text:
RxNorm Names
HYDROMORPHONE HYDROCHLORIDE injection, solution
[Hospira, Inc.]
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http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e9c9ef18-7dfc-4322-b2fc-29b934c30f8bCategory | DEA Schedule | Marketing Status |
HUMAN PRESCRIPTION DRUG LABEL | CII | New Drug Application |
HIGHLIGHTS OF PRESCRIBING INFORMATIONThese highlights do not include all the information needed to use HYDROMORPHONE HYDROCHLORIDE INJECTION, USP safely and effectively. See full prescribing information for HYDROMORPHONE HYDROCHLORIDE INJECTION, USP.
HYDROMORPHONE HYDROCHLORIDE INJECTION, USP for intravenous, intramuscular and subcutaneous route CII Initial U.S. Approval: 1984 WARNING: RISK OF RESPIRATORY DEPRESSION AND ABUSESee full prescribing information for complete boxed warning
INDICATIONS AND USAGEHydromorphone hydrochloride, is an opioid agonist indicated for the management of pain in patients where an opioid analgesic is appropriate. (1) DOSAGE AND ADMINISTRATIONThe usual starting dose is 1 mg to 2 mg subcutaneously or intramuscularly every 2 to 3 hours as necessary for pain. (2.3) The usual starting dose for intravenous administration is 0.2 mg to 1 mg every 2 to 3 hours (2.4) Patients with hepatic and renal impairment should be started on a lower starting dose. (2.5 & 2.6) DOSAGE FORMS AND STRENGTHSHydromorphone Hydrochloride Injection, USP, 1 mg/mL, 2 mg/mL and 4 mg/mL is available in ampules, Carpuject™ and iSecure™ syringes and single dose vials for parenteral administration. (3) CONTRAINDICATIONSWARNINGS AND PRECAUTIONSRespiratory depression: increased risk in the elderly, debilitated patients, and those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction (5.1) Abuse of hydromorphone hydrochloride poses a hazard of overdose and death (5.2) Risk of medication errors: Hydromorphone does not convert to morphine on a milligram per milligram basis. Use Table 1 to convert. (5.3) CNS effects: Alcohol, other opioids, CNS depressants, or illicit drugs may potentiate the central nervous system and respiratory depressant effects of hydromorphone. (5.4) Infants born to mothers physically dependent on hydromorphone will also be physically dependent and may exhibit signs of withdrawal. (5.5) Elevation of intracranial pressure: Respiratory depressant effects of hydromorphone promotes carbon dioxide retention that results in elevation of cerebrospinal fluid pressure, which can be markedly exaggerated in conditions predisposed to increased intracranial pressure. (5.6) Hypotension: Hydromorphone may cause severe hypotension in those with a depleted blood volume or with concurrent administration of drugs such as phenothiazines or general anesthetics. Administer with caution to patients in circulatory shock. (5.7) Use with caution in patients with biliary tract disease including pancreatitis (5.8) Use with caution with a reduced initial dose in the elderly or debilitated and special risk patients. (5.9) Use with caution in patients with alcoholism and other drug dependencies (5.10) Use may impair mental and/or physical ability and can produce orthostatic hypotension (5.11) ADVERSE REACTIONSThe most frequently observed adverse effects are light-headedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. Serious adverse reactions include respiratory depression and apnea, circulatory depression, respiratory arrest, shock and cardiac arrest. (6) To report SUSPECTED ADVERSE REACTIONS, contact Hospira, Inc. at 1-800-441-4100 or email@example.com or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. DRUG INTERACTIONSCNS depressants: increased risk of respiratory depression, hypotension, profound sedation, or coma. Mixed Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol, and buprenorphine) may reduce the analgesic effect and/or precipitate withdrawal symptoms. (7.2) MAO inhibitors: Allow at least 14 days after stopping MAOIs before initiating treatment with hydromorphone. (7.3) Anticholinergics: Medications with anticholinergic activity when used with opioid analgesics may result in increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (7.4) USE IN SPECIFIC POPULATIONSPregnancy: Based on animal data, may cause fetal harm (8.1) Labor and Delivery: Use with caution during labor (8.2) Nursing mothers: Nursing should not be undertaken while a patient is receiving hydromorphone hydrochloride. (8.3) Pediatrics: Safety and effectiveness in pediatric patients have not been established (8.4) Geriatric patients: use with caution in elderly patients, initiate dose at low end of dosing range. (8.5) Hepatic and Renal impairment: Start patients with hepatic and renal impairment on a lower starting dose (8.6, 8.7, 12.3) See 17 for PATIENT COUNSELING INFORMATION. Revised: 10/2009 |
Hydromorphone Hydrochloride Injection, USP, is an opioid agonist and a Schedule II controlled substance with an abuse liability similar to other opioid analgesics. Schedule II opioid agonists, including morphine, oxymorphone, hydromorphone, oxycodone, fentanyl and methadone, have the highest potential for abuse and risk of producing fatal overdose due to respiratory depression. Ethanol, other opioids, and other central nervous system depressants (e.g., sedative-hypnotics, skeletal muscle relaxants) can potentiate the respiratory-depressant effects of hydromorphone and increase the risk of adverse outcomes, including death. (5.1)
Hydromorphone can be abused in a manner similar to other opioid agonists, legal or illicit. These risks should be considered when administering, prescribing, or dispensing Hydromorphone in situations where the healthcare professional is concerned about increased risk of misuse or abuse. (5.2)
Hydromorphone hydrochloride is indicated for the management of pain in patients where an opioid analgesic is appropriate.
2.1 General Dosing Considerations
Selection of patients and administration of hydromorphone hydrochloride injection should be governed by the same principles that apply to the use of similar opioid analgesics to treat patients with acute or chronic pain, and depends upon a comprehensive assessment of the patient. Individualize treatment in every case, using non-opioid analgesics, opioids on an as needed basis and/or combination products, and chronic opioid therapy in a progressive plan of pain management such as outlined by the World Health Organization, the Agency for Healthcare Research and Quality, and the American Pain Society.
The nature of the pain, (severity, frequency, etiology, and pathophysiology) as well as the medical status of the patient, will affect selection of the starting dosage. Opioid analgesics, including hydromorphone hydrochloride injection, have a narrow therapeutic index in certain patient populations, especially when combined with CNS depressant drugs, and should be reserved for cases where the benefits of opioid analgesia outweigh the known risks.
2.2 Individualization of Dosage
Initiate the dosing regimen for each patient individually, taking into account the patient's prior analgesic treatment. Give attention to the following:
- the age, general condition and medical status of the patient;
- the patient's degree of opioid tolerance;
- the daily dose, potency, and specific characteristics of the opioid the patient has been taking previously;
- concurrent medications;
- the type and severity of the patient's pain;
- risk factors for abuse or addiction; including whether the patient has a previous or current substance abuse problem, a family history of substance abuse, or a history of mental illness or depression;
- the balance between pain control and adverse reactions
Periodic reassessment after the initial dosing of hydromorphone hydrochloride injection is required. If pain management is not satisfactory, and opioid-induced adverse events are tolerable, the hydromorphone dose may be increased gradually. If excessive opioid side effects are observed early in the dosing interval, reduce the hydromorphone hydrochloride dose. If this results in breakthrough pain at the end of the dosing interval, the dosing interval may need to be shortened. Dose titration should be guided more by the need for analgesia and the occurrence of adverse events than the absolute dose of opioid employed.
2.3 Subcutaneous or Intramuscular Administration
The usual starting dose is 1 mg to 2 mg subcutaneously or intramuscularly every 2 to 3 hours as necessary for pain. Depending on the clinical situation, the initial starting dose may be lowered in patients who are opioid naïve. Adjust the dose according to the severity of pain and occurrence of adverse events, as well as the patient's underlying disease and age.
2.4 Intravenous Administration
The initial intravenous starting dose is 0.2 mg to 1 mg every 2 to 3 hours as necessary for pain control.
Administer intravenous hydromorphone slowly, over at least 2 to 3 minutes, depending on the dose. Titrate the dose to achieve acceptable pain management and tolerable adverse events. Reduce the initial dose in the elderly or debilitated.
2.5 Hepatic Impairment
Start patients with hepatic impairment on one-fourth to one-half the usual dose of hydromorphone hydrochloride injection depending on the extent of impairment [see Clinical Pharmacology, Pharmacokinetics and Metabolism (12.3)].
2.6 Renal Impairment
Start patients with renal impairment on one-fourth to one-half the usual starting dose of hydromorphone hydrochloride injection depending on the degree of impairment [see Clinical Pharmacology, Pharmacokinetics (12.3)].
2.7 Conversion from Prior Opioid
Use the equianalgesic dose table below (Table 1) as a guide to determine the appropriate dose of hydromorphone injection. Convert the current total daily amount(s) of opioid(s) received to an equivalent total daily dose of hydromorphone injection and reduce by one-half due to the possibility of incomplete cross tolerance. Divide the new total amount by number of doses permitted based on dosing interval (e.g. 8 doses for every-three-hour dosing). Titrate the dose according to the patient's response. For opioids not in Table 1, first estimate the daily amount of morphine that is equivalent to the current total daily amount of other opioid(s) received, then use Table 1 to find the approximate equivalent total daily dose of hydromorphone injection.
Morphine Sulfate |
10 mg |
40 – 60 mg |
Hydromorphone HCl |
1.3 – 2 mg |
6.5 – 7.5 mg |
Oxymorphone HCl |
1 – 1.1 mg |
6.6 mg |
Levorphanol tartrate |
2 – 2.3 mg |
4 mg |
Meperidine HCl (pethidine HCl) |
75 – 100 mg |
300 – 400 mg |
Methadone HCl |
10 mg |
10 – 20 mg |
Nalbuphine HCl |
10 – 12 mg |
– |
Butorphanol tartrate |
1.5 – 2.5 mg |
– |
* Dosages, and ranges of dosages represented, are a compilation of estimated equipotent dosages from published references comparing opioid analgesics in cancer and severe pain. |
2.8 Administration
Inspect parenteral drug products visually for particulate matter and discoloration prior to administration, whenever solution and container permit. A slight yellowish discoloration may develop in hydromorphone hydrochloride ampules. No loss of potency has been demonstrated. Hydromorphone hydrochloride is physically compatible and chemically stable for at least 24 hours at 25°C protected from light in most common large volume parenteral solutions.
Hydromorphone hydrochloride injections are available as:
- Ampules 1 mg/mL, 2 mg/mL, and 4 mg/mL
- Carpuject Syringes 1 mg/mL, 2 mg/mL, and 4 mg/mL
- iSecure Syringes 0.5 mg/0.5 mL, 1 mg/mL, and 2 mg/mL
- Vials 2 mg/mL
The drug product is a clear, colorless to nearly colorless aqueous sterile solution. Each 1 mL of sterile solution contains 1 mg, 2 mg or 4 mg hydromorphone hydrochloride.
Hydromorphone hydrochloride is contraindicated:
- in patients with known hypersensitivity to hydromorphone
- in any situation where opioids are contraindicated, e.g., in patients with respiratory depression in the absence of resuscitative equipment or in unmonitored settings; or patients with acute or severe bronchial asthma
- in patients with, or at risk of developing, gastrointestinal obstruction, especially paralytic ileus because hydromorphone diminishes the propulsive peristaltic wave in the gastrointestinal tract and may prolong the obstruction.
5.1 Respiratory Depression
Respiratory depression is the chief hazard of hydromorphone hydrochloride. Respiratory depression occurs most frequently in the elderly, in the debilitated, and in those suffering from conditions accompanied by hypoxia or hypercapnia, or upper airway obstruction in whom even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Respiratory depression is also a particular problem following large initial doses in non opioid-tolerant patients or when opioids are given in conjunction with other agents that depress respiration.
Use hydromorphone hydrochloride with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of opioid analgesics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Alternative non-opioid analgesics should be considered, and hydromorphone hydrochloride should be employed only under careful medical supervision at the lowest effective dose in such patients.
5.2 Misuse and Abuse of Opioids
Hydromorphone is an opioid agonist with an abuse liability similar to morphine and a Schedule II, controlled substance. Hydromorphone has the potential for being abused, is sought by drug abusers and people with addiction disorders, and is subject to criminal diversion. Diversion of Schedule II products is an act subject to criminal penalty.
Abuse of hydromorphone hydrochloride poses a hazard of overdose and death. This risk is increased with concurrent abuse of alcohol or other substances. Schedule II opioid agonists have the highest potential for abuse and risk of fatal respiratory depression.
Hydromorphone injection can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing hydromorphone injection in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion.
Concerns about abuse, addiction, and diversion should not prevent the proper management of pain. Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
5.3 Risk of Medication Errors
Hydromorphone for parenteral administration is marketed in several concentrations. Take precautions to ensure that the different concentrations are not confused to avoid the risk of accidental overdose and death.
Hydromorphone does not convert to morphine on a milligram per milligram basis. Use Table 1 when converting a patient from morphine to hydromorphone to avoid errors that can lead to overdose or death.
5.4 Interactions with Alcohol, CNS Depressants, and Drugs of Abuse
The concurrent use of hydromorphone hydrochloride with other central nervous system (CNS) depressants, including but not limited to other opioids, illicit drugs, sedatives, hypnotics, general anesthetics, phenothiazines, muscle relaxants, other tranquilizers, and alcohol, increases the risk of respiratory depression, hypotension, and profound sedation, potentially resulting in coma or death. Use with caution and in reduced dosages in patients taking CNS depressants.
5.5 Neonatal Withdrawal Syndrome
Infants born to mothers physically dependent on hydromorphone hydrochloride injection will also be physically dependent and may exhibit signs of withdrawal. The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever. The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose. Neonatal opioid withdrawal syndrome may be life threatening and should be treated according to protocols developed by neonatology experts [see Drug Abuse and Dependence (9.3)].
5.6 Use in Head Injury and Increased Intracranial Pressure
The respiratory depressant effects of hydromorphone hydrochloride injection promote carbon dioxide retention which results in elevation of cerebrospinal fluid pressure. This increase in intracranial pressure may be markedly exaggerated in the presence of head injury, intracranial lesions, or other conditions that predispose to increased intracranial pressure.
Hydromorphone hydrochloride injection may produce effects on pupillary response and consciousness which can obscure the clinical course and neurologic signs of further increase in pressure in patients with head injuries.
5.7 Hypotensive Effects
Hydromorphone hydrochloride, may cause severe hypotension in an individual whose ability to maintain blood pressure has already been compromised by a depleted blood volume, or a concurrent administration of drugs such as phenothiazines or general anesthetics [see Warnings and Precautions (5), Drug Interactions (7)]. Hydromorphone hydrochloride may product orthostatic hypotension in ambulatory patients.
Administer hydromorphone hydrochloride with caution to patients in circulatory shock, since vasodilation produced by the drug may further reduce cardiac output and blood pressure.
5.8 Use in Pancreatic/Biliary Tract Disease and Other Gastrointestinal Conditions
The administration of hydromorphone hydrochloride injection may obscure the diagnosis or clinical course in patients with acute abdominal conditions [see Contraindications (4)].
Use hydromorphone hydrochloride injection with caution in patients who are at risk of developing ileus.
Use hydromorphone hydrochloride injection with caution in patients with biliary tract disease, including acute pancreatitis, as hydromorphone may cause spasm of the sphincter of Oddi and diminish biliary and pancreatic secretions.
5.9 Special Risk Patients
Give hydromorphone hydrochloride with caution and the initial dose should be reduced in the elderly or debilitated and those with severe impairment of hepatic, pulmonary or renal function; myxedema or hypothyroidism; adrenocortical insufficiency (e.g., Addison's Disease); CNS depression or coma; toxic psychoses; prostatic hypertrophy or urethral stricture; acute alcoholism; delirium tremens; or kyphoscoliosis associated with respiratory depression.
The administration of opioid analgesics including hydromorphone hydrochloride injection may aggravate preexisting convulsions in patients with convulsive disorders.
Hydromorphone, as with other opioids, may aggravate convulsions in patients with convulsive disorders, and may induce or aggravate seizures in some clinical settings.
Reports of mild to severe seizures and myoclonus have been reported in severely compromised patients, administered high doses of parenteral hydromorphone.
5.10 Use in Drug and Alcohol Dependent Patients
Use hydromorphone hydrochloride with caution in patients with alcoholism and other drug dependencies due to the increased frequency of opioid tolerance, dependence, and the risk of addiction observed in these patient populations. Abuse of hydromorphone hydrochloride in combination with other CNS depressant drugs can result in serious risk to the patient.
Hydromorphone is an opioid with no approved use in the management of addictive disorders. Its proper usage in individuals with drug or alcohol dependence, either active or in remission is for the management of pain requiring opioid analgesia.
5.11 Use in Ambulatory Patients
Hydromorphone hydrochloride may impair the mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating machinery). Patients should be cautioned accordingly. Hydromorphone hydrochloride may produce orthostatic hypotension in ambulatory patients [see Drug Interactions (7)].
5.12 Parenteral Administration
Hydromorphone hydrochloride injection may be given intravenously, but the injection should be given very slowly. Rapid intravenous injection of opioid analgesics increases the possibility of side effects such as hypotension and respiratory depression [see Dosage and Administration (2.3)].
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Serious adverse reactions associated with hydromorphone hydrochloride include respiratory depression and apnea, and to a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred.
The following serious adverse reactions described elsewhere in the labeling include:
- Respiratory depression and secondary effects on intracranial pressure [see Warnings and Precautions (5.1, 5.6)].
- Hypotension [see Warnings and Precautions (5.7)].
- Gastrointestinal effects and effects in sphincter of Oddi [see Warnings and Precautions (5.8)].
- Drug abuse, addiction, and dependence [see Drug Abuse and Dependence (9.2, 9.3)].
- Effects on the ability to drive and operate machinery [see Warnings and Precautions (5.11)].
The most common adverse effects are light-headedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain.
6.1 Less Frequently Observed Adverse Reactions
Cardiac disorders: tachycardia, bradycardia, palpitations
Eye disorders: vision blurred, diplopia, miosis, visual impairment
Gastrointestinal disorders: constipation, ileus, diarrhea, abdominal pain
General disorders and administration site conditions: weakness, feeling abnormal, chills, injection site urticaria
Hepatobiliary disorders: biliary colic
Metabolism and nutrition disorders: decreased appetite
Musculoskeletal and connective tissue disorders: muscle rigidity
Nervous system disorders: headache, tremor, paraesthesia, nystagmus, increased intracranial pressure, syncope, taste alteration, involuntary muscle contractions, presyncope
Psychiatric disorders: agitation, mood altered, nervousness, anxiety, depression, hallucination, disorientation, insomnia, abnormal dreams
Renal and urinary disorders: urinary retention, urinary hesitation, antidiuretic effects
Respiratory, thoracic and mediastinal disorders: bronchospasm, laryngospasm
Skin and subcutaneous tissue disorders: injection site pain, urticaria, rash, hyperhidrosis
Vascular disorders: flushing, hypotension, hypertension
6.2 Postmarketing Experience
The following adverse reactions have been identified during post-approval use of hydromorphone. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: anaphylactic reactions, confusional state, convulsions, dyskinesia, dyspnea, erectile dysfunction, hepatic enzyme increased, hyperalgesia, hypersensitivity reaction, injection site reactions, myoclonus, oropharyngeal swelling, peripheral edema, somnolence.
7.1 Interactions with other CNS Depressants
Hydromorphone hydrochloride injection should be used with caution and in reduced dosages when administered to patients concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, centrally acting anti-emetics, tranquilizers, and alcohol because respiratory depression, hypotension, and profound sedation or coma may result.
When such combined therapy is contemplated, the dose of one or both agents should be reduced. Opioid analgesics, including hydromorphone hydrochloride, may enhance the action of neuromuscular blocking agents and produce an increased degree of respiratory depression.
7.2 Interactions with Mixed Agonist/Antagonist Opioid Analgesics
Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol, and buprenorphine) should be administered with caution to a patient who has received or is receiving a course of therapy with a pure opioid agonist analgesic such as hydromorphone. In this situation, mixed agonist/antagonist analgesics may reduce the analgesic effect of hydromorphone and/or may precipitate withdrawal symptoms in these patients.
8.1 Pregnancy
Teratogenic Effects
Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women. Hydromorphone crosses the placenta. Hydromorphone hydrochloride injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
No effects on teratogenicity or embryotoxicity were observed in pregnant rats given oral doses up to 7 mg/kg/day which is 3-fold higher than the human dose of 24 mg hydromorphone hydrochloride injection (4 mg every 4 hours), on a body surface area basis. Hydromorphone administration to pregnant Syrian hamsters and CF-1 mice during major organ development revealed teratogenic effects likely the result of maternal toxicity associated with sedation and hypoxia. In Syrian hamsters given single subcutaneous doses from 14 to 258 mg/kg during organogenesis (gestation days 8-10), doses ≥19 mg/kg of hydromorphone produced skull malformations (exencephaly and cranioschisis). In CF-1 mice, continuous infusion of hydromorphone (≥15 mg/kg over 24 hours) via implanted osmotic pumps during organogenesis (gestation days 7-10) produced soft tissue malformations (cryptorchidism, cleft palate, malformed ventricles and retina), and skeletal variations (split supraoccipital, checkerboard and split sternebrae, delayed ossification of the paws and ectopic ossification sites). The malformations and variations observed in the hamsters and mice were observed at doses approximately 6-fold and 3-fold higher, respectively, than the human dose of 24 mg hydromorphone hydrochloride (4 mg every 4 hours), on a body surface area basis.
8.2 Labor and Delivery
Hydromorphone hydrochloride should be used with caution during labor. Occasionally, opioid analgesics including hydromorphone hydrochloride injection may prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor.
Opioid analgesics, including hydromorphone hydrochloride, may cause respiratory depression in the newborn. Closely observe neonates whose mothers received opioid analgesics during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone or nalmefene, available for reversal of opioid-induced respiratory depression in the neonate.
Neonates whose mothers have been taking opioids chronically may also exhibit withdrawal signs, either at birth or in the nursery, because they have developed physical dependence. This is not, however, synonymous with addiction [see Drug Abuse and Dependence (9.3)]. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening and should be treated according to protocols developed by neonatology experts [see Warnings and Precautions (5.5)].
The effect of hydromorphone hydrochloride, if any, on the later growth, development, and functional maturation of the child is unknown.
8.3 Nursing Mothers
Low levels of opioid analgesics have been detected in human milk. As a general rule, nursing should not be undertaken while a patient is receiving hydromorphone hydrochloride injection since it, and other drugs in this class, may be excreted in the milk.
8.4 Pediatric Use
The safety and effectiveness of hydromorphone hydrochloride injection in pediatric patients has not been established.
8.5 Geriatric Use
Clinical studies of hydromorphone hydrochloride did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Respiratory depression is the chief risk in elderly or debilitated patients, usually the result of large initial doses in non-opioid-tolerant patients. Titration in these patients should proceed cautiously [see Individualization of Dosage (2.2) and Warnings and Precautions (5)].
8.6 Renal Impairment
The pharmacokinetics of hydromorphone following an oral administration of hydromorphone at a single 4 mg dose (2 mg hydromorphone immediate-release tablets) are affected by renal impairment. Mean exposure to hydromorphone (Cmax and AUC0-∞) is increased by 2 fold in patients with moderate (CLcr=40 - 60 mL/min) renal impairment and increased by 4 fold in patients with severe (CLcr <30 mL/min) renal impairment compared with normal subjects (CLcr >80 mL/min). In addition, in patients with severe renal impairment, hydromorphone appeared to be more slowly eliminated with a longer terminal elimination half-life (40 hr) compared to patients with normal renal function (15 hr). Start patients with renal impairment on one-fourth to one-half the usual starting dose depending on the degree of impairment. Patients with renal impairment should be closely monitored during dose titration. [see Clinical Pharmacology (12.3)]
8.7 Hepatic Impairment
The pharmacokinetics of hydromorphone following an oral administration of hydromorphone at a single 4 mg dose (2 mg hydromorphone immediate-release tablets) are affected by hepatic impairment. Mean exposure to hydromorphone (Cmax and AUC∞) is increased 4 fold in patients with moderate (Child-Pugh Group B) hepatic impairment compared with subjects with normal hepatic function. Due to increased exposure of hydromorphone, patients with moderate hepatic impairment should be started at one fourth to one half the recommended starting dose depending on the degree of hepatic dysfunction and closely monitored during dose titration. The pharmacokinetics of hydromorphone in patients with severe hepatic impairment has not been studied. A further increase in Cmax and AUC of hydromorphone in this group is expected and should be taken into consideration when selecting a starting dose [see Clinical Pharmacology (12.3)].
9.1 Controlled Substance
Hydromorphone hydrochloride injection is a Schedule II controlled substance with an abuse liability similar to morphine. Hydromorphone hydrochloride can be abused and is subject to criminal diversion.
9.2 Abuse
Hydromorphone hydrochloride injection is intended for parenteral use only under the direct supervision of an appropriately licensed health care professional.
Abuse of hydromorphone hydrochloride injection poses a hazard of overdose and death. This risk is increased with concurrent abuse of alcohol or other substances. Parenteral drug abuse is commonly associated with transmission of infectious diseases, such as hepatitis and HIV.
Hydromorphone hydrochloride injection can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing, dispensing, ordering, or administering hydromorphone hydrochloride injection in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion. Prescribers should monitor all patients receiving opioids for signs of abuse, misuse, and addiction. Furthermore, patients should be assessed for their potential for opioid abuse prior to being prescribed opioid therapy. Persons at increased risk for opioid abuse include those with a personal or family history of substance abuse (including drug or alcohol abuse) or mental illness (e.g., depression). Opioids may still be appropriate for use in these patients, however, they will require intensive monitoring for indications of abuse.
Opioid drugs are sought by people with substance use disorders (abuse or addiction, the latter of which is also called "substance dependence") and criminals who supply them by diverting medicines out of legitimate distribution channels. Hydromorphone hydrochloride injection is a target for diversion.
"Drug-seeking" behavior is very common in persons with substance use disorders. Drug-seeking tactics include, but are not limited to, emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing or referral, repeated "loss" of prescriptions, altering or forging of prescriptions and reluctance to provide prior medical records or contact information for other treating physician(s). "Doctor shopping" to obtain additional prescriptions is common among people with untreated substance use disorders, and criminals who divert controlled substances.
The risks of misuse and abuse should be considered when prescribing or dispensing hydromorphone hydrochloride injection. Concerns about abuse and addiction, should not prevent the proper management of pain, however. Treatment of pain should be individualized, balancing the potential benefits and risks for each patient.
Addiction is a chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Drug addiction is a treatable disease, utilizing a multidisciplinary approach, but relapse is common.
Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances. Careful record keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised.
Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, proper dispensing and correct storage and handling are appropriate measures that help to limit misuse and abuse of opioid drugs. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised.
Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
9.3 Dependence
Tolerance to opioids is demonstrated by the need for increasing doses to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Tolerance to different effects of opioids may develop to varying degrees and at varying rates in a given individual. There is also inter-patient variability in the rate and extent of tolerance that develops to various opioid effects, whether the effect is desirable (e.g., analgesia) or undesirable (e.g., nausea). In general, patients taking opioid analgesics that are appropriately titrated for pain control develop tolerance to the respiratory depressant effects fairly reliably. Conversely, tolerance to the constipating effects of opioids rarely develops, even when they are administered over long periods of time.
Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy.
The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, mydriasis. Other symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.
In general, opioids used regularly should not be abruptly discontinued.
10.1 Signs and Symptoms
Signs and symptoms of acute overdosage with hydromorphone hydrochloride injection include: respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, bradycardia, hypotension, partial or complete airway obstruction, atypical snoring, apnea, circulatory collapse, cardiac arrest, and death.
Hydromorphone may cause miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origin may produce similar findings). Marked mydriasis rather than miosis may be seen with hypoxia in overdose situations.
10.2 Treatment
In the treatment of overdosage, primary attention should be given to re-establishment of a patent airway and institution of assisted or controlled ventilation. Supportive measures (including oxygen and vasopressors) should be employed in the management of circulatory shock and pulmonary edema accompanying overdose as indicated. Cardiac arrest or arrhythmias may require cardiac massage or defibrillation.
The opioid antagonists, naloxone, is a specific antidote against respiratory depression which may result from overdosage, or unusual sensitivity to hydromorphone hydrochloride. Therefore an appropriate dose of this antagonist should be administered preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. Naloxone should not be administered in the absence of clinically significant respiratory or circulatory depression. Naloxone should be administered cautiously to persons who are known, or suspected to be physically dependent on hydromorphone hydrochloride. In such cases, an abrupt or complete reversal of opioid effects may precipitate an acute withdrawal syndrome.
Since the duration of action of hydromorphone hydrochloride may exceed that of the antagonist, the patient should be kept under continued surveillance; repeated doses of the antagonist may be required to maintain adequate respiration. Apply other supportive measures when indicated.
Hydromorphone hydrochloride, a hydrogenated ketone of morphine, is an opioid analgesic. The chemical name of hydromorphone hydrochloride is 4,5α- epoxy-3-hydroxy-17-methylmorphinan-6-one hydrochloride.
The structural formula is:
The drug product is an aqueous sterile solution. Each 1 mL of sterile solution contains 1 mg, 2 mg, or 4 mg hydromorphone hydrochloride for the respective product strength. Each 1 mL also contains 5.4 mg sodium lactate and sodium chloride for isotonicity. The solution pH is adjusted with lactic acid or sodium hydroxide to between pH 3.5 and 5.5.
12.1 Mechanism of Action
The precise mode of analgesic action of opioid analgesics is unknown. However, specific CNS opiate receptors have been identified. Opioids are believed to express their pharmacological effects by combining with these receptors.
Hydromorphone hydrochloride is a mu-opioid receptor agonist whose principal therapeutic action is analgesia. Other members of the class known as opioid agonists include substances such as morphine, oxycodone, fentanyl, codeine, hydrocodone and oxymorphone.
Central Nervous System
Pharmacological effects of opioid agonists include anxiolysis, euphoria, feelings of relaxation, and cough suppression, as well as analgesia.
Hydromorphone produces respiratory depression by direct effect on brain stem respiratory centers. The mechanism of respiratory depression also involves a reduction in the responsiveness of the brain stem respiratory centers to increases in carbon dioxide tension.
Hydromorphone causes miosis. Pinpoint pupils are a common sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origin may produce similar findings).
Gastrointestinal Tract and Other Smooth Muscle
Gastric, biliary and pancreatic secretions are decreased by opioids such as hydromorphone. Hydromorphone causes a reduction in motility associated with an increase in tone in the gastric antrum and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased. Propulsive peristaltic waves in the colon are decreased, and tone may be increased to the point of spasm. The end result is constipation. Hydromorphone can cause a marked increase in biliary tract pressure as a result of spasm of the sphincter of Oddi.
Cardiovascular System
Hydromorphone may produce hypotension as a result of either peripheral vasodilation, release of histamine, or both. Other manifestations of histamine release and/or peripheral vasodilation may include pruritus, flushing, and red eyes.
Effects on the myocardium after intravenous administration of opioids are not significant in normal persons, vary with different opioid analgesic agents and vary with the hemodynamic state of the patient, state of hydration and sympathetic drive.
Immune System
In vitro and animal studies indicate that opioids have a variety of effects on immune functions. The clinical significance of these findings is unknown.
12.3 Pharmacokinetics
At therapeutic plasma levels, hydromorphone is approximately 8-19% bound to plasma proteins. After an intravenous bolus dose, the steady state of volume of distribution [mean (%cv)] is 302.9 (32%) liters.
Hydromorphone is extensively metabolized via glucuronidation in the liver, with greater than 95% of the dose metabolized to hydromorphone-3-glucuronide along with minor amounts of 6-hydroxy reduction metabolites.
Only a small amount of the hydromorphone dose is excreted unchanged in the urine. Most of the dose is excreted as hydromorphone-3-glucuronide along with minor amounts of 6-hydroxy reduction metabolites. The systemic clearance is approximately 1.96 (20%) liters/minute. The terminal elimination half-life of hydromorphone after an intravenous dose is about 2.3 hours.
Special Populations
Hepatic Impairment
After oral administration of hydromorphone at a single 4 mg dose (2 mg hydromorphone immediate-release tablets), mean exposure to hydromorphone (Cmax and AUC∞) is increased 4 fold in patients with moderate (Child-Pugh Group B) hepatic impairment compared with subjects with normal hepatic function. Patients with moderate hepatic impairment should be started at one fourth to one half the recommended starting dose and closely monitored during dose titration. The pharmacokinetics of hydromorphone in patients with severe hepatic impairment has not been studied. A further increase in Cmax and AUC of hydromorphone in this group is expected and should be taken into consideration when selecting a starting dose [see Use in Specific Populations (8.7)].
Renal Impairment
The pharmacokinetics of hydromorphone following an oral administration of hydromorphone at a single 4 mg dose (2 mg hydromorphone immediate-release tablets) are affected by renal impairment. Mean exposure to hydromorphone (Cmax and AUC0-∞) is increased by 2 fold in patients with moderate (CLcr=40 - 60 mL/min) renal impairment and increased by 4 fold in patients with severe (CLcr <30 mL/min) renal impairment compared with normal subjects (CLcr >80 mL/min). In addition, in patients with severe renal impairment, hydromorphone appeared to be more slowly eliminated with a longer terminal elimination half-life (40 hr) compared to patients with normal renal function (15 hr). Start patients with renal impairment on one-fourth to one-half the usual starting dose depending on the degree of impairment. Patients with renal impairment should be closely monitored during dose titration [see Use in Specific Populations (8.6)].
Pharmacokinetics of hydromorphone have not been evaluated in children.
In the geriatric population, age has no effect on the pharmacokinetics of hydromorphone.
Gender has little effect on the pharmacokinetics of hydromorphone. Females appear to have a higher Cmax (25%) than males with comparable AUC0-24 values. The difference observed in Cmax may not be clinically relevant.
The effect of race on hydromorphone pharmacokinetics has not been studied.
Pregnancy and Nursing Mothers
Hydromorphone crosses the placenta. Hydromorphone is also found in low levels in breast milk, and may cause respiratory compromise in newborns when administered during labor or delivery.
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Long term studies in animals to evaluate the carcinogenic potential of hydromorphone have not been conducted.
Hydromorphone was not mutagenic in the in vitro bacterial reverse mutation assay (Ames assay). Hydromorphone was not clastogenic in either the in vitro human lymphocyte chromosome aberration assay or the in vivo mouse micronucleus assay.
Impairment of Fertility
No effects on fertility, reproductive performance, or reproductive organ morphology were observed in male or female rats given oral doses up to 7 mg/kg/day which is 3-fold higher than the human dose of 24 mg hydromorphone hydrochloride injection (4 mg every 4 hours), on a body surface area basis.
Analgesic effects of single doses of hydromorphone hydrochloride oral liquid administered to patients with post-surgical pain have been studied in double-blind controlled trials. In one study, both 5 mg and 10 mg of hydromorphone hydrochloride oral liquid provided significantly more analgesia than placebo.
16.1 Safety and Handling Instructions
Hydromorphone hydrochloride injection poses little risk of direct exposure to health care personnel and should be handled and disposed of prudently in accordance with hospital or institutional policy. When hydromorphone hydrochloride injection is no longer needed, any unused liquid should be destroyed by flushing it down the toilet.
Access to drugs with a potential for abuse such as hydromorphone hydrochloride injection presents an occupational hazard for addiction in the health care industry. Routine procedures for handling controlled substances developed to protect the public may not be adequate to protect health care workers. Implementation of more effective accounting procedures and measures to restrict access to drugs of this class (appropriate to the practice setting) may minimize the risk of self-administration by health care providers.
16.2 How Supplied
Ampul, Box of 10, 1 mL (1 mg/mL); NDC 0409-2552-01
Ampul, Box of 10, 1 mL (2 mg/mL); NDC 0409-3356-01
Ampul, Box of 10, 1 mL (4 mg/mL); NDC 0409-2540-01
Carpuject™, Single-dose Prefilled Syringe with Luer Lock, Box of 10, 1 mL (1 mg/mL); NDC 0409‑1283‑31
Carpuject™, Single-dose Prefilled Syringe with Luer Lock, Box of 10, 1 mL (2 mg/mL); NDC 0409‑1312‑30
Carpuject™, Single-dose Prefilled Syringe, with Luer Lock, Box of 10, 1 mL (4 mg/mL); NDC 0409‑1304‑31
iSecure Single-dose Prefilled Syringe with Luer Lock, Box of 10, 0.5 mL (1 mg/mL); NDC 0409‑1283‑05
iSecure Single-dose Prefilled Syringe with Luer Lock, Box of 10, 1 mL (1 mg/mL); NDC 0409‑1283‑10
iSecure Single-dose Prefilled Syringe with Luer Lock, Box of 10, 1 mL (2 mg/mL); NDC 0409‑1312‑10
Single Dose Vial, Tray of 25, 1 mL (2 mg/mL); NDC 0409‑3365‑01
16.3 Storage
Keep covered in carton until time of use. Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].
16.4 Instructions for Use of the Syringe Systems
Instructions for using the Carpuject Syringe are available with the reusable Carpuject Holder, List 2049‑02.
To Use iSecure™ Syringe
1. Remove green tamper evident band in a clockwise motion. |
2. Depress (Push) the plunger rod. This will loosen the plunger rod that is located on the outside of the syringe barrel so that the plunger rod can be removed. This will also engage the syringe. |
Remove the plunger rod. |
Insert the plunger rod into the back end of the syringe barrel and turn clockwise 2 to 3 times to attach. | |
BEFORE REMOVING LUER TIP CAP, hold the syringe with tip cap upright. Press syringe plunger until plunger moves slightly. This motion breaks the seal between plunger and syringe barrel. |
3. Twist the luer tip cap clockwise or counterclockwise to break the tamper evident label. Remove the luer tip cap and discard it. Expel the air by pushing on the plunger rod. Attach needle or blunt cannula if required. |
Revised: 11/2011
Hospira, Inc., Lake Forest, IL 60045 USA
Patients receiving hydromorphone hydrochloride (hydromorphone hydrochloride) or their caregivers should be given the following information by the physician, nurse, or pharmacist:
1. Patients should be aware that hydromorphone hydrochloride contains hydromorphone, which is a morphine-like substance and which could cause severe adverse effects including respiratory depression and even death if not taken according to the prescriber's directions.
2. Patients should be advised to report pain and adverse experiences occurring during therapy. Individualization of dosage is essential to make optimal use of this medication.
3. Patients should be advised not to adjust the dose of hydromorphone hydrochloride without consulting the prescribing professional.
4. Patients should be advised that hydromorphone hydrochloride may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating heavy machinery).
5. Patients should not combine hydromorphone hydrochloride with alcohol or other central nervous system depressants (sleep aids, tranquilizers) except by the orders of the prescribing physician, because dangerous additive effects may occur, resulting in serious injury or death.
6. Women of childbearing potential who become, or are planning to become pregnant should be advised to consult their physician regarding the effects of analgesics and other drug use during pregnancy on themselves and their unborn child.
7. Patients should be advised that hydromorphone hydrochloride is a potential drug of abuse. They should protect it from theft, and it should never be given to anyone other than the individual for whom it was prescribed.
8. Patients should be advised that if they have been receiving treatment with hydromorphone hydrochloride for more than a few weeks and cessation of therapy is indicated, it may be appropriate to taper the hydromorphone hydrochloride dose, rather than abruptly discontinue it, due to the risk of precipitating withdrawal symptoms. Their physician can provide a dose schedule to accomplish a gradual discontinuation of the medication.
9. Patients should be instructed to keep hydromorphone hydrochloride in a secure place out of the reach of children.
Printed in USA EN-2699
Hospira, Inc., Lake Forest, IL 60045 USA
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
hydromorphone hydrochloride injection, solution |
Labeler - Hospira, Inc. (141588017) |


text: Lila Feisee is the Vice President for International Affairs at BIO and has been with the organization since June of 2000. As BIO's Vice President for International Affairs, Lila is responsible for international advocacy efforts in the areas of intellectual property protection and biologics regulations. Before joining BIO, Ms. Feisee worked for 10 years at the United States Patent and Trademark Office (PTO), first as an examiner and later in management and policy development. Her primary areas of expertise in both examination and management are protein engineering, therapeutics and assays. Ms. Feisee also worked at the National Institutes of Health in the National Cancer Institute, Laboratory of Genetics where she isolated and characterized viral and human oncogenes. Ms. Feisee received her B.S. degree in Biology from the University of Virginia and her post graduate degree in Genetics from the George Washington University School of Medicine.

subset: commoncrawl


text:
As I peruse the varied articles posted here on Horrornews.net I am constantly amazed at the amount of information that is disseminated each & everyday. I'm especially intrigued by the "Lists" columns. There are so many categories of lists that [...]
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Film Review: Red Room (1999) – CAT III
A cult hit amongst gore enthusiasts, this campy splatter flick takes its plot cues from reality TV game shows. Four young people are locked in a room and play cards. When someone loses, they must endure some of the most [...]
Book Review: Sixty-Five Stirrup Iron Road - Author Various
March 11th, 2014
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Category: Book Reviews
Book Review: Dead Hunger 6: The Gathering Storm - Author Eric A. Shelman
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February 23rd, 2014
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Category: Book Reviews
Interview: Bill Oberst Jr. (Coyote - Children of Sorrow - Circus of the Dead)
March 6th, 2014
Interviewed by: Doc Rotten
Interview: Lord Zion - Codirector / Writer (Meet the Cadavers)
March 5th, 2014
Interviewed by: Andrew Hawnt


text:
Jesse Baget, prod.; Damien Leone, dir.; Lisandro Novillo, casting.
This listing has expired.
Jesse Baget, prod.; Damien Leone, dir.; Lisandro Novillo, casting.
Production Description
Jesse Baget (prod.) is casting "All Hallow's Eve", a horror feature. Synopsis: "While babysitting two children, a young woman reluctantly watches a late night chiller theater program on Halloween night. The show features three tales of terror, all linked together by a murderous clown. As the night goes on and the show intensifies, strange things begin to occur in the house. It isn't long before the babysitter learns the horrifying truth—the maniacal clown is slowly working his way into her reality."
Rehearsal and Production Dates & Locations
Shoots approx. March 21-31, 2013 in NYC.
Compensation & Union Contract Details
$50/day and meals.
Seeking Talent Select a role below for more information and submission instructions.
an artist and a married woman, is gearing up for her first ever art exhibition, being a struggling artist up to this point has left her some... more
a babysitter and young college student, shy, a bit of a prude, loves children, has an intense fear of clowns known as coulrophobia.


text:
JGBs soften on profit-taking
TOKYO, Oct 3 (IFR) - Japan government bond prices ended Thursday morning session modestly lower in the 7-year and longer zone.
JGBs in the 5-year to 20-year zone opened slightly higher on the back of firmer U.S. Treasuries overnight.
But JGB prices turned into negative territory in the 10-year zone in mid-morning trading. A few large banks seemed to have sold the current 10-year JGBs in relatively large lots, after its yield fell sharply from Tuesday's auction yield of 0.682 percent to 0.635 percent Thursday morning.
Super-long yields followed the benchmark 10-year JGB yield in very thin trading. Meanwhile, 4-year JGBs saw relatively good two-way flow in the morning session. Large domestic banks sold mid-term JGBs in relatively large lots, while many regional banks bought them ahead of the Bank of Japan's policy decision on Friday, JGB traders and money managers said.
JGB players widely expect the BOJ to keep its current accommodative policy this month. One corporate pension fund manager said that the majority of fund managers at the trust bank expect JGB yields to rise slowly in response to stronger-than-expected economic fundamentals in the U.S. despite the current government shutdown.
On Thursday, the Ministry of Finance re-offers 300 billion yen in off-the-run 20-year, 30-year and 40-year JGBs in a liquidity enhancement auction.
The auction results due at 0345 GMT will have some impact on super-long JGBs.
At midday, the yield on the current 5-year JGBs are down 0.5 basis point at 0.225 percent, after dropping as low as 0.220 percent, their lowest level since May 9.
The 10-year yield was up 1.5 basis points at 0.655 percent .
In the super-long zone, the 20-year yield was up one basis point at 1.520 percent in extremely thin trading, while the 30-year yield was also up one basis point at 1.645 percent.
The lead December JGB futures moved in a 144.27-144.49 range before finishing down 0.05 point at 144.30.


text:
Free Shipping over $75 | Low Price Guarantee | No Sales Tax except CA |
Aspen Pet Antimicrobial Deluxe Pillow Bed is an incredibly warm, soft and cozy sleeping spot for your pet. This deluxe pet bed features Microban antimicrobial to help eliminate the growth of mold, mildew and odor-causing bacteria.
This comfy pet bed is made from faux suede and has a micro terry cover for even more comfort.
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text:
LG TV Remote for iPad 2011
This application is compatible only with LG Smart TVs which are released in 2011. Customers who own LG Smart TVs released in 2012 (not listed in supported models) should get "LG TV Remote".
"LG TV remote 2011" is a Wi-Fi remote controller which can control Network-enabled LG TVs released in 2011.
When a smart phone and LG TV are connected via router, after a simple pairing process, LG TV may be controlled conveniently with the smart phone similar to a regular or a Magic Motion remote controller.
[Supported models]
LZ9600 Series Higher @ TV 2011
(Model Code Starts with LZ9)
LW 5500 Series Higher @ TV 2011
(Model Code Starts with LW5)
LV 5500 Series Higher @ TV 2011
(Model Code Starts with LV3)
LV 3700 Series, (LV372S/ LV373S/ LV375S/ LV3700)
Except for Model Code Starts with LK
[Main Features]
VOL/CH: Change volume or channel.
My CH: Manage My channel list in iPad.
Touchpad: Control pointer on TV by touching the screen on a iPad.
Button: Use direction keys to navigate TV menus or to control media playback.
Setting: Connect TV, change TV name, set vibration or sound effect.
What's new
App icon is changed.
Share with Others
- Last changed:
- Jan 20, 2013
- Category:
- Utilities
- Developer:
- LG Electronics, Inc.
- Version:
- 1.4
- Average Rating:
- 3.00 (28)
- Size:
- Other Apps By This Developer
• Friedrich Diagnostic
• LG AV Remote
• LG Bluetooth Remote
• LG Car Audio WICS
• LG Car Remote
• LG Cloud
• LG HA SmartDiagnosis For USA
• LG Ipsolute HD
• LG Ipsolute mobile
• LG Lighting
• LG MULTI V IV AR for print AD
• LG Multi V IV(Cooling Only)
• LG Multi V IV(Heat Pump)
• LG Pentouch TV
• LG Remote for Audio & Video Devices
• LG Smart AC
• LG Smart Laundry & DW
• LG Smart Laundry & DW for iPad
• LG Smart Oven
• LG Smart Range
• LG Smart Refrigerator
• LG System Air Conditioner
• LG TV Gamepad 2013
• LG TV Remote
• LG TV Remote 2011
• LG WHiSEN
• LG 휘센앱 3.0 [2013년 Wi-Fi]
• Pocket Photo
• SIMs2.0 [Wi-Fi only]
• avc2
• avc3
• btc 2
• btc 3


text:
In addition to Gary's excellent post, I would mention that Toto has readily-available toilets in Ebony, which is what they call black. Just do a little research. Always check several prices because dealers vary widely in what they charge, and the biggest dealers usually have black in stock.
Last edited by wjcandee; 10-26-2012 at 02:51 PM.


text:
An Observational Study of Xeloda (Capecitabine) Monotherapy in Patients With Colorectal Cancer (AXEL)
This study is ongoing, but not recruiting participants.
Hoffmann-La Roche
Information provided by (Responsible Party):
Hoffmann-La Roche
ClinicalTrials.gov Identifier:
First received: January 12, 2011
Last updated: March 3, 2014
Last verified: March 2014
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
This observational study will evaluate Xeloda (capecitabine) monotherapy on the effect of disease-free survival in patients with colon cancer stage III (Duke C) after surgical resection. Data will be collected for 3 years.
Condition |
Colorectal Cancer |
Study Type: | Observational |
Study Design: | Observational Model: Cohort Time Perspective: Prospective |
Official Title: | The Efficacy of Adjuvant Chemotherapy With Capecitabine (Xeloda) Monotherapy in Patients With Colon Cancer Stage III (Duke C) Considering the Histopathology of the Tumour (AXEL) |
Resource links provided by NLM:
Further study details as provided by Hoffmann-La Roche:
Primary Outcome Measures:
- Disease-free survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Safety (Incidence of adverse events) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
Enrollment: | 100 |
Study Start Date: | March 2010 |
Estimated Study Completion Date: | October 2014 |
Estimated Primary Completion Date: | October 2014 (Final data collection date for primary outcome measure) |
Groups/Cohorts |
Cohort |
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Sampling Method: | Probability Sample |
Study Population
Patients with colon cancer stage III (Duke C) on Xeloda monotherapy
Inclusion Criteria:
- Adult patients, over the age of 18 years
- Presence of colon adenocarcinoma
- Surgical resection for colon cancer stage III (Duke C)
- Prior adjuvant therapy with Xeloda monotherapy
Exclusion Criteria:
- Contraindications for Xeloda
Contacts and Locations
More Information
No publications provided
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on March 10, 2014
No publications provided
Responsible Party: | Hoffmann-La Roche |
ClinicalTrials.gov Identifier: | NCT01276405 History of Changes |
Other Study ID Numbers: | ML25174 |
Study First Received: | January 12, 2011 |
Last Updated: | March 3, 2014 |
Health Authority: | Romania: National Medicine and Medical Devices Agency (NMMDA) |
Additional relevant MeSH terms:
Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms Digestive System Diseases Gastrointestinal Diseases Colonic Diseases |
Intestinal Diseases Rectal Diseases Capecitabine Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Antineoplastic Agents Therapeutic Uses |
ClinicalTrials.gov processed this record on March 10, 2014


text:
Definition of forbidden in English:
Line breaks: for¦bid|denPronunciation: /fəˈbɪd(ə)n
- 1Not allowed; banned: a list of forbidden booksMore example sentences
- Whether it was the forbidden joy of being allowed to paint on a wall, or the exhilaration of letting their inhibitions go, their faces glowed with excitement.
- The guys nick some four-eyed geek's suitcase full of forbidden books - and this is where the title's Balzac reference comes in.
- The community is forced to shut down the library, because all the books contain the forbidden letter.
prohibited, banned, debarred, vetoed, proscribed, ruled out, not allowed, disallowed, taboo, impermissible, not acceptable, unauthorized, unsanctioned; outlawed, illegal, unlawful, illicit, illegitimate, criminal; North American interdicted; German verboten; Islam haram; New Zealand tapu• informal no go, not on, out• rare non licet
- 2 Physics Denoting or involving a transition between two quantum-mechanical states that does not conform to some selection rule, especially for electric dipole radiation.More example sentences
- Surprises emerged when the researchers looked at the crystal's effect on ultrasound frequencies above the forbidden range.
- Light within a forbidden range of wavelengths can't propagate through the array, so if a row of cylinders is omitted, the light will be trapped in the missing row.
- The number of steps of descent from the same ancestor that bar two related people from marrying.More example sentences
- The only thing necessary for a legal marriage was the free consent of both parties, as long as they were of age, were not within the forbidden degrees of kinship, and were free of any other marriage.
- Incest was considered a major crime, and forbidden degrees of kinship were extensively prescribed in the act of 1580.
- In the act of 1580, forbidden degrees of kinship were extensively prescribed.
forbidden fruit
- A thing that is desired all the more because it is not allowed.[with biblical allusion to Gen. 2:17]More example sentences
- Noah is an openly gay male who seems to have it all until he finds himself desiring the forbidden fruit - women.
- Nostalgia is not a forbidden fruit but astute statesmen never allow prudence to succumb to it.
- They had an added cachet of being forbidden fruit: the Stalinists did not approve.
More definitions of forbidden
Definition of forbidden in:- The US English dictionary
- The English Synonyms
- The US English Synonyms


text:
We are pleased to announce that we will headline this year's Deer Shed Festival, on Sunday July 22nd. The festival takes place at Baldersby Park in North Yorkshire. Adult tickets for the three day weekend are priced £69, or £59 for a Saturday/Sunday ticket. A child full weekend ticket costs £20. For more information visit the festival website.
Last December we played a show at the Other Voices Festival in Dingle Ireland. You can watch My God Betrays taken from this performance at youtube here.


text:
Let's Get To Know
INDYCAR's Sarah Fisher On The Transition From Winning Race Car Driver To Winning Team Owner
12:30 pm, November 23rd | by Sarah Devlin
Sarah Fisher was a record-setting race car driver. Then she became a winning team owner. She talked to us about the challenges of being behind the wheel and behind the scenes in a heavily male-dominated field.


text:
- News
- Image Galleries
- The best of aviation and spacecraft (photos)
The right stuff
CNET reporter Daniel Terdiman came through this week as part of Road Trip 2010 and made sure to spend some time looking at some of the most famous airplanes in history.
As a fan of the terrific film "The Right Stuff," Terdiman couldn't resist the allure of this plane, the Bell X-1, in which Chuck Yeager became the first pilot ever to surpass the sound barrier. The plane has a 28-foot wingspan, is 30 feet, 11 inches long, and a total of 10 feet, 10 inches tall. It weighs 12,250 pounds and was made by Bell Aircraft company in 1946.
Click here to read the related story on the Smithsonian National Air and Space Museum and click here to check out the entire Road Trip 2010 package.
June 29, 2010 10:00 AM PDT
Photo by: Daniel Terdiman/CNET
| Caption by: Daniel Terdiman
Member Comments
Conversation powered by Livefyre


text:
101 Neptune East Northern Illinois University DeKalb, IL 60115 Phone: (815) email@example.com
Live with other students who are part of NIU's ROTC program and have a similar schedule. A number of rooms are on reserve for continuing and new cadets.
For Fall 2012 - Spring 2013, the ROTC House will be located in Douglas D (Floor 5).
For more information, contact David A. Dosier at email@example.com or 815-753-6240.


text:
Szenen Informationen
Download : Danny Somers, Johnny Hanson
- Aktualisiert : 2010-07-01 |
- Länge : 10:06 min |
- Grösse : 108 MB |
- Images : 8 |
- Mal angesehen : 4777 |
Danny Somers, Johnny Hanson
Rating : 9.7 out of 10
Danny Somers and Johnny Hanson lock eyes and immediately get down to business. Danny drops to his knees, eagerly throating Johnny's huge stiff cock. The men retire to Johnny's bedroom and their manly play continues. While Danny sucks his cock, Johnny fingers his smooth white ass, relaxing him and opening him up. Johnny fills Danny's hole, slamming his ass relentlessly until both men unleash their white-hot satisfaction.
Recommended Scenes
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Aktualisiert am: 07-01-2010
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Aktualisiert am: 07-01-2010


text:
Search Results for red dot sight accessories
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Universal Home Defense Accessory Kit
turn the Sightmark Triple Duty CRL Red Laser Sight on and point it at the door as you slowly walk out ... into the hallway. The dim red dot is slowly making its way on the wall, as you scan the house. ... invested in the OpticsPlanet Home Defense Accessory Kit because now you have everything needed to protect ... Defense Accessory Kit has you covered, because you have a Mini Maglite in your Kitchen Drawer ... Home Defense Accessory Kits for you to choose from so that you know you have all essential home ... accessory, the OpticsPlanet Home Defense Accessory kit is the perfect place to start. Features ... of OpticsPlanet Home Defense Accessory Kit: All the essential home defense accessories you need in one... |
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Invisible Man Kit by OpticsPlanet
w/ Scope Mount LG-ND3X40 Burris FastFire III Red Dot Reflex Sight - 3 MOA Dot, w/ Picatinny Mount ... Accessories Leupold Mark 4 ER/T 4.5-14x50mm (30mm) M5 Matte Front Focal Mil Dot Rifle Scope ... Invisibility takes many forms. From hiding in plain sight to total light-bending camouflage, you ... to modern day stealth aircraft, keeping out of sight of your enemy or prey has always been an advantage. ... of hearing, being invisible isn't as simple as keeping out of sight. You don't want to spook game ... on the list of hunting optics is a quality rifle scope. The Leupold Mark 4 ER/T 4.5-14x50mm Mil Dot ... 300234 Hunting Accessories Nikon 8x20mm Premier LX Waterproof Compact Binoculars 7506 Carl Zeiss... |
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Subjects taught at LSE | Services and divisions (administration)
All research groups | Research subject areas
Welcome to the home page of the Financial Support Office, which is situated within LSE's Student Services Centre. The Financial Support Office is responsible for administering School funds and a variety of scholarships, studentships, prizes and awards
A-Z Financial support site index|
Student Services Centre 11th April 2014
Please be aware that the Student Services Centre will be closed on Friday, 11 April. This is due to a technical upgrade which will prevent access to the systems needed in order to be able to advise students or prepare documentation. All drop-in sessions will be cancelled on this date.
LSE Bursary - Lent Term 2013/14
27.01.14 - We have recently learned that there has been a technical issue which has delayed the Lent Term instalment of the LSE Bursary for some students. The issue has now been resolved and payments should be received by mid February.
The School has an interest free short term loan| facility which students are welcome to apply to if this delay causes any difficulty. If you have any queries, please contact email@example.com.
Student Finance for 2013/14
UK and EU undergraduates (all years): if you who have not yet finalised your student loans and grants with Student Finance, please log in to your account with them and resolve any outstanding issues.
Those eligible for bursaries will then get their bursaries approved and the first instalment paid.
More information on applying for Student Finance|
Funding for 2014/15
Following the success of last years LSE India Scholarships we are pleased to confirm that at least 40 scholarships will be offered to applicants from India for 2014.
More information on LSE India Scholarships|
Donor scholarships are added at all points in the year so please check these pages regularly.
PhD students – are you writing up your thesis? There is funding available to support your writing up period| and help you finish on time.
Quick links
Financial support for Undergraduate study in 201|4


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Home Activities/Events Summer Activities Off-Road Adventures 4x4 Tours
Call Toll Free 1.800.944.7853 to confirm reservations within 24 hours of tour time.
Ask your Whistler.com agent how you can save both time and money by adding airfares, transfers, accommodation and more to your activity package. All tours and packages are in Canadian funds.
Call 1.800.WHISTLER (944.7853) to speak with a local travel consultant


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Whether a beginner or an expert orchid grower, you will find membership in the American Orchid Society a truly rewarding experience. You'll join over 16,000 others worldwide who share a passion for orchids, as well as furthering conservation and research efforts for these wondrous plants. Join the AOS now Click here
The first OCC conservation slide show is now available for Orchid Society meetings.
The program touches on issues of habitat loss and orchid conservation in Pennsylvania, USA, Sumatra, Indonesia; restoration at Jardin Botanico las Orquideas Ecuador; conservation at EcoMinga Foundation, Ecuador and at GROWISER, Oregon, USA.
This slide show is available as a free downloadable Powerpoint presentation or movie file. The slide show is fully narrated. It contains some animation and a movie clip and runs automatically on a computer and can be projected onto a screen or shown through a TV.
For more information visit - www.orchidconservationcoalition.org


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Photo of the Week: Growing a Cotton Industry in Uganda
January 24, 2014
With TechnoServe's assistance, smallholder cotton farmers in eastern Uganda are increasing their yields and selling to a thriving cotton processing business.
A truck painted with the words "Grow More Cotton" delivers the latest harvest from local farmers to Mutuma, a cotton processing business in Kiyunga, Uganda. With TechnoServe's assistance, smallholder producers in the region are doing just that – growing more cotton, the area's main cash crop. TechnoServe facilitated training on best agronomy practices, such as planting in properly spaced rows, which helped farmers more than double their yields. Our advisors also helped create or strengthen farmer business groups that allowed producers to aggregate their crops and access finance more easily.
Meanwhile, TechnoServe worked with Mutuma to capitalize on the farmers' improved productivity and organization. The business was able to scale up its production of cotton lint by more than 40 percent and seize a profitable new market opportunity – medical absorbent cotton. Mutuma has become an economic engine for the community, employing 250 people at peak processing season and buying cotton from 6,000 small-scale farmers.
Learn more about our work with Uganda's cotton industry.


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Manipulated with Topaz Clean.
Brand: | NIKON CORPORATION |
Camera: | Nikon D5000 Check out Nikon Nation! |
Recording media: | JPEG (digital) |
Date Taken: | 22 Oct 2012 - 12:48 PM |
Focal Length: | 48mm |
Lens Max Aperture: | f/4.8 |
Aperture: | f/8.0 |
Shutter Speed: | 1/250sec |
Exposure Comp: | 0.0 |
Exposure Mode: | Not Defined |
Metering Mode: | Multi-segment |
Flash: | Auto, Did not fire |
White Balance: | Auto |
Title: | Fowey - One Way - Ref 7176 - M |
Username: | LucienH |
Uploaded: | 14 Nov 2012 - 9:22 AM |
Tags: | Cornwall, Digitally manipulated, Dog, Fowey, People, Road, Street, Uk, Walk |
VS Mode Rating |
101 (50% won) These stats show the percentage of wins and the rating score that your photo has achieved. You can go to the VS Mode by clicking on this icon. Signup to e2Signup to e2 to see which photo this has won or lost against in the vs mode |
Votes: | 23 |
Nominating Constructive Critique
Nominating Constructive Critique
Glad she's walking the right way. A very good spot, Lucien.
Nominating Constructive Critique
It's a great shot very well captured says many things to me the main one is outstanding capture very well spotted and presented
Nominating Constructive Critique
Nominating Constructive Critique
Nominating Constructive Critique
That was naughty of you to snap Lillian unawares!
Nominating Constructive Critique
Quote: Fowey - One Way
Don't do that! It brings back trauma. We had a holiday cottage there in June off a very narrow one-way street. If you managed to turn the car around (tricky) you had to negotiate the very narrow lane to come out onto the one way street. Half the locals said it was one-way - the other half said not. Only problem was you couldn't turn right into the one-way flow you had to go left against it.
And the whole place was full of Notting-Hill types with Audi TTs
That last bit may have been a slight exaggeration.
Nominating Constructive Critique
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Unique Miniature "Good Luck" Wooden Elephant Wedding Favors
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Miniature "Good Luck" Wooden Elephants
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Weekend links: Densification
Glenmont Sector Plan unveiled: Montgomery County has released at last started the planning effort for its Glenmont Sector Plan. Officials envision a high-density, transit-oriented hub, but the land is split between many owners, making change difficult. (DCMud)
BRAC for the civies: A bill to create a civilian BRAC process is moving forward in the House. A commission identify which civilian properties can be sold or consolidated. (WBJ)
Big Chair relaunches, reopens: Historic Anacostia has its coffee shop back: Big Chair Café has reopened under new management, which wants to make it the neighborhood's gathering place. (WAMU)
An encouraging but timid plan for the Mall: NPS's conceptual plan for the Mall mostly has some elements which just tweaks around the edges and neglects its place as a park for residents, or so says the director G. Martin Moeller, Jr., senior vice president and curator of the National Building Museum, in his capacity as a private citizen. (City Paper)
What to call gentrification by non-whites: Gentrification is largely class-based, but are the outcomes the same when gentrifiers aren't white? (DCentric)
Fight for your right to cycle: Cyclists in Baltimore went ballistic when word leaked out that two college presidents may have quietly put the kibosh on a planned bike lane. Yet the lane isn't dead yet, and activists are fighting to keep it alive. (Baltimore Brew)
On the polycentric metro region: Regions with more than one major city are more productive, likely due to shared load between governments. But advantages of large cities, like cultural richness, get lost when the population is divided. (Per Square Mile)
Towards healthier transportation: Designing a city around the car is a recipe for poor health, and a bill in the Washington State House would factor in public health effects when planning transportation. (Seattle Times)
And...: There are some tricks to getting the light to change as a cyclist. (Patch) ... More details emerge on the I-395 air rights development, including LEED Platinum status. (CityBiz )... An interactive map of vacant buildings in Shaw. (EastShawDC)
Have a tip for the links? Submit it here.
MoCo planners haven't "released" the Glenmont Sector Plan yet; in fact, they haven't even written it yet. What they submitted to the Planning Board last month was the scope of work, which is basically a plan for the plan.
Yeah, I was expecting to see some pretty renderings upon visiting the link about Glenmont but instead just got the "before" photos, since, well, there's no "after" renderings just yet.
Sounds like most of the land near the station is within just five complexes, all obsolete retail or multifamily buildings. Sounds like a pretty straightforward suburban retrofit job to me.
I've had better luck with the red light sensors in Montgomery County detecting my bike, but in general the advice is sound. Place yourself and your bike directly over one of the loop lines in the direction of travel and stay there.
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- Is a walkable neighborhood out of reach for you?
- What's the point of supermarket gas rewards if you don't drive to the store?
- Design could make or break the 11th Street Bridge Park
- Fun on Friday: Play the Mini Metro game
- Adding 15-minute Circulator routes would dilute the Circulator brand
- DC Council race reviews: At-large and chairman
- Comparing Metrobus and Metrorail farebox recovery is apples and oranges


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On View: Female Kifwebe Mask
The kifwebe masquerade is a genre shared by the Luba and Songye, indicative of the interaction that has occurred between the two societies. ...
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Hiroshige's One Hundred Famous Views of Edo
Hiroshige's 118 woodblock landscape and genre scenes of mid-nineteenth-century Tokyo, is one of the greatest achievements of Japanese art.
On View: Bottom of Coffin
In the interior painting on this bottom half of a coffin, the large figure represents Osiris, king of the dead. The mummy would have origina...
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Brooklyn Museum Posse:Exploring the collection
When you join the posse, your tags comments and favorites will display with your attribution and save to your profile.
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My husband is going to try to install vinyl flooring (he`s no handyman although he liskes to think he is!!) in our entrance and on the three steps going from the entrance to the kitchen. The vinyl is in dark eathy tones and resembles slate. My problem is that I want wooden nosing because I find it looks so much better than then metal or rubber nosing but wooden nosing is made to be used with ceramic or floating floor only... Has anyone ever used wooden nosing with vinyl-covered stairs? Can this be bought or can it be made?
Hi luv2style. I think that the reason that wood stair nosing is not used in this application is because it is much thicker than the vinyl flooing and wouldn't look right or feel right to step on. Have you considered using the metal stair nosing and painting it in a colour to match the vinyl flooring?
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UW-Eau Claire's Counseling Website Reaches Out to the World by Tammy Kempfert, TTT Editor
UW-Eau Claire's Counseling Center has a website that receives approximately 900 hits a day--or at last count, almost 30,000 hits a month-- from all over the globe. It boasts an extensive self-help section, intended not only to educate the public but to encourage Eau Claire student to visit the center for further help. Read the full article to learn more about the site and the people who developed it. (Dec. 2000)


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You're sure to strike gold with this 4 Mile Shindy!
On March 15th, 2014, bagpipes will sound, glasses will rise, and a sea of green will flood Kansas City! Don't miss out on the 36th running of the Westport St Patrick's Day 4 Miler. Whether you hail from Missouri, Kansas, or the beloved hills of the homeland, sign up now for the greatest Gaelic gathering this side of the Atlantic …and may the luck o' the Irish be with you!


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VIDEO: A toe-tapping parody of the Marlins history
As the Miami Marlins begin their 20th season, we take a tongue-in-cheek, lyrical look back at their history of highs and lows, feats and foibles, majesty and missteps. It's sung to the tune of John Fogerty's baseball ode "Centerfield."
The lyrics:
They won the World Series in Game 7
But in the following days he gave them all away
The fans were all aghast - they thought success would last, felt betrayed
Trade them all away, we don't want to win, that way
Money is no object unless you must pay, them to play
There's no deal, It's unreal
Jeff Loria, hallelujah, in 2003
He bought a team, fulfilled his dream of a ring
But in the following days the champs were dealt away
Here we go again
The fans will never mend, so they sing...
Trade them all away, we don't want to win, that way


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No Surprises Here: How That Viral Samsung HD Camera Phone Commercial Was Created
Remember that viral Samsung ad with the mysterious disappearing phone? Me neither! *rewatches video* Oh right, that looked vaguely familiar. Well, this video explains how they made it just in case you care. And, not to ring our own collective bike bell or anything, but it's exactly how we all thought. Well, except for you -- you're slow. Like a turtle. ONE WHO CAN'T EVEN BEAT A RABBIT IN A FOOTRACE. But still, I like you. I like turtles.
Samsung's puzzling camera trick: here's how they did it [dvice]
This is a viral ad for Samsung's new I8910 camera phone. I found the guy in the video annoying but I would do his girlfriend. Twice. Once with the lights on. OUR CHALLENGE: GUESS HOW WE DID THIS. This clip was shot on an I8910 HD phone, a new camera phone just released by S... / Continue →
This is a viral video for Samsung's new touchscreen Omnia i900 phone. I don't want to ruin anything, so you'll just have to watch it. I thought it was cute. Well, not like bunny or kitten cute, but still, it's neat. Just not as neat as my bedroom. I'm OCD. Youtube Than... / Continue →
This is a Nokia viral ad for their N8 phone featuring the world's largest stop-motion animation, which was made on a beach using a crane (that's a real boat in the picture). It's a follow-up to their world's smallest stop-motion animation and NOT a follow up to the job intervi... / Continue →


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September 26 2012
Lyman celebrates Homecoming this week
Posted by Lucy
Monday Lyman School kicked off the annual week long homecoming celebration with cowboy dress up day. The homecoming King and Queen were crowned Tuesday night at Coronation.
Wednesday is color day, Thursday crazy day and Friday red, black & white day.
The girls' volleyball team entertains Platte/Geddes at home Thursday night at 6:30 PM.
An all school pep rally will be held Friday at 1 PM at the gym in Presho, followed by the parade at 2:00 PM.
The Raiders football team takes on Jones County Friday night with a 7 PM kick off at the sports complex in Presho. Due to the county-wide burn ban, the letters will NOT be burned after the game.
- Garnos inducted into Hall of Fame
- Playing at the farm and home show
- Garnos to be inducted into SD Amateur Basketball Hall of Fame
- Curtain to go up SATURDAY night on 20th play
- Group organizes to promote rail line rehab
- Vacancies open on city and town boards
- First year of Jr. Kindergarten program exceeds expectations
- Rails to the future
- Berg to retire from Reliance Post Office
- Weighing In
- A monster of a tournament


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Popular Categories
Right now, I'm working on a first and very rough draft of the third of the Evie Scelan novels. It does have a working title; but since the working title has changed three times since I began, I'm just calling it Book no. 3 for now. It's coming along more slowly than Wild Hunt did, but I have a sense of the arc of it, and it feels as if it could be really good.
I expect I'll be receiving more edits on Wild Hunt soon enough—I like how that book turned out, and I can't wait to see how it ends up.
In April, I'll be going back to my hometown for a library visit and an alumni evening at the Indiana Academy. After that, there's WisCon in May, some personal events in June, and then Worldcon in Montreal in early August! Wow, the summer's filling up fast.


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By Staci DaSilva
They're called "diet sodas," but should you drink them if you're looking to lose weight? One new nationally-recognized study says "no."
So, how much diet soda do you drink?
"24 ounces, to be fair. Diet Coke in the daytime, caffeine free Diet Coke at night," said Joanne Craig of Sioux City.
She's certainly not alone. Almost every soft drink in the aisle comes with a diet version.
Most think choosing the 0 calorie option is good for the waistline, but the artificial sweeteners used to make it so sweet could disrupt your metabolism.
Unity Point Health - St. Luke's Registered Dietician Allison Appletoft explains, "When we eat something sweet, we expect energy to follow that. When we eat artificially sweetened foods or drinks, we get the sweet but we don't get the energy or the calories from it."
Whether it's 1 drink a day or 15, pop, in general, can cause heart disease, diabetes and lead to obesity.
A study released this week by Purdue University argues that regular soda is actually better for you than diet if you're looking to lose weight.
Dietician Allison Appletoft disagrees.
"Water is still going to be better than diet soda but diet soda will probably be better than regular," said Appletoft.
Just so you know, the artificial sweeteners found in flavored water can be just as damaging as those in the diet soft drinks.
The lesson here? If you can, just stick to regular, unflavored water.
If you do choose unsweetened water, over other options, but still want some flavor, a good tip is to add lemon or lime juice!


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Leon G. Epstein, MD
Pediatric Neurology
This physician prefers to see new patients referred by another physician.Read important legal notice
Office Phone:
Office Hours:
- Wednesday:9:00 a.m. - 5:00 p.m.
Education and Training
Medical Education: |
Wayne State University School of Medicine 1973 |
Residency: |
Univ. of Arizona Medical Center 1976 |
Fellowship: |
New York-Presbyterian Hosp.-Columbia Med. Ctr. 1978 |
Board Certification
Child Neurology
Locations and Directions
the full disclosure of external professional relationships


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Social Networking for Fashion Doll Lovers
Dollfie Dream, DAE wig, faceup by me
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Factory original 505 option Slant Nose with all of its factory steel body panels and no evidence of paintwork or accident history. 29,230 original... More
1989 Mercedes-Benz 560SLClassic Mercedes-Benz Roadster in great conditionBlack Metallic exterior plus a Grey Leather interiorEquipped with an 8 Cylinder gas Automatic transmissionAnd currently with... More
YOU ARE VIEWING A STUNNINGÂ 1989 FERRARI MONDIAL TÂ COUPE! Â VIN ZFFFD32A3K0082574 Â THIS IS AN EXTREMELY RARE COUPE. Â LESS THAN... More
Chequered Flag International Inc is pleased to offer this 1989 Rolls Royce Corniche in White with Tan interior & top. 24,432 miles from new... More
This 1989 Jaguar XJ Series 2dr XJS Coupe features a 5.3L V12 FI SOHC 12cyl Gasoline engine. It is equipped with a 3 Speed... More
1989 Chevrolet Corvette People Buy Old Cars For Many Different Reasons For Some The Decision Is Driven By Nostalgia For Their Past While For... More
This is an absolutely gorgeous and meticulously preserved 911 Carrera Cabriolet. 1989 is the last year, and most desirable of the 3.2 liter G50... More
For sale in our Tampa showroom is an all original 1989 Porsche 928 S4. How would you like to own the only Porsche model... More
Sold new in Montana, it remained there with its original owner until brought Arizona in 2012. Now in Florida, it is in excellent original condition including... More
1989 Porsche Speedster 962 Twin-Turbo 3.3 litre 962 Engine Twin 959S K26 Turbos with Garretson Intercooler EFI Technology x3 race ecu with wideband and... More
This 1989 Jaguar XJS 2dr 2dr Convertible features a 5.3L V12 FI SOHC 12cyl Gasoline engine. It is equipped with a 3 Speed Automatic... More
1989 Pontiac Trans Am GTA for sale in our Chicago Showroom. This rare 1989 Trans Am GTA is powered by the numbers matching... More
1989 Chevrolet Corvette that needs a little TLC but can be driven anywhere, with 117,549 actual miles. The red exterior paint is fair, and... More
1989 LeBaron GTC with 46,400 original miles. This LeBaron GTC is one fun coupe. It features the 2.2 Turbo II engine and 5 speed-manual transmissions.... More
1989 Mercedes 300SEL - Long Frame An Original Classic Car Elevates Transportation To An Art Form An Indelible Part Of The American Experience... More


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Michael, the inventor of Arbitrary But Fun Friday, is asking what sci-fi movies best portray the future how it's likely to be. However, since he's picked the best ones, I'm forced to pass on this one. Instead, I'm going to set up a discussion question based on…
By TBogg
Read MoreBy Karen McVeigh, The Guardian
Read MoreBy Techdirt
Read MoreRaw Story is a progressive news site that focuses on stories often ignored in the mainstream media. While giving coverage to the big stories of the day, we also bring our readers' attention to policy, politics, legal and human rights stories that get ignored in an infotainment culture driven solely by pageviews.
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