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The key to a successful investment plan is to pick one that fits your personal style. If you're always busy and simply can't find the time to pay attention to your investments, you need to pick a style that matches your life. There's no sense adjusting your life to your investments, it should be the other way around. It's difficult to pigeonhole anyone into one particular bucket but find the various suggestions in each grouping to see how best to use them to match your life.
The Novice
Everyone starts as a novice, there's absolutely no shame in being a beginner when it comes to the stock market. In fact, it's probably better that you're a beginner. It was the experts that got us into the whole sub-prime mortgage mess. Until they closed their doors, the halls of Bear Stearns was full of experts. That being said, if you're a novice when it comes to the stock market, put your money into a high yield savings account [3] and start playing with a "play portfolio" at one of the finance sites. While you're learning, your savings will still earn a nice interest rate.
When I was learning, I used Yahoo! Finance [4] and a tool over at The Motley Fool [5] (if you're a novice, The Motley Fool is a great place to learn more about the markets). You can use one of any number of play portfolios to hone your skills and get used to the stock market (without the pesky "losing money" part).
The Regular Joe (or Jane)
The Regular Joe is someone who likes to check up on stocks every once in a while (whether that's once a day, once a week, or once a year) and keep up to date on the financial news. He or she has the time and inclination to read the news but simply isn't terribly interested in everything that's going on in the financial word. The solution? Try a "Lazy Portfolio [6]."
A lazy portfolios are buy-and-hold portfolios that consist of low-cost & no-load index funds. They are the bane of Wall Street and brokers hate them. They are created by financial experts and they perform quite well. Here are a few of the cooler sounding ones:
- Couch Potato: 50% Vanguard 500 Index & 50% Vanguard Total Bond Fund Index
- Sophisticated Couch Potato: 75% Vanguard 500 Index & 25% Vanguard Total Bond Fund Index
- Margarita: "One part total stock index, one part international stock index and one part inflation-protected Treasury securities." (if you went Vanguard, that'd be 33% Total Stock Market Index fund, 33% Total International Stock Index fund, and 33% Inflation-Protected Securities Fund)
- Coffeehouse: 40% Intermediate Bond Index, 10% in each of Total Bond Index, S&P 500 Index Fund, Large-Cap Value Fund, Small-Cap Fund, Small-Cap Value Fund, International Fund, and a REIT index fund.
- No-Brainer: 25% in an S&P 500 Index Fund, Small-Cap Fund, European Stock Fund and a Total Bond Market Fund.
There are plenty of other options out there, and you don't have to go with Vanguard, but those should get you started.
The Gambler
Everyone has a bit of gamble in them, some have more than others. I used to play quite a bit of online poker and blackjack in college, so I know that feeling. I know that rush of seeing good things happen and the despair when bad things happen (all too well), so I'm familiar with that mentality. I don't gamble much anymore but it's easy for one to fall into the trap of playing a little too much with the investment portfolio. So many of the same features of the stock market mimic the casino. Your money isn't "real" money, it's just numbers on a screen. Stock prices can jump and fall so quickly (even more quickly once you start talking options and derivatives) that it can give you that rush. (I wouldn't recommend for gambling addicts!)
The solution is to go "Regular Joe" (i.e. Lazy) on 90% of your portfolio and allow yourself to "play" with the remaining 10% (any safe percentage, or absolute number, will do). With the 10% you can put it on individual stocks, experiment with options or futures or even foreign exchange, and feed desire for excitement.
The Compulsive Ticker Checker
When I first started working, I checked Yahoo! Finance [4] every half hour while I was at work. I had some individual stocks in my Roth IRA and I was checking them every few minutes just to see what was going on. I did it because I didn't really have much else to do at the time and it was just a way for me to read up on news, check to see if anything crazy was happening, and otherwise just kill time. The real solution to a compulsive ticker checker, if you want to reduce risk and still maintain market returns, is to select broad market index funds and add them to your online portfolio tracker. You'll have plenty of information in those index fund news articles to keep you busy all day. Or get a hobby that isn't investment related!
The Overworked
If you're the type of person who wishes there were twenty-eight hours in a day, then you know that the reason your investments are being neglected is because you simply have too much on your plate. Rather than adjust your life's priorities so you can invest properly, you should adjust your investments to match your life's priorities. If you're way too busy to look at your investments, even just once a year, then go with entirely lifecycle or target retirement funds. They are simply mutual funds comprised of other mutual funds, designed for a specific retirement date in mind. They handle all the allocations, all the re-balancing, and all the headache you simply don't have the time to do yourself. They are also very affordable so you aren't paying out the nose for someone to manage your investments.
Selecting the right style is crucial to ensuring long term success. If you're a gambler (or have the itch of a gambler) and try to stick with a portfolio that doesn't let you satisfy your desire for risk, you'll end up making bad decisions somewhere once those bottled emotions get uncorked. If you're overworked and don't stick with something simple, things will fall through the cracks and your assets will suffer.
Which type(s) are you?
(photo: spencereholtaway [7])


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It may seem early for me to say this, but now is the time for gardeners to think about what they are going to grow in their garden this season. "But there are more than 10 weeks to the last frost date!" I hear you exclaim. Yup, and less than 4 weeks before you can sow your first pea seed.
Meantime, there is a lot of work to do.
Canadian gardening catalogues offer an extraordinary selection of vegetable, herb and flower seeds, and virtually all of them are available to the early bird. Wait much longer to order yours and you just might be out of luck. There is an extensive list of free catalogues on my website www.markcullen.com. Many of them are offered online.
Here is my garden primer of 'what to look for' when ordering seeds or buying off the seed racks at your favourite garden retailer:
Other vegetables that I recommend for the space constrained urban gardener include:
Bush beans. Small but productive plants with green beans are 'Provider' and my own 'Dusky Green' [Mark's Choice, Home Hardware]. Yellow beans include 'Gold Rush' and 'Gold Mine'.
For fun, grow some climbing Blue Hyacinth Beans. They twine around most anything for support, grow to 3 meters [14 feet], the foliage is an eye-catching blue/purple and they do produce edible fruit late in the season. But I grow it for its ornamental qualities.
Radishes. Haul the kids outdoors for radish sowing. They mature in an amazing 45 days or so, depending on the variety. 'Rover' performs in the heat of summer [less 'bolting' to flower] and 'Cherry Belle' is an old time favourite.
Carrots. Have fun with carrots and plant them in a deep [40 cm], sandy soil. When they are ready for harvest pull them from dampened soil, wipe them with a clean rag [your pant leg works too], and rinse them under your rain barrel. Eat. There. Nothing like it on earth. I like Nantes varieties best as they are easiest to pull and are the most productive per square foot. Look for 'Scarlet Nantes', 'Bilbo', and 'Goldfinger'.
For space constrained gardeners I do not recommend that you plant the following vegetables as they are space hogs [better to buy what you need from your local farmers' market]: corn, cucumbers [except the 'patio' type which grow compact], cabbage, broccoli, potatoes [which are very inexpensive in-season], parsnips, pumpkins [unless you have a sprawling compost pile in the sun: kids love this!], zucchini, and winter squash.
Do grow: onions, spinach, Swiss chard [one plant remains productive for more than two months] and the aforementioned veggies above.
Order early, shop the seed racks in March, and have fun!!
Note: most of the vegetable varieties that I list here can be found at Veseys Seeds (http://www.veseys.com) based in P.E.I. and other Canadian seed suppliers. Mark's Choice varieties are available at Home Hardware (www.homehardware.ca).
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subset: commoncrawl


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The Colts have traded their 2014 1st-round pick for RB Trent Richardson.
I would type up some analysis, but my heart is in too much pain. Let me sum up:
The Indianapolis Colts are determined to build a power running team despite all evidence pointing to the quarterback and the passing game being the key to winning in the NFL. On top of that, they have now given up a 1st-round pick in a very deep draft for a running back. Compounding the issue, the Colts are missing their starting TE and starting LG and are dealing with numerous other key injuries. It is very likely, given their schedule, that the Colts have a decently-high pick in the 2014 draft (top-15 at least). A team as desperately in need of talent as the Colts just gave up their best chance at getting that young, dynamic talent… for a running back. For a running back.
Stay tuned to Colts Authority. For what? I have no clue. Seriously.


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Liberal Studies, Master of Arts
The Master of Arts in Liberal Studies (M.A.L.S.) provides a multidisciplinary graduate opportunity to the intellectually curious through the study of interdisciplinary themes that draw from various academic disciplines.
There are four tracks in the M.A.L.S. program:
- Humanities
- Social Science
- Cultural Studies concentration in Women's and Gender Studies
- Innovative Research
The program is designed to provide a basis for a number of professional goals; it is not designed to duplicate or replace the specialized disciplinary training required for earning a Ph.D., though it is an excellent preparation for such training. The program is especially suited for the working professsional seeking to expand his or her horizons.
Department Contact
Rev. Jean-Pierre Ruiz, S.T.D.
Director, Master of Arts in Liberal Studies
Phone 718-90-1393
Fax 718-990-5726
Graduate Admission Information
Robert Medrano, Director
Office of Graduate Admission


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The 2010 Texas Republican Convention
The day started with Kay Bailey Hutchison's official endorsement of Gov. Rick Perry. The gubernatorial primary rivals did a pretty effective job of political Kumbaya, joking and appearing relaxed, with all that nasty election talk behind them.
They appeared on stage together at a Texas Federation of Republican Women event and not at the convention itself.
Hutchison made the same amount of news announcing at the TFRW breakfast she'd have made announcing at the GOP convention, but avoided a crowd that has never warmed to her like it has to Perry and others. There's a bit of ...


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Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Shrank, Choudhry, Kesselheim, and Avorn and Ms Agnew-Blais); Institute for Healthcare Studies and Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois (Dr Wolf); and Division of General Internal Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California (Dr Shekelle).
This article was corrected | View correction
Medication errors occur frequently, and poor medication labeling is cited as a potential cause. We assessed the format, content, and variability of prescription drug container labels dispensed in the community.
Identically written prescriptions for 4 commonly used medications (atorvastatin calcium [Lipitor], alendronate sodium [Fosamax], trimethoprim-sulfamethoxazole [Bactrim], and ibuprofen) were filled in 6 pharmacies (the 2 largest chains, 2 grocery stores, and 2 independent pharmacies) in 4 cities (Boston, Chicago, Los Angeles, and Austin [Texas]). Characteristics of the format and content of the main container label and auxiliary stickers were evaluated. Labels were coded independently by 2 abstractors, and differences were reconciled by consensus.
We evaluated 85 labels after excluding 11 ibuprofen prescriptions that were filled with over-the-counter containers that lacked labels printed at the pharmacy. The pharmacy name or logo was the most prominent item on 71 (84%) of the labels, with a mean font size of 13.6 point. Font sizes were smaller for medication instructions (9.3 point), medication name (8.9 point), and warning and instruction stickers (6.5 point). Color, boldfacing, and highlighting were most often used to identify the pharmacy and items most useful to pharmacists. While the content of the main label was generally consistent, there was substantial variability in the content of instruction and warning stickers from different pharmacies, and independent pharmacies were less likely to use such stickers (P < .001). None of the ibuprofen containers were delivered with Food and Drug Administration–approved medication guides, as required by law.
The format of most container labels emphasizes pharmacy characteristics and items frequently used by pharmacists rather than use instructions or medication warnings. The content of warning and instruction stickers is highly variable depending on the pharmacy selected.
The recent Institute of Medicine report, "Preventing Medication Errors: The Quality Chasm Series," estimates that 1.5 million medication errors occur annually in the United States, most in the outpatient setting, generating costs of more than $3.5 billion.1 The report identified poorly designed prescription drug labels as an important source of such errors. The United States Pharmacopeia reports that approximately one-third of errors it evaluates are, at least in part, because of confusion caused by the product labeling.2
When patients receive prescriptions at a pharmacy, there is commonly information affixed to the pill container (the "container label") and auxiliary leaflets, which may include official warnings from the Food and Drug Administration (FDA) or consumer medication information prepared by the pharmacy. Unlike the auxiliary leaflets, which patients can easily discard or ignore, the container label usually remains with the medication during the course of therapy. While patients ideally should receive information about their medications from physicians and pharmacists, there is considerable evidence that appropriate counseling about proper administration and adverse effects occurs infrequently.3- 5 Therefore, the container label may play an important role in the appropriate administration of prescription medication.
Labels are only effective if patients are able to read and understand them. Nearly half of all US adults have difficulty understanding and using health information in general; this problem of poor health literacy has been linked to higher rates of hospitalization and emergency service use.6 Health literacy challenges often arise when patients attempt to read prescription drug labels, especially container stickers with essential medication instruction and warning information.7,8 In particular, patients with less education and elderly patients frequently report having difficulty reading and understanding prescription labels.7- 9
Certain characteristics of container labels improve readability and understanding,10 including larger font,11,12 boldfacing and use of white space to emphasize important details,13 and organization of items consistent with the schema that patients use to process prescription information.14 Medical education guidelines explicitly suggest that font size must be 12 point or larger to optimize patients' ability to read health information.15 The human factors' literature suggests that all print on a label should be oriented in the same direction for a given task.16 While the FDA has limited standards for the content of drug labels17 and state boards of pharmacy provide additional content-related regulations, there are few regulations guiding the format of container labels.
Several studies have evaluated specific features of container labels, but little is known about national variations in the type and quality of information they contain. We sought to describe the characteristics of the content and format of information printed on prescription drug container labels and to evaluate variability in labels affixed by different pharmacies in 4 geographically diverse cities.
We identified pharmacies in 4 cities in the United States, representing geographically diverse metropolitan areas: Los Angeles, Boston, Austin (Texas), and Chicago. In each city, collaborating local physicians identified a purposeful sample of 6 pharmacies, including the 2 largest chain pharmacies in each area, 2 grocery store pharmacies, and 2 independent pharmacies.
We chose 4 commonly prescribed medications to use in our study sample: (1) the lipid-lowering agent atorvastatin calcium (Lipitor; Pfizer Inc, New York, New York), the top-selling medication in the United States18; (2) the osteoporosis medication, alendronate sodium (Fosamax; Merck & Co, Inc, Whitehorse Station, New Jersey), a medication with specific administration directions (patients must take with 6-8 oz [180-240 mL] of water and avoid reclining or eating for 30 minutes after consumption); (3) the antibiotic combination trimethoprim-sulfamethoxazole (Bactrim); and (4) ibuprofen, a nonsteroidal anti-inflammatory and analgesic agent. The FDA recently required all ibuprofen prescriptions to be dispensed with an FDA-approved medication guide,19 an auxiliary leaflet providing additional information about medication risks.
Collaborating physicians in each city wrote identically worded prescriptions for each drug for a female patient (1 in her 30s, 1 in her 40s, 1 in her 50s, and 1 in her 60s). Prescriptions were purchased without insurance.
We identified relevant components of the container label content and format for larger analysis by evaluating a preliminary sample of container labels obtained from 1 city. Three clinicians (W.H.S., N.K.C., and A.S.K.) and a health literacy expert (M.S.W.) assessed items on the label to create an inclusive list.
Relevant format variables included the font type and size of each content item, the use of color, the use of boldfacing or highlighting, and the placement or orientation of warning and instruction stickers. For stickers that used more than 1 font size, we determined the font size by averaging the smallest and largest font sizes observed.
Content-related variables included items specifically required to be placed on each container label by the FDA: drug name, patient name, physician name, pharmacy name, "Rx number" (a serial number), instructions, and refill status.17 Other variables identified through the preliminary analysis included quantity of pills dispensed, pharmacy telephone number, pharmacy address, pharmacist name or initials, patient address, original prescription date, fill date, manufacturer name, discard date, physician telephone number, and pill description. The inclusion and order of these items on the labels were evaluated along with the presence and content of auxiliary labels or warning stickers.
Information was abstracted from the container labels independently by 1 trained abstractor (J.A.-B.) and the lead investigator (W.H.S.). Variables on the container labels were coded as to their contents and format and compared between both abstractors. Disagreements were resolved by consensus between the abstractors.
The data were evaluated descriptively. Differences in font size and presence of warning and instruction stickers by type of pharmacy were examined using analysis of variance, with significance at P < .05. This study received an exemption from the West Los Angeles Veterans Affairs institutional review board.
A total of 96 prescriptions were filled, 24 each for ibuprofen, alendronate, trimethoprim-sulfamethoxazole, and atorvastatin. Almost half (n = 11) of the pharmacies substituted over-the-counter ibuprofen for the prescription written and did not create a patient-specific pharmacy label, leaving 85 labels for evaluation.
The order of presentation of FDA-required container label items was quite consistent. The pharmacy was listed first on all labels; the Rx number was listed either second (57 labels [67%]) or third (28 labels [33%]). Physician name was frequently listed third (34 labels [40%]) or fourth (26 labels [31%]), as was patient name (20 [24%] third or 50 [59%] fourth). Instructions were generally fifth (76 labels [89%]), drug name was generally sixth (75 labels [88%]), and refill status was typically seventh (79 labels [93%]).
There was substantial variation in the font size of different items. The largest item on 71 (84%) of the labels was the pharmacy logo. The mean font size was 13.6 point for the pharmacy logo, 9.3 point for medication instructions, and 8.9 point for drug name. Auxiliary instructions and warning stickers were a mean 6.5-point font (Figure).
Mean font size of container label components.
Use of color, boldface, or highlights in the label also showed variation. Items related to the pharmacy were the only items presented in color on the labels we evaluated. The pharmacy logo was presented in color on 82 (96%) of the labels, and color was also occasionally seen in the pharmacy slogan (12 labels [14%]), telephone number (16 labels [19%]), and address (16 labels [19%]). Auxiliary warnings and instruction stickers were presented in a variety of colors, of which the most common were yellow (54 labels [64%]), red or red outlines (39 labels [46%]), pink (16 labels [19%]), and blue (11 labels [13%]). Items that were most commonly boldfaced were the pharmacy name/logo (81 labels [95%]), Rx number (80 labels [94%]), and pharmacy telephone number (75 labels [88%]). The most commonly highlighted items were Rx number (70 labels [82%]), refill status (37 labels [44%]), quantity (23 labels [27%]), and pharmacy telephone number (15 labels [18%]) (Table 1).
In addition, we found that warning stickers frequently were not oriented in the same direction as the main container label, and 70 containers (82%) required the reader to tilt the bottle sideways to read the warning stickers. When comparing font sizes of label components by type of pharmacy (chain, grocery store, and independent), statistically significant differences were seen between font sizes, but the magnitude of those differences was small (Table 2).
Certain label items were present on all the labels we evaluated, including all items required by the FDA. Other items, such as the drug manufacturer, the physician's telephone number, a description of the appearance of the pill, and the pharmacist's name, appeared inconsistently (Table 3).
The content of the warning and other special instruction stickers on the labels varied considerably. For each of the 4 drugs we evaluated, between 7 (8%) and 21 (25%) containers did not include any warning or instruction stickers. Among those that did include a warning, there was substantial variability in the content of the stickers.
The most common sticker affixed to atorvastatin labels, present on 19 of the prescriptions, was a warning about grapefruit juice consumption. A smaller fraction included a warning about pregnancy, and less than 20% included directions about taking with food, taking with water, following directions precisely, and checking with a physician before starting other medications (Table 4).
Fourteen of the containers for alendronate included stickers with directions instructing the patient not to lie down for 30 minutes after administration. Other warnings concerning drug interactions, swallowing the medication whole, and pregnancy were present on less than one-third of the labels (Table 4).
Containers for trimethoprim-sulfamethoxazole had less variation. Twenty (83%) containers included stickers suggesting the medication should be taken with water, 19 (79%) warned about excessive sunlight, and 14 (58%) recommended finishing all the medication. Warnings about pregnancy and dizziness were less frequent (Table 4).
Ibuprofen containers included a broad range of warnings, but no warning was present on more than half of the prescriptions filled. Examples of warnings included the following: take the medication with water and/or food, avoid antacids and alcohol, and watch for potential drowsiness or dizziness (Table 4). None of the ibuprofen prescriptions were accompanied by FDA-approved official medication guides, as required by law.
When the results were stratified by pharmacy of origin, warnings and other informational stickers were observed less often in independent pharmacies than in chain or grocery store pharmacies (Table 2). We also found that prescriptions filled in larger bottles received significantly more warning labels than those filled in smaller bottles, although only a small amount of the variance was explained by this association (Pearson correlation = 0.36, P < .01).
This is the first study, to our knowledge, that assesses the variability of the content and format of prescription drug container labels. Although FDA-required items were present on every label, there was marked inconsistency with regard to other types of information. We found substantial discrepancies in the presence of warning or other important instruction labels. Some containers lacked warnings altogether and in other cases warnings were placed sporadically. Warnings or instructions were frequently printed in a small font, smaller than many elderly patients can read even with the assistance of refractive glasses.20 Instead, the labels emphasized items that identify the pharmacy, while less attention was called to medication warnings.
These findings underscore the need to further evaluate how to best communicate medication information to patients through medication labels. Poor container label construction may adversely affect patient safety and adherence to instructions by increasing patients' difficulty identifying and comprehending important messages about their drugs. We found numerous examples in which important critical warnings regarding potential adverse effects on the container label were omitted. Extensive data about medication safety are gathered by manufacturers and the FDA before approval of all drugs; careful attention is paid to every indication and warning listed on the official product description, a multipage review of indications, data, and warnings intended to educate physicians about the medication.21 However, there is no system to assess which warnings or instructions would be the most relevant to communicate directly to patients and to include on the container label. More attention must be paid to identifying key messages for patients for particular drugs and ensuring that these messages are communicated to patients in a legible and understandable manner.
One strategy that may help to optimize the utility of container labels would be the development of national standards for their format and content. Precedents for such national standards exist for other types of labels under FDA jurisdiction. To simplify the process of identifying nutrition information about food purchased at grocery stores, the FDA has required a uniform label, called Nutrition Facts.22 Similarly, the FDA has required that packaging for all over-the-counter drugs include a standardized drug facts label to simplify the process of identifying instruction and safety information about medications purchased without a prescription.23 Both of these developments have been widely hailed as beneficial to consumers. Standard formatting for prescription drug labels, the most complex products under the jurisdiction of the FDA, could simplify access to medication information. The extent to which standardized patient-oriented labels could improve medication safety is unclear and requires further research. However, standardized labels would be consistent with widespread efforts to improve patient safety by developing standardized processes in health care,24,25 and labeling improvements and specific standards have been called for in 2 recent Institute of Medicine reports1,26 focusing on medication safety.
While there are some existing standards promulgated by the FDA, our results showed varying compliance with even these few government regulations. We found all FDA-required items on every label, although in different orders and emphasized to varying degrees. However, the prescriptions we filled for ibuprofen did not include even 1 medication guide, even though they are required by law.
Our study assessed 4 commonly prescribed medications in 4 diverse metropolitan centers. This work should be replicated more broadly by assessing other medications in other geographic areas, including rural ones. Even so, the present findings are relevant to millions of patients, residing in these and other metropolitan areas, who use these common medications. Some variation in the warnings placed on the container labels may have been because of variability in patient age, which may have led to appropriate variability in warnings regarding pregnancy. Future studies should evaluate the extent to which pharmacies tailor warning information to individuals, and providers (physicians, pharmacists, nurse practitioners, or insurers) should consider the extent to which such patient-level variability might be warranted. In addition, we did not systematically collect information about the presence or content of patient counseling received at the pharmacies and did not account for the possibility that labels may not have included particular warnings if they were communicated in person. However, the prescriptions were frequently purchased and picked up by someone other than the patient, and qualitative feedback from medication purchasers suggests that limited counseling was offered, consistent with recent evidence about the frequency and quality of counseling offered by pharmacists.27
With passage of the Medicare prescription drug benefit, the federal government has become the largest purchaser of prescription drugs in the nation. As a result, it has an even larger responsibility to help improve the safety and appropriate administration of medications for Medicare beneficiaries. Federal standards for the content and format of container labels may help to meet this responsibility. Substantial research has been performed that can guide the development of an "evidence-based" prescription drug label that is easier to read and understand, although additional research is needed to better understand how labeling improvement affects medication-taking behavior.10 Further dialogue is necessary to establish which groups, including the FDA, manufacturers, pharmacies, and physicians' organizations, would be best suited to develop and implement improved patient-oriented labeling.
Correspondence: William H. Shrank, MSHS, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120 (firstname.lastname@example.com).
Accepted for Publication: April 11, 2007.
Author Contributions:Study concept and design: Shrank, Avorn, and Shekelle. Acquisition of data: Shrank and Shekelle. Analysis and interpretation of data: Shrank, Agnew-Blais, Choudhry, Wolf, Kellelheim, Avorn, and Shekelle. Drafting of the manuscript: Shrank. Critical revision of the manuscript for important intellectual content: Agnew-Blais, Choudhry, Wolf, Kesselheim, Avorn, and Shekelle. Statistical analysis: . Obtained funding: Shrank and Shekelle. Administrative, technical, and material support: Agnew-Blais, Choudhry, Wolf, Kesselheim, Avorn, and Shekelle. Study supervision: Shrank, Avorn, and Shekelle.
Financial Disclosure: None reported.
Funding/Support: This study was supported by a grant from the American College of Physicians Foundation Prescription Drug Labeling Project.
Role of the Sponsor: The funding body had no role in data extraction and analyses, in the writing of the manuscript, or in the decision to submit the manuscript for publication.
Additional Contributions: Neil Wenger, MD, Isabelle Hovermen, MD, and Patrick Fahey, MD, provided assistance in acquiring the prescriptions.
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I've been using a water only routine for a month and a half or so, and it's great. It looked kinda greasy when wet at first, but good when dry.
After getting a boar bristle brush, it doesn't look greasy when wet either, so seems to be working just fine for me.
My hair isn't that long though, so that factors in as well, I assume.


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"There's also the very keen nugget of wisdom that 95% of graphic design is actually typography" says Cliff Kuang, the editor of Co.Design. Cliff has posted these two compelling infographics to illustrate his point. We thought it was a great find and have posted it here for our clients' enjoyment. To read Cliff's original blog post, you can find it here >
©2016 Your Creative People | 221 Pelham Road Suite 201 Greenville, SC 29615 | PH 864.335.8211
Based in Greenville SC, Your Creative People is a forward-thinking brand development, web design and marketing communications agency that creates solutions that engage your audience. We are experts in integrating social media, e-mail marketing, video, and search engine optimization into campaigns that drive leads.


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Police Chief Mark Hudson said two officers pulled over a man later identified as Samuel Sirvoy Moore in front of the Westside Community Center at 125 Earl St. at about 2:44 p.m. Moore got out of the car and started firing at the two officers in the police cruiser, and the officers fired back, wounding the suspect, Hudson said.
The shots fired call came in at 2:47 p.m., he said. Moore was taken to Huntsville Hospital in critical condition, Hudson said. The officers are being interviewed and potential witnesses have been taken to the local police precinct for questioning, Hudson said.
Updated at 3:55 p.m. with details from police chief's news conference.


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A microcosm of ENron from 2005 SELL SELL SELL
If I were LIFEs attorney I would send a subpeona to the rats next you live in and sue you for what little you have left and make an example out of a turd like you. More TROLLS in cyber space should get sued for hiding behind there keyboards andd slandering people and companies, once that happens more and makes the news TROLLS will stop making false allegations.
Good to hear you want to sell.How much will you sell your shares to me for?
A self-proclaimed genius, just by his handle, has to be doubted. I think he just wants to or thinks he can push down the share price so he can buy more since he wasn't clever enough when the stock was in the teens to even give it a glance.


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When two young spoiled heirs to the throne are banished from the comforts of their royal realm, they are tasked with traveling to three neighboring kingdoms, restoring their greatness, and demonstrating to their father, the king, that they are the rightful heirs to the throne. Help Prince Fenwick and Princess Catherine roam the countryside as they seek the guidance of friendly Kings, Countesses, Dukes, and loyal subjects in Westward Kingdoms!
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With the way E3 is going, I'm glad Sony and Microsoft didn't announce any new consoles. Goes to show that they aren't scared by Nintendo's Wii U.
I was watching Nintendo's Press Conference on IGN, and although it could be caused by the fact I was watching it on a basic computer screen, Batman Arkham City looked really fugly. I'll need to watch it again just to be sure, but Nintendo isn't blowing my mind with the Wii U. Nintendo should focus on HD graphics at some point. I was briefly giddy when I saw New Super Mario Wii U because let's face it, I'm gaming because of Mario, but a friend of mine on Facebook reminded me that once Mario is finished, there not much else to play. I'm wondering if it's because I'm growing too old for Nintendo's product. Nothing is really appealing to me; besides Mario. Even Zelda, ever since the Legend of Zelda a Link to the Past on the Super NES, I was never able to get hooked on a Zelda game.
The MiiVerse and NintendoLand looks all fine and dandy, but it seemed more targeted at casual and younger gamers. I don't see the MiiVerse becoming as awesome as XBL or even the PSN. I saw IGN's Scott Lowe's tweet about the Wii U: "Wii U: Collecting dust in your home entertainment center after a few hours of use later this year". I have a hard time disagreeing because my Wii has been indeed collecting dust since 2008. I bought a few games here and there, but I barely manage to get invested in them because I got bored or way better games came out on Xbox360 or PS3
Again, Nintendo has been lackluster in it's annoucement for hardcore gamers, but again E3 barely began so maybe a surprise or 2 later on down the lane. I hope so because if not Nintendo will have failed again this year at E3. Still baffled as to why they won't announce the Wii U price point.
Also saw some footage of ZombiU; nothing to write home about. Looks fun, but not that good looking, so again, much like the Wii was 2 Gamecube stapled together, I'm starting to wonder if the Wii U is 3 Gamecubes stapled together. Although, in Nintendo's defense, I haven't see everything announced at E3 yet, but let's just say that I'm not impressed.
All in all, I'm hugely disappointed in Nintendo. The company that brought me into the gaming world seems to be losing steam; although the 3DS is doing well, there's still not fully focusing on every gaming crowd. When I look over at Microsoft....they did one hell of a job with Kinect for the casual gamers yet still maintaining the hardcore with Halo 4 and Gears of War Judgement (albeit I'm a little disappointed they're releasing a new Gears so soon....I'm barely level 90 in Gears 3).
Hope you enjoyed my 2 cents. Feel free to leave any comments; stay polite and respectful!


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Let's continue on that down to earth side. You said that he'd like to come over to your house to eat. Could you tell us about that?
Well, I always had a lot of food. Um. I guess my upbringing. I always cooked enough for three or four extra people in the event somebody was coming by. And he would always come and first thing he'd do is go to the kitchen, look on the stove, take the lid up off the pot. And I would always say, "You haven't washed your hands. Wash your hands before you lift the lid off of my pot." He'd go straight, take the lid up, look at what was in there and if it was anything he wanted to taste, get a fork and taste it. And he'd go to the refrigerator, just, just be at home. He felt very comfortable coming here and very comfortable when he got here.


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Image Archive
Detailed Record
Title: Clipper ship DREADNAUGHT at South Street, New York, circa 1865
Accession Number: 1950.967
Category: PHOTOGRAPHS
Type: stereograph
Place: USA, NY, New York
Date: Circa 1865
Description: Stereograph; albumen print mounted on yellow card; gray on back; South Street, New York, New York; at foot of Wall Street showing clipper ship DREADNAUGHT with its winged serpent figurehead, also visible is Wall Street ferry building, many masts, ca. 1865; handwritten on card lower right "foot Wall NY". DREADNAUGHT: built 1853 by Currier & Townsend, Newburyport, MA.
Mystic Seaport Image ID m129699 Information regarding reproductions


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The Official book to not surviving the invasion of the Space Monsters
146 backers pledged $5,046 to help bring this project to life.
Phase One - COMPLETE!
Hey there, everybody. I know I'm not updating this as often as I probably should, but I wanted to peek in and let you all know what the status of... Read more
Successfully raised $5,046 with 146 backers
Hi there, everyone. It happened, the Kickstarter is now more than 100% funded. Thanks to all of your support, we were able to fund this project in just 11 days.... Read more
Update Number...erm... the first one. Yeah.
Hi there!
So, yeah, nearly 50% funded within the first 24 hours! Thank you, all of you, for being so amazing and helping me get this far so quickly. I... Read more
Project launched


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News Archive:
Driver Charged With Assaulting Cyclist With A Deadly Weapon
The Oregonian: Arrest made in collision between car, cyclist
by Lisa Grace Lednicer, The Oregonian
Portland Police Bureau detectives have made an arrest in a collision between a car and a bicycle that occurred Friday afternoon.
Detectives today arrested and charged 35-year-old Wayne Conrad Thompson, the driver, with one count of assault in the first degree. The victim remains in serious condition, said Sgt. Michael Marshman.
Police say the collision occurred at 2 p.m. Friday in the area of Northeast 122nd Avenue and Northeast Glisan Street. When officers arrived at the scene, they discovered the driver of a Kia Sportage had hit a cyclist. The driver stayed at the scene. The cyclist was taken to a local hospital with serious injuries.


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SET 1: Runaway Jim, Foam, Paul and Silas, Reba, Wilson > Llama, The Lizards, Sweet Adeline[1], Run Like an Antelope
SET 2: Brother, Uncle Pen, Guelah Papyrus, Dinner and a Movie > Mike's Song > I Am Hydrogen > Weekapaug Groove, I Didn't Know, Fee > Split Open and Melt, My Sweet One, Cavern
ENCORE 2: The Squirming Coil
Add a Review
Mike Gordon: September 23, 2016
5 days ago
Catskill Chill at New Minglewood
Set 1: Say Something, Jumping, Waking Up Dead[1], Andelmans' Yard, Horizon Line, How Do I Know > Looking for Clues, Don't Chin The Dog, Let's Go[1], Tiny Little World
Encore: Yarmouth Road
[1] Mike Gordon debut.
Phish.net is a non-commercial project run by Phish fans and for Phish fans under the auspices of the all-volunteer, non-profit Mockingbird Foundation.
This project serves to compile, preserve, and protect encyclopedic information about Phish and their music.
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text:
Cookie Monster SNL Audition VideoMadeline Holler
It worked for Betty White. But does that mean it will work for a fuzzy, carb addict with a tendency to misuse parts of speech? A Facebook campaign is already 11,000 members strong to get Cookie Monster a hosting gig on Saturday Night Live.
We've known for decades that the C. Monster's got chops. But can he does he have what it takes to get through an entire evening of sketch comedy?
In his video, he's got fake news and a short and sweet monologue. His best four minutes come at the piano as Cookie Ga Ga. He's not wearing a meat dress, like the singer who influenced him, but he is draped with a type of food, three guesses which kind. (That's right, Cooooo-Kiiiiiiiiie.)
You can watch the video, which Sesame Street has posted on its YouTube channel (reposted below). If you like, then "like," over at the FB page Cookie Monster should host Saturday Night Live.
Personality Type and Birth Order
5 Unsafe Toys to Avoid
When Savers are Forced to Spend for the Holidays
Mark Zuckerberg's Obscene Policy
1o Books for Your Christmas Wish List
Hospital Visitation Policy to Soon be Humane
When Geeks Over Think the Holidays
Real Pro Cheerleaders (With PhDs!) Encourage Girls in Science
Bill Nye the Science Guy Collapses
Jimmy Kimmel on National Unfriend Day
6 Survival Tips for Kate Middleton
No Such Thing as "Oops!" Pregnancies
10 Common Myths About Adoption
Revolt Against TSA … Will You?
Cindy McCain Blames Her Husband for Gay Suicides
Healthy French Fry? Um, Not Really.
9 Subversive Bedtime Stories
Would Gross Pictures Keep you From Smoking?
More Naked Pregnant Women. And That is Good.
Dear Erica Jong: We Parent in a Vacuum, Not a Prison
Do Writer Moms Owe Their Kids More Privacy?
Squinkies? What are Squinkies?
Kids Mental Health Break? It's Called the Weekend


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Edited by Pepine Carl J., Hill James A., Lambert Charles R.. . 612 pages. Williams & Wilkins; , Baltimore: , 1989.. $69.50.
The scope of cardiac catheterization procedures continues to broaden as new techniques are developed and new applications are defined. This relevant and up-to-date book should become popular with those involved in cardiac catheterization. Forty-one authors from over 20 institutions have contributed to 33 chapters, and the editors share authorship on 11 of these. This diversity is a strength.
Most of the chapters have descriptions of procedure essential for the novice to learn but may also provide new perspectives for persons experienced in catheterization. Methods for venous and arterial access, direct left ventricular puncture, transseptal catheterization, endomyocardial biopsy, and pericardiocentesis
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text:
Investment grade as well. It seems to be exceptionally low at this time.
What is pressuring the preferred shares when the common is doing so well?
The fear of higher rates is affecting much of the credit universe...
Check out AFSI-PA and AGIIL.
Good question. Ago's preferred shares are rated BBB+ and A-. That's pretty good, but I suppose they're selling at a discount to par value because of fear about municipal bk's?


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Former Arlington elementary school principal convicted in Florida for sexually enticing a minor
A former principal at Arlington's Morton Elementary has been convicted in Florida for trying to get a minor to engage in illegal sexual activity.
Stephen Paulsen was arrested by the Boynton Beach Police Department in July. Authorities accused the 54-year-old of sending explicit messages to someone he believed to be underage — messages that read, among other things, "Love to teach you some intense passionate man love" and "It's a good day to lose your virginity." Paulsen, using the screen name Tony Texas, was really exchanging messages with an undercover officer.
He began sending the messages on July 12, while Paulsen, an eight-year employee of the Arlington Independent School District, was still the principal at the elementary school.
According to police records, Paulsen wasn't content just to exchange messages, and told the undercover officer that he'd be in Florida to see his father, who was suffering from Alzheimer's. He asked if they could meet. When they finally did, Paulsen had a condom in his pocket. He told the arresting officer that "his wife would kill him," according to police records.
In August, Paulsen pleaded not guilty to the charge of attempting to engage in an illegal sex act with a minor.
Following his conviction on Thursday, Paulsen faces a maximum sentence of life in prison.
The U.S. Immigration and Customs Enforcement's Homeland Security Investigation is "committed to stopping child predators and their illicit behaviors, especially those individuals in positions of trust with access to children," said Alysa D. Erichs, special agent in charge of HSI Miami, in a statement released Friday. "This case is another example of the extraordinary collaborative efforts among law enforcement in Florida to protect those who can't protect themselves."


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when should this happen
With my oldest, it was when he wanted different soaps. I think he was 3.
I still use the aveeno baby wash for both my kids because they have ezema and it dosen't irriate their skin like other soaps.
we never use J&J--everyone in our home has very sensitive skin and it's actually a very harsh soap. We use dove for sensitive skin cream wash on all of us per our dermatologist's recommendation, and head and shoulders for cradle cap.
He is 11.5 months and he is still using the baby soap but when i run out ill get him the kids soap i still another bottle left.
My children use Burt's bees and they all use it. My oldest is 6


text:
Capital Plastics offers the largest selection of premium coin holders of any available brand. The 2x3 style holder is made of clear molded plastic pieces that snap together around a black or white core with gold printing. It is sized similar to a slab and includes space at the top for a label.
Buy Together
Customers Also Bought
Customers who bought this item also bought...
Whitman Guidebook of Coin Collecting
HE Harris Morgan Dollar Frosty Case, 2x3
Whitman Large Dollar Snaplock, 2x2
HE Harris Eisenhower Dollar Frosty Case, 2x3


text:
The First Resort for Spa and Pool Safety ResourcesJanuary
Hot Tub Safety
Most people find comfort in unwinding after a stressful day in a hot tub or jacuzzi. Whether in their home, party, hotel, spa or gym, a sense of rejuvenation is common amongst hot tub enthusiasts. However, there are certain precautions to follow in order to ensure that your experience is as safe as it is rewarding. From checking water balance, to making sure the hot water doesn't have adverse effects on your body, safety is an important measure to carry out before your next plunge.
- Consumer Product Safety Alert Provides a description of hazards associated with use of a hot tub, whirlpool or spa.
- Hot Tub Tips Provides safety tips for both hot tubs and pools
- Hot Tub Fact Sheet Ensures safety in operating and using hot tubs
- Hot Tub Safety Tips Information on the dangers of hot tubs for children.
- Hot Tub Tips Provides safety tips for both hot tubs and pools
Drowning Prevention
Whether you're swimming in a pool or a natural body of water, the risk of drowning is still quite possible. It can still be an enjoyable, healthy activity, but it's important to note that it's one of the top 5 leading causes of death in the world and it happens still to strong swimmers. Understand what preventative measures can be taken to keep danger at bay when enjoying a swim at your local pool.
- National Drowning Prevention Alliance Provides a list of pool safety tips for parents and caregivers.
- Drowning Prevention Tips Provides tips for preventing drowning in all bodies of water as well as drowning statistics.
- Pool Safety 101 Provides information on current laws regarding pool safety as well as current guidelines and safety tips.
- Pool Safety Provides pool safety tips for adults and children.
- Pool Safety Tips Provides tips to protect children from drowning from the American Academy of Pediatrics.
- Pool and Spa Safety and Drowning Prevention Site Consumer Product Safety Commission kicks-off the Pool Safely national public education campaign.
Children's Guide
As much as children and their guardians have fun in aquatic activities, the unfortunate truth of the matter is that children are more susceptible to injuries, drowning and death. As much as swimming lessons and flotation devices ease the burden and promote safety, there are other precautionary measures to be taken to make sure your loved ones are able to have fun but be safe at the same time.
- Spa Safety for Kids A website provided by the American Association for Pool and Spa Professionals and the US government directed towards children.
- Safety Checklist for Kids Provides a safety checklist for kids to memorize as well as a checklist for adults.
- Swimming Safety An article directed towards children explaining why water safety is important.
- Coloring Activities Provides printable coloring activities for children to help teach pool safety.
- Coloring Book Provides a free printable coloring book to teach children about pool safety.
- Safe Swimming Tips for Children Provides swimming safety tips for parents and caregivers.
- Water Safety Prevention Learn how to protect your child when they are playing around the pool or beach.
Preventing Water Borne Illness
Although several measures are taken to make sure pools are sanitized, the spread of germs and diseases is still possible. It's difficult to know about other people's hygienic habits or health standing, but making sure the pool is clean, testing ph, alkalinity, etc. can be of great assistance in promoting good hygiene and more importantly, good health.
- Avoid Water-Borne Illnesses Tips for swimmers and spa-goers to help keep them safe this summer and to educate about the dangers of water-borne illness.
- A Clean Pool Is a Healthy Pool Steps towards ensuring that your next pool experience is a clean one.
- Swimming Pool Chemicals Parents and children's guide towards chemicals in pools.
- Disinfection and Remediation How to keep pools and hot tubs clean and sanitary.
- Be A Leak Detective How to prevent and detect leaks and unwanted chemicals in your pool.
Natural Bodies Of Water
Because of nature's unpredictability, swimming in natural bodies of water like creeks, lakes, rivers, oceans and beaches, has more inherent danger than in regulated environments. From overexposure to uv rays, to strong currents, it is imperative to be safe and prepared in natural water.
- Ocean Safety Read about what to look out for when swimming in oceans
- Beach Safety Tips How to be beach safe
- River and Lake Safety Tips Read about how to prevent drowning in lakes and rivers
- How To Surf Safely Tips on avoiding injuries while surfing
Sunbathing is considered by many the definitive way to relax. Tan, olive skin is also regarded as a thing of beauty in American society to the extent of using unnatural methods like booths and spray to achieve a bronzed look. In both methods, there are some risks, particularly Melanoma, which is skin cancer and is one of the leading cancers in America. Prevent overtanning by investing in quality sunscreen and not overdoing a good thing.
- Dangers of Tanning How to tan safely.
- Definition of Skin Cancer Skin Cancer facts and statistics.
- Skin Cancer Prevention More information on skin cancer and uv protection
- Treatin Melanoma How to help overexposed skin.
Scuba is an activity that is actually an acronym for Self Contained Underwater Breathing Apparatus. Many people enjoy this activity when visiting tropical areas and are required to have certain certifications before they dive. Even though it's regarded as an adventure sport, it is relatively safe, as long as the diver has proper training, does not veer away from safety guidelines, uses quality gear and does not exceed one's own experience level.
- Scuba Diving Safety FAQ about scuba diving and safety measures.
- Commercial Diving Safety and health when commercial diving.
- Pre Traveling Consultation-Scuba Diving SCUBA diving disorders and treatment help.
- Scuba Hazards How underwater confined spaces pose hazards to divers.
General Pool Safety Tips
With drowning, heatstroke and other issues on the rise, it's quite hard to leave your worries at the door whilst enjoying a leisurely swim. When factors such as alcohol and drug use while swimming come into play, these dangers increase exponentially. Whether you're at home, water park, pool party or at your local pool, it's important to veer on the side of caution.
- Pool Safety for Kids and Adults Provides safety tips for parents and caregivers as well as information regarding alcohol use around water.
- Water Safety Advice A comprehensive list of advice for adults and children regarding pools and spas.
- Pool Operation Safety Checklist Follow this easy to use checklist if you are the adult responsible for swimmers safety. This helpful checklist will encourage your guests to practice safe swimming.
- Pool and Spa Safety Pool and spa safety.


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He's spent his career innovating in the pharmaceutical industry.
Now Rob DeWit's job is to help others do the same.
DeWit took over in mid-January as CEO of the Southwest Michigan Innovation Center, the Kalamazoo business incubator that presently houses 14 startup life sciences companies.
For the 56-year-old DeWit -- a veteran scientist who ran human health research and development as Pfizer Inc.'s site leader in Kalamazoo prior to his departure last year -- the chance to serve as CEO of the Innovation Center represented a strong match for his background.
"The opportunity to help develop a new company as they create and form and build up new ideas is fantastic," DeWit said.
He spoke with Business Review last week about innovation.
What is innovation?
DeWit points straight to a dictionary definition that defines innovation as "bringing something new" to the market or "to be creative."
"To that end, in this role (at the Innovation Center), I think all of us have learned that change is certainly inevitable. And I think innovation has the opportunity to drive change, or innovation can anticipate new change."
Innovation, he said, also fits into three categories: fun, such as video games; utility, to make life easier -- the microwave oven, for instance; and to "add value to society or different businesses," such as the creation of a new drug.
How can we create a more innovative environment?
"The first thing is for people to recognize that change is inevitable. It sounds silly and it sounds a little pedestrian, but there is a certain percentage of people, I think, who want things to stay the same. The first recognition, I believe, is that that's not going to happen.
"Having that sort of a tone allows people to think in terms of 'Well, what could I do to make things better?' and that, hopefully, would be the primary driver, and 'What do I know about?" and 'What things interest me?'"
And, of course, innovators who are willing to take a risk need the money and expert support to "make things happen," he said.
Do we have an innovative mindset in West Michigan?
"I believe we do. There's no doubt about it. The Innovation Center here has been very successful and in Grand Rapids you have the Van Andel Institute. Many things are happening."
When somebody comes to you and says, "I have this innovative idea for ...," what's the first thing you look for and what's your best advice for them?
"Because of my past life, the first thing that comes to my mind, quite honestly, is can this get to market? And to answer that question, then I need to help that person find a group of knowledgeable people to answer the different aspects of that idea getting to market."
Do we have enough innovators or do we need to do more to encourage people to step forward with their ideas?
"The whole purpose of this facility and my new job is to encourage people to look for new ways to do things. The biggest change that we face -- and we are now immersed in it, though I still think no one understands it -- is we are in a 100 percent global environment. So one mentality is to recognize we're in a global environment and having, if you will, a bigger-picture view on what constitutes the competition is something that every region, including West Michigan, needs to make sure we understand completely."
What's your personal favorite innovation ever?
"Using graphite for flyrods and spinning rods has been a tremendous innovation," said DeWit, an avid fisherman who calls it "one thing that changed the world."
On a more serious note, he points to innovations to provide clean drinking water and antibiotic therapy as "two things that probably changed the world as much as any other innovation. They're not new ones, but without them we wouldn't be able to innovate further today."


text: Mr. and Mrs. Ray Sanor of 75 Cedarwood Drive, Beloit, will be honored on the occasion of their 65th wedding anniversary at an open house reception from 3 to 5 p.m. June 27 at the First Brethren Church in North Georgetown. The festivities will be hosted by their children, Kenneth (Sarah) Sanor, Donald (Sue) Sanor, and Gary (Connie) Sanor, all of Homeworth, Nancy (Gary) Diehl of Alliance, Diane (Mike) Gross of Lakeland, Fla., and Karen Cameron of Salem; and their 12 grandchildren. The Sanors also have six great-grandchildren.


text:
Download citation file:
From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Penn State College of Medicine, Hershey, Pennsylvania; and Pfizer, New York, New York.
Presented in part at the 26th Annual Meeting of the Society of General Internal Medicine, New Orleans, Louisiana, 12–14 May 2005.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Hollenbeak (e-mail, firstname.lastname@example.com). Data set: Access to the database is completely restricted but could be made available if approved by the University of Pennsylvania institutional review board.
Grant Support: From Pfizer to the University of Pennsylvania.
Potential Financial Conflicts of Interest:Employment: S.S.K. Tang (Pfizer). Stock ownership or options (other than mutual funds): S.S.K. Tang (Pfizer). Grants received: B.J. Turner (Pfizer), C.S. Hollenbeak (Pfizer), M. Weiner (Pfizer). Receipt of payment for manuscript preparation: B.J. Turner (Pfizer), C.S. Hollenbeak (Pfizer), M. Weiner (Pfizer).
Requests for Single Reprints: Barbara J. Turner, MD, MSEd, University of Pennsylvania School of Medicine, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail, firstname.lastname@example.com.
Current Author Addresses: Dr. Turner: University of Pennsylvania School of Medicine, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.
Dr. Hollenbeak: Department of Public Health Sciences, Penn State College of Medicine, 600 Centerview Drive, A210, Hershey, PA 17033.
Dr. Ten Have: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Blockley Hall, 6th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021.
Dr. Weiner: University of Pennsylvania School of Medicine, 1116 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.
Mr. Tang: Pfizer, 235 East 42nd Street, New York, NY 10017.
Author Contributions: Conception and design: B.J. Turner, M. Weiner, S.S.K. Tang.
Analysis and interpretation of the data: B.J. Turner, C.S. Hollenbeak, M. Weiner, T. Ten Have.
Drafting of the article: B.J. Turner, C.S. Hollenbeak.
Critical revision of the article for important intellectual content: B.J. Turner, C.S. Hollenbeak, M. Weiner, T. Ten Have, S.S.K. Tang.
Final approval of the article: B.J. Turner, C.S. Hollenbeak, M. Weiner, T. Ten Have, S.S.K. Tang.
Provision of study materials or patients: B.J. Turner.
Statistical expertise: B.J. Turner, C.S. Hollenbeak, T. Ten Have.
Obtaining of funding: B.J. Turner, S.S.K. Tang.
Administrative, technical, or logistic support: B.J. Turner, M. Weiner.
Collection and assembly of data: M. Weiner.
The study did not follow a protocol but was designed to address an a priori hypothesis raised by several groups of experts concerning the negative effect of unrelated comorbid conditions on achieving quality-of-care goals (2, 5). To test this hypothesis, we used intensification of antihypertensive treatment for uncontrolled blood pressure as an example of a quality-of-care measure. The final analysis plan was accomplished by an iterative process. The University of Pennsylvania institutional review board approved the use of the database for our research via an expedited review procedure.
*82% of patients had ≥1 hypertension diagnosis and a prescribed antihypertensive medication, 83% had ≥1 hypertension diagnosis and elevated blood pressure, and 92% had ≥2 elevated blood pressure readings at separate visits.
Data are adjusted for all variables in Table 2.
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be posted with your response.
In their study on the "Effect of unrelated comorbid conditions on Hypertension Management", Tuner et al. conclude that patients with more unrelated comorbidities were less likely to have their hypertension addressed. Two relevant limitations of the study make it necessary to handle this statement with due caution.
Firstly, Turner et al. equate intensification with "better quality of care" and non intensification with "poor performance" (p.584). The authors fail to acknowledge that raised blood pressure measurements may be due to reasons other than non response to medical treatment, making other approaches available to the clinician more appropriate than treatment intensification. Patients may have not adhered to the drug regime, or they may have made minimal temporary adjustments to their lifestyles (diet, exercise), making an emphasis on adherence to current management rather intensification a better approach. Alternatively, there may be an intercurrent problem explaining a the apparently uncontrolled hypertension, and again treating that problem may prove a better approach than intensification (incidentally, this may very well explain, at least in part, the negative association observed for some non related diseases associated with chronic-recurrent pain). Even if the patient is compliant, the physician may use the raised figure to stress the need for lifestyle changes. This may be particularly the case if the patient is on maximal dose of a number of drugs and pharmacological interactions and possibly medical contraindications that not allow for additional drugs. Although it is not possible to determine it from the data presented by the authors, some of these situations may occur more frequently among patients with non related comorbidities and may at least in part explain the differences observed.
Secondly, the concept of related disease is intuitive, but difficult to generalize. The lack of an explicit definition in this study makes it difficult to understand why some vascular diseases were considered related and some other not (e.g., collagen vascular disease, or pulmonary circulation disorders). As a matter of fact, although related diseases were expected to show a positive association with treatment intensification, one did not (chronic renal insufficiency) and another one even showed a strong reverse association (diabetes). Even those showing a positive association correspond to disease groups (single vs multiple vascular disease) that have not previously defined in relation to the related diseases. The interactions between comorbid conditions in terms of diagnosis, prognosis, and treatment and their impact on health care seems far too complicated to accomodate in these two categories.
None declared
To the editor:
We read with interest the article by Turner BJ and colleagues [1]. They clearly show that patients with more unrelated comorbid conditions are less likely to have uncontrolled hypertension addressed at a visit. The study is based on the data from electronic medical records. However, the authors don't evaluate the compliance of patients by follow up. Patients may have not adhered to the antihypertensive medication as the electronic medical records described. Furthermore, the patients with more unrelated comorbid conditions may receive other medication, which may affect blood presure or enhance (or weaken) the effect of antihypertensive medication. In our opinions, the reduction in the rate of uncontrolled hypertension may result from other factors except for antihypertensive treatment intensification. Could the authors comment on the statistical factors which induce the differences observed? In addition, this study is based on the participants living in the United States, so the results may not be applicable for Asians. Could the authors comment on the effect of racial diversify on hypertension management?
1. Turner BJ, Hollenbeak CS, Weiner M, Ten Have T, Tang SS. Effect of unrelated comorbid conditions on hypertension management. Ann Intern Med. 2008 Apr 15;148(8):578-86.
This letter raises concerns about evaluating quality of care for uncontrolled hypertension at only one visit, just as we do in our paper. We concur that a physician should not intensify treatment when a patient has been poorly adherent. Recommendations about lifestyle changes may also be reasonable depending on the blood pressure. Because of these short-term factors, Kerr and colleagues suggested that quality of care should be evaluated only after two consecutive visits with an elevated blood pressure (1). In light of this recommendation, we examined hypertension management in two urban primary care practices for patients aged 18 or older with moderately elevated blood pressure at two consecutive visits (i.e., at least 10 mmHg systolic or 5 mmHg diastolic) (2). We considered only patients whose treatment was not intensified at the first visit and withover one month between visits. We selected the first pair of eligible visits for patients with multiple sets. Our sample of 239 patients was primarily female (67%) and African-American (86%) with an average age of 66.7 years. Treatment was not intensified at the second visit or at any time until the third visit in 50.1%. Among the 120 patients without intensification, chart review revealed that, for 37 of these second visits (31%), a legitimate excuse was recorded such as the patient ran out of medication. Thus, even in a pair of visits with uncontrolled hypertension, an analysis of medication intensification alone overestimates poor quality of care.
So we agree with the observation in this letter and suggest that future work could consider a longer window to assess management of uncontrolled hypertension such as 6 months to a year to allow the physician to address patient factors. In regard to the second point , our "˜related' conditions are those included in most studies of hypertension management (i.e., coronary artery disease, stroke, and peripheral vascular disease). Physicians would not immediately think of hypertension as a key factor affecting collagen vascular disease or pulmonary circulation disorders. Therefore, we considered these to be "unrelated" diseases along with others occurring more commonly in the outpatient setting (e.g., gastroesophageal reflux, arthritis). Given that most studies consider only "˜related' comorbidities, we believe that our attempt to look at other unrelated competing comorbidities is a major advance. Again, future work needs to consider how to deal with diabetes and chronic renal insufficiency where the blood pressure standard is stricter.
1. Kerr EA, Krein SL, Vijan S, Hofer TP, Hayward RA. Avoiding pitfalls in chronic disease quality measurement: a case for the next generation of technical quality measures. Am J Manag Care. 2001 Nov;7(11):1033-43
2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72
Dr Turner has received unrestricted research funding from Pfizer, Inc. Mr Tang is employed by Pfizer, and Mr. St. Michel has no conflicts to declare
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After dark years, seems like good things are coming out from the Italian .NET community lately: the latest one is the free eBook on Data Structures and Algorithms wrote by Granville Barnett and the Italian UGIdotNET member, Luca Del Tongo.
I remember studying such things at the university, and the last time I helped a friend with his studies the books were still the same, and still based on "old" languages like C. Finally now a book covers the same important topics but with samples written in a modern object oriented language.
All the algorithms of the book are available in form...
This is the blog of Simone Chiaretta, an Italian .NET developer, architect, Microsoft MVP, ASPInsider, Subtext core member, ASP.NET MVC lover with a passion for mountain climbing.
Want to know more? Keep reading...
I also wrote a book about ASP.NET MVC and a news feed reader for Windows Phone 7
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By DJ Montoya, PA SMDC/ARSTRAT OpsOctober 17, 2012
COLORADO SPRINGS, Colo. -- Army Space Soldiers from the 117th Space Battalion, Colorado Army National Guard, took a step back in time for a Change of Responsibility ceremony at the Jet Center Brown Hanger by the Colorado Springs Airport on the afternoon of Oct. 14.
The occasion saw departure of outgoing Command Sgt. Maj. Dean R. Parsons and welcoming of incoming Command Sgt. Maj. Joseph A. Thill.
What made this ceremony different from previous ones was that the Noncommissioned Officer's Sword that is traditionally used was replaced with the passing of the halberd, a fearsome weapon dating back to the 1400s which combines a battle axe with hook and topped with a spear head on a six to seven-foot wooden shaft.
Halberds were used by NCOs to manage and direct formations in battle. They were also used to locate NCOs in camp. NCOs would post their halberds outside their tents.
On June 13, 2011, in keeping with the Army's back-to-basic movement, the U.S. Army Sergeants Major Academy decided to resurrect the centuries old symbol of the NCO authority. Today the halberd will represent the authority of the NCO Corps. This historic icon and emblem is specific and unique to the NCO Corps and its history.
The halberd bearer for this change of responsibility ceremony was Pfc. Ryan See, the youngest Soldier currentlyassigned to the 117th Space Bn.
"Today we witness the transfer of responsibility of the fourth command sergeant major for the battalion," said Lt. Col. Martin Bortolutti, commander of the 117th Space Bn. "This battalion is unique and very specialized. We are educated both in the military and civilian world. We are mature with both rank and age. And indeed we facilitate all the capabilities of space to help the theater commander make his or her decision.
"Today we have a new sergeant major for this unique battalion. I don't want necessarily a 'Green Beret,' an MP (military police), or even a space operator," Bortolutti said. "What I want is a sergeant major... one who can guide the troops... form them up, and simply state, 'I'm the pivot, guide off of me.' Or if needed, 'About face Soldier and do your duty.'"
Departing Parsons reflected on his time in the battalion by saying, "So how have I done as a leader? You always look for that one little thing that someone says or does. It was said to me just yesterday, and I didn't even realize it until my drive home."
Parsons explained that a Soldier in the battalion came up to him and told him he would be in attendance for the ceremony even though he was not required to be present.
"I told him go home and spend time with your family, but he said, 'No. You are my sergeant major.' And at that point, I know I have succeeded in leading Soldiers. And nothing else can be said. I wish you the best. I hope to see you around. Drive hard. Thank you very much."
Thill, the battalion's newest command sergeant major, addressed the Soldiers in formation saying, "We need to be enthusiastic more than ever because people need to know what enablers and force multipliers you are. What we make up for having small numbers in this battalion, we make up in big mission and high payoff. And what you do is important every single day. And you need to understand that at the strategic level what you do saves lives on the battlefield, and allows us to engage and destroy our enemies with precision."


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Tuesday, April 30, 2013
The Flowertown Garden Club creates the table decorations every year for the Senior Center Volunteer Luncheon at the Faith Sellers Senior Center. Flowertown Garden Club members who helped with the arrangements this year are, from left, Sherry Bardsley, Faye Campbell, Jane Langston, Kennedy Branstetter, Betsy Hehn, Faith Sellers and Maureen Minner.
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There are already over 2200 city of Montreal video surveillance cameras watching you.
And there could be more on the way.
Montreal mayor Denis Coderre has ordered an ad hoc committee to look into possibly setting up more cameras or even just moving around existing ones.
The issue comes on the heels of reports of increased violence in the Gay Village.
Montreal's police chief gave a presentation on video surveillance in the city at this morning's meeting of the executive committee.
Currently, there are about 20 police surveillance cameras, many of them on Ste Catherine St., 1200 cameras used in the metro and city buses, and 1000 cameras at city subsidized housing.
Coderre said he's in favour of more cameras but he wants to be sure they do this the right way, adding that they can find the funding if needed.
"We need kind of a balanced approach to openness and vigilance," Coderre told reporters.
"We have to make sure we are protecting the civil rights and the individuals, their private life. At the same time, we have some good examples that it shows clearly that because of those cameras that already exist that it lowers the rate of criminality."
Coderre also wants input from the public, be it at borough council or city council meetings.
A report from the committee is expected in the spring.
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Mission Earth (novel)
|This article needs additional citations for verification. (January 2008) (Learn how and when to remove this template message)
Mission Earth is a ten-volume science fiction novel series by L. Ron Hubbard, founder of the Church of Scientology. Hubbard died three months after the publication of volume 1, and other volumes were published posthumously.
The series' initial publisher, Bridge Publications coined the word dekalogy, meaning "a series of ten books", to describe and promote the novel. Made up of about 1.2 million words, the epic is a "satirical science fiction adventure set in the far future." Each volume in the series topped numerous bestseller lists.[1] The second volume, Black Genesis, was nominated for the 1987 Hugo Award in the Best Novel category.[2]
The books are written as the confessions of Soltan Gris, an agent of the Coordinated Information Apparatus ("CIA") of the Voltar Confederacy, as an exposé. Each book begins with a disclaimer from Lord Invay, the head Censor, denying the very existence of the planet Earth itself and denouncing the story as rankest fiction, despite the inclusion of characters who are real and known public figures in the novel's fictional world, such as Jettero Heller and the Countess Krak.
The Voltar Confederacy wishes to conquer the planet Earth, which they regard as an important potential base on the main route of their planned invasion of the galactic centre. The conquest of Earth is scheduled for more than 100 years in the future, but the Grand Council of Voltar is convinced that Earth is about destroy itself through pollution and possibly war, which would disrupt the future timetable of conquest. Fleet Combat Engineer Jettero Heller, a character of perfection, incorruptibility, and astonishing ability, is assigned to carry out the mission. Soon after reaching Earth, he heads to New York City to investigate why Earth is destroying itself, unaware that he is being tracked and that factions on Voltar want his mission to fail.
Unknown to Heller, Earth is also the base of a secret operation conducted by the insane, diabolically evil Lombar Hisst, the overall commander of the Apparatus, to seize the throne of the Empire of Voltar for himself. Hisst has been importing illegal narcotic drugs from Earth and using them to enslave the aristocratic heads of government on Voltar. By addicting the aristocracy to narcotics, Hisst plans to take control of the Empire for himself. Because of Earth's role as a supplier of drugs, Hisst decides that Heller's mission to save the planet must not succeed.
Lombar Hisst assigns a cowardly, sadistic, greedy stooge named Soltan Gris to supervise the mission to Earth, in order to sabotage it and destroy Jettero Heller. The majority of the story is told from Gris' point of view, with an emphasis on a series of comical situations as Gris tries to stop Heller. Over the course of the series, Gris finds himself in possession of twelve tons of pure gold, which he tries to launder through a Swiss bank account and keep for himself; he becomes a prisoner of two man-hating lesbians (who end up marrying Gris after he rapes them and thereby "cures" them of their lesbianism, but not before various ingenious tortures are inflicted on him, one of which involves a cheese grater and chili powder); he repeatedly finds himself losing large amounts of money, going bankrupt, and having to concoct wild schemes to save himself from his creditors; he has an affair with a young nymphomaniac teenage girl whom he cannot escape; he hires a hit man to kill Heller's fiancé, only to stumble through the affair and end up being a target for the hit man himself; he embarks on a long cruise through the Mediterranean; and finally, Gris becomes the target after Heller realizes that he is behind the operation to disrupt his mission.
Heller's investigations of Earth soon reveal to him that the entire planet is in the grip of a vast organized corporate conspiracy headed by the "Rockecenter" corporation and its head, Delbert John Rockecenter (the similarity to "John D. Rockefeller" is one of many blatant puns and references included in the series). Rockecenter is vast oil-producing corporation that keeps the population of Earth under control and sedated with drugs and rock and roll music. (Rock music is used in the novel to spread sexual deviancy, especially homosexuality, among the population of Earth.)
Heller's attempts to break the demonic control of Earth by Rockecenter make him a target, and the corporation uses its most dangerous weapons to destroy him: psychiatry and psychology, and a mad, idealistic public relations genius by the name of J. Walter Madison (known as "J. Warbler Madman"). Madison initiates a wide-reaching public relations campaign to make Heller known to the world as the "Whiz Kid", but results in destroying Heller's reputation so that all of Heller's efforts to save the planet come to naught, as Madison's employer, Rockecenter, wanted. Fortunately, Heller's outstanding skills and abilities are reinforced by the arrival on Earth of his fiancée, the Countess Krak, and the alliance and friendship of the Mafia — specifically the Corleone family.
After a series of world-shattering events, which include the impact of an ice meteor on the Soviet Union, the world's entire oil supply being turned radioactive, and a black hole orbiting the Earth (providing free energy for Heller to harness and make available to the world), Heller returns to Voltar to find that not only have Lombar Hisst's plans to enslave the government nearly succeeded, but Madison the PR madman has been loosed on the empire of Voltar and is in the process of starting a galactic civil war.
After the defeat of Hisst and Madison, a massive cover-up operation commences to wipe out the effects of PR, psychology and psychiatry, and the CIA from Voltar's empire. All mention of these subjects is censored and the planet Earth is eradicated from all star charts and similar items. As far as the Voltarans are concerned, there is no such place as planet Earth.
- Invaders Plan (October 1985, ISBN 1-59212-022-9), 559 pages
- Black Genesis (March 1986, ISBN 1-59212-023-7), 431 pages
- The Enemy Within (May 1986, ISBN 1-59212-024-5), 393 pages
- An Alien Affair (August 1986, ISBN 1-59212-025-3), 329 pages
- Fortune of Fear (October 1986, ISBN 1-59212-026-1), 329 pages
- Death Quest (January 1987, ISBN 1-59212-027-X), 490 pages
- Voyage of Vengeance (May 1987, ISBN 1-59212-028-8), 381 pages
- Disaster (June 1987, ISBN 1-59212-029-6), 337 pages
- Villainy Victorious (September 1987, ISBN 1-59212-030-X), 410 pages
- The Doomed Planet (September 1987, ISBN 1-59212-031-8), 333 pages
Page counts are from hardcover editions, and total 3992 pages.
Public reaction[edit]
Critical response[edit]
The The Encyclopedia of Science Fiction describes the series "whose farcical overemphases fail to disguise an overblown tale that would have been more at home in the dawn of pulp magazines." More forgiving literary critics usually cite Battlefield Earth as Hubbard's best work of the later years of his life. (i.e., better than Mission Earth, his only other later published work of fiction).
The books, however, do carry dozens of blurbs of praise from some newspapers and well known sci-fi authors, such as Orson Scott Card and A. E. van Vogt.
The New York Times review of the first volume, The Invaders' Plan, describes it thus: "... a paralyzingly slow-moving adventure enlivened by interludes of kinky sex, sendups of effeminate homosexuals and a disregard of conventional grammar so global as to suggest a satire on the possibility of communication through language."[3]
In L. Ron Hubbard and Scientology, a survey of Hubbard's literary career, Marco Frenschkowski of the Johannes Gutenberg University of Mainz described the Mission Earth series:[4]
- The satire is not humorous, but biting and harsh, which makes the novels not easy to read. Also Hubbard somehow had lost contact with developing narrative techniques: he writes exactly as he had done 40 years earlier. When read as entertainment Mission Earth is disappointing: it does not entertain. Many of the scenes (especially some sexual encounters) are incredibly grotesque, not in a pornographic sense, but they are violently aggressive about modern American ideals. The Mission Earth novels on the whole are a subversive, harsh, poignant attack on American society in the 1980s. As such they have so far received almost no attention, which perhaps they do deserve a bit more. They also have some quite interesting characters, especially when read with a deconstructionist approach. These 11 later novels by Hubbard are not Scientology propaganda literature, but have some topics in common, especially the very strong opposition against 20th century psychology and psychiatry, which is seen as a major source of evil. All open allusions to Scientology are strictly avoided. They are not as successful in their use of suspense and humour as Hubbard's early tales, but have to say perhaps more about the complex personality of their author.
Censorship attempt[edit]
In 1991, the town of Dalton, Georgia attempted to remove the Mission Earth books from its public library, citing what was described as "repeated passages involving chronic masochism, child abuse, homosexuality, necromancy, bloody murder, and other things that are anti-social, perverted, and anti-everything." The attempt was unsuccessful, though this placed the Mission Earth series into the category of banned books that have been challenged in the United States.[5]
Sales controversy[edit]
The Mission Earth books were a major sales success, particularly the earlier volumes in the series, with all individual volumes reaching the New York Times bestseller list.[6] The extent to which this reflects actual popularity is strongly questioned.[7] A large number of booksellers, publishing executives, and former Scientologists state that, as with other Hubbard books, the Church of Scientology engaged in a massive book-buying campaign, similar to the campaign to promote Battlefield Earth, so as to deliberately inflate sales of the series in order to promote it as a best-selling work of literature.[7] Stories of the books being sent to stores bearing other stores' price tags circulated throughout the science fiction fan community.
In a two-year span, Hubbard logged 14 consecutive books on the New York Times list. Adam Clymer, a New York Times executive, said that, while the books have been sold in sufficient numbers to justify their bestseller status, "we don't know to whom they were sold." He said the newspaper uncovered no instances in which vast quantities of books were being sold to single individuals.[7]
- ^ "Contemporary Authors Online". Thomson Gale. 2006.
- ^ "1987 Hugo Awards". The Hugo Awards.
- ^ Jonas, Gerald (1986-01-12). "Science Fiction". New York Times. p. BR22. Retrieved 2006-09-07.
- ^ Frenschkowski, Marco (July 1999). "L. Ron Hubbard and Scientology: An annotated bibliographical survey of primary and selected secondary literature". Marburg Journal of Religion. 4 (1). Retrieved 2006-11-10.
- ^ [1] Archived September 16, 2006, at the Wayback Machine.
- ^ New York Times bestseller list entries for the Mission Earth books: 1,2,3,4,5,6,7,8,9,10
- ^ a b c Welkos, Robert W.; Sappell, Joel (1990-06-28). "Costly Strategy Continues to Turn Out Bestsellers". The Scientology Story. Los Angeles Times. Retrieved 2007-07-30.
- Marco Frenschkowski: "L. Ron Hubbard and Scientology", Marburg Journal of Religion, Volume 4, No. 1 (July 1999)
- "Mission Earth", entry in The Encyclopedia of Science Fiction by John Clute and Peter Nicholls, St. Martin's Press, 1993 edition.
External links[edit]
- The Magnum Opus: Mission Earth (lronhubbard.org)
- Mission Earth series listing at the Internet Speculative Fiction Database
- Critical review of the Mission Earth books