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My husband has been a patient of Dr. Jay Bradley for about four years now. Let me start out by saying, my husbands case is very comlicated. Dr. Bradley is always willing to help us. He is very good at his profession, very kind and considerate, very personable, I think he is ...morethe kind of doctor we all look for. We feel very blessed to have him for our doctor. He genuinly cares about his patients.view less
Lubbock Ophthalmologists
1. Texas Retina Associates
The first time I saw Dr. Shami I could only wonder how the children in the concentration camps during WWII survived the torture and testing that was…
2. West Texas Eye AssociatesServices
This was my 1st visit to WTE and i'm am sooo happy with the treatment I received as well as the procedure. The doctor and his staff are extremely pl…
3. Laser Eye Center Of LubbockServices
I have been going to Laser Eye Center Of Lubbock since they opened. The staff is very friendly and extremely knowledgeable. They are always able to …
4. Shihab M Zuhair M.D.Services
4003 22nd StLubbock, TX 79410
From Business: Please Contact Us For More Information
5. Texas Tech Eye Consultants
4004 82nd St # 200Lubbock, TX 79423
6. Retina Associates
3812 24th StLubbock, TX 79410
7. Boothe Wm David MdServices
I have to say I had the exact opposite experience from kprien with the staff. They were friendly and helpful when it came to navigating my insuranc…
8. Frasier Eye Center
Took 3 visits to get prescription right. Waited 1 hour & 25 minutes in waiting room on one visit.
9. Ophthalmology & Visual Clinic
Do not trust Dr. Mahek in regards to billing. I went in with an eye issue that I on multiple occasions made explicitly clear would not be worth i…
10. Khater, Timothy T, Md - West Texas EyeServices
5109 80th StLubbock, TX 79424
11. Vision Central
411 University Ave Ste 110Lubbock, TX 79401
12. Curt W. Cockings, M.D., P.A.
3802 22nd PlLubbock, TX 79410
13. Staples, Robert
3601 4th St # 2A100Lubbock, TX 79430
14. Texas Tech Eye Clinic Optical Shop
3601 4th StLubbock, TX 79430
15. Wilson Surgicenter
4315 28th StLubbock, TX 79410
16. Wittman Cathy Od
4824 36th StLubbock, TX 79414
17. Boop Laser Eye Center
2719 81st StLubbock, TX 79423
18. Jason C Yeh
4004 82nd St Ste 200Lubbock, TX 79423
19. Fallin, Kelly D
3104 Indiana AveLubbock, TX 79410
20. Children's Vision Clinic
3415 19th StLubbock, TX 79410
21. Greg N Hogan Optmtrst
4825 50th StLubbock, TX 79414
22. Butterfield Vision
4413 82nd St Ste 110Lubbock, TX 79424
23. McPherson Scott A
4304 W Loop 289Lubbock, TX 79407
24. David Warshaw OD
6315 82nd StLubbock, TX 79424
25. Lubbock Eye Clinic
3702 34th StLubbock, TX 79410
26. Frasier Eye CenterServices
3804 21st St Ste ALubbock, TX 79410
27. Randal Billing O.D.
Outstanding Service! The doctor is extremely helpful and knows what he is doing. Office needs updating but staff and everyone there are really nic…
28. Davis Clayton
6002 Slide Rd Ste 68354Lubbock, TX 79414
29. Ryburn III, F Mac, MD
3420 23rd StLubbock, TX 79410
30. Mathews, Steven M, MD
5109 80th StLubbock, TX 79424
Dr. Bradley is very caring and concerned about his patient's and makes sure all needs are met. I cannot say enough "good" about him. He is an exceptional doctor. My surgery went very well for both eyes. Dr. Bradley deserves a "five star plus" rating...more! If you are needing corrective eye surgery of any kind you should go visit him.view less
I saw Dr. Bradley at West Texas Eye Associates. He explored some treatments with me that other eye doctors had not explored and I can sum it up by saying the first time I went to a restaurant and could see the menu without glasses, I literally cried. I would not hesitate to ...morerecommend West Texas Eye Associates and Dr. Bradley. view less


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letra de Loco de Enrique IglesiasLyrics → Artists: E → Enrique Iglesias lyrics → letra de Loco de Enrique Iglesias
letra de Loco de Enrique Iglesias
Enrique Iglesias Loco lyrics was added to the site 28 Aug, 2013 and since that time has 13 hits and voted 0 times. Other popular Enrique Iglesias lyrics are: Somebody's Me, Hero and El Perdedor.
Translation in progress. Please wait...
Enrique Iglesias lyrics:
- Volvere lyrics
- Somebody's Me lyrics
- Turn Up The Night lyrics
- Sad Eyes lyrics
- Se Te Ne Vai (Si Tu Te Vas) lyrics
- Adicto lyrics
- Physical lyrics
- Away lyrics
- When Somebody Loves You lyrics
- Don't Turn Of The Lights lyrics
- Live It Up Tonight lyrics
- Addicto lyrics
- Don't You Forget About Me lyrics
- Mckenzie Rules lyrics
- Vivire Y Morrire lyrics

subset: commoncrawl


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Lyrics Depot is your source of lyrics to Chattanooga Choo Choo by Ray Charles. Please check back for more Ray Charles lyrics.
Chattanooga Choo Choo Lyrics
Artist: Ray Charles
Album: The Genius Hits the Road
Chattanooga Choo-Choo
Hey there, pal, whatcha say?
Step aside partner, it's my day
Bend an ear and listen to my version
(Of a really solid, Tennessee excursion)
Pardon me boys, is that the Chattanooga Choo Choo?
(Yes Yes) Track 29!
Boy you can give me a shine
(Can you afford to board, the Chattanooga Choo Choo?)
I've got my fare
And just a trifle to spare
You leave the Pennsylvania station 'bout a quarter to four
Read a magazine and then you're in Baltimore
Dinner in the diner, nothing could be finer
(then to have your ham and eggs in Carolina)
When you hear the whistle blowing eight to the bar
Then you know that Tennessee is not very far
Shuffle all the coal in
Gotta keep it rollin'
(Whoo Whoo Chattanooga there you are)
There's gonna be, a certain party at the station
Satin and Lace
I used to call funny face
She's gonna cry
Until I tell her that I'll never roam
(So Chattanooga Choo Choo)
Won't you choo choo me home.
Get aboard...
All aboard...
Chattanooga choo choo
Wont you choo choo me home
Ray Charles Lyrics
Ray Charles The Genius Hits the Road Lyrics
More Ray Charles Music Lyrics:
Ray Charles - Bluesette Lyrics
Ray Charles - Booty-Butt Lyrics
Ray Charles - Im Movin On Lyrics
Ray Charles - Just for a Thrill Lyrics
Ray Charles - Mean to Me Lyrics
Ray Charles - Takes Two to Tango Lyrics
Ray Charles - Talkin' 'Bout You Lyrics
Ray Charles - You Dont Know Me Lyrics


text: The most adorable martial arts competition ever! By Kelly Krage April 15, 2014 5:12 PM Share on Facebook Share on Twitter Watch two girls practice their Judo skills! Subscribe to KQCL Power 96 on Filed Under: cute videos | Funny videos | viral videos Category: Audio | Kelly's Blog | Videos Share on Facebook Share on Twitter More Send to a friend! Print this page Pin it! Reddit This! Share on Tumblr! Best of Power 96 Faribault Bio Wood Processing Fire Causes "Considerable Damage" Wildfire Danger Going Up With The Temperature in Southern Minnesota Former Carleton Student Sues College Will Jerry Eat It? Sweet Pickled Ginger Recommended for You ZergNet Best of the Web ZergNet


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veronica | Let me start off with a confession here: I had previously read the first two installments of the Mara Dyer series by Michelle Hodkin in 2012. 198 more words
Tags » Michelle Hodkin
The Unbecoming of Mara Dyer by Michelle Hodkin
Note: All reviews are spoiler free unless otherwise stated!
Title: The Unbecoming of Mara Dyer
Author: Michelle Hodkin
# in series: 1st book in the Mara Dyer series… 268 more words
Cover Love #9
Sorry guys! It has been a while but we have had a really busy couple of weeks with the end of school quickly approaching (yes finally!). 677 more words
Book Review: The Evolution of Mara Dyer by Michelle Hodkin
Title: The Evolution of Mara Dyer
Author: Michelle Hodkin
Published: 2012
Genre: Young Adult Paranormal
Synopsis: The truth about Mara Dyer's dangerous and mysterious abilities continues to unravel in the New York Times bestselling sequel to the thrilling The Unbecoming of Mara Dyer. 362 more words
The Evolution Of Mara Dyer // Michelle Hodkin (Some Spoiler)
The Evolution of Mara Dyer by Michelle Hodkin
My rating: 5 of 5 stars
"Without Noah, I would be truly, completely alone in this… If I lost Noah, I might just lose my mind." 204 more words
The Retribution of Mara Dyer by Michelle Hodkin
It had to end sometime, but Mara had no idea it would end like this. Experience the mind-blowing conclusion to the New York Times bestselling Mara Dyer trilogy. 411 more words
Book Review: "The Unbecoming of Mara Dyer" by Michelle Hodkin | Spoiler-Free
So I am back with yet another spoiler-free review! This is for those thinking about reading this book. I am also making this because I can't accurately and articulately do this review in a spoiler fashion, so here we are. 313 more words


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Education software company LiveTiles raises AU$12m and lists via reverse takeover
Based in Times Square, education software provider LiveTiles has listed on the ASX following a reverse takeover of Mongolian coal developers, Modun.
Based in Times Square, education software provider LiveTiles has listed on the ASX following a reverse takeover of Mongolian coal developers, Modun.
The best-known graph database has a brand new version, with lots of the maturity associated with a third release.
The Network LookOut Administrator allows you to see live screens of remote computers. This way, you can always watch what users are...
The downside of the cloud is a password and username overload -- but there are technologies available to help.
Eastern Europe is building up a head of steam as a software outsourcing powerhouse, as companies focus more on cost-effectiveness and proximity, rather than just low cost.
Fear of the unknown: Intel's latest survey of 1,200 IT decision makers finds most don't know what vulnerabilities exist with their cloud providers and services.
StarStrider is a fully three-dimensional planetarium and 'software star ship'. You can visit not only the planets and moons of our...
The San Francisco-based Holberton School has found that if you remove bias from the admissions program, more women and minorities get into its software engineering program than do in ordinary colleges.
Microsoft plans to bundle new education-focused apps into Windows 10 Anniversary update, and is readying new Office 365 and MineCraft updates aimed specifically at the academic market.
Kno delivers the same textbooks students are used to, only better. With over 50 amazing features and a catalog of over 200,000 eTextbooks,...
Matt Barrie, CEO of ASX-listed Freelancer, wants to abolish state governments in a bid to retain and attract talent, and fix the technology crisis the nation currently finds itself in.
Oracle has stepped up its support of the Obama administration's $4bn plan to improve computer-science education for K-12 students in the US.
Experts at a Wharton conference on people analytics outlined what data can--and can't--do for people management.
The Queensland government has been ordered to pay the legal fees of technology giant IBM after it lost its attempt to sue the technology giant over the state's failed health payroll system.
Should you use public cloud exclusively or take a combined approach, with some of your data hosted internally? Here's a look at the good and the bad.
The tech giant's latest supplier responsibility report reveals better working conditions, a drastic drop in child labour, and a massive reduction in carbon emissions since it began probing its supply chain in 2008.
To get the most out of DevOps methodology and tools, you must get buy-in from the very top of the organisation.
New Zealand-based 9 Spokes wants to list on the Australian Securities Exchange, but needs to first raise up to AU$25 million in capital.
The software giant will set up its largest off-shore campus in Bengaluru, southern India.
Salesforce is the highest scoring Watchlist winner and an Elite once again. You want to know why? Read, my friend, read.
The software update fixes a flaw that allows iCloud-stored images and video sent over iMessage to be decrypted, and also adds a number of new features.
The famed technology fair in Germany this week was a major gathering place for the hot topic in business circles, digital transformation. The talk this year was much more on how, than why.
A group of hackers skilled at breaking Apple II copy-protection schemes is helping save old education and productivity software.
Ten tips to make Google Chrome faster and reduce how much RAM it uses
Smartphone survival test: LG Nexus 5X's sale price makes it a bargain
NSA is so overwhelmed with data, it's no longer effective, says whistleblower


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Enough with the Dubai bashing
A Dubai bashing article pushes Kipp over the edge
October 27, 2009 10:30 by kippreport
It's no secret that the world's media enjoys watching Dubai squirm under the weight of its debts, and we understand that Dubai bashing articles get lots of hits on the internet. But we genuinely thought that the spate of Dubai bashing articles, which feature the same old criticisms and statistics, was over. We were wrong.
The Daily Mail published yet another article about Dubai, which isn't a big deal, except that the article features nothing new.
Kipp isn't in the habit of defending any city, nation or company, but we're a little tired of articles that criticize for criticism's sake. If you're going to criticize, at least use some facts.
The irony is that there is no shortage of facts about Dubai that a journalist can use to write a sound critical piece; but for some inexplicable reason, most journalists choose to stick to the same old story.
If the Daily Mail journalist had done some serious digging, she would've found a story about Dubai worth writing about.
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6 Comments
Hello Kipp
The BIG story about Dubai right now is that Emiratis and Expats alike are being lied to by the Boss of this place.
The other BIG story about Dubai is how we can look back to the madness of last year, and feel sick to our stomachs about the amount of greed which has been allowed to run rampant in this place. But that's another story. Lets stick to the first:
The Boss knows that WE are his finest marketing tools. WE are his expats, his backbone, his local brainpower. We are the ones who skype home, write home, chat to our business colleagues and friends, we are the ones who spread the news about this place. We are the ones asked by our company headquarters, to write prognoses about the UAE for the next 5 or 10 years. People ask me, and I have this pained expression while I lift my shoulders in a sign of maaaaaaybe???
But the Boss cannot or will not give us a straight talking hard plan as to the roadmap of this place. We get a rumour here and a tidbit there, but the only way to get this place back on its feet is to fuel the Real Estate Engine back to life. That does not mean the madness of yesteryear – no, it means getting people here who can build their lives, pay normal rents, have their kids schooled in normal schools, and make this place stable.
The people I am talking about are NORMAL people – we need clarity as to the future of the Residence Visa, the Freelancer Work Permit, Health Plans – we need all the social tools in place which will attract the kind of people who can BUILD a nation, we should NOT cater simply for the tourist.
Your Highness, you need to tell everyone CLEARLY where we are going with Dubai – you will be amazed how quickly all "your" expats will jump to support you. We crave clarity.
I completely agree…enough with these Western articles. It is all a ploy to keep their collective foots on our throat so 'their' money doesn't find its way back to Dubai.
Keep trying Daily Mail, the UAE is proud and strong and your silly stats bounce off us like so much silly putty.
What exactly about the DM article (as cheap a paper as it is) is in fact untrue?
Why can't Kipp Report go and find and publish some real evidence backing up it's claims about the non-validity of DM's article, instead of throwing an e-tantrum like this?
or is KippReport just another media tool of the powers that be? Are they trying to show the world media that it won't take it any more? How? What are you going to do about it?
It's the Leaders of the UAE who have all the power to do good (or bad, as it were), no one has gotten in their way (as if they would be allowed to), this is all happening under their watch, with their 'skill;, 'talent' and 'wisdom'.
In fact, i think things are gong exactly according to plan, consistent with the values demonstrated by their actions..
flashy flashy, but no real substance. same applies to everything in D'bay..
Dubai gets bashed, coz it has boasted / gloated about being bigger / taller / richer / gleamier than anybody else in the world! Pride goes before a fall…..
Well said Yousif.
If someone points out 5 bad points, and one of them is exagerrated, Dubai's cheerleaders take it upon themselves to deny the other 4 points as well; " the author is biased and claimed there were 3000 cars at the airport when there were only 300!" So lets pretend there is no racism here, and everyone is treated well, and if you manage to bring proof to the contrary, we will cite how Red Indians and Aborigines were treated……
And its really funny when the cheerleaders turn out to be westerners who are very unwilling to upset the current apple-cart of being overpaid
and enjoying friday brunches.
@ Mohammad — Its a relief to see someone commenting with 100% truth, no dilutions……..I'm so used to seeing greys that B & W is refreshing …. Hope to see more of you here…..Adiós.
Keep Smiling.


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Use the tools below to refine your search by only displaying reviews with a certain number of star ratings or to only show reviews from a certain time period. Eg click on '1 star' to just display the reviews we have which received a 1 star rating click or 'Within the last month' to display just reviews posted over the last month.
Written on: 30/04/2016 by jenniferlemen-hogarth (1 review written)
Top class service! Highly recommended. Will definitely be using One77 again… Read Full Review
Written on: 26/04/2016 by ArchieArcher (1 review written)
I can't recommend enough, couldn't have been in safer hands. Hard working, professional, fast, great communication throughout process. Already recommended to 4 colleagues!… Read Full Review
Written on: 23/04/2016 by Terryvk115 (1 review written)
Highly recommend made the mortgage process and found me a great deal saving £100's per month… Read Full Review
Written on: 21/04/2016 by TomAnnear (1 review written)
It's been a great experience having Alastair and his team sort our mortgage for us. The options available to us were clearly explained and we felt in control at all times, but also able to ask questions too. A first class service from the back office team has meant that we've felt part of a slick but personal service at all times… Read Full Review
Written on: 19/04/2016
I needed advice regarding the possibility of getting a mortgage working only on fixed term contracts. I felt my advisor asked all the right questions, listened carefully and came back with some detailed options for me. She was very clear from the outset that there was no fee to pay which helped to put me at ease. The information I received has really helped in my decision making and helped to make a difficult time easier (I am going through a divorce). I would definitely recommend the company… Read Full Review
Written on: 11/04/2016 by DeshawnGustafson447 (1 review written)
We changed from a much bigger Mortgage brokers which was proving unreliable and slow to One 77 which provided an excellent service from the start. I discovered it by tracking down a particular staff member who was mentioned on MumsNet who now works for One 77. She was efficient, effective and supportive and from the start I knew we were in safe hands. We will definitely use One 77 again and would recommend them without reservation to anyone. Our mortgage adviser at One 77 also set up a… Read Full Review
Written on: 09/04/2016 by 378Alvarado (1 review written)
I like contacted One77 on recommendation from Crest Nicholson and I have to say the service provided has been second to none. My application for a mortgage in my own name following separation has been handled sensitively, efficiently and with excellent customer service. The process was handled over the phone or by email which is essential for full time workers. The product recommended was with a well known financial institution and perfectly meets my situation I would highly recommend… Read Full Review
Written on: 03/04/2016 by strugglinauthor (11 reviews written)
Knowing I needed a buy to let mortgage I looked around for a no-fee broker and having found one, was disappointed by the service; the usual stuff - phone calls not returned, promised info not arriving. I had a look on ReviewCentre and discovered One77. I'll admit I was skeptical about a company that had five star ratings from every reviewer. But here's the thing - they really are that good. The advisor assigned to me couldn't have done any more. The advice was spot on, communication was… Read Full Review
Written on: 01/04/2016 by pxSmith1 (1 review written)
We were introduced to One 77 Mortgages by a close friend and I must say we have never dealt with so professional people like the Mortgage Advisor who helped us. We were kept up to date with progress every step of the way and today we received our Mortgage Offer. Many thanks to the team at One77 - my wife and I are soever grateful. We will surely be recommending your great service to our family and friends. Our adviser was friendly and gave us the correct advise. At one point we thought we… Read Full Review
Written on: 31/03/2016 by Carr137 (1 review written)
Simply a very professional and easy to use service. Made the whole process stress free and quickly understood my needs and sought the most appropriate product. Good communication and very prompt in dealing with all aspects of the application. Previously I had always dealt directly with lenders (I've worked in Finance for over 30 years !) but wish I had used this firm earlier. Would highly recommend. This is no ordinary brokerage. It is staffed by highly competent people who are a pleasure to… Read Full Review
Written on: 23/03/2016 by SMeredith (1 review written)
We are first time buyers, and I'll admit that I did not know everything there was to know about mortgages, mortgage protection and other insurance policies needed (Buildings and Contents). We dealt with two individuals at One 77, one for the mortgage and one for the insurance policies, as well as our case manager. Every dealing with each person was excellent and professional. The advisors were responsive and more than happy to clearly explain the benefits and potential pitfalls of all of the… Read Full Review
Written on: 20/03/2016 by MilagrosSchneider17 (1 review written)
Prompt, helpful and efficient. Would recommend… Read Full Review
Written on: 09/03/2016 by Butcherpe434 (1 review written)
Thanks for all your hard work, i realy happy with you guys many many thanks… Read Full Review
Written on: 08/03/2016 by pheenix999 (1 review written)
Having had bad service locally I thought it was the end of my mortgage application, but was put on to One77 Mortgages who found me a good deal. Throughout the process they have been very thorough and made contact with me whenever information was needed to be passed on to me. Would totally recommend this company, in particular my advisor. Well done, we got there in the end!… Read Full Review
Written on: 02/03/2016 by Corbint176 (1 review written)
Recently completed a successful remortgage application with this company. Despite being self-employed relatively recently, my mortgage consultant guided me through all the paperwork I would need to provide in order to meet lending criteria. Then the range of mortgage options was clearly laid out for me with a deal found that we are very happy with. The application itself was made easy and we were communicated to every step of the way, with regular progress updates. First rate service -… Read Full Review
Written on: 23/02/2016
I was recommended to One 77 Mortgages by Redrow homes and after doing some investigation decided to contact them to initiate my first mortgage. The service I received regarding my application from Alastair was first class. I was kept in the picture at all times and he explained the process and answered any questions I had quickly and succinctly. The rate Alastair found for us was exceptional and far lower than I expected, in fact it was around 2.5% lower than my wife and I had planned for… Read Full Review
Written on: 18/02/2016 by kmWise336 (1 review written)
The team at One 77 Mortgages are the best. I cannot speak more highly of them. When other companies only seem to have their own interests at heart the team at One 77 work entirely with your interests in mind. They work tirelessly to find the best deal and jump through hurdles at every moment out of business hours to provide the best imaginable service. Seriously these guys are the best… Read Full Review
Written on: 17/02/2016 by Hull1983 (1 review written)
I have been extremely happy with the service I have received, due to work commitments a lot of the information gathering was carried out via email and the response time was never longer than a day. The information I received was accurate and easy to understand. The end to end process has been smooth and simple and I would recommend to family and friends… Read Full Review
Written on: 05/02/2016 by Tashiebb (1 review written)
A very friendly team of staff to work with. The communication between the staff is on top form. They are very informative and took the time to explain all areas of getting our first mortgage. I cannot recommend this company high enough. We all definitely be using them again. Thank you… Read Full Review
Written on: 02/02/2016 by Termsr (1 review written)
Very knowledgeable and helpful staff, who take time to explain everything and nothing was to much trouble for them. Kept me informed with regular updates throughout the process… Read Full Review
As rated by our community of reviewers
" Not polite and professional at all " Read More
" Efficient, transparent, good value for money and friendly " Read More
Written by Ag1980
" CS was friendly, informative & helpful. Was on the end of the p... " Read More
" Stress free " Read More
" Top class service! Highly recommended. " Read More
Written by jenniferlemen-hogarth


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From the blog
Free Gift: This Life April
Nothing like sneaking in at the last minute, right?! Did you think I forgot? I didn't. I'm just BUSY! I know you can understand. So here it is FINALLY! This Life: April. (Yes, I know we don't have … [Read More]
Latest Product
New Mugs in the shop!
Well, look at that - I have some new NON-digital products up in the shop! That's right, my merchandise line is expanding to include physical products! If you know me, you know I LOVE my coffee and … [Read More]
From the blog
Free Gift: This Life: March
March sure snuck up on me! As many of you know, my life is changing. I've closed Scrap Stacks and am now looking for a job out in the "real world!" As a result, I've spent the past couple of months … [Read More]


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A Pittsburgh man has been accused of cutting a line waiting to get free cakes from the Cake Boss and stealing four of them.
Hundreds of people were waiting Tuesday morning in downtown Pittsburgh to get the free cakes from the star of the Hoboken, N.J.-based TV show "Cake Boss," Buddy Valastro.
Police spokeswoman Diane Richard says William Davenport took four cakes worth about $27 each from a storage area. Police say when they stopped Williams he apologized for stealing the cakes and admitted he was intoxicated.
Police say the cake theft caused a great commotion among people who had been waiting in line for hours. Officers had to break up fights caused by other people who tried to jump the line.
No attorney for Williams is listed in court papers.
Pa. man accused of stealing Cake Boss' freebies
A Pittsburgh man has been accused of cutting a line waiting to get free cakes from the Cake Boss and stealing four of them.
Copyright 2013 by KCCI The Associated Press contributed to this report. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Long-time Iowa farm cartoonist fired after creating this cartoon
A warning to all Iowa drivers to check your license plate
New West Des Moines store closing just months after opening
Des Moines metro Sears store will close, liquidation sale set
Woman charged after caught on video incident at hospital


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Tonight at 7 at Longbranch. Make sure you come out for a fun night of trivia and support of all of these perfect little pets! Here is where you sign up! x.co/trivia
Tags » Trivia Night
WILMINGTON GIVES: 8th Annual Wilmington Rotary Trivia Night Set For June 10
WILMINGTON, MA — On Friday, June 10th the Wilmington Rotary will be hosting the 8th Annual Trivia Competition in the Fez Room at the Shriners Auditorium. 265 more words
TRIVA NIGHT 3rd of June- How well do you know your trivia?
SAVE the DATE !!
On the 3rd of June, the CYC is hosting a Trivia night for CYC members, family, and friends..
This fun evening will test your knowledge I am sure will include questions relating to our own clubs facts and figures: For example " … 77 more words
Friday Nights At The Knights: Music Trivia This Friday (April 29)
WILMINGTON, MA — Enjoy an evening of team trivia this Friday, April 29, from 8pm to 10pm, at the Wilmington Knights of Columbus Hall (112 Middlesex Avenue). 133 more words
Introvert in the Big City
As I write this, I'm hiding. I won't say where I'm hiding, in case I need to hide again, except that I'm sitting in a brightly-lit tea shop somewhere in Mid-ish-town with three notebooks, two novels, and a matcha vanilla latte in a paper cup. 520 more words
Trivia Night with Jericho Youth Services
Oh, what a night! From 6-10pm on Saturday, April 16, I gathered with the community at The Link in Sutton for a night of trivia in support of Jericho Youth Services. 230 more words
Cori Clark's Trivia Night!
It's that time of year, again! Cori's team, The Angry Beavers/BBC(you'll have to ask her what this stands for), is gearing up to go to Nationals! 109 more words


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Hummelstown Jobs
Looking for jobs in Hummelstown? Snagajob has great opportunities with the area's leading companies. And applying for Hummelstown jobs has never been easier. Look at the job listings below, click on a job title that interests you and hit the "apply now" button. Part-time jobs, teen jobs, student jobs and summer jobs are now just a click away. Start your job search now.
Hummelstown, PA Job Openings
Pizza Hut675 E. Main Street
Hummelstown, PA
Home Instead Senior CareHummelstown, PA
Hummelstown, PA
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Here's the question you clicked on:
Do you think photography is about preparation or luck? Why?
Why can't it be both?
And it's not just that, but composition and observation.
And really, think about what type of photographs your taking. Portraits? Nature? Animals? Flora? Environment?


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I love House of the Dead: Overkill. One has to respect a really shameless bit of entertainment that doesn't care how trashy it is so long as people are having a laugh. Looks like that shamelessness is perfectly preserved in its HD re-release, Extended Cut.
Here's a trailer showing off the game in all its gory, sweary glory. Have fun!
\ We've blogged about this before: read (2) back stories


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Mani Shankar Aiyar compares MPs with animals; BJP fumes
New Delhi: Bharatiya Janata Party (BJP) spokesperson Rajiv Pratap Rudy on Friday criticised Congress leader Mani Shankar Aiyar for comparing Opposition Members of Parliament with animals.
"Mani Shankar Aiyar has made a comment in television interview calling Members of Parliament as animals. Well we absolutely agree on one thing that Parliament should not be obstructed, but does this give right to Mr Aiyar to call Members of Parliament as animals," Rudy asked.
"Who is Mani Shankar Aiyar? Mani Shankar Aiyar is a Member of Parliament who has been nominated to Rajya Sabha and not even elected. He subsequently joins the Congress Party. I believe he has been a foreign diplomat. He served in the Indian Foreign Service for over 25 years," he said.
"I am just amused and shocked what he must have contributed in his 25 years as Indian Foreign officers, the language, which he uses, the behaviour which he exhibits especially in the back drop when the Congress party is all being charged with corruption, 2G scam, coalgate and commonwealth games etc.... I think it is shocking," he added.
In a television debate on Parliament deadlock over Foreign Direct Investment (FDI) in multi-brand retail, Aiyar said, "There is a decent and respectable way to express one`s point of view. This behaviour of the MPs reminds me of animals screaming in a well."
This came even as Parliament deadlock over FDI ended on Thursday after the government agreed for a vote on the issue both in the Lok Sabha and the Rajya Sabha.
Lok Sabha Speaker Meira Kumar accepted the notice for a discussion on the issue under Rule 184, while Rajya Sabha chairman Dr Hamid Ansari agreed to a discussion under Rule 167.
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- Karan Singh Grover's words for Bipasha Basu will restore your faith in love – Check them out
- Champions League: After knocking out Bayern Munich, Atletico Madrid ready to write history
- Premier League triumph: Leicester City's 'magic' hailed globally as the party goes on


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This article or section is currently in the middle of an expansion or major revamping. The information contained within this article should not be considered to be fully accurate until the article contributor(s) have removed this tag. You can help MapleWiki by contributing to it.
Aran (
KR:아란) is one of the six Heroes who sealed away the Black Mage and is part of the Warrior branch. With a Polearm in hand, Aran uses many ice and combination attacks against her foes.
To view Aran's skill list, click here.
A hundred years ago, an evil mastermind known as the Black Mage conquered all of Maple World. The citizens tried to resist, but had no way to fight back. However, there was one hope: the six Heroes of MapleStory.
Before the final battle of the Heroes against the Black Mage, Aran was wounded and was sent to a camp. The hero walked out of the tent, learning that Athena Pierce was organizing an expedition to Victoria Island with the intention of keeping the townsfolk safe. At the moment the hero approaches the ark, a child is missing, and Athena Pierce had little choice but to get the injured hero to rescue the child. After facing a few of the Black Mage's forces, the hero manages to return the child to the child's family. Athena Pierce urges the hero to join them and leave the others to fight the Black Mage. The hero stubbornly refuses and insists to join the rest of the hero's comrades.
After a fierce and violent battle, the Black Mage was sealed away. However, he did manage to lay one final curse on the Heroes which encased them in ice and erased Aran's memory. After Aran was cursed, Maha sealed the hero in a remote cave in Rien to slow down the curse.
A century later, Aran awakes in Rien and meets Lilin, the last member of her clan who believed in the hero's resurrection. Day by day, the citizens of Rien aid the awoken hero, and the hero slowly regains the hero's long-forgotten memories and powers.
Heroes of Maple
During the Black Heaven arc, she befriends Shade "again". When they were training, they received news of Lilin being kidnapped by the Demon Army. She brought along Shade and witnessed Evan's actions in Slumbering Dragon Island. She breaks the ice wall and fight several troops of the Demon Army, with Shade as a backup to save Lilin. They eventually met Afrien and she briefly fights Damien, being knocked back by his blade. The trio manages to escape the ice cave.
Due to Maha taking damage from Damien's previous attack, she have to catch up with Evan later. After Maha was healed, she and Shade fought the Demon Army from the other side of the Sanctum, taking them a long time to reach the heroes. The group eventually escapes the Demon Army when Evan starts up the airship.
She along with Evan and Mir stays behind in the Abraxas and discussed about Shade's curse, which was a hindrance for him to accompany the heroes. However, they were under attack by Damien's forces, who were aiming to delay the heroes by destroying the airship. Fortunately, they managed to escape and meet up with the other heroes on one of the skyscrapers, with Shade using a inter-dimension communication system to contact with them from the Maple World.
In the credits, she was shown laughing at the missing section of the mural depicting the heroes sealing the Black Mage, much to Shade's embarrassment.
The majority of Aran's attacks are activated through key commands.
Aran's way of fighting revolves around her Combo System, which increases based on how many consecutive hits the player has dealt to monsters and applies it to Aran's skills. Many skills focus on creating long combos and utilizing the combos to use special abilities. The combo will decrease by a certain amount over time. There are also skills that will increase the combo count so that some abilities can be used instantaneously. Certain skills can be used either with a key command, or activated by pressing the skill key, the latter of which deals more damage.
Heroes of Maple
As of the Heroes of Maple update, Aran's playstyle is changed significantly. While she still uses a Combo System, the Combos are not used to enhance certain attacks or use special abilities. Instead, when Aran reaches 1000 Combos, she will enter Adrenaline Boost, which grants a huge damage boost, an increase in attack count, and extra damage for select skills.
In 4th job, two new attacks are gained while in Adrenaline Boost, one of which deals continuous damage and pulls enemies to you, and the other of which can be held down and released to deal 1500% damage 15 times on a single enemy, with a damage cap of 99,999,999.
- The release of Aran introduced the first ever central plot of MapleStory with an antagonist.
- Aran's opening cutscene has many continuity errors:
- The cutscene says the Black Mage's curse wiped out the memories of all the heroes. Only Aran was affected by this.
- The archer heroine possesses a normal Bow. Mercedes' weapons are Dual Bowguns.
- Only five heroes are shown. There are actually six.
- This continuity error leads to the question as to whether Shade's storyline is true. Aran never came into the room where the Black Mage was being sealed until after Shade had sacrificed himself, so the picture above isn't accurate.
- Aran was depicted male in the class's initial release. Aran was later shown as female in the Age of Battle trailer, which became canon.
- It hasn't been explained why Aran was the only one who lost her memory.
- Both genders of Aran can be found in-game; a male Aran can be found in Leafre of Past while a female Aran appears in the Conference Room of the Alliance, and in Phantom's, Luminous's, and Shade's storyline.
- In the Explorer Warrior's storyline quest, the player talks to Lilin about Aran, who asks about Aran's gender. This choice determines the gender of Aran that appears in the same quest.
Availability of Aran
|Cygnus Knights
Dawn Warrior
Blaze Wizard
Wind Archer
Night Walker
Thunder Breaker
|Child of God
|Beast Tamer


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Chiquibaby's isn't trying to be anything but a bar
An evening of obscure karaoke corridos and two buckets of beer
Chad Deal 6:30 p.m., April 27
Intrepid Shakespeare Company presents a staged reading of Neil LaBute's dark and stormy "story of a brother and sister caught up in a terrible and complicated dynamic." Francis Gercke directs.
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Number: 0022
Aetna considers calcitriol (Calcijex) or paricalcitol (Zemplar) injection medically necessary for the management of hypocalcemia and/or secondary hyperparathyroidism in members with chronic renal failure undergoing hemodialysis.
Aetna considers calcitriol injection experimental and investigational for the treatment of the following diseases (not an all-inclusive list) because its safety and effectiveness for these indications has not been established:
Aetna considers paricalcitol injection experimental and investigational for the treatment of the following diseases (not an all-inclusive list) because its safety and effectiveness for these indications has not been established:
See also CPB 0020 - Injectable Medications.Background
Calcitriol is an anti-hypocalcemic agent or calcium regulator. It is used to suppress the levels of parathyroid hormone (PTH). Calcijex, the parenteral form of calcitriol, is used when patients have not responded to an oral form of calcitriol (Rocaltrol). Calcijex is administered intravenously. Paricalcitol (Zemplar), a vitamin D analog, is administered as an intravenous bolus injection and can be delivered at any time during dialysis. Paricalcitol is the most widely used vitamin D analog in the United States.
Studies have reported that parenteral calcitriol is more effective than pulse oral calcitriol in suppressing PTH (Andress 2001). Available evidence indicates that parenteral vitamin D therapy is associated with fewer episodes of hypercalcemia and hyperphosphatemia and that patients receiving pulse oral calcitriol require more phosphate binders. Because of the documented high non-compliance rate with oral medications in the dialysis population, parenterally administered vitamin D or vitamin D analog is expected to more completely suppress PTH and result in fewer parathyroidectomies.
Calcitriol is also available in oral form. Oral calcitriol (Rocaltrol) is indicated for hypoparathyroidism and pseudohypoparathyroidism. Oral calcitriol is also indicated for secondary hyperparathyroidism and resultant metabolic bone diseases in persons with moderate to severe renal failure not yet on dialysis.
Topical calcitriol (e.g., Vectical) is used for treatment of mild to moderate plaque psoriasis in adults.
Investigators are studying the potential anti-tumor effects of calcitriol and paricalcitol. In a review, Beer et al (2005) stated that calcitriol has been reported to exhibit significant anti-neoplastic activity in pre-clinical models of prostate cancer and many other tumor types. Its mechanisms of activity may include inhibition of proliferation, cell cycle arrest, induction of apoptosis, as well as reduction of invasiveness and angiogenesis. Differing mechanisms may be involved in different tumor types and under different experimental conditions. Pre-clinical data suggest that calcitriol acts via a synergistic and/or additive manner when combined with anti-neoplastic agents that are relevant to prostate cancer such as dexamethasone and several classes of cytotoxic agents. However, the anti-neoplastic effects of calcitriol occur at levels that markedly exceed the normal physiological range and cannot be safely attained with conventional daily dosing. Intermittent administration of calcitriol has allowed significant dose escalation. When used with weekly docetaxel (Taxotere), calcitriol produced encouraging results in a single-center phase II clinical trial. These investigators noted that an international placebo-controlled randomized study is under way to ascertain the safety and effectiveness of this combinational therapy.
In a phase I and pharmacokinetics study, Muindi et al (2009) determined the maximum tolerated dose (MTD) of intravenously (i.v.) calcitriol administered in combination with a fixed oral dose of dexamethasone and gefitinib in patients with refractory solid tumors. A fixed oral dose of dexamethasone of 4 mg/day was given every 12 hrs x 3 doses starting 12 hrs prior to i.v. calcitriol administration. Calcitriol was administered i.v. over 1 hr on weeks 1, 3, and weekly thereafter. The starting calcitriol dose level was 57 ug and escalation occurred in cohorts of 3 patients until the MTD was defined. Gefitinib was given at a fixed oral daily dose of 250 mg starting at week 2 (day 8). Serum calcitriol pharmacokinetics studies were performed on day 1 (calcitriol + dexamethasone) and on day 15 (calcitriol + dexamethasone + gefitinib). A total of 20 patients were treated. Dose-limiting hypercalcemia was observed in 2 out of the 4 patients receiving 163 mcg/week of calcitriol. Mean (+/- SE) peak serum calcitriol concentration (C (max)) at the MTD (125 microg/week calcitriol) was 11.17 +/- 2.62 ng/ml and the systemic exposure (AUC (0 to 72 hr)) of 53.30 +/- 10.49 ng h/ml. The relationship between calcitriol dose and either C (max) or AUC was linear over the 57-163 microg dose range. The authors concluded that the addition of a low-dose of dexamethasone allowed the safe escalation of calcitriol to the MTD of 125 microg/week. This dose level resulted in serum calcitriol concentrations that are associated with pre-clinical anti-tumor activity. However, no anti-tumor activity was noted clinically in patients with solid tumors.
Vitamin D analogues are being investigated in pancreatic cancer and other cancers. Chiang and Chen (2009) noted that pancreatic cancer is ranked 5th among cancer-related deaths worldwide with a 5-year survival rate of less than 5 %. Currently, surgery is the only effective therapy. However, most patients are diagnosed in the late stage and are not suitable for receiving curative surgery. Moreover, pancreatic cancer doesn't respond well to traditional chemotherapy and radiotherapy, leaving little effective treatment for advanced pancreatic cancer cases. 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)], the biologically active form of vitamin D(3), was originally identified during studies of calcium and bone metabolism, though it is now recognized that it exerts biological effects in almost every tissue in the body. Abundant evidence has shown that 1alpha,25(OH)(2)D(3) has anti-proliferative, apoptotic, pro-differentiation and anti-angiogensis effects in many types of cancer cells in vivo and in vitro, including breast, prostate, and colon. Similarly, the anti-tumor growth effect of 1alpha,25(OH)(2)D(3) on pancreatic cells has been demonstrated. The clinical use of 1alpha,25(OH)(2)D(3) is impeded by the lethal side effects of hypercalcemia and hypercalciuria. Thus, 1alpha,25(OH)(2)D(3) analogs, which are either equipotent or more potent than 1alpha,25(OH)(2)D(3) in inhibiting tumor cell growth but with fewer hypercalcemic and hypercalciuric side effects, have been developed for the treatment of different cancers. Recently, a pre-clinical study demonstrated that a less calcemic analog of 1alpha,25(OH)(2)D(3), 19-nor-1alpha,25(OH)(2)D(2) (paricalcitol), is effective in inhibiting tumor growth in vitro and in vivo, via up-regulation of p21 and p27 tumor suppressor genes. The authors stated that studies on the anti-tumor effects of a more potent analog of paricalcitol are underway; 1alpha,25(OH)(2)D(3) and its analogs are potentially attractive novel therapies for pancreatic cancer.
In a phase II clinial trial, Chadha et al (2010) examined the effects of intravenous calcitriol at a dose of 74 ug weekly (based on a recent phase I trial) and dexamethasone in patients with castration-resistant prostate cancer (CRPC). A 2-stage Kepner-Chang design was used. Oral dexamethasone at a dose of 4 mg was given weekly on days 1 and 2, and i.v. calcitriol (74 ug over 1 hour) was administered weekly on day 2 from 4 to 8 hours after the dexamethasone dose in patients with CRPC. Laboratory data were monitored weekly, and renal sonograms, computed tomography scans, and bone scans were obtained every 3 months. Disease response was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) and standard criteria for prostate-specific antigen (PSA) response. The calcitriol dose was derived from the authors' recent phase I study. Of 18 evaluable patients, 15 patients were Caucasian (83 %). No patients had a complete or partial response by either RECIST or PSA response criteria. Fourteen patients had progressive disease, 2 patients refused to continue treatment (after 64 days and 266 days), and 2 patients remain on the trial (for 306 days and 412 days). The median time to disease progression was 106 days (95 % confidence interval [CI]: 80 to 182 days). Fourteen episodes of grade 3 or 4 toxicity were noted in 7 patients (cardiac arrhythmia, chest pain, dyspnea, hyperglycemia, hypercalcemia, hypocalemia, hypophosphatemia, and pain). Only 1 episode of grade 3/ 4 toxicity was related definitely to calcitriol (hypercalcemia). No treatment-related deaths were noted. The authors concluded that high-dose, i.v. calcitriol at a dose of 74 ug weekly in combination with dexamethasone was well-tolerated but failed to produce a clinical or PSA response in men with CRPC.
In a clinical trial (n = 12), Koeffler and colleagues (2005) examined the effect of oral paricalcitol in the treatment of patients with myelodysplastic syndrome (MDS) whose disease varied between an international prognostic scoring system of low to high. Drug was well-tolerated in all patients. No responses were observed according to international working group criteria. However, the platelet count of 1 of the 12 subjects rose from 53,500 to 120,000/ul blood over 5 weeks; but the patient succumbed to a fatal fungal infection. These investigators concluded that paricalcitol given as a single agent to MDS patients is therapeutically not very effective; further trials of the vitamin D analog should be considered in combination with other approaches.
In a randomized, placebo-controlled, double-blind study, de Zeeuw et al (2010) evaluated if paricalcitol could be used to reduce albuminuria in patients with diabetic nephropathy. Patients with type 2 diabetes and albuminuria who were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were enrolled. Patients were assigned (1:1:1) by computer-generated randomization sequence to receive 24 weeks' treatment with placebo,1 μg/day paricalcitol, or 2 μg/day paricalcitol. The primary end-point was the percentage change in geometric mean urinary albumin-to-creatinine ratio (UACR) from baseline to last measurement during treatment for the combined paricalcitol groups versus the placebo group. Analysis was by intention-to-treat. A total of 281 patients were enrolled and assigned to receive placebo(n = 93), 1 μg paricalcitol (n = 93), or 2 μg paricalcitol (n = 95); 88 patients on placebo, 92 on 1 μg paricalcitol, and 92 on2 μg paricalcitol received at least one dose of study drug, and had UACR data at baseline and at least one time-point during treatment, and so were included in the primary analysis. Change in UACR was: -3 % (from 61 to 60 mg/mmol; 95 % CI: 16 to 13) in the placebo group; -16 % (from 62 to 51 mg/mmol; -24 to -9) in the combined paricalcitol groups, with a between-group difference versus placebo of -15 % (95 % CI: -28 to 1; p = 0.071); -14 % (from 63 to 54 mg/mmol; -24 to -1) in the 1 μg paricalcitol group, with a between-group difference versus placebo of -11 % (95 % CI: -27 to 8; p = 0.23); and -20 % (from 61 to 49 mg/mmol; -30 to -8) in the 2 μg paricalcitol group, with a between-group difference versus placebo of -18 % (95 % CI: -32 to 0; p = 0.053). Patients on 2 μg paricalcitol showed a nearly, sustained reduction in UACR, ranging from -18 % to -28 % (p = 0.014 versus placebo). Incidence of hypercalcaemia, adverse events, and serious adverse events was similar between groups receiving paricalcitol versus placebo. The authors concluded that addition of 2 μg/day paricalcitol to renin-angiotensin-aldosterone system inhibition safely lowers residual albuminuria in patients with diabetic nephropathy, and could be a novel approach to lower residual renal risk in diabetes. Moreover, they stated that the safety, effectiveness, and minimal need for monitoring of this drug should encourage future studies with hard renal outcomes to prove its renal and cardiovascular protective effects. Soloway (2010) commented that this study suggests that paricalcitol might augment protection of renal function in patients with diabetes when added to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. But this trial employed only surrogate endpoints; proof of efficacy will require longer studies with definitive renal and safety endpoints.
Vitamin D analogues are being examined as a treatment for multiple sclerosis. Niino and colleagues (2008) stated that multiple sclerosis (MS) is a major inflammatory and demyelinating disease of the central nervous system and has an increasing prevalence in populations residing at higher latitudes. This observation may indicate a protective effect of sunlight exposure, which is reduced at higher latitudes and may contribute to insufficient levels of vitamin D in the MS population. The vitamin D hormone is important for bone metabolism and can regulate cell proliferation and differentiation as well as apoptosis and immune regulation in immune cells such as T-helper cells and dendritic cells. Evidence from experimental autoimmune encephalomyelitis and prospective studies on MS suggests an important role of vitamin D as a modifiable environmental factor in MS. These provide guidance for future studies with regard to the potential role of vitamin D in the prevention and/or treatment of MS. In this regard, Smolders et al (2008) noted that there is a sound basis on which to initiate double-blind placebo-controlled studies that not only examine the effect of vitamin D on the clinical outcome of MS, but also on the regulatory T-cell compartment..
Reis (2010) stated that the management of cyclosporine A-induced nephrotoxicity remains one of the main challenges in kidney transplantation. The animal study by Park et al proposes that paricalcitol, a vitamin D analog with reno-protective actions reported in other conditions, attenuates cyclosporine A-induced kidney injury via the suppression of inflammatory, fibrotic, and apoptotic factors. However, before paricalcitol can be considered a feasible new therapeutic option for the management of patients with post-transplantation nephropathy, these interesting data require further studies evaluating other mechanisms of cyclosporine A-induced nephrotoxicity.
Henderson and Lester (1997) noted that serum levels of the important hormone 1,25-dihydroxyvitamin D (1,25-diOHD, calcitriol) have not been extensively evaluated in patients with cystic fibrosis (CF) during the critical period of skeletal growth and development. This study was a cross-sectional, observational assessment of 25-hydroxyvitamin D (25-OHD, calcidiol) and 1,25-diOHD levels in 54 patients with CF. The patients' ages ranged from 4.9 years to 19.5 years (mean of 11.0 years). Levels were correlated with pulmonary function tests, chest x-ray scores, height and weight Z scores, skinfold percentiles, CF genotype, serum chemistries, and use of a vitamin supplement. Levels were compared with those in more than 160 other pediatric patients living in the same region, and all assays were done in the same laboratory. Despite low-normal levels of the 25-OHD precursor, there was a high prevalence of low (18 %) and marginal (18 %) levels of 1,25-diOHD. None of the various parameters examined correlated with either 25-OHD or 1,25-diOHD levels. The cause, clinical significance, and treatment of low levels of this important hormone in children with CF warrant further study.
Ferguson and Chang (2009) stated that CF is a genetic disorder with multi-organ effects. In a subgroup with pancreatic insufficiency, malabsorption of the fat soluble vitamins (A, D, E, K) may occur. Vitamin D is involved in calcium homeostasis and bone mineralization and may have extra-skeletal effects. In a Cochrane review, these investigators evaluated the effects of vitamin D supplementation on the frequency of vitamin D deficiency, respiratory outcomes and vitamin D toxicity in the CF population. They searched the Cochrane CF and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Most recent search was June 9, 2009. Randomized and quasi-randomized controlled trials of vitamin D supplementation compared to placebo in the CF population regardless of exocrine pancreatic function. Both authors independently assessed the "risk of bias" of each included trial and extracted outcome data (from published trial information) for assessment of bone mineralization, growth and nutritional status, frequency of vitamin D deficiency, respiratory status, quality of life and adverse events. Three studies were included, although only data from 2 were available (41 adults and children with CF). One of these studies compared supplemental 800 international units (IU) vitamin D and placebo for 12 months in 30 osteopenic pancreatic insufficient adults; both groups continued 900 IU vitamin D daily. The other (abstract only) compared supplemental 1 g calcium alone, 1,600 IU vitamin D alone, 1,600 IU vitamin D and 1 g calcium and placebo in a double-blind randomized cross-over trial; only 11 children (vitamin D and placebo groups) after 6-months supplementation are included; inclusion criteria, pancreatic sufficiency or disease status of participants were not defined. There were no significant differences in primary or secondary outcomes in either study. The studies were not directly comparable due to differences in supplementation, outcome reporting and possibly participant characteristics (e.g., severity of lung disease, growth and nutrition, pancreatic sufficiency). There were no adverse events in either study. The 3rd study (abstract only) compared daily calcitriol (0.25 or 0.5 ug) with placebo in pancreatic insufficient children and young adults, only pre-intervention data were available. The authors concluded that there is no evidence of benefit or harm in the limited number of small-sized published trials.
Tamez et al (2012) noted that left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular (CV) morbidity and mortality. Vitamin D is linked to lower CV morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. These investigators examined the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post-hoc analysis of the PRIMO trial. A total of 196 patients with chronic kidney disease (CKD; estimated glomerular filtration rate [GFR] 15 to 60 ml/min per 1.73m(2)), mild-to-moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m(2), 95 % CI: -4.00 to -1.59 ml/m(2)) in the paricalcitol group compared with the placebo group (-0.70 ml/m(2) [95 % CI: -1.93 to 0.53 mL/m(2)], p = 0.002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8 % in paricalcitol versus 21.3 % in placebo, p = 0.02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, p = 0.03). The authors concluded that 48 weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. They stated that in a population where only few therapies alter CV-related morbidity and mortality, these post-hoc results warrant further confirmation.
In a multi-national, double-blind, randomized, placebo-controlled trial, Thadhani et al (2012) examined the effects of paricalcitol on left ventricular mass over 48 weeks in patients with an estimated GFR of 15 to 60 ml/min/1.73 m(2). A total of 227 patients (from 11 countries) with CKD, mild-to-moderate left ventricular hypertrophy, and preserved left ventricular ejection fraction, were included in this study. Participants were randomly assigned to receive oral paricalcitol, 2 μg/day (n =115), or matching placebo (n = 112). Main outcome measures were change in left ventricular mass index over 48 weeks by CV magnetic resonance imaging; secondary end points included echocardiographic changes in left ventricular diastolic function. Treatment with paricalcitol reduced PTH levels within 4 weeks and maintained levels within the normal range throughout the study duration. At 48 weeks, the change in left ventricular mass index did not differ between treatment groups (paricalcitol group, 0.34 g/m(2.7) [95 % CI: -0.14 to 0.83 g/m(2.7)] versus placebo group, -0.07 g/m(2.7) [95 % CI: -0.55 to 0.42 g/m(2.7)]). Doppler measures of diastolic function including peak early diastolic lateral mitral annular tissue velocity (paricalcitol group, -0.01 cm/s [95 % CI: -0.63 to 0.60 cm/s] versus placebo group, -0.30 cm/s [95 % CI: -0.93 to 0.34 cm/s]) also did not differ. Episodes of hypercalcemia were more frequent in the paricalcitol group compared with the placebo group. The authors concluded that 48-week therapy with paricalcitol did not alter left ventricular mass index or improve certain measures of diastolic dysfunction in patients with CKD.
Gonzalez-Parra et al (2012) stated that vitamin D has been recently associated with several renal, cardiovascular and inflammatory diseases, beyond mineral metabolism and bone health. This is due in part to widespread expression of vitamin D receptor (VDR) on tissues and cells such as heart, kidney, immune cells, brain and muscle. In CKD and other chronic disorders, vitamin D deficiency [serum 25(OH)D less than 20 ng/ml] is very common and is associated with adverse outcomes. Paricalcitol has demonstrated in several experimental and clinical studies of diabetic and non-diabetic CKD a favorable profile compared to other VDR activators, alone or as add-on to standard therapy. These beneficial effects are mediated by different actions such as reduction of oxidative stress, inflammation, down-regulation of cardiac and renal renin expression, down-regulation of calcifying genes and direct vascular protective effects. Furthermore, paricalcitol beneficial effects may be independent of baseline serum PTH, calcium and phosphate levels. They stated that these benefits should be confirmed in large and well-designed ongoing clinical trials.
Cozzolino et al (2012) noted that in CKD patients, CV morbidity and mortality rate is higher than in the general population, because of frequently concomitant hypertension, peripheral vascular disease, heart failure, vascular calcification (VC), diabetes and mineral bone disease. Recently, another important factor associated to CV risk in CKD has been deeply investigated: vitamin D deficiency. Vitamin D receptors are present in several systems and tissues and VDR activation is associated with positive effects, resulting in better blood pressure control and prevention of diabetic nephropathy. Unfortunately, the natural, non-selective vitamin D receptor activator (VDRA), calcitriol, is associated with higher serum calcium and phosphate levels, thus worsening CV risk in CKD. Recent data showed that the selective VDRA paricalcitol might have ameliorative CV effects. The authors concluded that the potential positive impact of the use of paricalcitol on diabetic nephropathy, cardiac disease, hypertension, and VC may open new paths in the fight against CV disease in CKD patients.
In a phase I/II pharmacokinetic and pharmacogenomic study, Ramnath et al (2013) determined the recommended phase II dose (RP2D) of 1,25-D3 (calcitriol) with cisplatin and docetaxel and its effectiveness in metastatic non-small-cell lung cancer. Patients were greater than or equal to 18 years, PS 0-1 with normal organ function. In the phase I portion, patients received escalating doses of calcitriol intravenously every 21 days prior to docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) using standard 3 + 3 design, targeting dose-limiting toxicity (DLT) rate less than33 %. Dose levels of calcitriol were 30, 45, 60, and 80 mcg/m(2). A 2-stage design was employed for phase II portion. These investigators correlated CYP24A1 tagSNPs with clinical outcome and calcitriol pharmacokinetics (PK). A total of 34 patients were enrolled. At 80 mcg/m(2), 2/4 patients had DLTs of grade 4 neutropenia. Hypercalcemia was not observed. The RP2D of calcitriol was 60 mcg/m(2). Among 20 evaluable phase II patients, there were 2 confirmed, 4 unconfirmed partial responses (PR), and 9 stable disease (SD). Median time to progression was 5.8 months (95 % CI: 3.4 to 6.5), and median overall survival 8.7 months (95 % CI: 7.6 to 39.4). CYP24A1 SNP rs3787554 (C > T) correlated with disease progression (p = 0.03) and CYP24A1 SNP rs2762939 (C > G) trended toward PR/SD (p = 0.08). There was no association between calcitriol PK and CYP24A1 SNPs. The authors concluded that the RP2D of calcitriol with docetaxel and cisplatin was 60 mcg/m(2) every 21 days. Pre-specified end-point of 50 % confirmed RR was not met in the phase II study.
In a randomized, placebo-controlled, cross-over trial, Joergensen et al (2015) evaluated the effects of paricalcitol on markers of cardiovascular risk and kidney function in people with type 1 diabetes mellitus and diabetic nephropathy. A total of 48 participants on stable renin angiotensin aldosterone system blockade and diuretics were assigned, in random order, to 12 weeks of paricalcitol and 12 weeks of placebo therapy, separated by a 4-week washout period. Primary and secondary end-points were changes in plasma N-terminal probrain natriuretic peptide and urinary albumin excretion rate obtained before and after each intervention. Glomerular filtration rates were estimated and measured (51 Cr-EDTA plasma clearance GFR) after each intervention. The mean (SD) age of the participants was 57 (9) years, the baseline geometric mean (95 % CI) urinary albumin excretion rate was 148 (85 to 259) mg/24 hour, the mean (SD) HbA1c was 70 (9) mmol/mol [8.6 (3)%], the mean (SD) estimated GFR was 47 (15) ml/min/1.73 m2 and the mean 24-hour blood pressure was 135 (17)/74 (10) mmHg. Compared with placebo therapy, vitamin D analog therapy had no significant effect on plasma N-terminal probrain natriuretic peptide concentration (p = 0.6), urinary albumin excretion rate was reduced by 18 % (p = 0.03 for comparison), estimated GFR was reduced by 5 ml/min/1.73 m2 (p < 0.001) and measured GFR was reduced by 1.5 ml/min/1.73 m2 (p = 0.2). The authors concluded that paricalcitol therapy did not affect plasma N-terminal probrain natriuretic peptide concentration in people with type 1 diabetes and diabetic nephropathy; however, the urinary albumin excretion rate was significantly lowered.
Trillini et al (2015) noted that secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol decreased serum PTH levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, cross-over, open-label study compared the effect of 6-month treatment with paricalcitol (1 μg/day for 3 months and then up-titrated to 2 µg/day if tolerated) or non-paricalcitol therapy on serum PTH levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum PTH levels significantly declined on paricalcitol from 115.6 (94.8 to 152.0) to 63.3 (52.0 to 79.7) pg/ml (p < 0.001) but not on non-paricalcitol therapy. At 6 months, levels significantly differed between treatments (p< 0.001 by analysis of co-variance). Serum bone-specific alkaline phosphatase and osteocalcin decreased on paricalcitol therapy only and significantly differed between treatments at 6 months (p < 0.001 for all comparisons). At 6 months, urinary deoxypyridinoline-to-creatinine ratio and 24-hour proteinuria level decreased only on paricalcitol (p < 0.05). Moreover, L3 and L4 vertebral mineral bone density, assessed by dual-energy x-ray absorption, significantly improved with paricalcitol at 6 months (p < 0.05 for both densities). Paricalcitol was well-tolerated. Overall, 6-month paricalcitol supplementation reduced PTH levels and proteinuria, attenuated bone remodeling and mineral loss, and reduced eGFR in renal transplant recipients with secondary hyperparathyroidism. The authors concluded that long-term studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes.
Note on documentation requirements: Laboratory tests results (before initiation of therapy) should be documented in the member's medical record showing the medical necessity of the treatment. The member's medical record should clearly document the need for the calcitriol or paricalcitol injection(s). These records should be available upon request.
Glucocorticoid-Induced Osteoporosis:
In open-label, randomized controlled study, Chen and colleagues (2015) evaluated the safety and effectiveness of calcitriol in the prevention and treatment of glucocorticoid-induced osteoporosis. A total of 66 patients treated with glucocorticoids (GC) for primary nephrotic syndrome (NS) were randomly assigned to 3 groups. Groups were designated as follows: (i) calcitriol alone (n = 22), (ii) calcitriol plus calcium carbonate (n = 23), or (iii) calcium carbonate alone (n = 21). Serum markers of bone metabolism and bone mineral density (BMD) were tested at 3 different time-points: the initiation of GC treatment (baseline), 12 weeks, and 24 weeks after the initiation of treatment. Levels of serum 25-hydroxy vitamin D, serum osteocalcin, and total serum collagen type N-terminal extension of the peptide were significantly decreased following GC therapy (p < 0.05). β-collagen serum-specific sequences were significantly increased following GC therapy. The above-mentioned changes were less dramatic in patients treated with calcitriol, although the differences were significant (p < 0.05). Changes in serum levels of calcium, phosphorus, alkaline phosphatase, and PTH were not significant; 24 weeks after the initiation of treatment, BMD of the lumbar spine and femoral bone significantly decreased in all of 3 groups. However, patients who received calcitriol had significantly higher BMD of the lumbar spine than patients who received calcium carbonate alone (calcitriol plus calcium carbonate versus calcium carbonate alone: 0.82 ± 0.19 g/cm2 versus 0.62 ± 0.23 g/cm2 p < 0.05; calcitriol versus calcium carbonate alone 0.805 ± 0.203 g/cm2 versus 0.615 ± 0.225 g/cm2 p < 0.05), respectively. No serious adverse events were observed. The authors concluded that calcitriol may be more effective than calcium carbonate in preventing and treating GC-induced osteoporosis in patients with NS. These preliminary findings need to be validated by well-designed studies.
In a phase II clinical trial, Leaf et al (2014) examined if administration of 1calcitriol to critically ill patients with sepsis would have beneficial effects on markers of innate immunity, inflammation, and kidney injury. These researchers performed a double-blind, randomized, placebo-controlled, physiologic study among 67 critically ill patients with severe sepsis or septic shock. Patients were randomized to receive a single dose of calcitriol (2 μg intravenously) versus placebo. The primary outcome was plasma cathelicidin protein levels assessed 24 hours after study drug administration. Secondary outcomes included leukocyte cathelicidin mRNA expression, plasma cytokine levels (IL-10, IL-6, tumor necrosis factor-α, IL-1β, and IL-2), and urinary kidney injury markers. Patients randomized to calcitriol (n = 36) versus placebo (n = 31) had similar plasma cathelicidin protein levels at 24 hours (p = 0.16). Calcitriol-treated patients had higher cathelicidin (p = 0.04) and IL-10 (p = 0.03) mRNA expression than placebo-treated patients 24 hours after study drug administration. Plasma cytokine levels (IL-10, IL-6, tumor necrosis factor-α, IL-1β, and IL-2) and urinary kidney injury markers were similar in calcitriol- versus placebo-treated patients (p > 0.05 for all comparisons). Calcitriol had no effect on clinical outcomes nor were any adverse effects observed. The authors concluded that calcitriol administration did not increase plasma cathelicidin protein levels in critically ill patients with sepsis and had mixed effects on other immunomodulatory markers. They stated that additional phase II trials investigating the dose and timing of calcitriol as a therapeutic agent in specific sepsis phenotypes may be warranted.
Dosage for Calcijex:
The FDA recommended initial dose of Calcijex (calcitriol), depending on the severity of the hypocalcemia and/or secondary hyperparathyroidism, is 1 meg (0.02 meg/kg) to 2 meg administered intravenously 3 times weekly, approximately every other day. Doses as small as 0.5 meg and as large as 4 meg 3 times weekly have been used as an initial dose. If a satisfactory response is not observed, the dose may be increased by 0.5 to 1 meg at 2 to 4 week intervals. During this titration period, serum calcium and phosphorus levels should be obtained at least twice-weekly. If hypercalcemia or a serum calcium times phosphate product greater than 70 is noted, the drug should be immediately discontinued until these parameters are appropriate. Then, the Calcijex dose should be re-initiated at a lower dose. Doses may need to be reduced as the PTH levels decrease in response to the therapy. Thus, incremental dosing must be individualized and commensurate with PTH, serum calcium and phosphorus levels.
Dosage for Zemplar:
Initial dose: 0.04 to 0.1 mcg/kg (2.8 to 7 mcg), injected as a bolus dose through a hemodialysis vascular access port at any time during dialysis.
|CPT Codes / HCPCS Codes / ICD-10 Codes
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":
|Other CPT codes related to the CPB:
|82310 - 82331
|Parathormone (parathyroid hormone)
|Phosphorus inorganic (phosphate)
|Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
|Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion
|HCPCS codes covered if selection criteria are met:
|Injection, calcitriol, 0.1 mcg
|Injection, paricalcitol, 1 mcg
|ICD-10 codes covered if selection criteria are met:
|End stage renal disease
|Secondary hyperparathyroidism of renal origin
|Dependence on renal dialysis
|ICD-10 codes not covered for indications listed in the CPB:
|Malignant neoplasm
|Myelodysplastic syndromes
|Diabetes mellitus with diabetic nephropathy
|Cystic fibrosis
|Multiple sclerosis
|Essential (primary) hypertension
|Hypertensive heart disease
|Hypertrophic cardiomyopathy
|Heart failure
|Other peripheral vascular disease
|Other osteoporosis without current pathological fracture [glucocorticoid – induced]
|Glomerular disorders in diseases classified elsewhere
|Complications of kidney transplant [post-transplantation nephropathy]
|Kidney transplant status


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Enter a few details about your move and receive up to four quotes within 24 hours.
This service is provided by Move, Inc. and is not affiliated with the real estate professionals associated with this property. By clicking "Get Moving Quotes," I consent to receiving moving quotes from up to four (4) companies as may be selected by Moving.com, who may contact me using an automated dialing system or a pre-recorded message at the phone number I've provided above.
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