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The condition types used to determine taxes are country-specific, thus I have not selected any in the previous table To use as an example, we will create a condition type representing a percentage discount from the sales price of a product, based on the conditions of sales organization, customer price group, and material (this information comes from the sales order) Our access sequence will have a second step of searching for a condition record to offer the discount based on the material only We ll begin by selecting the closest resemblance to the condition type we are after in the list of standard condition types This would be the standard condition type K007 In Figures 8-1 and 8-2 you will see the details that define how the condition type is to perform Here we are copying the standard condition type K007 and creating condition type Z007 In Figure 8-1 we see the condition type is automatic that is, a condition record will be found, if one exists, automatically This is seen by the assignment of an access sequence, K007 Should there be no access sequence, the condition type can then either be assigned a value manually or via a routine/formula The condition class is A, which determines that the condition type is a discount or surcharge This condition class is used by the system to determine what conditions it must redetermine and when For example, a copying rule may indicate to copy pricing conditions unchanged and re-determine taxes; the system would then use this indicator to determine what condition types are taxes, etc Specific rules are applied to the pricing type, in copy control, the pricing type G means Copy pricing elements unchanged and redetermine taxes The system will then re-determine the following condition types: Taxes (condition class D) Rebate (condition class C) Intercompany billing conditions (condition category I) Invoice list conditions (condition category R) Condition types with condition category L Cost conditions (condition category G) Cash discount conditions (condition category E).

D Human Growth Hormone (hGH)

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Recombinant human growth hormone (rhGH) has been synthesized as a 191-amino acid sequence (somatropin) identical to hGH; an rhGH of 192 amino acids (somatrem) is also available and is of equal potency Symptomatic adults with severe GH deficiency (serum IGF-I below 85 mcg/L) may be treated with a subcutaneous rhGH injection starting at a dosage of about 02 mg (06 IU)/day, administered three or four times weekly The dosage of rhGH is increased every 2 4 weeks by increments of 01 mg (03 IU) until side effects occur or a sufficient salutary response and a normal serum IGF-I level are achieved A sustained-release injectable suspension of GH is available (somatropin depot) It can be given once monthly and is therefore more convenient than standard rhGH preparations; however, its safety and dosing in adults remain to be established If the desired effects (eg, improved energy and mentation, reduction in visceral adiposity) are not seen within 3 6 months at maximum tolerated dosage, rhGH therapy is discontinued During pregnancy, rhGH may be safely administered to women with hypopituitarism at their usual pregestational dose during the first trimester, tapering the dose during the second trimester, and discontinuing rhGH during the third trimester Oral estrogen replacement reduces hepatic IGF-I production Therefore, prior to commencing rhGH therapy, oral estrogen is changed to a transdermal or transvaginal estradiol Side effects of rhGH therapy may include peripheral edema, hand stiffness, arthralgias, myalgias, headache, pseudotumor cerebri, gynecomastia, carpal tunnel syndrome, tarsal tunnel syndrome, hypertension, and proliferative retinopathy Side effects are more common in older patients, those with greater weight and higher BMI, and those with adult-onset GH deficiency Such symptoms usually remit promptly after a sufficient reduction in dosage Excessive doses of rhGH could cause acromegaly; patients receiving long-term therapy require careful clinical monitoring Serum IGF-I levels should be kept in the normal range and periodic determinations of serum IGF-I levels are helpful in guiding therapeutic dosing GH should not be administered during critical illness since, in one study, administration of very high doses of rhGH to patients in an intensive care unit was shown to increase overall mortality There is no role for GH replacement in the somatopause of aging Patients with resistance to GH have severe short stature and IGF-I deficiency IGF-I (mecasermin) is available to treat such patients.

Levothyroxine is given to correct hypothyroidism only after the patient is assessed for cortisol deficiency or is already receiving corticosteroids (See Hypothyroidism) The typical maintenance dose is about 16 mcg/kg body weight However, dosage requirements vary widely, averaging 0125 mg daily with a range of 0025 03 mg daily The optimal replacement dose of thyroxine for each patient must be carefully assessed clinically on an individual basis Serum free thyroxine (FT4) levels usually need to be in the high-normal range for adequate replacement Assessment of serum TSH is useless for monitoring patients, since levels are always low with TSH deficiency

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