Treatment selection

Thus, bench or pilot studies are necessary to avoid technology misapplication in the field. The loss of time in treatment or the requirement to provide additional treatment for the waste is very expensive. Therefore, the relatively small costs and time needed for these studies make them useful tools in treatment selection. Bench-scale treatability studies for demonstrated technologies can cost between 10,000- 50,000 and take up to 6 weeks. Demonstrated technologies are those for which the major design parameters and treatment efficiencies are well understood. Innovative (and some biological processes) will require substantially more time (4-16 weeks) and money ( 25,000-> 200,000). These are estimates, and actual time and costs are going to depend on what kind of technology is under consideration. 

In most engineering applications the supply water is not suitable for immediate use without treatment. It is essential that the method of water treatment selected be the one most suited to the application. If steam is used as the working medium for a process, it is essential that water treatment be used to prevent the precipitation of substances in the water from fouling pipe work and heat exchangers otherwise costly plant damage will result. 

The method of treatment selected depends on many factors, such as the nature of the salts and the pH of the water, and the assistance of a reputable specialist company is necessary to carry out regular testing and an analysis report. 

Boiler scales and corrosion product deposits also may form from the thermal breakdown of treatment chemicals. Breakdown products of chemicals such as sulfite, amines, hydrazine, and chelants often are steam-volatile, and subsequent reactions may produce corrosion debris that forms deposits and causes blockages. This problem typically occurs when chemical treatments selected for use are applied under unsuitable operating conditions (as when the boilers are highly rated or raise steam at particularly high operating pressure or temperature). 

Patients with a good response to therapy should consider intensification of anti-inflammatory therapy.1 Although guidelines recommend doubling the previous inhaled corticosteroid dose, this may not be necessary for mild exacerba-tions.3,41,42 Treatment selection should be individualized based on what has worked for the patient previously. 

The treatment selected for PUD depends on the following factors (1) the etiology of the ulcer (2) whether the ulcer is new or recurrent and (3) the presence of any ulcer-related complications. Figure 15-2 contains an algorithm for the evaluation and treatment of a patient with signs and symptoms suggestive of an H. pylori-associated or NSAID-induced ulcer. 

Along with selecting an effective treatment, selection of an appropriate antifungal agent requires consideration of location and severity of infection, medication adherence, potential drug... 

Many methods are available for restoring sin us rhythm, preventing thromboembolic complications, and preventing further recurrences (Fig. 6-1) however, treatment selection depends in part on onset and severity of symptoms. 

For further purification, primary cultures of PBEC are passaged at the third day of culture by gentle trypsinization at room temperature. This enzymatic treatment selectively releases endothelial cells, leaving behind contaminating cells, such as pericytes and smooth muscle cells. Usually, contamination by nonendothelial cells should be below 1-3%. Endothelial cells are then seeded at a density of 30,000-50,000 cells/cm2 on rat-tail collagen-coated cell culture inserts (Figure 17.5). 

A number of medical conditions are associated with high rates of depression (see Table 3.4). In some instances, the distinction between MDD and depression due to a general medical condition is largely academic with little bearing on treatment selection. For example, pancreatic cancer may induce depression directly through the release of tumor-secreted substances however, depression in the pancreatic cancer patient is treated with conventional antidepressant medications. In other cases, the diagnostic distinction bears important treatment implications. One commonly cited example is depression occurring in association with hypothyroidism. Patients with depression and hypothyroidism do not respond to antidepressant treatment alone but require a thyroid hormone supplement. 

The frequency of dosing is another factor that can gnide treatment selection. Most antidepressants are administered once or twice daily with the majority given once a day. Some patients may find it easier to comply with once-a-day dosing. 

Finally, the expense of treatment can be a decisive factor in treatment selection. Depending on the dose, the cost of the newer antidepressants is 1 to 3 per day. The older TCAs and MAOIs are available in cheaper generic forms. However, these reqnire more stringent medical monitoring and periodic assessment of serum drug levels. 

The first step in managing bipolar depression is, of course, to arrive at the correct diagnosis. Producing a life chart that delineates the duration, severity, and frequency of illness episodes is critical to treatment selection. Treatment that focuses on the management of the depressive phase is especially important for patients with three or more depressive episodes, particularly severe depressions, or significant subsyn-dromal depressive symptoms between episodes. 

First-line GAD treatments include (1) cognitive-behavioral therapy (CBT), (2) antidepressants, (3) buspirone, and (4) benzodiazepines. Treatment selection is determined by the severity of the illness, the presence of any comorbid illnesses, previous patient treatment responses, and patient preference. When treating mild GAD, we recommend eschewing psychotropic medication altogether in favor of CBT. Moderate-to-severe GAD usually requires pharmacotherapy, though combined CBT-pharmacotherapy is highly encouraged. 

FIGURE 41.1 A decision tree for antipsychotic treatment selection in childhood and adolescence (adapted and modified from Clark and Lewis 1998). 

Cartwright RD Rapid eye movement sleep characteristics during and after mood disturbing events. Arch Gen Psychiatry 40 197-201, 1983 Gasas M, Alvarez E, Duro P, et al Antiandrogenic treatment of obsessive-compulsive neurosis. Acta Psychiatr Scand 73 221-222, 1986 Gasebolt TL, Jope RS Long-term lithium treatment selectively reduces receptor-coupled inositol phospholipid hydrolysis in rat brain. Biol Psychiatry 25 329-340, 1989... 

After discussion with the patient and family about the risks and benefits of treatment, select the appropriate antipsychotic agent on the basis of the patient s physical status, the side-effect profile of the drug, and the patient s previous responses to medication, if known. 

Taking a stepwise, empirically based approach to treatment selection... 

Ludwig JA, Weinstein JN. Biomarkers in cancer staging, prognosis, and treatment selection. Nat Rev Cancer 2005 5 845-856. 

The treatment each trial participant receives is often decided by a process called randomization. This process can be compared to a coin toss that is done by computer. During clinical trials, no one likely knows which therapy is better, and randomization assures that treatment selection will be free of any preference a physician may have. Randomization increases the likelihood that the groups of people receiving the test drug or control are comparable at the start of the trial, enabling comparisons in health status between groups of patients who participated in the trial. 

Bowers, Jean M. Drug Abuse Prevention, Education, and Treatment Selected References. Washington, D.C. Congressional Research Service, 1998. A bibliography of Web links, printed resources, and organization contacts. Materials covered include programs and policy discussions. 

This study reports two gel permeation techniques used to evaluate water at various stages of (potable water) treatment. The water samples were taken from a surface-water pilot treatment plant that employed several levels of ozone treatment. Selected fractions of the permeate were subsequently analyzed by pyrolysis gas chromatography-mass spectrometry (GC-MS). 

Biyson, B., Heat Treatment. Selection, and Application of Tool Steels, Gardner Publications., Inc., Cincinnati. OH, 1997. 

As an aid to chemical inhibitor treatment selection, some inhibitor selection charts are included in Section 8.4.3.5 as Tables 8.3 to 8.10. Also refer to Chapter 5 and especially Tables 5.1 to 5.5. 

Thus a vital task for any representative-customer partnership is to determine, for an inhibitor treatment selection ... 

Blaiss MS. Antihistamines treatment selection criteria for pediatric seasonal allergic rhinitis. Allergy Asthma Proc. 2005 26 95-102. 

In spite of the dramatic advances in research on depression and the medications used for its treatment, it is important to remember that our understanding of the underlying mechanisms is still relatively elementary. So a clinician must utilize all available scientific information, yet bear in mind that it is incomplete. The application of scientific knowledge to the management of clinical situations has traditionally been referred to as a successful combination of science and art. What Leonardo da Vinci stated centuries ago— First study the science, then practice the art —is as valid today as it was then. The rules that may emanate from current medical knowledge are peppered with multiple exceptions and unexpected clinical developments. Every capable clinician knows that no two patients are fully alike. Moreover, as research advances, revisions of accepted practices will inevitably occur. With this caveat in mind, let us explore some elements that are often incorporated into the treatment selection and medication monitoring of a depressed patient. 

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