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Cataracts From Antidepressants? »
"March 12, 2010 -- SSRI antidepressants raise the risk of cataracts by about 15% -- enough to cause 22,000 extra cataract cases in the U.S. each year, Canadian researchers suggest.
The study does not prove that antidepressants cause cat"...
Clinical Worsening and Suicide Risk
Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.
The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4,400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1,000 patients treated) are provided in Table 1.
Table 1
|Age Range
|Drug-Placebo Difference in Number of Cases of Suicidality per 1,000 Patients Treated
|Increases Compared to Placebo
|< 18
|14 additional cases
|5 additional cases
|Decreases Compared to Placebo
|1 fewer case
|≥ 65
|6 fewer cases
No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide.
It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.
All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.
Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.
If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms (see PRECAUTIONS and DOSAGE AND ADMINISTRATION: Discontinuation of Treatment With PAXIL (paroxetine hydrochloride) ), for a description of the risks of discontinuation of PAXIL (paroxetine hydrochloride) ).
Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to healthcare providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for PAXIL (paroxetine hydrochloride) should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.
Screening Patients for Bipolar Disorder
A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that PAXIL (paroxetine hydrochloride) is not approved for use in treating bipolar depression.
Potential for Interaction With Monoamine Oxidase Inhibitors
In patients receiving another serotonin reuptake inhibitor drug in combination with a monoamine oxidase inhibitor (MAOI), there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued that drug and have been started on an MAOI. Some cases presented with features resembling neuroleptic malignant syndrome. While there are no human data showing such an interaction with PAXIL (paroxetine hydrochloride) , limited animal data on the effects of combined use of paroxetine and MAOIs suggest that these drugs may act synergistically to elevate blood pressure and evoke behavioral excitation. Therefore, it is recommended that PAXIL (paroxetine hydrochloride) not be used in combination with an MAOI (including linezolid, an antibiotic which is a reversible non-selective MAOI), or within 14 days of discontinuing treatment with an MAOI (see CONTRAINDICATIONS). At least 2 weeks should be allowed after stopping PAXIL (paroxetine hydrochloride) before starting an MAOI.
Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions
The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including treatment with PAXIL (paroxetine hydrochloride) , but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Serotonin syndrome, in its most severe form can resemble neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.
The concomitant use of PAXIL (paroxetine hydrochloride) with MAOIs intended to treat depression is contraindicated.
If concomitant treatment of PAXIL (paroxetine hydrochloride) with a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
The concomitant use of PAXIL (paroxetine hydrochloride) with serotonin precursors (such as tryptophan) is not recommended.
Treatment with PAXIL (paroxetine hydrochloride) and any concomitant serotonergic or antidopaminergic agents, including antipsychotics, should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated.
Potential Interaction With Thioridazine
Thioridazine administration alone produces prolongation of the QTc interval, which is associated with serious ventricular arrhythmias, such as torsade de pointes-type arrhythmias, and sudden death. This effect appears to be dose related.
An in vivo study suggests that drugs which inhibit CYP2D6, such as paroxetine, will elevate plasma levels of thioridazine. Therefore, it is recommended that paroxetine not be used in combination with thioridazine (see CONTRAINDICATIONS and PRECAUTIONS).
Usage in Pregnancy
Teratogenic Effects: Epidemiological studies have shown that infants born to women who had first trimester paroxetine exposure had an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects (VSDs and ASDs). In general, septal defects range from those that are symptomatic and may require surgery to those that are asymptomatic and may resolve spontaneously. If a patient becomes pregnant while taking paroxetine, she should be advised of the potential harm to the fetus. Unless the benefits of paroxetine to the mother justify continuing treatment, consideration should be given to either discontinuing paroxetine therapy or switching to another antidepressant (see PRECAUTIONS: Discontinuation of Treatment with PAXIL (paroxetine hydrochloride) ). For women who intend to become pregnant or are in their first trimester of pregnancy, paroxetine should only be initiated after consideration of the other available treatment options.
A study based on Swedish national registry data evaluated infants of 6,896 women exposed to antidepressants in early pregnancy (5,123 women exposed to SSRIs; including 815 for paroxetine). Infants exposed to paroxetine in early pregnancy had an increased risk of cardiovascular malformations (primarily VSDs and ASDs) compared to the entire registry population (OR 1.8; 95% confidence interval 1.1-2.8). The rate of cardiovascular malformations following early pregnancy paroxetine exposure was 2% vs. 1% in the entire registry population. Among the same paroxetine exposed infants, an examination of the data showed no increase in the overall risk for congenital malformations.
A separate retrospective cohort study using US United Healthcare data evaluated 5,956 infants of mothers dispensed paroxetine or other antidepressants during the first trimester (n = 815 for paroxetine). This study showed a trend towards an increased risk for cardiovascular malformations for paroxetine compared to other antidepressants (OR 1.5; 95% confidence interval 0.8-2.9). The prevalence of cardiovascular malformations following first trimester dispensing was 1.5% for paroxetine vs. 1% for other antidepressants. Nine out of 12 infants with cardiovascular malformations whose mothers were dispensed paroxetine in the first trimester had VSDs. This study also suggested an increased risk of overall major congenital malformations (inclusive of the cardiovascular defects) for paroxetine compared to other antidepressants (OR 1.8; 95% confidence interval 1.2-2.8). The prevalence of all congenital malformations following first trimester exposure was 4% for paroxetine vs. 2% for other antidepressants.
Animal Findings: Reproduction studies were performed at doses up to 50 mg/kg/day in rats and 6 mg/kg/day in rabbits administered during organogenesis. These doses are approximately 8 (rat) and 2 (rabbit) times the maximum recommended human dose (MRHD) on an mg/m2 basis. These studies have revealed no evidence of teratogenic effects. However, in rats, there was an increase in pup deaths during the first 4 days of lactation when dosing occurred during the last trimester of gestation and continued throughout lactation. This effect occurred at a dose of 1 mg/kg/day or approximately one-sixth of the MRHD on an mg/m2 basis. The no-effect dose for rat pup mortality was not determined. The cause of these deaths is not known.
Nonteratogenic Effects: Neonates exposed to PAXIL (paroxetine hydrochloride) and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome (see WARNINGS: Serotonin Syndrome— Potential for Interaction With Monoamine Oxidase Inhibitors).
Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN). PPHN occurs in 1 - 2 per 1,000 live births in the general population and is associated with substantial neonatal morbidity and mortality. In a retrospective case-control study of 377 women whose infants were born with PPHN and 836 women whose infants were born healthy, the risk for developing PPHN was approximately sixfold higher for infants exposed to SSRIs after the 20th week of gestation compared to infants who had not been exposed to antidepressants during pregnancy. There is currently no corroborative evidence regarding the risk for PPHN following exposure to SSRIs in pregnancy; this is the first study that has investigated the potential risk. The study did not include enough cases with exposure to individual SSRIs to determine if all SSRIs posed similar levels of PPHN risk.
There have also been postmarketing reports of premature births in pregnant women exposed to paroxetine or other SSRIs.
When treating a pregnant woman with paroxetine during the third trimester, the physician should carefully consider both the potential risks and benefits of treatment (see DOSAGE AND ADMINISTRATION). Physicians should note that in a prospective longitudinal study of 201 women with a history of major depression who were euthymic at the beginning of pregnancy, women who discontinued antidepressant medication during pregnancy were more likely to experience a relapse of major depression than women who continued antidepressant medication.
Activation of Mania/Hypomania: During premarketing testing, hypomania or mania occurred in approximately 1.0% of unipolar patients treated with PAXIL (paroxetine hydrochloride) compared to 1.1% of active-control and 0.3% of placebo-treated unipolar patients. In a subset of patients classified as bipolar, the rate of manic episodes was 2.2% for PAXIL (paroxetine hydrochloride) and 11.6% for the combined active-control groups. As with all drugs effective in the treatment of major depressive disorder, PAXIL (paroxetine hydrochloride) should be used cautiously in patients with a history of mania.
Seizures: During premarketing testing, seizures occurred in 0.1% of patients treated with PAXIL (paroxetine hydrochloride) , a rate similar to that associated with other drugs effective in the treatment of major depressive disorder. PAXIL (paroxetine hydrochloride) should be used cautiously in patients with a history of seizures. It should be discontinued in any patient who develops seizures.
Discontinuation of Treatment With PAXIL (paroxetine hydrochloride) : Recent clinical trials supporting the various approved indications for PAXIL (paroxetine hydrochloride) employed a taper-phase regimen, rather than an abrupt discontinuation of treatment. The taper-phase regimen used in GAD and PTSD clinical trials involved an incremental decrease in the daily dose by 10 mg/day at weekly intervals. When a daily dose of 20 mg/day was reached, patients were continued on this dose for 1 week before treatment was stopped.
With this regimen in those studies, the following adverse events were reported at an incidence of 2% or greater for PAXIL (paroxetine hydrochloride) and were at least twice that reported for placebo: Abnormal dreams, paresthesia, and dizziness. In the majority of patients, these events were mild to moderate and were self-limiting and did not require medical intervention.
During marketing of PAXIL (paroxetine hydrochloride) and other SSRIs and SNRIs, there have been spontaneous reports of adverse events occurring upon the discontinuation of these drugs (particularly when abrupt), including the following: Dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations and tinnitus), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Patients should be monitored for these symptoms when discontinuing treatment with PAXIL (paroxetine hydrochloride) . A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate (see DOSAGE AND ADMINISTRATION).
See also PRECAUTIONS: Pediatric Use, for adverse events reported upon discontinuation of treatment with PAXIL (paroxetine hydrochloride) in pediatric patients.
Akathisia: The use of paroxetine or other SSRIs has been associated with the development of akathisia, which is characterized by an inner sense of restlessness and psychomotor agitation such as an inability to sit or stand still usually associated with subjective distress. This is most likely to occur within the first few weeks of treatment.
Hyponatremia: Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including PAXIL (paroxetine hydrochloride) . In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Cases with serum sodium lower than 110 mmol/L have been reported. Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk (see PRECAUTIONS: Geriatric Use). Discontinuation of PAXIL (paroxetine hydrochloride) should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted.
Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death.
Abnormal Bleeding: SSRIs and SNRIs, including paroxetine, may increase the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anticoagulants may add to this risk. Case reports and epidemiological studies (case-control and cohort design) have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Bleeding events related to SSRIs and SNRIs use have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages. Patients should be cautioned about the risk of bleeding associated with the concomitant use of paroxetine and NSAIDs, aspirin, or other drugs that affect coagulation.
Bone Fracture: Epidemiological studies on bone fracture risk following exposure to some antidepressants, including SSRIs, have reported an association between antidepressant treatment and fractures. There are multiple possible causes for this observation and it is unknown to what extent fracture risk is directly attributable to SSRI treatment. The possibility of a pathological fracture, that is, a fracture produced by minimal trauma in a patient with decreased bone mineral density, should be considered in patients treated with paroxetine who present with unexplained bone pain, point tenderness, swelling, or bruising.
Use in Patients With Concomitant Illness: Clinical experience with PAXIL (paroxetine hydrochloride) in patients with certain concomitant systemic illness is limited. Caution is advisable in using PAXIL (paroxetine hydrochloride) in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
As with other SSRIs, mydriasis has been infrequently reported in premarketing studies with PAXIL (paroxetine hydrochloride) . A few cases of acute angle closure glaucoma associated with paroxetine therapy have been reported in the literature. As mydriasis can cause acute angle closure in patients with narrow angle glaucoma, caution should be used when PAXIL (paroxetine hydrochloride) is prescribed for patients with narrow angle glaucoma.
PAXIL (paroxetine hydrochloride) has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from clinical studies during the product's premarket testing. Evaluation of electrocardiograms of 682 patients who received PAXIL (paroxetine hydrochloride) in double-blind, placebo-controlled trials, however, did not indicate that PAXIL (paroxetine hydrochloride) is associated with the development of significant ECG abnormalities. Similarly, PAXIL (paroxetine hydrochloride) does not cause any clinically important changes in heart rate or blood pressure.
Increased plasma concentrations of paroxetine occur in patients with severe renal impairment (creatinine clearance < 30 mL/min.) or severe hepatic impairment. A lower starting dose should be used in such patients (see DOSAGE AND ADMINISTRATION).
Information for Patients
PAXIL (paroxetine hydrochloride) should not be chewed or crushed, and should be swallowed whole.
Patients should be cautioned about the risk of serotonin syndrome with the concomitant use of PAXIL (paroxetine hydrochloride) and triptans, tramadol, or other serotonergic agents.
Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with PAXIL (paroxetine hydrochloride) and should counsel them in its appropriate use. A patient Medication Guide about "Antidepressant Medicines, Depression and Other Serious Mental Illnesses, and Suicidal Thoughts or Actions" is available for PAXIL (paroxetine hydrochloride) . The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.
Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking PAXIL (paroxetine hydrochloride) .
Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.
Drugs That Interfere With Hemostasis (e.g., NSAIDs, Aspirin, and Warfarin): Patients should be cautioned about the concomitant use of paroxetine and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding.
Interference With Cognitive and Motor Performance: Any psychoactive drug may impair judgment, thinking, or motor skills. Although in controlled studies PAXIL (paroxetine hydrochloride) has not been shown to impair psychomotor performance, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that therapy with PAXIL (paroxetine hydrochloride) does not affect their ability to engage in such activities.
Completing Course of Therapy: While patients may notice improvement with treatment with PAXIL (paroxetine hydrochloride) in 1 to 4 weeks, they should be advised to continue therapy as directed.
Concomitant Medication: Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions.
Alcohol: Although PAXIL (paroxetine hydrochloride) has not been shown to increase the impairment of mental and motor skills caused by alcohol, patients should be advised to avoid alcohol while taking PAXIL (paroxetine hydrochloride) .
Pregnancy: Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy (see WARNINGS: Usage in Pregnancy: Temtogenic Effects and Nontemtogenic Effects).
Nursing: Patients should be advised to notify their physician if they are breastfeeding an infant (see PRECAUTIONS: Nursing Mothers).
Laboratory Tests
There are no specific laboratory tests recommended.
Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis: Two-year carcinogenicity studies were conducted in rodents given paroxetine in the diet at 1, 5, and 25 mg/kg/day (mice) and 1, 5, and 20 mg/kg/day (rats). These doses are up to 2.4 (mouse) and 3.9 (rat) times the MRHD for major depressive disorder, social anxiety disorder, GAD, and PTSD on a mg/m2 basis. Because the MRHD for major depressive disorder is slightly less than that for OCD (50 mg versus 60 mg), the doses used in these carcinogenicity studies were only 2.0 (mouse) and 3.2 (rat) times the MRHD for OCD. There was a significantly greater number of male rats in the high-dose group with reticulum cell sarcomas (1/100, 0/50, 0/50, and 4/50 for control, low-, middle-, and high-dose groups, respectively) and a significantly increased linear trend across dose groups for the occurrence of lymphoreticular tumors in male rats. Female rats were not affected. Although there was a dose-related increase in the number of tumors in mice, there was no drug-related increase in the number of mice with tumors. The relevance of these findings to humans is unknown.
Mutagenesis: Paroxetine produced no genotoxic effects in a battery of 5 in vitro and 2 in vivo assays that included the following: Bacterial mutation assay, mouse lymphoma mutation assay, unscheduled DNA synthesis assay, and tests for cytogenetic aberrations in vivo in mouse bone marrow and in vitro in human lymphocytes and in a dominant lethal test in rats.
Impairment of Fertility: Some clinical studies have shown that SSRIs (including paroxetine) may affect sperm quality during SSRI treatment, which may affect fertility in some men.
A reduced pregnancy rate was found in reproduction studies in rats at a dose of paroxetine of 15 mg/kg/day, which is 2.9 times the MRHD for major depressive disorder, social anxiety disorder, GAD, and PTSD or 2.4 times the MRHD for OCD on a mg/m2 basis. Irreversible lesions occurred in the reproductive tract of male rats after dosing in toxicity studies for 2 to 52 weeks. These lesions consisted of vacuolation of epididymal tubular epithelium at 50 mg/kg/day and atrophic changes in the seminiferous tubules of the testes with arrested spermatogenesis at 25 mg/kg/day (9.8 and 4.9 times the MRHD for major depressive disorder, social anxiety disorder, and GAD; 8.2 and 4.1 times the MRHD for OCD and PD on a mg/m2 basis).
Pregnancy Category D. See WARNINGS: Usage in Pregnancy: Teratogenic Effects and Nonteratogenic Effects.
Labor and Delivery
The effect of paroxetine on labor and delivery in humans is unknown.
Nursing Mothers
Like many other drugs, paroxetine is secreted in human milk, and caution should be exercised when PAXIL (paroxetine hydrochloride) is administered to a nursing woman.
Pediatric Use
Safety and effectiveness in the pediatric population have not been established (see BOX WARNING and WARNINGS: Clinical Worsening and Suicide Risk). Three placebo-controlled trials in 752 pediatric patients with MDD have been conducted with PAXIL (paroxetine hydrochloride) , and the data were not sufficient to support a claim for use in pediatric patients. Anyone considering the use of PAXIL (paroxetine hydrochloride) in a child or adolescent must balance the potential risks with the clinical need.
In placebo-controlled clinical trials conducted with pediatric patients, the following adverse events were reported in at least 2% of pediatric patients treated with PAXIL (paroxetine hydrochloride) and occurred at a rate at least twice that for pediatric patients receiving placebo: emotional lability (including self-harm, suicidal thoughts, attempted suicide, crying, and mood fluctuations), hostility, decreased appetite, tremor, sweating, hyperkinesia, and agitation.
Events reported upon discontinuation of treatment with PAXIL (paroxetine hydrochloride) in the pediatric clinical trials that included a taper phase regimen, which occurred in at least 2% of patients who received PAXIL (paroxetine hydrochloride) and which occurred at a rate at least twice that of placebo, were: emotional lability (including suicidal ideation, suicide attempt, mood changes, and tearfulness), nervousness, dizziness, nausea, and abdominal pain (see DOSAGE AND ADMINISTRATION: Discontinuation of Treatment With PAXIL (paroxetine hydrochloride) ).
Geriatric Use
SSRIs and SNRIs, including PAXIL (paroxetine hydrochloride) , have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event (see PRECAUTIONS: Hyponatremia).
In worldwide premarketing clinical trials with PAXIL (paroxetine hydrochloride) , 17% of patients treated with PAXIL (paroxetine hydrochloride) (approximately 700) were 65 years of age or older. Pharmacokinetic studies revealed a decreased clearance in the elderly, and a lower starting dose is recommended; there were, however, no overall differences in the adverse event profile between elderly and younger patients, and effectiveness was similar in younger and older patients (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION).
Last reviewed on RxList: 12/6/2010
This monograph has been modified to include the generic and brand name in many instances.
Paxil FDA Prescribing Information
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(888) 786-7696.
A complete résumé of
Dr. Charles B.
Pyke and a listing of services offered by Dr. Pyke and his companies can be found at his website:
Charles Pyke.
A complete résumé of Dr. Charles B. Pyke and a listing of services offered by Dr. Pyke and his companies can be found at his website: Charles Pyke.


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I help people connect to their audience with clear, beautiful WordPress websites.
I helped the hugely popular Surrey independent boarding school introduce WordPress across a range of websites to unify their visual identity and make content management simple and intuitive.
A highly rewarding project that included web and interface design, and custom WordPress theme development.
A beautiful travel destination that required an equally lush visual presence to help communicate the peace, tranquility and luxury of the hotel.
We worked together to create a clear and intuitive way to help potential visitors identify the right package for their stay.
An award-winning charcuterie brand in need of a visual overhaul, the new Cornish Charcuterie site aims to convey the passion behind the product range.
WordPress allows the client to easily update frequent news and events, with WooCommerce providing a seamless shopping experience.
IT Security experts JAW Consulting required a super-clean design to convey their expertise and experience in a highly image-conscious field.
We worked together in a highly collaborative process to create a site which communicates their services and trustworthiness in a clear, no-nonsense manner.
Peter Cox, Redhammer Management
"Luke accurately interpreted our brief with great creativity and expertise. We continue to use him on an ongoing basis because of his responsiveness, professionalism and consummate skill – highly recommended."
It's not enough for your website to just work well on a laptop or desktop computer anymore. The explosive growth of mobile and tablet devices means your site needs to load fast and be easy to use whichever device your audience are using.
Every website from Lunamedia is designed and built with multi-device compatibility in mind. So you can be sure your site will work flawlessly across the board, making sure you can reach your customers wherever they are.
Hello, I'm Luke Burford. I've been a web designer and developer for seven years, moving from London to beautiful Bude, Cornwall sometime in between.
In that time I've also worked for over a hundred clients from around the UK and beyond, from one-person businesses to global companies.
If you have a project or just want to shoot the breeze about the web, you can contact me. I'll usually get back to you within a few business hours.
You can also sign up to the mailing list for my occasional free newsletter on useful, practical web advice for your business.


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Thinking Compliance When Protecting Your Ideas Internationally
What are the Implications of Alice v. CLS?
Protecting Trade Secrets During Business Collaboration
IP|Trend: Inter Partes Review: Is It Still Right For You?
What Does the Supreme Court Ruling in Alice v. CLS Mean to a Software Entrepreneur?
Bill Beutler on Editing Wikipedia
Inter Partes Review Appeals: What You Need to Know
The AIA Has Moved the Cheese
Emerging Markets: Opportunity, Risk, and What it Means for Brand Protection
How is Graphene Currently Used and What is the Hope for the Future?
Derivation Proceedings: What You Need to Know
What is Graphene? Fenwick Patent Attorney Has the Answer
Examining Trends in Worldwide Design IP Filings
Two Tips for Inventors Filing Patent Applications
Track One and the Patent Prosecution Highway
The Intersection Between Intellectual Property Law and Employment Law
Lessons from Nautilus v. Biosig at the Supreme Court
Examining the Impact of the Supreme Court's Limelight v. Akamai Decision
FCPA Compliance and Ethics Report-Episode 72-interview with Michael Rasmussen
Although derivation proceedings only will be available for U.S. patent applications with an effective filing date on or after March 16, 2013, the USPTO already has published its final rules implementing the derivation...more
You've heard about the planned expansion of the domain name system, but what does it really mean for trademark owners?
Last year, the Internet Committee for Assigned Names and Numbers (ICANN), the organization...more
In This Issue:
"Alternative Dispute Resolution and The America Invents Act" and "Wake-Up Start-Up: A Start-Up and Small Business Patent Strategy for the Future"
Excerpt from Alternative Dispute Resolution...
A friend of...more
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Rustic Garden Ideas
Creating Your Own Backyard Wildflower Meadow: A Comprehensive Guide
Photo courtesy of wakest on flickr.com Guest post by Daniel Novak Even in the icy grip of winter it is never too early to start developing garden plans for spring planting. Awash with sunshine, resplendent with Shasta daisies, wild sunflowers, and purple coneflowers gently waving in the warm seasonal breeze, the subtle murmur of the… Continue reading
Innovative Vertical Gardens
More people and companies are turning to vertical gardens as a way to utilize wasted space, grow food in urban areas, and create healthier living environments. Green walls can play a role in lowering indoor air pollutants, help with reducing rain water runoff, and in protecting buildings. Check out the attached articles to see… Continue reading
Little Falls Arts & Craft Fair
I recently headed out for a fun weekend in Little Falls, MN with my best Junking-Buddy and sister, Lisa. We had a great time! Waller House Inn in Little Falls, MN With a great stroke of luck we landed rooms at the Waller House Inn in Little Falls. Oh my – what a… Continue reading
Greenhouse Inspiration
I've been busy in the greenhouse over at the Gardening Junky Shop. We have been converting an old greenhouse from a full functioning growing facility, into a green space for displaying our garden goods. We are still growing plants, just not on a large scale like a full-blown greenhouse. Now that we are almost done… Continue reading
Backyard Patio Ideas
Photo by Saxon Holt I'm looking out the window at two feet of snow and I'm daydreaming about patio ideas. Spring is coming, and I'm thinking about putting in a patio in the backyard where my firepit now sits. I found this funky round patio design in Sunset magazine. It is made… Continue reading
Garden Pizzazz at Etsy!
Winter is most definitely here in northern Minnesota. When the gardens are dormant I turn to gardening magazines, books, and online garden sites to give me inspiration for next summer's garden. Today I went in search of garden art and accessories at Etsy. Below are some items I found that would be a… Continue reading
Trendy Terrariums
Terrariums are making a comeback. I remember making terrariums years ago using old jars and glass vases. You didn't hear much about them for a couple of decades, but now they are back in a big way. Terrariums are an easy way for people who live in apartments, or who just don't really… Continue reading
Rustic Container Gardening
There are many reasons to create a container garden. Container gardening is a good way to dabble in gardening without throwing all your time into it. Some common reasons why people choose to start a container garden are: Outdoor space limitations. Physical limitations – can't bend down or are wheelchair bound. Your… Continue reading
Fall Rustic Garden Decor
Fall is here. The leaves are turning color and the air is crisp. I found these photos of simple, yet elegant rustic garden decor I wanted to share. It's easy to make beautiful fall decor out of natural items found in your own back yard. This simple grapevine wreath embellished with some… Continue reading
Love Garden Junk?
I do! All Rustic Gardens needs some treasures to dress things up a bit. As you can see, I tend to accumulate a bit more than the average Gardening Junky. I love to peruse garage sales and junk stores in pursuit of the perfect gardening container. Of course there isn't just… Continue reading


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Weekly Brief: DOJ Memo Details Justification For Killing US Citizens
According to "Companies' Stock Buybacks Help Buoy the Market," by Dan Strumpf, published in the WSJ on September 15, 2014, "[c]ompanies are buying their own shares at the briskest clip since the financial crisis, helping fuel...more
Standard & Poor's (S&P) Rating Services recently warned the health care sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." S&P noted...more
One thing common to all appellate lawyers— they love to appeal. But, as all appellate lawyers know, the right to appeal is fixed by statute. (Trede v. Superior Court (1943) 21 Cal.2d 630.) Thus, our ability to practice our...more
The summer may feel like a more leisurely time of year, but not in securities litigation news. Here are some of the more significant headlines...more
In an historic move, Standard & Poor's upgraded the Orange County Transportation Agency SR91 Express Lanes Toll Revenue Bonds to "AA-", making it one the highest rated managed lanes projects in the world. The bonds were...more
On July 24, S&P issued a request for comment on changes to methodology and assumptions for assessing Japanese RMBS.
On July 24, Fitch issued Asia-Pacific Consumer ABS ratings criteria.
On July 24, Fitch issued...more
On July 23, S&P's parent company, McGraw Hill Financial Inc., disclosed that it received a Wells notice indicating that the SEC's enforcement staff had made a preliminary determination to recommend that the SEC institute an...more
It's common knowledge that investors, analysts and other stakeholders view certain non-financial information as increasingly important indicators of a company's long-term value. This information tends to be grouped into three...more
On June 13, Moody's announced that its private student loan default rate index will continue to decline.
On June 13, Fitch announced that it has taken various conforming rating actions on enhanced municipal bonds and...more
Following Dechert's series of reports in relation to the Chilean pension funds market and its accessibility to Irish UCITS, see Dechert OnPoint - Moody's Upgrade Points to Reopening of the Chilean Pension Market to Irish...more
Stock Market Commentary -
The S&P 500's strong close on the final day of March accounted for nearly half of the first quarter return of 1.8%. Markets withstood a number of challenges, including a frigid winter, a...more
ESMA Reports on Information that Competent Authorities Should Provide to it Under the AIFMD -
The European Securities and Markets Authority (ESMA), has published a final report of technical advice for the European...more
On March 18, 2014, Standard & Poor's Ratings Services announced ratings upgrades for two bond insurers – Assured Guaranty Municipal Corp. (f/k/a Financial Security Assurance Inc.) to "AA" from "AA-" and MBIA Inc.'s National...more
On January 23, Fitch released its criteria for analyzing interest rate stresses in structured finance transactions and covered bonds. On January 22, DBRS released its methodology for rating wind power projects. On January 22,...more
Welcome 2014! We want to thank you for continuing to support the investment strategies we have in place to protect your wealth. The total return in the S&P Index in 2013 of 32.4% now has the index up an astounding 173% since...more
The Wall Street Journal recently highlighted director tenure in an article titled "The 40-Year Club: America's Longest Serving Directors." While the article noted that fewer than 30 public company directors have at least 40...more
Rating Agency S&P's "Puffery" Defense Rejected in U.S.'s Landmark Fraud Case Under FIRREA. Credit-rating agencies have successfully asserted several defenses to private investors' fraud claims, including a First Amendment...more
S&P announced this week that over €10bn of loans backing European CMBS transactions that it rates could need refinancing next year (SCI 3 December). About €3bn of the €13bn of loans scheduled to mature in 2014 has been...more
The Elevator Speech Overview -
The government shutdown continues as the stalemate on Capitol Hill shows no signs of abating. Lawmakers, media, and the public are becoming increasingly focused on the upcoming debt...more
On August 21, S&P released its asset isolation and SPE criteria for Canadian structured finance transactions. On August 19, Fitch released its insurance rating methodology....more
On August 14, Judge Curtis E.A. Karnow of the Superior Court of California, County of San Francisco, denied Standard & Poor's motion to dismiss a suit by the State of California....more
Three years ago, on May 6, 2010, U.S. capital markets experienced the "flash crash," when the Dow Jones Industrial Average suffered a stunning 1,000-point loss (9 percent) in five minutes, followed by an equally dramatic...more
On August 2, Fitch released its criteria for the rating of distressed debt exchanges. On August 1, Fitch released its criteria for the use of lenders' mortgage insurance (LMI) in RMBS transactions....more
FHFA Statement on Freddie Mac Risk-Sharing Transaction -
On July 24, the FHFA announced that Freddie Mac is nearing completion of its first risk-sharing transaction, a direct debt issuance, that will assist Freddie Mac...more
On July 16, Judge David O. Carter of the Federal District Court for the Central District of California denied Standard & Poor's Financial Service LLC's (S&P) motion to dismiss the U.S. government's $5 billion fraud suit...more
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Edited by canahuate On May 7, 2012 8:10 PM
Message Boards » Motivation and Support
TOPIC: getting discouraged!
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Joined Jan 2012
Posts: 3
May 7, 2012 7:31 PM
Trying to stay on track but sometimes I fall off the wagon ! any advice
Joined Dec 2011
Posts: 440
May 7, 2012 10:19 PM
This question may be better suited for the Motivation section. You have posted in the Website Suggestions section meant for provided suggestions for improvements to the website and apps. Also when you do post in the correct section, more details on why you "fall off the wagon" would be very helpful for providing advice that may actually help your situation.
Joined Feb 2010
Posts: 9
May 8, 2012 7:25 AM
I just came from my physician after about 6 weeks. He told me that it is okay to "sin" on occasion. He also asked that I do not eat the same foods all the time. Variety is the spice of life! Treat yourself, but in small portions. Have something different. Go and exercise to burn some calories and then reward yourself with a thoughtful and balanced meal.
I manage to drink 2 glasses of wine every day, eat meat and other fun foods. Yes, I have cut a few foods down to near nothing including pasta, chocolate, sweet drinks, cheese, butter. Yes, I have increased other foods like, olive oil, fish, raw vegetables, salads (just with a little EVOO and lemon juice or vinegar), fortified low calorie cereals.
Also keep in mind that it gets harder as you come down in weight. The first x-pounds/kilos are easy, they just melt away. Then it slows down and gets more difficult. But you can do it!
Joined Aug 2011
Posts: 26
May 8, 2012 7:31 AM
I will snack on wasabi peas, (hot) then go and do something, If I am in my office I will go and walk to another area. If I am at home I will go outside and play with the animals. Drink lots of water, MIO enhancer tastes good. If you fall off one day, get back on track the next. You can do this!
Joined Apr 2012
Posts: 80
May 8, 2012 7:49 AM
Have you ever walked across the room and tripped over nothing along the way......(the answer here is yes, we all have....), Well what would make 'THIS' EASIER than walking across the room? We all trip, we all FALL, we all get up again.....just get up again.....and carry on as usually until the next invisible thing crosses your path and trips you .....THEN GET UP AGAIN.....(do you see a pattern here )
Joined Feb 2012
Posts: 433
May 8, 2012 9:29 AM
We all have bad days. Every day is a fresh start and every small change you make will put you on the right path. Celebrate the positive changes you are making and don't give up. We are not failures if we keep going.
Joined Jan 2012
Posts: 3
May 13, 2012 6:42 AM
Very new to this, sorry I put it in the wrong place.
Joined Jan 2012
Posts: 3
May 13, 2012 6:44 AM
Thank you :)
MFP Staff
Joined Aug 2011
Posts: 4,553
May 13, 2012 8:48 AM
Moved to motivation support.
Joined Jan 2011
Posts: 459
May 13, 2012 8:56 AM
Yea, we all fall off the wagon.... like last night, I had cookies and toast for dinner. :P But today is a new day and we can start over!
Message Boards » Motivation and Support
Posts by members, moderators and admins should not be considered medical advice and no guarantee is made against accuracy.


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Members of the Muhlenberg men's and women's basketball teams stepped onto the court last Wednesday as they have hundreds of times in their careers. This time, however, it wasn't with the goal of defeating an opponent – it was to run a practice for their favorite sport with Special Olympics athletes from the Lehigh Valley.
This is the second year in a row that the team has participated in the event, which is held at Trexler Middle School.
"The Student Athletic Advisory Committee (SAAC) wanted to do more stuff with the Special Olympics this year," said senior Kate Clawson, who is a committee member. "We helped them organize the Lehigh Valley Polar Bear Plunge and wanted to continue our involvement with the organization."
The Polar Bear Plunge, held in January, benefitted Special Olympics Pennsylvania, and many of the organization's members participated in it.
Clawson, who interned for Special Olympics in her home state of Connecticut last summer, helped plan the basketball practice, and at the same time, got to be an active participant.
The players started off by leading the Special Olympics athletes through a series of warmups. Once they were ready to go, the athletes participated in a defensive stance drill where they had to smack the floor and get into position before shuffling left and right.
Fullcourt layups (righty and lefty!) were next, followed by three different work stations.
At one station, Clawson, juniors Austin Curry and Kevin Hargrove and sophomore Hannah Rush instructed the athletes on how to defend the dribble. At another, sophomores Abby Stenger and Malique Killing and freshmen Nick Melosky and Ryan Marchetti ran the athletes through series of ballhandling and dribbling drills. At the third station, senior Julie Kelly, sophomores Nicole Pepe and Jesse Lerner and freshman Alec Stavetski helped the players shoot from different spots on the floor.
At the end of the evening, men's assistant coach Marqus Hunter gave away Muhlenberg bracelets to the athletes who correctly answered various basketball trivia questions. But they didn't just have to answer the questions correctly, they had to make a shot before receiving their prize!
"The best part is just getting to come hang out with these athletes" added Clawson. "It's so nice to work with them – they're just so happy doing the little things. It really makes you appreciate your life and what you have.
"We're Division III basketball teams so it's not like we are heroes to everyone, but it's so cool that they all look up to us so much."


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PISCATAWAY, N.J. - The Rutgers men's basketball team hosts seven regular season, non-conference games and plays 11 non-league contests overall during the 2012-13 regular season. The Scarlet Knights, under the leadership of third-year head coach Mike Rice, begin their campaign at the Rutgers Athletic Center versus St. Peter's on Friday, Nov. 9.
Teams from seven different conferences will visit the RAC in 2012-13. In addition to the nine BIG EAST opponents, squads from the Atlantic 10 (George Washington, Dec. 11), Conference USA (UAB, Dec. 16), America East (Boston U., Nov. 20), MAAC (St. Peter's, Nov. 9; Rider, Dec. 27 or 28), MEAC (Howard, Dec. 21) and NEC (Sacred Heart, Nov. 12) travel to Piscataway. The contest versus Howard will be a doubleheader, with the Rutgers women's basketball team playing Stony Brook earlier in the day.
RU competes in the BIG EAST-SEC Challenge for a third-consecutive year and will travel to Oxford to play Ole Miss on Saturday, Dec. 1 in a game that will be televised live nationally on ESPNU. The Scarlet Knights will also make a return to the Madison Square Garden Holiday Festival, when they meet Iona on Saturday, Dec. 8.
Rutgers plays two standard road games out of conference, travelling to Princeton on Friday, Nov. 16 and to UNC-Greensboro on Sunday, Nov. 25.
In BIG EAST Conference action, Rutgers plays Cincinnati, Georgetown, St. John's and Seton Hall twice as part of an 18-game schedule. Cincinnati, Georgetown, Louisville, Marquette, Pittsburgh, Providence, St. John's, Seton Hall and USF all visit the RAC this winter. The Scarlet Knights' conference road opponents are Cincinnati, Connecticut, DePaul, Georgetown, Notre Dame, St. John's, Seton Hall, Syracuse and Villanova.
Day Date Opponent Site Time TV
Sun. Nov. 4 Holy Family (exhibition) RAC TBA ----
Fri. Nov. 9 St. Peter's RAC 7:30 p.m. RVision
Mon. Nov. 12 Sacred Heart RAC 7:30 p.m. RVision
Fri. Nov. 16 at Princeton Princeton, N.J. TBA TBA
Tue. Nov. 20 Boston University RAC 7:30 p.m. RVision
Sun. Nov. 25 at UNC-Greensboro Greensboro, N.C. 2 p.m. TBA
Sat. Dec. 1 at Mississippi (BE/SEC) Oxford, Miss. TBA ESPNU
Sat. Dec. 8 vs. Iona (Holiday Festival) Madison Square Garden TBA TBA
Tue. Dec. 11 George Washington RAC 7:30 p.m. RVision
Sun. Dec. 16 UAB RAC 12 noon RVision
Fri. Dec. 21 Howard RAC (DH) 7:30 p.m. RVision
Thu./Fri. Dec. 27/28 Rider RAC 7:30 p.m. RVision
Schedule is subject to change. The complete BIG EAST schedule, as well as additional times and television information, will be announced at later dates.


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Debbie Bilbrey-Honsowetz
1150 Canton Center S.
Recreation: 734/394-5460
Parks: 734/394-5310
Administration: 734/394-5360
Fax: 734/394-5366
Early Bird Registration begins Wednesday, August 14, 2013 at 5 p.m.
Online Registration, Resident and Non-Resident In-Person registration begins Wednesday, August 21 at Noon Summit on the Park, 46000 Summit Parkway.
Once your account has been established and approved, registration for programs and activities is easy:
If the Plymouth-Canton school district closes due to inclement weather, all recreation programs held prior to 4:00 p.m. will be cancelled.
For programs that begin at 4:00 p.m. or later, a decision to hold programs/activities will be made no later that 2:00 p.m. that day. Please contact Canton Leisure Services at 734/394-5460 after 200 p.m. to confirm if programs will be held.
An effort will be made to schedule a make-up class if a class is cancelled due to inclement weather or causes beyond our control. However, if that is not possible, no partial refund will be provided.
Purchase of a Summit facility membership does not entitle non-residents to register at the same time as residents. Non-residents are permitted to register beginning 5 days prior to the start of a program / activity. Summit facility members must have a valid membership to receive the membership rate.
Summit members with children 3 years of age and younger are entitled to receive the membership rate for that child, under the parent's membership.
Children 4 years and older must be included on a valid family membership to qualify for the member rate.
When registering for a parent & child class, only the child is enrolled for the parent/child class. Mail-in registrations accepted only where indicated.
The registrant/parent/guardian is responsible for verifying the age of a registering child is within the age guidelines of the program. Any falsification of the information provided, either intentional or unintentional, will result in penalties, up to and including dismissal from the program and forfeiture of all feed paid. for most programs, age requirements will be determined as of the start date of the first class.
All age requirements are designed to benefit the children and make instruction more consistent for the program instructor. In most instances, the requirements have been established for the child's safety. We reserve the right to request an original birth certificate.
Participants wishing to withdraw from a class/program must complete a Participant Withdrawal Request form for
Online processing fees are non-refundable.
For programs/activities with no available spaces, contact Canton Leisure Services at 734/394-5460 to inquire about being placed on a waiting list.
Canton Leisure Services reserves the right to cancel any activity due to low enrollment and will provide a refund.
Participants will have the option to enroll in another class if space is available.
An effort will be made to schedule a make-up class if a class is canceled due to inclement weather or causes beyond
our control. However, if that is not possible, no partial refund will be provided.
Canton Leisure Services is committed to providing the highest quality classes, programs and events for the Canton
Community. We are confident that everyone will enjoy our classes and programs. If after attending a
program/class/activity you are not satisfied with the level of service and/or the quality of the program, you may
complete a Program Satisfaction form, which can be obtained from the Summit front desk. All requests must be
received within 30 days of the completion of the program.
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Architects throughout the world were invited in 1960 to design a Cathedral for Liverpool which would relate to the existing Crypt, be capable of construction within five years, cost at the current prices no more than one million pounds for its shell, and most important of all, express the new spirit of the liturgy then being radically reformulated by the Second Vatican Council.
Of 300 entries from all over the world, Sir Frederick Gibberd's (1908-1984) design was chosen, and building began in October 1962. Less than five years later, on the Feast of Pentecost, 14 May 1967, the completed Cathedral was consecrated. The Papal Legate at the consecration, most appropriately, was His Eminence John Carmel Cardinal Heenan, Archbishop of Westminster, who had been succeeded as Archbishop of Liverpool three years earlier by George Andrew Beck. The long waiting was suddenly over.
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Ultimate Casino
Ultimate Casino went live for the New Jersey soft launch on November 21, 2013. It received approval to go live to the public on November 25, 2013. Players may download the casino software from ucasino.com. The poker software is located at Ultimatepoker.com.
New players receive a free $25 when signing up at either UCasino or Ultimate Poker. The free money may be used to enter poker tournaments and sit and gos or wagered at slot machines.
Ultimate Casino is partnered with Trump Taj Mahal in New Jersey. It is operated by Fertitta Interactive and majority owned by Station Casinos, a locals casino operator based in Las Vegas. Its most popular properties are Red Rock Resort, Green Valley Ranch and Palace Station. The Ultimate brand is related to the Ultimate Fighting Championship. The Fertitta family is heavily involved in this popular Mixed Martial Arts form.
Ultimate Casino offers a variety of casino games including video poker, blackjack and slots. It will also offer online poker through its Ultimate Poker brand. It was the first regulated online poker room in the United States. It launched in Nevada on April 30, 2013. It had a monopoly in that market until September 17, 2013 when WSOP opened its online poker room.
The casino offers three forms of blackjack, roulette, Let it Ride, Three Card Poker, Four Card Poker, Six Card Poker, Casino war, Raise it Up, Crazy4Poker, Pai Gow Poker, Mississippi Stud and Ultimate Texas Hold'em. Video poker titles include Jacks or Better, Deuces Wild, Double Bonus and Double Double Bonus.
Ultimate Poker
Ultimate Poker offers No Limit Texas Hold'em, Fixed Limit Texas Hold'em, Pot Limit Omaha, Pot Limit Omaha High/Low and Fixed Limit Omaha High/Low. There are also sit and gos in all games. Most multi table tournaments are No Limit Texas Hold'em.
Accounts may be made in person at Trump Taj Mahal or within the Ultimate Casino software. Players may be required to submit documentation that proves identification and age.
Ultimate Casino New Jersey – Banking Options
Deposits may be made by cash at a Trump Taj Mahal casino cage, electronic check, Visa and Mastercard. Withdrawals may be made by cash at a Trump Taj Mahal casino cage, electronic check or check by mail.
UCasino.com and Ultimate Poker also offer deposits through PayNearMe. These may be made at any 7-11 in New Jersey in amounts up to $500.


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Reader Comments (Page 1 of 1)
A question regarding crafted items and Wrath.
My prot warrior has weaponsmithing now (completely unused however), would you suggest I drop it for armorsmithing, in preparation of wrath?
Back when I was primarily fury, I dumped a significant amount of money into maxing out my blacksmithing to get myself those spiffy 1 handed axes. Then they nerfed the graphic (the flame no longer leaves a trial, so it went from awesome to just another weapon + flame graphic). Then they introduced the new isle badge vendors and the 1 handed fist weapons there completely obsoleted my weapons. I banked my axe and have since not bothered.
It's been so long since this change (the patch that introduced the isle), that I'm pretty settled into prot now and with how amazingly awesome prot has been in beta and even the ptr, I'm pretty confident I'm staying prot to level and pvp and on. Would you suggest I change over to armorsmith now, while I'm not occupied with other things (like leveling in wrath) or should I hold out in case they introduce badass tanking weapons for weaponsmithing?


text: Iced Starbucks VIA - Episode #166 Jason Coffee July 14, 2010 15 Comments Instant 0 Tweet Jason reviews Starbucks Via Iced Coffee. Related PostsDo you like Starbucks VIA?Starbucks Gazebo Blend Coffee Review – Episode #50Starbucks Sumatra Coffee Review on Ustream.TV – Episode #6Starbucks UK Coffee Review – Episode #180Starbucks Ipanema Bourbon – Episode #27Starbucks Arabian Mocha Sanani – Episode #25Starbucks French Roast Coffee Tasting – Episode #13BioTwitterFacebookGoogle+LinkedInLatest PostsBecome An Author Jason CoffeeHead Writer, Owner & Founder. at Coffee Cup News @coffeecupnewsFollow @coffeecupnews Jason Coffee +Jason Coffee Latest posts by Jason Coffee (see all) Luck Bros Peru – MyCoffeePub.com Subscription - August 4, 2014 Espresso is NOT a Bean, It's a Brew Method - June 7, 2014 HiLine Coffee Review: SoHo Blend - May 23, 2014 Coffee Cup Drums! - August 30, 2013 Coffee Review: Northern Espresso Signature Blend - August 2, 2013 Interested in writing for Coffee Cup News? Click here to become a Guest or Featured Author.


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Plaza Group Signs $35-Million Agreement With Huntsman
January 26, 2001
HOUSTON – The Plaza Group has announced a major agreement with Huntsman Corp., the world's largest privately held chemical company. The $35-million chemical-services contract makes The Plaza Group Huntsman's largest minority supplier. This new multi-year agreement represents an extension of the original contract with Huntsman, one of The Plaza Group's first customers when it opened its doors six years ago.
The new contract with The Plaza Group represents Huntsman's commitment to an equal-opportunity business environment. As a leader in minority-supplier support, Huntsman is pleased to reaffirm its commitment to diversity among its suppliers through the continuation of its relationship with The Plaza Group.
Huntsman Corp.'s operating companies manufacture basic products for a variety of global industries. For more information on Huntsman, visit the company's web site at www.huntsman.com.
The Plaza Group, headquartered in Houston, Texas, is an international marketing company of petrochemical products with sales of over $100 million. For orders, call 800-876-3738 or visit the company's Web site at www.theplazagrp.com


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$14 for a Dermatouch Heated Eyelash Curler - SEE VIDEO! ($30 Value)
- The ideal tool for when you feel your mascara just doesn't give you the eyelash boost you want!
- Brings you a long-lasting eyelash curl that lasts from morning to night.
- Heats up in just 15 seconds and is so easy to use it will instantly become a part of your morning beauty routine.
- Easy way to achieve a supremely glamourous look!
Buy Details
- Includes one Deramtouch heated eyelash curler tool with two AAA batteries.
- Unlimited buys and unlimited as gifts.
- Tax included. Expected Shipping Time: 2 Weeks. Shipping Charge: $5.
- Return Policy: The Purchaser shall not be entitled to any refund.
Expiry Date: No Expiry
What You're Getting:
- $14 for a Dermatouch Heated Eyelash Curler ($30 Value)
- Heats up instantly.
- Curls within seconds.
- Silicon pad indicates when curler is ready for use.
- AAA battery-operated (Batteries included).
How You Get It:
- Purchase your TeamBuy.
- Pay shipping charge and enter in your address information.
- Product will be mailed out to you once offer has closed.
- Products
- Website
We guarantee that TeamBuy is authorized to sell this product and that every brand we sell is authentic.


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How To Make A Batch File
I have seen this question asked many times on the forums here at PCMech. Sometimes, what one takes for granted, makes others scratch their head so I figured this is worth a tip posting.
Suppose you wanted a batch file to simply print the name of your computer. The command you would run would be the following:
echo %computername%
Here is how to make the above command a batch file:
- Open Notepad (you can use any text editor, but I am going to assume Notepad).
- Type/paste the commands you want to be in your batch file.
- Select File > Save As.
- In the dialog, browse to the location where you want to save the batch file.
- Change the "Save as type" option to "All Files (*.*)" and then enter the file name ending with ".bat", for example: MyComputerName.bat
- Alternate to step 5, you can enter the file name "MyComputerName.bat" (including the quotes) and this will ignore the Save as type setting.
- Click Save.
There you have it. You should now have a batch file in all its glory.
9 responses to How To Make A Batch File
Luis R. March 11th, 2008 at 7:39 am
Is there any difference with batch files with the .cmd extension?
Windows Batch Script To Backup Data » PCMech May 12th, 2008 at 8:57 am
[...] How to create a Batch file. [...]
totalcontrol July 24th, 2008 at 1:41 am
ok so we can make a batch file but how can we get windows to automatically open this batch file?
drake August 7th, 2008 at 11:11 pm
u go to [MY COMPUTER]and then u go to [DOCUMENTS AND SETTINGS] then go to [STARTUP]and then u place the file there and it will start up every time you start up the computer.
Kamrul March 28th, 2009 at 1:33 am
Batch Script To Open Multiple Programs At Once | PCMech November 14th, 2009 at 3:32 am
[...] save the above text into a batch file named Browsers.bat and then run it. You will see both Firefox and IE are launched. This is just a [...]
Roger January 5th, 2010 at 7:26 am
There are tools handier than Notepad. For example, Notepad++. I prefer to use Dr.Batcher ( http://www.drbatcher.com ). It's a tool designed especially to create batch files. Unfortunately, it's not freeware
somebody April 15th, 2010 at 8:17 pm
@echo off
title Matrix
color 2
echo %random% %random% %random% %random% %random% %random%
goto start
\\this is the way to make the matrix


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My name is Deborah Edwards-Onoro and I'm the owner of Lireo Designs, a website development and digital marketing company in Canton, Michigan. I'm a front-end web developer and user experience professional who uses WordPress to build engaging websites that are usable and accessible.
At Lireo Designs, I offer personalized service and listen carefully to your needs and goals. Based on conversations with you and careful research, I define your audience to learn what visitors might want and expect from your website and email campaigns.
One nonprofit client received an unexpected $50,000 donation from a website visitor who discovered the nonprofit's achievements from their site. View some of the sites I've created in my portfolio.
Groups and Associations
- Metro Detroit WordPress Meetup, Group Leader
- Refresh Detroit, Group Leader
- Detroit User Experience, Co-Organizer
- WordCamp Detroit 2011–2013, Planning Team
- Michigan Usability Professionals' Assocation, Member, Officer from 2008–2011
- Usability Professionals' Association
- Social Media Club Detroit
When I'm not on the computer, I can be found reading, shooting photos, bicycling, or bird watching.


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See and share Beautiful Nature Photos and amazing photos of interesting places
"The harder you work, the luckier you get."
Gary Player
Below is the poem entitled THE TYPEWRITER which was written by poet
Maria Paz
Samelo. Please feel free to comment on this poem. However, please remember, PoetrySoup is a place of encouragement and growth.
Read Poems by
Maria Paz
Maria Paz Samelo
Taking a course of being a secretary
Typewriter on the table is ready
My hands are aching to hit the letters
Speed depends on the movements of my fingers
A basic instrument of communication
You have to familiarize with the hands-on
Busy hands needs to type as many words
It's like having a competition with swords
Manual way of making documents for you and for me
You have to be sure to type the words and letters correctly
Bond papers, liquid erasers, and a heavy type writer
The complete set to accomplish the mission as typist
Typewriters will be remembered as the years go by
Modern computers will not beat its quality even if I buy
April 25, 2013
For Craig's Contest "The Typewriter"
I worked as a secretary in an insurance company before and I used typewriter for making documents, letters, etc. and missed using it for a long time... (^_^)


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Chris Cosentino: The Life of an Offal Chef
Watching someone eat offal for the first time in his restaurant Incanto or his salumi Boccolone provides him with a certain satisfaction, "It's great to see someone change their opinion about something they initially felt was a horrible thing. Most of the time customers have a bad perception of offal because of a past experience where it was not cooked properly or was not fresh," said Chef Cosentino. "So when you serve offal in all its glory, cooked properly, people are usually very excited at how good it can be. To see the look of hesitation when they first get the dish turn into a smile and then to see clean plate tells me I have done my job."
Chef Cosentino's favorite part of the pig? "I love pig's feet. They are delicious, rich and unctuous. They can be served so many different ways. Whenever I am out to eat, I like to order pig's feed to see what other chefs like to do with them."
One of the most important aspects of properly cooking offal is being able to acquire fresh animals and fresh fruits and vegetables. Being located in San Francisco is a key factor in his success, "being in San Francisco has given me access to great small ranchers, which in turn provides me with some of the best animals and produce around. The local farmers become like family; we now work together to find new varieties of vegetables and different stages to serve them. The fact that everything is so close makes things a bit easier."
As much as Chef Cosentino loves San Francisco he does have other favorite "food" cities, "there are so many great food cities. I love going to New York and Chicago. New York is always pushing the limits of design and food and Chicago is a meat lover's town, which is near and dear to my heart."
Chef Cosentino's history as a chef starts at a young age cranking the handle of his great-grandmother's pasta machine in her kitchen. He was raised in Rhode Island where he was raised on a fusion of typical New England Yankee fare and classic Italian cooking.
His family has a rich food tradition. His maternal ancestor's, the Easton's founded the Easton Sausage Company. Founded in 1860 in Newport, Rhode Island the Easton Sausage company was well known on the Eastern Seaboard for their quality sausage. In 1942 they closed their doors due to a shortage of quality spices. Recently Chris fulfilled what he calls his greatest food achievement by "keeping a promise to my grandparents and brining back Easton's breakfast sausage from the original family recipe."
Whether it was cooking in his great-grandmother's kitchen or the kitchen of Red Sage in Washington DC after his graduation from Johnson and Wales University other chefs have played an important part in his success. Chris lists Marco Pierre White, Fergus Henderson and Martin Picard as inspirations. However, Mark Miller was his most impactful food mentor: "All of the chefs I have worked for have been impactful, but Mark Miller was the first chef I trained under and an amazing teacher. He has also been my harshest critic over the years. He taught me that knowledge is power when it comes to food. And I've learned from him that examining history allows me to properly build dishes that make sense."
"I admire all chefs who put their heads down and works. This is a hard job and it takes a certain type of person to "marry" the kitchen. My hats is off to all chefs who have committed themselves to the stove. I have a lot of admiration for Daniel Patterson of Coi (San Francisco) and David Chang of Momofuku (New York). Each of us, in our own way, has chosen to follow the beat of a different drum," he said.
Many of Chef Chris Cosentino's patrons would agree that he has mastered the art of following the beat of a different drum.
(If you'd like to read more about Chef Cosentino take a look at In To The Flames, a new blog from my friend Rob.


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Excalibur Firebolt 20" Carbon Crossbow Bolt 4" Vanes Pack of 6
Product #: 410955 Excalibur #: 22CAV-6 UPC #: 626192122209
Product Information
Excalibur crossbow bolts are constructed from the highest quality materials available to produce the fastest and most accurate crossbow bolts possible. Made from series 22 carbon and come fletched with 4" vanes for superior accuracy. The color of the vanes is completely random and will vary from one production run to another. All of the bolts in each box will match, but the color of the vanes pictured above may not be the color of the vanes on other bolts.
Note: Excalibur Firebolt arrows do not require the use of a nock and are ready to use as they are supplied, with the flat ends.
Technical Information
Note: Excalibur Firebolt arrows do not require the use of a nock and are ready to use as they are supplied, with the flat ends.
Technical Information
- Arrow Material: carbon
- Weight: 350 grains
- Diameter: 21/64"
- Fletching: 4" Vanes
- Length: 20"
- Quantity: 6
Delivery Information
Shipping Weight: 0.450 PoundsXThe total weight of the product, including the product's packaging as it sits on our shelf. Since some products ship directly from the Manufacturer, their weight may be unavailable. Because of variations in the manufacturing process, similar products may have differing weights. Unless the product is designated as "Ships Alone", Shipping Weight does not include the shipping box or packing materials associated with your order.
Ships Alone: NoXProduct ships from MidwayUSA, separate from any other products on your order due to its size. Products that are Shipped Alone incur separate "Per Order" and "Per Pound" shipping charges.
DOT-Regulated: NoXProduct is regulated by the US Department of Transportation (DOT) and cannot be shipped via USPS or air shipping methods. DOT-Regulated products must ship UPS Ground.
Carrier Restrictions: NoXProduct is restricted by shipping carriers and cannot be shipped to certain locations or via certain shipping methods.
HazMat Product: NoXAdditional shipping charge for HazMat products. Carriers charge extra to ship packages with products they consider hazardous, such as reloading powder and primers.
Know someone who may like this? Email this Page to a Friend
Customer Reviews
The statements and opinions expressed within Customer Reviews reflect each author's personal perspective and do not imply endorsement by MidwayUSA, its Employees or any other organization. Customers should in no way infer that MidwayUSA has validated review information as safe, accurate or appropriate.
NOTE: Prices, specifications and availability are subject to change without notice.
We reserve the right to correct typographic, photographic and/or descriptive errors.
We reserve the right to correct typographic, photographic and/or descriptive errors.
Suggested Products
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- Excalibur Boltcutter Fixed Blade Broadhead 150 Grain Stainless... $36.49 Available
- TenPoint Bednar Perfect Arrow Puller Polymer Orange... $20.00 Available
- G5 T3 Crossbow Mechanical Broadhead 100 Grain Stainless Steel... $39.99 Available
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- TenPoint Shadow Ultra-Lite Crossbow Package with 3X Pro-View... Add to Cart for Price
- Excalibur Recurve Crossbow Stringer Polymer... $26.49 Available
- Barnett Wildcat C5 Crossbow Package with 4x 32mm Multi-Reticle... $403.99 Available


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|Hyatt Place Wrightstown hotels are provided below. Search for cheap and discount Hyatt Place hotel prices in Wrightstown, NJ for your family, individual or group travels. We list the best Hyatt Place Wrightstown lodging properties so you can review the Wrightstown Hyatt Place hotel list below to find the perfect place.
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Streaming today's top alternative music & more
Your one-stop source for local innovation news
I'd click that
Home of award-winning Boston Globe reporting.
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Avery Bradley may be ready for the start of the season
posted at 7/7/2012 8:44 PM EDT


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Norias of Hama
Coordinates: 35°8′7″N 36°45′11″E / 35.13528°N 36.75306°E
The Norias of Hama (Arabic: نواعير حماة) are a number of norias ("wheels of pots") along the Orontes River in the city of Hama, Syria. Only seventeen of the original norias remain. They are mostly unused now and serve an aesthetic purpose. They were called "the most splendid norias ever constructed."[1] The norias of Hama were submitted as a tentative World Heritage Site by the Syrian Arab Republic in June 1999.[2]
The earliest evidence for norias in Hama suggests they were developed during the Byzantine era, although none of the norias in Hama today precede the Ayyubid period. However, a mosaic found at Apamea dating to 469 CE pictures a noria very similar to those at Hama, suggesting they may have earlier origins.[3] It was during the Mamluk era that many of the norias—initially started during the rule of the Ayyubid dynasty in the late twelfth and early thirteenth century—were reconditioned and enlarged. The Mamluks also increased the amount of norias in the city. At one time, medieval Hama contained more than thirty of the waterwheels. Aqueducts and other channeling systems were built to take water from the Orontes River and use it to irrigate nearby fields. Now only 17 norias remain, unused.[4] On August 11, 2014, it was reported on Twitter that they had been burned down by drunken soldiers.[5][better source needed]
The noria wheel is up to 20 meters (66 ft) in diameter. The water in the river is channeled into a sluice so that its flow turns the wheel around. Wooden boxes attached to the wheel raise the water from the sluice and discharge it into an artificial channel at the summit of the wheel's rotation. The water is then led by gravity along a series of aqueduct channels. It was distributed to domestic or agricultural users in Hama; access to the flow was regulated at carefully worked-out times so that the water could be shared.[4]
There are two norias on the river close to the citadel. Upstream from the town center at Bichriyat, are four more wheels that can be viewed from outdoor restaurants. Downstream from the center is the largest noria, the al-Mohamadiyya, which used to supply the Great Mosque with water. Part of its old aqueduct still spans the road. It was built in the fourteenth century and restoration work on it began in 1977.[4]
- ^ Needham and Ronan, 1995, p.281.
- ^ http://whc.unesco.org/en/tentativelists/1291
- ^ Adriana De Miranda (2007). Water Architecture in the Lands of Syria: The Water-wheels. L'ERMA di BRETSCHNEIDER. pp. 53–. ISBN 978-88-8265-433-7. Retrieved 24 August 2012.
- ^ a b c Ring, Berney, Salkin, La Boda, Watson, and Schellinger, 1996, p.137-138.
- ^ Sindebad69 (9 August 2014). "#ناعورة #حماة" [#Norias #Hama] (in Arabic (comments)). Twitter. Retrieved 11 August 2014.
- Ring, Trudy; Berney, K.A.; Salkin, Robert M.; La Boda, Sharon; Watson, Noelle; Schellinger, Paul (1996), International Dictionary of Historic Places: Middle East and Africa, Routledge, ISBN 1-884964-03-6.
- Needham, Joseph; Ronan, Colin A. (1995), The Shorter Science and Civilisation in China: Volume 5, Cambridge University Press, ISBN 0-521-46773-X.


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The Colorado Court of Appeals ruled Thursday that governors' proclamations of a state Day of Prayer violate the Constitution's provisions for religious liberty.
When the state sponsors the particular religious practice of prayer, the three-judge panel found, it sends a message that those who pray are favored members of Colorado's political community.
"In doing so, they undermine the premise that the government serves believers and nonbelievers equally," Judge Steven Bernard wrote in a 73-page decision.
The content of six Colorado Day of Prayer proclamations, 2004 to 2009, is "predominantly religious," lacking a secular context or purpose, and the effect is "government endorsement of religion over nonreligion," Bernard wrote. Judges Alan Loeb and Nancy Lichtenstein concurred.
The governors' proclamations, made by Govs. Bill Ritter and Bill Owens, have included biblical verses and other religious themes. They are calls to actual worship, Bernard wrote.
Let's now apply this to the National Day of Prayer!
If Easter had been directed by M. Night Shyamalan.
For the first time since 2001, a plurality Americans say there is too much religious talk from politicians, according to a new survey released Wednesday by the Pew Forum on Religion and Public Life.
The poll showed 38% of Americans saying there was too much religious expression from politicians, compared to 30% who said there was too little. Twenty-five percent said the current level of religious rhetoric was the right amount.
Those figures represent a shift from 2010, when more Americans (37%) said there was too little talk of faith compared to those who said there was too much (29%).
Wednesday's survey was the first time since 2001 the figure for Americans believing there is too much religious talk in politics has surpassed the number who say there is too little.
It scares me that 30% believe that there is not enough religion in politics and that 25% think that the current religion in politics is ok.
Why Pascal's Wager doesn't work in one short comic.
On the same day Pope Benedict addressed and blessed a group of 1,800 children in Guanajuato, Mexico, three Mexican authors released a book accusing the Vatican of hiding or ignoring cases of child sex abuse by Roman Catholic priests.
The book, "La Voluntad de no Saber" (Willing Not to be Aware), chronicles multiple cases of sexual abuse of minors committed by Marcial Maciel, a Mexican-born Roman Catholic priest who was influential at the Vatican.
The book was authored by Jose Barba, a former seminarian who says he was the victim of sexual abuse by a priest. Historian Fernando M. Gonzalez, a co-author, says the book is based on 212 documents leaked from the Vatican.
Alberto Athie, a former Catholic priest and whistle-blower, also contributed to the book.
According to the book, the Vatican had knowledge of multiple cases of sexual abuse committed by Maciel decades ago, but church authorities chose to do nothing about it.
Athie said the church either ignored or archived for years allegations of child sex abuse when he reported them during his years as a priest.
And this is the church that is so offended that they might have to let their publicly funded hospitals and schools cover birth control.
Despite their negative reputations among many Americans, atheists tend to be very ethical and high-achieving, argue Gregory Paul and Phil Zuckerman in an opinion piece in The Washington Post.
Those who don't believe in God are widely considered to be immoral, wicked and angry. Is this knee-jerk dislike of atheists warranted? Not even close, write Gregory Paul and Phil Zuckerman.
Murder rates are far lower in secularized nations such as Japan or Sweden than they are in the much more religious United States, which also has a much greater portion of its population in prison. Even within this country, those states with the highest levels of church attendance, such as Louisiana and Mississippi, have significantly higher murder rates than far less religious states such as Vermont and Oregon.
Atheists tend to score high on measures of intelligence, especially verbal ability. They tend to raise their children to solve problems rationally, to make up their own minds when it comes to existential questions and to obey the golden rule. They are more likely to practice safe sex than the strongly religious are, and are less likely to be nationalistic or ethnocentric.
Denmark, which is among the least religious countries in the history of the world, consistently rates as the happiest of nations. And studies of apostates — people who were religious but later rejected their religion — report feeling happier, better and liberated in their post-religious lives.
On numerous respected measures of societal success — rates of poverty, teenage pregnancy, abortion, sexually transmitted diseases, obesity, drug use and crime, as well as economics — high levels of secularity are consistently correlated with positive outcomes in first-world nations.
Paul and Zuckerman argue that besides the positive statistics associated with atheists, there are more nonbelievers among us than ever: "Despite the bigotry, the number of American nontheists has tripled as a proportion of the general population since the 1960s. Surveys designed to overcome the understandable reluctance to admit atheism have found that as many as 60 million Americans — a fifth of the population — are not believers."
"Our nonreligious compatriots should be accorded the same respect as other minorities," Paul and Zuckerman conclude.


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Pink Lemonade Cupcakes - Recipe
caitymae1992 replied to your photo: made some pink lemonade cupcakes! i'm actually…
Did they taste bueno? If so can I have the recipe? I am totally into baking cupcakes (and decorating them) and love when I get awesome fun recipes! =D
Oh definitely, I'm happy to share! :D I've gotta say, this is probably the best luck I've had with a cupcake recipe, I was licking the bowl clean by the time I was done!
- 1 cup water
- 1 packet of Crystal Light Natural Pink Lemonade powder mix
- 1 box of cake mix (18.25 oz, vanilla or funfetti - it's up to you!)
- 1 tbsp canola or vegetable oil
- 1/4 cup "natural" apple sauce
- 1 tsp lemon juice
- A couple drops of yellow food coloring
- Preheat oven to 350 degrees Fahrenheit.
- Combine water and pink lemonade powder mix. Add in cake mix, vegetable oil, apple sauce, lemon juice, and food coloring. Mix thoroughly until batter is smooth.
- Pour batter into cupcake tray (with liners). Fill each liner roughly halfway.
- Bake for 24 minutes; make sure to test with a toothpick!
- Let cool, then decorate!
YIELD: 24 cupcakes. CALORIES: 90 per cupcake.
As for the glaze, I mixed together confectioner's sugar, vanilla Silk soy milk, about 1/3 of another pink lemonade packet, and a splash of water. I'm not sure what the ratios are since I just dumped it all together until it had the consistency and taste I wanted.


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Pocket Guides Publishing Pocket Guide to Emergency First Aid
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