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(incobotulinumtoxinA) for Injection, for Intramuscular or Intraglandular Use
Postmarketing reports indicate that the effects of XEOMIN and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses [see WARNINGS AND PRECAUTIONS].
The active ingredient of XEOMIN is botulinum toxin type A produced from fermentation of Hall strain Clostridium botulinum serotype A. The botulinum toxin complex is purified from the culture supernatant and then the active ingredient is separated from the proteins (hemagglutinins and non-hemagglutinins) through a series of steps yielding the active neurotoxin with molecular weight of 150 kDa, without accessory proteins. XEOMIN is a sterile white to off-white lyophilized powder intended for intramuscular or intra-salivary gland injection after reconstitution with preservative-free 0.9% Sodium Chloride Injection, USP (3). One vial of XEOMIN contains 50 Units, 100 Units, or 200 Units of incobotulinumtoxinA, human albumin (1 mg), and sucrose (4.7 mg).
The primary release procedure for XEOMIN uses a cell-based potency assay to determine the potency relative to a reference standard. One Unit corresponds to the median intraperitoneal lethal dose (LD50) in mice. As the method for conducting the assay is specific to XEOMIN, Units of biological activity of XEOMIN cannot be converted into Units of any other botulinum toxin assessed with other specific assays.
For Consumers
What are the possible side effects of incobotulinumtoxinA (Xeomin)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; feeling like you might pass out; swelling of your face, lips, tongue, or throat.
The botulinum toxin contained in this medication can spread to other body areas beyond where it was injected. This has caused serious life-threatening side effects in some people receiving botulism toxin injections, even for cosmetic purposes.
Call your doctor at once if you have any of these side effects, some of which can occur up to several weeks after an...
Cervical Dystonia
XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-naïve and previously treated patients.
XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).
Glabellar Lines
XEOMIN (incobotulinumtoxinA) is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients.
Instructions For Safe Use
The potency Units of XEOMIN (incobotulinumtoxinA) for injection are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of XEOMIN cannot be compared to or converted into Units of any other botulinum toxin products assessed with any other specific assay method [see WARNINGS AND PRECAUTIONS and DESCRIPTION]. Reconstituted Xeomin is intended for intramuscular injection only.
Cervical Dystonia
The recommended initial total dose of XEOMIN for cervical dystonia is 120 Units. In a placebo-controlled trial utilizing initial XEOMIN doses of 120 Units and 240 Units, no meaningful difference in effectiveness was demonstrated between the doses [see Clinical Studies]. In previously treated patients, their past dose, response to treatment, duration of effect, and adverse event history should be taken into consideration when determining the XEOMIN dose.
In the treatment of cervical dystonia, XEOMIN is usually injected into the sternocleidomastoid, levator scapulae, splenius capitis, scalenus, and/or the trapezius muscle(s). This list is not exhaustive, as any of the muscles responsible for controlling head position may require treatment [see Clinical Studies]. The dose and number of injection sites in each treated muscle should be individualized based on the number and location of the muscle(s) to be treated, the degree of spasticity/dystonia, muscle mass, body weight, and response to any previous botulinum toxin injections.
The frequency of XEOMIN repeat treatments should be determined by clinical response, but should generally be no more frequent than every 12 weeks [see Clinical Studies].
The recommended initial total dose of XEOMIN should be the same dose as the patient's previous treatment of onabotulinumtoxinA (Botox), although responses to XEOMIN and onabotulinumtoxinA (Botox) may differ in individual patients. In a placebo-controlled trial in which patients were dosed with the same number of Units as they had received previously with onabotulinumtoxinA (Botox), the mean dose per eye was about 33 Units (range 10 Units-50 Units), and the mean number of injections per eye was 6. The maximum dose per eye in the controlled trials was 50 Units, with a range of 10 Units-50 Units. In the controlled trial, few patients received a total dose of greater than 75 Units.
If the previous dose of Botox is not known, the initial dose of XEOMIN should be between 1.25 Units-2.5 Units/injection site.
The total initial dose of XEOMIN in both eyes should not exceed 70 Units (35 Units/eye).
The number and location of injection sites should be based on the severity of blepharospasm, and previous dose and response to onabotulinumtoxinA (Botox) injections. Subsequent dosing should be tailored to the individual patient, based on response, up to a maximum dose of 35 Units per eye [see Clinical Studies]. XEOMIN dosing has not been established in patients with blepharospasm who have not been previously treated with onabotulinumtoxinA (Botox).
The frequency of XEOMIN repeat treatments should be determined by clinical response but should generally be no more frequent than every 12 weeks [see Clinical Studies].
Glabellar Lines
The total recommended XEOMIN dose is 20 Units per treatment session divided into five equal intramuscular injections of 4 Units each. The five injection sites are: two injections in each corrugator muscle and one injection in the procerus muscle.
Retreatment with XEOMIN should be administered no more
frequently than every three months.
Special Populations
The safety and effectiveness of XEOMIN in the treatment of cervical dystonia, blepharospasm, and glabellar lines in patients below 18 years of age have not been assessed [see WARNINGS AND PRECAUTIONS].
Preparation And Reconstitution Technique
Prior to injection, reconstitute each vial of XEOMIN with sterile, preservative-free 0.9% Sodium Chloride Injection, USP [see Dosage Form and Strengths]. Draw up an appropriate amount of preservative-free 0.9% Sodium Chloride Injection, USP into a syringe (see Table 1 and [Dosage Form and Strengths]). Clean the exposed portion of the rubber stopper of the vial with alcohol (70%) prior to insertion of the needle. Gently inject the saline solution into the vial. If the vacuum does not pull the saline into the vial, then XEOMIN must be discarded. Gently mix XEOMIN with the saline by rotating the vial. Reconstituted XEOMIN is a clear, colorless solution free of particulate matter. XEOMIN should not be used if the reconstituted solution has a cloudy appearance or contains floccular or particulate matter.
Diluent volumes for reconstitution of XEOMIN are indicated in Table 1.
Table 1: Diluent Volumes for Reconstitution of XEOMIN
|Volume of Preservative-free 0.9% Sodium Chloride Injection, USP
|50 Unit Vial: Resulting dose in Units per 0.1 mL
|100 Unit Vial: Resulting dose in Units per 0.1 mL
|200 Unit Vial: Resulting dose in Units per 0.1 mL
|0.25 mL
|20 Units
|0.5 mL
|10 Units
|20 Units
|40 Units
|1 mL
|5 Units
|10 Units
|20 Units
|1.25 mL
|4 Units
|8 Units
|16 Units
|2 mL
|2.5 Units
|5 Units
|10 Units
|2.5 mL
|2 Units
|4 Units
|8 Units
|4 mL
|1.25 Units
|2.5 Units
|5 Units
|5 mL
|1 Unit
|2 Units
|4 Units
Reconstituted XEOMIN solution should be administered within 24 hours after dilution. During this time period, reconstituted XEOMIN should be stored in a refrigerator 2-8°C (36-46°F) [see HOW SUPPLIED/Storage and Handling].
Reconstituted XEOMIN is intended for intramuscular injection only. After reconstitution, XEOMIN should be used for only one injection session and for only one patient.
If proposed injection sites are marked with a pen, the product must not be injected through the pen marks; otherwise a permanent tattooing effect may occur.
The number of injection sites is dependent upon the size of the muscle to be treated and the volume of reconstituted XEOMIN injected.
XEOMIN should be injected carefully when injected at sites close to sensitive structures, such as the carotid artery, lung apices and esophagus. Before administering XEOMIN, the physician should be familiar with the patient's anatomy and any anatomic alterations, e.g., due to prior surgical procedures.
Cervical Dystonia
A suitable sterile needle (e.g., 26-gauge (0.45 mm diameter), 37 mm length for superficial muscles; or 22-gauge (0.70 mm diameter), 75 mm length for injections into deeper muscles) should be used in the administration in the treatment of cervical dystonia.
Localization of the involved muscles with electromyographic guidance or nerve stimulation techniques may be useful.
A suitable sterile needle (e.g., 26-gauge (0.45 mm diameter), 37 mm length for superficial muscles; or 22-gauge (0.70 mm diameter), 75 mm length for injections into deeper muscles) should be used in the administration in the treatment of blepharospasm.
Glabellar Lines
A suitable sterile needle 30-33 gauge (0.3-0.2 mm diameter), 13 mm length should be used in the administration in the treatment of glabellar lines.
Monitoring To Assess Effectiveness
The median first onset of XEOMIN effect occurs within seven days after injection. The typical duration of effect of each treatment is up to 3 months; however, the effect may last significantly longer, or shorter, in individual patients.
Dosage Forms And Strengths
Single-dose, sterile 50 Units, 100 Units, or 200 Units lyophilized powder for reconstitution only with sterile, preservative-free 0.9% Sodium Chloride Injection, USP, prior to injection.
Storage And Handling
Type 1 borosilicate glass single-dose vials with latex-free bromobutyl rubber closures and tamper-proof aluminum seals in the following pack sizes:
|Cervical Dystonia
single vial pack
|XEOMIN 50 Units
|XEOMIN 100 Units
|XEOMIN 200 Units
single vial pack
|XEOMIN 50 Units
|XEOMIN 100 Units
|Glabellar Lines
single vial pack
|XEOMIN 50 Units
|XEOMIN 100 Units
Unopened vials of XEOMIN can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C (-4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.
XEOMIN is reconstituted prior to use with sterile preservative-free 0.9% Sodium Chloride Injection, USP [see DOSAGE AND ADMINISTRATION].
XEOMIN should not be used if the reconstituted solution has a cloudy appearance or contains floccular or particulate matter.
Any reconstituted toxin solution for injection that has been stored for more than 24 hours, as well as any unused solution for injection, should be discarded.
Manufactured by: Merz Pharmaceuticals GmbH Eckenheimer Landstrasse 100 Frankfurt Germany U.S. License Number 1830. Distributed by: Merz Pharmaceuticals, LLC 6501 Six Forks Road Raleigh, NC 27615 and Merz North America, Inc. 4133 Courtney Street, Suite 10 Franksville, WI 53126. Revised: Nov 2015
The following adverse reactions to XEOMIN are discussed in greater detail in other sections of the labeling:
- Hypersensitivity [see CONTRAINDICATIONS and WARNINGS AND PRECAUTIONS]
- Dysphagia and Breathing Difficulties in Treatment of cervical dystonia [see WARNINGS AND PRECAUTIONS]
- Spread of Effects from Toxin [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug, and may not reflect the rates observed in practice.
Cervical Dystonia
The data described below reflect exposure to a single intramuscular dose of XEOMIN in a placebo-controlled, Phase 3 trial in patients with cervical dystonia [see Clinical Studies]. In this study, 159 patients received XEOMIN (78 were randomized to receive a total dose of 120 Units, and 81 were randomized to receive a total dose of 240 Units). XEOMIN-treated patients were 18 to 79 years old (mean 53 years), and were predominantly female (66%) and Caucasian (91%). At study baseline, approximately 25% had mild, 50% had moderate, and 25% had severe cervical dystonia. Approximately 61% of XEOMIN-treated patients had previously received another botulinum toxin type A product. Common adverse events ( ≥ 5% in any XEOMIN treatment group) observed in patients who received XEOMIN (120 Units or 240 Units) included dysphagia, neck pain, muscle weakness, injection site pain, and musculoskeletal pain.
Table 2: Most Common TEAEs ( ≥ 5%) and Greater than
Placebo: Double-Blind Phase of Clinical Trial
|System Organ ClassPreferred Term
|Double-Blind Phase
|XEOMIN 120 Units
|XEOMIN 240 Units
|Any TEAEs
|Musculoskeletal and connective tissue disorders
|Neck pain
|Muscular weakness
|Musculoskeletal pain
|Gastrointestinal disorders
|Nervous system disorders
|General disorders and administration site conditions
|Injection site pain
|Infections and infestations
|Respiratory, thoracic and
In the placebo-controlled Phase 3 trial in patients with blepharospasm previously treated with onabotulinumtoxinA (Botox) [see Clinical Studies], 74 patients received XEOMIN at a mean dose of approximately 33 Units per eye (minimum 10 Units, maximum 50 Units). XEOMIN-treated patients were 22 to 79 years of age (mean 62 years), predominantly female (65%), Caucasian (79%), and had a mean time since diagnosis of approximately 5 years.
The adverse events occurring in ≥ 5% of XEOMIN-treated patients and greater than placebo in the Phase 3 study were eyelid ptosis, dry eye, dry mouth, diarrhea, headache, visual impairment, dyspnea, nasopharyngitis, and respiratory tract infection. No serious adverse events occurred in patients who received XEOMIN; one placebo-treated patient experienced a serious adverse event (dyspnea).
Table 3: Most Common TEAEs ( ≥ 5%) and Greater than
Placebo: Double-Blind Phase of Clinical Trial
|System Organ Class
Preferred Term
|Double-Blind Phase
|Subjects with TEAEs
|Eye disorders
|Eyelid ptosis
|Dry eye
|Visual impairment*
|Gastrointestinal disorders
|Dry mouth
|Infections and infestations
|Respiratory tract infection
|Nervous system disorders
|General disorders and administration site conditions
|Respiratory, thoracic and mediastinal disorders
|*including vision blurred
Glabellar Lines
In three placebo-controlled trials in 803 subjects with glabellar lines, 535 subjects received a single dose of 20 Units XEOMIN and 268 subjects received placebo. XEOMIN treated subjects were 24 to 74 years old, and were predominantly female (88%). The most frequent adverse reactions in XEOMIN treated subjects were: headache 29 (5.4%), facial paresis 4 (0.7%), injection site hematoma 3 (0.6%) and eyelid edema 2 (0.4%). Four serious adverse events occurred in two placebo-treated subjects. Six XEOMIN treated subjects experienced six serious adverse events. All serious adverse events were assessed as unrelated to study drug.
The adverse reactions below reflect exposure to XEOMIN with glabellar lines in placebo-controlled studies. Adverse reactions are adverse events in which there is some basis to believe there is a causal relationship between the drug and the occurrence of the adverse event.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Table 4: Adverse Reactions in Placebo-Controlled Trials
|Adverse reactions
|Nervous system disorders
|33 (6.1)
|6 (2.2)
|29 (5.4)
|6 (2.2)
|Facial paresis (brow ptosis)
|4 (0.7)
|General disorders and administration site conditions
|5 (0.9)
|2 (0.7)
|Injection site hematoma
|3 (0.6)
|Injection site pain
|1 (0.2)
|Facial pain
|1 (0.2)
|Injection site swelling
|1 (0.4)
|Sensation of pressure
|1 (0.4)
|Eye disorders
|5 (0.9)
|Eyelid edema
|1 (0.2)
|Eye disorder
|Eyelid ptosis
In open label, multiple dose trials, adverse reactions were reported for 105 of the 800 subjects (13.1%). Headache was the most common adverse reaction, reported for 57 subjects (7.1%), followed by injection site hematoma in 8 subjects (1.0%). Adverse reactions reported in less than 1% of subjects were: facial paresis (brow ptosis), muscle disorder (elevation of eyebrow), injection site pain, and eyelid edema.
As with all therapeutic proteins, there is a potential for immunogenicity.
The incidence of antibody formation is highly dependent on the sensitivity and specificity of the assay. In addition, the observed incidence of antibody positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies across products in this class may be misleading.
Postmarketing Experience
The following adverse reactions have been reported during post-approval use with XEOMIN. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: eye swelling, eyelid edema, dysphagia, nausea, flu-like symptoms, injection site pain, injection site reaction, allergic dermatitis, localized allergic reactions like swelling, edema, erythema, pruritus or rash, herpes zoster, muscular weakness, muscle spasm, dysarthria, myalgia and hypersensitivity.
No formal drug interaction studies have been conducted with XEOMIN.
Coadministration of XEOMIN and aminoglycoside antibiotics or other agents interfering with neuromuscular transmission, e.g., tubocurarine-type muscle relaxants, should only be performed with caution as these agents may potentiate the effect of the toxin.
Use of anticholinergic drugs after administration of XEOMIN may potentiate systemic anticholinergic effects.
The effect of administering different botulinum toxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of XEOMIN.
Included as part of the PRECAUTIONS section.
Spread Of Toxin Effect
Postmarketing safety data from XEOMIN and other approved botulinum toxins suggest that botulinum toxin effects may, in some cases, be observed beyond the site of local injection. The symptoms are consistent with the mechanism of action of botulinum toxin and may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death related to the spread of toxin effects. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can occur in adults treated for spasticity and other conditions, and particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, symptoms consistent with spread of toxin effect have been reported at doses comparable to or lower than doses used to treat cervical dystonia.
Patients or caregivers should be advised to seek immediate medical care if swallowing, speech, or respiratory disorders occur.
Lack Of Interchangeability Between Botulinum Toxin Products
The potency Units of XEOMIN are specific to the preparation and assay method utilized. They are not interchangeable with the other preparations of botulinum toxin products and, therefore, Units of biological activity of XEOMIN cannot be compared to or converted into Units of any other botulinum toxin products assessed with any other specific assay method [see DESCRIPTION].
Hypersensitivity Reactions
Hypersensitivity reactions have been reported with botulinum toxin products (anaphylaxis, serum sickness, urticaria, soft tissue edema, and dyspnea). If serious and/or immediate hypersensitivity reactions occur further injection of XEOMIN should be discontinued and appropriate medical therapy immediately instituted.
Dysphagia And Breathing Difficulties
Treatment with XEOMIN and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with pre-existing swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or swallowing. When distant effects occur, additional respiratory muscles may be involved [See Spread of Toxin Effect].
Deaths as a complication of severe dysphagia have been reported after treatment with botulinum toxin. Dysphagia may persist for several months, and require use of a feeding tube to maintain adequate nutrition and hydration. Aspiration may result from severe dysphagia and is a particular risk when treating patients in whom swallowing or respiratory function is already compromised.
Treatment of cervical dystonia with botulinum toxins may weaken neck muscles that serve as accessory muscles of ventilation. This may result in critical loss of breathing capacity in patients with respiratory disorders who may have become dependent upon these accessory muscles. There have been post-marketing reports of serious breathing difficulties, including respiratory failure, in patients with cervical dystonia treated with botulinum toxin products.
Patients with smaller neck muscle mass and patients who require bilateral injections into the sternocleidomastoid muscles have been reported to be at greater risk of dysphagia. In general, limiting the dose injected into the sternocleidomastoid muscle may decrease the occurrence of dysphagia.
Patients treated with botulinum toxin may require immediate medical attention should they develop problems with swallowing, speech or respiratory disorders. These reactions can occur within hours to weeks after injection with botulinum toxin [See Spread of Toxin Effect above and ADVERSE REACTIONS].
Pre-existing Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) should be monitored particularly closely when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including severe dysphagia and respiratory compromise from typical doses of XEOMIN [See ADVERSE REACTIONS].
Corneal Exposure, Corneal Ulceration, And Ectropion In Patients Treated For Blepharospasm
Reduced blinking from injection of botulinum toxin products in the orbicularis muscle can lead to corneal exposure, persistent epithelial defect and corneal ulceration, especially in patients with VII nerve disorders. Careful testing of corneal sensation in eyes previously operated upon, avoidance of injection into the lower lid area to avoid ectropion, and vigorous treatment of any epithelial defect should be employed. This may require protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other means. Because of its anticholinergic effects, XEOMIN should be used with caution in patients at risk of developing narrow angle glaucoma. To prevent ectropion, botulinum toxin products should not be injected into the medial lower eyelid area.
Ecchymosis easily occurs in the soft tissues of the eyelid. Immediate gentle pressure at the injection site can limit that risk.
Risk Of Ptosis In Patients Treated For Glabellar Lines
Do not exceed the recommended dosage and frequency of administration of XEOMIN.
In order to reduce the complication of ptosis the following steps should be taken:
- Avoid injection near the levator palpebrae superioris, particularly in patients with larger brow depressor complexes.
- Corrugator injections should be placed at least 1 cm above the bony supraorbital ridge.
Human Albumin And Transmission Of Viral Diseases
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) is also considered extremely remote. No cases of transmission of viral diseases or CJD have ever been reported for albumin.
Patient Counseling Information
See FDA-approved patient labeling (Medication Guide)
Provide a copy of the Medication Guide and review the contents with the patient.
Patients or caregivers should be advised to seek immediate medical care if swallowing, speech or respiratory disorders arise.
Previously immobile or sedentary patients should be reminded to gradually resume activities following the injection of XEOMIN for the treatment of cervical dystonia and blepharospasm.
Patients should be informed that injections of XEOMIN may cause dyspnea, or mild to severe dysphagia, with the risk of aspiration [see BOXED WARNING and WARNINGS AND PRECAUTIONS].
Patients should be counseled that if loss of strength, muscle weakness, blurred vision, or drooping eyelids occur, they should avoid driving a car or engaging in other potentially hazardous activities.
Patients should be informed that injections of XEOMIN may cause reduced blinking or effectiveness of blinking, and that they should seek immediate medical attention if eye pain or irritation occurs following treatment.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Studies to evaluate the carcinogenic potential of XEOMIN have not been conducted.
Genotoxicity studies have not been conducted for XEOMIN.
Impairment of Fertility
In a fertility and early embryonic development study in rabbits, males and females were dosed with XEOMIN (1.25 Units/kg, 2.5 Units/kg, or 3.5 Units/kg) intramuscularly every two weeks for 5 and 3 doses, respectively, beginning 2 weeks prior to mating. No effects on mating or fertility were observed. The highest dose tested is approximately twice the maximum recommended human dose for cervical dystonia (120 Units) on a body weight basis.
Use In Specific Populations
Pregnancy Category C
There are no adequate and well-controlled studies in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. XEOMIN was embryotoxic in rats and increased abortions in rabbits when given at doses higher than the maximum recommended human dose (MRHD) for cervical dystonia (120 Units) on a body weight basis.
When XEOMIN was administered intramuscularly to pregnant rats during organogenesis (3 Units/kg, 10 Units/kg, or 30 Units/kg on gestational days [GDs] 6, 12, and 19; or 7 Units/kg on GDs 6 to 19; or 2, 6, or 18 Units/kg on GDs 6, 9, 12, 16, and 19), decreases in fetal body weight and skeletal ossification were observed at doses that were also maternally toxic. The no-effect level for embryotoxicity in rats was 6 Units/kg (3 times the MRHD for cervical dystonia on a body weight basis). Intramuscular administration to pregnant rabbits during organogenesis (1.25 Units/kg, 2.5 Units/kg, or 5.0 Units/kg on GDs 6, 18, and 28) resulted in an increased rate of abortion at the highest dose, which was also maternally toxic. In rabbits, the no-effect level for increased abortion was 2.5 Units/kg (similar to the MRHD for cervical dystonia on a body weight basis).
Nursing Mothers
It is not known whether botulinum toxin type A is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when XEOMIN is administered to a nursing woman.
Pediatric Use
Safety and effectiveness of XEOMIN in patients less than 18 years of age have not been established [see WARNINGS AND PRECAUTIONS].
Geriatric Use
Cervical Dystonia
In the Phase 3 study in cervical dystonia [see Clinical Studies], 29 patients were older than 65 years of age, including 19 patients who received XEOMIN and 10 patients who received placebo. Of these, ten (53%) XEOMIN-treated patients and four (40%) placebo-treated patients experienced an adverse event. For patients over 65 years of age treated with XEOMIN, the most common adverse events were dysphagia (4 patients, 21%) and asthenia (2 patients, 11%). One XEOMIN-treated patient (5%) experienced severe dizziness.
In the Phase 3 study in blepharospasm [see Clinical Studies], 41 patients were older than 65 years of age, including 29 of 75 patients (39%) who received XEOMIN and 12 of 34 patients (35%) who received placebo. Of these patients, 22 of 29 (76%) XEOMIN-treated patients, compared with 7 of 12 (58%) placebo-treated patients, experienced an adverse event. One XEOMIN-treated patient experienced severe dysphagia.
Glabellar Lines
There are limited clinical data with XEOMIN in subjects over 65 years of age and over in clinical studies with glabellar lines. Of the total number of subjects in the placebo-controlled clinical studies GL1 and GL2, 21 (4%) subjects were 65 and over. Efficacy was observed in 20% (3/15) of XEOMIN subjects 65 years and over. For the entire safety database of geriatric subjects, there was no increase in the incidence of adverse events related to treatment with XEOMIN.
Excessive doses of XEOMIN may be expected to produce neuromuscular weakness with a variety of symptoms. Respiratory support may be required where excessive doses cause paralysis of the respiratory muscles. In the event of overdose, the patient should be medically monitored for symptoms of excessive muscle weakness or muscle paralysis [See WARNINGS AND PRECAUTIONS]. Symptomatic treatment may be necessary.
Symptoms of overdose are not likely to be present immediately following injection. Should accidental injection or oral ingestion occur, the person should be medically supervised for several weeks for signs and symptoms of excessive muscle weakness or paralysis.
There is no significant information regarding overdose from clinical studies in cervical dystonia and blepharospasm.
In the event of overdose, antitoxin raised against botulinum toxin is available from the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. However, the antitoxin will not reverse any botulinum toxin-induced effects already apparent by the time of antitoxin administration. In the event of suspected or actual cases of botulinum toxin poisoning, please contact your local or state Health Department to process a request for antitoxin through the CDC. If you do not receive a response within 30 minutes, please contact the CDC directly at 770-488-7100. More information can be obtained at http://www.cdc.gov/ncidod/srp/drugs/formulary.html#1a.
Use in patients with a known hypersensitivity to the active substance botulinum neurotoxin type A, or to any of the excipients (human albumin, sucrose), could lead to a life-threatening allergic reaction. XEOMIN is contraindicated in patients with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation [see WARNINGS AND PRECAUTIONS and DESCRIPTION].
Infection At Injection Site
Use in patients with an infection at the injection site could lead to severe local or disseminated infection. XEOMIN is contraindicated in the presence of infection at the proposed injection site(s).
Mechanism Of Action
XEOMIN blocks cholinergic transmission at the neuromuscular junction by inhibiting the release of acetylcholine from peripheral cholinergic nerve endings. This inhibition occurs according to the following sequence: neurotoxin binding to cholinergic nerve terminals, internalization of the neurotoxin into the nerve terminal, translocation of the light-chain part of the molecule into the cytosol of the nerve terminal, and enzymatic cleavage of SNAP25, a presynaptic target protein essential for the release of acetylcholine. Impulse transmission is re-established by the formation of new nerve endings.
In patients, recovery from paralysis after intramuscular injection normally occurs within 3-4 months as nerve terminals sprout and reconnect with the muscle endplate.
General Characteristics Of The Active Substance
Using currently available analytical technology, it is not possible to detect XEOMIN in the peripheral blood following intramuscular injection at the recommended doses.
Clinical Studies
Cervical Dystonia
XEOMIN has been investigated in a Phase 3, randomized, double-blind, placebo-controlled, multi-center trial in a total of 233 patients with cervical dystonia. Patients had a clinical diagnosis of predominantly rotational cervical dystonia, with baseline Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score ≥ 20, TWSTRS severity score ≥ 10, TWSTRS disability score ≥ 3, and TWSTRS pain score ≥ 1. For patients who had previously received a botulinum toxin treatment for cervical dystonia, the trial required that ≥ 10 weeks had passed since the most recent botulinum toxin administration. Patients with swallowing disorders or any significant neuromuscular disease that might interfere with the study were excluded from enrollment. Patients were randomized (1:1:1) to receive a single administration of XEOMIN 240 Units (n=81), XEOMIN 120 Units (n=78), or placebo (n=74). Each patient received a single administration of 4.8 mL of reconstituted study agent (XEOMIN 240 Units, XEOMIN 120 Units, or placebo). The investigator at each site decided which muscles would receive injections of the study agent, the number of injection sites, and the volume at each site. The muscles most frequently injected were the splenius capitis/semispinalis, trapezius, sternocleidomastoid, scalene, and levator scapulae muscles. Table 5 indicates the average XEOMIN dose, and percentage of total dose, injected into specific muscles in the pivotal clinical trial.
Table 5: XEOMIN 120 Units Initial Dose (Units and % of
the Total Dose) by Unilateral Muscle Injected During Double Blind Pivotal Phase
3 Study
|Number of Patients Injected Per Muscle
|ose Injected
|Median XEOMIN Units
|75th percentile XEOMIN Units
|Splenius capitis/ Semispinalis capitis
|Levator scapulae
|Scalenus (medius and anterior)
Most patients received a total of 2-10 injections into the selected muscles. Patients were assessed by telephone at one week post-injection, during clinic visits at Weeks 4 and 8, and then by telephone assessments or clinic visits every two weeks up to Week 20.
The mean age of the study patients was 53 years, and 66% of the patients were women. At study baseline, 61% of patients had previously received a botulinum toxin as treatment for cervical dystonia. The study was completed by 94% of study patients. Three patients discontinued the study prematurely due to adverse events: two patients in the 240 Unit group experienced musculoskeletal pain and muscle weakness, and one patient in the 120 Unit group experienced nausea and dizziness.
The primary efficacy endpoint was the change in the TWSTRS total score from baseline to Week 4 post-injection, in the intent-to-treat (ITT) population, with missing values replaced by the patient's baseline value. In the ITT population, the difference between the XEOMIN 240 Unit group and the placebo group in the change of the TWSTRS total score from baseline to Week 4 was -9.0 points, 95% confidence interval (CI) -12.0; -5.9 points; the difference between the XEOMIN 120 Unit group and the placebo group in the change of the TWSTRS total score from baseline to Week 4 was -7.5 points, 95% CI -10.4; -4.6 points.
Figure 2 illustrates the cumulative percentage of patients from each of the three treatment groups who had attained the specified change in TWSTRS Score from baseline versus 4 weeks post-injection. Three change scores have been identified for illustrative purposes, and the percent of patients in each group achieving that result is shown.
Figure 2: Cumulative Percentage of Patients with
Specified Changes from Baseline TWSTRS Total Score at Week 4
The curves demonstrate that both patients assigned to placebo and XEOMIN have a wide range of responses, but that the active treatment groups are more likely to show greater improvements. A curve for an effective treatment would be shifted to the left of the curve for placebo, while an ineffective or deleterious treatment would be superimposed upon or shifted to the right of the curve for placebo.
Comparison of each XEOMIN group to the placebo group was statistically significant at p < 0.001. Initial XEOMIN doses of 120 Units and 240 Units demonstrated no significant difference in effectiveness between the doses. The efficacy of XEOMIN was similar in patients who were botulinum toxin naïve and those who had received botulinum toxin prior to this study.
Examination of age and gender subgroups did not identify differences in response to XEOMIN among these subgroups. There were too few African-American patients to adequately assess efficacy in that population.
XEOMIN has been investigated in a Phase 3, randomized, double-blind, placebo-controlled, multi-center trial in a total of 109 patients with blepharospasm. Patients had a clinical diagnosis of benign essential blepharospasm, with baseline Jankovic Rating Scale (JRS) Severity subscore ≥ 2, and a stable satisfactory therapeutic response to previous administrations of onabotulinumtoxinA (Botox). At least 10 weeks had to have elapsed since the most recent onabotulinumtoxinA administration. Patients with any significant neuromuscular disease that might interfere with the study were excluded from enrollment. Patients were randomized (2:1) to receive a single administration of XEOMIN (n=75) or placebo (n=34). Each patient in the XEOMIN group received a XEOMIN treatment (dose, volume, dilution, and injection sites per muscle) that was similar to the most recent onabotulinumtoxinA injection sessions prior to study entry. The highest dose permitted in this study was 50 Units per eye; the mean XEOMIN dose was 33 Units per eye.
In Table 6 the most frequently injected sites, the median dose per injection site, and the median number (and range) of injection sites per eye are presented.
Table 6: Median Dose and Median Number of Injection Sites
per Eye (Blepharospasm)
|Injection Area
|Median Units XEOMIN
|Median Number of Injection Sites (Min-Max)
|Temporal Area
|2(1 - 6)
|Eyebrow Area
|1 (1 - 4)
|Upper Lid Area
|2(1 - 4)
|Lower Lid Area
|2 (1 - 3)
|Orbital Rim
|1 (1 - 3)
Patients were assessed during clinic visits at Weeks 3 and 6, and then by telephone or at clinic visits every two weeks up to Week 20.
The mean age of the study patients was 62 years, and 65% of the patients were women. The study was completed by 94% of study patients. Approximately one third of patients had other dystonic phenomena; in all but 1% this was limited to facial, cervical, perioral and mandibular muscles. No patients discontinued the study prematurely due to adverse events.
The primary efficacy endpoint was the change in the JRS Severity subscore from baseline to Week 6 post-injection, in the intent-to-treat (ITT) population, with missing values replaced by the patient's most recent value (i.e., last observation carried forward). In the ITT population, the difference between the XEOMIN group and the placebo group in the change of the JRS Severity subscore from baseline to Week 6 was -1.0 (95% CI -1.4; -0.5) points. Comparison of the XEOMIN group to the placebo group was statistically significant at p < 0.001.
Figure 3: Frequency Distribution of Changes from Baseline
JRS Severity Subscore at Week 6
Examination of age and gender subgroups did not identify substantial differences in response to XEOMIN among these subgroups. There were too few African-American patients to assess efficacy in that population.
Glabellar Lines
Two identically designed randomized, double-blind, multi-center, placebo controlled clinical trials (Studies GL-1 and GL-2) were conducted to evaluate XEOMIN for use in the temporary improvement of moderate to severe glabellar lines. The studies enrolled 547 healthy patients ( ≥ 18 years old) with glabellar lines of at least moderate severity at maximum frown. Three hundred sixty six subjects were treated with 20 Units of XEOMIN and 181 subjects were treated with placebo. Subjects were excluded if they had marked ptosis, deep dermal scarring, or an inability to lessen glabellar lines, even by physically spreading them apart. The mean age of study subjects was 46 years. The majority of patients were female (86% and 93% in Studies GL-1 and GL-2, respectively), and predominantly Caucasian (89% and 65% respectively). The study subjects received either 20 Units of XEOMIN or an equal amount of placebo. The total dose was delivered in 5 equally divided intramuscular injections of 4 Units each to specific sites (see Figure 1). Subjects were followed up for 120 days.
Investigators and subjects assessed efficacy at maximum frown on Day 30 of treatment using a 4-point scale (0=none, 1=mild, 2=moderate, 3=severe). Composite treatment success was defined as a 2-grade improvement on this scale compared to baseline for both the investigator's and subject's assessments on Day 30. The percentage of subjects with treatment success was greater on the XEOMIN arm than the placebo arm at Day 30 in both studies (see Table 7). The percentage of subjects with composite treatment success at each visit are presented in Figure 4.
Table 7: Treatment Success at Day 30 (at Least 2 Grades
Improvement from Baseline at Maximum Frown)
|Composite Treatment Success*
|111 (60%)
|0 (0%)
|87 (48%)
|0 (0%)
|Investigator Assessment
|141 (77%)
|0 (0%)
|129 (71%)
|0 (0%)
|Subject Assessment
|120 (65%)
|0 (0%)
|101 (55%)
|1 (1%)
|* Success on both the Investigator and Subject Assessments
Figure 4: Percentage of Subjects with Composite Treatment
Success by Visit – Observed Cases (GL-1 and GL-2)
(incobotulinumtoxinA) for Injection, for Intramuscular Use
Read this Medication Guide before you start receiving XEOMIN® and each time XEOMIN® is given to you. There may be new information. This information does not take the place of talking to your doctor about your medical condition or your treatment. You should share this information with your family members and caregivers.
What is the most important information that I should know about XEOMIN®?
XEOMIN® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems after treatment with XEOMIN®:
- Problems with swallowing, speaking, or breathing. These problems can happen hours to weeks after an injection of XEOMIN® if the muscles that you use to breathe and swallow become weak after the injection. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with XEOMIN® .
- People with certain breathing problems may need to use muscles in their neck to help them breathe. These patients may be at greater risk for serious breathing problems with XEOMIN® .
- Swallowing problems may last for several months. People who cannot swallow well may need a feeding tube to receive food and water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving XEOMIN® have the highest risk of getting these problems.
- Spread of toxin effects. In some cases, the effect of
botulinum toxin may affect areas of the body away from the injection site and
cause symptoms of a serious condition called botulism. The symptoms of botulism
- loss of strength and muscle weakness all over the body
- double vision
- blurred vision and drooping eyelids
- hoarseness or change or loss of voice
- trouble saying words clearly
- loss of bladder control
- trouble breathing
- trouble swallowing
These symptoms can happen hours to weeks after you receive an injection of XEOMIN® .
These problems could make it unsafe for you to drive a car or do other dangerous activities. See "What should I avoid while receiving XEOMIN®?"
What is XEOMIN®?
XEOMIN® is a prescription medicine that is injected into muscles and used:
- to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in adults.
- to treat abnormal spasm of the eyelids (blepharospasm) in adults who have had prior treatment with onabotulinumtoxinA (BOTOX).
- to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary).
It is not known whether XEOMIN® is safe or effective in children.
Who should not take XEOMIN®?
Do not take XEOMIN® if you:
- are allergic to XEOMIN® or any of the ingredients in XEOMIN®. See the end of this Medication Guide for a list of ingredients in XEOMIN® .
- had an allergic reaction to any other botulinum toxin products such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC), or abobotulinumtoxinA (DYSPORT®).
- have a skin infection at the planned injection site.
What should I tell my doctor before receiving XEOMIN®?
Before you take XEOMIN® tell your doctor about all your medical conditions, including if you:
- have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome). See "What is the most important information I should know about XEOMIN®?"
- have allergies to any botulinum toxin product
- have had any side effect from any other botulinum toxin in the past
- have a breathing problem, such as asthma or emphysema
- have a history of swallowing problems or inhaling food or fluid into your lungs (aspiration)
- have bleeding problems
- have drooping eyelids
- have plans to have surgery
- have had surgery on your face
- are pregnant or plan to become pregnant. It is not known if XEOMIN® can harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if XEOMIN® passes into breast milk.
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal supplements.
Using XEOMIN® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received XEOMIN® in the past.
Especially tell your doctor if you:
- have received any other botulinum toxin product in the last four months
- have received injections of botulinum toxin such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC) and abobotulinumtoxinA (DYSPORT®) in the past. Be sure your doctor knows exactly which product you received. The dose of XEOMIN® may be different from other botulinum toxin products that you have received.
- have recently received an antibiotic by injection
- take muscle relaxants
- take an allergy or cold medicine
- take a sleep medicine
- take a blood thinner medicine
Ask your doctor if you are not sure if your medicine is one that is listed above.
Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.
How will I receive XEOMIN®?
- XEOMIN® is a shot (injection) that your doctor will give you.
- XEOMIN® is injected into your affected muscles.
- Your doctor may change your dose of XEOMIN® until you and your doctor find the best dose for you.
What should I avoid while receiving XEOMIN®?
XEOMIN® may cause loss of strength or general muscle weakness, blurred vision, or drooping eyelids within hours to weeks of taking XEOMIN® . If this happens, do not drive a car, operate machinery, or do other dangerous activities. See "What is the most important information I should know about XEOMIN®?"
What are the possible side effects of XEOMIN®?
XEOMIN® can cause serious side effects. See "What is the most important information I should know about XEOMIN®?"
- XEOMIN may cause other serious side effects including allergic reactions. Symptoms of an allergic reaction to XEOMIN® may include: itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing or asthma symptoms, or if you get dizzy or faint.
The most common side effects of XEOMIN® include:
- dry mouth
- discomfort or pain at the injection site
- tiredness
- headache
- neck pain
- muscle weakness
- eye problems, including: double vision, blurred vision, drooping eyelids, swelling of your eyelids, and dry eyes. Reduced blinking can also occur. Tell your doctor or get medical help right away if you have eye pain or irritation following treatment.
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 XEOMIN® . 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 1800-FDA-1088.
General information about XEOMIN®
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. XEOMIN® should not be used for a condition for which it was not prescribed.
This Medication Guide summarizes the most important information about XEOMIN® . If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about XEOMIN® that is written for healthcare professionals.
For more information go to www.Xeomin.com or call 888-493-6646.
What are the ingredients in XEOMIN®?
Active ingredient: incobotulinumtoxinA
Inactive ingredients: human albumin and sucrose
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


text:
|Do Corrupt Governments Receive Less Foreign Aid?
Weder, Beatrice; Alesina, Alberto
Note: Order does not necessarily reflect citation order of authors.
|Alesina, Alberto, and Beatrice Weder. 2002. Do corrupt governments receive less foreign aid? American Economic Review 92(4): 1126-1137.
|Full Text & Related Files:
alesina_corruptgovernments.pdf (302.1Kb; PDF)
|Critics of foreign aid programs argue that these funds often support corrupt governments and inefficient bureaucracies. Supporters argue that foreign aid can be used to reward good governments. This paper documents that there is no evidence that less corrupt governments receive more foreign aid. On the contrary, according to some measures of corruption, more corrupt governments receive more aid. Also, we could not find any evidence that an increase in foreign aid reduces corruption. In summary, the answer to the question posed in the title is "no."
|Published Version:
|Terms of Use:
|This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
|Citable link to this page:
|Downloads of this work:
Contact administrator regarding this item (to report mistakes or request changes)

subset: commoncrawl


text:
"dotCMS has been a great partner," said John Scudder, Director of ehc. "We selected dotCMS in part due to the system's low reliance on application developers. And it proved true. We can implement and heavily customize dotCMS 1.9 without an application dev
Miami FL (PRWEB) September 22, 2010
dotCMS announced today that it is the most widely adopted WCM among US healthcare providers. The count currently stands at 126 hospital, outpatient clinic and physician practice sites, and the company expects that number to triple in the next year.
Tweet this: dotCMS most widely adopted WCM in healthcare provider market; over 125 sites up and running http://bit.ly/d4AUtg
"We have been fortunate that the healthcare provider market has so quickly adopted dotCMS," said Will Ezell, CTO of dotCMS. "Our development focus in the future is around adding revenue performance capabilities to dotCMS, giving hospital marketers and business units the tools to engage and convert prospective patients. We will be developing more capabilities within our product to focus on the needs of the healthcare provider market."
"dotCMS has been a great partner," said John Scudder, Director of ehc. "We selected dotCMS in part due to the system's low reliance on application developers. And it proved true. We can implement and heavily customize dotCMS 1.9 without an application developer. That reduces our implementation time by 1/3."
A sample listing of sites running on dotCMS:
"The speed at which the healthcare landscape changes is dizzying," commented George Abbott, Director of Internet Strategy, HealthONE. "Without the ability of our internal teams to build new sections or add dynamic functionality quickly, we could not keep pace with the market. dotCMS allows us to quickly and efficiently develop new web-based tools for our patients, physicians, and health information seekers."
For more information on the company's healthcare provider capabilities, visit http://dotcms.com/solutions/hospitals/
About dotCMS
dotCMS is an enterprise-grade, open source J2EE/Java Web Content Management System. The system allows those with moderate or no technical capability to make massive changes in a site. This allows corporations, institutions and organizations to move at a quicker pace by removing the need for application development talent within a Web Team.
Among those who run on dotCMS Enterprise Edition include Toyota, Hospital Corporation of America, Thomson Reuters, University of Texas, Aquent, State of Ohio, and the Government of Quebec.
For more information go to http://www.dotcms.com or contact Lia Sacco at lia(at)dotcms(dot)com or 786.594.5276.


text:
Cycle. Group check-in hall
The approach to training is a highly individual thing. Some people like to work on a one-on-one with the instructor, and someone who does well may not, without the team and the spirit of competition. And modern fitness offers us every opportunity. For a born "joiners" even invented a special workout at the gym – cycle.
Indoor Cycling is not only a high-intensity cardio. but still fun and social environment. Class is held on the bikes as close in design to real racing bikes. The coach sets the pace, and the whole group is riding, traveling along the mountain slopes or high-speed highway, overcoming various obstacles.
The effect of presence creates the picture on the monitor showing your move, forest trails and roads. The coach builds the lesson that the group then escapes from imaginary pursuit, chasing a world leader in Cycling, travelling through the picturesque slopes of the mountains, Continue reading
Why run the athlete-the enforcer
Running to improve health for all, or even athletes, so to speak, cross-country sports. Running for such athletes has its own characteristics and advantages. Let's consider them in more detail.
We list the beneficial effects of regular practice of athletic training.
Firstly, running is able to deal with stress and insomnia, stimulating and soothing the nervous system. In addition, during the run produced specific substances, which, acting like a drug, improve mood and give a sense of
euphoria. Also running is able to deal with pain syndromes. It is noticed that post-workout pain go away much faster after running.
Secondly, running improves the cardiovascular system . It is proved that under the influence of processes while running dilate the lumen of the vessels, which leads to normalization groooming processes, prevents the formation of stagnation of blood in the muscles and organs. Normalized pressure and train the heart muscle. In addition, Continue reading


text:
Burke HS Charleston, SC Alumni List
Last names starting with "A"
Registered Alumni
All Alumni
- Class of 1968 Anthoney Aiken
- Class of 1936 Arthur Aiken
- Michael Aiken
- Class of 2008 Tajh Aiken
- Class of 1974 Sonya Allen-Brenton
- Class of 1985 Darren Alston
- Estelle Alston
- Class of 1989 Yolonda Alston
- Class of 1990 Michael Ancrum
- Class of 1983 Angela Anderson
- Class of 2002 Ashley Anderson
- Class of 1965 Audrey Anderson
- Don Anderson
- Class of 1966 Lawrence Anderson
- Class of 1979 Naomi Anderson
- Class of 1990 Stacye Anderson
- Class of 1993 William Anderson
- Class of 1957 Florence Andrew
- Class of 1966 Andre Andrews
- Class of 1968 Wayne Andrews
- Class of 1951 Grant Anna
- Class of 1979 Brown Anthony
- Class of 2008 Sieria Archer
- Class of 1995 Steven Archie
- Class of 1969 Cynthia Armon
- Class of 1970 James Ascari
- Class of 1962 Emma Ashby
- Class of 1997 Raymond Austin
Looking for Burke High School Charleston, SC alumni not listed? If so, check out Classmates.com® - hundreds of more BHS alumni have posted their profiles.
About the Burke High School Alumni Directory
Check out all of the names of the Burke High School alumni that attended high school in Charleston that are listed above. Registering will allow you to join the directory. You can share memories of those activities that you were involved with at Burke HS and you can view other alumni and read what other former students have posted about the time they spent at Burke.


text:
Nonwoven Apparel & Patient Care
Maintaining a safe and clean environment is an essential component to the care of the hospitalized patient today. Each year 1.2 million patients are affected by HAI's resulting in 99,000 deaths. The costs to treat HAI's are growing. Environmental hygiene (cleaning) is the first line of defense in any infection prevention program.
The PerfectCLEAN® Environmental Cleaning System delivers unrivaled performance in removal and trapping of the pathogens that cause Hospital Acquired Conditions.
Other Benefits:
More information about Environmental Cleaning, and the PerfectCLEAN® products:


text:
SOURCE: Edgetech International, Inc.
October 29, 2008 07:30 ET
LAUDERDALE BY THE SEA, FL--(Marketwire - October 29, 2008) - Edgetech International, Inc.
(together with its wholly-owned subsidiary, "Edgetech" or the "Company")
(PINKSHEETS: EGIL) is pleased to announce that the Company has executed an
agreement to provide GPS-based Roadside Assistance through The PC Edge
device. In addition to this user experience enhancement on the device, this
agreement also represents a substantial revenue opportunity. The agreement
allows Edgetech International to purchase NSD services at a wholesale rate
and then resell them at retail. The revenues will be generated on a
monthly per user basis.
The PC Edge Auto Club will provide members with a low cost high value
roadside assistance program. In addition to roadside assistance, members
will receive an Ultimate Discount Package which includes automotive
discounts at Aamco, Jiffy Lube, Maaco, Meineke, and Precision Tune Auto
Care. They also will receive car rental savings through Alamo, Avis,
Budget, Thrifty, Dollar, even RV Rentals through Cruise America RV Rental
and Sales. Additional Discounts are offered on Theme Parks, such as Sea
World, Busch Gardens, Adventure Island, Sesame Place, and Water Country
USA. As well as travel discounts made available through Marathon Travel
and Cruise Shops. Membership also gives discounts at Vision Express, with
the largest selection of brand name lenses and sunglasses, including glass
permeable, Acuvu, Optima, Sureview, and Focus. Another program included in
membership is the Rx Prescription Program. This offers discounts on
prescription drugs at over 51,000 pharmacies nationwide. This program gives
significant savings through mail orders, walk-in situations, and through
"preferred pricing" program.
"The PC Edge" is the Fastest Mobile Internet Device which delivers High
Speed Internet Access, displaying full HTML web pages, graphics and java
script. "The PC Edge" offers a desktop web experience, together with a
full QWERTY keyboard, access to Office Suite of programs, 50 GB storage and
Remote PC Access.
Edgetech CEO Lev Parnas stated, "This is a prime example of our company's
focus on providing enhanced services not only on The PC Edge device, but
also impacting the other important aspects of life, such as travel, health,
and safety. Our ability to apply GPS technology to these types of
applications allows us to offer new best in industry solutions for our
customer's everyday requirements."
Product Director for National Safe Drivers John Moore stated, "NSD is
looking forward to our partnership with The PC Edge. The relationship is
an exciting one because it fits with the technology driven direction of our
company as well as today's society. The PC Edge Roadside Assistance
program will literally keep control of a negative situation at the
fingertips of the customer and turn it in to a positive one. The PC Edge
is setting the standards for cutting edge technology to integrate needed
services and engaging the customer at levels much higher than anything we
have seen so far and NSD is proud to be a part of it."
About Nation Safe Drivers:
Since 1962, Nation Safe Drivers is a leading provider of business to
business roadside assistance and concierge services nationwide. Nation Safe
Drivers provides roadside assistance benefits to over nine million families
within associations, financial institutions, insurance companies, service
contract and automotive warranty companies. In addition to roadside
assistance and motor club services Nation Safe Drivers offers upwards of 65
other "niche" products to their business partners. The company looks to
help their partners stay competitive in their various markets by developing
products and services that deliver high value and help them differentiate
themselves from the competition.
About Edgetech International:
We are an authorized distributor of "The PC Edge." "The PC Edge" is the
Fastest Mobile Internet Device which delivers High Speed Internet Access,
displaying full HTML web pages, graphics and java script. "The PC Edge"
offers a desktop web experience, together with a full QWERTY Keyboard,
Access to Office Suite of programs, 50 GB storage and Remote PC Access.
The Company's executive office facility is located at 4401 W Tradewinds
Ave, suite 201, Lauderdale by the Sea, Florida 33308. Its telephone number
is 954-772-7782 and its website address is www.thepcedge.com.
Except for historical information contained herein, the matters set forth
above may be forward-looking statements that involve certain risks and
uncertainties that could cause actual results to differ from those in the
forward-looking statements. Words such as "anticipate," "believe,"
"estimate," "expect," "intend" and similar expressions, as they relate to
the Company or its management, identify forward-looking statements. Such
forward-looking statements are based on the current beliefs of management,
as well as assumptions made by and information currently available to
management. Actual results could differ materially from those contemplated
by the forward-looking statements as a result of certain factors, including
but not limited to the level of business and consumer spending, the amount
of sales of the Company's products, the competitive environment within the
industry, the ability of the Company to continue to expand its operations,
which is dependent upon its ability to secure additional needed capital,
the level of costs incurred in connection with the Company's planned
expansion efforts, economic conditions in the industry and the financial
strength of the Company's customers and suppliers. The Company does not
undertake any obligation to update such forward-looking statements.
Contact:Sales and MarketingEdgetech International, Inc.Keith R. JonesVice President of SalesTelephone No. 954-772-7782www.thepcedge.com
Investor RelationsInvestSource, Inc.Paul SalayTelephone:714-847-2460x103
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text:
Connecting with American Indians
August 20, 2016
Internships allow students to explore their life's path
Growing up, 21-year-old Angela Sas knew she wanted a career that would let her help others. But she could not envision what it would be.
Last summer, the Johnson County Community College student volunteered at a community-run permaculture farm in Nicaragua that focuses on environmentally sound practices that are economically viable. It was a great experience, she said, but afterward she remained unsure of which major field of study she should pursue.
This summer, after spending a week in July working with young people on an Indian reservation in north central South Dakota, she sees her future more clearly.
"I realized that I had been doing a lot of public health in the past and I already had a passion for it," she said. "I just didn't know what public health was last year."
JCCC, KU Medical Center lead
Sas was one of 10 students from across the nation who took part in the AIHREA Student Summer Internship Program, led annually by Sean M. Daley, director of the Center for American Indian Studies at JCCC and Christine M. Daley, director of the Center for American Indian Community Health at the University of Kansas Medical Center.
The program gives students a chance to work on community-based research projects with American Indian communities in Kansas and throughout the Plains region. During the eight-week paid internship, the students worked on ways to encourage American Indians to stop smoking and chewing tobacco and to embrace education and healthy diets and relationships. They also learned about the Cheyenne River Sioux Reservation before visiting it.
"This was our fourth summer working up there," said Sean Daley, who also spent his sabbatical there last year. "We have a nice relationship with them," he said. "They know us and we know them."
About the reservation
The remote reservation has fewer than 10,000 residents. It has an unemployment rate of about 85 percent and a per capita income of about $7,300 a year. There is one food store and three schools. Few go to college. One in every five teenage girls on the reservation contemplate suicide; one in 10 attempts it.
Though the statistics sound grim, Sean Daley said he sees a lot of positive changes.
"The tribe is doing a lot to combat the issues up there. They are trying to get businesses to move to the reservation; over the past few years they managed to get a Subway and Dairy Queen to open. They are currently building a movie theater. They also have several programs for the youth, including a summer recreation program and Head Start."
Connecting with the young people
Dasy Resendiz, an intern on the trip, said it didn't take long to bond with the elementary and high school students. The interns incorporated basketball (it's the favorite sport on the reservation) and made up other games with prizes to get their points across.
"The kids were awesome," Resendiz said shortly after their return. "I already miss them."
Applying for next summer
The internship program began in 2010; 80 students have participated to date. Most are from Kansas and Missouri but the program draws from across the nation. This summer, one was from Boston University; another was from Arizona State University.
Also this summer, half of the interns had connections to JCCC. That was the most ever. "It's amazing to see how many of our students are out there and making a difference in people's lives," Sean Daley said.
Applications for next summer will be due in early March. If you are interested, contact Sean Daley or Christine Daley.
Above photo by Matthew Kleinmann.
The interns stopped at the Badlands National Park in South Dakota on their way to the Cheyenne River Sioux Reservation. Pictured are, back row from left: Aspen Bell (KU), Clara Martin (Boston Univ), Christina Haswood (Arizona State U), Oliver Doerr (UMKC), Jordan Shepherd (JCCC), Cate Heil (KU Medical School)Front row from left: Alexandra Knauss (JCCC), Angela Sas (recent JCCC graduate, attending Truman State this fall), Anna Carson (JCCC transfer student, going to KSU this fall), Dasy Resendiz (recent JCCC graduate, now at KU)


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Frequently Asked Questions - e-Books
Unfortunately there is no way to "recall" or queue for e-books. If demand for a title is high, a second copy may be purchased and/or the loan period may be reduced to allow greater access to the e-book.
Unfortunately there is no way to "recall" or queue for e-books. If demand for a title is high, an additional copy may be purchased and/or the loan period may be reduced to allow greater access to the e-book.
You can find help at this URL: http://site.ebrary.com/lib/anysite/download.action?null
Need additional help? Contact us!
Where is e-book development going?
McMaster is part of OCUL (Ontario Council of University Libraries), a consortium which has licensed e-book software from ebrary. Over the next several years, OCUL will be developing an integrated e-book "platform" on Scholars Portal which will provide, among other things:
- a single interface ("look and feel") for e-books from multiple publishers (including purchased and subscription e-books)
- print-on-demand e-books
e-book standards and technologies are still evolving. Stay tuned!
Could an e-book be printed on demand, either the entire book or certain chapters?
At the moment, only a portion of an e-book can be printed (different portions, depending on the publisher). In the future, OCUL (Ontario Council of University Libraries) is looking into providing print-on-demand services (for more information, see the FAQ "Where is e-book development going?")
Do we have unlimited access to our e-books? If a professor wanted to assign a particular book to say, 800 students, could they all access it simultaneously?
It depends on the e-book supplier. For example, all EBSCOhost e-books (fomerly netLibrary) limit access to one user at a time. Other vendors allow unlimited or multiple concurrent users. Please check eBooks@Mac for usage limitations (Notes column).
Can e-books be downloaded onto one's own computer and does the file remain there for an unlimited time?
Yes, and no. Some of our e-books can be downloaded, but they will only be available for a limited time. Providing unlimited downloads would mean we were distributing free copies of copyrighted e-books, which is illegal. Most of our e-books are "tethered" to the Internet and their copyright is "protected" by the publishers, using some form of "digital rights management" (DRM). The e-books Mac Libraries provide our community can be read on multiple computers by authorized McMaster users (using either your MAC ID or an on-campus staff computer to logon). This model contrasts with, for example, Amazon, which sells individual copies of e-books to customers, which can be downloaded to a handheld electronic device or to a dedicated e-book reader.
Can e-books be used on a Macintosh computer?
Yes. Publishers aim to provide e-books on standard operating systems (i.e.. PC;Macintosh) and web browsers (i..e. Internet Explorer; Firefox). If we discover problems, we contact publishers and work with them to solve technical issues.
Some e-books have this note: "View e-book for 5 minutes and/or request a loan or purchase". How does that work?
How do I get a 5 minute preview?
- click on the "Link to online resource" link
- log in with your MAC ID and you'll go to the Ebook Library page
- on the left, under "Loan Options", click the "CLICK HERE TO BROWSE" button, or the "EBL Read Online" button
How do I request a loan?
- on the left, under "Loan Options", select "Click here to request a loan."
- fill out the request form
- request your loan period: either 1 or 7 days
- for urgent requests: please note this in the comments box
- click on "Send Request"
What happens then?
- the request goes to a librarian who reviews all of the requests several times throughout the day during business hours
- when your request is approved, you will receive an email giving instant access to the e-book
What can I do during the loan period?
- you can download the book or read it online
- you can print a portion of the book (but not the entire book)
- you can copy and paste parts of the text into another document
When does the loan period start?
- it begins the first time you click on the link to the e-book in your email to 'open' the e-book
What happens when the loan period expires?
- the downloaded title will become inaccessible on your computer
- if you try to open it, you will get a message that your loan period has expired
Can I renew?
- no, but you can request another loan on the same book
How do I request another loan on the same book?
- first remove all previous instances of the book (and prior loan) from your computer:
- go to the "My Digital Editions" folder in the My Documents folder, and delete the title
- open the Adobe Reader; in the Menu bar, click on File… Digital Editions… My Digital Editions
- in the My Digital Editions pop-up window, click on the expired title, right-click the image of its cover, select Remove, and click OK
- now you can request a second loan in the same way you did the first loan
What are the restrictions on printing and copying?
- For each title, you have the following permissions:
- print = up to 20% of text
- copy/paste = up to 5% of text
- the Online Reader will tell when you have used these permissions
- Adobe Reader can also tell you about your remaining permissions: while viewing the book, click File Menu… Properties
How do loans of EBL books work?
It is important that you use the link contained in the approval e-mail to access the book. Please note that these links are very long and often run across multiple lines in the e-mail. The link should begin with http://libaccess.lib.mcmaster.ca and end with ^u. If clicking the link gives you an error message, you may need to copy and paste the link into your browser window. If you do that, and ensure that there are no spaces in the URL, and it still doesn't work, please contact our "Need Help? Just Ask!" service and report the problem, and someone will help you.
If the library only holds an e-book copy can I request the print book through RACER (Interlibrary Loan)?
Unfortunately, no. For more information on what can be requested through Interlibrary Loan, visit this page.
Who can access e-books?
- From campus, or anywhere in the world with MAC ID:
- Currently registered McMaster students
- Current & retired McMaster faculty & staff
- IAHS and Conestoga students in collaborative degree programs
- Faculty of Health Sciences appointees and affiliates, including clinical faculty
- Visitors who are in the library may request a Guest Internet Account.
When we buy e-books, do we own them?
Most we own; others we subscribe to. Here are a few examples of:
- e-books we own:
- Springer e-books (over 14,000 titles)
- Early English Books Online (EEBO)
- e-books we subscribe to:
- major reference works like the Oxford English Dictionary (OED) and Britannica - because they are constantly updated
- Canadian Public Policy Collection (new content added each year)
- freely available e-books:


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For 20 minutes Saturday, Jeff Reinland and his band of eight Walla Walla Warriors matched Chemeketa shot for shot at the Northwest Athletic Association of Community Colleges men's basketball tournament in the Toyota Center.
Walla Walla even went into the locker room with a 36-33 lead when Eric Harr sank a 3-point field goal with under a second remaining.
But the Warriors were facing Chemeketa, David Abderhalden's sophomore-laden club that made it all the way to the NWAACC title game last season before losing to Tacoma.
And when the second half began, the Storm opened with an 11-0 run that gave it the lead for good in a 78-70 first-round victory.
"We felt against their zone defense we'd become stagnant," said Abderhalden. "And we needed to become more aggressive on defense."
So they took it to the hole, and Gavin Kauffman, Jacob Begin, Trevor Phillips and Andrew Saba all contributed points in that key 11-0 run.
The first three are sophomores.
"I think the first half was just probably nerves," said the 6-foot-7 Phillips, who is a Hermiston High graduate. "It's our first game of the tournament. Once everything fell into place, we calmed down."
And Walla Walla, which lives by the 3-point shot, couldn't get the ball to fall in the second half.
"I think defensively we did a good job overall," said Reinland. "They are a team that averages 90 points a game. So we slowed them down.
"But the bottom line is we shot 6 for 29 from the 3-point line," he added. "We've got to win a game like this. The game comes down to getting the ball in the hole. It's been real hit and miss with us this season."
Walla Walla — which entered the tournament with a 13-13 record — could only hit 2 of 12 trey attempts in the second half.
"We had some open shots that just didn't go in," said Walla Walla's Case Rada, a Kamiakin High School graduate who scored a game-high 23 points. "And they made some tough shots. We had our hands in their face and they were still making them."
Phillips, with friends and family in the building cheering him on, finished with a team-high 19 points for the Storm, which has a quarterfinal rematch with Tacoma at 2 p.m. today.
"Trevor has had a great year," said Abderhalden of the South Region MVP. "He has stayed way more consistent."
Kauffman added 16 points for Chemeketa, which is aiming to return to the title game with nine sophomores from last season.
"It's real helpful having them," said Abderhalder. "They know what to expect. There is no shock when they get on this floor."
Rada added seven assists, while Richland High grad Dylan Radliff added 12 points and seven assists, and Austin Nooner had 16 points and nine rebounds.
The Warriors will play Peninsula in a loser-out contest at 10 a.m. today.
WALLA WALLA — Dylan Radliff 5-17 1-3 12, Case Rada 8-20 4-4 23, Dallas Reich 0-3 0-0 0, Eric Harr 2-7 1-2 6, Austin Nooner 7-8 2-4 16, Dahrius Mills 0-0 0-0 0, Hunter Hahn 5-10 0-0 11, Morgan Scharf 1-1 0-0 2. Totals 28-66 8-13 70.
CHEMEKETA — Anadrew Saba 2-8 0-1 6, Jacob Begin 3-3 2-2 9, Gavin Kauffman 8-16 0-0 16, Jonny Howard 2-6 1-2 5, Trevor Phillips 7-11 5-7 19, Taylor Branch 1-1 0-0 2, Calvin Molan 5-10 0-1 11, Jordan Bately 2-4 0-0 4, Justin Hutt 0-0 0-0 0, Bradley Prazeau 3-4 0-0 6, Rodney Nelson 0-2 0-0 0. Totals 33-65 8-13 78.
Halftime— WWCC 36-33. 3-point goals—WW 6-29 (Rada 3-12, Radliff 1-4, Hahn 1-5, Harr 1-5, Reich 0-3), Chem 4-19 (Saba 2-5, Begin 1-1, Molan 1-5, Nelson 0-2, Howard 0-2, Kauffman 0-3). Rebounds—WW 30 (Nooner 9), Chem 38 (Kauffman 8). Assists—WW 16 (Rada 7, Radliff 7), Chem 18 (Kauffman 5). Turnovers—WW 9, Chem 11. Fouls—WW 14, Chem 8.


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Seneca's Documentary Filmmaking Institute (DFI) gives you the skills and knowledge to produce professional documentary and non-fiction media. You'll learn from award-winning filmmakers and industry experts how to shoot, edit, direct, and produce meaningful, compelling content.
The DFI began in 2009 with its summer institute format: 15 weeks of focused training from May to August. DFI Summer continues to attract emerging filmmakers from across Canada and around the world. On the back of its success the DFI has expanded to include an 8-month graduate certificate, Documentary and Non-Fiction Media Production.
A proud sponsor of Toronto's Hot Docs Documentary Film Festival, DFI is excited to continue its growth and support the successes of its graduates.
Sun-Kyung (Sunny) Yi
Program Coordinator/Professor
Sunny Yi
416.491.5050 ext. 33617


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Graced with the Rutherford region's rich soils and temperate climate, our orchards have proven ideal for eight distinctive varietals of Italian and Spanish olive trees, each selected for their flavors, aromas, superior reputations, and compatibility with the Napa Valley's unique microclimate.
Round Pond began importing and planting its carefully selected olive trees in 1998. Today, our olive orchards span 12 acres, for a total of 2,200 trees, some over 100 years old. These estate-grown olive trees produce rich and fragrant extra virgin olive oils. Offering an array of flavors, from the Tuscan-style fruity, green essence of Leccino olives to the rich and buttery flavors of our Spanish Sevillano olives, Round Pond oils are blended to emulate the finest Italian and Spanish oils, while setting a new standard for olive oil production in North America.


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The next time you head to your favorite fishing location, bring the Shakespeare® Ugly Stik GX2 6' M Casting Rod along with you. The rod features double-built graphite and glass blank construction with medium power and an 8 mm rubber butt cap with an epoxy-coated Ugly Stik logo. The EVA handle provides a comfortable grip, while 7 guides help line to slide freely without resistance. 1-piece design.


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The United States Geospatial Intelligence Foundation (USGIF) is a dynamic and agile 501(c)(3) nonprofit educational organization with $7 million in annual revenue. USGIF is the convening authority for the multi-billion-dollar global Geospatial Intelligence (GEOINT) Community. We are seeking a motivated and energetic full-time Vice President of Programs to fill a current vacancy as part of a high-performing team at our Herndon, VA headquarters. This is a unique opportunity to be engaged in national and international security efforts at the highest levels, shaping program content to contribute meaningfully to U.S. and Allied defense, intelligence, and homeland security efforts. USGIF also leads the introduction of geospatial intelligence as a business term of art in the commercial sector. Come join USGIF as a senior leader as we: Build the Community, Advance the Tradecraft, and Accelerate Innovation for the GEOINT Community.
The Vice President of Programs plays a pivotal, high visibility role as a member of the Senior Leadership Team, leading content development for all the Foundation's events and programs. This includes the Foundation's signature annual GEOINT Symposium, which draws as many as 5,500 total attendees from more than 30 countries, delivers a diverse program related to training, education, and professional development, and showcases 300 exhibitors in over 100,000 sq. ft. of exhibit space. The VP of Programs will be integrally involved with the launch of a new, commercially-focused geospatial intelligence event: trajectoryXyzt. Additionally, the VP of Programs will manage content development for a variety of workshops tackling enduring and emergent topics of interest in the areas of intelligence, defense, and homeland security—and, increasingly, the commercial sector.
The VP of Programs will also oversee overall membership engagement, to include championing the interface with member volunteers leading critically important Working Group efforts.
Critical Duties and Responsibilities:
Work Experience
Education and Knowledge/Skills/Abilities
Additional Information
How to Apply
Please email a both a cover letter with salary requirements, and résumé to Kelly Palmer at firstname.lastname@example.com with "VP of Programs" in the subject line. The opportunity to apply for this position closes on 31 August 2018.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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Con-way Truckload has purchased 525 new tractors in a replacement cycle that it says will maintain its 2,700-tractor fleet as one of the youngest and most modern in the truckload market.
In evaluating its equipment options, the company reports it turned to its drivers to provide input and feedback on different manufacturers and models. Manufacturers were invited to stage trucks at the company's five terminals nationwide. More than 200 drivers participated in the product review and surveys, and the majority selected the Kenworth T680 model. The addition of the 2014 Navistar ProStar was based upon positive feedback from drivers on the cab comfort and interior of the fleet's existing 2013 models.
Con-way's existing fleet consisted of predominately Kenworth T660s and Navistar ProStars with other makes from Freightliner, Peterbilt, Volvo and Navistar. This purchase of 525 new tractors, 325 Kenworth T680s and 200 Navistar ProStars, will allow for the retiring of the same number of tractors approaching 500,000 miles in service, which is the typical turn-in mileage for units in Con-way Truckload's fleet.
The new units are being delivered throughout the year, with the 525th scheduled to be on the road by December.


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Design a Logo
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Major/Minor Requirements
Please note: The information displayed here is current as of Friday, August 17, 2018, but the official Course Catalog should be used for all official planning.
2017-2018 Course Catalog
Required for the biology major
- BIOL 130, 150, and 170
- At least seven six-unit courses in biology numbered 200 or above (excluding Senior Experience courses), of which at least five must be laboratory courses
- Completion of biology Senior Experience (A student-directed project, 6 units of BIOL 650, 2 units of BIOL 600)
Note: Only two six-unit courses designated as tutorial, directed study, or independent study can be counted toward the major or minor requirements and only one of those can be counted toward the upper-level laboratory requirement. On-line coursework cannot be transferred to earn biology credit.
Required for the biology minor
- BIOL 130, 150, and 170. Students majoring in disciplines requiring a research methods and statistics course may request exemption from the BIOL 170 requirement.
- At least four six-unit courses in biology numbered 200 or above, of which at least two must be laboratory courses.
- C average in the minor
Note: Only two six-unit courses designated as tutorial, directed study, or independent study can be counted toward the major or minor requirements and only one of these can be counted toward the upper-level laboratory requirement. On-line coursework cannot be transferred to earn biology credit.
Required for the interdisciplinary major in the natural sciences in biology and physics or geology
- BIOL 130, 150, and 170
- PHYS 141 and 151 or 151 and 160
- GEOL 110 and GEOL 210, if geology is the secondary discipline.
- At least 10 six-unit courses in the natural sciences (biology, chemistry, geology, and physics) numbered 200 or above, with at least five in biology (of which at least three must be laboratory courses), and at least three in the secondary discipline in other departments
- Completion of the biology Senior Experience
Note: The interdisciplinary combinations of biology and chemistry have been replaced by the biochemistry major.
Teacher certification in biology or broad-field science
Students who seek certification to teach biology at the secondary level should choose a broad range of biology courses that includes ecology, plant and animal organismal biology, and molecular and cellular biology, and should gain experience in both field and laboratory research. Students also have the option of seeking broad-field science certification by completing a minimum of two courses in each of two other science disciplines and at least one course in each of the remaining sciences. Students who plan to seek teacher certification should review the requirements in the Education section of the catalog and meet with the director of teacher education, preferably before the end of the sophomore year.
Senior Experience in Biology
Required: A student-designed project, 6 units of BIOL 650, 2 units of BIOL 600.
Purposeful advising in the spring of the sophomore year and attendance at the spring BioFest is meant to inspire sophomore students to think about what they might want to undertake as their culminating project in biology. During the fall of the junior year, students will hear from department faculty, the internship coordinator, and others about opportunities available for Senior Experience projects at a weekend retreat. Breakout groups allow students to brainstorm project ideas. Project work (research, internship, creation of a curricular module, draft of a grant proposal, draft of a children's book on biology, production of art about biology, or other creative project) generally will be undertaken prior to Term II of the senior year and may be based on an internship, summer or academic year research, a tutorial, course work, independent study, or other student activities.
Usually in the senior year, students will take two terms of BIOL 600: Recent Advances in Biology Lecture Series (1 unit each), one term of BIOL 650 (5 units) in Winter Term and one additional unit of BIOL 650 in Spring Term for BioFest. The purpose of the BIOL 650 course is to bring to culmination each student's individual Senior Experience project and to place that project in an academic context. Each student prepares a paper that places her or his project into a biological context, compares it to our past and current understanding of the topic using primary literature, and summarizes the student's project or results. Students will begin gathering and organizing academic resources for this paper in the Term I BIOL 600 course. In BIOL 650, students preparing a thesis for honors will prepare a significant portion of their thesis, while a student creating a visual product or curriculum will describe the biological underpinnings of the work and reflect on the production of the work itself, for example. The Senior Experience will culminate with a symposium, BioFest, during Spring Term, at which all students will present the results of their projects (or the project itself) as a poster, demonstration, or other visual display.


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Brewery Software Industry Partners
Brewery Insurance Program
Carefully Crafted Coverage- Insurance, Safety, HR
At the Brewery Insurance Program, they don't just sell insurance. They assist their clients by implementing safety programs, improving their Human Resources operations, and maintaining OSHA compliance. This strengthens your business, keeps claims low and ensures premiums stay cost effective at each renewal.


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The impact of healthcare reform on nurses
The passage of healthcare reform will mean many changes throughout the entirety of the industry, but what changes will come to nurses and their profession? Kevin Fickenscher, MD, identifies the following five changes that will directly impact the nursing profession in a post on the popular blog, KevinMD.com:
- Increased funding for graduate education for nurses.
- Increased funding for education for nurses who plan to work in underserved areas.
- Increased Medicare reimbursement rates for advanced practice nurses.
- Creation of a midwife pilot program that will deliver Medicare reimbursements for nurse practitioners who have created or led "medical homes."
- Increased reimbursements for school-based clinics under Medicaid.
Dr. Fickenscher also points out that the reform bill recognizes the growing importance of nurses, which will only continue to grow as the act takes effect. Regardless of which side of the issue you are on, there is no doubt that the expanding roles of nurses will continue to grow even more crucial to the healthcare industry.
How do you foresee the reform impacting your profession in the coming years?
Correction: KevinMD is written by Kevin Pho. The above article references a post that Kevin Fickenscher contributed to KevinMD. You can read more from Kevin Fickenscher at TheFickenscherFiles.com.
Career, Nurse News and Opinion
The Scrubs Staff would love to hear your ideas for stories! Please submit your articles or story ideas to us here.
By Scrubs


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