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<channel>
	<title>nerds &amp;laquo; WordPress.com Tag Feed</title>
	<link>http://wordpress.com/tag/nerds/</link>
	<description>Feed of posts on WordPress.com tagged "nerds"</description>
	<pubDate>Sat, 06 Sep 2008 01:06:35 +0000</pubDate>

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<item>
<title><![CDATA[Killer Instinct 3 Mixes]]></title>
<link>http://epicponyz.wordpress.com/?p=954</link>
<pubDate>Fri, 05 Sep 2008 22:07:51 +0000</pubDate>
<dc:creator>epicponyz</dc:creator>
<guid>http://epicponyz.wordpress.com/?p=954</guid>
<description><![CDATA[
Our good friends over at The Nerdiest Kids recently created some AWESOME mixes of the song for Kill]]></description>
<content:encoded><![CDATA[<p><a href="http://epicponyz.files.wordpress.com/2008/09/ponyrave.jpg"><img class="alignnone size-full wp-image-955" title="ponyrave" src="http://epicponyz.wordpress.com/files/2008/09/ponyrave.jpg" alt="" width="328" height="283" /></a></p>
<p>Our good friends over at <a href="http://www.nerdiestkids.com">The Nerdiest Kids</a> recently created some AWESOME mixes of the song for Killer Instinct 3. The first one was done by <a href="http://www.nerdiestkids.com/?p=640">Chris Allen</a>. This post has more and one made <a href="http://www.nerdiestkids.com/?p=728">by Flitz</a>. Truly, these are some brilliant Remixes, and we suggest you check them out. Also <a href="http://www.nerdiestkids.com/forums/">Register over</a> at the forums while your there.</p>
<p><a href="http://epicponyz.com/2008/09/05/tell-meh-moar-about-buttsecks">&#60;&#60;&#60;Previous Image</a> Next Image&#62;&#62;&#62;<br />
<a href="http://www.myspace.com/epicponyz"><img src="http://img.photobucket.com/albums/v136/thepunisher10925/FINALMYSPACE.jpg" alt="" /></a></p>
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<item>
<title><![CDATA[Der große, gefährliche Motor Langeweile]]></title>
<link>http://abfallkalender.wordpress.com/?p=695</link>
<pubDate>Fri, 05 Sep 2008 20:13:31 +0000</pubDate>
<dc:creator>Sebastian</dc:creator>
<guid>http://abfallkalender.wordpress.com/?p=695</guid>
<description><![CDATA[- Den SWR zum Nachbarn zu haben bringt es mit sich, Dauergast bei Radioumfragen zu sein. Ob ich tats]]></description>
<content:encoded><![CDATA[<p>- Den SWR zum <a href="http://socialissuesandstuff.com/2007/09/17/nachbarn/">Nachbarn</a> zu haben bringt es mit sich, Dauergast bei Radioumfragen zu sein. Ob ich tatsächlich im Radio zu hören bin weiss ich nicht, denn selbstverständlich höre ich mir derlei Rotz nicht an - gerade Radioumfragen sind ja eine Pest. Sie sagen nichts aus. Sollen sie die Stimme des kleinen Mannes repräsentieren, ein wirkliches Stimmungsbild einfangen? Wohl nicht, sie sind einfach billige Lückenfüller Heute wurde ich gefragt, ob ich mir ein Elektroauto kaufen würde. Meine Antwort ging in etwa: "Hmm... ja, im Prinzip, also prinzipiell." - "Was heisst prinzipiell?" und um dieser Nachfrage Ausdruck zu verleihen, schiebt mir die hübsche, aber hypernervöse Summse das Mikrofon in die Nase, auf jeden Fall "naja, also prinzipiell gerne, wenn es nicht teurer ist als ein <em>normaler</em> Wagen" und normal heisst natürlich Benziner - normal. Ich wurde übrigens nicht gefragt, ob ich willens bin, irgendwelche Rechte an dieser Antwort abzutreten, ich stelle sie hiermit unter Creative Commons, für den Fall, dass ein Leser in so ein Umfrage gerät. Zu wünschen wäre es nicht. Ach, ich habe schon zu soviel Themen meinen Sermon beigetragen...</p>
<p>- Ironischerweise war ich gerade auf dem Weg zu meinem Wagen, als mir die Frage gestellt wurde, um diesen zu "reparieren". Der routinierte Autofahrer mag auflachen, aber für einen Spacko wie mich zählt das Austauschen einer Autobatterie auf jeden Fall schon zur höheren Kunst der Kfz-Mechanik. Im Nachhinein war es dann doch nicht wirklich schwer, aber es war das erste mal - ein erhabenes und doch beängstigendes Gefühl, das erste mal die Motorhaube zu öffnen und dem großen, gefährlichen Motor seine Aufwartung zu machen. Man weiss ja erstmal garnichts und hat sicherheitshalber alles an Werkzeug mitgenommen, was man im Hause hat. Der Werkzeugkasten ist aber mehr auf den Austausch von PC-Komponenten spezialisiert, ein Vorgang, den ich widerum seit rund 13 Jahren beherrsche, so dass ich wahlweise eine neue CPU in den Wagen hätte einbauen können (man liest doch so viel von Chiptuning, es scheint sich hier um eine Art Overclocking für Autos zu handeln), oder eben so ein neues Japanerauto hätte reparieren können, die sind ja mehr Elektro als <a href="http://de.wikipedia.org/wiki/Uffie">Uffie</a>. Es handelt sich bei meinem Wagen jedoch um einen alten Franzosen, einen Citroemitpünktchenen AX, der seit ca. 14 Jahren treu seine Dienste leistet. Klein und verwinkelt ist der Motorraum, so dass es einiges an Geschick erforderte, aber am Ende lief's.</p>
<p>- Über den Austausch einer Autobatterie so herzuschwallen, sowas können auch nur verweichlichte Blogger, deren Leben sich überall abspielt, aber nicht vor der eigenen Haustür. </p>
<p>- Sogar Nerds haben ein Sozialleben, weil sie unterhaltsam sind. Du würdest nicht mit ihnen losziehen und Party machen, aber Du tauschst Deine Videospiele mit ihnen und hängst mit ihnen rum, wenn Du sicher bist, dass es keiner sieht. Sie haben coole Filmsammlungen und einen wunderbar zynischen Humor. Angst machen Dir die Typen, die alleine sind und nicht mal das haben, weder geile Filme noch die Fähigkeit, ein einzelnes Zitat einer Simpsonsfolge zuordnen zu können. Das sind letztendlich die, die ihren eskapistischen Drang in der politischen Extreme suchen und bei PI landen oder Verschwörungsseiten. Mir macht das Angst, wenn jemand mit rotem Kopf auf seine Tastatur einhämmert, erzürnt. Emotionale Selbstkontrolle, das ist es, was den Leuten fehlt. Wo sich Menschen über [...] aufregen, brennen irgendwann [...] usw. Mein Motto seit jeher: Stock aus dem Arsch!</p>
<p>- Mein wahres Motto: Lieber einen guten Freund verloren, als einen guten Witz nicht gemacht. Ist von Karl Valentin und drückt einerseits aus, wie ich es mit Humor halte und andererseits, warum ich am Freitag abend Zeit habe, einen Blogeintrag zu schreiben.</p>
<p>- Die Zeit habe ich auch, weil wir grade versucht haben, Balto 3 zu sehen, einen unfassbar dämlichen Film. Ich habe nach einer knappen Stunde aufgegeben, Steffi hat's durchgezogen. Jetzt schaut sie nochmal den ersten Teil. Himmel! (Aber der erste ist eigentlich ganz gut.) Der zweite ist auch schlimm, irgendein Ethno-Schamanenmist, der dritte ist konventionell mit einer Rettungsgeschichte eines Piloten ausgestattet. Die zeichnerische Qualität nimmt auch ab von Teil zu Teil.</p>
<p>- In einem Land vor unserer Zeit kommt mittlerweile auf dreizehn (XIII!!! 13!!!) Teile. So viele Geheimnisse, in einer Zeit vor unserem Land. Die laufen auch gelegentlich auf Super RTL, aber ich sehe solche Sender nur wegen der guten Werbung. Spielzeugwerbung ist das größte, sie ist der einzige Grund, warum ich mich noch auf Weihnachten freue (Disclaimer: "Scheiss Kommerzfest, Industrie etc."), so wie ich überhaupt auch nur noch ins Kino gehe, um mir Trailer anzusehen. Trailer zeigen bekanntlich die besten Szenen eines Films, man bekommt also die besten Szenen aus 5 Filmen auf einmal + einen ganzen Film. </p>
<p>- Wer die Möglichkeit hat, mal in Kollegahs neues Album zu hören, der Track Kokamusik ist einfach Bombe. ab 3.20 dreht er vollkommen durch. Ich bekenne ja, eine Schwäche für "diese Art Musik" zu haben. Ändert nichts daran, dass ich Keith Richards recht gebe, wenn er sagt, Jailbait von Andre Williams ist der beste Song aller Zeiten:</p>
<p><span style='text-align:center; display: block;'><object width='425' height='350'><param name='movie' value='http://www.youtube.com/v/NWnyX12u9tQ'></param><param name='wmode' value='transparent'></param><embed src='http://www.youtube.com/v/NWnyX12u9tQ&rel=0' type='application/x-shockwave-flash' wmode='transparent' width='425' height='350'></embed></object></span><br />
(<a href="http://www.youtube.com/watch?v=NWnyX12u9tQ">Direktlink</a>)</p>
<p>Der hat ja auch eine unglaubliche <a href="http://en.wikipedia.org/wiki/Andre_Williams">Lebensgeschichte</a>, der Williams.</p>
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<item>
<title><![CDATA[Current Treatment Strategies for Rheumatoid Arthritis]]></title>
<link>http://medicalworld.wordpress.com/?p=11</link>
<pubDate>Fri, 05 Sep 2008 08:23:09 +0000</pubDate>
<dc:creator>medicalworld</dc:creator>
<guid>http://medicalworld.wordpress.com/?p=11</guid>
<description><![CDATA[The management of rheumatoid arthritis has changed considerably during the past 15 years. Current st]]></description>
<content:encoded><![CDATA[<p class="abs">The management of rheumatoid arthritis has changed considerably during the past 15 years. Current strategies emphasize the need for early diagnosis and therapeutic intervention based on the use of disease-modifying antirheumatic drugs. The advent of agents that are more tailored to inhibit the specific disease processes will profoundly affect management. Immunogenetic studies may eventually assist in identifying subgroups of patients with rheumatoid arthritis who have more aggressive disease and who require a more aggressive treatment approach.</p>
<p>Rheumatoid arthritis (RA) is a common disease that affects about 1% of the population worldwide. Women are affected almost 3 times as often as men. The prevalence increases with advancing age, and 4% to 6% of the white population older than 65 years may have RA. Although the cause is unknown, evidence suggests an association between severe RA and HLA, particularly to alleles coding for a shared epitope on the HLA-DRB1 molecule.</p>
<p>Major features of active disease include symmetrical polyarthritis with joint swelling and tenderness and morning stiffness lasting for an hour or longer. Subcutaneous nodules, presence of rheumatoid factor (in about 80% of patients with RA), and radio graphically evident erosions or juxta-articular osteoporosis in or adjacent to the involved joints are further characteristics of RA.</p>
<p>The onset and clinical course of RA are variable. Gradual onset is most common. About 20% of patients will have a monocyclic course, which will abate within 2 years, whereas the rest will have a polycyclic or progressive course.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib1">1</a></sup> The long-term prognosis of patients with abrupt onset of disease is similar to that for patients with gradual onset of disease.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib2">2</a></sup></p>
<p><a>Rheumatoid arthritis is one of the most common causes of disability. After 12 years of disease, more than 80% of patients with RA are partially disabled, and 16% are completely disabled.</a><sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib3">3</a></sup> Life expectancy is shortened by an average of 7 years in men and 3 years in women, an outcome equivalent to the increased mortality of patients with Hodgkin disease, diabetes, and stroke.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib4">4</a></sup> Factors contributing to the poor prognosis include the presence of extra-articular disease and infections, as well as complications of treatment such as gastrointestinal (GI) toxic effects of nonsteroidal anti-inflammatory drugs (NSAIDs).</p>
<p><strong>MANAGEMENT PRINCIPLES</strong></p>
<p>The goals of therapy for RA are to alleviate pain, control inflammation, preserve the ability of the patient to function in activities of daily living and work, and prevent joint destruction. Appropriate and timely therapeutic intervention after accurate diagnosis diminishes not only the symptoms but also the progress of RA. The primary care physician has a crucial role in this process by early recognition of the symptoms of RA, leading to its diagnosis and use of the resources necessary to establish a successful treatment program to achieve these goals, and by participating in the ongoing management of the patient with RA.Early in the course of RA, education on the disease and vocational, lifestyle, and family counseling must be provided. Patients are best served by a multidisciplinary team that includes a rheumatologist and other specially trained medical personnel, including nurses and occupational and physical therapists skilled and knowledgeable about RA. Physical modalities such as joint protection, orthotics and other adaptive devices, and exercises improve the symptoms, function, and well-being of the patient. Adequate rest reduces the fatigue associated with active RA, and resting the involved joints lessens the symptoms of inflammation.</p>
<p><strong>THERAPY</strong></p>
<p>Nonsteroidal anti-inflammatory drugs reduce inflammation and help relieve pain but seldom completely eliminate signs and symptoms of active arthritis. They inhibit 1 or both types of cyclooxygenase (COX). Cyclooxygenase-1 is constitutively expressed in the GI mucosa, kidneys, platelets, and vascular endothelium. Cyclooxygenase-2 is functionally expressed and promotes the elaboration of prostaglandins in inflamed tissues.</p>
<p>Selective blockage of COX-2 may lead to an improved safety profile for these agents. Celecoxib and rofecoxib are the first such agents available in the United States that selectively block COX-2. Rofecoxib is withdrawn from the market due proven increase in cardiac risk.  Of importance, the efficacy of these COX-2 inhibitors does not differ substantially from that of conventional NSAIDs. Their putative advantage is principally because of a reduced rate of adverse events, especially upper GI bleeding.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib5">5</a></sup> Cyclooxygenase-2 inhibitors should be considered in patients at high risk of GI bleeding, including those older than 65 years and those with a previous history of GI bleeding. Despite advantages, these drugs may be associated with important adverse reactions, including allergy and fluid retention, and like other NSAIDs should be used with caution in patients with renal insufficiency.</p>
<p>Glucocorticoids are the most potent suppressors of inflammation and may be needed to control severe polyarticular disease until disease-modifying antirheumatic drugs (DMARDs) have been added and become effective. At that point, the glucocorticoids should be tapered and discontinued. Glucocorticoids should not be used alone in the management of RA. Oral prednisone or an equivalent is given in dosages typically ranging between 2 and 15 mg/d, often in divided doses (eg, 2 mg twice a day). A split-dosing regimen is frequently necessary because the anti-inflammatory effect is relatively short. It is preferable, but often not possible, to avoid long-term glucocorticoid therapy in patients with RA because of the well-appreciated adverse effects of these drugs. Systemic extra-articular manifestations such as rheumatoid vasculitis may require treatment with initial prednisone dosages of 40 to 60 mg/d, tapering according to response.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib6">6</a></sup> Intra-articular injection of glucocorticoids is an effective means for reducing pain and inflammation in individual recalcitrant joints.</p>
<p>Disease-modifying antirheumatic drug therapy is associated with reduced morbidity and mortality in patients with RA.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib7">7</a></sup> It should be used when the diagnosis of RA has been established and before erosive change appears. Disease-modifying antirheumatic drugs are usually given with NSAIDs and glucocorticoids, if needed. The DMARDs currently in use are listed in <a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#7501crc-tab1">Table 1</a>. The mechanism of action of most of these agents is diverse and to a variable extent overlapping. For many of the agents, the mechanism of action is defined incompletely, whereas for some, including the new class of tumor necrosis factor (TNF) blockers, it is better understood.</p>
<p>For patients with mild disease, hydroxychloroquine is often the first drug of choice because of ease of use and its favorable toxicity profile. Retinopathy due to hydroxychloroquine rarely develops when appropriate dosages are used. The onset of antirheumatic disease activity occurs in about 3 to 4 months in almost 50% of patients, although 6 months may be needed for the full benefit to be realized. For patients with moderately active or severe newly diagnosed disease, methotrexate or sometimes sulfasalazine is a preferred initial choice. In patients with continuing active established disease, methotrexate may be used in combination with other agents including hydroxychloroquine, sulfasalazine, or both or cyclosporine, azathioprine, and the more recently available DMARDs.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib9">9</a></sup></p>
<p>For patients with acute and severe disease, a combination of DMARDs, prednisone, and an NSAID may be initiated; the dose of prednisone should be tapered during the ensuing weeks to months as disease control improves.</p>
<p>Because of its favorable efficacy and toxicity profile, methotrexate is regarded by many rheumatologists as the anchor therapy for RA. The initial dosage is usually 7.5 to 10.0 mg/wk, titrated upward to an average dosage of 12.5 to 15.0 mg/wk, although dosages of 20 to 30 mg/wk (if tolerated) may be necessary to realize this drug’s therapeutic potential before the response is deemed “inadequate.” Methotrexate may be given in tablet or liquid form; the liquid form is substantially less expensive than tablets, and injection may be associated with less stomatitis and GI upset. Appropriately managed, methotrexate can be used effectively for long periods to control RA. Although generally well tolerated, methotrexate can cause GI upset and hepatotoxicity including liver fibrosis and cirrhosis. Concomitant alcohol use is an important risk factor for methotrexate-related hepatotoxicity, and thus alcohol should not be used by patients taking this drug. Methotrexate can also cause a syndrome of pulmonary hypersensitivity manifested by dyspnea, cough, and fever and should not be used in patients with hepatic or renal insufficiency or severe lung disease. Supplemental folate (usually 1 mg/d) seems to reduce the occurrence of other adverse effects, including stomatitis, hair thinning, and bone marrow suppression. In patients taking methotrexate, physicians should avoid prescribing antifolate drugs such as sulfamethoxazole for sinusitis or cystitis, which may precipitate pancytopenia.</p>
<p>Use of DMARDs has substantially improved disease control and the long-term outlook for patients with RA. Their use may be associated with a lower incidence of extra-articular disease manifestations such as systemic vasculitis. In a series of more than 3000 patients monitored for up to 20 years, patients who had received DMARD therapy had a 30% reduction in long-term disability and improvement in survival compared with patients who had received NSAIDs alone.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib7">7</a></sup> Despite these successes, major challenges exist. For example, DMARDs are becoming more accepted among practicing physicians and their patients<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib10">10</a></sup> however, adverse effects or failure of the drug to produce long-term disease control often leads to a change in DMARD treatment.</p>
<p><a href="http://medicalworld.files.wordpress.com/2008/09/ra-rx-mayo2.png"><img class="alignleft size-large wp-image-15" src="http://medicalworld.wordpress.com/files/2008/09/ra-rx-mayo2.png?w=500" alt="" width="500" height="1517" /></a></p>
<p>To improve disease control, therapies that contain combinations of DMARDs are often used. About 50% of patients with RA treated by rheumatologists are prescribed combination therapies with either 2 or 3 DMARDs. The combination of methotrexate, hydroxychloroquine, and sulfasalazine is among the most popular regimens. Methotrexate is often combined with other DMARDs including cyclosporine, but many other combinations of DMARDs have also been used.</p>
<p>In addition to hydroxychloroquine and methotrexate, other traditional DMARDs include penicillamine, gold, and sulfasalazine. Sulfasalazine was among the first drugs to be developed for the treatment of RA and may be chosen as the initial DMARD for patients with no allergy to sulfa, rather than hydroxychloroquine or methotrexate. The use of gold or penicillamine is seldom recommended because of the limited efficacy and the pronounced incidence of adverse effects associated with these drugs.</p>
<p>Three to 6 months may be needed before agents such as gold, hydroxychloroquine, and even sulfasalazine are effective. If the response is inadequate after 6 months of treatment, a second DMARD should be added or the DMARD regimen should be changed.</p>
<p>In the past year, 3 new DMARDs, etanercept, infliximab, and leflunomide, have been approved for the treatment of patients with RA.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib11">11</a>,<a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib12">12</a></sup> Etanercept and infliximab are TNF-α antagonists that have powerful anti-inflammatory effects in patients with RA. Tumor necrosis factor is a potent inflammatory cytokine expressed in increased amounts in the serum and synovial fluid of patients with RA. It promotes the release of other proinflammatory cytokines, particularly interleukin (IL) 1, IL-6, and IL-8 and stimulates protease production. Etanercept consists of fusion monoclonal antibody composed of 2 identical chains of recombinant human TNF-α receptor fused with the Fc portion of human IgG1. In vitro it binds to soluble TNF. About 70% of patients receiving subcutaneous etanercept at dosages of 25 mg twice a week have substantial improvement in the extent of joint inflammation, often within 1 to 2 weeks after initiation of therapy. This improvement can be enhanced by combination with methotrexate. Adverse effects of etanercept are influenza-like symptoms and reactions at the injection site, which usually abate after the first few injections. The efficacy of infliximab, a recombinant TNF receptor fusion protein, seems to be roughly equivalent to that of etanercept. Infliximab is given intravenously once every 8 weeks, a regimen that may be more convenient for some patients. Potential long-term risks of these TNF-α antagonists have not been established. Infliximab may be associated with development of autoantibodies such as antinuclear antibodies. To date, neither drug has an increased risk of malignancy, autoimmune disease, or infection, issues that are the subject of ongoing postmarketing surveillance. The cost of these drugs is about $10,000 to $12,000 a year, generally higher for etanercept than infliximab. The available TNF-α antagonists should be considered in patients with recalcitrant disease not controlled by methotrexate.</p>
<p>Leflunomide is a pyrimidine synthesis inhibitor with clinical efficacy generally equivalent to methotrexate.<sup><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#bib13">13</a></sup> Adverse effects reported include rash, alopecia, allergy, weight loss, thrombocytopenia, and diarrhea. Diarrhea often occurs early in the course of treatment and may abate, but discontinuation of the drug is necessary when the diarrhea cannot be ameliorated with dose reduction or concomitant use of antidiarrheal agents.</p>
<p>Serious extra-articular disease manifestations including vasculitis, scleritis, and recalcitrant serositis generally require systemic glucocorticoids and may necessitate the use of immunosuppressive agents such as cyclophosphamide. In my opinion, the only indication for cyclophosphamide in the treatment of RA is severe extra-articular disease, especially vasculitis.</p>
<p>Of importance, the decision about the use and aggressiveness of DMARD therapy should not be based solely on the presence or absence of the rheumatoid factor. Early in the course of RA, the rheumatoid factor may be absent, whereas in patients with established poly articular arthritis, absence of the rheumatoid factor is not invariably associated with mild disease and good disease outcome. Treatment must be tailored to the disease manifestations and needs of the individual patient. Consultation with a rheumatologist is helpful for patients who are pregnant or considering pregnancy because many antirheumatic drugs have severe fetal toxic effects including teratogenicity. Management suggestions for several clinical scenarios involving patients with RA are listed in <a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#7501crc-tab2">Table 2</a>.</p>
<p>When the symptoms of RA are well controlled, the glucocorticoids should be tapered, and the NSAIDs may also be tapered or used as needed. As a generalization, DMARD therapy should be continued indefinitely; however, if the patient does well and has no signs of active disease for at least 1 year, DMARD therapy could be carefully tapered. With combination DMARD therapy, one of the DMARDs could be tapered if the patient has been in remission for at least 6 months. Methotrexate can be considered as an “anchor” therapy and generally continue this drug for the longest period. Of note, less than 5% of patients with bona fide seropositive RA remain in long-term disease-free remission.</p>
<p><a href="http://medicalworld.files.wordpress.com/2008/09/ra-rx-mayo-2.png"><img class="alignleft size-large wp-image-16" src="http://medicalworld.wordpress.com/files/2008/09/ra-rx-mayo-2.png?w=500" alt="" width="500" height="890" /></a></p>
<p>Rheumatoid arthritis is a serious disease. Follow-up early in the course of disease and in patients with poorly controlled disease should be every 2 to 6 weeks. Patients with well-controlled disease may be seen every 3 to 6 months. The primary care physician has an important role in the management of RA and can effectively guide and monitor routine therapy, with periodic consultation by a rheumatologist as needed. Assessment of disease activity and treatment efficacy is enhanced substantially with serial use of standard outcome measures, including duration of morning stiffness, severity of fatigue, presence and degree of joint pain and stiffness including joint counts, global and disease-specific health assessment instruments such as the modified Health Assessment Questionnaire, erythrocyte sedimentation rate, and radiographs of involved joints.</p>
<p>Appropriate medical care for patients with RA includes immunization and prompt treatment of infections. Patients with RA have a high risk of infections even if they are not taking DMARDs but particularly when they are taking immunosuppressive drugs. Several medications used to manage RA, including NSAIDs, cyclosporine, and glucocorticoids, may cause or exacerbate hypertension. Rheumatoid arthritis is associated with an increased incidence of pulmonary disease, and patients who smoke have an especially high rate of lung disease. In patients at high risk of GI bleeding, including elderly women and those with a previous history of GI bleeding, prophylaxis is achieved with agents such as proton pump inhibitors and misoprostol. As a general principle, use of NSAIDs should be avoided when possible and certainly discontinued when symptoms diminish. Virtually all patients with RA have or develop osteoporosis as a complication of the disease or its treatment. Adequate intake of calcium (1200-1500 mg/d) and vitamin D (400 IU/d) is important. In all patients receiving long-term corticosteroid therapy, including men, an antiresportive agent such as bisphosphonates or calcitonin should be considered. In postmenopausal women, estrogen replacement therapy or agents such as raloxifene may be considered. Finally, mouth and eye moisturization is necessary for patients with sicca complex symptoms.</p>
<p>Understanding the relationship of disease susceptibility and severity with genetic factors may provide an avenue for individualized treatment of patients with RA in the future. It may be possible to treat patients lacking genetic markers of severe disease with milder agents, while those with markers of severe disease may be treated more aggressively. More than 80 drugs are currently being developed for treatment of RA; thus, further advances in the management of the disease are forthcoming.</p>
<p><strong>Questions About Treatment of RA</strong></p>
<p><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#qa">1</a>. Which <em><span style="text-decoration:underline;">one</span></em> of the following would be an <em><span style="text-decoration:underline;">acceptable</span></em> therapeutic program for a patient with early mild RA?</p>
<ol type="a">
<li class="article-text">Hydroxychloroquine with an NSAID</li>
<li class="article-text">Hydroxychloroquine, methotrexate, and an NSAID</li>
<li class="article-text">Methotrexate and prednisone at 5 to 15 mg/d</li>
<li class="article-text">Etanercept and prednisone</li>
<li class="article-text">Leflunomide and sulfasalazine</li>
</ol>
<p><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#qa">2</a>. Which <em><span style="text-decoration:underline;">one</span></em> of the following regimens would be <em><span style="text-decoration:underline;">appropriate</span></em> for a patient with RA and new-onset systemic vasculitis?</p>
<ol type="a">
<li class="article-text">Azathioprine, hydroxychloroquine, and prednisone at 10 to 15 mg/d</li>
<li class="article-text">Prednisone, 20 mg/d, and methotrexate, 25 mg/wk</li>
<li class="article-text">Prednisone, 40 to 60 mg/d, and cyclophosphamide</li>
<li class="article-text">Cyclosporine and prednisone at 20 to 30 mg/d</li>
<li class="article-text">Prednisone, 40 to 60 mg/d, and immunoabsorption column treatment</li>
</ol>
<p><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#qa">3</a>. Which <em><span style="text-decoration:underline;">one</span></em> of the following situations is <em><span style="text-decoration:underline;">not</span></em> a relative contraindication to the use of etanercept?</p>
<ol type="a">
<li class="article-text">Patient with history of tuberculosis exposure</li>
<li class="article-text">Patient with history of lymphoma</li>
<li class="article-text">Patient with active chronic infection</li>
<li class="article-text">Patient with newly diagnosed RA</li>
<li class="article-text">Patient with established RA receiving hydroxychloroquine and methotrexate</li>
</ol>
<p><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#qa">4</a>. Which <em><span style="text-decoration:underline;">one</span></em> of the following statements about the clinical course of RA is <em><span style="text-decoration:underline;">false</span></em>?</p>
<ol type="a">
<li class="article-text">The median life expectancy of patients with RA is the same as that for the general population</li>
<li class="article-text">Most patients with RA have some disability after 12 years of disease</li>
<li class="article-text">Predictors of poor outcome in patients with RA include the extent of radiographic erosions, female sex, and functional class</li>
<li class="article-text">Patients in whom the rheumatoid factor is present have a worse prognosis than those with seronegative disease</li>
<li class="article-text">Disease-free remission is unusual</li>
</ol>
<p><a href="http://www.mayoclinicproceedings.com/inside.asp?AID=1352&#38;UID=#qa">5</a>. Which <em><span style="text-decoration:underline;">one</span></em> of the following statements about COX is <em><span style="text-decoration:underline;">true</span></em>?</p>
<ol type="a">
<li class="article-text">Cyclooxygenase-1 is constitutively expressed in the gastric mucosa, kidney, and platelets</li>
<li class="article-text">Use of the currently available selective COX-2 inhibitors is safe in patients with renal failure</li>
<li class="article-text">Currently available selective COX-2 inhibitors have been proved in multiple clinical trials to be safe in patients who are taking warfarin</li>
<li class="article-text">Cyclooxygenase-1 is functionally expressed and promotes the elaboration of prostaglandins important in the inflammatory cascade</li>
<li class="article-text">Selective COX-2 inhibitors are not associated with risk of GI bleeding <a name="qa">Correct answers: 1. <em>a</em>, 2. <em>c</em>, 3. <em>e</em>, 4. <em>a</em>, 5. <em>a</em></a></li>
</ol>
<p><strong>REFERENCES</strong></p>
<ol>
<li class="references"><a id="bib1"><span>Masi </span>AT.  Articular patterns in the early course of rheumatoid arthritis. <em>Am J Med.</em> 1983;75(suppl 6A):16-26.</a></li>
<li class="references"><a id="bib2"><span>Jacoby </span><span>RK, </span><span>Jayson </span><span>MI, </span><span>Cosh </span>JA.  Onset, early stages, and prognosis of rheumatoid arthritis. <em>BMJ.</em> 1973;2:96-100.</a></li>
<li class="references"><a id="bib3"><span>Sherrer </span><span>YS, </span><span>Bloch </span><span>BA, </span><span>Mitchell </span><span>DM, </span><span>Young </span><span>DY, </span><span>Fries </span>JF.  The development of disability in rheumatoid arthritis. <em>Arthritis Rheum.</em> 1986;29:494-500.</a></li>
<li class="references"><a id="bib4"><span>Mitchell </span><span>DM, </span><span>Spitz </span><span>PW, </span><span>Young </span><span>DY, </span><span>Bloch </span><span>BA, </span><span>McShane </span><span>DJ, </span><span>Fries </span>JF.  Survival, prognosis, and causes of death in rheumatoid arthritis. <em>Arthritis Rheum.</em> 1986;29:706-714.</a></li>
<li class="references"><a id="bib5"><span>Wolf </span><span>MM, </span><span>Lichtenstein </span><span>DR, </span><span>Singh </span>G.  Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. <em>N Engl J Med.</em> 1999;340:1888-1899.</a></li>
<li class="references"><a id="bib6"><span>Matteson </span><span>EL, </span><span>Conn </span>DL.  Extraarticular manifestations of rheumatoid arthritis. In: Weisman MH, Weinblatt ME, eds. <em>Treatment of the Rheumatic Diseases.</em> Philadelphia, Pa: WB Saunders Co; 1995:52-67.</a></li>
<li class="references"><a id="bib7"><span>Fries </span><span>JF, </span><span>Williams </span><span>CA, </span><span>Morfeld </span><span>D, </span><span>Singh </span><span>G, </span><span>Sibley </span>J.  Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies. <em>Arthritis Rheum.</em> 1996;39:616-622.</a></li>
<li class="references"><a id="bib8"> American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. <em>Arthritis Rheum.</em> 1996;39:723-731.</a></li>
<li class="references"><a id="bib9"><span>Borigini </span><span>MJ, </span><span>Paulus </span>HE.  Rheumatoid arthritis. In: Weisman MH, Weinblatt ME, eds. <em>Treatment of the Rheumatic Diseases.</em> Philadelphia, Pa: WB Saunders Co; 1995:31-51.</a></li>
<li class="references"><a id="bib10"><span>Ward </span><span>MM, </span><span>Fries </span>JF.  Trends in antirheumatic medication used among patients with rheumatoid arthritis, 1981-1996. <em>J Rheumatol.</em> 1998;25:408-416.</a></li>
<li class="references"><a id="bib11"><span>Weinblatt </span><span>ME, </span><span>Kremer </span><span>JM, </span><span>Bankhurst </span>AD, et al. A trial of etanercept, a recombinant tumor necrosis factor recepton:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. <em>N Engl J Med.</em> 1999;340:253-259.</a></li>
<li class="references"><a id="bib12"><span>Moreland </span><span>LW, </span><span>Baumgartner </span><span>SW, </span><span>Schiff </span>MH, et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. <em>N Engl J Med.</em> 1997;337:141-147.</a></li>
<li class="references"><a id="bib13"><span>Mladenovic </span><span>V, </span><span>Domljan </span><span>Z, </span><span>Rozman </span>D, et al. Safety and effectiveness of leflunomide in the treatment of patients with active rheumatoid arthritis. <em>Arthritis Rheum.</em> 1995;38:1595-1603.</a></li>
</ol>
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<title><![CDATA[The Office]]></title>
<link>http://venturapublicworks.wordpress.com/?p=329</link>
<pubDate>Fri, 05 Sep 2008 08:00:50 +0000</pubDate>
<dc:creator>senyorventura</dc:creator>
<guid>http://venturapublicworks.wordpress.com/?p=329</guid>
<description><![CDATA[&#8220;Roger, tots els informàtics sou uns nerds, oi?&#8221;
&#8220;Tots no. Jo no ho sóc, per exe]]></description>
<content:encoded><![CDATA[<p><em>"Roger, tots els informàtics sou uns <a href="http://es.wikipedia.org/wiki/Nerd">nerds</a>, oi?"</em></p>
<p><em>"Tots no. Jo no ho sóc, per exemple. Però tota la resta sí."</em></p>
<p>El Roger és un informàtic ideal: quan he tingut un problema amb l'ordinador, poques vegades me l'ha sabut solucionar, cert; però tampoc m'ha avassallat donant-me explicacions amb un lèxic de ciència ficció, que et fan sentir com un ximple.</p>
<p><em>"És que jo no sé ni la memòria RAM del meu ordinador. Quan me'l vaig comprar, sí que m'hi vaig fixar. Però després, de què em serveix recordar-la? Sé que està bé i prou."</em></p>
<p>El Roger no suporta els ajudants que li posen a les empreses on treballa.</p>
<p><em>"Són uns ignorants. Fan unes faltes d'ortografia inconcebibles. Jo els aviso i els dic com s'escriu, i ells em miren i fan cara de que ho han entès. Però l'endemà, m'ho torno a trobar igual! "</em></p>
<p>Costa trobar punts en comú amb la reta de companys.<em><br />
</em></p>
<p><em>"L'altre dia, vaig arribar a la feina a les 8 del matí, i estava tancat. La recepcionista  havia marxat de vacances i l'altre paio que té les claus no sabia que era ell qui havia d'obrir. Els quatre que érem allà vam haver d'esperar al bar fins a les 10. </em></p>
<p><em>Saps quin va ser el tema de conversa? Si el Windows Professional es pot instal·lar a més d'un ordinador, o sí tan sols té una llicència per ordinador. I creus que això dóna per dues hores de conversa? Doncs sí, tu. </em></p>
<p><em>En algun moment vaig preguntar si algú havia vist l'Espanya-Estats Units (era el dia següent de la final olímpica de bàsquet). I em van mirar com si els parlés de bàdminton o halterofília. Després ho vaig provar amb el futbol: 'Algú sap què va fer ahir el Madrid?' Jo ja sabia que el Madrid havia perdut! Però és que, a més, m'importava una merda què havia fet el Madrid! Només volia parlar d'alguna altra cosa que no fossin les llicències de Windows! Però aquesta gent ni tan sols es llegeix el Mundo Deportivo."</em></p>
<p>No és estrany, doncs, que el Roger, per les feines on passa, acabi entenent-se més amb les recepcionistes que amb els seus companys.</p>
<p>Aquí és on em recorda al <a href="http://www.bbc.co.uk/comedy/theoffice/characters/tim_person_page.shtml">Tim</a>, el noi jove de <a href="http://en.wikipedia.org/wiki/The_Office_(UK_TV_series)">The Office</a>, una sèrie que fa anys que tothom em recomanava pletòricament, i que he devorat aquest estiu quasi per accident.</p>
<p><em>"Roger, mira't 'The Office'. És que hi surts!"</em></p>
<p><em>"Passo. No tinc ganes que la gent se'n rigui de mi."</em></p>
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<title><![CDATA[Sarah Palin might not steal hearts, but she sure does eat them]]></title>
<link>http://intellectualthicket.wordpress.com/?p=66</link>
<pubDate>Thu, 04 Sep 2008 21:38:45 +0000</pubDate>
<dc:creator>Erik Gonzalez</dc:creator>
<guid>http://intellectualthicket.wordpress.com/?p=66</guid>
<description><![CDATA[While we&#8217;re on the subject of comparisons, this isn&#8217;t as much a comparison of looks tha]]></description>
<content:encoded><![CDATA[<p>While we're on the subject of comparisons, this isn't as much a comparison of looks than of style (and intent).</p>
<p>Newly-minted GOP VP candidate Sarah Palin:</p>
<p><img class="alignnone" title="Sarah Palin" src="http://farm2.static.flickr.com/1398/542389855_811a187e7b.jpg" alt="" width="220" height="300" /></p>
<p>Darla, from <em>BtVS </em>and <em>Angel</em></p>
<p><img class="alignnone" title="Darla" src="http://images1.wikia.nocookie.net/buffy/images/thumb/b/b0/Darla3.jpg/200px-Darla3.jpg" alt="" width="200" height="163" /></p>
<p>Enough said.</p>
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<title><![CDATA[Cory's Playlist]]></title>
<link>http://epicponyz.wordpress.com/?p=912</link>
<pubDate>Thu, 04 Sep 2008 21:11:13 +0000</pubDate>
<dc:creator>epicponyz</dc:creator>
<guid>http://epicponyz.wordpress.com/?p=912</guid>
<description><![CDATA[
Good friend of EPICponyz and The Nerdiest Kids Cory recently sent me a message he was starting his ]]></description>
<content:encoded><![CDATA[<p><a href="http://coryroof.wordpress.com/"><img class="alignnone size-full wp-image-913" title="corysplaylist" src="http://epicponyz.wordpress.com/files/2008/09/corysplaylist.jpg" alt="" width="422" height="333" /></a></p>
<p>Good friend of EPICponyz and <a href="http://www.nerdiestkids.com">The Nerdiest Kids</a> Cory recently sent me a message he was starting his own blog about Music. Yesterday he made his first post and we must say, this is FLATOUT amazing. His first post tackles the CD "The Sound of  Madness" by <a href="http://www.shinedown.com/">Shinedown</a>. Enjoy it, keep a daily eye on it. Great work so far my man.</p>
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<title><![CDATA[Old Kids on the Block]]></title>
<link>http://unterekless.wordpress.com/?p=1564</link>
<pubDate>Thu, 04 Sep 2008 20:16:05 +0000</pubDate>
<dc:creator>Karen</dc:creator>
<guid>http://unterekless.wordpress.com/?p=1564</guid>
<description><![CDATA[New Kids performed a medley of older stuff on the Today Show.

In the interest of honesty, you shoul]]></description>
<content:encoded><![CDATA[<p>New Kids performed a medley of older stuff on the Today Show.</p>
<p><span style='text-align:center; display: block;'><object width='425' height='350'><param name='movie' value='http://www.youtube.com/v/h3L226vEV7s'></param><param name='wmode' value='transparent'></param><embed src='http://www.youtube.com/v/h3L226vEV7s&rel=0' type='application/x-shockwave-flash' wmode='transparent' width='425' height='350'></embed></object></span></p>
<p>In the interest of honesty, you should know that I didn't start listening to NKOTB until much much later.  In elementary school, I mainly listened to... cassette tape biographies of classical composers.</p>
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<title><![CDATA[Ghost world]]></title>
<link>http://thiagoclash.wordpress.com/?p=48</link>
<pubDate>Thu, 04 Sep 2008 19:05:28 +0000</pubDate>
<dc:creator>thiagoclash</dc:creator>
<guid>http://thiagoclash.wordpress.com/?p=48</guid>
<description><![CDATA[
Imagine: Você acaba de sair da escola, está livre de todo aquele mundo de pessoas populares, esp]]></description>
<content:encoded><![CDATA[<p><a href="http://thiagoclash.wordpress.com/files/2008/09/cover_ghost_world_4328b1.jpg"><img class="size-full wp-image-51   alignright" title="cover_ghost_world_4328b1" src="http://thiagoclash.wordpress.com/files/2008/09/cover_ghost_world_4328b1.jpg" alt="" width="240" height="360" /></a></p>
<p>Imagine: Você acaba de sair da escola, está livre de todo aquele mundo de pessoas populares, esportistas, nerds, líderes de torcida, chatos e etc, e se sente perdido igual a maioria das pessoas da sua idade. Então, <strong>Ghost World </strong>mostra exatamente isso, essa fase em que a escola acaba e não temos a mínima idéia do que fazer.</p>
<p>Esse filme de 2001, do diretor Terry Zwigoff, gira em torno de duas amigas que estão nessa situação. Enid (Thora Birch) e Rebecca (Scarlett Johansson) acabaram a escola e têm milhões de planos pela frente.  Enid se envolve com o medonho Seymour (Steve Buscemi), que tem como hobbies colecionar discos de blues, morar sozinho e fantasiar relacionamentos com qualquer tipo de mulher. Na verdade, Enid e Seymour, são pessoas muito parecidas, só que com uma diferença de idade grande entre eles.</p>
<p>O que o filme retrata, nada mais é que a adolescência como ela deve ser levada: cheia de dúvidas, mal-humor, rebeldia e insanidades.</p>
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<title><![CDATA[Official PlayStation 3 Bluetooth SOCOM Headset Is $49 On October 14!]]></title>
<link>http://elohelgaming.wordpress.com/?p=521</link>
<pubDate>Thu, 04 Sep 2008 13:51:30 +0000</pubDate>
<dc:creator>era88</dc:creator>
<guid>http://elohelgaming.wordpress.com/?p=521</guid>
<description><![CDATA[
The official PlayStation 3 Bluetooth headset will be arriving in the US on October 14 for $49, or a]]></description>
<content:encoded><![CDATA[<p><a href="http://era88.files.wordpress.com/2008/09/psheadsetnew.jpg"><img class="alignnone size-full wp-image-3210" src="http://era88.wordpress.com/files/2008/09/psheadsetnew.jpg" alt="" width="425" height="415" /></a></p>
<p>The official PlayStation 3 Bluetooth headset will be arriving in the US on October 14 for $49, or a bundle price of $59 if you want to buy it and <em>SOCOM Confrontation</em> together. The headset itself has a "High-Quality" mode, which activates its dual mics and apparently uses "high bandwidth" to make you sound better to the other dudes on your team. There's also auto-pairing with the PS3 when you connect the headset via USB, and a speaker mode when you dock it in the desk charger. The problem with this "high-quality" mode is that it's only available for the PS3, not for your cellphone. Our guess is that HQ-mode takes up more power, or it'd be on all the time.</p>
<p>Source: Gizmodo</p>
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<title><![CDATA[Particle physics rap (or Things that Quakers like)]]></title>
<link>http://caulkischeap.wordpress.com/?p=2006</link>
<pubDate>Thu, 04 Sep 2008 05:42:04 +0000</pubDate>
<dc:creator>John in IL</dc:creator>
<guid>http://caulkischeap.wordpress.com/?p=2006</guid>
<description><![CDATA[
]]></description>
<content:encoded><![CDATA[<p><span style='text-align:center; display: block;'><object width='425' height='350'><param name='movie' value='http://www.youtube.com/v/j50ZssEojtM'></param><param name='wmode' value='transparent'></param><embed src='http://www.youtube.com/v/j50ZssEojtM&rel=0' type='application/x-shockwave-flash' wmode='transparent' width='425' height='350'></embed></object></span></p>
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<title><![CDATA[Xbox 360 Prices Dropping Confirmed... Just like Crackhead prices]]></title>
<link>http://elohelgaming.wordpress.com/?p=509</link>
<pubDate>Wed, 03 Sep 2008 21:41:32 +0000</pubDate>
<dc:creator>caesar84</dc:creator>
<guid>http://elohelgaming.wordpress.com/?p=509</guid>
<description><![CDATA[
It&#8217;s official!!!! Xbox360 prices dropping to as low as 199 for the bottom of the barrel SKUs ]]></description>
<content:encoded><![CDATA[<p><img class="aligncenter" src="http://kotaku.com/assets/images/kotaku/2008/09/price_slash.jpg" alt="" width="494" height="296" /></p>
<p>It's official!!!! Xbox360 prices dropping to as low as 199 for the bottom of the barrel SKUs in the U.S.</p>
<p>Xbox 360 Arcade - $199<br />
Xbox 360 - $299<br />
Xbox 360 Elite - $399</p>
<p>That is all....</p>
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