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Counselling Maple Ridge - Phobias Counsellors, Psychologists, Therapists in Maple Ridge
Maple Ridge
Counselling Maple Ridge contains information about counsellors, psychologists, and therapists in the Maple Ridge area. These counsellors, psychologists, and therapists may assist individuals, couples and/or families. As is typical with trained counselling professionals they may vary in their areas of expertise.
Explore the information within the counselling listings for Maple Ridge to get a better sense of which counselling professional might be a match for you.
Maple Ridge consists of the following neighbourhoods:
Albion, Cottonwood, East Central, North Maple Ridge, Northeast, Northwest Maple Ridge, Silver Valley, Southwest Maple Ridge, Thornhill, Websters Corners, West Central, Whonnock
If you want to search a nearby city then click on the check mark for Maple Ridge to unselect it and choose another city.
Phobias are classified as irrational fears that impede on normal daily life. While everyone has one or two irrational fears, they are minor. However, if irrational fears become so intense that they cause extreme anxiety that interferes with normal life, it is time to get therapy to help overcome these fears.
The most important thing people should understand is that phobias can be controlled and even cured. Between self-help strategies and professional phobia therapy, anyone can overcome irrational fears and start to live a life of freedom from phobias.
Phobias can interfere with life when you are forced to face them on a regular basis. People with phobias are generally afraid of things that pose little to no real danger at all. People with phobias generally fear heights, clowns, flying, driving, insects, small spaces, wide open spaces or needles.However, phobias are not limited to this, but to anything about which the fear is highly exaggerated.
While phobias are usually developed during childhood, adults may also develop new phobias. People will go to extreme lengths to avoid exposure to whatever they are phobic about.
The good news is that phobias are easily treated using a range of therapies. Cognitive behavioural therapy can help a person recognize their phobias and find different ways to react to their exposure to the things they fear. Desensitization therapy helps a person to learn how to manage being exposed to what they fear in a safe environment. A therapist will help the person understand that their fears are unfounded and as such, manage and eventually cure the phobia.
If you are looking for a counsellor or psychologist who offers phobias and related issues you may want to search the directory to find a professional whose approach will suit you best.
Note: You may narrow your search by selecting more than one filter below.
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- (-) Remove Phobias filterPhobias
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Underwood was the top-ranked female country touring artist of 2010, as she was in 2008. Special guests over the course of the tour this past year included Craig Morgan, Billy Currington and Sons of Sylvia.
The tour carried 80 personnel on the road, traveling over 35,000 miles in 13 trucks and 8 buses.
During the fall leg, Underwood donated 36 cents of every ticket sold to Save the Children's United States Programs. This initiative was inspired by the "36 cents" written in the lyrics of her album track Change, which addresses how even the smallest bit of spare change that one might have can add up to make a difference and help "change" the world.

subset: commoncrawl


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ATTENTION Unfortunately we are going to have to cancel the GUN SHOW that was planned for October 12-13 due to lack of interest. If you had reserved a table we will be sending out a full refund.read more
MJSA Gun Show
ATTENTION OUTDOOR ENTHUSIASTS!! WE ARE HOSTING OUR FALL "GUN SHOW" ON OCTOBER 12 & 13. THIS IS THE Fourth YEAR FOR THIS EVENT. IT IS OPEN TO THE PUBLIC. IF ANYONE IS INTERESTED IN HAVING A TABLE THE COST IS $20.00 PER TABLE. WE HAVE 50 TABLES AVAILABLE. SHOW HOURS...read more
Membership renewal time
It is that time of year again. RENEWAL TIME We are asking that ALL members fill out an application available on-line or at the club. This is to help keep our database current. Please include your email address. Dues amount are $50.00 individual, $75.00 family If you...read more
Outdoor 3D Archery
Come on out and test your skill against our 30 challenging 3D targets set in a wooded course including 2 elevated platforms April 13 & 14, May 18 & 19, June 8 & 9, July 13 & 14, July 27 & 28, Aug 10 & 11, Aug 24 & 25, Sept 7 & 8...read more
Trap Shooting
Come have some fun and sharpen your shotgun skills. Tuesday Evening's starting at 6:00 PM weather permitting. We turn the lights on at dusk and keep shooting. $4.00 per relay of 25 birds. OPEN TO THE PUBLICread more
High Power Shoots
High Power Rifle shoots 200 yards with elevating target butts. 2nd Sunday of the Month, starting at 8:30 AM Cost is $10.00 per relay Open to the public See Activities Tab for more informationread more


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Designed to enhance your mobile life, the Samsung Galaxy Tab A keeps you immersed in what matters most every day. Dive into images, videos and more. Enjoy your favorite content on any screen you own when you connect your Samsung devices with SideSync*. Work and create right from your tablet with Microsoft Office. And switch to Kids Mode when you want to entertain the kids while keeping all of your personal content secure. The new Galaxy Tab A connects you to the people and things you love.
Brand: SAMSUNG
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- Android 5.0 Lollipop, 9.7-inch Display
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- Android 5.0 Lollipop, 9.7-inch Display
- 1.2 GHz Quad-Core Processor
- 1.5GB of RAM & 16GB of Onboard Storage
- microSD Card Slot (Up to 128GB)
- Display Resolution: 1024 x 768 XGA
- Kids Mode offers a fun and secure place for kids, Share content effortlessly with Samsung SideSync 3.0


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John Shanahan
Michael Shellenberger, Founder - President of Environmental Progress: Bill McKippen, Alexandris, Ocasio-Cortez and Bernie Sanders are behind the Green New Deal in Congress. This will stop fossil fuels and nuclear and leave the government in charge of most of the things in our private lives. The Socialist revolutions of the last century all over again.
James Kennedy, President at ThREE Consulting & ThREEM3, John Kutsch, President, Thorium Energy Alliance:Heavy rare earths and Thorium are found together in nature. The most common and abundant source of heavy rare earths, Monazite, is currently diverted into mine-waste tailings lakes across the U.S., Canada and Brazil because of its companion element Thorium. The U.S. must address Thorium before it can develop a domestic rare earth supply chain for heavy rare earths. U.S. policy on Thorium is the basis for China's monopoly control of rare earths. With the creation of a privately funded Centralized Rare Earth Refinery and Thorium Bank the U.S. can become independent in both Rare Earths and Energy.
Eric Jelinski, past president of Environmentalists for Nuclear - Canada, farmer, environmentalist, university lecturer with degrees in mechanical, chemical and nuclear engineering: The question is really not, "Who can build nuclear?" but, "What does it take to build a nuclear plant," and "How to build nuclear keeping within the capability of your country?" Here is a summary for pressure tube heavy water reactors, PTHW, developed in Canada and appropriate for other countries similar to Canada in the 1970s../p>
Poul Hoilund-Carlsen, Department of Nuclear Medicine Odense University Hospital, Denmark, Mohn Doss, Medical Physicist in Diagnostic Imaging: "The good rays - let them shine" appeared in European Journal of Nuclear Medicine highlighting the invalidity of the LNT model and asking for relaxation of restrictions for low doses involved in nuclear medicine. The two major journals in nuclear medicine – Journal of Nuclear Medicine (JNM) and EJNM are editorially aligned against the LNT model.


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Your vehicle needs air filters for two main reasons. First is because your engine needs clean air for internal combustion. The engine air filter plays an important role to keep the engine running smoothly. The second reason is so that the vehicle's cabin does not get polluted.
Both air filters are in your car to avoid contaminants that could affect the performance of your vehicle. Air filters keep pollens, dust, leaves, and even bugs away from the engine and the inside of your car.
Knowing when your vehicle's air filters replaced really depends on how often you take your car out for a drive and where you usually drive. The bottom line is that the busier and more polluted the environment wherein you always drive, the more often you should have them cleaned and replaced.
Like the engine air filter, you should not ignore the cabin air filter. If your engine's air filter takes care of your vehicle's engine, the cabin air filter takes care of your passenger's health and yours.
The Cost to Replace Your Car Air Filters
Replacing your vehicle's air filters should not really cost you much since it is considered as a simple maintenance service. This is very important because it can save you lots of bucks when it comes to having your vehicle repaired for damages caused by ignoring your dirty air filters.
What you have to keep in mind is that if you take your car to a dealership, it may cost you more since dealerships tend to charge higher than regular body shops. A good tip we can give you is to have other services done to your vehicle when going to a dealership or body shop aside from changing your car's air filter to get the most out of what you will be paying for labor fees.
Labor rates all over the states could be different, but a simple maintenance service like changing your car's air filter should only cost you around $36-$70.
Some body shops would allow you to bring your own air filter replacement, so here is a list of the top brands and models available on the market so that you have an idea on how much a cabin air filter cost.
|Fram CF10374 Fresh Breeze Cabin Air Filter
|Toyota, Dodge, Pontiac
|Beck Arnley 042-2180 Cabin Air Filter
|Mann-Filter (CUK 29 005) Carbon Activated Cabin Air Filter
|Cleenaire CAF4561C Activated Carbon Protection Against Bacteria, Dust, Viruses, Odors and Allergens Cabin Air Filter
|Mann-Filter CUK 2939 Cabin Filter With Activated Charcoal
|Fram CF10285 Fresh Breeze Cabin Air Filter
|Jaguar, Pontiac, Lexus, Scion, Toyota
|EPAuto CP134 (CF10134) Premium Cabin Air Filter with Activated Carbon
|Honda, Acura
|Fram CF10134 Fresh Breeze Cabin Air Filter
|Honda, Acura
|EPAuto CP132 (CF10132) Toyota/Lexus Replacement Premium Cabin Air Filter includes Activated Carbon
|Toyota, Lexus
|EPAuto CP285 (CF10285) Premium Cabin Air Filter includes Activated Carbon
|Toyota, Lexus, Scion, Subaru
Your car AC filter price mainly depends on the year, make, and model of your vehicle. It should not really cost you more than a hundred bucks to buy a compatible air filter for your vehicle.
Where to get Your Car's Cabin Air Filter Replaced?
Since changing your car's cabin air filter is one of the simplest maintenance services you could get from a mechanic, you can visit most likely all body shops near you to have it done.
Here is a list of a few body shops that you can visit or schedule an appointment with.
|Body Shop
|Contact Number
|Fountain Valley Body Works
|(714) 540-2111
|Unique Body Shop
|(616) 534-0951
|Jim Burke Automotive
|(205) 286-9101
|Modern Auto Body Shop
|(336) 721-1855
|Japanese Auto Masters
|(757) 468-1333
|Bell and Osborn Auto Body Shop
|(636) 278-6700
|Thorpe's Body Shop
|(402) 339-4321
If you are from Virginia and is near Japanese Auto Masters, you would be happy to know that this body shop takes "making sure your cabin air filter is clean" seriously. It has a promo for the dirtiest cabin air filter of the month. If you happen to win this prize, it gets to do your oil change for free!
Now, that's a good deal. But that should not really motivate you to leave a dirty cabin air filter in your car for too long. The owners of this body shop came up with this idea to spread awareness that the cabin air filter exists. Apparently, a lot of its customers ask what that is when they come to the shop.
More About Cabin Air Filters
The earliest recorded date when cabin air filters were introduced was in 1983. Vehicles marketed in that year did not have any HVAC (Heating, Ventilation, and Air Conditioning) system yet, but they were already introduced for the same use – to avoid dust and pollens from entering the cabin or the inside of the car.
During that time, the main reason why manufacturers came up with air cabin air filters is because of pollens. The passengers' health was of importance. Up until now, it still is, but aside from pollens, cabin air filters now help keep other allergens and dust away from the cabin.
Nowadays, cabin air filters are made with materials that help eliminate more pollens and particles that could affect the passengers' health. Here are the known types of cabin air filters.
- Ionic Air Filter – this type of air filter relies on voltage to charge the air with negative ions. Negative ions help purify the air or oxygen that goes inside the HVAC system of your vehicle.
- HEPA Air Filter – this type of filter claim to remove 99.97% of airborne particles. This is found to be more effective than using negative ions to filter air.
- Carbon Air Filter – a lot of companies now produce air filters with activated carbon. Aside from keeping dust and other airborne particles away from the cabin, this also helps reduce the bad odor in your car. It keeps the air inside your car remain fresh.
- UV Light Air Filter – this type of filter uses an ultraviolet technology to avoid viruses and microorganisms from repopulating. This is best to use if your top priority is the health of your passengers.
When Should You Replace Your Car's Cabin Air Filter?
As stated, changing your vehicle's cabin air filter will depend on your car usage and where you usually drive. Some would suggest changing it every 3000, 12000 or even 24000 miles, but it's also best to check your car's manual.
Here are some signs that you should make you consider changing your car's cabin air filter right away:
- Reduced air flow – If your cabin air filter is already full of dust and debris, air will have a hard time penetrating your HVAC system. So if you are feeling hot even if your AC is on its maximum setting, then take a look at your air filter right away!
- Noise from the fan or AC – because debris can also be sucked in by your HVAC system, it's possible that your cabin air filter will be damaged. If the particles get past the filter, it would create noise in the HVAC system.
- Bad Odor or musty smell – if you got a cabin filter with activated carbon but your car suddenly smells damp, then you better get a new air filter.


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How to tell if your pet is suffering from summertime allergies
Signs, symptoms, treatments from veterinary medical journalist
SAN ANTONIO – The entire family may be suffering from allergies this summer, including your pets.
Dr. Jeff Werber, veterinarian and veterinary medical journalist from Los Angeles, said these behaviors may mean your dog has allergies:
- Scratching
- Excessive Rubbing
- Scooting
- Biting
- Licking
"It's all about the itch," Werber said. "If your furry friend experiences any of these symptoms, they're most likely exhibiting signs of summertime allergies."
Weber said to see a vet if these symptoms start interrupting daily activities.
There are different medications your veterinarian can provide, but Werber recommends Apoquel.
For more information about canine allergies, you can visit www.youranimalinstinct.com and take the dog itch quiz.
Upon submitting your quiz, a donation is made to the K-9 Courage Program, which helps support retired military and service dogs.
Copyright 2017 by KSAT - All rights reserved.


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To my friends in Paris/Europe at the moment, and to those who are going!
Picture via tumblr (I can't recall which tumblr exactly)
Oh, Andrew Gn
Does the name ring a bell? I first heard of him and saw him a few years back on a Channel NewsAsia documentary (I think it was CNA). But even if you haven't heard of him, it doesn't matter because NOW YOU WILL KNOW OF HIM.
Born in Singapore, Andrew Gn is now based in Paris, and his Fall 2010 RTW collection is quite orgasmic. He makes me like ruffles. And I normally dislike them. Actually, he makes me like a lot of things in this collection; it's 'tougher' than his other work I've seen. DAMN MY LACK OF INCOME!
I have too many favourites in this collection: the military coats, the wonderfully ruched dresses and cut-outs and the details and the cuffs and every other thing, really.
(I hate shaggy things but this is the Best outfit ever. Excuse me, but I really need this whole outfit now. I promise to wear it in the sweltering Singapore heat.)
It's so good, here it is in motionz.
All this excitement is fraying my nerves. I have to go lie down.
This is why Muse is awesome
via ohnotheydidnt
Negative Space
Things I've done:
- tried to go swimming, only to reach the pool and be thwarted by the rain
- bought new eyeshadows (they're pretty!)
- group meeting
- gone for a philosophy on tap session where I was following till I got confused by big words like epistemology
- went to shisha and had a funny discussion on alot of things (religion came up quite abit though), caught up with friends
- worked hard for my money
- had a lazy saturday evening at home, watching The Godfather and Seven Year Itch (yes, with that famous Marilyn Monroe scene)
- worked on my presentation, and upcoming report (though I haven't finished the work on the latter)
So now, I share with you something I've kept on my googlechrome tab for awhile. The use of Negative Space in Logos. What is Negative Space? Take a look and you'll figure it out. Here are some of my favourites, via logodesignlove. More at the source, of course.
Martin Newcombe Property Maintenance logo
Egg n Spoon logo (same day couriers)
Guild of Food Writers logo
ED logo
More Practice
I decided that I wanted to take some pictures. But it was too late to go out taking shots, so I scrummaged up some candles, found something random to shoot and voila.
More than 100 years ago in England, the first film adaptation of Alice in Wonderland was made.
Voila, painstakingly restored. Isn't it quite something? 100 years ago!
Big Night Out 2010
Hello all, I'm on my way to a baking session 😀 Apple crumble, yum.
Here are the pictures I managed to take with just my iPhone. I'll hopefully be getting a second hand Lumix LX 3 soon!
Muse was FANTASTIC as expected, though my shortness meant that o didn't have the best view possible. Nonetheless, I was happy to enjoy them from the back 🙂
From the moment Muse started playing, I just knew it was gonna be good.
Not much of a fan of Saosin, but I did find Rise Against enjoyable.
Lesson learnt- short people shouldn't buy Pen B standing tickets.
Still, it was great! Enjoy the pics. It's baking time, then cramming for the midterms I go!
Grammy Awards 2010
pwnage. And 2 reasons:
1. Lil Wayne. I got goose bumps just as he went into the hook the first time round.
2. Eminem. He killed it. The intensity made my heart rate speed up, I feel like throwing myself at him now (I know that's kinda disgusting).
Lady Gaga, take notes. They didn't need over-the-top ketchup on white costumes to do it.
I'm now going to rewatch this.
]Isn't it wonderful?


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Zakarya, S.A. and Kassim, A. and Lim, H.N. and Anwar, N.S. and Huang, N.M. (2010) Synthesis of titanium dioxide microstructures via sucrose ester microemulsion-mediated hydrothermal method. Sains Malaysiana, 39 (6). pp. 975-979. ISSN 0126-6039
Synthesis_of_titanium_dioxide_microstructures_via_sucrose_ester_microemulsion-mediated_hydrothermal_method.pdf - Published Version
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Titanium dioxide particles were successfully prepared using microemulsion-mediated hydrothermal processing route, with sucrose ester as a stabilising agent. X-ray diffraction patterns revealed that the particles possessed anatase crystal phase. Scanning electron micrographs showed micron-sized spherical particles with rough and smooth surfaces, which eventually interconnected with one another. The formation mechanism of the titanium dioxide microstructures was postulated. The as-prepared particles were subjected to photocatalytic degradation of methylene blue, which exhibited higher photocatalytic activity compared to their commercial counterpart.
|Item Type:
|Uncontrolled Keywords:
|Hydrothermal Microemulsion Sucrose ester Titanium dioxide
|Q Science > Q Science (General)
Q Science > QC Physics
|Faculty of Science > Dept of Physics
|Depositing User:
|miss munirah saadom
|Date Deposited:
|04 Apr 2013 01:50
|Last Modified:
|19 Mar 2019 08:37
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Asssociated Press
ARLINGTON, Texas — Natasha Howard and Jewell Loyd combined to score 30 of their 38 points in the first half and the Seattle Storm beat the Dallas Wings 78-64 Sunday, helping them clinch the No. 6 seed in the WNBA playoffs.
The Storm, the defending champions, play host to No. 7 seed Minnesota in a single-elimination first-round game on Wednesday. The Lynx lost at Los Angeles and the Storm have the tiebreaker between the two teams.
Tuesday's game will be played at Angel of the Winds Arena in Everett.
Seattle has won three in a row overall, and four straight at home, against the Lynx.
Howard had 16 of her 22 points in the first half and and Loyd had 14 of her 16 before the break.
Seattle (18-16) shot 53.1% (17-of-32) from the field in the first half while limiting the Wings to 8-of-29 (28.6 percent) and forcing 10 Wings turnovers to take a 44-26 lead into the break. Dallas trailed by at least 14 points the rest of the way.
Arike Ogunbowale led the Wings (10-24) with 25 points to finish the season with 630, the third-highest rookie scoring total in WNBA history.
Correction: An earlier version headline misstated the day the Seattle Storm host the playoff game. It will be Wednesday.


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(before October 1600)
Historical Records
From Henslowe's Diary, in a list headed "My Lords of penbrockes men begane to playe at the Rosse the 28 of octobȝ 1600 as followeth":
- octobȝ 28 Rd at RadeRicke ...... vs
- (Foakes, f. 83, p. 164; cf. Greg (I, 131), who reads "RodeRicke")
Theatrical Provenance
Henslowe's Diary shows that the play was written for Pembroke's Men at the Rose.
Probable Genre(s)
Possible Narrative and Dramatic Sources or Analogues
Roderick the Great of Gwynedd
If, as several scholars propose (see below), the play was about Rhodri Mawr, King of Gwynedd, Martin Wiggins (III, 393) suggests the following source:
- Caradoc of Llancarvan, The History of Cambria, Now Called Wales, trans. Humphrey Llywd (1584)
Roderic of Spain
Wiggins proposes (III, 393) that the play could have been about Roderic, the last Visigothic king of Spain; he suggests the following sources:
- Thomas Lanquet, An Epitome of Chronicles (1559; a brief outline only)
- Celio Augustino Curione, A Notable History of the Saracens, trans. Thomas Newton (1575), 27-31
- Robert Greene, Mamillia: A Mirror or Looking-Glass for the Ladies of England (1583; mentioned only in passing)
David Nicol (181) notes another English source available to the author of Roderick:
- Thomas Lodge, The Life and Death of William Long Beard (1593), H2v-H3r
The Pictish King Roderick
Wiggins (III, 393) proposes that another, less likely subject is Roderick, a Pictish king who visited Ireland. He suggests the following source:
- Raphael Holinshed, Chronicles of England, Scotland and of Ireland (1577, 1587)
References to the Play
None known.
Critical Commentary
John Payne Collier (I, 181) proposed that the play "may have been a drama on 'Roderick the great', who divided Wales, and who is mentioned in 'Thameseidos', 1600, by E.W., Lib. 2". W.W. Greg (II, 229) elaborated this identification: "he means Rhodri Mawr, prince of North Wales, who after fighting against the Danes fell in battle with the English in 877". Martin Wiggins (3:393) notes this possibility too, correctly referring to Rhodri as a uniter, rather than a divider of Wales.
Greg (II, 229) also raised, but found less likely, the possibility that the play was a prequel to Henry Chettle's Hoffman, since the father of that play's hero is called Roderick.
Wiggins (entry 1077; III, 393-4) proposes two alternative Rodericks who could have been suitable subjects for a play: Roderic, King of Spain, whose rape of Florinda legendarily brought about the invasion of the Moors in the 9th century; and a Pictish king Roderick who visited Ireland and fought in Scotland.
For What It's Worth
If the play was about Roderic of Spain, William Rowley's adaptation of that legend, All's Lost by Lust (1619-20), might offer clues as to how the author of Roderick could have dramatized it.
Works Cited
Site created and maintained by David Nicol, Dalhousie University; updated 10 August 2015.


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text: A light bodied, non-fibered, water-based rapid set anionic asphalt emulsion manufactured with chemical emulsifying agents. This product serves as a base emulsion for further compounding with latex. Being water-based, Ertech 6000 is environmentally and worker friendly. Ertech 6000 is low VOC, nonflammable and presents no hazards from open flame or welding in the work area.


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Notable works, Ali Pur Ka Aeeli, Alakh Nagri, Labbaik, Un Kahi, Talash, Muftianey. Notable awards, Sitara-e-Imtiaz, Munshi Premchand Award, Website. Mumtaz Mufti (Urdu: ممتاز مفتی) ( September 11, – October 27, ), was a writer from. AlakNagri by Mumtaz Mufti Presented by Pakistan Virtual Library. دبستان قدرت اللہ شہاب ۔۔ کی مسحور کن فضاوں کا جام.
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Birdie Today at 3: Jan 16, Hammad Hassan rated it it was amazing. Dec 09, Basirat Atif rated it it was amazing. The people who jump for defense of Mufti, have you even read all of his works?
Mumtaz Mufti was born in BatalaPunjab now mumgaz India. Saboo Today at 8: Maybe I blame him for too much? Despite all the changes in his viewpoints, he did manage to retain his individual point of view and wrote on subjects which were frowned upon by the conservative elements in the society. Notify me of follow-up comments by email. Jan 20, Muhammad added it. This site uses Akismet to reduce spam. August 5, August 6, Also, his honesty in writing accounts of partition in Pakistan is incredible.
We are not hosting torrents, we are giving alternative download links through torrent for ease. Alqkh have listened that alakh nagri mumtaz mufti great book for psychology lovers. Whether Mufti sahib is guilty of starting this trend or recording it I don't know, but this very wrong reading of the relationship has cost the Pakistani nation nagrl my opinion. October 16, at 6: A world full of mystery and fascination.
I think the strongest effect after reading this book is the quest for truth. His peer used to go to a brothel where he got naked and asked a prostitute to sit on his lap – when he felt mufgi was about to get an erection he told the prostitute to get off, this was his way of training his nafs so he can control it.
May 02, Tariq Mahmood rated it really liked it Shelves: Rana Sana Ullah showing his gutter mentality as usual, is there some way to cap thus gutter? Open Preview See a Problem?
Alakh Nagri – Mumtaz Mufti
Jan 16, Hammad Hassan rated it it was amazing. You must log in or register to reply here. Blogging is my passion.
One small incident with Allama Mashriqi's Khaksars in Lahore was very illuminating indeed as his movement has been completely white washed from the Pakistani history very similar to the Badshah Khan's Khudai Khidmatgars. Mufti sahib has a certain magical pull and certainly tell a story.
According to forewords mentioned in his later autobiography, Ali Pur Ka Aeeli is an account of a lover who challenged the social taboos of his times, and Alakh Nagri is an account of a devotee who is greatly influenced by the mysticism of Qudrat Ullah Shahab.
The book Talaash "Quest" was the last book written by Mumtaz Mufti. May 24, Gulshan Ali mufi it. By using this site, you agree to the Terms of Use and Privacy Policy. PappuChikna Today at Skip to content Advertisement.
Fast and without any application Click here to read it online on Fast server. In the beginning of his literary career, he was considered, by other literary critics, a non-conformist writer having liberal views, who appeared influenced by the psychologist Freud.
War Between Spiritual Forces & Awaited Era (Excerpts From Book Alakh Nagri)
Mufti sahab writes about his peer that in his youth the peer used to be a pehalwan not kidding here. To view it, click here.
By using this site, you agree to the Terms of Use and Privacy Policy. Though liked the first half of the novel but didnt enjoy the later one. One of my favourite books as it contains much information about Qudratullah shahab my favourite personality. No trivia or quizzes yet.
September 22, at Mohsin Riaz alakh nagri mumtaz mufti it liked it Nov 04, August 1, at 4: Mumtaz Mufti divided Alakh Nagri in two parts, first part 29 chapters is the continuum of Ali Pur Ka Eili Mufti's autobiography while the second part is about and mainly describing Qudrat Ullah Shihab a renowned bureaucrat and Sufi and the author sufi oriented relationship and experience with Qudrat Ullah Shihab.
Fawad Saleem rated it really liked it Jan 29, In the beginning he was considered among his contemporaries, a non-conformist writer having liberal views, who appeared influenced by Freud.
But good honest writer he is. Now views about Mufti are completely changed for me No doubt he is one of the mumtz urdu writer having u After quitting "alipur ka aili " and cursing the writer for his extreme liberal views I decided not to read anything by Mufti. August 30, at 8:


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text: Madelaine McMasters 20,507 Posted October 27, 2011 Marigold Devin wrote: But ... "... with none of the distraction of RL to slow your fall down the rabbit hole." I had plenty of RL distraction, including three separate men inviting me out on dates in one year, and having to put my brother's needs first, plus I never focussed 100% (or even 50% of my inworld time) with my ex-partner (he has a full-time job in real life, so was not logged in as much as me), and you know I had the ghost hunting for a while, and before that there were other interests/obsessions to distract me from the boys (!):matte-motes-wink-tongue: ... and still I don't know how I fell down that particular rabbit hole. Mari, I don't mean that RL doesn't distract us, I meant that, in SL relationships, the normal distraction and friction that RL applies to our direct connections is gone. You don't talk over me, you don't chew with your mouth open, you don't look away when I'm talking to you because you aren't interested. And I don't do any of those things to you . All those things happen in RL and slow the process of bonding, or prevent it altogether. In SL all that stuff is replaced with projected perfection. Meanwhile, all your RL relationships are filled with that crap! Is it any wonder we slip and fall? And as for falling in love with SL, I think the same things apply. SL is quiet, it never forces itself on you, you are in control, you can create on a scale that's just not possible in RL and you don't have to dust! What's not to love? We're both beyond needing counseling, but it might be helpful to others to think about how this all happens, to know they're not alone and that it gets better. Quote Share this post Link to post Share on other sites


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Living in a single-parent or step family order generic alesse pills, substance use among family members order 0.18mg alesse with amex, family conflict and poor parental supervision are all indicators for drug use in young people buy generic alesse on-line. As discussed in Chapter 6, a key question is what the primary aim of drug policy and legislation should be. At one end of the spectrum, it could simply be to reduce or eliminate illegal drug use, while at the other end it would focus entirely on the health and social problems of the individual drug user, by considering drug dependence as a chronic medical disorder. These are two examples of possible foci: the question is discussed in detail in Chapter 6. Current policy in Britain takes account of both viewpoints, as well as the wider social and economic factors associated with illicit drug use (see Chapters 3 and 6). This chapter examines the development of drug policy in Britain since the mid-19th century and the rationale behind current policy. Opium, and its derivative morphine, were available as patent medicines, in tinctures and other commercial products that were readily accessible through chemists and herbalists. The use of these products declined after the 1868 Pharmacy Act restricted opium sales to the pharmacist's shop, with the Act requiring pharmacists to keep records of the purchasers. The later 1908 Pharmacy Act moved morphine, cocaine, opium and derivatives containing more than 1 per cent morphine into part one of the poisons schedule. At this point, control was on availability and sale and was largely based on self-regulation by pharmacists, with little Government intervention. There was a small population of morphine-using addicts and some opium and cannabis smoking among artistic, mystic and bohemian circles but the population of drug users at the beginning of the 20th century was relatively small. At the same time, British pharmacists and physicians had nearly 40 years' experience of dispensing opiates and attempting to control their use. Britain became committed to a drug control policy as a result of the international narcotics control system established in the early 20th century. A series of international meetings, largely prompted by American concern about Far Eastern opiate use, laid the bases of the system. Britain's involvement in the Indian opium trade with China through the 19th century was brought to an end by the Anglo-Chinese opium agreement. There was some domestic pressure for drug control, with public and press concern about cocaine smuggling to India and opium and morphine smuggling to the Far East, some of which involved British ships. This was of particular concern in the wartime emergency situation of 1915-1916 and was compounded by reports of cocaine use among soldiers, especially those on leave in London, which was seen as compromising army efficiency. In 1916, the Army Council issued an order prohibiting the gift or sale of cocaine and other drugs to soldiers, except on prescription. This was the first time that a doctor's prescription was required by law for the purchase of specified drugs. The regulation made it an offence for anyone except physicians, pharmacists and vets to be in possession of, to sell or give cocaine. This Convention was the first global attempt at drug control and aimed to reduce the use of morphine and cocaine by restricting the manufacture of, trade in, distribution and use of, these drugs to 'legitimate' scientific and medical purposes only. Although it did not specify limiting the use of opium to scientific and medical purposes (and this was, essentially, not covered until 1961 – see Section 5. The Dangerous Drugs Act laid the foundation of further legislation and control policy in Britain and consolidated the precedence of the Home Office over the Ministry of Health in the area of drug policy. The Act generated little debate at large, with recent sensational accounts of recreational drug use among bohemian circles prompting a political and press demand for a penal approach to drug control. The population of opiate users at this time was small, largely middle class, addicted to morphine and in the medical and allied professions, or had become dependent in the course of medical treatment. At the suggestion of the Home Office, the Ministry of Health convened an expert committee (Departmental Committee on Morphine and Heroin Addiction) chaired by Sir Humphrey Rolleston, then President of the Royal College of Physicians, to consider and advise on the circumstances in which it was medically advisable to prescribe heroin or morphine to addicts. The report produced by the committee (usually known as the Rolleston Report),3 reaffirmed the doctor's freedom to prescribe regular supplies of opioid drugs to certain addicted patients in defined circumstances that the committee regarded as 'treatment' rather than the 'gratification of addiction'. While the possession of dangerous drugs without a prescription was still the subject of the criminal law, addiction to opioid drugs was recognised as the legitimate domain of medical practice (and hence prescribing). This balance of a medical approach within a penal framework became a hallmark of British drug control and has been called the 'British System' by commentators. The League of Nations was established after the First World War and provided a centralised body for administration of international drug control. The second Geneva Convention of 1925 was signed under the auspices of the League of Nations and required parties to the treaty to provide annual statistics on drug stocks and consumption, the production of raw opium and coca, and the manufacture and distribution of heroin, morphine and cocaine. The Geneva Convention was also notable in bringing cannabis under international control, and restrictions on cannabis were implemented in Britain with the 1928 Dangerous Drugs Act. This was a settled approach, as a major addiction problem was not apparent in the British drug scene. In the early 1960s, the first reports about the activities of young heroin users began to appear in British newspapers – a phenomenon that was new to Britain. The Home Office convened an interdepartmental committee under the chairmanship of Sir Russell Brain, largely prompted by concern about whether long-term prescribing was still appropriate more than 30 years after the Rolleston Report. The Brain Committee published its first report early in 1961,4 and concluded that the drug problem remained small and no changes in approach were needed. Increasing media and professional evidence of a heroin epidemic in Britain involving younger heroin users led to a Second Interdepartmental Committee on Drug Addiction, again chaired by Brain. Drug addiction was formulated as a 'socially infectious condition', for which it was appropriate to provide treatment. The committee concluded that the increase in heroin use had been fuelled by a small number of doctors who were overprescribing heroin and that individual doctors were unable to meet the demands of the new situation. The doctors who obtained licences were mostly consultant psychiatrists in charge of drug treatment centres. This limitation of doctors' clinical autonomy received some criticism from the medical profession. Prescription of heroin to addicts declined in the early 1970s, as doctors at the drug clinics were uncomfortable prescribing it. Concern over the use of amphetamines, or 'purple hearts' or 'pep pills' as they were commonly called, led to their control under the Drugs (Prevention of Misuse) Act 1964.
Materials Required : Abbe' refractometer 0.18mg alesse for sale, volatile oil buy alesse 0.18mg free shipping, xylene order alesse overnight delivery, capillary tubes ; Procedure : In order to obtain precise and accurate measurements the prism case of Abbe' refractometer is attached to a thermostat bath whose temperature is previously maintained at 25°C. Open the prism box gently and place a few drops of pure volatile oil on the lower prism with the help of a capillary tube and finally close the box. The mirrors are duly adjusted so as to obtain a bright illumination of the field of view. The knurled knob is turned gradually until the field of view displays a dark and light zone. In case, a col- oured-fringe is observed between the two zones it becomes necessary to adjust the Amici prisms carefully to achieve a sharp and black boundary. It is important to adjust this on the cross hair and finally the reading of refractive index is noted. After use, the prism box is opened and cleaned thoroughly with a lens cleansing 25 tissue moistened with xylene/acetone. It has been observed that a number of monomers usually hold all the hydrocarbon chains together specifically in the centre of the micelle which are ultimately responsible for minimising the free energy of the system. Using Abbe' refractometer measure the refractive indices of all the above six solutions besides the stock solution (25%) at 25°C. Explain the following with reference to 'Refractometry' : (a) Snell's Law, (b) Critical angle vis-a-vis Refractive index, (c) Molar refractivity, and (d) Atomic refractivities. Describe the optical system of Abbe's Refractometer, its optical path for upper prism and its operational procedure. In fact, there exists an indefinite number of planes that pass through the line of propagation, and an ordinary light usually vibrates in all the planes. Under certain specific circumstances, the vibrations may all be restricted to one direction only, in the perpendicular plane and this is termed as plane-polarized light. Thus, an ordinary light (unpolarized light) gets converted into a plane-polar- ized light by simply passing it through a lens made of the above cited materials and traditionally called a Nicol prism (after William Nicol-the inventor). Therefore, an optically active substance is one that rotates the plane of polarized light. In other words, certain specific substances by virtue of their internal structure may be able to transmit only such vibrations that are oriented along certain directions and entirely block vibrations in other directions. However, it is worth mentioning that the plane-polarized beam is the vector-sum of these two components. In other words, when a polarized light, oscillating in a specific plane, is made to pass through an optically active substance, it happens to emerge oscillating in an altogether different plane. Such types of molecules usually exist in two stereoisomeric forms as mirror images of each other. In the same vein, the example [ii (b)] represents 1-2 methy1-1-butanol ; a product derived from fusel oil. Non-superimposability and Optical Activity : Interestingly, in these two specific examples of lactic acid (d- ; and 1-isomers) and 2-methy-1-butanol (d- ; and 1-isomers) one criterion is common i. In other words, such compounds whose mirror images display non- superimposability exhibit optical activity. Thus, a pure sample of a single enantiomer must fulfil the following three important characteristic features, namely : (a) No molecule can serve as the mirror image of another molecule, (b) Exact cancelling out of rotations (of plane of polarized light) do not occur, and (d) Net result is offered in terms of the 'optical activity'. Principle : The underlying principle of a polarimeter is that light from the source, usually a sodium vapour lamp, first gets collimated at A, and subsequently falls upon polarizer B (acalcite prism). The polarizer permits only the light polarized in a particular direction to pass it. The emergent polarized ray now passes through the sample under investigation, kept in the polarimeter glass tube C to the analyzer D, which happens to be another polarizing prism. The analyzing rotator prism D (Nicol) is fixed in such a manner that it can be rotated easily about the axis of the incident light ray. Two situations arise when the analyzing rotator prism (D) is put into action,firstly, the prism being parallel to the plane of polarization of the incident light—the net result is that the intensity of light reaching the Null detector F is maximum ; and secondly, the prism being perpen- dicular to the plane of the polarized light—the net result is observed by the intensity of light reaching the detector as minimum. Specific Rotation : A polarized light when passed through an optically active substance, each mol- ecule of it encountered by the light beam rotates the plane of polarization by a constant amount characteristic of the substance. Consequently, a measure of the rotary power of the individual molecule, irrespective of the two parameters, namely : the path length and the concentration, is achieved by converting the measured rotation into a specific rotation by the help of the following expressions : T T 100 αλ []α λ =... Levodopa Theory : It has been observed that the specific rotation of levodopa in the visible region is rather on the 20 lower side i. Dementholised — — – 22° to – 29° Brazilian Oil, Mint Oil – 17° to – 24° Chinese Oil 8. It is pertinent to mention here that the specific optical rotation of a solid is always expressed to a given solvent and concentration. The mean value of at least five similar determinations is employed in the calculation of the specific optical rotation. Calculations : Calculate the specific optical rotation using the following expression, namely : 20 α For Liquids, []α D = 1d 20 100α For solids, []α D = 1c where, l = the length in dm of the polarimeter tube, d = the relative density of the substance, and c = the concentration of the substance expressed as a percentage w/v. Cognate Assays The specific optical rotation of a large number of potent pharmaceutical substances may be determined by the above mentioned procedure but specific concentrations and method of preparation of solutions is accord- ing to the official compendium as stated in Table 19. Substance Concentration/Preparation Specific Optical 20 of Solution Rotation []α D 1. How would you depict the plane polarized light, right circu- larly polarized light and left circularly polarized light diagramatically? How would you determine the optical rotation of the following pharmaceutical substances? How would you carry out the determination of specific optical rotation of the following official compounds? It is quite evident that the optical characteristics of each suspension shall alter according to the concentration of the dispersed phase. In fact, the measurement of the intensity of the transmitted light through such suspensions vis-a-vis the concentration of the dispersed phase serves as the basis of turbidimetric analysis. The observed opalescence or cloudiness is the net result caused by irregularly and diffusely reflected light from the suspension.
Phenytoin depresses Phase 4 depolarization purchase 0.18mg alesse overnight delivery, which makes it useful for treating digoxin-induced arrhythmias buy alesse 0.18mg with amex. Contraindications Heart block and sinus bradycardia are contraindications for phenytoin administration generic alesse 0.18mg on line. Drug-Drug Interactions Phenytoin may decrease the effectiveness of ritonavir, valproic acid, ethosuximide, warfarin, oral contraceptives, corticosteroids, etoposide, doxorubicin, vincristine, methotrexate, cyclosporine, theophylline, chloramphenicol, rifampin, doxycycline, quinidine, mexiletine, disopyramide, dopamine, or nondepolarizing muscle relaxants. Serum phenytoin levels may be increased by cimetidine, chloramphenicol, felbamate, zidovudine, isoniazid, trimethoprim, or sulfonamide. Rifampin, zidovudine, cisplatin, vinblastine, bleomycin, antacids, and folic acid may decrease phenytoin levels. Dubin Poisoning Information Symptoms of phenytoin poisoning include unsteady gait, slurred speech, confusion, nausea, hypothermia, fever, hypotension, respiratory depression, and coma. Flecainide Indication Flecainide is indicated for treatment of atrial, junctional, and ven- tricular arrhythmias. Flecainide has a long time constant and takes longer to dissociate from sodium channels. In specialized conduction tissue, refractory periods are shortened and automaticity is decreased. Dosing Children: Oral: initial dose, 1 to 3 mg/kg/day or 50 to 100 mg/m2/day, in three divided doses. Increase every few days to usual 3 to 6 mg/kg/day or 100 to 150 mg/ m2/day in three divided doses, up to 8 mg/kg/day or 200 mg/m2/day Adults: Oral: 50 to 100 mg every 12 hours; increase by 100 mg/day every 4 days. Usual dose, at most 300 mg/day; maximum, 400 mg/day Pharmacokinetics Flecainide shows complete absorption. The half-life in newborns is 29 hours; infants, 11 to 12 hours; children, 8 hours; and adults, 12 to 27 hours. Antiarrhythmic Medications 161 with left hemiblock or trifascicular block, cardiogenic shock, and myocardial depression. Antacids, carbonic anhydrase inhibitors, or sodium bicarbonate may decrease clearance of flecainide. Compatible Diluents/Administration Dairy products may interfere with the absorp- tion of flecainide. Propafenone Indication Propafenone is indicated for treatment of atrial, junctional, and ven- tricular arrhythmias. Dubin Propafenone has effects on the slow inward calcium current and delayed out- ward potassium current. Upper dose range, 600 mg/m2/day Adults: Oral: Immediate release: 150 mg every 8 hours; increase every 3 to 4 days to 300 mg every 8 hours Extended release: 225mg every 12 hours; increase every 5 days to 325 mg every 12 hours, to a maximum of 425 every 12 hours Pharmacokinetics Propafenone is well absorbed. Propafenone is metabolized in the liver, with two genetically determined groups described (fast and slow me- tabolizers). Drug-Drug Interactions Cimetidine, quinidine, ritonavir (contraindicated), fluoxet- ine, and miconazole may increase propafenone levels. Propafenone may increase levels of digoxin, metoprolol, propranolol, theophylline, and warfarin. Antiarrhythmic Medications 163 Poisoning Information Propafenone has a narrow therapeutic index and severe toxicity is seen slightly above the therapeutic range, especially if propafenone is combined with other antiarrhythmics. Acute single ingestion of twice the daily dose of propafenone is life threatening. Additional boluses can be adminis- tered, with an increase in the infusion rate up to 200mg/kg/min Adults: I. Repeat until therapeutic dose or a maximum main- tenance dose of 200µg/kg/min is reached Pharmacokinetics Esmolol is metabolized in blood by esterases. Contraindications Contraindications of esmolol use are sinus bradycardia or heart block, uncom- pensated heart failure, and cardiogenic shock. Dubin Precautions/Warnings Use esmolol with care in patients with reactive airway disease. Caution should be exercised when discontinuing esmolol, to avoid withdrawal effects. Compatible Diluents/Administration Esmolol must be diluted to a final concentration of 10 mg/mL. Propranolol Indication Propranolol is used to treat atrial and ventricular tachyarrhythmias and hyper- tension. The half-life of propranolol in infants is 3 to 4 hours; in children and adults, it is 6 hours. Caution should be exercised when discontinuing propranolol to avoid potential withdrawal. Drug-Drug Interactions Phenobarbital and rifampin may increase propranolol clearance and decrease its activity. Compatible Diluents/Administration Propranolol is incompatible with bicarbonate; protect from exposure to light. Atenolol Indication Atenolol is used to treat atrial and ventricular tachyarrhythmias and hyper- tension. Do not exceed the adult maximum dose of 100 mg/day Adults: Oral: initial, 25 to 50mg/dose administered daily; usual dose, 50 to 100 mg/dose administered daily. Maximum dose, 100 mg/day Dosing adjustment in renal impairment: If Clcr 15 to 35mL/min, use a maximum dose of 50mg or 1mg/kg/dose daily. If Clcr less than 15mL/ min, use a maximum dose of 50 mg or a 1 mg/kg/dose every other day Pharmacokinetics Atenolol reaches a peak concentration 2 to 3 hours after an oral dose; and has a half-life of up to 9 to 10 hours. Antiarrhythmic Medications 167 active metabolites; and is eliminated in urine and feces. Drug-Drug Interactions Atenolol has additive effects with other antihypertensive agents. Metoprolol Indication Metoprolol is used to treat atrial and ventricular tachyarrhythmias and hyper- tension. For adolescents, limited infor- mation suggests 50 to 100 mg twice daily for control of hypertension 168 A. Max- imum dose, 15 mg every 3 to 6 hours Oral: initial dosing, 100mg/day, in one to two doses a day. Usual dosage, 100 to 450 mg/day Pharmacokinetics Metoprolol undergoes extensive first-pass hepatic transformation. Metoprolol has a half-life of 3 to 8 hours; has no active metabolites; and is excreted in the urine.
Note that severe and life- threatening toxic effects are associated with the loading phase and chronic use of amiodorane discount alesse 0.18mg on line. These precautions should be maintained for up to 4 months follow- ing discontinuation of drug therapy buy alesse 0.18 mg otc. Adverse reactions • Oral Ð Common: headache purchase alesse 0.18mg otc, dizziness, fatigue, muscle weakness, solar dermatitis, photosensitivity, discoordination, hyperlipi- demia, nausea, vomiting, constipation, anorexia, tremor, paresthesias,visual disturbances. Clinically important drug interactions • Drugs that increase effects/toxicity of amiodarone: calcium channel blockers, cimetidine, ritonavir, volatile anesthetics. Advise patient to instill methy- cellulose ophthalmic solution frequently to minimize problem. Editorial comment • Oral: Bioavailability of amiodarone is 40–60% depending on absorption. Iodine dose is about 40 mg/pill and this likely contributes to the most common adverse reaction: thyroid dysfunction. Most adverse end-organ problems are cumula- tive dose-related and therefore lower maintenance doses have been better tolerated for longer periods. These patients may be at higher risk for conduction abnormalities and myocardial dysfunction secondary to anesthetic agents. Warnings/precautions • Use with caution in patients with the following conditions: epilepsy, angle-closure glaucoma, cardiovascular disease, his- tory of urinary retention, suicidal tendencies, benign prostatic hypertrophy, concurrent anticholinergic drugs, hyperthyroid patients receiving thyroid drugs, alcoholism, schizophrenia. Sit at the edge of the bed for several minutes before standing, and lie down if feeling faint or dizzy. Adverse reactions • Common: sedation, anticholinergic effects (dry mouth, consti- pation), nausea, dizziness, headache, taste disturbance, weight gain. Advice to patient • Use two forms of birth control including hormonal and barrier methods. Sit at the edge of the bed for several minutes before standing, and lie down if feeling faint or dizzy. Clinically important drug interactions • Drugs that increase effects/toxicity of calcium blockers: cime- tidine, β blockers, cyclosporine. Impaired renal func- tion prolongs duration of action and increases tendency for toxicity. Susceptible organisms in vivo: [same as ampicillin] Streptococcus pneumoniae, beta-hemolytic streptococci, Enterococcus faecalis, viridans streptococci, Escherichia coli, Hemophilus influenzae, Neisseria gonorrhoeae, Proteus mirabilis, Salmonella (often resist- ant), Shigella (often resistant), Listeria monocytogenes, Neisseria meningitidis. Adjustment of dosage • Kidney disease: creatinine clearance 10–30 mL/min: 250 or 500 mg q12h; creatinine clearance <10 mL/minute: 250 or 500 mg q24h. Consider skin testing, with major and minor antigenic components, of penicillin hypersensitivity in patients with β-lactamase allergy who require amoxicillin for life-threatening infections, to assess possibility of a hypersensitivity reaction. If patient is given drug parenterally, observe for at least 20 minutes for possible anaphylactic reaction. Negative history of penicillin hypersen- sitivity does not prelude a patient from reacting to the drug. Clinically important drug interactions • Drugs that increase effects/toxicity of penicillins: probenecid, disufiram (increase levels). Editorial comments • Amoxicillin is preferred over ampicillin for oral use because incidence of diarrhea is less. Amoxicillin is also used orally for prophylaxis of endocarditis after dental procedures in high-risk patients. Class of drug: Antibiotic, penicillin family plus β-lactamase inhibitor (clavulanate). Clavulanate inhibits the β-lactamase of methicillin-susceptible Staphylococcus aureus, Hemophilis infuenzae, Branhamella catarrhalis, anaerobic organisms, Neisseria gonorrhoeae. Warnings/precautions • Diarrhea is more common with amoxicillin–clavulanate than with amoxicillin alone. Consider skin testing, with major and minor antigenic components, of penicillin hypersensitivity patients with β-lactamase allergy who require amoxicillin for life-threatening infections, to assess the possibility of a hyper- sensitivity reaction. If patient is give the drug parenterally, observe for at least 20 min for possible anaphylactic reaction. Negative history of penicillin hypersensitivity does not prelude a patient from reacting to the drug. Administer at least 1 hour before a bacteriostatic agent is given (eg, tetracycline, eryth- romycin, chloramphenicol). Advice to patient • If you are receiving an oral contraceptive, use an alternative method of birth control. Clinically important drug interactions • Drugs that increase effects/toxicity of penicillins: probe- necid. Editorial comments • Amoxicillin–clavulanate is used for complicated or chronic sinusitis and otitis media because its spectrum includes S. It is the drug of choice for bite-related infections, as it provides coverage for oral anaerobes, streptococci, and Pasteurella multocida. Mechanism of action: Increases fungal cell membrane perme- ability causing cell death. Adverse reactions • Common: increased liver enzymes, tachycardia, azotemia, hypokalemia, hypotension, chills, fever, nausea, hyperbiliru- binemia. Clinically important drug interactions • Drugs that increase effects/toxicity of amphotericin B: amino- glycosides, cisplatin and other antineoplastic drugs, cyclosporine, corticosteroids, nephrotoxic drugs. Editorial comments • Currently two forms of amphotericin B are available on the market. While Ambisome is incorporated into a liposomal drug delivery system, Abelcet is combined with phospholipid. Fevers and chills have been reported to occur 1–2 hours after beginning intravenous infusion with Abelcet. Susceptible organisms in vivo: Streptococcus pneumoniae, beta- hemolytic streptococci, Enterococcus faecalis, viridans streptococci, Escherichia coli, Hemophilus influenzae, Neisseria gonorrhoeae, Proteus mirabilis, Salmonella (often resistant), Shigella (often resist- ant), Listeria monocytogenes, Neisseria meningitidis. Adjustment of dosage • Kidney disease: creatinine clearance <10 mL/min: increase dosing interval to 12 h. Consider skin testing, with major and minor antigenic components, of penicillin hypersensitivity in such patients to assess the possibility of a hypersensitivity reac- tion.
The particle size cheap 0.18mg alesse free shipping, surface charge and gene transfer efficiency of plasmid/dendrimer complexes prepared with the 5th generation of dendrimers has been shown to be influenced by dendrimer concentration in the complexes purchase alesse discount. The colloidal and surface properties of plasmid/chitosan complexes have been shown to depend on the molecular weight of chitosan discount 0.18mg alesse amex, the ratio of plasmid to chitosan and the preparation medium. Smaller nanoparticles have been observed with low molecular weight chitosan (2 kDa) as compared to high molecular weight chitosan (540 kDa). Interestingly, the transfection efficiency of the complexes was not affected by the presence of serum proteins, even though the presence of serum is known to adversely affect the transfection efficiency. The blood capillary walls are comprised of four layers, namely plasma-endothelial interface, endothelium, basal lamina, and adventia. Macromolecules can cross the endothelial barrier: • through the cytoplasm of endothelial cells themselves; • across the endothelial cell membrane vesicles; • through inter-endothelial cell junctions; • through endothelial cell fenestrae. Based on the morphology and continuity of the endothelial layer, capillary endothelium can be divided into three categories: continuous, fenestrated, and discontinuous endothelium (see Section 5. The continuous capillaries are found in skeletal, cardiac, and smooth muscles, as well as in lung, skin, subcutaneous and mucous membranes. The endothelial layer of brain microvasculature is the tightest endothelium, with no fenestrations. Capillaries with fenestrated endothelia and a continuous basement membrane are generally found in the kidney, small intestine and salivary glands. Most of these capillaries have diaphragmed fenestrae, which are circular openings of 40–60 nm in diameter. The discontinuous capillaries, also known as sinusoidal capillaries, are common in the liver, spleen, and bone marrow. These capillaries show large interendothelial junctions (fenestrations up to 150 nm). Highly phagocytic Kupffer cells line the sinusoids of the liver, and those of the bone marrow by flattened, phagocytic reticuloendothelial cells. In the spleen, the endothelial cells contain a large number of pinocytic vesicles (up to 100 nm in diameter). Due to their large molecular weight (> 1,000 kDa) and hydrodynamic diameter in aqueous suspension of 100 nm, plasmids extravasate poorly via continuous capillaries because of tight junctions between the cells. However, plasmids can easily extravasate to sinusoidal capillaries of liver and spleen. Formulating plasmids into unimeric particles of 20–40 nm in diameter may enhance extravasation of plasmids across continuous and fenestrated capillaries. The (patho)physiology and microanatomy of tumors is significantly different from normal tissues (see Section 5. A tumor contains vessels recruited from the pre-existing network and vessels resulting from angiogenic response induced by cancer cells. There is a considerable variation in the cellular composition, basement membranes and in the size of the interendothelial cell fenestrations. Tumor interstitium is characterized by large interstitial volume and high diffusion rate. Sven Frøkjaer, Lona Christrup and Povl Krogsgaard-Larsen; Munksgaard, Copenhagen, 1998, pp. Tumor accumulation of plasmid could result from the enhanced permeability of the tumor vasculature, combined with their reduced clearance from the tumor due to the absence of the lymphatic system. Pharmacokinetic analysis of in vivo disposition profiles of radiolabeled plasmid provides useful information on the overall distribution characteristics of systemically administered plasmids, with one critical limitation. The plasma half-life of plasmid is less than 10 min, and hence tissue distribution and pharmacokinetic parameters of plasmid calculated on the basis of total radioactivity are not valid at longer time points. Thus, polymerase chain reaction and Southern-blot analysis are required to establish the time at which the radiolabel is no longer an index of plasmid distribution. The deposition of plasmids after systemic administration is restricted to the intravascular space due to its low microvascular permeability in most organs with continuous capillary bed. Some organs with fenestrated capillaries, such as liver, spleen, and bone marrow, provide some opportunities for extravasation of plasmids. Intravenously injected plasmids initially perfuse the pulmonary vascular beds, maximizing the 347 Figure 14. Reproduced with permission from: Biodistribution and gene expression of plasmid/lipid complexes after systemic administeration, Mahato R. Southern-blot analysis of blood showed the rapid degradation of plasmid, with a half-life of less than 5 min for intact plasmid, and was no longer detectable at 1 hr postinjection. By Southern-blot analysis, there was no detectable plasmid in the brain, large intestine, small intestine, or gonads at the 1-hr timepoint. Southern blot analysis also demonstrated that plasmid remained in the liver, spleen, lung, marrow, and muscle, although at diminished levels, up to 24 hr postinjection. The plasma membrane is the next obstacle to be overcome in delivering genes into a cell. Gene delivery systems rely on binding to cell surface molecules, either specific, non- specific or both, prior to cellular internalization. The surface bound material usually gains entry into the cell either by endocytosis or membrane fusion. The schematic representation of the process of gene delivery and expression is shown in Figure 14. Gene delivery systems can distribute plasmids to the desired target cells, after which the plasmid is internalized into the cell by a number of mechanisms, such as adsorptive endocytosis, receptor-mediated endocytosis, micropinocytosis, caveolae-mediated endocytosis and phagocytosis (see Section 1. The intracellular fate of plasmids depends on the means by which they are internalized and translocated to the cytoplasms and then to the nucleus. Extacellular environment → tissue targetability → cellular uptake → intracellular trafficking → nuclear entry → gene expression The transition from coated vesicle to early endosome is accompanied by acidification of the vesicular lumen that continues into the late endosomal and lysosomal compartments, reaching a final pH in the perinuclear lysosome of approximately 4. Such acidification associated with endosome maturation provides the means by which certain viruses gain access to the cytosol. Acid-induced conformational changes in the viral proteins trigger translocation across the endosomal membrane via a fusion process. By taking advantage of the endosomal acidification, pH-sensitive liposomes, adenovirus and endosomolytic peptides have been used to facilitate the release of plasmids into the cytoplasm prior to lysosomal degradation. Non-clathrin-coated pit internalization can occur through smooth imagination of 150–300 nm vesicles or via potocytosis. This pathway has been shown to be involved in the transport of folate and other small molecules into the cytoplasm. Plasmids are taken up by muscles through the T-tubules system and caveolae via potocytosis.
Note that the guidelines do not address behavioural alesse 0.18mg, structural and biomedical prevention interventions that do not involve the use of ArV drugs buy alesse with paypal. Chapter 7: Includes recommendations on ArT for adults (including pregnant and breastfeeding women) purchase 0.18 mg alesse amex, adolescents and children, including updated recommendations applicable to the majority of populations regarding the optimal timing for initiating ArT (when to start); updated recommendations on the most effective and feasible frst- and second-line treatment regimens (what to start and what to switch to); updated recommendations for monitoring the response to and toxicity of ArT; and a discussion of third-line ArT. The chapter proposes steps to ensure fair, inclusive and transparent decision-making processes at the country level; discusses parameters to consider in assessing and adapting the global recommendations in countries; and suggests tools for costing and planning. Considerations for implementation across the health system and for specifc, key recommendations in the guidelines are also discussed. It proposes a range of indicators that may be used to track the implementation of new recommendations and indicators to monitor the performance of programmes across the continuum of care. Chapter 11 also highlights opportunities provided by new recommendations to review and strengthen monitoring and evaluation systems. In the longer term, the guidelines will contribute to and inform efforts to achieve universal health coverage, a key pillar of the post-2015 development agenda. The public health approach seeks to ensure the widest possible access to high-quality services at the population level, based on simplifed and standardized approaches, and to strike a balance between implementing the best-proven standard of care and what is feasible on a large scale in resource-limited settings. Some countries may face signifcant ethical challenges as they seek to implement these guidelines in the context of constraints on resources and health systems. A key challenge may involve the need to give priority to ensuring ArT for the people who are most ill and those already receiving treatment, while also striving to implement expanded eligibility criteria. Each country will need to plan its own approach to ensuring that current ArV programmes are not disrupted and that expanded access is fair and equitable. A strong recommendation for a specifc approach to service delivery should not necessarily be viewed as an endorsement of that model over an effective service delivery model already in place in a country. Systematic reviews were outsourced to researchers who developed search protocols and conducted reviews of the available scientifc evidence. Methods and process for developing the guidelines 49 Two global community and civil society consultations on service delivery across the continuum of care in generalized and concentrated epidemic settings. Consultations with health workers working with adults and with children on the values and preferences related to priority areas in the guidelines were conducted through an e-survey (Web Annex www. An impact assessment using the Spectrum model to estimate the increased number of adults and children eligible for ArT based on various eligibility criteria (Web Annex www. A full draft of the guidelines was circulated for comment to members of the Guideline Development Groups and the external peer review group. A total of 21 Guideline Development Group members and 12 peer reviewers declared membership of pharmaceutical industry or other advisory panels or receipt of consulting fees, and 23 Guideline Development Group members and 13 peer reviewers declared pharmaceutical industry fnancial support through grants for research. There was also a further declaration at the Guideline Development Group meeting of the involvement of members as investigators in key trials and studies. The broad range of constituencies represented on the different Guideline Development Group panels was also noted, and that the majority of members had no declared interests. All individuals with declared interests therefore proceeded to participate fully in the Guideline Development Group meetings or to act as peer reviewers. The proposed recommendations were then considered, informed by a standardized decision-making table for each topic (Box 3. The Guideline Development Groups discussed both the proposed wording of the recommendations and the rating of its strength (strong or conditional). All decisions were reached by discussion and consensus on the recommendations, including their strength and, where appropriate, the conditions to be attached to the recommendations. Disagreements were resolved through e-mail discussions, teleconferences and redrafting recommendations and rationale. Early drafts of sections of the guidelines were circulated to Guideline Development Group members, and a full draft of the guidelines was circulated to Guideline Development Group members and peer reviewers for comment. The extensive comments from more than 100 reviewers were addressed where possible and incorporated into the revised guidelines. The quality of evidence is defined as the confidence that the reported estimates of effect are adequate to support a specific recommendation. Observational studies are initially rated as low-quality evidence but may be upgraded if the magnitude of the treatment effect is very large, if multiple studies show the same effect, if evidence indicates a dose–response relationship or if all plausible biases would underestimate the effect (10). The higher the quality of evidence, the more likely a strong recommendation can be made. The strength of a recommendation reflects the extent to which the Guideline Development Group was confident that the desirable effects of following a recommendation outweigh the potential undesirable effects. The strength is influenced by the following factors: the quality of the evidence, the balance of benefits and harms, values and preferences, resource use and the feasibility of the intervention (Table 3. A strong recommendation is one for which the Guideline Development Group was confident that the desirable effects of adhering to the recommendation outweigh the undesirable effects. A conditional recommendation is one for which the Guideline Development Group concluded that the desirable effects of adhering to the recommendation probably outweigh the undesirable effects but the Guideline Development Group is not confident about these trade-offs. The reasons for making a conditional recommendation include the absence of high- quality evidence; imprecision in outcome estimates; variability in the values and preferences of individuals regarding the outcomes of interventions; small benefits; applicability in all settings versus specific settings; and benefits that may not be worth the costs (including the costs of implementing the recommendation). The more that the benefts outweigh the risks, the more likely that a strong recommendation will be made. Values and If the recommendation is likely to be widely accepted or highly valued, a preferences strong recommendation will probably be made. If there are strong reasons (acceptability) that the recommended course of action is unlikely to be accepted, a conditional recommendation is more likely to be made. Costs and fnancial Lower costs (monetary, infrastructure, equipment or human resources) implications or greater cost–effectiveness will more likely result in a strong (resource use) recommendation. Feasibility If an intervention is achievable in a setting where the greatest impact is expected, a strong recommendation is more probable. This applies to specific topics in Chapter 9, including retention across the continuum of care, but this did not lead to formal recommendations. Structured discussions were held among Guideline Development Group members regarding setting priorities for key clinical recommendations in various epidemic scenarios (settings with generalized and concentrated epidemics and with low, moderate and high ArT coverage). A short version will summarize key new and existing recommendations for easy reference. A library of all supporting documentation and evidence will also be made available on the web site. Assistance will be provided to Member States to adapt the guidelines to their national contexts.
This section presents the results of some key convenience studies and review papers 0.18mg alesse fast delivery. Antimicrobial Drugs Antimicrobial drugs treat bacterial discount alesse 0.18 mg without prescription, viral effective alesse 0.18mg, fungal, and parasitic diseases. There are considerable data to suggest that antimicrobial drug quality, par- ticularly the quality of antibiotics and antimalarials, is a problem in low- and middle-income countries. In 2007 Kelesidis and colleagues conducted a comprehensive literature review on antimicrobial drug quality, reviewing Copyright © National Academy of Sciences. They found that a lack of methodological detail prevented pooling or interpreting aggregate results (Kelesidis et al. As Table 3-6 indicates, they found reason for con- cern with antibiotic quality in low- and middle-income countries, though reports of poor-quality antibiotics surface all over the world, including the United States and Europe (Kelesidis et al. A year later, a study of 111 amoxicillin samples collected in four Arab countries found that 56 percent failed U. It is diff- cult, however, to draw frm conclusions about substandard drug production from these studies. Antibiotics degrade quickly in warm climates; it is hard to distinguish substandard manufacture from poor storage and handling. When researchers test only authorized products, they bias their sample against the unregistered products used by the poorest (Seear et al. Some convenience samples have compared the quality of approved and un- approved products. Between 2008 and 2012, Bate and colleagues collected samples of 2,652 anti-infective drugs from around the world: 11 African cities, 3 Indian cities, Bangkok, Beijing, Istanbul, Moscow, and São Paulo. The report mentions that the failure rates were higher among samples from Africa than among samples from middle- income nations (Bate et al. Acute malaria episodes come on quickly and often; antimalarials are bought on short notice from the most 3 Including, but not limited to, amoxicillin, ampicillin, chloroquine, rifampicin, and co-trimoxazole. For these reasons, they are often the target of criminals and unscrupulous manufacturers. Investigators found unregistered medicines least often at the central distribution level (see Figure 3-4). A recent review paper includes some higher estimates of poor-quality antimalarial drugs (Nayyar et al. The review included 28 published and unpublished studies, mostly (n = 22) from convenience samples, but also 7 that included some type of randomized design (Nayyar et al. Of the 497 samples that failed chemical testing, 34 percent had no active ingredient; 4 percent had low active ingredient. In a subset of 919 samples with intact packaging and a verifed, genuine packaging sample for comparison, 46 percent failed packaging analysis (Nayyar et al. Investigators classifed all drugs failing packaging analysis as falsifed, as well as those substandard drugs that contained no active ingredient or an ingredient not listed on the label (Nayyar et al. Nayyar and colleagues used the same criteria to categorize samples from sub-Saharan African countries (Nayyar et al. Forty-fve percent of the studies reported active ingredient test results, fnding that 121 (15 percent) had low active ingredient and 3 percent had excessive active ingre- dient (Nayyar et al. Only one study reported packaging analysis, and it found 36 percent failure (Nayyar et al. Nayyar and colleagues had fewer African samples (n = 389) from which to calculate the percentage of falsifed drugs; they found 20 percent falsifed (see Table 3-7) (Nayyar et al. A consistent problem with all convenience surveys of drug quality is that they tend to sample heavily from the formal market: licensed phar- macies and dispensaries. Results of these studies will likely underestimate the burden of falsifed and substandard drugs in places where much of the population buys essential medicines in unregulated bazaars. Sampling from these vendors is diffcult, but a convenience sample of informal and private medicine sellers in Guyana and Surinam found 58 percent of the antimalarial samples from Guyana and all the samples from Surinam to be falsifed or substandard (Evans et al. In a Burkina Faso study, Tipke and colleagues compared antimalarial drug quality in licit and illicit vendors. They found that 90 percent of samples from street vendors and open markets were substandard, and only 10 percent of samples from legal vendors were substandard (Tipke et al. This section presents the results of a few population-based random surveys of drug quality. Kaur and colleagues analyzed antimalarial quality in drugs drawn from a systematic, random sample of a range of Tanzanian retail outlets, including drug stores, general stores, street hawkers, and medicine kiosks Copyright © National Academy of Sciences. Investigators stratifed districts according to their par- ticipation in a national bed net program, chose districts at random from among the strata, and then surveyed 30 percent of wards in each study district (Kaur et al. They divided wards into major and nonmajor trading centers and drew half the samples from each type of market (Kaur et al. Between May and September 2005, investigators collected 1,080 samples from 2,474 vendors, one from each store that had them in stock on the day of the study visit (Kaur et al. After excluding 166 expired samples and 32 with no labeled expiry date, investigators had 882 samples, from which they systematically chose 301 for chemical analysis (Kaur et al. Taylor and colleagues collected 581 drugs from 35 randomly selected registered pharmacies in urban Nigeria (Taylor et al. They found 42 percent of antimalarials, 41 percent of antibacterials, and 54 percent of antituberculosis drugs outside of British Pharmacopoeia limits (Taylor et al. A stratifed random sample of medicine shops and licensed pharmacies in Laos found 90 percent of artesunate samples failed quality testing (Sengaloundeth et al. Researchers in southeast Nigeria attempted to include unlicensed private medicine dealers in their sample of antimalarial drug quality (Onwujekwe et al. They collected samples of a range of antimalari- als from patent medicine dealers, pharmacies, public and private hospitals, and primary health care centers (Onwujekwe et al. Pharmacopeia specifcations, by either not containing the active ingredient listed or containing it in low doses (Onwujekwe et al. Among the failed samples, 60 percent came from low-level shops, mostly the patent-medicine shops (Onwujekwe et al. Though most epidemiologically rigorous research on drug quality has tested antimicrobial drugs, there is some information about other essential medicines. In a 2012 study, Stanton and colleagues prepared an exhaus- tive sampling frame of formal and informal drug sellers in three districts in Ghana (Stanton et al. They chose 75 vendors at random from the sampling frame, from which patient actors collected 101 samples of ergometrine and oxytocin, the thermally unstable, uterotonic drugs used to treat postpartum hemorrhage (Stanton et al.


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