2012年1月5日星期四

No one in this country has ever been sued for giving epinephrine

Ammaria Johnson, 7, died Monday after suffering an allergic reaction during recess at her Chesterfield County moncler jackets elementary school, Hopkins Elementary.

"She came to the school clinic after feeling she had hives and shortness of breath," Lt. Jason Elmore, a spokesman for the Chesterfield County Fire Department, told ABC News. It's unclear how long Johnson was in the clinic before school officials called 911 at 2:26 p.m.

"When emergency crews arrived, she was already in cardiac arrest in the clinic," said Elmore.

Johnson was rushed to a local hospital where she was pronounced dead.

What caused the reaction is still under investigation, but Johnson's mother, Laura Pendleton, told local reporters the girl had a peanut allergy.

"We can only assume that at this time," said Elmore. "We have EMS protocols in place for allergic reactions and we performed those in hopes of saving her life, but unfortunately this time we could not."

Calls to Pendleton were not immediately returned. She arrived at the hospital after Johnson had died, Elmore said.

The death is still under investigation by the Chesterfield County Police Department, according to a spokeswoman, but the state medical examiner will not be involved.

Experts say Johnson could have been saved by an EpiPen -- a device that injects epinephrine, currently available only by prescription.

"The epinephrine reverses severe moncler jackets symptoms, giving time to get the person to an emergency room for monitoring and more care," said Dr. Scott Sicherer of the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York.

But Hopkins Elementary had no such device on hand for Johnson.

Chesterfield County school policy states that parents are responsible for providing the school "with all daily and emergency medications prescribed by the student's health-care provider," and keeping medications up to date.

"For any medication, the school would have to be in possession of that medication to provide it," said Shawn Smith, a spokesman for Chesterfield County Public Schools. Even if the school had an EpiPen prescribed for another student, they would not be able to use it.

"The medication we receive, or should receive, has to be specific to that child, whether it's over-the-counter or prescription," Smith said.

Smith declined to comment on Johnson's case specifically, but said managing severe allergies starts at home.

"At the beginning of the school year, we sent information to parents outlining the different responsibilities for the family and the child, the principal, the teacher, the doctor and the nurse," he said. "First and foremost, is does begin at home. Working with their doctor, the family would outline a health care plan that deals with those severe allergies."

Pendleton told local reporters her daughter did have a plan, but said the school refused to take Johnson's EpiPen and failed to give her Benedryl -- an over-the-counter antihistamine also listed in her plan -- at the first sign of a reaction.

Because severe allergies can develop without warning, some experts say schools should stock EpiPens like bandages and other first-aid supplies.

"There are kids who don't know they're food allergic until they get into the food," said Dr. Dan Atkins, head of ambulatory pediatric at National Jewish Health in Denver. "In that situation, it would be good to have an EpiPen available."

A school EpiPen stash could soon be a reality with a proposed bill that would encourage states to adopt laws requiring schools to have EpiPens on hand. The School Access to Emergency Epinephrine Act, proposed in December 2011, would mean EpiPens could be used for any student or staff member in an anaphylactic emergency.

"When it comes to a life-threatening allergic reaction, it's so simple to save that life," said Maria Acebal, chief executive officer of the Fairfax, Va.-based Food Allergy and Anaphylaxis Network, which championed the bill.Moncler women boots cheap sale, 2011 moncler winter boots outlet. "I have no doubt that the school where this little girl went had an EpiPen in the office -- it just didn't have Ammaria's name on it."

The bill would include liability protection for school officials who give epinephrine in good faith, Acebal said.

"No one in this country has ever been sued for giving epinephrine, to my knowledge," said Acebal. "All the lawsuits come about because school officials don't give it when it's needed."

In a healthy child, epinephrine can cause a rapid heart rate, nausea and light-headedness -- mild symptoms that wear off in 15 minutes. It would only be dangerous in children born with a congenital heart condition, which school officials would be aware of.

"We need to do a better job of educating the public about the safety of epinephrine," said Atkins. "Because it's an injection, it scares people. And because it's a device, it scares people. But rather than thinking, 'I might kill a kid with this,' they should be thinking, 'I could save a life.'"

Acebal, whose eldest daughter has a food allergy, said her other children learned how to inject epinephrine by age 6.

"If I can teach a 6-year-old to do it, we can teach school staff," she said.

Acebal said having epinephrine cheap moncler on hand in school would give students, staff and parents added peace of mind.

2012年1月4日星期三

We are at the moment

The step was a reversal of the Taliban’s longstanding public denials that they were involved in, or even willing to consider, talks related to their insurgency, and it had the potential to revive a reconciliation effort that stalled in September, with the assassination of the head of Afghanistan’s High Peace Council. Cheap burberry - designer bags, shoes, accessories, clothing outlet 2012.

It was unclear, however, whether the Taliban were interested in working toward a comprehensive peace settlement or mainly in ensuring that NATO ends its operations in Afghanistan as scheduled in 2014, which would remove a major obstacle to the Taliban’s return to power in all or part of the country.

In a statement, Zabiullah Mujahid, a spokesman for the Taliban, said that along with a preliminary deal to set up the office in Qatar, the group was asking that Taliban detainees held at the American prison in Guantánamo Bay, Cuba, be released. Mr. Mujahid did not say when the Qatar office would be opened, or give specifics about the prisoners the Taliban wanted freed.

“We are at the moment, besides our powerful presence inside the country, ready to establish a political office outside the country to come to an understanding with other nations,” the statement said.

American officials have said in recent months that the opening of a Taliban mission would be the single biggest step forward for peace efforts that have been plagued by false starts. The most embarrassing came in November 2010, when it emerged that an impostor had fooled Western officials into thinking he represented the Taliban and then had disappeared with hundreds of thousands of dollars used to woo him.

The official killed in September, Burhanuddin Rabbani, had been greeting a supposed Taliban negotiator when the man detonated a bomb in his turban.

The opening of an office in Qatar is meant to give Afghan and Western peace negotiators an “address” where they can openly contact legitimate Taliban intermediaries. That would open the way for confidence-building measures that Washington hopes to press forward in the coming months. Chief among them, American officials said, is the possibility of transferring a number of “high-risk” detainees — including some with ties to Al Qaeda — to Afghan custody from Guantánamo Bay. The prisoners would then presumably be freed later.

American officials said they would consider transferring only those prisoners the Afghan authorities requested. Among the names being discussed are Muhammad Fazl, the former Taliban deputy defense minister; two former provincial governors, Khairullah Khairkhwa of Herat and Noorullah Nori of Balkh; Abdul Haq Wasiq, a former top Taliban intelligence official; and one of the Taliban’s top financiers, Muhammad Nabi. Mr. Fazl is accused of having commanded forces that killed thousands of Shiite Muslims, who are a minority in Afghanistan, while the Taliban ruled the country.

The American officials said that another idea under consideration was the establishment of cease-fire zones within Afghanistan, although that prospect was more uncertain and distant. The officials asked not to be identified because of the delicacy of the talks.

Some analysts are skeptical of the prospect for meaningful peace negotiations with the Taliban. The Taliban are viewed as unlikely to cede significant ground at a time when NATO has begun to withdraw troops and intends to end combat operations here in less than three years. Another uncertainty is the role of Pakistan, which provides safe haven to Taliban leaders and has undermined past efforts at reconciliation talks that it sees as jeopardizing its interests.

But American officials have said for years that the war in Afghanistan would ultimately require a political solution. The “surge” of additional troops at the end of 2009 has largely been aimed at getting the Taliban to the negotiating table from www.cheapburberryoutlet2012.com.

On Tuesday, the White House affirmed the necessity of a negotiated solution. Tommy Vietor, a spokesman for the White House’s National Security Council, said in an e-mail that such “Afghan-led peace initiatives” were central to the American strategy of “denying Al Qaeda a safe haven, reversing the Taliban’s momentum, and strengthening the capacity of Afghanistan’s security forces and government.”

In three complementary crossover trials

Anti-herpetic agents reduce recurrence of herpes simplex-2 (HSV-2) symptoms but do not completely block subclinical shedding of moncler jackets virus, even at high doses, researchers reported.

In three complementary crossover trials, short episodes of genital shedding occurred despite daily therapy, according to Christine Johnston, MD, of the University of Washington in Seattle, and colleagues.

The finding may explain why even high doses of anti-herpetic drugs do not prevent transmission of the virus, Johnston and colleagues suggested online in The Lancet.

The researchers enrolled 113 patients with confirmed HSV-2 infection for the three trials, which tested:

No medication against a standard 400-milligram dose of acyclovir (Zovirax) twice a day
A standard 500-milligram dose of valacyclovir (Valtrex) once a day, against 800 milligrams of acyclovir three times daily
Standard-dose valacyclovir against 1 gram of valacyclovir three times daily

Participants in each trial were assigned to one of the arms for four through seven weeks, had a week without any treatment, and then moncler jackets for women were crossed over to the other arm.

They took genital swabs four times a day and all told collected 23,605 swabs, of which 1,272 (or 5.4%) were positive for HSV-2.

Johnston and colleagues reported that 23 participants took 2,123 swabs while receiving no medication, and the virus was found in 384 (or 18%) of them.

In comparison, all of the drug regimens reduced the frequency of detection of the virus on swabs to between 1% (for standard-dose acyclovir) and 6% (for standard-dose valacyclovir).

Despite that, the researchers reported, "breakthrough reactivation occurred at all drug doses."

The number of such episodes per person year – the annualized episode rate – ranged from a high of 28.7 for no medication to a low of 10 for standard-dose acyclovir, while in the other four treatment groups the rates ranged from 14.9 to 22.6.

The number of episodes per person-year did not differ significantly for standard-dose valacyclovir versus high-dose acyclovir (22.6 versus 20.2, P=0.54), and standard-dose valacyclovir versus high-dose valacyclovir (14.9 versus 16.5; P=0.34), but did for no medication and standard-dose aciclovir (28.7 versus 10, P=0.001).

The researchers noted that the drugs benefit patients by reducing clinical recurrences.

But, they added, the outcome "suggests that the maximum benefit of shedding reduction has probably been reached for currently moncler 2011 available antiviral drugs."

The findings "should encourage patients to use condoms and adopt safe sex practices," commented Philippe Van de Perre, MD, PhD, and Nicolas Nagot, MD, both of Université Montpellier in Montpellier, France.

In an accompanying commentary, they argued that new drugs would help, as long as they had good coverage and long-term adherence.

But those needs "are unlikely to be met," they noted, because about 20% of people in the U.S. and Europe are infected with HSV-2, "most of whom have no clinical need for anti-herpetic therapy."

In the absence of new drugs, other tools, such as vaccines, will be needed, but their development has been hampered by the lack of both a good animal model and pharmaceutical company commitment, they concluded.

The study was supported by the National Institutes of Health. The journal said Johnston reported financial links with AiCuris, GmbH, which is developing treatments for herpes simplex virus. Several other authors also reported financial links with industry.

The journal said the editorial writers cheap moncler declared they had no conflicts.

2012年1月3日星期二

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There have been short supplies of drugs to treat infections

That's no surprise to people who've gone from pharmacy to pharmacy trying to fill their child's prescription -- or to moncler jackets those who've had to pay high prices for brand-name drugs to treat ADHD (attention deficit hyperactivity disorder).

The drugs in question are stimulants that calm and focus people with ADHD. The shortages have affected the two main classes of ADHD drugs: methylphenidates and amphetamines.

Some popular drugs, such as Novartis' Ritalin LA, are in short supply in some dosages but not in others. Other drugs, such as Teva's extended-release amphetamine, are on back order. Still others, such as Shire's Adderall XR and its two "authorized generics" are in good supply, according to the FDA and the American Society of Health-System Pharmacists.

One reason for the shortage is extremely high demand for the drugs. While people with ADHD make up nearly all of the legitimate market, there's a huge demand for off-label and illicit use of stimulant drugs. Many companies say they simply can't keep up with this demand.

So why don't the companies simply make more ADHD drugs? One reason is that these drugs are controlled substances. The Drug Enforcement Administration (DEA) decides how much of each controlled substance the U.S. legitimately needs -- and then sets quotas on how much manufacturers can produce.

Since 2007, the U.S. has been limited to 50,000 kilograms of methylphenidate. The amphetamine quota went up to 18,600 kilograms in 2009. Several drugmakers have publicly stated that these constraints have cheap moncler jackets limited their ability to meet demand.

"The DEA's point of view is there is plenty of the active ingredient out there," DEA spokeswoman Barbara Carreno tells WebMD. "The DEA is tasked with making sure there is enough for legitimate need without making so much (that) it is diverted for illicit purposes. So we try to ascertain the legitimate medical need in America and make sure there is enough out there to meet it."

Last month, the DEA announced that the 2012 quota for methylphenidate will increase to 56,000 kilograms, and the quota for amphetamine will increase to 25,300 kilograms. It remains to be seen whether these increases will ease ADHD drug shortages.
Shortage Points to Bigger Problem

The shortage of ADHD drugs is a symptom of a larger problem facing the nation's drug supply. Supplies of many different kinds of drugs are becoming hard to predict.

According to IMS, a medical informatics firm, more than 80% of drug shortages are generics. Cancer drugs are particularly likely to be in short supply. They made up 28% of all shortages in 2010 to 2011, the FDA reports.

But it's not just cancer. There have been short supplies of drugs to treat infections, heart disease, nervous system disorders, and pain, IMS reports.

In October 2011, the FDA issued a special report on drug shortages. Among its findings:

From 2005 to 2010, the number of drug shortages tripled from 61 to 178.
The leading reasons for drug shortages are problems at the manufacturing facility (43%), delays in manufacturing or shipping (15%), and shortages of the active ingredient (10%).
"Just in time" manufacturing and inventory practices "leave little room for error."Moncler vest for men, buy cheap moncler mens vests online.The vast majority of drug shortages -- 130 of the 178 shortages in 2010 -- were sterile injectable drugs.

And the less that gets disseminated to the public

David Caplan, a celebrity-news editor who has worked at People and Star, noted that confirming separations during a busy time falls under "PR 101." "Burying a celeb split over a holiday is a time-honored celeb tradition, really kicked off by Jessica Simpson and Nick Lachey back in the day, when they finally split and announced it the night before Thanksgiving," he explained. "It's a smart tactical move on their end, as it gets buried a bit because of all the year-end news." Cheap burberry - designer bags, shoes, accessories, clothing outlet 2012.

See a timeline of Katy Perry and Russell Brand's relationship.

Caplan added that it's not just about a slower news cycle, but also a slower work schedule for those in the celebrities' inner circle and those who get paid to follow celeb news. "From a logistics point of view, news outlets, particularly the celebrity media, are either shut down or working with a skeletal staff, so pursuing the story and advancing it is difficult since it simply means there are less reporters available to dig further and to disseminate the story to the public," he noted. "Plus, celeb publicists are typically not too available over a holiday, which makes getting info harder for the journalist, which means less gets disseminated to the public cheap moncler.

"And the less that gets disseminated to the public, particularly anything that Katy or Russell's publicists didn't send out, the happier Katy and Russell are, since they're, in a way, controlling the flow and content of information about their split to the public."

While more details begin to leak from inside their now-defunct relationship, one expert explained that it's only a matter of time before even more specifics come out. "Holidays are always the time when moncler jackets celebs think they bury bad news, but those days are over," explained Rob Shuter, columnist for HuffPost Celebrity. "Now the news cycle is 24/7, 365 days a year. I'm sure over the next few weeks, we will all know exactly what went wrong."

2012年1月2日星期一

Manning threw three touchdown passes

Manning threw three touchdown passes, including a momentum-grabbing 74-yarder to rising star Victor Cruz, and the Giants claimed the final spot in the NFL playoffs, beating the Cowboys 31-14 on Sunday night to win the NFC East moncler jackets.

"We've had a lot of ups and down, but when our team needed it most we responded," said Cruz, who capped his team-record setting season with six catches for 178 yards. "We were able to keep level-headed when we were on the four-game skid."

New York (9-7) won three of its final four games for their 65-year-old coach and earned a wild-card game at home next Sunday against the Atlanta Falcons (10-6).

The Giants, who opened the season 6-2, haven't won a playoff game since beating the-then unbeaten New England Patriots in the Super Bowl in February 2008. However, they seem to be peaking much as they did at the end of that regular season.

Linebacker Mathias Kiwanuka believes the Giants are capable of making another run after dominating an all-or-nothing game that left Cowboys owner Jerry Jones frustrated.

"There is no doubt," Kiwanuka said. "That's what we are setting ourselves up for. We went a roundabout way of doing it, but once you're in, you're in."

The Cowboys (8-8) are out after losing four of their final five games in their first full season under coach Jason Garrett.

"It's extremely painful and it's a damn shame," Jones said. "We have a good team and I thought we would be going to the playoffs, but that didn't happen. We have to be able to take some of the good with the bad and move on. We did a lot of good things this year, but to point to one thing why this happened would be subjective. We're 8-8 and we have to be better than that cheap moncler."

Dallas was its own worst enemy with the season on the line. It missed tackles on all three of the Giants' three first-half touchdowns, failed to recover two fumbles within its grasp in the half and failed to convert on a Tony Romo sneak on fourth-and-1 at the Giants 10 while trailing 21-7.

Romo, who played with a bruised right hand, moved the Cowboys in the second half, but touchdown passes of 34 yards and 6 yards to Laurent Robinson weren't enough to rally Dallas.

"You can't make excuses,' said Romo, who finished 29 of 37 for 289 yards and one interception. "Either you win or you go home. Give them credit for coming in here and being ready. This is not going to sit well with me or anyone else on this team. It should fuel the fire to come back, but right now, it hurts."

The shorter touchdown pass to Robinson got Dallas within a 21-14 with 10:15 to play, but Cruz, the second-year pro from nearby Paterson who has become a fan favorite with a big plays and salsa celebrations, came through again.

Cruz boxed-out cornerback Orlando Scandrick on 44-yard third-down jump-ball catch and caught another for 20 yards to set up a 28-yard Lawrence Tynes' field goal. Manning iced the Giants' second win over Dallas in four weeks with a 4-yard TD pass to Hakeem Nicks with 3:41 to play cheap burberry outlet 2012.