text:
Orally administered colonic purgative formulations and methods of its use for effecting partial or complete purgation of the colon in mammals, the formulations consisting of non-aqueous admixtures of monobasic, dibasic and tribasic sodium phosphates administered in tablet or capsule form in concentrations of from 0.01 to 0.85 grams per kilogram body weight. Preferred embodiments include the addition of binders, dispersants and buffers which do not adversely affect osmolality or effectiveness of the purgative formulations.
1. An orally administrable composition capable of dispersal in the stomach for inducing purgation of the colon in humans consisting essentially of an effective colonic purgative amount of at least one sodium phosphate salt wherein said composition is in a non-aqueous form selected from the group consisting of tablets and gelatin capsules and wherein one or more additives selected from the group consisting of buffering agents, dispersal agents and binding agents are optionally present.
2. The composition in claim 1 wherein said sodium phosphate salt is monobasic sodium phosphate and further wherein the concentration of said salt is from approximately 70 to 73 percent by weight.
3. The composition of claim 1 wherein said sodium phosphate salt is dibasic sodium phosphate and further wherein the concentration of said salt is from approximately 26 to 30 percent by weight.
4. The composition of claim 1 wherein said sodium phosphate salt is a mixture of monobasic sodium phosphate in a concentration range from approximately 70 to 73 percent by weight and-dibasic sodium phosphate in a concentration range from approximately 26 to 30 percent by weight.
5. The composition of claim 1 wherein said sodium phosphate salt is a mixture of monobasic sodium phosphate, dibasic sodium phosphate and tribasic sodium phosphate.
6. The composition of claim 5 wherein a buffering agent is present and is selected from the group consisting of magnesium hydroxide, aluminum hydroxide, calcium carbonate and magnesium carbonate.
7. The composition of claim 5 wherein a buffering agent is present and is selected from the group consisting of anhydrous lactose, microcrystalline cellulose and AC-DI-SOL.
8. The composition of claim 5 wherein a buffering agent is present and is selected from the group consisting of non-ionic detergents, mechanical adhesives and microcrystalline cellulose.
9. A method of inducing purgation in the colon of humans comprising the steps of:
(a) preparing a non-aqueous mixture consisting essentially of at least one sodium phosphate salt to form a purgative formulation;
(b) forming an orally administrable, dry dosage form of said purgative formulation;
(c) orally administering a pharmaceutically effective amount of said formulation to a human without dispersing said dry dosage form into water prior to administration; and
(d) allowing said administered dry dosage form to induce purgation.
10. The method of claim 9 wherein step (a) further includes the step of adding to said purgative formulation at least one member selected from the group consisting of buffering agents, dispersal agents and binders.
11. The method of claim 9 wherein said orally administrable dosage form is selected from the group consisting of gelatin capsules and tablets.
12. The method of claim 9 wherein the admixture formed in step (a) includes monobasic sodium phosphate and dibasic phosphate.
13. The method of claim 12 wherein said monobasic sodium phosphate is administered at rate of from about 0.4 grams per kilogram body weight to 0.85 grams per kilogram body weight.
14. The method of claim 12 Wherein said dibasic sodium phosphate is administered at a rate of from about 0.1 grams per kilogram body weight to 0.5 grams per kilogram body weight.
15. The method of claim 9 wherein said sodium phosphate salt is tribasic sodium phosphate.
16. The method of claim 9 wherein said sodium phosphate salt is dibasic sodium phosphate and at least one member selected from the group consisting of monobasic sodium phosphate and tribasic sodium phosphate.
17. A method of inducing purgation of the colon in mammals comprising the steps of:
(a) preparing a non-aqueous admixture of approximately 72% by weight monobasic and approximately 26% by weight dibasic sodium phosphate salts to form a purgative formulation;
(b) forming orally administrable tablets of said purgative formulation;
(c) orally administering said tablets to said mammal at a rate of from 0.1 to 0.5 grams per kilogram body weight of dibasic sodium phosphate; and
(d) allowing said administered dosage to induce purgation.
18. The method of claim 17 wherein step (c) is repeated at least once.
19. An orally administrable, nonaqueous composition capable of dispersal within the stomach for inducing purgation in the colon of humans comprising an effective colonic purgative amount of approximately 70 to 73% monobasic sodium phosphate, approximately 26 to 30% dibasic sodium phosphate and approximately 1 to 4% inert additives selected from the group consisting of tablet binders, dispersants and buffering agents, wherein said composition is in a form selected from the group consisting of tablets and gelatin capsules.
This application is a continuation of application Ser. No. 08/411,350, filed Mar. 31, 1995, now abandoned, which is a continuation of application Ser. No. 08/064,640, filed May 18, 1993, now abandoned.
This invention relates to colonic purgative formulations and, more particularly, to nonaqueous purgative formulation compositions which may be administered in capsule or tablet form for preparing the colon for surgical or diagnostic procedures.
In order to carry out a number of medical procedures, such as colonoscopy, radiographic examination and in preparation for patients undergoing bowel surgery, it is often critical that the colon be emptied as completely as possible. For example, one of the most essential conditions for obtaining satisfactory radiographs is that the intestines be cleansed sufficiently, particularly with regard to the elimination of gas from the colon. The same condition also applies when the colon is preoperatively prepared for surgery, or for diagnostic procedures such as colonoscopies, in which case it is also necessary to remove fecal waste materials.
In the past, in order to effect an emptying of the colon, water enemas have been previously employed wherein large quantities of water are introduced into the colon to induce emptying; the contents of the colon being expelled in the form of a suspension. It has however been recognized that the introduction of too large a quantity of water in enemas or too frequently administered enemas may be injurious to the patient. In view of the hazard and disadvantages associated with large volume water enemas, it has become know to introduce enemas of a hypertonic aqueous solution typically, of various salts to substitute for the large water enema. The advantage of these salt formulations is that they requires significantly less water volume in their administration. The effect of these hypertonic enemas is based on the increase of the osmotic pressure in the colon which, in turn, may have undesirable side effects, particularly, if the hypertonic solution diffuses through the wall of the colon and disturbs the fluid balance of the body. While an improvement over simple water enemas, this potential side effect limits the utility of these compositions.
Additionally, many enema compositions in aqueous solutions include a contact laxative agent causing peristalsis in the colon with sufficient concentration of laxation without the need for excessive amounts of water. Such compositions often include salt mixtures and may also chemical agents such as propylene glycol and non-ionic wetting agents such as polyether alcohols. The problems with these formulations, aside from the often problematic methods of enema administration, are incomplete evacuation of the bowels often requiring repeated administrations and the inclusion of certain chemicals which may have an irritating effect on the colonic walls. Furthermore, because it is often necessary to employ repeated washout enemas to clear the colon effectively, the potential for such chemical irritation is greatly increased.
More recently, a number of orally administered liquid pharmaceutical compositions have been developed for use as gastrointestinal washes for diagnostic purposes or for use as cathartic laxatives. Such preparations consist of aqueous solutions of polyethylene glycol and electrolytes such as sodium sulfate, sodium bicarbonate, sodium chloride and potassium chloride. These orally administered compositions are particularly useful in the rapid washing of the colon for diagnostic purposes. For example, when a powerful gastrointestinal wash is required, such preparations are generally administered in a quantity of about four liters, the composition being typically formulated according to the following: polyethylene glycol 59 g., sodium sulphate 5.68 g., sodium bicarbonate 1.69 g., sodium chloride 1.46 g., potassium chloride 0.745 g. and water to make up one liter. Laxation and relatively thorough evacuation is often significantly improved over enema formulations, and generally without the problems often encountered with enema administrations.
The advantages of using these preparations over other orally administered preparations are a drastic reduction in wash time (from 3-2 days to 4-5 hours) and the minimization of water and electrolyte losses. The advantages which these types of solutions provide are derived from two essential characteristics of the preparation, namely, its isoosmoticity with the physiological liquids, and the balance of the ion species in solution, so as to compensate the transport mechanisms which regulate gastrointestinal absorption. These characteristics result in substantial isotonicity between the preparation and the intracellular and extracellular fluids at the tissues of the digestive tubes walls.
Commercially available product embodying these formulations typically utilize a polyethylene glycol formula serving as a non-absorbable osmotic agent with a mixture of electrolytes for replenishment, so that patients do not become dehydrated. Patients are required to ingest a significant amount of volume for purgation which may include a one eight ounce glass every ten minutes for a total of one gallon of fluid. Due to the fact that the volume is so high, use of this type of formulation is frequently associated with a tremendous amount of distention and significant amounts of nausea.
Another serious drawback of these know preparations is their decidedly unpleasant, bitter, noticeably saline taste which in the more sensitive patients can lead to vomiting thereby preventing ingestion. However, as the requirement of solution isotonicity is necessary to obtain the aforesaid advantages, the introduction of water soluble adjuvants, for example, to alter taste, must be avoided. Even the most common natural sweeteners such as glucose, fructose, saccharose, and sorbitol could change the osmolarity of these solutions and the inclusion of such adjuvants are generally expressly prohibited. Moreover, even altering the unpleasant taste of these preparations with artificial sweeteners or flavorants in these commercial preparations must be avoided as they could also alter the critical isotonicity.
Furthermore, in the aforesaid preparations of the known art, it is also well recognized that the addition of appreciable quantities of substances which can be fermented by the intestinal flora should be avoided. This is because gas could form which could be extremely dangerous in the case of colonoscopy with electrocautery.
In an attempt to avoid the problems associated with the high volume types of preparations, other investigators have utilized ingestible preparations which consist of aqueous solutions of phosphate salts. The aqueous phosphate salt solution produces a tremendous osmotic effect on the intra-luminal contents of the bowel and therefore, evacuation of the bowel occurs with a tremendous increase in the influx of water and electrolytes into the colon. This has been developed for the express purpose of decreasing the volume required in colonic purgations. One such preparation basically is comprised of 480 grams per liter monobasic sodium phosphate and 180 grams per liter dibasic sodium phosphate in stabilized buffered aqueous solution and is sold under the brand name Fleet� Phospho�-Soda. Patients are typically required to take two three ounce dosages of this preparation, separated by a three hour interval for a total of six ounces, which is a significant reduction compared to for the example the 128 ounces required by other high volume preparations.
The major short-coming of such concentrated aqueous phosphate solution administration is however, that the aqueous solution is extremely unpalatable, so much so that the recommended dosage form is administered ice cold so as to minimize the objectionable saline taste. Often patients complain of severe nausea and vomiting, possible secondary to the extremely salty taste of the preparation. Frequently, patients cannot even tolerate the ingestion of this preparation at the initial dose and often the second dose becomes even more problematic due to the unpalatable extremely salty taste, even when the taste is partially masked by the use of flavoring agents. Thus, while concentrated purgation solutions represent a slight improvement over other methods of inducing purgation, the short comings of these solutions are readily apparent.
From the foregoing, it can be seen that it is desirable to have an orally administered colonic purgative formulation which may be easily and conveniently administered and which avoids the problems and objectionable tastes of known formulations. It can also be seen that it is desirable to have such a purgative formulation which may be administered without large volumes of water necessary in conventional formulations and which avoids other potentially irritant chemicals or chemicals which could effect osmolality.
It is an object of the present invention to provide an easily and conveniently administered dosage formulation of an effective colonic purgative.
It is also an object of the present invention to provide such a formulation which may be used as a purgative or as a laxative according to the dosage formulation.
It is yet another object of the present invention to provide a colonic purgative formulation which avoids the unpleasant salty taste of such know formulation.
It is still another object of the present invention to provide a method of administering a colonic purgative with a minimum amount of patient discomfort.
Yet another objective of the instant invention is to provide a formulation for colonic purgatives which avoids the addition of other components which may be broken down by intestinal flora.
These and other objects and advantages of the invention will be evident after reading the following description.
The present invention relates to a colonic purgative formulation in which are contained pharmaceutically active amounts of sodium phosphate salts in a stable, nonaqueous tablet dosage form. In one preferred embodiment, the dosage formulation comprises a mixture of monobasic sodium phosphate and dibasic sodium phosphate. In this embodiment, the formulation is an admixture of approximately 0.4 to 0.85 grams per kilogram body weight of monobasic sodium phosphate and 0.1 to 0.5 grams per kilogram body weight dibasic sodium phosphate which may be conveniently administered to the patient in a tablet or capsule form. Preferably the patient dosage is 0.62 grams per kilogram body weight of monobasic sodium phosphate and 0.23 grams per kilogram body weight dibasic sodium phosphate.
In other preferred embodiments, the formulation may be predominately or exclusively dibasic sodium phosphate within the above ranges and may further include tablet binders, dispersants and/or buffering agents. Further, in other preferred embodiments, the formulation may include tribasic sodium phosphate in addition to either monobasic or dibasic sodium phosphate, or both, within the above ranges.
The physiology of intestinal secretion and absorption is generally well known as reflected in the reported literature. It is quite clear that intestinal absorption of sodium and water occurs largely in the small intestine. Approximately nine liters of gastrointestinal fluid is produced per day from the saliva, stomach, liver, pancreas and proximal small intestine and all but one to one and one half liters is reabsorbed by the small intestine before this passes the ileo-cecal valve into the colon. The colon the efficiently reabsorbs approximately 80% of the residual fluids culminating into a normal stool output of approximately 200 milliliters per day. The majority of sodium and water reabsorbed by the jejunum is due to the high permeability of the membranes of the cells of the small intestine along with active sodium pumping from the cell into the interstitial fluid, culminating eventually into absorption into the capillary system. The net flux of sodium and water from the lumen into the blood is dependent upon many different factors. For example, changes in the intra-luminal osmolality of the proximal intestinal contents will promote a decrease in reabsorption of sodium and water and a net secretion of water into the lumen, ultimately producing diarrhea. As the osmolality of intra-luminal fluid increases, this produces a transmucosal flux of water from the capillary and interstitial fluid into the lumen in an effort to produce isotonicity. This tremendous flux of water that occurs with highly osmolar intra-luminal substances brings along with it sodium via a solvent drag phenomenon, thusly, which increases intra-luminal water to tremendous degrees. The amount of intra-luminal water increases directly proportional to the osmolality of the intra-luminal fluid. Applicant's invention is believed to function by creating an increase in intra-luminal fluid of the small bowel to a significant degree allowing for a net secretion of sodium and water into the lumen, and thus allowing for tremendous fluxes of water to be present within the gastrointestinal lumen, producing a purgative effect.
In a preferred embodiment, Applicant's invention consists of a dry admixture of monobasic and dibasic sodium phosphates in an anhydrous state. One hundred grams of the formulation may be prepared by combining approximately 70-73% weight of pharmaceutical grade anhydrous monobasic sodium phosphate with approximately 26-30% weight of pharmaceutical grade anhydrous dibasic sodium phosphate in a ribbon blender or other similar mixing apparatus to effect complete mixing of the components. Additional constituents such as tablet binders, dispersants and/or buffering agents in the range of approximately 1 to 4% weight, may also be included in the admixture.
In other preferred embodiments, the amount of monobasic sodium phosphate may be substantially reduced or eliminated in its entirety. In these formulations, dibasic sodium phosphate or tribasic sodium phosphate may be used alone or in combination as the principal or exclusive form of phosphate in the formulation, while maintaining complete purgative effect. Upon ingestion, phosphate salts cause a tremendous amount of water to be drawn into the gut. This influx of water causes an increase in intraluminal pressure, which in turn exerts a mechanical stimulus causing an increase in intestinal motility. The purgative effect of the phosphate salts appears to be proportionately related to the increase in the anionic state of the phosphate salt and may be differentiated in their mode of action from other salt formulations which are capable of producing a limited cathartic effect. One such salt, magnesium sulfate, for example, exerts its effect via the magnesium cation which causes hypermotility of the gut.
The admixture is formed into an easily administered dosage form, such as tablets or into capsules by methods well known in the art. As used herein, the term admixture refers to a formulation which includes at least one phosphate salt and at least one other component including other phosphate salts or other additives as disclosed herein. When forming tablets containing the purgative formulation, it will be appreciated that the salts can be compressed into a uniform mixture and can optionally include inert diluents such as a tablet binder. Preferably, the tablet binder is a pharmaceutically acceptable binder and is one which produces no appreciable osmotic effects. Examples of useful binders include non-ionic detergents such as Pluronic F-68 (a trademark of BASF-Wyandotte Chemicals, defined as a condensate of ethylene oxide with a condensate of propylene oxide and propylene glycol) and mechanical adhesives such as polyvinyl alcohol and sodium carboxymethylcellulose. Microcrystalline cellulose (MCC) may also be used to enhance the compactability of the phosphate salts into the tablet or capsule form.
In another preferred embodiment of the instant invention, the tablet or capsules may also include inert dispersal agents which will facilitate dissolution of the tablet or capsule contents in the stomach of the patient. Preferably, the dispersal agent is a pharmaceutically acceptable dispersant and is one which also produces no appreciable osmotic effects. Examples of acceptable dispersants include microcrystalline cellulose (which is also useful as a compacting agent) and anhydrous lactose. A preferred dispersal agent is AC-DI-SOL, a cross-linked starch.
In another preferred embodiment of the present invention, the preferred composition may also include a buffering agent to minimize any acid imbalance which may accompany ingestion of the purgative formulation of Applicant's invention. Suitable buffering agents include magnesium hydroxide, aluminum hydroxide, calcium carbonate and magnesium carbonate.
An important characteristic of the colonic purgative formulations of the instant invention is that they function effectively as purgatives when administered in low volume dosages, as compared to known formulations. In this manner, 5 to 12 tablets, and preferably 7 to 10 tables per dose, depending on tablet size and weight, with only fluids necessary to assist in swallowing the tablets, will provide complete purgation. The dosage may be administered in a single application but is preferably administered in two applications separated by approximately 2 to 4 hours. Use of the formulations of this invention in tablet form effectively removes the colonic contents without requiring injestion of large quantities of water. Conventional purgative products historically and currently available on the market have had to employ much greater liquid volumes in order to obtain the desired result.
Another important characteristic of the instant formulations is that at lower dosages they will function effectively as laxatives. Concentration ranges for laxative effect are from approximately 0.025 to 0.1 grams/kg body wt. and preferably are from 0.05 to 0.07 grams/kg body wt.
The foregoing description is illustrative of the preferred embodiments shown. It is not intended to limit the present invention to the specific formulations shown and described, but instead it will be appreciated that adaptations and modifications will become apparent from the present disclosure and are intended to be within the scope of the claims.
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are you shooting cast lead bullets? or are you shooting copper jacketed bullets? modern commercial jacketed ammo are very hard and shouldnt produce leading at all.
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The Ard-Vark. Arduino compatible box that allows control of servos and motors fast. No soldering. No study.No nerd degree needed
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- by KerwinLumpkins
- Collected by one user
The Ard-Vark is a simple to use box that allows you to drive servos or DC motors and get input from sensors, and easily control on your smart phone. It is a project now at http://www.kickstarter.com/projects/694850905/the-ard-vark I made one of these for myself because I was tired of cobbling together pieces to get simple wireless control of projects. I frequently do a simple little project where I add a servo motor or two to something for fun. Like making a stuff animal move in a co-worker's cube to scare them. But every time I did one of these little projects, I had to re-invent several wheels. Finally, I did a design, made a circuit board and wrote the code and wrote the code for a smart phone app to control it. It occurred to me that others might like to have this kind of stuff simplified for them, so I put it on kickstarter.com to see if I could get funded to make it enough quantities to make it relatively cheaply as a product. The wifi control bit was not simple. I'm an electrical engineer and do know what I'm doing. Yet, it took me several hours to get a project working whenever I wanted to do this stuff. For a beginner, it would take weeks. If you would like to concentrate on building and creating, not on learning electronics, you should give this a look. If you don't want to pre-order one at a price of $105 with shipping, then maybe you would consider giving $1, or $10 and get a "I kickstarted an Ard-Vark" hackey sack or $25 for a way cool T shirt. Thanks, Kerwin
good luck with your device
good luck with your device ... looked further and checked out the kickstarter site and overall found it very interesting, lots of different projets looking for and getting support from CNC machines to 3D printers,
I'll take that as a compliment birdmun :-)
I actually think this is a great little device for its target group. What I would add are a couple of solid state relays to handle bigger loads and then you could control lots of stuff via your wireless network. As it's built on Arduino it would be very hackable to the more advanced user. But for that to be of any use he needs to have a header for all the IO pins.
I don't know if the plan is to build on top of a regular Arduino or if he will make his own custom board. But I hope it will be open source (hardware/software).
Again, we are probably not in the target group and a price of $ 105,- doesn't seem that bad. A Arduino Uno might cost you $30,- the WiFi module $35,- a Arduino protoboard $10,- a sturdy project box $20,- So for a user that doesn't want to figure out all the parts and how to hook them up and have no interest in programing, this is not a bad price at all.
That said, I have no problem with him asking for support in here as there are other that are advertising their products as well.
Just buy a robot kit like
Just buy a robot kit like the Asuro or a complete robot and be happy with it if you're too lazy too build a chassis. No need to spend any money on this.
So it takes away all the fun
So it takes away all the fun of learning about robots :(
Funny thing, but are you
Funny thing, but are you posting a project on LMR just to beg for money?


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The Presidio Trust awarded MV Transportation Inc. a contract to provide the operation and maintenance services for the Presidio Shuttle, which serves the California cities of San Jose, Hayward, Livermore and Vallejo. MV also announced that the city of Capitola, Calif., chose to allow the company to continue providing management and operation services for its weekend Summer Shuttle service.
Under the terms of the eight-year Presidio contract, MV began providing service on March 1, 2009, through the use of more than eight CNG vehicles. The company will also provide all operations and maintenance, as well as several of its proprietary real-time technology tools, comprehensive vehicle maintenance program and extensive vehicle operator training program.
Meanwhile, the Capitola contract, which covers five years and is worth $95,000, will have MV continue providing operation and management services for the shuttle program, with the new contract beginning in May.
Based in Fairfield, Calif., MV is a private provider of paratransit services and the largest privately-owned transportation contracting firm in the U.S. The company employs more than 12,000 transit professionals and operates more than 190 paratransit, fixed-route, shuttle and Medicaid contracts in 24 states, the District of Columbia and Canada.
At various times, the county paid too much when prices should have decreased, missed deadlines to seek damages from its contractor for alleged substandard performance and failed to accurately calculate the most basic of contract functions — cost of living adjustments.
The new contract, which begins July 1, enables city of Independence riders with disabilities who depend on paratransit services would only need to make one phone call to get transportation.
The driver was spotted driving poorly, before slamming his brakes, causing a 90-year-old passenger to fall to the floor. According to the arrest report, the driver's blood alcohol content was more than three times the legal limit.
CarFreeAtoZ plans trips in a manner similar to Google Maps or Mapquest, but it combines different transit options, such as walking, using the Metro and biking.
Models coming on the market or in development can climb stairs, turn tight corners, make their way over trails, and are lighter and easier to maneuver than earlier generations.
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text:
Includes these downloadable MP3 audio files:
Practice of Opening
Giving and Receiving
Includes these downloadable MP3 audio files:
Calm Mother
Sitting Into Energy Body
Breast-Breathing, Breath Feeding
Practice Of Healing
Calm Parents
Includes these downloadable MP3 audio files:
Practice of Healing
Vase Breathing
Reversal of Suffering
Thomas R. Verny, M.D.
Thomas R. Verny, M.D.
Sandra Bardsley
I grew to love CalmBirth® meditation and noted its great value for mother, baby, and the partner. I love how it works on a quantum physics/energy level as well as meditation science to access energies that are invisible, but very much present. I love how it draws the woman into her own experience and power, instead of using hypnotic techniques to move away from herself and her own power. Indeed, mother and baby form a unified dyad and I see the CalmBirth®/Calm Mother meditation practices producing a firm foundation for greater health and stability for both members. I saw it build a stronger bond between partners, thus ensuring the baby a safer family unit in which to grow.
Barbara Findeisen
Calm Birth®, A new Method for Conscious Childbirth by Robert Bruce Newman, successfully bridges ancient feminine healing wisdom and meditation to contemporary birth practices. With a broad overview of the history of birth, and deep personal knowledge of meditation, the author presents practical methods which have the power to redefine birth from a "medical problem" to a natural human process that blesses life itself. With the possibility of safe and calm birth, bonding and trust occur easily and naturally and spread to family, community, and beyond. This book is a must for anyone interested in childbirth.
Wendy Anne McCarty, Ph.D., R.N.
Robert Newman's Calm Birth® program provides couples and professionals alike a beautiful map, a method and a philosophy, to prepare for birth in a way that honors and helps them connect with their deepest innate nature and abilities. Meditation methods in Calm Birth® opens up a vista of hope, empowerment, inner wisdom, and confidence to trust the ability to birth naturally. Families' stories gracefully illuminate how Calm Birth® ignites transformational experience in life, pregnancy, birth, and beyond. I hope you read this book.
David Chamberlain, Ph.D.
Calm Birth® will help parents see pregnancy as a master path, an opportunity to support fuller development of their babies, and perhaps to provide them with the ultimate opportunity to give human evolution a boost in the right direction.
William Emerson, Ph.D.
Childbirth in America is in trouble. But that is not the major message of this wonderful book, just the opposite. The author, Newman, acknowledges the "medicalization of birth" and its numerous implications. But more so, Newman offers a program called CalmBirth® as a potent solution. It follows the tradition of the earlier pioneers such as Dick-Read, Lamaze, and Bradley in offering practical and ground-breaking solutions to the stresses of birth, but exceeds their efforts by a wide margin. This is essential reading for birth and other professionals who handle birth-related impacts, such as pediatricians, pre and perinatal practitioners, childbirth educators, doulas, midwives, nurses, and others. CalmBirth® is essential reading for expectant parents who can promote the health of their babies and prevent unnecessary negative impacts. And the book is magnificent reading!
William Emerson, Ph.D.
Christiane Northrup, MD
Calm Birth® is a sublime gift to all of us. It contains the blueprint for reconnecting with birth wisdom on all levels. Reading through this book and doing the practices will transform the birth process and imprint a peaceful beginning in both mother and child. The positive impact of this on society can't be overestimated.
Ari and Ivory
Robert sent us an email with a written version of Womb Breathing and from the beginning Denise began breathing light and life into our little boy. During meditation I would do the same. It was such a wonderful feeling to be intending freedom and energy towards my unborn child. I knew God was sending us this child as a gift, wrapped in Denise, already in a perfect state. This was an amazing, calming sensation ...
Maria Ocanto
Logan Jaymes
Nicholas Shapira
Nicholas Shapira
Cooper William
Womb Breathing helped me work with the labor process instead of fighting it. This helped me a lot. I think it would have gone on longer if I didn't do Womb Breathing. It was noninvasive and empowering.
CalmBirth® was helpful for me and I think it was helpful for Cooper also. He's a mellow baby. . . I think that's a benefit from CalmBirth®. - Molly
Luci Capri Formisani
Ellis Grace
At 22 weeks pregnant I went to the doctor for an ultrasound, excited about the possibility of finding out whether I was having a boy or a girl. Instead I discovered that I had almost no cervix left. Rather than being in the average range of 3-5 centimeters, my cervix was internally dilated and only 2 millimeters long. I knew this meant that the odds of carrying my baby to term were not in my favor. I was immediately admitted to the hospital ...
Ethan's birth was the most amazing experience. I feel so blessed to have had such a wonderful birth. Matt and I are really lucky to have found Judith and Eden (our doula), both of them Calm Birth teachers. Having Eden with us through labor and delivery made all the difference in keeping my birth calm. Between all the support, the great hospital staff and Calm Birth, I feel that I was as ready as I could ever be to bring Ethan, my first child, into this world. I am so thankful for the wonderful birth and I give thanks every day for such a fantastic child! - Jeanne
All Class Photos Taken by Judith Halek


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Just got the head redone in my daughter's '99 Eclipse rs 2.0. Can someone tell me the torque sequence or tell me where to find out?
5 Answers
I don't know how much torque the Mitsu head takes. The sequence starts at the center and goes outward in a spiral. Go almost tight for the first pass and come around full torque on the second pass.
yes as tenspeed stated like this.
its says on the first pass tighten to 15 ft/lbs. Then an additional 90 degrees, then another 90 degrees.
1 out of 1 people think this is helpful.
Dsmtalk.com or dsmtuners.com
Be sure to use new head bolts on reassembly.
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Deek Photographer
Janice LynnModel Female Philadelphia, Pennsylvania, US My MM URL: http://www.modelmayhem.com/janicelynn
Mayhem # 2892160
About MeHello Model Mayhem Family!!
Thank you for checking out my profile and portfolio. My name is Janice Lynn, and I am born and raised in West Philadelphia. I'm an aspiring actress/model. Fashion has been an inspiration to me. I started to develop that passion when I was a teenager. I have some experience with modeling classes, fashion show, beauty pageant, local photoshoots, film and stage performances and other occassional events.
Currently, I graduated at Community College with an Associate's Degree in Theatre Arts. I'm still updating my portfolio. I enjoy posing for the camera/s I'm looking forward to meeting with professional photographers, models, muas, wardrobe stylists, and many more.
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Looking for Advice on Mods
I'm driving a 1999 Dodge Ram 1500 Sport, and right now I'm trying to decide whether to sell my truck and upgrade to something else, or to upgrade my current truck to make it more enjoyable. As part of this decision, I'm looking for advice and input from fellow ram drivers on what upgrades are worth paying for.
I know that I want to uprgrade the suspension, plugs wires and distributor cap, air intake, and possibly new exhaust. So I'm looking for advice on quality products in the those categories. In addition, anything else you guys think is worth paying for.
Thanks for the help.
I'd consider the cost of the mods and the cost of a newer truck in order to make the decision as which way to go. The other thing is, how many miles does your Ram have on it? Any issues (mechanical, rust, etc) with it?
Basically figure out the best use of your money.
well, if you really wanna wake up your truck and make it more enjoyable for you, get an exhaust first. You'll feel the difference, and it sounds a lot better.
I agree with RB . Whats the overall condition of the truck ? Is it worth modding or doing repairs to it to make it last and look good for years to come . If it's in good shape then I would definitely look into exhaust , cai , and a tuner . Tuner will run roughly $300.00 . A cai $225.00 - $300.00 . Exhaust pretty much depends on what you want to do . Could range anywhere from a couple hundred dollars to a thousand dollars , but thats with a wide range of possible exhaust combinations .
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The high school music teacher from Navarra, Spain, said his images of storms
in the Spanish desert owe as much to luck as they do technical skill. "Storms
are frequent in Navarra in August and September," he said. "I had never
taken photos of lightning before and these were my first attempts. To watch
the storms is amazing because you can feel the power of nature and you feel
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I think we can all agree with this post. Tuxedo Mask is so dreamy...
Fellow Internet poster, your reputation precedes you...
People who think about TV too much must be really happy people. Here I am sitting here depressed and not thinking about gay stereotypes in a children's show. I wish I had this guy's life.
New rule: you can't dislike any show with an Asian person in it. Sorry, it's the law.
Eh, I think Olbermann gives Oscar the Grouch a run for his money. And tonight, my special comment on the letter T.
Elmo is like the Adam Sandler of Sesame Street and every other character is like, uhm, Tim Meadows.
You know, this post may sound stupid to you, but Matt Groening had a bug up his ass about Homer strangling Bart too so fuck both of them.
It's not TV, it's art.
Did Louis C.K. jerk off in front of two female comics? And why are these ladies squandering an opportunity to learn from a comedy legend?
Elliot said my breakup must have been due to the sweater curse, an unexplained phenomenon where anyone who gives their significant other a hand-knit sweater gets dumped. The only way to break the curse, Elliot said, was to destroy the sweater.
Just in time for Shark Week, a barrelful of fishy cinematic horrors!
Goon-made alternate Confederate and 'Don't Tread on Me' flags: Put THAT on your pole and salute it!
This game is so busted th- *interrupted by smart aleck Joker and Batmobile sequence*
There are hundreds of stories happening on the World Wide Web. Let me tell you, that's a very wide web. Our goal at Weekend Web is to bring you the latest headlines from around the Internet. We go into the very bowels of message boards everywhere and find out what millions of online citizens have to say.
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VIEWS: 10 PAGES: 17 POSTED ON: 8/1/2010 Public Domain
Swine Flu Information Resources flu strain
pH1N1 Flu Virus (Human Swine Influenza) Information Resources Current as of September 11, 2009 at 4pm Highlights • CDC says H1N1 virus has claimed 47 children's lives • PHAC releases Pandemic Vaccine Prioritization Framework • H1N1 Vaccines Safe, Immunogenic in Single Dose • HPA - Preparing for swine flu. Guidance and resources for schools, early years and other educational settings • Pandemic influenza: a priority for the neurological community • WHO Pandemic (H1N1) 2009 briefing note 10 Measures in school settings • Three new articles from NEJM on vaccine safety Updated Friday, September 11, 2009 at 4pm Page 1 Contents Events Updates by Jurisdiction Ontario Ontario Ministry of Health and Long-Term Care (MOHLTC) Ontario Agency for Health Promotion and Protection (OAHPP) Canada Public Health Agency of Canada (PHAC) United States Centers for Disease Control and Protection (CDC) Center for Infectious Disease Research & Policy Other US Sources Europe United Kingdom's Health Protection Agency (HPA) UK Department of Health European Centre for Disease Control and Prevention (ECDC) European Union International World Health Organization (WHO) Pan American Health Organization (PAHO) Australia and New Zealand Other Resources Consumer Health Information Resources Research Articles Clinical and Public Health Practice Tools Historical Resources Travel Advisories Updated Friday, September 11, 2009 at 4pm Page 2 Events Current / Upcoming [SEP 23] Planning for an Influenza Pandemic in the Home Health Care Sector (Web Conference) To showcase resources that can support emergency preparedness planning within the home health care sector, particularly in the face of a potential H1N1 pandemic, AHRQ will host a Web conference, Planning for an Influenza Pandemic in the Home Health Care Sector, on September 23, 2009. Emergency preparedness planners and providers, as well as Federal, State, and local community health and home care planners, are all invited to attend. This event will feature a panel discussion and insights from home health care emergency preparedness planners representing different perspectives: health system, government, health policy, and industry. [SEP 22-23] Keeping the World Working During the H1N1 Pandemic: Protecting Employee Health, Critical Operations, and Customer Relations (Minneapolis, MN) We're convening pandemic response experts in public and private sectors who know their business and are ready to act. By participating in this summit, you will: • Interact with pressure-tested peers willing to share what's worked for them • Get the straight story on vaccines, antiviral drugs, and infection control • Benchmark pandemic HR policies on sick leave, pay, travel, & HIPAA • Identify work-around tactics to deal with supply-chain shortages • Turn guidance into actions that will keep you in business • Go back to work with best-of-class knowledge and resources [SEP 10-11] Global Health Security Inititative: Special Ministerial Meeting on Pandemic (H1N1) 2009, hosted by the European Commission in Brussels, Belgium. Archived [ARCHIVED] U.S. DHHS H1N1 Video Briefing archive September 8: Rear Admiral Anne Schuchat (CDC) gives a briefing on updated recommendations on the use of antivirals as well as an update on the H1N1 (swine) flu. [ARCHIVED] Know what to do about the flu : webcast series from the U.S flu.gov September 9: Parents and Child Care Providers August 27: Pregnant women and new moms August 20: Business guidance August 04: H1N1 Response status update [SEP 2-3] Severe H1N1 Disease: Preventing Cases, Reducing Mortality Winnipeg, Manitoba, Canada Updated Friday, September 11, 2009 at 4pm Page 3 Ministry of Health and Long-Term Care (MOHLTC) [SEP 8] Ontario Influenza Bulletin: Surveillance Week 34 (Aug 23 – 29) For the surveillance period of August 23 to August 29, 2009: • Overall, influenza activity in Ontario was similar compared the previous week. • However, the rate of influenza-like illness (ILI) in patients seen by sentinel physicians is above what is expected for this time of year, particularly for those less than 19 years of age. • Slightly fewer patients reporting influenza-like symptoms consulted sentinel physicians this week than the previous week. • All the health regions reported sporadic activity. • There are 4,062 confirmed cases of H1N1 flu virus reported through the integrated Public Health System (iPHIS) as of August 29, 2009. As of September 3: • 23 deaths have been reported among confirmed H1N1 cases. • 19 people who have the H1N1 flu virus were in hospital as of 8:30 a.m. on September 3, a number of whom have underlying medical conditions. 347 other people have been hospitalized and have since been discharged. • A fewer number of hospitalized cases were reported this week compared to last week. No new deaths among cases was reported this week. [SEP 3] The H1N1 Flu in Ontario: A Report by Ontario's Chief Medical Officer of Health See also: Media release about the report [ARCHIVED] Previous MOHLTC updates and news conference video footage Important Health Notices Last H1N1 update was August 18 Ontario Agency for Health Protection and Promotion (OAHPP) [SEP 10] Weekly Synthesis of Surveillance Information, Literature & Government Updates (week ending Sep 4, 2009) [ARCHIVED] Swine influenza outbreak page Public Health Agency of Canada (PHAC) PHAC issues national updates on H1N1-associated deaths on Tuesdays and Thursdays at 4 pm, and will report regularly on any unusual outbreaks or clusters of illness. [SEP 11] Pandemic Vaccine Prioritization Framework [SEP 10] Deaths associated with H1N1 flu virus in Canada One death in Quebec, of an out-of-country resident, reported since the previous update. The cumulative total of H1N1 deaths is 74 as of September 10. Updated Friday, September 11, 2009 at 4pm Page 4 [SEP 10] News release : Government of Canada Takes Further Measures to Help Reduce H1N1 Transmission in Communities [SEP 10] Individual and Community Based Measures to Help Prevent Transmission of Influenza-Like-Illness (ILI) in the Community, Including the Pandemic Influenza (HINI) 2009 Virus [SEP 09] Public Health Guidance for the prevention and management of Influenza-like-illness (ILI), including the Pandemic (H1N1) 2009 Influenza Virus, related to mass gatherings [SEP 09] FluWatch findings for Week 34 (week ending Aug 29) • The overall trend of influenza activity has slightly decreased this week compared to last week. In fact, the ILI consultation rate is nearly within the range of expected level at this time of the year. The peak period of Pandemic (H1N1) 2009 occurred between weeks 22 to 24 (May 31, 2009 and June 20, 2009). • The intensity of Pandemic (H1N1) infection 2009 in the population is low with only a small number of hospitalizations (n=13) and one death reported this week. As of August 29, 2009, a total of 1,454 hospitalized cases, 283 cases admitted to an intensive care unit (ICU) and 72 deaths had been reported since the beginning of the pandemic. • While the Pandemic (H1N1) 2009 has spread to all provinces and territories, approximately 90% of hospitalized cases and more than 85% of deaths are reported from 4 provinces (AB, MB, ON, QC). Hospitalized cases were reported from AB, MB and ON this week. • Children under 2 years of age, pregnant women, persons under 65 years of age with underlying medical conditions and Aboriginal populations have higher rates of hospitalizations and greater risk of severe outcomes (ICU admissions and deaths). Aboriginal communites have more pregnant women, young children, and underlying chronic disease than the general Canadian population, which may explain the disproportionate number of severe cases in this population. [ARCHIVED] Previous PHAC documents and updates Centers for Disease Control and Prevention (CDC) and US Department of Health and Human Services CDC reports the total number of H1N1 hospitalizations and deaths each Friday. [SEP 8] Interim Guidance for State and Local Health Departments for Reporting Influenza-Associated Hospitalizations and Deaths for the 2009-2010 Season [SEP 8] Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season [SEP 8] Q&A: Revised Recommendations for the Use of Influenza Antiviral Drugs Updated Friday, September 11, 2009 at 4pm Page 5 [SEP 4] Preparing for the Flu: A Communication Toolkit for Child Care and Early Childhood Programs [SEP 4] Technical Report for State and Local Public Health Officials and Child Care and Early Childhood Providers on CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season This Technical Report provides explanations of the strategies presented in the CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season and suggestions on how to use these strategies. The guidance is designed to decrease exposure to seasonal flu and 2009 H1N1 flu and limit the disruption of the essential service early childhood provides to families [SEP 4] CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season This document provides guidance to help decrease the spread of influenza (flu) among children in early childhood programs and among early childhood providers during the 2009-2010 flu season. [SEP 4] 2009 H1N1 Flu: U.S. Situation Update [SEP 4] 2009 H1N1 Flu: International Situation Update [SEP 4] Weekly FluView Map and Surveillance Report for Week Ending August 29, 2009 [ARCHIVED] Previous CDC documents and updates Other US Sources [SEP 11] Harvard Opinion Research Program, Harvard School of Public Health: BUSINESS PREPAREDNESS: NOVEL INFLUENZA A (H1N1) July 16-August 12, 2009 [SEP 09] NIAID Launches 2009 H1N1 Influenza Vaccine Trial in Pregnant Women [SEP 3] Institute of Medicine of the National Academies: Respiratory protection for healthcare workers in the workplace against novel H1N1 Influenza A [SEP 3] Assessment of the of the 2009 Influenza A (H1N1) Outbreak on Selected Countries in the Southern Hemisphere [AUG 27] SHEA, APIC, ACOEM, and IDSA Joint Position Statement: Healthcare Personnel at High-Risk for Severe Influenza Illness:Care of Patients with Suspected or Confirmed Novel H1N1 Influenza A Updated Friday, September 11, 2009 at 4pm Page 6 Center for Infectious Disease Research and Policy [SEP 10] Early results suggest 1 dose of H1N1 vaccine may be protective Preliminary clinical trial results suggest that pandemic H1N1 vaccines made by Novartis and CSL Ltd. will provide protection in adults with just one dose. [SEP 10] Experts push hard for early seasonal flu vaccination The National Foundation for Infectious Diseases (NFID) discusses uncertainty surrounding the pandemic flu strain and the complexity of launching two vaccine campaigns. [SEP 10] CDC says H1N1 virus has claimed 47 children's lives Forty-seven children died of confirmed 2009 H1N1 flu between Apr 26 and Aug 29, the CDC reported in an MMWR early release [SEP 10] Resistant H1N1 strain found in summer camp cabin mates A report in the Sep 11 MMWR describes the first known instance of oseltamivir- resistant H1N1 infection in patients with epidemiologic links. [SEP 10] Colleges report big increase in flu-like illness cases The American College Health Association, in its surveillance report for the week ended Sep 4, reported 4,974 flu-like illness cases at 236 participating schools, a 105% increase from the week before. [SEP 10] EU official says early H1N1 vaccine trial results promising The head of the European Union's drug regulatory agency said early clinical trial results for pandemic H1N1 vaccines in Europe look promising, Reuters reported [SEP 10] NIAID launches trial of pandemic vaccine in pregnant women Federal officials yesterday announced the start of the first clinical trial of a pandemic H1N1 vaccine in pregnant women, who face an increased risk of complications from the virus. The trial is to enroll up to 120 women in the second or third trimester of pregnancy, the National Institute of Allergy and Infectious Diseases (NIAID) said. The women will receive two doses, 21 days apart, of a Sanofi Pasteur vaccine. NIAID Director Anthony Fauci said interest in the trial has been "extraordinary." [SEP 10] Harvard survey finds business preparedness gaps Only one third of businesses responding to a national survey said they could sustain operations if half their employees were absent for 2 weeks because of pandemic H1N1 flu, researchers from the Harvard School of Public Health reported today. Though 74% offer sick leave, only 35% of businesses allow paid leave for taking care of sick family members. The report's lead author advised businesses to start making continuity and disease-prevention plans now. [ARCHIVED] Current overview and older updates from CIDRAP Updated Friday, September 11, 2009 at 4pm Page 7 Health Protection Agency (UK) [SEP 11] Preparing for swine flu. Guidance and resources for schools, early years and other educational settings [SEP 10] HPA Weekly National Influenza Report [selected highlights from the summary included below] • The National Pandemic Flu Service (NPFS) continues to issue antiviral drugs to people in England with an influenza-like illness who call or log onto the internet site. The number of assessments and antiviral collections through this service have remained stable over the past week. • The main influenza virus circulating in the UK continues to be the pandemic (H1N1) 2009 strain, with few influenza H1 (non-pandemic), H3 and B viruses detected through sentinel and non-sentinel surveillance. To date, in the UK, no pandemic viruses have been confirmed to be resistant to the antiviral drugs oseltamivir or zanamivir. • The majority of pandemic influenza cases continue to be mild. The cumulative number of deaths reported due to pandemic (H1N1) 2009 in the UK is 75. There was a total of 238 new patients hospitalised with suspected pandemic influenza in week 36 (up to 8am Monday 07 September); a decrease of 110 from the previous week. The highest hospitalisation rates have consistently been in the under 5-year age group. Hospitalisation rates have remained fairly stable and low in recent weeks in all age groups. [SEP 10] HPA weekly pandemic flu media update • This week there has been a further reduction in the rates of flu-like illness and related activity. • Weekly GP consultation rates continued to decrease over the last week in England. • The majority of cases continue to be mild. There is still no sign that the virus is changing. • Interpretation of data to produce estimates on the number of new cases continues to be subject to a considerable amount of uncertainty. HPA modelling gives an estimate of 3,000 new cases in England last week (range 1,500 to 6,500). This estimate incorporates data from National Pandemic Flu Service and GP consultations. • Many countries in the southern hemisphere have now passed the peak of their winter flu epidemic. Flu activity in Australia is now returning to baseline levels and in total there have been 35,897 confirmed cases and 165 deaths. • Serological studies conducted at the WHO collaborating centres suggest that a proportion of older adults have some level of cross-reactive neutralizing antibodies to the pandemic H1N1 2009 virus [SEP 09] Weekly international summary: This update summarizes information published by the World Health Organization WHO) about the latest global situation. [ARCHIVED] Swine Influenza page Updated Friday, September 11, 2009 at 4pm Page 8 Department of Health (UK) [SEP 11] NHS to double provision of intensive care beds for winter swine flu cases [SEP 10] Critical care strategy: managing the H1N1 flu pandemic – September 2009 [SEP 10] Pandemic Influenza and the Mental Health Act 1983 :Consultation on Proposed Changes to the Mental Health Act 1983 and its Associated Secondary Legislation From the DH website: To further strengthen our resilience during this pandemic, we have today published a consultation on possible temporary changes to the Mental Health Act, 1983. During the peak of a pandemic, when the workforce is likely to be under considerable pressure, these changes would enable SHAs to provide continuity of service as set out by the 1983 Act. They would allow a potentially stretched mental health workforce greater flexibility, in order to balance the best interests of the health and safety of patients and the protection of others. [SEP 10] Pandemic Influenza Paediatric Clinical Pathways: Information for Health Care Professionals Working in Primary Care and the Community [SEP 8] Pandemic Influenza Paediatric Clinical Pathways: Information for Health Care Professionals Working in Hospitals [ARCHIVE] DH Pandemic Flu site European Centre for Disease Prevention and Control (ECDC) and European Society for Clinical Microbiology and Infectious Diseases [SEP 11] ECDC Situation Report for Sep 11 • Weekly overview of selected non-EU countries pandemic situation included; • 455 new cases reported in the EU and EFTA countries, reaching a total of 50 470 cases. [SEP 11] European Influenza Surveillance Network: Weekly electronic bulletin Week 36: 31 August 2009 - 07 September 2009 Summary: Sporadic or local activity in a number of number of European countries due to A(H1N1) 2009. Rates are declining in parts of the UK following their earlier peak but in Sweden influenza activity is reported to be widespread, at medium level and rising. There is very little co-circulation of seasonal influenza A(H3) or B viruses reported and no circulating viruses resistant to oseltamivir or zanamivir. [ARCHIVED] Maps, surveillance summaries and previous ECDC updates Updated Friday, September 11, 2009 at 4pm Page 9 European Union [SEP 11] Communiqué - Global Health Security Initiative Special Ministerial Meeting on Pandemic (H1N1) 2009 [SEP 4] Regular coordination meetings with member states [AUG 31] Dutch researchers create swine flu videogame [ARCHIVE] European Union Influenza H1N1 page World Health Organization (WHO) WHO no longer issues the global tables showing the numbers of confirmed cases for all countries. Regular updates describing the situation in the newly affected countries are provided. [SEP 11] Measures in school settings Pandemic (H1N1) 2009 briefing note 10 [SEP 11] Pandemic (H1N1) 2009 - update 65 In the temperate region of the southern hemisphere (represented by countries such as Chile, Argentina, Australia, New Zealand, and South Africa), influenza activity continues to decrease or return to baseline. Active transmission persists in tropical regions of the Americas and Asia. Many countries in Central America and the Caribbean continue to report declining activity for the second week in a row. However, countries in the tropical region of South America (represented by countries such as Bolivia, Ecuador, and Venezuela) are reporting increasing levels of respiratory disease. In the tropical regions of Asia, respiratory disease activity remains geographically regional or widespread but the trend is generally increasing as noted in India, Bangladesh, and Cambodia. In the temperate regions of the Northern Hemisphere activity is variable. In the United States, regional increases in influenza activity are being reported, most notably in the south eastern states. Most of Europe is reporting low or moderate respiratory diseases activity, but parts of Eastern Europe are beginning to report increases in activity. [SEP 4] Weekly Epidemiological Record on Pandemic H1N1 2009 [SEP 2] From the current issue of the Bulletin of the World Health Organization: WHO supports fair access to influenza A (H1N1) vaccine (an interview with Dr Marie-Paule Kieny, Director of the Initiative for Vaccine Research at the WHO) [ARCHIVED] WHO H1N1 Guidance Documents [ARCHIVED] Older WHO Updates Updated Friday, September 11, 2009 at 4pm Page 10 Pan-American Health Organization (PAHO) [SEP 4] Regional Update for Sep 4: Pandemic (H1N1) 2009 As of 4th September 2009, a total of 120,653 confirmed cases have been notified in all 35 countries in the Americas Region. A total of 2,467 deaths have been reported among the confirmed cases in 22 countries of the Region. [ARCHIVED] PAHO Influenza A (H1N1) Portal Australia and New Zealand [SEP 11] Australia National H1N1 Influenza 09 Update • At noon today Australia has 35,921 confirmed cases of pandemic (H1N1) 2009. • The number of deaths associated with pandemic (H1N1) 2009 continues to increase. As of 11 September, 169 people have died. Of these deaths, four were pregnant women and 20 (12.12%) were Indigenous. • There are currently 334 people in hospital around Australia with pandemic (H1N1) 2009. Of these, 21 of the people in hospital are Indigenous Australians. • There are 65 people in Intensive Care Units at present. • The total number of hospitalisations in Australia since pandemic (H1N1) 2009 is identified at 4,642. [SEP 11] New Zealand Pandemic Influenza (H1N1) 09 Swine Flu - Update 150 • The number of deaths from Pandemic Influenza (H1N1) 09 swine flu is 17. • There are a total of 3151 confirmed cases of Pandemic Influenza (H1N1) 09 swine flu, up from 3150 on 9 September. [ARCHIVED] New Zealand's H1N1 page [ARCHIVED] New Pandemic Phase (PROTECT) Guidelines [Australia] Research Articles (1 week backfile) What's new today, plus a one week backfile. Articles with an asterisk (*) indicate that a subscription is required to view the full text. Contact your library for access. Medline literature search on H1N1 (current as of today) [SEP 11] Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine — Preliminary Report. Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, Dawson G, Hu W, Leggio C, Washington D, Basser RL. NEJM. 2009; Published at www.nejm.org September 10, 2009 (10.1056/NEJMoa0907413). Updated Friday, September 11, 2009 at 4pm Page 11 [SEP 11] Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine — Preliminary Report. Clark TW, Pareek, M Hoschler K, Dillon H, Nicholson KG, Groth N, Stephenson I. NEJM. 2009; Published at www.nejm.org September 10, 2009 (10.1056/NEJMoa0907650) [SEP 11] Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, Liu F, Dong L, DeVos JR, Gargiullo PM, Brammer TL, Cox, NJ, Tumpey TM, Katz JM. NEJM. 2009; Published at www.nejm.org September 10, 2009 (10.1056/NEJMoa0906453) [SEP 11] Pandemic Influenza Vaccine Policy — Considering the Early Evidence Neuzil KM.NEJM. 2009; Published at www.nejm.org September 10, 2009 (10.1056/NEJMe0908224) [SEP 11] A/H1N1 flu pandemic: History and economics lessons in asymmetrical flu threats.* Awofeso N. BMJ. 2009 Sep 7;339:b3618. doi: 10.1136/bmj.b3618 [SEP 11] Rapid Antigen Tests for Diagnosis of Pandemic (Swine) Influenza A/H1N1. Vasoo S, Stevens J, Singh K. Clin Infect Dis. 2009 Oct 1;49(7):1090-3, quiz 1094-5. [SEP 11] Mortality burden of the 1918–1920 influenza pandemic in Hong Kong. Ho PL, Chow KH. Influenza and Other Respiratory Viruses. 2009; Published Online: Sep 10 2009 DOI: 10.1111/j.1750-2659.2009.00105. [SEP 11] A bizarre case of drowning as a result of pandemic influenza (1918 pandemic)* Wilson N, Summers J, Baker M, Rice G. J New Zealand Med Assoc. 2009; 122(1302): [SEP 11] Receptor-binding specificity of pandemic influenza A (H1N1) 2009 virus determined by carbohydrate microarray.* Childs et al. Nature Biotechnology, 2009; 27 (9): 797 DOI: 10.1038/nbt0909-797. [SEP 11] Pandemic influenza: a priority for the neurological community* The Lancet Neurology. 2009; 8(10):869. [SEP 11] The Transmissibility and Control of Pandemic Influenza A (H1N1) Virus* Yang Y, Sugimoto JD, Halloran ME, Basta NE, Chao DL, Matrajt L, Potter G, Kenah E, Longini Jr. IM. Science. 2009. Published Online September 10, 2009 DOI: 10.1126/science.1177373 [SEP 11] A Race Against Time to Vaccinate Against Novel H1N1 Virus.* Cohen J. Science. 2009; 325(5946): 1328-1329. [SEP 11] When pigs fly: the avian origin of a 'swine flu'.* Wertheim JO. Environ Microbiol. 2009 Sep;11(9):2191-2. No abstract available. Updated Friday, September 11, 2009 at 4pm Page 12 [SEP 11] Will we be judged ready for the influenza pandemic?* Racette RJ. Healthc Manage Forum. 2009 Summer;22(2):6-11, 18-23. [SEP 10] Behavioural responses to influenza pandemics Balinska M, Rizzo C. PLoS Currents: Influenza. 2009. Published online Sept 10, 2009. [SEP 10] Systematic telephone triage of possible 'Swine' influenza leads to potentially serious misdiagnosis of infectious diseases* Payne R, Darton TC and Greig JM. J Infect. 2009. Journal of Infection, In Press, Accepted Manuscript, Available online 10 September 2009, doi:10.1016/j.jinf.2009.09.005 [SEP 08] Social versus independent interest in 'bird flu' and 'swine flu' Bentley RA and Ormerod P. PLoS Currents: Influenza. 2009. Published online Sept 8, 2009. [SEP 08] Panorama phylogenetic diversity and distribution of type A influenza viruses based on their six internal gene sequences Ji-Ming Chen, Ying-Xue Sun, Ji-Wang Chen, Shuo Liu, Jian-Min Yu, Chao-Jian Shen, Xiang-Dong Sun, Dong Peng. Virology Journal 2009, 6:137 (8 September 2009) [SEP 08] Should cities hosting mass gatherings invest in public health surveillance and planning? Reflections from a decade of mass gatherings in Sydney, Australia Sarah Thackway, Timothy Churches, Jan Fizzell, David Muscatello, Paul Armstrong BMC Public Health 2009, 9:324 (8 September 2009) [SEP 09] Use of cumulative incidence of novel influenza A/H1N1 in foreign travelers to estimate lower bounds on cumulative incidence in Mexico. Lipsitch M, Lajous M, O'Hagan JJ, Cohen T, Miller JC, Goldstein E, Danon L, Wallinga J, Riley S, Dowell SF, Reed C, McCarron M. PLoS One. 2009 Sep 9;4(9):e6895. [SEP 09] The diagnostic assay recommended by the WHO for swine-origin influenza A(H1N1) virus cross-reacts with H5N1 influenza. Peacey M, Hall RJ, Bocacao J, Huang QS. J Clin Microbiol. 2009 Sep 9. [Epub ahead of print] [SEP 09] Swine flu and antibiotics. Barlow GD; on behalf of the BSAC Council. J Antimicrob Chemother. 2009 Sep 9. [Epub ahead of print] [SEP 09] Disaster planning: potential effects of an influenza pandemic on community healthcare resources.* Mareiniss DP, Hirshon JM, Thibodeau BC. Am J Disaster Med. 2009 May- Jun;4(3):163-71. Updated Friday, September 11, 2009 at 4pm Page 13 [SEP 09] Responses to the outbreak of novel influenza A (H1N1) in Japan: risk communication and shimaguni konjo*. Shigemura J, Nakamoto K, Ursano RJ. Am J Disaster Med. 2009 May-Jun;4(3):133- 4. [SEP 04] Australia's pandemic 'Protect' strategy: the tension between prevention and patient management. Eastwood K, Durrheim DN, Massey PD, Kewley C. Rural Remote Health. 2009 Jul- Sep;9(3):1288. Epub 2009 Sep 4. [SEP03] Modelling the progression of pandemic influenza A (H1N1) in Vietnam and the opportunities for reassortment with other influenza viruses Maciej F Boni, Bui HUU Manh, Pham QUANG Thai, Jeremy Farrar, Tran TINH Hien, Nguyen TRAN Hien, Nguyen VAN Kinh, Peter Horby BMC Medicine 2009, 7:43 (3 September 2009) [SEP 10] Letters : A pandemic problem with public transport * Benjamin C Cowie MJA 2009; 191 (5): 288-289 [SEP 10] Letters: Australia's influenza containment plan and the swine flu * epidemic in Victoria Catton MG, Druce JD, Birch CJ. MJA 2009; 191 (5): 288-289 [SEP 10] The community's attitude towards swine flu and pandemic influenza * Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D, et al. MJA 2009; 191 (5): 288-289 [SEP 10] Detection of Influenza A(H1N1)v virus by real-time RT-PCR. Panning M, Eickmann M, Landt O, Monazahian M, Ölschläger S, Baumgarte S, Reischl U, et al. Euro Surveill. 2009;14(36):pii [SEP 10] Does receipt of seasonal influenza vaccine predict intention to receive novel H1N1 vaccine: Evidence from a nationally representative survey of U.S. adults * Nature. Volume 27, Issue 42, 25 September 2009, Pages 5732-5734 [SEP 10] News from Lancet H1N1flu resource center: Pandemic Flu Virus's Binding Properties May Contribute to Lung Pathology By Heidi Splete Elsevier Global Medical News The pandemic influenza A(H1N1) virus appears to replicate faster and strike harder in the lungs of animal models, compared with the seasonal H1N1 virus, according to correspondence published in the journal Nature Biotechnology on Sept. 10. [SEP 09] Views and Reviews: Personal View: Should I have an H1N1 flu vaccination after Guillain-Barré syndrome? BMJ 2009;339:b3577 [SEP 09] Swine influenza (H1N1): Diagnostic dilemmas early in the pandemic.* Cunha BA, Pherez FM, Strollo S. Scand J Infect Dis. 2009 Sep 7:1-3. [Epub ahead of print] [SEP 09] Que sera, sera: evolution of the swine H1N1 influenza A virus. Hensley SE, Yewdell JW. Expert Rev Anti Infect Ther. 2009 Sep;7(7):763-8. [SEP 09] Swine flu agitates the adjuvant debate * Updated Friday, September 11, 2009 at 4pm Page 14 Schubert C. Nat Med. 2009 Sep;15(9):986-7. [SEP 8] The State's role and health – swine flu as a case study* Sim F, Mackie P. Public Health. 2009;123(8):521-2. [SEP 8] Editorial: Tamiflu – the wrong message?* Drug Ther Bull. 2009 Sep;47(9):97. [SEP 8] Protecting Children During Disasters: The Federal View* Adirim T. Clin Pediatr Emerg Med. 2009;10(3):164-72. [SEP 8] Challenges Facing Pediatric Preparedness* Mason K, Anderson MR. Clin Pediatr Emerg Med. 2009;10(3):159-61. [SEP 8] Pediatric Disaster Readiness: How Far Have We Come? * Chung S. Clin Pediatr Emerg Med. 2009;10(3):123-5. [SEP 8] An early 'classical' swine H1N1 influenza virus shows similar pathogenicity to the 1918 pandemic virus in ferrets and mice* Memoli MJ, Tumpey TM, Jagger BW et al. Virology. 2009 Sep 4. [SEP 8] Detection of an oseltamivir-resistant pandemic influenza A/H1N1 virus in Hong Kong* Leunga TWC, Taia ALS, Chenga PKC, Konga MSY, Lim W. J Clin Virol. 2009 Sep 4. [Epub ahead of print] [SEP 8] Letter: Antiviral drugs: distinguish treatment from prophylaxis Cowling BJ, Ng S, Longini IM Jr. BMJ. 2009;339:b3620. [SEP 8] News: Australia's swine flu vaccination plans come under fire Sweet M. BMJ. 2009;339:b3656. [SEP 8] A Model-based Assessment of Oseltamivir Prophylaxis Strategies to Prevent Influenza in Nursing Homes Van den Dool C, Hak E, Bonten MJM, Wallinga J. Emerg Infect Dis. 2009 Oct; [Epub ahead of print] [SEP 8] Poor Clinical Sensitivity of Rapid Antigen Test for Influenza A Pandemic (H1N1) 2009 Virus Dexler JF, Helmer A, Kirberg H, Reber U, Panning M, Müller M, et al. Emerg Infect Dis. 2009 Oct; [Epub ahead of print] [SEP 4] Flu vaccination campaign poses monitoring difficulties CMAJ Updated Friday, September 11, 2009 at 4pm Page 15 Business Resources Harvard Health Publications [ARCHIVED] Business Preparedness for Pandemic: Executive Briefing for Corporate and Governmental Decision-makers [ARCHIVED] Link to report from U.S. Government Accountability Office re Pandemic Planning and funding Canadian Business [ARCHIVED] H1N1 virus: A Plan for the Worst Consumer Health Information Resources [ARCHIVED] Krames Patient Education Handouts - H1N1 Flu Virus [ARCHIVED] MEDLINEplus - H1N1 Flu (Swine Flu) [ARCHIVED] Specialized Information Service - National Library of Medicine [ARCHIVED] Tufts University - (SPIRAL) Selected Patient Information in Asian Languages Clinical and Public Health Practice Tools [AUG 18] Infectious Disease Outbreaks: Tools and Strategies for Front-line Clinicians Created in consultation with front-line clinicians and infectious disease experts from across Canada, this course is evidence-based and focuses on the coordination between clinical care, public health and the laboratory. [JUNE 15] Algorithms from 18 US States to Assist in Decisions Regarding Testing and Treatment of H1N1 Historical Resources [AUG 17] A comparative study of the 1918-1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning. Richard SA, Sugaya N, Simonsen L, Miller MA, Viboud C. Epidemiol Infect. 2009 Aug;137(8):1062-72. [JUN 30] Swine flu of 1976: lessons from the past. An interview with Dr Harvey V Fineberg Fineberg HV. Swine flu of 1976: lessons from the past. An interview with Dr Harvey V Fineberg. Bull World Health Organ. 2009 Jun;87(6):414-5. Updated Friday, September 11, 2009 at 4pm Page 16 [JUN 29] The Persistent Legacy of the 1918 Influenza Virus. New England Journal of Medicine. Morens DM, Taubenberger JK, Fauci AS. The persistent legacy of the 1918 influenza virus. N Engl J Med. 2009 Jul 16;361(3):225-9. Epub 2009 Jun 29. [JUN 29] Historical Perspective — Emergence of Influenza A (H1N1) Viruses. New England Journal of Medicine Zimmer SM, Burke DS. Historical perspective--Emergence of influenza A (H1N1) viruses. N Engl J Med. 2009 Jul 16;361(3):279-85. Epub 2009 Jun 29. [ARCHIVED] Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic. JAMA. 2007;298(6):644-654. [ARCHIVED] The Swine Flu Affair: Decision-Making on a Slippery Disease Neustadt RE, Fineberg HV. The Swine Flu Affair: Decision-Making on a Slippery Disease. Washington: US Department of Health, Education, and Welfare; 1978. Online book. Travel Advisories [AUG 28] Travel Health Notice: Human Swine Influenza in United States [AUG 28] Travel Health Notice: Swine Flu in California and Texas [MAY 19] Public Health Agency of Canada no longer recommends Canadians postpone elective or non-essential travel to Mexico Updated Friday, September 11, 2009 at 4pm Page 17
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Gear Review
I bought the micro as a back up stove for mountaineering, not even planning on using it. On a recent trip up Rainier while sitting at Muir melting snow with my Dragonfly stove I decided to try out the Micro.DANG this thing is awesome! I filled up a Backcountry 750ml Ti pot with snow and opened the micro up all the way. It took the Micro no time at all at 10,200ft to melt the snow and bring it to a rolling boil. I was amazed! This will be my go to stove for soloing and fast and light adventures.
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