A6 T H E BULLETIN e WEDNESDAY, JULY 22, 2015
Cloud
Medication Guide
Continued from A1
XIAFLEX® (Zi a flex) (collagenase clostridium histolyticum)
The effort to conduct even a
small-scale test — overseen by the University of Washington,
For injection, for intralesional use
Readthis Medication Guide before you receiveXIAFLEX forthe treatment of
which has numerous experts
Dupuytren's contracture and each time you getan injection .There may be new information. This Medication Guide does not take the place of talking with your healthcare provider about your medical condition or treatment.
thinking in the scientific com-
W hat is the most important information Ishould know about XIAFLEX forthe treatment ofDupuytren's contracture?
XIAFLEXcan cause serious side effects,including: 1. Tendon rupture or ligament damage. Receiving an injection of XIAFLEXmay cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare
provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit. 2. Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit.
3. Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX,because it contains foreign proteins. Callyour healthcare providerright away ifyou have any of these symptoms of an allergic reaction after an injection of XIAFLEX: Hives, swollen face, breathing trouble, chest pain, low blood pressure, dizziness or fainting
What is XIAFLEX? XIAFLEX is a prescription medicine used to treat adults with Dupuytren's contracture when a "cord" can be felt. It is not known if XIAFLEX is safe and effective in children under the age of 18.
Who shouldnot receive XIAFLEX? Do notreceive XIAFLEX ifyou: are allergic to collagenase clostridium histolyticum, or any of the ingredients in XIAFLEX, or to any other collagenase product. See the end of this Medication Guide
for a complete list of ingredients in XIAFLEX. Talk to your healthcare provider before receiving this medicine if you have any of these conditions.
What should I tell my healthcare provider before receiving XIAFLEX? Before receiving XIAFLEX, tell your healthcare provider if you: have had an allergic reaction to a XIAFLEX injection in the past, have a bleeding problem, have received XIAFLEX to treat another condition, have any other medical conditions, are pregnant or plan to become pregnant. It is not known if XIAFLEX will
harm your unborn baby. are breastfeeding or plan to breastfeed. It is not known if XIAFLEX passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if
in atmospheric science — represents a dramatic shift in munity, which until recently resisted conversations about deliberate manipulation of the climate.
The reason for the change: There is scientific consensus
that even if the world succeeds in shifting away from fossil fuels, warming of the planet is inevitable — and it may have catastrophic consequences. Critics of geoengineering, however, warn against altering nature's patterns, arguing that we don't yet understand all the potential ramifications. And
they worry that if people see a quick fix for climate change, they may not try as hard to reduce greenhouse gas emissions. "Personally, I doubt that the
world is ready for this," said Stephen Gardiner, a University of Washington philosophy professor who studies the ethics of environmental policies. "Geoengineering raises huge ethical and political questions, nationally and internationally." But the Silicon Valley scien-
tists say the world might not have a choice. "We need to research the technology," said project leader Armed Neukermans, 74, whose achievements indude the development of the
earliest ink jet printers and who led teams at Xerox Labs, Hewlett-Packard, Tencor and Xros.
None of the men will be alive
you receive XIAFLEX. Tell your healthcare provider about all the medicines you take, including
by the end of this century, when the concentration of carbon
prescription and over-the-counter medicines, vitamins, and herbal supplements. Using XIAFLEX with certain other medicines can cause serious side effects.
expected to be double what it
dioxide in the atmosphere is
Especially tell your healthcare provider if you take: medicines to thin your blood (anticoagulants). If you are told to stop taking a blood thinner before your XIAFLEXinjection, your healthcare provider should tell you when to restart the blood thinner. Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Know the medicines you take. Keep a list of them to show to your healthcare provider
and pharmacis twhenyougeta new medicine. How will I receive XIAFLEX? XIAFLEX should be injected into a cord by a healthcare provider who is experienced in injection procedures of the hand and treating people with Dupuytren's
is now — and temperatures are likely to be so high they will harm ecosystems and human health and welfare.
"But all of us have children or grandchildren," Neukermans said. "We' ve got to preserve the future." The group favors an approach that wafts tiny aerosolized water droplets into the
Lipc Ching / Bay Area News Group via Tribune News Service
Aqua MetrologySystems' Armand Neukermans, 73,background left, and engineer Jack Foster, 79, right, check the operations of
a cloud condensation nuclei droplet spraying system prototype during a test to measure droplet particles at Aqua Metrology Systems last month in Sunnyvale, California.
doing, if not in the heart of SilBut no one has ever tried to icon Valley," Cooper said. "Evdeliberately brighten a cloud. erytlmg we need is next door, Lab and computer studies or we know somebody who has "can only tell us so much about it." the potential viability of some Through painstaking trial proposed dimate-intervention and error, the scientists are detechnologies," said Michael signing and building a nozzle Thompson of American Uni- that emits particles that are versity's Forum for Climate En- small enough to rise and remain gineering Assessment. suspended in air — 0.2 to 0.3 miThe project seemed like a crometers, about one-tenth the worthy challenge for longtime size of the period at the end of friends who'd rather invent this sentence. The nozzle's holes things than play golf. are so narrow that they fit only After it was conceived at a two strands of human hair. 2006 meeting between Latham In one early effort, tiny nozand top atmospheric scientists, zle holes got dogged. Another the team began a feasibility was more successful, but restudy with Neukermans' lead- quired too much energy and ershipand $300,000 from the was corrosive. Bill Gates-supported Fund for Funding, not science, could Innovative Climate and Energy prove to be the group's biggest Research. challenge. Because geoengiThe team — whose members neering straddles the fields of range in age from 60 to 79 —in- physics, atmospheric science cludes pharmaceuticalchem- and engineering, it's not eligiist Gary Cooper; Suds Jain, ble for traditional government formerly with Broadcom; Bob grants, the group says. Ormond, with Aqua MetroloThe next phase of the project gy Systems; physicist Foster, is a small, land-based "proof of who helped create the first su- concept" experiment in Moss permarket checkout scanners Landing, planned for next year. and was formerly with Sandia It would cost about $6 million. served greater research.
National Labs, Sylvania, Hewlett-Packard and Tencor, and
The third phase — conduct-
ed out at sea, with blowers instrument designer Lee Gal- mounted on a small ship, probraith, formerly with Tencor pelling droplets that reach real and Sandia. He is famed for in- douds — is scheduled for 2018 venting a way to find flaws on or 2019 and would cost about semiconductor wafers. By all indications, the sci-
$10 million.
or otheracts of self-harm or
dealing with gang violence and crowding worsened by stiffer sentences, began removing an
Call your healthcare provider right away if you have:
The technology could be used entists seem to be on the verge for creating fog to cool stressed mirror that increases clouds' of building a successful cloud redwood forests or overheated reflectivity. whitener. coral reefs, the team says. But The cloud-brightening conFor instrumentation, "we' ve the daymay come, according cept was first proposed in had to beg, borrow and steal," to the National Academy of Sci1990 by British physicist John joked Cooper. ences, when more global strateLatham, who published an artiSome tools come from the gies might be explored. cle in the journal Nature called University of W a shington, That could entail injecting "Control of global warming?" others from NASA Ames and droplets more than 10 miles And in February, the presti- Stanford. A lot come from their intostratosphere, a far more gious National Academy of own garages. ambitious and c ontroversial "We couldn't do what we' re endeavor. Sciencessaid the concept de-
— signs of infection after your injection, such as fever, chills, increased redness, or swelling, numbness or tingling in the treated finger, trouble bending the injected finger after the swelling goes down Return to your healthcare provider's office as directed 1 to 3 days after your injection. During this first follow-up visit, if you still have the cord, your healthcare provider may try to extend the treated finger to "break" the cord and try to
Solitary
contracture. If you have more than 1 contracture, your healthcare provider may give
you 2 injections in 1 of your hands during your visit. Your healthcare provider will inject XIAFLEX into the cord that is causing your finger to bend.
After an injection of XIAFLEX, your affected hand will be wrapped with a bandage. You should limit moving and using the treated finger after the injection. — Do not bend or straighten the fingers of the injected hand until your healthcare
provider says it is okay.This will help to keepthe medicine from leaking out of the cord. — Do not try to straighten the treated finger yourself. Keep the injected hand elevated until bedtime.
straighten your finger. Your healthcare provider will provide you with a splint to wear on the treated finger. Wear the splint as instructed by your healthcare provider at bedtime to keep your finger straight.
Do finger exercises each day, as instructed by your healthcare provider. Follow your healthcare provider's instructions about when you can start doing your normal activities with the injected hand.
What arethe possible side effectsofXIAFLEX? XIAFLEX maycause seriousside effects,including: • See "What is the m ost im portant information Ishould know about XIAFLEX?"
increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX.Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEXmay not be right for you. The most common side effects with XIAFLEX for the treatment of Dupuytren's contracture include: swelling of the injection site or the hand, bruising or bleeding at the injection site, pain or tenderness of the injection site or the hand, swelling of the lymph nodes
(glands) in the elbow or armpit (axilla), itching, breaks in the skin, redness or warmth
of the skin, pain in the armpit Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all of the possible side effects with XIAFLEX. For more information, ask
your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Generalinformation about the safe and effective use of XIAFLEX. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. This Medication Guide summarizes the most important information about XIAFLEX. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider or pharmacist for information about XIAFLEX that is written for
health professionals. For more information, go to www.XIAFLEX.corn or call 1-877-663-0412.
What are the ingredients in XIAFLEX? Active ingredient: collagenase clostridium histolyticum Inactive ingredients: hydrochloric acid, sucrose, and tromethamine. The diluent contains: calcium chloride dihydrate in 0.9o/o sodium chloride
This Medication Guide has been approved by the U.S. Food and Drug Administration. Manufactured and distributed by: Auxilium Pharmaceuticals, Inc. Malvern, PA 19355 US License No. 1816 US Patent Nos. 7,811,560 and RE39,941 PL-1109-001.g
Approved: 05/2015
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atmosphere, creating a natural
compulsive actions like pacing Continued from A1 or cl eaning acelloverandover. "Do we really think it makes "When they get out, they are sense to lock so many people broken," said Dr. Terry Kupers, alone in tiny cells for 23 hours a psychiatrist in California who a day, sometimes for months or
consults on prison conditions
increasing number of inmates
from the general population, including some who did not pose a serious threat.
evenyearsata tim e?"Obama and mental health programs. They sent them to isolation asked in a speech at a conven- "This is permanent damage." units where prisoners in most tion of the NAACP in Phila-
delphia, where he called for an overhaul of the criminal justice system. "That is not going to make us safer. That's not going to make us stronger. And if
Cornell William Brooks, the
cases spent 23 hours or more a
president of the NAACP, said day in their cells, often without prolonged solitary confinement visiting privileges or access to amounted to torture. rehabilitation programs. The "Putting someone in soli- solitary confinement unit at tary confinement does horrible
Pelican Bay State Prison in Cal-
things to a person's personality, ifornia, where some inmates released, how are they ever go- their psyche, their character," havebeen keptform orethan20 ing to adapt? It's not smart." he said. "It might be said that years, was specially designed to While other changes to the condemning a person to soli- minimize human interaction. justice system would require tary confinement treats a perObama can exert little conCongress to act, this is one area son as an animal. And so that trol over state prison systems, where the president has at least they emerge from such treat- but he hopes that any changes some latitude, although it is un- ment exhibiting animalistic be- he makes in the federal system certain how much. Either way, havior can't be surprising." will prod states to follow suit. it could be a test of his drive in Many corrections officials, An aide to Obama, who vishis final 18 months in office to even those who believe that sol- ited the El Reno federal prison remake America's prisons. In itary confinement is overused, in Oklahoma last week, said his NAACP speech and during caution that in some situations, the issue "has been on his raa visit to a federal prison, the it may be unavoidable. dar screen for many years." "If someone has committed White House officials said the first by a sitting president, Obama expressed a concern a violent assault, whether it be Justice Department r eview, for the lives of prisoners that a staff member or another in- to be conducted by Attorney few ifany ofhis predecessors mate, until you can somehow General Loretta Lynch, would have shown. solve that problem, that person determine the leeway the pres"No president has ever sug- is going to need to be isolated," ident has to change the federal gested that there's anything said Rick Raemisch, executive system. A Justice Department problematic about solitary directorof Colorado's correc- official would not say how the confinement, that we should tions department. He pointed review would be conducted or be studying it or that it's over- to an inmate who said he would how long it might take. used," said Margaret Winter, kill someone if he were allowed Graves, who was convicted associate director of the Amer- out of solitary, a threat mental and sentenced to death for the ican Civil Liberties Union's Na- health professionals considered murder of six people in 1992 tional Prison Project. "I feel like credible. only to be dedared innocent that has got to be some sort of a Raemisch has worked to sub- and released nearly two detipping point." stantially reduce the use of soli- cadeslater,has become a leadThe Rev. Ron Stief, execu- tary confinement in Colorado ing voice for curbing solitary tive director of the National but said groups that opposed it confinement. Placed in solitary Religious Campaign Against altogether should help develop confinement because he was Torture, called the moment "a other ways to handle inmates on death row, Graves has, since game changer." He said, "We' ve who pose a danger of violence. hisrelease,started an advoca"There are those that say this cy group called Anthony Bebeen saying for decades, 'It' s time,' and it really feels now is bad," he said, "but when you lieves and testified before Conlike it is time. The silence has look around for an alternative, gress. He said he was glad that been broken." people have left the room." Obama had taken on the issue. "It's a good thing that he' s Solitary's impact A widespread practice actually talking about it and Studies have found that solSolitary confinement has going to look at it because it itary confinement exacerbates been widespread since the puts it on the map," Graves said. mental illness and that even 1980s, when many states built But by his own account, Graves stable people held in isolation super-maximum security pris- is impatient. "I'm just tired of report experiencing psychiatric ons. They were intended to hold speeches," he said. "I just want symptoms, including anxiety, the most dangerous criminals, somebody to do something depression, anger, self-cutting but corrections departments, about it." those individuals are ultimately