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From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.
Grant Support: By the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (IIR 04-016 and Career Scientist Awards 08-027 [Dr. Bosworth] and 91-408 [Dr. Weinberger]).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0851.
Reproducible Research Statement:Study protocol: Available from Dr. Allen (e-mail, firstname.lastname@example.com) Statistical code and data set: Potentially available from Dr. Allen (e-mail, firstname.lastname@example.com) on the basis of request and written agreements regarding use.
Requests for Single Reprints: Kelli D. Allen, PhD, U.S. Department of Veterans Affairs Health Services Research and Development Service (152), Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705; e-mail, firstname.lastname@example.com.
Current Author Addresses: Drs. Allen, Oddone, Coffman, Datta, Weinberger, and Bosworth; Ms. Juntilla; Ms. Lindquist; and Ms. Walker: U.S. Department of Veterans Affairs Health Services Research and Development Service (152), Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Author Contributions: Conception and design: K.D. Allen, E.Z. Oddone, C.J. Coffman, S.K. Datta, M. Weinberger, H.B. Bosworth.
Analysis and interpretation of the data: K.D. Allen, E.Z. Oddone, C.J. Coffman, S.K. Datta, J.H. Lindquist, M. Weinberger, H.B. Bosworth.
Drafting of the article: K.D. Allen, C.J. Coffman, S.K. Datta, K.A. Juntilla, M. Weinberger, H.B. Bosworth.
Critical revision of the article for important intellectual content: K.D. Allen, E.Z. Oddone, C.J. Coffman, S.K. Datta, M. Weinberger, H.B. Bosworth.
Final approval of the article: K.D. Allen, E.Z. Oddone, C.J. Coffman, S.K. Datta, K.A. Juntilla, J.H. Lindquist, T.A. Walker, M. Weinberger, H.B. Bosworth.
Provision of study materials or patients: K.A. Juntilla, T.A. Walker.
Statistical expertise: C.J. Coffman, J.H. Lindquist.
Obtaining of funding: K.D. Allen, E.Z. Oddone, S.K. Datta.
Administrative, technical, or logistic support: E.Z. Oddone, T.A. Walker, H.B. Bosworth.
Collection and assembly of data: S.K. Datta, K.A. Juntilla, J.H. Lindquist, T.A. Walker.
Background: Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized.
Objective: To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthritis in a primary care setting.
Design: Randomized clinical trial with equal assignment to osteoarthritis self-management, health education (attention control), and usual care control groups. (ClinicalTrials.gov registration number: NCT00288912)
Setting: Primary care clinics in a Veterans Affairs Medical Center.
Patients: 515 patients with symptomatic hip or knee osteoarthritis.
Intervention: The osteoarthritis self-management intervention involved educational materials and 12 monthly telephone calls to support individualized goals and action plans. The health education intervention involved nonosteoarthritis educational materials and 12 monthly telephone calls related to general health screening topics.
Measurements: The primary outcome was score on the Arthritis Impact Measurement Scales-2 pain subscale (range, 0 to 10). Pain was also assessed with a 10-cm visual analog scale. Measurements were collected at baseline and 12 months.
Results: 461 participants (90%) completed the 12-month assessment. The mean Arthritis Impact Measurement Scales-2 pain score in the osteoarthritis self-management group was 0.4 point lower (95% CI, −0.8 to 0.1 point; P = 0.105) than in the usual care group and 0.6 point lower (CI, −1.0 to −0.2 point; P = 0.007) than in the health education group at 12 months. The mean visual analog scale pain score in the osteoarthritis self-management group was 1.1 points lower (CI, −1.6 to −0.6 point; P < 0.001) than in the usual care group and 1.0 point lower (CI, −1.5 to −0.5 point; P < 0.001) than in the health education group. Health care use did not differ across the groups.
Limitation: The study was conducted at 1 Veterans Affairs Medical Center, and the sample consisted primarily of men.
Conclusion: A telephone-based osteoarthritis self-management program produced moderate improvements in pain, particularly compared with a health education control group.
Primary Funding Source: U.S. Department of Veterans Affairs Health Services Research and Development Service.
Osteoarthritis management should engage patients in a healthy lifestyle, but practices often lack resources for patient education.
This randomized trial assigned primary care patients with hip or knee osteoarthritis to receive telephone-based health education support, health education materials, or usual care. At 12 months, the intervention group had more improvement in some pain measures than did the control groups.
The study was conducted in the Veterans Affairs health care system, and most patients were men. For one measure, end point data were missing for 20% of patients.
This study supports the role of a telephone-based patient self-management program in reducing osteoarthritis-related pain.
—The Editors
Osteoarthritis is a leading cause of pain and disability and one of the most common conditions treated in primary care (1–2). Optimal management of osteoarthritis involves both pharmacologic intervention and behavioral strategies, such as exercise and weight management (3). However, most patients with osteoarthritis do not adequately practice these behavioral strategies, and most primary care practices are not set up to support them (4–5). Previous studies (6–7) show that self-management programs can improve both healthy behaviors and outcomes among patients with osteoarthritis. However, many osteoarthritis self-management programs involve multiple in-person sessions, and attendance may not be feasible for many patients. Only about 10% of patients with arthritis report ever having taken an educational class to teach them how to manage this condition (5), which suggests that alternatives to in-person classes (the most common format offered) are needed to disseminate these programs more widely. Telephone-based self-management interventions could overcome the limitations of other delivery methods because they are widely accessible; relatively low-cost; and allow individualized, ongoing interaction with patients. Our objective was to examine the effectiveness of a 1-year, telephone-based, self-management support intervention for patients with hip and knee osteoarthritis who were recruited from a primary care setting.
The institutional review board of the Durham Veterans Affairs Medical Center (VAMC) reviewed and approved this study.
We randomly assigned eligible, consenting patients equally to the osteoarthritis self-management, health education (attention control), or usual care control groups. Randomization was stratified by race (white vs. nonwhite), with block sizes of 12. Race stratification was used because of known racial differences in osteoarthritis-related pain and function (8–9). Randomization was computer-generated and maintained separately from participant enrollment. A detailed description of our methods is published elsewhere (10).
Participants were eligible if they were enrolled in primary care at the Durham VAMC; had a physician diagnosis of hip or knee osteoarthritis; and had persistent, current, self-reported joint symptoms (11). Exclusion criteria included other rheumatologic conditions, psychoses, dementia, other serious health conditions that would probably prevent participation in the study, being on a waiting list for arthroplasty, or participation in another osteoarthritis-related or lifestyle intervention study.
Using the electronic medical records of the Durham VAMC, we identified patients who had an International Classification of Diseases, 9th Edition, code for hip or knee osteoarthritis and no exclusionary codes. Medical records were then further examined to verify a physician's diagnosis of osteoarthritis on the basis of radiography. Patients who met these criteria were mailed introductory letters, and a study team member called to further assess their eligibility. Participants' telephone numbers were initially obtained from VA medical records. Once participants were enrolled in the study, they provided additional or alternate telephone numbers as appropriate. Eligible patients came to the Durham VAMC to give informed consent and receive baseline assessments. The study coordinator then informed participants of their group assignment by telephone. Recruitment began on 3 October 2006 and ended on 30 June 2008.
Participants were reimbursed $10 after the baseline and follow-up assessments ($20 total). All participants continued to receive usual care for osteoarthritis. Participants in the usual care group received the written osteoarthritis self-management materials after they completed follow-up assessments, but no other intervention.
Our self-management support intervention was grounded in social cognitive theory and focused on the key health behavior determinants of self-efficacy, knowledge, outcome expectations, health goals, and perceived facilitators and barriers (12). The intervention included 2 main components: providing education related to managing osteoarthritis symptoms, and helping participants develop goals and action plans related to osteoarthritis management. These have also been key components of other arthritis self-management programs (7, 13). Participants received written and audio versions of osteoarthritis self-management educational materials, including 10 topics that reflect core aspects of managing osteoarthritis (Table 1). Participants also received an exercise video designed for persons with osteoarthritis. The health educator called participants monthly for 12 months to discuss key points from the educational modules and provide participants with an opportunity to ask questions. During each telephone call, the health educator also discussed the participant's goals and action plans. Participants were asked to identify and write down 1 or more goals related to their osteoarthritis symptoms and management, as well as weekly action plans for achieving these goals. For example, a participant could choose a goal of increasing their walking; corresponding action plans could then specify distances they would attempt to walk on a specific number of days each week. The health educator guided participants in overcoming barriers they experienced in completing their weekly action plans. Participants were asked to rate how successful they were at completing the previous month's action plan on a scale of 0 (low) to 10 (high).
Participants in this group received written and audio materials regarding the common health problems of hypertension, high cholesterol, diabetes, eye problems, dental problems, colorectal cancer, skin cancer, breast and cervical cancer or prostate cancer (sex-specific modules), and osteoporosis, as well as related screening recommendations (10). The health educator called participants monthly for 12 months to review key points from the educational modules, assess whether participants were being appropriately screened, and make suggestions for screening as needed. Participants in this group received the written osteoarthritis self-management materials after completing follow-up assessments.
We collected study measures at baseline and 12 months. The health educator was not involved in outcome assessments. The baseline measures and most (80.6%) of the follow-up measures were collected in person, but when participants could not return to the Durham VAMC during the specified period, follow-up measures were collected by telephone.
Our primary outcome was the pain subscale of the Arthritis Impact Measurement Scales-2 (AIMS2), which consists of 5 items that assess typical pain, pain severity, and pain during specific times of the day by using a 5-point Likert scale (from "all days" to "no days") (14–15). The possible range of scores is 0 to 10, with higher scores indicating more severe pain.
Secondary outcomes were the AIMS2 physical function and affect subscales, the Arthritis Self-Efficacy Scale, and a 10-cm pain visual analog scale (VAS). The AIMS2 physical function subscale includes 28 items across 6 domains: mobility, walking and bending, hand and finger function, arm function, self-care, and household tasks. Because we focused on lower-extremity osteoarthritis, we examined the mobility and walking and bending scores separately. The AIMS2 affect subscale includes 10 items that encompass mood and tension. All items on the AIMS2 physical function and affect subscales are measured on a 5-point Likert scale (from "all days" to "no days"). Subscale scores can range from 0 to 10, with higher scores indicating worse function or affect. The Arthritis Self-Efficacy Scale measures how certain patients are that they can perform 8 specific activities or tasks, in terms of their arthritis (16). Items are scored on a Likert Scale from 1 (very uncertain) to 10 (very certain); total scores range from 1 to 10. Participants also indicated their average pain during the past 2 weeks on a standard 10-cm VAS with established validity and reliability (17), using anchors of "no pain" and "pain as bad as it can be." Because the 10-cm VAS must be administered in person, data are missing for 92 participants who completed follow-up assessments by telephone (33 in the osteoarthritis self-management group, 24 in the health education group, and 35 in the usual care group).
We calculated costs for the osteoarthritis self-management and health education interventions to inform their future implementation in clinical settings. Costs consisted of labor and nonlabor inputs. The labor inputs included the time for training the health educator (a counselor with a master's degree and previous experience in delivering health-related interventions) and making the intervention calls. The health educator received approximately 30 hours of intervention-specific training, which was applied to both intervention groups. The training consisted of learning the intervention materials, becoming familiar with the intervention delivery database, and delivering intervention calls to practice participants. Because the health educator's training is a one-time fixed cost and would approach 0 (per patient) over time, we also calculated labor costs without the training cost. The health educator's salary was based on the federal government's General Schedule, level 11-4, plus 30% for fringe benefits in the base case. To calculate an intervention cost range, we used the minimum and maximum salary range on the General Schedule for level 11. Indirect costs were calculated as a percentage of direct costs. The VA's Health Economics Resource Center recommends allocating indirect costs as a percentage of the direct costs of a service (18). We used administrative data from the VA Decision Support System to ascertain direct and indirect costs for telephone-based services provided at the Durham VAMC. We used these cost figures to calculate a direct cost–indirect cost ratio of 0.59, which is similar to the 0.61 ratio in a previous VA study (19). We applied the 0.59 ratio to the direct cost to impute the amount of variable indirect cost to be allocated to the intervention.
For both interventions, nonlabor inputs included printing educational materials and creating CDs ($12.75 for the osteoarthritis self-management group and $5.50 for the health education group, because the booklet for the letter group had fewer pages). Development of educational materials was treated as a nonrecurring cost. Participants in the osteoarthritis self-management intervention also received an exercise video ($19.95).
We collected the following variables by patient self-report: age, sex, race and ethnicity, marital status (married vs. not married), education (categorized as high school education or less vs. some education after high school), work status (working full- or part-time vs. not working), perceived inadequate income (defined as having to cut back on things to pay the bills or not being able to pay the bills), self-rated current health (excellent, very good, or good vs. fair or poor), current self-reported height and weight (from which body mass index was calculated), duration of osteoarthritis-related symptoms in hips or knees (in years), and joint with the most severe pain (hip vs. knee).
Our primary hypotheses were that the osteoarthritis self-management program would result in a significantly greater improvement in pain (measured by the AIMS2 subscale) than either usual care or the health education intervention. Our secondary hypotheses examined differences between the osteoarthritis self-management and the usual care and health education groups for the 4 secondary outcomes we described. We also compared VA health care use between the osteoarthritis self-management group and the usual care and health education groups.
Our sample size estimate was based on detecting a difference between the osteoarthritis self-management group and the health education group. On the basis of our pilot study, we expected a baseline mean AIMS2 pain score of 3.96 (SD, 1.74) and estimated that a sample size of 147 patients per group was needed to detect a 0.57-point (14%) difference in change of AIMS2 pain subscale scores between the groups with 80% power. The estimated 12-month dropout rate of 15% resulted in a final study sample size of 173 participants per study group.
All analyses were performed by using SAS software (SAS Institute, Cary, North Carolina). The primary analyses involved all randomly assigned participants. For the primary and secondary analyses, we fit linear mixed models by using an intention-to-treat approach (20). The primary predictors in the models included indicator variables for the 12-month follow-up time and treatment group–by–follow-up time indicator interaction variables (the osteoarthritis self-management group was the reference group). This model assumes that the groups have equal baseline means, which is appropriate for a randomized, controlled trial and is equivalent in efficiency to an analysis of covariance model (21). A benefit of using a mixed-model framework for longitudinal analysis is that all available data are used. The estimation procedure used in this framework yields unbiased estimates of parameters when missing outcomes are assumed to be ignorable (related to either observed covariates or response variables but not to unobserved variables) (22). Because 92 participants were missing 12-month pain VAS values owing to the logistics of travelling to the Durham VAMC for a follow-up visit, we believe it is reasonable to assume ignorability in our analytic strategy. In addition, baseline demographic characteristics, pain VAS scores, and 12-month AIMS2 pain scores did not differ at follow-up between participants surveyed in person and those surveyed by telephone. The number of completed intervention calls was also similar between those surveyed in person or by telephone at follow-up in both the osteoarthritis self-management group (7.8 vs. 6.7 calls) and the health education group (8.9 vs. 9.3 calls).
For the repeated measures over time, we used a compound symmetry covariance. The final models also included our stratification variable for race. Our inference for all analyses was based on the treatment group–by–follow-up time indicator parameters, which are the estimated differences between the osteoarthritis self-management and comparison groups at 12-month follow-up. Residual plots from mixed models were examined to assess model assumptions and the effects of potential outliers.
This study was funded by the VA Health Services Research and Development Service, which had no direct role in the study design, conduct, analyses, or reporting beyond approval of the scientific protocol in peer review for funding.
We identified 3477 persons from VA electronic medical records; of 1153 persons screened by telephone, 653 were eligible to participate, and 523 consented and were randomly assigned (Figure 1). Among those who were eligible, more nonwhite than white persons declined to participate (26% vs. 12%), but participants did not differ from nonparticipants in sex or age. Of the participants who were randomly assigned, 8 were excluded from analyses because a subsequent review of VA medical records revealed no documentation of radiographic evidence of knee or hip osteoarthritis, which meant that these participants did not meet the initial eligibility requirements (23). Of our analysis sample of 515 patients, 461 (90%) completed the study (Figure 1). Completion rates were similar for white and nonwhite participants (88% and 91%). No serious study-related adverse events occurred.
* 8 persons were excluded from analyses because subsequent medical record review showed that they did not meet eligibility criteria.
Participants were primarily men, had a mean age of 60 years, and were evenly split between white and nonwhite persons (Table 2). Most nonwhite participants (93%) were African American. Osteoarthritis was more common in the knee than the hip, and about three quarters of patients indicated that the knee was their most painful joint.
At 12 months, the estimated mean AIMS2 pain score in the osteoarthritis self-management group was 0.4 point lower (95% CI, −0.8 to 0.1 point; P = 0.105) than in the usual care group, indicating improvement in pain, and 0.6 point lower (CI, −1.0 to −0.2 point; P = 0.006) than in the health education group (Table 3 and Figure 2).
Treatment group estimates are at 12 months. AIMS2 = Arthritis Measurement Impact Scales-2; OA = osteoarthritis.
The AIMS2 function and affect subscale scores (including the mobility score) did not significantly differ between the osteoarthritis self-management group and either the usual care or health education group at 12 months (Table 3). However, the estimated mean AIMS2 walking and bending score in the osteoarthritis self-management group was 0.5 point lower (CI, −1.0 to −0.0 point; P = 0.035) than in the health education group at 12 months (Table 3), indicating improvement. The estimated mean arthritis self-efficacy score in the osteoarthritis self-management group was 0.4 point higher than in either the usual care (CI, −0.0 to 0.7 point; P = 0.066) or health education (CI, 0.0 to 0.8 point; P = 0.043) groups (Table 3 and Figure 2). The estimated mean VAS pain score in the osteoarthritis self-management group was 1.1 points lower (CI, −1.6 to −0.6 point; P < 0.001) than in the usual care group, indicating improvement in pain, and 1.0 point lower (CI, −1.5 to −0.5 point; P < 0.001) than in the health education group at 12 months (Table 3 and Figure 2).
Of the 267 goals set by 157 participants in the osteoarthritis self-management group, 56% were related to exercise or physical activity and 30% were related to weight management. The median rating of success at completing action plans from the previous month was 6.6 on a scale of 0 to 10 (interquartile range [IQR], 5.6 to 7.6). About 35% of participants used the exercise video "occasionally," 15% used it "regularly," and 10% used it "frequently."
In the osteoarthritis self-management group, 1324 intervention calls were made to 172 participants (mean call length, 9.0 minutes; median calls, 9 [IQR, 6 to 10]). In the health education control group, 1539 calls were made to 172 participants (mean call length, 4.9 minutes; median calls, 10 [IQR, 9 to 10]).
The total per-participant cost (in 2010 dollars) was $118 (range, $111 to $134) for the osteoarthritis self-management intervention and $63 (range, $57 to 73) for the health education intervention. When the health educator training costs were excluded, the per-participant costs were $107 (range, $100 to $121) for osteoarthritis self-management and $51 (range, $47 to $60) for health education.
We examined the effectiveness of a 1-year, telephone-based self-management support program for patients with hip or knee osteoarthritis. To our knowledge, ours is one of the few studies to examine an entirely telephone-based self-management intervention for patients with osteoarthritis (24–25). The osteoarthritis self-management group had significantly greater improvement on the AIMS2 pain subscale than the health education group. Although AIMS2 subscale pain scores were also lower than for the usual care group, this difference did not achieve statistical significance. The usual care group had a small decrease in pain over time, which may partly explain why we did not find a significant effect. Although we cannot explain why changes in pain over time differed for the 2 comparison groups, the between-group differences were of similar magnitude (−0.6 and −0.4 point between the osteoarthritis self-management group and the health education and usual care groups, respectively). The osteoarthritis self-management group also had a roughly 1-cm greater improvement on the VAS than either the health education or usual care groups (P < 0.001). Although previous studies (26–28) have reported different results regarding clinically meaningful differences in VAS pain scores, the study that examined a pain VAS most similar to ours (global pain during the past week) indicated that a change of 0.8 cm is clinically relevant (26).
The osteoarthritis self-management group did not differ from the other groups in terms of changes in AIMS2 affect or global physical function. However, the osteoarthritis self-management group had greater improvement on the AIMS2 walking and bending subscale (P < 0.035) than the health education group. This is important, because walking and bending are 2 aspects of physical function that are substantially affected by knee and hip osteoarthritis. The osteoarthritis self-management group also had greater improvement in arthritis self-efficacy than the health education group (P < 0.043).
Our results are consistent with meta-analyses (6, 29–31) that show that arthritis self-management interventions are associated with modest improvements in pain and function. Most previous studies involved community-based samples recruited by self-referral, which suggests that the participants may have been very motivated to engage in behavior change. In contrast, our study actively recruited a more generalized sample of patients with osteoarthritis by using study-initiated letters and follow-up telephone calls, which may have resulted in a study sample with more mixed levels of readiness to change than self-referred samples. It is therefore important that we showed changes in some outcomes in a real-world clinical setting and patient sample. Different types of intervention strategies may be more effective for patients at various stages of readiness-to-change (32–33), and a tailored, stage-based approach may be most effective when implementing osteoarthritis self-management broadly in clinical settings, but these questions remain to be explored. In addition, osteoarthritis self-management programs may also have a greater effect in clinical settings if they are more fully integrated into the health care environment. Linking osteoarthritis self-management more directly to clinical care could foster an ongoing patient–provider partnership and lead to more sustained healthy behaviors and improved outcomes (34). This would require support for health educators within clinical settings.
Our study has limitations. First, it was conducted at 1 VAMC. Users of the VA health care system have poorer health overall and more severe arthritis symptoms and activity limitations than the general population (35–37), and most patients are men, all of which may limit generalizability. Second, the health educator for this study delivered both the osteoarthritis self-management and health education interventions, which could increase the risk for contamination between intervention groups. We attempted to minimize this risk by using detailed, standardized scripts for both interventions; the health educator did not discuss any osteoarthritis-related issues with participants in the health education group. Third, although we intended for the osteoarthritis self-management and health education interventions to be equal in intensity (for example, having the same number and volume of calls), the average length of the telephone calls was shorter in the health education group. Finally, our intervention did not involve direct communication with health care providers about patients' self-management efforts or symptom changes or efforts to improve provider facilitation of self-management.
In summary, we demonstrated that an entirely telephone-based osteoarthritis self-management support program was feasible to implement among patients actively recruited from a primary care setting, and it resulted in modest improvements in pain and some aspects of self-reported lower-extremity function. Telephone-based programs may be more readily integrated into clinical practice than face-to-face programs and seem to be particularly useful for reaching some vulnerable patient groups, including those who are older, have more disabilities or lower socioeconomic status, or live in a rural area. Given the high and increasing prevalence of osteoarthritis (38), the tremendous underutilization of behavioral approaches (such as exercise or weight management) for managing osteoarthritis (4, 39–40), and the need to more widely implement osteoarthritis self-management interventions (41–42), our results show that telephone-based administration of such programs should be a key component of an overall strategy for dissemination. Future work should examine strategies for strengthening the effects of osteoarthritis self-management programs, including more complete integration into the health care environment (34).
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Evaluating Telephone Calls to Help Reduce Pain in Patients With Hip or Knee Arthritis
The summary below is from the full report titled "Telephone-Based Self-management of Osteoarthritis. A Randomized Trial." It is in the 2 November 2010 issue of Annals of Internal Medicine (volume 153, pages 570-579). The authors are K.D. Allen, E.Z. Oddone, C.J. Coffman, S.K. Datta, K.A. Juntilla, J.H. Lindquist, T.A. Walker, M. Weinberger, and H.B. Bosworth.
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Washington PostComplex spinal surgery jumps in US elderly: studyReutersCHICAGO (Reuters) - Older patients with lower back pain are increasingly getting more complex and costlier spinal fusion surgeries, resulting in higher ...A questionable increase: Complex spinal fusion surgeries soarLos Angeles Times (blog)Complex Spinal Operations Soar Despite DrawbacksBusinessWeekThe Increasing Morbidity of Elective Spinal Stenosis SurgeryJournal of American Medical Association (subscription)Tampabay.com -TopNews United States -St. Louis Post-Dispatch (blog)all 373 news articles »
Enrollment complete in Paradigm Spine's comparative study of coflex ...News-Medical.netParadigm Spine, LLC, a developer of innovative non-fusion and fusion spinal implant solutions, announced today that it has completed patient enrollment in ...and more »
Slipped disk painCBS42Spinal disks are the fibrous pads between the vertebrae containing soft, gel-like centers that provide cushioning and flexibility. ...
The Numbers: Spinal ResearchThird SectorThe figures behind the charity which funds medical research into paralysis caused by a broken back or neck. £450k - The cost of generating voluntary income, ...
Stuff.co.nzPhil Collins Talks About Drumming After SurgeryRTT News(RTTNews) - Rocker Phil Collins has spoken out about the difficulties he faces in drumming after undergoing surgery to correct a spinal cord injury and ...Phil Collins suffers nerve damageStuff.co.nzPhil Collins Talks About Recovery From Neck Surgery411mania.comPeople: Drummer Phil Collins struggles with disabilityDenver Postall 10 news articles »
The GuardianMy week: Helen Fernandes, brain surgeonThe GuardianI do surgery on the brain to remove tumours, but I also do a lot of spinal surgery to treat back and neck pain, so my work runs from the very urgent ...
Quick Exam Detects Spinal Injuries in Gunshot VictimsMedscapeEach patient was evaluated by a senior resident or attending surgeon and then followed through their hospital course for all spinal injury diagnoses, ...
Washington Post (blog)Geoengineering 'fixes' help us view climate changeWashington Post (blog)... many people still don't think of human activities as turning the planet's thermostat up to 11, to use a reference from the movie This Is Spinal Tap. ...
'Ozone Therapy useful for spinal disorders'Indian ExpressDoctor Kares Hospital, The Ozone Forum of India and the ML Kumar Memorial Medical Trust organised 'Fourth International Ozone Therapy Conference' in New ...and more »
Alphatec Spine Completes Acquisition of Scient'x Groupe SASCNNMoney.com (press release)The combined company will be the third-largest independent spinal company with a global span of product distribution. Scient'x is the largest privately held ...and more »
Stuff.co.nzChallenge raises nearly $8000 for spinal-injury victimsStuff.co.nzMany Christchurch people ran, walked or pushed yesterday, raising nearly $8000 for spinal-injury victims nationwide. The inaugural Push 2 Pier Challenge, ...and more »
... Spinal Fusion Overview Alternative Names Vertebral interbody fusion; Posterior spinal fusion; Arthrodesis; Anterior spinal fusion; Spine surgery - spinal fusion Definition of Spinal fusion: Spinal fusion is surgery to fuse spine bones (vertebrae) that cause...
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One of my favorite scenes from the best movie ever made. Rate, comment, and subscribe. Thanks.
...business, based in Memphis, Tenn., is the global leader in today's spine market and is committed to advancing the treatment of spinal conditions. The Spinal business collaborates with world-renowned surgeons, researchers and innovative partners to offer state-of-the-art...
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...spinal cord injuries, and the determination to not give up. A look into the world of stem cells with a focus on the treatment of spinal cord injuries with special attention to various studies on mice and rats, and the promising results they yielded. ...
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Music video by Spinal Tap performing The Majesty Of Rock. (C) 1991 UMG Recordings, Inc.
Music video by Spinal Tap performing Bitch School. (C) 1982 UMG Recordings, Inc.
...deformity, or injury of the thoracic, lumbar, and sacral spine, the TSRH 3Dx Spinal System offers an alternative for spinal stabilization with fusion. About the Spinal and Biologics Business at Medtronic The Spinal and Biologics business, based in Memphis,...
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...of the art hospitals, latest instruments and well trained medical staff. Patients are explained in detail about the surgery by spinal surgeons who are trained in US and UK. In India the hospital costs are very less as compared to other countries. Low cost...
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...special X-ray examination that involves the use of a dye What to expect during the procedure Spinal fusion : - Spinal Fusion, Spinal Fusion Surgery, Chronic Back Pain, Back Pain Treatment, Healthcare Procedures Spinal fusion permanently connects two or more...
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...are produced systemically, they also may damage other tissues. Popovich noted that, along with paralysis, individuals with spinal cord injury may also have systemic problems, such as chronic bladder problems. These are usually attributed to chronic catheterization...
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Science Daily
...and Cakes" Spinal Tap "Gimme Some Money" Spinal Tap "Heavy Duty" Spinal Tap "Hell Hole" Spinal Tap "Rock 'n' Roll Creation" Spinal Tap " Stonehenge " Spinal Tap "Tonight I'm Gonna Rock You Tonight" In addition, the Wii will be playing catch-up once again with...
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...Tap ? America ? Spinal Tap ?Big Bottom? Spinal Tap ?Cups and Cakes? Spinal Tap ?Gimme Some Money? ...
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...(Reggae Stylee)" Spinal Tap " America " Spinal Tap "Big Bottom" Spinal Tap "Cups and Cakes" Spinal Tap "Gimme Some Money" Spinal Tap "Heavy Duty" Spinal Tap "Hell Hole" Spinal Tap "Rock 'n' Roll Creation" Spinal Tap " Stonehenge " Spinal Tap "Tonight I'm...
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Click this link for everything in todays video: tinyurl.com Or Just want to watch my extra vid: www.youtube.com haha and yes the shakeweight is real, and no I was not paid to put it in: www.shakeweight.com
From Rob Reiner's "Spinal Tap" movie. A funny scene where the band pays tribute to the King...
This is Hardcore Spinal Tap (Glastonbury 2009)
...Aleve control pain. You might need stronger pain medicines. Epidural injections of cortisone ease inflammation and give the spinal canal and spinal nerves more room. "Epidural" means the injection is made into a space in the spinal canal above its covering...
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Dr. Edward Hall, director of the University of Kentucky's Spinal Cord and Brain Injury Research Center, outlines the pathophysiology of spinal cord injury and discusses promising single and multi-drug therapeutic approaches for improving neurological outcomes.
Film ThreatANVIL! THE TRUE STORY OF ANVILFilm Threat, CAby Zack Haddad I am going to go out on a limb and assume a lot of you have seen "This is Spinal Tap." If that is the case, then you are going to be thrilled when I tell you about a new movie that proves "Spinal Tap" is for real, and it is every bit ...
The Express Times - LehighValleyLive.comEmbryonic stem-cell research finally gets it's federal dollars ...The Express Times - LehighValleyLive.com, PATry and repair spinal injuries or cure diabetes and suddenly there's a religious outcry. But how do you justify forcing more than a half-million people in the US alone -- many of them young -- with long-term spinal injury to give up a line of hope just ...
Sunshine Coast DailyGood news for NRL star's dadSunshine Coast Daily, AustraliaTragic blow: Ben Ross won't play football again after suffering spinal fractures in a late tackle on the weekend. Photo: Anthony Reginato\150377 After days of thinking the worst, there was some good news for the Ross family yesterday. ...Cronulla prop Ben Ross close to being in a wheelchair Melbourne Herald Sunall 6 news articles
Sky News'Knives Destroy Lives - Just Look At Oli'Sky News, UKThe 21-year-old's spinal cord was partially severed during the stabbing, leaving him paralysed from the neck down. He had been accepted for a fashion design course at the prestigious St Martin's School of Art but instead spent five months on a ...Oli was tipped to be a star until a knife thug left him paralysed Mirror.co.ukSchoolboy stabber paralysed student Cambridge Evening NewsArt student paralysed by random knife attack in street This is LondonDaily Mailall 10 news articles
TVNZCutting-edge surgery soon for paralysed KiwisTVNZ, New ZealandThe experimental procedure, which has only been attempted in a few countries, uses the patient's own stem cells to try to repair the severed spinal chord. Some say the procedure will offer a ray of light for the paralysed, but others warn the procedure ...
TheHorse.comAAEP 2008: Acquired Scoliosis in EquidsTheHorse.com, KYThe horses also demonstrated neurologic problems consistent with stenosis (narrowing) of the cervical vertebrae (wobbler syndrome) and associated compression of the spinal cord. Muscles on the convex side of the malformation lacked tone, while those on ...
CBC.ca'Steering' stem cells presents a challenge for treatmentsCBC.ca, CanadaNo one hears, however, about the individuals who died due to complications of surgery, said Dr. Hans Keirstead, a Canadian researcher who made a paralyzed rat walk back in 2004 by injecting its spinal cord with cells derived from human embryonic stem ...
Ortho SuperSiteYour Diagnosis?Ortho SuperSite, NJRadiographs demonstrate interval migration of the polyetheretherketone (PEEK) L2-L3 interbody cage (arrow) posteriorly into the spinal canal. The L3-L4 interbody cage is unchanged. Note stable grade 1 anterolisthesis of L4 on L5. ...

subset: commoncrawl


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Walking in love is essential to walking by Jesus' example. Listen to today's Points of Power to hear Yolanda Adams and AV discuss being able to forgive and live on purpose through love.
Get more Points Of Power here and listen LIVE weekdays at 9:45 am EST/8:45 am CST on "The Yolanda Adams Morning Show!"
RELATED: Yolanda's Take: How To Practice Self-Love [EXCLUSIVE AUDIO]
RELATED: AV's Say What: You Knew You Found Love When… [EXCLUSIVE AUDIO]
RELATED: How Earnest Pugh Is Spreading Love To Fans [EXCLUSIVE AUDIO]
Keep Up With Yolanda Adams On Facebook!
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Adam Levine posted an Instagram photo on Tuesday of him and bride Behati Prinsloo nearly naked and dripping with what looks like blood.
The very telling caption? "#ANIMALS," the title of Maroon 5's second single from the band's latest album, V.
Prinsloo, 25, and Levine, 35, married in Mexico in July, and made their red carpet debut as newlyweds at the MTV Video Music Awards in August.
In an interview with Ryan Seacrest on Aug. 29, the singer said he's eager to start a family – but we'll have to wait to see that baby carriage.
"I want to have 100 kids," PEOPLE's reigning Sexiest Man Alive joked. "I want to have more kids than is socially responsible. We can't do it right now, but it's in the works."


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Virginia Tech is building a Tactical Hazardous Operations Robot, known as THOR, for the competition. The team plans to emphasize hardware resilience and robot autonomy coupled with intuitive operation, so THOR can infer its operator's intentions on a task.
DARPA Challenge: Build Virtual Robots
DARPA Develops Tiny Helpers To Spot Bioterror Attacks
10 Breakthrough DARPA Technologies
Robotics Rumble: Teens Fight For Tech Glory
iRobot, Cisco Create Telepresence Robot
NASA Launches Second Robot Challenge
Pentagon Seeks Robotic Hand With Soft Touch
DARPA Seeks Situational Awareness Tech
25 Most Influential Government CIOs


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TRENTON — As police continued to probe the death of the 32-year-old city man gunned down in the Wilbur section Wednesday night, the Trenton resident who was wounded in the shooting remained in critical but stable condition in the hospital yesterday, police said.
Iridious Wise, 32, a Trenton resident, was found on the second floor inside stairwell of a small apartment building facing North Walter Avenue and pronounced dead at the scene.
A second, wounded man, 23-year-old Brandon Willie Palmer, was shot multiple times but was alive on the front stoop when police officers arrived around 7:45 p.m., according to police.
"We have a couple of theories right now we're working on, but none I'm willing to put out," said Lt. Ed Gonzalez, head of the department's Criminal Investigations Bureau.
Wise's death is the city's fourth homicide of the year, and the first since Jan. 30. Palmer was taken to Capital Health Regional Medical Center, where he was treated and stabilized Wednesday night.
"He's not giving us any information at this point in time," Gonzalez said yesterday.
Gonzalez said police are searching for "one or two" gunmen, but do not have complete descriptions of either and have not arrested anyone in connection with the crime.
Palmer has not been charged with a crime, and Gonzalez said he does not believe Palmer was involved in the shooting or returned fire at his attacker.
Police believe a relative of Palmer's lives in the building. Wise was a resident of Cuyler Avenue a short distance away.
Mark Jacobs lives in a first-floor apartment inside the building where the two men were found. He said he was sitting on his bed when he heard what sounded like three shots coming from on the street just outside his first floor window.
"You hear it, it sounds like someone was in the room with you it was so loud," Jacobs said.
After immediately calling his fiancée Angela Bennett, who was around the corner at the store, to make sure she was safe, Jacobs went outside in the hall, where he found Palmer.
"He was just lying in the hallway, crying for help," Jacobs said. "He was talking to me at the moment, I didn't ask him his name. I was just talking to him."
Bennett waited at the store for a moment to make sure the coast was clear, then hurried home and joined Jacobs outside their apartment with Palmer.
"I told him to hold on, just wait, they're coming," she said.
"'I got shot," Bennett said Palmer was repeating. "I said, 'Just hold on, they're coming.'"
Police and an ambulance soon arrived. No weapons were recovered, and detectives are continuing their investigation. Jacobs said the whole experience made him think of the sudden visits from death and violent crime that are seemingly a regular occurrence in the capital city.
"You just never know who's going to come out of the corner, to lurk on the side — you don't know what to expect," he said. Gonzalez said getting help from the residents and people who spend time in the East State Street/South Olden Avenue area would not be easy.
"They're a very tight-knit community that keeps to itself," he said.
Anyone with information on the crime should contact police at (609) 989-4170, or the Confidential Tip Line at (609) 989-3663.
• Trenton shooting kills one man, injures another
Contact Alex Zdan at firstname.lastname@example.com or (609) 989-5705.


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In October 2005, Love Revealed, a major exhibition about the work of the Jewish and homosexual Victorian artist Simeon Solomon, opened at the Birmingham Museum & Art Gallery in the UK. To mark this important intervention in nineteenth-century British cultural history, the Yale Center for British Art is holding a symposium that takes the extraordinary career of Solomon as a starting point for an examination of marginality in late Victorian Britain and beyond. Papers will explore the social, sexual and political contexts in which he worked, and will address the nature of
marginality. Sessions on aestheticism, on the classical tradition and sexuality, and on history and Jewishness will complicate our understanding of the relationship between margin and center in Victorian Britain and its Empire.
The keynote lecture on Friday 5 May at 5.30 will be given by Colin Cruise (University of Staffordshire), curator of the Solomon exhibition and editor of the accompanying publication. Other participants will include: Joe Bristow (UCLA), Jonathan Shirland (University of York), Elizabeth Prettejohn (University of Bristol), Morna O'Neill (Yale Center for British Art), David Feldman (Birkbeck, London), and Gayle Seymour (University of Central
The symposium is free and open to the public. Advance registration is required. To register or for more information, please contact Serena uerrette at 203.432.7192 or e-mail firstname.lastname@example.com.


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The 76ers hadn't gotten much sleep when they met Sunday for one last time about 12 hours after their season had ended with Saturday's 85-75 loss to the Celtics in Game 7 of the Eastern Conference semifinals in Boston.
The players and management assessed a season that started quickly, with 20 wins in the first 29 games, and hit some major bumps in the road before the Sixers picked it up in the end, earning a longer postseason stay than anyone had predicted.
Yes, the Sixers were helped in the first round by injuries to Chicago's Derrick Rose and then Joakim Noah. But they still earned some league-wide respect after lasting 13 games in two playoff rounds.


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How did human emotions evolve to help us survive? For the last decade, cultural anthropologist Chelsea Shields Strayer has studied the indigenous healing practices of the Ashante people of Ghana, discovering that emotional pain serves useful purposes — including the relief of physical pain. In this conversation with the TED Blog, she tells the fascinating story of how she struggled to free herself from her gender-biased Mormon culture to study another culture far away, in the process gathering important information about the physiological basis of the placebo effect, learning how social ostracization affects physical well-being, and getting a new perspective on the community she comes from.
How did you end up studying traditional healing cultures in Ghana?
I grew up in a very conservative Mormon culture in Utah. My father works for the church educational system, and my mother is a stay-at-home mom of eight. None of the women in my family have ever gotten a higher education or worked outside the home, so I didn't have any role models outside my own culture, or any within it of women pursuing less traditional paths. I was a four-sport athlete and had straight As during high school, but it never even crossed my mind that I could go anywhere besides the church university, where traditional gender roles were reinforced everyday. My female pre-med friends were told that if they got into medical school they would be "taking the spot of a man that needed to provide for his family." I never even had a female professor until my senior year.
Because of the rigid modesty culture that makes you a "good Mormon girl" I had never even kissed anyone until college. At 19, I started to date my first boyfriend. Everyone, including my church leaders, wanted me to marry him. There was a lot of pressure. So I remember feeling really trapped and very confused. I believed in my religious leaders; I believed they received revelation from God. But I did not want to marry; I was so young, and had so many things I wanted to do.
So I very quixotically said, "I can't do anything until I accomplish my goal — which is go to Africa someday." My boyfriend said, "Okay, I guess we could do that later, when we're married. We can go as missionaries." Again, so much pressure not to do my thing. I was almost like a drowning person. I just had to do something, to get out. So eventually I just did it. I bought a plane ticket to West Africa. I left the country for the first time, at 20 years old, all by myself.
What did your parents think?
No one had ever been to Africa, so they didn't know anything. We were all just super naive. I don't think they realized how scary it was. I don't think even I realized. I remember my dad taking me to San Francisco International Airport and it hit me. This silly plan of mine was actually coming to fruition! I had no idea what would be on the other side of the world when I stepped off the plane. It was terrifying. The best moment, however, was when my mom called me and with tears in her voice said she was really proud of me — proud that I had a dream and that I was making it happen. How rare and special that was. I think that is what gave me the strength to get on the plane and not just live in SFO airport for six months, which was my Plan B.
I attended the University of Ghana in Legon for a semester as an international student and lived in the dorms with Ghanaian roommates. I made a lot of friends, attended my local Mormon ward in Ghana and spent the entire time immersing myself in the culture, backpacking and traveling throughout West Africa.
Being in a completely different culture was good for me, but it was really hard. I didn't speak the language. I didn't understand the social norms. I would see Ghanaian street vendors selling things on their head and I didn't know what was food or soap (I only made that mistake once)! It took a good four or five months of being completely out of my comfort zone and changing everything about my life (what I ate, where I slept, how I went to the bathroom, how I showered, what I wore, how I communicated, how I spent my time, etc) until resilience kicked in and I adjusted to this new lifestyle.
You see, in my culture women are supposed to be very beautiful and high-maintenance because your job is to look attractive so you can get married someday. And here I was sitting in this country where my makeup is melting off in the 100% humidity, my nice clothes are dirty in two seconds via the dirt paths and crowded tro-tros, my padded bras are completely uncomfortable in the two 12- mile walks you take everyday to get anywhere, and I was blow-drying my hair (when there was electricity) while sweating so much it would re-wet my hair. Very quickly, I had to get rid of all those cultural symbols I had about who I was and what made me special. I was stripped of everything I knew, and it forced me to create a new worldview where my decisions were based a little less on what I was "supposed" to do and a little more on what I "wanted" to do.
How did you get involved with the healing community in Ghana?
When I got back to Utah, I had enough perspective and strength to start making decisions about what I wanted. I broke up with my boyfriend, said I didn't want to get married before I got a degree, decided to major in anthropology and helped start a study-abroad program to Ghana at my university. I ran that program in different capacities for about five years while I finished school.
All along the way, I had to fight and push against invisible patriarchal boundaries that exist in my culture. Even though I was a top anthropology student, it surprised faculty, family and friends when I applied to graduate school, but I received a Foreign Language and Area (FLAS) full-ride scholarship to Boston University for an MA/PhD in anthropology and African studies.
Over the course of the last twelve years I went back to Ghana five times, for a total of 26 months. I became friends with some Asante healers early on, and have maintained those relationships over the last decade. I've watched them go from apprentices to master healers, I've been invited to attend everything from very private ceremonies to public performances for the Asantehene King, I have even had healers who allow me to record and take measurements of them in spirit possession.
Was your interest in anthropology always focused on healing culture?
Not at first. My BA, MA and PhD were in cultural anthropology, and I was studying the religious and social aspects of Asante indigenous healing. At first, I was more concerned with what all of the cultural symbols in ritual healing meant, rather than how it worked. Halfway through my research, though, I realized that my informants and I were talking past each other. They would tell me about witchcraft cursings, familial discord and the process through which they cured a patient, and I would build an ethnomedical explanatory model — which explained Asante sociocultural constructions of sickness and healing. They were talking about ritual healing ceremonies as effective techniques for altering physiological pathologies, and I was describing why they thought that. I was not discovering if ritual ceremonies actually alter physiological processes or how and why they do it. I did not have the tools to understand, frame or measure those claims. So I went back to Boston University and completed all of the PhD requirements in biological anthropology as well.
Why did you need to study biological anthropology?
The healers I've worked with don't think that they are just building the community, easing tensions or creating social support. They say they are healing — affecting a physiological change. I felt that no matter how I wrote about what they were doing, from my academic perspective, I was belittling their biophysiological claims of ritual healing unless I could understand and explain why and how social processes can influence physiological ones.
What I learned from the healers was that because the body is made up of both spiritual and physical matter, variables affected in one state can manifest in the other. Since non-physical or psycho-social (social, psychological, spiritual, etc.) variables can influence bodily states, the healer's job is to manipulate those psychosocial processes in order to elicit specific reactions from the body. This is not a foreign concept in mind-body medicine. We know that psychosocial factors such as stress, fear, inferiority, ostracism and negative expectations exacerbate physical and mental ailments and inhibit healing processes. We also know that relaxation, expectations, empathetic relationships and meaningful interventions can activate and even enhance healing processes. What we are talking about are the context-specific physiological effects of the ritual of medicine, the provisions of care. Another word for this phenomenon is the "placebo effect."
There's a lot of confusion around the placebo effect. How do you approach it?
Having studied it for the last eight years I can tell you that most people don't really understand what it is. The most common understanding is that a placebo effect means that nothing is happening when the opposite is actually the case. Something biochemically is happening — it is just that the cause is psychosocial rather than physical. An inert sugar pill has no physical effect on the body, but that same pill — when wrapped in all of the rituals, meanings and social interactions of healthcare and imbued with encultured expectations — has incredible and powerful effects of the body! A handful of anthropologists have been talking about this for years, the effect that meaning has on the healing process. What I contribute to this dialogue is describing the effect that social interaction has on the healing process. I meticulously go back through our evolutionary history and show how encephalization and increased sociality, infant dependency, juvenility and attachment make human bodies particularly vulnerable to changes in our psychosocial environments. I show how for our ancestors, belonging and ostracism were literally the difference between life and death and how we evolved very powerful prosocial emotions (psychological and physiological warning systems) that are hypersensitive to cues in our social environments. Because the fitness consequences of prosocial behavior was so costly to our ancestors, our bodies are full of somatic "warning" systems that keep us from being too anti-social.
For example, one of these warning systems is social pain, or the unpleasant sensory experience we feel when we make a social misstep; that moment of cringing or embarrassment when we've put our foot in our mouth or the anxiety-riddled feeling right before a speech, interview or performance. Like many of our adaptations, the social pain warning system evolved out of and on top of preexisting structures in our bodies — in this case our physical pain warning system. This is called the pain overlap theory, and basically states that because these two warning systems occupy the same neural pathways, you can inhibit the one by activating the other.
The best examples of this are when someone self harms or cuts themselves in order to numb the psychosocial pain they are experiencing or, on the opposite side of the coin, when someone's social environment determines how much physical pain they experience. (Think about a skateboarder having a horribly painful fall but getting up quickly and laughing it off because he doesn't want to lose status in front of his friends, or a baby who falls and then looks up to her mother to determine whether she should cry or not.)
To read the full interview, visit the TED Blog >>>


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Top Definition
To ejaculate or blow your load rapidly. Used in the porn industry to describe when a guy sprays his cum all over the female actress' face.
How bout I cumbust all over ur face.
מאת Rajib 17 במאי, 2005
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Wall Street Decline Takes Its Toll...
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Expanding Use of NGS Has Largely...
OSI Pharmaceuticals reported FDA clearance of its flagship anticancer drug, Tarceva®, as maintenance therapy for patients with locally advanced or metastatic non-small-cell-lung cancer (NSCLC) that has not progressed after four cycles of platinum-based, first-line chemotherapy. The announcement comes less than a month after OSI and its partner, Roche, confirmed that the EMEA's Committee for Medicinal Products for Human Use (CHMP) was also in favor of extending approval of Tarceva into the equivalent maintenance NSCLC therapy indication.
The latest FDA approval and European recommendation for approval of the Tarceva NSCLC maintenance therapy indication are based on data from the global Phase III SATURN trial. The study involved 889 patients with advanced disease. Participants whose disease had not progressed after four cycles of standard first-line platinum-based chemotherapy were randomized to receive either Tarceva or placebo.
The results showed overall survival was 23% higher in the Tarceva group compared with the placebo group. Tarceva therapy also improved progression-free survival by 41% and reduced the risk of cancer progression or death by 29%.
FDA clearance of Tarceva for maintenance NSCLC therapy has not been without incidence, however. In December 2009, the agency's Oncologic Drugs Advisory Committee voted by 12 to one against approval of the maintenance NSCLC therapy indication. The following month FDA extended the review period for the sNDA by 90 days following OSI's submission of further data in support of the application.
Tarceva has been approved in the EU since September 2005 and in the U.S. since November 2004 for the treatment of patients with locally advanced or metastatic NSCLC with or without EGFR-activating mutations after failure of at least one prior chemotherapy regimen. According to OSI, the drug is now approved for sale in 109 countries for the treatment of advanced NSCLC.
Tarceva is also approved in the U.S. and Europe in combination with gemcitabine for the first-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer.
Roche reported global sales of Tarceva reached CHF 1.3 billion in 2009 (about $1.22 billion), up 10% on 2008, and representing 3% of the firm's overall global sales. In 2009, the drug represented Roche's eight biggest selling pharmaceutical.
OSI says that its Tarceva-related revenues reached $359 million in 2009, compared with $335 million in 2008. The 2009 figure included Tarceva-related royalties of $146 million from Roche. Royalty revenues in 2009 were based on Tarceva net sales in the rest of the world of approximately $724 million.
The blockbuster status of Tarceva was one of the reasons OSI gave for its board unanimously rejecting Astellas' recent and unsolicited $52.00 per share, or reportedly about $3.5 billion, cash bid for the company.
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|Tests of Chinese-supplied anti-ship Cruise missiles; Danger to US troops in Gulf
|US commitment to security of Persian Gulf; Iran support for terrorism
QUESTION: The Secretary chose not to say much about the Iran decision to test their cruise missiles, which apparently adds a new dimension to Iran's military capability. There is another component to the question. That is the fact that the Chinese were the apparent suppliers of this equipment, and I thought you might want to say something about that.
MR. BURNS: You know, George, I usually don't need this book very much. Today I need it on this question. I can't find it. I have no idea where this has been put. It's been hidden someplace. Let me tell you, this report this morning in The Washington Times is another report based on alleged intelligence sources. I never comment on intelligence sources, number one.
QUESTION: What about Secretary Cohen?
MR. BURNS: Pardon?
QUESTION: Secretary Cohen announced it in the Gulf.
MR. BURNS: Are you talking about the article by Bill Gertz?
QUESTION: No, no.
MR. BURNS: That's the question you asked the Secretary.
QUESTION: No, no, no.
MR. BURNS: What is your question?
QUESTION: Secretary Cohen, in Bahrain, I believe --
MR. BURNS: I don't think then - I'm not sure. Well, anyway, I think she thought you were talking about the other article.
QUESTION: Well, Secretary Cohen said the Chinese have begun testing an anti-ship cruise missile, and the implication is -
QUESTION: You said China.
QUESTION: What did I say? China. No, no, that the Iranians are testing these missiles. And the implication is that this could pose increased dangers for American troops in the Gulf. And the suppliers, as I understand it, are the Chinese. It's been on the wires since 5:00 a.m. this morning.
MR. BURNS: And Secretary Cohen made these remarks?
QUESTION: That's right.
MR. BURNS: Haven't seen the remarks.
QUESTION: Okay.
MR. BURNS: I have to check with the Pentagon and see what Secretary Cohen said.
QUESTION: I suppose some of our countries which leading Syria, Iran, Iraq try to establish some kind of military pact as a counter for Turkish-Israeli military cooperation agreement. And, also, we heard that Libya showed a desire to join this counter -
MR. BURNS: Could you name the countries again?
QUESTION: Syria, Iraq, Iran and might be Libya.
MR. BURNS: That's a motley crew.
QUESTION: Yeah, it is.
MR. BURNS: Isn't it? You think so?
QUESTION: It is.
MR. BURNS: You know, I can't see anything good coming from an alliance of those countries. I can't see anyone who would want to join it. It's a bunch of dictators. We do talk to the Syrians. We don't talk to the Libyans or the Iranians or the Iraqis. It's a motley group. I don't think it's a very distinguished group of countries.
QUESTION: And also the Turkish navy is visiting the Israeli ports and most probably they are planning to prepare some kind of military exercise, navy exercise, in the eastern part of the Mediterranean. Do you have any reaction on this?
MR. BURNS: I don't know the particulars of these reported military exercises with the government of Israel, but we have encouraged Turkey and Israel to conduct military exercises and training together -- of course making sure this is outside any area of controversy in the eastern Mediterranean. That is always helpful in these cases. But we very much encourage the rapprochement between Turkey and Israel. It is significant. It is helpful to both countries and to the United States. Yes, Laura.
QUESTION: Generally speaking, do you think that Iran poses a threat to U.S. troops stationed in the Gulf region, regardless of the fact that you are unaware of Secretary Cohen's comment?
MR. BURNS: I did see that Secretary Cohen said this morning that the United States seeks peace in the Gulf. We also seek, and have sought for nearly 50 years now, freedom of navigation in the Gulf and of shipping, and we will keep the Gulf open for shipping. We will defend our troops and our assets and our allies, if necessary. The Iranians know that and they won't fool around with us because we are stronger than they are. I think that was the import of what I saw Secretary Cohen say on that particular issue.
QUESTION: Do you think that Iran supports terrorism?
MR. BURNS: Iran definitely supports terrorism. It is a chief funder and manipulator of some of the major terrorist groups in the Middle East -- Hezbollah and Hamas, to name two. That is one of the three reasons that President Clinton and Secretary Albright have cited why the United States has such a lousy relationship with Iran. It's support of terrorism is a big concern of ours and we are not going to let Iran get away with it without public comment and private action to counteract it. Yes, ma'am, yes....................
[end of document]


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Note: In 2010 I changed my name from Amanda Curry Henck to Amanda Henck Schmidt. Previous research appears under both names.
We have a blog for the lab - Oberlin College Geomorphology Research Group - that my students and I post to about lab projects.
During summer 2013, Jenny Bower (OC'13) and I traveled to Yunnan, China with UVM graduate students, Thomas Neilson and Veronica Sosa Gonzalez, and Sichuan University graduate students, Wei Renjuan and Zhang Chunmin, for field work. We were featured on the Oberlin College website in an article by James Helmsworth (OC'13).
During summer 2011 while in the field with Xenna Goh (OC'12) I blogged for the NY Times Scientist at Work blog.
I was featured in the June 2011 issue of the Fulbright Student Newsletter. The story is about my time in Jiuzhaigou in 2010 as a Fulbright Student Fellow.
In my research I try to use a variety of tools to understand why the surface of Earth looks the way that it does. At the biggest scale, I am interested in how we can learn about what forces shape the landscapes that we see today. My research ranges in scale from small-scale projects that are community driven and aim to understand how people interact with their environments to large-scale projects to understand landscape evolution over million-year timescales
My latest research is driven by two overarching questions:
1) What happens to sediment movement over the landscape when people change the environment?
2) What has shaped the long-term evolution of the landscape of Eastern Tibet?
To conduct this research I use a variety of tools including short-lived radionuclides (which we will be able to process in house after Geology Department renovations in summer 2011), cosmogenic radionuclides, field work, GIS and remote-sensing based landscape analysis, and Chinese sediment data. I collaborate closely with colleagues at a number of universities in geology, geography, anthropology, urban planning, and forest resources departments.
My research is primarily focused in western China. I work on small-scale problems in western and northern Sichuan Province and larger scale problems in eastern Tibet, Yunnan, and western Sichuan. I have close collaborative relationships with the Cosmogenic Nuclide Laboratory and Geomorphology Research Group at the University of Vermont, the Scottish Universities Environmental Research Centre, the Archaeology and Environmental Studies departments at Sichuan University, the School of Hydrology at Sichuan University, the International Research Lab at Jiuzhaigou National Park, and with Yangjuan Primary School.
Last update: 9 December 2013
amanda . schmidt at oberlin . edu
(remove extra spaces and replace at with @)
CARN 406 (office) and 418 (lab)
Phone: 440-775-8342


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Working With Baby Birds Training your bird at a young age is ideal when compared to re-training or correcting the bad habits of an older bird. Some pet owners can become sidetracked by the freshness of having a new bird and enjoying their cuteness while they're still baby birds; however, you must remember that in order to set the stage for the future, it is important to socialize your bird, work on good communication, and establish trust at a young age. Just as human babies need to learn to eat with a spoon and play well with others before they tackle long division, baby birds need to start with the basics. Spend time with your young bird developing trust and teaching the basics of good bird behavior. For example:
You will begin to notice better communication between you and your baby bird. Working with your bird frequently allows you to become familiar with the body language and preferences of the bird, making it easier to know what your pet wants and how to respond to its actions. By taking time to teach your bird new tricks, you are encouraging desired behavior. Your bird will begin to demonstrate the favorable behavior because it learns it receives your attention then, as opposed to misbehaving. The stimulation training provides your bird is also very important to cater to their intelligence and appease their curiosity.
*Content generated by our loyal visitors, which includes comments and club postings, is free of constraints from our editors' red pens, and therefore not governed by I-5 Publishing, LLC's Gold Standard Quality Content, but instead allowed to follow the free form expression necessary for quick, inspired and spontaneous communication.
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We enjoy hearing from you as much as you enjoy writing. These days, there is so much going on locally, nationally and around the world, that some of you probably have a hard time deciding what issue to address. Our one letter per reader, per calendar month rule no doubt doesn't help much!
We appreciate loyal readers who submit frequent letters, but we want to see some new faces, too. So please try to adhere to the one-letter rule.
Letters should be no longer than 200 words. Guest columns can be from 500 to 800 words and accompanied by a recent photo.
We look forward to reading your views.
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Will appear in Toledo, Sylvania, other areas throughout the day today.
Former congressional staffer is set to be formally nominated without opposition.
Donald Trump may have jeered at Arizona Sen. John McCain for having been captured in Vietnam, and drawn criticism for challenging the Muslim parents of a U.S. soldier killed in Iraq. And one of his chief proposals to overhaul the Department
Portman, Strickland call attention to attacks, victims.
'She was put on antibiotics and advised to rest,' doctor says.
Ohio attorney general's son is on state Supreme Court.
Poor adults would have paid more.
Dems have redirected ad funds in Senate race.
U.S. Rep. Marcy Kaptur (D., Toledo) announced the award of $210,000 on Friday to the University of Toledo for a three-year project to build on the recent success of quantum defect theories for atom-atom and ion-atom interactions. The annual
Approval of bipartisan bill puts Congress on a collision course with President on the eve of the 15th anniversary of the attacks.


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To the editor:
In a recent paper there were two people again spouting the Obama talking points.
One obviously is uninformed since she thinks she lives in a democracy and not the republic to which this country was founded.
She went on to say that the reason for voter ID was the work of a party "afraid to stand on its own ideas." Romney stands on valued ideas that are in accord with the founding principles of this nation. Obama stands on ideas absent of values and even his own party refused to vote for which resulted in a Senate "nay" vote of 99 to 0. And that was when not only the White House but the Senate and the Congress were controlled for two years by the Democratic Party with left-wingers Reid and Pelosi controlling the voting agenda.
Voter ID only offends those who are not eligible to vote. It exposes fraud. If a person must show an ID when purchasing prescriptions, get a loan, drive a vehicle, be admitted to a hospital and even when making an appointment at a doctor's office or do most of those things for which an ID is required then why the difficulty in showing an ID to vote - the most important value of a free people? Of course voter ID would expose illegal voters who overwhelmingly would vote for the "food stamp president."
Another writer listed eight points, all socialist mantras, in her attempt to d--n Romney. Romney would not destroy Medicare since he would not need to do so being that Obama is already doing that by the transfer of over $700 billion from that program to his socialist tax program - power grab, ObamaCare.
I am a senior deeply disturbed that Medicare will be destroyed once ObamaCare is fully implemented. The bureaucrats will be determining what medical care I can receive, not the doctors or the other caregivers that are knowledgeable of my medical needs. And ObamaCare will also impose negatively upon religious values therefore mocking the protections under the First Amendment of our Constitution.
We might also look at the money given to so-called "green" businesses who have gone bankrupt already with dozens more teetering on the edge. Those companies for the most part were Obama donors and gifted by taxpayer funding now gone down the sewer of political greed. Funds that could have been used for "job ready" projects instead.
But the writer would ignore such follies so that the Obama give-away for votes programs (bribery) can secure his means to get a second and more destructive term on the throne, on which he obviously believes he sits.
Diane L. Logan


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Cancer Genomes Mapped
Scientists at the Wellcome Trust Sanger Institute have sequenced lung cancer (on the SOLiD system) and melanoma (on Illumina's system). The two studies were published in Nature in December. Researchers discovered 33,000 DNA errors in melanoma, most caused by sun exposure and 23,000 errors in lung cancer, most due to cigarette smoke—one for every 15 cigarettes. Wellcome Trust researchers predict that this will be the beginning of thinking about cancer in a very different way.
Pharma IPO
Aveo Pharmaceuticals signaled a brighter 2010 for the pharma industry by filing for an initial public offering in mid-December. The cancer therapeutics firm, originally known as GenPath and with a start-studded advisory board that reads like a Who's Who of the oncology community, is a former Bio•IT World "company to watch."
HP Supports Lilly
HP Enterprise Services signed a seven-year infrastructure agreement with Eli Lilly and Company to provide the pharma with a flexible and scalable foundation to support Lilly's technology needs and improve its ability to collaborate with external partners. Under the terms of the agreement, HP will manage Lilly's employee workplace computing and messaging environment across its global operations, including service desk and site support services for more than 60,000 employee desktops.
Third Gen Sequencing
The Chinese Academy of Sciences and Inspur Group have reportedly started a joint project to develop a third-generation genome sequencing instrument. The instrument is expected to sequence a person's genome in an hour at the cost of $1000.
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Craftsman 10' Rail Extension Kit for Chain Drive Garage Door Opener
$15.93 - $37.93
Store pickup
1 year parts and labor
Allows Craftsman chain drive garage door openers to handle a garage door up to 10' high. Includes front section of an SSR rail. New chain/cable is used, replacing original from carton.
- For use with current Craftsman chain drive garage door openers
- Works on garage doors up to 10' high
- Includes rail extension, mounting brackets, and all necessary hardware
Specifications & Dimensions
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Teen accused of vandalizing Hardin County school
Published 12:43 AM EDT Oct 02, 2012
A teen is facing charges after a local school was vandalized.
Kentucky State Police said several thousand dollars in damage was done to East Hardin Middle School in Glendale.
Through video surveillance, school staff members identified one of the suspects as 18-year-old Christopher Blaine of Glendale.
When a trooper arrested Blaine at his home, police said he implicated himself and two juveniles.
Blaine was charged with burglary and criminal mischief.
Charges against the juveniles are pending.
Copyright 2012 by WLKY.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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"Here Come the Brides: The Complete Second Season,"
(Shout! Factory, 6-DVDs, $44.99 list price)
"Here Come the Brides" lasted just two seasons on ABC, but its loyal, vocal fan base has clamored for its release on home video for years.
Sony Pictures Home Entertainment obliged in 2006 by releasing the first season. Now out-of-print, sealed copies of that six-DVD set sell on Amazon.com and elsewhere for between $215 and $299.
Since 2006, fans have petitioned for the release of the second and final season. Their prayers were answered today, thanks to the folks at Shout! Factory, who have issued "Here Come the Brides: The Complete Second Season" on DVD.
The ABC series centered on the fictional Bolt brothers (Robert Brown, David Soul and Bobby Sherman), who brought 100 New Bedord, Massachusetts bachelorettes to love-starved loggers in post-Civil War Seattle. Bridget Hanley co-starred as the beautiful, strong-willed (possible) bride-to-be Candy Pruitt. Oscar nominee Joan Blondell played saloon owner Lottie Hatfield, who served up wisdom and whiskey to the loggers. Unlike other Western dramas of the 1960s, "Here Come the Brides" was light on violence and heavy on settling disputes through talking.
Second season stories range from a sniper firing on loggers in "Lorenzo Bush" to a shortage of whiskey in "How Dry We Are." Along the way, the Bolt brothers and people of Seattle battle trappers, Big Foot and a raging fire.
While there are no significant extras in this DVD set, Jonathan Etter, author of the "Gangway, Lord: The 'Here Come the Brides' Book" contributes brief introductions to several episodes. The video transfer and film prints are equal in quality to those used by Sony in its earlier collection.
Fans will be thrilled to know that the theme song "Seattle" with words and music by Hugo Montenegro, Ernie Sheldon and Jack Keller is featured in this collection, rather than the instrumental utilized on the first season set.