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The physician performing the abortion shall report the sexual conduct with a minor to the proper law enforcement officials pursuant to § 13-3620 and shall preserve and forward a sample of the fetal tissue to these officials for use in a criminal investigation order cheapest azulfidine and azulfidine. A person who performs an abortion in violation of this section is guilty of a class 1 misdemeanor discount azulfidine 500mg without prescription. A person is not subject to any liability under this section if the person establishes by written evidence that the person relied on evidence sufficient to convince a careful and prudent person that the representations of the pregnant minor regarding information necessary to comply with this section are true purchase azulfidine 500mg free shipping. The civil action may be based on a claim that failure to obtain consent was a result of simple negligence, gross negligence, wantonness, wilfulness, intention or any other legal standard of care. The civil action may be brought against the person who performs the abortion in violation of this section and any person who causes, aids or assists a minor to obtain an abortion without meeting the requirements of this section. Money damages for all psychological, emotional and physical injuries that result from the violation of this section. Statutory damages in an amount equal to five thousand dollars or three times the cost of the abortion, whichever is greater. A civil action brought pursuant to this section must be initiated within six years after the violation occurred. The consent required by this section must be obtained on a form prescribed by the department of health services. List the possible medical risks that may occur with any surgical, medical or diagnostic procedure, including the potential for infection, blood clots, hemorrhage, allergic reactions and death. List the possible medical risks that may occur with a surgical abortion, including hemorrhage, uterine perforation, sterility, injury to the bowel or bladder, a possible hysterectomy as a result of a complication or injury during the procedure and failure to remove all products of conception that may result in an additional procedure. List the possible medical risks that may occur with a medication abortion, including hemorrhage, infection, failure to remove all products of conception that may result in an additional procedure, sterility and the possible continuation of the pregnancy. The information may be given to or withheld from the spouse, parent, or guardian without the consent and over the express objection of the minor. This section shall not apply to custodial property given or held under the terms of the “Colorado Uniform Transfers to Minors Act”, article 50 of title 11, C. Such consent shall not be subject to disaffirmance because of minority, and, when such consent is given, said minor shall have the same rights, powers, and obligations as if he or she had obtained majority. Consent to organ or tissue donation may be revoked pursuant to section 12-34-106, C. The consent of a minor parent shall not be subject to disaffirmance because of minority, and, when such consent is given, said minor parent has the same rights, powers, and obligations as if he or she were of legal age. Equally important is the duty of those performing such service or providing such materials to exercise due care under the attending circumstances to the end that those receiving health care will benefit and adverse results therefrom will be minimized by the use of available and proven scientific safeguards. The imposition of legal liability without fault upon the persons and organizations engaged in such scientific procedures may inhibit the exercise of sound medical judgment and restrict the availability of important scientific knowledge, skills, and materials. It is, therefore, the public policy of this state to promote the health and welfare of the people by emphasizing the importance of exercising due care, and by limiting the legal liability arising out of such scientific procedures to instances of negligence or willful misconduct. No physician, surgeon, hospital, blood bank, tissue bank, or other person or entity who donates, obtains, prepares, transplants, injects, transfuses, or otherwise transfers, or who assists or participates in donating, obtaining, preparing, transplanting, injecting, transfusing, or transferring any tissue, organ, blood, or 32 component thereof from one or more human beings, living or dead, to another living human being for the purpose of therapy or transplantation needed by him for his health or welfare shall be liable for any damages of any kind or description directly or indirectly caused by or resulting from any such activity; except that each such person or entity remains liable for his or its own negligence or willful misconduct. The consent of the parent, parents, or legal guardian of such a minor shall not be necessary in order to authorize such donation of blood, organs, or tissue and penetration of tissue. Medical treatment also means the examination and treatment of any laceration, fracture or other traumatic injury, or any symptom, disease or pathology which may, in the judgment of the treating health care professional, if left untreated, reasonably be expected to threaten health or life. A minor giving such consent shall be deemed to have the same legal capacity to act and the same legal obligations with regard to giving such consent as if such minor were 18 years of age or over. Consent so given shall not be subject to later disaffirmance by reason of such minority and the consent of no other person or court shall be necessary for performance of the lawful procedures required to be performed in order to receive such donation. A minor giving the consent shall be deemed to have the same legal capacity to act and the same legal obligations with regard to giving consent as if the minor were of full legal age. Consent so given shall not be subject to later disaffirmance by reason of such minority; and the consent of no other person or court shall be necessary for the performance of the diagnostic and lawful therapeutic procedures, medical or surgical care and treatment rendered such minor. Constructive service of process may be used, provided the petitioning parent makes an actual, diligent search to discover the location of, and provide notice to, the nonpetitioning parent. An order removing the disabilities of nonage shall have the effect of giving the minor the status of an adult for purposes of all criminal and civil laws of the state, and shall authorize the minor thereafter to exercise all of the rights and responsibilities of persons who are 18 years of age or older. Such consent shall not be subject to disaffirmance because of minority, unless the parent or parents of such minor specifically object, in writing, to the donation or penetration of the skin. Each hospital or other health care facility, health care provider, and any other person or entity who acts in good faith reliance on any such direction or decision shall be protected and released to the same extent as though such person had interacted directly with the patient as a fully competent person. The consent of no other person or persons, including but not limited to a spouse, parent, custodian, or guardian, shall be necessary in order to authorize the provision to such minor of such medical or surgical care or services as are described in this subsection. Such information may be given to or withheld from the spouse, parent, custodian, or guardian without the consent of the minor patient and even over the express refusal of the minor patient to the providing of such information. If the minor patient is not diagnosed as being pregnant or afflicted with venereal disease, such information as well as the application for diagnosis may be disclosed, at the discretion of the treating physician after consulting with the minor patient. A minor who consents to the provision of medical care and services under this section shall assume financial responsibility for the costs of such medical care and services. As used in this chapter, “primary medical care and services” does not include invasive care, such as surgery, that goes beyond standard injections, laceration care, or treatment of simple abscesses. A minor without support who consents to the provision of primary medical care and services under this chapter shall assume financial responsibility for the costs of the primary medical care and services. The plan may require that the request for confidential communication be made in writing and that it contain a statement that disclosure of all or part of the information to which the request pertains could endanger 45 the minor. The plan shall have fourteen days to make any changes necessary to comply with the request for confidentiality. The plan may accommodate requests by the minor or the licensed health care practitioner to receive communications related to the primary medical care and services by alternative means or at alternative locations. The court shall provide her with counsel unless she appears through private counsel. All records contained in court files of judicial proceedings arising under the provisions of this section shall be confidential and exempt from disclosure pursuant to section 9-340G, Idaho Code. Dockets and other court records shall be maintained and court proceedings undertaken so that the names and identities of the parties to actions brought pursuant to this section will not be disclosed to the public. If the court fails to issue its ruling at the conclusion of the hearing, the petition is deemed to have been granted and the consent requirement is waived. A minor shall file her notice of appeal within five (5) days, excluding weekends and holidays, after her petition was denied by the district court. The appellate court shall hold the hearing within forty- eight (48) hours, excluding weekends and holidays, after the notice of appeal is filed and shall issue its ruling at the conclusion of the hearing. If the appellate court fails to issue its ruling at the conclusion of the hearing, the petition is deemed to have been granted and the consent requirement is waived. Filing fees are not required of the pregnant minor at either the district court or the appellate level. The consent of the parent, parents, or legal guardian of such minor shall not be necessary to authorize hospital, medical and surgical care related to such disease and such parent, parents, or legal guardian shall not be liable for payment for any care rendered pursuant to this section.

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Notes: (1) % of (very) big chance: scores 4 and 5 on a 5-point scale from 1 ‘very small chance’ to 5 ‘very big chance’ buy 500 mg azulfidine with amex. Further analysis What are the factors affecting driving under the influence of an impairing substance? In order to investigate the association of self-declared impaired driving with the various predictors generic azulfidine 500mg on line, we developed four logistic regression models cheap azulfidine 500 mg without prescription. The outcome variable in these models is the dichotomized variable indicating the absence (never) or presence (at least once) of self-declared impaired driving. The following explanatory variables were considered: socio-demographic variables (gender, age group and level of education), driving frequency, acceptability of impaired driving, attitudes towards impaired driving, support for road safety measures, risk perception, reported police checks and perceived likelihood of being checked for impaired driving. In models 2 and 4 the variable ‘countries’ has also been taken into consideration. Factors affecting drink-driving Possible factors affecting (self-declared) drink-driving are presented in this section, in the first logistic regression model without the variable ‘countries’ (Table 3), and in the second logistic regression model with the variable ‘countries’ (Table 4). For the logistic regression models on drink-driving, we chose the less restrictive question, because of the similarity of the formulation of the question on drug-driving. Other advantages of the question on drink-driving we selected for the logistic regression is that it does not take into account the differences in national alcohol limits and encompasses a longer time period. In the analysis, we selected only car drivers who answered that they drive at least a few days a year and for whom the level of education was known. It is the only statistically significant result concerning the level of education. According to this model, the likelihood of (self- declared) drink-driving is lower among drivers with a lower level of education. In comparison with the persons who drive only a few days per year, the odds ratios are respectively 1. There is also a significant association between self-declared drink-driving and perception of risk. Drivers who think that an important part of the road traffic accidents are caused by alcohol are less likely to report that they drink-drive than drivers who think that this percentage is below 6%. Table 3: Logistic regression model for drink-driving in the past 12 months (Model 1). Compared to Austria (reference category in the logistic regression model of Table 4), the odds of self- declared drink-driving increase significantly by 77% in Belgium, 38% in Denmark and 29% in Portugal. Factors affecting drug-driving In this section, the first logistic regression model presents possible factors affecting (self-declared) drug-driving without the variable ‘countries’ (Table 5) and the second logistic regression model includes these same factors as well as the variable ‘countries’ (Table 6). No association can be pointed out either between level of education and drug-driving or between driving frequency and drug-driving. This means that drivers fully in agreement with these statements report less often that they drug-drive. Drivers who think that an important part of the road traffic accidents are caused by drugs report less often that they drug-drive than drivers who think that this percentage is below 6%. There are no countries where the likelihood of self-declared drug-driving is significantly lower than in Austria. Discussion Driving under the influence of alcohol and/or drugs constitutes an important cause of road casualties. During the last decades, several safety measures were implemented in the European countries in an attempt to reduce road traffic crashes due to impaired driving and especially driving under the influence of alcohol. There are nevertheless notable differences between the countries and little is known about the evolution of the prevalence of driving under the influence of illegal drugs or psychoactive medicines, and even less about the evolution of road traffic crashes due to these substances by country. The most impressive decrease of the self-reported drink-driving rate that had taken place between the two surveys was noted for Italy (decreasing from 33% in 2010 to 14% in 2015). According to several studies, socially-desirable responding is more likely to occur in interviewer-administered surveys than with online-surveys (Baker et al. A clear relationship can be observed between the self-reported drink-driving rate and the prevalence of alcohol in these nine countries (Figure 22). There is also a positive relationship between the self-reported drug-driving rate and the prevalence of drugs in the roadside survey (Figure 23). This relationship is however strongly influenced by the results in Spain where the self-reported drug-driving rate and the prevalence of illegal drugs are particularly high. At the other extreme, we find two countries where the self-declared drug-driving rate and the prevalence of illegal drugs are particularly low (Finland and Belgium). The fact that Belgium belongs to the countries with the highest rate of self-reported drink-driving and at the same time to the countries with the lowest rate of self-reported drug driving is confirmed by the results of the roadside surveys. No relationship can be observed between the rate of self-reported driving under the influence of medication that may influence the driving ability and the prevalence of medicinal drugs in the different countries according to the roadside surveys (Figure 24). Possible explanations are that on the one hand, many drivers seem to be unaware that they are driving under the influence of an impairing medication, and on the other hand, not all the relevant medicines were considered in the roadside surveys (i. It might for instance be that the persons who were checked for alcohol are more likely to be underway at a time when the police suspects drink-driving (selective alcohol checks) and that they were indeed driving under the influence of alcohol. Interestingly, an analysis on a national level suggested that countries where the likelihood of police checks for alcohol is higher have a lower prevalence of driving under influence of alcohol than countries where alcohol checks are less likely (Meesmann et al. This is surprising because alcohol consumption is more frequent in people of lower socio-economic status. Maybe, the explana- tion lies in the fact that the persons with a lower level of education are even more willing to give a socially desirable answer (‘I never drink when I drive’) than those with a higher level of education. It is the country with the highest percentage of respondents indicating that it is acceptable to start driving 1 hour after using drugs (other than medication), while it has one of the lowest acceptability rate for drink-driving. The relatively high acceptability rate of drug-driving in Finland is probably due to the translation of the English word ‘drug’ into the Finnish word ‘Lääke’ which means not only drugs but also psychoactive substances like benzodiazepines. Conclusions Driving under the influence of an impairing substance is considered a main cause of serious traffic accidents worldwide. Generally, drink-driving is perceived as more problematic than drug-driving in Europe. The harmful effects of alcohol have been studied for decades and are well documented, the effects of drugs, however, are more difficult to establish. In recent years, however, the number of road fatalities attributed to drink-driving has decreased more than the number of total road fatalities. This favourable development is undoubtedly due to changing public attitudes towards drink-driving and the adoption of legal measures and intensified enforcement. There are notable disparities in the behaviours and attitudes towards impaired driving between the different countries and between population groups. For instance:  While a large part of the population is aware of the inappropriateness of driving after having consumed an impairing substance, a small proportion of persons (about 3. Belgium belongs to the countries with the highest rate of self-reported drink-driving and at the same time to the countries with the lowest rate of self-reported drug-driving.

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An effect of 50% means that the average effect in the total population is 50% of the maximum (and not a 50% effect in one individual) (Figure 10) buy azulfidine online from canada. The concentration that gives the minimum useful effect is the therapeutic threshold cheapest generic azulfidine uk, while the plasma concentration at which the maximum tolerated side effects occur is called the therapeutic ceiling order azulfidine without prescription. Remember that Cp/response curves represent the dynamics in a group of patients, and can only offer a guideline when thinking in terms of an individual patient. The plasma concentration in one or more patients during a certain period is depicted in a so called plasma concentration/time curve (Cp/time curve). This implies that if the dose is doubled, the steady state plasma concentration is also doubled (Figure 12). The Cp/time curve with a therapeutic window Two horizontal lines can be placed over the Cp/time curve, indicating therapeutic threshold and ceiling. Drug treatment aims at plasma concentrations within Figure 13: Cp/time curve and therapeutic window this therapeutic window. The possible variables to be considered are therefore (1) the position and the width of the window, and (2) the profile of the curve. Therapeutic window The position and the width of the window are determined by pharmacodynamic factors (Figure 14). The position of the window may shift upwards in case of resistance by the patient or competitive Figure 14: Place and width of antagonism by another drug: a higher plasma therapeutic window concentration is needed to exert the same effect. The window can shift downwards in case of hypersensitization or synergism by another drug: a lower plasma concentration is needed. For example, the therapeutic window of theophylline is narrower in small children than in adults. Curve The profile of the curve is determined by four factors: Absorption, Distribution, Metabolism and Excretion. Although most treatments consist of more than one dose of a drug, some pharmacokinetic parameters can best be explained by looking at the effect of one dose only. This means that per unit of time the same percentage of drug is eliminated, for example 6% per hour. The half-life of a drug is the time it takes to decrease the plasma concentration to half of its initial value. With 6% per hour the half-life is about 11 hours (if no more of the drug is given in the meantime). If the original plasma concentration falls within the therapeutic window, a decline to 6. For this reason it is usually said that drugs no longer have a pharmacological effect 4 half-lives after the last dose. Drug treatment The total Cp/time curve is influenced by three actions by the prescriber: starting the drug-treatment; steady state treatment; stopping the treatment. Starting drug treatment The most important issue in starting treatment is Figure 16: Steady state is reached the speed at which the curve reaches steady after 4 half-lives state, within the therapeutic window. If you give a fixed dose per unit of time, this speed is only determined by the half-life of the drug. On a fixed dosage schedule, steady state is reached after about 4 half-lives (Figure 16). In case of a long half-life it may therefore take some time for the drug to reach a therapeutic concentration. Steady state drug treatment 102 Annex 1 In steady state drug treatment two aspects are Figure 17: Dose dependent important. First, the mean plasma concentration fluctuations in the is determined by the dose per day. The relation Cp/time curve between dose and plasma concentration is linear: at double dose the mean plasma concentration also doubles. Second, fluctuations in the curve are determined by the frequency of administration. With the same total dose per day, a higher frequency of administration gives fewer fluctuations in the curve (Figure 17). If you decide to raise the dose it will again take about 4 half-lives before you reach the new steady state. Stopping drug treatment Figure 18: Stopping drug treatment For drugs with first-order elimination kinetics the plasma concentration decreases by 50% each half-life period, if no more of the drug is taken (Figure 18). The effect of the drug stops when the concentration falls below the therapeutic threshold. For example, if the initial plasma concentration is 300 ug/ml, the therapeutic threshold 75 ug/ml and the half-life 8 hours, this will take 16 hours (2 half-lives). For example, 100 mg is eliminated per day, regardless of whether the total amount in the body is 600 mg or 20 grams. This also means that the Cp/time curve never levels off to a certain maximum: the plasma concentration can rise forever if more of the drug is administered than the body can eliminate. To maintain a steady state you will have to administer exactly the amount that the body eliminates. The dosage of drugs in this category requires great care because of the increased risk of accumulation. Special features of the curve In commonly used dosage schedules with identical doses taken at regular intervals, the required steady state is reached after 4 half-lives, and plasma concentration drops to zero when the treatment is stopped. In Figure 19: Loading dose steady state the total amount of drug in the body remains constant. If you want to reach this state quickly you can administer at once the total amount of drug which is present in the body in steady state (Figure 19). Theoretically you will need the mean plasma concentration, multiplied by the distribution volume. In the majority of cases these figures can be found in pharmacology books, or may be obtained from the pharmacist or the manufacturer. The first reason is when a drug has a narrow therapeutic window or a large variation in location of the therapeutic window in individuals. This means that you should not raise the dose before this time has elapsed and you have verified that no unwanted effects have occurred. Table 7 in Chapter 8 lists drugs in which slowly raising the dose is usually recommended. Tapering the dose Sometimes the human body gets used to the presence of a certain drug and physiological systems are adjusted to its presence. To prevent rebound symptoms the treatment cannot be abruptly stopped but must be tailed off to enable the body to readjust. To do this the dose should be lowered in small steps each time a new steady state is reached. Table 8 in Chapter 11 lists the most important drugs for which the dosage should be decreased slowly. These are essential tools in your prescribing, as they indicate which drugs are recommended and available in the health system. In many cases they are used by countries when developing their national treatment guidelines. London: British Medical Association & The Pharmaceutical Society of Great Britain.

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