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Onset of Arrhythmic Action Peak Effect Duration 30 min–2 h 2–3 h 8–12 h Food: Take with food or antacid cyproheptadine 4mg line. Advice to patient • Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known discount 4 mg cyproheptadine visa. Clinically important drug interactions • Drugs that increase effects/toxicity of mexiletine: cimetidine best cyproheptadine 4 mg, other antiarrhythmic drugs, metoclopramide. If pulse rate falls to less than 50 beats/min or becomes irregular reduce or discontinue mexiletine. Susceptible organisms in vivo: Streptococcus pneumoniae, beta- hemolytic streptococci, Enterococcus faecalis, Escherichia coli, Hemophilus influenzae, Klebsiella sp, Neisseria gonorrhoeae, Proteus mirabilis, Salmonella sp, Shigella sp, Morganella mor- ganii, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Enterobacter sp, Citrobacter sp, Pseudomonas aerugi- nosa, Serratia sp, Acinetobacter sp, Clostridium sp, Peptococcus sp, Peptostreptococcus sp, Bacteroides sp, Fusobacterium sp, Eubacterium sp, Veillonella sp. Editorial comments • Mezlocillin is used to treat aerobic gram-negative infections. Mechanism of action: Thickens cell wall, thereby altering per- meability of fungal cell membrane. Susceptible organisms in vitro: Coccidioides immitis, Candida albicans, Cryptococcus neoformans, Histoplasma, Paracoccid- ioides, Brasiliensis. Clinically important drug interactions • Miconazole increases effects/toxicity of oral anticoagulants, sulfonylureas, phenytoin. American Academy of Pediatrics expresses concern about breast- feeding while taking benzodiazepines. Contraindications: Hypersensitivity to benzodiazepines, preg- nancy, narrow-angle glaucoma. These effects result in increased force of cardiac muscle contraction and vasodilation. Adjustment of dosage • Kidney disease: Creatinine clearance <50 mL/min: reduce infusion rate of milrinone; creatinine clearance 50 mL/min per 1. Warnings/precautions: Use with caution in patients with ventric- ular arrhythmias, atrial fibrillation or flutter, obstructive disorders of the aortic or pulmonic valve, renal impairment, electrolyte abnormalities. Parameters to monitor • Renal function, fluid and electrolytes, especially potassium carefully during therapy. Hence, care should be taken to monitor patients carefully during and shortly after infusion. Mechanism of action: Inhibits bacterial protein synthesis after specific ribosomal binding. Susceptible organisms in vivo: Borrelia burgdorferi, Borrelia recurrentis, Brucella sp, Calymmatobacterium granulomatis, Chla- mydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Ehrlichia sp, Helicobacter pylori, Q fever, Rickettsia sp, Vibrio sp. Contraindications: Hypersensitivity to any tetracycline, patients with esophageal obstruction, children <8 years. Adjustment of dosage • Kidney disease: Reduce dose by one-third usual in renal failure. Onset of Action Peak Effect Duration 30 min 2–3 h 2–5 d Food: May be taken with or without food. Adverse reactions • Common: edema, tachycardia, breast tenderness, weight gain, hypertrichosis. Clinically important drug interactions • Drugs that increase effects/toxicity of minoxidil: guanethidine, diuretics, other antihypertensives. Significant changes, eg, heart rate increase >20 beats/min, probably require reduction of dosage. Editorial comments • Minoxidil should be given along with a diuretic unless the patient is on hemodialysis. Minoxidil stimulates resting hair folli- cles and increases cutaneous blood flow via its vasodilatory properties. Adjustment of dosage • Kidney disease: Adjust dosage according to side effects only. Onset of Action Duration 30 min 3–6 h Food: Misoprostol should be administered with meals and at bedtime. Warnings/precautions • Misoprostol should not be prescribed for a female patient who is potentially capable of childbearing unless patient under- stands effect of misoprostol in causing abortion, is capable of complying with recommended contraception, and has a nega- tive pregnancy test within 2 weeks of initiating therapy. Advice to patient: Use two forms of birth control including hor- monal and barrier methods. This tends to be self- limited and can be minimized by giving the drug with meals. Adjustment of dosage • Kidney disease: Creatinine clearance <10 mL/min: administer 75% of usual dose. Warnings/precautions • Use with caution in patients with active infection, kidney or liver disease, respiratory disorders, decreased bone marrow reserve.

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The therapeutic value of contact lenses was first demonstrated in a study which showed a significant increase in aqueous humor levels produced by drug-soaked lenses when compared with the conventional eyedrop discount cyproheptadine 4 mg on line. The use of Bionite contact lenses for delivery of idoxuridine 4 mg cyproheptadine fast delivery, polymyxin B and Pilocarpine also showed that instillation of a drug solution onto an unmedicated contact lens was significantly more effective than instillation of a more concentrated drug solution directly to the cornea buy cyproheptadine 4mg. However, the soaking of lenses in ophthalmic formulations to incorporate the drug into the lens may cause toxicity to corneal epithelium because preservatives, such as benzalkonium chloride, have a great affinity for the hydrophilic contact lens material and are concentrated in the contact lens. Contact lens for sensitive wearers may also cause foreign-body sensation, blurring and decreased oxygen tension on the corneal surface resulting from occlusion by contact lens. An alternative system, manufactured as a wafer-like insoluble implant, has been developed (Ocusert). The system is preprogrammed to release pilocarpine at a constant rate of 20 or 40 μg/hr for a week to treat chronic glaucoma; however, release from inserts may be incomplete and approximately 20% of all patients treated with the Ocusert lose the device without being aware of the loss. The device also presents problems including foreign-body sensation, expulsion from the eye, and difficulty in handling and insertion. An alternative to the advanced non-erodible systems is an erodible insert for placement in the cul-de-sac. The bioavailability of pilocarpine was shown to be increased sixteen-fold using this system. The system showed considerable promise for prolonged drug delivery since vision is minimally affected by the presence of an insert positioned on the sclera. When the device is placed in the lower fornix, the contact area for the released drug is the sclera and little material is in contact with the cornea. Furthermore, topical application of drugs for the treatment of posterior segment disorders is severely limited by the highly efficient clearance mechanisms and attempts to improve precorneal residence time of the drugs by addition of viscosity enhancing agents, gelling agents, mucoadhesive polymers etc. Moreover, most diseases affecting the posterior segment are chronic in nature and require prolonged drug administration. An intravitreal injection provides therapeutic concentrations of the drug adjacent to the intended site of activity and a much smaller dose is required. Following injection, the drug diffuses through the vitreous gel with little restriction to diffusion. For most drugs the diffusion coefficient through the vitreous humor is close to that through water. Once distributed throughout the vitreous humor, rapid elimination of the drug is observed. Drug loss from the vitreous takes place via two routes: • anteriorly—by simple diffusion to the posterior chamber and followed by removal to the systemic circulation along with the aqueous humor drainage; • posteriorly—across the retina where it is removed by active secretion. Drugs lost primarily by anterior chamber diffusion have a long half-life in the vitreous, usually in the order of 20–30 hours. In contrast, drugs lost via the trans-retinal route, such as the penicillins, have typically 314 much shorter half-lives of 5–10 hours. Ocular inflammation results in the breakdown of blood retinal barrier and increases the elimination of non-transported drugs from the vitreous. In contrast to the elimination of non-transported drugs, drugs that are removed by the active transport systems reside longer in the vitreous following ocular inflammation due to the failure in the transport system. As the majority of the posterior segment disorders are chronic in nature, sustained delivery of medications is highly desirable. Liposomes and microparticulates are such systems designed to release the encapsulated drug gradually and over an extended period of time. For reviews on intra-ocular drug delivery systems see Gregoriadis and Florence (1993), Metrikin and Anand (1994), and Peyman and Ganiban (1995) detailed at the end of this chapter. For example, liposome-encapsulated amphotericin B produced less toxicity than the commercial amphotericin B solution when injected intravitreally. Liposomes have also been used to study the release and distribution of dyes, which in turn reflect the integrity of the retinal vascular constitution. Direct intravitreal injection of liposomal-encapsulated drugs has shown enhanced vitreal levels for extended periods of time in the vitreous of rabbit models. Biodistribution of dexamethasone sodium phosphate has been evaluated following intraocular delivery in rabbits. The liposomes were found to bind to various ocular tissues including the retina, iris, sclera and cornea. Using gold-colloid loaded liposomes, it was demonstrated that retinal bound liposomes were attached to the inner limiting membrane and did not penetrate the inner cells of the retina. Heat-sensitive liposomes containing carboxyfluorescein have also been used to examine the potential of liposomes for targeted drug delivery to selected areas of the retina. Liposomes to deliver cyclosporin A (CsA) have been incorporated into collagen shields. This delivery system provided the highest levels of CsA in both the cornea and sclera with higher levels in the aqueous humor compared to unencapsulated and capsulated CsA but not loaded into collagen shields.

This little bit of play acting made the examiners only too anxious to strip away his mask of health and to discover triumphantly the epilepsy which he was so cleverly simulating generic 4mg cyproheptadine visa. Some Unmasking Techniques Among the "strategic ruses" offered by Jones and Llewellyn (47) is the method of suggestion purchase cyproheptadine 4 mg on line. In this procedure purchase 4 mg cyproheptadine mastercard, the interviewer suggests other symptoms by inquiring about their presence, and usually about symptoms which might be inconsistent with the syndrome originally presented. If the malingerer does not immediately agree that he suffers with that symptom, he may show up with it at the next interview. Cases are reported in the literature where the malingerer picked up the most outlandish and unusual suggestions made by the examiner and displayed that bizarre behavior shortly after the interview. This may consist of any number of devices, including drugs, electroshock, or hypnosis. In the malingerer the suggested potency of a therepeutic maneuver may shake his confidence and lead to his dropping the symptom. There is much in the literature to indicate that suggestibility is increased when the situation is ambiguous, unstructured, or difficult, and the person has few guideposts on which to rely. Under such -287- circumstances, he seems to be greatly influenced by the attitudes and perceptions of peers and authorities. On the other hand, studies by Spohn (81) and Didato (20) indicate that schizophrenics may be less susceptible to social pressures to conform. They may therefore be less susceptible to suggestions made by an interviewer regarding their improvement or symptoms. The success reported for the Rorschach in detecting malingering seems to follow from the same principles. The malingerer is confronted with an unstructured stimulus, and there is very little in his background or experience which would indicate to him the responses to the Rorschach which would be consistent with the illness he is simulating. Thus, once again, the malingerer would be hampered by inadequate role expectations and an unsatisfactory frame of reference. Whether or not a Rorschach can be changed enough to fool an experienced psychologist is still undetermined. Fosberg (24, 25) asked his subjects to give two Rorschachs, a good impression one and a bad impression one, and when he found high correlations between the scoring categories on the two Rorschachs, he concluded that the Rorschach cannot be manipulated, at least with regard to its formal scoring categories. Carp and Shavzin (16) also asked their subjects to fake the Rorschach, and using a somewhat different method of ordering the data, found correlations between the good impression and bad impression Rorschachs ranging from. The authors state that no attempt was made to determine whether the subjects were successful in altering their responses in the desired direction. In each of these studies, the malingerer is described as constricted, evasive, suspicious, reluctant to respond, and determined not to give himself away. He may appeal for clues on how to respond, show increased reaction times, and may very often attempt to reject a particular card or the entire procedure. The malingerer must deal with the unexpected when he is presented with the Rorschach, and very often he seems to err by giving an extremely poor or wildly bizarre Wechsler and then a constricted, evasive but "good" Rorschach. Thus, there may be inconsistencies not only on the Rorschach but throughout the battery of tests. Ganser Syndrome Before turning to the simulation of mental deficiency and amnesia, it is necessary to mention a pathological state which resembles malingering and resembles psychosis, but which may be neither. In this condition, the person appears to be psychotic, but his behavior is strikingly similar to that of the person who is simulating psychosis. The symptoms are an imperfect representation of the condition they resemble and correspond to the mental picture that the patient might be expected to have of psychosis (32, 53, 86). MacDonald (58) reports that such a patient may enter a room and stand on his head, wear his clothes inside out, eat the skin instead of the banana, and try to light his cigarette with the wrong end of the match. Instead he gives an approximate answer, one which is not too far wrong and is obviously related to the question, but is wrong nevertheless. This has been called "vorbeireden," or talking past the point, and it was first described by Ganser (26). An example of this would be the patient who says that 2 + 2 equals 5, 5 times 5 equals 24, a cat has three ears, and that there are eleven months in the year. These responses are usually given after great deliberation and concentration, and the patient does not appear to be upset or irritated when he is told he is wrong. Almost all authors agree that this peculiar mental state arises when the patient is faced with a crisis and when irresponsibility would help mitigate the crisis. It is differentiated from malingering in that malin- -289- gering is a deliberate pose, whereas the patient is unaware of the driving forces which lead him into the Ganser syndrome (53, 58, 68, 89). Historically it has been considered a hysterical twilight state, characterized by vorbeireden, clouding of consciousness, excitement or stupor, and bizarre behavior (26, 49).

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Trichinellosis: Trichinellosis (trichinosis) is caused by infecton with the larvae of Trichinella spiralis cheap 4 mg cyproheptadine overnight delivery. Each case of confrmed or even suspected trichinellosis infecton should be treated in order to prevent the contnued producton of larvae order cyproheptadine 4mg free shipping. In both adults and children purchase cyproheptadine 4 mg line, mebendazole (200 mg daily for 5 days), albenda- zole (400 mg daily for 3 days) and pyrantel (10 mg/kg daily for 5 days) are all efectve. Prednisolone (40-60 mg daily) may be needed to alleviate the allergic and infammatory symptoms. Visceral Larva Migrans: Visceral larva migrans (toxocariasis) is caused by infecton with the larval forms of Toxocara canis and less commonly, T. A 3 week oral course of diethyl- carbamazine kills the larvae and arrests the disease, but established lesions are irreversible. To reduce the intensity of allergic reactons induced by dying larvae, dosage is commonly commenced at 1 mg/kg twice daily and raised progressively to 3 mg/kg twice daily (adults and children). Ocular larva migrans occurs when larvae invade the eye, causing a granuloma which may result in blindness. In order to suppress allergic infammatory responses in patents with ophthalmic lesions, prednisolone should be administered concurrently, either topically or systemically. Albendazole* Pregnancy Category-C Schedule H Indicatons Echinococcus multlocularis and E. Hydatd disease: 400 mg twice daily with meals for 28 days (therapy may be repeated afer 14 days in three cycles). Contraindicatons Pregnancy, adequate measures must be taken for non-hormonal contraceptve during and one month afer therapy; hypersensitvity. Precautons Pregnancy (see notes above and Appendix 7c); liver impairment, increased intracranial pressure; seizures; monitor blood count and liver functon. Mebendazole Pregnancy Category-C Schedule H Indicatons Echinococcus granulosus and E. Precautons Pregnancy (Appendix 7c; see also notes above); lactaton; interactons (Appendix 6c, 6d); expulsion of ascaris from mouth or nose; monitor blood count or hepatc functon. Adverse Efects Gastrointestnal disturbances; headache and dizziness; adverse efects associated with use in cestode infectons; abdominal pain, diarrhoea; rashes, urtcaria, angioedema. Precautons Chronic constpaton (restore regular bowel movement before treatment); give antemetc before treatment; not efectve against larval worms; pregnancy (Appendix 7c). Adverse Efects Nausea; retching; abdominal pain; lightheadedness; pruritus; anorexia, emesis, perianal itching. Pyrantel Pamoate Pregnancy Category-C Schedule H Indicatons Ascariasis; hookworm infectons; enterobiasis; trichostrongyliasis; tssue nematode infecton. Dose Oral 11 mg/kg (max 1g) in a single dose (given for 2 consecutve days in case of heavy hookworm infestaton). Precautons Pregnancy (Appendix 7c; lactaton; liver disease (reduce dose); severe malnutriton, anaemia, concurrent administraton with piperazine. Adverse Efects Mild gastrointestnal disturbances; headache; dizziness; drowsiness; insomnia; rash and elevated liver enzymes. It may be a self-limitng localized skin lesion but may range from this to disseminated progressive disease. In endemic areas there is usually a reservoir of disease in a mammalian host and the usual vectors are sandfies. Visceral Leishmaniasis: Visceral leishmaniasis (kala-azar) is caused by Leishmania donovani and L. Both dosage and duraton of treatment need to be adjusted according to the clinical response. Patents are considered to be clinically cured when no parasites are detected in splenic or bone marrow aspirates. However, biopsies should be repeated afer 3 and 12 months since relapse is frequent. Antmonials combined with allopurinol, pentamidine isothionate and amphotericin B have been used with success in patents in relapse who have become unresponsive to antmonials alone. These conditons are charac- terized by a cell-mediated reacton of varying intensity at the site of inoculaton. When the lesion is infamed or ulcerated or when obstructon of lymphatc drainage or destructon of cartlage creates a risk of serious disfgurement or disability, antmonials should be administered systemically as well as locally. In this form of the disease the primary lesions do not heal and spread to the mucosa may occur. It usually responds to antmonials and, when relapses occur, more extended courses of treatment are ofen successful. Patents who stll fail to respond should receive amphotericin B or pentamidine isothionate, although neither treatment is highly satsfactory. Emergency use of cortcosteroids may be needed to control pharyngeal or tracheal oedema produced by severe infam- maton resultng from antgens liberated from dead parasites during the early phase of treatment. Antbiotcs may also be needed to treat secondary infectons and plastc surgery ofers the only means of amelioratng disfg- uring scars.

To ground the pedagogical terms of the іntensification of students‘ cognitive activity Materials and methods generic cyproheptadine 4mg on line. In the results of scientific literature studying and analysis we consider that pedagogical environment for cognitive activity of students intensification – is the pedagogical environment directed by the teacher buy 4mg cyproheptadine mastercard, system of pedagogical methods buy 4 mg cyproheptadine amex, pedagogical interactions complex. In this system, in the context of humanitarian disciplines teaching, it is reasonable to determine the following: democratic relationships between educational process participants; professional orientation providing; interactive methods of education implementation (teaching methods in the game form, methods of critical thinking, projects methods). Realization of above mentioned pedagogical terms in the process of future specialists training in the course humanitarian disciplines teaching allows to form and develop such personal skills as: creativity, capability for studying, purposefulness in the cognitive activity process. With the aim of possibilities creation for individual approach in the process of humanitarian disciplines teaching, it is reasonable to implement into life ―pedagogical optimism‖ principles, to plan and use at auditory classes such methods of teaching which help to create the situation of success during the educational process. Among them: – the ―method of not interfering‖ – it helps to reach maximal self-sufficiency in the tasks solving by the students; – ―emotional encourage‖ – students are encouraged to be self-confident; – ―the situation of giving chance‖ – the creation of situation in terms of which the students get unexpected for themselves possibility to realize their own talents; 377 – ―watch us‖ – the method gives the students the opportunity to feel the joy due to their intellectual power; – ―emotional brainstorm‖ – the situation which provides emotional charge of self-confidence to the students by reminding them about great intellectual possibilities; – ―competition situation creation‖ – the teacher chooses a ―worthy competitor‖ among the group mates and creates a situation of intellectually creative competition under the teacher‘s supervision; –―the friends‘ help‖ – on-time teacher‘s or friends aid for difficulties overcoming; – ―eureka‖ – intensification of the students work for discovery by them well- known facts, what makes them think the problem over; ―the intended mistake method‖ – the teaching method intended for students attention intensification. The author identifies such varieties of the students‘ projective activities as informative and search projects preparation (reports, presentation etc); projects connected with creative activity (video reports, wall newspaper, intellectual games etc); organizational projects (festivals organization, plays and dramas performing, participation in concerts. When organizing the students work on the project, we advise to realize intellectual competitive system of cooperation. Thus, it gives possibilities for reaching the most important targets of education – it provides the students, as the subjects of education, the strategy of educational process and help in the process of their own opportunities development accompanied by realizing the fact that they are really competitive. It is reasonable to organize the projects presentation during the last practical class. On the ground of the fact, that humanitarian education is considered to be as the education, which forms individual culture, we think, that it would be purposeful to refer to the following most significant pedagogical terms of the students‘ cognitive activity: democratic relationships between the participants of educational process; professional orientation of the educational; interactive methods of education. In the modern transformation period of socio-economic development of Ukraine significantly enhanced requirements for quality education of future professionals who will work in the future development of our state. Solving this problem requires new approaches to the educational process and study conditions for its implementation. In light of this priority area of educational differentiation is education, which is necessary for high -quality mastering educational material, increased cognitive activity, exercise self- control, improvement of intellectual, practical and communicative abilities of the future professionals. In the context of the research problem important to emphasize that disclosure of the concept of "differentiation" requires scientific definition of "differentiation". Definition of different approaches to the interpretation of the concept of "differentiation" engaged in such scholars (S. Logical-semantic analysis of the concept of "differentiation" was done by studying articles, dictionaries and encyclopedias. The word "differentiation" is derived from the Latin ―differentia‖, which means the difference, contrast. The notion of differentiation is defined thus: 1) separation section, a separation into different parts, forms, meetings; 2) the emergence of a body (or its site) in the development of morphological and functional differences. It is important to emphasize that education is the principle of unity and differentiation. Most important in the functioning of this principle - is to ensure simultaneous action of these two educational arm lever. Unity means not only access to education for all members of society, lack of social and national barriers, equal rights for graduates continuity of all types of 379 schools, but the common principles of the educational process, the unity of the programs and curricula across the country. Analysis psychologist and educational literature indicates that different authors approach the definition of "differentiated education" from different perspectives and in different ways:  holistic process of preparing the individual for life in the light of its interests, abilities, aptitudes and capabilities, a process in which teacher and student advocate equal, willing and active participants (M. Ohurtsov);  educational system in which there is a division of curricula and programs in areas (humanities, natural - mathematical) (I. Butuzov);  ability to pick and choose the best way to swim students, given their age and individual characteristics and protecting their sense of human dignity (I. Synytsya);  creation of optimal conditions to identify instincts, abilities and interests of each student, is focused on social influence in shaping the creative, intellectual and professional potential of society (V. Yeremeyeva);  specially organized cognitive activity that takes into account individual differences of students, their starting opportunities and social experience aimed at optimal intellectual development of every person and involves structuring the content of educational material selection forms, techniques and methods according to typological characteristics of students (P. Formation of cognitive motivation is not possible without a strong motivation for educational and cognitive activity in higher educational establishment. Motivation determines professional orientation and students‘ activity during their educational and cognitive activity, characterizes the causes and mechanisms of their conscious behavior, and has impact on their professional self- determination and personal development. Motivation for students‘ educational and cognitive activity is variable and it is a continuous process that caused by personal students‘ orientation, activation of all psychological processes (thinking, perception, and understanding). Students with high level of motivation inherent activity and independence, persistence in achieving goals, confidence in a successful result, enjoying the process of their own professional development, and obtaining the necessary professional knowledge and skills. Students‘ educational and cognitive activity is the process of their interaction with the subjects of educational space of a higher educational establishment, so a student reaches deliberately goal, resulting from the emergence of the need to acquire professional knowledge. Motivation for educational and cognitive activity is an indicator of student‘s individual achievements, which is characterized by complex of emotional and volitional processes, determination of grounds on getting chosen specialty and perspectives of self-fulfillment as a specialist. Creating of positive educational motivation is the process of formation and consolidation of positive incentives to educational and cognitive activity in future trainers. The basic meaning of educational and cognitive activity is the changes in intellectual, moral, and personal development.

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The optional (2) Compliance is determined as spec- ingredients referred to in paragraph ified in §146 best cyproheptadine 4mg. Seeds added to adjust soluble solids as pro- (except embryonic seeds and small vided for in paragraph (a)(1) of this sec- fragments of seeds that cannot be sepa- tion cyproheptadine 4mg without a prescription. The name "orange juice" may ther before or after such heat treat- be preceded on the label by the varietal ment trusted cyproheptadine 4mg, all or a part of the product may name of the oranges used, and if the or- be frozen. The finished pasteurized or- anges grew in a single State, the name ange juice contains not less than 10. If the food is reticulata or Citrus reticulata hybrids filled into containers and preserved by (except that this limitation shall not freezing, the label shall bear the name apply to the hybrid species described in "Frozen pasteurized orange juice". Seeds (except embryonic words "pasteurized" or "frozen pas- seeds and small fragments of seeds that teurized" shall be shown on labels in cannot be separated by good manufac- letters not less than one-half the turing practice) are removed, and pulp and orange oil may be adjusted in ac- height of the letters in the words "or- cordance with good manufacturing ange juice". If the adjustment involves the (2) If the pasteurized orange juice is addition of pulp, then such pulp shall filled into containers and refrigerated, not be of the washed or spent type. The the label shall bear the name of the solids may be adjusted by the addition food, "chilled pasteurized orange of one or more of the optional con- juice". If it does not purport to be ei- centrated orange juice ingredients ther canned orange juice or frozen pas- specified in paragraph (b) of this sec- teurized orange juice, the word tion. One or more of the optional "chilled" may be omitted from the sweetening ingredients listed in para- name. The words "pasteurized" or graph (c) of this section may be added "chilled pasteurized" shall be shown in in a quantity reasonably necessary to letters not less than one-half the raise the Brix or the Brix-acid ratio to height of the letters in the words "or- any point within the normal range usu- ange juice". I (4–1–10 Edition) statement "prepared in part from con- this section may be added, in a quan- centrated orange juice" or "with added tity reasonably necessary to raise the concentrated orange juice" or "con- Brix or the Brix-acid ratio to any point centrated orange juice added". However, for the purpose of this the Brix hydrometer reading to the section, the name "sweetener" may be grams of anhydrous citric acid per 100 used in lieu of the specific name or milliliters of juice is not less than 9 to names of the sweetening ingredients. All the words in the follow the name of the food, without name shall appear in the same size, intervening written, printed, or graph- color, and style of type and on the ic matter. Each of the in- the food is not sold under refrigeration gredients used in the food shall be de- clared on the label as required by the and if it does not purport to be chilled applicable sections of parts 101 and 130 pasteurized orange juice or frozen pas- of this chapter. How- unfermented juice obtained from ma- ever, for the purpose of this section, ture oranges of the species Citrus the name "sweetener" may be used in reticulata or Citrus reticulata hybrids lieu of the specific name or names of (except that this limitation shall not the sweetening ingredients. Seeds (except embryonic pears on the label so conspicuously as seeds and small fragments of seeds that to be easily seen under customary con- cannot be separated by good manufac- ditions of purchase, the statement turing practice) are removed. Orange specified in this section for naming the oil and pulp may be adjusted in accord- optional ingredients used shall imme- ance with good manufacturing prac- diately and conspicuously precede or tice. The adjustment of pulp referred to follow the name of the food, without in this paragraph does not permit the intervening written, printed, or graph- addition of washed or spent pulp. To such mixture gredients used in the food shall be de- may be added orange juice as defined in clared on the label as required by the §146. The finished orange from the juice of mature oranges as juice from concentrate contains not provided in §146. In its preparation, (c) The name of the food is "Orange seeds (except embryonic seeds and juice from concentrate". The words small fragments of seeds that cannot "from concentrate" shall be shown in be separated by good manufacturing letters not less than one-half the practice) and excess pulp are removed, height of the letters in the words "or- and a properly prepared water extract ange juice". Orange oil, orange pulp, orange centrate contains any optional sweet- essence (obtained from orange juice), ening ingredient as listed in paragraph orange juice and other orange juice (b) of this section, whether added di- concentrate as provided in this section rectly as such or indirectly as an added or concentrated orange juice for manu- ingredient of any orange juice product facturing provided in §146. I (4–1–10 Edition) added in single strength or con- "frozen concentrated orange juice, centrated form prior to concentration lll plus 1" or "frozen orange juice of the Citrus sinensis juice, or in con- concentrate, lll plus 1", the blank centrated form during adjustment of being filled in with the whole number the composition of the finished food. However, where the label bears aurantium, or both, shall not exceed, on directions for making 1 quart of orange a single-strength basis, the 10 percent juice from concentrate (or multiples of maximum for Citrus reticulata and the 5 a quart), the blank in the name may be percent maximum for Citrus aurantium filled in with a mixed number; for ex- prescribed by this paragraph. Any of ample, "frozen orange juice con- the ingredients of the finished con- centrate, 41⁄3 plus 1". For containers centrate may have been so treated by larger than 1 pint, the dilution ratio in heat as to reduce substantially the en- the name may be replaced by the con- zymatic activity and the number of centration of orange juice soluble sol- viable microorganisms. The finished ids in degrees Brix; for example, a 62° food is of such concentration that when Brix concentrate in 31⁄2-gallon cans diluted according to label directions may be named on the label "frozen con- the diluted article will contain not less centrated orange juice, 62° Brix". The dilution ratio shall be ditions of purchase, the statements not less than 3 plus 1. For the purposes specified in this section for naming the of this section and §146. Each of the in- (c) If one or more of the sweetening gredients used in the food shall be de- ingredients specified in paragraph (b) clared on the label as required by the of this section are added to the frozen applicable sections of parts 101 and 130 concentrated orange juice, the label of this chapter. A process involving the use The name of the food concentrated to a of anionic ion-exchange resins per- dilution ratio greater than 3 plus 1 is mitted by §173.