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Created the basis for further future growth from four distinct major nodes. In the three cases above, external partners were critical to the creation of these new firms as nodes, and they were underpinned by new and deeper linkages with partners and supportive agents; the failure of the Optica joint venture was precipitated by the Optica parent withdrawing support. Group. United Kingdom transient ischemic attack UK-TIA ; Aspirin Trial: interim results. BMJ 1988; 296: 316-330 Clarke RJ, Mayo G, Price P, et al. Suppression of throm.

Measuring undisturbed swimming speeds This study used larvae reared in an enclosed environment to examine undisturbed swimming speeds and changes in nocturnal behaviour throughout development. It is difficult to establish how the behaviour of Implications of larval behaviour The speeds maintained during undisturbed swimming by reef fish larvae throughout development have. The Dagon of Calvinism, or, The Moloch of decrees; a poem, in three cantos. [n.p.] Printed for the publisher. 1827 To which is annexed, A song of reason. By the same.; vi, [7]-95 p.; 13.5 cm. Reel: 36, No. 604 Dailey, W.B. Saratoga: a dramatic historical romance of the Revolution. Corning, [N.Y.], T. Messenger. 1848 96 p.; illus. Reel: 36, No. 605 The Daisy; or, Little rhymes for little readers. New Haven, S. Babcock. 1844 16 p.; illus.; 9 cm. Reel: 36, No. 606 Dale, Agania. Country verses. Washington, D.C., Philp & Solomons. 1865 8, [13]-87 p.; 12 cm. Reel: 47, No. 852 Dalee, Justus. An address delivered to the scholars of the English school, in district no. 27, in the town of Cambridge, state of New-York. Albany, Printed for the author by Churchill & Abbey, no. 95, State street, five doors east of the Episcopal church. 1815 To which is added a poem, composed upon the name of every scholar who attended school. March 22, 1815.; 12 p.; incl. 1 plate.; 19.1 cm. Reel: 19, No. 496 Dalee, Justus. An address delivered to the scholars of the English School, in District no. 27, in the town of Cambridge, state of New-York. Albany, Printed for the author, [by Churchill & Abbey]. 1815 To which is added a poem, composed upon the name of every scholar who attended school. March 22, 1815. 2nd ed. Corr. and rev. by the author.; 12 p.; incl. 1 plate.; 12 x 19 cm. Reel: 19, No. 497 Damon, Howard Franklin, 1833-1884. Winter evenings, a poem, delivered before the Mercantile Library Association, of Boston, on the occasion of the introductory lecture to the members' course, November 16, 1858. [Boston, John Wilson and Son, Printers]. [1858?] 11 p.; Author's presentation copy. Reel: 47, No. 854 Damon, Samuel Chenery, 1815-1885. The history of Holden, Massachusetts, 1667-1841. [Worcester, Mass., Wallace and Ripley, printers]. 1841 viii, 154 p.; incl. front.; 22 cm. Reel: 36, No. 607 Dana, Daniel. A discourse delivered in the First Presbyterian church in Newburyport, on Tuesday, Nov. 19, 1844, it being the fiftieth anniversary of the authors ordination. Newburyport, [Mass.] John G. Tilton. 1845 32 p.; 23 cm. Reel: 36, No. 608 Dana, Daniel, 1771-1859. A discourse on the character and virtues of General George Washington; delivered on the twenty-second of February, 1800: the day of national mourning for his death. Newburyport From the press of Angier March, sold at his bookstore, north side of Market Square. [1800] By . minister of a church in Newburyport. Published at the desire of the bearers, to whom it is affectionately inscribed.; 31 p.; 20 cm. Reel: 19, No. 498 Dana, Eliza A. Fuller ; . The broken fold: poems of memory and consolation. New York, A.D.F. Randolph. 1868 [5], iv-124 p.; 18.5 cm.; Half-title.; "Privately printed". Reel: 48, No. 855 [Dana, Eliza A. Fuller ; ]. Gathered leaves. Cambridge, [Mass., Printed by H.O. Houghton]. 1864 2 p.l., [vii]-viii, 160 p.; 21 cm.; "Private edition."; Dedication signed: Eliza A. Dana. Reel: 48, No. 856 Dana, Joseph, 1742-1827. A discourse on the character and death of General George Washington, late president of the United States of America; delivered at Ipswich on the 22d, February, A.D. 1800. Newburyport, Printed by Edmund M. Blunt. 1800 By . [a] pastor of the South church in that place. Published by desire.; 28, [1] p.; 20.5 cm. Reel: 19, No. 499 Dana, Richard Henry, 1787-1879. The buccaneer, and other poems. London, G. Slater. 1850 xviii, [19]-154 p.; 14 cm.; [ Slater's shilling series. no. 21 ; ]. Reel: 36, No. 610 Dana, Richard Henry, 1787-1879. The buccaneer, and other poems. London, H.G. Clarke and co. 1844 xviii, [19]-156 p.; 13.5 cm. Reel: 36, No. 609.

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Liking fatty rich foods and sweet things. He was fairly untidy in the house but careful with his work. He enjoyed current affairs and documentary programmes and tended to read factual books rather than fiction. I felt that his overall constitution fitted that of the medicine Sulphur and therefore gave him three doses of Sulphur 30c at 12-hourly intervals. He made a good recovery from his IBS and needed a further course of Sulphur after about 12 weeks. When reviewed the following autumn he remarked that he had had virtually no hay fever symptoms that year. Indeed, he had not needed to buy any antihistamines at all. Mohandas Karamchand Gandhi was born on October 2, 1869, at Porbandar, a port on the south-west coast of the Kathiawar peninsula in Western India, and capital of a principality in which several members of his fam ily, including his father, had held the office of Prime M inister. He died in New Delhi on January 30, 1948, in his 79th year, by the hand of a Hindu extrem ist. Three great periods mark the course of his life: a period of preparation only remotely connected with his future m ission, set in India and England, which ended in 1893 when he was 24; a South African period 1893-1914 ; when Gandhi forged his "method" and tentatively practised it in a marginal area of the Indian Diaspora; and a period of fulfilment 1915-l 948 ; when he perfected his method in India itself, applying it on an increasing scale until its messagewas carried beyond the frontiers of the vast nation he had fathered. Like so many educated Indians, Gandhi had first to master and reconcile the dual cultures of East and West which disputed possession of his heart and m ind. It is easy to imagine how closely the world of his early childhood was bounded by the Hindu tradition. He belonged to a "caste" fam ily which ranked third in the tiers of the rigidly graded Hindu society "Gandhi" means "spice merchant" ; , though the fam ily' status was certainly s improved by the political and administrative functions entrusted to some of its members. Gandhi was 16 when his father died. Two years later he left for England, against the orders of his caste, which excommunicated him . While in Britain 1888-1891 ; studying to be a barrister, he . not only improved his acquaintance with Western culture, but also rediscovered the Hindu faith in which he had been nurtured and astemizole. Background: Previous epidemiologic studies have shown that regular use of nonsteroidal anti-inflammatory drugs NSAIDs ; is associated with decreased colorectal cancer risk. However, few studies have examined associations between NSAID use and subsite-specific colorectal cancer risks. Because tumors of the proximal and distal colon differ with respect to their genetic alterations, clinicopathologic features, and demographic distribution, further investigation of subsite-specific colorectal cancer risks may be rewarding. Methods: Data about aspirin and nonaspirin-NSAID use were recorded by self-report in 1992 among the initially cancer-free cohort of postmenopausal women in the Iowa Women's Health Study n 27, 160 ; . In total, 637 women developed colorectal cancer during the 11 years of follow-up, including 365 proximal colon, 132 distal colon, and 120 rectal cancer cases 11 overlapping and 9 not specified ; . Results: For colon cancer, the multivariable-adjusted hazard ratios HR ; for women reporting use of aspirin two to five times and six or more times weekly compared with nonusers of aspirin ; were 0.79 [95% confidence interval 95% CI ; , 0.591.04] and 0.76 95% CI, 0.58-1.00 ; , respectively. The corresponding HRs for nonaspirin NSAIDs were 0.63 95% CI, 0.41-0.96 ; and 0.85 95% CI, 0.63-1.15 ; , respectively. For proximal colon cancer, the multivariable-adjusted HRs for women reporting use of aspirin or nonaspirin NSAIDs two or more times weekly compared with nonusers of each ; were 0.67 95% CI, 0.51-0.87 ; and 0.71 95% CI, 0.52-0.97 ; , respectively. No statistically significant association was found between either distal colon or rectal cancer and aspirin or nonaspirin NSAID use. Discussion: Our study is consistent with a limited number of prior reports that have observed stronger associations between NSAID use and proximal versus distal colorectal cancer. Cancer Epidemiol Biomarkers Prev 2006; 15 10 ; : 178590.

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With the thermodynamic stability of retinoid isomers, with the alltrans molecules being more stable than the corresponding cis-isomers 33, 34 ; . Some authors advocate the hypothesis that isomerization is catalyzed by sulfhydryl groups present in the proteins of the microsomal preparation that are mostly oxidized during the heating process. Catalysis could occur by a free radical mechanism rather than a Michaelis addition of a thiolate anion 1214 ; . RA metabolism is complicated by many isomerization reactions that occur at different stages of the biotransformation pathway. The natural metabolite of each RA isomer is the corresponding 4-oxo compound. But interconversion of all-trans-, 13-cis- and 9-cis-RA isomers leads to the formation of the two other 4-oxo metabolites. Furthermore, each 4-oxo compound can produce the two others by an isomerization process. This explains why, after incubation of one of the three RA isomers with hepatic microsomal fractions, we were able to recover the three 4-oxo metabolites in the incubation mixture. RA metabolism characterized by C4-hyroxylation has been studied predominantly in hepatic microsomes from several mammalian species, including hamsters, rats, rabbits and humans. Martini and Murray 22 ; demonstrated that the CYP3A subfamily is involved in RA hydroxylation in untreated rat liver. But, the enzymatic activity is neither related to the rat CYP3A1 isozyme that is not expressed in untreated rat liver, nor to the rat CYP3A2 isozyme that is the constitutive male-specific steroid 6 -hydroxylase. They described a sex and atovaquone. PLATE 16 Gout In the acute stage there is severe pain, redness, and swelling of the joint--often the metatarsophalangeal joint of the big toe podagra ; . Attacks are due to the deposition of sodium monourate crystals in and around joints and may be precipitated by trauma, surgery, starvation, infection, or diuretics. With long-term hyperuricaemia, after repeated attacks, urate deposits tophi ; are found in peripheries, eg pinna, tendons, joints. `Secondary' causes: polycythaemia, leukaemia, cytotoxics, renal impairment, long-term alcohol excess. Diagnosis depends on finding urate crystals in tissues and synovial fluid serum urate not always ; . Synovial fluid microscopy: negatively birefrin16 gent crystals; neutrophils + ingested crystals ; . X-rays may show only softtissue swelling in the early stages. Later, well-defined `punched out' lesions are seen in juxta-articular bone. There is no sclerotic reaction, and joint spaces are preserved until late. Prevalence: ~1%. : 5 : 1. Treating acute gout: Use a strong NSAID eg naproxen ; . If contraindicated eg peptic ulcer ; , give colchicine 0.5mg 812h, or 0.5mg 23h PO until pain goes 17 or D&V occurs or 6mg given. NB: in renal impairment, NSAIDs and colchicine are problematic: steroids may be effective, but have their own SE get expert help ; . Preventing attacks: Avoid prolonged fasts, alcohol excess, and high purine food.1 Lose weight. Avoid low-dose aspirin it serum urate ; . Consider reducing serum urate with long-term allopurinol, but not until 3wks after an attack. Start with regular NSAID or colchicine cover as introduction of allopurinol may cause gout attack. Allopurinol dose: 100300mg 24h PO PC, adjust in the light of serum urate levels typically 200mg 24h; max 300mg 8h ; . SE: rash, fever, WCC|. If simple treatment fails, refer to rheumatologists. Calcium pyrophosphate dihydrate CPPD ; arthropathy Risk factors: 18 Dehydration Intercurrent illness Hyperparathyroidism Myxoedema PO3|; Mg2 + | Osteoarthritis; old age Haemochromatosis Acromegaly 4 Acute CPPD monoarthritis pseudogout ; : Similar to gout; affects different joints mainly wrist or knee ; . Chronic CPPD: Destructive changes like OA, but more severe; affecting eg knees also wrists, shoulders, hips ; . Can present as polyarthritis pseudo-rheumatoid ; Tests: Polarized light microscopy of joint fluid: crystals are weakly positively birefringent. Associated with soft-tissue calcium deposition on x-ray, eg triangular ligament in wrist or in cartilage chondrocalcinosis ; . Treatment: NSAIDs help but are rarely sufficient and often contraindicated in the elderly; consider steroids eg triamcinolone IM 60mg or prednisolone EC 20mg d for 2wks. For chronic disease, consider hydroxychloroquine 200mg d, upto 200mg 12h PO. 19.

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By Robert Bree, MD, MHSA odgkin's disease and non-Hodgkin's lymphoma, or NHL, are the two major types of lymphoma. Computed tomography scans frequently serve as the initial diagnostic examination performed in the case of lymphoma because of the nonspecific symptoms often accompanying the disease. CTs usually are an accurate staging technique, obviating the need for invasive staging procedures, such as laparotomy. Because staging classification depends on the extent of involvement, CT is an excellent tool to identify gross disease, particularly in the NHL group, where the disease tends to be bulky. Histopathologic tissue examination is important not only for diagnosis but also for lymphoma classification, which directly affects treatment protocols. University of Missouri Health Care's Department of Radiology offers image-guided biopies using CT and, more often, ultrasound. The outpatient procedure results in minimal observation following the treatment and little discomfort. Prior to the procedure, patients are screened for coagulopathy and are asked to refrain from aspirin use for several days before the biopsy. On the day of the procedure, a radiology nurse greets and escorts the patient either to CT or ultrasound, where he or she will be placed under conscious sedation for the biopsy. Image-guided percutaneous biopsy is well-accepted around the country. An 18gauge needle is advanced into a mass with direct guidance. In the case of ultrasound, the guidance takes place in real time. The needle is capable of obtaining core biopsies, which are submitted to pathologists. In the case of suspected lymphoma, fresh tissue is submitted to the pathology department. A pathologist then determines which tissue should remain fresh, which should be submitted for flow cytometry and which should be placed in formalin for histologic determination of a lymphoproliferative disorder. In patients with suspected lymphoma, it is important to obtain as much tissue as possible, considering the site of the mass and risks of multiple biopsies. Recently introduced coaxial equipment makes the procedure even safer -- only one pass with an outer needle is necessary. Furthermore, the inner needle passes directly into the abnormality without going and atropine. With BMIs under 25, have average annual health care costs increased by 105% for prescription drugs, 14% for outpatient services, 38% for inpatient services, and 36% for all medical care.59.
Complicated by respiratory failure; the effects of mechanical ventilation. Chest 1990; 85: 21-8 and auranofin. Anti-inflammatory painkillers probably work better than paracetamol or aspirin to ease migraine. Although, strictly speaking aspirin is an anti-inflammatory painkiller. ; They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac, naproxen, or tolfenamic acid need a prescription. Some points about anti-inflammatory medicines include.

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Calcium remains important to bone health. The WHI study found that not all women need to routinely take calcium supplements if they are able to get adequate daily calcium through diet. However, if women do not get enough calcium through food, then taking a supplement plays an important role in filling that gap. For those who obtain adequate calcium through diet, there appears to be no additional benefit from taking a calcium supplement. In fact, too much calcium can slightly increase the risk of kidney stones in some people. To determine whether you need a supplement, keep a oneweek food diary of the calcium-rich foods and dairy products that you eat each day including highly fortified foods such as some citrus juices ; . Note the calcium content and number of servings you eat at every meal. Be sure to include foods that have small amounts of calcium, because often a balanced diet can include up to 250 mg of calcium from trace sources. At the end of each day, total the amount of calcium you consumed. Then, at the end of the week, total your calcium intake for all days and divide by seven to find your average daily calcium intake from food sources. If you are getting less than 1, 200 mg of calcium per day, then add a supplement in the amount you need to meet your calcium requirements. Be sure to read the labels of any multivitamins that you take as most contain calcium. You need to consider that amount in your daily intake of calcium, too. For optimal bone health, vitamin D is critically important. There are not many foods which contain vitamin D and skin production is impaired by sunblock and avoiding sunlight. Therefore, many individuals need to take a vitamin D supplement and avalide. May increase the clearance of valproate. For example, phenytoin, carbamazepine, and phenobarbital or primidone ; can double the clearance of valproate. Thus, patients on monotherapy will generally have longer half-lives and higher concentrations than patients receiving polytherapy with antiepilepsy drugs. In contrast, drugs that are inhibitors of cytochrome P450 isozymes, e.g., antidepressants, may be expected to have little effect on valproate clearance because cytochrome P450 microsomal mediated oxidation is a relatively minor secondary metabolic pathway compared to glucuronidation and beta-oxidation. Because of these changes in valproate clearance, monitoring of valproate and concomitant drug concentrations should be increased whenever enzyme inducing drugs are introduced or withdrawn. The following list provides information about the potential for an influence of several commonly prescribed medications on valproate pharmacokinetics. The list is not exhaustive nor could it be, since new interactions are continuously being reported. Drugs for Which a Potentially Important Interaction Has Been Observed: Aspirin - A study involving the co-administration of aspirin at antipyretic doses 11 to 16 mg kg ; with valproate to pediatric patients n 6 ; revealed a decrease in protein binding and an inhibition of metabolism of valproate. Valproate free fraction was increased 4-fold in the presence of aspirin compared to valproate alone. The -oxidation pathway consisting of 2-E-valproic acid, 3-OH-valproic acid, and 3-keto valproic acid was decreased from 25% of total metabolites excreted on valproate alone to 8.3% in the presence of aspirin. Caution should be observed if valproate and aspirin are to be co-administered. Felbamate - A study involving the co-administration of 1200 mg day of felbamate with valproate to patients with epilepsy n 10 ; revealed an increase in mean valproate peak concentration by 35% from 86 to 115 g mL ; compared to valproate alone. Increasing the felbamate dose to 2400 mg day increased the mean valproate peak concentration to 133 g mL another 16% increase ; . A decrease in valproate dosage may be necessary when felbamate therapy is initiated. Meropenem - Subtherapeutic valproic acid levels have been reported when meropenem was co-administered. Rifampin - A study involving the administration of a single dose of valproate 7 mg kg ; 36 hours after 5 nights of daily dosing with rifampin 600 mg ; revealed a 40% increase in the oral clearance of valproate. Valproate dosage adjustment may be necessary when it is co-administered with rifampin. Drugs for Which Either No Interaction or a Likely Clinically Unimportant Interaction Has Been Observed: Antacids - A study involving the co-administration of valproate 500 mg with commonly administered antacids Maalox, Trisogel, and Titralac - 160 mEq doses ; did not reveal any effect on the extent of absorption of valproate. Chlorpromazine - A study involving the administration of 100 to 300 mg day of chlorpromazine to schizophrenic patients already receiving valproate 200 mg BID ; revealed a 15% increase in trough plasma levels of valproate. Haloperidol - A study involving the administration of 6 to mg day of haloperidol to schizophrenic patients already receiving valproate 200 mg BID ; revealed no significant changes in valproate trough plasma levels. Cimetidine and Ranitidine - Cimetidine and ranitidine do not affect the clearance of valproate. Effects of Valproate on Other Drugs Valproate has been found to be a weak inhibitor of some P450 isozymes, epoxide hydrase, and glucuronyl transferases. The following list provides information about the potential for an influence of valproate co-administration on the pharmacokinetics or pharmacodynamics of several commonly prescribed medications. The list is not exhaustive, since new interactions are continuously being reported. Drugs for Which a Potentially Important Valproate Interaction Has Been Observed: Amitriptyline Nortriptyline Administration of a single oral 50 mg dose of amitriptyline to 15 normal volunteers 10 males and 5 females ; who received valproate 500 mg BID ; resulted in a 21% decrease in plasma clearance of amitriptyline and a 34% decrease in the net clearance of nortriptyline. Rare postmarketing reports of concurrent use of valproate and amitriptyline resulting in an increased amitriptyline level have been received. Concurrent use of valproate and amitriptyline has rarely been associated with toxicity. Monitoring of amitriptyline levels should be considered for patients taking valproate concomitantly with amitriptyline. Consideration should be given to lowering the dose of amitriptyline nortriptyline in the presence of valproate. Carbamazepine carbamazepine-10, 11-Epoxide - Serum levels of carbamazepine CBZ ; decreased 17% while that of carbamazepine-10, 11-epoxide CBZ-E ; increased by 45% upon co-administration of valproate and CBZ to epileptic patients. Clonazepam - The concomitant use of valproic acid and clonazepam may induce absence status in patients with a history of absence type seizures. Diazepam - Valproate displaces diazepam from its plasma albumin binding sites and inhibits its metabolism. Co-administration of valproate 1500 mg daily ; increased the free fraction of diazepam 10 mg ; by 90% in healthy volunteers n 6 ; . Plasma clearance and volume of distribution for free diazepam were reduced by 25% and 20%, respectively, in the presence of valproate. The elimination half-life of diazepam remained unchanged upon addition of valproate. Ethosuximide - Valproate inhibits the metabolism of ethosuximide. Administration of a single ethosuximide dose of 500 mg with valproate 800 to 1600 mg day ; to healthy volunteers n 6 ; was accompanied by a 25% increase in elimination.

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MINUTES OF THE ANNUAL GENERAL MEETING-2001 The Annual General M eeting AGM ; of the IEEE Delhi Section was held at 11 on January 21, 2001 Sunday ; at India International Centre. It was attended by 35 members. It was the 24th AGM and 2001 is being celebrated as the Silver Jubilee Year of Delhi Section. The deliberations of the AGM are as follows: 1. Welcome address by the Chairman, IEEE Delhi Section 1.1 Mr. R.K. Asthana, Chairman IEEE Delhi Section welcomed the members to the AGM. He briefed the members on the various activities organized during 2000. He mentioned that the section had organized 48 events, of which 27 were technical, educational and professional activities. 1.2 During the year Region 10 Committee Meeting was held at Langkawi Island Malaysia ; which was attended by Section Chair. IEEE President visited Delhi during the year and all members were invited for interaction with him. Proceedings of these meetings are already published in Section Newsletter, BEACON. 1.3 Section membership grew from 876 in Dec. 96 ; to 2400 in Dec. 99. Though the figure was 1827 as on Dec. 8, 2000, it is expected to rise to the previous high level after the renewals for 2001. Section Chair congratulated Publication SubCommittee and its Chairman Mr. P.K. Srivastava, for timely publication of BEACON and its new get up. Section Chair appreciated Electronic Communication Coordinator, Dr and avandamet. Class features All of the following are class features of the war chanter prestige class. Weapon and Armor Proficiencies: War chanters gain no proficiency with any weapon or armor. Inspire Toughness Su ; : A war chanter with 9 or more ranks in Perform sing ; or Perform oratory ; can use her song or poetics to impart a kind of berserk resiliency on her allies including herself ; . To be affected, an ally must be able to hear the war chanter sing or speak ; . The effect lasts for as long as the ally hears the war chanter sing and for 5 rounds thereafter. An affected ally receives + 2 temporary hit points for every class level of the war chanter. At 6th level and higher, a war chanter also grants affected allies the benefit of the Diehard feat when using this ability. War Chanter Music: War Chanter music follows the same rules as bardic music. War chanter levels stack with bard levels for the purpose of determining how often a character can use war chanter music or bardic music. War chanter levels do not stack with bard levels for determining which songs a bard has access to. Inspire Recklessness Su ; : A war chanter of 3rd level of higher with 12 or more ranks in perform can use her song or poetics to inspire an often dangerous, but very effective, ferocity in one of her allies within 60 feet or in herself ; . The effect lasts for as long as the ally hears the war chanter sing and for 5 rounds thereafter. An affected ally or the warchanter herself ; is inspired to recklessness, gaining the ability to decrease her Armor Class by a number less than or equal to her base attack bonus and add the same number to her melee attack rolls as a morale bonus. On her action, before making any attack rolls in a round, the affected character must choose to subtract a number from her Armor Class and add the same number to all melee attack rolls this number may be 0 ; . The penalty to Armor Class and the bonus on attack rolls apply until the character's next action. Combine Songs Su ; : A war chanter of 5th level or higher with 12 or more ranks in any Perform skill can combine two types of bardic music or war chanter music to provide benefits to both normal stacking rules for bonus types apply ; . Inspire Awe Su ; : A war chanter of 7th level of higher with 15 or more ranks in any Perform skill can inspire uneasiness, fear or even terror in her foes. To be affected, a foe must be within 60 feet of the war chanter and must be able to hear the war chanter. Foes get a Will save DC 10 + war chanter's class level + war chanter's Cha modifier ; to resist the effect. The severity of the effect depends on the difference between the foe's Hit Dice and the war chanter's Hit Dice character level ; . Subtract the foe's HD from the war chanter's HD and consult the following table. The effect lasts for as long as the foe can hear the war chanter and for 1 round thereafter. If a foe's hearing of the war chanter's song is interrupted, the foe needs to make another saving throw when he hears the war chanter's song again. HD Difference + 10 or more + 1 to less Effect Foe is paralyzed with fear Foe is panicked Foe is frightened Foe is shaken and aspirin.

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CLINICAL MEDICINE POSTERS P3 COMPARISON OF THE FREQUENCY OF HIV-1 DRUG RESISTANCE MUTATIONS IN TREATED AND UNTREATED PATIENTS FROM VARIOUS COUNTRIES Chew C B1, 2, Wang B2, Shaw C O 1, Potter S2, Saksena K N2, Dwyer D E1, 2 1 Center for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, NSW, Australia; 2 Center for Virus Research, Westmead Millennium Institute, NSW, Australia The development of antiretroviral drug resistance mutations is a serious obstacle to sustained suppression of HIV during HAART. Antiretroviral drug resistance testing allows clinicians to choose appropriate therapeutic options. A retrospective study was conducted to assess the prevalence of antiretroviral resistance mutations in treated and untreated HIV patients in a clinic environment, and results compared with overseas data. Resistance to at least one PI was fairly similar approximately 2% ; among treatment nave patients in different countries, except for Canada 3.8% ; . More variation was observed with NRTI, with resistance to 1 or more NRTI ranging from 1.2% in Argentina to 28.9% in Warsaw. NNRTI resistance ranged from 0.2% to 4.9%. Warsaw had higher frequency of resistance mutations in M184V 17% ; , K70R 42% ; and M41L 9% ; . In pretreated patients, the proportion of PI resistance among the various countries varied from 12% to 58%. The percentage of NRTI resistance mutations ranged from 48 to 77%. Westmead had a higher frequency of L74V 19% ; and Y181C 18% ; mutations, Brazil-T69D N 47% ; , Canada-M41L 50% ; , M184V 65%, D67N 43% ; and L90M 46% ; , Spain-T215Y 51% ; , G190A S 13.6% ; and Puerto Rico -K103N 40% ; . Thailand had a lower frequency of PI resistance mutationsL90M 7% ; , I54V L 6% ; , V82A 8% ; . The prevalence of primary and secondary resistance mutations in different regions or country will depend on the local treatment practices and antiretroviral drug availability, the patterns of cross-resistance, the presence of different HIV-1 subtypes, and the frequency of resistance mutations in treatment nave individual. P4 VALIDITY OF A NEW COMPUTERISED BATTERY FOR THE ASSESSMENT OF NEUROCOGNITIVE FUNCTIONS IN ADVANCED HIV-INFECTION AND AIDS DEMENTIA COMPLEX Cysique L A1, Maruff P2, 4, Brew B J3, Darby D4 1 Faculty of Medicine, St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; 2 School of Psychology, LaTrobe University, VIC, Australia; 3 Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, NSW, Australia; 4Cogstate Ltd, Melbourne, VIC, Australia The early identification of AIDS Dementia Complex ADC ; , the most severe manifestation of HIV-associated neurocognitive impairment is essential, as several studies have demonstrated the benefit of Highly Active Antiretroviral Therapy HAART ; . Conventional neuropsychological assessment is costly in time and resources. A practical brief screening tool is needed. Sixty individuals with advanced HIV-infection stage CDC C3, 1993 ; were randomly selected from a tertiary referral hospital outpatients clinic. Eleven were currently diagnosed with ADC stage 1 or 2. Twenty-one seronegative individuals were recruited as controls. Participants were examined with a comprehensive standard neuropsychological examination and a brief computerised examination, lasting ten to fifteen minutes, assessing psychomotor speed, attention, decisionmaking and memory learning. Computerised assessment showed that advanced HIVinfected individuals were significantly slower p .000 ; and less accurate p .03 ; than controls. ADC patients demonstrated worse performance when compared to non-demented patients on most speed measures p .000 ; and the most demanding accuracy p .03 ; measures. Computerised measures were correlated with standard measures of complex attention and processing speed r .45 to .62 ; . Computerised total reaction time p .003 ; and learning accuracy p .02 ; were significant predictors of neuropsychological impairment and ADC. When using the standard neuropsychological measures as a gold standard, the brief computerised examination had a sensitivity of 83.8% and specificity of 47.8%. In conclusion, our study showed that a short computerised battery was sensitive to the neurocognitive deficits associated with HIV-infection. The use of this battery could help screening patients at risk for ADC. P5 MEANINGFUL DATA THE CHALLENGE FOR ALL CLINICIANS Furner V L1, Jin F2 1 Albion Street Centre, Prince of Wales Hospital, Sydney, NSW, Australia; 2HARDU, Sydney Hospital, Sydney, NSW, Australia The effective treatment of HIV and hepatitis C HCV ; in recent years has resulted in increased life expectancy and quality of life for HIV and HCV patients. However the number of patients who present to non-inpatient services with complex needs has grown enormously. South Eastern Sydney Area Health Service SESAHS ; is well recognized as being at the epicentre of the HIV AIDS epidemic in Australia. However it was also recognized that there was a need for improvement in the collection and reporting of the HIV AIDS, HCV and Sexual Health data arising from non-inpatient attendances to hospital based services in the area. In 2001 Working Groups of interested, representative multi-disciplinary clinicians, including HIV specialists and Allied Health, of the six high caseload hospital based services were established. The aim was to formulate a Minimum Dataset for HIV AIDS, HCV and Sexual Health for the ambulatory care, outpatient and Community Health services in SESAHS. The initiative was supported, and the database funded, by the AIDS Infectious Diseases Branch, NSW Health. A uniform core set of definitions encompassing 22 broad categories of demographic, clinical and service utilisation was established. Patient profile data items include Sex, Age, Country of Birth, Aboriginality, Postcode, Source of Referral, Risk Category together with and health outcome data relating to Diagnosis, Intervention, Treatment etc. In addition, the database also encompasses CD4, viral load and anti-retroviral graphical functions and preliminary Clinical Indicators in HIV and HCV care. The minimum dataset dictionary has been piloted area-wide and refined over the past two years and at the end of 2003, culminated in the development of a computerized database for utilisation by all HIV, HCV and Sexual Health services across SESAHS. In February 2004 data extraction was commenced areawide. We report on the collaborative process of developing such a database and on the challenges encountered in the development, implementation and outcomes of the first Australian area-wide Minimum Dataset and computerised database in these three important clinical areas and avastin.

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