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In this issue

Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review Feb. 1, 2010 / 18 Shevat 5770

Candidates, campaigns, and New Coke

By Jeff Jacoby

Jeff Jacoby

http://www.JewishWorldReview.com | Denouncing the Supreme Court's Jan. 21 ruling in the Citizens United campaign-finance case, President Obama called it "a green light to a new stampede of special interest money in our politics" and "a major victory for big oil, Wall Street banks, health insurance companies, and the other powerful interests." He denounced it again in his State of the Union address last week, saying it would "open the floodgates for special interests" and adding: "I don't think American elections should be bankrolled by America's most powerful interests."

The president's rebuke was not without chutzpah. In his 2008 White House run, he became the first candidate in the modern era to reject public financing, thereby freeing himself to amass a staggering $745 million in campaign contributions. Much of this was "special interest money" -- according to the Center for Responsive Politics, Obama's record-breaking campaign haul included $43 million from lawyers and lobbyists, $19 million from donors connected to the health-care industry, $18 million from investment and commercial banking, $10 million from real estate interests, and $9 million from Hollywood and the television industry.

Obama isn't the only critic of the high court's decision whose outrage at the thought of corporate influence in political campaigns seems a trifle ... contrived. Senator Charles Schumer, a New York Democrat, condemned the court for having "predetermined the winners of next November's elections. It won't be Republicans. It won't be Democrats. It will be corporate America." Coming from Schumer, that's a curious complaint: He is the Senate's leading recipient of campaign contributions from political action committees and other donors in nearly two dozen industries, including real estate, construction, securities, liquor, insurance, and hedge funds.

Worse than hypocrisy, though, is the condescension for voters that underlies so much of the fury aimed at the Supreme Court's ruling.

Letter from JWR publisher

Newsweek's Jonathan Alter wailed in alarm that "if Goldman Sachs wants to pay the entire cost of every congressional campaign in the US, the law of the land now allows it." (Actually, it doesn't: The decision left intact the ban on direct corporate donations to politicians.) Alan Colmes, the house liberal at Fox News, predicted a "corporate takeover over of America." Monica Youn of the Brennan Center for Justice, writing before the ruling was handed down, warned that if the justices deregulated corporate political speech "voters will be forced into a couch-potato role, mere viewers of the electoral spectacle bought and paid for by wealthy companies."

But voters are not mindless dolts. Campaign advertising doesn't turn them into automatons, blindly voting for whichever candidates "approve this message" the most. American politics is replete with candidates and campaigns that lost handily, notwithstanding the fortune spent on newspaper ads, radio spots, and TV commercials promoting them. The court's decision simply allows corporations, like countless other associations and groups, to have their say during election campaigns. It has no effect at all on the ability of voters to ignore what those corporations may choose to tell them.

You wouldn't know it from all the hyperventilating about dastardly corporate advertising, but Americans are perfectly capable of thinking for themselves. Why do so many smart people find that hard to accept? It's an old story. In 1958, John Kenneth Galbraith published The Affluent Society, a bestseller that argued among other things that big business had grown more powerful than the laws of supply and demand, since corporate advertising could always generate the demand needed to keep production high. As it happens, 1958 was also the year that the Ford Motor Company decided to pull the plug on the Edsel, the new car model it had introduced the previous fall with great fanfare and a vast ad budget -- but that American drivers steadfastly refused to buy.

Whether corporations will walk through the door the Supreme Court has now opened for them is not clear. Many corporations will doubtless avoid taking sides in heated election campaigns for fear of antagonizing their customers; others may decide that government-relations budgets are better spent on quiet lobbying than on open electioneering.

But even those that do choose to advertise during an election cycle will not make the mistake so many of the court's detractors are making. They know that Americans are not sheep, easily herded by means of clever commercials. If corporate advertising was irresistible, after all, we'd all be drinking New Coke.

Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.

Jeff Jacoby is a Boston Globe columnist. Comment by clicking here.

Jeff Jacoby Archives

© 2010, Boston Globe


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• Get ready to get sick: Australian girls as young as 10 and 11 are getting Brazilian waxes. And preschool aged girls want to paint their nails and wear "bras tailored for toddlers." WTF? •

• Australian researcher Maggie Hamilton interviewed thousands of parents and kids for her book What's Happening To Our Girls?. She found that the hypersexualization of kids has lead many youngsters to feel like they have to be, well, hypersexual. • But there is some good news out of Australia today: Australians are pretty pro-choice, says a new study. Only 4% of Australians oppose abortion outright, and 57% think abortions should be readily available for those who want them. • According to a recent paper, cosmetic eyelid surgery actually improves quality of life. They asked patients who had undergone the procedure to fill out a retrospective questionnaire, the results of which indicated that cosmetic surgery may in fact improve the lives of those unhappy with their looks. • A Canadian dominatrix and two other sex workers have asked Ontario's Superior Court of Justice to change Canada's prostitution laws, on the grounds that they are unconstitutional. Terri-Jean Bedford, 49, told the Toronto Star that she plans to bring her riding crop to court. "You never know when you might run across a naughty boy, or a naughty judge," she said. • A study from the University of Copenhagen found that women who join a soccer league are more likely to stick to their workouts than those who run. The soccer plays also reaped more health benefits from their exercise, and tended to enjoy working out more. • Sitting up straight may actually help improve your self esteem. Researchers found that people who are told to sit up at their desks are more likely to believe positive things about themselves than those who slump over. • A pregnant aerobics instructor who was wounded when George Sodini fired at least 52 shots into her fitness club has sued the estate of the gunman, saying that the injuries she received that day put her in danger of having a miscarriage. • Egyptian lawmakers have called for a ban on the Artificial Virginity Hymen Kit. The kit is manufactured in China, but they advertise that it ships to all countries in the Middle East. Conservative Egyptians fear that women will begin using them to trick their new husbands, and that it may make it easier for women to "give in to temptation." Some have even called for the exile of any woman caught ordering the kit. • Burmese pro-democracy leader Suu Kyi was escorted into "surprise talks" with a junta leader on Saturday. Optimists think this may be the start of a new era of cooperation between Suu Kyi and the current government. • A woman from Florida was the victim of a raccoon "gang attack" at her Lakeland house. A group of five raccoons pounced on the woman after she tried to shoo them away. Fortunately, she is in recovery and will be fine. • The Supreme Court has decided to refuse the request of the Connecticut Diocese and keep court documents on the sexual abuse committed by clergy members unsealed. • South Africa's African National Congress says that since Caster Semenya was raised as a girl, she should "continue to run as a woman." • Harriet the Spy will become a live-action TV movie on the Disney Channel. • Return to the Hundred Acre Wood, an authorized sequel to A.A. Milne's Winnie the Pooh books, came out today. The book features a new character, a pearl-wearing otter, and the author says, "I made Eeyore a little more proactive so he wasn't always the victim." • Scientists have discovered a damaged gene that is linked to half of all breast cancers. Damaged NRG1s have been found in 50% of all breast cancer patients, and it has also been linked to ovarian and bladder cancers. Although everyone is born with an intact NRG1, many cancer patients have faulty NRG1s, which were damaged at some point during their lives, but doctors have yet to pinpoint how. •

Image via Yahoo TV

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As Frank Ocean so eloquently crooned, we all try and that is what Lifetime is doing with their latest casting in the forthcoming Whitney Houston made-for-TV biopic. Last week, Yaya DaCosta was announced as the lead actress who will play Houston herself.

But Madame Noire shares that Belizean actor Arlen Escarpeta will play Bobby Brown, but he's not giving my "Rock Wit'Cha" just-out-of-New-Edition Bobby. I'm trying to picture Escarpeta humping the floor or a speaker and I'm struggling.

But I guess the gumby haircut helps?

Whatever happens, Lifetime's scriptwriters must acknowledge and try to re-create the couple's epic duet to sass all of their haters, "Something in Common." Whitney and Bobby were the original Chris Brown and Rihanna and respect to their bad song championing their poor decisions to date one another must be noted.

Image via Lifetime and Getty.


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Thursday, April 27, 2006

Sullivan, read the book before you embarrass yourself anymore

Andrew Sullivan is just sometimes content to embarrass himself for seemingly no other reason than because his ego is too large for him not to say anything about something he knows nothing about. Yesterday and today he's attacking Ramesh Ponnuru's book (which he hasn't read) because of its title here and here. Ramesh replies to Sullivan's first post here.

Sullivan says, "Conservative writers have now made fortunes calling their partisan opponents traitors, godless, and now pro-death. Their rhetoric increasingly equates being a Christian with being a Republican. I never thought someone as civilized and intelligent as Ponnuru would sink to this kind of rhetoric."

Pseudo-conservative writers now make fortunes calling the title of a book they haven't read "reprehensible." Their rhetoric now creates silly and ignorant strawman arguments since I've read the book and never noticed Christianity being equated with being a Republican. I'm well aware that someone as "knowledgeable" as Sullivan would attack a book he hasn't read based on nothing but the book's title even though he doesn't care seem what the author means by the title. Thanks Andrew. Never let your complete ignorance on a subject keep you from self-righteously taking cheap shots at others.

But I really think Andrew should read the book because Ramesh aptly discusses and logically destroys Sullivan's "personally prolife" position also famously held by Mario Cuomo. You see Andrew "abhors abortion as a moral matter" and "can never condone it" (seemingly because abortion intentionally ends the life of an innocent human being) yet he thinks that "attempt(s) of the government to police a woman's body in the first stages of pregnancy to be a deeply unconservative idea." Sullivan can never condone abortion yet thinks restricting abortion in the first trimester is deeply unconservative? Gee, thanks. How many sides of his mouth can he talk out of? Why attempts to police a woman's body later in pregnancy (after the first trimester) aren't "deeply unconservative" is never explained.

Sullivan provides no reasoning (except saying "balancing of goods") as to why it should be illegal to abort 12-week fetuses yet illegal to abort 13-week fetuses. What changes in that one week make the developing human being worthy of legal protection? Is there no real reason except to "balance the goods?"

Why the first trimester? Why not the first quadmester?

Nor does Sullivan seem to recognize in his second post that one branch of the federal government (the Supreme Court) has already imposed itself into the abortion debate.

If Sullivan took the time to research the book a little before commenting (if he didn't feel like waiting to read it) he might notice that various bloggers like Amy Welborn and Naaman have already shared what Ramesh says he means by the title.

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Thursday, December 11, 2008

Who You Gonna Call ...

Who you gonna call to investigate a horrible mid-air collision: an internationally respected professional aviation authority such as the U.S. National Transportation Safety Board -- or a a group of people who owe their paychecks to the military authority responsible for operating the very air-space in which the accident occurred?

Some news reports today give abundant credence to the 266-page report issued yesterday by the Brazilian Air Force (which runs all air-traffic control in that country). The report, signed by two Air Force generals, naturally finds that the American pilots of a business jet were almost entirely responsible for the tragic mid-air collision over the Amazon that killed 154 on a 737 Brazilian airliner on Sept. 29, 2006.

(The New York Times story today puts the issue into proper context. Here's a link. Newsday also gets it right. The AP, of course, does not.)

The Brazilian report does concede, in a few of its 266 pages, that various, uh, issues with Brazilian air-traffic control may have, uh, been, uh, simultaneously ongoing, uh, concurrent with the occurrence of the, uh, incident.

Off to the races and down the rabbit-hole we go again.

I'll link to the Brazilian report today.

I'll also link to the U.S. National Transportation Safety Board findings, also issued yesterday.

The NTSB came to a far different conclusion -- that the "probable causes" of the accident were systemic errors and specific mistakes in Brazilian air-traffic control, including the fact that the American business jet that collided with the 737 had been ordered to fly at 37,000 feet, on a collision course that went undetected on the ground at air traffic control, for about 50 minutes until the collision.

The NTSB finds that the air-traffic control mistakes were the "probable causes" of the disaster. The NTSB found that the non-functioning transponder and anti-collision system on the Legacy was a "contributing factor." Neither the Legacy pilots nor the air-traffic controllers (who were supposed to be monitoring the flight) realized that the Legacy transponder wasn't signaling for about 50 minutes before the collision.

No one has yet come up with anything but a guess to explain how the transponder went off-line, by the way. Was it pilot error? Somehow, with a slip of the foot or hand, did one of the American pilots accidentally turn off the unit? Was it faulty equipment? No one has been able to say.

The Brazilians have basically thrown everything including the kitchen sink into these charges against the American pilots, Joe Lepore and Jan Paladino, and ExcelAire, the Long Island air-charter company that had just bought the Legacy in Brazil and was ferrying it home when the disaster occurred.

There is another, uh, issue, incidentally. And it involves the Brazilians' strategic release of the voice recordings from the Legacy cockpit during the entire flight, most notably during the 50 minutes up to the collision and the 25 harrowing minutes afterward as the damaged Legacy was going down, before the pilots spotted a runway gashed into the deep jungle and fought the plane down safely.

Yesterday, the International Federation of Air Line Pilots Associations released a statement denouncing the leaking of cockpit voice recordings. Such leaked recordings, the international pilots group said, "are being used by a media provider for public entertainment."

Now, the grandly named International Federation of Air Line Pilots Associations (IFALPA) has long been known for its own tradition of elephantine harrumphing, not to mention bureaucratic obfuscation. What in the world are they getting at?

Media accounts noting the IFALPA statement correctly surmised that it addressed what is, in fact, a disgraceful use of cockpit voice recordings -- to provide meretricious, cheap dramatic thrills for the paying audience (or readership, with Web site links to the horror) as a plane and its passengers go down in hellish horror.

Incidentally, my own first public comments on this horror came as I was consumed by a far-lesser horror, having been one of seven people on the Legacy who survived the disaster. At least I was alive.

After being held in custody and questioned endlessly day and night in Brazil following the accident, addled, deeply traumatized and emotionally and physically exhausted, I arrived back in the United States on a flight that came into Kennedy airport at dawn. I cleared Customs and saw my wife and our two-year-old grandson (whom she had been babysitting that weekend) waiting anxiously ahead.

But as I went to them, I was ambushed by a Brazilian TV crew based in New York and demanding to know how I felt about the 154 dead. The bodies were only then being pulled out of the jungle. I had had no access to news reports while in custody. I could not even begin to grasp the horror that had suddenly fallen into the lives of the families and loved ones of the dead.

Stunned and stammering, I tried to convey my profound sympathy with the TV lights in my face. And in days of numbing, seemingly endless TV, print and radio interviews afterward, I tried to do it again and again, but in Brazil the emotional howl against the Americans was overwhelming. It did not seem to matter that we who had lived mourned those who had died. Instead, we were falsely depicted in the Brazilian media maelstrom as being cold and uncaring, the perpetrators of an unspeakable crime.

But back to the matter of those cockpit recordings:

In a disaster, cockpit voice recordings pick up the screams of the dying passengers. Using them to exploit a horror is despicable -- but we all know what some media are capable of in the service of cheap dramatic narrative, the curse that will finally kill decent journalism in this country.

But the IFALPA statement, as weedling as it was in general tone, also illuminated a problem specific to this incident. Let me explain:

If you are a layperson unfamiliar with how an airplane is flown, and if you were to listen to the cockpit chatter on any flight, you would probably be surprised. It doesn't sound at all like those stentorian pronouncements the captain makes to the passengers in the cabin on that 767 in its final approach to Houston.

That's because flying a sophisticated airliner (and the Legacy is a modification of the Embraer 135/145 regional-jets familiar to most airline passengers) is nothing at all like driving a car down Interstate 95.

Unlike a driver, a pilot does not need to constantly have a hand on the equivalent of a steering wheel on an airplane flying at cruise altitude under auto-pilot. Pilots don't have to keep their eyes ahead every second, as you do on a highway. In a cockpit under normal conditions, pilots can gossip, joke, gripe, talk to a flight attendant, whatever -- and still be absolutely vigilant about the aircraft in flight.

In a journalistically disgraceful article in the January Vanity Fair magazine, William Langewiesche, himself a private pilot, spins a fantasia that purports to narrate the scene in the Legacy cockpit on Sept. 29, 2006.

To do so, he makes gross suppositions about the motives and thoughts of those of us who were on that airplane, based exclusively on his interpretation of the Legacy cockpit voice-recordings, including an audio copy that was slipped to him by the Brazilians -- who, of course, uh, had no ulterior motive. (Shockingly, Langewiesche did not speak with the pilots or, I can hereby attest, with me or any of the other four passengers on board, or any of their legal representatives, to construct his fantasia. But you'll hear more on that later -- here and elsewhere.)

The flight being utterly normal till it crashed, the voice recordings depict a routine cockpit environment at 37,000 feet in wide open skies. The plane was on auto-pilot. The pilots performed their standard duties. In the interludes, they chatted with each other.

At one point, they can be heard expressing confusion about how to turn on an in-flight entertainment system that shows the aircraft position, altitude, etc. on screens back in the cabin. At another point, one of them took his new digital camera out and they groused about the typically indecipherable instructions.

At another point, the captain, Joe Lepore, left the cockpit to use the bathroom and stayed away for 16 minutes. At various points, as is utterly typical on a business jet flight, some of the passengers came up to the open cockpit door and chatted briefly with the pilots.

At the pilots' invitation, I went forward and very briefly exchanged some pleasantries before returning to my seat by the left wing to continue working on my laptop.

(By the way, I was in the Navy for four years and I never called a ship a "she." Despite what Langewiesche interprets from a muddy voice recording, I doubt very much that I said "How's she flying?," as if I was some schnook trying clumsily to sound cool to the pilots. I haven't listened to the recordings, but most likely I said, "How's it flying?" But checking with me would have killed the joke. I was also in naval aviation, and I am not unfamiliar with airplane cockpits of all sorts. As I reported in the New York Times right after the crash, I read the Legacy's altitude off the altimeter, despite Langewiesche's clumsy ridicule. If he'd checked with me ... oh, never mind.)

I had been in Brazil on assignment from a trade magazine to spend two days touring Embraer's headquarters near Sao Paulo, including its factories. It was two days and nights of wonk-work, being marched through production facilities and interviewing engineers, designers and Embraer planners.

Among the many things the Vanity Fair article gets very wrong is that. I was not on assignment to write about riding on some business jet, which would have been a stupid assignment. When the plane crashed, of course, that changed. I would have told Langewiesche that he was wrong -- wrong about the scene on the flight, wrong about so many things but, of course, he never attempted to contact me. And yes, more on that lapse later, here and elsewhere.)

Anyway, my point is (and I think it was IFALPA's as well) that unscrupulous media can use any cockpit voice recording to suggest, to those unfamiliar with what really transpires in a cockpit on routine flights, that the pilots are goofing off. (By the way, if you read the Vanity Fair article, note how the far more relaxed and even raucous scene in the cockpit of the doomed Gol 737 is depicted without ominous portent.)

Is this merely a journalistic objection, a protest that an honest journalist does not, not ever, pipe a scene to create a false impression and build a phony narrative from guesses?

Well, there's more.

The Brazilian Air Force report on the crash just happens to, uh, make note of the very same observations about the scene in the Legacy cockpit, strictly as extrapolated from the voice recordings.

It notes, by way of trying to buttress its contention that the pilots were grievously at fault in myriad ways, that "the haste to depart and the pressure from the passengers hinder[ed] adequate knowledge of the flight plan."

{By the way, the alleged "pressure form the passengers" is in part a shot at me, a risible suggestion, also unwisely made in several instances by Langewiesche, that the presence of a reporter on board the airplane created "pressure" on the Legacy pilots and contributed to the crash. More on that later, here and elsewhere.)

The Brazilian Air Force report says -- in assertions directly disputed by the U.S. NTSB report that, of course, has no ax to grind -- that the Legacy pilots' preparation for the flight was "inadequate."

The cockpit interaction, says the Brazilian Air Force report asserting that the Americans caused the disaster, was characterized by "informality."

That's one of the reasons that cockpit voice recordings shouldn't be put in the hands of the unscrupulous who are determined to manipulate the uninformed.

But more on that later. Here and elsewhere.

Robey said...

Wow, I had the same reaction on your behalf when I read the article after it was linked to a blog I read. I couldn't figure out why a professional journalist would simply assign feelings and motives to people he could very easily interview. It was telling that a friend who, while reading the VF article, simply assumed both planes had crashed because there were no quotes from anyone on either plane. Thank you for setting the record straight.

Robey said...

Thank you for setting the record straight. Since I regularly read your column in the Times I was fairly certain you were alive and was surprised not to see you interviewed for this article. Especially after what you had already written in the Times. Hey, you're no shaman but I would think you could offer some first hand perspective. Apparently that would have been inconvenient for Langewiesche who had no trouble assigning feelings and motives to you and the pilots. It was telling that a friend of mine, a freelance journalist, while reading the VF article assumed both planes had crashed since there were no quotes from either planes' occupants. She was surprised to read that your plane had landed safely. Keep up the good work.

Anonymous said...

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Katherine Karver
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text:
Tuesday, May 08, 2012

Harvesting the Light Field

RioGrandeStatePark003a (Rio Grande State Park, north of Albuquerque)

LosRanchos003a (Los Ranchos acequia, in north Albuquerque)

(Composed on iPad2 using iWriter, typed on Underwood Universal. Images scanned and processed from 4"x5" pinhole paper negatives.)

Blogger Rob Bowker said...

Wise and enlightening observations. The 'art' is the evidence from a journey. And you can't help it. While nothing's new, everything is. Even if you pass the same way twice, the journey's different, you are older, time's passed and the evidence you leave will show this. And as witnesses, your audience contemplates what you share.

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Blogger rino breebaart said...

great post - I for one like the soft-edged pinhole pix you've posted! It's very much a slow, deliberate and careful process - and as such has plenty value, in terms of creative pay-off. Because ultimately you're carefully managing attention - it reflects the effort and intent. I've been getting back into film again - despite it almost being a joke at photo shops! The grain and (bokeh - for want of a better word) is just so different. cheers, rino

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Skip Navigation LinksHome > June 2012 - Volume 31 - Issue 6 > The Effect of Continuous Positive Airway Pressure Treatment...
doi: 10.1097/ICO.0b013e31824a2040
Clinical Science

The Effect of Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Syndrome on the Ocular Surface

Hayirci, Emre MD*; Yagci, Ayse MD*; Palamar, Melis MD*; Basoglu, O. K. MD; Veral, Ali MD

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Purpose: To evaluate the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea syndrome on the ocular surface.

Methods: This is a prospective, sectional cohort study of 80 eyes of 40 patients diagnosed with obstructive sleep apnea syndrome. Routine ophthalmologic examination and ocular surface evaluation, including biomicroscopy, Schirmer 1 testing, tear break-up time measurement, ocular surface staining, and conjunctival impression cytology, were performed in both of each patient's eyes before and 4 months after starting CPAP therapy.

Results: After CPAP therapy, increases in squamous metaplasia (Nelson classification: t = 0.34, P = 0.014) and Schirmer 1 score (t = 3.20, P = 0.008), and decreases in tear break-up time (t = −1.38, P = 0.008) in the right eyes were statistically significant, as compared with the pretreatment values. Although these parameters changed in a similar fashion in the left eyes, differences between the pre-CPAP and post-CPAP values were not significant.

Conclusions: The findings indicate that CPAP therapy increased ocular irritation, tear evaporation, and squamous metaplasia in the conjunctiva of the patients' right and left eyes. Although the parameters measured were similar in both eyes before CPAP therapy, these parameters changed significantly after CPAP therapy only in the right eyes. The observed differences between the right and left eyes require further investigation to determine the possible effects of sleeping position, CPAP mask displacement, and the other factors involved.

© 2012 Lippincott Williams & Wilkins, Inc.

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Obstetrics & Gynecology

Skip Navigation LinksHome > March 2005 - Volume 105 - Issue 3 > High Compared With Standard Gentamicin Dosing for Chorioamni...
Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000151106.87930.1a
Original Research

High Compared With Standard Gentamicin Dosing for Chorioamnionitis: A Comparison of Maternal and Fetal Serum Drug Levels

Locksmith, Gregory J. MD*; Chin, Anita MD*; Vu, Tammy MD*; Shattuck, Karen E. MD†; Hankins, Gary D. V. MD*

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From the *Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, and †Department of Pediatrics, Division of Neonatology, University of Texas Medical Branch, Galveston, Texas.

Presented at the Annual Meeting of the Society for Maternal-Fetal Medicine, February 3–7, 2004, New Orleans, Louisiana.

Reprints are not available. Address correspondence to: Gregory J. Locksmith, MD, Arnold Palmer Hospital for Children and Women, 105 West Miller Street, Orlando, Florida 32806; e-mail: glocksmi@orhs.org.

Received July 30, 2004. Received in revised form October 1, 2004. Accepted October 14, 2004.

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OBJECTIVE: To compare umbilical cord and maternal serum peak gentamicin concentration, gentamicin elimination, and clinical outcomes between women who received once-daily compared with standard, thrice-daily dosing for clinical chorioamnionitis.

METHODS: We randomly assigned 38 laboring women, at least 34 weeks gestation, with clinical chorioamnionitis, into 1 of 2 gentamicin dosing groups: 5.1 mg/kg every 24 hours (once-daily; n = 18), or 120 mg followed by 80 mg every 8 hours (standard; n = 20). We measured maternal serum peak and delivery gentamicin concentrations and cord serum levels at delivery. Polynomial curve fitting was used to summarize gentamicin elimination. We also compared maternal and neonatal outcomes.

RESULTS: Demographic characteristics of the 2 groups were similar. Median maternal peak gentamicin levels were higher with once-daily (18.2 μg/mL) compared with standard dosing (7.1 μg/mL) (P < .001). Maternal serum levels decreased below 2 μg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group. Extrapolated peak cord serum levels were 6.9 μg/mL in the once-daily and 2.9 μg/mL in the standard dosing arm. Cord levels decreased below 2 μg/mL by 10 hours in the once-daily and by 5 hours in the standard dosing group. We found no differences in maternal or neonatal outcomes.

CONCLUSION: Peak maternal serum gentamicin levels ranged from 13 to 25 μg/mL after a dose of 5.1 mg/kg. Single-dose gentamicin resulted in fetal serum peak levels that were closer to optimal neonatal values. Gentamicin clearance in the term fetus was similar to published values for the newborn infant. No adverse effects of high-dose therapy were noted.

The standard of care for acute chorioamnionitis is antibiotic therapy immediately upon making the diagnosis. The primary rationale behind this practice is to reduce the risk of neonatal sepsis.1 Although universal agreement does not exist regarding the antibiotic regimen of choice, most studies to date have evaluated intravenous ampicillin (2 g every 6 hours) plus gentamicin (1.0–1.5 mg/kg every 8 hours).1 Concerns about using gentamicin and other aminoglycosides in pregnancy are rooted in their potential to cause kidney or eighth cranial nerve damage in the mother or neonate.2 Administering the total daily dose of gentamicin once daily, rather than in divided doses, has been proposed as a means of reducing toxicity.3 Higher doses of aminoglycoside antibiotics administered at longer intervals also result in higher peak levels and longer duration of bacterial killing after serum drug concentrations fall below the minimum inhibitory concentration (MIC), purportedly improving efficacy.4,5 One could also argue, however, that shorter dosing intervals are preferable with a bacteriocidal agent such as gentamicin. Improved effectiveness and reduced toxicity have been difficult to demonstrate in prospective studies, but once-daily dosing has been shown to be more cost-effective than traditional dosing.6–9

We undertook this investigation in laboring women with clinical chorioamnionitis primarily to compare fetal and maternal peak serum gentamicin concentrations between subjects who received once-daily compared with standard, thrice-daily dosing of gentamicin. We also compared gentamicin elimination between the two study groups. Maternal and neonatal clinical outcomes were evaluated secondarily.

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This randomized study was approved by the University of Texas Medical Branch Institutional Review Board. From November 25, 2001, through May 5, 2003, we enrolled 38 women of at least 34 weeks gestation with clinical chorioamnionitis. The diagnosis of chorioamnionitis was based on a fever during labor of at least 37.8°C combined with at least 1 of the following clinical signs: maternal heart rate greater than 100 beats per minute, fetal heart rate greater than 160 beats per minute, uterine tenderness, or malodorous amniotic fluid. In the interest of patient safety, we excluded women with a history of renal insufficiency or myasthenia gravis, serum creatinine level greater than 1.4 mg/dL, allergy to gentamicin, receipt of magnesium sulfate or a neuromuscular blocking agent within 24 hours of enrollment, hypocalcemia, or receipt of a diuretic agent within the week before enrollment. To reduce confounding, women with coexisting maternal infection requiring systemic antibiotic therapy also were excluded.

After providing informed consent, subjects were randomly assigned to 1 of 2 gentamicin dosing groups: conventional dosing (n = 20), and once-daily dosing (n = 18). Randomization was accomplished with sequentially numbered sealed, opaque envelopes. A randomization schedule was created by using a computer-generated random number table. Women assigned to the conventional dosing group received a 120 mg loading dose followed by 80 mg every 8 hours. Women assigned to the once-daily dosing group received 5.1 mg/kg of ideal or adjusted body weight every 24 hours. Ideal body weight (in kilograms) was calculated by adding 2.3 kg for every inch in the subject's height over five feet to a base of 45.5 kg. If the subject's actual body weight was more than 30% greater than her ideal body weight, an adjusted weight was used to derive her dose of gentamicin by adding her ideal body weight to 40% of the difference between her actual and ideal body weight. Ampicillin 2 g intravenously every 6 hours, was also provided to all subjects.

Maternal serum gentamicin levels were obtained 30 minutes after completion of each dose (peak) and at delivery. We also measured umbilical cord serum gentamicin concentrations at delivery. From these values we constructed elimination curves for each dosing group, in both maternal and fetal compartments, plotting gentamicin concentration against time. For the mothers, we calculated an elimination constant (ke) in each subject using the following formula: ke = ln(C1/C2)/(t1−t2),10 where C1 is the peak gentamicin concentration, C2 is the concentration at delivery, and t1-t2 is the interval from drug administration to delivery. With the elimination constant, the half-life (t1/2) for each subject was calculated using the following formula: t1/2 = 0.693/ke.10 Because only 1 umbilical cord serum sample was taken from each fetal subject, elimination constants and half-lives were calculated for each study group by selecting 2 points on each composite elimination curve that encompassed the highest concentration of data points.

We compared the following maternal outcomes between the 2 groups: duration of labor after a diagnosis of chorioamnionitis, cesarean delivery rate, length of febrile illness in the postpartum period, and length of hospitalization. Evaluations of specific maternal morbidity included puerperal infection, peripartum hemorrhage, need for blood transfusion, and death. Neonatal outcomes of interest included Apgar scores, urine output (assessed by daily diaper counts), serum creatinine levels, suspected and confirmed sepsis rates, need for antibiotic therapy, length of antibiotic therapy, length of hospitalization, and death. Practitioners who performed the initial neonatal physical examination were instructed to note specifically the presence or absence of respiratory depression and neuromuscular weakness. Additionally, neonates underwent audiologic evaluation as part of a state mandated hearing screening program for newborn infants before discharge. Those with abnormal tests were referred to the audiology service for follow-up diagnostic testing.

Reviewers who assessed outcomes were blinded to the assignment of patients to treatment groups. Categorically defined outcomes were compared using χ2 and Fisher exact tests where appropriate. Outcomes defined on a continuous scale with normal distribution were compared with the Student t test. Ordinal variables and continuous variables that were not normally distributed were compared using the Mann-Whitney U test. Pearson correlation was used to evaluate the relationship between umbilical cord serum gentamicin concentrations and time from their mothers’ last dose. A significance level of 0.05 and a power level of 0.80 were selected. To detect a 1.5 μg/mL difference in peak fetal gentamicin levels, assuming a range of values between 4 and 10 μg/mL, a sample size of 17 subjects per group was required.

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Overall, 45 women were invited to participate in the study. Thirty-eight subjects provided consent. Eighteen subjects were randomly assigned to once-daily dosing, and 17 of these provided maternal peak serum samples, 17 provided serum samples at delivery, and cord serum samples were obtained in 17. Of the 20 subjects assigned to the standard dosing group, 17 provided maternal peak serum samples, 18 provided serum samples at delivery, and cord samples were obtained in 19. All of the subjects in the once-daily group received only 1 dose of gentamicin before delivery. Dosages in the once-daily dosing group ranged from 280–410 mg. All subjects in the standard dosing group received 120 mg of gentamicin with their first dose. One subject in the conventional dosing group received 2 gentamicin doses before delivery, and the remainder received only 1 dose. Maternal characteristics at the time of enrollment are depicted in Table 1. The isolated maternal gentamicin concentration obtained right after the second dose of 80 mg was not used for determination of the median peak value in Table 2. Clinical outcomes were analyzed in all 38 subject pairs. Dosing groups did not differ significantly with respect to demographic characteristics, gestational age, fetal weight, and clinical criteria for chorioamnionitis. All subjects were in labor at the time of enrollment.

Table 1
Table 1
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Table 2
Table 2
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Figure 1 displays maternal serum peak gentamicin concentrations and levels at delivery in the once-daily and conventional dosing groups. Mean maternal peak levels were 18.1 μg/mL in the once-daily and 7.5 μg/mL in the conventional dosing group (P < .001). Maternal serum levels decreased to below 2 μg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group.

Fig. 1
Fig. 1
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Umbilical cord serum gentamicin levels at the time of delivery are depicted in Figure 2. Strong inverse correlations between fetal gentamicin concentration and time from the mother's last dose were noted with both once-daily (r = −0.79, P < .001) and conventional dosing (r = −0.76, P < .001). Three subjects from each group delivered within 1 hour of receiving their first dose. Mean cord serum levels from these women were 6.5 μg/mL (once-daily) and 3.0 μg/mL (standard) (P = .04). A best fit elimination curve was constructed, and the extrapolated peak cord serum levels were similar to these mean values (once-daily 6.9 μg/mL, standard 2.9 μg/mL). From this curve, fetal serum half-lives were estimated at 5.6 hours in the once-daily dosing group and at 4.5 hours in the standard dosing group. Cord serum levels decreased to below 2 μg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group.

Fig. 2
Fig. 2
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Maternal outcomes are presented in Table 2. After the clinical diagnosis of chorioamnionitis was made, there were no differences in duration of labor, cesarean rate, duration of maternal fever, overall maternal morbidity, or duration of hospital stay. No maternal deaths occurred. Table 3 lists neonatal outcomes. At the time of birth, neither Apgar scores nor signs of neuromuscular weakness differed between groups. No cases of culture-positive sepsis, respiratory depression, or inadequate urine production were found, and no perinatal deaths occurred. Rates of suspected sepsis requiring antibiotic use were similar, as was the duration of neonatal antibiotic administration between groups. No difference in mean serum creatinine levels was found between the 2 groups, and none of the neonates in this study demonstrated evidence of compromised urinary output. Overall morbidity and length of hospitalization among the neonatal groups were similar. One infant, from the standard maternal dosing group, had an abnormal hearing screening examination that was found on follow-up diagnostic evaluation to be normal.

Table 3
Table 3
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The primary focus of this small study was to compare fetal and maternal peak gentamicin concentrations and elimination between our 2 study groups. The once-daily gentamicin dosing regimen resulted in fetal serum peak drug levels that were consistently greater than 5 μg/mL and typically in the range of 7–8 μg/mL, whereas conventional dosing led to peak fetal concentrations in the range of 2–4 μg/mL. A higher peak serum drug level provides increased and more rapid in vitro antibacterial activity and longer periods of bacterial killing after the MIC has been reached. The latter phenomenon, known as the post antibiotic effect, results not only in greater antibacterial activity but also in reduced adaptive resistance.11

Studies evaluating optimal peak gentamicin concentrations on neonates are few, and recommendations for dosing in these patients are guided by extrapolated data from adult studies. Achievement of peak serum concentrations greater than 5–8 μg/mL in adults with serious infections has been associated with a lower incidence of mortality and a higher overall clinical response rate.3,4,12 Respected authorities in neonatology and pediatrics recommend aiming for the same goal in the relatively immunocompromised neonate.13–15 Five to 10% of neonates delivered to mothers with clinical chorioamnionitis have bacteremia or pneumonia.1 These fetuses are probably infected in utero, and their ultimate response to therapy might be improved by obtaining higher peak drug levels before they are delivered. Achieving the same gentamicin levels in the fetus as are targeted in the newborn infant is, in our opinion, worthy of further investigation.

As expected, peak fetal gentamicin levels were one-third that of maternal peak concentrations. Approximately 50% of the drug crosses the placenta unchanged.16 Additionally, the volume of distribution of gentamicin is larger in neonates than adults.17,18 A number of pharmacokinetic studies in neonates have demonstrated that loading doses of 5 mg/kg are required to achieve desired initial peak therapeutic concentrations of 5–10 μg/mL.17–19 According to our results, maternal loading doses of 5, or even perhaps 7, mg/kg would be necessary to achieve peak values consistently in this range.

We found 1 report in the literature that compared neonatal (rather than fetal) serum gentamicin concentrations after once-daily compared with conventional dosing regimens in the mothers.20 This group found no relationship between individual serum concentrations in the infants and the time from their mothers’ last dose. Their findings create concern regarding the fetus’ ability to clear gentamicin from the bloodstream. In contrast, we found inverse correlations between umbilical cord gentamicin concentration and time. We constructed elimination curves and estimated half-lives for each group. Fetal gentamicin clearance was not abnormally prolonged in either the high-dose or standard-dose group. The estimated half-lives in each group were consistent with published values of approximately 5 hours in newborn infants aged 0–7 days.21 These findings indicate that the term or near-term fetus is able to clear gentamicin as effectively as the term neonate.

Aminoglycoside nephrotoxicity is almost always reversible and results from accumulation and retention of the drug in the proximal tubular cells.22,23 The initial manifestation of damage is excretion of enzymes at the renal tubular brush border.24 Later, renal concentrating ability and glomerular filtration are impaired, and casts may appear in the urine.25 Ototoxicity results from progressive destruction of hair cells in the cochlea (organ of Corti)26 and vestibula (crista ampullaris).27 These histologic changes result in impaired ability of the cochlea to generate an action potential in response to sound. Once these sensory cells are lost, regeneration does not occur, resulting in degeneration of the auditory nerve and permanent hearing loss.2

Animal models have demonstrated that gentamicin uptake in the renal cortex and ear perilymph is a saturable process that is relatively unaffected by drug concentration.28 A conclusion from these studies is that prolonged moderate drug levels, rather than transient high peak serum concentrations, lead to excessive drug accumulation in the renal and cochlear systems. Studies in adults with serious infections have concluded that desirable gentamicin trough concentrations are less than 2 μg/mL.29 These levels were reached in the fetus at 8–9 hours in the once daily dosing group. Once-daily dosing potentially reduces nephrotoxicity and ototoxicity by limiting the total exposure per dosing interval and by ensuring a low concentration or drug-free period in each dosing interval to allow redistribution of the aminoglycoside out of the proximal renal tubules and perilymph where it is known to concentrate.30 Dosing intervals of 24 hours should allow sufficient time for the fetal kidney and cochlea to clear the drug. Such large intervals between doses, however, raise concern about efficacy. More study is needed to determine the optimal dosage and interval between doses.

Peak gentamicin levels in both of the groups of laboring women in our study were similar to those achieved with equivalent gentamicin doses in postpartum women with endometritis in other studies.6,7,31–34 The 90–120 minute half-life of gentamicin in our laboring subjects is shorter than the 2–3 hours that is generally described for the postpartum period6,7,31–34 and similar to what has been described during pregnancy.35 The standard MIC of 2 μg/mL in the mothers and their fetuses was reached 6–10 hours after dosage administration in the once-daily group. The postantibiotic effect in vivo after aminoglycoside administration lasts from 1–13 hours in animal models of gram-negative bacterial infection.36 This effect is extended by higher peak aminoglycoside concentrations37,38 and by concurrent administration of a cell-wall active antibiotic.39 As with our findings in the fetus, our maternal results indicate that doses higher than 5.1 mg/kg or intervals shorter than 24 hours might be preferred in pregnant women who receive high-dose gentamicin.

Several shortcomings of this study deserve mention. More than 85% of the subjects in our study were of white race and Hispanic ethnicity. Our data might be reliably extrapolated to other racial or ethnic populations; however, further study in other groups is needed before our conclusions can be generalized with a high degree of confidence. Although neonatal gentamicin toxicity is very unlikely to have occurred given the short duration of exposure, our methods of follow-up for these outcomes were not optimal. The most common manifestation of aminoglycoside nephrotoxicity is a mild elevation of the serum creatinine level. Severe acute tubular necrosis is a rare complication of prolonged gentamicin exposure.2 Measurement of urine output is performed routinely for neonates in our nursery. Measurements of neonatal urine output and serum creatinine levels were a part of our safety monitoring for this study; however, mild renal impairment could have occurred after the infants were discharged from the hospital. Hearing loss can occur several weeks after aminoglycoside therapy has been discontinued.2 Although we performed newborn hearing screening on all of our neonatal subjects before discharge from the hospital, these results do not eliminate the possibility of some auditory compromise.

The outcomes of gentamicin concentrations are surrogates for the much more important measures of maternal and neonatal morbidity. Although we did assess clinical outcomes and found no difference between groups, this study was not powered nearly enough to overcome type II error. Moreover, no infection-related morbidity was noted in our mothers or neonates. This probably relates to the clinical methods by which we diagnose chorioamnionitis. A larger presence of serious intra-amniotic infection among our study subjects could have affected clinical outcomes, the transfer of gentamicin across the placenta, or gentamicin clearance in the mothers or neonates. Further study, in larger populations, using once-daily dosing is needed to determine whether achieving higher peak values in mothers and fetuses translates to better perinatal outcomes. Further study will also provide more precise data on maternal, fetal, and amniotic fluid gentamicin elimination, particularly during the period from 5–12 hours after administration.

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1. Duff P, Gibbs RS. Progress in the pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol 1991;164:1317–26.

2. Chambers HF. Antimicrobial agents: the aminoglycosides. In: Hardman JG, Limbird LE, Goodman Gilman A, editors. Goodman & Gilman's the pharmacological basis of therapeutics. New York (NY): The McGraw Hill Medical Publishing Division; 2001. p. 1219–38.

3. Gilbert DW. Once-daily aminoglycoside therapy. Antimicrob Agents Chemother 1991;35:399–405.

4. Noone P, Pattison JR, Davies DG. The effective use of gentamicin in life-threatening sepsis. Postgrad Med J 1974;50:9–16.

5. Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis 1987;155:93–9.

6. Del Priori G, Jackson-Stone M, Shim EK, Garfinkel J, Eichmann MA, Frederiksen MC. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis. Obstet Gynecol 1996;87:994–1000.

7. Sunyecz JA, Wiesenfeld HC, Heine RP. The pharmacokinetics of once-daily dosing with gentamicin on women with postpartum endometritis. Infect Dis Obstet Gynecol 1998;6:160–2

8. Thureen PJ, Reiter PD, Gresores A, Stolpman NM, Kawato K, Hall DM. Once- versus twice-daily gentamicin dosing in neonates ≥ 34 weeks’ gestation: cost effectiveness analyses. Pediatrics 1999;103:594–8.

9. Mitra AG, Whitten K, Laurent SL, Anderson WE. A randomized, prospective study comparing once-daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection. Am J Obstet Gynecol 1997;177:786–92.

10. University of Florida College of Pharmacy. Useful pharmacokinetic equations. Available at: http://www.cop.ufl.edu/safezone/pat/pha5127/5127-all-equations.pdf. Retrieved September 21, 2004.

11. Daïkos GL, Lolans VT, Jackson GG. First-exposure adaptive resistance to aminoglycoside antibiotics in vivo with meaning for optimal clinical use. Antimicrob Agents Chemother 1991;35:117–23.

12. Moore RD, Smith CR, Lietman PS. The association of aminoglycoside plasma levels with mortality in patients with gram-negative bacteremia. J Infect Dis 1984;149:443–8.

13. Lundergan FS, Glasscock GF, Kim EH, Cohen RS. Once-daily gentamicin in newborn infants. Pediatrics 1999;103:1228–34.

14. Lewis DB, Wilson CB. Developmental immunology and the role of host defenses in neonatal susceptibility to infection. In: Remington JS, Klein JO, editors. Infectious diseases of the fetus and newborn infant. Philadelphia (PA): WB Saunders; 1995. p. 20–98.

15. Wilson CB. Immunologic basis for increased susceptibility of the neonate to infection. J Pediatr 1986;108:1–12.

16. Weinstein A, Gibbs R, Gallagher M. Placental transfer of clindamycin and gentamicin in term pregnancy. Am J Obstet Gynecol 1976;124:688–91.

17. Watterberg KL, Kelly HW, Angelus P, Backstrom CL. The need for a loading dose of gentamicin in neonates. Ther Drug Monit 1989;11:16–20.

18. Semehuk W, Borgmann J, Bowman L. Determination of a gentamicin loading dose in neonates and infants. Ther Drug Monit 1993;15:47–51.

19. Isemann BT, Kotagal UR, Mashni SM, Luckhaupt EJ, Johnson CJ. Optimal gentamicin therapy in preterm neonates including loading doses and early monitoring. Ther Drug Mon 1996;18:549–55.

20. Regev RH, Litmanowitz I, Arnon S, Shiff J, Dolfin T. Gentamicin serum concentrations in neonates born to gentamicin-treated mothers. Pediatr Inf Dis J 2000;19:890–1.

21. Yow MD. An overview of pediatric experience with amikacin. Am J Med 1977;62:954–8.

22. Aronoff GR, Pottratz ST, Brier ME, Walker NE, Fineberg NS, Glant MD, et al. Aminoglycoside accumulation kinetics in the rat renal parenchyma. Antimicrob Agents Chemother 1983;23:74–8.

23. Lietman PS, Smith CR. Aminoglycoside nephrotoxicity in humans. J Infect Dis 1983;5(suppl):S284–92.

24. Patel V, Luft FC, Yum MN, Patel B, Zeman W, Kleit SA. Enzymuria in gentamicin-induced kidney damage. Antimicrob Agents Chemother 1975;7:364–9.

25. Schentag JJ, Gengo FM, Plaut ME, Danner D, Mangione A, Jusko WJ. Urinary casts as an indicator of renal tubular damage in patients receiving aminoglycosides. Antimicrob Agents Chemother 1979;16:468–74.

26. Theopold HM. Comparative surface studies of ototoxic effects of various aminoglycoside antibiotics on the organ of Corti in the guinea pig. A scanning electron microscopic study. Acta Otolaryngol 1977;84:57–64.

27. Wersäll J, Bjorkroth B, Flock A, Lundquist PG. Experiments in the ototoxic effects of antibiotics. Adv Otorhinolaryngol 1973;20:14–41.

28. Tran Ba Huy P, Bernard P, Schact J. Kinetics of gentamicin uptake and release in the rat: comparison of inner ear tissues and fluids with other organs. J Clin Invest 1986;77:1492–500.

29. McCormack JP, Jewesson PJ. A critical reevaluation of the “therapeutic range” of aminoglycosides. Clin Infect Dis 1992;14:320–9.

30. Laurent G, Kishore B, Tulkens P. Aminoglycoside-induced renal phospholipidosis and nephrotoxicity. Biochem Pharmacol 1990;40:2383–92.

31. Liu C, Abate B, Reyes M, Gonik B. Single daily dosing of gentamicin: pharmacokinetic comparison of two dosing methodologies for postpartum endometritis. Infect Dis Obstet Gynecol 1999;7:133–7.

32. Briggs GC, Ambrose P, Nageotte MP. Gentamicin dosing in postpartum women with endometritis. Am J Obstet Gynecol 1989;160:309–13.

33. Gardner DK, Schneider PJ. Gentamicin dosage requirements in postpartum patients. Clin Pharm 1984;3:416–8.

34. Munar MY, Lawson LA, Samuels P, Gibson GA. Gentamicin pharmacokinetics in postpartum women with endomyometritis. DICP 1991;25:1306–9.

35. Zaske DE, Cipolle RJ, Strate RG, Malo JW, Koszalska MF. Rapid gentamicin elimination in obstetric patients. Obstet Gynecol 1980;56:559–64.

36. Craig WA. Post-antibiotic effects on experimental infection models: relationship to in-vitro phenomena and to treatment of infections in man. J Antimicrob Chemother 1993;31:149–58.

37. Craig WA, Redington J, Ebert SC. Pharmacodynamics of amikacin in vitro and in mouse thigh and lung infections. J Antimicrob Chemother 1991;27:29–40.

38. Kapusnik JE, Hackbarth CJ, Chambers HF, Carpenter T, Sande MA. Single, large, daily dosing versus intermittent dosing of tobramycin for treating experimental pseudomonas pneumonia. J Infect Dis 1988;158:7–12.

39. Gudmundsson S, Einarsson S, Erlendsdottir H, Moffat J, Bayer W, Craig WA. The post-antibiotic effect of antimicrobial combinations in a neutropenic murine thigh infection model. J Antimicrob Chemother 1993;31:177–91.

Cited By:

This article has been cited 2 time(s).

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Obstetrical & Gynecological Survey, 62(4): 253.
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© 2005 The American College of Obstetricians and Gynecologists

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  • Rafael Alcaraz

    Rafael Alcaraz said (4 Oct 2009):

    Woww love this shot. Great contrast between the floats and sand also love the way it drwas you to follow the floats. Yep I'll save this on Fave's.

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    wow...powerful red intensity...class angle!

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    I know the feelings!!!!

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    david ong gave props (11 Oct 2009):

    textbook illustration, or maybe belongs in a gallery somewhere

  • David Fullman

    David Fullman gave props (1 Mar 2010):

    Great shot.

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Uploaded 6 Dec 2009 — 17 favorites
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© Russ Wills
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24 responses

  • Alicia Busch

    Alicia Busch gave props (19 Dec 2009):

    What a precious photo!!

  • Earl Shane Cielo

    Earl Shane Cielo gave props (25 Jan 2010):

    Peacefully amazing

  • Megan Henkel

    Megan Henkel gave props (30 Jan 2010):

    beautiful child!

  • Vidyavati Chandan

    Vidyavati Chandan gave props (31 Jan 2010):

    sweet shot!!

  • Linda Deacon

    Linda Deacon said (6 Feb 2010):

    aww so sweet

  • Andrew Lorimer

    Andrew Lorimer (Deleted) gave props (7 Feb 2010):

    Too adorable :) a very gentle spirit :)

  • Leslie Hunziker

    Leslie Hunziker   gave props (7 Feb 2010):

  • Warren ~Mangione~

    Warren ~Mangione~ gave props (11 Feb 2010):

    Total peaceful sleep. This is what to sleep like a baby means! Well done!

  • Leanne Silva

    Leanne Silva gave props (14 Feb 2010):

  • Sophia Rudman

    Sophia Rudman gave props (15 Feb 2010):

    too cute =]

  • Peggy Maguire

    Peggy Maguire (Deleted) said (16 Feb 2010):

  • Billy Houckham

    Billy Houckham said (22 Feb 2010):

    Sweet Dreams

  • Kevin Barron

    Kevin Barron gave props (26 Feb 2010):

  • Katelyn Baker

    Katelyn Baker gave props (28 Feb 2010):

    so so sweet

  • Donna Marino

    Donna Marino gave props (4 Mar 2010):

  • Linda Deacon

    Linda Deacon said (6 Mar 2010):

    aww great picture

  • Al Gieryna

    Al Gieryna gave props (17 Mar 2010):

    I like how this is framed. It draws the viewer into the innocence. Very nice capture.

  • Karen Menyhart

    Karen Menyhart gave props (18 Mar 2010):

    this is just stunning! love the composition and light...

  • Natalie S

    Natalie S gave props (22 Mar 2010):

  • Michael Cousineau

    Michael Cousineau gave props (11 Apr 2010):

    Such a wonderful and special capture. Many props....

  • Laura Brown

    Laura Brown gave props (19 Jun 2010):

    This is by far my favorite! I love the angle and crop, excellent shot!!

  • Chibelle

    Chibelle gave props (8 Jun 2011):

    Precious moment

  • Merike MÃ¤ll

    Merike MÃ¤ll gave props (9 Jun 2011):

    suurepÃ¤rane foto-hea vÃµte

  • Christopher J Chalk

    Christopher J Chalk gave props (9 Jun 2011):

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death in autumn

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© niko niko
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  • when there was less
  • death in autumn
  • the things she's seen
  • passing time

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  • Hey good lookin
  • death in autumn
  • The Gate Keeper
  • Too close for comfort !
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fallen leaves and fallen birds

4 responses

  • Kevin Kott

    Kevin Kott (Deleted) gave props (2 Apr 2012):

    My vote!!!

  • Giselle Goloy

    Giselle Goloy gave props (8 Apr 2012):

    it's sad but i can't stop staring. got my vote!

  • Davide Simone

    Davide Simone (Deleted) gave props (4 May 2012):

    poor vote

  • Roxana Brivent-Barnes

    Roxana Brivent-Barnes said (15 May 2012):

    Sad, voted!

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Texas Sunset

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© David Ramirez
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  • Reflections
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A nice, radiant sunset, the day of my daughter's birthday.

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Smoke jumpers 02

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© Jason Barnhart
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A stand out image for me personally, I want into their world in the worst way!

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text:
Fishing boat in sunset

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