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It is very common for hospitalized patients to receive more than one antimicrobial agent simultaneously. The rationale for using antimicrobials in combination is not always clearly defined, and there are a number of potential disadvantages to combination therapy. The basis for using combination therapy is considered in this section.Possible Reasons for Using Combination Antimicrobial Therapy
Clinical indications for using combination antimicrobial therapy fall into one of five categories. Two of these categories (empirical therapy and polymicrobial infections) relate to maximizing the likelihood that at least one agent of the combination will be active against known or suspected pathogens. The other three reasons for using combinations (minimizing toxicity, preventing the emergence of resistance, and obtaining syner-gistic inhibition or killing) attempt to exploit unique advantages of the combinations as compared with any component drug alone.Broad Coverage during Empirical Therapy
A common reason for using more than one antimicrobial in hospitalized patients is to provide broad coverage against potential pathogens and to maximize the likelihood of delivering an active antimicrobial agent as quickly as possible to seriously ill patients. When the pathogen is unknown, the choice of antimicrobials will often include an agent broadly active against gram-positive bacteria, including methicillin-resistant S. aureus (MRSA), such as vancomycin, as well as an agent active against aerobic or facultative gram-negative bacteria. Selection of the latter will be strongly influenced by local patterns of antimicrobial resistance specific to the institution and might include an extended-spectrum cephalosporin, an aminoglycoside, a fluoroquinolone, a β-lactam–β-lactamase inhibitor drug, or a carbapenem. The latter two choices would also provide activity against gram-negative anaerobes if desired, such as for an intra-abdominal infection. Alternatively, one could add an agent such as metronidazole to provide anaerobic activity. In some situations, for patients who are not severely ill, a β-lactam might be used empirically as monotherapy when MRSA or other β-lactam–resistant gram-positive organisms are deemed unlikely pathogens.
Because of the high frequency of antibiotic resistance in Pseudomonas aeruginosa isolates, in settings in which P. aeruginosa is encountered frequently, empirical use of two agents with antipseudomonal activity could be justified to maximize the likelihood that at least one of the agents will inhibit the organism.
Combination therapy is widely used in the initial treatment of hospitalized patients with community-acquired pneumonia. Commonly used regimens include a third-generation cephalosporin such as ceftriaxone with a macrolide or fluoroquinolone. The cephalosporin provides antimicrobial activity against S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and several other "typical" bacterial pathogens associated with community-acquired pneumonia, with the notable exception of MRSA, which can sometimes cause pneumonia in outpatients. The macrolide—azithromycin is commonly used—or the fluoroquinolone inhibits "atypical" bacteria that cause pneumonia, including M. pneumoniae, C. pneumoniae, and Legionella sp. Although fluoroquinolones approved for respiratory tract infections are likely to cover most or all of the organisms targeted by the cephalosporin, isolates of S. pneumoniae resistant to fluoroquinolones do exist, so many clinicians prefer the extra security of combination therapy in patients with severe pneumonia requiring hospitalization.Treatment of Documented Polymicrobial Infections
For many infections from which two or more pathogens are recovered, it is possible to provide adequate coverage with a single, broadly active antimicrobial agent. Switching to a single agent reduces exposure of the patient to potential antibiotic toxicities, is usually more convenient for nursing, and may be less expensive. For some patients, susceptibility profiles or allergy to broad spectrum agents justifies the use of antibiotic combinations for treatment of polymicrobial infections.Attempts to Reduce Toxicity
It is theoretically possible to use two or more drugs of different classes, with additive antimicrobial activities and independent toxicities, each at relatively low doses to achieve sufficient potency while avoiding toxicity. However, there are no instances in current bacterial therapy in which the approach of using submaximal doses of multiple agents is predictably effective in accomplishing this goal. This does not exclude the possibility that in isolated instances a successful response may be attained when drugs with marginal activity are combined. In antifungal therapy, combinations of antifungal agents can potentially improve the clinical response when poor results are noted with the usual doses of individual drugs and toxicities preclude further dose escalation of a single agent.Preventing the Emergence of Drug Resistance
Antimicrobial use in the treatment of tuberculosis provides the paradigm for using combination drugs in an attempt to prevent the emergence of resistance to any one agent. The basis for this approach is that if resistance to two different agents occurs by independent mechanisms, the probability of resistance developing to both drugs will be the product of the probability of resistance to each drug, which is likely to be very low, so resistance should not emerge. For example, if the frequency of resistance to drug A is 10-6 and that of resistance to drug B is 10-7, resistance to both drugs should be encountered no more frequently than once in 1013 colonies.
Similar reasoning has justified the use of combination regimens when rifampin is required for the treatment of nonmycobacterial infections. Rifampin is not used alone (with rare exceptions, such as brief courses for eradication of meningococcal carriage) because resistance to this agent emerges quickly. As mentioned earlier, rifampin is particularly useful in the treatment of infections related to foreign devices because of its activity against biofilm-associated bacteria. In such use, it is combined with another active antimicrobial, such as vancomycin for coagulase-negative staphylococcal prosthetic valve endocarditis (usually with a brief course of gentamicin as well to reduce the bacterial inoculum further at the beginning of therapy) or a fluoroquinolone for orthopedic device–related infections.
It has been more difficult to show unequivocally that combination therapy provides protection against the emergence of resistance to antimicrobial drugs in other situations, including infections caused by P. aeruginosa or Enterobacter sp. There are two plausible explanations why combinations may not prevent resistance predictably. First, there may be differential penetration of the two antimicrobials to an infected site or differences in activity at the site of infection. Thus, a more readily penetrating agent may be left relatively unprotected in a privileged site of infection. Second, for many commonly encountered bacteria, resistance mechanisms against unrelated antimicrobial classes may not be truly independent. Some bacterial efflux pumps recognize chemically unrelated substrates, so upregulation of pump activity may confer resistance to several classes of antimicrobials. In other instances there may be coordinated upregulation of efflux mechanisms and downregulation of outer membrane protein channels (porins), again potentially conferring resistance simultaneously to two or more antimicrobial classes.Use of Combinations to Attain Synergism
Decades ago, the surprising benefits of using penicillin and streptomycin together for the treatment of enterococcal endocarditis were discovered empirically. Penicillin alone usually inhibits but does not kill enterococci, and failure rates were high when penicillin G was used alone to treat enterococcal endocarditis. Streptomycin has no significant activity against enterococci at clinically relevant concentrations. However, the combination results in bactericidal synergism in vitro and high cure rates in patients with enterococcal endocarditis. Detailed studies of this phenomenon demonstrated that in the presence of a cell wall–active antibiotic, uptake of the aminoglycoside into the bacterial cell increases substantially. Unfortunately, increasing rates of high-level resistance to streptomycin (MIC >2000 μg/mL) or to gentamicin (MIC >500 μg/mL), or both, has nullified the benefit of such combinations against a substantial number of enterococcal isolates today. An example of bactericidal synergism between vancomycin and gentamicin against an Enterococcus isolate is illustrated in Figure 301-1A .
FIGURE 301-1 Bactericidal synergism and antagonism. A, Bactericidal synergism between vancomycin (diamonds) and gentamicin (triangles) against an isolate of Enterococcus sp. Killing by the combination (squares) is substantially greater than by each agent alone. B, Antagonism of the bactericidal activity of oxacillin (triangles) against an isolate of Staphylococcus aureus by the more slowly bactericidal agent vancomycin (diamonds). Killing by the combination (squares) is less than that by oxacillin alone. Growth in the absence of antibiotics is shown by the solid line without markers. CFU = colony-forming units.
Since the early demonstrations of synergistic killing of enterococci, combinations of cell wall–active agents plus aminoglycosides have been shown to achieve synergistic killing against a broad range of gram-positive and gram-negative bacteria when tested in vitro. Modest clinical benefits were shown when short courses of gentamicin were added to nafcillin for the treatment of S. aureus endocarditis. Against strains of viridans streptococci that are relatively insensitive to penicillin, the addition of an aminoglycoside for the first 2 weeks of a 4-week course of penicillin G is believed to result in a higher likelihood of cure.
Once considered important in the treatment of gram-negative bacterial infections, especially in immunocompromised (e.g., neutropenic) patients, the clinical value of a synergistic combination of a cell wall–active agent and an aminoglycoside has been difficult to prove in recent experience. To a large extent, the introduction of agents with very potent activity against gram-negative bacteria has diminished interest in and the perceived value of synergistic combinations. Nevertheless, there is some evidence that administering two or more active drugs for empirical therapy may achieve a better outcome than possible with a single active agent for P. aeruginosa infections, especially in neutropenic patients. Soon after the introduction of ciprofloxacin, high rates of inhibitory synergism against P. aeruginosa were demonstrated in vitro when antipseudomonal β-lactams were combined with this fluoroquinolone. In recent years, however, an increasing proportion of isolates have become resistant to fluoroquinolones, as well as to antipseudomonal β-lactams. Although resistance does not preclude the possibility of synergistic interactions, it is unlikely that such positive interactions would occur as frequently today as was documented 2 decades ago.
The combination of sulfamethoxazole with trimethoprim, agents that block sequential steps in folic acid synthesis, can also achieve bacteri-cidal (or bacteriostatic) synergism against a number of important gram-positive and gram-negative pathogens. This agent has been available for more than 30 years and still enjoys wide use. Quinupristin and dalfopristin are streptogramin antibiotics that display inhibitory activity against gram-positive organisms. Combining these two agents results in bactericidal synergism against organisms susceptible to both. Quinupristin-dalfopristin is provided as a 30:70 mixture of the two components and is approved for the treatment of staphylococcal or streptococcal complicated skin and skin structure infections and for infections caused by vancomycin-resistant enterococci that are associated with bacteremia.
β-Lactam–β-lactamase inhibitor antimicrobials represent another example of synergistic combinations. Four drugs of this category are currently marketed in the United States: amoxicillin-clavulanate, ampicillin-sulbactam, ticarcillin-clavulanate, and piperacillin-tazobactam. The β-lactamase inhibitors themselves, clavulanic acid, sulbactam, and tazobactam, are devoid of significant antimicrobial activity, with rare exceptions. However, by inhibiting the common β-lactamases that are sensitive to these agents, the inhibitors restore the activity of the hydrolyzable penicillins against many target pathogens elaborating these enzymes.Antagonism
As mentioned earlier, using antimicrobial combinations does have possible disadvantages, including exposure of the patient to the potential toxicities of the multiple individual components and the added cost to purchase and administer multiple antibiotics. However, antibiotic combinations can sometimes also result in microbiologic antagonism, with the result that the combination may have reduced activity when compared with the most active single agent of the treatment regimen. In vitro, antagonism can be demonstrated with assays for killing of bacteria in broth culture. For example, tested alone in broth culture, oxacillin exerts a bactericidal effect against (methicillin-susceptible) S. aureus, usually defined as ≥3 log10 CFU/mL killing over a 24-hour period of incubation. In such assays, vancomycin alone tends to kill organisms more slowly. When the drugs are combined, the result may more closely resemble the slower killing seen with vancomycin. Time-kill curves illustrating this antagonism are shown in Figure 301-1B . In this example, the more slowly bactericidal drug, vancomycin, antagonizes the killing effect of the intrinsically more bactericidal drug, oxacillin. Antagonistic interactions against S. aureus between less bactericidal (linezolid) and more bactericidal (vancomycin) antimicrobials have also been demonstrated in vivo in experimental endocarditis.
The D-zone test for detection of inducible resistance to clindamycin, described earlier, illustrates in vitro antagonism as measured by a reduction of the inhibitory activity of clindamycin in the presence of inducing concentrations of erythromycin. In vitro antagonism can also be demonstrated when certain β-lactams are tested in combination against gram-negative bacteria with inducible β-lactamases. Here, exposure to one β-lactam can de-repress the synthesis of inducible β-lactamases, which then degrade the second antibiotic.
The most striking example of clinically important antagonism emerged from studies on the treatment of bacterial meningitis. In 1951, Lepper and Dowling reported pneumococcal meningitis mortality rates of 21% in patients treated with penicillin alone. For patients who also received chlortetracycline, the mortality rate was greatly increased at 79%. In this case, inhibition of bacterial growth by the bacteriostatic agent (chlortetracycline) is believed to have compromised the bactericidal activity of penicillin, which is greatest against actively growing bacteria.
Nevertheless, it is uncommon to encounter clinically apparent antagonism between antibiotics in the patient care setting, in part because offending combinations such as the ones described in the preceding paragraphs are not very likely to be used in routine clinical care today. However, if in desperation unusual antimicrobial combinations are used increasingly against isolates exhibiting multiple drug resistance, it is possible that clinically relevant antagonism will be encountered more often in the future. Antagonism of bactericidal activities may also be difficult to detect in clinical practice because most common infections (with the exception of endocarditis and meningitis) do not unequivocally benefit from bactericidal therapy. As long as one agent maintains inhibitory activity, it is unlikely that failure resulting from antagonism will be observed.


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A modern dictionary of Catholic terms, both common and obscure. Find accurate definitions of words and phrases.
The deliberate administering of Holy Communion by a Catholic minister of the sacrament to a baptized person who is not a Catholic. Also the reception by a Catholic of Holy Communion from non-Catholic minister of religion. According to the directives of the Holy See, "Admission to Catholic Eucharistic Communion is confined to particular cases of those Christians who have a faith in the sacrament in conformity with that of the Church, who experience a serious spiritual need for the Eucharistic sustenance, who for a prolonged period are unable to have recourse to a minister of their own community, and who ask for the sacrament of their own accord; all this provided that they have the proper dispositions and lead lives worthy of a Christian" (In Quibus Rerum Circumstantiis, June 1, 1972). More-over, "It is the local ordinary's responsibility to examine those exceptional cases and to make concrete decisions" (Dopo la Publicazione, October 17, 1973). The question of reciprocity arises only with those churches which have preserved apostolic succession and the sacrament of orders. "Hence a Catholic cannot ask for the Eucharist except from a minister who has been validly ordained" (Directorium Oecumenicum, 55).
All items in this dictionary are from Fr. John Hardon's Modern Catholic Dictionary, © Eternal Life. Used with permission.

subset: commoncrawl


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About a year ago, a strange thing happened to my roommate and me. The two of us were sharing one small room in a sort of boarding house in Harlem, full otherwise of French… Read More
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Genomics & Health Impact Update
Published by the Office of Public Health Genomics (OPHG), the Update includes CDC announcements, publications, blogs and other products. The Update also includes links to genomics and health impact news and publications. The Update features genomic tests, family history, programs and practice, policy and legislation and public health science. To receive this update electronically every week sign-up here.
Thursday, January 31, 2013 Volume 30 Number 5
Healthy People 2020: Review of Progress in Cancer Genomics
- What is Healthy People 2020? Healthy people provides science-based, 10-year national objectives for improving the health of all Americans. Healthy People 2020 establishes benchmarks and monitors progress over time. To find out more
- Healthy People 2020 Progress Review: Cancer and Genomics Topic Areas February 6, 2013 12:30 pm EST- Please join online
- Healthy People 2020: Genetic tests have the potential to improve health via disease diagnosis, risk prediction, prevention & treatment
- Did you know that 2 tier 1 genomic applications (BRCA and Lynch syndrome) are included in Healthy People 2020 objectives?
- CDC Blog Post: What gets measured gets done: Genomics and Healthy People 2020
- NIH Genetics 101: Understand basics of genetics and genomics testing—Resources designed with health literacy in mind
Features of the Week
Polio Eradication, Primary Immune Deficiency and Public Health Genomics
- CDC blog post: What's the connection between polio eradication and primary immunodeficiency? A public health role for human genetics. By Marta Gwinn
- National primary immunodeficiency resource, Jeffrey Modell Foundation
- Ten warning signs of primary immune deficiency
Smoking and Health
- 21st-century hazards of smoking and benefits of cessation in the United States
Prabhat Jha et al. New Engl J Med Jan 24
- 50-year trends in smoking-Related mortality in the United States
Thun M, Carter B, Feskanich D, et al. New Engl J Med Jan 24
- In a NEJM editorial, Schroeder addresses new evidence that cigarette smoking remains most important health hazard.
- CDC information: Tobacco control state highlights 2012
- NCI Tobacco Control Monograph: Phenotypes and endophenotypes: Foundations for genetic studies of nicotine use and dependence. [PDF 6.22 MB]
- Since 2001, more than 5100 publications have looked at genetic associations with smoking and smoking related diseases. These include 80 genomewide association studies. GSTM1, GSTT1, CYP1A1 are the top genes studied. To find out more, visit the HuGE Navigator
- CDC blog post: Never let genetics blind you to the harsh reality of cigarettes
- Smokefree.gov information: Smoking cigarettes is expensive. Use our calculator to find out how much of your money is going up in smoke
Diseases of the Week
- American Heart Association new public service announcement to teach Americans how to spot a stroke F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call 911)
- Check out this F.A.S.T. infographic
- CDC stroke information: Stroke is a leading cause of death in the United States.
- CDC stroke information: Genomics and family history
- CDC information: Sickle cell disease is a genetic disease associated with increased risk of stroke.
- Fighting misconceptions about sickle cell disease in the ER, NPR, Jan 24
- Did you know that more than 900 genes have been studied in relation to risk of stroke? This includes 47 genomewide association studies. To find out more, visit the HuGENavigator
- Baseline characteristics and mortality among people in care for chronic viral hepatitis: the chronic hepatitis cohort study.
Moorman AC, Gordon SC, Rupp LB, et al. Clin Infect Dis. 2013 Jan;56(1):40-50.
- New data highlight US hepatitis burden, Healio, Jan 23
- CDC paper: Molecular surveillance of hepatitis C
- CDC paper: Antibody- and genome-based identification of recent HCV infection
- CDC paper: Application of mass spectrometry to molecular surveillance of hepatitis B and C viral infections
- CDC recommendation for the identification of chronic hepatitis C virus infection among persons born during 1945–1965
- Since 2001, 1252 genes have been studied in relation to hepatitis infection, complications and treatment. This includes 39 genomewide association studies. The most commonly studied genes are IL28B, HLA-DRB1 and TNF. To find out more visit the HuGENavigator
- CDC information: High flu activity continues nationwide
- CDC information: If you get a flu shot, you're 60% less likely to get sick & spread flu to others. Learn more
- CDC information: It's not too late to get flu vaccine, but our second line of defense, prompt treatment, also important
- CDC information: People with certain genetic diseases are at high risk for serious illness from flu. Find out more
- The role of host genetics in susceptibility to influenza: A systematic review.
Horby P et al. PLoS One 2012
- Genetic basis of pathogenicity of influenza: 1. Genes in humans associated with more severe influenza 2. A new genetic virological factor in influenza viruses that modulates the host response. ECDC Review 2012
- CDC study: A pilot study of host genetic variants associated with influenza-associated deaths among children and young adults.
Ferdinands JM, Denison AM, Dowling NF, et al. Emerg Infect Dis. 2011 Dec;17(12):2294-302.
- CDC study: Innate immune function and mortality in critically ill children with influenza: A multicenter study
Hall MW, Geyer SM, Guo CY, et al. Crit Care Med. 2013 Jan;41(1):224-236.
- Did you know that 10 human genes have been reported with risk or severity of human influenza? To find out more, please visit the HuGE Navigator
Interferon-induced transmembrane protein-3 genetic variant rs12252-C is associated with severe influenza in Chinese individuals
Yong-Hong Zhang, Yan Zhao, Ning Li, Yan-Chun Peng, et al. Nature Communications 4:1418 Jan 29
- Genetics may explain severe flu in Chinese people, Yahoo News, Jan 29
Select Events
2013 Gastrointestinal Cancer Symposium, San Francisco Jan 24-26, 2013
- Genetic Alliance Webinar Series: What about Privacy and Progress in Whole Genome Sequencing? Starts Feb 12
- The Genomics Landscape a Decade after the Human Genome Project National Human Genome Research Institute Symposium April 25, 2013
Funding Opportunities
NIH to fund ethical, legal, social studies of genomics research in Africa, Genome Web, Jan 28 [by free subscription only]
Reports and Publications
Comparison and validation of genomic predictors for anticancer drug sensitivity.
Papillon-Cavanagh S, et al JAMIA Jan 2013
Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non–clinic-based sample of women in northern California
Lin, W. T., Beattie, M., Chen, L.-m., et al. Cancer. 2013 Jan 29
- Early menopause may occur in women with BRCA gene, Science Daily, Jan 29
DNA-mutation Inventory to Refine and Enhance Cancer Treatment (DIRECT): A catalogue of clinically relevant cancer mutations to enable genome-directed cancer therapy
Yeh P, et al. Clin Cancer Res 2013 Jan
Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?
Powell CB, et al. Int J Gynecol Cancer 2013 Jan
Early onset breast cancer in a registry-based sample of African-American women: BRCA mutation prevalence, and other personal and system-level clinical characteristics.
Pal T, Bonner D, Kim J, et al. Breast J. 2013 Jan 16.
Exploring resources for intrafamilial communication of cancer genetic risk: we still need to talk
McClellan KA, et al. Eur J Hum Genet 2013 Jan
Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO.
Clark VE, Erson-Omay EZ, Serin A, et al. Science. 2013 Jan 24.
- Genetic landscape of common brain tumors holds key to personalized treatment, Science Daily, Jan 24
Long-term ovarian cancer survival associated with mutation in BRCA1 or BRCA2.
McLaughlin JR, Rosen B, Moody J, J Natl Cancer Inst. 2013 Jan 16;105(2):141-8.
Risk-reducing salpingo-oophorectomy and ovarian cancer screening in 1077 women after BRCA testing
Mannis GN et al. JAMA Jan 28
Significance analysis of prognostic signatures
Beck A, Knoblauch N, Hefti M, et al. PLoS Comput Biol 9(1): e1002875
Stool DNA testing for the detection of colorectal neoplasia in patients with inflammatory bowel disease
Kisiel JB, et al. Aliment Pharmacol Ther 2013 Jan
Survey of melanoma mutations reveals changes in regulatory regions for telomerase
Franklin W. Huang et al. Science Jan 24
Telomerase promoter mutations in familial and sporadic melanoma.
Horn S et al. Science Jan 24
TERT promoter mutations in familial and sporadic melanoma.
Horn S, Figl A, Rachakonda PS, et al. Science. 2013 Jan 24.
- Highly recurrent TERT promoter mutations in human melanoma
Huang FW, Hodis E, Xu MJ, et al. Science. 2013 Jan 24.
- Non-coding mutations may drive cancer, the Scientist, Jan 24
- Mutations found in melanomas may shed light on how cancers grow, The New York Times, Jan 24
- Highly recurrent TERT promoter mutations in human melanoma
Ethics in prevention science involving genetic testing
Fisher CB & Harrington McCarthy EL Prev Sci 2013 Jan
Genetic discrimination and life insurance: a systematic review of the evidence
Joly Y, Feze N, Simard J. BMC Medicine 2013, 11:25 Jan 31
- Experts propose overhaul of ethics oversight of research, Science Daily, Jan 23
Genomics in Practice
Citizens' perspectives on personalized medicine: a qualitative public deliberation study
Bombard Y, et al. Eur J Hum Genet 2013 Jan
Cystic fibrosis testing in a referral laboratory: results and lessons from a six-year period
Ridge PG, et al. J Clin Bioinforma 2013 Jan;3(1):3
Family health history communication networks of older adults: importance of social relationships and disease perceptions
Ashida S, et al. Health Educ Behav 2013 Jan
Guidelines and Recommendations
Guidance for industry on clinical pharmacogenomics: Premarket evaluation in early-phase clinical studies and recommendations for labeling; availability, Federal Register, Jan 28
- Risk categorization for oversight of laboratory-developed tests for inherited conditions
Monaghan KG, Benkendorf J, Cherry AM, et al. Genet Med. 2013 Jan 24.
Newborn Screening
- Cascade carrier testing after a child is diagnosed with cystic fibrosis through newborn screening: investigating why most relatives do not have testing
McCalren BJ et al. Genet Med. 2013 Jan 24
Pharmacogenomics in the pocket of every patient? A prototype based on quick response codes.
Samwald M, Adlassnig KP. J Am Med Inform Assoc. 2013 Jan 23.
Prenatal Testing
Clinical utility and cost of non-invasive prenatal testing with cfDNA analysis in high risk women based on a U.S. population
Song K, et al. J Matern Fetal Neonatal Med 2013 Jan
- Recent advances in the prenatal interrogation of the human fetal genome
Hui L, Bianchi DW. Trends in Genetics, Feb 2013
The uptake and outcome of prenatal and preimplantation genetic diagnosis for Huntington's disease in the Netherlands (1998-2008)
van Rij MC, et al. Clin Genet 2013 Jan
Public Health Sciences
Characterizing biobank organizations in the U.S.: results from a national survey.
Henderson GE et al. Genome Medicine Jan 25
Familial risk of venous thromboembolism in first-, second- and third-degree relatives: a nationwide family study in Sweden
Zoller B, et al. Thromb Haemost 2013 Jan;109(3)
- Systematic identification of interaction effects between genome- and environment-wide associations in type 2 diabetes mellitus.
Patel CJ, et al. Hum Genet Jan 2013
- Vitamin D and mortality: A mendelian randomization study
Trummer O, et al. Clin Chem Dec 2012
Reviews and Commentaries on Science & Technology
- Half a million DVDs in your DNA by Service R. Science, Jan 23
- Claim that most biomedical research is wrong is being challenged by a new result suggesting that only 14 per cent is wrong. MIT Review, Jan 23
- Will DNA someday replace the hard drive? By Katherine Bourzac, MIT review, Jan 23
- Transposable elements re-wire and fine-tune the transcriptome.
Cowley M, and Oakey RJ. PLoS Genetics Jan 24
- Genomics technology to add value and address problems in energy and mining by M Spear, GenOmics Blog Post, Jan 25
- Sustainable health systems visions, strategies, critical uncertainties and scenarios [PDF 1.68 MB], Jan 2013
- Has big data reached its moment of disillusionment? Hesseldahl E, Jan 24
- Genomic analysis results: understanding, or fairy dust? Mermaid's Tale Blog Post, Jan 28
- Genes, junk food and weight, NIH Research Matters, Jan 28
- Blue-sky HIV test chip will upload results to the cloud, Nature blog post, Jan 28
- Gene sequencing yields breakthrough for children with rare Parkinson's-like disorder, Nature blog post, Jan 30
- RNA fragments may yield rapid, accurate cancer diagnosis
Ferguson W, Scientific American, 2013 Jan 30
CDC-Authored Genomics Publications
CDC authors are indicated in bold
Reproductive patterns among mothers of males diagnosed with Duchenne or Becker muscular dystrophy
Nabukera SK, Romitti PA, Caspers KM, Street N, Cunniff C, Mathews KD, Fox DJ, Puzhankara S, Ciafaloni E, James KA, Su Y. Am J Med Genet A. 2013 Jan;161(1):70-75.
View previous CDC-authored publications
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Naughty or Nice: Kmart's 'Show Your Joe' jingle
Is Kmart's new jingle naughty or nice?
The department store got lots of attention earlier this year with its tongue-in-cheek "Big Gas Savings" and "Ship Your Pants" ads. Its latest ad – just in time for the holidays—will either make you giggle or grimace.
Kmart's "Show Your Joe," ad features six men who appear to be dressed in tuxedos sitting behind a table, playing a Christmas jingle with hand bells.
Once the table slides away, the men continue playing the bells by shaking their hips in boxers.
The video debuted Friday and has already been shared thousands of times on social media sites.
What do you think of the ad? Hilarious or bah humbug? (Watch: http://bit.ly/1alWpSI )


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A Traditional South African warm dessert
YIELD: 6 People
200g Sugar
2 Eggs
1 Tbsp Smooth Apricot Jam
150g Flour
1 tsp Bicarb of Soda
pinch of Salt
15g Butter
1 tsp Vinegar
100ml Milk
200ml Cream
100g Unsalted Butter
150g Sugar
100ml Water
Beat sugar & eggs until thick & smooth
Add jam & stir in
Sieve flour, bicarb & salt
Melt butter & add vinegar
Alternately add butter mix & dry ingredients to the sugar & eggs - mix well.
Bake in an oven-proof dish (not cake tin) for 45 minutes at 180*C
Melt all sauce ingredients to near boiling point.
Pour over sponge as soon as it comes out the oven.
Allow to stand for 10 minutes before serving.
Serve with whipped cream or vanilla ice cream.


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Police responding to a shooting call in north Tulsa early Thursday found a man dead on the ground outside a vehicle.
The car, a dark-colored Chrysler, came to rest in the yard of a home in the 300 block of West 63rd Place North. Police have not released the identity of the slain man, who was found laying in the yard outside the home.


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Well, I started looking for another motherboard today, and honestly, I really didn't get anywhere. Does anyone know of a good site to get some reviews and such for motherboards? I tried a few, like Toms Hardware and a few others, but couldn't find any reviews that suited what I am looking for. Basically, I am looking for the best mobo I can buy that supports, at least:
AMD Athlon XP 3200
Dual Channel DDR400
SATA and PATA at the same time
There are many mobos out there, but I am having a helluva time deciding which to get. My wife's system is using an ASUS A7N8X Deluxe, with an AMD XP 2500 Barton, and that board has been a dream... like a rock. I was thinking of just getting the updated version to that board (the '-e') but it only has two new features that I really don't need (wireless LAN via ASUS plugin card, and some other worthless thing). I may just end up getting another one of my wife's boards, but would just like to get a definitive answer, as to whether or not a better board is out there (I am a little biased, due to this board being as well of a performer as it is, so I can't make up my mind).
Any advice/suggestions or other info would be much appreciated.


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Employee: Kelly Smith
Employer: Charming Shoppes, Inc.
Insurer: Royal Insurance Company of America
Board No.: 071280-01
(Judges Horan, Fabricant and McCarthy)
Gregory J. Angelini, Esq., for the employee
Michael E. Kiernan, Esq., for the insurer at hearing and on appeal
Lauren M. Bergheimer, Esq., for the insurer on appeal
HORAN, J. The employee appeals from an administrative judge's decision denying her claim alleging an emotional injury arising out of a series of events over a three-day period at work. For the following reasons, we affirm the decision.
Kelly Smith, the employee, is a forty-year-old single mother with a high school education. Over the years, she has treated for a variety of emotional conditions including panic attacks, depression, anxiety, agoraphobia, and attention deficit hyperactivity disorder. (Dec. 5, 9; Ex. 1, Impartial report.) In April 2001, she began working for the employer as a head cashier. Until the work events in September of 2001, she was functioning reasonably well, with few symptoms related to her emotional problems. (Dec. 8.)
On September 25, 2001, the employee attempted to call her supervisor, Danielle Milone, to inform her that she would be late for work; unfortunately, the line was busy. When Ms. Smith arrived at work approximately a half-hour late, she discovered Ms. Milone had called in a replacement for her. When the employee tried to explain why she was late, Milone refused to listen. The employee became upset, and complained to the district manager, who advised her to go home. The district manager promised to discuss the matter with Ms. Milone; however, she failed to do so. For the next two days, Ms. Milone gave the employee "the silent treatment" at work, and was generally less than amicable. On September 27, the employee again called the district manager who said she would try to visit the store. That morning, the employee had two panic attacks; she resigned from her job later that day. (Dec. 5-6, 8, 10-12.)
Following these work events, the employee experienced a "full recurrence of her panic attacks and depression." She resumed treatment with her therapist, who increased her medications. In July of 2002, she was able to perform part-time work at Mount Wachusett Community College. By August 2003, she was functioning quite well emotionally. (Dec. 5-6, 8-10.)
The employee's claim was denied at conference, and she appealed to an evidentiary hearing, claiming a closed period of § 34 benefits from September 27, 2001 to August 3, 2003, and § 35 benefits thereafter. Among the defenses raised by the insurer at the hearing were § 1(7A) and "Bona Fide Personnel Action." [1] The judge found that the report of the impartial physician, Dr. Bruce Goderez, was adequate, and denied the employee's motion for additional medical evidence. The parties later deposed Dr. Goderez. (Dec. 2-3.)
In his January 27, 2003 report, Dr. Goderez opined the employee was totally disabled due to a "major depressive disorder, recurrent, in partial remission, panic disorder with agoraphobia, generalized anxiety disorder, [and] attention-deficit hyperactivity disorder." (Dec. 6-7.) He wrote:
The workplace injury consisted of conflict with an apparently abusive supervisor. In her account, she presents her attempts to deal with the situation reasonably and maturely by approaching the supervisor to try to discuss their differences. When this was not successful, she appealed to the district manager, who failed to respond within several days. She explained to me that the district manager was in close geographic proximity, and could easily have come in that amount of time. It is evident from her account that she felt quite betrayed at that point, and suddenly began to experience an extreme degree of panic symptoms. She subsequently decompensated completely, having a full recurrence of panic and depression which has only responded partially to vigorous pharmacological treatment and supportive psychotherapy.
There seems to be no question that the recurrence of her long-standing anxiety and depressive symptoms were [sic] precipitated by the situation with her supervisor at work.
(Ex. 1, Impartial report, 3; see Dec. 8.)
At deposition, Dr. Goderez testified the "incident" at work "caused all her defenses to fall apart and after that all her psychopathology was full blown again and she was unable to function." (Dep. 50-51; Dec. 8.) He was asked if the incident at work was "a major but not necessarily predominant cause" of her disability, to which he replied "absolutely." (Dep. 14; Dec. 7.) He was never asked to opine whether the incident at work was "the predominant contributing cause" of the employee's disability, in accordance with the applicable standard for mental and emotional disabilities that do not result from a compensable physical injury. Cornetta's Case, Mass. App. Ct., No. 2006 - P - 9, slip. op. (January 25, 2007). Nor was he asked to specifically identify which work-related event, or combination of events, precipitated the employee's disability.
Acknowledging the lack of an explicit opinion regarding "the predominant contributing cause" of the employee's disability, the judge nevertheless found "the intent of [Dr. Goderez's] meaning does meet the heightened predominant standard." (Dec. 13.) However, the judge also found that some of the work events were bona fide personnel actions and, as such, any disability resulting from them would not be compensable in the absence of the intentional infliction of emotional harm, which he did not find. (Dec. 14.) The events the judge deemed bona fide personnel actions were: Ms. Milone calling in a replacement for the employee when she was late; docking the employee a day's pay; and the failure of the district manager to intervene in the dispute, or to return the employee's call. [2] (Dec. 12.) The judge found Ms. Milone's "silent treatment and less than amicable attitude" toward the employee were not bona fide personnel actions. (Dec. 13.) The judge concluded:
[A]s I find that some of the events at work were based on bona fide personnel actions and that the impartial physician does not differentiate among the various events that precipitated the recurrence of Ms. Smith's pre-existing symptoms, I determine that the employee has not met her difficult burden in this very complex case and I deny her claim.
Dr. Goderez does not report what specific events and incidents were the predominant cause of Kelly Smith's disability. There is no way of knowing whether such events or incidents are bona fide personnel actions. Consequently, there is no persuasive expert medical opinion that the work events, excluding bona fide personnel actions, are the predominant cause of the mental disability.
(Dec. 14.) Accordingly, he denied and dismissed the employee's claim. (Dec. 15.)
On appeal, the employee advances one argument. She maintains that because Dr. Goderez's causal relationship opinion was based on a description of incidents at work which did not include the events the judge designated as bona fide personnel actions, she carried her burden of proving compensability. Specifically, the employee avers it is clear Dr. Goderez opined that the incidents at work which caused the employee's disability were the "abusive style of the supervisor" and the fact that the supervisor kept "brushing her off," neither of which the judge found to be bona fide personnel actions. (Employee br. 8, quoting Imp. dep. 54.) We disagree. Dr. Goderez was aware of the district manager's involvement, and factored it into his causation analysis. [3] In his report, Dr. Goderez stated:
The client reports that she tried several times to approach the supervisor to talk about the incident, and when that was not successful, called the district manager who promised to come over and help mediate the situation. She failed to come within 2 days, at which point the client started suffering panic attacks, and on the third day after the incident, she resigned from her job.
(Ex. 1, Impartial rep. 1; emphasis added.) At his deposition, Dr. Goderez iterated that, "there was an unpleasant situation and then she had to appeal to a higher authority who had not responded in a timely fashion. She evidently felt betrayed. . . ." (Dep. 9.) He further testified, "[s]he called the next one up the line who was supposed to mediate. Several days later she found herself with a full blown panic attack." (Dep. 54.)
Based on the foregoing medical evidence, the judge could reasonably conclude Dr. Goderez based his causation opinion, at least in part, on the failure of the district manager to intervene. Cf. Patterson v. Liberty Mutual Ins. Co., 48 Mass. App. Ct. 586, 597-598 (2000)(a medical opinion based on facts not found by the judge is entitled to no weight). Because the judge found that the district manager's failure to intervene constituted a bona fide personnel action, he properly denied the claim. [4] Descoteaux v. Raytheon Co., 19 Mass. Workers' Comp. Rep. 211, 214-215 (2005)(a disability is excluded from the definition of personal injury unless employment events, not deemed to be bona fide personnel actions, are its predominant contributing cause).
Thus, finding no merit to the only [5] argument advanced by the employee, we affirm the decision of the administrative judge.
So ordered.
Mark D. Horan
Administrative Law Judge
Bernard W. Fabricant
Administrative Law Judge
McCARTHY, J., (dissenting). I agree with the majority that Dr. Goderez factored into his causation opinion a bona fide personnel action. I further agree that, as a result, the judge was warranted in finding he was unable to determine whether work events, which were not bona fide personnel actions, were the predominant cause of the employee's emotional disability. However, I think that because Ms. Smith did not know, when she was developing the medical evidence, what events, if any, the judge would find were bona fide personnel actions, she has been deprived of a realistic opportunity to prove medical causation -- and perhaps of her due process rights as well. See O'Brien's Case, 424 Mass. 16, 22-23 (1996). Therefore, I would recommit the case so, armed with this knowledge, she may appropriately develop the medical evidence.
Cases involving mental and emotional disabilities are often among the most complex compensation cases to analyze and prove. See Nason, Koziol and Wall, Workers' Compensation §§ 9.9, 9.10 (3d ed. 2003). The judge must first determine whether a work event or series of events, rather than non-work stressors or pre-existing psychiatric problems, are the predominant contributing cause of the employee's disability. If he finds in the affirmative on that issue, he must " 'go on to make findings on whether the "disability arose principally out of a bona fide, personnel action including a transfer, promotion, demotion or termination[.] § 1(7A)' " Caruso v. Hair Club for Men, 18 Mass. Workers' Comp. Rep. 249, 252 (2004), quoting Walczak v. Massachusetts Rehab. Comm'n, 10 Mass. Workers' Comp. Rep. 539, 549 (1996). Moreover, " '[w]here a case presents both stressful [work] events and bona fide employer actions, each must be assessed indepen-dently of the other under the statutory criteria' to determine whether the disability arose principally out of events that were bona fide personnel actions or out of another event or series of events occurring within the employment." Vining v. Walter E. Fernald State School, 11 Mass. Workers' Comp. Rep. 250, 252 (1997)(emphasis in original), quoting Beckett v. Cummings Alden, Inc., 10 Mass. Workers' Comp. Rep. 641, 644 (1996); see also Golec v. Chestnut Knoll Retirement Community, 12 Mass. Workers' Comp. Rep. 76, 82 (1998). There is no liability if the causative events are deemed bona fide personnel actions, in the absence of intentional infliction of emotional harm. Caruso, supra; Walczak, supra.
It is the rare claim for emotional disability where there is one clear-cut work event producing incapacity. In many, if not most, cases, there are a series of events. And yet, as in this case, prior to the issuance of the judge's decision, the parties do not know what events the judge will deem bona fide personnel actions, or even, into how many events the judge will subdivide the events at work. Will there be two events or six? Which ones, if any, will be bona fide personnel actions? [6] Under such circumstances, it is virtually impossible for the parties to frame hypothetical questions reflecting the precise scenario ultimately found by the judge.
I agree with the majority's suggestion that it would be advisable for a judge to issue a preliminary ruling, prior to the taking of medical deposition testimony, setting forth which work events he considers are bona fide personnel actions. (See n.3.) Indeed in a complex emotional disability case like this one, such a preliminary ruling may be essential! I would recommit the instant case so the employee, equipped with knowledge of the judge's bona fide personnel action determinations, may have the "opportunity to present testimony necessary to present fairly the medical issues," O'Brien's Case, supra, through further questioning of the impartial physician or the admission of additional medical evidence. Without such knowledge, I do not think the employee has had a realistic opportunity to meet her burden of proof.
William A. McCarthy
Administrative Law Judge
Filed: March 8, 2007
[1] G. L. c. 152, § 1(7A), provides, in relevant part:
Personal injuries shall include mental or emotional disabilities only where the predominant contributing cause of such disability is an event or series of events occurring within any employment. . . .No mental or emotional disability arising principally out of a bona fide, personnel action including a transfer, promotion, demotion, or termination except such action which is the intentional infliction of emotional harm shall be deemed to be a personal injury within the meaning of this chapter.
[2] The employee does not challenge the judge's findings that these events were "bona fide" or that they were "personnel actions" as contemplated by the statute.
[3] At the deposition, counsel did not ask the doctor to segregate the potentially bona fide personnel actions from other work events when addressing the causation issue. Nor did counsel request bifurcation of the case to seek a preliminary determination concerning which, if any, of the work events were bona fide personnel actions. In emotional disability cases involving more than one work-related event, it may be advisable for the moving party to ask the judge to issue a preliminary ruling, prior to the taking of medical deposition testimony, describing which events are bona fide personnel actions. This should enable the parties to better tailor their questioning of the medical experts regarding causation.
[4] Though the judge did not explicitly find the employee's disability arose "principally out of" the bona fide personnel actions, he need not go that far. Instead, he found the employee failed to prove the work events, excluding those deemed to be bona fide personnel actions, were the predominant cause of her disability. Even if, arguably, the doctor's deposition testimony could be interpreted differently, it is the judge's interpretation, not counsel's, and not ours, which governs. G. L. c. 152, §§ 11, 11B, 11C.
[5] We note the employee has not claimed her due process rights were violated when the judge denied her motion to introduce additional medical evidence. Nor does the employee assert the judge had an obligation to advise her, prior to the doctor's deposition, which of the employment events were bona fide personnel actions. The dissent urges a recommital. We are empowered to recommit cases "when appropriate" . . . "for further findings of fact." G. L. c. 152, §11C. The employee had ample opportunity to pose a series of questions based on various combinations of events with the proper causation standard in mind. Recommital is not appropriate here because it would be the equivalent of granting the employee a second bite at the apple.
[6] In his decision, the judge subdivided the work "event" into five smaller events, three of which he found to be bona fide personnel actions. In his causation opinion, Dr. Goderez mentioned only three of the five events parsed out by the judge.


text:
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Introduced by Clinique in 1999 HAPPY is a refreshing fruity fragrance. This Perfume has a blend of citrus lemon mandarin orange and grapefruit. It is recommended for office wear.
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Veto on Dora cause of Dora the explorer(60 Posts)
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New Release!! "Essentials Walking Bass"
"Explores the concept of playing walking bass in different styles"
Click below for a course preview
click here for instant download $19
click here for disc + download $39
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I remember singer Al Jarreau once telling me he still gets nervous before every show. That shocked me at the time, but is probably more common than you would think...read more
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I love it when music breathes. When it has dynamics and space combined with creativity it seems to come alive, and engage people.
That being said, as a bass player one of the things that inhibits my enjoyment and engagement while playing music is when another instrument (normally keyboard) plays in my register...read more
Bass solo tips for the "non" soloist
There are very few bass players, in my opinion, that really excel at both playing the groove and soloing. It's obviously very difficult to be equally great at both skills. read more
8 Keys to knowing the bass part
1. Play the track a few times, just listening, not playing. You are listening to the bass line, phrasing, note choices, note length, groove, dynamics, articulation, variations in repeated sections, all those things that give a bass line its character, along with just getting a vibe for the song, the melody, chords, drum groove, etc. read more
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To link to this article, copy this persistent link:
(Mar 31, 2009) On February 3, 2009, Switzerland promulgated an amendment to the Constitution that abolishes any statutory limitation of actions for pornographic or sexual offenses committed against prepubescent children (Bundesbeschluss, June 13, 2008, Amtliche Sammlung 471 (2009), available at http://www.admin.ch/ch/d/as/2009/index0_5.html : yes"> (click on page 471)). The new provision is article 123b of the Constitution (Bundesverfassung, Federal Constitution of the Swiss Confederation of April. 18, 1999, Systematische Sammlung des Bundesrechts No. 101 [in English], available at http://www.admin.ch/org/polit/00083/index.html?lang=en). This article was adopted by a popular initiative, in accordance with article 139 of the Constitution.
The National Assembly (the combined federal legislature) had recommended a vote against the initiative (Bundesbeschluss, June 13, 2008, Bundesblatt 5245 (2008), available at http://www.admin.ch/ch/d/ff/2008/index0_25.html (click on page 5245)), possibly because its content was better suited to the Criminal Code than the Constitution. The enacted article, however, is the second of its kind. In 2004, a popular initiative led to the adoption of article 123a of the Constitution. It mandates life imprisonment for extremely dangerous sex offenders and violent criminals.
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Energy Journey Game
The Arlington Initiative to Rethink Energy (AIRE) team created a life sized board game to challenge players on everyday actions that have an energy impact. Stations were set up throughout the game designed to inspire and educate players on how they can change their everyday activity to help reduce their energy use, and to save money. All ages participated in the event, that generated over 300 players, all with the help of nearly 90 volunteers in a successful and educational afternoon.
Learn more about the Arlington Initiative to Rethink Energy
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Arlington-based CACI International Inc. has named John Mengucci chief operating officer for U.S. operations, Washington Technology reported.
He will oversee the company's four main business groups: enterprise technologies and services, the mission systems group, national solutions group and transformation solutions group. Mengucci comes from Bethesda-based Lockheed Martin Corp., where he served as president of the company's information systems and global solutions — civil product line.
In Maryland, all sorts of marine life is living among more than 100 sunken ships.


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Republican Party
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News about Republican Party, including commentary and archival articles published in The New York Times.
Chronology of Coverage
Nov. 12, 2012
Election results have set stage for struggle within Republican Party by exposing its vulnerability to potent demographic shifts; party's first challenge seems to be to find common ground in diagnosing its problems. MORE
Nov. 23, 2011
Republican debate on foreign policy highlights the party's lack of a single national security vision as the presidential candidates differ on the pace of withdrawal from Afghanistan, aid to Pakistan and what to do with illegal immigrants in the United States; the debate is a test for Newt Gingrich, who has risen to the top of the pack in polls. MORE
Nov. 16, 2011
Embarrassing gaffes from the Republican presidential candidates are piling up, and some veteran Republicans are beginning to wonder whether the cumulative affect is weakening the party brand, especially in foreign policy and national security, where Republicans have typically dominated Democrats. MORE
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Kevin McCarthy's Bid for Speaker Will Fall Short, Jason Chaffetz Says
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Asthma: Over The Counter Treatment (cont.)
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is asthma?
- What medications are used to treat asthma?
- How do over-the-counter (OTC) medicines for asthma work?
- What factors should be considered in choosing and using OTC epinephrine or ephedrine?
- What side effects and drug interactions are there with OTC asthma medicines?
- What are additional measures in the management of asthma?
- Find a local Asthma & Allergy Specialist in your town
What are additional measures in the management of asthma?
- Patients should avoid known triggers of asthma attacks (for example, exercise or allergens).
- Good control of allergic rhinitis (nasal allergies) helps to control asthma.
- Some patients with asthma must avoid aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen and Motrin since they may induce an episode of asthma.
- All asthma patients should avoid beta-blocker drugs (Inderal, Tenormin,Visken, and Lopressor) because they may worsen asthma or precipitate an episode.
- All patients with asthma should seek professional advise from their physicians on how to optimally manage their condition.
Medically reviewed by James E Gerace, MD; American Board of Internal Medicine with subspecialty in Pulmonary Disease
"Over-the-counter medications"
Asthma and Allergy Foundation of America
Source: MedicineNet.com
Allergies & Asthma
Improve treatments & prevent attacks.


text:
Attempting to hit back, Stone and Kuznick wrote the following letter to the editor that appeared recently in The Wall Street Journal. Here is what they write:
Wallace Had the Right Ideas on U.S.-Soviet Relations
In his Jan. 11 opinion piece "Just When You Thought Soviet Propaganda Was Dead," Ronald Radosh attacks our "Untold History of the United States" as "discredited leftist Cold War 'revisionist' history." But his main point of contention is that we have not only rescued Franklin Roosevelt's Vice President Henry Wallace from the dustbin of history but that we've restored him to the heroic stature we believe he deserves.
What most rankles Mr. Radosh is our applauding Wallace's effort to prevent the Cold War and nuclear arms race and our assertion that had he remained on the ticket in 1944, as 65% of voters wanted, we might have avoided one of the darkest and most perilous periods in human history. In that convention eve Gallup Poll, Harry Truman came in last with 2%. Staying on as secretary of commerce, Wallace did everything he could to change U.S. policy.
Mr. Radosh attacks Wallace because, in October 1945, he told a Soviet intelligence official that he wanted atomic weapons and know-how turned over to the United Nations, a view supported by such notorious radicals as future Secretary of State Dean Acheson and Atomic Energy Commission head David Lilienthal, the two of whom Truman commissioned to draft a plan to that effect, and by just-retired Secretary of War Henry Stimson and General Dwight Eisenhower.
Wallace understood that the U.S. atomic monopoly, which Secretary of State James Byrnes had just used to bully the Soviets at a foreign ministers meeting in London, was exacerbating the already tense relations between the U.S. and U.S.S.R. He told the Soviet intelligence officer that mankind's future depends on good relations between the two countries and asked for unspecified Soviet assistance in supporting the progressive faction in the Truman administration against the anti-Soviet hard-liners. What that probably meant, given Wallace's views at the time, was Soviet liberalization in Eastern Europe to take away the Soviet-bashers' main issue.
That Wallace would speak so openly to a representative of the nation that only one month earlier had been one of our two principal wartime allies makes him in Mr. Radosh's view a "willing tool of Moscow." We see him as a visionary. Franklin Roosevelt said that though some called Wallace a "communist," there was "no one more American . . . no one more of the American soil." If forced to choose between Mr. Radosh's view of Wallace and Roosevelt's, we'll take the latter.
Oliver Stone Los Angeles
Peter Kuznick Bethesda, Md
Let me pause to dissect this nonsensical and rather pathetic attempt at an answer. FDR, who wanted Wallace off the ticket in 1944, agreed to allow the Democratic convention to pick the vice-presidential candidate, a sure sign that he was not happy with keeping on the ticket his current sitting vice president. They write that Wallace had the support of 65 percent of the voters. Yet four years later, when Wallace ran on the Communist controlled Progressive Party ticket (a campaign that Stone and Kuznick support in their documentary), Wallace and his running mate Glen Taylor won only 2.4 percent of the vote. The huge expected vote some polls had Wallace and Taylor winning did not materialize, and only in New York did enough people vote for the two that the state went to the Republican, Thomas E. Dewey.
The main part of their argument is nothing but completely preposterous. They make it appear that proposals for an international agreement on atomic energy and manufacturing of an A-bomb by others were precisely the same goals favored by Wallace. Wallace, however, favored attainment of the know-how for a bomb by the Soviets, as Truman himself wrote in a famous diary entry quoted in the documentary by Stone as if Truman was foolish. Moreover, Stone and Kuznick make light of Wallace's secret meeting with the KGB station chief in Washington, D.C., while in the President's cabinet. They think nothing of Wallace asking his help in his fight against those he saw as anti-Soviet hardliners in the administration.


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RA Selection Process
Welcome to the Texas Academy of Mathematics and Science Resident Assistant Selection page. We are excited you are here and that you are interested in applying for the TAMS RA position. We are looking for academically motivated, bright, creative, responsible UNT students. If this sounds like you, you are at the right spot!
Please follow the menu items under RA Selection Process for important information regarding the RA position. We encourage you to read all information on the website to get a better idea of who we are and what the position is about. If you have further questions, feel free to email the McConnell Hall Directors, Cali DiOrio-Saye or Joshua Barnhart
We wish you the best of luck in the process and look forward to getting to know you!


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Comment magazine serves Christian leaders and culture makers with rooted, fresh ideas for the faithful practice of North American public life. Leaning on 2000 years of Christian thought, we seek a renewed social architecture - "not new wine into old wine-skins, but old wine in new wineskins for festive drinking" (Calvin Seerveld, "Footprints in the Snow").
Comment works to:
Comment is the first principles journal of Cardus, a think tank dedicated to the renewal of North American social architecture. We publish online essays, reviews, and opinions, as well as a print edition.


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It's holiday season; time to visit family and friends, buy gifts and celebrate. It's easy to get caught up in the excitement of sales and shopping, but if money is tight right now, you may wonder if you can afford all that holiday cheer. Before you start ringing up holiday expenses, make a budget and get a fix on your income, expenses and what you have to spend. Keep your budget — and long-term finances — in mind as you decide how to cover holiday expenses. Continue Reading >
Close to half a million people who bought Sensa, a sprinkle-on weight loss product, will share more than $26 million in refunds, thanks to the FTC. The money comes from the FTC's settlement with Sensa's marketers, who said their powder would help people lose weight. According to the FTC, the company didn't have the scientific evidence they needed to back up the claims. Continue Reading >
Mark Twain once said, "Never put off till tomorrow what may be done day after tomorrow just as well." If you live by this mantra, you might find yourself scrambling at the last minute to finish your holiday shopping this season. Enter the gift card. Continue Reading >
Investors often fail to check the background of their financial professional, making themselves vulnerable to fraudsters. Additionally, investors can sometimes overlook signs that indicate there's something wrong with the person, and instead focus on just the supposed profit. This can leave them vulnerable to fraud and financial predators. Continue Reading >
As fall weather cools down, plans for Thanksgiving and the charitable giving season are heating up. Here come the requests for donations — in your mail and email, in person, on social networking sites, through your mobile devices — you name it. Want to express your thankfulness with a gift to a charity? Find an organization that spends wisely on a cause you support, and screen out any requests scammers send your way.
If you get a request from an unfamiliar group: Continue Reading >
Have you seen news reports about foreign websites showing live feeds from unsecured wireless cameras — like nanny cams, baby monitors, and security cameras — in the U.S. and around the world? It's creepy stuff, but there are steps you can take to protect your camera from prying eyes. Continue Reading >
"Free credit scores" sounds good, right? But what if you signed up for "free credit scores," then found out you were enrolled in a credit monitoring program that costs $29.95 per month? Not so good. That's what the FTC says happened with a company called One Technologies, Inc. Continue Reading >
Companies have left people's sensitive personal and financial information in all the wrong places — in dumpsters, on car seats, and even in employees' backpacks.
Now, the FTC has sued two debt sellers for posting spreadsheets with the sensitive information of more than 70,000 people on a public website, making it — along with information about a debt they might owe — available to anyone who happened on the site. Continue Reading >
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1192 Park Avenue
At The Northwest Corner of 94th Street | Carnegie Hill
There are currently no apartments available
Please contact the management company for current availability information
Are you ready to view apartments? Contact Us
Nearby Subway Stations
- 86th Street (at Lexington Ave) (0.41 miles)
- 86th Street (at Lexington Ave) (0.41 miles)
- 96th Street (at Lexington Ave) (0.16 miles)
This attractive building at 1192 Park Avenue on the northwest corner at 94th Street has a very warm brown brick façade with very attractive and ornate wrought-iron window grills on the first floor.
Located in the heart of the desirable Carnegie Hill neighborhood, it was erected in 1926 and converted to a cooperative in 1952.
The 15-story edifice has 75 apartments.
It was designed by Rosario Candela, who is widely considered to have been the country's greatest designer of luxury apartment buildings and who collaborated with many of the city's most famous architectural firms.
Carter Horsley's Review
of 1192 Park Avenue
Read a Review of 1192 Park Avenue byCarter Horsley
Features & Amenities
- FT Doorman
- Pre War
- Elevator
- Doorman
- Designed by Rosario Candela
- Close to many fine schools
- Close to many museums
- Close to several religious institutions
- Attractive pre-war building in heart of desirable Carnegie Hill neighborhood
- Gym
- Pets are permitted
- No health club
- No sundeck
- Protruding air-conditioners
- Inconsistent fenestration
- Across sidestreet from Hunter College Campus School
Famous Residents at 1192 Park Avenue
Pricing Comparison of Similar Buildings
1192 Park Avenue 12 Month Sales SummaryView By Apartment Sizes
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- We'll introduce you to the city's most trusted real estate pros. Talk to our pros
- View the most up-to-date apartment listings Start your Search
- Just sign up for a free account & experience all this and more! Sign up now


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Treadmill Training for Spinal Cord Injury
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
This is a trial to test whether treadmill training can be used to improve the "walking" of patients with partial spinal cord injury. While on the treadmill, patients will be partially supported through the use of a specially designed harness attached to an overhead lift (also called Body Weight Supported Treadmill Training, BWSTT). Patients who enroll in this study will be randomly assigned to either the experimental group, which receives 12 weeks of this specialized treadmill training with regular physical therapy, or to the control group, which receives 12 weeks regular physical therapy. The ability of the patients to "walk" will be measured before and after treatment as well as 6 and 12 months later, using standard tests that examine mobility independence and speed of ambulation. The trial takes place across five sites in the US and Canada. Patients eligible for this trial will have had a traumatic spinal cord injury within 8 weeks of trial entry.
Spinal Cord Injury
Procedure: body weight-supported treadmill training
Phase 2
|Study Type:
|Study Design:
|Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Single Blind
|Official Title:
|Locomotor Therapy Trial for Spinal Cord Injury
|Estimated Enrollment:
|Study Start Date:
|March 1999
|Estimated Study Completion Date:
|February 2004
This is a 5-site randomized clinical trial of a task-oriented locomotor intervention for acute spinal cord injury (SCI). The intervention, body weight-supported treadmill training (BWSTT), partially supports the weight of the patient via an overhead lift attached to a harness. Therapists train the patient to walk on a treadmill by correcting gait deviations and manipulating sensory input that enhance control of the stance and swing phases of walking at increasingly higher speeds and less weight support. 100 patients with incomplete SCI (from below C4 to T10/11) and 100 patients with lesions at T12 to L3 will be randomly assigned to 12 weeks of conventional therapy programs for mobility versus the same intensity and duration of a combination of conventional therapy plus BWSTT. The primary outcome measures are the level of independence for ambulation and the maximal speed for walking 50 feet. Patients will be tested by masked examiners before and after the 12 weeks of therapy, and 6 and 12 months after entry into the study.
|Ages Eligible for Study:
|16 Years to 65 Years
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Traumatic spinal cord injury (within 56 days)
- Incomplete lesion: - ASIA C or D, from below C4 to L3 - ASIA B at or below C7
- Unable to ambulate over ground without at least moderate assistance (FIM locomotor 3 or less)
- Able to offer at least 3/5 strength in elbow extensors
- No clinically-significant cognitive impairment
Exclusion Criteria:
- Symptomatic fall in blood pressure greater than 30 mm Hg when upright
- Halo or other cervical brace or TLSO (unless primary surgeon agrees)
- Contraindication to weight bearing on lower extremities
- Pressure sore with any skin breakdown below level of the SCI
- Any debilitating disease prior to the acute SCI that would cause exercise intolerance
- Premorbid, ongoing major depression or psychosis
- Required use of anti-spasticity medication
- Subject unlikely to complete intervention or return for follow-up
Please refer to this study by its ClinicalTrials.gov identifier: NCT00006429
|United States, California
|Rancho Los Amigos Medical Center
|Downey, California, United States, 90242
|United States, Georgia
|Shepherd Center
|Atlanta, Georgia, United States, 30309
|United States, Ohio
|Ohio State University
|Columbus, Ohio, United States, 43210
|United States, Pennsylvania
|Six Franklin Plaza
|Philadelphia, Pennsylvania, United States, 19102
|Thomas Jefferson University Hospital
|Philadelphia, Pennsylvania, United States, 19107
|Canada, Ontario
|University of Ottawa
|Ottawa, Ontario, Canada, K1H 8M2
|Canada, Quebec
|McGill University
|Montreal, Quebec, Canada, H3G 1Y5
|Principal Investigator:
|Bruce H. Dobkin, MD
|University of California at Los Angeles (UCLA)
Additional Information:
|ClinicalTrials.gov Identifier:
|NCT00006429 History of Changes
|Other Study ID Numbers:
|Study First Received:
|November 1, 2000
|Last Updated:
|May 20, 2011
|Health Authority:
|United States: Federal Government
Keywords provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):
Spinal Cord Injury
Body Weight Supported Ambulation Training
Treadmill Training
Physical therapy
Assisted Ambulation
Additional relevant MeSH terms:
Spinal Cord Injuries
Central Nervous System Diseases
Nervous System Diseases
Spinal Cord Diseases
Trauma, Nervous System
Wounds and Injuries
ClinicalTrials.gov processed this record on October 07, 2015


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Tasks does not highlight when selected in a list.
When I have the app open and I tap on a task in the list, the options appear at the bottom and function correctly, but there is nothing in the user interface indicating which task I have selected (I.e. the selected task or tasks remain the same color). On the Android widget I see a change in the background color (becomes more reddish) when selecting a task.
All responses
Phone: Desire HD
Android version: 2.3.7
Android Distribution: cyanogenmod-7.0.2-ace
Hello Colin,
Please tell me:
- In what view does this happen exactly?
- Could you please send us a screenshot showing this issue to firstname.lastname@example.com and firstname.lastname@example.com ?
- If you have an option to test it on a "stock" Android distribution, please let us know if the issue persists there too.
Best regards,
This happens within every view that displays a task list. It does NOT happen on the todoist widget, only in the app itself.
Screenshots emailed!
Thank you for the screenshots, this issue will be addressed in the next updates.
Best regards,


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Abilene teen mom fondly remembered after car strikes, kills her
Fighting back emotion, tears welling in his saddened eyes, Juan De Los Santos stood on his porch Friday, mere feet from where Denise Fletcher — the 15-year-old mother of his son's child — had been struck and killed by a passing vehicle a night earlier.
His emotion changed from one of hurt and pain to one of smiling and recollection of a young woman who was a "beautiful girl growing up to be a beautiful young lady" and top-notch mom to her prized 3½-month-old son Adrian.
He fondly recalled how she referred to him as "Big John."
"She smiled, always smiled, always laughing. She was a very, very good young lady," said De Los Santos, overlooking a front yard at North 18th and Kirkwood streets that now features two crosses erected to honor the Abilene High freshman.
The accident was reported at approximately 10:25 p.m. Thursday when officers, responding to a report of a disturbance in progress in the 2200 block of North 18th Street, found Fletcher lying the roadway after a vehicle traveling westbound on North 18th had hit her.
The teenage girl was transported via ambulance to Hendrick Medical Center, where she died about 5 a.m. Friday.
Abilene police spokesman Sgt. Keith Shackleford said it is not believed to be a hit-and-run accident or that alcohol was involved, but the investigation is ongoing.
Shackleford confirmed that police detained a 63-year-old man for questioning, but he has since been released. According to Shackleford, toxicology specimens were taken from the unidentified man.
Shortly before the accident, Fletcher's stepfather Donald Mandrell said he got out of bed after having a feeling something bad was about to happen and headed on foot from his home on Lillius Street toward De Los Santos' home on North 18th.
As he rounded the corner and caught view of his wife and Fletcher's sister ahead, Mandrell said a vehicle sped by, traveling fast enough to raise his shirt. He said he watched the vehicle brake, hit the gas again and jump the curb before striking his stepdaughter, sending her onto the hood, into the windshield, over the top, and onto the trunk before hitting the ground.
De Los Santos said Fletcher and his 18-year-old son, Jonathan, were standing at the end of the driveway when she was hit.
"And she had bright colors on — bright pink," Mandrell said, asking why police let the man go.
In the wake of the accident, De Los Santos and Mandrell said something has to be done to slow traffic along North 18th Street.
"If somebody really wants to make a difference, they should do something about this," De Los Santos said, noting it isn't uncommon for traffic to travel 70 to 80 miles per hour along the stretch in front of his house.
"They don't care," De Los Santos said. "They will run you over."
What's especially troubling to Mandrell, in addition to the speeding, is the frequency that motorists are spotted driving with "beer in their lap,"
"I just don't want it to happen to nobody else," Mandrell said. "I hope it opens everybody's eyes — what happened to my baby girl."
Mandrell's baby girl definitely left an impression on those who knew her.
"When she smiled, it was just like an angel," Mandrell said.
Dennis Townsend, principal of Abilene High's Freshman Academy, said Denise Fletcher possessed a "beautiful smile" and was outgoing, outspoken and a "spitfire" who was memorable in the classroom.
"She was a kid with lots of energy and lots personality," said Townsend, noting extra efforts were taken Friday to counsel students and teachers grieving Fletcher's death. "She was the type of person that people knew who she was. You always knew she was in the room."
While she wasn't involved in extracurricular activities, Townsend said, "Family was important to her."
Most important to her, those who knew her said, was her baby.
"She was the best mom to a kid that a kid could ever have," Mandrell said. "She went to school, but every minute she was thinking of her baby."
On Friday afternoon, a large contingent of family gathered at Mandrell's home on Lillius Street, recalling how she had impacted their lives.
"You could be mad crying, but she could always put a smile on your face," cousin DeCole Harden said.
"It just happened too fast," said an emotional Dwayne Crosby, Fletcher's uncle. "She's gone. I'm gone."
Family members said a candlelight memorial for Fletcher will be held at 6 p.m. today at the accident scene of North 18th and Kirkwood streets.
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Flag Baby Gender Game Cake
Now the anticipation is about to come to its peak! Soon you will know: boy or girl. Each guest will pull a flag as to what he or she thinks the baby will be. There will be a blue group and a pink group. As soon as the cake is cut, the winners will be declared.
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Established in 1993, Elysian Films is a UK-based producer of award-winning feature films, shorts and documentaies. Its first international feature film, SKIN, starring Sam Neill and Sophie Okonedo, dramatises one of the most bizarre and fascinating true stories to emerge from South Africa (www.skinthemovie.net).
Freeze-Frame is a new short film, currently in production, starring Freddie Fox (Pride, Riot Club) and a dynamic young Chinese actress, Tuan Yuan. It has been commissioned by the Foreign and Commonwealth Office and VisitBritain as part of the government's GREAT campaign; its aim is to promote British talent, locations and expertise in China, following the signing of a new co-production agreement between the two countries. Written by David and Keith Lynch, the film is being Executive Produced by Carter Pilcher of Shorts TV, and directed by Anthony Fabian. Shot on location in London, Edinburgh and Shanghai in October, it was released in December 2014 and is currently showing on all Virgin Airllines flights.
Madmen meets Downton Abbey - a new, long-running TV series. Adapted from Fiona MacCarthy's acclaimed book, Last Curtsey, DEBS follows the lives of four friends from their 'coming out' rites in 1958 to adulthood in the emancipated world of '60s London. The series charts the women's interconnected lives over a ten year period: from the last presentations to the Queen and the debutante season that followed, to the revolutionary, anti-establishment prism of sex, drugs, fashion and rock and roll, dramatising the breakdown of the class system and women's lib. DEBS will counterpoint the hide-bound late 50s with the world of swinging '60s London, just as Downton Abbey has given the world access to high society at another time and place, and Mad Men has brilliantly illuminated advertising in New York across the same era.


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Company's Franklin station continuing its broadcasting
Nothing but static can now be heard on Sylva's WRGCAM (680) radio station. Late last Wednesday night (Aug 30), the radio station went off air and a notice from station management posted on its website informed listeners it is uncertain if or when they will return.
The notice cited that "incredibly difficult economy has made it impossible for us to secure the local advertising support needed to continue providing Jackson County a full service community radio station."


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Gear Gallery
There's no better way to celebrate the Olympics than channeling your inner Speed Racer, and here are the skis to help you do it.Your boots may already be obsolete. Here's why.When is it worthwhile to ditch the rentals and invest in kids' skis?We like having a little extra around the waist, and here's why.Jackets serve three main functions: to keep you warm, dry and looking good. Here are the best.Whether it's tight bumps and groomers, or trees and chutes you want, these are the skis that'll get you there.We tested hundreds of men's ski boots, and this is what rose to the top.We tested hundreds of ski boots, and these are the best of the best.The best excuse to buy new gear is to get rid of your old stuff.Here are some of the best ski jackets you'll find this winter.
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We are based in Newbury Berkshire and operate a local mobility company. We cover all of Berkshire, most of Oxfordshire & Wiltshire & parts of Hampshire. This enables us to give the very best customer service whilst keeping our overheads and prices low. Used Stairlifts, Scooters and Wheelchairs are our specialty, but new are available if preferred. We have been involved with the sales, service & repair of mobility products since 1992. We aim to be the most affordable & reliable local suppliers.
Because we are literally "Close Enough to Care" we make sure all our customer are no more than 1 hour away. It makes sense to use a local company, you could wait for weeks for a national company to visit if you have a problem, where as we can usually pop round and take a look straight away.
We offer a complete range of services. Our experienced friendly team are qualified and ready to help. So if you're worried that your mobility product may need some attention, repair, safety check or service. Maybe its time to upgrade or part-exchange or you're considering you're first purchase, give us a call and see how we can help.
There are more solutions available for people with mobility issues than ever before. Whether you can walk independently and only need support in stability, or are unable to walk even with help, there are mobility aids designed to cater perfectly for your needs. Prices have generally reduced significantly in recent years, while reliability has improved greatly.
Contact Us today to see how we can assist you with a Stairlift, Mobility Scooter or Electric Wheelchair in Berkshire, Wiltshire, Oxfordshire and Hampshire. Alternatively please look at our FAQ page to see if we can help with any initial questions you may have.


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9 ways to get your car to 200K miles (or more)
And with the average car adding more than 10,000 miles to the odometer each year, it's practically a given that you'll hit the once-notable milestone of 100,000 miles. In fact, you might even triple that without needing a big-dollar repair, such as a new engine or transmission.
But reaching those loftier targets requires some input from you, the owner. Squeezing maximum life out of your ride at minimum cost means being attentive to your car in a variety of ways. We've outlined nine here. Take a look.
Regular Maintenance Is Crucial
Photo: Thinkstock
There's no getting around this one: A car that's not regularly serviced won't last as long as one that is. It might not even make it to 100,000 miles.
Regular maintenance is "the key to the automotive fountain of youth," says Tom Torbjornsen, author of "How to Make Your Car Last Forever."
What is regular maintenance? It's what it says right there in the maintenance schedule of your owner's manual, says Torbjornsen. Follow the "severe duty" schedule of more frequent servicing if your manufacturer specifies one.
But at a certain point, the manufacturer's schedule may fail a high-mileage driver — as it sometimes lacks specifics beyond, say, 150,000 miles, other than to start over as if the car were at mile zero. "Can [manufacturers] truly believe that an engine with more than 50,000 moving parts – with 150,000 miles – is going to replicate an engine straight off the assembly line?" wonders Pam Oakes, a certified technician and author of "Car Care for the Clueless." "What about a 180,000-mile engine? Would that have the same wear as an engine with 30,000 miles? I don't think so."
Like other experts we spoke with, Oakes recommends building your own maintenance schedule with a trusted, certified mechanic who knows you're interested in going the distance.
Use Your Senses: Sight
If your routine is to plop into the driver's seat in a darkened garage at one end of your trip and slam the door behind you in a darkened garage at the other end, it's time to shake things up a little. "Do a 'preflight' at least once a week," says Tony Molla, vice-president of communications for the National Institute of Automotive Service Excellence (and a certified technician with years of experience). "Walk around your car. Have your kid step on the brake and see if the lights come on. By spotting a problem now, when it's small, you might save yourself more than just a ticket."