled by the swings of the host tidal troughs and hydrodynamic forces upon tidal sand ridge and influenced slightly by human constructions; (3) Steadily and slowly, they are the main tidal troughs with large scale and a steady orientation in this area and have slow lateral movement. The differences in migration mode of tidal trough shift result in different rates of migration and impact upon tidal sand ridges. Lateral accumulation on current tidal trough and deposition on abandoned tidal troughs are the two types of sedimentation of the tidal sand ridges formation. The whole radial sand ridge was generally prone to division and retreat although sand ridges fluctuated by the analysis of changes in talwegs of tidal troughs and shorelines of sand ridges.

Sole plate fixing details for modern methods of timber construction.

In order to resist lateral loads, modern methods of timber construction are reliant on the in-plane shear strength of the walls orientated parallel to the applied action. In closed panel systems, the shear stresses are transferred to the foundations by the sole plate through the sheathing board, which is usually mechanically jointed to the timber frame. Since closed panels are delivered to site as single units, access to the internal bottom rail is rather restricted and novel, efficient solutions to secure the panel to the substrate are required. Sole plate fixing components for open and closed panel systems were tested in isolation and combination in order to validate a simplistic version of the weakest link theory. As a result, findings were embedded into a software database with a direct link to a previously developed sole plate and racking design application. This integrated process facilitates the structural optimization of the sole plate detail.

Japanese women speak : a message from the Christian women of Japan to the Christian women of America / by Michi Kawai, Ochimi Kubushiro ; cover design and frontispiece by the Japanese artist Rokuyåo.

http://www.archive.org/details/japanesewomenspe032256mbp

Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.