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1) . ___. They prefer to nest in a large hollow in a tree or even to occupy the deserted nest of a hawk or crow. These structures are large and rough, built of sticks and bark and lined with leaves and feathers. Sometimes owls nest on a rocky ledge, or even on bare ground.
A) Owls are poor home builders,
B) It takes a long Time to raise a family of owlets,
C) The mother lays two or three eggs,
D) The mother stoically settles herself on the nest,
E) The parent birds weary of family life by November and drive the young owls away to establish hunting ranges of their own.
2) . We all know that learning is important. ____? A dictionary may tell you that learning is acquiring knowledge through experience and study. A teacher might tell you that it is memorizing what he wants you to know for an examination. Your boss might tell you that it is mastery of the task you are hired to do. A psychologist might tell you that it is a relatively permanent change in behaviour due to past experience. Obviously, learning takes place in many ways and forms.
A) How is it managed
B) What exactly do you mean
C) Yet can one depend on it
D) But what exactly is it
E) Do you think it can be mastered
3) . Someone once said that there are three sides to every uncertain issue: your side, my side, and the right side. ____. For instance, the reactions 1:o the issue of abortion are usually divided into two basic: viewpoints: for or against. But the issue is not that simple. Other questions begin to surface, which turn the issue into a complex one and make it necessary for us to look at it from many sides.
A) Unknowingly people become conditioned to speak out of prejudice
B) In truth, there may be many sides, depending upon the issue instead
C) As we mature, our beliefs are also shaped both directly and indirectly by the media
D) Consequently our thinking process becomes evaluated by other's opinions,
E) Even when we think we are acting as individuals by rejecting the ideas of one group, we are often just accepting the ideas of another.
4) . Some sociologists are concerned that America is/no longer "a melting pot," but "a salad bowl." Unlike most earlier immigrants who were willing to learn English and wanted to "melt" into American life, many of today's immigrants do not see the need. ____ ? How will all this affect American/s future?
A) Why did most European immigrants settle in the cities rather than/on farms
B) What was city life like for most immigrants
C) What changes can we expect in the make-up of American's population by the year 2002
D) What hardships did the early immigrants face when they arrived in America.
E) How far back can an American trace his roots
5) . .---- o The filtering economy they inherited was now under
additional pressure from those newly unemployed, including the million- man army of the former regime. There were critical shortage of foreign exchange and gold much of which had been stolen in the final days of the war. There were also at least two million new refugees, nearly 20% of the population. Virtually, the country was in a state of total bankruptcy.
A) The end of the war in Vietnam brought massive problems to the new leaders of the country.
B) In the first place, all industry was nationalized by the new Vietnam government
C) One unexpected problem facing the new government has continuing military activity
D) One solution to the urban problems facing Vietnam was to get people to return to the countryside,
E) In their first months in power Vietnam's new leaders succeeded in persuading hundreds of thousands of people to move back to their farms.
6) . Getting information on a possible adversary or adversaries is only the start of intelligence process. The raw material, once in hand, must be drawn together, analyzed, correlated, and evaluated prior to it becomes useful knowledge. ____. From this appraisal, which points to his most likely course of ac ion, the target state can chart a course of action best designed
to meet the developing situation.
A) The ethics of secret intelligence operations have long been debated
B) At this stage there emerges an estimate of the adversary's intentions and of his ability to achieve them.
C) But the richest source is usually the secret agent, who is always a highly skilled and well-trained professional.
D) Intelligence findings are, therefore, usually classified and limited in circulation
E) In recent decades technology has enormously lengthened the reach and sharpened the he penetration of intelligence.
7) . In the 1900s cancer was nearly always fatal; by the 1930s .one out of five cancer patients was saved; by 1975 treatment was successful in one out of every three cancer patients ____.
A) New evidence suggests that the highest risk for lung cancer occurs in asbestos workers who smoke.
B) Indeed every one knows that cancer refers to a group of over 120 different diseases
C) Today scientists and physicians believe that half of all cancer patients can be saved if present knowledge is applied promptly in every case,
D) Rehabilitation of the cancer patient has become an important new concern for social workers,
E) The aim of cancer rehabilitation is to help the patient lead as normal a life as possible.
8) . The idea that oil originated in the sea is supported by several evidence. First, almost all the oil-fields on Earth are near the oceans of today.......... Further, the rocks in which oil is found are sedimentary rocks, which were formed originally in the sea. Lastly, shells and other proofs of sea life are usually found near an oil well.
A) In some places, oil is in fact found in the sea, where it comes up to the surface.
B) On the other hand, the large oceans contain significant unexplored and unexploited oil reserves.
C) Undersea oil provides a great potential for us to increase our oil production, considerably in the future.
D) However, oil reserves in the sea are difficult to exploit for practical reasons.
E) Yet, it is easier to work on land for better.
9) ....... They were encouraged to share their feelings, observations and reservations at informal sessions throughout the program. In the end of the semester, skills acquired during the program were applied by students in the form of original productions.
A) Students were not really prepared for such a course.
B) An entrance exam had to be passed.
C) Not many were really eligible for such a course.
D) I really felt that the students were over-qualified.
E) The students were informed of the experimental nature of this one year program.
10) . There are no less than 120 countries the so-called third world known variously as less developed. There is a great diversity among them, and yet they have a number of qualities in common....... For instance, some of the oil producing countries have achieved very high levels of income per capita while retaining many of the other characteristics of less developed countries.
A) Their natural sources are so limited that economically they are mostly dependent on international aid.
B) Population explosion is a major problem many countries are unable to cope with.
C) In such countries there is a great demand for an educated and skilled workforce.
D) Death rates have fallen sharply in response to improved health services
E) Foremost among these is their poverty, but even poverty is not universal.
11) . Even the smallest organization, public or private, has a personal function. People are an organization's the most important resource and, although the relations between the
personnel department and other department are not always obvious, it is important that cooperation between all departments and personnel is maintained. It is the personnel department, with the help of other departments, which will decide any manpower policies by recruiting, selecting and training all employees.........
A) This shows that personnel departments carry out crucial functions in organizations.
B) That is why institutions will be forced to make huge investments.
C) Certainly, some functions such as research or legal advice are carried out by different staff.
D) In fact, no government agency would have been involved in such a case.
E) Initially, each department was required to submit their proposals for improvement.
12) . It was the worst ice-storm in living memory. What started in the clouds as rain became ice as it hit power lines, houses and shop windows....... Well over 90,000 people had to leave their freezing homes for those of luckier or better equipped
A) It fell for days and it paralyzed much of Quebec, knocking out the power supply to 3 million people.
B) Until then it was regarded as one of the worst natural disasters ever to hit Canada.
C) The cleaning up process was soon in full swing and life returned to normal.
D) Old people in particular are at risk if temperatures continue to fall in this way.
E) The midweek forecast for the area is far from encouraging.
13) . Bulbs are ideal for garden lovers because they are easy to plant and flower well in their first season....... and grow happily in all types of soil. They come up year after year and delight the eye with their rich colours and lovely shapes.
A) They require comparatively little attention.
B) The tulip, however, isn't everybody's favourite flower.
C) As a result, the site must be chosen with great care.
D) Of these the crocus is native to Turkey.
E) Even experienced gardeners get disappointing results.
14) . Countries has its own stories that people tell each other. These stories are called folk tales. Folk tales tell something very important about people...... Instead they indicate that people everywhere are very much alike.
A) They give a lot of information about their cultural heritage.
B) They don't show us that we are different.
C) However, they vary from one country to another.
D) Despite cultural differences, folk tales exhibit striking similarities.
E) So every child enjoys listening to them.
15) ....... It is only when the runner successfully overcomes all the difficulties inherent in every one of the stages he has to pass through that we can confidently say that success has been attained.
A) I would not advise anyone to take up sport for there are too many dangerous steps.
B) Becoming a good runner is a process that goes on at several levels and continues over many years.
C) Sport is something that everyone at every age can do.
D) For everyone who wants to become a good athlete, it is advisable that they should first consult their doctors.
E) Many runners have come and gone in the last decade.
16) . At the beginning of this century, a group of writers from scattered mid western cities came together in commercial Chicago. From the rough immediacy of the city, they created a style that was distinctively and unsparingly realistic.........In fact the critics were soon to describe Chicago as the literary capital of the US.
A) Most of them, however, eventually moved away from Chicago.
B) The "Chicago Renaissance" fuelled by these writers soon captured the attention of the rest of the nation.
C) It is now a commonplace of literary criticism that there is a close relationship between cities and their writers.
D) Chicago is indeed a city of absorbing contrast, and not least in the field of architecture.
E) American realism differs in many obvious ways from European realism.
17) . It is now a commonplace to note how the aircraft and the TV box have changed our old ideas of geography. Technology has indeed compressed time and space....... In the past people grew familiar with their neighbours across the seas slowly and gradually over generations. This is no longer the case. The
meeting is abrupt and often violent.
A) The Pacific world at that time had already the experience of centuries of commerce behind it.
B) Documentaries of the natural world are particularly instructive.
C) Naturally older people tend to feel nostalgic about their youth.
D) It was Spain in the sixteenth century that pioneered this sort of work.
E) But living with these new realities is not so easy as talking about them.
18) . In the beginning of 1910s cancer was nearly always fatal; by the 1920s one out of five cancer patients was saved; by 1978, treatment was successful in one out of every three cancer patients.......
A) New evidence suggests that the highest risk for lung cancer occurs in asbestos workers who smoke.
B) Indeed everyone knows that cancer refers to group of over 100 different diseases.
C) Today scientists and physicians believe that half of cancer patients can be saved if present knowledge is applied promptly in every case.
D) Rehabilitation of the cancer patient has become an important new concern for social workers.
E) The aim of cancer rehabilitation is to help the patient lead as normal a life as possible.
19) .1982 was not an easy year for the Heinlemann Government in Britain. It was a year of confrontation with the trade unions...... Indeed, it was even forced to adopt certain policies similar to those which it had attacked so vehemently
when it had been in opposition.
A) Finally, after 1982, there was industrial action in protest against the Government's prices and incomes policy.
B) These problems were aggravated by persistently high levels of unemployment, especially in certain regions.
C) It was also a year in which the pressure of circumstances forced the Government to abandon many of the initiatives it had started in 1980.
D) Moreover, negotiations with the EEC started immediately after the general election of 1980.
E) Consequently, a 90-day standstill was imposed on wages, and prices and charges for goods and services were similarly frozen.
20) . Many people take vitamins for illness ...... For anaemia they swallow vitamin B and D. When winter arrives, they quickly consume huge quantities of Vitamin C. However, they may not be doing themselves all that much good. Certainly the use of vitamins can be beneficial, but taken in large quantities, they can also be dangerous.
A) To heal wounds or cure certain diseases, they may take vitamin E or A, sometimes both.
B) Unfortunately, many people believe that if one vitamin is good, two are better.
C) While a daily vitamin supplement is undoubtedly beneficial, there is no evidence that large doses of vitamins do much good.
D) Excessive use of vitamin D can lead to kidney damage, and vitamin A may cause incurable skin problems.
E) It is a fact that nowadays people use vitamins excessively.
21) . We all know that learning is important. ........ ? A good dictionary can tell you that learning is to acquire knowledge through study. A teacher might tell you that it is memorizing what she wants you to know for an examination. Your boss might tell you that it is mastery of the task you are hired to do. A psychologist might tell you that it is a relatively permanent change in behaviour due to past experience. Obviously, learning takes place in many ways and forms.
A) How is it managed
B) What exactly do you mean
C) Yet one can depend on it
D) But what exactly is it
E) Do you think it can be mastered
22) . Undeveloped countries are those in which economic structure and development are too slow. The causes of the condition of lack of development are complex, but two opposing sets of theories dominate discussion....... On the other
hand there are the theories that ascribe underdevelopment directly to the distortions of economic structure and the exploitation involved in the relations between the developed and the underdeveloped countries.
A) In other words, development and underdevelopment are mutually interdependent.
B) This view implies that the state and process of underdevelopment in certain countries is inevitable.
C) On the one there are those theories that attribute lack of development to the internal characteristics of the undeveloped countries themselves.
D) Accordingly, such countries are responsible for their own underdevelopment.
E) However, no country in the world is completely isolated from the current monetary polices.
23) . Collecting information on a possible adversary or adversaries is only the start of the intelligence process. The raw materials, must be drawn together, analyzed and evaluated before it becomes useful knowledge. ...... From this appraisal,
which points to this most likely course of action the target state can chart a course of action best designed to meet the developing situation.
A) The ethics of secret intelligence operations have long been debated.
B) At this stage there emerges an estimate of the adversary's intentions and of his ability to achieve them.
C) But the richest source is usually the secret agent, who is always a highly skilled and well trained professional.
D) Intelligence findings are, therefore, usually classified and limited in circulation.
E) In recent decades, technology has enormously lengthened the reach and sharpened the penetration of intelligence.
24) . The natives of the Canaries in the Pacific were originally the mutineers of the ship Bounty. They took possession of the island of the islands in 1790, and it was not until 1814 that their whereabouts were ascertained, accidentally, by a passing
ship....... In the course of years they increased so much in numbers that they were too many for the island to support. Finally, in 1856 they were removed by the U.S. Government to the much larger Norfolk Island.
A) The Bounty was originally chartered to explore the Pacific Islands and establish British colonies there.
B) Actually, much of their history is still controversial and there is a considerable difference of opinion about their origin.
C) Up to that date trade in the Pacific region had been their main occupation.
D) The British Government sponsored a number of search projects, but all of them ended in failure.
E) The mutineers, under their leader Adams, had settled to a communal existence and married several women.
25) . The planets are the celestial bodies that revolve round the sun in elliptical orbits, ...... There are also a large number of minor planets, commonly called asteroids. Today many things concerning the planets can be answered by means of probes sent to them. These include the measurement of the magnetic
field, if any, of the planets and the study of their atmospheres.
A) Among them Pluto was the last planet to be discovered in 1930 by the American astronomer Tombaugh.
B) At present only nine major planets are known, and they are different in many respects from the fixed stars.
C) Scientists have recently managed to land on the surface of Mars with an extremely efficient instrument for exploration.
D) Yet, the moon revolves round the earth and has already been explored.
E) However, Pluto is the most distant of the planets and has an orbit more elliptical than the other planetary orbits.
kpds.org bedava ingilizce hazırlık ve testler


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Report: 2015 NFL Draft To Be Held in Chicago
The wait is finally over: the 2015 NFL Draft will reportedly be held April 30 to May 2 in Chicago. The 2015 NFL Draft will be held in Chicago, per a league source. — Rand Getlin (@Rand_Getlin) October 2, 2014 The NFL draft has been held in New York City […]Read more ›

subset: commoncrawl


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Please enter your search criteria below to find a healthcare provider.
Use the form below to select organization criteria and click the Search button.
A thoracic aneurysm is an abnormal enlargement of the wall of
the aorta in the chest. Life threatening complications of
aneurysms include rupture and dissection. Timely diagnosis and
treatment is critical. Thoracic aortic aneurysms are the 13th
leading cause of death in the United States. The treatment of
an aortic aneurysm depends on multiple factors including the
size, rate of growth, location of the aneurysm, and the
patient's age. Patients with marfans syndrome and those with
bicuspid aortic valve disease are at increased risk of rupture.
At Northwest Regional Heart and Vascular aortic aneurysms are
treated by a multidisciplinary team including cardiac surgery,
vascular surgery, and interventional cardiology. Treatment may
include medical management, stent graft repair, and open
surgical repair.
Aortic root aneurysms are usually associated with leaking
(insufficiency) of the aortic valve. Open chest surgery is
usually required. Your surgeon will advise you regarding the
options for aortic replacement including biologic and
mechanical valve conduit versus valve repair.
Aneurysms of the first part of the aorta in the chest
(ascending aortic aneurysms) usually require open surgery with
graft replacement of the aorta. Many aneurysms involving the
descending portion of aorta can be treated with less invasive
approaches including repair with long thin tubes called
catheters introduced through a small incision in the groin
(endovascular stent graft repair).


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Bruno Mars did it again. Friday night he performed for a second night in a row on Jimmy Kimmel Live, celebrating it's new timeslot vs. Letterman and Leno.
Below you can see the reworked version of Locked Out Of Heaven with a little reggae twist.
Tags: 'Jimmy Kimmel Live' » bruno mars » celebrities » entertainment » jimmy kimmel » locked out of heaven » unorthodoxed jukebox » When I was your man
Copyright ©2016, Interactive One, LLC . All Rights Reserved Powered by WordPress.com VIP


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Anyone Having MIL or SO's mother in the delivery room??
I competely understand but just think you are going to be in some of the most akward positions of your life. Is that something you really need to share with everyone? ;) Plus you never know how you might respond to labour etc. If I'm a total B*%$& I don't need everyone knowing that. Try to explain it to your DH like that.
Benjamin and Lily September 2011
Emily June 2013
Me + DH = DS (8/10), DD (6/13)
I was going to have my MIL in the room last time, but she ended up being the only one who could watch my son. She has two sons and I'm pretty sure she wasn't there for any of my SIL's births. If she asked or really wanted to be in the room this time I wouldn't say no since she hasn't gotten to see any of her grandchildren born, but honestly she gets on my nerves normally and I've been very short tempered this pregnancy...prob not the best idea.
My mother has been present for every one of my deliveries and is planning on coming for this one too. My MIL was present for my second. I agreed to it because she wasn't able to be there for her own daughter's deliveries and it was something she wanted to experience. She kept telling me "if you want me to leave, tell me. You won't be hurting my feelings," but to be honest, the delivery room was so crowded with medical staff that I wanted to leave the room! lol It was definitely weird having her there since she got a nice view of my girly bits, but I was very happy to give her the chance to see one of her grandkids being born.
Kitty + Blue = Raelin / 5.6.06 | Logan / 8.22.08 | Four Angels / 2011 | Inara / 7.27.12 | Aeris / 7.7.13


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- Main
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Our Team
Goodman School of Business
Our Team
Our team of top Goodman School of Business students combines the education they receive with their own unique experiences and skills to offer affordable and highly-competitive consultancy services.
Kajsa Cirocco
Kajsa is currently enrolled in the MBA program with a concentration in Human Resources Management. Prior to pursuing the MBA, Kajsa graduated from Brock University with a Bachelor of Arts Honours in Psychology and Liberal Arts. Kajsa has experience in conflict resolution and customer relations management, and has held leadership positions in the banking and hospitality industries. In addition, Kajsa is fluent in English and Italian and is an active volunteer in the Niagara community. Her areas of specialization include:
- Communications and Client Relations
- Human Resources
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Jenna Dustanova
Jenna is currently enrolled in the MBA program with a concentration in Accounting and is working towards completing her Certified Management Accountant designation. Jenna has a Bachelor of Mathematics from the Aktobe State Pedagogical Institute in Kazakhstan. Jenna has worked both as a Math instructor in Kazakhstan and as an accounting assistant for Bethesda Community Services in Canada. Jenna is fluent in English, Russian, Kazakh. Her areas of specialization include:
- Accounting
- Market Research
- Financial Analysis
Nancy Lan
Nancy is currently enrolled in the MBA program with a concentration in Marketing. She graduated from Goodman School of Business with a Bachelor of Accounting. Prior to pursuing her MBA, Nancy has worked in two CMA/CGA accounting firms. Nancy has experience working in the food industry with a focus on importing and logistics and has been active as a volunteer in Niagara during her education. Her areas of specialization include:
- International Trade
- Marketing Strategy
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Nageena Naimi
Nageena is currently enrolled in the traditional MBA program at the Goodman School of Business. Nageena graduated from the Goodman School of Business with a Bachelor of Business Administration Honours with a concentration in Marketing. Nageena has worked on multiple projects with local businesses with a focus on developing business strategies, marketing strategies, and promotional plans. Nageena has also worked with a local start-up to develop a comprehensive marketing plan. Her areas of specialization include:
- Marketing Strategy
- Marketing Communication
- Business Management
Abdul R. Rahimi
Abdul is currently enrolled in the traditional MBA program. Previously, he completed a Masters of Pharmaceutical Technology from Kings College London, UK and a Bachelors of Pharmaceutical Science in London, UK. Abdul has held a number of technical and leadership roles within the pharmaceutical industry across the UK including technology transfer manager, process development & validation specialist, capital project management, and industrialization lead. In addition, Abdul is fluent in English, Persian, Pashto, and Hindi/Urdu. His areas of specialization include:
- Project Management
- Operations Management
- Product Development
Glenn Stevens
Glenn has completed his MBA program with a concentration in Accounting and is working towards completing his Certified Management Accountant designation. A graduate of the University of Waterloo's Engineering program, prior to pursuing his MBA Glenn worked in the field of new product development as a research engineer in the construction products industry and holds two U.S. patents. His areas of specialization include:
- Product Development
- Project Management
- Knowledge Management


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Open innovation!
Hello, we are e-nova, a small team of talented digital veterans. We build next generation web applications with awesome people.get in touch!
Fresh from the oven!
Quica is a young consulting firm helping non profits and green startup to find fundings. We worked together to define their brand and create an online identity. Quica.org is a good example of what we can do in a very tight budget, with less than a week worth of work!have a look
Click On French
Click On French will take you step by step through French language via a structured course and a vibrant community. Go through grammar, vocabulary, pronunciation and culture lessons, and listen to sound files recorded by French natives.learn french now!
Mystery project
We have a lot of hope for our next flagship product Passbolt! It is a password manager for teams entirely web-based, built on top of opengpg.js. It is still in development but will be available for free as an open source product very soon!comming soon!


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Reds slugger Trey Doten smacks an RBI double while Braves catcher Luke Carrell watching in the Reds' 11-6 victory in Monday's Davis Little League Majors National League Championships game. Fred Gladdis/Enterprise photo
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Email Address


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Hotel Le Roi(3 stars)Via Genova 43 17019 Varazze View on map
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hotel.de *
Our whole team would like to enthusiastically welcome you to the Hotel Leroi. It doesn't matter whether you're staying for one night or more, you will find lots of parking spaces available at the cushy hotel. Free for you A free newspaper delivered once a day is included in all the rooms. Free parking is available at the hotel. Make yourself at home Give your valuables to the knowledgeable reception staff for storage or keep them in the safe in your appealingly arranged. Use the lift to access the upper floors of the comfortable hotel. The hotel's garden terrace provides an enjoyable atmosphere for its guests. Enjoy your tasty evening meal in the high-quality dining room , and sample the delights of our leisurely bar in good company. Where you will stay All of the rooms in our hotel are equipped with a blow-dryer, an AC and a minibar stocked with many different beverages. Courtesies, for instance a writing table, a hand-held hair-dryer, a safe and a radio receiver, are to be found in each room. Within your room you will find international newspapers. In each and every hotel room a properly functioning telephone is included. Hotel guests can enjoy the comfort of windows in the bathroom. For your convenience, we have a shower, a bathtub and a hairdryer located in our bathrooms. After you get out of your bathroom's shower, grab a towel from the towel heaters. You can then easily get ready with the make-up mirror and hand-held hair-dryer in your bathroom. All hotel rooms are fitted with soundproof windows for the comfort of our guests. Hop on one of our boats and spend a day out at sea. We provide boating activities for you and your family and friends to enjoy. Reception hours: On business days: from 07:00 to 23:59
* Neither HolidayCheck nor the provider assumes liability for the accuracy and completeness of the content displayed above. Please take note of the hotel description of the respective operator and bear in mind that the services included in an offer may differ from the catalog description presented here. We are obliged to offer solely those services available at the time of booking as shown on the booking form. © 2013 Giata
Hotel amenities
- Terrace
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Room amenities
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Other hotel information
- Express check in and check out
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Pulse 189 by lightfootcomicsWatch
©2014-2016 lightfootcomics
The chapter is winding down, only two pages left.
I wonder if anyone is going to be confused by the word Tabitha used in the last panel.
I wonder if anyone is going to be confused by the word Tabitha used in the last panel.
Talk about a Thunderous Punch! (Please vote for pulse on Top Web Comics...I do,but I'm just an old guy with a .44) Didn't the B-29 "Bockscar" bomb Nakama in August 1945? OH, Nagasaki? That's completely different...Never mind!`'
This is not looking good.
Looks like Annie gets to spend a lot of time tinkering with his arm while she recovers. Well, if anyone brings bits of it to her bed I guess.
Only the people who haven't watched a bunch of anime while also hanging out online.
Nakama means 'friend'!
I thought it meant like more than friends, like someone who was almost family. I think another anime uses that too, not just One-Piece.
Oh. I thought it meant pirate crewmate, since it's only used on One Piece when Luffy describes one of the Straw Hats, and theyre all pirates.


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Heiress of Evil by voldiexx
Rated: 1st-2nd Years [Reviews - 15]
Summary: Whew, those thirteen years were nasty, but Voldemort's back and better than ever. He's got plenty to do, consolidating a power base, punishing traitors, and not letting the haters get him down, but he's spared some time to look over the custody agreement he signed fourteen years ago...
Annabel Curry wanted to spend the summer getting a tan, perfecting her Cheering Charms, and ensnaring Terry Boot. Instead, she's spending it with her dad the mass murderer and his unshaven goons. Oh yeah, and the shower doesn't work, AND NO ONE BUT HER SEEMS TO CARE.
First dates. Sparkly nail polish. Magical plumbing fiascos. Some heartwarming father-daughter moments. And some not-so-heartwarming ones.
The Epic Tale of the Hogwarts Food-fight by Gin_Drinka
Rated: 3rd-5th Years [Reviews - 769]
Summary: "Some mistakes are too much fun to make just once."
After Lily Evans, Head Girl of Hogwarts, starts a food-fight with James Potter, Head Boy of Hogwarts, they are both given detention for the rest of the year, and are assigned a 'detention journal', which the staff say will help to settle their 'overwhelming and disturbing differences'. We have come across Lily's journal; her take on why the whole affair ever started, her intriguing relationship with one 'supreme git of the galaxy', the extents to which she will go for revenge and where it will lead her...
"And if for some unknown reason you come across this, Potter, and the paragraph above does not manage to penetrate your unusually thick head and convince you of my stupendous dislike of you, I hope the following sentence helps: I HATE YOU!"
Bedside Manner by kalae_zoe
Rated: 3rd-5th Years [Reviews - 5]
Summary: Harry Potter was late for work. In the two years he had been employed as a Ministry Auror, he had never once been late for work. However, this morning a sore throat, an annoying headache and an overall tiredness, caused him to oversleep, making him late.
As Harry comes down with a bad case of the flu, who should come to his rescue, but his good friend Ginny Weasley?
Slightly AU as H/G never got together in sixth year. Everything else is canon.
Adventures in Courtship by SunDevil05
Rated: 6th-7th Years [Reviews - 997]
Summary: The war is over. Harry Potter and Ginny Weasley finally have the chance for the happiness they've been craving. But, with Harry recovering from the war and Ginny back in school, can they finally have the relationship they've always wanted?
******Higher rating just to be safe.


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A group of scientists skeptical of the connection between humans and climate change has taken aim at a recent AP article.
The AP report, by Seth Borenstein, claimed that global warming was a "ticking time bomb" that was "accelerating." Among the critics are University of Oklahoma geologist David Deming, retired University of Idaho chemist Michael Fox, and Florida State University professor emeritus James O'Brien.
According to Deming, the article is evidence that the media talks about global warming as fact—despite a lack of evidence.
"If the issues weren't so serious and the ramifications so profound, I would have to laugh at it," Deming explained. "The mean global temperature, at least as measured by satellite, is now the same as it was in the year 1980."
According to Deming, the article is evidence that the media talks about global warming as fact—despite a lack of evidence. The Associated Press stands behind the report.
"There's very little that's right about [the report]," Fox echoed, calling the article "dishonest." Fox claims El Niño in 1998 created the "big spike in global warming" and had little to do with CO2. He also believes factors such as sunspots, solar winds, the solar magnetic field, and solar irradiation all have created fluctuations in the earth's temperature over millions of years.
O'Brien acknowledges climate change but cautioned that it's quite different than global warming: "Global climate change is occurring in many places in the world. But everything that's attributed to global warming, almost none of it is global warming." He added that melting Arctic Ocean ice should lower, not raise, sea level due to the Archimedes Principle, and called sea level changes a "major scare tactic" used by those who believe global warming is a human-created threat.
Answers in Genesis has also spent time and resources looking into the issue of global warming from the young-earth perspective in the book and DVD Global Warming: A scientific and biblical exposé of climate change. Read on at Global Warming: Fact or Fiction?
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I have a couple of questions related to that and body condition scoring.
I'll just make up a horse to use as an example:
Let's say, at a score of 5, as they should be, the horse weighs 1200lbs.
What would they weigh, approximately, at a score of 4?
What would be the appropriate time frame for the horse to put on that amount of weight?
Same question for an overweight horse -
If 1200lbs is a 5, then what would a 6 or 7 be, and how quickly/slowly should the horse shed that extra weight?
Just trying to learn more about body condition and estimating weight.
Thanks :)


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Page 1
Current Drug Safety, 2009, 4, 55-61 55 1574-8863/09 $55.00+.00 © 2009 Bentham Science Publishers Ltd. Drug-Induced Hypokalaemia Chaker Ben Salem*,1, Houssem Hmouda2 and Kamel Bouraoui1 1Department of Clinical Pharmacology, Faculty of Medicine of Sousse, Sousse, Tunisia 2Medical Intensive Care Unit, Sahloul University Hospital, Sousse, Tunisia Abstract: Hypokalaemia (defined as a plasma potassium concentration <3.5 mEq/L) is a common electrolyte abnormality in clinical practice. Drugs are a common cause of either asymptomatic or symptomatic hypokalaemia. Drug-induced hy-pokalaemia is an important problem particularly in the elderly and in patients with cardiovascular, renal or hepatic dis-ease. Hypokalaemia can complicate the use of the drug in the therapeutic concentration range, and can also be precipitated with overdose or conditions leading to drug intoxication. Because the etiologies of hypokalaemia are numerous, the diag-nosis of drug-induced hypokalaemia may be overlooked. Physicians should always pay close attention to this common side effect. Evaluation and management of a hypokalaemic patient should include a careful review of medications history to determine if a drug capable of causing or aggravating this electrolyte abnormality is present. EPIDEMIOLOGY tion <3.5 mEq/L) is one of the most common electrolyte abnormality found in clinical practice. Mild hypokalaemia is usually well tolerated in healthy people, but hypokalaemia can be lifethreatening when severe. The risks of morbidity and mortality are increased in the elderly, patients with car-diovascular, hepatic or renal disease. Patients with underly-ing cardiovascular disease including myocardial infarction have an increased risk of ventricular dysrhythmias which is almost linearly related to the degree of hypokalaemia. In fact, the catecholamine surge that accompanies acute myo-cardial infarction causes redistributional hypokalaemia and hyperpolarizes non-ischemic myocardium, producing electri-cal inhomogeneity and ventricular arrhythmias [1]. Hy-pokalaemia seems also to be an independent predictor of mortality in heart failure. In a recent study serum potassium <4 mEq/L was associated with increased mortality, with a trend towards increased hospitalization in wide spectrum of ambulatory patients with chronic, mild to moderate systolic and diastolic heart failure [2]. Potassium depletion can lead to muscle cramps and other symptoms. However, the elderly are less likely to have classic symptoms since they are less active, and their symptoms may be confused with other medical problems. In addition, they are predisposed to be-coming potassium depleted because of possible inadequate dietary intake of potassium, and greater number of medica-tions that may lead to potassium depletion [3]. Potassium depletion causes a decrease in acetylcholine levels due to diminished choline acetylase activity. This effect can depress neuromuscular function causing decreased intestinal motility and even paralytic ileus, contributing to the precipitation of hepatic coma in patients with hepatic insufficiency. In addi-tion, hypokalaemia can contribute to the development, or aggravates the symptoms of hepatic encephabopathy by in-creasing proximal tubule ammoniagenesis. In hepatic Hypokalaemia (defined as a plasma potassium concentra- *Address correspondence to this author at the Departement de Pharmacolo-gie Clinique, Faculté de Médecine de Sousse, Avenue Mohamed Karoui, 4002 Sousse, Tunisia; Tel: 00 216 98 240 775; Fax: 00 216 73 224 899; E-mail: firstname.lastname@example.com or email@example.com insufficiency, the increased systemic burden of ammonia resulting from increased renal ammoniagenesis can be suffi-cient to cause the development or worsen the symptoms of hepatic encephabopathy [4]. the diagnosis of drug-induced hypokalaemia may be over-looked. Only systematic review of medications history al-lows recognition and prompt treatment. Below, we provide an exhaustive review of drug-induced hypokalaemia, and discuss the underlying mechanisms and consequent relevant issues for clinical practice. Because the etiologies of hypokalaemia are numerous, between January 1966 to June 2008, regardless of the lan-guage. The approach used was: hypokalaemia and potassium disorders as keywords with the subheading "drug-induced", and certain drugs were inserted as keywords. Data were identified from MEDLINE from the period describe the same topic, only English or French articles were analysed. However, in our review, pertinent informations in articles written in other languages (such as Danish or Chi-nese) has been extracted from the abstract in MEDLINE. Identified articles were evaluated to determine whether any of their references contained additional relevant publications. We excluded the articles with insufficient clinical or labora-tory data. If there were relevant articles in many languages which lyte abnormality [5,6], and can induce either mild and as-ymptomatic disorder or severe, even lethal hypokalaemia. Patients with mild hypokalaemia usually have no symptoms. If serum potassium level decreases further, nerves and mus-cles are predominantly affected, causing weakness, fatigue, leg cramps, myalgias, fasiculations, constipation and ileus [7]. In severe cases, rhabdomyolysis, ascending paralysis and respiratory failure may occur. Other manifestations may be associated such as atrial flutter, paroxysmal atrial tachycar-dia, ventricular tachycardia and fibrillation, metabolic alka-losis, nephrogenic diabetes insipidus, and enhanced renal chloride excretion. Medications constitute a common cause of this electro-
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56 Current Drug Safety, 2009, Vol. 4, No. 1 Ben Salem et al. hypokalaemia in hospitalised patients. Hypokalaemia has been reported in over 20% of hospitalised patients (potas-sium level <3.6 mmol/l), and a level < 3 mmol/l was found in almost 3.5 to 5% in these studies [6,8,9]. Profound hy-pokalaemia, defined as a serum potassium level of less than 2.5 mmol/l, is rare and occurred in less than 1% of hospital-ised patients [9,10]. Mortality in the hypokalaemic popula-tion was 10-fold higher than the general hospitalised popula-tion. Drugs accounted for a consequent proportion in the pathogenesis of this electrolyte abnormality in these hospi-talised patients. In a recent study, drug-induced hypokalae-mia is found in 2.5% of a population of the very old elderly (subjects aged ?75 years) [11]. Hence, it is important to ap-propriately detect and treat hypokalaemia. Several studies have examined the incidence and cause of MECHANISMS two major mechanisms. Hypokalaemia may result from re-distribution between extracellular and intracellular compart-ments, or an increased potassium loss through the gastroin-testinal tract or kidney. TRANSCELLULAR POTASSIUM SHIFTS Drugs can decrease serum potassium concentration by extracellular compartment to cells but the total body potas-sium remains usually normal. Consequently, hypokalaemia may be sometimes apparently minor, but should not be un-derestimated [3]. Indeed, clinicians should be aware that the extent and consequences of hypokalaemia may vary in clini-cal practice depending on factors such as co-morbidity, co-prescribed medications, self-medications, drug dosage or regimen. Numerous drugs can cause a shift of potassium from the ?2-Agonists the Na+-K+-ATPase pump, leading to a shift of extracellular potassium to the intracellular space [12]. Conventional intra-venous or inhaled doses of selective ?2-agonists reduce se-rum potassium by 0.4-1.2 mmol/l in a dose dependent man-ner [13,14]. Indeed, profound hypokalaemia (less than 2.5 mmol l-1) has been described when ?2-agonists are used in higher doses and in self poisoning [15]. Patients with severe asthma, taking also theophylline and corticosteroids that also decrease potassium level, appear to be more likely to de-velop severe hypokalaemia when treated with ?2-agonists [16]. Serum potassium levels should therefore be monitored. More interestingly, the hypokalaemic effect of ?2-agonists is used in some cases to treat hyperkalaemia. Indeed, albuterol was prescribed as adjunctive therapy to insulin and glucose to manage hyperkalaemia. ?2-agonists may precipitate hypokalaemia by activating Inhibitors of Uterine Contraction patients treated with intravenous ritodrine or terbulatine [17]. The stimulation of cellular potassium uptake by these drugs underlies the decrease of serum potassium level with a maximum decrease in plasma potassium occurring few hours of drug infusion. Changes in plasma aldosterone, renal po-tassium excretion or acid-base homeostasis do not contribute to ritodrine-or terbutaline-induced hypokalaemia. Careful Various degrees of hypokalaemia have been described in monitoring of electrolytes and cardiac rhythm during toco-lytic therapy with ritodrine or terbutaline are mandatory. Decongestants are potent stimulants of the Na+-K+-ATPase activity [18]. Intentional ingestion of large amounts of pseudoephedrine and the abuse of ephedrine used in some cough mixture can cause severe hypokalaemia [19]. The association of corticos-teroids with these decongestants can aggravate hypokalae-mia. Physicians should be aware of the potential for these drug-combinations to cause hypokalaemia. In experimental studies, pseudoephedrine and ephedrine Catecholamines pamine and dobutamine can cause hypokalaemia [20,21]. At dosages of epinephrine > 80 ng/kg/min, hypokalaemia is common [22]. Catecholamines shift the potassium of ex-tracellular space to the intracellular space via stimulation of the ?2-adrenoceptors and enhancement of insulin secretion. They may lead to arrhythmias and rhabdomayolysis in se-vere cases [23]. Therefore, potassium levels must be moni-tored during and after high doses infusion of epinephrine particularly during cardiac arrest [24]. Catecholamines such as adrenaline, noradrenaline, do-Xanthines toxication but it can also be seen with therapeutic doses [25]. A linear concentration-response relationship was docu-mented between serum theophylline concentration and hy-pokalaemia [26]. Theophylline increases Na+-K+-ATPase activity by inhibiting cellular phosphodisesterase with a re-sultant trans-cellular shift of potassium which may aggravate the theophylline-induced arrhythmia. Consumption of large quantities of caffeine, present in some drinks, can lead to severe hypokalaemia by stimulating cell membrane Na+-K+-ATPase [27]. Severe hypokalaemia was noted with theophylline in-Calcium-Channel Blockers pathogenesis of hypokalaemia remains equivocal [28]. Cal-cium-channel blockers alter potassium transport to cells [29]. Their possible hypokalaemic effect may be due in a part to the enhancement of the adrenaline-induced intracellular transfer of potassium from the extracellular space [30]. Long term treatment with nifedipine and nitrendipine may reduce serum potassium concentrations in hypertensive patients [31]. Verapamil does not usually lead to hypokalaemia when serum verapamil levels are therapeutic; however, intentional ingestion of excess amounts of verapamil, can significantly reduce plasma potassium levels [32]. The implication of calcium-channel blockers in the Insulin can lead to hypokalaemia. Exogenous insulin always causes a transient reduction in serum potassium but severe hy-pokalaemia can occur during the treatment of diabetic ke-toacidosis or in intentional overdose of insulin [33]. Insulin tolerance test may also be responsible for severe hypokalae-mia with cardiac arrhythmias [34]. Insulin increases cellular potassium uptake in the liver, muscle, and adipose tissue by activating the cellular Na+-K+-ATPase pump. The fall in Insulin promotes transfer of potassium to the cells and
Page 3
Drug-Induced Hypokalaemia Current Drug Safety, 2009, Vol. 4, No. 1 57 potassium level is independent of plasma aldosterone and epinephrine levels [35]. Chloroquine large amounts of chloroquine [36]. It seems due to a potas-sium shift from extracellular space to cells. The decrease of potassium serum is closely correlated with chloroquine con-centration. Profound hypokalaemia (< 2mmol/l) has been reported in 11% of cases after acute chloroquine intoxica-tion. Patients who died from chloroquine overdose had sig-nificantly lower serum potassium than survivors, but this disorder could not be directly considered as the cause of death in most cases [36]. Potassium supplementation can be used for the treatment of severe chlorquine-induced hy-pokalaemia; however aggressive replacement can lead to hyperkalaemia which potentially could contribute to the car-diotoxic effects of this drug [37]. Hypokalaemia was frequently noted after ingestion of Anaesthetic Drugs lowing anaesthesia. The cause of this decrease is uncertain. It may be due to the adrenergic stimulation or hyperventilation during surgery. Thiopental sodium may induce severe hy-pokalaemia [38]. The exact mechanism of thiopental-induced hypokalaemia is not elucidated, but seems secondary to the movement of potassium between the extracellular and intra-cellular compartments [39]. Hypokalaemia was also noted with supra-normal levels of lidocaine [40]. A decrease in serum potassium levels has occurred fol-Increased Loss of Potassium Loss from Gastrointestinal Tract In addition, sodium wasting in diarrhoeal stool can aggravate potassium loss from both gut and kidney by secondary aldos-teronism. Laxatives abuse causes excessive potassium loss in the stool and may result in hypokalaemia, sometimes severe resulting in rhabdomayolysis [41]. Phenolphthalein and docusate sodium has been found empirically to cause more potassium loss than other laxatives such as sorbitol or so-dium sulphate [42]. In all cases of hypokalaemia, a laxative abuse must be looked for in the patient history. Phosphate enemas, used in bowel clearance before radiology, endo-scopy and surgery, are associated with significant hy-pokalaemia [43], and should be used cautiously in children [44]. Drug-induced chronic diarrhoea can cause hypokalaemia. with severe diarrhoea leading to hypokalaemia [45]. Chemo-therapy which induces diarrhoea and vomiting can also lead to hypokalaemia [46]. Diarrhea is the most common cause of hypokalaemia in patients treated by capecitabine [47]. Cyclo 3 fort, used in the treatment of chronic venous insufficiency, can cause chronic diarrhoea with hypokalaemia [48]. Diace-tylrhein, a chondroprotective agent, can also cause severe diarrhoea with hypokalaemia. Persistent vomiting complicating drug therapy could lead to hypokalaemia which is generally due to metabolic alkalo-sis and hyperaldosteronism. For example, recreational drug-induced vomiting can lead to severe hypokalaemia and metabolic alkalosis [49]. Vomiting-induced by quinine in-toxication can cause severe hypokalaemia, potentiating the Some antibiotics can cause pseudomembranous colitis risk of quinine-induced arrhythmias [50]. Vomiting due to digitalis toxicity can aggravate an existing lack of potassium. Even, at therapeutic dose, digitalis-induced arrhythmias can be observed when hypokalaemia is present. Potassium deple-tion must be corrected in patients taking digoxin. Loss from Kidney of potassium by various mechanisms. The main mechanisms include renal tubular damage, increased delivery of sodium or an excessive anion load to the distal tubule, and an inap-propriate increase of sodium potassium exchange in the nephron. Many classes of drugs may cause excessive kidney loss Diuretics of drug-induced hypokalaemia [5]. Loop diuretics seem to produce less average fall of potassium concentration com-pared with thiazides [51]. However, the potassium depletion is usually mild and severe hypokalaemia (less than 3.0mmol/l) is uncommon with diuretics. The prevalence of diuretic-induced hypokalaemia varies from a study to an-other and with the used dosage. A recent study found that diuretic-induced hypokalaemia was the most prevalent ad-verse drug reaction in an elderly hospitalised population both during hospitalisation and at the time of admission [52]. In a retrospective study, 33% of elderly patients taking fu-rosemide alone were hypokalaemic as compared to 4% of those receiving furosemide in combination with potassium supplementation [53]. In a recent observational study, hy-pokalaemia occured in 8.5% of patients treated with low doses of thiazide diuretics but in only about 1% did the po-tassium level fall to less than 3 mmol/l [54]. The risk of hy-pokalaemia with thiazide is dose dependent and is greater when dietary sodium intake is higher [55]. There was no significant association with age and no association with gen-der. Diuretics affect the potassium serum levels by a variety of mechanisms. Loop and thiazide diuretics block chloride-associated sodium reabsorption in the loop of Henle and in the early distal tubule respectively, resulting in an increased sodium delivery to the distal tubule channel. Sodium is se-lectively reabsorbed via the amiloride-sensitive sodium channel creating a favourable gradient for potassium secre-tion via potassium channels leading to hypokalaemia. Moreover, Volume depletion caused by diuretics activates renin-angiotensin-aldosterone pathway. Therefore, increased production of aldosterone stimulates the reabsorbtion of so-dium and water and promotes excretion of potassium via the secretory potassium channels in the collecting ducts leading to hypokalaemia [55]. In addition, aldosterone can cause metabolic alkalosis which can worsen the diuretic-induced hypokalaemia by increasing potassium shift into cells. Hy-pokalaemia can also contribute to the maintenance of a metabolic alkalosis by enhancing bicarbonate absorption and increasing chloride excretion in the kidney. Aldosterone also has an extrarenal activity by stimulating cellular Na+-K +-ATPase pump activity. Loop and, occasionally, thiazide diu-retics may cause hypomagnesemia. The coexistent hyomag-nesemia can promote renal potassium wasting and increase the potential for arrhythmias. In fact, any magnesium deficit should be detected and corrected with magnesium supple-mentation. Magnesium is important for potassium uptake Loop and thiazide diuretics are the most common cause
Page 4
58 Current Drug Safety, 2009, Vol. 4, No. 1 Ben Salem et al. and for the maintenance of intracellular potassium levels, particularly in the myocardium. Combined deficiency may potentiate the risk of cardiac arrhythmias [56]. tolerance. It has been also implicated as a cause of new onset diabetes and in theory in a possible reduction in benefice of diuretic therapy. However, the new onset diabetes that oc-curs during diuretic treatment has not been shown to increase cardiovascular disease, either in clinical trials, or during longer observational studies [57]. The exact mechanism by which hypokalaemia may cause glucose intolerance is still unclear. It seems related to the inhibition of insulin secretion by the beta cells, and reductions in extracellular fluid volume and cardiac output. In addition, the evidence linking ar-rhythmias or cardiac death to the diuretic-induced hy-pokalaemia remains an area of controversy. Some studies suggest that hypokalaemia-induced arrhythmias, torsades de pointes and cardiac arrest have been involved as a cause of the deleterious effect of diuretics on cardiovascular risk, es-pecially in patients at greatest risk such as history of left ven-tricular hypertrophy, heart failure or myocardial infarction [58-60]. However, several studies have shown no increase in the cardiac arrhythmias or in the mortality [61,62]. Even though the evidence linking arrhythmias and cardiac death to the diuretic-induced hypokalaemia remains an area of con-troversy; this latter is undoubtedly associated with a risk of serious arrythmias when diuretics are co-administrated with drugs that prolong the QT interval. Therefore, caution should be taken when diuretics are co-administrated with drug-inducing QT interval prolongation. Diuretic-induced hypokalaemia may lead to glucose in- increase of the delivery of sodium and bicarbonate to the distal nephrons leading to potassium excretion. During long-term therapy with this drug, hypokalaemia is not common due to a compensatory potassium retention secondary to aci-dosis [63]. Acetazolamide can causes hypokalaemia. It causes an Antibiotics sium excretion by increasing sodium delivery to the distal nephron and by acting as nonreabsorbable anions in the dis-tal renal tubule, which enhances the secretion of potassium and hydrogen ion and results in hypokalaemia and metabolic alkalosis [64]. In a series of 16 patients treated with ticarcil-lin, the risk of hypokalaemia appeared greatest among pa-tients who received higher doses (>18g/day) [65]. Oxacillin, dicloxacillin, flucloxacillin and piperacillin can also cause severe hypokalaemia [66]. Meropenem [67], outdated tetra-cycline, neomycin, polymyxin B, colistin and bacitracin have also been reported to cause hypokalaemia [68]. Large doses of penicillins may promote urinary potas- tassium wasting by inducing depletion of magnesium. These drugs can cause Bartter-like syndrome, which associated hypokalaemic metabolic alkalosis, hypomagnesemia, and hypocalcemia. NSAIDs are beneficial in some situations; however, in one of the cases, electrolyte abnormalities were unaffected by indomethacin treatment but were partially cor-rected by large doses of spironolactone [69]. In a more recent case, gentamicin therapy induced a marked hypokalaemia and hypomagnesaemia associated with excessive kaliuresis and magnesiuria. Hypokalaemia was corrected with potas-Aminoglycosides and capreomycin can induce renal po-sium and magnesium supplements and the use of diclofenac [70]. The frequency of hypokalaemia ranges from 4 to 15% of patients receiving capreomycin therapy for 6 to 26 months. In a cohort study, among 44 patients taking capreo-mycin, 30 (68.2%) developed hypokalaemia (defined as se-rum potassium below 3.3 meq/l) [71]. Capreomycin-induced hypokalaemia seems to be more common in patients with low initial body weight or malnutrition. The exact mecha-nism of the urinary loss of potassium and magnesium due to aminoglycoside is not entirely elucidated. It may be due to aminoglycoside-induced hyperaldosteronism and tubular toxicity. Chou and colleagues [72] hypothesize that gentami-cin, stimulates calcium-sensing receptors on the thick as-cending loop of Henle and distal tubule leading to renal wasting of potassium, sodium and magnesium. Close moni-toring of serum potassium in patients who receive aminogly-coside especially capreomycin and/or high doses of penicil-lins is mandatory. Antifungal Drugs effect on the renal tubule. It causes inhibition of hydrogen ions secretion by collecting-duct cells as well as magnesium depletion [73]. Amphotericin-induced hypokalaemia is dose dependent and generally occurs before renal failure. In com-parison with amphotericin, the lipid formulation of ampho-tericin causes less hypokalaemia [74]. Hypokalaemia is sig-nificantly less common with caspofungin than with ampho-tericin [75]. Amiloride may be beneficial in amphotericin-induced hypokalaemia [76]. Spironolactone may also pre-vent amphotericin-related hypokalaemia in neutropenic pa-tients [77]. Itraconazole can induce severe hypokalaemia by excessive urinary loss of potassium [78]. In a recent study, hypokalaemia represents the most common adverse effect of itraconazole therapy [79]. Hypokalaemia is also seen with oral fluconazole [80]. Patients who are treated with these antifungal drugs should have their serum potassium level monitored. Amphotericin promotes renal potassium wasting by toxic Drugs Associated with Mineralocorticoid Effects serum potassium and is occasionally accompanied by hy-pokalaemia and severe metabolic abnormalities. Only a few case reports about severe hypokalaemia have been described. The maximum decrease in potassium serum levels is reached in the first week of corticosteroids treatment [81]. High doses of hydrocortisone (> 100 mg/day) can induce severe hypokalaemia by causing sodium retention and excessive renal potassium loss secondary to their significant mineralo-corticoid effect [82]. Dexamethasone, methylprednisolone, cortisol and prednisolone seem to be less likely to induce hypokalaemia [83]. Severe potassium depletion can occur when these drugs are prescribed with concomitant diuretics [84]. Fludrocortisone, used in the treatment of Addison's disease and orthostatic hypotension, can cause potassium wasting and severe hypokalaemia especially in the elderly population [85]. It is proposed in the treatment of hy-perkalaemia in patients undergoing hemodialysis. Long-term therapy with corticosteroids slightly reduces dependent hypokalaemia in 1% of users [86]. Some patients were reported to have chronic persistent hypokalaemia long after cessation of gossypol treatment. Gossypol-induced hy-Gossypol, a male contraceptive agent, can cause dose
Page 5
Drug-Induced Hypokalaemia Current Drug Safety, 2009, Vol. 4, No. 1 59 pokalaemia is related, in part, to the inhibition of 11 ?-hydroxysteroid dehydrogenase that causes an apparent min-eralocorticoid excess leading to excessive potassium excre-tion and sodium resorption. Carbenoxolone can cause also hypokalaemia by inhibiting the renal enzyme ?11-hydroxysteroid dehydrogenase. Hypokalaemia appears most frequently in those receiving excessive doses of carbenox-olone [87]. Mifepristone, an antiprogestogenic steroid, has also been incriminated as a possible cause of severe hy-pokalaemia which is related to excessive cortisol activation of the mineralocorticoid receptor [88]. Chemotherapy and Other Nephrotoxic Drugs bolic alkalosis, hypomagnesaemia, and hypocalciuria resem-bling Gitelman's syndrome [89]. The exact mechanism of this drug's nephrotoxicity is not elucidated, but it seems to be due to a tubular necrosis, predominantly in the distal con-voluted tubule and the collecting ducts, which may result in salt wasting and stimulation of the renin-angiotensin-aldosterone system, with consequent hypokalaemic meta-bolic alkalosis. Cisplatin has been associated with hypokalaemic meta- secondary to proximal renal tubular dysfunction [90]. The lower weight, the concomitant association of ritonavir or didanosine and the long duration of tenofovir use appear to be risk factors for tenofovir-induced renal tubular disease [91]. Foscarnet may cause hypokalaemia by renal potassium wasting probably by magnesium depletion [92]. Tenofovir can lead to nephrotoxicity and hypokalaemia Immunosuppressants act mechanism is still unknown, but seems to be secondary to a dysfunction of ion channels on skeletomuscular mem-branes [93]. Sirolimus has been shown to cause hypokalae-mia by excessive urinary excretion of potassium, probably secondary to tubular dysfunction. Potassium deficit is mild and seems to be dose dependent and it can disappear when doses are reduced. It can occur without associated metabolic acidosis, hyperaldosteronism or Fanconi syndrome. Patients with sirolimus-induced hypokalaemia respond well to potas-sium supplements [94]. Methotrexate may induce severe hypokalaemia. The ex-Miscellaneous Agents vere hypokalaemia and metabolic alkalosis, especially in patients with impaired renal function [95]. Hypokalaemia is due to an excessive delivery of acid, sodium or bicarbonate to distal tubule which stimulates distal tubular hydrogen ions secretion and potassium secretion leading to hypokalaemia. Sodium bicarbonate is also proposed in treatment of hy-perkalaemia with metabolic acidosis [96]. Salicylate intoxi-cation can cause hypokalaemia, which may be aggravated with forced alkaline diuresis used in this situation. Hpoka-lemia may complicate poisoning with papaverine when there is a lactic acidosis. The biochemical features of papaverine-induced acid-base disturbance closely resemble those caused by salicylates [97]. Paracetamol overdose is associated with dose-related hypokalaemia, and kaliuresis of short duration (<24 h). A specific renal effect of paracetamol in overdose possibly linked to cyclo-oxygenase inhibition, distinct from any nephrotoxic effect of paracetamol, irrespective of N-Excessive administration of bicarbonate may lead to se-acetylcysteine administration and independent of whether vomiting occurred has been suggested [98,99]. Vitamin D intoxication induces potassium and water depletion and hy-pernatraemia probably because of renal tubular damage [100]. The abuse of thyroxine can cause severe hypokalae-mia [101]. Indeed, animal studies show that the thyroid-hormones stimulate the synthesis of Na+-K+-ATPase pump [102]. Overdose of risperidone and quetiapine, has also been associated wih hypokalaemia [103]. Symptomatic hy-pokalaemia has also been reported with infliximab [104], ibuprofen [105], ondansetron [106], and meglumine antimo-niate [107]. DRUGS INDUCING CELLULAR PROLIFERATION during initial treatment. The presumed mechanism was an increase in cellular proliferation with sudden production of millions of new cells leading to a shift of potassium to cells [108]. In addition, such patients are probably chronically hypoxic and predisposed to total body potassium depletion. Massive leukocytosis after Granulocyte–macrophage colony-stimulating factor therapy has also been associated with se-vere hypokalaemia due to potassium shift to cells recently formed [109]. Hydroxocobalamin may rarely precipitate hypokalaemia TREATMENT GUIDELINES and the presence of symptoms and ECG abnormalities. Cor-rection of drug-induced hypokalaemia is generally not indi-cated especially in the case of transcellular potassium shift. This situation may not have significant total body potassium deficit and when corrected rebound hyperkalaemia can occur and should be kept in mind by the clinician. Withdrawal of the offending drug is usually sufficient to restore a normal level of serum potassium. However, severe hypokalaemia should be corrected by intravenous infusion of potassium. In moderate hypokalaemia, and in the absence of digoxin toxic-ity or severe heart disease, oral administration of potassium salts may be useful, but can cause gastrointestinal adverse effects and contact irritation. The daily dose should be di-vided into three to four doses to prevent these side effects. When drug-induced hypokalaemia is predictable e.g with prescription of diuretics, concomitant potassium supplements should be provided to patients. In case of co-existent magne-sium depletion, its correction will facilitate more rapid cor-rection of hypokalaemia. The treatment of hypokalaemia depends on its severity REFERENCES [1] Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients? J Am Coll Cardiol 2004; 43: 155-61. Ahmed A, Zannad F, Love TE, et al. A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure. Eur Heart J 2007; 28: 1334-43. Isaac G, Holland OB. Drug-induced hypokalaemia. A cause for concern. Drugs Aging 1992; 2: 35-41. Weiner ID, Wingo CS. Hypokalaemia--consequences, causes, and correction. J Am Soc Nephrol 1997; 8(7): 1179-88. Gennari FJ. Hypokalaemia. N Engl J Med 1998; 339: 451-8. Paice BJ, Paterson KR, Onyanga-Omara F, Donnelly T, Gray JM, Lawson DH. Record linkage study of hypokalaemia in hospitalised patients. Postgrad Med J 1986; 62: 187-91. Riggs JE. Neurologic manifestations of electrolyte disturbances. 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A Bartter's-like syndrome from capreo-mycin, and a similar gentamicin tubulopathy. Am J Kidney Dis 1986; 7: 245-9. Shiah CJ, Tsai DM, Liao ST, Siauw CP, Lee LS. Acute muscular paralysis in an adult with subclinical Bartter's syndrome associated with gentamicin administration. Am J Kidney Dis 1994; 24: 932-5. Shin S, Furin J, Alcántara F, et al. Hypokalaemia among patients receiving treatment for multidrug-resistant tuberculosis. Chest 2004; 125: 974-80. Chou CL, Chen YH, Chau T, Lin SH. Acquired bartter-like syn-drome associated with gentamicin administration. Am J Med Sci 2005; 329: 144-9. Barton CH, Pahl M, Vaziri ND, Cesario T. Renal magnesium wast-ing associated with amphotericin B therapy. Am J Med 1984; 77: 471-4. Subirà M, Martino R, Gómez L, Martí JM, Estany C, Sierra J. Low-dose amphotericin B lipid complex vs conventional ampho-tericin B for empirical antifungal therapy of neutropenic fever in patients with hematologic malignancies--a randomized, controlled trial. Eur J Haematol 2004; 72: 342-7. Falagas ME, Ntziora F, Betsi GI, Samonis G. Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials. Int J Antimicrob Agents 2007; 29: 136-43. Bearden DT, Muncey LA. The effect of amiloride on amphotericin B-induced hypokalaemia. J Antimicrob Chemother 2001; 48: 109-11. Ural AU, Avcu F, Cetin T, et al. Spironolactone: is it a novel drug for the prevention of amphotericin B-related hypokalaemia in can-cer patients? Eur J Clin Pharmacol 2002; 57: 7713. Ruiz-Contreras J, Rodriguez R, Gómez de Quero P, González Tomé MI, Sánchez Díaz JI. Severe hypokalaemia and rhabdomy-olysis associated with itraconazole therapy. Pediatr Infect Dis J 2003;22:1024-5. Wang A, Zhang Y, He L, et al. Clinical study on the efficacy and safety of intravenous itraconazole infusion for the treatment of in-vasive fungal infection in china. Jpn J Infect Dis 2006; 59: 370-6. Kidd D, Ranaghan EA, Morris TC. Hypokalaemia in patients with acute myeloid leukaemia after treatment with fluconazole. Lancet 1989; 1: 1017. Li N, Wang GF, Wu YF, et al. Side effects of glucocorticosteroids in the management of 1291 patients of SARS. Beijing Da Xue Xue Bao 2004; 36: 519-24. Tsai WS, Wu CP, Hsu YJ, Lin SH. Life-threatening hypokalaemia in an asthmatic patient treated with high-dose hydrocortisone. Am J Med Sci 2004; 327: 152-5. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF. The mineralocorticoid effects of high dose hydrocortisone. BMJ 1995; 310: 656-7. Thorn GW. Clinical considerations in the use of corticosteroids. N Engl J Med 1966; 274: 775-81. [63] [64] [65] [66] [67] [68] [69] [70] [71] [72] [73] [74] [75] [76] [77] [78] [79] [80] [81] [82] [83] [84] [85] Hussain RM, McIntosh SJ, Lawson J, Kenny RA. Fludrocortisone in the treatment of hypotensive disorders in the elderly. Heart 1996; 76: 507-9. Qian SZ. Gossypol-hypokalaemia interrelationships. Int J Androl 1985; 8: 313-24. Metcalfe MJ, Entrican JH. Carbenoxolone and hypokalaemia. Lancet 1987; 2: 1525-6. Hoffman AR, Feldman D. Successful long-term treatment of re-fractory Cushing's disease with high-dose mifepristone (RU 486). J Clin Endocrinol Metab 2001; 86: 3568-73. Mohammadianpanah M, Omidvari S, Mosalaei A, Ahmadloo N. Cisplatin-induced hypokalaemic paralysis. Clin Ther 2004; 26: 1320-3. Shepp DH, Curtis S, Rooney JF. Causes and consequences of hy-pokalaemia in patients on tenofovir disoproxil fumarate. AIDS 2007; 21: 1479-81. Cirino CM, Kan VL. Hypokalaemia in HIV patients on tenofovir. AIDS 2006; 20: 1671-3. Gearhart MO, Sorg TB. Foscarnet-induced severe hypomagne-semia and other electrolyte disorders. Ann Pharmacother 1993; 27: 285-9. Thuss-Patience PC, Peters U, Jurkat-Rott K, et al. Acute hy-pokalaemic tetraparesis induced by intravenous methotrexate. J Clin Oncol 2003; 21: 1896-7. Morales JM, Andrés A, Dominguez-Gil B, et al. Tubular function in patients with hypokalaemia induced by sirolimus after renal transplantation. Transplant Proc 2003; 35: 154S-156S. Lin CJ, Chen YC, Chen HH, Liu CC, Wu CJ. Life-threatening ventricular arrhythmia induced by hypokalaemia during sodium bi-carbonate infusion. South Afr Med J 2008; 101: 215-6. Carvalhana V, Burry L, Lapinsky SE. Management of severe hyperkalemia without hemodialysis: case report and literature review. J Crit Care 2006; 21: 316-21. Vaziri ND, Stokes J, Treadwell TR. Lactic acidosis, a complication of papaverine overdose. Clin Toxicol 1981; 18: 417-23. Pakravan N, Bateman DN, Goddard J. Effect of acute paracetamol overdose on changes in serum and urine electrolytes. Br J Clin Pharmacol 2007; 64: 824-32. Waring WS, Stephen AF, Malkowska AM, Robinson OD. Acute acetaminophen overdose is associated with dose-dependent hy-pokalaemia: a prospective study of 331 patients. Basic Clin Phar-macol Toxicol 2008; 102: 325-8. Anderson DC, Cooper AF, Naylor GJ. Vitamin D intoxication, with hypernatraemia, potassium and water depletion, and mental depression. Br Med J 1968; 4:744-6. Chen YC, Fang JT, Chang CT, Chou HH. Thyrotoxic periodic paralysis in a patient abusing thyroxine for weight reduction. Ren Fail 2001; 23: 139-42. Clausen T. Clinical and therapeutic significance of the Na+,K+ pump*. Clin Sci (Lond) 1998; 95: 3-17. Malik AR, Wolf PK, Ravasia S. Hypokalaemia from risperidone and quetiapine overdose. Can J Psychiatry 2005; 50: 76. Karamanolis G, Tzathas C, Triantafyllou K, Tsiamoulos Z, Ladas S. Symptomatic hypokalaemia associated with infliximab in a pa-tient with Crohn's disease. Inflamm Bowel Dis 2006; 12 :1010-1. Gaul C, Heckmann JG, Druschky A, Schöcklmann H, Neundörfer B, Erbguth F. Renal tubular acidosis with severe hypokalaemic tetraparesis after ibuprofen intake. Dtsch Med Wochenschr 1999; 124: 483-6. Turner SR, Pinsk M. Ondansetron-associated Hypokalaemia in a 2-year-old With Pre-B-cell ALL. J Pediatr Hematol Oncol 2008; 30: 58-60. Bouvresse S, Matichard E, Mahé E, et al. Symptomatic hy-pokalaemia caused by meglumine antimoniate. Ann Dermatol Venereol 2007; 134: 387-8. Lawson DH, Murray RM, Parker JL, Hay G. Hypokalaemia in megaloblastic anaemias. Lancet 1970; 2: 588-90. Viens P, Thyss A, Garnier G, Ayela P, Lagrange M, Schneider M. GM-CSF treatment and hypokalaemia. Ann Intern Med 1989; 111: 263. [86] [87] [88] [89] [90] [91] [92] [93] [94] [95] [96] [97] [98] [99] [100] [101] [102] [103] [104] [105] [106] [107] [108] [109] Received: August 22, 2008 Revised: September 20, 2008 Accepted: September 30, 2008


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2014: Appeared in all 13 games, making seven tackles on special teams ... made a career-high three tackles against Toledo (10/4).
2013: Appeared in 11 games, making five special teams tackles ... made collegiate debut against Nicholls (9/7) ... first career kick return for 13 yds at Northwestern (9/14) ... registered third special teams tackle against CMU (11/16).
HIGH SCHOOL: Member of a team that went 18-4 overall and 10-2 in league action during last two seasons … holds WVHS records for rushing attempts in a game (40), season (320) and career (590) … holds WVHS rushing records for yards in a season (2,377) and career (4,126) … holds rushing records at WVHS for TDs in a game (4), season (31) and career (54) … shares the record for the longest TD run in program history (96 yards vs. Brother Rice in 2010) … scored four rushing TDs in a game five times in career.


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Student Trustees are involved with decisions that will shape the future of the University and its students. It is a great way for students to make connections, gain valuable leadership skills and create change at UA.
Applications are available online at the USG website, or in the Undergraduate Student Government Office in Student Union 307a. Completed applications may be turned into the USG secretary, Joanne Dabb. If you have any questions, please contact USG President Turner Anderson at email@example.com.
It is expected that the Presidential Advisory and Screening Committee will recommend finalists from the applicant pool who will visit campus (most likely during April) for comprehensive interviews with the multiple Constituency/Advisory Groups representing campus and community.
Meanwhile, there has been a public records request from the media asking the Board to release the applications for the position, along with their application materials.� In compliance with the public records statutes, we are providing those materials.� As this is an issue of interest and significance to our campus community—first and foremost—we are providing the information to you as well.
The following are applicants currently under consideration:
Martin H. Belsky, J.D.Randolph Baxter Professor of Law, The University of Akron(Former Dean of UA School of Law)
Dennis D. Berkey, Ph.D.Former President and CEO, Worcester Polytechnic Institute (Mass.)(Former Dean of Arts and Sciences and Provost of Boston University)
Ronald V. Bucci, Ph.D.Interim Vice President for Professional & Support Services and Administrative Director of Radiology/Anesthesia/Pain Management, Akron Children's Hospital
Charles C. Canver, M.D., M.B.A.Chief Medical Officer, Presence United Samaritans Medical Center (Danville, Ill.)
F. Dominic Dottavio, Ph.D.President, Tarleton State University (Stephenville, Tex.)(Former President of Heidelberg University)
Jorge Haddock, Ph.D.Professor of Business, George Mason University(Former Dean of Business of GMU and of the University of Richmond)
Leslie D. Hannah, Ph.D.Director, Cherokee Programs and Chair, Department of Languages and Literature,Northeastern State University (Tahlequah, Muskogee and Broken Arrow, Okla.)
Pamela J. Kalbfleisch, Ph.D.Dean of Arts and Sciences, Concordia University Chicago(Former Professor and Special Assistant to the President for Strategic Initiatives, University of North Dakota and American Council on Education Fellow)
Ronald S. Kaplan, Ph.D.Vice President for Research, Rosalind Franklin University of Medicine & Science andInterim Executive Vice Dean, Chicago Medical School (North Chicago, Ill.)
Stephen Lehmkuhle, Ph.D.Chancellor, University of Minnesota Rochester(Former Senior Vice President for Academic Affairs, University of Missouri System)
Peter A. McAllister, Ph.D.Dean of Arts and Letters, California State University, Los Angeles(Former Director, School of Music at University of Arizona and at Ball State)
Ronald A. Nykiel, Ph.D.Provost and Vice President-Academic Affairs, University of Maryland Eastern Shore(Former Dean of Business of Husson University)
Richard H. Owens, Ph.D.President, West Liberty University (W. Va.) andTrustee and Vice Chair, Columbus State College(Former President of Heidelberg College)
Joi F. Patterson, Ph.D.Vice President of Academic Affairs/Chief Operating Officer, Calumet College of St. Joseph (Whiting, Ind.)
Michele Drabant Perkins, Ed.D.President, New England College (Henniker, NH)
Faye Ran, Ph.D.Professor of Literature, Metro College of New York(Former Associate Provost and Founding Dean of MCNY Graduate School for Business)
Cathy A. Sandeen, Ph.D., M.B.A.Vice President for Educational Attainment, American Council on Education(Former Dean, Continuing Education at University of California Los Angeles)
Scott L. Scarborough, Ph.D., M.B.A.Provost and Executive Vice President for Academic Affairs, The University of Toledo(Former Executive Vice President for Finance and Administration of DePaul University)
James P. Tressel, M.A.Executive Vice President for Student Success, The University of Akron
We are also providing a link to the application materials, including cover letters and resumes provided by the applicants currently under consideration.�
Details about the process of selecting the 16th President of The University of Akron are readily available on our website.� We will continue to keep you updated with new information especially when the finalists will be coming to campus for interviews.
See details and sign up by March 24: http://www.uakron.edu/safety/away.dot
To demonstrate movement toward their degree objectives, Osher Scholars must maintain a minimum GPA of 2.0 at the end of the first semester on scholarship. If a student's GPA falls below a 2.0, the student must document the reasons for the substandard performance, and submit a plan of action to raise the GPA.
Having maintained an appropriate GPA and compiled a strong record of academic performance, Osher Scholars who meet the application requirements may have the opportunity to renew their Osher Reentry Scholarship award, and/or receive additional scholarship support when they are admitted to their degree-granting colleges.
The deadline to apply is March 31.
More details and how to apply.
The CIFF has expanded its program for college students to offer free morning, matinee and late night screenings when they present their valid college IDs. Free films will be screened each weekday of the festival between 9 a.m. and 3 p.m., as well as after 11 p.m. on the Fridays and Saturdays of the festival.
Tickets will be available one hour before the screening start times at Tower City Cinemas, and are distributed on a first-come, first-served basis while supplies last. For all other 38th CIFF screenings, student discounts are available through online ticket purchases and at the Film Festival Box Office located inside the lobby of Tower City Cinemas, by using the code COLLEGE.
On Thursday, March 27, UA students will find the free screenings within walking distance when the second annual "Day and Knight in Akron" is held.
The sampling of feature films and short subjects will be presented at the Akron Art Museum, 1 South High St., and the Akron-Summit County Public Library Main Auditorium, 60 South High St.
"Day and Knight in Akron" is presented with funding from the John S. and James L. Knight Foundation and additional support from the Akron Community Foundation and the GAR Foundation. To learn more about all the films, visit the Cleveland International Film Festival online.
Here's the March 27 schedule:
Registration is now open for the Black Male Summit, which will be held April 11-12 in the Student Union. In its seventh year, the summit annually celebrates and encourages the success of black male students.
Keynote speakers include:
The two-day event — free to UA students, faculty and staff — is open to the public for $50.
Registration is required. Register now.
Michael J. Bender, who is president of Walmart West and is responsible for all aspects of Walmart business in 22 states, will begin the dialogue.
The panel's distinguished discussants include:
"The goal of the Pre-Black Male Summit Panel Discussion is to reinforce connections to those critical supports needed to improve the educational outcomes for African American Males," says Lee Gill, associate vice president for inclusion and equity and chief diversity officer at UA.
Those interested in attending the Pre-Black Male Summit Panel Discussion are encouraged to register early online, as space is limited.
To register separately for the Black Male Summit, April 11-12, visit the Black Male Summit website.
Fifty exhibitors, including University Catering and area wedding experts, will be on hand to offer advice, food tastings and more. The first 25 brides who attend wearing a veil will receive free admission and a special gift from Today's Bride.�Exhibitor information on show specials, wedding packages and giveaways is available on�TodaysBride.com.


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Pecan Sandies Cookies Recipe
4.5 30
Whenever Mother made these cookies, there never seemed to be enough! Even now when I make them, they disappear quickly. These melt-in-your mouth treats are great with a cold glass of milk or a steaming mug of hot chocolate. —Debbie Carlson, San Diego, California
- 2 cups butter, softened
- 1 cup confectioners' sugar
- 2 tablespoons water
- 4 teaspoons vanilla extract
- 4 cups all-purpose flour
- 2 cups chopped pecans
- Additional confectioners' sugar
- Preheat oven to 300°. In a large bowl, cream butter and sugar. Add water and vanilla; mix well. Gradually add flour; fold in pecans.
- Roll dough into 1-in. balls. Place on ungreased baking sheets and flatten with fingers.
- Bake 20-25 minutes or until bottom edges are golden brown. Cool on a wire rack. When cool, dust with confectioners' sugar. Yield: about 5 dozen.
Originally published as Pecan Sandies Cookies in Taste of Home February/March 1994, p39
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