Impairment expenses

Approximately 500,000 Americans suffer strokes each year. Many of the 80% that survive suffer paralysis and impaired vision and speech, often needing rehabiUtation and/or long-term care. Hence, whereas treatment using rt-PA is likely to be expensive (costs are 2200/dose for treating heat attacks), the benefits of rt-PA could outweigh costs. In the case of heart attacks, the 10 times less expensive microbiaHy derived streptokinase can be used. There is currentiy no competing pharmaceutical for treatment of strokes (18,19). Consequentiy, the cost of manufacture of rt-PA may not be as dominant an issue as would be the case of other types of bioproducts. 

Zinc, traditionally less expensive than copper, does not too gready impair conductivity and ductihty as it solution hardens copper. 

The paraffin wax is oxidized by air in a liquid phase process at 110-130°C. Catalysts for this radical reaction are cobalt or manganese salts [54]. The quality of the obtained mixture of homologous carboxylic acids is impaired by numerous byproducts such as aldehydes, ketones, lactones, esters, dicarboxylic acids, and other compounds. These are formed despite a partial conversion of the paraffin and necessitate an expensive workup of the reaction product [50,55]. 

Hetastarch 6% has comparable plasma expansion to 5% albumin solution but is usually less expensive, which accounts for much of its use. Hetastarch should be avoided in situations in which short-term impairments in hemostasis could have adverse consequences (e.g., cardiopulmonary bypass surgery, intracranial hemorrhage), because it may aggravate bleeding due to mechanisms such as decreased factor VIII activity. 

The stomach is generally the least expensive and least labor-intensive access site however, patients who have impaired gastric emptying are at risk for aspiration and pneumonia. 

Calcium-phosphorus balance is mediated through a complex interplay of hormones and their effects on bone, GI tract, kidney, and parathyroid gland. As kidney disease progresses, renal activation of vitamin D is impaired, which reduces gut absorption of calcium. Low blood calcium concentration stimulates secretion of parathyroid hormone (PTH). As renal function declines, serum calcium balance can be maintained only at the expense of increased bone resorption, ultimately resulting in renal osteodystrophy (ROD) (Fig. 76-7). 

Because immunotherapy is expensive, has potential risks, and requires a major time commitment from patients, it should only be considered in select patients. Good candidates include patients who have a strong history of severe symptoms unsuccessfully controlled by avoidance and pharmacotherapy and patients who have been unable to tolerate the adverse effects of drug therapy. Poor candidates include patients with medical conditions that would compromise the ability to tolerate an anaphylactic-type reaction, patients with impaired immune systems, and patients with a history of nonadherence to therapy. 

As with other specialty chemicals, which can impair human health and therefore need extensive and expensive testing prior to commercialization, R D in biocides is concentrating on formulations and applications, rather than on new chemical entities. NCEs are developed for substitution of old products with environmental hazards, such as the copper/arsenic compounds used in timber and wood preservation. 

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