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By M. Gambal. University of Oregon. 2018.

The total area under cultivation in 2010 is based on 2009 figures for Bolivia and will be revised when class is also responsible for an increasing share of treat- the 2010 figure becomes available cheap imitrex 25mg overnight delivery. Increases were registered in crime groups in the main countries of consumption reap Myanmar in 2010 purchase 25mg imitrex mastercard, however order 25 mg imitrex otc, which resulted in an the largest profits. The opium yield is also increasing in Myanmar, causing the country’s potential Cocaine opium production to increase by some 75%. In 2009, the annual prevalence of cocaine use was esti- Nonetheless, global opium production dropped to mated between 0. Though the lower and upper bounds of stan’s opium production as a result of disease in opium cocaine users in 2009 have widened somewhat, con- poppy plants. Taking qualitative in 2011 predict a further small decline or at least a sta- information into account, the actual number of cocaine bilization of overall opium poppy cultivation at the users is probably closer to the lower end of the range. If opium yield returns to the average level, opium production is likely to increase in Afghanistan in Despite significant declines in recent years, the largest 2011. An largest cocaine market is that of Europe, notably West estimated 460-480 mt of heroin were trafficked (includ- and Central Europe, where consumption is estimated at ing seizures) worldwide in 2009, of which 375 mt 123 mt. In recent years, there transportation and seaports has been identified as a key are some signs of stabilization, though at the higher emerging threat. In West and Central Europe, users pay 2006-2009, amounting to some 732 mt in 2009. The role as they require more specialized equipment, precursor of West Africa in cocaine trafficking from South America chemicals and greater skill levels. The increase was have changed their tactics, and the area remains vulner- mainly driven by methamphetamine seizures, which able to a resurgence in trafficking of cocaine. Amphetamine tries in the Asia-Pacific, with potentially large consumer seizures rose by some 10% to 33 mt. Ecstasy seizures markets, registered increasing cocaine seizures in 2008 decreased somewhat from the already low 2008 level, and 2009. Since then, several people aged 15-64 who had used such substances at least additional facilities have been uncovered. India is one of the world’s largest manufac- of people entering treatment, 2009 turers of precursor chemicals and Bangladesh also has a *Total is greater than 100% due to polydrug use. Over the past 10 years, experts from an increas- ing number of countries have been reporting stable can- away from West and Central Europe – where seizures are nabis use trends. Despite this, cannabis use accounts for at their lowest level for the last 10 years - to the promi- the bulk of treatment demand in Africa and Oceania. Recent studies have shown that intensive (long-term regular use, high doses) exposure to cannabis products with high potency levels may increase the risk of psy- chotic disorders. Cannabis herb cultivation is widely dispersed as it is mostly produced for domestic or regional markets. Cannabis resin production is more localized and the drug is trafficked over larger distances. The countries most often identified as sources by the cannabis resin consumer markets are Morocco, Afghanistan, Lebanon and Nepal/India. Moreover, cannabis has become a competitor to opium poppy as a lucrative crop for farmers in the coun- try. The preliminary second survey in 2010 gave no indications of major changes in the levels of cultivation and production compared to 2009. Cannabis herb seizures increased somewhat – returning to the levels of 2006-2007 following a drop in 2008 - and amounted to some 6,000 mt. North America accounts for the bulk of herb seizures, and seizures in the United States and Mexico increased in 2009. Cannabis resin seizures, on the other hand, decreased from their peak level in 2008. Cannabis herb seizures dimensions – production, trafficking and consumption, suggest a stable level of cannabis herb production glo- including prevalence, drug-related treatment, drug- bally. This is fol- Cannabis resin production is geographically more lim- lowed by a regional overview. Based on information on the origin of cannabis on specific drug markets (opiates, cocaine, cannabis and resin, supplied by Member States, this seems to take amphetamine-type stimulants) can be found in subse- place primarily in Morocco – mainly producing for the quent chapters. Moroccan authorities report that cannabis resin produc- a) Production tion has declined in recent years. The second largest ally stable level in 2010, compared to a year earlier illicit drug production is related to cocaine, followed by (which was 1,500-3,500 mt in 2009). Amphetamine-type stimulants production seems to be at comparable levels with heroin. Information on production is more readily available Cannabis – the most widely produced illicit drug when it comes to heroin and cocaine. These surveys showed clear declines over the cannabis, in contrast, is concentrated in developed 2007-2009 period (-21% for opium and -13% for coca).

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If resulting increases in story grammar elements within student compositions include the generation of oral and written narratives the child is assigned to produce but fail to extend to personal nar- ratives buy imitrex 50mg on line, the clinician may switch focus toward intermediate goals consistent with this basic goal imitrex 25 mg lowest price, such as spontaneous production of key components of personal narratives buy 50 mg imitrex with visa. For example, specific goals for the preschooler in our ongoing example might focus on increased use of specific nouns to make requests to get things during a given routine, such as mealtime (e. At least in the early stages, specific goals might include mostly nouns, but a focus on verbs and social words would be necessary if the child did not begin to use some of these forms spontaneously. The goals for the school-age child might similarly focus on increased inclusion or elaboration of setting, characters, and problem/initiating event in written narratives. Because of the interaction of related goals, specific goals imply more general goals, even when general goals are unstated (Fey & Cleave, 1990); that is, specific goals are never ultimate goals themselves. They are, rather, important steps along a path to their broader and more functional objectives (i. Selection of specific goals implies the clinician’s assumption that the child will progress more rapidly on intermediate and basic goals if the intervention provides some type of focus on the specific targets. The clinician consequently must develop activities that will provide high concentrations of models and/or opportunities for use of the specific behavior or skill being targeted as a goal. A rare but clear exception is the focus on parental responsiveness to child communication in responsivity education (Chapter 3). In this part of responsivity education/prelinguistic milieu teaching, parents are taught to respond positively to most child communication attempts. There is no effort to focus on any specific child communication acts—that is, because there are no specific goals for this parent component, parents place no special emphasis on the child’s acquisition and use of any particular language form or communication act. In some intervention approaches, specific goals also imply multiple levels of subgoals, a carefully constructed set of measurable steps by which specific goals are achieved. Subgoals often incorporate operational measures of achievement that Excerpted from Treatment of Language Disorders in Children, Second Edition by Rebecca J. In fact, subgoals are usually developed after choices are made about other components of the intervention, such as goal attack strategies and particular procedures (Fey et al. Thus, an early subgoal for our preschool child with limited verbal communication might be three to five uses of verbal or nonverbal requests during a snack activity with a verbal prompt, or even an imi- tative stimulus. As the child begins more consistent use of this type of word pro- duction with prompts, the prompts would be faded until the same words are used spontaneously to request common objects. At this point, the specific goal would have been reached, and other subgoals, requiring progressively more independence from the child, may be developed where necessary. A specific subgoal for an older child with limited skills at constructing adequate written narrative might be in- creased inclusion of characters at the beginning of all child-generated stories with graphic reminders of story elements provided. As the child becomes more profi- cient at including information about the characters, the visual icons representing story components would be faded until the child consistently included a character description in self-generated stories without cuing, thereby meeting the specific goal. These types of objectives are especially characteristic of interventions that are based to some degree on operant conditioning and were the hallmark of operant approaches from the 1960s and 1970s (e. Goal Attack Strategies Consider a case in which a clinician identifies three semantic relations—agent + action, action + object, and attribute + object—as goals for a preschooler limited to single-word productions. A key question in this case is “How do I help the child to reach all three of these goals most efficiently, given that each is developmentally appropriate and that development of these three relations could lead to spontaneous facilitation of other multiword constructions? Fey (1986, 1990, 1992) identified three general strategies that provide options in the answer to this question, although there are many possible variations of each, and we know very little about how they affect treatment outcomes. Vertical strategies involve a progression from one goal to another, and advance- ment to the next goal is based on the child’s attainment of a predetermined level of performance on an outcome variable. In our example, the clinician would prioritize the three goals and attack them one at a time, waiting for some criterion on the first goal before attacking the second goal, and so forth. Horizontal strategies involve simultaneous attention to multiple specific goals within a single session. Within this strategy, all three semantic relations would receive focus in each intervention session. This strategy may increase the time it takes for a child to reach criterion for a single target, but it may shorten the time it takes for the child to learn all three relations, and it may hasten the child’s development of other multiword relations and combinations of relations. Cyclical strategies involve clinical focus on one goal for a period of time, followed by movement to another goal whether or not the child makes progress on the first goal. In our example, agent + action might be the focus of the Week 1 ses- sions, followed by attribute + object during Week 2 and action + object during Week 3. Excerpted from Treatment of Language Disorders in Children, Second Edition by Rebecca J. This strat- egy is based on the assumption that the child will continue learning, even when a goal is no longer serving as a focus of treatment (Hodson & Paden, 1991). Thus, over time, the child would be expected to acquire more language forms with the cyclical approach than the more traditional vertical approach. Procedures and Activities Procedures consist of all of the acts performed by the intervention agent that are ex- pected to lead the child directly to the intervention goals. They make up what may be hypothesized to be the “active ingredients” of the intervention and include a variety of acts, such as modeling the child’s target, giving the child structured practice with the target, reinforcement of the child’s use of target behaviors, systematic responses to child utterances or actions, and even explicit description of the target (Fey, 1990). Activities create the social and physical conditions within which the intervention agent may apply the procedures.

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Moreover purchase 25mg imitrex visa, for goods that were sold in both periods cheap 25 mg imitrex otc, the Laspeyres fixes the relative importance of these goods at the base period levels and therefore does not reflect any changes in the composition of goods sold over time imitrex 25 mg with amex. A Fisher Ideal index provides relative importances that are more closely aligned with the composition of goods sold over time. It is normally written as: F 1/2 I 0,1 = { [Σi Pi,1 Qi,0/ Σi Pi,0 Qi,0 ] [Σi Pi,1 Qi,1/Σi Pi,0 Qi,1 ] } (3) It is an average (a geometric average) of the Laspeyres index—the first term—and the 3 Paasche index—the second term. The Paasche index is similar to the Laspeyres except that it uses a different market basket to measure price change—it compares the actual cost of buying the bundle in period 1 (Σi Pi,1 Qi,1) to what it would have cost to buy that bundle at period 0 prices (Σi Pi,0 Qi,0). The Fisher index may also be written as a ratio of weighted averages: F 1/2 I 0,1 = { Σi wi,0 Pi,1 / Pi,0 ] / [Σi wi,0 Pi,0 / Pi,1] } (4) with the Laspeyres in the numerator and the inverse of a Paasche in the denominator. Here it is easy to see that, unlike the Laspeyres, the Fisher uses expenditure shares from both periods. So, as market shares change over time, the Fisher places a higher weight on goods that are gaining market share whereas the Laspeyres does not. Just like the Laspeyres, however, this index ignores the entry of new goods and the exit of older goods. In a dynamic industry such as pharmaceuticals, the omission of new and exiting drugs can have important empirical implications. For drugs, the evidence is that pricing for new drugs can be very different from that of older, more established drugs, indicating that an index that includes new drugs will likely show different price growth than one that does not (Berndt 2002). One way to better incorporate any price change for new drugs is to construct indexes over shorter spans of time and to cumulate, or chain, the resulting price indexes. One could construct two Fisher price indexes, one for price change from F F 2003 to 2004 (I 2003,2004 ) and another for price change from 2004 to 2005 (I 2004,2005). While the only new drugs included in (4) are those introduced in 2003, the chained F index includes drugs introduced in 2004 in the I 2004,2005 index. Chained indexes thus provide a way of folding in new goods more quickly and so the index more closely tracks prices for the goods actually sold in the market. However, as discussed earlier, it is widely understood that the applicability of this theory in the health care setting is tenuous at best. Fortunately, there are other criteria that one can use to compare the relative merits of these formulas. In his “axiomatic approach,” Diewert (1992) considers about 20 properties that one would like to see in a price index. For example, one property is a time-reversal test which requires that if the prices and quantities in the two periods being compared are interchanged the resulting price index is the reciprocal of the original price index. Diewert showed that the Fisher index formula met this and other criteria better than other available formulas. Empirical results An important contribution of the empirical literature was to demonstrate that the choice of formula and chaining method matters. The Fisher formula takes into account any changes in the relative importance of drugs over time, whereas the Laspeyres formula does not. For example, in their study of drugs sold by four companies making up about 25% of the market, Berndt, 10 Griliches and Rosett (1993) found that price growth in chained indexes was slower than that in fixed-based indexes. But, in their study of antidepressant drugs, Berndt, Cockburn and Griliches (1996) found the opposite—chained Laspeyres tended to show faster price growth than the unchained counterparts. Which way it goes depends on how fast prices for new goods grow relative to established goods, and how the composition of drugs in the market is changing over time. This says that folding in new goods into the index more quickly yields indexes that grow slower and suggests that, in our sample, prices of new drugs grow slower than those of older drugs. First, the chained price indexes show faster (not slower) price growth than the unchained ones. This reflects the fact that prices for new molecules grow faster than those of older molecules that include generics: as molecules lose patent protection, the diffusion of the less expensive generics pushes down the price of the molecule. Hence, folding in new molecules faster—as the chained indexes do—yields an index that includes molecules with faster price growth and so the chained index grows faster. The unchained Laspeyres—the dotted line in chart 2—grows until mid- 2004 and then exhibits a declining trend through the last quarter in our data. This contour is driven entirely by the influx of generics into the market over this period. The pattern we see in the price index is mirrored in the number of generic prescriptions as a share of total: the rise in prices in the earlier period is associated with a decline in the generic share and the subsequent decline in the price index coincides with sustained increases in 11 the generic share. The patterns in the Fisher and Laspeyres indexes are similar because both indexes include the same molecules (both exclude entry and exit). But, the Fisher shows slightly faster price growth because molecules with the fastest price growth also gain market share over time and thus have a bigger weight in the Fisher index than in the Laspeyres.