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ABSTRACT: Medication adherence is a critical aspect of managing cardiometabolic conditions, including diabetes, hypertension, dyslipidemia, and heart failure. Patients who have multiple cardiometabolic conditions and multiple prescribers may be at increased risk for nonadherence. The purpose of this study was to examine the relationship between number of prescribers, number of conditions, and refill adherence to oral medications to treat cardiometabolic conditions. In this retrospective cohort study, 7933 veterans were identified with 1 to 4 cardiometabolic conditions. Refill adherence to oral medications for diabetes, hypertension, and dyslipidemia was measured using an administrative claims-based continuous multiple-interval gap (CMG) that estimates the percentage of days a patient did not possess medication. We dichotomized refill adherence for each condition as a CMG ≤20% for each year of analysis. Condition-specific logistic regression models estimated the relationship between refill adherence and number of cardiometabolic conditions and number of prescribers, controlling for demographic characteristics, other comorbidities, and a count of cardiometabolic drug classes used. Compared with patients with 1 prescriber, antihypertensive refill adherence was lower in patients seeing ≥4 prescribers (odds ratio [OR] = 0.69; 95% CI = 0.59-0.80), but the number of cardiometabolic conditions was not a significant predictor. Antidyslipidemia refill adherence was lower in patients seeing 3 prescribers (OR = 0.80; 95% CI = 0.70-0.92) or ≥4 prescribers (OR = 0.77; 95% CI = 0.64-0.91). Conversely, antidyslipidemia refill adherence improved with the number of cardiometabolic conditions, but differences were only statistically significant for ≥3 conditions (OR = 1.31; 95% CI = 1.09-1.57). In multivariate regression models, the number of conditions and number of prescribers were not significant predictors of refill adherence in the group of patients with diabetes. Effective management of care and medication regimens for complex patients remains an unresolved challenge, but these results suggest that medication refill adherence might be improved by minimizing the number of prescribers involved in a patient's care, at least for hypertension and dyslipidemia. © The Author(s) 2014.Annals of Pharmacotherapy 12/2014; 49(3). DOI:10.1177/1060028014563266 · 2.92 Impact Factor
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ABSTRACT: To examine the associations of provider-patient communication, glaucoma medication adherence self-efficacy, and outcome expectations with glaucoma medication adherence. Prospective, observational cohort study. Two hundred seventy-nine patients with glaucoma who were newly prescribed or taking glaucoma medications were recruited at 6 ophthalmology clinics. Patients' visits were video recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits. The following adherence variables were measured for the 60-day period after their visits: whether the patient took 80% or more of the prescribed doses, percentage of the correct number of prescribed doses taken each day, and percentage of the prescribed doses taken on time. Higher glaucoma medication adherence self-efficacy was associated positively with better adherence with all 3 measures. Black race was associated negatively with percentage of the correct number of doses taken each day (β = -0.16; P < 0.05) and whether the patient took 80% or more of the prescribed doses (odds ratio, 0.37; 95% confidence interval, 0.16-0.86). Physician education about how to administer drops was associated positively with percentage of the correct number of doses taken each day (β = 0.18; P < 0.01) and percentage of the prescribed doses taken on time (β = 0.15; P < 0.05). These findings indicate that provider education about how to administer glaucoma drops and patient glaucoma medication adherence self-efficacy are associated positively with adherence. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.Ophthalmology 12/2014; DOI:10.1016/j.ophtha.2014.11.001 · 6.17 Impact Factor
Article: Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.[Show abstract] [Hide abstract]
ABSTRACT: Background Patients with multiple chronic conditions often have multiple prescribers, which has been associated with greater health care utilization and medication nonadherence in claims-based analyses. This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.Methods This qualitative study involved three focus groups comprising 23 outpatients from a single Veterans Affairs (VA) Medical Center with at least one chronic cardiometabolic condition (hypertension, diabetes, dyslipidemia, or congestive heart failure). Participants were asked about their experiences, including perceived of advantages and disadvantages, of having multiple prescribers of cardiometabolic medications. Conventional content analysis was used to analyze the data.ResultsMultiple prescribers arose through referrals and patients actively seeking non-VA prescribers (primary care and/or specialist) to maximize timeliness and access to medications, provide access to medications not on the VA formulary, and minimize out-of-pocket costs. Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.Conclusions Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.BMC Health Services Research 10/2014; 14(1):490. DOI:10.1186/s12913-014-0490-8 · 1.66 Impact Factor
Article: Associations Between Patient-Provider Communication And Socio-Cultural Factors In Prostate Cancer Patients: A Cross-Sectional Evaluation Of Racial Differences[Show abstract] [Hide abstract]
ABSTRACT: Objective To examine the association between socio-cultural factors and patient-provider communication and related racial differences Methods Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims. Results Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p < 01), prostate cancer communication (p < .001), and physician trust (p < .001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values < .001). For both African and Caucasian Americans, better patient-provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values<.01), and at least high school education (p<.05). Conclusion(s) Socio-cultural factors are associated with patient-provider communication among men with cancer. No evidence supported associations differed by race. Practice implication To facilitate patient-provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.Patient Education and Counseling 09/2014; 97(3). DOI:10.1016/j.pec.2014.08.019 · 2.60 Impact Factor
Article: Patient Question-Asking About Glaucoma and Glaucoma Medications During Videotaped Medical Visits.[Show abstract] [Hide abstract]
ABSTRACT: We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.Health Communication 07/2014; DOI:10.1080/10410236.2014.888387 · 0.97 Impact Factor
Article: Discussions between medical providers and children/caregivers about the benefits of asthma-control medications[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES To describe the content of discussions between general pediatric providers and children and their caregivers about the benefits of asthma-control medication; describe the extent to which these discussions occur; and examine factors that are associated with medication benefit discussions. DESIGN Cross-sectional secondary analysis of audiotaped medical visits. SETTING Five primary care pediatric clinics in North Carolina. PARTICIPANTS 35 pediatric providers and 248 children with persistent asthma and their caregivers. MAIN OUTCOME MEASURES Presence of discussion about benefits associated with asthma-control medications. RESULTS Providers discussed benefits associated with asthma-control medications during 56% of medical visits. Benefits were more likely to be discussed when the child was younger and when medication adherence was discussed during the visit. When providers discussed benefits of asthma-control medications, they were most likely to ask questions and make statements regarding symptom control/prevention. CONCLUSION General pediatric medical providers often do not discuss the benefits of asthma-control medications. Pharmacists could fill this information gap by counseling both children and their caregivers about benefits that a child with asthma can expect as a result of treatment.Journal of the American Pharmacists Association 05/2014; 54(3):251-7. DOI:10.1331/JAPhA.2014.13097
Article: Provider Education about Glaucoma and Glaucoma Medications during Videotaped Medical Visits[Show abstract] [Hide abstract]
ABSTRACT: Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients' visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.Journal of Ophthalmology 04/2014; 2014:238939. DOI:10.1155/2014/238939 · 1.94 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson χ = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson χ = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson χ = 5.62, p = 0.02). Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.Optometry and vision science: official publication of the American Academy of Optometry 04/2014; DOI:10.1097/OPX.0000000000000244 · 1.53 Impact Factor
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ABSTRACT: Care continuity is considered a critical characteristic of high-performing health systems. Few studies have examined the continuity of medication management of complex patients, who often have multiple providers and complex medication regimens. The purpose of this study was to characterize patient factors associated with having more prescribers and the association between number of prescribers and acute care utilization. A retrospective cohort study was conducted of 7,933 Veterans with one to four cardiometabolic conditions (diabetes, hypertension, hyperlipidemia or congestive heart failure) and prescribed medications for these conditions in 2008. The association between number of cardiometabolic conditions and prescribers was modeled using Poisson regression. The number of cardiometabolic conditions and number of prescribers were modeled to predict probability of inpatient admission, probability of emergency room (ER) visits, and number of ER visits among ER users. Demographic characteristics, number of cardiometabolic medications and comorbidities were included as covariates in all models. Patients had more prescribers if they had more cardiometabolic conditions (p < 0.001). The adjusted odds of an ER visit increased with the number of prescribers (two prescribers, Odds Ratio (OR) = 1.16; three prescribers, OR = 1.21; 4+ prescribers, OR = 1.39), but not with the number of conditions. Among ER users, the number of ER visits was neither associated with the number of prescribers nor the number of conditions. The adjusted odds of an inpatient admission increased with the number of prescribers (two prescribers, OR = 1.27; three prescribers, OR = 1.30; 4+ prescribers, OR = 1.34), but not with the number of conditions. Having more prescribers was associated with greater healthcare utilization for complex patients, despite adjustment for the number of conditions and medications. The number of prescribers may be an appropriate target for reducing acute care utilization by complex patients.Journal of General Internal Medicine 01/2014; 29(4). DOI:10.1007/s11606-013-2746-0 · 3.42 Impact Factor
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ABSTRACT: The objectives of the study were to examine provider-family communication about attention deficit disorder during pediatric asthma visits. Children with asthma, aged 8 through 16 and their parents were recruited at five pediatric practices. All medical visits were audio-taped. There were 296 asthmatic children enrolled into the study and 67 of them also had attention deficit hyperactivity disorder (ADHD). ADHD communication elements suggested by national guidelines were discussed infrequently. Providers were more likely to discuss, educate, and ask one or more questions about ADHD medications if the visit was non-asthma related. Providers included child input into the ADHD treatment regimen during 3 % of visits and they included parent input during 4.5 % of visits. Only one child and three parents asked questions about ADHD. Providers may neglect essential aspects of good ADHD management and communication in children who have ADHD plus another chronic condition such as asthma. Providers should set appropriate treatment expectations, establish target symptoms, and encourage children and parents to ask questions so mutual decision-making can occur.Community Mental Health Journal 12/2013; DOI:10.1007/s10597-013-9678-3 · 1.03 Impact Factor
Article: How Often Do Providers Discuss Asthma Action Plans With Children? Analysis of Transcripts of Medical Visits[Show abstract] [Hide abstract]
ABSTRACT: Objective. To examine how often providers discussed asthma action plans with children and their caregivers and child, clinical, and provider characteristics that were associated with those discussions. Method. This was a cross-sectional analysis of audio-recorded visits between 35 general pediatric providers and 260 children (8-16 years old) with asthma and their caregivers. The visits were transcribed into text. The transcripts were coded for discussions about written asthma action plans. Results. Providers discussed written asthma action plans with 21.0% of children and caregivers. Providers were significantly more likely to discuss asthma action plans when the child was enrolled in Medicaid, the visit was asthma related, the visit was longer, the provider was not White, or more provider education. Conclusion. In our sample, providers rarely discussed action plans with children and their caregivers. Providers should discuss asthma action plans with every child with persistent asthma and their caregivers and revise them regularly.Clinical Pediatrics 10/2013; 52(12). DOI:10.1177/0009922813506256 · 1.26 Impact Factor
Article: Provider-Caregiver-Child Discussions About Risks Associated With Asthma Control Medications: Content and Prevalence[Show abstract] [Hide abstract]
ABSTRACT: The objectives of this study were to: (1) describe the extent to which general pediatric providers discuss risks associated with asthma control medications with families, and (2) examine factors that are associated with risk discussions. This study was a cross-sectional secondary analysis of audio taped medical visits involving 35 pediatric providers and 248 children with asthma with their caregivers. Transcripts of the visits were coded for discussions about asthma medication risks. Generalized estimating equations were used to analyze the data. Providers discussed asthma control medication risks during 23% of visits. Risks were more likely to be discussed when the visit was longer and when the provider prescribed a new asthma control medication. When providers discussed asthma control medication risks, they were most likely to ask the family general questions and make general statements. Across all of the visits, caregivers asked a total of 16 questions and made a total of 20 statements about risks associated with asthma medications; children asked a total of 3 questions and made two statements about risks associated with asthma control medications. Providers discussed risks associated with asthma control medications in less than one-quarter of medical visits. Providers should involve families in discussions about risks associated with medications during every visit to assess potential barriers to medication adherence. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.Pediatric Pulmonology 09/2013; 49(8). DOI:10.1002/ppul.22892 · 2.38 Impact Factor
Article: A prospective examination of asthma symptom monitoring: Provider, caregiver, and pediatric patient influences on peak flow meter use.[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: This study examined whether provider, caregiver, and child communication predicted peak flow meter (PFM) use one month later. Methods: Five practices, 35 providers, and 296 children with persistent asthma and their caregivers comprised the study sample. Audio-recorded provider-caregiver-child communication during the baseline medical visit captured discussion of the PFM; and child and caregiver baseline interviews after the medical visit collected factors associated with PFM use. Child- and caregiver-reported PFM availability and use, and observed child use of PFM were collected one-month later in the family's home. Results: During the medical visit, provider communication about PFM use was infrequent (10% maximum) and child- or caregiver-initiated communication was nearly absent (0-2%). Despite this, children demonstrated good use of the PFM one month later. Children were significantly more likely to perform at least six PFM steps correctly one month later when there was more communication about PFM during the medical visit. Few other factors predicted availability and use. Conclusions: Few providers discussed use of a PFM; observed performance was predicted by having talked about it with the child's provider. Provider communication should be targeted in future interventions to improve asthma management skills.Journal of Asthma 09/2013; DOI:10.3109/02770903.2013.838255 · 1.83 Impact Factor
Article: An evaluation of physicians' engagement of children with asthma in treatment-related discussions[Show abstract] [Hide abstract]
ABSTRACT: Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.Journal of Child Health Care 06/2013; 18(3). DOI:10.1177/1367493513489780 · 0.97 Impact Factor
Article: The relationship between patient-provider communication and quality of life for children with asthma and their caregivers.[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: This study examined whether patient-provider communication is associated with asthma-related quality of life (QOL) and asthma outcomes among children with asthma and their caregivers. Methods: Children ages 8-16 with asthma and their caregivers (n=296) were recruited at five pediatric practices in North Carolina. Children and caregivers reported demographic and clinical characteristics immediately after an audiotaped medical visit with their health care provider. During a home visit that took place one month after the medical visit, children and caregivers reported asthma-related QOL, and caregivers reported child asthma outcomes, including asthma symptom days and missed school days. Generalized estimating equations were used to determine whether patient-provider communication during the medical visit was associated with child and caregiver QOL and child asthma outcomes one month later. Results: On average, providers asked caregivers 4.5 questions and children 3 questions per visit, whereas caregivers and children asked less than one question per visit. Providers asked children more asthma-related questions, caregivers reported better QOL and fewer asthma symptom days one month later. Children and caregivers with higher asthma-management self-efficacy at the office visit reported better quality of life one month later. Conclusions: Mirroring national guideline recommendations, our results suggest that providers should ask children about their asthma during medical visits. Future longitudinal studies should conduct mediation analyses to determine whether asking children asthma-related questions during medical visits increases children's asthma management self-efficacy and ultimately improve outcomes, such as quality of life, health care utilization, symptom days, and missed school days.Journal of Asthma 06/2013; DOI:10.3109/02770903.2013.808347 · 1.83 Impact Factor
Article: Child and caregiver reported problems in using asthma medications and question-asking during paediatric asthma visits.[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES: The objectives of the study were to describe the extent to which lay caregivers and children who reported asthma medication problems asked medication questions during their medical visits. METHODS: Children with asthma ages 8 through 16 years and their caregivers were recruited at five paediatric practices and their medical visits were audiotape recorded. Children were interviewed after their medical visits and caregivers completed questionnaires. A home visit was conducted 1 month later. Generalized estimating equations were used to analyse the data. KEY FINDINGS: Two hundred and ninety six families participated. Among those caregivers who reported asthma medication problems, only 35% had asked at least one medication question during the visit. Among children who reported asthma medication problems, only 11% had asked at least one medication question during their consultation. Caregivers and children who reported a problem with their asthma medications were significantly more likely to have asked medication questions if providers had asked more questions about control medications. Children who reported higher asthma management self-efficacy were significantly more likely to have asked an asthma medication question. CONCLUSIONS: Only one in three caregivers and one in 10 children who reported an asthma medication problem asked a question during their medical visits and many still reported these problems 1 month later. Pharmacists should encourage caregivers and children to report problems they may be having using their asthma medications.05/2013; DOI:10.1111/ijpp.12043
Article: Patient-health care provider communication among patients with newly diagnosed prostate cancer: Findings from a population-based survey.[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences. METHODS: The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling. RESULTS: Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCP's contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient-HCP communication and prostate cancer communication. CONCLUSION: Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer. PRACTICE IMPLICATIONS: HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer.Patient Education and Counseling 01/2013; DOI:10.1016/j.pec.2012.12.002 · 2.60 Impact Factor
Article: Prevalence of bipolar disorder diagnoses and psychotropic drug therapy among privately insured children and adolescents.[Show abstract] [Hide abstract]
ABSTRACT: To estimate the treated prevalence of bipolar disorder in a privately insured population, describe the characteristics of children and adolescents receiving these diagnoses, and describe patterns of their psychotropic drug therapy. Retrospective, repeated cross-sectional study. MarketScan Commercial Claims and Encounters inpatient, outpatient, and pharmacy claims databases. A total of 22,360 children and adolescents (aged 0-17 yrs) with one inpatient or two or more outpatient claims for any bipolar spectrum disorder between January 1, 2005, and December 31, 2007. Annual cross-sections were used to estimate the treated prevalence of bipolar disorder diagnoses, patient characteristics, and psychotropic drugs used 30 days after a child's latest recorded bipolar disorder diagnosis within each year. The annual treated prevalence of any bipolar spectrum disorder in this privately insured population was 0.24% in 2005 and 0.26% in 2006 and 2007. Approximately 25% of diagnoses were for children younger than 13 years. Approximately 30% of children had coexisting attention-deficit-hyperactivity disorder during the year. In each year, 35% of patients used no psychotropic drug therapy in the 30-day period after their most recent diagnosis. Twenty-five percent used one psychotropic drug, and 40% used two or more drugs. The most common drug regimens were antipsychotic or mood stabilizer (lithium or anticonvulsant) monotherapy and the combination of mood stabilizers and antipsychotics. Drug therapy patterns suggest that children and adolescents with bipolar diagnoses receive complex treatment regimens, often involving multiple classes of psychotropic drugs. Research on treatment combinations, particularly antipsychotic and mood stabilizer combinations, should be prioritized to better understand the safety and effectiveness of commonly prescribed treatments.Pharmacotherapy 12/2012; 32(12):1085-94. DOI:10.1002/phar.1148 · 2.31 Impact Factor
Article: Trends and Variations in Intravenous Vitamin D Use among Hemodialysis Patients in the United States.[Show abstract] [Hide abstract]
ABSTRACT: Injectable vitamin D agents are commonly used to manage secondary hyperparathyroidism in dialysis patients. Yet, there are few data documenting the trends and geographic variations in the use of these agents in large, representative samples. We sought to describe patterns and variations in the use of vitamin D formulations (calcitriol, paricalcitol, and doxercalciferol) in hemodialysis patients. We studied patients in the United States Renal Data System between January1999 and December 2008 with Medicare as a primary payer. Annual percentages of patients treated with each type of formulation were tabulated by race, sex, and age at dialysis initiation. The geographical distribution of vitamin D dose per patient was mapped at the state level. Intravenous vitamin D use has increased sharply from 1999 to 2008 with 83.9% of patients treated with any vitamin D formulation in 2008. The use of calcitriol has declined since 1999, going from being administered in 58.6% of patients in 1999 to 1.8% in 2008. Paricalcitol was found to be the overwhelmingly preferred formulation during the study years. In 2008, the average dose among black patients was 84% greater than among white patients (136 mcg vs. 73.6 mcg). Higher doses of vitamin D were administered to patients in the southern region of the country. Vitamin D use has increased and parallels the rise in use of paricalcitol and doxercalciferol. Given the variations in use and known pharmacologic differences in vitamin D formulations, future research should focus on whether the formulations differentially affect patient outcomes.Renal Failure 10/2012; DOI:10.3109/0886022X.2012.734260 · 0.94 Impact Factor
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ABSTRACT: Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.10/2012; 2012:902819. DOI:10.5402/2012/902819This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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University of North Carolina at CharlotteCharlotte, North Carolina, United States
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University of New Mexico
Albuquerque, New Mexico, United States
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Harvard Medical School
Boston, MA, United States
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The Mysteries of Birth
Who am I? A moment ago I was Free Dancing with the Angels. Now I am your child. Yet I know we have been. together many times. We are young, old, a baby yet ancient. Many times have we laughed and cried. Many times have we loved. Many times we have touched the stars and the Heart of God.
This poem is from Chapter 2 of The Secret Journey to the Enlightened Mind - Dr James Yogadhi Weldon avalable in hard copy and e-book on Amazon.com and many other locations worldwide.
In this chapter I discuss a memory that came during meditation one day. This memory propelled me back to the intence experience of death not so long before in Tibet whe the Chinese invaded my town in 1947-8 in one of the first incursions into that country.
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1 person found this helpful
"Avoid at all costs "
- Comp & Benefits
- Work/Life Balance
- Senior Management
- Career Opportunities
I have been working at Electronic Data Systems
EDS has some redeeming qualities:
VERY good work/life balance. I typically barely work 40hrs/wk. And honestly most of the day is not very intesne.
Pretty generous vacation policy: I got 3 weeks off as a new hire. Even better if you can get on the GM account, tons of bonus vacation days.
Workplace is not very competitve, If one cares at all and is remotely intelligent you can probably advance in your career.
Wow where to begin....
Piss poor compensation. And going down. Within the past month a 5% cut, then another 10%. Plus Salary Freezes.
Job cuts related to merger.
Management consistently disrespects and devalues the employees.
Would recommend this company to no one. Particularly new college graduates as the culture is very bad: everyone is 40-50 year old and boring.
Provide a decent work environment and show the employees some respect when it comes to compensation.
- Any Location
- Any Job Title
"An HP Company....thank goodness! "
- Comp & Benefits
- Work/Life Balance
- Senior Management
- Career Opportunities
I have been working at Electronic Data SystemsPros
Due to the HP acquisition, it will look great on your resume. EDS has employees whom have been with the company well over ten years and are willing to share their experiences, assist in navigating through the multi-layered, top-heavy management team.Cons
Lack of innovation in company strategy
Lack of professional development
Top-heavy senior leadership, many of whom should have been gone a long time, yet somehow survived the rounds of lay-offsAdvice to ManagementAdvice
Lose the dead weight
Bring in and retain more innovative leadersDoesn't RecommendNo opinion of CEO
"Used to be a great place to work. "
- Comp & Benefits
- Work/Life Balance
- Senior Management
- Career Opportunities
I have been working at Electronic Data SystemsPros
People and environment . Raise generally were decent and occurred almost every year. Direct management, generally receptive to personal considerations.Cons
Used to be a great place to work until the bench time was cut to zero, and now it's even worse with the HP acquisition - Pension contribution are frozen, pay cuts to everyone of 5%, 401k contributions currently stopped, Tuition reimbursement temporarily? stopped. We will most likely have to go the the HP variable pay structure which may reduce our salaries again.Advice to ManagementAdvice
One of the tenets that used to keep employees happy and doing whatever it takes to get the job done was the people care that EDS had established since the beginning.Doesn't RecommendDisapproves of CEO


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Terrorist Group Threatens Nearly 300 Kidnapped Schoolgirls
Abubakar Shekau, leader of the Islamic extremists Boko Haram in Nigeria, is threatening to sell them.
Terrorist Group Vows to Sell Kidnapped School Girls in Nigeria
Boko Haram claims responsibility for abducting 200+ teens 3 weeks ago.
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Student Life
Never A Dull Moment
Involvement in Student Life is an important part of the college experience.
Activities help a student to grow socially, to foster friendships, to appreciate diversity, to develop management skills and to benefit from leadership roles. Special events, social and club activities, meetings and other events are scheduled for afternoons, evenings, and weekends. All students, full-time and part-tme, are encouraged to participate in extracurricular activities and college events.
Come and be a part of Student Activities and acquire skills, characteristics and experiences that will assist in every student's personal and professional goals and will help to create an enthusiastic spirit for Stevenson University.
Explore Student Life
Calendar of Events
- Stevenson Film Festival
- Thu Apr 09
- Owings Mills Campus - Rockland Center
- Field Hockey Alumni Game and Reception
- Sun Apr 12
- Owings Mills Campus
- Art Exhibition: E3: Exploring Eastern Europe (Commuter Reception)
- Tue Apr 14
- Greenspring Campus
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10949 Boulevard Circle
Owings Mills, MD 21117


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Book your room at The Original Rosslyn Hotel
Please enter your travel dates.
Edinburgh hotel with a complimentary breakfast
Situated in Edinburgh, this hotel is close to Lauriston Castle, Edinburgh Zoo, and Bruntsfield Links Golf Course. Also nearby are Royal Burgess Golf Course and Western General.
Hotel Features
Amenities at The Original Rosslyn Hotel include complimentary wireless Internet access and free self parking.
Room Amenities
All guestrooms include private bathrooms.Information missing or incorrect? Tell us!
Hotel Amenities
Hotel Amenities
A complimentary breakfast is offered. High-speed wireless Internet access is complimentary. Complimentary self parking is available on site.
- Free breakfast
- Free WiFi
- Free self parking
Available in some public areas: Free WiFi
Free self parking
Room Amenities
- Daily housekeeping
- Private bathroom
- Shower only
- Hair dryer (on request)
Where to Eat
A complimentary breakfast is offered.
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Extra-person charges may apply and vary depending on hotel policy.
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Teachers who work with English as a Second Language learners will find ESL/ESOL/ELL/EFL reading/writing skill-building children's books, stories, activities, ideas, strategies to help PreK-3, 4-8, and 9-12 students learn to read.
New on Colorín Colorado!
Unaccompanied Children in Schools: What You Need to Know
The following tips from the American Federation of Teachers offer useful, basic information about unaccompanied children and what schools need to know to best meet their needs.
This Month's Highlights
Answering Guiding Questions with Middle School ELLs
See how middle school ELL teacher Katie Soto engages her students in a discussion about the novel Travels With Charley by John Steinbeck through related guiding questions.
This video is part of our Common Core and ELLs project from Poughkeepsie, NY.
Recommended Resources
Professional Title: Creating a College Culture for Latino Students: Successful Programs, Practices, and Strategies
Concha Delgado Gaitan, an award-winning professor, scholar, and first-generation Latina college graduate, shares winning strategies for creating effective college-readiness programs for Latino students of all ages at the district and school level. Topics covered include working with families to promote Latino student achievement and best practices for counselors, tutors, teachers, and administrators.
Search Colorín Colorado
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I plan to definitely do maybe a workshop with my classroom parents and go over the web site with them to give them ideas on how to help.
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Common Core and ELLs Blog
Featuring ELL expert Dr. Diane Staehr Fenner.


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Properties in Bromley, Outer London between £700,000 and £800,000
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£750,000 Sold STC 6 Bedrooms The Avenue, Bickley, Bromley
CHAIN FREE. A Truly Substantial 6 Bedroom 2 Bathroom Detached Residence located within a 10 minute walk from Bickley station with fast services to Victoria. Downstairs the property boasts 2 large reception rooms, a private study,cloakroom and super 23 x
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First mix section from D3, Featuring Beaver, Jack Lacey, Ant Rodgers, Liam Forkings, Fozzy, Marshall, Wes, Paul Forbes.
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Oprah's Next Chapter:
How Muhammad Ali Inspired Swimmer Janet Evans
It was a moment Janet Evans says she'll never forget. During the opening ceremony of the 1996 Olympic Games in Atlanta, Janet, a swimmer who won three gold medals in 1988, was chosen to pass the Olympic torch to boxing legend Muhammad Ali. Janet tells Oprah how this helped her overcome a tough defeat and taught her how to be a true champion.


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Zeiss Victory NightVision 5.6x62 LT*
Zeiss Nigh Vision Victory 5.6 x 62mm Monocular offers a very wide field of view of 146 m at 1,000 m ... Victory 5.6x 62 Zeiss Night Vision Scope to be operated like a compact camcorder. Of course, Zeiss ... Victory Night Vision 5.6x62 T* Night Vision Scopes are rubber armored, waterproof and nitrogen ... filled. The adjustable loop permits Zeiss 5.6x62 Victory NightVision Scope 52 30 07 9901 to be held ... 3.15" / 3.94" Weight: 2.21 lb. Features of Zeiss Night Vision Scopes 5.6x ... stand connections Package Contents: Zeiss Victory Night Vision 5.6x62 Scope - 52 30 07 - 9901 ... Zeiss Victory NightVision 5.6x62 LT* 5230079901 uses the principle of residual light...
Zeiss Victory HT 3-12x56mm Rifle Scope
Exit Pupil Diameter: 3x - 14.9mm; 12x - 4.7mm Twilight Factor: 3x - 8.5; 12x - 25.9 Field ... Zeiss Victory HT 3-12x56mm Rifle Scope is a specialized scope designed for use during ... LotuTec Lens Riflescope: Magnification: 3x to 12x Effective Lens Diameter: 3x - 44mm; 12x - 56mm ... for all-weather performance Nitrogen filled for fog proofing Package Contents: Zeiss Victory HT 3-12x56mm Rifle Scope ... obstructing the target. The Carl Zeiss Optics Victory HT 3-12x T* Coated Riflescope can be mounted on most ... scope rings, thanks to its 30mm tube, and its ergonomic construction, rubberized features, and slim ... HT 3-12x56 Schott HT Glass Rifle Scope is a sure thing for the serious hunter. Zeiss...
Starts at $1,999.99
Zeiss Victory HT 2.5-10x50mm Rifle Scope
Zeiss Victory HT 2.5-10x50mm Rifle Scope gives you the ultimate in all-around rifle scope ... for Zeiss Victory HT 2.5-10x50mm Reticle 60 Riflescope: Magnification: 2.5x - 10x Effective Lens ... fogging Package Contents: Zeiss Victory HT 2.5-10x50mm Rifle Scope ... Schott HT Glass Scope. Zeiss 522421-9906-000: 2.5-10x50 Victory HT #6 reticle Rifle Scope, Matte ... Black Zeiss 522421-9906-010: 2.5-10X50 Victory HT # 6 ASV Elevation Turret Rifle Scope, Matte Black ... Zeiss 522421-9906-020: 2.5-10X50 Victory HT # 6 ASV Elevation Turret Rifle Scope, Matte Black Zeiss ... 5224259960: 2.5-10x50 Victory HT Rifle Scope with T* Multi-Coatings, Reticle #60 Zeiss 5224249960:...
Starts at $1,799.99
Zeiss Victory HT 1.5-6x42mm Rifle Scope
Zeiss Victory HT 1.5-6x42mm Rifle Scope gives you ultimate flexibility on the hunt, whether you're ... Specifications for Zeiss Victory HT 1.5-6x42mm 30mm Tube Rifle Scope: Magnification: 1.5x to 6x Effective ... 14.1°; 6x - 4° Diopter Adjustment Range: +2 to -4 dpt Eye Relief: 90mm Parallax Free: 100m ... Finish: Matte Black Features of Zeiss VictoryHT 1.5-6x-42mm Illuminated Dot Riflescope: Flexible ... coating repels water from the lens 30mm tube diameter fits most scope rings Package Contents: Zeiss Victory HT 1.5-6x42mm Rifle Scope ... Scope. Zeiss 5224159960: 1.5-6x42 Victory HT Rifle Scope with T* Multi-Coatings, Reticle #60 Zeiss ... 5224149960: 1.5-6x42 Victory HT Rifle Scope with T* Multi-Coatings, Reticle #60, Rail Mount...
Starts at $2,449.99
Zeiss Victory HT 1.1-4x24mm Rifle Scope
Zeiss Victory HT 1.1-4x24mm Rifle Scope is a high definition rifle scope that combines precision ... Mount Specifications for Zeiss Victory HT 1.1-4x24mm Illuminated Dot Rifle Scope: Magnification: ... 1.1x to 4x Effective Lens Diameter: 16.3mm to 24mm Exit Pupil Diameter: 1.1x - 14.8mm; 4x - 6mm ... Finish: Black Matte Features of Zeiss Victory HT 1.1-4x 30mm Riflescope: High brightness ... Package Contents: Zeiss Victory HT 1.1-4x24mm Rifle Scope ... conditions. The close-range, 1.1x to 4x magnification range of the riflescope is ideal for driving, stalking, ... and comfortable eye relief. The Zeiss Victory HT 1.1-4x T* Coated Riflescope has an ergonomic body...
Starts at $2,399.99
Zeiss Victory Diavari 4-16x50 T* FL Riflescope
. The Victory Diavari Riflescope 4-16 x 50 by Zeiss features a large 50mm objective diameter ... Specifications for Zeiss Victory Riflescope Diavari 4-16x50: Magnification: 4-14x Effective Lens Diameter: 50 ... Zeiss Victory Diavari 4-16x50 T* FL Riflescope combine unmatched optical quality with lightweight, ... 4-16x50 Diavari Riflescope offers a range in magnification that makes it a very versatile rifle ... at long ranges. Zeiss 5217779920: Victory Diavari 4-16x50 T FL 30mm with Reticle 20, Hunting ASV ... Zeiss 5217779972: Victory Diavari 4-16x50 T FL 30mm with Rapid-Z 800, Hunting Turret ... water, grease, dirt, dust Package Contents: Zeiss Victory Diavari 4-16 x 50 T* FL Riflescope...
Zeiss Terra 3x 4-12x50mm Riflescope
335mm Weight: 496g / 17.5oz Features of Zeiss Terra 3x Riflescope - 4-12x50mm: German Design ... The Zeiss Terra 3x Riflescope - 4-12x50mm has been created to be the perfect scope for any ... the Terra 3x 4-12x50mm is the perfect scope for almost any environment. For a great way to make sue you ... Zeiss 522741-9920-000: Terra 3X 4-12x50mm Riflescope w/ Plex Reticle, Matte Black Zeiss 522741-9980-000: ... Terra 3X 4-12x50mm Riflescope w/ RZ8 Reticle, Matte Black Specifications for Zeiss Terra 3x ... Riflescope - 4-12x50mm: Magnification: 4-12x Effective Entry Pupil 4x: 50mm Effective Entry Pupil ... with proprietary ZEISS MC coatings Package Contents: Zeiss Terra 3x Riflescope - 4-12x50mm...
Starts at $499.99
Zeiss Terra 3X 4-12x42 Rifle Scope w/ Hunting Turret 522711
inch Weight: 14.8 oz Features of Zeiss 4-12x42mm Terra3X Riflescope: Uncompromising Optical ... yet still compact enough to manage rugged, mountainous terrain, the Zeiss Terra 4-12x42mm Rifle Scope ... : Magnification: 4x-12x Effective Lens Diameter: 42 mm Exit Pupil Diameter: 10.5 mm - 3.5 mm ... Made for uncompromising performance, the Zeiss Terra 3X 4-12x42 Rifle Scope is a higher-powered ... solidly onto your zero on the Zeiss Terra 3x 4-12x42 Rifle Scope. Zeiss 522711-9920: Terra 4-12x ... encounters with your next trophy. Zeiss 522711-9980: Terra 4-12x42 Rifle Scope w/ Reticle RZ8 & ... acquisition during low light encounters. Zeiss 5227119920-KIT1: Zeiss Terra 4-12x42 Rifle Scope w/ Reticle 20...
Starts at $459.99
Zeiss Terra 3X 3-9x42mm Riflescope w/ Hunting Turret 522701
Riflescope gives you reliable repeatability with 1/4-MOA adjustments. Zeiss 522701-9920: Terra 3-9x ... Magnification: 3x-9 x Effective Lens Diameter: 42 mm Exit Pupil Diameter: 13.8mm - 4.6mm ... Center Tube Diameter: 25.4 mm Objective Tube Diameter: 50 mm Water Resistance: 400 mbar Functional ... Terra3X Riflescope 3-9x42mm: Uncompromising Optical Performance - ZEISS optics with MC anti-reflective ... The Zeiss Terra 3X 3-9x42 Riflescope is an all-purpose scope that features a slightly larger ... hunters and others who need visibility in the dusk and dawn hours. The Zeiss Terra 3-9x42mm Riflescope ... give you bright, high contrast images. Take it off, re-mount it - the Zeiss Terra 3X 3-9x42mm...
Starts at $399.99
Zeiss HD5 Conquest 5-25X50 Rifle Scope
Rifle Scope. Zeiss 522641-9920-000: Conquest HD5 5-25x50mm Riflescope w/ Plex Reticle, Matte Black ... 5-25X50 Compact Rifle Scope: Magnification: 5-25x Objective Lens: 50mm Features of Zeiss HD5 ... Zeiss HD5 Conquest 5-25X50 Rifle Scopes are the most compact high-magnification riflescopes in ... to extra-long-range hunting. The Zeiss HD5 Conquest 5-25X50 RAPID-Z Varmint Reticle Riflescope has a wide ... Zeiss 522641-9982-000: Conquest HD5 5-25X50 Rifle Scope w/ RZ800 Reticle, Matte Black Zeiss ... 522647-9920-000: Conquest HD5 5-25X50 Rifle Scope w/ Lock Plex Reticle, Matte Black Zeiss 522647-9983-000: ... Conquest HD5 5-25X50 Rifle Scope w/ LK RZ1000 Reticle, Matte Black Zeiss 522647-9985-000: Conquest HD5...
Starts at $1,029.99
Zeiss Conquest HD5 3-15x50mm Riflescope
low profile, modern design 100% repeatability: precision mechanics with 1/4 MOA Package Contents: Zeiss Conquest HD 3-15x50mm Hunting Scope ... 3-15x50mm Riflescope w/ Plex Reticle, Matte Black Zeiss 522631-9981-000: Conquest HD5 3-15x50mm ... Riflescope w/ RZ600 Reticle, Matte Black Zeiss 522631-9982-000: Conquest HD5 3-15x50mm Riflescope w/ RZ800 ... Reticle, Matte Black Zeiss 522637-9920-000: Conquest HD5 3-15x50mm Riflescope w/ Lockable Plex ... 3-15x50mm Hunting Scope was designed to be the most versatile scope that you will ever take into the field. ... and alpine mountains. For long-range hunters, the new lockable target turret on the Conquest HD5 3-15x50mm ... Reticle, Matte Black Specifications for Zeiss Conquest HD Riflescope - 3-15x50mm: Magnification: 3-15x...
Starts at $1,029.99
Z.E.R.O. (Zombie Extermination, Research and Operations) Kit by OpticsPlanet
Vision Scope 64 lp/mm GNVPVS14-OPMOD FLIR Systems HM-224Pro First Mate Thermal Image Camera-240x ... Rangefinder Leupold Mark 4 20-60x80mm, Black Spotting Scope, TMR Reticle 110826 Laser Devices ... Zombie Scope 1.56-6x32mm Z-CIRT Reticle Black 849843 Plano Moulding Zombie Ammo Can Champion Zombie ... dealing with the undead. Our Z.E.R.O. (Zombie Extermination, Research and Operations) Kit takes ... viewing, the OPMOD PVS-14 Night Vision Scope will let you peer into the darkness. When patrolling your ... the Thermal-Eye X-50 Thermal Imaging Camera. As we all know, rising from the grave expels most of the heat ... valuable forms of currency in the post-zombie world. While we only included one box in our Z.E.R.O...
Yukon Compact Head Mount for Sea Wolf and NVMT Night Vision Scopes
SEAWolf NV Head Mount: Compatible with: NVMT 1x24 Monocular; NVMT 2x24 Monocular (#24021); NVMT 4x50 ... such as the 90 flip-lock, securing the night vision scope in a fixed position relative to the eyes. ... with a night vision device is ideal for high-tech ranger games, night hiking and air-soft shooting, ... Monocular (#24027) with use of interchangeable NVMT 2x24 Objective Lens (#29051) Features...
Weaver Tactical 4-20X50 30mm SF Matte Mil Dot Riflescope
The Weaver 4-20x50mm tactical Mil Dot Reticle Side Focus Riflescope 800380 has been designed ... of eye relief, the Weaver Tactical 4-20x50mm MIL DOT Rifle Scope is perfect for shooting or eye ... glasses. 800380: Weaver MIL DOT Riflescope - 4-20x50mm, 30mm, SF, Matte, Mil Dot Reticle ... Contents: Weaver 4-20x50mm tactical Mil Dot Reticle Side Focus Riflescope 800380 ... Specifications for Weaver Tactical Rifle Scope - 4-20x50, Mil Dot Reticle: Magnification: 4-20 Objective ... Tactical MilDot 50mm Riflescope is designed to water, shock and fog proof, so you can easily take ... MIL Adjustment Range: 55MOA Weight: 28oz Tube Diameter: 30mm Features of Weaver 4-20x...
Weaver Rimfire 3-9X32 mm A/O Matte Black Dual-X RV-9 Riflescope 849398 Rifle scope
Weaver Riflescopes - fixed power for shooters that like simplicity. Weaver Rimfire 3-9X32 mm A/O ... 3-9X32 mm A/O Rifle scope fully multi-coated lenses improve image brightness and reduce glare. Weaver ... Rimfire 3-9X32 mm A/O Dual-X Riflescope one-piece, aircraft-grade aluminum tube holds the lenses ... Specifications for Weaver Rimfire 3-9X32 mm A/O Black Matte Dual-X RV-9 Rifle-scope 849398: ... Dual-X Features of Weaver Rimfire 3-9X32 mm A/O Black Matte Dual-X RV-9 Riflescope 849398: ... Package Contents: Weaver Rimfire 3-9X32 mm A/O Black Matte Dual-X RV-9 Riflescope 849398 In addition ... to Weaver Rimfire 3-9X32mm A/O Matte Black Dual-X RV-9 Riflescope 849398, make sure to check other...
Weaver Kaspa 3-12x50mm Rifle Scope
405g Fog Proof: Yes Features of Weaver 3-12x50mm Kaspa Tactical Scope: Fog Proof 1/4 MOA click ... Weaver Kaspa 3-12x50mm Rifle Scope is designed for tactical use and is perfect for military ... weaver, choose the Weaver Kaspa 3-12x50mm Fully Multi-Coated Scope. Weaver 849808: Kaspa 3-12x50mm Rifle ... Scope, Matte Black, Dual-X Reticle Weaver 849809: Kaspa 3-12x50mm Rifle Scope, Matte Black, ... Ballistic-X Reticle Specifications for Weaver Kaspa 3-12x50mm Matte Black Riflescope Magnification: 3x ... lenses for excellent light transmission Durable one-piece tube construction Crisp matte black finish Package Contents: Weaver Kaspa 3-12x50mm Rifle Scope ... condensation won't obstruct your target. The Weaver Kaspa 3-12x50 Fog Free Tactical Scope...
Starts at $134.79
Weaver Classic 8x56 Matte Dual-X Reticle Riflescope
zero to 10,000 rnd from a .375 H&H magnum rifle. The Classic 8x56mm Dual-X Reticle Riflescope by ... Magnification: 8x Objective Lens Diameter: 56mm Eye Relief (in/mm): 3.5/89 Field of View ... (ft@100yd): 12.8 Exit Pupil (mm): 7.0 Tube Size: 1in Adjustment Graduation (in): 1/4 Adjustment ... Range (in@100yd): 50 Finish: Matte Reticle: Dual-X Length (in): 13.5 Weight (oz): 16.2 ... Features of Weaver Classic 8x 56mm Matte Dualx Reticle Riflescope 8-49440: Fully multi-coated lenses ... Weaver Classic 8x56 Matte Dual-X Reticle Riflescope 849440 manufactured from a one-piece aircraft ... for open field hunting. The Weaver Classic K-Series 8x56 Riflescope 849-440 is one of the easiest...
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The Dark Age of Virtual Reality-Based Torture Is Approaching Fastby Doug Bierend · 1 month ago
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I suppose that one thing that grates about all this fulmination from Presbyterians, Anglicans, Methodists, and the rest of the alphabet soup of Protestant Christian cults, is that they have the arrogance to imagine that they have any place at the table to discuss these things.
This is a conflict between Jews and (mostly Muslim) Arabs. Christians only see themselves as deserving a voice in this because they imagine that their faith is the true heir to the revelations on Sinai. And that the Jews are an irrelevant and irascible remnant, which refuses to go away. That, indeed, is the entire premise of Sabeel and its "replacement theology".
The arrogance of the Christian cults is astounding, and they should check themselves and be reminded that, "Everyone who is arrogant is an abomination to the LORD; be assured, he will not go unpunished." (Proverbs 16:5)


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T rey Morgan [ Link ] talked about a subject today that has been stewing in my head for some time now with his post "Children Come Second?". Who is more important in your marriage or relationship: your spouse or your children?
I'm sure my wife and I aren't too different from many other couples out there. We both work full time jobs, we both love our kids immensely, we don't have a ton of free time and we used to have a stronger marriage before children.
Wait…what? " had a stronger marriage before kids?"…Yes, you read that correctly…a stronger marriage before we had children.
I always thought that once you have kids your marriage grew stronger - it had to in order to weather the storms of raising children…right? Well, when you combine 2 busy, exhausted, full-time working parents with 2 sleepless, yet amazing children it's easy to want to spend all your free time being "parent" and not "lover".
There. I said it. And my wife knows it. My wife is more important than my kids.
Why? Because, as a dad and a man, it's my duty to set the bar high for any guy in the future who wishes to date one of my daughters. I want my daughters to benchmark future boyfriends against me to see how they stack up and if I've neglected my relationship with my wife then it just sends the wrong signals.
I also don't want the kids to grow up and leave and not know the person sitting across the table from me at breakfast.
In Trey's article, he mentions what one couple said to him:
"We don't have a marriage, we have a business. We make money, pay bills and raise kids, period."
There have been plenty of days where I've felt the same way - I feel like my business partner comes home, we say our cordial "hello's" and "how are you's" but we fail to really connect because we're so busy playing mom and dad and not husband and wife.
Don't get me wrong - I think my wife is an amazing person. She's a compassionate mother and a fascinating woman and we love each other more than we ever have. We've certainly struggled with connecting and growing our relationship like we should over the past 3+ years and I have been just as guilty in the past when it comes to putting our kids first.
T his quote has been stuck in my head ever since I realized that I was going to be a father back in early 2005:
The most important thing a father can do for his children is to love their mother. Author Unknown
Maybe it's because I'm a man, or it's because I'm not a mother, I find it easier to put my wife ahead of my children. Is that true for all the dads out there?
Our youngest is only 7 months old and it's easy for me to sit here and say that my wife needs to make more time with me. I haven't decided if that's just me being selfish or just being a guy. I also understand that it's all a balancing act - I don't want to her to neglect our children because of me. Come on…I'm not that selfish.
When my wife spends so much time away from the girls everyday, naturally she wants to come home and be mom. I on the other hand, can put not seeing my kids all day aside, and come home wanting to be husband first then dad. My first thought coming through the door is "Where's my wife so I can give her a hug and a kiss?" After that I can play dad.
I don't have all the answers here…I'm still trying to figure out how I can finagle some quality alone time with my wife. Maybe this post will help - maybe it won't! We'll see and, in the mean time, if you have any suggestions on how to get more quality time with your wife I'd love to hear from you. Drop me a comment below and add to the conversation.


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Forum - View topicWhat's your favorite anime/Japanese music and why?
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Sunbeam vi Britannia
Posts: 3
Location: Austin, Texas
Kon'nichiwa anime aikō-ka Does anybody have any favorite anime musics that you watched, like their opening theme/ending theme musics?
For me, I liked most of them, like Bleach, Code Geass, Deathnote, and Full Metal Alchemist. Also, I liked the old anime series liked Eureaka 7's openings, Big O's, Lupin the 3rd's, and Neon Evengelion Genesis'. The best reasons why I love their musics is because they have good up-beat tempo, good quality, and their singing makes me feel happy. I also listened to the full versions of it
too, I love the piano, electric guitar, and any other music instruments being played. It sounds great. Even some sounds creepy and barely romantic. In my opinions.
I am happy to be here, I hope things go okay here. I love anime so much, I am looking forward into it.
Last edited by Sunbeam vi Britannia on Wed Jan 05, 2011 8:21 am; edited 2 times in total
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Tony K.
Posts: 9668
Location: Frisco, TX
Please don't overuse the smilies and please don't reply to yourself. If you need to add something, there's a button that let's you edit your own posts.
You might also want to add some substance as to why you like the music in those series. Talk about the instrumentation, the composition, the feelings they bring out in you, or something like that. It doesn't have to be fancy, but the rules around here require that you at least try to back up your statements. That way, it not only gets you thinking, but it might also get others to think, and then a discussion starts.
Good luck with that.
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Posts: 7
|I like both of the Hakuouki OP songs. They really fit the anime well and had a nice/catchy beat to them. The artist had a lovely voice too.
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Arsene Lupin III
Posts: 4
Sunbeam, I see that you mentioned Lupin the 3rd's music soundtrack, by Yuji Ohno. I really like this series and it's music. The only modern anime soundtrack that compares to Lupin III's, is Cowboy Bebop's, that's also really awesome.
I have to admit though, to enjoying some of the moodier music of various other anime series. One that comes to mind is InuYasha's soundtrack. The background music behind this series is sometimes just amazing, as in romantic, dramatic, as well as cautious and wary. I like some of the more subtle work behind the series, in addition to the more well-known pieces. I can't really say the same for some of the intros and ending themes though, for some reason.
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Olaf Forkbeard
Posts: 9
Location: North America, IL
I personally have a playlist that currently is at 248 song's from Animes I have finished. I generally like all of them, but if I had to pick favorites I'd say the bands The Pillows and Abingdon Boys School's stuff.
The Pillows did virtually all the music for FLCL with an exception being a short classical piece. The song Ride on Your Shooting Star makes me smile even if I don't want to. Probably has something to do with an unsafe amount of nostalgia. Hybrid Rainbow, Crazy Sunshine and Runners High are really good too.
Abingdon Boys School sounds... good. I can't pick one. Look em up, they've done more than just anime music (I think.)
As for singles that I haven't yet found band related stuff for. T.M. Revolutions Resonance gives me goosebumps. I need to find more on that band.
Here's a small list of others that shouldn't be ignored.
Yu Yu Hakusho - A Smile Thats A Bomb
Tengen Toppa Gurren Lagann - Libera me from hell
Tengen Toppa Gurren Lagann - Sora iro Days
Spice and Wolf - Ringo Biyori
And that's my.. Hobby I guess.
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Posts: 156
Location: Honolulu, Hawaii
For me it started with the soundtrack for Please Save My Earth most of the songs are very haunting and the melodies stirs up emotions that make you sit up and take notice, most of the compilations are instrumental there is one song called "rings" that is very interesting to listen to thru out the song there are chiming of bells.
Another is one of the Best of collection from Bleach the first one, I didn't think I was going to like it but also included in the CD was a DVD that actually showed video clips of some of the OP or ED songs within the series, full length videos and music songs in its entirety which was great, that was a nice little added bonus surprisingly.
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Posts: 11
|[EDIT: No listing. Put reasons for your choices. -TK]
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Camiru Mylle
Posts: 47
Hmm. I love a lot of anime Japanese. music especially Intro and Ending songs of my favorite anime.
I personally like every songs of Back-on. They sang themes for Air Gear and Eyeshield 21 and their songs rock my ears with those poppin, funky, groovy and rockin beats.. it goes boom boom in my mind and I head bang on it:)) bam bam! haha.
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Posts: 35
Hmm. I'm quite fond of most pop rock songs.
For example, both the OP and ED of Steins;Gate stick out for me. I actually have the piano sheet music for the ED. The dark piano intro serves as my ringtone, as well.
Recently, I started listening to Supercell a lot. It might have been Bakemonogatari's ED that started it, but the OP for Guilty Crown just reinforced it.
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Posts: 1
|[EDIT: Reasons. -TK]
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Posts: 1134
Location: North wales coast
I quite like maximum the hormone and i only know of em cos whats up people and zetsubou billy were on death note.
Im into metal already but they have a kind of cheerful pop-punk element to their stuff thats not found in most other metal bands. They kind of stand out a bit really.
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Posts: 143
|[EDIT: Put reasons, please. -TK]
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Posts: 560
Location: Colorado Springs CO
I tend to prefer music that isn't comprised of J-pop. Not that there is anything terribly wrong with J-pop, it's just that it's so prevalent and obvious a choice for OP/ED's that it just becomes an eye-roller after a while.
That said, the themes of Ghost in the Shell: Stand Alone Complex, Cowboy Bebop, Samurai Champloo, Ergo Proxy, and Serial Experiments Lain (to name just a few) were standout for me. If they were electronic, they were a non-pop-esque sort of electronic. Otherwise, they were either jazzy or alternative rock (the good, indie kind of alternative rock).
I'm still waiting on an underground metal soundtrack for an anime. Especially if it is comprised of music from the Scandinavian masters--let's face it, most of the best metal comes from Sweden.* Think Katatonia, Dark Tranquillity, Opeth, In Flames, Meshuggah, etc.
* Though my favourite band just happens to be Agalloch, from America.
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Posts: 7
Location: United Kingdom
|[EDIT: Can no one around here read? Put.. reasons. -TK]
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Posts: 187
Location: Texas
Just lately I cannot stop listening to any songs by Nana Mizuki, although I think her songs from Nanoha are the absolute best. I can't quite put my finger on why they're better than her other songs. It may just be the very upbeat energy they have. I like the combination of synthesizers, piano, and electric guitars I think. Nana Mizuki's voice is really great as well. I like when she has that vibrato thing going.
So Nana Mizuki's songs from Magical Girl Lyrical Nanoha are my favorite music of the moment.
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I have been working at AvanadePros
- Good place to work if you are a .Net coder
- $2,000/year to spend on gadgets
- Pretty good health benefitsCons
- Laser focus on selling to CIOs makes it a poor place to work for business solution consultants (ERP, CRM, BI)
- New career model has virtually stopped all career advancement
- Shift from regional to service line organization has drastically reduced leadership roles and opportunities
- Old boys club mentality among leadership (most worked together at Accenture or Microsoft Consulting Services)
- 80% of business is hand-me-down work from Accenture
- Very poor work/life balanceAdvice to ManagementAdvice
Figure out a strategy to sell outside of the CIO office. Using people that can sell to a CIO to try to sell to a CFO or COO doesn't work.Disapproves of CEO


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Add some variety to your fitness routine with these upper and lower leg exercises from The American Council on Exercise. We have a large selection of leg exercises that will will help you strengthen and build muscle throughout your legs including your hamstrings, thighs, shin and calf muscles. Start taking advantage of this free information today! If you are looking for full workout routines that incorporate these leg exercises, check out our Workouts section.
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