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Author Affiliations: Arizona Department of Health Services, Phoenix. Dr Bronson-Lowe is now with the Department of Infection Control, Carle Foundation Hospital, Urbana, Illinois.
To examine the impact of a minimum interval schedule for administering diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) in infants during a statewide pertussis outbreak on receipt of inactivated polio vaccine (IPV) and pneumococcal conjugate vaccine (PCV).
Retrospective cohort study using the state immunization registry.
Arizona children born between February 1 and September 30, 2005, who received their initial DTaP dose during a statewide pertussis outbreak (N = 45 129).
Main Exposures
Children who received at least 1 dose of DTaP on the minimum interval schedule (minimum interval group) compared with children who received all doses of DTaP on the standard childhood and adolescent immunization schedule (standard group).
Outcome Measures
Timing and receipt of 3 doses of the DTaP, IPV, and PCV.
Compared with children in the standard group, children in the minimum interval group were more likely to receive 3 doses of DTaP (relative risk, 1.34; 95% confidence interval, 1.32-1.35), 3 doses of IPV (1.27; 1.25-1.29), and 3 doses of PCV (1.37; 1.35-1.39).
Recommending a minimum interval DTaP schedule during a statewide pertussis outbreak had a positive association with the receipt of IPV and PCV, 2 vaccines normally administered at the same time as DTaP.
The introduction of the pertussis vaccination program in the 1950s in the United States has significantly reduced the incidence of pertussis; since the 1980s, however, the annual number of reported pertussis cases has increased.1,2 Although much of this rise appears to be due to increased case reports among adolescents and adults, infants remain particularly susceptible to severe disease.3 Pertussis infection and mortality is highest in the first few months of life.4 To protect these infants, receipt of 3 doses of an acellular pertussis vaccine is required for optimal protection during the first year of life.5,6
According to the standard schedule for the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), the first dose of the vaccine is administered starting at 2 months of age. Infants are recommended to receive the next 2 doses at 4 and 6 months of age, with 8-week intervals between each dose.5 If needed, a minimum interval schedule for DTaP immunization can be used to administer this vaccine earlier than the standard infant DTaP immunization schedule. The main purpose of this schedule is to provide a mechanism for children who have not completed the recommended immunizations to do so as quickly as possible. As an alternative, this schedule can be used in an outbreak setting to accelerate vaccination coverage of susceptible children. The minimum interval DTaP schedule starts with an initial dose administered as early as 6 weeks of age; the second and third doses can be given at intervals of 4 to 8 weeks after the previous doses.2
One advantage of the standard immunization schedule is that other vaccines are generally administered to infants at the same clinic visit when DTaP is administered. However, the use of the minimum interval schedule for DTaP results in a lack of synchronization with other recommended routine vaccinations. Concern that the minimum interval schedule for DTaP would adversely affect the administration of other childhood vaccines has deterred health departments from recommending the minimum interval DTaP schedule as an outbreak control measure.7 Although studies have shown that hepatitis B vaccine completion rates have been improved when a minimum interval schedule was used, few data evaluating the impact of the DTaP minimum interval schedule on vaccine completion rates are available.8,9
In 2005, Arizona experienced a community-wide pertussis outbreak involving more than 830 reported cases. In May 2005, the Arizona Department of Health Services (ADHS) recommended the use of the DTaP minimum interval schedule for all infants who had not yet received the first 3 DTaP vaccinations. The ADHS recommendation remained in effect until the outbreak ended in October 2005. To determine whether the minimum interval schedule had an adverse effect on receipt of the inactivated polio vaccine (IPV) and the pneumococcal conjugate vaccine (PCV), we performed a retrospective cohort analysis of immunization records for Arizona children during the outbreak period. In addition, we performed a similar analysis of a second cohort to determine how frequently the minimum interval schedule is used and whether it adversely affects the receipt of other vaccines in a nonoutbreak setting.
Since 1998, all immunizations administered to children in Arizona have been required to be reported to the Arizona State Immunization Information System (ASIIS). Providers can report vaccine administration via several mechanisms, including electronic transactions from their billing systems or electronic medical records, direct entry into a secure Internet-based application, or mailing of paper forms to the ASIIS for entry. The ASIIS also includes population-based data on children born in Arizona from birth certificate data that are downloaded on a daily basis from the ADHS Office of Vital Records. These data are used to track the percentage of the population eligible to receive vaccinations.
We performed a retrospective analysis of immunization data from 2 separate cohorts extracted from the ASIIS in February 2008. All children were followed up through 12 months of age. Data reported in the registry were compared with death certificates recorded in the ADHS Office of Vital Records to exclude from the study individuals who died before age 1 year. Children who were known to have moved out of the state were also excluded from the analyses. This study was granted an exemption by the ADHS Human Subjects Review Board.
To capture children who were eligible to receive their first dose of DTaP during the outbreak, from May to October 2005, we extracted ASIIS vaccination data from children born between February 1 and September 30, 2005, who received their initial DTaP dose during the outbreak period (outbreak cohort).
To evaluate the effect of the minimum interval schedule during a nonoutbreak period, we analyzed vaccination data from a second cohort of children. These children were born between February 1 and September 30, 2004, and received their first DTaP dose during the same 6-month period 1 year before the statewide outbreak, from May through October 2004 (nonoutbreak cohort).
Vaccination schedules for individuals in both cohorts were categorized as the standard vaccination schedule or the minimum interval vaccination schedule, depending on when each dose of DTaP was administered. The minimum interval schedule was defined as receipt of the first dose of DTaP vaccine during the sixth week of life (42-48 days after birth) and receipt of subsequent doses 4 to 6 weeks (28-48 days) after the prior dose. Children who received at least 1 dose of DTaP on the minimum interval schedule were assigned to the minimum interval group. Those who received all doses of DTaP on the recommended schedule or later were assigned to the standard group (Figure).
Definitions of minimum interval and standard schedule groups by week of vaccine administration.
To compare the socioeconomic status of the groups among the cohorts, we used participation in the Vaccines for Children (VFC) program as a proxy variable. The VFC program is a federally funded program that provides recommended pediatric vaccines to children who are at risk of not being vaccinated because of an inability to pay.10
In each cohort, we calculated the mean age at each dose of DTaP, IPV, and PCV and the percentage of children who received 3 doses of each vaccine. These values were compared between the standard and minimum interval groups for each cohort. We used χ2 tests for comparison of categorical variables and risk ratios to determine differences in the vaccine completion percentages for 3 doses of DTaP, PCV, and IPV. Because the populations in both groups were not normally distributed, we calculated interquartile ranges to examine the variability in the ages when each dose of vaccine was given.
During May through October 2005, 45 129 children had vaccination records reported in the ASIIS. Of these, 19 228 (42.6%) were included in the minimum interval group and 25 901 (57.4%) were included in the standard group. Girls constituted 49.0% of children in the standard group and 49.7% of children in the minimum interval group. In the 2 groups, 19.4% and 16.2% of children, respectively, qualified for the VFC program.
Children in the minimum interval group were 34% more likely to have received 3 DTaP doses by 1 year of age (relative risk [RR], 1.34; 95% confidence interval [CI], 1.32-1.35), 27% more likely to have received 3 doses of IPV by 1 year of age (1.27; 1.25-1.29), and 37% more likely to have received 3 doses of PCV by 1 year of age (1.37; 1.35-1.39) than those in the standard group (Table 1). Compared with the children in the standard group, children in the minimum interval group were significantly more likely to have received all 3 doses of DTaP, PCV, and IPV by 1 year of age (P < .001) and to have completed these 3 doses at an earlier age (Table 1 and Table 2).
For infants born during the outbreak, individuals in the minimum interval group received all 3 doses of DTaP at a considerably younger age than children in the standard group, at mean ages of 24.1 (95% CI, 24.0-24.2) vs 30.0 (29.9-30.0) weeks, respectively (Table 2). On average, children in the minimum interval group received their first dose of DTaP 2 weeks earlier and their second dose of DTaP 5 weeks earlier compared with children in the standard group (Table 2). In addition, the mean age at which all 3 doses of IPV and PCV were administered was considerably younger for the minimum interval group than for the standard group (Table 2).
During the outbreak, the length of the interquartile ranges for the minimum interval group varied from 2.7 to 9.4 weeks, with the least variability observed at DTaP dose 1 and the greatest variability at DTaP dose 3. The interquartile ranges in the standard group were highest for IPV dose 3 (6.5 weeks) and lowest for DTaP dose 1 (1.6 weeks). Greater variation was observed with each additional dose administered, and children in the minimum interval group showed greater age variability compared with the children in the standard group. This finding was expected because some children in the minimum interval group received every dose on the minimum interval schedule (11.7%), whereas others reverted to a standard schedule or had longer intervals between each dose.
There were 44 853 children with vaccination records reported in the ASIIS who received their first DTaP dose during the 6-month period 1 year before the statewide outbreak. Of these, 5355 (11.9%) were included in the minimum interval group and 39 498 (88.1%) were included in the standard group. Girls constituted 48.8% of children in the standard group and 47.3% of children in the minimum interval group. In both groups, 19.3% and 20.9% of children, respectively, qualified for the VFC program.
Even in a nonoutbreak setting, children who received DTaP vaccinations on a minimum interval schedule were 20% more likely to receive 3 doses of DTaP by 1 year of age (RR, 1.20; 95% CI, 1.19-1.21), 24% more likely to receive 3 doses of IPV by 1 year of age (1.24; 1.22-1.27), and 20% more likely to receive 3 doses of PCV by 1 year of age (1.20; 1.18-1.22) compared with children who used the standard schedule (Table 1). In the nonoutbreak cohort, the mean ages at which the children in the minimum interval group received their third doses of all 3 vaccines were similar to those of children in the standard group (data not shown). This was remarkably different from the outbreak cohort and was likely because only 344 of the 5355 children in the nonoutbreak cohort (6.4%) received 2 or more DTaP doses at the minimum interval schedule compared with 8322 of the 19 228 children in the outbreak cohort (43.3%).
To determine whether socioeconomic status affected receipt of vaccinations on the minimum interval schedule, we evaluated the percentage of children qualifying for the VFC program by comparing the minimum interval group with the standard group for each of the cohorts. The percentage of children eligible for the VFC program was similar for both groups in a nonoutbreak setting. However, during the outbreak, a higher percentage of VFC program–eligible children were included in the standard group. These data suggest that, during an outbreak, children of lower socioeconomic status are less likely to participate in the minimum interval schedule (χ2 = 77; P < .001).
The use of a minimum interval schedule has been shown to have a positive effect on completion rates for the hepatitis B vaccine.8,9 Our study is, to our knowledge, the first to examine whether use of the minimum interval immunization schedule for DTaP has an adverse effect on the administration and timing of other vaccines in outbreak and nonoutbreak settings. Instead of a negative impact, receipt of at least 1 dose of DTaP on the minimum interval schedule during an outbreak had a positive association with completion rates for other vaccines. During their first year of life, children who received any DTaP vaccinations on the minimum interval schedule were more likely to receive 3 doses of DTaP, IPV, and PCV compared with children who received DTaP doses on the standard interval schedule. This was true regardless of the presence of an outbreak. During the outbreak, children in the minimum interval group were also more likely to receive all 3 vaccines at an earlier age than those in the standard group. This finding is critical because previous studies indicate that receipt of just 1 DTaP dose in infants (age, <1 year) is protective against pertussis-associated hospitalization.6 In addition, another study estimates that using the minimum interval schedule for the first dose of DTaP would prevent 1236 cases of pertussis and 7 deaths attributable to pertussis each year in the United States.11
The percentage of children receiving vaccinations on the minimum interval schedule increased from 11.9% in the nonoutbreak cohort to 42.6% during the outbreak, indicating that many providers and clinics were following the public health recommendation to use the minimum interval schedule. Outside of an outbreak setting, the main purpose of the minimum interval schedule is to provide a mechanism for children who have not completed the recommended immunizations to do so as quickly as possible. Before the outbreak, there were no known initiatives or recommendations to promote the minimum interval schedule in Arizona children. Therefore, it was surprising that more than 10% of the children in the nonoutbreak cohort received at least 1 dose of DTaP on the minimum interval schedule. Examination of the nonoutbreak cohort revealed 763 instances of children who had not received a DTaP vaccination according to the standard schedule but who then received a minimum interval dose, which might have indicated attempts to bring children onto the standard schedule.
One particularly interesting finding in our study was that, in a nonoutbreak setting, the mean age at receipt of dose 3 for all vaccines was similar in both the minimum interval and standard groups. This was remarkably different from the outbreak cohort, in which children received their third dose of all vaccines at a younger age in the minimum interval group compared with the standard group. These findings suggest that, during an outbreak, children are more likely to receive multiple doses of vaccine on a minimum interval schedule and, therefore, at a younger age compared with children on a standard schedule.
Our study had several limitations. Despite a legal requirement for health care providers to report all vaccinations administered to children, not all vaccinations are submitted to the registry. This study could not evaluate whether there were significant differences between children whose records were reported to the ASIIS compared with children whose records were not. However, because of the large sample sizes used in our study, it is unlikely that underreporting had a major effect on the outcomes.
To evaluate the timeliness and completeness of registry data, the ASIIS staff monitors the number of health care providers using the system and the frequency with which they use it. In December 2005, 82.4% of public providers and 87.3% of private providers had reported vaccinations to the system within the past 6 months.12 In addition, 72.9% of these providers reported immunization data on a monthly basis. Data from the population-based National Immunization Survey in 2006 indicated that 89.4% of Arizona children who were 13 months of age had received 3 DTaP doses.13 Our study showed that 73.2% of children who were 12 months of age and who were born between February 1 and September 30, 2005, received 3 DTaP doses. These data suggest that the ASIIS may underestimate the true vaccination coverage rates in Arizona. This finding is consistent with those of previous studies of immunization registries, which have indicated that registry-based data results in lower vaccination coverage estimates than data from health care provider reports and population surveys.14,15 In these studies, the primary reason for the lower estimates was incomplete or missing records, which can result from children moving in and out of the state or from health care providers not reporting vaccine administrations.
As with any passive surveillance system, there are significant delays in the reporting of vaccination data to the immunization registry. In 2005, only 48.1% of the administered vaccinations were entered into the registry within 30 days.12 However, the data used in this study were accessed in 2008, minimizing the impact of reporting delays on our analyses.
The minimum interval schedule used in this study differs from the recommendations of the Advisory Committee on Immunization Practices for minimum ages and intervals between doses of vaccines. The criteria used for inclusion in the minimum interval group were more stringent than the Advisory Committee on Immunization Practices recommendations and required children to receive their DTaP doses at least 7 days before the recommended age according to the standard immunization schedule. This definition was used to avoid misclassification of doses that were administered early out of convenience rather than representing these early administrations as attempts to follow the health department's recommendation.
We intend to examine the effect of the recommendation on the same children at 2 years of age, looking at not only the DTaP/IPV/PCV set of vaccines but also the vaccine series consisting of 4 doses of DTaP, 3 doses of poliovirus vaccine, 1 dose of measles vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine. In addition, our analyses were not able to consider the effects of health care costs and health insurance reimbursement issues. Further analyses are needed to determine the influence of these economic factors.
Our findings suggest that, in both outbreak and nonoutbreak settings, recommending the use of the minimum interval schedule for DTaP does not have an adverse effect on the receipt of other childhood vaccines normally given at the same time as DTaP. Furthermore, recommending a 4-week minimum interval DTaP schedule during an outbreak, starting with DTaP dose 1 at 6 weeks of age, was associated with an increased probability of receiving 3 doses of IPV and PCV. Based on our findings, implementation of the minimum interval DTaP schedule should be considered to increase vaccination rates among susceptible individuals during a pertussis outbreak.
Correspondence: Shoana M. Anderson, MPH, Arizona Department of Health Services, 150 N 18th Ave, Ste 140, Phoenix, AZ 85007 (email@example.com).
Accepted for Publication: January 7, 2009.
Author Contributions: Dr Bronson-Lowe had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Anderson. Analysis and interpretation of data: Bronson-Lowe and Anderson. Drafting of the manuscript: Bronson-Lowe and Anderson. Critical revision of the manuscript for important intellectual content: Anderson. Statistical analysis: Bronson-Lowe. Administrative, technical, and material support: Anderson. Study supervision: Anderson.
Financial Disclosure: None reported.
Funding/Support: This study was supported by Immunization and Vaccines for Children grant 2H23IP922545-06 from the Centers for Disease Control and Prevention (CDC).
Role of the Sponsor: The CDC provides funding for immunization and epidemiology staff at the state level. The design and conduct of the study; the collection, analysis, and interpretation of the data; and the preparation of the manuscript were all performed as part of the authors' routine work duties.
Additional Contributions: The following individuals from the ADHS Immunization Program Office and Bureau of Epidemiology and Disease Control contributed to this study: Lisa Rasmussen, BS, provided immunization data and manuscript review; Michael Conklin, BS, provided immunization data; Sanny Chen, PhD, provided statistical expertise and manuscript review; and Karen Lewis, MD, Cara Christ, MD, Rebecca Sunenshine, MD, Kris Bisgard, DVM, and Ken Komatsu, MPH, provided helpful comments and manuscript review. The immunization staff and all health care providers who contributed vaccination data to the state immunization registry provided invaluable assistance.
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on June 26, 2013 - 7:50 PM
Dec. 3, 1936 – June 24, 2013
Rita M. Deschamps, a retired switchboard operator for The Buffalo News, died Monday in her Buffalo home, while under hospice care after a lengthy illness. She was 76.
Born Rita Gallagher in Buffalo, she was a graduate of South Park High School.
Mrs. Deschamps worked as a phone operator in the newsroom of The News from October 1981 to May 1999, when she retired.
She was a former president of the Valley Community Association in Buffalo.
Her husband, Desmond, died in 1995.
Survivors include four sons, Douglas, Rick, Randy and Joshua; four daughters, Kelly and Michelle Benzo, Sharon and Patti-Ann; and a sister, Geraldine Thompson.
A Mass of Christian Burial will be offered at 10 a.m. Friday in St. Clare Parish, 193 Elk St.

subset: commoncrawl


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PFS Rapid Review – #TBT Edition – The Sacrament
By Keegan Handley
The Sacrament is Ti West's best film yet. We follow three VICE correspondents into a utopian community called Eden Parish; they want to investigate for the show and meet the one they call "Father". Ti West revels in the slow burn suspense, and the way he ratchets up the tension is masterful. The end game is reminiscent of a real moment in history, but as seen here it carries a weight and an inevitability that will leave you shaken as the credits roll.
PFF22 Alum The Sacrament is now available VOD.
Keegan Handley is a film major at Temple University interested in the cinematic form and all it has to offer. He's a lover of music and good beer and is partial to horror movies but appreciates any and all flavors of movie…even the bad ones. A huge fan of intricate camera shots, he hopes to one day contribute both his writing and his burgeoning Steadicam prowess to the film world.


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In praise of volunteerism
29 May 2006
by Herbert Lewis
Over the past few weeks, I have been touched by the many comments made by those whom many Jamaicans refer to as the 'little man'. And one might very well ask what the 'little man's' comments are about.
The comments were about a news item which appeared on one of our television's evening newscast. It concerned a small boy who needs surgery to one of his eyes to remove what was reported to be a cataract. From the report, if he does not have the surgery, he is likely to lose both eyes. His parents are poor. They do not have the money to pay a doctor. The cost of the surgery is $60,000.
The question being asked by many people who saw the newscast is whether there is any doctor out there who also saw the newscast. There are many Jamaicans who refuse to believe that in this day and age for the sake of $60,000, a doctor could feel comfortable with himself or herself to see a child lose his sight because his parents are unable to find the money to pay for the surgery.
Not an unusual case
As funny as it may sound to those who seem surprised, this is not an unusual case. My understanding is that there are doctors out there who even refuse to treat a fellow doctor's family member unless the money is paid up front. Yes, indeed, times have changed, and changed for the worse in many places. The question is: Where have the oaths of some of our doctors gone? Or are those oaths meaningless things of the past?
It has often been lamented that Jamaicans are not very good at volunteering themselves for worthy causes. But this is not necessarily so in all cases. Most volunteers do so quietly and efficiently, and the public is often unaware of the immense contributions they are making. Don't get me wrong. There are a number of volunteers who are helping the disabled and the elderly, and it is heart-warming to note that of the volunteers, many are in the medical profession.
Front line
Doctors are often the front line for problems faced by the disadvantaged in our society. The disadvantaged are diagnosed and their disability assessed by medical practitioners. The elderly are more prone to illnesses and often seek doctors for help. Faced with these cries, it is natural to expect those whose calling is to alleviate suffering, to respond in a positive way.
Like all of us, doctors have their obligations to meet. Many have children to send to school, rent or mortgage to pay loans to repay, etc. But not withstanding all these things, there are some who need to stop for a while and look at their professional behaviour.
Money is important yes but it can't be the 'be all and end all'. Don't quarrel with me for this article. Take some time and listen to what the public is saying about some doctors. Many are giving this honourable profession a very, very bad name.
There is a professional body out there which I understand sets rules and regulations for its members (the Medical Association of Jamaica). It is not enough to have policies. It is not enough to have rules and regulations. It is not enough to have procedures. It is not enough to have good intentions. All of these can help. But to be successful and meaningful, all this must be embedded in a culture of ethics. This, therefore, might be a good time for the Medical Association to take a look at its members' behaviour and remind them of the fact that their professional conduct is at stake. And that their calling is to alleviate suffering.
The medical profession often gets bad press when a small number of doctors behave in a selfish or anti-social manner. The good which many doctors do voluntarily, often goes unnoticed because of those who pull down the profession through selfishness and sometimes greed. I think it would not hurt to let the public know that some doctors do have a heart.
People do talk about their experiences and quite often they lament the fact that many of our doctors who behave in unprofessional ways derived their education from public funding - from the taxes paid by some of those whom they refuse to treat or from those whom they will not treat unless the fees are up front, before they are treated.
God knows that many of our sick are unable to buy their medication after they have paid the doctor's fees. I recently heard an elderly gentleman asking a pharmacist the cost of medication which was prescribed for him. When he was told the cost, his response was: "Give me a half of it." He could not afford it.
Note to deviants
Finally, may I suggest to those whose behaviour leaves room for improvement, that in your quiet moments, when you are alone, ask yourself these questions:
We all have a duty, not a choice, to treat people as people, with respect, benevolence and love. Remember too that life has relevance to our community and our country. Value it. Our lives are all gifts from the Great Creator of the universe. Let us share this gift as freely and generously as possible.
Herbert Lewis is an industrial relations specialist and former president of the Jamaica Employers' Federation.


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Pneumococcal Infection in Children
What is pneumococcal infection?
Pneumococcal infection is caused by the pneumococcus bacteria. It can cause serious illness in children, including pneumonia, infection in the blood, and meningitis (infection in the tissues around the brain and spinal cord). In young children, pneumococcal infection often causes ear infections, which can very rarely lead to more serious complications, such as meningitis.
Can I prevent pneumococcal infection?
The best way to prevent pneumococcal disease is by getting vaccinated. The pneumococcal vaccine is a shot that helps protect against some of the many types of pneumococcal bacteria. There are currently 2 types of vaccines:
Pneumococcal conjugate vaccine (PCV13 or Prevnar). This vaccine protects against the 13 types of pneumococcal that causes severe illness in children. It can also help prevent some ear infections. PCV13 protects children by preparing their bodies to fight the bacteria. Adults with certain medical conditions can also get this vaccine.
Pneumococcal polysaccharide vaccine (PPSV23). This vaccine protects against 23 types of bacteria. Talk with your child's health care provider about whether or not your child is high-risk.
It is also important to get a flu shot every year because having the flu increases your risk of getting pneumococcal disease.
When is PCV13 given?
PCV13 is one of the routine childhood immunizations. It is given as a series at the following ages:
2 months
4 months
6 months
12 to 15 months
Children between 2 to 4 years who have not had the vaccine or who have not finished the series of 4 doses should get one dose of PCV13.
What are the risks from PCV13?
A vaccine, like any medication, is capable of causing serious problems, such as severe allergic reactions. However, the most common reactions to PCV13 include the following:
Pain and redness at the location where shot was given
Muscle aches
An allergic reaction would most likely occur within a few minutes to a few hours of the shot. Signs of an allergic reaction may include difficulty breathing, wheezing, (squeaking sounds while breathing due to tight airways), weakness, fast heartbeat, hives, and paleness. Report these or any other unusual signs immediately to your child's health care provider.
How do I care for my child after immunization with PCV13?
Give your child an aspirin-free pain reliever, as directed by your child's health care provider.


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WPU professors don't have to look for proof of what the Biology Department does for its students. It comes to them. Every semester the phone calls, emails and letters come from graduates, thanking the professors for preparing them for their post-graduate work and meaningful careers with top companies.
It's no mistake WPU biology students hit the ground running when they graduate. We offer small class sizes with experienced faculty members who take a stake in your future. Through exciting lab opportunities, students step out of the classroom and truly experience the field. WPU also provides teaching assistantships to exceptional students where they can work alongside professors and get valuable teaching and research experience.
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In fact, many of our students over the years have contributed to hands-on research with our faculty and staff regarding Polychlorinated Biphenyl (PCB) levels throughout Crabtree Creek in Wake County. According to the Environmental Protection Agency (EPA), the creek became contaminated with PCB many years ago following a chemical spill by Ward Transformer Company, a facility that handled transformers and other types of electrical equipment. Ward has been called "the Triangle's nastiest industrial polluter" with a "half-century legacy of toxic PCB contamination in the Raleigh area."
You too can help perform research like this. To learn more, watch the video below, or visit this link: youtu.be/eM34tbhsmZQ
|Bonner, Lisa A.
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The actor, 38, was traveling from New York to Kentucky when his plane was delayed, according to TMZ.com, which first reported the story. While the aircraft was on the runway, he pulled out his BlackBerry and began texting, despite being told by a flight attendant to turn off his phone.
After Duhamel refused the request, the aircraft was turned around and sent back to the gate, and the actor was escorted off.
According to his rep, the actor was texting about his flight delay. "He's sorry," Duhamel's rep tells PEOPLE.
The TMZ account also alleges that Duhamel was asked by a male flight attendant to turn off the device three separate times. Before boarding the flight, Duhamel reportedly was watching the Cleveland-Miami basketball game in an airport bar.
See what other readers have to say about this story – or leave a comment of your own


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Top Definition
Bay area street name for a Pat Huskins. A blunt laced with meth. The name gets it's inspiration from former San Jose Sharks player Kent Huskins and Washington DC news reporter Pat Collins. Pat collins is overly dramatic and Kent Huskins always appears to be sleepy.
"You see Johnny last night? He was trippin after he smoked his first Sleepy Pat!"
Por Columbus Sammich Swapper 28 de septiembre de 2011
Trending Now
Can you define these popular missing words?


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|VisitKorea does not guarantee the quality of products or services introduced on its site and is not responsible for any direct or indirect losses resulting from use of said products or services.
|Jungmun Resort is a multi tourism area of Jejudo Island and the largest resort in Korea. It is located on the seashore of Jungmun area in Seogwipo. Its facilities blend in beautifully with its surrounding nature, and in 1971, it was designated an International Tour Site. In the Resort, there are many interesting sites to visit, such as Pacific Land, Yeomiji Arboretum, fishing village for tourists, Seonimgyo Bridge, Cheonjeyeon waterfall, and Jungmun Beach. Also there are great hotels such as Shilla Hotel, Lotte Hotel, and the Hyatt Hotel that are internationally well known because celebrities often visit from abroad. This is the biggest Tourist complex in Korea.
The seashore of the Jungmun Tourist Complex (Jungmun Resort) is especially beautiful, and it is often used as a shooting location for movies, dramas, and commercials. A bench in the garden of Shilla Hotel was used in the movie 'Swiri'and the area has become known as 'Swiri Hill.' Yeomiji Arboretum is also a must-see travel spot. This arboretum has 2,000 kinds of rare plants in the greenhouse, and 1,700 kinds of flowers and trees outside. A tour train can be used between the arboretum and the garden, and if you go up to the sky lounge in the middle of the garden, you can see the whole arboretum. On a clear day, you can even see Marado Island in the distance.
|+82-64-735-7200, +82-64-739-1330
|Operating Hours
|09:00-18:00 (Last admission: 17:30)
|Available Facilities
|Yeomiji Botanical Garden, Teddy Bear Museum, Pacific Land, Chocolate Land, Jeju International Peace Center, Cheonjeyeon Falls, Jusangjeolli Cliff, etc.
* Refer to the homepage for details
|Admission Fees
|* Yeomiji Botanical Garden (064-735-1100 / 09:00-18:00)
Adults: 7,000 won (4,800 won) / Youths: 4,500 won (3,000 won) / Children: 3,500 won (2,500 won)
* Pacific Land (064-738-2888)
Adults: 12,000 won / Youths: 10,000 won / Children: 8,000 won
* Teddy Bear Museum (064-738-7600 / 09:00-20:00)
Adults: 8,000 won (6,000 won) / Youths: 7,000 won (5,000 won) / Children: 6,000 won (4,000 won)
* Sound Island Museum (064-739-7782 / 09:00-19:00)
Adults: 7,000 won (6,000 won) / Youths: 7,000 won (6,000 won) / Children: 5,000 won (4,000 won)
* Cheonjeyeon Falls (064-738-1529 / 08:00-Sunset)
Adults: 2,500 won (2,050 won) / Youths & Children: 1,350 won (850 won)
* Jusangjeolli Cliff (064-738-1532 / 08:00-Sunset)
Adults: 2,000 won (1,400 won) / Youths: 1,000 won (600 won) / Children: 1,000 won (600 won)
* Jeju International Peace Center (064-735-6550 / 09:00-18:00)
Adults: 3,000 won (2,500 won) / Youths & Children: 1,500 won (1,000 won)
※ Numbers in parenthesis (): Admission fees for groups
>> Click here for more details
|* From Seoul to Jeju
- Gimpo Airport (Gimpo Airport Station, Seoul Subway Line 5)
- Incheon Airport (Airport Limousine Bus Schedule www.airport.kr +82-1577-2600)
* From Jeju to Jungmun Resort
1) From Jeju International Airport, take limousine bus 600 to Jungmun Resort. (Duration: about 45 min)
2) From Jeju Intercity Bus Terminal, take the Jungmun Express Bus and get off at the entrance of Jungmun Resort. (Duration: about 50 min)
3) Local Bus: Take Bus 120 or 130 to the entrance of Cheonjeyeon Falls or Jungmun Resort. Or, take Bus 110 and get off at the bus stop inside of the tourism complex.


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Product Description
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EM pistol
Redirected from EM sidearm
this wiki
The EM pistol, also called the EM-33 Plasma Pistol, was the standard issue EM weapon used by Earth's Starfleet officers and the Earth Cargo Service personnel during the mid-22nd century.
While most Starfleet officers had only received training in the use of EM weapons, by 2151, the EM-33 fell out of use aboard Starfleet vessels in favor of the phase-pistol. (ENT: "Broken Bow") One of the disadvantages of the EM-33 was the need to compensate for particle drift, making the transition to the next generation, point-and-shoot phased pulse weapons difficult for some Starfleet personnel. (ENT: "Sleeping Dogs")
The weapon also remained in use aboard Earth Cargo Authority vessels like the ECS Fortunate, as it was seen in the hands of Matthew Ryan. (ENT: "Fortunate Son")
Background information Edit
According to the script of "Broken Bow", the pistol was a plasma pistol and the ammunition it fired were plasma bullets, [1] as the effect was also identified on screen in ENT: "Shadows of P'Jem". In his joint "Broken Bow" audio commentary with Rick Berman, Brannon Braga stated that the weapon was a pulse gun and that he always thought that they looked better than the Starfleet phase-pistols designed for the series and wished they would have stuck with the pulse guns through the series.
These props were in fact later re-used to represent the MACO phase-pistols and an alien pistol weapon in the second season episode "Canamar". The MACO particle rifle appeared to be a rifle version of this pistol prop based on its appearance, as it incorporated a similar barrel and fired similar energy discharges. The MACO pistols were identified as phase-pistols that fire phase pulses in ENT: "United".
While the EM-33 pistols seen in "Broken Bow" were grey with black highlights, the pistols seen on the Fortunate were black with grey highlights. This type of weapon is referred to merely as a "plasma pistol", firing "plasma bolts", in the script of "Fortunate Son". The studio model of this weapon was designed by Craig Binkley and Jim Martin. [2] According to Binkley, it was roughly based on the Israeli "Desert Eagle" handgun. [3]


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Of The Post and Courier Staff
MOUNT PLEASANT - Four days before proposals to house the Confederate submarine H.L. Hunley are due from three municipalities, Mount Pleasant Mayor Harry Hallman Jr. named former congressman Tommy Hartnett to head a task force to demonstrate the town's support for housing the Civil War relic.
Mount Pleasant, Charleston and North Charleston are expected to turn in competing proposals to the Hunley Commission by Friday. Mount Pleasant wants the submarine located at Patriot's Point Naval and Maritime Museum.
Hallman said the intent of the task force is "to rally the support of the business community so that the Hunley Commission will know support for the Hunley is more than nine members of Mount Pleasant Town Council." Hartnett's position is voluntary.
"I think Tommy, with him being an ex-congressman and a businessman in the community, brings a lot of credentials to the table," Hallman said. "And he's a good salesman."
Hartnett, who served in Congress from 1980 to 1986, is president of Hartnett Realty, a commercial real estate company in Charleston, and a long-time Mount Pleasant resident.
Hartnett, also a former state_representative and state senator in the 1970s, lost bids for lieutenant governor in 1986, the U.S. Senate in 1992 and governor in 1994.
He said his role in lobbying for the Hunley should be "easy ... because all the heavy lifting has been done," a reference to the joint effort by Mount Pleasant and Patriot's Point to make a competitive bid for the submarine.
"Patriot's Point is a natural place for the Hunley to be," Hartnett said of the naval and maritime museum that draws more than 250,000 visitors a year.
At a press conference Monday, Hartnett took a few jabs at Charleston and North Charleston, saying that Charleston is crowded and suffers from parking problems and that the site in North Charles-ton would be difficult for tourists to find.
Other members of the task force have not been chosen. Hartnett will appoint members to work with him.
Hallman used the press conference to stress a theme of bringing the Hunley "back home." The town also unveiled a proposed historic marker noting that the Hunley crew was temporarily housed at Shell Hall, or "Ronkin's Long Room," at 205 Ferry St. in Mount Pleasant, in early 1864.


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on January 16, 2013 - 11:53 PM
The American health care system will be examined from a sociological perspective when Debra Street, chairwoman of the sociology department at the University at Buffalo, speaks at the League of Women Voters Lunch & Issues meeting Friday in Scotch and Sirloin Restaurant, 3999 Maple Road at North Bailey Avenue, Amherst.
Street also will touch on the health care outlooks for middle-aged and older Americans and how they compare with those of Canadians at similar stages of life.
The program is open to the public. Guests are welcome. Cost is $16. For reservations and information, call Judy Metzger at 688-2351 or email Sally Metzger at firstname.lastname@example.com.


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Erie man charged with trying to force way into eastside residence
An Erie man was jailed this afternoon after police said he attempted to break into a woman's eastside residence this morning.
Stephon L. Pulliam, 48, of the 600 block of East 19th Street, was placed in the Erie County Prison on $20,000 bond after he was arraigned before Erie 6th Ward District Judge Dominick DiPaolo on charges of burglary, criminal trespass, criminal mischief, harassment and disorderly conduct.
Police accuse Pulliam of attempting to break into a residence in the 1700 block of Prospect Avenue by trying to force open a window. Police said Pulliam is prohibited from being on the property.


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We are a leading global food and beverage company with brands that are respected household names throughout the world.
PepsiCo Chairman and CEO Indra Nooyi describes the program and its three supporting pillars.
Our brands are available in more than 200 countries and territories around the world.
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PepsiCo anticipated the need to take environmental stewardship to a whole new level at the start of the new millennium, recognizing that environmental sustainability was becoming a core component of sustainable performance.
We began to put in place the systems, processes and metrics needed to drive continuous improvement in energy and water conservation as well as greenhouse gas, packaging and waste reduction. We also advanced innovations in packaging and sustainable agriculture, and improved performance in overall productivity and plant efficiency.
To learn more about our efforts, download our 2014 Sustainability Report.
PepsiCo takes a comprehensive approach to water stewardship – in our operations, our supply chain and the communities where we live and work.
In 2013, PepsiCo's operational water efficiency programs achieved estimated water flow savings of more than 14 billion liters, which translated into cost savings of nearly $15 million.
42 facilities across PepsiCo have achieved LEED certification.
PepsiCo is working to improve our energy use efficiency in order to reduce greenhouse gas emissions, conserve fuel and reduce our costs.
As a leading food and beverage company, agriculture is central to PepsiCo's business, and we continue to support sustainable agriculture by expanding best practices with our growers and suppliers.
PepsiCo's Sustainable Farming Initiative was piloted in 2011 and 2012 across 14 countries and officially rolled out in 2013 across the U.S., the U.K., Brazil, Chile, Argentina and Mexico.
As part of our commitment to reducing waste, we've been reusing our Frito-Lay shipping cartons multiple times since 2012. In doing so, we avoid purchasing nearly 300,000 new cartons annually.
At PepsiCo, we continually think about new ways to package and deliver our products to minimize our impact on the environment and reduce costs.
Responsible sourcing means looking at what we purchase beyond the traditional aspects of cost, quality and consistent supply.
In 2013, Naked Coconut Water became one of the first Fairtrade- certified coconut waters to be sold in the United States.


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Martin Short eyeing new TV sitcom on NBC
BEVERLY HILLS, Calif. — Martin Short could be back in the weekly TV business with his former "Saturday Night Live" boss, Lorne Michaels.
Short says he's waiting to hear whether NBC will pick up a comedy pilot produced by Michaels as a series next season.
The untitled sitcom stars "SNL" writer John Mulaney and is loosely based on Mulaney's life. Short plays a quiz show host who uses jokes written by Mulaney's character. The former "SNL" cast member says Elliott Gould is also in the cast.
NBC and other networks will announce their lineups for 2013-14 season next month.
Thandie Newton wants to empower women
ATLANTA — Thandie Newton doesn't shy away from the idea that she might be a role model.
With a leading television role, she hopes to empower women like the stars who have come before her.
"Empowerment anywhere leads to empowerment everywhere," said Newton, a racially mixed actress who is of British and Zimbabwean descent. "The world is changing at a pace where it needs to be. That's how I feel, and I'm proud to be a part of this movement."
The 40-year-old actress stars in the dramatic series, "Rogue" on DirecTV's in-house channel Audience Network.
On the 10-episode "Rogue," Newton plays Grace Travis, an undercover detective who takes on a gangster after her son is killed.
"It's the most time I've had to explore a character. It was a luxury," she said. "That's why TV is so great. You get to see deeper than you would if it was an hour and a half, although it felt like we were making a 10-hour movie."
Newton has starred in movies such as "Crash" and "The Pursuit of Happiness."
Kris Jenner's TV talk show set for July debut
LOS ANGELES — The studio behind Kris Jenner's new daytime talk show says it will launch the program in July.
Twentieth Television said that the show, titled "Kris," will air for six weeks starting July 15 on selected Fox-owned stations. The limited run for "Kris" is aimed at proving itself for a national niche.
Kris Jenner is the matriarch of the media clan that includes daughters Kourtney, Kim and Khloe Kardashian.
Mary-Louise Parker to return to Broadway
NEW YORK — Mary-Louise Parker is coming back to Broadway in the world premiere of Sharr White's "The Snow Geese."
The Manhattan Theatre Club and MCC Theater said that previews will begin Oct. 1 and the play will open Oct. 24 at the Samuel J. Friedman Theatre.
Set as World War I rages, the play is "about a family waking up from their own personal Gilded Age as the world around them changes forever," according to producers.
Vanilla Ice joins Amish for DIY home show
NEW YORK — The DIY television network is proving a comfortable home for rappers turned renovators.
"Vanilla Ice Goes Amish" will debut on the network this year. Network executive Burton Jablin says the former rap star will live with an Amish community in Ohio to learn how they do construction. Vanilla Ice already has a renovation series on the network that will return for its fourth season this fall.
Reverend Run of Run DMC will have a series next year starring with his wife and three children as they renovate their home.
Keeping with the music theme, DIY will also feature Daryl Hall next year as he renovates a farmhouse in Connecticut.
Zachary Quinto trusts his instincts for causes
NEW YORK — Zachary Quinto might be headed into other worldly places this summer in "Star Trek Into Darkness," but he says a social issue that's near and dear to him is taking care of the Earth.
He conserves water and electricity whenever he can. It's the little things that add up, he said.
Quinto served with Alanis Morissette as Kiehl's Earth Day ambassadors in the beauty brand's fifth year working with Recycle Across America. The effort aims to standardize recycling labels and collect empty grooming-product jars, and Quinto designed a limited-edition label for facial cream that is a fundraiser.
"I felt inspired by this organization. It's trying to make a tangible difference. Sometimes part of the challenge of getting involved in a cause is when it's abstract," Quinto said.
TV's 'Dexter' to end with upcoming season
LOS ANGELES — The end is coming for Showtime's serial killer drama "Dexter."
The cable channel said that the series' upcoming eighth season will be its last.
"Dexter" stars Michael C. Hall as a Miami Police Department blood-spatter expert who's got his own list of murder victims. The drama debuted in 2006 and became Showtime's first hit series, with a steady performance in the ratings through its run.
The final season begins June 30. It will feature English actress Charlotte Rampling as a neuropsychiatrist specializing in serial killers.
Friars Club to honor Don Rickles for career
LOS ANGELES — The Friars Club is honoring Don Rickles with a lifetime achievement award.
The entertainers' group said it will celebrate the 86-year-old comedian at its annual awards ceremony at the Waldorf Astoria Hotel in New York.
Bob Costas, Tony Danza, Kathy Griffin, Bob Newhart, Regis Philbin and Joan Rivers are among those set to participate in the honors June 24.
Rickles started his career in the 1950s and has worked with generations of legends, including Frank Sinatra, Bob Hope and Lucille Ball. He still appears on the late-night shows.
Widow of Ex-SEAL contributes to his book
NEW YORK — The widow of Chris Kyle, the former Navy SEAL and best-selling author shot dead in February, has contributed a foreword and afterword to a book her husband had been working on at the time of his death.
William Morrow, an imprint of HarperCollins Publishers, announced that Taya Kyle's tribute will be included in "American Gun: A History of the U.S. in Ten Firearms." The book comes out June 4 and was written by Chris Kyle and William Doyle. Chris Kyle's previous work was the million-selling autobiography "American Sniper."
Taya Kyle writes that she hopes readers "feel the presence" of her husband while reading the new book, which covers innovations in weaponry from the Revolutionary War to modern times.
Kyle and a friend were killed at a Texas gun range. An Iraq war veteran who they were trying to help deal with PTSD has been charged.
Associated Press
FILE - This June 21, 2011 file photo shows actress Mary Louise Parker at the premiere of the feature film "A Better Life" in Los Angeles. Parker is coming back to Broadway in the world premiere of Sharr White's ìThe Snow Geese.î The Manhattan Theatre Club and MCC Theater said Wednesday, April 10, 2013, that previews will begin Oct. 1 and the play will open Oct. 24 at the Samuel J. Friedman Theatre. Daniel Sullivan will direct. (AP Photo/Dan Steinberg, file)×
FILE - This Feb. 6, 2013 file photo shows Kris Jenner at the Red Dress Collection 2013 Fashion Show in New York. The studio behind Kris Jenner's new daytime talk show says it will launch the program in July. Twentieth Television said Thursday that the show, titled "Kris," will air for six weeks starting July 15 on selected Fox-owned stations. Those will include stations in New York and Los Angeles, with more to be announced later. Jenner is the matriarch of the media clan that includes daughters Kourtney, Kim and Khloe Kardashian. (Photo by John Minchillo/Invision/AP, file)×
Recording artist Vanilla Ice (right), born Robert Van Winkle, is shown in the new series "Vanilla Ice Goes Amish," where Van Winkle learns construction from craftsmen.×
Thandie Newton stars as a conflicted undercover cop in a new television crime series, "Rouge."×
Michael C. Hall. (AP Photo/Showtime, Peter Iovino) ** NO SALES **×


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- Power 710 Express data sheet (753KB)
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- A high-performance, energy efficient, reliable and secure infrastructure and application server in a compact 2U package. With IBM® POWER7+™ workload-optimizing technologies, the Power® 710 Express server is designed to handle today's compute-intensive combination of business transactions along with social and mobile activity.
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Investigators are still piecing together clues in a shooting outside a Kissimmee day care center, which hurt a mother and son.
A 32-year-old mother and her 9-year-old son were sitting outside Tiny Tots Child Care on Saturday morning when someone shot them.
The two were rushed to a nearby hospital. Their injuries were not life-threatening, according to officials.
It was not clear whether the shooting was random. Officers say they do not have a description of a possible suspect and need the public's help to gather more information.
Anyone with information regarding this incident is asked to call Crimeline at 1-800-423-TIPS. All calls are anonymous, and a tip that solves the crime is eligible for a cash reward.


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Top Definition
somthing that rocks and kicks ace.
Oh my god dude that movie was so awsum cause you could see that ladies nipples when she walked thru the frozen food isle at the grocery store
Natures_Reject가 작성 2005년 08월 08일 (월)
Trending Now
Can you define these popular missing words?
said by an idiot how can't spell "awesome" correctly.
Idiot: Oh my god! Twilight waz so awsum! :D
Literate person: Shut the hell up. :|
Literate person: Shut the hell up. :|
ALiteratePerson가 작성 2010년 07월 31일 (토)


text:
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bone disease
Spring 1998 Volume 2, Issue 10:
Bisphosphonates For Myeloma - Current Approach To Treatment
By Phillip R. Greipp, MD, Mayo Clinic, Rochester, MN
Two types of cells normally work together to constantly remodel and strengthen the existing bone. Those cells called osteoclasts normally resorb old bone while osteoblasts build new bone. In myeloma, this balanced relationship between osteoclasts and osteoblasts is uncoupled and bone is damaged. This happens not because myeloma cells themselves destroy bone, but because they affect changes in the normal function of these bone cells. Myeloma increases osteoclast bone resorption and decreases osteoblast bone building. As a result, bone density and bone strength are decreased and bone lesions develop. A goal of myeloma therapy is to restore the balanced cooperation between osteoclast and osteoblast activity to produce more normal bone.
Bisphosphonates are often used as an adjunct to chemotherapy to prevent the complications of myeloma bone disease. The most commonly used bisphosphonate, now approved by the FDA for use in myeloma and breast cancer with bone disease, is pamidronate (Aredia). It is typically given by intravenous infusion over 2-4 hours once every 4 weeks. A total of 90 mg of pamidronate is diluted in 250 to 500 ml normal saline and infused. The pharmaceutical company has data which confirm no loss in activity for 1 and 2 hour infusions compared to 4 hour infusions. Pamidronate has been shown to reduce the number of skeletal related events (SREs) in patients with bone lesions. SREs included fractures, orthopedic surgery and radiation to bone. Bisphosphonates also effectively lower the high blood calcium level that can occur when myeloma is more active. Pamidronate (Aredia) also reduces the frequency of subsequent episodes of hypercalcemia. In the clinical trials led by Dr. James Berenson at UCLA, differences in the rates of SREs have been observed for up to 21 months of use.
What are bisphosphonates, what do they do?
Bisphosphonates are inorganic chemical compounds that bind to hydroxyapatite in bone and prevent osteoclastic absorption of bone. They directly affect osteoclast number and activity. Bisphosphonates also work to restore the critical linkage between bone destruction and formation. Finally, bisphosphonates appear to reverse the decrease in bone density induced by glucocorticoids, often used to treat myeloma.
Bisphosphonates are absorbed poorly from the intestinal tract. After absorption or intravenous administration, 20-80% of the available dose may quickly wind up in bone. The rest is excreted by the kidneys. Most trials have been with intravenous formulations including: etidronate, clodronate, tiludronate, pamidronate, risendronate, ibandronate, and alendronate (in order of increasing potency). The more potent oral compounds are effective in preventing post menopausal osteoporosis. Oral doses sufficient to affect myeloma bone disease can cause inflammation and damage to the esophagus.
Which bisphosphonate is best for patients with myeloma?
Pamidronate (Aredia) is the only approved bisphosphonate for myeloma bone disease. In a placebo controlled trial, pamidronate, 90 mg intravenously over 4 hours, repeated monthly for 9 months, reduced the number of skeletal related events by about half compared to the rate observed in the placebo group. Bone pain, pathological fractures, and the need for palliative radiotherapy were all significantly reduced. This trial led to FDA approval of pamidronate for use in myeloma bone disease. Side effects were minimal and included transient hypocalcemia in some patients. This was easily treated.
Are there other beneficial effects to bisphosphonates?
Observations of an anti-interleukin-6 effect in vitro has prompted theories that pamidronate might have a beneficial effect on myeloma disease progression, but this is unproven. One of the results of the placebo controlled trial of pamidronate versus placebo was the observation of somewhat prolonged survival in a subset of patients with relapsed disease. This observation requires confirmation. Another benefit of bisphosphonates is the prevention or reversal of glucocorticoid induced osteoporosis. The benefits of bisphosphonates in patients without bone disease (about 15% of myeloma patients) is not established.
Should I be taking a bisphosphonate?
If you have myeloma bone disease and no contraindication to the use of bisphosphonates, then you should be taking a bisphosphonate. Oral bisphosphonates such as alendronate (Fosamax) in doses used for osteoporosis are not effective in myeloma. Whether higher oral doses may be effective is not known but esophagitis is a potential problem. Soon there will be published guidelines concerning bisphosphonate use in myeloma. At the same time, we will also be seeing new more potent bisphosphonates and also new doses and schedules for old bisphosphonates. Guidelines will likely need to be adapted to reflect knowledge gained from new modes of administrations, changes in dose and schedule, and the new agents themselves.
How can I tell if the bisphosphonate is doing any good?
Patients may not notice the benefits immediately, but eventually they may have less pain and function better. Accurate assessment of response to bisphosphonates in the individual patient is difficult because successful chemotherapy may produce similar benefits. Bone mineral density may be measured by dual photon absorptiometry. In addition there are measures of bone turnover, including the urinary cross-linked collagen telopeptide assay. The proper use of these tests and their interpretation should become more clear as the results of recent trials become available.
For how long should I take bisphosphonate?
No one knows the ideal duration of therapy. Dr. Berenson's trial suggests pamidronate (Aredia) produces benefits for at least 21 months. In osteoporosis trials, bone loss can be measured in only a few months after discontinuation of bisphosphonate. We advise treatment with bisphosphonate be continued indefinitely.
Are there any precautions for the use of bisphosphonates?
Bisphosphonates such as pamidronate taken at the prescribed dose and schedule are safe and effective. Rapid infusion can cause a chemical inflammation at the injection site along the path of the vein. Slower infusion may avoid this complication. Too rapid an infusion can also cause a low blood calcium. Most patients, however, tolerate infusions over 2 hours rather than 4 hours without side effects. Dosage in kidney failure should be reduced since bisphosphonate excretion is delayed. Intravenous pamidronate can cause inflammation of the eyes, but this side effect is treatable. High doses have been reported to exert a negative effect on bone mineralization in children or in Paget's disease.
If some bisphosphonate is good for my bones... is more better?
We simply don't know the answer to this question. Investigators are now testing the relative merits of higher doses and more frequent administration of bisphosphonates. Charges for a single pamidronate infusion vary from $700 to $1600, or more. Over a period of 3 years of pamidronate administration, charges may range from $25,200 to $57,600. Increasing the standard dose and shortening the interval between treatments could further increase the cost for that period up to $150,000 per patient. The cost of preventing one fracture or SRE could be many multiples of that. A cost of over a million dollars per skeletal event would be hard to justify for routine use, unless it impacted quality of life in a major way. Clearly, more cost effective formulations and delivery are needed.
Are there better bisphosphonates on the way?
More potent bisphosphonates could reduce costs by shortening the time required for intravenous infusions and by allowing the development of other formulations that eliminate the need for intravenous infusions, such as a patch or an oral preparation.
What is the Mayo Clinic philosophy about the use of bisphosphonates for myeloma?
We recommend pamidronate (Aredia) for patients with myeloma bone disease. Discontinuation of bisphosphonate in patients with osteoporosis is associated with resumption of bone loss in a few months. Because of this observation and because an extended trial shows continued benefit in myeloma patients, we recommend it be used indefinitely. If a skeletal related event occurs, pamidronate should still be continued.
We do not recommend the routine use of pamidronate (Aredia) in myeloma patients without bone disease. However there are two situations in which patients without significant bone disease may benefit from the use of bisphosphonates: 1) when patients are being treated with significant doses of glucocorticoids, they may benefit from the use of a bisphosphonate to prevent progression of osteoporosis or even reverse it; and 2) in smoldering or indolent myeloma bisphosphonates may prevent or delay myeloma bone disease.
The thinking with regard to the use of bisphosphonates in smoldering or indolent myeloma is evolving. If a skeletal MRI shows unequivocal myeloma bone disease when the bone radiograms are negative (rare in our experience), or if bone density is decreased due to myeloma, we recommend pamidronate (Aredia) therapy. If the patient has incidental post-menopausal osteoporosis, we consult with our metabolic bone disease specialists and recommend estrogens or a trial of alendronate (Fosamax) orally with follow-up bone density in six months.
Higher doses, a more frequent schedule, or a more potent formulation of bisphosphonate may be needed to have a measurable impact on the progression of myeloma. We hope zoledronate and other more potent bisphosphonates are developed as oral agents or as a patch, overcoming both the high cost and inconvenience of intravenous formulations. We are actively engaged in studying the efficacy of zoledronate. We await results of trials of other agents like gallium nitrate that may also inhibit bony osteolysis in myeloma.
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text:
A Bible Course from Genesis to Revelation
An Explanation of the Beckwith Art Chart of Bible History and Prophecy
George D. Beckwith
Author, The American Home and Character Trends, etc.
Copyright © 1942
edited for 3BSB by Baptist Bible Believer in the spirit of the Colportage ministry of a century agohttp://www.baptistbiblebelivers.com/~ In the public domain ~
Public Domain under Rule 6 of the U.S. Copyright Statutes
During online Internet searches of the Library of Congress database in Washington D.C.,
performed on 9-15-2010, no evidence of a current copyright renewal within 28 years of copyright prior to 1964 was found for this publication.God bless you from the Baptist Bible Believers website!Please tell everyone you know about this website, pray for this ministry - and that will be payment enough!"Buy the truth, and sell it not; also wisdom, and instruction, and understanding" (Proverbs 23:23)TABLE OF CONTENTS
To My Wife
Whose Faithfulness, Trust, Knowledge of
the Word and Sympathetic Counsel Has
Helped Make This Book Possible;
. . . . . . . .
And to the Service of God
In the Church of Jesus Christ.
This is what we might call "The Chart Age." Business charts, weather charts, etc., are the order of the day. Information travels through "eye gate" as well as "ear gate," and a full mind results when advantage is taken of both means of access to one's inner understanding.
In recent years, "Charts" have come to the front in the pictorial presentation of the Scripture. And without doubt beautiful diagrams greatly aid one's desire for a comprehensive grasp of some aspect of truth.
Of all the Bible charts that I have seen, none has impressed me so much as the "Beckwith Art Chart." It is one of the finest obtainable. Scripturally correct and attractively produced, it is an investment no teacher of the Word will ever regret. For Bible study work, it is unique, and calculated to hold the interest of all concerned.
The designer, George D. Beckwith, is to be highly commended for the most useful key, or explanation, he has prepared. The 25 chapters of his illuminating course of Bible History and Prophecy offer preachers abundant material for a series of messages that will help to stimulate a passion for the Scriptures on the part of their people.
We heartily commend the "Chart" along with its book, "God's Prophetic Plan Through the Ages," praying that the consecrated labors expended in the production of such will stimulate deeper interest in the more sure word of prophecy.
Herbert Lockyer, D.D.
Liverpool, England.
"For other foundation can no man lay than that is laid, which is Jesus Christ" (I Corinthians 3:11).
"If any man will do His will, he shall know of the doctrine, whether it be of God, or whether I speak of myself" (John 7:17).
The foundation theme upon which the Beckwith Art Chart is built is salvation from sin, through the cross of Jesus Christ. Jesus Christ entered into an atonement for sin, big enough to include the last sinner. Countless thousands of people have proved that the blood of Jesus Christ cleanseth from all sin. "Wash me in the blood of the Lamb and I shall be whiter than snow."
Now let us visualize the very beginning of this chart. First, a large, plain, white canvas, 14 feet 5 inches by 4 feet, was stretched on a wooden frame. Near the center of this canvas was drawn a large cross, which was painted blood-red representing the cross of Jesus Christ. Over the cross was placed this reference, 1 Corinthians 3:11. Out from the cross in all directions, all the other drawings on the chart were developed.
It is very significant that this cross was drawn and painted on "Good Friday," the anniversary of the crucifixion of Jesus Christ, our Savior. As the student studies the Bible more and more, he will realize that the books of the Bible, which precede the story of the cross, lead up to the cross as the center of the Bible theme; and that the books of the Bible which follow the story of the cross point back to the cross.
On Resurrection Sunday, just two days after this "Good Friday," there was added to the canvas the open tomb, and the Resurrection of Jesus Christ from the grave. Thus, on this glorious Sunday, there appeared alone on the chart, the cross, the open tomb, and the resurrection.
This chart and this book are made possible because of the combination of four things in the experience of the author,
- Some experience in drafting gained as an engineering student at Syracuse University;
- Some knowledge of painting;
- A lifelong interest in the study of the Word of God;
- The inspiration and direction of the Holy Spirit.
The author feels that this chart and this book are true to Scripture. They are presented humbly and prayerfully with the hope and belief that they will be a blessing to many who already are children of God; and that they will be used, under the direction and power of the Holy Spirit, in the conversion of many yet unsaved. "The secret of the Lord is with them that fear Him; and He will show them His covenant" (Psalm 25:14).
Many Bible references are given both on the chart and in this book. The Scofield Reference Bible gives to the student many connecting references, comments, and summaries.
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text:
Preservation attempts for local bridge unsuccessful
January 24, 2013
MARTINSBURG — Although preservation attempts have been made, the future of a local bridge slated for replacement remains unclear....
I sure hope that damn-one-way bridge on golf course road is the next one to go.
4 Agrees | 4 Disagrees | Report Abuse »
Not every thing that man builds is historic and needs to be preserved. Know locally as the "green bridge" it's just an ugly twisted steel cable structure. Recycling would be a better idea.
5 Agrees | 1 Disagrees | Report Abuse »
If you can't raise the funds privately, cut it up and turn it into cars. Sometimes you can't save everything,and don't continue to stain the taxpayers. End of story!
3 Agrees | 0 Disagrees | Report Abuse »
I can't believe a new bridge costs just over $2000. Was that another Journal typo? Re the stone bridge over the Opequon--that is an historic bridge and a duplicate of Burnside's Bridge at Antietam. What probably should be done is to add another bridge there and keep the historic structure.
3 Agrees | 1 Disagrees | Report Abuse »
Here we go folks, this is one that Maj and I agree on. This bridge as far as I know has no real historic value and is not aesthetically pleasing. Turn the page.
4 Agrees | 2 Disagrees | Report Abuse »
Showing 5 of 5 comments


text:
LC-MS Gains Favor Due To the...
As Immunotherapy Revolutionizes the Cancer Treatment...
Developers of DTC Genetic Testing Are...
Quadruple Helices Appear To Have Role...
Investigators have demonstrated the potential to reduce inflammatory responses in diseases such as rheumatoid arthritis using a small molecule agonist of the chemokine receptor CXCR3. Researchers at Newcastle University and Northumbria University in the U.K. have found that a previously reported CXCR3-specific agonist effectively desensitizes T cell chemokine receptors and stops the migration of activated T cells to chemokines present in the synovial fluid of patients with active RA. Importantly, the compound had no effect on the mobilization of regulatory T cells.
Newcastle's John A. Kirby, Ph.D., and colleagues, report their findings in PNAS, in a paper titled "Chemokine receptor CXCR3 agonist prevents human T-cell migration in a humanized model of arthritic inflammation."
Inflammatory diseases such as rheumatoid arthritis are mobilization of T lymphocytes in diseases such as rheumatoid arthritis is regulated via stimulation of the cells' chemokine receptors. The human chemokine system is also complex, comprising some 44 ligands and 21 G protein-coupled receptors (GPCRs) that have so far been identified.
The situation is complicated further because most chemokines can activate more than one receptor, and a number of the receptors have more than one chemokine ligand. In fact, over 12 chemokines have been identified in synovial fluid samples from patients with rheumatoid arthritis, the researchers write. Although a number of chemokine receptor/ligand-neutralizing antibodies and small molecule receptor antagonists have been developed as therapeutic approaches to inflammatory diseases, it isn't yet clear whether these will be effective in a clinical setting.
The Newcastle University resaerchers' current work focused on the potential to dampen responses triggered by the chemokine receptor CXCR3. Activation of CXCR3 by CXCL9, CXCL10, and CXCL11 represents a proinflammatory signal that recruits activated CXCR3-expressing T cells. Indeed cells expressing CXCR3 have been implicated in a range of diseases including psoriasis, multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis
Dr. Kirby's team and others have previously generated nonglycosaminoglycan-binding chemokines that still act as agonists to their receptors, but also mediate a powerful anti-inflammatory effects by a mechanism believed to involve chemokine receptor desensitization.
One report identified a 589 Da small molecule known as PS372424, as an agonist that is specific to the human form of CXCR3, and the Newcastle team has now further evaluated the potential of the compound to desensitize CXCR3 and other chemokine receptors on activated human T cells.
Their initial studies showed that treating activated T cells with PS372424 induced high levels of ERK phosphorylation and rapid internalization of cell-surface CXCR3. Moreover, the agonist significantly inhibited T cell migration towards its CXCL11, CXCL12, or CCL5, whereas the previously reported CXCR3 antagonist NBI-74330 only prevented T cell migration towards CXCL11.
Further analysis of chemokine receptors expressed by resting and activated human T cells and human regulatory T cells (Tregs) showed that while CCR5 is primarily expressed by activated T cells and Tregs, CXCR3 is almost exclusively expressed by activated T cells, and CXCR4 is expressed at roughly the same levels by each of T cell subpopulations. Rheumatoid arthritis synovial fluid (RASF) from patients with active inflammation induced significant migration of each T-cell population, and PS37242 specifically blocked migration of activated T cells towards RASF. In contrast chemotactic migration of the three T cell populations towards RASF couldn't be reduced by treatment with either the CXC3 neutralizing antibody or a CXCR4 antagonist AMD3100.
PS372424 is specific for human CXCR3, so to carry out in vivo studies the researchers established a murine model of human T cell migration, using animals humanized using peripheral blood mononuclear cells (PBMCs). An air-pouch model of inflammation was established in these animals, by injecting human CXCL11 into air pouches, and this induced significant recruitment of human CD45+ cells. Notably, this cell recruitment was markedly reduced following intravenous administration of PS372424, without any apparent adverse effects on the animals, even after five days of daily treatment.
Intravenous PS372424 also reduced to background levels the recruitment of human lymphocytes to air pouches filled with either CXCL12, CCL5, or, notably, human RASF. In contrast, neither the CXCR4 antagonist AMD3100, the CXCR3-blocking antibody, nor the small-molecule CXCR3-antagonist NBI-74330 could inhibit human cells in response to RASF. "This result reflects the situation during active human disease, where inflammation is produced by a myriad of chemokines," the authors write. "Importantly, PS372424 inhibited the migration of activated T cells toward RASF but allowed normal chemotactic recruitment of resting and regulatory T cells, which both express little CXCR3, suggesting a potential to modify the composition of the inflammatory infiltrate in vivo."
Moreover, they report, NBI-74330 wasn't capable of modifying human cell migration toward pouches filled with CCL5. This compound doesn't have any agonist activity, and the experimental results thus indicate that PS372424 may exert its heterologous anti-inflammatory effects by signaling through CXCR3 rather than just by blocking formation of the CXCR3/CCR5 heterodimer.
In fact, analysis of cell-surface chemokine receptor expression by human T cells recovered from the spleen of PS372424-treated humanized mice identified a significant reduction in both CXCR3 and CCR5, which FRET analysis had demonstrated form heterodimers on the cell surface. "Chemokine receptor heterodimerization suggests a mechanism by which specific activation of one receptor can induce desensitization of another," the investigators suggest.
PS372424 may therefore desensitize multiple chemokine receptors expressed by activated T cells, "but did not affect the migration of potentially beneficial Tregs," they conclude. "These data make a clear argument for exploration of agonist-induced chemokine receptor desensitization strategies for the treatment of important inflammatory diseases."
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text:
Coconut Supreme Torte RecipeRead Reviews Be the first to add a review
4.5 2 2
This three-layer coconut treat starts with a boxed mix. "A neighbor made this scrumptious cake and passed along the recipe to me," shares Vernelle Lazzarini of Upland, California.
- 1 package yellow cake mix (regular size)
- 1-1/3 cups water
- 4 eggs
- 1 package (3.4 ounces) instant vanilla pudding mix
- 1/2 cup vegetable oil
- 1-1/2 cups flaked coconut, toasted
- 1 cup chopped walnuts
- 1 package (8 ounces) cream cheese, softened
- 2 teaspoons milk
- 1 teaspoon vanilla extract
- 3-1/2 cups confectioners' sugar
- 2 cups flaked coconut, toasted, divided
- In a large bowl, combine the cake mix, water, eggs, pudding mix and oil. Beat on medium speed for 4 minutes, scraping sides of bowl occasionally. Stir in coconut and walnuts.
- Pour into three greased and floured 9-in. round baking pans. Bake at 350° for 23-27 minutes or until a toothpick inserted near the center comes out clean. Cool for 10 minutes before removing from pans to wire racks to cool completely.
- For frosting, in a large bowl, beat cream cheese, milk and vanilla until smooth. Gradually beat in confectioners' sugar. Stir in 1-1/2 cups coconut.
- Place bottom cake layer on a serving plate; spread with 3/4 cup frosting. Repeat layers. Top with remaining layer and frosting; sprinkle with remaining coconut. Store in the refrigerator. Yield: 16 servings.
Originally published as Coconut Supreme Torte in Light & Tasty
Reviews for Coconut Supreme Torte
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Reviewed Mar. 10, 2014
"I don't usually use cake mixes, but decided to try this recipe. My husband said it was' very good'. Toasting the coconut really accentuates its flavor."
Reviewed Jun. 17, 2010
"I've been making this cake for years and still get requests to make it. It is so easy to make and looks impressive."


text:
Serves 6 |
Prep Time 30 minutes |
Cook Time 1 hour
3 medium parsnips, sliced into 2" chunks
2 medium organic sweet potatoes, sliced into 2" chunks
2 tsp Eden Extra Virgin Olive Oil
2 tsp Eden Shoyu Soy Sauce
2 Tbsp balsamic vinegar
3 Tbsp Eden Barley Malt Syrup
Grated zest from one lemon
1 small bunch greens, (watercress, mustard, kale, Italian broccoli, dandelion, etc.)
Preheat oven to 350°. In a large bowl, combine parsnips and sweet potatoes with oil, soy sauce, vinegar, malt and lemon zest. Mix well to coat the vegetables. Transfer the vegetables to a shallow baking dish, taking care not to overlap the vegetables (this will cause uneven baking). Cover and bake for 35 minutes. Remove the cover and bake for another 15 to 20 minutes, until tender and the edges are browned. Meanwhile, bring a medium pot of water to a boil and cook the greens until crisp but bright green, about 2 to 3 minutes. Drain well and cut into bite-size pieces. To serve, arrange greens on a platter and mound roasted vegetables on top. Serve with lemon wedges, if desired.
American, Good/High Fiber, Japanese Food, Low Fat, Low Sodium, Macrobiotic, Oils, Side Dish, Sweeteners, Vegan


text:
Top Definition
The Webbos are the area of the male, or female, groin. Often Chip 'n' Dale dancers shave this sensitive area.
CND: Being a Chip'N'Dale dancer is hard, especially when it comes to shaving my Webbos. That's why I use 'Webbo Splash-On'
Female singer: Webbo Splash, You sexy Motherfucker!
Female singer: Webbo Splash, You sexy Motherfucker!
dodane przez The BIZ grudzień 27, 2003
Trending Now
Can you define these popular missing words?
Noun: Web-bos: This spelling of the spanish word huevos (eggs). In spanish slang huevos mean balls. In 1997 Jorge Estevez coined the word Webbos when he created the website www.mywebbos.com. The word was phonetically written for the noon spanish speakers and graphicly created so that the two b's in webbos could represent the 2 balls and playing off the word web. In 2008 Jorge Estevez recreated the website and new logo that displays the W as the scrotum sac for the word webbos. Webbos means Balls, Guts, Machismo!
Are you Looking at My Webbos? I saw you ex-girlfriend on My Webbos! You never know who you will find on My Webbos! "All I have in this world is my Word and My Webbos, and I don't break them for anyone!"
dodane przez Jorge Estevez kwiecień 10, 2008
he has big webbos
dodane przez webbo styczeń 06, 2003
The area around ur sack and dick, the part u shave
after i shave my webbos i use webbos splash
haha i rubbed my webbos on u
jeff is a webbos
haha i rubbed my webbos on u
jeff is a webbos
dodane przez connor and jeff marzec 05, 2007
A wannabe website designer
Designed by webbo 2005
dodane przez webbo luty 21, 2005
A way to make fun of someone's sexual preference
My little brother sucks webbos.
dodane przez ZDart styczeń 17, 2010
A king amoung mere mortals. Someone who owns the football pitch. Good looking, charming with a air of debonair.
Webbo you rock!
dodane przez illest styczeń 25, 2004