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naproxen sodium(redirected from Aflaxen)
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naproxen sodium
Amerge, Naramig (UK)(Tysabri)StarlixBystolicArranon, Atriance (UK)ViraceptNeo-Fradin, Nivemycin (UK)Prostigmin
Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Nonopioid analgesic, antipyretic, anti-inflammatory
Pregnancy risk category B (first and second trimesters) D (third trimester)
Pregnancy risk category B (first and second trimesters) D (third trimester)
Pharmacologic class: Selective 5-hydroxytryptamine1 (5-HT1) agonist
Therapeutic class: Vascular headache suppressant, antimigraine drug
Pregnancy risk category C
Pharmacologic class: Recombinant humanized IgG4K monoclonal antibody
Therapeutic class: Immunologic agent
Pregnancy risk category C
Pharmacologic class: Amino acid derivative
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Pharmacologic class: Beta-adrenergic blocker
Therapeutic class: Antihypertensive
Pregnancy risk category C
Pharmacologic class: Phenylpiperazine
Therapeutic class: Antidepressant
Pregnancy risk category C
Pharmacologic class: Antimetabolite
Therapeutic class: Antineoplastic
Pregnancy risk category D
Pharmacologic class: Protease inhibitor
Therapeutic class: Antiretroviral
Pregnancy risk category B
Pharmacologic class: Aminoglycoside
Therapeutic class: Anti-infective
Pregnancy risk category D
FDA Box Warning
Drug increases risk of progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the brain that usually leads to death or severe disability.
Monitor patient and withhold drug immediately at first sign or symptom suggestive of PML.
Drug is available only through a special restricted distribution program, TOUCH® Prescribing Program, and must be administered only to patients enrolled in this program.
Unknown. Thought to inhibit prostaglandin synthesis.
Oral suspension: 125 mg/5 ml
Tablets: 250 mg, 375 mg, 500 mg
Tablets (delayed-release): 375 mg, 500 mg
naproxen sodium
Caplets, tablets: 220 mg, 275 mg, 550 mg
Tablets (controlled-release): 375 mg, 500 mg, 750 mg
⊘Indications and dosages
➣ Pain; osteoarthritis; ankylosing spondylitis; dysmenorrhea; bursitis; acute tendinitis
Adults: 250 to 500 mg (naproxen) P.O. b.i.d. (up to 1.5 g/day); 375 to 500 mg (naproxen delayed-release) P.O. t.i.d.; 250 mg, 375 mg, or 500 mg (naproxen oral suspension) P.O. b.i.d.; 275 to 550 mg (naproxen sodium) P.O. b.i.d. (up to 1.65 g/day)
Children: 10 mg/kg P.O. daily in two divided doses (naproxen only)
➣ Mild to moderate pain; primary dysmenorrhea
Adults: Initially, 500 mg (naproxen) P.O., followed by 250 mg q 6 to 8 hours p.r.n., to a maximum of 1.25 g/day. Or initially, 550 mg (naproxen sodium) P.O., followed by 275 mg q 6 to 8 hours p.r.n., to a maximum of 1,375 mg/day.
➣ Gout
Adults: Initially, 750 mg (naproxen) P.O., followed by 250 mg q 8 hours or initially, 825 mg (naproxen sodium) P.O., followed by 275 mg q 8 hours. On day 1,1,000 to 1,500 mg (naproxen sodium controlled-release formulation) P.O. once daily, followed by 1,000 mg once daily until attack has subsided.
➣ Management of pain, primary dysmenorrhea, acute tendinitis and bursitis
Adults: Initially, two 500-mg naproxen sodium controlled-release tablets P.O. once daily. Or, for patients requiring greater analgesic benefit, two 750-mg naproxen sodium controlled-release tablets P.O. once daily. Or, three 500-mg naproxen sodium controlled-release tablets may be used for a limited period. Thereafter, total daily dose shouldn't exceed two 500-mg tablets.
➣ Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis
Adults: Initially, two 375-mg naproxen sodium controlled-release tablets P.O. once daily, one 750-mg tablet P.O. once daily, or two 500-mg tablets P.O. once daily. During long-term administration, adjust dosage up or down depending on patient's clinical response. Use lowest effective dose in all patients. (Patients already taking naproxen 250 mg, 375 mg, or 500 mg b.i.d. may have their total daily dosage replaced with naproxen sodium controlled-release tablets as a single daily dose.)
Dosage adjustment
• Renal or hepatic impairment
• Elderly patients
• Hypersensitivity to drug or other NSAIDs
• Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
• Perioperative pain in the setting of coronary artery bypass graft surgery
Use cautiously in:
• severe cardiovascular, renal, or hepatic disease
• advanced renal disease (not recommended)
• history of ulcer disease or GI bleeding (use with extreme caution)
• chronic alcohol use or abuse
• elderly patients
• pregnant patients
• breastfeeding patients (avoid use)
• children (naproxen sodium controlled-release) and naproxen use in children younger than age 2 (safety not established).
• Give with food or milk to avoid GI upset.
Adverse reactions
CNS: dizziness, drowsiness, headache, vertigo, light-headedness
CV: palpitations, tachycardia, hypertension
GU: renal toxicity (with long-term use in patients in whom renal prostaglandins have a compensatory role in maintenance of renal perfusion), renal papillary necrosis
EENT: visual disturbances, tinnitus, auditory disturbances
GI: nausea, diarrhea, constipation, heartburn, abdominal pain, stomatitis, GI bleeding
Skin: rash, pruritus, skin eruptions, sweating, photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis
Other: thirst, edema, allergic reactions including anaphylaxis
Drug-drug.Acetaminophen (chronic use), cyclosporine: increased risk of adverse renal effects
Anticoagulants, thrombolytics: increased anticoagulant effect
Antihypertensives, cefamandole, cefoperazone, cefotetan, diuretics, eptifibatide: decreased response
Antineoplastics, methotrexate: increased risk of nephrotoxicity
Aspirin: decreased naproxen efficacy
Aspirin, corticosteroids, other NSAIDs: additive adverse GI effects
Clopidogrel, plicamycin, ticlopidine, valproic acid: increased risk of bleeding Insulin, oral hypoglycemics: increased risk of hypoglycemia
Lithium: increased lithium blood level and risk of nephrotoxicity
Other photosensitizing agents: increased risk of photosensitivity
Probenecid: increased naproxen blood level, increased risk of toxicity
Drug-diagnostic tests.Alanine amino-transferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydroge-nase, potassium: increased levels
Bleeding time: prolonged for up to 4 days after therapy ends
Creatinine clearance, glucose, hematocrit, hemoglobin, leukocytes, platelets: decreased values
Urine 5-hydroxy-indoleacetic acid, urine steroids: test interference
Drug-herbs.Anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, licorice: increased anticoagulant effect, increased risk of bleeding
Patient monitoring
• Monitor GI status. Stay alert for signs and symptoms of GI bleeding.
In long-term use, assess CBC with white cell differential and coagulation studies, and monitor for visual and hearing impairment and renal toxicity.
• Monitor cardiovascular status for tachycardia, palpitations, hypertension, and edema.
• Monitor blood glucose level closely in diabetic patients.
Monitor patient for signs and symptoms of serious skin manifestations; discontinue drug at first appearance of rash or other signs of hypersensitivity.
Patient teaching
• Tell patient to take medication with food or milk followed by 8 oz of water, and to stay upright for 30 minutes afterward.
• Inform patient that he may crush or break regular tablets but must swallow delayed- or controlled-release form whole.
• Tell patient that drug's full therapeutic effect may take up to 2 weeks.
• Caution patient not to exceed recommended dosage.
Instruct patient how to recognize and immediately report signs and symptoms of renal toxicity and serious skin manifestations.
• Advise patient to use sunscreen to prevent photosensitivity reaction.
• Instruct patient not to take over-the-counter medications unless prescribed.
• Tell patient to consult prescriber before taking herbs.
• Advise female patient to tell prescriber if she is pregnant or breastfeeding before starting drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
naratriptan hydrochloride
Pharmacologic class: Selective 5-hydroxytryptamine1 (5-HT1) agonist
Therapeutic class: Vascular headache suppressant, antimigraine drug
Pregnancy risk category C
Binds with specific 5-HT1 receptors in intracranial blood vessels and sensory trigeminal nerves, leading to vasoconstriction and migraine relief
Tablets: 1 mg, 2.5 mg
⊘Indications and dosages
➣ Migraine headache
Adults: 1 or 2.5 mg P.O. as single dose; may repeat in 4 hours. Don't exceed 5 mg in 24 hours; don't use to treat more than four headaches per month.
Dosage adjustment
• Mild to moderate renal or hepatic impairment
• Hypersensitivity to drug or its components
• Hemiplegic or basilar headaches
• Severe renal, cardiovascular or hepatic impairment
• History of cerebrovascular or peripheral vascular conditions
• Ischemic bowel disease
• Uncontrolled hypertension
• Use of ergot-type drugs (such as dihydroergotamine) and other 5-HT1 agonists within 24 hours
• MAO inhibitor use within past 14 days
Use cautiously in:
• mild to moderate renal or hepatic impairment, cardiovascular risk factors
• elderly patients (not recommended)
• pregnant or breastfeeding patients
• children (safety not established).
• Know that drug does not prevent migraine.
• Give only if patient's cardiovascular status has been evaluated and determined to be safe, and if first dose can be given under supervision.
Adverse reactions
CNS: dizziness, drowsiness, malaise, fatigue, paresthesia, cerebral hemorrhage, subarachnoid hemorrhage, stroke, other cerebrovascular events
CV: significant blood pressure elevation including hypertensivecrisis (rare), coronary artery vasospasm, myocardial infarction, ventricular fibrillation or tachycardia
GI: nausea, vomiting, colonic ischemia with abdominal pain, bloody diarrhea
Other: pain or pressure sensation in throat or neck, peripheral vascular ischemia, serotonin syndrome, hypersensitivity including anaphylaxis or anaphylactoid reactions
Drug-drug.Ergot-type compounds (dihydroergotamine, methysergide): prolonged vasospastic reaction
Hormonal contraceptives: increased naratriptan blood level and effects
MAO inhibitors: increased systemic exposure to naratriptan, increased risk of adverse reactions
Selective serotonin reuptake inhibitors: weakness, hyperreflexia, incoordination Sibutramine: serotonin syndrome
Drug-herbs.S-adenosylmethionine (SAM-e), St. John's wort: increased risk of adverse serotonergic effects
Drug-behaviors.Cigarette smoking: increased naratriptan metabolism
Patient monitoring
• Maintain especially close monitoring in patients with cardiovascular risk factors (such as hypertension, hypercholesterolemia, obesity, diabetes mellitus, cigarette smoking, strong family history), postmenopausal women, and men older than age 40.
• Assess vital signs and ECG.
• Monitor neurologic status closely. Institute safety measures as needed to prevent injury.
Discontinue drug if serotonin syndrome is suspected.
Patient teaching
• Tell patient to take at first sign of headache.
• Advise patient to take second dose (if approved) at least 4 hours after first dose if headache has not gone away completely or has returned.
• Caution patient not to take more than two tablets in a 24-hour period.
Instruct patient how to recognize and immediately report signs and symptoms of stroke and other neurologic conditions, serotonin syndrome, hypersensitivity, or bloody diarrhea.
• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient to avoid cigarette smoking and to discuss herb use with prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.
Pharmacologic class: Recombinant humanized IgG4K monoclonal antibody
Therapeutic class: Immunologic agent
Pregnancy risk category C
Drug increases risk of progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the brain that usually leads to death or severe disability.
Monitor patient and withhold drug immediately at first sign or symptom suggestive of PML.
Drug is available only through a special restricted distribution program, TOUCH® Prescribing Program, and must be administered only to patients enrolled in this program.
Binds to the α4-subunit of α4β1 and α4β7 integrins expressed on the surface of all leukocytes except neutrophils, and inhibits the α4-mediated adhesion of leukocytes to their counterreceptor(s). The receptors for the α4 family of integrins include vascular cell adhesion molecule-1 (VCAM-1), which is expressed on activated vascular endothelium, and mucosal address in cell adhesion molecule-1 (MAdCAM-1) present on vascular endothelial cells of the GI tract. Disruption of these molecular interactions prevents transmigration of leukocytes across the endothelium into inflamed parenchymal tissue. Specific mechanisms by which drug exerts its effects in multiple sclerosis (MS) and Crohn's disease haven't been fully defined.
Solution for infusion: 300 mg/15-ml vial (20 mg/ml)
⊘Indications and dosages
➣ Relapsing forms of MS; moderately to severely active Crohn's disease in patients with evidence of inflammation who have had inadequate response to or can't tolerate conventional therapy
Adults: 300 mg by I.V. infusion over approximately 1 hour q 4 weeks. In Crohn's disease, discontinue in patient who hasn't experienced therapeutic benefit by 12 weeks of induction therapy and in patient who can't discontinue long-term concomitant steroids within 6 months of starting natalizumab.
• Hypersensitivity to drug
• History of or current PML
Use cautiously in:
• hepatic impairment
• infections, immune reconstitution inflammatory syndrome
• concurrent use of TNFa inhibitors, antineoplastics, prolonged immunosuppressant or immunomodulatory therapy; systemic medical condition resulting in significantly compromised immune system (avoid use)
• pregnant or breastfeeding patients
• children younger than age 18 (safety and efficacy not established).
Don't give as I.V. push or bolus.
• To prepare solution, withdraw 15 ml of drug concentrate from vial. Inject concentrate into 100 ml 0.9% sodium chloride injection, leading to concentration of 2.6 mg/ml. Don't use other I.V. diluents or mix with other drugs. Gently invert vial to mix completely; don't shake. Following dilution, infuse solution immediately or refrigerate at 2° to 8° C (36° to 46° F), and use within 8 hours.
• Infuse 300 mg in 100 ml 0.9% sodium chloride injection over approximately 1 hour (infusion rate approximately 5 mg/minute). After infusion is complete, flush with 0.9% sodium chloride injection.
Observe patient during infusion and for 1 hour after infusion is complete. Promptly discontinue infusion at first sign or symptom consistent with a hypersensitivity reaction.
Obtain MRI scan in MS patients before starting therapy to help differentiate subsequent MS signs and symptoms from those of PML. Withhold drug immediately at first sign or symptom suggestive of PML.
• Be aware that a baseline brain MRI in patients with Crohn's disease may help distinguish preexisting lesions from newly developed lesions.
For patients with Crohn's disease who start drug while taking long-term corticosteroids, start steroid withdrawal as soon as therapeutic benefit has occurred. If patient can't discontinue systemic corticosteroids within 6 months, discontinue natalizumab.
Discontinue drug in patients with jaundice or other evidence of significant liver injury.
Adverse reactions
CNS: headache, fatigue, depression, somnolence, vertigo, tremor, PML
EENT: tonsillitis, pharyngolaryngeal pain, sinusitis
GI: nausea, diarrhea, constipation, dyspepsia, gastroenteritis, abdominal discomfort, flatulence, aphthous stomatitis, exacerbation of Crohn's disease, intestinal obstruction or stenosis
GU: vaginitis; irregular menstruation; dysmenorrhea; amenorrhea; ovarian cyst; urinary tract infection; urinary incontinence, urgency, frequency
Hepatic: abnormal liver function test values
Musculoskeletal: arthralgia, extremity pain, back pain, muscle cramps, joint swelling, limb injury
Respiratory: upper and lower respiratory tract infections, cough
Skin: rash, dermatitis, pruritus, urticaria, dry skin, skin laceration, thermal burn
Other: infections, chest discomfort, seasonal allergy, weight changes, tooth infections, toothache, herpes infection, night sweats, rigors, peripheral edema, influenza-like illness, immunosuppression, infusion reactions, hypersensitivity reactions including anaphylaxis
Drug-drug.Corticosteroids, immunosuppressants (such as azathioprine, cyclosporine, 6-mercaptopurine, methotrexate), TNFα inhibitors: increased risk of PML and other infections
Drug-diagnostic tests.Circulating basophils, eosinophils, lymphocytes, monocytes, nucleated RBCs: increased levles
Hemoglobin: decreased level
Patient monitoring
• Monitor CBC with differential and hepatic function tests.
Continue to monitor patient for hypersensitivity reactions; infection; hepatotoxicity; signs and symptoms of immune reconstitution inflammatory syndrome (including unanticipated clinical decline in patient's condition after return of immune function and in some cases after apparent clinical improvement; and PML signs and symptoms (such as progressive weakness on one side of the body, limb clumsiness, vision disturbances, and changes in thinking, memory, and orientation leading to confusion and personality changes).
Patient teaching
• Explain the TOUCH Prescribing Program to patient.
Instruct patient to immediately report hypersensitivity reactions (such as flushing, nausea, headache, dizziness, fatigue, hives, or itching); signs and symptoms of infections; signs and symptoms of hepatotoxicity (such as yellowing of skin or eyes, dark urine, or right upper abdominal pain or discomfort); unanticipated clinical decline in condition or new signs and symptoms; or signs and symptoms of PML (such as progressive weakness on one side of the body, limb clumsiness, vision disturbances, and changes in thinking, memory, and orientation leading to confusion and personality changes).
• Instruct patient to tell prescriber about all drugs he's taking, because some drugs have potential for serious drug interactions and shouldn't be taken with natalizumab.
• Advise female patient of childbearing age that drug should be used during pregnancy only if potential benefit justifies potential risk to fetus.
• Advise breastfeeding patient that she should decide whether to discontinue breastfeeding or discontinue drug, taking into account importance of drug for her treatment.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Pharmacologic class: Amino acid derivative
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Decreases blood glucose level by stimulating insulin secretion from pancreatic beta cells; interacts with calcium and potassium channels in pancreas
Tablets: 60 mg, 120 mg
⊘Indications and dosages
➣ To decrease glucose levels in type 2 (non-insulin-dependent) diabetes mellitus not adequately controlled by diet and exercise
Adults: 120 mg P.O. t.i.d. up to 30 minutes before meals, or 60 mg P.O. t.i.d. if patient is near glycosylated hemoglobin (HbA1c) goal
• Hypersensitivity to drug or its components
• Diabetic ketoacidosis
• Type 1 (insulin-dependent) diabetes mellitus
Use cautiously in:
• renal or hepatic impairment, adrenal or pituitary insufficiency
• elderly or malnourished patients
• pregnant or breastfeeding patients.
• Give 30 minutes before meals. If meal is missed, don't give dose.
• Know that drug may be given alone or with metformin.
Adverse reactions
CNS: dizziness
GI: diarrhea
Metabolic: hypoglycemia
Musculoskeletal: back pain, joint pain
Respiratory: upper respiratory tract infection, bronchitis, coughing
Other: flulike symptoms, trauma
Drug-drug.Beta-adrenergic blockers, MAO inhibitors, nonsteroidal antiinflammatory drugs, salicylates: increased hypoglycemic effect
Corticosteroids, sympathomimetics, thiazides, thyroid products: reduced hypoglycemic effect
Drug-diagnostic tests.Glucose: decreased level
Patient monitoring
• Monitor blood glucose and HbA1c levels.
• Assess pulmonary status for bronchitis, upper respiratory infection, and flulike signs and symptoms.
• Monitor musculoskeletal status. Check for back pain and arthropathy.
• Note GI complaints, and identify nutritional deficiencies.
Patient teaching
• Instruct patient to take dose up to 30 minutes before each main meal.
• Advise patient not to skip a meal. If he does, tell him to also skip accompanying nateglinide dose, to prevent hypoglycemia.
• Teach patient how to monitor blood and urine for glucose and ketones, as prescribed.
• Instruct patient to report adverse CNS effects and signs and symptoms of respiratory infection.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects sensation and balance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Pharmacologic class: Beta-adrenergic blocker
Therapeutic class: Antihypertensive
Pregnancy risk category C
Not fully known. The following factors may be involved: decreased heart rate, reduced myocardial contractility, decreased tonic sympathetic outflow to periphery from cerebrovasomotor centers, suppressed renin activity, vasodilation, and decreased peripheral vascular resistance.
Tablets: 2.5 mg, 5 mg, 10 mg
⊘Indications and dosages
➣ Hypertension
Adults: Individualized; 5 mg P.O. daily. If patient requires further blood pressure reduction, dosage may be increased at 2-week intervals up to 40 mg P.O. daily.
Dosage adjustment
• Moderate hepatic impairment or severe renal impairment (creatinine clearance less than 30 ml/minute)
• Hypersensitivity to drug or its components
• Severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless permanent pacemaker is in place)
• Severe hepatic impairment
Use cautiously in:
• moderate hepatic impairment
• severe renal impairment
• congestive heart failure (CHF)
• peripheral vascular disease
• bronchospastic disease (use not recommended)
• diabetic patients receiving hypoglycemic drugs
• known or suspected pheochromocytoma
• concurrent use of myocardial depressants, AV conduction inhibitors (such as cardiac glycosides and certain calcium antagonists), or antiarrhythmics (such as disopyramide)
• perioperative use with anesthetics that depress myocardial function (such as ether, cyclopropane, or trichloroethylene)
• pregnant patients
• breastfeeding patients (use not recommended)
• children (safety and efficacy not established).
• Give with or without food.
• Be aware that drug may be used alone or in combination with other antihypertensives.
• Know that drug shouldn't be combined with other beta blockers. Closely monitor patients receiving catecholamine-depleting drugs (such as reserpine or guanethidine), because added beta blockade may decrease sympathetic activity excessively. In patients receiving nebivolol with clonidine, discontinue nebivolol for several days before gradually tapering clonidine.
Don't withdraw drug abruptly; taper over 1 to 2 weeks when possible. Drug may mask signs and symptoms of hyperthyroidism, such as tachycardia; abrupt withdrawal may exacerbate signs and symptoms of hyperthyroidism or may trigger thyroid storm.
Adverse reactions
CNS: headache, fatigue, dizziness, insomnia
CV: bradycardia
GI: nausea, diarrhea
Respiratory: dyspnea
Skin: rash
Other: chest pain, peripheral edema
Drug-drug.Antiarrhythmics (such as disopyramide), myocardial depressants or AV conduction inhibitors (such as cardiac glycosides and certain calcium antagonists): increased risk of slowed AV conduction and bradycardia
Cimetidine: increased d-nebivolol (active isomer) blood level
CYP2D6 inhibitors (such as fluoxetine, paroxetine, propafenone, quinidine): increased d-nebivolol blood level
Other beta-adrenergic blockers: excessive reduction of sympathetic activity Sildenafil: decreased effect of sildenafil
Drug-diagnostic tests.Blood urea nitrogen, triglycerides, uric acid: increased levels
Cholesterol, high-density lipoproteins, platelet count: decreased
Patient monitoring
Be aware that beta blockade may further depress myocardial contractility and trigger more severe heart failure in patients with compensated CHF. If CHF worsens, consider discontinuing drug.
During perioperative use, closely monitor patients receiving anesthetics that depress myocardial function, such as ether, cyclopropane, or trichloroethylene. Also, know that if drug is withdrawn before major surgery, the heart's impaired ability to respond to reflex adrenergic stimuli may increase risks of general anesthesia and surgery.
• Because of significant negative inotropic and chronotropic effects in patients treated with verapamil- or diltiazem-type beta blockers or calcium channel blockers, use caution in patients treated concomitantly with these agents; monitor ECG and blood pressure.
Patient teaching
• Tell patient drug may be taken with or without food.
• Advise patient not to stop taking drug unless prescriber approves.
Instruct patient to immediately report difficulty breathing, increasing shortness of breath, excessively slow pulse, or weight gain.
• Caution patient to avoid driving and other hazardous activities until drug's effects on alertness are known.
• Advise breastfeeding patient not to breastfeed during therapy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
nefazodone hydrochloride
Potentiates effects of norepinephrine and serotonin by blocking synaptic reuptake in nerve cells and disrupting alpha1-adrenergic receptors
Tablets: 50 mg, 100 mg, 150 mg, 200 mg, 250 mg
⊘Indications and dosages
➣ Major depression
Adults: Initially, 100 mg P.O. b.i.d. May increase weekly up to 600 mg/day in two divided doses.
Dosage adjustment
• Elderly patients
• Hypersensitivity to drug, its components, or other phenylpiperazines
• Active hepatic disease, baseline transaminase elevation, or previous drug withdrawal necessitated by hepatic damage
• MAO inhibitor use within past 14 days
• Concurrent cisapride (not available in U.S.), pimozide, carbamazepine, or triazolam therapy
Use cautiously in:
• cardiovascular or cerebrovascular disease
• history of suicide attempt, drug abuse, or mania
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18 (safety not established).
• Give with food or milk if GI upset occurs.
• Know that tablets may be crushed.
Don't give concurrently with cisapride, pimozide, carbamazepine, or triazolam.
Don't give within 14 days of MAO inhibitors.
Adverse reactions
CNS: dizziness, asthenia, agitation, light-headedness, insomnia, drowsiness, confusion, weakness, headache, impaired memory, poor concentration, paresthesia, psychomotor retardation, tremor, suicidal behavior or ideation (especially in child or adolescent)
CV: hypotension, orthostatic hypotension, peripheral edema
EENT: abnormal or blurred vision, eye pain, tinnitus, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, dry mouth
GU: urinary frequency or retention, urinary tract infection
Hepatic: hepatotoxicity, hepatic failure
Respiratory: increased cough
Skin: rash, pruritus
Other: increased appetite, thirst, infection, chills, fever, flulike symptoms
Drug-drug.Alprazolam, triazolam: increased blood level and effects of these drugs
Antihypertensives, nitrates: additive hypotension
Carbamazepine, cisapride, pimozide: increased nefazodone blood level, leading to toxicity
CNS depressants (including antihistamines, opioids, sedative-hypnotics): additive CNS depression
Digoxin: increased digoxin blood level
HMG-CoA reductase inhibitors: increased risk of myopathy
MAO inhibitors: potentially fatal reactions (hyperpyrexia, excitation, seizures, delirium, coma)
Drug-diagnostic tests.CBC, cholesterol, glucose, hematocrit: decreased levels
Hepatic enzymes: increased levels
Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression
S-adenosylmethionine (SAM-e), St. John's wort: increased risk of adverse serotonergic effects, including serotonin syndrome
Drug-behaviors.Acute alcohol ingestion: additive hypotension
Alcohol use: increased CNS depression
Patient monitoring
• Monitor vital signs with patient lying down, sitting, and standing. Notify prescriber if blood pressure drops 20 mm Hg.
• Assess CBC.
Monitor liver function tests frequently. Notify prescriber of abnormal results.
• Closely monitor neurologic status.
• Evaluate patient for withdrawal symptoms (which may occur if therapy stops abruptly).
Monitor closely for increasing depression and suicidal ideation (especially in child or adolescent).
Patient teaching
• Advise patient to take with food or milk to minimize GI upset.
• Tell patient to crush drug if he can't swallow it whole.
• Inform patient that therapeutic response may take up to 4 weeks. Encourage him to keep taking drug as prescribed.
Tell patient drug may cause adverse CNS effects. Advise him to report significant mood changes (especially depression or suicidal thoughts). Caution parent to report these problems in child or adolescent.
Instruct patient to immediately report unusual tiredness, yellowing of skin or eyes, nausea, or anorexia.
• Instruct patient to rise slowly and carefully, to avoid dizziness from temporary blood pressure drop.
• Tell patient to avoid alcohol and to consult prescriber before taking herbs.
Instruct patient not to stop taking drug abruptly. Dosage must be tapered.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
Pharmacologic class: Antimetabolite
Therapeutic class: Antineoplastic
Pregnancy risk category D
Administer I.V. only.
Give under supervision of physician experienced in use of cancer chemotherapy.
Drug has caused severe neurologic events, including severe somnolence, seizures, and peripheral neuropathy. Demyelination-associated events also have occurred. Drug discontinuation doesn't always lead to full recovery from these events. Monitor patient closely for neurologic changes; discontinue drug for serious neurologic events.
Inhibits DNA synthesis in leukemic blasts, leading to cell death
Solution for injection: 250 mg/50 ml
⊘Indications and dosages
➣ T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma in patients whose disease hasn't responded to at least two chemotherapy regimens or who've relapsed after such therapy
Adults: 1,500 mg/m2 I.V. undiluted over 2 hours on days 1, 3, and 5; repeat every 21 days. Continue therapy until disease progresses, unacceptable toxicity occurs, patient becomes eligible for bone marrow transplant, or patient no longer benefits from therapy.
Children: 650 mg/m2 I.V. undiluted over 1 hour daily for 5 consecutive days; repeat every 21 days. Continue therapy until disease progresses, unacceptable toxicity occurs, patient becomes eligible for bone marrow transplant, or patient no longer benefits from therapy.
Dosage adjustment
• Neurologic or hematologic toxicity
• Hypersensitivity to drug or its components
Use cautiously in:
• renal or hepatic dysfunction
• patients undergoing concurrent intrathecal chemotherapy
• patients previously treated with intrathecal chemotherapy or craniospinal irradiation
• concurrent administration of live vaccines (immunocompromised patients)
• elderly patients
• pregnant or breastfeeding patients.
• Administer undiluted.
• Infuse over 2 hours in adults or over 1 hour in children.
• In patients at risk for tumor lysis syndrome, take measures to prevent hyperuricemia (such as hydration, urine alkalization, and allopurinol prophylaxis).
Discontinue drug if serious neurologic adverse reactions occur.
Adverse reactions
CNS: confusional state, insomnia, depression, headache, peripheral neuropathy, somnolence, paresthesia, hypoesthesia, fine motor dysfunction, neurologic disorder, tremor, ataxia, abnormal gait, dizziness, amnesia, balance disorder, sensory loss, demyelination, asthenia, fatigue, rigors, decreased level of consciousness, seizures, cerebral hemorrhage, coma
CV: tachycardia, chest pain, hypotension
EENT: blurred vision, epistaxis, sinusitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, abdominal distention, stomatitis, anorexia
Hematologic: anemia, neutropenia, thrombocytopenia, leukopenia
Metabolic: dehydration
Musculoskeletal: myalgia, arthralgia, back pain, muscle weakness, extremity pain
Respiratory: pneumonia, cough, dyspnea, exertional dyspnea, wheezing, pleural effusion
Skin: petechiae
Other: abnormal taste, infection, fever, edema, peripheral edema, pain, non-cardiac chest pain
Drug-drug.Pentostatin: decreased nelarabine efficacy
Drug-diagnostic tests.Bilirubin, serum creatinine, transaminases: increased
Blood albumin, CBC, calcium, glucose, magnesium, platelets, potassium: decreased
Patient monitoring
Watch closely for neurologic events, such as somnolence, confusion, seizures, ataxia, motor incoordination, and peripheral neuropathy (which may not subside even after therapy ends). Know that previous craniospinal irradiation or current or previous intrathecal chemotherapy may increase patient's risk of adverse neurologic events.
• Closely monitor patients with hepatic or renal dysfunction for adverse reactions.
• Monitor CBC regularly.
Patient teaching
• Instruct patient or caregiver to read patient information leaflet thoroughly.
Urge patient or caregiver to immediately report neurologic symptoms, such as extreme sleepiness, confusion, seizures, unsteadiness or weakness on walking, difficulty with tasks such as buttoning clothing, and numbness and tingling in fingers, hands, or feet.
Tell patient to immediately report easy bruising, bleeding, fever, or signs or symptoms of infection.
• Inform patient that he'll need to undergo frequent blood tests.
• Instruct patient to avoid live virus vaccines.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• Urge female with childbearing potential to avoid pregnancy and breastfeeding during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
nelfinavir mesylate
Pharmacologic class: Protease inhibitor
Therapeutic class: Antiretroviral
Pregnancy risk category B
Inhibits action of human immunodeficiency virus (HIV) protease and prevents cleavage of viral polyproteins, resulting in production of immature, noninfectious virus
Oral powder: 50 mg/1 g powder (1 g powder/level scoopful)
Tablets: 250 mg, 625 mg
⊘Indications and dosages
➣ HIV infection
Adults and children older than age 13: 750 mg P.O. t.i.d. or 1,250 mg b.i.d., given with other antiretrovirals
Children ages 2 to 13: 20 to 30 mg/kg P.O. t.i.d., given with a meal or light snack
• Hypersensitivity to drug or its components
• Concurrent use of amiodarone, dihydroergotamine, ergonovine, ergotamine, midazolam, pimozide, quinidine, rifampin, sildenafil (when used for pulmonary arterial hypertension), or triazolam
Use cautiously in:
• moderate or severe hepatic impairment (avoid use)
• hemophilia, diabetes mellitus
• concurrent use of lovastatin, simvastatin, or St. John's wort (not recommended)
• concurrent use of other HMG-CoA reductase inhibitors also metabolized by the CYP3A pathway, proton pump inhibitors, and rifampin
• phenylketonuria (oral powder contains phenylalanine)
• breastfeeding patients.
• Give tablets with food.
• For adult who can't swallow tablets whole, crush and mix in food or dissolve in small amount of water. Have patient consume mixture immediately, or refrigerate for up to 6 hours.
• For child who can't swallow tablets, mix oral powder with small amount of water, formula, or milk. Have child consume mixture immediately, or refrigerate for up to 6 hours.
• Don't mix powder with water in its original container.
• Don't mix powder with acidic juice (combination produces bitter taste).
Don't give concurrently with amiodarone, astemizole, cisapride, dihydroergotamine, ergotamine, midazolam, quinidine, rifampin, terfenadine, or triazolam.
Adverse reactions
CNS: anxiety, depression, dizziness, drowsiness, emotional lability, headache, hyperkinesia, insomnia, malaise, migraine headache, sleep disorders, weakness, myasthenia, paresthesia, suicidal ideation, seizures
EENT: acute iritis, rhinitis, sinusitis, pharyngitis
GI: nausea, diarrhea, abdominal pain, flatulence
GU: nephrolithiasis, sexual dysfunction
Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: dehydration, hyperuricemia, hyperglycemia, hypoglycemia
Musculoskeletal: joint pain, arthritis, back pain, myalgia, myopathy
Respiratory: dyspnea, bronchospasm
Skin: pruritus, rash, sweating, fungal dermatitis, folliculitis, urticaria
Other: fever, body fat redistribution, allergic reactions, immune reconstitution syndrome
Drug-drug.Amiodarone, dihydroergotamine, ergotamine, midazolam, quinidine, triazolam: excessive sedation, vasoconstriction, serious arrhythmias
Atorvastatin, rosuvastatin: increased statin concentration
Azithromycin, bosentan, colchicine, inhaled fluticasone, salmeterol: increased concentration of these drugs
Carbamazepine, phenobarbital, phenytoin, rifampin: decreased nelfinavir blood level and efficacy
Delavirdine: increased nelfinavir concentration, decreased delavirdine concentrations
HMG-CoA reductase inhibitors: increased risk of serious reactions, such as myopathy and rhabdomyolysis
Hormonal contraceptives: decreased contraceptive blood level and efficacy
Immunosuppressants (cyclosporine, sirolimus, tacrolimus): increased immunosuppressant concentration
Indinavir, saquinavir: increased indinavir or saquinavir concentration and increased nelfinavir concentration
Methadone, trazodone: decreased concentration of these drugs Nevirapine: decreased nelfinavir concentration
Rifabutin: decreased rifabutin metabolism and effects Ritonavir: increased nelfinavir concentration
Sildenafil, tadalafil, vardenafil: increased risk of adverse events
Warfarin: affected warfarin concentration
Drug-diagnostic tests.Alanine amino-transferase, alkaline phosphatase, amylase, aspartate aminotransferase, creatine kinase, gamma-glutamyl transpeptidase, lactic dehydrogenase lipids, uric acids: increased levels Blood glucose: increased or decreased level
Hemoglobin, platelets, white blood cells: decreased levels
Drug-food.Most foods: enhanced drug absorption
Drug-herbs.St. John's wort: decreased nelfinavir blood level and efficacy
Patient monitoring
Watch for signs and symptoms of depression and suicidal ideation.
• Evaluate neurologic status closely, particularly for seizures and sensori-motor dysfunction.
• Assess CBC, lipid panel, uric acid level, and HIV-specific tests.
• Watch for secondary infections, particularly fungal and EENT infections.
Be aware that immune reconstitution syndrome may occur in patients receiving combination anti-retroviral therapy. During initial phase of therapy, patient whose immune system responds may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium complex, cytomegalovirus, Pneumocystis jiroveci pneumonia, and tuberculosis), which may necessitate further evaluation and treatment.
Patient teaching
• Advise patient to take with a meal or snack. Inform him that he may mix oral powder with nonacidic fluids.
• Tell patient he may take missed dose up to 1 hour before next scheduled dose.
Instruct patient to report depression or suicidal thoughts.
• Tell patient that drug may predispose him to other infections, especially fungal and EENT infections. Advise him to avoid crowds and to wash hands often and thoroughly.
• Tell patient with phenylketonuria (or caregiver) that powder contains phenylalanine.
Tell patient to immediately report new or worsening signs or symptoms.
Advise patient not to use St. John's wort while taking this drug.
• Advise female patient to use reliable barrier contraception.
• Advise female patient not to breastfeed, because breast milk may transfer HIV to infant.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, strength, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
neomycin sulfate
Pharmacologic class: Aminoglycoside
Therapeutic class: Anti-infective
Pregnancy risk category D
Systemic absorption follows oral use and may lead to toxic reactions. Observe patient closely for indications of toxicity. Neurotoxicity (including ototoxicity) and nephrotoxicity have occurred, even at recommended doses. Perform serial, vestibular, and audio-metric tests as well as renal function tests, especially in high-risk patients. Risk of nephrotoxicity and ototoxicity is greater in patients with renal impairment. Ototoxicity may be delayed, and patients developing cochlear damage won't have symptoms during therapy; total or partial deafness may occur long after drug is stopped.
Neuromuscular blockage and respiratory paralysis may follow oral use. Consider these risks, especially to patients receiving anesthetics or neuromuscular blockers (such as tubocurarine, succinylcholine, and decamethonium) and those receiving massive transfusions of citrated anti-coagulated blood. If blockage occurs, calcium salts may reverse these phenomena, but patient may need mechanical respiratory assistance.
Avoid concurrent or sequential systemic, oral, or topical use of other aminoglycosides or neurotoxic drugs, as toxicity may be additive.
Advanced age and dehydration increase risk of toxicity.
Avoid giving drug concurrently with potent diuretics, as some diuretics are ototoxic. Also, I.V. diuretics may enhance neomycin toxicity by altering its blood and tissue levels.
Interferes with bacterial protein synthesis by binding to 30S ribosomal subunit, causing misreading of genetic code. Inaccurate peptide sequence then forms in protein chain, causing bacterial death.
Ointment: 0.5%
Oral solution: 125 mg/5 ml
Tablets: 500 mg
⊘Indications and dosages
➣ Preoperative intestinal antisepsis
Adults: 1 g P.O. q hour for four doses, then 1 g q 4 hours for 24 hours or 1 g at 19 hours, 18 hours, and 9 hours before surgery
➣ Hepatic encephalopathy
Adults: 4 to 12 g/day P.O. in divided doses
➣ Superficial bacterial infections
Adults: Apply ointment topically one to five times daily.
• Hypersensitivity to drug or other aminoglycosides
• Intestinal obstruction
Use cautiously in:
• renal impairment, neuromuscular diseases (such as myasthenia gravis), hearing impairment
• obese patients
• elderly patients
• pregnant or breastfeeding patients
• children under age 18 (safety not established).
• Give preoperative dose before bowel surgery, after cathartic administration, as ordered.
Adverse reactions
CNS: neuromuscular blockade
EENT: ototoxicity (with prolonged, high-dose use)
GI: nausea, vomiting, diarrhea, malabsorption syndrome
GU: nephrotoxicity (with prolonged, high-dose use)
Other: superinfection
Drug-drug.Acyclovir, amphotericin B, cephalosporin, cisplatin, other amino-glycosides, vancomycin: increased risk of ototoxicity and nephrotoxicity
Digoxin: decreased digoxin absorption
Dimenhydrinate: masking of ototoxicity symptoms
Oral anticoagulants: increased anticoagulant effect
Potent loop diuretics: increased risk of ototoxicity
Patient monitoring
• Assess for neuromuscular blockade, ototoxicity, and nephrotoxicity.
• Monitor kidney function tests.
Patient teaching
• Instruct patient to drink plenty of water.
• Tell patient to complete full course of therapy.
• Inform patient that drug may cause muscle weakness.
• Instruct patient to report hearing problems and change in urination pattern.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects neuromuscular status.
• Tell patient he'll undergo frequent blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.


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Cowboys Cannot Afford to Release T.O.
Ok we have been talking about T.O. being released since the day the season was over; well here are my thoughts on the subject
T.O. is a solid number one superstar at wide receiver, and there are not many guys in the league that have his skills and that command so much attention from defenses. Just his presence on the field makes everyone he plays with better. It takes that one guy, that FREE safety away from say, Witten running down the seam or keeps him from coming up to help contain Barber from breaking a big run. It basically puts everyone man on man which I would take everytime. His attitude is what it is, we all know what happened in San Francisco and Philadelphia. But I have seen a more mature Terrell Owens the last couple of years, he wants the ball and wants to win! We see him barking on the sideline frustrated with the way things are going, let me ask you this, if that was Tony barking would he be called a cancer? Or would we all be happy that he is finally trying to lead his team? It is not a coincidence that the Cowboys scoring offense was ranked 25th and 15th the two years prior to T.O., then it jumped up to 5th and 2nd his first two years, it is real simple he makes the team better !
I think releasing Terrell would be one of the biggest mistakes in Dallas Cowboy history. If you thought Galloway for two first round picks was dumb, that was absolute peanuts compared to this if they were to let him go, unless it was a trade for suitable replacement its just crazy talk. Some of the wide receivers that are on the trading block are Plaxico, Ocho Cinco, and Anquan Boldin , the only one that would make any sense is obviously Boldin, but that is highly unlikely. You think T.O. gets bad press playing for Americas team, can you imagine what it would be like for Plaxico and Ocho Cinco.
Roy Williams in my opinion is at best right now a 1a wideout. He has the skills he just doesn't command the same attention that Terrell does, now if Jerry made the mistake of letting him go and moved Roy to the one spot who's our two?? Crayton? I think he has proved the last two years he is nothing more than a 3rd slot receiver at best. Are Austin or Hurd ready to jump up to two?? Don't think they are just yet… The deep playmaking threat would be gone and we would have just a good offense, not a deadly one.
So where do we get his replacement, probably not a trade or within the team how about free agency? Well after T.J. Houshmanzadah the cupboard is bare, he is the only guy that could come close to filling T.O.'s shoes. The Bengals just franchised Scott Graham so this pretty much assures he will hit the market. I won't even mention the draft because with our first pick being in the middle of the second round it is more likely that I will root for Tom Brady (which will never ever happen) than us finding Michael Crabtree or Percy Harvin in the mid second round.
So there we are. We let T.O. go and it would be one of the biggest mistakes in Cowboy history!
P.S Did I mention if Terrell was released it would cost the Cowboys over 9 million dollars against next years salary cap YIKES!!!!!!

subset: commoncrawl


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PCs and Displays
List Content goes here
EPEAT is an easy-to-use resource for identifying high-performance, environmentally preferable products. Join hundreds of businesses, schools, hotels, hospitals and governments around the world that trust EPEAT to help them make informed purchasing decisions. By using EPEAT to purchase greener electronics, you can show progress toward your sustainability goals and build your environmental reputation.
Public and private entities in more than 42 countries use EPEAT as a uniform purchasing specification. Brand owners that create environmentally preferable electronics should register them with EPEAT to build their reputation among these purchasers and gain access to procurement contracts valued at tens of billions of dollars worldwide. With EPEAT, brand owners can both demonstrate and profit from their commitment to developing technology with a reduced environmental impact. Purchasers can view some of the EPEAT-participating manufacturers at this link, which also has some resources for manufacturers that are considering registering devices with EPEAT.
Many organizations support the creation, purchase and promotion of greener electronics, even if they don't directly create those products themselves. From influential distributors and technology resellers to forward-looking associations and registration partners, the EPEAT registry is widely supported by a host of groups around the world. These organizations and others play an important role in the adoption, sale and future development of greener electronics. These entities include EPEAT Channel Partners, retailers, EPEAT Champions and Product Registration Entities, among others.
"We liked EPEAT standards because they are comprehensive. [It is] more cost effective for suppliers as they don't have to coordinate multiple customer requirements."– read the case study
The simplicity of using EPEAT, by demonstrating that changing purchasing practices can be easy, also created momentum for additional positive actions by city staff and managers.– read the case study
EPEAT currently includes rating criteria for PCs and Displays, Imaging Equipment and Televisions. Click an icon below to learn more about the specific criteria used for EPEAT verification.
EPEAT currently includes rating criteria for PCs and Displays, Imaging Equipment and Televisions. Click an icon below to learn more about the specific criteria used for EPEAT verification.


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avater159 wrote:you've help me a lot but I'm still confused. here let me restate what i want to do. i want to send a signal strait to space to which a satellite would receive the command excite it then possibly send it back. all this would be self contained to my location and my equipment except the satellite. hopefully this is clearer on what I'm asking.
fashizzlepop wrote:I thought it was a legitimate question guys. I have no idea however on how you would go about this.
Ps. Lookup double rot 13 and guess what the rest of their posts are about... :/
Goatboy wrote:It would help to know why you want to do this. If you plan on physically moving the satellite via your connection, you're going to need a T03-X11 emulation thread. This will help in stabilizing the satellite in zero-G space. If, however, you are going to use it to create a distribution vertex, you should go with a T03-X15 emulation thread. This is because the X15 has enhanced encryption and uplink speeds.
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Take a look at the trades PCJS made during the draft last year.
Jets receive:
Second-round pick (No. 43):Stephen Hill
Seahawks receive:
Second-round pick (No. 47): Bobby Wagner
Fifth-round pick (No. 154): Korey Toomer
Seventh-round pick (No. 232): Greg Scruggs
Eagles receive:
First-round pick (No. 12): Fletcher Cox
Seahawks receive:
First-round pick (No. 15): Bruce Irvin
Fourth-round pick (No. 114): Jaye Howard
Sixth-round pick (No. 172): Jeremy Lane
Traded down 3 spots in the 1st round for 2 additional players, and traded down 4 spots in the 2nd round for 2 additional players.
I hear people worrying that SF has 14-15 draft picks this year and we only have 10. The takeaway from this is that if John Schneider really wants 14 picks, he can easily attain them by trading down a couple times.


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In my recent post; Are you a Pit Bull or a Poodle I share a quick test I give clients who are considering entering the entrepreneurial game. One of the key indicators you are a Pit bull is you ;
"Play life like a champion."
So what does it mean to play life like a champion?
Having lived in North Canton Ohio most of my adult life the Pro Football induction ceremonies and celebrations are a big event we looked forward to each year. Aside from the parades and ribs burn off I often would listen to the speeches recognized Hall of fame champions gave when they were inducted.
This year was not exception as Emit Smith's speech was one all business owners setting out to be the dominant market leader in their field should listen to. Below are some key bullet points I gathered from his speech;
don't set out to be good, set out to be the best
write your goals down and they become real
study the greats that went before you
demand excellence of your self and those around you
be thankful each day you are blessed to be playing
rarely is personal recognition won without the contribution of others
share your goals with others who will hold you accountable
understand it will take sacrifice and make sure you are willing to do what it takes
Never, never ever give up
I found this speech particularly inspiring as so many business owners and their leadership teams face challenging times.
As leaders we must be intentional about the values and principles we weave into the fiber of our cultures. Just as goals not written down are just dreams, failure to intentionally state and reward the behaviors you desire of yourself and your team is a mistake as champions do not "just happen".
Hall of Fame Football champions do not "just happen", they are born of a relentless desire for excellence.
So how about you…..
Do you have a clear written goal that demands excellence to achieve it?
Does your team clearly understand the goal and the path required to achieve it?
Does your team reward the behaviors of champions?


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5 Gutsiest Calls in Super Bowl History
With a championship at stake, every play called in a Super Bowl is magnified. Regardless of the risks, some coaches have gambled by calling unconventional plays in the season's biggest game.
Here are the 5 Gutsiest Calls in Super Bowl History:
Super Bowl XLIV: The Saints' Onside Kick To Start The Second Half
Trailing 10-6 at halftime of Super Bowl XLIV, New Orleans Saints head coach Sean Payton was reluctant to give Peyton Manning, his enormous forehead and the Indianapolis Colts the ball to start the second half. Payton called for an onside kick, which his team recovered to help jump start the Saints' rally to a 31-17 win. The call wasn't without precedent: Steelers' coach Bill Cowher called for a surprise onside kick early in the fourth quarter of Super Bowl XXX, with Pittsburgh trailing Dallas 20-10. Despite a quick Steelers' touchdown drive after the kick, the Cowboys captured a 27-17 victory.
Super Bowl XXXVI: The Patriots Play For The Win, Instead of OT
St. Louis was favored to beat New England in Super Bowl XXXVI, maybe because Patriots head coach Bill Belichick had yet to don his Sith-like hoodie that he's worn on the sideline for so many wins. After Kurt Warner's 26-yard touchdown pass to Ricky Proehl tied the game for the Rams with 1:30 remaining, New England, which had no timeouts left, was expected to hold the ball and go into overtime. Instead, Belichick allowed young quarterback Tom Brady to guide the Patriots into position for Adam Vinatieri's game-winning, 48-yard field goal as time expired, giving the New England a 20-17 win and its first Super Bowl title.
Super Bowl XXI: The Giants' Fortunes Shift On A Fake Punt
The New York Giants, a team which popularized the Gatorade bath and the self-destructive superstar (Lawrence Taylor), trailed the Denver Broncos, 10-9, at halftime of Super Bowl XXI. With the Giants facing a 4th-and-1 on the first series of the second half, New York head coach Bill Parcells sent in punter Sean Landeta. However, Landeta shifted out of punt formation, while backup quarterback Jeff Rutledge dropped in behind the center. Taking a quick snap, Rutledge dove for the first down on a sneak, and the Giants scored later in the drive on their way to a 39-20 win. See the play.
Super Bowl XIV: The Rams' Halfback Option Pass
Most coaches aren't successful when they ask a player who can't throw to beat the defense, just ask current Jets' coach Rex Ryan. The Los Angeles Rams trailed the heavily-favored Pittsburgh Steelers, 17-12 in the third quarter of Super Bowl XIV. Los Angeles running back Lawrence McCutcheon, whose throwing motion was as fluid as Tim Tebow's, tossed a 24-yard touchdown pass to Ron Smith, giving the Rams a 19-17 lead. However, Los Angeles couldn't maintain the advantage, and the Steelers won 31-19. Years later, Pittsburgh would use a double-reverse option pass to help them win Super Bowl XL over Seattle, as Antwaan Randle El threw a 43-yard touchdown to Hines Ward.
Super Bowl XLVI: The Patriots Let Them Score
Allowing the other team to score seems like a terrible strategy to win a championship, otherwise the Detroit Lions would be up to their butt crack in Lombardi Trophies. However, a coach sometimes decides to make this unconventional call to prevent the opponent from running out the clock. In Super Bowl XLVI, the New England Patriots led 17-15 in the fourth quarter, but the New York Giants had the ball on the Patriots' six-yard line with 1:03 to play, well in range for a game-winning field goal. With only one timeout left, New England head coach Bill Belichick told his defense to allow the Giants to score, which they did on Ahmad Bradshaw's dash on the next play. After failing on the two-point conversion, New York kicked-off to New England, but the Patriots were unable to drive for a game-winning score. Years earlier in a tied Super Bowl XXXII, Green Bay Packers head coach Mike Holmgren told his defense to let the Denver Broncos score the go-ahead touchdown from the 1-yard line with 1:47 to play and one timeout. The Packers were unable to rally, as the Broncos won 31-24.


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Missouri overcomes slow start, beats Tenn. St.
COLUMBIA, Mo. (AP) — Stefan Jankovic scored all 14 of his points in the second half, helping No. 12 Missouri overcome a sloppy first half en route to a 68-38 victory over Tennessee State on Saturday.
Laurence Bowers had 18 points and 10 rebounds and Alex Oriakhi added 15 points and 10 rebounds for Missouri (8-1), which defeated its second consecutive Ohio Valley Conference team following a 81-65 win Tuesday over Southeast Missouri State.
Robert Covington scored 12 points and Jordan Cyphers added 11 points for Tennessee State (4-6), which entered the matchup having won three consecutive games.
Both teams failed to make a basket for several-minute stretches in the first half, combining for 18 turnovers and 34.6 percent shooting from the field.
But Missouri regrouped during the break and went on a 14-3 run to start the second half.
Phil Pressey's 3-pointer and Negus Webster-Chan's fast-break layup within a 20-second stretch gave Missouri a 32-22 lead with 15:16 remaining.
Missouri led by at least nine the rest of the way, gradually extending its lead following an M.J. Rhett free throw that cut the deficit to 32-23 with 15:07 left.
But after making four of its first six shots from the field, Tennessee State made only 11 of its next 57 attempts.
The Tigers, who were picked to finish second in the conference's East Division, have played eight of their first 10 games on the road.
Bowers and Oriakhi combined for all of Missouri's 23 points in the first half except for an Earnest Ross free throw with 4:01 remaining.
The Tigers endured stretches of 5:54 and 4:49 without scoring a basket in the first half and turned the ball over 11 times, yet managed to shoot 40 percent from the field to take a three-point lead at halftime.
Tennessee State scored 10 points off turnovers in the first half, but also struggled with poor shooting.
Missouri outrebounded Tennessee State 52-27 for the game and made 15 of 19 free throws. Tennessee State only attempted five, all in the second half, and made two.
Missouri extended its home winning streak against nonconference opponents to 71 games dating to the 2005-06 opener.


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Cancer: The Patient Survives, but Now What?
A new push for cancer "rehab" is helping patients avoid long-term physical disability and complications after treatment ends. WSJ's Laura Landro and Julie Silver, Harvard Medical School assistant professor, discuss on Lunch Break. Photo: Getty Images.
This transcript has been automatically generated and may not be 100% accurate.
... I ... for cancer survivors ... sigh thanks after treatment can walk us through what that help is only confined to smile and issues are informed patient calmness also joined us is to lease oversees the Harvard Medical School assistant professor in she did all the survivors to training probe of its being adopted ... a number of states and health systems welcome to you both want to ... start with you know a lot of people think that once the treatments done the chemo is done the radiation is done ... if you're you're lucky it's back to normal not the case definitely not an in your lucky obviously survive the changing tide ... chemo radiation and debilitating physically they can leave you with the team taking the email marriage because you have an evening your chances and doing strange things with that in your Friday ... if you've had surgery maybe you cut something like a Whipple procedure which is no practically like being about ... it you can be so debilitated after these treatments ... it's very hard to just get back to normal life and happy note that future ... ages the little things like getting an out of pure carbon able to stand at the core remains tight and learning to turning your neck if you've had with no box surgery or something or Cantor had neck surgery in Chile to you specifically you launch it from called the star program which stands for survivors to training and we have now this is the problem has been adopted health systems ... in multiple states ... this came from your own specific experience on tells about that and give us a little bit of a flavor for what star guns ... I would actually thirty years the aunt ... and a doctor at Harvard Medical school working impacted but I would die at the camp there ... and I don't have an ... on campus to capped by ... a screening test may be an anagram or a blood test or MRI or whatever ... and he started feeling really can it ... continue to Traci and and you feel really really there at the end of treatment ... still that could happen to me your unwed mother out why a ... daughter of Dr to handle the role of hell ... and I would ... do for ... that I'd been my last chemotherapy treatment like that ... oh ... I actually rehabilitated myself because that was my only option at that time and then ... began to get the last program called the TARP programs that help hospital ... I've developed their own chance to recapture that this has been quite successful places where it's been implemented is honestly not everywhere yet there was this sounds like a model that other places to follow if you don't have star available to you what else to look for these issues are battling ... the fact is most cancer hospitals the big ones are going to have rehabilitation services ... I think what to its been trying to do is get them to Courtenay so in college department and then the rehabilitation department might be separate to maybe ... maybe nobody's asking the patient may need them and I think what really sets me was an ... idea as some people might think this is the new normal to be this way you know ... maybe this is just the way my life is can it be so I think what you have to do is be around advocating savior oncologists to your search and what can I do don't call them back until we can say I'm really having trouble getting out of bed ... I need to have maybe I'm a consultation with them and rehabilitation medicine specialist ... and I think it's it's a little bit know you gotta ask for help it's often available it may not be as quart needed if the Caribbean star program and that's the key was shot dead trying to do with this premise makes sure that all the doctors are talking to each other than to fall into the physical therapist was also talking TDI and if you're going to this and in protecting its like if you have a relapse down the road into that that people the court made both side effects than in the next stage of your care ... Chile people will wonder about something like Star in terms of how that ... works with insurance and coverage can you tell Slavov about that ... Sheeler ... really had rehabilitation or is it that should be offered to everyone to the tothe I it there but that that should be up for leukemia a cancer survivors include an ... evaluation that could tie it to the other doctors but needed specialized in rehabilitation added that ... at twelve physical occupational and speech therapist today but actually covered by your insurance just like if you back into a car accident ... just like if you have to throw ... your insurance would cover the ... debt repayment trooper camp there ... when that they think that we he ... did actually get disconnected Laura with and then get ... between the rehabilitation oncology department in fact one easy way for the hospital to be are they doing a good job is to look at the number of new cancer patient they're having ... to Cali app and the weather stick the five to ninety percent of the patient is ... being referred for rehab the kid that with every picture ... that about thinking I've been meaning to the camp survivors ... physical impairment that need to be treated by a rehabilitation ... write to Lynn something someone says ... stop for a while and she's informed


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Featuring Jeannie Berlin, Robert Foxworth, Robin Weigert, Michael Weston and JoBeth WilliamsPreviews Begin November 28, 2012; Opening Is December 9; Continues Through January 6, 2013
Rehearsals have begun for Center Theatre Group's production of the Tony-nominated "Other Desert Cities" by Jon Robin Baitz. The cast features performances by Jeannie Berlin, Robert Foxworth, Robin Weigert, Michael Weston and JoBeth Williams. Robert Egan directs the West Coast premiere which starts previews on November 28, 2012, opens December 9 and runs through January 6, 2013.
Set design for "Other Desert Cities" is by Takeshi Kata, costume design by Alex Jaeger, lighting design by Lap Chi Chu, sound design by Adam Phalen and original music by Karl Fredrik Lundeberg. Casting is by Erika Sellin, CSA. Production Stage Manager is James T. McDermott.
"Other Desert Cities" tells the story of a once promising novelist who returns home after a six year absence to spend the holidays with her parents, her brother and her aunt. When she announces that she is about to publish a memoir focusing on an explosive chapter in the family's history, the reunion is thrown into turmoil.
Ben Brantley of The New York Times said that "Other Desert Cities" is ". . . the most richly enjoyable new play for grown-ups that New York has known in many a season . . . In his most fully realized play to date, Mr. Baitz makes sure our sympathies keep shifting among the members of the wounded family portrayed here. Every one of them emerges as selfish, loving, cruel, compassionate, irritating, charming and just possibly heroic." Linda Winer of Newsday said that the play is "…a smart, juicy, gorgeously written family drama that knows individual psychology as keenly as it understands the world around it. ..."
Jeannie Berlin (who plays Silda Grauman) recently appeared in the film "Margaret," for which she received Best Supporting Actress nods from The New York Times' A.O. Scott, the Village Voice 2011 Critics' Poll, the N.Y. Film Critics Award and more. She is also known for the films "Sheila Levine" and "The Heartbreak Kid" (Golden Globe nomination), among others. She appeared on stage in "Power Plays" opposite Alan Arkin, and in "After the Night and the Music."
Robert Foxworth (Lyman Wyeth) recently appeared as Henry Drummond in "Inherit the Wind," at The Old Globe in San Diego, where he is an Associate Artist. On Broadway, he has appeared in "Twelve Angry Men," "Ivanov," "Judgment at Nuremberg," "August: Osage County," and more. He has starred and guest-starred in numerous series, including "Six Feet Under" and "Falcon Crest." He is the voice of Ratchet in all three of the "Transformers" movies.
Michael Weston (Trip Wyeth) appeared off-Broadway in "Extinction" and "Snakebit," as well as in "Dead End," "Matchmaker" and "Johnny On The Spot," all at Williamstown Theatre Festival. In Los Angeles, he was seen in "Waverly Gallery" at the Pasadena Playhouse. Recently he starred in the A&E mini-series "Coma." His film credits include "State of Play," "Garden State" and "The Last Kiss," among others, and he has played recurring roles on the popular series' "House," "Six Feet Under" and "Scrubs."
Robin Weigert (Brooke Wyeth) has appeared on and off-Broadway in numerous productions, receiving Drama Desk and Lucille Lortel award nominations for her work in "Madame Melville." She recently played the eponymous Angel in Tony Kushner's "Angels in America" at the Signature Theatre Company in NYC. She is known to TV audiences for the role of Calamity Jane in "Deadwood" and a recurring role in the FX series "Sons of Anarchy." Her film work includes "The Good German," "Things We Lost in the Fire," "Fragments," "My One and Only," Charley Kaufman's "Synecdoche, New York" and "The Private Lives of Pippa Lee," as well as the "The Sessions."
JoBeth Willams (Polly Wyeth) recently appeared in "Quality of Life" at the Geffen Playhouse. Notable films include "The Big Chill" and "Poltergeist," as well as the television movies "Adam" and "Baby M," both of which brought her Emmy and Golden Globe nominations.
CTG has presented five Jon Robin Baitz plays including "Dutch Landscape" (world premiere – 1988-1989 season), "The Substance of Fire" (1992-1993 season), "Three Hotels" (1994-1995 season) and "Ten Unknowns" directed by Robert Egan (2002-2003 season), all at the Taper, and the world premiere of "The Paris Letter" (2004-2005 season) at CTG's Kirk Douglas Theatre. His other plays include "The Film Society," "The End of the Day," "A Fair Country," "Mizlansky/Zilinsky" and a new version of Ibsen's "Hedda Gabler" (for Broadway, starring Kate Burton). He is a Pulitzer Prize finalist for "A Fair Country" and a Guggenheim, NEA and American Academy of Arts & Letters Award winner. His screenplays include "The Substance of Fire" and "People I Know" starring Al Pacino, both for Miramax. He created the ABC-TV drama "Brothers & Sisters" in 2006, after writing an episode of "The West Wing" ("The Long Goodbye").
Robert Egan is the Artistic Director/Producer of the acclaimed Ojai Playwrights Conference. Prior to Ojai he was the Producing Director of the Taper for 20 seasons, where he founded and produced 15 seasons of the New Work Festival and directed "Made in Bangkok," "Closer," "Hedda Gabler," "Arcadia" and Jon Robin Baitz's "Ten Unknowns," among many others. He is also the Founder and President of RHEgan Productions LLC and Eye Street Media where he has conceived, written, produced and directed major live events and media celebrating Cure Autism Now, Operation Smile, LA Team Mentoring, Global Green USA and Homeboy Industries. Egan was recently named the Artistic Director/Producer of Watts Media, one of the nation's leading companies in strategizing and creating live events and media for corporations and non-profits across the country. Other directing and producing credits include major productions ranging from world premieres to Shakespeare at theatres across the country including in Los Angeles, New York, San Francisco and in London and Europe.
"Other Desert Cities" premiered at Lincoln Center Theater in December 2010 and played at the Booth Theatre on Broadway, October 2011 through June 2012, receiving a total of five Tony nominations.
Tickets for "Other Desert Cities" are available at www.CenterTheatreGroup.org, the CTG box office located at the Ahmanson Theatre, or by calling (213) 628-2772.


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CONWAY, S.C. -- Coastal Carolina University's baseball team opened the season with an 8-7 comeback victory over East Tennessee State, Friday, thanks to sophomore Adam Keim. Keim, who began the day as the starting pitcher, ended it with an eighth inning homer to win the ballgame.
Last year's starting shortstop went 6.1 innings in his pitching debut, leaving the game with a 5-3 lead. But the Buccaneers (0-1) scored four runs in the top of the eighth to go up 7-5, as ETSU opened the inning with four straight hits, and capped the scoring as Kirk Keithley drove home two on a double to left center. Coastal ace Scott Sturkie, who pitched the final 2.2 innings out of the pen, did manage to strike out the side, but not before the damage was done.
The Chants (1-0) who struggled to come up with clutch hits last season, came up with two in the bottom of the eighth. Freshman Aaron Mayhew led off the inning by having the ball graze his uniform to send him to first, and came around to score on Ryan McGraw's triple to center field. With two outs and the tieing run at third, Keim blasted his first career home run over the wall in left center off of ETSU's Jackson Simerly (0-1), who took the loss.
Sturkie (1-0) came back out in the ninth and pitched around a leadoff single to close out the game and pick up the win, his first of the season, and the 24th of his career, to move him into a tie for fifth-place all-time with Rett Johnson.
The game was the first of a three-game series, as they meet again tomorrow and Sunday, with both games beginning at 2:00 p.m.


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We watched The Wall come down.
Dennis and I lived in West Berlin from 1988-1991. Dennis was working as a manager for the Army-Air Force Exchange System (PX system), and I was a busy mother of one, then two small children. Keely turned three shortly after we moved to Berlin in 1988, and Isaac was born there in June, 1989.
In honor of the 20th anniversary of the Fall of the Berlin Wall, this post and its photos will tell a little about Berlin from the viewpoint of an American who was there when the Wall was opened.
The geography
For a refresher course on post-WWII geography, please examine the map at right. The British (green), French (blue) and American (orange) sectors were West Germany. The Russian sector (red) was East Germany. The Soviets and East Germans maintained a barricaded, heavily-guarded border between West Germany and East Germany. It was one segment of the "Iron Curtain".
If you look at the east side of East Germany, you'll see a little block of four colors that represents Berlin. The capitol city was divided into four sectors at the end of WWII, just as the nation was. The French, British, and American sectors became West Berlin, and the Soviet controlled sector was East Berlin. (This map is courtesy of Wikimedia.)
The Wall erected
The Berlin Airlift of 1948-1949 kept West Berlin supplied when the Russians blockaded Berlin to try to gain control of the entire city. Over 200,000 flights were made into the city by the Americans, British, French, and other nations. When the Soviets eventually realized that it was impossible to starve out West Berlin, they lifted the blockade, and travel resumed on the overland corridor from West Germany to Berlin.
The border between East and West Germany was closed in the early 1950s, but people could still cross into the West by entering West Berlin. In 1961, the East German army built the Wall around West Berlin -- the French, British, and American sectors -- to stop the exodus through that one remaining portal. Too many young, educated people were leaving.
The Berlin Wall was actually a double wall that went all the way around West Berlin. The West Berliners saw the inside wall. Much of it was covered with graffiti, as you may have seen in photographs. The well-guarded "death strip", with lights, towers and a patrol road, lay between the inside and outside walls. It was a hundred yards wide or more in many places. The East Germans saw the outside wall. A successful escape required crossing both walls as well as the space between them.
Living in West Berlin
Life in West Berlin was often compared to life on an island. As Department of Defense (DOD) civilians, we lived in military housing and generally had the same privileges and restrictions as military personnel.
We lived as free people within West Berlin, but our travel on the East German side of the wall was heavily restricted by military regulations. We could request paperwork that would allow us to go through Checkpoint Charlie to visit East Berlin, and we sometimes did. We could not go beyond East Berlin boundaries, so we had to be very careful when exploring.
Travel from Berlin to West Germany -- from Checkpoint Bravo to Checkpoint Alpha -- required an impressive stack of letter-perfect paperwork. Checkpoint Bravo was the only American, British, and French entrance/exit through the Wall on the west side of West Berlin. Checkpoint Alpha was located on the border of East and West Germany at Helmstedt/Marienborn, a 105 mile drive on the autobahn from Checkpoint Bravo.
Military travelers were allotted a certain amount of time between Alpha and Bravo. Soviet soldiers stamped the departure time on the travel papers. Travelers received detailed instructions about what not to do and how to handle emergencies. We drove through there a total of three times -- once when we moved there, and then a round trip out and back in when we traveled to West Germany to visit the villages where my great-grandparents were born. Our other trips in and out of the city were by air.
Cracks in the Iron Curtain
During 1989, a great amount of unrest developed in the eastern European countries. The USSR began to implode. "Solidarity" was happening in Poland. Hungary opened its borders, and East Germans started coming through Hungary to Austria. Then they were able to come west through Czechoslavakia. Thousands of East German refugees were arriving in West Germany. Huge crowds of East Germans demonstrated in cities all across East Germany, day after day. In East Berlin, hundreds of thousands of people demonstrated relentlessly. Finally the East German government decided that it had no recourse except to open its borders as well.
On Friday evening, November 9, 1989, I was sitting in our living room, nursing my five-month-old son and watching CNN. I heard a report by a stunned newsman that the East Germans had decided to open their borders for private travel. I called Dennis at work, and he was as amazed as I was. He decided that he would go down to Checkpoint Charlie when he got off work and see what was happening.
At Checkpoint Charlie, a huge crowd had gathered on the west side of the Wall. The East German guards, unsure of what they should be doing, were letting people through from the East, one at a time with long delays between each crossing. Each time someone came through the checkpoint, the West Berliners cheered wildly. One young man came through, pushing a bicycle and wearing a big backpack -- he was prepared to stay.
The Wall crumbles
Dennis came home after a while, but the excitement and celebration carried on through the night. The next day was Saturday, and the entire city of West Berlin was in a state of high jubilation. Visitors from East Berlin were everywhere. Some came over and used the public transportation, and others drove over in their Trabants. The electricity of freedom was in the air.
The banks opened to give welcome money to all the East Berliners who had come over. The West German government at that time gave visitors from East Germany 100DM of welcome money. They did this because East Germany allowed their elderly citizens to visit West Germany for up to 4 weeks per year, but they could not bring any money with them.
All the stores stayed open extra late that night, to accommodate the dazzled, goods-hungry East German shoppers. Shelves were depleted of such basic goods as sugar. A clever bit of Wall graffiti made the news the next day: "They came, they saw, they did a little shopping."
On Monday, the city calmed down a little because everyone had to go back to work, but the next weekend, the Easterners were back again. The West Berliners met them at the checkpoints with an outpouring of welcome. Some brought flowers to hand out to the visitors; church groups set up refreshment stands and gave away coffee and cookies.
At first, travelers across the checkpoints still had to deal with East German guards, but within a few weeks, even this pretense of regulation was abandoned. It had become pointless -- the Wall was being torn down. In some places, the Berliners themselves bashed through it with pickaxes and hammers.
By spring in 1990, Dennis and thousands of other Berliners were riding their bicycles on the long patrol road of the Wall, formerly the death strip. We often walked a half-dozen blocks from our home, crossed the former wall, and flew kites in an East German field. (That field, Keely, is where you were so happy to find what you thought was a "dinosaur bone" -- actually, a horseshoe.)
20 years of freedom celebrated
Yesterday (November 9, 2009), ceremonies were held in Berlin, in celebration of the fall of the Berlin Wall. President Obama declined to attend. (I don't often discuss current events and such on this blog, but I'm going to deviate from the norm for a few sentences.) I am ashamed of the President's refusal to honor America's role in opening the Berlin Wall and restoring Germany as a nation.
Remember, this is the man who recently traveled to Copenhagen to beg for the Olympics to be held in Chicago. He should have attended the Berlin ceremonies himself, instead of sending the Secretary of State. It's an insult not just to the Germans and our World War II allies, but to Freedom itself -- and a slap in the face to the many, many people around the world who have struggled to gain it and sacrificed to secure it for others.
More photos
- East Germans at an East Berlin store, waiting to enter. They coped with a chronic shortage of consumer goods. Much of what they did have was of inferior quality.
- The Brandenburg Gate, with the Berlin Wall in the background. It was enclosed within the two sections of the Wall. On the East Berlin side, the Wall was short so that people could look across and see the Gate. This photo was taken on the East Berlin side.
- An East German car -- the Trabant. There were several models, but only one make. It was the only East German car, and citizens ordered them years in advance of receiving them.
- Graffiti on the West Berlin side of the wall. East Berlin buildings are seen in the background. I think this photo was taken in the Checkpoint Charlie area.
- More graffiti. An interesting thing (not seen in the photo) -- along the wall on the West Berlin side, there were towers where West Berliners could climb up and look across and maybe wave to an East German family member.
- Dennis in the brown coat and little Keely in her red coat at the Teltow crossing. Watching the East Germans cross over was a major entertainment in West Berlin for several weeks. (Isaac, you were there too -- I was packing you in a carrier on my chest and taking pictures over your head.)
- East German border guards checking IDs and asking questions at the Teltow crossing
- Holes in a section of the Berlin Wall, spring of 1990
- The wide, lighted death strip between the two walls, seen after the opening of the Wall. This was only about a mile from where we lived.
- Barbed wire, removed and rolled
- A guard tower in the death strip, one of many left standing vacant. I suppose most of them have been knocked down by now.
- The many miles of abandoned patrol road rapidly became popular with bicyclists and hikers.


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Recommended electives: Photography 102, 103, 270, 290, 296. Suggested courses for Photography Fine Arts, Design Emphasis: ARTF 193, PHOT 180, 181, 235, 240. Suggested courses for Photography Advertising, Commercial Emphasis: PHOT 125, 220, 230, 240, 250.


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Here are the newest zines in the JPL Zine Collection. Check a bunch out, get inspired and write your own!
American spectarian. : zodiac v.3
Spontaneous lunchbox combustion
Josh Sullivan Comics! Vol. 10
Ink nineteen : June 1996
Ink nineteen : July 1996
Ink nineteen : August 1996
Girls a go go : the ye ye issue
The East Village inky. Vol. 38
The frugal vegan's spring and summer survival guide
Caboose. Vol. 1
What I did on my summer vacation
Milkyboots. Vol. 4
Somnambulist. Vol. 8
Bipedal, by pedal! Vol. 2 : confidential Mad Libs
Smile hon, you're in Baltimore. Vol. 11
The book bindery
The East Village inky. Vol. 40
Middle school
Make/shift. Vol. 8
Functionally ill. Vol. 5 : adventures with mental health
Scam. Vol. 7
Cometbus. Vol. 36
Duplex planet. Vol. 181
Duplex planet. Vol. 186
The iconoclast. Vol. 85
Girls are not chicks coloring book
Mishap. Vol. 26
This is what concerns me presents : remainders
Ink nineteen : May 1996
Worn. Vol. 7 : fashion journal
Better looking than a blog. a collection. : ten foot rule journal comix
A day in Rennes-le-Chateau
Strap yourself in. Vol. 8
Samantha Dorsett tribute zine
Smile hon, you're in Baltimore. Vol. 9
The black cloud. Vol. 3
Zine name
These yams Are delicious


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Twin Hills Chiropractic Health Center is conveniently located in Muncy, PA on Lycoming Mall Drive near the Lycoming Mall. We serve Williamsport, Montoursville, Muncy, Hughesville, Montgomery, and other surrounding areas in Lycoming County.
Twin Hills Chiropractic Health Center is committed to providing our patients with the highest quality of care with compassion and a focus on healing. Our Chiropractors, along with every staff member, are highly qualified, thoroughly trained and eager to help. Every patient is encouraged and guided to achieve his/her individual goals.
Chiropractors working under one roof offering Chiropractic Care and Occupational Health Services... One Source. Total Health.