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Dr. Panayotou's remarks about the need to focus on the up-market segment of tourism provoked a lot of questions. Specifically, many groups feared that by focusing on high rates less people and more money ; , a substantial number of people would be taken out of the market, since they would not be able to afford the high prices. This strategy would also greatly constrain and restrict the economic opportunities for local and indigenous communities, relegating their participation to the low end of the service sector instead of providing opportunities for entrepreneurship at the local level, such as for smaller scale tourist facilities run by the local communities. Dr. Panayotou responded to such concerns by stating that opening Panama's natural and cultural resources to all kinds of tourism would impose a cost on those resources that would not be sustainable in the long-term. That does not necessarily mean that only five-star hotel tourists could bring benefits to the economy. For the lower-end of tourism you could have ecotourism activities with very low costs and impacts, where the net benefits could still be great, provided these people are guided and taught about the surroundings. Dr. Panayotou expressed that there is a lot of evidence around the world showing that the damage caused to the environment national parks, coral reefs, etc. ; is proportional to the number of people that are let into those areas. The situation may vary in certain places, but generally, if you want to maximize the net benefits and minimize the environmental and cultural damage, it is better to focus on the up-market segment of tourism although not necessarily to the exclusion of the lower scale tourism ; . In any case, an analysis of environmental, social and cultural benefits and costs must be taken into account. It is also important to identify the different segments of the market, such as the retired people, the honeymooners, the scientific tourists, the students, etc. What services does each of these segments want? How much are they willing to pay for it? How much is it going to cost for Panama to provide those services? Dr. Panayotou also reminded conference participants that it is important not to confuse quality and scale. In Iceland, for example, small farmers run many ecotourism operations. These high quality excursions allow you to spend ten days "working" in a small dairy farm. Although the dairy industry is currently unprofitable in that country, these farmers have found their niche in tourism. Smaller farms charge higher rates than the larger farms. This example could be applied to Panama's indigenous people, who could provide an intimate, high quality product. TCR projects will aim at preserving Panama's culture. Therefore, indigenous communities will have an important role in the upper end of the tourism product, providing their valuable knowledge about lands, biodiversity and the use of traditional herbs and medicines.
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Item 5, supra note 1, at Sections 1 date of birth ; , 5 education ; , 6 employment ; , 8 spouse ; , 9 relatives ; , and 11 military service ; is the source for the facts in this paragraph, unless otherwise stated. Unless stated otherwise, the source for the facts in this section is Applicant's affidavit to a Special Investigator of the Office of Personnel Management on April 19, 2006. Applicant noted that details concerning the numbers of times he used drugs and the dates of use may vary from previous statements, and such details were difficult for him to recall. 3 and
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Supporting the family. Great advice. That was what happened". Philippa, an only child, was born and brought up in Christchurch and remembered a happy childhood in a large backyard vegetable garden which she loved. On leaving school she trained as a primary school teacher and it was as a student she met and married student electrical engineer Michael Spackman. After first living in Wellington, Michael took up a 5-year scholarship in England where they moved with daughter, Caroline. They returned to New Zealand with two more children, Adrian and Claire. They settled again in Wellington and Philippa returned to teaching before enrolling for a Science degree majoring in Botany at Victoria University. Once graduated, she stayed with the School of Biological Sciences for 18 years. Her love of gardening continued into her retirement with Michael: "For old times' sake I do try to grow a few vegetables in our garden here amidst the vagaries of Wellington's famous climate. Even if the amount of produce is small, I love to harvest." Together they travelled and had only.
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How does your health care provider know what diagnosis to give you when you visit about a particular concern? How does your provider know that you have a type of hepatitis rather than a type of liver cancer? You are likely the main source of information as you report what physical symptoms you have been experiencing. Your provider probably has your previous history to be guided by as well as observing how you present during this particular visit. You may be accompanied by a spouse, a relative or a friend who may also be able to provide additional information as to how you have been functioning. In coming up with an accurate diagnosis, your provider will likely be guided by the classifications and categories contained in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ICD 10 ; . This is a diagnostic manual that lists the known diseases and diagnostic categories for medical and psychiatric disorders. Earlier versions of the ICD did not provide adequate consideration of the full range of psychiatric disorders. To bridge this gap the Diagnostic and Statistical Manual of Mental Disorders DSM ; was developed. The DSM, currently the fourth edition DSM IV ; , has, over the years been developed to be collaboratively used with the ICD. Why a separate diagnostic and classification system for mental disorders? The original motivation was to collect incidence and prevalence information on mental disorders. Over the years, the DSM has evolved into much more than a statistical gathering tool. The DSM IV now contains a diagnostic and classification system that attempts to capture in a holistic way, the client's major psychiatric illness or main clinical issue, the personality attributes and or the intellectual capability that may contribute to the client's dynamics, any underlying medical illness that may influence the clinical picture, short and long term psychosocial issues that would impact the client's ability to function, and the client's overall ability to manage day to day events. In other words, the DSM can now provide a more complete biopsychosocial profile of the client, for clarity of diagnosis and treatment, and for education and research and
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CONCLUSION When planning your company's adoption of serialisation, electronic pedigree and RFID tracking, focus on gaining business payback in higher revenue and improved profit margin. The pharmaceutical industry can improve patient safety, expand brand security across the supply chain in a collaborative manner with partners, and gain better visibility. What appears to be a cost of compliance can become a strategic investment delivering significant and sustained return on investment. N The author can be contacted at brenda supplyscape.
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Business for Affordable Medicine, "Hatch Waxman Reform Legislation, " : bamcoalition HWReform accessed May 1, 2002 ; . 226 Business for Affordable Medicine, : bamcoalition accessed June 21, 2002 ; . 227 Minnesota Multistate Contracting Alliance for Pharmacy MMCAP ; , : mmd.admin ate.mn mmcapii accessed July 17, 2002 ; . 228 "MASPB Facts, " The Commonwealth of Massachusetts Pharmaceutical Purchasing Program, for example, protonix and side effects.
Mrs Chan emphasised the importance of post-marketing surveillance in tackling counterfeit drugs and also mentioned the need to organise workshops and publicise the problem of fake pharmaceuticals in the marketplace. She also stated that there is a need to share information on detected cases and measures taken against counterfeiters of drugs and
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Pharmacokinetics in Humans Oral Administration ; Oral dolasetron is well absorbed, although parent drug is rarely detected in plasma due to rapid and complete metabolism to the most clinically relevant species, hydrodolasetron. Hydrodolasetron appears rapidly in plasma, with a maximum concentration occurring approximately 1 hour after dosing, and is eliminated with a mean half-life of 8.1 hours CV 18%; n 30 ; . The apparent absolute bioavailability of oral dolasetron, determined by the major active metabolite hydrodolasetron, is about 75%. Food does not affect the apparent bioavailability of dolasetron taken by mouth. Hydrodolasetron is eliminated by multiple routes, including renal excretion, after metabolism, mainly glucuronidation and hydroxylation. Two-thirds of the administered dose is recovered in the urine and one-third in the faeces. Hydrodolasetron is widely distributed in the body with a mean apparent volume of distribution of 5.8 L kg CV 25%; n 24 ; . Sixty-nine to 77% of hydrodolasetron is bound to plasma proteins. The binding of hydrodolasetron to 1-acid glycoprotein is approximately 51%. In a study with 14C-labelled dolasetron, the distribution of radioactivity to blood cells was not extensive. The pharmacokinetics of hydrodolasetron are linear and similar in men and women. The pharmacokinetics of hydrodolasetron following oral administration, in special and targeted patient populations, are summarized in Table 2. The pharmacokinetics of hydrodolasetron are similar between adult healthy volunteers and cancer patients receiving chemotherapeutic agents. The apparent clearance of hydrodolasetron following oral administration of dolasetron is not affected by age in adult cancer patients. The apparent clearance of hydrodolasetron decreases 42% with severe hepatic impairment and 44% with severe renal impairment.
Omeprazole Prilosec ; 30 to 40 0.5 to 3.5 0.5 to 1.0 95 77 Lansoprazole Prevacid ; 80 to 85 1.7 1.3 to 1.7 97 14 to Rabeprazole Aciphex ; 52 1.0 to 2.0 1.0 to 2.0 96 30 to Pantoprazole Prtonix ; 77 1.1 to 3.1 1.0 to 1.9 98 71 to and lansoprazole Prevacid ; , has been well established.2 The safety profiles of the newer agents, rabeprazole and pantoprazole, appear to be similar to those of the older agents.2, 5, 7 PPIs are only contraindicated if the patient has a known history of hypersensitivity to them, and they should be used with caution in patients with severe hepatic disease. Omeprazole is a pregnancy category C agent; the others are pregnancy category B medications. PPIs are not recommended for use in breastfeeding mothers.8-12 Drug Interactions PPIs cause significant increases in gastric pH, which may alter the absorption of weak acids or bases. They may inhibit the absorption of drugs such as griseofulvin Grisactin ; , ketoconazole Nizoral ; , itraconazole Sporanox ; , iron salts, vitamin B12, cefpodoxime Vantin ; , and enoxacin Penetrex ; , many of which are weak bases and require acid for absorption.2, 5, 6, 13 Coadministration with these agents should be approached cautiously because it may result in clinical treatment failure.2 PPIs are metabolized to varying degrees 274.
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