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Conditional recommendation rumalaya forte 30pills with amex spasms cure, low-quality evidence Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment) Pre-referral treatment options Where complete treatment of severe malaria is not possible but injections are available discount 30pills rumalaya forte amex spasms of the heart, give adults and children a single intramuscular dose of artesunate order rumalaya forte 30 pills online spasms to right side of abdomen, and refer to an appropriate facility for further care. Strong recommendation, moderate-quality evidence Where intramuscular injections of artesunate are not available, treat children < 6 years with a single rectal dose (10 mg/kg bw) of artesunate, and refer immediately to an appropriate facility for further care. Strong recommendation, moderate-quality evidence Mortality from untreated severe malaria (particularly cerebral malaria) approaches 100%. With prompt, effective antimalarial treatment and supportive care, the rate falls to 10–20% overall. Within the broad defnition of severe malaria some syndromes are associated with lower mortality rates (e. The exact risk depends on the species of infecting malaria parasite, the number of systems affected, the degree of vital organ dysfunction, age, background immunity, pre-morbid, and concomitant diseases, and access to appropriate treatment. Tests such as a parasite count, haematocrit and blood glucose may all be performed immediately at the point of care, but the results of other laboratory measures, if any, may be available only after hours or days. As severe malaria is potentially fatal, any patient considered to be at increased risk should be given the beneft of the highest level of care available. The attending clinician should not worry unduly about defnitions: the severely ill patient requires immediate supportive care, and, if severe malaria is a possibility, parenteral antimalarial drug treatment should be started without delay. Severe acidosis manifests clinically as respiratory distress (rapid, deep, laboured breathing). Decompensated shock is defned as systolic blood pressure < 70 mm Hg in children or < 80 mm Hg in adults, with evidence of impaired perfusion (cool peripheries or prolonged capillary refll). Severe knowlesi malaria is defned as for falciparum malaria but with two differences: • P. Secondary objectives are prevention of disabilities and prevention of recrudescent infection. Death from severe malaria often occurs within hours of admission to a hospital or clinic, so it is essential that therapeutic concentrations of a highly effective antimalarial drug be achieved as soon as possible. Management of severe malaria comprises mainly clinical assessment of the patient, specifc antimalarial treatment, additional treatment and supportive care. An open airway should be secured in unconscious patients and breathing and circulation assessed. The patient should be weighed or body weight estimated, so that medicines, including antimalarial drugs and fuids, can be given appropriately. An intravenous cannula should be inserted, and blood glucose (rapid test), haematocrit or haemoglobin, parasitaemia and, in adults, renal function should be measured immediately. A detailed clinical examination should be conducted, including a record of the coma score. Several coma scores have been advocated: the Glasgow coma scale is suitable for adults, and the simple Blantyre modifcation is easily performed in children. Unconscious patients should undergo a lumbar puncture for cerebrospinal fuid analysis to exclude bacterial meningitis. If facilities are available, arterial or capillary blood pH and gases should be measured in patients who are unconscious, hyperventilating or in shock. Blood should be taken for cross-matching, a full blood count, a platelet count, clotting studies, blood culture and full biochemistry (if possible). Careful attention should be paid to the patient’s fuid balance in severe malaria in order to avoid over- or under-hydration. Cerebral malaria is not associated with signs of meningeal irritation (neck stiffness, photophobia or Kernig’s sign), but the patient may be opisthotonic. As untreated bacterial meningitis is almost invariably fatal, a diagnostic lumbar puncture should be performed to exclude this condition. There is also considerable clinical overlap between septicaemia, pneumonia and severe malaria, and these conditions may coexist. In malaria-endemic areas, particularly where parasitaemia is common in young age groups, it is diffcult to rule out septicaemia immediately in a shocked or severely ill obtunded child. In all such cases, empirical parenteral broad-spectrum antibiotics should be started immediately, together with antimalarial treatment. Two classes of medicine are available for parenteral treatment of severe malaria: artemisinin derivatives (artesunate or artemether) and the cinchona alkaloids (quinine and quinidine). The largest randomized clinical trials ever conducted on severe falciparum malaria showed a substantial reduction in mortality with intravenous or intramuscular artesunate as compared with parenteral quinine. The reduction in mortality was not associated with an increase in neurological sequelae in artesunate-treated survivors. The trials were conducted in various African and Asian countries between 1989 and 2010. Other considerations The guideline development group considered that the small increase in neurological sequelae at discharge after treatment with artesunate was due to the delayed recovery of the severely ill patients, who would have died had they received quinine. Although the safety of artesunate given in the frst trimester of pregnancy has not been frmly established, the guideline development group considered that the proven benefts to the mother outweigh any potential harm to the developing fetus. Strong recommendation based on pharmacokinetic modelling The dosing subgroup reviewed all available pharmacokinetic data on artesunate and the main biologically active metabolite dihydroartemisinin following administration of artesunate in severe malaria (published pharmacokinetic studies from 71 adults and 265 children). Simulations of artesunate and dihydroartemisinin exposures were conducted for each age group. The revised parenteral dose regimens are predicted to provide equivalent artesunate and dihydroartemisinin exposures across all age groups. Population pharmacokinetics of intravenous artesunate: a pooled analysis of individual data from patients with severe malaria. Artesunate is dispensed as a powder of artesunic acid, which is dissolved in sodium bicarbonate (5%) to form sodium artesunate. The solution is then diluted in approximately 5 mL of 5% dextrose and given by intravenous injection or by intramuscular injection into the anterior thigh. The solution should be prepared freshly for each administration and should not be stored. Artesunate is rapidly hydrolysed in-vivo to dihydroartemisinin, which provides the main antimalarial effect. Studies of the pharmacokinetics of parenteral artesunate in children with severe malaria suggest that they have less exposure than older children and adults to both artesunate and the biologically active metabolite dihydroartemisinin. Body weight has been identifed as a signifcant covariate in studies of the pharmacokinetics of orally and rectally administered artesunate, which suggests that young children have a larger apparent volume of distribution for both compounds and should therefore receive a slightly higher dose of parenteral artesunate to achieve exposure comparable to that of older children and adults. Between 2010 and 2012, there were six reports involving a total of 19 European travellers with severe malaria who were treated with artesunate injection and developed delayed haemolysis. In a prospective study involving African children, the same phenomenon was reported in 5 (7%) of the 72 hyperparasitaemic children studied. Artesunate rapidly kills ring-stage parasites, which are then taken out of the red cells by the spleen; these infected erythrocytes are then returned to the circulation but with a shortened life span, resulting in the observed haemolysis. Thus, post-treatment haemolysis is a predictable event related to the life-saving effect of artesunate. Hyperparasitaemic patients must be followed up carefully to identify late-onset anaemia. Artemether and artesunate have not been directly compared in randomized trials in African children.
D O’Mahony buy cheap rumalaya forte 30pills spasms that cause coughing, P Gallagher discount rumalaya forte 30pills with visa muscle relaxant zolpidem, C Ryan discount generic rumalaya forte canada spasms eye, S Byrne, H Hamilton, P Barry, M O’Connor, J Kennedy. Use of Medicines in nursing homes for older people: Advances in Psychiatric Treatment. Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013). National Quality Standards for Residential Care Settings for older People in Ireland. National Standards for Residential Services for Children and Adults with Disabilities. National Guidelines – Communicating with service users and their families following adverse events in healthcare. How-to Guide: Prevent Adverse Drug Events by Implementing Medicines Reconciliation. Miscellaneous Provisions Act, 2006 Medicinal Products (Prescription and Control of Supply) Regulations, 2003 (S. Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations (S. Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2011. Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended. Managing and administering medicines in care homes for older people: A review of information and literature. Explanatory note on the Documentation and Other Requirements to be met by Pharmacists in Retail Pharmacy Businesses in making supplies of Controlled Drugs to patients in nursing homes. Guidance on the Supply by Pharmacists in Retail Pharmacy Businesses of Medicines to Patients in Residential Care Settings/Nursing Homes. Individuals 65 years direct efects or cross-use efects are not often considered; and older account for one-third of all medications • The use of alcohol in conjunction with prescribed, which is disproportionate to many pharmaceuticals poses signifcant the percentage of the population that they risks; and represent, approximately 13% of the population • Fortifed foods, dietary supplements, in the United States. Furthermore, the number of and “functional foods” sold with varying people over 65 taking three or more prescription biological efects. Overarching is the issue of how these drugs increased from about one-third in 1988 to substances can interact to potentate or almost one-half in 2000. Misuse is defned as non-adherence to prescription directions and can be either willful or accidental. Non- adherence may place an undue burden on social services through increased use of medical resources (physician visits, lab tests, hospital admissions etc. Prescription drug abuse is present • Morphine (Kadian®, Avinza®) in 12% to 15% of elderly individuals who seek medical • Codeine (Tylenol® #2, 3, 4) attention. In addition to the toll on individuals and • Oxycodone (OxyContin®, Percodan®, Percocet®) families, abuse places a heavy fnancial toll on health • Hydrocodone (Lortab®, Lorcet®, Vicodin®) care systems. Health problems related to substance • Propoxyphene (Darvon®) abuse cost Medicare $233 million dollars in 1989, • Fentanyl (Duragesic®) and probably account for much larger expenditures • Hydromorphone (Dilaudid®) today. Whereas youth are using prescription - Alprazolam (Xanax®) drugs to get high, party, or as a study aid, senior - Triazolam (Halcion®) citizens, the focus of this issue, are more inclined - Estazolam (ProSom®) towards inadvertent misuse. Abuse or misuse of prescription drugs is second only to alcohol abuse in Common stimulants include: this over 65 demographic. Primarily used include opiates, central nervous system depressants, 3 to treat anxiety and sleep disorders, there are two types and stimulants due to their addictive qualities. Opiates are very efective analgesics (pain narcolepsy and attention defcit hyperactivity disorder relievers). The most commonly known prescription as well as elevate blood pressure, heart rate, and opiates are Vicodin® and OxyContin®. Currently one in eight Americans consumer segment for legal drugs in the United States. More specifcally, elderly individuals use prescription The first wave of baby boomers will turn 60 over the drugs approximately three times as frequently as the next decade. The estimated annual expenditure people 65 and older than 14 and under in the United on prescription drugs by the elderly in the United States States. Of the current population, 83% of older adults, people age 60 and over, take prescription drugs. Older adult women take an average of fve prescription drugs at a time, for longer periods of time, than men. And studies show that half of those drugs are potentially addictive substances, like sedatives, making older females more susceptible to potential abuse issues. Contributing factors The life changes that occur as one reaches their twilight years are signifcant. Elderly patients can experience a mixture of social-emotional, physical, and functional changes that may encourage addiction. Physiological contributors include high rates of co-morbid illnesses, changes in metabolism (that afect drug potency), and shifting hormone levels, for example changes in melatonin levels resulting in altered sleep/wake cycles. Mental health concerns also arise, especially with those experiencing major health problems. Though not considered a normal part of aging, depression is a specifc concern that can initiate or exacerbate a decline in function and overall health. Physically, some seniors slow down and become compromised in their mobility and dexterity. If unable to engage socially or participate in activities-of-daily-living as they are accustomed to, seniors may turn to using medications that ease this reality or that appear to make life easier. Often, doctors prescribe “coping” drugs to help patients with anxiety, depression, or sleeplessness, many of which are addictive. Some factors to consider when examining this issue include: • The elderly are more likely to be prescribed several diferent medications at once and for a prolonged duration of time. Symptoms can be masked by normal or perceived signs of aging, the elderly may deny symptoms of abuse, and may be unaware of their misuse. This include the following: contrasts with the 56% increase in prescriptions written for non-controlled medications. As with other • Many of the symptoms of misuse and abuse populations, seniors who are using these medications mirror common signs of aging in general. Some of these continue use: perceptions include: (1) Prescription Fraud - This ranges from forging or altering prescriptions, to impersonating physicians over • Memory loss the phone, to producing counterfeit prescriptions. The individual then • Chronic boredom has these prescriptions flled at diferent pharmacies to avoid suspicion of illegal activity. Many elderly individuals are turning to not uncommon for a person to have multiple internet pharmacies for discount price prescription prescriptions for diferent conditions, without any drugs.
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Gen Dent 61:33 cheap rumalaya forte 30 pills without prescription spasms in back, of bone resorption that shows treatment effect more often than 2013 cheap generic rumalaya forte uk spasms with kidney stone splint. Graziani F order rumalaya forte 30 pills on line muscle relaxant 5658, Vescovi P, Campisi G, et al: Resective surgical ap- multiple myeloma patients: clinical features and risk factors. J Clin proach shows a high performance in the management of advanced Oncol 24:945, 2006. Mucke T, Koschinski J, Deppe H, et al: Outcome of treatment and parameters infuencing recurrence in patients with bisphospho- nate-related osteonecrosis of the jaws. Saussez S, Javadian R, Hupin C, et al: Bisphosphonate-related lofac Surg 72:61, 2014. Ann Oncol 20:331, Proposal of a refned defnition and staging system for bisphospho- 2009. Oral Surg Oral Med Oral for osteonecrosis of the jaw secondary to bisphosphonate therapy. Ferrari S, Bianchi B, Savi A, et al: Fibula free fap with endosse- Surg 67:96, 2009. Atropine, scopolamine Adrenergic drugs (catecholamines, noncatecholamines) Catecholamines Ex. Benztropine, diphenhydramine, levodopa, carbidopa-levodopa Anticonvulsant drugs Ex. Phenytoin, Phenobarbital, Carbamazepine, Clonazepam, Valproic acid Antimigraine drugs Ex. Aspirin, acetaminophen, ibuprofen, naproxen Opioid agonist and antagonist drugs Ex. Disopyramide, quinidine, lidocaine, flecainide, propranolol, amiodarone,sotalol, verapami Ex. Systemic antibiotics, antacids, H2-receptor antagonists, cimetidine, rantidine Proton pump inhibitors, omeprazole Antidiarrheal and laxative drugs Ex. Diphenoxylate with atropine, loperamide, kaolin, psyllium, docusate, bisacodyl, mineral oil Antiemetic and emetic drugs Ex. Selective serotonin reuptake inhibitors – fluoxetine, sertraline Tricyclic antidepressants – amitriptyline, amoxapine Monoamine oxidase inhibitors – phenelzine, trancylcypromine Miscellaneous – Lithium, trazadone Antipsychotic drugs Ex. Tamoxoifen, testosterone, flutamide, medroxyprogesterone Monoclonal antibodies Ex. This increase is largely attributed to deaths involving prescription opioid analgesics—this coincided with a nearly 4 fold increase in use of prescription opioids nationally (Hernandez & Nelson, 2010; Paulozzi, Budnitz, & Xi, 2006). Acute Medication Side Effects and Withdrawal Symptoms Prescription drugs all have potential acute (side) effects that range from mild symptoms to more severe reactions that can lead to significant morbidity and potentially death (see above). Frequent use of stimulants during a short period of time can lead to feelings of hostility or paranoia. Large doses can lead to irregular heartbeat and high body temperature, as well as potential for heart failure or seizures. These long-term effects can lead to an increase in physical disability related to these subsequent medical conditions (Manchikanti & Singh, 2008). Opioid analgesics, which are in the pain reliever category of prescription drugs, are more likely to lead to dependence. In 2004, 1 in 3 adolescents in drug treatment had a diagnosis of prescription drug abuse or dependence (Colliver et al. National survey data suggest that adolescent females may be at greater risk of dependence on prescription drugs compared to their male counterparts. There are several hypothesized reasons for this difference, including potentially greater pharmacologic sensitivity in females, as well as greater access to prescription drugs by females since they are more likely to be prescribed medications (Cotto et al. Hall and colleagues (2010) found that among a sample of 723 adolescents in residential care for antisocial behavior, those who endorsed high levels of anxiety and depression also reported significantly greater amount of sedative/anxiolytic misuse compared to adolescents who did not report high levels of anxiety and depression. Both groups of adolescents reported high scores on a measure of depression (Subramaniam & Stitzer, 2009). Additional research is needed to determine whether certain classes of prescription drugs are related to different types of psychiatric or other medical conditions. The regions that appear to be affected include brain regions responsible for the regulation of affect and impulse control, as well as the centers of the brain involved in reward and motivation functions (Upadhyay et al. However, in a longitudinal study of adolescents assessed from grade 10 to age 20, the only unique predictor of nonmedical opiate prescription drug use was violent behavior. This relationship remained significant after accounting for licit (alcohol, tobacco) and illicit (marijuana, cocaine/crack, psychedelics, heroin) drug use (Catalano et al. Academic Functioning Greater misuse of prescription drugs is associated with lower levels of educational attainment (Harrell & Broman, 2009). Economic loss associated with decreased work productivity due to disability, death and withdrawal from the workforce is also included. Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991-1992 and 2001-2002. Unintentional overdose and suicide among substance users: A review of overlap and risk factors. Gender effects on drug use, abuse, and dependence: a special analysis of results from the National Survey on Drug Use and Health. Racial/ethnic differences in correlates of prescription drug misuse among young adults. Nonmedical prescription drug use in a nationally representative sample of adolescents: evidence of greater use among rural adolescents. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Does early onset of non- medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Emergency department visits involving nonmedical use of selected prescription drugs - United States, 2004-2008. Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999– 2008. Nonmedical use of prescription opioids among teenagers in the United States: trends and correlates. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. If we approve the request, payment is still subject to all general conditions of Amerigroup, including current member eligibility, other insurance and program restrictions. To help us expedite your Medicaid authorization requests, please fax all the information required on this form to 1-800-359-5781.
There is discrimination “de facto” buy cheap rumalaya forte 30 pills on line spasms pregnant belly, when the measure order rumalaya forte 30 pills overnight delivery spasms right side under ribs, while apparently being of general application discount rumalaya forte 30 pills fast delivery muscle relaxant in surgeries, only affects the covered foreign investor. Mexico tribunal made a distinction between producers and resellers of cigarettes; the Champion Trading v. United States tribunal made a distinction between steel producers in general and those who could participate in a highway project. United States the tribunal established that “…it would be as perverse to ignore identical comparators if they were available and use comparators that were less like, as it would be perverse to refuse to find and apply less like comparators when no identical comparators exist”. Any other interpretation would negate the effect of the non-discriminatory provisions…” See Corn Products International Inc. Canada tribunal established that “Differences in treatment will presumptively violate Article 1102(2), unless they have a reasonable nexus to rational government policies that: (i) do not distinguish, on their face or de facto, between foreign-owned and domestic companies. However, an objective approach, where current international law concepts are considered, is generally used where multilaterals treaties dealing with human rights or maritime territory are in issue, being areas where international law has developed rapidly…” (Dixon and McCorquodale 2003). The treaty also specifies whether the treatment afforded to foreign investors and/or their investments is circumscribed to the post- establishment phase or whether it will apply to the pre-establishment phase as well. Illustrative examples of treaties can be found that identify the beneficiaries, covered phases of the investment cycle, conditions, exceptions and qualifications/clarifications. The post-establishment model is generally constructed through an “admission clause” in the basic treaty explicitly subjecting the entry of investments to the domestic legal framework. Each Contracting Party shall admit investments in accordance with its laws and regulations. Neither Contracting Party shall in its territory subject investments or returns of investors of the other Contracting Party to treatment less favourable than that which it accords, in like circumstances, to investments or returns of its own investors or to investments or returns of investors of any third State 2. Neither Contracting Party shall in any way impair by arbitrary or discriminatory measures the management, maintenance, use, enjoyment or disposal of investments in its territory of investors of the other Contracting Party. Article (3) National Treatment and Most-Favoured-Nation Treatment (1) Neither Contracting Parties shall in its territory subject investments owned or controlled by investors of the other Contracting Party to treatment less favourable than it accords to investments of own investors or to investments of investors of any third State. Energy Charter Treaty (1994) Article 10 Promotion, Protection and Treatment of Investment […] (2) Each Contracting Party shall endeavour to accord to Investors of other Contracting Parties, as regards the Making of Investments in its Area, the Treatment described in paragraph (3). That treaty shall be open for signature by the states and Regional Economic Integration Organizations which have signed or acceded to this Treaty. Negotiations towards the supplementary treaty shall commence not later than 1 January 1995, with a view to concluding it by 1 January 1998. This development can be explained by the fact that these treaties pursue liberalization objectives and see deeper investment commitments as interlinked with trade (particularly trade in services) disciplines. Pre-establishment covers the entry phase, which means that host States may not apply any discriminatory measure between foreigners as far as the entry conditions of the investor are concerned. In other words, under this model the host State accepts a certain limit on its sovereignty to regulate foreign investment. Given these far-reaching effects pre-establishment commitments are normally accompanied with specific country exceptions (through a “negative” or “positive” 1 list approach ) as opposed to the post-establishment model. There are variations as to liberalization commitments, notably when it comes to economic integration arrangements or regional agreements on investment. Each Party shall accord to investors of another Party treatment no less favorable than that it accords, in like circumstances, to investors of any other Party or of any non-Party with respect to the establishment, acquisition, expansion, management, conduct, operation, and sale or other disposition of investments in its territory. Each Party shall accord to covered investments treatment no less favorable than that it accords, in like circumstances, to investments in its territory of investors of any other Party or of any non-Party with respect to the establishment, acquisition, expansion, management, conduct, operation, and sale or other disposition of investments. The Parties agree to widen the scope of this Agreement to cover the right of establishment of one Party’s firms on the territory of the other and liberalisation of the provision of services by one Party’s firms to consumers of services in the other. The Association Council will make recommendations for achieving the objective described in paragraph 1. The Association Council will make a first assessment of the achievement of this objective no later than five years after this Agreement enters into force. There may be measures affecting the investment but not the investor, affecting the investor but not the investment or affecting both. By doing so the Contracting Parties substantially ease the commitment given that the investment shall be bound not only by the conditions of entry but also by any new measure issued in the form of a law or regulation by the host State (see box 12). Without prejudice to its laws and regulations, each Contracting party shall accord to investments and activities with such investments by the investors of the other Contraction Party treatment not less favorable than that accorded to the investments and associated activities by its own investors. Neither Contracting Party shall subject investments and activities associated with such investments by the investors of the other Contracting Party to treatment less favorable than that accorded to the investments and associated activities by the investors of any third State. Examples of general exceptions include: public order and morals, national security, and emergency exceptions and the denial of benefits clause. The first refers to the benefits or privileges granted by a State by virtue of free trade agreements, customs unions, labour integration markets or any other sort of regional economic arrangements. The second exception refers to international agreements that partly or mainly deal with taxation issues. The reason is that under double-taxation treaties, the contracting parties partly renounce, on a mutual basis, their right to tax investors located in their territories in order to avoid double taxation. The treatment granted by this Article does not refer to the advantages that one of the Contracting Parties grants to the investor of a third State as a result of an agreement to avoid the double taxation or other agreements relating to taxation matters. In case there is no such double taxation agreement between the Contracting States, the respective national tax law shall be applicable. The treatment granted under this Article shall also not relate to advantages which either Contracting State accords to investors of third States by virtue of a double taxation agreement or other agreements regarding matters of taxation. The reason is that States may have a number of potentially inconsistent measures as regards entry conditions. These exceptions must be consistent with the domestic framework and reflect existing non-conforming measures. Here, the exceptions do not necessarily reflect domestic law but allows some flexibility that the Contracting Parties wishes to retain with respect to said sectors, sub-sectors or activities. The provisions of Articles 3, 4 and 6 of this Agreement shall not apply to: (a) procurement by a Party or state enterprise; (b) subsidies or grants provided by a Party or a state enterprise, including government-supported loans, guarantees and insurance; 6. The provisions of Article 4 of this Agreement shall not apply to financial services. Canada reserves the right to adopt or maintain any measure that accords differential treatment to a country pursuant to any existing or future bilateral or multilateral agreement relating to: a) aviation; b) fisheries; c) maritime matters, including salvage. If a Party accords more favourable treatment to investors of a non-Party and their investments by concluding or amending a free trade agreement, customs union or similar agreement that provides for substantial liberalisation of investment, it shall not be obliged to accord such treatment to investors of the other Party and their investments. Any such treatment accorded by a Party shall be notified to the other Party without delay and the former Party shall endeavour to accord to investors of the latter Party and their investments treatment no less favourable than that accorded under the concluded or amended agreement. The former Party, upon request by the latter Party, shall enter into negotiations with a view to incorporating into this Agreement treatment no less favourable than that accorded under such concluded or amended agreement. Each Party shall accord to investors of the other Party treatment no less favourable than that it accords, in like circumstances, to investors of any third State with respect to the establishment, acquisition, expansion, management, conduct, operation, and sale or other disposition of investments in its territory. Notwithstanding paragraphs 1 and 2, the Parties reserve the right to adopt or maintain any measure that accords differential treatment: (a) to socially or economically disadvantaged minorities and ethnic groups; or b) involving cultural industries related to the production of books, magazines, periodical publications, or printed or electronic newspapers and music scores. Different treatment is justified if the would-be comparators are in different objective situations.