UPMC HEALTH PLAN'S website is frequently updated with new materials containing important information to help you better serve your patients. The latest addition to the site is a greatly expanded and more userfriendly version of the Private Feefor-Service Terms and Conditions. Located in the "For Providers" section of the website, this new tool allows you to quickly and easily search for individual topics such as the deeming process, billing guidelines, or the claims submission process without reading through the entire document. UPMC HEALTH PLAN is committed to consistently using and creating the best and most up-to-date Web-based tools.
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Analysis of Table 5: In the 200002 school year, the minor possession charges comprised 67.8% of the total offenses 156 of 230 ; . Intoxication offenses represented an additional 18.7% of the total 43 of 230 ; . Trafficking and possession of a controlled substance were only 31 of the total 230, or 13.5%. The 2001-02 school year followed a similar pattern for substancerelated charges: 62.2% of all types of charges totaling 12 or more were for minor possession allegations, while 18.5% were for intoxication, and 19.3% for trafficking and possession of a controlled substance.
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Useless. But studies in monkeys suggest that "it doesn't seem to be a large issue, " says Thomas Clarkson of Wake Forest. Modeling heart disease in animals is an imperfect science. To mimic early-stage disease, scientists can injure a major artery. They sometimes feed monkeys extremely high-fat diets. Or they rely on genetically altered mice deficient in the enzyme ApoE. These animals develop a form of atherosclerosis, but it's unclear how closely their disease hews to the human version. Oddly enough, even mice with serious disease rarely die of it. "Most of these animals don't drop dead of heart attacks, " says Banka. So researchers rely on other measures, such as improvements in arterial lesions or carotid thickness, to assess estrogen's benefits. Still, lesions aren't a surefire way to predict death from atherosclerosis in humans, who normally succumb when an arterial plaque ruptures. "These are highly artificial systems, " says Jan-ke Gustafsson, a molecular endocrinologist at the Karolinska Institute in Stockholm, Sweden. Back to the lab In the 16 months since the WHI combination hormone trial was halted, the response of animal researchers has varied. Because the study focused on women over 60, some reject its applicability to women in their early 50s, who make up the bulk of those starting hormone therapy. Other scientists are more circumspect. "The failure of these trials is sending us a strong message, " says Michael Rosenfeld, a pathologist at the University of Washington, Seattle. Amid all the debate and defensiveness lies an uncomfortable fact: The design of many animal trials did not reflect the reality of hormone therapy in humans, he says. Going forward, Rosenfeld adds, the two need to run as parallel as possible. Whether anyone will follow his recommendation isn't clear. Banka, who last month gave her mice combination hormones for the first time, says she's never seen a published mouse study documenting the effects of estrogen and progestin. And although researchers such as Clarkson have experimented with combination hormones in monkeys, Clarkson says it's too costly to do so every study because that would require a third group of animals on estrogen alone. But some researchers are already tackling one glaring contrast between the lab and clinic: They are studying animals as unhealthy as human subjects. Animals in traditional hormone experiments receive estrogen while their arteries are still clean or when they have fatty lesions but no arterial plaques. Roughly half of all middle-aged women, meanwhile, are thought to harbor subclinical atherosclerosis, says Jacques Rossouw of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, who is project officer for the WHI. Recent animal work suggests that arteries spotted with plaques may react very differently to estrogen than healthier ones do. In a 4-year study, Clarkson's team removed the ovaries of monkeys, then fed them what he calls an "imprudent" diet high in fats; some of those monkeys also received equine estrogens orally. After 2 years the equivalent of 6 years in a woman ; , all the animals received hormones. Those given estrogens when the, for instance, feldene use.
1141 Advanced Age, Complications, and Outcome after Neurosurgical Procedures Pascal Militzer, MD Haroon Choudhri, MD Peter D. LeRoux, MD Arif Malik, MD New York, NY ; Key Words: age, complications, outcome, neurosurgical procedures Objective: Census data demonstrate that the fastest growing population group in the United States is persons 65 years and older. This study was undertaken to determine if advanced age is an independent prognostic factor for complications or poor outcome after neurosurgical procedures. Methods: The hospital records and the Veterans Administration VA ; surgical risk profile of 1000 consecutive patients who underwent neurosurgical procedures at the Manhattan VA Medical Center between August 1993 and August 1999 were reviewed for complications and adverse outcomes. Results: Twenty-three patients died within 30 days after a neurosurgical procedure. Surgical and medical complications were identified in 67 and 34 patients respectively. Many of these complications were minor, such as a urinary tract infection or superficial wound infection, and after treatment did not affect outcome. Multivariate analysis factors that were associated with surgical or medical complications included the American Society of Anesthesiology ASA ; grade, pre-existing medical conditions particularly severe cardiac disease or dialysis ; , poor nutrition, immunocompromise, and smoking. Age alone was not found to be associated with adverse events. Conclusions: Surgical complications or poor outcome after neurosurgical procedures were not associated with age alone. Instead, adverse events were predicted by the patient's ASA grade and premorbid condition and sinemet.
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Analgesics, so providers need to treat this form of pain with what are often termed "adjuvant" medications, which include tricyclic antidepressants, antiseizure medications, and membrane stabilizers. Most patients, however, will be managed by some combination of adjuvant medications and opiates. Practitioners should allow adequate time for gastrointestinal absorption of these drugs, a process that can take up to 90 minutes. In the case of many longer-acting opiates, there can be a four-hour lag from ingestion to activity. Therefore, follow-up doses of the scheduled medication should be taken well before drug levels in the blood drop to sub-therapeutic levels. The therapeutic goal of any pain-relief regimen is to achieve an adequate level of drug in the blood stream, a level high enough to assure relief of "background" pain when you are resting. If the patient experiences pain during activity, additional medications should be available to blunt this breakthrough pain. To manage both forms of pain, two forms of medication are needed: a long-acting drug, taken on a fixed schedule to eliminate background pain and a rapid-onset medication, used on an as needed basis for the breakthrough pain and hytrin.
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Hospice and palliative care has been defined as a concept of care which provides coordinated medical, nursing and allied services for people who have a terminal illness, delivered where possible in the environment of the person's choice, and which provides physical, psychological, emotional and spiritual support for patients and for patients' families and friends. The provision of hospice and palliative care services includes grief and bereavement support for the family and other carers during the life of the patient, and continuing after death, 1 where appropriate. Palliative care: stresses advanced planning rather than crisis intervention; offers a multidisciplinary model of care which is focussed on the whole person within their social and emotional context, rather than just the one disease; and requires a good knowledge of the natural history of the disease and relevant oncological practice.2 and aripiprazole.
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Alsmede een in de Verenigde Staten gevestigde vennootschap First International Trade S.A., blijkens het factuurpapier overigens met een vertegenwoordigend kantoor in Congo-Brazzaville. De Bradbury-transacties moesten betaald worden op een Luxemburgse bankrekening. Uit prod. 17 zijdens Glaxo, eveneens kopien uit de boekhouding van Asklepios, blijkt echter dat in ieder geval bepaalde voor Bradbury bestemde medicijnen afkomstig waren uit Ivoorkust bijvoorbeeld de exportverklaring Eur. 1 A No. 0354439 d.d. 6 november 2001: Pays . ; dont les produits sont considrs commes originaires: Cte d'Ivoire . ; Pays . ; de destination: France hoewel op hetzelfde formulier als Destinataire staat aangegeven Bradbury met een Luxemburgs adres ; , met onder het kopje Observations vervolgens de opmerking: Origine: Cte d'Ivoire ; . Andere toeleveranciers van uiteindelijk ; Asklepios waren blijkens deze als prod. 17 overgelegde documentatie Afrique Aide uit Guinee douaneaangifteformulier d.d. 30 november 2001, waarin tegelijkertijd als land van verzending uitvoer Frankrijk wordt opgegeven en als land van bestemming Belgi ; , Pharmacie de Gbossime uit Togo daaropvolgend douaneformulier uit prod. 17 met onleesbare datum ; , Sougoumar Keita te Senegal douaneformulieren d.dis. 21 en 26 februari 2002, 8 april 2002 2x , terwijl verder in prod. 17 nog op een aantal douaneformulieren zonder nader aanstonds te traceren afzender anders dan met een lang nummer ; staat aangegeven dat het medicijnen betreft met als land van verzending uitvoer Kongo 1x ; , Guinee 1x ; , Ivoorkust 3x ; , Togo 6x ; en Senegal 7x ; . Uit prod. 18 van Glaxo, eveneens kopien uit de administratie van Asklepios, blijkt tenslotte dat substantile bedragen rechtstreeks aan Afrikaanse banken dienden te worden betaald. Ook is door Glaxo terecht bij pleidooi aangevoerd dat uit prod. 44 van Asklepios c.s. pv verhoor Bellavoine ; blijkt dat de HIV-remmers na aankomst in Dakar vanuit de loods van de door Glaxo ingeschakelde vervoerder Saga Air in opslag zijn gekomen bij Transcontinental Transit, alwaar AAA over deze medicijnen kon beschikken. Ook dat wijst bepaald niet op een transit status. 3.13 Benard heeft in de geschetste omstandigheden niet mogen afgaan op de enkele mededeling van Bellavoine dat het transitgoederen zou betreffen. Zeker niet nu eveneens uit meerbedoelde eigen administratieve bescheiden van Asklepios blijkt dat door Asklepios substantile bedragen moesten worden betaald in Afrika zelf of op Luxemburgse bankrekeningen. Daarbij is medebeslissend de kennelijk lucratieve marge die door Asklepios kon worden gemaakt ondanks haar op zichzelf geringe zakelijke inspanningen, gegeven het haar al aangedragen zijn van klanten ; , zoals door Glaxo becijferd en door Asklepios c.s. onvoldoende steekhoudend weersproken. Ook al zou de stelling van Asklepios c.s. juist zijn dat in de medicijnen-parallelhandel zeer grote marges haalbaar zijn, dan had zij als ervaren marktspeler juist met HIV-remmers uit Afrika onraad moeten ruiken. Naar het oordeel van de rechtbank hebben Asklepios c.s. daarmee willens en wetens het risico op de koop toe genomen dat geprofiteerd werd van fraude en zodoende een zorgvuldigheidsnorm jegens Glaxo geschonden. Voor de vestiging van hun aansprakelijkheid uit onrechtmatige daad merkinbreuk ; jegens Glaxo is dat naar het oordeel van de rechtbank voldoende. De vraag of ook overigens, buiten merkinbreukcontext, onrechtmatig is gehandeld jegens Glaxo door Asklepios c.s. zoals Glaxo heeft aangevoerd maar zijdens Asklepios c.s. is bestreden, onder meer met een beroep op art. 6: 163 BW en de dat verband besproken correctie-Langemeijer, kan bij die stand van zaken naar het oordeel van de rechtbank buiten beoordeling blijven. Voor zover zijdens Glaxo is aangevoerd dat Asklepios c.s. onrechtmatig hebben gehandeld door te profiteren van wanprestatie, heeft te gelden dat enkel profiteren daarvan geen onrechtmatige daad constitueert en onvoldoende aanvullende feiten zijn gesteld die dat anders zou kunnen maken. De merkinbreuk zelf is in de gegeven situatie voldoende voor vestiging van aansprakelijkheid terzake waarvan Asklepios schadeplichtig is. Voor het overige is de enkele prijsstelling van de door Asklepios betrokken medicijnen, ook al is die.
The teacher leads a discussion and, using an example such as a "youth group, " the class discusses the potential influence the group has regarding the members' health. Using the Trading Card Technique, the class generates ideas on how belonging to a group can influence one's health in a positive relationships, experience safe environments ; and or negative gang allegiance, peer pressure and risky behaviours ; way. The teacher provides each student with two index cards. On one card each student will identify a group and its positive influence on health. On the second card each is to identify a group and its negative influence on health. Students are not to put their names on the cards; anonymity works well when you think an individual may have reasons not to disclose information to the entire group. The teacher collects the cards, shuffles them and redistributes the cards to the class. Working in small groups, students discuss the information on the index cards and identify what makes a group healthy versus unhealthy. One person reports to the entire class or places information on class flip chart.
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Appendix E: Specifications in the Special Orders Sent to Brand-Name Companies In addition to routine questions about the name, address, and incorporation date of the responding company and its subsidiaries, and the name, business address, and official capacity of the official supervising the company's response, the FTC asked brand-name companies the company ; to provide answers to the following five questions about specific drugs: 1. Submit all agreements between the company and any person1 including corporations or other business entities acquired since the agreement s ; was were ; executed ; executed after December 31, 1994, 2 relating to3 an ANDA involving any Drug Product, 4 where the company holds the rights to the NDA corresponding to the ANDA that is the subject of the agreement. Examples of such agreements include, but are not limited to: a ; patent litigation settlements full or partial ; between the company and persons that have filed an ANDA involving any Drug Product; b ; agreements related to the filing or non-filing ; of an ANDA by any applicant or potential applicant ; involving any Drug Product; c ; licensing agreements between the company and persons that have filed an ANDA involving any Drug Product; and d ; agreements related to any acquisition, divestiture, joint venture, alliance, license or merger by the company of any business involving the research, development, manufacture or sale of any Drug Product that is the subject of an ANDA. The company is not required to submit purchase orders for raw material supplies, equipment and facility contracts, or employment or consulting contracts, nor is the company required to submit agreements executed after the generic manufacturer had begun commercial marketing of the generic Drug Product corresponding to the ANDA for which it had received FDA approval. The company also is not required to submit information that has already been submitted to the Commission pursuant to the Premerger Notification Rules 16 CFR 801-803 1998 and Section 7A of the Clayton Act 15 U.S.C. 18a ; , or Sections 6, 9, 13, and 20 of the Federal Trade Commission Act 15 U.S.C. 46, 49, 53, and 57b-1 ; , although the company must identify such information as having been previously submitted. For any such agreement submitted, also submit all studies, surveys, analyses and reports which were prepared by or for any officer s ; or director s ; of the company or, in the case of unincorporated entities, individuals exercising similar functions ; that evaluate or analyze the reasons for making such agreement or any of the provisions in such agreement ; , and indicate if not contained in the document itself ; the date of preparation, and the name and title of each individual who prepared each such document.
Supplemental contracting officer's statement at 3; supplemental report at 1 any event, we note that such a determination of therapeutic interchangeability involves a matter of the agency's medical judgments and policies and is not for our review.
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