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Ignored in this setting and that not all people with HCV will be comfortable accessing services lumped together with HIV and other sexually transmitted diseases. As a result many experts believe that multiple approaches are needed to access the entire population at risk. The workshop ended with a comment that the CDC will soon be releasing a call for new funding proposals in Spring 2003. Unfortunately, it was also stated that the funding will not be increased because of the budgetary reallocation to the potential threat of the West Nile virus and of bioterrorism Developing effective harm reduction messages for counselors to use is one of the most difficult barriers to overcome in the integrated setting. Various agencies discussed the messages they developed in a session called "Counseling and Case Management for People with Hepatitis C." The Multnomah County Health Viral Hepatitis Integration Program developed two messages--a core message for people with hepatitis C, and a general message for all clients at risk. Core message for people living with hepatitis C: Reduce or abstain from alcohol and other liver-toxic substances Get vaccinated against hepatitis A and hepatitis B Find and see a health care provider routinely Specific message for people at risk: Use new or clean syringes and all injection equipment--use needle exchange If you can't use new needles, clean equipment with water-bleach-water for three minutes. Even though this method has not been proven to kill HCV, it can reduce the risk of transmission of HCV and other diseases Have an overdose prevention plan Use barriers when blood may be involved in sexual activities Meet the client at their level with clearly defined messages. There was also a discussion on the importance of meeting clients "where they are at" by assessing their readiness, willingness, and ability to change behaviors. As well, some techniques were presented for working with people who are unsure, not ready, or who may be ready to change behaviors. This session ended with a discussion on hepatitis C and harm reduction within the context of a needle exchange program. Clean Needles Now CNN ; provides health education, including HCV transmission information, that is specific to injection drug users and other drug users. Information about the liver, testing options, and self-care for living with hepatitis C is given. CNN provides their clients with "positive packets" that contain practical information about living with hepatitis C by incorporating specific wellness strategies, such as drinking water, stress reduction techniques, diet, exercise, strategies for meeting specific needs, and information on the effect of their drug use on the liver. Lessons learned from the Hepatitis Project New York City ; Putting into practice the goal of integrating viral hepatitis principles into existing services that include viral hepatitis counseling, testing, and follow-up medical care is the ultimate goal of screening, but follow-up medical care is the most difficult component to implement due to cost restraints. Michael Kluger, MPH New York University School of Medicine ; presented study results from a program founded in 1999 in New York City called the Hepatitis Project at the Lower East Side Harm Reduction Center NEX and HRC ; . This pilot project was started to address the issues of testing, post-test counseling, care, and support. To date, the program has tested approximately 465 individuals, with 25% of their clients testing positive for hepatitis A, 39% positive for hepatitis B with 6% having chronic HBV ; , and 51% testing positive for hepatitis C. In addition, they have administered 240 hepatitis A vaccines, 270 hepatitis B vaccines, and provided education to countless others. Of interesting note is that this study found that 63% of the participants reported that they had never been screened for hepatitis--the omission of which is viewed as a lost opportunity to identify an at-risk population Kluger noted that screening without offering a link to followup care contradicts the definition of screening. Their goal was to offer an accessible and affordable panel of medical providers to perform PCR confirmatory testing for hepatitis, to determine if chronic infection is present, and to provide follow-up medical care if necessary. The goal of the program is to offer informal referrals to a local primary care physician for all those who test positive. Since the Project's population is largely composed of injection drug users, every effort was made to refer clients to medical providers who are sensitive to this population. Providing these services for clients in organizations that are generally poorly funded is the biggest obstacle to overcome. As would be expected, a major expense of staffing a medical clinic is the salary of trained medical professionals: a nurse practitioner .50 hr ; , a physician assistant .50 hr ; , and a physician .00 hr ; . In addition, a nurse practitioner or physician assistant cannot provide services unless a physician is present or accessible by telephone, which carries a large price tag. These.
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Regimens. Morbidity was reduced at every evaluation during pamidronate treatment. Both the need for radiation treatment to bone and episodes of hypercalcemia were reduced after three cycles of treatment, and there was a significant reduction in pathologic fractures by the end of nine cycles. Furthermore, a longer time passed before there was any skeletal event, pathologic fracture, or need for radiation treatment to bone in the patients treated with pamidronate. To analyze the efficacy of the study drug with respect to the status of myeloma disease, we stratified the patients at entry into the study according to whether their current chemotherapy was a first-line treatment stratum 1 ; or a second or subsequent treatment stratum 2 ; . First-line systemic chemotherapy may result in remission and often palliates bone pain associated with advanced multiple myeloma.27, 28 In general, rates of remission are lower and bone pain decreases less in patients who receive another type of therapy when their disease has progressed during or after an initial treatment regimen.29, 30 This pattern was illustrated in the present study by the fact that among the patients receiving placebo, the proportion who required radiation therapy to bone was larger in stratum 2 than in stratum 1 34 percent vs. 15 percent, respectively ; . Most patients treated with radiation to bone were so treated to relieve bone pain. Pamidronate reduced the proportion of patients in stratum 2 who required radiation therapy to bone P 0.03 ; , suggesting that the drug palliates bone pain associated with bone disease in myeloma when chemotherapy no longer does so effectively. Conversely, although the proportion of patients with pathologic fractures was smaller in the pamidronate group than in the placebo group, this difference was statistically significant only in stratum 1. This finding may be due to the smallness of the sample studied or to the fact that bone destruction was advanced in the pa and parnate.
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During the Tuesday Morning Countdown, the debate focused on the role of young people. Among some of the most significant comments made were, "Youth must be brought into the mainstream and not just be left at the sidelines" and "We should not just talk about youth but we must talk to youth." At this conference there are several events, including the Youth Lounge, that target young people specifically and there is one event that will give young delegates a chance to speak out about their experiences. But is it enough? It has been acknowledged that young people are central to the creation of any youth-targeted efforts but how often do they get a chance to be included not as an audience but as designers and implementers? Two events on Tuesday provided chances for young people to vocalise their concerns. At Major Session 7 - "Young People's Experiences" - over 80 young people and close to 60 not-so-young delegates gathered to hear firsthand accounts of young ex-drug users from Thailand and Indonesia, and a report from Vi.
Bisphosphonate use increases risk of jaw problems - jul 10, 2007 cancer consultants press release ; , the original reports involved the use of zometa zoledronic acid ; , but cases have now been reported following the use of aredia pamidronate ; as well and paromomycin.
Figure 11. Posteroanterior prone radiograph shows bilateral pedicular punctures in a 67-year-old man with L3 osteoporotic compression fracture. The left needle had been removed following polymethylmethacrylate injection into the left half of the vertebral body!
The key finding of this report is that there will be a considerable gap between the demand for skills that would be implied by the development of a biotechnology cluster in Ireland in the medium-term and the projected output of relevant skills over this period. If Ireland is to be successful in developing this industry then this deficiency must be overcome. The recommendations put forward to achieve this can be summarised under three broad themes. 1. Initiatives to increase interest in the study of science and in careers in science; 2. Measures to improve the capacity of the Irish economy to supply suitably skilled personnel; and 3. Supporting interventions, particularly in the development of Ireland's research competency. These reflect the arguments that have been put forward: that intervention must increase the demand for training in science as well as the number of available places. In addition, the quality and structure of the skills that are produced must be appropriate. In summary, the output of relevant skills by the education sector needs to be increased significantly if the biotechnology sector in Ireland is to realise its full potential over the period 2004-2010 and pbz.
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Jay Campbell, B.S. Pharmacy, JD Executive Director NC Board of Pharmacy.
64. Lin F, Xiao D, Kolluri SK, Zhang X. Unique anti-activator protein-1 activity of retinoic acid receptor h. Cancer Res 2000; 60: 3271 Cho Y, Talmage DA. Protein kinase Ca expression confers retinoic acid sensitivity on MDA-MB-231 human breast cancer cells. Exp Cell Res 2001; 269: 97 Cho Y, Tighe AP, Talmage DA. Retinoic acid induced growth arrest of human breast carcinoma cells requires protein kinase C a expression and activity. J Cell Physiol 1997; 172: 306 Goffin J, Eisenhauer E. DNA methyltransferase inhibitors--state of the art. Ann Oncol 2002; 13: 1699 Stewart DJ, Donehower RC, Eisenhauer EA, et al. A phase I pharmacokinetic and pharmacodynamic study of the DNA methyltransferase 1 inhibitor MG98 administered twice weekly. Ann Oncol 2003; 14: 766 and pegasys.
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In the year ended 30 June 2005, Mayne Pharma's EMEA operations generated sales of A6.3 million, an increase of 60.4% over the prior year. EMEA is Mayne Pharma's most important sales region accounting for 47.5% of Mayne Pharma's pro-forma total sales in the 2005 fiscal year. It is estimated that Mayne Pharma is the market leader based on sales in injectable generic pharmaceuticals in the UK and continental Europe. The business currently employs almost 600 people. The regional head office is located in the UK with satellite offices located in Germany, France, Italy, Spain, Belgium, Luxembourg, Portugal, Ireland, Denmark, Norway, Sweden, the Netherlands, the United Arab Emirates and Saudi Arabia. Mayne Pharma has distribution arrangements in a further 33 countries within EMEA, including Austria, Finland and Greece. Mayne Pharma believes that its broad European injectable generic sales force provides a competitive advantage in product distribution and in seeking product licensing opportunities with developers and manufacturers of pharmaceuticals who do not have this broad sales and distribution capability. Following the acquisition of a leading Spanish specialised hospital generic pharmaceutical distribution business from ROVI in December 2004, Mayne Pharma now has a direct presence in each of the five largest pharmaceutical markets in Europe. It is estimated that Mayne Pharma is the market leader in injectable generics in the United Kingdom, Italy and Belgium, is the number two supplier of injectable generic pharmaceuticals in Spain and a significant supplier in the Netherlands, France, Portugal, the Nordic region and Germany. Overall it is estimated Mayne Pharma is the market leader in injectable generics in continental Europe. With an extensive distribution network in place, Mayne Pharma is leveraging its manufacturing and sales capabilities by taking products currently manufactured for other regions and selling them to new countries. The continental European rollout of two key oncology products, pamidronate and Paxene, demonstrates the success of Mayne Pharma's geographic expansion strategy. In May 2004, Mayne Pharma acquired a USFDA approved manufacturing facility in Wasserburg, Germany, specializing in freeze-dried, non-cytotoxic injectable pharmaceutical manufacturing. This facility provides additional manufacturing capacity needed to support Mayne Pharma's global growth strategy and has a profitable contract manufacturing business. In June 2005, Mayne Pharma acquired Intra-tech, a manufacturer and distributor of aseptically prepared pre-filled syringes and infusion bags, based in the UK. An aseptic manufacturing service enables hospital pharmacies to outsource the preparation of individual patient doses of medicines from licensed pharmaceutical products. Aseptic manufacturing is consistent with Mayne Pharma's vertical integration strategy for commodity generic products and is highly complementary to its strong oncology portfolio in the UK. Products Mayne Pharma's product portfolio in Europe, the Middle East and Africa is currently focused on oncology, which accounted for nearly 70% of revenue in fiscal year 2005. Mayne Pharma has also successfully increased the number of molecules marketed in the region through internal development and in-licensing activities, from 53 in fiscal 2002 to 75 in fiscal year 2005. In addition to adding new molecules to the portfolio during this time, a number of smaller, less profitable products have been phased out. Approximately 67% of Mayne Pharma's fiscal year 2005 revenue came from commodity generics, 17% from branded generics, with the remainder coming from contract manufacturing at Wasserburg and compounding services. Mayne Pharma has been successful in being first to market with key products in Europe. Paxene, the first alternative to Bristol MyersSquibb's Taxol marketed across most Western European countries, was launched in Europe in May 2004. This was facilitated by Mayne Pharma's ownership of a vertically integrated paclitaxel supply chain, the collaborative agreement with Ivax and broad European sales and distribution infrastructure. Paxene paclitaxel ; was the only alternative to Taxol across the major European markets for approximately nine months from the date Paxene was launched. In the last two years, Mayne Pharma has been first to market in Europe with three other important generic hospital drugs the oncology products pamidronate and irinotecan, and the thalassemia drug, desferrioxamine, reflecting Mayne Pharma's regulatory expertise in the region. Biogenerics Mayne Pharma is well positioned in the evolving biogenerics industry in Europe. In February 2005, it entered into a strategic collaboration with Pliva, a leading Eastern European based generic and specialty pharmaceutical company, to develop and manufacture two major biogeneric products commonly used by cancer patients: EPO and G-CSF. Mayne Pharma will exclusively market and distribute these products in Western Europe and other selected markets around the world. Pliva has strong research and development capabilities and is well advanced in its development of these products. The agreement complements Mayne Pharma's hospital and oncology emphasis and provides a significant opportunity to establish a strong sales position in the emerging market for generic biological drugs. Sales and marketing Mayne Pharma employs more than 100 people in sales and marketing in Europe, the Middle East and Africa. In Europe, Mayne Pharma has sales staff located in 13 countries, compared with six countries when it acquired the business in 2001. Mayne Pharma has distribution arrangements in a further eighteen countries in Europe, compared with nine countries in fiscal year 2002. Mayne Pharma's approach to sales and marketing differs country by country. As an example, in the UK, the sales process is largely tender driven. Long term contracts with a small number of regional tender boards cover the majority of generic pharmaceuticals supplied to hospitals. This necessitates a relatively small sales force that concentrates on maintaining strong and long term relationships with these organisations and pegfilgrastim.
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FIG.1. Inhibition of forskolin-stimulatedadenylyl cyclase by NPAor SRIF.PaneZA, GH4Cl cells were labeled with L3H1adenineand assayed with 25 forskolin in the presence of SRIF A ; or NPA 0 ; at the concentrations indicated. [3HlcAMP was isolated and quantified as described under "Experimental Procedures." The accumulation of [3HlcAMP was determined as a percent of the total VHIATP + ADP pool for each sample after correction for recovery from chromatography the steps. This corrected value for [3HlcAMP normalized as a percent of was the cAMP accumulation obtained with forskolin alone.The data shown are the mean and S.E. of triplicate determinations and are representative of nine experiments. Panel B, clone 1 cells were derived from 1 the stable transfection of the cDNA for the D2s receptor into GH4Cl cells. These cellswere assayed, labeled, and [3HlcAMP-quantifiedas described in PaneZA. This experiment is representative of 10 experiments.
Label, dose ranging trial of intravenous bolus zoledronic acid, a novel bisphosphonate, in cancer patients with metastatic bone disease. Cancer 91 144154. Berenson JR, Rosen LS, Howell A, Porter L, Coleman RE, Morley W, Dreicer R, Kuross SA, Lipton A & Seaman JJ 2001b Zoledronic acid reduces skeletal-related events in patients with osteolytic metastases. Cancer 91 11911200. Berruti A, Dogliotti L, Terrone C, Cerutti S, Isaia G, Tarabuzzi R, Reimondo G, Mari M, Ardissone P, De Luca S, Fasolis G, Fontana D, Rossetti SR & Angeli A 2002 Changes in bone mineral density, lean body mass and fat content as measured by dual energy X-ray absorptiometry in patients with prostate cancer without apparent bone metastases given androgen deprivation therapy. Journal of Urology 167 23612367. Bilezikian JP 1999 Osteoporosis in men. Journal of Clinical Endocrinology and Metabolism 84 34313434. Body J-J 2003 Effectiveness and cost of bisphosphonate therapy in tumour bone disease. Cancer 97 Suppl 3 ; 859865. Body J-J, Lichinitser MR, Diehl IE et al. 1999. Double-blind placebo controlled trial of ibandronate in breast cancer metastatic to bone. Proceedings of the American Society of Clinical Oncology 18 575a. Boissier S, Ferreras M, Peyruchaud O, Magnetto S, Ebetino FH, Colombel M, Delmas P, Delaisse JM & Clezardin P 2000 Bisphosphonates inhibit breast and prostate carcinoma cell invasion, an early event in the formation of bone metastases. Cancer Research 60 29492954. Brown JE, Thomson CS, Ellis SP, Gutcher S, Turner L, Purohit OP & Coleman RE 2003a Bone resorption predicts for skeletal complications in metastatic bone disease. British Journal of Cancer 89 20312037. Brown J, Cook R, Coleman RE, Major PP, Lipton A, Zheng M, Hei Y & Seaman J 2003b The role of bone turnover markers in predicting clinical events in metastatic bone disease. Proceedings of the American Society of Clinical Oncology 22 Abstract 2969. Bryden AA, Hoyland JA, Freemont AJ, Clarke NW & George NJ 2002 Parathyroid hormone related peptide and receptor expression in paired primary prostate cancer and bone metastases. British Journal of Cancer 86 322325. Chiao JW, Moonga BS, Yang YM, Kancherla R, Mittelman A, Wu-Wong JR & Ahmed T 2000 Endothelin-1 from prostate cancer cells is enhanced by bone contact which blocks osteoclastic bone resorption. British Journal of Cancer 83 360365. Coleman RE 1998 Pamidronate disodium in the treatment and management of hypercalcaemia. Reviews in Contemporary Pharmacotherapy 9 147164. Coleman RE & Rubens RD 1987 The clinical course of bone metastases in breast cancer. British Journal of Cancer 55 6166. Coleman RE, Purohit OP, Black C, Vinholes JJ, Schlosser K, Huss H, Quinn KJ & Kanis J 1999 Double-blind, randomised, placebo-controlled study of oral ibandronate in patients with metastatic bone disease. Annals of Oncology 10 311316. Conte PF, Latreille J, Mauriac L, Calabresi F, Santos R, Campos D, Bonneterre J, Francini G & Ford JM 1996 Delay in progression of bone metastases treated with intravenous and pegvisomant.
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