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Critical healthcare goods can bring patients new hope. But only if they arrive on time and intact. UPS Premier upgrades parcels with advanced sensor technology that ensures they have a priority lane in our network with highly specialised handling, which provides enhanced visibility and control along the way.Ask an Expert
Now small parcels can get "white glove" services normally reserved for speciality freight. Thanks to our sensor labelling system, your package will get priority handling at every node in the network as well as preferred delivery services and proactive alerts.
Advanced RFID, mesh, or cellular sensor technology built into to our highly visible labelling system allow you to tailor your level of visibility services for the needs of each shipment.
Live agents at our Command Centre provide 24 hours a day/7 days a week monitoring and intervention services for your most critical shipments when you choose UPS Premier.
Pre-configured handling instructions allow the UPS team to effectively locate your package and quickly take action on distressed shipments within the network, mitigating risk for even your most fragile payloads. We also offer insurance options to limit financial exposure.
While all plans offer priority lane shipping, live monitoring, and risk mitigation, each offers a different level of sensor technology to protect your shipment.
Coverage: In network only
Visibility: Point-in-time
Precision: General
Temp. Sensors: No
Recovery: Configurable
Coverage: In network only
Visibility: Real time
Precision: Within 2 meters
Temp. Sensors: No
Recovery: Configurable and expedited
Coverage: In or out of network
Visibility: Real time
Precision: Within 2 meters
Temp. Sensors: Included
Recovery: Configurable and expedited
We'd love to find out more about your business needs.
Contact us to learn how a customised logistics plan could help position you for success.


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subset: commoncrawl


text:
A majority of the state's 1,030 school districts have now adopted a resolution urging Texas lawmakers to "Make Education a Priority."
Proposed state budgets would cut public education by $10-11 billion and dramatically harm Texas public schools, many school administrators say. State lawmakers say they will close a huge budget shortfall by cutting expenses. The budget shortfall is at least $15 and as big as $27 billion if you measure what it would take to maintain current services, such as funding student enrollment growth (about 85,000 additional students every year).
John Folks, superintendent of Northside ISD
State lawmakers created an inequitable school finance system five years ago and froze school district funding at 2005-2006 levels, says John Folks, superintendent of San Antonio's Northside Independent School district and past president of the Texas Association of School Administrators.
"That is unconscionable," Folks said.
The proposed budget cuts would make things even worse, he said this morning during a state conference of Texas school administrators.
His school district has cut or not filled 192 staff positions and is in the process of making 373 additional cuts. But that won't be nearly enough to meet the state's budget cuts.
It would take another 400 job cuts for his district to reach a 10 percent budget cut.
The state's budget proposals would demand even more slashing at the local level, Folk said – about $97 million per year for Northside.
"I don't know how we could operate. When you take almost $200 million out of an operating budget of $680 million, that's a 28.5 percent cut," Folks said.
About 85 percent of a school district budget goes for salaries.
"There is no question that we will be laying off people. Education is labor intensive, and we use people to serve kids," he said.
Those cut first will involve academic support staff, including instruction coaches and language support teachers, Folks said.
"It's that extra help that have allowed school districts all across Texas to raise student achievement and narrowing the gap. That's going away," Folks said. That's one of my biggest fears. It's going to hurt student achievement as we eliminate jobs, as we raise class size."
If the proposed budget is not significantly changed, Northside has to cut nearly $100 million a year.
"At $50,000 a pop, that's 2,000 teachers. We have 7,500 teachers at Northside. We can't operate," Folks said.


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8" Extra High Bowl in Black
8.25" Diameter x 3" H
Hasami Porcelain, located in Hasami, Nagasaki one of the foremost pottery districts in Japan, is keeping the rich 400 year old porcelain tradition alive. Using a unique mixture of porcelain and clay the pieces have the sharpness of traditional porcelain yet the gentler more organic feel of pottery., Hasami's porcelain collection was inspired by the tiered lacquer-ware used in traditional Japanese cuisine.
Certain Bowls, mugs, plates and trays have the same diameter allowing them to nest on top of one another. Trays and plates become lids and mugs and bowls become beautiful sculpture. Customize your own selection of coordinating Hasami earthenware with this beautiful collection.
- Dishwasher and Microwave Safe
- Made in Japan


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Turkish-style Breguet watchBreguet Museum has acquired an extremely prestigious pocket-watch
The Breguet Museum has acquired an extremely prestigious watch, made in 1808 for a dignitary of the Ottoman Empire, for the sum of CHF 650,000. This represents a record bid for a Turkish-style Breguet watch, and also a record for a pocket-watch auctioned on the youthful inland China market.
This historical piece was ordered in 1807 by His Excellency Esseid Ali Effendi, former Turkish ambassador to Paris of the nation nicknamed "The Sublime Portal", and a personal friend of Abraham-Louis Breguet. He contributed to the latter's early awareness of the Turkish market's significance, especially since Turkey was the only major power still allied with Napoleonic France… One may recall at this juncture that Napoleon's gift to mark the instatement of Sultan Mahmud II in 1813 was a Breguet sympathique clock covered in precious stones – the most expensive object ever made by A.-L. Breguet, and which is still kept in the Topkapi Palace in Istanbul.
The Breguet N° 1090 Grande Complication watch is a quarter-repeating model with independent grande and petite sonnerie featuring a case and double-case enamelled in the classic Turkish style, along with a dial graced with ancient Arabic numerals – all in an exceptionally good state of conservation. This piece was the highlight of the sale held by Poly Auction in Beijing and generated intense bidding. It will thus now be joining the other Breguet Museum treasures and will be exhibited in a few weeks' time in Paris in the Breguet Museum located above the iconic boutique on the Place Vendôme.


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Top Items:
Roger Parloff / Fortune:
Microsoft takes on the free world — Microsoft claims that free software like Linux, which runs a big chunk of corporate America, violates 235 of its patents. It wants royalties from distributors and users. Users like you, maybe. Fortune's Roger Parloff reports.
Mary Jo Foley / All about Microsoft: Microsoft: Free and open source software violates 235 Microsoft patents
Ilya Lichtenstein / Neomeme: Microsoft vs. Open Source Battle Intensifies
Dennis Crouch / Patent Law Blog: Microsoft: FOSS Infringes Our Patents
Robert Scoble / Scobleizer: Microsoft about to enter into patent war?
Noel Le / IPcentral Weblog: Microsoft Patent Strategies
David Dalka:
MyBlogLog to Rebrand and Make Significant Changes — At SOBcon yesterday in Chicago, Robyn Tippins, who was recently hired as the MyBlogLog community manager, spoke about several major upcoming changes with MyBlogLog. — There are several changes in the works:
Discussion: CenterNetworks
Allen Stern / CenterNetworks: MyBlogLog about to rebrand/redesign... does anyone use this widget anymore?
Michael Arrington / TechCrunch:
Yahoo To Finally Upgrade MyBlogLog — MyBlogLog, the ubiquitous blog widget that shows pictures of recent visitors to a site, was one of the "instant" success stories of 2006 - Yahoo acquired the company before most people even had a chance to hear about it. — Like many blogs, we had the MyBlogLog widget on TechCrunch for months.
Discussion: duncanriley.com
Michael Arrington / TechCrunch:
AllFreeCalls Back From DeadPool, Now Called Yak4Ever — AllFreeCalls Back From DeadPool, Free Calls Are Here Again — When AllFreeCalls shut down in February as a result of litigation, most people thought it was gone for good. The service, which allows people to call overseas for free …
Discussion: :Ben Metcalfe Blog and Global Neighbourhoods
Pat Phelan / Roam4free:
We did it, Yak4ever goes live — Its been a long time coming. This guy had us on a deathwatch and Mike even put us in the "deadpool" — We said we would be back and we knew we would be back it just took a lot longer than we had ever imagined. — So how does it work
Discussion: SMS Text News
Robert Scoble / Scobleizer:
We need better statistics... Almost every entrepreneur I talk to lately whines privately about the stats they see on places like Compete.com, Comscore, and Alexa. Today Tom Conrad of Pandora told me that they are extremely low. He says his service requires registration …
Discussion: WebMetricsGuru, The Universal Desktop and Smalltalk Tidbits …
Marshall Sponder / WebMetricsGuru: Second Life Key Metrics - April 2007
Ryan Stewart / The Universal Desktop: Metrics and the evolving web
James A. Robertson / Smalltalk Tidbits, Industry Rants: Nielson's Take Two — Scoble talks web stats:
Richard Siklos / New York Times:
Tilting at a Digital Future — IN Rupert Murdoch's world, two things are certain: the sun never sets on the kingdom, and a TV is always on in the background. — On the evening of April 26, several large television monitors adorned the terrace of Mr. Murdoch's Beverly Hills mansion …
Discussion: Industry Girl, rexduffdixon.com, TeleRead and Between the Lines
Give Hammer a break — The collective response to Michael Arrington including MC Hammer on his TechCrunch 20 review panel is pretty lame, IMO. — Commenters should keep in mind that this is a real guy they're talking about. Have some friggin courtesy. I've actually met the guy at a party …
Discussion: Ego Food
Michael Arrington / TechCrunch:
Internet Pornography Stats — Check out this video from Good Magazine that shows a number of stats about the Internet pornography industry, in an "almost" not safe for work format. It is staggering how much actual money flows through porn and how many people are involved in the industry:
Discussion: Howard Lindzon, rexduffdixon.com, Mark Evans and broadstuff
Liz Foreman / Lost Remote:
Offshoring journalism: A job list — Note: A draft of this post has been sitting on my desktop for a few months, but in light of even more journalism offshoring news, I thought I'd polish this up and hit the publish button. — This interesting article on Poynter has me thinking.
Janko Roettgers / GigaOM:
Mashup litmus test for Web 2.0 start-ups — Social music darling Last.fm announced this week that they are going to start a video service any minute now. Some folks apparently couldn't wait and just developed their own mashups in the mean time. — Take Lasttube for example.
Tom Evslin / Fractals of Change:
Flash! Vermont Legislature Passes E-State Bill — An hour or so ago the Vermont House and Senate both gave final approval to a bill designed to make Vermont the nation's first e-state. As defined in Vermont, e-stateness means cellular and adequate broadband coverage - fixed and mobile - everywhere in the state by 2010.
Discussion: A VC
Erica Sadun / The Unofficial Apple Weblog:
Found Footage: AT&T's Stan Sigman gifts iPhone at West Texas A&M — As noted earlier tonight, there seems to be at least one iPhone in the wild. TUAW is pleased to bring you this exclusive video from our agent-on-the-spot Mikal. Today, Stan Sigman, CEO of AT&T Wireless (Cingular) …
Discussion: Engadget and Mobility Site
Conrad Quilty-Harper / Engadget: AT&T gifts iPhone, Apple contemplates 3rd party software access
Jack Cook / Mobility Site: The rollout is starting: albeit early ....
Duncan Riley / TechCrunch:
Thriving Office for the Non-Thriving Office — The Internet and Web 2.0 may finally be delivering the promise of telecommuting. Working in pure, golden silence, aside from the occasional twittering bird for me has always been one of my favorite things about working from home.
Discussion: Download Squad, Web Worker Daily and rexduffdixon.com
Peter White / Download Squad: Download yourself a Thriving Office
Rex Dixon / rexduffdixon.com: Stupid office noises to ruin your day...


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If you're searching for your next home, or just curious about the market there is no better tool to help you quickly find homes that meet your needs and wants.


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Used 2020 Forest River RV Cherokee Alpha Wolf 27RK-L
Travel Trailer
Stock #23338 RA
Pataskala, OH
Favorite RVs
Save your favorite RVs as you browse. Begin with this one!
Haven't been able to use it yetLike most: The room and the cozy nature about it.
Spacious with lots of storageLike most: Plenty of storage and more room to move around than we thought there'd be. Being first time trailer owners, the control board is easy to understand and use.
Fun great and love the roomLike most: Love the room
We are here to help!
*All RV prices exclude tax, title, registration, documentary, prep and freight fees. Any price listed excludes sales tax, registration tags, and delivery fees. Manufacturer pictures, specifications, and features may be used in place of actual units on our lot. Please contact us @740-927-2050 for availability as our inventory changes rapidly. All calculated payments are an estimate only and do not constitute a commitment that financing or a specific interest rate or term is available.


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The blackout on WordPress.org is active. It is an interstitial, but you have to scroll all the way to the bottom to get the clickthrough link. It will go away if you click that link and be replaced by the Stop Censorship ribbon for 1 hour, at which point the cookie expires and you have to do it again. We'll run the blackout for 24 hours. Yes, it will annoy you. I wanted to shut everything down, so count your blessings.
The reason we did this instead of a full shut-down is that there are many businesses and people who help drive the independent web that need access to the WordPress Codex, forums, plugin/theme repos, and APIs. We wouldn't want to penalize them in our protest, so we just made it impossible to ignore instead.
The action on WordPress.com has also started. The primary home page of WordPress.com has blacked out all of its normal "Freshly Pressed" content. The WordPress.com official blog is sporting a ribbon — if we blacked out the blog, then WordPress.com bloggers would lose access to the post telling them how they can black out their sites using the option we deployed this evening. We launched on option tonight for all blogs on WordPress.com to either blackout (8am-8pm EST) or add a ribbon. In the couple of hours since we launched it, it looks like more than 10k have chosen full blackout, and around 3k have added the ribbon. People who chose blackout will have a ribbon before and after the blackout. Ribbons will remain until January 24, when PIPA comes up for vote in the Senate.
Both the WordPress.org and the WordPress.com blackout pages include a short message that includes a text link to the sopastrike.com site, the Fight for the Future video, the email form, the call form, and the non-U.S. petition form.
These things are what I spent the last consecutive 18 hours working on.
For more information, check out americancensorship.org.


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Today in the News: Trayvon Martin marijuana past not allowed at trial
News to know
A judge in the trial of George Zimmerman ruled today that victimTrayvon Martin's marijuana useand familiarity with guns can't be brought up during the trial. Zimmerman's team wanted to use the information as part of a character claim. The marijuana use still could be brought up if it's deemed relevant based on the prosecutor's case, the judge said. Zimmerman's trial begins June 10.
Quote of note
"Down the shore, everything's all right." - President Barack Obama, quoting a Bruce Springsteen song during a tour of New Jersey's coast seven months after Superstorm Sandy. Obama and New Jersey Gov. Chris Christie toured the area together, as they did after Sandy hit.
Hot video: Raw: Christie wins Obama a stuffed bear
During a football toss game along the Jersey Shore, New Jersey Gov. Chris Christie won a stuffed bear in one shot after several attempts by President Barack Obama.
More Content Now


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We completely disagree with the notion that one day everybody has to grow up. We will never get tired of enjoying playground equipment, and quite frankly, are a little sad that this transforming seesaw bench was only designed with tiny tots in mind.
Created by artist Dirk Ploos van Amstel who obviously hasn't let his imagination be trampled by the harsh realities of adulthood, the bench doesn't appear to be available to the general public just yet. But if it ever goes on sale, and in a version large enough for a couple of grownups to enjoy, it will be the perfect replacement for that inflatable couch in your living room you've been holding onto since college. [Dirk Ploos van Amstel via Artibazar]


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A splendid Florentine villa built by the end of 1700. Residence of the owners until 1950, it was then turned into a Hotel, and in 1990 completely restored by the present management: the Messina family.
The Hotel Royal is located in a quite zone of the town only 500 meters from the Central Station, from the Congress Center and from the Cathedral. The Hotel has a beautiful ancient garden with a swimming pool on the back and and a large parking place in front for its guests. Both services are with extra charge
All rooms are equipped with colour-TV with remote control, safe, minibar, direct-dial telephone, air-conditioning, hair-dryer. The stylish furniture grants to all rooms a sober and warm elegance.


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What is Cardene and how is it used?
Cardene is a prescription medicine used to treat the symptoms of High Blood Pressure (Hypertension), and Chronic Stable Chest Pain (Angina). Cardene may be used alone or with other medications.
Cardene belongs to a class of drugs called Calcium Channel Blockers; Calcium Channel Blockers, Dihydropyridine.
It is not known if Cardene is safe and effective in children.
What are the possible side effects of Cardene?
Cardene may cause serious side effects including:
- hives,
- difficulty breathing,
- swelling of your face, lips, tongue, or throat,
- lightheadedness,
- pounding heartbeats,
- fluttering in your chest, and
- severe or ongoing chest pain
Get medical help right away, if you have any of the symptoms listed above.
The most common side effects of Cardene include:
- headache,
- dizziness,
- swelling in your feet,
- weakness,
- flushing (warmth, redness, or tingly feeling), and
- nausea
Tell the doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Cardene. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
CARDENE SR® is a sustained release formulation of CARDENE. CARDENE SR® capsules for oral administration each contain 30 mg, 45 mg or 60 mg of nicardipine hydrochloride. Nicardipine hydrochloride is a calcium ion influx inhibitor (slow channel blocker or calcium entry blocker).
Nicardipine hydrochloride is a dihydropyridine derivative with the IUPAC (International Union of Pure and Applied Chemistry) chemical name (±)-2-(benzyl-methyl amino) ethyl methyl 1,4-dihydro-2,6 dimethyl-4-(m-nitrophenyl)-3, 5-pyridinedicarboxylate monohydrochloride, and it has the following structure:
Nicardipine hydrochloride is a greenish-yellow, odorless, crystalline powder that melts at about 169°C. It is freely soluble in chloroform, methanol and glacial acetic acid, sparingly soluble in anhydrous ethanol, slightly soluble in n-butanol, water, 0.01 M potassium dihydrogen phosphate, acetone and dioxane, very slightly soluble in ethyl acetate, and practically insoluble in benzene, ether and hexane. It has a molecular weight of 515.99.
CARDENE SR is available in hard gelatin capsules containing 30 mg, 45 mg or 60 mg nicardipine hydrochloride. All strengths contain a two component capsule fill. A powder component containing 25% of total nicardipine hydrochloride dose contains pregelatinized starch and magnesium stearate as inactive ingredients. A spherical granule component containing 75% of total nicardipine hydrochloride dose also contains microcrystalline cellulose, starch, lactose and methacrylic acid copolymer Type C as inactive ingredients.
The colorants used in the 30-mg capsules are titanium dioxide, FD&C Red No. 40 and red iron oxide, and the colorants used in the 45-mg and 60-mg capsule are titanium dioxide and FD&C Blue No. 2.
CARDENE SR is indicated for the treatment of hypertension. CARDENE SR may be used alone or in combination with other anti-hypertensive drugs.
The dose of CARDENE SR should be individually adjusted according to the blood pressure response beginning with 30 mg two times daily. The effective doses in clinical trials have ranged from 30 mg to 60 mg two times daily. The maximum blood pressure lowering effect at steady-state is sustained from 2 hours until 6 hours after dosing.
When initiating therapy or upon increasing dose, blood pressure should be measured 2 to 4 hours after the first dose or dose increase, as well as at the end of a dosing interval.
The total daily dose of immediate release nicardipine (CARDENE) may not be a useful guide to judging the effective dose of CARDENE SR. Patients currently receiving immediate release nicardipine may be titrated with CARDENE SR starting at their current total daily dose of immediate release nicardipine and then reexamined to assess the adequacy of blood pressure control.
Concomitant Use With Other Antihypertensive Agents
- Diuretics: CARDENE may be safely coadministered with thiazide diuretics.
- Beta-Blockers: CARDENE may be safely coadministered with beta-blockers (see DRUG INTERACTIONS).
Special Patient Populations
Renal Insufficiency
Although there is no evidence that CARDENE SR impairs renal function, careful dose titration beginning with 30-mg CARDENE SR bid is advised (see PRECAUTIONS).
Hepatic Insufficiency:
CARDENE SR has not been studied in patients with severe liver impairment (see PRECAUTIONS).
Congestive Heart Failure:
Caution is advised when titrating CARDENE SR dosage in patients with congestive heart failure (see WARNINGS).
NDC:68151-0089-0 in a PACKAGE of 1 CAPSULE, EXTENDED RELEASES
Nicardipine HCL 30 mg SR caps
Carilion Materials Management. Revised: Aug 2016
SLIDESHOWSee Slideshow
In multiple-dose US and foreign controlled studies, 667 patients received CARDENE SR. In these studies adverse events were elicited by non-directed and in some cases directed questioning; adverse events were generally not serious and about 9% of patients withdrew prematurely from the studies because of them.
The incidence rates of adverse events in hypertensive patients were derived from placebo-controlled clinical trials. Following are the rates of adverse events for CARDENE SR (n=322) and placebo (n=140), respectively, that occurred in 0.6% of patients or more on CARDENE SR. These represent events considered probably drug related by the investigator. Where the frequency of adverse events for CARDENE SR and placebo is similar, causal relationship is uncertain. The only dose-related effect was pedal edema.
Percentage of Patients With Probably Drug Related Adverse Events in Placebo-Controlled
|Adverse Event
|CARDENE SR (n=322)
|Placebo (n=140)
|Pedal Edema
|Postural Hypotension
|Increased UrinaryFrequency
|Sweating Increased
Incidence (%) of Discontinuations Due to Any Adverse Event in Placebo-Controlled Studies
|Adverse Event
|CARDENE SR (n=322)
|Placebo (n=140)
|Pedal Edema
|Blurred Vision
|Chest Pain
|Face Edema
|Myocardial Infarct
Uncontrolled experience in over 300 patients with hypertension treated for up to 27.5 months with CARDENE SR has shown no unexpected adverse events or increase in incidence of adverse events compared to the controlled clinical trials.
Rare Events
The following rare adverse events have been reported in clinical trials or the literature:
Body as a Whole: infection, allergic reaction
Cardiovascular: hypotension, atypical chest pain, peripheral vascular disorder, ventricular extrasystoles, ventricular tachycardia, angina pectoris
Digestive: sore throat, abnormal liver chemistries
Musculoskeletal: arthralgia
Nervous: hot flashes, vertigo, hyperkinesia, impotence, depression, confusion, anxiety
Respiratory: rhinitis, sinusitis
Special Senses: tinnitus, abnormal vision, blurred vision
Data are available from only 91 patients with chronic stable angina pectoris who received CARDENE SR 30 to 60 mg administered twice daily in open-label clinical trials. Fifty-eight of these patients were treated for at least 30 days. The four most frequently reported adverse events thought by the investigators to be probably related to the use of CARDENE SR were vasodilatation (5.5%), pedal edema (4.4%), asthenia (4.4%), and dizziness (3.3%).
In controlled clinical studies, adrenergic beta-receptor blockers have been frequently administered concomitantly with CARDENE. The combination is well tolerated.
Cimetidine increases CARDENE plasma levels. Patients receiving the two drugs concomitantly should be carefully monitored.
Some calcium blockers may increase the concentration of digitalis preparations in the blood. CARDENE usually does not alter the plasma levels of digoxin; however, serum digoxin levels should be evaluated after concomitant therapy with CARDENE is initiated.
Fentanyl Anesthesia:
Severe hypotension has been reported during fentanyl anesthesia with concomitant use of a beta-blocker and a calcium channel blocker. Even though such interactions were not seen during clinical studies with CARDENE, an increased volume of circulating fluids might be required if such an interaction were to occur.
Concomitant administration of nicardipine and cyclosporine results in elevated plasma cyclosporine levels. Plasma concentrations of cyclosporine should therefore be closely monitored, and its dosage reduced accordingly, in patients treated with nicardipine.
When therapeutic concentrations of furosemide, propranolol, dipyridamole, warfarin, quinidine or naproxen were added to human plasma (in vitro), the plasma protein binding of CARDENE was not altered.
Increased Angina In Patients With Angina
In short-term, placebo-controlled angina trials with CARDENE (an immediate release oral dosage form of nicardipine), about 7% of patients on CARDENE (compared with 4% of patients on placebo) have developed increased frequency, duration or severity of angina. Comparisons with beta-blockers also show a greater frequency of increased angina, 4% vs 1%. The mechanism of this effect has not been established.
Use In Patients With Congestive Heart Failure
Although preliminary hemodynamic studies in patients with congestive heart failure have shown that CARDENE reduced afterload without impairing myocardial contractility, it has a negative inotropic effect in vitro and in some patients. Caution should be exercised when using the drug in congestive heart failure patients, particularly in combination with a beta-blocker.
Beta-Blocker Withdrawal
CARDENE is not a beta-blocker and therefore gives no protection against the dangers of abrupt betablocker withdrawal; any such withdrawal should be by gradual reduction of the dose of beta-blocker, preferably over 8 to 10 days.
Blood Pressure:
Because CARDENE decreases peripheral resistance, careful monitoring of blood pressure during the initial administration and titration of CARDENE is suggested. CARDENE, like other calcium channel blockers, may occasionally produce symptomatic hypotension. Caution is advised to avoid systemic hypotension when administering the drug to patients who have sustained an acute cerebral infarction or hemorrhage.
Use In Patients With Impaired Hepatic Function:
Since the liver is the major site of biotransformation and since CARDENE is subject to first-pass metabolism, CARDENE should be used with caution in patients having impaired liver function or reduced hepatic blood flow. Patients with severe liver disease developed elevated blood levels (fourfold increase in AUC) and prolonged half-life (19 hours) of CARDENE.
Use In Patients With Impaired Renal Function:
When 45-mg CARDENE SR bid was given to hypertensive patients with moderate renal impairment, mean AUC and C values were approximately 2-fold to 3-fold higher than in patients with mild renal impairment. Doses in these patients must be adjusted. Mean AUC and C values were similar in patients with mildly impaired renal function and normal volunteers (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION).
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Rats treated with nicardipine in the diet (at concentrations calculated to provide daily dosage levels of 5, 15 or 45 mg/kg/day) for 2 years showed a dose-dependent increase in thyroid hyperplasia and neoplasia (follicular adenoma/carcinoma). One- and 3-month studies in the rat have suggested that these results are linked to a nicardipine-induced reduction in plasma thyroxine (T4) levels with a consequent increase in plasma levels of thyroid stimulating hormone (TSH). Chronic elevation of TSH is known to cause hyperstimulation of the thyroid. In rats on an iodine deficient diet, nicardipine administration for 1 month was associated with thyroid hyperplasia that was prevented by T4 supplementation. Mice treated with nicardipine in the diet (at concentrations calculated to provide daily dosage levels of up to 100 mg/kg/day) for up to 18 months showed no evidence of neoplasia of any tissue and no evidence of thyroid changes. There was no evidence of thyroid pathology in dogs treated with up to 25 mg nicardipine/kg/day for 1 year and no evidence of effects of nicardipine on thyroid function (plasma T4 and TSH) in man.
There was no evidence of a mutagenic potential of nicardipine in a battery of genotoxicity tests conducted on microbial indicator organisms, in micronucleus tests in mice and hamsters, or in a sister chromatid exchange study in hamsters.
No impairment of fertility was seen in male or female rats administered nicardipine at oral doses as high as 100 mg/kg/day (50 times the maximum recommended daily dose in man, assuming a patient weight of 60 kg).
Pregnancy Category C
Nicardipine was embryocidal when administered orally to pregnant Japanese White rabbits, during organogenesis, at 150 mg/kg/day (a dose associated with marked body weight gain suppression in the treated doe) but not at 50 mg/kg/day (25 times the maximum recommended dose in man). No adverse effects on the fetus were observed when New Zealand albino rabbits were treated, during organogenesis, with up to 100 mg nicardipine/kg/day (a dose associated with significant mortality in the treated doe). In pregnant rats administered nicardipine orally at up to 100 mg/kg/day (50 times the maximum recommended human dose) there was no evidence of embryolethality or teratogenicity. However, dystocia, reduced birth weights, reduced neonatal survival and reduced neonatal weight gain were noted. There are no adequate and well-controlled studies in pregnant women. CARDENE SR should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Nursing Mothers
Studies in rats have shown significant concentrations of nicardipine in maternal milk following oral administration. For this reason it is recommended that women who wish to breastfeed should not take this drug.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Geriatric Use
Pharmacokinetic parameters did not differ significantly between elderly hypertensive subjects (mean age: 70 years) and younger hypertensive subjects (mean age: 44 years) after 1 week of treatment with CARDENE SR (see CLINICAL PHARMACOLOGY: Geriatric Pharmacokinetics).
Clinical studies of nicardipine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Three overdosages with CARDENE or CARDENE SR have been reported. Two occurred in adults, 1 of whom ingested 600 mg of CARDENE and the other 2160 mg of CARDENE SR. Symptoms included marked hypotension, bradycardia, palpitations, flushing, drowsiness, confusion, and slurred speech. All symptoms resolved without sequelae. The third over-dosage occurred in a 1-year-old child who ingested half of the powder in a 30-mg CARDENE capsule. The child remained asymptomatic.
Based on results obtained in laboratory animals, overdosage may cause systemic hypotension, bradycardia (following initial tachycardia) and progressive atrioventricular conduction block. Reversible hepatic function abnormalities and sporadic focal hepatic necrosis were noted in some animal species receiving very large doses of nicardipine.
For treatment of overdose. standard measures (for example, evacuation of gastric contents, elevation of extremities, attention to circulating fluid volume, and urine output) including monitoring of cardiac and respiratory functions should be implemented. The patient should be positioned so as to avoid cerebral anoxia. Frequent blood pressure determinations are essential. Vasopressors are clinically indicated for patients exhibiting profound hypotension. Intravenous calcium gluconate may help reverse the effects of calcium entry blockade.
CARDENE is contraindicated in patients with hypersensitivity to the drug.
Because part of the effect of CARDENE is secondary to reduced afterload, the drug is also contraindicated in patients with advanced aortic stenosis. Reduction of diastolic pressure by any means in these patients may worsen rather than improve myocardial oxygen balance.
Mechanism Of Action
Nicardipine is a calcium entry blocker (slow channel blocker or calcium ion antagonist) that inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of nicardipine are more selective to vascular smooth muscle than cardiac muscle. In animal models, nicardipine produces relaxation of coronary vascular smooth muscle at drug levels that cause little or no negative inotropic effect.
Pharmacokinetics And Metabolism
Nicardipine is completely absorbed following oral doses administered as capsules, and the systemic bioavailability is about 35% following a 30-mg oral dose at steady-state. The pharmacokinetics of nicardipine are nonlinear due to saturable hepatic first-pass metabolism.
Following oral administration of CARDENE SR, plasma levels are detectable as early as 20 minutes and maximal plasma levels are achieved as a broad peak generally between 1 and 4 hours. The average terminal plasma half-life of nicardipine is 8.6 hours. Following oral administration increasing doses result in disproportionate increases in plasma levels. Steady-state Cmax values following 30-, 45- and 60- mg doses every 12 hours averaged 13.4, 34.0, and 58.4 ng/mL, respectively. Hence, increasing the dose twofold increases maximum plasma levels 4-fold to 5-fold. A similar disproportionate increase is observed with AUC. In comparison with equivalent daily doses of CARDENE capsules, CARDENE SR shows a significant reduction in Cmax. CARDENE SR also has somewhat lower bioavailability than CARDENE except at the highest dose. Minimum plasma levels produced by equivalent daily doses are similar. CARDENE SR thus exhibits significantly reduced fluctuation in plasma levels in comparison to CARDENE capsules.
When CARDENE SR was administered with a high-fat breakfast, mean Cmax was 45% lower, AUC was 25% lower and trough levels were 75% higher than when CARDENE SR was given in the fasting state. Thus, taking CARDENE SR with the meal reduced the fluctuation in plasma levels. Clinical trials establishing the safety and efficacy of CARDENE SR were carried out in patients without regard to the timing of meals.
Nicardipine is highly protein bound (>95%) in human plasma over a wide concentration range.
Nicardipine is metabolized extensively by the liver; less than 1% of intact drug is detected in the urine. Following a radioactive oral dose in solution, 60% of the radioactivity was recovered in the urine and 35% in feces. Most of the dose (over 90%) was recovered within 48 hours of dosing. Nicardipine does not induce its own metabolism and does not induce hepatic microsomal enzymes.
Nicardipine plasma levels following administration of CARDENE SR in hypertensive patients with moderate renal impairment (creatinine clearance 10 to 55 mL/min) were significantly higher following a single-oral dose and at steady-state than in hypertensive patients with mildly impaired renal function (creatinine clearance >55 mL/min). After 45-mg CARDENE SR bid at steady-state, Cmax and AUC were 2- fold to 3-fold higher in the patients with moderate renal impairment. Plasma levels in patients with mildly impaired renal function were similar to those in normal subjects.
In patients with severe renal impairment undergoing routine hemodialysis, plasma levels following a single dose of CARDENE SR were not significantly different from those patients with mildly impaired renal function.
Because nicardipine is extensively metabolized by the liver, the plasma levels of the drug are influenced by changes in hepatic function. Following administration of CARDENE capsules, nicardipine plasma levels were higher in patients with severe liver disease (hepatic cirrhosis confirmed by liver biopsy or presence of endoscopically-confirmed esophageal varices) than in normal subjects. After 20-mg CARDENE bid at steady-state, Cmax and AUC were 1.8-fold and 4-fold higher, and the terminal half-life was prolonged to 19 hours in these patients. CARDENE SR has not been studied in patients with severe liver disease.
Geriatric Pharmacokinetics
The pharmacokinetics of CARDENE SR in elderly hypertensive subjects (mean age 70 years) were compared to those in younger hypertensive subjects (mean age 44 years). After a single dose and after 1 week of dosing with CARDENE SR there were no significant differences in Cmax, Tmax, AUC or clearance between the young and elderly subjects. In both groups of subjects, steady-state plasma levels were significantly higher than following a single dose. In the elderly subjects, a disproportional increase in plasma levels with dose was observed similar to that observed in normal subjects.
In man, nicardipine produces a significant decrease in systemic vascular resistance. The degree of vasodilation and the resultant hypotensive effects are more prominent in hypertensive patients. In hypertensive patients, nicardipine reduces the blood pressure at rest and during isometric and dynamic exercise. In normotensive patients, a small decrease of about 9 mm Hg in systolic and 7 mm Hg in diastolic blood pressure may accompany this fall in peripheral resistance. An increase in heart rate may occur in response to the vasodilation and decrease in blood pressure, and in a few patients this heart rate increase may be pronounced. In clinical studies mean heart rate at time of peak plasma levels was usually increased by 5 to 10 beats per minute compared to placebo, with the greater increases at higher doses, while there was no difference from placebo at the end of the dosing interval. Hemodynamic studies following intravenous dosing in patients with coronary artery disease and normal or moderately abnormal left ventricular function have shown significant increases in ejection fraction and cardiac output with no significant change, or a small decrease, in left ventricular end-diastolic pressure (LVEDP). Although there is evidence that nicardipine increases coronary blood flow, there is no evidence that this property plays any role in its effectiveness in stable angina. In patients with coronary artery disease, intracoronary administration of nicardipine caused no direct myocardial depression. CARDENE does, however, have a negative inotropic effect in some patients with severe left ventricular dysfunction and could, in patients with very impaired function, lead to worsened failure.
"Coronary Steal," the detrimental redistribution of coronary blood flow in patients with coronary artery disease (diversion of blood from under-perfused areas toward better perfused areas), has not been observed during nicardipine treatment. On the contrary, nicardipine has been shown to improve systolic shortening in normal and hypokinetic segments of myocardial muscle, and radionuclide angiography has confirmed that wall motion remained improved during an increase in oxygen demand. Nonetheless, occasional patients have developed increased angina upon receiving nicardipine. Whether this represents steal in those patients, or is the result of increased heart rate and decreased diastolic pressure, is not clear.
In patients with coronary artery disease nicardipine improves L.V. diastolic distensibility during the early filling phase, probably due to a faster rate of myocardial relaxation in previously under-perfused areas. There is little or no effect on normal myocardium, suggesting the improvement is mainly by indirect mechanisms such as afterload reduction and reduced ischemia. Nicardipine has no negative effect on myocardial relaxation at therapeutic doses. The clinical consequences of these properties are as yet undemonstrated.
Electrophysiologic Effects
In general, no detrimental effects on the cardiac conduction system were seen with the use of CARDENE.
Nicardipine increased the heart rate when given intravenously during acute electrophysiologic studies and prolonged the corrected QT interval to a minor degree. The sinus node recovery times and SA conduction times were not affected by the drug. The PA, AH and HV intervals* and the functional and effective refractory periods of the atrium were not prolonged by nicardipine and the relative and effective refractory periods of the His-Purkinje system were slightly shortened after intravenous nicardipine.
Renal Function
There is a transient increase in electrolyte excretion, including sodium. CARDENE does not cause generalized fluid retention, as measured by weight changes.
*PA=conduction time from high to low right atrium, AH=conduction time from low right atrium to His bundle deflection or AV nodal conduction time, HV=conduction time through the His bundle and the bundle branch-Purkinje system.
Effects In Hypertension
CARDENE SR produced decreases in both systolic and diastolic blood pressure throughout the dosing interval in clinical trials. The antihypertensive efficacy of CARDENE SR administered twice daily has been demonstrated using in-clinic blood pressure measures in placebo-controlled trials involving patients with mild to moderate hypertension and in trials using 12 or 24 hour ambulatory blood pressure monitoring.
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August 25th, 2010
New York's Bloomberg: We are all Muslims
Editor's Note: Stephen Prothero, a Boston University religion scholar and author of "God is Not One: The Eight Rival Religions that Run the World," is a regular CNN Belief Blog contributor.
By Stephen Prothero, Special to CNN
In a smart commentary on the shrill Republican silence in the face of the "Obama is a Muslim" nonsense, Slate's John Dickerson wrote that "with so much traffic on the low road in American politics, you'd imagine a politician or two might take the high road simply to beat the congestion."
Well, New York City's Mayor Michael Bloomberg continues to take the road less traveled.
We are now in the Islamic holy month of fasting called Ramadan, and Bloomberg hosted last night an annual iftar, or fast-breaking dinner, at Gracie Mansion.
In his his remarks, Bloomberg, who has previously supported the Park51 project in the name of both property rights and religious freedom, once again spoke truth to fear and hatred. He admitted that "there are people of good will on both sides of the debate." He acknowledged that the World Trade Center site is "hallowed ground." And he observed that "there are people of every faith–including, perhaps, some in this room–who are hoping that a compromise will end the debate."
"But it won't," he said.
The community center can and must be built at the Park51 site, he said. Anything less would "compromise our commitment to fighting terror with freedom."
During his remarks, Bloomberg welcomed Talat Hamdani, whose son, Salman Hamdani, a paramedic and Ne York City Police Department cadet, died on 9/11. He also welcomed Sakibeh and Asaad Mustafa, whose children, he said, "have served our country overseas."
Bloomberg brought home the point that the propaganda war now being waged on Islam in America threatens to undercut our counterinsurgency battle for "hearts and minds" in Iraq and Afghanistan. "If we do not practice here at home what we preach abroad–if we do not lead by example–we undermine our soldiers," he said. "We undermine our foreign policy objectives. And we undermine our national security."
Bloomberg ended his talk by quoting some words from the embattled Imam Feisal Abdul Rauf:
"In that spirit," Bloomberg concluded, in words that echoed John F. Kennedy's "Ich bin ein Berliner" speech, "let me declare that we in New York are Jews and Christians and Muslims, and we always have been. And above all of that, we are Americans, each with an equal right to worship and pray where we choose. There is nowhere in the five boroughs that is off limits to any religion."
The opinions expressed in this commentary are solely those of Stephen Prothero.
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About this blog
The CNN Belief Blog covers the faith angles of the day's biggest stories, from breaking news to politics to entertainment, fostering a global conversation about the role of religion and belief in readers' lives. It's edited by CNN's Daniel Burke with contributions from Eric Marrapodi and CNN's worldwide news gathering team.


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TomTom has announced it has teamed up with Billy Connolly, adding the comedian's voice to its sat nav range.
The Scottish comic's dulcet tones now sit alongside other celebrity luminaries – Sven Goran Eriksson, Snoop Dogg and John Cleese – whose familiar voices guide you safely on your car journey.
And it's not just his Glaswegian twang he has given TomTom but some of his jokes too, including this absolute cracker: "Turn around when possible. It is advisable to turn your entire car around. Do not just turn around inside the car."
Excuse us while we wipe the tears from our eyes.
Wee canny sat nav
Billy Connolly said about his TomTom escapades: "You'll take the high road and I'll take the low road, and I'll be in Scotland afore ye with my wee canny sat nav".
No we have no idea what this means, either.
If you fancy having Billy Connolly telling you where to go, then you will have to pay £8.99 for the privilege.
Oh, and if you think it isn't the real Big Yin, it is as Mr Connelly states in TomTom's press release: "This really is Billy Connolly. It's not the creepy guy you get on cheap birthday cards. It's my real voice. No swearing, no dirty bits, I'll keep you safe".
No swearing or dirty bits? We're out, but if you are still in, then got to www.tomtom.com/billyconnolly (opens in new tab).


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The following research article in a particular field of the history of medicine, written by two eminent experts, Drs Adnan A. Al-Mazrooa and Rabie E. Abdel-Halim, is composed of two parts. This first part surveys the use of narcotics for pain relief from Antiquity up to the Renaissance; the second part is a historical investigation in the contribution of the Islamic medical tradition to develop anaesthesia methods and uses. Reviewing some of the medical texts written by Muslim scholars from the 9th to the 14th century, the authors present evidence that anaesthesia monitoring and resuscitation were practised by Muslim scientists more than 1000 years ago.
Table of contents
1. Narcotics in Greek and Roman medicine
2. Narcotics in The Middle Ages and Islamic era
3. Notes and references
* * *
Pain is a subjective experience which requires the presence of consciousness. Over the ages there has been a demand for methods of relief. In the following sections, we present a brief report about the use of narcotics for pain relief from antiquity up to the Renaissance, in Greek and Roman medicine and in the Middle Ages, before turning to analyse the anaesthesia in the Islamic medical tradition.
1. Narcotics in Greek and Roman medicine
Figure 1: Drawing of the cross section of the Brain and the Eyes made by the 13th century Khalifa ibn Abi Al Mahasin Al-Halabi (from Aleppo) in his book Al-Kafi Fi Al-Kuhl (The Book of Sufficient Knowledge in Ophthalmology) (Source).
Though Celsus [1], in the 1st Century, used opium and mandrake for pain relief, Galen in the 2nd century (as stated by Cumston [2] and De Moulin) recommended great care with the use of powerful narcotics such as opium, considering it a dangerous drug. According to Campbell [4] and Cumston [2], Galen was looked upon as one of the great physicians. He summarized the knowledge accumulated in Greek medicine up to his time and studied every aspect of medicine. In cases of colic or other very violent pains, he used only opium.
After Galen, Greek medicine produced four writers who did not contribute any advancement. Their works mainly consisted of quotations from Hippocrates and Galen [4]. As a consequence, the strong narcotic drug mandrake used by Celsus [1] seems to have fallen into neglect; confirmation of this is that Paulus [5] in the 7th Century, who is regarded as having summed up all medical knowledge accumulated up to his time, did not use it in his trochisci as an anodyne.
Paulus did not give the toxic dose or details of the specific actions of either mandrake or opium. It seems that there was no standardization or regulation of dosage [6] [7]. It was therefore impossible to standardize the results [6] [8] [9] and, attempts at the conquest of pain were sporadic [10].
2. Narcotics in The Middle Ages and Islamic era
Figure 2: The prologue page of a manuscript of Kitab Al-Mansuri Fi Al-Tib written by Muhammad Ibn Zakariya Al-Razi (Source).
In the Middle Ages, Christian Europe was in a state of intellectual stagnation [2] [4] [7] [11] [12] and the theological doctrine that pain serves God's purpose and must not be alleviated militated against the improvement in methods of narcosis. Nuland [7] points out that the Middle Ages in Europe were dark ages so far as advances in the pharmacology of anaesthesia was concerned. However in the East, with the firm establishment of the Muslim supremacy between the 9th and 16th centuries, the study of medicine along with other branches of science revived and acquired a truly scientific nature [2] [4] [13] [14] [15].
Therefore, not only Ibn Sina (Avicenna) [16] but also Al-Razi [17], Al-Baghdadi [18] and Ibn al-Quff [19], paid great attention to the phenomenon of pain. They attributed it not only to a breach of continuity, as stated by Galen, but also to a sudden change of temperament (by only heat, cold or dryness) with or without abnormal humours. Hence, for pain relief, they stressed the treatment of the underlying cause and they subsequently developed a large number of analgesics with variable modes of action. The anaesthetics they described included a wide range of medical plants as well as ice or very cold iced water as an efficient and safe mode of local anaesthesia even though there might be an increase in the pain at the beginning. Refrigeration anaesthesia which is considered by some to be a modern discovery, thus, had its origin in the medicine of the past.
They attributed the anaesthetic action of the various medical plants used to a specific poisonous property of variable strength, and thus according to Ibn Sina (Avicenna) [16], opium is the most powerful, then mandrake, papaveris, henbane or hyocyamus, hemlock, solanum and wild lettuce. These drugs, especially opium, were used as local anaesthetics in dental cases, earache, eye pain and joint pain (especially in gout).
In dentistry, they used opium, mandrake root or henbane juice in the form of pastes, patches or fillings. Gargles from decoctions of mandrake root, henbane root or seeds or the root of solanum were also used.
Opium drops in rose oil, infusion of root of solanum, decoction of papaveris, oil or juice of henbane and angelica juice were used for earache. The relief of eye pains was achieved by either using dressings from mandrake leaves or mixing the eye medicines with mandrake tears or juice of hemlock. Embrocations of the juice of henbane leaves or seeds were also used on the eye and, for joint pains, dressings from mandrake leaves or embrocations from opium, hemlock, henbane or cannabis.
In addition, because it was noticed that severe pain may lead to death, the soporific action of these drugs was employed especially pre-operatively in the cases of amputation, cautery, circumcision and lacerations. They were administered by ingestion, inhalation or rectally. Infusions of solanum, cannabis, opium and mandrake were given orally or rectally on a plug which has to be changed hourly. Opium, mandrake and henbane were also used by inhalation in the form of odorants.
Figure 3: Page of a manuscript copy of al-Razi's Kitab al-Hawi fi al-tibb [The comprehensive book of medicine], as copied by an unnamed scribe in 1441. © Bodleian Library, University of Oxford, MS Marsh 156, folio 2r. (Source).
The wild lettuce has a mild soporific effect. It was used either fresh or boiled as an adjuvant to any of the previous medications or alone in cases of insomnia.
These physicians not only determined the required dose in each drug precisely but also were able to fix the length of time which the anaesthesia was to last with great precision. Avicenna for example, gave the dose of one 'mithkal' of mandrake for 3-4 hours of general anaesthesia.
Unlike Paulus [5], Ibn Sina [16], AI-Razi [17], Al-Baghdadi [18], Ibn EI-Quff [19] and Ibn al-Baytar [20] in the light of their own experiments and observations, described the general and special botanical characters of the plants in detail as well as indicating their habitats and what was best selected from each. They also specified methods for obtaining the active ingredients whether as juice or in the various medical forms that can be prepared as infusions, decoctions or dressings.
They also described the specific actions and side effects on the various systems of the body and stated with great accuracy the required dosage from juice, bark or decoctions as well as the toxic dose. Finally, they outlined the action of antidotes, adjuvants and alternative remedies.
The Muslims must be given the credit for developing the science of botany [12] [13] [21]. Ibn al-Baytar is one of the greatest Arabian botanists [2] [20] [22] [23]. His book Al-Gami' Al-Kabir is the most original among the Arabic materia medica texts of the mediaeval period. Arabic materia medica had a considerable impact on European herbal and antidotarium authors from the 12th to the 17th century [2] [4] [24] [25]. Constantine wrote nothing original; all his books are plagiarisms or skilfully disguised translations from the Arabic. The medicinal remedies reported by Dioscorides are thus of Islamic origin [2]. The same may be said of the work of Celsus which was hardly noticed by the Greeks and overlooked in the Middle Ages [26]. In the section on emollients (vol. 2), Celsus describes one of them as the invention of a certain Arab, and some of his recipes are based on Arabic materia medica with its tables of weights and measures (pound, dirham and dinarium or dinarii).
The only conclusion possible is that the writings of the Muslim scholars in their Latin form influenced European medical thought over a very considerable period.
[1] Celsus, De Medicina. London: Heinemann; Cambridge: Harvard University Press, 1938, vols 1-3.
[2] Cumston C G, An introduction to the history of medicine from the time of the Pharoahs to the end of the XVIII Century. London: Dawsons, 1968.
[3] De Moulin D, "A historical phenomenological study of bodily pain in Western man", Bull Hist Med 1974; 48: 540-70.
[4] Campbell DC, Arabian medicine and its influence on the Middle Ages. Amsterdam: Philo Press, 1974, (reprint).
[5] Paulus Aegineta, The seven books of Paulus Aegineta, translated by F. Adams. London, Sydenham Society, 1844-1847, vols 1-3.
[6] Keys T, The history of surgical anaesthesia, New York: Schuman's, 1945.
[7] Nuland SB, The origins of anaesthesia. Birmingham: The Classics of Medicine Library, 1983.
[8] Tallmadge GK, "Some anaesthetics of antiquity". J Hist Med All Sci 1946: 1: 515-20.
[9] Horine FE, "Episodes in the history of anaesthesia". J Hist Med All Sci 1946; 1: 521-6.
[10] Kitz RJ, Vandam LD, "A history and the scope of anaesthetic practice". In: Miller RD ed., Anaesthesia vol 1, 2nd ed., New York: Churchill Livingstone, 1986, 3-25.
[11] Bickers W, "Adventures in Arabian Medicine". J Roy Coll Surg Ir 1969; 5: 5-14.
[12] Desnos E, "The history of urology up to the latter half of the thirteenth century". In: Murphy LJT, ed., The history of urology. Springfield: Thomas, 1972.
[13] Dickinson EH, The medicine of the ancients. Liverpool: Holden, 1875.
[14] Kirkup JR, "The history and evolution of surgical instruments. I. Introduction". Ann Coll Surg Engl 1981; 63: 279-85.
[15] Sigrid Hunke. Allah's sonne uber dem abendland unser Arabische erbe, Arabic Translation by F. Baidoon and K. Dosoky, 6th Ed. Beirut: Dar AI-Aafak AI-Jadida, 1981.
[16] Ibn-Sina, Kitab aI-qanun fi al-tibb, Beirut: Dar Sadir, reprint of Cairo Boulak edition, 1877.
[17] Al-Razi, Kitab al-Hawi fi al-tibb (Rhazes Liber Continens), vol 23, 1st ed., Hyderabad: Osmania Oriental Publications, Osmania University, 1961. De Moulin D, "A historical phenomenological study of bodily pain in Western man". Bull Hist Med 1974; 48: 540-70.
[18] AI-Baghdadi, Kitab aI-mukhtarat fi al-tibb, vols 1-4, 1st ed. Hyderabad: Osmania Oriental Publications, Osmania University, 1942-1944.
[19] Ibn al-Quff, AI-'Umda fi al-jiraha, vol 1-2, 1st ed. Hyderabad: Osmania Oriental Publications, Osmania University, 1936.
[20] Ibn al-Baytar, Jami' mufradat al-adwia wa-'I-aghzia (A Dictionary of simple drugs), MS No. 3979, Chester Beatty Library in Dublin, Microfilm at Imam Ibn Saud University Library, Riyadh.
[21] Margotta R, in: Lewis, P, ed., An illustrated history of medicine. Feltham: Hamlyn, 1968.
[22] Hamerna SK. "Tareekh Al-Tibb Wa Assaidala End Al-Arab". Vol 1-2. Cairo: 1967.
[23] Ibn Abi Usaybi'a, 'Uyun al-anba' fi tabaqat aI-atibba' (The sources of the knowledge of classes of doctors). Beirut: Dar Maktabat al-Hayat, 1965.
[24] Garrison FH, An introduction to the history of medicine, 3rd ed. Philadelphia and London: Saunders, 1924.
[25] Dunlop DM, "Arabic medicine in England". J Hist Med 1956; 2: 166-82.
[26] Guthrie D, A history of medicine. London: Thomas Nelson, 1945. Dunlop DM, "Arabic medicine in England". J Hist Med 1956; 2: 166-82.


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Ethica Institute of Islamic Finance, the Dubai-based global leader in Islamic finance certification believes that the options in Islamic finance education are only as good as their adherence to third-party standards.
Dubai, United Arab Emirates (PRWEB) November 29, 2013
"Where do I learn Islamic finance?" seems to be the question on everyone's mind these days. With options ranging from short workshops to masters-level programs, students are spoiled for choice. With the spread of Islamic finance globally, the spread of Islamic finance education was sure to follow. The Global Islamic Finance Education research report from Yurizk helps individuals and institutions weigh their options.
Yurizk's CEO Sadia Karim said, "Human capital development is a critical challenge for the Islamic finance industry and previously there was no comprehensive study that addresses the major issues and at the same time backs the insight with collective data. GIFE 2013 bridged that gap of information and brought critical insight into the challenges facing the Islamic finance industry in human resources development and the industry's long term sustainability."
Ethica Institute of Islamic Finance, the Dubai-based global leader in Islamic finance certification, believes that the options in Islamic finance education are only as good as their adherence to third-party standards: "Islamic finance is one of the few global industries in which one cying that it is actually Shariah compliant. The onus is on Islamic finance educators to ensuan get away with calling something 'Shariah compliant' without any independent third-party verifre that what they are teaching has been checked by an Islamic finance scholar as adhering to a globally accepted standard like AAOIFI." Ethica was amongst the report's key contributors and submitted a section on the need for standardizing Islamic finance education.
As options for Islamic finance education grow, the prestige of institutions will likely be measured by their Shariah authenticity more than by any other factor. The Global Islamic Finance Education report gives students a sound starting point before committing to a program of study.
(Long Island Newsday / 28 Nov 2013)---
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Living in Terror Under a Drone-Filled Sky in Yemen
Children fear "planes that shoot" as communities grieve lost loved ones.
A small house, once made of large cement blocks, is reduced to rubble in a sea of untouched homes and shops in Jaar, a town in South Yemen's Abyaan governorate. There are no signs of life where that house once stood -- no photos, furniture, and certainly no people left behind. In May 2011, the house was struck by a drone -- American, the locals say. Some believe the sole occupant, a man named Anwar Al-Arshani, may have been linked to Al Qaeda, although he kept to himself, so no one knows for sure. As Al-Arshani's house smoldered from the powerful blow, townspeople frantically rushed to inspect the damage and look for survivors. And then, just as the crowd swelled, a second missile fired. Locals say 24 people were killed that day, all of them allegedly innocent civilians.
Eighteen-year-old Muneer Al-Asy was among them. His mother Loul says she knows nothing about America -- not of its democracy or politics or people or values. All she knows is that it killed her son. She cannot read and does not own a television. Like many in her village, she says Al-Qaeda is "very bad," but the thought of her youngest son being killed by an American missile haunts her dreams at night. She screams in fury at the people who took her son: "criminals!" She rocks anxiously back and forth on her sole piece of furniture -- a long cushion in her single-room home -- recalling the day her son was "martyred" by a U.S. drone. "I am like a blind person now," says Loul. "Muneer was my eyes."
Thousands of miles from Washington, where the debate rages on over the moral and legal implications of using unmanned aerial vehicles for lethal targeting, the names and faces of many of the victims paints a somber picture. Some are fathers who can no longer buy food and medicine for their children. Some are kids whose only crime in life was skipping out on studies to play soccer with friends. Some are expectant mothers who were simply in the wrong place at the wrong time. As the U.S. focuses attention on the successful targeting of names on the notorious "kill list," the number of innocent civilians killed by U.S. drones on the rise -- threatening to destroy families, spark resentment, and fuel Al-Qaeda recruitment.
While strikes in Pakistan have been recorded since at least June 2004, drones have become more common in Yemen in recent years, used to weed out and eliminate members of Al Qaeda's notorious Arabian Peninsula network (AQAP). AQAP has been linked to recent schemes including the foiled 2012 underwear bomb plot, as well as for parcel bombs intercepted before reaching synagogues in Chicago in 2010. The drone program has seen some successes, including strikes on high-profile targets like Saeed al-Shihri, a Saudi citizen who co-founded AQAP, and senior operatives Samir Khan and Anwar al-Awlaki. The latter was a preacher who often delivered his provocative sermons in English and, like Khan, was at one time an American citizen.
However, with the growing use of so-called "signature strikes" -- attacks against suspected but unidentified targets -- there have been increasingly troubling signs that many victims are deemed guilty by association. Having committed no crime, their names not part of any list and in some cases, not even known.
The targeting of Awlaki's son, 16-year-old Abdulrahman, a minor and an American citizen at the time of the October strike that killed him, has triggered a fiery debate on Capitol Hill over the limits of this technology if American citizens can be killed overseas so unapologetically. Abdulrahman hadn't seen his father in two years when he was killed. He had no known links to Al-Qaeda and is said to have lived the life of an ordinary teenage boy similar to any in America.
AQAP "is a huge problem," Farea Al-Muslimi, a Yemeni activist and analyst who recently testified at the first U.S. Senate Judiciary Committee about the drone wars, addressing an attack on his own village, said in an interview. "What you're doing is making any counter efforts to AQAP more problematic. It has set the rules of the game. They have no problem with getting shot. Even if they die, there is a new generation rising up inside the organization."
U.S drone attacks in Yemen skyrocketed to 53 last year, almost triple the number of attacks in 2011, according to Washington-based think tank the New America Foundation. The civilian casualty rate from those strikes is estimated between 4 percent and 8.5 percent. The George W. Bush administration, by contrast, only launched one drone attack in Yemen in its eight years. In Pakistan, the Obama administration has deployed at least 316 drone strikes since assuming office, versus the 52 strikes conducted by the Bush administration. One of few international organizations attempting to compile statistics on drone-linked deaths, the London-based Bureau for Investigative Journalism (TBIJ), estimates the number of civilians killed in confirmed drone strikes in Yemen is as high as 45 people. However, that does not include the unconfirmed, covert strikes, which TBIJ estimates could account for as many as 136 additional civilian deaths to date. Civilian deaths in Pakistan since 2004 have totaled anywhere from 411 to 884 - with children accounting for as many as 197 of those deaths, TBIJ said.
More significantly, thousands of Yemeni residents are showing signs of a vast range of psychological disorders linked to the fear of living under spy planes and drones, including trauma, anxiety, and post-traumatic stress disorder, particularly since many report hearing a constant buzzing sound from the drones flying overhead. Some women claim to have miscarried from the sound of nearby strikes, and activists say this is a growing phenomenon. None of the families interviewed has received any type of compensation for damage or death. "Whether true or false, if Yemenis believe drones are causing miscarriages, that's as detrimental to the U.S. winning hearts and minds as if it were reality," said Letta Tayler, a Yemen expert with New York-based Human Rights Watch. "There is an enormous amount of anger over the targeted killing program. If the U.S. makes mistakes, it needs to apologize, compensate, and hold thorough investigations to help prevent further deaths of civilians."
In January, the United Nations High Commission on Human Rights launched an inquiry into the impact drones are having on civilians in countries like Yemen, Pakistan, Somalia, and Afghanistan and is aiming to assess whether the program is in-keeping with international law. Many activists in Yemen point to the tight-lipped policies of the American drone program, which make it extremely difficult to prove civilian casualties. "There is no accountability," said Atiaf Alwazir, a Yemeni-American researcher and blogger who has worked to document the cases of civilian victims. "There is no information regarding the kill list. An entire population could be deemed militant because they live in a certain area."
Calls and emails to the White House and Central Intelligence Agency were not returned. The Department of Defense pointed to past comments made by now-CIA director John Brennan last year about the program, in which he notes: "The United States has never been so open regarding its counterterrorism policies and their legal justifications...one can argue that never before has there been a weapon that allows us to distinguish more effectively between Al-Qaeda terrorists and innocent civilians."
Many in Yemen dismiss this. "The U.S. drone has entered the realm of the boogeyman here in Yemen," said Haykal Bafana, a Yemeni-Singaporean international lawyer whose hometown Wadi Hadhramaut has been heavily targeted. "What's the point of winning the war against Al Qaeda if America has to throw away all of its principles and moral values?"
Residents in the oasis governorate of Ma'rib say they are on the front line of this battle. Locals say Al-Qaeda is increasingly moving into their area, and bringing trouble ranging from air strikes to recruitment. At least one civilian has been killed so far this year by a U.S. drone, relatives and local activists say. Fatimah, 9, says she feels frightened from the "planes that shoot" and her heart beats fast every day when she escorts her younger siblings to school. "I'm afraid they will shoot me," she says.
In January, tribesmen blocked the main roads linking to the capital in protest of government neglect. A number of tribes had attempted to alert Yemeni authorities to the increasing presence of Al-Qaeda in their area. But the authorities did nothing. The tribes were forced to rely on themselves, taking up arms against militants in an effort to drive them out. "The reality is my tribe can protect me from Al-Qaeda, but they cannot protect me from drones," said Entisar Al-Qadhi, 30, a native of Ma'rib.
"The Yemeni government had a chance to capture them, arrest them and put them on trial, but they are ignoring this fact and instead, hitting them with drone strikes and causing fear and panic among the local residents and families of that area," said Baraa Shiban, Yemen project coordinator at Reprieve, a legal rights organization that has also worked with detainees at Guantanamo Bay. Yemen's president of 33 years, Ali Abdullah Saleh, an American ally, was forced out of office in February 2012 after a year of popular protests. Many in Yemen have cast doubt over their government's sincerity in the fight against terrorism since the military's offensive against the group has traditionally come in waves. It has also been a steadfast supporter of the drone program, opening its skies and granting liberties to the U.S. government, which last year committed an additional $52 million in aid for areas hit hard by the country's war against Al-Qaida, bringing total annual U.S. assistance to Yemen to $170 million.
In a September interview with the Washington Post, Yemeni President Abd-Rabbu Mansour Hadi said: "Every operation, before taking place, they take permission from the president."
The arguments in support of this evolving form of warfare are both spirited and defensive. Many point to national security, citing the need to take action in the face of credible evidence of deadly plots against the U.S. and its citizens. Advocates of the drone program say that using unmanned planes allows for more time, less pressure and better judgment by its operator than a fighter pilot would have at the controls of an F-18, for instance -- and, as a result, make less mistakes. Many different parties, including lawyers, also supervise drone operators, as opposed to fighter pilots who, in most cases, call the shots on their own. "You do not know collateral damage until you send humans dropping bombs from 35,000 feet who are afraid for their lives," said Mary Cummings, associate professor of Aeronautics and Astronautics at the Massachusetts Institute of Technology and a former fighter pilot for the U.S. Navy. "There is no question in my mind that this is a better way, and with any luck we will get better and better about it and maybe one day we can do it without casualties."
But that is a hard case to make to the people living in fear that they will be the next casualty. Magda Awad Mohammed, 25, was widowed from that double strike in Jaar and is now faced with a daily, gut wrenching fear that she cannot feed her three young children. Her husband Adel Ahmed Mohammed was a day laborer who often took jobs selling bananas in town. She was happy when he didn't come home that day because she assumed it meant he found work. As fate would have it, he was in a souk near to Anwar Al-Arshani's home when it was hit by a drone. "My son is sick and I don't have money to buy him medicine," Magda says. "I can't do anything for them. I am helpless now."


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Destination Mars: The New Age Of Space Exploration
Barack Obama announced ambitious new space plans when he visited the Kennedy Space Center on April 15th.
His speech mentioned "a sequence of deep-space destinations" and "progressing step-by-step until we are able to reach Mars." As I watched his speech, I couldn't help but wonder if this will be the catalyst for a new age of space travel and human discovery, as happened on Earth five centuries ago.
There's also the distinct possibility it will lead to the overturning of the current theory of everything, just as humanity slowly accepted the Earth was not flat half a millennium ago.
This week, news from space offered hope of finding life on planets orbiting dead stars; but also cast more doubt on finding life outside our solar system. It has also been discovered that some planets do not orbit their stars in the same rotational direction, which is the reverse of the dominant scientific theory.
The European Age
One thousand years ago, Europeans must have looked out at the Atlantic Ocean and wondered what lay beyond the horizon. Maybe they thought that God had created the world to keep some knowledge beyond humanity where nobody dared to venture.
Then Christopher Columbus traveled towards the horizon, and beyond it, to start the European migration to the 'New World.' Columbus thought he had reached Asia, yet of course, we now know that he reached a whole new continent previously unknown to him.
Thousands of travelers now cross the sea and horizon by plane and boat every day. On clear nights, many people look up at the sky, marveling at the colours created by the sun rising or setting, and wonder what is really out there among the stars.
Just as we have mapped much of our planet today, our descendants will know our universe as we now know Earth, and look back at our limited knowledge in the same way we viewed world geographical knowledge in Columbus's age. It is likely they will be able to experience space as we now travel around the Earth.
From Moon Landings to Hubble Images
While flying machines are still in relative infancy, telescopes have four times the history, as they were first invented in the early seventeenth century.
Four hundred years of innovation have seen them reach incredible power and intricacy; the pinnacle of the technology is the Hubble telescope that is circling the planet to bring amazingly clear images from galaxies and nebulas almost too far away for us to comprehend.
The only equivalent in Columbus's days might have been the stories and images brought back to Europe by Marco Polo and other travelers to the Far East. As some of those fantastic stories were proven to be accurate, while others were mistaken identities or downright falsities, the same might be true of our current perceptions about the physics of the universe.
It is currently believed that the Cassini spacecraft has discovered liquid methane lakes on Saturn's moon Titan, which if true, is the first surface water found anywhere else in the universe.
NASA also believes they have discovered forty planets outside our solar system, and within a decade, they hope to find one in a habitable zone: the right distance from the sun to retain water on its surface.
The Future Awaits
While we are starting to map the solar system as Columbus began charting the Americas, there had been a long history of sailing before those expeditionary voyages.
Just over forty years ago, the Apollo missions took the first humans to the moon.
While this was a momentous achievement, if space exploration takes us to the edge of our solar system, or even out into intergalactic space, the moon landings might one day seem more like one small step rather than a giant leap.
Don't miss the Top 10 Images Taken By The Hubble Telescope.
What do you think of the new age of space exploration? Does it ignite wonder or skepticism? Share your thoughts in the comments!


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A's upend Indians in rubber match
Oakland, CA – Chris Young homered and had two RBI and Josh Donaldson drove in three runs as the Oakland Athletics upended the Cleveland Indians, 7-3, in the rubber match of a three-game series.
Alberto Callaspo went 3-for-4 with a solo homer, while Dan Otero (2-0) tossed 1 2/3 scoreless innings of relief behind Tommy Milone to earn the win, Oakland's third in four games.
"It was important for us to win this game just as each and every game after this is going to be," Donaldson remarked.
Scott Kazmir (7-6) got some extra rest after a forgettable stint against the Angels on Aug. 9, but the lefty struggled again Sunday, allowing five runs on 10 hits and two walks in five innings of work.
Ryan Raburn hit a solo home run while Jason Kipnis and Carlos Santana each had two hits and an RBI for the Indians, who fell to 3-3 on a nine-game road trip that ends with three games against the Angels.
Young broke a 3-3 tie in the fifth inning with a one-out solo blast over the scoreboard in left field, and Callaspo followed two batters later with a shot just out of Michael Brantley's reach and over the shorter fence in left.
"We busted our butt to be able to tie the game up going into the fifth inning and then it's very crucial to have a sit-down inning to get these guys back up to the plate and it just didn't happen," Kazmir said.
The A's tacked on two insurance runs in the ninth courtesy of Nick Swisher's error at first base. Callaspo scored when Swisher missed Asdrubal Cabrera's routine throw from shortstop, and Donaldson followed with an RBI single.
Jed Lowrie and Derek Norris singled and doubled, respectively, to get Oakland's offense going in the first inning. Lowrie scored on Donaldson's groundout and Norris came around when Young poked a base hit to right field.
Raburn took Milone deep to straightaway center to open the second, but the A's got the run back in the bottom half as Donaldson singled in front of Drew Stubbs in center field to knock in Lowrie.
Callaspo's throwing error led to a pair of runs in the fifth, as Kipnis and Santana each provided run-scoring hits with two outs, signaling the end of Milone's outing.
Milone was starting in place of the injured Bartolo Colon and was charged with three runs -- one earned -- on six hits.
Game Notes
Milone was called up from Triple-A Sacramento after Colon was placed on the 15-day disabled list with a left groin strain ... Kazmir was 4-0 with a 2.65 ERA in six day-game starts this season ... The Indians went 2-for-10 with runners in scoring position and stranded seven baserunners.


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When It Comes To Character Detail, 'Pitch Perfect' Nails It
Pitch Perfect, the new comedy that opened in some cities last Friday and goes wider this Friday, is set in a world very close to my own heart: college a cappella.
I know, I know — it's dorky, it's silly, you hated those people at your school — I get it. But I loved it when I did it, and even now, I carry around a few of these compilations on my phone.
But as much as I enjoyed all the singing (and I did), it's not how the film won me over. What won me over was Beca's raggedy manicure.
Up at the top of the post, that's Beca. Played by Anna Kendrick, she shows up at college as an aspiring DJ whose first stop is an internship at the college radio station. She's not even sure she wants to be in college, but in a very movie-like development, she promises her dad she'll try for a year and participate in something. The something winds up being the Bellas, the women's a cappella group that's fallen on hard times after a disastrous showing in a national competition.
And by the time she's been at school for a while, these are Beca's nails.
Here's why I care: There's absolutely nothing new in the main structure of Pitch Perfect that you haven't seen in other movies about people joining ragtag groups — it's not only a little Bring It On, but a little Bad News Bears, a little Mighty Ducks, a little School Of Rock. A movie like this, in all honesty, is a little like a cover of a song you already know: it's about execution.
But what I liked so much about this one, and what made it feel a little different, is that unlike the grumpy coaches and high-strung weirdos who often are your entry point into a story like this, Beca comes into the movie as a pretty complete, pretty happy person. She has something she loves (making mixes), she's pursuing it in a competent, normal way (working at the radio station), and she gives off a kind of relaxed confidence that's dishearteningly unusual in stories about young women in college. For one thing, it's the same relaxed confidence that the guy she meets (Skylar Astin) has, so we're not in the realm of romances based on anyone needing to lighten up, get more serious, get less serious, pull it together, or learn to love himself or herself. They start likable and stay likable, and the inevitable bumps are the kinds of bumps that likable people sometimes bump into.
So, the manicure: It's very unusual that I would notice anyone's fingernails in a movie, but I genuinely did in this case, and the reason I did is that these are a busy college girl's nails. They tell a whole little tale about her: she keeps them short, she polishes them now and then (dark polish, naturally), but after a while, she's doing other things, and sometimes she picks at them in class, and she doesn't really care that much, so now she has the broken-down manicure of the actual preoccupied 18-year-old. I've had this nail polish. Many if not most women have had this nail polish. When? In college. Old enough to polish your nails, not old enough to keep them up.
It shouldn't be a big deal to see a movie that makes you say, "Whoever made this decision has actually met humans who are kind of like the ones in the movie!" But it is. I have no idea who made this decision, but nails in a movie, on a movie star, are not that way by accident. Somebody decided she should have a deteriorating polish job, and that person was right.
Copyright 2021 NPR. To see more, visit https://www.npr.org.


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Silver Diner Debuts New Local/Healthy Menu
I swear I'm not going to become a food blogger. But I do love food- and apparently people notice when I write about food.
After writing about my brunch at Liberty Tavern, Silver Diner across the street invited me to a dinner with other bloggers to try out their new Fresh & Local menu. The new menu features items that are locally bought ingredients, gluten and allergy free, and health conscious.
I was surprised that co-founder and CEO Robert Giaimo was bluntly honest about the demographic of his customers. He asked how many of us have dined at one of his establishments and then asked how many of us were sober while doing so. Since I live across the street from this particular location I was proud to keep my hand up (even though I think I spent the later night of a Cinco de Mayo there as well.) However since he understands his clientele he also knows where the future of dining was going- and wants Silver Diner to lead the charge as they become the Next Generation Diner.
I was also impressed by the other co-founder and Vice President of Culinary Operations Ype Von Hengst. A chef born in The Netherlands, he was not what I pictured Silver Diner's top food man to be. He knew how to entertain the crowd, comparing the new local produce as food that wasn't cranky from a week long trip across the country.
Like I said I'm no food critic, if you want more informed opinions of the the new menu please consult my good friends at DC Gluttony and Every Food Fits.
I will say this though- they certainly treated us to a feast and it was good- and fellow TMG alumni Lisa approves as well.
Silver Diner is located all over Virginia and Maryland- check out their website to find out where the closest one to you is and if they carry the new menu, which is being rolled out in phases.


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Khabur khäbo͝or´ [key], river, c.200 mi (320 km) long, rising in SE Turkey, and flowing generally south through NE Syria to enter the Euphrates River, near Dayr az Zawr. The Khabur River project, begun in the 1960s, involved the construction of a series of dams and canals. The Khabur valley, which now has about 4 million acres (1.6 million hectares) of farmland, is Syria's main wheat-producing area. In ancient times the Khabur was known as the Habor; along its banks in Gozan the Israelite captives from Samaria were settled in the 8th cent. BC (2 Kings 17.6; 18.11).
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2023, Columbia University Press. All rights reserved.
See more Encyclopedia articles on: Middle Eastern and Iranian Physical Geography


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Lane and Brenda Rees resign from county GOP posts
Lane Rees, who was arrested April 1 and charged with possession and transmission of child pornography, has resigned as Walton County's Republican state committeeman.
His wife, Brenda Rees, also has stepped down as the county's Republican state committeewoman.
They announced their resignations last week in a phone call to Jim Anders, chairman of the Walton County Republican Executive Committee.
The Reeses also resigned their county precinct committee posts, Anders said.
An election to fill their spots will be held at the May 3 meeting of the county's Republican Party Executive Committee, Anders said. The meeting will be at 6 p.m. Any executive committee member can run, and the election will be decided by secret ballot.
State officials have told Anders that the positions can be filled by a vote of just the 34 members of the executive committee. GOP state committeemen and women typically are chosen by a vote of registered Republicans in the county.
Lane Rees, who runs a business called Human Resources Solutions, was arrested by the Walton County Sheriff's Office after the National Center for Missing and Exploited Children found child pornography being sent to and from his work computer.
Rees' plea date is scheduled for May 14.
He served as a county commissioner from 2000 to 2004.
Contact Daily News Staff Writer Tom McLaughlin at 850-315-4435 or email@example.com. Follow him on Twitter @TomMnwfdn.


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Searched for: subject%3A%22Qualitative%255C%252Bresearch%22
(1 - 3 of 3)
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Background. Multiple job holding (MJH) is a common and growing phenomenon in many countries. Little is known about experiences with MJH among older workers. The objective of the present study is to gain insight in experiences with MJH among Dutch workers aged 45 years and older. Methods. Multiple job holders were selected from the Study on...article 2018
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Aims: Information about risk factors and preventive measures given before conception is estimated to prevent 15-35% of adverse pregnancy outcomes. We aimed to identify women's motives for not responding to an invitation for preconception counseling (PCC) from their general practitioner. Methods: A purposive sample of 11 women who did not respond...article 2008


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Release Date: June 25, 2013
Swiss Grind monsters return to the fold with their second Relapse full length 'Flies Will Starve'. Four years in the making, 'Flies Will Starve' further establishes Mumakil as behemoths of the grind-scene---24 overgrown songs of pounding blasting fury that make you feel like you've been run over by a herd of the fictional multi-tusked elephant beasts from which the band derived their name. An absolute must for grind-freaks the world over.


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Story highlights
"It's a monkey on your back," says a man trying to kick the habit
Phillip Seymour Hoffman is the latest in a growing list of deaths
The number of users is rising, and they are getting younger
It's threatening to become an epidemic, says a rehab director
At 33 years old, Jamie is trying to get clean.
The native Bostonian started at a young age: drinking, then smoking pot, then taking pain pills and eventually heroin.
"I never thought in my wildest dreams I would stick a needle in my arm," said Jamie, who didn't want his last name revealed. "Not in a million years."
But the low cost, the readily availability and the prescription pill-like high makes heroin a draw that's hard to resist.
"It's a monkey on your back that you can't shake," he says.
If autopsy results bear out what officials suspect, actor Philip Seymour Hoffman will be the latest in a growing list of substance abusers who paid a deadly price for using heroin.
In July, heroin (mixed with alcohol) took the life of "Glee" star Cory Monteith.
In August, Emylee Lonczak, a 16-year-old Virginia high school student who'd never injected heroin before, died when a friend shot it into a vein for her.
And last week, Maryland officials said that heroin tainted with fentanyl had claimed at least 37 lives since September. Another 22 cases were reported in Pittsburgh and other towns in western Pennsylvania.
To be sure, heroin has been a scourge for a long, long time. But lately, it's showing an uptick that has authorities, health officials and parents disturbed.
"Heroin is pummeling the Northeast, leaving addiction, overdoses and fear in its wake," said James Hunt of the Drug Enforcement Administration's New York Office.
A 2012 survey by the federal Substance Abuse and Mental Health Services Administration (PDF) found that about 669,000 people over age 12 had used heroin at some point in the year. About 156,000 of those were first-time users, and roughly 467,000 were considered heroin-dependent – more than double the number in 2002.
"I've been here over six years, and literally this is the first year that I can remember seeing this many people coming in here with an addiction to heroin," said Robert Parkinson, director of the Beachcomber Rehabilitation Center in Delray Beach, Florida.
It's not at an epidemic level yet, he says, but "it's going to be there. … It's that bad."
Heroin remains comparatively rare, according to administration figures. By comparison, more than 31 million people used marijuana or hashish in 2012 alone, and another 4.7 million used some form of cocaine that year.
But about 4.6 million people – about 1.8% of the teenage and adult population – reported using heroin at some point in their lives, the survey found. The average first-time user was 23.
Here, we examine the reasons behind the rise in heroin use and its fatal draw:
It's cheap. Bill Patrianakos was hooked on OxyContin, a prescription pain reliever. He didn't just like it; he loved it. The problem was, he couldn't afford it.
"I was pawning things: stealing from my parents, my sister, everyone who cared about me," he said. "Even that wasn't enough."
So he moved on to heroin. It gave him the same high, he said, but at a fraction of the cost.
"I started out snorting," he said. "And, of course, to conserve my money, I moved on to shooting it."
The bottom line for users: Heroin is cheap.
Part of the reason is the nationwide crackdown on prescription pill abuse, which has made those drugs harder and more expensive to obtain.
In the first two weeks of 2014, police in Delray Beach, Florida, say, they seized more heroin than they did in the past 10 years combined.
"People were getting pills for $10 around here, and now it's much more expensive," said Delray Beach Police Sgt. Nicole Guerriero. "People are now turning to heroin to get their high."
And how cheap is heroin?
"We've heard for as low as $6 a capsule," she said.
It's everywhere. David is a self-described addict who doesn't want his last name revealed. His drug of choice is oxycodone. But he knows that when he can't get it, he can always score some heroin.
"It's literally five minutes down the road," he said. "It's everywhere. Everywhere."
Pam Anderson of Atlanta lost her college-age son to a heroin overdose.
"In the college campuses what they are doing with it, is like they are just passing bowls of pills," she said.
"They give it out for free to get somebody hooked. And then they start with a lower price on the pills and jack it up, jack it up as they are more addicted."
Indeed, heroin availability rose in 2012, according to the DEA, most likely because of an uptick in Mexican production and traffickers expanding into new markets.
Authorities are doing what they can to put a dent in those activities, but they have a ways to go. Between 2008 and 2012, the amount of heroin seized each year at the southwest border more than tripled.
But pushers are getting creative.
Last month, police said they arrested a McDonald's employee in Pittsburgh for selling heroin in Happy Meal boxes.
It's potent. Heroin makes for a common substitute for prescription pills. But unlike pills, there's no way to regulate the dosage of heroin, given the undetermined purity.
And that can be a fatal recipe.
"Unlike with prescription drugs, heroin purity and dosage amounts vary, and heroin is often cut with other substances, all of which could cause inexperienced abusers to accidentally overdose," the DEA says in its drug threat assessment report for 2013.
Between 1999 and 2009, 32 states saw an increase in heroin-related patients, according to the Department of Health and Human Services.
But rather than acting as a deterrent, the drug's undetermined potency actually serves as a draw for some users.
Last month, at least 22 people in western Pennsylvania died after using heroin that had been mixed with fentanyl, a powerful narcotic used to treat cancer patients' pain. The drug cocktails were being sold under harmless sounding names, such as "Theraflu" and "Bud ice."
Andrew, a 19-year-old Pennsylvanian who didn't want his last name revealed, overdosed on the drug mixture twice and almost died. But he kept going back. It took his friend's overdose death to scare him back into rehab.
"That's the sick thing about addiction," he said. "When someone knows that there are heroin bags that are killing people or making them overdose, then we know that those are the good bags."
It's hard to kick. Last year, Hoffman told TMZ he strugged with substance abuse but kicked the habit for 23 years. But then he fell off the wagon. He started slowly with prescription pills and slipped into snorting cocaine.
That experience is not uncommon.
"Someone with opiate addiction, they are doing pushups their whole lives," said HLN's Dr. Drew Pinsky. "And they must work on it all the time. And even working on it, there's a high probability of relapse. And God willing, they get adequate treatment, and they re-engage in treatment, and things go well."
"But often," he added, "it's a frequently fatal condition."
READ: Piecing together Philip Seymour Hoffman's final hours
READ: Sources: Nearly 50 envelopes of suspected heroin in Hoffman's apartment
READ: 5 reasons we loved Philip Seymour Hoffman
CNN's Shimon Prokupecz contributed to this report.