text:
It's Sunday and the piles of laundry on my floor have led me to believe that my carpet has gone on vacation. It has up and left, taking refuge in either the Bahamas or perhaps a hardwood floor store. These piles start at the door to my bedroom and form mountains between the foot of my bed and bathroom door. There is even a small one forming in my "walk-in" closet, although it's really more of a "step-in, turn around, step-out" closet.
I'm not sure when my hatred of laundry formed, but it probably just stems from my general laziness and apathy towards household chores. I do love vacuuming, though. I would vacuum the carpet everyday if there was any proof that I actually have a carpet.
But today I have decided to do my laundry. I am sick of having to leap over piles of clothes to get to the bathroom or the computer desk. These hills of whites and darks and colors have turned walking around my room into a sport. One hop to the left, leap to the right, forward jump over the pile of tie-dyed shirts, catapult myself using the footboard, and all the while attempting to not knock over any of the ambiguously arranged mounds.
So this morning I started. Actually, I started this afternoon around 2:00, but considering that I didn't wake up until about noon, 2:00 still felt like morning. First I washed my sheets. Bella, the dog/in house toy destroyer, has become fond of cuddling up at the place on the bed where the pillows meet the sheets and a thin layer of black hair has collected in the spot where she lays. They are now in the dryer and I am anxiously awaiting that obnoxious buzzer so that I can make my bed and take my first load of darks out of the washer.
Let me just tell you, laundry day has always been a long process for me. When I lived in the dorms on campus, I didn't do laundry until well into the first semester, maybe sometime around Halloween. The first thing that is frightening about this is the fact that I have enough clothes to last me that long without washing anything. The second thing that is frightening about this is that when the time came to wash my stuff, I can honestly say that I occupied nearly an entire row of washers and dryers in the building's laundromat. Sorry about that, guys. It's safe to estimate that I used an entire box of dryer sheets that day. And so the cycle began. (no pun intended?)
Freshman year I did laundry maybe four times. At Christmas I took some dirty clothes home for my mom to tackle. Spring break, too. Sophomore year was better because I moved into my house and had easy access to a private washer and dryer. Did I do more laundry? No. But it was less of a hassle when I actually got around to it. However, this also enabled my room to transform into a certifiable disaster area. In the dorm, I couldn't spread my crap out all over the universe because I had to respect my roommate's area. Here at the house, I can put my stuff wherever I feel like so that means my room turns into a dirty clothes graveyard until I muster up the motivation to do something about it.
It is going to be a lifelong saga of room cleaning and sheet washing. As soon as all of my clothes are washed and put away, it comes time to get dressed in the morning for classes. I stand in my closet, hands on my hips, surveying the hangers among hangers of perfectly acceptable garb, not wanting to wear any of it. Try on a shirt. Take it off. Throw it on the floor. I'm running late, after all. Pair of shorts after pair of shorts after pair of shorts. Finally find an outfit. Look disastisfyingly into the full length mirror, spritz of Marc Jacobs perfume, flip flops on, out the door. Meanwhile, Bella is still sleeping, but now she comfortably snoozes atop a pile of perfectly clean clothes in the place between my closet and my bed. Tomorrow, it will all start again.
My mom always argues that if you clean up as you go, it only takes about 5 minutes. I can see her logic, but it has never worked for me, mainly because I refuse to do it. So I will remain a laundry hater. It will always take me hours and hours to do a few months worth of dirty clothes. People will ooh and aah over the amount of clothes that I have and how messy my room can become in a matter of seconds and a flurry of outfit changes.
Gotta go –
buzzer is calling for me!
Below: my room! $10 to the first person who finds the carpet! haha. There is even laundry in my hammock swing!


text:
Pasquale Castrilli Omi
Vatican City (Agenzia Fides) - The small Catholic community in Laos (less than 1% out of seven million inhabitants) is preparing to celebrate two new priestly ordinations in 2017: say to Agenzia Fides the Laotian Bishops that concluded the ad limina visit at the Vatican. One of the deacons who is preparing for his priestly ordination - programmed in the current year, belongs to the Apostolic Vicariate of Pakse, the other belongs to Luang Prabang. Louis-Marie Ling, Apostolic Vicar of Pakse, tells Fides is "hopeful", after the solemn public celebration of the beatification of the martyrs: "It was a feast with more than seven thousand faithful, a historical event, a miracle for us".
The pastoral activities, Ling says to Fides, proceed calmly, "we sometimes have some small problems with some diligent provincial officials, but as priests and religious we visit families, we celebrate the sacraments, we do catechism without problems". With the new deacon, whose ordination is scheduled for next March, "I will have five active and two retired priests in Pakse", he says. They are entrusted parishes and over 13 thousand faithful of the Vicariate. "It is not my job nor my merit, everything is God's work. We follow the inspiration of the Holy Spirit", confides the Bishop to Fides.
Even Tito Banchong, apostolic administrator in Luang Prabang, in the north of the country, celebrated the ordination of three priests in September 2016 and is preparing for the gift of another vocation. "In my area, where for 12 years, from 2000 onwards, I was completely alone, we are blessed with the thriving of vocations to priesthood: a sign that the Lord is near. He is the God-with-us. And he was also with us in the time of suffering", says the Bishop, who between 1976 and 1986 spent five years in prison, when the pressure of the communist Pathet Lao regime on religious freedom was stronger.
On 30 January in his homily during Mass in the Casa Santa Marta, before the Bishops of Laos, Pope Francis said that "the greatest strength of the Church today is in the little Churches, tiny, with few people, persecuted, with their bishops in prison. This is our glory today, and our strength today".
At the end of the ad limina visit, Bishop Tito Banchong remarked: "We are very happy. This visit gave us the certainty of unity with the Pope. The Pope knows us, loves us, has opened his heart. He is really a father for us who listens to us. He told us to move forward in our mission: it is for us a precious encouragement". (PA) (Agenzia Fides 01/02/2017)
AMERICA/ARGENTINA - Let's free ourselves from indifference and media sensationalism, let's look at the distressing reality of the natives
AFRICA/GUINEA - The clergy: "We are concerned about the social and political crisis that leads young people to flee"

subset: commoncrawl


text:
Whether your little girl wants to spend the day at the beach, an outdoor garden party, or on a nature hike, we've got all kinds of adorable and durable girls' sandals to keep her comfortable and cute all day long.
Amazon.com takes steps to keep your girl clad in the kicks she craves. Our featured categories of girls' shoes are designed to put a spring in her step, whether you're looking for ballet flats, sandals, mary janes, running shoes, or crib shoes. We are passionate about helping you save time and money in outfitting your girl, so we provide handy filters to easily browse all of our designs for girls' shoes. From athletic shoes, boots, clogs and mules to crib shoes and first walkers all the way to flats, loafers, outdoor, oxfords, sandals, slippers, sneakers, and uniform and school shoes; you can make sure she's appropriately shod for the occasion.
Because we strive to provide you with quality designs in all of our girls' shoes, we feature a wealth of brands, including outdoor favorites KEEN and crocs, athletic favorites New Balance and Merrell, and classics from Robeez by Stride Rite. And because color and design can matter as much as the brand, we also offer a girls' shoes color filter so you can pick those tie-dyed mules or pink mary janes your mini maven's been talking about.
We know time is as precious as the shoes on your little one's feet, so closures matter too. Using our handy girls' shoes search toolbar, you can quickly browse for lace-ups, buckles, or adjustable closures. Plus, you can narrow your search by size and shoe width, so getting the shoes on her feet is as easy as getting her into her favorite tutu or tee.
She'll need a great pair of shoes at every stage of her life, and Amazon.com is here to help with our wide selection of comfortable girls' shoes.


text:
Who IS this girl?
My name is Jenifer Herring. I have a Bachelor's Degree from Palm Beach Atlantic University in print journalism with a minor in television. I originally started this blog to promote events while interning at renowned PR company in Palm Beach, Florida. I also love writing and this gives me an outlet to be creative. I believe being able to tell a story is a tremendous blessing. Words cause emotion and evoke change. The ability to create change is typically viewed/assumed by people in power (i.e. government), but the untold secret is journalists hold the key. As a journalist, you are to report the truth-a rare gem in today's world. My promise to you is the truth. This blog is a way for you to get to know my personality. Some people find me to be entertaining and others….find my snarky sarcasm annoying. Either way, the end result is you know ME. Now that we're somewhat acquainted, call me Jen. It's nice to meet you. (:
I am currently a host for NBC6 Miami's, "Inside Couture":http://insidecouture.com/ictv/about/ic-host –>Check out their website to see interviews!
My past work can be seen below:


text:
As a student at Aalborg University Esbjerg there are plenty of exciting opportunities for you to enjoy in your spare time. Esbjerg has many cultural experiences to offer – from concerts to theatre shows. You will also find many great sports facilities such as Svømmestadion Danmark, sports clubs, fitness centres, an ice rink etc.
Culture and sports in Esbjerg
Cultural meeting point for students in Esbjerg
In the culture and activity house Huset in Esbjerg Municipality you can meet up with other students and enjoy a cup of coffee and a game of scrabble. You can also go to concerts, participate in cocktail, dinner and film evenings or attend art exhibitions.
Admission to the events is often free of charge or extremely cheap, and prices at Huset's cafe are student-friendly. Huset is run by its users so your input and ideas matter in terms of future events and activities at the place.
Sports clubs and associations in Esbjerg
If you want to practise any sports when you are not studying at Aalborg University Esbjerg, your options are excellent as there are many sports clubs and associations in Esbjerg. You may, for instance, play football, handball, ice hockey, go for a swim, box or practise martial arts.
At the same time, this gives you an opportunity to meet new people in the town.
Concerts and theatre shows in Esbjerg
Whether you prefer rock or classical music, Esbjerg has something exciting to offer.
At the popular and nationally known music venue Tobakken (in Danish) you can listen to rock, pop and jazz. If you prefer classical music, you ought to visit The Academy of Music and Dramatic Arts, Southern Denmark where you may also enjoy jazz concerts. In Musikhuset Esbjerg (in Danish) you can enjoy musicals, theatre, opera and stand-up shows etc.
Finally, it is worth mentioning that during the summer, you can enjoy outdoor concerts both at Torvet and in Byparken.
Cafes in Esbjerg
In Esbjerg's cafes (in Danish) you may enjoy delicious food and drinks, and at Aalborg University Esbjerg you can meet up with other students in the Friday cafe "Smuthullet" (in Danish), which is run by students.
If you enjoy partying, you can participate in university parties organised by the Student Society (in Danish) at regular intervals.
Student testimonial
"Esbjerg Municipality, in partnership with Aalborg University Esbjerg, often organize cultural events where you can find a perfect environment for socializing.
People in Esbjerg have a great passion for organized sports, and personally, I love trail running and working out outdoors. Esbjerg offers a lot of green areas such as parks and natural forests, and it's very easy to find places to run or work out during the day. Therefore, I believe that AAU-Esbjerg provides the perfect student life."
Virgil Roland Drimba MSc . Oil and Gas Technology
Watch sporting events in Esbjerg
If you enjoy cheering from the spectator's seat during sporting events, Esbjerg is the perfect place for you as it offers plenty of opportunities for you to watch handball, football and ice hockey in some of best leagues in Denmark.
More information is available on these homepages:


text:
A late-night walk downtown
posted March 24th, 2019 at 6:26 PM
28 CommentsPost a Comment
You're not alone
Mar 25, 2019 at 9:25am
I spent 2 decades as a resident in the West End in the 80's and 90's.
I remember the awesome beaches, great restaurants, great neighbours. The cool vibe.
Now it's just as you say in your awesome post, just a very depressing place now.
I was going to sell my New West condo and move back when I retire and rent but forget it. Besides turning ugly the neighbourhood isn't safe.
It's called change
Mar 25, 2019 at 9:51am
"Teeming masses of people clearly not from the area": how would you know unless you checked their ID for their address? Just because you think people don't "look like" they're from the area doesn't mean anything. Empty shops? Well if your office is anything like mine, everyday we get mountains of packages from couriers and Canada Post from people shopping online. If people don't support local shops, the bricks and mortar stores shut down. Things are constantly changing here for better or worse. Personally I don't see myself living here in the next 10 years as I've outgrown it.
It's happening everywhere
Mar 25, 2019 at 11:52am
It has to do with automation. All the stores and malls are closing all over North America and the world. Stop blaming immigrants for everything.
"masses of people clearly not from the area... Do we really need more of them in this city?"
Exactly the question the natives were asking when your people came here: it was much better before you arrived. Newsflash: this land doesn't belong to you.
You could help by...
Mar 25, 2019 at 1:06pm
Stop supporting Amazon and it's predatory pricing and other online shopping sites. This is why the Europeans are going after the Google, Facebook and Amazon. They're monopolies. Only the monopoly wins.
Yeah yeah
Mar 25, 2019 at 1:17pm
everything was better 'back in the day'
@Yeah Yeah
Mar 25, 2019 at 2:44pm
I would agree that people look at their pasts through rose coloured glasses because they were younger and having more fun etc.. But the area of Vancouver is definitely going through a transitional phase and is pretty shit right now and won't recover without affordable housing and a "retail renaissance". The problem is that the cost of living is too high for a city of Vancouver's stature. We have lower first tier city prices in a lower second tier city.
A major correction must be made or we will continue to lose young people, the creative class and young families. What kind of city is left when all you have is affluent boomers and empty apartments owned by people hiding their money from their governments? A pretty lame city, IMO.
Mar 25, 2019 at 3:12pm
Says the guy "living in Olympic Village"...lol
Mar 25, 2019 at 3:14pm
Davie used to be where the LGBT community felt safe...now that community feels comfortable just about anywhere so that's one part of the "different vibe"..
@ yeah yeah
Mar 25, 2019 at 3:54pm
>it was
Mar 25, 2019 at 5:26pm
The "Brain Drain" is not happening so stop spreading that myth.Smart energetic people are doing fine in Vancouver.


text:
The time difference between: Magadan (Russia) and Novokuznetsk (Russia)
Welcome! On this page you can find out what is the time difference between Magadan and Novokuznetsk. If you are planning a trip, keep in mind that the time difference between Magadan (Russia) and Novokuznetsk (Russia) is -4 hours 0 minutes. It means when in Magadan it's 20:27:07, in Novokuznetsk it's 16:27:07. This data can be explained by the distance between the cities. It's 3791 km. If cities have air links, direct flight Magadan – Novokuznetsk will last approximately 4.5 hours.
Timezone difference between cities Magadan and Novokuznetsk is -4 hours 00 minutes


text:
I have made great strides stitching Baker Beach. I finally finished the 7th page out of 10. I have also gotten a really good start on the 8th page.
Unfortunately, all that wonderful stitching is on somewhat of a hold right now, because I aggravated a trigger finger problem in my right hand. My palm is now swollen and sore. I have a doctor's appointment scheduled for next week to get a shot of cortisone in my palm. That is definitely not something I am looking forward to. You may recall that I had this happen last year too. I have a feeling that I will eventually need surgery to fix this problem once and for all. (I had the surgery on my left hand when I was a teen many moons ago) That will have to wait until summer if it is necessary.
I have also been knitting my shawl.
It is almost done.
This is probably another reason why my hand is hurting.
I am now doing a whole lot of reading....no computer, no crafting, so that leaves books. I have recently read The Silent Sister, by Diane Chamberlain and Orphan Train, by Christina Baker Kline. Although both of these books are a little dark in their story line, I really liked them. They are two totally different types of books, but both contain a sad family story with secrets. They were on my list to read for quite some time and I am glad that I finally read them. I would highly recommend them. They each have short chapters that keep your interest. I am now reading The Runaway Quilt by Jennifer Chiaverini. This is the fourth book of the Elm Street Quilt series. I am enjoying this easy read series immensely.
I will be joining Kathy for some Slow Sunday Stitching this week. I am hoping to put a few stitches in on Baker Beach. I will also hopefully be joining the Stitchery Link Party on Monday at Super Mom - No Cape. Pop on over to these sites to see what other bloggers are stitching.
I hope I can regularly keep in touch.
Thanks for stopping by!


text:
So I was thinking a big farm table with upholstered linen chairs and perhaps an antique cocktail cabinet. Mr. P, however, saw an intimate bar area at the Menlo Grill (really excellent, btw) and got hooked on the idea of creating a more lounge feel than a formal dining room. In trying to strike a balance, I pulled these items together. I think it hits the comfortable bar atmosphere note, has a high degree of function (hello storage in that hutch!), and with the right amount of candlelight could be warmed up into a really inviting space. The only downside is that the table and chairs are not bar height - something we'd really like to try.
How do you balance style differences?
Clockwise from Top L:
Macy's - Excell Napkin Rings (on sale!)
Crate and Barrel - French Kitchen Table
Ethan Allen - Duncan Hutch and Buffet
Crate and Barrel - Lowe Onyx Leather Side Chair


text:
Skip to content
Welcome to Aquarena
My Home
Rates Payment Options
Pensioners / Seniors
Emergency Service Levy
Rate Forms
My Rate Notice Explained
Rates Notice Brochures
Interim Rate Notices
About Greater Geraldton
Greater Geraldton Maps
Intramaps Public
Printable Maps
Dog Exercise Areas
Horse Exercise Areas
Property Street Addressing
Greater Geraldton Videos
Living near the coast
Parking in Geraldton
Pesticide Use Notification Plan
Pet Ownership
Private Swimming Pools and Spas
Rubbish Collection
FOGO - Food Organic Garden Organic Trial
FOGO Waste Trial Households
Septic Systems
Stormwater and Drainage
Street Lighting
Verges and Crossovers
National Broadband Network
My Community
Aboriginal Culture
Arts and Culture
Public Art
Queens Park Theatre
Artist Register
Community Development
Community Directory
Community Grants
Community, Respect and Equality (CRE) Agreement
Disability Information
Education and Schools
Health and Hospitals
Local Heritage
Multicultural Geraldton
Neighbourhood Development Groups
Abandoned Vehicles
Infringement Appeal Form
Seniors Information
Youth Networks
The U-turn Project
My Environment
Coastal Adaptation Works - Potential - Underway - Completed
Coastal Hazard Risk Management and Adaptation Planning
Coastal Erosion and Inundation Studies
Climate Change and the Coast
What shapes our coastline?
Why is sea level rise important?
Adapting to sea level rise
What is a 100-year flood?
What are the options for adapting to erosion and inundation?
Why should we adapt to climate change?
Role of insurance in adaptation
Frequently Asked Questions about Coastal Adaptation Planning
The Consequences of Erosion & Inundation
Geraldton Coastal Hazard Risk Management and Adaptation Planning Report
Community Nursery
Community Nursery Native Plant Propagation Guide
Energy Efficiency
Environmental Health
Food Safety
Temporary Foodstalls
Septic Systems
Air Quality Monitoring in Geraldton
Environmental Health Forms and Guidelines
Fire and Emergency
Invasive Species
African Boxthorn
Golden Crownbeard
Weeds of National Significance
Living near the coast
Million Trees Project
Make Your Tree Count
Geraldton Wax
Natural Resources Management
Off Road Vehicles
Report a Problem - Snap Send Solve
Residential Waste and Recycling
Landfill (Tips)
Recycling in Geraldton
Rubbish Collection
Work With Us
Welcome from the CEO
Meet Our People
Work Placements
How to Apply
Why Work With Us
Aboriginal Employment
Career Information
Meet Our Executives
Employment Opportunities
Supplier Information
Growing Greater Geraldton
Geraldton Jobs and Growth Plan 2020 – 2023
Investment Prospectus
Geraldton City Centre Revitalisation Plan
Innovation and Technology
Sister Cities Program
Translated Documents
Economic and Socio-economic Profiles
Economic Sectors and Key Industries
Employment in Greater Geraldton
Economic Sectors
Socio-Economic Profiles
Doing Business in Greater Geraldton
Investing in Real Estate
Everlasting Partnerships Program
Our Everlasting Partners
Film Friendly Geraldton
Start or Grow Your Business
Geraldton Airport
Senior User-friendly Business
China Connect
What's On
Events Calendar
Artdrive 2020
Cruising Geraldton
Sundays by the Sea
WoW Fest 2020
Planning an Event
Event Forms
Planning an Event
Venues For Hire
Event and Venue Maps
Art Gallery
Geraldton Multipurpose Centre
Heritage Services
Landfill (Tips)
QEII Seniors and Community Centre
Queens Park Theatre
Visitor Centre
Rocks Laneway
Sports & Leisure
Club Development
Golf Course
Mid West Sports Awards
Parks and Playgrounds
Sport Clubs and Facilities
Sporting Achievement Grants
Sports Tourism Project
Swimming Pools
Application Requirements
Application Forms and Guides
Information Sheets
Building Fees and Charges
Online Building Permit Applications
Swimming Pools and Spas
Town Planning
Town Planning
Town Planning Public Comment
Application Form and Checklists
Fees and Charges
Submission and Consultation Forms
Zoning Information Sheets
Local Planning Schemes
Subdivision / Amalgamation Proposals
Development Assessment Panel
Town Planning Publications
Local Development Plans
Local Planning Policies
Structure Plans
Strategic Planning Documents
Bushfire Management Plans
Crossover and Verges
Land Development
Stormwater and Drainage
Fire and Emergency
Street Lighting
Sustainable Transport
Public Transport
Integrated Transport Strategy
Traffic and Transport
Waste and Recycling
Rubbish Collection
Landfill (Tips)
Recycling in Geraldton
Municipal Heritage Inventory
Geraldton Heritage Places
Greenough Heritage Places
Mullewa Heritage Places
Geraldton/Beachlands Heritage Area
Your Council
About Council
Annual Reports
Citizenship Ceremonies
Council Meetings
Questions From the Public
Live Streaming of Council Meetings
Past Council Meetings
Committee Book
Council Policies
Candidate Nominations
Budget 2019/20
Freedom of Information
Key Council Documents
Strategic Documents
Reference Documents
Information Documents
Council Policies
Local Laws
Public Interest Disclosure
Register of Gifts and Contributions to Travel
Notifiable Gift Register
Complaints Register
Having Your Say
Having Your Say
Ward and Councillor Representation Review
Geraldton Coastal Hazard Risk Management and Adaptation Panning Report
Whitehill Road Realignment Survey Report
Disability Access & Inclusion Plan Review
Draft Spalding Precinct Plan
Community Voice - Shaping our Future Project
Completed Engagement Activities
Beresford Foreshore Community Survey & Workshop
Community Plan Workshop
Mullewa Services Summit
Whitehill Road Community Workshop
Sunset Beach Traffic Calming Community Survey and Workshop
Community Playground Reference Group
Customer Service Plan Survey and Workshop
Mountain Bike Trails Community Information Session
Coastal Adaptation Planning Community Workshops and Survey
St Georges Close Plebiscite
Geraldton 2050 Cycling Strategy
Point Moore Community Lease Renewal
#changesCGG Community
10 Year Capital Works Plan Community Panel
Range and Level of Services Community Panel
Mullewa Services Summit
The Community Summit
2029 and Beyond Project
2029 and Beyond Project Outcomes
Community Engagement Awards
News and Information
Contact Us
Customer Service
Customer Service Plan
Our Customer Service Values
Customer Service Standards
Customer Service Charter
Feedback, Complaints and Suggestions
Customer Feedback Form
Translating and Interpreting Assistance
Festive Season Opening Hours
Geraldton Wifi
Latest News
Online Forms
Social Media
Talk about Greater Geraldton
Key Infrastructure Projects
Key Infrastructure Projects
Geraldton Airport Upgrade Project 2018-19
Meru Waste Facility Cell Five Construction Project
New State Emergency Services Building
Rocks Laneway Project
Sunset Beach Coastal Adaptation Works
Completed Key Infrastructure Projects
Access and Inclusion
Francis Street Finger Jetty
West End Revitalisation
Wonthella Oval Flood Lights
Wonthella Skate Park
Spalding Park Pathway
Abraham Street Bridge
Abraham Street Roundabout
Mullewa Waste Transfer Station
RV Dumping Station
Mullewa Youth Centre Refurbishment
Queens Park Theatre Upgrades
Derna Park Nature Playground
Beresford Foreshore Coastal Protection Project
CBD Underground Power Project
Beresford Foreshore Coastal Enhancement Project
Chapman River Regional Park Mountain Bike Trials
Contact Us
Pay Online
Online Services
Online Services Home
Online Forms
Rubbish Collection
Pound Register
Intramaps Public
Document Centre
Infringement Appeal Form
Terms and Conditions
Snap Send Solve
Pay Online
Rates Payment
Debtors Payment
Infringements Payment
Dog Registration
Cat Registration
Online Applications
Online Building Permit Application
Online Building Permit Help
My Account
Log In
New User Registration
Edit User Details
Change Password
Recover Password
I Want To
I Want To
Change My Address
Find my lost pet
Contact a ranger
Contact the Council
Have my say
Report a problem (Snap Send Solve)
Find It
Next Council meeting and minutes
My bin collection day
Jobs at the Council
Library opening hours
Recycling in Geraldton
Aquarena Home
Entry Fees
Swimming Lessons
Swimming Lessons Terms and Conditions
Super Sharks
Watch Around Water
Adult Lessons
Contact Us
Equipment Hire
Frequently Asked Questions
Group Fitness
Infant Aquatics
Junior Lifeguard Club
One to One Private Lessons
Return to the
City of Greater Geraldton
home page
Site Map
High Contrast
Search Website:
Content Filter:
Web Page Content
Entry Fees
Swimming Lessons
Group Fitness
Equipment Hire
Contact Us
Frequently Asked Questions
Information to come


text:
From West Virginia, USA:
I'm 25 years old and recently diagnosed with Type 1 diabetes. During the past four months I have gained fairly tight control of my blood glucose levels through diet, exercise, and insulin injections. Prior to my diagnosis, I weighed 105 pounds. I am 5'4" tall. During the first three months of insulin injections, I gained close to 20 pounds. I now weigh 130 pounds and feel very uncomfortable and confused about this weight gain. I am eating a low-fat diet and exercising daily. Is this weight gain normal and is it possible for me to lose about 10 pounds?
It is very common for people newly diagnosed with IDDM to regain lost weight and sometime to increase beyond their previous levels. However, there's no doubt that insulin plays a key role in getting fatter and that, to same extent, our shape is genetically programmed. Your current weight is quite fine for your height and I would discourage you from eating a self-made diet or, perhaps worse, to attempt to lose weight without medical advice.
You didn't mention exercise and, although this has primarily very important benefits in terms of body fitness and psychological well-being, it obviously burns calories and therefore, at least in theory, you are more likely to increase your weight if you eat more after exercise or even normally. Speak to your dietitian at the diabetes clinic to ensure that you are currently eating the correct things - it would be a real mistake simply to eat a low fat diet.
Additional Comment by Dr. LebingerIt is not uncommon to unexpectedly gain weight when improved control is obtained. The average weight gain in the DCCT study (Diabetes and Complication Trial) was 11 pounds in the intensively managed patients.
This can be very frustrating. I would suggest discussing with your physician whether or not it would be OK to slightly decrease your insulin dose. If your blood sugars increase, you could then try to decrease your diet or increase your exercise to lower the blood sugars.
You may be able to decrease your insulin dose if you decrease the proportion of calories from carbohydrate and increase the proportion calories from protein and/or fat even if the total calories remain the same. (Don't increase the total calories). This is because calorie for calorie, carbohydrates require more insulin than protein and fat. Too much insulin promotes weight gain.
Please make sure that you first discuss any possible change in insulin or diet with your physician.
Original posting 29 May 97
Additional comment added 8 Jun 97
|Return to the Top of This Page
Last Updated: (none)
This Internet site provides information of a general nature and is designed for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other health care professional.
This site is published by T-1 Today, Inc. (d/b/a Children with Diabetes), a 501c3 not-for-profit organization, which is responsible for its contents. Our mission is to provide education and support to families living with type 1 diabetes.
By using this site, you agree to our Terms of Use, Legal Notice, and Privacy Policy.
© Children with Diabetes, Inc. 1995-2018. Comments and Feedback.


text:
Lean On
Sarah Martin
Sarah Francis Martin is a wife, mother, friend, mentor, author and wanna be artist. Shehas a passion to encourage women to make Jesus famous in every part of life. She is the author of Just RISE UP!: A Call To Make Jesus Famous (Thomas Nelson 2012). Sarah's relevant and conversational style will invigorate readers to live rise up off the couch of complacency live with faith-filled purpose for the renown of Jesus . When Sarah is not typing away at her laptop you can usually find her getting her hands messy with craft paint. Check out more at www.liveitoutblog.com.
- 2014 Aug 12
LEAN ON... He whispered into my heart.
I was not planning on writing this post. I don't love sharing my vulnerabilities...who does, really? Yes, my goal in ministry is to be real and raw and relevant. For some reason this feels beyond raw. It feels raw because in the broad spectrum of life, my issue is not earth shaking, life threatening or really that big of a deal. But, it is real to me. Last Friday on The List post I alluded to some health stuff going on. This Friday I'm having some minor surgery. I'm balancing feelings of gratefulness (for I have great health in general, praise Him) and fear (I don't love being physically uncomfortable...I'm kind of a wimp...) I'm also balancing something even harder. This is something that I know if I am open to, I will walk away from this season of life with a better grip on how to...
I'm counting on allowing God to work on my pride as I LEAN ON.
I'm counting on experiencing His strength in a new way as I LEAN ON.
I'm counting on finding even firm footing in life as I LEAN ON because I know this will not be the last time I'm ever in a place of needing Him, needing others.
During this season of health issues I realize that I don't ask for help well. I think it is because I so love to give help not receive it. In my mind, asking for help means I am weak. Asking for help means I don't have what it takes at the moment. This is uncomfortable for me.
As I typed that last bit I recognized the over use of the words "I" and "Me."
The Great I AM (God Almighty) shows me that when I LEAN ON Him in weakness, I have the privilege of experiencing His strength and greatness. This is good for the soul. From the depths of our being to the outward physical extremities, we were created to rely on and experience His greatness. We were created to LEAN ON because when we do, we put aside that soul ravaging pride which depletes and deprives.
I don't want to live depleted and deprived in the depths of my soul, do you?
Let us live in the mindset and with the heart condition that we need to LEAN ON. Let us soften the rough edges of our heart that keeps the Great I AM at arms length for fear that He will not come through. It takes faith to LEAN ON, yes. The alternative is to never experience the release which over takes when when we LEAN ON. The release of pride, the release of grasping and striving on our own is tiring on our soul and even our bodies.
Today I am trusting that He carries me in His strong arms with loving care. I am trusting and I will LEAN ON because the Great I AM says...
Be strong and brave, and don't tremble in fear of them, because the Eternal your God is going with you. He'll never fail you or abandon you! (Deuteronomy 31:6 THE VOICE)
On a lighter note! I wanted to be sure to give you the link to get a sample chapter of my upcoming book Just RISE UP!: A Call To Make Jesus Famous. Click HERE to download!


text:
Fighters from the militant group Islamic State in Iraq and Syria (ISIS) seized around a third of the historic Syrian city of Palmyra on Wednesday after fierce clashes with the military and allied combatants, a group monitoring the war said.
The city, known as Tadmur in Arabic, is home to a UNESCO World Heritage site and the violence has fuelled fears Islamic State will destroy ancient ruins. The offshoot of al-Qaeda advanced into the city over the weekend but had been repelled.
Syrian state television, citing a military source, said in a news flash that armed forces had confronted "the Daesh (ISIS) terrorist group" when it tried to enter a northern neighbourhood of the city on Wednesday.
Palmyra's 2,000-year-old monuments, which lie on the south-western fringe of the modern city, were put on UNESCO's World Heritage in danger list in 2013. Islamic State has destroyed antiquities and ancient monuments in Iraq and is being targeted by U.S.-led air strikes in both countries.
The Britain-based Syrian Observatory for Human Rights said the enemy sides were shelling each other in Palmyra and that the Syrian military had carried out air strikes.
Pictures posted by ISIS supporters on social media showed gunmen in what they described as the streets of Palmyra, about 240 kilometres northeast of Damascus.
Further east, Kurdish forces backed by U.S.-led air strikes are pressing an attack on Islamic State that has killed at least 170 members of the jihadist group this week, a Kurdish official and the Observatory said.
The official said Kurdish YPG fighters and allied militia had encircled ISIS in a dozen villages near the town of Tel Tamr in Hasaka province, which borders land controlled by ISIS in neighbouring Iraq.
The Kurdish YPG appears to be trying to drive ISIS from a stronghold in the mountainous Jabal Abdul Aziz area to the southwest of Tel Tamr, said Rami Abdulrahman, who runs the Observatory.
The U.S.-led alliance bombing ISIS has been coordinating its air strikes in Hasaka with the YPG, after joining forces with the Kurds to drive the jihadists from Kobani, or Ayn al-Arab, in January.
The Kurdish official, Nasir Haj Mansour, said around 80 ISIS fighters were killed in an ambush when they tried to flee the Tel Tamr area for Jabal Abdul Aziz earlier this week. Dozens more were killed in air strikes.
"The confirmed number of (ISIS) dead is between 170 and 200," said Mansour, speaking by telephone from Syria.
ISIS is still believed to be holding some 200 Assyrian Christians abducted in February from villages near Tel Tamr.


text:
Cardinal Health to buy Harvard Drug Group
Cardinal Health said on Friday in a statement it will buy Harvard Drug Group for $1.2 billion to increase its generic drug distribution. Bloomberg writes that Harvard Drug Group, a Livonia, Michigan-based distributor of generic drugs and over-the-counter remedies, had revenue of about $450 million last year, according to the statement. The purchase will also bolster Cardinal Health's telesales capabilities and add specialized packaging options desired by hospitals. "We view the transaction as 'right down the middle' given the obvious strategic rationale and attractive financial considerations," said Ross Muken, an analyst with Evercore-ISI. "This should prove to be a welcome surprise."
Cardinal Health agreed in March to buy Johnson & Johnson's Cordis business for about $1.94 billion, bulking up the medical distributor's device-making capabilities. It plans to issue $1.5 billion in new debt to fund the Cordis and Harvard Drug Group purchases. Court Square Capital Partners, a New York-based private-equity firm, bought Harvard Drug Group in 2010 for an undisclosed price. Cardinal Health's purchase is expected to be completed in the year ending in June 2016, the company said.
The company added that the acquisition would bring specialized packaging offerings to its portfolio of products, such as gloves and surgical apparel, that it offers to hospital systems and institutions, notes the Wall Street Journal.
The company will fund the deal with existing cash and new debt. It expects to issue $1.5 billion of new debt related to these two acquisitions, reports Reuters.


text:
When you make an appointment, you and a librarian will work together for up to 30 minutes. However, you do not need to make an appointment to work with a librarian. Any librarian at the Research Help Desk can help you. You can find our research help hours here.
You can make an appointment if:


text:
Posted on Mar 13, 2018
in Fishing Reports by J4B Administrator
Comments Off on March 11, 2018 – Lake Okeechobee Bass Fishing Report
www.okeechobeejust4bass.com was fishing with Troy and Kristi Hartwick on Captain Scott Kerslake's boat. This was an 8 hour charter with wild shiners and artificial's. Here is a picture of some of the fish they caught.
Tags: Bass, Bass Fishing, FIshing Lake Okeechobee, Lake Okeechobee, Lake Okeechobee Fishing, Lake Okeechobee Fishing Report, Okeechobee Bass Guide
Comments are closed.
Just 4 Bass | PO Box 1742, Okeechobee, FL 34973 | 910-330-9821


text:
My very first post on my new blog!
UUugh! Soo exciting.
Is of course my newest YouTube video, about how to create an appropriate office and work makeup look – as it is something that probably all of my friends have requested at this point.
Makeup is fun and around to help us feel and look beautiful – in my opinion. And of course you can wear your makeup to (most) workplaces and meetings and whatnot, even though you do not work in the beauty industri.
I believe the most common barrier to wearing makeup on a day to day basis is time. And then perhaps the fear of going over-board – and being 'in appropriate.
So here is my take on a quick makeup for every day use – that is both long wearing and toned down enough to take you through an entire day of work.
If you have any questions regarding the products im using in this video then please do not hesitate to ask away.


text:
Visiting Hop Haus Restaurant & Craft Beer in Plantsville on a wintry Monday night, we didn't have the good fortune of encountering owner Michael Miller, head chef Michael Harty or restaurant manager Sara Armstrong, listed on its website as the Hop Haus team. No matter. The bar was being held down by a capable, friendly, down-to-earth bartender named Eliza, who I assure you was no Doolittle but was cheerfully managing the entire floor, venturing out from behind the bar frequently to attend to tables like ours. And they say you can't get good help these days!
They say you can't get great craft beers and sophisticated pub grub in (relatively) out-of-the-way spots like Plantsville, either. Located in a brick structure on the corner of South Main and West Main streets, Hop Haus certainly puts the lie to that! The full-service bar has 28 craft brews on tap, including enlightened choices like Black Hog Coffee Milk Stout, Firefly Hollow Toadstool Oat Stout, Innis & Gunn Scottish Porter, my companion's Goose Island Ten Hills Pale Ale and my Ithaca Flower Power IPA. There's also an impressive selection of coffee drinks, martinis, specialty drinks, bourbons, whiskeys and single malts.
From our limited tasting, the food appears even more fun. The Haus nuts included herb-roasted almonds, pecans, cashews and peanuts with just a tinge of sweetness. Korean BBQ Haus wings were wonderfully flavorful. We wanted to order the bacon-wrapped meatloaf special, but were told by the kitchen that the posted specials weren't served on Mondays. So instead we enjoyed a terrific Reuben and an 8-ounce Frenchie burger with caramelized onion, Swiss cheese and roasted garlic mayonnaise, both benefiting from superior meat.
The one frustration, after being denied the specials, was spying a bacon-wrapped meatloaf coming from the kitchen as we were leaving. Guess it pays to be one of those regulars.
Hop Haus Restaurant & Craft Beer, 28 W. Main St., Plantsville, 860-276-9326; hophauscraftbeer.com


text:
|DH-2000 with integrated shutter from Ocean Optics
|Ocean Optics
|DH-2000 with integrated shutter
| Identical to the DH-2000, but comes with a shutter (controlled via a TTL signal or switch up to 5 Hz)
The DH-2000 Deuterium Tungsten Halogen Light Source combines the continuous spectrum of deuterium and tungsten halogen light sources in a single optical path. The combined-spectrum light source produces a powerful, stable output from 215-200 nm. In addition, deep-UV versions of the light source are available, providing a 190-1700 nm wavelength range.
Options and Accessories
Integrated shutters are also available with the DH-2000 and can be driven either by a switch or by a TTL signal. Another option is to include a filter holder with the system, which accepts filters up to 4 mm in thickness and as large as 25-mm square or 20-mm round in diameter. All versions of the DH-2000 have an SMA 905 Connector for easy coupling to our spectrometers and accessories via optical fiber, and a safety shutter for blocking the light when the fiber is not attached.
All versions of the DH-2000 have a potentiometer on the back of the light source to balance the light level between the deuterium and tungsten halogen light sources. This potentiometer allows you to adjust the optical power of the tungsten halogen light from 10-100%.
| Ocean Optics
830 Douglas Ave.
Dunedin, FL 34698 USA
Fax Number: 727-733-3962
Web Site: http://www.oceanoptics.com


text:
Grand Summit Hotel is a Full-Service, Full-Amenity Ski-in/Lift out Hotel located at the base of Canyons Village
The Grand Summit Hotel is located at the base of the Red Pine Gondola and the Orange Bubble Express– arguably the ultimate resort address within Canyons Resort. You can walk outside your condo and be on a lift within seconds. This is the prime ski-in-ski-out destination at Canyons Resort as few places exist in the world such as this; great location, many floor plans available, combined with entry-level vacation home pricing.
The Grand Summit Resort Hotel combines ownership benefits with luxury resort hotel services, a concept that has revolutionized second-home ownership. Both whole and fractional ownership is available in these well-appointed condos. Suites at Grand Summit Hotel range from 370 sq.ft. studios to 3,700 sq. ft. 4- bedroom penthouses. Fractional owners enjoy 13 weeks of usage per year on a rotating pre-set schedule. Unlike most fractional ownership options, owners in the Grand Summit Hotel have the right to rent their condominiums when they are not in residence.
Grand Summit Education Series – Grand Summit 101
Amenities at the Grand Summit Hotel include:
– 15,000 square feet of conference and meeting space, including a Grand Ballroom.
– Concierge / Bell Service and Ski Valet
– Underground parking with valet service
– Owner's game room and lounge / library
– Year-around children's daycare
– 24 Hour Reception and Front Desk
– Shuttle Services
– Complimentary Wireless High Speed Internet
– Full Service Spa and Heath Club
– Fitness Facilities
– Sauna and Steam Room
– Outdoor Pool and Hot Tub
– Restaurants and Bars
– The Farm Restaurant and Lounge
– Red Tail Grill at the Orange Bubble Express
– First Track's Café
There truly are not many real estate opportunities in the world that combine ski in ski out access to a world-class ski resort at prices starting under $50,000 for deeded property.
From the Park City MLS: Canyons Grand Summit Hotel Listings
Aspen Creek Crossing real estate |Enclave at Sun Canyon real estate|Fairway Springs Ski and Golf Villas real estate|Grand Summit Hotel real estate|Hidden Creek real estate|Hyatt Escala Lodge real estate|Juniper Landing real estate|Red Pine real estate|Silverado Lodge real estate|Sundial Lodge real estate|Vintage on the Strand real estate|The Colony real estate|The Lodge at Westgate real estate|The Residences at Waldorf Gondola real estate|The Timbers real estate|Timberwolf Lodges real estate|Waldorf Astoria Park City real estate|Canyons Resort real estate|Park City real estate
The multiple listing information is provided by Park City Board of Realtors from a copyrighted compilation of listings. The compilation of listings and each individual listing are copywritten 2013 by the Park City Board of Realtors. All Rights Reserved. Access to the multiple listing information through this website is made available by Talisker Mountain Realty as a member of the Park City Board of Realtors multiple listing service.
Lorie Schumacher is on Google+


text:
Calgary, AB- On Saturday night at the Flames Community Arenas, the Mount Royal Cougars (4-4-2) dropped their second straight game at the hands of the Canada West leading University of Saskatchewan Huskies (9-1), by a score of 4-1.
Kohl Bauml, Josh Roach, Zak Stebner, and Levi Cable tallied for the Huskies. Matthew Brown scored the lone marker for the Cougars.
Mount Royal gave the nod to goaltender Cam Lanigan for his third start of the year, while the Huskies' workhorse Jordan Cooke, who has only dropped one game all year, started his ninth game of the season.
Just over a minute into the game Huskies rookie Kohl Bauml came rushing into the Cougars' zone and sent a shot at Lanigan from the blue line. Bauml used his speed to get past two Mount Royal defenders and chased down the poorly placed rebound in the slot. From the hash marks he sniped a wrist shot through Lanigan's five-hole.
The Cougars had an opportunity to answer with a power play early in the second. Cam Maclise managed to fit a pass through a wave of Huskies' sticks to Matt Brown in the slot. Brown sent a quick one-timer past Cooke for his eighth of the season.
The teams went back and fourth for the remainder of the period as good chances were few and far between. The Cougars managed to hold the Huskies to only three shots on goal in the second period. With time ticking down in the frame, Cody Cartier took a tripping penalty after a productive Huskies' shift, sending Saskatchewan to the power play to start the third.
It looked as if Mount Royal had escaped the Huskies' man advantage unscathed, however just seconds after the power play expired Saskatchewan forward Josh Roach blasted a shot that ricocheted off the post and in restoring the Huskies' lead.
The Huskies increased their lead on a power play with 12 minutes left in the game. Roach sent a pass to defenceman Zak Stebner who, from the point, sent a perfectly placed slap shot through a screen over the glove of Lanigan.
Levi Cable added an empty net goal for Saskatchewan in the final minutes, sealing the weekend sweep for the second ranked team in the nation.
Jordan Cooke improved to an impressive 8-1 on the year; making 32 saves on 33 shots. Cam Lanigan turned aside 20 of the 23 shots he faced dropping to 0-2-1 on the season.
Mount Royal will travel to Regina next weekend for a set against the Canada West's other Cougars squad. Saskatchewan will head home for a two games against the University of British Columbia Thunderbirds.


text:
Active ingredient
- atorvastatin calcium
Legal Category
POM: Prescription only medicine
POM: Prescription only medicine
This information is intended for use by health professionals
HypercholesterolaemiaAtorvastatin is indicated as an adjunct to diet for reduction of elevated total cholesterol (total-C), LDL-cholesterol (LDL-C), apolipoprotein B, and triglycerides in adults, adolescents and children aged 10 years or older with primary hypercholesterolaemia including familial hypercholesterolaemia (heterozygous variant) or combined (mixed) hyperlipidaemia (Corresponding to Types IIa and IIb of the Fredrickson classification) when response to diet and other nonpharmacological measures is inadequate.Atorvastatin is also indicated to reduce total-C and LDL-C in adults with homozygous familial hypercholesterolaemia as an adjunct to other lipid-lowering treatments (e.g. LDL apheresis) or if such treatments are unavailable.
Prevention of cardiovascular diseasePrevention of cardiovascular events in adult patients estimated to have a high risk for a first cardiovascular event (see section 5.1), as an adjunct to correction of other risk factors.
PosologyThe patient should be placed on a standard cholesterol-lowering diet before receiving Atorvastatin and should continue on this diet during treatment with Atorvastatin.The dose should be individualised according to baseline LDL-C levels, the goal of therapy, and patient response.The usual starting dose is 10 mg once a day. Adjustment of dose should be made at intervals of 4 weeks or more. The maximum dose is 80 mg once a day.
Primary hypercholesterolaemia and combined (mixed) hyperlipidaemiaThe majority of patients are controlled with Atorvastatin 10 mg once a day. A therapeutic response is evident within 2 weeks, and the maximum therapeutic response is usually achieved within 4 weeks. The response is maintained during chronic therapy.
Heterozygous familial hypercholesterolaemiaPatients should be started with Atorvastatin 10 mg daily. Doses should be individualised and adjusted every 4 weeks to 40 mg daily. Thereafter, either the dose may be increased to a maximum of 80 mg daily or a bile acid sequestrant may be combined with 40 mg atorvastatin once daily.
Homozygous familial hypercholesterolaemiaOnly limited data are available (see section 5.1).The dose of atorvastatin in patients with homozygous familial hypercholesterolemia is 10 to 80 mg daily (see section 5.1). Atorvastatin should be used as an adjunct to other lipid-lowering treatments (e.g. LDL apheresis) in these patients or if such treatments are unavailable.
Prevention of cardiovascular diseaseIn the primary prevention trials the dose was 10 mg/day. Higher doses may be necessary in order to attain (LDL-) cholesterol levels according to current guidelines.
Renal impairmentNo adjustment of dose is required (see section 4.4).
Hepatic impairmentAtorvastatin should be used with caution in patients with hepatic impairment (see sections 4.4 and 5.2). Atorvastatin is contraindicated in patients with active liver disease (see section 4.3).Use in the elderlyEfficacy and safety in patients older than 70 using recommended doses are similar to those seen in the general population.
Paediatric use
Hypercholesterolaemia:Paediatric use should only be carried out by physicians experienced in the treatment of paediatric hyperlipidaemia and patients should be re-evaluated on a regular basis to assess progress.For patients aged 10 years and above, the recommended starting dose of atorvastatin is 10 mg per day with titration up to 20 mg per day. Titration should be conducted according to the individual response and tolerability in paediatric patients. Safety information for paediatric patients treated with doses above 20 mg, corresponding to about 0.5 mg/kg, is limited.There is limited experience in children between 6-10 years of age (see section 5.1). Atorvastatin is not indicated in the treatment of patients below the age of 10 years.Other pharmaceutical forms/strengths may be more appropriate for this population.
Method of administrationAtorvastatin is for oral administration. Each daily dose of atorvastatin is given all at once and may be given at any time of day with or without food.
Liver effectsLiver function tests should be performed before the initiation of treatment and periodically thereafter. Patients who develop any signs or symptoms suggestive of liver injury should have liver function tests performed. Patients who develop increased transaminase levels should be monitored until the abnormality(ies) resolve. Should an increase in transaminases of greater than 3 times the upper limit of normal (ULN) persist, reduction of dose or withdrawal of Atorvastatin is recommended (see section 4.8).Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease.
Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)In a post-hoc analysis of stroke subtypes in patients without coronary heart disease (CHD) who had a recent stroke or transient ischemic attack (TIA) there was a higher incidence of hemorrhagic stroke in patients initiated on atorvastatin 80 mg compared to placebo. The increased risk was particularly noted in patients with prior hemorrhagic stroke or lacunar infarct at study entry. For patients with prior hemorrhagic stroke or lacunar infarct, the balance of risks and benefits of atorvastatin 80 mg is uncertain, and the potential risk of hemorrhagic stroke should be carefully considered before initiating treatment (see section 5.1).
Skeletal muscle effectsAtorvastatin, like other HMG-CoA reductase inhibitors, may in rare occasions affect the skeletal muscle and cause myalgia, myositis, and myopathy that may progress to rhabdomyolysis, a potentially life-threatening condition characterised by markedly elevated creatine kinase (CK) levels (> 10 times ULN), myoglobinaemia and myoglobinuria which may lead to renal failure.Before the treatmentAtorvastatin should be prescribed with caution in patients with pre-disposing factors for rhabdomyolysis. A CK level should be measured before starting statin treatment in the following situations:− Renal impairment− Hypothyroidism− Personal or familial history of hereditary muscular disorders− Previous history of muscular toxicity with a statin or fibrate− Previous history of liver disease and/or where substantial quantities of alcohol are consumed− In elderly (age > 70 years), the necessity of such measurement should be considered, according to the presence of other predisposing factors for rhabdomyolysis− Situations where an increase in plasma levels may occur, such as interactions (see section 4.5) and special populations including genetic subpopulations (see section 5.2)In such situations, the risk of treatment should be considered in relation to possible benefit, and clinical monitoring is recommended.If CK levels are significantly elevated (> 5 times ULN) at baseline, treatment should not be started.
Creatine kinase measurementCreatine kinase (CK) should not be measured following strenuous exercise or in the presence of any plausible alternative cause of CK increase as this makes value interpretation difficult. If CK levels are significantly elevated at baseline (> 5 times ULN), levels should be remeasured within 5 to 7 days later to confirm the results.Whilst on treatment− Patients must be asked to promptly report muscle pain, cramps, or weakness especially if accompanied by malaise or fever.− If such symptoms occur whilst a patient is receiving treatment with atorvastatin, their CK levels should be measured. If these levels are found to be significantly elevated (> 5 times ULN), treatment should be stopped.− If muscular symptoms are severe and cause daily discomfort, even if the CK levels are elevated to ≤ 5 x ULN, treatment discontinuation should be considered.− If symptoms resolve and CK levels return to normal, then re-introduction of atorvastatin or introduction of an alternative statin may be considered at the lowest dose and with close monitoring.− Atorvastatin must be discontinued if clinically significant elevation of CK levels (> 10 x ULN) occur, or if rhabdomyolysis is diagnosed or suspected.
Concomitant treatment with other medicinal productsRisk of rhabdomyolysis is increased when atorvastatin is administered concomitantly with certain medicinal products that may increase the plasma concentration of atorvastatin such as potent inhibitors of CYP3A4 or transport proteins (e.g. ciclosporine, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole and HIV protease inhibitors including ritonavir, lopinavir, atazanavir, indinavir, darunavir, etc). The risk of myopathy may also be increased with the concomitant use of gemfibrozil and other fibric acid derivates, erythromycin, niacin and ezetimibe. If possible, alternative (non-interacting) therapies should be considered instead of these medicinal products.In cases where co-administration of these medicinal products with atorvastatin is necessary, the benefit and the risk of concurrent treatment should be carefully considered. When patients are receiving medicinal products that increase the plasma concentration of atorvastatin, a lower maximum dose of atorvastatin is recommended. In addition, in the case of potent CYP3A4 inhibitors, a lower starting dose of atorvastatin should be considered and appropriate clinical monitoring of these patients is recommended (see section 4.5).The concurrent use of atorvastatin and fusidic acid is not recommended, therefore, temporary suspension of atorvastatin may be considered during fusidic acid therapy (see section 4.5).
Interstitial lung diseaseExceptional cases of interstitial lung disease have been reported with some statins, especially with long term therapy (see section 4.8). Presenting features can include dyspnoea, non- productive cough and deterioration in general health (fatigue, weight loss and fever). If it is suspected a patient has developed interstitial lung disease, statin therapy should be discontinued.
Paediatric useDevelopmental safety in the paediatric population has not been established (see section 4.8).
Diabetes MellitusSome evidence suggests that statins as a class raise blood glucose and in some patients, at high risk of future diabetes, may produce a level of hyperglycaemia where formal diabetes care is appropriate. This risk, however, is outweighed by the reduction in vascular risk with statins and therefore should not be a reason for stopping statin treatment. Patients at risk (fasting glucose 5.6 to 6.9 mmol/L, BMI>30kg/m2, raised triglycerides, hypertension) should be monitored both clinically and biochemically according to national guidelines.
ExcipientsAtorvastatin contains lactose. Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Effect of co-administered medicinal products on atorvastatinAtorvastatin is metabolized by cytochrome P450 3A4 (CYP3A4) and is a substrate to transport proteins e.g. the hepatic uptake transporter OATP1B1. Concomitant administration of medicinal products that are inhibitors of CYP3A4 or transport proteins may lead to increased plasma concentrations of atorvastatin and an increased risk of myopathy. The risk might also be increased at concomitant administration of atorvastatin with other medicinal products that have a potential to induce myopathy, such as fibric acid derivates and ezetimibe (see section 4.4). CYP3A4 inhibitorsPotent CYP3A4 inhibitors have been shown to lead to markedly increased concentrations of atorvastatin (see Table 1 and specific information below). Co-administration of potent CYP3A4 inhibitors (e.g. ciclosporin, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole and HIV protease inhibitors including ritonavir, lopinavir, atazanavir, indinavir, darunavir, etc.) should be avoided if possible. In cases where co-administration of these medicinal products with atorvastatin cannot be avoided lower starting and maximum doses of atorvastatin should be considered and appropriate clinical monitoring of the patient is recommended (see Table 1).Moderate CYP3A4 inhibitors (e.g. erythromycin, diltiazem, verapamil and fluconazole) may increase plasma concentrations of atorvastatin (see Table 1).. An increased risk of myopathy has been observed with the use of erythromycin in combination with statins. Interaction studies evaluating the effects of amiodarone or verapamil on atorvastatin have not been conducted. Both amiodarone and verapamil are known to inhibit CYP3A4 activity and co- administration with atorvastatin may result in increased exposure to atorvastatin. Therefore, a lower maximum dose of atorvastatin should be considered and appropriate clinical monitoring of the patient is recommended when concomitantly used with moderate CYP3A4 inhibitors. Appropriate clinical monitoring is recommended after initiation or following dose adjustments of the inhibitor.
CYP3A4 inducersConcomitant administration of atorvastatin with inducers of cytochrome P450 3A (e.g. efavirenz, rifampin, St. John's Wort) can lead to variable reductions in plasma concentrations of atorvastatin. Due to the dual interaction mechanism of rifampin, (cytochrome P450 3A induction and inhibition of hepatocyte uptake transporter OATP1B1), simultaneous co- administration of atorvastatin with rifampin is recommended, as delayed administration of atorvastatin after administration of rifampin has been associated with a significant reduction in atorvastatin plasma concentrations. The effect of rifampin on atorvastatin concentrations in hepatocytes is, however, unknown and if concomitant administration cannot be avoided, patients should be carefully monitored for efficacy.
Transport protein inhibitorsInhibitors of transport proteins (e.g. ciclosporin) can increase the systemic exposure of atorvastatin (see Table 1). The effect of inhibition of hepatic uptake transporters on atorvastatin concentrations in hepatocytes is unknown. If concomitant administration cannot be avoided, a dose reduction and clinical monitoring for efficacy is recommended (see Table 1).Gemfibrozil / fibric acid derivativesThe use of fibrates alone is occasionally associated with muscle related events, including rhabdomyolysis. The risk of these events may be increased with the concomitant use of fibric acid derivatives and atorvastatin. If concomitant administration cannot be avoided, the lowest dose of atorvastatin to achieve the therapeutic objective should be used and the patients should be appropriately monitored (see section 4.4).EzetimibeThe use of ezetimibe alone is associated with muscle related events, including rhabdomyolysis. The risk of these events may therefore be increased with concomitant use of ezetimibe and atorvastatin. Appropriate clinical monitoring of these patients is recommended.ColestipolPlasma concentrations of atorvastatin and its active metabolites were lower (by approx. 25%) when colestipol was co-administered with atorvastatin. However, lipid effects were greater when atorvastatin and colestipol were co-administered than when either medicinal product was given alone.Fusidic acidInteraction studies with atorvastatin and fusidic acid have not been conducted. As with other statins, muscle related events, including rhabdomyolysis, have been reported in post- marketing experience with atorvastatin and fusidic acid given concurrently. The mechanism of this interaction is not known. Patients should be closely monitored and temporary suspension of atorvastatin treatment may be appropriate.
Effect of atorvastatin on co-administered medicinal products
DigoxinWhen multiple doses of digoxin and 10 mg atorvastatin were co-administered, steady-state digoxin concentrations increased slightly. Patients taking digoxin should be monitored appropriately.Oral contraceptivesCo-administration of atorvastatin with an oral contraceptive produced increases in plasma concentrations of norethindrone and ethinyl oestradiol.WarfarinIn a clinical study in patients receiving chronic warfarin therapy, co-administration of atorvastatin 80 mg daily with warfarin caused a small decrease of about 1.7 seconds in prothrombin time during the first 4 days of dosing which returned to normal within 15 days of atorvastatin treatment. Although only very rare cases of clinically significant anticoagulant interactions have been reported, prothrombin time should be determined before starting atorvastatin in patients taking coumarin anticoagulants and frequently enough during early therapy to ensure that no significant alteration of prothrombin time occurs. Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on coumarin anticoagulants. If the dose of atorvastatin is changed or discontinued, the same procedure should be repeated. Atorvastatin therapy has not been associated with bleeding or with changes in prothrombin time in patients not taking anticoagulants.
Table 1: Effect of co-administered medicinal products on the pharmacokinetics of atorvastatin
|Co-administered medicinal product and dosing regimen
|Dose (mg)
|Change in AUC&
|Clinical Recommendation#
|Tipranavir 500 mg BID/ Ritonavir 200 mg BID, 8 days (days 14 to 21)
|40 mg on day 1, 10 mg on day 20
|↑ 9.4 fold
|In cases where co-administration with atorvastatin is necessary, do not exceed 10 mg atorvastatin daily. Clinical monitoring of these patients is recommended.
|Ciclosporin 5.2 mg/kg/day, stable dose
|10 mg OD for 28 days
|↑ 8.7 fold
|Lopinavir 400 mg BID/ Ritonavir 100 mg BID, 14 days
|20 mg OD for 4 days
|↑ 5.9 fold
|In cases where co-administration with atorvastatin is necessary, lower maintenance doses of atorvastatin are recommended. At atorvastatin doses exceeding 20 mg, clinical monitoring of these patients is recommended.
|Clarithromycin 500 mg BID, 9 days
|80 mg OD for 8 days
|↑ 4.4 fold
|Saquinavir 400 mg BID/ Ritonavir 300 mg BID from days 5-7, increased to 400 mg BID on day 8), days 5-18, 30 min after atorvastatin dosing
|40 mg OD for 4 days
|↑ 3.9 fold
|In cases where co-administration with atorvastatin is necessary, lower maintenance doses of atorvastatin are recommended. At atorvastatin doses exceeding 40 mg, clinical monitoring of these patients is recommended.
|Darunavir 300 mg BID/ Ritonavir 100 mg BID, 9 days
|10 mg OD for 4 days
|↑ 3.3 fold
|Itraconazole 200 mg OD, 4 days
|40 mg SD
|↑ 3.3 fold
|Fosamprenavir 700 mg BID/ Ritonavir 100 mg BID, 14 days
|10 mg OD for 4 days
|↑ 2.5 fold
|Fosamprenavir 1400 mg BID, 14 days
|10 mg OD for 4 days
|↑ 2.3 fold
|Nelfinavir 1250 mg BID, 14 days
|10 mg OD for 28 days
|↑ 1.7 fold^
|No specific recommendation
|Grapefruit Juice, 240 mL OD *
|40 mg, SD
|↑ 37%
|Concomitant intake of large quantities of grapefruit juice and atorvastatin is not recommended.
|Diltiazem 240 mg OD, 28 days
|40 mg, SD
|↑ 51%
|After initiation or following dose adjustments of diltiazem, appropriate clinical monitoring of these patients is recommended.
|Erythromycin 500 mg QID, 7 days
|10 mg, SD
|↑ 33%^
|Lower maximum dose and clinical monitoring of these patients is recommended.
|Amlodipine 10 mg, single dose
|80 mg, SD
|↑ 18%
|No specific recommendation.
|Cimetidine 300 mg QID, 2 weeks
|10 mg OD for 4 weeks
|↓ less than 1%^
|No specific recommendation.
|Antacid suspension of magnesium and aluminium hydroxides, 30 mL QID, 2 weeks
|10 mg OD for 4 weeks
|↓ 35%^
|No specific recommendation.
|Efavirenz 600 mg OD, 14 days
|10 mg for 3 days
|↓ 41%
|No specific recommendation.
|Rifampin 600 mg OD, 7 days (co-administered)
|40 mg SD
|↑ 30%
|If co-administration cannot be avoided, simultaneous co- administration of atorvastatin with rifampin is recommended, with clinical monitoring.
|Rifampin 600 mg OD, 5 days (doses separated)
|40 mg SD
|↓ 80%
|Gemfibrozil 600 mg BID, 7 days
|40 mg SD
|↑ 35%
|Lower starting dose and clinical monitoring of these patients is recommended.
|Fenofibrate 160 mg OD, 7 days
|40 mg SD
|↑ 3%
|Lower starting dose and clinical monitoring of these patients is recommended.
Table 2: Effect of atorvastatin on the pharmacokinetics of co-administered medicinal products
|Atorvastatin and dosing regimen
|Co-administered medicinal product
|Medicinal product/Dose (mg)
|Change in AUC&
|Clinical Recommendation
|80 mg OD for 10 days
|Digoxin 0.25 mg OD, 20 days
|↑ 15%
|Patients taking digoxin should be monitored appropriately.
|40 mg OD for 22 days
|Oral contraceptive OD, 2 months - norethindrone 1 mg - ethinyl estradiol 35 μg
|↑ 28% ↑ 19%
|No specific recommendation.
|80 mg OD for 15 days
|* Phenazone, 600 mg SD
|↑ 3%
|No specific recommendation
Paediatric populationDrug-drug interaction studies have only been performed in adults. The extent of interactions in the paediatric population is not known. The above mentioned interactions for adults and the warnings in section 4.4 should be taken into account for the paediatric population.
Women of childbearing potentialWomen of child-bearing potential should use appropriate contraceptive measures during treatment (see section 4.3).
PregnancyAtorvastatin is contraindicated during pregnancy (see section 4.3). Safety in pregnant women has not been established. No controlled clinical trials with atorvastatin have been conducted in pregnant women. Rare reports of congenital anomalies following intrauterine exposure to HMG-CoA reductase inhibitors have been received. Animal studies have shown toxicity to reproduction (see section 5.3).Maternal treatment with atorvastatin may reduce the fetal levels of mevalonate which is a precursor of cholesterol biosynthesis. Atherosclerosis is a chronic process, and ordinarily discontinuation of lipid-lowering medicinal products during pregnancy should have little impact on the long-term risk associated with primary hypercholesterolaemia.For these reasons, Atorvastatin should not be used in women who are pregnant, trying to become pregnant or suspect they are pregnant. Treatment with Atorvastatin should be suspended for the duration of pregnancy or until it has been determined that the woman is not pregnant (see section 4.3.)
BreastfeedingIt is not known whether atorvastatin or its metabolites are excreted in human milk. In rats, plasma concentrations of atorvastatin and its active metabolites are similar to those in milk (see section 5.3). Because of the potential for serious adverse reactions, women taking Atorvastatin should not breast-feed their infants (see section 4.3). Atorvastatin is contraindicated during breastfeeding (see section 4.3).
FertilityIn animal studies atorvastatin had no effect on male or female fertility (see section 5.3).
Blood and lymphatic system disordersRare: thrombocytopenia. Immune system disorders Common: allergic reactions. Very rare: anaphylaxis.
Metabolism and nutrition disordersCommon: hyperglycaemia.Uncommon: hypoglycaemia, weight gain, anorexia.
Psychiatric disordersUncommon: nightmare, insomnia.
Nervous system disordersCommon: headache.Uncommon: dizziness, paraesthesia, hypoesthesia, dysgeusia, amnesia. Rare: peripheral neuropathy.
Eye disordersUncommon: vision blurred. Rare: visual disturbance.
Ear and labyrinth disordersUncommon: tinnitusVery rare: hearing loss.Respiratory, thoracic and mediastinal disorders: Common: pharyngolaryngeal pain, epistaxis.
Gastrointestinal disordersCommon: constipation, flatulence, dyspepsia, nausea, diarrhoea.Uncommon: vomiting, abdominal pain upper and lower, eructation, pancreatitis.Hepatobiliary disorders Uncommon: hepatitis. Rare: cholestasis.Very rare: hepatic failure.
Skin and subcutaneous tissue disordersUncommon: urticaria, skin rash, pruritus, alopecia.Rare: angioneurotic oedema, dermatitis bullous including erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis.
Musculoskeletal and connective tissue disordersCommon: myalgia, arthralgia, pain in extremity, muscle spasms, joint swelling, back pain. Uncommon: neck pain, muscle fatigue.Rare: myopathy, myositis, rhabdomyolysis, tendonopathy, sometimes complicated by rupture.
Reproductive system and breast disordersVery rare: gynecomastia.
General disorders and administration site conditionsUncommon: malaise, asthenia, chest pain, peripheral oedema, fatigue, pyrexia.
InvestigationsCommon: liver function test abnormal, blood creatine kinase increased. Uncommon: white blood cells urine positive.As with other HMG-CoA reductase inhibitors elevated serum transaminases have been reported in patients receiving atorvastatin. These changes were usually mild, transient, and did not require interruption of treatment. Clinically important (> 3 times upper normal limit) elevations in serum transaminases occurred in 0.8% patients on atorvastatin. These elevations were dose related and were reversible in all patients.Elevated serum creatine kinase (CK) levels greater than 3 times upper limit of normal occurred in 2.5% of patients on atorvastatin, similar to other HMG-CoA reductase inhibitors in clinical trials. Levels above 10 times the normal upper range occurred in 0.4% atorvastatin- treated patients (see section 4.4).
Class Effects Sexual dysfunction Depression Exceptional cases of interstitial lung disease, especially with long term therapy (see section 4.4) Diabetes Mellitus: Frequency will depend on the presence or absence of risk factors (fasting blood glucose ≥ 5.6 mmol/L, BMI>30kg/m2, raised triglycerides, history of hypertension).
Paediatric PopulationThe clinical safety database includes safety data for 249 paediatric patients who received atorvastatin, among which 7 patients were < 6 years old, 14 patients were in the age range of 6 to 9, and 228 patients were in the age range of 10 to 17.
Nervous system disordersCommon: Headache
Gastrointestinal disordersCommon: Abdominal pain
InvestigationsCommon: Alanine aminotransferase increased, blood creatine phosphokinase increasedBased on the data available, frequency, type and severity of adverse reactions in children are expected to be the same as in adults. There is currently limited experience with respect to longterm safety in the paediatric population.
Homozygous familial hypercholesterolaemiaIn a multicenter 8 week open-label compassionate-use study with an optional extension phase of variable length, 335 patients were enrolled, 89 of which were identified as homozygous familial hypercholesterolaemia patients. From these 89 patients, the mean percent reduction in LDL-C was approximately 20%. Atorvastatin was administered at doses up to 80 mg/day.
AtherosclerosisIn the Reversing Atherosclerosis with Aggressive Lipid- Lowering Study (REVERSAL), the effect of intensive lipid lowering with atorvastatin 80 mg and standard degree of lipid lowering with pravastatin 40 mg on coronary atherosclerosis was assessed by intravascular ultrasound (IVUS), during angiography, in patients with coronary heart disease. In this randomised, double- blind, multicenter, controlled clinical trial, IVUS was performed at baseline and at 18 months in 502 patients. In the atorvastatin group (n=253), there was no progression of atherosclerosis.The median percent change, from baseline, in total atheroma volume (the primary study criteria) was -0.4% (p=0.98) in the atorvastatin group and +2.7% (p=0.001) in the pravastatin group (n=249). When compared to pravastatin the effects of atorvastatin were statistically significant (p=0.02). The effect of intensive lipid lowering on cardiovascular endpoints (e. g. need for revascularisation, non fatal myocardial infarction, coronary death) was not investigated in this study.In the atorvastatin group, LDL-C was reduced to a mean of 2.04 mmol/L ± 0.8 (78.9 mg/dl ± 30) from baseline 3.89 mmol/l ± 0.7 (150 mg/dl ± 28) and in the pravastatin group, LDL-C was reduced to a mean of 2.85 mmol/l ± 0.7 (110 mg/dl ± 26) from baseline 3.89 mmol/l ± 0.7 (150 mg/dl ± 26) (p<0.0001). Atorvastatin also significantly reduced mean TC by 34.1% (pravastatin: - 18.4%, p<0.0001), mean TG levels by 20% (pravastatin: -6.8%, p<0.0009), and mean apolipoprotein B by 39.1% (pravastatin: -22.0%, p<0.0001). Atorvastatin increased mean HDL-C by 2.9% (pravastatin: +5.6%, p=NS). There was a 36.4% mean reduction in CRP in the atorvastatin group compared to a 5.2% reduction in the pravastatin group (p<0.0001).Study results were obtained with the 80 mg dose strength. Therefore, they cannot be extrapolated to the lower dose strengths.The safety and tolerability profiles of the two treatment groups were comparable.The effect of intensive lipid lowering on major cardiovascular endpoints was not investigated in this study. Therefore, the clinical significance of these imaging results with regard to the primary and secondary prevention of cardiovascular events is unknown.
Acute coronary syndromeIn the MIRACL study, atorvastatin 80 mg has been evaluated in 3,086 patients (atorvastatin n=1,538; placebo n=1,548) with an acute coronary syndrome (non Q-wave MI or unstable angina). Treatment was initiated during the acute phase after hospital admission and lasted for a period of 16 weeks. Treatment with atorvastatin 80 mg/day increased the time to occurrence of the combined primary endpoint, defined as death from any cause, nonfatal MI, resuscitated cardiac arrest, or angina pectoris with evidence of myocardial ischaemia requiring hospitalization, indicating a risk reduction by 16% (p=0.048). This was mainly due to a 26% reduction in re-hospitalisation for angina pectoris with evidence of myocardial ischaemia (p=0.018). The other secondary endpoints did not reach statistical significance on their own (overall: Placebo: 22.2%, Atorvastatin: 22.4%).The safety profile of atorvastatin in the MIRACL study was consistent with what is described in section 4.8.
Prevention of cardiovascular diseaseThe effect of atorvastatin on fatal and non-fatal coronary heart disease was assessed in a randomized, double-blind, placebo-controlled study, the Anglo- Scandinavian Cardiac Outcomes Trial Lipid Lowering Arm (ASCOT-LLA). Patients were hypertensive, 40-79 years of age, with no previous myocardial infarction or treatment for angina, and with TC levels ≤6.5 mmol/l (251 mg/dl). All patients had at least 3 of the pre-defined cardiovascular risk factors: male gender, age ≥55 years, smoking, diabetes, history of CHD in a first-degree relative, TC:HDL-C >6, peripheral vascular disease, left ventricular hypertrophy, prior cerebrovascular event, specific ECG abnormality, proteinuria/albuminuria. Not all included patients were estimated to have a high risk for a first cardiovascular event.Patients were treated with anti-hypertensive therapy (either amlodipine or atenolol-based regimen) and either atorvastatin 10 mg daily (n=5,168) or placebo (n=5,137).The absolute and relative risk reduction effect of atorvastatin was as follows:
|Relative Risk Reduction (%)
|No. of Events (Atorvastatin vs Placebo)
|Absolute Risk Reduction1 (%)
|Fatal CHD plus non-fatal MI Total cardiovascular events and revascularization procedures Total coronary events
| 36%
| 100 vs. 154
389 vs. 483
178 vs 247
| 1.1%
| 0.0005
|Relative Risk Reduction (%)
|No. of Events (Atorvastatin vs Placebo)
|Absolute Risk Reduction1 (%)
|Major cardiovascular events (fatal and non-fatal AMI, silent MI, acute CHD death, unstable angina, CABG, PTCA, revascularization, stroke) MI (fatal and non-fatal AMI, silent MI) Strokes (Fatal and non-fatal)
| 37%
| 83 vs. 127
38 vs 64
21 vs. 39
| 3.2%
| 0.0010
Recurrent strokeIn the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study, the effect of atorvastatin 80 mg daily or placebo on stroke was evaluated in 4731 patients who had a stroke or transient ischemic attack (TIA) within the preceding 6 months and no history of coronary heart disease (CHD). Patients were 60% male, 21-92 years of age (average age 63 years), and had an average baseline LDL of 133 mg/dL (3.4 mmol/L). The mean LDL-C was 73 mg/dL (1.9 mmol/L) during treatment with atorvastatin and 129 mg/dL (3.3 mmol/L) during treatment with placebo. Median follow-up was 4.9 years.Atorvastatin 80 mg reduced the risk of the primary endpoint of fatal or non-fatal stroke by 15% (HR 0.85; 95% CI, 0.72-1.00; p=0.05 or 0.84; 95% CI, 0.71-0.99; p=0.03 after adjustment for baseline factors) compared to placebo. All cause mortality was 9.1% (216/2365) for atorvastatin versus 8.9% (211/2366) for placebo.In a post-hoc analysis, atorvastatin 80 mg reduced the incidence of ischemic stroke (218/2365, 9.2% vs. 274/2366, 11.6%, p=0.01) and increased the incidence of hemorrhagic stroke (55/2365, 2.3% vs. 33/2366, 1.4%, p=0.02) compared to placebo.− The risk of hemorrhagic stroke was increased in patients who entered the study with prior hemorrhagic stroke (7/45 for atorvastatin versus 2/48 for placebo; HR 4.06; 95% CI, 0.84-19.57), and the risk of ischemic stroke was similar between groups (3/45 for atorvastatin versus 2/48 for placebo; HR 1.64; 95% CI, 0.27-9.82).− The risk of hemorrhagic stroke was increased in patients who entered the study with prior lacunar infarct (20/708 for atorvastatin versus 4/701 for placebo; HR 4.99; 95% CI, 1.71-14.61), but the risk of ischemic stroke was also decreased in these patients (79/708 for atorvastatin versus 102/701 for placebo; HR 0.76; 95% CI, 0.57-1.02). It is possible that the net risk of stroke is increased in patients with prior lacunar infarct who receive atorvastatin 80 mg/day.All cause mortality was 15.6% (7/45) for atorvastatin versus 10.4% (5/48) in the subgroup of patients with prior hemorrhagic stroke. All cause mortality was 10.9% (77/708) for atorvastatin versus 9.1% (64/701) for placebo in the subgroup of patients with prior lacunar infarct.
Paediatric PopulationHeterozygous Familial Hypercholesterolaemia in Paediatric Patients aged 6-17 years oldAn 8-week, open-label study to evaluate pharmacokinetics, pharmacodynamics, and safety and tolerability of atorvastatin was conducted in children and adolescents with genetically confirmed heterozygous familial hypercholesterolemia and baseline LDL-C ≥4 mmol/L. A total of 39 children and adolescents, 6 to 17 years of age, were enrolled. Cohort A included 15 children, 6 to 12 years of age and at Tanner Stage 1. Cohort B included 24 children, 10 to 17 years of age and at Tanner Stage ≥2.The initial dose of atorvastatin was 5 mg daily of a chewable tablet in Cohort A and 10 mg daily of a tablet formulation in Cohort B. The atorvastatin dose was permitted to be doubled if a subject had not attained target LDL-C of <3.35 mmol/L at Week 4 and if atorvastatin was well tolerated.Mean values for LDL-C, TC, VLDL-C, and Apo B decreased by Week 2 among all subjects. For subjects whose dose was doubled, additional decreases were observed as early as 2 weeks, at the first assessment, after dose escalation. The mean percent decreases in lipid parameters were similar for both cohorts, regardless of whether subjects remained at their initial dose or doubled their initial dose. At Week 8, on average, the percent change from baseline in LDL-C and TC was approximately 40% and 30%, respectively, over the range of exposures.
Heterozygous Familial Hypercholesterolaemia in Paediatric Patients aged 10- 17 years oldIn a double-blind, placebo controlled study followed by an open-label phase, 187 boys and postmenarchal girls 10-17 years of age (mean age 14.1 years) with heterozygous familial hypercholesterolaemia (FH) or severe hypercholesterolaemia were randomised to atorvastatin (n=140) or placebo (n=47) for 26 weeks and then all received atorvastatin for 26 weeks.. The dosage of atorvastatin (once daily) was 10 mg for the first 4 weeks and up-titrated to 20 mg if the LDL-C level was >3.36 mmol/l. Atorvastatin significantly decreased plasma levels of total-C, LDL-C, triglycerides, and apolipoprotein B during the 26 week double-blind phase. The mean achieved LDL-C value was 3.38 mmol/l (range: 1.81-6.26 mmol/l) in the atorvastatin group compared to 5.91 mmol/l (range: 3.93-9.96 mmol/l) in the placebo group during the 26-week double-blind phase.An additional paediatric study of atorvastatin versus colestipol in patients with hypercholesterolaemia aged 10-18 years demonstrated that atorvastatin (N=25) caused a significant reduction in LDL-C at week 26 (p<0.05) compared with colestipol (N=31).A compassionate use study in patients with severe hypercholesterolaemia (including homozygous hypercholesterolaemia) included 46 paediatric patients treated with atorvastatin titrated according to response (some subjects received 80 mg atorvastatin per day). The study lasted 3 years: LDL-cholesterol was lowered by 36%.The long-term efficacy of atorvastatin therapy in childhood to reduce morbidity and mortality in adulthood has not been established.The European Medicines Agency has waived the obligation to submit the results of studies with atorvastatin in children aged 0 to less than 6 years in the treatment of heterozygous hypercholesterolaemia and in children aged 0 to less than 18 years in the treatment of homozygous familial hypercholesterolaemia, combined (mixed) hypercholesterolaemia, primary hypercholesterolaemia and in the prevention of cardiovascular events (see section 4.2 for information on paediatric use).
AbsorptionAtorvastatin is rapidly absorbed after oral administration; maximum plasma concentrations (Cmax) occur within 1 to 2 hours. Extent of absorption increases in proportion to atorvastatin dose. After oral administration, atorvastatin film-coated tablets are 95% to 99% bioavailable compared to the oral solution. The absolute bioavailability of atorvastatin is approximately 12% and the systemic availability of HMG-CoA reductase inhibitory activity is approximately 30%. The low systemic availability is attributed to presystemic clearance in gastrointestinal mucosa and/or hepatic first-pass metabolism
DistributionMean volume of distribution of atorvastatin is approximately 381 l. Atorvastatin is ≥ 98% bound to plasma proteins.
BiotransformationAtorvastatin is metabolized by cytochrome P450 3A4 to ortho- and parahydroxylated derivatives and various beta-oxidation products. Apart from other pathways these products are further metabolized via glucuronidation. In vitro, inhibition of HMG-CoA reductase by ortho- and parahydroxylated metabolites is equivalent to that of atorvastatin. Approximately 70% of circulating inhibitory activity for HMG-CoA reductase is attributed to active metabolites.
ExcretionAtorvastatin is eliminated primarily in bile following hepatic and/or extrahepatic metabolism. However, atorvastatin does not appear to undergo significant enterohepatic recirculation. Mean plasma elimination half-life of atorvastatin in humans is approximately 14 hours. The half-life of inhibitory activity for HMG-CoA reductase is approximately 20 to 30 hours due to the contribution of active metabolites.
Special populationsElderly: Plasma concentrations of atorvastatin and its active metabolites are higher in healthy elderly subjects than in young adults while the lipid effects were comparable to those seen in younger patient populations.Paediatric: In an open-label, 8-week study, Tanner Stage 1 (N=15) and Tanner Stage ≥2 (N=24) paediatric patients (ages 6-17 years) with heterozygous familial hypercholesterolemia and baseline LDL-C ≥4 mmol/L were treated with 5 or 10 mg of chewable or 10 or 20 mg of film-coated atorvastatin tablets once daily, respectively. Body weight was the only significant covariate in atorvastatin population PK model. Apparent oral clearance of atorvastatin in paediatric subjects appeared similar to adults when scaled allometrically by body weight. Consistent decreases in LDL-C and TC were observed over the range of atorvastatin and o- hydroxyatorvastatin exposures.Gender: Concentrations of atorvastatin and its active metabolites in women differ from those in men (Women: approx. 20% higher for Cmax and approx. 10% lower for AUC). These differences were of no clinical significance, resulting in no clinically significant differences in lipid effects among men and women.Renal insufficiency: Renal disease has no influence on the plasma concentrations or lipid effects of atorvastatin and its active metabolites.Hepatic insufficiency: Plasma concentrations of atorvastatin and its active metabolites are markedly increased (approx. 16-fold in Cmax and approx. 11-fold in AUC) in patients with chronic alcoholic liver disease (Child-Pugh B).SLCO1B1 polymorphism: Hepatic uptake of all HMG-CoA reductase inhibitors including atorvastatin, involves the OATP1B1 transporter. In patients with SLCO1B1 polymorphism there is a risk of increased exposure of atorvastatin, which may lead to an increased risk of rhabdomyolysis (see section 4.4). Polymorphism in the gene encoding OATP1B1 (SLCO1B1 c.521CC) is associated with a 2.4-fold higher atorvastatin exposure (AUC) than in individuals without this genotype variant (c.521TT). A genetically impaired hepatic uptake of atorvastatin is also possible in these patients. Possible consequences for the efficacy are unknown.
Film-coating:Opadry II White 85F28751 containing: Polyvinyl alcoholTitanium dioxide (E171) Macrogol 3000Talc (E553b)
No. 1 Church Road, Richmond upon Thames, Surrey, TW9 2QE, UK
+44(0) 20 3751 1888
+44(0)20 3751 1889


text:
Parliament Hall (PAR) a suite-style residence hall consisting of both double and single rooms for freshmen. All suites feature a common entrance and two bathroom facilities. Each bedroom is equipped with unlimited access Ethernet connections and basic cable television service. Parliament Hall also offers a 24-hour desk operation community kitchen classroom library computer lab fitness room activity room multipurpose room laundry facilities and two-story study lounges. Enhancing the student experience PAR has an attached retail dining facility.
777 Glades Road, Boca Raton, FL 33431
One of my favorite things from college.I learned so much that I apply to my company now. Hope you have a good turn out!
I got up early for this. I dressed up nice fir this. I commuted to Boca Raton for this. But, the training workshop didn't really take place at the scheduled tome and place.
It was a great eye-opener and made me become more open minded and more aware of my environment.
Login to interact with events, personalize your calendar, and get recommendations.


text:
Nine compelling reasons.
Why SmartIntego has special appeal for operators and managers of complex building systems.
01. Components successful worldwide
More than 12,000 SimonsVoss digital locking and access control systems with over 1.2 million locking devices impress with their precision and reliability in tough, practical use.
02. Supports all major card formats
MIFARE® Classic, MIFARE Plus®, MIFARE® DESFire® / EV1, Calypso CSN, ISO 7816-4 Elementary File, and UID (CSN) as per ISO 14443 in conjunction with MIFARE®, Legic Advant and HID® iClass.
03. Made in Germany
All system components are developed and produced to the highest standards exclusively in Germany.
04. Less work involved for integration
Powerful communications protocols and a high degree of automation thanks to SmartIntego Manager reduces significantly the work involved to integrate SmartIntego.
05. Optimally networked at all times – also virtually
The exchange management of security-relevant information between the management system and SmartIntego access media is guaranteed for each locking operation in Virtual CardNetwork mode.
06. Unique wireless technology
Wider ranges in the wireless network due to 868-MHz technology ensures no interference from other networks, such as WLAN and Bluetooth in the 2.4 GHz range.
07. Flawless performance
With two integrated batteries, the SmartIntego locking cylinder and the SmartIntego SmartHandle provide up to 80,000 activations and five years on standby in wireless online mode and up to 50,000 activations and six years in standby mode in a Virtual CardNetwork. This ensures years of operation without needing to replace batteries.
08. Range of versions for every type of use
Digital SmartHandle is available in Euro Profile, Swiss Round and Scandinavian Oval versions. There is also a Scandinavian Round version of the digital locking cylinder.
09. Perfect in form to the very last detail
Anything which is efficient and useful should also be beautiful. The SmartIntego locking cylinder and the SmartIntego SmartHandle have been honoured with many design awards.


text:
The Ferric Chloride yesterday evening, so we got on with etching our multi-effect pedal board, made with the (much cheaper) press-n-peel alternative. The result was pretty impressive. In short, the cheaper alternative works as well as the real thing for us. Which is just as well, as we've invested in about 50 sheets of the stuff!
A bit of drilling and filling and a bit later, we had a populated board!
Of course, the eagle-eyed will spot that there are still components missing off this board. Can you believe we can't find a 10K or 1K rated resistor in amongst all the junk in the nerd cupboard?! It's not like we're after some obscure rated component, just some common-or-garden, everyone-uses-them 10K resistors….
Here's the board soldered up (minus a few critical components) complete with "pass-through" switches. By setting these switches, you can have the input signal directed straight to the output jack (clean sound), have it pass through the fuzz circuit then straight to output, have the input go to the wah circuit only, or have the input go into fuzz then wah before hitting the output jack.
Still not quite ready for testing, but it's looking quite promising so far….


text:
Join Donegal Railways
Members help sustain this local organisation while enjoying many outstanding benefits throughout the year.
The CDRRL supporters aim for the preservation and presentation of the railway heritage, and eventually the re-installation of the railway: Our members are encouraged to contact us on visits, via the telephone, fax, e-mail or web site, which keeps them informed of progress. Members also receive a complimentary magazine and newsletters to update them of progress in Donegal. If we are to continue at the current pace of saving and restoring the County Donegal Railway as an attraction we do need more members, especially from County Donegal and the Border Counties, so please, if you can, give your support.
All members receive:
- Free admission to the museum 2x per year
- Members-only emails with advance notice of events, programs, and offers
- Discounts in The Railway Shop
- Eligibility to rent museum spaces for private events
Membership Levels
Each membership also comes with either a digital or hard-copy of the "The Phoenix" magazine produced here at the Donegal Railway Heritage Centre.


text:
I don't remember where I found these on the internet but they have become a holiday tradition in our family! We have actually even made different variations of this as well, but I love the how the chocolate and the candy canes taste together.
Candy Cane Brownies Recipe
- 1 brownie mix 9×13 inch size
- 18 Candy Cane Hershey Kisses
- 1/2 Cup chocolate chips
- 2 Tablespoons heavy cream
- 3 original candy canes, crushed
- Preheat oven to 350 degrees F.
- Prepare brownie mix according to package directions and scoop into a mini cheesecake pan or mini muffin tin pan that has been generously sprayed with cooking spray, about 3/4 way full.
- Press kisses into center of brownie batter, do not push all the way to bottom, some of the tip should stick out the top.
- Bake for 20-23 minutes or until brownies are cooked through. Let cool completely.
- Melt chocolate chips in microwave 30 second intervals until smooth and melted.
- Stir in cream until silky smooth. You can place back in microwave for 10 seconds to smooth more if needed.
- Dip tops of brownies into melted chocolate, then sprinkle with crushed candy canes.
Candy Cane Brownies Recipe, by Cassie – Crazy & Cool with a side of Crafty