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Scooped by
Martin (Marty) Smith
onto Curation Revolution |
Sometimes the proximity of things you write creates a new idea. Two recent ScenttTrail Marketing posts got smashed up today:
The New Altruism: Wright, Shermer and Benkler
Why Internet Marketing Must Disrupt To Win
These recent posts got me thinking (always dangerous lol). What if we can use Altruism as a disruptive force?
Pepsi achieve disruption in the Cola Wars with the magical User Generated Content platform Pepsi refresh (see this great AdAge summary and infographic for more http://adage.com/article/viewpoint/a-teaching-moment-professors-evaluate-pepsi-refresh-project/237629/ ).
MasterCard is disrupting my TV time with the weird guy singing about standing up to cancer (http://mastercard.standup2cancer.org/ ) and nonprofits are becoming disruptive as RobinHood.org and ChairityWater.org prove.
Can Altruism Disrupt?
Altruism may be the ONLY marketing act sure to disrupt from now to the end of time. Sure Altruism has HUGE proponents in Google and Facebook, but as Benkler discussed in the video included in my The New Altruism post PAPA GOT A BRAND NEW BAG.
I've been wondering why we seem to have suddenly made this turn toward altruism when Benkler explained it so beautifully. This trend isn't a turn, a tune or a change. The majority of people, like 70%, have always wanted a fair expression of altruism in their lives.
We assumed, and you know what happens when we Internet marketers do that, everyone was the 30% of self-interested pirates. Benkler makes the same point as Gladwell in Tipping Point. Given the right context we jump the turnstile, we break the window, we join the 30%.
We are NOT all one thing or another ever. We are a strange mix of all kinds of things. Art, science, anger, love and magician and bully are present and, given the right circumstance, will visit and sometimes make it feel like we are THAT or THIS.
Not so much as it turns out. Perhaps I have unique perspective on the question of who I am. In quick succession I lost my role in the company I co-founded, the love of my life and heard "cancer" and my name in the same sentence. Tough couple of years taught me some HARD things about ME. I can be an ASS and a kind, loving, generous person sometimes in the same day, hour, minute (lol).
Pema Chodron taught me to forgive and Eckhart Tolle taught me to live in this moment, the one happening NOW. Both these great teachers help create the complex self Benkler discusses.
Perhaps this self-awareness is why DISRUPTION is so important. A company, brand or product willing to disrupt is unsure, acting in the NOW with courage. They may FAIL, some believe Pepsi did, or they may just create a new less selfish and more connected future.
I may not get to that future with you or your children, but it is coming and I will spend every dime I've ever saved and every moment I have to help altruism DISRUPT because life is short, magical and full of joy. Why wouldn't we share such a disruptive message?
What about you? What have you disrupted or been good to lately? Share your experience with Altruisim or cause marketing and I will curate in. Thanks, you ROCK. Marty
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REI.com & Williams-Sonoma.com win first Holiday Ecommies. L.L. Bean wins most improved from November to December. Delete the scoop?
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Fires happen to every website no matter how careful their overseers. Fires destroy value. Today's fires are complex and intertwined requiring specialized cross functional teams to extinguish called Hellfighters. Delete the scoop?
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Oreo kicked off the year with a brilliant, impromptu online ad during the Super Bowl, the success of which inspired countless other real-time marketing campaigns, many of which fell short Tech companies like Samsung and Google aired clever commercials... Via Brian Yanish - MarketingHits.com
Martin (Marty) Smith's insight:
Great examples to emulate and avoid here. Love Dov'e beauty sketches and "dunk in the dark" by Oreo. Delete the scoop?
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Here are the content marketing tips for #startups and #smbs shared in this post: 2. Support great posts about you by writing about them. 3. Don't SELL, CURATE instead. 4. Create content with an eye toward what you want. 5. Tools matter. Delete the scoop?
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Sharing Our Secrets
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Can a soda machine teach important Intenret markeitng lessons? Yep, the brilliant Coke Feestyle machine is a stduy in Lego-like building simple, adding touch so even complex things feel easy and the "appification" of everything.
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One of the top 5 ScentTrail posts of all time asks a simple question, do you need an Internet marketing degree. My thought when I wrote this piece was NO since classrooms can't keep up with the speed of Internet marketing innovation. If anyone has attended helpful classroom instruction in Internet marketing let me know and I will curate into the post. Delete the scoop?
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Great Conent Marketing * Cause marketing, since it is highly emotional, generates great social shares and links. That last bullet may be a little "trust me" for some, but trust me ANYTHING you do now must be supported by content marketing OR your assets will be stolen and/or be worth less. Delete the scoop?
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Selling Everything For Story of Cancer Foundation Delete the scoop?
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G+ Most Disruptive & Great Resource List fromDustin Stout Delete the scoop?
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SEO Infographic based on the market research is showing that 93 % of consumers use search engines to look for something and then visit these websites. Via massimo facchinetti
Martin (Marty) Smith's insight:
Got into a controversy over the weekend about how SEO is or isn't dead (http://scenttrail.blogspot.com/2013/11/death-of-seo-controversy.html ). Let's leave that controvery as settled and understnd that telling Google or any search engine what your branded web pages are about is and will always be important. Delete the scoop?
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Online Audience Optimization 1. Focus on the brand 2. Be consistent and clear about your strategy and purpose, 3. Cast a wide net 4. At the same time, cast a targeted net. 5. Encourage audience participation 6. Employ engagement mechanics and gamification techniques. 7. Integrate your mobile strategy 8. Don't obsess about keyword density 9. De-emphasize metatagging
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Even brand powerhouses like Marty's old employers M&M's, P&G must realize what happens online today is most important product in a digital first world.
Martin (Marty) Smith's insight:
After scooping a Neil Ferree post about lawyers needing to accept content and social marketing I realized my 2008 Infinite Inventory, Moore's Law, Saving Ford ScentTrail Marketing post didn't go near far enough. Neil's post made me smile because if lawyers, traditionally the antelope at our Internet marketing waterhole, are beginning to understand the need for content marketing supported by social media surely the 7th sign is here. Better stock up on canned goods, water and plenty of content and social media marketing if we want to survive :). Delete the scoop?
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lorrinda's curator insight,
November 7, 4:22 AM
"If your online presence isn't as great as your real world experience a slow decay will rot your brand's foundation" --having a strong digital footprint is critical |
Here are 5 Quick and Easy Content Marketing Tips for Small To Medium Sized Businesses: Delete the scoop?
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When the lit match of gamificaiton hits the exposed jet fuel of crowdfunding both will feed speed, scale and intelligence into the other. I've read the Forrester report that predicts 80% gamification failure by 2015 and have two thoughts. 2. That means 20% are going to win BIG, very big. Delete the scoop?
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Ferananda's comment,
December 7, 5:14 PM
We have began to see this with crowdrise as it integrates some mechanics, yet not interesting dynamics. What is the platform you see its approaching to this model the most?
Martin (Marty) Smith's comment,
December 7, 11:30 PM
Great question Fernanda. I see product development as the most likely "killer app" for ecom merchants. Quiry-like product development boards cost nothing, will generate tons of social buzz and help keep merchants in touch with new product trends and great developers. Versions of this "outsourcing R&D" is already happening at P&G and other companies. P&G is particularly interesting because when I worked there in the 1980s there was NOTHING they were more proud of than their ability to create products. When they discovered "more than a million" R&D experts around the world "at least as good as" their internal teams they began to share previously unimaginable secrets.
Working hard on a SaaS set of publishing tools and was analyzing what it takes to "cross the chasm" from unknown SaaS to successful, well loved tool. Here is what I found: Delete the scoop?
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Internet Marketing Start Here Delete the scoop?
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Scooped by Martin (Marty) Smith |
Cause marketing is popular, but is easy to do BADLY. This post outlines how Cause Marketing when added to a diversified Internet Marketing portfolio helps create a new and better form of "advertising" and the post includes a link to our new CauseMarketingBecause.com website.
Atlantic BT BLog Post
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Scooped by Martin (Marty) Smith |
How can content create Dylan's sense of space? How can stories confuse, thrill and teach? What your content's tone? Confident? Fun? Mysterious? Kind? Are words music? Do they sing off the page?
Wait before you roll eyes and click away. Why create content? Writing is an intimate act, a share between siblings, a whisper in an early quiet dawn. Great content is calm. We read or listen because we must.
Tangled Up In Blue.
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Rescooped by Martin (Marty) Smith from SEO 101 for Marketers |
While infographics are touted by some as wonderful examples of making information accessible, in today's Whiteboard Friday, Rand shows us a very different view of them, making the case for using individual visual assets instead.
Great Rand Fishkinn Whiteboard Friday on why your marketing should think in terms of "visual assets" not infogrpahics.
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Great VIDEO on INFOGRAPHICS. I agree 100% with Rand. I think infographics are mostly worthliess.
As an alternative, he recommends photos, charts/graphics, concept representations, comic/storyboards, and screenshots with explanations.
If you like this scoop, please consider a thumbs up or share.
Scooped by Martin (Marty) Smith |
Back in the stone age (2005), a talented search optimization agency could rank any page for any term if given enough resources. In fact, that's still the case, but you need even more resources and the results last a lot less time.
My conentin is my friend Phil Buckley's great Content Is The New SEO post on Scoopiteer Jan Gordon's new and very exciting http://www.Curatti.com Editors of Chaos website is NOT crushing my Curation is Disruptive post (http://bit.ly/1aS8m4p )
These two posts form a complimentary diptych is my story, so no crushing here (lol). Honestly if you haven't explored Jan's new website you shuld if for no other reason than to see the CRUSHING one brother is giving another :). Marty
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Scooped by Martin (Marty) Smith |
CrowdFunde Helps Ecommerce Merchants Tap Crowd Wisdom to "Test Before They test". Ecommerce merchants test everything all the time. Problem is testing costs money and time.
CrowdFunde is a new tool created to help ecommerce teams "test before they test". Testing everything from promotions to capital formation helps lower costs and increase profits.
CrowdFunde is brand new. Sign up for our mailing list if you are interested in lowering your website's risks and increasing your profits.
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Scooped by Martin (Marty) Smith |
One of the best Scoop.it curators, Jan Gordon, launched Curatti.com Editors of Chaos today. Jan's laudable mission is to increase relevance and knowledge while decreasing spam and the mount of info we all attempt to wrestle to the ground daily. Go Jan Go!
Great mission, great curators, writes and editors of chaos mean Curatti will quickly become an indispensible tool to separate wheat from chafe.
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Rescooped by Martin (Marty) Smith from MarketingHits |
When visual analytics platform Curalate set out to quantify the impact that different image qualities have on Instagram, it discovered that photos with blue as the main color got the most likes. Reds and oranges on the other hand tended to receive 24 percent less likes than blue-tinted shots.
Neither the clear and overwhelming impact COLOR plays online nor blue winning surprises me, but it does suggest taking more pictures on bright Carolina Blue days than not.
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Colour and Photographs, an interesting find by thenextweb.com
El azul en tus fotos de Instagram hace que tengas más "me gusta" según un estudio. Muy interesante!


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Scott Thompson at San Diego Comic Con 2010- Danny Husk graphic novel
Media Junkyard Canadian Correspondent, Alirio, talks with comedian Scott Thompson (Kids in the Hall) about his new graphic novel series based on his character Danny Husk. Also, lots of Canadian stuff and…glory holes? Check out Part 2 HERE.
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subset: commoncrawl


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The whole brogue boot/Sherlock-Chic look has been with us for a few winters but it hasn't quite had the overkill like the standard brogue. The brogue boot still looks very neat and Victorian and the Edward Green ones for Hardy Amies are the best; you can almost touch the quality in the picture. ASOS, as always, have a great option for an unbelievable price.
See StreetGeek - how to wear - Click here
Edward Green for Hardy Amies - Shannon Brogue Boots - £855
ASOS - Brogue Boot - £55


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Group Visit Info |
GROUP VISITS: Groups of 10 or more can make an appointment for a garden tour ($2 per person), a box lunch or supper ($8.50 per person), a workshop (see listing & price) or a presentation (45 min plus questions, $50). Deposits are required for presentations, pre-payment required for box lunches and workshops. |


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My FOX
MyFox Spokane BIZ
$$ Deals
Fox28 Blog
FOX 28 Primetime
Almost Human
Brooklyn Nine Nine
New Girl
Raising Hope
Sleepy Hollow
The Mindy Project
The X Factor
Animation Domination
Animation Domination HD
American Dad
Bob's Burgers
Family Guy
The Simpsons
Comedy Block
The Big Bang Theory
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Two and a Half Men
FOX 28 Fullguide
Advertising Staff
Antenna Set-up
Careers / EEO Info
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Fox First at Ten
Traffic Cameras WA
Ski Reports
Ski the Northwest Rockies
MyFOX Golf
Football Schedules
High School Sports
Community Calendar
Add an Event
Military Greetings
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/ Authorities
Final resting place of Newtown gunman a mystery
Submitted by
Fox First at Ten
on December 31st
By MICHAEL MELIAAssociated Press HARTFORD, Conn. (AP) - The body of the man who massacred 26 people at a Connecticut elementary school was claimed by his father, a family spokesman said Monday, but the public may never know what happened with the remains. Like families of other mass killers, Adam
9 killed in tour bus crash along Oregon highway
Submitted by
Fox First at Ten
on December 30th
PENDLETON, Ore. (AP) - A tour bus careened through a guardrail along an icy Oregon highway and 100 feet down a steep embankment Sunday, killing nine people and injuring more than 20 others, authorities said. The charter bus carrying about 40 people lost control around 10:30 a.m. on snow- and ice-
Times Square packed with security for New Year's
Submitted by
Fox First at Ten
on December 30th
By TOM HAYSAssociated Press NEW YORK (AP) - When revelers pack Times Square for the annual New Year's eve celebration on Monday night, police will observe a tradition of their own: giving them lots of company. Each year, the New York Police Department assigns thousands of extra patrols to
3 found dead in Calif. apartment blaze; 3 injured
Submitted by
Fox First at Ten
on December 30th
By JOHN S. MARSHALLAssociated Press SAN FRANCISCO (AP) - A couple and their granddaughter were killed and three others were injured - including a police officer credited with saving at least one person - in a late-night fire at a Northern California apartment complex, authorities said Sunday. The
Indian gang rape victim's body cremated privately
Submitted by
Fox First at Ten
on December 30th
By ASHOK SHARMAAssociated Press NEW DELHI (AP) - A young woman who died after being gang-raped and beaten on a bus in India's capital was cremated privately as millions of grieving, angry residents demanded greater protection for women from sexual violence. The cremation took place during a
Missing Ga. boys located in Texas, father held
Submitted by
Fox First at Ten
on December 30th
ATLANTA (AP) - Police said two young boys from Georgia who were reported missing this week were found safe in Texas on Saturday and their father is in custody and facing charges. Brothers Ben and Henry Cleary - ages 9 and 7 - were visiting with their father, Daniel Cleary, of Roswell, and were
5 children, 1 adult die in Mississippi wreck
Submitted by
Fox First at Ten
on December 29th
By JEFF AMYAssociated Press JACKSON, Miss. (AP) - Five young siblings and one adult died early Saturday when a sport utility vehicle went off an eastern Mississippi road and plunged into a rain-swollen creek, authorities said. Neshoba County Sheriff Tommy Waddell said the victims appear to have
Mother of 2, grandmother die in crash; man charged
Submitted by
Fox First at Ten
on December 29th
MATTHEWS, N.C. (AP) - A North Carolina man whom authorities say caused an alcohol-related wreck that killed a mother of two and the children's grandmother outside Charlotte has been charged with involuntary manslaughter and felony death by vehicle, police said Saturday. Police say 28-year-old
2 teens, 12-year-old charged in Durham slaying
Submitted by
Fox First at Ten
on December 29th
DURHAM, N.C. (AP) - Two teenagers and a 12-year-old girl have been charged in the shooting death of a North Carolina man during a carjacking. Investigators say the three approached 35-year-old Johnny Danilo Villatoro of Durham on Friday night and asked him for a ride before carjacking and shooting
Woman charged with murder in NY subway shove death
Submitted by
Fox First at Ten
on December 29th
By COLLEEN LONGAssociated Press NEW YORK (AP) - A woman who told police she shoved a man to his death off a subway platform into the path of a train because she has hated Muslims since Sept. 11 and thought he was one was charged Saturday with murder as a hate crime, prosecutors said. Erika Menendez
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Referenced in
Mentioned by Cleveland
Blaine mentions that he sent Kurt a "Gilmore Girls" box set.
Alex calls Gibbs and Milo "Gilmore Girls".
Mark says that he owns every season of "Gilmore Gals" on DVD.
Tom mentions the show by name.
Alexis Bledel's role mentioned
mentioned in dialogue
Seth MacFarlane mentions that he appeared on an episode of the show
Penny says she and her mom are like the Gilmore Girls, but better.
Referenced in "Law & Ogre"
mentioned in dialogue
Jay mentions that Lauren Graham starred in the show
"And yet I like Gilmore Girls. Weird, huh?"
Poster shown to introduce Alexis Bledel
Jay mentions that Lauren Graham was on the show
according to Kyle, he and Mira met doing some extra work on Gilmore Girls.
Reference to the setting in a $10,000 question
Dr. Venture: "It looks like the set of 'The Gilmore Girls'."
Ellen says you may recognize Alexis Bledel from this series
Mentioned in a story on tours of Warner Bros. Studios.
Norah mentions the show by name.
Mentioned in reference to Emmy party.
Mentioned in the "Gaystrogen" segment
one of the shows brought up in the TV show identification duel between Lester and Morgan
Yancy Devlin calls Dan a "Gilmore Girl"
The tour guide indicates where the show was filmed and adds, "Maybe if we're lucky we'll see one of the stars." The camera is on Sam as she says this; Jared Padalecki (Sam) starred on the show for 5 seasons.
"I'm just trying to figure out which Gilmore Girl you are."
Referenced in the "Jason and the Argonauts" spoof
Danny mentions show whilst talking to Lauren Graham.
Melissa (Melissa McCarthy) says she quit "Gilmore Girls".
"'Gilmore Girls' boxset" mentioned
Turk watches it on "Turk Night", then calls JD at the hospital and they discuss the episode.
Judy offers to take Lauren shopping and she replies we've already discussed this we're not the Gilmore Girls
Jack: "We hate her even more than the know-it-all daughter on the Gilmore Girls.
Gilmore Girls is mentioned in this episode.
Mentioned in Gaystrogen commercial
Mentioned in 'Gaystrogen' ad
Title mentioned by the The DeMarco Family
mentioned by Joey
Lois and Brian watch the show on tv
Stewie talks with Olivia about having a part in this series.
Roger talks of it to the wolf.
Mentioned in dialogue.
The program "interrupted" by the news bulletin as Splinter sits down to watch TV.
Random girl passing by says, "Did you see Gilmore Girls last week?"
Playing around in bed, the two characters, Brian and Devon, make a joke about Rory from "Gilmore Girls"
A giant ad appears near a McDonalds
In episode 2.18, the tour guide references "Gilmore Girls."
Featured in
screwdriver moves itself


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Any future talk about banning plastic bags in Regina would take a long time, according to Wade Murray city councillor for Ward six.
"We've never had that discussion but something like that would entail a tremendous amount of debate because there are so many nuances that would be involved in it," he explained.
He was very surprised to hear that Toronto's city council banned plastic
bags on Wednesday in what appeared to be a snap decision at their
Wednesday night meeting.
"It's just crazy that it would take 20 minutes or whatever time it took
them to decide oh let's just flippedly ban plastic bags," Murray
He says this exactly the opposite to how these decisions are usually
made because they usually require hours of debate so they can consider
options from all angles.
Murray also doesn't think an outright ban would work even if the idea did come up because in his opinion it should be up to city council.
"It's a corporate choice, it's something that the corporations could simply say 'we no longer supply plastic bags' and they could do it from their end but but people need to have choice," Murray commented.
Even if a motion to ban plastic bags from all stores did come up in Regina, Murray doesn't think it would work very well.
"My preference would be that you try to nudge people in the direction that's better and more environmentally concious as oppose to slam the fist down and say this is the way it will be," he said.
Murray pointed out that if stores decided to charge more for plastic bags they could solve the problem on their own.
"Really if you charge five cents or ten cents a bag people very quickly would say hang on I'm going to get rid of my plastic and bring my recyclable bags in all the time and they would stop forgetting them," he said.
In fact simply forgetting to bring the reusable grocery bags was the most common response from people we talked to outside a Safeway in Regina on Thursday.
Other people pointed out that plastic bags can be reused for different purposes.


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I found an interesting article in Yahoo today that blamed Charlie Manuel for not starting Cliff Lee off of three days rest in Game 4 of the World Series. The Yankees started their Ace C.C. Sabathia off of three days rest, why didn't the Philies counter with their own Ace who held the same advantage? An interesting nugget that might explain their reasoning is this, " They saw history this decade-teams that start pitcher's on three days' rest in the postseason are 12-27-and panicked." Did the Phillies allow their fears to force them into making a bad decision? Then interestingly enough the columnist, Jeff Paassan goes on to show how Sabathia's 2nd (short rest) 3-day start on Sunday, didn't look as pretty as his first go-around against the Dodgers when he shut them down for 8 Innings but he still survived the Chase Utley HR and left the game in the 5th Inning with a Yankee 4-3 lead. His line was 6.2 IP 7H 3R 3ER 3BB 6K. Blanton's was 6.0IP 5H 4R 4ER 0HR 2BB 7K. Now with an extra rest sure Joe Blanton seemed like the right decision and maybe Lee wouldn't have worked out but know with a loss, the Philies will never know that. Even it it wasn't his best start, Sabathaia did his job, it was Jaba Chamberlain who foiled the Yankee's lead. He also recounts how the greats like Curt Schilling and Randy Johnson pushed their work loads against the Yankees in the 2001 WS when the Diamondbacks won it all. Not saying Cliff Lee is one of those guys but could he be if he gets more say in his starts? I don't want to "beat a dead horse" if you will with all this infromation but I thought it was something worth pondering on. The article has a lot more to say then I can so let me know what you think.
Yahoo article:


text:
adidas Originals Shopping Bag
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The Morning After The Night Before, LVIII
About the middle of the third quarter, one guy on press row turns to the guy next to him and says, "I've never seen so many people wearing sunglasses inside."
Dude on the other side leans over and says, "posers."
Welcome to Staples Centre.
And, to cap a starlet-free trip, here we go:
Three Things I Learned
Kobe's good
Now, wait. Kobe's really good.
Hang on. Kobe's freaking out-of-this-world good.
One play: He's on the left baseline, gets by his man (easily and I don't remember who it was) but has his path blocked. He ends up switching the ball over and taking a left-handed runner that gets nothing but net. At full speed. Two guys around him. I don't think anyone else in the NBA makes that play.
Dude is other-worldly. As I may have mentioned, MVP voting stops and starts with him.
A tribute?
In the second quarter, they flash Kareem's picture up on the board, introduce him as The Captain and the place goes nuts. Standing O. Well-deserved. Guess T.J. got in the mood, too, because I swear that third-quarter quasi-sky hook he put up had to be in homage of Abdul-Jabbar.
Speaking of T.J., I got almost as many "he sucks" e-mails last night as I did after the Orlando game. I guess you can't please everyone. Personally, I think 23 shots is a tad excessive but watching him last night, you didn't think he was forcing as many as he did against the Magic. And it wasn't like anyone else was really filling it up. He had an advantage over Derek Fisher and Jordan Farmar and he took advantage of it.
Changing it up
Not sure what you call it, but they showed a kind of new-look defence last night that worked pretty well. It was something akin to a box-and-one on Kobe, or a floating matchup zone, a little twist that might have stolen a game if a Laker team that came into the game shooting 37 per cent range didn't knock down 15 of 32 tries. It was a bit of a gamble but it worked as well as they'd hoped and maybe it's a precursor to what we might see in the first round of the playoff if Cleveland and LeBron are the opposition.
Quickly to the mail, because it's 6:15 a.m. here as I type and I've got to be in the lobby at 7 to get to the airport.
Q: As a follow-up to the question about Dikembe's finger wag.
Apparently, the rumour goes that a while back when the NBA instituted stricter taunting rules, Deke went to David Stern because the finger wag was his signature move that he had been doing since the dawn of time.
Stern said that he could continue doing it, but that he could not wag his finger in the direction of any players on or off the court, which is why he turns to the fans and wags it with pride.
Any truth to that or is it just an urban legend?
Matthew S, Victoria
A: Not sure if Deke actually spoke to the commish but the rule does say you can wag, but only to the fans and Mutombo's the only wagger in the league. The NBA is as much about the show as it is the game and it's a good show.
Speaking of Deke, check this out, which was pointed out to me by the velvet-voiced yet sunburned E. Smith of the broadcast crew.
Here's an ominous sign, and then a good one.
Talking to Bosh before the game, someone asked him if he could play if it was the playoffs; you know, fight through the pain and all?
He says, "even if I wanted to play, I couldn't. They'd score on me every time and I couldn't move on offence."
Guess his return isn't imminent.
However, he was on his way to the court to get up some set shots, the first shots he'd taken since the pain in his knee arrived.
The L.A. Times chronicles the game thusly. And the San Francisco Chronicle sets up tonight's contest like this.
Take the over. No matter what it is. (although gambling, unless sponsored by the goverment, is illegal)
The Golden State Warriors lead the league in scoring, averaging 111 points a game. They also lead the NBA in points allowed, giving up 108.
Here's a couple more from the mail
Q: Lucky Doug. Enjoying the warm weather while I'm toiling with snow removal. Your blog and the mailbag are indeed great consolation for this winter turmoils!
1) O great one, why not Jefferson over Nocioni for BC's summer hunt? Is it due to financial equation, or is it because Nocioni is the missing Argentinian to BC's (aka Noah) collection of twos?
2) If 'team performance minus the candidate' is the main criterion for MVP consideration, who will get your vote among Kobe, LeBron, Paul and Garnett?
3) Knowing that the Raptors are still playoff-bound even while losing all these 5 western trip games, is the lack of urgency a factor in keeping Bosh out of the lineup as long as the team's comfort zone? Would you see his absence a blessing in disguise leading to matchup with a more preferable opponent in the first round?
Rikki C, Burlington
A: Hello, again.
Nocioni, I think, does more of the things the Raptors need than Jefferson, who certainly doesn't suck and would be a good addition. But Noce's defence, his ability to guard a couple of positions and his all-around game's a better fit. The money's cheaper, too.
I think if you read above you'll know Kobe's the MVP in my humble opinion.
You can't manage where you're going to finish, it's folly. Let's say they finish sixth and Cleveland ends up catching Orlando. What good does that do anyone? No, you've got to play to win every game and see what happens when the season is over.
Q: I honestly think that Chris Bosh cannot be a true "franchise player". Even given time to grow and blossom to reach his peak, he will never be a clutch performer. It seems he should be a second superstar to be a "sidekick" of a true superstar. Either we should acquire a true superstar now, or trade Bosh while he is still worth something big for a huge name that may take the Raps to the conference finals. And honestly, why do we still have Joey Graham.
Greg H, Toronto
A: I honestly think, with all due respect, that you may be off your rocker. You don't find a lot of 22 and 9 guys around the NBA these days. I'm all for them acquiring "a true superstar" but if it was easy, wouldn't everyone be doing it. If anyone's learned anything in the last two weeks, it's just how valuable Bosh is to this team.
Joey? Well, you gotta have guys on the end of the roster and he's as good as any other 11th, 12th or 13th guy in the league.
Okay, off the LAX, will check in later from lovely San Francisco. Keep the cards and letters coming.


text:
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Plantation Island Resort
Renowned for its pristine white sandy beaches and crystal blue waters, Plantation Island Resort is only a 50 minute boat ride or 10 minute flight from Nadi. Plantation has over 123 acres of coconut palms and tropical gardens and fronts a 7km beach and sheltered lagoon.
Relax around one of the three swimming pools or enjoy a wide variety of complimentary activites including snorkelling trips and handline fishing trips, kayaking, windsurfing, tennis plus many more. Kids can join the "Coconuts Kids Club" with free daily activites and kids club t-shirts to decorate.
Plantation Island Resort also has a 9-hole par 32 golf course, PADI Scuba facilities, game fishing, para sailing, plus a variety of water sports and day trip excursions on offer.
Meal options include a choice of three restaurants featuring nightly themed buffets and beachside dining, four island bars and two mini-supermarkets. Plantation Island Resort is ideal for weddings and caters for small or large groups.
24 Hours
.5kms - Malolo lai lai airport
Ol' Copra Ched - Nightly themed buffets and a la carte meals. International cuisine. 7-10am, 12-2pm, 6-9pm
Anada's Bar and Restaurant - A la carte meals specialising in barbeque faire, Indo-Fijian curries and fresh seafood. 6-9pm
Kana Vale snack bar - Beachside snack bar featuring hamburgers, hot chips, toasted sandwiches, pies etc. 10am-3pm
Visa, Mastercard, Diners, American Express
Note that a credit card may be requested upon check-in as a form of security deposit.
Malolo Cat - 3 x Daily 50min boat to/from Denerau Marina
Plane - 10mins from Nadi Airport
Helicopter - 10mins from Nadi Airport
Sea Plane - 10mins from Nadi Airport
Speedboat - 45min from Denerau Marina


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The North Face Women's Kizamm Jacket
Item No.
Products on Sale are Discontinued Styles or Colors.
DECENT FEATURES of The North Face Women's Kizamm Jacket
- Adjustable fixed hood
- Pit-zip vents
- Napoleon zip pocket
- Handwarmer zip pockets
- Wrist accessory pocket with goggle cloth
- Internal media security pocket
- Snap-back powder skirt with elastic gripper
- Internal goggle pocket
- Adjustable hem system
- Hook-and-loop adjustable cuffs
- Imported
The SPECS of The North Face Women's Kizamm Jacket
- Average Weight: 33.51 oz / 950 g
- Center Back Length: 25.5"
- Shell: HyVent 2L plain weave
- Lining: Taffeta
- Insulation: 100 g/80 g Heatseeker
This product can only be shipped within the United States. Please don't hate us.


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Sunday, November 7, 2010
More Canning!
In early October, my friend M and I got together to do some more canning (she and I made the salsa together, too).
This time, we made dilly beans! Again, we got our canning recipe from this book. We ended up with 10 pints. I haven't opened one up yet, so I don't know how they turned out, but if they're anything like the other recipes from this book they're going to be delicious!
Then last weekend, my friend A and I got together to make raspberry jam. We made it together last year, as well. We both have raspberry bushes in our yards, so we pick over the summer and freeze a bunch of the raspberries.
Then we can make our jam in one big batch, instead of a bunch of small ones during the summer.
We ended up with 46 half-pints! Yum!
Last year, I decorated most of my jars of jam to give as gifts:
A and I will be getting together again soon to package our jam up for this year!
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After seeing apple peak in April the stock has finally taken a breather and went through a six month consolidation. After breaking above $430 it never really looked back and the stock gained 50% in a mere three months. It looks like the stock can be entering its third wave in a long term bullish trend. A few important points to consider:
- Fundamentally Apple is not a "high-flying" tech stock with ridiculous multiples - Currently trading at roughly 15 P/E it is hard for anyone to justify it being anything other than cheap.


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October 16, 2013 at 4:02 PM
Proposition 1 and its effect on Seattle
Big money decides elections
In reading the article "Is Prop. 1 answer to big money in City Council campaigns?" [NWMonday, Oct. 14], I couldn't help but to reflect on the current state of big money in our local elections.
Here in Seattle, there are two elections that take place; the first is among the donor class financing its candidates and the second is the general election decided out in the open.
Big money decides who runs for office; just five percent of the funds raised for City Council candidates came from small donors. With the concentration of funds coming from the likes of developers, businesses, unions and wealthy individuals — often outside Seattle itself — I invite you to draw your own conclusions as to who our candidates are listening to first.
We should have higher standards for elections. In our local politics, the size of your wallet should not determine the volume of your voice, which is why we need reforms that will empower small donors and increase the clout of average wage-earning citizens in our political process. Seattle needs to put it's support behind Proposition 1.
Chris Esh, Seattle
Comments | More in proposition 1 | Topics: Proposition 1
October 16, 2013 at 7:33 AM
Proposition 1 and the Seattle City Council
Helps incumbents, not new candidates
I am writing to voice concerns over the upcoming vote on Seattle Proposition 1, which is being referred to as a campaign finance reform measure ["Is Prop. 1 answer to big money in City Council campaigns?" NWMonday, Oct. 14].
I think most people will agree there is too much money in politics. As people become more educated about Proposition 1, they will agree that the additional taxpayer money this measure will throw at candidates is not the solution — and may in fact make matters worse.
Proposition 1 is a $9 million property tax levy that will finance only City Council candidates' campaigns. It's not surprising that two City Council members, Mike O'Brien and Nick Licata, are considered the primary advocates for this measure.
Under Proposition 1, a candidate who raises $30,000 will then be eligible for $180,000 in taxpayer money to use for campaign purposes. This measure does not require any candidate to abide by those limits, nor restrict in any way special interest money or PAC expenditures. This measure would also require candidates to have more than 600 donors. Multiple analyses have observed that this requirement could help incumbents rather than bring new candidates into the process, which is Proposition 1's stated goal.
Laverne Lamoureux, Seattle
Bring small donors into the fold
Proposition 1 will be incredibly beneficial to Seattle. Allowing a number of small donors to play a more significant role in City Council elections is incredibly important.
It would allow candidates to raise small donations, which could be matched by public funds to finance their campaigns. This makes small donations much more important, while at the same time diluting the power of large donations.
The example of public financing in the New York City Council races is evidence that this can work. When small donations began to be matched by public funds, the number of people who donated to campaigns increased substantially. These donors were from areas that had been disproportionately left out of the political process, and resulted in more people having an impact in politics while using less money.
We can accomplish this here, and it can only be an improvement in Seattle politics.
Wes Ahrens, Seattle
Comments | More in proposition 1, Seattle City Council | Topics: Proposition 1, Seattle City Council


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Posted by JW on March 13, 1998 at 06:28:27:
In response to Can someone please help me out?, written by Isabella Rose on March 13, 1998 at 00:28:16] I am having difficulty finding some straight answers to a few questions of mine.
] The fact is that I know very little about the Regency. I would like to know what the deal is with the whole title thing. For example, in P&P, we have Colonel Fitzwilliam. Colonel Fitzwilliam is the son of an Earl. His father is frequently called the Earl of Matlock. Is this a place? A town . . . somewhere? He is frequently called Lord _______ (Lord Wallingford, on a few occasions). Yet his name is Fitzwilliam. Somebody help me out here, I'm confused . . .
] Thanks,
] Isabella
JW: A peer, an earl, marquis or duke, would have a territorial title which would originally have related to where his estates were. Later creations took titles from their birthplace or from some event--eg Wellington was also Baron Douro from a victory in Portugal. The eldest son of a peer took a courtesy title, again a place name on the family estates. Hope this helps. What was special about the British peerage was that only the eldest son was noble, unlike France where all children were noble and hence there was an impoverished and rapacious nobility which paid no taxes and monopolised the avanues to advancement--hence the Revolution. In Britain the other children had to shift for themselves, by marriage , joining the Navy or Army or going into trade or the law. Hence a much more mobile society, and no revolution.
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SOURCE China Toy & Juvenile Products Association
BEIJING, Sept. 17, 2013 /PRNewswire/ -- Mainland China's most influential baby products fair China Kids Expo will open to worldwide buyers on October 15-17, 2013 at the Shanghai New International Expo Center. With an exhibition area that has been increased by over 12,000 square meters to accommodate more exhibitors, the fair will increase its advantage in strollers, ride-ons, and car seats, and is expected to welcome 60 percent more international visitors in 2013.
Increasing its advantage in strollers, ride-ons, and car seats
China Kids Expo excels in exhibiting strollers, ride-ons, and car seats over other events in mainland China, and its advantage is expected to increase as exhibitors for these products have once again seen rapid growth of 57 percent in 2013. Additionally, this year's space expansion also reflects the growth of cribs, baby care, and feeding products exhibitors, with over 30% increase seen since.
Local small, medium, and large factories from Kunshan, Ningbo, Pinghu, and Cixi in East China and Zhongshan and Pingxiang in South and North China exhibit their latest products on the show each year. Apart from regular exhibiting brands like Goodbaby, Angel, Best Baby, INF, and more, Goldenbaby, Rastar Baby, Smart Sports, Babyluxe, Huada and Value Bicycle, and others will participate in the show for the first time.
Pre-registered international buyers grow 60%
Each year large retailers like Carrefour, Wal-Mart, Kmart, Home Retail Group, Parkson, GIFI, and global trading companies, distributors, and e-tailers attend the event for sourcing. Until now, the overall pre-registered international buyers have seen a 60 percent growth, especially in buyers from the United States, Italy, Australia, Russia, Japan, and South Korea.
Jointly hosted by the China Toy & Juvenile Products Association and Koelnmesse, China Kids Expo is held every October concurrently with the China Toy Expo and Brand Licensing Hall.
Pre-register now to get the FREE admission badge: http://system.china-kids-expo.com/2013/babycarrier/visitor/prereg.asp
Visit http://www.china-kids-expo.com/ to learn more.
About China Toy & Juvenile Products Association (CTJPA)
CTJPA is the sole national association in the Toys & Juvenile Product industry in China. Registered members consist of toys and baby products producers and distributors, testing laboratories, and educational institutions in China.
About Koelnmesse
As a world-renowned trade fair organizer, Koelnmesse has an excellent track record of organizing some of the world's most successful trade events, such as Kind+Jugend in Cologne, Germany.
©2012 PR Newswire. All Rights Reserved.
The government's recent efforts to cut down on Medicare fraud may be hurting the people who need help the most.
1960 Union Ave. Memphis, TN 38104 (901) 726-0555 FCC Public File firstname.lastname@example.com 901-726-0501 EEO Report Closed Captioning


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Madison Street Bars, Restaurants Thrilled for Business to Return
Westend Bar general manager Matt Doherty got everybody back into the hockey mood when he got to work this morning.
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Lieutenant Commander Henry B. Cook November 30, 1933 - April 30, 2012
We are so sorry for your loss of Uncle Henry. Chip and I both wish we could have been there, but know that the family are in our thoughts and prayers.Saturday, May 05, 2012
Tom, I am very sorry for your lose. You and your family will be in my prayers.Thursday, May 03, 2012
Tom call me if you need anything...BelindaThursday, May 03, 2012
Tom, I lost my dad 12 years ago. It's never easy to lose anyone that close. My thoughts and prayers are with you and your family. God bless each of you.Thursday, May 03, 2012
So sorry to hear about Hank. I"ll bet he is petting "Commander" and "Prince Red" right now.Wednesday, May 02, 2012
Tom you and your family are in my prayers.Wednesday, May 02, 2012
gwinna,I AM DOTS SISTER AND I WANTED TO SAY THAT MY PRAYERS ARE WITH YOU AND I AM SO SORRY FOR YOUR LOSSTuesday, May 01, 2012
My sincere sympathies to Gwinda and the entire family. Hank was always very sweet.Tuesday, May 01, 2012
I will miss you ,my friend...My thoughts and prayers are with your family Dot CaytonTuesday, May 01, 2012
Our thoughts and prayers are with the Cook family during this time. May God wrap his arms around your family and give you the peace and comfort only he can provideCasey, Karen (Patterson), Gracie and Dawson RazerTuesday, May 01, 2012


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American politics, or maybe American entertainment, reached some sort of milestone on June 19. When Vice President Quayle declared Ice-T's album "Body Count" "obscene" for its inclusion of a song called "Cop Killer," it became official: This year, both major parties had found rappers to run against.
While the Vice President was condemning Ice-T, the brouhaha continued over Gov. Bill Clinton's swipe at Sister Souljah. He construed a comment she made in a Washington Post interview as condoning blacks murdering whites and criticized the Rev. Jesse Jackson for inviting her to a Rainbow Coalition forum. Mr. Jackson, and many observers, suggested that the candidate was trying to distance himself from black causes.
Mr. Clinton's courageous stand against racially motivated murder put him back in the news, unlike his policy statements. The Vice President's equally courageous stand against killing police officers was also good for a sound bite. It's not boring like health care; it's fun, a grudge match. In hip-hop slang, Sister Souljah and Ice-T have both been dissed (disrespected, insulted, put down) by the candidates.


text: Gov. Sonny Perdue banned the washing of state vehicles and ordered inmates to take one quick shower a day as part of an effort to reduce water use in his drought-stricken state. Mr. Perdue also ordered state agencies to reduce water use by 10 percent to 15 percent, banned installation of new landscaping and required employees to look for water leaks in state buildings.


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We got the parts you need to replace a shattered screen or back. Keep your iPhone looking new by visiting iPhone 4 Parts today!
Hitachi KC18DBL 18V 1.5Ah Lithium Ion 4-Tool Combo Kit Technology is the common thread behind the Hitachi brand. It's what makes Hitachi products superior in design and durability. From its birth, Hitachi has pioneered innovative technologies that have improved lives around the world. This knowledge is shared across all Hitachi divisions worldwide and is incorporated into applications that benefit many different products.


text:
The Washington Post reports that Michael Jordan is in talks to buy a piece of the Washington Wizards NBA team, serving as its president of basketball operations, in partnership with America Online executive Ted Leonsis and Washington businessman Jonathan Ledecky.
But the Post said the deal would hinge on the Wizards' present owner, Abe Pollin, selling the team to Leonsis and Ledecky, who have a right of first refusal as part of their purchase of the Washington Capitals hockey team from Pollin. And Pollin insisted in a recent memo to his staff that he's "the boss now and . . . for many years to come."


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The Wonders of Marketing and Advertising .....
Dr. James Mwangi, CEO and Managing Director Kenya: Equity Bank Limited
Dr. James Mwangi's journey at Equity Bank started in 1993 when the Governor of the Central Bank of Kenya obtained a damning report ranking Equity 66th out of 66 banks. The Governor decided to close the bank to protect depositors, but James left a well-paying job to save the institution.
Eighteen years later, he has turned Equity into one of the region's leaders. Its purpose is to transform the lives of Africans by providing modern financial services that maximize their opportunities.
With more than 7.3 million accounts, Equity has over 50% of all bank accounts in Kenya, giving it the largest customer base in the region. Through his initiative, the bank also established the Equity Group Foundation, which champions educational initiatives aimed at creating transformational leaders.
Equity has focused on the empowerment of youth and women and has spearheaded a successful agricultural campaign. James says,
"This award is in recognition for Africans who have continued to believe in themselves, and are constantly working to transform their lives."
Equity Bank Limited is a public company providing personal, business and corporate banking services and products.
(Source: prepaidafrica)
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Ryan Reynolds will play an aspiring rock star in Superbad director Greg Mottola's newest film, Adventureland.
The coming-of-age comedy, also written by Mottola, will star Jesse Eisenberg (The Squid and the Whale) as a recent college graduate in 1987 who has no choice but to work at a local amusement park. The uptight Eisenberg will learn to loosen up with the help of his love interest (Kristen Stewart, In The Land of Women) and Reynolds' character, who is worshipped by all the kids at the park.
Reynolds is currently dating Hollywood darling Scarlett Johansson. Though the couple has not confirmed their status, they caused a tabloid frenzy last week when they were photographed walking hand in hand at LAX. They were returning from Vancouver, where Johansson was reportedly introduced to Reynolds' family.
Reynolds was previously engaged to fellow Canadian Alanis Morissette.


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Jul 15, 2010 Table of Contents
Treating Diabetic Peripheral Neuropathic Pain
Am Fam Physician. 2010 Jul 15;82(2):151-158.
Patient information: See related handout on diabetic peripheral neuropathic pain, written by the authors of this article.
Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. Patients can realistically expect a 30 to 50 percent reduction in discomfort with improved functionality. The main classes of agents used to treat diabetic peripheral neuropathic pain include tricyclic antidepressants, anticonvulsants, serotonin-norepinephrine reuptake inhibitors, opiates and opiate-like substances, and topical medications. Physicians should ask patients whether they have tried complementary and alternative medicine therapies for their pain. Only two medications are approved specifically for the treatment of diabetic peripheral neuropathic pain: pregabalin and duloxetine. However, evidence supports the use of other therapies, and unless there are contraindications, tricyclic antidepressants are the first-line treatment. Because patients often have multiple comorbidities, physicians must consider potential adverse effects and possible drug interactions before prescribing a medication.
Peripheral neuropathy is a common complication of diabetes mellitus, occurring in 30 to 50 percent of patients with the disease.1 It involves the loss of sensation in a symmetric stocking-and-glove distribution, starting in the toes and progressing proximally. Approximately 10 to 20 percent of patients with diabetes have diabetic peripheral neuropathic pain, which is a burning, tingling, or aching discomfort that worsens at night.1,2 Patients with diabetic peripheral neuropathic pain may also experience allodynia and hyperalgesia. Diabetic peripheral neuropathic pain interferes with sleep quality, mood, and activity level. Initial management goals include controlling hyperglycemia, which may acutely worsen pain.3 Although complete relief is ideal, pain reduction of only 30 to 50 percent can be expected in most patients taking maximal doses of medication.4,5 Available evidence on treating diabetic peripheral neuropathic pain is limited to small studies and few head-to-head trials. Although the American Society of Pain Educators has released consensus guidelines for treatment, they offer little guidance on choosing a first-tier agent.6,7 Figure 1 presents a treatment algorithm for diabetic peripheral neuropathic pain based on available evidence.4 There are five main classes of medications and some alternative options used to treat diabetic peripheral neuropathic pain. Table 1 provides dosages, costs, and numbers needed to treat (NNT) of selected medications.5,8–29 Table 2 lists common adverse effects of the medications.5,8–11,14,18–20,30
Clinical recommendation | Evidence rating | References |
First-line treatment of diabetic peripheral neuropathic pain includes tricyclic antidepressants (e.g., amitriptyline, nortriptyline [Pamelor]). If these agents are contraindicated, newer anticonvulsants (e.g., gabapentin [Neurontin], pregabalin [Lyrica]) should be considered. |
Serotonin-norepinephrine reuptake inhibitors (e.g., venlafaxine [Effexor], duloxetine [Cymbalta]) or opiates and opiate analogs (e.g., morphine, tramadol [Ultram]) may be used if first-line treatments are unsuccessful. |
Topical treatments (e.g., capsaicin cream [Zostrix], lidocaine 5% patches [Lidoderm]) may be added to systemic treatments at any time. |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.
Figure 1.
Table 1. Medications Used to Treat Diabetic Peripheral Neuropathic Pain
Medications Used to Treat Diabetic Peripheral Neuropathic Pain
Drug* | Dosage | Cost of generic (brand)† | Comments |
Amitriptyline‡ |
10 to 150 mg at bedtime |
NNT = 1.3, NNH = 28 (major adverse events) |
Nortriptyline‡ (Pamelor) |
25 to 150 mg at bedtime |
$13 ($692)§ |
NNH = 6 (minor adverse events)8|| |
Desipramine‡ (Norpramin) |
25 to 150 mg at bedtime |
$23 ($44) |
Pregabalin (Lyrica) |
150 to 600 mg per day, divided into two or three doses |
300 mg twice per day |
100 mg three times per day |
50 mg three times per day |
Gabapentin (Neurontin) |
300 to 1,200 mg three times per day |
$60 ($182) |
Carbamazepine (Tegretol) |
200 to 600 mg twice per day |
$10 ($86)§ |
Venlafaxine, extended release (Effexor XR) |
150 to 225 mg per day |
$142 ($150) |
NNT = 3.1, NNH = 16.2 (major adverse effect) |
NNH = 9.6 (minor adverse effect)8 | |||
Duloxetine (Cymbalta) |
60 to 120 mg per day |
Morphine |
15 to 120 mg per day |
$17 |
Adverse effects and potential for addiction may limit use; decreased tolerated dose with similar effectiveness when used with gabapentin14,15 |
Oxycodone, controlled release (Oxycontin) |
10 to 40 mg twice per day |
$61 ($152) |
NNT = 2.6 based on single small RCT16 |
Another RCT showed benefit17|| | |||
NNH = 816 (adverse effects led to withdrawal from study) | |||
Tramadol (Ultram) |
200 to 400 mg per day |
$64 ($246) |
NNT = 3.8, NNH = 7.7 (adverse effects led to withdrawal from study)18 |
Capsaicin cream (Zostrix) |
0.075% topical cream four times per day |
NA ($22 per 57-g tube) |
NNT = 5.7 (adverse effects make blinded trials difficult) |
NNH = 2.5 (local adverse effect) | |||
NNH = 9.8 (adverse effects led to withdrawal from study)19 | |||
Lidocaine 5% patch (Lidoderm) |
Up to three patches per day, each patch worn up to 12 hours; patches may be worn at the same time; a 12-hour drug-free interval is necessary |
NA ($217 for one patch per day) |
l-carnitine |
1,000 mg three times per day |
$40 |
Review of two RCTs showed improved pain and nerve fiber regeneration22 |
Alpha-lipoic acid |
600 mg per day |
$10 |
Two RCTs showed conflicting results; long-term studies with oral formulation are needed23 |
Acupuncture |
Types variable |
$60 to 120 per treatment |
Small RCT and pilot study have shown benefit; a Cochrane review is underway 24–26 |
Frequency-modulated electromagnetic neural stimulation |
30 minutes per day |
Depends on cost of hardware |
Two small studies showed benefits alone and in conjunction with amitriptyline27–29 |
NA = not available; NNH = number needed to harm; NNT = number needed to treat; RCT = randomized controlled trial.
*—Listed in order of recommended use.
†—Estimated retail price of one month's treatment based on lowest dosage provided. Information obtained at http://www.drugstore.com (accessed April 23, 2010). Generic price listed first; brand price listed in parentheses..
‡— Adverse effects make blinding difficult; numerous adverse effects and contraindications.
§—In retail discount program; may be available at discounted prices ($10 or less for one month's treatment) at one or more national retail chains.
||—NNT based on diabetic peripheral neuropathic pain specifically (others based on generalized neuropathic pain).
Table 2. Common Adverse Effects from Treatment for Diabetic Peripheral Neuropathic Pain
Common Adverse Effects from Treatment for Diabetic Peripheral Neuropathic Pain
Drug | Adverse effect | Patients who experienced effect (%) |
Constipation |
14 | |
Dizziness |
28 | |
Dry mouth |
90 | |
Somnolence |
66 | |
Capsaicin cream (Zostrix)19 |
Cough |
8 |
Skin irritation |
54 | |
Constipation |
9 | |
Diarrhea |
6 | |
Fatigue |
9 | |
Headache |
10 | |
Nasopharyngitis |
6 | |
Nausea |
22 | |
Somnolence |
8 | |
Sweating |
6 | |
Gabapentin (Neurontin)11 |
Confusion |
7 |
Diarrhea |
10 | |
Dizziness |
24 | |
Headache |
10 | |
Nausea |
8 | |
Somnolence |
20 | |
Lidocaine 5% patch (Lidoderm)20 |
No adverse effects significantly different from placebo |
— |
Opiates14 |
Constipation |
33 |
Dizziness |
21 | |
Nausea |
33 | |
Somnolence |
29 | |
Vomiting |
15 | |
Dizziness |
7 to 28 | |
Edema |
6 to 16 | |
Somnolence |
5 to 13 | |
Weight gain |
4 to 9 | |
Tramadol (Ultram)18 |
Constipation |
22 |
Headache |
17 | |
Nausea |
23 | |
Somnolence |
12 | |
Venlafaxine (Effexor)8 |
Anorexia |
5 |
Dyspepsia |
10 | |
Flatulence |
6 | |
Impotence |
5 | |
Insomnia |
10 | |
Myalgia |
5 | |
Nausea |
10 | |
Sinusitis |
7 | |
Somnolence |
15 | |
Sweating |
10 | |
Vomiting |
5 |
Studies of medications used to treat diabetic peripheral neuropathic pain assess effectiveness primarily by measuring reduction in pain. Few studies have examined the effects of diabetic peripheral neuropathic pain on quality of life. However, one study used the Nottingham Health Profile, a validated quality-of-life questionnaire, to examine the quality of life in patients with diabetic peripheral neuropathic pain.31 The study showed decreased quality of life in areas of sleep, energy, and exercise tolerance, as well as increased emotional reactivity, suggesting considerable benefits to treating diabetic peripheral neuropathic pain.
Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) are recommended as first-line therapy for diabetic peripheral neuropathic pain in appropriate patients, although their mechanism of action is uncertain. Physicians have been using TCAs, such as amitriptyline and nortriptyline (Pamelor), to treat neuropathic pain for years, without approved labeling from the U.S. Food and Drug Administration (FDA).8 An updated Cochrane review of antidepressants for treating neuropathic pain revealed an overall effectiveness, with an NNT of 1.3 for diabetic neuropathy based on five studies involving TCAs.8
Although TCAs are generally affordable and effective, they should be used with caution. One in five patients discontinues therapy because of adverse effects.8 Potential drug interactions must be reviewed. Any cardiac history, including heart failure, arrhythmias, or recent myocardial infarction, is a contraindication for TCAs. Because of the anticholinergic effects of TCAs, physicians should be cautious when prescribing them for patients with narrow-angle glaucoma, benign prostatic hypertrophy, orthostasis, urinary retention, impaired liver function, or thyroid disease. QTc interval should be assessed in those with additional risk factors: syncope or presyncope, cardiovascular disease, electrolyte disturbance, and older age.8,32 If QT prolongation is present, other medications should be used because of the risk of torsades de pointes. Care should be exercised in patients older than 60 years because of the increased likelihood of comorbidities.6–8,33
Anticonvulsants are divided into two categories: newer (e.g., gabapentin [Neurontin], pregabalin [Lyrica]) and traditional (e.g., carbamazepine [Tegretol], valproate [Depacon]). Evidence is lacking for the use of other newer anticonvulsants, such as topiramate (Topamax) and lamotrigine (Lamictal).34,35
Based on available evidence, gabapentin and pregabalin should be used as first-line treatment for diabetic peripheral neuropathic pain if there are contraindications or an inadequate response to TCAs.6 Although their mechanism of action is not completely understood, pregabalin and gabapentin bind to the alpha2-delta subunit of the calcium-sensitive channels, modulating neurotransmitter release. Pregabalin is one of only two medications approved by the FDA for the treatment of diabetic peripheral neuropathic pain. In a 2008 meta-analysis of seven trials, pregabalin was used to treat diabetic peripheral neuropathic pain in 1,510 patients, and the results showed effectiveness with a dose-related response.10 When compared with placebo, measurable pain relief was achieved with 150, 300, or 600 mg per day, divided into three doses. However, pain control occurred earlier with higher dosages (at day 4 with 600 mg versus day 13 with 150 mg).10
A 2005 Cochrane review evaluating the use of gabapentin in painful neuropathy calculated a combined NNT of 4.3 from five studies of diabetic peripheral neuropathic pain and two studies of postherpetic neuralgia and mixed neuralgia.11 Because gabapentin is not protein-bound and is excreted unchanged in the urine, it has few drug interactions. However, the review concluded that although gabapentin is effective for neuropathic pain, physicians should consider the cost before prescribing. The Cochrane authors recommended further study comparing medication classes.11
Traditional anticonvulsants, such as carbamazepine, phenytoin (Dilantin), and valproate, have been used to treat neuropathy since the 1960s.36 Carbamazepine is FDA-approved for neuropathic pain, but not specifically for diabetic peripheral neuropathic pain. One Cochrane review examined 12 studies including 404 participants with a variety of types of neuropathic pain. The review found an NNT of 2.5 to achieve moderate pain relief with carbamazepine.12 Adverse effects included drowsiness, dizziness, constipation, nausea, and ataxia.12
Laboratory monitoring is important to consider when prescribing carbamazepine. Before beginning treatment, the patient's blood urea nitrogen, creatinine, transaminase, and iron levels should be checked, and a complete blood count (including platelets), reticulocyte count, liver function test, and urinalysis should be performed. A lipid panel and measurement of drug levels are also recommended every six to 12 months.37,38 Additionally, carbamazepine carries a boxed warning for serious dermatologic reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome.37 Risk is increased 10-fold in conjunction with human leukocyte antigen-B*1502, which occurs almost exclusively in Asians. Physicians should perform genetic testing before initiating carbamazepine in this population.12
Because of the need for laboratory monitoring and the risk of drug interactions, newer anticonvulsants are preferred over carbamazepine.12 Valproate and phenytoin have not been investigated as extensively as carbamazepine, but have many of the same drawbacks.4,6,39 Phenytoin has the added complication of elevating glucose levels, making it less appealing for use in patients with diabetic peripheral neuropathic pain.9
SNRIs and SSRIs
Studies suggest that diabetic peripheral neuropathic pain is related to an unbalanced release of norepinephrine and serotonin from neurons.5,13 Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor) and duloxetine (Cymbalta), are a promising category of antidepressants for treatment of diabetic peripheral neuropathic pain. They are better tolerated and have fewer drug interactions than TCAs. A 2004 trial showed that higher doses of venlafaxine led to greater improvements in pain scores, likely because venlafaxine has a more balanced noradrenergic-to-serotonergic effect at higher doses.40 A 2007 Cochrane review examined three studies of venlafaxine for neuropathic pain, revealing an NNT of 3.1.8 This result is similar to that of TCAs for general neuropathic pain (NNT = 3.6). However, further studies are needed to investigate the effectiveness of venlafaxine for diabetic peripheral neuropathic pain specifically.
Duloxetine is the second drug approved for the treatment of diabetic peripheral neuropathic pain. Duloxetine is relatively balanced in its affinity for noradrenergic and serotonergic reuptake inhibition.5,13 A 2006 randomized controlled trial (RCT) revealed similar effectiveness with 60 mg once per day and twice per day (NNT = 5.1).13 The modified intention-to-treat analysis did not follow patients who dropped out of the study, which may have created a bias toward treatment.
Selective serotonin reuptake inhibitors (SSRIs) have also been used to treat diabetic peripheral neuropathic pain; however, there is only limited evidence showing a beneficial role. Although they are better tolerated than TCAs, the 2006 consensus guidelines list citalopram (Celexa) and paroxetine (Paxil) as options in the "other" category, after first- and second-tier agents, based on limited evidence and small trials.6 The Cochrane Collaboration suggests that more high-quality studies are needed.8
Opiates and Opiate-Like Medications
Monotherapy with opiates should be reserved for patients who do not achieve pain relief goals with other therapies. A 2006 Cochrane review evaluated the use of opiates for general neuropathic pain.14 Methadone, levorphanol, morphine, and controlled-release oxycodone (Oxycontin) were included in the review. Nine intermediate-term (28-day average) studies involving 460 participants demonstrated the superiority of opiates over placebo. Although these studies consistently showed benefit, only a portion of patients taking opiates achieved a modest pain reduction of approximately 20 to 30 percent, and were not evaluated for longer than eight weeks.14 Despite concerns about dependency and controversial evidence for the benefit of chronic opiate therapy for nonmalignant pain, consensus guidelines suggest a benefit in patients with diabetic peripheral neuropathic pain.41 Caution should be used because chronic opiate use leads to tolerance and hyperalgesia.42,43
Tramadol (Ultram) is a synthetic, opiate-like medication. It acts centrally at the muopioid receptors and weakly inhibits the central neuronal reuptake of norepinephrine and serotonin. A 1998 RCT of 131 participants revealed that patients taking tramadol scored better in pain control, quality-of-life measures, and physical and social functioning.44 Because it lowers the seizure threshold, tramadol should be avoided in patients with epilepsy or in those at risk of seizures.18 Although there is lower potential for abuse in patients taking tramadol compared with opiates, tramadol should not be used in patients who are opiate-dependent or who have a tendency to abuse drugs.44 In patients taking tramadol, the NNT to achieve 50 percent pain reduction is 3.8.18
Topical Medications
Common topical treatments for diabetic peripheral neuropathic pain include capsaicin cream (Zostrix) and lidocaine 5% patches (Lidoderm). Capsaicin stimulates the C fibers to release, and subsequently deplete, substance P. Many patients using capsaicin experience a stinging sensation during the first week of treatment, which dissipates with continued use. In a 2004 meta-analysis involving six trials of 656 patients, capsaicin had an NNT of 6.4 and 5.7 for 50 percent pain reduction at four and eight weeks, respectively.19
Lidocaine 5% patches block neuronal sodium channels. There have been small effectiveness trials with this medication. An RCT in 2003 revealed an NNT of 4.4 for 50 percent pain reduction.20 Adverse effects are primarily dermatologic, resolving on removal of the patch. The primary advantage to topical treatment is that it can be added to systemic treatment at any time.
Complementary and Alternative Medicine
As with many chronic conditions that interfere with quality of life, patients with diabetic peripheral neuropathic pain may explore complementary and alternative medicine (CAM) options. CAM therapies are being applied to diabetic peripheral neuropathic pain, although the data are limited. Asking patients about CAM treatments they are using can help physicians provide more complete care of the patient. CAM therapies with the most promise include l-carnitine and alpha-lipoic acid, which are available over the counter. Early studies have shown positive results, but more long-term data are needed.22,45 Data involving acupuncture have been limited. However, a pilot study and small RCT have shown promise.24,25 A Cochrane review is currently underway.26
Combination Therapy and Drug Interactions
Because of the complicated drug interaction profiles of the medications used to treat diabetic peripheral neuropathic pain (Table 3 46), it is advisable to exhaust monotherapy options before considering combination therapy, with the exception of topical agents. Few studies have considered the role of combination therapy, although one study showed a decreased need for opiates when combined with gabapentin.15 If combination therapy is necessary, physicians should consider the mechanism of action when choosing medications and consider consulting a pain management specialist.7 It is important to avoid combining TCAs with SSRIs or SNRIs to avoid serotonin syndrome, a life-threatening condition with autonomic and neurologic symptoms.47
Table 3. Drug Interactions in Treatment for Diabetic Peripheral Neuropathic Pain
Drug Interactions in Treatment for Diabetic Peripheral Neuropathic Pain
Drug | Interaction |
Carbamazepine (Tegretol) |
May increase toxic effects of CNS depressants* |
May decrease effectiveness of CYP1A2 substrates†, CYP2B6 substrates‡, CYP2C9 substrates§, CYP3A4 substrates||, oral contraceptives, thyroid medications, and TCAs | |
Effects can be decreased by CYP3A4 inducers¶ | |
Toxic effects can be increased by CNS depressants* and SSRIs | |
Absolutely contraindicated with MAOIs | |
Duloxetine (Cymbalta) |
May increase toxic effects of CNS depressants*, |
SSRIs, and warfarin (Coumadin) | |
May decrease effectiveness of TCAs | |
Effects can be decreased by CYP1A2 inducers** | |
Toxic effects can be increased by CNS depressants* and SSRIs | |
Absolutely contraindicated with MAOIs | |
Oxycodone, controlled release (Oxycontin) and morphine |
May increase toxic effects of CNS depressants*, MAOIs, and SSRIs |
Effects can be decreased by CYP3A4 inducers¶ | |
Toxic effects can be increased by CNS depressants* | |
Pregabalin (Lyrica) and gabapentin (Neurontin) |
May increase toxic effects of CNS depressants* |
Toxic effects can be increased by CNS depressants* | |
Tramadol (Ultram) |
May increase toxic effects of CNS depressants* and SSRIs |
Toxic effects can be increased by CNS depressants*, SSRIs, and TCAs | |
TCAs |
May increase toxic effects of CNS depressants*, QTc-prolonging agents††, SSRIs, St. John's wort, sulfonylureas, tramadol, and warfarin |
Effects can be decreased by carbamazepine and St. John's wort | |
Toxic effects can be increased by CNS depressants*, duloxetine, QTc-prolonging agents††, SSRIs, and St. John's wort | |
Absolutely contraindicated with MAOIs | |
Venlafaxine (Effexor) |
May increase toxic effects of CNS depressants* and SSRIs |
Effects can be decreased by CYP3A4 inducers¶ | |
Toxic effects can be increased by CNS depressants*, CYP2D6 inhibitors‡‡, CYP3A4 inhibitors§§, and SSRIs | |
Absolutely contraindicated with MAOIs |
CNS = central nervous system; CYP = cytochrome P450; MAOIs = monoamine oxidase inhibitors; SSRIs = selective serotonin reuptake inhibitors; TCAs = tricyclic antidepressants.
*— Carbamazepine, gabapentin, opiates, pregabalin, tramadol, trazodone, and TCAs.
† — Duloxetine, estrogens, flutamide, mirtazapine (Remeron), propranolol, and ropinirole (Requip).
‡ — Bupropion (Wellbutrin), cyclophosphamide, efavirenz (Sustiva), promethazine, and selegiline (Eldepryl).
§— Celecoxib (Celebrex), dapsone, fluoxetine (Prozac), fosphenytoin (Cerebyx), glimepiride (Amaryl), glipizide (Glucotrol), losartan (Cozaar), monte-lukast (Singulair), phenytoin (Dilantin), tamoxifen, trimethoprim/sulfamethoxazole (Bactrim, Septra), trimethoprim, and warfarin.
||— Alfuzosin (Uroxatral), amiodarone (Cordarone), atorvastatin (Lipitor), calcitriol (Rocaltrol), citalopram (Celexa), clonazepam (Klonopin), enalapril (Vasotec), estrogens, felodipine, ketoconazole, progesterones, and tetracycline.
¶ — Carbamazepine, dexamethasone, efavirenz, fosphenytoin, phenytoin, and St. John's wort.
**— Carbamazepine, phenobarbital, and rifampin.
†† — Amiodarone, azithromycin (Zithromax), clarithromycin (Biaxin), fluoxetine, haloperidol (formerly Haldol), risperidone (Risperdal), and sotalol (Betapace).
‡‡— Amiodarone, celecoxib, cimetidine (Tagamet), clomipramine (Anafranil), desipramine (Norpramin), duloxetine, haloperidol, imipramine (Tofranil), isoniazid, ketoconazole, lidocaine (Xylocaine), methadone, pioglitazone (Actos), and sertraline (Zoloft).
§§— Amiodarone, cimetidine, clotrimazole (Lotrimin), cyclosporine (Sandimmune), desipramine, diltiazem (Cardizem), efavirenz, erythromycin, fluconazole (Diflucan), grapefruit juice, haloperidol, metronidazole (oral [Flagyl], gel [Metrogel]), sertraline, tetracycline, and verapamil.
Information from reference 46.
Before initiating therapy, physicians should thoroughly review medication lists for potential interactions in patients with comorbidities. Drugs that may interact with diabetic peripheral neuropathic pain therapies include statins, beta blockers, sulfonylureas, levothyroxine, warfarin (Coumadin), and loop diuretics. Drug interactions stem primarily from hepatic metabolism through the cytochrome P450 system or because a drug is highly protein bound.48
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14. Eisenberg E, McNicol E, Carr DB. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2006;(3):CD006146.
15. Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352(13):1324–1334.
16. Watson CP, Moulin D, Watt-Watson J, Gordon A, Eisenhoffer J. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain. 2003;105(1–2):71–78.
17. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology. 2003;60(6):927–934.
18. Hollingshead J, Dühmke RM, Cornblath DR. Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2006;(3):CD003726.
19. Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ. 2004;328(7446):991.
20. Meier T, Wasner G, Faust M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain. 2003;106(1–2):151–158.
21. Barbano RL, Herrmann DN, Hart-Gouleau S, Pennella-Vaughan J, Lode-wick PA, Dworkin RH. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Arch Neurol. 2004;61(6):914–918.
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23. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care. 1999;22(8):1296–1301.
24. Hamza MA, White PF, Craig WF, et al. Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain. Diabetes Care. 2000;23(3):365–370.
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27. Kumar D, Alvaro MS, Julka IS, Marshall HJ. Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief. Diabetes Care. 1998;21(8):1322–1325.
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30. Max MB, Culnane M, Schafer SC, et al. Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology. 1987;37(4):589–596.
31. Benbow S, Wallymahmed M, MacFarlane IA. Diabetic peripheral neuropathy and quality of life. QJM. 1998;91(11):733–737.
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45. Ametov AS, Barinov A, Dyck PJ, et al.; SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial [published correction appears in Diabetes Care. 2003;26(7):2227]. Diabetes Care. 2003;26(3):770–776.
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This is one in a series of "Clinical Pharmacology" articles coordinated by Allen F. Shaughnessy, PharmD, Tufts University Family Medicine Residency at Cambridge Health Alliance, Malden, Mass.
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i am really considering taking this i am just worried i am going to lose all my gains once i am done with the stack ..
any1 take this yet !?!?:clean:
No worries about losing gains, because you probably won't have what you are expecting.
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Japanese Woodblock Print Okuyama Gihachiro - Tokyo browse these categories for related items... All Items: Vintage Arts: Regional Art: Asian: Japanese: Woodblock Prints: Pre 1960: item # 688535
Petrie-Rogers Gallery P.O. Box 65647 Tucson, AZ 85728 (520) 293-8355 Guest Book $325 |
Oversized Japanese "sosaku hanga" woodblock print titled "Tokyo Station" by Okuyama Gihachiro (1907-1981) dating circa 1950. Pencil-signed and titled in English on the lower margin and in Japanese on the right margin. Paper size: 19"V x 9 1/2"H. Very good overall condition with possibly some faint minor discoloration to the back. Several color illustrations of Okuyama's work can be found on pages 174-175 of "Collector's Value Guide to Japanese Woodblock Prints" by Sandra Andacht. |


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The A-Unicornist
Skepticism. Science. Reason. Unicorns.
About - Comment Policy - FAQ
Essential Reading
The Gospel Challenge
The Problem of Suffering
An atheist reads "True Reason"
08 April 2011
While we wait...
While we wait for someone to post video from last night's debate, here's a beautiful four minutes in which Harris calmly and concisely eviscerates Christianity.
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