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By P. Innostian. American InterContinental University.

The following ents specified in this section purchase cleocin 150mg with amex skin care doctors edina, by the safe and suitable ingredients may be procedure set forth in paragraph (b) of used: this section cleocin 150 mg online skin care laser clinic birmingham, or by another procedure (1) Dairy ingredients purchase cleocin 150 mg visa acne 8 year old child. Milk buy cleocin 150 mg line acne zones, nonfat which produces a finished cheese hav- milk, or cream, as defined in §133. Rennet and/or the procedure set forth in paragraph (b) other clotting enzymes of animal, of this section is used. It is cured for weight of the dairy ingredients, used as not less than 90 days at a temperature a coagulation aid. Harmless artificial blue or may be added to the surface of the green coloring in a quantity which neu- cheese. I (4–1–10 Edition) paste, or other safe and suitable milk- in this manner, sufficient vitamin A is clotting enzyme that produces equiva- added to the curd to compensate for lent curd formation, singly or in any the vitamin A or its precursors de- combination (with or without purified stroyed in the bleaching process, and calcium chloride in a quantity not artificial coloring is not used. The mass is manufacturing practice, may be added cut, stirred, and heated so as to pro- to the cheese during the kneading and mote and regulate the separation of stretching process and/or applied to the whey from curd. This whey is the name of such cheese is withdrawn, the curd is allowed to mat, "Caciocavallo siciliano cheese". These are made from sheep’s milk or goat’s milk washed in hot whey until the desired or mixtures of these, or one or both of elasticity is obtained. The curd is re- these with cow’s milk, the name is fol- moved from the vat, drained, pressed lowed by the words "made from into oblong forms, dried, and salted in lll", the blank being filled in with brine, and cured. Each of the in- ing in the curing or development of fla- gredients used in the food shall be de- vor of caciocavallo siciliano cheese clared on the label as required by the may be added during the procedure, in applicable sections of parts 101 and 130 such quantity that the weight of the of this chapter, except that enzymes of solids of such preparation is not more animal, plant, or microbial origin may than 0. If the (2) Such milk may be bleached by the dairy ingredients used are not pasteur- use of benzoyl peroxide or a mixture of ized, the cheese is cured at a tempera- benzoyl peroxide with potassium alum, ture of not less than 35 °F for at least calcium sulfate, and magnesium car- 60 days. The name of the subjected to the action of a lactic acid- food is "cheddar cheese". Each of the in- more of the clotting enzymes specified gredients used in the food shall be de- in paragraph (b)(2) of this section is clared on the label as required by the added to set the dairy ingredients to a applicable sections of parts 101 and 130 semisolid mass. The mass is so cut, of this chapter, except that: stirred, and heated with continued stir- (1) Enzymes of animal, plant, or mi- ring, as to promote and regulate the crobial origin may be declared as "en- separation of whey and curd. The whey zymes"; and is drained off, and the curd is matted (2) The dairy ingredients may be de- into a cohesive mass. The mass is cut clared, in descending order or predomi- into slabs, which are so piled and han- nance, by the use of the terms "milkfat dled as to promote the drainage of and nonfat milk" or "nonfat milk and whey and the development of acidity. The curd is salted, stirred, conforms to the definition and stand- further drained, and pressed into ard of identity prescribed for cheddar forms. Rennet and/or ents and in the same manner pre- other clotting enzymes of animal, scribed in §133. The letters in crobial orgin, used in curing or flavor the words "low sodium" shall be of the development. The weight of the hydrogen per- or names of the ingredient or ingredi- oxide shall not exceed 0. Colby cheese shall be deemed not dure set forth in paragraph (b) of this to have been made from pasteurized section is used. Sufficient rennet, or may contain an optional mold-inhib- other safe and suitable milk-clotting iting ingredient consisting of sorbic enzyme that produces equivalent curd acid, potassium sorbate, sodium sor- formation, or both, with or without pu- bate, or any combination of two or rified calcium chloride in a quantity more of these, in an amount not to ex- not more than 0. The mass is a clear aqueous solution prepared by so cut, stirred, and heated with contin- condensing or precipitating wood ued stirring, as to promote and regu- smoke in water as provided in para- late the separation of whey and curd. A graph (d)(1) of this section, the name of part of the whey is drained off, and the the food is immediately followed by curd is cooled by adding water, the the words "with added smoke fla- stirring being continued so as to pre- voring" with all words in this phrase of vent the pieces of curd from matting. Colby cheese for manufacturing con- (2) All cheeses used in a cold-pack forms to the definition and standard of cheese are made from pasteurized milk identity prescribed for colby cheese by or are held for not less than 60 days at §133. If there is no applicable and in the same manner prescribed in definition and standard of identity, or §133. Any safe and (ii) The fat content of the solids of a suitable ingredient or combination of cold-pack cheese made from a single ingredients that contains no sodium variety of cheese is not less than the and that is recognized as a salt sub- minimum prescribed by the definition stitute may be used. The letters in the the solids of cold-pack gruyere cheese words "low sodium" shall be of the is not less than 45 percent. I (4–1–10 Edition) pack cheese made from two or more of citric acid, acetic acid, and phosphoric the varieties cheddar cheese, washed acid, in such quantity that the pH of curd cheese, colby cheese, and granular the finished cold-pack cheese is not cheese is not more than 39 percent. For the purposes of this sec- (ii) The fat content of the solids of a tion vinegar is considered to be acetic cold-pack cheese made from two or acid. The weight of each variety of "Cold-pack lll cheese", "lll cold- cheese in a cold-pack cheese made from pack cheese" or "lll club cheese", three or more varieties of cheese is not the blanks being filled in with the less than 15 percent of the total weight name or names of the varieties of of all, except that the weight of blue cheese used, in order of predominance cheese, nuworld cheese, roquefort by weight. These limits do not apply be designated "Cold-pack American to the quantity of cheddar cheese, cheese"; or when cheddar cheese, washed curd cheese, colby cheese, and washed curd cheese, colby cheese, granular cheese in mixtures which are granular cheese, or any mixture of two designated as "American cheese" as or more of these is combined with prescribed in paragraph (d)(2) of this other varieties of cheese in the cheese section. Such mixtures are considered ingredient any of such cheeses or such as one variety of cheese for the purpose mixture may be designated as "Amer- of this paragraph (a)(6). Wherever any word or state- contain substances prepared by con- ment emphasizing the name of any in- densing or precipitating wood smoke. The or any mixture of two or more of these, weight of each variety of cheese in the may be designated as "American cold-pack cheese food made with three cheese". These limits do not cheese or such mixture may be des- apply to the quantity of cheddar ignated as "American cheese". Such mixtures are considered as one variety of cheese for (a)(1) Cold-pack cheese food is the the purposes of this paragraph (a)(6). The full name of the hydrated cream, skim milk cheese for food shall appear on the principal dis- manufacturing, and albumin from play panel of the label in type of uni- cheese whey. Wherever dients used in cold-pack cheese food any word or statement emphasizing the are pasteurized or made from products name of (other than in an ingredient that have been pasteurized. When two or more of the following: Any prop- one or both such optional ingredients erly prepared fresh, cooked, canned, or is used, dioctyl sodium sulfosuccinate dried vegetable; any properly prepared complying with the requirements of cooked or canned meat. Rennet and/or or meats contain fat, the method pre- other clotting enzymes of animal, scribed for the determination of fat by plant, or microbial origin. Each of the in- kaese, is the food prepared by the pro- gredients used in the food shall be de- cedure set forth in paragraph (a)(3) of clared on the label as required by the this section or by any other procedure applicable sections of parts 101 and 130, which produces a finished cheese hav- except that enzymes of animal, plant, ing the same physical and chemical or microbial origin may be declared as properties. The milkfat content is not jected to the action of a lactic acid- less than 4 percent by weight of the fin- producing bacterial culture. One or ished food, within limits of good manu- more of the clotting enzymes specified facturing practice. The finished food in paragraph (b)(2) of this section is contains not more than 80 percent of added to set the dairy ingredients to a moisture, as determined by the method semisolid mass. The whey is drained from the cluding, but not limited to, milk or curd and the curd is cured for 2 or 3 substances derived from milk. It is then heated to a tempera- gredients used that are not derived ture of not less than 180 °F until the from milk shall serve a useful function hot curd will drop from a ladle with a other than building the total solids consistency like that of honey. The hot content of the finished food, and shall cheese is filled into packages and be used in a quantity not greater than cooled. One or more of the other op- is reasonably required to accomplish tional ingredients specified in para- their intended effect. The creaming graph (b)(3) of this section may be mixture shall be pasteurized; however, added during the procedure. The following terial starters, may be added following safe and suitable ingredients may be pasteurization. I (4–1–10 Edition) (1) The words "cottage cheese" which enzyme that produces equivalent curd shall appear in type of the same size formation, are added and it is held and style. The co- (2) The statement "not less than l agulated mass may be cut; it may be percent milkfat" or "l percent warmed; it may be stirred; it is then milkfat minimum", the blank being drained. The curd may be washed with filled in with the whole number that is water and further drained; it may be closest to, but does not exceed, the ac- pressed, chilled, worked, seasoned with tual fat content of the product. This salt; or statement of fat content shall appear (ii) Food grade phosphoric acid, lac- in letters not less than one-half of the tic acid, citric acid, or hydrochloric height of the letters in the phrase spec- acid, with or without rennet and/or ified in paragraph (c)(1) of this section, other safe and suitable milk-clotting but in no case less than one-eighth of enzyme that produces equivalent curd an inch in height. The curd is on the label so conspicuously as to be washed with water, stirred, and further seen under customary conditions of drained.

These cyclization approaches can include side chain to side chain generic 150mg cleocin acne 11 year old, backbone to backbone order cleocin 150mg skin care tips in hindi, and side chain to backbone generic cleocin 150 mg online acne hyperpigmentation. A common cyclization strategy used by nature is the disulfde bridge 150mg cleocin overnight delivery acne you first, but the synthetic opportunities to create different types of cycliza- tions in peptides are only limited by the creativity of the investigator and the available orthogonal synthetic strategies. One of the most common synthetic cyclization that has historically been incorporated into peptides is the lactam bridge. This has been primarily due to the same chemistry as the typical amide bond formation of a grow- ing peptide chain. All the peptides in the library consist of the same par- ent sequence, but differ in ring size. Constrained amino acids strategy has led to the discovery of peptides that show increased binding affnity, potency, and selectivity toward one or more of the receptors. Peptide backbones consist of amide bonds that are most commonly found in a trans confguration under normal conditions and are very susceptible to the biodegradation, which limit the ability of peptides to act as therapeutic agents. However, the modif- cation of the amide backbone can help stabilize a postulated pharmacophore model, add increased enzymatic and biological stability. Modifcations of the peptide amide bond with a bioisosteric group that resembles an amide without the drawbacks listed above, result in the somewhat rigid or locked conformation of the ligand that may have enhance binding affnity to specifc target. Amide bond surrogates range from simple olefnic groups to more sophisticated heterocycles. Recent examples in this context are the novel chimeric melanotropin–deltorphin analogs by Han et al. These approaches resulted in the emergence of the privileged scaffold concept, which was proposed by Evans et al. Parallel synthesis and testing of multiple analogs with different conformational constraints, d-amino acids, dehydroamino acids, amide and disulide cyclic constraint, and reverse turn mimetics offer a rapid approach to the determination of the receptor-bound conformation [115]. Identifcation of putative receptor residues important for ligand binding is a key component to homology modeling goals. A desirable approach to identify peptide–receptor inter- actions is to obtain an X-ray structure based on the formation of a protein complex crystal. Homology molecular modeling has been traditionally utilized for decades by X-ray crystallographers, and thus is a widely accepted and validated computational experimental approach. These approaches range from manual alignment to computer-assisted programs on a variety of different platforms. Determining the putative structure of the ligand and the conformation that will be used to dock into the receptor can occur using a variety of approaches. Typically, the actual docking process is now performed by a computer program, but oversight and chemical intuition by scientists is still an important aspect for performing and monitoring these types of studies. Once a 3D model of the peptide–receptor complex has been generated, puta- tive key ligand–receptor interactions between side chains as well as backbones are postulated. In these experiments, it is advantageous to have both binding as well as functional data, so that changes in pharmacology can be associated as important for receptor structure–function, peptide molecular recognition, and/or receptor activation. Orphan G-protein coupled receptors: novel drug targets for the pharmaceutical industry. Over one hundred peptide-activated G protein-coupled receptors recognize ligands with turn structure. Requirement of rigid-body motion of transmem- brane helices for light activation of rhodopsin. Characterisation of an improved two-dimensional p22121 crystal from bovine rhodopsin. Crystal structure of squid rhodopsin with intracellularly extended cytoplasmic region. High-resolution crystal struc- ture of an engineered human beta(2)-adrenergic G protein-coupled receptor. The binding site of aminergic G protein-coupled receptors: the transmembrane segments and second extracellular loop. Structure modeling of all identifed G protein-coupled receptors in the human genome. The crystallographic model of rhodopsin and its use in studies of other G protein-coupled receptors. Uncovering molecular mechanisms involved in activation of G protein-coupled receptors. Diversity and complexity of signaling through pep- tidergic G protein-coupled receptors. Acidic residues in extracellular loops of the human-y1 neuropeptide-y receptor are essential for ligand binding. Identifcation of residues responsible for the selec- tive binding of peptide antagonists and agonists in the V2 vasopressin receptor. Irreversible activation of the gonadotropin-releasing hormone receptor by photoaffnity cross-linking: local- ization of attachment site to Cys residue in Nterminal segment. Studies using an improved mutagenesis/expression vector reveal a novel mechanism for the regulation of receptor occupancy. Identifcation of ligand binding determinants in the somatostatin receptor subtypes 1 and 2. The N-terminal amino group of [Tyr8]bradykinin is bound adjacent to analogous amino acids of the human and rat B2 receptor. Direct identifcation of a distinct site of interaction between the carboxyl-terminal residue of cholecystokinin and the type A cholecystokinin receptor using photoaffnity labeling. Direct identifcation of a second distinct site of contact between cholecystokinin and its receptor. Tetrazole and carboxylate groups of angiotensis receptor antagonists bind to the same subsite by different mechanisms. Rhodopsin activation blocked by metal-ion-binding sites linking transmembrane helices C and F. Agonist-induced conformational changes at the cytoplasmic side of transmembrane seg- ment 6 in the beta2 adrenergic receptor mapped by site-selective fuorescent labeling. Agonist-induced conformational changes in the G-protein-coupling domain of the beta 2 adrenergic receptor. Metal ion site engineering indicates a global toggle switch model for seven-transmembrane receptor activation. Identifcation of an agonist-induced conformational change occurring adjacent to the ligand-binding pocket of the M(3) muscarinic acetyl- choline receptor. Agonistinduced conformational changes in thy- rotropin releasing hormone receptor type I: disulfde crosslinking and molecular model- ing approaches. The inhibitory guanine nucleotide-binding regu- latory component of adenylate cyclase. The inhibitory guanine nucleotide-binding regu- latory component of adenylate cyclase. Leukemia-associated Rho guanine nucleotide exchange factor promotes G alpha q-coupled activation of RhoA. Regulation of polyphosphoinositide-specifc phospholipase C activity by purifed Gq. Interaction of Galpha 12 and Galpha 13 with the cytoplasmic domain of cadherin provides a mechanism for beta -catenin release. Isozyme-selective stimulation of phospholipase C-beta 2 by G protein beta gamma-subunits.

She did well at school and started work in a local estate agent’s office when she left school discount cleocin 150mg line acne shoes. Mr Y was a heroin user and eventually she started smoking cigarettes that he gave her buy cheap cleocin 150 mg on line acne and pregnancy. After a few months discount 150mg cleocin with mastercard skin care over 40, she noticed that she felt very unwell if she did not smoke and Mr Y told her that the cigarettes had heroin in them discount 150mg cleocin visa za skincare. She had very little antenatal care and avoided the appointments with the social worker, who she only met once. For a few weeks she went back, with her baby, to live with her parents (with the support of social services) and stopped using heroin but the rows with her mother were so bad she eventually left the baby with her mother and went to live with Mr Y in a big city. She came into treatment when Mr Y was arrested for aggravated burglary and went to prison. She was prescribed buprenorphine and managed in an antenatal liaison clinic, where she received antenatal care and drug treatment. Social services were involved from the beginning and found her a place in a local women’s hostel. Ms B was able to stop using heroin and begin to think about some of the problems she had with her abusive relationship and her history of sexual abuse. Her second baby, a little girl, was born at full term and was immediately subject to child protection proceedings and taken into foster care but Ms B had regular contact with the baby. She subsequently went, with the baby, to a mother and baby rehabilitation centre where her parenting could be assessed and she could reduce her buprenorphine. Ms B was clear she wanted to stop using all drugs, keep her daughter and re-establish a relationship with her son and her family. Case study details provided by Dr Emily Finch, a consultant addiction psychiatrist. It is safest to prescribe opiate substitution (see Chapter 8) ‘at a dose that stops or minimises illicit use’. In all pregnant women using or prescribed opioid drugs, particular consideration will also need to be given to their birthing plan, including pain management and the risk of fetal distress at birth. In view of the potential harms to the fetus and to the mother’s health, the pregnant woman should be given support to stop using cocaine during pregnancy. A non-judgemental, sensitive approach, with clear and effective multidisciplinary communication and team working are again essential, addressing the full spectrum of psychosocial and physical health needs. The maximum penalty is life imprisonment for supply of Class A drugs, with seven years for possession, but sentences between two and 14 years are used for possession or supply of Class B or C drugs (see Chapter 1). This has implications for the medical professional, as many illicit drug users first come into contact with the medical profession via the criminal justice system. This can create particular challenges for medical professionals working within the criminal justice setting, which are highlighted throughout this chapter. It offers a valuable opportunity for effective medical treatment of drug use disorder and ultimately the best chance for many dependent drug users to be rehabilitated. A report from the Probation Service explained that she had been picked up by police after having collapsed in the stairwell of a housing estate in east London. It also explained that she was homeless; she had been living in a local authority hostel but had been thrown out of it for taking men back into the hostel for the purpose of prostitution in order to raise funds to feed her drug habit. She was barely conscious at the time that she was found by the police and was high on drugs. She was due to be sentenced for a series of offences, which included attempted robberies of mobile phones from young women whom she had threatened with a knife, and attempts to snatch handbags, also from young women leaving a tube station late at night. The probation report explained that she committed these offences to raise funds to buy drugs and that she was so dependent that, unless she was taken off the streets (and in effect given a lengthy prison sentence), there was a real risk that she would die. The oldest was a six-year-old girl, who had been taken away by the grandmother to Belgium (it was said that she had, in effect, abducted the granddaughter to save her from her mother) and she also had a two-year-old child who was in care. After hearing evidence from the Probation Services, the court imposed a prison sentence at the maximum end of the scale for offences of that nature. The court discussed the possible range of sentences with defence and prosecution counsel and the discussion proceeded upon the basis that it was, in effect, common ground that, for her own good, she needed to be given a custodial sentence of the longest duration that was proper in the circumstances. This would give the defendant the best chance of receiving drug treatment in prison. The case was unusual in that the Probation Service was able to make enquiries about which prison the defendant would be sent to, and about the availability of drug treatment courses in that prison. This was exceptional, since it is very rare indeed for a sentencing judge to know anything about the prison to which a defendant is to be sent, or about the availability of drug rehabilitation courses in that prison. While drug treatment programmes delivered in a controlled prison environment may offer some prisoners the opportunity to be rehabilitated, rates of drug use during incarceration remain high. Analysis of the findings of the 1997 National Survey found that over a quarter of the men who had used heroin reported first initiating use in prison. Care planning is integral to the process; this is an agreed plan of action between the service user and the Criminal Justice Intervention Team worker, which involves setting goals based on the individual needs identified. This plan documents and enables routine review of the service user’s needs, goals and progress across four key domains: • drug and alcohol use • physical and psychosocial health • offending • social functioning (including housing, employment and relationships). The different levels/tiers of treatment reflected their intensity and ranged from non-specialist general healthcare through open drugs treatment and community-based drug treatment to residential drug treatment. This requirement is one of a menu of 12 requirements to which offenders can be sentenced. There are three levels of intensity of contact, which include, but do not entirely consist of, medical treatment. Before making the requirement, the court must be satisfied that: • the offender is dependent on or has a propensity to use any controlled drug • he or she would benefit from treatment • the necessary arrangements can be made for the treatment • the offender agrees to comply with the requirement. Arrangements for treatment are available through the Probation Trusts, which operate at a local level. There is provision for the court to review the progress of the offender during the order, and to agree changes in the treatment. The treatment can be residential or non-residential, which is decided by the court, and must be supervised by a suitably qualified person. A review of the National Drug Rehabilitation Requirement found a variation in treatment delivery across England and Wales. Sessions were set aside in existing magistrates’ courts for dedicated panels of magistrates or particular district judges to sit for sentencing. Appropriate sanctions and other rehabilitation services that could be included in community sentences were available to all courts in England and Wales. In January 2011, the Ministry of Justice published The Dedicated Drug Courts Pilot Evaluation Process Study. It also leads to a blurring of the distinction between judicial and therapeutic strategies, with the result that a drug user may view the doctor treating them as part of the judicial system and be confused about whether they are being punished, or treated as a patient. Effective communication is essential to ensure that those undergoing treatment fully understand their rights as outlined in Section 10. Issues that arise for health professionals include the following: • high rates of illiteracy and learning disability in offenders, often coupled with a lack of time and/or privacy for consultations, which raise serious questions about their freedom to give informed consent • the perception of offenders that the doctor is not impartial but is working for the police or prison • the ethics of providing treatment when the patient has effectively been coerced to consent. It has been estimated that the value of illicit drugs within prison is about £100 million. There is disagreement as to which of the routes of illicit supply is the most prominent. A Policy Exchange report in 2010 contends that the majority of drug dealing within prison is highly organised and involves the collusion of around 1,000 corrupt staff, which equates to around seven prison officers per prison.

Packaging technologies: Detecting fake packaging Inexpensive Low Fast Yes mPedigree developed scratch-of codes for holograms purchase 150 mg cleocin acne 38 weeks pregnant, barcodes buy cleocin 150 mg mastercard acne 70 off, prescription boxes safe cleocin 150mg skin care clinique. Consumers text the code to a pedigrees phone number and receive a confrmation—or not—that their product is genuine (Sharma order 150mg cleocin with amex skin care associates, 2011). Physical and bulk property Varies, but usually identifying the active Varies Low-high Varies Varies An artesunate extraction should signifcantly lower the testing (e. Disintegration tests Determining whether product will Inexpensive Low Fast Yes Close to 12% of drugs sampled from Delhi in a study of disintegrate correctly drug quality in India failed disintegration testing (Bate et al. Dissolution tests Determining whether product will dissolve Expensive High Slow No In one study, 14% of drugs that initially passed correctly, a measure of bioavailability dissolution testing subsequently failed, rendering them substandard, after 6 months of storage in tropical conditions (Kayumba et al. Artemisinin is sometimes substituted for its and tablet coatings derivatives, such as artemether, in falsifed products (Kaur et al. Near-infrared spectroscopy Identifying and quantifying active Moderate-expensive Moderate Fast Yes Was able to distinguish real from falsifed artesunate ingredients, excipients tablets with 100% accuracy in an analysis of samples from Southeast Asia (Dowell et al. Raman spectroscopy Identifying active ingredients and excipients, Moderate-expensive Moderate Fast No Close examination of Raman spectra comparing a (conventional) relative concentration of ingredients; suspected falsifed drug to a real sample revealed a identifying tablet coating composition slight discrepancy due to diferences in tablet coating (Witkowski, 2005). Raman spectroscopy Same as conventional Raman spectroscopy, Moderate Low Fast Yes Falsifed artesunate samples did not produce the strong (portable) but can be less reliable fuorescence characteristic of artesunate when scanned with a portable device (Ricci et al. High-performance liquid Identifying and quantifying active Expensive High Slow No Distinguished between falsifed and genuine samples of chromatography-mass ingredients, excipients, undeclared Nigerian dihydroartemisinin (Kaur et al. Artemisinin is sometimes substituted for its and tablet coatings derivatives, such as artemether, in falsifed products (Kaur et al. Near-infrared spectroscopy Identifying and quantifying active Moderate-expensive Moderate Fast Yes Was able to distinguish real from falsifed artesunate ingredients, excipients tablets with 100% accuracy in an analysis of samples from Southeast Asia (Dowell et al. Raman spectroscopy Identifying active ingredients and excipients, Moderate-expensive Moderate Fast No Close examination of Raman spectra comparing a (conventional) relative concentration of ingredients; suspected falsifed drug to a real sample revealed a identifying tablet coating composition slight discrepancy due to diferences in tablet coating (Witkowski, 2005). Raman spectroscopy Same as conventional Raman spectroscopy, Moderate Low Fast Yes Falsifed artesunate samples did not produce the strong (portable) but can be less reliable fuorescence characteristic of artesunate when scanned with a portable device (Ricci et al. High-performance liquid Identifying and quantifying active Expensive High Slow No Distinguished between falsifed and genuine samples of chromatography-mass ingredients, excipients, undeclared Nigerian dihydroartemisinin (Kaur et al. The emerging feld of medicines authentication by nuclear quadrupole resonance spectroscopy. Working paper: The impact of improved detection technology on drug quality: A case study of Lagos, Nigeria. Pilot study comparing technolo- gies to test for substandard drugs in feld settings. New technology represents next-generation tool for detecting substan- dard and counterfeit medicines. Poor quality drugs: Grand challenges in high throughput detection, coun- trywide sampling, and forensics in developing countries. Development and valida- tion of a reversed-phase lc method for analysing potentially counterfeit antimalarial medicines. Tanzanian food and drugs authority receives four unique mobile compact laboratories. Short communication: Authentication of artemether, artesunate and dihydroartemisinin antimalarial tablets using a simple colori- metric method. Use of refractometry and colorimetry as feld methods to rapidly assess antimalarial drug quality. Establishment of a fast chemical identifcation system for screen of counterfeit drugs of macrolide antibiotics. Ensuring safe foods and medical products through stronger regulatory systems abroad. Ofoxa- cin: Laboratory evaluation of the antibacterial activity of 34 brands representing 31 manufacturers available in Pakistan. A concise quality control guide on essential drugs and other medicines: Colour reaction tests. Paper read at 3rd Global Forum on Pharmaceutical Anticounterfeiting, Prague, Czech Republic. The quality of essential antimicrobial and antimalarial drugs marketed in Rwanda and Tanzania: Infuence of tropical stor- age conditions on in vitro dissolution. Detection of substandard fxed-dose combination tuberculosis drugs using thin-layer chromatography. Reliable low-cost capillary elec- trophoresis for drug quality control and counterfeit medicines. Analysis of organic volatile impurities as a forensic tool for the examination of bulk pharmaceuticals. A collaborative epidemiological investigation into the criminal fake artesunate trade in South East Asia. Combining two-dimensional diffusion-ordered nuclear magnetic resonance spectroscopy, imaging desorption elec- trospray ionization mass spectrometry, and direct analysis in real-time mass spectrom- etry for the integral investigation of counterfeit pharmaceuticals. Assessment of hand-held Raman instrumentation for in situ screening for potentially counterfeit artesunate antimalarial tablets by ft-Raman spectroscopy and direct ionizatoin mass spectrometry. Criteria for the identifcation of compounds by liquid chromatography-mass spectrometry and liquid chromatography-multiple mass spectrometry in forensic toxicol- ogy and doping analysis. Strategies for characterizing silde- nafl, vardenafl, tadalafl, and their analogues in herbal dietary supplements, and detect- ing counterfeit products containing these drugs. Multiple injection technique for the determination and quantitation of insulin formulations by capillary electrophoresis and time-of-fight mass spectrometry. High-performance liquid chromatographic method with diode array detection for iden- tifcation and quantifcation of the eight new antidepressants and fve of their active metabolites in plasma after overdose. Intelligence alert: Viagra® mimic tablet containing amphetamine in Fejer County, Hungary. Ensuring the quality of medicines in resource-limited coun- tries: An operational guide. Towards a decade of detecting new analogues of silde- nafl, tadalafl and vardenafl in food supplements: A history, analytical aspects and health risks. The use of Raman spectroscopy in the detection of counterfeit and adulterated pharmaceutical products. Identifcation of the “wrong” active pharmaceutical ingredient in a counterfeit Halfan™ drug product using accurate mass electrospray ionisation mass spectrometry, accurate mass tandem mass spectrometry and liquid chromatography/mass spectrometry. Countering the Problem of Falsified and Substandard Drugs 7 An International Code of Practice for Falsifed and Substandard Medicines Ensuring a safe, reliable drug supply is ultimately a matter for indi- vidual countries. To this end, every nation has four main responsibilities: regulating the responsible manufacture of safe and effective medicines; pre- venting falsifed and substandard drugs from entering the market; detecting them when they do; and punishing those who knowingly manufacture and trade them. Executing these responsibilities requires strong national systems for drug regulation, surveillance, and law enforcement. Governments must work with key stakeholders in industry, professional associations, and civil society to protect the drug supply. However, no country acting alone can protect its citizens from falsifed and substandard medicines. The problem, as seen throughout this report, is international, fueled by international trade and telecommunications. Crime and easy money are powerful forces driving the illegitimate medicines busi- ness. Its perpetrators gravitate to countries where surveillance, regulation, and law enforcement are the weakest.

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