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By guest author, Bob Twillman, PhD, FAPM
On July 25 2012, Physicians for Responsible Opioid Prescribing (PROP) submitted a petition to the US Food and Drug Administration (FDA) on behalf of its members, several other individual healthcare provider signatories, and the advocacy group Public Citizen, requesting changes to the currently approved label for opioid analgesics. [The petition document is available here.]
I have a number of concerns about this petition and about the quality of the stated scientific basis for it. I believe the changes requested could severely impede the provision of the kind of high-quality, individualized, integrated biopsychosocial care for chronic pain called for by the 2011 Institute of Medicine report on chronic pain.
In their letter, the petitioners explain that the current FDA-approved indication for nearly all opioid analgesics on the market is for treatment of "moderate to severe pain," with the addition of "when a continuous, around-the-clock analgesic is needed for an extended period of time" for extended-release opioids. They assert that many clinicians mistakenly believe that this indication means that long-term opioid therapy is appropriate for chronic non-cancer pain, leading to overprescribing and harm to patients.
They further assert that the current label for opioid analgesics is noncompliant with the Federal Food, Drug, and Cosmetic Act's requirement that "a drug intended to treat a condition must be proven safe and effective for use as labeled." The petition then asks FDA to change the approved indications for opioid analgesics when they are used in the context of noncancer pain. Specifically, the petition requests three changes to opioid analgesic labels:
- "Strike the term 'moderate' from the indication for noncancer pain" [so that only "severe" pain remains on the label];
- "Add a maximum allowable daily dose, equivalent to 100 milligrams of morphine for noncancer pain"; and
- "Add a maximum duration of 90 days for continuous (daily) use for noncancer pain."
The document then includes 9 "statements of scientific basis for petition," each of which will be described in some detail further below.
Suggested Dosing & Time Limits
The petitioners request that FDA limit the label indication for opioids for noncancer pain, NCP (note this is not just chronic NCP, but all NCP, including acute NCP) as outlined above, and they state that this would enable FDA "to reinforce adherence to dosing limits that have been recommended by the United States Centers for Disease Control [CDC], the state of Washington, and the New York City Department of Health and Mental Hygiene [NYC]."
Interestingly, a review of these 3 cited sources reveals a suggested threshold of 120 mg morphine-equivalent dose (MED) per day in two cases (CDC and Washington), and 100 mg MED in the NYC guideline. But these are not absolute limits that are not to be exceeded; in fact, each of these guidelines suggests that patients at or above these dosage levels either be considered for referral to a specialist for consultation (again, CDC and Washington) or for "reassessment of the patient's pain status and treatment plan, and reconsideration of other approaches to pain management" (NYC); not that patients be automatically tapered off the medication.
The shifting nature of the target dose supports the assertion by many that these thresholds are arbitrarily chosen, and could just as easily be set at the 200 mg MED mark suggested in the American Pain Society/American Academy of Pain Medicine guideline for treatment of NCP referenced in the petition (a document, incidentally, whose first author was Roger Chou; he and co-author Jane Ballantyne are both signatories of this petition).
Similarly, the 90-day limit on use of opioids for NCP is arbitrarily chosen, and could just as easily be set at 180 or 360 days. I am aware of no scientific data supporting the notion that something occurs at the 90-day mark that makes this threshold more significant than any other arbitrarily-chosen threshold, and the petitioners do not cite a source for this number.
It is possible that the omission of the word "chronic" from the petition's requested actions was an oversight, given that further references in the document all focus on chronic noncancer pain. However, this is a significant omission, as many patients with severe acute NCP, such as those with severe multiple traumatic injuries, can easily require doses of opioids higher than 100 mg MED for extended periods of time. Further, many definitions of chronic pain specify a minimum duration of 90 days, meaning that the request for a 90-day maximum duration of opioid therapy implies that opioid therapy for chronic NCP is always inappropriate.
Does This Label Comply with the Law?
As the authors note, the law allowing FDA to determine official indications for medications states that a drug must be proven safe and effective for use as labeled. Obviously, to make this determination, some standard for "safe and effective" must be established, and FDA is granted the statutory authority to determine the standard to be used. Historically, when considering opioid analgesics, FDA has used the standard of a 12-week trial of the medication. It has not required longer studies, and has acted on the basis of evidence from 12-week trials whenever it has considered an opioid analgesic. In so doing, FDA technically has been in compliance with the law.
The petitioners, it seems, really want to challenge the decision of FDA to establish a 12-week standard as adequate, rather than to accuse it of breaking the law. It might be determined, after further review, that long-term studies (6 months? 12 months?) are necessary, given knowledge that has accumulated since these medications were approved. However, that is a different question, and one that is not included in this petition.
Statements of Scientific Basis for Petition
The petitioners include 9 statements purporting to provide a scientific rationale and support for the requested label changes. These statements are based on scientific works that are as sparse as the bodies of evidence supporting long-term opioid therapy criticized by the petitioners as being insufficient. I will critically examine each in turn.
- "Over the past decade, a four-fold increase in prescribing of opioid analgesics has been associated with a four-fold increase in opioid related overdose deaths and a six-fold increase in individuals seeking treatment for addiction to opioid analgesics."
This statement references a November 1, 2011 report from the CDC, which I have critiqued in a previous Pain-Topics UPDATE [here]. The many methodological flaws aside, this report sheds little light on the relationship between long-term opioid use and risk of overdose death and addiction. It is not at all clear how many of the people dying of overdoses involving opioids were taking their medication as prescribed, how many were taking their own medication in ways other than as directed, and how many were taking someone else's medication.
For example, Hall et al. [2008, ref below at end] found that 79% of people dying from overdoses involving opioids tested positive for alcohol and other drugs, and that 56% of cases had no prescription for an opioid. The solutions for these problems differ greatly, depending on the mediating factors between prescription and overdose death.
The sharper increase in admissions to substance abuse treatment could be seen as a positive factor, indicative of an increased recognition of need for treatment and of treatment program availability.
To be completely clear, even one case of addiction and even one case of death from overdose is a tragedy. So, too, is one case of inadequately treated chronic pain. The fact that increased rates of prescribing are matched by increased rates of overdose death suggests that the adverse outcome is a phenomenon that occurs at a certain rate regardless of how many prescriptions are written. To prevent the tragedies, though, we need to know how you get from "Point A" prescribing to "Point B" overdose and/or "Point C" addiction.
In short, the correlation between prescribing and these two outcomes represents a signal that there may be a relationship, but the proper solution can be determined only by gaining a full understanding of the intervening factors between the supposed cause and its seemingly-related outcome.
- "Prescribing of opioids increased over the past 15 years in response to a campaign that minimized risks of long-term use for CNCP [chronic noncancer pain] and exaggerated benefits."
Certainly, any campaign supporting the use of opioid analgesics should provide accurate information about both the risks and benefits of their long-term use. The FDA has taken corrective action in this area, as have the courts, punishing manufacturers who marketed their products wrongfully, as the petitioners' references in support of this point indicate.
It strikes me as interesting, though, that the petitioners imply that there is no real evidence of benefits of long-term high-dose opioid therapy (LTHDOT), yet they claim that manufacturers exaggerated such benefits that may not exist. As we will see below, the same may be said with respect to the accusation of minimizing risks.
- "Long-term safety and effectiveness of managing CNCP with opioids has not been established."
As mentioned above, the FDA's standard for evidence of safety and efficacy (note the difference between efficacy and effectiveness; these studies address the former and not the latter, and this is a significant difference) requires a series of 12-week clinical trials. Longer studies have not been mandated by FDA.
A recent FDA workshop found general agreement among experts that high-quality long-term data on both risks and benefits are lacking. However, a number of post-marketing studies have been conducted, demonstrating continuing pain relief efficacy in some patients. Other reports in the literature, including Ballantyne [2006], find that low-quality evidence sources, such as case studies, demonstrate that some patients can attain satisfactory analgesia by using opioids for up to 6 years.
At least one systematic review of long-term opioid treatment for NCP has been published. Devulder et al. [2005] presented the results of 11 studies that evaluated long-term treatment with opioids in patients with chronic NCP and also assessed quality of life (QoL; n=2877). Six of the studies were randomized trials and the remaining 5 were observational studies.
Of the 4 randomized studies in which baseline QoL was reported, 3 showed an improvement in QoL. Similarly, of the 5 observational studies, a significant improvement in QoL was reported in 4 of them. The authors found that there is ample evidence suggesting that long-term treatment with opioids can lead to significant improvements in functional outcomes and QoL in patients with chronic NCP. However, the authors suggest, further investigations will help to confirm the long-term QoL benefit of opioid therapy in such patients, and to clarify any effects of physical tolerance, opioid withdrawal syndrome, and/or addiction — all potentially associated with long-term use of opioids — on patients' continued functional status.
This is not intended to endorse long-term opioid therapy; however, it is necessary to remember that the absence of evidence for long-term opioid safety and efficacy does not equal evidence of absence of long-term opioid safety and efficacy. The simple truth is that we just do not know with much certainty how many, or which, individuals with chronic NCP benefit from, or are harmed by, LTHDOT. Unless and until FDA changes the standard on which it bases its labeling decisions, and adequate data are collected to demonstrate the contrary, the current labeling should stand, based on the absence of evidence to the contrary.
- "Recent surveys of CNCP patients receiving COT [chronic opioid therapy] have shown that many continue to experience significant chronic pain and dysfunction."
The use of the word "many" here is vexing. How many is "many"? What does it mean if "many" continue to experience significant pain and dysfunction?
Given the current state of the science of pain management and therapeutics, it is unreasonable to expect anyone with chronic pain to find complete relief and return of normal functioning through the use of medication alone. Chronic pain represents a broad spectrum of conditions; all of these conditions are complex (as are all chronic conditions); some may respond well to pharmacologic intervention with opioids, and others may not.
This depends on the particular nature of the condition and the person. In most cases, optimal treatment for chronic pain conditions require a host of other biological, psychological, social, and spiritual interventions as well. Successful treatment also depends largely on the willingness of people with chronic pain to become active participants in their care and make lifestyle changes (ie, eating well, exercising, employing stress reducing techniques, etc.).
The fact that opioids do not alleviate all pain and dysfunction is, in fact, an expected outcome. Few, if any, medications on the market are 100% efficacious in treating any condition, especially medications whose effects are primarily mediated through the central nervous system (eg, opioids, antipsychotic medications, antidepressants, and benzodiazepines).
- "Recent surveys using DSM criteria found high rates of addiction in CNCP patients receiving COT."
The two studies referenced by the petitioners to support this point do find a high percentage of people using long-term opioid therapy for chronic NCP meeting criteria for diagnoses of opioid dependence and opioid use disorder. Boscarino et al. [2010] administered a standard structured interview to patients using opioids to treat chronic noncancer pain, and determined if they met the diagnostic criteria for a DSM-IV-TR diagnosis of opioid dependence. Later, the researchers used the same data set, but retrospectively applied the proposed DSM-5 criteria for opioid use disorder [Boscarino et al. 2011].
Neither DSM-IV-TR nor DSM-5 has diagnostic criteria specifying the term "addiction," leaving the diagnoses of opioid dependence and opioid use disorder the closest approximation. The 2010 study found 26% of subjects meeting criteria for current opioid dependence and 36% for lifetime opioid dependence, while the 2011 study reports a 35% lifetime rate of opioid use disorder. Curiously, the 2011 study does not report current opioid use disorder rates.
Boscarino and colleagues note that both DSM-IV-TR and DSM-5 criteria for these disorders include tolerance and withdrawal, which, as signs of physical dependence, are normal expected consequences of long-term opioid therapy. Other diagnostic criteria also could be benignly endorsed by many long-term opioid therapy patients, including use of the medication in higher amounts or over a longer term than intended, and a persistent desire or unsuccessful efforts to cut down or control use of the medication.
Many patients in clinical pain management settings report that they never wanted to use opioids for as long as they have, or at the doses they have used, and many try to exert control by stopping or curtailing their use without medical advice to do so — only to discover that withdrawal occurs, as we would expect. This, I submit, is not evidence of addiction, but rather of a normal desire of the patient to achieve pain relief without having to rely on opioids.
Finally, these diagnoses in both DSM-IV-TR and DSM-5 require a determination that the patient is experiencing significant dysfunction and/or distress as a result of their substance use. Many people with chronic pain experience significant dysfunction and distress resulting from their chronic pain, and it is not clear to what extent Boscarino et al. determined whether it was the pain or the medication causing the observed dysfunction and distress.
Other studies have produced very different findings about the prevalence of addiction in people on long-term opioid therapy. The issue of normal sequelae of long-term opioid use clouding the diagnosis of addiction was addressed by Elander et al. [2003]. Using DSM-IV criteria, they found that 31% of a sample of sickle cell disease patients taking opioids for pain met criteria for substance dependence — remarkably similar to the results of Boscarino et al. — however, when the assessment excluded pain-related symptoms, the rate fell to only 2%. More recently, Fleming et al. [2007] studied a sample of patients receiving daily opioid therapy from primary care physicians, and found a 3.1% point prevalence of DSM-IV opioid dependence.
Evidence regarding the rate of addiction among patients with chronic pain using opioids long-term is, at best, equivocal. The extreme range of prevalence estimates, from 2% to 26% for current diagnoses, suggests that there may be methodological issues that need to be resolved in order to determine the true prevalence of addiction, as it is unlikely that samples with similar characteristics, drawn from similar medical settings, would differ to this high degree purely because of sampling error. This body of evidence does not support a change in opioid analgesic labeling.
- "A large sample of medical and pharmacy claims records found that two-thirds of patients who took opioids on a daily basis for 90 days were still taking opioids five years later."
It is hard to know what the petitioners intended to prove by including this finding. In essence, it says that patients who use opioids long-term do, in fact, often continue to use opioids longer-term. Is that a bad thing, a good thing, or some of both?
Without knowing why these patients continue to use opioids, it is impossible to interpret the meaning of this finding. The patients may be continuing to use (prescribed) opioids because they are experiencing improved pain and functioning. They may be continuing to use opioids because they are addicted. They may be continuing to use opioids because they provide some degree of pain relief and improved function and they have not been offered other options by their providers. Unfortunately, in the case of the latter, this is all too prevalent because too few providers have the knowledge and skills to provide patients with optimal care and too few insurance companies reimburse for the full range of effective treatments.
In any event, this claim by the petitioners contradicts some criticisms of long-term opioid treatment that high rates of patients discontinue the therapy because of inadequate pain relief or intolerable adverse effects. Without the necessary context to explain these findings, it provides no useful information with respect to labeling.
- "Patients with mental health and substance abuse co-morbidities are more likely to receive COT than patients who lack these risk factors, a phenomenon referred to as adverse selection."
There is considerable evidence that this is true, and I'm not going to dispute it. However, this is irrelevant to the discussion at hand; it says nothing about the long-term safety and efficacy of opioids. The solution to so-called "adverse selection" is to train prescribers to be more effective in their assessment practices, so that they detect these co-morbidities and treat them appropriately. Changing the label on opioid analgesics will not accomplish this, and it will not stop patients with these co-morbidities from receiving long-term opioid therapy at higher rates than those without them.
- "Three large observational studies published in 2010 and 2011 found dose-related overdose risk in CNCP patients on COT."
The 3 studies cited by the petitioners in support of this point have been thoroughly critiqued in previous Pain-Topics UPDATES: the Dunn et al. (2010) study [here], the Bohnert et al. (2011) study [here], and the Gomes et al. (2011) study [here].
These large observational studies are retrospective exercises in data mining, involving initial sample sizes running well over 100,000 in two cases, with opioid-related fatality rates well under 1%. The studies do not control for a variety of potential confounding factors, such as the concomitant use of other central nervous system depressant medications, population factors that may increase the risk of overdose and death, and determination of the extent to which decedents used their medications in ways other than as prescribed.
The elevated risk of death is cited in relative terms based on arbitrary dosage ranges (eg, patients using <20 mg morphine equivalent per day had a death rate of X, while those using 21-90 mg per day had a death rate of 2X). What gets lost in the shuffle is the fact that 'X' is very small in absolute terms. Twice (or 3 times, or 5 times) a very small number is STILL a very small number.
Additionally, even if the numbers are meaningful and significant, the lack of important contextual information makes this nothing more than a signal that there is a problem. It does not tell us the nature of the problem, leaving us with only one possible solution; ie, removing the one known factor — opioid analgesics. Data mining studies are useful for generating hypotheses but not for testing or proving those hypotheses.
- "COT at high doses is associated with increased risk of overdose death, emergency room visits and fractures in the elderly."
This statement is misleading in a number of ways; although, this concern does not endorse the safety of high-dose opioids. First, the Gomes et al. article is cited again in support of overdose risk, just as it was in the previous statement; there is no need to review and dispute it again here.
Second, the petition cites a report by Braden et al. [2010, ref below] on risk factors associated with emergency room (ER) visits among people using opioids long-term. The subjects come from two different populations; Arkansas Medicaid (n = 10,159) and a private insurance plan covering parts of 14 states (n = 38,491). Among other things, the study determines average daily opioid dose in mg MED per day, and then divides the sample into three categories: a) those taking less than the median dose (35 mg and 32 mg MED in the two samples, respectively); b) those taking between the median dose and 120 mg MED; and c) those taking more than 120 mg MED.
The authors note that a cut point of 120 mg MED was arbitrarily chosen because it is the threshold recommended in dosing guidelines issued by authorities in Washington state. Data analyses determined that the two higher-dose groups had an elevated risk of ER visits in the Arkansas Medicaid sample (RR = 1.30 and 1.08, respectively), but not in the private insurance sample (RR = 1.03 and 0.97). Note that, despite the modest relative risk elevation in absolute terms, the Arkansas Medicaid findings reach statistical significance because of the very large sample size.
However, given that the private insurance sample is nearly 4 times as large, the failure to find significant results in that group suggests that there really is no difference to be found, and there may be something specific about the Arkansas Medicaid sample that changes the findings. Methodologically, one also wonders what the findings would have been if a more traditional analysis comparing only groups above and below the median had been conducted.
Third, a study by Saunders et al. [2010] is cited in the petition as examining the occurrence of bone fracture in people 60 years of age and older who had previously been prescribed opioids 3 or more times in a 90-day period. They examined risk of fracture as a function of current dose, including in one group that had discontinued opioid use and thus served as a no-current-opioid control.
In a sample of 2,341 subjects followed for 6,379 person-years, 320 fractures were confirmed. Median daily dose of opioids was 7.6 mg MED. Groups based on opioid dose were arbitrarily established as: 0 mg MED; 1 – <20 mg MED; 20 – <50 mg MED; and 50+ mg MED.
Compared to patients no longer taking opioids, patients currently taking any dose of opioids did not display a significantly elevated risk of fracture; although, there was a clear trend in the direction of more fractures (hazard ratio = 1.28, CI 0.99-1.64). Within the dosage levels, only the group taking 50+ mg MED displayed a significantly elevated fracture risk (hazard ratio = 2.00, CI 1.24-3.24); although, the confidence interval here overlapped with the overall, nonsignificant results for those taking any opioids.
So, in order to display an elevated risk of fracture, patients needed to be taking an average opioid dose roughly 6 times the median dose for the population. The authors control for a number of confounding factors, but exclude perhaps the most obvious one: the patients' underlying diagnoses.
Those patients who continue to take opioids at elevated doses, compared to those who started opioids but were able to discontinue them, might well have painful conditions that necessitate the use of opioids. Those painful conditions themselves might create or mark an elevated risk of fractures. In any case, even if these findings hold up in subsequent studies, they represent valuable information about risks that are to some degree manageable through patient education and the provision of adequate assistive devices, they are not absolute contraindications.
The Problem of Defining "Noncancer Pain"
Even if the petitioners had an ironclad case supporting their assertions about the risks of long-term high-dose opioid therapy, I believe they would still have a significant problem with their requests of the FDA. That problem lies in their specification of proposed labeling changes applying to "noncancer" pain.
"Noncancer" pain is not, I submit, a solitary diagnostic entity. It is a category subsuming a large number and wide variety of conditions, some of which most pain management clinicians would agree may benefit from LTHDOT, and some of which clearly do not. The proposed label changes might be perfectly reasonable if the condition being treated is fibromyalgia, but they might be totally unreasonable for a person with severe rheumatoid or osteoarthritis that is not helped by other treatments.
And while "noncancer" pain is not a solitary entity, neither is "cancer" pain. In fact, with an ever-increasing number of long-term cancer survivors who have chronic pain as a result of their treatment, applying the label "cancer" pain starts to strain credulity. Yet, under the petitioners' proposal, it would be deemed acceptable to use LTHDOT to treat, for instance, phantom limb pain resulting from a below-the-knee amputation due to osteosarcoma, but it would not be acceptable to treat the same condition resulting from a traumatic amputation. That's just not logical, and it exposes how inadequate and inappropriate the false dichotomy of "cancer" versus "noncancer" pain can be.
To those unfortunate individuals who have moderate to severe pain unrelated to cancer, and relieved by LTHDOT, what are we to say? "I'm sorry, but even though you achieved greater pain relief with each opioid dose increase up to 100 MED, I am not allowed to go any higher, so you'll just have to live with the pain that you have." Or, "I'm sorry, I realize that the opioids I have prescribed for you have given you relief for the past 3 months, but now I have to stop giving them to you; good luck finding something else that works." Neither of these seems either reasonable or consistent with the moral obligations of the medical profession.
Summing Up: No Simple Solutions for Complex Issues
In considering all of this, it appears that the petitioners are asking for changes to the indications for LTHDOT for noncancer pain based on a small number of studies with significant methodological shortcomings and findings that are not conclusive. In short, they are basing their request for label changes on the same kind of evidence that they, themselves, criticize as being insufficient to support the safety and efficacy of LTHDOT for noncancer pain.
Evidence is not conclusive until there is a sufficient accumulation of high-quality studies with consistent findings, something that has not been demonstrated by the evidence proposed as supporting this petition. For its part, the FDA sponsored a 1½ day workshop last May at which it considered these issues at length. Having attended that workshop, I have to say that I left with the conclusion that, based on the large body of solid scientific studies presented, we do not know much at all about either the risks or the benefits of LTHDOT. [A transcript of that workshop is available here.]
What we DO know about this therapy is primarily derived from anecdotal clinical observation. That source of information tells us that there are, indeed, some patients who benefit from this type of therapy, while there are others who are harmed by it. The question, it seems to me, is not the simple "Why should we ever do this?" but rather the more complex "When should we do this, in which patients, using what clinical protocols, and with which safeguards?"
The petitioners' proposal is a blunt instrument solution based on the faulty premise that this problem will be solved if we only restrict the supply of opioid analgesics to a sufficient degree. Unfortunately, such "supply-side" solutions threaten the ability of people with chronic pain to obtain safe and effective relief when opioids are responsibly prescribed, in conjunction with other treatments, by skilled clinicians.
Chronic pain is not simple, it is complex; addiction is not simple, it is complex; the solution to the problem of prescription drug abuse also is not simple, but complex. Having reasonable discussions about the nature of the problems and their solutions, with a willingness to move away from the extremes of either hard-and-fast prohibitionist or "opioids-for-everyone" stances is what will be required to find the complex answers that we need. It is time to invest our efforts in that productive pursuit and balanced dialogue, rather than in a constant tug-of-war over which extreme position is right.
- Ballantyne JC. Opioids for chronic noncancer pain. Southern Med J. 2006;99(11):1245-1255.
- Bohnert AS, Valenstein M, Bair MJ, et al. (2011). Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA, 305:1315-21.
- Boscarino JA, Rukstalis MR, Hoffman SN, et al. Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria. J Addict Dis. 2011;30:185-194.
- Boscarino JA, Rutstalis M, Hoffman SN, Han JJ, Erlich PM, Gerhard GS, Stewart WF. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system Addiction 2010; 105:1776-1782.
- Braden JB, Russo J, Fan MY, et al. Emergency department visits among recipients of chronic opioid therapy. Arch Intern Med 2010;170:1425-32.
- Devulder J, Richarz U, Nataraja SH. Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain. Curr Med Res Opin. 2005(Oct);21(10):1555-1568.
- Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M. Opioid prescriptions for chronic pain and overdose: a cohort study. Annals of Internal Medicine 2010;152:85-92.
- Elander J, Lusher J, Bevan D, Telfer P. Pain management and symptoms of substance dependence among patients with sickle cell disease. Soc Sci & Med 2003;57:1683-1696.
- Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain 2007;8(7):573-582.
- Gomes T, Mamdani MM, Dhalla IA, et al. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med 2011;171: 686–91.
- Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613-2620.
- Saunders KW, Dunn KM, Merrill JO, et al. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 2010;25:310-5.
About the Author: Bob Twillman, PhD, FAPM, is the Director of Policy and Advocacy for the American Academy of Pain Management. A 2011-2012 Mayday Pain & Society Fellow, he is also a Clinical Associate Professor of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine. Dr. Twillman practiced as a clinical psychologist in academic medical centers for 20 years, primarily in the areas of psycho-oncology and pain management.
Proviso: All observations, opinions, advice, or facts expressed above are those of the guest author, and do not necessarily reflect the positions of Pain Treatment Topics, our staff and advisors, or our educational supporters/sponsors. Opposing views, opinions, or clarifications regarding this UPDATE article are welcomed in comments below or by separate submission for consideration of publication.
There now is a site for the petition at www.Regulations.gov: "Physicians for Responsible Opioid Prescribing - Citizen Petition; Docket ID: FDA-2012-P-0818" [click here]. The petition document is available there as a PDF. Also, there is a "Comment Now!" button at that site [or click here], so those interested can type-in comments or submit documents with comments directly to the FDA.
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Chris Brown Takes To Twitter To Support Gay Rights In Cameroon
Chris Brown has used his massive audience on Twitter to share the message of equality.
The controversial rapper posted this week, "Love is not a crime. Gay or straight. Love who u wanna love. Stop the hate & sign here http://bit.ly/19BPAbF #Unity."
The link goes to an online petition urging Cameroon President Paul Biya to accept United Nations recommendations to protect lesbian, gay, bi and trans people in the nation.
The African country has seen a rise in anti-gay protests and mobs, which the government has thus far refused to stop. It has, however, said it will investigate police officers accused of attacking gays.
Accepting the United Nations recommendations would crack down on anti-gay violence, remove laws making it illegal to be homosexual, and free those jailed for being homosexual.
As of this writing, the online petition has 70,000 signatures of the 100,000 goal it seeks before bringing the petition before the Cameroon President.
Brown has a checkered past when it comes to gay rights. His single with the deceased Aaliyah, Don't Think They Know, was dedicated to gay rights. "The new single is apart [sic] of my 'UNITY CAMPAIGN' which encourages all races, genders, sexes, (everyone) gay or straight to love each other," he wrote at the time. However, it was reported earlier in the year that he and his posse attacked Frank Ocean over a parking spot while spouting anti-gay rhetoric. He has also used homophobic slurs several times on Twitter.

subset: commoncrawl


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MILWAUKEE--(BUSINESS WIRE)--Rockwell Automation (NYSE: ROK) Chairman and CEO Keith Nosbusch will present at the Electrical Products Group Conference in Florida, on Monday, May 21, 2012.
The presentation will be webcast beginning at approximately 1:15 p.m. Eastern Time and will be available on the company's website at www.rockwellautomation.com.
Rockwell Automation, Inc. (NYSE: ROK), the world's largest company dedicated to industrial automation and information, makes its customers more productive and the world more sustainable. Headquartered in Milwaukee, Wis., Rockwell Automation employs about 21,000 people serving customers in more than 80 countries.


text: Faillon isn't as cranky as Dave but does have Lorne Michaels in his corner so I don't think he's going anywhere anytime soon. Other than the week when he first moved to 11:30, no. (See the chart in the article I posted about ratings) Leno still beat him in demo most of the time. However, Leno's lead was shrinking and as I stated earlier in this thread, I don't think he could have maintained it for more than another year or two. (His lead in demo took a significant hit in the Conan fiasco.) I've been mulling over similar thoughts. I'm not sure that even the Great Carson would do so well in today's environment with everything else that's available. I'm guessing that you didn't watch Leno's final show but at the end when he was saying goodbye, you could tell that he absolutely loved, loved doing this job. For him, it's not so much the money but the fact that this was his dream job. And by his employer's metrics (ratings), he did the job very well, made them a lot of money, and didn't cause them a lot of problems (ala Charlie Sheen) and was a good soldier for them. And his bosses rewarded him for all his good work and loyalty by taking his dream job away from him, twice. On that level, I felt sorry for him.


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Pawsitively Meow-Worthy
(Page 3 of 16: Viewing Diary Entry 21 to 30)
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Kaci SunshineNovember 9th 2010 4:50 pm
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Oh my god, we are in tears and so sad right now. My momma's eyes are leaking bad. Our wonderful, sweet little friend Kaci Sunshine is in the hospital and failing rapidly! oh my gosh! Kaci's momma JUST lost Miss Mittens a short time ago, this will kill her! Please purr very, very hard and loud everyone! Kaci is loved by so many! Kaci Sunshine.
Kaci Sunshine is FINE!November 9th 2010 7:16 pm
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Okay this was a real poopy mess but we're just the messengers so don't shoot us! We just got a pawmail from Kaci Sunshine herself saying she has no idea why everyone thinks she's in the hospital, she's home and doing okay! We think because Boxie Brown has been real sick he hasn't updated the Get Well Purr list in a week so one of our friends saw it there and started the purr chain. LOL. We're just relieved that Kaci is okay! Phew! My momma can go to sleep easy now tonight. Thanks for the purrayers everybody. Even if they weren't immediately needed, they are always needed. Kaci still isn't out of the woods. But she's okay, HURRAYYYY!
Pink Panther & PoohNovember 16th 2010 1:07 pm
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Momma clicked on my page last night and saw that my Pink Panther music wasn't coming on. I didn't stop it and she didn't stop it! It was that youtubey thingy. They said it was copyright infringement. What fringes are they talking about? I didn't copy no fringes? Oh well, hopefully they'll leave my Winnie the Pooh music alone!
wouldn't ya know it?November 19th 2010 1:05 pm
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So, me and Finney have been EXTREMELY bored and blah lately. And NO, this is not rubbing off from our momma. We're getting out of our kitten stage and settling down which has thrown momma for a loop actually. She kinda likes it and yet was a little worried. She talked to a doctor friend of hers who has around 6 kitties and she said it's completely normal this time of year and our age. We're eating well, feeling fine, etc. etc. etc.
Oh boy! It's my gotcha day!November 22nd 2010 7:46 am
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Well I must have known it was my gotcha day because Finney and I woke up this morning and have been tearing through the house like we haven't done in weeks! Course the full moon probably helps too. But we have had the blahsies and not eating as gung ho as we usually do. Last night we started chowing and this morning we are bouncing off the walls and making momma laugh so hard she almost spit water out of her nose (that would have been really funny)!
Thanks for my Gotcha Day Presents!November 24th 2010 11:46 am
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Hi everyone! I want to say my thanks today for my gotcha day presents and well wishes AND because tomorrow is a day to give thanks. So from me and my family thank you everyone in Catsterland for sharing your friendship, support, good times and bad with us. We really found a great home here and we're so very grateful for all of our friends!
No Internet!November 26th 2010 11:35 am
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Lacey's mom here! We just wanted to let everyone know that our internet is down and we may not have it back until TUESDAY! I'm not a happy camper right now. I'm at a neighbor's house right now using his computer but may not be able to come over in the next couple of days. So if you all don't hear from us or anyone needs me on my website, still email me anyways because I'll try to check in. I just wanted to warn you in case you don't get an immediate response. It's "technical difficulties"! Grrrrr. Or as Lacey would say "RRRREEEEOOOOOOWWWWWW, PSFFTTTT". Hope you all had a good Thanksgiving!
My new jobDecember 2nd 2010 7:48 am
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So I have a new job now. My first priority and job is to be guard kitty of the house. Whenever I hear someone coming up the stairs or even talking in the stairway, I growl. I'm momma's alarm system. But I have a new job that I REALLY love!!! I'm a massager! At least once a day, maybe 2 times a day, I jump up on bed and start my purring machine and get my concentration ready.
So sadDecember 7th 2010 2:21 pm
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Ohhhhh, my momma is really sad hearing of the death of Elizabeth Edwards. Momma met her way back when her "crummy" husband was running for President. My mom had worked for his campaign and met his wife several times. She said that he was very, very charming and handsome. But his wife was the nicest, warmest lady and really had a huge heart and a brilliant mind. She fought the brave fight with that awful breast cancer!
This is REALLY REALLY REALLY funny!December 10th 2010 2:25 pm
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HAHAHAHAHAHA! Ohhhhh, my mommy is so silly it's almost too easy. She doesn't trust me and Finney around any decorations so she really never does much for any season. She says it stinks because the house looks so drab.
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Family Pets


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Mystery of the Last Olympian at Last!
Charlie's Corner Cafe
Actually, in all fairness, the schedule for research, writing, and publishing, Mystery of the Last Olympian Titanic's Tragic Sister Britannic, has been pretty ambitious. The scope of the project was wider than most of my other books and there were a lot of significant people to interview as well as intricacies in blending history, science, technology, adventure, and memoir together. It has been an exciting ride and initial response to the book has been strong. At the moment, it's available on Amazon (in print and Kindle), and Barnes & Noble and BooksAMillion will be added later. It can also be ordered through Best Publishing and the dedicated website, http://mysteryofthelastolympian.com will be periodically updated with news and photographs.
Richie Kohler, of Shadow Diver and "Deep Sea Detectives", fame has made multiple appearances in addition to the big launch we had at the, "Our World Underwater Dive Show", in Chicago the last week of February. Even though the book focuses heavily on the saga of forty years' worth of exploration on this extraordinary shipwreck, the intent was to tell the story in a way that could appeal to broad readership. It was especially gratifying when a friend of Richie's posted a blog where she fully acknowledges she is a non-diver and said, "You don't need to be a history buff to enjoy this book, it grabbed my attention and that says a lot ;). For those of you who are wondering, I was not paid to write this. Yes, Richie is a personal friend but as you know, I don't promote anything I don't believe in, especially a book about sinking ships."
We've had numerous questions about an audiobook and the odds are that will come about although I'm not certain of when. Unlike what I usually do, I can't post the entire first chapter because of certain restrictions, but I have provided the Table of Contents.
And yes, with the time this project has taken, my novel writing has lagged. I'll update about that as soon as I have a better handle on what my schedule is going to be in the near future.
I hope all of you who are still coping with cold weather will have warmth returning soon and beautiful blossoms on the way before too long.
Copyright © 2001-2016, Charlie Hudson. All rights reserved.


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The Jervis McEntee Diaries - November 24, 1883
Diary Entry:
Saturday, Nov 24, 1883 Painted all forenoon on my studio. It was foggy and damp but cleared off warm and pleasant by noon. In the afternoon I went down town and paid a great many bills getting rid of over five hundred dollars. Paid $150 on a note to S. Abbey & Sons, Paid Tracy Stebbins poor Maurices funeral expenses, Myre, the wagon makers bill, Canfield, Terrek and others. Girard rode down with me. He is in great straits and says his father refused on the interview he had with him last night, to do any thing for him. I feel sorry for him and am trying to think out some way to help him.


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It's one of the great ironies of life.
How did I, Aaron Torres, living in a region obsessed with baseball, in a college basketball crazed state, grow up to be such a big college football fan? It's like the Bermuda Triangle, Jimmy Johnson's hair, or going on a season of the Real World and being unable to hook-up. There's really no answer.
But I did. And not only did I grow up to be one of the biggest fans I know, but I also sprouted my college football legs at a time where the conference I was most affiliated with, the Big East, was coming under its greatest fire.
Believe me, I was attending UConn right around the time that Miami, Virginia Tech and Boston College decided to skip town for the ACC, and I heard it all about my beloved Big East football:
"Take away their automatic BCS bid!!"
"How soon until basketball season starts?"
"I've seen casts of Showtime late night movies with more talent than these teams!"
That last one especially stung. Even if I did just make it up.
But after all that, all the "Big Least," remarks and everything else, I've got a dirty little secret for college football fans. As we enter the second decade of the 21st century, and scholarship limits, weight training, nutritional developments and technological advances give this sport more parity than its ever had before, Big East football has actually become…pretty good. Quite frankly, it's a lot better than you think.
Looking around the landscape of college football, this league has everything needed to suceed going forward. The conference's facilities are all but caught up with the big boys (Seriously, do yourself a favor and see what UConn, Rutgers or Louisville are working with. They're as good as anywhere. Believe me.). Athletic Directors like Tom Jurich (Louisville) and Jeff Hathaway (UConn) are as good as anybody in the business. And after years of watching guys like Jim Leavitt and Steve Kragthorpe pace the sidelines with expressionless, "I just saw my grandma naked," stares, the league has finally caught up in the coaching department too.
No place is that more apparent than at South Florida.
In principle, the Bulls should be the flagship football school in this conference. They play in an NFL Stadium (Raymond James in Tampa). They have one of the largest undergraduate student populations in America (No seriously. Over 46,000 which ranks No. 9 in the country). And the school is in freakin' Hillsborough county, whoever's coaching there can't throw a rock without hitting a Division I recruit.
Yet despite all those built in advantages, the program has eerily seemed to regress each and every season under Leavitt. Every fall was the same story: Jump out to a hot start, win a bunch of games, have the National media get behind you, then inexplicably lose a few games, start finger pointing and finish in the middle of the Big East pack. It was a fall tradition right up there with pumpkin picking, turning back your clocks and seeing your Uncle Rich get drunk at Thanksgiving. In other words, it was a certainty.
Over time the players lost trust in Leavitt, and who could blame them. He always seemed a little too emotional, yet often times coached like he had an early dinner reservation to catch. Much like the guy who marries out of college, becomes the CEO of a major company and then divorces his wife for a woman half his age, it was time for a change at South Florida. The program had simply outgrown the guy who'd been there from the start.
Enter Skip Holtz, for my money the perfect candiate for what could potentially be this conference's best job.
He's got a coaching pedigree (Although I honestly don't know if he has a pathological, borderline uncomfortable disposition to Notre Dame like his father does. We'll have to wait and see on that one), won the last two Conference USA championships, beat West Virginia and Virginia Tech in 2008 and nearly coached his team to an upset of Arkansas in this year's Liberty Bowl.
More importantly, he's shown to have an icy-cool demeanor, a guy who kept his players calm in the waning moments of that Liberty Bowl, even as a victory was slipping through their fingertips. Mark my words, after years of Leavitt's in your face, Red-Bull-gives-you-wings, dog off the leash energy levels and temperament, Holtz will be a nice change of pace in Tampa.
When you couple Holtz with Charlie Strong taking over for Kragthorpe at Louisville, and Doug Marrone replacing Greg "Have You Seen My Baseball," Robinson at Syracuse in 2009, that's three major coaching upgrades in the last 14 months alone.
And with Randy Edsall seemingly hitting his stride at UConn, Greg Schiano continuing to clean up in New Jersey, and Dave Wannstedt returning Dion Lewis at Pittsburgh, by my math, six out of eight teams in this conference are on the upswing. The only uncertainties lie at West Virginia with Bill Stewart (Who I still say is passing up a lucrative career as a casino greeter to stay coaching at WVU) and with the new Cincinnati head man Butch Jones. (And I can't lie, watching Jones handle himself on the sidelines during this year's Sugar Bowl, he screamed "Superstar Head Coach in Waiting," to me. Honestly, I wanted to grab my pads and go play for him right then and there, although it's probably best for all parties involved that I didn't).
Now with all that said, will the Big East ever be the SEC? Of course not. Will any school ever have the inherent built in advantages of USC, Texas or Ohio State? I doubt it. These are the realities of the Big East.
But at the same time, let me ask you this: Would you rather have Charlie Strong, with his ties in the recruiting and coaching circles (with the financial flexibility to bring in a pretty solid coaching staff around him) taking over your program right now, or Mike London, a successful (albeit in a short time) Division I-AA coach, that is taking over at Virginia? Would you rather have Holtz recruiting South Florida for you, or Turner Gill combing the plains of Kansas? Would you rather have Doug Marrone's mess at Syracuse or Danny Hope's at Purdue? Would you rather have Bill Stewart offering you comps at the breakfast buffet or…Wait never mind.
But to answer those first three questions, my answer to all would be an unequivocal yes.
Again, the Big East will never be the SEC in football, and that's ok. The SEC will never be the Big East in basketball. That's just life.
But for the first time in a long time, it looks like maybe, possibly, the league has caught up to everyone else.
It hasn't happened overnight, and there's still a lot to do. But believe me when I say this, the league hasn't been in better shape overall since Miami and Co. were part of the action almost a decade ago.
And I've got to admit, it couldn't have come any sooner. I could only hear, "How soon until basketball season starts," so many more times.
(Love the article? Hate it? Let Aaron know by commenting below or by e-mailing him at firstname.lastname@example.com. Also be sure to follow all of Aaron's thoughts on the sporting world on Twitter (Aaron_Torres) and Facebook (Facebook.com/AaronTorres-Sports)


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Hayes Martin Associates, INC. Takes Top Honors at 2010 SoCal Awards for Major Category Wins.
NEWPORT BEACH, CA October 28th, 2010 — October 23rd was a night to shine for Hayes Martin Associates, Inc., as the agency was named winner of seven online and offline marketing programs at the prestigious 2010 SoCal Awards. This highly coveted mark of achievement is awarded annually by SMC's of the BIA of Southern California, making Hayes Martin Associates, Inc. one of the year's big winners.
Demonstrating the agency's full-service capabilities and history-making expertise, Hayes Martin Associates' list of wins is the latest in its 23-plus years. The agency was excited to receive top honors in the category of Best Overall Advertising Campaign for Irvine Company Community Development's Village of Woodbury East. From Best Online Banner Ad Campaign and Best Interactive Point-of-Sale Experience to Best Eblast Campaign for the Buyer Retention Strategy for William Lyon Homes, these awards give power to the agency's long standing record of success.
"We thank the 2010 SoCal Awards Judges and we salute our co-nominees for the coveted awards we brought home Saturday evening," said Sandra Keedy, President and Creative Director of Hayes Martin Associates, Inc. "The strategic thought and collaborative spirit that drove these varied efforts is at the heart of what we believe in as an essential component of our client/agency partnerships. We're thrilled that these strategies and creative efforts stand out as excellent because each one demonstrates our focus on the unique needs of our clients and their communities, villages and neighborhoods."
Hayes Martin Associates, Inc. captured multiple major awards in the below categories:
- Best Eblast Campaign &mdash Buyer Retention Program/William Lyon Homes
- Best Banner Ad Campaign &mdash Get Your Move On/William Lyon Homes
- Best Overall Advertising Campaign &mdash the Village of Woodbury East/Irvine Company Community Development
- Best Website for a Builder or Community &mdash www.lyonmirasol.com/William Lyon Homes
- Best Interactive Point of Sale Experience &mdash Blossom Grove/William Lyon Homes
- Community of the Year Attached &mdash ThreeSixty at South Bay/William Lyon Homes
- Community of the Year Detached over $600,000 &mdash Pasado at Del Sur/William Lyon Homes
Hayes Martin Associates, Inc. points to their process as the power driver of this impressive variety of awards. "HMA's strategic planning efforts and broad-view of branding carries right down to the personal buying experience. Sales driven creative produces results. Now we've been acknowledged by industry peers and judges for strategic and creative innovation and stand out positioning, that means a lot to each member of our team," concluded Ms. Keedy.
Hayes Martin Associates is one of the nation's leading marketing, advertising and public relations firms of residential homebuilders, land developers and master-planned communities. Since its founding in 1987, the award-winning firm has provided clients with the combined talents of highly experienced and respected team of professional specialists.
The agency represents a client roster of highly regarded homebuilders and master planned community developers including The Irvine Company, which relies on Hayes Martin Associates, Inc. for a broad spectrum of marketing expertise and strategic programs for the Villages of Irvine®, William Lyon Homes, K. Hovnanian® Homes®, Rancho Mission Viejo and California Pacific Homes. All enjoy profitable marketing partnership with Hayes Martin Associates, Inc.
Hayes Martin Associates is also actively involved in numerous philanthropic organizations and institutions, from HomeAid Orange County, the charitable arm of the Building Industry Association of Southern California, and City of Hope to the Sisters of the Sacred Heart Retreat Center. Sandra Keedy currently serves on the Board of Directors for HomeAid.
A full scope of the agency's capabilities is available at www.hayesmartin.com. Visit the website today to learn more. You may also follow HMA on Facebook and Twitter. Hayes Martin Associates, Inc. offices are located at 1300 Dove Street, Suite 205, Newport Beach, CA 92660. Please contact by email at email@example.com or phone at 949-417-1799.


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My name is Michael Stalter and when the oncologist told my wife and me that there was nothing more that could be done to cure her and she was going to die from the cancer, I felt the weight of the world fall on me. I was literally in shock. I had tried to prepare myself for this, I had imagined the cancer doctor saying this, but when he did, I still couldn't comprehend what this would mean to me. How was I going to keep going, how was I going to finish raising our two children, and how was I going to be able to do all the things that a wife does for a family? I was a man and I could face death myself, I had felt that I had many times working in a maximum security prison but how could I face my wife's death? How could I face my children?
Those were the first things I thought of after the shock of having our doctor tell my wife and me that the breast cancer was going to kill her. My mind raced but it was like an engine racing in neutral. I thought of so many things that Mary did not only for me but for our kids, our parents and how could I do all the things that she did? Who was going to put up all the Christmas decorations, who was going to help our kids with their homework, who was going to clean the house, bake the birthday cakes, make us a family? Mary was the foundation, she was the glue, and she was the one that bound us all together into a family with love and affection.
In my book Still Have Faith, I describe how Mary's terminal cancer destroyed our fairy tale life together and how we were able to function as a family and plan for the eventual death of the heart of our family. I talk about my struggles as a husband and how I was able to not be like 70% of the men who leave their terminally ill spouse within 2 years of finding out their wife is dying of cancer! I stayed when so many others like John Edwards and Newt Gingrich left. I made some mistakes and I felt lost and alone but I didn't abandon my wife and children like some coward on a battle field running away. I stayed and became a hero to my wife and children, although I didn't feel like one. Mary, Tom and Sarah looked at me like I was their hero.
There were no books or guides or anything to help me realize how much my family, Mary, Tom, and Sarah, needed me back in 2001 when Dr. Jeong told Mary and me that there was nothing more medical science could do to cure Mary and that we need to tell the kids that she was going to die. It was a few weeks before Christmas in 2001 and Mary asked if we could wait until after Christmas to tell our children, Tom, who was 12, and Sarah, who was 6, that mommy was going to die. He told us we could wait but not to wait too long after Christmas to tell them.
I wrote a book about my wife's 17 ½ year battle with breast cancer and the 4 years since her death. I talk about these issues and many more that a couple has to deal with when the wife has cancer. My story is about a husband's emotions, feelings, and struggles in dealing with his wife's battle with breast cancer and her death. Over this time period, I had to deal with the deaths of other family members, raising my two children and rebuilding my life. It is a very compelling story, written from a man's perspective on how men think and feel in a very down-to-earth style like it is being told to the reader by a friend.
The book is entitled Still Have Faith because I still have my faith in God. My website is StillHaveFaith.com and the book is 261 pages and priced at $14.99 plus shipping or $4.99 for the e-book version which is sold on Amazon.com. I think my story can help others understand what a man goes through when his wife has breast cancer or any terminal illness and then dies from it.
Still Have Faith has 8 reviews on Amazon.com and they are all 5 out of 5s. Please check out my website and the reviews on Amazon.com.
Michael D. Stalter spent 17 ½ years being his wife's primary caregiver and helping her battle breast cancer. Mike has a Bachelor's of Science with majors in History, Education, and English, with minors in Political Science and Special Education. He retired from the Illinois Department of Corrections as the Chief Fiscal Officer of the Maximum Security Prison in Pontiac IL. For more information, please visit StillHaveFaith.com.


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B-Class Finance PCP Example (includes delivery and a 3 year service plan)
Book a test drive with MSL Mercedes-Benz and drive the B-Class today.
Download a brochure for the Mercedes-Benz B-Class by clicking on the link below.
Click link below for the Mercedes-Benz B-Class multimedia special
Families might not be able to plan everything, but they can count on anything happening.
The B-Class meets the demands that daily life has in store for you. Generous amounts of space demonstrate a great sense of order. The confident, sporty exterior and high-quality interior are stylish companions on every journey. Numerous assistance systems pamper you and ease the burden on you or help ensure safety, the standard-specification COLLISION PREVENTION ASSIST being a case in point. And efficient engines, combined with clever BlueEFFICIENCY measures, make being out on the road as harmless to the environment as possible. Because there's no finer thing than a future. Because you are already thinking of tomorrow today. And because the next generation always has priority. The B-Class. For what's coming up.
Who says responsibility can't be fun?
When a couple gets a couple of new additions, it's good to be able to count on another member of the family who is prepared for everything right from the start: the B-Class has a particularly safety-conscious character because it can identify what the road ahead has in store for you at a distance of several metres. Its spacious interior with high-quality materials has the capacity to make life easier while the exterior impresses with a self-assured face, high-tech headlamps and dynamically sculpted sides.
I may be looking to the right, but I'm looking straight ahead, too.
In front of you, the traffic; behind you, the struggle for control of the rear seat. When one pair of eyes is not enough, the B-Class has another set on hand: the standard-fit COLLISION PREVENTION ASSIST system keeps "looking" ahead resolutely to spot hazards at an early stage if you happen to glance behind you for an instant. Up to ten more assistance systems ensure that the B-Class is a decidedly safe haven for your family. Who says you can't have eyes in the back of your head?
Its compact exterior fits into just about any parking space, its interior is your second home: the B-Class has a boot whose 488-litre capacity allows it to swallow everything from a pushchair to the weekly shop – and can even be increased with the optional EASY-VARIO-PLUS system. Well-thought-out stowage facilities provide accommodation for every last item. And the back seat, which is able to take sustained punishment from up to three pairs of short legs in its stride, will still be in great shape by the time their owners are teenagers.
Wherever you go in the B-Class, you go in style. Four fine equipment packages and additional optional extras offer you unrivalled scope for expressing your own distinctive character. Metallic surfaces in fine silver chrome reflect self-assurance, painstaking attention to detail creates an ambience of wellbeing, dark-tinted heat-insulating glass for the rear windows is a cool way of giving prying eyes the cold shoulder. With all these possibilities, the B-Class demonstrates to perfection that good taste has at least as many dimensions as you do.
Green now comes in jupiter red too.
With the B-Class you're already well placed to meet the demands of the future with regard to saving fuel, reducing emissions, recycling materials and conserving resources. And in case you're thinking that the standard-specification BlueEFFICIENCY measures – such as the ECO start/stop function – don't go far enough, it's good to know that one of the best c0 values in its class makes your B-Class that bit greener – irrespective of the paint colour you've chosen.
Terms and Conditions
†Includes delivery and related charges. Model is shown for illustrative purposes only. ††The Guaranteed Minimum Future Value (GMFV) is payable if you renew or retain the vehicle at the end of the agreement. Further charges may be applied by your Mercedes-Benz Dealer subject to kilometre limits/condition of the vehicle.*Lending criteria and conditions apply. Fixed APR (Annual Percentage Rate) 3.9% which is inclusive of a documentation fee of €63.49. To qualify for this Finance Offer; a minimum deposit of 10% is required. Rate quoted is correct as at 18th November 2016 and subject to change. Offer available on all new B-Class B160 petrol Style models registered from 18th November 2016 until 31st January 2017 at MSL Mercedes-Benz dealerships. This is a Consumer Hire Purchase agreement provided by Bank of Ireland t/a Bank of Ireland Finance.


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Minnesota Department of Natural Resources Contact us
Home > Destinations > State parks and recreation areas > Great River Bluffs >
From Explore MN Tourism
Picnic Area
12 Sites
Includes picnic tables and pedestal grills. Near walking trail that leads to scenic overlooks. Area includes more secluded picnic sites.
Sliding Hill
Between park contact station and office
© 2016
Minnesota Department of Natural Resources | Equal Opportunity Employer | State of Minnesota | Data Access | Disclaimers, Legal Notices and Policies
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From Wikipedia, the free encyclopedia
|Look up Lichter in Wiktionary, the free dictionary.
Lichter is a German surname meaning somebody who castrates animals[1] The Jewish surname Lichter means "lights".[2]
Notable People[edit]
- Ivan Lichter (1912–2009), New Zealand surgeon
- Marika Lichter (born 1949), Austrian actress
- Samuel Robert Lichter, American political scientist
- Distant Lights (2003 film) (Lichter), a 2003 German film
- ^ Hans Bahlow: Deutsches Namenlexikon, Gondrom Verlag, Bindlach, 1990, ISBN 3-8112-0294-4
- ^ "Lichter Family History". Ancestry.com.
|This page or section lists people with the surname Lichter. If an internal link intending to refer to a specific person led you to this page, you may wish to change that link by adding the person's given name(s) to the link.


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Father's heart attack inspired 2012 Iatros winner to pursue cardiology
By Lin Lofley
When Dr. Samvit Tandan won the Iatros Award at the celebratory social gathering of the 2012 medical school graduating class, perhaps the biggest surprise was that he wasn't there. He had always been there for other class events.
But Dr. Tandan – "Sam" to his friends, which means pretty much everyone in the Class of 2012 – was between flights at the airport in Charlotte, N.C., delayed returning from a housing search in New York City.
"I got a call from a friend telling me about the award," the recent UT Southwestern Medical School graduate said, "and right after that I started to get a lot of texts of congratulation. I never expected it, I can tell you that."
Classmate Dr. Bruce Koehler, who made the congratulatory phone call and whom Dr. Tandan calls his best friend, had a different take: "I wasn't surprised, and I couldn't be happier for him. He did a lot for our class, and because he's been around for a while, he's done a lot of things. He's an interesting person and very busy, but he'll still give you a ride to the airport."
The Iatros winner is determined by votes of the graduating class to honor the individual who most emulates the complete qualities of a physician. "Iatros" is a Greek word for "physician."
Dr. Tandan, 33, worked in the laboratory of Dr. Joseph Hill at the University of Iowa after earning his undergraduate degree in biology in 2003 from Knox College in Galesburg, Ill.
Dr. Hill, now Chief of Cardiology and Director of the Harry S. Moss Heart Center, came to the medical center in 2002, and Dr. Tandan rejoined the Hill lab early the next year while working on his doctorate. After earning a Ph.D. in integrative biology in 2008, he set his sights on medical school.
"Before and after matriculating at UT Southwestern, Sam has impressed me as a bright student who further distinguishes himself through his intellectual curiosity, diligent work ethic, and polished interpersonal skills," Dr. Hill said of Dr. Tandan, now in residency at the Montefiore Medical Center in New York City.
Dr. Tandan, a native of Mumbai, India, became interested in medicine at age 8. His father, Atul Tandan, had suffered a heart attack, and during recovery at their home, Dr. Tandan saw his dad's electrocardiograms and angiograms.
"That got me interested in cardiology right there," Dr. Tandan said.
Dr. Tandan is enthusiastic about his internship in the Bronx: "The hospital there felt a lot like Parkland Memorial Hospital, and in my interviews I could tell that they have a passion for teaching.
"It felt like UT Southwestern, to be honest. From my PhD years all the way through my medical school years, I benefited from the passion for teaching at UT Southwestern. I felt the pure support from top to bottom."
Dr. Hill holds the James T. Willerson, M.D., Distinguished Chair in Cardiovascular Diseases and the Frank M. Ryburn Jr. Chair in Heart Research.


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A little table for six on New Year's Eve.
Silver chargers and glass plates have
clock faces nestled between them.
Ready for champagne.
Silver and gold ribbon curls
provide a festive touch.
Mini silver frames are used as place cards.
We are all ready to welcome 2013!
A silver pedestal dish holds poppers for midnight.
Party hats and horns await guests.
Tick, tock, midnight will be here soon!
All is well with candle light
A few scattered ornaments complete the tablescape.
An elegant dinner is in the making.
Claudia will soon be here.
An easy design for New Year's!
Silver, glasses and plates are vintage,
chargers are from Sur la Table,
napkins and table cloth are from Home Goods
and napkin ring is from Target.
All set! Here's how I started....
I used 8 x 10 copies of clock faces.
And, these simple glass plates....
Hello, 2013!
p.s. here are some cute plates
that would work too!
that would work too!


text:
Nils Schneider has updated the Heat Synthesizer Android App to version 0.8.6.
Android App changes in version 0.8.6:
- New: As the Preset database keeps growing, you can now search for Presets by name.
- New: Share Presets with others, send them by mail, Facebook, and Twitter.
- Fix: Rare crash in Arpeggiator when touching outside of the note grid bounds.
- Fix: Modulation source was not visible on all devices once selected.
VST Plugin changes in version 0.8.6:
- Fix invalid plugin window size in some hosts.
Note: New VST plugins or Presets may sound slightly different because of the filter envelope change.


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Results 1 to 10 of 13
php wont recognize array 7 Aug 2011 @ 15.09
i just started designing a website, and most of it requires php to run.
i have a problem with an array which php isn't recognizing. the array is pulled from a database, so i just put the variable as an array. which doesn't seem to work.
my code will probably explain better.
PHP Code:
phpif (isset($_GET['bid'])) {
$DPView = "";
$detailPhotoView = "";
$targetID = $_GET['bid'];
$Bsql = mysql_query("SELECT * FROM builds WHERE id = $targetID");
while ($row = mysql_fetch_array($Bsql)){
$DP = $row["photo"];
$DetailPs = $row["detail_photos"];
$DetailPA = array($DetailPs);
$DPsql = mysql_query("SELECT * FROM photos WHERE id = $DP");
$DPD = mysql_result($DPsql,0,'details');
foreach ($DetailPA as $DetailP){
$DetailP = $DetailP;
$DetPsql = mysql_query("SELECT * FROM photos WHERE id = $DetailP");
while ($row = mysql_fetch_array($DetPsql)){
$DetailPD = $row["details"];
$detailPhotoView .='

Delete | Submit

Details:

<textarea name="details" id="details" cols="70" rows="8">'.$DetailPD.'</textarea>
$DPView .= '

Delete | Submit

Details:

<textarea name="details" id="details" cols="70" rows="8">'.$DPD.'</textarea>
the array is $DetailPA, for the array ive put $DeatilPs which is data from a database. if i just put number instead of $DetailPs it semms to work properly, but with the variable it doesnt seem to explode the data to get each individual number.
any ideas?
Last edited by Frinkky; 7 Aug 2011 at @ 15.24. Reason: Cleaned up your code - easier to work with and easier to debug
8 Aug 2011 @ 09.17
When debugging your code, you often need to inspect the values of variables. Sometimes they are not what you think they should be. Use the following code to do this:
<?php var_dump($myVariable); ?>
Before inserting arrays into databases, you need to use PHP's serialize($array) function. And when you extract the array from the database, you need to use unserialize($array) to convert it back into a PHP array.
8 Aug 2011 @ 10.00
i tried showing the variable and its showing it as an array. it shows variables.PNG
i think thats what they should be, unless they shouldn't have the ' on each end of the array.
how would i use the unserialize function, ive never used it before?
8 Aug 2011 @ 10.20
Oh, I think I understand what's happening.
$detailPs is what came from the database. This is a string, not an array. You then tried to turn this into an array, $DetailPA.
Technically you succeeded, but I don't think you got the result you wanted. $DetailPA is an array with only one key, which has the value '3,1,7' -- which is just a string of characters (like a word).
I think you wanted this:
$DetailPA = array [0] => 3 [1] => 1 [2] => 7
Last edited by Mike Hopley; 8 Aug 2011 at @ 10.45.
8 Aug 2011 @ 10.47
yeh thats right.
do i need to change the field type in my database to an int value?
8 Aug 2011 @ 11.06
Do you control the code that inserts this into the database? If so, the neatest option would be to serialize() the array before you insert it, and then unserialize() the array when you extract it.
Otherwise, you'll need to convert the string into an array:
$DetailPA = explode(",", $detailPs);
$DetailPA = array [0] => '3' [1] => '1' [2] => '7'
foreach ($DetailPA as &$value) { settype($value, "integer"); } unset($value);
Last edited by Mike Hopley; 8 Aug 2011 at @ 11.27.
8 Aug 2011 @ 11.07PHP Code:
$DetailPA = explode(',',$DetailPA[0]);
8 Aug 2011 @ 11.12
8 Aug 2011 @ 11.20
got it
i used
PHP Code:
$DetailPA = explode(',',$DetailPs);
thanks for the help


text: We've had a couple posts on the curious downplaying by the national media of the abortion doctor Kermit Gosnell's mass murder trial going on right now in Philadelphia. We've noted, among other things, that USA Today is one of the few outlets to have mentioned the story more than once. Well, today that national newspaper [Read More…]


text:
my account
energy & information
safety & outages
business resources
about us
Con Edison Media Relations
June 21, 2012
10:30 a.m.
NEW YORK – As the high heat continues today, Con Edison urges all customers to use electricity wisely as crews work around the clock to keep the power flowing to 9 million New Yorkers.
Some steps to stay cool include:
The company has reduced voltage by 5 percent in some neighborhoods in Queens and Brooklyn due to problems on electrical equipment and has asked customers to curtail their use of non-essential appliances in the following areas:
The voltage reductions were done as a precaution to protect equipment and maintain service as crews work to repair the problems. Con Edison has asked customers in these areas not to use appliances such as washers, dryers, air conditioners and other energy-intensive equipment, and to turn off lights and televisions when not needed until the equipment problems are resolved.
Customers can report power interruptions or service problems, view service restoration information and the outage map online at www.conEd.com, as well as on their mobile devices. They also may call 1-800-75-CONED (1-800-752-6633) promptly if they are experiencing any service difficulties. When reporting an outage, customers should have their Con Edison account number available, if possible, and report whether their neighbors also have lost power. Customers who report outages will be called by Con Edison with their estimated restoration times as they become available.
The equipment problems in these neighborhoods have no effect on the rest of the Con Edison system. Con Edison will provide updates to affected customers both directly and through the media as the situation warrants. The company is in constant communication with the New York City Office of Emergency Management.
contact us | search | careers | site map | consolidated edison, inc. | privacy policy


text:
..Ok, this is my first post so here goes.
I am trying to solve
Use common or natural logarithms to solve symbolically.
2e^2x+2= 6
first I divide both sides by 2
e^2x+2= 6 Mr F says: This line is wrong. You have to divide all terms by 2, not just the first ....... e^2x + 1 = 3. Personally, my first step would be to subtract 2 from both sides: 2 e^2x = 4 .......
use natural logarithms
ln e^2x+2 = ln 6
2x+2 = ln 6
subtract 2 from both sides
2x = ln 6-4
Divide by 2
x = ln 6-4/2
I enter this into my Ti-83plus
ln (6-4)/2
my answer is .34657 It is wrong I figure it is the way I have entered it into the calc. Anybody have any thoughts of what is wrong?


text:
Bicycling, April 2008 - ""Schwinn's carbon Peloton Pro is a marvelous bike. The ride is sharp and stiff enough to qualify as raceworthy, yet plush enough for all-day riding. It's neither whippy or sluggish, responds to your input rather than forcing you to react to it and never gets in your way.""
2008 Peloton Pro, Bicycling, April 2008
Mar 31, 2008


text:
You purchased this item onView this order
Avalon Organics, Wrinkle Therapy, with CoQ10 & Rosehip, Cleansing Milk, 8.5 fl oz (251 ml)
- You earn loyalty credit for every order you place at iHerb!
- Loyalty credit is equal to 10% of the value of your order, excluding shipping charges.
- Your loyalty credit will be applied towards your next order as soon as your current order has shipped.
- Your loyalty credits are valid for up to 60 days from the date of your last purchase.
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Expiration Date:?Jan 2020Expiration Date
The length of time for the expiration date or "best used before" date depends on the type of product, as well as the brand.
Perishable items (such as flax oils or certain probiotics) generally have shorter expiration dates. Although our warehouse is fully air-conditioned, these more fragile items are put in cold storage (freezer or refrigeration unit) for maximum freshness.
Our receiving department does its best to verify and then enter the correct expiration dates for all incoming products. However, discrepancies do occur from time to time. This being said, the exceptionally high turnover at iHerb ensures that our inventory is among the freshest in the industry.
Shipping Weight:?0.77 lbs (0.35 kg)Shipping WeightThe Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: AVA-35812
- UPC Code: 654749358122
- Package Quantity: 8.5 fl oz (251 ml)
- Dimensions: 1.8 x 2.8 x 6.4 in, 0.65 lbs (0.29 kg)
|Combo Discount:
|- $3.00
- New & Improved
- Creamy Cleanser Gently Purifies Without Stripping Away Moisture
- NSF - Contains Organic Ingredients
- No GMOs
- Vegan
- Biodegradable
- Contains Organic Ingredients
- Deep Rooted Beauty Since 1994
This Cleansing Milk contains soap-free, botanical cleansers that gently lift away grime without drying or stripping skin. A wrinkle-fighting ensemble of Co-Enzyme Q10, Rosehip Oil and Hyaluronic Acid energizes and replenishes skin to counteract the visible signs of aging.
This product replaces CoQ10 Repair Facial Cleansing Milk.
Suggested Use
Use moistened hands to massage over face and neck, then rinse clean. For added anti-aging benefits, follow with Wrinkle Therapy Perfecting Toner.
Other Ingredients
Aloe barbadensis leaf juice(¹), aqua (water), stearic acid, glycerin, glyceryl stearate SE, cetearyl alcohol, caprylic/capric triglyceride, cetyl alcohol, helianthus annuus (sunflower) seed oil(¹), aleurites moluccana seed oil, borago officinalis seed oil(¹), butyrospermum parkii (shea) butter(¹), prunus amygdalus dulcis (sweet almond) oil(¹), rosa canina (rosehip) seed oil (¹), arnica montana flower extract(¹), camellia sinensis leaf extract(¹), chamomilla recutita (matricaria) flower extract(¹), glycyrrhiza glabra (licorice) root extract(¹), lavandula angustifolia (lavender) flower/leaf/stem extract(¹), leucojum aestivum bulb extract, olea europaea (olive) leaf extract(¹), salix alba (willow) bark extract(¹), tocopheryl acetate, cetearyl glucoside, phenethyl alcohol, ribose, sodium hyaluronate, sorbitol, ubiquinone (CoQ10), xanthan gum, alcohol(¹), benzyl alcohol, potassium hydroxide, potassium sorbate, sodium benzoate, citronellol, geraniol, linalool
(¹)Certified Organic Ingredient
Product is preserved with Sodium Benzoate
No GMOs, parabens, harsh preservatives, synthetic colors or fragrances, phthalates, sodium lauryl/laureth sulfate or animal testing.
Caution: For external use only. Avoid contact with eyes. Keep out of reach of children.
I really love this cleanser it is creamy and leaves my face feeling soft, not oily or dry while rinsing off cleanly. It has a very mild fragrance unlike some other brands loaded with strong smelling perfumes and odors. Avalon products are excellent and this was my first time shopping here at iHerb and it was a very good experience.
I was hoping for a more smoothing, nutrient rich and moisturizing facial cleanser for my aging face and this one doesn't really work for me. Nothing against Avalon Organics because I've used and enjoyed other products from them. Unfortunately, this one stings when I use it.
Soft skin
Posted by 5262462037184150319 on Dec 03, 2016
Soft skin
not bad
Posted by 4894574777049301273 on Nov 13, 2016
soft after using.
Avalon Organics, Wrimkle Therapy, with CoQ10 & Rosehip, Cleansing Milk
Posted by 5725423582016180683 on Oct 31, 2016
Product well packed and very prompt delivery.
The smell is fantastic
Posted by 4737387132248762826 on Oct 30, 2016
Finally a cleaning milk for my mixed skin that smells good and natural, cleans basic makeup okay but afterwards I still need to use skin toner or oil. If you are looking for everything in one package (cleaning makeup, moisture and freshness) this is not your product.
not impressed
Posted by SwedishDamsel on Oct 09, 2016
I was not impressed with this one. It is ok at cleansing but it leaves my skin very dry and I don't like the smell. If you find my reviews helpful, then give me thumbs up.


text:
I am so grateful for days like yesterday.
It wasn't anything special, in fact someone else may even call it a boring day.
But for me, it was perfect.
We were able to do the things we needed to (work and school), but still spend time together, laugh, make food we love, and just BE.
It was awesome.
And it was made even awesome-r by the addition of our toddler friend Chico. (Chico's mom--and whole family--are super special to us. Like family.)
Anyway, my point!
We're so glad Whitt and Jason were willing to share Chico with us yesterday. We'd forgot (forgotten?) what it was like to have a mini-person running around the house. I'm telling you, it's pretty hilarious. There's just something funny about having a person who is slightly taller that the dog tell you to "Let ME smash the beans" as you make dinner.
|Chico and LuLu.
PS: If you are new to the blog, Chico's mom, Whittney, was my back-up Loved One for Survivor both times I played. And fortunately during Caramoan, CBS/Sprint flew BOTH of our Loved Ones out to the game/Philippines.
It was mind-blowing for all of us. Dave-man and Whittney were able to tour Tribal Council, paddleboard in the Philippines, boat past our campsites, and spend time with the other players' family members (Cochran's mom and dad; Andrea's mom and sister, etc.).
I'm so grateful for that part of the Survivor experience--to have both Dave-man and Whitt there on the island.
It's a memory I will always always be grateful for. (And yes, I'm ending a sentence with "for.")


text:
Medieval, pre-baroque, and baroque recorders
Click here for a video showing how the recorder is bored on the lathe with one these drills.
There are also two films (in French) here, in which these tools can be seen in use.
These 18th century spoon drills come from the page in Diderot & Dalembert's Encyclopédie (18th century) dedicated to tools for making woodwind instruments.
Philippe BOLTON, 22 Le Grand Portail, F-84570 VILLES-SUR-AUZON, FranceTEL : +33 4 90 61 86 11


text:
EARTH 133 - Geologic Field Seminar of the Colorado Plateau
Depart - Saturday, May 21, 2016, 8:30 a.m. (Luggage leaves the previous day.)
Return - Saturday, June 4, 2016, late afternoon - early evening
Cost - $275 - Make checks payable to: SBCC. Please pay at the Cashier's Office in the Student Services building. Some scholarship assistance is available--see an instructor for details.
Last Day for Payment - Saturday, May 7, 2016. No refunds.
Transportation - SBCC vans (no private vehicles).
Food - Meals are prepared in our field kitchen by staff with student help.
Accommodations - Camping in National Monument and Park group sites.
Scholarship Information - There is a limited amount of scholarship money available to qualified students. Scholarships are based on need and merit. See your instructor if you wish to apply for aid. If you are applying for a scholarship, please do not pay the $275 immediately as your scholarship award is deducted from your fee. All scholarship applications are due by Monday, May 2, 2016 at 5:00 p.m.
Pre-field Trip Organizational Meeting - There will be an organizational meeting for the trip on Saturday, May 7, 2016, from 3:00 - 5:00 p.m. at Rocky Nook Park. If you are planning on participating on the trip, please set this date aside. If you absolutely cannot attend, contact Jeff Meyer or Jan Schultz as soon as possible.
Preparation of Student Presentations
May 11 - 20, 2016
The week before the field trip and after your finals will be devoted to the preparation of student presentations for the trip. Instructors, preparation materials, and guidance will be available. If you have unalterable plans and will be unavailable during this week, you must see one of the instructors.
For more information, click on the following topics:
Field Course Information Sheet
Pre-Trip Organizational Meeting Flier
Pre-Trip Orientation Information
List of Seminar Topics for Student Presentations
Contact Jeff Meyer or Jan Schultz or come by the EPS office in EBS 114!


text: RG III: I can't take those amount of hitsThat doesn't mean he wants the amount of hits he had against Minnesota . "Bottom line, I can't take those amount of hits," Griffin said, via John Keim of ESPN.com. Redskins quarterback Robert Griffin III got hit way too much against the Vikings in last Th… (more)Sources: ESPN.com profootballtalk.com


text:
I have always loved the bright, shiny look of all the shimmer powders available on the market. Across the board in various brands – there are 1000000000000's of shimmer colors to choose from – right? And yet I have always picked up my palette of shadows. Maybe because it is so easy.
But part of the reason I love Palettes so much is the part I played in developing them. I fondly remember gluing pans to gray foam I purchased and cut and placed in clear Lucite boxes. I named them Maquillage and sold them to friends on movies sets I worked on like Boogie Nights. When Boogie Nights was being made, The Nakeds (by Ultima II) were in. Bobbi Brown was queen of neutrality and bright colors were just extremely hard to find. With the makeup story boards of Boogies Nights I diligently set out to find COLOR. In a tiny, little, old school beauty supply in downtown Hollywood I found a pile of bold colors. The packaging was so old I thought I found makeup someone forgot to take out of the case for a decade. Little did I know at the time, I found a gem of a line that I would be associated with for the next fifteen years, called La Femme. I bought each and every one of the bright blues, greens, purples, pinks and corals, and they not only matched our story boards, but the little pots of real color were fabulous. I was in love.
Later I worked with a friend to develop our own Palettes (that did not have to be glued to gray foam), we had black plastic vacuum formed to fit 8 pans. We matched them to various ethnic skin tones and launched a little known line called World Girl. They had a clear top and our logo on the other side. I believe we had to have 3000 made to fulfill the vacuum form minimum. We sold them all, and I am sorry to say, I only have a few of them myself and none of the original self-glued Maquillage Palettes.
By the time mass produced empty palettes came along I had already started MakeUpMania.com. So what was a Palette lover to do? Create The Palette Lab of course! Not only did I want to sell the palette idea I loved so much, but I wanted people to be able to make their own. Which is what I always did and loved about the ideas of pans and palettes in the first place. So I guess that pretty much explains why it is hard for me to turn my back on my dearly loved palettes.
But now, Stacks are back!
Back in the day I was making my own Palettes, I also spent alot of time creating my own Stacks. Little pots that screw together so you can carry oodles of loose powder in your kits. Between my Palettes and Stacks I could carry a tons of color, pressed or loose. This past year, I started playing with stacks again. I have found (much to my surprise) that Stacks are great - almost as great as Palettes! I have also found that mixing pressed color with shimmer or loose color is an easy thing to master and the amazing variances of outcomes is a true makeup junkies dream.
Start to collect stacks for your kit and cross fill with brands to your heart's content, La Femme, OCC, Graftobian, etc. Since so much of the powders are made in the same dozen or so factories, especially in the US, the colors are repetitive at times. Therefore, I am looking at pigmentation and the last-ability to help choose what I want to work with. Now I am always impressed to find colors I have never seen before. I love that OCC is doing this and adore their "Chlorophyll". A true unique color in the loose color powder market. And I have my glitter stacks. Next? Stacks of Rhinestones I hope to complete by Christmas for Holiday Makeover. I have even Stacks of Lashes to carry more lashes easily and safe, than ever before.
Palettes and Stacks ....ahhhh Nirvana.
On Formulas: News application methods for makeup such as Ellis Faas or the IPKN Artist Wave. Bright Nail colors with lots of shimmer, Crème blushes (quickly trending up even faster this year), Chubby Pencils of lipstick, lip gloss, eye correctors, still big.
Kit Building & Care: Mark the top lid of your stack by dipping it lightly in a shallow well of nail polish color You won't need very much to saturate the top. Let it dry, then your stacks in your kit will be easy to remember. You can carry 5 or 6 stacks of five, thus 25 -30 colors with you in your kit and they take up very little room.
Make-up Glossary: Shimmer Powder(n) common generic name that describes a fine powder with high mica content and shines.
Make-up Historical Encyclopedia: Shimmer powders are not new in the market. Stemming from the 70's dusts of colors that started slowly entering the market by companies such as Barone NY (circa 1978) and Madeline Mono (with the superb double pot concept). The bottom one being the main color (I had a royal turquoise color). The smaller top pot, that was attached to the lid of the bigger jar, had the highlight color. In this case, it was a shimmer white with a tan undertone.


text:
I was reading a nice article about a swell person who recently got some certification related to beer and, as I am sure you do, wondered the same question I think every time I remember how touted the Canadian Prime Minister's MA in Economics - so what?I? I mean everyone has a certification of one sort or another these days, and, anyway, doesn't the anatomy class rule apply? You know that one, don'tcha? Q: What do you call a doctor who got a "D" in anatomy class? A: Doctor.
So, a question along those lines with a few pre-chewed responses for you to consider.
=> Do you consider the opinions of others at all? I mean isn't it largely the case that we are creatures of habit and for the most part like replicating pleasurable experiences? So, what part of your beery experience is actually not about new sources of knowledge - whatever your level of experience with the far corners of the land of beer is.
=> Do you assume that clever people are taking care of things behind the scenes? I trust this is actually what the certifiable amongst us actually do. They help vendors and producers and retail staff and bar staff do a better job. But as with making sausages, you don't really want to know but you know you like to know that someone knows.
=> Do you study a bit and prepare yourself in any particular way but gleaning from the thoughts of those who have gone before hoping to trace some level of certainty in your beery travels? Or do you want to place yourself cannily in a bar or a city that is well recommended but are quite open to either new beery surprises or rediscovering old friends depending on what comes along?
=> Do you demand nothing but control of the situation with the skill and experience of all the possible resources and voices that are available to you? Have you come to rely on this beer writer or that one as a guide to a great experience every single time you lift the glass? Do you even get upset with beer writers when your experience has not met the expectations they created for you?
I am actually quite interested in this. Interested enough to post the chimp head, that is. Me, I have read a lot and written a lot and drained a lot over now that I can look back from the wisdom of this new sixth decade of life. But I also really don't give a rat's ass about so much that, on the one hand, hovers around or, on the other, smothers good beer discussion. Maybe there are particular topics within beer that fit into one of the degrees of interest in the expertise of others set out above but for the most part you fit in another, less aggressive approach? How do others intervene between you and your beer?


text:
Lyle Denniston looks at why it is hard to predict the progress of same-sex marriage across the nation, despite New Jersey's move on Monday.
Search Results for: "constitution check"
Constitution Check: Is the Supreme Court only willing to work at the fringes of the Second Amendment?
Lyle Denniston examines evidence that the Supreme Court is not staying completely away from lawsuits involving gun rights.
Constitution Check: Does banning affirmative action promote racial equality?
Lyle Denniston looks at the state of Michigan's argument in the Schuette affirmative action case, and if the Supreme Court can be persuaded that banning affirmative action creates an equal opportunity for all races.
Constitution Check: Should only U.S. citizens serve on juries?
Lyle Denniston looks at an issue that California is debating: If noncitizens are considered "persons" under the 14th Amendment's guarantee of legal equality, should they have the right to serve on juries?
Constitution Check: Is a new revolution on campaign finance stirring?
Lyle Denniston looks at Tuesday's arguments in the McCutcheon case and if there were signs the Court may act in a revolutionary way in setting campaign finance restrictions.
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Home/Aerators, Scarifiers & Dethatchers
Lawnflite Verticutter VG45BM – 45cm/18 5hp
£385.38 ex.VAT | £462.46 inc.Vat
The Lawnflite VG45BM is a powerful petrol 5hp Thorx 35H Scarifier / Verticutter. It is ideal for large lawns or areas where there is no convenient electricity power supply. The wide 45cm / 18 working width combined with the petrol engine ensure a far greater work rate than any electric Scarifier/ Verticutter. Scarifiers / Verticutters are an essential tool for those gardeners who want to keep their lawns in tip-top condition. Used regularly a Scarifier / Verticutter will remove moss and thatch from your lawn allowing the grass to grow more healthily. Many Scarifiers/Verticutters in the market place have relatively lightweight spring tines but our Lawnflite range feature solidsteel blades. Not only are these more robust than spring tines they also cut lateral growing grass roots forcing the root to grow downwards to where the best moisture and nutrients lie. Specifications Blades:Fixed Blades De Thatching Width:45cm/18 Deck Material:Steel Depth Control Settings:Central Lever Drive:Belt Engine:5hp Thorx Warranty:1 Year Weight:35 kg Wheels Size Front:18cm/7
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