text:
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
Click here to Subscribe:
$75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.
Click Here to DOWNLOAD the article*:
$20 to access a PDF version of a specific article from the current issue of JCSM.
*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.
Subscribers can download and print full articles from current and past issues of the JCSM
Login to JCSM
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS).
Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety.
All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p < 0.001) and SL-MWT (+2.8 vs -0.4 minutes, p = 0.009) were significantly greater with modafinil than with placebo. ESS total score decreased from > 11 to < 11 at the final assessment in 69.2% of modafinil-treated patients and 30.6% of placebo-treated patients (p < 0.001). Corresponding rates at week 1 were 57.7% and 33.9% (p = 0.014). Changes in nocturnal polysomnography, PSQI, and apnea-hypopnea index from baseline to the final assessment were similar in both groups. Adverse drug reactions occurred in 36.5% and 22.6% of patients in the modafinil and placebo groups, respectively (p = 0.146).
Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy.
Inoue Y; Takasaki Y; Yamashiro Y. Efficacy and safety of adjunctive modafinil treatment on residual excessive daytime sleepiness among nasal continuous positive airway pressure-treated Japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study. J Clin Sleep Med 2013;9(8):751-757.
Obstructive sleep apnea syndrome (OSAS) is a chronic condition characterized by recurrent episodes of upper airway collapse that occur during sleep. OSAS frequently causes nocturnal intermittent hypoxemia, sympathetic activation and fragmented/disrupted sleep.1 Studies of Caucasian and Asian populations have consistently estimated that the prevalence of OSAS associated with excessive daytime sleepiness ranges from 3% to 7% in adult men and from 2% to 5% in adult women.2 In Japan, Nakaya-Ashida et al.3 reported that the prevalence of moderate to severe sleep disordered breathing (respiratory disturbance index ≥ 15) was 22.3% in male workers aged 23-59 years.
Factors predisposing to OSAS include obesity, advanced age, male sex, and craniofacial abnormalities.4,5 The diagnosis of OSAS generally requires objective measurement of obstructive respiratory events and the presence of characteristic symptoms, such as excessive daytime sleepiness and unrestored nocturnal sleep that could not be better explained by other factors.6 Severe OSAS is often associated with vascular morbidities,7,8 cognitive impairment, occupational and vehicular accidents attributable to excessive daytime sleepiness, and worse quality of life than unaffected individuals.9
Current knowledge/Study Rationale: Very few studies, and none in Asian patients, have examined the effects of modafinil on subjective or objective sleep measures in patients with residual sleepiness on optimal nCPAP.
Study Impact: Treatment with 200 mg modafinil once daily improved residual daytime sleepiness in Japanese patients with OSAS on optimal nCPAP compared with placebo.
Management of OSAS requires the use of nasal continuous positive airway pressure (nCPAP) therapy, a first-line treatment, which acts as a pneumatic splint to maintain patency of the upper airway. nCPAP therapy is widely accepted to reduce excessive sleepiness and to improve daytime functioning and self-reported health status.10–12 However, despite the reported improvements of respiratory events, clinically significant excessive sleepiness persists in some patients on optimal nCPAP. In some of these patients, the residual sleepiness may reflect the presence of other sleep disorders, including narcolepsy, behaviorally induced sleep insufficiency syndrome and periodic limb movement disorders.13 In other patients, this outcome may be caused by hypoxia-induced cerebral metabolic changes.14 In a recent study in France, 6.0% (95% confidence interval [CI] 3.9-8.0) of OSAS patients who were optimally treated with nCPAP had evidence of residual excessive sleepiness.15 Considering the potential adverse outcomes that may affect the health and safety of the patients, residual sleepiness requires prompt attention.
The Standards of Practice Committee of the American Academy of Sleep Medicine recommends use of the wake-promoting agent modafinil in nCPAP-treated patients without other identifiable causes for their residual sleepiness.16 Modafinil differs from other amphetamine-like wake-promoting agents, such as methamphetamine and methylphenidate, in its chemical structure and mechanisms of action.17–20 Modafinil mainly interacts with the dopamine transporter,21,22 and affects the γ-amino butyric acid (GABA)-ergic, serotonergic, glutaminergic, noradrenergic, and histaminergic neurotransmitter systems,22–26 which may contribute to its wake-promoting activity. Double-blind placebo-controlled clinical studies on nCPAP-treated patients with residual sleepiness associated with OSAS have revealed that modafinil significantly improved objectively determined sleep latency, overall subjective severity of sleepiness, health-related quality of life, and functional status, and that it was well tolerated.27–29 To date, however, no studies have examined the effects of modafinil on residual excessive sleepiness in Japanese patients with OSAS on optimal nCPAP treatment. Furthermore, although central nervous system stimulants may theoretically disturb nocturnal sleep,30 previous studies have not documented the effects of modafinil on subjective or objective nocturnal sleep measures.
Therefore, in the present study, we evaluated the effects of modafinil on the efficacy and safety of modafinil in Japanese patients with OSAS and excessive daytime sleepiness despite optimal therapeutic use of nCPAP. We also examined the effects of modafinil on subjective and objective measures of nocturnal sleep in these patients.
This randomized, double-blind, placebo-controlled, parallel-group study was conducted at 37 sites specialized in sleep disorders in Japan between May 2009 and December 2009. The study included a screening visit, an observation period ≥ 15 days, and a 4-week double-blind treatment period. The protocol and the informed consent form were reviewed and approved by the internal review board at each institution. All patients provided written informed consent to participate in this study.
Patients evaluated in this study were required to be receiving effective nCPAP therapy to rule out inadequate or incorrect nCPAP use as a cause of their residual sleepiness. Patients with sleep disorders other than OSAS were excluded from the study. The main inclusion criteria for eligible patients in this study were as follows: men and women aged 20-70 years; confirmed diagnosis of OSAS; and the presence of subjective excessive sleepiness (i.e., Epworth Sleepiness Scale [ESS] total score ≥ 11)31 despite optimal use of nCPAP; having received nCPAP therapy for ≥ 3 months and being willing and able to continue its use during the study period; the use of nCPAP for ≥ 70% of nights for ≥ 4 h/night32 for 14 days before the baseline visit; and an apnea-hypopnea index (AHI) ≤ 10 determined by nocturnal polysomnography (PSG) during the observation period. Definitive diagnosis of OSAS or other sleep disorders was made using PSG data obtained before randomization based on Rechtschaffen and Kales criteria33 and American Sleep Disorders Association arousal criteria.34 The data were scored according to American Association of Sleep Medicine criteria.35 Patients who met any of the following criteria were excluded from this study: diagnosis of other sleep disorders (e.g., narcolepsy, periodic limb movement disorders, and central sleep apnea); pregnant, potentially pregnant, or lactating women; presence of arrhythmias, angina, and clinically significant cardiac, respiratory, cardiovascular diseases, psychiatric disorders (e.g., depression36), or hypertension with systolic blood pressure ≥ 160 mm Hg and diastolic blood pressure ≥ 100 mm Hg,37 as specified in the exclusion criteria of the U.S. OSAS study.29 Patients who were concomitantly administered prohibited drugs, such as central nervous system stimulants, sedative medications, antidepressants, antiepileptic drugs, acetazolamide, warfarin, monoamine oxidase inhibitors, or antimigraine drugs, within 2 weeks before the start of the study, were also excluded. Patients fulfilling these criteria were identified by the physicians and invited to participate in the study at the physician's request.
Patients were randomly assigned in a blocked randomization manner to receive 2 tablets of 100 mg modafinil (total dose, 200 mg/day) or placebo once daily in the morning, to be administered before or after meals. Randomization was performed using a computer-generated random number list prepared by an independent contract research organization. Clinicians contacted the organization via telephone to obtain the randomization sequence for each patient.
Efficacy assessments were conducted at the start (i.e., baseline) and at Weeks 1 and 4 of the double-blind treatment period. The primary efficacy measure was ESS score at Week 4 of treatment. The secondary efficacy measure was mean sleep latency on the maintenance of wakefulness test (MWT).38,39 The MWT was conducted in a subset of patients (modafinil, n = 22; placebo, n = 28) at baseline and at Week 4 of the double-blind period on the days immediately after nocturnal PSG. Each MWT session lasted 20 min. Because of the methodology, the MWT was only performed at study sites with the facilities required to conduct the test. Some patients at these facilities were unable to do the MWT because of the burden associated with the test. Other secondary variables were ESS score at each visit, and the total score of Japanese version of Pittsburgh Sleep Quality Index (PSQI),40 which represents the severity of subjective sleep disturbance, and sleep parameters measured by nocturnal PSG at baseline and Week 4. PSG and MWT were conducted in an inpatient setting.
Safety was assessed by evaluating adverse drug reactions (ADRs) as well as the results of general laboratory tests (blood and urine), physiological variables (blood pressure and pulse rate), 12-lead electrocardiograms, and physical examinations. ADRs were defined as any unfavorable or unintended symptom or disease that was considered to be associated with the study drug during the study period.
Continuous demographic variables were compared using the 2-sample t-test. Categorical variables were compared using the Fisher exact test. The efficacy population (n = 114) was defined as patients who received ≥ 1 dose of modafinil and underwent ≥ 1 postbaseline evaluation for any efficacy or safety variable during the treatment period. The changes in efficacy variables (ESS and MWT) from baseline to the final assessment (Week 4) were compared between the modafinil and placebo groups using analysis of covariance with the baseline value as a covariate. To verify the efficacy of modafinil administration, the point estimate and 2-sided 95% (CI) of the difference between the modafinil and placebo groups were calculated using the least squares mean (LS mean) method. Statistical tests were performed at a significance level of 5% using SAS System (Release 9.1.3, SAS Institute Inc., Cary, NC, USA). Changes in other secondary variables (PSQI and nocturnal PSG) from baseline were also compared between the modafinil- and placebo-treated groups. Safety data are summarized using descriptive statistics.
A total of 114 patients were randomized—52 patients to modafinil and 62 patients to placebo. All 114 patients completed the study (Figure 1). There were no differences between the 2 groups in terms of demographic and baseline characteristics (Table 1). Males accounted for > 94% of the patients in both groups. Before starting treatment with the study drug, the patients in both groups had moderate levels of residual sleepiness, with mean total ESS scores ≥ 14 despite effective nC-PAP therapy; mean AHI was ≤ 10 in both groups. The mean duration of nCPAP use per night was 6.1 ± 1.0 and 6.0 ± 0.6 h in the modafinil and placebo groups, respectively (Table 1). Concomitant diseases included hypertension (modafinil, n = 13 [25%]; placebo, n = 20 [32%]) and hyperlipidemia (modafinil, n = 4 [8%]; placebo, n = 14 [23%]).
Patient characteristics
(more ...)
*37 patients were not randomized to the study for the following reasons: 35 patients did not meet the eligibility criteria, one patient withdrew consent, and one patient gave up on the starting dose because of changes in work schedule.
Patient disposition*37 patients were not randomized to the study for the following reasons: 35 patients did not meet the eligibility criteria, one patient withdrew consent, and one patient gave up on the starting dose because of changes in work schedule.
Mean ESS total scores were determined at baseline and at the final assessment in both groups. The mean changes in ESS total score from baseline to the final assessment were -6.61 in the modafinil group and -2.44 in the placebo group (LS mean). The between-group difference of -4.17 (95% CI -5.66 to -2.69) was therefore significantly greater with modafinil than with placebo (p < 0.001). The change in mean ESS total score at 1 week after starting treatment was also significantly greater in the modafinil group than in the placebo group (p < 0.001; Figure 2).
The least significant mean change from baseline ± standard error is shown in the table. *The pvalues were determined by analysis of covariance.
Mean Epworth Sleepiness Scale total score at baseline, and after 1 and 4 weeks of treatment with modafinil or placeboThe least significant mean change from baseline ± standard error is shown in the table. *The pvalues were determined by analysis of covariance.
The patients whose ESS total scores were ≥ 11 at baseline and decreased to < 11 at the final assessment were defined as responders with normalization of ESS. Overall, 69.2% of patients (36/52) treated with modafinil and 30.6% of patients (19/62) treated with placebo were classified as responders. The Fisher exact test showed that a significantly higher percentage of patients treated with modafinil were classified as responders compared with patients treated with placebo (p < 0.001). The corresponding response rates at week 1 were 57.7% (30/52) and 33.9% (21/62) (p = 0.014).
Fifty patients (modafinil, n = 22; placebo, n = 28) underwent the MWT. There were no differences in patient characteristics, including baseline ESS total score, between patients who did or did not undergo the MWT (p = 0.292). Mean sleep latencies determined by MWT at baseline and at the final assessment in both groups are shown in Figure 3. The LS mean change in MWT sleep latency from baseline to the final assessment was 2.8 min in the modafinil group and -0.40 min in the placebo group. The between-group difference of 3.2 min (95% CI 0.8 to 5.6) was statistically significant, showing greater effects of modafinil versus placebo (p = 0.009).
*The p-value was determined by analysis of covariance.
Mean maintenance of wakefulness test sleep latency at baseline and after 4 weeks of treatment with modafinil or placebo*The p-value was determined by analysis of covariance.
Summary statistics for sleep parameters were determined in 101 patients who underwent nocturnal PSG at baseline and at the final assessment (modafinil, n = 45; placebo, n = 56). As shown in Table 2, there were no significant differences in the changes in any nocturnal PSG parameters between the 2 groups.
Comparison of nocturnal PSG indices at baseline and after 4 weeks of treatment with modafinil and placebo
The total PSQI score decreased from 6.3 ± 2.7 at baseline to 4.8 ± 2.2 at the final assessment in the modafinil group, as compared with a change from 6.1 ± 2.3 to 5.4 ± 1.7 in the placebo group. The mean difference in total PSQI score between the 2 groups for the change from baseline to the final assessment was -0.7 points (95% CI: -1.5 to 0.0 points) and was not statistically significant.
ADRs were reported by 19 patients (36.5%) in the modafinil group and 14 patients (22.6%) in the placebo group. There were no significant differences in the rate of ADRs between the 2 groups (p = 0.146; Fisher exact test). The most frequent ADRs in the modafinil group were headache (n = 6, 11.5%), insomnia (n = 2, 3.8%), and palpitation (n = 2, 3.8%). The most frequent ADRs in the placebo group were headache (n = 4, 6.5%) and upper abdominal pain (n = 2, 3.5%) (Table 3). All of these ADRs were mild or moderate in severity, and no deaths or other serious adverse events were reported. None of the patients withdrew from the study because of ADRs.
Adverse events occurring in two or more patients in either treatment group
Regarding the time of onset of ADRs, the frequency of ADRs was greatest within 7 days after starting treatment in both the modafinil group (15/19 patients who experienced ADRs) and the placebo group (10/14 patients).
Laboratory test abnormalities included increased γ-glutamyl transpeptidase in one patient in each group; increased alkaline phosphatase in one patient in each group; increased alanine aminotransferase and increased thyroid stimulating hormone in one patient each in the modafinil group; the presence of urinary glucose and decreased white blood cell count in one patient each treated with placebo; and multiple liver enzyme abnormalities (increased aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase) in one patient treated with placebo. Decreased body weight (from 77.0 kg at baseline to 73.0 kg at week 4 of the treatment period) was observed in one patient treated with modafinil. Sinus tachycardia (at Week 1 of the treatment period) and sinus bradycardia (at Week 4 of the treatment period) were observed in one patient each in the modafinil group. Ventricular extrasystole (at Week 1 of the treatment period) was observed in one patient treated with placebo. No clinically relevant abnormalities were observed in the other variables, including laboratory tests, blood pressure, pulse rate, body weight, or electrocardiogram.
This study was the first Asian study to investigate the efficacy of modafinil for treating residual sleepiness in patients with nCPAP-treated OSAS using both subjective and objective measures. In this study, residual sleepiness was defined as excessive daytime sleepiness in patients who were compliant with OSAS treatment but had subjective sleepiness without any other identifiable cause of sleepiness, applying enrollment criteria identical to those in studies in the United States.27,29 The degree of residual sleepiness at baseline, as represented by the ESS total score, of the patients enrolled in this study, was also comparable to that in the US studies.27,29
The use of the MWT was limited to a subgroup of patients in this study; hence, a subjective measure of sleepiness (the ESS) was used as the primary efficacy parameter. Consequently, in this 4-week study, the improvement in ESS total score was significantly greater in the modafinil group than in the placebo group. Four weeks of treatment with modafinil normalized the ESS total score in approximately two-thirds of the patients. In terms of ESS total score, significant improvements of excessive daytime sleepiness in the modafinil group were observed at the first posttreatment evaluation, i.e., one week after starting treatment, compared with the placebo group. Overall, the mean ESS total scores were normalized (to < 11) within 1 week of modafinil administration in 57.7% of patients, increasing to 69.2% at week 4. Modafinil also improved sleep latency determined by the MWT, representing the patient's ability to maintain wakefulness.
As described above, modafinil exerts its wake-promoting activities by targeting several neurotransmitter systems, rather than a specific molecule or specific neurotransmitter system. Thus, the effects of modafinil on residual sleepiness in OSAS patients are at least partly attributable to its nonspecific pharmacological actions.
The present study evaluated adjunctive oncedaily administration of 200 mg modafinil. Another placebo-controlled study evaluated this dose and a higher dose (400 mg once daily) in a comparable patient population.29 Interestingly, when the efficacy data for the 200 mg doses in both studies were compared, the changes in ESS score from baseline to Week 4 of treatment were -6.52 ± 5.04 (n = 52) and -3.20 ± 4.25 (n = 95) in our study and in the US study,29 respectively. The respective changes in MWT sleep latency were 2.97 ± 5.25 (n = 22) and 1.20 ± 4.33 (n = 84). These data suggest that the response to 200 mg/day modafinil is greater in Japanese patients than in US patients, which may indicate slight differences in pharmacokinetic profiles among different ethnicities, as already reported among other ethnic groups.41,42 Differences in the pharmacokinetic profiles, including the absorption and distribution of modafinil, may also be attributable to the differences in body size between Japanese and US patients, as the mean BMI of patients treated with 200 mg modafinil was 27.9 ± 4.3 kg/m2 in our study versus 36.2 ± 7.6 kg/m2 in the US study.29 Alternatively, excess obesity is known to exacerbate daytime sleepiness,43,44 possibly resulting in more severe symptoms or less apparent improvements in symptoms in US patients than in Japanese patients. Additionally, differences in the timing or content of the morning meal may partly explain the differences in clinical outcomes between these studies. Nevertheless, the precise reasons for this difference between Japanese and US patients are unclear, and this study was conducted to evaluate safety and efficacy in Japanese OSA patients and not to elucidate the difference between US and Japanese patients. However, the trends in positive outcomes for patient-reported sleepiness and objectively determined sleep latency in the present study were similar to those reported in the US study.29
Of note, in this study of Japanese patients, treatment with modafinil did not significantly affect sleep parameters in terms of nocturnal PSG findings or total PSQI score. Therefore, the administration of modafinil in the morning did not seem to adversely affect the structure or quality of nocturnal sleep.
Generally, modafinil was well tolerated. The safety and tolerability findings of the current study are consistent with those of other double-blind placebo-controlled studies.27,29 Headache, insomnia, and palpitation were the most common ADRs in modafinil-treated patients. However, modafinil therapy was not associated with clinically significant changes in blood pressure or heart rate relative to placebo. Furthermore, there were no serious adverse events in either group in this study.
Some limitations of this study should be mentioned. First, most of the patients in this study were male, and there are some differences in the pharmacokinetics of modafinil between males and females.41,42,45 Second, we only included patients with OSAS on nCPAP. The efficacy of modafinil should therefore be evaluated in OSAS patients with residual sleepiness on other treatments.
In conclusion, residual daytime sleepiness was improved in Japanese patients with OSAS treated with 200 mg modafinil once daily. We found significant improvements in ESS total scores at 1 week after starting modafinil that were maintained until the end of the 4-week study. Modafinil may be an effective and well-tolerated adjunct treatment for the chronic management of residual daytime sleepiness in patients with OSAS who experience excessive daytime sleepiness despite regular nCPAP use.
This study was funded by Alfresa Pharma. Dr. Inoue has consulted for Hisamitsu Pharmaceutical Co., Inc. He has also provided expert testimony for Nippon BoehringerIngelheim Co., Ltd.; Philips Respironics GK; Alfresa Pharma Corporation; Takeda Pharmaceutical Company Limited; MSD, K.K.; Pacific Medico Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; and Mitsubishi Tanabe Pharma Corporation. He has received lecture fees or service bureau fees from Philips Respironics GK; Takeda Pharmaceutical Corporation; Otsuka Pharmaceutical Co., Ltd.; and Eisai Co., Ltd. Lastly, he has received manuscript preparation fees from Takeda Pharmaceutical Company Limited and Eisai Co., Ltd. The other authors have indicated no financial conflicts of interest.
adverse drug reactions
apnea-hypopnea index
confidence interval
Epworth Sleepiness Scale
γ-aminobutyric acid
least squares
nasal continuous positive airway pressure
obstructive sleep apnea syndrome
Pittsburgh Sleep Quality Index
sleep latency on maintenance of wakefulness test
The authors thank the members of the Modafinil OSAS Study Group in Japan for their help in this study.
Eckert DJ, Malhotra A, authors. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:144–53. [PubMed Central][PubMed]
Punjabi NM, author. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43. [PubMed Central][PubMed]
Nakayama-Ashida Y, Takegami M, Chin K, et al., authors. Sleep disordered breathing in the usual lifestyle setting as detected with home monitoring in a population of working men in Japan. Sleep. 2008;31:419–25. [PubMed Central][PubMed]
Ito D, Akashiba T, Yamamoto H, Kosaka N, Horie T, authors. Craniofacial abnormalities in Japanese patients with severe obstructive sleep apnoea syndrome. Respirology. 2001;6:157–61. [PubMed]
Young T, Skatrud J, Peppard PE, authors. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6. [PubMed]
McNicholas WT, author. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc. 2008;5:154–60. [PubMed]
Nieto FJ, Young TB, Lind BK, et al., authors. Association of sleep disordered breathing, sleep apnea and hypertension in a large community-based study. JAMA. 2000;283:1829–36. [PubMed]
Peppard PE, Young T, Palta M, Skatrud J, authors. Prospective study of the association between sleep disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. [PubMed]
Finn L, Young T, Palta M, Fryback DG, authors. Sleep disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study. Sleep. 1998;21:701–6. [PubMed]
Jenkinson C, Davies RJ, Mullins R, Stradling JR, authors. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999;353:2100–5. [PubMed]
Jenkinson C, Davies RJ, Mullins R, Stradling JR, authors. Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea. QJM. 2001;94:95–9. [PubMed]
Hack M, Davies RJ, Mullins R, et al., authors. Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnea. Thorax. 2000;55:224–31. [PubMed Central][PubMed]
Guilleminault C, Philip P, authors. Tiredness and somnolence despite initial treatment of obstructive sleep apnea syndrome (what to do when an OSA patient stays hypersomnolent despite treatment). Sleep. 1996;29:S117–22.
Macey PM, Kumar R, Woo MA, Valladares EM, Yan-Go FL, Harper RM, authors. Brain structural changes in obstructive sleep apnea. Sleep. 2008;31:967–77. [PubMed Central][PubMed]
Pépin J-L, Viot-Blanc V, Escourrou P, et al., authors. Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study. Eur Respir J. 2009;33:1062–7. [PubMed]
Morgenthaler TI, Kapen S, Lee-Chiong T, et al., authors; Standards of Practice Committee American Academy of Sleep Medicine. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031–5. [PubMed]
Duteil J, Rambert F, Pessonnier J, Hermant JF, Gombert R, Assous E, authors. Central α1-adrenergic stimulation in relation to the behavior stimulating effect of modafinil; studies with experimental animals. Eur J Pharmacol. 1990;180:49–58. [PubMed]
Lin JS, Roussel B, Akaoka H, Fort P, Debilly G, Jouvet M, authors. Role of catecholamines in the modafinil and amphetamine induced wakefulness, a comparative pharmacological study in the cat. Brain Res. 1992;591:319–26. [PubMed]
Simon PH, Panissaud CH, Costentin J, authors. The stimulant effect of modafinil on wakefulness is not associated with an increase in anxiety in mice: a comparison with dexamphetamine. Psychopharmacology. 1994;114:597–600. [PubMed]
Shelton J, Nishino S, Vaught J, Dement WC, Mignot E, authors. Comparative effects of modafinil and amphetamine on daytime sleepiness and cataplexy of narcoleptic dogs. Sleep. 1995;18:817–26. [PubMed]
Mignot E, Nishino S, Guilleminault C, Dement WC, authors. Modafinil binds to the dopamine uptake carrier site with low affinity. Sleep. 1994;17:436–7. [PubMed]
Madras BK, Xie Z, Lin Z, et al., authors. Modafinil occupies dopamine and norepinephrine transporters in vivo and modulates the transporters and trace amine activity in vitro. J Pharmacol Exp Ther. 2006;319:561–9. [PubMed]
Tanganelli S, Fuxe K, Ferraro L, Janson AM, Bianchi C, authors. Inhibitory effects of the psychoactive drug modafinil on gamma-aminobutyric acid outflow from the cerebral cortex of the awake freely moving guineapig. Possible involvement of 5-hydroxytryptamine mechanisms. Naunyn Schmiedebergs Arch Pharmacol. 1992;345:461–5. [PubMed]
Ferraro L, Tanganelli S, O'Connor WT, Antonelli T, Rambert F, Fuxe K, authors. The vigilance promoting drug modafinil decreases GABA release in the medial preoptic area and in the posterior hypothalamus of the awake rat: possible involvement of the serotonergic 5-HT3 receptor. Neurosci Lett. 1996;220:5–8. [PubMed]
Ferraro L, Antonelli, Tanganelli S, et al., authors. The vigilance promoting drug modafinil increases extracellular glutamate levels in the medial preoptic area and the posterior hypothalamus of the conscious rat: prevention: by local GABAA receptor blockade. Neuropsychopharmacology. 1999;20:346–56. [PubMed]
Ishizuka T, Sakamoto Y, Sakurai T, authors. Modafinil increases histamine release in the anterior hypothalamus of rats. Neurosci Lett. 2003;339:143–6. [PubMed]
Pack AI, Black JE, Schwartz JRL, Matheson JK, authors. Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea. Am J Respir Crit Care Med. 2001;164:1675–81. [PubMed]
Dinges DF, Weaver TE, authors. Effects of modafinil on sustained attention performance and quality of life in OSA patients with residual sleepiness while being treated with nCPAP. Sleep Med. 2003;4:393–402. [PubMed]
Black JE, Hirshkowitz M, authors. Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome. Sleep. 2005;28:464–71. [PubMed]
Nishino S, Okura M, Mignot E, authors. Narcolepsy; Genetic predisposition and neuro-pharmacological mechanisms. Sleep Med Rev. 2000;4:57–99. [PubMed]
Johns MW, author. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. [PubMed]
Kribbs NB, Pack AI, Kline LR, et al., authors. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147:887–95. [PubMed]
Rechtschaffen A, Kales A, authors. Manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. 1968. Washington, DC: US Government Printing Office.
Atlas Task Force of the American Sleep Disorders Association. EEG Arousals: scoring rules and examples. Sleep. 1992;15:174–84.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89. [PubMed]
Koutsourelakis I, Perraki E, Bonakis A, Vagiakis E, Roussos C, Zakynthinos S, authors. Determinants of subjective sleepiness in suspected obstructive sleep apnoea. J Sleep Res. 2008;17:437–43. [PubMed]
National Heart Lung and Blood Institute, National Institutes of Health. What is high blood pressure? Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/.
Mitler MM, Gujvarty KS, Browman CP, authors. Maintenance of wakefulness test: a polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence. Electroencephalogr Clin Neurophysiol. 1982;53:658–61. [PubMed Central][PubMed]
Poceta JS, Timms RM, Jeong DU, Ho SL, Erman MK, Mitler MM, authors. Maintenance of wakefulness test in obstructive sleep apnea syndrome. Chest. 1992;101:893–7. [PubMed]
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ, authors. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28:193–213. [PubMed]
Guo T, Zhao LS, Xia DY, authors. Pharmacokinetic study of modafinil in relation to gender and ethnicity in healthy young Chinese volunteers. J Pharm Pharm Sci. 2010;13:443–9. [PubMed]
Tao G, Longshan Z, Kehua W, et al., authors. Population pharmacokinetics of modafinil in Chinese Han, Mongolian, Korean, Uygur, and Hui healthy subjects determined by nonlinear mixed-effects modeling. Ther Drug Monit. 2010;32:189–93. [PubMed]
Bixler EO, Vgontzas AN, Lin HM, et al., authors. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005;90:4510–5. [PubMed]
Vgontzas AN, Bixler EO, Tan TL, et al., authors. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158:1333–7. [PubMed]
Wong YN, King SP, Simcoe D, et al., authors. Open-label, single-dose pharmacokinetic study of modafinil tablets: influence of age and gender in normal subjects. J Clin Pharmacol. 1999;39:281–8. [PubMed]


text:
Official opening kicks off seventh edition of Moscow Grand Slam
Moscow, Russia, June 10, 2014 - An official opening of
the Moscow FIVB Grand Slam took place on Tuesday at the Dinamo Center for beach sports at the Vodniy stadium in Russia's capital.
"We are pleased to welcome all of you once again to one of the biggest events in international beach volleyball. Moscow is hosting the FIVB Grand Slam for the seventh consecutive year," said
Ilya Volodarsky.
Herwin Brillemans noted the important role of Russia in beach volleyball and the high profile of the Moscow Grand Slam.
"On behalf of the International Volleyball
Federation we are delighted to welcome everyone to the Moscow Grand Slam. Russia is
an important country for the world of volleyball, including beach volleyball.
There are lot of talented players in your country, who have already shown good
"This year we have quite a tight start to the season. Several weeks ago was the Anapa Open in Russia, then the European Championship final in Italy and now the Grand Slam in Moscow. We want to have a successful event here - the home tournament was always very special for us. Last year one of our teams took fifth place in Moscow so I want, at least, to repeat this result this year," said Solyustri.
One of the leading players of the Russian men's team Vyacheslav Krasilnikov promised that the Russians will do everything to please their fans.
"Last year I took fifth place in Moscow with my partner Konstantin Semenov, so this year we'll do everything to make it, at least, to the semifinals. We want to see many fans at the stands because it's a very great feeling to play in front of home stadium. I want to invite everybody to the Vodniy Stadium from June 11 to 15. It will be interesting!" said Krasilnikov.
The matches of FIVB Beach Volleyball Moscow Grand Slam will start on June 11 with a qualifying tournament with the pool play matches starting the next day. The winners of the competition will be decided on Sunday, June 15.

subset: commoncrawl


text:
by Matthew Dalby, sports information graduate assistant
FLORENCE, S.C. – The No. 6-seed Georgia College softball team (15-35) fought hard, but couldn't muster enough runs to top the Jaguars of Augusta State University (32-17), falling 6-0 in the Peach Belt Conference (PBC) Tournament.
Junior Sabrina Chandler (Covington, Ga.) looked great early on, going through the first two innings unscathed. Unfortunately, the Jaguars would tack on a run in each of the next two innings before plating three in the bottom of the fifth to give them a 5-0 lead.
GC struggled offensively, managing just four hits in the game. The Bobcats got all four hits in the first three innings of play, before Jaguar pitchers Emily Headrick and Hather Hughes combined to retire 15 of the last 16 batters they faced.
Freshman Whitney Okvist (Kennesaw, Ga.) 1-for-3 on the day, leading-off the game with a single. Classmate Lindsey Conway (Madison, Ga.) backed that up with a single of her own and finished 1-for-3 as well.
It was a magical run for the Bobcats down the stretch, as they won three of their last five games to end the season. GC shocked No. 3-seed Columbus State 3-1 in the first round of the PBC Tournament, before falling to No. 2-seed Armstrong Atlantic, 4-2.
Georgia College says goodbye to four seniors in Kati Pickowitz (Keller, Texas), Brandie Monroe (Savannah, Ga.), Lauren Potts (Gray, Ga.) and Bailey Thompson (Vidalia, Ga.), all of whom have contributed greatly to the softball program during their careers.
The 'Cats will bring back seven starters next year, including all-conference performers Haley Burnett (Columbus, Ga.), Anna Parker (Columbus, Ga.) and Okvist.
The Georgia College Department of Athletics, back-to-back winners of the PBC Commissioner's Cup, sponsors 10 varsity athletic programs at the NCAA Division II level. As a Division II program, Bobcat Athletics prides itself on balancing the life of the student-athlete, evidenced by the teams' multiple appearances in post-season competition as well as documented academic success and community-service involvement. Sign up at www.twitter.com/BobcatSports and www.facebook.com/gcbobcats for up-to-the-minute reports, and visit www.GCBobcats.com for more information, and to nominate your favorite former Bobcats and Colonials to the GC Athletics Hall of Fame.


text:
Anyone can give up, it's the easiest thing in the world to do. But to hold it together when everyone else would understand if you fell apart, that's true strength
Diagnosed with severe Crohn's colitis in May 2005. I deal with daily arthritis ALL over my body, cystic acne, & fibromyaglia. Have taken Imuran, Remicade, TPN, Colozal, Entocort, Flagyl, PamineForte, Cipro, Dicyclomine, Prednisone, Asacol, Prevacid, and the list goes on. Taking low amounts of Pred now & 3600mg of Asacol currently...Can't wait till I can get back on Remicade, my miracle drug!


text:
Therapeutic Effect of Quercetin and the Current Treatment of Erosive and Atrophic Oral Lichen Planus
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01375101
Recruitment Status : Unknown
Verified July 2011 by Mashhad University of Medical Sciences.
Recruitment status was: Recruiting
First Posted : June 17, 2011
Last Update Posted : July 26, 2011
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
Lichen planus (LP) is a common chronic inflammatory mucocutaneous disease with an immunologic etiology ,which has number of different clinical forms. Alternative natural or herbal origine drugs with antioxidant and anti-inflammatory properties have been used individually or in combination with systemic corticosteroids in order to decrease adverse drug reactions.
This study was conducted to evaluate the effect of quercetin on treatment of erosive -atrophic lesions of oral lichen planus (OLP).
|Condition or disease
|Atrophic Oral Lichen Planus Erosive Oral Lichen Planus
|Drug: placebo Drug: Quercetin
|Phase 1
|Study Type :
|Interventional (Clinical Trial)
|Estimated Enrollment :
|30 participants
|Intervention Model:
|Parallel Assignment
|Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
|Primary Purpose:
|Study Start Date :
|April 2010
|Estimated Primary Completion Date :
|September 2011
|Estimated Study Completion Date :
|September 2011
Active Comparator: quercetin
quercetin is one of flavonoids , and having therapeutical anti-inflammatory and antioxidant action
Drug: Quercetin
The patient is directed to digest quercetin hydrate capsule two times a day,until one mouth
Placebo Comparator: placebo
placebo capsul is produced with lactose for using in placebo/ control group.
Drug: placebo
The patient is directed to use placebo capsule two times a day, ,until the one mouth
- the effects of this Drug on OLP measured with VAS scale for pain and evaluation of intensity of lesions. [ Time Frame: 2 months ]In the present work the Analogical Visual Scale is used TO evaluate pain,and we also record the intensity of lesions weekly and any side effect of this Drug
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|12 Years to 60 Years (Child, Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- confirmation of clinical diagnosis of Atrophic and erosive lichen planus by histological examination
- two weeks wash out periods after the last treatment
- having the experience of atrophic and erosive lesion greater than 1 cm having the experience of pain and burning greater than 3.5 in VAS Score
Exclusion Criteria:
- confirmation of dysplasia and malignancy in histologic examination
- confirmation of lichenoid reaction in histologic examination
- pregnancy and breast feeding
- using fluorokinolon and cyclosporin which interact with quercetin
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01375101
|Contact: maryam amirchaghmaghi, assistant professor
|Iran, Islamic Republic of
|Mashhad university of Medical science, Research Center of oral and maxillofacial medicine
|Mashhad, Khorasan Razavi, Iran, Islamic Republic of, 91735
|Contact: maryam amirchaghmaghi, assistant professor 0098-0511882901 firstname.lastname@example.com
|Responsible Party:
|maryam amirchaghmaghi, assistant professor of oral medicine department- mashhad medical school
|ClinicalTrials.gov Identifier:
|NCT01375101 History of Changes
|Other Study ID Numbers:
|First Posted:
|June 17, 2011 Key Record Dates
|Last Update Posted:
|July 26, 2011
|Last Verified:
|July 2011
lichen planus
Lichen Planus, Oral
Lichen Planus
Pathological Conditions, Anatomical
Lichenoid Eruptions
Skin Diseases, Papulosquamous
Skin Diseases
Mouth Diseases
Stomatognathic Diseases
Molecular Mechanisms of Pharmacological Action
Protective Agents
Physiological Effects of Drugs


text:
Egypt troops in Sinai sweep mistakenly hit funeral
CAIRO Egyptian troops and police mistakenly fired on a Bedouin funeral in the Sinai Peninsula on Tuesday, security officials said, in the opening salvo of a sweep searching for security personnel kidnapped by suspected militants.
The incident illustrated the hazards of the military operations prompted by the kidnapping last week. A heavy handed attempt to free the captives risks bringing a backlash in Sinai, where resentments among the local population against past security crackdowns have fueled the rise of militancy in the volatile peninsula bordering Gaza and Israel.
Faced with anger among the public and within the security forces over the kidnappings, President Mohammed Morsi has said all options are on the table for securing the release of the seven captives and that the presidency is not negotiating with the kidnappers.
On Tuesday, Interior Minister Mohammed Ibrahim said the zero hour for an operation against the kidnappers has not yet been decided particularly since they are well armed, with anti-aircraft and anti-tank missiles. He spoke to the state news agency MENA.
Calls for a tough response have been fueled by a video released this week on YouTube showing the captives blindfolded and pleading for Morsi and his defense minister to meet the kidnappers' demands for the release of scores of prisoners from the Sinai, including convicted militants. The captives include six members of the security forces and a military border guard.
But multiple officials have said mediators have been in contact with the kidnappers exploring possibilities for their release. Islamist allies of Morsi who have connections to militants in the Sinai have urged a negotiated solution.
«This crisis must be resolved. I think a political solution must be given a priority to protect the lives of the conscripts and not to cause further deterioration to the situation in Sinai,» said Tarek el-Desouki, a leading member of the ultraconservative Salafi Al-Nour Party who traveled to Sinai to meet with officials there about the crisis. «There is still a chance.»
El-Desouki said the security deployment is «acceptable as a pressure card to force them to accept a political solution.»
Since Monday, military and police reinforcements backed by armored vehicles and helicopters have moved into northern Sinai in a show of strength, deploying heavily around the provincial capital, el-Arish. A military official in Cairo said troops are conducting reconnaissance and search operations, but wouldn't say if this is start of operation to rescue captives. The official spoke on condition of anonymity because he was not authorized to talk about the operations.
Tuesday's incident came while police and military troops backed by helicopters swept through several villages near the border with Israel where officials say they suspect the captives are held.
The forces encountered a funeral convoy of eight pickup trucks and when the vehicles refused orders to stop, the troops thought they were gunmen and opened fire, security officials said.
Some in convoy fired back most Bedouin are armed prompting clashes, until the mourners fled the scene, 경주출장샵 leaving behind the body of the man they had intended to bury. The troops thought the man had been killed in the fight, until local tribal leaders explained to security commanders that the convoy was a funeral for a man who had drowned, the officials said.
Ahmed Elayan, a tribal chief in the area and close to the tribe of the drowned man, said the helicopter crew suspected the funeral procession, which had the body in an open-back truck, to be a convoy of militants.
«The helicopter came all the way down low and forced the vehicle to stop,» Elayan said. «They let us go when they cleared up the situation.» He said the misunderstanding was clarified after calls to security agencies. When a senior military officer learned of the incident, he came to the funeral, Elayan said. «They didn't want to upset anyone.»
Morsi has been consulting with his security team, government officials, political and religious leaders how to resolve the crisis, which highlighted the complex security situation in Sinai.
A decades-old land mine buried in the sand in in northern Sinai killed three children and seriously injured a woman Tuesday evening, according to police officials.
Sinai residents have long complained of discrimination and neglect.
The region is bitter over repeated security crackdowns during the rule of ousted autocrat Hosni Mubarak. During the 2000s, Islamic militants staged attacks on tourist resorts in the peninsula, prompting a vast sweep of arrests.
Crackdowns have seen frequent reports of torture of Sinai's detainees, and some detainees have been held for years without conclusive trials. Repeated promises to families and tribes of detainees to resolve their cases have gone unfulfilled, fueling resentments.
Extremist groups only increased their activity in Sinai amid the breakdown in law and order since Mubarak's 2011 ouster, with increasing attacks into neighboring Israel.
Morsi faced his first Sinai challenge in August last year, just over a month after taking office, when militants carried out the most brazen attack ever on military troops, killing 16 Egyptian soldiers along the border with Gaza and Israel. Morsi at the time vowed to restore stability, launching a brief military operation that resulted in the closures of some smuggling tunnels between Sinai and Gaza and the arrest of the man believed to be at the heart of the current kidnapping, Ahmed Abu Shita.
Abu Shita was convicted to death in absentia in September for involvement in a major attack on a northern Sinai police station in 2011 that left three policemen dead. Thirteen others, including seven others in absentia, were also given death sentences in the case.
Those behind the current kidnapping demand the release of Abu Shita, along with 23 other convicted militants, including some dating back to the 2004 and 2005 bombings in Sinai, Interior Minister Ibrahim, who is in charge of police, told MENA. Rights groups have been calling for the release of five convicted in those bombings under Mubarak-era emergency laws who have been granted a retrial after years in custody.
Ibrahim called the demands «unacceptable,» but recognized that the kidnappers are too well-armed tot be confronted by the police forces alone.
He said the kidnappers have planned the operation two months before and are armed with anti-aircraft and anti-tank missiles, surface-to-air missiles and other heavy weaponry smuggled from Libya.
«They are all weapons that the vehicles of the ministry can't deal with alone,» he said, apparently explaining why the military is joining the Sinai operation.
Ibrahim said his ministry had sent 100 combat units, several dozen armored vehicles, and fast-deployment vehicles to enable the forces to deal with about 500 militants in 30 locations.
The military has sent rocket launchers, armored vehicles and personnel carriers to Sinai.
Such strong security buildup is uncommon in Sinai. The 1979 peace deal between Egypt and Israel restored Sinai to Egypt after it was captured by Israel in the 1967 war. But it restricted numbers of troops and types of weapons Egypt could station there. Nothing more than a light weapon was allowed in most of the peninsula, and only police not soldiers were allowed in the zone directly on the border.
But for the past years, with rising lawlessness in Sinai and increased smuggling activities with Gaza, Israel bent some of the rules.
Major Egyptian military operations there would require Israeli consent under the terms of the peace agreement. Israeli officials declined to comment Tuesday, but in the past have said that security cooperation has remained strong since the new Islamist government took office. The official silence could be a signal of Israeli consent.


text:
Passiflora incarnata, or also commonly known as Passion flower was initially discovered by Spanish Jesuits in the 17th century somewhere in Peru. They named the flower after they noticed its resemblance to the crucifixion of Jesus Christ on a cross. The Jesuits believed that Christ approved their exploration with the discovery of the flower. May be if they knew that passion flower tea for stress and anxiety, then they might even think that the flower was a miracle sent from Heaven with its benefits.
Passion flower is native in America from a genus of flowering vines, which family members and relative plants known and found to grows almost anywhere in the world. Some passion flowers bear an edible fruit that is called maypop, which is used as a flavoring for soft drinks and for Hawaiian Punch.
It lived up to its name for providing overflowing greatness, positivity and calmness for the mind and body. Furthermore, it has a very striking appearance with "a ring of flat violet-colored petals beneath an inner ring of darker tendril-like petals", as described in a report by SF Gate.
Benefits of Passion Flower for the Mind and Body
If people are aware of the healthy organic passion flower tea benefits and where to buy them, then they would not have issues of getting healthy and well for both mind and body as it is relatively easy to prepare a simple tea.
It was initially used in Europe to treat agitation, indigestion, seizures and restlessness. But it is now popular as an anxiety treatment.
The Web MD reported that passion flower is used for treating gastrointestinal (GI) upset, anxiety or nervousness, insomnia, general anxiety disorder (GAD), seizures, symptoms of menopause, irregular heartbeat, high blood pressure, fibromyalgia, relieving pain, hysteria, and attention deficit-hyperactivity disorder (ADHD).
It works by boosting the release of a chemical known as GABA in the brain that lowers it activity, thus produces a calming effect.
Organic Passion Flower Tea
Healthy passion flower tea recipe benefits many people who prefer to have their drink made at home or personally created for assurance that they get the most out of the flower itself. Experts always say that "the best way to take passion flower is through tea", as said in Healthline.
The recipe is relatively easy to make as you only need some dried passion flower leaves, tincture or extract. See the dosage indicated in the label for tincture and extracts because too much passion flower can produce a sedative effect. It was advised in NYU Langone Medical Center that a passion flower tea should need up to one teaspoon of dried leaves, or teabag, for one cup of warm/hot water that will be soaked or 10 to 15 minutes prior to intake.
This is how to make the best organic passion flower tea and take note that it is already known to be safe and effective. However, the effect on children and pregnant women is still yet to be approved.


text:
Implementing sustainable technology to monitor the integrity of the nation's bridges
Today, humans perform visual inspections every two years of most of the nation's older bridges. But with a scarcity of inspectors and tens of thousands of bridges, that process can be long and laborious.
While newer bridges have monitoring devices already incorporated into their design, there are thousands of bridges erected during the 1960s and '70s, when much of the nation's infrastructure was built that would benefit from such a system.
To address the issue, a team of University of Miami College of Engineering researchers are implementing a self-powered monitor system for bridges that can continuously check their condition using wireless sensors that "harvest" power from structural vibration and wind energy.
"Just as when someone goes to see a doctor and gets all sorts of tests done to see how healthy they are and how long they'll live, we're doing the same with bridges," says Antonio Nanni, professor and chair of the Department of Civil, Architectural, and Environmental Engineering and lead investigator of the nearly $14 million project.
Nanni and his team plan to place newly developed wireless sensors—some as small as a postage stamp, others no longer than a ballpoint pen—along strategic points inside the 27-year-old Long Key Bridge, in the Florida Keys and on a Northwest 103rd Street quarter-mile steel overpass that leads into Hialeah, in Florida.
The sensors, developed by project collaborators Virginia Tech University and New Jersey-based Physical Acoustics Corporation, record all sorts of data, from vibrations and stretching to acoustic waves and echoes emitted by flaws such as cracks. Even the alkaline levels in the concrete of bridge supports are being measured.
"The beauty of this project is that the data can be shared with other researchers via a Web site," Nanni says. "We could share information with the department of transportation in the UK and show them what's happening with the Long Key Bridge here in Florida. They would see the data as we see it, in real time."
Once all the information is culled and analyzed, Nanni and his team will form a prognosis of the bridges' health, and should any defects be found, the decision on how to repair the structures will be made by the Florida Department of Transportation. Nanni, who directs a College of Engineering Industry/University Cooperative Research Center supported by the National Science Foundation and called RB2C (Repair of Building and Bridges with Composites), hasn't ruled out the possibility of suggesting how to repair any damage found.
Researchers at the University of South Carolina at Columbia also are partners in the study, monitoring a series of bridges in their state and forming diagnoses jointly with UM engineers.
The project is the second bridge health-monitoring study being undertaken by Nanni and his colleagues. With a group of students, they are also placing sensors along Miami's Grove Isle Bridge as part of a smaller, one-year study funded by the National Science Foundation RB2C.
With the Federal Highway Administration estimating that more than 70,000 of the nation's bridges are structurally deficient, the system Nanni and his team develop could be used as a national model for monitoring the structural integrity of bridges nationwide and alerting bridge owners to potential dangers.
Source: University of Miami (news : web)
Explore further


text:
Vast online inventory of high-quality toys, treats, and accessories for dogs and cats at discounted prices
Customer Reviews
All reviews are from people who have redeemed deals with this merchant.
What You'll Get
Choose Between Two Options
- $10 for $20 worth of chews, toys, treats, accessories, and more
- $25 for $50 worth of chews, toys, treats, and accessories, and more
The Fine Print
Promotional value expires 90 days after purchase. Amount paid never expires. Online only. Must create an account. Valid only for option purchased. Must use promotional value in 1 visit. Limit 1 per person. Limit 1 per order. Valid for new customers only. Merchant is solely responsible to purchasers for the care and quality of the advertised goods and services.
About Coupaw
Run by a passionate staff of cat and dog lovers, Coupaw hooks pet owners up with deals and discounts on high-quality pet food, toys, accessories, and services. The idea came about after one of Coupaw's founders raved about a local dog-walking company—raved so much, in fact, that the company offered him a discounted rate for bringing them so much business. Ever since, Coupaw has done the same for pet owners across the U.S. and Canada, who can simply sign up and receive dog and cat deals via email.
The Exclusive Gift of the Month Club, for example, sends your pet a gift every single month at a price that won't put your wallet's tail between its legs. Every gift is hand-picked by Coupaw's team and is double- and triple-checked to ensure value and quality. Subscribers can also browse and buy discounted items for their pets, and they can even share their favorite deals and get cash credit toward future purchases. Additionally, every order made on Coupaw provides six meals to hungry pets in need.


text:
This Centennial Collection directional light will update the exterior of your home with its transitional and eye-catching design. Featuring a weathered iron finish, this fixture will accommodate a variety of outdoor decor styles. With its easy installation and low upkeep requirements, this directional light will not disappoint.
- Uses (1) LED bulb, 7 watt maximum
- Bulb included
- Durably crafted from metal, making it ideal for outdoor installation
- Weather resistant coating increases sustainability
- Includes installation hardware, easy instructions and template for convenient setup
- Please allow 5 days for shipping


text:
|Linn Klimax Kontrol Stereo Preamplifier
|Sunday, 01 June 2003
Page 1 of 2Introduction
The Klimax Kontrol preamplifier is the newest in Linn's series of no-compromise audio products. Included in this series, you will find the Linn CD12 CD player, a product that transcends previously known levels of perfection, as well as the ultra-slick Klimax Twin stereo amplifier, both previously reviewed in Audio Revolution.
The Linn Klimax Kontrol is a remote-controlled line-level stereo preamplifier that sells for the major league price of $10,000. The Kontrol measures 2.36 inches in height, 13.78 inches wide, 13.98 inches deep, and weighs 24 pounds. For such a diminutive package, the Kontrol packs a wallop when it comes to features. For I/O, the Kontrol accepts up to five inputs. Input One accepts balanced or single-ended connectors. Inputs Two through Four accept single-ended connections only. The fifth input is available via Linn's proprietary Knekt connection. Output is available though either single-ended or balanced connections. The Kontrol features a unity gain function that is available on any input for synchronous use in a modern home theater system. This feature configures the designated input to pass the signal through without attenuation. All inputs have individual balance adjustments, as well as input gain adjustments to compensate for connected equipment output level variations. Inputs can be programmed and/or named to your taste.
When it comes to build quality, the Kontrol makes no excuses. The chassis is constructed with just two machined parts made from solid billets of aluminum. Its rear panel has the finest connectors that I have encountered. The component has a blue LED display, which looks a treat, although I found it a little too small to read from any real distance. Although the Kontrol feels tough enough to survive a nuclear winter, the jewel-quality satin finish inspires delicate handling and physical respect. According to Linn, this chassis is designed to provide mechanical and electrical isolation for the electronics. The case also performs the thermal management for the electronics. The Kontrol uses a proprietary Linn high-speed switching power supply and has two PC boards, one for analog circuits and one for the digital circuits. The remote is made of a molded aluminum shell, with a luxurious-feeling finish on the top. The remote has no backlighting, but it does have a layout that makes it reasonable to memorize the locations of the critical buttons.
Set-up was pretty simple, but required the use of the manual to get everything configured properly. I used the Kontrol with my two-channel system and also took advantage of the unity gain function for connection to my theater system. I used a Muse/Theta combo on the front end for CD playback, with the Klimax Twin amplifier driving a pair of Revel F30 speakers.
The Music
From the very moment I started listening, it was obvious that the Kontrol was special. My system sounded more open and natural than it ever had. With AC/DC Live from the Atlantic Studios (East/West Records), I was immediately impressed with the sheer lack of electronic signature. For a hard rock band, this is a great live performance and a pretty good recording. The last three tracks, starting with "Jack," put me into the zone, as some audiophiles would call it. The equipment in my system seemed to completely disappear. All of the instruments floated freely in space with no hint of smearing. The Kontrol recreated the impact of the kick drum more effectively than any other preamp that I have heard. I could hear low-level detail throughout the entire audible frequency range. With other good preamplifiers, I have heard this low-level detail in the midrange and even highs, but with the Kontrol, I heard low-level detail in the bass region as well. The timing between hearing the initial sound of the guitar and hearing the echo off of the walls and other equipment on stage was convincing and helped to solidify the illusion of physically being there.
The saxophone in the first track, "Promised Land," from Ani DiFranco's Evolve CD (Righteous Babe Records), was impressively detailed. I could actually hear the lips peel off of the reed during breaths. What made this so amazing was that it sounded naturally detailed beside the sound coming out of the instrument. The Kontrol never sounded dry, etched or overly detailed. The guitar in Track Eight, "Phase," had a percussive attack that showed off the low-level detail in the bass and midrange. All of the detail in the sound of the hand hitting the surface of the guitar was present, while the natural decay in the resonance of the body of the guitar faded beautifully and infinitely realistically.
Isaac Hayes' Ultimate Collection CD (Hip-O Records) is full of some soulful tracks from the '70s. On Isaac Hayes' signature song "Theme From Shaft," the cymbals sounded extended, with loads of detail in the highest frequencies. This track has the propensity to sound a little harsh at higher volumes in some systems, yet with the Kontrol, the sound never became offensive in the least. This is unquestionably due to the Kontrol's complete lack of grain throughout the entire frequency spectrum. On Track Four, "Do Your Thing," the Kontrol's bass presentation was engaging to the point of being addictive. In addition, I found it interesting that I could play the system louder than usual without overloading my room. The extensive use of effects in this recording was more obvious than ever before and surprisingly less offensive than usual. While listening to track Four, "Walk On By," I was transported back to my childhood, when I was relegated to listening to my sister's stereo because my dad wouldn't let us listen to that "crap," as he called it, on his system. This track makes use of many different types of instruments, including the trademark disco-sounding synthesizers. I wouldn't claim that this is a great recording, but through the Kontrol, I enjoyed the presentation more than ever before.
The CD Under the Table and Dreaming (RCA) by the Dave Matthews Band has some great music and a huge sound. On the first track, "What Would You Say," the soundstage far exceeded the boundaries of my room. I am used to hearing lots of transient detail with solid-state gear, but through the Linn, I also heard the sweetness in the sound of the strings on the guitar and violin that I have only heard with tubes before.
My next pleasant surprise was an experience that I had with the Best of War CD (Rhino). This is another CD that I have had mixed results with in the past. On some systems, this recording can be almost unbearable. In fact, I usually save this quality of recording for my car stereo, where I just use it as background music. With the Kontrol, all of this changed. On "Low Rider," I could hear a guitar that I had never even noticed before. This guitar is very low in level and is usually obscured by the bass line in the song. Damn, it's fun when a piece of audio equipment allows you to hear things in a recording that you had never heard before. I really like the bass lines in War's music, and through the Kontrol, the bass lines were more involving than ever. By the time I got to the fourth track, "Slippin' Into Darkness," characteristics of my entire stereo system had once again disappeared. I was so entranced with the music that when it ended, I realized that I had forgotten to take any notes, even though that is specifically why I had started that particular listening session.
The Weavers Live Reunion at Carnegie Hall-1963 (Analogue Productions) is one of the best live recordings that I have ever experienced. This CD includes tracks from two different concert performances, which were put together to celebrate the Weavers' 15th anniversary. Track Four, "Ramblin Boy," features Pete Seeger's warm vocals, along with a guitar. Through the Kontrol, the size of the venue was more easily perceived than with any other preamp that I have heard. When the crowd joined in and started to sing, the surround effect was so good that it made me think that multi-channel sound might be unnecessary. One of the other aspects of the CD that makes it such a special audiophile gem is the vocal content in the music. On Track Nine, "Guantanemera," all of the male and female voices sounded smooth yet detailed. The space between the singers was more evident and believable than ever. Even with some of the best equipment that I have heard, groups of singers tend to blend and merge into a single voice. With the Kontrol, the singers could all be easily identified separately. Track 10, "If I Had a Hammer," again features Seeger's powerful vocal presence. The Kontrol reproduced the power and emotion very effectively.


text:
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.
To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.
Different ways to prevent cancer are being studied, including:
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
See the following PDQ summaries for more information about breast cancer:
Breast cancer is the second most common type of cancer in American women.
Women in the United States get breast cancer more than any other type of cancer except skin cancer. The number of new cases of breast cancer has stayed about the same since 2003. Breast cancer is second to lung cancer as a cause of cancer death in American women. However, deaths from breast cancer have decreased a little bit every year for the past several years. Breast cancer also occurs in men, but the number of new cases is small.
Avoiding risk factors and increasing protective factors may help prevent cancer.
Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.
NCI's Breast Cancer Risk Assessment Tool uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.
The following risk factors may increase the risk of breast cancer:
Estrogen (endogenous)
Endogenous estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways:
Hormone replacement therapy/Hormone therapy
Hormones that are made outside the body, in a laboratory, are called exogenous hormones. Estrogen, progestin, or both may be given to replace the estrogen no longer produced by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (HRT) or hormone therapy (HT) and may be given in one of the following ways:
Exposure to Radiation
Radiation therapy to the chest for the treatment of cancers increases the risk of breast cancer, starting 10 years after treatment and lasting for a lifetime. The risk of developing breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty. For example, radiation therapy used to treat Hodgkin disease by age 16, especially radiation to the chest and neck, increases the risk of breast cancer.
Radiation therapy to treat cancer in one breast does not appear to increase the risk of developing cancer in the other breast.
For women who are at risk of breast cancer due to inherited changes in the BRCA1 andBRCA2genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.
Obesity increases the risk of breast cancer in postmenopausal women who have not used hormone replacement therapy.
Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.
Inherited Risk
Women who have inherited certain changes in the BRCA1 and BRCA2genes have a higher risk of breast cancer, and the breast cancer may develop at a younger age.
The following protective factors may decrease the risk of breast cancer:
Exercising four or more hours a week may decrease hormone levels and help lower breast cancer risk. The effect of exercise on breast cancer risk may be greatest in premenopausal women of normal or low weight. Care should be taken to exercise safely, because exercise carries the risk of injury to bones and muscles.
Estrogen (decreased exposure)
Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:
Selective estrogen receptor modulators
Selective estrogen receptor modulators (SERMs) are drugs that act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Tamoxifen is a SERM that belongs to the family of drugs called antiestrogens. Antiestrogens block the effects of the hormone estrogen in the body. Tamoxifen lowers the risk of breast cancer in women who are at high risk for the disease. This effect lasts for several years after drug treatment is stopped.
Taking tamoxifen increases the risk of developing other serious conditions, including endometrial cancer, stroke, cataracts, and blood clots, especially in the lungs and legs. The risk of developing these conditions increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. Talk with your doctor about the risks and benefits of taking this drug.
Raloxifene is another SERM that helps prevent breast cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women at both high risk and low risk of developing the disease. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Like tamoxifen, raloxifene may increase the risk of blood clots, especially in the lungs and legs, but does not appear to increase the risk of endometrial cancer.
Other SERMs are being studied in clinical trials.
Aromatase inhibitors
Aromatase inhibitors lower the risk of a new breast cancer in women who have an increased risk of breast cancer. Women with an increased risk of breast cancer include the following:
In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen.
Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired.
Prophylactic mastectomy
Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is lowered in these women. However, it is very important to have a cancer risk assessment and counseling about all options for possible prevention before making this decision. In some women, prophylactic mastectomy may cause anxiety, depression, and concerns about body image.
Prophylactic oophorectomy
Some women who have a high risk of breast cancer may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the onset of symptoms of menopause, including hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density. These symptoms vary greatly among women.
Fenretinide is a type of vitamin A called a retinoid. When given to premenopausal women who have a history of breast cancer, fenretinide may lower the risk of forming a new breast cancer. Taken over time, fenretinide may cause night blindness and skin disorders. Women must avoid pregnancy while taking this drug because it could harm a developing fetus.
The following have been proven not to be risk factors for breast cancer or their effects on breast cancer risk are not known:
There does not appear to be a link between abortion and breast cancer.
Oral Contraceptives
Taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. The most commonly used oral contraceptive contains estrogen.
Progestin-only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer.
Studies have not proven that being exposed to certain substances in the environment (such as chemicals, metals, dust, and pollution) increases the risk of breast cancer.
Diet is being studied as a risk factor for breast cancer. It is not proven that a diet low in fat or high in fruits and vegetables will prevent breast cancer. For more information on diet and health, see the Fruits and Veggies Web site.
Active and passive cigarette smoking
It has not been proven that either active cigarette smoking or passive smoking (inhaling secondhand smoke) increases the risk of developing breast cancer.
Studies have not found that taking statins (cholesterol -lowering drugs) affects the risk of breast cancer.
Cancer prevention clinical trials are used to study ways to prevent cancer.
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include exercising more or quitting smoking or taking certain medicines, vitamins, minerals, or food supplements.
New ways to prevent breast cancer are being studied in clinical trials.
Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials section of the NCI Web site. Check NCI's list of cancer clinical trials for breast cancer prevention trials that are now accepting patients.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether a certain drug or nutrient can prevent cancer. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients and those who are at risk for cancer. During prevention clinical trials, information is collected about the effects of a new prevention method and how well it works. If a clinical trial shows that a new method is better than one currently being used, the new method may become "standard." People who are at high risk for a certain type of cancer may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-08-10
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


text:
Saturday, May 22, 2010
Sweet Potato & Tamarind Curry with Basmati rice
This week I have slacked a bit on the kitchen duties.
I have been cooking the really quick dinners. You know the kind, BLT's, spaghetti, soup, etc.
Tonight I made a quick curry...one of my favorite comfort foods. I luv'it!!
I wish I had more experience in Indian cooking, maybe if I return to the restaurant industry, I would love to try my hand in a professional Indian kitchen.
I used the tamarind I bought a while back. I remember my first experience using it. I just added it, and ended up with a crunchy-seedy curry. Not the best. So this time I soaked a chunk of it in a little water and loosened the seeds. Drained it and added it to the curry. It has a sweet and sour taste, I think it gives the curry more "umpf".
I also have some exciting news...but I can't divulge it quite yet ;) I will know more as the week progresses. hehehe
2 tbsp vegetable oil
1 onion-sliced
3 cloves garlic-minced
1 tbsp fresh ginger-minced
1 tbsp cumin powder
1 tbsp paprika
1 tbsp curry powder
1/4 tsp allspice
2 tbsp fennel seeds- toasted and crushed
1 can coconut milk
1 can water
3 tbsp tamarind paste- soaked in 1/4 cup water-drained
1 cup cooked chickpeas
1 green pepper-chopped
2 tsp cane sugar
2 tsp sea salt
freshly ground pepper
In a large saute pan heat pan on medium high heat, add oil.
Add onions and saute for 3-4 minutes until soft. Add garlic and ginger.
Add spices and stir around until no longer powdery.
Add potato, stir to cover with spices.
Add coconut milk and water. Bring to a boil. Let simmer for 5 minutes
Add chickpeas and tamarind. Season with sugar,salt and pepper.
3 comments:
Hope your little ones are hetting better...no fun!ReplyDelete
Picture is gorgeous and I love sweet potatoes in curry!
What's the news?!?!?! :)
Oh wow... I'm sooooooo happy I just discovered this blog! My mouth is watering and I can't wait to make my grocery list and give some of these recipes a try!!ReplyDelete
3 Researches REVEAL How Coconut Oil Kills Waist Fat.ReplyDelete
The meaning of this is that you literally burn fat by eating coconut fat (including coconut milk, coconut cream and coconut oil).
These 3 studies from major medicinal journals are sure to turn the conventional nutrition world around!
Subscribe to: Post Comments (Atom)


text:
Write a News Story
Meet a Pioneer Pilot
Amelia Earhart Home
Back to
Story List
Amelia Earhart
By: Amber L.
Wisconsin, Age 11
Amelia Earhart had became the first women to fly solo from Honolulu, Hawaii, to Oakland, to California, January 11-12. She also made many other solo flights one of her most daring flight was to fly around the world which was in 1937. And samewhere on her way she is underwater or crashed somewhere. We've been looking for her ever since she got lost. She broke many other records. We have never given up looking for her.
Back to
Story List


text:
How years as a waiter prepped me for my PR career
From swag bags to doggy bags: Keeping cool while multitasking, putting the client first, and growing a thick skin—all are as necessary in public relations as they are in the restaurant sector.
I started my "career" as a fine dining waiter. At the time, I thought I was being a slacker. I didn't know what I wanted to do with my life. Now, I look back on it as a formative and productive time.
I think everyone should spend time waiting tables. You want to get to know humanity? Stand between them and their next meal.
I learned a lot during that time. I'll pick these five lessons-all of which helped me prepare for a career in PR and communications.
Learn to maintain composure when it all hits the fan.
Some of us were better at keeping our cool than others during the symphony rush when we have a full seating and all the guests have to be out the door by 6:30 pronto. I used to make fun of one co-worker: He'd walk so fast he was practically running back and forth through my station—inefficiently obviously, because of the multiple trips—giving my poor guests wind burn as he flew by.
Imagine spending $100 a head for dinner and your waiter is racing around like Millie at the diner. Being a fine dining waiter teaches you to be efficient, to multi-task, and to keep it cool when you're about to lose it because you have entrees on the hot line, the chefs are screaming at you, and Susie at table 8 needs a slice of lemon for her water.
[FREE DOWNLOAD: 2019 Internal Communications Measurement Survey Results]
You will master the basics of reputation management.
Your ahi tuna was undercooked? I bite my tongue. "Of course. Let me take care of that for you." "Your soufflé is coming right out. I apologize for the delay. Can I treat you to a glass of Muscato while you wait?"
People get upset and impatient when their food is not prepared to their wishes. We learn quickly to deal with dissatisfaction quickly and flawlessly. Make it go away. Apologize, empathize, remove the offending item, and replace it.
You will grow a pair.
You won't last long in the restaurant business if you're overly sensitive. I'd get berated by cooks who think I'm a complete bimbo because I've asked for no sauce on the fish, please. As if I was standing out there at the table telling my guests how to order. "You should definitely get the sauce on the side. The cooks love when you do that."
Co-workers trade barbs and joke relentlessly. One night, my sister was visiting from the East Coast so I took her to dinner at the five-diamond restaurant where I worked in Aspen. The back waiter set the cream of asparagus soup in front of me, and I looked down and nearly spit out my $15 ($7.50 with employee discount!) sip of chardonnay. They had written Eff You with the creme fraîche squeeze bottle on the top of my soup rather than squiggling it decoratively as they would have for any of the full-paying guests.
Then there was the time our co-worker came in for dinner with a date and his waiter sprinkled pulverized mushrooms on their salad. I'm not talking the porcini or shiitake variety, either.
But it was all in good fun, and it meant you were loved. A decade in the fine dining service and I grew a thick skin. Between the picky and discriminating guests, irate chefs with horrible tempers, and co-workers brandishing the $150 bottle of wine they just sold on their way out to the floor, I learned not to take things personally. If I did, it would just ruin me.
You learn to read people and anticipate their needs.
I don't care what business you are in. We are all in the service business one way or another. My compensation depended on my ability to read my guests and anticipate their needs. Some guests didn't want to be bothered; others wanted to engage in conversation. To this day, intrusive service is my pet peeve: "I'm in the middle of a conversation here. Don't ask me if I want more water; just pour the damn water."
Joe Foodie wants to tell the chef how to prepare his meal (and I'll suffer for it when I go back to the kitchen.) He knows what wine to order for the table. He might really know his stuff, or he could be like the one guy who swirled his wine taste so hard it splashed all over his crisp white Brooks Brothers shirt.
Then there is the couple who is out on a big splurge: It's a special occasion, and they could use some help walking through and understanding the menu. They feel embarrassed to say they don't know how to choose the wine. I'm happy to accommodate, and without judgment—unless your wine taste swirlie is overenthusiastic—in which case we might laugh at you in the kitchen.
Bottom line, I quickly read my people and adjusted my behavior accordingly; knowing when to provide counsel when to keep quiet.
I started to dislike people toward the end, I won't lie. That's when I realized it was time for me to get out and get on with my "career."
Ten years of waiting tables in fine dining restaurants taught me to understand people, anticipate needs, adjust service to my audience, and toughen up for rough feedback. The lifestyle afforded me great adventures and the closest relationships in my life. I wouldn't change a thing.
One last thing: When your waiter asks whether you'd like something to drink, don't say, "No, I'll just have water." Water is a drink.
A version of this article first appeared Big Leap Creative.
Ragan.com Daily Headlines
Sign up to receive the latest articles from Ragan.com directly in your inbox.