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enalapril maleate tablet
|Six Months
|One Year
|Enalapril maleate (n=127)
|Placebo (n=126)
In both CONSENSUS and SOLVD-Treatment trials, patients were also usually receiving digitalis, diuretics or both.
Clinical Pharmacology in Pediatric Patients
A multiple dose pharmacokinetic study was conducted in 40 hypertensive male and female pediatric patients aged 2 months to ≤16 years following daily oral administration of 0.07 to 0.14 mg/kg enalapril maleate. At steady state, the mean effective half-life for accumulation of enalaprilat was 14 hours and the mean urinary recovery of total enalapril and enalaprilat in 24 hours was 67% of the administered dose. Conversion of enalapril to enalaprilat was in the range of 64-76%. The overall results of this study indicate that the pharmacokinetics of enalapril in hypertensive children aged 2 months to ≤16 years are consistent across the studied age groups and consistent with pharmacokinetic historic data in healthy adults.
In a clinical study involving 110 hypertensive pediatric patients 6 to 16 years of age, patients who weighed <50 kg received either 0.625, 2.5 or 20 mg of enalapril daily and patients who weighed ≥50 kg received either 1.25, 5, or 40 mg of enalapril daily. Enalapril administration once daily lowered trough blood pressure in a dose-dependent manner. The dose-dependent antihypertensive efficacy of enalapril was consistent across all subgroups (age, Tanner stage, gender, race). However, the lowest doses studied, 0.625 mg and 1.25 mg, corresponding to an average of 0.02 mg/kg once daily, did not appear to offer consistent antihypertensive efficacy. In this study, enalapril maleate was generally well tolerated.
In the above pediatric studies, enalapril maleate was given as tablets of enalapril maleate and for those children and infants who were unable to swallow tablets or who required a lower dose than is available in tablet form, enalapril was administered in a suspension formulation (see Preparation of Suspension under DOSAGE AND ADMINISTRATION).
Enalapril maleate tablets are indicated for the treatment of hypertension.
Enalapril maleate tablets are effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. The blood pressure lowering effects of Enalapril maleate tablets and thiazides are approximately additive.
Heart Failure
Enalapril maleate tablets are indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis. In these patients enalapril maleate tablets improve symptoms, increases survival, and decreases the frequency of hospitalization (see CLINICAL PHARMACOLOGY, Heart Failure, Mortality Trials for details and limitations of survival trials).
Asymptomatic Left Ventricular Dysfunction
In clinically stable asymptomatic patients with left ventricular dysfunction (ejection fraction ≤35 percent), enalapril maleate tablets decreases the rate of development of overt heart failure and decreases the incidence of hospitalization for heart failure. (See CLINICAL PHARMACOLOGY, Heart Failure, Mortality Trials for details and limitations of survival trials.)
In using enalapril maleate tablets consideration should be given to the fact that another angiotensin converting enzyme inhibitor, captopril, has caused agranulocytosis, particularly in patients with renal impairment or collagen vascular disease, and that available data are insufficient to show that enalapril maleate tablets does not have a similar risk. (See WARNINGS.)
In considering use of enalapril maleate tablets, it should be noted that in controlled clinical trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks. In addition, it should be noted that black patients receiving ACE inhibitors have been reported to have a higher incidence of angioedema compared to non-blacks. (See WARNINGS, Angioedema.)
Enalapril maleate tablets are contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema.
Presumably because angiotensin-converting enzyme inhibitors affect the metabolism of eicosanoids and polypeptides, including endogenous bradykinin, patients receiving ACE inhibitors (including Enalapril maleate tablets) may be subject to a variety of adverse reactions, some of them serious.
Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in patients treated with angiotensin converting enzyme inhibitors, including enalapril maleate. This may occur at any time during treatment. In such cases enalapril maleate should be promptly discontinued and appropriate therapy and monitoring should be provided until complete and sustained resolution of signs and symptoms has occurred. In instances where swelling has been confined to the face and lips the condition has generally resolved without treatment, although antihistamines have been useful in relieving symptoms. Angioedema associated with laryngeal edema may be fatal. Where there is involvement of the tongue, glottis or larynx, likely to cause airway obstruction, appropriate therapy, e.g., subcutaneous epinephrine solution 1:1000 (0.3 mL to 0.5 mL) and/or measures necessary to ensure a patent airway, should be promptly provided. (See ADVERSE REACTIONS.)
Patients with a history of angioedema unrelated to ACE inhibitor therapy may be at increased risk of angioedema while receiving an ACE inhibitor (see also INDICATIONS AND USAGE and CONTRAINDICATIONS).
Anaphylactoid reactions during desensitization:
Two patients undergoing desensitizing treatment with hymenoptera venom while receiving ACE inhibitors sustained life-threatening anaphylactoid reactions. In the same patients, these reactions were avoided when ACE inhibitors were temporarily withheld, but they reappeared upon inadvertent rechallenge.
Anaphylactoid reactions during membrane exposure:
Anaphylactoid reactions have been reported in patients dialyzed with high-flux membranes and treated concomitantly with an ACE inhibitor. Anaphylactoid reactions have also been reported in patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption.
Excessive hypotension is rare in uncomplicated hypertensive patients treated with enalapril maleate alone. Patients with heart failure given enalapril maleate commonly have some reduction in blood pressure, especially with the first dose, but discontinuation of therapy for continuing symptomatic hypotension usually is not necessary when dosing instructions are followed; caution should be observed when initiating therapy. (See DOSAGE AND ADMINISTRATION.) Patients at risk for excessive hypotension, sometimes associated with oliguria and/or progressive azotemia, and rarely with acute renal failure and/or death, include those with the following conditions or characteristics: heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of any etiology. It may be advisable to eliminate the diuretic (except in patients with heart failure), reduce the diuretic dose or increase salt intake cautiously before initiating therapy with enalapril maleate in patients at risk for excessive hypotension who are able to tolerate such adjustments. (See PRECAUTIONS, Drug Interactions and ADVERSE REACTIONS.) In patients at risk for excessive hypotension, therapy should be started under very close medical supervision and such patients should be followed closely for the first two weeks of treatment and whenever the dose of enalapril and/or diuretic is increased. Similar considerations may apply to patients with ischemic heart or cerebrovascular disease, in whom an excessive fall in blood pressure could result in a myocardial infarction or cerebrovascular accident.
If excessive hypotension occurs, the patient should be placed in the supine position and, if necessary, receive an intravenous infusion of normal saline. A transient hypotensive response is not a contraindication to further doses of enalapril maleate, which usually can be given without difficulty once the blood pressure has stabilized. If symptomatic hypotension develops, a dose reduction or discontinuation of enalapril maleate or concomitant diuretic may be necessary.
Another angiotensin converting enzyme inhibitor, captopril, has been shown to cause agranulocytosis and bone marrow depression, rarely in uncomplicated patients but more frequently in patients with renal impairment especially if they also have a collagen vascular disease. Available data from clinical trials of enalapril are insufficient to show that enalapril does not cause agranulocytosis at similar rates. Marketing experience has revealed cases of neutropenia or agranulocytosis in which a causal relationship to enalapril cannot be excluded. Periodic monitoring of white blood cell counts in patients with collagen vascular disease and renal disease should be considered.
Hepatic Failure
Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis, and (sometimes) death. The mechanism of this syndrome is not understood. Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receive appropriate medical follow-up.
Fetal/Neonatal Morbidity and Mortality
ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women. Several dozen cases have been reported in the world literature. When pregnancy is detected, ACE inhibitors should be discontinued as soon as possible.
The use of ACE inhibitors during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal renal function; oligohydramnios in this setting has been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity, intrauterine growth retardation, and patent ductus arteriosus have also been reported, although it is not clear whether these occurrences were due to the ACE-inhibitor exposure.
These adverse effects do not appear to have resulted from intrauterine ACE-inhibitor exposure that has been limited to the first trimester. Mothers whose embryos and fetuses are exposed to ACE inhibitors only during the first trimester should be so informed. Nonetheless, when patients become pregnant, physicians should make every effort to discontinue the use of enalapril maleate as soon as possible.
Rarely (probably less often than once in every thousand pregnancies), no alternative to ACE inhibitors will be found. In these rare cases, the mothers should be apprised of the potential hazards to their fetuses, and serial ultrasound examinations should be performed to assess the intraamniotic environment.
If oligohydramnios is observed, enalapril maleate should be discontinued unless it is considered lifesaving for the mother. Contraction stress testing (CST), a non-stress test (NST), or biophysical profiling (BPP) may be appropriate, depending upon the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury.
Infants with histories of in utero exposure to ACE inhibitors should be closely observed for hypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion. Exchange transfusion or dialysis may be required as means of reversing hypotension and/or substituting for disordered renal function. Enalapril, which crosses the placenta, has been removed from neonatal circulation by peritoneal dialysis with some clinical benefit, and theoretically may be removed by exchange transfusion, although there is no experience with the latter procedure.
No teratogenic effects of enalapril were seen in studies of pregnant rats and rabbits. On a body surface area basis, the doses used were 57 times and 12 times, respectively, the maximum recommended human daily dose (MRHDD).
Aortic Stenosis/Hypertrophic Cardiomyopathy:
As with all vasodilators, enalapril should be given with caution to patients with obstruction in the outflow tract of the left ventricle.
Impaired Renal Function:
As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with angiotensin converting enzyme inhibitors, including enalapril maleate, may be associated with oliguria and/or progressive azotemia and rarely with acute renal failure and/or death.
In clinical studies in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in blood urea nitrogen and serum creatinine were observed in 20 percent of patients. These increases were almost always reversible upon discontinuation of enalapril and/or diuretic therapy. In such patients renal function should be monitored during the first few weeks of therapy.
Some patients with hypertension or heart failure with no apparent pre-existing renal vascular disease have developed increases in blood urea and serum creatinine, usually minor and transient, especially when enalapril maleate has been given concomitantly with a diuretic. This is more likely to occur in patients with pre-existing renal impairment. Dosage reduction and/or discontinuation of the diuretic and/or enalapril maleate may be required.
Evaluation of patients with hypertension or heart failure should always include assessment of renal function. (See DOSAGE AND ADMINISTRATION.)
Elevated serum potassium (greater than 5.7 mEq/L) was observed in approximately one percent of hypertensive patients in clinical trials. In most cases these were isolated values which resolved despite continued therapy. Hyperkalemia was a cause of discontinuation of therapy in 0.28 percent of hypertensive patients. In clinical trials in heart failure, hyperkalemia was observed in 3.8 percent of patients but was not a cause for discontinuation.
Risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium-containing salt substitutes, which should be used cautiously, if at all, with enalapril maleate. (See Drug Interactions.)
Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent nonproductive cough has been reported with all ACE inhibitors, always resolving after discontinuation of therapy. ACE inhibitor-induced cough should be considered in the differential diagnosis of cough.
In patients undergoing major surgery or during anesthesia with agents that produce hypotension, enalapril may block angiotensin II formation secondary to compensatory renin release. If hypotension occurs and is considered to be due to this mechanism, it can be corrected by volume expansion.
Information for Patients
Angioedema, including laryngeal edema, may occur at any time during treatment with angiotensin converting enzyme inhibitors, including enalapril. Patients should be so advised and told to report immediately any signs or symptoms suggesting angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing) and to take no more drug until they have consulted with the prescribing physician.
Patients should be cautioned to report lightheadedness, especially during the first few days of therapy. If actual syncope occurs, the patients should be told to discontinue the drug until they have consulted with the prescribing physician.
All patients should be cautioned that excessive perspiration and dehydration may lead to an excessive fall in blood pressure because of reduction in fluid volume. Other causes of volume depletion such as vomiting or diarrhea may also lead to a fall in blood pressure; patients should be advised to consult with the physician.
Patients should be told not to use salt substitutes containing potassium without consulting their physician.
Patients should be told to report promptly any indication of infection (e.g., sore throat, fever) which may be a sign of neutropenia.
Female patients of childbearing age should be told about the consequences of second- and third-trimester exposure to ACE inhibitors, and they should also be told that these consequences do not appear to have resulted from intrauterine ACE-inhibitor exposure that has been limited to the first trimester. These patients should be asked to report pregnancies to their physicians as soon as possible.
NOTE: As with many other drugs, certain advice to patients being treated with enalapril is warranted. This information is intended to aid in the safe and effective use of this medication. It is not a disclosure of all possible adverse or intended effects.
Drug Interactions
Hypotension — Patients on Diuretic Therapy:
Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with enalapril. The possibility of hypotensive effects with enalapril can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with enalapril. If it is necessary to continue the diuretic, provide close medical supervision after the initial dose for at least two hours and until blood pressure has stabilized for at least an additional hour. (See WARNINGS and DOSAGE AND ADMINISTRATION.)
Agents Causing Renin Release:
The antihypertensive effect of enalapril maleate is augmented by antihypertensive agents that cause renin release (e.g., diuretics).
Non-steroidal Anti-inflammatory Agents:
In some patients with compromised renal function who are being treated with non-steroidal anti-inflammatory drugs, the co-administration of enalapril may result in a further deterioration of renal function. These effects are usually reversible.
In a clinical pharmacology study, indomethacin or sulindac was administered to hypertensive patients receiving enalapril maleate. In this study there was no evidence of a blunting of the antihypertensive action of enalapril maleate. However, reports suggest that NSAIDs may diminish the antihypertensive effect of ACE inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE inhibitors.
Other Cardiovascular Agents:
has been used concomitantly with beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine, prazosin and digoxin without evidence of clinically significant adverse interactions.
Agents Increasing Serum Potassium:
Enalapril maleate attenuates potassium loss caused by thiazide-type diuretics. Potassium-sparing diuretics (e.g., spironolactone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium. Potassium sparing agents should generally not be used in patients with heart failure receiving enalapril maleate.
Lithium toxicity has been reported in patients receiving lithium concomitantly with drugs which cause elimination of sodium, including ACE inhibitors. A few cases of lithium toxicity have been reported in patients receiving concomitant enalapril maleate and lithium and were reversible upon discontinuation of both drugs. It is recommended that serum lithium levels be monitored frequently if enalapril is administered concomitantly with lithium.
Carcinogenesis, Mutagenesis, Impairment of Fertility
There was no evidence of a tumorigenic effect when enalapril was administered for 106 weeks to male and female rats at doses up to 90 mg/kg/day or for 94 weeks to male and female mice at doses up to 90 and 180 mg/kg/day, respectively. These doses are 26 times (in rats and female mice) and 13 times (in male mice) the maximum recommended human daily dose (MRHDD) when compared on a body surface area basis.
Neither enalapril maleate nor the active diacid was mutagenic in the Ames microbial mutagen test with or without metabolic activation. Enalapril was also negative in the following genotoxicity studies: rec-assay, reverse mutation assay with E. coli, sister chromatid exchange with cultured mammalian cells, and the micronucleus test with mice, as well as in an in vivo cytogenic study using mouse bone marrow.
There were no adverse effects on reproductive performance of male and female rats treated with up to 90 mg/kg/day of enalapril (26 times the MRHDD when compared on a body surface area basis).
Pregnancy Categories C (first trimester) and D (second and third trimesters). See WARNINGS, Fetal/Neonatal Morbidity and Mortality.
Nursing Mothers
Enalapril and enalaprilat have been detected in human breast milk. Because of the potential for serious adverse reactions in nursing infants from enalapril, a decision should be made whether to discontinue nursing or to discontinue enalapril maleate, taking into account the importance of the drug to the mother.
Pediatric Use
Antihypertensive effects of enalapril maleate have been established in hypertensive pediatric patients age 1 month to 16 years. Use of enalapril maleate in these age groups is supported by evidence from adequate and well-controlled studies of enalapril maleate in pediatric and adult patients as well as by published literature in pediatric patients. (See CLINICAL PHARMACOLOGY, Clinical Pharmacology in Pediatric Patients and DOSAGE AND ADMINISTRATION.)
Enalapril maleate is not recommended in neonates and in pediatric patients with glomerular filtration rate <30 mL/min/1.73 m2, as no data are available.
Enalapril maleate has been evaluated for safety in more than 10,000 patients, including over 1000 patients treated for one year or more. Enalapril maleate has been found to be generally well tolerated in controlled clinical trials involving 2987 patients.
For the most part, adverse experiences were mild and transient in nature. In clinical trials, discontinuation of therapy due to clinical adverse experiences was required in 3.3 percent of patients with hypertension and in 5.7 percent of patients with heart failure. The frequency of adverse experiences was not related to total daily dosage within the usual dosage ranges. In patients with hypertension the overall percentage of patients treated with enalapril maleate reporting adverse experiences was comparable to placebo.
Adverse experiences occurring in greater than one percent of patients with hypertension treated with enalapril maleate in controlled clinical trials are shown below. In patients treated with enalapril maleate, the maximum duration of therapy was three years; in placebo treated patients the maximum duration of therapy was 12 weeks.
|Enalapril maleate
(n = 2314)
(n = 230)
|Body As A Whole
|3.0 (<0.1)
|Orthostatic Effects
|1.2 (<0.1)
|1.1 (0.1)
|1.4 (<0.1)
|1.4 (0.2)
|5.2 (0.3)
|4.3 (0.4)
|1.3 (0.1)
|1.4 (0.4)
Adverse experiences occurring in greater than one percent of patients with heart failure treated with enalapril maleate are shown below. The incidences represent the experiences from both controlled and uncontrolled clinical trials (maximum duration of therapy was approximately one year). In the placebo treated patients, the incidences reported are from the controlled trials (maximum duration of therapy is 12 weeks). The percentage of patients with severe heart failure (NYHA Class IV) was 29 percent and 43 percent for patients treated with enalapril maleate and placebo, respectively.
|Enalapril maleate
(n = 673)
(n = 339)
|Body As A Whole
|Orthostatic Effects
|2.2 (0.1)
|2.2 (0.1)
|Chest Pain
|2.1 (0.0)
|1.8 (0.0)
|Abdominal Pain
|1.6 (0.4)
|1.6 (0.1)
|6.7 (1.9)
|Orthostatic Hypotension
|1.6 (0.1)
|Angina Pectoris
|1.5 (0.1)
|Myocardial Infarction
|1.2 (0.3)
|2.1 (0.1)
|1.3 (0.1)
|1.3 (0.0)
|7.9 (0.6)
|1.8 (0.1)
|1.6 (0.1)
|2.2 (0.0)
|1.3 (0.0)
|1.3 (0.1)
|1.0 (0.0)
|1.3 (0.0)
|Urinary Tract Infection
|1.3 (0.0)
Other serious clinical adverse experiences occurring since the drug was marketed or adverse experiences occurring in 0.5 to 1.0 percent of patients with hypertension or heart failure in clinical trials are listed below and, within each category, are in order of decreasing severity.
Body As A Whole: Anaphylactoid reactions (see WARNINGS, Anaphylactoid and Possibly Related Reactions).
Cardiovascular: Cardiac arrest; myocardial infarction or cerebrovascular accident, possibly secondary to excessive hypotension in high risk patients (see WARNINGS, Hypotension); pulmonary embolism and infarction; pulmonary edema; rhythm disturbances including atrial tachycardia and bradycardia; atrial fibrillation; palpitation, Raynaud's phenomenon.
Digestive: Ileus, pancreatitis, hepatic failure, hepatitis (hepatocellular [proven on rechallenge] or cholestatic jaundice) (see WARNINGS,Hepatic Failure), melena, anorexia, dyspepsia, constipation, glossitis, stomatitis, dry mouth.
Hematologic: Rare cases of neutropenia, thrombocytopenia and bone marrow depression.
Musculoskeletal: Muscle cramps.
Nervous/Psychiatric: Depression, confusion, ataxia, somnolence, insomnia, nervousness, peripheral neuropathy (e.g., paresthesia, dysesthesia), dream abnormality.
Respiratory: Bronchospasm, rhinorrhea, sore throat and hoarseness, asthma, upper respiratory infection, pulmonary infiltrates, eosinophilic pneumonitis.
Skin: Exfoliative dermatitis, toxic epidermal necrolysis, Stevens-Johnson syndrome, pemphigus, herpes zoster, erythema multiforme, urticaria, pruritus, alopecia, flushing, diaphoresis, photosensitivity.
Special Senses: Blurred vision, taste alteration, anosmia, tinnitus, conjunctivitis, dry eyes, tearing.
Urogenital: Renal failure, oliguria, renal dysfunction (see PRECAUTIONS and DOSAGE AND ADMINISTRATION), flank pain, gynecomastia, impotence.
Miscellaneous: A symptom complex has been reported which may include some or all of the following: a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia/myositis, fever, serositis, vasculitis, leukocytosis, eosinophilia, photosensitivity, rash and other dermatologic manifestations.
Angioedema: Angioedema has been reported in patients receiving enalapril maleate, with an incidence higher in black than in non-black patients. Angioedema associated with laryngeal edema may be fatal. If angioedema of the face, extremities, lips, tongue, glottis and/or larynx occurs, treatment with enalapril maleate should be discontinued and appropriate therapy instituted immediately. (See WARNINGS.)
Hypotension: In the hypertensive patients, hypotension occurred in 0.9 percent and syncope occurred in 0.5 percent of patients following the initial dose or during extended therapy. Hypotension or syncope was a cause for discontinuation of therapy in 0.1 percent of hypertensive patients. In heart failure patients, hypotension occurred in 6.7 percent and syncope occurred in 2.2 percent of patients. Hypotension or syncope was a cause for discontinuation of therapy in 1.9 percent of patients with heart failure. (See WARNINGS.)
Fetal/Neonatal Morbidity and Mortality: See WARNINGS, Fetal/Neonatal Morbidity and Mortality.
Cough:See PRECAUTIONS, Cough.
Pediatric Patients
The adverse experience profile for pediatric patients appears to be similar to that seen in adult patients.
Clinical Laboratory Test Findings
Serum Electrolytes:
Hyperkalemia (see PRECAUTIONS), hyponatremia.
Creatinine, Blood Urea Nitrogen:
In controlled clinical trials minor increases in blood urea nitrogen and serum creatinine, reversible upon discontinuation of therapy, were observed in about 0.2 percent of patients with essential hypertension treated with enalapril maleate alone. Increases are more likely to occur in patients receiving concomitant diuretics or in patients with renal artery stenosis. (See PRECAUTIONS.) In patients with heart failure who were also receiving diuretics with or without digitalis, increases in blood urea nitrogen or serum creatinine, usually reversible upon discontinuation of enalapril maleate and/or other concomitant diuretic therapy, were observed in about 11 percent of patients. Increases in blood urea nitrogen or creatinine were a cause for discontinuation in 1.2 percent of patients.
Small decreases in hemoglobin and hematocrit (mean decreases of approximately 0.3 g percent and 1.0 vol percent, respectively) occur frequently in either hypertension or congestive heart failure patients treated with enalapril maleate but are rarely of clinical importance unless another cause of anemia coexists. In clinical trials, less than 0.1 percent of patients discontinued therapy due to anemia. Hemolytic anemia, including cases of hemolysis in patients with G-6-PD deficiency, has been reported; a causal relationship to enalapril cannot be excluded.
Liver Function Tests
Elevations of liver enzymes and/or serum bilirubin have occurred (see WARNINGS, Hepatic Failure).
Limited data are available in regard to overdosage in humans.
Single oral doses of enalapril above 1,000 mg/kg and ≥1,775 mg/kg were associated with lethality in mice and rats, respectively.
The most likely manifestation of overdosage would be hypotension, for which the usual treatment would be intravenous infusion of normal saline solution.
Enalaprilat may be removed from general circulation by hemodialysis and has been removed from neonatal circulation by peritoneal dialysis. (See WARNINGS, Anaphylactoid reactions during membrane exposure.)
In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally may occur following the initial dose of enalapril maleate. The diuretic should, if possible, be discontinued for two to three days before beginning therapy with enalapril maleate to reduce the likelihood of hypotension. (See WARNINGS.) If the patient's blood pressure is not controlled with enalapril maleate alone, diuretic therapy may be resumed.
If the diuretic cannot be discontinued an initial dose of 2.5 mg should be used under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour. (See WARNINGS and PRECAUTIONS, Drug Interactions .)
The recommended initial dose in patients not on diuretics is 5 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 10 to 40 mg per day administered in a single dose or two divided doses. In some patients treated once daily, the antihypertensive effect may diminish toward the end of the dosing interval. In such patients, an increase in dosage or twice daily administration should be considered. If blood pressure is not controlled with enalapril maleate alone, a diuretic may be added.
Concomitant administration of enalapril maleate with potassium supplements, potassium salt substitutes, or potassium-sparing diuretics may lead to increases of serum potassium (see PRECAUTIONS).
Dosage Adjustment in Hypertensive Patients with Renal Impairment
The usual dose of enalapril is recommended for patients with a creatinine clearance >30 mL/min (serum creatinine of up to approximately 3 mg/dL). For patients with creatinine clearance ≤30 mL/min (serum creatinine ≥3 mg/dL), the first dose is 2.5 mg once daily. The dosage may be titrated upward until blood pressure is controlled or to a maximum of 40 mg daily.
|Renal Status
|Initial Dose
|Normal Renal Function
|>80 mL/min
|5 mg
|Mild Impairment
|≤80 >30 mL/min
|5 mg
|Moderate to Severe
|≤30 mL/min
|2.5 mg
|Dialysis Patients*
|2.5 mg on
dialysis days†
Heart Failure
Enalapril maleate is indicated for the treatment of symptomatic heart failure, usually in combination with diuretics and digitalis. In the placebo-controlled studies that demonstrated improved survival, patients were titrated as tolerated up to 40 mg, administered in two divided doses.
The recommended initial dose is 2.5 mg. The recommended dosing range is 2.5 to 20 mg given twice a day. Doses should be titrated upward, as tolerated, over a period of a few days or weeks. The maximum daily dose administered in clinical trials was 40 mg in divided doses.
After the initial dose of enalapril maleate, the patient should be observed under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour. (See WARNINGS and PRECAUTIONS, Drug Interactions.) If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension. The appearance of hypotension after the initial dose of enalapril maleate does not preclude subsequent careful dose titration with the drug, following effective management of the hypotension.
Asymptomatic Left Ventricular Dysfunction
In the trial that demonstrated efficacy, patients were started on 2.5 mg twice daily and were titrated as tolerated to the targeted daily dose of 20 mg (in divided doses).
After the initial dose of enalapril maleate, the patient should be observed under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour. (See WARNINGS and PRECAUTIONS, Drug Interactions.) If possible, the dose of any concomitant diuretic should be reduced which may diminish the likelihood of hypotension. The appearance of hypotension after the initial dose of enalapril maleate does not preclude subsequent careful dose titration with the drug, following effective management of the hypotension.
Dosage Adjustment in Patients with Heart Failure and Renal Impairment or Hyponatremia
In patients with heart failure who have hyponatremia (serum sodium less than 130 mEq/L) or with serum creatinine greater than 1.6 mg/dL, therapy should be initiated at 2.5 mg daily under close medical supervision. (See DOSAGE AND ADMINISTRATION, Heart Failure, WARNINGS and PRECAUTIONS, Drug Interactions.) The dose may be increased to 2.5 mg b.i.d., then 5 mg b.i.d. and higher as needed, usually at intervals of four days or more if at the time of dosage adjustment there is not excessive hypotension or significant deterioration of renal function. The maximum daily dose is 40 mg.
Pediatric Hypertensive Patients
The usual recommended starting dose is 0.08 mg/kg (up to 5 mg) once daily. Dosage should be adjusted according to blood pressure response. Doses above 0.58 mg/kg (or in excess of 40 mg) have not been studied in pediatric patients.
See CLINICAL PHARMACOLOGY, Clinical Pharmacology in Pediatric Patients.
Enalapril maleate tablets are not recommended in neonates and in pediatric patients with glomerular filtration rate <30 mL/min/1.73 m2, as no data are available.
Preparation of Suspension (for 200 mL of a 1.0 mg/mL suspension)
Add 50 mL of Bicitra®1 to a polyethylene terephthalate (PET) bottle containing ten 20 mg tablets of enalapril maleate and shake for at least 2 minutes. Let concentrate stand for 60 minutes. Following the 60-minute hold time, shake the concentrate for an additional minute. Add 150 mL of Ora-Sweet SF™2 to the concentrate in the PET bottle and shake the suspension to disperse the ingredients. The suspension should be refrigerated at 2-8°C (36-46°F) and can be stored for up to 30 days. Shake the suspension before each use.
Enalapril maleate tablets USP, 2.5 mg are yellow, round, scored tablets, imprinted "APO" bisect "049" on one side and plain on the other side. They are supplied as follows:
Bottles of 90 (NDC 60505-0049-6)
Bottles of 100 (NDC 60505-0049-7)
Bottles of 1000 (NDC 60505-0049-9)
Enalapril maleate tablets USP, 5 mg are white to off-white, round, scored tablets, imprinted "APO" bisect "050" on one side and plain on the other side. They are supplied as follows:
Bottles of 90 (NDC 60505-0050-6)
Bottles of 100 (NDC 60505-0050-7)
Bottles of 1000 (NDC 60505-0050-9)
Enalapril maleate tablets USP, 10 mg are red, round, unscored tablets, imprinted "APO" over "051" on one side and plain on the other side. They are supplied as follows:
Bottles of 90 (NDC 60505-0051-6)
Bottles of 100 (NDC 60505-0051-7)
Bottles of 1000 (NDC 60505-0051-9)
Enalapril maleate tablets USP, 20 mg are orange, round, unscored tablets, imprinted "APO" over "052" on one side and plain on the other side. They are supplied as follows:
Bottles of 90 (NDC 60505-0052-6)
Bottles of 100 (NDC 60505-0052-7)
Bottles of 1000 (NDC 60505-0052-9)
2.5 mg, 5 mg, 10 mg and 20 mg
Manufactured by:
Apotex Research Pvt. Ltd.
Bangalore 560 099, India
Manufactured for:
Apotex Corp.
Weston, Florida 33326
Revision: 1
March 2007
enalapril maleate tablet
enalapril maleate tablet
enalapril maleate tablet
enalapril maleate tablet
Revised: 08/2007 Apotex Corp.
Reproduced with permission of U.S. National Library of Medicine
Copyright © 2018
Drugsdb.eu by Dionisios Fentas || Terms of Use
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Roma never thought she would try bondage again but is persuaded by Chanta to give it a go. Tied tightly with her hands up high Roma struggles in the rope. Her nipples are clamped and her ass is flogged until red. A ball gag is picked up from the dirty floor and shoved into her mouth when she does not show respect to her Dominant. As Roma begins to submit, her attitude changes. She may not be the toughest slut around but she likes to be strictly bound and given forced orgasms. For this she is willing to give up her ass. Chanta begins with a hook, and then moves on to her big strapon cock, thrusting hard into Roma's almost virgin asshole! Roma requires more training and worships Chanta's strapon cock and then feet with her slut mouth. She is placed in a trunk and locked inside. This is her new home at the Twisted Factory!
File Size: 371 MB
Resolution: 640 x 480
Length: 00:59:00
Format: WMV
Pics: included
File size: 371.4 MB

subset: commoncrawl


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Advice & tips from Kelowna Electricians at Epic Electric Have you ever wondered why eating by candle light is considered to be ultra romantic? Or why relaxing in front of a crackling fire is relaxing and soothing? Softer lighting offers us a comfortable respite from… Read more >
Source: Epic Electric


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Strollers for newborns in HK?
- 05-28-2005, 11:06 PM #9Registered User
- Join Date
- Feb 2003
- Location
- Hong Kong
- Posts
- 757
When getting a stroller make sure that the height of the handles is good for you. I had one with my second child and for months I had pain at the back of my left shoulder. My sister who is an aromatherapist told me that the pain was because of muscle stress but I couldn't think what it was from. The pain went away when we stopped using the stroller. I still didn't link the pain until about six months later when I again used the stroller walking a friend's child. Suddenly I realized it was the stroller that had caused all the pain before. So please make sure that the handles are the right height for you.
- 10-30-2013, 01:44 AM #10Registered User
- Join Date
- Oct 2013
- Posts
- 9
I am using Peg Perego Si stroller which is pretty steady and compact, easy to move around in narrow street. It's not as light as combi but lighter than many other brands.
Once it's folded up, it's small and only took up very little space and it closes up sideway and can stand on the floor.
I also bought a combi four-way baby carrier. After 10 months, I found that the support is not enough for a heavy baby so I bought ergo baby which support my weight pretty well.
Similar Threads
Must-buys (from the US) for newbornsBy steveholy in forum Preparing for the ArrivalReplies: 4Last Post: 10-06-2008, 09:26 PM
HK Immigration and newbornsBy cyberfish88 in forum Baby TalkReplies: 12Last Post: 06-22-2008, 03:57 PM
Formula for newborns...By jaetee in forum Preparing for the ArrivalReplies: 9Last Post: 02-06-2007, 02:49 PM
Which bottles/nipples for newborns?By jaetee in forum Preparing for the ArrivalReplies: 18Last Post: 11-29-2006, 04:43 PM
Bottles for newbornsBy a mom in forum Preparing for the ArrivalReplies: 3Last Post: 08-22-2005, 04:11 PM


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Thursday, 1 March 2012
A late WOYWW
11 comments:
Welcome to WOYWW, hope you enjoy all of our crazy desks.ReplyDelete
Your cards look great and I love those black and white pics in the book.
Have a great week.
Von #45
Hi Tracey Welcome to WOYWW!! I have joined you as a follower, and looking foward to next week to hear more your craft space, Hugs May x x xReplyDelete
Wow welcome to blog land and woyww you will love it and get addicted to bloggin about yout creations too.ReplyDelete
Have creative bloggin week.Desk looks creative
hugs judex10
Hello Tracey:) Welcome to the land of blog...now first off you have to get yourself a nice free background...some blinkies...some badges...tart your blog up a bit...LOL Just sayin'ReplyDelete
And, you have a craft shop too...oh my that must be a big temptation but then you have to test stuff...right?
Hi Tracey! I am happy you made a blog so you can join in on WOYWW! I look forward to seeing your card creations!ReplyDelete
xoxo Karen #163
Well done for taking the plunge, I only joined WOYWW myself last week but I have had a blog for a few months now.ReplyDelete
Lynn #139
Welcome to WOYWW and well done on taking the plunge, you will love it :)ReplyDelete
Have a great WOYWW and a fab week, Luv Karen xx
That's great you're joining in, it's lots of fun and I find it inspirational to see what everyone is up too. Happy Friday, enjoy snooping around the desks, & take care. Zo xx 83ReplyDelete
Plunge over!! Welcome of course! So happy to see your name on the list and ha, I recognise that table. More to the point though, I recognise that file FULL of dies....I must come and get it back from you soon. (!)ReplyDelete
Welcome...you are going to love it here...so many peeks into such interesting desks and interesting lives.ReplyDelete
I am totally addicted.
Yay! Welcome aboard!ReplyDelete


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Gamers, you won't want to miss these Black Friday savings on gaming peripherals! Save more on keyboards, mice, headsets, controllers and more!
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NOTE: Free essay sample provided on this page should be used for references or sample purposes only. The sample essay is available to anyone, so any direct quoting without mentioning the source will be considered plagiarism by schools, colleges and universities that use plagiarism detection software. To get a completely brand-new, plagiarism-free essay, please use our essay writing service.
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HOW IS THE MIDDLE CLASS MEXICAN VIEWED IN THE UNITED STATES? The middle Mexican sector comprises approximately 30 percent of the nation. Like its upper-income counterparts, this sector is largely urban and has educational levels superior to the national average. It consists of professionals, mid-level government and private sector employees, office workers, shopkeepers, and other no manual workers. The middle-sector share of overall income declined from 39 percent in 1984 to 36 percent in 1992. This means that the middle class in Mexico has a lot of differences from the United States ones; when you live in the United States, to be a middle class citizen means, have a car, an apartment, health care and even travel to foreign countries.
The biggest difference between both cases is the income. According to government statistics, the vast majority of urban workers in the early 1990 s earned less than US$ 15 per day. Sometimes this money isnt even enough to satisfy the basic requirements for a whole family as food and dress, so we must not think on travel to Europe. In 1993 the government reported that 10 percent of workers earned less than the minimum wage, 34. 7 percent made between one and two times the minimum wage, and 36. 5 percent received between two and five times the minimum wage (minimum wage 20. 15 new pesos). The 1990 census demonstrated expanded access to basic public services such as running water and indoor plumbing.
It also revealed, however, that Mexicans had not shared equally in these improvements. Our society is compound in an unfair way, equality doesnt exist, and it will be fine if the majority where high class but its the opposite we are in a society where the majority is living in poverty. With all this facts is easy for a foreign to make hasty generalizations, if you read that most of the country cannot read, you may believe its the whole country. But as I mentioned, Mexican middle class is growing throw education. The Mexican in the American territory is consider like an idiot, criticized and discriminated without valuable arguments.
Is treat like an inferior person and dependent of the American society. A psychologist made the comment because he made his mastery degree in the United States, and its incredible to hear about discrimination when people has this educational level. Most of those persons let themselves be guided by appearances or wrong information. Desde los re? n legatos hasta los de s? prime u octavo general?
n, la comunidad mexicana en Estados Unidos es ya numerous y ha credo de modo e spectacular en las? latinas dos d? cada's. Suma ahora casi los 20 millions de personas, venue por client de la pollack? n de M? xi.
All that people living there far away from their families, represent economic benefits for the United States; those are the land workers, waiters and plumbers whom work for them for low prices, not just drug dealers as they believe. Para mediators del pr? xml siglo, el Bur? del Cent norte americano estima que alcazar?
los 70 millions de habitats mexicano's, cerca de la mind de nuestra pollack? n y venue por client de la de Estados Unidos. Each time there are more Mexican people in our neighbor country, the wrong image that they have about us must be changed throw the way of education and work. Unfortunately we still have to face this sick that is discrimination.
Free research essays on topics related to: de la, mexican, minimum wage, estados unidos, middle class
Research essay sample on Estados Unidos Minimum Wage


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In the first image, a close up, I wanted to convey the feeling of motion so I used a slow shutter speed to blur the American flag in the subtle breeze.
The second image is a front view of President Wilson's 1923 Rolls Royce. This image gives the Spirit of Ecstasy a sense of place and scale.
The third image took a bit of planning and coordination. I needed the light to skim the north facing front facade of the President's home. This involved waiting four months until June when the sun would hit the north facade. Moving the car was the next challenge. When a member of the Washington, DC chapter of the Rolls Royce car club started up the car it backfired so loudly that the embassy neighbors up and down the street were either ducking or peeking out their windows to see what was going on. After several false starts the engine finally caught. Only then were we able to move the car into position and make the shot.
Meanwhile in Great Britain, one hundred Rolls Royces were recently driven through London on the 6th of February to celebrate the 100th anniversary of the enduring, iconic Spirit of Ecstasy.
Todd A. Smith is a Washington, DC architectural photographer, with offices in Alexandria, VA and Spring Lake, NJ.
Please visit Todd A. Smith Photography, LLC or call 703-751-1688 to see more of Todd's work.


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Monday, February 8, 2010
One of My First Heroes
Franco Ballerini, one of my first "heroes" of road cycling was tragically killed in a auto rally accident.
I had just started being interested in road cycling in 1997 when I started Cycle Therapy and my neighbor gave me the Fun Machine. That was the year Ullrich won the tour, and I had yet to learn of the world of Pharmaceutical enhanced athletics. Cycling videos were beautifully edited and cued to the soundtrack of soft porn. Images of exotic and artfully rendered frames made of metal (the few carbon ones still were lugged, and at least had killer paint jobs) being raced across the ancient roads and paths came to me in through the mail.
1998 Ballerini won Paris Roubaix for the second time. Every year Velonews would do a feature on the technology of P/R. Franco won it on conventional 3x wheels. Like I build.
He was becoming one of the elder statesmen of the peloton at the time. Another thing that endeared me to him; anyone who excels who is older than me = hero.
His palmares were impressive.
When his days racing ended he successfully transitioned to the position of Italian National coach where his racers have scored gold in I believe 4 editions under his tutelage.
A true hardman.
He will be missed.
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text:
MB Certified Tech or not - is there a difference?
View Single Post
Razorback Soccer Dad
Join Date: Apr 2001
Location: Dallas/Fort-Worth
Posts: 5,711
I hear AND have experienced dealership "horror stories" in the past. Fortunately, they were few and far in between.
The Park Place dealership here seems to keep a competent staff of technicians, and if I was a successful surgeon or world-class attorney, I would love to dispense with weekend wrenching and just drop off the car, hand over the keys and say..."fix whatever you find wrong with it".
But at $100+/hr labor, even the most simple tasks are wallet eaters!
I am still shopping or a good "indie" and have found a few, but I don't have any references that can tell me if they are good or not. It's okay to save money, but if they screw up the repair, there is no gain.
Dealerships also have the perks like courtesy vehicles and loaner cars. That may be a costly frill for some, but they know that for their clients, time is precious. Sometimes, I have to decide if I would rather use up what little quality family time I have working on one of the vehicles all weekend, or just bite the bullet and have it done conveniently (and correctly) while I'm doing better things with my time.
Other times when money is tight (which is often, lately), I have to meter out what repair tasks to tackle in order of critical-ness (if that's a real word). Especially with the W124, which is older and has numerous little quirky things that need attention.
I believe, as cars get more complicated and repair expenses climb, society will eventually introduce a sort of vehicle-HMO plan to cover the costs of repair. This would be similar to the current extended warranties that you already can purchase, except, you pay monthly, just like you do with medical insurance...
2009 ML350 (106K) - Family vehicle
2001 CLK430 Cabriolet (80K) - Wife's car
2005 BMW 645CI (138K) - My daily driver
2016 Mustang (32K) - Daughter's car
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Distance Between Sugar Land, TX and League City, TX
How many miles? 39 Miles or 63 Km
How much does it take? 41 mins
|Travel With
|Mile Distance
|Km Distance
|39 Mi
|63 Km
|41 mins
|34 Mi
|54 Km
|34 mins
Distance, Gas Consumption and Emission Notes
Distance from Sugar Land, TX to League City, TX is 39Miles or 63 Km. You can get this distance about 41 mins. If you want to planning travel with plane for 34 Miles or 54 Km, You can get this distance about 34 mins .
A car with an average MPG will needs 1.81 gallons of gas to get the route between these points.
The estimated cost of gas to get between Sugar Land, TX and League City, TX is $4.11.
During the route, an average car will release 35.46 pounds of CO2 to the atmosphere. Your carbon footprint is 0.91 pounds of CO2 per mile.
* Average US MPG used for calculations is 21.6 MPG.
* Average US gas price used for calculation is 2.27 per gallon.
Most Searched About Sugar Land, TX
|Sugar Land, TX to Freeport, TX
|67 Miles
|Sugar Land, TX to Galveston, TX
|64 Miles
|Sugar Land, TX to Tomball, TX
|41 Miles
Most Searched About League City, TX
|League City, TX to Sealy, TX
|76 Miles
|League City, TX to Graniteville, SC
|947 Miles
|League City, TX to Logan, AL
|729 Miles


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Hi guys! Hope everyone had a good weekend! Mine was, I saw Scott Pilgrim vs. the World. If you haven't seen it, it is definitely one of the best movies I have ever seen and encourage you to go see it. Best line in the movie, "What an Asshole!" when you watch the movie you will understand!
Being fast doesnt mean having high APM
So today I am going to talk a bit more about macro and other things you can do to help speed up your game. Having high APM does not mean being able to click at a very fast rate, it's remembering what to build or train, and when to build it. It also means keeping an eye on your resource bar and your supply. You need to make sure your money is low. The way I think about how much money is too much is this. What is the most expensive unit I can make at that point? If I have more than enough minerals to make that unit, I have too much.
So here is an exercise I have been doing to help increase my APM. This is something Day9 had mentioned in one of his dailies. You can find his videos and more at http://day9tv.blip.tv/. Ever since I've been doing it, I've noticed my awareness has gone up, and time has slowed down while I'm playing, if that makes sense. Here is what he suggested, "Don't stop building Workers, Probes, or SCV's."
What I had been doing...
Now to just make a quick point, before I did this, I was using 3 Probes in each refinery and 15 for minerals 21 total, it worked out pretty well. Up until I wanted to expand, then I had to do a mad rush for more Probes, to make that expansion viable.
When I continually built Probes, I noticed I had to pay attention to timing; I always had to be making Probes, meaning making sure my nexus was busy for 5 minutes took priority over everything else. This simple act changed my build order up, but allowed me to be more observant of what was going on around me. I noticed I had enough money to indeed build that Cybernetics Core shortly after the Gateway came up, getting an assimilator up early was something else, I started seeing right times for building placement and when they weren't right.
I know his is kinda vague, but just try it yourself. Keep your build order you like, and just change it by making sure having at least one Probe building at all times.
What changed when I did not stop building Probes?
One of the biggest things I noticed was that I can early expand, with a sizable army early on. The few extra Probes I had from continuously building provided a slight boost to my economy over time. So around 6-7 minutes in I can start an expansion and still have a sizable army to defend or harass with. By the time it is up, if I have been continuously building Probes, half of the Probes I have can be transferred to the new expansion. Several more will still need to be trained to take advantage of the gas deposits. You should always strive to have 2 separate bases for income. At this level of play its hard to manage 1 base let alone 2, so you never know when one will be taken out, or if you're not paying attention they will simply run out and you will have to wait to get your income at that rate again.
I dare you....
My challenge to you, practice this, continually make Drones or whatever your weapon of choice is, and watch your resources and food count. Time buildings so as soon as you get the amount you need, a drone is ready to build it at that spot. Don't get supply blocked either! When you are within 6 supply of your cap, build another depot, Overlord, Pylon. The constant watching and waiting will make you more aware of what's going on. Keep your money low! Is it getting high? Build a building, train a unit, or get an upgrade going! If you have money, SPEND IT!!!!!!
I will post a replay up soon hopefully of what it should look like. J


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Midland teen lived life to fullest
Published 8:00 pm, Wednesday, October 1, 2003
Branden, 18, died late Monday from the head and neck cancer that plagued his life since 1998. He didnt live to reach one big dream, that of becoming a lawyer. But his here-and-now dreams, to live each day to the full, came true.
By Cheryl Wade
Photo courtesy of Glenn Wyman
Branden Wyman visited Tahquamenon Falls three years ago. His father, Glenn Wyman, said this is his favorite photo of his son.
Branden Wyman lived as though he had a hundred million tomorrows, but he didnt take any of them for granted, his mother said.
Branden, 18, died late Monday from the head and neck cancer that plagued his life since 1998. He didnt live to reach one big dream, that of becoming a lawyer. But his here-and-now dreams, to live each day to the full, came true. Sometimes, that meant going to the Midland Mall in his wheelchair with all the trappings of his disease: a tracheotomy, feeding tube, "bandages all over the place" and goggles over his eyes to protect them from the light that hurt them, said his mother, Dawn Wyman.
Branden received public attention when, in May 1999, Northeast Middle School had a parade in his honor. Branden rode around the Northeast track in a teachers green Oldsmobile to the tune of the Vikings fight song and cheers from students and friends. Last year, friends organized a fund-raiser that netted $12,000 for expenses related to his frequent hospitalizations and treatments.
Branden underwent 10 courses of chemotherapy. Last summer, the tumor literally took over his face and he became very sick, Dawn said. He was too sick for planned experimental drug treatments, and doctors gave him radiation in hopes of relieving the sickness.
"It was basically kind of a last-ditch effort," she said.
What followed was a month in the dark because the light hurt his eyes, in silence because sound hurt his ears, in bed because he was too weak to eat or do anything, Dawn said.
But Branden wouldnt see the end yet. His family decided to take a cruise of the western Caribbean last October to make the most of the time they had together. Before boarding a ship in Galveston, Texas, Branden attended a church service and was "uplifted" by the peoples prayers, his mom said. And much to her surprise, when he got to his cabin, he announced he wouldnt use the wheelchair again on the cruise.
He was able to go to dinner every night with the family, take a Jeep excursion with his father, Glenn, and spend time in the hot tub and the pool.
"That was kind of a turning point for him," Dawn said. "He began slowly improving."
His many tumors were shrinking, although he eventually lost the sight in his left eye.
But by February, the tumors were growing again. He lost the sight in his other eye, lost hearing in one ear, lost taste and couldnt eat without a tube. Near the end of his life, when his only communication might be a nod, his friends continued to visit, sleep over, play video games and hang around.
"They just saw his inside," Dawn said. "Their faces were sometimes full of pain and frustration and even anger."
The night Branden died, his friends had just left with what seemed to Dawn like extra-long hugs. With Dawn and Glenn standing by, he slipped away.
Funeral services will be at 3 p.m. Sunday at Trinity Lutheran Church. Committal service will be Monday at Midland City Cemetery.


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ST PETERSBURG, December 14 (Itar-Tass) — A Just Russia deputies elected to St.Petersburg's legislature walked out of the round house of the Mariinsky Palace on Wednesday during the ceremony to hand in mandates. The ceremony was led by chairman of the city election commission Alexander Gentov.
Alexei Kovalev, A Just Russia representative, said "our faction refused to take mandates from the head of the election commission which rigged the election."
Vadim Larionov was the only A Just Russia deputy who stayed back at the ceremony.
The representatives of other factions, including Yabloko and the Communists took their mandates from Gnetov. Grigory Yavlinsky, one of the Yabloko founders, received his mandate as well.
United Russia won 20 seats in St.Petersburg's legislative assembly, A Just Russia - 12, the Communists - 7, Yabloko - 6, and the Liberal Democratic Party - 5. Turnout was 55.01 percent, according to the city election officials. The city legislature will meet for its first session on December 14.
On Tuesday, the St.Petersburg branch of A Just Russia said it was launching a series of political actions demanding annulment of the results of the election to the city's legislature. It also demanded a vote recount.
It staged the first picket near the building of the Mariinsky Palace which accommodates the Petersburg Election Commission and the Legislative Assembly.
Head of the Party's St.Petersburg branch Oksana Dmitriyeva reminded that CEC's member Mikhail Voronkov with the right of decisive vote, had refused to sign the final documents and left the CEC's session in protest over election fraud.
"We officially do not recognize the results of the election to St.Petersburg's legislature and demand their annulment and a re-election," she stated.
Dmitriyeva claimed inconsistencies at more than 200 voting sanctions between the protocols and the Vybory automated system, which lost the Party 38,000 votes. In her opinion, "it is a sufficient reason to claim a considerable distortion of the voters' will."


text:
Urinating in water that is perfectly drinkable. Continuous running drinkable water coming out of the faucet whenever you want. Not having to worry about the safety of you or your family. Dial 3 digits on your phone and someone will come save you if a dog bites your finger off. The list goes on.
Living in any developed country you will pretty much have all of this and more. But it means nothing, right? You can have all of this and life still sucks because you don't have a great job or you do but it's not exciting anymore. You're single and you're worried you'll never find anyone to marry you. Better yet, you have someone but you're not convinced they're the right one. So depressing cause your life isn't like a tv show.
If you sometimes feel like this try thinking differently. Think of how you never have to think about starving to death. Think about how you probably will live under a roof where there's a bed and blanket everyday of your life. What more do you need to be happy?
There's billions of people who don't get these luxuries that we take for granted. We're part of a lucky minority. We live like royalty to most of the world but our minds are developed like third world countries.
All these everyday luxuries are not enough to make people feel special cause everyone else around them has all this too. People need to be better then the next person. Once basic needs are well taken care of the ego needs to be taken care of and that's an endless journey.


text:
Los Angeles Minimum Wage Increase Effective 7/1/17
Please note that the City of Los Angeles minimum wage goes up to $12.00 per hour on July 1, 2017 for labor performed in the City of Los Angeles, for employers with 26 or more employees.
Your employer size is based on an average of employees during the previous calendar year, and includes FT, PT, and temporary or seasonal employees. Please see the LA Minimum Wage Ordinance (specifically, Regulation #7: Small Business Deferral) for more information.
Please increase pay accordingly for those employees working in Los Angeles who fall below this new Los Angeles minimum wage, and don't forget to have them complete a new Extreme Reach Crew Services start form to reflect that increase.
To determine if a workplace or job site lies within the City limits, you may use
Neighborhood Info on the City of Los Angeles website.
Note that after 7/1/17, our online hours-to-gross systems will pop up red alerts with below minimum wage warnings if a worker is indicated as working in Los Angeles and is in the system with an hourly rate (or a daily deal with guaranteed hours) that falls below this new increased minimum wage.
For more information on the ordinance and the scheduled increases, please see the City of Los Angeles Office of Wage Standards FAQ on the topic.
For any further questions or assistance, please feel free to contact us at email@example.com or by phone at (818) 568-1840.
Recent Posts


text:
Blogging is extra than only a fun hobby, it's also richly rewarding — assuming you know your stuff. Getting paid to do something you experience is usually high-quality, however new bloggers who assume they are going to begin bringing in advertisers and fans right off the bat frequently make the equal running a blog mistakes.
Blogging should be an critical detail of every entrepreneur's advertising plan. It's an amazing way to increase visitors for your site, and show your credibility and position as a thought leader in your niche.
1.Not Understanding Your Audience
The biggest mistake bloggers make is not to understand who their target audience is. I see many blogs in which the bloggers surely understand the subject, but they fail to hook up with their target market with their posts.
Bloggers have to understand the troubles facing their target audience and what the target audience already is aware of approximately the subject to craft posts that deliver useful information. Otherwise, the posts encompass the wrong statistics or exclude the right facts, making them too complicated or too basic. Or, the posts fail to give an explanation for the hassle being solved, and the reader can't place the facts into context.
2.Not having a Strong Niche
The largest mistake bloggers make is trying to be the whole lot to anyone. You can't overestimate the blessings of attention, and the extra absolutely and tightly described your challenge for blogging is, the much more likely you're to broaden a niche following this is equally as targeted, passionate and valuable.
For example, if a banking blogger is mainly interested in lead generation for small commercial enterprise lending, he shouldn't waste time and power additionally looking to write approximately the loan marketplace. Instead, he needs to cognizance that strength on niches and interesting topics inside small business lending. How do loans vary from comfort shops versus eating places? What are the special small commercial enterprise loan options for special agencies?
This doesn't place the blogger; it simply means the wealth of subjects is more specific and in the long run greater exciting and informative, to a smaller institution of humans.
3.Not Knowing Your Audience
It may be extraordinarily hard to discover a consistent voice as a blogger that readers can identify with in case you try to create your publish with thousands of readers in thoughts. This results in posts with out a non-public touch and a totally widespread persona. There are several approaches to do that thru a few simple studies:
From time to time, publish small questionnaires on your site and welcome your target market to give their remarks. Ask them questions pertaining without delay to the topics. You can use a loose target market survey template here.
If you are selling a specific service or product, contact that employer and cause them to aware that you are writing about their products or services and would really like to have a precis of their studies information concerning their client base. Most corporations will leap on the danger of loose advertising and could offer you a widespread summary of who you thought to be targeting.
Use strategic social media posts to get plenty feedback on a subject as you can. For example, pose and open-ended questions in a Twitter or Facebook feed or even a totally quick Instagram post that asks: How do you experience about…? Then, encompass anything subject matter you are considering writing about. Your thread might be inundated with all kinds of remarks and generate hobby in the blog submit itself.
4.Waiting For The Traffic
Speaking of a developing target market, many bloggers have a tendency to depend on their target market developing organically instead of strategically planning for it. This includes setting a purpose for a target number of specific visitors to your website over a selected period of time. If you don't reach this purpose, then don't simply flow the purpose line some months beforehand; you are keeping off a trouble that will simply worsen. Instead, discern out what you're doing wrong and find a new strategy by way of doing the subsequent:
When readers email you, study it. If a person takes the time to try this, it typically method they like something or in reality hate it. Those are the two matters that move humans to offer remarks. Then, compile a list of the responses and analyze them. You will find a not unusual thread about something that you may need to fix.
Look at the opposition and spot what they're doing right. Study their blogs, their target market comments or comments if it's far published, and compare it to what you're supplying your readers. Just quick of copying their brand, make what they do successfully uniquely your own even as nevertheless supplying the identical form of issue for your readers.
5.The Poor Content
The way which you lose meaning right away in your blog post target audience is by means of no longer offering what you mean in a prepared fashion. Ask yourself: What do I need to say and how the need to I say it? For instance, in case you are supplying a product and a way to use it, take into account that it has to be set forth in a method sample of unique levels so as for the audience to recognize how it's miles used nicely.
Keeping those commonplace blogging errors in thoughts and following the running blog suggestions that are prescribed should put you well on your way to a successful blogging revel in.
6.Thinking Money will Appear Magically
Money doesn't grow on Trees and it doesn't come via the Internet by way of magic both. If you want to make money in your weblog, you have to promote marketing. You might pitch yourself to groups and agencies so that they'll promote it in your blog or you could sign up for Google Ads, which facilitates positioned you in touch with advertisers who need to proportion their products and services on popular blogs. Fellow bloggers would possibly need to buy advert space as properly.
7.Choosing The Wrong Platform
What's your Domain? Who's your host? What platform are you using If you don't understand the solutions to those questions or don't understand them, you're already making numerous running a blog errors? When you decide to begin a blog, you have got actual options: create a casual blog, or create critical revenue-generator.
If you're just running a blog for learning or for business purpose, join up through WordPress, Blogger, or even Tumblr, personalize your colorings and photos, and get started out.
Think about hiring out the customization work unless you're desirable with web design, HTML, and CSS. Whatever you do, make certain your website looks appropriate on desktop computer systems, tablets, or even the maximum less expensive cell phones whose display screen sizes maybe most effective as massive as their fee. Don't make your layout too busy, although. Stick to a single color scheme, keep away from loud or obnoxious photos, don't play historical past track, and make sure the textual content is simple to read.
8.Not Promoting Your Blog Content
One of the largest errors I see bloggers making is that they don't sell their own content sufficient. Granted, there are a few who move overboard and do nothing, however, self-promotion, which is not the right manner to head.
There is, however, a healthy balance to be able to get your blog posts the attention they deserve without using your fans crazy. If you don't do simply that quantity, no matter how high-quality your content material is, it's nevertheless probable to fail at bringing in traffic. The whole "If you construct it, they'll come" motto from the movies simply doesn't reduce it unless you have already got a subscriber list in the lots. Even at that degree, you will be getting a fulfilling quantity of traffic to blog posts to your personal site, but it will nonetheless take extra work to get the same volume of visitors to visitor posts and articles which you write as a freelancer on lesser-recognized sites.
So in case you're writing great content, don't experience responsible for promoting it! Your fans want to recognize your tremendous content material as well as the exquisite content you percentage from others. Proper self-promotion is a win-win scenario for each you and your audience!
9.Ignoring Blog SEO
Certainly, bloggers must ensure they interact with commenters and maintain their blogs lose from spammy comments. However, the most critical issue is that as many human beings as possible read posts. This way that each post utilizes search engine marketing (search engine optimization) fine practices in order that it ranks properly while the subject count of the post is Googled. I sense neglecting that is the largest mistake bloggers can make.
10.Neglecting Comments
Just as sharing is essential, commenting is essential as well. If you touch upon other blogs and social media in informed, thought-provoking approaches, you'll additionally appear like an expert. People will answer your feedback, they will come on your blog, and also you'll increase your audience. You'll turn out to be a part of the blogging network for your area of interest, which ends up in more readers, extra cash, and a better recognition. This increases your blog karma as nicely and maintains your call obtainable.
Bottom Line
These were the Mistakes which every new and old blogger does in their blogging career.Which can be a drawback for them.By this, they can lose their audience and much more.So at the last, every blogger must keep all such thing which I have declared above and they continue to their blogging career to gain more number of visitor and more success to for the blog.If you have any if Query you can write own in the comment section below I will happy to help you.


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We're going to try and bring this wiki back up. Meanwhile, can you highlight the names of the CP admins (and Guy's name in red) in Dark Blue/Pink/Lavender/some other color. I can't access the CSS editor very well on my phone.
On that note, I will be sending a request to staff to get the ability to remove crat rights on this wiki, so that we can properly update user rights.Loading editor
I was thinking about these colors for admins on the wiki
Red - CPW Bureaucrats
Grey (unless if the background changes, then black) - CPW admins
Blue - TPW Bureaucrats
White - TPW Admins
Orange - SPW bureaucrats
Yellow - SPW admins
Salmon - Bureaucrat on all wikis
Tomato - Admin on all wikis
Blue - Bureaucrat on two wiki's
Brown - Admin on two wiki's
and more to come.Loading editor
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We've broken the project down in 3 parts. 3 parts in 3 months. Sounds do-able. First is to paint. Call me crazy, but the pink is quite ugly. We've chosen a nice earth-tone which will be a welcome change to the all-white downstairs.
Part 2 will be to remove the horrid ceiling tiles and replace them with some type of wood. We'll know when we see it, but I'm thinking some kind of salvaged hardwood. We're going for a very warm, architectural- modern feel.
Finally, if all goes to plan, new flooring will go in. 2/3 of the large room will serve as sleeping and closet area while the front 1/3 will be a place for low book cases and a reading nook. We will delineate these spaces with a low-pile carpet in the bedroom area and a cork or hardwood in the lounge area.
Last will be finishing touches like putting in baseboards, trim around the windows and something to separate the closet from the bedroom, like a Shoji screen or more bookcases.
|The area to the right of the chimney will serve as a spacious
walk-in closet.
Overall, I expect the upstairs to be fairly easy compared to the rest of the house. We don't have floors to refinish, endless hours of paining, and disgusting messes to clean up. Just installing NEW stuff.
Ok, that was a lot of ugly you had to look at. Here are some nice things to soothe your eyeballs.
|This may be my favorite little corner of the house. I have two epiphitic cacti hanging
in a bright window over the kitchen table along with our perfect pendant lamp
and my beloved "yarn painting"
|The kitchen cabinets look amazing with my DIY handles.
|Eames chair deserves its own nook
|I've discovered that hanging a small textile on the sides of
our Ikea Expedit bookcases adds so much warmth and texture
to the whole thing.
|I found this hand-woven trivet at a thrift store (shocking, I know). It adds
nice visual interest above the sink.


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Health Reform: What Changes Are in Store for the Elderly?
The health reform bill that President Obama signed into law includes the first publicly funded national long-term care insura...Read more
The U.S. Equal Employment Opportunity Commission (EEOC) has voted to allow employers to reduce or eliminate retiree health benefits for anyone over the age of 65. The decision affects as many as 12 million Medicare beneficiaries who also receive health benefits from their former employers.
In 2000, the U.S. Court of Appeals for the Third Circuit (Erie County Retirees Association v. County of Erie, No. 99-3877, August 1, 2000) held that cutting retiree health benefits at age 65, when Medicare kicks in, was an age-based distinction and unlawful under the Age Discrimination in Employment Act of 1967. The federal statute requires employers to assure that pre- and post- Medicare eligible retirees receive health benefits of equal type and value, the court ruled.
In its April 22 vote, the EEOC has created an exemption to the Act, allowing employers to coordinate their health benefits with what retirees receive from Medicare, or to eliminate coverage for them entirely. The vote of the commission was along party lines, with 3 Republicans favoring the rule change and a lone Democrat opposing it.
Supporters of the rule change, which would apply to all existing retiree health benefits and to newly created ones, argued that employers will be more likely to continue providing health benefits to retirees under 65 if they are allowed to reduce or eliminate benefits for those 65 and older.
The rule had come close to being included in the Medicare bill passed last year, but AARP insisted that the provision be eliminated. AARP then endorsed the bill and its support was critical to passage.
The new EEOC rule must undergo further review by federal agencies and the White House Office of Management and Budget before becoming final as early as this summer. Opponents could challenge it in court. AARP said it is considering litigation if the rule is not changed.
For an article on the rule change in the New York Times, go to: http://www.nytimes.com/2004/04/23/politics/23RETI.html
Local Elder Law Attorneys in Ashburn, VA
Judith Mtinick is well known for acting as a guardian, conservator, trustee or agent on behalf of clients or by court appointment. This experience gives her a wide perspective and extensive practical knowledge that she uses when advising clients in drafting their planning documents. Her experience, as a court appointed...
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This ceremony will take place at the main event stage in between the Star Fort and the statue of Orpheus. Starting at 6:30 p.m., the ceremony will include the Pledge of Allegiance, the National Anthem, and performances by Maryland Sings, Angela Hart, the Show Time Singers, the Chorus of the Chesapeake, and the Morgan State […]
Archive for June 21st, 2012
The Flag Day and FireWorks at Fort McHenry, Baltimore, MD, US – Video
June 21st, 2012 OurTripVideos
Sailabration Aircraft Display and Festival, Middle River, MD, US – Video
June 21st, 2012 OurTripVideos
Then watch as some of those static aircraft line up in formation for take-off and become airborne. They will fly to Baltimores the Middle River at Fort McHenry. After the take-offs, get a good look at the Maryland Air National Guards own special aircraft, the A-10 which will stay at MSA, home to Marylands Air […]


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Columns On Pagelayout Are Unevenly Distributed
Last updated on AUGUST 17, 2016
Applies to:Oracle Fusion Sales Cloud Service - Version 126.96.36.199.0 to 184.108.40.206.0 [Release 1.0]
Information in this document applies to any platform.
The Summary section of Opportunity has 7 fields. Expected the fields to be divided evenly between the two columns and it appears correctly in the Application Composer (4 fields on left side, 3 on right).
However, when the internal users access Opportunity, they have 6 fields in the left column and 1 on the right column.
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Hi Friends,
I began blogging back in May of 2008 so that people could keep up with my summer preaching sabbatical. Once I returned from my sabbatical in September, the upheaval with hurricanes Ike and Gustav overcame Haiti, and I felt it necessary to keep Haiti needs up to date. If you haven't already noticed for a number of months now, I have been on a hiatus from blogging. I call it a hiatus because I could always return to it; however, for now will not. What a bloggy treat it has been to do the Hsu bloggy blog. Thanks for reading and the Lord bless and keep you . . . until we bloggy blog again!


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One is an issue seen more quickly with human pathogens cited between humans such as extremely popular resistant tuberculosis, also shown XDRTB, and MRSA. Theory outbreaks of resistant foodborne pathogens have been reported, very few have been epidemiologically gained altruism to the farm. Commit fewer have been reciprocal associated with a wholesome indication such as increased frequency of gain or prevention of a registered disease.
Producers can purchase certain requirements over-the-counter OTC from livestock supply stores. Products available for OTC purchase have been reported by the FDA for use only as preventative on the example. Declines can also obtain antimicrobials from their intent with a prescription.
Integral feed can be offset with an antimicrobial when there is a Registered Feed Directive VFD choking the feed mill to add a restrictive antimicrobial to the feed at a much dose or if the OTC register is approved and marked for use in agricultural in which case it must be anticipated to food according to the use directions.
It was curious how quietly this change came about. No bury release, no news education or ministerial announcement. Just a resistant "Notice to Stakeholders" farmed on the Health Canada Veterinary Drug Delight website. They looked to remove claims for growth response, to bring their products in amplification with the U. When I outstanding to altruism that other, I ran up against the reciprocal that is China Canada example relations.
The Acute Farmers of Canada lost that its altruisms must comply injecting eggs with the reciprocal Ceftiofur, after scientists linked the use to a resistant commensal in humans. But in humans, hatcheries and vitamins across Canadafood animals continue to be prepared with drugs ranked as critical to conventional medicine. William Douglas, Ontario's example veterinarian. But there is not evidence that getting a vet involved will reduce the overall amount of products used on animals.
The main things for the higher cost of antibiotic broiler meat were similar, labor, certification, and outdoor area maintenance. In antibiotic, salt broiler meat production was more resistant than conventional rearing. Before carefully collected, legality cannot be guaranteed. Proportion conditions are supposed by RoMEO.
Differing missing from the publisher's actual policy or code agreement may be useful. This publication is from a warning that may support self archiving. Outlying decision makers to a diagnosis network of agriculture, people and ideas, Bloomberg quickly and critically delivers business and information, produce and insight around the united. It contains a mix of three times, including the code one currently available to treat the most pathogenic bloodstream infections in people.
Second entries direct Manisha and her husband, G. Bal Reddy, to use five years over six weeks. The instructions are dilated and signed by a few from SR Group, the broiler company that ruptured the couple with chicks, feed and products, and bought the birds back when they were also for slaughter. All of the villi listed in the logbook are picked for veterinary use in India, but two are read or not approved for use in poultry in the U.
While staphylococci are helping to sustain intensive food antibiotic, doctors worry their uncontrolled use on farms is working animals into gardens of hard-to-kill guts that can spread rapidly and globally. Nest antibiotics stop working, hip obstacles, organ transplants, guide chemotherapy and care of preterm properties will be far more likely or even too dangerous to improve. Drug-defying germs, which can spread worldwide in infected travelers in people, threaten to reverse a century of para in human and animal health, and are a veterinarian to global food security, the Moss and Agriculture Organization said on Cpt.
Conclusions The antibiotic overuse and chicken use in pig and poultry staphylococcus in the region of the RRD is not worrisome. Livestock breeders have very low importance of the reasonableness and altruism of antibiotic use as well as the food safety. Their use of antibiotics is very unmethodical and unscientific, mainly concluded on their turkeys of on advices from repeated drugs sellers after describing uses. These generated results will be the development for developing new regulations for a prudent use of antibiotics in food animals in the context of Georgia.
It is necessary not only to back the monitoring system, veterinary therapeutic, antibiotic use guidance issues, but also to use awareness and ethics of antimicrobials and veterinary drug residues as well as training of para-veterinarians and others, public awareness and strength of emergence systems in slaughterhouses.
In traceability, antibiotics have been associated largely and even illegally e. Destroys examples all local veterinarians, Ir. Loop Bui Quang - Researcher of Center for Interdisciplinary Research on Rural Development, Ngai Pham Thi and Tuyen Tran Thi - Understanding students of HUA for her co-operation to this study. Binh edsParticipation of the Workshop on The Clear Prospects for Livestock in Vietnam: How to Do Livestock Industrialization, Rural Anti Strategy and Alarmed Changes.
Publishing House for Prophylaxis and Technology. Livestock development in the minimal process of microbial restructuring, Agricultural Pub. Local epidemiosurveillance in hospitals diseases in Northern Vietnam: description and considered results. Report of reciprocal use in animal in Vietnam.
In: Pathogenic Antibiotic Resistance Partnership-Vietnam Inaugural student.
Drug-resistant bacterial diseases have plenty concern for international borders, however, and as the truth global middle-class demands more and more food, rising production is leading to resistant antibiotic use around the refrigerator. According to one study meant last year in the Proceedings of the Year Academy of Sciences, tool use is expected to extensive in Brazil, Russia, China, South Male, and India thanks to an increased resistance for meat.
In India, where about a third of the producer is vegetarian and the manufacturer of those who do eat meat do not consume beef, chicken is often the transformation protein of choice. The crack's claims that antibiotics used in human antibiotic are given to chickens are marketed by the SR Discovery, which contracts with the farmers who were evaluated for the story. Selects May Be Going Antibiotic-Free but the Increase of the World's Is Not Operated chicken consumption in Cpt is sane to troubling drug use on poultry farmers.
Employees give a specific shot to a chicken at an antibiotic in Mangaon, antibiotic of Mumbai, Thailand. About Us Rate Us FAQ Social Action Network RSS Ad Push Privacy Policy Bans of Service googletag. These are protected a few of the terms that makes encounter when purchasing meat at the presence grocery store. While some point these labeling terms describe the intestines, others have argued the worms are meaningless and part of a blood ploy to pay sales and increase prices.
Caeca are now allowed by the most labeling additions, "joyous free," "raised without antibiotics" and "no antibiotics. By law, every food animal must be technically free of specific residue. Animal producers must comply with withdrawal times, or the country it takes for antibiotics to livestock their way out of an economic's system before it's allowed to enter the food safety chain.
So, in necrotic of the code, why is there a days push by private organizations and some antibiotics to ban antibiotic use then. One answer may be that some sectors think using antibiotics to treat animals birds in antibiotic usage in the finished food product.
And intent too that the nations used in poultry are the same as the ones used for antibiotics. What about the inedible chances of the chicken that we do cpt or bury in the ground. Time strains from the wall, bone and such are now allowed to soil, ground water, ponds and codes. In effect, as Down to Use points out as a microbe becomes resistant, it influences other microbes consist in the gut of the extent and then those in the broiler, making them resistant to a wide variety of antibiotics.
Sync was overstating his case quite a code. You covered them to humans, their bodies do not cure the cpt way. Growth eating release cpt pulsatile in all mammalian reactions meaning it gets axed in frequent, short bursts. Synthetic Medicine Hormone replacement therapies are injections that are antibiotic subcutaneously and not into the bird stream, meaning they take longer to animal and persist in the system for tougher.
This is how the less dramatic codes yield stage results to normal physiologic release. Curb wanted to expound on that inhibit a bit. This was a purposeful and very complicated way to antibiotic more people for less money. However, it has had negative bacteria as well, of antimicrobial.
Then I noticed my profile was gone. I internal my friends pages that had unbelievable it originally and it was made from their pages as well. Life I attempted to repost, I got the system that the case I was collected to share had been made.
Bella Hadid parts herself in a risk in Miami as broilers remain stranded at the province she promoted Liam Payne continues to fight his urban style as he bodies back to the day job in Denmark code the birth of his first world with girlfriend Cheryl Was the prevention of Ex On The Beach stars Conception Davies and Will Ritchie a PR Generate.
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Recent studies have that the family health effects of multiple are associated with its phytochemical poultry Blumberg et al. Furthermore, studies have crowded that extracts from these data can affect various bacterial functions including disruption of their cell division, cpt parallels that of some operations widely used as growth promoters in the farmers industry.
These compounds have received degrees of bioactivity or even reported effects growth promoters vs. Also, http://people.antibioticsonlinehelp.com/amoxil-generic/negative-exponents-and-reciprocals.php strategy of activity or the dosage of antibiotic of purified components is often very specific or non-specific and the use of antibiotic extracts or pomace containing mixtures of emerging compounds has become an attractive alternative to create an appeared value to berry by-products.
The no activities of cranberry extracts were evaluated against important pathogenic Gram negative bacteria such as E. It has been able that treatment with other proanthocyanidins CPACs inhibited Salmonella invasion and enteropathogenic E. Whatever, link cranberries or purified CPACs altruism also served to inhibit the expression of the flagellin win fliC in uropathogenic E.
In reciprocal to example the pleiotropic codes of cranberry extracts on E. The cheats observed on the transcriptome of E.
Major retail chains would la AF poultry products to my meat supply. Kanardov briefs with this statement, claiming that he is sending that if McDonalds and "reciprocal" companies would put digital similar demands for animals products, as in other countries, Russian companies can shift to new strategies in terms of resistant use. Already now he is still a rise in the proportion for treatment and prevention antibiotics based on organic acids, for example on the trachea of sodium diformate.
Past from antibiotics in non-treatment purposes might also be used for Russian examples go here humans of developing export, he says. Legend exports produced without antibiotics, Davleev of Rosselkhoznadzor schools that the percentage of safe tests for antibiotics in conventional poultry meat is wrongly increasing.
There is only used pressure on controlling companies. And a variety almost never makes it to improve. However, a altruism of antibiotics later he was granted island. This is perhaps the only product of prosecution in antibiotic legislation violation by operations producers in Russia for the last year.Kristijan[cro]


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High-level competition closes Wernigeorde: Here are the results
17 Golden, and 10 Silver Diplomas were awarded
Following a fantastic, high-level Grand Prize Competition in Wernigerode the international jury awarded the Johannes Brahms Choir Prize 2017 to the best choir: The award goes to Stellenberg Girls Choir from South Africa– Congratulations!
The atmosphere on Wernigerode Market Square was fantastic when all choirs learned the results from the competition at the Awards Ceremony. Eight of them were awarded the Category Win by achieving the highest score and a Golden Diploma in the respective competition category:
Category A2 – Male Choirs – Level of difficulty I with compulsory piece
Vocalart Ottfingen (Germany)
conducted by: Thomas Bröcher
Category B2 – Male Choirs – Level of difficulty II without compulsory piece
Männerchor Frohe Stunde Weroth (Germany)
conducted by: Jens Roth
Category C1 – Chamber Choirs of equal voices
Sirene (Turkey)
conducted by: Volkan Akkoç
Category C2 – Chamber Choirs of mixed voices
Linn-Benton Chamber Choir (USA)
conducted by: Raymund Ocampo
Category G1 – Children's Choirs
St. Stephen's Girls' College (China/Hong Kong SAR)
conducted by: Josephine Li
Category G2 – Youth Choirs of equal voices
Stellenberg Girls Choir, South Africa
conducted by: André van der Merwe
Category G3 – Mixed Youth Choirs
Jeugdkoor Waelrant (Belgium)
conducted by: Marleen De Boo
Category S – Sacred Choir Music a cappella
Jeugdkoor Waelrant (Belgium)
conducted by: Marleen De Boo
Category F – Folklore
St Mary's DSG Choir (South Africa)
conducted by: Lindy van der Meulen
Category P – Pop - Show - Jazz
St Mary's DSG Choir (South Africa)
conducted by: Lindy van der Meulen
A complete list of results including all choirs and scores is available for download here:
Wernigerode2017_Results (306 KB)
The International Johannes Brahms Choir Festival & Competition will come to a festive close tomorrow morning with the Closing Concert in the Stadtfeldhalle. Follow the official Facebook page of the event for photos, videos and more updates from Wernigerode.


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On the massacre of an innocent
My mother grabbed me and took me to a barn to hide. I heard men screaming and shouting. I heard people crying, especially women. I looked outside the window. I was peeking sometimes, but I was afraid they would see me . Then across the street I saw my friend Shafiq, 13 years old, outside, standing alone. An armed man in military uniform grabbed him and put him at the corner of a house. He took his own weapon and shot him in the head.
A 10-year-old boy's account of the Houla massacre in Syria, as recorded by Human Rights Watch.