text:
Suffolk, ss. Division of Administrative Law Appeals

Board of Registration in Medicine,

v. Docket No. RM-07-460

Joseph Z. Zolot, M.D.,

Appearance for Petitioner:

Amy B. Sharff, Esquire

Complaint Counsel
Board of Registration in Medicine
560 Harrison Avenue, G-4
Boston, MA 02118

Appearance for Respondent:

Jeffrey N. Catalano, Esquire

Todd & Weld, LLP
28 State Street, 31st FL
Boston, MA 02109

Administrative Magistrate:

Judithann Burke

On June 20, 2007, the Petitioner, Board of Registration in Medicine (BRM), issued a Statement of Allegations ordering the Respondent, Joseph Z. Zolot, M.D., to show cause why he should not be disciplined for: providing substandard care to thirty (30) patients, committing misconduct in the practice of medicine, committing malpractice, engaging in conduct that undermines the public confidence in the integrity of the medical profession, engaging in conduct that has the capacity to deceive or defraud, and violating G.L. c. 94C and the BRM's regulations.

On the same date, the BRM summarily suspended the Respondent's license to practice medicine, Registration No. 78630, effective immediately, pursuant to 243 CMR 1.03(11). The BRM determined that the Respondent posed a serious and immediate threat to the health, safety and welfare of the public.

On July 16, 2007, the Respondent filed a Motion to Dismiss or Otherwise Vacate the Order of Temporary Suspension along with a memorandum in support of same in which he contended that the BRM's summary decision is predicated upon a fatally defective presentation which is insufficient to withstand scrutiny as a matter of law.

A hearing on the summary suspension was commenced on July 30, 2007 at the offices of the Division of Administrative Law Appeals (DALA), 98 North Washington Street, 4th FL, Boston, MA. The proceedings were stenographically recorded. The BRM proffered the affidavit of its investigator, Philip Beattie, Jr., along with myriad medical records, eight (8) autopsy reports, and reports from the BRM's expert, Seyed A. Mostoufi, M.D., pertaining to thirty (30) patients, all on a CD-ROM. There are more than five thousand eight hundred (5800) documents depicted on the CD-ROM. There were no witnesses. At the conclusion of the presentation of the BRM's case-in-chief, the Respondent argued his Motion to Dismiss.

The Respondent's Motion to Dismiss was denied and the BRM's summary suspension was upheld in a DALA Decision dated August 27, 2007. The Respondent did not appeal either ruling.

On December 11, 2007, the Respondent filed a Motion to Compel Production of Documents and specified that he is requesting records obtained by the BRM from all government and law enforcement entities. The BRM filed an Opposition to the Motion to Compel on December 31, 2007.

A hearing on the Motion to Compel was held on March 21, 2008 at the offices of the Division of Administrative Law Appeals (DALA), 98 North Washington Street, Boston, MA. On that date, the United States Attorney filed a Motion to Intervene and a Motion in Opposition to Discovery. All parties submitted memoranda in support of the motions and provided oral arguments. The record was left open for the filing by the Respondent of his Opposition to the Motion to Intervene. This was received at DALA on April 7, 2008.

A. Motion to Intervene

In said Motion, the United States submitted that the Respondent seeks to compel production of, among other items, "federal reports of investigation relating to him". The United States contended that, because these reports are confidential, privileged, and sensitive, and are protected from discovery on a variety of bases, it should be allowed to intervene for the limited purpose of opposing the production of investigative documents belonging to the United States Attorney. The Motion to Intervene is ALLOWED.

The Standard Adjudicatory Rules of Practice and Procedure, 801 CMR 1.01 et. seq., that govern proceedings before this agency are silent as to the criteria for intervening in an administrative action. Accordingly, it is necessary to look toward the Massachusetts and Federal Rules of Civil Procedure for guidance.

Mass. R. Civ. Pro. 24(a) provides:

…the applicant claims an interest relating to the property or transaction which is the subject of the action and he is so situated that the disposition of the action may as a practical matter impair or impede his ability to protect that interest, unless the applicant's interest is adequately represented by existing parties.

With the exception of the substitution of "Commonwealth" for "Untied States", the Mass. Rule is identical to Rule 24(a) of the Federal Rules of Civil Procedure.

The Untied States has filed its Motion to Intervene and set forth several bases for opposing the production of documents by the BRM. One of the grounds that it has raised is that the documents are protected by virtue of the law enforcement privilege. Only law enforcement agencies may avail themselves of this privilege. Sterling Merchandizing, Inc. v. Nestle, S.A., 470 F. Supp. 2nd 77, 83 (D.P.R. 2006). The BRM is not a law enforcement agency. Accordingly, the BRM alone cannot represent the interests of the United States. Further, a granting or partial granting of the Respondent's Motion to Compel could "impair or impede" the United States' ability protect the law enforcement material in question. The Untied States Attorney is entitled to intervene to argue any interests it has in the Motion to Compel.

B. Motion to Compel

With respect to the Respondent's request for documents, the Standard Adjudicatory Rules, supra, are silent with respect to the discoverability of specific classes of documents. Rather, these rules simply set forth administrative procedures to be followed by the parties and the Administrative Magistrate when demands for information are made. The same may be said for the "Toughy" regulations, 28 C.F.R. s. 16.21-16.29, that govern the disclosure of Department of Justice records in federal and state proceedings. See Toughy v. Ragen, 340 U.S. 462, 470 (1951) and Puerto Rico v. United States, 490 F. 3d 50, 61-61 (1st Cir. 2007).

Rule 26(b) (1) of the Massachusetts Rules of Civil Procedure provides:

Parties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action… (Emphasis added).

The materials sought by the Respondent are privileged and they are not relevant to the pending action. The Motion to Compel is DENIED.

The BRM investigator had access to, and reviewed many of the documents that were compiled by state and federal law enforcement agencies during his review of the case for purposes of the Summary Suspension. These materials were borrowed from the United States Attorney for this review. The documents are the property of the Department of Justice and they are under the control of the United States Attorney.

The Summary Suspension was upheld on August 27, 2007. The Respondent did not appeal that Decision. The present action involves the BRM's allegations of substandard patient care concerning several patients. The BRM has represented that the sought after materials will not be referred to or relied upon in any way by the BRM in its prosecution on the merits of the allegations. As such, the United States Attorney's files are not relevant in the matter at hand. See In re Jansen, 444 Mass. 112, 118 (2005), Commonwealth v. Lampron, 441 Mass. 265, 269 (2004) and Commonwealth v. Wanis, 426 Mass. 639, 644 (1998). Moreover, the DALA Decision will be based upon the relevant documents proffered by both the BRM and the Respondent before and during the hearing on the merits and witness testimony. The Respondent is entitled to cross examine all witnesses against him and to present the testimony of witnesses and adverse witnesses in his own behalf. Therefore, the Respondent's due process rights remain protected notwithstanding the denial of the Motion to Compel.

The documents that are sought are protected via the law enforcement/investigatory privilege and are exempt form disclosure. See Black v. Sheraton Corp., 564 F. 2d 531, 542 (D.C. Cir. 1977). Generally, when this privilege is claimed, the public interest protected by the privilege is weighed against the public interest served by the disclosure. The privilege, once successfully invoked, protects the information from both release to the other party and from the need for an in camera review. Black, supraat 545. Whether the showing of relevance and need rises to the requisite level is a discretionary determination that must be made on a case by case basis. Miller v. Mehltretter, 478 F. Supp. 2d 415, 424 (W.D.N.Y. 2007).

In the present case, the law enforcement documents are not relevant to the administrative action on the Respondent's medical license. Accordingly, a balancing test involving an in-depth analysis of the Respondent's need versus the public interest in non-disclosure is unnecessary. The documents have no evidentiary value to DALA. Wanis, supra. Limitation of discovery in a civil case is indeed appropriate where a parallel criminal proceeding may be underway. United States v. Kordel, 397 U.S. 1, 12 (1970).

The Unites States has aptly noted that, in Larouche Campaign v. F.B.I., 106 F.R.D. 500, 501 (D. Mass. 1985), the court faced a situation where the U.S. attorney in that case argued that an ongoing criminal investigation was endangered by civil discovery.

Finding that the subjects of the investigation would be able to gain access to information in civil discovery to which they would not be entitled as subjects of a criminal investigation or even defendants in a later case, the court opined that it would stay discovery to ensure they "cannot receive through the 'backdoor' that which cannot be obtained through the front". Larouche, supra502.

Finally, it is necessary to mention that the reports that are sought after are not in the custody of the BRM. Rather, they have been loaned to the BRM under limitations upon their dissemination. The documents were shared with the BRM with the expectation that they would remain confidential and that there would be no relinquishment of control over the ultimate dissemination of the reports. The BRM does not have the right to produce the documents over the objection of the United States Attorney.

For the reasons set forth herein, the Motion to Compel is DENIED.

Division of Administrative Law Appeals,

Judithann Burke
Administrative Magistrate

DATED: June 2, 2008

This information is provided by the Division of Administrative Law Appeals .


Content-Type: application/http; msgtype=response

WARC-Type: response

text:
Description: freighter.
Dimensions: length 350 ft., width 47 ft., depth 17.2 ft.
Tonnage: gross 3668.
Propulsion: steam, propeller.
Machinery: (1) 3 cylinder triple expansion engine, cylinder diameters 25.5", 41", 68" with a stroke of 48", 353 nominal horsepower; 3 single ended steel boilers, 9 plain furnaces.
Cargo: general cargo including ingots of bronze and tin, bronze ingots marked "Ajax Maganese Bronze - Cowles Patent 11.26.1889"; 300 crates of bottles.

The Shipwreck

Date Sunk: January 22, 1906.
Cause: collision.
Location: southwest of Cuttyhunk.
Coordinates: latitude 41° - 22' - 33" N; longitude 71° - 00' - 58" W.
Loran: 14291.4 and 43921.4.

Prior to the construction of the Cape Cod Canal, Vineyard Sound was a crossroads of east-west shipping along the New England coast. Although protected from the sea's fury by Martha's Vineyard and Nantucket Islands, its western entrance was only three miles wide, which, in restricted visibility before the invention of radar, was like a hair's breadth.

Late in the morning of January 22, 1906, a dense fog shut in the southern coast of Massachusetts. Enroute from Philadelphia to Boston, the freighter Trojan was moving at reduced speed through the gray shrouded mist with extra lookouts posted. All hands strained to hear the tell-tale sounds of an approaching steamer or surf breaking on shore. Moments earlier, Captain Thatcher had passed the Vineyard Sound Lightship and knew that attempting the western entrance to Vineyard Sound in this fog would be hazardous at best. The prudent course of action would be to anchor until the fog lifted. After the Captain's order of "all stop", Trojan had not yet lost headway when lookouts spotted the prow of another steamer shoot out of the fog to port.

It was the liner Nacoochee, from Savannah, Georgia, also bound for Boston. Aboard the liner there was little time to react. Captain Diehl ordered both engines reversed, but the ship's momentum was to great and the great liner struck Trojan just aft of amidships. The force of the impact knocked the freighter's sleeping crew from their bunks. Trojan heeled so far to starboard that Captain Thatcher feared it might capsize. But Nacoochee's engines were still reversed and the two ships soon parted. However, the liner's steel shod prow had cut a huge hole in the freighter's side. Fearing that the other vessel would sink before its crew could be saved, Nacoochee's skipper ordered "full speed ahead." By a fine display of seamanship and daring, Captain Diehl pushed the bow of his vessel into the big hole in the Trojan's side and kept the vessel afloat until Captain Thatcher and all his crew of 27 men had scrambled aboard the Nacoochee. The Trojan went to the bottom in three quarters of an hour."

Although Captain Diehl's quick thinking probably saved the lives of many aboard Trojan, the Steamboat Inspection Service found that his use of poor judgement and lack of good seamanship in driving his vessel at high speed through the fog, was the cause of the accident. His license was suspended for 30 days.

Dive Site Conditions

Depth in feet: maximum 110.

With this vessel lying on a muddy bottom, visibility is usually poor. The hull forward of the boilers is mostly scattered debris. However, aft of the boilers the stern is partially intact and in some places the decking is in place.

Draggers' nets have fouled on portions of wreckage. As always, caution should be observed when exploring the wreck.

Historical Background

Constructed: year 1897, in Newcastle, United Kingdom by Tyne Iron S.B. Co. Ld.
Construction details: built as a collier; 1905 - converted to a freighter with the addition of a 'tween deck; 1 steel deck, iron spar deck; 6 cemented bulkheads; water ballasted with a cellular double bottom, aft; flat keel.
Crew: 27; Master: T.J. Thorkildson (1892-97); Captain Thatcher (1906).
Owners: S.S. Trojan Co. Ld. (E.C. Thin).
Home or Hailing Port: Liverpool.
Former Name(s) and date(s): Orion (1888-1905).
Official number: 106888. Country: U.K.
Other Comments: engine and boilers manufactured by N.E. Marine Co. Ld., Newcastle, U.K.

The February 7, 1906, New York Maritime Register, reported that the tug Storm King and lighter Oak spent two days searching for the wreck but were unsuccessful. It wasn't until August that the lighthouse tender Verbena discovered Trojan's remains, which were then scheduled for destruction.

In 1972 sport divers recovered several tons of bronze and tin ingots.

Fishable Wrecks and Rockpiles; Coleman & Soares, 1989
Lloyds Register of Shipping; 1903-04
New England's Legacy of Shipwrecks; Keatts, 1988
New York Maritime Register; January 24, February 7, August 8, 1906
New York Times; January 24, 1906

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text:
Rachel Orenstein and Brian Siegel

The Republican Lifestyle Desk By The Republican Lifestyle Desk The Republican
on July 16, 2011 at 8:00 AM
Rachel Orenstein and Brian Siegel.JPGRachel Orenstein and Brian Siegel announce their engagement.

Dr. Richard and Muriel Orenstein, of Syracuse, N.Y, formerly of Longmeadow, announce the engagement of their daughter, Rachel Aviva Orenstein, to Brian Elliot Siegel, both of Boylston. Rachel is the granddaughter of Esther Greenberg, of Springfield.

The future bridegroom is the son of H. Michael and Ellen Siegel, of Churchill, Pa.

The bride-to-be is a graduate of Longmeadow High School and Westfield State University. She earned her master’s degree in social work from Simmons College and is employed as a clinical social worker with Tufts Health Plan in Boston.

The future bridegroom graduated from Pennsylvania State University and is employed as a senior configuration analyst with Raytheon Corp. in Sudbury.

An Oct. 14, 2012, wedding is planned at Temple Beth Shalom in Squirrel Hill, Pa.


text:
View Full Version : What kind of grill

05-21-2012, 11:55 AM
I am looking for a grill that i can take out with the family when we head to the lake. We have a little sandbar that everyone like to pull up to and get out and play in the water and at the volleyball net, i want to get me a portable grill that will fit in my X15 anyoen got a suggestion. I have looked at the magmum newport but am not sure about it. I have also looked a the brinkmann tailgate that way i could use it for tailgating at football games but i think that one may be a little to big. what does everyone else use?

05-21-2012, 11:57 AM
the propane weber smokey joe, its great, stores easy, and works awesome.

05-21-2012, 12:23 PM

05-21-2012, 02:07 PM
the propane weber smokey joe, its great, stores easy, and works awesome.

This the best way to go. Small, compact, heats up fast and cools down fast.

05-21-2012, 03:34 PM
I've got this one and use it fairly often

05-21-2012, 03:40 PM
I have weber q series that fits in my x15. It's annoyingly big if you're only grilling for a few people. It very nice if you have a decent number. I store it in what amounts to a giant canvas duffle bag to make it easier to get in and out of the rear storage compartment.


text:
Shopping By:

  • Theme: Fantasy
  • Section: Science, Discovery and Exploration

Uncle Milton

When the folks at Uncle Milton declare that their mission is to design, produce and market quality, innovative, children's products which inspire a spirit of wonder, exploration and discovery, you know they must know a thing or two about great toys. And when you see a child's fascination with any one of their fun, educational toys, you know they've succeeded in accomplishing their goal!

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Our Price:   $39.99
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Ages 6 and up

"Become an expert on lightsaber technology, you will" says Yoda. The final challenge in becoming a Jedi Knight is to build your own lightsaber! With the Uncle Milton Star Wars Lightsaber Room Light, young Padawans can construct their own Jedi Lightsaber and mount it on their wall! Remote control lets you select from 9 awesome colour effects, including 8 different colours plus auto-spectrum mode - and sound effects too!

  • 1 IR Remote Control
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Requires 5 AAA batteries (NOT INCLUDED).

Measures approximately 25" long.

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25 year old man | Arvada, CO, USA | Seeking women 18-25 within 50 miles

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His details

Never Married
Have kids:
Wants kids:
White / Caucasian
Body type:
Athletic and toned
6'1" (185cms)
Christian / Catholic
No Way
Social Drinker

In his own words

Hey, I'm a laid back guy who loves to laugh and just enjoy life. I love to play sports, watch movies, read novels, play guitar, write and spend time with my family. I've been told I'm hilarious but I'll let you be the judge of that. I'm looking for a girl who is smart, funny, beautiful inside and out. I just want someone who I can spend time with and can't wait to see again. Hopefully she's out there, who knows, it may even be you :)

His interests

Book club , Dining out , Movies/Videos , Music and concerts , Exploring new areas , Performing arts , Playing sports , Travel/Sightseeing

Sports & exercise

Auto racing / Motorcross, Baseball, Basketball, Football, Soccer, Walking / Hiking

I exercise 5 or more times per week.

I like Dogs

No pets @ the moment

Favorite hot spots

Anywhere outside and I'm happy.

Favorite things

Music: John Mayer, Zeppelin, U2, Coldplay, RHCP Books: Mysteries and Thrillers TV Shows: Walking Dead, Big Bang

For fun

Love playing guitar, going to movies, reading, playing sports, cars.

Last read

Girl With the Dragon Tattoo

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Height: 6'1" (185cms) 4'8" (142cms) to 5'10" (177cms)
Body type: Athletic and toned Slender, About average, Athletic and toned
Eyes: Brown No preference
Hair: Dark brown No preference
Smoke: No Way No Way
Drink: Social Drinker Social Drinker
Occupation: Student No preference
Income: I'll tell you later No preference
Relationship: Never Married Never Married
Have kids: No No
Wants kids: Someday Someday
Ethnicity: White / Caucasian No preference
Faith: Christian / Catholic No preference
Languages: English, Spanish English
Education: Bachelors degree High school, Some college, Associates degree, Bachelors degree
University of Colorado Denver
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33 year old woman | Marne, MI, USA | Seeking men 29-32 within 50 miles

Active within 1 week

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Her details

Never Married
Have kids:
Wants kids:
White / Caucasian
Body type:
About average
5'2" (157cms)
Christian / Catholic
No Way
Social Drinker
Looking for a honest, fun person and seeing where it goes

In her own words

My friends would say I am shy but I open up after you get to know me. I am looking for someone to hang out with, have some fun and see where it goes. I have had my heart broken a couple of times by guys in the past. I love the arts, sports, I am a huge fan of sports, baseball, hockey. I have 3 older sisters, I am the youngest of the family we basically watch out for each other. I love people and helping out the community, I am a employee at Steelcase in the factory where we build office furniture for many different companies, I enjoy it pretty well, though the hours can seem pretty long

Her interests

Camping , Dining out , Gardening/Landscaping , Movies/Videos , Museums and art , Music and concerts , Performing arts , Playing sports , Travel/Sightseeing , Volunteering , Watching sports

Sports & exercise

Aerobics, Baseball, Bowling, Dancing, Swimming, Walking / Hiking

I have Cats, Dogs

I like Fish, Horses, Other

My dog is a standard Poodle that I love, he is loyal and at times quite the entertainment. :) Also my 2 cats are awesome.

Political views

Middle of the Road

Favorite hot spots

I love going to the Van Andel Arena to watch our town champion hockey team The Grand Rapids Griffins-winner of the Calder Cup. Also my parents cottage in Newaygo, Grand Haven beach, and Whitecaps baseball park.

Favorite things

I love sports and the arts as I have already mentioned. I also love the Beatles, their music is amazing. Also animals as well I have 2 cats which I adopted from the humane society and a dog.

For fun

I love the arts-drawing and painting, dance, theatre, music. I also love animals. Sports is also another part of my life that I love, I played softball in the fourth grade which I loved, also I did track as well mostly long jump.

Last read

The Return of Sherlock Holmes.

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Height: 5'2" (157cms) 5'1" (154cms) to 6'4" (193cms)
Body type: About average Slender, About average, Athletic and toned
Eyes: Blue Blue, Brown, Green, Hazel
Hair: Light brown Black, Light brown, Dark brown, Blonde, Dark blonde
Smoke: No Way No Way, Occasionally, Yes, but trying to quit
Drink: Social Drinker Never, Social Drinker, Moderately
Occupation: I'll tell you later No preference
I work at Steelcase, where I am in the factory putting together office furniture.
Income: I'll tell you later No preference
Relationship: Never Married Never Married, Currently Separated, Divorced
Have kids: No Yes, and they sometimes live at home, No, Yes, and they live away from home, Yes, and they live at home
Wants kids: Definitely Definitely, Someday
Ethnicity: White / Caucasian No preference
Faith: Christian / Catholic Christian / Catholic, Christian / Other
Languages: English English
Education: Some college High school, Some college
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36 year old woman | Albany, NY, USA | Seeking men 30-40 within 100 miles

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Yes, and they sometimes live at home (3)
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Black / African descent
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5'7" (170cms)
Christian / Other
No Way
Iam a virtuous woman with a loving heart

In her own words

When you ask a person to describe themselves they only tell you what will make them sound good but I am different from that I am going to tell you how I am on a day to day. My family means everything to me. I love to work and enjoy what life has to offer!!!!!

Her interests

Cooking , Movies/Videos , Music and concerts , Nightclubs/Dancing , Shopping/Antiques , Video games

Sports & exercise

Basketball, Bowling, Dancing, Football, Martial arts, Other types of exercise, Walking / Hiking

I exercise 3-4 times per week.

I like Fish

Favorite hot spots

My favorite spot to go would be Boston, MA to chill hwith my frinds out there or the Bronx to go to the best clubs. I love going to Miami but most of all being with my friends and family

Favorite things

My favorite thing would have to be reality TV shows and Juniors strawberry cheesecake

For fun

For fun I like to hang out with my friends and do crazy thing with my children

Last read

The last thing I read was about the Devestating event that has taken place in New York City

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  Her What she is looking for
Height: 5'7" (170cms) 5'11" (180cms) to 6'8" (203cms)
Body type: Curvy About average, Athletic and toned
Eyes: Brown No preference
Hair: Black Black
Smoke: No Way No Way
Drink: Never Social Drinker
Occupation: Administrative / Secretarial No preference
Wel I work for the county
Income: $25,001 to $35,000 No preference
Relationship: Never Married No preference
Have kids: Yes, and they sometimes live at home (3) Yes, and they live away from home
Wants kids: No No, but it's OK if my partner has kids
Ethnicity: Black / African descent Black / African descent
Faith: Christian / Other No preference
Languages: English English
Education: Associates degree High school
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text:
Welcome to the IdeaMatt blog!

My rebooted blog on tech, creative ideas, digital citizenship, and life as an experiment.

Some David Allen "twos" - two reasons we procrastinate, and two kinds of problems

Here is a pair of related thoughts that I picked up from David Allen's Getting Things Done. Paraphrasing him:
  • There are only two reasons for procrastination: The task is either a) overwhelming (too big), or b) not motivating (unpleasant).

  • There are only two problems in life: a) You know what your want, and you don't know how to get it, and/or b) you don't know what you want.
As you might have guessed, Allen's solution (typically clear and powerful) is to apply his two big focusing questions, respectively:
  1. What's the next action?
  2. What's the desired outcome?
(They're usually shown in the reverse order.) More specifically, for the first case (procrastination), he advises us to either break it down even further (Lakein calls this his "Swiss Cheese" method - poke some holes in it, AKA "instant tasks"), or focus on the positive outcome (you're doing it for a reason - harness that motivation to work around the avoidance). For the latter, Lakein has additional advice: either 1) deal with the unpleasantness directly (fear), 2) recognize the greater unpleasantness that results from delay (risks), or 3) create enthusiasm that counterbalances the unpleasantness (stress the benefits).

The second case ("life problems"), which Allen credits "Steven Snyder" for (here?) is really a generalization of his approach - we haven't clarified the task sufficiently to "intelligently dumb down" your mind, or we haven't focused sufficiently on the positive outcome.

What looking at this finally connected for me was what Allen says at the end of his book (and which is one of the quotes on his complimentary RoadMap notepad): There are only two solutions:
  • Make it up.
  • Make it happen.
(You can find a little more about it in his article Making It Up and Making It Happen.) I find that these are simple, deep, and really apply to me personally - I'm exploring this area (GTD, personal productivity, time management etc.) without a map (no training or certification programs from davidco, for example), so I'm truly making it up. And to make it happen, I'm doing everything I can - writing, reading, thinking, talking, and meeting others. Fun!

For reference, here are some other ideas for addressing procrastination and todo anxieties:And finally, for fun, here are all the quotes from the RoadMap seminar notepad:
  • If it's on your mind, it's probably not getting done
  • Make it up! Make it happen!
  • Psychic Ram has limited space and it's a terrible office
  • Your ability to generate power is directly proportional to your ability to relax
However, as popular as Allen's work is, I doubt you'll be seeing these in the movie theater before your next show. It might get people thinking, though...

My GTD tally: 70 NAs, 30 PROJs, & 15 AORs

A quickie: I attended David Allen's GTD | RoadMap seminar on Friday in Boston (it was great), and I again heard his various average "counts" for professionals - Next Actions, Projects, etc. So I thought I'd add mine up - I'd be curious how these compare with yours: Right now I have ~70 Next Actions (including Waiting Fors and Agenda items), ~30 projects, and ~15 areas of responsibility. According to Allen (depending on when you talk to him) most people have 150-170 Next Actions, 30-100 projects, and 10-15 categories of areas of responsibility. (So I'm an overly responsible person with a lower-than-average amount of work to do? Doesn't feel that way!)

I didn't include the higher level horizons (Goals, Vision, and Purpose) because I haven't worked them out clearly enough, and (to be honest) they seem like the weakest and least thought out portion of Allen's book. (Yes, I'm a little resistant, you might notice.) As a result, I came out of the seminar realizing that getting clarity in those areas is one of the next challenges I'd like to work on.

Hipster BC - My GTD business card, with a surprise on the back

Here's a quick snap of the front and back of the business cards I had made up for David Allen's GTD | RoadMap seminar that I attended on Friday in Boston (more on the seminar in another post):

GTD Business Card, Front and Back

The card's front (left hand side) has basic contact info; it's hard to see in the photo, but at the bottom it reads (in gray):
collect - process - organize - review - do
On the back (right hand side) is Doug Johnston's incomparable GTD Quick Reference Card, which includes "a flow chart, a weekly review list, and a list of 'Stuff' (TM, patent pending)".

Rather than going for something traditional, I wanted to make a card that would a) draw some attention (Doug's images does so nicely - always good for a "cool!"), b) educate a bit about the Allen's work, and c) give me some visual GTD talking points. The diagram is small, but I'm using it both for a visual symbol (icon) as well as concepts for me to go over with interested folks. I've found that even if someone can't read the words, I know them, and can present the flow while talking and pointing to the boxes. Of course I always give appropriate credit to Allen and Johnston (thanks, guys).

Getting the most from David Allen's RoadMap seminar?

This Friday I'll be attending David Allen's GTD | The RoadMap seminar in Boston (if you'll be there, please ), and I'm trying to prepare so as to get the most out of it. Following are some tips from two sources that I thought were smart; I'd love to hear any additional ideas from you.

First, here are some tips from Jason Womack:
  • Do your research - In Learn more, faster, he recommends thorough research before the event.
  • Arrive Early - Meet the staff!
  • Move around the room at each break - He suggests asking people if it's OK to switch seats. One gets a different experience from each location.
  • Don't feel the need to write too much - This seminar goes fast, and others have blogged about it in some detail.
  • Stay open - Some people tune out when they hear something that sounds like it doesn't apply to them. If that situation occurs: a) ask yourself why you don't want it to apply, and b) search for a way for it to apply. Connect the parable/story to something you've experienced, or might experience. Stay an active and engaged listener.
  • Bring 150 business cards, and try not to go home with any.
There was also some great advice from Getting the Most Out of Attending Conferences:
  • Choose carefully - talk to someone who has previously attended.
  • Combine travel with other events/possibilities in area.
  • Decide successful outcome - reflect on goals and objectives.
  • Be an active listener - listen for nuggets of information that you can use. Look for easy-to-implement high-impact ideas.
  • Bring questions/problems for Q/A, and introduce yourself when asking.
  • Make contact with the presenter after the session is over.
  • Socialize - Never eat alone. Collect and pass out business cards, but be discriminating, jot a reminder note on the back, and follow up afterwards.
  • Follow up - call locals on attendees list you didn't meet.
  • Share within your organization - let others know what you learned (basic overview, plus learnings).

Did these miss any of your favorites?

Organizing Electronic Documents GTD-Style?

Over at Lifehack.Community user anithri asks "How do I organize a large and growing collection of Electronic documents?":
I have a collection of 200+ PDF's, Word docs, text files...It's easy to find one if I know the name of what I'm looking for already, but opening a large number of them looking for what I'm currently interested in is getting very old very quickly.

What I'd ideally like is an application that allows me to "tag" my files ala del.icio.us or flickr.com and then allow me to pull up lists of all files with a particular tag.
This is a big problem that's near and dear to my heart, and one that hasn't been adequately addressed yet. It's a huge topic (the British Computer Society recently called "Memories for life" one of the Grand Challenges in Computing), but I wanted to briefly: a) observe that current techniques are missing the point (relationships), and 2) ask if a GTD-style A-Z reference system apply to the digital realm.

Current Filing Techniques Aren't Relational

The two suggestions given in response to the Lifehack article ("use Spotlight as the tagging system", and "look into Google Desktop") are based on an IR-style index-and-search approach, also discussed in The Death of Folders? and The File Manager Is Dead. Long Live the Lifeblog. However, I think these approaches are missing one of the fundamental concepts about our information: It is connected. Among other things, documents relate to:
  • people (e.g., about them (incl. photos), received from them, or sent to them),
  • events (e.g., prepared for, or received during), or
  • projects (e.g., supporting information or output artifact)
In fact, it's hard for me to think of any document that simply exists by itself; i.e., context provides much greater meaning for documents. The recent move towards tagging tries to leverage connections in an ad hoc manner - by providing support for arbitrary keywords, a form of linking in which connections are expressed via sharing the same keyword(s). However, this impoverished form of linking has limitations, including not supporting attributes on the links themselves. More on this later, but you might want to leave you with some related links.
A simple alpha filing system for electronic documents?

The other idea this question stimulated is applying David Allen's GTD filing system to the digital realm. I'm currently testing this for email, and it has worked pretty well so far. Briefly, in addition to @action and @waiting-for, I have a top-level email directory for each letter of the alphabet, each of which contains email archive files (mbox files on my unix machine) for each project (e.g., n/nsf-site-visit-2005, p/personal-information-web). Finally, each of those latter files contains the relevant messages. Here's the conceptual map (vertical dimension is 'containment', with the outer-most container at the top):

filing cabinetemail system
A-Z dividera-z top-level directory
file foldermbox email file
piece of paperemail message

This works OK - Filing is pretty fast, for the same reasons as with the analog GTD version: Quick to dream up a name, only a few places I might have put it, etc. However, due to the email client I use (pine), textual search is pretty difficult. (Side note: When will someone write a simple lucene Java app to index mbox files? JavaMail has been around forever!) What I'd like to know is how well an analogous system would apply to documents. Maybe I'll give it a try, at least for new ones. However, compared to most people my electronic document needs are pretty basic - I seem to rely mostly on email, printed documents, Manila folders, and letter size paper. (Yes, it's about as low tech as possible.)

As always, comments are welcome.


text:
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Search Jobs

Job Details

Please see job description for application instructions.

Cleveland Clinic

Job Category
Health Care-Cleveland Clinic
Job Type

See job description

Education Level

See job description

Experience Level

See job description

Job Ref #

Job Title

Data Coordinator II- DDI Job

Reference Title
HR Use Only: Data Coordinator II- DDI
Hospital: Cleveland Clinic Main Campus & Family Health Centers
Department: DDI/Gastroenterology
Job Code: U18006
Pay Grade: 09
Schedule: Full Time
Shift: Days
Hours: 8a-5p
Job Details:

Summary: Builds and maintains data collection forms, data edit check plans and standard procedures. Identifies data discrepancies and issues data clarification forms. Documents and resolves discrepancies in database. Performs quality assurance audits. Prepares monthly/quarterly reports for studies.

Job Responsibilities: Completes all: aspects of data collection. Enters and maintains updated patient data. Generates, monitors and distributes data collected. Accurately enters data into database. Reviews database for accuracy and notifies the appropriate individuals of discrepancies. Participates in committee meetings. Assists in the review of study documentation. Verifies and facilitates end-users ability to interpret the results. Provides feedback to improve data issues and documentation. Participates in data audits. Ensures all required study data is collected and appropriately documented. May communicate the results of the audit to the appropriate individuals. Runs reports and locks clean records as appropriate. Provides back up support for other team members as required. Other duties as assigned.

Education: High School Diploma or GED.

Experience: Minimum three years experience in data management. Experience collecting, entering, cleaning and analyzing research and statistical data. Bachelor's Degree in related field may substitute for experience requirement.

Licensure/Certification/Registration: None required.

Physical Requirements: Manual dexterity to operate office equipment. Ability to lift and transport up to 25 pounds. Requires extended periods of standing, walking and sitting. Normal or corrected vision and hearing to normal range.

Category: Clerical/Administrative Support

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Treatments for tension headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.

Signs and symptoms of a tension headache include:

  • Dull, aching head pain
  • Sensation of tightness or pressure across your forehead or on the sides and back of your head
  • Tenderness on your scalp, neck and shoulder muscles

Tension headaches are divided into two main categories — episodic and chronic.

Episodic tension headaches

Episodic tension headaches can last from 30 minutes to a week. Frequent episodic tension headaches occur less than 15 days a month for at least three months. Frequent episodic tension headaches may become chronic.

Chronic tension headaches

This type of tension headache lasts hours and may be continuous. If your headaches occur 15 or more days a month for at least three months, they're considered chronic.

Tension headaches vs. migraines

Tension headaches can be difficult to distinguish from migraines. Plus, if you have frequent episodic tension headaches, you can also have migraines.

Unlike some forms of migraine, tension headache usually isn't associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren't common symptoms.

When to see a doctor

Make an appointment with your doctor

If tension headache disrupts your life or you need to take medication for your headaches more than twice a week, see your doctor.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).

When to seek emergency help

If you have any of these signs or symptoms, seek emergency care:

  • Abrupt, severe headache
  • Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
  • Headache after a head injury, especially if the headache gets worse

The cause of tension headache is not known. Experts used to think tension headaches stemmed from muscle contractions in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests muscle contractions aren't the cause.

The most common theories support a heightened sensitivity to pain in people who have tension headaches and possibly a heightened sensitivity to stress. Increased muscle tenderness, a common symptom of tension headache, may result from a sensitized pain system.

Stress is the most commonly reported trigger for tension headaches.

Risk factors for tension headache include:

  • Being a woman. One study found that almost 90 percent of women and about 70 percent of men experience tension headaches during their lifetimes.
  • Being middle-aged. The incidence of tension headaches appears to peak in the 40s, though people of all ages can get this type of headache.

Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable, particularly if they're chronic. The frequent pain may render you unable to attend activities. You might need to stay home from work, or if you do go to your job, your ability to function is impaired.

You're likely to start by seeing your family doctor. You then may be referred to a doctor who specializes in treating nervous system disorders, such as headache (neurologist).

Here's some information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to your headaches.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you're taking, and share this information with your doctor.
  • Write down questions to ask your doctor.

For tension headaches, some basic questions to ask your doctor include:

  • What type of headache do you think I'm experiencing?
  • What tests do I need? What will these tests rule out?
  • Is my condition likely temporary or chronic?
  • What treatments are available? Which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Do I need to see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • What are common side effects of the medications you're prescribing?
  • Do you have brochures or other printed material I can take home? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor will likely ask you questions, such as:

  • When did you begin experiencing symptoms?
  • Have you noticed any common triggers, such as stress or hunger?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • How often do you have headaches?
  • How long does each headache last?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting to see your doctor, you can take an over-the-counter painkiller, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to temporarily relieve the pain.

Keep a headache diary. To gather information about your headaches that will help your doctor, keep a headache diary. For each headache, jot down:

  • Date. Charting the date and time of each headache can help you recognize patterns.
  • Duration. How long did your headache last?
  • Intensity. Rate your headache pain on a scale from 1 to 10, with 10 being the worst.
  • Triggers. List possible triggers of your headache, such as certain foods, physical activities, noise, stress, smoke, bright lights or changes in weather.
  • Symptoms. Did you have symptoms before you got the headache?
  • Medications. What medications have you taken? List any, including dosage, even if they're unrelated to your headache.
  • Relief. Have you experienced any pain relief and from what?

If you have chronic or recurrent headaches, your doctor may conduct physical and neurological exams, then try to pinpoint the type and cause of your headaches using these approaches:

Your pain description

Your doctor can learn a lot about your headaches from a description of your pain. Be sure to include these details:

  • Pain characteristics. Does your pain pulsate? Or is it constant and dull? Sharp or stabbing?
  • Pain intensity. A good indicator of the severity of your headache is how much you're able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
  • Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Imaging tests

If you have unusual or complicated headaches, your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common tests used to image your brain include:

  • Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain.
  • Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.

Some people with tension headaches don't seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.

A variety of medications, both OTC and prescription, are available to reduce the pain of a headache, including:

  • Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine).
  • Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than are single-ingredient pain relievers. Many combination drugs are available OTC.
  • Triptans and narcotics. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.

Preventive medications

Your doctor may prescribe medications to reduce the frequency and severity of attacks, especially if you have frequent or chronic headaches that aren't relieved by pain medication and other therapies.

Preventive medications may include:

  • Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. Side effects of these medications may include weight gain, drowsiness and dry mouth.
  • Other antidepressants. There also is some evidence to support the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron) in people who don't also have depression.
  • Anticonvulsants and muscle relaxants. Other medications that may prevent tension headache include anticonvulsants, such as topiramate (Topamax). More study is needed.

Preventive medications may require several weeks or more to build up in your system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking the drug.

Your doctor will monitor your treatment to see how the preventive medication is working. In the meantime, overuse of pain relievers for your headaches may interfere with the effects of the preventive drugs.

Rest, ice packs or a long, hot shower may be all you need to relieve a tension headache. A variety of strategies can help reduce the severity and frequency of chronic tension headaches without using medicine. Try some of the following:

  • Manage your stress level. One way to help reduce stress is by planning ahead and organizing your day. Another way is to allow more time to relax. And if you're caught in a stressful situation, consider stepping back.
  • Go hot or cold. Applying heat or ice — whichever you prefer — to sore muscles, may ease a tension headache. For heat, use a heating pad set on low, a hot-water bottle, a warm compress or a hot towel. A hot bath or shower also may help. For cold, wrap ice, an ice pack or frozen vegetables in a cloth to protect your skin.
  • Perfect your posture. Good posture can help keep your muscles from tensing. When standing, hold your shoulders back and your head level. Pull in your abdomen and buttocks. When sitting, make sure your thighs are parallel to the ground and your head isn't slumped forward.

The following nontraditional therapies may help if you have tension headache pain:

  • Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. Acupuncture practitioners treat you using extremely thin, disposable needles that generally cause little pain or discomfort. The American Academy of Medical Acupuncture website provides referrals to medical doctors who use acupuncture in their practices.
  • Massage. Massage can help reduce stress and relieve tension. It's especially effective for relieving tight, tender muscles in the back of your head, neck and shoulders. For some people, it may also provide relief from headache pain.
  • Deep breathing, biofeedback and behavior therapies. A variety of relaxation therapies are useful in coping with tension headache, including deep breathing and biofeedback.

Living with chronic pain can be difficult. Chronic pain can make you anxious or depressed and affect your relationships, your productivity and the quality of your life.

Here are some suggestions:

  • Talk to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
  • Join a support group. Support groups can be good sources of information. Group members often know about the latest treatments. Your doctor may be able to recommend a group in your area.

In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.

  • Biofeedback training. This technique teaches you to control certain body responses that help reduce pain. During a biofeedback session, you're connected to devices that monitor and give you feedback on body functions such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing yourself.
  • Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress and may help reduce the frequency and severity of your headaches.
  • Other relaxation techniques. Anything that helps you relax, including deep breathing, yoga, meditation and progressive muscle relaxation, may help your headaches. You can learn relaxation techniques in classes or at home using books or tapes.

Using medications in conjunction with stress management techniques may be more effective than is either treatment alone in reducing your tension headaches.

Additionally, living a healthy lifestyle may help prevent headaches:

  • Get enough, but not too much sleep.
  • Don't smoke.
  • Exercise regularly.
  • Eat regular, balanced meals.
  • Drink plenty of water.
  • Limit alcohol, caffeine and sugar.
July 16, 2013


text:
Description and Brand Names

Drug information provided by: Micromedex

US Brand Name

  1. Oseni

Alogliptin and pioglitazone combination is used to treat high blood sugar levels caused by type 2 diabetes. Normally, after you eat, your pancreas releases insulin to help your body store excess sugar for later use. This process occurs during normal digestion of food. In patients with type 2 diabetes, your body does not work properly to store the excess sugar and the sugar remains in your blood. Chronic high blood sugar can lead to serious health problems in the future.

Many people can control type 2 diabetes with diet alone or diet and exercise. Following a specially planned diet and exercising will always be important when you have diabetes, even when you are taking medicines. To work properly, the amount of alogliptin and pioglitazone you take must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both, you will want to test your blood sugar to find out if it is too low. Your doctor will teach you what to do if this happens.

Alogliptin and pioglitazone combination does not help patients who have insulin-dependent or type 1 diabetes, because they cannot produce insulin from their pancreas. Their blood sugar is best controlled with insulin injections.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Tablet

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Appropriate studies have not been performed on the relationship of age to the effects of alogliptin and pioglitazone combination in the pediatric population. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alogliptin and pioglitazone combination in the elderly.

Information about this alogliptin-and-pioglitazone-oral-route
Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amisulpride
  • Aripiprazole
  • Asenapine
  • Atazanavir
  • Balofloxacin
  • Besifloxacin
  • Ciprofloxacin
  • Clozapine
  • Cobicistat
  • Darunavir
  • Elvitegravir
  • Enoxacin
  • Fleroxacin
  • Flumequine
  • Fosamprenavir
  • Gatifloxacin
  • Gemifloxacin
  • Ifosfamide
  • Iloperidone
  • Indinavir
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Bovine
  • Insulin Degludec
  • Insulin Detemir
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Lanreotide
  • Levofloxacin
  • Lomefloxacin
  • Lopinavir
  • Lurasidone
  • Moxifloxacin
  • Nadifloxacin
  • Nelfinavir
  • Nifedipine
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Paliperidone
  • Pasireotide
  • Pazufloxacin
  • Pefloxacin
  • Piperaquine
  • Pixantrone
  • Prulifloxacin
  • Quetiapine
  • Risperidone
  • Ritonavir
  • Rufloxacin
  • Saquinavir
  • Sertindole
  • Sparfloxacin
  • Telaprevir
  • Tipranavir
  • Tolvaptan
  • Tosufloxacin
  • Ziprasidone
  • Zotepine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone
  • Acebutolol
  • Atenolol
  • Atorvastatin
  • Betaxolol
  • Bisoprolol
  • Bitter Melon
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Esmolol
  • Fenugreek
  • Furazolidone
  • Gemfibrozil
  • Glucomannan
  • Guar Gum
  • Iproniazid
  • Isocarboxazid
  • Ketoconazole
  • Labetalol
  • Levobunolol
  • Linezolid
  • Methylene Blue
  • Metipranolol
  • Metoprolol
  • Moclobemide
  • Nadolol
  • Nebivolol
  • Nialamide
  • Nilotinib
  • Oxprenolol
  • Penbutolol
  • Phenelzine
  • Pindolol
  • Practolol
  • Procarbazine
  • Propranolol
  • Psyllium
  • Rasagiline
  • Rifampin
  • Selegiline
  • Sotalol
  • Timolol
  • Topiramate
  • Tranylcypromine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol, excessive use of or
  • Gallbladder stones or
  • Pancreas problems, history of—Use with caution. May increase risk for getting pancreatitis (swelling and inflammation of the pancreas).
  • Angioedema (swelling of the face, lips, tongue, throat, arms, or legs), history with other dipeptidyl peptidase-4 (DPP-4) inhibitors—Use with caution. May increase the risk of this condition occurring again.
  • Bladder cancer, active or
  • Diabetic ketoacidosis (high ketones and acid in the blood) or
  • Heart failure, severe or
  • Kidney disease, severe or
  • Type 1 diabetes—Should not be used in patients with these conditions.
  • Diabetic macular edema (swelling of the back of the eye) or
  • Edema (fluid retention) or
  • Liver disease—Use with caution. May make these conditions worse.
  • Fragile bones (especially in women)—Use with caution. This medicine may increase the risk for fractures.
  • Kidney disease, moderate—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Carefully follow the special meal plan your doctor gave you. This is the most important part of controlling your diabetes, and is necessary if the medicine is to work properly. Exercise regularly and test for sugar in your blood or urine as directed.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

You may take this medicine with or without food.

Swallow the tablet whole. Do not crush, break, or chew it.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For type 2 diabetes:
      • Adults—At first, one tablet (either alogliptin 25 milligrams [mg] plus pioglitazone 15 mg or alogliptin 25 mg plus pioglitazone 30 mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than alogliptin 25 mg plus pioglitazone 45 mg per day.
      • Children—Use is not recommended.
      • For patients switching from a combination of alogliptin and pioglitazone as separate tablets:
        • Adults—The starting dose is the same dose of alogliptin and pioglitazone that you are already taking. Your doctor may adjust your dose as needed. However, the dose is usually not more than alogliptin 25 mg plus pioglitazone 45 mg per day.
        • Children—Use is not recommended.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Certain women may be at an increased risk for pregnancy while taking this medicine. If you had problems ovulating and had irregular periods in the past, this medicine may cause you to ovulate. This could increase your chance of becoming pregnant. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

If you are rapidly gaining weight, having shortness of breath, chest pain or discomfort, extreme tiredness or weakness, irregular breathing, irregular heartbeat, or excessive swelling of the hands, wrist, ankles, or feet, check with your doctor immediately. These may be symptoms of heart problems or your body keeping too much water.

Pancreatitis (swelling and inflammation of the pancreas) may occur while you are using this medicine. Check with your doctor right away if you have a sudden and severe stomach pain, chills, constipation, nausea, vomiting, loss of appetite, fever, or lightheadedness.

This medicine may cause serious allergic reactions, including anaphylaxis, angioedema, or certain skin conditions (Stevens-Johnson syndrome). These reactions can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, blistering, peeling, or loosening of the skin, fever or chills, trouble breathing or swallowing, or any swelling of your hands, face, mouth, or throat while you are using this medicine.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may increase the risk for bone fractures in women. Ask your doctor about ways to keep your bones strong to help prevent fractures.

Using this medicine longer than 12 months may increase your risk for bladder cancer. Tell your doctor right away if you have blood in the urine, a frequent, strong, or increased urge to urinate, painful urination, or pain in the back, lower abdomen, or stomach.

Check with your doctor right away if blurred vision, decreased vision, or any other change in vision occurs while you are taking this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

This medicine may cause hypoglycemia (low blood sugar). Low blood sugar can also occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, cannot eat because of nausea or vomiting, take certain medicines, or take alogliptin with another type of diabetes medicine (eg, insulin, glimepiride, glipizide, glyburide, or metformin). Symptoms of low blood sugar must be treated before they cause you to pass out (unconsciousness). People feel different symptoms with low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly.

Symptoms of low blood sugar include anxiety, behavior changes similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, a fast heartbeat, headaches that continue, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness.

If symptoms of low blood sugar occur, check your blood sugar level. If you have low blood sugar, eat glucose tablets or gel, corn syrup, honey, or sugar cubes; or drink fruit juice, non-diet soft drinks, or sugar dissolved in water. Glucagon is a medicine that is used in emergency situations when severe symptoms, such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. The members of your family should also know how to use glucagon.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your diet plan, have a fever or infection, or do not exercise as much as usual.

Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination (frequency and amount), loss of appetite, sleepiness, stomachache, nausea, or vomiting, tiredness, troubled breathing (rapid and deep), unconsciousness (passed out), or unusual thirst.

If symptoms of high blood sugar occur, check your blood sugar level and call your doctor for instructions.

There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes with a list of all your medicines.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  1. Anxiety
  2. blurred vision
  3. chest pain
  4. chills
  5. cold sweats
  6. coma
  7. confusion
  8. cool, pale skin
  9. decreased urine output
  10. depression
  11. dilated neck veins
  12. dizziness
  13. extreme fatigue
  14. fast heartbeat
  15. headache
  16. increased hunger
  17. irregular breathing
  18. irregular heartbeat
  19. nausea
  20. nightmares
  21. seizures
  22. shakiness
  23. slurred speech
  24. swelling of the face, fingers, feet, or lower legs
  25. tightness in the chest
  26. troubled breathing
  27. unusual tiredness or weakness
  28. weight gain

  1. Blistering, peeling, or loosening of the skin
  2. bloating
  3. blood in the urine
  4. constipation
  5. cough
  6. darkened urine
  7. diarrhea
  8. difficulty with swallowing
  9. feeling of discomfort
  10. fever
  11. frequent, strong, or increased urge to urinate
  12. hives
  13. indigestion
  14. inflammation of the joints
  15. itching
  16. joint or muscle pain
  17. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  18. loss of appetite
  19. muscle aches
  20. pain in the back, lower abdomen, or stomach
  21. painful urination
  22. pains in the stomach, side, or abdomen, possibly radiating to the back
  23. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  24. rash
  25. red skin lesions, often with a purple center
  26. red, irritated eyes
  27. sore throat
  28. sores, ulcers, or white spots in the mouth or on the lips
  29. swollen lymph glands
  30. vomiting
  31. yellow eyes or skin

Incidence not known

  1. Change in vision
  2. general feeling of tiredness or weakness
  3. light-colored stools
  4. stomach pain, continuing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  1. Back pain
  2. body aches or pain
  3. ear congestion
  4. loss of voice
  5. sneezing
  6. stuffy or runny nose

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


text:
What you can expect

By Mayo Clinic Staff

Locating the area to be removed

Your lumpectomy procedure begins with locating the area of your breast that contains the abnormality.

If your breast abnormality was detected on a mammogram and confirmed with a biopsy, your radiologist may have placed a tiny marker or clip in your breast during the biopsy. If this is the case, a thin wire or radioactive marker may be inserted in your breast just before surgery and passed down to the marker or clip. Your surgeon can use the wire as a guide to the precise area that needs to be removed during surgery.

If you have a lump or mass in your breast that can be easily felt through the skin, the wire procedure may not be necessary because the surgeon can more easily find the abnormal area to be removed.

Preparing for lymph node removal

Lymph nodes are often removed during surgery to determine whether cancer has spread beyond the breast. Options may include:

  • Axillary node dissection. During this procedure, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor. Your surgeon may recommend this procedure if a lymph node biopsy done before surgery shows signs of cancer.
  • Sentinel lymph node biopsy. During this procedure your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. Your doctor may recommend this procedure if there are no concerns about enlarged lymph nodes prior to your surgery.

    Before your surgery, a radioactive substance or blue dye or both is injected into the area around the tumor or the skin above the tumor. The dye travels to the sentinel node or nodes, allowing your surgeon to identify and remove them.

    If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options, such as receiving radiation to the armpit to treat the affected lymph node. If this is what you decide to do, you will not need to have more lymph nodes in the armpit removed.

During the procedure

A lumpectomy is usually performed using general anesthesia, which will make you unaware during the procedure.

Your surgeon will make an incision over the tumor or over the area that contains the wire, remove the tumor and some surrounding tissue, and send it to the lab for analysis. He or she will do the same for the sentinel lymph node or nodes if you're having a sentinel node biopsy or the axillary lymph nodes if you're having an axillary node dissection.

The surgeon will then close the incisions with attention to preserving the appearance of your breast, using stitches (sutures) that will either dissolve on their own or be removed later by your doctor.

After the procedure

After your surgery, you'll be taken to a recovery room. During this time, your blood pressure, pulse and breathing will be monitored.

If you've had outpatient surgery — usually lumpectomy and sentinel node biopsy — you'll be released when your condition is stable.

If you've had axillary node excision, you may need to stay in the hospital for a day or two if you're experiencing pain or bleeding.

Expect to have:

  • A dressing (bandage) over the surgery site
  • Some pain, numbness and a pinching sensation in your underarm area
  • Written instructions about post-surgical care, including caring for the incision and dressing, recognizing signs of infection
  • Prescriptions for pain medication and possibly an antibiotic
  • Some restrictions of activity
  • A follow-up appointment with your doctor, usually seven to 14 days after surgery
Oct. 23, 2014


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Current projects

Past projects

ROV enhancements

Tiburon Midwater Toolsled upgrade
Project Manager/Lead Scientist: Kim Reisenbichler
Lead Engineer: Ed Mellinger

The Midwater Toolsled was the first in a series of purpose-built toolsleds to be deployed on the remotely operated vehicle (ROV) Tiburon. The initial deployments of this toolsled were highly successful and many of the concepts initiated during that development continue to be incorporated into newer sleds. However, there have also been changes to newer toolsleds that should be retrofitted to the Midwater Toolsled in order to optimize compatibility between toolsleds. In addition, after using this toolsled for a number of years, we have identified a number of small improvements that can be made to maximize its capability to support sample collections and quality video observations.

There are two significant changes and additions that we propose to make to the Midwater Toolsled during this one-year project. First, we will upgrade the toolsled electronics by removing the hydraulic control boards from the data concentrator and housing an off-the-shelf replacement board in a separate oil filled housing. This will bring the Midwater Toolsled data concentrator up to the configuration of the newer sleds, thus increasing the compatibility of hardware and software between sleds. This change will also free up valuable data concentrator space for future use. Second we will add the capability to field additional detritus samplers on the vehicle in order to maximize our capability to collect delicate midwater animals. These additional samples can be deployed and operated by using hydraulic functions that are already available on this toolsled.


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Kids Need Tools To Battle Bullying

October is Bullying Prevention Awareness Month. Stamford underscored the growing seriousness of the issue by actually arresting a 12-year-old girl last week. She allegedly was tormenting another girl to the point that the estranged friend was considering suicide.

The targets of bullies are many times caught in a quandary. They are reluctant to tell an adult for fear of being labeled "a snitch," but they also don't have the strategies to counter the bullying behavior. So, they simply try to avoid it; stressing every day about having to be confronted by the offender. It is a horrible existence that contributes to absenteeism, depression, self-image problems — even suicide.

Youth suicide in Connecticut is the second leading cause of death in children 10 to 14 years old and the third leading cause of death for those 15 to 24. Twenty five percent of the state's high school students and 35 percent of ninth-graders say they have been bullied or harassed at school, according to the state Commission on Children.

To tweak an old adage: Sticks and stones break bones and names do indeed hurt. I remember Logan West, the 2012 Miss Connecticut Teen, telling me last year of her experiences being bullied at age 12 and how it almost shattered her self-esteem.

"I'm starting to believe now that I would rather have a bruise, than have someone tear a piece of me with their words,'' she said then.

Although I'm empathetic to the pain of chronic harassment, resorting to arresting a 12-year-old is extreme — even if the specter of suicide is the driver. Stamford's efforts at mediation and intervention were exhaustive, but obviously not very effective. The arrest was an act of desperation — maybe even a ploy — to send a life-changing message to the young offender about the severity of her actions. I get it. But maybe the parent or guardian should have been put in cuffs instead.

Ultimately, parents have to be held responsible for any chronic, threatening behaviors of their children.

A bully, clinicians will tell you, is someone who is in pain and has his or her own self-image problems. Bullies are simply redirecting their hurt onto others. The key is make all children feel so good about themselves that they disregard or laugh off those who target them for name-calling. It's not easy, particularly if the self-image problem is coming from home. But if kids are pre-loaded with positive self-images from an early age, they'll develop the mentality that what someone thinks about them is none of their business. Yes, that's asking a lot of a child, particularly when most adults don't have that same capability.

Connecticut schools are mandated to have a bullying policy and every complaint is supposed to be investigated. Still, clinicians say the best strategy is to start these prevention programs in elementary school — teaching children early how to resolve conflicts without violence and name-calling. Parents can do their part by talking to their kids about how painful words can be and by engaging their children in conversation. I'm always surprised at how open my 13-year-old daughter is to talking when I just ask: "How's it going at school. Is anyone bothering you?"

With the rise of the Internet, school has become the secondary mode of harassment for the offender. Cyber bullying is rising; its impact magnified by the sheer number of people who can witness a painful post or picture.

The thing about bullying is that it has no boundaries — race, gender, sexuality, body shape, developmental challenges, appearances and speech all are fair game for the bully.

Connecticut children's author Jerry Craft has published a new book, in collaboration with his young sons Jaylen and Aren, about the effects of bullying. "The Offenders — Saving the World while Serving Detention!" is the story about five middle school bullies who are granted super powers. But as part of the transformation, the bullies also take on the characteristics of their targets. So, while their mystical powers are at an all-time high, their self-esteem is at an all-time low.

The book is about empathy. The message to the offenders: It's very hurtful when you become the target.

Stan Simpson is host of "The Stan Simpson Show'' ( and Saturdays, 5:30 a.m., on FOX CT).

Copyright © 2015, The Morning Call


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May 31, 2014

Exchange of Idaho soldier Bowe Bergdahl for Taliban detainees sets off debate

An American soldier who spent nearly five years in Taliban captivity was freed Saturday in exchange for five members of the Taliban who’d been imprisoned for years at the U.S. detention center at Guantanamo Bay in an unprecedented prisoner exchange that sparked both jubilation and controversy.

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White House

July 22, 2013

Poll: Obama’s job approval plunges; Congress, especially GOP, still unpopular

Stung by Americans’ persistent worries about the economy and a capital gripped by controversy and gridlock, President Barack Obama is suffering his lowest job approval numbers in nearly two years, according to a new McClatchy-Marist poll.

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Photo by Rob Wallator

Towering Haydn Fleury is fourth in team scoring on the offensively challenged Red Deer Rebels, leading all defensemen (63-7-35-42, 9th in the league). The Rebels are the seventh worst team in goal scoring (189) in the WHL and have won only four of the last 15 games, dropping them to a .500 record (30-30-1-4) and a battle for a playoff spot. Fleury has struggled along with the rest of Brent Sutter’s squad in February with a disappointing minus eight on the month (13-1-6-7, – 8), after posting a plus 19 the prior four months. He has cooled offensively since turn of the calendar in January with only two goals (26-2-12-14, -1). He marked an impressive pace to begin the year with a 0.75 points per game on the quiet offensive team (37-5-23-28, +18) with an intriguing package of hockey smarts and size.

The Rebels assistant captain is currently ranked second among defensemen, tenth overall, in McKeen’s Hockey’s 2014 NHL Draft midterm report in January. Fleury played for Team Canada and won gold at the 2013 Ivan Hlinka tournament contributing one goal in five games (5-1-0-1). In a surprisingly slim defensive pool in this years NHL Draft he will draw much scrutiny in the early picks of the first round. Clearly the consensus second choice to highly touted defense prospect, Aaron Eklund, in most expert rankings, edging slightly ahead of fellow WHL defenseman Julius Honka at #12 according to McKeen’s. Notable this season is the clear separation of these top three prospects from the rest of the defensive pack with the fourth ranked defenseman, Brycen Martin, not appearing until the 26th pick overall according to McKeen’s. The dearth of quality high end rearguards may prompt some teams to move more quickly on draft day than anticipated.

Andy Levangie provides a scouting report:

Photo by Rob Wallator

Photo by Rob Wallator

 Haydn Fleury, D, 2014, Red Deer Rebels

Already a towering presence at 6, 3”, 200 lbs and quickly becoming a minute eating top pair rearguard for Brent Sutter’s Rebels squad .. a rare opportunity for a 17 year old in the WHL, noted for developing many top NHL defenseman .. rarely found out of position, constantly shifting small distances to cut down angles and disrupt passing plays, especially close to the crease .. intelligent instincts clearly evident .. possesses the physical ability to lean on opposing players and a long reach to protect the puck allowing him to create turnovers and disrupt the oppositions forecheck .. creates calm around his goaltender intelligently chipping pucks or making a short pass to relieve pressure and put a teammate in position to quickly clear the zone .. uses size well in front of the net to control opponents.. always looking to drive the play away from the middle of the ice in his own end .. a punishing force along the wall in his own zone .. .. strong gap control, but can get caught tracking the puck and not the body .. a fluid skater with a strong stride that drives forward and has length to it, quickness needs improvement as do most big young defenseman growing into their frame .. adequate top speed with notable reverse skating evident when tracking attacking offensive players .. rarely beaten to the outside or forced onto his heels .. needs continued work on speed and explosiveness to reach an NHL level .. above average offensive instincts with a quick deceptive wrist shot from the point which springs from his stick with surprising force, rising off the ice, making it elusive to blockers, and finding the top of the net .. a quick wind up creates a strong slap shot ..  guards his blueline well on the power play,  keeping puck in, rarely remaining static and constantly looking to push pucks low .. stays open and makes himself an option for his teammates, choosing his pinches wisely .. smart instincts provide a good balance between growing offensive skills and his already solid defensive play.

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