Treatment phases

For large superfund sites, the proeess ean be similar to the DOE proeess as deseribed. Onee the site has been adequately assessed, a remedy ean be ehosen. This remedy ean vary but eould inelude a removal or stabilization phase, a treatment phase, a maintenanee phase, and, finally, dismantlement and deeontamination phases. 

Lilienthal H, Winneke G. 1996. Lead effects on the brain stem auditory evoked potentials in monkeys during and after the treatment phase. Neurotoxicol Teratol 18 17-32. 

Additives are badly represented in LCA case studies. This is not because they do not contribute to impacts, but because they are not included in the assessment. The most likely reason for that is that specific LCI data for additives are missing to a large extent, and additive data are not included in the compound materials. Moreover, this fact is not obvious. Possibly, LCA practicioners are not aware of this gap. Additive data for the use phase and waste treatment phase are lacking as well. LCIA data for additives are also lacking. Approaches exist, however, to estimate interim characterization factors based on substance characteristics. 

Drzyzga et al. [411] conducted experiments to evaluate the levels of incorporation and transformation of TNT and metabolites into the organic soil matrix of anaerobic and sequential anaerobic-aerobic treated soil/molasses mixtures. They proposed a two-step treatment process (i.e., anaerobic-aerobic bioremediation process) with some special procedures during the anaerobic and the aerobic treatment phases. The transformation of TNT at the end of the experiments was above 95% and 97% after anaerobic and sequential anaerobic-aerobic treatment, respectively. This technique is considered the most promising method for effective, economic, and ecologically acceptable disposal of TNT from contaminated soils by means of immobilization (e.g., humification) of this xenobiotic. 

Benzodiazepines. The benzodiazepines were developed in the 1950s and introduced into the U.S. market in the 1960s. They have found a variety of uses including the treatment of several anxiety disorders, insomnia, seizure disorders, alcohol withdrawal, surgical anesthesia, and others. The benzodiazepines have also been used to calm agitated patients and are therefore useful during the acute treatment phase of bipolar mania. 

As with other antiarrhythmics, in the elderly or patients with marked previous myocardial damage, increase dose more gradually during initial treatment phase. 

Before describing the treatment of pediatric MDD, several terms of treatment response and the treatment phases of MDD will be defined (Table 36.1). The definitions depicted have been extensively used in the pediatric and adult literature (e.g., Emslie, et ah, 1997a,b Birmaher et ah, 2000a). 

FIGURE 36.1 Major depressive disorder—acute treatment phase. 

It is recommended that adult patients with second episodes of depression and who fulfill the criteria for maintenance therapy noted above be maintained for several years (up to 5 years in adult studies), using the same dosage of the antidepressant used to achieve clinical remission during the acute-treatment phase. Maintenance therapy for patients with three or more episodes of MDD, patients with second episodes associated with psychosis, severe impairment, and severe suicidality, and those who proved very difficult to treat should be considered for longer periods of time, even for the life of the patient (AACAP, 1998). 

In summary, during the maintenance treatment phase, both psychosocial and pharmacological treatments have been found to be beneficial in preventing recurrences. However, as yet, in adults the evidence is stronger for pharmacotherapy. Also, it is not clear whether psychosocial treatments are efficacious in pre-... 

One exception is the behavioral therapy used in the controlled study of IMI for SAD discussed above (Klein et ah, 1992). About half of the 45 subjects enrolled in the study responded to behavioral therapy in the initial 4-week treatment phase prior to medication treatment. The authors noted about half of the subjects who responded to behavioral treatment and did not meet randomization criteria still continued to have clinically significant separation anxiety requiring treatment. Given the results prior to medication randomization, Klein and colleagues (1992) further suggested that behavioral therapy be considered a potential first treatment for SAD before medication treatment. 

Relapse prevention with medication has been studied in BN as well as AN. In 1991 Walsh et al. placed bulimics who had a 50% or more reduction in binge eating on desipramine in maintenance treatment. About half of the patients relapsed below the 50% reduction within 4 months, despite continued use of the medication. In a second multicenter collaborative study examining the efficacy of fluoxetine maintenance in bulimic patients who had responded to the drug with a 50% reduction of symptoms, the patients who were maintained on the active drug were significantly less likely to relapse than those who were switched to placebo at the end of the acute treatment phase (Romano, 1999). 

FI6U RE 6 5 B. Mood analogue ratings showing unequivocal response to nimodipine after placebo substitution in a patient with bipolar 11 disorder with ultra-ultrarapid cycbng. Mean deviation above 13 for the entire treatment phase (not just the 1 month illustrated). M = mania D = depression T = euthymia. 

Because many antidepressant compounds are also effective in panic disorder, we performed a trial of inositol in panic (Benjamin et al. 1995). Twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, random assignment crossover treatment trial of inositol 12 g/ day versus placebo, with 4 weeks in each treatment phase. Frequency of panic attacks and severity of panic disorder and of agoraphobia declined significantly more on inositol than on placebo the effect was comparable to that of imipramine in previous studies. Side effects were minimal. 

As mentioned earlier, the clinical trials with TCAs in children and adolescents with MDD have generally been disappointing ( 120, 122,123). In addition, these medications have a less favorable adverse effect profile and thus higher patient attrition rates during the acute treatment phase compared with newer antidepressants. They also have a lower therapeutic index (i.e., difference between therapeutic and toxic dose see Chapter 7). 

Voigt [1705] prepared transparent Ge02 glasses on hydrolysis of Ge(OEt)4 the temperature of glass formation is about l(XfC lower in comparison with that used in conventional methods. On crystallization of amorphous oxide prepared on hydrolysis of Ge(OPri)4, a mixture of two phases, crystoballite and a-quartz, is formed. On further thermal treatment, phase transition of crystoballite to a-quartz occurs, while grinding in air results in the transition to a rutile-type structure on treatment at temperatures higher than 1050°C all phases are tranferredto a-quartz [1766]. 

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