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Synopsis `Supporting local delivery', produced jointly by Department of Health and Department for Education and Skills sets out the national support that will be provided to local agencies to support them in implementing the National Service Framework for children, young people and maternity services. It also identifies how the NSF, and the wider health agenda, fits into the `Every child matters: Change for children programme' and what this means for health organisations. Most recently, J&J acquired Scios for $2.4 billion in cash in an acquisition that underlines the importance of the above strategies. J&J gains both an established cardiovascular drug that will benefit from their S&M and a promising new treatment of rheumatoid arthritis that could benefit from J&J's best practices and scale. Competing Growth Strategies Now that we have taken a look at J&J's strategy of growing through acquisition, it is important to understand other growth strategies that are being used by their pharmaceutical industry rivals. In order to meet double-digit earnings growth expectations, firms must either grow their product line or cut costs or both ; . Three strategies have emerged within the industry: 1. 2. 3. Mergers with other large pharmaceutical companies Organic growth Strategic acquisitions of smaller pharmaceuticals and biotech. We recently reported in your journal the use of selective arterial injection of calcium with hepatic venous sampling in localizing confirmed insulinomas 1 ; . Fukunag; a et al. now suggest in their letter that this technique may be Used to diagnose insulino%s with normal insulin levels. This is a potentially valuable extension of the indications for this investigation, in a difficult diagnostic area. We are concerned however about the use of ratios of glucose to insulin to aid the diagnosis of an insulinoma. This implies a linear relationship of insulin to glucose that is incorrect, as the relationship is sigmoidal. The use of such ratios may lead to the diagnosis of a "normoinsulinemic insulinoma" when the insulin is inappropriately raised given the degree of hypoglycemia. The diagnostic criteria for an insulinoma are well established: documented hypoglycemia 40 mg dL or 2.2 nmol L ; with concomitant detectable insulin levels 6 pU mL 4.3 pmol ; , c-peptide 0.2 nmol ; , and a negative sulphonylurea screen. In difficult cases a 72-h fast may be needed to make the diagnosis, but in practice 80% will be hypoglycemic in 24 h and the remainder by the end of the 72 h 2 ; Thus, the severe symptomatic hypoglycemia 1.7 mmol L ; in the patient reported by Fukunago et al. along with the detectable insulin 34.4 pmol L ; , would support the diagnosis of an insulinoma. We agree that selective intraarterial calcium injection may be a powerful technique for localizing insulinomas with normal insulin levels, but the use of glucose to insulin ratios may increase the apparent incidence of such tumors. Donal O'Shea, Andreas Rohrer-Theus, Royal Postgraduate Medical School, London, United Kingdom Stephen Hammersmith R Bloom Hospital. The total rest was often an unacceptable option to the athlete. Entry Phosphonium Resin Carbonyl Compound Olefin 1 81 5: Isolated Yield cis: trans ; a % GC Purityb 95 2 94 Table 3. Wittig reaction using PS-Triphenylphosphine a Ratio determined by 1H NMR analysis b GC analysis: HP-5 phenylmethylsilicone column 100-250 C, 15 C min, 10 min hold, for instance, lithium eskalith lithobid. Words are taken as strings of characters separated from other strings by one or more whitespace characters spaces, tabs, newlines ; . Punctuation is removed first in the hope that many of the intra-word characters which spammers use to confuse a Bayesian filter will be removed. Our stop-word list consisted of the 57 of the most frequent prepositions, pronouns, articles and conjunctives. Stemming was done using an implementation of Porter's 1980 algorithm, more recently reprinted in [22]. All words less than three characters long are ignored. For more general information on these and other approaches to pre-processing, the reader is directed to [18, 31]. In terms of the biological results, synthesized compounds were initially tested against recombinant falcipain-2. Commercially available isatins were screened for comparison purposes and were found to be ineffective with the exception of 5-nitro isatin, which showed an IC50 value of 43 M. the other hand, thiosemicarbazones showed some activity albeit modest in many cases ; . The most notable thiosemicarbazone scaffold from this limited series are 12g and 12I, which showed activity against the target protease with IC50 values of 10 M less Fig. 4.

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