Introduction Institutions, understood as the formal and informal rules that constrain human behaviour, mainly reflect dynamics which are rooted in specific social, political and economic realities. Whatever attempt to understand the origins of the stagnation in the institutional development of MERCOSUR cannot, therefore, but start with a study of these dynamics. With the intention of contributing an analysis of these characteristics, this article will focus mainly on certain dynamics which were to be found in the regional economic arena in the 90's, a time when the region changed radically the pillars on which its development had been based for the previous fifty years. An analysis of this type cannot, however, concentrate solely on the regional dimension ignoring certain particular dynamics which were to be found in the international and national markets at that same time. In the former, as can be seen in Figures 1 and 2, from the mid-70's and the mid-80's respectively an acceleration in growth in the global flows of trade and foreign direct investment was recorded, reflecting great technological advances which allowed for a reduction in the cost of transport and communication as well as a for a reduction in restrictions on the movement of goods, services, and capital between countries and the multiplication in the number of agreements at a multilateral, plurilateral and bilateral level to regulate those processes. These transformations have favoured the creation of new and more profound relations and interdependencies between countries and between companies, mainly through alliances and mergers led by transnational companies. Furthermore, they have also allowed for the progressive specialization of work within companies and the adoption of long-term growth strategies with globally extension which have given rise to "global plants" which reproduce on a larger scale processes which previously had been limited to the local arena1. In this context, companies -once again especially transnational ones-, have "regionalized" their strategies and structures favouring a de facto integration which, in turn, has a strong influence on the characteristics to be adopted by the formal regionalisation that, in the case of MERCOSUR, is guided by the states. MERCOSUR countries actively took part in this process attracting 3.1% of global foreign direct investment flows between 1991 and 1996, and 4.4% between 1997 and 2000, which represented around 19% of foreign investment directed to developing countries and almost 45% of that directed to Latin America and the Caribbean2. This, as we can see from Figures 3 and 4, explained the increasing prominence of transnational affiliates within the top companies in the countries of the region, both in terms of participation and sales. Moreover, when the Treaty of Asuncin was signed, on a national level it was the moment when profound structural reform programmes were implemented by countries in the region which were clearly on the same wavelength as the aforementioned international trend towards liberalisation. The reforms signalled an end to the import substitution industrialization ISI ; strategy that countries had in place since the 30's and the opening up of a new economic and social path of development. These reforms, which included the privatisation of public companies, the deregulation of the markets and a large unilateral opening up to the international flows of goods, services and capital amongst other measures, had a significant impact on the national production.

PHARMACISTS INTERVENTION IN CARDIAC RISK REDUCTION FOR PATIENTS WITH THE METABOLIC SYNDROME * Kimberly A Boaz, Bella H Mehta, and Jennifer L Rodis The Ohio State University College of Pharmacy, 500 W 12th Avenue, Parks Hall, Columbus, OH, 43235 boaz.6 osu Purpose: For patients identified with the Metabolic Syndrome MetS ; , the purpose of this study is to 1 ; assess patient perceptions of personal cardiovascular risks, 2 ; measure changes in outcomes of cardiovascular risk measures with the pharmacist intervention and 3 ; report on patient satisfaction. Methods: Patients will be recruited through wellness screenings. Patients must meet 3 out of 5 criteria for MetS according to NCEP-ATP III guidelines. Eligible patients will be contacted by a clinical pharmacist for voluntary enrollment in the Cardiac Risk Reduction CRR ; clinic. The pharmacist will meet with each patient initially and at 4-week intervals up to 12 weeks, and follow-up at 24 weeks. At each visit, a Framingham 10year risk prediction score will be calculated, and measurements of total cholesterol, LDL, HDL, triglycerides, blood pressure, fasting blood glucose, abdominal girth, and weight will be performed. The pharmacist will provide patient education on lifestyle modification and serve as a health coach to assist the patient in setting goals to decrease risks. Patients will complete baseline surveys to assess patient satisfaction with pharmacist care and to assess perceived cardiovascular risks. The patient satisfaction survey will be repeated at 12 weeks and at 24 weeks and the assessment of perceived cardiovascular risks will be repeated at 12 weeks. Results: To date, of the 58 patients screened, 11 patients have met the diagnostic criteria for MetS and therefore qualify for the study. Screenings and data collection will continue. Currently, two patients are enrolled in the study. Outcomes measured will include patient satisfaction with the program, changes from baseline of Framingham 10-year risk scores, changes in diagnostic parameters, and changes in patient perceptions of cardiovascular risks. Conclusions: It is expected that improvements will be seen in cardiovascular risk measures and that patients will be satisfied with the pharmacist's intervention. Learning Objectives: Understand the diagnostic criteria for the metabolic syndrome according to the NCEP-ATP III guidelines. Evaluate the prevalence of metabolic syndrome and discuss current pharmacologic and non-pharmacologic recommendations for treatment. Self Assessment Questions: True or False: A patient may meet the diagnostic criteria for metabolic syndrome regardless of LDL cholesterol level. True or False: The World Health Organization definition of metabolic syndrome differs from the NCEP-ATP III definition in that it focuses on glucose regulation and insulin resistance.

Benefits: This activity primarily encourages creativity but is also a medium through which discipline and team spirit gets established. Students are more conscious of their manners and good behavior when they work as a team; they are more considerate and adaptable; and they gain a lot of confidence. What is striking is that this method empowers the student to make decisions this goes a long way in helping them make the right decisions, it teaches them discrimination. The science behind it: Effective learning takes place when children put into practice what they have learnt in theory over a period of time. Teaching needs to incorporate experiential techniques and establish two-way communication. Students need to discuss and experience lessons. When a father tells his three year old not to play with the photo frame crystal vase or it will break; he does not learn that. Only when he picks up the object and drops it, it breaks. It is then that the child learns through experience. With small group discussions and activities related to specific topics, the learning experience becomes our own and we remember it permanently. Children can listen to hours of lecture on the life cycle of a butterfly, but how much of it can be retained? Only by actually watching the formation of the cocoon and seeing the butterfly emerge out of the curtailing cocoon, can the child internalize factual information into a personal learning experience. When information is colored with story telling we take more interest, we remember the point much better. The strength of emotion deepens the impact of memory. Weaving the story into the fabric of the lesson will leave a lifetime impression on us. So also does drama, art, singing, etc, strengthen our learning experience and expand our awareness. The teacher must keep in mind while designing lessons that some children are visual learners, some audio learners, some.

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The purpose of these notes is to explain the institutional structure and the form of civil society's participation in the Dominican Republic's trade negotiations. We have divided our presentation into three parts: first, we will examine the context of trade policy. The Dominican Republic was an isolated country whose exports were mainly focused on a few traditional farm products. In recent years it has attempted to develop an active policy of insertion in international markets while restructuring its foreign currency income based on services. Secondly, we will deal with the institutions associated with the negotiations. This determines the framework of participation for social agents. Finally, we will present an explanation of the manner in which the private sector and civil society in general participate in trade negotiations. The context of trade policy In 1990 the Dominican Republic was probably the most isolated country in America. This situation was the result of various factors. They included historic reasons, a deliberate policy of abandonment in regard to external relations, an export structure that was concentrated on a few traditional products which were sold in preferential markets, the late development of industry through import substitution and finally, the restructuring of foreign currency income around tourism and the customs-free areas, aimed at a preferential market in the US. During the sixties, seventies and part of the eighties, the centre of economic activity was the export of sugar, coffee, cocoa and tobacco 75% 90% of foreign income ; and the external trade policy aggressive and successful consisted in maintaining and expanding the sugar quota in the preferential North American market. International policy was passive and kept step with the US. The main items on the foreign agenda were the Haitian question which was limited to managing problems along the border, and the US agenda which was limited to the sugar quota and technical, financial and military co-operation. Conscientious industrial development began in 1968. It never passed the "easy stage" and failed to develop an export base. It led to a highly-protectionist and regulation-based trade policy licences, import duties, permits, prohibitions and exemptions ; affecting both exports and imports CEPAL 2001, p.243 ; . The import-substitution strategy entered into crisis in the eighties. Three factors coincided. These were the growing need for imports, which placed constraints on the balance of payments, severe falls in prices and a structural crisis in the export business2 sugar, coffee, cocoa and tobacco ; together with the pressure of external debt. During the eighties, foreign currency income was restructured and traditional export activities dismantled. The latter were replaced by the export-processing zones for exports and by tourism.

In 1999, the New Jersey Supreme Court issued its decision in Perez v. Wyeth Laboratories, Incorporated, becoming the first court to recognize a direct-to-consumer advertising exception to the learned intermediary doctrine.172 At the time, manufacturers were legitimately concerned that other jurisdictions would follow suit. That has not occurred, however. To the contrary, since Perez, every jurisdiction to consider a direct-to-consumer advertising exception has rejected it. Not only have other jurisdictions not embraced a direct-to-consumer advertising exception to the learned intermediary doctrine, but a New Jersey court has seemingly limited the exception. In Banner v. Hoffmann-La Roche Inc., the New Jersey Superior Court rejected the plaintiffs' contention that the direct-to-consumer advertising barred application of the learned intermediary doctrine.173 In that case, the plaintiffs alleged that Accutane caused severe birth defects in their son. The plaintiffs alleged that the manufacturer marketed the drug directly to the patient and, in doing so, failed to provide patients with adequate warnings of the risk of birth defects. Plaintiffs specifically allege that the manufacturer engaged in the following direct-to-consumer advertising: 1 ; supplied doctors' offices with brochures concerning Accutane; 2 ; placed non-branded ads in magazines; and 3 ; developed a Pregnancy Prevention Program.174 The court ruled that "Plaintiffs, in our view, read Perez too broadly." The Court ruled that in recognizing a direct-to-consumer advertising exception to the learned intermediary doctrine, the New Jersey Supreme Court "rested its conclusion upon the dramatic shift that had occurred in the nature of marketing of prescription medications, from advertisements directed solely to the prescribing physicians to advertisements directed to the consuming public and intended to induce the patient to request a particular medication."175 According to the New Jersey Superior Court, the court in Perez "stressed the mass nature of such advertising, involving television, radio, magazine, and newspapers."176 The court ruled that the plaintiffs' allegations of direct-to-consumer advertising-- informational brochures, non-branded ads, and the Pregnancy Prevention Program -- "cannot fairly be equated with a course of mass advertising or be deemed direct-to-consumer advertising so as to remove and permax.

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