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My mouth is watering, and there's not a thing I can do about it.
I've spent the past couple hours listening to drool-inducing descriptions of delicious food, from fall-off-the-bone ribs and foie gras mac 'n' cheese to steaming mussels and shepherd's pie.
But instead of running out to quelch my hunger, I have to be very, very quiet.
I'm at a taping for "Check, Please! Arizona," the local restaurant review show that airs weekly on Eight, Arizona PBS. The set, on the sixth floor of ASU's Cronkite Building in downtown Phoenix, is quiet as host Robert McGrath gets the go-ahead from producers in the control room.
At their signal, McGrath smiles and launches into the greeting viewers of the show, beginning its third season Jan. 3, have come to recognize: "Hello, and welcome to 'Check, Please! Arizona.'"
In the green room
Since it went on the air in January 2011, "Check, Please! Arizona" has reviewed 78 Valley restaurants. Producers have received about 800 nominations, says producer Suzanne Guery, all from everyday people. The show also accepts nominations from around Arizona.
Three restaurants are covered in each half-hour episode, with guests discussing each eatery's food, atmosphere and service.
Interested to know who applies to the show and what it's like to be a guest, I arrive at the Eight studio one cool winter morning and am shown to the green room. It's where guests — who have dined at each other's favorite restaurants in recent days but have never met — hang out until it's time to shoot their episode.
On the program this time: a pharmacist and a lawyer from Phoenix and Mary Len Wright, a nurse at Mercy Gilbert Medical Center in Gilbert. Like them, I'm sworn not to reveal their chosen restaurants until the episode airs.
Wright, 43, says her family of five eats out regularly at places close to work and their Chandler home, such as Dilly's Deli, Floridino's, Señor Taco and Joe's Farm Grill.
Guest Heather Doyle, 40, also likes to uncover local gems.
"I'm from a small town in Nebraska. When we moved out here, it was like, 'Wow! There are so many great places to go!' My husband and I are always looking for the local places," says the Phoenix pharmacist.
As we chat, each guest takes a quick turn in the makeup studio next door, getting a dusting of cosmetics made to look good on high-definition TV screens.
The chatter grows louder as three more guests, just finishing the taping of their episode, come into the room.
"It's like sitting around the dinner table, just having a conversation. It's not a rushed thing at all," Kelly Madison, a guest from Tempe, reassures us.
Minutes before it's my group's turn to go in front of the cameras, Guery and producer Scott Wallin enter the room, giving the guests a flurry of instructions:
"Look at Robert or at each other, but not at the camera."
"Don't touch your mic."
"We'll go through your meal — appetizer, entree and dessert."
"When the introductions are going, look at Robert, and give a nice smile."
Before anyone can feel nervous about keeping all that straight, Wallin disarms us.
"Don't worry," he says, as we head out the door to the studio. "If you're really bad, we have a little electric shock in the seat."
On the set
On set — which is smaller than it looks on TV — the lighthearted mood gets even more buoyant, thanks to McGrath.
The 58-year-old winner of the culinary world's prestigious James Beard Award and founding chef of Roaring Fork and Renegade Canteen restaurants in Scottsdale is affable and funny — and very good at establishing rapport with the guests, who he's meeting for the first time.
"It's trying to put them at ease and, also, use that time to suss them out a bit, try to figure out the different personalities," he says. "You want to hit them with something right before the cameras roll so they all end up laughing and they're loosened up. It becomes more fun and more gregarious and helps set the tone at the beginning of the show."
McGrath, who rises at 5:30 a.m. on taping days after working late into the night at his Market Street Kitchen in Scottsdale, says he's benefitted from the show as a diner.
"I've learned about a lot of restaurants I probably never would have known of, tucked into small places."
And he's not afraid that, at 13 episodes per season, "Check, Please! Arizona" will run out of restaurants worth featuring.
"There is growth (in the Valley dining scene), and there's growth from within the community. These are chefs that have been working here for a while and have been sous chefs for other chefs. It's a generational thing, an ongoing progression," he says.
Just before the three giant cameras roll, he slips in a split-second line to surprise us: "Now is the time to get scared; now's the time to really freak out!"
How it works
In order to be on "Check, Please!" viewers must submit an online application nominating three of their favorite diners, lunch trucks, cafes or fine-dining restaurants.
Guery, Wallin and other staffers give the most promising applicants a call, trying to discern who would be a good fit for the show.
"When people nominate their restaurants, they're very eloquent and passionate. But we can't tell if they spent three weeks writing (their application). Talking to them, we can see how they think on their feet," says Guery.
"We're trying to get three people together who will make for a lively show, trying to get a feel for how someone talks so we don't get someone who freezes up on camera. And we want it to be a mixture of restaurants and price points."
Once selected, applicants receive restaurant assignments. They must dine at all three eateries without revealing to the restaurant staff or anyone else that they're on a mission for "Check, Please! Arizona." They're sworn to secrecy until their episode airs.
Guests are not paid, but they are given a modest stipend after their episode is taped to help cover the cost of meals.
Guery says most guests have one thing in common: "They're a foodie. They like to talk about food."
Dishing on local places to eat
A thread evident with my group was an appreciation for local establishments.
"I wanted to share a really good thing with others," says Kathy Lange, a Phoenix interior designer and guest on the show. "When someone is doing something right, doing something so well, they deserve all the accolades they can get. I want to share that with someone else."
Dominic Verstegen, 37, an attorney, says he'll drive from Phoenix for good, local barbecue, such as Joe's Real BBQ in Gilbert.
And some just like to eat.
"... (W)hen they called me, I was excited — and (my husband) was super excited because he got to go to all the restaurants with me," says Wright.
She was pleasantly surprised to learn how many of her friends and relatives watch the show.
"You know, PBS isn't quite NBC. So I was telling people (about being on the show), and I had a lot of people say, 'I thought I was the only one who watched that show!' Let me tell you, this show has quite the following. People love it."
McGrath thinks "Check, Please!" is a hit for the way it dishes on local places to eat.
"It's a grass-roots perspective on restaurants in the Valley," he says. "There's no food professional. There's no food critic. Essentially, I'm a facilitator, so the guests are the ones doing all the discussion, and I think folks are more likely to identify with that than they are with some expert telling them, 'This is how it's supposed to be.' It's not intimidating to people. It's comfortable, it's casual."
See for yourself
New episodes of "Check, Please! Arizona" begin Jan. 3, 2013. The show airs 7 p.m. Thursdays and 3 p.m. Saturdays on Eight HD.


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played by:
J.Cub - E.A.R / CUB Records, SW, Alkalino, Juno Recommends Deep House, L'Atelier
UK don James Johnston and German champ Alex Agore once again come together on their hot-to-trot No Matter What imprint to lay down the law on their righteous tributes to vintage house music. Johnston delivers some dreamy garage swing on "Think About U Everyday", and takes things deeper on "Do U Understand?" by drawing you in with an alluring chord line that purrs at the heart of the track. Agore is in equally feisty mood with some textbook vocal turns over his "In My Soul" workout, and then switches up for a breezy, carefree wriggler in the form of "In Your Arms".
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ALGIERS, July 8 (Reuters) - Algerian President Abdelaziz Bouteflika is expected to leave hospital in Paris and return to Algeria in the coming hours, a source close to the presidency told Reuters on Monday.
Boutdflika, 76, was rushed to hospital in France on April 27 after a stroke. (Reporting by Lamine Chikhi, Editing by William Maclean and Stacey Joyce)


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Bruce Krinkie, owner of Krinkie's Heating, Air and Plumbing
View article.
Originally published: 11.01.11 by Terry Tanker
Getting better at sales is a career-long endeavor. There's always something you can learn that will help you to do better. In this issue we have two columns on improving sales. This article gives basic tips I've learned. The following tips seem simple, and so are often overlooked — but they can make anyone better at sales.
1. Leave brief, complete, professional voicemails.
I'm away from my desk a great deal, whether it's off- site meetings, business travel, or internal meetings; and that means sales people trying to reach me have to leave a voicemail. The range of messages is horrible to excellent. When prospecting, you can look at voicemail as either your friend or your enemy. With 70% of your prospecting calls going to voicemail, it's time to make friends with it.
Improve your call- back rate by treating them as if they were 30- to 60-second one- on-one sales calls. Prepare three to five separate benefit- focused voicemail messages that you can leave over a period of days or weeks for one decision-maker before you move on, and put the prospect in the long-range category. Each message should focus on a single, unique customer-focused benefit.
2. Answer the question, "so what?"
When you are giving a presentation, selling on the telephone, or one-on-one in your prospect's office or home, picture them having the words SO WHAT stamped on their foreheads. Imagine that for everything you say, the prospect is asking, "So what? Why should I care?"
Remember, prospects care only about how your product or service can eliminate a problem that they have or help to make their business or life better. The answer to this question is always what your product does for them (benefits), not what your product is (features).
3. Cast yourself in a movie.
So, you think you've got your sales presentation down pat and you're pretty slick. Set up your digital phone or camera and record yourself giving that presentation to a co-worker, or a friend. I guarantee you'll find 10 things you'll want to stop doing and/or start doing. For decades the very best sales organizations have paid thousands to tape their sales team in role-playing scenarios. You can do it for free and become a significantly better sales person.
4. Watch and listen how prospects process information.
Customers and prospects interpret information differently. Some are visual, others are auditory, and yet others are primarily kinesthetic. If you pay attention and listen, you can tell fairly quickly which method someone uses to process information.
Kinesthetic people say things like: That doesn't feel right to me.
Auditory people might say: I don't like the sound of that.
5. Recognize why customers buy.
Do you ever analyze why you made a sale? If not, I suggest you do because it's worthwhile. In short, it's buyer profiling. Understanding buying is where selling should start. Assuming you "listen and watch" your prospective customer during your sales call, you'll realize they fit into categories. Some of the categories may include health needs, IAQ, price, overall comfort, repeat customer, etc. Often when you "recognize" the customer, you'll be able to tailor your sales presentation to them because they will have similar buying patterns. Clear and specific after-sales notes are a requirement. And, after a period of time you'll recognize the customer and the steps they take as they move through their buying process.


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P.S.: Did Slender Man ever get those 20 dollars!?


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Product Spotlight
Featured Research
Quick Stats
You are here
Diet Candy Is Big
Sales quadruple between 2000 and 2004.
U.S. sales of candy low in sugar and fat quadrupled between 2000 and 2004 as consumers became more concerned with the growth of obesity and childhood diabetes and embraced a bevy of better-tasting products, according to an Associated Press report.
Last year, consumers bought an estimated $495 million in diet candy, compared to $118 million four years earlier, according to a report by Packaged Facts, a division of Rockville, Md.-based MarketResearch.com.
While the growth has slowed over the past year as the low-carbohydrate diet craze cooled off, researchers said they expect diet candy to remain a key piece of the $26 billion industry.
"People, adults and kids, are getting heavier, and there are well-publicized efforts to crack down on junk food advertising and availability, particularly in schools," said Don Montuori, acquisitions editor for the study. "In this climate, as a marketer you can make a stronger case for a sweet that is 'low' in something better than a sweet that is full-bore caloric and fattening."
Also, Montuori said, companies are developing better artificial sweeteners and sweetener blends that make diet products more palatable and open the door to providing diet versions of popular types of candy.
"It's a very untapped market and as we see innovations in that market were going to see more interest as well," said Susan Fussell, a spokeswoman for the National Confectioners Association. She added that the overall candy market has grown only 1 percent to 2 percent per year.
Among the companies that have done the best in the diet arena is Kansas City-based Russell Stover Candies Inc., which had $102.4 million in sales during the first four months of the year, or 37 percent of the overall market. Russell Stover has seen the biggest sales increase in diet candy -- $85.7 million -- since 2000.
Hershey Foods came in second during that period at $39.9 million, or 14.4 percent of the market, overtaking Atkins Nutritionals, which has been hurt by the slumping popularity of its namesake diet, at $33.5 million, or 12.1 percent, the report said.
Tom Ward, president and chief operating officer of Russell Stover, said the company has been successful because it came into the market when no other national brands were making candy aimed at diabetic and diet-conscious consumers.
"When we got in there with our name, and with great taste and with chocolate, it expanded the sugar-free category," Ward said, adding that sugar-free and low-carb candy makes up around a quarter of sales.
Looking ahead, Montuori said the industry will continue contracting as low-carb runs its course. But he expects $1.3 billion in sales by 2009, especially if companies like Hershey, Nestle and Mars can roll out diet versions of their key candy bar brands and can achieve the same level of popularity within their market as sugarless gum and diet soda have in theirs.


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Phil Fish could become Canada's Shigeru Miyamoto.
I've never made such a comparison in the 15 years I've been writing about games, but as I played the just-released Xbox Live Arcade game Fez this weekend it became clear that this young and gifted game maker from Montreal has a preternatural knack for platform game design that outpaces his contemporaries, and by some distance.
The passionate and often outspoken Mr. Fish – who has made headlines for boldly pronouncing that modern Japanese games "just suck," for stating that he would kill himself if he failed to finish his years-in-the-making game, and for being one of the primary subjects of the Sundance award-winning documentary Indie Game: The Movie – has created one of the cleverest and most innovative interactive experiences I've come across in a long while. It's filled with brilliant ideas that I think Nintendo's great guru and Mario mastermind would be proud to have called his own.
The game's bizarre, brazenly abstract opening scenes are too memorable for me to ruin here with a clumsy description. Suffice to say it plays ingeniously on the game's old-school, 16-bit aesthetic, which is made up of beautiful pixel art backgrounds and animations and a lush, retro score constructed of surprisingly atmospheric bloops and bleeps.
Our champion is a marshmallow-like creature named Gomez who lives in a two-dimensional world. He and his fellow villagers are ignorant of the existence of a third dimension, blithely dismissing the concept of objects like cubes as pure fantasy. However, our pixel-y protagonist acquires a new perspective on things when he dons the game's titular tasselled hat, which allows him to rotate his once flat environment by 90 degree increments.
We flip through the world's four sides at the tap of a button, revealing a bounty of hidden doors, platforms, and ledges. The catch is that the world remains flat while viewed from any one side. Platforms hovering in front of or behind the plane on which our fluffy white hero stands become flattened and part of a single plane.
Trying to use words to describe this inherently visual mechanic, which opens up all sorts of unimagined possibilities, is nearly enough to spur an aneurism, but it's surprisingly intuitive when experienced firsthand. I got the hang of things in minutes.
What keeps us on our toes are the twists Mr. Fish adds with each new environment we encounter. For example, a darkened level has black platforms the locations of which are revealed only be quick flashes of lightning and tiny splashes of raindrops. A series of sewer environments have players controlling water levels via valve handles that simultaneously shift our perspective with each twist. And there are loads of smart little puzzles, such as one that sees pushing around blocks so that they match specific configurations when viewed from different angles, all at the same time.
This wave of satisfyingly brain-breaking concepts seems never to stop rising, making for a profoundly compelling experience that I found nigh impossible to quit (my first session lasted nearly four hours).
And beyond the delight of exploring the game's gorgeous and inspired world lie the MacGuffins that drive Gomez's journey: Scores of golden cubes required to halt the pending dissolution of his reality. Finding one leads to a burst of giddy excitement; finding the final cube in a set and creating a larger cube releases a surge of pleasure that borders on addictive.
However, finding every last cube will likely prove a little frustrating. After an initial and wonderfully gratifying surge of exploration, which will see players spending several hours freely hopping around countless islands floating in the sky, you'll find yourself forced to begin backtracking to look for any cubes you may have missed.
Here we arrive at Mr. Fish's sole significant misstep. The map system is confusing, and figuring out how to travel to far off levels takes a lot of time. A simpler world hub and a more accessible means of teleporting to and from the game's various locales would have made a big difference.
Another problem – but one that I'm hesitant to attribute to the game's chief designer – is that it's a bit buggy. I experienced a jumpy frame rate and brief freezes throughout, as well as unanticipated loading screens that popped up where no loading screen had a right to be. As long as it was in the making – Fez was originally announced way back in 2007 – it seems Polytron's programming department could have used even more time for optimization.
Still, I was willing to scrape up against the occasional jagged edge if it meant getting to the next consummately crafted bit of platform and puzzle play. Phil Fish's voice now rings out loud and clear in Canada's already impressive choir of indie game makers, and in the best of ways. Fez is a fountain of original design properly regarded as an essential indie game experience, and, hopefully, an exciting prelude to even greater things to come from Polytron.
Platform: Xbox Live Arcade
Developer: Polytron
Publisher: Polytron
Release: April 13, 2012
ESRB: Everyone
Score: 9/10Report Typo/Error


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Green Day Flower – Things Named After Famous People
Thing Named After Green Day: Macrocarpaea dies-viridis – a species of night-blooming flowers within the Macrocarpaea genus named after Billie Joe and co.
From what our research has told us, the flower named after Green Day looks more like a dried-up weed. However, when its in a nocturnal bloom, the particular type of Macrocarpaea named after the punk-rock trio probably looks similar to the picture above (which is actually one of its sister species).
According to Rolling Stone, "Harvard researchers bestowed the name "dies-viridis" (Latin for "green day") upon their newly minted species of night-blooming flower after listening to the band while driving throughout Ecuador on their research trips."
We wonder which Green Day tracks made it onto their road trip playlist… we'd put money on 'Welcome to Paradise.'


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Q. What kind of mouth wash and tooth paste do you recommend?
A. Act mouth wash and whatever tastes best to you. If you do not like the taste you will not use it.
Q. What is the best way to whiten my teeth?
A. Custom trays done by the dentist. They are made to fit your teeth.
Q. Can I use super glue to repair my denture or crown?
A. No. Super glue chemically destroys the acrylic on the denture or partial. Recementing a crown on a live tooth with super glue can kill the tooth, it will suck all of the moisture out of the tooth cause it can become brittle.
Q. I broke my tooth over the weekend what can I do until I can get in to a dentist?
A. At most pharmacies or drug stores they carry tempenol or some sort of temporary filling for teeth. Follow directions on the box and it will help with the tooth. The temporary filling helps to prevent cutting your tongue or cheek on the rough spots and keeps food out of the hole. You should schedule to see your dentist within one week of using the temporary filling material to prevent possible infection.
Q. What is the difference between gingivitis and periodontitis?
A. Gingivitis is a gum infection that does not affect the bone. Periodontitis is where the infection moves down the tooth root to ligaments and bone.
Q. Why are my teeth sensitive?
A. There are several reasons. One of the most common is gum recession. Gum recession causes dentin to be exposed and dentin is sensitive because it has tiny holes that communicate with the nerve of the tooth. When external stimuli such as cold water touches the dentin it excites the nerve.
Q. How often should I have my teeth cleaned?
A. Every 6 months at least to catch early decay and prevent gum disease.
Q. Do you take Medicaid?
A. Yes we offer Medicaid services for both children and adults. We do enhanced Medicaid dental services for adults as well.
Q. Do you take payment plans?
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Q. Do you take emergencies?
A. Yes, we do have spots open for emergencies, we also offer same day appointments. We do not do walk-ins but you may be appointed the same day by phone.
Q. Do you take new patients?
A. Yes, we are taking new patients. We will bill up to two insurances for you. We bill all insurances and are preferred providers for Medicaid, Denali Kid Care, Metlife, and Delta Dental.
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Q. Why do I need a crown?
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ARKADELPHIA, Ark. – Behind a 20 kill, 12 block effort from sophomore Kaitlin McKenna, the Saint Leo University volleyball team halted their three-game losing streak as they went 2-0 in the first day of regional action from Arkansas. The Lions defeated Harding University 3-1 (29-27, 25-21, 23-25, 25-20) in the first match, and closed out the day thumping host Henderson State University 3-0 (25-21, 25-23, 25-17) as SLU notched their 20th win of 2008.
In the contest against Harding (15-7), the Lions held the Lady Bisons to a .177 hitting percentage while posting a .220 average of their own. Defense was again a staple of the Saint Leo effort as they out-blocked their opponents from Searcy, Arkansas 13-to-1. Both teams went toe-to-toe in the opening set, but Saint Leo's ability to score the big point when it's needed looked to be the back-breaker for the match. Although the Lady Bisons snuck away with a Game 3 win, Saint Leo was able to rebound and easily put the match to bed in the fourth set.
A short 45-minute break saw the Lions again take the Duke Wells Center Court, this time against the host Henderson State University Lady Reddies (3-16), who Saint Leo quickly dispatched in three-straight sets. Although the Lions were outhit in Game Two, the breaks begin to fall the Lions' way, something that did not happen during the previous week's struggles. The Lions finished with a .289 hitting percentage and dropped seven blocks on the Lady Reddies.
McKenna finished the day with a .486 hitting percentage, going 20-for-35 with one error while sophomore Leah Perry had 17 kills and a .302 percentage. Junior Michelle Nogueras chipped in with 53 assists and added 11 kills as well.
The Lions (20-6) will attempt to sweep through the final day of their visit to the Land of Opportunity as they face Gulf South Conference schools Ouachita Baptist University and Arkansas Tech University. The Lions open the day against Ouachita Baptist with a 10:00 a.m. match that will be broadcast on the Saint Leo Lions AudioCast Network.


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|Home > World News > Article
An Australian astronomer in California could be a key eyewitness to solving the mystery of today's space shuttle disaster.
Anthony Beasley, an Australian working at an observatory north of Los Angeles, said he saw what could be tiles falling off the Columbia as it flew over California and on its way to the scheduled landing in Florida.
Most video footage and eyewitness reports of the shuttle breaking up came from witnesses in the central US state of Texas.
If Beasley is correct, it indicates the shuttle began to disintegrate on the west coast above California.
Beasley telephoned US television network ABC to tell of his sighting.
"After the first few flashes I thought to myself that I knew the shuttle lost tiles as it re-entered and quite possibly that was what was going on," Beasley, speaking live, told ABC news anchor Peter Jennings.
The Australian told how he saw "a couple of flashes" and "things clearly trailing" the shuttle.
"I think that after the particularly bright event I started to wonder whether or not things were happening how they should," Beasley said.
Two US space experts who were listening to Beasley's description said the information was highly valuable.
They said tiles falling off the shuttle would be too small to be picked up by NASA radar.
"This says that something was coming off the shuttle far earlier than what happened over Texas would suggest," former space shuttle astronaut, Norm Thagard, told ABC.
"It leads in the direction that tile loss or some type of structural loss like that was likely to be a cause. But it still doesn't rule out other possibilities."
Former NASA engineer, Jim Oberg, described Beasley's eyewitness report as "an extraordinary account".
"If the left wing is losing tiles you then not only have over-heating in that wing but you have extra drag and it's like flying along and having your wing run into something," Oberg said.
"It could violently turn, twist the nose of the ship to the left and that would be it. That would be the point where it would be torn apart."
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Archive for October 31st, 2008
Cruise Shrinkage?
One cruise line is shuttering it doors, another is dissolving, cruise ships are repositioning and returning to America for the summer rather than sailing in Europe. Exactly what is going on here? Cruise shrinkage? Majestic America Lines is going to sell all of its boats, so river steamboats are going to disappear in America for at least […]
Posted: October 31st, 2008 under Paul Motter.
Comments: none
A Caveman, A Nun, and Peter Pan Walk Into A Bar
The NCL Jewel arrived off the coast of Samana, Dominican Republic this morning, and yes, we were still on it when in arrived. I wouldn't even be mentioning it if I weren't on it, now would I? We anchored off shore. Well, Mrs. Kuki and I didn't do it as we were still in bed. […]
Posted: October 31st, 2008 under Kuki.
Comments: 7


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I have installed Subscribe2 plugin to Wordpress and working fine with it for 100s of members for a long time until some users complained me that they don't receive any email from us at all. I investigated the problems and found out that it was due to my hosting with GoDaddy that limits SMTP to 1000 email recipients per day.
GoDaddy even doesn't support external SMTPs. They have completely blocked SSL/TLS ports so great email services like Gmail isn't possible with them (Gmail is also having a limit of 500 emails per day with each email supporting up to 100 recipients. i.e.: 500x100 = 50000 which is more than enough for any user). The GoDaddy support guy called Adma Gomez confirmed that. He is really a great support guy. He explained all these very clearly. He said it is a GoDaddy policy to control spam with such limitations.
I was totally upset and decided to change the hosting to another server. But every hosting company I contacted had such limitations. Most of the people are giving 250 relays (recipients per day). There were some hosting companies who support external SMTPs including some free hosting companies (I have bad expereince with free hosting so I didn't want to even think about it). When you buy a hosting account, consider external SMTP support as well.
There wasn't any built in way to throttle emails with WordPress unless we write something by our own.
Luckily, thankful to the author of Subscribe2, I found his email queue solution that we can control the number of emails per day. Though it is not free, it is a very nice job by him. Have a look at http://wpplugins.com/plugin/76/wordpress-mail-queue-wpmq/.


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The other night my daughter was sitting on my lap, stuff while I was watching television. She had at some point previously managed to snag a small pillow. I think it was originally velcroed in to her car seat, ed not sure where she found it, click but as small objects the baby can grab a small pillow seemd pretty innocuous.
As I sat there minding my own business, my little girl turns around and looks up at me. She stood up on my lap, the pillow clutched in both hands. She made eye contact and smiled. Then very slowly but firmly she wedged the pillow over my nose and mouth. She made quiet and cheerful little cooing noises as she tried to smother me.
Once again, not sure if this is adorable or horrifying.


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Power's preparations fell short under former coach
The Arena Football League isn't shy about reporting the embarrassing record set last week by the Power when owner Matt Shaner fired coach Derek Stingley one game into the season.
"Stingley's release one game into the season is the fastest in-season firing of a head coach in professional football history," the league-generated release stated while promoting the Power's game Saturday night at Consol Energy Center against the San Jose SaberCats.
A coach can't get fired any quicker — unless it's done at halftime of the first game. Stingley survived the first half of the 63-53 loss to the Cleveland Gladiators on March 15, but he was doomed by three factors and fired six days later:
• His 7-20 record since the middle of the 2012 season.
• The availability of Ron James, who was looking for a job at the same time the Power was looking for a coach.
• An ill-prepared team, according to Power wide receiver Aaron Lesue.
"I think it's what we needed as far as the preparation aspect," Lesue said of James taking over as head coach. "Last week, with Cleveland, I think there were a couple of situations in the game where we could have been a little bit more prepared as a team, as a whole, our mindset."
Lesue played for James with the Utah Blaze, and believes the coach can reverse the misfortunes of a franchise that has lost 16 of its past 20 games. Two years ago in Utah, James was AFL Coach of the Year, quarterback Tommy Grady MVP and the team finished 12-6.
"We had great chemistry, great teamwork," James said. "Team beats talent every time."
Lesue said James' passion for the game and detailed preparation will win over the players.
"Players see that, and they want to play for him," he said. James has steep challenges ahead, starting with the SaberCats (2-0 and No. 2 in the AFL coaches' poll). San Jose beat the defending American Conference champion Philadelphia Soul last week, 70-33, with rookie quarterback Nathan Stanley replacing injured starter Russ Michna and throwing six touchdown passes.
James, who left a wife and two children in Salt Lake City to come to Pittsburgh, said there is talent on the Power's roster.
"It's just a matter of getting them to play together and keeping them focused," he said.
Lesue is eager for the rest of the season.
"After seeing Coach James come in with what I know and what I'm used to, it actually makes lot of sense to me as far as what the team needs," he said. "I think Coach James is exactly what the team needed from the head coaching position, the leadership."


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Post-Workout Meal Ideas
Speak Up: What Do You Nosh on After Working Out?
After working out, it's important to eat something. Your body needs to replenish itself and repair any muscle damage, which occurs when you strength train. It's also important not to wait too long to eat. Try having a snack within 45 minutes of your workout — your muscles are more responsive to insulin and your body can process carbs more efficiently immediately after a workout.
After the gym I always try to eat a snack or meal that's high in carbs, low in fat, and contains protein. My favorite post-gym snacks are a big salad, eggs, or a healthy turkey sandwich. In a pinch, I'll eat an apple to hold me over until dinner. Many experts suggest chocolate milk is the perfect post-workout snack. Russell Brand — fiance to Katy Perry — opts for a liquid snack post-workout. This week, he was seen leaving the gym in some seriously sporty socks with what I'm hoping is a nutritious protein shake.
How about you — what's your post-workout snack or meal?


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Quick Links
The article you requested is
Persistent Antipsychotic Polypharmacy and Excessive Dosing in the Community Psychiatric Treatment Setting: A Review of Medication Profiles in 435 Canadian Outpatients
Ric M. Procyshyn, PhD, PharmD; William G. Honer, MD; Tony K. Y. Wu, BSc; Rebecca W. Y. Ko, BSc; Sean A. McIsaac, BSc; Allan H. Young, MD, PhD, FRCPsych; Joy L. Johnson, PhD, RN; and Alasdair M. Barr, PhD
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Objective: The present study aimed (1) to
determine the proportion of patients treated with persistent antipsychotic polypharmacy in an outpatient population and (2) to determine if persistent antipsychotic polypharmacy is associated with excessive dosing.
Method: Using a province-wide network that links all pharmacies in British Columbia, Canada, to a central set of data systems, we identified community mental health outpatients who had been treated with the same pharmacologic regimen for at least 90 days. Apart from antipsychotics, data collection included anticholinergics, antidepressants, mood stabilizers, benzodiazepines, lipid-lowering agents, and antidiabetic agents.
Demographic data including sex, age, and diagnosis were obtained from the patient's chart. In order to compare dosages of the various antipsychotics we used a fixed unit of measurement based on
dividing the prescribed daily dose (PDD) by
the defined daily dose (DDD). A PDD/DDD ratio greater than 1.5 was defined as excessive dosing.
Results: Four hundred thirty-five patients met the inclusion criteria and were included in the analysis. Overall, the prevalence of persistent antipsychotic polypharmacy was 25.7% for the entire cohort. The prevalence of persistent antipsychotic polypharmacy was highest for patients with schizoaffective disorder (33.7%), followed by schizophrenia (31.7%), psychosis not otherwise specified (20.0%), bipolar disorder (16.9%), and major depression (14.3%). The mean ± SD PDD/DDD ratio for all patients prescribed persistent antipsychotic polypharmacy was not only excessive, it was significantly greater compared to that of patients receiving antipsychotic monotherapy (1.94 ± 0.12 vs 0.94 ± 0.04, P < .005).
Conclusions: Using a diagnostically heterogeneous outpatient population, this study is, we believe, the first to report that persistent antipsychotic polypharmacy is associated with excessive dosing, in and of itself as well as compared to antipsychotic monotherapy.
J Clin Psychiatry
Submitted: November 22, 2008; accepted January 9, 2009.
Online ahead of print: March 9, 2010 (doi:10.4088/JCP.08m04912gre).
Corresponding author: Ric M. Procyshyn, PhD, British Columbia Mental Health & Addictions Research Institute, A3-113, 938 W 28th Ave, Vancouver, British Columbia, Canada, V5Z 4H4
Objective: The present study aimed (1) to determine the proportion of patients treated with persistent antipsychotic polypharmacy in an outpatient population and (2) to determine if persistent antipsychotic polypharmacy is associated with excessive dosing.
Method: Using a province-wide network that links all pharmacies in British Columbia, Canada, to a central set of data systems, we identified community mental health outpatients who had been treated with the same pharmacologic regimen for at least 90 days. Apart from antipsychotics, data collection included anticholinergics, antidepressants, mood stabilizers, benzodiazepines, lipid-lowering agents, and antidiabetic agents. Demographic data including sex, age, and diagnosis were obtained from the patient's chart. In order to compare dosages of the various antipsychotics we used a fixed unit of measurement based on dividing the prescribed daily dose (PDD) by the defined daily dose (DDD). A PDD/DDD ratio greater than 1.5 was defined as excessive dosing.
J Clin Psychiatry 2010;71(5):566–573
© Copyright 2010 Physicians Postgraduate Press, Inc.
Corresponding author: Ric M. Procyshyn, PhD, British Columbia Mental Health & Addictions Research Institute, A3-113, 938 W 28th Ave, Vancouver, British Columbia, Canada, V5Z 4H4 (email@example.com).
Despite lack of endorsement by clinical treatment guidelines, the practice of antipsychotic polypharmacy continues to increase.1–10 A review of the literature finds that the overall point prevalence of antipsychotic polypharmacy ranges anywhere from 4.1% to 69%.11–27 This wide range can be explained in part by differences in study design, patient population, diagnosis, coverage, and treatment setting. An increase in the prevalence over time has also been reported in the literature. In 2 studies that examined longitudinal prescribing trends in Medicaid recipients, antipsychotic polypharmacy increased from 5.7% in 1995 to 24.3% in 1999 (n = 836) and from 32% in 1998 to 41% in 2000 (n = 31,435).11,28 We have also reported an increase in antipsychotic polypharmacy at a tertiary care facility in British Columbia; in this case, the practice increased from 27.5% to 44.7% between 1996 and 2000.20,21
A shortcoming of studies that have reported prevalence rates of antipsychotic polypharmacy is that their operational definition of antipsychotic polypharmacy is limited by study design. Most studies that have examined antipsychotic polypharmacy have been cross-sectional and collected data from either 1 point in time or used a narrow time window, such as 1 month. In doing so, the accuracy of the resultant prevalence rates is jeopardized, as cross-sectional methods do not allow one to differentiate short-term from persistent antipsychotic polypharmacy. To illustrate this point, Kreyenbuhl et al27 compared the prevalence rate of antipsychotic polypharmacy using a stringent criteria of greater than 90 days to rates using cross-sectional definitions. The cross-sectional definitions (including a prescription for a different antipsychotic within 7 days and discharge from hospital with more than 2 antipsychotics) failed to identify as many as 89% of patients receiving persistent polypharmacy. Similarly, these definitions were also associated with false positive rates as high as 50%. In the later case, this result would reflect patients who were receiving short-term overlapping antipsychotic medications either during periods of acute symptom exacerbation or during cross-titration; practices generally considered within the standard of care.29
To date, few studies have examined persistent antipsychotic polypharmacy in an entirely outpatient setting. What is more, no study has examined whether persistent antipsychotic polypharmacy, compared to monotherapy, is associated with excessive dosing. The present study used a diagnostically heterogeneous group of psychiatric outpatients, and its objectives are (1) to determine the proportion of patients treated with persistent antipsychotic polypharmacy in an outpatient population and (2) to determine if persistent antipsychotic polypharmacy is associated with excessive dosing.
Patients for this study were recruited from the 8 community mental health teams within the city of Vancouver, British Columbia between October 20, 2005 and October 6, 2006. These mental health teams provide individuals living in defined catchment areas with psychiatric assessment and comprehensive treatment including medication management, counseling, and rehabilitation. At the time of our study, the teams provided some form of service to 5,972 individuals, or approximately 1% of Vancouver's population, and thus offered an excellent opportunity for drawing a representative sample from the population of noninstitutionalized persons with severe and persistent mental illness.
Click figure to enlarge
To investigate persistent antipsychotic polypharmacy and excessive dosing, we screened a sample of 788 patients who gave written informed consent to have their medication profiles reviewed (Figure 1). Inclusion in the study at hand required (1) that the patient's comprehensive medication profile was available through British Columbia (BC) PharmaNet (a province-wide network that links all pharmacies in British Columbia, Canada, to a central set of data systems); (2) that the patient be treated with at least 1 antipsychotic; and (3) that the patient had been treated with the same pharmacologic regimen (same medications and dosages) for at least 90 days (Figure 1).
Data collected from BC PharmaNet included the following list of medications: antipsychotics, anticholinergics, antidepressants, mood stabilizers, benzodiazepines, lipid-lowering agents, and antidiabetic agents. This method did not include "as needed" hora somni medications; none of which were antipsychotics. Demographic data including sex, age, and diagnosis were obtained from the patient's medical chart. Diagnoses were based on clinical interviews performed by a psychiatrist. For a small minority of subjects (n = 27), medical charts were unavailable at community centers, and so diagnoses were obtained from PARIS, which is the Vancouver Coastal Health Authority integrated electronic database.
In order to compare dosages of the various oral antipsychotics, we have used a fixed unit of measurement based on dividing the prescribed daily dose (PDD) by the defined daily dose (DDD). The DDD is the international unit of drug utilization that has been approved by the World Health Organization for drug use studies.30 DDD is defined as the "assumed average maintenance dose per day for a drug used in its main indication in adults."30 It is a unit of measurement and does not necessarily reflect the recommended daily dose. Using DDD allows for a convenient method for comparing the cumulative dose of antipsychotics irrespective of whether they are used as a single agent or as part of a polypharmacy regimen. A PDD/DDD ratio equal to 1 would indicate that the PDD equals the DDD. Thus, a PDD/DDD that is greater than 1 would indicate that the PDD is higher than the standard dosage. To be consistent with previous investigators,31,32 we have defined patients as being prescribed excessive doses if their PDD/DDD ratio is greater than 1.5. Although depot antipsychotics were included in the overall assessment of antipsychotic polypharmacy prevalence, they were excluded from the dosage analysis due to the inherent variability in their dosing intervals (ie, every 2–4 weeks). This variability prohibited us from calculating the PDD/DDD ratio, which stipulates a prescribed "daily" dose as the numerator.
Parametric analysis was conducted on continuous variables using the Student t test, assuming equal variances. To test categorical variables for independence, the χ2 or Fisher exact test was performed. The study protocol was approved by the University of British Columbia Research Ethics Board. The study was conducted in accordance with the principles of Good Clinical Practices and the Declaration of Helsinki.
Four hundred thirty-five patients met the inclusion criteria of having received at least 90 days of stabilized (unchanging) pharmacotherapy. Among these patients were 164 diagnosed with schizophrenia, 83 with schizoaffective disorder, 49 with major depression, 77 with bipolar disorder, and 30 with psychosis not otherwise specified (NOS) (Table 1). No diagnoses were available for 32 of our patients. Overall, the prevalence of persistent antipsychotic polypharmacy was 25.7% for the entire cohort. When diagnoses were considered, significant differences in the prevalence of persistent antipsychotic polypharmacy were observed (χ24 = 12.63, P = .013; Figure 2A). The prevalence was highest for patients with schizoaffective disorder (33.7%), followed by patients with schizophrenia (31.7%), psychosis NOS (20.0%), bipolar disorder (16.9%), and major depression (14.3%).
Significant differences were also noted between antipsychotics in terms of how they were utilized in polypharmacy combinations (χ25 = 13.61, P = .018; Figure 2B). In this respect, a higher proportion of oral conventional antipsychotics was used as part of a polypharmacy regimen, with a rate of 54.7%. For the atypical agents, quetiapine was used proportionately more often as part of a polypharmacy regimen (43.9%) followed by risperidone (37.3%), olanzapine (31.4%), and clozapine (27.7%).
Mean ± SD values of PDD/DDD ratios and the proportion of patients prescribed excessive doses (ie, PDD/DDD > 1.5) are depicted in Figure 3A and B. The mean ± SD PDD/DDD ratio for all patients prescribed persistent antipsychotic polypharmacy was not only excessive, it was significantly greater compared to patients prescribed antipsychotic monotherapy (1.94 ± 0.12 vs 0.94 ± 0.04, P < .005; Figure 3A). Without exception, the mean ± SD PDD/DDD ratios across all diagnoses were significantly greater for patients prescribed persistent antipsychotic polypharmacy compared to patients prescribed antipsychotic monotherapy (Figure 3A). Examining only those patients prescribed excessive doses, our data found that excessive dosing was significantly associated with persistent antipsychotic polypharmacy, compared to monotherapy, irrespective of diagnoses (P < .005, Figure 3B). Furthermore, the mean PDD/DDD for each of the atypical antipsychotics increased whenever it was prescribed as part of a polypharmacy regimen (Figure 4).
Overall, significantly more individuals treated with a persistent antipsychotic polypharmacy regimen were also treated with an anticholinergic agent compared with those individuals prescribed only 1 antipsychotic (29.5% vs 13.3%, respectively, χ21 = 15.05, P < .001, Table 1). However, a post hoc analysis revealed that the significant finding was limited to schizophrenia patients (χ2 = 5.51, P = .02). Persistent antipsychotic polypharmacy was not found to be associated with a significantly increased utilization of other concomitant medications, including antidepressants, mood stabilizers, benzodiazepines, lipid-lowering agents, or antidiabetic agents (Table 1).
The primary finding of this study was that 25.7% of our outpatient sample was treated with persistent antipsychotic polypharmacy. When diagnosis was considered, those with schizoaffective disorder and schizophrenia had the highest prevalence rates at 33.7% and 31.7% respectively. Meaningful comparison of these findings to those of others is limited due to differences in (1) study design, (2) the year in which the study was conducted, (3) diagnoses of the sample population, and (4) the operational definition of antipsychotic polypharmacy. With these constraints in mind, we limited our comparison to studies that reported prevalence rates of persistent antipsychotic polypharmacy of more then 60 continuous days in an entirely outpatient population. Sixty days was chosen as a cutoff, since expert consensus guidelines33 have suggested that short-term antipsychotic polypharmacy, defined as less than 60 days, may be warranted for some patients. The majority of studies were conducted using Medicaid claims databases and the reported prevalence rates of persistent antipsychotic polypharmacy ranged from 4.1% to 47.1% (Table 2). In the study that identified patients with schizophrenia, bipolar disorder, and depression, the rates of antipsychotic polypharmacy were 12.9%, 7.3%, and 5.2%, respectively.35 Furthermore, in one study the rate of persistent antipsychotic polypharmacy was very likely conservative, as the definition was limited to 2 atypical antipsychotics.34
Our second main finding was that persistent antipsychotic polypharmacy was associated with excessive dosing according to the definition that we and others have used (ie, PDD/DDD > 1.5).31,32 Not only was the mean PDD/DDD ratio for all patients across all diagnoses prescribed persistent antipsychotic polypharmacy excessive, it was also significantly greater compared to that of patients prescribed antipsychotic monotherapy (Figure 3A). Of particular note is the fact that the mean PDD/DDD for the individual atypical antipsychotics actually increased when prescribed as part of an polypharmacy regimen (Figure 4). Not surprisingly, the cumulative mean PDD/DDD of the resulting polypharmacy combinations are greater than 1.5 in every case. Taken together, these findings fail to support a previously proposed rationale for antipsychotic polypharmacy; that using lower dosages of 2 agents with different receptor and side effect profiles may achieve efficacy while mitigating side effects that would have occurred at a higher dosage of a single agent.38 Also, the suggestion that practitioners may be prescribing small doses of a second antipsychotic to treat auxiliary symptoms such as sleep or anxiety is not substantiated by these data.
The excessive doses associated with antipsychotic polypharmacy raise concerns about the potential for increased adverse events. Although it is well known that, when these agents are used as monotherapy they can cause potentially serious adverse events that include an increase in blood glucose, body weight, serum triglycerides, and QTc interval,39,40 virtually no information is available regarding the prevalence and severity of these and other adverse events that may be associated with persistent antipsychotic polypharmacy in and of itself or when combined with excessive dosing. In this regard, Waddington et al41 reported, in a cohort of patients with schizophrenia followed prospectively over a 10-year period, that antipsychotic polypharmacy was associated with reduced survival (relative risk = 2.46, 95% CI, 1.10–5.47; P = .03). At the least, when physicians initiate a polypharmacy regimen they should assess the benefit-to-risk ratio.
The overall rate of excessive dosing (monotherapy and persistent antipsychotic polypharmacy) in our study was 30.0%, which is consistent with another study that used the same definition (ie, PDD/DDD > 1.5). In this 1-year European study31 that examined in- and outpatients with schizophrenia (N = 375), it was reported that 28% of all patients, irrespective of polypharmacy, were treated with persistently high doses of antipsychotics. Baseline use of a conventional plus an atypical antipsychotic, as well as high antipsychotic doses at baseline, was found to be a predictor of excessive dosing, whereas psychopathology was not. In another prospective study32 (N = 402) that examined a more diagnostically heterogeneous group of psychiatric inpatients, the overall rate of excessive dosing was 15.4%. In this study, the strongest predictor of persistence with excessive doses of antipsychotics was antipsychotic polypharmacy on admission, followed by the male sex and positive symptoms. Negative symptoms were found to be negatively associated with high doses of antipsychotics. In both studies, the investigators did not compare the prevalence rate of excessive dosing associated with antipsychotic polypharmacy to monotherapy.
When we examined adjunctive medications, schizophrenia patients treated with persistent antipsychotic polypharmacy, compared to those treated with monotherapy, were more likely to be prescribed an anticholinergic agent. Using data from Medicaid claims (California and Georgia, N = 10,584) of individuals with schizophrenia, regression analysis confirmed that exposure to "Parkinson disease drugs" was associated with long-term (ie, greater than 60 days) antipsychotic polypharmacy (adjusted odds ratio = 2.84; 95% CI, 2.50–3.23, P < .0001).11 Similarly, using data from the Veteran Affairs National Psychosis Registry (1999–2001, N = 45,571), Kreyenbuhl et al42 reported an increase in the overall utilization of anticholinergic agents in schizophrenia and schizoaffective patients receiving persistent antipsychotic polypharmacy compared to monotherapy (50% vs 36%, respectively; P < .001). Finally, rates of anticholinergic utilization were also reported in a study37 that assessed the use of psychiatric services and prescriptions in outpatients with long-term psychiatric disorders. In this case, anticholinergics were prescribed in 56.3% of patients treated with antipsychotic polypharmacy (ie, one conventional agent plus one atypical agent), in 44.8% of patients treated with a single conventional antipsychotic, and in 8.1% of patients treated with a single atypical antipsychotic (χ22 = 17.1, P < .01).
This study exposes a relatively high prevalence of persistent antipsychotic polypharmacy in an outpatient population with severe and persistent mental illness. However, this study is unable to report the reasons clinicians prescribe a persistent antipsychotic polypharmacy regimen. We can only speculate that there may be many reasons, including physician's comfort with antipsychotics that may result in trials of new combinations, pressure from patients and family for better treatment outcomes, marketing from the pharmaceutical industry, and inadequate treatment response to clozapine monotherapy.35,43 We do not believe that the latter point is a likely explanation, as we would have expected to see a much greater proportion of patients receiving polypharmacy combinations with clozapine. As it is, our data show that clozapine is the agent least likely to be coprescribed with another antipsychotic. In fact, its underutilization (overall prevalence = 7.6%) is cause for concern, and we must question, as did Taylor et al,44 whether polypharmacy is contributing to reluctance and the delay in prescribing clozapine. Whatever the rationale may be for prescribing a polypharmacy regimen, it is very likely influenced by subjective clinical impressions rather than by scientific evidence.
In a recent review, Tranulis et al45 concluded that antipsychotic polypharmacy was not supported by the evidence-based literature. Weaknesses identified included small sample sizes, lack of control of confounding variables, and short duration of follow-up. The reality is that the majority of the evidence for this questionable practice comes from uncontrolled open-label trials, case series, and case reports (see Tranulis et al45 for review). In fact, to date there have only been 4 randomized controlled trials that have evaluated the efficacy of antipsychotic polypharmacy; more specifically clozapine augmentation with risperidone46–48 and sulpiride.49 In the first controlled antipsychotic polypharmacy trial ever conducted (N = 28), investigators randomly assigned clozapine partial responders to receive either sulpiride 600 mg/d or placebo.49 After 10 weeks of treatment, the sulpiride/clozapine group was found to exhibit significant improvements in positive and negative symptoms compared to the placebo/clozapine group. Similarly, in another trial (N = 40), clozapine partial or nonresponders were randomly assigned to have their clozapine augmented with either risperidone (up to 6 mg/d) or placebo for 12 weeks.47 From baseline to week 6 and 12, positive and negative symptom improvement was significantly greater in the risperidone augmentation group compared to the placebo augmentation group. This positive finding for augmenting clozapine with risperidone was not confirmed by 2 other studies. In one study46 (N = 30), patients with schizophrenia showing only partial response to clozapine were randomized to risperidone up to 6 mg/d or placebo. After 6 weeks, no benefit was found in psychopathology or quality of life in patients in the risperidone/clozapine group. In fact, greater improvement in positive symptoms was found in the placebo/clozapine group. Finally, our group also conducted a trial in a group of patients with schizophrenia and poor response to treatment with clozapine (N = 68).48 After the 8-week blinded phase (and 18-week open-label phase of risperidone augmentation), no statistically significant difference in symptomatic benefit was noted between the 2 groups. The latter studies failed to show efficacy but, apart from that result, they also reported significant increases in prolactin46 and blood glucose,48 thus raising concerns about the safety of this combination.
The results of this study need to be interpreted within the context of the limitations imposed by its cross-sectional design. First, the cross-sectional design is limited to the observation of a defined population at a single point in time. As investigators, we did not actively manipulate the experimental variables in this design but rather looked for relationships among variables. As such, cross-sectional studies are useful for establishing associations between variables, but they in themselves do not establish causation. This study design also precludes our determining the reasons physicians prescribe an antipsychotic polypharmacy regimen or the therapeutic outcomes it produces. Furthermore, we are unable to comment on aspects of the chronological treatment course, such as severity of illness, previous pharmacologic trials (including clozapine), or number of psychiatrically related hospitalizations, that led to a persistent antipsychotic polypharmacy regimen.
Using a diagnostically heterogeneous outpatient population, this study is, we believe, the first to report that persistent antipsychotic polypharmacy is associated with excessive dosing, in and of itself as well as compared to antipsychotic monotherapy. Given that persistent antipsychotic polypharmacy very likely increases costs28 and the risk of adverse effects,50 drug interactions, decreased treatment adherence, and perhaps mortality,41,51 more research is needed to determine the actual effectiveness and safety of persistent antipsychotic polypharmacy in the treatment of individuals with severe and persistent mental disorders.
Drug names: clozapine (FazaClo, Clozaril, and others), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal and others).
Author affiliations: British Columbia Mental Health and Addictions Services Research Institute, Vancouver (Drs Procyshyn, Honer, and Barr); Department of Psychiatry, University of British Columbia, Vancouver (Drs Procyshyn, Honer, and Young and Mr McIsaac); Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver (Dr Barr, Mr Wu, and Ms Ko); and Nursing and Health Behaviour Research Unit, University of British Columbia, Vancouver (Dr Johnson), Canada.
Potential conflicts of interest: The authors report no financial or other relationship relevant to the subject of this article.
Funding/support: This research was supported by a grant from the National Cancer Institute of Canada with funds from the Canadian Cancer Society (#016334). A.M.B. is both a Michael Smith Foundation for Health Research Scholar and Canadian Institutes of Heath Research New Investigator.
Acknowledgment: The authors thank Leslie A. Malchy, BA, MSc, with the Centre for Nursing and Health Behaviour Research and NEXUS, School of Nursing, University of British Columbia, Vancouver, Canada, for database management; Ms Malchy reports no conflict of interest.
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25. Patrick V, Schleifer SJ, Nurenberg JR, et al. An initiative to curtail the use of antipsychotic polypharmacy in a state psychiatric hospital. Psychiatr Serv. 2006;57(1):21–23. PubMed doi:10.1176/appi.ps.57.1.21
26. Faries D, Ascher-Svanum H, Zhu B, et al. Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry. 2005;5:26. PubMed doi:10.1186/1471-244X-5-26
27. Kreyenbuhl J, Valenstein M, McCarthy JF, et al. Long-term combination antipsychotic treatment in VA patients with schizophrenia. Schizophr Res. 2006;84(1):90–99. PubMed doi:10.1016/j.schres.2006.02.023
28. Clark RE, Bartels SJ, Mellman TA, et al. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implication for state mental health policy. Schizophr Bull. 2002;28(1): 75–84. PubMed
29. Canales PL, Olsen J, Miller AL, et al. Role of antipsychotic polypharmacotherapy in the treatment of schizophrenia. CNS Drugs. 1999;12(3):179–188. doi:10.2165/00023210-199912030-00002
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31. Barbui C, Nosè M, Mazzi MA, et al. Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries. Int Clin Psychopharmacol. 2006;21(6):355–362. PubMed doi:10.1097/01.yic.0000224785.68040.43
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33. McEvoy JP, Scheifler PL, Frances A. The Expert Consensus Guidelines Series: Treatment of Schizophrenia 1999. J Clin Psychiatry. 1999; 60(suppl 11):1–80.
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Oct 28, 2013
Personalized, Preventive Care is Appropriate for Older Heart Patients
"I may be old but I ain't dead yet, and as long as I'm here I expect to be treated with the same dignity and respect that everyone deserves". These words came from one of my patients the other day. He was...


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Barroco Grill
12906 Madison Ave. (Dowd Ave.) Send to Phone
216-221-8127 | Make Restaurant Reservations
OpenLunch & Dinner daily
- Dress code: Casual
- Kid-friendly
- Take-out available
* Click here for rating key
Barroco Grill Restaurant Review: Barroco Grill's ambience is more food truck than fine dining, but the cooking renders the uncomfortable chairs and wobbly tables completely irrelevant. An open kitchen lets patrons view cooks creating a well-crafted menu of authentic Colombian fare. Start with the cheesy corn made with chicken, bacon and molten mozzarella, served in a crock alongside deep-fried arepa fingers (a corn cake made from precooked corn flour) for dipping fondue-style. For a main course, arepas can be filled with chicken, steak or vegetables and eaten like a sandwich. You can customize them to your heart's content and top them with house sauces. The Barroco burger, with garlic and chimichurri sauces, bacon and mozzarella, is also an option. Barroco Grill is BYOB friendly.
Find out which restaurants and chefs top the list of GAYOT's 2016 Annual Restaurant Awards.


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With easy access to the Loop, the Midland Convention Center, downtown Midland and attractions like the Permian Basin Petroleum Museum, the Luxury Inn Motel offers a great location in the heart of The Tall City. Add a host of handy amenities and services, and business and leisure travelers alike will find this casual yet stylish non-smoking hotel in Midland, TX, an ideal place to rest and rejuvenate. Add its downtown Midland TX location and nearby Midland Airport and you will find its convenience matches its services.
Local Attractions
Midland Center
Located in the heart of downtown Midland, the Midland Center provides the flexibility to accommodate meetings, conventions, trade shows, banquets, and a variety of specialty events. Each year the facility hosts hundreds of events from small and intimate to large and formal.
Permian Basin Petroleum Museum
The Permian Basin Petroleum Museum is a museum in Midland, Texas, USA, with exhibits relating to the oil and gas industry of the Permian Basin of west Texas and southeast New Mexico.
Midland International Air and Space Port
Midland International Air and Space Port is a city-owned international airport located approximately midway between the cities of Midland and Odessa, in the US state of Texas. It is owned and operated by the City of Midland.
Featured Amenities
- Free Wi-Fi
- Free Local Calls
- Free Parking
- Cable Television
- Daily Housekeeping
- In Room- Hairdryer


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ABC knows Photoshop.
There's a big new story leading the Health section at ABC News. It seems reporter Jonathan Fenaroli is feeling bad about being vegetarian but is too weak to go vegan, so he set out to find some quotes to support his insecurities. Only, all the vegans he quotes, including SuperVegan's own Jason Atkins, are totally not condescending or high-horsey. Fenaroli does quote a few vegetarians with apocryphal stories of being preached at, but basically the whole thing reads like fishing for quotes in support of a fishy thesis (no offense to the fish).
As Jason says, "naming is counterproductive because it causes division. I would like it personally if everyone were vegans, but that's not very realistic. Some people consider veganism giving something up. I don't see it that way; I just don't want to purchase or contribute to anything that hurts animals." Right on.
3 Comments
Comment by
chrisjson #
Whether or not they realize it, it's the opposite in my mind. The non-vegans have this implicit "holier than thou" mentality that puts their desires for meat, milk, leather, etc above the nonhuman's right to freedom. Vegans reject that idea, acknowledging the equality between humans and nonhumans.
Comment by
susieon #
This is a completely incompetent piece of journalism. The reporter just called up a bunch of vegetarians and vegans he knew, got some quotes and threw it together–typical big-box culture piece reportage that makes trendster subjects look completely self-obsessed. It's really too bad this will be the only source of info for a lot of people outside the veg community on the topic. (On the bright side, Jason Atkins came off great!)
Comment by
BANUon #
I just want to point out that everyone should look at the comments and read the ridiculous conversations going on there. People are stupid.


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Windows Vista May Be Delayed in Europe
Windows Vista may not ship in the European Union at the same time that it is released in the United States as a result of possible issues with European competition law, Microsoft acknowledged on Sept. 7.
The problem from Microsoft's perspective is that the EU has been slow in letting the software giant know exactly what it needs in order for Windows Vista to ship in Europe.
"We don't know have clear guidance from the Commission about what they think should be included or removed from Vista and today's statements don't provide any further guidance," Microsoft spokesman Guy Esnouf told eWEEK in an interview on Sept. 7.
The matter is further complicated by the fact that a 2004 judgment against Microsoft primarily dealt with Windows Media Player, not with other technologies that have been included in Vista like BitLocker, Windows Security Center and PatchGuard.
Can Microsoft's BitLocker save us from ourselves? Click here to read more.
Microsoft also has the right to challenge any changes the Commission finally decides it wants in Vista if it feels these are not covered by EU competition rules or the 2004 antitrust judgment, which included a record fine of 497 million and an order requiring it to produce a version of Windows without Windows Media Player bundled.
Esnouf did acknowledge that companies have the right to make legal challenges going forward, but said that was premature and speculative at this point.
"We would welcome hearing from the Commission specifically what their concerns are, so that we could then have a discussion on how to resolve them. We currently just don't know what their concerns are. We have made concrete proposals to them and are waiting to see what happens from here," he said.
Microsoft wants to deliver Vista to European customers on time, but understands that it needs to be fully compliant with EU competition law. "I can't speculate about the outcome as we haven't heard back from them," Esnouf said.
Read the rest of this eWEEK story: "Windows Vista May Be Delayed in Europe"


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Beggars can't be choosers!
Hours after embattled New York congressman Anthony Weiner resigned from his position in the House of Representatives Thursday in the wake of a lewd Twitter pic scandal, a new report says he's already fielded a new, high-profile job offer.
According to The Hollywood Reporter, Entourage creator Doug Ellin approached Weiner, 46, to play himself on the HBO series for this summer's eighth and final season.
But rather than follow in the footsteps of past guest stars Jessica Simpson and Christina Aguilera and jump at the chance, Weiner has remained silent about the offer, which went out before he resigned from office.
When THR asked Ellin what response he's gotten from the politician's office, the exec replied simply, "Nothing."
The eighth season of Entourage premieres July 24 on HBO.
By Allison Corneau for Us Weekly. For more Channel Surfing, click here.


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People love to bring home some of the amazing things we see in nature. It's important that you are choosy though and that you don't disturb wildlife habitat.
Natural objects you might collect include:
Once you have some items you'd like to celebrate, find a table, shelf or vase where you'd like to display them.
Or you might display your finds in a clear glass vase.
Over time, you might find new things. If so, be sure to return your other items to the wild again. You could take a photo of your table as it changes from season to season.
Some people like to store their nature finds in a clear shoe organizer with many pockets.
Get more tips on making a Nature Table.


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One who, while dressed in brightly coloured silly clothes and an inadequate helmet, rides a (racing) bicycle (often in heavy urban or rush-hour traffic) at high speed and without signls, as if they have no interest in their own safety or that of others, and genuinely wish to die as soon as possible in a multi-vehicle collision of their own making. They invariably look offended if forced to give way to cars, whatever the circumstances. See also kamikaze.
by Eighth of Seven January 07, 2007
The Urban Dictionary Mug
One side has the word, one side has the definition. Microwave and dishwasher safe. Lotsa space for your liquids.Buy the mug


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By Alan Duffy
A goal which is sure to have impressed his new Man Utd boss (and current Dutch one) Louis van Gaal, Robin Van Persie's magnificent chest-trap and volley combo was a thing of beauty. The goal came in the Netherlands's 1-1 draw with Ecuador in Amsterdam at the weekend and highlighted just how clinical and classy RVP can be for both club and country.
Video: 101gg


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Watford golf, mates, good times
- A fab venue - great course/facilities/food/people
Published on: 18 August 2017
From £149pp
1 night's dinner, bed & breakfast and 1 round of golf (Bowood Course)
1 night's dinner, bed & breakfast and 2 rounds of golf (Bowood Course)
2 nights' dinner, bed & breakfast and 3 rounds of golf (Bowood Course)
1 in 12 Stay & Play Free
Valid All Year
Situated in Wiltshire, at the heart of the Bowood Estate, the beautiful Bowood Hotel, Spa and Golf Resort has all the makings for a great golf trip. The fantastic hotel and spa facilities provide all the luxury you would expect from a 4* hotel, whilst the on-site championship golf course will deliver on the golf front.
Bowood Golf Club offers a challenging layout located in the picturesque surroundings of Bowood Estate. Designed by Dave Thomas, of Belfry fame, this course encapsulates mature woodland, moulded bunkers, skilfully planned hillocks and fast rolling greens.
Bowood Hotel can be found on the A4, between Chippenham and Calne, at Derry Hill (signposted from the M4, Junction 17).
If you are looking for a stunning championship golf course with impressive and affordable accommodation, and leisure facilities to match, look no further than Bowood Hotel. Each of the hotel's 43 en-suite rooms are the epitome of luxury, with plasma screen TV's, free Wi-Fi, a safe, and of course complimentary toiletries available to make your stay as comfortable as possible.
The Clubhouse Brasserie boasts a variety of delicious dishes and is the venue for dinner. An upgrade to fine dining in the hotel's Shelburne Restaurant can be arranged for small parties of up to 6 people for an additional supplementary cost. Additionally, The Stables Restaurant serves a range of hot and cold dishes in the historic surroundings of Bowood House. For a lighter bite to eat then you should visit the hotels on-site café, or alternatively book a table at The Library for afternoon tea.
There is also an on-site spa where you can rewind after your round of golf, or where the non-golfers in your party can relax when you are on the golf course. The state of the art spa includes a swimming pool, gym, sauna, steam rooms, aromatherapy showers and a juice health bar. Beauty therapists are also on hand to provide the best comfort and treatments in the many therapy rooms.
Take a stroll around Bowood Gardens, an area within the resort of extreme natural beauty. Or if you would prefer a day outside of the venue grounds, the local town of Bath is quite the tourist attraction, as is the charming village of Castle Coombe. Wiltshire is full of brilliant places just waiting to be explored.
If you're looking for luxury on your golf break, then a Bowood golf break could be the one for you. The course is long and challenging, and the accommodation is second to none.