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2nd Annual Battle of the Bands May 16, 2015 4:00pm-10:00pm Olive Branch Pickers, 9086 Pigeon Roost Rd, Olive Branch Got a band that consists of more than a couple of guys with air guitars? Or even an individual simply trying … Continue reading
You can't go wrong on Mississippi's Great River Road: Click on the community buttons at left to explore our attractions by cities and communities, or peruse this Road-wide list, which is arranged alphabetically by subject.
Big Walter Horton Blues Marker
E. Center St. Horn Lake, MS 38637 662-393-8770 www.sodesoto.com Big Walter Horton, also known as Walter "Shakey Horton" was born in Horn Lake, moved to Memphis as a child and then on to Chicago where he first appeared on the … Continue reading
Biscuits & Blues
315 Main Street Natchez, MS 39120 Phone: (601) 446-9922 Biscuits and Blues often offers live entertainment by single or small group artists, usually playing blues or acoustic guitar. The performances generally take place during the evening dinner hours, but occasionally … Continue reading
Blues & More Driving Tour
600 Third Street PO Box 490 Cleveland, MS 38732 662 843 2712 visitclevelandms.com Take the backroads. Start your tour from Cleveland. Take a guided driving tour of the 13 Mississippi Blues Trail Markers throughout Bolivar County. Experience the history of where … Continue reading
Bologna Performing Arts Center
1003 W. Sunflower Rd Cleveland, MS 38733 662.846.4626 www.bolognapac.com/ The Mississippi Delta, and particularly Cleveland, is rich in visual and performing arts. At the center of the lively entertainment scene is the Bologna Performing Arts Center at Delta State University, … Continue reading
Cat Head Delta Blues & Folk Art
252 Delta Avenue Clarksdale, MS 38614 662-624-5992 cathead.biz Email: firstname.lastname@example.com Hours: Mon – Sat 10-5 Cat Head specilizes in Delta blues CDs and videos, southern books and blues & folk art, photography, live music, and books on all things … Continue reading
Charles Evers Blues Marker, Fayette
http://www.msbluestrail.org/locations/charles-evers-map In 1973 Mayor Charles Evers of Fayette and B. B. King began to cosponsor concerts at the Medgar Evers Homecoming in honor of the slain civil rights activist. Dozens of blues, soul, and gospel acts performed at the annual … Continue reading
Cleveland Night Life
600 Third Street Cleveland , MS 38732 662-843-2712 Check out the following places for weekend entertainment: Airport Grocery- Hwy 61; Crawdad's- Merigold; Hey Joe's- Hwy 8; On the Rocks- Hwy 8; Pickled Okra- Sharpe Ave; Po' Monkey's- Merigold; Sky Kings- … Continue reading
Club 129
129 North Walnut Street Greenville, MS 38701 662-335-1861
Delta Center for Culture and Learning
DSU campus- Ewing Hall 103 Cleveland, MS 38732 662-846-4311 Located in Ewing Hall, North lobby alcove at DSU. There is a collection of over 50 sculptural life masks of blues performers cast directly from their faces.
Delta State University
Hwy 8 West Cleveland, MS 38732 662 846 3000 www.deltastate.edu Delta State University offers a variety of opportunities for students and visitors. Tour the beautiful architectural buildings on the campus Visit the Delta Center for Culture and Learning in Ewing Hall … Continue reading
Doc Biglove's
408 Main Street Natchez, MS 39120 P: (601) 445-5300 Late night fun is always on hand at Doc Biglove's, and the weekends are especially great because the club often has live entertainment. Doc is big on providing a wide variety … Continue reading
Elvis and Priscilla Presley's Honeymoon Cottage
5921 Goodman Rd. W. @ Hwy. 301S Horn Lake, MS 38637 662-393-9897 www.hornlakechamber.com/ Elvis and Priscilla spent their honeymoon in this cottage when it was all a part of Circle G Ranch that Elvis owned. The home is not open … Continue reading
Gateway to the Blues Visitor Center
Begin your next road trip at the Tunica Visitors Center on Highway 61, the entrance of America's Blues Highway. Then travel the Mississippi Blues Trail – a journey of over 120 historical markers scattered throughout the state that tell the … Continue reading
Ground Zero Blues Club
Blues Alley Clarksdale, MS 38614 Located next door to the Delta Blues Museum, Ground Zero Blues Club features performances by both local and national blues bands, and is co-owned by Oscar-winning actor and native Mississippian, Morgan Freeman. Decor alone is … Continue reading
Gus Cannon's Gravesite
Oak Grove M.B. Church Cemetery, Hwy 51 Hernando, MS 38632 662-393-8770 www.sodesoto.com Born in 1874, Gus Cannon was a banjo player who also "played the jug." He wrote and first recorded the song, "Walk Right In," which became a number … Continue reading
Gus Cannon, Robert Wilkins and Jim Jackson Blues Marker
400 West Park Street Hernando, MS 38632 662-393-8770 www.msbluestrail.org Mississippi Blues Trail Marker "Beale Town Bound" honors musicians Gus Cannon, Robert Wilkins and Jim Jackson. Gus Cannon wrote "Walk Right In", which was recorded by the 1960's folk group Rooftop … Continue reading
Hwy 61 South Mississippi Blues Trail Marker
Jackson Street Vicksburg, MS 39183 Highway 61 occupies an important place in the blues, serving both as a popular lyrical symbol for travel and the actual route by which many artists moved northward. The original route of U. S. Highway … Continue reading
Jerry Lee Lewis' Home
1595 Malone Road Nesbit, MS 38651 662-393-8770 jerryleelewis.com The "Killer's" home is referred to as "The Lewis Ranch." The home is a red brick ranch house surrounded by a large brick and board fence. While the home is not open … Continue reading
Joe Callicott's MS Blues Trail Marker and Gravesite
Mount Olive C.M.E. Church Cemetery, 1919 Getwell Rd Nesbit, MS 38651 662-393-8770 msbluestrail.org Born in October 1899, Joe Callicott spent his whole life in the area south of Memphis. His chief musical associate was Garfield Akers and it was as … Continue reading


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Fidelity Strikes Deal Over Calif. Kickback Claims
California Insurance Commissioner Steve Poizner announced the settlement Monday, saying Fidelity had since cleaned up its act.
Under the agreement, the title insurer will pay penalties of $345,000, as well as another $20,000 to the California Department of Insurance to cover attorneys' fees and expenses.
The regulator began investigating Fidelity's marketing activities in its Orange...
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subset: commoncrawl


text:
Supplements are of great help because the help you achieve your goals when training and diet aren't working that well. Other than this, supplements also improve your general health by bringing in improvements to different areas of your body. For instance, if you are facing the issue of intense hair fall then whichever supplements the physician prescribes, you will take them, and they will make your hair strong and free from hair fall. This article will tell you about the six types of supplements that you can start with, depending on your need.
#1 Whey
This is a quick digesting protein that must be taken after an hour of your last exercise set to jumpstart protein synthesis. It helps in muscle repair and along with that even works to improve the overall mood of the user by reducing depression. It also benefits the hair and skin. One thing that should be seen before buying whey is that cheap priced whey should be avoided because it is usually made from rejected junk.
#2 Casein
This slower digesting casein protein is great for people who want to build their bodies and make it big with muscles. The drink should be taken before you go to the gym. If you take this protein at night before going to bed, then the bulking up process will be accelerated. It, however, has sugar in it so people who are working out for weight loss should avoid its intake.
#3 Creatine
This supplement is found naturally in red meat and fish. It provides the body with a lot of energy and improves the athletic performance. This supplement is backed up by scientific proof that it increases strength. Again, buying a cheaply priced product will not be advised.
#4 Fish oil
There is a lot of confusion in whether fish oil is beneficial or not. For people, it is better just to focus on all that science has to say and ignore whatever media or the internet says. Science says that these are one of the best supplements that we can take for general improvements. It helps to reduce depression and keeps all nails, skin, and hair in their healthiest forms. When buying, people should be careful in checking for the label of saturated fat content.
#5 Branched-chain amino acid
Branched chain amino acids, also referred to as BCAA, are the building blocks of protein. They are namely leucine, isoleucine, and valine. When we have meat, this nutrient goes into our body. They help to preserve our muscles and provides a great boost in strength and energy.
#6 Multivitamins
Multivitamins can help your body in different issues. It is usually taken when you are not getting the desired nutrients from your diet. They are not be taken regularly, but only when you feel weak or tired or have lost some energy. When you are not taking the right diet, then the missed nutrient should be taken in the form of multivitamins.


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Re: University of Port Harcourt 2016/17 Course Registration Deadline Announced
Registration of courses online ends on Friday, 10th March 2017. Students are advised to complete their online course registration on or before the above slated date. Students are also advised to use their current departmental brochure to register their courses online and submit a printed copy to the Head of Department after completing the registration.
Signed: Management
Like our page for all the latest news from Nigerian tertiary institutions >>>Facebook.com/vaxity


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Ethical data sharing system allows brewer to view and assess supplier practices
DENVER, CO: Molson Coors Brewing Company and MillerCoors have joined the Supplier Ethical Data Exchange (SEDEX), an independent membership organization for businesses committed to continuously improving the ethical performance of their supply chains.
SEDEX offers member companies a secure Web-based platform for sharing information on four key pillars: health and safety, labour standards, business integrity and the environment. SEDEX was created with the mission to reduce duplication of ethical data in the supply chain and help drive improvements in working conditions.
Molson Coors and MillerCoors are asking their leading manufacturing suppliers that support the North American breweries to use the SEDEX tool in 2011. Initial suppliers who have already agreed to participate include Cargill Corn Milling North America and Ball Corporation.
"Joining SEDEX helps us better manage important issues within our supply chain," said Greg Wade, global chief supply chain officer for Molson Coors. "By working with a third party to ensure that our suppliers adhere to our high standards of sourcing principles, we are taking a significant step to embed corporate responsibility into our global procurement process."
Membership in SEDEX gives Molson Coors and MillerCoors access to a global database where the companies can qualify current and prospective suppliers and ensure they are fulfilling Molson Coors' Responsible Sourcing Principles. Molson Coors created the Responsible Sourcing Principles in 2009 to formalize its commitment to ethical business practices, working conditions, human rights, environmental impact and alcohol responsibility standards in its complex supply chain.
"The SEDEX platform opens the door to a robust exchange of data that will ultimately help Molson Coors and MillerCoors and their suppliers shape their ethical supply chain strategy," said Carmel Giblin, general manager of SEDEX. "The collaborative approach to collecting, managing, analyzing and reporting on supplier data helps streamline the auditing process and drives improvements in the supply chain."
Additional information on Molson Coors' corporate responsibility and sustainability efforts and initiatives can be found at http://molsoncoors.com/responsibility.


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Question about Toshiba Satellite M115-S1061 Notebook
I have had this reoccuring problem with net zero over the past few weeks
i use my phone to connect and i have the cables connected to the phone
and computer and when i try to connect it doesn't go through and says that
no dial tone is detected
i have already done everything that they have suggested and sometimes
it will connect and then for an unknown reason will disconnect me and i
try again and it will not work...i even deleted the program and reinstalled
it to see if that makes a difference and it doesn't
i am basically fed up with net zero and will not be using their services
again once my commitment is over on june 1st
till then i have been using my computer at the library, as they have wi-fi access
i would like to be able to use the service at home since i am still paying for
it...i haven't called net zero because they charge for the technical support and i have a feeling i will get nowhere with them anyway and they don't speak english very clearly and it wouldn't be worth my time
i hope you can help me with this
thanks very much
Posted by rawgal4ever on
Try lowering the settings of your modem so that it will not cut-off and try modem diagnostics to be sure that your modem is functioning well. or try to replace the phone cord you are using.
Posted on Feb 18, 2008
SOURCE: I have freestanding Series 8 dishwasher. Lately during the filling cycle water hammer is occurring. How can this be resolved
Hi there,
Save hours of searching online or wasting money on unnecessary repairs by talking to a 6YA Expert who can help you resolve this issue over the phone in a minute or two.
Best thing about this new service is that you are never placed on hold and get to talk to real repairmen in the US.
Here's a link to this great service
Good luck!
Posted on Jan 02, 2017
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February / December
March / July / October
March / July / September
March / June / September / December
July / September / December
[Lacuna] is an imprint of Golden Orb Creative, ABN 57737397443, and a full member of the Small Press Network. Contact us.
All prices are in Australian dollars and include GST.


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By Olivia Arnow
Nourishing the Planet's new Saturday Series, in which we interview inspiring people that our readers have nominated. These people are working on the frontlines to improve the global food and agricultural systems. Want to nominate someone? E-mail your suggestions to Danielle Nierenberg!
Sarah Alexander and the Keystone Center work to facilitate problem-solving models in the areas of sustainability, agriculture, and environmental cleanup. (Photo credit: keystone.org)
Name: Sarah Alexander
Affiliation: The Keystone Center
Bio: Sarah serves as the Director of Environmental Practice for The Keystone Center. Her work with conflict resolution and consensus building on sustainability issues over the past 18 years has resulted in important agreements, innovations, and policy impacts for agriculture and land use.
How did you come to the Keystone Center? What sort of work you do?
After studying environmental studies in college, I had a particular interest in agriculture and food systems and knew I wanted to help find solutions to environmental issues. That's what the Keystone Center does: they bring people together to fight problems collaboratively and proactively.
Keystone does a broad variety of work with health and energy and initially I worked with cold war infrastructure, finding ways to return federal facilities and military bases back to the community. It was through Keystone's sustainability work that I got back into agriculture.
What sort of work have you done with Keystone's agriculture initiatives?
I mostly work on Field to Market, the Keystone Alliance for Sustainable Agriculture, which focuses on building stakeholder consensus on how to measure and improve sustainability within the United States. The alliance of about 40 organizations includes farmer groups, conservation organizations, universities, food companies, and other participating members of the food chain. We work primarily to meet production needs as well as maintain and improve environmental health and social and economic wellbeing.
We started Field to Market in 2006 to focus on commodity agriculture, a topic that had only previously been discussed internationally. Rather than discuss whether GMO or organic food was going to feed the world, we started with more basic questions: What are our basic expectations for agriculture? How can we measure them? Can farmers meet these expectations going forward?
In 2009, we produced our first report, which looks at the ways in which mainstream producers are affecting resource distribution nationally. Since then, to make our efforts more applicable on the farm, we created our Field Print Calculator, an interactive web-based tool that helps growers assess corn, wheat, soybean, and cotton in terms of land use, soil conservation, soil carbon, water use, energy use, and greenhouse gas emissions. Next month we'll release an updated calculator, which will include rice and potatoes and provide additional information on national socioeconomic indicators.
What sort of international work have you been involved with?
Field to Market has focused on U.S. agriculture but is gaining interest from international audiences that are beginning to adopt and adapt their approaches and tools. At the moment we are consulting loosely with organizations trying to do similar efforts in Canada and Brazil.
Because Field to Market is a multi-stakeholder initiative, we are really facilitating an international discussion where individuals have been able to sit next to people they normally wouldn't sit next to. We didn't want to set a standard state of practices because we realize that what works in Iowa may not work in North Dakota, let alone West Africa. We strive to find some things that are universal, yet we acknowledge that others depend are dependent on geographic and social factors.
Separate from Field to Market, I've worked with The International Union for Conservation of Nature (IUCN) collaborating on their forestry efforts in Ghana. Keystone was brought in to work with IUCN and the Ghanaian government to negotiate agreements with the EU, allowing them to use their market presence to help Ghana set up legal timber harvesting. It was a novel effort to not take things at face value, but get structure set up locally so when decisions were made about the legality of timber harvesting the support would be within the community. We also worked with the Cameroon government to observe the later process after the decisions had been made.
What sort of work do you do with The Keystone Center in the Colorado area?
The Keystone Center works on a variety of projects within the Colorado area including strategic planning, working with local watershed initiatives, and addressing local policymakers. In addition, we have a 23-acre Science School where students learn about hands on outdoor science and develop skills that our participants work on, like critical thinking and separating individual biases. We also have a teacher-training program, where educators from all across the country come to learn about ways to improve science and outdoor education.
What are the challenges in pushing for an environmental agenda? In your 18 years at the Keystone Center have you noticed that the conversation has changed as sustainability and environmental issues have come to the forefront?
I think the conversation has really changed for a couple of reasons. First, the environmental agenda is more organized at this point. There are more organizations doing work, particularly in the NGO network, so there is a larger constituency that is knowledgeable, informed, and bringing their own strategies and solutions. There's also much more public awareness and activism that we didn't see in the last decade. Second, relationships between privates sectors and NGOs have certainly aided environmental efforts. In the last ten years or so we've seen a shift from companies taking a more adversarial approach to wanting to be a part of the solution.
That being said, we still face some challenges, particularly from the government. There's so much at stake but such little negotiation from Congress, so national change and policymaking continues to be a challenge. Also the environment is changing (or we're more cognizant of it). Decisions we made a hundred years ago are now coming home to roost, so to speak, so the environmental community is focusing on how we can adapt and change to our changing environment.
We can't just take national parks and say they are the way Teddy Roosevelt set them aside; we have to adapt in order to develop a healthy environment. This is where partnerships come in. There are many potential areas for collaboration.
Olivia Arnow is a research intern with the Nourishing the Planet project.


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The new 2016 American Silver Eagle marks the 30th anniversary of the very popular series and the 100th anniversary of the original Walking Liberty coin engraving it carries!
Containing a full troy ounce of silver, the enormously popular collector coin is the largest silver dollar in U.S. minting history and was originally issued three decades ago in 1986.
Its magnificent Walking Liberty design first appeared a century ago on the 1916 U.S. half dollar during World War I. Regarded as the finest U.S. silver engraving, it's much larger in this silver dollar form. This most unabashedly patriotic coin design in American history, features Miss Liberty garbed in the American flag as she strides towards the dawn of a new era.
Join the celebration of this most popular of American coins and its dual anniversaries! The U.S. Mint does not sell the enormously popular silver eagle BUs directly to individual collectors, but we're pleased to offer the new BU to our customers.
SEE ALL OUR SILVER EAGLE HOLDERS HERE.40.6mm
Looking For Other Silver Eagle Dates? Click here to view all our Silver Eagle options.


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|900 sq ft
|Property type
|Minimum Stay
|3 - 90 nights
Receive $100 off off remaining August 2018 weeks. This adorable cottage house is walking distance from Long Beach and a block away from Short Sands, you'll agree this house is the PERFECT LOCATION.
Large bright enclosed front porch welcomes you to this classic beach cottage where you love to hang-out after a day at the beach.
The blue and green colors of sea glass welcome you home every day when you step into the bright living room, dinning room and both bedrooms cheerfullly painted ceiling and refinished all wood floors! Breezy beach-themed living room with pull out couch (if a friend stops by), tv and WiFi. Have a big meal in this charming dining room with built-in china hutch. On those rare crazy hot days, the AIR-CONDITIONER will help you cool off.
2 bedrooms with 2 full beds and single bed. With all rooms on one floor, this is a great option for all. TV and WiFi included.
This sunny kitchen also has a WASHER and DRYER.
The bathroom is freshly painted like soft sunshine where you can enjoy a shower or a bath in comfort.
The back entrance makes unloading groceries and going to the beach a breeze!
There is a small back yard where you can use our grill every night for easy meals on the picnic table. We also have driveway parking for 2 cars.
So close to the playgroup and the downtown shops and a few blocks from Long Sands Beach. Walking distance to Nubble Lighthouse. Just walk down the hill to enjoy all of downtown York Beach, with its bandstand, Ellis Park, playground, basketball courts, shops, and Goldenrod taffy!
We also own a larger a 3, 5 and 8 bedroom house which are available too. Please ask for info and pictures if you are interested.
Hello travelers! Our name is Sarah and Herb Taylor. We have owned this wonderful house, 5 Broadway, for 4 years as well as the two houses beside this house 7 Broadway (3 bedroom) and 3 Broadway (8 bedroom). We also own 11 Long Beach Ave (4 bedroom) which is on the the corner of Long Beach and Church Street. Herb has been vacationing in York with his family since he was a child. We love York Beach and our proud to share our houses with our special guests so they can enjoy this magical town with their families every year. We are so pleased to have guests come back every year to our houses and now consider these houses an important part of their family tradition! The location of our houses were chosen to be convenient to both beaches AND the downtown food and fun. Welcome to a great vacation!
My husband and I rented this house two summers ago and we've rented the little home over the winters for my parents as well. Sarah and Herb (and their family) are the best and are so friendly, kind, and a pleasure to deal with. The house is so sweet and comfortable and in a perfect location between the two beaches and with Nubble Light within walking distance as well. It just takes a minute or two to walk down to the beach and the York Beach area is so lovely -- plenty of shops, restaurants, bakeries, and fun things to do at night, too. Much nicer to stay here and have the house to yourself than a crowded inn or B&B -- we had lobsters and wine on the porch on a summer night and could hear the band that was playing in the gazebo on the beach, it was so peaceful and fun. Highly recommended!!
My husband and I with our 2 year old boy rented this property for the fist time this past 4th of July week. This house was exactly what we were looking for. It's location was perfect. A short walk to short sands beach and all the restaurants and shops, but also not so far from long sands either. The house was stocked with everything we needed and very clean. There were plenty of beds/sleeping space and I liked the fact that all the rooms were located on one floor for our little guy. The enclosed porch was my favorite spot of the week. A great space to start my day with a cup of tea or to take an afternoon nap. Sarah and Herb were always very responsive and so welcoming and kind. We booked the house as soon as we left for the following year and can't wait to spend the week with our soon to be family of 4 :-) We highly recommend renting this property.
My wife and my two boys (2yo and 6yo) have rented this property for the last two summers in August. It is perfectly located and a very short walk to the ocean, park, shops and playground. We have already resevered for our third year in a row. Sarah and Herb (new owners) have always been in constant contact with us with any questions we have. They have already done a lot of renovations and it makes us even more excited to get back. The bedrooms are both good size. Big dining room and family room too. There is a fully enclosed porch with plenty of seating and windows on three sides to allow nice breezes to come in. We highly recommend renting this property.
Activities and attractions in York Maine:
You will love being able to walk...
...to "Short Sands" beach with all the excitement of thedowntown a few feet away
...to "Long Sands" beach to feel the softest sand anywhere
boogie-board in the waves, look for sand dollars
...to "Nubble Light" (considered one of America's prettiest lighthouses) is in the neighborhood in walking/biking distance.
...to "Browns" ice cream is down the street for a huge cone or brownie sundae!
...to the "Goldenrod" and smelling the sweet aroma ofsaltwater taffy being made right there in front of you
...to the "Town Gazebo" at Ellis Park to hear the weekly concerts on the lawn and even get up and dance a while with folks of all ages
...to the playground with it's multiple climbing structuresand swings where the kids will play for hours while you lookout to the ocean in front of it
...to the many downtown shops and restaurants
|Refundable damage deposit
|Cleaning Fee
2017 Summer Season (June 17- September 9) = $1,800/week
Check-in Saturday from 3:00 pm through check-out Saturday by 10:00 am.
Renters are expected to leave the house tidy and as they found it.
NO smoking and no pets.


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Every physician is required to submit performance data under Merit-based incentive payment system (MIPS). Payments are adjusted based on participation results.
MIPS requires submission of data in (4) categories:
1. Advancing care information(ACI).
a. Security Risk Assessment of EHR.
b. e-Prescription.
c. Timely Access – Providing access to medical record data via the Patient Portal.
d. Send Summary of Care.
e. Request or Accept Summary of care.
2. Quality.
a. HgbA1c for Diabetics.
b. Tobacco Use.
c. Falls risk and plan.
d. Pain management plan.
e. Pneumonia vaccination status.
f. Provider Medication Reconciliation.
g. BMI Screening and Plan.
h. Diabetes foot exam.
i.. Use of high-risk medications in the elderly.
j. Controlling high blood pressure.
3. Improvement activities.
a. Adopt a formal model for quality improvement.
b. Measure and improve a quality of care.
c. Implementation of a falls screening and assessment program.
4. Cost.
This does not require any submission from physicians but is going to be calculated by Medicare based on submitted claims.
It is important that every member of ACHM starts focusing on quality metrics. If you are not part of the qualified registry, please contact us. ACHM is working with US Wound Registry to provide each one of you member-only rates.
Dr. Jayesh B. Shah
President, AAPI


text:
Benefits of Water
I'm sure you have heard a thousand or so times how you should drink more water, but do you know why? Water is the key to good skin, increasing your energy, aiding in weight loss, and so much more! Take a look at all these great benefits of drinking water!! Increase Energy + Relieve Fatigue… Read More Benefits of Water


text:
Welcome to Mr. Nielsen's Math and Science Homepage!
Somehow, CMS hasn't yet deleted this page. If you haven't already heard, I chose to transfer to a middle school in Union County, which is both closer to my house and closer to the professional goals I've set for myself.
Thanks, Community House students, for a fun year! Good luck in 8th grade!
Mr. Kris Nielsen


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AUSTIN, Texas (Reuters) - Former President George H.W. Bush remained in the intensive care unit of a Houston hospital on Thursday, but his longtime chief of staff issued a reassuring message, urging the media and the public to "put the harps back in the closet."
Bush, 88, a Republican who during his one term in office led a coalition of nations that ejected Iraqi forces from Kuwait in 1991, was admitted to Methodist Hospital November 23 for bronchitis.
He was transferred to intensive care on Sunday after setbacks including a persistent fever, family spokesman Jim McGrath has said.
"I don't have any guidance so far today except to say no news is good news," McGrath said on Thursday. Hospital spokesman George Kovacik added that the former president remained in intensive care on Thursday.
But in a statement addressed to the "national media" on Bush's condition on Thursday, chief of staff Jean Becker sought to strike an upbeat tone.
"Yes, President Bush is in ICU where he is getting the best medical care in the world," she wrote. "Is he sick? Yes. Does he plan on going anywhere soon? No. He has every intention of staying put.
"He would ask me to tell you to please 'put the harps back in the closet,'" she said.
On a more serious note, Becker said her boss was expected to remain in the hospital for "a while," adding, "He is 88 years old, he had a terrible case of bronchitis which then triggered a series of complications." She did not elaborate.
McGrath on Wednesday described Bush as alert and talking to medical staff.
Bush has lower-body parkinsonism, which causes a loss of balance, and has used wheelchairs for more than a year.
The 41st U.S. president, and father of former President George W. Bush, served as a congressman, ambassador to the United Nations, envoy to China, CIA director and vice president for two terms under Ronald Reagan during a political career spanning four decades.
Reporting by Corrie MacLaggan; Writing by Steve Gorman; Editing by Paul Thomasch, Phil Berlowitz and Paul Simao


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1st floor - 379 Olivewood Rd, Toronto, ON
Sorry, this listing is no longer available
Want help from a real estate pro?
20,000 ft²IndustrialN/ANot Available
20,000 ft²
Not Available
The Space
Suite TypeIndustrial
Suite Number1st floor
Size20,000 ft²
Drive In Doors2
Legal DescriptionLOTS 76,77,78 & 79 PLAN 1553,ETOBICOKE
Truck Level Doors2
Loading Dock
Drive In Door
The Building
Sale of Business without property. Turnkey Food processing plant. Meat and related products. Provincially inspected - GMP. Close to Ontario Food Terminal. Close to Subway Station and all major Highways.
Property TypeIndustrial
Building Size20,000 ft²
Base Year2016
Drive In Doors2
Legal DescriptionLOTS 76,77,78 & 79 PLAN 1553,ETOBICOKE
Truck Level Doors2
Typical Floor Size0 sf
Construction StatusExisting
Loading Dock
Drive In Door
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text:
Responsible Patrol Guiders were sent an email containing a letter with information and instructions on Tuesday January 11. The letter refers to a number of required forms and associated deadlines. This post includes links to download the necessary forms, as well as a list of deadlines.
A large event such as SOAR includes many deadlines to ensure the event proceeds smoothly. You can download a printable list of deadlines here: Deadlines (pdf file)
Forms and Documents
Letter for Patrol Guiders – will be emailed to the RPG
Program Options Books – Guide/Pathfinder Program Options(pdf) & Ranger Program Options (pdf)
Health and Wellness Information (pdf file)
SG.2 Parent/Guardian Permission – will be gathered on ePACT
SG.5 Release of Liability – will be gathered on ePACT
H.1 Personal Health Form (girl) – will be gathered on ePACT
H.2 Personal Health Form (adult) – will be gathered on ePACT
H.3 Medication Plan and Administration Record H.3 (pdf file) or H.3 (doc file)
H.4 First Aid Treatment Record H.4 (pdf file) or H.4 (doc file)
H.5 Wellness Statement H.5 (pdf file) or H.5 (doc file)
H.7 Medications Consent H.7 (pdf file) or H.7 (doc file)
WA.2 – Swim and boating test verification for individuals WA.2 (pdf file) or WA.2 (doc file)
WA.3 – Swim and boating test verification for groups WA.3 (pdf file) or WA.3 (doc file)
Waivers – will all be available from and gathered on ePACT


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you never know what's coming next!
Take a risk each day - one small or bold stroke that will make you feel great once you've done it.
Even if it doesn't work out the way you wanted it to, at least you've tried.
Life is huge! And, like life itself ... you never know what's coming next!
Even if it doesn't work out the way you wanted it to, at least you've tried.
Life is huge! And, like life itself ... you never know what's coming next!
Susan Jeffers
The NiNa Programme for Young Entrepreneurs started last month, this cycle has 16 young ladies, some of the most brilliant and articulate sisters between the ages of 16-17 that I have the pleasure of being with every week. I learn so much from them, I look forward to the sessions and come away feeling refreshed and renewed. Today's session, I walked into the room and surprise- each of the 16 cooked a dish, the table was set and we sat together and ate from each of the 16 dishes (well truth be told I skipped some because I am a vegetarian and those sisters love their chicken and lamb!) I was so blown away by the gesture, it was an opportunity to sit and chat over a meal, a simple act which brings so much joy! I had to thank them for taking the initiative, the time and the effort to prepare all those lovely dishes!
Some of them having cooked for the first time- a few laid on the disclaimers hard! but the took the risk to show up with their dishes to share, to laugh and to show that making an attempt is important.
I truly feel blessed to be a part of their lives even if for a short time.
I think this will now become a tradition of the NiNa Programme


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(Bloomberg) A computer system underpinning the U.S. health care overhaul has completed security testing and is ready to go, the federal government says.
The update may ease concerns that the network might not be functional when the uninsured begin shopping for coverage on Oct. 1. The computer hub, a frequent target of Republicans, is designed to route data on customers using new insurance exchanges from seven federal agencies including the Internal Revenue Service and Social Security Administration.
"After over two years of work, it is built and ready for operation, and we have completed security testing and certification to operate," U.S. Chief Technology Officer, Todd Park said in an e-mail from a spokesman for the Centers for Medicare and Medicaid Services.
The system will enable the exchanges to provide "accurate and timely eligibility determinations," Park said. The inspector general for the Department of Health and Human Services, which built the system, said last month that testing had fallen behind schedule and might not be completed until Sept. 30.
Congressional Republicans have questioned whether the hub presents a security risk because of the amount of sensitive data it will handle. The system will use the databases of the IRS and the other federal agencies to confirm information about Americans' income, citizenship and insurance coverage when they apply for plans through the exchanges.
Defends Ability
The Obama administration has defended its ability to keep the hub secure. The CMS has long experience securing personal data under Medicare. The hub itself won't store any data, officials have said.
"The hub and its associated systems have several layers of protection in place to mitigate information security risk," the Medicare agency said in a fact sheet. Health exchanges will use a "continuous monitoring model" to quickly identify and react to "irregular behavior and unauthorized system changes" on their networks, the agency said.
The hub was authorized to operate on Sept. 6, according to the fact sheet. The network is subject to the 1974 Privacy Act, the 1987 Computer Security Act and the 2002 Federal Information Security Management Act. It operates under rules set up by the Office of Management and Budget, Homeland Security Department and the National Institute of Standards and Technology, the fact sheet shows.
At a hearing in mid-September by the House Energy and Commerce Committee, an executive for the contractor building the hub said that software coding was finished.
"Performance and integration testing" of the hub is continuing, Michael Finkel, an executive vice president for the contractor, Quality Software Services Inc., told the committee in prepared testimony. QSSI is a unit of Minnetonka, Minnesota-based UnitedHealth Group Inc., the largest U.S. health insurer.
Park didn't respond directly to an e-mail asking about Finkel's testimony.
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by Paul Benson
My beloved spake, and said unto me, Rise up, my love, my fair one, and come away. 11 For, lo, the winter is past, the rain is over and gone; 12 The flowers appear on the earth; the time of the singing of birds is come, and the voice of the turtle is heard in our land; 13 The fig tree putteth forth her green figs, and the vines with the tender grape give a good smell. Arise, my love, my fair one, and come away. Song 2:10-13
Come Spring
What a poignant and beautiful allegory we get from this book of the Bible. There's a day coming! A wonderful bright spring day arrives after a time of winter's harshness. Who doesn't anticipate spring after all the cold and moisture involved with the winter season? (Up here in Montana it comes in the form of snow and ice, and often sub-zero temperatures!)
I don't think this allegory is speaking of winter and spring in the sense of months and years, but in the sense of the time of man, so to speak. As the closing of a year gives way to the brutality of winter, and as the fullness of life gives way to the troubles of old age, so also the fullness of this era of mankind is sadly giving way to great darkness. But thank God, there IS a day coming!
A coming springtime day in which the Bride of Christ will rise up to meet the Groom as he returns to earth as promised. Rise up, my love, my fair one, and come away. If you are a believer and those words don't stir you deeply you better check your pulse. The Resurrection at the last day, and our catching away to meet Jesus, has been the hope and expectation of the Church for nearly 20 centuries. Just as assuredly as Jesus came to earth to redeem us by his sacrifice on that Cross, he will return for those he has redeemed.
Come Sunrise
For, behold, the day cometh, that shall burn as an oven; and all the proud, yea, and all that do wickedly, shall be stubble: and the day that cometh shall burn them up, saith the LORD of hosts, that it shall leave them neither root nor branch. 2 But unto you that fear my name shall the Sun of righteousness arise with healing in his wings; and ye shall go forth, and grow up as calves of the stall. Malachi 4:1-2
A stunning contrast is painted for us here of the marked difference that day will bring for those longing for his Return compared to the fate of those who reject his Lordship. One day but with two very different outcomes for those who experience it. For the wicked it will be a time of judgment and destruction; a grim end without hope of redemption. But to the righteous it will be a time of healing and renewal; the start of a new day full of promise and blessing; portrayed in the following passage as a glorious sunrise after a long dark night of great tribulation and trial.
Arise, shine; for thy light is come, and the glory of the LORD is risen upon thee. 2 For, behold, the darkness shall cover the earth, and gross darkness the people: but the LORD shall arise upon thee, and his glory shall be seen upon thee. Isaiah 60:1-2
I know this scenario doesn't jive with what a lot people are teaching about the Return of Christ (many erroneously have the Bride departing before the bitter winter) but this is the pattern given us here, and so many other places in the Word. Jesus is coming to dispel the darkness, not to take us away from it.
Come Kingdom
And the seventh angel sounded; and there were great voices in heaven, saying, The kingdoms of this world are become the kingdoms of our Lord, and of his Christ; and he shall reign for ever and ever. Revelation 11:15
As believers we await a coming King as well as a coming Kingdom. He has not promised to take us off to his Kingdom; but he has promised to bring it here to us! The exhortation of the Scriptures is for us to be awaiting a Return, not a departure. Isn't that the whole point of praying 'thy kingdom come' like Jesus said to? Christians have been praying for this day since he departed!
Come Lord Jesus
Until the day break, and the shadows flee away, I will get me to the mountain of myrrh, and to the hill of frankincense. Song 4:6
Some great advice here on how to pass the time awaiting that wonderful day. Climb a fragrant mountain and wait there! David called this the secret place of the Most High where one abides under the shadow of the Almighty. A place where the Magnificent one feeds among his lilies. A place of fellowship and strength only known to those who press in with the whole heart, hungering and thirsting after righteousness. I hope you know where that place is. Maybe I'll see you there; we can pray for his Return together.
My beloved is mine, and I am his: he feedeth among the lilies. 17 Until the day break, and the shadows flee away, turn, my beloved, and be thou like a roe or a young hart upon the mountains of Bether. Song 2:16-17


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FileMaker Pro Crack Plus Serial Key Free Download
FileMaker Pro Crack is excellent software which helps to create custom apps for the cloud, mobile, and other devices. Users can easily build the custom app or explore built-in Starter Solutions for managing contacts, projects, inventory, and more. Users can use flexible design features for making layouts look and work without extensive experience or IT skills. FileMaker Pro Keygen helps to create custom apps which work together seamlessly across iPad, iPhone, Mac, Windows, and the web. Users can easily get more details about the security … Read More


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I have been into deeper thoughts quite often as I keep on planning for my future. I wanted to become efficient environmentalist, researcher, professor, architect, and carpenter as I liked so much playing around with woods and use newer technologies related to it. I wanted to build models and make furniture for my house. Such thoughts lingers in me for long and sometimes I even dream of building my house by myself. I wanted everything to be unique that will eventually prove that I have learn engineering.
The great passion I have for my career let me not stop thinking to become professor and that's my ultimate target in life. I will be happy and my parents will be proud. I found doing research is the best way to learn and create new ideas and techniques that will also paved way towards becoming a professor. Becoming an expert in the field of environment being a fond lover of what everything nature does and appreciate what is possess will perhaps make me efficient environmentalist. Not only this, I was even thinking of my grand marriage party, fascinating new cars, mountain bikes and list goes on. Indeed, I was dreaming a lot and just wishing if I have 36 hours instead of 24 hours a day, I may get it all done.
After all this, a single final thought changed my mind.
|This is how I imagine my office to be in future
I was too selfish in dreaming, if it really is going to happen. May not happen because people of my age already prove be done with it. However, this are all just thoughts. I was selfish because I almost forgot to include the welfare, dreams and happiness of my parents and family. I realized that their hard work in last twenty years has been invested in me and now within few years into career was about to ruin my thoughts.
What if my thoughts are to invest in them for rest of my life?
They have invested in my career that brought me happiness, and now it's my turn to invest in their happiness. What will bring them the happiness that they have never achieved before? I know they don't expect much but I should make it happen. This should be my thoughts and dreams of priority henceforth. So I changed my mind and that changed me and will changed my attitude too. Will wait and see what magical things happen next. Until then, live a happy present day life because it's all times well known saying that past are gone, future is yet to come, so everything that u do today matters.


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Alannah Myles - Music, Song Lyrics and Videos by Alphabet
All Songs by Alannah Myles sorted by Alphabet
If you are missing lyrics that should be there for this artist, they will propably be published to the website soon. If you have one or more lyrics for Alannah Myles, and you want them to be online, feel free to submit them to us.
Artist submitted by Marcel on 03/27/2013
All music by Alannah Myles
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Statement of Purpose
Our Statement of Purpose has been produced in line with the requirements of the legislation and guidance that we are measured by. It includes information about how we are to meet the National Minimum Standards for Older People as set by our registering authority, the Care and Social Services Inspectorate Wales (CSSIW)
Our Purpose
We provide holistic care to people in their later years in a warm, homely environment and endeavour to meet and exceed the standards set out by CSSIW.
You can find our Statement of Purpose here:
The Laurels
Residential Care Home
The Laurels Residential Care Home 2015


text:
Status: Closed
Know more about this business than we do? Cool! Please submit any corrections or missing details you may have.Help us make it right
Karen Stavins Enterprises is Chicago's longest-established, largest and most reliable source for non-union talent. We supply actors, models, voice-over and trade show talent to local, national and international clients of all sizes. We have high-quality talent to fit virtually any budget. Since 1985, Karen Stavins Enterprises has earned a reputation for reliability, integrity, value and...
Be the first YellowBot user to add photos or videos of Corporate Presenters
Corporate Presenters can be found at E Wacker Dr 303. The following is offered: Movie Pre-Production. The entry is present with us since Sep 8, 2010 and was last updated on Nov 12, 2013. In Chicago there are 6 other Movie Pre-Production. An overview can be found here.
Corporate Presenters is located at 303 E Wacker Dr, Chicago, IL. This location is in the The Loop neighborhood. This business specializes in Talent Agencies.
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text: I don't wanna create two separate threads, because I wanna kinda compare this two. I love playing card games on consoles, IMO it is a better way to actually play them and besides, you don't spend anything trying to collect all the cards. The Eye of Judgement (PS3) This game actually looks awesome, and the price wasn't too shabby either, for 65USD you can have the game AND the PlayStation Eye. Altought this game kinda cheats on not actually having to buy the cards, but I've heard an read that you can actually print your own cards for multiplayer support. Single player, you don't need to buy anything else. Culdcept Saga (360) This one is also about controlling areas, but the arenas will have different layouts. Looks awesome, I still don't know if it will be a retail game or a Live download, because it doesn't look it THAT advanced. Seems fun alright. Any other card game fans?


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Health Concerns in Beijing
Filed Under News | Leave a Comment
Running on Fumes in Beijing
By Gina Kolata, The New York Times, Olympic Coverage – It was a hot, humid, oppressive Thursday night, but my running group was ready to go. Jen Davis, one of the regulars, had mapped out a hilly eight-and-a-half-mile course in Princeton, N.J., and nine of us set out, trying to ignore the steamy weather.
I had a hard time. My legs felt heavy and I just could not get going. Along with five others in the group, I ended up cutting the run short, avoiding the last couple of miles. And that's something I almost never do.
When I got home, I called my coach, Tom Fleming, to tell him what happened.
"I have just one word for you," Tom said. "Beijing."
Yes, I'm going. I'll be part of the New York Times reporting team. And yes, I intend to run when I'm in China. I'll even have a training schedule and will e-mail my results to Tom and talk to him via Skype.
One running partner, if our plans work out, will be Mary Wittenberg, president of New York Road Runners. She hopes to run for an hour at least every other day, if not more often.
"I'm going in there optimistic," she said. "How bad can it be?"
Still, it gives me pause that the United States' track and marathon athletes are not arriving in Beijing until the last minute. They're training in Dalian, a comparatively pollution-free city north of Beijing, where they can get accustomed to the time zone and heat. They won't even try to be out there breathing the Beijing air every day while sweating in the intense heat and humidity.
And it is hard to dismiss the cautionary tales. Tom Fleming, who won the New York Marathon in 1973 and 1975, is an experienced runner and coach. He was in Beijing twice, in 1991 and 1994, both times as coach for the United States women's ekiden team. In ekiden, a relay race popular in Asia, runners cover various distances to equal a marathon distance of 26.2 miles.
The ekiden races were in March, so heat and humidity were not severe, Tom said, but the pollution had him worried. "What I noticed was that my white shirt was gray," he said. "That's when I said, 'Holy crow.' You know it can't be good.
"Let me know if you see any Chinese people running," he added. "I never saw anyone."
That's because ordinary Beijing residents almost never run on the streets where Tom was running.
Running, it turns out, is not a sport for most people in China. And when they do run, their style is, to Western eyes, a bit unusual. Joseph Kahn, a deputy foreign editor for The Times who just returned from five years as Beijing bureau chief, said athletics in China was mostly confined to sports academies that train young people to be Olympians. Otherwise, exercise takes place in the morning in parks, where people do yoga and tai chi and run backward, which they think helps with balance.
"Rarely do people run on the streets, but not never," he said.
Some athletes who have competed in Beijing said they were defeated by the conditions there.
Jeremy Horgan-Kobelski, a mountain biker, entered a race in Beijing last September. He started coughing soon after the race began, and his coughing fits were so severe that he had to drop out halfway through. Almost everyone had trouble, he said, with only 8 of 50 cyclists finishing the race.
Still, you can avoid the worst of one pollutant, ozone, by running in the morning. Levels peak at midday. And there is some evidence that you can develop tolerance to ozone over a five-day period, said Kenneth W. Rundell, director of respiratory research and the human physiology laboratory at Marywood University in Scranton, Pa.
Added to the air pollution is the pollen. The Chinese government has warned that August is pollen season, and counts are expected to be high. I'm bringing over-the-counter pills containing the decongestant pseudoephedrine, a drug that is banned for Olympians under antidoping regulations but is legal for non-Olympians like me.
But Randall L. Wilber, a senior sports physiologist at the United States Olympic Training Center, told me that heat and humidity would take a bigger toll. "We're actually focusing very, very heavily on heat and humidity as opposed to air pollution," he said.
Endurance athletes who exercise in heat and humidity can become acclimated in about two weeks. The body adjusts by increasing the plasma volume, making it easier for the heart to pump blood to muscles and to the skin, for cooling. In addition, when you are acclimated, sweating starts sooner and the sweat is more profuse and more diluted.
But athletes — and others who try to exercise — will be affected by heat and humidity even if they are acclimated. And they may also feel the effects of pollution in Beijing, Dr. Wilber said.
He should know. He visited Beijing several times in preparation for the Olympics, and while there he did runs of 40 to 45 minutes.
"I've never been there when the air quality was good for more than 24 hours," Dr. Wilber said. When he returned home, he coughed up phlegm, particularly after exercise. "It gradually worked its way out," he said.
Dr. Wilber said he expects the air quality during the Olympics to be better than many anticipate. He is confident that the government's pollution control measures will help.
I hope so. At least by running in the latest New Jersey heat wave, I should be as acclimated to heat and humidity as I can get. And when I run in Beijing, I'm going to try to abide by my coach's advice. "The only advantage I had running in Beijing was that I did not try to maintain my same training schedule," Tom told me.
If it is really hard to run or if it seems impossible to run as far as I'd planned, I hope I have the sense to cut a run short.
A Musical Score for Disease
Filed Under News | Leave a Comment
Connecting the dots: A Harvard researcher has translated genes (circles) into music by charting the relationship (lines) between them and determining key networks (red nodes). Each network is assigned a musical note.
Credit: Gil Alterovitz
Click here to listen to examples of gene-based music.
Converting genetic activity into music may be a way to monitor health
By Jennifer Chu, July 2008, MIT Technology Review – When set to music, colon cancer sounds kind of eerie. That's the finding of Gil Alterovitz, a research fellow at Harvard Medical School who is developing a computer program that translates protein and gene expression into music. In his acoustic translation, harmony represents good health, and discord indicates disease.
At any given time in each of our cells, thousands of genes are churning out their molecular products while thousands more lie senescent. The profile of which genes are on versus off is constantly changing–with specific diseases such as cancer, for example.
Searching for a more simplified way to represent the complex library of information inherent in gene expression, Alterovitz decided to represent those changes with music. He hopes that doctors will one day be able to use his music to detect health-related changes in gene expression early via a musical slip into discord, potentially improving a patient's outcome.
The first step in the gene-to-sound conversion was to pare down multiple measurements to a few fundamental signals, each of which could be represented by a different note. Together, the notes would form a harmonic chord in normal, healthy states and become increasingly out of tune as key physiological signs go awry, signaling disease.
Alterovitz employed mathematical modeling to determine relationships between physiological signals. Much like the various systems in an automobile, many physiological signs work in synchrony to keep a body healthy. "These signals [are] not isolated parts," says Alterovitz. "Like in a car, one gear is working with other gears to control, for example, power steering. Similarly, there are lots of correlations between physiological variables. If heart rate is higher, other variables will move together in response, and you can simplify that redundancy and information."
Using data collected from a study of protein expression in colon cancer, Alterovitz analyzed more than three thousand related proteins involved in the disease. He whittled down the thousands of proteins to four key networks, using various genetic databases that catalog relationships between genes and proteins. He then assigned a note to each network, and together, these notes formed a harmonic chord. He compared the "music" of normal, healthy human data sets to that of the colon-cancer samples and found that, according to his model, colon cancer sounded "inharmonious."
Researchers may be able to translate other diseases into music by "tuning" the system that Alterovitz has developed. For example, researchers can identify protein networks related to the disorder of interest and then assign notes that, in combination, form inharmonious chords, compared with their healthy counterparts.
He adds that the technique may have applications outside medicine, such as for simplifying information for air-traffic controllers, and in any other industry that requires analysis of large data sets. There is also an opportunity to use protein music purely for music's sake: a DJ in the Boston area has expressed interest in playing Alterovitz's "music" in local bars–a potential revenue stream for musician and mathematician alike.
Go here for, gene based music
By Alex Berenson, August 5, 2008, The New York Times – Can Byetta, an injectable drug that lowers blood sugar, really help people with diabetes to live longer?
Possibly, according to the results of a major clinical trial presented at the American Diabetes Association annual conference. In the trial, called Accord, patients with Type 2 diabetes were prescribed Byetta or any of several other diabetes medicines. Patients who took Byetta had a much lower chance of dying, about 75 percent lower, than those who took any other drug.
The finding, presented in June, has generated a stir among diabetes researchers, although so far it has attracted little public notice. Neither Eli Lilly or Amylin, the companies that jointly market Byetta, is publicizing the findings, in part because no one is sure whether the reduction in the death rate is real or a chance finding. Only about 825 patients in the 10,000-patient Accord trial took Byetta, and those who did were likelier to be healthier than other patients.
"We don't know whether it's the drug or the healthy participant," said Dr. Michael Miller, professor of biostatistics at Wake Forest University and the lead statistician on the Accord trial.
The trial's finding came as a surprise even to Lilly and Amylin, said Dr. James Malone, the global medical director of Byetta for Lilly.
"We were not aware of the results before they were presented at A.D.A., and I was sitting in the audience and my jaw just dropped," Dr. Malone said. The trials that Lilly and Amylin have conducted on Byetta, have not shown a reduction in mortality in patients taking the medicine, but they were not intended to do so.
Although Byetta has been a moderate success in the market, with sales expected to reach about $700 million this year, prescriptions are short of what analysts had forecast when the medicine was introduced in 2005.
For the Accord finding to be proved, it must be tested in a large trial that would compare the cardiac health and overall death rates of thousands of patients, half receiving Byetta and half receiving a placebo. So far, Lilly and Amylin have not committed to undertaking such a trial, which would take years and cost tens of millions of dollars.
Further complicating the issue is that the two companies are working a reformulated version of Byetta, which could be injected once weekly instead of twice daily, and they may prefer to run the trial on the new medicine, which has not yet been approved by the Food and Drug Administration.
Dr. Malone said the two companies hoped to make a decision on holding a large mortality trial by the end of the year.
Even so, the finding adds to an emerging body of evidence that Byetta — the first in a new class of diabetes medicines called incretin mimetics — may work better than other diabetes medicines, at least for people who can tolerate its side effects, which can include severe nausea.
Byetta is less likely than other diabetes medicines to cause hypoglycemia, or dangerously low blood sugar. In addition, while most diabetes medicines cause patients to gain weight, patients on Byetta typically lose several pounds each year on the medicine. Weight gain is associated with cardiovascular problems, the most common causes of death for people with diabetes.
"My suspicion is that when you look at the determinants of mortality, which were weight gain and hypoglycemia in that study, Byetta would be the antimortality drug, because it's associated with weight loss and less hypoglycemia," said Dr. Alan Garber, an endocrinologist and professor of medicine at Baylor.
In addition, animal trials offer some evidence that Byetta may directly benefit the heart, Dr. Malone said.
Byetta, generically called exenatide, is a synthetic version of a protein originally discovered in the venom of a lizard, the Gila monster. It encourages digestion and the production of insulin. Byetta is currently approved for use alongside other diabetes drugs, and Lilly and Amylin have asked the F.D.A. to approve it as a monotherapy as well.
When Byetta was introduced in 2005, prescriptions for it grew rapidly. But for the last year, Byetta prescriptions have been roughly flat at about 250,000 a month.
Doctors say that some patients cannot tolerate the nausea that Byetta can cause and others do not like injecting the medicine twice daily. Concerns about pancreatitis, an inflammation of the pancreas that can be fatal in rare cases, have also hurt the drug, although Byetta has not been proved to cause pancreatitis.
Dr. Joel Zonszein, an endocrinologist at Montefiore Medical Center in the Bronx, said some primary care doctors do not like to prescribe Byetta because they must teach patients how to give injections, a time-consuming process. "It is a drug that is difficult to prescribe," Dr. Zonszein said.
Meanwhile, prescriptions for Januvia, a medicine in pill form from Merck that works in a somewhat similar way as Byetta, have taken off since Merck introduced it in October 2006. More than 500,000 patients a month are being given prescriptions for Januvia or Janumet, which combines Januvia with a second diabetes medicine in a single pill.
"Januvia has been effectively marketed in the primary care community," said Dr. John Buse, vice chairman for the Accord study and professor of medicine at the University of North Carolina, Chapel Hill. "I think there is some misunderstanding about the relationship between Januvia and Byetta among primary care providers."
Dr. Buse said that the data from Accord was intriguing but not enough to persuade him that Byetta could reduce deaths in diabetes patients.
"The number of patients in Accord that were treated with exenatide was a very small proportion of the total patients in Accord, and they got exenatide relatively late in the trial," he said. He said he hoped Lilly and Amylin would decide to invest in the trial necessary to test Byetta's effect on mortality.
"They need to do it," he said.
Health Authorities Tout Benefits of the Meningococcal Meningitis Vaccine
Filed Under News | Leave a Comment
On the front page of the Wall Street Journal's (8/5, D1) Personal Journal section, Melinda Beck writes in the Health Journal column that "[m]eningococcal meningitis strikes" approximately "1,400 to 2,800 Americans a year…with terrifying speed and consequences," as nearly "10 percent of victims die, often hours after symptoms set in." Of those who survive, roughly 15 percent "are left with brain damage, hearing loss, or amputations" of gangrenous limbs. Although "the disease is largely preventable with a vaccine called Menactra," according to the Centers for Disease Control and Prevention (CDC), just "12 percent of" adolescents between 11 and 18 "had received the vaccine" as of 2006, in part "because adolescents tend to steer clear of the doctor's office." Therefore, the "CDC is pushing the idea of an adolescent doctor visit to discuss…the meningitis vaccine, a diphtheria-tetanus-pertussis booster, and the human papillomavirus shot for girls." Yet, some remain critical of vaccinations, particularly after "a handful" of recipients came "down with Guillain-Barre syndrome (GBS)…after receiving Menactra." But Paul Offit, of Children's Hospital in Philadelphia, said that individuals "have a 20-fold greater chance of getting meningococcal meningitis without the vaccine than of getting GBS from the vaccine."
Fewer patients are undergoing in-depth treatment as antidepressants and other drugs are more widely used. The shift is attributed partly to insurance reimbursement policies
Should insurance companies dictate the treatment methods?
By Denise Gellene, August 5, 2008, Los Angeles Times – Wider use of antidepressants and other prescription medications has reduced the role of psychotherapy, once the defining characteristic of psychiatric care, according to an analysis published today.
The percentage of patients who received psychotherapy fell to 28.9% in 2004-05 from 44.4% in 1996-97, the report in Archives of General Psychiatry said.
Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects.
Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind.
Psychotherapy is an interpersonal intervention that may involve such things as behavior modification and group discussion. It is recommended — with or without medication — for major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.
Besides psychiatrists, a range of mental health professionals not covered in the report also conduct psychotherapy, including psychologists, social workers and marriage counselors.
The study was based on data drawn from the National Ambulatory Medical Care Survey, an anonymous survey of office-based physicians that tracks characteristics of patients and physicians, and records the diagnosis and treatment, during a typical week.
Researchers examined data on 14,108 psychiatric office visits during a 10-year period.
Psychiatrists who said they provided psychotherapy to all of their patients declined to 10.8% in 2004-05 from 19.1% in 1996-97, according to the report. Consistent with previous studies, researchers found that patients who paid out of pocket, generally the wealthiest patient group, were more likely to receive psychotherapy.
Financial incentives were weighted against psychotherapy, the report said. Reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15-minute medication management visits, the report said, citing a 2003 study. Anticipated changes in Medicare reimbursement are expected to bring payments into closer balance, experts said.
Also fueling the trend, according to the report, was the aggressive marketing of psychotropic medications to psychiatrists and patients. That push, for example, has helped make antidepressants one of the largest-selling classes of drugs.
Dr. Mark Olfson of Columbia University Medical Center, a study author, said patient attitudes might also be hastening the shift. Taking a pill may look a lot easier to patients than psychotherapy, which is more time-consuming and may involve the regular participation of family members.
The report found evidence of a cultural preference for psychotherapy in the Northeast, which Olfson said might be attributable to the influence of the Yale School of Medicine and the University of Pennsylvania School of Medicine, whose faculties are strong proponents of psychotherapy.
Because the study looked only at psychiatrists, it couldn't determine whether patients who needed psychotherapy were receiving it from other mental health providers or going without treatment, Olfson said.
Dr. William H. Sledge, interim chairman of the department of psychiatry at Yale, said the report was worrisome. Although training in psychotherapy is a standard part of psychiatric training, he said, the know-how is in danger of becoming lost.
"A group of practitioners is losing an important skill. It is like going to war with fewer weapons at your disposal," Sledge said.
Dr. Alan F. Schatzberg, chairman of the department of psychiatry at Stanford University School of Medicine and president-elect of the American Psychiatric Assn., said the trend was not necessarily bad. It could be seen as a natural evolution, similar to what is seen in other fields of medicine.
"Years ago, if someone had a herniated disk, they had a very complicated surgical procedure and were in traction for weeks," he said. "Fields change. What we don't want to do is decide treatment based on reimbursement."
Amateurs Increasingly Turn to Drugs for an Extra Edge
By Laura S. Jones, August 5, 2008, The Washington Post – The International Olympic Committee will conduct 4,500 tests for performance-enhancing drugs at the Beijing Olympics this month. Good, you may think; they need to catch the drug cheats.
But what if that term applies to you and other weekend warriors?
Ridiculous? Maybe not, if performance-enhancing drugs include not only amphetamines, steroids and human growth hormone but also the common stimulants that experts and athletes say a growing number of people have begun using.
Endurance events have exploded in popularity, particularly among older athletes. Over the past four years, membership in USA Triathlon, the main sanctioning body for many triathlons and other multi-sport events, has doubled to 100,000; about seven times as many train for these events as take part in them. The number of Boston Marathon runners ages 40 to 59 has nearly tripled since 1997, to more than 10,000 this year, close to half the field.
And although the vast majority of participants compete for good health and fun, experts say a growing number are using painkillers, caffeine (in pill and standard liquid form), decongestants and asthma drugs to get an edge by increasing their energy and the flow of oxygen-carrying blood.
Because few amateur events test competitors for drugs, there are no hard data to back up these claims, but experts such as Charlottesville internist Martin Katz offer plenty of anecdotal evidence.
Katz says he gets requests for asthma inhalers from patients training for races who probably don't need the drugs. An athlete himself, Katz usually gives these patients the benefit of the doubt, but when "the symptoms don't sound typical," he suggests the patient get tested for exercise-induced asthma.
Olwen Huxley, a USA Triathlon-certified coach, a former rower for the U.S. national team and multi-time Ironman finisher, says she's seen an explosion in the number of inhaler devices left on the beach after the start of a triathlon's swim stage.
"When you start feeling your age ," says Huxley, "you are as subject to giving in to the allure of performance-enhancing drugs as an Olympic athlete."
Ethics aside, the practice is risky. When combined and used to boost performance, sports doctors say, these stimulants can endanger health, particularly for older athletes.
"People have come into my office with cardiac arrhythmias caused by combining a Red Bull habit with Sudafed," says New York internist Gary I. Wadler, who helps pick the drugs banned by the World Anti-Doping Agency, or WADA. "Drugs are for medical conditions. Being an athlete is not a medical condition."
Katz agrees. "The problem is that stimulants will elevate your heart rate, and combining them is a bad idea."
One reason drug abuse might be more prevalent at all levels of sport than it was 30 years ago, says former University of Virginia head strength and conditioning coach Derek Laing, is that there are simply more drugs. So "when people reach the limits of their God-given talent, and they don't want their dream to end there," he says, it's easy for them to explore what drugs can do for them.
An informal survey of four Internet sports forums (USMS.org, Slowtwitch.com, Letsrun.com and CuttingEdgeMuscle.com) showed a range of attitudes among amateur athletes.
Some posters freely offered advice on which drugs to take and when. Others spoke out vehemently against doping. But even among those who condemned the practice, many admitted to using caffeine and ibuprofen as performance boosters before and during races. (Caffeine, unregulated by WADA, is up for reconsideration as a banned substance, Wadler says.)
On the Letsrun.com forum, a poster asked, "Are there any performance-enhancing drugs that any recreational runner is able to pick up at a pharmacy w/out a prescription? Drugs that obviously aren't meant for performance enhancing but are?" Replies a fellow poster: "Creatine [an over-the-counter dietary supplement and muscle builder], caffeine and other stimulants found in cold medicine, allergy medicine or weight loss pills."
Those in search of a drug boost can get the ingredients from any convenience store. Or they can, as one poster on CuttingEdgeMuscle.com suggested: "Just tell a doc you tried Tramadol [a prescription opiate] for back pain and it worked great. Then take it with caffeine 30 minutes before a race for a big boost."
Jim Clemmons, 57, a masters swimmer from Dublin, Calif., described his tamer formula in an e-mail interview: "One ibuprofen, one Red Bull, a caffeinated energy drink, and wash em down with a cup of coffee about 30 minutes before high intensity demand. Ready to go."
Ed Hickey, 40, of Madison, Wis., says he and fellow cycling racers shrug off stimulant use. "I know lots of people who pop Sudafed to enhance their performance and pound Cokes and Red Bulls. " Hickey notes that most of the benefit is probably psychological.
Race organizers have done little to combat the practice, but that may change. "Sport," Wadler says, "should be a contest of character, not a contest of pharmacology."
Dean Jagusch, 30, a coach and a former triathlete from Baltimore, says one of the big problems in triathlons is that you have amateurs racing beside pros. "They see what the pros are doing — No-Doz strapped to the bike, for example — or something worse. And they'll follow their heroes." And the sport's headlines have been telling us lately that these heroes, at least some of them who competed last month in the Tour de France, definitely aren't clean.
USA Triathlon is considering testing all athletes, pros and amateurs, who compete in its events. Skip Gilbert, executive director of the organization, says, "Given what you hear, you just don't know. [Performance-enhancing drugs] are on our radar."
Gilbert is mostly concerned about steroids, EPO (erythropoietin, a substance that boosts red blood cells' oxygen-carrying capacity) and human growth hormone, drugs that have not only a reputation for improving athletic performance but also the potential for dangerous side effects. But he says stimulants might be included in testing as well.
Jagusch notes: "The whole amateur side of it, people take it too seriously. They think nothing of spending all their savings on equipment when all they need to do is train more and lose weight. Why wouldn't these same people, looking for an edge, turn to drugs? It's a Type A personality, where their goals are the be-all and end-all of their existence."
Wadler agrees. "Absolutely, a 45-year-old who spends $10,000 on a bike will find a doctor who will help with a friendly diagnosis" to get a drug with performance-enhancing abilities, whether it is a stimulant or a steroid.
So will you have to produce a urine sample after your next triathlon or masters swimming race? Maybe.
But Jim Miller, past president of US Masters Swimming, national team physician for USA Swimming and a doping control officer for FINA (the international governing body of swimming), is doubtful that's the answer.
"If you start drug testing in masters sports, you are as likely to catch a 75-year-old legitimately taking hormones for prostate cancer" as you are to find a steroid abuser, he says. He's pushing instead for more education about ethics and health risks.
Charlottesville triathlete Travis Mawyer, who says he refuses to take performance-enhancing drugs, wishes more people thought about the ethics. In an e-mail, he wrote: "I do have a sense of morality, integrity and honesty which seems to take precedence over my desire to be a better athlete. That is not to say the thought [of taking Sudafed or getting an inhaler] hasn't crossed my mind. I just let it slide on in, through and out of my mind."
Innocent Farmers Lost $100 Million in Sales
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US tests never turned up one single domestic tomato with the Salmonella saintpaul bacteria
By Cindy Skrzycki, August 5, 2008, The Washington Post – While throwing a few rotten tomatoes at U.S. regulators might help ease growers' pain, those involved in the latest salmonella epidemic would prefer cash for their trouble.
After weeks of implicating domestic tomatoes in an outbreak of Salmonella saintpaul, federal food-safety sleuths shifted the spotlight to jalapeño and serrano peppers grown in Mexico.
But before the U.S. Food and Drug Administration lifted the tomato advisory July 17, U.S. tomato growers were left holding the shopping bag.
Growers said they lost $100 million in sales during the investigation, which they charge was conducted poorly and without enough consultation with them.
The growers knew the agency hadn't gotten to the source of the problem after the FDA told people to stop eating tomatoes and the illnesses increased, said Robert Guenther, senior vice president for public policy for United Fresh Produce Association, an industry group in Washington.
Things got even more problematic for investigators when tests didn't turn up a single domestic tomato with the bacteria.
The late reprieve for the industry shows how difficult it is to conduct international investigations of food-borne illnesses with limited resources and imperfect ways to trace a product back to its source.
At the same time, pressure has intensified to solve cases quickly and to pay for "mistakes" made.
Holding a tomato in one hand and a jalapeño in the other, Rep. Bart Stupak (D-Mich.), chairman of the Energy and Commerce Committee's oversight and investigations subcommittee, pressed the FDA on whether the tomato was still a "vegetable of interest" or had been cleared.
David W.K. Acheson, the FDA's associate commissioner for food, responded at a July 31 hearing that no mistakes had been made and that tomatoes on the market were safe to eat.
The FDA said it followed the leads provided by the Centers for Disease Control and Prevention. It found in early interviews with sick people that, overwhelmingly, they had eaten raw tomatoes in salsa or Mexican-style restaurant food.
The Salmonella saintpaul case began in May when federal and state investigators identified cases of the infection, which can cause serious illness and death, in New Mexico and Texas.
As the weeks passed, tomato growers became increasingly critical of the investigation.
It's not feasible for growers to legally challenge the government for their losses — and the investigation isn't yet over — but they hope Congress will help.
Rep. Tim Mahoney (D-Fla.) is sympathetic to the $1.3 billion tomato industry, as are other members of the state's delegation. He introduced a bill July 24 that would compensate growers and packers for losses up to $100 million. (Florida growers supply about half the nation's fresh tomatoes annually.)
"There should be some compensation," Mahoney said. "They have done nothing. They shouldn't be held accountable. You have indicted an entire industry and left doubt that it's okay to eat tomatoes."
Bill Marler, a food-safety plaintiff attorney with Marler Clark in Seattle, said the push to exonerate tomatoes may be premature.
"Everyone empathizes," Marler said of the industry's losses. He cautioned that imperfect information may have implicated tomatoes, but "we would ask for their heads on a platter if it was tomatoes."
There are other policy questions about penalizing agencies for their conclusions in the course of an investigation.
"You can't have public health people fearing liability," said Michael Taylor, a research professor at George Washington University's School of Public Health.
Taylor, who was a top food-safety official in the Clinton administration, suggested preventative measures and more efficient investigations.
"The government should mandate a set time period to provide answers to questions of where the produce came from," he said.
Tomato growers think they have a case for compensation from Congress since they don't qualify for other aid programs.
For example, the U.S. Department of Agriculture runs crop-insurance programs that cover disasters from floods and hurricanes, but not crops ensnared in recalls.
Some companies have recall insurance, but they're not likely to collect unless there is a recall — not a warning or an advisory.
This isn't the first time produce growers looked to Congress for help with a food-safety issue.
Even though the 2006 bagged spinach recall involving Dole Food and Natural Selection Foods was more contained, growers took a $100 million hit, according to the United Fresh Produce Association.
Spinach growers got a financial-aid provision part way through Congress but didn't succeed.
In March 1989, the U.S. banned the entry of seedless grapes from Chile after two grapes were found to have been contaminated with cyanide, leaving Chilean growers, exporters and importers with millions of dollars in losses. The industry tried to recover about $210 million only to get word four years later that a federal judge ruled that the FDA wasn't responsible because it was doing its job.
"We got no compensation," said Richard Eastes, a California fruit and vegetable consultant who worked for a company affected by the ban. "It was just a bad dream."


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