Rationale and design of a randomized, double-blind, placebo controlled multicenter trial to study efficacy, security, and long term effects of intermittent repeated levosimendan administration in patients with advanced heart failure: LAICA study.

BACKGROUND Advanced heart failure (HF) is associated with high morbidity and mortality; it represents a major burden for the health system. Episodes of acute decompensation requiring frequent and prolonged hospitalizations account for most HF-related expenditure. Inotropic drugs are frequently used during hospitalization, but rarely in out-patients. The LAICA clinical trial aims to evaluate the effectiveness and safety of monthly levosimendan infusion in patients with advanced HF to reduce the incidence of hospital admissions for acute HF decompensation. METHODS The LAICA study is a multicenter, prospective, randomized, double-blind, placebo-controlled, parallel group trial. It aims to recruit 213 out-patients, randomized to receive either a 24-h infusion of levosimendan at 0.1 μg/kg/min dose, without a loading dose, every 30 days, or placebo. RESULTS The main objective is to assess the incidence of admission for acute HF worsening during 12 months. Secondarily, the trial will assess the effect of intermittent levosimendan on other variables, including the time in days from randomization to first admission for acute HF worsening, mortality and serious adverse events. CONCLUSIONS The LAICA trial results could allow confirmation of the usefulness of intermittent levosimendan infusion in reducing the rate of hospitalization for HF worsening in advanced HF outpatients.

A-1A Supplemental Security Income Program, January 2004

Monthly report from the Iowa Department of Human Services on Supplemental Security Income Program (SSI).

A-1A Supplemental Security Income Program, February 2004

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, March 2004

Monthly report from the Iowa Department of Human Services on Supplemental Security Income Program (SSI).

A-1A Supplemental Security Income Program, April 2004

Monthly report from the Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, May 2004

Monthly report from Iowa Department of Human Services on income.

Food security, food safety and small farmers

Some of the elements that characterize the globalization of food and agriculture are industrialization and intensification of agriculture and liberalization of agricultural markets, that favours elongation of the food chain and homogenization of food habits (nutrition transition), among other impacts. As a result, the probability of food contamination has increased with the distance and the number of “hands" that may contact the food (critical points); the nutritional quality of food has been reduced because of increased transport and longer periods of time from collection to consumption; and the number of food-related diseases due to changes in eating patterns has increased. In this context, there exist different agencies and regulations intended to ensure food safety at different levels, e.g. at the international level, Codex Alimentarius develops standards and regulations for the marketing of food in a global market. Although governments determine the legal framework, the food industry manages the safety of their products, and thus, develops its own standards for their marketing, such as the Good Agricultural Practices (GAP) programs. The participation of the private sector in the creation of regulatory standards strengthens the free trade of food products, favouring mostly large agribusiness companies. These standards are in most cases unattainable for small producers and food safety regulations are favouring removal of the peasantry and increase concentration and control in the food system by industrial actors. Particularly women, who traditionally have been in charge of the artisanal transformation process, can be more affected by these norms than men. In this project I am analysing the impcact of food safety norms over small farms, based on the case of artisanal production made by women in Spain.

A-1A Supplemental Security Income Program, September 2005

Supplemental Security Income Program

A-1A Supplemental Security Income Program, September 2006

A-1A Supplemental Security Income Program produced by the Department of Human Services

A-1A Supplemental Security Income Program, June 2002

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, January 2002

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, February 2002

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, March 2002

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, April 2002

Monthly report from Iowa Department of Human Services on income.

A-1A Supplemental Security Income Program, May 2002

Monthly report from Iowa Department of Human Services on income.