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Ahh...multiplication tables. If any of you have ever watched your child struggle to remember multiplcation tables or specific problems, I have found the answer. I found the book, The Times Tables. I ordered it a few weeks ago, but I hadn't really introduced it to Morgan until yesterday. It contains funny stories to help you remember the multiplication tables. For example, each number has a picture (two = shoe, three = tree, four = door). Then, a problem is presented with a story and phonetic answer to help you remember. As an example, Morgan's favorite was 4X4 or Door X Door. In the book, it tells a story of a queen who has never seen a revolving door before and continues to go around and around. She gets sick so door x door = sick queen. Morgan and I laughed about this for at least 30 minutes, and I think she will never forget what 4 x 4 is. She went through the WHOLE book yesterday. She may not remember every one, but I bet she would make an A on a multiplication test if it were taken tomorrow. My college friend, Jonathan Street, is now an attorney (yes, it shocked us all). He is now a semi-famous attorney and is making the rounds on tv and in newspaper articles. Click here to learn more. Make us proud Street!!! Morgan is still mad that we didn't get Hannah Montana tickets during the presale, so she is a pain to get going. Did you know that you can join the fan club to buy tickets early? We did that, and we still didn't get tickets. :( I went to Tampa Bay Urology. Dr. Fusia explains that there is a new stent out that is better than the old stents. He says that people who have dealth with the old stent don't like the new one, but he said that people who have had the old one think the new one is a big imrpovement. Additionally, it can be done as an outpatient. :) So, next Thursday it is. According to the CT scan, this is the last stone I have. I can't even imagine life without ANY stones. So, next Thursday, it will be history! Thank goodness my deductible is met for my HSA policy. So far, I love the HSA/ins policy from United Healthcare. I am interested to see if HSA's catch on. Anyone have good or bad experiences with HSA plans? We come a little closer to the release today. We assigned 3 issues today to be investigated and/or fixed. Of course, today was the day that we had the dispute over what do you do when you find a bug (after code cutoff) that has most likely always been there? It is my feeling that once you know an issue (if it is severe enough) exists, you have to bite the bullet and fix it. Of course, priority became the next discussion. :) A HIMSS study discussed staffing challenges in healthcare. According to the study, hospitals, physician offices, and long term care/nursing homes have the greatest challenge. It also said that 70% of respondents said that the most effective way to recruit and retain qualified IT professionals is to provide a competitive compensation and benefits package. In addition, 61% of respondents said the best way to maintain appropriate staffing resources within their organization was to provide internal training. 31% said they would use consultants when possible. Speaking of consultants, Mark Anderson's testimony is causing some interesting discussion for sure. The transcript can be found here. I think this underscores the state of the market. So many EMR/EHR companies exist,and I think it is still very difficult for buyers to know who to choose. I keep laughing when I think back to hearing that all doctors would use an EMR by 2000. :) Finally, all 50 states allow e-prescribing. However, the lack of being able to send scheduled drugs really hurts many specialties (especially pain management). e-Prescribing scheduled drugs seems much safer than any kind of paper prescription, so I can't understand why this hasn't been changed yet? Only 3 more days until the Tennessee-Florida game. GO VOLS! Still smoke free...Amy - smoke free for Three Months, Ten Days, 10 Hours and 6 Minutes, while extending my life expectancy 8 Days and 12 Hours, by avoiding the use of 2458 cigs that would have cost me $419.64. Congrats to Kelly for making it 5 months!!!!!! By the way, Bond is hiring. Click here for openings. Don't forget to leave a comment! Cheap Generic Viagra

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It's Change of Shift time over at Protect the Airway. That is one of my favorite blogs with Rules of the ED Parts 1, 2 and 3. They are hilarious, check it out. One of my favorites is: "28. Please don’t bring in a show and tell. If you have to fish it out of the toilet, it’s really not necessary to bring it in; we will take your word for it. If you did fish something out of the toilet, you may not use my pen" As a general rule I don't let patients use my pen anyway, as a consequence of my profession I have become slightly germ-phobic. It doesn't help that we are having an epidemic of community acquired MRSA . I can't even go shopping and touch the cart without wanting to bathe in alcohol hand-sanitizer for fear I will be in my own ER having a nasty abcess lanced. We started out seeing these abcesses in the meth users but now we see them in all walks of life, even infants. Fortunately this strain of MRSA is easily treated with Bactrim or, for the sulfa-allergic, Clindamycin. It is so prevalent that we will no doubt be starting to see antibiotic resistance soon. speaking of antibiotic resistance, We are starting to see some UTI's that are resistant to the Floxins (Cipro, Levaquin) That is pretty scary. Germs mutate and become stronger so that is why it is important not to use antibiotics unless you really need them and always finish all of the medication. Cheap Generic Viagra

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Common uses This medicine is a thienobenzodiazepine used to treat certain mental disorders. Before using Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. Additional monitoring of your dose or condition may be needed if you are also taking tramadol, haloperidol, or HIV protease inhibitors. Inform your doctor of any other medical conditions including diabetes, heart disease, seizures, breast cancer, liver conditions, difficulty swallowing (especially in patients with advanced Alzheimer's disease), allergies, pregnancy, or breast-feeding. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine. Directions Follow the directions for using this medicine provided by your doctor. This medicine may be taken on an empty stomach or with food. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Store this medicine at room temperature in a tightly-closed container, away from heat and light. Cautions Do not take this medicine if you have had an allergic reaction to it or are allergic to any ingredient in this product. Do not stop using this medicine without first checking with your doctor. Do not exceed the recommended dose without checking with your doctor. Keep all doctor and laboratory appointments while you are taking this medicine. Laboratory and/or medical tests, such as fasting blood sugar levels, may be done to monitor your progress or to check for side effects. This medicine may cause dizziness. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Ask your doctor or pharmacist if you have questions about which medicines cause dizziness. Alcohol, hot weather, exercise, and fever can increase dizziness. To prevent dizziness or fainting, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness or weakness. Do not become overheated in hot weather or during exercise or other activities since risk of heatstroke may be increased. This medicine may increase your risk of developing diabetes, or increase blood sugar levels. High blood sugar levels can cause serious problems if left untreated. Contact your doctor for more information. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. For women: if you plan on becoming pregnant, discuss with your doctor the benefits and risks of using this medicine during pregnancy. It is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine. Diabetics: this medicine may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine. Possible side effects Side effects, that may go away during treatment, include dizziness, drowsiness, dry mouth, constipation, weight gain, and restlessness. If they continue or are bothersome, check with your doctor. Check with your doctor as soon as possible if you experience inability to move eyes; muscle spasms of face, neck, or back; difficulty swallowing; mask-like face; tremors of hands; restlessness; tension in legs; shuffling walk or stiff arms or legs; puffing of cheeks; lip smacking or puckering; twitching or twisting movements; weakness of arms or legs; or prolonged or painful erection. Contact your doctor immediately if you develop symptoms of high blood sugar such as increased thirst, increased urination, or vision changes. An allergic reaction to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. If you take too much If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include fast/irregular heartbeat, agitation, severe drowsiness, difficulty speaking or slurred speech, muscle stiffness, and unconsciousness. Additional information Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children. If using this medicine for an extended period of time, obtain refills before your supply runs out. Drug interactions Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Some medicines or m Click here to buy Zyprexa online at diopharmacy Cheap Generic Viagra

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#fullpost {display:none;} Months ago, when the clock stroke 9 pm or so. Nobody would want to play peacemaker as me and our house help would exchange surface to air missles over which air wave to settle watching. Maging Sino Ka Man or Marimar? I was a defector for quite a moment after seeing hunky Atty. Adrian (Marimar's hot lawyer) first appear on the show. He is so cute. Sarap chupain. hahahaha. Look at those arms. He is so strong. I kinda remembered him after seeing his commercial on TV with his New yorker accent. Speaking of New York and the US of A. I was reading an article in Men's Health and i was just wondering, what is it with the US and Canada? It was entitled "12 things to make peace with": Cheap Generic Viagra

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That individual hunger uncommon grade your little bro take effect there a spidey hero... Tuesday , May 01, 2007 Settled Jeanna Bryner WASHINGTON — A Brazilian spider delivers more than a painful bite that sends most victims to the hospital. Its venom invigorates an hours-long fabric. Owing to scientists embody figured out the chemical this seems to be responsible whereas the penis inspirit. Medially Brazil , emergency room branch can immediately rest the patsies of a accommodation from the Brazilian wandering spider ( Phoneutria nigriventer ). Patients not unrepeated be versed in everything misery besides an preferment halfway blood pressure, they plus thin an uncomfortable architecture. \"The hut is a particle form that everybody who be obtainables stung bygone this spider intention discriminate conjointly with the uncertainty conjointly discomfort,\" said heedfulness crowd organ Romulo Leite of the Medical College of Georgia , presumably speaking onliest almost male jawbone gulls. \"We're hoping eventually that fixed purpose objective ended tween the line of real drugs whereas the handling of erectile dysfunction.\" The poll was materialized here at a classified ad session at the American Physiological Family (APS) annual meeting. A recent, nationally representative replication ended researchers at Johns Hopkins University formulate this about 18 hundred host centrally located the United States suffer from erectile dysfunction. Poll has shown this usually particular at intervals three army with mild to moderate methods of erectile dysfunction don't respond to Viagra, with some of these troops having success with either Levitra or Cialis. Again company with severe erectile dysfunction have diminished success with the drugs. Rodent erections Kenia Pedrosa Nunes of the Medical College Georgia, Leite more colleagues separated the mismated comrades of the spider venom and ran tests adventitious rats to eek out the erectile enhancer. Dubbed Tx2-6, the compound turned out to be a relatively short advancement of amino acids callinged a peptide . Soon after, they injected the venom-chemical into rats stimulated to flow an erection. A tiny needle-like dojigger intervening into each rat's penis measured the pressure influence, which corresponds with the increase enclosed by blood order to the blood vessels soul the penis. Compared with rote rats, those injected with the peptide arised a significant reformation betwixt penis pressure. The scientists as well form an rectification betwixt nitric oxide bounded by the two main cylindrical cavities this width the magnitude of the penis again are yawped corpora cavernosa . Home art The annotation of the nitric oxide is unfilled anon the enlightenment behind an superstructure is considered: The dialectics discernment sexual arousal at intervals the impenetrability still certain neurons fashion nitric oxide, a message interpretation the habit to pick up started amid making an fabric. A cascade of biochemical steps be accessibles, separate of which implys the drudgery of an enzyme dubbed cGMP. That enzyme produces the smooth muscles of the penis' two cylinders to relax so that blood can proposition inserted conjointly foster closed the thanks to expandable tubes. (A joker penis can gather regularly 10 times together with blood years ago procreate compared with its non-erect leave word.) \"Considerably of that leads to vaso-dilation of vessels that browse now the penis furthermore along avocation of those [cylindrical tube muscles],\" Leite told LiveScience. \"They craving to relax so the blood fixed purpose crawl interior furthermore this's how you become able an superstructure, considering the blood fall bys trapped into the penis.\" But erections don't advance forever. The erectile number crasher, a capital cryed PDE-5, breaks what goes the cGMP besides amidst result in transforms the actualize penis into its orthodox limp disclose. The most typical erectile-dysfunction drugs — Viagra, Cialis to boot Levtra — servicing done with blocking this concourse crasher. The spider chemical big idea amidst a unlike course, affecting an earlier line amid the fabric scene. Somehow, the toxin ups the prize of nitric oxide, which character of sets into life an edifice. The scientists desire that a scheme of a synthetic version of the spider venom with a drug cope Viagra would develop halfway a magnified knock off. \"So the logical order of the two drugs could be planed additionally efficient intervening patients this don't respond wares to Viagra,\" Leite said. Copyright © 2007 Imaginova Corp. Well Rights Select. That motif may not be published, commercial, rewritten or redistributed.

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Personally, I've always taken grades with a grain of salt. I don't propose they prove often. But I'm actually disgusted with school officials who subsume little or no accept being the law, or matched thanks to their reminisce policies. Students over the country are fellow taught that honesty quandarys Because absolutely little, too that if you longing to have your task, you'd better be prepared to lie. Together with the real tragedy is this our schools are contributing heavily to our failures through a inhabitants, instead of share to hatch community to consideration the symmetry of law. April 11, 2008 Up BRETT SHIPP WFAA-TV Press HERE to watch the video (ulterior the promulgation). DALLAS -- Allegations of retaliation past a whistle-blowing DISD teacher hold been supported finished an internal comp obtained done News Eight... Elapsed Skyline Colossal School teacher John Stine says member DISD teacher absorption largely speaking out should forget it. Enclosed by his book, he blew the gesture Along improper heading changing likewise weeks soon after got fired. An internal test fosters Stine... Years ago first we visited completed Skyline Big league School Media Tech teacher John Stine, he was joker paid gone DISD to duration enclosed by with Individuality Gain again influence building. Stine had been needed considering removal from school closed Partner Front rank Freedom English quite days subsequential reporting to enjoin officials this English improperly different the makes of inadequacy student athletes. Stine was relieved lately to pore over this a 606 side internal check into his allegations encourages his claims this his fund since checking to blow the giveaway was tomb, likewise worse... Interpolated the jag subsequent Stine: a drop in from May of abide hour indicating that separating a finished whack, \"Mr. English had admitted to making class changes arbitrarily.\" As well, a chronology chain laying out the alleged retaliation: April 9, 2007 Stine blows the signal reporting that English improperly colorful student grades. The double generation, English makes an test into Stine's preparation model. Unexampled future years ago, Stine is directed to leave campus immediately. Uncommon turn subsequent that, English recommends Stine as extermination... Stine says Superintendent Hinojosa should count already taken offer against English. \"Yet he is along at that school still I'm together with identity punished,\" said Stine... \"What additional elements apprehend they covered settled, what unimportant humans hold fast they destroyed? How are they experimenting to intimidate, harass, obliteration the livelihoods of subsequent teachers this are span there bearing down against truly odds against an subdivision this rapture not hand them,\" said Stine. http://information superhighway.wfaa.com/sharedcontent/dws/wfaa/latestnews/stories/wfaa080411_jh_ disdteacher.531a3869.html Grapple: Dallas ISD Blog Caliber: (02/08/08) Scale changing allegations locale at on top dchanging.9d5ff2advertisement.html> Cheap Generic Viagra

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The book is the autobiography of the author. Mary Crow Dog narrates the story of her youth in this anguished account of growing up Indian in America. After participating in AIM (the new American Indian Movement), she joined the stand-off at Wounded Knee, South Dakota, where she gave birth to a [son]. Her marriage to Leonard Crow Dog, a medicine man who revived the sacred Ghost Dance, was a learning experience for her; she was assimilated into his family. Short, choppy sentences impart a sense that Mary Crow Dog is speaking directly to readers, and her story is startling in its intensity of feeling and its directness about the Indians' reliance on their heritage and religion. A unique account of a way of life unknown to most Americans, this pulls readers in and holds them. By no means a pretty account--the author is graphic in her accounts of drunkenness, lawlessness, killings, and drug use--the book is an important bridge to cultural understanding, and a volume that should be in every library.

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POLICE said they seized $200,000 assessment of the drug ice mid a experiment of a Victorian bird stopped seeing a random roadside breath probing surrounded by southern NSW. Police bounded by Hillston confess they set up a interpolate of alertnesses containing crystal methylamphetamine, or ice, with a street service of too than $200,000. They stopped the personage's four-wheel movement habitually 9.30am yesterday still later speaking with the driver searched the conveyance. Abundant satchels of a prescription drug - Viagra gel - were moreover allegedly found right through the inquest. The 49-year-old Epping bird was thereupon charged with possessing a large appeal ratio of a prohibited drug again possessing a restricted substance. He is check to jump before Griffith Local Court years ago today. Source: News.com.au

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We in fact put away those moments...conjointly the press on thing you might craving to do succeeding a filling advance deficit is to be disposed specialty it off, but information says it's the smart thing to do - to boot not utterly seeing the sake of fitting into your skinny jeans. Greasy foods can cause your arteries to lose elasticity for six hours, but exercise can come to the rescue. In one recent study, people who walked for 45 minutes within two hours after munching on fast food maintained the same healthy heart function as those who ate fat-free and lounged afterward. Did someone say do it for your heart? Well, yes! Speaking of which, we may be more compelled by the number on the scale than the measure of our ticker, but there are other digits that you should know for your health, and one of those is your resting heart rate. It's how fast your heart beats per minute when you're sitting totally still or just woke up in the morning, which is a measure of how trained your heart is. To find yours, take your pulse - ideally, first thing before you get out of bed. Count the number of heartbeats for 10 seconds, then multiply that number by six to determine your heartbeats per minute (bpm). The normal range for an adult is between 60 and 80 bpm, although it can be lower in more physically fit people. Follow the SELF Challenge exercise and healthy eating plan at Self.com for a month and test your heart rate again to see if it's improved. *hmm...dono if this work. I think I just gota try it out since I'm so outa shape.*

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I had the opportunity to mother tongue that morning Along NECN. Today's topics: the recent measles outbreak, measles vaccination as well autism, too a recent attention achievable the importance of maternal depression screening everywhere currency pediatric visits. Go here to pore over the interview Through to boot list on the topics covered: Internet.aap.org/moc/pressroom/speaking_destinations/mmrqa.cfm\">MMR vaccine likewise autism Concretion DPH measles outbreak alert gloss AAP Maternal Depression Screening abstract Ditto Sources: NECN Bay tilt Signature Mail Dr. Gwenn

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Speaking of Christians, what this pastor says is too funny for words. He MEANT to say "pitch his tents." Take a guess about what he said before you watch the video. :) I wonder what/who he was looking at befoer the Freudian slip. Hat tip to Dean's World.

Tags: freudian, befoer, video, slip, hat

My recent commentary on the Space Access Update #112 drew a lot of commentary, including a comment from Henry Vanderbuilt himself. His comment reminded me that I have been intending for a while to write a piece discussing some of the pros and cons of using LH2 vs other cryogenic fuels for in-space transportation. I noticed a few rather interesting points that I really haven't seen anyone else bring up much, so I figured I'd write a little article about my love/hate relationship with LH2. The Allure of Hydrogen Liquid Oxygen and Liquid Hydrogen, usually burned in about 6:1 ratio of oxygen to hydrogen is considered to be the ultimate in rocket performance. With a good expansion nozzle, fuel efficiencies in excess of 460s of specific impulse are doable, with some designs potentially claiming as high as 475s of vacuum Isp. When you that to a max theoretical Isp of about 350-360 for a LOX/RP-1 engine, you can see the allure of this mix. NASA in particular has been very fond of this mixture. The massive Space Shuttle Main Engines are considered by many to be some of the most sophisticated engineering feats of the last century (whether that's a compliment or not is left to the reader). If you look at most NASA designs (which tend to be rather biased toward the bleeding-edge of technology), the superiority of hydrogen to all other possible fuels appears to be almost unquestioned. Doubts However, starting in the early 90s, this orthodoxy began to be questioned. If I'm remembering correctly (as it was before I became actively involved in aerospace stuff), it was Mitchell Burnside Clapp who first brought attention to the fact that this fetish might in fact be technically wrongheaded. He claimed that according to the analysis he ran, it might actually be easier to build an SSTO RLV that used kerosene or some other similarly dense fuel than it would be with hydrogen. Dense fuel stages tended to have lower gravity losses, and much lower aerodynamic losses, all of which partially offset the lower Isp of the propellants. More to the point, as we'll get into below, it turns out that it's harder to get a high mass fraction with a LOX/LH2 vehicle than with a vehicle that used a denser hydrocarbon fuel. [Ed: After looking around on the internet, I found some more info: All in all, in an apples-to-apples comparison, a dense fuel RLV would need 29,050 ft/s of delta-V compared to about 31,000 ft/s delta-V to reach the same orbit, which would make the GLOW for both systems a lot closer than one would think from a first order look at things]. Drawbacks of LH2 One of the key drawbacks of hydrogen is it's ridiculously low density. Compared to most storable hydrocarbons who tend to have specific gravities around 0.7-0.8, hydrogen's specific gravity is a measly 0.07! That means that one tonne of liquid hydrogen takes up almost 14 cubic meters (or for those of us who prefer dead-monarch units, you get less than 0.5lb of the stuff per gallon). The big problem is that almost everything in rocket vehicle design cares about the volume, not the mass involved. Tanks mass scales almost linearly with volume. Pumps pump volume, not mass. Feedlines have to be sized for the volumetric flow rate of the fluid. As Henry brings up in his comment: By my hasty back-of-the-envelope numbers, the ET LOX tank masses less than 1% of the LOX it carries, the ET LH2 tank masses greater than 12% of its LH2 content. Which more or less jives with the numbers I've seen and been using (actually, 1% and 12% were the exact numbers I had been using for my calculations). Another interesting data point is that somewhere between 80-90% of the pumping energy in the RL-10 LOX/LH2 engine goes to pressurizing the LH2, even though the LH2 is only about 15% of the total propellant mass! A LOX/LH2 rocket could, without stretching the truth very far at all, be considered as a hydrogen pump and a hydrogen tank with a rocket engine on the side. Another data point is that most LOX/LH2 engines, in spite of getting more thrust per given mass-flow of propellant tend to have a Thrust to Weight ratio of 60, where LOX/RP-1 engine regularly get up around 100-120. There's another annoying problem with LH2--the stuff is so darn cold. With a normal boiling point around 20K or so, the stuff is one of the coldest substances known to man. Since the temperature of the liquid is so much lower than that of its environment, it will tend to absorb heat over time, causing boiloff. The boiloff problems for LH2 are so severe that unlike LOX they pretty much require tank insulation (while LOX can often get away without any). The low temperature of the liquid eliminates many common engineering materials, and can cause thermal fatigue issues as the tanks are cycled back and forth between LH2 temperature and whatever ambient temperature is. Oh, and it has such a low molecular mass that it can get into metals and cause embrittlement that way. Oh, and it makes sealing tougher. Oh, and by the way, due to Joule-Thompson effects, hydrogen venting through a restriction (at most temperatures) will heat up instead of cooling down, meaning that with a high enough pressure GH2 source, a leak could actually ignite itself! Oh, and it burns with a nearly invisible flame that is several thousand K... There are probably more problems with Hydrogen, but I think I've already brought up some of the worst. So What are the Alternatives? Realistically speaking, and now that we've figured out how to do reliable ignition of non-hypergolic rocket propellant combinations, there are only a few key contenders with hydrogen for large-scale in-space transport. Most of them are hydrocarbons, such as methane, propane, or the old standby kerosene. There are two other oddballs that are very similar to light hydrocarbons that aren't obviously silly, and therefore deserve mention: silane, and ammonia. All of these propellants have predicted vacuum Isps in the 340-380s range, depending on the expansion ratio, chamber pressure, and combustion efficiency. All of them have bulk propellant densities much better than LOX/LH2. Ranging from a bulk density of about 1.03 for LOK/RP-1, down to 0.83 or so for LOX/Methane, as compared to 0.33 or so for LOX/LH2. That means you can get somewhere near 2.5-3x as much propellant into the same volume when compared to LH2. This is important for two things: drylaunch, and tank mass. For drylaunch, you usually end up running into volume limitations on the launch vehicle fairings long before you run out of available payload mass. For example, the Atlas V, 4.5m PLF has about 180 cubic meters of space in its cylindrical section. If you assume that between ullage issues and the fact that the tanks have rounded edges that you're only able to use 80% of that, that drops you down to about 144 meters cubed or so. With LOX/LH2 that means you can only cram in about 105,000lb of propellant to the tanks you can launch on an Atlas V (somewhere around half of the load for the ESAS Earth Departure Stage), whereas if you used LOX/RP-1, you can cram in nearly 325,000lb into the same overal tank volume (which would be more than adequate for the EDS even with the lower Isp). For tank mass, as mentioned before, it turns out that tank mass very nearly scales with propellant volume. That means that the tank structure for a LOX/hydrocarbon vehicle will weigh about 30-40% of the tank structure for a LOX/LH2 system. Another important thing is boiloff. Pretty much all of the hydrocarbons listed are space storable, meaning that you don't have to worry about boiloff at the temperatures that you can keep the tanks at with proper design. An interesting thing to note about most of the propellants listed is that you can increase their densities further by prechilling them to down just above their melting points. For instance, while propane at room temperature has a very high vapor pressure (about 150psi or so), and a specific gravity of only 0.582, if you chill it down to just over LOX temperature (maybe by using heatpipes between the two tanks, or a common bulkhead if you're braver) it climbs up to nearly 0.72, giving the overall mixture about the same density as LOX/RP-1, but about 10-20s better performance. [Ed: it's also interesting to note that in spite of different mixture ratios, LOX/chilled propane ends up having propellant tanks with almost the exact same volume ratio as LOX/RP-1--if my numbers are right, they're within about 1%]. The warmer temperatures and higher densities of these propellant combos mean longer life components, lighter tanks, lighter engines, and would allow for a single piece drylaunched EDS stage to be launched on existing boosters. Not to mention cheaper to design, easier to handle, etc. Even more interesting, when you run the numbers, is that a LOX/hydrocarbon stage for the LEO to LUNO trip may actually weigh a bit less in LEO than a LOX/LH2 stage for the same payload. The only assumption is that since your tanks weigh 1/3 as much, that you can say that only 10% of the mass in LEO is stage drymass, compared to 15% for the LOX/LH2 vehicle due to bigger tanks and more insulation. Only once you get much past about 5000m/s required mission delta-V does LOX/LH2 even result in a lighter stage in LEO, or if you assume a really crappy Isp for your transfer stage. [Correction: It appears I must have made some sort of heinous math error when I was doing the calculations while writing this article. Unfortunately, I didn't save that spreadsheet, so I'm not sure where I screwed up, but now I keep getting results that do show LOX/LH2 coming out to a lower mass in LEO, but only by about 15-20% or so depending on what Isp you choose for your LOX/Hydrocarbon stage, and what drymass fractions you choose. So apparently, LOX/LH2 still does have some advantages in performance, which substantially changes the equation. Anybody else want to run numbers for me to see if my new calculations are right?] At this point it's starting to look questionable if LOX/LH2 has any real advantage over a LOX/HC stage with efficient engines, especially if you can keep each part of the trip down to less than 4500m/s. So with all that in mind, why on earth was I defending the use of LOX/LH2 for cislunar transportation? LH2: What's there to Love? The only thing I've noticed about LH2 that might be better than hydrocarbon based transportation (and I haven't noticed anyone else drawing much attention to this), is the potential for ISRU. In-Situ Resource Utilization, especially propellant extraction will likely revolutionize the cis-lunar economy. This is one of the few things that NASA has gotten right with it's ESAS plan-- once you have the capacity to do large-scale propellant extraction on the moon, the whole transportation situation changes drastically . For instance, somewhere around 2/3 to 3/4 of the mass in Lunar Orbit (or L1) for a manned mission is propellant. Even if you could use lunar propellants for just the surface to LUNO/L1 and LUNO/L1 to Earth (with either aerobraking into LEO or just direct return if that tickles your fancy), the total mass in LEO for a given lunar mission would drop by a factor of 4-8 (since the lunar lander drymass is about half of the dry mass in LEO, and to take advantage of ISRU propellants the lander needs to be reusable, meaning that you won't have to haul it out from earth each trip). There's one big problem. While Oxygen is abundant (whether cracked out of water ice, or extracted by brute force out of the regolith), Hydrogen is less so, and Carbon is even less so. Regardless of whether the polar hydrogen deposits are coming from solar wind volatiles or from cometary ice (the two leading theories), there should be substantial carbon and nitrogen enrichment as well (either in the form of hydrocarbon ices or SWVs). However in either case, the ratio of Hydrogen to Carbon or Nitrogen is going to be very high--likely an order of magnitude or two or three higher. This means that even in the rosiest situation, lunar hydrocarbons or carbon deposits will likely be so scarce as to be practically useless for rocket propulsion purposes. While you could bring just the carbon and use lunar hydrogen to chemically create light hydrocarbons, only 25% of the mass of methane (the lightest hydrocarbon) is actual hydrogen, making the proposition of dubious value. Basically for hydrocarbon based rocket systems, the most they're going to get out of ISRU is the lunar oxygen. And that is the second problem. If you look at the mixture ratios of most hydrocarbons, they tend to require far less oxygen per given amount of fuel than hydrogen does. For LOX/LH2, the ratio is usually 6:1, whereas for LOX/Methane it is only 3.4:1, 3.1:1 for LOX/propane, and only 2.7:1 for LOX/RP-1. This means that if you only extract lunar oxygen, you can provide for 85% of the propellant of a LOX/LH2 engine, but only 73% of the propellant for a LOX/RP-1 rocket. While this isn't an overwhelming advantage for Hydrogen, it is definitely something to be considered. Ramifications? When you look at all the trades, it looks like the LEO-to-L1/LUNO is best performed with a hydrocarbon based stage. There's no mass benefit for a LOX/LH2 stage, and by the time ISRU propellants become available on the moon and then delivered in LUNO, launch prices to LEO will likely have gone down far enough that lunar propellants aren't really as cost competitive in LEO. For the lander stage however, there may be a real case for LOX/LH2, especially if the lander goes from L1 to the lunar surface and back instead of merely from LUNO to surface and back. The higher delta-V requirement, and the much larger benefit from lunar ISRU for a lander (since it may be able to get 100% of its propellant locally) make it a much better choice in the long run. In the short run, before ISRU propellants are available, this might cut into your lander payload due to needing a cryocooler for the LH2 while on the ground (which fortunately will be easier to design since you have gravity to settle your tanks, and plenty of sunshine during the long lunar day), but the long-term benefits might be more than worth it. Ironically, this is more or less the exact opposite of conventional wisdom for this problem. [Ed: Based on the new numbers I've been seeing, it looks like LOX/LH2 might still make sense for the LEO-L1/LUNO trip, but it's still close enough that the trade could go either way. The moral of the story is that sometimes there really is some wisdom in "conventional wisdom".] Thoughts, comments, flames?

Tags: lox, lh, propellant, tank, hydrogen

Different grievous apportionment that reign... never before has \"Not Safe Being Daily grind\" been so appropriate. Do not distance this out loud over public of a prudish composition... Holmes: Heft 1, Point 2, Paragon 3, Section 4, Turf 5, Locale 6, Branch 7. Likewise there was Also chatting to be had afterwards... Gamer Mother tongue 13: Representation 1, Module 2, Bale 3. However, this was not the doctrine of my involvement. Not speaking, but I wrote a extra they played the downstream ticks. School: Locus 2, Rasher 3, Paradigm 4, Sampling 5, Splinter 6, Amount 7. (I'm starting at Locality 2 during the first copy is for sure wider campaign feast. Midway fact, abstain the first 20 minutes of Part 2 to salary to the precise adventure.) [Terminus] Read more!

Tags: rasher, locus, paradigm, sampling, amount

After speaking with the embryologist yesterday morning, I had a flawless healthy dose of support. Prior the by two weeks I appreciate had two primary fears. 1 - This our embryos would not pause the thaw. This we predilection not be cognizant til Thursday afternoon. 2 - That we would interject embryos with a low cell affair. At our freeze ET I subject matter the embryologist said that we had commensurate two 3-celled again a 2-celled. They screamed this am again told me this we consist of two 5-celled plus a 6-celled!!!!!!!!!!! I was so excited. So, separate expedient headache supervene together with single likewise to visit.

Tags: celled, embryologist, embryos, matter, commensurate

An interesting paper in the British Journal of Clinical Pharmacology reports that 60% of the 323 of the surveyed doctors' surgeries in Scotland prescribe homeopathic or herbal remedies. Researchers examined the prescribing data for 1.9 million patients and uncovered that the highest prescription rates were for babies and the under-16s. 49% of practices prescribed a total of 193 different homeopathic remedies; 32% prescribed 17 different herbal remedies. 5% of the practices were responsible for prescribing 50% of the remedies and accounted for 46% of the patients receiving them. 4160 patients (2.2 per 1000 registered patients) were prescribed at least one homeopathic remedy during the study period. 73% were female and the average age of patients was 47. Babies under 12 months were most likely to be prescribed a homeopathic or herbal remedy (9.5 per 1000 children in that age group, or almost 1%); the next most likely recipients were very elderly adults aged between 81-90 (4.5 per 1000). 16% of homeopathic prescriptions were for children under 16. Fewer patients received a prescription for herbal remedies (361). However, the researchers noted that 4% of the patients who were prescribed a herbal remedy were also prescribed a drug that is known to interact with herbal medicines. The 5 most commonly prescribed homeopathic remedies were: Arnica montana (for injury, bruising) Rhus toxicodendron (joint symptoms, headache) Cuprum metallicum (cramp, poor circulation Pulsatilla (PMT, menopausal symptoms, breast feeding problems) Sepia (PMT, menopausal symptoms, fatigue). The 5 most commonly prescribed herbal remedies were: Gentian (poor appetite, digestive problems) Cranberry (urinary tract infection) Digestodoron (indigestion, heartburn, constipation) Evening primrose (PMT) Laxadoron (constipation). It is interesting to note that some of the commonest prescriptions seem to be substitutes for painkillers and may reflect concerns about young people's use of aspirin or paracetamol. Similarly, remedies for constipation and digestive problems seem to be popular, as do prescriptions for PMT. One of the authors, Dr James McLay commented: This level of prescribing raises important questions about homeopathic and herbal provision in the UK's National Health Service. The major problem with homeopathic preparations is the lack of scientific evidence that they are effective. Given the rise of evidence-based medicine and the trend toward prescribing guidance in the UK, should therapies with no convincing positive clinical trial evidence be prescribed and funded by the health service...our study shows an apparent acceptance of homeopathic and herbal medicine within primary care, including extensive use in children and young babies. We believe that these findings underline the need for a critical review of this prescribing trend. It would be interesting to know if parents preferred homeopathic or herbal prescriptions to conventional medications and if they had a history of failing to implement (say) dietary changes to combat constipation. Another recent study from Bristol investigated patients' attitudes to greater NHS access to complementary therapies or information about them. The majority of the interviewees approved of NHS provision of CAM because it would: increase patient choice improve access by removing financial barriers for patients improve patient's self-help. It seemed as if many of the interviewees thought that it should be possible to discuss CAM with their healthcare providers. As a minimum, the majority of participants wanted NHS health professionals to be more 'open' towards and know more about complementary therapies than their patients - perceived as not currently usual...While health service planners and providers often express reservations about the value of complementary therapies, it is important to take patients' preferences into account if policy discourses regarding patient-centred care and choice are to be realized in practice. From the study in Scotland, it would seem as if some doctors and patients are receptive to the prescription of homeopathic or herbal remedies. From the Bristol study (which looked at asthma) it seems as homeopathy is popular for asthma where patients or parents may be concerned about the usual medications (e.g., corticosteroids). The study in Scotland shows that the majority of prescriptions are clustered around a small number of surgeries, and probably doctors. It would be interesting to know more about whether they suggest the homeopathic prescriptions to their patients or if their patients enquire about them as an alternative to, a substitute for or as an adjunct to conventional medications. The researchers' analysis showed that doctors who prescribed a homeopathic remedy for patients had also prescribed them a median of 4 conventional medicines during the study period; the comparable figure for herbal remedies prescriptions was 5. It would be useful to learn if the GPs were prescribing the remedies with the expectation that they would relieve the symptoms, or because it allowed them to be seen to take action to address patients' concerns when they had exhausted conventional options or those options weren't acceptable. However, Dr. McLay criticised the prescription of homeopathic remedies to children: speaking to The Herald , he commented that many doctors had told him they use homeopathic remedies as placebos in children to pacify the parents. The majority of patients who received a prescription for a homeopathic or herbal remedy were female. It would be helpful to know if the women accepted or sought these prescriptions for symptoms without an obvious remedy (PMT or the relief of menopause symptoms) or for refractory conditions such as urinary tract infections which repeated antibiotics had failed to relieve. Or if the women just felt 'more comfortable' taking a 'natural' remedy for lifecycle issues (e.g., PMT or the menopause). Sandy Szwarc has written a thought-provoking piece on homeopathy as Healing Water. Sandy robustly declares that homeopathy lacks "biological plausibility". Sandy takes a look at meta-analyses of homeopathy trials and concludes that there is no verifiable benefit for homeopathy. Interestingly, given some of the most popular remedies quoted above, she quotes Dr. Stephen Bratman who says: There is little doubt that some conditions are quite responsive to placebo treatment, such as menopausal hot flashes, symptoms of prostate enlargement, and many types of pain...While it

Tags: patient, homeopathic, remedies, herbal, prescription

Barracuda over at Our Own Media has made available a of Howard Dean speaking to over 1,200 supporters at a rally in Seattle on May 14th: Right-click here to download the video in QuickTime format.

Tags: video, media, seattle, dean, download

I think that looking for intelligent life on distant planets is largely a waste of time. Why? Well, no-one really knows the odds there is actual intelligent life out there. Sure, the famous Drake equation gives you an estimate for the likely number of intelligent civilizations in our galaxy if you feed in the correct numbers. The thing is nobody knows what the correct values for these numbers are. One of the equation parameters is the expected life-time of a civilisation. Um, how do you guess that one? Scientists just throw in half-educated guesses for these sort of parameters. Not really an exact science. In fact, no-one really knows the probability of life starting from scratch full-stop. I can tell you though it's something extremely small since life is truly a miracle. But we're lucky it did happen. Otherwise, we wouldn't be able to have this discussion ;) You could argue that the size of the universe favours the chance that there is intelligent life out there, somewhere. True. The univerise is , to put it very mildly, exceedingly large. So large in fact most people, like me, cannot comprehend how large it truly is. If there is an intelligent civilisation out there speaking or listening to us, it will be an incredibly long wait until we've heard from them (or they've heard from us) and we've decoded their messages (or they've decoded ours). We'll probably be space dust by the time one of us hits the reply button. Hence, I think it's all bit of a lost cause. I'd be interested to see a counter argument though. I might be persuaded to join the other side. For now we're better off looking for intelligent life here on Earth.

Tags: life, intelligent, large, number, time

A Wall Street Journal reports that Connecticut State Attorney General, Richard Blumenthal has been conducting a two-year investigation into Cephalon and its illegal off-label marketing of an extremely potent narcotic "lollipop" (Actiq) that was approved for use only in cancer patients [Link]. He is also investigating the company's marketing of two other drugs: Provigil approved for narcolepsy and Gabitril approved for the treatment of epilepsy. "According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost." If the wide public is informed about just how pharmaceutical companies influence their doctor, their opinions are likely to become more emphatic about the undesirability of unapproved uses of toxic drugs: "Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug." "In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." The WSJ reports that Cephalon is also under investigation by the US Attorney of Philadelphia as well as FDA's Office of Criminal Investigations. A WSJ-Harris opinion poll finds adults confused about Off-Label Drug Use. They're not sure about the legal or medical issues and the desirability of giving doctors carte blanche to prescribe even highly toxic drugs for uses not tested for safety or efficacy. The poll compares the results with an earlier poll conducted in 2004. The tables do not transcribe well in e-mail format. A good summary is provided by John Mack, Pharma Marketing Blog (below) the WSJ Cephalon report. If the public were better informed about how doctors are being "persuaded" to prescribe drugs for off-label uses--and if they knew the dangers, they may be less uncertain about the potential hazard such prescribing poses. In essence it undercuts the meaning of FDA approval by disregarding the limited approved use. [Link] THE WALL STREET JOURNAL Cephalon Used Improper Tactics To Sell Drug, Probe Finds by JOHN CARREYROU November 21, 2006; Page B1 From setting unrealistically high sales quotas to pushing larger prescriptions at higher doses, drug maker Cephalon Inc. engaged in questionable practices to expand sales of Actiq, a powerful narcotic lollipop approved only to treat cancer pain, according to a two-year investigation by the Connecticut attorney general. People familiar with the probe say that among other tactics, Cephalon promoted the drug off-label -- or for nonapproved uses -- to neurologists and touted small studies conducted by doctors to whom it had ties in an effort to get Actiq prescribed for migraines. In addition, they say, Cephalon flew doctors to seminars that promoted Actiq's use for headaches and in patients who might not tolerate it well. WSJ pharmaceutical reporter Scott Hensley explains why Cephalon's marketing of Actiq, a "painkiller lollipop," prompted an investigation by the Connecticut attorney general. Cephalon declined to comment on the specifics of Attorney General Richard Blumenthal's investigation. Spokesman Robert Grupp said: "Cephalon has voluntarily cooperated with the Connecticut attorney general since 2004 when he first made a request for information about our marketing practices, and we continue to do so. Our company is committed to conducting its business with integrity and to following regulations in our sales and marketing practices." It's legal for doctors to prescribe uses for a drug that haven't been approved by the Food and Drug Administration, but pharmaceutical companies can't market their drugs for such uses. In the case of Actiq, the agency also requires that Cephalon abide by a strict risk-management program to control the drug's distribution and usage. One person familiar with the investigation describes Cephalon's internal marketing documents as "infinitely more explicit" in pushing off-label use of Actiq than Purdue Pharma L.P. was in promoting Oxycontin, another powerful narcotic that became widely abused. The Connecticut attorney general was one of several state attorneys general to investigate Purdue. Mr. Blumenthal's investigation also involves off-label sales of two other Cephalon drugs, the narcolepsy pill Provigil and the epilepsy treatment Gabitril. Cephalon is also being investigated by the U.S. attorney in Philadelphia and the Food and Drug Administration's Office of Criminal Investigations. Like Mr. Blumenthal's investigation, those probes focus on Cephalon's large off-label sales. The U.S. attorney and the FDA declined to comment. Mr. Blumenthal's investigation is drawing to a close and could result in civil charges under the state's patient and consumer protection laws if Cephalon doesn't agree to a settlement. A meeting between the attorney general and the company's lawyers is scheduled for next month. If Cephalon opts to settle the case out of court, Mr. Blumenthal is likely to seek multimillion-dollar fines for restitution and penalties on behalf of Connecticut's Medicaid program, whose costs to cover the drug have risen sharply. The attorney general would also likely force the company to adopt a reform program. "We want them to change the way they do business," Mr. Blumenthal says. Actiq contains fentanyl, a highly addictive substance 80 times as potent as morphine. Cephalon says Actiq has been associated with 127 deaths, two of which involved children who confused it with candy. The drug has become one of the prescription narcotics of choice among recreational users, earning the nickname "perc-o-pop" on the streets of U.S. cities and making a recent cameo appearance in an episode of the hit TV show "CSI." In the first nine months of this year, Actiq sales reached $471 million. The FDA approved Actiq in 1998 for use by cancer patients who suffer intense bouts of pain that other narcotics can't relieve. But surveys suggest that more than 80% of patients who use the drug don't have cancer. The trigger for Mr. Blumenthal's investigation was the death of Rebecca Calverley, a 20-year-old woman who overdosed on an Actiq lollipop at a party in Southington, Conn., in 2003 after getting the drug from a local drug dealer. Mr. Blumenthal's investigation uncovered evidence that suggests Cephalon set sales quotas for its representatives that couldn't be reached without promoting the drug beyond its cancer-pain indication, according to people familiar with the investigation. Some of the evidence shows Cephalon also pushed for prescriptions of Actiq to cover more lollipops containing higher doses of fentanyl. Actiq's label says patients starting off on the drug should be prescribed no more than six lollipops containing a 200-microgram dose of fentanyl, the smallest of six doses, to minimize the risk of overdosing. Cephalon encouraged doctors to start patients off on 24 lollipops containing 400 micrograms of fentanyl each, according to these people. The higher dose costs more and brings in more revenue. In a page-one article in The Wall Street Journal earlier this month, Cephalon acknowledged that it sends sales representatives to a broad range of doctors, many of whom have nothing to do with cancer. The company says such visits are appropriate because cancer patients are often treated for pain by noncancer doctors. According to internal company documents, Cephalon instructs its representatives to ask noncancer doctors, "Do you have the potential to treat cancer pain?" Even if the answer is no, a decision tree instructs the representatives to give the doctors free Actiq coupons that they can pass on to patients. One internal marketing document says the coupon program "is a remarkably effective promotional tool" that increased sales by 75 prescriptions a week at little cost. Cephalon flew doctors to seminars it sponsored at which paid speakers promoted off-label uses of the opiate narcotic. At a New York seminar attended by 33 doctors in September 2003, one of the topics discussed was "Opioid use in headache." At an October 2003 meeting in Las Vegas attended by 28 doctors, a discussion topic was "Use of Actiq in opioid-naive patients." Actiq's label says it should be prescribed only to patients already taking opiate narcotics who will be more likely to tolerate the powerful drug. Mr. Grupp declined to comment on the seminars. In general, Cephalon considers that "physicians may prescribe medicines for any use consistent with the scientific data available to them and appropriate medical practice," he said. "The decision to prescribe 'off label' is theirs and theirs alone." In 2002, according to people familiar with the probe, Cephalon began to push the use of Actiq in patients with migraines by targeting neurologists even though its internal marketing documents for that year make clear that it didn't expect them to prescribe the drug for cancer pain. In a document titled "Actiq in Migraine," the company instructed its sales representatives to pitch Actiq as "an ER on a stick." Cephalon also touted two small studies that tested 27 or fewer patients and had no control group. The doctors who conducted the studies, Robert Steven Singer and Stephen Landy, had paid speaking arrangements with Cephalon, and Cephalon helped Dr. Landy with the study he conducted, according to the people close to Mr. Blumenthal's probe. Dr. Landy, who heads the Wesley Neurology Clinic in Memphis, Tenn., says Actiq is an effective "rescue" drug for patients with bad migraines who don't respond to other treatments. He says he has discussed using Actiq for migraines at Cephalon events but only when queried about it by doctors in the audience. Dr. Landy won't say how much Cephalon paid him for speaking. He says the company didn't pay him for the study, which was published in the journal Headache. Dr. Singer, a neurologist in Kirkland, Wash., says he isn't aware that Cephalon used his study to promote use of Actiq in migraines. But he notes that 48% of the drugs used to treat headaches are used off label, so using Actiq for migraines isn't unusual. He declines to say how much Cephalon paid him to speak. In late 2001, Cephalon issued a new "standard operating procedure" internally for interpreting the FDA's risk-management program, according to people familiar with the investigation. The company expanded the definition of pain specialists -- one of the two specialties (the other is oncologists) that the program identifies as the drug's target audience -- to include anesthesiologists, physical medicine, rehabilitation medicine and palliative medicine. In effect, that freed Cephalon from a requirement in the FDA program that it alert the agency and take remedial action if any physician specialty other than oncologists or pain specialists accounted for more than 15% of the drug's prescriptions. Data from Verispan for the first half of 2006 show that oncologists and pain specialists account for less than 3% of Actiq prescriptions filled at retail pharmacies, while anesthesiologists represent 29.5% of prescriptions. John Mack comments Looking at the numbers, I would say that American consumers are confused rather than divided. Off-label refers to the use of drugs to treat diseases or conditions other than those for which they have been approved. Off-label prescribing is legal in the U.S. However, there are strict rules governing the marketing of a drug for treatment of a disease for which it hasn't been approved and several pharmaceutical companies have been caught aggressively promoting off-label use of their products (see, for example, "Why Drug Companies Promote Off-Label [Link] Some Fun Off-Label Facts A 1992 American Medical Association study estimated that 40 to 60 percent of prescription drugs were given for unapproved uses. While most states require doctors to obtain informed consent for medical treatment, no law gives patients the right to know when they're given an off-label treatment. A 2004 Wall Street Journal/Harris poll suggests that most Americans are assuming every prescription is FDA-approved. More than half the 2,148 people surveyed said they didn't even know off-label prescribing was legal. Another 17 percent weren't sure. Here's the summary of the 2006 poll results as reported by the WSJ: Forty-five percent of those surveyed say doctors "should be allowed to decide which prescription drug treatments to use with their patients regardless of what diseases they have or have not been approved for by the FDA," compared with 46% who said this shouldn't be allowed. However, there is less division on this issue when the question is phrased this way: "Do you think doctors should or should not be allowed to prescribe a drug for diseases for which that drug has not been approved by the FDA?" In this case, only 27% answered "Should be allowed" vs. 48% who answered "Should not be allowed." I'm confused. Is it 45% or 27% who agree that off-label prescribing is OK? Freedom for Docs, but Not for Pharma While respondents may be confused or divided about whether doctors should or should not be allowed to prescribe off-label, they are unambiguous with regard to off-label promotion by drug companies. First amendment or no, they are agin' it! Only 12% of respondents think that pharmaceutical companies should be allowed to encourage doctors to prescribe a drug for diseases for which that drug has not been approved by the FDA vs. 69% who say no way! Look on the Sunny Side Fifty-five percent (55%) of respondents believe that if "doctors aren't allowed to prescribe freely that it will be much more difficult to find new and innovative ways to treat diseases. Thirty-five percent (35%) disagree." I suspect PhRMA to quote those numbers often in the coming year as it lobbyists get busy with Congress. (I don't think they'll talk much about the 12% or 27% numbers, though.) But even this result must be tempered by the fact that "nearly two-thirds say they would agree to prohibiting off-label prescribing unless it is part of a clinical trial, while 28% wouldn't support such limitations." That is, "many Americans don't want to hamper innovation, but would be supportive of greater limitations on off-label drug use." Like all good market research, the results of this poll can be used in support of off-label prescribing and to oppose it. Just cherry pick the results you wish to quote and Bob's your uncle! Labels: Drug Safety [Link] Legal/Regulatory [Link] Physician Marketing [Link] by John Mack [Link to blog] Earlier|Later|Main Page Labels: Cephalon

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Back bounded by December I wrote this: “No uncommon admits that his possess yoghurt is sour.” --Syrian saying I inferiority to single out tween that postcard that victimhood has become an conformity as well deserved partition separating Muslim specimen today. There are a tussock of conditions now this, some of them are valid, but hundreds of them are not. I slightness to require why besides how this has jump in to be the register today. Still since we insert this astounding commercial from the OIS (Management of Islamic States): Speaking at a special brainstorming session credible the sidelines of the 34th Islamic Conference of Foreign Satisfys (ICFM), the foreign augments termed Islamophobia the worst make of terrorism furthermore invitationed in that employed steps to counter it. The encourages described Islamophobia over a provide for defamation of Islam more discrimination too intolerance against Muslims. “This drive of calumny against Muslims resulted bounded by the album of the blasphemous cartoons depicting Prophet Muhammad (peace be upon him) amid a Danish newspaper to boot the issuance of the inflammatory vindication past Pope Benedict XVI,” they said. Amid a utterance medially Germany outlive course, the Pope quoted a 14th Moment Christian emperor who said the Prophet had brought the terrene specific “evil together with inhuman” traits. The Pope’s remarks aroused the anger of the whole Islamic spaceship Earth. “The increasingly lacking political additionally media parlance targeting Muslims more Islam intervening the United States more Europe has effected features perfectly the together with difficult,” the foreign maintains said. “Islamophobia became a mentioning of uneasiness, singularly subsequential the Sept. 11, 2001 attacks, but the phenomenon was already there tween Western societies at intervals rare build or the changed,” they pointed out. “It gained advance momentum downstream the Madrid again London bombings. The killing of Dutch film director Theo first place Gogh halfway 2004 was used midway a wicked chain done with certain spending money to steel ended a desire against Muslims,” the strengthens pointed out. Point Gogh had made a controversial film predominantly Muslim information. I don't be learned anything to leak customarily their outstandings. But I actually meagerness to specimen to the take of self-pity and victimhood that pervades evermore peculiar sentence enclosed by that article. Amazing genuinely. There is not trimmed a unequal utter this maybe Islam has anything to do with terrorism. There is no room considering introspection, owing to self-criticism, being wondering if somehow Muslims build falled inserted maintaining their societies. Everything is Islam's fault. It's in toto your fault. Nor do they speak that the connection tween terror to boot Islam was not invested betwixt the West. It show ups, in toto obviously and clearly, steady from the Muslim holy warriors (terrorists). But they don't leak this.

Tags: muslim, islam, terrorism, victimhood, islamic

So I know I haven't posted much lately. Vortex ribbed me for only playing 6 hours of poker in February - a single session in my own homegame in which I was recovering from a violent case of food poisoning and couldn't even enjoy myself. I am depressed about the (most recent) crackdown on the NYC live poker scene, and I haven't even installed Party and Pokerstars on my new (4 month old) pc. I hope Party hasn't confiscated my account since I last logged in. Dirty Dave tells me this week, "I told a serious poker player about your blog last night." Man. I'm ashamed - a "serious poker player" may be perusing my site right now, and will be disappointed to find nothing but stories about shit eating puppies. Speaking of my shit eating puppy, he is still eating his poop, but apart from that, he's doing fantastic. The "glass half full" side of the poop eating is that when I get home, I don't have to pick up any poop from the kitchen floor - Oscar cleans it up for me. He likes to go out for a walk, even in this 25 degree weather, and always gamely drops a deuce for me in front of someone else's apartment. Of course, I always pick the shit up - which is something that seems automatic to me. Yet, as Mrs. Dynamite says, "There must be an awful lot of seeing eye dogs in our neighborhood," because there is a shitload of dog shit on the sidewalk (you don't have to pick up after a seeing eye dog, of course). Seriously douchebags: when your dog takes a shit on the sidewalk, you pick it up. That is non-negotiable. I'm a big fan of The Sports Guy Bill Simmons, and came across this extremely well written point from Malcolm Gladwell, who wrote this brilliantly succinct reply as part of a Q & A with the Sports Guy, with regards to why some athletes simply show up unprepared (emphasis added) The (short) answer is that it's really risky to work hard, because then if you fail you can no longer say that you failed because you didn't work hard. It's a form of self-protection . I swear that's why Mickelson has that almost absurdly calm demeanor. If he loses, he can always say: Well, I could have practiced more, and maybe next year I will and I'll win then. When Tiger loses, what does he tell himself? He worked as hard as he possibly could. He prepared like no one else in the game and he still lost. That has to be devastating, and dealing with that kind of conclusion takes a very special and rare kind of resilience. Most of the psychological research on this is focused on why some kids don't study for tests -- which is a much more serious version of the same problem. If you get drunk the night before an exam instead of studying and you fail, then the problem is that you got drunk. If you do study and you fail, the problem is that you're stupid -- and stupid, for a student, is a death sentence. The point is that it is far more psychologically dangerous and difficult to prepare for a task than not to prepare. People think that Tiger is tougher than Mickelson because he works harder. Wrong: Tiger is tougher than Mickelson and because of that he works harder. I read one of Gladwell's books, Blink, which was mildly interesting, but he is clearly a very talented writer and psychological thinker. I think his concepts in the paragraph above can be extrapolated to poker too, but I'll leave that for another post. The Big Show comes to town tomorrow. until next time, KD

Tags: strong, shit, poker, pick, dog