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In This Issue ... Search Tip Staff Profile Search Strategies -- Current Clinical Issues The IDIS Thesaurus 1995 FDA Drug Approvals 1996 FDA Drug Approvals Exhibit Schedule |
It is beneficial to perform a title and abstract search when looking for very specific side effects. Important, noteworthy side effects often appear in article titles and abstracts in the medical literature. Otherwise, eighteen different side effect descriptors identifying drug induced side effects reported in the medical literature are available for searching. These descriptors represent drug induced side effects by organ system, but also include descriptors 49 SIDE EF DEPEND REBOUND, 48 SIDE EF FETAL EFFECT and the general side effect descriptor term 46 SIDE EF ADVERSE REACTION. Specific drug induced side effects noted in the literature are cross referenced to one of these eighteen valid side effect descriptors. Cross references for a specific side effect are found in the Thesaurus which is accessed by selecting F3 and then Thesaurus. The Thesaurus is a combination of the Drug, Disease and Descriptor cross references and valid terms. Descriptor cross references are prefaced with (DE).
When using the Descriptor field of the Field Search template, a valid side effect descriptor term must be used. It is permissible however, to use only part of the complete valid term. For example, descriptor 82 SIDE EF CARDIOVASCULAR may be entered in the Descriptor field using only the code number, 82, or CARDIOVASCULAR.
When using the Global Search template, the descriptor code number searching is not recommended because searching is not limited to the descriptor field. A descriptor code number is likely to match journal volume, page, and issue numbers. In this case, it is best to use either the complete term, 82 SIDE EF CARDIOVASCULAR, or, at least, SIDE EF CARDIOVASCULAR.
The valid terms for all eighteen side effect descriptors begin with SIDE EF. To find all side effects reported for a specific drug, search using only SIDE EF. Searching with only descriptor 46 SIDE EF ADVERSE REACTION would not be the appropriate way to find all side effects for a drug. This side effect descriptor is currently used only when "side effects" (or absence of) are mentioned without further clarification.
Brad Gilchrist, R.Ph.
Helen rejoined the IDIS team in January 1995. Since graduation with a Bachelor of Pharmacy degree from the South Australian Institute of Technology (now the University of South Australia) Helen has gained extensive experience in clinical hospital pharmacy practice, and provision of drug information services in Australia, the U.K. and the U.S.A. Before rejoining IDIS, Helen was most recently employed as a clinical pharmacist by The Drug and Therapeutics Information Service (DATIS), an educational outreach and academic detailing service based at the Repatriation General Hospital in Adelaide, South Australia, Australia.
Helen's responsibilities at IDIS include indexing articles added to the database each month, providing information and assistance to current and prospective subscribers, planning quality improvement/quality assurance activities, and communicating with IDIS's on-line and CD-ROM vendors; KnightRidder Information, Ovid Technologies and SilverPlatter.
Helen enjoys reading, teaching Sunday school and walking with her husband in the picturesque state parks surrounding Iowa City. They are both looking forward to the birth of their first child in June.
The IDIS SYSTEM/CD-ROM database can be used to effectively retrieve valuable information covering a multitude of current issues in clinical practice. In the following examples, the topic of interferon treatment in multiple sclerosis is used to illustrate some of the search strategies formulated to retrieve current clinical information.
A. Search strategy: Identifying drug and disease terms - Searching for review articles
Several options are available in performing a broad search of the database. Press the F3 function key (Select Search) and select the Thesaurus from the pull-down menu, to identify correct terms for drug and disease in the IDIS database.
Type, interferon, or truncate the term using the asterisk. There are a large number of entries (over 50) for this drug term, including interferon alfa, interferon beta, interferon gamma, interferons, interferon beta-1b. Press the Escape key twice to return to the Thesaurus and type, multiple sclerosis. There is only one disease term listed SCLEROSIS, MULTIPLE 340. Select F3 again and choose the field search template. Enter interferon ( or interfer*) in the drug field and multiple sclerosis ( or the disease number 340.) in the disease field. Over 70 citations will be retrieved. Alternately, a global search can be conducted, using the same two terms. After browsing the titles, index records and abstracts of the citations retrieved, it is possible to identify the specific drug, interferon beta-1b, which has recently shown promising results in the treatment of multiple sclerosis.
Conduct the previous field searches again, this time using the specific drug term interferon beta-1b, to narrow the results. This search will retrieve between 40 and 50 citations. To obtain an overview of the topic, restrict the citations to review articles only by returning to the field search template and adding the term review to the descriptor field, or returning to the global search template and adding review. The citations retrieved (between 10-20) provide a good summary of the current published information.
B. Overview of information retrieved by the search
Interferon beta-1b was given FDA approved-labeling for use in relapsing-remitting multiple sclerosis in 1993, based on results of a landmark trial conducted in patients from the USA and Canada by the IFNB Multiple Sclerosis Study Group. This is the first controlled clinical trial where a treatment has been shown to favorably alter the natural course of multiple sclerosis. The trial produced evidence that interferon beta-1b effectively reduces relapse rates and disease burden as measured by magnetic resonance imaging in relapsing-remitting multiple sclerosis. Unfortunately, the trial was of relatively short duration, with only a three year follow-up. The vital question of whether treatment with interferon beta -1b will reduce long-term disability still remains unanswered, and is the subject of further investigation.
A. Search strategy: Retrieving clinical studies
After perusing the reviews, we see there is one major study on which the FDA drug approval was based. This study can be retrieved by searching the author field, title field or the journal field in the field search template, or a more general search for all clinical studies can be conducted. To perform a search for all clinical studies type in the same drug and disease terms, with the addition of the term study in the descriptor field. The study cited by the FDA is retrieved in this search.
B. Clinical Information: Study details
A randomized, double-blind study, enrolled 372 ambulatory patients with clinically or laboratory confirmed relapsing-remitting multiple sclerosis of more than one years' duration, and assigned patients to receive interferon beta-1b (1.6 or 8 million international units) or placebo subcutaneously on alternate days. All patients had comparable baseline characteristics prior to trial entry including gender, age, disease duration, disability, and previous number of exacerbations. To meet trial inclusion criteria, the patients were ambulatory, had experienced at least two exacerbations of disease in the last two years, were clinically stable, were 18-50 years of age, and had relapsing-remitting disease.
In this study, patients receiving 8 million international units (MIU) of interferon beta-1b experienced reduced exacerbation frequency and a greater proportion were exacerbation free than either the 1.6 MIU, or the placebo group. After two years both interferon treatment groups had lower exacerbation rates than the placebo group. The proportion of exacerbation free patients was lower in the 8 MIU group than the placebo group, but not in the 1.6 MIU group.
As with all new therapies, the relative costs and benefits of treatment require assessment, along with identification of patients likely to gain the most benefit from treatment. Interferon beta-1b therapy is relatively expensive, and not without adverse effects. Mental disorders with serious consequences were a disturbing finding in this study, and require further investigation. Assessment of the effects of interferon beta-1b treatment on patient quality of life has yet to be studied.
A. Search strategy: Patient selection criteria
Most of the information regarding patient selection criteria is contained in the published clinical study data and these citations have already been retrieved. An additional title search for patient selection could be performed, using patie* select* in the title field of the field search template, with multiple sclerosis and interferon beta-1b in the disease and drug fields. One citation specifically addressing this issue was retrieved.
B. Clinical information: Patient selection criteria
As strict patient selection criteria were used in this study, the results can only be directly applied to that specific patient population: ambulatory patients with relapsing remitting multiple sclerosis. However, patients with other types of multiple sclerosis, ( progressive disease for example) other age groups, (age greater than 50 years) or patients who are not ambulatory or who have not experienced at least two exacerbations of disease in the last 12 months, may still find interferon beta-1b treatment helpful. For a more detailed discussion of patient selection criteria see the selected bibliography.
A. Search strategy: All adverse effects
To search for all adverse effects of any drug, use the term side ef in the descriptor field, or in the global search template. To retrieve citations concerning specific adverse effects, use the Thesaurus to identify the specific descriptor terms.
B. Clinical information: Summary of some important adverse effects
Adverse effects of interferon beta-1b may vary with dose, route and regimen. For subcutaneous administration, interferon beta-1b is generally well tolerated. The most common adverse effects experienced during the IFNB Multiple Sclerosis Study Group trial include flu-like symptoms, fever, chills, myalgias, sweating, nausea, anorexia, fatigue, malaise and headache.
Other adverse effects reported with less frequency are mental disorders including depression, anxiety, emotional lability, depersonalization, confusion, and suicide attempts. One suicide and 4 attempts were reported among the 372 trial patients during the three year study period, all in patients assigned to interferon therapy. No suicide attempts were reported in the patients assigned to the placebo group. It is not yet known whether the mental disorders seen in the study are a consequence of interferon treatment, or underlying neurologic abnormalities in multiple sclerosis, or a combination of both.
A case report of severe necrotizing cutaneous reactions as a result of interferon beta-1b therapy was also retrieved.
A.Search strategy: Dosage regimen - Cost
To search for dosage regimen use the term dosage in the descriptor field to retrieve all citations that contain dosing information. Over 20 citations are identified.
To search for cost of drug therapy, first check the thesaurus to find the correct descriptor, which is 129 ECON DRUG ECONOMICS. Use 129 in the descriptor field, in addition to the drug and disease terms in their appropriate fields.
B. Clinical information: Dosage regimen and cost of therapy
The recommended dosing regimen for interferon beta-1b treatment of patients with relapsing-remitting multiple sclerosis is 8.0 MIU administered subcutaneously on alternate days. The cost of treating a patient with this regimen is approximately US $7,500 to US $10,000 per year.
The above simple search strategies efficiently retrieved a large amount of pertinent clinical information and answered the following key questions:
As always, the IDIS pharmacy team is available to provide timely, relevant, clinical information from the primary literature. Contact us via phone (U.S. toll free 800-525-4347), fax, e-mail, our WWW home page address, or regular mail to make the most of your IDIS subscription, and take advantage of our free subscriber search service.
Helen Scott, B. Pharm., R.Ph.
Article Number 329583: CONNELLY J F. INTERFERON BETA FOR MULTIPLE SCLEROSIS. ANN PHARMACOTHERAPY 1994, 28:610-616.
Article Number 337447: GOODKIN D E. INTERFERON BETA-1B. LANCET 1994, 344:1057-1060.
Article Number 354727: BECKER C C; GIDAL B E; FLEMING J O. IMMUNOTHERAPY IN MULTIPLE SCLEROSIS, PART 2. AM J HEALTH-SYST PHARM 1995, 52:2105-2120.
Article Number 342460: (EDITORIAL); MCDONALD W I. NEW TREATMENTS FOR MULTIPLE SCLEROSIS: MAY DELAY DETERIORATION. BMJ 1995, 310:345-346.
Article Number 313026: SIBLEY W A; EBERS G C; PANITCH H S; REDER A T; ET AL. INTERFERON BETA-1B IS EFFECTIVE IN RELAPSING-REMITTING MULTIPLE SCLEROSIS. I: CLINICAL RESULTS OF A MULTICENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL. NEUROLOGY 1993, 43:655-661.
Article Number 313027: PATY D W; LI D K B; TANTON E L; ZHAO G J; ET AL. INTERFERON BETA-1B IS EFFECTIVE IN RELAPSING-REMITTING MULTIPLE SCLEROSIS. II: MRI ANALYSIS RESULTS OF A MULTICENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL. NEUROLOGY 1993, 43:662-667
Article Number 350104: DUQUETTE P; KNOBLER R L; LUBLIN F D; FRANCIS G S; ET AL. INTERFERON BETA-1B IN THE TREATMENT OF MULTIPLE SCLEROSIS: FINAL OUTCOME OF THE RANDOMIZED CONTROLLED TRIAL. NEUROLOGY 1995, 45: 1277-1285.
Article Number 333877: ALTER M; BYRNE T N; DAUBE J R; FRANKLIN G; ET AL. PRACTICE ADVISORY ON SELECTION OF PATIENTS WITH MULTIPLE SCLEROSIS FOR TREATMENT WITH BETASERON. NEUROLOGY 1994, 44:1537-1540.
Article Number 348229: (LETTER TO ED); SHEREMATA W A; TAYLOR J R; ELGART G W. SEVERE NECROTIZING CUTANEOUS LESIONS COMPLICATING TREATMENT WITH INTERFERON BETA-1B. N ENGL J MED 1995, 332:1584.
Article Number 355223: (LETTER TO ED); SHINOHARA K. MORE ON INTERFERON-INDUCED CUTANEOUS NECROSIS. N ENGL J MED 1995, 333: 1222.
Article Number 355224: (LETTER TO ED); TRAUTINGER F; KNOBLER R M. MORE ON INTERFERON-INDUCED CUTANEOUS NECROSIS. N ENGL J MED 1995, 333:1222-1223.
Article Number 355225: (LETTER TO ED); SHEREMATA W A; TAYLOR J R; ELGART G W. MORE ON INTERFERON-INDUCED CUTANEOUS NECROSIS (REPLY). N ENGL J MED 1995, 333:1223-1224.
We choose the search word/phrase with the hope that it will retrieve only relevant material. A balance between retrieving everything possibly useful (too much) and retrieving only some of the relevant items (too little) can be achieved with the help of a controlled vocabulary and a thesaurus.
Pharmacy and medical literature is replete with words and phrases that have the same or very nearly the same definition or meaning. Authors of journal articles do not write with a standardized vocabulary for drugs, diseases, diagnostic tests or treatment modalities. While a clever searcher can identify all the synonyms, formats and permutations of a concept he or she wishes to search, this does take time and an expertise in multiple biological disciplines. The IDIS database has controlled this rich, but unwieldy, medical/pharmacy vocabulary by creating standardized drug, disease and descriptor vocabularies to index the concepts found in journal articles. One drug name (generally the United States Adopted Name) is used in the article index scheme regardless of the name appearing in the article. Likewise, one disease name (International Classification of Diseases - 9th Edition - Clinical Modifications) identifies all instances of the same disease concept. IDIS descriptors provide standardized access to journal articles' contents.
The goal of the searcher in retrieving information from a database, like IDIS, that uses a standardized or controlled vocabulary is to choose the single vocabulary term under which all relevant articles will be indexed. IDIS provides the searcher with a valuable tool -- the thesaurus. The IDIS thesaurus began in the mid-1960's as an in-house document to aid pharmacists indexing journal articles. Before long, the size and value of the thesaurus had grown considerably. It became apparent that IDIS subscribers' would also benefit from the thesaurus. The IDIS thesaurus evolved from paper copy, to microfilm to CD-ROM and expanded to include not only drug nomenclature but also diseases and descriptor terms. During 1995 the thesaurus grew by 464 drug, 1278 disease and 257 descriptor terms.
A controlled index vocabulary coupled with an extensive thesaurus provides searchers with the best opportunity to achieve a balanced search strategy sensitive enough to identify all possibly useful citations, but specific enough to limit the retrieval to only relevant citations.
Hazel H. Seaba, Director
The FDA's approval of 85 new drugs and biological products in 1995 was highlighted by the continuing decline in drug median approval times and the approval of seven drugs for AIDS and other life-threatening disease in six months or less. One of these new products, saquinavir, was approved in 97 days. Fifteen of the approved new drug applications were in the "priority" category reserved for medications that are expected to have important therapeutic value. The median approval time for these products was 6 months, compared to that of 15 months in 1994.
Twenty-eight of the new drug approvals last year were new molecular entities, products containing an active substance that had never before been marketed in any form in the United States. This compares to 22 new molecular entities approved in 1994. Of the FDA new molecular entities approvals in 1995 almost 20% represented oncologic agents. Cardiovascular agents constituted another 20% and metabolic agents and antivirals comprised another fifth of the approvals. The median review time for these new molecular entities was 15.9 months, nine percent faster than the 17.5 months required for similar approvals in 1994. However, the FDA continues to approve a large proportion of these drugs at the end of the year. Nine (32%) of the total 1995 new molecular entities were approved in December.
Ruth Ann Calloway, M.S., R.Ph.
Generic Name (FDA
Therapeutic Classification)
Trade Name | Valid IDIS Drug Term Drug Number (IDIS Citations)* | Indication/Use | Valid IDIS Disease Term Modified ICD-9-CM Number |
Acarbose (1S)** Precose Bayer (Sep. 6) | ACARBOSE 44100011 (60 citations) | Treatment of non-insulin dependent diabetes mellitus | Diabetes Mellitus 250. |
Alendronate Sodium (1P)*** Fosamax Merck (Sep. 29) | ALENDRONATE 92000234 (26 citations) | Treatment of postmenopausal osteoporosis and Paget's Disease | Osteoporosis 733.0
Disorder, Menopause/Post NEC
Osteitis Deformans |
Amifostine (1P) Ethyol U.S. Bioscience (Dec. 8) | AMIFOSTINE 78080003 (38 citations) | Reduction of cumulative renal toxicity associated with repeated administration of cisplatin in advanced ovarian cancer | Neop, Mgn-Ovary 183.0
Disorder, Kidney/Ureter NEC |
Anastrozole (1S) Arimidex Zeneca (Dec. 27) | ANASTROZOLE 10120127 (3 citations) | Treatment of advanced breast cancer in postmenopausal women who have progressed on tamoxifen therapy | Neop, Mgn-Female Breast 174.
Disorder, Menopause/Post NEC |
Azelaic Acid (1S) Azelex Allergan (Sep. 13) | AZELAIC ACID 84500401 (21 citations) | Topical treatment of mild-to-moderate inflammatory acne vulgaris | Acne 706.0 |
Bicalutamide (1S) Casodex Zeneca (Oct. 4) | BICALUTAMIDE 68080407 (24 citations) | Treatment of advanced prostate cancer (used in combination with a luteinizing hormone-releasing hormone analog | Neop, Mgn-Prostate 185. |
Carvedilol (1S) Coreg SmithKline Beecham (Sep. 14) | CARVEDILOL 12160153 (60 citations) | Treatment of hypertension | Hypertension 401. |
Ceftibuten (1S) Cedax Schering-Plough (Dec. 20) | CEFTIBUTEN 8120656 (37 citations) | Treatment of acute bacterial exacerbations of chronic bronchitis, otitis media, and pharyngitis/tonsillitis | Bronchitis, Chronic NEC 491.
Otitis Media
Pharyngitis, Acute |
Cetirizine (1S) Zyrtec Pfizer (Dec. 8) | CETIRIZINE 4000031 (248 citations) | Relief of symptoms with seasonal and perennial allergic rhinitis and chronic urticaria | Urticaria NEC 708.
Allergic Rhinitis NEC |
Dexrazoxane (1P) Zinecard Pharmacia & Upjohn (May 26) | DEXRAZOXANE 10120118 (28 citations) | Cardioprotective | Cardiomyopathy 425.
Failure, Heart, Congestive |
Dirithromycin (1S) Dynabac Lilly (Jun. 19) | DIRITHROMYCIN 8121221 (18 citations) | Treatment of acute bacterial exacerbations of chronic bronchitis & secondary bacterial infection of acute bronchitis due to Moraxella
catarrhalis or Streptococcus pneumoniae Treatment of community-acquired pneumonia due to Streptococcus pneumoniae, Mycoplasma pneumoniae, & Legionella pneumophila | Bronchitis, Acute 466.0
Pneumonia, Pneumococcus
Pneumonia, Mycoplasma Pneumoni
Pneumonia, Bacteria NEC |
Epoprostenol Sodium (1P) Flolan Glaxo Wellcome (Sep. 20) | EPOPROSTENOL 20120610 (374 citations) | Long-term I.V. treatment of primary pulmonary hypertension in NYHA Class III & IV adult patients | Hypertension, Pulm, Prim 416.0 |
Glimepiride (1S) Amaryl Hoechst Marion Roussel (Nov. 30) | GLIMEPIRIDE 68200610 (1 citation) | Reduction of blood glucose in patients with noninsulin-dependent diabetes mellitus | Diabetes Mellitus 250. |
Hepatitis A Vaccine Havrix SmithKline Beecham (Feb. 22) | HEPATITIS A VACCINE 80120037 (77 citations) | Prevention of hepatitis A | Hepatitis, Viral A 070.0
Inoculation and Vaccination |
Iopromide (1S) Ultravist Berlex (May 10) | IOPROMIDE 36680039 (21 citations) | Contrast media for X-ray imaging and computed tomography | Contrast Arterio-Aortography 88.42
Contrast Angiocardiography
Contrast Arterio- NEC
Pyelogram |
Lamivudine (1P) Epivir Glaxo Wellcome (Nov. 17) | LAMIVUDINE 8180077 (34 citations) | Antiviral used with zidovudine for AIDS | Syn-Acq Immune Deficiency 042.
Infection, HIV, Asymptomatic |
Lansoprazole (1S) Prevacid TAP (May 10) | LANSOPRAZOLE 56400026 (51 citations) | Treatment of erosive esophagitis, duodenal ulcer, and hypersecretory conditions including Zollinger-Ellison Syndrome | Esophagitis 530.1
Ulcer, Duodenal
Abnormality, Gastrin Secret |
Losartan (1S) Cozaar Merck (Apr. 14 | LOSARTAN 24080020 (43 citations) | Treatment of hypertension | Hypertension 401. |
Moexipril (1S) Univasc Schwarz Pharma (Apr. 19) | MOEXIPRIL 24080232 (7 citations) | Treatment of hypertension | Hypertension 401. |
Mycophenolate Mofetil (1P) Cellcept Syntex/Roche (May 3) | MYCOPHENOLATE MOFETIL 92000205 (29 citations) | Prophylaxis of organ rejection in patients receiving allogeneic renal transplants | Complication, Organ Transpl 996.8
Transplant, Kidney |
Nalmefene(1S) Revex Ohmeda (Apr. 17) | NALMEFENE 28100006 (30 citations) | Opioid antagonist | Condition, Brain NEC 348. |
Nisoldipine (1S) Sular Miles/Zeneca (Feb. 2) | NISOLDIPINE 24120406 (135 citations) | Treatment of hypertension | Hypertension 401. |
Porfimer Sodium (1P) Photofrin QLT PhotoTherapeutics (Dec. 27) | PORFIMER 10120126 (24 citations) | For phototherapy of esophageal cancer obstructions | Phototherapy NEC 99.83
Neop, Mgn-Esophagus |
Riluzole (1P) Rilutek Rhone-Poulenc Rorer (Dec. 12) | RILUZOLE 92000236 (17 citations) | Treatment of amyotrophic lateral sclerosis | Sclerosis, Amyotrophic 335.20 |
Saquinavir (1P) Invirase Roche (Dec. 6) | SAQUINAVIR 8180076 (16 citations) | Use in combination with nucleoside analogs for advanced HIV Infection | Syn-Acq Immune Deficiency 042. |
Sevoflurane (1S) Ultane Abbott (Jun. 7) | SEVOFLURANE 28040008 (144 citations) | General anesthetic | Anesthesia/Paresthesia 782.0 |
Tramadol HCl (1S) Ultram RW Johnson (Mar. 3) | TRAMADOL 28081217 (40 citations) | Management of moderate to moderately severe pain | Pain NEC 782.2 |
Varicella Virus Vaccine Live Varivax Merck (Mar. 17) | VARICELLA VACCINE 80120078 (137 citations) | Prevention of chickenpox | Chickenpox 052.
Inoculation and Vaccination |
*Complete bibliographic citations will be provided upon request.
**(1S) New Molecular Entity given standard review by FDA.
***(1P) New Molecular Entity given a priority review.
American Society of Hospital Pharmacists (ASHP)
American College Clinical Pharmacy (ACCP)
Annual Meeting
Nashville, Tennessee
August 4-7
American Society of Hospital Pharmacists (ASHP)
Midyear Clinical Meeting (MCM)
New Orleans, Louisiana
December 4-8
On January 19 the FDA announced licensing of Respiratory Syncytial Virus (RSV) Immune Globulin Intravenous (Human) (RSVIGIV) to protect high-risk infants against the worst effects of RSV disease, the most common cause of lower respiratory infections in children. While the product does not prevent infections by RSV, it is the first product that reduces serious RSV disease in high-risk children. RSVIGIV is given intravenously in five monthly doses, with the first dose given in November before the start of the RSV season. Rare allergic reactions to RSVIGIV are possible. In addition, infants with pulmonary disease may retain fluids and a small percentage of infants in the trials needed new or extra diuretics after receiving RSVIGIV. Because the product is made from human plasma, a small risk exists for the transmission of blood-borne viruses. However, the risk is low because plasma donors are screened carefully and the product is treated with a solvent-detergent viral inactivation procedure which inactivates most significant blood-borne viruses, including the one that causes AIDS.
The intravenous cephalosporin antibiotic cefepime was approved January 18 for uncomplicated and complicated urinary tract infections (UTIs), uncomplicated skin and skin structure infections and pneumonia. The recommended cefepime dose for mild to moderate UTIs is 0.5 g to 1g intravenously or intramuscularly twice daily for seven to 10 days; for severe UTIs, 2 g I.V. twice daily for 10 days; for pneumonia, 1 g to 2 g I.V. twice daily for 10 days; and for skin and skin structure infections, 2 g I.V. twice daily for 10 days. Intravenous administration should occur over approximately 30 minutes. Dosage administration of cefepime in the elderly should be adjusted as appropriate if the patient's creatinine clearance is 60 mL/minute or less. No dose adjustment is necessary for patients with impaired hepatic function.
Technetium TC99m tetrofosmin was approved by the FDA on February 9 for scintigraphic imaging of the myocardium following separate administrations under exercise and resting conditions. It is useful in the delineation of regions of reversible myocardial ischemia in the presence or absence of infarcted myocardium. Recommended dosing is 5-8 mCi at peak exercise and a second dose of 15-24 mCi approximately four hours later at rest. Recommended imaging time is 15 minutes at stress and 30 minutes at rest. In clinical trials three patients experienced serious episodes of angina after injection of the drug. Other adverse effects, occurring in less than 1% of the patients, included hypertension, torsades de pointes, vomiting, abdominal discomfort, cutaneous allergy, hypotension, dyspnea and effects on the senses.
Ruth Ann Calloway, M.S., R.Ph.
Generic Name (FDA
Therapeutic Classification)
Trade Name | Valid IDIS Drug Term Drug Number (IDIS Citations)* | Indication/Use | Valid IDIS Disease Term Modified ICD-9-CM Number |
Cefepime (1S)** Maxipime Bristol-Meyers Squibb (Jan. 18) | CEFEPIME 8120655 (77 citations) | For uncomplicated and complicated urinary tract infections; for uncomplicated skin and skin structure infections; and for pneumonia | Infection, Urinary Tract 599.0
Infection, Skin/SQ NEC
Pneumonia, Bacterial NEC |
Respiratory Syncytial Virus Immune Globulin Intravenous (Human) RespiGam MedImmune Inc. (Jan. 19) | RESP SYNCYTIAL VIRUS IG 80040037 (12 citations) | Reduce serious RSV in high risk infants (under 2 years age) with lung problems due to chronic bronchopulmonary dysplasia or prematurity | Pneumonia, Syncytial Virus 480.1 |
Technetium Tc 99m Tetrofosmin (1S) Myoview Medi-Physics (Feb. 9) | TC 99M TETROFOSMIN 78040246 (19 citations) | Scintigraphic imaging of the myocardium | Radioisotope Scan, Cardiovas 92.05 |
*Complete bibliographic citations will be provided upon request.
**(1S) New Molecular Entity given standard review by FDA.
World of Drugs is published quarterly (March, June, September, December) by the Division of Drug Information Service.
Editor: Donna Brus |
Iowa Drug Information Service
The University of Iowa, 100 Oakdale Campus, N330 OH
Iowa City, IA 52242-5000 U.S.A.
Telephone: 319-335-4800 U.S. Toll-Free: 800-525-IDIS Fax: 319-335-4077
E-Mail: firstname.lastname@example.com Home Page: http://www.uiowa.edu/~idis


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Preschool Storytime: Say Hello to Storytime
Start Date: September 04, 2014 6:30 PM
End Date: September 04, 2014 7:15 PM
Location: Main - Secret Garden (Max 75 people)
Storytimes at EPL provide a fantastic opportunity to engage your child
in an environment that fosters lifelong learning and literacy.
friends will meet once a week during their registered storytime
throughout the school year. Each week we will explore a different theme
with books, songs, fingerplays, games, and crafts!
Preschool Storytime is for children between ages 2 and 6.
Registration is required, contact the Children's Department to sign up!


text:
Good luck!
Good luck Charlie, be safe: knee pads and very well-cooked road kill only. xx
Day One - Leaving Mwanza
Beard: None
Distance Travelled: 0km
Frame of Mind: Apprehensive
All my bags are packed (almost) I'm ready to go (almost). Still need a new air filter and a plug spanner but I'm going to try and make it to Nairobi to get them there. I'm only a week late in leaving and it is a little bit emotional. I said goodbye to all my friends, the dogs, my flat and my classroom and will be driving to Musoma, TZ to spend the night. The last time I went to Musoma was a chaotic affair involving car breakdowns, bonnets coming off, and no time in Musoma. This time I hope it will be easier.
264km. The roads are good so I reckon 4 hours. My bike is very happy at around 80/90 kmph. He's only a 250cc so can't manage much more than that. Especially fully laden. I am planning on no more than 300km per day, else this trip may become a bit of a chore. I mustn't forget that I am supposed to be having some fun and seeing some sights. I will NOT be able to make it back for the World Cup. No matter how much I drive.
I will try and update you as much as possible. It certainly won't be every day-you know I'm rubbish at that. And yes Mum, I'll be careful.
TTFN, C x
You really gone?
Just sitting here at J and J's wondering if you are still at Flats and want to meet us for a cold one at corner bar? Just kidding, we know you really left today. After all, how many leaving meals can one baldie need? I'm guessing you'll make it to Serengeti Stop Over point tonight, but we'll see.
Seriously though, you are off on the adventure of a lifetime and we are all really looking forward to hearing the play-by-play including bureaucratic sagas, break-downs, and side trips. If you decide to go Loki way, let me know and I'll send you Argo's number. Missing you already. A
OMG - you're going to die!!!!
Can't believe you've actually set off - guess I thought (or hoped!) you might bottle it.
Please be careful - you know we're all going to worry.
Have fun, I'm sure you'll make the most of every opportunity, just take care and get home safely ... and don't forget to keep in touch.
Linz xXx
Bon voyage!
Hey baby! Can't believe you're on your way! And what a small world running into Argo! Be careful on that plane and don't let him dump your bike along with aid supplies! Be careful in Sudan and keep texting and calling me. Love you babe! XXX
heyaaaaaaaaa mr. clark!! its me hawa ur student!! heh!OMG r u really gna make it!! i didnt belive this till i visited ths site n saw ur pics!! u look good wid no hair lol!! hahahahh!! yeh ryt! newayz good luck! hope u make it! hope u get into guiness world record!! wish all da best!! love u sooo much!!!!!!!!!!
hawa osman! PiNKy


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What does MTL mean in Unclassified?
This page is about the meanings of the acronym/abbreviation/shorthand MTL in the Miscellaneous field in general and in the Unclassified terminology in particular.
Find a translation for MTL in other languages:
Select another language:
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Use the citation below to add this abbreviation to your bibliography:
"MTL." Abbreviations.com. STANDS4 LLC, 2015. Web. 4 Mar. 2015. <http://www.abbreviations.com/term/114869>.
MTL also stands for:
- MAC Transaction Layer
- Main Transfer Line
- Main Transmission Line
- Maitland, New South Wales, Australia
- Malawi Telecommunications Limited
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KARACHI - Exploiting the public fear of the militant group, criminal gangs in Pakistan are using Taliban's name to extort money from businessmen, traders and citizens in the south Asian Muslim country.
We have busted various gangs, and arrested several individuals who had been using Taliban's cover to commit different kinds of crimes, particularly kidnap for ransom and extortion, Farooq Awan, a senior official of the anti-violent crime cell in the Karachi police, told OnIslam.net.
Nearly 50 people have been arrested over involvement in kidnap-for-ransom in the name of the Taliban.
The most interesting case surfaced last month when a Chinese employer was arrested in Karachi.
The attackers threatened the victim's family to kill the hostage if they did not pay a ransom of $100,000.
They also sent pictures of some bearded people to the hostage's wife, dubbing them as Taliban members.
But after a week in custody, the hostage was released by the captors without ransom due to the unavailability of a proper place.
Later, it was found out that the captor was a Chinese employee in the same company.
He was taken into police custody and confessed that he had kidnapped his boss as he thought that his family would not take a long time to pay ransom after hearing the Taliban's name.
This is not the only case, Awan, a senior police superintendent, said.
We have recently arrested an employee of a local business man, who too had kidnapped his boss for ransom in the name of Taliban.
Karachi, the commercial hub of Pakistan, is known for violence, where ethnic and sectarian terrorism has claimed 2,000 lives in the past year.
The city is also a haven for criminals who have been involved in bank robberies, kidnap for ransom, car theft, and other crimes taking advantage of the shortage of police personnel and lack of a proper security plan.
Fearing Taliban Police officials believe that criminals are using the Taliban's name to improve their bargain position.
This is an issue of rating, Awan told OnIslam.net.
If an ordinary criminal uses the name of Taliban, he can be in a better bargain position exploiting the fear of Taliban.
The country's business community is the prime target of extortionists and kidnappers who have been using Taliban cover.
Extortion has become an organized crime in Pakistan, especially in Karachi, for the past decade.
Earlier, only selected businessmen, traders and rich people had to pay money to area criminals for their security, but, nowadays, according to police sources, almost 99 percent businessmen and traders are being extorted in one way or other.
Businessmen and traders receive letters from different criminal groups weekly or monthly for the money.
In many cases, when they refuse to entertain the criminals' demands, their houses, shops and factories are attacked.
Using Taliban's name (by criminals) has become a fashion nowadays, Fayyaz Khan of the Central Investigation Cell (CID), who has arrested many so-called Taliban, told OnIslam.net.
Observers opine that the bloody clashes between Taliban and both Pakistani and US forces in the northern belt and neighboring Afghanistan have painted a grim picture of the militant group, playing into the hands of criminals.
The extortionists or kidnappers think that the victims will not dare contact the police if they use the Taliban's name, Khan said, referring to incidents in which the Taliban have beheaded their opponents and later released their videos.
These videos have increased their fear in the society.
Awan, who rose to fame in 2001 when he had detained the accused involved in the kidnap and killing of Wall Street journalist Daniel Pearl in Karachi, said after reports and confessions of criminals involved in extortion and kidnap for ransom, the Taliban deputy commander Wali-ur-Rehman had to issue a statement asking citizens not to pay any money to anyone in the Taliban's name.Even he has given telephone numbers of Waziristan for general public, if they are threatened or asked for money by any Taliban, Awan said.
Reproduced with permission from OnIslam.net


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Updated on
August 03, 2008,
asks from
Tulare, CA
July 30, 2008
Step Daughter Troubles
my step daughter is 12 and she still acts like a "little girl", when she is at my house if i even get around her dad she gets mad or will try to get between us,she trys to be very affectionet with her dad and it seems like she trys to do it to make me upset (but i dont get upset)and she wants to argue with me all the time , when she says really nasty stuff to me and i tell her father she just crys and says i am lying .please someone let me know that im not the most horrible person in the world. what can i do about this??? i forgot to mentoin that im not new to the family, ive been their step mother for four years and this has gone on the whole time
So What Happened?™
i have been spending alot of alone time with my step daughter, and the fighting has disapeered..we had a long talk and she said she really just wants my attention, i did explain that she isnt going to have positive attention to negative behavior, we are not considering therapy yet they have been in group sesions for a few years and i dont think we want to take that next step(since it is getting better) thank you to all you mothers that responded,.....
More Answers
A.A. answers from Las Vegas on July 31, 2008
had to respond because I'm sitting here reading the responses, and flashing back to when my step mom came to live with us. Us being me and my dad. did you catch that? he WAS MY DAD... then he just became HER husband. get it? honestly, I WANTED sooooo badly to love her, and have a real mom/daughter relationship with her. I really did. but when I acted out, she ignored me. truthfully all that showed me was that I'll never be her daughter. she'll NEVER love me like she does their children. and it showed me that I didn't belong. I ran away at 14. I did all kinds of things that I pray and try my hardest to make sure my kids never do. My choices were wrong, but I'm sure deep down that had a whole lot to do with it. even running away was to try to get some kind of emotional response from her! HER not him. I think this little girl (she really is still a little girl that does need attention from her daddy!) is just wanting a relationship with YOU! I know I know. she's being a brat, and doesn't deserve it. and after 4 years of her acting this way she must be on your last nerves. well, I'm sure none of us are perfect... but if you truly do care about her. (and you must if your trying to get help... ) please tell me you do care for her, and not just wanting to get her out of your way to have her dad all to your self!!! anyway, you got some good advise. take her to the mall. take her to get ice cream. take her on your jog. take her to the grocery store. take her. take her. take her. I KNOW I would have started acting better if I knew (knew-not just heard) that she wanted me around. give her privileges that the other kids don't have because 'she the oldest'.. You get it? give her HER rightful place in YOUR family. then she will be able to give you YOUR rightful place in HER family. Oh, and don't let her get away with too much. When I first realized that my step-mom didn't love me was when I did bad stuff and she didn't say anything. even as a little girl I realized that if she cared she would have punished me. but try not to push her too far until you've tied some heart strings.
if you need to talk
4 moms found this helpful
E.S. answers from Los Angeles on July 31, 2008
Sounds like this little girl is insecure in her relationship with her Dad, I think that she needs a lot of love and reassurance from both you and her Dad. You didn't mention if her biological Mom was part of her life. If she is a product of divorce she might be feeling that you are taking her Dad away... Good luck!
3 moms found this helpful
C.V. answers from Los Angeles on July 31, 2008
First of all, PLEASE don't take any of that advice about ignoring her. That is just sad- she is part of your family now and you should never treat her like a burdern in your life. How you help raise her now will greatly impact the rest of her life. Raise her with love and she'll not only respond positively to you down the road, but she will love you and appreciate you forever.
So anyways...
Do you spend 1-on-1 time with her? Take her to the movies, to the mall, clothes shopping, etc. Of course she's jealous, that's common problem, but with enough love it will get better. Teenagers are hard to deal with no matter what, I'm sure she will be acting out with her real mom as well. Just do your best to make her feel like you want her around.
Do you want her around? Do you love her? If the answer is no, then the problem isn't only with her. You may want to consider family counseling or even marriage counseling if your husband doesn't believe what you're telling him.
Sometimes you have to let pre-teen's/teenager's attitudes roll off your shoulders, remember YOU'RE the grown up so don't feed into her games.
Try some bonding things like painting her nails or letting her do your makeup, play board games as a family, have a family movie night where she gets to pick the movie you all rent.
Bottom line, let her know that you're all in this together and you're not trying to squeeze her out of the picture.
Good luck, and always keep your cool, don't fuel the fire by responding negatively to her crying out for security.
Put yourself in her shoes. Deep down all any child wants is our love!
3 moms found this helpful
S.R. answers from Reno on July 31, 2008
You are not the most horrible person in the world, but four years is too long for this problem to have gone on without resolution. My heart goes out to you because it sounds as though her parents have not dealt with the problems and assisted the 12 year old in acting with proper respect and manners. You are only 10 years her senior so there are all sorts of potential problems that you will have to turn into advantages - maybe you'll find that you have a better sense of what she and her friends consider "fashionable" than her parents do. Perhaps the two of you enjoy some of the same music? Can you teach her some dances that she's just dying to learn and impress her friends with? Your fantastic husband needs to help his daughter understand that while she will always be his beloved daughter with a very special place in his heart and life, you are his wife, his partner and he expects her to show you respect. He can help by giving her affection at appropriate times, but let her know that he is not going to give her affection when she is trying to horn in between the two of you or when she is being rude to you. He also needs to make it very clear that she is never to accuse you of lying and help her understand that he completely trusts you to care for her without questioning you. If she accuses you of lying or treats you with disrespect, he needs to make it very clear to her that he will be sending her home to her mother until (or some other appropriate change in privileges) she learns to behave correctly. If her mother is using her "child-free" time for herself, then it might be important for her to help the daughter learn to give you respect, also.
I do think it will help you if you find some activities that the two of you can do together - start creating your own memories and histories. She'll probably fight you at first so you'll have to make it VERY appealing! Perhaps your husband will watch the other children because he certainly should NOT be with you on these outings - they need to be girls only and no one competing for your husband's time.
God bless you and yours. I do hope that you will be able to resolve this, but it will take help from your husband and it would be nice if her mother would help her to behave better.
S. Russ
2 moms found this helpful
J.C. answers from San Diego on July 31, 2008
I really empathize with you. It is not easy raising a step family, because you can end up feeling unappreciated by the stepchildren. I think what is going on in your situation is that the 12 yr. old is having to share her dad's time with so many people that she feels left out. If you have two other stepchildren and a two year old plus you and the animals, that is a lot of people to share with. Maybe she subconsciously wants her mom and dad back together, I don't know. I think what would help out is if you encourage your husband to have 1 on 1 time with just his 12 year old while you watch the other children. He needs to find out her likes and dislikes and spend some time at least every week with JUST her. I think that will make your situation a little easier. Don't get in any confrontation with her, just treat her with respect.
2 moms found this helpful
D.C. answers from Los Angeles on July 30, 2008
You are not a horrible person at all. What it sounds like is happening is that your step daughter is possibly jealous of you being in her fathers life and is doing all she can to show him that she's his number one girl. I am not sure how long before you two were together that they were alone but it is a defense mechanism. My children don't like it when mommy and daddy touch each other and we think it's cute right now but there is a greater dynamic in your situation because according to her, you are the newcomer.
I would suggest counseling for all of you so that they can teach all of you how to have a blended family and to deal with the issues that are involved with having a blended family and a kid who may feel threatened by you being in her fathers life.
Things will get better but it's going to take some time. You have to have a lot of patience and at some point put your foot down with this young lady without being abrasive or condescending. But she has to understand as well that you are her new step mother and you are there because her father wants you there and you want to be there and you want everyone to be a family but try the counseling first and see how that goes.
1 mom found this helpful
M.V. answers from Honolulu on July 30, 2008
There is a wonderful book called I Don't Have To Make Everything All Better by Gary and Joy Lundgren that has among all its other fabulous chapters a specific chapter on the request in your post.
1 mom found this helpful
J.W. answers from San Diego on July 30, 2008
Your description tells me that you are already lacking in self love. Take some time for yourself, ignore her when she comes unless you can be very respectful of her and take some time for yourself to do what you want. Show her you don't need her but always show her respect even when she does not deserve it. When she is ugly to you tell her that you treat her with respect and expect the same from her. Then go take a bath and let him deal with his children.
1 mom found this helpful


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Orange Is Yellow!
2 5 Share TweetAfter writing a tipster on how to tame your Lomography X-pro 200, I realized there's one tip that needs more explanation and more photos. Now I will try to give you all quick tips about Orange Is Yellow. Here's how to turn yellow flash into Orange photos!
Orange Is Yellow!
It's not really a secret or something you can't try, but this one is easy and simple. All you have to do pair a colorsplash flash or Fritz the blitz flash, or any flash you have on your hand, and just put the yellow filter on it. After preparing the yellow flash, the next move is just put your trusty Lomography X-Pro 200 into your camera. As I mentioned earlier this tipster is like a continuation for my tips How to tame your Lomography X-pro 200 so I recommend to try this tipster while using this film but if you want to try with another film and get different results as this, it's up to you! Surprise me with your different results here!
So if you have the camera ready loaded with Lomography X-pro 200 and the yellow flash, you'll be ready for some Orange Is Yellow!
So are you ready for Orange Is Yellow! Come on try this quick and easy tips!


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Slovakia profile
Right at the heart of Europe and with a history intertwined with that of its neighbours, Slovakia has proudly preserved its own language and distinct cultural traditions.
It was part of Czechoslovakia until the "velvet divorce" in January 1993.
Having uncoupled itself from its western neighbour, Slovakia at first struggled to prove itself as an independent democracy, but by the time of the twentieth anniversary of the "velvet divorce" in January 2013, it had come to be seen as one of Europe's biggest success stories.
The first five years after independence were marked by frosty relations with the European Union and Nato as a result of concerns over the Slovak leadership's democratic credentials.
There was growing international criticism of the lack of respect for minority rights and the democratic process shown by the authoritarian prime minister, Vladimir Meciar. Under Mr Meciar, the country's public debt ballooned and it was shunned by foreign investors.
At a glance
- Politics: PM Robert Fico from the leftist Smer party won general elections in March 2012. He was a critic of the former government's austerity programme
- Economy: Eurozone member Slovakia has seen rapid economic growth, driven by exports of electronic goods and cars
- International: Slovakia joined the EU in 2004 and the eurozone in 2009. Its forces have taken part in the Nato-led operation in Afghanistan, and in peacekeeping duties in Kosovo
Country profiles compiled by BBC Monitoring
He led a string of coalition governments pursuing nationalist and populist policies until October 1998, when an alliance of liberals, centrists, left-wingers and ethnic Hungarians ousted him, forming a new coalition with Mikulas Dzurinda as prime minister.
Under Mr Dzurinda, Slovakia underwent a complete change of direction. His government forged ahead with an economic reform programme and was rewarded with a boost in foreign investment. It also tried to improve the lot of minorities.
Slovakia's ethnic Hungarian community constitutes about a tenth of the country's population, and the status of this substantial minority has long been a source of tension between Slovakia and Hungary.
Mr Dzurinda's government oversaw Slovakia's entry into the EU and Nato in 2004, but the austerity measures it introduced made it unpopular with voters, and in 2006 it was replaced by a centre-left coalition led by Robert Fico.
Mr Fico's government relied on the support of the Slovak National Party, and his premiership was marred by controversy over treatment of the Hungarian minority. He lost the 2010 parliamentary election, but returned for a second term as prime minister after winning the 2012 election.
Slovakia also has a significant Romany population which suffers disproportionately high levels of poverty and social deprivation.
The post-war Benes decrees, which called for the expulsion of 3 million ethnic Germans and 600,000 ethnic Hungarians from then-Czechoslovakia and the confiscation of their property, remain a sensitive issue in relations with neighbours.


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National Philharmonic: Brian Ganz: Chopin, the StorytellerSaturday, February 22, 2014 at 8:00 PMMusic Center at Strathmore
Explore Chopins compelling works for the piano with Brian Ganz, who returns by popular demand with his fourth Chopin recital in his journey to perform all of the composers works. This concert features Chopins masterpiece of narrative and emotional power, the Ballade No. 4 in F minor, Op. 52; the Mazurka in A minor, Op. 17, No. 4, one of his most soulful and mysterious works; the epic Nocturne in C minor, Op. 48, No. 1; the tender and storied Waltz in A-flat Major, Op. 69, No. 1 (LAdieu); as well as the highly dramatic Prelude in C-sharp minor, Op. 45. Ganz has been a prizewinner in the Queen Elisabeth of Belgium and the Marguerite Long-Jacques Thibaud (Paris) International Piano Competitions. There isnt much about Chopin that Brian Ganz doesnt know. The pianist has explored the nocturnes, the etudes, the sonatas and concertos and the rest in concerts, master classes and recordings for years now. His delight and wonder in this music seem to grow, apparently without bounds, as time goes on (The Washington Post).
Kids age 7-17 are free. Please call the Strathmore Ticket Office directly at (301) 581-5100 to purchase Kids free tickets. Kids free tickets are not available for online purchase.
Please note: The National Philharmonic will not perform on this concert.
Single tickets starting at $28.


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By Sgt. Peter D. Morrison
Two Maine Army National Guard Soldiers have begun to run 21 marathons in 21 days and will end their endeavor at Arlington National Cemetery in Washington, D.C., on May 31.
By running 550 miles, Col. Jack Mosher and Maj. Herbert Brock want to encourage Soldiers returning from or preparing for a deployment to live up to their greatest fitness potential.
"We believe fitness builds resiliency; it builds purpose in your life and makes you a better friend, Soldier and family member," said Mosher. "Soldiers health is our primary concern."
By running 26.2 miles per day, Mosher and Brock hope they are doing something every good Army officer should do — lead from the front.
"We want Soldiers to recognize their personal responsibility for their health and those they love, to be able to live their lives to the greatest potential," said Mosher. "Our nation expects it.
You can't be the next greatest generation if you can't get off the couch."
As the nation pauses on Memorial Day, Mosher wants people to know they are also celebrating the young men and woman throughout our nation's history, who helped provide our freedom.
"Some never got to be fathers or mothers, or have a life long partnership with people they love; for us to squander the life we have left on this Earth is an injustice to the sacrifice they have made for us," said Mosher.
The 21-gun salute is an age old custom, rendering honor to those both living and dead. By running 21 marathons in 21 days, Mosher hopes it not only honors but inspires fellow Soldiers to get out and get healthy.
(Source: National Guard)


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Big banks cool on clean coal plant
PUBLISHED: 03 Nov 2011 00:01:50 | UPDATED: 03 Nov 2011 09:05:32PUBLISHED: 03 Nov 2011 PRINT EDITION: 03 Nov 2011Mathew Dunckley
The backers of a proposed "clean coal" power plant in Victoria's Latrobe Valley face a shrinking field of financiers. Several large foreign banks have signalled they will not bankroll the project.
HRL has won $150 million in federal and state funding support. The deed covering the grants requires the company to have secured the additional finance it needs by the end of the year.
Australia's four major banks have already signalled they will not finance the power station. Now a number of international banks have indicated they are unwilling to be involved. In response to a letter campaign by Dutch-based group BankTrack, banks including Unicredit, BNP Paribas, HSBC and Rabobank suggested the project would likely fall foul of their internal investment policies on energy.
HSBC's energy sector policy stipulates power stations need to have a carbon intensity of 550 grams of carbon emissions per kilowatt hour of generation to qualify for financing.
HRL's proposal to dry brown coal before burning it, is tipped to produce about 800 grams of emissions per kilowatt hour of generation. HSBC takes into account factors such as offsetting.
Rabobank has signalled its focus is on renewable infrastructure. Several other banks including Credit Agricole and Citi said they had no involvement while Bank of America and UBS declined to discuss individual projects.
Well-placed sources suggest HRL could seek an extension of its funding arrangement given that it is also locked in an appeal against a decision by Victoria's Environment Protection Authority which halved its proposed capacity from 600 megawatts to 300 megawatts.
Greenpeace climate and energy campaigner Julien Vincent said the project was "out of touch" with economic reality.
"HRL are not just running out of time, they are running out of banks," Mr Vincent said.
"And as the first-choice lenders drop off the table, that's only going to increase the risk and expense of providing finance to this dirty project."
HRL and federal Energy and Resources Minister Martin Ferguson did not respond to The Australian Financial Review's inquiries by the time of going to press.
The Australian Financial Review
Read more
Topics | Technology /Clean Technology , Environment, Energy & Utilities, Company News |


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Three personal micro-essays loosely connected by theme.
A popular version of the Arthur legend has Merlin living his life backwards.
I've always thought that was a cheat. A cop-out of philosophy that excuses the author from explaining why a powerful man backs an apparent loser, justified as reasonable response to empirical future fact. A fundamental fraud as story because it denies me as a reader any concrete reasons of motivation that I can consider, learn from, and possibly adopt in advance of the result that justifies the choice.
I'm an inherent structuralist, a systemic thinker, a rationalist. In my worldview, things happen for reasons, the spiritual is just the rational that hasn't been explained yet, and mysticism is an excuse for fuzzy logic and poorly articulated thought. Intuition is the lazy man's way of denying responsibility for a bad decision based on weak logic. The subconscious may exist, but until it's exhumed it's at best only marginally (and inconsistently) useful.
In other words, know what you believe, have reasons for that belief, and know what those reasons are.
Which is not to say that I'm a literalist in fiction. I make no demands that things be mundane or even real, only that they exist for reasons known to the author and discoverable by the reader—even if the reason is because it clarifies a metaphor or reveals a conceptual incongruity. Art is when that reason is both rational and conceptually revelatory. I love absurdism precisely because it so carefully reveals the disconnect between perception and reality, and invites the reader to ponder that gap.
But even absurdism relies on a well-understood model of reality from which it can depart.
As a reader I have a lot more flexibility with the unreal, because as long as there is some internally consistent model or structure for it, I can follow the author wherever it leads. As an author, though, that has proven a difficult barrier to overcome, because my mind seems made to structure and interpret models, rather than create the unmodeled.
In other words, I have to work out the reasons before I can write the story. The pieces and parts have to make sense to me in advance of the telling. I can interpret a read story after the fact, but I struggle to tell a story I haven't interpreted before the fact.
As a science fiction writer and sometime fantasist, that has proven to be limiting. As a Mormon writer that makes character creation a challenge at times, as my own viewpoint is so hopelessly informed (limited?) by a well-defined set of cosmological assumptions.
I'm well into my second year of unemployment. The reasons are many and varied (having mostly to do with a lack of a bachelor of anything degree), but the effect is a persistent sense of panic about how I can make any sort of successful future from limited available materials.
That should be great source material for a fiction writer. I have insight into another side of human experience, and plenty of time to write. But it's hard (for me) to write *instead* of looking for a new job. It's hard to devote the time and energy to a pursuit (fiction writing) that has yet to show either social or financial rewards despite twenty years of part-time engagement, when I have bills to pay and a daughter to send off to college.
I've spent the last twenty months trying to get re-employed, and it's slowly sinking in that I may no longer be re-employable doing what I did (software product management) at the level that I did it (enterprise software development; products that cost $50K plus). I still do contract work, but those are becoming fewer and further between.
In other words, my assumptions about my employment future are breaking down at an accelerating rate. I'm quickly losing the handle on how to rescue myself short of a full reset. The model I had in my mind of how things (should) work is being forcibly deconstructed in such a way that I can no longer pretend otherwise. It appears that I have lost the game I was playing.
It's disorienting, and more than a bit frightening. I find myself wondering if it's time to scrap all my assumptions and start over again—by going back to school full-time at the age of 48. Reset my entire life at a time when many are starting to plan for relaxation and eventual retirement.
I'm relatively lucky. My wife has a job (making about half what I used to make) with some exceptional educational benefits that can enable that reset. But where that idea was unthinkable two years ago, now it's not only feasible, it's also no longer risky. The context has completely changed, and what was once a selfish dream has become a positive opportunity.
All I had to do was give up hope. Or rather, lift up my eyes and dare to consider other possibilities than the dry, fruitless road I found myself on.
Strangely, I no longer feel guilty about writing fiction. Okay, a little guilty…but I can manage it.
One of the things I've noticed as I've started to write fiction again is that many of the limits I used to feel are lifting. The details don't all have to make sense, though I still prefer that they do. Strong emotional response on-camera is okay. I'm willing to forgo rigorous (and defensible) realism for useful realishness that opens more avenues of investigation. I'm starting to let loose on both subjects and approaches.
It's a late start, and I still have to overcome more than twenty-five years of practice at living in a very tiny and well-defined box, but at least I'm open to the possibility. With practice I hope to get better at it, and perhaps even start to make some legitimate sales (and perhaps a bit of useful coin as well).
But it's taken a horrible wrench to do it, a nearly complete upheaval of my thoughts and plans and assumptions. No promises that it will be any good, but it will be different—and at least it's movement.
Over the last few months on this blog we've discussed what can and should be done in Mormon literature, what can't or shouldn't be done if we want to be seen as legitimate and take our rightful place in the larger literary canon. The conversation has revealed some fundamental differences in assumption and method and goal. It has led to the occasional overstatement and more than occasional harsh critique.
It seems to me that we are in the midst of a rather startling expansion of our traditional concepts of Mormon literature. As I've been reading Monsters & Mormons off and on over the last two months, and some of James Goldberg's and Theric Jeppson's short fiction over the past month I'm struck with how very different some of that work is from the traditional canon and assumptions I've had about Mo-lit over the last twenty years.
And it's intentional. There's an active effort going on to expand the possibilities, to rethink what we can and should be doing with our unique voices and viewpoints. A lot of it makes me uncomfortable, but the more I consider it the more I think it's a useful discomfort, a forcible reset that I would rather avoid if I can, but that will ultimately open up more and better opportunities for future paths that are very different than those blazed early on.
I suppose I've failed in the primary goal of the blogger, which is to ask questions that spark discussion. But for me this has been an odd month of resets, reconsiderations, and integrations, and I wanted to take a minute to articulate some new hopes and ideas that have started to seep into my long-static and nearly ossified brain as a direct result of integrating my own life experience with the more conceptual discussion going on here.
It's movement, and that has to be useful—and perhaps even interesting.


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What does DSF mean in Unclassified?
This page is about the meanings of the acronym/abbreviation/shorthand DSF in the Miscellaneous field in general and in the Unclassified terminology in particular.
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DSF also stands for:
- Dansk Sportsdykker Forbund
- David Suzuki Foundation
- Dead Space Free
- Debt Sustainability Framework
- Debugger Services Framework
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What does IRDAC stand for?
What does IRDAC mean? This page is about the various possible meanings of the acronym, abbreviation, shorthand or slang term: IRDAC.
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IRDAC | συβουλευτική επιτροπή βιοηχανικής έρευνας και ανάπτυξης |
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"IRDAC." Abbreviations.com. STANDS4 LLC, 2015. Web. 6 Mar. 2015. <http://www.abbreviations.com/IRDAC>.


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Korda-Ainsworth engagement
Together with their families, Hannah Korda (daughter of Margaret and Sandy Korda of Orwell) and Christopher Ainsworth (son of Kathy and Duane Ainsworth of Lyndonville) announce their engagement.
Welcome, new Eagle readers in Bristol!
New Market Press, publisher of the Eagle, welcomes hundreds of new readers in the Bristol area starting with the Feb. 1 newsprint edition.
Miss Vermont 2013 is from Windsor County
Jeanelle Achee, a 22 year-old from Rochester, was chosen as the new Miss Vermont 2013 last week.
A new Mrs. Vermont America is crowned!
Hannah Boucher Kirkpatrick of South Burlington is the new Mrs. Vermont America 2013.
Always a bridesmaid, never a bride
Skiing bridesmaids tackle Okemo's slippery slopes
Having survived the torment of being as a gawky kid, I've been dogged by Valentine's Day and its sappy overtones ever since.
Elethrop, Cole wed
Anna Victoria Elethrop and Tyler James Cole were united in marriage on July 2, 2011, by Judge James O'Brian on Mt. Defiance overlooking the majestic Fort Ticonderoga/Lake Champlain.