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It's back by popular demand – the Photo Challenge!
To celebrate May the month of Mother's Day, we are running a photo comp to celebrate all your treasured moments. We are already receiving some amazing entries, and are so happy to be able to share your beautiful treasured moments!
Head to Facebook to see the entries, and while you're there submit your own treasured moment! Invite your friends to vote for yours, you can vote once per day, and the moment with the most votes at the end of the comp will win a $1000 TVSN Voucher!
Here are a couple of the beautiful entries we have received so far:
This is my Mum and I (two years old) having a kiss in the pool at the Halekulani Hotel in Honolulu, Hawaii – 1988. Mum still tells everyone the story of when I pooped in my swimmers as I was having a splash, and she had to "swirl" the evidence around and around so it would disappear into the pool filter. Every year when Mum stays in Hawaii for her outrigger paddling competitions, she emails me a picture of this same pool and asks me if I remember. Thanks for the constant reminder Mum xxx – submitted by Lauren Hall
It was love at first sight, when aged 35 and after 13 years of believing we would never meet, I finally can hold you and love you like I have never loved someone before. You are and always will be "My Treasured Moment" my gorgeous son Brandon, I Love You. – Submitted by Sylvia Paull
All the entries can be viewed over on our Facebook page. There are many other beautiful stories, and we feel very privileged to be sharing in these special memories!
Entries close midnight on Mother's Day, 12th May, and the overall winner will be announced on 17th May.


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San Marco 2494 - 30124 Venice ( Veneto Italy )
Hotel Ala is located in an an early 18th-century building in Santa Maria del Giglio square, really close to the vaporetto stop and 5 minute walk from Saint Mark's Square.
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What we Would've CHANGED About our 2 Month Road Trip
We wanted to buy a van and set it up like a mini camper. We ended up getting our GMC for free, so we can't really complain. We set up two single half-inflated air mattresses in the back every night. It was a very annoying setup, as we had no space to store our stuff. We would have to move it to the front seat every evening and then move it all back in the morning before driving again. This chore is part of what contributed to our exhaustion on the road trip. If we had a van we could have built a little platform and stored stuff underneath the bed. We could have also got a small foam mattress instead. Maybe if we had a more convenient set-up then we could have lasted longer on the road trip and seen more sights. We worked with what we had so a better set-up would have cost money.
Better Camping Equipment:
Our equipment did a pretty decent job but there were a few things that could have been improved. We needed a better, more waterproof, rain fly for our tent. We also needed more stakes and rope in order to secure the rain fly so that it didn't touch the tent. This would have made camping in the rain more feasible as there were a few times that we ended up getting soaked which made things a little miserable.
Our butane stove was quite compact but the cost of fuel and poor performance made us think that a propane stove may have been a better option. Also, camping sized propane appears to be cheaper and more readily available. Our butane stove was not very efficient and couldn't effectively boil water for pasta. It was alright for tea and coffee but it couldn't hold a boil long enough for pasta. It was mainly suitable for reheating canned food. Maybe we could have eaten better if we had a propane stove. Having more than a single burner would have been convenient as well. The problem is that we already had the butane stove so we would have had to purchase or borrow a propane stove.
A bug tent to go over the campsite picnic table area would have been quite helpful and made cooking and eating outside less of an ordeal; especially in Manitoba and Northern Ontario. The bugs were pretty bad and it's kind of a shame that it got in the way of our enjoyment of some places.Again this would have cost money but it might have been money well spent.
Bigger Budget:
Canada is expensive. Hotels, fuel, events, city parking, campsites etc. We didn't have a big enough budget to stay in bigger cities longer like we wanted. In the end, we are budget travellers and in saying this, we probably would have spent the same amount of money as we had planned in the first place. The budget seems to be the overall thing we would have changed since budget constraints were behind our SUV setup and our camping equipment. Here are a few other changes we'd make relating to budget:
- More Hotel Stays: We were getting pretty exhausted sleeping the the SUV. Sleeping in a nice bed would have helped keep our energy levels up and kept us more enthusiastic. In order to afford more hotel stays we could have done...
- More Walmart Stays:On the saving money side, a few more Walmart stays would have helped with our funds and extending our trip. Maybe a bigger budget wasn't needed. Maybe we could have cut costs in some areas to be able to spend in others. If we stayed at more Wal-Marts then maybe we could have stayed at more hotels or even had...
- More Vegan Restaurant Visits: We did go to a few vegan places across the country but a lot of the time we were focused on saving money and making food ourselves rather than seeking out vegan food. Part of it was that there wasn't vegan food available in restaurants in a large portion of the places we went to. We would have liked to have gone to more of the vegan restaurants in the places that had them or to work our travel more around visiting vegan places in small towns. Showing vegan restaurant food would have been more interesting for our blog/vlog than showing us eating rice and beans for the large majority of 2 months.
Planned around Vegan Festivals/Events/Meetups:
We know there were a few vegan festivals going on in Ontario around the time we were there. We should have planned to attend one of them. We were, however, playing the whole trip by ear, and it was hard to be in a specific place at the right time. We did visit quite a few people across the country including family, friends and fellow travellers but maybe we could have met up with more people.
There are lots of people on vegan Facebook groups across the country and it would have been a lot of fun to go to a vegan meetup. Also, sometimes there are travel blogger/vlogger events and it would have been fun to attend something like that on our trip. We did have fun in the big cities we visited but maybe we needed to have more events planned to make it worthwhile to visit longer. There is only so much sightseeing you can do in a city before it feels like it is time to move on.
Longer Trip:
Ideally, we wouldn't have got so exhausted being on the road and we'd be able to spend more time in each place. There were a few factors that contributed to the shortening of our trip such as exhaustion, SUV set-up, equipment, budget, and a shortage of meetups/events. Like we mentioned previously, we think that if we had a better set up we would have been able to last longer on the road trip. Since we were setting up/taking down our sleeping arrangements we were getting a bit exhausted. If we had a bigger budget we could have afforded to pay for the things that would have made the trip more comfortable and enjoyable. If we planned our trip to more events like vegan festivals or visiting more people then it would have kept things more interesting. Then we would have been able to last longer on the road.
What it comes down to is that we planned the best we could and made do with the tools we had in order to make this trip a reality. No trip is going to be perfect and some if not all of these proposed changes weren't possible because of time, money, logistics and time of year. Canada is a huge country and definitive planning of a road trip over such a huge distance is kind of pointless since things are bound to change. That is one of the things we would not have changed about our trip. We enjoyed the spontaneity and how our plans were so loose that we had the freedom to do whatever we felt like. Of course, you can plan a better trip with a bigger budget but it all comes down to drawing the line on whether or not the added expense will make the trip that much better.
We hope you enjoyed reading and can learn from some of these insights in order to make your own road trips better. Happy road-tripping.
If you are thinking about planning a road trip check our our post How to Plan a LONG Road Trip to get started!


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FILTER 46: Getting to Know: Serenades
By Mike Hilleary on December 22, 2011
Sitting in his apartment in Stockholm, Adam Olenius is having trouble finding the right word in English to best describe the balancing act of taking on a musical side project. Even the results of an Internet search finds little in terms of a satisfactory suggestion. ("Damn Google translator," he says with a sigh.)
"It's [tough] because I like those bands that stay together forever and are almost like a religion," says Olenius. "But bands can also get stuck. If you're the lead songwriter, it's really, really great to share your ideas with someone else or somewhere else."
The opportunity to do something different, to bounce ideas off someone who wasn't a longstanding fixture in his musical past is what largely brought the Shout Out Louds frontman to fellow Swedish musical artist Markus Krunegård (of Laakso). Meeting by chance while their respective bands were making a tour-traveling pit stop along the German autobahn, the two became close as they continued to run into one another at various Swedish festival and club performances. When their schedules would allow it, the two inevitably began working on demos together. "We were becoming friends," says Krunegård. "I don't know what people do when they become friends, whether they play badminton or drink beer. We both write music so it felt quite natural."
Dubbing the project "Serenades," the two eventually committed themselves to making a proper album last fall. The resulting full-length, entitled Criminal Heaven, swells with the kind of happy-go-lucky freedom typically reserved for kids prone to playing with make-believe friends. Taking cues from the likes of The Stone Roses and Panda Bear, the record layers itself in shimmering textures, dual vocal harmonies and lush, simplistic melodies. "We wanted to have a very playful sound," says Olenius. "Very collage-inspired music."
For roughly three months, the two artists recorded in a small studio just around the corner from where Olenius lives. At the onset, Olenius and Krunegård established a number of guidelines for the process. "It's hard to get two lead singers to work together," says Krunegård. "To have these egos together, you have to put up rules."
Among their various policies, the duo promised one another that they would treat their time in the studio like a regular workday. No extracurricular work for the album could be conducted outside the studio. "It was good that we had a time limit each day," says Krunegård. "It was a bit of a hurry every day, like, 'Oh, shit, we have to do this choir part!' It was good. You couldn't think too much. You have to work off of instant feeling instead of analyzing things. I think that's the problem with a lot of new music. Some people have no limit of time." Structuring themselves in this way, the two were regularly writing and recording a single song in the course of a day.
Another rule was that they both were to sing in lead harmony all of the time ("[On] only one song we do the revolutionary thing where we sing on our own," jokes Krunegård). Taking inspiration from religious hymns, Serenades songs were initially designed to follow the design of a spiritual mantra, repeating a single phrase or line with evolving changes in its delivery. Olenius and Krunegård eventually felt through the course of recording, however, that this kind of structure would alienate the majority of listeners, and began building off those beginning lines while maintaining the songs' overall sense of positivity and joy.
With the record scheduled for release in the U.S. in the spring of 2012, Olenius ultimately believes that just as Serenades became a new outlet for two artists looking for something new, Criminal Heaven is itself about escape and getting away from the norm. "It's sort of about just traveling far away," he says. Krunegård, meanwhile, elaborates that activities can be a little limited in Sweden. "It's cold and it's dark. You either make a lot of kids or a lot of music." F
3 albums that inspired Serenades to make music
The first pop record I ever listened to. I actually listened to it a couple months ago and it's still very good. All those long, extended mixes. And I've always liked George Michael. He was cool. ADAM OLENIUS
Fire of Love
Gun Club is still my favorite band. I love how Jeff Lee Pierce sings. MARKUS KRUNEGÅRD
The Stone Roses
I like the sweetness of the pop songs and how Ian Brown and John Squire did lots of harmonies together. There are some really, really good harmonies on that record. ADAM OLENIUS
This article is from FILTER Issue 46


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Clinical Effectiveness of Coronary Stents in Elderly PersonsResults From 262,700 Medicare Patients in the American College of Cardiology–National Cardiovascular Data Registry
Author + information
- Received February 13, 2009
- Revision received March 5, 2009
- Accepted March 9, 2009
- Published online May 5, 2009.
Author Information
- Pamela S. Douglas, MD*,* (pamela.douglas{at}duke.edu),
- J. Matthew Brennan, MD*,
- Kevin J. Anstrom, PhD*,
- Art Sedrakyan, MD, PhD†,
- Eric L. Eisenstein, DBA*,
- Ghazala Haque, MBBS, MHS*,
- David Dai, PhD*,
- David F. Kong, MD*,
- Bradley Hammill, PhD*,
- Lesley Curtis, PhD*,
- David Matchar, MD*,
- Ralph Brindis, MD‡,§ and
- Eric D. Peterson, MD, MPH*
- ↵*Reprint requests and correspondence:
Dr. Pamela S. Douglas, 7022 North Pavilion DUMC, P.O. Box 17969, Durham, North Carolina 27715
Objectives The aim of this study was to compare outcomes in older individuals receiving drug-eluting stents (DES) and bare-metal stents (BMS).
Background Comparative effectiveness of DES relative to BMS remains unclear.
Methods Outcomes were evaluated in 262,700 patients from 650 National Cardiovascular Data Registry sites during 2004 to 2006 with procedural registry data linked to Medicare claims for follow-up. Outcomes including death, myocardial infarction (MI), revascularization, major bleeding, stroke, death or MI, death or MI or revascularization, and death or MI or stroke were compared with estimated cumulative incidence rates with inverse probability weighted estimators and Cox proportional hazards ratios.
Results The DES were implanted in 217,675 patients and BMS were implanted in 45,025. At 30 months, DES patients had lower unadjusted rates of death (12.9% vs. 17.9%), MI (7.3 of 100 patients vs. 10.0 of 100 patients), and revascularization (23.0 of 100 patients vs. 24.5 of 100 patients) with no difference in stroke or bleeding. After adjustment, DES patients had lower rates of death (13.5% vs. 16.5%, hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.72 to 0.79, p < 0.001) and MI (7.5 of 100 patients vs. 8.9 of 100 patients, HR: 0.77, 95% CI: 0.72 to 0.81, p < 0.001), with minimal difference in revascularization (23.5 of 100 patients vs. 23.4 of 100 patients; HR: 0.91, 95% CI: 0.87 to 0.96), stroke (3.1 of 100 patients vs. 2.7 of 100 patients, HR: 0.97, 95% CI: 0.88 to 1.07), or bleeding (3.4 of 100 patients vs. 3.6 of 100 patients, HR: 0.91, 95% CI: 0.84 to 1.00). The DES survival benefit was observed in all subgroups analyzed and persisted throughout 30 months of follow-up.
Conclusions In this largest ever real-world study, patients receiving DES had significantly better clinical outcomes than their BMS counterparts, without an associated increase in bleeding or stroke, throughout 30 months of follow-up and across all pre-specified subgroups.
The dramatic reductions in restenosis and repeat revascularization associated with coronary artery drug-eluting stents (DES) compared with their bare-metal stent (BMS) counterparts (1) prompted swift adoption into clinical practice (2). However, reports of late stent thrombosis (3,4) and higher mortality (5,6) resulted in release of 2 special Food and Drug Administration (FDA) advisories in 2006 (7,8) as well as subsequent studies refining event rates (1,6,9–13). The rarity of late DES complications means that extremely large sample sizes are required to clarify their frequency. Furthermore, the ability to examine rates of lower frequency complications in important patient subgroups is limited in smaller sample sizes (14).
Accordingly, the Agency for Healthcare Research and Quality and the U.S. FDA commissioned the formation of a nationally representative percutaneous coronary intervention (PCI) database to determine the safety and effectiveness of DES and BMS among a contemporary "real-world" cohort. This was accomplished through linkage of the American College of Cardiology–National Cardiovascular Data Registry (ACC-NCDR) with the Centers for Medicare and Medicaid Services national claims database. The resulting analyses will better inform national practice patterns overall and in important patient and lesion-level subgroups.
Study population
The national ACC-NCDR CathPCI Registry collects information for patients undergoing PCI procedures. We included all CathPCI patients ≥65 years of age undergoing an inpatient intracoronary stent procedure between January 1, 2004, and December 31, 2006. Patients receiving more than 1 stent type (i.e., both BMS and DES) were excluded (Fig. 1).The Duke University Medical Center Institutional Review Board granted a waiver of informed consent and authorization for this study.
Follow-up information
Because ACC-NCDR data are limited to a single episode of care we used the research-identifiable Medicare 100% inpatient fee-for-service claims file for longitudinal patient follow-up. The PCI procedure codes (International Classification of Diseases-Ninth Revision-Clinical Modification [ICD-9-CM] procedure codes: 00.66, 36.0x, 37.22, 37.23, and 88.5x, except 88.59) were used to identify potential index procedure matches in the Medicare files, which were then linked to NCDR with indirect identifiers (nonunique fields that when used in combination might identify unique hospital stays) to create unidentified longitudinal profiles and obtain up to 3 years' follow-up. Linking rules used a hierarchy of evidence approach such that rules with the most information were applied before those with less information. Once a match was achieved for a patient, no further rules were applied. Our linking rules contained combinations of information denoting the index PCI procedure site, patient date of birth (or components thereof) or age, admission date, discharge date, and sex. In the rare event that a single ACC-NCDR record could be matched with multiple Medicare records with the same rule, no linking occurred. Sites that did not match to Medicare records were excluded, as were patients whose index PCI procedure did not occur during a period of fee-for-service enrollment.
Clinical end points
We evaluated 8 clinical end points: 5 events and 3 composites. Death was the only event defined both during the index PCI procedure (with ACC-NCDR information) and after discharge (with the Medicare denominator file). Clinical end points were defined with the Medicare claims file as the primary diagnosis for a hospital admission. The ICD-9-CM diagnosis codes used to identify events were: myocardial infarction (MI) (410.X1), stroke (430.X, 431.X, 432.X, 434.X), and bleeding (430-432, 578.X, 719.1X, 423.0, 599.7, 626.2, 626.6, 626.8, 627.0, 627.1, 786.3, 784.7, or 459.0). Revascularizations were identified with ICD-9-CM procedure codes (PCI: 36.00, 36.06, 36.07, 36.09; coronary artery bypass grafting [CABG]: 36.10-19). Only revascularizations occurring after discharge from the index hospital stay were included in the revascularization analysis. The composite events used in this study were: MI or death, MI or death or revascularization, and MI or death or stroke.
Statistical analysis
Baseline and propensity matching characteristics were categorized by stent type (DES vs. BMS) and summarized as counts and percentages for categorical variables and mean with standard deviations for continuous variables. Statistical significance was defined as p ≤ 0.05, with no correction for multiple comparisons, with SAS statistical software (version 9.1, SAS Institute, Cary, North Carolina) for all calculations.
Propensity score models
We used propensity scores to adjust for between-treatment group differences in baseline characteristics (15). Propensity scores represent the estimated probabilities of patients receiving DES versus BMS in our population (15), in this case conditioned upon 102 observed covariates (Online Table). Inverse probability weighted (IPW) estimators incorporating propensity scores were used to compare treatment groups (16). The propensity score model had a c-index of 0.690. In addition, the distribution of propensity scores for DES patients closely match those for BMS patients as evidenced by the 5-number summaries (min, 25th, 50th, 75th, max) describing the curves for patients receiving each type of stent: BMS (14.5%, 70.7%, 79.6%, 85.9%, and 99.1%) and DES (16.0%, 79.7%, 86.1%, 90.7%, and 99.5%). The overlap between the groups is excellent and suggests that the propensity score approach is statistically appropriate.
Inverse probability weighted estimators with monthly data partitions were used to calculate cumulative incidence rates for clinical end points (adjusted and unadjusted) (17,18). Unadjusted estimates were based upon Kaplan-Meier estimates for treatment-specific censoring distributions, whereas adjusted estimates were based upon weights that were functions of Kaplan-Meier censoring estimates and propensity score estimates (17,18). Adjusted hazard ratios (HRs) were calculated according to the IPW approach of Cole and Hernan (19). In particular, we calculated 2 IPW Cox proportional hazards models—1 with an indicator for DES as the only covariate and 1 with DES plus a selected group of clinically important variables including: sex, age, diabetes, renal disease, prior revascularization, prior MI, multivessel coronary artery disease, year of procedures, and race. From these models, we estimated the adjusted HR for DES versus BMS along with a 95% confidence interval (CI) on the basis of the sandwich estimated standard errors. To visually assess the proportional treatment effect assumptions, we plotted the monthly cumulative incidence rates over the 30-month follow-up period. Additionally, we plotted the treatment-group specific cumulative incidence rates excluding events from the first 6 and 12 months to identify the long-term component of the treatment effect. We refer to these latter analyses as 6- and 12-month landmark analyses.
Cox model
A Cox proportional hazards mortality model (without propensity score weighting) was developed with backward selection of the propensity score variables with a selection threshold of p = 0.05. Forward selection was used in a sensitivity analysis for internal validation of the final model, which contained 60 covariates. These models served to validate the adjusted HR estimates from the IPW Cox regression model method of Cole and Hernan (19).
Subgroup analyses
The PCI status included ST-segment elevation myocardial infarction (STEMI) (primary, rescue, or facilitated), urgent (non–ST-segment elevation myocardial infarction [NSTEMI] or unstable), and elective subgroups. Within the DES group, off- versus on-label use subgroups were examined. For patients enrolled in NCDR, with version 2 of the data collection form, off-label use was defined as intervention on ACC/AHA Type C lesion, PCI status of urgent or STEMI, intervention in a previously treated lesion, use of more than 2 stents in a lesion, treatment of a left main or graft segment, or multi-vessel PCI. For those enrolled using data collection form version 3, the off-label use definition was modified to also include device diameter ≤2.5 or >4 mm, total stented or lesion length ≥30 mm, and bifurcation lesions.
Sensitivity analyses
We conducted 2 sensitivity analyses. For the first analysis, each of the 5 main outcomes were examined in a subgroup of patients fitting the inclusion and exclusion criterion from the TAXUS IV (Treatment of de novo coronary disease using a single paclitAXel-elUting Stent IV) and SIRIUS (multicenter randomized double-blind study of the SIRolImUS-coated Bx Velocity stent in the treatment of patients with de novo coronary artery lesions) trials (n = 49,355) (20,21) with a recalibrated propensity score including 76 clinical variables with a c-index of 0.71.
The second sensitivity analysis estimated "cause of death" after stent implantation according to the primary diagnosis of a hospital stay during which the patient expired or the most recent hospital stay within 6 months of death. With a previously validated list of ICD-9 codes (22), we examined the relative distribution of causes of death across DES and BMS patients.
Between January 2004 and December 2006, 390,973 NCDR patients ≥65 years of age underwent stent implantation, and 76% were linked to longitudinal Medicare records. After exclusions, the study population included 262,700 patients from 650 sites (Fig. 1). Comparison of NCDR patients who did and did not match to Medicare records revealed nonmatch patients to be slightly younger (age 73 years vs. 74 years) and more likely to be men (62% vs. 58%) and to have commercial insurance (15% vs. 3%).
Overall, 45,025 patients received 1 or more BMS and 217,675 received 1 or more DES (54% paclitaxel-eluting, 46% sirolimus-eluting). Unadjusted baseline characteristics show significant differences between DES and BMS; these differences were reduced after propensity score weighting (Table 1).Sixty-nine percent of DES implantations were for non–FDA-approved indications. Mean follow-up for BMS patients was slightly longer (496 ± 371 days) than for DES patients (456 ± 302 days), due to the trends in stent use over the time period studied.
During the 30-month study period, 21,254 deaths occurred. Thirty-month overall mortality was higher in patients who received BMS than DES both before (17.9% vs. 12.9%; p < 0.0001) and after adjustment for population differences (16.5% vs. 13.5%, HR: 0.75; 95% CI: 0.72 to 0.79) (Table 2).The adjusted mortality difference was statistically significant in the initial 6 months after PCI and continued to increase throughout the 30-month follow-up period (Fig. 2A).The estimated HR obtained with an unweighted Cox proportional hazards mortality model with backward variable selection was similar at 0.79 with a 95% CI (0.76 to 0.81). In addition to the use of DES, other factors favorably influencing 30-month post-PCI survival included female sex and prior PCI or CABG. As expected, mortality was higher in those with diabetes, renal failure, STEMI, or congestive heart failure.
There were 10,528 MIs during the study period. Unadjusted MI rates at 30 months were 10.0 of 100 patients in BMS versus 7.3 of 100 patients in DES (p < 0.0001) with similar results after adjustment (8.9 of 100 patients vs. 7.5 of 100 patients, HR: 0.77; 95% CI: 0.72 to 0.81) (Table 2). This result was driven by lower MI rates in DES patients during the first 12 months after PCI (Fig. 2B), with no difference between 12 and 30 months of follow-up. In a secondary analysis, DES patients experienced a small increase in STEMI events beyond 12 months (Fig. 3).
Revascularization (PCI or CABG) was performed in 34,751 patients, with a total of 40,427 revascularizations; 30-month unadjusted revascularization rates for BMS and DES populations were 24.5 of 100 patients and 23.0 of 100 patients, respectively (p = 0.007). With risk-adjustment, no difference in overall revascularization was observed in DES versus BMS patients at 30 months (23.5 of 100 patients vs. 23.4 of 100 patients, HR: 0.91; 95% CI: 0.87 to 0.96) (Table 2) (Fig. 2C). However, revascularization rates were lower in DES patients 12 months after PCI (13.3 of 100 patients vs. 15.2 of 100 patients), followed by a late rebound in revascularization procedures in the DES group between 12 and 30 months (10.2 of 100 patients vs. 8.2 of 100 patients). When CABG and PCI revascularizations were examined separately, CABG was more common in BMS than DES over the 30-month follow-up period (3.7 of 100 patients vs. 2.5 of 100 patients), whereas the rate of PCI was similar.
Stroke and major bleeding
During follow-up, 4,010 strokes and 5,120 major bleeding events required hospital stay, with 59% of strokes and 49% of bleeds occurring within 6 months after PCI. Unadjusted and adjusted stroke rates were roughly 3 of 100 patients at 30 months in each group (HR: 0.97; 95% CI: 0.88 to 1.07), and only a minimal difference was noted in bleeding (3.6 of 100 patients BMS vs. 3.4 of 100 patients DES, HR: 0.91; 95% CI: 0.84 to 1.00) (Table 2) (Figs. 2D and 2E).
Composite end points
Each of the composite end points tracked closely with its individual components, favoring DES- over BMS-treated patients both before and after statistical adjustment (Table 2). The unadjusted 30-month rates of death or MI (17% vs. 23%), death or MI or revascularization (32% vs. 38%), and death or MI or stroke (19% vs. 24%) were each lower in DES than BMS patients.
Subgroup analyses
The 30-month DES survival advantage was present across all patient subgroups, independent of sex, age, comorbidities, and procedural indication or urgency (Fig. 4A).This effect was somewhat less pronounced in those with a prior history of CABG and renal failure, with or without dialysis. Notably, patients receiving DES in 2005 and 2006 had a greater relative survival benefit than those receiving DES in 2004. Similarly, the 30-month risk of MI was lower in all patient subgroups except those with renal failure and insulin-dependent diabetes (Fig. 4B).
Most patient subgroups experienced a slightly lower 30-month rate of revascularization with DES compared with BMS (Fig. 4C). However, no benefit was observed in patients age >75 years or with diabetes, renal failure, heart failure, or 3-vessel disease. Revascularization rates were similar in patients undergoing PCI in 2006, in contradistinction to the slightly lower DES revascularization rates from 2004 and 2005 (Figs. 4D and 4E).
Sensitivity analyses
Randomized Trial Cohort
The 49,355 NCDR registry patients fitting the inclusion and exclusion criteria for the Taxus IV and SIRIUS DES randomized controlled trials (RCTs) had 30-month outcomes similar to those of the overall population such that those receiving DES had a lower 30-month risk of death (HR: 0.62; 95% CI: 0.55 to 0.70), MI (HR: 0.66; 95% CI: 0.55 to 0.80), death or MI (HR: 0.64; 95% CI: 0.57 to 0.70), and revascularization (HR: 0.87; 95% CI: 0.80 to 0.96) compared with BMS. No difference in stroke (HR: 0.97; 95% CI: 0.74 to 1.28) or major bleeding (HR: 0.87; 95% CI: 0.71 to 1.05) was noted between trial-eligible DES and BMS patients.
Cause of Death
Presumed "cause" was extrapolated in 19,132 (90%) deaths with the algorithm described in the preceding text and included 8,451 inpatient and 10,591 outpatient deaths. Slightly more BMS deaths were attributable to MI (15.0% vs. 13.5%, p = 0.01) and malignancy (6.7% vs. 5.5%, p = 0.002), whereas more DES deaths were more attributable to chronic lung disease (2.5% vs. 1.9%, p = 0.01) and cerebrovascular disease (5.3% vs. 4.2%, p = 0.003). No significant differences were found for any of the remaining diagnoses. Overall, DES patients had a lower risk of cardiovascular-only (including congestive heart failure and MI) deaths compared with BMS patients (HR: 0.80; 95% CI: 0.74 to 0.86) as well as noncardiovascular death from all other causes (HR: 0.74; 95% CI: 0.70 to 0.78).
Our study is the largest-ever observational comparison of long-term outcomes in older patients receiving BMS or DES. A DES implantation was associated with lower risk of death and MI at 30 months as compared with BMS, whereas there were minor, if any, differences in bleeding, stroke, and overall revascularization. Our methodology allowed determination of comparative effectiveness in unselected individuals, in contemporaneous DES and BMS cohorts, with device selection and subsequent management of patients reflecting real-life, community practice.
Pre-specified outcomes
Prior analyses comparing survival in DES- and BMS-treated patients from RCTs and smaller registries have produced conflicting results with relatively low precision. Whereas no difference in late survival was demonstrated in some RCTs (1,23), registries, and meta-analyses (9–11,23–28), other more recent studies have demonstrated a DES survival advantage with a point-estimate similar to that observed in our population (13,29–32). The higher annualized mortality rates for patients in our population receiving either DES or BMS (5.4%/year vs. 6.6%/year) than previously reported in some registries (range 1.3%/year to 4.3%/year) (23–27,33,34) are likely due to higher risk in our elderly, inpatient population and are comparable to other Medicare cohorts (11,35).
Patients receiving DES experienced a 23% relative reduction in subsequent MI with no late increase in combined NSTEMI/STEMI risk, a result similar to several other analyses (1,9,11). Angiographic assessment of stent thrombosis was not possible in our dataset; however, isolated analysis of STEMI events revealed a slight increase in very late (>12 months) STEMI risk in DES patients, consistent with prior published reports on late stent thrombosis (6) and the expected time-course of clopidogrel discontinuation (36,37).
Although DES have been associated with low revascularization rates (6,9,11,13,29–32,34), recent registry reports suggest that they might actually be as high as 15% to 19% over a 2- to 3-year follow-up (6,11,26), with little difference between DES and BMS patients (6). The higher rate of repeat revascularization in our population (24%) might be due to not censoring patients after an event and to the inability to differentiate target lesion revascularization from nontarget lesion revascularization follow-up procedures with claims data. For example, a recent report from the Duke database identified a 2-fold higher rate of overall revascularization versus target vessel revascularization in DES patients at 2 years (12.0% vs. 6.6%) (26). Thus, the lack of anatomic data makes this database less than ideal for the comparison of revascularization between DES and BMS. An additional concern is the higher rate of late revascularization in DES compared with BMS, which tends to obscure the early benefit when examining overall DES-BMS HR. Our revascularization results should be interpreted cautiously.
Stroke and Major Bleeding
Few differences in stroke or major bleeding rates requiring repeat hospital stay were observed between the overall DES and BMS populations. The anticipated greater use of clopidogrel in the DES group might have conferred a bleeding disadvantage, as has been seen in other studies (38,39); however, no statistically significant difference was observed in our population. Unexpectedly, although a slightly higher unadjusted rate of anemia-associated deaths was observed in DES patients, no significant adjusted or unadjusted difference in gastrointestinal hemorrhage-associated deaths was evident at 30 months.
Registry versus RCT results: sensitivity analyses
The differences in outcomes between registry and RCT analyses have been previously attributed to possible differences in DES performance in a real-world (registry) population as compared with a restricted RCT population, with the lack of a survival difference in RCTs being an artifact of their restricted patient populations. Because creation of a population subset fitting the inclusion and exclusion criteria of the Taxus IV and SIRIUS DES RCTs (20,21) only sharpened the precision for each end point, differences in age, acuity, lesion characteristics, and off-label use in the registry and RCT populations are unlikely explanations of the observed differences in results.
Incomplete risk-adjustment after biased real-world stent selection might also contribute to the survival advantage noted in this and other registry analyses. Although we used both propensity analyses and Cox proportional hazards models to adjust for differences in baseline characteristics, it is possible that unmeasured baseline population differences remained. In fact, our "cause of death" sensitivity analysis did show slightly higher rates of death due to malignancy in BMS patients, suggesting that biased patient selection might have contributed to the overall mortality result, such that "sicker" patients with more comorbid disease received BMS. Although it is possible that the observed differences between DES and BMS patients are the sole product of unmeasured patient selection biases not reflected by this analysis, this explanation is less likely, given the large number of covariates used in our propensity matching.
Study strengths
This represents a novel large-scale linkage between a national procedural registry and a robust claims database, demonstrating that nationally representative analyses are feasible with clinically rich, procedural registries and a claims-based structure for follow-up. In combination, these 2 resources provide a powerful mechanism for tracking the post-marketing use and outcomes of novel devices and procedural innovations, at minimal cost. Importantly, the project was financed by the Agency for Healthcare Research and Quality and the Cardiovascular Consortium of Effective Healthcare Program and was independent of industry.
Data entered in NCDR are intended to be used as a quality improvement tool and undergo rigorous quality control (40), whereas the Medicare claims database captures all inpatient care episodes. Despite these disparate intents and the size and complexity of these 2 databases, our linkage rate was over 75%, adding to the generalizability of our results. We analyzed these data by 3 methods: IPW alone, IPW with Cox proportional hazards modeling, and standard Cox proportional hazards modeling to compare results between the different approaches. The high level of agreement between these methods enhances confidence in our findings.
Study limitations
Our data are observational and therefore dependent on the accuracy and completeness of the 2 matched datasets. Reliance on a claims database for outcomes might be fraught with under-reporting or misclassification of events. Such misclassification and underreporting should be nondifferential, however, and should bias our estimates toward the null value of no overall difference. Although differences in baseline characteristics were rigorously adjusted for using propensity weighting, it is possible that additional unadjusted differences between BMS and DES patients affected results, because our analyses are limited to the data collected by ACC-NCDR and Medicare. Thus we are unable to directly address some important questions that have been raised regarding the safety of stents, including whether repeat revascularization represented target lesion or vessel restenosis, the incidence of late stent thrombosis, and the impact of variations in thienopyridine use. Although the slight excess of STEMIs in DES patients after 12 months fits the time course of late stent thrombosis, these events did not translate to increased late mortality.
Although the linkage rate of 76% is incomplete, it is reflective of populations known to be absent from the Medicare data set, such as patients treated at Veterans Administration facilities, with Medicare Advantage insurance coverage, or undergoing outpatient procedures. Our findings are drawn from hospitalized patients over age 65 years, an age group that accounts for approximately one-half of all PCIs nationally. Although this cohort is likely sicker than the generally younger outpatient PCI population, the similarity in outcomes in those age 65, 75, and >75 years suggests that these differences might have been accounted for in the risk adjustment.
In summary, in this large population of Medicare beneficiaries undergoing PCI at facilities participating in the ACC-NCDR registry, patients who received DES had significantly lower mortality rates, including an early decrease in MI, than those who received BMS. No excess of major bleeding or stroke was noted. The survival advantage associated with DES was maintained across all subgroups analyzed and throughout the 30 months of follow-up. Drug-eluting stents seem to be safe and effective in community practice in the elderly population. Longer follow-up studies will need to be conducted to further support these results and to confirm the possible effects of antiplatelet agents.
For a supplementary table on the covariates used in the propensity score model, please see the online version of this article.
Clinical Effectiveness of Coronary Stents in Elderly Persons: Results From 262,700 Medicare Patients in the American College of Cardiology National Cardiovascular Data Registry[S0735109709007438_mmc1.doc]
This project was sponsored by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, Maryland, as part of the Cardiovascular Consortium and funded under Project ID: 24-EHC-1 and Work Assignment Number: HHSAA290-2005-0032–TO4-WA1 as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Additional support was obtained from the National Cardiovascular Data Registry, American College of Cardiology, Washington, DC. Dr. Anstrom has received research support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Co., and Medtronic, and has served as a consultant for Johnson & Johnson and Pfizer. Dr. Eisenstein has received research support from Medtronic Vascular and Eli Lilly and Co. Dr. Curtis has received research support from Allergan, Eli Lilly and Co., GlaxoSmithKline, Medtronic, Merck & Co., Johnson & Johnson (Ortho Biotech), Novartis, OSI Eyetech, and Sanofi-Aventis. Dr. Peterson has received research support from BMS/Sanofi and Merck/Schering.
- Abbreviations and Acronyms
- American College of Cardiology
- bare-metal stent(s)
- coronary artery bypass grafting
- confidence interval
- drug-eluting stent(s)
- Food and Drug Administration
- hazard ratio
- inverse propensity weighted scoring
- myocardial infarction
- National Cardiovascular Data Registry
- non–ST-segment elevation myocardial infarction
- percutaneous coronary intervention
- randomized controlled trial
- ST-segment elevation myocardial infarction
- Received February 13, 2009.
- Revision received March 5, 2009.
- Accepted March 9, 2009.
- American College of Cardiology Foundation
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Discover the Bund, Shanghai's most popular place (aka Waitan), with it's colonial buildings and skyscraper views, using our travel tips and tour map.
For a century, the Bund has been one of the most recognizable symbols and the pride of Shanghai. The architecture along the Bund is a living museum of the colonial history of the 1800s. You've never been to Shanghai if you haven't seen the Bund.
The Bund is a mile-long stretch of waterfront promenade along the Huangpu River. To the west of this stretch stand 52 buildings of various architectural styles, including Gothic, baroque, and neoclassical styles. It is often referred to as "the museum of buildings".
The best way to appreciate the buildings is to have a walk along the Bund. Roaming among the architectural complexes, you'll have a better understanding of the century-long charm of this city.
We have specially designed a 2½-hour in-depth Bund culture discovery tour for those who want to learn more interesting stories about the Bund and old Shanghai...
For more details see for example Day 1 of our customizable 2-Day Shanghai Essence Tour itinerary.
After a walk along the Bund, you can consider taking a Huangpu River cruise. On the cruise, you will see the historical architecture on the Bund, as well as the modern skyscrapers opposite the Huangpu River, giving you a distinctive contrast between modern life and the past.
There are several tour lengths you can choose from, from a 30-minute cruise to a 3½-hour cruise.
You are recommended to take a night cruise and you will be impressed by the enchanting night view of Shanghai.
If your time is limited and you want to save some money, you can take a ferry across to Pudong. It costs 2 yuan but still provides an opportunity to see the scenery on both sides of the river.
The Bund is not just a place for tourists but is also a great place for the local people to do their morning exercises. If you wake up early, you can go to the Bund and watch the locals practicing tai chi, jogging, and more. It is a way to experience the real lifestyle of the local people.
At the northern end of the Bund is Huangpu Park. It is like a small oasis situated between the Bund and busy shopping areas. The manicured lawn and gardens particularly stand out as there is not much green space in this part of Shanghai.
It is a wonderful place to have a rest and to take photos, day or night.
There are three ideal locations to see the full view of the Bund: Pudong Binjiang Avenue, on a Huangpu River Cruise, and one of the skyscrapers in Pudong like Shanghai World Financial Center, Oriental Pearl TV Tower, Jin Mao Tower and Shanghai Tower.
If you want to take beautiful photos of the Bund, we advise you to hire a guide who can give you tips about when and where to go. A knowledgeable guide can arrange different places to take photos according to the weather.
The best time to visit is before sunset. You can enjoy the sunset over the Huangpu River and stay until late evening to gaze at Shanghai's spectacular skyline.
The Bund is a landmark of Shanghai and is full of history and culture. To travel with a professional guide is necessary and helpful if you want to learn the story behind it. Please feel free to contact us if you need any assistance on your tour arrangement.
Here are our most popular Shanghai tours including the Bund:


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MV Appeal process and time
PUT/ UT/Work permit
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MV Appeal process and time
PUT/ UT/Work permit
9.Aug.2019, 05:22 AM
Post #1
Joined: 24.Feb.2019
So I was wondering if anyone has been through the appeal process with MV? (specifically for PUT) What did you have to do? How long did it take? I would appreciate any and all info regarding the process.
I was told while the appeal is ongoing, I cannot travel to Sweden. Is there anything else I should know and be aware of?
Also when sending in your appeal, did you send in a physical letter or an email? Was it addressed to someone specific? I am asking specifically for someone that's residing outside of Sweden currently. Is the appeal process the same for someone on a UT or work permit?
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Also known as demon lover.
In occult lore, a lewd female demon or goblin which takes on the illusory appearance of a female human being and seeks sexual intercourse with men, usually while they are asleep.
The princess of all the succubi (plural) is Nahemah. Its male counterpart is called Incubus. A semi-human offspring is called Cambion.
According to the church fathers, the succubus was an angel who fell from grace because of his insatiable lust for men. As a demon, the Succubus continued with its carnal desires, preying upon vulnerable men, tempting them in their sleep and inciting sexual desires that only herself could satisfy.
Traditional wisdom professes that demons were only spirits and had no corporeal form. To be able to do his 'thing', Succubus was presumed to come upon its physical form in one of two ways: either reanimating a human corpse, or using human flesh to create a body of its own, which was then endowed with artificial life.
Especially mischievous and clever succubi made themselves appear in the persons of real people a wife, a neighbor, a friend, a sexy maiden.
So how could a man tell for sure if his lover was a demon or not? There were a few clues. If he freely admitted the succubus to his bed, it would have the power to put everyone else in the house into a deep sleep — even his wife, who might be lying right beside him.
According to the view of most medieval theologians, incubi outnumbered succubi by nine to one, but the ladies made up in menace for what they lacked in numbers by being alluring and persuasive, using their considerable charms to seduce men and lead them to eternal damnation.
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Sources: (1) Masello, Robert, Fallen Angels. . . and Spirits of the Dark, The Berkley Publishing Group; (2) The Encyclopaedia Britannica Eleventh Edition Handy Volume Edition, Oxford University Press; (3) Dictionary of the Occult, Caxton Publishing; (4) Melton, J. Gordon and Shepard, Leslie A. (editors), Encyclopedia of Occultism and Parapsychology, Gale Group.
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This is the latest installment in our Energy Startup Series that gives executives at cutting-edge energy firms an opportunity to share insights and experiences about the energy industry, their careers and their companies…
The garages of Palo Alto are famous birthplaces for some of the most impactful high-tech companies in history. But for Quin Garcia, a managing director of the Palo Alto venture capital firm Autotech Ventures, garages represent not only the birthplace of high-tech startups, but also the key to solving major transportation energy and safety challenges.
With a team of venture capitalists, transportation executives, and entrepreneurs, Autotech's goal is to bridge the gap between innovative startup companies and large corporations to deploy new road transportation technologies. Energy and transportation are inextricably linked; this Q&A gives insight into how the transport sector is looking at the energy puzzle.
1- What is the greatest challenge facing the energy industry over the next 5 years?
In terms of the intersection of transportation and energy, our biggest challenge is finding a way to transport people and goods along roads without inflicting damage on our society. Road transportation is responsible for a major portion of the world's energy consumption, emissions, and human fatalities, but we can apply many existing energy and information technologies to the road transport sector to improve energy efficiency, emissions, and safety.
2- What has been the biggest positive energy industry change since the start of your career?
During the 20th century in the road transportation sector, vehicle designs remained fundamentally unchanged, information technology was underutilized, and startup companies made little impact. But, in just the past decade, new technologies are making their way into vehicles, the information technology sector (eg. Google) is converging with the transportation sector, and even the most conservative auto industry corporates are embracing startups as a source of innovation. The past 10 years have already altered the transportation sector, but in the coming years we'll see even more dramatic transportation technology advances which will eventually culminate in fully autonomous vehicles, zero road fatalities, and dramatically increased energy efficiency.
3- What has been the biggest negative energy industry change since the start of your career?
During the Cleantech buzz of 2005-2010, the venture capital community invested enormous amounts of capital into transportation energy startups, but most of these investments failed due to the venture capital community's lack of deep understanding of the transportation sector. As a result, from 2010-2013 it was very difficult for transportation startups to get funded, but recent successful transportation startups like Lyft, Mobileye, Tesla Motors, Uber, and Waze are leading a resurgence.
4- What is the greatest satisfaction of working in an energy-related field?
As venture capital investors in road transportation, we have early visibility on new transportation technologies that will dramatically alter our society some years down the road (no pun intended). It's not only exciting to see groundbreaking transportation startups when they're still just an idea, but it's also rewarding to support these startups and their corporate partners as their technology becomes widespread and impactful.
5- What is the greatest frustration of working in an energy-related field?
A relatively small group of large and powerful corporations historically controlled much of the road transport ecosystem, and in many cases these corporations were hesitant to change, or even worse unaware of the need to change. For many years, this delayed commercialization of new transportation technologies, but luckily most of these large corporations have now realized that technological change is not only in their interest, but inevitable as well.
6- What is your firm's greatest strength?
Our firm's greatest strength is our focused expertise at the intersection of road transportation and venture capital. We only partner with leading investors, corporations, and startups which share this interest, so we leverage the road transport knowhow of these partners as well. We're proud to say that unlike most generalist venture capital firms, we only do road transport, so we know very little about biotech, water tech, social media, or bitcoin.
7- What do you think the future holds for energy technology?
Many future transportation technologies will not be developed by large corporations alone, but via partnerships between large corporations and nimble transportation startups. We see many startups coming up with new mobility service, infotainment, driver assistance, and vehicle energy efficiency technologies, and over the coming years these startups and their corporate partners will grow to improve the convenience, safety, emissions, and efficiency of transporting people and goods along roads.
8- What is your favorite energy-themed film or television show?
My favorite show is "Jay Leno's Garage", as the guy is not only funny, but has the most ridiculous garage of futuristic and historical vehicles I've ever seen. If anyone knows Jay Leno, please let him know I'd be more than happy to pay HIM to let me work as his mechanic and hang out in his garage.
9- What is your favorite energy-themed book (fiction or non-fiction)?
This may sound nerdy, but I grew up building cars in my garage, and was obsessed with technical books and repair manuals for classic cars and racecars. I still have all those manuals, but nowadays they're just collecting dust. It may not be a book, but the movie Interstellar really got me thinking about new ideas.
10- What would you have been if you didn't work in energy?
I'd probably still be messing around with startups and cars even if it weren't my "job", so why not make living out of it!
Source: Breaking Energy


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Richemont, the world's second largest luxury group, has tasked business bank Nomura to find a buyer for Lancel, a French leatherwear brand, because of its disappointing results.
Half a billion euro
The Swiss luxury group hopes to receive some 500 million euro for the French label, having bought it in 1997 for some 210 million euro. It seems quite a hefty price for a company that has taken losses for years: in 2011 it managed to return to positive numbers, but fiscal year 2012 has seen another loss of 20 million euro, with a turnover of 350 million euro. Those disappointing results meant that Marty Wikstrom, CEO of Richemont's fashion and accessories branch, left the company last May.
Three quarters of Richemont's turnover comes from jewelry (Cartier, Van Cleef & Arpels) and watches (Piaget, IWC, Jaeger-LeCoultre among others), but the company is also actively involved in the fashion and leatherwear sector with brands like Lancel, Alfred Dunhill, Azzedine Alaia and Chloé.


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Water resources are not endless, but must nevertheless support huge and ever increasing social and economic needs. Structured water resources management is therefore of major importance to ensure them to sustainably comply with these needs.
Water resources management / Water quality
In the use of water resources different demands must be evaluated against availability. Strategies must be developed in order to establish priorities, and to determine whether water saving measures are required. Not the mere availability, but the availability of sufficient fresh water resources of good quality is important. Different users may require different qualities. Salt water intrusion along estuaries and canals and saline coastal aquifers require specific attention. Sufficiently good water quality is required for the conservation of wetland and river ecosystems. IMDC provides the necessary tools to model availability and quality, to investigate scenarios and to develop strategies.
Impact assessment / Climate change Large infrastructural projects exert huge pressure on the water system during and after works. Changes in water quality, ground and surface water levels, etc. may strongly affect nature, agriculture, stability of foundations, etc. IMDC uses different types of models to study the changes in the water system, allowing for the evaluation of effects on the environment, and to study measures to mitigate the effects. IMDC often provides technical input for EIA. Climate change influences the hydrologic regime. Using perturbation factors derived from climate models IMDC calculates the effect of changes in temperature and rainfall on discharges using hydrological models. This allows us to take climate change into account when evaluating water resources.


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Dec 10, 2011 - 2:13 pm
I completed Avastin maintenance Oct 27th. I have bowel issues, but yet feel blah. I don't have to nap everyday, that is better...but just feel down...and sad... Anyone feel this way?
Dec 12, 2011 - 4:15 pm
Double post
Dec 12, 2011 - 4:14 pm
Thought I'd just reply to your post. I am not in remission but I do understand sadness. I spend a lot of my time trying to be cheerful and upbeat whenever I am with my friends and family. So often when I am alone I feel sad.
I am sad that this disease has appeared and I have not control over it
But I am grateful that I am still here and I will make the most of everything I still have. Having cancer has made me count my blessings and I love my friends and family so much.
Tina xxx
Dec 12, 2011 - 6:06 pm
Oh Tina...
You list many things to be sad about; I feel for you, truly. Despite which, you are an inspiration and as I have followed you here for just a few months, I so admire your knowledge, courage and honesty. I guess sadness is relevant to one's particular situation. I remember this past April, being finally free of chemo, returning to work and normality, I was incredibly "sad" and couldn't really work out why. None the less, it lifted and I have eased back into life pretty much as it was before. The oncologist told me to be realistic about PPC and it's recurrance rate so with that information, I try to go forward enjoying these free days....like you say, making the most.
With best wishes for Christmas and the NY,
Dec 12, 2011 - 7:43 pm
I feel terrible reading about ur sadness. I think i always assume u are the strong one on here. I just hope that you know how special u truly are. I cannot change anything u are going through, but i tell you this, everyone in ur family, friends, etc. they will all be better people for knowing you no matter how long a period of time.
Dec 14, 2011 - 7:23 am
And that's what you have to leave to your children, your grandchildren. You will never really leave them because the legacy which is you is already running wild in their hearts and in their voices. You are in them now, empowering them now.
I agree with Best Friend.
And though I cannot say honestly that I feel the sadness that Carolyn feels - only because I'm not in your space Carolyn - when Tina lists her reasons for being sad, it becomes easy to feel her sadness.
Carolyn, I think often it's harder to find yourself feeling sad, for example, when you don't know *why* you do. But then again, you are still having bowel difficulties. Another thing which just comes to my mind is the rememberance of those times when I've come through a tremendous upheaval or crisis and it is *aftward*, when I realize that I've come through that, that can leave me feeling most need of support. I don't know why. It's as if I am able to bring all my strength to deal with the crisis, but find I have none left after it is over, and that's when I am most in need in support.
I don't know if that goes in any way though to the sadness that you are experiencing. Either way, your experience of illness is an ongoing thing.
You get the right to be sad on any day of any week that you like!
Hugs and my best wishes,
Dec 16, 2011 - 4:55 pm
Tina, I feel your sadness.... but, I also feel your strength. I haven't been on this board long, but I know you are a great support to others and I hope that in this all..you will know you are never alone....we are all here for you. Every morning I wake up, I come to this board and read. Today, I wrote out cards and cleaned....so I am a bit delayed....keep your head up high...I feel best too when I am busy with family-friends...or just to grocery store...this disease sucks! Have a good day.....
Dec 12, 2011 - 6:19 pm
Hello Carolyn,
I had a period of time back in the Spring when I was incredibly "sad"...I did post a comment here atually to find out if anyone else had felt such feelings.
Wishing you all the best,
Dec 13, 2011 - 9:30 pm
Yes we all have every reason to be sad and we must work thru this and come to terms with things. If the sadness goes on for a bit or I feel like I cant climb out of it I turn to low dose anti-depressants. I have used them for short periods of time a couple times. I would have used them all the time if I felt I needed them. I feel we have enough to deal with that we should do whatever makes us feel better.
Dec 16, 2011 - 4:49 pm
Thanks ladies for your suggestions.....I just found out my bowel issues are C Diff...a bacterial infection in the GUT! I have talked to my doctor about sadness, she is not one to give meds to for that, she says...so I went to my primary and she gave me celexsa ??
Dec 16, 2011 - 5:36 pm
My sadness is not a constant. It comes and goes and just lately it is less than it used to be. Thank-you to everyone who has showed me concern. I am taking anti-depressants which help me a lot but as it has been 2 years since my diagnosis I have kinda gotten used to having a terminal illness. It seems like I have always had it and I have new friends who have only ever known me "with cancer".
What I am trying to say it that it is something we get used to as we find a way to live our lives "with cancer". It becomes normal to go to the chemo clinic for chemo. It becomes normal to feel 'sicky' sometimes and tired other times. When you lose your hair or it thins - you accept it as normal because that's how things are for me now.
So I try to look for the positive aspects of my situation and I have discovered that I love my life. I know it sounds daft but I appreciate everything that I have. I have lots of good good friends who care for me. I am able to spend quality time with my family and I am loving my job which in tunr helps me to feel "normal" and when I am at work I am Tina the teacher and not Tina with cancer.
So sadness comes now and again and it doesn't overwhelm me as much as it used to do. A little tip that may help you - Everyday try to count your blessing and think of at least one thing you are pleased to have in your life.
Love and hugs to all of my friends on here, love Tina xxx
Dec 25, 2011 - 10:24 pm
"So sadness comes now and again and it doesn't overwhelm me as much as it used to do."
A little tip that may help you - Everyday try to count your blessing and think of at least one thing you are pleased to have in your life.
Dec 26, 2011 - 8:09 pm
I am trying to be thankful. I know times i act like a big baby and all. It is ok to be sad. I am just happy that i can have those moments on here so people don't think i am losing my mind while at work and such. Thanks to everyone.I am truly thankful to have met all of you.
Dec 27, 2011 - 2:49 pm
I actutually started a "blessings" book and try to write down each time I see something that is a blessing and I found I couldnt even keep up!


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TV-radio notebook: KILT leads way as sports stations rise
The advent of monthly Arbitron reports has made writing about Houston sports radio ratings a little bit like living through Groundhog Day every four weeks.
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KILT's morning show tied for fourth overall and for second among English-language stations in men 25-54, the key demographic for sports radio. Its afternoon show was fifth overall and second among English-language stations.
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KILT's lightning rod
And now it's time to pay off an agreement I made with KILT program director Gavin Spittle last fall. I told Spittle if KILT could crack the top 10 in men 25-54, I would have an extended chat with Josh Innes, KILT's afternoon drive co-anchor and clearly the most polarizing sports talk guy in Houston in the 15 years I have been writing about radio and TV here.
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The Kanobis Amplifier Research Facility
Artist Statement
Kanobis Amplifier Research Facility (KARF) is an installation/performance art work by Steve Storz (see stevestorz.com for images). KARF was initially envisioned to be an outdoor installation set in New Mexico, surrounded by sage bushes and chamisa plants, under the vast blue sky of the southwest. Although KARF was not intended as an historical re-creation, it was a manifestation of my imaginings of the covert and inaccessible science industry of New Mexico, particularly during the period of time when Los Alamos National Laboratories was initially established. My mind conjured its own version of what was going on with all the roads, special vehicles, water tanks, electrical power plants, and secretive people who were part of first establishing the Los Alamos Labs. What was going on behind those tall and dangerous fences, windowless buildings, and spread-out installations with their stoic guard shacks? Over the years my own installation formed in mind. I reflected on the historical materials I would gather as I imagined the rudimentary structures of the first facilities in Los Alamos. I explored the work-shed of Robert Goddard, where he developed his first rockets in Roswell. I researched the early attempts to establish "technology clusters" in the Albuquerque area. KARF is a manifestation of my fantasies built around the now antiquated New Mexico technologies and infrastructures. KARF now consists of The Shed installed with two electronic research stations and a live performance. Two actors perform as the "researcher" and the "liaison". There are opportunities for viewers to interact closely with the installation/performance.


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The AV Awards 2013 Shortlist has been announced! Feltech are once again standing out in the field of AV Systems Integrators with their JCB Presentation Theatre project. Shortlisted in the Business Installation of the Year category, the winners are due to be announced on October 11th at the Hilton on Park Lane.
JCB have had a presentation theatre for many years, however many of their systems had become obsolete and sporadic updates of single elements through the years had led to a mismatched and counter intuitive system with many flaws. JCB as a whole is very focused on the environmental impact of its product and operations and previous systems were particularly inefficient and energy-hungry.
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A key consideration for JCB's Theatre upgrade focused on the need to address environmental targets within the lighting scheme.
A new modular rigging structure was created to support multiple intelligent light installations, with ECO LED Intelligent moving head light and colour wash fixtures for the stage area and ECO LED Chroma Pixel Strips for side wall effects. These changes have reduced the power consumption of the facility by 60%, one of the major goals of the upgrade.
Strobe lighting, laser scanners, hazers and fog machines to boost lighting and laser effects were specified to enhance the stage shows, alongside a white cyclorama at the rear of stage for virtual backdrop projection.
Feltech specified lighting consoles from Avolites, incorporating touch control with hardware faders, and DMX distribution around the stage area and auditorium.
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Want to find out more?
For more information about AV Systems Integrator Feltech and the JCB Presentation Theatre project click here to see the case study.