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Speed Nation: Methamphetamine, HIV and HepatitisJuly/August 2005 A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information! "This conference is amazing."
It was a comment heard again and again from speakers at the podium and attendees in the corridors of the First National Conference on Methamphetamine, HIV, and Hepatitis. In mid-August 2005, over 900 people jammed into the cramped meeting rooms of a Salt Lake City hotel to attend the event sponsored by the Harm Reduction Project of Salt Lake City and the Harm Reduction Coalition of New York City. The sheer quantity of information offered could certainly be called amazing, with 20 plenary speakers and nearly 100 presentations in 34 breakout sessions. But equally amazing was the confluence of so many diverse people and perspectives in the same room: drug policy people rubbing shoulders with HIV prevention people; law enforcement with "party safe" proponents; rural social services providers with urban social scientists; harm reduction advocates with hard-core 12-steppers; counselors with prosecutors. The energy at the conference had no doubt been kicked up a notch by the attention of Indiana Republican and harm reduction antagonist Rep. Mark Souder, who offered a public damnation of U.S. government involvement in the event. Souder complained to Health and Human Services (HHS) Secretary Mike Leavitt that a $3,000 grant allowing several HHS employees to attend the conference "completely undermines the work of the president, the Congress, and the men and women who work in law enforcement across the nation who are trying desperately to fight the meth epidemic." With nine breakout sessions running at the same time it was impossible to see everything, but here is a sampling of what was heard in Salt Lake City. Speed in AmericaPatricia Case, a professor of social medicine at Harvard University, opened the conference by tracing the history of "America's love affair" with stimulants. There is nothing so American as stimulant use, she said, because it allows people to "accomplish things, to go faster, and do more." There always seems to be a drug scare of one sort or another in this country, and now we have an "epidemic" of methamphetamine. But "the word epidemic grates on me," Case said. While the term conveys urgency and makes good headlines, stimulant use in the U.S. is so pervasive that it might better be described as "endemic," with periodic outbreaks, such as we see now.The latest outbreak has some new features, including local production (and the role of the Internet in disseminating instructions for making the drug at home), the use of meth along with other drugs, the national scale of the outbreak, the involvement of multiple subpopulations, and the increase in smoking as a route of administration. But an emerging concern with the current meth wave in America -- and the reason for this conference -- is the strong association between meth use and HIV, hepatitis C virus (HCV), and sexually transmitted diseases (STDs) in populations where those diseases are prevalent or where meth is commonly injected. It is becoming apparent that the boundaries between these "sub-populations" are fluid, and that HIV and HCV infection may be on the move into new groups and regions. Despite all the recent attention garnered by meth using gay, urban, party boys, most American meth users are poor people for whom the drug serves as "the best antidepressant on the street." Dr. Case sees motivation for the current wave of substance use in our times and culture, with the essentially unexamined impact of 9/11, the current Iraq War, and economic uncertainty helping to make escape into drugs attractive. For gay men, the unexamined loss of two decades of AIDS is an important contributor, she thinks, but for all groups, poverty, class and social marginalization are likely factors. Yet, Case warns, focusing on only one facet of the current outbreak, such as among urban gay men, may obscure what is happening in other communities, citing meth use in unexpected quarters such as among the Amish, Mormons, and the recent appearance of dime bags on the streets of Latino neighborhoods in New York.
History: Speed RoundAmphetamine was first synthesized in Germany in 1887 and its more powerful cousin methamphetamine in Japan in 1919. In the 1930s, Benzedrine inhalers (containing a form of amphetamine) were sold over the counter in the U.S. People would remove drug-soaked cotton from the inhalers and dissolve the amphetamine in coffee for an extra lift. Benzedrine tablets (bennies) became available in 1935, and by 1939 the medical literature reported nearly 40 conditions that were treatable by amphetamine, including an indication for perking up "tired physicians." The first published report of addiction appeared in 1938.Amphetamine production and use soared during World War II, because, as Dr. Case put it, "all sides go to war on amphetamines." Bennies were included in field kits and some soldiers attributed the long, unrelenting battles on the Pacific islands to the drugs issued to soldiers on both sides. Supplying speed to soldiers continued through the Korean and Vietnam Wars down to the invasion of Iraq, where military personnel were issued modafinil, or Provigil, a new generation, non-amphetamine-based "go-pill" that is said to have a good safety profile. Sales of Provigil in 2004 reached $500 million. After World War II, Benzedrine tablets were available on the surplus market in large quantities and soldiers and airmen returning from the war brought "pep pills" into the workplace where they became established in the culture of truck drivers and anyone who had to work long hours. Soldiers returning from Vietnam introduced speed to the drug culture, where it developed a bad reputation as an unmellow high, spawning the warning, "Speed Kills." Some wonder if another chapter in America's love affair with speed may soon be written as soldiers return from the Middle East accustomed to revving up for work and play. In the postwar era, speed started to cause problems on campuses, and public outcry over youth on drugs led to the regulation of Benzedrine and to the removal of over-the-counter amphetamine inhalers by 1959. In a pattern that continues to the present day, as one form of speed was restricted, the market shifted to new sources and technologies. California biker gangs became pioneer underground producers of amphetamine in the early 1960s, smuggling the "crank" in the crankcase of a motorcycle. And the pharmaceutical industry responded to the removal of amphetamine inhalers by producing inhalers that used methamphetamine. By 1965 all inhalers had been removed from market shelves and federal law now required a prescription to obtain the drugs. By 1967, not surprisingly, the number of prescriptions written for "diet pills" -- primarily dispensed to women -- was soaring. Speed had become an attractive treatment for the burdens of everyday life for millions of housewives. By 1970, 10 billion tablets a year were prescribed legally, with billions more consumed without medical supervision. Burroughs Wellcome, now Glaxo Smith-Kline, advertised its pharmaceutical methamphetamine diet pills with the promise of keeping "the reducer happy." Dr. Case proposed that the "hidden agenda" of medicalized speed appeared to be the production of the ideal suburban housewife, a kind of "Stepford Wife" -- with boundless capacity for housework, a lithe figure, and enhanced sexual appetites. That the pills effectively alleviated depression no doubt made them particularly attractive to members of the target market. Classified as a Schedule II drug, pharmaceutical methamphetamine is still manufactured by Abbott Laboratories and marketed as Desoxyn by Ovation Pharmaceuticals. It is prescribed for treating weight loss and for calming hyperactive kids. What Does Meth Do?Don McVinney, of the Harm Reduction Institute, New York, reported on the facts and physiologic effects of methamphetamine. Meth, like cocaine, releases dopamine and inhibits its reuptake at the synapses. Dopamine is a messenger molecule that works in the pleasure and reward centers of the brain. Whereas cocaine use produces dopamine levels 400% of basal release levels, methamphetamine boosts dopamine release by up to 1500%. After the initial release -- and accompanying wave of pleasure -- the dopamine is depleted and the neurons require time to recover before normal dopamine traffic can resume.Richard Rawson, of the University of California, Los Angeles, illustrated the effects of meth on humans by showing before-and-after MRI images of dopamine uptake in the "pleasure centers" of the brain. Methamphetamine damages the terminals of dopamine neurons in the brain, which can show up to a 60% reduction in neurotransmitter levels one month after using the drug. The good news is that these neurons can recover within 6-24 months, but during that time the user may experience a period of anhedonia, when nothing in life feels good. It is this "low" following meth use that may drive people to use again. Methamphetamine also has persisting effects on the "judgment" centers of the brain that affect impulse control, and can impact the amygdala, which may result in increased cravings or inappropriate stimulus of the "fight or flight" response. Meth promotes sexual drive for both men and women, in contrast to opiates, which tend to replace sexual pleasure with the pleasure of the drug. Don McVinney explained that the latest form of methamphetamine on the street is called crystal or "ice," and resembles rock candy. Current prices for the drug run from about $20 per quarter gram in San Francisco to $60-80 in New York. Methamphetamine can be eaten, smoked, snorted, injected, or inserted in the rectum (booty bumped). Smoking produces the fastest onset, acting within three minutes, while swallowing may take 15-20 to produce effects. Swallowing meth probably has fewer risks than the other modes of administration. A single dose will last from 8-12 hours. When administered, methamphetamine produces a rise in blood pressure and heart rate. Breathing becomes faster and shallower, and the internal body temperature rises. There have been cases of kidney failure, dehydration, stroke, and seizures reported after a single dose of meth. The mouth becomes dry and users often develop characteristically bad breath. Longer-term use can produce "meth mouth," an increasingly recognized form of tooth decay caused by chronic dry mouth, grinding of the teeth, and osteoporosis. Coming down from meth can be unpleasant. The features of methamphetamine post acute withdrawal syndrome (PAWS) include depression, excessive sleep, and psychotic or paranoid behavior. Because of the long acting effects of methamphetamine, users are generally unable to sleep while high and may sleep too long after crashing. Many meth users will also turn to other drugs such as sleeping pills and opiates to help manage the crash. Users who combine meth with sleeping pills such as Ambien may experience periods of amnesia if they remain awake despite the sedative. There is a long list of personal and social harms that can result from methamphetamine use including increased susceptibility to HIV, HCV, and STDs. Meth users with HIV may stop taking antiretroviral drugs due to loss of attention to time or to a sense of invincibility and a feeling that they don't need their medication. Violence is associated with meth use, partly due to the aggressive tendencies of some heavy users, but also because of contacts with criminal actors, such as drug dealers. The combination of a gun plus drug-induced paranoia has become a staple of police blotters throughout the U.S.
Meth and SexUsers will often experience physical sexual effects, including "crystal dick," where the penis becomes erect but remains much smaller than normal. This can contribute to condoms slipping off during sex, which may be a factor in the association of meth use with HIV infection. Users often combine methamphetamine with Viagra or a similar drug to counteract the sexual side effects. It is possible that the drying of mucosa observed in the mouth and nose may also occur in the rectum, and that "dry sex" could also be an important factor in increasing HIV transmission risk among meth users. A mantra of prevention workers who reach out to users is: "Lube, lube, and more lube."Sexual behaviors and desires may also be altered while on methamphetamine, with individuals changing accustomed sex roles due to loss of inhibitions. Thus, a committed top might become a bottom during a meth session. One survey also noted forays into homosexual behavior by men with only prior heterosexual experience, which may contribute to a disconnect between identity and behavior that often goes undetected by the usual categories of social science investigation. While meth is appreciated for its sexual effects among urban gay users, the sexual attributes of the drug were noted in the early medical literature. Dr. Case related a 1937 report of almost instantaneous orgasm after using methamphetamine, while a 1947 report described an "indescribably delightful" session of masturbation. A 1952 paper quoted a user finding "more desire but less satisfaction" from sex. The presumed split between the sexual motivations of urban gay users and motivations of rural users may not be so clear. An audience member reported that law enforcement was increasingly finding sex toys and pornography in raids on rural meth houses. He wondered if perhaps he had introduced these ideas to his clients because he had been distributing meth awareness pamphlets aimed at gay men -- the only educational materials he could find. A Doctor's ViewNeil Flynn, of the University of California, Davis, is a physician who sees many meth users in his HIV practice. Flynn focused on the drug's disinhibiting effects and the bravado that users display as a source of risk for both users and partners. Users often feel invincible and believe that they can't become infected or reinfected, or that they don't need to keep taking their antiretroviral medications. Meth users with HIV are also often taking testosterone, he said, which increases sexual desire, and they often ask for Viagra. Users may be at greater risk physiologically too. The likelihood of rectal injury due to drying of the rectal mucosa may be further increased because of the long periods of sexual activity due to delayed orgasms that users typically report.Despite all the attention to the sexual behaviors associated with methamphetamine, Flynn noted that many users -- gay and straight -- are motivated by nonsexual pleasures of using the drug. Meth relieves depression and self doubt, controls weight, and increases stamina and energy, including the capacity for work. The link to sexual activity often comes as a byproduct of the elimination of feelings of shame about the user's body or desires. Who Uses Meth and Why?Patterns of methamphetamine use are varied, and many presenters noted that addiction after a single episode is largely a myth. Most people who have tried meth have only used it on an experimental basis. Others use the drug as part of a social ritual or on special party occasions. Some users may ingest only a single dose during a weekend and others will go on five-day long binges. Thus the "set and setting" of meth use, like all drugs, is critical to evaluate.Rafael Diaz of the Cesar E. Chavez Institute, San Francisco, presented a fascinating study on the subjective experiences of stimulant users (both meth and coke) in the nonheterosexual Latino community. His study (n=300) included half meth users and half cocaine users. Drug use in general, he found, was associated with gay culture. Poppers were commonly used, often with Viagra. Yet there were different motives for users of the two stimulants. Methamphetamine use was most often associated with sexual performance, while cocaine use was associated with making social connections. Meth users were motivated by feelings of invincibility and energy, which especially appealed to men with AIDS, and because the drug negated both emotional and physical pain. Users also liked that they lost weight. Despite problems with sexual dysfunction, meth users reported that they could have sex without guilt and the mental distractions of shame or embarrassment. For those using the Internet to find partners, they said the loss of inhibition allowed them to have sex with "whoever showed up" at the door at 3:00 in the morning. Users said they felt more passionate and found a sense of unity with their partner -- finding an "oasis" in the sexual moment. Diaz said users also reported feeling and behaving more "hard core" during sex and were more willing to explore new behaviors and erogenous zones. This may explain tops becoming bottoms and heretofore heterosexuals veering into homosexuality while on meth. But the study also found that consistent meth users tended to become increasingly socially isolated, which was related to the frequency of meth use. Sam Friedman of the National Development and Research Institutes, New York, presented a visual depiction of how networks of individuals injecting cocaine and heroin and having sex can be linked together outside of the usual or expected categories. In the Brooklyn neighborhood of Bushwick, heterosexual women, lesbians, gay men, and straight men were all connected on a chart by sex and injection drug use. Although HIV was tagged to only a few nodes on the chart -- a fact Friedman attributes to effective syringe exchange programs -- HCV infection appeared to be nearly universal. Friedman wondered if the risks for HIV and HCV will increase or decrease if methamphetamine is introduced into this network in a significant way. The value in looking at networks is that it allows researchers to see whole communities and not just a few people in isolation. These findings may also call into question awareness and outreach campaigns that focus too specifically on cultural subpopulations. William Zule, of Research Triangle Institute (RTI) International, North Carolina, compared his observations of 40 years of meth use in Texas with recent patterns in North Carolina. In the 1960s, speed use was introduced into the counterculture community of Austin. Use of methamphetamine peaked in the 1970s in Texas, then stabilized until increasing again in 2000. While smoking is the preferred route in North Carolina, he said, injection seems to predominate in Texas. Zule traced the history of restrictions on the drug and speculated about the unintended consequences of current efforts to crack down on meth. After over-the-counter sales were restricted in 1965, there was an increase in drug store burglaries and "script mills." When script doctors came under closer scrutiny and drug stores secured their premises, local labs took over supplying the drug. When the precursors for a method of production suited to large-scale laboratories were restricted, the "cooks" shifted to using the ephedrine method, which produces smaller batches of meth with a higher percentage of the active D-isomer of the drug. Zule fears that with new limits on ephedrine now coming into play, the supply will shift to meth imported by established cocaine and heroin smuggling networks. The result will likely be diffusion of the drug into the minority urban markets. Yet Zule thinks that, if history follows its pattern, the current wave of meth use will decline naturally and return to its usual endemic state.
Government ResponsesSeveral sessions focused on responses by government agencies, including law enforcement, substance abuse services, social welfare, and child protective services. B. J. Van Roosendaal, of the Utah Department of Substance Abuse, described the rise of speed usage from the 1990s to the present, from the first ripples to the eventual tsunami they are experiencing now. Although speed had an "ugly reputation" in the early 1990s, meth usage has climbed steadily, increasing from 16% to 65% as a factor in drug-related emergency room admissions from 1991 to 2004, even as usage of other drugs remained constant. During this period the proportion of women admitted rose from 17% to 35%. Many users report that meth was "the answer to their prayers at first" but soon got into trouble with the drug. Meth users commonly use other drugs and meth abuse is a factor in many other kinds of crimes. Law enforcement was first to recognize the emerging problem, Van Roosendaal said, and alerted the human services sector to the issue. She noted that for many people trapped in meth abuse, law enforcement "can be your friend," and even people who are forced into drug treatment by the courts can benefit.Adam Trupp, of the Utah Department of Child Protective Services, described the challenges in bringing law enforcement together with social services under a shared vision as creating a "mixed marriage." There are commonalities in that both law enforcement and child protective services investigate child abuse and neglect and make interventions into families, using legal means to help children. However, the social services side fears that prosecution will prevent access to treatment, he said. The police have proposed a partnership where liaisons from Child Services are involved in planning drug raids on homes where children are expected to be present. Trupp said there has been concern within the social services that they will become involved in prosecutions and lose their identity as social service providers if they "start speaking 'cop.'" But, he said, they have recognized that cooperation is preferable to receiving a call to come pick up the kids after a drug raid has gone down. The goal, Trupp says, is to bring law enforcement, child services, and treatment services to the same vision. Prisoners remain underserved for education, prevention, and treatment of HIV, HCV, and drug addiction. In a breakout session on prison issues, one individual involved in corrections health said her facility had a high percentage of inmates on antiretroviral therapy, but questioned the care available to them after release: "What do they do when they walk out?" Another participant said, "The public policy does not support our educational messages." Testing policies for HIV and HCV in prisons are uneven. One participant reported that Indiana has mandatory HIV testing "on the way in" but doesn't test people when they leave due to concerns about liability if they have become infected while inside. Another reported that her county's jail only recently stopped the practice of requiring prisoners to share razors. Hepatitis C infection is a growing concern among people in jails and prisons, one participant said. "I visit the local jails to teach about HIV but they are clamoring for HCV information. Now I mix it up." Treatment for HCV infection remains rare for incarcerated people. "Our state prison will treat HCV for people with a long-term sentence," one audience member said, "but the county jail won't treat it even though people might spend four years in there." Vickie Sickels, of Iowa Health, Des Moines, gave some tips for communicating about meth and other health issues with sex workers. She said that the challenge of becoming abstinent from both sex work and drug use can be overwhelming for many women and recommends taking it one step at a time by proposing to clients that "work is better when not high." Despite common lore, she said, the reality is that "you can talk to people when they are high -- well, maybe not after four days of being high." She suggests preparing activities for the restless client and for using only the most basic harm reduction messages. Materials should be fact based and relevant to the person you are trying to reach, she said. "Avoid educational materials that take a shame-based approach," Sickels said. "You only make people feel worse." Epidemiology of HIV and MethThomas Stopka from the California State Department of Health reported on a large survey of injection drug users (IDUs) in his state. He summarized the findings of 34,255 HIV counseling and testing sessions with heterosexual male (59%) and female (41%) IDUs. Access to clean needles was relatively good, with 28% of all participants obtaining syringes through needle exchange programs. Access through pharmacies represented a small proportion in the current data, though this is expected to increase now that pharmacy sales have begun in the state. There was a gender gap in unsafe needle sharing practices, with 4.04% of females versus 2.5% of males reporting sharing. Overall, 29% of meth users versus 38% of other IDUs said they never shared syringes; 10% versus 7% said they always shared.Meth injectors in the study made less use of needle exchange programs with 13% of meth users versus 24% of other IDUs reporting they always obtained needles through exchange programs. Syringe cleaning practices among meth users were similar to those of other drug injectors. Rates of methamphetamine injection differed according to ethnic identification, with 25% of African American IDUs reporting meth use compared to 69% of whites, 68% of Native Americans, and 69% of Asian Pacific Islanders. Meth was reported used by 42% of Latino IDUs, Stopka said. Of female meth users, 0.8% tested HIV-positive versus 1.8% of other female drug injectors. Among male meth users, 1.6% were HIV-positive versus 1.8% of other drug injectors. Fewer male meth injectors compared to male injectors of other drugs self-reported being infected with hepatitis C virus (19.8% vs. 33%), although meth injectors might be expected to have a higher risk for acquiring HCV. The disparity may be explained by the meth users' younger age and shorter injection career at the time when they were surveyed. Meth users in the sample had similar rates of gonorrhea as non-meth IDUs but had twice the rate of chlamydia (7.0% vs. 3.4%) and HBV (4.0% vs. 2.1%) infections. Only 37.4% of injectors in Los Angeles county report injecting meth, compared to 84.3% in rural Kern County. This suggests that there is a lower percentage of meth injectors in the population pools where HIV and HCV prevalence is highest. It also suggests that any shift of meth use patterns toward the urban centers might herald a sharp increase in these infections. Grant Colfax from the San Francisco Department of Health reported on epidemiology and prevention efforts in the Bay Area. Among San Francisco gay men in general, the prevalence of meth use was about 17% but rose to 42% among attendees of gay circuit parties. HIV infection rates were three times higher in meth users than in non-meth users (6.3% vs. 2.1%). Another San Francisco study, the EXPLORE cohort, found 5.7% HIV positivity rates in meth users, compared to 2.5% in non-meth users. It is speculated that the higher risk of HIV infection for methamphetamine users is likely due to partner selection (selecting sex partners from a pool with a higher HIV prevalence), and a tendency of meth users to engage in longer periods of sex with a greater frequency of condom breakage. Alternatively, it may be that HIV-positive gay men are more inclined to begin using meth. Treating the HIV-Positive Meth UserWhile some test tube studies suggest that methamphetamine can speed up HIV replication, this has not been observed in people, although the sequelae of crystal use, such as poor nutrition and lack of sleep, may play a role in disease progression. The more significant impact of meth use and injection drug use on HIV disease may be indirect, by affecting adherence to medication and the quality of services that drug users receive from medical professionals.Sharon Stancliff, M.D., of the Harm Reduction Coalition, New York, says that medical providers may be less willing to prescribe antiretroviral (ARV) therapy to active drug users because they feel the user will not be adherent. Yet doctors are poor predictors of adherence, she says. In one study, 32% of active drug users achieved viral suppression below 400 copies/mL compared to 44% for former users and 46% of non-users. The key finding is that if an individual was able to suppress HIV while on ARVs, then there was no difference between the groups. Stancliff cited a study of 230 men that reported meth users were less likely to receive ARVs, and that current users had higher viral loads than nonusers or former users. Injection drug users or their doctors may also fear drug interactions and forgo ARVs. The potential for such interactions has not been studied, although a few cases of fatal of near-fatal interactions with ARV regimens containing ritonavir have been reported. Another key factor in maintaining adherence, she said, is the quality of a patient's relationship with the provider. Many doctors don't like to take care of drug users, citing "reduced professional satisfaction." Neil Flynn acknowledged that meth users can be difficult patients and are frustrating for providers to treat. Adherence to ARVs is generally poorer with methamphetamine users compared to heroin users, probably because they believe they are invincible and don't need them. Users also have a tendency to miss appointments as they careen between flying high and crashing into depression when not using, and providers should recognize that these patients have different priorities in their lives and make accommodations. Flynn offers his meth-using patients special "drop in" privileges so they know they can be seen whenever they are ready to get attention. Flynn admits that it can be difficult to spend a half hour with a person who is high on meth and recognized that providers are often left with a sense of failure and chaos when dealing with users. He suggested considering the difference in perspective between the provider, who finds his patient distractible and flighty, and the patient, who may view the provider as too slow and too dense to understand what is going on. Flynn listed a simple set of goals for working with methamphetamine users: reduce risk, prevent disease, get an early diagnosis, avoid hospitalization and emergency-room use, maintain a trusting relationship, and promote introspection and counseling. The best outcome is simply increased satisfaction with life. However, Flynn admits that he counts establishing any kind of ongoing relationship as a success. Treatment for users should include treatment of the underlying psychiatric disorders in addition to 12-step addiction therapy. Substitution with Adderall may also benefit some users, said Flynn. Can Meth Addiction be Treated?Michael Siever, of The Stonewall Project, San Francisco, described what he called a familiar pattern in the demonization of methamphetamine by the government and the sensationalist media. "What's speed got to do with it?" he asked, noting that dosage was most often responsible for the harm caused. While therapeutic doses of methamphetamine might be in the range of 20-25mg, the typical dose consumed on the street is ten times higher. Echoing Patricia Case, Siever cited the 85-year history of the drug and noted decades of high level usage on the west coast, describing it as a "constant" among gay men, but also noting that it is now "everywhere."He blamed our culture's "attention deficit disorder" for fixating on this latest demon and ignoring the fact that crack cocaine usage is still as prevalent as ever. Siever is involved with tweaker.org, a Web site that educates meth users on how to protect themselves from the most dangerous effects of the drug. Taking this approach, Siever said, allows that "you don't have to be clean and sober, or even want to be," a comment that brought hisses from audience members sitting behind me. Nevertheless, he said, the risk for acquiring HIV, HCV, and STDs is high, regardless of use patterns and one episode is enough to become infected. Key to addressing the problems with meth, Siever says, is to understand that the drug is fun, that users are not crazy, and that they repeat their use because they are trying to recapture the fun. The drug is not inherently addictive, he said, and many users only tweak occasionally. These people likely don't need drug treatment despite the treatment industry myth that addiction is impossible to overcome without therapy. We need a more nuanced picture of the issue, Siever said: "it is not hopeless and people do get beyond their addictions." Grant Colfax, of the San Francisco Department of Health, reported on the seeming success of contingency management (CM) as a technique for reducing methamphetamine usage. CM essentially offers to pay drug users for not using and offers vouchers for "clean" urine tests. A study of this "peeing for prizes" method, versus counseling, versus both, found a reduction of sexual risk behaviors that was achieved using both approaches; however, CM tended to produce longer lasting effects. Unfortunately, Colfax said, 20 years into this HIV epidemic, outcome data for most prevention approaches are still lacking. Richard Rawson reiterated the lack of data on treatment efficacy and said the best available data come from treating cocaine dependency. The field is also lacking a treatment to reverse an overdose of methamphetamine, and there is currently no good treatment to reduce paranoid feelings in meth users. The most promising efforts around meth are in preventing STDs and other infections, he said. John Grabowski, of the University of Texas, Houston, discussed the therapeutic potential for treating stimulant dependency with stimulants. The risks seen with methamphetamine abuse are extensions of their therapeutic action, he said, and asked, "Can a medication be primary therapy?" While behavioral therapists might disagree, Grabowski thinks that for some people, medication alone will work "just fine" as therapy, while for others, a combination or behavior therapy alone will be better. He noted the commonalities with treatment for other substance addictions and regretted the lag in translation from those modalities to treating meth dependency. Grabowski showed data from a small trial using sustained-release methamphetamine to reduce cocaine consumption. The problems with amphetamine abuse come from using doses far outside of the therapeutic range, he said. "In fact, these are reasonably safe drugs" when used at therapeutic doses. Yet, he said, it is difficult to perform research with these agents in the U.S. and said he was called a "cowboy" because he wanted to give amphetamine to cocaine users. Nevertheless, the few available data from trials and observational studies indicate that there is some benefit -- or at least reduction of harm -- in giving amphetamine to cocaine and amphetamine users. While the use of amphetamine is fraught with political problems, there are new drugs coming along that are promising. The problem, he feels, is that most clinicians have been "brainwashed" to think that these drugs are all harmful, and work will have to be done to "depoliticize" these treatment modalities. He quoted a colleague who said "the best treatment for cocaine and amphetamine dependence would be amphetamine by another name, thus sidestepping all the political issues." Vincent Hayden of the National Black Alcoholism and Addictions Council, Minneapolis, questioned why his attention is being drawn to crystal meth at this time, since the drug is not big in the African American community. As with previous drug scares, he thinks the opportunity to make money can be a disruption and worries that the dollars going to fight methamphetamine will be taken from treatment efforts directed at problems that once held the spotlight but have never gone away, such as crack cocaine. "What happens to people in treatment for alcohol and crack as the money shifts to meth? Why the focus on the drug du jour?" he asked. "Do I have to look at how meth gets into the African American community if I want to get or keep getting funding?" Initially, crack was addressed with jail time, Hayden pointed out. The result was more black men in prison than in college. Now treatment is the preferred response. But, increasingly, he said, more white guys are landing in prison due to meth. "If we separate ourselves based on the drug then we look at the non-commonalities. All of these drugs are addictive. Treatment is good for all dependencies," Hayden concluded.
Back to the GMHC Treatment Issues July/August 2005 contents page.
A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information! This article was provided by Gay Men's Health Crisis. It is a part of the publication GMHC Treatment Issues. Visit GMHC's website to find out more about their activities, publications and services.


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This seminar is the first part of a two seminar session.
Abstract: Transportation systems are rather complex organizations which involve a great deal of human and material resources and which display intricate relationships and trade-offs among the various decisions and management policies affecting their different components. The freight transportation industry must achieve high performance levels in terms of economic efficiency and quality of service. Economic efficiency has always been a main goal because a transportation firm has to make profits while involving in an increasingly open and competitive cost-driven market, where cost is still the major decision factor in selecting a carrier or distribution firm. Service network design, as part of the tactical planning process in transportation systems, aims to ensure that the proposed services are performed as stated and customers' requirements are satisfied, while operating in a rational, efficient, and profitable way.
This research looks at a stochastic, time-dependent, capacitated, multi-commodity service network design problem in which periodic, cyclic schedules are built. We find and illustrate the underlying structures of stochastic solutions by studying the optimal solutions to the stochastic network design problem and comparing them with deterministic counterparts. To achieve this, the following issues are addressed: Why does the solution select one particular route rather than others? What drives the solution to add/drop a service? Structural properties that characterize the stochastic solutions are found when addressing these issues and are then used to develop a pair-wise heuristic algorithm. The heuristic approach systematically increases the flexibility of the solution to hedge against demand uncertainty, and gradually nudges the solution towards having a more hedging and consolidation-based structure, which is more suitable in the stochastic environment.

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I am an old car mechanic, and would like to have some car related things to design in the logos...:image28:
Denny, a great place for free images of cars, trucks, motorcycles and tools are dingbats. Dingbats can be found on font sites. There is at least a dozen auto/transportation fonts available and some aren't even classified as dingbats but are spread between through out all the pages of fonts. http://www.dafont.com/theme.php?cat=721
They say a picture is worth a thousand words. To give you the basic idea how dingbats work see attachment...Hitting a key on your keyboard will produce an image instead of a letter . You download, unzip and install them to your system font folder. Dingbats behave EXACTLY as fonts do and all the options you can do to text you can do dingbats. Color, use all the built in text effects in TLC, outline etc. The added bonus is that dingbats are like free vector art never an unwanted background to deal with. To save you time and energy you will find a font viewer/ character map is a must. It will show you if the dingbat used upper and lower case, just lower case or just upper case. For a PC you can't beat The Font Thing and it is free and available at http://members.ozemail.com.au/~scef/tft.html It works with XP even though it doesn't say so
KD, please don't think me to dumb on this, but, I downloaded the fonts. Downloaded the viewer, which is a nice setup. But, how do I get a font into my logo design ? :image10-1: I feel dumb at this point.
Once installed into your system's main font folder you will see the preview in TLC in the system font folder. Free car clipart: http://www.freefever.com/freeclipart/transportation/car.html
I'm sorry KD, but I just can't get this to work. I installed the fonts in my system fonts. Is there something I need to change to the end of the font name ? I can only see them in the viewer I down loaded. I do not have a folder in TLC like that, (preview in TLC in the system font folder), or I'm not doing something correctly. :image10:
DW if your using a PC and not a mac, You want to install the fonts in your C:\windows\fonts...after you have done that you will see them show up in your systems fonts on TLC, Does this help? If you installed them , make darn sure they are not in their own folder in the windows Font folder, If that is the case then you are going to have to copy them over to your windows \Fonts and erase that folder.
Thanks worlock for the additional help. It's my fault I didn't mention my system. Yes, it's a PC, with windows xp pro. I unzipped the downloaded fonts into a folder. Then, installed them to the C:/windows fonts. That didn't work, so I also put them in the system32 fonts folder. I can see them there, and in the windows C fonts folder. But, I do not know how to get them into the TLC. I have 2 pictures here that I captured of my screen showing this. It's probably really simple, but I'm stumped on this. If I can't put the pictures in here, I will have to upload them to photo bucket then here, so it will take a little bit.
When I said "preview" I was describing (when you choose system fonts in TLC) what you usually see ....the font name and a sample of that the font/dingbat looks like. TLC will only use fonts in the main Windows FONT folder. It will see fonts in secondary folders but cant use them
reboot your computer then when its finished rebooting, open up TLC add a text, then look at your system fonts selector, and choose it then select your installed font you want to use, They will show up! and then you can use them now! Also see this post: http://www.logodesignforum.com/forums/showthread.php?t=8635
OH...I got ya now. Yes, I see what I'm doing wrong. I'll be right back after re-boot. That slipped my mind totally. You have to have the text there before you can change it. Yes KD, I have a desktop PC. Be right back. I really appreciate the help also.
Hey DennyW would you be interested in testing something for me? It deals with vehicles and is for TLC.
worlock, and KD. Thanks VERY MUCH for the help. Once worlock mentioned what he did, the light bulb went off, and bang, I got it. guys are great !!! I know I have to separate the combo fonts, but they are all there, and showing up now. ps: The funny thing is, I have done this more than once. My mind was just on Blank mode.... Sure Chris, what do you have ?
I have a TLC add on pack I designed that has 3 automobiles, 1 motorcycle in it. It is far from finished but you seem like a good person to test it out for me. Would you like to? I can setup a download link for you to download it if you want to. Don't worry it is a self installing file as long as you have the latest version of TLC.
Sure. I do a lot of pictures, avatars, animated gifs, and have been helping with logos for my friends sites. I recently started up my own automotive forum, which I probably shouldn't put the link here since it doesn't relate to TLC. I made the logo for that also. I enjoy working with pictures and things. I just turned 60, and the computer is about all I have left. The reason for the automotive forum, to help teach those that want to learn. :image28: Here's the link to that, which you can remove. I just thought you guys here might want to take a look. http://dennyscartalk.phpbb3now.com/index.php?sid=a5ef6f1c2748e88817574f07fb3eab4b Oh, I have version 5.1.
Ok Chris. Here is my first one. I'm partial to Mustangs. I have a couple side notes, which I can pm you on for this. I think it would be a benefit.


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A small selection of work I've done in the past. Click to view more.
Websites I've worked on recently. Some are completely mine, (design and development) and some are strictly front-end development only (existing design). Click for more.
Would you like to reach me? Ask me a question? Have a project I can assist you with? Then just click here.
A little bit more about me. Click here.


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BP Comment Quick Links
November 6, 2008 Transaction AnalysisAL Addenda
Signed RHP Sergio Mitre to a one-year minor league deal with a team option for 2010. [11/3] Mitre's deal is a split contract, where his compensation will be $1.25 million if he's on the big-league team; since he'll be on the DL until sometime in June or July recuperating from Tommy John surgery, the real key here is the club option, making this sort of similar to the decision to sign Jon Lieber in February 2003, knowing that his real value to the team would be in 2004. Add in the personal familiarity that comes from Mitre's pitching for skipper Joe Girardi's Marlins in 2006, and it adds up to a decent minor gamble for a filler pitcher for the back end of the rotation down the stretch next year, and potentially earning that role with the 2010 team. It isn't often that you see the Yankees go down-market, but it's as sensible for them as it is for anybody else. As for Giambi and Pavano, neither became ex-Yankees cheaply, as it cost $5 million to make Giambi go away, and $1.95 million to bring to an end their initial four-year engagement with the pitching mound's answer to Amy Winehouse (at least in terms of a remarkable capacity to miss appearances).
Outrighted INF-R Donnie Murphy and RHP Kirk Saarloos to Sacramento (Triple-A). [10/3] Ellis' career has been blighted by what I like to call Saberhagen's Arrhythmia, a plight where the guy's performance veers from one extreme to the next, going from valuable asset to problem from year to year. In Ellis' case, the peaks and valleys seem to have been dialed back down to a teen-points decline, not as severe as the nearly 50-point drop-off that made the 2006 hangover from his comeback season in 2005 that much more nasty. Inconsistent second basemen might seem something of an organizational norm for the A's: going all the way back to the slick-fielding Dick Green and the disappointments that followed his career year in 1969, A's fans have also had to ride out the occasional brilliance and more frequent frustrations of their keystone crop over the years. The erratic fragility of Tony Phillips provided the team with flashes of defensive gifts afield and leadoff ability at the plate, a spread of skills marred by an inability to stay healthy playing up the middle on an everyday basis; to make things a little more interesting, there was also some hopscotching by the nimble Mike Gallego from utility to flailing despair and back again to make even the alternatives exciting. (Gallego's lovely little '91 season took him to the Bronx for Bomber bucks a-plenty, but who could begrudge him that? He'd be back, as he is yet again as the team's new third-base coach; sadly, he's just not as acrobatic in the coach's box as he was around the bag.) The brief, embittering wishcasts of the "Brent Gates Era" certainly didn't provide an answer. All of which brings me to this perhaps-surprising proposition, that to some extent Ellis might rank as the best second baseman in Oakland A's history, not too shabby for a guy who was the throw-in on the deal that made Ben Grieve and Angel Berroa other people's problems. Admittedly, it's a field populated by the only occasionally effective, sort of a rogue's gallery no different than similar lists of Cubs third basemen between Ron Santo and Aramis Ramirez (to use another team with a problem that's spanned a similar length of time). Since we're "only" talking four decades, I guess it's not that surprising. None of which addresses the more basic question of whether Ellis is worth this many pennies. He should be recovered from the labrum surgery that shut him down early in plenty of time for spring training, and I suppose it isn't unreasonable, even in the face of his performance swings-a review of last year's long-term forecast suggests performance parameters that are worth it financially, and if he has one more year like 2005 or 2007 in him in the next two, it's that much more worthwhile. In the near term, if he proves that he's healthy and productive next year or in 2010, he'll be an affordable commodity in barter, enough so that I'm not really worried about his standing in the way of Adrian Cardenas or eventually Jemile Weeks. This also keeps things simple as far as what Cliff Pennington or Gregorio Petit are for-to fill in at short after the next Bobby Crosby injury, and to challenge Crosby if he afflicts the organization with more of the same punchlessness. The other move to like here is nabbing the current reigning underutilized professional hitter capable of doing his team some good; face it, if you were going to name a team likely to take a chance on Dillon, the A's would almost certainly rank towards the top of the list. That said, let's stop short of ranking this with the initial rescue of Matt Stairs-the Wonder Hamster was 28 when Beane "discovered" him, while Dillon is already 33-but even so this is an especially nifty little move because of what it does to address multiple needs simultaneously. Dillon isn't a good third baseman, for example, but he can play the position, and for any team employing Eric Chavez, that kind of flexibility comes in handy. Whether as a right-handed alternative to Chavez at third, Daric Barton at first, Jack Hannahan when- and wherever, or as an upgrade on Emil Brown to mix and match with the team's squad of lefty-batting outfielders, Dillon represents a sometime platoon hero, an effective roster space-saver, and thus the likely guarantor of the roster spot for some 12th pitcher TBD. On the other hand, his positional flexibility probably means a Sacramento summer for Matt Murton, among others, especially if Bob Geren decides to retain both Dillon and Hannahan. As for losing Dan Meyer to the Fish, let's just anticipate that if Brad Pitt has to do any Tim Hudson-related scenes in the screen adaptation, we'll see either his frowny-faced Achilles glumly pouting through a bad day at the office, or a flash of Chad Feldheimer ex machina by way of explanation. While the real purpose of the deal was to save money spent in other areas-all the better to afford the expanding paydays of Eric Chavez, for example-the fact that Meyer, Charles Thomas, and Juan Cruz (flipped for Brad Halsey in an equally unhappy exchange) didn't really do the A's a whole lot of good hardly helps burnish anyone's image.
Declined their club options for 2009 on DH-L Cliff Floyd and LHP Trever Miller; outrighted C-R Michel Hernandez to Durham (Triple-A). [11/3] While everyone understands how Floyd and Miller were brought in to provide veteran leavening, there comes a point where you can recognize that you've already got a loaf. Between the notable lack of a regular right fielder and Floyd's persistent problems with health, there was no real incentive to keep him, not even at the relatively modest price of $2.75 million. There's not much more than a shadow of his former greatness left to him, and as Eric Hinske (also now a free agent) proved handily, you don't always have to spend seven figures to get solid production from a slugging slot. The money saved can instead be added to the money saved by letting Rocco Baldelli slip into free agency as well to better address the twin holes in the lineup, right field as well as at DH, in a more lasting manner. Pace Miller, because when you've already got a premium lefty in the pen in J.P. Howell making less than market rates, why pay $2 million for an aging, moderately effective second lefty? Whether you want to attempt to repeat the success enjoyed with Howell by taking a look at James Houser in a relief role, or betting that you can patch that slot-only if you really feel it's necessary-via some sound scouting and/or minor league free agency and/or the Rule 5 draft. Regardless, it's better to have the money in the till, because Miller, like Floyd, is the kind of player you fall into if your other plans don't pan out. This early in the winter, it's better for the Rays to have possibilities and money than to lock everything down. As for Hernandez, the former Cuban "it-boy" must-have backstop prospect did not end up appearing in a single post-season game. Even so, credit the Rays for bringing him in at the end of August (as well as Jorge Velandia) to add insurance at a couple of skill positions up the middle, effectively as a roster prophylactic anticipating the very scenario that they ended up having to deal with-losing one of their catchers, in this case Shawn Riggans, with a knee injury that didn't heal up in time. Riggans will be fine next year, so this temporary inconvenience was really a matter of poor timing, but the front office did its job in gaming the situation, and Hernandez did his by knowing how to don the tools of ignorance.
Claimed RHP Dirk Hayhurst off of waivers from the Padres; designated 2B-L Kevin Melillo for assignment (and subsequently outrighted him to Triple-A). [10/6] If you're thinking the Jays are increasingly desperate for pitching and grabbing every Quad-A hurler with decent command and modest stuff, then you and I share a command of the obvious. A staff reliant on Hayhurst and Bullington or Jimenez and Walrond isn't going to go far, but with Shaun Marcum out for most of 2009, Dustin McGowan, Jeremy Accardo, and Casey Janssen all trying to come back from injuries, and A.J. Burnett pondering the rewards of defecting, there's almost no one area of the pitching staff that isn't burdened with question marks. This could end up being an infamously ugly staff by International League standards if the Jays don't win a few rehabilitation campaigns this winter, to the point that a last-place finish might not be all that improbable. All of which might help explain a readiness to accept Barajas' brand of adequacy as a regular catcher. Catching is one of the few areas the Jays have some talent on the way up, but spending $2.5 million for a decent placeholder isn't a bad investment, especially if J.P. Arencibia proves ready at some point next season, potentially freeing up Barajas for a deadline deal. I know that it would be more sabermetrically orthodox to lament the decision to not employ Gregg Zaun to better effect last season, but he's never really earned much respect for his work behind the plate, he'll be 38 next season, and what would be the point of keeping him? Having elected to prefer Barajas, Cito Gaston's sticking with a more transparently catch-and-throw type, and on a staff likely to suffer from more than a little turnover, I can't say I blame him. If this makes space for Curtis Thigpen to put up or shut up in the reserve role in the early going, that's not the worst use of roster space. If there's an interesting minor pickup, it's the decision to give Loewen a shot as a hitter. The Canadian was a highly-regarded hitting prospect as an amateur, rating as a "borderline first-round talent" according to Kevin Goldstein, playing first base and batting cleanup for Chipola College, a juco powerhouse in Florida, on the days he wasn't pitching. This is also the upshot of the revelation that if Loewen had tried to continue pitching, doctors anticipated that he'd just continue to fracture his left elbow. The Jays immediately sent Loewen to Hawaii to play some winter ball and get back into the grind of hitting every day; six years is a long time, after all. It's an experiment to see if there's value there to recapture, but as Rick Ankiel signally demonstrates, it's worth taking these sorts of shots, on the off chance that you wind up with a slugger from nowhere.
Christina Kahrl is an author of Baseball Prospectus. 12 comments have been left for this article.


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Get Trained© is a program intended to be used as a tool and resource for scripted training of unlicensed school staff to administer epinephrine via an auto injector during an anaphylactic emergency. The program recommendations and content are based on best practices. Each school nurse must exercise independent professional judgment when practicing and conducting training. Because nurse practice acts differ from state to state, each school nurse must ensure before presenting the training that it is consistent with applicable state laws and regulations, including those governing delegation, as well as applicable school district policies and procedures.
The Get Trained School Nursing Program is only intended to provide training to unlicensed school staff to administer an epinephrine auto-injector.
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Designers of a superlarge planetarium transferred data from an astronomy program into their CAD software as a means of locating 4,000 stars on a dome's surface.
The CAD software, KeyCreator from Kubotek USA, Marlborough, Mass., also helped Spitz Inc., Chadds Ford, Pa, modernize production. The aluminum tubes that frame the dome can now be drilled prior to being rolled to needed diameters. This eliminates the need to hold the tubes with special straps while being drilled. Manual drilling was slow and imprecise, and demanded hands-on attention from the manufacturing team.
The Spitz design team now generates models which are exported as IGES files to the manufacturing team which uses the data to guide NC machines.
Kubotek USA, (508) 229-2020, kubotekusa.com, Spitz Inc., (610) 459-5200, spitzinc.com


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Vivanta by Taj Panaji Hotel
3N GoaLast Booked 13 hours ago
What's Included
Destination | Nights | Hotel and Room | Meals |
Goa | 3 night(s) |
Vivanta by Taj Panaji Hotel
Deluxe Allure
Room only |
- Two way Airport Transfers by AC Coach
- 20% discount on Food & Soft Beverage (a la carte only)
- Current taxes
Hotel Overview
Vivanta by Taj - Panaji, Goa, is the new buzz in town. Where meeting has many meanings. It's close to where the river Mandovi meets the Arabian sea. Where the road leading down from the Chief Minister's residence in Altinho meets the centre of Goa's art & culture - The Kala Academy. 28 kms from Dabolim airport and bang in the heart of the city, the hotel is a smart stroll from all that is see-able and do-able in this capital city of Goa. It's where business meets pleasure. And today meets tomorrow. In rooms that spell Charm, Delight and Indulgence. Where work spaces define new standards in modern technology. A fully wired ballroom, hi-tech boardrooms, high profile meeting rooms set the Agenda for Debate, Strategy and Analysis. It's where the nouvelle restaurants, the high octane bar, and the Jiva spa will have you go. Soak in the space that's close to the business hub of Goa. Drive in from the airport delighting in backseat surprises (we're not revealing here). Better still take a speed boat or catamaran if the weather permits. You'll see how we mean business in a quiet efficient way from the moment you step in. Slowly discover the turtle theme design which to the local Hindu Goan community means good luck. And make it your business to quickly find out how fast we are up to speed. For every business need.
Hotel Highlights
- 30 km from the airport
- 1 km from city center
- 1 km to the beach
Facilities at hotel
- Air Conditioning
- Golf
- Swimming Pool
- Baby Sitting
- Airport Transfer
- Tennis Courts
- Concierge Services
- Bar
- Coffee Shop
- Restaurant
- Spa
- Pets Allowed
- Casino
- Wi-Fi
- Gym
- Room Service
- Conference Facility
- Children's Club
Cancellation Policy
- The package once booked is refundable and cancellable.
- Flight cancellation will be as per airline cancellation policy.
- Date of booking to 30 days before travel the cancellation charges will be 10% of the tour cost
- 30 to 15 days before travel - cancellation charges will be 50% of the tour cost
- 15 to 7 days before travel - cancellation charges will be 75% of the tour cost
- 0 to 7 days before travel - cancellation charges will be 100% of the tour cost. No refund shall be given
- Please note cancellation policy is subject to change. It depends on the hotel policy. In peak season, some hotels may charge 100% cancellation.
Additional Information
- Check-in at hotel starts from 14:00 hrs.
- Check-out time is until 12:00 hrs.
- Early check-in or late check-out is subject to availability and may be chargeable by the hotel.
- Once your payment has been processed, we will send you an email confirmation.
- You will receive all travel vouchers required for your flights and accommodation shortly afterwards.


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More About BESTSUSIEYET
Visit My SparkPage Send Me SparkMail
Recipes I've Shared:
Tasty mix for a summer meal. Makes 6 side servings or 3 main dish servings (nuturition calculations are for side servings)
I tried to lighten my old favorite recipe by using Smart Balance Omega3 sticks instead of butter, and dark chocolate chips instead of Hershey Milk Chocolate on top.
Adapting another recipe & turning it into a Stir Fry Meal to serve over brown or wild rice.
I adapted a recipe I've used since 1970 -- has always been a family favorite.
An EatingWell recipe (The EatingWell Diet - 2007; EatingWell Serves Two)
A simple saute of apple and cabbage is terrific on top of grilled chicekn sausage.
I adapted a Hunry Girl recipe (since I didn't have a couple key ingredients called for in that recipe).
The chili recipe I've used for years, substituting Bison for ground beef to reduce fat content. Use different beans if you don't like it spicy.
I added veggies and substituted lean turkey sausage to an old Bisquik recipe. Choose the veggies you like or have on hand. Leave out the sausage for a vegetarian dish. Calories could be reduced with the new lower-fat Bisquik (but that's not what my hubby bought). I fix for breakfast or dinner -- add fruit and/or salad.
I adapted a recipe from Taste of Oregon (Rolled French Bread). This is super easy - no kneading necessary. You CAN bake your own bread!!
My plan was to duplicate a packaged snack I got at a conference; added the dark chocolate since I've reached goal and am trying to increase calories a bit.
One of my favorite summer salads - great for picnics since there's no mayo to spoil.
This is my favorite Pork Tenderloin recipe - from Colorado Collage Cookbook. Summer (on the grill) or winter (in the oven) - add seasonal side dishes and everyone will rave!
from HungryGirl cookbook "200 Under 200"
-- Makes 4 wraps (each about 200 calories!)
This is a Supper Solutions Recipe - very good! I prepare and package 2 servings/bag. Pork marinates as it thaws, and is an easy main dish that evening.
Recipes I've Rated:
- Chicken Fajita Stuffed Peppers
- Green Chili Pork Stew
- Pumpkin-Oatmeal Chocolate Chip Muffins
- Peanut Butter Banana Bread
- Honey Garlic Pork Chops
- Protein Fudge
- Pumpkin Chocolate Chia Seed Pudding
- Olive Garden Style Chicken Gnocchi Soup
- Cocoa Meringue Shells
- SF FF Hot chocolate mix
- Rhubarb Custard Cake
- Slow Cooker Lasagna
- Roasted Butternut Squash Soup
- Red Velvet Oatmeal Cookies
- Autumn Harvest Bake
- FANNETASTIC FOOD'S Cinnamon Raisin Almond Balls
- Bison Mini-Meatloaves
- Whole wheat buttermilk drop biscuits (dough)
- Blueberry Sorbet
- Applesauce Oatmeal Muffins
- Crustless Strawberry Pie
- Taco Soup
- Grilled Vegetables with Pineapple
- Baby Artichokes with Creamy Horseradish-Dill Dip
- Low-Fat Spinach Lasagna
- Spinach-Berry Salad
- Zoom Breakfast Granola
- White Chicken Chili
- Best Pork Green Chili
- Upside Down German Chocolate Cake
- Zesty Bean Soup with lime and Salsa
- Chocolate Zuchinni bread
- Homemade Turkey Soup
- Roasted Tomato & Black Bean Soup
- Black Bean Brownies
- Strawberry Smoothie
- Eggplant Stew
- Chocolate Covered Pretzels
- Eggnog- HungryGirl's No-Nonsense Nog!
- Cranberry Apple bread
- Spiced Cranberry Pears
- Roasted Pork Chops with Sweet Potatoes & Apples
- Grandma Lasley's Rice Pudding
- Zucchini Bread with a twist
- Pumpkin Custard
- Quaker Oat Bran Muffins
- Italian Turkey Sausage Marinara
- Yellow Squash Bread
- waffles whole wheat oatmeal
- Shrimp Scampi with Zucchini
- Cottage Cheese and Noodles
- Blueberry Flax Seed Muffins
- Easy Zucchini Parmesan
- peach ice cream fat free no added sugar
- Oatmeal & Spice Muffins w/ Peaches
- Stuffed Zucchini Boats
- Peach Crumble
- Summer No-Cook Oatmeal
- Roasted Red Pepper and Tomato Soup
- Tuna and White Bean Salad
- Mandarin Orange Cake - Low Fat
- P.F. Changs Chicken Lettuce Wraps w/ Special Sauce
- Strawberry Cheesecake Shake
- Spinach Chicken Pizza
- Pomegranate-Ginger Spritzer
- Healthier Version of Amish Friendship Bread
- Cheesy Vegetarian Sweet Potato with Beans
- Skillet Lasagna
- Baked French Fries
- Baked Homemade Granola
- Breaded Baked Chicken nuggets
- Honey Flaxseed Whole Wheat Applesauce Waffles
- Mango Black Bean Salad
- Quick Chicken-Corn Chowder
- Pacific Sizzle Salad
- Sweet Potato and Black Bean Burritos
- Chicken Lemon Orzo Soup
- Stuffed Bell Peppers
- Potato soup
- Breakfast Bread Pudding
- Whole Wheat/ Wheat germ Blueberry Muffins
- chicken enchilada casarole
- Herb Roasted Sweet Potatoes
- Perfect Pasta Primavera


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It's that time of year again. The 2013-14 school year is winding down at Corona Centennial High School but football coach Matt Logan is ramping up preparations for the Huskies 2014 football season.
For Logan and his record-setting Huskies the 2013 season might not have ended the way they wanted but the bigger take away for Centennial football is that many of the components of that prolific offense are gone.
Knowing he'd have to retool the offense for the upcoming season, Logan must have thought, 'Why stop there, we should ramp up the strength of schedule too.' Throw in some new uniforms and a possible CIF-SS Division change from Inland to Pac5 and one of the most dominant football programs in Southern California (if not the state and/or nation) is doing what it does best - move forward.
"That's one of the great things about high school football, Every year is different," Logan said.
Entering his 22nd season of coaching, 19th at Centennial and 18{+t}{+h} as the Huskies head coach, Logan is preparing for likely the biggest boost in competition the program has seen in some time.
In five preseason games, the Huskies will face four Pac 5 teams â" Santa Ana Mater Dei, Orange Lutheran, Long Beach Poly and La Puente Bishop Amat â" and the Maxpreps No. 17{+t}{+h}-ranked team in the country, Las Vegas Bishop Gorman.
"We will see what were made of that's for sure," Logan said. "We'll have some growing pains in there too. Weâre going to learn a lot.
"That's the best thing about a tough schedule, when you play good people you find out who you are right away.â
If the preseason schedule doesnât raise Centennialâs level of competition enough for fans and observers, a rumored proposed change in CIF-SS football Division placement will. Logan confirmed whatâs been bandied about for some months now â" the Big VIII will likely change from the Inland Division to the Pac 5.
"I think that will be the case this fall," Logan said. "We'll find out in little less than a month when they make the ruling.
"Who doesn't want to compete at the highest level. If that's the best division, who doesn't want to compete in it."
And, to get to that next level, Logan knows heâs going to need a quarterback.
With the graduation of two-year starter Robert Webber, the four-player competition for the quarterback position will be interesting. Logan says heâs got four vying for the spot but among them arenât many varsity snaps.
"We will be new at quarterback and have four kids will be competing for it," said Logan. "Knock on wood, whoever takes the job or if its by committee, they can step in and run the offense the way we expectâ¦and have success."
Many would scoff at that statement if it had been from any other coach, but Logan is in a different position. To say that Logan has an eye for quarterback talent is an understatement.


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Blessed Damian dei Fulcheri
Also known as
- Damian of Finario
- Damian of Fulcheri
- Damian of Finale
- Damian of Finarium
- Damiano
- Damianus
Born to wealthy Italian nobility. When he was kidnapped as an infant by a mentally ill man, his parents prayed fervently to the Virgin Mary for help; searchers were led to his hiding place by a miraculous light, and the baby was returned unharmed. Damien joined the Dominicans at Savona, Italy. Priest. Famous preacher throughout Italy with hundreds converted during his missions. Known as a miracle worker in life, there were miracles reported at his tomb, and he became the object of popular devotion almost immediately on his death.
- at Fulcheri, Liguria, Italy
- 1484 at Modena, Reggio d'Emilia, Italy of natural causes
God of truth, for the salvation of the faithful you endowed Blessed Damian with wondrous virtues and powers of speech. Through his prayers may we hear your word with an open heart and hold fast to it with patience. We ask this through our Lord Jesus Christ, your Son, who lives and reigns with you and the Holy Spirit, one God, for ever and ever. – General Calendar of the Order of Preachers
MLA Citation
- "Blessed Damian dei Fulcheri". CatholicSaints.Info. 20 March 2015. Web. 27 March 2017. <>


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CAMDEN, N.J. (AP) — A reputed southern New Jersey street gang leader who admitted leading a narcotics network in Camden has been sentenced to 15 years in prison.
Prosecutors say 29-year-old Kyle Ogletree of Camden was among 14 people arrested in 2011 after a joint investigation by local, state, and federal law enforcement agencies.
Ogletree must serve nearly 13 years of the sentence imposed Friday before he becomes eligible for parole. He had pleaded guilty in February to racketeering charges.
Ogletree's uncle, 35-year-old Philadelphia resident Sean Ogletree, was also sentenced Friday for his role in the network's operations. He had pleaded guilty to a lesser racketeering count and was given a seven-year term.
State authorities say most of the defendants accused of roles in the drug network have pleaded guilty.
NJ narcotics network leader gets 15-year sentence
May 5, 2013 at 5:40 PM
May 5, 2013 at 5:42 PM


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Elegant oleander petals surround centered gemstones, making this pair a verdant addition to your jewelry box.
Round Diamond
Round Yellow Sapphire
null / null
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ABERDEEN – A Tennessee man died Wednesday in a two-vehicle accident on Miss. Highway 25 South of Aberdeen, about two miles south of Miss. Highway 382.
Gerald Bailey, 44, of Franklin County, Tenn., was killed while traveling north on Highway 25. Bailey was driving a 2007 Volvo tractor-trailer.
The second vehicle was a 2001 Ford Escape driven by Jan Herbert Krummrich, 71, of Aberdeen. He was traveling south on Highway 25.
Details of the accident were not released immediately.
Krummrich was taken to North Mississippi Medical Center in Tupelo. The crash is still under investigation by the Mississippi Highway Patrol.
NEMS Daily Journal


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Sunday, March 11, 2007
Babes in Bumland
One of them has now set up a Coleman tent on the sidewalk in the alley. Every man's home is his castle. It is no mean trick to be a homeowner with real estate in this city of obscenely inflated housing prices. I can't manage it myself.
Attracted by the sound of my engine, he lifted the canvas flap of his castle and scuttled over. I had no money, having just engaged in a cash transaction with some Girl Scouts in my neighborhood. Girl Scouts do not take credit cards for cookies. I told him that I would take care of him when I returned. After I had completed my errands, I went to an ATM to get bum money. Then I had to spend some to get change because I was damned if I would give him the whole $20. If I am going to spend $20 on liquor, Flip is going to drink it.
I went to the Godiva store and bought myself a diabetic coma. When I returned to my car, a different person of the homeless persuasion approached me for a payoff. I figured he was the other guy's lawyer. As I attempted to get money out of the tiny pocket of my jeans without tweezers, the first watchman slithered out of his tent and reminded me that he was the one guarding my car. I knew that. Contrary to what he may think, all persons of the homeless persuasion do not look alike to me. I inched a few bills out of my pocket and handed them over. Yes, it's graft. He is probably a politician who works for the state. A public servant. But his prices are not as high as the parking garage. However, all was not well in Bumland. He chastised me for not giving his friend money, too. I told him it was all I had. (I had eaten a lot of chocolate. Dark chocolate over candied orange peel. And some truffles. And something else they gave me for buying three truffles.) I like chocolate.
Flip suggested that we buy a case of vodka and take it to the tent dweller.
"Are you expecting a dinner invitation?" I asked. He assured me that he wasn't. He just thought it would be a nice thing to do. Flip would give away the clothes on his back if allowed. He has always been so generous that it makes me feel stingy by comparison. I stopped storing quarter rolls in the car after watching him scoop out handfuls at red lights for people who were too drunk to stand up. I feel bad for those less fortunate. I do. But if we run out of quarters, we cannot park our car at meters and there is almost no unmetered parking in the city. Parking tickets are ubiquitous and obscenely expensive.
I would gladly buy a meal for someone who needs one, and have done so many times. But I cannot bring myself to donate money for booze or drugs. Flip assured me that he wouldn't buy the most expensive vodka. Which was not exactly the point. I told him we were making assumptions. They probably are all drunks, but with so many vices to choose from, we don't know for sure which particular one did them in. I may not choose to give them all our money, but I don't want to hurt their feelings either. If I were a crackhead, for instance, and someone offered me liquor, I would be offended. And vice versa. I think you need to know what people really like if you are going to bring them a hostess gift.
28 comments:
- thethinker said...
My teacher gives them fruit.
They ask for money, and she gives them fruit. Healthy, and it doesn't support their addictions.
Sometimes I wonder if any of them actually eat the fruit. - 11:21 PM
- heartinsanfrancisco said...
So that's what that mushy, rotten-smelling stuff all over the street was. - 11:29 PM
- Pickled Olives said...
Bum money in the alley, a small price to pay to live in SF!!
- Odat said...
You're a braver woman than I. I would never leave my car for a "bum" to watch. Here in NYC there probably would be nothing it it when I got back.
Peace - 6:44 AM
- Thailand Gal said...
I do think it was a bit nervy for the guy to chastise you for not sharing money with his friend as well. Street loyalty is a real driver, I suppose, but it was still nervy.
The fruit idea is a good one.
~Chani - 7:43 AM
- Open Grove Claudia said...
Boy, I remember this and I haven't lived in the Bay Area for almost twenty years! In fact, I never, ever carry cash because of these interactions. It annoys my friends but I learned my lesson all those years ago.
I donate to the Samaritan House and the Denver Mission to alleviate my guilt.
But that won't save your car.... - 8:06 AM
- Lee said...
I remember San Fran having one of the worst homeless problems I've ever encountered. I agree that a case of vodka may do more harm than good.
Once, in NYC with my kids, a guy stepped on the subway car with us and asked everyone very nicely for any change or food. We had just finished lunch and Quirky-son was carrying the leftover half of his sandwich. I looked at him and his big eyes and asked him if wanted to give it to the guy. He nodded emphatically and ran it over to him. He cried the rest of the trip. His heart was broken. - 8:25 AM
- heartinsanfrancisco said...
That's what I think.
I would prefer that they not "watch" it, but it's their alley. I'm the intruder.
Fruit is a lovely idea, but it isn't always convenient to carry around a sack like Johnny Appleseed.
I hardly ever have cash on me because spending plastic is less painful. I wonder if the alley men take checks. (Which I also never carry as credit cards are quicker.)
That's a wonderful story. I think that child is destined for greatness. No, wait. He's great now. I meant that one day, everyone will know how great he is. - 8:39 AM
- mist1 said...
If it would make Flip happy, I would appreciate a gift of vodka. I don't live in a tent, but sometimes, I make a fort out of sheets and my dining room table.
- goodthomas said...
We have a lot of issues here in Chicago, but I cannot recall ever paying a homeless guy to park in an alley. I love the idea of that actually, in a "not right" kind of way.
I also love the rest of this story -- especially the fact of going to an ATM, getting change for a $20 by buying chocolate (a lot of chocolate) and then not having enough to grease all the palms looking to be greased.
So. . . what kind of Girl Scout cookies did you get? - 9:55 AM
- heartinsanfrancisco said...
And you bathe, too.
A girl can't have too many forts. Or too much vodka.
Well, it is possible to park there w/o all the greasing. I have perfected the art of saying "I don't speak English" in many different accents.
But in a not-right way, it wouldn't seem right to ignore them on their own turf. And it IS theirs == squatters' rights.
Do-si-do's, the new little brownies (which kind of suck) and the things that look like Mallomars but w/peanut butter inside. And that was only Round 1. - 10:13 AM
- Ryane said...
see, now--in DC, they would watch your car for you, too. All the way to the other side of town, where it could be stripped for parts and sold off piecemeal. haha.
- heartinsanfrancisco said...
You made me laugh. In fact, I am always surprised when I return to find my car still there, windows and trunk intact, etc. (I'm from New York.) - 11:49 AM
- Christina_the_wench said...
In Detroit, our homeless people just shoot you and take your money AND chocolate.
Stay far, far away, heart. - 11:55 AM
- jali said...
I have homeless "buddies" that I see when I take the bus and train. I try to donate a little something to the cause, but if I don't have cash, the guys are still pretty nice to me.
I've had homeless watch my car on Empire Blvd in Bklyn - not too expensive and my car was safe. - 1:59 PM
- heartinsanfrancisco said...
Oh, no, not the CHOCOLATE.
I give them credit for seeing a need and creating their own jobs. I'm sure there must be a corporate term for that. - 4:03 PM
- MsLittlePea said...
My Grandma used to give them sandwiches.
My friend's car got broken into after she paid a guy for "car watching" services. He said it happened while he was on his break.
If I were a crackhead, I would be offended if someone gave me vodka too. - 5:07 PM
- The Law Fairy said...
Oh man, heart. Candied orange peel dipped in dark chocolate is one of my favorite things in the world. Thanks to you, I might have to stop at Godiva before I head home tonight. And I really had hoped to kind of get back on the diet wagon...
I've given a fair deal of money to the homeless every so often. Yeah, a lot of them are probably going to just spend it on alcohol, and maybe they're even lying about their sob story. But I guess my feeling is that, as far as God is concerned, my responsibility is only to show compassion. Random Homeless Dude #7 is responsible for what he does with that compassion. I only have to worry about my actions -- he can answer to God/the powers that be/Shirley MacLaine himself. Which in a bizarre way is completely selfish. Ah, the paradox of do-gooditude. - 5:11 PM
- Jocelyn said...
I just really like you and your sensibility and your important love of chocolate.
I hadn't realized how much I was missing the word "graft" until I read it here. And I would love to know what dinner you'd be served if you ever do score that dinner invitation... - 6:22 PM
- My heart runneth over... said...
It's difficult passing somone by like that. My heart usually hurts when I see someone like that. I like to buy them food when I can. Worse is when you see young kids living that way. I'm back. Sorry I was away for so long. Glad to find you well. All the best, M.
- CSL said...
I nealry got side-tracked by the dark chocolate over candied orange peel and truffles bit. Godiva - a gift from the gods. I remmebr a homeless and obviously stoned man follwing us in San Francisco and shouting to my kids, "Your Daddy's a faggot!" My younger son (who was 8) thought he'd said "fathead," and we didn't correct him.
- heartinsanfrancisco said...
Sweet Pea,
On his BREAK? Oh, give me a break. I'd say he was a bum of small conscience.
Law Fairy,
Sorry I've corrupted you. They may not have any left, you know. I was pretty thorough.
I do believe that our karma depends upon our actions, not effects of them over which we have no control. Of course, Shirley might disagree. You should probably ask her and not take the word of a person in a dark chocolate frenzy.
I really, really have no taste for dumpster food, so don't hold your breath on this.
I hate to think of the way these people live, but I remind myself that it is usually their choice.
I really like you, too. Would you like a chocolate or ten?
I'm so glad you've come back. I missed you.
Homeless folks with children is a whole other topic. It's just so unspeakably wrong.
Some of them, like anyone, can get hostile. Most are self-medicated into passivity, though. I don't feel threatened, except olfactorily. - 7:03 PM
- velvet girl said...
Ooh, chocolate. And vodka. ;)
After being finacially challenged while living in Philly after college and being pan-handled by bums who made more in a day than I did (and tax free), I got a bit hardened to the whole begging thing.
One particulary starving day, I passed a beggar (his schick was calling out "quarter! nickel! dime! dollar!" in whatever order amused him) who berated me for passing him by on my way to work every day and not giving him anything... I growled for him to "get a job!" (remember that I was very hungry at the time) and he replied, "Baby, this is my job!" Grrrrr.
Since that day, I'll only give money to people who are genuinly trying to work for their money, be it an attempt at entertaining (no matter how bad it is... at least they're making an effort to earn it) or offering some sort of service, like your "parking attendant".
-velvet - 9:25 AM
- heartinsanfrancisco said...
"Parking attendant" is the perfect job description. So much classier than "Panhandler." It's good to see the American work ethic at work.
I used to feel guilty when I saw people begging in the streets, and still have to fight that feeling as I remind myself that I work for my money. If they are able-bodied, they can do the same. I do understand mental disability, but if they're strident and act entitled, I'm less likely to be generous.
I also consider street musicians workers, and donate what I can to them. - 11:10 AM
- PARLANCHEQ said...
Great story. You mention that you don't like to buy booze for a homeless person but you will gladly buy a meal. Does that include liquid lunches? ;)
- heartinsanfrancisco said...
You don't mean Slim Fast, do you?
I didn't think so. :) - 11:33 PM
- zorak163 said...
I usually give the homeless bagels and bottles of water. If one of them ever actually said that they needed money for a drink I might then be tempted to give it to them because of the honesty. Otherwise it's non-cash donations only from me.
- heartinsanfrancisco said...
Once in a while, I see somebody with a sign that says, "Why lie? Need a beer."
And that is irresistible.
The all-night pharmacy in my neighborhood has a large population of sidewalk dwellers. My favorite is the one whose sign asks for "Just 23 cents." Who is going to demand change of a quarter? I think he deserves something, too, for his ingenuity in a competitive market. - 1:07 PM


text:
/// Catalonia Woos Hollywood With New Incentives
MADRID — Barcelona is coming to the table. Having born the brunt of a double-dip recession, on Friday a delegation from Catalonia, boasting Barcelona as its capital, will present at the Hotel Andaz in West Hollywood what Spain's most modern region can offer to Tinseltown. A dinner cocktail, washed down by Codorniu and Gramona cavas,… Read more


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A thinking mind. I can respect any change in opinion or policy if it was preceded by thorough research and an effort to deeply understand the issues. Leaders should have not only the ability but also the desire to look at things differently when new facts arise. To me, a shift is a sign of an energetic intellect.
Catherine S. Vodrey
East Liverpool, Ohio
An open mind and a tolerant attitude. You should have faith in your convictions but not be blinded by them. In other words, be like the Dalai Lama. He has met and talked with countless public figures and has shown respect to each and every one, regardless of their politics.
Rhi Cook
Tempe, Arizona
Practicing humility—that is, serving your people rather than insisting that they serve you. My dad has been a pastor and a counselor for more than 30 years and has raised eight children. In all that time, I've never seen him too busy to lend an ear, offer a piece of advice (when asked), or give a helping hand. A true leader is not known for how great he is as an individual but rather for how greatly he aids the people around him.
Grace Velasquez
Salt Lake City, Utah
A willingness to get in the trenches with underlings. In college, I worked in a deli. When my boss saw that we were slammed, he would come behind the counter and ask, "OK, what do you need me to do?" Through this offer, he let us know that he didn't consider himself "above" our tasks. It's amazing how such a simple act can generate team morale and enthusiasm.
Heather Solsvik
Coeur d'Alene, Idaho
The best leaders have the ability to express kindness and sympathy. My last two managers (both at a financial institution with more than 60,000 employees) took the time to get to know me as a person, to find out what motivated me, and to show that they cared about my personal and professional development. When it comes to bosses, it really doesn't get better than that.
Lindy Vaught
Indianapolis, Indiana
I would say decisiveness coupled with wisdom. Throughout history, the most influential leaders—President Franklin Delano Roosevelt among them—proved to be strong decision makers. I have more admiration for someone who makes a poor call and learns from it than for someone who never makes the call at all.
Jen Ko
Foster City, California


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CAIRO (AP) — Egypt asked the United States to push Israel to stop its offensive against Hamas militants in the Gaza Strip, warning that the violence could "escalate out of control," the Foreign Ministry said Thursday.
Foreign Minister Mohammed Kamel Amr spoke with U.S. Secretary of State Hillary Rodham Clinton late the night before, asking for "immediate U.S. intervention to stop the Israeli aggression," the ministry said in a statement. The call came after Egypt recalled its ambassador to Israel to protest the offensive.
Israel barraged the Gaza Strip with airstrikes and shelling Wednesday and killed the Hamas military chief in a targeted strike, launching a campaign aimed at stopping rocket attacks from Islamic militants. The assault killed 10 other Palestinians, including two children and seven militants. On Thursday, militant rockets fired into Israel killed three Israelis, raising the likelihood of a further escalation.
Amr told Clinton that if Israel's offensive does not stop, "matters will escalate out of control" and asked the U.S. "to use what contacts it has with Israel."
President Barack Obama on Wednesday spoke with Egypt's Islamist president, Mohammed Morsi, as well as Israeli Prime Minister Benjamin Netanyahu, expressing his support for Israel's right to self-defense and saying Hamas rocket fire must end.
Egypt asks US to stop Israel's Gaza offensive
Nov 15, 2012 at 5:24 AM
Nov 15, 2012 at 5:24 AM


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Look of the day
May 15, 2012
Dakota is wearing the CRYBABY sheer licorice dress with a pair of platform espadrilles. She is also wearing a CULT GAIA floral crown and Illesteva Beca sunglasses. Lisa is wearing the CRYBABY crinkle dress, BLK DNM jean shirt and a pair of Spanish espadrilles.


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Nokia Ports HERE Transit to Its Asha Platform
Jan 20, 2014, 8:22 AM by Eric M. Zeman @phonescooper
Nokia today announced the availability of HERE Transit for select Asha devices. HERE Transit is the public transportation leg of its HERE mapping and routing suite of apps. HERE Transit will allow Asha device owners to plot trips via public transportation, including buses, subways, and trains. The app provides timetables, ETAs, and walking routes from transportation stations to the journey's actual end point. HERE Transit is available to the Asha 500, 501, 502, and 503. It can be downloaded from the Nokia Store for free.
more info at Nokia »
more info at Store »
Just in time...
And now, it will have HERE Transit.