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1 PROBLEMS WITH INPATIENT DRUG USERS IN JEDDAH Nayyer Iqbal, MRCPsych Background: To identify problems associated with the treatment of inpatient drug users in Jeddah, and suggest ways of improving the delivery of health care service to these drug users. Subjects and Methods: Three hundred and two subjects with substance dependence who were admitted to the Voluntary Detoxification Unit of Al Amal Hospital, Jeddah, between January and April 997 (inclusive) were studied. A data gathering form was designed to collect relevant information. Outcome was recorded after discharge or transfer from the unit. Results: Over half the subjects were single, unemployed, without high school education and came to the hospital unaccompanied. About.2% used heroin and 2.52% used alcohol. About 7.% were intravenous drug users (IVDUs) and 54.9% started injecting from the outset. Just under half of the subjects were from outside Jeddah. There were regional variations in the choice of abused drugs. Most inpatients were on their first or second admission. The vast majority of subjects were readmitted within a year of discharge, and 44.7% gave no specific reason for their hospitalization. Unaided abstinence was reported by 42.7% and posttreatment abstinence by 57.52%. On admission, 57.4% expressed no desire to complete the program. About 54.% were discharged after receiving medical detoxification, and 7.% went on to have drug rehabilitation. Conclusion: The main finding of the study was that very few drug users were committed to completing the treatment program. There is a need to review the related factors that may be responsible for this situation. Changes have to be made to improve compliance and increase retention of the inpatient program. Contractual and probationary treatment of drug users should be initiated. Current restrictions on admissions have to be eased. There should also be a decentralization and development of local services, as well as a reappraisal of addiction services. Ann Saudi Med 2;2(4):92. Key Words: Addiction, drugs, detoxification, rehabilitation. Substance use disorder is a chronic condition of unknown etiology,2 characterized by abstinence and relapses. 5 Morbidity and mortality are high,,7 and the medical and psychological consequences are familiar to all.,9 Sustained substance use can result in damage to the brain., The harmful effects of drug use extend well beyond the individual. 2 Treatment must be initiated early. This saves lives, reduces criminal activity, improves social functioning and enhances the quality of life of the individual. 5 The longer the treatment the better the outcome.,7 Providing treatment to substance abusers is not easy. Studies show that many never request any help, their retention in treatment programs is low,,9 and the relapse rate after discharge is high. 2,2 Similar difficulties have been encountered at Al Amal Hospital Jeddah, which is the only specialized center treating drug addicts in the Western region of Saudi Arabia. The facility provides comprehensive assessment, medical detoxification and drug rehabilitation. Detoxification consists of symptomatic medical treatment of both substancespecific (e.g., heroin, From Al Amal Hospital, Jeddah, Saudi Arabia. Address reprint requests and correspondence to Dr. Iqbal: Al Amal Hospital, P.O. Box 722, Jeddah 2452, Saudi Arabia. Accepted for publication June 2. Received October 2. alcohol) and nonspecific (e.g., amphetamines, volatiles) withdrawal states. Drug rehabilitation comprises educational and religious activities, group therapies, relapse prevention and counseling. It has been perceived that some changes in the treatment program and services might be required to improve retention and outcome. A hospitalbased inpatient survey was done with the purpose of identifying problems with the treatment of drug users and suggesting ways of improvement. Subjects and Methods A total of 2 men aged and above with substance dependence admitted to the Voluntary Detoxification Unit between January and April 997 (inclusive) were interviewed. Their diagnoses were based on DSM IV. A form was designed to collect data on sociodemographic characteristics, severity of drug problem, reason for seeking treatment, past admissions, commitment to complete treatment program, abstinence type and duration, and outcome. As part of the admission process, a psychiatrist first saw every patient. All relevant data were collected during this interview. On admission, subjects were given the choice of either detoxification alone or detoxification followed by rehabilitation (i.e., complete the program). 9 Annals of Saudi Medicine, Vol 2, Nos 4, 2
2 INPATIENT DRUG USERS TABLE. Sociodemographic factors. No. of subject Percentage (%) Demographic characteristics Single Married 7.42 Divorced 5. Employed 5.7 Unemployed Referral to hospital Unaccompanied With family 9.7 By police 5. With friends. Level of education Primary 9.9 Intermediate Secondary Higher education (college) 5. Illiterate 2.97 Monthly income Low (under 5 SR) Medium (under, SR).9 High (over, SR) 2.7 Daily spendings on drugs Under SR Under 2 SR Under SR 7.5 Over SR.9 TABLE 2. Prevalence of substance dependence. No. of subjects Percentage (%) Single substance Heroin Alcohol Volatiles 2.95 Amphetamines 4. Other substances* Polydrugs Heroin and another drug 2.97 Alcohol and another drug Heroin and alcohol 4. Other two drug combinations.99 Three or more drugs *Cannabis, benzodiazepines, dextromethorpan etc., excluding heroin and alcohol; includes 4 heroin, 7 alcohol, 2 both heroin and alcohol. Outcome was recorded after discharge or transfer from the unit. Four subjects were unwilling or unfit (e.g., medically ill) to be interviewed and were excluded from study. Results The sociodemographic characteristics of the studied patients are listed in Table. Over 5% of drug users were single, unemployed, of a low income group, without high school education, and presented for treatment unaccompanied, i.e., without family, friends or employer. The majority of the patients were from Jeddah, but a significant number came mostly from other adjacent areas: 75 (57.94%) resided in Jeddah, 4 (27.%) in Mecca, 22 (7.2%) in Taif and 2 (.95%) in other areas. The type of abused drugs varied according to the area of residence: 9 (%) of the Jeddah patients were using heroin, 2 (.2%) were using alcohol and the rest were on other substances; 7 (9.47%) of Mecca patients were using heroin and 2 (4.2%) were using alcohol; 5 (22.72%) of the Taif patients were using heroin and 9 (4.9%) were using alcohol; 5 (2.%) patients from other areas were using heroin and (.9%) were using alcohol. Dependence was generally severe. Overall, heroin was the single most common drug used, to which 2 patients (.2%) were addicted. This figure included polydrug users (Table 2). A total of patients (7.%) were IV users and 99 (54.9%) reported IV use from the outset, 4 (25.4%) changed to the IV route within months and a further (.7%) initiated IV use by 2 months. A total of 59 patients (2.59%) injected heroin of less than g per day, 2 (45.%) under g, 44 (24.%) under 5 g, and (.%) more than 5 g. Some 27 patients (.%) used heroin by the nonparenteral route (insufflation). Of these, 9 (.%) took under g of heroin per day, (4.74%) under g, 5 (.5%) under 5 g, and 2 (7.4%) more than this amount. Two subjects were using both routes. Five heroindependent subjects (2.42%) presented with overdose. A total of 5 subjects (2.52%) were alcohol dependent, with (5.7%) using arak, 7 (2.5%) aftershave lotion (eau de cologne) and 5 (2.7%) using both. Fifteen subjects (7.42%) who were on volatile substances used glue, (4.2%) used paint, 2 (9.52%) used both and (4.7%) used insecticide spray. Of these subjects, 2 (9.52%) had druginduced psychosis. Seven amphetaminedependent subjects (5.4%) consumed over captogen tablets per day, and 5 (.4%) had druginduced psychosis. Fiftyseven (.7%) were polydrug users. One hundred and thirtyfive subjects (44.7%) gave no tangible reasons for seeking treatment, but family or marital problems were the most common reasons given for treatment in 54 (7.%) (Table ). Twothirds of the subjects were either first or second admissions and one subject had more than four admissions. Most subjects reported readmissions within 2 months of discharge, 57 (.4%) had readmissions within months, 29 (5.59%) within six months, 49 (2.4%) within a year and 5 (27.4%) after longer periods. Ninetyfive subjects (.5%) gave a verbal commitment to complete the treatment program on admission, i.e., detoxification followed by rehabilitation; and 72 (57.4%) committed only to medical detoxification (Table 4). In terms of outcome, 5 (54.%) were discharged after completing detoxification, 9 (.%) in absentia after failing to return from leave, 2 (7.%) went on to drug rehabilitation, and the remainder left for other facilities or were discharged against medical advice. From Annals of Saudi Medicine, Vol 2, Nos 4, 2 97
3 IQBAL TABLE. Reasons given for treatment. No. of subjects Percentage (%) No reasons Family problems Problems at work 2.2 Withdrawal symptoms Hit bottom 2.97 Relapsed after abstinence 4. Financial difficulties Behavioral problems. Intoxicated/comatosed Deterioration in physical health Failed to stop on their own 5.5 Legal problems.99 Others (getting married, etc.).99 TABLE 4. Commitment for treatment on admission and type of dependency. Heroin Alcohol Volatile AP Others PD Requested detox only 7* Requested rehabilitation Finally went to rehabilitation *Number of subjects; percentage; AP=amphetamine; PD=polydrugs. TABLE 5. Readmission and type of dependency. Admission no. Heroin Alcohol Volatile AP Others PD First 49* Second Third Fourth *Number of subjects; percentage; AP=amphetamine; PD=polydrugs. the 72 subjects committed to only medical detoxification, (5.%) reverted back to drug rehabilitation. From the 95 subjects committed to program completion, only (.57%) went to rehabilitation while the rest requested discharge after detoxification. Two (9.9%) of the undecided group went on to drug rehabilitation. Also, 2 subjects (7.4%) had a past history of abstinence, 29 (42.7%) of them unaided and 7 (57.52%) following treatment at Al Amal Hospital. Unaided abstinence was reported by 7 (7.24%) of first admissions. Among readmissions 2 (7.2%) had never abstained, 25 (.44%) reported unaided abstinence, (4.54%) abstained following treatment, 2 (.97%) had both unaided and posttreatment abstinence and 22 (.2%) had abstinence in a controlled environment, e.g., prison. From those reporting posttreatment abstinence, 5 (4.7%) had undergone drug rehabilitation while others received only medical detoxification. Ninetyfour (7.5%) of the posttreatment and 97 (75.9%) of the unaided group (Table 4) had abstinence in excess of months duration, and 4 (4.4%) reported occasional use of other substances, e.g., alcohol, benzodiazepine, and cannabis during abstinence from the main drug. Discussion The main limitation of this study is that it deals entirely with inpatients in the detoxification unit and relies on selfreports. Although it focuses on hospitalized subjects, the recommendations extend beyond the hospital setup. The goal of the inpatient treatment program is to achieve abstinence, improve functioning and allow individuals to adjust normally in society. The most important finding was that only a small minority was committed to completing the program (Table 4). The majority (57.4%) wanted just medical detoxification. The number who finally went to rehabilitation was even lower (.5%). Both program and patientrelated factors could be responsible. For example, some aspects of the treatment program may be culturally unsuitable, the length of stay was unacceptably long, subjects were poorly motivated or not psychologically ready, and there is controversy on addiction treatment and outcomes, etc. A treatment program should match the needs and expectations of the drug users. 22,2 Any misconceptions on treatment should be clarified in the minds of patients and public through education. Utilizing brief and intensive methods of treatment could shorten the total length of stay. 24 Subjects should be screened regarding their suitability for psychotherapeutic interventions before being referred to rehabilitation. The treatment program would require changes to meet the needs of both those who are psychologically ready and those who are not. Perhaps a separate skilloriented and psychotherapyoriented rehabilitation program is needed for these two distinct groups. The modern psychotherapeutic approaches are based on secular principles. 25 To be effective, the psychological therapies must conform in theory and practice to the prevailing religious beliefs. Religion had been undervalued, underutilized and underresearched as a treatment modality in psychiatry. 2 Religion acts as a buffer against adversity and stress. It is known to offer protection against drinking, drug use, depression and suicide. 27 The drawback of religion is that it lacks the objectivity of science. Scientific studies based on religion are, therefore, needed. For instance, the impact of religion on coping behavior has never been studied objectively. Psychometric evaluation or measurement of religious beliefs is also a neglected area. The posttreatment abstinence rates reported were somewhat similar to other outcome studies. However, oneyear abstinence rates were lower (.4%). The vast majority of those who received previous treatment in Jeddah had detoxification and not rehabilitation. This does not imply that rehabilitation was ineffective, as the study was hospital based and did not include all those who received rehabilitation. More research is needed to identify 9 Annals of Saudi Medicine, Vol 2, Nos 4, 2
4 INPATIENT DRUG USERS treatment factors and pre and posttreatment variables that predict good outcome. Unaided abstinence also requires further study. Governmental regulations allow for up to four voluntary admissions to drug users. Further treatments are involuntary in a secure Ministry of Interior (MOI) unit for a fixed duration. Most subjects in the study were first or second admissions, with fourth admissions constituting a small number (Table 5). This restriction may be discouraging those with more admissions from getting further inpatient treatment. This policy needs to be reexamined. The authorities could exercise leniency in applying this rule to all those presenting voluntarily for further inpatient treatment. Contingency contracting could be used to ensure that the system is not abused. A sizable number of subjects were admitted for nonspecific withdrawal states that used up their admission chances (Table 2). The current admission policy requires reevaluation. Inpatient management of nonspecific withdrawal states should be avoided. All voluntary treatments should be contractual, i.e., duration, completion criteria, etc., should be defined, fully understood and agreed upon before hospitalization. This would reinforce selfresponsibility for treatment and might lead to improved compliance. Compulsory treatments could be made by a special order 29 after a specialist in drug dependency treatment had assessed such cases regarding suitability for treatment. Based on the recommendations, a probation order could be issued with attached conditions, e.g., type and duration of treatment, discharge requirements, followup arrangements, postdischarge restrictions, etc. Family, police, court or employers could make probation requests. These measures would lead to improvement in retention rates by selecting only those who were motivated and committed to the program. The majority of addicts were single, unemployed, from a low income group and without high school education (Table ). Many had never worked before. Being employed improves recovery. Opportunities to further educational standing and learn new occupational skills must, therefore, be provided. Special educational and vocational training programs are needed. Associating this with workplace assignments would be advantageous. Some incentive to employers would be necessary to make this arrangement work. These measures would facilitate reestablishment of recovered individuals back in the community. A substantial number of subjects came to the hospital unaccompanied, i.e., without family, friends or employer. Most subjects gave no specific reason for seeking treatment (Table ). It is possible that some wanted only respite care. Attempts should be made to keep them in treatment. Family and employer involvement is known to increase the prospect of treatment completion. Engaging them in treatment planning is important and should not be overlooked. Comprehensive addiction treatment in the Western region is only available at Al Amal Hospital, Jeddah. Many addicts came from places outside Jeddah, where treatment facilities are very limited. Local services that can react to the needs of these individuals are required. This would involve decentralization of the prevailing setup. 2 Regional psychiatric hospitals and psychiatric units in local general hospitals could be enlisted to render medical detoxification, health education and information. Other types of residential facilities, such as therapeutic communities, halfway houses and hostels, are needed. Communitybased assessment, treatment, psychological therapy and counseling services providing an alternative to inpatient care should be developed. Most of the readmissions occurred within a year of discharge. Aftercare facilities in the community for discharged patients are scant. Nonresidential programs providing day care, drop in, work training, shelter, housing and other social facilities are urgently needed. This would render support, opportunities for developing leisure and work skills, respite care, refuge and social mingling to discharged individuals. Voluntary and religious organizations could be motivated to assist with some of these efforts. In this study heroin was found to be the most common substance used (Table 2). Figures indicate a decline in heroin and a rise in polydrug use compared to earlier findings. This may signal a change in the trend of drug use. The pattern of drug use also varied regionally. For instance, heroin was the main drug in Jeddah and Mecca, but not in other areas. All this has implications for future treatment planning and must be studied further by general surveys. A high number of subjects were intravenous drug users. The hospitalbased prevention program is already targeting AIDS and hepatitis education. Similar programs are needed in the community, as many addicts never come to the attention of health services. Drug services in the Kingdom were conceived over two decades ago. The needs of the population change with time. A reappraisal of addiction services is now necessary. Adequate data on service users should first be collected. A local monitoring system depicting those seeking treatment is therefore needed. 4 This would provide the relevant information required for designing future services. Public expectations on cure, care and control of addicts must be addressed before any changes are introduced. Acknowledgements I wish to thank Dr. Mohammed Farag, Mohammed Zahed Khan and staff of Unit B for their cooperation and assistance with this study. References. Valliant GE. Twelveyear follow up of New York narcotic addicts. II. The natural history of a chronic disease. N Engl J Med 9;275: Maddux JF, Desmond DP. Careers of opioid users. New York: Praeger, 9. 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5 IQBAL. Nurco DN, Cisin IH, Balter MB. Addict careers II. The first ten years. Int J Addict 9;: Rounsaville BJ, Kosten TR, Kleber HD. The antecedents and benefits of achieving abstinence in opioid addicts: a 2.5year follow up study. Am J Drug Alcohol Abuse 97;: McLellan AT, Luborsky L, O Brien CP. Is treatment for substance abuse effective? JAMA 92;247:42.. Centers For Disease Control Update. Acquired immunodeficiency syndrome associated with intravenous drug use United States, 9. MMWR 99;: Selwyn PA, Hartel D, Wasserman W. Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program. Am J Public Health 99;79:52.. Brown LS Jr, Hickson MJ, Ajuluchukwu DC. Medical disorders in a cohort of New York City drug abusers: much more than HIV disease. J Addict Disord 99;2: Raskin VD, Miller NS. The epidemiology of the comorbidity of psychiatric and addictive disorders. J Addict Disord 99;2:457.. Wig NN, Verma SK. Pattern of longterm heavy cannabis use in North India and its effects on cognitive functions: a preliminary report. Drug Alcohol Depend 977;2:29.. Wilkinson DA. CT scan and neuropsychological assessments of alcoholism. In: Parsons DA, Butters N, Nathan PE, editors. Neuropsychology of alcoholism. Implications for diagnosis and treatment. New York: Guilford Press, Nurco DN, Ball JC, Shaffer JW. The criminality of narcotic addicts. J Nerv Ment Dis 95;7:942.. McLellan AT, Luborsky L, O Brien CP. Alcohol and drug abuse treatment in three different populations: is there improvement and is it predictable? Am J Drug Alcohol Abuse 9;2:2. 4. Bale RN, Van Stone WW, Kaldau JM. Therapeutic communities vs methadone maintenance. Arch Gen Psychiatr 9;7: Simpson DD, Sells SB. Effectiveness of treatment for drug abuse: an overview of DARP research program. Adv Alcohol Subst Abuse 92;2:729.. Hubbard RL, Marsden ME, Rachal JV. Drug Abuse Treatment. A National Study of Effectiveness. Chapel Hill, North Carolina: University of North Carolina Press, 99: Simpson DD. National treatment system evaluation based on Drug Abuse Reporting Program (DARP) followup research. In: Tims FM, Ludford JP, editors. Drug abuse treatment evaluation: strategies: progress and prospects. NIDA Research Monograph 5. Washington DC: US Govt Print Off., 94:294.. Pickens RW, Fletcher BW. Overview of treatment issues: improving drug abuse treatment. NIDA Research Monograph Series, 99;: O Brien CP. Treatment research. In: Drug Abuse and Drug Abuse Research. Second Triennial Report to Congress from the Secretary of HHS. Washington DC: US Govt Print Off., 97; Savage LJ, Simpson DD. Posttreatment outcomes of sex and ethnic groups treated in methadone maintenance during J Psychedelic Drugs 9;2: Hubbard RL, Marsden ME. Relapse to use of heroin, cocaine and other drugs in the first year after treatment. In: Tims FM, Leukefeld CG, editors. Relapse and recovery in drug abuse. NIDA Research Monograph 72. Washington DC: US Govt Print Off., 9: Brady M. Culture in the treatment, culture as treatment: a critical appraisal of developments in addiction for indigenous North Americans and Australians. Soc Science Med 995;4: Waltman W. Key ingredients to effective addictions treatment. J Subst Abuse Treat 995;2: Gottheil E, Stimmel B. Intensive outpatient treatment for the addiction. J Addict Dis 997;: Lovinger R. The secular and religious background of the therapist. In: Lovinger R, editor. Working with religious issues in therapy. New Jersey: Jason Aronson Inc., 994:. 2. Sims A. Psyche: spirit as well as mind? Br J Psychiatr 995;5: Kendler KS, Gardner CO, Prescott CA. Religion, psychopathology, and substance use and abuse: a multimedia, geneticepidemiological study. Am J Psychiatr 997;54: Hoffman NG, Miller NS. Treatment outcomes for abstinencebased programs. Psychiatr Ann 992;22: Anglin MD. The efficacy of civil commitment in treating narcotic addiction. In: Leukefeld CG, Tims FM, editors. Compulsory treatment of drug abuse. Research and Clinical Practice. NIDA Research Monograph. Washington DC: US Govt Print Off., 9:4.. Kleinman PH, Millman RB, Lesser ML, Robinson H, et al. Vocational enhancement. In: Harris LS, editors. Problems of drug dependence, 994. Vol. II. Proceedings of the 5th. Annual Scientific Meeting. NIDA Research Monograph 5, 995:47.. Carise D, Forman R, Randall M. Effect of drug choice, family involvement and employer involvement on treatment completion rates of substance abusers. In: Harris LS, editor. Problems of drug dependence, 994. Vol. II. Proceedings of the 5th Annual Scientific Meeting. NIDA Research Monograph 5, 995: Klingman HKH. Drug treatment in Switzerland: harm reduction, decentralization and community response. Addiction 99;9:72.. Iqbal N. Substance dependence: a hospitalbased survey of 799 inpatients. Saudi Med J 2;2: De Villaer M. Establishing and using a community interagency client monitoring system to develop addictions treatment programs. Addiction 99;9:79. 2 Annals of Saudi Medicine, Vol 2, Nos 4, 2
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Wallace & Gromits Grand Adventures: Fright of the Bumblebees (PC) review
"It never quite gets going, surely a symptom of its short duration over anything else. At just a few hours long, nothing really kicks off until the finale, but it's one that sets the scene for what could be a delightful little adventure. Fright of the Bumblebees is an impressively promising start to this four-part release, and if it carries on in the same direction, later instalments could be just the ticket. This one's a fine introduction, but I'm almost certain it'll be the least memorable."
Freelance review by Lewis Denby (March 25, 2009)
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Gulf of Mexico oil companies start evacuations
Gulf of Mexico oil companies start evacuations
Oil companies are evacuating some Gulf of Mexico oil rigs in advance of Tropical Storm Isaac.
For now the storm is close to the Dominican Republic and Haiti. But oil installations would be at risk if it heads to the Gulf of Mexico and reaches hurricane strength.
BP says it has begun evacuating all workers from its Thunder Horse platform in the eastern Gulf of Mexico, and will suspend oil and natural gas production there. It is also evacuating non-essential workers from offshore facilities in the central Gulf.
Apache Corp., the oil services company, says it is evacuating non-essential workers in the eastern Gulf of Mexico.


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|Dhoti Kurta For Bridegroom
The most important of the wedding is the dress to be worn. Kurta pajama is one of the most favored choices of dress for men. Some of the recent collections of wedding kurta pajama are embroidered kurta pajamas for marriage ceremonies and wedding receptions, designer wedding kurtta pajama, Indian kurtha pajama and many more.


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When I first read the Politico story referring to Barry Soetoro's "Big Bang", I automatically assumed it was a reference to what he is doing to people who work, people who pay taxes, people who pay their mortgages, people who serve in the military, people who contribute to charities and people who have seen their retirement depleted.
I was right:
At the White House Tuesday morning, Obama began the day with a sharp push-back against the idea that his uncommonly ambitious agenda on health care, energy and other initiatives is too much, too soon.
Not so fast there, Barry-
Barack Obama's Big Bang Theory of Governance is starting to face its first big test among the new president's fellow Democrats.
Another timing is everything moment:
March 18 (Bloomberg) — President Barack Obama may try to push through Congress a health-care overhaul, energy proposals and tax increases by using a partisan tactic that would thwart Republican efforts to block the measures.
The administration and congressional Democrats are debating whether to use a parliamentary procedure called reconciliation to advance some of the biggest items on the president's agenda. The move would allow Democrats to approve plans to raise taxes by $1 trillion, create a cap-and-trade system to rein in greenhouse-gas emissions, and overhaul health care without a single Republican vote.
Maybe not. These measures enjoy bipartisan opposition.


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NAU's Management degree program allows busy professionals to earn their bachelor of science or bachelor of arts degree through our fully accredited, competency-based Personalized Learning online platform. This innovative learning environment allows students to set their own pace, and complete lessons according to their own timeline. With no deadlines and no set schedules, it's the ideal online degree program to advance your career!
NAU's Personalized Learning Management degree provides your choice of emphasis, with the option of either a human resources or healthcare focus. You'll learn topics pertinent to today's business world, including technology, finance, marketing and leadership, providing you with advanced management skills that will give you the competitive edge in a local or international work environment.
You will gain applicable knowledge in areas including:
The core competencies for the Management degree are listed above, while each emphasis has additional competencies that must be mastered, including the following:
The Human Resources emphasis (B.S. and B.A. - 21 credit hours):
The Healthcare emphasis (B.S. and B.S. - 21 credit hours):
Additional study includes the following for both the Human Resources and Healthcare emphases:
Foundations- 7 credits Foundations- 7 credits
Liberal Studies- 25 credits Liberal Studies- 28 credits
Spanish- 16 credits Science- 13 credits
Please contact us to speak with one of our Admissions Counselors, who can provide further details on the program and the application process at (800) 628-0040.


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Recent news
Opera challenges Microsoft in new business area
Opera + Linux = 75% cheaper set-top boxes
Oslo, Norway - September 9, 2003
Opera Software today challenged Microsoft in another business area: set-top boxes (STB). A STB running Microsoft's operating systems inside will cost over USD 300. By combining Opera and Linux, STBs at one-third of that price are now within reach for the residential market. Moving from Microsoft to Opera-enabled Linux STBs based on open standards will save the iTV industry's operators hundreds of millions of dollars, providing improvements and saved costs in all parts of the value chain. Opera's entry into this market is met with excitement from industry insiders.
In STBs Opera functions as more than just a Web browser. Opera's technology is used as a HTML presentation engine that executes the majority of navigational functions and renders content. Operators can now move away from Microsoft's offering that requires expensive middleware or is built on closed, proprietary standards. By enabling low-cost, standards-based STBs, Opera is paving the way for iTV finally becoming an attractive mass-market for operators. In a double-whammy, cost in the long-term is also reduced. Operators' content can be produced in HTML, significantly cheaper than using special proprietary standards.
"The high price of running Microsoft inside set-top boxes is stopping the iTV market from taking off. Microsoft has avoided the issue of the final product's price in their sales pitch," says Jon S. von Tetzchner, CEO, Opera Software ASA. "European and Asian operators are now realizing this, and looking for alternatives."
Analysts agree that lowering STB prices is vital for the industry to evolve.
"Previously we have said that for mass deployment of IP/DSL set top boxes to occur, prices need to be less than USD 200. Pricing below USD 100 is even better for operators' business case for launching video services," says Michelle Abraham, Senior Analyst, In-Stat/MDR. "By 2007 we expect shipments of 8 million IP/DSL set top boxes annually and price will definitely be a critical factor for this prediction to hold true."
The industry is ready to provide cheaper STBs. One of Germany's leading designers of IP-based STBs, LechValley, has recently won significant deals in Germany, Austria and India. LechValley's solution for the IP-TV market is based on the well known and proven embedded JNT (Java Network Technology) system, developed by the German powerhouse Infomatec since 1995.
"Given an order of significant volume for residential IP-TV market, there is new silicon architectures out there that can achieve a sub USD 100 price point," says Joachim Kline, director of sales, LechValley. "But it is the combination of Linux and Opera that makes this all possible."
Opera's use of Linux and open standards has the community excited.
"Opera's Linux based solution provides an economical business model for both the short-and long-term," says Dennis Thompson, Chairman, TV Linux Alliance. "Using Linux-based alternatives together with open standards produces economical platforms, therefore delivering the benefits of open standards to everyone in the value chain."
Learn more about Opera for iTV.
Find out more:
About Opera
Since its founding in 1996, Opera has been a pioneer in shaping the future of the internet. Providing faster and more innovative web browsers, Opera is the everyday browser of choice for more than 320 million people.
Opera Software AS is a privately held company and is headquartered in Oslo, Norway. Follow our news at http://blogs.opera.com/news/.
Opera is a trademark of Opera Software AS.


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The Rivercity Condo,51200 Jalan Ipoh,KL Homestay Condo is a modern condominium cum commercial development located along Jalan Ipoh. It's only hundreds of meters away from the heart of city centre and located right across Kuala Lumpur Performing Arts Centre.
- 3 bedrooms
- 2 bathrooms
- 09th floor
- Fully furnished
- Washing and cooking facilities
- Air-cond in all rooms including living room
- Shower heater in both bathrooms
- Flat screen TV, fridge and sofa
Condo facilities:
- Outdoor exercise terrace and stone walk
- Landscaped deck and walkways
- 24 hours security with access card
- Covered parking
- 7-Eleven, Guardian and 99 Speedmart
- Saloon, laundry and hardware store
- Hyderabad Recipe and Domino's Pizza
- Bakery and Nasi Kandar Arifah
- Petron Petrol Station
- Maybank and Hong Leong Bank
- Affin Bank, HSBC and Subway
- Rivercity and Riverwalk Village
- Taxi and bus (in front of the condo)
- Sentul KTM Station (15 minutes walk)
- Sentul Timur LRT Station (25 minutes walk)
- KLCC (13 minutes)
- Bukit Bintang (14 minutes)
- Sogo (9 minutes)
- KL Sentral (12 minutes)
* Flexible check in and check out time
* Special rate for frequent stayers


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Had migration in the period between the 2002 and 2012 censuses been "normal", Guyana's population should have fallen in a range of 790,000 to 1,009,000 persons, economist Dr. Clive Thomas says.
According to figures released by the Bureau of Statistics (BoS) on June 30, the 2012 census determined that Guyana's population stood at 747,884 persons, down from 751,223 persons in 2002. The resulting difference is 3,339 and Chief Statistician Lennox Benjamin described the drop as marginal, a description several analysts disagree with.
In his Sunday Stabroek column, Thomas said that it is impossible to establish to a significant degree of accuracy, a figure that represents what would have been the population size in 2012, if "normal" population events had occurred. He proffered six population growth rate estimates for the period between the 2002 and 2012 censuses.
According to Dr. Thomas, if Guyana's population growth rate was 0.5% during that period, the population in 2012 would have been 789 640 persons. If the growth rate was 1%, the 2012 population figure would be at 829 817 persons and if the rate was 1.2%, the population would have been at 846 396 in 2012. Had the growth rate been 1.5%, the population in 2012 would have stood at 871 824 persons and at a rate of 2%, the population would have been at 915 736 persons while had the population grown at a rate of 3%, in 2012, Guyana's population would have stood at 1 009 580 persons.
Thomas pointed out that the six population growth rate estimates are higher than the revealed growth rate for the period between 2002 and 2012 which is (minus) -0.04 per cent. He also noted that the estimates are higher than the population growth rate of 0.03 per cent for the years of the PPP/C administration, 1991-2012, a rate that would require, he pointed out, about two and one-third centuries for Guyana's population to double.
Further, because the simulation is based on the period between the 2002 and 2012 censuses, this does not reflect population events before then, which might have resulted in a larger estimated size for the 2012 population, the economics professor said.
He further explained that the six growth rates were chosen because firstly, worldwide information suggests the population growth rate without exceptional migration for Guyana-type countries falls between a minimum of 0.5 – 1.0 per cent and a maximum of 3.0 – 4.0 per cent. "Second, the rate of 1.2 per cent is based on two considerations. One is that this rate is conservative in that Guyana's long-term population growth rate (between the end of World War II and the New Millennia 1946-2002) was 1.2 per cent…The other is that the world population growth rate is presently 1.2 per cent," Dr. Thomas said.
He also pointed out that the 1.5 per cent falls on the mid-point and median rate from among those figures he selected and fourthly, the choice of 2.0 per cent reflects the typical rate for most small states. "Finally, the choice of 3.0 per cent represents a conservative upper limit of historically recorded population growth rates. Sustained rates in excess of 3.0 per cent are relatively rare," the economist said.
"Based on these considerations the simulations suggest that exceptional population events (primarily emigration) account for a shortfall of between 42 thousand and 262 thousand persons at the time of the 2012 Census.
This represents a percentage shortfall in the range of 6 to 35 per cent of the Preliminary Census population," he asserted.
"Put another way, the census population should have fallen in a range of 790,000 to 1,009,000 persons without exceptional emigration," Thomas said.
He had noted that many had attributed the population decline to outward emigration in the decade of the 2000s and said that he found this plausible although the 2012 Preliminary Report does not examine fertility, mortality or death rates. "When a similar decline in the population was identified for the first time in Guyana's census history in the 1991 Census, the BoS indicated that this outcome was 'consistent with the peak emigration flows recorded during the decade of the 1980s'," he noted.
Thomas also cautioned that the 2012 Report is preliminary and changes in the information presented in the Final Report could differ, as has happened before.
Shortly after the Preliminary Report of the 2012 Census was revealed, an analysis of population trends since the 1980s by chartered accountant Christopher Ram suggested that Guyana's population would have been between 1.2 million and 1.5 million by now but he said that nothing is being done to counter migration.
"If Guyana had maintained growth rates experienced during the decade of the turbulent 60s, or even at the lower rates of growth per decade of 20% and 15%, our population would have been in the range of 1,200,000 and 1,500,000, in other words our population would have doubled, we would have had a surplus of skills, a large number of consumers, entrepreneurs and businesses," he said on his blog chrisram.net.
"Looked at another way, a 20% increase over ten years is only 1.84% compounded annually, while a 15% over ten years require an annual compounded rate of 1.41%. These are well below the annual growth rates of countries at our level of development. It is not however a question of fertility – the birth rate far exceeds the death rate – our problem is migration for which we seem to have no interest, let alone policy," Ram, who is also an attorney, had said.


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Kimber & Billy's Raised Vegetable Garden
Raised beds are the perfect addition to any backyard, especially if you are interested in growing your own vegetables and herbs to harvest. The advantages to raised beds are numerous; better drainage, higher yields, they're easier to water and weed, and they make it possible to grow on trickier sites such as rooftops, solid rock or cement. Here's a peek inside our process of building a raised bed…
There's nothing more satisfying to us than spending time in our garden. But first, given that all we had was a rectangular dirt pad, we had to build one. Last year we transformed our small city backyard by adding a DIY stone patio and a few flower beds. We knew our grand plan included building a raised vegetable bed, but we fell short on time and money.
While there are numerous kits for purchase online or in garden centers, we decided to build ours from scratch. For lumber, we chose cedar wood (for the boards and the corner posts) instead of treated wood, which can leach chemicals into your growing soil (Redwood is also a safe alternative). The cedar will mellow to a lighter ash color over time, giving the wood an aged look. With the boards cut to size, we lined up the plank boards with the corner posts. Holes were drilled and galvanized carriage bolts were inserted to fasten them together. Once the entire box was connected, we moved it into location, resting it on leveled soil. Metal stakes were tapped into the ground by the corner posts, and then screwed into the frame, giving the box added stability. Triangle boards were cut from the remaining wood scraps, and used to cover the corner posts, which also allows us a place to rest a pot or two. An additional board was screwed into the top front of the box - this extra ledge is a great place to set tools, harvested vegetables, or can even be used as extra seating.
Once the boxes were complete (we built two), and given that we had spent most of our budget on the materials, we knew we needed a cost-effective way to fill them. One borrowed trailer and a 3 hour drive to family later, we had compiled enough free compost and dried horse manure to fill our square raised box. Because of the sheer height of it, it took a bit more soil than we imagined. (Note: We wanted to build our boxes this high to help keep the neighborhood pests out. A bed this deep is not required for growing herbs and vegetables.)
This year our vegetable roster includes heirloom tomatoes, okra, tomatillos, cucumbers, sweet peppers, hot peppers, artichokes, squash and zucchini. We also have an extensive herb garden, horseradish, strawberry plants, and blueberry bushes. As far as what is growing in our raised bed, it will be a bit of trial and error when it comes to the planting arrangement. We have learned that the peppers do not grow as large, or as fast, and will be better suited growing in the ground next year as to not be too shaded from neighboring tomato plants. Bamboo poles were staked towards the back, and by weaving rows of twine up the poles, this will add a trellis for cucumbers or other climbing plants.
A couple of books we found invaluable during the process were All New Square Foot Gardening: Grow More in Less Space! and The Backyard Homestead: Produce All the Food You Need on Just a Quarter Acre!.
(Re-edited from a post originally published on 6.10.2010 - CM)
(Images: Kimberly Watson)


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Laboratory Diagnosis of Myocardial Infarction
A number of laboratory tests are available. None is completely sensitive and specific for myocardial infarction, particularly in the hours following onset of symptoms. Timing is important, as are correlation with patient symptoms, electrocardiograms, and angiographic studies. The following tests are available as markers for acute myocardial infarction:
Creatine Kinase - Total:
The total CK is a simple and inexpensive test that is readily available using many laboratory instruments. However, an elevation in total CK is not specific for myocardial injury, because most CK is located in skeletal muscle, and elevations are possible from a variety of non-cardiac conditions.
Creatine Kinase - MB Fraction:
Creatine kinase can be further subdivided into three isoenzymes: MM, MB, and BB. The MM fraction is present in both cardiac and skeletal muscle, but the MB fraction is much more specific for cardiac muscle: about 15 to 40% of CK in cardiac muscle is MB, while less than 2% in skeletal muscle is MB. The BB fraction (found in brain, bowel, and bladder) is not routinely measured.
Thus, CK-MB is a very good marker for acute myocardial injury, because of its excellent specificity, and it rises in serum within 2 to 8 hours of onset of acute myocardial infarction. Serial measurements every 2 to 4 hours for a period of 9 to 12 hours after the patient is first seen will provide a pattern to determine whether the CK-MB is rising, indicative of myocardial injury. The CK-MB is also useful for diagnosis of reinfarction or extensive of an MI because it begins to fall after a day, dissipating in 1 to 3 days, so subsequent elevations are indicative of another event.
A "cardiac index" can provide a useful indicator for early MI. This is calculated as a ratio of total CK to CK-MB, and is a sensitive indicator of myocardial injury when the CK-MB is elevated.
CK-MB Isoforms:
The CK-MB fraction exists in two isoforms called 1 and 2 identified by electrophoretic methodology. The ratio of isoform 2 to 1 can provide information about myocardial injury.
An isoform ratio of 1.5 or greater is an excellent indicator for early acute myocardial infarction. CK-MB isoform 2 demonstrates elevation even before CK-MB by laboratory testing. However, the disadvantage of this method is that it is skilled labor intensive because electrophoresis is required, and large numbers of samples cannot be run simultaneously nor continuously. False positive results with congestive heart failure and other conditions can occur.
Troponin I and T are structural components of cardiac muscle. They are released into the bloodstream with myocardial injury. They are highly specific for myocardial injury--more so than CK-MB--and help to exclude elevations of CK with skeletal muscle trauma. Troponins will begin to increase following MI within 3 to 12 hours, about the same time frame as CK-MB. However, the rate of rise for early infarction may not be as dramatic as for CK-MB.
Troponins will remain elevated longer than CK--up to 5 to 9 days for troponin I and up to 2 weeks for troponin T. This makes troponins a superior marker for diagnosing myocardial infarction in the recent past--better than lactate dehydrogenase (LDH). However, this continued elevation has the disadvantage of making it more difficult to diagnose reinfarction or extension of infarction in a patient who has already suffered an initial MI. Troponin T lacks some specificity because elevations can appear with skeletal myopathies and with renal failure.
Myoglobin is a protein found in skeletal and cardiac muscle which binds oxygen. It is a very sensitive indicator of muscle injury. The rise in myoglobin can help to determine the size of an infarction. A negative myoglobin can help to rule out myocardial infarction.. It is elevated even before CK-MB. However, it is not specific for cardiac muscle, and can be elevated with any form of injury to skeletal muscle.
Lactate dehydrogenase:
The LDH has been supplanted by other tests. It begins to rise in 12 to 24 hours following MI, and peaks in 2 to 3 days, gradually dissipating in 5 to 14 days. Measurement of LDH isoenzymes is necessary for greater specificity for cardiac injury. There are 5 isoenzymes (1 through 5). Ordinarily, isoenzyme 2 is greater than 1, but with myocardial injury, this pattern is "flipped" and 1 is higher than 2. LDH-5 from liver may be increased with centrilobular necrosis from passive congestion with congestive heart failure following ischemic myocardial injury.
Troponin I - A Highly Specific Marker for Cardiac Muscle
The enzyme tests used for the diagnosis of myocardial infarction are CK and AST, with LDH being useful in delayed presentations. When the source of a raised CK is unclear, CKMB has been measured to confirm or rule out myocardial infarction.
Recently a more specific marker of myocardial injury has been described - Troponin I. Unlike CKMB which is found in small amounts in skeletal muscle, cardiac Troponin I is only found in cardiac muscle. Concurrent skeletal muscle injury in the presence of myocardial damage has sometimes posed a problem with CKMB since the CKMB index could give a false negative value in that situation. Not Troponin I. Therefore Troponin I is more sensitive than CKMB in detecting myocardial infarction or injury. CKMB may be falsely elevated in some chronic muscle diseases. Not Troponin I. Therefore Troponin I is more specific than CKMB. These properties make Troponin I the ideal test to confirm or rule out myocardial damage when the diagnosis is in doubt.
Troponin I becomes positive at about the same time as CKMB does ie 4-8 hours after a myocardial infarct. However unlike CKMB, Troponin I remains raised for 5-9 days after the event - permitting late diagnosis of MI and making LDH measurements redundant. CKMB normalises two days after the event.
Normal healthy people have undetectable levels of Troponin I in blood. However, sick patients may have minor increases in Troponin I. The reference range in our system (Abbott Axsym) is <2.0 ug/L. Marginal increases in Troponin I above 2.0 ug/L may be seen in unstable angina. It has been suggested that patients with unstable angina who have marginal increases in Troponin I have a significantly worse prognosis than patients with undetectable Troponin. Troponin I is now used in risk stratification and management of patients with unstable angina.
NB. Troponin I should be distinguished from Troponin T, a similar marker but which does not seem to be as specific as Troponin I for cardiac muscle damage.
Troponin I measured by the Stratus Dade method gives different concentrations, although there is very good correlation with the Abbott results. Much of the published data is based on the Dade method. The reference range for this method is <1.5ug/L.
Key References.1. Cardiac Troponin I. A marker with high specificity for cardiac injury. Adams JE et al. Circulation 1993; 88: 101-106
2. Diagnosis of perioperative myocardial infarction with measurement of cardiac Troponin I. Adams JE et al. New England Journal of Medicine 1994; 330: 670-674
3. Cardiac specific Troponin I levels predict the risk of mortality in
patients with acute coronary syndromes. Antman EM et al. New England Journal of
Medicine 1996; 335: 1342-1349
[last reviewed February 1999]


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The rural highlands of Ecuador are extremely picturesque, ranging from snow-topped peaks to verdant valleys scattered with lakes and meandering rivers. Lying in a scenic valley high up in the Andes, the old Inca capital of Quito has a vibrant atmosphere and is filled with craft markets, cosmopolitan galleries and architectural wonders.
Enjoy a walking tour of the old quarter where you will find numerous churches, spacious plazas and ancient monasteries. The San Domingo and San Francisco monasteries are particularly impressive, each boasting spectacularly ornate interiors. You can spend many hours soaking up the rich colonial architecture, stopping every now and then for a rest at one of the colourful terrace cafes.
If you've ever wanted to stand at the centre of the earth, you have the opportunity to do so at the Mitad del Mundo just outside of Quito. This monument marks the location of the equator, so take the chance to stand with one foot on each hemisphere.
Jump on board the Teleferico sky tram up 4,000 metres to Cruz Loma for an excellent view over Quito's mountainous landscape. You can stop there, but those more active may want to hike an extra 3 hours to reach the summit of Rucu Pinchincha.
Ask one of our Ecuador experts for a personalised, luxury itinerary and find out what makes Quito tick.
Thank you for making it everything we had hoped it would be. The holiday of a lifetime.- JD, India, 2014


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For more than a year, the fate of three Israeli soldiers seized by Hezbollah guerrillas on the border with Lebanon has been a mystery. The Islamic movement demanded the release of 19 prisoners in exchange for the men but refused to say whether the soldiers were dead or alive.
The Israeli army now thinks it knows what happened. On Monday, armed with what a senior official called reliable and secret new intelligence, the army announced that the soldiers probably are dead and have been since they were ambushed.
"The probability that they are dead is very high," Maj. Gen. Gil Regev said at a news conference in Tel Aviv. "Until today, we assumed they were alive, and now we assume they are dead."
Coming in the early days of the 13-month Palestinian uprising, the case of the three soldiers heightened tensions at a dangerous time. Violence was spinning out of control in the West Bank and Gaza Strip, and suddenly Israel felt threatened on its northern border as well.
Months earlier, Israel had ended its two-decade occupation of southern Lebanon, a long-awaited withdrawal certified by the United Nations. But Hezbollah, with backing from Lebanon and Syria, continued to dispute a small portion of land near Shabaa Farms that Israel had captured from Syria during the 1967 Mideast war.
Eventually the soldiers' case strained Israel's relations with the United Nations, which had withheld evidence about the attack and later admitted it.
Sgt. Maj. Omar Souad, Sgt. Benjamin Avraham and Sgt. Adi Avitan were ambushed by Hezbollah on Oct. 7, 2000. According to reports at the time, the guerrillas fired Katyusha rockets at an Israeli outpost in the disputed border area. When Israeli troops arrived at the scene, guerrillas fired on them and snatched the three soldiers.
Blood at the site suggested that the men at least had been seriously wounded. Hezbollah consistently refused to disclose their conditions unless Israel would meet its demands: the release of 19 Lebanese prisoners.
Regev said the army now believes the injuries were fatal and the three soldiers died immediately or soon thereafter. The army's chief rabbi, after consulting with other leading rabbis, will decide whether to declare them dead. It is a highly unusual and sensitive matter in Israel to declare an MIA dead without finding a body.
Regev refused to reveal the nature of the new intelligence. He denied reports that Israeli authorities received body parts. Germany has interceded between Israel and Hezbollah on the soldiers' fates and may have relayed the new information.


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Not a true post, but a quick update/venting session.
I went to the dentist this morning because it felt like one of my veneers was coming loose (if you remember back, there was an issue with some bad bonding agent and I had to have most redone). Specifically, its the tooth to the right of my right front tooth, or the #7 lateral incisor. I noticed at the beginning of last week that it bothered me when I'd bite down. Upon further inspection, I found that I could wiggle the tooth back and forth a little bit more than normal. Well, I should say normal for me - my front 4 teeth haven't 100% stabilized from the accident last year, and they all have a bit of "wiggle room" (clearly a technical term). I'm thinking they might pop off the veneer and cement it back on again... no big deal. Surely it's just an issue with the veneer.
The tooth is dying off.
... Are you effing kidding me?!
So, Wednesday I'll have a root canal at 7 in the morning (good morning!) in an attempt to save the tooth from totally dying. If it dies, I'll have to have an implant done. This isn't a complete shock to me, as I was warned initially that at any point in my life the teeth I damaged can just die off without warning. It's a phenomenon that dentists don't truly understand - you can be fine for years after a traumatic incident to your teeth, and then suddenly the body kills the tooth off. I just didn't think this would actually happen.
Here's to hoping my teeth stay in my mouth.
07 December 2009
Seriously... AGAIN?!!
Not a true post, but a quick update/venting session.
Posted by Lindsay at 2:18 PM 3 comments Links to this post