text:
(zi PRAS i done)
Index Terms
- Zeldox
- Ziprasidone HCl
- Ziprasidone Hydrochloride
- Ziprasidone Mesylate
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral, as hydrochloride:
Geodon: 20 mg, 40 mg, 60 mg, 80 mg
Generic: 20 mg, 40 mg, 60 mg, 80 mg
Solution Reconstituted, Intramuscular, as mesylate [strength expressed as base]:
Geodon: 20 mg (1 ea)
Brand Names: U.S.
- Geodon
Pharmacologic Category
- Second Generation (Atypical) Antipsychotic
Ziprasidone is a benzylisothiazolylpiperazine antipsychotic. The exact mechanism of action is unknown. However, in vitro radioligand studies show that ziprasidone has high affinity for D2, D3, 5-HT2A, 5-HT1A, 5-HT2C, 5-HT1D, and alpha1-adrenergic; moderate affinity for histamine H1 receptors; and no appreciable affinity for alpha2-adrenergic receptors, beta-adrenergic, 5-HT3, 5-HT4, cholinergic, mu, sigma, or benzodiazepine receptors. Ziprasidone functions as an antagonist at the D2, 5-HT2A, and 5-HT1D receptors and as an agonist at the 5-HT1A receptor. Ziprasidone moderately inhibits the reuptake of serotonin and norepinephrine.
Well absorbed; administration with 500-calorie meals increases serum levels ~80% (Lincoln, 2010).
Vd: 1.5 L/kg
Extensively hepatic, primarily chemical and enzymatic reductions via glutathione and aldehyde oxidase, respectively; less than 1/3 of total metabolism via CYP3A4 and CYP1A2 (minor)
Feces (~66%; <4% of total dose as unchanged drug); urine (~20%; <1% of total dose as unchanged drug)
Clearance: Children: Mean: 11.5 to 13.1 mL/minute/kg (Sallee 2006); Adults: Mean: 7.5 mL/minute/kg
Time to Peak
Oral: Children: Mean: 5 to 5.5 hours (Sallee 2006); Adults: 6 to 8 hours
IM: ≤60 minutes
Half-Life Elimination
Oral: Mean terminal half-life:
Children: Mean: 3.3 to 4.1 hours (Sallee 2006)
Adults: 7 hours
IM: Mean half-life: 2 to 5 hours
Protein Binding
>99%, primarily to albumin and alpha-1 acid glycoprotein
Special Populations: Hepatic Function Impairment
Increases the AUC of ziprasidone.
Use: Labeled Indications
Treatment of schizophrenia; treatment of acute manic or mixed episodes associated with bipolar disorder with or without psychosis; maintenance treatment of bipolar disorder as an adjunct to lithium or valproate; acute agitation in patients with schizophrenia
Hypersensitivity to ziprasidone or any component of the formulation; history of (or current) prolonged QT; congenital long QT syndrome; recent myocardial infarction; uncompensated heart failure; concurrent use of other QTc-prolonging agents including arsenic trioxide, chlorpromazine, class Ia antiarrhythmics (eg, disopyramide, quinidine, procainamide), class III antiarrhythmics (eg, amiodarone, dofetilide, ibutilide, sotalol), dolasetron, droperidol, gatifloxacin, halofantrine, levomethadyl, mefloquine, mesoridazine, moxifloxacin, pentamidine, pimozide, probucol, sparfloxacin, tacrolimus, and thioridazine
Dosing: Adult
Bipolar disorder (acute and maintenance as adjuncts to lithium or valproate): Oral: Initial: 40 mg twice daily; may increase to 60 or 80 mg twice daily on second day of treatment; subsequently adjust dose based on response and tolerability. Usual dosage: 40 to 80 mg twice daily.
Schizophrenia: Initial: 20 mg twice daily. Increase dose based on response and tolerability no more frequently than every 2 days; ordinarily patients should be observed for improvement over several weeks before adjusting the dose. Usual dosage: 40 to 100 mg twice daily. Note: Dosages up to 320 mg per day appear safe; however, there is no data suggesting improved efficacy at higher doses (APA 2004).
Acute agitation (schizophrenia): IM: 10 mg every 2 hours or 20 mg every 4 hours (maximum: 40 mg daily). Oral therapy should replace IM administration as soon as possible.
Delusional parasitosis (off-label use): Oral: 20 to 80 mg twice daily (De Berardis 2013; Freudenmann 2008). Additional data may be necessary to further define the role of ziprasidone in this condition.
Major depressive disorder (adjunct to antidepressants) (off-label use): Oral: Initial: 20 mg twice daily; may increase dose by 20 mg twice daily at weekly increments up to 80 mg twice daily based on response and tolerability. Average daily dose was 98 mg/day in the clinical trial (Papakostas 2015).
Discontinuation of therapy: American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse (APA [Lehman 2004]; Cerovecki 2013; CPA [Addington 2005]; WFSBP [Hasan 2012]); risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics (Cerovecki 2013). When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month (APA [Lehman 2004]; CPA [Addington 2005]). Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms (Cerovecki 2013). When switching antipsychotics, 3 strategies have been suggested: Cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting (Cerovecki 2013; Remington 2005).
Dosing: Geriatric
No dosage adjustment is recommended; consider initiating at a low end of the dosage range, with slower titration.
Psychosis/agitation associated with dementia (off-label use): Oral: Initial: 20 to 40 mg daily, in 1 to 2 divided doses; increase total daily dose by 20 to 40 mg increments every 2 to 7 days; doses as high as 160 mg daily have been studied (Berkowitz 2003; Cole 2005; Rocha 2006). In patients without a clinically significant response after 4 weeks, taper and withdraw therapy. In patients with an adequate response, attempt to taper and withdraw therapy within 4 months, unless symptoms recurred with a previous taper attempt. Assess symptoms at least monthly during taper and for at least 4 months after withdrawal of therapy (APA [Reus 2016]).
Dosing: Renal Impairment
Oral: No dosage adjustment necessary.
IM: Cyclodextrin, an excipient in the IM formulation, is cleared by renal filtration; use with caution.
Ziprasidone is not removed by hemodialysis.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling; however, drug undergoes extensive hepatic metabolism and systemic exposure may be increased. Use with caution.
Each vial should be reconstituted with 1.2 mL SWFI. Shake vigorously; will form a pale, pink solution containing 20 mg/mL ziprasidone.
Extemporaneously Prepared
A 2.5 mg/mL oral solution may be made with the injection. Use 8 vials of the 20 mg injectable powder. Add 1.2 mL of distilled water to each vial to make a 20 mg/mL solution. Once dissolved, transfer 7.5 mL to a calibrated bottle and add quantity of vehicle (Ora-Sweet®) sufficient to make 60 mL. Label "shake well" and "refrigerate". Stable for 14 days at room temperature or 42 days refrigerated (preferred).Green K and Parish RC, "Stability of Ziprasidone Mesylate in an Extemporaneously Compounded Oral Solution," J Pediatr Pharmacol Ther, 2010, 15:138-41.
Oral: Administer with a meal containing at least 500 calories (Lincoln, 2010).
Injection: For IM administration only.
Dietary Considerations
Capsule: Take with food.
Capsule: Store at 25°C (77°F); excursion permitted to 15°C to 30°C (59°F to 86°F).
Vials for injection: Store at 25°C (77°F); excursion permitted to 15°C to 30°C (59°F to 86°F). Protect from light. Following reconstitution, injection may be stored at room temperature up to 24 hours or under refrigeration for up to 7 days. Protect from light.
Drug Interactions
Acetylcholinesterase Inhibitors (Central): May enhance the neurotoxic (central) effect of Antipsychotic Agents. Severe extrapyramidal symptoms have occurred in some patients. Monitor therapy
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy
Amisulpride: Antipsychotic Agents may enhance the adverse/toxic effect of Amisulpride. Avoid combination
Amphetamines: Antipsychotic Agents may diminish the stimulatory effect of Amphetamines. Monitor therapy
Analgesics (Opioid): CNS Depressants may enhance the CNS depressant effect of Analgesics (Opioid). Management: Avoid concomitant use of opioid analgesics and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification
Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy
Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (Second Generation [Atypical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Management: Consider using an alternative antipsychotic agent when possible in patients with Parkinson disease. If an atypical antipsychotic is necessary, consider using clozapine or quetiapine, which may convey the lowest interaction risk. Consider therapy modification
Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination
Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy
Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
CarBAMazepine: May decrease the serum concentration of Ziprasidone. Monitor therapy
Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification
Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy
Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy
Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification
FLUoxetine: May enhance the QTc-prolonging effect of Ziprasidone. Ziprasidone may enhance the serotonergic effect of FLUoxetine. This could result in serotonin syndrome. Avoid combination
Highest Risk QTc-Prolonging Agents: May enhance the QTc-prolonging effect of other Highest Risk QTc-Prolonging Agents. Avoid combination
HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification
Indapamide: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Consider therapy modification
Ivabradine: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy
Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Methotrimeprazine: May enhance the CNS depressant effect of CNS Depressants. CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification
Methylphenidate: May enhance the adverse/toxic effect of Antipsychotic Agents. Antipsychotic Agents may enhance the adverse/toxic effect of Methylphenidate. Monitor therapy
Metoclopramide: May enhance the adverse/toxic effect of Antipsychotic Agents. Avoid combination
MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy
MetyroSINE: May enhance the adverse/toxic effect of Antipsychotic Agents. Monitor therapy
MiFEPRIStone: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Minocycline: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Moderate Risk QTc-Prolonging Agents: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination
Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination
OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification
Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination
Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification
Piribedil [INT]: May diminish the therapeutic effect of Antipsychotic Agents. Antipsychotic Agents may diminish the therapeutic effect of Piribedil [INT]. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended. Avoid combination
QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying): May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Management: Avoid such combinations when possible. Use should be accompanied by close monitoring for evidence of QT prolongation or other alterations of cardiac rhythm. Consider therapy modification
Quinagolide: Antipsychotic Agents may diminish the therapeutic effect of Quinagolide. Monitor therapy
Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy
Saquinavir: Ziprasidone may enhance the arrhythmogenic effect of Saquinavir. Avoid combination
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy
Serotonin Modulators: May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline. Monitor therapy
Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification
Sulpiride: Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride. Avoid combination
Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification
Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification
Teneligliptin: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Monitor therapy
Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination
Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Vinflunine: May enhance the QTc-prolonging effect of Highest Risk QTc-Prolonging Agents. Avoid combination
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification
Adverse Reactions
Frequencies represent oral administration unless otherwise indicated. Note: Although minor QTc prolongation (mean: 10 msec at 160 mg/day) may occur more frequently (incidence not specified), clinically relevant prolongation (>500 msec) was rare (0.06%) and less than placebo (0.23%).
Central nervous system: Drowsiness (oral and IM: 8% to 31%; may be dose-related), extrapyramidal reaction (oral: 1% to 31%), headache (oral and IM: 5% to 18%), dizziness (oral and IM: 3% to 16%; includes lightheadedness; may be dose-related)
Gastrointestinal: Nausea (oral and IM: 8% to 12%)
1% to 10%:
Cardiovascular: Orthostatic hypotension (IM: ≤5%, oral: ≥1%; may be dose-related), chest pain (3%), hypertension (oral and IM: 1% to 3%), tachycardia (1% to 2%), bradycardia (oral and IM: ≤2%), facial edema (≥1%), angina pectoris (≤1%), peripheral edema (≤1%)
Central nervous system: Akathisia (oral: 8% to 10%; IM: ≤2%), anxiety (oral: 5%; may be dose-related), hypoesthesia (1% to 2%), agitation (oral: ≥1%, IM: ≤2%), personality disorder (IM: ≤2%), speech disturbance (oral and IM: ≤2%), amnesia (≥1%), ataxia (≥1%), chills (≥1%), confusion (≥1%), delirium (≥1%), dystonia (≥1%; may be dose-related), falling (≥1%), flank pain (≥1%), hostility (≥1%), hypothermia (≥1%), vertigo (≥1%), withdrawal syndrome (≥1%), anorgasmia (≤1%), atrial fibrillation (≤1%), male sexual disorder (≤1%), paralysis (≤1%), insomnia
Dermatologic: Skin rash (1% to 5%; may be dose-related), fungal dermatitis (1% to 2%), diaphoresis (IM: ≤2%), furunculosis (IM: ≤2%), skin photosensitivity (≥1%), alopecia (≤1%), contact dermatitis (≤1%), ecchymoses (≤1%), eczema (≤1%), exfoliative dermatitis (≤1%), maculopapular rash (≤1%), urticaria (≤1%), vesiculobullous dermatitis (≤1%)
Endocrine & metabolic: Weight gain (4% to 16%), albuminuria (≤1%), amenorrhea (≤1%), dehydration (≤1%), glycosuria (≤1%), hypercholesterolemia (≤1%), hyperglycemia (≤1%), hypermenorrhea (≤1%), hypokalemia (≤1%), increased lactate dehydrogenase (≤1%), increased thirst (≤1%)
Gastrointestinal: Constipation (oral: 9%, IM: ≤2%), dyspepsia (oral: 8%, IM: 2% to 3%), vomiting (oral and IM: 1% to 5%), xerostomia (oral: 4% to 5%; may be dose-related), diarrhea (oral and IM: ≤5%), sialorrhea (4%; may be dose-related), abdominal pain (oral and IM: ≤2%), anorexia (oral and IM: ≤2%; may be dose-related), dysmenorrhea (IM: ≤2%), dysphagia (≤2%), buccoglossal syndrome (≥1%)
Genitourinary: Hematuria (≤1%), impotence (≤1%), lactation (female: ≤1%), priapism (IM: ≤1%), urinary retention (≤1%)
Hematologic & oncologic: Rectal hemorrhage (oral and IM: ≤2%), anemia (≤1%), eosinophilia (≤1%), leukocytosis (≤1%), leukopenia (≤1%), lymphadenopathy (≤1%)
Hepatic: Increased serum alkaline phosphatase (≤1%), increased serum transaminases (≤1%)
Hypersensitivity: Tongue edema (≤3%)
Local: Pain at injection site (IM: 7% to 8%)
Neuromuscular & skeletal: Weakness (oral: 5% to 6%; may be dose-related), myalgia (1% to 2%), paresthesia (oral and IM: ≤2%), abnormal gait (≥1%), akinesia (≥1%), choreoathetosis (≥1%), dysarthria (≥1%), dyskinesia (≥1%), hyperkinesia (≥1%), hypokinesia (≥1%), hypotonia (≥1%), neuropathy (≥1%), tremor (≥1%; may be dose-related), twitching (≥1%), cogwheel rigidity (oral: ≥1%), hypertonia (≥1%), increased creatine phosphokinase (≤1%), tenosynovitis (≤1%)
Ophthalmic: Visual disturbance (3% to 6%; may be dose-related), diplopia (≥1%), oculogyric crisis (≥1%), blepharitis (≤1%), cataract (≤1%), conjunctivitis (≤1%), photophobia (≤1%), xerophthalmia (≤1%)
Otic: Tinnitus (≤1%)
Renal: Polyuria (≤1%)
Respiratory: Respiratory tract infection (8%), rhinitis (oral: 4%), cough (3%), pharyngitis (3%), dyspnea (1% to 2%), flu-like symptoms (oral: ≥1%), epistaxis (≤1%), pneumonia (≤1%)
Miscellaneous: Accidental injury (4%), fever (≥1%), motor vehicle accident (≥1%)
<1% (Limited to important or life-threatening): Agranulocytosis, basophilia, bundle branch block, cardiomegaly, cerebral infarction, cerebrovascular accident, cholestatic jaundice, decreased glucose tolerance, deep vein thrombophlebitis, diabetic coma, DRESS syndrome, ejaculatory disorder, facial droop, fecal impaction, female sexual disorder, first degree atrioventricular block, galactorrhea, gingival hemorrhage, granulocytopenia, gynecomastia, hematemesis, hemophthalmos, hemoptysis, hepatitis, hepatomegaly, hyperchloremia, hyperkalemia, hyperreflexia, hypersensitivity reaction (including allergic dermatitis, orofacial edema), hyperthyroidism, hyperuricemia, hypocalcemia, hypochloremia, hypocholesterolemia, hypochromic anemia, hypoglycemia, hypomagnesemia, hypomania, hyponatremia, hypoproteinemia, hypothyroidism, increased blood urea nitrogen, increased gamma-glutamyl transferase, increased monocytes, increased serum creatinine, increased serum prolactin, jaundice, keratitis, keratoconjunctivitis, ketosis, laryngismus, liver steatosis, lymphedema, lymphocytosis, mania, melena, myocarditis, myoclonus, myopathy, neuroleptic malignant syndrome, neutropenia, nocturia, nystagmus, oliguria, opisthotonos, oral leukoplakia, oral paresthesia, phlebitis, polycythemia, prolonged Q-T interval on ECG, pulmonary embolism, respiratory alkalosis, seizure, serotonin syndrome (with or without serotonergic medications), sleep apnea syndrome (obstructive) (Health Canada 2016, Shirani 2011), Stevens-Johnson syndrome, syncope, tardive dyskinesia, thrombocythemia, thrombocytopenia, thrombophlebitis, thyroiditis, torsade de pointes, torticollis, trismus, urinary incontinence, vaginal hemorrhage, visual field defect
ALERT: U.S. Boxed WarningIncreased mortality in elderly patients with dementia-related psychosis:
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients between 1.6 and 1.7 times that seen in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was approximately 4.5% compared with a rate of approximately 2.6% in the placebo group. Although the causes of death varied, most of the deaths appeared to be cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Ziprasidone is not approved for the treatment of patients with dementia-related psychosis.
Concerns related to adverse effects:
• Blood dyscrasias: Leukopenia, neutropenia, and agranulocytosis (sometimes fatal) have been reported in clinical trials and postmarketing reports with antipsychotic use; presence of risk factors (eg, preexisting low WBC or history of drug-induced leuko-/neutropenia) should prompt periodic blood count assessment. Discontinue therapy at first signs of blood dyscrasias or if absolute neutrophil count <1,000/mm3.
• Dermatologic reactions: Cases of dermatologic reactions (including Stevens-Johnson syndrome and drug reaction with eosinophilia and systemic symptoms [DRESS]) have been reported; may be fatal. Symptoms of DRESS include a combination of 3 or more of the following: severe skin eruption (rash or exfoliative dermatitis), fever, lymphadenopathy, eosinophilia and one or more systemic complications (eg, hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis). Discontinue use if DRESS or other severe cutaneous reactions are suspected.
• Dyslipidemia: Has been reported with atypical antipsychotics; risk profile may differ between agents.
• Esophageal dysmotility/aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; use with caution in patients at risk of pneumonia (ie, Alzheimer's disease).
• Extrapyramidal symptoms: May cause extrapyramidal symptoms (EPS), including pseudoparkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia (risk of these reactions is generally much lower relative to typical/conventional antipsychotics; frequencies reported are similar to placebo). Risk of dystonia (and probably other EPS) may be greater with increased doses, use of conventional antipsychotics, males, and younger patients. Factors associated with greater vulnerability to tardive dyskinesia include older in age, female gender combined with postmenopausal status, Parkinson disease, pseudoparkinsonism symptoms, affective disorders (particularly major depressive disorder), concurrent medical diseases such as diabetes, previous brain damage, alcoholism, poor treatment response, and use of high doses of antipsychotics (APA [Lehman 2004]; Soares-Weiser 2007). Consider therapy discontinuation with signs/symptoms of tardive dyskinesia.
• Hyperglycemia: Atypical antipsychotics have been associated with development of hyperglycemia; in some cases, may be extreme and associated with ketoacidosis, hyperosmolar coma, or death. Use with caution in patients with diabetes or other disorders of glucose regulation; monitor for worsening of glucose control. There is limited documentation with ziprasidone and specific risk associated with this agent is not known.
• Hyperprolactinemia: May increase prolactin levels; clinical significance of hyperprolactinemia in patients with breast cancer or other prolactin-dependent tumors is unknown.
• Neuroleptic malignant syndrome (NMS): Use may be associated with neuroleptic malignant syndrome (NMS); monitor for mental status changes, fever, muscle rigidity and/or autonomic instability.
• Orthostatic hypotension: May cause orthostatic hypotension; use with caution in patients at risk of this effect or in those who would not tolerate transient hypotensive episodes (cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia).
• Priapism: Rare cases of priapism have been reported.
• QT prolongation: May result in QTc prolongation (dose related), which has been associated with the development of malignant ventricular arrhythmias (torsade de pointes) and sudden death. Observed prolongation was greater than with other atypical antipsychotic agents (risperidone, olanzapine, quetiapine), but less than with thioridazine. Avoid hypokalemia, hypomagnesemia. Use caution in patients with bradycardia. Discontinue in patients found to have persistent QTc intervals >500 msec. Patients with symptoms of dizziness, palpitations, or syncope should receive further cardiac evaluation. Also see Contraindications.
• Rash: Use has been associated with a fairly high incidence of rash (5%); discontinue if alternative etiology is not identified.
• Sedation: Moderate to highly sedating, use with caution in disorders where CNS depression is a feature; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• Suicidal ideation: The possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder; use with caution in high-risk patients during initiation of therapy. Prescriptions should be written for the smallest quantity consistent with good patient care.
• Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, dehydration, and concomitant medication possessing anticholinergic effects.
• Weight gain: Significant weight gain has been observed with antipsychotic therapy; incidence varies with product. Monitor waist circumference and BMI.
Disease-related concerns:
• Cardiovascular disease: Use is contraindicated in patients with recent acute myocardial infarction (MI), QT prolongation, or uncompensated heart failure. Avoid use in patients with a history of cardiac arrhythmias; use with caution in patients with history of MI or unstable heart disease.
• Dementia: [US Boxed Warning]: Elderly patients with dementia-related behavioral disorders treated with antipsychotics are at an increased risk of death compared to placebo. Most deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Use with caution in patients with Lewy body dementia or Parkinson disease dementia due to greater risk of adverse effects, increased sensitivity to extrapyramidal effects, and association with irreversible cognitive decompensation or death (APA [Reus 2016]). Ziprasidone is not approved for the treatment of dementia-related psychosis.
• Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy.
• Hepatic impairment: Use with caution in patients with hepatic disease or impairment.
• Parkinson disease: Use with caution in patients with Parkinson disease; antipsychotics may aggravate the motor disturbances of Parkinson disease (APA [Lehman 2004]; APA [Reus 2016]).
• Renal impairment: Use the intramuscular formulation with caution in patients with renal impairment.
• Seizures: Use with caution in patients at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold. Elderly patients may be at increased risk of seizures due to an increased prevalence of predisposing factors.
Concurrent drug therapy issues:
• Sedatives: CNS effects may be potentiated when used with other sedative drugs or ethanol.
Dosage form specific issues:
• Intramuscular formulation: Use the intramuscular formulation with caution in patients with renal impairment; formulation contains cyclodextrin, an excipient which may accumulate in renal insufficiency, although the clinical significance of this finding is uncertain (Luke, 2010).
Other warnings/precautions:
• Discontinuation of therapy: When discontinuing antipsychotic therapy, the American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid physical withdrawal symptoms, including anorexia, anxiety, diaphoresis, diarrhea, dizziness, dyskinesia, headache, myalgia, nausea, paresthesia, restlessness, tremulousness, and vomiting (APA [Lehman 2004]; CPA [Addington 2005]; Lambert 2007; WFSBP [Hasan 2012]). The risk of withdrawal symptoms is highest following abrupt discontinuation of highly anti-cholinergic or dopaminergic antipsychotics (Cerovecki 2013). Additional factors such as duration of antipsychotic exposure, the indication for use, medication half-life, and risk for relapse should be considered. In schizophrenia, there is no reliable indicator to differentiate the minority who will not from the majority who will relapse with drug discontinuation. However, studies in which the medication of well-stabilized patients were discontinued indicate that 75% of patients relapse within 6 to 24 months. Indefinite maintenance antipsychotic medication is generally recommended, and especially for patients who have had multiple prior episodes or two episodes within 5 years (APA [Lehman 2004]).
Monitoring Parameters
Mental status; vital signs (as clinically indicated); blood pressure (baseline; repeat 3 months after antipsychotic initiation, then yearly); ECG (as clinically indicated); weight, height, BMI, waist circumference (baseline; repeat at 4, 8, and 12 weeks after initiating or changing therapy, then quarterly; consider switching to a different antipsychotic for a weight gain ≥5% of initial weight); CBC (as clinically indicated; monitor frequently during the first few months of therapy in patients with pre-existing low WBC or history of drug-induced leukopenia/neutropenia); electrolytes (annually and as clinically indicated; perform baseline potassium and magnesium measurements in patients at risk for electrolyte disturbances and periodically monitor if diuretics are initiated during ziprasidone treatment); liver function (annually and as clinically indicated); personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease (baseline; repeat annually); fasting plasma glucose level/HbA1c (baseline; repeat 3 months after starting antipsychotic, then yearly); fasting lipid panel (baseline; repeat 3 months after initiation of antipsychotic; if LDL level is normal repeat at 2-5 year intervals or more frequently if clinical indicated); changes in menstruation, libido, development of galactorrhea, erectile and ejaculatory function (at each visit for the first 12 weeks after the antipsychotic is initiated or until the dose is stable, then yearly); abnormal involuntary movements or parkinsonian signs (baseline; repeat weekly until dose stabilized for at least 2 weeks after introduction and for 2 weeks after any significant dose increase); tardive dyskinesia (every 12 months; high-risk patients every 6 months); ocular examination (yearly in patients >40 years; every 2 years in younger patients) (ADA, 2004; Lehman, 2004; Marder, 2004).
Pregnancy Risk Factor
Pregnancy Considerations
Adverse events were observed in animal reproduction studies. Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements (extrapyramidal symptoms [EPS]) and/or withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization. Ziprasidone may cause hyperprolactinemia, which may decrease reproductive function in both males and females.
The ACOG recommends that therapy during pregnancy be individualized; treatment with psychiatric medications during pregnancy should incorporate the clinical expertise of the mental health clinician, obstetrician, primary healthcare provider, and pediatrician. Safety data related to atypical antipsychotics during pregnancy is limited and routine use is not recommended. However, if a woman is inadvertently exposed to an atypical antipsychotic while pregnant, continuing therapy may be preferable to switching to a typical antipsychotic that the fetus has not yet been exposed to; consider risk:benefit (ACOG, 2008).
Healthcare providers are encouraged to enroll women 18-45 years of age exposed to ziprasidone during pregnancy in the Atypical Antipsychotics Pregnancy Registry (1-866-961-2388 or http://www.womensmentalhealth.org/pregnancyregistry).
Patient Education
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience fatigue, agitation, loss of strength and energy, nausea, vomiting, anxiety, constipation, diarrhea, dry mouth, headache, cough, or rhinorrhea. Have patient report immediately to prescriber signs of infection, signs of high blood sugar (confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit), signs of kidney problems (urinary retention, blood in urine, change in amount of urine passed, or weight gain), signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), signs of a pancreas problem (pancreatitis; severe abdominal pain, severe back pain, severe nausea, or vomiting), suicidal ideation, severe dizziness, passing out, tachycardia, bradycardia, behavioral changes, mood changes, change in balance, abnormal movements, twitching, dysphagia, difficulty speaking, difficulty focusing, seizures, vision changes, shortness of breath, swelling of arm or leg, excessive weight gain, enlarged breasts, sexual dysfunction, nipple discharge, amenorrhea, severe injection site irritation, priapism, signs of neuroleptic malignant syndrome (fever, muscle cramps or stiffness, dizziness, very bad headache, confusion, change in thinking, fast heartbeat, abnormal heartbeat, or sweating a lot), signs of tardive dyskinesia (unable to control body movements; tongue, face, mouth, or jaw sticking out; mouth puckering; and puffing cheeks), or signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
More about ziprasidone
Consumer resources
Professional resources
- Other brands: Geodon


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PHOTO: Mad Man Attack And Stabs Two Policemen With BottleFriday, August 01, 2014
The mad man inside the police truck in the photo above was arrested at Alakija bus stop in Lagos after he allegedly attacked two policemen on duty with a bottle. The incident happened inside the premises of a Redeemed Christian Church of God in Alakija area of Lagos state yesterday.
The policemen on duty were attacked as they tried to chase an insane woman away from the premises of the aforementioned church.
According to an eyewitness:
"Trouble started when the woman was standing in front of the church and policemen deployed to the area attempted to evict her.
"Suddenly, a madman, who was watching what was going on, went to meet the policemen ostensibly to stop them.
"The policemen left the woman and confronted the insane man. They started beating him with their batons. The madman, who was with a stick started flogging the policemen.
"Suddenly, the madman brought out a broken bottle from his bag and stabbed the two policemen, who were later rushed to Navy Town Hospital by church members and onlookers.
"News got to other policemen attached to the church that their colleagues had been stabbed by the madman and they reinforced and began to look for the madman, whom they found at Alakija Bus-stop.
"The five policemen surrounded the madman and tried to overpower him and after much struggle, they tied him up with a rope and bundled him into their van and took him back to the church for interrogation."Many people who witnessed the drama said the woman and the man are both kidnappers disguised as insane people to carry out their evil plot.
1 Comments, Add Yours
- Anonymous2 August 2014 at 08:56
Everything is now kidnappers back,kidnappers with a broken bottle in his bag to kidp someoneReplyDelete
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subset: commoncrawl


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Small-town sweethearts Carolyn and Billy built a booming business and had a lovely family during their 43 years together, then Carol is found in a pool of blood.
After marrying for the third time, John Smith is accused of murdering his first wife and is suspected in his second wife's disappearance.
A woman marries her long-time crush, then he ends up in federal prison because of a gambling addiction.


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Valter Jacinto marked "n216_w1150" as hidden on the "Xanthocephalus xanthocephalus" page.
Reasons to hide: low quality
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We have a wide variety of your Gino's favorites, served hot from our restaurant in downtown Latrobe, PA.
- View our TAKE OUT MENU
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- View our DINE IN MENU (Everything Else!)
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Fresh vine-ripened tomatoes, olive oil, salt, spices and love. By the Quart and Pint.
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United States Steel Corporation (NYSE:X) initiated the shares trading at $26.44 and showed positive change of +2.19% while the stock's final trade was registered at $ 27.49. However, its previous closing price was seen at $26.90. The stock negotiated total number of 16.52 million shares as compared to 3 months average volume of 16.05 million shares.
The stock price demonstrated downbeat change from its 50 day moving average of 19.42 and had been up from its 200 Day Moving Average of 14.84.
United States Steel Corp.'s (X) has price-to-cash ratio of 4.91 and price to sale ratio of 0.39. The company net profit margin is -16.40% and gross profit margin is 2.00%. A look on the firm performance, its monthly performance is 72.14% and a quarterly performance of 44.23%. The stock price is moving up from its 20 days moving average with 32.67% and isolated positively from 50 days moving average with 54.61%.
Brokerage Recommendations:
According to ZACKS data, different Brokerage Firms rated the stock about their BUY, SELL or HOLD recommendations. Currently shares have been suggested as "BUY" from "0" brokerage firms and recommended as "Strong Buy" by "1" brokerage firms. 2" brokerage firms have issued "Sell" rating for the company and "Strong Sell" rating was issued by "4" brokerage firms. "6" brokerage firms have rated the company as a "Hold". The Corporation has average brokerage recommendation (ABR) of 3.62 based on consensus of the brokerage firms issuing ratings.
Shares of Noble Energy Inc. (NYSE:NBL) climbed +1.39% and ended at $35.72 greater than previous closing price of $35.23. The total 3.81 million shares were bought and sold throughout the most recent trading session more than average volume of 3.5 million shares.
The average true range of Noble Energy, Inc.'s (NBL) is recorded at 1.01 and the relative strength index of the stock stands 50.20. The stock price is going above to its 52 week low with 51.17% and lagging behind from its 52 week high with -9.83%. Analyst recommendation for this stock stands at 2.10. A look on the firm performance, its monthly performance is -1.62% and a quarterly performance of -0.80%. The stock price is trading upbeat from its 200 days moving average with 6.05% and down from 50 days moving average with -0.74%.
Brokerage Recommendations:
The stock has received ratings from many brokerage firms according to ZACKS. Currently shares have been rated as "Buy" from "3" brokerage firms and "13" brokerage firms say as "Strong Buy". "0" brokerage firms have suggested "Sell" for the company. "7" brokerage firms have recommended as a "Hold". Strong Sell rating was given by "0" brokerage firms. The Company has average brokerage recommendation (ABR) of "1.74" based on consensus of the ZACKS brokerage firms.


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Robert Picard
this wiki
Robert Picard (pronounced as the French ro-BARE) was the son of Maurice and Yvette Picard and the elder brother of Starfleet Captain Jean-Luc Picard. (TNG: "Family") His mother had died by 2364. (TNG: "Where No One Has Gone Before")
Robert always refused to own replicators, and would not allow their use anywhere in his home or property. (TNG: "Family")
Their relationship was tumultuous. As children, Robert often bullied and picked on Jean-Luc. Robert, who his parents considered the responsible one, always resented that Jean-Luc broke all the rules and got away with it. Robert was jealous of Jean-Luc's success and resented him for it. He had to remain on Earth to tend to the Picard family vineyards in La Barre, France while Jean-Luc went off to Starfleet, gaining fame.
They were reconciled in 2367 when Jean-Luc returned to La Barre to recuperate shortly after his assimilation by the Borg. At first, their reunion was filled with animosity, since Robert still felt that Picard was arrogant. Relations between Jean-Luc and Robert worsened, particularly as the subject of Jean-Luc's recent problems came up. After Jean-Luc was offered a new job and he had to decide whether to leave Starfleet, Robert tormented him. Robert told Jean-Luc that Jean-Luc had become unsure of himself and asked him what happened to him. The argument lead to a brawl in the vineyards that eventually left the sibling rivals laughing and covered in mud. Jean-Luc told Robert that he felt guilty over his inability to fight the Borg after they kidnapped him and the deaths that ensued. Robert told Jean-Luc that he had to come to terms with his guilt and realize that it was not his fault. (TNG: "Family")
Like his younger brother, Robert suffered from Shalaft's Syndrome. (Star Trek Nemesis)
Robert died in a fire in 2371 at the family home, along with his only son, René. He was survived by his wife, Marie. (Star Trek Generations)
Background informationEdit
According to the script for "Family", Robert was six to eight years older than his brother Jean-Luc, placing his birth sometime between 2297 and 2299.
Robert was played by Jeremy Kemp in "Family".
A different actor played him in Generations, where he appeared only in the form of photographs in Jean-Luc's album.
British actor Ian Abercrombie provided ADR voiceover work for Jeremy Kemp in "Family", especially in several scenes shortly before the fight.
In the TNG Relaunch novels, Picard and Doctor Beverly Crusher have a son who they name Rene Jacques Robert Francois Picard in honor of Robert and Rene. (Paths of Disharmony)
External linkEdit
- Robert Picard at Memory Beta, the wiki for licensed Star Trek works


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342 search results for David O. Russell
Jennifer Lawrence: David O. Russell respects me so much he calls me a man
Type: Post | Date: Thursday, Dec 17, 2015
Robert De Niro compares his relationship with Scorsese to Jennifer Lawrence's with David O Russell
Type: Video | Date: Thursday, Dec 17, 2015Robert De Niro sees many simularities between Martin Scorsese and the duo Jennifer Lawrence & David O Russel.
Jennifer Lawrence: David O Russell respects me so much he calls me a man
Type: Video | Date: Thursday, Dec 17, 2015Jennifer Lawrence discusses how Joy reflects women in Hollywood.
Why Are Legendary Filmmakers and Actors Moving To The Small Screen? | Fandemonium
Type: Post | Date: Wednesday, Aug 17, 2016
Alfonso Cuarón, David O. Russell, Martin Scorsese earn DGA nominations
Type: Post | Date: Tuesday, Jan 7, 2014The Coen brothers and Spike Jonze miss in the significant precursor
Megan Ellison back in the David O. Russell business with two-picture Annapurna deal
Type: Post | Date: Thursday, Oct 2, 2014Company previously financed Best Picture contender 'American Hustle'
10 things that make Jennifer Lawrence the Millennial Messiah
Type: Article | Date: Wednesday, Nov 18, 2015How the 25-year-old 'Hunger Games' star has won over the world
Why Are Legendary Filmmakers and Actors Moving To The Small Screen? | Fandemonium
Type: Video | Date: Monday, Aug 15, 2016Miri Jedeikin discusses with Alan Sepinwall about the trend of big movie stars and filmmakers moving from the big screen to the small and the creative freedom within the Television streaming model.
Review: Jennifer Lawrence gives her all but can't quite make 'Joy' fly
Type: Post | Date: Tuesday, Dec 8, 2015This latest collaboration with her 'Silver Linings' director bites off more than it can chew
The movie formerly known as David O. Russell's 'Nailed' has a trailer
Type: Post | Date: Tuesday, Jan 6, 2015'Accidental Love' imagines itself as a goofy rom-com


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"Win Your Money Back" Offer on Purchase of Wusthof Knives at Everten
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About the Company:
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Check in from 14h / Check out prior to 11h
Park Inn West Bromwich: Find photos, reviews, information, amenities and compare prices for 3 stars hotels in West Bromwich, United Kingdom.
Offering a Jacuzzi, a sauna and an indoor pool, this relaxed hotel is a short car trip from Oldbury. It also features an express check-in and check-out feature, 24-hour room service and a coffee bar.
Hotel description
Park Inn West Bromwich treats guests to a range of leisure amenities, including billiards and InnAction. Attentive and professional staff are available 24-hours a day.
Each relaxed room at Park Inn West Bromwich comes with tea and coffee making facilities and cable/satellite channels, and the bathrooms feature showers and hair dryers. All provide a flat-screen TV, heating and a laptop safe.
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Thousands upon Thousands Americans on the Medicare program are are now discovering that with the proper Medicare Supplemental Insurance Coverage it's possible to:
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Purchase a Medicare Supplemental Policy with us and obtain peace of mind about both your more affordable costs and the exceptional protection.
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Ask any of our customers and they'll tell you that things like this don't happen on our watch. Our Medigap Insurance Brokers in-house are also professional "field underwriters.†So we will not only help you to locate the most affordable for Medicare Supplemental Rates, but we will make certain you will meet the requirements for the insurance policy we go forward with any paperwork. With a couple of quick quick questions about your health and medical history, you could easily qualified for Medicare Supplement Insurance Policies which should approve you the first time, without a bunch of stress or fears you might revoked plans.
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Medicare Supplemental Insurance Plans are also known as "Medigap Plansâ€
Medigap is an insider term applied to health insurance policies called Medicare Supplement Insurance. Medigap Plans cover the gaps in standard coverage that are not covered by Medicare Parts A and B and are made to fit with Medicare like a key fits into a lock.
A Medigap Plan is not an stand-in for Original Medicare like Medicare Advantage Policy, but instead works in conjunction with Original Medicare. Additionally, Medigap Plans differ from Medicare Advantage since they've no deductibles, no co-pays and no worries about being "in nework" that could interfere with you medical treatment.
Did you know that if you select the right Medicare Supplemental Medicare Supplemental Plan a Medicare Supplement Plan F for example you should never be made to fork over a single dime when you get prescribed treatment in a hospital, specialty treatment center or doctor's office that accepts Original Medicare.
So this means that you decide on a Medicare Supplement Plan F, if your health care bills are out-of-this-world, you will never have to pay any extra bills for health care bills when Original medicare gives the OK to your medical procedures.
Medicare Supplement Insurance Rates: How it all works
When you require medical care with a doctor, specialty treatment center, or hospital, you only have to show your Medicare Supplemental card to the specialty treatment center, doctor or hospital. Then, almost magically, everything will be taken care of for you.
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Like hundreds of thousands of Americans that we have assisted over the years, you've discovered that attempting carry out the decision on a Medicare Supplement Insurance Plans can be exacting right?. Additionally, attempting to get a Medicare Supplemental Provider who will help you out as you examine Medicare Insurance Policies is usually hard to do.
Fortunately, it doesn't have to be that way. Finding a Medicare Insurance Policy Broker whom you can trust is no problem because:
And, we never, ever charge you for our services.
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If you are on Medicare, you're as likely as not looking at difficult decisions on selecting the correct Medigap Plan and you're as likely as not being misled by Medicare Advantage salespeople.
Medicare Supplement Insurance Policy Providers are all required by federal law to give each customer the same coverage. This is why it's so very crucial to look at all Medicare Supplement Insurance Policy Rates from the best carriers through a brokerage that's on your side.
We're not like others, because we work on your behalf, not for any one particular Medicare Supplemental Insurance Plan Provider. Our insurance industry professionals check out every of the Medicare Supplemental Insurance Plan Providers that sell Medicare Supplemental Rates and search those that are reputable and will be able to live up to their contracts for many years to come. It's pretty simple,, our analysts weeds out all the insignificant Medicare Supplement Insurance Plan Carriers and the unreliable.
Once our team has found the top Medigap Providers that match our rigid terms and stipulations, we employ our proprietary and state of the art software technology to do Medigap Rate online comparisons. By shopping around for you, our agents acquire the lowest monthly costs for current status , not what the Medicare Supplement Insurance Plan Carriers want you will purchase from them.
However that is not all we want to do. Ever tried buy an insurance plan like a Medicare Insurance Plan? Many Medicare patients, are denied coverage or gotten restrictions on their policy that they didn't see coming only after they'd taken care of the initial premium. There will be great issues involved receiving your money back or signing up for new Medigap Policy or other coverage.
Things like this don't happen on our watch.
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We won't ever advise you to sign up for a Medicare Supplemental Insurance Policy for you unless we're certain that you qualify to be approved by the Medicare Supplemental Insurance Policy provider. Furthermore, our Best Premium Guarantee ensures that you never pay a penny for our services and that you pay the cheapest rate for the recommended policy you are qualified for.
To make it easy on you, we have made arrangements with the Medicare Supplemental Policy Providers to let you sign up for a plan on the phone quickly. You get the cheapest Medicare Supplemental available in your area, a policy for life and, if you select a Medicare Supplemental Plan F, you will never ever pay extra money again for Medicare-covered Medicare-eligible.


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Candlewood Suites Wichita-Northeast
Candlewood Suites Wichita-Northeast
Take Pleasure in Free Amenities at Our Extended Stay Hotel in Wichita, KS.
Adjacent to local businesses and attractions, the Candlewood Suites® Hotel Wichita - Northeast puts Kansas at your fingertips. Our East Wichita, KS location is near I-235 and KS-96, which makes visiting your clients or local attractions convenient. It is our desire to ensure that our guests feel at home during a short or long-term stay. We make it easy to settle in.
In the heart of the aviation hub, we are near Hawker Beechcraft, Cessna and Boeing. We are minutes from the Kansas Heart Hospital and the Kansas Spine Hospital, which is convenient for our medical guests staying with us. We're a great corporate housing alternative thanks to our comforts of home amenities: free Wi-Fi access, the Candlewood Cupboard, free laundry facilities, relaxing gazebo area, our 24-hour (Candlewood Gym), Lending Library and Lending Locker.
The popular Old Town and Red-Brick districts, provides a perfect home base for your vacation, too. One of the area's biggest attractions is the Bradley Fair, an outdoor shopping, dining and entertainment complex. In addition to our great location, we also provide a warm atmosphere and exceptional staff whose service keeps you coming back.
With spacious suites, full kitchens, and flexible workspaces, our Wichita, KS hotel provides everything you need to keep life and work in sync while on the road.
Quick Info
- Check In: 3:00 PM
- Check Out: 12:00 PM
- Minimum Check-In Age: 21
- Late Check Out Available
- Parking: Free
- Print Fact Sheet
- Chat With Us
- On-site Guest Self-Laundry Facilities
- Standard Wireless Internet service is free for all members
- On-site Fitness Center Available
It's hard to leave your best buddy at home when you're traveling for extended periods, so we provide a pet friendly experience. Restrictions and fees apply.
Whether you are booking suites for a family reunion or suites for your company's training needs, Candlewood Suites hotels can accommodate your group.
Workout whenever you want: Candlewood Gym always has an open door and lots of aerobic and cardio equipment to make it easier to stick to your exercise routine, no sweat.
The IHG Green Engage system is an online tool that gives our hotels the means to measure their day-to-day environmental impact.
Getting Here
Guest Reviews
Overall Experience
no popcorn
ByZ arm Zeigler
January 16, 2017
Usually a bag in the micro or on the counter.. did not have one this time
Friendly and caring staff
ByKansas Walker
January 15, 2017
The staff is friendly and takes care of any concerns you might encounter during your stay.
Nice Facility
January 15, 2017
Great option for NE Wichita area. Close to medical facilities and good price for family members staying in an area near patients at Heart Hospital or other NE Wichita hospitals.
Nice place to stay
January 12, 2017
Clean room, quiet, good location, friendly staff, nice kitchen area although we ate out. Have stayed here four different times, never any issues with the stay.


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Since 1947
Inside: My Christmas List is more than just a way to keep track of The special people God has brought into my life to love
Every name's a touchstone that leads a place and time, Where God has used another's heart to reach out and touch mine.
It may have happened years ago or even yesterday, But every person on my list has changed my life some way.
So please know that this greeting is more than a Christmas wish, It's a "thank you" card to God for putting on my list.
Each and every one whose name I've come to hold so dear…Those who've shown me Christmas joy each day of the year.
This elegant greeting features a snow-covered church in crisp white ink on a royal blue linen-textured card thanking God for each and every loved one in your life.
With a unique, linen-like texture, card tri-folds to 5 1/2 x 4 1/2"; white envelopes included.
Personalization: Specify family name for the cover (up to
2 lines, 14 characters each). Specify names as they are to be printed inside the cards.
Set of 20
Save on additional sets!
For non-personalized cards, simply select one of the two options below and leave the personalization area blank while ordering.
(based on 33 reviews)
Ratings Distribution
5 Stars
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of respondents would recommend this to a friend.
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I would buy cards again.
By Artheritic sue
from Warsaw IN
About Me Budget shopper
Comments about Personalized Religious Christmas Cards:
Conveince for me , I have arthritics in my hands . But with your help I can send my Christmas wishes.
Bottom Line Yes, I would recommend this to a friend
Was this review helpful? Yes / No
- You may also flag this review
Do you agree?
By Jann F
from Ohio
Does anyone else think there's a word missing in the second to last bar? It says something like, "" A thank you note to God and putting on my list."" What's that? Or am I just not reading it correctly. Lmk please.
Bottom Line No, I would not recommend this to a friend
Christmas Cards
By Bob
from Charleston, S.C.
Ordered these Christmas cards and had them within 10 days. Beautiful and all the notations were perfect.
(3 of 3 customers found this review helpful)
Review of Christmas Card ordered
By Ronimarie
from Burghill, Ohio
About Me Midrange shopper
I ordered very nice personalized Christmas card & I am happy with everything other than the ink used on them. Several friends,family & myself could barely see the message because the ink they were printed with is too light to see it. That is the only problem I have with them.
(2 of 2 customers found this review helpful)
Personalized Religious Christmas Cards
By Neeterweb
from Jacksonville, FL
I really like the Christmas Cards I ordered. .. I'm sure my Customer's, as well as my friends and family will like them. Very pleased with everything I have ordered from Walter Drake. Thank you, Merry Christmas and Happy New Year
(2 of 3 customers found this review helpful)
The Blessings of Words
By Pippi
from Catonsville, Md
The recipients of my cards are always interested in knowing where I purchased them because of the uniqueness of the sentiments.
(1 of 1 customers found this review helpful)
Big hit - Beautiful wording
By CC
from Henrico, VA
People that received this card called to tell me how beautiful it is.
Beautiful Card
By bigboy
from VA
I have been a customer for several years. This is one of the thought provoking Christmas cards that we have ever ordered.
Beautiful cards, Beautiful message.
By Sandy
from Utica, NY
These cards say exactly what I am feeling this year about my Church family.
Christmas Blessings
By none
from Brodhead, KY
It was a very Beautiful card. I would buy it again and again. I recieved lots of comments on this card about the beauty of it and the words that were written


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Prep events postponed
Four additional prep sports events were postponed Monday evening due to extreme wind chills in the area. They include; Bark River-Harris at Westwood girls basketball, Forest Park at Mid Peninsula girls basketball and Bark River-Harris at Republic-Michigamme boys basketball. Also postponed was the Gladstone at Kingsford swim meet. Make up dates have not yet been announced.
Games rescheduled Tuesday night include; Escababa at Marquette girls, which has been postponed to Monday, Jan. 27 and Engadine at Superior Central boys, which has been postponed to Thursday, Feb. 6 at 2 p.m. Escanaba at Manistique girls basketball has been rescheduled for Wednesday evening.
Menominee at Escanaba boys basketball, originally scheduled for Monday night, has been rescheduled for Monday, Jan. 13.


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This is Yann Frisch, the guy with quick fingers. This amazing performance will blow your mind!
Keywords: Career planning, Web Development, Music, Internet Tools
This is Yann Frisch, the guy with quick fingers. This amazing performance will blow your mind!
What trials unite not only Harry Potter or Frodo Baggins but many of literature's most interesting heroes? And what do ordinary people have in common with these literary heroes? Matthew Winkler takes us step-by-step through the crucial events that ma...
Technology projects a touchscreen onto your hand, clothes, a wall, or any surface, so you can operate your phone without removing it from your pocket.
TED Talks In this fun, 3-min performance from the World Science Festival, musician Bobby McFerrin uses the pentatonic scale to reveal one surprising result of the way our brains are wired.
kid plays instrument awesomely My Facebook page http://www.facebook.com/flystew Click to Download My Mixtape http://www.mediafire.com/?pp323zn3hy5v1na My Clo...
Lately it seems like everyone is getting laid off and those who have been able to hold their jobs are worried sick. We have been hit with layoffs for quite
Like infographics and data visualizations? Visual.ly is the world's largest community of dataviz and infographics. Come explore, share and create.


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A Chance to Contribute
On September 22, 2013 the National Postal Museum opened the William H. Gross Stamp Gallery, the world's largest and most technologically sophisticated stamp exhibition facility. The Gallery includes seven interior galleries, the Byrne Education Loft and cutting edge interactives.
We need your help to stay on the cutting edge and maintain the level of excellence that the Gallery opened with.
To contribute to the William H. Gross Stamp Gallery, make a gift online or download this form.
To make an online donation, click the "Donate Now" button below.
On the next page, enter the amount and select the William H. Gross Stamp Gallery Fund.
Thank you for your generous support!
There are a variety of ways you can support this landmark philatelic project, including:
- outright gifts made in one payment
- pledges that spread out payments over a period of time
- proceeds from the sale of stamps from personal collections
- bequests and other planned gifts toward an endowment fund
The museum will recognize major gifts by naming a gallery, exhibit, display or other feature in a way that honors your commitment.
If you would like to be part of this defining moment, or if you would like to learn more about giving opportunities, please contact:
Hannah Trumbull
Development Officer
Smithsonian National Postal Museum
2 Massachusetts Avenue, NE
Washington, DC 20002
(202) 633-4738 | email@example.com


text:
The Lady & the Sailor Quilted Sweatpant
The Lady & the Sailor Quilted Sweatpant
Drawstring sweatpants; Ankle length, banded, and front pockets. 50% Cotton/50% Modal Made of Eco Materials Made in the USA Size & Fit Model is 5'8" and wears a small. Care Instructions Hand wash cold. Shake out to regain shape. Lay flat to dry.
Shipping and returns (when eligible) are FREE for purchases from US and Canadian boutiques when shipped to customers located in the US or Canada. We offer a flat shipping fee of $20 for all international transactions.
Shipping Details
Returns are accepted on full-priced items except when item is marked as Final Sale. All sale items, including Make an Offer items, are FINAL SALE.
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Key advancements have been made in understanding the complexity of reactive stroma microenvironments in prostate cancer during the previous progress period. Our studies show that TGF-?1 is overexpressed in prostate cancer epithelial cells and that a reactive stroma composed of myofibroblasts/carcinoma-associated fibroblasts co-evolve with cancer foci. We have shown that a reactive stroma grade 3 is predictive of prostate cancer progression. Moreover, xenograft models with engineered stroma recombined with carcinoma cells shows this stroma is tumor-promoting and TGF-?1 is a key regulator of this process. The target progenitor cells of tumor-promoting reactive stroma, the process of their recruitment, and the downstream genes that transduce the tumor-promoting biology of this reactive stroma are not understood. To address this biology, we have constructed transgenic mouse lines with TGF-?1 expression targeted to prostate epithelium. These mice exhibit focal stromal proliferative responses. The proposed studies are a direct extension of work in the previous period. We hypothesize that overexpression of TGF-?1 in premalignant prostate cancer induces a co-evolution of a spatially associated reactive stroma that may be recruited from either local or circulating, marrow-derived progenitor cells. To address this hypothesis in detail we propose 3 Specific Aims: 1). To assess the spatial and temporal correlation between overexpression of TGF-beta and reactive stroma grades in human prostate cancer. 2). To determine the role of TGF-beta in the co-evolution of reactive stroma in prostate cancer. 3). To determine the role of TGF-beta and reactive stroma in regulating prostate cancer progression. We propose the use of novel transgenic models with recombined xenograft and in vitro approaches to address these aims. Dissecting these processes and key pathways is important for long-range studies that will focus on directed therapeutics that target the reactive stroma compartment in human prostate cancer.
This project will provide pre-clinical data to help determine the recruitment and tumor-regulatory biology of the cancer stromal microenvironment. Data gained will help identify whether targeting TGF-?1 induced biology can be used as a strategic approach for the treatment of prostate cancer via its microenvironment.
|Carstens, Julienne L; Shahi, Payam; Van Tsang, Susan et al. (2014) FGFR1-WNT-TGF-? signaling in prostate cancer mouse models recapitulates human reactive stroma. Cancer Res 74:609-20
|San Martin, Rebeca; Barron, David A; Tuxhorn, Jennifer A et al. (2014) Recruitment of CD34(+) fibroblasts in tumor-associated reactive stroma: the reactive microvasculature hypothesis. Am J Pathol 184:1860-70
|Yang, Feng; Zhang, Yongyou; Ressler, Steven J et al. (2013) FGFR1 is essential for prostate cancer progression and metastasis. Cancer Res 73:3716-24
|Ayala, Gustavo E; Muezzinoglu, Bahar; Hammerich, Kai H et al. (2011) Determining prostate cancer-specific death through quantification of stromogenic carcinoma area in prostatectomy specimens. Am J Pathol 178:79-87
|Ressler, Steven J; Rowley, David R (2011) The WFDC1 gene: role in wound response and tissue homoeostasis. Biochem Soc Trans 39:1455-9
|Schauer, Isaiah G; Rowley, David R (2011) The functional role of reactive stroma in benign prostatic hyperplasia. Differentiation 82:200-10
|Barron, David A; Strand, Douglas W; Ressler, Steven J et al. (2010) TGF-ýý1 induces an age-dependent inflammation of nerve ganglia and fibroplasia in the prostate gland stroma of a novel transgenic mouse. PLoS One 5:e13751
|Schauer, Isaiah G; Ressler, Steven J; Rowley, David R (2009) Keratinocyte-derived chemokine induces prostate epithelial hyperplasia and reactive stroma in a novel transgenic mouse model. Prostate 69:373-84
|Schauer, Isaiah G; Ressler, Steven J; Tuxhorn, Jennifer A et al. (2008) Elevated epithelial expression of interleukin-8 correlates with myofibroblast reactive stroma in benign prostatic hyperplasia. Urology 72:205-13
|Yang, F; Strand, D W; Rowley, D R (2008) Fibroblast growth factor-2 mediates transforming growth factor-beta action in prostate cancer reactive stroma. Oncogene 27:450-9
Showing the most recent 10 out of 30 publications


text:
No harm in looking. New #jobs
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Critical appreciation is when a reader examines and evaluates a piece of literature from a discerning point of view. In other words, the reader knows the work well enough to have an intelligent basis for liking or disliking something. Let me give you an example.
If you say that you like the works of Sophocles, the Greek author of tragedies, then a critical appreciation of Sophocles will give reasons why you like him. You can say that you like his poetry style, his use of language, and the like. You can also say that you like his character development and his themes. You can say that he work is applicable to life. You can also write what you find difficult and not so favorable as well.
The key point is that you know the works well enough to give an in depth reason for your judgments.


text:
Copying Your Production Database to Staging on Heroku
While working on Roundtrip, I decided the best solution as a one man team was to use Heroku to host my application. It's just one less thing I need to worry about. On Heroku I have a staging environment, where I test changes before releasing to production. In order to do this, I need to copy the production database over to staging, to test on real data. While looking for an easy way to do this, I came across this Thoughbot article, but it's a little out of date. Here's how I managed to copy my data from production to staging in one command.
You'll then be asked to confirm you wish to make changes to your staging application, simply confirm and you're good to go!


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XG Mobile is the portable version of the acclaimed program "eXtreme Gammon" for PC. You can now have the power and accuracy of eXtreme Gammon in the palm of your hands.
XG Mobile is the perfect app for all strengths of players:
• Are you a beginner? no worries, XG Mobile will let you know when you make a mistake. That's a fun and efficient way to improve your skills
• Are you an expert player? You can practice against a world class opponent.
Trust the pros opinions:
- NEIL KAZAROSS (6 time American Backgammon Tour Winner, Backgammon Giant #4): "I can now state that XG is stronger than its competitors on equivalent settings as well as at least several times faster on those settings."
- MOCHIZUKI MASAYUKI (2009 World Champion, Backgammon Giant #1): "I like eXtreme Gammon very much. I truly believe this program is the strongest bot in the world."
- MICHIHITO KAGEYAMA (Runner up in the 2012 World Championship, Backgammon Giant #2): "[...] this time I took only my iPad at the Backgammon World Championship 2012. I often checked some positions by using XG mobile. It's really fast and easy because iPad starts up in a few seconds, and I can arrange checkers by using touch screen"
- CHRIS BRAY (Author, Backgammon Correspondent for The Independent): "My strong recommendation is to invest in XG Mobile. Like the PC version it will quickly become the de facto standard for the game"
XG Mobile features:
• The strongest backgammon program on iPhone and iPad.
• Play against computer opponents ranging in skill from Beginner to World Class.
• 2-player mode: play against friends using XG Mobile as a portable board (please note: live play, not online).
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• Choice of Backgammon or NackGammon Variation.
• High Quality Graphics (optimized for Retina displays) , choice of multiple boards and checkers.
• Share positions on Facebook, twitter etc...
• Ask the computer for hint at any time.
• Tutor mode analyzes your choice as you play and warns you of any mistake you made, allowing you to reconsider your choice.
• Training mode also analyzes your choice as you play and lets you know of any mistake you made. You cannot reconsider your choice
• Setup a position, analyze it or even start a session from this position.
• Games are Saved and can be copied using iTunes or emailed for later analysis on your Mac or PC.
• Extensive profile information tracking your level of play, your results and dice statistics.
• Competition mode allows you to play in live tournament conditions (no help, no pip count, etc...).
• Integrated help, including backgammon rules.
If you're looking for the best backgammon app on the market, download XG Mobile Backgammon now and enjoy the program players trust


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Lake Village Real Estate
Lake Village is located in Indiana. Lake Village, Indiana has a population of 674. Lake Village is less family-centric than the surrounding county with 14.57% of the households containing married families with children. The county average for households married with children is 30.55%.
The median household income in Lake Village, Indiana is $44,615. The median household income for the surrounding county is $49,816 compared to the national median of $53,046. The median age of people living in Lake Village is 53 years.
Lake Village Weather
The average high temperature in July is 84 degrees, with an average low temperature in January of 13.4 degrees. The average rainfall is approximately 39.6 inches per year, with 31.3 inches of snow per year. No weather information available.
Lake Village, IN Homes for SaleView all >>
Lake Village Map
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|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|"Carsten Ziegeler" <cziege...@s-und-n.de>
|RE: [Vote]: Where to define the sitemap components?
|Thu, 14 Mar 2002 13:08:41 GMT
> Sylvain Wallez wrote > < snip> > > > >Hmm, currently I'm thinking of voting -1 for defining the components > >in the xconf. This would create a deadlock. Very interesting > >and funny thing... > > > Does sitemap-local xconf remove the lock ? > Hm, now it seems that we all agree on the Blocks thoughts in some way. This new concept will perhaps solve all our problems. So why not have all sitemap components in the sitemap for 2.0.2 and then start with the blocks design/implementation after the release? If we now move some components, the user will get confused and have to learn a new schema. And then some time later we introduce the blocks and they have to learn a third one, then. Except for "it would be nice if the components are all defined in the cocoon.xconf", I see really no pro for it. Again, the opposite is true if you think of components defined in sub-sitemaps which we all seem to agree on that this is a good think. Carsten --------------------------------------------------------------------- To unsubscribe, e-mail: email@example.com For additional commands, email: firstname.lastname@example.com
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A better elevator button design
Intuitive, logical. lowest floor at bottome, highest floors at top. Layout that appears
Add line drawing graphic here.
Elevator button placement
Buttons on an elevator panel should be placed in a composition that is orderly, logical, and intuitive. Lower floors should be towards the bottom and the numbers should increase as their location rises on the panel. These shown to the left are in the garage elevator at the airport on Oklahoma City. Users at the airport may be in a hurry and have a lot on their mind. That person, trying to catch a departing flight, does not want to have to think about the buttons. Just make it clear. Most of the users in this elevator cab (if not all) will be heading down to the tunnel that connects to the terminal building. That's the T on the panel, although many people would not know that the T was for tunnel; some might not even know that they would be taking a tunnel. The T button should be ridiculously well marked so that the user enters the cab and, in a quick glance, sees to punch that button to get to the terminal. No thought, no deciphering, no explanatory plaques or signs - just an obvious label - large, clear, and demanding - that quickly communicates exactly what the user wants to know.
More bad button placement
Placement of controls on a stove, car dashboard, and in elevators should allow some sense of intuition and common sense to determine the function and connection between the task and its control device. The star represents the level to exit the building, usually ground level. The other buttons should be arranged in a way that makes some rational sense to the rider and can be understood rapidly.
In this foto, the button for floor 3 is lower than the one for floor 1 - intuitively, floor 3 should be above floor 1. This picture was shot in an academic research building at OSU. Since these control panels are custom made for each installation, this one could have easily have one column of the 5 floor buttons on one side with the 'door close' and 'door open' buttons. This column should be closest to the elevator doors so entering patrons can access them easily with less disruption to the other riders. The other column could have the non-customer, less-frequently-used buttons, alarms, and locks.
And another
These are two elevator panels in my condo building in NYC. The building has 9 floors and a basement. The elevator on the left services only the 9 residential floors. The one on the right serves the 9 floors plus the basement. The basement is accessible only by building staff (to get to the trash compactor, maintenance room, etc.) However, the two panel arrangements do not jive (see foto 1 & 2 below). One has 9 floor buttons while the other has 10. Having each elevator panel different means that the user can't learn the arrangement and punch buttons consistently. It would have been easy to have both panels laid out the same (see foto 3 below). The C or cellar button could be in one of the blank slots below the numbers. It does not need to be in a logical position since it is only staff that punch that button. There are already two blank slots; there's no need to add three slots above the panel to accommodate that 10th button. The proposed solution would have been cheaper (no additional button slots), more consistent and uniform, and more efficient and appropriate for the primary users - the building residents and visitors.
Existing elevator with 9 buttons. Existing elevator with 10 buttons. Proposed location of 10 buttons
Red button for Emergency Information
Walking through the subway station, I noticed this call box mounted on a column. The lettering was easy enough to read, but the buttons weren't quite right. It seemed there might be two options, but it wasn't very clear. Was it one button for Emergency Information or two buttons - one for Emergency and another for Information. As I studied it more closely, I saw the second button below the word Information. Two distinct options. There are 2 problems:
• The Info button does not stand out and can be easily overlooked, especially from a distance or if in panic mode.
• The text word labels are not in proximity to their buttons.
On the right, above, is a revised version with a brighter info button and the word labels moved closer to their respective buttons. Below: side by side comparisons:
Lesson: Proximity is an important design guideline - position related elements in close proximity to each other.


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Iberostar Djerba Beach, this charming property of 4 stars belongs to iberostar chain in Tunisia, it's located in the touristic zone of Djerba-Midoun, directly on the beautiful and fine sandy beach with turquoise waters which is several km in lengh. The hotel is fully renovated and it's ideal for families and also for couples, due to it's beautiful decoration, it's special and typical tunisian style and the differents facilities of the highest quality it's considered like an important destination for the travellers who want to relax in a quiet location. When you enter for the first way to hotel you feel right at home due to cordial welcome from the exellent multilingual staff who help you and give you all informations that you need about differents services in the hotel and many Other supplementary informations.
Rooms Number: Array