text:
|Juan Rodriguez from Oviedo (Spain)
What researching will you do during the Venus flybys?
|Peter from Basel, Switzerland
Messenger orbiting the Planet Mercury - Where is the Lander?
|Art from Los Altos
What imaging and spectrographic instruments will be aboard the spacecraft, and what data do you hope to gather, and what are you expecting to learn from this information?
|Rich from Elk Grove
How long will MESSENGER's science mission last, and what will happen to MESSENGER when it is done with its mission?
|Dan Sez from Dallas
What special equipment and strategies are used to protect the spacecraft from much higher levels of solar radiations, CMEs and other solar specific threats?
|Juan Fernandez from Barcelona (Spain)
What is/are the OS that is governing the Messenger systems?
|John Tate from Yucca Valley, California
What are the estimated temperatures way out there?
|Renato from San Paulo, Brazil
How close will be the Mercury flybys? What level of resolution can we expect of the pictures taken during these flybys?
|Vikram from Kurnool
What if during the flyby, a solar flare occurs and is so strong that it interferes with MESSENGER'S communications? Did you plan for this already? What's your interest in studying Mercury? How can data be transferred without interruption if solar bursts occur?
|Kenny Keese from Dallas, Texas
How will the gravity assist flight plan differ for MESSENGER, as opposed to other deep space launches, since the spacecraft is ultimately traveling towards the Sun? Can we expect MESSENGER to reach a higher traveling velocity than previous flights and how will that affect the procedures of orbit insertion?
|Kenny Keese from Dallas, Texas
At the conclusion of MESSENGER's mission, what is the current plan for the spacecraft's disposal? If it collides with another object will it exceed the record set by the Galileo spacecraft for a man made collision?
|Pawan from Sharjah
Will MESSENGER be able to find out the contents in Mercury's core? What type of materials and terrain are the scientists expecting to be found on the surface of Mercury?
|Junichi from Niihama-City
How will you protect MESSENGER from high energy solar winds and really high temperatures and/or freezing cold temperatures?
|Junichi from Niihama-City
Would MESSENGER be affected by the twisting of space time effects by the Sun?
|Junichi from Niihama-City
With Mercury being so close to Sun, what is the most complex feature that had to be designed to protect the MESSENGER spacecraft?
|Junichi Maki from Niihama-City
What is the most significant difference between the previous Mariner 10 Mission and the upcoming sophisticated MESSENGER?
|Junichi Maki from Niihama-City
Will high-resolution pictures of Mercury bring us Mercury's geophysical composition in details?
|Junichi from Niihama-City
Some scientists say that Titan and Mars are the most important places to explore, others say Mercury is a really important planet because it is so similar EARTH in terms of the composition of materials of its surface. I wonder which would bring us cutting edge results for us to know where Earth came from and where Earth would go?
|Junichi from Niihama-City
What is the most fascinating aspect of Mercury versus the other planets in terms of solving the secrets of our Solar System?
|Junichi from Niihama-City
What is the difference in the instruments and equipment of MESSENGER compared to the Mariner 10 Mission?
|Junichi from Niihama-City
What do you think most interests scientists about MERCURY in terms of the Solar System mechanism?
|Junichi from Niihama-City
What is the most advanced or cutting edge equipment of MESSENGER versus Mariner 10?
|Junichi from Niihama-City
What will the advanced instruments on MESSENGER reveal about the surface Mercury? What is different from the Mariner 10 mission in 1975 and the most distinguished features of MESSENGER?
|Robert from Tucson, Arizona
What is the Caloris Basin, and why is this area of Mercury unique in our solar system? Would this be a primary point of interest to MESSENGER?
|Robert from Tucson, Arizona
If there is a trace of an atmosphere on Mercury what would that be composed of?
|Robert from Tucson, Arizona
Can MESSENGER help explain why Mercury's axis is virtually perpendicular to the plain of the orbit? What caused this to happen?
|Glenn from Moscow
What exploration programs of Mercury surfaces will be carried out during this mission?
|Raymond from Portland, Oregon
What are the criteria, in general, for choosing the orbital path, i.e., what information gathered on the three flybys will influence your final decision. Also, what is the range of possible orbits? Polar? Equitorial? Stationary?
|David from Barcelona
Why such a long journey? Is it because of low-cost constraints? Didn't Mariner missions in the 60's arrive at Mercury in a few months?
|Matthew from Big Lake
What science do you hope is obtained by MESSENGER? Do you hope to find out what Mercury is made of? And, why it is hot on one side and cold on the other side of the planet?
|Joey V. from Austin
How will MESSENGER be able to operate with the intense heat from the Sun?
|Bob from Belvidere
Will MESSENGER be able to take pictures in color?
|Bob from Belvidere
How does the sunshade get deployed and how close will it be to the Sun when it needs to be deployed? Also, does the sunshade move in relation to the spacecraft or does the spacecraft itself have to keep orienting itself to keep the sunshade between it and the Sun?
|Ashutosh from Mumbai, India
During this long journey of seven years, are you going to do any science to study the space between Sun and Earth?
|Ashutosh from Mumbai, India
As we are moving towards the Sun, will there be any impact of sun spots on MESSENGER during this long journey of seven years?
|Shawn from Parison
Hi to all NASA experts... I heard about the landing of MESSENGER on Mercury's pole!! Do you really believe that MESSENGER will arrive at Mercury as you intend, due to interplanetary mediums and cosmic rays sent by our star, the Sun?
|Matthew from Los Altos
How will MESSENGER map the surface of Mercury?
|Junichi from Niihama-City
Why does Mercury go around the Sun "in a wildly elliptical (non-ciricular) orbit?" Is it because of the Sun's effect of warping of space time due to the presence of a the nearby massive Sun?
|Junichi Maki from Niihama-City
Is Mercury affected by the geodetic effect of the presence of a massive Sun?
|Grace from Clarksville
How much fuel is it going to take to get to Mercury and how big is the fuel tank?
|Edward from Albuquerque
Who made the solar cells on MESSENGER?
|Valesca from Palm Harbor
Could you explain how light works with the spectroscope?
|Pulakesh Saikia from India
Does MESSENGER have any Mirror System For reflection of excess heat and diversion of sunlight into the instruments?
|Jason from Greenville
Why does it take so long to get to Mercury, which I heard is at times Earth's closest planetary neighbor? Does Mercury have a dark side that does not face the Sun? If it has a dark side, is it cold?
|Steven from Spartanburg
What kind of propulsion does MESSENGER use to get to Mercury? Is it advanced technology?
|Mike from Louisville
Why will it take so long to get to Mercury? It only takes eight to nine months to get to Mars.
|Bert from Norwood
When will the questions on the MESSENGER message board be answered? My question is why does it take seven years after launch to reach orbit?
|Berne from Paris, Kentucky
Will there be relativistic space time physics experiments performed to test Einstein and other modern physics theory while in Mercury's high velocity orbit around the Sun?
|Carl from Lethbridge, Canada
Would Mercury have been torn apart by the Sun's radiation if it did not have a magnetic field?
|Nishant from Mumbai
Is the MESSENGER safe and will it be safe till the end?
|Kim from Winnemucca, Nevada
Will MESSENGER do any science at Venus?
|Manfred from Buford, Georgia
How is MESSENGER protected against the high energy particles (solar winds) if it has no magnetic field to use as a shield? Will it be kept on the dark side of Mercury to maintain communication with Earth?
|George from Mesquite
Given Mercury's similarities to the Earth, how will the lessons learned at Mercury help us better understand our own planet?
|John from Leicester, United Kingdom
When MESSENGER reaches Mercury, what type of shielding will MESSENGER use to protect itself from the Sun's heat and harmful radiation?
|Matthew from Zagreb
What do you expect to find on Mercury? Thank you.
|Wade from Adelaide
Do you expect any major surprises or unknowns to be unearthed during the investigation of Mercury by MESSENGER?
|Daniel from San Jose
How long will MESSENGER last, do you think, due to the harmful radiation?
|Shivani from Melbourne
What's your actual mission on Mercury? Is it to find out that people can survive on Mercury or not?
|Hardik Gajjar from Ahmedabad, India
What is the reason to send a probe to Mercury, where life is not possible? Don't you think that it will be good to spend more on Mars rather than spending on Mercury or other such planets?
|Venkatesh from Hyderabad
Why isn't Mercury slanting? Does it require a moon like Earth?
|Erykah from West Sacramento
How do you know that the MESSENGER will not encounter any problems, such as asteroids, or comets, on its way to Mercury?
|Evan from Soo
I've heard there is a special covering over the rocket to protect the probe from the extreme heat. Do you foresee any other complications from the extreme heat and radiation?
|Greg from Mechanicsville
Why is the MESSENGER spacecraft going to loop around several planets including Mercury before entering orbit around the planet? In other words, why can't we fly directly to the planet like we do to the Moon?
|Arthur from Vancouver
Mercury is one of the inner planets, so why will it take seven years to reach it? Cassini took seven years to reach Saturn, and the distance to Saturn is far greater. 57 million miles to Mercury compared to 744 million miles to Saturn, that's when they are the closest to Earth.
|George from Mesquite
Will MESSENGER be able to study the solar wind while en-route, or will it be sleeping?
|Enigman from Warren
Do you think there will be a heavier concentration of heavier metals on Mercury i.e., the platinum group or possibilities of greater amounts of Uranium?


text:
Author Affiliations: Divisions of Pharmacoepidemiology (Drs Solomon, Avorn, and Brookhart, and Ms Polinski) and Rheumatology (Drs Solomon and Katz), Brigham and Women's Hospital, Boston, Mass; Endocrine Unit, Massachusetts General Hospital, Boston, Mass (Dr Finkelstein); and Department of Society, Human Development and Health, Harvard School of Public Health, Boston (Dr Arnold).
Long-term compliance with pharmacologic treatments for many asymptomatic conditions may be suboptimal, but little is known about compliance with medications used for osteoporosis. This study was undertaken to assess the level and determinants of compliance with drugs prescribed for osteoporosis.
This retrospective cohort study used pharmacy claims data from US Medicare and filled prescriptions from a state pharmaceutical benefits program. We included persons 65 years or older who initiated use of a medication for osteoporosis (alendronate sodium, calcitonin, hormone therapy, raloxifene hydrochloride, or risedronate) from January 1, 1996, through December 31, 2002. The outcome of interest was suboptimal medication compliance, defined as equal to or less than 66% of days with medication during a 60-day period.
One year after initiating treatment for osteoporosis, 45.2% of the 40 002 patients were not continuing to fill prescriptions. Five years after initiation, 52.1% of patients were not continuing to fill prescriptions for an osteoporosis medication. Several characteristics independently predicted compliance: female sex, younger age, fewer comorbid conditions, using fewer nonosteoporosis medications, bone mineral density testing before and after initiating a medication, a fracture before and after initiating a medication, and nursing home residence during the 12 months before initiating a medication. However, models adjusted for the significant patient variables explained only 6% of the variation in compliance.
Most patients who initiate a medication for osteoporosis do not continue to take it as prescribed. Although several patient characteristics significantly correlated with compliance, adjusted models explained little of the variation.
Several effective drug treatments for osteoporosis have become widely available during the past decade. Because patients with osteoporosis may have no symptoms from weakened bones until a fracture occurs, treatment for low bone mineral density (BMD) frequently begins during an asymptomatic phase of the condition. Data for several other chronic and largely asymptomatic conditions suggest that long-term medication compliance is often poor. Large community-based studies have shown that 40% to 60% of patients continue to take medications for hypercholesterolemia 1 year after initiation.1 Although prior research on osteoporosis treatment compliance has suggested that 60% to 80% of patients continue to receive therapy for at least 1 year, these studies were conducted in selected patient groups, several had relatively small samples, and some relied on patient self-report of medication use.2- 4
We examined rates and predictors of compliance with medications for osteoporosis among a large population of unselected low- to moderate-income Medicare beneficiaries who all had a state-funded drug benefit requiring a minimal copayment. The cost of medications may be an important factor affecting noncompliance in other populations, but we were able to minimize this effect by studying compliance in a population with a drug benefit. We hypothesized that in addition to patient characteristics at the time of initiating treatment, time-varying factors, such as recent hospitalizations, fractures, or BMD testing, would influence long-term compliance. Although we are aware that some patients who discontinue their medications are actually being compliant with a physician's request, the term compliance will be used to refer to long-term continuation with any osteoporosis medication.
The study database included all Medicare beneficiaries also eligible for a state-run drug benefits program in Pennsylvania—the Pharmaceutical Assistance Contract for the Elderly (PACE). Beneficiaries of PACE have annual incomes between $10 000 and $20 000 and are 65 years or older. The PACE drug benefit provides all outpatient drugs at a small copayment of $6 to $10. None of the medications for osteoporosis had prescribing restrictions.
We limited the study population to beneficiaries of PACE who had initiated use of a medication for osteoporosis from January 1, 1996, through December 31, 2002. These included bisphosphonates (alendronate sodium and risedronate), calcitonin, hormone therapy (except progesterone-only preparations and vaginal creams), and raloxifene hydrochloride. Teriparatide was not included because it became available only in late 2002. Because indications for medications were not identified in the database, some of the prescriptions for medications like hormone therapy were probably not explicitly used for osteoporosis but were included as such. All patients in this study were aged at least 65 years, so hormone therapy would not have been used for short-term menopausal symptoms. To reduce the chance that patients were obtaining medications through other means, we excluded patients who had not filled medications for any condition through PACE in each of the two 6-month intervals immediately preceding their initial osteoporosis prescription. Medication information from PACE consisted of the drug name, dosage, number of pills dispensed, and days' supply. The study database included Medicare information on all inpatient and outpatient encounters, including diagnoses, procedures, and tests (without results). The study investigators have data use agreements in place with Medicare and PACE. To ensure patient confidentiality, all personal identifiers were removed from the study database after linkage was achieved. The institutional review board of Partners Healthcare, Boston, approved this research.
This retrospective analysis was designed as a cohort study of patients who initiated an osteoporosis medication from January 1996 through December 2002. We examined osteoporosis medication use in sequential 60-day periods starting with the initial prescription and the index date, and we followed the patients' progress until they died or lost eligibility for PACE. Sixty days was chosen as the period to study because most prescriptions allow for a supply of 30 or 60 days, and the shorter 30-day period would be prone to less stable estimates. Within each 60-day period, we defined the proportion of days that osteoporosis medications were available to participants (days covered) on the basis of the day supply field. The days covered was calculated by summing the number of days when an osteoporosis medication was available and dividing by the period length of 60 days.
Because patients commonly have brief intervals between active prescriptions, we did not require them to fill medications to cover 100% of days in each interval. No data definitively establish the percentage of days required for an osteoporosis medication to be effective. However, results of 1 observational study suggested that patients reporting compliance for at least two thirds of days had better BMD than those reporting less; thus, we used greater than 66% of days covered as the primary threshold for compliance.3 Sensitivity analyses were used to explore alternative thresholds, such as greater than 50% and greater than 85% of days covered. Results for these alternative thresholds were similar to those of the primary analysis and are not included here. We also assessed several categories of compliance: no days with medications, 1% to 33% of days, 34% to 66% of days, and greater than 66% of days.
We had 2 objectives for developing multivariable models of compliance: (1) to examine predictors of compliance, and (2) to identify factors available from the baseline year that could be used to identify patients likely to be compliant. Results from the second set of analyses could help inform quality improvement interventions that might be initiated when drugs are started. Although these modeling exercises are closely related, different types of variables were entered into the models. For the first goal, we examined potential predictors of osteoporosis medication compliance in the 12 months before initiating treatment (baseline variables) and then since initiation of the osteoporosis medication (time-varying variables). For the second goal, we entered only baseline variables in the model. The baseline 12-month period extended back into 1995 for patients who initiated treatment in 1996.
Baseline variables included age; sex; race; annual income; marital status; nursing home residence; acute care hospitalization; fractures of the hip, wrist, humerus, or spine; BMD testing; number of physician visits; number of comorbid conditions (a comorbidity index)5; and total number of different nonosteoporosis medications used. For each 60-day period after initiation of a medication for osteoporosis, we repeated the assessment for the time-varying variables such as nursing home residence, acute care hospitalizations, fractures, and BMD testing.
We first calculated the proportion of days covered by an osteoporosis medication for each 60-day period after initiation of treatment. Kaplan-Meier survival curves were then constructed to estimate the distribution of time until a patient had 2 consecutive 60-day periods with no supply of any osteoporosis medication. The Kaplan-Meier curves were stratified on several key variables. Differences between the survival curves were evaluated by using a log-rank test.
Multivariable regression models were then constructed to assess variables associated with an increased likelihood of osteoporosis medication compliance. Our primary definition of medication compliance was a dichotomous categorization, and secondary analyses treated compliance as a continuous percentage. For the primary analyses, we initially dichotomized compliance as greater than 66% of days with any osteoporosis medication in a 60-day period. We constructed models for this dichotomous end point by using both a logarithmic and a logistic link function. The results were similar, and we display the results from the log-linear models, since the variables are interpretable as relative risks. All possible baseline and time-varying predictors were tested. Only the variables significant at P<.05 were retained for the final models. This process was repeated in a linear regression model with the percentage of days covered as the outcome, and predictors included baseline and time-varying patient-level variables. Because each participant contributed multiple periods, all analyses report standard errors that are estimated by using a generalized estimating equations approach for repeated measures data.6,7 Sensitivity analyses were used to test 120 days as the period length. There were no important differences between the 60-day and 120-day periods. All analyses were conducted using SAS version 8.02 (SAS Institute Inc, Cary, NC).
We identified 40 002 patients who initiated a medication used for osteoporosis from January 1996 through December 2002 (Table 1). The mean age of the treated population was 80 years. Most were white and female, reflecting the makeup of the underlying population enrolled in PACE. On the basis of information from the 12 months before initiating an osteoporosis drug, patients in the study sample had an average of 2 major comorbid conditions and used 9 different medications. About a third had an acute care hospitalization, and 12% had resided in a nursing home for at least part of the baseline year. Approximately one fifth had a fracture during the baseline year, and a similar proportion underwent BMD testing.
After initiation of 1 of the osteoporosis study medications, the percentage of days covered decreased rapidly during the first year (Figure 1). At the end of the first year of treatment, 45.2% of patients had discontinued osteoporosis treatment. This finding was demonstrated by at least 120 consecutive days without any filled prescriptions for osteoporosis. The proportion of patients filling their prescriptions did not change substantially after the first year. After 5 years of follow-up, 52.1% of patients were not continuing to fill prescriptions for an osteoporosis drug.
This bar graph represents the compliance with medications used for osteoporosis. The y-axis represents the proportion of the population in each category of compliance. The x-axis represents 60-day periods after date of osteoporosis medication initiation (index date). Four categories of compliance are graphed for each 60-day period after initiation. The black bar represents the proportion of patients who had filled prescriptions for any osteoporosis medication that covered greater than 66% of all days in the 60-day period, the dark gray bar represents patients with 34% to 66% of days with any osteoporosis medication, the light gray bar represents the patients with 1% to 33% of days, and the white bar represents the patients with no days of medication.
Kaplan-Meier curves suggest a similar trend of noncompliance with osteoporosis medications (Figure 2A). Those who underwent baseline BMD testing were more likely to remain compliant with osteoporosis medications than those who did not undergo BMD testing during the 12 months preceding medication initiation (Figure 2B). Compliance also differed significantly according to patient age, with the lowest compliance observed in patients 85 and older (Figure 2C).
The Kaplan-Meier curves illustrate the proportion of patients who had 2 consecutive 60-day periods without any osteoporosis medication: all patients (A), patients stratified according to bone mineral density (BMD) testing (0, no testing; 1, testing) in the prior 12 months (B), and patients stratified according to age in years at the time of drug initiation (C).
In the multivariable models that included time-varying and baseline variables, several patient characteristics were associated independently with increased compliance (Table 2): female sex, BMD testing before and after initiating a medication, fracture before and after initiating a medication, and institutionalization in a nursing home before initiating a medication. Variables that reduced the likelihood of remaining compliant included being older, more comorbid conditions, more nonosteoporosis medications used, and institutionalization in a nursing home after initiating a medication. After controlling for these patient characteristics, patients who began taking raloxifene were more compliant than those who began taking a bisphosphonate; those who began taking hormone therapy or calcitonin were the least compliant. However, these multivariable models explained only 6% of the variation in compliance (R2 = 0.06).
The second set of models included only factors available at the time of initiating treatment (baseline variables). These models included virtually the same baseline variables as the previous set of models and produced similar point estimates (Table 2).
Finally, we examined models that considered the percentage of days covered with an osteoporosis medication in a 60-day period as a continuous end point (Table 3). The final set of variables in these models was similar to those in the models in which a dichotomous end point was used. However, these data can be interpreted directly with respect to increases in compliance. For example, women were compliant with osteoporosis medications for 3.3 days more than men in a given 60-day period.
In this study of unselected older adults, we found relatively low compliance with medications used for osteoporosis. After 1 year, 45.2% of patients were no longer still taking an osteoporosis medication; this increased to 52.1% after 5 years. Several characteristics of patients during the 12 months before their first prescription, as well as several variables since initiation, were associated with greater compliance. An adjusted model with many patient characteristics still had a relatively low ability to explain the variation in compliance. This finding suggests that other factors—patient beliefs or socioeconomic, physician-related, or health system issues—might be important correlates of osteoporosis medication compliance.
Prior research on compliance with osteoporosis medications is not entirely consistent with these findings. Authors of a large study from a health maintenance organization found that among women 45 years or older who had undergone BMD testing, 78% self-reported continuing osteoporosis medications 7 months after initiation.2 Treatment discontinuation was more common in women who reported bothersome adverse effects or did not think that their BMD test results showed osteoporosis. The much lower discontinuation rate in that study than what we observed may be related to several factors: drug use was measured by means of self-report; all women had undergone BMD testing at baseline; and the health maintenance organization population was younger and more likely to be health seeking, better educated, and more affluent. Authors of another study, also from a health maintenance organization, assessed compliance among women who had undergone BMD testing; they found that approximately 70% of respondents were compliant with osteoporosis medications.3
Our study differed in important ways from those in the literature. We included all older adults enrolled in a large drug benefits program for low- and moderate-income elderly patients in 1 US state. These persons are relatively frail and at high risk of future fractures, so they are an important group to study. The fact that all patients in the study had a drug benefit with minimal copayment limited our ability to study the effects of drug costs on compliance, even though economic issues may be an important correlate of long-term drug use, especially when the benefits of medication use may not be immediately obvious to patients. Although use of a large population of older adults is a potential strength of the study design, reliance on pharmacy claims has important limitations.
First, we were unable to assess the reasons for starting or stopping medications, so some of the prescriptions that we included as osteoporosis treatments were for other indications. Some of the hormone therapy noncompliance, as well as noncompliance with other medications, may have been at the advice of physicians on the basis of potential risks and/or adverse events. We attempted to deal with this limitation by considering patients who switched among treatments for osteoporosis as compliant. This categorization limited our ability to look at compliance with any given drug, but it did not lead to misclassification of a patient who switched medications as noncompliant. Nevertheless, some of the women who discontinued hormone therapy after the publication of the Women's Health Initiative in July 2002 may have done so because of the lack of cardiovascular benefit.8 Because our study period was from January 1996 through December 2002, most of our follow-up occurred before the publication of the Women's Health Initiative. Moreover, we found low rates of compliance no matter which medication was used at initiation.
Second, our pharmacy claims data did not include over-the-counter calcium and vitamin D supplement use. Patients who switch from a prescription medication to nonprescription calcium and/or vitamin D would be considered noncompliant. Although many consider these treatments suboptimal if a patient has confirmed osteoporosis, not all patients included in our cohort would be considered to have definite cases of osteoporosis.
Third, pharmacy claims data report only prescription filling, not actual medication use. We assumed that regular refilling of prescriptions is a good surrogate for long-term medication use, but it may not be. However, it is clear that patients who do not fill prescriptions consistently are likely to be noncompliant.
Finally, our data were limited to claims for procedures, diagnoses, and medications. We had no information about BMD test results. This limited our ability to determine the appropriateness of treatment. We chose the availability of medications on greater than 66% of days on the basis of 1 prior observational study that found this level to be a threshold for improved BMD.3 The results of our analyses were similar regardless of whether we used the alternative (50% or 85%) thresholds, but more work is necessary to determine whether intermittent use of these agents is effective. Moreover, the optimal duration of treatment is unclear.9,10
Our findings have several implications. Clinicians need to be aware that many patients initiating a medication used for osteoporosis do not continue to take these drugs long term, which limits the effectiveness of these treatments and suggests the need for interventions to improve compliance. Although the variables we identified do not explain much of the variation in compliance, some may provide valuable insights into improving long-term use of these medications. Several of the stronger correlates of long-term compliance included BMD testing at baseline and testing subsequent to initiation of treatment. It is unclear whether BMD testing motivates patients to remain compliant or whether it is a marker for patients and physicians who are concerned with osteoporosis and are more likely to remain compliant with medications. Another notable correlate of compliance was nursing home residence. Residence in a nursing home during the 12 months prior to initiating a treatment for osteoporosis was associated with an increase in compliance, but nursing home residence subsequent to initiation was associated with a reduced likelihood of persistent use. At first inspection, these findings seem contradictory. However, we think that certain physicians may be comfortable initiating osteoporosis medications on the basis of clinical indications. Other physicians, perhaps at different nursing homes, may think that treating osteoporosis is not worthwhile or is dangerous in frail recumbent residents of a nursing home. Thus, some patients transferred to their care may have their osteoporosis treatments discontinued. This finding warrants further analyses to determine how frequently medications for osteoporosis are discontinued in the nursing home setting and to develop strategies for improving osteoporosis treatment in this setting.
The low long-term compliance rates we observed highlight the need for improved strategies to ensure compliance with osteoporosis medications and/or medications that are easier to use. Patient reminder systems and improved physician-patient communication about compliance may help improve long-term use of these medications. New medications and new formulations of older medications requiring less frequent dosing also may help improve this discouraging picture. The promise of more effective medications for osteoporosis will not be realized until the health care system can effectively enhance long-term compliance with pharmacologic treatments. This issue looms large as the population ages and the number of persons at risk of osteoporosis grows.
Correspondence: Daniel H. Solomon, MD, MPH, Division of Pharmacoepidemiology, Brigham and Women's Hospital, 1620 Tremont S, Suite 3030, Boston, MA 02120 (email@example.com).
Accepted for Publication: July 8, 2005.
Financial Disclosure: None.
Funding/Support: This study was supported by grants AR-48616, DK-02759, and AR-47782 from the National Institutes of Health, Bethesda, Md. Investigators are also supported by grants from the Arthritis Foundation, Atlanta, Ga, and its Engalitcheff Arthritis Outcomes Initiative. There was no pharmaceutical industry support for this study.
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Hopefully you caught the season premiere of The Biggest Loser. If so, you saw what I meant on Friday when I said the reaction to show trainers was euphoric. I have to say, when I first walked onto the stage, I felt the same nervous butterflies that I felt at the first live finale that I hosted in season 4.
I knew we were introducing the kids first, and they were so nervous that I was nervous for them. Then Sunny, Lindsay and Biingo started talking about being part of the show and they immediately warmed my heart with their excitement to get healthy and to change their lives and the lives of their families.
For those of you wondering, Noah goes by Biingo because he likes it better and he has two 'I's in his name to be different. I love that he owns his individuality. And how about the poise of all three of them and their reaction to being paired with their trainer? To watch them enjoy outdoor activities with Dolvett and to open up with Jillian just reinforced how much this experience means to them.
That said, the warm and fuzzy aspect of The Biggest Loser definitely ended for the adult contestants when they walked onto the Ranch. If you expected Jillian to be sweeter and softer now that she's a mom, think again. Jillian is back and more determined than ever to change the lives of those who need it most (and who want it most).
Her relentless determination to enact change and her knowledge of what will resonate with each contestant never ceases to amaze me. That said, I have to admit, I was relieved to not be in the gym with her those first days! Can you imagine if she would have been on the show when Conda and Jeremy were there?
Trae Patton / NBC
And now for my favorite moment of the show: Jillian jumping into Bob's arms and him welcoming her home. How could you not love that moment?
Make sure you tune in Monday night (8 p.m. ET) on NBC to see what happens when the San Diego Chargers' Antonio Gates makes a special appearance.


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Mysonne 3AM in NY Lyrics
Last updated: 02/11/2014 02:17:22 PM
Niggas is Pulp Fiction, that's why I just don't listen
Tell all the tall tales bout the keys and the coke pitchin
They say the game change but to me it is no different
Rule number one, I repeat it, it's no snitching
You see it, there's no bitching the made man
[O]ficial niggas stick to that script, there's no switching the game plan
Nigga prick his finger, call you his main man
Then get up on a stand and point you out with the same hand
Despicable, dudes have no principles
I can see their moves before they make them, they so predictable
Niggas use that Instagram, pics in new and different shoes
To convince you they hot, got this shit confused
I get amused by bum bitches in new ????
And new dudes that talk about real beefs on YouTube
If you think that shit is gangsta, than you fools
The play is changed and the game got new rules
You lose if you chose, honor over dollar dog
Pussy niggas talking, Vagina Monologues
They tryina floss, I'm tryina feed my son
I pray the day comes that I don't need my guns, motherfucker
Thanks to 718 Soldier for submitting 3AM in NY Lyrics.


text:
A nice Corporate/motivational song. This is a perfect optimistic background music that includes Arpeggio and rhythm ukulele, electric guitar, bass, rhythmic drums, claps, xylophone and tambourine. This track fit perfectly in any corporate videos, commercials, advertisement or as web page music.
I'd love Videohive Authors to use my preview together with their works! Please drop me an email with the link if you use it!!
Thank you for rating this song!!


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Your work is handled by a seasoned attorney. Our attention to detail is only the beginning. You'll receive professional services and advice based on more than a century of combined legal experience.
Physicians call it "bedside manner." We call it caring. We take a personal interest in each client. We build a relationship that you can rely on as you make important business and personal decisions. Our commitment includes a prompt response with an understanding of each client's need for an efficient, result oriented service.


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I have been seeing a lot of lists lately about who are the best players at positions like running back or quarterback. I thought it was time that the unsung heroes of the NFL get their due.
I have compiled a list of the top 10 offensive linemen in the game going into this season. Now, of course there aren't many stats to back up any of these selections, so what this list is based off is film and, to an extent, player reputation.
Here is my list, please feel free to comment.


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'Pay to play" deals where public officials hand out big money state contracts to their friends or campaign donors have a troubling history in South Carolina. In particular, plaintiffs' lawyers donating to statewide politicians and then receiving excessive contingency fees — or slices of any settlement — in lawsuits on behalf of the state has embedded itself within the state's culture.
Fortunately, there is a solution that would protect taxpayers' pocketbooks and help stop real and perceived corruption.
Lately, State Treasurer Curtis Loftis has been under fire for a deal that will result in a multi-million dollar payout for his longtime friend and fraternity brother, attorney Mike Montgomery. Montgomery will reportedly receive a $2 million award as part of a settlement agreement which Loftis reportedly "pounded the table" to maximize, in a lawsuit involving pension fund losses. Though none of what Montgomery will receive will detract from what the pension fund will receive from the settlement, his lottery-sized pay day stemming from his coziness with Loftis has certainly raised eyebrows.
But this problem runs deeper than any particular deal, individual, or even specific office.
For example, in one of the largest related payouts dating back to the tobacco litigation of the 1990s, former Attorney General Charles Condon hired seven firms to pursue related lawsuits. Six of these firms had donated to his campaign, but only one had previous experience with tobacco litigation. Condon hired these firms with no formal process, and in 2000 they received an $82.5 million fee, an amount that a former federal judge and arbiter said was "grossly excessive."
More recently, former Attorney General Henry McMaster, in a suit on behalf of the state, hired private attorneys who had given over $60,000 in contributions to his campaign. One of the attorneys, John Simmons, had already been the subject of a controversial case in 2000 in which he and another attorney, representing the state on a contingent basis, sought a $2.14 million fee, one third of the state's settlement, in a case that was never tried.
Attorneys general and others represent the public, and they are required to pursue justice. In some cases, the interests of justice may call for dropping a case, pursuing a non-financial settlement, or taking another course other than all-out pursuit of the maximum possible financial recovery.
But private attorneys working on a contingent fee earn a percentage of the money they recover, and therefore have an incentive to pursue whatever course will maximize their own personal enrichment — regardless of what is in the interest of justice and the taxpayers.
Arrangements like these can undermine the public trust and deserve the highest level of scrutiny. Recognizing this concern, numerous other states have passed outside counsel sunshine laws to establish reasonable restrictions of the practice.
So far, Alabama, Arizona, Florida, Indiana, Iowa, Mississippi, and West Virginia have passed laws or adopted policies modeled after the Transparency in Private Attorney Contracting Act that open the relationships between state officials and private lawyers hired to work with them to public scrutiny.
And just this month, Wisconsin passed the nation's strongest outside counsel sunshine law yet.
Typically, these laws ban state entities from hiring outside lawyers on a contingency fee basis absent a finding that the contract is both cost effective and in the public interest. They also usually require a competitive bidding process, the state to retain supervisory authority over the lawsuit, and the public posting of and a cap on the total payments that outside lawyers can collect.
A bill introduced in the South Carolina legislature, the Transparency in Private Attorney Contracts Act (S-773), would impose these common sense safeguards around the public contracting process in the state.
Lawmakers should immediately pass this outside counsel sunshine bill into law to prevent further conflicts of interest and favoritism.
The only ones with anything to lose are the state officials who dole out big money contracts to their friends and campaign donors, and the plaintiffs' lawyers lining their pockets by cashing in on their connections.
Lisa A. Rickard is president of the U.S. Chamber of Commerce's Institute for Legal Reform.


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100 Years Ago
1913-The Maui Glee Club is making a hit in San Francisco, and the boys are all feeling happy. On the way to the Mainland, the boys had the luck to have as fellow passengers, Mr. Harry Baldwin and wife. The Paia manager got busy and arranged a show on board. The "shower" of silver after the concert came to a fair sum.
75 Years Ago
1938-Public health-minded persons see the day when even in the rural island of Molokai, all babies will be born in hospitals. Molokai has made great progress and now has 20 percent more babies delivered in hospitals than the average throughout the Territory.
50 Years Ago
1963-Public schools on Maui, Molokai and Lanai have suffered a net loss of 113 students with a total enrollment in 30 schools at 11,071. Reporting no change in enrollment were Kaupo with six students and Keanae with 44.
25 Years Ago
1988 -A section of wall from the 80-year-old Chee Kwung Tong Society hall on Vineyard Street crashed into a neighbor's yard Thursday. The building was built in 1908 and has been vacant since the 1960s when its last occupant died. The building is to be torn down and replaced with a replica.
10 Years Ago
2003 -Now that students are settled in, visitors will be welcome Saturday to see the brand new Kamehameha Schools Maui high school campus. High school Principal Mitchell Kalauli said his 288 students are adjusting just fine.
* "Looking Back Through The Maui News" is a weekly feature compiled by Gail Ainsworth.


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Community Spotlight: Behind the desk of a traffic safety coordinator
By RACHEL BRANT
Staff writer
Leading the Kitsap County Traffic Safety Task Force is a tough job, but Carolyn Pence is up for the challenge. The former legal assistant has served as the task force coordinator for the past two years and loves educating people on driving safe on the roadways.
Pence re-cently invited us into her Silverdale office to answer the questions everyone wants to know.
Question: How did you get involved with the Kitsap County Traffic Safety Task Force?
Answer: When they advertised for the position I applied for it and thought that it was perfect for me. I have a degree in criminal justice and Ive always enjoyed working with and educating the public. I thought it was the best of both worlds.
Q: What is your favorite part of Silverdale?
A: Old Town. Its close to the water and my hair salons down there and theres lots of cute shops.
Q: What do you like the most about your job?
A: Being able to go out and work with law enforcement on educating the public. This job has given me the opportunity to work with a lot of officers who all pretty much have the same mission in mind to keep the roads safe for drivers.
Q: Family, kids?
A: I live with my husband, Lee, and almost 10-year-old daughter Kathryn.
Q: Do you have a favorite meal?
A: It would probably be a nice steak dinner with all the trimmings, you know, a baked potato and salad.
Q: What is your favorite flavor of ice cream?
A: I like coffee-flavored ice cream.
Q: What is your first memory of Silverdale?
A: It was coming to Silverdale more than 20 years ago and staying at the Poplars with my parents. It was one of the only hotels in Silverdale and the mall wasnt here.
Q: Do you have a favorite hobby?
A: Photography. When I take landscape photos with great sunsets or water, theres a sense of calmness. It just seems to go on forever.
Q: Who would play you in a movie of your life?
A: Angelina Jolie, but shed have to make a few changes first. Wed have to work on her a bit.
Q: What is your favorite type of music?
A: I like 80s music. It takes me back to a fun time in my life when I was just getting out of college.
Q: What is your favorite television show?
A: Law and Order: SVU, its a family favorite. Our daughter, Kathryn, will pick that over other shows.
Q: What is your favorite movie?
A: Anything with Morgan Freeman. He does those great crime dramas, hes just great.
Q: Which local event do you always participate in?
A: Central Kitsap Family Night, Kids Day, Kitsap County Fair & Stampede and Back-to-School Day in South Kitsap. My daughter likes to participate as well.
Q: What has been your most memorable vacation spot?
A: Our first trip to Disneyland with our daughter. Her mouth was just wide open the whole time.
Q: What is one thing you want to try in your life?
A: It may happen sooner than later, but I want to get into rock climbing.
Q: If you could change one thing about Silverdale, what would it be and why?
A: It goes back to my job, getting people to make the right choices, not to speed and not to drive while under the influence of alcohol and/or drugs. A change in behavior is one of the hardest things to do.
Q: If you could have any magical power, what would it be?
A: Teleportation. Id like to go from one place to another instantly just to be able to be where I want to be quickly.
Q: What is your favorite season and why?
A: Fall, the colors are just beautiful.
Q: Whats the worst job youve ever had?
A: I was a security guard at Capital Mall in Olympia. It was my first job out of college and I had to wear a uniform.
Q: What do you see as the biggest issue on the roads today?
A: I would start with speeding, especially in Kitsap County. The winding roads and big trees, you go around a corner too fast and hit a tree. I would say speeding is prevalent and impaired driving. A significant number of younger drivers under the age of 26 are exhibiting their independence by speeding and driving impaired.
Q: If you could change one thing about Kitsap Countys laws, what would it be?
A: We need stricter DUI laws because you can lower the speeds, write them tickets, but stricter DUI laws and consequences are needed. You can kill someone with your car and get six years in jail or you can go out and shoot someone and get 25 years, but both used lethal weapons.
Q: Who has made the biggest impression on your life?
A: My parents they always supported me in what I did.
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text:
San Antonio Spurs 111, Golden State Warriors 96: Spurs win, but it's not all "flowers and lollipops"
AT&T CENTER–Tiago Splitter notched his first NBA double-double (10 points, 14 rebounds), Steve Novak provided another spark off the bench, and the defense held Monta Ellis to 10 points. Yet the San Antonio Spurs 111-96 victory was, as head coach Gregg Popovich put it, "not flowers and lollipops."
That's because Tim Duncan went down early against the Golden State Warriors, again, only unlike last time there would be no return for a triple-double. X-rays were negative, but as Sean Elliott reported, Duncan could be out a couple weeks.
"It's bad timing. Hopefully it's nothing really bad, but I saw him in pain and he's not one of those guys that's going to pretend or do that if he's not hurting," Manu Ginobili said. "It's bad, but hopefully it's just a couple games and he'll be back soon."
With Duncan limping to the locker room, Tiago Splitter stepped in and had a very productive first quarter with eight points and six rebounds. With big nights from Novak (13 points, 5-6 shooting), Tony Parker (17 points, a tied-for-career-high 15 assists), and Ginobili (28 points) it was enough to get past these Warriors without Tim Duncan. But not without some cause for concern.
Notably, after the game Popovich was unhappy with the team's inability to finish off the Golden State Warriors–having to put starters back in the game–playing Parker and Ginobili near their season averages in minutes in what should have been a runaway victory–after the bench let the visiting team claw back within single digits in the fourth quarter. It is a trend Pop would rather not see continue.
"Unfortunately Tony and Manu needed to be on the court as long as they were," Popovich said. "If everybody on the bench would have shown, but we had a couple of guys who need to step up their games as we get down the stretch and into the playoffs.
"I just need the bench to be more consistent and I don't think they've been as consistent as I would like in the last five or six games, even though we've won a few."
That statement could easily have been directed at Matt Bonner, who hit his first shot, and his last shot, but missed the seven in between. It's been a rough couple of games for Bonner, eased a bit for the Spurs by the minutes put in by Novak.
"He's human. He's one of the best shooters in the league and he hasn't had two consecutive bad shooting games all season up until this point," Ginobili said of Bonner. "He just needs to keep shooting."
There will be ample opportunity in the coming weeks in the absence of Duncan, and not just for Bonner, but for everyone.
"We're going to have to play a little bit faster, a lot of pick and rolls with myself and Manu," Tony Parker said. "And just try to get everybody else to pick it up and be aggressive."
Without Duncan, expect a lot more of the offense to fall in the hands of Parker, who has been nothing short of brilliant over the past few weeks. While he still may not possess the creativity and artistry of a Steve Nash or Chris Paul, Parker has honed his decision making and passing.
Keeping in mind that it's Golden State, Parker was still able to get in the paint at will. And while he'll never be as adept at slipping passes through multiple defenders at will as his aforementioned peers–though he's not bad by any means–he does not need to be. His ability to get in the lane is so potent, and he draws so much attention, he'll always have his pick of passing lanes.
That being said, this team is not going where it needs to be without Tim Duncan. Get well soon.


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The following tribute to John Duffey was written by Dudley Connell for Sing Out Magazine.
John said, `There were enough versions of `Blue Ridge Cabin Home' and `Cabin in Caroline' to go around. 'He was looking for something different. Hence the Country Gentlemen's song bag included John's jazzy mandolin interpretation of `Sunrise', Bob Dylan's `Its All Over Now Baby Blue', and a mandolin version of the theme from the movie `Exodus'. John also recognized the importance of the Folk Revival in the early 1960s and spent a considerable amount of time at the Library of Congress, researching material and achieving considerable success in composed melodies for old poems he found during his research. Songs entering the Country Gentlemen's repertoire in this manner include the classic, `Bringing Mary Home' and `A Letter to Tom'. In addition to collecting and arranging old songs and poems, John composed and dedicated to his wife Nancy, `The Traveler', and the haunting `Victim to the Tomb', along with many others. But by the late 1960s John had tired of all the traveling necessary to sustain a bluegrass band. `I just got tired of saving up to go on tour,' he said. In 1969 Duffey left the Country Gentlemen with no intentions of performing again. During the 1969 to 1971, John operated a musical instrument repair shop. But in 1971 John again found himself involved with music business, and again, by accident. He was joined in a informal group by former Country Gentlemen bassist Tom Gray, and by Ben Eldridge, Mike Auldridge and John Starling. This band would go on to be known as the Seldom Scene.
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Faculty Hall of Fame Award 2004
Dr. Hyunsoon Whang
Hyunsoon Whang, D.M., of Lawton, was born in Seoul, Korea, and received her high school diploma from the North Carolina School of the Arts. She earned a B.M. in piano performance from St. Louis Conservatory of Music, M.M. in piano performance from The Juilliard School and D.M. in piano performance and literature from Indiana University. She is a professor of music at Cameron where she has served since 1993. She founded the Cameron University Piano Competition for high school students and is faculty advisor for Cameron's Asian Pacific Island Student Association. She is founder and coordinator of Lawton's chapter of Musiclink program. A nationally renowned pianist, she has distinguished herself in more than 350 concerts across the United States and other countries and has appeared as soloist with eminent conductors including Leonard Slatkin. She has given many performances in the Lawton-Fort Sill area and has performed benefits for KCCU. She has received the Entertainer of the Year from the Earth Day Coalition in Cleveland, Ohio, the Distinguished Research Award from the Southwest Oklahoma Advanced Technology Association and Artist of the Year from the Lawton Arts and Humanities Council.


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Wrong study, do you have a shortened procedure for Little Alb? It's just so overly long.(Original post by Rizzy J)
5 year old boy taken to freud suffering from phobia of horses. Freud saw hans once or twice. Information came mostly through hans father.
At age 3, hans developed interest in his own penis. Age 5 mother threatened to cut it off if he did not stop playing with it. Developed fear a white horse would bite him. Hans fathee related to freud that this was probably related to horses large penis. Father objected him into getting into parents bed in the morning. Hans feared going out of the house incase he encounted a horse. Fear became limited to horses with black harness noses, hans father interpreted this as his black moustache. Hans had two fantasises: he had several imaginery children, asked who the mother was, said why mummy and you're granddad. Also imagined a plumber fitting him with a bigger penis.
Freud saw phobias as expression of Oedipus complex-fantasised himself with a big penis like his father and married to his mother with father in role of grandad
Edexcel AS Psychology UNIT 2 29th May 2012
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(Original post by stephbeeeify)
Neurotransmitters are chemicals that are found in the synaptic gap between two neurones. They pass messages from one neurone to another. Neurotransmitters come from one terminal button from one neurone and are passed to the dendrite on the next neurone. The neurotransmitter fits onto the receptor on the second neurone which changes the shape and allows an electrical current (message) to pass from one neurone to another
A bit mixed up! haha
Describe your practical for the biological approach (5 marks)
Do females have better memory at object location.
Given an image to look at for one minute. Then given another image to look at for two minutes. had to note down the differnce between the two images.
ppts allowed to withdraw from the experiment. informed consent given before experiment. debriefed at end of expeiment.
results were significant as the caluculated figure was higher than the critical value.
describe the oedipus complex and relate to hans study
(Original post by al0)
Wrong study, do you have a shortened procedure for Little Alb? It's just so overly long.
A- explore whether a fear response to a stimulus could be classically conditioned
P- 9 month old infant chosen for emotional stability
unafraid of a range of stimuli including rat. 2 month later was shown the rat again and when he reached for it, a lound noise was made with a hammering and a steel bar which scared him. repeated 5x, 1 week later
R- when steel bar was struck, albert showed fear. second trial, cautious about the rat and leaned away when the rat was presented. 5 days later albert cried in response to the rat and various objects with fur, coat, and theses responses persisted until the final testing, 7 weeks after start of the study
C- classically conditioned to be afraid of the rat and through generalisation became afraid of other white, furry object's.
I think that Hans, Dibs and Money are gonna come up
- Thread Starter
Yeah i think Dibs and Money are very likely to come up. And the comparison of the gender development between the approaches. Maybe some bits on animal studies too. I'm going to sleep, its almost 2am hahah. Good luck in your exam everyone!
do you guys think inferential stats will come up ?
Good luck guys!
How did you guys all find the exam?
we're allowed to talk about it now! Haha
I was so happy about the Craner study
What did everyone write about to do with the woman not smoking on the plane, what therapy did you put?
I used aversion therapy for the smoking
What did you use?
I used token economy!!
I didn't think the exam was too bad!
the 12 marker who wrote about bachrach?
i was so happy with this exam!
i did Systematic Desensitisation to get rid of the fear of flying.
was so glad Axline came up as the 12 marker :P
and the comapre Biological and Learning (:
I did systematic desensitisation too
I thought it was a really nice exam actually.
Has any one got a copy of a provisional markscheme yet please
(Original post by Oli-Ol)
I did systematic desensitisation too
I thought it was a really nice exam actually.
Full marks or close to it
how'd people get on?
I got 115/120
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Rome often brings to mind snapshop images from a warmer time of year when the city is bathed in that sunny and delicious glow. While the months of March through November are indeed a beautiful time of year to be in Rome, there's definitely a higher price tag to go with it and in more ways than just financial. Here are some very compelling reasons to consider coming to Rome in the winter months:
High season in Rome runs at least 8 months – from March through October and is slowly starting to extend into a 9th month with November. It starts off slow, but then Rome gradually starts bursting at the seams and the popular spots in particular can be suffocating. Yet come the winter months, and in particular January and February, and you expect to see tumbleweeds blowing down the street. Not that Rome is ever a ghost town, but there's just more breathing room in the winter.
The Big 3 – Rome, Florence and Venice – become different cities especially in January and February. In a way you can even say that they seem to be returned to their residents when the insanely large crowds have all but disappeared. One of the main reasons is because of the weather. Most people equate blue skies and dazzling sunshine with Italy and they would be correct. However, while colder temperatures, rain and grey clouds don't coincide with many people's preconceived ideas of Italy – it also makes for an experience that is unique and yet just as wonderful if not more so. You can still find clear blue skies and sunny days in winter, but walking in Rome's center on a crispy cold night with the golden glow of its street lights and the city wrapped in fog, mist or rain will also make some great memories and moody photographs. With the lack of crowds, the sights, the smells are much easier to appreciate and that's when you can truly experience the magic here.
Many people think that March and April being the start of high season, will be a good combo of nicer weather and less people, but keep in mind that these months are also the time of year European schools have their yearly trips and so many large and small towns around Italy are taken over by school groups.
It's difficult anymore to predict airline fares, but rates in January and February are on average several hundred US dollars less during these months than at other times of the year and even lower if you are internet savvy or have a great travel agent. Within Europe, low cost airlines such as RyanAir, EasyJet, AirOne, Transavia to name a few are always a bargain, but even more so during low season. Many accommodations (including yours truly) have lower prices during this time of year and during particularly slow periods additional discounts are sometimes available. In the summer it can be hard to even find a place, and if you're traveling around without firm plans, hoping to book as you go, you'll waste a lot of time trying to find something decent at the last minute. In the winter, places like our Beehive which are difficult to find a spot in high season – often have space available in low season.
Rome can be sensory overload – traffic, people, and so much to see. Going to the Vatican Museums when you're already fatigued is a recipe for disaster, but fatigued you will feel after waiting in a queue in the heat of summer for over an hour. Want to visit the Borghese gallery in the summer and didn't reserve weeks in advance? It's not likely you'll get a reservation at the last minute. An experience I had in Florence a couple of years ago is indicative of what it's like in the bigger cities in winter. I was able to walk right into the Accademia without a ticket, no queue to buy my ticket and had a completely unobstructed view of Michelangelo's David. The same was true for the hike up to the cupola of the Duomo – no queues at all. All the places you want to see – well, many other people want to see also and in peak season you'll be competing for space with a much larger pool of people. Visiting when it's less busy, you'll not only cruise right into many of these places, often without reservations, but you'll also have more breathing room to actually enjoy what you're looking at.
Our favorite time of year for food here is the winter. Artichokes, greens galore, chestnuts, cavolo nero (kale, used for ribollita soup), and don't even get me started on the citrus – clementines, mandarins and Sicilian blood oranges called tarocchi. There's nothing like a glass of red wine and a hearty Tuscan soup on a cold, dreary day or a cup of thick hot chocolate with panna (whipped cream) to warm you up or a cozy cocktail near the Colosseum when the rain is coming down. And gelato knows no season!
When you take all of the above together – it causes you to slow down. Your energy isn't sapped by the heat or the crowds, some rain may make it so that you find yourself with a good book in a cozy cafe or with your partner or friend sharing a drink and good conversation instead of non-stop sightseeing. The shorter daylight hours urge you to get up earlier to take advantage of the daylight and to get a bit more sleep at night. While it's great to see everything – you have to reconcile with the fact that you really won't see and do everything – so take this time during Rome's winter season to enjoy the city in a different and special way.
[…] • 5 nights accommodation for 2 in Rome at The Beehive Hotel during our low season (read here why that's a great time to come). […]
[…] Source: http://www.the-beehive.com […]
All true! I lived in Florence for a year and what I miss most is the smell of chestnut-flavoured woodsmoke from chimneys in the countryside. Here in the antipodes we don't burn chestnut wood and winter doesn't quite seem as rich without it!
Ssshhhh! Don't tell anyone!
[…] • 5 nights accommodation for 2 in Rome at The Beehive Hotel during our low season (read here why that's a great time to come). […]
> Siteseeing – as in actually being able to see the sites
They are things you came to SEE- Sights!!
Sites are pieces of land where people build things. Unless you're a surveyor, it's unlike you came to Rome to look at sites.
The Pantheon is not a site. it is a sight!
Wow, fantastic tips about enjoying a visit to this amazing city and the off season is definitely the time to travel. I love Rome and touring around this ancient capital. Sharing are some images of my favorite hangout spots and landmarks to visit around the city http://travelphotodiscovery.com/rome-20-pictures-to-inspire-you-to-visit/
And how is it in the second half of december?
Definitely slowed down, but the Christmas/New Years holidays starting around 20 December until 6 January is a bit busier period – mostly with Italian tourists as that is when children are out of school.