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Author Affiliations: Department of Medicine (Drs Dhruva and Redberg); Department of Clinical Pharmacy, School of Pharmacy (Dr Bero); Institute for Health Policy Studies, School of Medicine (Dr Bero); and Division of Cardiology (Dr Redberg), University of California, San Francisco.
Context Medical devices are common in clinical practice and have important effects on morbidity and mortality, yet there has not been a systematic examination of evidence used by the US Food and Drug Administration (FDA) for device approval.
Objectives To study premarket approval (PMA)—the most stringent FDA review process—of cardiovascular devices and to characterize the type and strength of evidence on which it is based.
Data Sources and Study Selection Systematic review of 123 summaries of safety and effectiveness data for 78 PMAs for high-risk cardiovascular devices that received PMA between January 2000 and December 2007.
Data Extraction Examination of the methodological characteristics considered essential to minimize confounding and bias, as well as the primary end points of the 123 studies supporting the PMAs.
Results Thirty-three of 123 studies (27%) used to support recent FDA approval of cardiovascular devices were randomized and 17 of 123 (14%) were blinded. Fifty-one of 78 PMAs (65%) were based on a single study. One hundred eleven of 213 primary end points (52%) were compared with controls and 34 of 111 controls (31%) were retrospective. One hundred eighty-seven of 213 primary end points (88%) were surrogate measures and 122 of 157 (78%) had a discrepancy between the number of patients enrolled in the study and the number analyzed.
Conclusion Premarket approval of cardiovascular devices by the FDA is often based on studies that lack adequate strength and may be prone to bias.
Cardiovascular devices are increasing in number, use, complexity, and cost.1,2 In 2008, at least 350 000 pacemakers, 140 000 implantable cardioverter-defibrillators, and 1 230 000 stents were implanted2 (Mike Weinstein, BS, J.P. Morgan Securities; written communication). Although there has been recent scrutiny of evidence used in the US Food and Drug Administration (FDA) drug approval process,3 less attention has been paid to the approval process for medical devices. Medical devices are less likely than drugs to have demonstrated clinical safety before they are marketed,4 and evidence shows that "review performance has begun to decline."5
Devices are stratified by increasing risk for patients, as class I, II, and III, with stringency of the approval process corresponding to device risk.6 Class III devices, the highest risk, are defined as "usually those that support or sustain human life, are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury."7 The scientific and regulatory review process "to evaluate the safety and effectiveness of class III medical devices" is the premarket approval (PMA), "the most stringent type of device marketing application required by FDA."8 The PMAs are required for "novel or high risk" devices.9 Class III devices account for 50 to 80 of the 8000 new medical devices marketed each year.4
As clinical use and insurance coverage often quickly follow FDA approval of a device,10 and as medical devices are increasingly being marketed directly to consumers after FDA approval,11,12 it is important to understand thoroughly the study data on which such approval is based. Further, the US Supreme Court's February 2008 decision in Riegel v Medtronic means that FDA approval of a device preempts consumers from suing because of problems with the safety or effectiveness of the device, making this approval a vital consumer protection safeguard.13 Given these issues, it is essential that the study evidence on which device approval is based is of high quality. Ideally, this evidence should consist of randomized, double-blind studies with adequate controls, sufficient duration, and thorough follow-up on prespecified primary end points without bias.14
After a device receives PMA, the FDA makes publicly available its approval order, labeling guidelines, and a summary of safety and effectiveness data (SSED). The SSED "is intended to present a reasoned, objective, and balanced critique of the scientific evidence which served as the basis of the decision to approve or deny the PMA."15 To our knowledge, this study evidence has not been systematically examined. Therefore, the type and quality of study evidence for devices were analyzed, focusing on cardiovascular devices, because it was expected they would undergo the most stringent approval process given their far-reaching impact on morbidity and mortality and their increasing use.
On October 15, 2008, a search of the PMA database was performed16 using the parameters of Advisory Committee: Cardiovascular and Supplement Type: Originals Only. All PMAs with a date received between January 1, 2000, and December 31, 2007, were included and their SSEDs were downloaded (Figure). Data were abstracted from each SSED's "Summary of Clinical Studies" section and from the adverse events section if it described clinical study information presented in the "Summary of Clinical Studies." We recorded each PMA's number, the device's trade name as it appears in the SSED, the applicant's name as it appears in the SSED, the applicant's name as it appears on the FDA Web site with a link to the SSED, the date the PMA was received by the FDA, and the FDA's decision date. Except when coding surrogate measures, 1 author (S.S.D.) classified all data, which were verified by at least 1 other author (L.A.B. or R.F.R. or both).
PMAs indicates premarket approvals; SSEDs, summaries of safety and effectiveness data.
All 127 studies listed under the "Summary of Clinical Studies" sections in the SSEDs were included in the analysis. Pooled studies whose data were not presented separately were counted as 1 study, which occurred 4 times and encompassed 8 studies (in P010041, P020040, P000007, and P030047). Therefore, we coded 123 studies. We coded fields of data pertaining to essential characteristics of studies aimed to reduce bias and confounding and several characteristics of primary end points (Box).
Coding for Each Study
Demographic data. Coded as "stated" for each mean age and standard deviation, percentage of male participants, and racial breakdown of participants with the number of patients who represented these data or as "not stated." If stated, data were recorded in the form presented. If a study reported demographic data but not the number of participants for which these data were available, the data were recorded as not stated. In studies with retrospective controls where demographic data were provided on retrospective patients, they were included along with those of enrolled participants. In 1 instance where 2 studies shared the same control group, its demographics were included only once. In 1 case when median instead of mean age was reported, median was substituted.
Number of enrolled patients. Coded as "stated" or "not stated." If stated, the number of enrolled patients was recorded. Lead-in, roll-in, or training cases were added to the number enrolled if their number was provided and they had been excluded for analysis.
Randomization. Coded as "yes" if all patients were randomized or "no" if not randomized or if not stated that a study was randomized. If randomization occurred at any time other than enrollment, such as after a period of nonrandomized training/lead-in/roll-in cases, coded as no.
Blinding. Coded as "yes" if double-blind or single-blind stated or "no" if not blinded or not stated that a study had blinding. The specific type of blinding (single or double) also was recorded.
Single-center or multicenter. Coded as "stated" or "not stated" if study was single-center or multicenter. If stated multicenter, the total number of sites was recorded if it was reported.
US study location. Coded as having "all," "some," or "none" of their sites in the United States or "not stated." Studies stating "North American" sites without further localization were coded as not stated.
Coding for Each Primary End Point
Identification. Each primary end point, objective, or outcome (hereafter all are referred to as "end point" for simplicity) was identified. When a study did not explicitly state a primary end point, if there were up to 3 analyzed end points, all 3 were designated as primary end points. If there was no discernable primary end point or more than 3 end points analyzed without any being designated as primary, this was recorded as having no primary end point.
Controls. Coded as "having any (active or retrospective) controls" or "not having controls."
Retrospective controls. Coded as "having retrospective controls" or "not having retrospective controls." All studies in which the premarket approval compared a primary end point with "historical controls" were coded as having retrospective controls.
Composite. Coded as "composite, more than 1 component" or "not composite, only 1 component." Composites were further examined to determine if results for each component were provided. This was coded as "all," "some," or "none" of component results listed separately. End points measuring the total adverse events or complications were considered composites.
Surrogate. Coded as "surrogate" or "not surrogate" using the following definition: "a surrogate end point of a clinical trial is a laboratory measurement or a physical sign used as a substitute for a clinically meaningful end point that measures directly how a patient feels, functions, or survives. Changes induced by a therapy on a surrogate end point are expected to reflect changes in a clinically meaningful end point."1,20 If a composite end point included a surrogate, it was classified as a surrogate end point. This field was coded by 2 authors, and disagreements were resolved by consensus in consultation with the third author.
Training/lead-in/roll-in patients excluded from analysis. Coded as "having lead-in, roll-in, or training cases" if their data were excluded from analysis of the primary end point or "not having such patients."
Number analyzed. Coded as "stated" the number of patients analyzed for each primary end point or "not stated." If stated, the number analyzed was recorded and compared with the number enrolled. In studies that reported primary end points as intent-to-treat and in other ways, we recorded the number of intent-to-treat patients. When data for retrospective controls were included in a primary end point analysis, these patients were added to the number analyzed.
Post hoc analysis. Coded as "post hoc analysis" if primary end points or study design were redefined at any point after study initiation, if new patients were added into the study after completion of initial enrollment, if prespecified controls were changed, if the initially designated statistical analysis of a primary end point was changed after study initiation, if the primary end point goal was not met but some post hoc data review justified device approval, or if the Food and Drug Administration deemed the study characteristics no longer applicable at the time of review and approved the device on qualitative merits—or coded as "no post hoc analysis."
Interpretable. Coded as "interpretable" or "not interpretable." If not interpretable, the reason for this was coded into 4 categories: no target goal, no statistical analysis, insufficient data, or no results.
Follow-up time. The length of time at which a primary end point analysis was performed was recorded. For primary end points analyzed for time to hemostasis, time to implantation, implant success, procedure success, hospital stay, or at the end of an intervention, "<24 hours" was recorded. When a range of times for follow-up was stated instead of a preplanned time, we recorded the longest follow-up duration. When the longest period was not mentioned, the cumulative follow-up time was divided by the number of patients analyzed for the primary end point to determine an average time of follow-up.
Studies With No Primary End Point
For studies in which no primary end point could be discerned, we coded as "not applicable" in the following fields: number of patients analyzed for primary end point, composite primary end point, surrogate primary end point, follow-up (time) at primary end point analysis, primary end point result interpretable, and post hoc end point analysis.
For each category, data were tabulated across PMAs, studies, and primary end points. These summary data are presented as numbers (PMAs, studies, or primary end points); percentages of the whole category to which they refer; and mean, standard deviation, and range when applicable. In calculating the mean, standard deviation, and minimum number of end points, we excluded studies with no primary end points. In calculating the number of PMAs not reporting 1 or more US centers, we included studies that did not state their location. Median follow-up times were calculated based on subcategories of cardiovascular devices.
Eighty-one cardiovascular PMAs were approved between January 1, 2000, and December 31, 2007. Two SSEDs (P040016, P020035) were not available on the FDA Web site. Two PMAs had identical SSEDs (P030039 and P010022) and those data were included only once. The remaining 78 PMAs included in our analysis included 123 studies (eTable). With the exception of closure devices, all devices were either implanted or invasive during their use.
The mean (SD) number of studies stated in SSEDs supporting each PMA was 1.6 (0.9) (range, 1-5 studies). Of the 78 PMAs, 51 (65%) were supported by a single study. For the 123 studies, only 98 SSEDs (80%) reported the number of participants enrolled (mean [SD], 308 [284] participants) (Table 1). Both the number enrolled and number of sites were provided for 80 studies (65%). The median number of patients enrolled per site was 13 (interquartile range, 8-21 patients).
Of 123 studies cataloged in SSEDs, mean age was stated in 87 (71%), enrollment by sex in 89 (72%), and enrollment by race in 11 (9%) (Table 1). The mean (SD) age was 62.7 (11.4) years, 66.9% of study participants were male, 87% white, 6% African American or black, 5% Hispanic or Latino, and 3% another race or ethnicity.
Of 123 studies in SSEDs, 33 (27%) were randomized and 17 (14%) were blinded (Table 1). Some device groups had a higher proportion of randomized and blinded studies. For example, of the 24 studies for cardiac stents, 13 (54%) were randomized and 11 (46%) were blinded. One hundred ten studies were multicenter, although 20 (18%) did not specify the number of sites. Of studies stating the number of sites, the mean (SD) was 23 (17) sites (range, 1-80 sites).
Follow-up time varied by type of device; the longest median follow-up time for primary end point analysis was for intracardiac devices and endovascular grafts, both at 365 days, and the shortest was for hemostasis devices at 1 day (Table 1).
For SSEDs stating the number of patients enrolled and the number analyzed for each study, there was a discrepancy for mean age in 37 of 74 studies (50%), for number by sex in 37 of 78 studies (47%), and for number by race in 5 of 11 studies (45%).
Of 123 studies, 17 (14%) did not state a primary end point. There were a total of 213 primary end points and a mean (SD) of 2.0 (1.5) end points per study (range, 1-10 end points per study). Thirty of these end points (14%) were designated, all in cases where there was no explicitly stated primary end point for a study.
Of the 213 primary end points, 111 (52%) were compared with controls and of these, 34 (31%) were retrospective controls. Studies without controls were compared with objective performance criteria, which specified safety and/or efficacy targets for the device. One hundred nineteen primary end points (56%) were composites (Table 2).
Of 213 primary end points, most (187, or 88%) were surrogate end points. Examples of surrogate end points include target lesion revascularization for a coronary stent, primary patency for an endoprosthesis, and lead implant success for an electrophysiology device.
In the SSEDs, there were 157 primary end points for which both the number enrolled and analyzed were stated. Of these, 122 (78%) had a discrepancy between the number enrolled and those analyzed. One hundred thirteen discrepancies (93%) were that more patients were enrolled than analyzed; for these primary end points, a median of 50 patients was enrolled but not analyzed (range, 1-604 patients). These 113 primary end point discrepancies totaled 10 351 patient exclusions, 27% of the total enrolled. In 9 of 122 primary end points (7%), there was a greater number analyzed than enrolled. All of these were due to retrospective controls, meaning that patients from a previous study were included in the PMA analysis, leading to more patients being analyzed than enrolled. For these, the median discrepancy was 238 excess analyzed patients (range, 50-848 patients).
Of 213 primary end points in the SSEDs, the results of 32 (15%) were noninterpretable (Table 2). The most common reason was that no target goal for device performance was stated in 25 end points (78%), and in one instance the results were not stated. Forty primary end points (19%) had training, lead-in, or roll-in patients excluded from analyses and 21 (10%) had a post hoc analysis of the primary end point (Table 2).
In some instances, end points were interpreted to meet their targets when they may have met only a part of them. In 1 PMA, for example, 107 of 226 patients (47.3%) had chronic success in the effectiveness analysis cohort (defined as "no recurrence of clinically relevant monomorphic ventricular tachycardia that were targeted at ablation"17), with a 95% lower confidence bound of 41.7%. The target end point on that same table in the SSED,17 however, is shown to be 50% chronic success with a 95% lower confidence bound of 40%. The SSED explains this discrepancy as follows: "The results demonstrate that the percentage of subjects achieving chronic success (47.3%, 95% lower confidence bound of 41.7%) met the protocol end point for chronic success. This is due to the fact that although the point estimate for chronic success was lower than the protocol end point, the 95% lower confidence bound of the estimate was higher than the protocol end point."17
Of 78 PMAs, 24 (31%) had at least 1 randomized study and 10 (13%) at least 1 blinded study (Table 3). Four PMAs (5%) were supported by at least 2 blinded randomized studies. More than one-third, 28 PMAs, did not report a study with at least 1 US center (Table 3). Seven PMAs had no primary end point for any study. Of the 71 PMAs with at least 1 primary end point, 16 (23%) used at least 1 retrospective control group and 16 (23%) based device approval at least in part on a post hoc analysis.
For example, 1 device was approved wholly on a post hoc analysis for a single subgroup studied in the single preapproval study discussed in the SSED. However, because this subgroup did not meet the prespecified target performance standard, the SSED stated the following: "CDRH [Center for Devices and Radiological Health] determined that the OPCs [objective performance criteria] designated for the overall study population should not be used to evaluate the safety and effectiveness of the device in the AVNRT [Atrioventricular Nodal Reentry Tachycardia] subgroup. As a result, the device system for the proposed indication was evaluated on its merits, as CDRH qualitatively considered the device risk-benefit profile."18
The evidence presented in the SSEDs for FDA-approved cardiovascular device PMAs from 2000 through 2007 showed that the majority of studies are not blinded or randomized. Blinding for some devices such as left ventricular assist devices is not possible,1 but most cardiovascular device PMAs do not have even 1 blinded or 1 randomized study. Controls are used in a little more than half of studies, and the common use of retrospectively selected controls can introduce bias by allowing for the selection of control groups that favor the device. The vast majority of end points are surrogates, which may not be reliable predictors of actual patient benefit.19 Although surrogate outcomes are attractive because they decrease the time and costs required to do a study, they must be linked to a clinically meaningful end point to be valid.
Composite outcomes are also common, and in cardiovascular trials they have been shown to comprise individual end points that often vary in clinical significance and do not contribute equally to the composite measure.20 The frequent discrepancies between the number of enrolled patients and the number analyzed for primary end points, despite the short follow-up times, may introduce bias because patients with less favorable outcomes may be lost to follow-up and safety concerns may underlie this missing data. The common practice of excluding data from the training/roll-in/lead-in period also introduces bias because this preferentially excludes patients in whom the device may not be associated with a favorable outcome. In some instances where bias may not initially be present, devices are approved using a post hoc analysis of data, which could introduce bias favoring the device. The PMA is the most rigorous device approval process, and strict standards for cardiovascular devices are expected given their far-reaching effects, permanent nature, and use in critically ill patients.
Study populations should be representative of the patient populations in which these devices will be used. The FDA guidelines stating that data from outside the United States be "applicable to the US population and US medical practice"21 are increasingly important as more trials are conducted internationally. In more than one-third of PMAs, however, we were not able to ascertain that even 1 study had been conducted in the United States. This results in uncertain generalizability of approved medical devices to the US population.22
There are several possible reasons the criteria on which FDA device approval is based appear to be less rigorous than those for drug approvals. First, device approvals are a more recent activity for the FDA, having begun in 1976 with the FDA Device Amendment,6 so the agency has less experience with devices than it does with drugs. Further, the last decade has brought a significant increase in the number and complexity of devices. In addition, on the FDA approval continuum, devices, which are almost always implanted, are between drugs, which have relatively strict criteria for approval, and new surgical operations, which do not require FDA approval.
The importance of the "seal of FDA approval" cannot be overstated. Many manufacturers immediately encourage widespread use of their devices based on FDA approval through direct-to-consumer advertising,11,12 detailing to physicians, and continuing medical education venues. An oft-repeated assertion by the sponsor is that FDA approval is sufficient grounds for insurance coverage and rapid dissemination of new devices. This rapid diffusion encourages use beyond evidence or overutilization of the health care system.23 The findings in this study raise questions about the quality of data on which some cardiovascular device approvals are based.
There is a balance between getting new drugs and devices to market quickly and ensuring the evidence of benefit is sufficient before FDA approval and marketing. However, the bar for evidence of benefit should be higher for devices because they are implanted and cannot simply be discontinued, as drugs can. In addition, although devices can be lifesaving, they also have great potential for risk and adverse events. For example, after 268 000 implantations in 3 years after approval, the Medtronic Sprint Fidelis implantable cardioverter-defibrillator lead was found to have an increased risk of fracture.24 Further, despite the risks of using this device, lead removal is quite dangerous for patients.25
The importance of FDA device approval is magnified as it preempts consumer lawsuits on device safety. Drug approval by the FDA no longer guarantees preemption26; current legislation in Congress seeks to overturn this inconsistency and allow consumers' lawsuits to become a part of the regulatory framework for devices.27 Postmarket surveillance is also weak protection because, although postmarket studies are sometimes required, manufacturers are not actively required to seek out device malfunctions, so device-related adverse events are substantially underreported.24,28,29 In addition, although FDA approval may address only a specific, narrow population and indication, physicians may use devices for unapproved indications.6 For example, Medicare data show that 69% of current drug-eluting stent use is "off-label."30
All of these factors make it critical to public health that FDA device approval require sufficient high-quality evidence to support device safety and effectiveness, as determined in the PMA process. Yet, 65% of PMAs were based on a single study, which suggests that there may not be adequate evidence prior to FDA approval. Another option is to rely more on independent, systematic evidence-based assessments, although these will be hindered by the lack of rigorous clinical trial data and disincentives after approval for such studies.31 For example, after FDA approval of a medical device, interventionalists often are reluctant to randomize patients to a medical control group.32
The FDA approval process is an important determinant of health care spending: when the FDA approves devices more quickly, spending on new devices increases.6 Given that health care spending in the United States was 16.2% of the gross domestic product in 200733 and is projected to increase to 31% by 2031, and that rapid increase in health care spending is attributed principally to new technologies,34 rigorous outcome evaluation prior to approval is critical to increasing value for US health care expenditures. Fewer than half of medical decisions are supported by firm evidence of effectiveness, and many incentives in the US health care system encourage use of expensive treatments and procedures unrelated to evidence of patient benefit.35 There is a new focus on comparative effectiveness research, which has been allocated $1.1 billion by the Obama administration.36 The success of comparative effectiveness depends on the use of its principles in FDA reviews.37 Cost containment would likely occur if rigorous clinical effectiveness reviews are used for new drugs and technologies and spending concentrated on devices shown to benefit patients.38 Cardiovascular and peripheral vascular disease rank second among the primary research areas designated by the Institute of Medicine.39 This study suggests that the FDA device approval process would benefit from such rigorous research, using meaningful clinical outcomes and valid, active (not historical) controls in randomized, blinded studies conducted in populations that reflect the US population in which they are intended for use.
A limitation of this study may be that the data source is primarily publicly available SSEDs. However, it is possible that at least some of the data missing from the SSEDs were also omitted from the proprietary reports to the FDA. The SSEDs should contain all data presented to the FDA. If sufficient data are not presented or are inconsistent, the SSED should be checked for thoroughness prior to making a decision and posting on the FDA Web site. Given that the specific stated purpose of SSEDs is to present the basis of the FDA's decision,15 the SSEDs should be a thorough and accurate compilation of the FDA's critique of evidence. Further, SSEDs are the only FDA-reviewed evidence available for clinicians, and they form the sole basis of data that can be used for systematic reviews and guideline development. This study reinforces the need for improved access to complete FDA reviews40 for both pharmaceutical and device data.
The emphasis at the FDA in the last 17 years since the Prescription Drug User Fee Act has been rapid approval of new drugs. This study suggests that the emphasis for the FDA in 2009 and beyond must be approvals based on research that meets rigorous scientific standards for evidence of benefit and lack of harm to patients. To uphold the FDA's mission of ensuring "safe and effective" medical devices, it is essential that high-quality studies and data are available.
Corresponding Author: Rita F. Redberg, MD, MSc, Division of Cardiology, Department of Medicine, 505 Parnassus Ave, Ste M-1180, San Francisco, CA 94143-0124 (email@example.com).
Author Contributions: Dr Redberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Dhruva, Bero, Redberg.
Acquisition of data: Dhruva, Redberg.
Analysis and interpretation of data: Dhruva, Bero, Redberg.
Drafting of the manuscript: Dhruva, Redberg.
Critical revision of the manuscript for important intellectual content: Dhruva, Bero, Redberg.
Study supervision: Redberg.
Financial Disclosures: Dr Redberg reported being a member of the FDA Circulatory System Devices Panel and a member of the California Technology Assessment Forum. No other disclosures were reported.
Additional Contributions: Mark Pletcher, MD, Department of Epidemiology and Biostatistics, UCSF, provided statistical assistance, which was supported by NIH/NCRR grant UL1 RR024131 to the UCSF Clinical and Translational Science Institute. Jeffrey Tice, MD, and Steven Schroeder, MD, Department of Medicine, UCSF, provided helpful comments, and Deborah Airo, BA, Department of Epidemiology and Biostatistics, UCSF, provided editorial assistance. The UCSF Pathway to Discovery in Health and Society also provided assistance. None received compensation for their contribution.
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By Pure Matters
Problems with the kidneys may include conditions such as kidney failure, kidney stones, and kidney cancer. These problems with the kidneys may be caused by the following:
- Aging
As we age, changes in the structure of the kidneys can cause them to lose some ability to remove wastes from the blood, and the muscles in the ureters, bladder, and urethra tend to lose some of their strength.
- Illness or injury
Damage to the kidneys caused by illness or an injury can also prevent them from filtering the blood completely or block the passage of urine.
- Toxicity
The kidneys may be damaged by substances such as certain medications, a buildup of some substances in the body, or toxic substances such as poisons.
Source: http://resources.purematters.com/healthy-body/overview-of-kidney-disorders
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Overview of content related to 'elib'
This page provides an overview of 1 article related to 'elib'. Note that filters may be applied to display a sub-set of articles in this category (see FAQs on filtering for usage tips). Select this link to remove all filters.
The Electronic Libraries programme (eLib) resulted from the recommendations in chapter 7 of the Joint Funding Councils' Libraries Review Group, chaired by Sir Brian Follett. This Group reviewed libraries and related provision in higher education in the UK, and was commissioned jointly by the four UK HE funding bodies, HEFCE, SHEFC, HEFCW and DENI. Its report (known as the Follett report) was published in December 1993. The programme had £15,000,000 of funding over three years. The aim of eLib was to 'transform the use and storage of knowledge in higher education institutions'. It was managed by the JISC's Committee on Electronic Information, though the JISC committee which was set up initially to take forward the Follett recommendation was the Follett Implementation Group for Information Technology, FIGIT. Phase 3 was designed to build on successes and to have four components: 1) hybrid libraries; 2) large scale resource discovery, or clumps; 3) preservation; 4) turning early projects into services. An (unmaintained) archive of eLib programme and project information can currently be found on the UKOLN website. (Excerpt from this source)
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The Access Catalogue Gateway to Resources
Terry Hanson explores how libraries might develop effective ways of indicating their access arrangements to their users.
May 1998, issue15, feature article


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Embellishments are so "in" right now and last night the stars brought out all the bells, whistles, plumage, and sequins imaginable! Fabulously feathered, Diane Kruger, worked a lavender single shoulder garment at the New Yorkers For Children Benefit, Drew Barrymore rocked -yet another- fierce frock outside of The Late Show, and Lady Gaga is bringin' bling to the friendly skies as she arrives in London. On the earth, up in the sky, it is all about the add-ons, folks!
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The Diabetes Dictionary: R - Z
previous page R S T U V W X Y Z
rapid-acting insulin (RA-pid-AK-ting) (IN-suh-lin):
a type of insulin with an onset of 15 minutes, a peak at 30 to 90 minutes, and a duration of 3 to 5 hours. See insulin aspart, insulin glulisine, and insulin lispro.
rebound hyperglycemia (REE-bound) (HY-pur-gly-SEE-mee-uh):
see Somogyi effect.
receptors (ree-SEP-turz):
see insulin receptors.
Recognized Diabetes Education Programs (REH-kig-NYZD) (DY-uh-BEE-teez) (EH-juh-KAY-shuhn) (PROH-gramz):
diabetes self-management education programs that are approved by the American Diabetes Association.
regular insulin (REH-gyuh-lur) (IN-suh-lin):
a short-acting insulin with an onset of 30 to 60 minutes, a peak of 2 to 4 hours, and a duration of 5 to 8 hours. Also called R insulin. (Brand names: Humulin R, Novolin R.)
renal (REE-nuhl):
of or relating to the kidneys. A renal disease is a disease of the kidneys. Renal failure means the kidneys have stopped working.
renal threshold of glucose (REE-nuhl) (THRESH-ohld) (uhv) (GLOO-kohss):
the blood glucose concentration at which the kidneys start to excrete glucose into the urine.
repaglinide (ruh-PAG-luh-nyd):
an oral medicine used to treat type 2 diabetes. Repaglinide lowers blood glucose by helping the pancreas make more insulin right after meals. Repaglinide belongs to the class of medicines called meglitinides. (Brand name: Prandin.)
retina (RET-ih-nuh):
the light-sensitive layer of tissue that lines the back of the eye.
retinal hemorrhages (RET-ih-nuhl) (HEM-uh-ruhj-ez):
bleeding blood vessels in the retina, which can cause protein deposits, or exudates, in the retina. Laser surgery is required to prevent blindness. Retinal hemorrhage is a common form of diabetic retinopathy.
retinopathy (RET-ih-NOP-uh-thee):
see background retinopathy, proliferative retinopathy, and diabetic retinopathy.
R insulin (AR) (IN-suh-lin):
see regular insulin.
Riomet (RY-oh-met):
see metformin.
risk factor:
anything that raises the chances of a person developing a disease.
rosiglitazone (rohss-ih-GLIH-tuh-zohn):
an oral medicine used to treat type 2 diabetes. Rosiglitazone helps treat insulin resistance, the condition in which your body doesn't use insulin the way it should. Rosiglitazone belongs to the class of medicines called thiazolidinediones. (Brand name: Avandia.)[Top]
previous page R S T U V W X Y Z
saccharin (SAK-uh-rin):
a dietary sweetener with no calories and no nutritional value.
saturated fat:
a type of dietary fat that can increase the risk of heart disease. Saturated fat is found in meat, poultry skin, butter, lard, shortening, and all milk and dairy products except fat-free versions.
secondary diabetes (SEK-uhn-DAIR-ee) (DY-uh-BEE-teez):
a type of diabetes caused by another disease or certain drugs or chemicals.
the ongoing process of managing diabetes. Includes meal planning, planned physical activity, blood glucose monitoring, taking diabetes medicines, handling episodes of illness and of low blood glucose and high blood glucose, managing diabetes when traveling, and more. The person with diabetes designs his or her own self-management treatment plan in consultation with a variety of health care professionals such as doctors, nurses, dietitians, pharmacists, and others.
sharps container:
a container for the disposal of used needles and syringes; often made of hard plastic so that needles cannot penetrate the container.
short-acting insulin (short-AK-ting) (IN-suh-lin):
a type of insulin with an onset of 30 to 60 minutes, a peak at 2 to 4 hours, and a duration of 5 to 8 hours. See regular insulin.
side effects:
the unintended action(s) of a drug.
sitagliptin phosphate (sih-tuh-GLIP-tin) (FOSS-fayt):
an oral medicine used to treat type 2 diabetes. Sitagliptin lowers blood glucose by helping the body make more insulin when it's needed. It also helps keep the liver from putting stored glucose into the blood. Sitagliptin belongs to the class of medicines called DPP-4 inhibitors. (Brand name: Januvia.)
sliding scale:
a set of instructions for adjusting insulin on the basis of blood glucose test results, meals, or activity levels.
Somogyi effect (soh-MOH-jee) (uh-FEKT):
when the blood glucose level swings high following low blood glucose, or hypoglycemia. The Somogyi effect may follow an untreated hypoglycemic episode during the night and is caused by the release of stress hormones. Also called rebound hyperglycemia.
sorbitol (SOR-bih-tol):
1. a sugar alcohol-a sweetener-with 4 calories per gram. 2. a substance produced by the body in people with diabetes that can cause damage to the eyes and nerves.
split mixed dose:
division of a prescribed daily dose of insulin into two or more injections given over the course of the day.
another name for carbohydrate, one of the three main nutrients in food.
Starlix (STAR-liks):
see nateglinide.
a condition in which the blood supply to the brain is suddenly cut off, caused by a blockage or the bursting of a blood vessel in the brain or neck. Then brain tissue can be damaged. A stroke can cause a person to lose the ability to speak or move parts of the body.
subcutaneous injection (SUHB-kyoo-TAY-nee-uhss) (in-JEK-shuhn):
putting a fluid into the tissue under the skin with a needle and syringe.
sucralose (SOO-kruh-LOHSS):
a dietary sweetener made from sugar but with no calories and no nutritional value.
a two-part sugar made of glucose and fructose. Known as table sugar or white sugar, it is found naturally in sugar cane and in beets.
1. a class of carbohydrates with a sweet taste; includes glucose, fructose, and sucrose. 2. a term used to refer to blood glucose.
sugar alcohols:
sweeteners that produce a smaller rise in blood glucose than other carbohydrates. Their calorie content is about 2 calories per gram. Includes erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. Also known as polyols.
sugar diabetes (SHU-gur) (DY-uh-BEE-teez):
former term for diabetes mellitus.
sulfonylurea (SUHL-foh-nil-yoo-REE-uh):
a class of oral medicine for type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. (Generic names/Brand names: chlorpropamide/Diabinese; glimepiride/Amaryl; glipizide/Glucotrol, Glucotrol XL; glyburide/DiaBeta, Glynase PresTab, Micronase; tolazamide [generic only]; tolbutamide [generic only].)
Sunett (SOO-net):
see acesulfame potassium.
Symlin (SIM-lin):
see pramlintide acetate.
Syndrome x:
see insulin resistance and metabolic syndrome.
syringe (suh-RINJ):
a device used to inject medications or other liquids into body tissues. The syringe for insulin has a hollow plastic tube with a plunger inside and a needle on the end.
systolic pressure (siss-TOL-ik) (PRESH-ur):
the blood pressure when the heart pushes blood out into the arteries.[Top]
previous page R S T U V W X Y Z
team management:
a diabetes treatment approach in which medical care is provided by a team of health care professionals including a doctor, a dietitian, a nurse, a diabetes educator, and others. The team provides information and advises the person with diabetes.
thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn):
a class of oral medicine for type 2 diabetes that helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin. (Generic names/Brand names: pioglitazone/Actos; rosiglitazone/Avandia.)
see transient ischemic attack.
tight control:
see intensive therapy.
tinea pedis (TIN-ee-uh) (PEE-diss):
see athlete's foot.
see transient neonatal diabetes mellitus.
tolazamide (tol-AZ-uh-myd):
an oral medicine used to treat type 2 diabetes. Tolazamide lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Tolazamide belongs to the class of medicines called sulfonylureas. (Available only in generic form.)
tolbutamide (tol-BYOO-tuh-myd):
an oral medicine used to treat type 2 diabetes. Tolbutamide lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Tolbutamide belongs to the class of medicines called sulfonylureas. (Available only in generic form.)
trans fat:
a type of dietary fat that increases the risk of heart disease. Trans fat is produced when liquid oils are turned into solids through a process called hydrogenation. Foods with trans fat include those listing hydrogenated or partially hydrogenated fat on the label, such as crackers, snack foods, commercially produced baked goods, and some stick margarines.
transient ischemic attack (TIA) (TRANZ-see-uhnt) (iss-KEE-mik) (uh-TAK):
a condition in which blood flow to the brain is temporarily blocked. TIAs can cause temporary weakness or numbness, sudden confusion, dizziness, vision problems, or severe headache.
transient neonatal diabetes mellitus (TNDM) (TRANZ-see-uhnt) (NEE-oh-NAY-tuhl) (DY-uh-BEE-teez) (MEH-luh-tuhss):
a rare, monogenic form of diabetes that occurs in the first 6 months of life. TNDM disappears during infancy but can reappear later in life.
transplant (TRANZ-plant):
replacement of a damaged or diseased organ with a healthy one.
triglyceride (try-GLISS-ur-eyed):
the storage form of fat in the body. High triglyceride levels may occur when diabetes is out of control.
type 1 diabetes (typ) (whuhn) (DY-uh-BEE-teez):
a condition characterized by high blood glucose levels caused by a total lack of insulin. Occurs when the body's immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Type 1 diabetes develops most often in young people but can appear in adults.
type 2 diabetes (typ) (too) (DY-uh-BEE-teez):
a condition characterized by high blood glucose levels caused by either a lack of insulin or the body's inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults but can appear in children, teens, and young people.
type I diabetes (typ) (whuhn) (DY-uh-BEE-teez):
former term for type 1 diabetes.
type II diabetes (typ) (too) (DY-uh-BEE-teez):
former term for type 2 diabetes.
previous page R S T U V W X Y Z
U-100 (YOO-whuhn-HUHN-dred):
see unit of insulin.
see United Kingdom Prospective Diabetes Study.
ulcer (UHL-sur):
a deep, open sore or break in the skin.
United Kingdom Prospective Diabetes Study (UKPDS) (yoo-NY-ted) (KING-duhm) (pruh-SPEK-tiv) (STUHD-ee):
a British study conducted from 1977 to 1997 in people with type 2 diabetes. The study showed that if people lowered their blood glucose, they lowered their risk of eye disease and kidney damage. In addition, those with type 2 diabetes and hypertension who lowered their blood pressure also reduced their risk of stroke, eye damage, and death from long-term complications.
unit of insulin (YOO-nit) (uhv) (IN-suh-lin):
the basic measure of insulin. U-100 insulin means 100 units of insulin per milliliter (mL) or cubic centimeter (cc) of solution. Most insulin made today in the United States is U-100.
urea (yoo-REE-uh):
a waste product found in the blood that results from the normal breakdown of protein in the liver. Urea is normally removed from the blood by the kidneys and then excreted in the urine.
uremia (yoo-REE-mee-uh):
the illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion.
urinalysis (YOOR-ih-NAL-ih-siss):
a test of a urine sample that can reveal many problems of the urinary tract and other body systems. The sample may be observed for color, cloudiness, concentration; signs of drug use; chemical composition, including glucose; the presence of protein, blood cells, or germs; or other signs of disease.
urine (YOOR-in):
liquid waste product filtered from the blood by the kidneys, stored in the bladder, and expelled from the body by the act of urinating.
urologist (yoo-ROL-uh-jist):
a doctor who treats people who have urinary tract problems. A urologist also cares for men who have problems with their genital organs, such as erectile dysfunction.
previous page R S T U V W X Y Z
vaginal yeast (VAJ-ih-nuhl) (yeest):
see Candida.
vascular (VASS-kyoo-lur):
relating to the body's blood vessels.
vein (vayn):
a blood vessel that carries blood to the heart.
very-low-density lipoprotein (VLDL) cholesterol (VAIR-ee-loh-DEN-sih-tee) (LIP-oh-PROH-teen) (koh-LESS-tur-ol):
see VLDL cholesterol.
vitrectomy (vih-TREK-tuh-mee):
surgery to restore sight in which the surgeon removes the cloudy vitreous humor in the eye and replaces it with a salt solution.
vitreous humor (VIT-ree-uhss) (HYOO-mur):
the clear gel that lies behind the eye's lens and in front of the retina.
VLDL cholesterol (VEE-EL-DEE-EL) (koh-LESS-tur-ol):
stands for very-low-density lipoprotein cholesterol. A form of cholesterol in the blood. High levels may be related to cardiovascular disease.
void (voyd):
to urinate; to empty the bladder.
previous page R S T U V W X Y Z
wound care:
steps taken to ensure a wound such as a foot ulcer heals correctly. People with diabetes need to take special precautions so wounds do not become infected.
previous page R S T U V W X Y Z
xylitol (ZY-lih-tol):
a carbohydrate-based sweetener found in plants and used as a substitute for sugar; provides calories. Found in some mints and chewing gum.
[Top]previous page R S T U V W X Y Z
Back to Dictionary Index
Page last updated: December 5, 2011


text:
Who I Am: A Memoir
Who I Am: A Memoir (Hardcover)
Related Editions
From the voice of a generation: The most highly anticipated autobiography of the year, and the story of a man who... is a Londoner and a Mod.... wanted The Who to be called The Hair.... loved The Everly Brothers, but not that "drawling dope" Elvis.... wanted to be a sculptor, a journalist, a dancer and a graphic designer.... became a musician, composer, librettist, fiction writer, literary editor, sailor.... smashed his first guitar onstage, in 1964, by accident.... heard the voice of God on a vibrating bed in rural Illinois.... invented the Marshall stack, feedback and the concept album.... once speared Abbie Hoffman in the neck with the head of his guitar.... inspired Jimi Hendrix's pyrotechnical stagecraft.... is partially deaf in his left ear.... stole his windmill guitar playing from Keith Richards.... followed Keith Moon off a hotel balcony into a pool and nearly died.... did too much cocaine and nearly died.... drank too much and nearly died.... detached from his body in an airplane, on LSD, and nearly died.... helped rescue Eric Clapton from heroin.... is banned for life from Holiday Inns.... was embroiled in a tabloid scandal that has dogged him ever since.... has some explaining to do.... is the most literary and literate musician of the last 50 years.... planned to write his memoir when he was 21.... published this book at 67.
About the Author
Pete Townshend is the legendary lead guitarist and principal songwriter for The Who, one of the most influential rock-and-roll bands of all time. Townshend is responsible for having written over 100 songs and rock operas in the band's important catalogue. He is one of Rolling Stone's "100 Greatest Guitarists of All Time" and was inducted into the Rock and Roll Hall of Fame in 1990. He resides in West London, where he was raised.
Praise for Who I Am: A Memoir…
"Intensely intimate…candid to the point of self-laceration…[Townshend's] tone is less lofty than anyone would have expected, just as this book is more honest than any fan would have hoped."
-Rolling Stone (Four 1/2 Stars!)
"Mr. Townshend's self-portrait is raw and unsparing...as intimate and as painful as a therapy session, while chronicling the history of the band as it took shape in the Mod scene in 1960s London and became the very embodiment of adolescent rebellion and loud, anarchic rock 'n' roll."
-Michiko Kakutani, New York Times
"Unusually frank and moving…[Who I Am] isn't one of those rock memoirs that puts the what before the why. His past is a puzzle Mr. Townshend is sweating to decipher."
-The Guardian (UK)
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Messina Hof Sunset Tour
July 6, 2012 (Fri)
from 6:00 PM - 7:00 PM
Messina Hof Winery
Bryan, Texas 77808
Event Details
Join us for a casual evening stroll around our Bryan estate vineyard & resort led by one of our Messina Hof hosts. Learn about the history of Texas' most awarded winery, view the romantic Villa and gourmet Vintage House restaurant, and see where your favorite Messina Hof wines are made. Afterwards, you'll indulge in a flight of three wines perfectly paired with three delectable tapas conceived by our Chef and the Messina Hof culinary team. What a stellar way to start your weekend!
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Hives Center - Auburn, AL
Auburn Dermatologist Doctors for Hives
Type of Physician: Dermatologist
What is a Dermatologist?
A certification by the Board of Dermatology; practitioners treat pediatric and adult patients with disorders of the skin, mouth, hair and nails as well as a number of sexually transmitted diseases. They also have expertise in the care of normal skin, the prevention of skin diseases and cancers, and in the management of cosmetic disorders of the skin such as hair loss and scars.
Specialty: Dermatology
Common Name: Skin Doctor
Dermatologist Doctors in Auburn *
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Dermatology Associates
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Mark D Herron MD LLC
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Hives facts
Other Related Hives Articles
Emergency Contact for Auburn
Nearby Auburn Hospitals *
East Alabama Medical Center
VA Central Alabama Medical Ctr
Lake Martin Community Hospital
George H Lanier Memorial Hosp
Community Hospital
Jack Hughston Memorial Hospital
Doctors Hospital
Medical Center
Bradley Center Of St Francis
Hughston Hospital
St Francis Hospital
Bullock County Hospital
*Provider Directory Terms of Use:
The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval.


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Broadway powerhouse Billy Porter stopped by Show People with Paul Wontorek to discuss how his leading lady role in Kinky Boots is the culmination of a dazzling but difficult career.February 8, 2013
Zosia Mamet dropped by Show People with Paul Wontorek to discuss her Girls character, life on the Mad Men set, dealing with the red carpet and tapping into her survival instincts for Really Really.January 31, 2013
Sierra Boggess is back on Broadway! The Phantom star chats with Show People host Paul Wontorek about hanging with "the Lord" Andrew Lloyd Webber, her Little Mermaid birthday cake and her craziest backstage antics.January 25, 2013
The former Broadway star of Bonnie & Clyde and Newsies revisits Show People with Paul Wontorek to promote his role on the revamped second season of NBC's Smash.January 18, 2013
On this week's Show People with Paul Wontorek, studly stage vet Andy Karl (Legally Blonde, Jersey Boys, Wicked) chats about backstage raps at The Mystery of Edwin Drood, acting with his eyebrows and life with Broadway diva Orfeh.January 11, 2013
The new season of Show People with Paul Wontorek kicks off with Les Miserables star Aaron Tveit. Hear him dish about his Les Miz co-stars, going undercover on his new TV show Graceland and why he says "no" to social media.January 4, 2013
Hunky leading man Richard Fleeshman stopped by Show People with Paul Wontorek to chat about his post-Ghost plans, as well as his in utero TV debut, life as a teenage soap opera star, fave drunk food, beautiful penis and much more.August 9, 2012
Audra McDonald, who picked up her fifth Tony earlier this summer for Porgy and Bess, stopped by Show People with Paul Wontorek to discuss her trophy collection, life with fiance Will Swenson & memories of starring in Evita at age 16!July 27, 2012
Tony winner John Lloyd Young, who recently returned for a limited run in Jersey Boys, stopped by Show People with Paul Wontorek to chat about honoring Oreo cookies with his art, Kung Fu fighting fans, living "outside the box" and more.July 19, 2012
Broadway dreamboat Cheyenne Jackson is breaking ground as a recording artist, and he stopped by Show People with Paul Wontorek to chat about finding his sound, Tony Award fake-outs, showing T&A, the real secret to his lasting love and more.July 12, 2012
Lindsay Mendez's powerful voice has blown Broadway audiences away in shows like Grease and Godspell, and now she drops by Show People to talk with Paul Wontorek about life as a bona fide leading lady in the musical Dogfight.June 29, 2012
Once star Steve Kazee drops by Show People to discuss his first Tony win, ex-girlfiend Megan Hilty (Smash) and his love of drag queens and hitting the dance floor at gay bars. Kazee also shares his dreams of joining HBO's True Blood! Naked!June 22, 2012


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Westinghouse J34 Cutaway
The J34, Westinghouse's second successful jet engine, was developed in the late 1940's and was an enlarged version of their J30. It produced twice as much thrust, at 3,000 lbs., as the J30 whith later models producing as much as 4,9000 lbs. of thrust with the addition of an afterburner.
Built during a time of rapid jet engine development, it was used often as an interim engine and was sometimes fitted to aircraft as a supplement to other powerplants.
This engine is located in the Military Hangar near the tail of the Grumman F-14.


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Heyneke Meyer's selection of Fourie du Preez for the three home matches in this season's Rugby Championship is a coup and a masterstroke.
It will also give both player and coach an opportunity to assess the player's appetite for Test rugby and his appetite to commit to the 2015 World Cup in England.
Du Preez's quality as a player should never be questioned. It doesn't matter that he has played his rugby in the less demanding environment of Japan in the last 18 months. If anything that would have added to his international longevity.
Du Preez, in the context of the Springboks, has the same value as Dan Carter to the All Blacks. Du Preez has always been the team's backline general and master tactician.
Du Preez, at scrumhalf, like Carter, at flyhalf, offers a unique value to the position. They set the standard.
In Du Preez's Bok absence no scrumhalf has come close to making a similar impact. Francois Hougaard has promised great things but never delivered on the tutorship of Du Preez.
Ruan Pienaar, since playing for Ulster, is more dependable than dashing and Jano Vermaark and Piet van Zyl simply are not in Du Preez's class.
Meyer has worked very hard with Du Preez's Japanese club to get a release for the three Rugby Championship Tests in South Africa. The Bok coach has shown professionalism and a healthy respect for the realities of professional rugby to facilitate Du Preez's participation, even if it is just for half the tournament.
Rugby, as a profession, will probably take another decade to settle. The administration of the game is still more shamateur than business-like and inept, apathetic and incompetent elected officials still operationally govern the game globally.
A player revolt would change that, but the players are still too steeped in amateur ethos and values.
This will change, if not before the 2019 World Cup in Japan.
In 10 years time it won't matter where a player is based. If he is the best in his position he will be selected to play for his country.
For now there is still too much amateur tradition that clouds the judgement and influences public sentiment.
Many supporters still feel a player is turning his back on the national jersey when accepting lucrative offers to play overseas. I've never understood how supporters could feel aggrieved at a player maximizing his earning potential.
It's not personal and it's not unpatriotic.
It's a bit like a Kaizer Chiefs player being accused of treason for accepting an offer to play for Manchester United.
The national cause should never be compromised because a player doesn't base himself in South Africa.
And it's pleasing to see Meyer being allowed to make informed selection choices. The South African Rugby Union, in this regard, is ahead of the New Zealand and Australian Rugby Union, in allowing the national coach to select whoever he believes to be the best, irrespective of whether they play their domestic rugby outside of South Africa.
The European club structure is as good as that on offer in the southern hemisphere and many of the European club have a healthy contingent of southern hemisphere players.
Meyer has always emphasized that on 50/50 selection calls he would favour the local based player. It's a view that is logical, but he has also insisted that if the South African player based overseas offers more to the prospects of the Springboks winning, then he would select this player.
Francois Louw is the best example of a player who has improved since relocating to Bath. Louw was good when he left the Stormers. He is now very good as an international openside flank option.
Meyer recognized this, selected Louw and immediately saw the on-field value to the Boks.
There are players who have improved since moving overseas. If good enough, pick them for the Boks.
Meyer's aim is for the Boks to be the best. To do so he must select who he considers to be the best, which is why the selection of a motivated Du Preez is a no brainer.
Meyer has invested in 10 foreign-based players and there are still a few more who could push for selection in the November internationals against France, Scotland and Wales.
Toulon and former Bulls strong man Bakkies Botha is just one example of a European-based player good enough to play Test rugby. Don't be surprised to see him playing against France in Paris.
Japanese-based Jaque Fourie, in 2015, will also challenge for a place with the Boks.
Meyer has shown consistency in his selections and has been aggressive in developing international depth in his squad.
I'll continue to disagree with him on his omission of Cheetahs flanker Heinrich Brussow, but there is little else to counter in his selections.


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Jay Bradner:
Open-source cancer research
How does cancer know it's cancer? At Jay Bradner's lab, they found a molecule that might hold the answer, JQ1 — and instead of patenting JQ1, they published their findings and mailed samples to 40 other labs to work on. An inspiring look at the open-source future of medical research. (Filmed at TEDxBoston.)
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Winky Wright vs Paul Williams 4/11/09
TV14 Duration 5:49 :
HBO WCB - Apr. 11, 2009
Arreola vs McCline
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Phase Ib Trial of MPDL3280A with Bevacizumab or with Bevacizumab + FOLFOX in Patients with Solid Tumors
What is the purpose of this trial?
The purpose of this study is to find the best dose, and what affects, good and/or bad, and experimental drug (MPDL3280A) has when used in combination with bevacizumab and with bevacizumab plus FOLFOX chemotherapy to treat subjects with locally advanced or metastatic solid tumors.
Participation Guidelines
- Age:
- 18 Years and older
- Gender:
- Both
Click here for detailed information about who can participate in this trial.
- Sponsor:
- Genentech, Inc.
- Dates:
- 10/07/2013
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To provide photographers with a broader perspective about mobiles, lenses and cameras, here are links to articles, reviews, and analyses of photographic equipment produced by DxOMark, renown websites, magazines or blogs.
Announced in 2012, the Nikon D800 is the current undisputed king of DxOMark, with results that eclipse every other camera from all other manufacturers. However, with so much resolution on tap, the question is, which lenses should you use to make the best of what you've got? The DxOMark labs have tested 61 different lenses on the D800 to bring you an unparalleled resource of which lenses are best and which should be avoided. To make it easy to follow, we have broken the reviews down into sections so you can concentrate on the lenses that are important to you. This first section will give you an overview of the D800. We will follow this with a review of the standard focal length lenses, then the telephoto lenses and super-zooms and finally there will be a wide-angle review.
Tamron SP AF 28-75mm F/2.8 XR Di LD Aspherical [IF] tested on Canon and Nikon mount.
Launched in 2003, this lens is still a very good choice if you are looking for a cheap standard zoom lens. See the comparisons against famous competitors: Tamron SP AF 28-75mm F/2.8 XR Di LD Aspherical [IF] Nikon Vs Canon EF 24-70mm f/2.8L USM Vs Nikon AF-S Nikkor 24-70mm f/2.8G ED, here.


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Los Angeles Angels Tickets
Los Angeles Angels Tickets Tickets Rated 0.00/5 based on 0 customer reviews
2013 Record (78-84) Missed playoffs The 2013 season for the Los Angeles Angels was extremely disappointing. Under long-time manager Mike Scioscia the Angels finished third in the AL West and missed the playoffs. Finishing 18 games back of first with the amount of talent the Angels have was unacceptable. Superstar players Josh Hamilton and Albert Pujols both contributed to the cause with down years. However, even with a disappointing season the Angels were a can't miss team. Mike Trout is a once in a generation type of player and he plays center field for the Angels. The 22 year old has already been to two all star games, won two silver slugger awards and finished second in MVP voting twice while adding a rookie of the year award to his name. Looking to the 2014 season the Angels will look to Trout to continue his ridiculous pace. Improved seasons thus far from big time pitchers CJ Wilson and Jared Weaver have the Angels looking to fight for a playoff spot when all is said and done. With one of the most talented rosters in all of baseball look for the Angels to get back to their winning ways. Don't miss out on the action! For the best spot at the best price get your seats today at Gold Coast Tickets!
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Imagine Dragons Biography & News
Imagine Dragons Details
|Official site
About Imagine Dragons
Imagine Dragons yells its "Battle Cry"
Who knew that "Transformers" would nearly transform the career of Imagine Dragons?
Sure, the band has been touring in support of its debut album, "Night Visions," for the last two years. Then the phone rang and a guy named Michael Bay was on the other end, asking if Imagine Dragons would compose a song for the latest installment of his alien-robot movie franchise. You can bet they weren't about to turn him down.
The next step involved Imagine Dragons lead singer Dan Reynolds sitting down with Bay to watch parts of the film. That bore the idea for the original song, "Battle Cry," which the band wrote along with composers Steve Jablonsky and Hans Zimmer. The end result was a song that builds from delicate strings into a swelling, drum-filled chorus.
"Battle Cry" was released as a one-off single on June 2, several weeks before "Transformers: Age of Extinction" hit theaters in the U.S. Since then the band has played to the deafening roars of thousands of fans (old and new), including a headline slot at Dover, Delaware's Firefly Music Festival. Their single "Radioactive" also just ended an astonishing 87-week run on the Billboard Hot 100 chart.
For fans seeking new music from Imagine Dragons, you won't have to wait long. The quartet recently revealed they have more than 100 demos in their possession, and have been writing since "Night Visions" came out two years ago. They also purchased a house in Las Vegas that has been renovated into a studio, cutting down on future expenses incurred in the recording process.
Catch Imagine Dragons on the road as they headline the upcoming Target All-Star Concert July 12, three days before the MLB All-Star Game in Minneapolis.
About Imagine Dragons
Imagine going through a baptism by fire scenario in which you learn to deal with major media exposure almost overnight. That's the story of the Imagine Dragons, an alternative-rock-band-turned-overnight-sensation following the release of their debut studio album "Night Visions" in September 2012.
What follows goes something like this: the media circus known as the late night talk show circuit ("Jimmy Kimmel Live" and "The Tonight Show"), sensational praise from magazines (Billboard and Rolling Stone) and a world tour that blazed a trail through the United States, Canada and many countries in Europe (where virtually every show was a sellout).
Though the band officially got its start in 2008, has released seven EPs and is on its fourth tour, Imagine Dragons is still very much in its infancy. Sure, "Night Visions" peaked at #2 on the Billboard 200 chart, selling 83,000 copies in its first week. Yes, it reached #1 on the Alternative and Rock Album charts, not to mention climbing into the top ten in eight other countries. But the bottom line is that these guys were just named one of Billboard's "Brightest New Stars" of 2012, and the best is undoubtedly yet to come.
Imagine Dragons recently performed their single "It's Time" on "The Late Show with David Letterman" and is booked for "Late Night with Jimmy Fallon" on July 26, 2013. They are scheduled to perform at summer festivals including Yahoo! On the Road Festival, Hangout Music Festival, Summerfest, Lollapalooza, Reading and Leeds Festivals, and so many more.
Imagine Dragons go Into the Night, Onto Big Stages
Imagine Dragons Concert Tickets & Tour Dates Imagine Dragons Concerts Imagine Dragons Video for "Demons" Imagine Dragons Into The Night Tour They're so hot, they're "Radioactive," and Imagine Dragons have announced it's time to heat up some big arenas in the US with an arena tour. The 2014 Imagine Dragons Into the Night tour will…Read more
Imagine Dragons Ticket PricesFind Tickets
Past 12 Months
$116Average Price
$766High price
$6Low price
Cost for Upcoming Imagine Dragons Shows
$80Average Price
$32 - 137Listing RangeIn Secondary Market
Past Tour Dates for Imagine Dragons
Imagine Dragons Tour Dates 2015
date city state venue 06/03/2015 Portland OR Moda Center 05/29/2015 Napa CA Napa Valley Expo 05/29/2015 Napa CA Napa Valley Expo 04/27/2015 Mexico City Dif Palacio de los Deportes 04/23/2015 San Juan PR Coliseo de Puerto Rico 04/18/2015 Sao Paulo SP Arena Anhembi 04/16/2015 Rio de Janeiro Rio De Janeiro Citibank Hall 04/12/2015 Santiago RM Movistar Arena 02/25/2015 Atlanta GA Terminal West 02/23/2015 Las Vegas NV Vinyl at Hard Rock Hotel & Casino Las Vegas
Imagine Dragons Tour Dates 2014
date city state venue 12/14/2014 Inglewood CA The Forum 12/13/2014 Inglewood CA The Forum 12/13/2014 Oakland CA Oracle Arena 12/11/2014 Las Vegas NV Hard Rock Hotel And Casino- The Joint 12/09/2014 Seattle WA Key Arena 11/13/2014 Denver CO Ogden Theatre 08/30/2014 Los Angeles CA Grand Park 08/30/2014 Los Angeles Los Angeles Grand Park 08/30/2014 Los Angeles CA Grand Park 08/30/2014 Los Angeles Los Angeles Grand Park 08/22/2014 Leeds Yorkshire Bramham Park 08/22/2014 Belfast Ant Custom House Square 08/20/2014 Berlin BE Zitadelle Spandau 08/19/2014 Hamburg HH Stadtpark Freilichtbuhne 07/12/2014 Minneapolis MN TCF Bank Stadium 07/11/2014 Kinross ?? Balado Airfield 07/03/2014 Werchter Vbr Werchter Park 06/29/2014 Saint Gallen Festivalgelande 06/28/2014 Saint Gallen Festivalgelande 06/25/2014 Pilton Som Worthy Farm 06/21/2014 Dover DE Dover International Speedway 06/19/2014 Dover DE Dover International Speedway 06/19/2014 Dover DE Dover International Speedway 05/18/2014 Las Vegas NV MGM Grand Garden Arena 03/26/2014 Zapopan Jal Auditorio Telmex 03/15/2014 Denver CO Pepsi Center 03/13/2014 Rosemont IL Allstate Arena 03/12/2014 Saint Paul MN Xcel Energy Center 03/11/2014 Austin TX ACL Live at The Moody Theater 03/08/2014 East Rutherford NJ Izod Center 03/07/2014 Camden NJ Susquehanna Bank Center 03/06/2014 Worcester MA DCU Center 03/04/2014 Toronto ON Air Canada Centre 03/03/2014 Montreal QC Bell Centre 03/02/2014 Toronto ON Air Canada Centre 03/01/2014 Uncasville CT Mohegan Sun Arena 02/28/2014 Norfolk VA Constant Convocation Center 02/26/2014 Atlanta GA Philips Arena 02/24/2014 Nashville TN Bridgestone Arena 02/22/2014 Tulsa OK BOK Center 02/21/2014 Dallas TX American Airlines Center 02/20/2014 Austin TX Frank Erwin Center 02/17/2014 Phoenix AZ US Airways Center 02/15/2014 San Diego CA Valley View Casino Center 02/14/2014 Inglewood CA The Forum 02/13/2014 San Jose CA SAP Center 02/11/2014 Seattle WA Key Arena 02/10/2014 Vancouver BC Rogers Arena 02/08/2014 Boise ID Taco Bell Arena 02/05/2014 Brooklyn NY Barclays Center 01/26/2014 Los Angeles CA Staples Center 01/23/2014 Los Angeles CA The Wiltern
Imagine Dragons Tour Dates 2013
date city state venue 12/30/2013 Las Vegas NV Hard Rock Hotel And Casino- The Joint 12/13/2013 Bournemouth Nottinghamshire Bournemouth Solent Hall 12/11/2013 Bremen HB Pier 2 12/09/2013 Zurich ZH Maag Music Event Hall 12/07/2013 Barcelona Cat Palau Sant Jordi 12/06/2013 Madrid Mad Palacio Vistalegre 12/03/2013 Vienna Vienna Wiener Rathauskeller 12/02/2013 Zurich ZH Maag Music Event Hall 11/30/2013 Esch-sur-Alzette L Rockhal 11/29/2013 Brussels Cirque Royal 11/27/2013 London London O2 Academy Brixton 11/26/2013 London London O2 Academy Brixton 11/25/2013 London London O2 Academy Brixton 11/24/2013 Los Angeles CA Nokia Theatre LA Live 11/23/2013 Bournemouth Nottinghamshire Bournemouth Solent Hall 11/22/2013 Birmingham W Mids O2 Academy Birmingham 11/21/2013 Nottingham Ntt Rock City 11/19/2013 Swindon Wiltshire Oasis Leisure Centre 11/18/2013 Newcastle upon Tyne T & W O2 Academy Newcastle 11/16/2013 Leeds Yorkshire O2 Academy Leeds 11/15/2013 Glasgow Glg O2 Academy Glasgow 11/14/2013 Manchester Lancashire O2 Apollo Manchester 11/12/2013 Cologne NW E-Werk 11/08/2013 Bremen HB Pier 2 11/07/2013 Oslo 03 Sentrum Scene 11/05/2013 Stockholm ?? Klubben 11/02/2013 Amsterdam ?? Melkweg 10/31/2013 Strasbourg Bas-rhin La Laiterie 10/29/2013 Paris Ile L'Olympia 10/27/2013 Las Vegas NV Downtown Las Vegas 10/26/2013 Las Vegas NV Downtown Las Vegas 10/26/2013 Las Vegas NV Downtown Las Vegas 10/25/2013 Ogden UT Dee Events Center 10/19/2013 Brisbane Qld The SWARM 10/18/2013 Newtown ?? Enmore Theatre 10/15/2013 Auckland Auckland Powerstation 10/12/2013 Mexico City ?? Autodromo Hermanos Rodriguez 09/30/2013 Saint Paul MN Roy Wilkins Auditorium 09/28/2013 Dallas TX South Side Ballroom 09/27/2013 Dallas TX South Side Ballroom 09/26/2013 The Woodlands TX The Cynthia Woods Mitchell Pavilion 09/24/2013 Tampa FL USF Sun Dome 09/23/2013 Orlando FL The Venue At Ucf 09/21/2013 Atlanta GA Piedmont Park 09/20/2013 Atlanta GA Piedmont Park 09/20/2013 Columbia MD Merriweather Post Pavilion 09/20/2013 Atlanta GA Piedmont Park 09/17/2013 Rochester Hills MI Meadow Brook Music Festival 09/16/2013 Indianapolis IN The Lawn at White River 09/14/2013 Maryland Heights MO Hollywood Casino Amphitheatre 09/07/2013 Sacramento CA Cesar Chavez Plaza 08/31/2013 Philadelphia PA Ben Franklin Parkway 08/31/2013 Philadelphia PA Ben Franklin Parkway 08/30/2013 Atlantic City NJ Borgata Event Center 08/23/2013 Leeds Yorkshire Bramham Park 08/23/2013 Leeds Yorkshire Bramham Park 08/22/2013 Dublin D Olympia Theatre 08/20/2013 Dublin D Olympia Theatre 08/19/2013 Belfast Ant Ulster Hall 08/03/2013 Montreal QC Parc Jean-Drapeau 08/02/2013 Chicago IL Grant Park 08/02/2013 Montreal QC Parc Jean-Drapeau 08/02/2013 Chicago IL Grant Park 08/02/2013 Montreal QC Parc Jean-Drapeau 07/31/2013 Chicago IL Metro 07/31/2013 Chicago IL Metro 07/30/2013 Cleveland OH Jacobs Pavilion at Nautica 07/29/2013 Toronto ON Echo Beach 07/27/2013 Nashville TN Carl Black Chevy Woods Amphitheater 07/25/2013 Wantagh NY Nikon at Jones Beach Theater 07/24/2013 Boston MA Blue Hills Bank Pavilion 07/18/2013 Bern BE The Gurten 07/12/2013 Kinross ?? Balado Airfield 06/29/2013 Milwaukee WI Marcus Amphitheater 06/28/2013 Kansas City MO Starlight Theatre 06/21/2013 Dover DE Dover International Speedway 06/14/2013 Bergen 12 Bergenhus Festning 06/12/2013 Bergen 12 Bergenhus Festning 06/03/2013 Phoenix AZ Comerica Theatre 06/01/2013 San Diego CA Cal Coast Credit Union Open Air Theatre 05/31/2013 San Francisco CA America's Cup Pavilion 05/30/2013 Los Angeles CA Hollywood Palladium 05/29/2013 Los Angeles CA Hollywood Palladium 05/24/2013 George WA Gorge Amphitheatre 05/24/2013 Calgary AB BMO Centre 05/23/2013 Edmonton AB Shaw Conference Centre 05/21/2013 Boise ID Idaho Botanical Garden 05/20/2013 Orem UT UCCU Center 05/19/2013 Gulf Shores AL Hangout Music Festival 05/18/2013 Irvine CA Irvine Meadows Amphitheatre 05/17/2013 Gulf Shores AL Gulf Shores Beach 05/16/2013 Morrison CO Red Rocks Amphitheatre 05/15/2013 Saint Louis MO The Pageant 05/11/2013 Saint Augustine FL St Augustine Amphitheatre 05/10/2013 Boca Raton FL Sunset Cove Amphitheater 05/09/2013 Lisbon 11 TMN AO VIVO 05/08/2013 Raleigh NC Red Hat Amphitheater 05/07/2013 Charlotte NC Uptown Amphitheatre at NC Music Factory 05/04/2013 Milan Factory Club 05/03/2013 Paris Ile Le Bataclan 05/02/2013 Brussels Bru Ancienne Belgique 04/29/2013 Frankfurt HE Gibson 04/20/2013 Cologne NW Live Music Hall 04/19/2013 Hamburg HH Grosse Freiheit 36 04/18/2013 Copenhagen Danish Capital Regio Vega House Of Music 04/16/2013 Oslo 03 Bla 04/13/2013 Amsterdam ?? Melkweg 04/11/2013 London Lnd The Forum 04/09/2013 Birmingham War The Institute 04/08/2013 Manchester Dby Club Academy 04/06/2013 Glasgow Rfw O2 ABC Glasgow 04/05/2013 Dublin D Science Gallery, Trinity College 04/04/2013 Liverpool Lan O2 Academy Liverpool 04/02/2013 Bristol Bst O2 Academy Bristol 03/26/2013 Tulsa OK Donald Reynolds Center 03/23/2013 Denver CO Fillmore Auditorium 03/22/2013 Salt Lake City UT The Complex 03/20/2013 Los Angeles CA The Wiltern 03/19/2013 Anaheim CA House of Blues Anaheim 03/18/2013 San Diego CA House of Blues San Diego 03/16/2013 San Francisco CA The Warfield 03/15/2013 Portland OR Roseland Theater 03/14/2013 Vancouver BC Commodore Ballroom 03/12/2013 Calgary AB MacEwan Ballroom 03/11/2013 Edmonton AB The Starlite Room 03/09/2013 Winnipeg MB Garrick Centre at the Marlborough 03/08/2013 Minneapolis MN Varsity Theater 03/06/2013 Saint Louis MO The Pageant 03/05/2013 Chicago IL House of Blues 03/04/2013 Chicago IL House of Blues 03/02/2013 Milwaukee WI The Rave/Eagles Club/Eagles Ballroom 03/01/2013 Detroit MI The Fillmore Detroit 02/28/2013 Indianapolis IN Egyptian Room at Old National Centre 02/27/2013 Toronto ON Sound Academy 02/25/2013 Boston MA House of Blues Boston 02/23/2013 New York NY Roseland Ballroom 02/22/2013 Silver Spring MD The Fillmore Silver Spring 02/18/2013 Philadelphia PA Electric Factory 02/16/2013 Asheville NC The Orange Peel 02/15/2013 Orlando FL House of Blues Orlando 02/14/2013 Atlanta GA The Tabernacle 02/12/2013 Houston TX House of Blues - Houston 02/11/2013 Dallas TX House of Blues Dallas 02/09/2013 Las Vegas NV Hard Rock Hotel And Casino- The Joint 02/08/2013 Tempe AZ Marquee Theatre 01/05/2013 San Francisco CA The Independent
Imagine Dragons Tour Dates 2012
date city state venue 12/31/2012 Mammoth Lakes CA Canyon Lodge - Mammoth Mountain 12/09/2012 Universal City CA Gibson Amphitheatre 12/08/2012 Oakland CA Oracle Arena 12/07/2012 San Diego CA Viejas Arena 12/06/2012 Highland CA San Manuel Indian Bingo and Casino 12/02/2012 Jacksonville FL Metropolitan Park 12/01/2012 Saint Petersburg FL Vinoy Park 11/28/2012 Norfolk VA Constant Convocation Center 11/16/2012 Manchester Man The Ruby Lounge 11/15/2012 Glasgow Glasgow Nice N Sleazy 11/14/2012 Oxford Oxf O2 Academy Oxford 11/12/2012 London Lnd Dingwalls 11/10/2012 Amsterdam Nhl Paradiso 11/08/2012 Paris ?? Le Divan du Monde 11/05/2012 Hamburg HH Molotow 10/25/2012 Orlando FL House of Blues Orlando 10/24/2012 Tampa FL The Ritz Ybor 10/23/2012 Atlanta GA The Tabernacle 10/22/2012 Nashville TN Cannery Ballroom 10/20/2012 Dallas TX House of Blues Dallas 10/18/2012 Austin TX Emo's Austin 10/16/2012 Albuquerque NM Sunshine Theater 10/11/2012 Los Angeles CA Club Nokia 10/09/2012 San Diego CA House of Blues San Diego 10/08/2012 San Francisco CA Great American Music Hall 10/06/2012 Vancouver BC Venue 10/02/2012 Seattle WA The Showbox 10/01/2012 Boise ID Knitting Factory - Boise 09/25/2012 Minneapolis MN Varsity Theater 09/23/2012 Kansas City MO Uptown Theater 09/22/2012 Saint Louis MO The Pageant 09/21/2012 Indianapolis IN Egyptian Room at Old National Centre 09/19/2012 Columbus OH Newport Music Hall 09/18/2012 Detroit MI Saint Andrews Hall 09/17/2012 Toronto ON The Opera House 09/15/2012 Chicago IL Humboldt Park 09/15/2012 Covington KY Madison Theater 09/15/2012 Milwaukee WI Veterans Park 09/13/2012 Pittsburgh PA Altar Bar 09/11/2012 Hartford CT Great Hall At Union Station 09/10/2012 Portland ME State Theatre 09/05/2012 Las Vegas NV Body English 05/17/2012 Tucson AZ Club Congress 04/25/2012 Saint Louis MO The Firebird 04/23/2012 Omaha NE The Waiting Room 04/18/2012 Columbus OH A and R Music Bar
Imagine Dragons Tour Dates 2011
date city state venue 03/03/2011 Las Vegas NV Count's Vamp'd


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Research and Publications
Journal Articles
Do Liquidity Measures Measure Liquidity?
2009, Journal of Financial Economics
Ruslan Goyenko, Craig W. Holden, Charles A. Trzcinka
Given the key role of liquidity in finance research, identifying high quality proxies based
on daily (as opposed to intraday) data would permit liquidity to be studied over
relatively long timeframes and across many countries.Using new measures and widely
employed measures in the literature, we run horseraces of annual and monthly
estimates of each measure against liquidity benchmarks. Our benchmarks are effective
spread, realized spread, and price impact based on both Trade and Quote (TAQ) and Rule
605 data.We find that the new effective / realized spread measures win the majority of
horseraces, while the Amihud [2002. Illiquidity and stock returns: cross-section and
time-series effects.Journal of Financial Markets 5, 31–56] measure does well measuring
price impact.
Goyenko, Ruslan, Craig W. Holden, and Charles A. Trzcinka (2009), "Do Liquidity Measures Measure Liquidity?," Journal of Financial Economics, Vol. 92, No. 2, May, pp. 153-181.
Lead Article.
Download Publication
Do Liquidity Measures Measure Liquidity? (4105 KB)


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Parkinson's Disease Center - Merced, CA
Merced Neurologist Doctors for Parkinson's Disease
Type of Physician: Neurologist
What is a Neurologist?
A certification by the Board of Psychiatry & Neurology; practitioners focus on the diagnosis and treatment of all categories of disease or impaired function of the brain, spinal cord, muscles and nervous system, as well as the blood vessels that relate to these structures. The neurologist is often the primary physician but also serves as a consultant to other physicians and may render all levels of care, including the continuing care of outpatients and/or inpatients. The neurologist will often perform and interpret tests that relate to the nervous system or muscles.
Specialty: Neurology
Common Name:
Neurologist Doctors in Merced *
Thomas B Bryan MD
Kin C Chan MD
Diana J Hylton MD
Children's Hospital Of Merced
Hillside Internal Medcn/Nrlgy
Choo Seng Lee MD
Fatemeh Pazouki MD
Turlock EMG & Neurology
Childrens Hospital Ctl CA
Childrens Hospital Ctl CA
Childrens Hospital Ctl CA
Kaiser Permanente Med Ctr Frsno
Kaiser Permanente Med Ctr Frsno
Kaiser Permanente Med Ctr Frsno
Sierra Valley Medico Inc
California Neurological Center
Margolin Brain Institute
Community Nrlgy/Plmnry Med Grp
Wolf Epilepsy Center
Spruce Multi-Specialty Group
Melvin R Helm MD
Nighat Sarwar MD
Nighat Sarwar MD
Walton MD Incorporated
Madhav Suri MD
George K Siu MD Inc
Fresno Neurobehavioral Assocs
Frank L Cantrell MD Inc
Lorenzo Aguilar MD
Neuro-Pain Medical Center
Neuro-Pain Medical Center
Harvey L Edmonds MD Inc
Sutter Gould Medical Group
Sutter Gould Medical Group
Alan G Schaffert MD
Gilbert R Eggen DO
Jeffrey R Levin MD
Sanjay J Chauhan MD Inc
Gary W Platt MD
Sierra Health Center
Sierra Health Center
UCSF Alzheimers Memory Center
Loan Nguyen DO
University Neurology Associates
University Neurology Associates
Central California Fac Med Grp
University Neurology Associates
University Neurology Associates
Central California Fac Med Grp
Kaiser Permanente Neurology
Kaiser Permanente Neurology
Donald D Van Fossan MD
San Joaquin Childrens Clinic
Sierra Park Orthopedic/Neurolgy
Amberstone Medical Group
Dugger Gannon & Karnaze MDs
Dugger Gannon & Karnaze MDs
Dugger Gannon & Karnaze MDs
Oshtory & Oshtory MDs
Oshtory & Oshtory MDs
Madan Prasad MD
Kaiser Permanente Medical Group
Kaiser Permanente Neurology
Kaiser Permanente Medical Group
Kaiser Permanente Medical Group
Lodi Memorial Cmnty Clnc Vine
Nancy T Huang-Santos MD
Sutter Gould Medical Group
Sutter Gould Medical Foundation
Jin-Mei Woan MD
Vladimir Royter MD
Michael N Baker MD
Adventist Health Community Care
Rajiv S Pathak MD
Michael P Sullivan MD
Merced, California
Parkinson's Disease
Parkinson's disease facts
Other Related Parkinson's Disease Articles
Emergency Contact for Merced
Nearby Merced Hospitals *
John C Fremont Healthcare Dis
Mercy Medical Center
Sonora Regional Medical Center
*Provider Directory Terms of Use:
The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval.


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Punk-101 wrote:therealdeal wrote:It's one preseason game, so I'm not upset about it. What I'm worried about is Meeks' mentality because he has BEEN practicing with those guys. Not to mention we've all heard Brown talk about Hill's "natural backup 4" position which pushes Jamison up.
I'm worried that Meeks becomes upset here and doesn't get his chance because he's a solid young player and what he showed me on the court yesterday was good defense and a solid stroke. I want to see him backing up Kobe Bryant, not Ebanks.
Hill didn't play one minute at center last night which is troubling. His new found offense has given Brown a Boner. Hill at pf screws everything up, pushing Jamison to sf and Ebanks to sg. Play Hill at center and everyone else slides down to where they need to be. Hill's jumpshot may be a curse. (if those crap lineups were more than preseason tinkering)
Yeah I agree. I'm willing to give a pass for this game and for the preseason, but when the time comes to play games I expect to see Meeks in there at the 2 and while you can run Hill some at the 4, I expect him to play a 4/5 position, not a 4 position. I can understand the idea of playing him more, but if you really must do that, then just play Ebanks less. Meeks is the right person for the 2nd spot.
The wierd thing is that there's a commercial for TWC that shows an early depth chart and it clearly shows Meeks behind Kobe. The end of the rotation gets muddled with Jamison/Hill, but Meeks is the backup 2 and Ebanks the 3. I'm not going to get riled up over this, but I definitely am concerned.


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Bennett Center / Practice Management Center
Named in honor of Irving G. Bennett, OD '44, the Bennett Business and Practice Management Center currently provides educational programs and support services to students and alumni in the optometry program. Plans are currently underway to provide similar resources for our Audiology, Physician Assistant students and alumni.
The Center also assists all related healthcare professionals in securing a new associate or partner, selling a practice or in obtaining an optometric practice appraisal. A major benefit of the Bennett Center is a specialized placement network program, "Perfect EyeSite." This web-based program is available to all eye care practitioners seeking an optometrist, or for any student or practicing optometrist seeking an opportunity. A list of all job opportunity providers can be viewed at http://ecampus.salus.edu/placement.
For students, the Bennett Center is a unique resource, offering business and practice management electives, mentoring programs, counseling in debt management, professional career choices and a variety of job placement services, mainly through the University's Placement Website.
The Center encompasses a broad range of services such as resume writing, employment/contract review and personalized counseling. Its current mission for optometry students is to create an awareness and knowledge of the various methods of practicing their profession. The Bennett Center will assist students to focus on their goals as healthcare professionals for the achievement of career and personal success.
For more information, please contact:
Janice Mignogna, Director
Bennett Center for Business and Practice Management


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Now Foods, Beta Carotene, 25,000 IU, 250 Softgels
By Now Foods70 Reviews
Expiration Date:?Feb 2017
Expiration Date
The length of time for the expiration date or "best used before" date depends on the type of product, as well as the brand.
Perishable items (such as flax oils or certain probiotics) generally have shorter expiration dates. Although our warehouse is fully air-conditioned, these more fragile items are put in cold storage (freezer or refrigeration unit) for maximum freshness.
Our receiving department does its best to verify and then enter the correct expiration dates for all incoming products. However, discrepancies do occur from time to time. This being said, the exceptionally high turnover at iHerb ensures that our inventory is among the freshest in the industry.
Shipping Weight:?0.24 lbs (0.11 kg)
Shipping Weight
The Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: NOW-00312
- UPC Code: 733739003126
- Package Quantity: 250 Softgels
- Dimensions: 2 x 2 x 4.1 in, 0.2 lbs (0.09 kg)
- Volume Discount
Buy 2+
Save 10%
Buy 4+
Save 12%
Buy 12+
Save 15%
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Total: $18.68
Combo Discount: -$2.10
Together: $16.58
Product Overview
- Essential Nutrition
- Converted to Vitamin A in Body
- GMP Quality Assured
- A Dietary Supplement
Beta Carotene is converted into Vitamin A in the body. It performs antioxidant functions which regular Vitamin A does not. Beta Carotene and Vitamin A are essential for the maintenance of healthy epithelial tissue, which is found in the eyes, skin, respiratory system, GI and urinary tracts.
Suggested Use
As a dietary supplement, take 1 softgel 1 to 2 times daily, preferably with meals. Consider taking this product in combination with NOW Tru-E BioComplex, Alpha Lipoic Acid and Vitamin D.
Other Ingredients
Soybean oil and softgel capsule (gelatin, glycerin, water).
Contains no sugar, salt, starch, yeast, wheat, gluten, corn, milk, egg, shellfish or preservatives.
Store in a cool, dry place.
|Supplement Facts
|Serving Size: 1 Softgel
|Amount Per Serving
|% Daily Value
|Beta-Carotene (as pro-Vitamin A 15 mg)
iHerb Customer Reviews
My eyesight has sharpened dramatically. I use this in conjunction with lutein esters and Vitamin D-3. I was starting to need reading glasses and now I can read small print without struggling.
Great protection if you go into the sun. If you don't or in winter, this product still gives you a little healthy color.


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(NewsUSA) - A majority of Americans underestimate the prevalence and severity of heart failure, according to a survey by Boston Scientific Corp., a developer and manufacturer of medical devices.
Although heart conditions are the leading cause of hospitalization for Americans 65 and older, Boston Scientific's survey found that the majority of Americans believe otherwise. In fact, more than half believe that the common cold, flu, accidents, falls, infections and afflictions such as Alzheimer's disease top the list for hospitalizations.
The survey of more than 1,000 adults in the U.S. also found that most Americans have misconceptions about the functioning of heart disease. For instance, three out of four Americans incorrectly believe that heart failure occurs when blood flow is blocked or when the heart has stopped beating.
Heart failure is actually a condition in which the heart weakens and gradually loses the ability to pump blood effectively. Nearly 22 million people worldwide, including approximately 5.5 million Americans, currently suffer from heart failure, which experts say represents the most rapidly growing cardiovascular disorder.
"Heart failure will affect an increasing number of Americans in the foreseeable future," said John Russell, vice president and general manager of patient management at Boston Scientific's Cardiac Rhythm Management Group. "The public needs to know how to successfully manage it if they or a loved one are diagnosed with heart failure."
An increasing number of heart failure patients receive an implanted defibrillator device to help treat their problem. For these patients, symptoms can be tracked as often as daily via wireless technology. Boston Scientific's Latitude Patient Management system, for example, was the first product approved by the Food and Drug Administration for such wireless home monitoring.
Available as optional components to the Latitude system are a weight scale and blood pressure cuff, which also make use of wireless communications. Closely tracking blood pressure and weight are two of the key factors to monitoring heart failure once diagnosed, as increases in these health measurements can be indicators of a worsening condition.
The Latitude system keeps tabs on a patient's weight and blood pressure and can detect changes, which enables physicians to intervene earlier in a patient's care.
For patients, systems such as Latitude can offer daily assurance and peace of mind knowing that specific heart failure symptoms can be monitored on a regular basis from the convenience of their homes.


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This is the new Style Bytes website, where we will be showcasing not just technology, but technology with style and flair. You will soon find a fantastic array of deals and discounts while flipping through the new pages designed to appeal to your sense of color, style, and all things beautiful.
Why are we so pleased about this new announcement? Because you spoke, and we heard you. You wanted more options, more colors, and frankly, more products. The entire redesign has been a lot of fun for us as we create the new interface to respond to the new technology. So, get ready for the next wave to arrive! We're almost there!


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Recommended Just For You
Customer Raves & Reviews
Perfect for Halloween
I would recommend using 2 close up photos for this announcement. I used one photo that was taken up close and the other was a distance shot. Because the size of this announcement is smaller than I expected, it would have been best to choose 2 close up photos.