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¿Por qué elegir GibbsCAM?
GibbsCAM is a cutting-edge CAM system for programming CNC machine tools. GibbsCAM has the power and flexibility to let you make parts the way you want. With its shop-friendly interface that is easy to navigate, you'll maximize productivity. Whether CNC programmer, machinist or manufacturing engineer, the user will find familiar terminology. Icons will make sense. Processes will be logical. With GibbsCAM, CNC programming is flexible, fast, reliable, and efficient.
Mill, Drill, Turn, Burn—GibbsCAM Does it All
GibbsCAM programs any CNC milling, turning, mill-turn or wire EDM machine. From 2-axis turning and 2.5 axis milling, to 3-, 4- and 5-axis simultaneous and the most complex multi-spindle, multi-turret, multi-tasking and Swiss-style MTM machines, GibbsCAM drives them all.
Programmers Get Up to Speed Fast
The interface icons are easily understood, and the menu structure is flat, so programmers don't have to step through menu after menu to get something done. It enables quick navigation and fast programming for experienced programmers and rapid learning for new programmers.
Seamless Integration with Any CAD System
Whatever CAD format your customers, designers or engineers prefer to use, that's the format that GibbsCAM will read or open directly and accurately, so you can quickly modify part models for machinability.
Accurate, Flexible and Reliable Toolpath Creation
Reads, translates, creates, modifies and machines part features with precision. Provides multiple ways to drive cutting tools, including high-speed machining strategies, so parts can be programmed and machined your way. Saves tools and processes so you can quickly program a family of parts or react to engineering without having to reprogram the entire part.
Toolpath Verification
Toolpath simulation with collision detection, which is available at any point in the programming, shows tool motion and rendered surface finish, highlighting gouges and unwanted cuts for fast error correction.
Accurate Machine SimulationFrom the most complex multi-axis machine, to the simplest, GibbsCAM Machine Simulation can prevent costly errors at the machine, and greatly reduce on-machine prove-out.
Error-free Post Processors
Take advantage of the huge library of over 13,000 error-free post processors created and maintained by Gibbs, or have Gibbs create post processors for you, to precisely match your requirements.
Grows with You
Just buy the options you need today, and add optional functionality as you buy new machines. New capabilities integrate directly into the interface and menus your programmers already know.
Backed by Exceptional Support
Your local GibbsCAM Reseller is always there to assist you, but if for any reason their technical experts are not immediately available, GibbsCAM Technical Support has you covered.
Lowers Costs, Increases Profit
GibbsCAM was developed to be efficient for the programmer, efficient for the machinist, and efficient at the machine. With GibbsCAM you'll get more programs done faster. You'll get higher accuracy and reliability. You'll spend less time testing and proving programs. You'll get faster cycle times and more parts out the door, to keep more customers satisfied. With GibbsCAM, you have a winning solution!
Maximize Your Investment
Want to make sure you are maximizing your investment? Ensure that you gain programming capability, efficiency and a competitive edge by keeping your GibbsCAM software current with the GibbsCAM Maintenance Program.


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Secure ProcFS Entries
From Linux-VServer
The Linux-VServer project provides a mechanism to protect entries in the proc filesystem from being seen in every context, this has been introduced in development release 1.3.5 and stable release 1.23.
The system consists of three flags: admin, watch and hide. To view/set these, a recent version of the util-vserver package, containing setattr and showattr, is required. (There is another tool called vproc, but this won't be discussed here). The logic behind these flags has been changed in experimental release 0.09, and new devel / stable releases that also use this logic, are coming soon, so the old logic won't be explained here (if you're running an older version of Linux-VServer, you probably already figured it out yourself anyways).
Note: When referring to the flags, I'll follow the syntax used by the showattr tool of the util-vserver package, where a means admin, w means watch and h means hide, also lower case means disabled and upper case means enabled.
Flag logic (Linux-VServer 2.4 branch > 1.3.7 / 2.6 branch > 0.08)
The flags have the following meanings:
|always visible in context 0
|always visible in context 1
This means a mapping of flagging to visibility according to this table:
|* * h
|Visible everwhere (admin and watch flags don't matter)
|A w H
|Visible only in context 0
|a W H
|Visible only in context 1
|Visible in contexts 0 and 1
|a w H
|Totally invisible (cannot be reverted without rebooting!)
Default flagging
As of now the stable vs1.2.x (2.4 kernel defaults to all proc entries visible everywhere, stable vs2.0.x (2.6 kernel), development and experimental versions default to all proc entries only visible in context 0 and 1.
Setting flags
To set those flags you'll need the setattr tool from a recent util-vserver package (0.30.193 works), the usage is pretty much self-explanatory from the command-line help. To make the /proc/loadavg entry visible everywhere, you have to unset the hide flag:
setattr --~hide /proc/loadavg
The admin and watch flag can be in any state as hiding is controlled by the hide flag only.
To keep vservers from reading the interrupt information, you need to hide the /proc/interrupts entry. If you want this to be accessible in the admin context (0) only use:
setattr --hide --admin --~watch /proc/interrupts
With alpha util-vserver comes a tool called vprocunhide that sets reasonable flags for a number of proc entries that are generally needed to be visible. There is also an init script, normally located at /usr/local/etc/init.d/vprocunhide that you can use to include it in your boot process.

subset: commoncrawl


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GOP official who sent Obama chimpanzee email: 'I am not a racist'
April 19, 2011 | 6:45 am
An Orange County Republican Party official who sent an email that portrays
President Obama's face superimposed on a chimpanzee with the words: "Now you
know why -- No birth certificate!" apologized for her action but insisted
she's not a racist.
The comments of Marilyn Davenport, an elected member of the party's central
committee, marks a turnaround for the official, who over the weekend
described the controversy as "much to-do about nothing."
County GOP Chairman Scott Baugh has called for Davenport to resign, saying
the email was "dripping with racism and is in very poor taste."
"The California Republican Party believes the actions in question are
completely unacceptable," California Republican Party Chairman Tom Del
Beccaro added in a statement Sunday.
In an interview with the OC Weekly on Monday, Davenport said: "I wasn't wise
in sending the email out. I shouldn't have done it. I really wasn't thinking
when I did it. I had poor judgment." She added: I am not a racist, but I do
think I need to apologize again with different words."
In a statement over the weekend, Davenport had said "in no way did I even
consider the fact he's half black when I sent out the email. In fact, the
thought never entered my mind until one or two other people tried to make
this about race."


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On to Plan C
Sen. Jim Webb puts out a statement that puts the notion of a quick Senate vote out of reach and pretty much makes a certification fight moot:
In many ways the campaign in Massachusetts became a referendum not only on health care reform but also on the openness and integrity of our government process. It is vital that we restore the respect of the American people in our system of government and in our leaders. To that end, I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.
And good luck getting Lieberman to vote for cloture this week, anyway.


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Moldavite Pendant Sterling Silver Genuine MoldavitePrevious Next
Moldavite Pendant Sterling Silver 1.5 Inches 7 Grams Genuine Moldavite. The simple sterling setting shows off the beautiful moldavite specimen's raw energy.
Moldavite has long been known as a powerful sacred stone. Its rich color and beautifully etched surface make it a desirable stone for jewelry. Because of Moldavite's intense vibration, wearing it allows its energies to remain in the wearer throughout the day, strengthening its effects. Best known for its power of rapid transformation. Chakra: Heart, Third Eye, Crown
Moldavite supplied by Milan Purkart of the Czech Republic.
United States, Canada, Australia, France, Germany and Mexico.
Orders are shipped within 3-5 days. We ship by US Post Office First Class, Priority and Express Mail. Shipping cost depends on the class of service you select. First Class shipping is available for orders under 16 oz. However First Class Mail is not insured. Priority Mail is insured for non-delivery or damage. Priority Mail shows "Priority Two Day" or "Priority Three Day" mail, however, they do not guarantee that time. It is their estimate for their part of the process. Express Mail is insured for non-delivery or damage and delivery date is guaranteed, usually 1-2 days. We recommend that you choose Priority Mail shipping. We will pack and ship at the best possible Priority rate, which may include Flat Rate Shipping, and refund any shipping overages you may have incurred. At this time we ship to Canada, Australia, France, Germany and Mexico by USPS International and International Priority Mail. USPS does not offer tracking outside of the United States. We cannot be responsible for the shipment after it leaves the United States unless you have selected USPS International Priority Mail shipping which is insured.
Undamaged Items.
We want you to be satisfied, and understand that sometimes what you can see on a web site doesn't match exactly how the item appears physically. We do our utmost to photograph and describe our products accurately, but recognize that we can't always meet everyone's expectations. We do require that you notify us within 7 days of receipt, and that you have returned the item back to us in 30 days. All sales are final 30 days after receipt. If you are returning an item, once we receive it in the same condition in which it was sent, we will refund your money for the item. Mail the package to New Earth Gifts and Beads, 7821 SE Mammoth Drive, Hobe Sound, FL 33455. Be sure to include your name and address. Shipping charges for returning items are the customer's responsibility.
Damaged Items.
Please contact us immediately so that we may take the appropriate steps to issue your refund. We do apologize for any damage in shipment. We pack very carefully and take all possible precautions. However, on very rare occasions, damage does occur due to mishaps in transit. Please contact us at once if you receive an item damaged in the mail. We must be notified so that we can properly file an insurance claim. Please check all shipments immediately and keep all packing material and wrapping should an item be damaged. We require photos of the damaged items and the shipping box. Please understand we need your assistance in filing an insurance claim so that we can refund your purchase price. Note: If you selected First Class shipping for your order, the items are not insured and there is no recourse for damaged or missing items.


text:
Buy with confidence! Order samples for just $5 with free shipping.
Buy with confidence! Order samples for just $5 with free shipping.
Our Roxbury Elyptic Diamond Mosaic features natural stone in a diamond pattern. Suitable for wall, floor and wet applications. Explore similar mosaic tile designs in our Elyptic Diamond collection.
Find a local dealer or order a sample for $5. Only available within continental United States. Samples ship free.
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Our custom tile is made-to-order by hand in Phoenix, Arizona, and shipped with foam injection packaging, ensuring that your mosaic is delivered to you with the utmost integrity and care.
© 2023 Unique Design Solutions.


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Jessica & Philip
Your wedding photographs are ready!
Some information about your gallery
The gallery will remain active for as long as possible, but I guarantee it'll be up for at least 12 months. I recommend downloading your images to keep them safe in case of any website downtime.
If you'd like to order any albums there's a little more information about that below your gallery link.
Your gallery contains all the high resolution edited photographs. You have unlimited downloads of these and can use them wherever you'd like - you're also more than welcome to send the gallery to your friends and family who can also download the photos.
If you'd like to order prints, you'll be able to do that through the gallery or you're more than welcome to download the images and get them printed wherever you'd like to.
I'm a huge believer in printing photos
I love to print photos and I think your wedding day memories deserve to be printed and displayed. Albums and coffee table books are the perfect way to take your photos off your laptop and phone and have something real and tangible to enjoy!
If you're ready to order an album, simply send me an email to get started.
Coffee table books
Coffee table books have thinner pages than the luxury albums and also contain 70 photographs. These are 10x10 and can have a photo printed on the front of the hardcover with your names and wedding date.
Coffee table books are £200.
These luxury albums are hand-bound and made with thick, lay flat pages. You're able to order them in a variety of cover options including velvet and linen and a variety of colours. They hold 70 photographs and the size is 10x10.
You can also have engraving on the front - perfect for your name, date and venue!
Albums are £350.
Thank you again for having me at your wedding, I'm so grateful you chose me to be part of your day.
Thank you
I hope you love your photos and enjoying looking back over them. It was such a joy to capture your wedding and so lovely to get to know you in the run up to your wedding.
Wishing you all the happiness!


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Today I walked around Philadelphia hitting all of the historical sites I could. Yes, I visited the first AND the second Bank of the United States because that's how I roll. For lunch I stopped by Blackbird Pizzeria, a completely vegan pizza place that sits just south of the historical district on South 6th Street and Lombard. This was actually the second time I ate here (well, third because I came a few years ago when it was Gianna's Grille), but this time I had my camera. I just love the concept as well as the simple yet sufficient menu.
The first time I got a simple pepperoni and cheese slice and a mushroom slice. This time, cherry tomatoes, garlic, and tofu topped with Daiya, and a red onion and sausage slice.
All in all, not bad. I love the big slices and super thin New York style crust. The mushroom slice was a touch greasy, and I prefer the pieces with less Daiya rather than more. My only complaint is that the crust is dry. I like a pliable crust that can be folded to accommodate its thinness. Still, I love the convenience of being able to drop in and choose a variety of pizza slices and will be sure to visit one more time before I leave the city.


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Forex Pips Calculator
Units per 1 lot vary on non-forex pairs, please check with your broker
In MT4 and MT5 right click a symbol and then click Specification. The Contract Size field tells how many units are in one lot.
View image
Use our Pip Value Calculator to accurately calculate the pip value for forex pairs, indices, cryptocurrencies, and more, using live market quotes, account base currency, lot size and traded pair.
What are pips in forex?
A pip in forex means the smallest price change a currency pair can make, except for fractions of a pip or 'pipettes'.
For most currency pairs 1 pip is 0.0001; for currency pairs with the Japanese Yen, such as USD/JPY, 1 pip is 0.01. When trading metals, 1 pip for Gold and Silver is 0.01.
When the EUR/USD moves up from 1.0925 to 1.0926, the change is 1 pip. With 5-digit pricing, if the EUR/USD moves up from 1.09255 to 1.09260, the move would be half a pip.
How to use this pip calculator
Instrument: Traders can select from major forex crosses, minors, exotics, the most popular cryptocurrencies (such as ADA, BTC, ETH, LTC and XRP) and several commodities, including Gold, Silver and Oil. Let's choose for our example the EUR/USD.
Trade size: Forex pairs are 100,000 units per 1 lot, but units per 1 lot vary on non-forex pairs. In this field there's also the option of calculating the pip value based on the lots traded, or, the units traded. Let's choose, for our example, a trading size lot of 10,000 currency units (0.10 mini-lot).
Deposit currency: Pip values are different for each FX pair and for each cryptocurrency cross. Pip values are also subject to the current market/exchange quotes. Selecting an account currency in this field will enable an accurate calculation of the pip value, for the selected instrument, in a trader's account base currency (from AUD to ZAR). We choose EUR as our deposit currency.
Now, we hit the "Calculate" button.
The results: The pip calculator uses a market price live feed with the current interbank rate (in a 5-digit format) and it will display the current pip value based on the selected account base currency (in our example, the EUR).
So, the pip value for a 0.10 lot of EUR/USD, with a market rate of 1.21580, on a EUR trading account, is currently €0.8225.
Traders should note that for trading accounts in other base currencies, such as GBP or AUD, pip values can vary, depending on the current market rate for the GBP/USD, or AUD/USD, for example. The following conversion formula is applied to calculate the pip value in other currencies:
The result would be:
Add this pip calculator to your website
Our tools and calculators are developed and built to help the trading community to better understand the particulars that can affect their account balance and to help them on their overall trading.
Regardless if investors trade the Forex market, cryptocurrencies or any other financial instruments, our complete suite of accurate Forex tools and calculators are programmed to work with any data inputted.
If you're a webmaster and consider that these calculators can create added value for your website on a "Tools/Calculators" section, you are free to embed them on your website.
The embedding widget can be used as it is or it can be fully configured to match your website's colours. When you are happy with the settings, simply copy/paste the final code to embed the tool/calculator widget on your page.


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some of you have been having with it- I am leaving my comments moderated though
which means they won't show up right away- but they will show up when I get them.
We are planning a bloggers meet up at The Vintage Bricoleur
in the Roseville area next week~we are talking about blogging
and more!!
Would love to see you there!
The Vintage Bricoleur


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It's a pleasure having you on board Jeff. Congratulations on publishing the book!
"After all, Will Chin was going to be my new editor-in-boss here at WiseBread. Don't want to get off on the wrong foot with the Boss Man. Particularly since I was calling Will to reconfirm that he wouldn't be editing my posts..."
Ha, like I'm going to fall for that one! As a great philosopher once said.
Will CHEN


text: As an Amazon Associate and Affiliate Marketer, I earn from qualifying purchases. If you click a product affiliate link on Delicious Table and make a purchase, I may receive a commission at no additional cost to you, ever! I own every cooking product I recommend and love how they perform. Happy Cooking! Lisa XO


text:
Category: Business (Internet/Marketing), Business (Small Business),
Owner: Abbey
Description: Living My Moment is a great new resource for all MoMs. We provide MoMs that own small business free advertising space so they can gain additional exposure for their company.
We wanted to make the service free because we know that the economy is rough for everyone right now and small business owners sometimes get hit the hardest. Our blog site focuses on things that we feel are important to MoMs, written with a humorous twist on life. There is also a MoMresource of the day (or tip of the day), MoMbiz Specials for our MoM businesses, MoMfeature (where we feature one MoMbiz a week) and new to our site is MoMgiveaways.
If you are a MoM and/or a MoM with a business or blog and would like free advertising or resources, please come visit us at LivingMyMoment.com.
Blog URL:
Feed URL:
Visit: Living My MoMent
Tech Tags: mompreneurs, free advertising, mom owned businesses, small business, women, women's blogs, blog promotion, Living My MoMent, Blogging Women


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This cute pocket oscilloscope is a perfect companion to your tool box. For beginners, its a good starter scope - it is not as complicated as a benchtop scope so its easy to use. For advanced EE's, its useful as a scope-on-the-go, for field-debugging, when you don't want to drag your scope over, or when a floating-ground is needed (it will naturally do 'differential' measurements as long as its not plugged into a computer USB port). It's not a terribly fast scope, best used for signals up to 100KHz, and it is only a single channel, but we still find uses for it all the time, especially with analog projects! The new version 3.0 has a nice fully-metal case for increased durability
- Portable and lightweight, only 76 grams and 95mm x 62mm x 13mm
- 2.8" 320x240 Color TFT display
- Built in Lithium polymer battery, USB rechargeable
- Waveform storage and playback to built in 2 MB flash memory. This model no longer has a microSD card slot, but it does have built in memory instead so no SD card needed!
- 6 triggering modes
- 1 channel input, 200Khz Analog Bandwidth, 1 Mega-sample-per-second. Best for use on signals from DC to 100 KHz
- Complete measurement markers and signal characteristic
- Built-in Signal Generator
- Comes complete with: 2 types of probes, one with hooks, one for plugging into a PCB, screwdriver, carrying bag, stand
- DSO Nano manual
Please note! The case is metal, so do not use the DSO on high voltages above earth ground! Also, while plugged into a USB port, the ground probe and case will be connected to Earth ground through the PC so do not connect the ground probe to a voltage above Earth ground.
Technical Details
- Display: Full Color 2.8" TFT LCD 65K 320×240
- Analog bandwidth: 0 - 200KHz
- Max sample rate: 1Msps 12Bits
- Sample memory depth: 4096 Point
- Horizontal sensitivity: adjustable with indicator
- Vertical sensitivity: 10mV/Div~10V/Div (with ×1 probe)/ 0.5V/Div~100V/Div (with ×10 probe)
- Vertical position: adjustable with indicator
- Input impedance: >500KΩ
- Max input voltage: 80Vpp (by ×1 probe)
- Coupling: DCs
- Trig modes: Auto, Normal, Single, None, Scan and Fit; Rising/Falling edge/level trigger; Trig level adjustable with indicator; Trig sensitivity adjustable with indicator.
- Waveform Functions: Auto measurement: frequency, cycle time, duty cycle, peak voltage, RMS voltage, Average voltage and DC voltage; Precise vertical/horizontal measurement with markers; Hold/Run.
- Signal Generator: 10Hz~1MHz square wave
- Waveform storage: 2MB FLASH internal
- PC connection via USB: as SD card reader
- Upgrade: USB
- Power supply: 500mAh 3.7V Lithium battery/ USB
- Dimension (w/o probe) 91mm*62mm*13mm
DSO Nano manual
Source code (firmware) and schematic
Many users suggest updating the firmware, check this forum for details!


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Website Detail Page
written by Taha Mzoughi
A page linking to sixteen YouTube and Google Flash videos dealing with sound. Information on how to download and convert the videos is also provided.
Please note that this resource requires Flash.
ComPADRE is beta testing Citation Styles!
Record Link
Mzoughi, Taha. YouTube Videos of Sound Phenomena. July 31, 2008.
AIP Format
T. Mzoughi, (2007), WWW Document, (http://alo.academy/TIPS/youtube-sound.shtm).
T. Mzoughi, YouTube Videos of Sound Phenomena (2007), <http://alo.academy/TIPS/youtube-sound.shtm>.
APA Format
Mzoughi, T. (2008, July 31). YouTube Videos of Sound Phenomena. Retrieved September 29, 2023, from http://alo.academy/TIPS/youtube-sound.shtm
Chicago Format
Mzoughi, Taha. YouTube Videos of Sound Phenomena. July 31, 2008. http://alo.academy/TIPS/youtube-sound.shtm (accessed 29 September 2023).
MLA Format
Mzoughi, Taha. YouTube Videos of Sound Phenomena. 2007. 31 July 2008. 29 Sep. 2023 <http://alo.academy/TIPS/youtube-sound.shtm>.
BibTeX Export Format
@misc{ Author = "Taha Mzoughi", Title = {YouTube Videos of Sound Phenomena}, Volume = {2023}, Number = {29 September 2023}, Month = {July 31, 2008}, Year = {2007} }
Refer Export Format
%A Taha Mzoughi %T YouTube Videos of Sound Phenomena %D July 31, 2008 %U http://alo.academy/TIPS/youtube-sound.shtm %O application/flash
EndNote Export Format
%0 Electronic Source %A Mzoughi, Taha %D July 31, 2008 %T YouTube Videos of Sound Phenomena %V 2023 %N 29 September 2023 %8 July 31, 2008 %9 application/flash %U http://alo.academy/TIPS/youtube-sound.shtm
Disclaimer: ComPADRE offers citation styles as a guide only. We cannot offer interpretations about citations as this is an automated procedure. Please refer to the style manuals in the Citation Source Information area for clarifications.
Citation Source Information
The AIP Style presented is based on information from the AIP Style Manual.
The APA Style presented is based on information from APA Style.org: Electronic References.
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text:
Flowchart of participants from study recruitment through screening, randomization, and follow-up. SR indicates sustained release.
Study timeline including all study visits for both assessment as well as treatment. *Counseling session. †All treatments were administered through week 8 except for the lozenge, which was continued until week 12.
Survival curves for latency to relapse, or the number of days until the participants smoked on 7 consecutive days following the target quit day for the 6 treatment conditions.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Piper ME, Smith SS, Schlam TR, et al. A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253–1262. doi:10.1001/archgenpsychiatry.2009.142
© 2023
Little direct evidence exists on the relative efficacies of different smoking cessation pharmacotherapies, yet such evidence is needed to make informed decisions about their clinical use.
To assess the relative efficacies of 5 smoking cessation pharmacotherapy interventions using placebo-controlled, head-to-head comparisons.
A randomized, double-blind, placebo-controlled clinical trial.
Two urban research sites.
One thousand five hundred four adults who smoked at least 10 cigarettes per day during the past 6 months and reported being motivated to quit smoking. Participants were excluded if they reported using any form of tobacco other than cigarettes; current use of bupropion; having a current psychosis or schizophrenia diagnosis; or having medical contraindications for any of the study medications.
Participants were randomized to 1 of 6 treatment conditions: nicotine lozenge, nicotine patch, sustained-release bupropion, nicotine patch plus nicotine lozenge, bupropion plus nicotine lozenge, or placebo. In addition, all participants received 6 individual counseling sessions.
Main Outcome Measures
Biochemically confirmed 7-day point-prevalence abstinence assessed at 1 week after the quit date (postquit), end of treatment (8 weeks postquit), and 6 months postquit. Other outcomes were initial cessation, number of days to lapse, number of days to relapse, and latency to relapse after the first lapse.
All pharmacotherapies differed from placebo when examined without protection for multiple comparisons (odds ratios, 1.63-2.34). With such protection, only the nicotine patch plus nicotine lozenge (odds ratio, 2.34, P < .001) produced significantly higher abstinence rates at 6-month postquit than did placebo.
While the nicotine lozenge, bupropion, and bupropion plus lozenge produced effects that were comparable with those reported in previous research, the nicotine patch plus lozenge produced the greatest benefit relative to placebo for smoking cessation.
Many smokers have successfully quit using a variety of smoking cessation pharmacotherapies, yet there is little direct evidence on the relative efficacies of these different pharmacotherapies. Without such evidence clinicians and smokers lack a strong empirical basis for recommending or selecting among them. We report data on the efficacies of 5 different smoking cessation pharmacotherapies. This research also evaluates the efficacy of the nicotine lozenge, providing additional information on a treatment that has been supported by only 1 placebo-controlled study published to date. Finally, this research evaluates 2 different medication combinations, one of which (ie, the nicotine patch plus nicotine lozenge) has not been previously evaluated.
There is a great deal of evidence that smoking cessation medications increase the success of attempts to quit smoking.1-4 The 2008 Update to the Public Health Service (PHS) Treating Tobacco Use and Dependence Clinical Practice Guideline found that 5 nicotine replacement therapies (NRTs) and 2 non–nicotine replacement first-line pharmacotherapies (sustained-release bupropion [bupropion SR] and varenicline) reliably increase abstinence rates relative to a placebo control.1 However, less is known about the relative efficacies of these medications. This limitation is due, in part, to a lack of clinical trials that provide head-to-head comparisons of different pharmacotherapies within the same study. Cessation studies of individual medications differ in myriad respects, which makes it difficult to gauge effectiveness across treatments, even when the individual studies contain a placebo control for the medication. Meta-analyses that attempt to account for interstudy differences may yield conclusions that conflict markedly with large-scale head-to-head trials.5 Without evidence based on head-to-head comparisons, clinicians and smokers lack a strong empirical basis for recommending or selecting from the available smoking cessation medications. Finally, the small number of studies offering head-to-head comparisons yield some conflicting evidence.6,7
Five pharmacotherapies were selected for comparison in this placebo-controlled trial: nicotine lozenge, nicotine patch, bupropion, nicotine patch plus nicotine lozenge, and bupropion plus nicotine lozenge.1 These therapies were selected for several reasons. The nicotine lozenge was selected because there was limited evidence regarding its efficacy. The 2008 PHS Guideline Update identified only 1 randomized placebo-controlled trial that evaluated the lozenge and thus gave the lozenge a B-level strength-of-evidence rating. The single placebo-controlled trial on the lozenge suggests that it is both acceptable to smokers and highly efficacious.8
The nicotine patch was included in this study because it is the most commonly used pharmacotherapy for smoking cessation.6,9,10 Given that so many smokers use the nicotine patch, it is important to determine the efficacy of other agents relative to the patch. Finally, it is important to examine the efficacy of the patch because recent data suggest that patch efficacy may have declined over the past 5 to 10 years.11-13
Bupropion SR was selected because there is modest evidence that it may be more efficacious than the nicotine patch.11,14 Also, bupropion has never been directly compared with the nicotine lozenge. Finally, smokers could be encouraged to seek out this prescribed agent, and insurers and health care systems could be encouraged to make this treatment more widely available, if it could be demonstrated that bupropion is more efficacious than over-the-counter medication (eg, the nicotine patch or lozenge).
In addition to the 3 monotherapies, we tested 2 combination therapies. Research has generally supported the efficacy of NRT combinations. The 2008 PHS Guideline identified long-term (>14 weeks) nicotine patch use paired with either nicotine gum or nicotine nasal spray as efficacious relative to placebo and relative to the nicotine patch alone.1 A recent Cochrane meta-analysis also found that the nicotine patch plus fast-acting NRT was more effective than monotherapy.2 Combination NRT could be superior to monotherapy for several reasons. For instance, the use of 2 NRTs might produce more adequate nicotine replacement (ie, higher blood nicotine levels15) than a single NRT, though high-dose nicotine patches have not been shown to produce higher abstinence rates than standard-dose patches on a consistent basis.1,2 Another possibility is that each type of agent works through a different mechanism, so that having 2 types produces additive effects. The patch, for instance, produces a steady supply of nicotine to prevent severe nicotine withdrawal, and ad libitum NRTs (gum and lozenges) provide a means for coping with situational challenges and transient urges to smoke.15,16
The combination of bupropion and the nicotine lozenge was also examined because of promising initial results with the nicotine lozenge as a monotherapy.17 Also, the combination of the nicotine patch with bupropion was found to be highly efficacious in the 2008 PHS Guideline meta-analysis (odds ratio [OR], 2.5).1 It is possible that an NRT that permits ad libitum dosing would produce even better outcomes.
The current research evaluated the 5 pharmacotherapy interventions on a range of outcome indices, including 6-month 7-day point-prevalence quit rate, a traditional standard for assessing efficacy of smoking cessation interventions.1 This research also determined whether the medications were efficacious in helping a smoker achieve early success (ie, being able to quit for a week following the quit date) or any success at all (ie, being able to establish abstinence for at least 1 day during the first week of a quit attempt). In addition, outcomes assessed whether different medications increased the time to first lapse (the first cigarette smoked after quitting) or the time to relapse (smoking on 7 consecutive days following the quit day) or prevented a lapse from becoming a relapse. These different outcomes may help researchers understand the mechanisms of action of different medications and may be helpful in cessation counseling. For instance, if a medication reduces the transition of a lapse to a relapse,18 smokers could be urged to continue medication use despite lapsing.
In sum, this research attempted to gauge the relative efficacies of widely available smoking cessation medications. The results were intended to permit more informed decisions about the selection and use of smoking cessation pharmacotherapies as a means of enhancing treatment effectiveness.
Participants were 1504 smokers (58% female, 83% white) who agreed to participate in a 3-year smoking cessation (year 1) and health outcomes (years 2 and 3) study conducted in Madison and Milwaukee, Wisconsin (principal investigator, T.B.B.). Adult smokers were recruited via television, radio, and newspaper advertisements; flyers; earned media, including press conferences; and television and radio news interviews from January 2005 to June 2007. Inclusion criteria included smoking more than 9 cigarettes per day on average for at least the past 6 months, having an alveolar carbon monoxide level greater than 9 ppm, and being motivated to quit smoking. Exclusion criteria included using any form of tobacco other than cigarettes, currently taking bupropion, or having a current psychosis or schizophrenia diagnosis. In addition, participants were excluded if they had medical contraindications for any of the study medications, including high alcohol consumption (6 drinks per day on 6 or 7 days of the week), a history of seizure, high blood pressure (>160/100 mm Hg), bipolar disorder, an eating disorder, a recent cardiac event, or allergies to any of the medications. Only 1 person per household could participate. Finally, pregnant or breastfeeding women were not eligible for participation; eligible female participants had to agree to take steps to prevent pregnancy during the medication treatment phase of the study. All participants provided written informed consent and the study was approved by the University of Wisconsin Health Sciences institutional review board.
Interested smokers telephoned a central research office and completed a telephone screen to determine eligibility. Participants who passed the telephone screen were invited to an informational session where they provided written informed consent. Next, participants completed 3 in-person baseline sessions. During the first baseline session, participants underwent further screening, including collection of relevant medical history information, vital signs measurement, and a carbon monoxide breath test. Additionally, at this visit, participants completed several demographic, smoking history, and tobacco dependence questionnaires.
After additional medical assessments at 2 more baseline sessions (eg, brachial artery reactivity, carotid intima media thickness, and small-particle lipoprotein testing), participants were randomized to 1 of 6 treatment conditions: (1) bupropion SR (150 mg twice daily for 9 weeks total: 1 week prequit and 8 weeks postquit [prequit and postquit refer, respectively, to the periods prior to and following a patient's targeted quit date]); (2) nicotine lozenge (2 or 4 mg based on appropriate dose-for-dependence level per package instructions for 12 weeks postquit); (3) nicotine patch (24-hour patch; 21, 14, and 7 mg; titrated down during 8 weeks postquit); (4) nicotine patch (24-hour patch; 21, 14, and 7 mg; titrated down during 8 weeks postquit) plus nicotine lozenge (2 or 4 mg based on appropriate dose-for-dependence level per package instructions for 12 weeks postquit) combination therapy; (5) bupropion SR (150 mg twice daily for 9 weeks total: 1 week prequit and 8 weeks postquit) plus nicotine lozenge (2 or 4 mg based on appropriate dose-for-dependence level per package instructions for 12 weeks postquit) combination therapy; or (6) placebo. There were 5 distinct placebo conditions, matched to each of the active treatment conditions (ie, placebo bupropion, placebo lozenge, placebo patch, placebo patch plus lozenge, and placebo bupropion plus lozenge) (Figure 1). Participants received study medication at each visit and returned any unused medication at the following visit. Randomization was double-blind and used a blocked randomization scheme with sex and self-reported race (white/nonwhite) as the blocking variables. Staff did not know to which type(s) of medication (ie, patch, pill, and/or lozenge) a participant would be assigned until the moment of randomization, and study staff were blinded to whether the medication was active or placebo. In addition to pharmacotherapy, all participants received 6 one-on-one counseling sessions based on the PHS Guideline.1 Study staff who provided counseling and conducted study sessions were bachelor-level, trained case managers supervised by a licensed clinical psychologist. Sessions lasted 10 to 20 minutes and occurred during 7 weeks with the first 2 counseling sessions occurring prior to quitting and the subsequent 5 occurring on the quit date or thereafter (Figure 2). The last baseline visit, when randomization occurred and medication was dispensed, took place between 8 and 15 days prequit to ensure the bupropion up-titration schedule could be completed. Participants were instructed to start taking medications on the designated quit date, except for bupropion SR, which they were instructed to begin taking 1 week prior to the quit date as per the package insert instructions. Participants had study visits on their quit day and at 1, 2, 4, and 8 weeks postquit. At study visits, vital signs, adverse events, and smoking status were all recorded.
Baseline questionnaires assessed demographics, smoking history, and nicotine dependence. The demographics questionnaire measured characteristics such as sex, race (smokers were asked which race they most strongly identified with), Latino ethnicity (ie, reporting ≥1 parent of Latino origin), income, education level, and age. A smoking history questionnaire provided information about smoking behavior, smoking restrictions at home and work, self-efficacy to quit smoking, spouse smoking patterns, and motivation to quit smoking. Nicotine dependence questionnaires included the Fagerstrom Test of Nicotine Dependence,19 the Nicotine Dependence Syndrome Scale,20 the Tobacco Dependence Screener,21 and the Wisconsin Inventory of Smoking Dependence Motives.22
Smoking status was assessed both as 7-day point-prevalence abstinence ("Have you smoked at all, even a puff, in the last 7 days?") and continuous abstinence (smoking at all since the target quit day), using a smoking calendar and the timeline follow-back method.23,24 All participants' self-reports of smoking status during study visits were confirmed by an expired carbon monoxide level of less than 10 ppm measured using a Micro-3 Smokerlyzer (Bedfont Scientific, Williamsburg, Virginia).
All analyses were conducted using SPSS 15.0 software (SPSS Inc, Chicago, Illinois). After verifying that all treatment groups were similar across demographic and tobacco-related variables, we evaluated treatment effects on multiple outcome variables, including (1) carbon monoxide–confirmed 7-day point-prevalence abstinence at 1 week postquit, end of treatment (8 weeks postquit), and 6 months postquit; (2) number of days to lapse (latency to smoke a first cigarette after the target quit day); (3) number of days to relapse (latency to smoke on 7 consecutive days after the target quit day); (4) latency to relapse after the first lapse; and (5) initial cessation (whether the participant went ≥1 day without smoking in the first week postquit; due to missing data, n = 1424 for this outcome). Logistic regression was used for dichotomous outcomes (eg, 7-day point-prevalence abstinence), while Cox regression was used for continuous outcomes (eg, latency to lapse).
We conducted 11 comparisons for each outcome, which constituted a family of analyses that compared each active treatment with placebo (5 comparisons), each monotherapy with the other (3 comparisons), the 2 combination therapies with each other (2 comparisons), and a composite of the monotherapies with the bupropion plus lozenge combination and the patch plus lozenge combination (2 comparisons). To control for the familywise error when conducting multiple tests, we used a Bonferroni-corrected P value (P = .0045) for the 11 comparisons for an overall α = .05 (all tests 2-sided). We report both adjusted as well as unadjusted P values. All analyses were conducted using the intent-to-treat principle such that all smokers who were randomized to a treatment were included in the analyses and individuals with missing data were considered to be smoking. Analyses were also conducted controlling for race (white vs nonwhite), sex, and site. This study had an a priori power of 0.88 to detect a clinically significant improvement in abstinence rates of 12% at 6 months posttreatment (eg, 12% vs 24%), with no correction for multiple comparisons (α = .05) and a power of 0.60 for the Bonferroni-corrected α = .005. To detect an improvement in abstinence rates of 15% (eg, 12% vs 27%), this study had an a priori power of 0.97 for α = .05 and a power of 0.84 for α = .005.
Table 1 provides demographics and smoking history data for the 1504 adult smokers who were randomized in this double-blind placebo-controlled smoking cessation study. There were no statistically significant differences between the active and placebo treatment groups by age, cigarettes smoked per day, Fagerstrom Test of Nicotine Dependence score, baseline carbon dioxide level, sex, marital status, race, Latino origin, or education. Figure 1 presents the study's CONSORT data.
There were no statistically significant differences among the placebo conditions in 7-day point-prevalence outcomes at 1 week, end of treatment, or 6 months postquit. Therefore, for all subsequent analyses, the placebo conditions were combined into a unified placebo condition.
There was a significant main effect for study site, such that, relative to Madison, Milwaukee had significantly lower 7-day point-prevalence abstinence rates at all 3 follow-up points. However, there were no treatment by site interactions, and analyses that controlled for site produced results similar to those in the uncontrolled analyses.
Comparing all 5 active treatments with the placebo group in 7-day point-prevalence analyses and using an uncorrected P = .05, logistic regression analysis indicated that all active treatments produced higher rates of initial cessation and higher 7-day point-prevalence abstinence rates at 1 week, end of treatment, and 6 months postquit (with the exception of the lozenge at 1 week) relative to placebo (Table 2 and Table 3). The ORs at 6 months postquit were 1.63 for bupropion, 1.76 for lozenges, 1.83 for the patch, 1.74 for bupropion plus lozenge, and 2.34 for patch plus lozenge. With corrected P = .0045, only the patch and the 2 combination therapies were efficacious at 1 week and the end of treatment, and only the patch plus lozenge condition was efficacious at 6 months postquit (Table 2 and Table 3). Using the corrected P values, all treatments, except the lozenge, significantly increased the rates of initial cessation (not smoking for at least 1 day in the first week postquit). The same effects were obtained when logistic regression analyses controlled for race, sex, and site.
Survival analyses (Cox regression) revealed that relative to placebo all active treatments significantly increased the number of days to relapse using both the unadjusted (P < .05) as well as the Bonferroni-corrected P value (P ≤ .001). Only the 2 combination conditions significantly increased the number of days to lapse relative to placebo when using the Bonferroni-corrected P value (P < .001). Figure 3 illustrates the survival curves for latency to relapse. The survival curves for latency to lapse and for latency to relapse following a lapse were similar to the survival curves for latency to relapse. All active treatments increased the latency to relapse following the first lapse (P ≤ .003) with the exception of the lozenge (Wald = 6.39, P = .01, OR, 0.73; 95% confidence interval [CI], 0.75-0.93). The same effects were obtained when analyses controlled for race, sex, and site.
The bupropion plus lozenge condition and the patch plus lozenge condition were both compared with a composite monotherapy condition to determine whether either of the combination conditions was superior to monotherapy. Results of logistic regression analyses revealed that, relative to the monotherapies, the patch plus lozenge treatment produced significantly higher initial cessation rates and end of treatment abstinence rates (Table 3), using the Bonferroni-corrected P value. There were no other differences between the combination conditions and the composite monotherapy condition. The results were similar after controlling for race, sex, and site. It should be noted that there were no significant differences either between the 2 combination conditions or among the monotherapy conditions at any of the time points using the Bonferroni-corrected P value.
With respect to the latency outcome variables, Cox regression analyses revealed that patch plus lozenge users had a greater latency to lapse, relative to the composite monotherapy condition (Wald = 7.31; P = .007; OR, 0.80; 95% CI, 0.78-0.94); a similar effect was found for number of days to relapse (Wald = 5.45; P = .02; OR, 0.79; 95% CI, 0.64-0.96). These differences were not significant with the Bonferroni correction (P < .005). Even without the Bonferroni correction, there were no differences among the combination and monotherapy groups in latency to relapse after smoking the first cigarette (ie, after lapsing). The same effects were obtained when analyses controlled for race, sex, and site.
At each visit, participants were given additional medication and asked to return any that was unused. We computed the percentage of medication each participant used by subtracting the amount of medication the participant returned from the amount of medication given to the participant and then dividing that by the total amount of medication given to the participant. On average, participants used approximately 77% of the medication given during the course of the study (placebo, 75%; patch, 86%; bupropion, 85%; lozenge, 67%; bupropion plus lozenge, 77%; and patch plus lozenge, 74%). A 1-way analysis of variance revealed significant differences in the amount of medication used by treatment condition (F5,1187 = 17.64, P < .001). Post hoc Tukey tests revealed that individuals in the lozenge condition used significantly less medication (67% of the medication given) than individuals in any of the other treatment conditions (P = .03 to <.001).
The most common adverse events varied by treatment group but were consistent with previous research. In the placebo condition, the most common adverse events were headaches, skin irritation in the patch condition, sleep disturbances/abnormal dreams in the bupropion condition, nausea in the lozenge condition, sleep disturbances/abnormal dreams in the bupropion plus lozenge condition, and both sleep disturbances/abnormal dreams and skin irritation in the patch plus lozenge condition (Table 4). Participants in the combination conditions (patch plus lozenge and bupropion plus lozenge) reported more adverse events than those in either the monotherapy or placebo groups. There were 32 serious adverse events during the 6-month period following the target quit day (eg, hospitalization for pneumonia or due to falling), but only 1 serious adverse event, hospitalization for seizures, was possibly related to study medication. Seizures are an identified potential adverse effect of bupropion, which the participant was taking at the time of the seizure. Four people (0.27%) withdrew from the study owing to events related to medication: 1 in the bupropion group because it interacted with other antidepressants and the participant's physician requested that the participant withdraw, 1 in the bupropion group because of heartburn, 1 because of a "negative experience" while taking placebo medication, and 1 in the bupropion plus lozenge condition owing to hospitalization for seizures.
A principal goal of this research was to identify particularly efficacious smoking cessation pharmacotherapy interventions among the 5 different treatments tested in a head-to-head comparison. The nicotine patch plus lozenge combination emerged as the treatment with the strongest support. Its OR at 6 months postquit was 2.34, while the next highest OR was 1.83 (for the nicotine patch). The nicotine patch plus lozenge combination emerged as the only efficacious treatment (after Bonferroni correction for multiple tests) relative to placebo at 6 months postquit. In addition, relative to a monotherapy composite, the patch plus lozenge condition produced higher initial cessation rates and end-of-treatment 7-day point-prevalence rates using the Bonferroni-corrected α level. The patch plus lozenge combination also tended to produce more positive outcomes than any other condition, active or placebo, on measures such as days to lapse and days to relapse (Figure 3); these differences did not exceed protection levels for multiple comparisons, however. These effects are consistent with previous research showing that the patch plus ad libitum NRT increases the time to relapse.25 Finally, while there was substantial evidence that the patch plus lozenge combination was highly efficacious relative to the placebo condition, it is important to note that its 6-month outcome did not differ significantly from the other active cessation treatments in head-to-head comparisons.
While the patch plus lozenge combination was notably efficacious relative to placebo, the other pharmacotherapies were also significantly effective if tested using unadjusted P values (Table 3). These pharmacotherapies, with ORs ranging from 1.63 to 1.83, would have been found to be efficacious relative to placebo had they been tested in a typical randomized clinical trial involving only a single active treatment and a placebo control. Thus, the current results suggest that there was a relatively strong effect of the patch plus lozenge vs placebo, rather than unusually weak effects of the other interventions. This pattern of findings should be evaluated in light of the relatively high abstinence rates that occurred in the placebo condition. At 6 months postquit, participants in the placebo group achieved a 22.2% abstinence rate. This abstinence rate is larger than many 6-month abstinence rates in active treatment conditions in other studies.7,11 The success of placebo may have been due to the intensive counseling participants received (6 sessions, totaling more than 60 minutes of counseling)26 or to the high level of motivation required to participate in a 3-year longitudinal trial.
During treatment, the patch, bupropion plus lozenge, and patch plus lozenge conditions were all significantly more efficacious than placebo with the familywise error correction. However, after treatment was discontinued, by 6 months postquit only the patch plus lozenge remained efficacious. These findings agree with the 2008 Guideline Update meta-analyses that showed that the combination of long-term patch plus gum or spray had the highest OR for efficacy (6-month abstinence) of any of the evaluated pharmacotherapies (monotherapies and combination therapies) when tested against a placebo control condition (OR, 3.6).1 These findings suggest that long-term pharmacotherapy (>14 weeks), particularly with the nicotine patch, may be important given that the effects of bupropion plus lozenge diminished significantly once participants stopped using them at the end of treatment. Future research should examine relapse dynamics following the discontinuation of treatment; it would be important to know if treatment discontinuation was more consequential for some pharmacotherapies than for others.27,28 Future research should also address the promising issue of using pharmacotherapy prior to the quit attempt.1,2
One of the outcomes assessed in this research was whether pharmacotherapy treatment could help people achieve at least 1 day of abstinence (initial cessation). The ability to achieve initial abstinence is not only a stepping stone to successful quitting, but research suggests that duration of abstinence in prior quit attempts enhances success in subsequent attempts.29-31 In this regard, the patch and patch plus lozenge conditions resulted in the highest rates of initial abstinence (using adjusted P values) (Table 2). This finding is consistent with earlier findings that the high-dose nicotine patch was significantly more effective in helping smokers achieve initial abstinence relative to placebo.18 It should be noted that bupropion alone and bupropion plus lozenge also had significantly higher initial cessation rates relative to placebo using adjusted P values.
Previous research on combination NRT paired the patch with nicotine gum,25,32 nicotine nasal spray,7,33 or a nicotine inhaler.34,35 The present results suggest that the nicotine lozenge can also be effective as an adjuvant to the nicotine patch. The key seems to be that an ad libitum, or as needed, agent must be paired with the patch; simply using higher patch doses does not seem to augment outcomes to the same degree.36-39 While the nicotine lozenge appears to be an effective patch adjuvant, its performance as a monotherapy was not as impressive as the patch. For instance, the lozenge did not produce significantly higher cessation rates than placebo in either the first week of treatment or at the end of treatment (with α adjustment) (Table 3).
While overall medication adherence reached an average of 77%, there were significant differences in rates of use of the different medications. Bupropion and the nicotine patch had the highest use rates followed by the 2 combinations; the nicotine lozenge had the lowest use rates. These findings suggest that smokers are especially unlikely to use as needed medications adherently (ie, a recommendation of 9 lozenges per day). This is consistent with other literature that suggests an inverse relation between the number of doses prescribed and medication adherence40 and with research showing a direct positive relation between medication adherence and cessation outcome.41-46
The pharmacotherapy interventions used in this research appear to be safe and well tolerated. Only 4 individuals out of 1504 withdrew from the study for medication-related reasons. There were more adverse events, however, among individuals in the combination pharmacotherapy vs the monotherapy or placebo conditions (Table 4). Combination therapy did not appear to increase serious adverse events or study withdrawal compared with monotherapy. These findings agree with prior research that supported the safety and patient acceptance of combination NRT.15,25,32,47,48
One limitation of this study is that treatment took place in the context of a longitudinal study, which may have selected participants with greater motivation to quit than smokers in the general population. In addition, treatment lasted only 8 weeks (with the exception of the nicotine lozenge, which lasted for 12 weeks). Future research will be needed to determine whether long-term use of these pharmacotherapies improves efficacy (though some evidence suggests that longer use is not efficacious1). A final limitation is that the study did not include varenicline among the tested medications (varenicline was not approved by the Food and Drug Administration at the time of study initiation), and therefore it is unknown how these agents would have fared relative to varenicline, the monotherapy designated as most effective by the 2008 PHS Guideline.1 The results do suggest the importance of testing varenicline against a combination of the nicotine patch and an ad libitum NRT medication, as we identified this intervention to be especially efficacious relative to placebo.
In this study assessing 5 different pharmacotherapy interventions, the nicotine patch plus lozenge produced the greatest benefit relative to placebo. These findings plus recent meta-analyses published in the 2008 PHS Guideline Update suggest that a combination pharmacotherapy comprising the nicotine patch and an ad libitum NRT should be routinely considered for use as a smoking cessation treatment. In addition, this study illustrates that after more than 20 years the patch remains a highly efficacious pharmacotherapy for helping people quit smoking.
Correspondence: Megan E. Piper, PhD, Center for Tobacco Research and Intervention, 1930 Monroe St, Ste 200, Madison, WI 53711 (firstname.lastname@example.com).
Submitted for Publication: October 31, 2008; final revision received April 1, 2009; accepted April 3, 2009.
Financial Disclosure: The authors report the following potential conflicts of interest for the last 5 years: Dr Smith has received research support from Elan Corporation. Dr Baker has served as an investigator on research projects sponsored by pharmaceutical companies, including Sanofi-Synthelabo, Pfizer Inc, and Nabi Biopharmaceuticals. Dr Jorenby has received research support from the National Institute on Drug Abuse, the National Cancer Institute, Pfizer Inc, Sanofi-Synthelabo, and Nabi Biopharmaceuticals. He has received support for educational activities from the National Institute on Drug Abuse and the Veterans Administration and consulting fees from Nabi Biopharmaceuticals. Dr Fiore has received honoraria from Pfizer. He has served as an investigator on research studies at the University of Wisconsin that were funded by Pfizer, Sanofi-Synthelabo, GlaxoSmithKlein, and Nabi Biopharmaceuticals. In 1998, the University of Wisconsin appointed Dr Fiore to a named chair funded by an unrestricted gift to University of Wisconsin from Glaxo Wellcome. All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding/Support: This research was conducted at the University of Wisconsin–Madison and was supported by grant P50 DA019706 from the National Institute on Drug Abuse and by grant M01 RR03186 from the General Clinical Research Centers Program of the National Center for Research Resources. Dr Piper was supported by an Institutional Clinical and Translational Science Award, University of Wisconsin–Madison (KL2 grant 1KL2RR025012-01). Medication was provided to patients at no cost under a research agreement with GlaxoSmithKline.
Disclaimer: No part of the manuscript was written or edited by anyone employed by a pharmaceutical company. The authors are solely responsible for the analyses, content, and writing of this article.
This article was corrected online for error in data on 11/2/2009, prior to publication of the correction in print.


text:
Convicted killer's former attorney testifies
A prominent capital defense attorney who represented convicted killer Joseph Edward Duncan III during his death penalty hearing five years ago says Duncan's bizarre beliefs infected their case.
Judy Clarke was in Boise's U.S. District Court Tuesday to testify in Duncan's competency hearing. Duncan was sentenced to death in 2008 after admitting he kidnapped and tortured two northern Idaho children before killing one of them in Montana.
A federal appellate court ordered the retrospective competency hearing to determine if Duncan was mentally competent when he gave up his right to appeal.
Clarke said Duncan didn't want to participate in his own defense because he believed he'd had an epiphany and that he could lead others to enlightenment by refusing to participate in the legal case.


text:
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Trio of meatballs stuffed with fresh mozzarella and topped with Mellow red sauce, then sprinkled with shaved Parmesan, fresh basil and breadcrumbs.$7.49(360 cal)
Cloud 9
The premium Mellow wing experience. 9 double-baked wings coated in a rich garlic Parmesan sauce with just a hint of heat. Garnished with grated aged Parmesan and chives. Served with celery, carrots and your choice of ranch or bleu cheese dressing.(9): $14.29(800 cal)
Double-baked for a crispy and flavorful wing. Tossed in your choice of sauce: hot, mild, BBQ, jerk, sweet Thai chili, teriyaki or naked. Served with celery, carrots and your choice of ranch or bleu cheese dressing.Half (5): $6.99Whole (10): $12.99
Greek Salad
Roma tomatoes, cucumbers, green peppers, sweet onions, mushrooms, pepperoncinis, banana peppers, Kalamata olives and feta cheese on a bed of Romaine and iceberg lettuce tossed with shredded carrots and red cabbage.Lil: $6.99Reg: $9.99(150/300 cal)
House Salad
A medley of fresh greens mixed with freshly chopped Romaine topped with Roma tomatoes, cucumbers, black olives, sweet onions and shaved Parmesan.Lil: $4.79Reg: $6.99(90/180 cal)
Caesar Salad
All hail the perfect salad. Freshly chopped romaine lettuce tossed with all-natural Caesar dressing, grated aged Parmesan, and house-made croutons.Lil: $5.99Reg: $8.99(400/800 cal)
Bacon Bleu Wedge
A chilled Iceberg wedge served with bleu cheese dressing and bleu cheese crumbles. Topped with roasted tomatoes and applewood-smoked bacon. Garnished with chopped chives.Reg: $7.99(570 cal)
The Elevated Cobb
A higher order of salad made with antibiotic-free Springer Mountain Farms chicken, applewood-smoked bacon, fresh avocados, crumbled bleu cheese and sliced Roma tomatoes on a bed of chopped romaine lettuce.Reg: $12.49(710 cal)
Enlightened Spinach Salad
Dried cherries, diced apples, house-made glazed pecans and crumbled feta cheese on a bed of fresh spinach.Try with Pomegranate Acai dressing.Lil: $6.99Reg: $9.99(310/620 cal)
Signature Esperanza(220/440 cal)
Pomegranate Acai(110/220 cal)
Balsamic Vinaigrette(140/280 cal)
Chunky Bleu Cheese(200/400 cal)
Caesar(240/470 cal)
Ranch(200/410 cal)
S 4 Slices / M 6 Slices / L 8 Slices
Calories listed per slice.
Choice Of "Classic" Crust Or Mellow "Thin" Crust
Our pies are basted with garlic butter and sprinkled with Parmesan cheese.
10" gluten-free pizzas are also available for an additional $3.00.
Mighty Meaty
A carnivorous mix of pepperoni, Italian sausage, ground beef, honey ham and applewood-smoked bacon on top of Mellow red sauce and mozzarella.Small: $12.99Medium: $20.99Large: $26.99(360 cal)
Great White
An olive oil and garlic base layered with mozzarella, provolone, seasoned ricotta, roasted tomatoes, crumbled feta cheese, fresh Roma tomatoes and sweet onions. Finished with chopped fresh basil.Small: $12.49Medium: $19.99Large: $25.99(320 cal)
Buffalo Chicken
Made with mozzarella, then layered with Buffalo chicken, caramelized onions and applewood-smoked bacon. Finished with a double swirl of Buffalo sauce and your choice of chunky bleu cheese or ranch dressing.Small: $12.99Medium: $20.99Large: $26.99(370 cal)
Holy Shiitake Pie
An olive oil and garlic base with roasted shiitake, button and portobello mushrooms, caramelized onions, mozzarella and creamy MontAmoré® cheese. Finished with fresh chives, shaved Parmesan, a garlic aioli swirl and a spritz of black truffle oil.Small: $12.99Medium: $19.99Large: $25.99(340 cal)
Funky Q. Chicken
Shredded mozzarella topped with our signature BBQ chicken, sharp cheddar cheese, caramelized onions and applewood-smoked bacon. And to keep it funky, finished with a swirl of BBQ sauce.Small: $12.99Medium: $20.99Large: $26.99(330 cal)
Kosmic Karma
Filled with goodness, this pie starts with Mellow red sauce covered with spinach, roasted tomatoes, mozzarella, fresh Roma tomatoes and crumbled feta cheese. A hypnotic pesto swirl adds the finishing touch.Small: $12.99Medium: $19.99Large: $25.99(300 cal)
Pacific Rim
Aloha! Mellow red sauce topped with mozzarella, honey ham, applewood-smoked bacon, caramelized onions, pineapple and jalapeños add a final kick.Small: $12.99Medium: $19.99Large: $25.99(310 cal)
Veg Out
Mellow takes veggies to the max. This pie starts with Mellow red sauce layered with mozzarella, spinach, green peppers, sliced mushrooms, sweet onions, black olives and Roma tomatoes.Small: $10.99Medium: $17.49Large: $24.99(250 cal)
House Special
The Ultimate Mellow: red sauce, mozzarella, topped with pepperoni, Italian sausage, ground beef, honey ham, applewood-smoked bacon, black olives, sliced mushrooms, Roma tomatoes, green peppers, sweet onions and the finishing touch... more mozzarella.Small: $12.99Medium: $20.99Large: $26.99(350 cal)
Backyard BBQ
Fire up the appetite. This pie is filled with mozzarella cheese, roasted pork tossed in house-made BBQ sauce, roasted mild poblano peppers and topped with chives and sweet Peppadew® peppers.Small: $12.99Medium: $20.99Large: $26.99(290 cal)
The Merry Prankster
Take the trip less travelled. Starts with an herb aioli base layered with chicken, Italian sausage, garlic roasted red peppers, green bell peppers, mozzarella, Wisconsin aged white cheddar, and finished with an herb aioli drizzle.Small: $12.99Medium: $20.99Large: $26.99(360 cal)
Wild In Havana™
This pie will take you for a ride. This Cuban-inspired pizza comes with jerk marinated pork, ham, salami, Swiss and mozzarella cheeses, diced pickles, and an irresistible mayo-mustard drizzle.Small: $12.99Medium: $20.99Large: $26.99(310 cal)
10" / 4 Slices (210/260 cal)
14" / 6 Slices (260/310 cal)
16" / 8 Slices (280/330 cal)
Cheese OnlySmall: $8.99Medium: $13.99Large: $17.59
1 IngredientSmall: $10.49Medium: $16.49Large: $20.49
2 IngredientsSmall: $11.99Medium: $19.25Large: $23.49
3 IngredientsSmall: $13.49Medium: $20.99Large: $26.49
Additional IngredientsSmall: $1.50Medium: $2.50Large: $3.00
Bleu Cheese(20/80 cal)
Cheddar, sharp(15/60 cal)
Feta(20/80 cal)
MontAmoré®(30/120 cal)
fresh(20/80 cal)
shredded(20/80 cal)
shaved(10/100 cal)
Provolone(25/100 cal)
seasoned(40/80 cal)
Follow Your Heart® Vegan Cheese(20/80 cal)
Artichoke Hearts(5/10 cal)
Avocado(10/110 cal)
Banana Peppers(5 cal)
Garlic(5/15 cal)
Green Peppers(5 cal)
Jalapeños(5/20 cal)
Mushrooms(10 cal)
Mushrooms, portobello(10 cal)
Mushroom Trio
roasted(15/25 cal)
Olives, black(10/45 cal)
Olives, green(5/45 cal)
Olives, Kalamata(10/80 cal)
Onions(5/10 cal)
Onions, caramelized(5/10 cal)
Peppadew® peppers(5 cal)
Pepperoncinis(5/15 cal)
Pineapple(10/35 cal)
Poblano Peppers(5 cal)
Red Peppers
garlic roasted(10 cal)
Spinach(20 cal)
roasted(20/45 cal)
Roma(5 cal)
Anchovies(20/50 cal)
Bacon*, applewood-smoked(20/130 cal)
Roasted Pork(45/60 cal)
Chicken(25/100 cal)
Ground Beef(20/70 cal)
Genoa Salami(60/110 cal)
Honey Ham(10/60 cal)
Italian Sausage(10/35 cal)
Meatballs(25/50 cal)
Pepperoni(35/130 cal)
grilled ribeye(40/140 cal)
Tempeh(35/150 cal)
Tofu(5/50 cal)
garlic butter, sprinkled with Parmesan and
served with a side of Mellow red sauce. (90 cal)
Build Your Own Calzone
Start with a cheese calzone and add your favorite ingredients. Each ingredient$1.50
The Sausagefest
Meatballs, Italian sausage, Genoa salami, mozzarella, provolone and seasoned ricotta.$12.99(1320 cal)
Stuffed with spinach, mushrooms, Roma tomatoes, mozzarella, provolone and seasoned ricotta.$10.99(1230 cal)
Steak & Cheese
Grilled, shaved all-natural ribeye steak with mushrooms, sweet onions, green peppers, mozzarella, provolone and seasoned ricotta.$12.99(1360 cal)
Mozzarella, provolone and seasoned ricotta.$9.99(1180 cal)
with choice of Kettle Chips. +210-220 cal
Avocado Hoagie
Mayo, lettuce, Roma tomatoes, melted provolone cheese, sweet onions, topped with avocado slices seasoned in lemon juice, kosher salt and black pepper.Half: $6.99Whole: $10.99
Meatball Hoagie
Seasoned and seared meatballs smothered in Mellow red sauce and topped with melted mozzarella and Italian seasoning.Half: $6.99Whole: $10.99
Steak or Chicken & Cheese Hoagie
Mayo, lettuce, and Roma tomatoes, melted provolone, choice of grilled, shaved all-natural ribeye steak or teriyaki chicken, grilled onions, mushrooms and green peppers.Half: $7.49Whole: $11.99
Italian Hoagie
Honey ham, Genoa salami, pepperoni, caramelized onions, fresh mozzarella and mayo, toasted and finished with fresh greens tossed in a roasted tomato-infused oil, sliced Roma tomatoes and fresh chopped basil.Half: $6.99Whole: $10.99
Havana Hoagie
Simple, yet lively. This Cuban-inspired hoagie comes with grilled pork, ham, pickle slices, Swiss cheese melted on top and the perfect amount of mustard.Half: $6.99Whole: $10.99
California Club
In terms of clubs, it doesn't get more Mellow. Served with chilled chicken, roasted tomatoes, applewood-smoked bacon, seasoned smashed avocado and garlic aioli on multigrain ciabatta.$8.99(680 cal)
Pizza, meet burger. Burger, meet pizza. This ultimate burger is topped with Mellow red sauce, mozzarella cheese, pepperoni and garlic aioli. Served on a grilled and buttered brioche bun.$12.99(1400 cal)
Mel's Classic
Lettuce, tomato, pickle and onions. Served on a grilled and buttered brioche bun.$10.99+ Add your choice of cheese: $0.79 | (150 cal)
Melted Swiss, caramelized onions, garlic aioli, romaine lettuce, Roma tomatoes and pickles. Served on a grilled and buttered brioche bun.$12.99(1150 cal)
Build Your Own Burger Just The Way You Like It
All BYOB's start with a Mel's Classic including lettuce, tomato, pickle and onions.$11.99(1030 cal)
Calorie needs vary. General nutrition recommends 2,000 calories a day. Additional nutrition information available upon request.
All catering orders include plates, serving utensils, cutlery, and napkinsper order.
V = Lacto-ovo vegetarian
Hawaiian Pizza
Say goodbye as soon as you say hello. Mellow red sauce topped with mozzarella, ham and pineapple.S: $12.99M: $19.99L: $25.99(270 cal)
Magical Mystery Tour Pizza
The only mystery is whether one is enough. Featuring a pesto base with button and portobello mushrooms, feta and mozzarella cheese, spinach and light jalapeños.S: $12.99M: $19.99L: $25.99(310 cal)
Maui Wowie Pizza
Enjoy a pesto base with mozzarella, ham, pineapple, jerk chicken, banana peppers, and applewood-smoked bacon.S: $12.99M: $20.99L: $26.99(350 cal)
Thai Dye® Pie
Sweet. Savory. And out of this world. An olive oil and garlic base, all-natural curry chicken, mozzarella, Roma tomatoes, onions, topped with fresh basil, cucumbers and a swirl of Thai chili sauce.S: $12.99M: $20.99L: $26.99(300 cal)
One 1-Topping Slice + Lil House Salad$8.25
Two 1-Topping Slices$7.99
Soup + Lil House Salad$8.25
Half Hoagie + Lil House Salad$8.99
Half Hoagie + Chips$8.99
1-Ingredient Calzone$8.50
Small 1-Topping Pizza$8.50
Gourmet Cookie$2.99Peanut Butter (580 cal) Sugar (630 cal) Triple Chocolate Chunk (600 cal)
Mary Jane's Triple Chocolate Brownie
A chewy brownie generously loaded with HERSHEY'S® KISSES, bittersweet and semi-sweet chocolate chunks and drizzled with dark chocolate truffle sauce.$2.99(550 cal)
Gluten-Free Brownie
Individually wrapped brownie, baked with cage-free eggs, a blend of gluten-free flour, sustainable chocolate and ingredients free of GMOs and artificial additives.$4.00(360 cal)
Time For A Sundae
All-natural vanilla bean ice cream, dark chocolate truffle sauce, freshly whipped cream and topped with an all-natural Bing cherry.$2.99+ Cookie: $3.00 | (600 cal)+ Brownie: $3.00 | (410 cal)
Strawberry Lemon-Limeade
Our house-made lemonade, blending all-natural strawberry pureé with fresh lemon and lime juices$4.00(140 cal)
Peach Iced Tea
Made fresh to order with all-natural peach pureé and Lipton Iced Tea$4.00(210 cal)
A blend of Lipton Iced Tea and Minute Maid Lemonade.$4.00(40/210 cal)
Lipton Iced Tea
Sweet or unsweet$2.75(210 cal)
Fountain Drinks$2.75Coca-ColaDiet CokeCoke ZeroSpriteCherry CokeBarq's Root BeerPibb XtraMello YelloMinute Maid LemonadeHi-C Flashn' Fruit Punch
Red Bull
Regular & Sugarfree$5.00(10/110 cal)


text:
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A typical program involves: installation and optimization of sampling; measurement of the current status of the process; running defined test programs; and the generation of comprehensive reports. The aims include finding the best parameters for process control and testing sensitivity to process change. There is an option to rent or buy the Insitec Voyager system after completion of the study.
As part of the consultancy process, clients also have the opportunity to assess the need for permanent installation of on-line particle size analysis and to determine the optimal set-up required. Where a permanent on-line analysis solution is selected as a result of the study, then much of the preliminary testing and analysis normally required will already have been completed. This makes installation and commissioning rapid and straightforward, resulting in a much faster return on investment. Full details are available at www.malvern.com


text:
Pork Dumpling Recipe to Ring in the Chinese New Year
These dumplings are delicious whether you put the classic pleats in them or not.
by Gourmet
yield: Makes 4 main-course servings (makes 32)
active time: 1 1/4 hr
total time: 1 1/4 hr
1 3/4 cups all-purpose flour plus additional for dusting
1 (2-inch) piece peeled fresh ginger
1/2 cup light soy sauce
1 bunch scallions, thinly sliced
3/4 lb ground pork (from shoulder; not lean)
special equipment
a 3 1/4-inch round cookie cutter
See more:15 Perfect Pasta Dishes
* Stir together flour and 1/2 cup lukewarm water in a bowl until a dough forms. Knead on a lightly floured surface until just smooth, 1 to 2 minutes, then wrap tightly in plastic wrap and let stand at room temperature at least 10 minutes.**
* While dough stands, halve ginger, then finely chop 1 half and cut remaining half into very thin matchsticks (less than 1/8 inch thick).
* Combine 5 tablespoons soy sauce with ginger matchsticks in a small bowl.
* Reserve 2 tablespoons scallions for garnish, then finely chop remainder and put in a bowl along with pork, finely chopped ginger, and remaining 3 tablespoons soy sauce. Gently knead with your hands in bowl until just combined. Chill, covered, 10 minutes.
* While pork mixture chills, line a large baking sheet with paper towels and dust lightly with flour, then lightly dust a work surface with flour. Halve dough and rewrap 1 half. Pat remaining half into a flat square. Roll out dough into a 13-inch square (less than 1/8 inch thick) with a lightly floured rolling pin, dusting work surface with additional flour as needed, then cut out 12 rounds (very close together) using cookie cutter. (If dough is sticking to cutter, lightly dip cutter in flour and shake off excess before cutting out each round.) Reserve scraps.
See more:17 Delicious Cheese Recipes
* Transfer rounds to lined baking sheet and cover loosely with another layer of paper towels lightly dusted (on top) with flour. Roll out remaining half of dough and cut out 12 more rounds in same manner, then transfer rounds to lined baking sheet. Combine scraps of dough and wrap in plastic wrap, then let stand at least 10 minutes.
* While scraps are standing, begin forming dumplings. Line another large baking sheet with paper towels and dust lightly with flour. Put 1 dough round on fingers of 1 hand near palm and put 2 slightly rounded teaspoons pork mixture in center of round. Fold round in half, enclosing filling, and pinch edges together to seal. Put dumpling on lined baking sheet and form 23 more dumplings in same manner (you may have some filling left over). Cover dumplings loosely with more paper towels. Roll out scraps into a 10-inch square (less than 1/8 inch thick) and cut out 8 more rounds. Form 8 more dumplings for a total of 32. Discard remaining scraps.
* Gently drop all dumplings into a 6- to 8-quart pot of boiling water, gently stirring once to prevent sticking, and cook 6 minutes. (Dumplings will float to top while cooking.) Transfer dumplings with a slotted spoon to a serving dish and sprinkle with reserved scallions. Serve with ginger dipping sauce.
cooks' note:
* Dumplings can be formed 1 day ahead. Chill in 1 layer, not touching, on lined baking sheet, loosely but completely covered with plastic wrap.
**Store-bought wrappers can be used as a homemade dough alternative.
More fromGourmet:
Top 10 Timeless Recipes
Gourmet's Classic Comfort Foods
Chocolate Desserts for the Ultimate Chocolate Lover
The Best Ways to Eat Meatballs


text: Super Bowl Sunday, folks. And no, the Pats aren't playing, but at least Bruno Mars and the Red Hot Chili Peppers are, right? No? Well, if you're looking for a different kind of music experience this weekend, we've got you covered. You can catch electronic music at a rock climbing gym, chamber pop music at an art museum, or experimental punk in a record store. Check out all of this weekend's best bets. More