Author: Admin

Posted on by

Stop Loss Algorithms By Fap Turbo Forex Trading Software

This is simply because changes inside a certain country can impact how much 1 currency is worth in one more country. All Forex trades entails the continuous getting and selling of currencies but the currency pair which will be the two currencies involved is generally thought of as a single unit. Should you acquire a currency pair, you purchase the base currency and sell what is known as the quote currency. What this indicates is the bid which is termed the purchasing price is representative of just how much of the quoted currency is required to ensure that you are able to get 1 unit of the base currency and vice versa. A Martingale system entails doubling the bet soon after each and every loss, which may be initially successful but can provide for extreme loses in the end.In real terms, it works like this: if you are trading within the currency pair EUR/USD, and also the currency pair is quoted at becoming EUR/USD = 0.667 in which the quantity is solely dependent upon the market value at the time and you get the pair, that means that US$0.667 would buy 1 euro.Now, FAP Turbos algorithm utilizes fixed quit loss values so that the losses are limited and little. In impact, the algorithm uses different sale filters, as well as indicators, to help prevent the pitfalls related to risky trading conditions. Their fundamental strategies are brief and long-term in nature. They utilize a effective mixture of the two techniques a Long-Term Advanced Method along with a Short-Term Scalping Strategy for a blanketing effect of the marketplace. Both of these methods are built into FAP Turbos algorithm and could be utilized simultaneously depending on which currency pair you’re trading under. Depending on the pair, you’ll be able to utilize FTs customizable features to switch either of these techniques on or off employing the Use Scalper Technique parameter inside the settings. Every of these methods uses their own designated time frame. There are limitations, although. Inside the software program, their Long-Term technique only works on EUR/USD along with the Short-Term strategy works best on four other currency pairs: EUR/GBP (euro/British Pound), GBP/CHF (Pound Sterling/Swiss Franc), EUR/CHF (euro/Swiss Franc) and USD/CAD (US dollar/Canadian dollar). In addition, FAP Turbos system, based on its site, does not rely on what’s termed a Martingale betting program. FAP Turbos software for Forex trading relies on the buying and selling of currency between 1 country and another. Its algorithm relies available on the market volatility between the respective two countries and uses fixed quit loss values to ensure that you wont lose an excessive amount of income at any one specific time.

Posted on by

Methadone, Buprenorphine, And Naltrexone To Treat Illicit Drug Addiction

Introduction

Addiction to illicit drugs, alcohol, or other substances is a major problem that affects many millions of individuals in the US alone. Drug users are more likely to get, and transmit sexually transmitted infections, and blood borne infections. For instance, 61% of youth between the ages of 15 and 24 have reported using a drug at some point during their life; cannabis was found to be the most commonly used drug (>80%) (1). Drugs can fall into four distinct categories: stimulants, depressants, hallucinogenics, and opioids. The following are the most frequently used illicit drugs: benzodiazepine, opioid, amphetamine, cocaine, ecstasy, and misused volatile substances (4). Drug abuse is typically accompanied by abuse of other drugs, mental illnesses, and anxiety disorders (19). Drugs typically affect the brain most of which lead to the activation of the dopamine system. When a neurotoxin that can deplete dopamine called 6-hydroxydopamine was administered to rats, the rats did not self-administer amphetamine or cocaine (2). Cocaine, amphetamine, and methylphenidate are dopamine reuptake blockers (2). For instance, cocaine has been known to increase release of dopamine, norepinephrine, and serotonin; excessive dopamine results in anger, aggressiveness, hallucinations, and delusions, amongst other symptoms of psychosis (3). Cocaine intake, for instance, results in paranoia in 68% to 84% of individuals, as well as suspiciousness; in particular, 29% to 53% of cocaine users develop hallucinations, and delusions (3). Misuse of illicit drugs can result in acute intoxication, harmful use (ex: hepatitis or depression), dependence syndrome, withdrawal, and psychotic disorders (4). The most serious of these is drug induced psychosis. Drug induced psychosis is psychosis induced by psychotomimetic drugs such as cocaine, LSD, marijuana, methamphetamine, or PCP. Psychosis is a state of mind wherein the individual in question incorrectly perceives reality (5). Typically, auditory hallucinations, delusions, withdrawal, and mental confusion are present. A psychotic episode implies the presence of psychotic symptoms which can subsist for years. Legally, individuals diagnosed with psychosis are not “insane” (5). Alternatively, illicit drugs can result in death. In 2010, approximately 40 393 individuals died from drug-related issues; every 13 minutes, an individual dies in the US due to illicit drugs (6). The goal of this paper is to review the treatment options for illicit drug addiction.

Methadone

Methadone, a full µ-opiate-receptor agonist, acts as an antagonist of receptors that are typically bound by opioids, and is utilized for opioid dependence and the treatment of chronic pain (10, Figure 1). Methadone is not recommended for patients whose drug habits are not severe (< 0.25g heroin/day) (4), and adverse side effects such as respiratory depression with other drugs have been noted (8). Methadone is also accompanied by the following side effects: sweats, constipation, and sexual dysfunction. The average dose of methadone is between 21 and 68 mg (7), and its half-life is approximately one day (but can be as high as 120 hours) (10). In one particular study, patients were administered either 0mg (beginning at 25mg of methadone, and dropping incrementally to 0mg by week 6), 20 mg (beginning at 25 mg and dropping to 20mg at week 5), or 50 mg (beginning at 25mg, and increasing incrementally until at week 6 the dose is 50mg) of methadone. It was shown that patients on the 50 mg treatment had fewer opioid-positive urine by week 4; methadone was not found to affect cocaine positive patients on the three treatments (7). The number of positive urine samples on methadone doses greater than 50 mg is between 21% and 62%; retention on methadone doses greater than 50 mg is between 31% and 90% (25). The authors imply that larger methadone doses should be administered when one wishes to abstain from drug use, and lower doses to control withdrawal (7). In yet another study conducted in 1979, heroin addicts who were administered 60mg of methadone per day showed a drop in use after a 4 month period; further, criminal conviction rates were double in the no-methadone control versus the methadone treatment group (9). However, it should be noted that methadone can result in mortality in some patients. In Australia, mortality due to methadone – approximately 238 individuals from 1990-1995 – was attributed to the fact that proper clinical assessments and review of patients was ignored; mortality in these cases were due to drug-related (44%), medical illness (24%; of which 53% was due to HIV/AIDS), trauma (17%; of which 28% were vehicular accidents, 15% stab wounds, and 13% beatings), suicide (8.8%), drug and medical (2.1%), drug and trauma (1.7%), and unavailable (2.5%) (11). In 93% of the cases, psychoactive drugs – such as benzodiazepine (55%), morphine (34%), other opioids (20%), alcohol (16%), cannabis (16%), and antidepressants (13%) – were detected during autopsy (11). In another study over a 12 year period, approximately 8% of the patients died, however the mean dose was less than the suggested 60-120 mg; in this case, it was reported that approximately 36% died due to drug dependence/related, 7% due to endocarditis/cardiovascular, 8% due to HIV related, 12% due to cancer, 3% due to pneumonia and related, 8% due to accidents, traumas, and self-harm, 5% due to liver disease/hepatitis C, and 20% due to other causes (12). It has been noted that those with psychiatric illness face a higher chance of mortality (12). Yet in another 7 year study, approximately 1.85% (515/28554) of patients on methadone died (13); Buster et al. (14) showed that out of 5200, 42 died on methadone during treatment, and 26 died after treatment. It is suggested that all patients on methadone be tested 3 to 5 days following initial dose to ensure that clinical signs of respiratory depression or arrhythmia are not present (10). An ECG prior to use of methadone is recommended; initial doses should be low, and titration of dose should be slow (10). In particular, for opioid addiction, initial doses should be between 30 – 40 mg/day; increases should be by no more than 10mg/day (10). Further methadone should not be administered if sedation is observed; administration of other drugs can augment symptoms.

Buprenorphine

Buprenorphine, a partial µ-opiate-receptor agonist and ?-receptor antagonist (17), is typically utilized to treat opioid addiction/dependence, and chronic pain (21, Figure 1). In conjunction with naloxone, it is a full µ-opiate-receptor antagonist (17); buprenorphine binds tightly to receptors and as such has a slow dissociation rate (21, 25, 26). Relatively speaking, buprenorphine is used by 65 000 individuals while methadone is used by 6000 to 7000 individuals in France (26). Further, buprenorphine is preferentially administered to individuals with favorable prognoses (26). Buprenorphine is typically available in 2 or 8 mg dose buprenorphine hydrochloride or as a combination of buprenorphine (2 or 8 mg) and naloxone (0.5 or 2 mg); usually, the ratio of buprenorphine to naloxone is 4:1 (21). The initial dose is between 2 to 4 mg administered 12 hours post-abstinence from short-acting opioids; titration is by 2 to 4 mg every 2 hours up to 8-16 mg (days 1, and 2), 12-24 mg (day 3) (21, 26). Doses should not exceed 24 mg per day (26). It is recommended that patients refrain from short-acting opioids for a period of 12 hours, and show signs of opioid withdrawal prior to administration of buprenorphine (21). Relative to a placebo treatment, it has been shown that buprenorphine has been shown to be effective in treating drug use. In a study comparing buprenorphine (max dose of 22.1 mg) to methadone (max dose of 93.1 mg), it was found that fewer individuals on buprenorphine (46.1% with an average of 103.8 days in treatment) completed the treatment as opposed to methadone (74.1% with an average of 141.3 days) after a 24 week period (22). Further, a 60mg dose or above of methadone resulted in 80% retention, and doses of 120 mg or higher resulted in a 91% of the patients completing the treatment; retention on buprenorphine improved with dosage and with a dose of 30-32 mg buprenorphine, the completion rate was about 60% (22). The number of positive urine samples (for illicit drugs after administration) on 8 mg buprenorphine is between 32% and 90%, on 12 mg is 58%, and on 8-16 mg of buprenorphine is 62%; retention on buprenorphine doses greater than 8 mg is between 20% and 68% (25). Given the poor gastrointestinal absorption rates of buprenorphine, it is typically used in conjunction with naloxone, and is significantly less dangerous in the case of an overdose; sublingual bioavailability can result in higher absorption. Short term side effects include headaches, drowsiness, nausea, constipation, sleep problems, depression, anxiety, weight gain, sweating, rash, itching, abdominal pain, lassitude, menstrual effects, and decreased libido (21, 27). Not much is known about the long-term side effects of buprenorphine. When combined with alcohol, opioids, or CNS depressants, respiratory depression might ensue; in combination with intravenous benzodiazepines, death might ensue (21, 23). In one study, 182 individuals out of a total of 391 individuals (47%) died when on buprenorphine (average buprenorphine in blood = 1.4 ug/l); of these, benzodiazepine – Diazepam-group drugs (63%), alprazolam (28%), temazepam (23%), and oxazepam (14%) – was found in approximately 82% of these cases (23). Most individuals who died of buprenorphine poisoning had a buprenorphine concentration between 0 and 2 ul/l (23). However, side effects such as respiratory depression are difficult to remedy; intravenous buprenorphine has resulted in fatal buprenorphine-induced respiratory depression (19). It is recommended that liver function be audited during treatment, and intravenous use is not recommended. Buprenorphine, with a half-life of 37.5 hours, is deemed safer than other antidotes (ex: methadone), does not require constant monitoring, and is very effective (20); there has been concern about non-compliance (18). Buprenorphine, unlike methadone, is available everywhere, however it does not carry the name or fame of methadone, and can be abused/misused. Further, due to stigmatization, and mortality associated with methadone, a patient must utilize methadone for 2 years before being allowed to use of a one month supply at home; buprenorphine does not have such strict regulation (19). However, buprenorphine is deemed expensive ($250-$450 per month) (19, 20). Buprenorphine is not as effective as methadone for severe addicts; addicts on high doses of methadone have a longer abstinence period, higher number of drug-free urine samples, and tend to adhere to treatment regimens longer than do patients on buprenorphine (19). Methadone has also been shown to be preferable to buprenorphine in dual addiction – the treatment of opioid and cocaine dependence for example – in particular when combined with dopaminergic drugs (19). Retention is also lower on buprenorphine. One study compared retention rates of patients on 20 mg and 65 mg methadone and 4 mg and 12 mg buprenorphine. On all four treatments, the rate of opioid use was found to decrease; abstinence from drug use was higher on high-dose (65mg methadone or 12mg buprenorphine) treatments (24). After 24 weeks in the treatment program, individuals on the 65 mg methadone had the highest retention rates (approximately 64.3%), and those on the 4 mg buprenorphine had the lowest retention rates (approximately 34.5%) (24). Further, at least 3 consecutive weeks of abstinence was documented as follows: 65 mg methadone (50%), 20 mg methadone (40%), 12 mg buprenorphine (34.5%), and 4 mg buprenorphine (20.7%) (24). It can be said that higher doses are more effective than smaller doses. However, buprenorphine has a ceiling effect – the latter means that above a given dosage, there is no treatment effect (which is the reason why individuals on the treatment have a lower risk of respiratory depression) (27).

Naltrexone

Naltrexone, a µ and ? opioid receptor antagonist (competitive antagonism) (35), is typically utilized for opioid and alcohol addiction (28, Figure 1). Naltrexone (half-life of 4 hours) is efficiently absorbed by the gastrointestinal tract, and exclusively metabolized in the liver to 6-?-naltrexol (with a half-life of 13 hours) (30). The main problem in using anti-addiction drugs such as methadone or buprenorphine is that it replaces addiction drugs (such as heroin); in other words, an addict might then seek out the anti-addiction drug to abuse (37). Unlike other anti-addiction drugs, naltrexone does not cause dependence on itself (anti-addiction drug) (35). Naltrexone inhibits the euphoric and analgesic effects of drugs such as heroin – as well as that of alcohol, and amphetamine (36) – such that if and when addicts discontinue naltrexone, and subsequently use heroin, the effects of said heroin are intensified which also increases the risk of an overdose (29). However, naltrexone is clinically less effective than methadone. Moreover, methadone must be discontinued approximately 10 to 14 days prior to administration of naltrexone (31). Naltrexone is capable of addressing cravings accompanied by drug use with notable effects 3 to 5 weeks after induction (35). The effects of naltrexone can last between 48 and 72 hours, and does not lead to physical dependence (31). Naltrexone can cause hepatotoxicity in large doses; it is contraindicated for individuals with hepatitis or liver failure (30). Side effects of naltrexone include the following: headaches, sleep disturbance, anxiety, dizziness, nausea, diarrhea, and rashes (28). Administration of 50 mg, 100 mg and 150 mg of naltrexone can suppress 25 mg of heroin for a period of 24, 48 and 72 hours respectively (31, 35). However, naltrexone is also not accompanied by reinforcing effects and as such retention is low (32, 33). In one study on naltrexone, the number of individuals who remained in the treatment for 14-52 weeks was 10/73; in the naltrexone treatment group, it was noted that 1% of the patients were likely to abide by the treatment (34). Naltrexone is best suited for self-motivated individuals; further, it is quite facile to begin and end treatment with naltrexone (35). The problem with naltrexone is as such compliance. As such, sustained release formulations (SRX) – injectable intramuscular suspension and surgically implantable pellets – were developed (36). Polylactide suspensions (380 mg polylactide + naltrexone) are injections administered approximately every 4 weeks or every month (40); surgically implanted capsules are implanted subcutaneously (30 pellets results can last 7 months) with accompanying minor side effects such as pain, itching and redness due to implantation procedure (36). Retention on surgical implants (prodetoxon) was found to be 52% in the treatment group (naltrexone) at week 10 and 28% in the placebo group; treatment effect-wise, the naltrexone group showed a 56% significant improvement with no side effects while the placebo group showed a 14% significant improvement (37). In other words, surgical implants increases retention on naltrexone, and decreases use of illicit drugs. In another experiment with 380 mg of injectable naltrexone XR-NTX, 45% of patients were completely abstinent on XR-NTX while 28% were completely abstinent in the placebo group; the experiment lasted for approximately 24 weeks, and individuals in the XR-NTX group were abstinent 90% of the time while those in the placebo group were abstinent 35% of the time (38). Further, in the XR-NTX group, 50% of individuals has at least one adverse event (32% in the placebo group), and 26% had at least one drug-related adverse event (10% in the placebo group) (38). Naltrexone, in particular, significantly decreases craving (38). Another study compared NR-NTX administered to patients in non-injectable, and injectable modes, and found that the length of stay was much higher in the injected group (23.6 days) compared to the not-injected group (16.4) (39). Naltrexone can also be used in conjunction with other anti-addiction drugs such as buprenorphine (40).

Conclusion

Addiction to illicit drugs is a serious problem that affects both the health and life of the addict. Thus far, only a handful of drugs that can control addiction have been brought to the market, and amongst these are methadone, buprenorphine, and naltrexone. Methadone is very effective, but also not easily acquired; buprenorphine is fairly effective, but quite easily procured, and can be used “at home”. However, both methadone, and buprenorphine are rather addictive (the patient can become addicted to the anti-addiction drug), in such cases, naltrexone may be utilized as it does not cause dependence (though also less effective). Further, a combination of drugs can also be used to treat addiction.

References

1.

Public Health Agency of Canada. Canadian Street Youth: Findings from Enhanced Surveillance [Internet]. 1st ed. 2007 [cited 6 August 2015]. Available from: http://www.publichealth.gc.ca/sti

2.

Robbins T, Everitt B. Drug addiction: bad habits add up. Nature. 1999;398:567-570.

3.

Morton WA. Cocaine and Psychiatric Symptoms. Prim Care Companion J Clin Psychiatry. 1999;1(4):109–13.

4.

Gerada C, Ashworth M. ABC of mental health: Addiction and dependence—I: Illicit drugs. 315. 1997;BMJ:297-300.

5.

George Washington University Michael T Compton Department of Psychiatry and Behavioral Sciences, Sciences GWUBBDoPaB. The First Episode of Psychosis: A Guide for Patients and Their Families: A Guide for Patients and Their Families: Oxford University Press; 2009.

6.

Consequences of Illicit Drug Use in America2014. Available from: www.wh.gov/drugpolicyreform.

7.

Strain E, Stitzer M, Liebson I, Bigelow G. Methadone dose and treatment outcome. Drug and Alcohol Dependence. 1993;33(2):105-117.

8.

Herrlin K, Segerdahl M, Gustafsson L, Kalso E. Methadone, ciprofloxacin, and adverse drug reactions. The Lancet. 2000;356(9247):2069-2070.

9.

Newman R, Whitehill W. Double-blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong. The Lancet. 1979;314(8141):485-488.

10.

Chou R, Cruciani R, Fiellin D, Compton P, Farrar J, Haigney M et al. Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Dependence, in Collaboration With the Heart Rhythm Society. The Journal of Pain. 2014;15(4):321-337.

11.

Zador D, Sunjic S. Deaths in methadone maintenance treatment in New South Wales, Australia 1990-1995. Addiction. 2000;95(1):77-84.

12.

McCowan C, Kidd B, Fahey T. Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. BMJ. 2009;338(jun16 4):b2225-b2225.

13.

Krebs E, Becker W, Zerzan J, Bair M, McCoy K, Hui S. Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. Pain. 2011;152(8):1789-1795.

14.

Buster M, Brussel G, Brink W. An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam. Addiction. 2002;97(8):993-1001.

15.

DrugBank. Methadone [Internet]. [cited 28 September 2015]. Available from: http://www.drugbank.ca/drugs/DB00333

16.

DrugBank. Buprenorphine [Internet]. [cited 28 September 2015]. Available from: http://www.drugbank.ca/drugs/DB00921

17.

Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim J et al. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy. 2015;10(1).

18.

Ling W, Mooney L, Hillhouse M. Prescription opioid abuse, pain and addiction: Clinical issues and implications. Drug and Alcohol Review. 2011;30(3):300-305.

19.

Bonhomme J, Shim R, Gooden R, Tyus D, Rust G. Opioid Addiction and Abuse in Primary Care Practice: A Comparison of Methadone and Buprenorphine as Treatment Options. J Natl Med Assoc. 2012;104(0):342–350.

20.

Quest, BS T, Merrill, MD J, Roll, PhD J, Saxon, MD A, Rosenblatt, MD, MPH R. Buprenorphine therapy for opioid addiction in rural Washington: The experience of the early adopters. Journal of Opioid Management. 2012;8(1):29-38.

21.

Ling W, Mooney L, Torrington M. Buprenorphine for opioid addiction. Pain Manag. 2012;2(4):345–350.

22.

Hser Y, Saxon A, Huang D, Hasson A, Thomas C, Hillhouse M et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2013;109(1):79-87.

23.

Häkkinen M, Launiainen T, Vuori E, Ojanperä I. Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. European Journal of Clinical Pharmacology. 2011;68(3):301-309.

24.

Schottenfeld R, Pakes J, Oliveto A. Buprenorphine vs Methadone Maintenance Treatment for Concurrent Opioid Dependence and Cocaine Abuse. Arch Gen Psychiatry. 1997;54(8):713.

25.

Simoens S, Matheson C, Bond C, Inkster K, Ludbrook A. Pharmaco-economics of community maintenance for opiate dependence: A review of evidence and methodology. Drug and Alcohol Dependence. 2006;84(1):28-39.

26.

Kahan M, Srivastava A, Ordean A, Cirone S. Buprenorphine New treatment of opioid addiction in primary care. Canadian Family Physician. 2011;57:281-289.

27.

Saxon A, Hser Y, Woody G, Ling W. Medication-assisted treatment for opioid addiction: Methadone and buprenorphine. Journal of Food and Drug Analysis. 2013;21(4):S69-S72.

28.

U.S. National Library of Medicine. Naltrexone [Internet]. 2015 [cited 12 October 2015]. Available from: http://livertox.nih.gov/Naltrexone.htm

29.

Rea F, Bell J, Young M, Mattick R. A randomised, controlled trial of low dose naltrexone for the treatment of opioid dependence. Drug and Alcohol Dependence. 2004;75(1):79-88.

30.

Center for Substance Abuse Treatment. Chapter 4—Oral Naltrexone [Internet]. National Center for Biotechnology Information. 2009 [cited 12 October 2015]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64042/

31.

Karch S. Drug Abuse Handbook, Second Edition. 2nd ed. CRC Press; 2006.

32.

Tai B, Blaine J. Naltrexone An Antagonist Therapy for Heroin Addiction [Internet]. National Institute on Drug Abuse (NIDA), U.S. Department of Health and Human Services. 2015 [cited 13 October 2015]. Available from: http://archives.drugabuse.gov/meetings/Naltrexone.html

33.

Bell J, Young M, Masterman S, Morris A, Mattick R, Bammer G. A pilot study of naltrexone-accelerated detoxification in opioid dependence. MJA. 1999;171:26-30.

34.

Hollister L, Schwin R, Kasper P. Naltrexone treatment of opiate-dependent persons. Drug and Alcohol Dependence. 1977;2(3):203-209.

35.

Kleber H. Naltrexone. Journal of Substance Abuse Treatment. 1985;2:117-122.

36.

Kunøe N, Lobmaier P, Ngo H, Hulse G. Injectable and implantable sustained release naltrexone in the treatment of opioid addiction. British Journal of Clinical Pharmacology. 2014;77(2):264-271.

37.

Tiihonen J, Krupitsky E, Verbitskaya E, Blokhina E, Mamontova O, Föhr J et al. Naltrexone Implant for the Treatment of Polydrug Dependence: A Randomized Controlled Trial. American Journal of Psychiatry. 2012;169(5):531-536.

38.

Krupitsky E, Nunes E, Ling W, Illeperuma A, Gastfriend D, Silverman B. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. The Lancet. 2011;377(9776):1506-1513.

39.

Leslie D, Milchak W, Gastfriend D, Herschman P, Bixler E, Velott D et al. Effects of injectable extended-release naltrexone (XR-NTX) for opioid dependence on residential rehabilitation outcomes and early follow-up. The American Journal on Addictions. 2015;24(3):265-270.

40.

Mannelli P, Wu L, Peindl K, Swartz M, Woody G. Extended release naltrexone injection is performed in the majority of opioid dependent patients receiving outpatient induction: A very low dose naltrexone and buprenorphine open label trial. Drug and Alcohol Dependence. 2014;138:83-88.

Posted on by

Mortgage Aggregators Vs Mortgage Wholesalers

Mortgage Aggregators vs Mortgage Wholesalers

by

Herona Kim

Mortgage Aggregators

Mortgage aggregators belong to the secondary mortgage market. They purchase mortgages from various mortgage lending financial institutions and secure such mortgages with mortgage-backed securities (MBS). Mortgage aggregators get their profits by purchasing individual mortgages at much lower prices and selling such mortgages at substantially higher prices. In short, they assemble small products into large packages and sell them to a larger market. They charge appropriately for making this combination and presenting it as a package. Along with mortgage aggregators, dealer groups and franchise groups also act as wholesalers between mortgage brokers and lenders. All of them are termed as mortgage aggregators.

Majority of banks and other lenders have minimum volume requirements along with variance compliance requirements. Most of the average mortgage brokers would find it quite difficult to meet these requirements. Hence, they are forced to work with mortgage aggregators who offer not only easy access to banks and lenders but also provide various types of support that mortgage brokers might need, such as loan comparison software, customer record management, loan lodgment, management support, lending, generation of leads, sales and compliance training, and back office support. However, mortgage aggregators invariably charge a fee for such services, either in the form of retaining a percentage of commission from banks or lenders, a monthly fee, an annual fee, or a fee for each transaction.

[youtube]http://www.youtube.com/watch?v=W5428WOMX14[/youtube]

Mortgage Wholesalers

Mortgage wholesales utilize average mortgage brokers as individual loan officers. They offer lower rates to the mortgage brokers and the broker would have to add necessary compensation while selling the mortgage loan to the client. This compensation rate would normally be equal to the rate that the client would obtain directly from a mortgage banker but this could vary from one broker to another and from one client to another, depending on the type of mortgage that the client seeks.

Mortgage Brokers

The advantage that mortgage brokers obtain when dealing with mortgage wholesalers is that the wholesaler would be able to repackage a mortgage loan that had been declined by a lender for some reason and present it to another lender. They achieve this by utilizing the concept of white label product, since mortgage managers and lenders have to offer similar products to remain competitive in the mortgage market. Even though minor differences might be present from one lender to another, the principle of white label product forces them to offer mortgage products that do not have much variance. Mortgage wholesalers utilize this to obtain mortgages to individuals in difficulty. Thus, the mortgage wholesalers offer valuable service to mortgage brokers.

Line of Finding

Since individual borrowers would find it difficult to obtain access to large mortgage banks or other mortgage lenders directly, they would be forced to go through a mortgage broker. In turn, the mortgage broker would be dealing either with a mortgage aggregator or with a mortgage wholesaler to reach the right lender. Hence, the line of funding becomes slightly complicated but all the parties involved in mortgage benefit from this kind of line of funding. However, the individual mortgage borrowers and the mortgage brokers might at times land up with greedy mortgage aggregators or mortgage wholesalers, resulting in higher rates for the borrowers and lesser profit for the brokers. Hence, borrowers and brokers should select mortgage aggregators or mortgage wholesalers carefully.

Copyright (c) 2013 Herona Kim

Mortgage Aggregators vs. Mortgage Wholesalers

heronakim.com/

Article Source:

ArticleRich.com

Posted on by

Portable Prefabricated Kiosk

By Camille Howe

If you have the need for any outdoor sales space, such as for tickets or concessions, then the best solution to your needs is likely to be a prefabricated kiosk. Offering a wide range of different options when it comes to the exact specifications of the units, from the size through to the exact color, the chances are that companies are able to provide you with exactly the space that you need at a price that meets your requirements. There are a number of factors that you need to consider when purchasing a prefabricated kiosk, and choosing the right model for your needs is essential.

The main benefit of a prefabricated ticket booth kiosk is that it can be delivered to the site in complete condition, ready for use.Perhaps the most important thing that you need to consider when choosing an outdoor sales unit or ticket booth is that it is an attractive structure that encourages customers to use it. With this in mind, companies can offer a number of well designed and attractive prefabricated kiosks that can fit into a number of different situations, and can be customized to a high level in order to ensure that they meet your own particular corporate identity.

[youtube]http://www.youtube.com/watch?v=qXK7gIh3C98[/youtube]

Security is another major factor that is vitally important for both staff and business. When people are working in a kiosk, they are to a certain extent, exposed to the rest of the world, and may well be working on their own in an isolated area. While it is impossible to offer anything that is completely safe in the form of a prefabricated kiosk, the range of products offered by Easy Rack do feature a high standard of construction that produce greater levels of protection for staff when they are working, as well as being attractive and accessible.

One of the main criticisms that has been leveled against temporary portable buildings in the past is that the quality of the buildings and the facilities that they offer are of a low quality in comparison to traditional buildings.Choosing the right design of prefabricated kiosk is important, as it will have a major impact on the way in which people view your business; however there are also a number of other benefits of using this system. The main benefit of a prefabricated kiosk is that it can be delivered to the site in complete condition, ready for use. The construction is carried out off site, and features all of the supplies such as electricity that your staff will need when they come to use the kiosk in the future. The advantage of almost instant construction will allow you to benefit from being able to react quickly to changes in the market, as well as add additional units in the future that match the design of the original one.

There are a number of different designs of prefabricated kiosk available from most companies, and these can fulfill a variety of different roles for your business. From ticket booths through to security guard stations, and from small shops through to customer information centers, the only constant with a kiosk is that it is a place where representatives of your business and your customers can come together. With this in mind, it is important to choose a design that is welcoming and attractive, and one that is in keeping with your overall company image – something that you will find easy thanks to the range of products available from many companies.

About the Author: Easyrack.org for more information on modular buildings and installation or prefabricated portable kiosk please visit us.

Source: isnare.com

Permanent Link: isnare.com/?aid=232941&ca=Home+Management

Posted on by

White Bumps On Penis Why They Appear

White Bumps on Penis Why They Appear

by

John Dugan

Introduction

If you have noticed white bumps on your penis, don’t wait before getting it treated. The appearance of white bumps on the penis can be a distressing and painful condition for many men, and it can interfere with urination, sex and physical activity. Getting an accurate diagnosis is important, as penile white bumps are a symptom of STI’s, inflammatory diseases and block hair follicles and sweat glands. Vitamins, minerals and cr mes for penis health can support normal tissue healing and reduce inflammation, as well as support immune health.

Papules: Papules are small white spots which may contain a white fluid, similar to pimples. Only rarely are papules caused by a disease or pathogen, but they can result in some serious complications, especially in men who are immune-compromised. Possible causes of papules include blocked hair follicles or sweat glands, eczema, pearly penile papules (this appears like small warts but is non-infectious) and Fordyce spots. Infectious causes of papules include genital warts and molluscum contagiosum – both contagious STI’s that can be difficult to treat. If you are suffering from any form of papules, seek medical attention for a proper diagnosis.

[youtube]http://www.youtube.com/watch?v=ar6sf4b94x8[/youtube]

Ulcers: Ulcers are more serious than papules, and are often caused by infectious disease. When they are small, ulcers may appear similar to papules, but eventually grow larger and fill with clear, white or red fluid. The tissues within and around the ulcer may eventually turn black with necrosis, causing serious complications. Causes of penile ulcers can include STI’s like syphilis, chancroid and herpes, cancerous lesions from squamous cell carcinoma, and chronic inflammatory conditions such as Beh et’s disease and Reiter’s syndrome. Sometimes ulcers can be the result of a physical trauma or blow to the penis. Proper diagnosis is essential, as all cases of penile ulcers require urgent medical attention.

Plaques: Plaques present as thickening, scaly skin conditions which may begin as smaller white bumps on the penis. While some cases of plaques can have an infectious or disease-related cause, often they are due to chronic inflammatory conditions such as acute dermatitis, eczema and psoriasis. During these conditions the skin may appear dry, flaky, itchy and present with small white bumps. Balanitis and posthitis are highly painful inflammatory skin conditions of the penis and foreskin, which may be the result of a candida infection. Liche n sclerosis is another inflammatory condition which can cause irritation and thickening of the foreskin, to the point of causing phimosis.

Medications

Internal treatments: What sort of medications you can take for white bumps on the penis varies greatly, as it depends on your diagnosis? Papules and ulcers are likely to be treated by antibiotic therapy, in order to rid the body of infectious pathogens. Eczema, dermatitis and psoriasis are difficult to treat with internal medicine, but undergoing detoxification and trying the Elimination Diet under medical supervision can be very helpful to some people.

Topical treatments

Treating white bumps on the penis often will involve both internal and external therapies. Upon diagnosis doctors and genitourinary specialists can prescribe a range of different topical treatments, including antibiotics, hydrocortisone creme, and antiviral cr mes. Natural creme include botanical extracts, vitamins and minerals may also help to support tissue healing and reduce inflammation. Using a penis health formula (most health professionals recommend Man1 Man Oil) provides vitamin C for tissue healing, vitamin E to reduce scarring, vitamin A to control inflammation, vitamin D for healthy skin regeneration and shea butter for tissue moisturization.

For additional information on most common

penis health

issues, tips on improving penis sensitivity, and what to do to maintain a healthy penis, visit:

penishealth101.com

John Dugan is a professional writer who specialized in men’s health issues and contributes feature articles and blogs to numerous publications.

Article Source:

White Bumps on Penis Why They Appear

Posted on by

How To Stop Aggression In Your Dog

Submitted by: Michael Marsden

Dogs are integrally aggressive beings and are actually capable of causing serious harm both to dogs and humans alike. Being that aggressive is quite understandable because wild dogs need to defend themselves from other creatures, defend their territory, food and mate. They also need to hunt in order to survive. Over time, dogs have been tamed and have even been proclaimed as man s best friend. But some dogs may become more dangerous and aggressive if they lack behaviour training. In order to keep you and your family safe, take steps to stop dog aggression.

The two main types of aggression in dogs are aggressiveness towards strangers or even family members as well. They primarily become like that because of fear, nervousness or even insecurity. These dogs bark, bite and snap when they are at that particular state. These dogs also become a lot more protective or possessive of their property. This certain property can possibly be a family member, your house, its toy or food. Dogs that are this protective can even prevent your home from being robbed.

[youtube]http://www.youtube.com/watch?v=MZm037jPNgc[/youtube]

There are dogs which are aggressive because of they possess a dominant personality. If a dog has that trait, it will feel that it is the dominant one in that particular area. This is not really that common to dogs but statistics have shown that this kind of aggressive behaviour applies only to specific breeds of dogs.

As a dog owner, you should have a lot of resources to aid in controlling your dog s aggression problem. Here are 6 steps you can take in order to stop dog aggression:

1. The initial step you must take is to check with your dog s vet to rule out any kind of medical cause of your dog s aggressive behaviour. 2. Consult a professional dog trainer for help. This kind of problem will not just disappear by itself. In order to work with aggression problems, you will need some home help from an animal behaviour specialist. 3. Ensure the safety of everyone. This must be your priority. Confine and supervise the activities of your dog until the time you get professional help. You are liable for the behaviour of your dog. If you have to take your dog for a walk, use a cage-type of muzzle as a precaution for the meantime. 4. Keep your dog away from the situations you have observed in which it shows aggression. If possible, when that situation comes, confine your dog to a safe room. This limits the contact with other people. 5. If your dog is protective of its food, treats, or even a particular place, do not allow it to access those things. In case of an emergency situation, bribe your dog with something that it thinks is better. 6. Neuter or spray your dog. Dogs that are intact are most likely to show dominance, protective aggressive or territorial behaviour.

If you think you have tried everything you can but your dog is still hard to control, consult your dog s vet. Keep in mind that all dogs out there can be controlled in some way. You just have to come across the perfect training program designed for your problem.

About the Author: Are you trying to learn how to stop dog aggression? We are the #1 source for dog obedience information. Go to

dogobedienceshortcuts.com/

to put a stop to your dogs bad behavior once and for all!

Source:

isnare.com

Permanent Link:

isnare.com/?aid=544920&ca=Pets

Posted on by

No Down Payment Poor Credit Mortgage Loans Understanding 80/20 Loan Option

By Carrie Reeder

When applying for a mortgage loan, down payments are generally required as part of the financing. Many traditional mortgages will only finance 80 percent of the home price. Thus, homebuyers are obligated to provide the additional 20 percent. Having a down payment of 20 percent is ideal in a perfect world. In reality, few people have access to this type of money. For this reason, mortgage lenders are offering 80/20, or piggyback mortgage loans.

How Do 80/20 Home Loans Work?

The concept around 80/20 home loans is very simple. Ordinarily, if a homebuyer did not have a down payment of 20 percent, they would have to purchase private mortgage insurance, (PMI), to complete the home financing. On average, PMI increases mortgage payments by $100.

If accepting an 80/20 home loan, PMI is not required. Instead, homebuyers receive two loans to finance the home purchase. A first mortgage is approved to finance 80 percent of the home cost, whereas a second mortgage or home equity loan is approved to finance the remaining 20 percent.

[youtube]http://www.youtube.com/watch?v=t0zZ7qDEKbI[/youtube]

Who Qualifies for an 80/20 Home Loan?

Any homebuyer hoping to avoid private mortgage insurance may qualify for an 80/20 option. Piggyback loans are especially beneficial for first time homebuyers. Young couples will also benefit from these loans. Usually, these individuals have not been able to build a large cash reserve. This way, they do not have to put off buying a home.

An 80/20 home loan is also offered to individuals with poor credit. Mortgage lenders vary in their loan qualification guidelines. Traditional lenders such as banks, credit unions, and mortgage companies prefer applicants that have a high credit rating. Thus, they may not approve loan requests for credit scores that fall below 640.

On the other hand, many lenders offer a range of bad credit mortgage loans. These consist of loans that provide assistance for down payments, closing costs, low mortgage rates, etc.

Applying for an 80/20 Loan with Bad Credit

Mortgage brokers are very effective with helping bad credit applicants find a fitting home loan program. To smooth the process, brokers have websites available, which offer explanations on various bad credit home loans. Moreover, you can request a mortgage quote online, and receive up to four offers from different lenders granting piggyback loans to people with bad credit.

About the Author: Go to abcloanguide.com/badcreditmortgage.shtml for more information on a No Down Payment Poor Credit Mortgage Loan.

Source: isnare.com

Permanent Link: isnare.com/?aid=61027&ca=Finances

Posted on by

The Increasingly Popular Transport Wheelchairs

The Increasingly Popular Transport Wheelchairs

by

Kirk Peterson

Walking disabled people are more fortunate nowadays. While in the past they always have felt incapacitated and immobile, nowadays, they are provided with more and better means to roam and move around. With the development and heightened popularity and usage of wheelchairs, such handicapped people are given more advantage and privilege. The emergence of transport wheelchairs have significantly helped improve the way people make use of wheelchairs.

What are transport wheelchairs? Transport wheelchairs are machines or equipment that facilitate for mobility and movement of wheelchair confined people at public places. While it is true that simple wheelchairs can do the trick, transport wheelchairs are specifically designed and manufactured to facilitate better roaming and mobility at malls, restaurants and parks where people usually converge to relax.

How are transport wheelchairs different from conventional and usual wheelchairs? To begin with, the materials with which transport wheelchairs are made are of more superior quality and strength. That is because transport wheelchairs are made very specifically to facilitate movement at public and outdoor places. Also, transport wheelchairs are made of materials that are highly durable to enable it to carry out its purpose. Thus, it is often that users complain about the limited usefulness and comfort of using the wheelchairs.

Modern transport wheelchairs

To answer and respond to concerns over modern transport wheelchairs usefulness and comfort, manufacturers are devising ways on how the machines can be made more efficient and cozy. Thus, as more users used to complain about their comfort when using transport wheelchairs over extended periods of time, makers are quick to respond by spending significant amount of time and efforts to making such initiatives.

[youtube]http://www.youtube.com/watch?v=eBMxqq17Vq0[/youtube]

Now, transport wheelchairs are made more effective and comfortable. As a matter of fact, there are more and softer cushions that are integrated into the machines. The wheels are also made lighter but more durable and efficient for better facilitation of mobility.

As for the issues over comfort, the overall designs of transport wheelchairs are modified and significantly improved. The seats are now made broader and more comfortable so that the user would not feel discomfort when seating at it over extended periods of time.

There are also transport wheelchairs that have footrests and arm rests. Such added features make transport wheelchairs advantageous and highly useful. Now, there is a rising number of transport wheelchairs that are praised and preferred because of such comforting features.

Choosing the best transport wheelchairs

Choosing the best transport wheelchairs is highly imperative. That is because consumers basically would aim to extract and get the best services and products available in the market. No one wants to get substandard transport wheelchairs at prices that are almost close to prices of highly comfortable and premium ones.

There are several trusted brands of manufacturers of transport wheelchairs. As you choose the best products there are, it would be helpful if brand names would given utmost consideration. It follows that the best and most trusted brands are also those that are likely to come up with the best transport wheelchairs in the market.

It is a basic requirement to be more discerning and selective when buying transport wheelchairs. With so many machines and brands out in the market, you would resent it if you would invest in products that would otherwise be not so helpful to you.

Buying transport wheelchairs

Transport wheelchairs can be easily purchased. Visiting and shopping around at the nearest and most reliable wheelchair stores would be of great help. When you do so, be sure to spot the transport wheelchair that you think would be highly useful to you. Take note of the materials used, the comfort provided and the height.

Transport wheelchairs also come in handy and foldable types. These transport wheelchairs are very convenient and can facilitate more convenience because they can easily be transported and carried anywhere the user and the attendants would go. Thus, whether the user would go to the mall or go cruising at the park, there would always be a handy and reliable transport wheelchair for you.

Online purchases are more advisable because such transactions are more convenient. Usually, online acquisitions of transport wheelchairs are more preferred because such actions would scrap and leap from the tedious action of actual buying.

Transport wheelchairs are becoming more popular because they are more useful. Such machines facilitate for better roaming and mobility especially in public places and centers, where typical and conventional wheelchairs would not normally function and be useful properly. Browse our website for the

transport wheelchair

and

wheelchair cusion

.

Article Source:

ArticleRich.com

Posted on by

Pool Equipment Supplies

Your search for pool pump supplies may result in confusion asthousands of product listings will pop up in your online research. Thebest place to start in your pool pump search and in your search forpool pump supplies is determining the primary use of your pool. If youown a small pool that will act as a hot tub on occasion, a Jacuzzi poolpump can help create relaxing bubbles. You should investigate Pentair’sline of hydraulic high-pressure pumps if your goal is simply to have aswimmable pool filled with clean water.

Your pool equipment supply search/ pool pump supplies search isincomplete if you do not look for products that will make poolmaintenance easier. A pool filter timer allow pool owners to conserveenergy setting the pump to work certain hours of the day, eliminatingenergy waste when the pool is not in use. Once your pool is covered forthe night, a strong rainstorm may pass through and fill your pool coverwith water. You can use a pool cover pump to drain dirty rain waterfrom your cover before opening the pool for business.

Newcomers to pool equipment supplies may be shocked at thenumber of different pool covers on the market. Solar covers areinexpensive products that trap heat into plastic bubbles, distributingthat heat gradually to keep the pool warm year-round. Leaf nets areplaced on top of traditional or solar covers to collect leaves, sticksand other debris in the autumn. Every family should own a safety coverfor the backyard pool to ensure the safety of visitors and guests. Asafety cover is a heavy-duty cover that anchors to the edges of thepool, protecting accident-prone guests from falling into the deep endof the pool.

[youtube]http://www.youtube.com/watch?v=o6ghQZcIoog[/youtube]

After the pool cover is removed in the morning, pool owners haveto ensure that the water has been purified before the first cannonballsand dives. A pool owner should have an automatic cleaner and a chlorinegenerator in his pool equipment suppliesto keep water clean at all times. An automatic cleaner will sweep thebottom of the pool and remove debris that may have gotten under thecover. Instead of trying to find the right balance between chlorine andwater, a chlorine generator can be used to dole out small amounts ofchlorine to avoid burnt eyes and skin discomfort.

Your pool is not complete without a set of stairs to allow easyentrance into the water. Budget-conscious families may opt for plasticladders and above-ground stairs that can be stored in the garage whenthe pool isn’t in use. Other pool owners will opt for in-pool stairsand decks that span above the water to make access easier for theirguests. Pool equipment suppliers will have all of these stairs in stockbecause many families opt for multiple entry options.

Posted on by

Find A Dentist Who Offers Advice And More

Find a Dentist Who Offers Advice and More

by

Anna Woodward

When you see a dentist, you should get a few different benefits from the visit. This is because they should not only diagnose patients using modern equipment, but they should also treat them and offer advice. Find out what you have to look forward to at your next dental visit.

When you arrive, you will likely talk to your dentist about your dental habits. He or she will probably ask about how often you floss and brush your teeth. You should answer truthfully, especially since the real answer may be obvious when your practitioner looks in your mouth. In addition, you will get some advice that can help you. So if you let your practitioner know you only brush once a day because that is all you have time for, he or she can tell you the best toothpaste and toothbrush to use for the most thorough cleaning, allowing you to get the most out of every brushing session. If you mention you do not like to floss because your gums bleed, the practitioner can tell you why that is, and how to solve the issue.

[youtube]http://www.youtube.com/watch?v=N618fLxQP6w[/youtube]

Once you are done getting advice, your dentist should take a close look at your mouth. Most can start to diagnose based on just looking at the teeth and gums carefully since they know what to look for. They might use a small mirror to help them get a closer look. If they want to know more about the issue, they will likely take a few x-rays to accurately diagnose the condition, so prepare to be probed a bit with some of the most common types of dental equipment.

Once there is an accurate diagnosis, you can be treated. If you have a cavity, your dentist will decide whether to fill it or pull the tooth out entirely, depending on your circumstances. If your tooth is cracked or broken, the practitioner can either fix it in the office or refer you to a specialist. In most cases, your dentist should discuss the treatment with you before doing it since you need to know how much it will cost and how to both prepare and recover.

Most dental practices follow these steps, letting you know ahead of time what to expect from every appointment. If you find that your dental specialist does not use the proper tools to diagnose you, or never offers advice, you might consider finding a new one. This allows you to find a dental office that is thorough when it comes to advice, diagnosis, and treatment.

To find a great

dentist Portland Maine

residents go to all kinds of lengths. For a friendly, knowledgeable dental practice that patients love, go to

foresidedental.com/

.

Article Source:

ArticleRich.com