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The Wait of Glory
My family has been blessed mightily in the last six months or so. My dear wife Denise and I have suffered through two miscarriages. (And three more in the years before that.) Our daughter Shannon, who is mentally retarded, began …Read More
A Lasting Virtue
Most of us recognize that patience is one of the cardinal Christian virtues — we're just in no hurry to obtain it. Others just define patience as a delay in getting what we want. As Margaret Thatcher once famously remarked: …Read More
Patience in Suffering
I hate pain. I try to avoid suffering, and I don't go out of my way to look for affliction. But pain, suffering, and affliction find me. They find all of us. If you are free of these things, brace …Read More
Resolved by the Grace of God
When I was nineteen years old, I joined the staff of a large evangelical church. A few of the pastors on the staff became wonderful friends and mentors, but as I encountered some of the pastors at that church and …Read More
Total Surrender
Gary Thomas, in his book Seeking the Face of God, makes this statement: "Christian health is not defined by how happy we are, how prosperous or healthy we are, or even by how many people we have led to the …Read More
Thriving at College
College represents a minefield of temptation for the Christian student. It is often the first time a young person raised in a godly home is under the direct, ongoing infl uence of both professors with secular agendas and classmates with …Read More
A World of Tomorrows
Like the March hare, I'm late, I'm late, for a very important date. My column for this issue of Tabletalk was due yesterday. This morning I received from my friends at Ligonier a polite email reminding me of that truth. …Read More
Radically Contagious
When they saw the boldness of Peter and John, and perceived that they were uneducated, common men, they were astonished. And they recognized that they had been with Jesus" (Acts 4:13). I have always been leery of vaccinations. The idea …Read More
Uncommon Belief
"Earth's crammed with heaven, and every common bush afire with God; but only he who sees takes off his shoes; the rest sit around it and pluck blackberries." — Elizabeth Barrett Browning, Aurora Leigh, Book VII Through our study of …Read More
Unquenchable Joy
"Count it all joy, my brothers, when you meet trials of various kinds, for you know the testing of your faith produces steadfastness" (James 1:2). Was James a masochist? "When you face trials, do it with joy." Who gets their …Read More
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Oak Grove, KY, United States | Member Since 2015
"I Love This Series"
This is a great series. I can't wait to dig my claws ito the next book. The characters are excellent! I could totally see Dirk Pitt reading all about Issac Bell. :-)
"Are you sure Clive Cussler wrote this?"
I am hoping that the unabridged version of this is better.
Ron Mclarty is not the worst narrator i have heard but just because you have a deep voice doesn't mean you should be a narrator. Its not that his reading skills are lacking its just that his voice does not have the range to accommodate multiple characters. All of the characters sounded like agitated old men. Also the manner in which he pronounced Titanium was amusing to me ( Tie Tan E Um) but this could just be a accent.
I love all of Clive's books but it is hard for me to really get into this one. I doubt I will finish.
Oreagon, Numa files, Issac bell are all good series. but this book doesn't stand up to what I would expect from Clive Cussler. Perhaps a grandkid or nephew or someone wrote this and he slapped his name on it to humor them.
"Hooked in an Instant"
Super Audio Crack
Atticus, because he isnt perfect. Even after 2000+ years he still makes bonehead mistakes. I like that he isnt some perfect super hero. More down to earth and easier to identify with the character. Oh yeah and he has a cool dog.
Lucke does an excellent job just as he has done on the last 3 books. I especially like that he pronounces Asgard as (Ass Guard). Im not sure if this is doe on purpose but everytime it brings a smile to the little boy trapped inside me :-)
Atticus & Oberon > Sookie Stackhouse. They deserve their own show. But I think BBC could do a better job of it then HBO. They would stay more true to the books and not try to add in there own lame ass ideas.
"Lots of info on progression of medical field"
This book is great. At first i was getting bored with the medical history lesson and wasnt quite sure how it all related to the title, but it all came together. Its amazing all of the things that came together to create the perfect storm for this plague to cause so much death ad destruction. The scope of the deaths was far more then i first imagined.
This book was very informative, if not unsetteling. I recommend this to everyone.
Scott brick does an awsome job with the narration.
"Almost started cheering for the Bad Guy, almost."
Yet another excellent Cussler book. As much as i love Juan and the crew of the Oregon, i almost found myself cheering for the bad guys, But in the end Juan triumphs and i suppose its for the best.
"I Love The Ending for this one!! also see warning"
I have read Cussler books for years and now i listen to them. I rank this one up at the top along with Fire Ice. I truely love the ending scene for this book. Juan is the biggest smart ass out there.
If you too are listening to this series I want to warn you that the next book "The Jungle" experiences a change in narrator. please see my review on that before you purchase the audio version. you may want to just read it in print.
"Why Change Narrator to phone sex Darth Vader!"
I have listened to many many Clive Cussler books and all of them were narrated by Scott Brick who did an excellent job. Now we reach the most current book in this series and we run into a narrator change. This just threw everything off for me. I could get past the different voices for the characters, but what i couldnt stand was Jason Culps choppy reading style and darth vader like breathing. Seriously you could hear every breath he took like he was gasping for air after coming to the surface from drowning. Maybe he wouldnt need so much air if he wasnt reading with a breathy phone sex operator voice.
I love Clive cussler books but from now on i will pay more attention to the narrator and if its this clown i will pass and just read the print version.
While i haven't finished the book I am sure the story is wonderful just like all of cusslers other books. Just please bring back Scott Brick.
"New to Urban fantasy"
Im new to Urban Fantasy but am really really enjoying this. Between Harry and Atticus from Iron Druid Chronicals i have a new favorite type of books
"Another Excellent Issac Bell Novel"
I really enjoyed this story. Issac Bell is one of my new favorite characters. I really enjoy the historical points smattered in here and there.
"A must read for any history buff"
This was amazing. I learned a whole lot about GW i never knew. There was a whole lot of politicing back then i had no clue.
"A new favorite series"
This is a great series. I can't wait to dig my claws ito the next book. The characters are excellent! I could totally see Dirk Pitt reading all about Issac Bell. :-)

subset: commoncrawl


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Religious and Spiritual Life
Office of the Chaplains
Welcome! The Chaplains of the College seek to accompany the entire Gustavus community in a solidarity that celebrates diversity and embraces connectedness. Because of the Swedish-Christian-Lutheran heritage of the college, the Chaplains promote spiritual exploration through respectful inclusion and enriching dialogue in the context of global religious pluralism. In doing so, the Chaplains seek to strategically integrate faith and spiritual development into learning and life for the sake of restoring communities through radical compassion and hospitality.
Christ Chapel is a worship and learning place where the Gustavus community can experience music from around the world, listen to messages from a variety of perspectives, and gather together during significant personal and corporate life passages.
The Chaplains engage in conversations with people regarding vocation, faith questions, relationship struggles, crisis situations, and the daily joys and sorrows of life. These conversations happen in classrooms, on retreats, after worship, in the Marketplace, during discussions, on walks in the Arboretum, in Bible studies, during service in the St. Peter community, and in many other ways and places.
Name | Title | Phone | |
Brian Konkol | Chaplain of the College | 507-933-7450 | |
Siri Erickson | Chaplain of the College | 507-933-7446 | |
Grady St. Dennis '92 | Chaplain and Director for Church Relations | 507-933-7661 | |
Chad Winterfeldt | Cantor | 507-933-7446 | |
Kathy Chalhoub | Assistant to the Chaplains | 507-933-7446 |


text: munoz1.jpgmunoz2.jpgmunoz4.jpgSome repairs. One in the tail. And one of the rails looks like it got a fin through it at one point. It was repaired but could use some touching up. Id imagine someone would buy this as a "wall Hanger" but it is still very rideable. Price is negotiable. Also interested in trades. Looking fror a fish around 5'4-5'6. (848)480-3492 James


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Morningside Heights is located in the northernmost section of the Upper West Side. Despite its geographical location on the UWS, Morningside Heights is referred to by many today as "Greater Harlem.".
Some also refer to it as SoHa, meaning "south of Harlem." Before any of these names, however, the neighborhood was known in the 17th century as Vandewater's Heights.
learn more about this neighborhood#52Neighborhood popularity:
based on Naked Apartments searchesBuilding Mix
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It feels like the whole state of ATI drivers on linux has just back flipped completely in less then 24 hours - this is awesome news for the AVIVO driver. Too bad it will pretty much obsolete Revenge.
Why introduce a new driver and not integrate into current one? Would ease up hw detection - just everything from ATI vendor pciid to ati driver. Currently you need a list with all supported old cards for ati and you use the rest for vesa. When you want to write a list for new driver then good luck... It is enough to update my own pci id list from fglrx driver.
The article will be published at noon EST tomorrow.
Waht about specifications for R300 and R400? There are open source drivers, but they also need more development(slow, not everything works). Will there be any progress for those, too?
If you read the press release for the Kernel Summit, they pretty much stated that they want to support Open Source drivers for across the board ATI products, so most likely, yes, that includes R300/400 products too


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xrandr doesn't work with multiple video cards configured as a single logical screen.
OK, So I got the kernel configured and everything seems right. Both video cards come up at boot in the kernel and then when xorg loads they both get detected and seem to be auto configured properly... However xrandr is only showing the head that is plugged into the 6850. It seems that xrandr doesnt work with multiple video cards. I currently have 1.4.0 installed which claims support for multiple video cards but it still only shows the 6850... Does anybody have any idea how to make this work?
xrandr doesn't work with multiple video cards configured as a single logical screen.
OK thats kinda screwed up. So xinerama is out of the question.
What about zaphod? Would that work?
Zaphod worked out ok. LXDE on the other hand didnt work so good I just get a black screen with a stylized "X" curser on the second screen. XFCE seems fine. KDE has some bugs with the mouse curser but otherwise works.
The main reason for wanting to use the integrated card instead of putting them both on the 6850 is because I like to watch movies while playing video games and video playback was very choppy. It seems better now with the video playing on a different gpu but it still has some choppiness to it.
Thanks for your help all is working pretty good.
EDIT: The only other problem I have to figure out now is that XBMC seems to steal mouse focus so I can't move the mouse back to the main monitor..... time for some google searching i think.....
Last edited by duby229; 02-28-2013 at 04:09 PM.


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MIX pork, cabbage, onions, egg and 2 Tbsp. each of the dressing and soy sauce until well blended. Spoon evenly onto won ton wrappers, adding about 1 tsp. of the pork mixture to each wrapper. Moisten edge of each wrapper with water; fold in half to form a half-moon, pressing edges together to seal. If desired, edges can be pleated with five or six folds.
HEAT 2 tsp. of the oil in large nonstick skillet on medium-high heat. Add 10 dumplings; cook 1 to 1-1/2 min. or until bottoms are golden brown. Gradually add 1/4 cup of the water; cover. Reduce heat to medium-low; cook 2 to 2-1/2 min. or until filling is cooked through and water has evaporated. Remove dumplings to serving plate; wipe skillet dry. Repeat with remaining dumplings.
COMBINE remaining 2 Tbsp. dressing, remaining 2 Tbsp. soy sauce and remaining 1 Tbsp. water. Serve as a dipping sauce with the dumplings.


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Mysterious aircraft puzzles residents
UPDATED 12:12 AM EDT May 10, 2013The Federal Aviation Administration knows what's up there but it's not telling the public.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


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Jim Joyner, PharmD, CGP
Haloperidol (Haldol) is one of the most useful medications in the hospice setting. It is classified as an antipsychotic drug and is widely used to help manage psychotic symptoms and agitated states resulting from a variety of conditions during end-of-life care in hospice patients. In addition to the psychotropic activity, it is very effective for controlling nausea and vomiting, especially nausea-vomiting that is induced by opioids. Haloperidol is available in a variety of dosage forms including crushable oral tablets, oral concentrated solution (2mg/ml) which may be given sublingual, and a sterile solution for IM or IV injection. These various dosage forms are very advantageous for compromised hospice patients who can no longer take traditional oral tablets due to lack of adequate swallowing ability or severe nausea.
Unfortunately, many hospices have experienced resistance from administrators and directors when they attempt to use Haloperidol during end-of-life care for their patients who reside in skilled nursing facilities (SNFs). In some cases, this resistance has risen to the level of threatening to completely derail the relationship between the hospice and the SNF. Reasons for the resistance often do not have anything to do with quality of patient care, but are driven primarily by fear of deficiency reports and related fines which might be levied upon the SNF by State and Federal licensing agencies citing the inappropriate use of this drug.
Haloperidol is an antipsychotic drug. The Centers for Medicare and Medicaid (CMS) have developed very strict standards governing the use of all antipsychotic drugs in patients who reside in the skilled nursing facilities. These standards are backed with the force of regulation and licensing survey teams may assess deficiency notices and fines with regard to perceived inappropriate use of these antipsychotic medications in the SNF.(1) The regulatory measures were developed in response to past history of abusive practices at some SNFs where antipsychotics were used inappropriately to "chemically restrain" patients and not as a part of coordinated clinically acceptable intervention to manage their condition. Current regulations have been drafted with the intent to ensure that antipsychotic drugs are used to treat a specific documented condition for which the medication helps to maintain the patient's highest practicable mental, physical, and psychosocial well-being in collaboration with the attending physician and facility staff. This includes the administration of the lowest effective dosage, for a duration that is clinically indicated to treat the patient's specific condition, and appropriate non-pharmacological interventions are considered as a part of therapy along with the antipsychotic drug. Periodic tapering of doses and trials of discontinuation are also recommended as a part of the detailed regulatory guidance for this class of drugs. Close monitoring of patient behaviors and possible adverse effects is required along with detailed documentation of all observations related to the monitoring.
SNF compliance with these regulations can be daunting considering the level of documentation required as well as the highly subjective way in which many of the licensing survey teams interpret the regulations and apply them to individual patients. This is why many SNF administrators and directors of nursing may view antipsychotic medications, and Haloperidol specifically, as high risk to their organization. For this reason, most SNFs will attempt to limit antipsychotic utilization as much as possible.
These regulations were created with the intent to guide antipsychotic utilization in the SNF patient suffering from one of the various forms of dementia or otherwise unspecified agitation. For this reason, specific exceptions were written into the surveyor guidance regarding intent of the regulation. The exceptions preclude requirements normally imposed on the use of these medications in the SNF. One of these exceptions is the use of antipsychotic drugs for "adjunctive therapy at end of life," and another exception is for "nausea and vomiting associated with cancer or cancer chemotherapy". This is exactly the case when Haloperidol (or other antipsychotics) are used for a hospice patient in the SNF. Unfortunately, many practitioners as well as some licensing surveyors are not well versed on the distinction between these exceptions for hospice patients and other non-hospice SNF patients. Hospice directors and administrators can take a lead role by being pro-active and discussing this issue with their counter parts at the SNFs to help correct the misconceptions.
Haloperidol is sometimes singled out as the major offender of this regulatory scenario since it is one of the older classes of antipsychotic drugs commonly referred to as "traditional" antipsychotics. The newer generation of antipsychotic drugs such as Quetiapine (Seroquel) or Risperidone (Risperdal) are commonly referred to as "atypical" antipsychotic drugs since they tend to be more effective for certain types of atypical psychoses associated with catatonia. The older, traditional antipsychotic drugs may have a greater risk for inducing involuntary movement disorders (parkinsonism, tardive dyskinesia, etc.) than the newer atypicals in general. For this reason Haloperidol is sometimes perceived to be a greater risk to SNF patients than the newer generation antipsychotic drugs. This may be true at high doses, however, at daily doses of 5mg or less (commonly used), haloperidol is tolerated just as well as the newer generation antipsychotic drugs. (2,3) In addition, much of the involuntary movement disorder risk is associated with longer durations of therapy of 3 to 6 months, or more. Such long durations of therapy are unusual for hospice patients.
It was never the intent of the SNF regulations to restrict the use of antipsychotic drugs, including Haloperidol, for use in managing end-of-life symptoms in hospice patients. Unfortunately, the distinction between end-of-life care and care for other nursing home residents has become blurred in many instances resulting in the denial of an extremely useful medication for dying patients.
1. Federal regulation (Centers for Medicare & Medicaid Services – Skilled Nursing Facilities)
F-329; 483.25(l) Unnecessary Drugs, subsection 2. Antipsychotic Drugs
2. Parellada,et al. Risperidone in the Treatment of Patients with Delirium
J. ClinPsychiatry2004;65:348-53. 16
3. Han, et al. A Double Blind Trial of Risperidone and Haloperidol for the
Treatment of Delirium.
Psychosomatics2004:45(4): 297-301
Esther Liu, PharmD, MSIA, CGP
As of April 20th, 2015, the American Society of Health-System Pharmacist (ASHP) has officially announced that there is a shortage of atropine ophthalmic solution.
Atropine was one of the U.S. Food and Drug Administration (FDA) grandfathered medications originally marketed before 1938 which was prior to current requirement of filing a New Drug Application with the FDA. Many manufacturers could legally produce generic atropine products without filing New Drug Application (NDA) or Abbreviated New Drug Application (ANDA), which made atropine ophthalmic solution a very cost-effective medication in the past.
Since July 2014, Akorn, one of the many generic atropine ophthalmic solution manufacturers, filed an original NDA for atropine ophthalmic solution and obtained FDA approval. This act removed atropine ophthalmic solution from the FDA's grandfather list. This requires any manufacturers, who wish to continue producing atropine ophthalmic solution to file for an ANDA and obtain FDA approval. This shift in FDA approval status on atropine ophthalmic solution has discouraged the rest of the generic manufacturers from continuing to produce the product and Akorn has become the only atropine ophthalmic solution manufacturer since January 2015. Due to this sudden drop in availability from multiple manufacturers, there has been a shortage of atropine ophthalmic solutions from Akorn, as well as a significant price hike on this medication.
Moving forward, we will expect to see only the Akorn atropine ophthalmic solution products in the market until more generic manufacturers have successfully obtained FDA approval on their ANDA. There is no estimated date on when this will happen.
Here is the current price and shortage status for the Atropine Sulfate 1% Ophthalmic Solution, Akorn
2ml Bottle, NDC 17478-0215-02 ---- AWP $30.74 (~ 1week supply if used 1 gtt QID)
5ml Bottle, NDC 17478-0215-05 ---- AWP $58.35 (~ 2 weeks supply if used 1 gtt QID) à shortage
15ml Bottle, NDC 17478-0215-15 ---- AWP $95.25 (~ 4 – 6 weeks supply) à back ordered
In a hospice setting, atropine ophthalmic solution was recommended in many hospice formularies and their comfort kits for the use of managing excessive secretions when used orally. Atropine injectable solution was sometimes used orally as well as a substitution when the ophthalmic solution was not available, but there is currently also a shortage of this formulation since February 2015. Here are some comparable cost-effective alternatives for managing excessive secretions while atropine ophthalmic solution is in shortage (price quoted on 15 day-supply):
Hyoscyamine (Levsin) 0.125mg Sublingual tab (0.125mg QID) --- AWP $52
Glycopyrrolate (Robinul) 1mg tab (1mg TID) --- AWP $59
Atropine Eye Drop 5ml Bottle (1gtt QID) ---- AWP $58 à in shortage
With the current increase in price of atropine ophthalmic solution, the cost of managing excessive secretions routinely is roughly the same amongst atropine ophthalmic solution, hyoscyamine and glycopyrrolate (see above price comparison for 15 days). However, atropine ophthalmic solution is a less cost-effective option for hospice comfort kits now due to its smallest non-breakable package size being a 2ml bottle (cost $30 per bottle) in comparison to Levsin or Robinul, which can be dispensed in smaller quantity such as 6 tablets ($5 - $8). It is highly recommended for hospices using atropine ophthalmic solution to evaluate the need to substitute atropine with hyoscyamine on their formulary, as well as their comfort kits due to the significant accessibility issues and cost-effective reasons.
ASHP Drug Shortage Updates:
FDA Drug Shortage Database:
Dr. Jim Joyner, PharmD, CGP
A hiccup is an involuntary reflex involving the respiratory muscles of the chest and diaphragm, mediated by the phrenic and vagus nerves and a central (brainstem) reflex center. A single episode can last for a few seconds to as long as several days. Persistent hiccups can last for months. There are a wide range of possible causes for hiccups including; stress or excitement, esophageal or gastric distension, liver disease, CNS lesions, or cancer. Irritation of the vagus nerve or the diaphragm is a common mechanism.
Many drug and non-drug treatments have been used, but there is little evidence of any one superior approach to management; virtually all current data are anecdotal. When choosing a drug treatment strategy for hiccups, consider the suspected etiology, patient's drug-allergy history, potential drug-disease state contraindications, and potential adverse effects from any proposed drug therapy.
Chlorpromazine (Thorazine) is the only drug with an FDA approved indication for treatment of hiccups. Haloperidol (Haldol) is a useful alternative. Chlorpromazine and Haloperidol should not be used in patients with Parkinson's disease because they may exacerbate involuntary movements. Metoclopramide (Reglan) increases GI motility and may be especially useful if hiccups are related to esophageal or gastric distention. The muscle relaxant, Baclofen (Lioresal), is thought to have a direct relaxation effect upon the diaphragm and may be most useful in patients where an irritation of the diaphragm is suspected. Dexamethasone (Decadron) may be appropriate as an adjunct to one of the previously mentioned drugs if there is hepatomegaly or tumor involvement. All of these drugs are available as relatively low cost generics, so the choice of therapy should be based upon the suspected etiology behind the hiccups, the patient's drug allergy history, and other health conditions that may predispose the patient to adverse drug effects. In difficult cases it may be necessary to combine two to three of the drugs listed below in order to achieve adequate results (haloperidol and chlorpromazine should not be combined because they exert a similar mechanism of action that would represent at therapeutic duplication).
Common Doses for Hiccups:
Chlorpromazine (Thorazine) 25-50mg Q6h po,pr
Haloperidol (Haldol) 1– 2mg Q6h po, sl
Metoclopramide (Reglan) 10-15mg Q6h po
Baclofen (Lioresal) 5 –10mg Q6h po
Dexamethasone (Decadron) 2-6mg daily po
Dr. Jim Joyner, PharmD, CGP
Opioids are the mainstay of treatment for management of severe dyspnea in late stage CHF and COPD. The use of opioids in dyspnea is supported by extensive experience as well as clinical studies with the use of both oral and parenteral opioids, specifically morphine. The mechanism of action is unclear and it is interesting that opioids can alleviate dyspnea in many patients without changing the respiratory rate or producing any measurable changes in blood gas parameters. Speculation as to the actual mechanism of action has centered around the probability that opioids decrease brainstem responsiveness to carbon dioxide and diminish reflex vasoconstriction caused by increased PCO2 levels, decreasing the perception of dyspnea. There is also the opioid induced effect of decreased anxiety which often accompanies dyspnea.
Morphine and other opioids are often administered in small doses orally, sublingually, or by injection (SC & IV) for dyspnea management. Nebulized inhaled opioids are also used for this purpose, but to a much lesser extent. The use of the inhaled route of administration is favored by some in the palliative care community because of the possibility of a more rapid onset than oral or sublingual routes and possibly less side-effects than systemically administered opioids.
There are no controlled trials to confirm the perception that nebulized opioids have any clear benefits over the other more conventional routes including oral, sublingual, subcutaneous, and intravenous. One extensive review of 18 randomized, double-blind, controlled trials of opioids for management of dyspnea in terminally ill patients concluded that there was adequate evidence to support the use of oral or IV opioids for dyspnea, but not the use of nebulized opioids. (1) An earlier published report evaluated blood levels after nebulized morphine and orally administered morphine which demonstrated rapid absorption by the inhaled route compared with oral morphine, but significantly more variability. (2)
Disadvantages of administering opioids via nebulizer would include to the following:
• Increased cost over other routes (nebulizer & preservative-free drug solutions)
• More complex method of administration
• Lack of portability (nebulizer)
If opioids are to be used via nebulizer, the "preservative-free", sterile solutions for injection are preferred in order to avoid respiratory irritation. The drug solution is diluted in 2 to 3ml of "preservative-free" normal saline prior to administration. Doses used fall within these ranges:
Morphine 2.5 – 10mg
Hydromorphone 0.25 – 1mg
Fentanyl 25- 50mcg
The majority of hospice patients with dyspnea will benefit from non-inhaled opioids and tolerate them well. The nebulized opioid alternative may be appropriate for those few patients who may refuse oral or injectable opioids or those who have exhibited certain adverse effects to systemic therapy.
(1) Jennings, Davies, Higgins et al. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001; 4CD002066
(2) Masood, Thomas. Systemic absorption of nebulized morphine compared with oral morphine in healthy subjects. Br J Clin Pharmcol. 1996; 41:250-2
Dr. Stephanie Cheng, PharmD, MPH
Striverdi Respimat was given FDA approval on July 31, 2014 and is indicated for use as a long-term, once-daily maintenance bronchodilator treatment of COPD, including chronic bronchitis and/or emphysema. The active ingredient, olodaterol, is a long-acting beta2-adrenergic agonist (LABA) bronchodilator that is formulated as a liquid spray for use via the latest type of inhalation device called a Respimat. The recommended dose is 2 inhalations once daily. Each actuation of the device delivers 2mcg of olodaterol.
Warnings/Side Effects
Thus far, Striverdi Respimat has only been indicated for use in COPD and has not been studied in patients with asthma. As with all LABA, it is not for use for the relief of acute symptoms and is contraindicated in patients with asthma without use of a long-term asthma control medication. Striverdi Respimat should not be initiated in patients with acutely deteriorating COPD and should be used with caution in patients with cardiovascular or convulsive disorders, thyrotoxicosis or sensitivity to sympathomimetic drugs. A life-threatening paradoxical bronchospasm can occur and Striverdi Respimat should be discontinued immediately. The most common adverse reactions include: nasopharyngitis, upper respiratory tract infection, bronchitis, urinary tract infection, cough, dizziness, rash, diarrhea, back pain and arthralgia.
Safety and Efficacy
Compared to other LABA bronchodilators (formoterol, indacaterol, salmeterol, and arformoterol), olodaterol has demonstrated similar safety and efficacy.
Advantages of Striverdi Respimat
Striverdi Respimat is being promoted with two advantages over the current LABA on the market. The first advantage is Striverdi Respimat is dosed as once daily. All of the other LABA, aside from Arcapta Neohaler (indacaterol), are dosed BID.
The second promoted advantage of Striverdi Respimat is the drug delivery system. The Respimat Inhaler system is a multi-dose, propellant-free, hand-held liquid inhaler. The device delivers a pre-measured amount of medication in a slow-moving mist, which the patient inhales through a mouthpiece. This method of medication delivery allows more of the drug to enter the lungs instead of the esophagus compared to devices with a propellant, such as a Metered Dose Inhaler (MDI). Compared to the LABAs that come as a Dry-Powder Inhaler (DPI) (formoterol, indacaterol and salmeterol), a patient requires less force to inhale the medication. There have also been studies done which show that patients preferred the Respimat device over the other types of inhaled drug delivery devices, particularly if the patient has vision problems or arthritis.
These advantages are hoped to improve patient compliance with the medication.
Disadvantages of Striverdi Respimat
One of the main disadvantages of Striverdi Respimat is that in patients with COPD, positive inhalation pressure becomes a problem as the disease progresses. Most patients with severe or end-stage COPD are unable to inhale deep enough for inhalers to be effective and are generally switched to the nebulized form of LABAs (Brovana or Perforomist).
Another disadvantage of Striverdi Respimat is that it requires more training and education for a patient to use it correctly. One clinical trial comparing a patient's proper technique in using the Respimat or a MDI for the first time demonstrated that the proportion of patients demonstrating good technique was higher for the MDI (80%) versus the Respimat (48%). By the final attempt, 98% of patients demonstrated satisfactory inhaler technique with the MDI compared to 96.4% with the Respimat.
Cost is a third disadvantage of Striverdi Respimat. Similar to other long-acting beta agonist bronchodilators currently available (Arcapta, Foradil, Serevent), Striverdi Respimat is also relatively expensive. Cost for these products may range between $6 - $8 per day based upon average wholesale price (AWP).
Place in Hospice Therapy
Although Striverdi Respimat provides another option for patients with COPD that could help with improving patient compliance with the medication, it is largely cost prohibitive in the hospice setting. Additionally, because of the training required for proper inhaler technique and the inability of most severe or end-stage COPD patients to have enough positive inhalation, this dosage form may not be as efficacious compared to other dosage forms.
1. [Package Insert] Striverdi Respimat (olodaterol) Inhalation Spray. Boehringer Ingelheim Pharmaceuticals, Inc. Aug 2014.
2. Anderson P. Use of Respimat Soft Mist Inhaler in COPD patients. Int J Chron Obstruct Pulmon Dis. Sept 2006;1(3):251-259.
3. Feldman GJ, Bernstein JA, Hamilton A, et.al. The 24-h FEV1 time profile of olodaterol once daily via Respimat and fomoterol twice daily via Aerolizer in patients with GOLD 2-4 COPD: results from two 6-week crossover studies. Springerplus. 2014 Aug 9;3:419.
4. Koch A, Pizzichini E, Hamilton A, et.al. Lung function efficacy and symptomatic benefit of olodaterol once daily delivered via Respimat versus placebo and formoterol twice daily in patients with GOLD 2-4 COPD: results from two replicate 48-week studies. Int J Chron Obstruct Pulmon Dis. 2014 Jul 5;9:697-714.
Dr. Jim Joyner, PharmD, CGP
The results of a clinical trial of ABH topical gel vs placebo for the management of nausea in cancer patients were recently published in the Journal of Pain and Symptom Management.(1) ABH topical gel is a pharmacy-compounded product consisting of Lorazepam (Ativan), Diphenhydramine (Benadryl), and Haloperidol (Haldol) usually prepared in a pluronic lecithin organogel (PLO) base. It has been used frequently in some palliative care settings for management of nausea and vomiting, despite very limited scientific data to support continued use. The product has gained a following due to the ease of use (topical administration) and perceived efficacy.
This recent study was a well designed, randomized, double-blind, placebo controlled, crossover clinical trial to compare the effectiveness of ABH topical gel against a placebo gel. The trial was completed with 20 patients who had an active cancer diagnosis. Nausea in these patients was related to the following: pain, pain medication, bone marrow transplant, or related to their cancer. Results of this trial showed no difference in efficacy between ABH topical gel or the placebo gel for treating nausea or vomiting. The researchers concluded that ABH topical gel should not be used in cancer patients experiencing nausea.
The results of this trial are consistent with earlier research on healthy volunteers who received topical ABH gel and had serial blood samples drawn at various intervals up to 4 hours after application.(2) Blood levels of each of the 3 drugs were evaluated. That small study on 10 volunteers, published in 2012, demonstrated that none of the three medications in the ABH gel formulation were absorbed to any significant degree. The researchers concluded that topical application of this product was ineffective.
The data is conclusive that ABH topical gel is not an efficacious product and cannot be recommended.
(Also see our previous 2011 blog article on ABH Gel.)
1. Fletcher, Coyne, Dodson, et al. A Randomized Trial of the Effectiveness of Topical ABH Gel vs Placebo in Cancer Patients with Nausea. Journal of Pain and Symptom Management. Vol 48;5.
November 2014
2. Smith, Ritter, Poklis, et al. ABH Gel is not Absorbed From the Skin of Normal Volunteers.
Journal of Pain and Symptom Management. Vol 43;5 May 2012
Jennifer Chen, PharmD
A new formulation of Spiriva will be available on the market in January 2015. Both Spiriva Handihaler and Spiriva Respimat contain the same active ingredients – tiotropium. Tiotropium is an anticholinergic bronchodilator indicated for the long-term, once-daily, maintenance treatment for COPD. This new formulation turning the inhalation powder of tiotropium into inhalation spray is called Spiriva Respimat. The dry-powder inhalation, Spiriva HandiHaler, will continue to be available on the market. Spiriva Respimat provides a pre-measured amount of medicine in a slow-moving mist that helps patients inhale the medicine and is intended to deliver medication in a way that does not depend upon how fast the dry powder is breathed in from the inhaler. This new formulation may reduce the errors involving the inadvertent oral administration of Spiriva HandiHaler capsules for inhalation.
The results from clinical trial (TIOSPIR) shows Spiriva Respimat had a safety profile and exacerbation efficacy similar to Spiriva HandiHaler device(1). The most common side effects reported include sore throat, cough, dry mouth and sinus infection. One study assessed the effect of switching from HandiHaler to Respimat in patients with COPD shows similar effects and usability but patients experienced cough for the first 4 weeks of switching before they got used to the new formulation. The other finding was that dry mouth appeared to improve after switching to Respimat. However, this study was done on a small group of COPD patients (about 30 patients) and these patients were followed for 12 weeks after switching(2).
With similar costs and efficacy, the use of Spiriva Respimat may be limited in the hospice setting due to its requirement of active inhalation for effectiveness of drug delivery and training of inhaler technique as most end-stage COPD patients do not have effective positive force to inhale medication contents from the inhalers.
Comparison of Spiriva HandiHaler and Spiriva Respimat and Instructions
1. Wise RA, Anzueto A, Cotton D, et al. Tiotropium Respimat Inhaler and the Risk of Death in COPD. N Engl J Med 2013;369:1491-501.
2. Asakura Y, Nishimura N, Maezawa K, et al. Effect of switching tiotropium HandiHaler to Respimat Soft Mist Inhaler in patients with COPD: the difference of adverse events and usability between inhaler devices. J Aerosol Med Pulm Drug Deliv 2013 Feb;26(1):41-5.
Jim Joyner, PharmD, CGP
Hysingla ER, extended-release hydrocodone, has recently been approved by the FDA on November 20, 2014. This is the second single-entity, extended release hydrocodone medication to be approved in a little over 1 year. Last fall, Zohydro ER was approved and detailed on the Outcome Resources blog in March of 2014. Both of these products are intended for routine management of chronic severe pain.
Hydrocodone analgesics were previously only available in combination with acetaminophen (as Lortab, Norco, or Vicodin) or in combination with ibuprofen (Vicoprofen). These new products represent a significant increase in hydrocodone unit strengths. The older combination products contained hydrocodone in strengths of 5 or 10mg, while the two new extended release products are available in single tablet or capsule strengths as high as 50mg (Zohydro ER capsule) or 120mg (Hysingla ER tablet). The availability of hydrocodone in these new strengths, which are 5 to 10 times greater than the old combination products, have many clinicians very concerned about the potential for serious dosing errors, mis-use, or abuse of these new high-potency opioid products. Both of these products are being touted by the manufacturers as being free from the risk of acetaminophen induced liver toxicity that may occur with high doses of the older combination products. While this is true, the greater risk may actually be associated with the much higher strengths of hydrocodone available in these new products.
Hysingla ER has been formulated to reduce the potential for abuse when the drug is chewed and then taken orally, or crushed and snorted, or injected. The tablet is difficult to crush, break or dissolve. It also forms a viscous hydrogel (thick gel) and cannot be easily prepared for injection. The FDA has determined that the physical and chemical properties of Hysingla ER are expected to make abuse by these routes difficult. However, abuse of Hysingla ER by these routes is still possible. Zohydro ER is not currently available in an abuse deterrent dosage-form, however, the manufacturer has applied to the FDA for approval of a new version of the product that would have similar deterrents built into it. FDA approved Zohydro ER last year amid significant criticism related to the product's lack of abuse deterrent attributes. If approved, the new abuse deterrent version of Zohydro ER would be available in the spring of 2015.
Hysingla ER is designed to release drug over a 24 hour period. It should be taken just once a day (every 24 hours) on a routine schedule. It is not appropriate for "prn" usage for breakthrough pain. Several strengths will be available: 20, 30, 40, 60, 80, 100 and 120mg. Tablets must be swallowed whole.
Zyhydro ER is designed to release drug over a 12 hour period. It should be taken every 12 hours on a routine schedule. Like Hysingla ER, it is not appropriate for "prn" use either. Zohydro ER is available in the following strengths: 10, 15, 20, 30, 40, and 50mg. Capsules must be swallowed whole. Alcohol must be avoided in patients taking Zohydro. Consumption of alcoholic beverages or the use prescription or non-prescription products that contain alcohol while taking Zohydro ER may result in increased plasma levels and a potentially fatal overdose of hydrocodone.
The role of these new long-acting hydrocodone products in hospice patients will be very limited due to factors such as high cost and the availability of other long-acting opioids with established track records of efficacy in severe chronic pain (Methadone tablets and solution, Morphine Extended Release dosage-forms, etc.)
Jim Joyner, PharmD, CGP
Yesterday, (11/24/2014), Aurobindo Pharma issued a voluntary recall of their Gabapentin 300mg capsules due to some of the capsules being empty. Other strengths are not affected. Only product from this manufacturer is affected. This recall is extended to the patient level. Empty capsules could result in missed dose(s) of gabapentin resulting in adverse health consequences that could range from no effect, short term reduction in efficacy, short term withdrawal effect, or status epilepticus that could be life-threatening. Aurobindo Pharma has not received any reports of adverse events related to this recall as of yesterday, but has received four complaints for empty capsules.
The affected Gabapentin lot is GESB14011-A, Expiration 12/2015 and is packaged in 100-count bottles, NDC 16714-662-01. The product can be identified by the imprint D on yellow cap and 03 on yellow body with black edible ink. Product was distributed through Northstar label to retail outlets nationwide.
Outcome Resources is including this information on our blog for the hospice clinicians since Gabapentin is widely used in hospice for a variety of indications and this news may impact your patients. It is advisable to check with your patients who have current orders for Gabapentin and evaluate if they are affected by this recall. If you suspect that one of your patients has the affected product, call the pharmacy which dispensed the prescription and have the prescription label in hand to provide necessary information to the pharmacist. In the event you encounter the recalled product, return it to the pharmacy that dispensed it for a replacement.
Sora Yoon, Pharm.D. Candidate 2015, Western University of Health Sciences
FDA has recently approved a new medication for opioid-induced constipation: Movantik (naloxegol), an opioid antagonist manufactured by AstraZeneca. Used in adults with long-lasting chronic pain that is not caused by cancer. Movantik is dosed once daily on empty stomach 1 hour before first meal of day in the morning or 2 hours after meal. It should not be taken concomitantly with other laxatives.
According to AstraZeneca website, Movantik 25mg was studied in 446 patients lasting 12 weeks. Results showed 44% of patients had ≥3 spontaneous bowel movements (SBMs) per week and a change from baseline of ≥1 SBM per week for at least 9 out of 12 weeks as well as 3 out the last 4 weeks. 61-70% of patients had a SBM within the first 24 hours of first dose. Safety and efficacy were studied in 1146 patients for six to twelve months supporting the safety and tolerability profile of Movantik.
Movantik does carry two specific warnings: gastrointestinal perforation and opioid withdrawal. Gastrointestinal perforation has been reported with use of another peripherally acting opioid antagonist in patients who may have localized or diffused reduction of structural integrity in the wall of their gastrointestinal tract. Hyperhidrosis, chills, diarrhea, abdominal pain, anxiety, irritability, and yawning are consistent with opioid withdrawal symptoms. Combination of three or more of these symptoms are defined as possible opioid withdrawal, but must occur within the same day and not related to gastrointestinal system. Patients who receive methadone for pain control have experienced higher frequency of gastrointestinal adverse reactions related to opioid withdrawal than any other opioids. Also, patients who may have disruptions in the blood-brain barrier (BBB) may be at increased risk for opioid withdrawal or reduced analgesia. The most common adverse reactions reported in ≥3% of patients are abdominal pain, diarrhea, nausea, flatulence, vomiting, and headache. Movantik will be distributed with a medication guide that instructs on its use and information on potential risks.
Currently, on the market is Relistor (methylnaltrexone) with same indication for use and limited ability to cross the BBB. It mainly blocks the µ-opioid receptors in the gastrointestinal tract that causes opioid-induced bowel dysfunction and does not interfere with analgesic effects. It is administered subcutaneously, making it an invasive medication, which may not be appropriate for patients at end-of-life.
Movantik is a schedule II controlled substance due to its structural similarity to noroxymorphone; however, AstraZeneca has filed a petition to US DEA for descheduling, as it has no risk of abuse or dependency. Proposed planned launch of Movantik will be the first half of 2015.
Opioids are the most commonly prescribed class of drugs in the U.S., accounting for over 240 million prescriptions a year. They are increasingly being used to treat chronic pain, both cancer and non-malignant conditions. At end-of-life, long-term pain management with opioids is highly required for palliative care, with that comes opioid-induced constipation. Therefore, it is important to start patients on laxatives when starting opioids. In hospice care, Movantik would be last line of use, due to its cost and specific warnings. With many patients having a decline in debility, this drug may not be warranted for use as it can cross the BBB, which can then affect patients' ability to take medications by mouth and lead to further complications. Once a patient has exhausted other options, can this medication be considered given the patient's current state at that time.
1. Movantik [package insert]. Wilmington, DE: AstraZeneca; 2014. http://www.azpicentral.com/movantik/movantik.pdf#page=1
2. Tack, J. and Corsetti, M. "Naloxegol for the treatment of opioid-induced constipation." Expert Review of Gastroenterology & Hepatology. 2014:1-7.
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The Reebok® youth Black Ice Premier jersey is a hip take on a classic design. The highly detailed, blacked-out version of the NHL® team crest is embroidered on the front and shoulders, and a printed twill player name and number is appliquéd on the back. Two-way stretch mesh and solid mesh inserts provide comfort and ventilation.
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Ladies Suede Motorcycle Jacket
ITEM: 6057 This chic, easy care motorcycle style jacket is loaded with edgy accents like an asymmetrical zipper, lots of zippered pockets and epaulettes. Snap tabs at collar and waist, with adjustable snap cuffs. Warm polysatin lining. Imported. Washing instructions included.Learn MoreRegular Price: $193.75
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Top Definition
1) Intupontmeation: To do that which you do not - and probably NEVER will - understand. 2)Intupontmeate: To make do with what you have - "rig it so that it works well enough." 3) Intupontmeator: One who intupontmeates.
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Open any magazine or newspaper today and you'll likely find a column on fitness and health. Celebrities and fitness experts all claim to have the magic formula for reaching the personal fitness levels we seek.
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The Pursuit of Tappiness
At the time of this writing, there are nearly 70 million tablet users in the U.S. alone, a figure that has doubled from the year before. This means that nearly 30% of the country's Internet users are browsing on a tablet device. Tablet traffic to e-commerce sites grew by 348% from 2011 to 2012, overtaking smartphone traffic for the first time. With the tablet market as young as it is, its footprint is only going to expand.
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Improve Your Site's Tappiness in Six Easy Steps
Just a few subtle adjustments to your CSS can greatly improve legibility and navigation dexterity on a tablet.
1. Increase the size and margin for buttons and calls-to-action. The average width of the index finger for most adults translates to about 45-57 pixels. Why make your visitor work harder to find and tap the "Buy" button?
2. Ensure links and calls-to-action look tap-able without hover states. Hover states do not exist on a tablet. Style your text links to use a clear, contrasting color. And don't be afraid to use underlines for the default link state.
3. Increase font sizes for legibility. Bumping up your font sizes by a couple pixels or partial em's can make a difference. A little goes a long way.
4. Increase padding around navigation menu items. Try increasing padding by 5-10 pixels to start—or more, if your design allows.
5. Increase margins on pages and content blocks. This improvement supports overall legibility and reduces visual complexity. Increased "white space" can result in the impression that your website's content is easier to consume, as compared to a website with crowded content.
6. Increase form field size and spacing. Make it easier for your visitors to tap and enter information into form fields. Improvements to your forms may make the greatest impact to your conversion rate.
As an added bonus, these simple CSS changes will likely benefit your desktop visitors as well. But, as always, be sure to run QA on your changes for all platforms and browsers before committing to them.
Websites with Tappiness
Below are a few websites that exemplify tappiness. Try these out on your tablet as well as your desktop. Notice these sites don't employ separate layouts or versions for tablets. Yet the same site looks good and works well on both platforms.
Fitbit uses a healthy amount of white space coupled with large text and generously-sized touch targets.
Comcast's website offers large text and spacing. You'll also notice clearly indicated links, well-spaced navigation and sub-navigation, and large, easy-to-use form fields.
While Skillshare could bump up the size of their body text a bit more, they do offer large, easy-to-use buttons for navigation and calls-to-action. There is also plenty of space surrounding content blocks.
It's no surprise that Apple's website has tappiness (after all, they did pioneer the design for hand-held touch screens.
Does your site provide tappiness? Check it out on a tablet device and see for yourself. Your website may be losing visitors, conversions, and money by creating an unpleasant experience for tablet users.
The good news: you don't need to spend a lot of time or money to make tiny, incremental changes that will vastly improve your user experience on tablet devices. For many of you, that means money in the bank.
Continue the conversation
Share a website that brings you tappiness! Have a question or comment regarding this topic? Please post a response.
Image of woman tapping tablet courtesy Shutterstock.
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hi~so thanks your article,so nice.can you tell me the first picture from which website? it 's so pretty website, so glad to accept your answer, thanks
Awesome article. Always nice to have simple actionable tips as well as big concepts. Thanks.
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Thanks for your comments, Erik.
Agreed, CSS3 @media queries are a great way to layer on further refinement and control, after utilizing some basic principles from above first. I plan to address additional techniques like this in an upcoming post soon. In the mean-time, for those that want further background on media queries and responsive design in general, I recommend this article: http://uxmag.com/articles/a-primer-on-responsive-design
This is a good start, but I would have liked to see some references as to how to implement the changes dynamically, like via user agent detection or viewport width. Something like the ipad mini (or the retina to be honest) has the effective size of 1024x768, but so can a desktop. So how do you know when to make your buttons/interactions larger for an ipad? Or do you just make them larger when it is at least 1023x767? In that case, user agent detection might be more appropriate, but that isn't always reliable. So both?
You also say that someone might not have the time to make a responsive design - which I totally agree. But setting up stylesheets with lots of @media queries to change the sizing of buttons, form fields, whatever - essentially you're making responsive design minus a maleable grid layout.
Anyways - I am all for more touch affordances on tap devices. I just don't want people going "Great idea! How do I do it?" And maybe the article presumes that a developer will handle all that wizardry, which is probably fine.
Thanks, Warwick!
Great point about avoiding top level links where there is a dropdown menu below it. I would also recommend adding a down-arrow icon to any top menu item that contains a dropdown, for a helpful visual cue.
Great post. I'd also like to add don't link top level menu items if there is a dropdown menu below it.
Websites this works great as you can have a hover menu but on touch devices you never see that menu. Actually I'd just say remove all hover flyouts all together.
Other than that great points!


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Order must total $75 after discounts and not including customization. Excludes team orders, items with extra freight & shipping outside the contiguous US. Not valid on previous purchases. Expedited shipping additional. Expires 7/01/15 at 11:59 PM ET.
Compression-molded shoulder pad liner conforms to the body and flexes with your movements. Increased foam density in hot zones protects areas prone to contact. Reflective King head pattern is highly visible for day and night action.


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Marlins aim to even series behind Koehler
Pirates counter with Morton in rematch from 11 days ago
Tom Koehler and the Marlins have experienced their share of low points this season, but Miami, which owns the third-worst record in the Major Leagues entering Wednesday, has a youthful rotation in place that is working out the kinks.
"It's a real good group of guys, a talented group," Koehler said. "I think everybody kind of wants to go out there and one-up each other. We talk a lot, we bounce things off each other. We're all learning together. We're pretty new at this."
Koehler brings a 3-6 record and 4.52 ERA into Wednesday's middle game of the three-game series against the Pirates in 13 starts this season, but he is coming off one of the best starts of his young career. On Aug. 1 he beat Matt Harvey and the Mets with six scoreless innings -- his only scoreless outing in 14 career starts.
He started the year in the bullpen and has had mixed results since joining the Marlins' rotation on May 12. One of Koehler's low points came against Charlie Morton and the Pirates on July 27. Koehler threw five innings and allowed five runs on nine hits in a loss, getting outdueled by Pittsburgh's 29-year-old right-hander. The Marlins took two of three games in the series.
Morton will again oppose Koehler, 11 days after beating him without his best stuff. Morton lasted five innings, allowing nine hits and four (three earned) runs. He struck out six and walked none.
Morton took the loss in a rough outing against the Cardinals on Aug. 1, though, getting roughed up for five earned runs on 10 hits in six innings. He brings a 4-4 record and 4.07 ERA into Wednesday in nine starts this season.
Marlins: Koehler experiencing ups and downs of first full season
Koehler lost five of his first seven starts this season and may have thought his first big league win would never come.
But since his rough start, the 27-year-old right-hander has posted a 3-1 record and 3.18 ERA in six starts entering Wednesday.
"It's about being consistent," Koehler said. "Getting ahead of hitters. Any time you fall behind, it doesn't matter who you're facing, it's going to be a struggle. You've got to go out there, and be aggressive, right from the start."
• Justin Ruggiano lifted a routine pinch-hit flyout to center field in the eighth inning on Tuesday. Ruggiano is now 0-for-34, setting a Marlins record for longest streak without a hit by a position player. Mike Jacobs was 0-for-33 in 2007.
Pirates: Melancon getting job done with less emotion
The Pirates lost closer Jason Grilli to a strained forearm tendon on July 22 and Mark Melancon has filled in nicely, although fans may not see much of a resemblance.
Melancon is much more subdued than Grilli, but the 28-year-old right-hander is 4-for-4 in save opportunities with no runs allowed in six innings since stepping into the closer's role.
"I don't know if personality matters. It's all about getting three outs," said Melancon. "I'm not trying to show anybody up, or make myself look bigger than the team. I'm one to just bulldog, and go after it."
• With Tuesday's walk-off 4-3 win in the opener, the Pirates are 11-2 this season after an off-day.
• The three-game series against Miami will conclude the Pirates' schedule against National League East teams. They hold a 18-14 record against the division entering Wednesday's action.
Worth noting
• Since June 16, Marlins starters have given up three or fewer runs in 39 of 44 games, including nine straight.
• Since May 31, the Marlins have a 10-7-1 record in 18 series.
Kevin Massoth is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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Shopper at Hooksett Market Basket: 'It's gone on too long'
The governors of Massachusetts and New Hampshire late Friday released a joint statement about a pending resolution to the Market Basket stalemate.
"In briefings today, all parties report that they are optimistic that an agreement will be reached to sell the company to Arthur T. Demoulas and to restore him to operating authority on an interim basis until the sale closes. Subject to reducing their agreement in principle to writing by Sunday, the Board will forestall taking adverse employment action against the employees who have abandoned their jobs. We are hopeful that employees will return to work, and the stores will reopen, early next week," according to Gov. Maggie Hassan and Mass. Gov. Deval Patrick.
"If a person comes through with a smaller order, it might be 10 or 15 minutes before we see a person (again)," Curren said.
"Seven employees have gotten jobs between Hannaford, Shaw's and an Irving gas station, and all are coming back," O'Brien said.
For the past few weeks, all 297 part-time workers at the Hooksett store got no scheduled work hours after store directors were ordered to better match payroll with their withering cash register receipts.
On Friday, people couldn't order a freshly made pizza, but they could buy a frozen one. They wouldn't find a pork chops or chicken leg but could buy ham and kielbesa.
"I really didn't want to come in," said one woman, who didn't want to give her name. "I don't want to feed the greed, but she does."
"It's gone on too long," said the second woman, who also would not give her name.
Curren, manning the register in the absence of part-timers Friday, normally is in charge of ordering and stocking items in Aisle 5, including juices and canned vegetables. He said he won't remain working at Market Basket if a conglomerate buys the chain.


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The Dublin Central Hostel
The Dublin Central Hostel is the perfect place to relax after exploring the city. We offer a TV/DVD room a lounge area, smoking yard and a newly set up garden in the back. We offer free semi continental breakfast as well as free WIFI. Al our rooms have wooden floors, a nice big window and the bathroom en suite. Our hostel is a clean and quiet place. Our young reception crew will help you in any way in making your stay as comfortable as possible. A warm welcome is guaranteed. We are also able to book all your day tours and tickets, browse to our information board and we will help you to find a suitable excursion for you. We believe in an old Irish saying: "A stranger is just a friend, you have not met yet." Book now and be our guest. |
Availability & Rates
To view availability and prices please select dates and click 'Update Dates'Hostel Facilities & Policies
- Adaptors
- Bicycle parking
- Board Games
- Book exchange
- Breakfast Included
- Cable TV
- Child Friendly
- Common Room
- DVDs
- Free City Maps
- Free Internet Access
- Free Wifi
- Fussball
- Games Room
- Hair Dryers
- Hair Dryers For Hire
- Hot Showers
- House Keeping
- Kitchen
- Laundry Facilities
- Linen Included
- Lockers
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- No Curfew
- Non Smoking
- Outdoor Terrace
- Tea/Coffee Making Facilities
- Tours/Travel Desk
- Towels Included
- Washing Machine
Cancellation Policy
This property has a 2 day cancellation policy. Failure to cancel within this time will result in a cancellation charge equal to the first night of your stay.Must-Read Hostel Info
This property has specific Terms & Conditions.***PLEASE NOTE***
Maximum night stay of 7 nights. Guests booking longer than 7 days will cancelled.
Minimum age for the 8 bed dorms is 18 years and maximum age 35 years.
Reception is open from 7 am until 12 am.
DirectionsShow MapHide Map
The bus line 16 will bring you from the airport to the hostel and back. Tell the bus driver you have to get our at the corner of Dorset Street and Blessington Street and you will be at the hostel with in two minutes.
A taxi from the airport will cost you between 20 and 25 euro.
The \\\\\\\"air coach\\\\\\\" and the \\\\\\\"air link\\\\\\\" (express susses) will drop you off on O\'Connnell Street which is just 5 minutes away from the hostel/
Located Near
The hostel is located in the heart of Dublin, all major tourist attractions are in walking distance. We are only 5 minutes away from O'Connell Street, the Spire and the GPO. Grocery stores and an ATM machine are just across the road as well as a deli shop with delicious coffee, scones and freshly made sandwiches.
The bus line 16 will bring you from the airport to the hostel.
A taxi from the airport will cost you between 20 and 25 euro.


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On April 2, Toby Qualls, a sophomore at Mammoth High School, traveled to Lancaster, Calif., to run in the very competitive, Michele Perry Invitational. Many California high schools travel to this invitational, because of the high level of competition.
Qualls began competition in the varsity 1600 meter event. Because of his previous fast times in the 1600, he was then bumped up automatically into the elite championship race.
On Friday, April 15, Mammoth Lakes Police Officers and Paramedics responded to a radio call in the Old Mammoth area and discovered a deceased 21-year-old woman. Evidence at the scene indicated that she had died of a heroin overdose. Agents from the Mono Narcotics Enforcement Team (MONET) followed up and identified the dealer who supplied the heroin to the victim.
Winds of nearly 100 miles an hour slammed into Mammoth Mountain early Monday morning, while rain and snow in the Sierra put water watchers on alert.
The winds, which preceded Monday morningŌĆÖs rain and snow, reached 99.8 miles an hour at 4 a.m., according to ski patrol data.
It didnŌĆÖt let up for more than an hour. At 5 a.m., ski patrol measured a wind gust at 99.6 miles an hour.
The average wind speed for the two hours was 70.3 miles an hour.
Ryan Hall, one of MammothŌĆÖs great distance runners, on Monday set a new American record for the Boston Marathon.
Hall, formerly a member of the Mammoth Track Club but who still trains here, ran the 26 miles in 2:04:55.
It is not a formally recognized record because the Boston Marathon is a kind of an odd duck in marathon circles, not quite conforming to world or national standards.
He led for much of the race before being overtaken near the end.
More to come as details roll in.
Mammoth is good at fund-raising. WeŌĆÖve got a million of ŌĆśem, it seems.
But at the top of the heap right now is the Mammoth Invitational, a race-filled weekend featuring pro skiers and boarders that went off last weekend on behalf of the Mammoth Community Foundation.
Foundation executive director John Armstrong said the event on Mammoth Mountain raised nearly $500,000 on behalf of the townŌĆÖs kids.
The foundation is committed to raising funds to provide an added margin of excellence for academic and athletic programs for youth in our community.
Finally, the call that Mammoth High Shool had been waiting for came.
Word arrived late Tuesday afternoon that the school has been awarded the prestigious California Distinguished School award, one of 97 schools in the state to get the coveted award this year.
A product of rising test scores across all the students in the school ŌĆō whether English Language Learners, English speakers, Caucasian or Hispanic, the award is a testament to several hard years of work by students, parents and staff alike, said school superintendent Rich Boccia.
ItŌĆÖs probably inevitable.
Garbage disposal rates are going to go up sometime soon and some hours or days are going to get cut at most of the countyŌĆÖs landfills, in an attempt to plug a funding hole that is leaking as much as $2,000-$3,000 a day from the countyŌĆÖs coffers.
The proposed increase, which goes to the public for a hearing on April 19, will increase residentsŌĆÖ garbage disposal fees by about 11 percent, if the plan laid out by county staff and approved in theory by the county supervisors passes a final vote on April 19 at a meeting in Mammoth Lakes.
ŌĆśOne manŌĆÖs loss is another manŌĆÖs gain.ŌĆÖ
That might be the most appropriate sentiment regarding losing Mono County Administrative Officer Dave Wilbrecht to the Town of Mammoth Lakes as its newest Town manager.
After eight years at the helm of Mono County, Wilbrecht leaves behind a county in enviable shape compared to almost every other county in the state: in the black, solvent, with a small but still present reserve for emergencies and economic hard times.
It was a love fest.
When The Town Council named Dave Wilbrecht as the new Town Manager this week, Mammoth residents universally approved the decision.
From Tom Cage, of Kittredge Sports and P3 and Nordic advocate Brian Knox, to recreation commissioner Bill Sauser, former town planner Bill Taylor and former National Forest Service administrator Sandy Hogan, all were crazy nuts about the decision.
ŌĆ£HeŌĆÖs a natural leader,ŌĆØ Hogan said, echoing county tourism director Alicia Vennos. ŌĆ£The town is very, very lucky. HeŌĆÖs an incredible leader,ŌĆØ Vennos said.
Skip Harvey has a cwazy idea.
Except this time, it might not be so cwazy to turn the south frontage road on Main Street into a combination pedestrian mall and small festival place.
Harvey, the owner of the Base Camp Caf├®, which would benefit from such a makeover, also is mayor of the town.
The makeover, called ŌĆ£an experiment,ŌĆØ would hit the road, so to speak, in Mid-June and last until the end of September.
MAMMOTH ER ROCKS Recently, I needed immediate medical attention. My visit to Mammoth HospitalŌĆÖs emergency room, created by an abscessed tooth infection, and a touch of pneumonia, was mandatory.
After careful scrutiny, some retracted comments from myself, and an accurate diagnosis, I came to a conclusion.
The staff at MammothŌĆÖs facility won my gratitude, and my heart. To see the emergency roomŌĆÖs pageant of ŌĆ£needy,ŌĆØ busted up folks I love, helped, in an organized fashion, rendered me quite appreciative. You employees ŌĆ£rock!ŌĆØ Michael K. Mahoney Mammoth Lakes
Is there ever such a thing as too much ice cream? Pita Vasquez, a Cerro Coso College student, took full advantage of the Ben and JerryŌĆÖs free cone day, eating 13 cones in an afternoon. ŌĆ£I never want to eat ice cream again. I had seriously all of them,ŌĆØ she said. Her friend, Bailey Morley, a Mammoth High School senior, had even more ŌĆö 17 ŌĆö and was of the same mind. ŌĆ£I feel so bad,ŌĆØ she said late Wednesday night. ...
Some Crowley Lake residents would rather remain in their cell phone dead zone than put up with two towers smack dab in the middle of their neighborhood. Mono County Planning commissioners supported them when they denied a permit to build the towers on Crowley Lake Drive, concluding a meeting last night (Thursday, April 14) at the Crowley Lake Community Center. Area residents who spoke at the meeting sided 14 to 9 against the permit, as they addressed a standing-room-only crowd of more than 60 concerned residents.
Dr. Rick Johnson, Mono County Public Health Officer, has today (April 13, 2011) submitted the following statement on the cell tower issue in Crowley Lake. He emphasizes it is separate from the Planning/approval process of any individual tower or base station, and simply expresses his opinion as the Health Officer in response to requests for information regarding RF emissions:
"It ShouldnŌĆÖt Be About The Tower!
It's been a long wait for Mammoth High School, but late this afternoon, the school finally found out that it is now a California Distinguished School, one of only 97 other schools to get the award this year.
The award is a reflection of several years of higher test scores and other academic accomplishments for the high school, much of it accomplished under the leadership of former Mammoth High principal Mike Agnitch. The MT will update this story as soon as possible.
In the meantime, here's the state's announcement:


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Your account has expired. Please contact a Swapalease Customer Service Representative at 1-866-792-2442 to reactivate your account.
We help you GET OUT OF A LEASE by finding someone who wants to TAKE OVER your lease through a lease transfer.
Actually swapping leases is not necessary! You can get out of a lease or get into a lease.
Websites like Swaplease.com have helped facilitate such transactions. You pay to dump a lease, but the price can be thousands less than you would owe if you turned the lease in early to a dealer. Meanwhile, buyers can pick up some sweet rides for hundreds less than their normal cost, with short-term contracts and no down payment.
Consumers aren't limited to what's being offered on the auto lots. They can buy a car, or take over someone else's lease on Web sites like Swapalease.com, a popular site that act as matchmakers between buyers and sellers.
Terminating a Car Lease The problem: Getting out of a cal lease early The Solution: Find someone to take over your lease through service such as Swapalease.com. The site charges a fee to post a listing, and say finding someone is easiest for leases with 24 months or less left.


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The Hotlist is an outgrowth of CBR's comprehensive Comics Twitter Directory presenting the most popular talent, publishers and retailers based on follower count. Every Monday, CBR will reset these lists, which are populated by data collected over the last seven days.
See any problems? Known someone who should be included on this list that's not? Send us an e-mail and we'll add it to the list! And don't forget to follow CBR on twitter at twitter.com/cbr!


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Welcome to the COMSOL Image Gallery. The simulation images on this page are available for
editors and journalists to use in appropriate articles. The phrase "Image made using COMSOL
Multiphysics® and provided courtesy of COMSOL®." must appear in the vicinity of every image
or at the bottom of the article.
For all other uses you must contact COMSOL directly through www.comsol.com/contact/
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COMSOL Multiphysics 3.5a
Propane Concentration in a Steam ReformerThis example illustrates how the COMSOL Chemical Engineering Module 3.5a can be used for modeling a steam reformer that serves a fuel cell unit hydrogen. Solving strongly coupled mass, energy, and momentum balances results in this image, which shows the propane concentration as a slice plot and the temperature distribution as a boundary plot. The arrows represent the velocity field vector.
Free Convection in a Light BulbThis image, created with COMSOL Heat Transfer Module 3.5a, shows a color plot of the temperature distribution in a light bulb. The simulation includes heat transport through conduction, radiation, convection, and non-isothermal flow.
Transient Analysis of a Valve CapRepetitive opening and closing of a valve cap can affect its structural integrity. This model shows a transient contact analysis in COMSOL Structural Mechanics Module 3.5a of a valve cap made of an elasto-plastic material as it is closing.
Transient Analysis of a Viscoelastic Structural DamperIn regions prone to such natural events as earthquakes or high winds, tall buildings are often built with damping elements to help mitigate the possibility of collapse. Here, the COMSOL Structural Mechanics Module 3.5a has been used to perform a structural analysis of such a damper made from a viscoelastic material. The boundary color plot is displacement in the z-direction, and the deformed shape plot illustrates damper displacement.
Fully-coupled Physics: Joule Heating, CFD and Chemical ReactionsA fluid carrying several chemical components flows through past a wire that is heated through Joule heating in order to detect changes in density through its subsequent cooling through convection. However, the wire's temperature ignites exothermic chemical reactions, which increases the temperature even more. The image shows the temperature distribution in the detector compartment while the arrow plot indicates the flow.
Fluid-Structure Interaction in Aluminum ExtrusionIn the rolling or extrusion of metal alloys, deformation in the hot state occurs through material flowing under ideally plastic conditions. Such processes can be simulated effectively using computational fluid dynamics, where the material is considered as a fluid with a very high viscosity that depends on velocity and temperature. This adapted, benchmark model simulates such, where the picture shows isosurface and boundary color plots of the temperature distribution. Internal friction of the moving material acts as a heat source, and the heat transfer equations are fully coupled to the non-Newtonian flow. In addition, the model also calculates the stresses in the die due to the thermal and fluid pressure loads.
Planar Transformer on a PCBVersion 3.5a of the COMSOL AC/DC Module, RF Module, and MEMS Module now have a new ECAD interface that lets you import printed-circuit board geometry from an ODB++(X) file and then create a full 3D model automatically.
The Schumann Resonance FrequenciesSchumann resonance frequencies are a set of eigenmodes in the extremely low frequency (ELF) range of the electromagnetic field spectrum. They are only present in planetary-like bodies with a substantial ionosphere acting as a perfect electric conductor. Here, COMSOL RF Module 3.5a calculates the Schumann resonance frequencies for the Earth and displays the norm of the electric field as a boundary color plot..
Loudspeaker in a Vented EnclosureUsing COMSOL Acoustics Module 3.5a, you can simulate how a loudspeaker's enclosure and placement affect sound in a room. This model simulates the application of a nominal driving voltage to extract sound pressure level as a function of the frequency. The isosurface plot shows the sound pressure level, while the boundary color plot is the pressure.
Contact Analysis of a Cellular Phone using the bidirectional interface with Autodesk® Inventor®The bidirectional interface with Autodesk Inventor and COMSOL allows you to quickly examine the effects of changes to the geometry. The picture shows a collage, where the bidirectional interface is used in the simulation of the stresses in a cellular phone.
Magnetic Prospecting of Iron Ore DepositsPassive magnetic prospecting relies on accurate mapping of local deviations from the natural magnetostatic fields. Version 3.5a of the COMSOL AC/DC Module was able to use topographic data from the U.S. Geological Survey for this simulation of magnetic iron ore prospecting. The color surface plot visualizes the depth of the iron ore in relation to the crustal surface, while the streamlines indicate the magnetic flux. Data available from U.S. Geological Survey, EROS Data Center, Sioux Falls, SD.
Convection Cooling in an AmplifierA fan located at one of the sides of an amplifier forces cooling air through its internal electronics. The picture shows a boundary color plot of the temperature distribution, and an arrow plot that indicates the direction of the flow. Evident from these results is the extent of poor cooling of the components towards the back of the amplifier.
Polymerization in a Multijet Tubular ReactorThis image of a multijet tubular reactor, created with version 3.5a of the COMSOL Chemical Engineering Module and the Reaction Engineering Lab, shows the concentration of polymer being produced in the reactor. The arrows indicate the direction of the flow and the extent of mixing that occurs in the beginning of the reactor. The simulation also includes turbulent flows and rapid reaction kinetics, which are common in the production of polymers. In a multijet tubular reactor system, the complex interplay between fluid dynamics and fast chemical reactions can impact reactor performance significantly.
Thermal Expansion in an RF SolenoidThis model developed with the COMSOL RF Module 3.5a shows electromagnetic waves heating a solenoid, causing the material to expand. The shape plot of the coil illustrates the solenoid's deformation, while the boundary color plot reveals the temperature distribution. The streamlines indicate the direction of the magnetic flux density.
Freeze DryingFreeze drying, commonly used for preserving food-stuffs and pharmaceuticals, can also be used in bioseparations to remove solvents. This COMSOL Chemical Engineering Module 3.5a model simulates the process of freeze drying to solve for diffusion and heat transfer while also tracking the interface between phases. The arrows indicate the heat flux, and the color plots show temperature.
Structural Analysis of a Solar Panel in a High WindAt times, solar panels can be subjected to wind loads of great magnitude. This example demonstrates how version 3.5a of the COMSOL Structural Mechanics and Chemical Engineering Modules can pair up to perform a coupled fluid and structural analysis of a solar panel in an open field. The results seen here show the turbulent fluid flow around the structure and the panel regions with the greatest stresses.
Thermal Analysis of a Disk-Stack Heat SinkCOMSOL 3.5a heat and flow simulations are up to 8 times faster than its predecessor. This COMSOL Heat Transfer Module image shows a simulation of a PC board where a disk stack heat sink prevents overheating of a power IC. The temperature distribution color plot on both the board and heat sink illustrate the effectiveness of the cooling fins.