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Table 2 reveals that the measured coordination numbers in the second coordination sphere are clearly lower for C-S-H samples compared to hemimorphite. This can be a sign for the lower ordering of the Zn environment. Another possibility is that the samples contain a mixture of different Zn sorption modes or newly formed phases. Any attempt to model the spectra of the C-S-H samples with a linear combination of spectra from different reference compounds was not successful. Interestingly, by taking the spectrum of the sample at the lowest Zn concentrations 1 M-30 min ; and adding the hemimorphite spectrum, the spectra of the sorption samples could be successfully simulated. This approach yielded a hemimorphite contribution in the range of up to 20%. This may be an indication for changes in the Zn coordination structure toward a more hemimorphite-like structure with increasing zinc content of the samples and would explain the significantly lower Zn-Zn coordination numbers compared to hemimorphite and the fact that the fit quality degraded when the data were fit with a Zn-Si and Zn-Ca shell instead. The nature of the structure in the sample with the lowest Zn concentration cannot be explained conclusively. Possibly, Zn is coordinated with Si and Ca groups at surfaces of the C-S-H particles. Such a behavior would be in agreement with former investigations of Ziegler et al. 20 ; . They investigated the Zn sorption to C-S-H I ; with a combination of kinetics, sorption experiments, and microscopic measurements and showed that at short equilibration times, Zn is predominantly sorbed at the surfaces of the C-S-H I ; surfaces and, afterward, Zn diffuses into the C-S-H particles. For samples with low Zn content 1 and 19 M Zn samples ; the isotherm as well as the microscopic measurements did not indicate the formation of Zn surface precipitates. On the basis of considerations about the C-S-H I ; structure, they proposed the incorporation of Zn in the interlayer of C-S-H I ; with the diffusion of Zn into the C-S-H I ; particles. They argued that this incorporation could not be a classical 1: isomorphous substitution of Zn at particular sites in the C-S-H I ; structure, because quantitative analysis of C-S-H I ; particles did not show any significant exchange of Zn for Ca or Si. The results from XAFS analysis with corresponding samples reveal the presence of some Si bonding in the second coordination sphere of Zn in all samples from low to high Zn content. With ZnO4 tetrahedra present in the interlayer of C-S-H I ; , a bonding to Si-O sites is feasible at two different corners of SiO4 tetrahedra oriented toward the interlayer. Because of the stereochemical hindrance within the C-S-H I ; structure and the significantly larger ZnO4 tetrahedron compared to a SiO4 tetrahedron, the ZnO4 tetrahedra can only be connected to the SiO4 corners by slightly twisting. With this, the observed Zn-Si distances have to be smaller than the maximum theoretical Zn-Si distance of 3.56 derived from corner sharing of a ZnO4 and a SiO4 tetrahedron. This is in agreement with the XAFS data, which show Zn-Si distances of 3.0 , a common value for zinc silicate minerals. Additionally, these observations are in agreement with the data from Moulin et al. 18 ; . Their isotherm measurements were accompanied by 29Si NMR measurements to characterize the Zn retention sites in C-S-H I ; . Their spectra showed Si lines that can be attributed to sites involving Si-O-Zn bonds. They concluded, therefore, that Zn is structurally retained by C-S-H I ; , but they did not make any further conclusions about the effective sorption mechanism. In summary, our XAFS data confirm the presence of Si-O-Zn bonds. The incorporation of Zn in the interlayer of C-S-H I ; at least partially connected to Si sites appears to be a possible mechanism for the incorporation of Zn into C-S-H I.
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In an animal pre-treated with insulin Before the beginning of the record, insulin 25 i.u. kg-' ; was infused, producing a decrease in blood glucose and the hyperpolarization of both cells. A, the effect of glucose injection 100 , usl of a 250 mM solution ; at the time indicated by the arrow. B, expanded records of the last oscillations recorded in both cells.
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There is an emerging trend happening in homes across the US, right under parents' noses. Recently, there have been news reports of overdoses and theft of this drug nationwide. What is this drug? It is the abuse of over-the-counter cough suppressants. Dextromethorphan DXM ; . DXM is a semisynthetic narcotic related to opium and found in many over-the-counter cough suppressants in the United States and most countries. DXM is contained in any drug whose name includes "DM" or "Tuss." The drug comes in various forms. Most common are cough suppressants in caplet or liquid form, including Corcidin, Robitussin, Vicks Formula 44, Drixoral, and several generic brands. A caution: Not all medicines under these brands contain the drug, since most brands put out several formulations. Look on the label for "DM, " "Tuss, " or "Maximum Strength." ; Less publicized and more easily obtained than the more well-known club-drug ecstasy, DXM's legal status and familiarity may lure some kids into taking it, despite the dangers it poses of addiction, injury, and death. "It's not an ugly drug. It's much less intimidating than snorting a powder or injecting a strange substance, " said William Bobo, M.D., a.
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Cohen A. Infant deaths associated with cough and cold medications two states, 2005. MMWR Morb Mortal Wkly Rep 2007; 56: 14. Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. J Emerg Med 2005; 23: 589666. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999; 281: 19001905. Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med 2003; 139: 493498. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC Growth Charts: United States. Advance Data from Vital and Health Statistics; No. 314. Hyattsville, MD: National Center for Health Statistics, 2000. Brent J, Phillips SD, Wallace KL, Donovan JW, Burkhart K, eds. Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Philadelphia: Mosby, 2005. Dart RC, ed. Medical Toxicology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2004. Haddad LM, Shannon MW, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia: WB Saunders, 1998. Kleinschmidt KC, Wainscott M, Ford MD. Opioids. In: Ford MD, Delaney KA. Ling LJ, Erickson T. Clinical Toxicology. Philadelphia: WB Saunders, 2001: 627639. Nelson LS. Opioids. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York: McGraw-Hill, 2006: 590613. Albertson TE. Dextromethorphan. In: Olson KR, ed. Poisoning & Drug Overdose. 5th ed. New York: McGraw-Hill, 2007: 181183. Paul IM, Shaffer ML, Yoder KE, Sturgis SA, Berlin CM, et al. Doseresponse relationship with increasing doses of dextromethorphan for children with cough. Clin Ther 2004; 26: 15081514. Henretig F, Cugini D, Durbin D, Kearney T, Vuignier BI, Torrey S, DeMarco J. Dextromethorphan DM ; overdose in children [abstract]. Vet Hum Toxicol 1988; 30: 364. Devlin KM, Hall AH, Smolinske SC, Wruk KM, Kulig KW, Rumack BH. Toxicity from long-acting dextromethorphan preparations [abstract]. Vet Hum Toxicol 1985; 27: 296. Hanzlick R. National Association of Medical Examiners Pediatric Toxicology PedTox ; Registry Report 3. Case submission summary and data for acetaminophen, benzene, carboxyhemoglobin, dextromethorphan, ethanol, phenobarbital, and pseudoephedrine. J Forensic Med Pathol 1995; 16: 270277. Iglesias Platas I, Fernandez Santervas Y, Luaces Cubells C, Garcia Garcia JJ, Pou Fernandez J. Intoxicacin por dextrometorfano. An Esp Pediatr 2002; 57: 492493. Katona B, Wason S. Dextromethorphan danger. N Engl J Med 1986; 314: 993. Marinetti L, Lehman L, Casto B, Harshbarger K, Kubiczek P, Davis J. Over-the-counter cold medications-postmortem findings in infants and the relationship to cause of death. J Anal Toxicol 2005; 29: 738743. Pender ES, Parks BR. Toxicity with dextromethorphan-containing preparations: A literature review and report of two additional cases. Pediatr Emerg Care 1991; 7: 163165. Shaul WL, Wandell M, Robertson WO. Dextromethorphan toxicity: Reversal by naloxone. Pediatrics 1977; 59: 117118. Warden CR, Diekema DS, Robertson WO. Dystonic reaction associated with dextromethorphan ingestion in a toddler. Pediatr Emerg Care 1997; 13: 214215. Baker SD, Borys DJ. A possible trend suggesting increased abuse from Coricidin exposures reported to the Texas Poison Network: Comparing 1998 to 1999. Vet Hum Toxicol 2002; 44: 169171 and dicloxacillin.
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Victims of abuse or neglect that to identify individual needs, and interIn reflecting on the Victory prompts the child's removal from a venes at critical junctures with prodJunction fundraising campaign, dangerous setting. ucts and services that provide the most Twisdale remarked, "Steve did a lot Second to receive a Micro positive impact, including clothes, toibehind the scenes to focus the Community Grant in South Carolina is letries and school supplies for the Foundation on Victory Junction and Crossroads Group Home of Greenville, immediate needs of children entering really took us to the next level." Slack nominated by the Piedmont Chapter of the system. LCOR also creates libraries added, "Steve really believed in the Credit Unions. idea of the Foundation and he realEstablished as a residential ly worked hard to get credit treatment center in 1993, the unions behind it." group home provides treatment Slack is a 16-year veteran of for girls from the ages 10 to 18 the credit union movement, and years old who have been physicalhas never worked in any other ly, sexually, or emotionally field. He has been with CUNA abused. Residents are accepted Mutual Group for ten years. based on the nature of their vicPreviously, he worked at multiple timization, their motivation for credit unions in Delaware, rising treatment, and their medical and to become to vice president of criminal histories. lending. Notably, Crossroads is the first Slack's agenda for the group home in South Carolina to Foundation will center on the use Animal Assisted Therapy in Micro Community Grants MCG ; its treatment of victims. program, the new Social On May 26, CCUF and the Responsibility Project of the chapter presented Crossroads CCUF. Group Home a check for , 750, "It's the perfect way for credit which is earmarked for a new roof unions to show their heart and for Crossroads girls' residence. soul, and further deepen ties with Crossroads Group Home CEO their communities, " Slack Lorraine Turner was grateful for remarked. the generous grant and the answer The MCG program allows it provided for ongoing needs. credit unions and chapters to sub"With all the help we receive mit funding grants to the CCUF. from contributors such as the Elam made early headway Carolinas Credit Union with the MCG program, awarding Foundation, Crossroads will confour grants between the Carolinastinue to meet the needs of the chil-two per state. CCUF's Elam and Executive Director-Elect First in South Carolina was the John Slack hope LowCountry Orphan Relief top ; dren we serve, " Turner said. LowCountry Orphan Relief Fund and Crossroads Group Home above ; were just the "From the staff and residents, we thank them so much." LCOR ; , nominated by the first of many Micro Community Grant winners in As he leaves the Foundation's Charleston Chapter of Credit South Carolina. leadership to Slack, Elam will likeUnions. LCOR is an all-volunteer, ly look back at credit unions' impact on and recreational rooms at emergency non-profit organization that provides Victory Junction Camp as his most sigshelters for long-term use. services to children where social and nificant work. Slack sees an equal Because LowCountry Orphan government services leave off. future ahead with Elam's legacy and The , 000 grant was so important Relief has no direct financial support to LCOR Founder Lynn Young that she from any federal agencies or the United the Micro Community Grants. "It's a great approach for credit Way, they depend on donations. The made a personal appearance in Myrtle unions to connect in their communiexceptions are undergarments and toiBeach at the South Carolina Credit ties, " said Slack, "and I think it has letries, both of which must be new. Union League's 2006 Annual Meeting. national implications for the industry." Typical children served by LCOR LCOR works directly with other are from birth through age 17, and are non-profits and government agencies 6.
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Treatment naive patients must have a trial of a preferred agent before a non-preferred agent in its corresponding class will be authorized. Patients stabilized on non-preferred agents will receive authorization to continue these drugs. Additions to that therapy will require a trial of preferred agent in its respective class unless one of the exceptions on the PA form is present and dilaudid.
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