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How does this medication work? What will it do for me?
Gabapentin belongs to the class of medications called anti-epileptics. It is used in combination with other seizure control medications for the management and prevention of seizures associated with epilepsy. Gabapentin does not cure epilepsy and only works to control seizures as long as the medication is taken. Gabapentin works by affecting the transmission of nerve signals in the brain.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
How should I use this medication?
The usual recommended adult dose of gabapentin begins with 300 mg 3 times daily and increases to as much as 600 mg 3 times daily, according to individual need and as prescribed by the doctor. The usual maximum daily dose is 2,400 mg taken in 3 equal doses of 800 mg each.
Gabapentin may be taken with or without food.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is less than 4 hours until your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
What form(s) does this medication come in?
100 mg
Each capsule with white opaque body and cap, printed "Gabapentin / 100 mg" on the cap in blue ink contains gabapentin 100 mg. Nonmedicinal ingredients: corn starch, lactose, and talc; capsule shell: gelatin and titanium dioxide.
300 mg
Each capsule with yellow opaque body and cap, printed "Gabapentin / 300 mg" on the cap in blue ink contains gabapentin 300 mg. Nonmedicinal ingredients: corn starch, lactose, and talc; capsule shell: gelatin, titanium dioxide, and yellow iron oxide.
400 mg
Each capsule with orange opaque body and cap, printed "Gabapentin / 400 mg" on the cap in blue ink contains gabapentin 400 mg. Nonmedicinal ingredients: corn starch, lactose, and talc; capsule shell: gelatin, titanium dioxide, red iron oxide, and yellow iron oxide.
Who should NOT take this medication?
Do not take gabapentin if you are allergic to gabapentin or any ingredients of this medication.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal heartbeat or heart palpitations
- abnormal thoughts
- involuntary eye movements, double vision, or other vision changes
- poor coordination
- problems with your teeth or gums
- shortness of breath
- speech problems such as slurred speech; abnormal rhythm, speed, or tone (such as sounding hoarse or "nasal") of speech; limited mouth or tongue movements; or drooling
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- symptoms of liver problems (e.g., abdominal pain, persistent vomiting, feeling unwell, fever, itching, yellowing of the skin and eyes, dark urine)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- hallucinations
- signs of a serious allergic reaction (e.g., swelling of face or throat, hives, or difficulty breathing)
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Alcohol: Avoid alcohol while taking gabapentin, as gabapentin may cause alcohol intolerance that leads to an unpleasant reaction after drinking alcohol, such as flushing, redness of the face after drinking alcohol, nausea, palpitations, or headache.
Diabetes: Gabapentin may affect blood sugar levels. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Drowsiness/reduced alertness: If you have uncontrolled epilepsy, do not drive or handle potentially dangerous machinery. Gabapentin may cause drowsiness, dizziness, or problems with coordination. Avoid any activity requiring mental alertness or physical coordination until you determine that gabapentin does not affect you in this way.
Kidney function: Gabapentin is not removed from the body as quickly in people with reduced kidney function as compared with those who have regular kidney function. Your doctor may reduce your dose as needed.
Stopping the medication: As with other medications used to control seizures, stopping gabapentin suddenly could increase the risk of seizures. Do not stop gabapentin suddenly. Ask your doctor how to safely and gradually stop the medication.
Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking gabapentin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.Children: The safety and effectiveness of using this medication have not been established for children.
What other drugs could interact with this medication?
There may be an interaction between gabapentin and any of the following:
- antacids containing magnesium or aluminum
- cimetidine
- mefloquine
- narcotic pain relievers (e.g., codeine, hydrocodone, morphine, oxycodone)
- other medications which cause drowsiness
- sodium bicarbonate
- tapentadol
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.


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Such was our "quick" day trip to New Ulm, in Brown county, Minnesota. We were actually going there to do some research on my husband's Ulmer relatives, but his great-grandfather Conrad Schlechter and Conrad's second wife Mary Fischer Schlechter, from another branch of his family, were buried there as well. After the death of Conrad's first wife in South Dakota, he left his family and moved to New Ulm, where he met and eventually married Mrs. Fischer in 1922.
As I mentioned, we had a photo of their graves, and by looking at the background details, were able to zero in on its location rather quickly. I snapped a few pictures of my own, we paid our respects, and on the way back to the car it occurred to me to check the back of the stone, just in case there was a verse or something special on it. What I found befuddled me.
Melchior Hippert, 12 June 1858 – 14 May 1888
Katharine Hippert, 30 Oct 1883 – 20 July 1900
Richard Geisinger, 06 Feb 1855 – 13 May 1911
M. A. Hippert, 28 May 1888 – 17 May 1918
Otto J. Geisinger, 14 July 1890 – 14 July 1932
In addition, there was a small, flat stone on either side, one that read "Otto J. Geisinger, July 14, 1890 – July 14, 1932" and one that read "Mother."
Mary was born in 1862, and died in 1938. Who were the Hipperts? And the Geisingers? I had not heard these surnames before. Were they friends from Germany? Perhaps Mary's siblings? Why were they all buried together?
We went to the library, and I immediately began looking at census records while my husband looked through the surname file for these new names. In the next few hours, we learned that Mrs. Mary Fischer Schlechter was born Mary Dauer, daughter of Mr. and Mrs. Lorenz Dauer. She first married Melchior Hippert (1858-1888); their children were Katharine (1883-1900), Dora (1885-?), and Melchior A. (1888-1918). The year after Mr. Hippert's death, she married Richard Geisinger (1855-1911) and had one son: Otto J. Geisinger (1890-1932). After Mr. Geisinger's death, she married Carl Fischer. Whether this marriage ended in Mr. Fischer's death or divorce is currently unknown. She then married Conrad Schlechter.
Besides being able to put together the pieces of this family puzzle, we learned that the Geisinger's operated the Chicago House hotel in New Ulm, and we obtained a photo of it. In addition, we acquired a photo of Mary Dauer Hippert Geisinger Fischer Schlechter (whew!).

subset: commoncrawl


text:
Strahan to join 'Good Morning America' part time
See Gallery
NEW YORK (AP) - Talk show host and former football star Michael Strahan is expected to soon join the cast of ABC's "Good Morning America," at least on a part-time basis.
A person with knowledge of the negotiations who requested anonymity because the deal hasn't been completed said Tuesday that Strahan will work semi-regularly during the show's first hour. Strahan continues as host of the daytime talker "Live with Kelly and Michael."
The top-rated morning news show has lost two male cast members in the past four months: Sam Champion to The Weather Channel and Josh Elliott to NBC Sports, the latter in a deal expected to be formally announced Wednesday. Talks with Strahan reportedly predate Elliott's departure, announced on Sunday.
Strahan would join cast members George Stephanopoulos, Robin Roberts, Amy Robach, Lara Spencer and weather forecaster Ginger Zee.


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They're impossible to miss. Deeply golden orbs of various colors with what appears to be a chopstick pierced through their centers. For those who grew up with this childhood treat (me!) catching sight of these is like zipping back in time when kiddie birthday parties included bobbing for apples, decorating your own cookie, and of course eating those caramel apples, which to my mind, are the original dessert fondue. Sticky, chewy, sweet, and crunchy, it's a treat that can't be beat, especially now that I'm all grown up and I have a bigger mouth to take more satisfying bites.
"Most people who stop by ask me "Is that a doughnut?" So says SanFo treats owner, Rochelle Santiago, the purveyor of these caramel apples. "A few times people think it's cake, then doughnuts. They think it's new but it's not. So I have to be in the store answering questions like how is it made? and why is it like that? But for the people who know about it, it's a nostalgic treat for them."
Rochelle grew up in San Francisco and held a job at Pier 39 making apples at the Embarcadero. Surprisingly, she would look for the sweet every time she'd come back home to Manila but wouldn't find any. "The closest one I found was in Enchanted Kingdom where they sliced an apple and put caramel sauce on top of it," she remembers. "But that's not a caramel apple. So last December I decided to make a few and then I gave it to my fiancé [now her husband] to bring to work. So the 35 apples became I don't know, 5,000 in 2 weeks. And I didn't think anyone would order!" She exclaims.
The caramel apple is not a new invention. They were invented in the 1950's by Dan Walker, a Kraft Foods sales representative, who used the company's popular caramels to come up with an ingenious treat. SanFo Treats makes its own caramel from scratch, using the same recipe that Rochelle used at Pier 39. Tweaking it a little to allow for Manila's humidity (moisture in the air prevents candy from hardening), it's a delicious caramel made with butter and sugar and cooked to a particular temperature. "The apples are dipped thrice in caramel." Rochelle explains. And speaking of apples, she tells me that she goes through the apples one by one, tapping each one to check for hardness and shine. "I choose the apples myself. The rock-hard ones are the best. Our caramel apples can stay at room temperature for four to five days but after that, stick it in the fridge. It'll be good for as long as the apple is good." While traditional caramel apples are made with Granny Smiths or Red Delicious, Rochelle prefers Fuji apples because they're not too sweet or too tart and they're juicy too. She readily admits that Pinoys don't seem to be too fond of green apples.
Aside from the regular caramel-dipped one which purist me is a fan of, other flavors flying off the shelves are the apples with chocolate sprinkles, the marshmallow boulder, black forest with cherry, chummy bears, snow gecko, goldfish, peanut butter, and the cosmopolitan (pictured above) which is dipped in chocolate and then drizzled with a chocolate in a contrasting color. There are also apples with candy bar chunks of Butterfinger or Reeses's Pieces. "There's something new every day … we offer at least 50 varieties," Rochelle replies, her eyes lighting up when I ask her if she ever runs out of ideas. "These are personalized designs. I come up with flavors everyday, and I haven't thought about what wouldn't go with an apple," she avers.
Rochelle also accepts custom orders for personalized apples. Basically, if you can dream it up, she'll make it for you. "Just give me a budget per apple along with the color and theme, and I can do it." She tells me that she recently made a Dora the Explorer-themed caramel apple upon the request of a customer who wanted some for her daughter's birthday party. Orange and pink sprinkles with lavender and pink chocolate, Rochelle "… liked it so much that I put it in the store and called it Princess." Another order that's now a store favorite is the Charley Brown, dipped in chocolate and decorated with yellow sprinkles, it uncannily looks like the shirt that the delightful cartoon character wears.
SanFo Treats' caramel apples are P50-P80, depending on flavor. They're relatively affordable, whereas if you buy them in the States, they're $5 each. Also available are other candy novelties: Chocolate covered marshmallows (P25) and frozen bananas (bananas dipped in chocolate and then frozen) in various flavors (P30/P35/P40). Rochelle describes one frozen banana that has caramel in it: "… caramel that is drizzled around the banana and then we dip it in chocolate. So the effect is you eat the banana, you taste the banana and the chocolate and then you have this chewy candy as a treat after you eat the banana. I thought it would be hard but it became chewy. I like it." Sounds like I'd like it too. If you're lucky, you'll be able to spot the Rice Krispies treats (they aren't available often), cereal rice puffs bound with melted marshmallow, another kiddie treat that I've only seen in Wheatberry.
I have to ask, "So what do you say when people ask "˜how do you eat a caramel apple?' " Rochelle chuckles since she believes the answer is all too obvious. But she gamely replies, "Since we're here in the Philippines and some people think it's too messy to eat, I ask if they want it sliced. Otherwise, hold the stick, flip it over and bite. I love it when somebody comes over and grabs it by the stick and walks away eating it. That's the greatest advertising ever!"
Rochelle has done exceedingly and impressively well for herself. Three stores in three months, all in excellent locations. She's incredulous remembering how she just started SanFo Treats last November with her household team of two. Now she has a team of 12 that makes 600 apples a day! I'm impressed with her admiration for the apple. "Every apple goes through me. I put the final chocolate and the drizzles, that's me. I dress them up before it goes to any store," she says proudly. We talk a lot about how she loves what she's doing and the word "passion" pops up frequently, as it often does when I interview people in the food industry. Rochelle talks of one day opening a café with "… those fudge bars that you cut up and weigh; selling a few deli products from San Francisco; serving hot chocolate, tea and coffee, and of course the apples. I'm in love with the product. I don't consider it a business, it's something that I'm doing that I love."
SanFo Treats
*1/L Glorietta, fronting Tag Heuer
*U/L Megamall A, fronting Toy Kingdom, around the corner from Roti Mum
*Fun Ranch, beside Tiendesitas
Rochelle accepts party orders that include sno-cones and an activity table with a chocolate fountain and toppings where the kids decorate the apples themselves.
For inquiries call (632) 628-2993 / 0927-4637248.


text: Overview PhD student loans The UK Government has introduced PhD loans of up to £25000 to UK and EU nationals, residing in England, for postgraduate research programmes starting in the academic year 2018-19. Read more here. About the course Research students are welcomed to Brunel as valued members of our thriving, research-intensive community. A research degree provides the opportunity to investigate a topic in depth, and contribute new knowledge to your discipline. Find out more about Research Degrees at Brunel. A PhD involves demonstrating through original research or other advanced scholarship the creation and interpretation of new knowledge, a systematic acquisition and understanding of a substantial body of knowledge at the forefront of an academic discipline or professional practice, the ability to conceptualise, design and implement a project for the general of new knowledge, applications or understanding at the forefront of the discipline. Both full-time (3 years) and part-time (6 years) study routes are available. Welcoming environment for research students We welcome practice-based proposals for all kinds of writing that demonstrates originality, a commitment to generic advance or reinvention, and a high standard of artistic accomplishment. We offer our graduates expert support in professional preparation for a literary career and encourage them to begin to establish a publication record. Brunel also runs the Brunel Centre for Contemporary Writing which organises research seminars. It also runs the annual 3K Brunel International African Poetry Prize. Research strengths English at Brunel has gone from strength to strength over the last decade to the point where it is now regularly ranked in the top ten English departments in the UK in the Guardian league tables.Our particular areas of strength, which include modern and contemporary literature, Shakespeare, Renaissance studies, Victorian literature and culture, and world literature in English.Contemporary Writing at Brunel University London is a leader in the field. We have a thriving graduate community in the subject, and welcome PhD applications in our particular areas of expertise. The writers at Brunel are all actively publishing and specialists in many areas of writing including: all aspects of modern literary fiction all aspects of contemporary commercial fiction poetry, including for performance women's and multicultural writing horror and thriller writing all aspects of fantasy fiction post-colonial fiction children's/ YA fiction non-fiction screenwriting screen adaptation comedy writing writing for radio writing for opera autobiographical writing female genital mutilation in Africa and the UK the Fusion of creative writing and dramatherapy creative writing for therapeutic purposes autobiographical writing female genital mutilation in Africa and the UK the fusion of creative writing and dramatherapy creative writing for therapeutic purposes Enquiries Contact our Enquiries team. Course Enquiries: +44 (0)1895 265599 (before you submit an application) Admissions Office: +44 (0)1895 265265 (after you submit an application) Back to top Employability Careers and your future Paid work available to research studentsUndertaking teaching and learning support duties represents an important professional and career development opportunity for postgraduate research students. Brunel offers two levels of paid work available to Postgraduate Research students. The first level post is as a Demonstrator and the second level post is as a Graduate Teaching Assistant (GTA). Teaching and learning support duties will vary between Departments and research students should not rely on such opportunities being available. Find out more here. At Brunel we provide many opportunities and experiences within your degree programme and beyond – work-based learning, professional support services, volunteering, mentoring, sports, arts, clubs, societies, and much, much more – and we encourage you to make the most of them, so that you can make the most of yourself. » More about Employability Back to top Entry criteria 2019/20 The general University entrance requirement for registration for a research degree is normally a First or Upper Second Class Honours degree. All international students must show evidence that they meet the English requirement for their course of study. The Senate reserves the right to assess the eligibility of applicants on an individual basis. Research statement As part of our application process for entry on our research degree (MPhil and PhD) programmes, we ask you to provide a 500-1,000 word research statement, excluding any references/bibliography you may include, setting out your research motivation, ideas and aspirations. Learn how to prepare a research statement here. Entry criteria are subject to review and change each academic year. International and EU entry requirements Please select a country Afghanistan Albania Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Belarus Belgium Belize Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Cambodia Cameroon Canada Chile China Colombia Congo Costa Rica Croatia Cuba Cyprus Czech Republic Democratic Republic of Congo Denmark Dominican Republic Ecuador Egypt El-Salvador Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guyana Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kosovo Kuwait Latvia Lebanon Libya Lithuania Luxembourg Macadonia Macao Madagascar Malawi Malaysia Malta Mauritius Mexico Moldova Mongolia Montenegro Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Palestine Panama Papua New Guinea Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saudi Arabia Scotland Senegal Serbia Sierra Leone Singapore Slovakia Slovenia South Africa South Korea Spain Sri Lanka Sweden Switzerland Syria Taiwan Tajikstan Tanzania Thailand Tonga Trinidad & Tobago Tunisia Turkey UAE Uganda Ukraine Uruguay USA Uzbekistan Venezuela Vietnam Yemen Zimbabwe If your country or institution is not listed or if you are not sure whether your institution is eligible, please contact Admissions This information is for guidance only by Brunel University London and by meeting the academic requirements does not guarantee entry for our courses as applications are assessed on case-by-case basis. English language requirements IELTS: 7.5 (min 7W, 7L, 7R, 7S) Pearson: 73 (64 in all subscores) BrunELT: 75% (min 70% in all areas) You can find out more about the qualifications we accept on our English Language Requirements page. If you require a Tier 4 visa to study in the UK, you must prove knowledge of the English language so that we can issue you a Certificate of Acceptance for Study (CAS). To do this, you will need an IELTS for UKVI or Trinity SELT test pass gained from a test centre approved by UK Visas and Immigration (UKVI) and on the Secure English Language Testing (SELT) list. This must have been taken and passed within two years from the date the CAS is made. Should you wish to take a pre-sessional English course to improve your English prior to starting your degree course, you must sit the test at an approved SELT provider for the same reason. We offer our own BrunELT English Test and have pre-sessional English language courses for students who do not meet requirements or who wish to improve their English. You can find out more information on English courses and test options at the Brunel Language Centre. Back to top Special features Facts and figures Brunel University London REF2014 Submission: English Language and Literature. The Research Excellence Framework (REF) is a system for assessing the quality of research in UK higher education institutions. The results of the REF2014 have been made public in December 2014, replacing the previous REF conducted in 2008. The next REF will be undertaken in 2020. Research Excellence Framework (REF) 2014 - A Guide for PhD Students Excellent research support and training Extensive training and support is offered to all research students by the Graduate School, with regular Masterclasses and individual advice on academic issues as part of the Researcher Development Programme. Read more about the available Research Support and Training. Library services Brunel's library is open 24 hours a day, has 400,000 books and 250,000 e-books, and an annual budget of almost £2m. Subject Information Specialists train students in the latest technology, digital literacy, and digital dissemination of scholarly outputs. state-of-the-art research information management tools including a research publication and grant database one of the largest UK's full text repository an integrated data management system analytical tools such as Altmertic and InCites Open Access centrally managed fund Back to top Fees and funding Fees for 2019/20 entry Home/EU students: International students: Fees (per year): Full-time Part-time Full-time Part-time (for students not requiring Tier 2 visa) 2019/20 £4,327 £2,163 £16,850 £8,425 2020/21 £4,407 £2,203 £17,355 £8,675 Research funding We offer a range of PhD studentships, partial scholarships, and academic prizes, to help with your research fees. Explore external funding, particularly the Research Councils, as well as other support. Some courses incur additional course related costs. You can also check our on-campus accommodation costs for more information on living expenses. Fees quoted are per year and are subject to an annual increase. Back to top


text:
Hexen II
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The Four Horsemen of the Apocalypse lurk in the shadows before you. They are Death, Pestilence, Famine, and War. They are the root of all that is evil. They are the least of your worries. The last know Serpent Rider, Eidolon, lives. As the Necromancer, the Assassin, the Crusader, or the Paladin, you must defeat the dark generals and their Hell-spawned legions before you can face the Archfiend and attempt to end his ravenous onslaught.
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text:
I wish you could see the full beauty of this angel picture. Each white dot sparkles in the picture, but the blog doesn't show that.
Poster says: Someone You Know Has Lupus,"
left side: "A rash across the cheeks and nose resembling a 'butterfly' can be a symptom of lupus," "The butterfly has become the Lupus Foundation of America's national symbol of hope." Hope is an underlying message of the campaign. Lupus usually strikes in the prime of life. But new research brings hope that safer and more effective treatments, and ultimately a cure, can be found.
right side
"Lupus is: an autoimmune disease, the body attacking itself, difficult to recognize and diagnose, sometimes mild, sometimes life-threatening, mostly seen in women, especially African Americans, Hispanics, Native Americans and Asians, also found in men and children, a widespread chronic illness that can kill," the poster explains. "Symptoms [include]: joint pain, fever, joint swelling, fatigue, skin rashes, anemia, chest pains, and sun sensitivity."


text:
11 January 2013 at 12.08pm | Comment on this article
The opera tells the story of the Minotaur, half-man and half-bull, who has been imprisoned in the Labyrinth on the Greek island of Crete. Every year, a group of young Athenians are sent to be sacrificed to him. Theseus, Prince of Athens, vows to end this ritual by killing the Minotaur. But can he succeed, and will Ariadne, Princess of Crete, be able to help him and achieve her own desire to leave the island?
The Minotaur was commissioned by The Royal Opera and first performed at the Royal Opera House in 2008. The librettist, David Harsent, was also Harrison Birtwistle's librettist for his first Royal Opera commission, Gawain, and has worked with Birtwistle on several other projects. The Minotaur opened to enthusiastic reviews and has been released on DVD.
The opera's story comes from Greek mythology, and has inspired many writers and artists. Librettist David Harsent adds a layer of psychology to the drama, exploring why the Minotaur is driven to savagery, why Ariadne is so eager to help Theseus and why he later abandons her.
Birtwistle makes use of a vast variety of orchestral colours to create a highly dramatic score for The Minotaur. Particularly striking effects include the sensual solo saxophone that accompanies Ariadne as she describes her mother's seduction of the Minotaur's bull father, a battery of percussion and chattering chorus as Ariadne consults the Snake Priestess in Act II and the delicate, translucent textures of the scenes depicting the Minotaur's dreams, where he imagines he can speak.
Stephen Langridge's production of The Minotaur pays tribute to the Classical world. The Minotaur is tortured in a space that resembles an amphitheatre, surrounded by a masked chorus – like the chorus in Greek theatre – while a bull's head, recalling those used in ancient Cretan rituals, is a key part of the set. Alison Chitty's designs also acknowledge artists throughout the ages fascinated by bulls and minotaurs, from Classical sculptors to Picasso.
The Minotaur is on stage from 17 to 28 January 2013.


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Event detail
Swahili Weekly Social Hour
Social Event | September 25 – December 4, 2017 every Monday | 5:30-6:30 p.m. | Blue Door Cafe | Note change in location
2244 Bancroft Way, Berkeley, CA 94704
Speak Swahili with your fellow Swahili students and enthusiasts over a drink at Blue Door Cafe (check for location updates). This is an informal gathering to connect with other Swahili speakers on campus and in Berkeley. Each person will support their own beverage purchases (water, soda, coffee, tea, beer, etc), but we will provide the good company! And of course, Swahili speaking only! All skill and experience levels are welcome. Karibuni sana!
CA, email@example.com, 510-642-8338


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Public Housing Breaks the Mold
A version of this article appears in the September/October 2001 issue of Home Energy Magazine.
September 01, 2001
Multifamily public and low-income housing have particular problems when it comes to moisture and air pollutants. In this first of a two-part series, we look at one particular type of multifamily construction: midrise housing.
Sick buildings are a growing concern in all sectors of the building industry. As homes become tighter and more energy efficient, other performance factors, particularly moisture and ventilation problems, often become apparent. Each day, building scientists and public health researchers learn more about the link between poor home performance and poor occupant health. These health problems cannot be taken lightly; for example, Cleveland's public housing stock is the epicenter of recent mold-related deaths among children. In our work in the fields of energy efficiency and forensic architecture,we have investigated building problems in more than 200 subsidized housing developments. Based on our experiences with this housing stock,we find that moisture problems are the major cause of suspected healthrelated building problems in subsidized housing, and that adding controlled mechanical ventilation is one of the easiest and least expensive means of reducing or resolving many of these problems. In many of the homes we've seen, specifically midrise and Veterans Era (post-World War II) housing, high surface humidity due to a lack of ventilation coupled with thermal bridging is a large ...
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to firstname.lastname@example.com.


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Ice Age: Continental Drift
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Design is a question of love. Founded by Marcel Wanders and Casper Vissers, this avant-garde Dutch brand has seduced the world with innovative designs since its inception in 2001. Derived from the Dutch word 'Moooi', meaning 'beautiful', Moooi possesses an extra 'o' for its extraordinary beauty. Moooi specializes in lighting, furniture and textiles. Moooi's style is exclusive, daring, playful, exquisite. In addition to Marcel Wanders' designs, the Moooi portfolio contains a range of work from other renowned designers including: Jurgen Bey, Bertjan Pot, Maarten Baas, Ross Lovegrove, Neri & Hu, Studio Job and Nika Zupanc. Moooi produces timeless objects of beauty which posses the uniqueness and character of antiques combined with the freshness of modern times. Designs by Moooi outlast everyday interiors, defining our home's personalities & delivering an extra touch of creativity and beauty.
- Design/Year: Bertjan Pot/2015
- Manufactured In: Netherlands
- Location Rating: UL Listed
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Cuil, an old Irish work for "knowledge" is looking better and better to some by implementing features that Google has yet to use. These features include:
Drilldowns - Basically a way to close the range of relevant search items. If you search for something ambiguous a box will popup asking if you would rather search further for something a little more specific giving you a window like so:
Tabs - Small clarifications that you can click on to make a more specific search, with hopes of getting more of what you want on a single page.
and Search Term Suggestions - While you are typing it offers various ideas of what you may be going towards and you can select one ofthem to make your search go faster.
Cuil looks to offer the most correct results based on the search input, and as such doesn't supposedly doesn't worry about popularity when search strings become more specific than 1 or 2 words.
In all, and after a little use their engine is fairly nice, has a few things to work out but is less than a year old so what can you expect? Check it out at Cuil.com
This post has been edited by BetaWar: 29 July 2008 - 09:04 AM


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pfeiffer.liam necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 60 diseños de 16 diseñadores freelance.
We are a US-based start-up internet company currently developing a web platform that aims to be the primary online service marketplace for service buyers to get instant access to service providers. Our application will allow household owners, business organizations or any individual needing a job done to post their requirements and receive price estimates from our network of service providers, freelancers or independent contractors.
Our target market will consist of two groups of people within USA typically in their mid-20's to mid-40's: (1) the service buyers like household owners or busy professionals looking for a quick and easy method to access service contractors and (2) service providers such as home improvement companies, auto repair shops, and independent professionals, freelancers looking to explore new markets or reach customers outside their geographical scope without the need for expensive advertisement costs.
We want to brand the Squid as the face of our company. The reason behind this is because the Squid's tentacles seem to reach in many directions.
1. The squid should be half-lovable/half-professional character.
2. His tentacles should be used to convey both size and power.
3. The squid needs to be a 3D figure as opposed to a flat, two-dimensional image.
4. The general color scheme is attached. Please make sure the Logo complements these colors and does not clash. It doesn't have to be a perfect match, but there should be some coordination.
5. You're not required to integrate our company name "SquidJob" into the design.
6. We had an idea to interweave the squid with some geographic parameter, be it the Earth or the US. The idea should convey the squids grasp on our user's community.
7. Another idea was to use each tentacle to reach a different offered service. Our general service categories are auto repair, household, personal, legal and medical.
8. However, we are open to all suggestions and the logo that best fits the guidelines of 1-4 will be the winner.
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.


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i would like to know the formula for attenuations of tapped autotransformer, if someone can help me, thanks.
i would like to know the formula for attenuations of tapped autotransformer, if someone can help me, thanks.
Question: 09-24-2003, 05:46 PM
Answer: 02-10-2005, 05:37 AM
Is that service or what!?
Ok. I put this graphic together after lifting the tapped autotransformer pic from here - http://www.allaboutcircuits.com/vol_2/chpt_9/5.html
This is something I've been meaning to put together for a very long time.
I am indebted to David Smith for supplying the fundamental formulas for my spreadsheet.
Modeling a tapped autotransformer courtesy of David Smith.
Another model using my software showing the spice data
David's LEAP Crossover Shop software is better in that it automagically calculates the secondary inductance value.
good stuff Thanks.
Is there some formula to convert it to this series and parallel R/L substituting circuit?
You somewhere posted this for the 3145 network but it would be useful to be able to convert all the other networks with these tapped AT's
Not that I know of. Those conversions were all done the hard way. Greg Timbers supplied the original voltage drives along with a few suggestions and I had to plug and chug until the voltage drives looked identical. I never did get around to doing the 4315, L65, S21, or L220. I think Tim G might be able to import voltage drives into SoundEasy and do something with them.Originally Posted by Guido
Originally Posted by Giskard
i just see (saw?) your post, you don't forget me !
i'm very happy ...
very good post, thanks. fonzy
Hi Fonzy,
I send you a P.M about this case
OK, so building 4315, L65, S21, or L220 will be a challengeOriginally Posted by Giskard
At least we have the 3145 circuit.
Somebody should give us a little tutorial here. What's this about? How does it apply?
55030 Tapped Autotransformer
In this particular instance, used to make the 52978 "1.55mH" tapped autotransformer in the LX80/LX80A/LX300/N333/3131/3133
Tapped autotransformer shown above measured:
red to black - 1.51 mH 0.69 ohms DCR
1st yellow to black - 0.39 mH 0.48 ohms DCR (-6 dB)
2nd yellow to black - 0.27 mH 0.42 ohms DCR (-7.5 dB, spec'd as - 8 dB)
orange to black - 0.14 mH 0.39 ohms DCR (-10 dB)
red to 1st yellow - 0.36 mH 0.46 ohms DCR (-6 dB)
red to 2nd yellow - 0.52 mH 0.48 ohms DCR (-4.5 dB)
red to orange - 0.75 mH 0.52 ohms DCR (-3 dB)
Using the fomulas posted in #2 above for a 1.51 mH inductor:
It's a way to model tapped autotransformers to simulate voltage drives. Once the voltage drive has been simulated one can replace the tapped autotransformer with resistor pads and regular inductors which will yield the same voltage drive. It's probably easier to do with something like SoundEasy or LEAP Crossover Shop than with something like pSpice.Originally Posted by Zilch
Hi all,
After a PM exchange with Giskard, i would like to inform you about the availability of autotransformers :
2 months ago , i had a talk with a FRench Hartsfield owner ( a Classic Audio Repro) about autotransformers versus L Pad.(IMO L.Pad are ALL poor quality and very imprecise component).
He gave me the information that this kind of transformer was available at SOWTER UK, as a particular order.
Then, we decided to order 10 of them in January.THey are on the way from UK to France for the present.
The conditions of the contract included 9 positions, from -1 to -10 db.Contrary to the JBL original parts, those transformers DO NOT includes the L circuit. THerefore you have to instal the inductor separatly, thus the 10 stepped selector with the different resitors in front of the circuit.( scheme included)
The price of each transformer is about 140 /180 $ without local taxes.
I hope it could help!
Warmest regards,
Measured impedance curve of 1.55 mH tapped autotransformer without and with preceding 7.5 ohm parallel resistor.
This is the load the 16.5 uF capacitor sees.
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Bridal Jewelry
Bomi is your source for bridal jewelry. We offer a large selection of engagement rings and wedding bands and our quality and attention to detail means you get the best value. Shop online or visit our store for a larger selection and personal touch. Don't see what you're looking for? We would love to custom design the perfect piece for you.


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The St. Paul Chamber Orchestra's musicians and management have tentatively settled one of the stickiest labor disputes of the musical world this season, a conflict that has caused the cancellation of concerts since October.
Dobson West, the orchestra's board president and chairman, said on Wednesday that negotiators for both sides had agreed to a contract except for broadcast and recording rights. Once that final issue is resolved the contract can go before the musicians for ratification, he said.
Logistics still need to be worked out, but the goal is to return to performances "as soon as possible," he said. Concerts have been canceled through April 21, with the next scheduled performance on April 25. The St. Paul Chamber Orchestra is one of the leading groups of its kind in the country, and about seven weeks of the season remain.
"We are excited to return to the stage as quickly as possible," Carole Mason-Smith, the co-chair of the musicians' negotiating committee, said. One difficulty in planning for a resumption of performances is that some orchestra members have taken up temporary jobs with other ensembles, Mr. West said.
The tentative contract calls for an 18.6 percent cut in annual guaranteed salary, which will become $60,000; a guarantee that extra pay negotiated on an individual basis will not be cut more than 20 percent; reduction in the number of players to 28 from 34; and better retirement benefits. The old contract expired Sept. 30 and the musicians were locked out on Oct. 21.
Mr. West said that credit in helping break the impasse should go to St. Paul's mayor, Chris Coleman, who pushed both sides to reach an agreement; his efforts included an eight-hour session of shuttling between the sides at City Hall last month.
The Twin Cities' other major orchestra, the Minnesota Orchestra, remains idle because of its own labor dispute.


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ex out(redirected from ex'd me out)
ex out
To draw an ex (X) or series of exes over some written word or name so as to designate its removal or need to be disregarded. A noun or pronoun can be used between "ex" and "out." A: "Why is Amy's name exed out?" B: "Because she's not coming on the field trip anymore." Just ex out all of the words that you feel need to be deleted in the next draft.


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Coughton Court - National Trust
Coughton Court is a beautiful Tudor house set in 25 acres of landscaped gardens in Alcester, Warwickshire. Through its rich and varied history, the house has witnessed some of the most defining moments in British history – from the court of Henry VIII to the Gunpowder plot of 1605.
The grounds of Coughton Court are managed by the family, while the house is currently managed by the National Trust. Clare McLaren-Throckmorton inherited the estate in 1992 and, together with her daughter, garden designer Christina Williams, has devoted the past 17 years to developing what is now one of the finest gardens in Britain.
Venue Type:
Historic house or home, Garden, parklands or rural site
Please check the National Trust website before visiting.
Adult House & Gardens £9.70
Child (under 16) House & Gardens £4.90 (under 5's free)
Family (2+2) House & Gardens £24.50
Adult Gardens Only* £6.50
Child (under 16) Gardens Only* £3.25 (under 5's free)
Family (2+2) Gardens only* £16.25
Groups House & Gardens £8
Groups Gardens Only* £5.50
*Nominal charge may apply for Walled Garden.
National Trust members - Free Admission to House and Grounds with valid membership cards.
- National Trust
Coughton Court - National Trust
National Trust
Coughton Court


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The death penalty may retake center stage in California, courtesy State Senator Loni Hancock who says she wants to ban it entirely, and soon.
Calling capital punishment "an expensive failure," Hancock said she will introduce legislation next week to abolish it.
The bill would convert existing death sentences to life without the possibility of parole.
U.S. & World
Hancock's legislation is timed to coincide with the release of a Los Angeles Law Review report that puts the cost of maintaining death row for its 714 inmates at $184 million a year.
The total cost through 2030 is estimated at $5 billion.
The report will be published next week, but Hancock and others have already had a peek.
Hancock's legislation would require approval by voters if it passes the Legislature.
Taxpayers have paid $4 billion for the 13 executions performed since 1978, according to the report, putting the cost of each execution at $308 million.
Despite the cost, victims' advocate Marc Klaas said he disagrees with Hancock's plan.
Klaas' daughter Polly was kidnapped from her bedroom during a slumber party in 1993. Her case became a lightening rod for stricter sentencing, which led to California's Three Strikes law.
The case did not impact the state's death penalty laws. Richard Allen Davis was found guilty of murdering Klaas and was sentenced to death in 1996. He remains on death row.
"There's a guy who kidnapped raped and murdered my 12-year-old daughter who was sentenced to death per the laws of California and now there are people who are working to make laws to spare his life," Klaas said. "It's just absolutely unbelievable."


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Opened December 3, 1915 and had 1,200 seats. Operated by Landmark Theatres since 1989. It was twinned in 1990.
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Just like with any profession, there are pros and cons to being a doctor. You have to take the good with the bad. However, it's especially important for those considering a career in the medical industry to be mindful of what those pros and cons are. And for patients, it helps knowing all of the challenges faced by top doctors on a regular basis – this gives us a better idea of the appreciation and respect we should all have for our doctors.
Let's take a look at some of the best and worst parts of a top doctor's job, below:
Best part: You get to help people get better
Health is a valuable, fragile part of life. Without our health, we can't live. Knowing the positive impact a top doctor can have on patient's life by helping them fight a disease, or cure an illness, or even prevent an illness altogether, makes the job worthwhile. There's something special about knowing your job means more than a paycheck – it means helping people.
Worst part: Sometimes there's nothing you can do to help people get better
On the flip side, sometimes doctors run out of options for helping people overcome a serious illness, like cancer or heart disease. This is emotionally devastating – doctors are people and have hearts too. They don't want to see their patients in pain or losing their lives to cruel circumstances. Unfortunately, this comes with the job of being a top doctor.
Best part: Physicians make decent incomes
Being a doctor is a job, and people have jobs to earn a living. This is a given. However, it helps to know that most physicians are compensated well. According to Forbes, the average income for a primary care doctor (family doctors, internists and pediatricians) was about $220,942 in 2013. This is just one example of an income for a top doctor, as salaries can vary per specialty.
Worst part: Malpractice insurance
In recent years, more and more patients are blaming doctors for the death of their loved ones instead of fate, like they often did in the past. No matter how careful a doctor may be, they may find themselves dealing with legal battles for the right to continue practicing medicine. Doctors aren't perfect, and rising malpractice costs are one of the worst parts about being a doctor.
Best part: Relationships with patients
Top doctors aren't just random people seen by patients every few years – they're true partners in the health of their patients. They get to know their patients and their medical history well. There is a sense of comfort and trust among good doctor and patient relationships. This is a great benefit to being a physician, since positive relationships at work can make a job more fulfilling.
Worst part: Relationships with patients
You may be wondering, how can this be a pro AND a con? The answer is simple: not all patients are respectful and appreciative towards their doctors. That's when this can become a downfall to being a physician – a lack of respect at the workplace is extremely taxing. This can weigh heavily on top doctors who just want help.
Overall, there are good and bad components to being a top doctor. However, most doctors will say that the good outweighs the bad. Learn more about the importance of choosing a top doctor for yourself and your loved ones today.


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Updated Toxic Substances Control Act Back in Action
Updated Toxic Substances Control Act Back in ActionMillions of parents around the U.S. are becoming aware of the dangers of toxic chemicals in our homes and in the environment. They've taken steps to eliminate them: They buy organic crib mattresses, outfit their baby's nursery with non-toxic furniture and décor, use non-toxic cleaning supplies, wear clothing made with natural fibers, use air purifiers, eat organic food, and so on. But we're all still waiting for the federal government to step up to the plate and update the Toxic Substances Control Act to help give us the protection we need.
Although the Toxic Substances Control Act has been on the books since 1976, the way it's written makes it virtually impossible for anything to be done when goods made with toxic chemicals enter the marketplace. In fact, about 80,000 new chemicals have been created and introduced to our daily lives since 1976 and only about 200 have been tested for safety and only a handful have been restricted.
Last fall, an updated Toxic Substances Control Act was introduced to congress by New Jersey's Senator Frank Lautenberg. Check out Sen. Lautenberg's video about the bill. It did not pass at the time, but has just been reintroduced.
There is an abundance of scientific evidence linking toxic chemicals to health problems. Study results have been clear enough to warrant 18 states passing their own laws. Also, hundreds of thousands of businesses now offer non-toxic alternatives. Almost every major grocery store chain now carries non-toxic cleaning supplies, for example, and some corporations, like Walmart, have even taken it as far as banning products with specific, very commonly used but dangerous chemicals from their shelves.
The American Sustainable Business Council (ASBC) is just one group of supporters. It represents more than 70,000 businesses – Naturepedic is among them.
Our founder – also a grandfather, concerned citizen and environmental engineer - Barry A. Cik, was quoted by the ASBC in a recent news release:
"I saw Lake Erie die and then observed how the Resource Conservation and Recovery Act of 1976 helped bring it back to life," he said. "Our company was created to help stop the rampant misuse of chemicals. Naturepedic is determined to give babies and their families an alternative free of questionable chemicals. There are very few, if any, responsibilities that we have that are more important than providing a safe environment for our children. Naturepedic is asking Congress and the American public to level the playing field for businesses and make sure that all babies and children are provided with safe and healthy products free of questionable chemicals by passing this needed legislation."
With 18 states having their own laws in place – although they don't cover all the bases by a long shot – and hundreds of thousands of companies offering non-toxic goods, you can have a close to toxic-free household with little effort. But the new Toxic Substances Control Act will give us more choices and make it easier to get what we need to help ensure the health of our children, ourselves, and our environment.
To summarize the new law, called the Safe Chemicals Act of 2011, we would see the following changes:
- The Environmental Protection Agency (EPA) would be required to identify and restrict the "worst of the worst" chemicals, those that persist and build up in the food chain.
- Any product containing chemicals and being introduced to the marketplace, or continuing to be available, would be required to first supply basic health and safety information.
- Scientific methods for testing and evaluating chemicals would be upgraded to reflect best practices called for by the National Academy of Sciences.
- Generally provide EPA with the tools and resources it needs to identify and address chemicals posing health and environmental concerns.
If you would like to support the Safe Chemicals Act of 2011, call your congressman and let him know how you feel.


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Salty getting acclimated to NL pitchers
MIAMI -- Adapting to a new pitching staff was Jarrod Saltalamacchia's first priority after signing as a free agent with the Marlins. Familiarizing himself to the National League was next.
The Marlins catcher is starting to do just that. After a couple of rough days at the plate to open the season, the 28-year-old is finding his stride, evident by his 4-for-8 showings with two doubles in the first two games of the series against the Padres.
"The first few games, I was kind of searching," Saltalamacchia said. "I don't know these pitchers too well. So I was taking some pitches maybe I should have been swinging at. I'm getting more familiar with these guys and starting to feel more comfortable at the plate."
Saltalamacchia was the Marlins' major offseason acquisition. A switch-hitter entering his prime, Saltalamacchia gave the organization immediate credibility. He brings championship experience, coming off a World Series campaign in Boston.
But changing from the American League to the NL while learning a new pitching staff is an adjustment. Making his transition easier is the fact the Marlins' offense has responded early, providing plenty of run production. Thus far, Giancarlo Stanton and Casey McGehee have been major contributors.
"The way the offense has been swinging, I don't have to do too much except put fingers down," Saltalamacchia said, referring to calling pitches from behind the plate.
A year ago, with mostly rookies and inexperienced players, the Marlins ranked last in the Majors in runs scored.
Saltalamacchia sees a much more polished team in Miami this year. And he credits the front office for targeting proven veterans to help guide a young nucleus.
"Like I said in Spring Training, you had guys who were in Double-A coming up for the first time last year," Saltalamacchia said. "It's tough to figure things out at the big leagues.
"They did a great job bringing some veteran guys in who have experience, and they have an approach at the plate. They can kind of help everybody out. And the pitching staff has been doing a phenomenal job to help us stay in the game."


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into New Mexico, border control found more than they bargained for. According
to the Associated Press, in addition to a truckload of hot red peppers, they
also discovered a drunken stowaway and a bottle of tequila. A resident of
Mexico, the man had hopped aboard the chile truck in an attempt to get to Chicago.
However he didn't make it very far as the truck's unusual load was discovered
only 100 yards into the state of New Mexico.
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Day after day, Hazel Eng sat on her couch, a blank stare on her face. The powerful antipsychotics she was taking often cloaked her in sedation. And when they didn't, the 89-year-old lashed out at her nursing home's aides with such anger and frequency her daughter wondered if her mother would be better off dead.
Until, in a matter of days, everything seemed to change.
Eng's daughter, Jean Lynch, says her mother was moved to a different section of the Ecumen home in North Branch, Minn., and taken off every drug but her daily aspirin. She now beams as she ambles the hallways, reads the newspaper, tells stories and constantly laughs.
"Now I hope she lives till she's 200 years old," Lynch said. "She's just so happy."
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Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive and paranoid behavior related to dementia.
The drugs can limit seniors' ability to effectively communicate, socialize or participate in everyday life. But a series of warnings has prompted a movement of nursing homes trying to reduce the decades-old practice, often resulting in remarkably positive changes.
Still, doctors say the drugs are sometimes the only things that help the small number of dementia patients that display psychotic behavior, making them a danger to themselves and others.
Ecumen's three-year-old program called "Awakenings" isn't just about reducing drugs. Personalized care plans use exercise, aromatherapy, pets and other methods. Patients who were sedated and detached are now playing video games, listening to music and playing balloon volleyball.
"It was quiet before but now it's not," said Eva Lanigan, a nurse who piloted Ecumen's program. "Life is going on here again."
A government audit released in May looked at Medicare payments for atypical antipsychotics, as a newer class of the drugs is known, and found in a six-month period that was analyzed in 2007, about one in seven nursing home patients aged 65 or older had been prescribed them. Some 83 percent of Medicare claims for such drugs were for off-label purposes such as dementia, the audit found.
Since 2005, atypical antipsychotics have been under an FDA warning alerting doctors they could increase the risk of death in patients with dementia due to heart attacks or pneumonia. The most common atypical antipsychotics are sold under the brand names Risperdal, Zyprexa, Seroquel, Geodon, Abilify and Invega.
An older class of the drugs, known as typical antipsychotics, was added to the FDA warning three years later.
The warnings did not apply to other medicines widely used in nursing homes, such as the antidepressants Prozac and Paxil, and the anti-anxiety medicines Xanax and Valium.
Still, off-label use of antipsychotics has continued to be widespread. Some see it as a crutch, used to quiet seniors' outbursts or mask difficult personalities, though many others say it's the only pharmaceutical option to treat a patient with a cadre of behavioral problems.
"Give someone enough medications, you don't have to worry about them wandering around or cursing or fighting," said Dr. Karl Dhana, medical director at MorseLife, which operates a nursing home in West Palm Beach, Fla.
For several years, MorseLife has done quarterly reviews of any patient on an antipsychotic, antidepressant or sedative to see if such medication is necessary. At the start, around a quarter of patients were on such drugs. Dhana said the rate is now around 14 percent.
But the shift hasn't been without challenges. There are no FDA-approved drugs for behavioral problems related to dementia. Nursing home patients today are often sicker and showing more signs of behavior problems than in years past.
Dr. Jason Karlawish, a fellow at the University of Pennsylvania's Institute on Aging, said he uses antipsychotics in only about 5 percent of his dementia patients. But sometimes they're the only thing that helps, such as with a woman he treated who was showing clear signs of psychoses, convinced that her house was on fire.
She attacked caregivers, tore pictures off the wall, wouldn't eat or be bathed. When she was put on an antipsychotic, the symptoms subsided, Karlawish said.
"There is a role for these drugs," he said.
Cobble Hill Health Center, a Brooklyn nursing home, began a program several years back to reduce such drugs, but the home's medical director, Dr. Louis Mudannayake still remembers the doomsday prediction of one nurse.
"She said, 'Lou, you're crazy! We're going to have all the patients stripping," he recalled.
Cobble Hill has cut the number of patients on antipsychotics from about 30 percent to less than 15 percent, and the nurse's predictions never came true. The staff has learned to help patients avoid outbursts without pills. The solution is often simple: Asking before entering a room, serving a meal earlier or putting on a favorite Nat King Cole album.
Private "old age homes" began cropping up after Social Security was established in 1935 and by the 1950s, antipsychotic drugs were commonplace and remained so for decades. Some estimated as many as 85 percent of nursing home patients were being given antipsychotics before the Nursing Home Reform Law was passed in 1987.
The use of such drugs was reduced — by around one-third, by some estimates — after the law, but then began to increase again once new antipsychotics were introduced in the 1990s.
The FDA's warning on the drugs led to nursing homes again rethinking their use of antipsychotics. Dr. Izchak Kohen, a geriatric psychiatrist for North Shore-Long Island Jewish Health System, surveyed nursing homes across the country and found 39.1 percent had decreased their use of the drugs since the warning.
Spending by Medicaid — the largest payer of nursing home care in the U.S. — also indicates a shift. For all age groups, in the 2006 fiscal year, antipsychotics drug bills totaled about $7.9 billion for Medicaid. The following year, it dropped to about $4.9 billion. Spending in 2008, the latest year for which data is available, totaled about $3.7 billion.
However, the increasing use of generics may have also helped bring the dollar figure down. The addition of the Medicare prescription drug program, for which some Medicaid patients are also eligible, is also believed to have drawn down the spending figure.
It may be difficult to reduce the use of antipsychotics further, Kohen said, because there aren't alternative drugs. Kohen said he continues to have to prescribe the drugs in certain cases, particularly for elderly dementia patients who are paranoid or aggressive.
"Until we come up with better treatments, I think we're going to have to use them," he said.
Nicole Brandt, a pharmacist who teaches geriatric pharmacotherapy at the University of Maryland and has lectured on antipsychotic use, said low doses of the drugs can sometimes help a dementia patient who is agitated, delusional or hallucinating. But sometimes, she said the drugs are used to treat anxiety, depression or sleep problems, for which they're not helpful.
"There are times when you have to wonder if an antipsychotic is the best treatment," Brandt said. "There may be a safer alternative."
Eng, a retired department store worker with advanced Alzheimer's disease, continues to thrive without the drugs, her daughter says. Teeth grinding that started when she was on the medications, has gone away, and she's again able to feed herself finger foods.
More than anything, though, Lynch says she can tell her mother is happy again. She sees it in her face.
Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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IPCC probes alleged Milly Dowler/NotW leak
Independent investigation is go
The Independent Police Complaints Commission has opened an investigation into allegations that a Surrey cop leaked information about the probe into Milly Dowler's murder in 2002 to the News of the World.
"An IPCC Deputy Senior Investigator has been over at Surrey Police this morning to get more information about the case and will be writing to the Dowlers' solicitor at the family's request," said the Commission in a statement issued this afternoon.
"Until we have shared further detail with him it would not be appropriate for us to make it public."
The IPCC said it had received a voluntary referral from Surrey Police about the allegation.
Thirteen-year-old Milly Dowler was murdered in 2002, after disappearing from school in Walton-on-Thames, Surrey.
Levi Bellfield, a doorman, was convicted of her murder in June this year.
News International-owned Sunday tabloid News of the World was closed down for good last month, after its company was swamped with allegations of widespread illegal phone-tapping at the paper. ®
Sponsored: Practical tips for Office 365 tenant-to-tenant migration


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Mozambique is located on the east coast of Africa. Pristine beaches line the 2500 km of Indian Ocean coastline, dotted with enticing tropical islands beckoning intrepid explorers. Apart from the cities and larger towns, Mozambique remains an untouched wilderness; travelling in Mozambique entails leaving your watch behind, and experiencing the beauty of the bush and the beach at a leisurely pace and with a certain degree of 'paciência'.
Mozambique has a diverse culture, with reflections of Arabic, African, Indian and Portuguese influences evident throughout the main cities and towns in the magnificent and often dilapidated buildings, the colourful attire, the elaborate carvings, and the various religions that live together in harmony. Traces of the civil war are still evident, but Mozambique is surging on and is now seizing the opportunity to show off its natural wonders to the rest of the world, with Maputo setting the trend by becoming an upbeat and vibrant city.
Mozambique's waters boast world-class scuba diving sites from the islands of the Quirimbas and Bazaruto Archipelagos, to Ponta do Ouro in the south, with coveted sightings of humpback whales, dolphins, whale sharks, manta rays and green sea turtles. Mozambique is becoming an increasingly popular destination for serious game fishing, whale watching, island hopping, dhow sailing and also kite-surfing. Combine the marine wilderness with a fascinating and cultural visit to the famous World Heritage site of Ilha de Mocambique or the deserted streets of Ibo Island, a safari in Gorongosa National Park, or the Niassa Reserve – truly breathtaking countryside studded with inselbergs and a wide range of indigenous flora and fauna.
Let us tailor an itinerary to your specific interests so that you can experience the best that Mozambique has to offer on your holiday, whether it be scuba diving, beaches and other watersports at Inhambane, Tofo, Vilanculos, Nacala or Pemba; or off the beaten track of phenomenally beautiful Lake Niassa. There is something for everyone!
Mozambique is bordered by the Indian Ocean to the east, Swaziland and South Africa to the southwest, Zimbabwe to the west, Malawi & Zambia to the northwest and Tanzania to the north.
LAM (Linhas Aéreas de Moçambique) is the only airline that operates domestically within Mozambique and flies regionally to Johannesburg, Luanda, Dar-es-salaam and Nairobi and also code shares with TAP to Lisbon. Other international airlines flying in to Mozambique are Airlink from Johannesburg, Ethiopian Airlines from Addis Ababa, and Kenya Airways from Nairobi.
Mozambique can also be accessed by road from all bordering countries. If you are driving from Tanzania you have to get your visa in Dar-es-Salaam or you will not be allowed into the country.
Kaskazini recommends:
Vamizi, one of the most northerly of the Quirimba islands, is simply in a class of its own.
Coral Lodge is quite simply, fabulous and only 15 minutes by boat from Ilha de Mozambique.


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Worried about the Republican tax overhaul's potentially negative effects on local finances, Democrats in high-tax states such as New York and California are looking for ways around the new $10,000 cap on state and local tax deductions. Ben Casselman of The New York Times reviewed some of the options state-level politicians are considering:
- Replace state income taxes with payroll taxes on employers, who would reduce worker pay by the same amount while gaining a big write-off
- Replace state income taxes with charitable deductions to state governments, which are deductible. The donations would count against state taxes owed
- Challenge the constitutionality of the new limits on state and local tax deductions.
These ideas would have seemed far-fetched just a few months ago, Casselman notes, but political leaders in high-tax states feel like they have been targeted and are worried about the long-term consequences of the new rules. New York Gov. Andrew Cuomo said last week, "They want to target us for certain provisions? Well, let's see if we can redesign our tax code to get out of the federal trap that they set."
Whatever steps they end up taking, there's no doubt that state and local governments are worried that the new federal tax rules will create increased pressure to reduce taxes, which in turn will force a reduction in public spending on education, health care and infrastructure. Of course, this is exactly the outcome many Republicans from low-tax states may be looking for. But they may not get quite what they want. One alternative some states could turn as they seek new sources of revenue: legalizing marijuana sales in order to apply new taxes.


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This was published 7 years ago
Weighing price of gun freedom
IT IS easy to get lost in the numbers. In Connecticut on Friday, 20 primary school children and five staff were shot dead by a man with a military-style rifle.
So far this year, more than 140 people have been killed or injured in mass shootings in the United States. There have been 70 mass shootings in America between 1982 and 2012, and of those seven occurred this year.
According to an analysis by the New Republic, 45 per cent of those killed in mass shootings in the past 30 years were killed since 2007.
But these numbers don't tell the story. Each year nearly 100,000 people are wounded or killed by gunfire in America and according to the Brady Campaign to Prevent Gun Violence, a million have been killed since the assassinations of Martin Luther King and Robert Kennedy in 1968.
Despite the carnage, the gun lobby has never appeared more powerful. The day before the shootings here in Newtown, politicians in Michigan ignored the protests of their school boards to pass a law allowing people to carry concealed weapons in schools.
Now that even the most basic background check regulations have been neutered by the exemptions granted to purchase made at gun shows - where by some estimates 40 per cent of guns are sold - the gun lobby is concentrating on expanding ''concealed carry'' rights.
At some level, then, America and its leaders have decided that this level of bloodshed is a fair price to pay for the defence of the second amendment right to bear arms.
But it was not always this way. After the assassinations of 1968, governments across the nation began introducing restrictions on gun sales and ownership. Even the National Rifle Association's leadership was co-operating with governments to help restrict the flood of cheap handguns into the inner cities.
That changed in 1977, when a group of hardliners staged a coup and replaced the entire NRA leadership overnight. Suddenly an organisation that was once concerned with safety training and recreational shooting became a fierce single-minded lobby dedicated to defending the Second Amendment.
By the 1990s, the group was so powerful that Bill Clinton declared in his memoir that ''the NRA was an unforgiving master: one strike and you're out. The gun lobby claimed to have defeated 19 of the 24 members on its hit list … and could rightly claim to have made [Newt] Gingrich the House Speaker.''
Today, America's political right can rely on the NRA to provide it with a rump of single-issue voters easily scared up to vote against Democrats. In turn Democrats are mute.
In courts across America, where benches are still replete with conservative appointees of the Bush administration, the literal interpretation of the Constitution remains in vogue.
Despite all this, a survey conducted just after a gunman killed 12 people at a movie theatre in Aurora, Colorado, by the Pew Research Centre (which has tracked attitudes to gun ownership for 20 years) found that 47 per cent said it was more important to control gun ownership, while 46 per cent said it was more important to protect the rights of Americans to own guns.
The abject horror of this most recent massacre could shift the balance even further towards gun control.
In his address on Saturday, Barack Obama declared the time had come for ''meaningful action''. It is the strongest language he has used on the issue during his presidency.
He plans to spend Sunday night with victims' families - it will be hard for him to duck the issue now.
Obama's comment has spurred the usual pro- and anti-gun debate here. Some of the arguments are tired, some are preposterous - if only the teachers were armed - and some make grim sense. It is a fair point to make that given there are 300 million guns in America today, it could be too late to try to control them.
Either way, Newtown's grief cannot be ignored.
Now it is for Americans to decide whether the literal interpretation of the Second Amendment - and the occasionally fanatical defence it engenders - is worth the price in blood the nation is paying.


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U.S. celebrates news of bin Laden's death
President Obama announced tonight that al Qaeda's former leader was killed after a firefight with Navy Seals. He confirmed Internet rumors that Osama bin Laden's body was in U.S. possession. Many Americans are rejoicing, especially at Ground Zero.
The president said killing bin Laden was among his first directives:
" ... Shortly after taking office, I directed Leon Panetta, the director of the CIA, to make the killing or capture of bin Laden the top priority of our war against al Qaeda, even as we continued our broader efforts to disrupt, dismantle and defeat his network."
And he reminded viewers that the United States is not at war with Islam:
"I've made clear, just as President Bush did shortly after 9/11, that our war is not against Islam. Bin Laden was not a Muslim leader; he was a mass murderer of Muslims. Indeed, al Qaeda has slaughtered scores of Muslims in many countries, including our own."
If you missed it, the full text of the president's speech is online.
Meet the man who may be in charge: Bin Laden's second in command, Ayman al-Zawahri, is a surgeon who was born in Egypt.
Bill Moyers wrote up a quick rundown of al Qaeda's history. A few outlets are carrying bin Laden's obit.
President Bush, other Republican politicians and notables from around the world react.