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Noorie College of Nursing (NCN), Kolar
Kolar (Karnataka) Estd : 1997 Approved by : Indian Nursing Council (INC), Karnataka Nursing Council (KNC) Type : Private
Noorie College of Nursing is situated in Kolar in Karnataka state of India. Established in 1997, it is accredited from Indian Nursing Council (INC), Karnataka Nursing Council (KNC) and it is affiliated to Rajiv Gandhi University. NCN, Kolar offers 6 courses across 2 streams namely Nursing, Pharmacy and across 5 degrees like GNM, BSc, B.Pharm, M.Pharm, Diploma.Hostel facility is not available for its students. Additional campus facilities such as Library, Medical Facilities, Cls. Room are also there.
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Authorities say one person has been hospitalized after he struck the rear of a Scotts Bluff County road grader south of Melbeta Monday morning.
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Overman says the accident occurred between County Roads 29 and 30, and said Conklin did not see the road grader, driven by 55-year-old Dane Bolzer of Mitchell, until it was too late to avoid the collision. Bolzer was not injured.
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brittonlj reacted to a post in a topic: iOS Dice Roller
It took absolutely forever but I recoded most of my app. I Added a Hit Location Helper on the damage page that tells you what to do after you roll and subtract defenses. Added a Hit Location Tab with full body to graphically target specific areas of the body. Added dice graphics for easier roll understanding and I changed the DCV calculator to work with the ( OCV + 11 - your roll ) method. Phew! Please let me know if there are any bugs or other oddities that need addressing. This was a ton of work and I'm really excited to know what you think. https://t.co/SMslPQGsqF
Ah, so if I flip my killing damage to normal damage it changes from 3.5d6 killing to 11d6 normal damage? Not sure if I could do that exactly, but I'll look into it. I added a little set of buttons for modifiers like -1 +1 and 1/2.
That should be pretty easy to do. I just wonder if I should replace the current OCV DCV calculator with it. The app is more player focused than GM focused so it would make sense. I'll definitely think about it. I really like that idea, I could put a little guy on screen and do the math if you tap on his arm or whatever.
I only released it for iOS, but you should be able to get it for your iPad if you tell it to search for iOS stuff. If I can figure out a Universal iPad update it would be a good idea.
iOS Dice Roller
sdsj posted a topic in Other Software & Online ResourcesI'm learning to code so I put together a 6e Hero System dice rolling app as my first. It's only for iOS, I figured I should share it here if I wanted anyone to learn about it who cared! To the app store, HeroDice 6e https://t.co/SMslPQGsqF Thanks, and let me know what you think. It can do quite a bit with normal damage to killing damage and modifiers therein, but it does not save previous rolls. It can also do normal 3d6 rolls, and OCV and DCV calculation. If there are any bugs or rule errors or anything, let me know! Thanks so much, you can reach me here or @cortlandune on twitter.


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Monday, July 4, 2016
A Foolish Consistency: a Literary Digression...
The County has been prepping the Upper Loop Road for resurfacing all spring. I first noticed the white graffiti highlighting pavement cracks. Then the serpentine black sealer cover up, (one looked suspiciously like a '60's peace symbol; County guys having a little fun?). Yellow plastic tabs next and the gravel overlay for the asphalt to follow. Thus the warnings for bikers rumbling (screaming?) devil-may-care through the Valley.
But propping a warning sign at the head of a long driveway seemed a bit superfluous and brought to mind a string of literary allusions, the first of which was Emerson's famous quote from his essay "Self-Reliance": "A foolish consistency is the hobgoblin of little minds/Adored by little statesmen, philosophers, and divines."Another on the topic of consistency stated by Kenneth Roberts in the forward to his novel Lydia Bailey:
"...; narrow men who consistently upheld the beliefs and acts of one political party and saw no good in any other; shortsighted men who consistently refused to see that the welfare of their own nation was dependent on the welfare of every other nation; ignorant men who consistently thought that the policies of their government should be supported and followed, whether these policies were right or wrong...;"
And then there's the poem "Mending Wall" by New England's poet laureate Robert Frost in which his subject is a stubborn neighbor whose "foolish consistency" binds him to the old saying "Good fences make good neighbors." As he complies with the neighbor's stubborn demand they annually repair the stone wall dividing their properties, Frost maintains their labors are just "another kind of outdoor game...there where it is we do not need the wall:/ He is all pine and I am apple orchard./ My apple trees will never get across/ And eat the cones under his pine trees, I tell him." But the neighbor "...will not go behind his father's saying,/ And he likes having thought of it so well/ He says again, 'Good fences make good neighbors.'"
Our County servants, in their defense, constipated by regs, codes, and guidelines would be the first to justify--consistently, of course-- the misuse of common sense and resources as "We're just doing our job." After all, Jim Cabe's driveway is a designated "County Road" (Christenson Rd.), thus must be posted with the cautionary warning. However should Gladys and I decide to visit the Cabes, we'll heed the advice and pedal carefully because Gladys is like William Faulkner's mule, "[She] will work for you patiently for ten years for the chance to kick you once."
Just one more allusion for you. No need for thanks. Call it literary lagniappe. Print this post
Posted by T.M.Johnson at 4:53 PM
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Shanghai Online Streaming
Storyline Shanghai
A small town somewhere in India is poised to become the next Shanghai. Billions of dollars are being poured into an upcoming International Business Park. On the eve of its launch a drunk truck driver mows down a prominent social activist. A lone girl believes it to be a murder, supported by a porn film maker who claims to have the proof that will bring the government down. A high ranking bureaucrat is brought in to investigate the accident. Shanghai, a political thriller, follows the journey of these unlikely heroes as they come together to find justice in the labyrinth of Indian democracy.
Movie details Shanghai
Release : 2012-06-08
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You are here: Home > Prescription(RX) Drugs > B > Boniva (Genentech, Inc.)
ibandronate sodium injection, solution
(ibandronate sodium)
BONIVA (ibandronate sodium) is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption. The chemical name for ibandronate sodium is 3-(N-methyl-N-pentyl)amino-1-hydroxypropane-1,1-diphosphonic acid, monosodium salt, monohydrate with the molecular formula C9H22NO7P2Na•H2O and a molecular weight of 359.24. Ibandronate sodium is a white- to off-white powder. It is freely soluble in water and practically insoluble in organic solvents. Ibandronate sodium has the following structural formula:
BONIVA Injection is intended for intravenous administration only. BONIVA Injection is available as a sterile, clear, colorless, ready-to-use solution in a prefilled syringe that delivers 3.375 mg of ibandronate monosodium salt monohydrate in 3 mL of solution, equivalent to a dose of 3 mg ibandronate free acid. Inactive ingredients include sodium chloride, glacial acetic acid, sodium acetate and water.
Mechanism of Action
The action of ibandronate on bone tissue is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.
Area under the serum ibandronate concentrations versus time curve increases in a dose-proportional manner after administration of 2 mg to 6 mg by intravenous injection. After administration, ibandronate either rapidly binds to bone or is excreted into urine. In humans, the apparent terminal volume of distribution is at least 90 L, and the amount of dose removed from the circulation into the bone is estimated to be 40% to 50% of the circulating dose. In vitro protein binding in human serum was approximately 86% over an ibandronate concentration range of 20 to 2000 ng/mL (approximate range of maximum serum ibandronate concentrations upon intravenous bolus administration) in one study.
There is no evidence that ibandronate is metabolized in humans. Ibandronate does not inhibit human P450 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4 isozymes in vitro.
The portion of ibandronate that is not removed from the circulation via bone absorption is eliminated unchanged by the kidney (approximately 50% to 60% of the administered intravenous dose).
The plasma elimination of ibandronate is multiphasic. Its renal clearance and distribution into bone accounts for a rapid and early decline in plasma concentrations, reaching 10% of Cmax within 3 or 8 hours after intravenous or oral administration, respectively. This is followed by a slower clearance phase as ibandronate redistributes back into the blood from bone. The observed apparent terminal half-life for ibandronate is generally dependent on the dose studied and on assay sensitivity. The observed apparent terminal half-life for intravenous 2 and 4 mg ibandronate after 2 hours of infusion ranges from 4.6 to 15.3 hours and 5 to 25.5 hours, respectively.
Following intravenous administration, total clearance of ibandronate is low, with average values in the range 84 to 160 mL/min. Renal clearance (about 60 mL/min in healthy postmenopausal women) accounts for 50% to 60% of total clearance and is related to creatinine clearance. The difference between the apparent total and renal clearances likely reflects bone uptake of the drug.
Special Populations
Since ibandronate is not known to be metabolized, the only difference in ibandronate elimination for geriatric patients versus younger patients is expected to relate to progressive age-related changes in renal function (see Special Populations: Renal Impairment).
Renal Impairment
Renal clearance of ibandronate in patients with various degrees of renal impairment is linearly related to creatinine clearance (CLcr).
Following a single dose of 0.5 mg ibandronate by intravenous administration, patients with CLcr 40 to 70 mL/min had 55% higher exposure (AUC∞) than the exposure observed in subjects with CLcr >90 mL/min. Patients with CLcr <30 mL/min had more than a two-fold increase in exposure compared to the exposure for healthy subjects (see DOSAGE AND ADMINISTRATION: Patients with Renal Impairment).
Drug Interactions
Ibandronate does not undergo hepatic metabolism and does not inhibit the hepatic cytochrome P450 system. Ibandronate is eliminated by renal excretion. Based on a rat study, the ibandronate secretory pathway does not appear to include known acidic or basic transport systems involved in the excretion of other drugs.
A pharmacokinetic interaction study in multiple myeloma patients demonstrated that intravenous melphalan (10 mg/m2) and oral prednisolone (60 mg/m2) did not interact with 6 mg ibandronate upon intravenous coadministration. Ibandronate did not interact with melphalan or prednisolone.
Osteoporosis is characterized by decreased bone mass and increased fracture risk, most commonly at the spine, hip, and wrist. The diagnosis can be confirmed by a finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis indicative of vertebral fracture. While osteoporosis occurs in both men and women, it is most common among women following menopause. In healthy humans, bone formation and resorption are closely linked; old bone is resorbed and replaced by newly formed bone. In postmenopausal osteoporosis, bone resorption exceeds bone formation, leading to bone loss and increased risk of fracture. After menopause, the risk of fractures of the spine and hip increases; approximately 40% of 50-year-old women will experience an osteoporosis-related fracture during their remaining lifetimes.
In studies of postmenopausal women, BONIVA Injection at doses of 0.5 mg to 3 mg produced biochemical changes indicative of inhibition of bone resorption, including decreases of biochemical markers of bone collagen degradation (cross-linked C-telopeptide of Type I collagen [CTX]). Changes in markers of bone formation (osteocalcin) were observed later than changes in resorption markers, as expected, due to the coupled nature of bone resorption and formation.
Year 1 results from an efficacy and safety study comparing BONIVA Injection 3 mg every 3 months and BONIVA 2.5 mg daily oral tablet demonstrated that both dosing regimens significantly suppressed serum CTX levels at Months 3, 6, and 12. The median pre-dose or trough serum CTX levels in the ITT population reached a nadir of 57% (BONIVA Injection) and 62% (BONIVA 2.5 mg tablets) below baseline values by Month 6, and remained stable at Month 12 of treatment.
Clinical Studies
Daily Oral Tablets
The effectiveness and safety of BONIVA daily oral tablets were demonstrated in a randomized, double-blind, placebo-controlled, multinational study (Treatment Study) of 2946 women aged 55 to 80 years, who were on average 21 years postmenopause, who had lumbar spine bone mineral density (BMD) 2 to 5 SD below the premenopausal mean (T-score) in at least one vertebra [L1-L4], and who had one to four prevalent vertebral fractures. BONIVA was evaluated at oral doses of 2.5 mg daily and 20 mg intermittently. The main outcome measure was the occurrence of new radiographically diagnosed, vertebral fractures after 3 years of treatment. The diagnosis of an incident vertebral fracture was based on both qualitative diagnosis by the radiologist and quantitative morphometric criterion. The morphometric criterion required the dual occurrence of two events: a relative height ratio or relative height reduction in a vertebral body of at least 20%, together with at least a 4 mm absolute decrease in height. All women received 400 IU vitamin D and 500 mg calcium supplementation per day.
Quarterly IV Injection
The effectiveness and safety of BONIVA Injection 3 mg once every 3 months were demonstrated in a randomized, double-blind, multinational, noninferiority study (DIVA Study) in 1358 women with postmenopausal osteoporosis (L2-L4 lumbar spine BMD, T-score below -2.5 SD at baseline). The control group received BONIVA 2.5 mg daily oral tablets. The primary efficacy parameter was the relative change from baseline to 1 year of treatment in lumbar spine BMD, which was compared between the intravenous injection and the daily oral treatment groups. All patients received 400 IU vitamin D and 500 mg calcium supplementation per day.
Effect on Vertebral Fracture
BONIVA 2.5 mg daily oral tablet significantly reduced the incidence of new vertebral and of new and worsening vertebral fractures (Daily Oral Tablet – Treatment Study). Over the course of the 3-year study, the risk for vertebral fracture was 9.6% in the placebo-treated women and 4.7% in the women treated with BONIVA 2.5 mg daily oral tablet (p<0.001) (see Table 1). In an unapproved regimen, intermittent oral administration of 20 mg BONIVA, involving a 9- to 10-week drug-free interval, produced a statistically significant reduction (50%) in the incidence of new vertebral fractures, similar to that seen with the daily oral 2.5 mg regimen.
Effect on Nonvertebral Fractures
There was a similar number of nonvertebral osteoporotic fractures at 3 years reported in women treated with BONIVA 2.5 mg daily oral tablet [9.1%, (95% CI: 7.1%, 11.1%)] and placebo [8.2%, (95% CI: 6.3%, 10.2%)]. The two treatment groups were also similar with regard to the number of fractures reported at the individual non-vertebral sites: pelvis, femur, wrist, forearm, rib, and hip (Daily Oral Tablet - Treatment Study).
Effect on Bone Mineral Density (BMD)
Daily Oral Tablet - Treatment Study: BONIVA 2.5 mg daily oral tablet significantly increased BMD at the lumbar spine and hip relative to treatment with placebo. In the 3-year osteoporosis treatment study, BONIVA 2.5 mg daily oral tablet produced increases in lumbar spine BMD that were progressive over 3 years of treatment and were statistically significant relative to placebo at 6 months and at all later time points. Lumbar spine BMD increased by 6.4% after 3 years of treatment with BONIVA 2.5 mg daily oral tablet compared with 1.4% in the placebo group. Table 2 displays the significant increases in BMD seen at the lumbar spine, total hip, femoral neck, and trochanter compared to placebo.
Quarterly IV Injection – DIVA Study: In the ITT efficacy analysis, the least-squares mean increase at 1 year in lumbar spine BMD in patients (n=429) treated with BONIVA Injection 3 mg once every 3 months (4.5%) was statistically superior to that in patients (n=434) treated with daily oral tablets (3.5%). The mean difference between groups was 1.05% (95% CI: 0.53%, 1.57%; p<0.001; see Figure 1). The mean increases from baseline in total hip BMD at 1 year were 2.1% in the BONIVA Injection 3 mg once every 3 months group and 1.5% in the BONIVA 2.5 mg daily oral tablet group. Consistently higher BMD increases at the femoral neck and trochanter were also observed following BONIVA Injection 3 mg once every 3 months compared to BONIVA 2.5 mg daily oral tablet.
Bone Histology
The effects of BONIVA 2.5 mg daily oral tablet on bone histology were evaluated in iliac crest biopsies from 16 women after 22 months of treatment and 20 women after 34 months of treatment. The histological analysis of bone biopsies showed bone of normal quality and no indication of osteomalacia or a mineralization defect.
The histological analysis of bone biopsies after 22 months of treatment with 3 mg intravenous ibandronate every 3 months (n=30) or 23 months of treatment with 2 mg intravenous ibandronate every 2 months (n=27) in women with postmenopausal osteoporosis showed bone of normal quality and no indication of a mineralization defect.
Animal Pharmacology
Animal studies have shown that ibandronate is an inhibitor of osteoclast-mediated bone resorption. In the Schenk assay in growing rats, ibandronate inhibited bone resorption and increased bone volume, based on histologic examination of the tibial metaphyses. There was no evidence of impaired mineralization at the highest dose of 5 mg/kg/day (subcutaneously), which is 1000 times the lowest antiresorptive dose of 0.005 mg/kg/day in this model, and 5000 times the optimal antiresorptive dose of 0.001 mg/kg/day in the aged ovariectomized rat. This indicates that BONIVA Injection administered at a therapeutic dose is unlikely to induce osteomalacia.
Long-term daily or intermittent administration of ibandronate to ovariectomized rats or monkeys was associated with suppression of bone turnover and increases in bone mass. Vertebral BMD, trabecular density, and biomechanical strength were increased dose-dependently in rats and monkeys, at doses up to 8 to 4 times the human intravenous dose of 3 mg every 3 months, based on cumulative dose normalized for body surface area (mg/m2) and AUC comparison, respectively. Ibandronate maintained the positive correlation between bone mass and strength at the ulna and femoral neck. New bone formed in the presence of ibandronate had normal histologic structure and did not show mineralization defects.
BONIVA Injection is indicated for the treatment of osteoporosis in postmenopausal women.
In postmenopausal women with osteoporosis, BONIVA increases BMD and reduces the incidence of vertebral fractures (see CLINICAL PHARMACOLOGY: Clinical Studies). Osteoporosis may be confirmed by the presence or history of osteoporotic fracture or by a finding of low bone mass (BMD more than 2.0 standard deviations below the premenopausal mean [ie, T-score]).
The safety and effectiveness of BONIVA for the treatment of osteoporosis are based on clinical data of one year duration. The optimal duration of use has not been determined. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis.
BONIVA Injection, like other bisphosphonates administered intravenously, may cause a transient decrease in serum calcium values (see PRECAUTIONS).
BONIVA Injection must only be administered intravenously. Care must be taken not to administer BONIVA Injection intra-arterially or paravenously as this could lead to tissue damage.
Do not administer BONIVA Injection by any other route of administration. The safety and efficacy of BONIVA Injection following non-intravenous routes of administration have not been established.
Mineral Metabolism
Hypocalcemia, hypovitaminosis D, and other disturbances of bone and mineral metabolism must be effectively treated before starting BONIVA Injection therapy. Adequate intake of calcium and vitamin D is important in all patients. Patients must receive supplemental calcium and vitamin D.
Renal Impairment
Treatment with intravenous bisphosphonates has been associated with renal toxicity manifested as deterioration in renal function (ie, increased serum creatinine) and in rare cases, acute renal failure. No cases of acute renal failure were observed in controlled clinical trials in which intravenous BONIVA was administered as a 15- to 30-second bolus. The risk of serious renal toxicity with other intravenous bisphosphonates appears to be inversely related to the rate of drug administration.
Patients who receive BONIVA Injection should have serum creatinine measured prior to each dosage administration. Patients with concomitant diseases that have the potential for adverse effects on the kidney or patients who are taking concomitant medications that have the potential for adverse effects on the kidney should be assessed, as clinically appropriate. Treatment should be withheld for renal deterioration.
BONIVA Injection should not be administered to patients with severe renal impairment (ie, patients with serum creatinine >200 µmol/L [2.3 mg/dL] or creatinine clearance [measured or estimated] <30 mL/min).
Jaw Osteonecrosis
Osteonecrosis, primarily in the jaw, has been reported in patients treated with bisphosphonates. Most cases have been in cancer patients undergoing dental procedures, but some have occurred in patients with postmenopausal osteoporosis or other diagnoses. Known risk factors for osteonecrosis include a diagnosis of cancer, concomitant therapies (eg, chemotherapy, radiotherapy, corticosteroids), and co-morbid disorders (eg, anemia, coagulopathy, infection, pre-existing dental disease). Most reported cases have been in patients treated with bisphosphonates intravenously but some have been in patients treated orally.
For patients who develop osteonecrosis of the jaw (ONJ) while on bisphosphonate therapy, dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of ONJ. Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit/risk assessment.
Musculoskeletal Pain
In postmarketing experience, severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking bisphosphonates that are approved for the prevention and treatment of osteoporosis (see ADVERSE REACTIONS). However, such reports have been infrequent. This category of drugs includes BONIVA (ibandronate sodium) Injection. Most of the patients were postmenopausal women. The time to onset of symptoms varied from one day to several months after starting the drug. Most patients had relief of symptoms after stopping. A subset had recurrence of symptoms when rechallenged with the same drug or another bisphosphonate.
Atypical Subtrochanteric and Diaphyseal Femoral Fractures
Atypical, low-energy, or low-trauma fractures of the femoral shaft have been reported in bisphosphonate-treated patients. These fractures can occur anywhere in the femoral shaft from just below the lesser trochanter to above the supracondylar flare and are transverse or short oblique in orientation without evidence of comminution. Causality has not been established as these fractures also occur in osteoporotic patients who have not been treated with bisphosphonates.
Atypical femur fractures most commonly occur with minimal or no trauma to the affected area. They may be bilateral and many patients report prodromal pain in the affected area, usually presenting as dull, aching thigh pain, weeks to months before a complete fracture occurs. A number of reports note that patients were also receiving treatment with glucocorticoids (e.g., prednisone) at the time of fracture.
Any patient with a history of bisphosphonate exposure who presents with thigh or groin pain should be suspected of having an atypical fracture and should be evaluated to rule out an incomplete femur fracture. Patients presenting with an atypical fracture should also be assessed for symptoms and signs of fracture in the contralateral limb. Interruption of bisphosphonate therapy should be considered, pending a risk/benefit assessment, on an individual basis.
Information for Patients
BONIVA Injection must be administered intravenously only by a health care professional. Patients should be instructed to read the Medication Guide carefully before taking BONIVA, and to re-read it each time the prescription is renewed because it contains important information the patient should know about BONIVA.
BONIVA Injection should be administered once every 3 months. If the dose is missed, the injection should be administered as soon as it can be rescheduled. Thereafter, injections should be scheduled every 3 months from the date of the last injection. Do not administer BONIVA Injection more frequently than once every 3 months.
Patients must receive supplemental calcium and vitamin D.
Drug Interactions
Drug/Laboratory Test Interactions
Bisphosphonates are known to interfere with the use of bone-imaging agents. Specific studies with ibandronate have not been performed.
Carcinogenesis, Mutagenesis, Impairment of Fertility
In a 104-week carcinogenicity study, doses of 3, 7, or 15 mg/kg/day were administered by oral gavage to Wistar rats (systemic exposures in males and females up to 3 and 1 times, respectively, human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). There were no significant drug-related tumor findings in male or female rats. In a 78-week carcinogenicity study, doses of 5, 20, or 40 mg/kg/day were administered by oral gavage to NMRI mice (exposures in males and females up to 96 and 14 times, respectively, human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). There were no significant drug-related tumor findings in male or female mice. In a 90-week carcinogenicity study, doses of 5, 20, or 80 mg/kg/day were administered in the drinking water to NMRI mice. A dose-related increased incidence of adrenal subcapsular adenoma/carcinoma was observed in female mice, which was statistically significant at 80 mg/kg/day (32 to 51 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). The relevance of these findings to humans is unknown.
There was no evidence for a mutagenic or clastogenic potential of ibandronate in the following assays: in vitro bacterial mutagenesis assay in Salmonella typhimurium and Escherichia coli (Ames test), mammalian cell mutagenesis assay in Chinese hamster V79 cells, and chromosomal aberration test in human peripheral lymphocytes, each with and without metabolic activation. Ibandronate was not genotoxic in the in vivo mouse micronucleus tests for chromosomal damage.
Impairment of Fertility
In female rats treated from 14 days prior to mating through gestation, decreases in fertility, corpora lutea and implantation sites, and increased preimplantation loss were observed at an intravenous dose of 1.2 mg/kg/day (117 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). In male rats treated for 28 days prior to mating, a decrease in sperm production and altered sperm morphology were observed at intravenous doses ≥0.3 mg/kg/day (≥40 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison).
Pregnancy Category C
In pregnant rats given intravenous doses of 0.05, 0.15, or 0.5 mg/kg/day from Day 17 post-coitum until Day 20 post-partum, ibandronate treatment resulted in dystocia, maternal mortality, and early postnatal pup loss in all dose groups (≥2 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). Reduced body weight at birth was observed at 0.15 and 0.5 mg/kg/day (≥4 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). Pups exhibited abnormal odontogeny that decreased food consumption and body weight gain at 0.15 and 0.5 mg/kg/day (≥18 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). Periparturient mortality has also been observed with other bisphosphonates and appears to be a class effect related to inhibition of skeletal calcium mobilization resulting in hypocalcemia and dystocia.
Exposure of pregnant rats during the period of organogenesis resulted in an increased fetal incidence of RPU (renal pelvis ureter) syndrome at an intravenous dose of 1 mg/kg/day (≥47 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison). In this spontaneous delivery study, dystocia was counteracted by perinatal calcium supplementation. In rat studies with intravenous dosing during gestation, fetal weight and pup growth were reduced at doses ≥0.1 mg/kg/day (≥5 times human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison).
In pregnant rabbits given intravenous doses of 0.03, 0.07 or 0.2 mg/kg/day during the period of organogenesis, maternal mortality, reduced maternal body weight gain, decreased litter size due to increased resorption rate, and decreased fetal weight were observed at 0.2 mg/kg/day (19 times the recommended human intravenous dose of 3 mg every 3 months, based on cumulative body surface area comparison, mg/m2).
Bisphosphonates are incorporated into the bone matrix, from where they are gradually released over periods of weeks to years. The extent of bisphosphonate incorporation into adult bone, and hence, the amount available for release back into the systemic circulation, is directly related to the total dose and duration of bisphosphonate use. Although there are no data on fetal risk in humans, bisphosphonates do cause fetal harm in animals, and animal data suggest that uptake of bisphosphonates into fetal bone is greater than into maternal bone. Therefore, there is a theoretical risk of fetal harm (eg, skeletal and other abnormalities) if a woman becomes pregnant after completing a course of bisphosphonate therapy. The impact of variables such as time between cessation of bisphosphonate therapy to conception, the particular bisphosphonate used, and the route of administration (intravenous versus oral) on this risk has not been established.
There are no adequate and well-controlled studies in pregnant women. BONIVA Injection should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.
Nursing Mothers
In lactating rats treated with intravenous doses of 0.08 mg/kg, ibandronate was present in breast milk at concentrations of 8.1 to 0.4 ng/mL from 2 to 24 hours after dose administration. Concentrations in milk averaged 1.5 times plasma concentrations. It is not known whether BONIVA is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when BONIVA Injection is administered to a nursing woman.
Geriatric Use
Of the patients receiving BONIVA Injection 3 mg every 3 months for 1 year (DIVA study), 51% were over 65 years of age. No overall differences in effectiveness or safety were observed between these patients and younger patients, but greater sensitivity in some older individuals cannot be ruled out.
Daily Oral Tablet
Treatment with BONIVA 2.5 mg daily oral tablet was studied in over 3900 patients in postmenopausal osteoporosis trials of up to 3 years duration. The overall adverse event profile of BONIVA 2.5 mg once daily tablet in these studies was similar to that of placebo.
Most adverse events were mild or moderate and did not lead to discontinuation. The incidence of serious adverse events was 20% in the placebo group and 23% in the BONIVA 2.5 mg daily oral tablet group. The percentage of patients who withdrew from treatment due to adverse events was approximately 17% in both the BONIVA 2.5 mg daily oral tablet group and the placebo group. Overall, and according to body system, there was no difference between BONIVA daily oral tablet and placebo, with adverse events of the digestive system being the most common reason for withdrawal.
Table 3 lists adverse events from the Treatment and Prevention Studies reported in ≥2% of patients and in more patients treated with BONIVA 2.5 mg daily oral tablet than patients treated with placebo. Adverse events are shown without attribution of causality.
Quarterly IV Injection – DIVA Study
In a 1-year, double-blind, multicenter study comparing BONIVA Injection administered intravenously as 3 mg every 3 months to BONIVA 2.5 mg daily oral tablet in women with postmenopausal osteoporosis, the overall safety and tolerability profiles of the two dosing regimens were similar. The incidence of serious adverse events was 8.0% in the BONIVA 2.5 mg daily group and 7.5% in the BONIVA Injection 3 mg once every 3 months group. The percentage of patients who withdrew from treatment due to adverse events was approximately 6.7% in the BONIVA 2.5 mg daily group and 8.5% in the BONIVA Injection 3 mg every 3 months group.
Table 4 lists the adverse events reported in >2% of patients without attribution of causality.
Acute Phase Reaction-like Events
Symptoms consistent with acute phase reaction (APR) have been reported with intravenous bisphosphonate use. The overall incidence of patients with APR-like events was higher in the intravenous treatment group (4% in the BONIVA 2.5 mg daily oral tablet group vs. 10% in the BONIVA Injection 3 mg once every 3 months group). These incidence rates are based on reporting of any of 33 potential APR-like symptoms within 3 days of an IV dose and for a duration of 7 days or less. In most cases, no specific treatment was required and the symptoms subsided within 24 to 48 hours.
Injection Site Reactions
Local reactions at the injection site, such as redness or swelling, were observed infrequently, but at a higher incidence in patients treated with BONIVA Injection 3 mg every 3 months (<2%; 8/469) than in patients treated with placebo injections (<1%; 1/465). In most cases, the reaction was of mild to moderate severity.
Ocular Adverse Events
Bisphosphonates may be associated with ocular inflammation such as uveitis and scleritis. In some cases, these events did not resolve until the bisphosphonate was discontinued.
Laboratory Test Findings
There were no clinically significant changes from baseline values or shifts in any laboratory variable with oral ibandronate. As expected with bisphosphonate treatment, a decrease in total alkaline phosphatase levels was seen with 2.5 mg daily oral ibandronate compared to placebo. There was no difference compared with placebo for laboratory abnormalities indicative of hepatic or renal dysfunction, hypocalcemia, or hypophosphatemia. There also was no evidence that BONIVA Injection 3 mg every 3 months induced clinically significant laboratory abnormalities indicative of hepatic or renal dysfunction compared to BONIVA 2.5 mg daily oral tablet.
No cases of overdose were reported in premarketing studies with BONIVA Injection. Intravenous overdosage may result in hypocalcemia, hypophosphatemia, and hypomagnesemia. Clinically relevant reductions in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate, and magnesium sulfate, respectively.
Dialysis would not be beneficial unless it is administered within 2 hours following the overdose.
The recommended dose of BONIVA Injection for the treatment of postmenopausal osteoporosis is 3 mg every 3 months (see INDICATIONS AND USAGE) administered over a period of 15 to 30 seconds.
No cases of acute renal failure were observed in controlled clinical trials in which intravenous BONIVA was administered as a 15- to 30-second bolus. The risk of serious renal toxicity with other intravenous bisphosphonates appears to be inversely related to the rate of drug administration (see PRECAUTIONS).
BONIVA Injection must be administered by a health care professional.
BONIVA Injection must only be administered intravenously (see WARNINGS). Care must be taken not to administer BONIVA Injection intra-arterially or paravenously as this could lead to tissue damage.
Do not administer BONIVA Injection by any other route of administration. The safety and efficacy of BONIVA Injection following non-intravenous routes of administration have not been established.
Administer BONIVA Injection using the enclosed needle. Prefilled syringes are for single use only. Discard unused portion.
BONIVA Injection must not be mixed with calcium-containing solutions or other intravenously administered drugs.
Parenteral drug products should be inspected visually for particulate matter and discoloration before administration, and not used if particulate matter is visible or product is discolored. Prefilled syringes with particulate matter or discoloration should not be used.
If the dose is missed, BONIVA Injection should be administered as soon as it can be rescheduled. Thereafter, injections should be scheduled every 3 months from the date of the last injection. Do not administer BONIVA Injection (3 mg) more frequently than once every 3 months.
Patients must receive supplemental calcium and vitamin D (see PRECAUTIONS: Information for Patients).
Patients with Hepatic Impairment
No dose adjustment is necessary (see CLINICAL PHARMACOLOGY: Special Populations).
Patients with Renal Impairment
No dose adjustment is necessary for patients with mild or moderate renal impairment where creatinine clearance is equal to or greater than 30 mL/min.
BONIVA Injection should not be administered to patients with severe renal impairment, ie, patients with serum creatinine >200 µmol/L (2.3 mg/dL) or creatinine clearance (measured or estimated) <30 mL/min (see CLINICAL PHARMACOLOGY: Special Populations).
Geriatric Patients
No dosage adjustment is necessary in the elderly (see PRECAUTIONS: Geriatric Use).
One prefilled syringe of BONIVA Injection (ibandronate sodium), 3 mg/3 mL single-use, clear glass prefilled syringe, in a box with 1 needle and 2 alcohol swabs (NDC 0004-0188-09).
Each syringe is a 5 mL (5 cc) volume syringe supplied with a 25-gauge, 3/4 inch needle with wings, needle-stick protection device, and a 9 cm plastic tubing for attachment.
BONIVA is a registered trademark of Roche Therapeutics Inc.
Distributed by:
Genentech USA, Inc.
PI Revised: January 2011
Boniva® (bon-EE-va)
Read the Medication Guide that comes with BONIVA before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment. Talk to your doctor if you have any questions about BONIVA.
What is the most important information I should know about BONIVA?
BONIVA Injection is given in your vein (intravenously) and only given by a healthcare provider. Do not give BONIVA Injection to yourself.
BONIVA can cause serious side effects including:
Call your doctor right away if you have any of these side effects.
What is BONIVA?
BONIVA is a prescription medicine used to treat osteoporosis in women after menopause. BONIVA helps increase bone mass and helps reduce the chance of having a spinal fracture (break).
It is not known how long BONIVA works for the treatment of osteoporosis. You should see your doctor regularly to determine if BONIVA is still right for you.
It is not known if BONIVA is safe and effective in children.
Who should not take BONIVA?
Do not take BONIVA if you:
What should I tell my doctor before taking BONIVA?
Before you start BONIVA, be sure to talk to your doctor if you:
Tell your doctor and dentist about all the medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Certain medicines may affect how BONIVA works.
Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist each time you get a new medicine.
How will I receive BONIVA?
What are the possible side effects of BONIVA?
BONIVA may cause serious side effects.
The most common side effects of BONIVA are:
Tell your doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of BONIVA. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I handle BONIVA if I need to pick it up from a pharmacy?
General information about the safe and effective use of BONIVA.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use BONIVA for a condition for which it was not prescribed. Do not give BONIVA to other people, even if they have the same symptoms you have. It may harm them.
This Medication Guide summarizes the most important information about BONIVA. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about BONIVA that is written for health professionals.
For more information, go to www.myboniva.com or call 1-888-692-6648.
What are the ingredients in BONIVA?
Active ingredient: ibandronate sodium
Inactive ingredients: sodium chloride, glacial acetic acid, sodium acetate and water
This Medication Guide has been approved by the U.S. Food and Drug Administration.
Issued: January 2011
Distributed by:
Genentech USA, Inc.
© 2011 Genentech, Inc. All rights reserved.
Representative sample of labeling (see the HOW SUPPLIED section for complete listing):
PRINCIPAL DISPLAY PANEL - Prefilled Syringe Carton
3 mg/3 mL
PHARMACIST: Dispense the enclosed Medication Guide to each patient.
Package contains:
1 Single-Use Prefilled Syringe,
Sterile. For I.V. Use Only.
Each Carton Contains: 1 Single-Use Prefilled Syringe
Rx only
Revised: 02/2011 Genentech, Inc.
Reproduced with permission of U.S. National Library of Medicine
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text:
First time I've sat down to scrap in ages. These photos have been waiting for weeks now to put down on paper. After starting gymnastics up again Trey and Gabi flip all over the house after class. After watching them do this for weeks on end, fighting over who's turn it was to go first next time, I had the kids take turns flipping around for me for a photo session. I like to scrap those random moments that show their typical life moments. Man, they flipped over time after time for me to get good photos of them smiling. I used TAC's Sands of time paper pack, and the solid blue is from DCWV. Sands of time is one of my favorites. (Little tidbit, I was published in the Fall 2007/2008 TAC catty with this paper line, and give thanks stamp set.) I find it ideal to use when I'm scrapping a page with both kids. It has blues and greens, and pinks in the designs. I like my pages to be matchy-matchy with clothes. Sometimes it's hard with a boy and a girl to have that work together unless I plan ahead with photo sessions. However for this, I didn't think ahead by planning out the clothes, but I think they both look wonderful with the paper. I used two punches from SU, the photo corner punch-big fav of mine and the scallop punch. My friend Kim from Sunshine days sent me some brads, which worked perfectly with the page. The other embellishments are from TAC. Than to top off my page, I used my scrapbooking program and created the title. I wanted it to reflect the theme of being upside down, so I put flipped over upside down.
The layout was based on a layout in Jeanette Lynton's book "Cherish". That book is one my favorite scrapping supplies! Just makes creating nice layouts so easy! She's got another one out, and I'm dying to get my hands on it!


text:
2501 N Orange Ave Ste 235
Orlando, FL 32804
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There are many mobile discos in Fife
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Cement & Blast Furnace Slag - LOESCHE | Innovative ,
Grinding of cement clinker and granulated blast furnace slag in roller , The breakthrough in grinding this type of material on the vertical roller mill did not take.Chat Now!
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text: A buddy has a 2000 FSR with e-type front d. and his tapered spindle BB threads in the frame are pulled out. Is there a sleave or oversized cup that can be installed. Can you TIG in some material and re-tap the threads? What about using an external bearing crank?


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|"White Glads," oil, 24"h x 18"w, copyright Jill Banks 2012
This is hopefully the conclusion of a painting started at the Torpedo Factory ... that gave me a full dose of challenges while there.
Something about painting a work of yours at a different angle ties the brain in knots.
Web: www.jillbanks.com
Blog: jillbanks.blogspot.com
100 Faces in 100 Days Project
Phone: 703.403.7435
Events and Exhibits
September 8-30, Visiting Artist Program Exhibit, Torpedo Factory, 105 N. Union St., Alexandria, VA. "Rainy Morning Breakfast" and "Dining Alfresco" are on view.
Sunday, October 14, MPA Artfest Outdoor Juried Arts Festival, McLean Central Park, McLean, VA
Saturday and Sunday, October 20&21, Great Falls Annual Studio Tour, 10am-5pm, visit artists in their studios throughout Great Falls on a self-guided tour. I'll be at the Artists' Atelier, 1144 Walker Road, Suite G, Great Falls, VA 22066
More October and November events are listed on my web site: www.JillBanks.com


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The Urbana Junior League of Anti-Floccinaucinihilipilificators
With parent-teacher conferences on Thursday and Friday and then the weekend, it seems like a really long time since I have written a "real" blog post on my adventures in teaching fourth grade. Yeah, I know I wrote a post on Thursday, but it was a quick one that was composed on my phone because it was also my father-in-law's birthday. So it feels nice to be writing again.
It is not really a secret that I love the English language. I love that we have a rich and diverse vocabulary that has begged, borrowed, and stolen from so many other languages. Once a person masters the affixes we use in our language, we can do all sorts of fun things with our words. Sure, many of the words we use are pure gibberish or are just made up, but neologisms and portmanteaus are fun anyway. (My father-in-law probably finds such a statement coming from me to be ridiculous, since I am so often talking about how I am a language purist. Let me clarify: I am okay with making up new words. I am not so okay with randomly changing the meanings of the words we already have. I know that we have a living language that evolves, but I don't think it is evolving to simply use a word in a completely foreign way.)
Because I love my language, I have devoted a large part of my life to understanding my language and learning the words. I have always been very good at spelling. When I was in eighth grade, I participated in my school's spelling bee and eventually went on to represent my district in the regional spelling bee. (I was knocked out in the first round when I was given the word vicious and spelled viscous instead. That's a mistake I'll never make again!)
As a result of this, I was really excited to get an email from our Assistant Superintendent to announce the Champaign-Urbana Schools Foundation's 1st Annual Adult Team Extreme Spelling Bee. Teams of three would be facing off to compete in a spelling bee that would be raising money for the schools in our communities. Unfortunately, the entry fee was $150. Then we got another email informing us that several administrators in the district had made contributions to pay for the entry fees and teachers were invited to apply to be a part of the team. The application process was simple: Submit a one-sentence explanation of why you should be on the team. While the exact email I sent was lost, I remember the essence of what I wrote: I was my district's spelling champion when I was in the 8th grade and feel like I would be an excellent contribution to the district's team. Only a few others applied and so I received yet another email informing me that I would be a part of the team! We were asked to suggest a team name.
I thought about it for about fifteen minutes before coming up with an awesome name: the Urbana League of Anti-Floccinaucinihilipilificators! What does that mean, you ask? Well, we are a group from the Urbana School District, which explains the Urbana League part. "Anti" means "against." And floccinaucinihilipilification is the process of deeming something worthless or of little value. So a floccinaucinihilipilificator is a worthless, lazy person. So we are opposed to being lazy. (As a fun aside, floccinaucinihilipilification is the longest non-technical word in the English language, beating antidisestablishmentarianism by one letter.)
My team name suggestion was accepted and my wife, being the amazing graphic designer she is, came up with a shirt design for us. The spelling bee was on Saturday. My team didn't make it to the Finals, but we did make it to the 21st round of the Swarm Competition, before failing to spell fallacious correctly. (We left out an l.) So we were runners-up to making it to the Finals. The bee was a lot of fun and I got a great t-shirt out of it, which I wore to school today. We also won the award for best team name!
My reason for wearing it to school was two-fold. First, whenever I attend an event that is school related and I get a t-shirt, I like to wear it to school the following day. Second, I wanted to tie my experience with the spelling bee into my students' spelling work, which I decided to get rolling this week. I told my students about the spelling bee this morning and mentioned we'd start doing spelling work in the afternoon. As promised, I announced the spelling curriculum and gave the students their first assignment. They were given a list of twenty-four words that they needed to sort according to their vowel/consonant patterns. There were three patterns that I wanted them to specifically look at: VCV (such as in hoping), VCCV (as in hopping), and VVCV (like in cleaning). Then the students will do some other activities, such as writing the words multiple times in print or cursive, and using at least twelve of the words in sentences, in a story, or by giving the definitions. We will have our first spelling test on Friday afternoon. Those students who complete the spelling assignment and pass the test with an 80% or better (get at least 20 words correct), will become members of the Urbana Junior League of Anti-Floccinaucinihilipilificators! (Then they will have to get at least 90% correct on the next test and 100% on the third test to stay in the UJLA-F. My expectation is that the students will begin to see patterns emerging in their vocabulary that will transfer to their spelling. We'll see how it goes!


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(PRWEB) September 23, 2014
While deciding what to include into the new Domain Overview tab, the developer considered which information about a website users would like to always have at hand:
"SEO PowerSuite helps one improve websites for better search engine rankings and performance", says Erin Madison, User Experience Manager at Link-Assistant.Com. "And, there is a set of essential website metrics one would want to be able to access and preview at all times – and that's exactly what "Domain Overview" now allows you to do".
Inside "Domain Overview"
The new tab contains the most important metrics regarding the website analyzed in a specific SEO PowerSuite project. For instance, if one is analyzing "example.com" in a project, they'll get statistics for "example.com" in the "Domain Overview" section.
The metric one sees right at the top of the table is Domain Strength. Its a complex metric estimated based on a number of key domain factors such as its age, PageRank, backlinks, social signals, and others. Its presented on the scale from 0 to 10 and can be used to tell how authoritative a domain could be considered by search engines.
Besides Domain Strength, other metrics in "Domain Overview" are:
1. External Domain Characteristics: Google PageRank, Alexa and Compete Rank, Google domain popularity.
2. Domain info: domain's age, IP address and average loading time.
3. Indexing in search engines: the number of domains pages indexed in major search engines.
4. Web catalog listings: domain listings in DMOZ, Yahoo! Dir and Yandex Catalog.
5. Backlinks: key statistics regarding ones backlink profile such as the number of links, the number of backlink domains and the dofollow/nofollow ratio in the profile.
A preview of this metric is available at http://www.link-assistant.com/news/quick-domain-analysis.html
6. Social media popularity and traffic: the number of signals and visits to a site from social media).
7. Traffic to the site: key traffic statistics for ones site (to see these data in the software, one is required to enter their Google Analytics account details).
On SEO PowerSuite tools
SEO PowerSuite is a pack of 4 search engine optimization tools that each serve a specific purpose.
Rank Tracker (rank-tracker.org) allows one to monitor search rankings and discover new keywords for an SEO campaign. WebSite Auditor is on-page SEO software one can use to optimize their sites structure and content for search engines. SEO SpyGlass is SEO PowerSuites backlink checker and backlink comparison tool, while LinkAssistant is a link outreach and link campaign management app.
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Meaning and definition of research methodology
A succinct definition of action research appears in the workshop materials we use at the. (meaning the information represents what.
Define Research :- 2. - WikiEducator
Describe the meaning of the term love, friendship, hatred. Research Paper.The methodology employed in an experiment is essential to its success, and bad methodology has spoiled thousands of research projects.
Research Methodology Is A Systematic Process – Page 3It comprises types of research, definitions. and it is the job of the researcher to use objective research methods.
2.1 Definition of Research - University of IdahoMeasuring outcomes: applying cost-benefit analysis to middle-sized and smaller public libraries. (Public Libraries) The NFESC is interested in technologies and methodologies that are new, innovative, or that advance the state of the art or increase knowledge of a technology or methodology.
Scientific Research | Methods, Definition, Proposal
What Is Action Research? - ascd.orgData Collection Methodology. Director of the Terrorism Research Initiative.Definition: Research is a scientific inquiry aimed at learning new facts, testing ideas, etc.Maimonides suggests that the distinction lies in the methodology of taking the land.Read our methodology below to see how we came up with our list.
Research in this field of methodology is now very closely related to.Gain access to thousands of additional definitions and advanced search features—ad free.Kobach criticized the methodology in the GAO report and said 2008 and 2012 are not comparable because there was no statewide election in 2012 that mobilized get-out-the-vote efforts.
WhatisKT - Evaluation ResearchIf you are searching for the ebook APA Dictionary Of Statistics And Research Methods (APA Reference Books) in pdf format, in that case you come onto the right website.Learn the correct uses of these two commonly confused homophones.Custom Writing.
A key concept relevant to a discussion of research methodology is that of validity. we must first define a few terms.
What is Research? definition and meaning
Research is a careful and detailed study into a specific problem, concern, or issue using the scientific method.
Dictionary of Polynesian Mythology - eltonresearch.com
Gain an understanding of common survey research terms on our Definitions of. the meaning of the term.Research Requiring IRB Review. Federal regulations define research.See also: Classification 1. the science of method or orderly arrangement and classiflcation. 2. any system created to impose order.Manager Sahab 12,165 views. 10:54. Research Definition - Duration: 13:41.Dictionary Of Polynesian Mythology, you are right to find our website which has a.
Research Requiring IRB Review - Vice President for
research method fm - Carter CenterDefinition 7: Evaluation Research: the use of scientific research methods to plan intervention programs,.
Both items were ruled inadmissible because of the methodology used to collect, store, and test the items.While the original GTD1 employed the definition of terrorism utilized by.Uncovering value: by using embedded value reporting, insurers can get a clearer picture of where they are making--and losing--profits With funding from the Public Library Association, the authors developed a cost-benefit analysis methodology and applied it to five large public library systems.


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Health Issue Briefs
Prescription Drug Work Group issue brief highlighting prescription drug issues present in our health care system, including cost drivers, the effect on various stakeholders, and possible approaches that might help address the health care cost growth associated with prescription drugs. (March 7, 2018)
High-Performance Network Work Group issue paper on addressing the growth in health care spending through high-performance networks, which generally focus on delivering high-quality care that also is efficient care. These networks generally result in lower total costs for health programs. (February 26, 2018)
Health Practice International Committee issue brief on global aging demographics, quality of life during the end-of-life period, palliative versus curative care, and strategies for address health care challenges at the end of life using case studies from a variety of countries.
(December 6, 2017)
(December 6, 2017)
Health Care Delivery Committee issue brief providing an actuarial overview of comparative effectiveness research, including measuring its impact and its potential to reduce health care costs. (November 17, 2017)
Health Practice Council paper on what cost-sharing reductions are and why they need to be funded. (July 24, 2017)
Medicare Subcommittee issue brief on significant concerns about Medicare's long-term financial health. (July 19, 2017)
Health Practice Council FAQ on how risk pooling in the individual health insurance market works. (July 14, 2017)
Individual and Small Group Markets Committee issue brief providing an overview of the general factors underlying premium rate setting and highlighting the major components driving premium changes in 2018. (July 11, 2017)
Risk Sharing Subcommittee issue brief examining the risk adjustment program implemented under the Affordable Care Act (ACA) and the implications for the program under different potential changes to current insurance market rules. (May 10, 2017)
Health Practice Council issue brief examining ways in which the individual health insurance market can be strengthened and made more viable.
(April 24, 2017)
(April 24, 2017)


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The Backlink Investigation Report helps you to see who's linking to a particular Online page. You can use it to research one-way links to some competitor's web site and Assess them to your own website page's backlinks. Websites that backlink to some leading-rated website page could
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Arab Israeli Conflict
Middle East
Israel News
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International news
ANKARA - Turkey's President Abdullah Gul said on Wednesday an armed intervention by Egyptian security forces against protesters in Cairo supporting ousted president Mohamed Morsi was "completely unacceptable"."Armed intervention on civilians, on people demonstrating ... This is completely unacceptable," Gul told reporters in the capital Ankara.Turkey has emerged as one of the fiercest international critics of what it has called an "unacceptable coup" after Egypt's military ousted the elected Morsi.
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