text:
HIV treatment
Sep 15, 2007
Sir, can antirectoviral drugs be taking to prevent HIV infection.
Response from Dr. Frascino
Hello John,
The concept you are referring to is called PrEP (Pre-Exposure Prophylaxis). There are several clinical trials in process that are attempting to evaluate the feasibility and efficacy of various PrEP regimens. I'll post some information from the archives related to PrEP below.
Stay tuned to The Body. We'll keep you posted as more information becomes available on this and other measures to prevent HIV transmission.
Dr. Bob
taking anti-retro regularly as a prohylaxis? (PRE-EXPOSURE PROPHYLAXIS) Jul 22, 2007
Hase there been any research on developing a medication as a ant-retro prophylaxis?
The idea would be, if you are negative and sexually active, take a pill a day and you would reduce your risk.
Response from Dr. Frascino
"Anti-retro prophylaxis"??! Hmmm . . . sounds like some type of magical charm to ward off polyester leisure suits, neckerchiefs and platform shoes.
What you are wondering about is called PrEP or Pre-Exposure Prophylaxis. And yes, there has been considerable research on this topic as well as ongoing clinical trials. PrEP is not yet ready for "primetime," but some studies do look encouraging. I've discussed this topic several times before (check the archives of this forum). I'll reprint some recent information from the CDC below pertaining to PrEP clinical trials. (By the way, anyone wearing polyester leisure suits, neckerchiefs and platform pumps is automatically excluded from entering these clinical trials.)
Dr. Bob
Q & A: CDC's Clinical Studies of Pre-Exposure Prophylaxis for HIV Prevention
April 2007
Research Rationale Why is CDC launching trials of pre-exposure prophylaxis for HIV prevention? CDC is sponsoring these trials because safe and effective new approaches to HIV prevention are urgently needed. Worldwide, nearly 11,000 people continue to become infected every day (over four million per year). In the United States alone, an estimated 40,000 people become infected each year. Although behavior change programs have contributed to dramatic reductions in the number of annual infections in the United States and many other nations, far too many people remain at high risk.
With an effective vaccine years away, there is mounting evidence that antiretroviral agents may be able to play an important role in reducing the risk for transmission. Researchers believe that an HIV drug approved by the Food and Drug Administration -- tenofovir disoproxil fumarate (tenofovir, brand name Viread) used alone or in combination with emtricitabine (together, known by the brand name Truvada) -- taken daily as an oral preventive is among the most important new prevention approaches being investigated today. The approach is called pre-exposure prophylaxis, or PrEP.
If proven safe and effective, PrEP could help address the urgent need for a female-controlled prevention method for women worldwide who are unable, because of cultural and other barriers, to negotiate condom use. Furthermore, if effective, it could provide an additional safety net for all men and women at risk due to sexual or drug-using behaviors, when combined with reducing the number of sexual partners, HIV counseling and testing, condom use, use of sterile syringes, and other prevention measures.
How would HIV treatment drugs work to protect against HIV infection? The concept of providing a preventive before exposure to an infectious agent is not new. For example, travelers to an area where malaria is common are advised to take medication before and during travel to prevent the disease. The medicine to prevent illness is then already in their bloodstream if they are exposed to the malaria parasite.
Researchers believe that the same concept may work to protect people from HIV infection. Theoretically, if HIV replication can be inhibited from the moment the virus enters the body, it may not be able to establish a permanent infection.
What data suggest that this approach may be safe and effective? Several sources of data suggest that an antiretroviral drug, taken regularly, may prove effective in reducing a person's risk for infection:
Providing a single dose of the antiretroviral drug nevirapine to HIV-infected women during labor and to their newborns immediately after birth has reduced the risk for mother-to-child transmission of HIV about 50%. In observational studies, the antiretroviral drug zidovudine, taken soon after exposure and continued for several weeks, has been associated with an 80% reduction in the risk of HIV infection among health care workers after needlesticks or other accidental exposures. Animal studies have shown that tenofovir, administered before and immediately after a single retroviral exposure, can reduce the transmission of a virus similar to HIV in monkeys. Finally, animal studies have also demonstrated that pre-exposure administration of tenofovir plus emtricitabine, provided significant protection to monkeys exposed repeatedly to an HIV-like virus. The safety and efficacy of tenofovir and a tenofovir-emtricitabine combination pill for the treatment of HIV infection has been well established in clinical studies and medical settings. The U.S. Food and Drug Administration (FDA) licensed tenofovir for use as an HIV treatment in adults in October 2001, and licensed the tenofovir-emtricitabine combination pill for use as an HIV treatment in August 2004. Over 150,000 HIV-infected patients around the world have now used these drugs. Among these patients, tenofovir has resulted in a relatively low level of side effects, compared to other HIV treatments. The most common side effects include nausea and vomiting, and loss of appetite. Tenofovir plus emtricitabine has also been associated with a relatively low level of side effects, which include diarrhea, nausea, fatigue, headache, dizziness, and rash.
One of the key objectives of these trials is to determine for certain whether the study drugs are safe and well tolerated by HIV-negative persons; and safety will be closely monitored throughout the trials. Researchers expect side effects to be even less common in the healthy, HIV-negative volunteers in these HIV prevention trials.
Why study two different drugs? Globally, an estimated 11,000 new HIV infections occur daily. As such, additional prevention approaches are urgently needed. A combination of studies -- of both tenofovir alone and tenofovir plus emtricitabine -- will allow us to move forward as quickly and effectively as possible in the search for new solutions.
There are significant data suggesting the promise of both of these HIV treatment drugs. Because we don't yet know for sure how the animal data will correlate to human protection, we believe it is essential to move forward as quickly as possible to evaluate both of these promising interventions.
Trial Designs and Objectives What specific CDC studies are under way or planned? CDC is currently sponsoring three separate trials in Thailand, Botswana, and the United States, which together are designed to answer important questions about the safety and efficacy of PrEP for several of the populations now at greatest risk for infection worldwide. In all, these trials will involve 3,600 participants.
In Thailand, CDC is conducting a trial to determine if once-daily oral tenofovir is safe and effective in reducing HIV transmission among injection drug users (IDUs). The trial is being conducted in collaboration with the Bangkok Metropolitan Administration and the Thailand Ministry of Public Health. In Botswana, CDC is conducting a trial in collaboration with the Botswana Ministry of Health to provide data on the safety and efficacy of a once-daily tenofovir plus emtricitabine pill in reducing transmission among young heterosexual men and women. The Botswana research will also provide important information on the safety of tenofovir alone in this population. Because the trial had originally planned to study tenofovir alone (before there was evidence to support initiating trials of tenofovir plus emtricitabine), the study had already enrolled 71 high-risk men and women. Researchers continued to follow these participants until the new trial was initiated to obtain data on the safety of tenofovir alone.
In the U.S., CDC is evaluating the safety and tolerability of once-daily tenofovir alone among men who have sex with men (MSM). This trial will not be large enough to evaluate the drug's effectiveness in reducing HIV transmission. It is being conducted in collaboration with the San Francisco Department of Public Health, the AIDS Research Consortium of Atlanta, and Fenway Community Health in Boston. (Note: The efficacy of a once-daily PrEP regimen among MSM in Peru and Ecuador is being evaluated independently by the National Institutes of Health.) In addition to the three trials currently under way, CDC is in the planning stages for a separate U.S. study to assess the clinical safety of tenofovir plus emtricitabine in HIV-uninfected persons. Potential sites for this study are still being evaluated.
What other issues will the trials examine? All three CDC studies are also designed to address several issues that will be critical to the design of future studies, as well as HIV prevention and treatment programs.
Impact on behavior: Understanding the potential impact of use of a daily preventive drug on HIV risk behaviors will be critical should any PrEP drug prove effective in reducing HIV transmission. One of the greatest risks, as efforts progress to identify new biomedical prevention approaches, is that persons at risk for HIV infection will reduce their use of proven behavioral prevention strategies. Because no single prevention strategy will be 100% effective against HIV transmission, reducing transmission will require determining how best to integrate all available prevention strategies -- both biomedical and behavioral. During the trials, all participants will receive state-of-the-art HIV risk-reduction counseling and other proven HIV prevention interventions.
Adherence and acceptability: Even if these trials demonstrate that PrEP can reduce HIV transmission, it is critical to understand whether persons at risk will be willing and able to maintain consistent use of a daily drug. These trials will therefore closely examine participants' adherence to, and acceptance of, daily oral preventive drug use.
Resistance: A key question about resistance will be addressed during the trials. Although resistance to tenofovir is uncommon among HIV-infected persons when used in combination with other drugs, it is unclear how often resistance may develop if prophylaxis fails and persons become infected while taking tenofovir alone. Similarly, while the risk of drug-resistant virus will likely be lower in the tenofovir plus emtricitabine trial, due to the presence of two drugs, it will be important to assess any resistance to either drug that emerges.
Several study procedures have been designed to minimize the risk of resistance among any individuals who become infected despite receiving PrEP. Regular HIV testing with a rapid HIV test and immediate discontinuation of study pills if participants become infected will result in a very low risk of resistant virus emerging. Additionally, HIV resistance testing will be provided to all persons infected during the trial. These data will provide important information on the degree to which resistance occurs and will help guide treatment decisions as infected persons are referred to treatment and care.
When did the trials begin and how are they designed? The Thailand and U.S. trials of tenofovir began in 2005 and the Botswana trial of tenofovir plus emtricitabine began in early 2007. All three trials are randomized, double-blind, placebo-controlled trials. In each trial, all participants receive risk-reduction counseling and other prevention services, including condoms. In addition, half of the participants are assigned by chance to receive one antiretroviral pill daily (either tenofovir alone or tenofovir plus emtricitabine, depending on the trial site), and the other half are assigned by chance to take one daily placebo pill (a similar pill without active medication). Neither researchers nor participants know a participant's group assignment. This design allows the researchers to determine in a scientifically valid way whether the risks for side effects and HIV infection are different for persons taking the study drug versus persons taking the placebo.
Botswana and Thailand
The trials in Botswana and Thailand are safety and efficacy trials. The Botswana trial is examining the safety and efficacy of tenofovir plus emtricitabine, and the Thailand trial is examining the safety and efficacy of tenofovir.
Botswana: The Botswana trial is being conducted in collaboration with the Botswana government and is enrolling 1,200 HIV-negative heterosexual men and women, aged 18-29, in the nation's two largest cities, Gaborone and Francistown. Participants are being recruited at a number of venues, including HIV voluntary counseling and testing centers, sexually transmitted disease and family planning clinics, youth organizations, and community events.
Thailand: The Thailand trial is being conducted in collaboration with the Bangkok Metropolitan Administration and the Thailand Ministry of Public Health and is enrolling 2,000 HIV-negative injection drug users (IDUs) at 17 drug-treatment clinics in Bangkok. Participants are being recruited at the drug treatment clinics, at community outreach sites, and through a peer referral program.
United States
The U.S. trial is designed to assess the clinical and behavioral safety of once-daily tenofovir among HIV-negative men who have sex with men (MSM). The trial is being conducted at three sites in collaboration with the San Francisco Department of Public Health, the AIDS Research Consortium of Atlanta, and Fenway Community Health in Boston. A variety of previously successful recruitment techniques, including outreach and referrals through clinician and community-based service organizations, are being used to enroll 400 HIV-negative MSM who report having had anal intercourse during the past 12 months. To reflect the demographics of the U.S. HIV epidemic, a substantial proportion of participants will be MSM of color.
Participants are randomly assigned to one of four study groups. Two groups receive either tenofovir or placebo immediately; the other two groups receive either tenofovir or placebo 9 months after enrollment. This design will allow researchers to compare risk behaviors among persons who are and persons who are not taking a daily pill. This analysis will be critical to understanding the potential impact of a daily drug regimen on HIV risk behavior.
Why have these populations been selected to take part in the trials? It is critical to evaluate new prevention methods among the populations who most urgently need them. These and other studies of PrEP will determine if the strategy is safe and effective in reducing transmission among individuals at highest risk for HIV infection around the world.
Botswana has one of the most widespread HIV epidemics in the world: an estimated 31% of the population 15-49 years of age are infected. Data suggest that new infections are increasing most rapidly among young heterosexual men and women. It is estimated that 24% of sexually active women aged 18-19 are infected with HIV and that almost 40% of those aged 20-24 are infected. Among men, the peak seems to occur later: 11% of men aged 20-24 and 28% of men aged 25-29 are believed to be HIV infected. These data suggest very high incidence among young men and women.
In Thailand, HIV prevalence is high among injection drug users (IDUs): an estimated 42% of IDUs are already infected. As a result of the extensive risk reduction counseling and other prevention services provided, HIV incidence among IDUs participating in research trials in the Bangkok drug treatment clinics has declined by over 50% since 1996. Still, a recent study found that HIV incidence among Thai IDUs was over 3% per year. Given estimates of the number of IDUs in Bangkok, this means that approximately 750 men and women in the city become infected through this transmission route every year.
In the United States, MSM continue to be at the greatest risk for HIV infection. Recent data from the 33 states with long-standing HIV reporting systems indicate that in 2005, MSM accounted for 49% of new HIV diagnoses. Of the roughly one million people living with HIV in the U.S., an estimated 45% are MSM. Additionally, a recent five-city study of HIV prevalence among MSM found that 25% of MSM overall, and 46% of black MSM, were infected in those cities.
Who is eligible to participate in the PrEP trials? Because the trials are designed to determine the safety and efficacy of PrEP as an HIV prevention strategy, all participants will be healthy and HIV-negative. To protect the health of participants and ensure that trial data are accurate, several conditions would render some persons ineligible for participation. These include the ongoing use of prescription medication, pregnancy or breast feeding, a history of kidney or bone disease, and participation in any other HIV clinical trial. Additional conditions, including active, untreated syphilis, hypertension, and alcohol or substance use, may also prevent some MSM from participating in the U.S. trial.
Are similar trials being conducted elsewhere? Yes. In 2006, Family Health International, with funding from the Bill and Melinda Gates Foundation, has completed a similar trial of tenofovir for HIV prevention among young women in Ghana. That trial will soon provide important data on the safety and acceptability of a once-daily PrEP regimen. The study provided the first data showing PrEP with tenofovir to be both safe and acceptable for use by HIV negative individuals. The National Institutes of Health will be conducting a PrEP safety and efficacy trial among MSM in Peru and Ecuador.
What is the cost of the CDC studies of PrEP? CDC estimates that the total contribution for all three PrEP trials will be $47 million over 7 years. For the Botswana trial, CDC will provide approximately $23 million in support. In Thailand, CDC's contribution is estimated to be $14 million, and in the United States, CDC will provide $10 million in support of the three institutions conducting the trial.
Safeguards and Services for Trial Participants What safeguards are in place to ensure protection of the volunteers? To ensure that each of these trials remains on a solid scientific and ethical foundation, all procedures and plans are reviewed and approved by scientific and ethical review committees at CDC (called institutional review boards, or IRBs), as well as by IRBs established by each host country and research site. Additionally, data on safety, enrollment, and efficacy will be reviewed at standard intervals by an independent data safety and monitoring board (DSMB) for the Botswana and Thai trials and by an independent safety review committee for the U.S. trial. These committees review emerging data to ensure that continuing the trial is safe and during the Phase III components, to determine the point at which the results are conclusive. If scientific questions arise during the trials, these committees will meet more frequently.
Will trial participants increase their risk behavior when they begin taking daily pills? Several critical steps are being taken to guard against this possibility. First, it is important to ensure that participants understand that trial participation may not protect them from HIV infection -- because they may receive a placebo, or they may receive tenofovir, the efficacy of which remains unproven. This and other key aspects of the trial, including potential risks and benefits of participation, are explained to potential volunteers in depth in language they understand, prior to their enrollment. To ensure participants fully understand all aspects of their participation, all volunteers are required to pass a comprehension test prior to providing written informed consent.
Second, to assist participants in eliminating or reducing HIV risk behaviors, extensive counseling is provided at each study visit, and more often if needed. The interactive counseling to be provided has been proven to reduce the risk of HIV and other STDs in multiple populations, including past participants of similar trials. Participants are also offered free condoms and STD testing and treatment to reduce their risk for HIV infection. Additionally, injection drug users are referred to, and/or offered follow-up in, a methadone treatment program and will receive bleach and instructions on how to use it to clean needles. Consistent with Thai government policy, sterile syringes will not be provided but are widely available in Thailand without a prescription and at low cost (one sterile syringe and one needle cost about 5 Thai baht, or about $0.12).
How will CDC evaluate the impact of PrEP if participants reduce their risk behavior? Although participants will likely be at lower risk for infection because of the prevention services received during the trial, the design of the trial will enable CDC to distinguish between the impact of these services and the impact of the study drugs. Because all participants will receive equivalent prevention services but only half will be given the study drugs, any difference in the rate of HIV infection between the two groups should be due to the study drugs.
What will happen to participants who do become infected during the trial? Despite optimal prevention counseling, some participants will become HIV infected during the trial. To ensure that infected participants are quickly referred to the best available medical and psychosocial services, they receive free rapid HIV testing at every visit. Participants who become infected will receive confirmatory testing for infection, post-test risk-reduction and support counseling, as well as help enrolling in local HIV care programs. Both Thailand and Botswana have antiretroviral treatment and HIV care programs in place at minimal or no cost to patients. In the United States, participants will be referred to local health care providers or public programs for needed medical and social services.
To help guide treatment decisions and to determine whether prior exposure to tenofovir or tenofovir plus emtricitabine affects the course of disease, testing will be provided for viral load, CD4 count, and HIV resistance mutations, and infected participants will be followed up for an additional 12 months.
What are the most common side effects associated with the drugs being tested? These trials are among the first to evaluate the safety of tenofovir alone and tenofovir plus emtricitabine in HIV-negative persons. However, among HIV-positive persons who have taken tenofovir in combination with other antiretroviral drugs, the most common side effects are nausea, vomiting, and loss of appetite. There have also been reports of uncommon, but more serious effects, such as impaired kidney function or reductions in bone density. These effects have largely been reversible when the person stopped taking the drug.
Tenofovir plus emtricitabine has also been associated with a relatively low level of side-effects, which include diarrhea, nausea, fatigue, headache, dizziness, and rash. There have been infrequent reports of more serious side effects, including impaired kidney function and lactic acidosis (a build-up of lactic acid in the blood). As with tenofovir, these effects have largely been reversed after use of the drug was discontinued.
Laboratory testing is used to carefully monitor all participants for signs of these conditions so that the study drugs can be stopped immediately should problems be identified. Researchers anticipate that healthy, HIV-negative participants will experience fewer side effects than do HIV-infected populations taking multiple medications. In the single study of tenofovir safety among uninfected individuals completed to date, there were no serious side effects found to be associated with the drug.
Will health care be provided for any health problems related to the drugs? In all three trials, researchers are monitoring participants closely for drug-related side effects. If problems requiring treatment occur, participants will be quickly linked to needed medical care. Care systems differ by country.
In Botswana, the government will provide any needed medical care through the national health care system. In the United States, participants will access needed care through private health insurance or if uninsured, will be provided facilitated referrals to public health care providers. In Thailand, care will be provided in local government clinics.
Community Involvement What is being done to solicit input from the communities in which these trials will be conducted? CDC will continue to work closely with community partners at each research site to ensure active community participation during the planning and implementation of these trials.
Botswana: In Botswana, community advisory boards have been established at each site. The boards comprise representatives from local governments (elected and traditional), as well as community members and representatives from key stakeholder organizations. Participant advisory boards have also been established. These groups will provide input to researchers throughout the trial. Additionally, community liaisons at each site conduct outreach to community organizations and respond to any questions or concerns.
Thailand: In Thailand, a community relations committee, composed of injection drug users from each of the 17 drug treatment clinics, family members, and representatives of local community organizations, meets regularly and provides advice to trial staff on all aspects of trial design and implementation. Additionally, a community liaison serves as a bridge between researchers and community organizations, responding to questions or concerns throughout the trial.
United States: In the United States, all three sites have established active community advisory boards that are consulted regularly about trial procedures and educational materials for potential participants. Members of these boards will provide advice throughout the trials. Community educators at each site work to ensure that community organizations are updated on trial progress and to respond to questions or concerns.
In addition to the regular input received by these established committees, broader outreach and consultations with advocates and community-based organizations representing populations at risk for HIV have been, and will continue to be, held, as needed, to address plans for HIV prevention research and programs.
Anticipated Results and Impact When will the results of the trials be available? As eager as we are for data about this new approach for HIV prevention, results of the trial won't be available until sufficient data have been collected and analyzed to determine whether the drugs are safe and effective. We are probably a year to three years away from trial results. Independent panels of experts will monitor the trials closely so that the trials can be concluded as soon as definitive answers are available.
If PrEP does prove to be effective at preventing HIV infection in this trial, how will the drugs be made available to people who need or want it? If the efficacy trials in Botswana and Thailand prove that one or both PrEP drugs are effective, participants in these trials and their communities will be the first to benefit. All trial participants will receive the appropriate drugs immediately and will continue to receive them for one year while CDC works with the Botswana Drugs Regulatory Unit and/or the Thai Food and Drug Administration for approval of use by the health care systems in these countries.
CDC is also working to determine how possible trial outcomes will influence future HIV prevention research, policy, and programs in the United States and worldwide. CDC will collaborate with its partners in the Department of Health and Human Services, the State Department, the Food and Drug Administration, and the World Health Organization to determine how to most effectively apply various potential results from these trials to real-world practice.
If the drugs prove safe and effective in one population, will they work equally well in other populations? CDC is conducting studies in different populations to help address this question. In general, HIV is more readily transmitted through injection drug use than through sexual exposure and more easily transmitted during rectal intercourse than during vaginal intercourse. However, the correlates of protection for various modes of transmission are not fully understood. It is therefore not known what level of antiretroviral drug activity at which sites (e.g., in the blood, the vaginal mucosa, or the rectal mucosa) will be needed to interrupt transmission. For these reasons, the efficacy of particular drugs in reducing HIV transmission in one population may not necessarily apply to other at-risk populations.
If studies show that PrEP reduces the risk of HIV transmission, will people still have to practice other risk-reduction behaviors for HIV? Yes. Regardless of the outcome, CDC will not recommend PrEP as a first-line defense against HIV infection. Abstinence and mutual monogamy with an HIV-negative partner will remain the only 100% effective ways to prevent infection. However, if effective, this strategy could provide an additional safety net to sexually active persons at risk, when combined with reduction in the number of sexual partners, HIV counseling and testing, consistent and correct condom use, and other prevention strategies.
It is also important to remember that taking PrEP drugs will not prevent acquisition of syphilis, gonorrhea, chlamydia, herpes, hepatitis, or other sexually transmitted diseases, many of which play a role in facilitating HIV transmission or speeding HIV disease progression.
Will support for these trials take away funding from behavioral interventions? Absolutely not. As we move forward with our search for new prevention strategies, it will be critical to determine how the approaches that are proven effective can best be integrated into programs. Effective behavior-change programs have greatly reduced the rate of HIV infection in the United States, and many other nations during the past 2 decades of the HIV epidemic. Because no strategy will be 100% effective in preventing HIV infection, their future impact will ultimately be determined by how effectively strategies are used in combination to provide the greatest protection to individuals at risk.
Are physicians in certain places already prescribing the drugs being studied for HIV prevention? According to media reports, a small number of physicians in the United States and the United Kingdom are already prescribing PrEP in hopes of preventing HIV infection among patients in their practices. But individuals who take HIV medications before engaging in high-risk behavior to avoid infection are doing so in the absence of clinical data demonstrating that the drugs are safe and effective, and at potentially serious risk. This is especially true if they are using the drugs instead of, rather than in addition to, existing prevention methods.
That is why CDC is conducting these important trials -- to contribute to the work of scientifically evaluating the safety and efficacy of PrEP among persons who are at risk. The trials will answer important questions about the impact of a daily pill on risk behavior and help us to determine how PrEP, if effective, can be used in combination with other proven strategies.
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text:
In a highly unusual development, a California appeals court has overturned the civil commitment of a convicted sex offender for the second time in a row due to egregious prosecutorial misconduct.
The prosecutor in the most recent trial engaged in a "pervasive pattern" of misconduct and "flagrantly" violated the law by implying that jurors would become social pariahs if they did not vote to civilly commit sex offender Dariel Shazier, the appellate court wrote.
Prosecutor Jay Boyarsky, now the second in command of the district attorney's office in Santa Clara County (San Jose), also improperly impugned the reputation of the forensic psychologist who testified for the defense, according to the scathing opinion by the Sixth District Court of Appeal.
This was the second civil commitment verdict against Dariel Shazier to be overturned on appeal due to prosecutorial misconduct. The license of the previous prosecutor, Benjamin Field, was suspended in 2010 based on his severe misconduct in several cases, including Shazier's 2006 trial. In the first of Shazier's three trials, a jury deadlocked as to whether the convicted sex offender qualified for civil detention as a sexually violent predator.
"This is not a case in which the prosecutor engaged in a few minor incidents of improper conduct. Rather, the prosecutor engaged in a pervasive pattern of inappropriate questions, comments and argument, throughout the entire trial, each one building on the next, to such a degree as to undermine the fairness of the proceedings. The misconduct culminated in the prosecutor flagrantly violating the law in closing argument, telling the jury to consider the reaction of their friends and family to their verdict, implying they would be subject to ridicule and condemnation if they found in favor of defendant."
Prosecutor Jay Boyarsky
The case revolves around the controversial diagnosis of hebephilia. Shazier served nine years in prison for sexual misconduct with teenage boys. At the end of his sentence, in 2003, the district attorney began efforts to commit him indefinitely to a locked hospital based on his risk of reoffense. At Shazier's most recent trial, two state evaluators testified that he suffered from hebephilia, thereby making him eligible for civil commitment. However, they admitted that hebephilia was highly controversial and had only come into vogue with the advent of civil commitment laws.
Incendiary questioning of defense expert witness
The appellate court chastised the prosecutor for stepping far over the line in his questioning of a psychologist who was called by the defense to rebut the diagnosis of hebephilia. Psychologist Ted Donaldson testified that hebephilia is not a legitimate mental disorder, and that socially unacceptable or immoral conduct does not constitute a mental illness.
On cross-examination, Boyarsky questioned Donaldson about previous cases in which he had testified that sex offenders were not mentally disordered. Naturally, Donaldson had not brought the files from all of his old cases to court with him. This, the appellate court wrote, gave the prosecutor an excuse to recite inflammatory facts from select cases, which the defense correctly complained "were only brought up to incite the passions and prejudice of the jury."
The appellate court also chastised Boyarsky for impugning Donaldson's character. In his closing argument, the prosecutor described Donaldson as "completely biased and not helpful," called his opinion "laughable," and implied that he was biased because he had repeatedly testified for the defense:
"He has got a streak that would make Cal Ripken jealous. Cal Ripken the baseball player and the Iron Man that played in something like 4,000 straight games. Dr. Donaldson's streak of 289 straight times testifying exclusively for the defense. Now he would like to tell you that is not his fault, because he offered to teach the State of California all his wisdom. His brilliance has yet to be fully appreciated by this society. It is appreciated by defense attorneys who pay him...."Boyarsky also improperly attacked a psychiatric technician at Atascadero State Hospital (where Shazier was undergoing sex offender treatment while awaiting the outcome of his case) who testified for the defense. The appellate court critiqued "rhetorical attempts to degrade and disparage" that witness during cross-examination. The justices highlighted Boyarsky's question: "Mr. Ross, you don't know what you're talking about, do you?"
"Here, the prosecutor's questioning … was clearly argumentative, and was not intended to glean relevant information. 'An argumentative question is a speech to the jury masquerading as a question. The questioner is not seeking to elicit relevant testimony. Often it is apparent that the questioner does not even expect an answer. The question may, indeed, be unanswerable. . . . An argumentative question that essentially talks past the witness, and makes an argument to the jury, is improper because it does not seek to elicit relevant, competent testimony, or often any testimony at all.'(People v. Chatman (2006) 38 Cal.4th 344, 384.)"The appellate opinion strongly rebuked trial judge Alfonso Fernandez for overruling repeated objections by defense attorney Patrick Hoopes. "Defense counsel objected to all of the prosecutor's improper questions, statements and arguments. We observe that not one of counsel's well-taken objections was sustained by the court. The court erred in overruling these objections."
Who's grooming who?
In a humorous twist, Boyarsky was also reprimanded for misusing the loaded term "grooming" during his closing argument.
The prosecutor tagged off this in his closing argument, warning the jury that Shazier had "groomed" them during his testimony. "The grooming behavior, the manipulation, it still continues," Boyarski stated.
The appellate court agreed with the defense that this statement was "intended to inflame the jury, making them each feel like victims in the case." The justices went even further, noting that Shazier was not necessarily the one doing the grooming:
"During trial, Dr. Murphy defined grooming as a 'slow, steady manipulation to get a person in a compromising position or violate boundaries without awareness.' The irony here is that the prosecutor's conduct toward the jury throughout the trial closely fit Dr. Murphy's definition of grooming."
The unanimous appellate ruling is HERE. San Jose Mercury News coverage is HERE; the San Francisco Chronicle's, HERE.

subset: commoncrawl


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PHS Report Summarizes Current Scientific Knowledge on the Use of Post-Exposure Antiretroviral Therapy for Non-Occupational Exposures
Therapy Remains Unproven: Should Not be Used Routinely
September 1998
In recent years, the Public Health Service (PHS) has recommended the use of antiretroviral drugs to reduce the risk of occupational HIV transmission following workplace exposures (e.g., health care workers exposed through accidental needle-sticks). Scientific studies have shown the drugs to be both safe and effective for this use. While this type of therapy is not 100% effective, it has been found to significantly reduce the risk of HIV infection among health care workers following percutaneous (through the skin) exposures.
Questions have arisen about whether similar therapy should be offered to people with unanticipated sexual or drug injection-related exposures to HIV. However, researchers do not know if findings among health care workers are applicable in other settings where therapy may not be initiated as quickly, where the HIV status of the source may not be known, where the regimen cannot be closely monitored, and where repeated exposures may occur. To consider these questions, PHS convened scientific experts from across the nation to review all available data. The September 25, 1998, issue of the Morbidity and Mortality Weekly Report summarizes the data considered and the outcomes of this consultation.
While the number of AIDS cases is declining, the number of people living with HIV infection is growing. This increased prevalence of HIV in the population means that even more prevention efforts are needed, not fewer. For individuals at risk, increased prevalence means that each risk behavior carries an increased risk for infection. This makes the danger of relaxing preventive behaviors greater than ever.
PHS has concluded that there are no conclusive data on the effectiveness of antiretroviral therapy in preventing HIV transmission after non-occupational exposures. It is therefore not possible to make definitive recommendations regarding its use. Because the therapy remains unproven and can pose risks, physicians should consider its use only in individual circumstances when the probability of HIV infection is high, the therapy can be initiated promptly, and adherence to the regimen is likely. It should not be used routinely and should never be considered a form of primary prevention.
Decisions regarding use should be made by physicians, in consultation with their patients and, as needed, an expert in the use of antiretroviral drugs. To help guide these discussions, the PHS report provides physicians a summary of available data and outlines factors that should be considered before prescribing therapy. The following factors should be evaluated in considering the potential benefit of therapy:
Potential benefits must be weighed against the risks of drug toxicity, the difficulty of compliance with the regimen, and the potential for individuals at risk to abandon more effective prevention strategies. Because post-exposure is an experimental therapy of unproven efficacy, it should only be prescribed with the informed consent of the patient, after explanation of the potential benefits and risks. Antiretroviral therapy should never be used routinely and should not be used when there is a low risk of transmission or when people seek care too late to anticipate an interruption in transmission.
The report also requests that physicians notify CDC of all cases in which post-exposure therapy is prescribed for nonoccupational exposures. Data collected through the CDC reporting system on the utilization, effectiveness, and toxicity of this therapy may provide the information needed to refine future recommendations.
Primary conclusions of the report include:
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.


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A group of five unproven, mostly unknown players entered N.C. State's preseason football camp in 2008 competing with one another for the starting quarterback job.
It was an intense battle in which a redshirt freshman named Russell Wilson rose above the rest to beat out teammates Mike Glennon, Daniel Evans, Harrison Beck and Justin Burke.
You know the rest of that story.
Now fast-forward to this summer and another group of five unproven, mostly unknown Wolfpack quarterbacks heading into a preseason camp with hopes of having history repeat itself.
Although it's probably too much to ask for any members of this current crop to develop into a leader even close to Wilson's caliber, new coach Dave Doeren is hoping to find at least some quality amongst all that quantity.
Or at the very least, someone serviceable enough among the quintet of junior Pete Thomas, sophomore Manny Stocker, senior newcomer Brandon Mitchell and true freshmen Bryant Sherriffs and Josh Taylor to hold down the position until Florida transfer Jacoby Brissett becomes eligible in 2014.
"We'll get into camp and all five guys will get reps," Doeren said last week at the ACC's Football Kickoff event in Greensboro. "The older guys will get more early on, and the rep count will change pretty quickly. If we can name (a starter) we will. If we can't, we'll compete a little and let a guy win it in a game.
"I do like the fact that when I got here there were two quarterbacks to deal with and now there's five. So I have better odds of maybe one of them being good enough to get it done."
The uncomfortable chuckle that followed Doeren's final statement suggests that despite the positive spin he's trying to put on the situation, those odds are still stacked against him.
It's a reality that was amplified this summer when, unhappy with the spring performance of the two quarterbacks he inherited, the energetic young coach sought out Mitchell from Arkansas as a potential "free agent" stopgap until Brissett can play.
"Pete came out of the spring ahead of Manny and we added Brandon Mitchell because we didn't feel like we were in a position yet to name a starter and thought we needed more competition for Pete," Doeren said.
It's doubtful, however, that Doeren would have brought in a graduate student with only one season of eligibility remaining if he didn't plan on giving him every opportunity to win the job. It's even more doubtful Mitchell would have chosen to come to State without such an understanding.
Mitchell played nine games at quarterback for the Razorbacks in 2011 before being moved to wide receiver last season. That's not much experience, but it's still more than Stocker gained while playing only 40 snaps and throwing two incomplete passes as Glennon's backup last season.
Mitchell's skill set is also makes him a much better fit for running Doeren's hybrid spread offense than Thomas, a two-year starter at Colorado State who was recruited as a classic dropback passer in former coach Tom O'Brien's pro style attack.
As for the freshmen, Sherriffs figures to have the better shot at playing his way into the mix after throwing for more than 2,300 yards and rushing for more than 1,000 as a high school senior last year while Taylor is a preferred walkon.
But at this point, all options are still on the table – including the possibility of Doeren deciding to go with a two-quarterback rotation.
"It doesn't scare me," Doeren said. "As the head coach, I want to put the best possible formula out there for our players to win. If that's two guys, that's what it will be. In a perfect world it wouldn't be that way. But that's where we are now."
Where the quarterback situation will be when the Wolfpack opens its season against Louisiana Tech on Aug. 31 is anybody's guess, including Doeren's.
But at least he's got five shots at having somebody emerge from the crowd, seize the opportunity and become the leader State needs so badly. Even if he doesn't turn out to be another Russell Wilson.


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A three-year effort to fine-tune curbs on volatility for individual stocks enters a new phase today in the U.S.
Trying to reduce market disruptions, regulators are instituting a plan that creates price bands in which shares are allowed to trade on American equity exchanges, replacing the old system of immediate pauses when shares swing rapidly. New restraints to halt all U.S. stock, options and index futures when the Standard & Poor's 500 Index plunges will also take effect. Both will operate as one-year pilot programs.
Regulators and exchanges are altering the speed bumps adopted after the May 2010 flash crash to boost confidence in a market that has become faster and more complex over the last decade. While replacing automatic halts with the new system known as limit-up/limit-down is "the right answer," getting ready for it hasn't been easy for broker-dealers, according to Chris Concannon, a partner at electronic market-maker Virtu Financial LLC in New York.
"It adds more complexity," Concannon said. "It sounds simple, but for firms managing thousands of customer orders, you have to program how you'll manage them, how you'll deal with quotes and trades across 50 destinations, routing decisions and execution quality."
Under limit-up/limit-down, trades won't be permitted to occur more than a specified percentage above or below a stock's rolling five-minute average price. If the lowest price at which investors are willing to sell shares reaches the stock's lower band, or the highest purchase price reaches the higher band, the stock enters a so-called limit state for 15 seconds. Should no trades occur between the bands, trading will cease for five minutes, according to the U.S. Securities and Exchange Commission.
Gradual Adoption
More than two dozen companies listed on exchanges owned by NYSE Euronext, Nasdaq OMX Group Inc. and Bats Global Markets Inc. will adopt the new trading bands today. More will join each week through mid-May until all S&P 500 and Russell 1000 Index corporations and more than 400 exchange-traded products are included in the revised program.
The curbs will operate from 9:45 a.m. to 3:30 p.m. New York time. Other securities will be added in August, when the program will also run the full day from 9:30 a.m. until 4 p.m.
"There's going to be some hiccups," Adam Sussman, director of research at consulting firm Tabb Group LLC in New York, said in a phone interview. "Where it's going to get tricky for brokers is how they handle responses to when a stock is in a limit state."
Copyright 2014 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


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We've decided that OB Cookie, minus her job as resident at a busy obstetric ward in Dallas (or "baby catcher extraordinaire," as she calls it), is our well-traveled, Texas-based alter ego. She whips egg whites to blow off steam. (Us too!) She could eat a whole hamburger at age one. (Us too!) And most of all, like everyone in this FOOD52 community, she loves nothing more than feeding others, to get home after a long day and get her hands dirty in the kitchen. On her FOOD52 profile page, she asks us: "What greater joy is there than bringing over enchiladas and margaritas for friends on a languid Texas August afternoon?" Our only response is: can we join?
Although OB Cookie has traveled the world -- she lived in Singapore in junior high and Chile for a year in college -- many of her recipes are gleefully, wholeheartedly, unapologetically American. Creamy Potato Soup with Bacon Vinaigrette (pictured above). Spicy Caramel Corn. Malt Ball Pretzel Gooey, Chewy Crunchy Cookies. (Seriously.) And if those don't entice you (and how could they not?), OB Cookie has her share of intercontinental flavors: Broccoli with Raisins and Pinenuts from Italy, Lamb Meatballs from the Middle East. The recipes we want next? Her Texas-style enchiladas and margaritas.
Read our profile Q&A with OB Cookie below.


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French arrogance
Anyone knows the reason for that? If anyone knows me well enough, then they'll know that the one thing that I hate the most in people is arrogance. From the little I know about the French people I find them more than fine. Cultured, sophisticated, and so on. There is a general stereotype about them however that they are arrogant, which I never particularly found that obvious, but I don't know that many French to be able to judge.
Well, I saw it a few times with that Marketing guy at one of my previous companies maybe. Overall, my relationship with him was fine, but there were those moments that he'd piss me off with his atittude and I'd have to give it to him with my sharp responses. The guy finally convinced the CEO that the Egypt site was no good, and spun-off the business and took control of it.
I did know a French girl a long time ago who was extremely nice and sweet, and one of my friends really adored her for her light atittude. She insisted that we pronounce Charles de Gaulle properly though. She and my friend once were acting like complete drunks in the Opera house once, so maybe she's not that French afterall.
Now, this guy from the French embassy in Cairo sends me an email asking me questions about myself and my blog to help him in this study he's doing for the embassy. Lots of questions, personal stuff, facts about me, political stuff, religious stuff, everything. So I'm not really comfortable doing all the work for him, but I provide some answers, refuse to answer the factual questions about me, and ask him to send me the study when he's done to know what he's written about me.
The guy responds back with this email:
Thank you for your answers. Unfortunately, I don't think I will be able to give you a copy of my paper, for French diplomacy is not accustomed to circulate its confidential documents. I have personnal information about some bloggers they would not like to be known.
About the questions you did not want to answer to, this is a little bit problematic, since the sociological profile of bloggers is one of the most important part of my study. Knowing the bloggers is as much important as knowing their blogs. Perhaps you could just tell me if you are born into a middle-class or upper middle-class family, if you studied, and the domain of your job?
I don't like his response. So I reply back:
If my answers are not sufficient, then you should take me out of your study.
Actually, I'd like you to take me out of your study. If French diplomacy doesn't want to tell me what the study says about me, then my diplomacy doesn't want me to be included in that study.
I think you should do your homework and go read the blogs instead of looking for direct answers from bloggers. Read the blogs and deduce what you can about the social profile or whatever else you're looking for.
I'm starting to worry about my next job now since it involves alot of interaction with the French. Any advise on how to deal with these guys?


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Student Health Services
Wellness Is Quality Living
Your health plays an important role in how well you achieve your academic, social and personal goals during your college years.
Wellness involves choosing a positive lifestyle that moves you toward optimal health.
Health Services Is...
More than a place to go when you are ill. Our goals are:
- to help you develop a healthy lifestyle that will enable you to become the best you can be.
- to offer a strong emphasis on prevention of illness through education.
- to encourage healthy choices that will improve one's quality of life.
The Doctor Is In
Tuesdays & Thursdays
Health Services is available to all Marywood students who have submitted a completed Health History Physical & Immunization Form.
The professional staff of Health Services is committed to meeting today's highest health standard. Registered Nurses are available to provide health care that is sensitive to the needs of all students. A certified Registered Nurse Practitioner is available Monday through Friday, 8:30 a.m. to 4:00 p.m., either by appointment or walk-in. This is an exceptional cost saving benefit for our students.
Health Records
All information is strictly confidential. Access to medical records is limited to Health Services personnel and may not be released without the student's written consent.
Once accepted for admission, all students are encouraged to submit a completed Health History Physical & Immunization Form. No student will be seen for non-emergencies unless her/his record is on file.
Referral Off-Campus
Students requiring medical follow-up will be referred to appropriate services off-campus. Transportation and fees incurred are the responsibility of the student.
Medical Excuses
Health Services does NOT issue medical excuses. It is the responsibility of the student to notify instructors regarding absences.
If a faculty member requires verification of a student's visit to Health Services, they may either call the Director of Student Health Services or the Nurse Practitioner at 570-348-6249 or e-mail the Director of Student Health at email@example.com. The date and time of the visit is the only information that will be given.


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Last Week's Winner: Last week's winner was Pete Gray of New York for this Adventurous Hamster themed piece.
Next Week's Theme: Spring Fever
This Week's Prize: Creature Skateboards Summer Pack and Cruiser Board! Includes beer coozies, a cooler, a cruiser board, TShirt, beer opener, and shades... We used the cooler yesterday to cool some beers for after work style, and worked like a charm.
We had some great entries this week that we couldn't run, either because they weren't sized right or had nothing to do with theme. Just to be clear, when the next theme comes out the old theme is offically over. Please don't send in more submissions for old themes. It makes up feel bad when you send us stuff and we can't post it up so please read the guidlines below:
- The size formatting is 600 pixels in width OR length - if they are bigger than this they will not be posted. So if you have a long skinny one, please make sure it is not over 600 in length or we will not be able to see it well.
- Name your submission your first and last name. Example: john_doe.jpg
- Include the words "Fecal Face" somewhere in the art so we know you created it (please do not to add it in later with Photoshop).
- One submission per person by Friday at 12pm PST.
- If you have a website (or two) please specify which one you would like me to link in the body of your email. Also, let us know where you're from!
- Send it all to freefridayz (at) fecalface.com.
#1 - Jeroen Blok (Holland)
#2 - Dylan Humphreys (Nelson, BC)
#3 - Alex Warble
#4 - Max Green (Stockholm, Sweden)
#5 - Nathan Pope (San Diego, CA)
#6 - Dan Vem (Sweden)
#7 - Travis Simpson (Denver, CO)
#8 - Jess Hahn (Wilmington, NC)
#9 - Pete Gray (Upstate, NY)
#10 - Elliott Chalmers (Boone, NC)
#11 - Sam Brewster (Lincoln, UK)
#12 - Rick Kercz (Bmore)
#13 - Eells (Philadelphia, PA)
#14 - Sam Owen (Lawrence, KS)
#15 - Kyle Bryant (Berlin, Germany)
#16 - Chad Kipfer (Emeryville, CA)
#17 - Leigh Metzler (Philadelphia, PA)
#18 - Marcie Belandres
#19 - Peekasso
#20 - NKM (Montreal)
#21 - Kinoko (Seattle, WA)
#22 - Isaac Santella (Knoxville, TN)
#23 - Richard Constantin
#24 - Diana Smith
#25 - Ezra Livingston
#26 - Yolanda Mason (Vancouver, BC)
Don't forget next week's theme: Spring Fever
Don't forget next week's theme: Spring Fever{moscomment}
|< Prev
|Next >


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Resources and databases
Medicinal Plant Names Services (MPNS)
Building a global resource for medicinal plant names to allow health professionals and researchers access to information about plants and plant products.
Legumes of the World Online
Research one of the most economically important plant families online with Kew's LOWO database.
UK Germination Toolbox
Find information on successful seed germination conditions for UK native species; mostly from the Millennium Seed Bank's collections.
Search the UK Germination Toolbox
Search our databases, including collection databases, plant name resources and world checklists.
Millennium Seed Bank resources
Resources from the Millennium Seed Bank including field manuals for seed collectors and information about seed conservation and storage.


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How do we feel about this half-placket pull-over polo-thing under that suit? True story: He broke his foot while jumping rope. This was taken at the premiere of The Company You Keep at The Museum of Modern Art on April 1, 2013 in New York City. (Photo by Larry Busacca/Getty Images)
Related: Remember how cute he was in Holes? Disney cute, not heartthrob cute.


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2. Runkeeper
If you a runner, Runkeeper is just for you. This app is not only free but also one of the most popular fitness tools online. It tracks how long, how fast and how much you're hitting the streets through GPS, and allows your friends to send you messages while you run. You can also use Runkeeper to keep track of outdoor activities like skiing, swimming or mountain biking.
3. Livestrong.com - Calorie Tracker (a.k.a. MyPlate)
Livestrong's Myplate calorie tracker is a calorie and exercise logging tool, available for $2.99. This mobile app gives you an estimated daily calorie intake that works to help you reach your diet, weight loss and meet your fitness goals. However, it will not advise you when to exercise or how to eat or anything more than how many calories you should net in a day.
4. Nike Training Club
Nike Training Club, whose slogan is "get your own personal trainer, anytime, anywhere," is a big database filled with bodyweight exercise routines to help you move quickly. The app includes detailed instructions and audio guidance from top Nike trainers, with over 100 custom workouts for you to choose. You can even sync your own music to your workout and enjoy your favorite songs while perfecting your body.
5. Fitocracy
Fitocracy is free and available on iPhone and Android. This application challenges you with missions to fulfill and turns your workouts into a game by gaining points when you burn calories. Besides, you can post your workout stats to twitter or facebook and share your progress so that your friends can motivate you.
Related articles:


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CAB abstracts
Covers the significant research and development literature in the applied life sciences, including agriculture, forestry, human nutrition, veterinary medicine and the environment. Coverage dates back to 1973.
CAB abstracts archive
Combines 17 printed abstract journals produced between 1910 and 1972 into a single database. The database includes over 1,860,000 records, providing information on agricultural science, veterinary medicine, nutrition, and natural resources.
Covers the world's agricultural literature, including plant and animal sciences, forestry, soil and water resources, and earth and environmental sciences. Records describe journal articles, book chapters, books, series, microforms, audiovisuals, maps, and other types of material. Coverage: 1970-current.
Related Databases
- BIOSIS previews - (description)
- Conference papers index - (description)
- Crop protection compendium (Article Database) - (description)
- Entomology abstracts - (description)
- FSTA -- Food science and technology abstracts - (description)
- NC State University Safety Data Sheets (SDS) Management System - (description)
- Plant management network - (description)
- Plant science - (description)
- Web of Science - (description)


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Ricky Martin Gives Rio Boxers-Only Balcony Show
Jonathan Higbee | March 14, 2014
Ricky Martin has continued his half-dressed world tour of hotel balconies in Rio de Janeiro, Brazil, where he strutted his stuff in nothing but boxers. A month ago, Ricky materialized on a Miami balcony ready to flex for a selfie. What's next, RM?
Head to JustJared for more pics of Ricky's balcony adventures!


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Monday, August 25, 2008
I am currently back in my homeland, the Philippines. This was an emergency trip, as my father has urgent health issues that I needed to attend to being his one and only child. It sucks big time to see your parents get older and in failing health. If you're curious and would want to know specifically what the emergency is about, then please check my personal blog here and here.
Suffice it to say that I am having one of the most challenging times of my life and would appreciate if you can say a word or two of prayer for my father and our family.
I miss cooking and blogging. But I gotta do what I need to do, and for now, my priority is my father to get well. I may be checking in once in a while, but I won't promise that I will be able to post anything till I get back to the U.S. a couple of weeks from now.
Hope you'll continue to check my blog... For Jude and Bethany, thanks for the tag/awards.. I will blog about it later when the dust settles.
Thank you.
8 comments:
- ironstef said...
I am sorry to hear about your father's health problems! My thoughts are with you and your family.
- August 25, 2008 at 1:44 PM
- [eatingclub] vancouver || js said...
So sorry to hear about your family's trials right now. Our best wishes are with you.
- August 25, 2008 at 7:32 PM
- Everything's Herbed said...
praying for your dad's speedy recovery...
- August 25, 2008 at 10:10 PM
- Mochachocolata Rita said...
Girl, our prayers are with you and your family. Hang in there :)
- August 27, 2008 at 2:54 AM
- mikky said...
such a sad reason to come home... been there, and it was really hard... will be praying for you... God bless...
- August 27, 2008 at 4:52 AM
- Tom Aarons said...
Good luck and best wishes to everyone. May it all work out well.
- August 27, 2008 at 8:06 AM
- Dhanggit said...
i see myself in you few months back, when i needed to rush to philippines for my sick dad, alas he left us...i will be praying for you jescel and be strong! dont worry we will still be here when you go back :-) lots of love
- August 29, 2008 at 7:10 AM
- Cynthia said...
Very sorry to hear about your dad. I will keep you and your family in my thoughts and prayers.
- August 31, 2008 at 9:29 AM


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This take on Minted was made by
undefined from , a member of Minted's
community of independent artists.
Celebrate the mom-to-be with unique baby shower invitations designed to perfectly compliment the guest of honor, no matter her style. Whether you are looking for modern boy baby shower invitations or stylish girl baby shower invitations, you are guaranteed an invitation as beautiful as your event. All of our designs are created exclusively for Minted by our global community of independent artists. Each year we host a contest where designers submit their exclusive creations, our customers vote on their favorite selections, and the winners are featured on our site. This model ensures that every year we not only have the most unique and fresh designs, but that we also have the greatest selection.
Choose from an array of card shapes and colors to make your invitations just right, or submit any special customizations requests to our design team so we can help. From fine tuning to creating completely custom design we are dedicated to making your baby shower invitations everything you imagined. Include our gift of FREE recipient address labeling, for that perfect finishing touch. A variety of our styles even go the extra mile with matching baby shower thank you cards and favor tags you can include, to make your event that much more special. You can even select from six perfect paper types, in a variety of finish and weights, to match your baby shower invitation and event with ease.
At Minted we are dedicated to going the extra mile to make your custom products everything you imagined. Not sure how to word your invitations? Our dedicated design associates are happy to help with baby shower invitation wording or answer any other design or etiquette questions to make your shower invitations truly one of a kind. But, the celebration doesn't have to end here. Continue to show off your bundle of joy, after their arrival, with our gorgeous photo birth announcements.
We uncover design genius through ongoing design competitions. At Minted, all that matters is good design. Designers submit, and the Minted community votes to tell us what to sell.


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Selecting your vehicle's make, model, and year allows us to display only parts and items specific to your car's model and year.
Part# GPE7076
Be the First to Review
OPGI Price: $279.99
Part Type: (A) Aftermarket product, usually an enhancement product
Years: 1962-1963
Sold As: EACH
All drop-shipped orders must be prepaid. Rates vary depending upon weight.
Four layers thick with a very soft inner layer, the "Evolution 4" by Kimberly-Clark offers our best combination of water-resistance and breathability in a medium-priced fabric. The fabric's 4-layer thickness absorbs impacts better than any other fabric and has high-resistance to tears and punctures. Evolution 4 comes with a 4-year limited warranty. Includes antenna grommet.
OUR BEST CAR COVER! Made for indoor/outdoor use.


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After missing most of the 2011 season with an ankle injury, Davis struggled for much of the first half but avoided a trip to the minor leagues with the promise of the 19 homers he slugged in his 2010 rookie season when he finished seventh in the Rookie of the Year balloting. Davis responded with a scorching second half in 2012 that salvaged his season with 32 homers and 90 RBI. The wishful thinking on the Mets' part was two strong halves could lay the groundwork for perhaps the breakout season they had long hoped for the first baseman with the looping swing and game-breaking power. Even with the homers Davis produced some worrisome numbers, such as a .227 average, .308 on-base percentage, and 141-61 strikeouts-to-walks ratio. If Davis could cut down on his swing and improve his patience at the plate, why couldn't he become a star?
Davis didn't come close to two strong halves. He didn't even have two mediocre halves; try an awful first half and a poor second half. Davis couldn't avoid the minor leagues this year, and consequently played in just 103 games with 317 at-bats. Davis hit .305 with a .326 on-base percentage, .334 slugging percentage, nine homers, 33 RBI and 101 strikeouts with 57 walks, and most discouraging, had no better plate presence when he returned than when he left for Triple-A Las Vegas. The season ended with speculation the Mets might not tender him a contract and let him leave as a free agent. Davis made $3.1 million last year, and even a miniscule arbitration raise would seem too much for the budget conscious Mets. The current plan is for Davis and Lucas Duda competing for the first base job in spring training.
John Delcos Says: Manager Terry Collins said after the season he didn't think it would be likely the Mets could carry both Davis and Duda coming out of spring training. Trading Davis for anything of quality would be highly unlikely this winter. Teams needing a first baseman might gamble on the Mets waiving Davis as not to give up a player. Should Davis make the Opening Day roster, how could anybody project with any confidence he will finally have a breakout season? Davis' track record is one of injury and poor performance, with one good second half in 2012. Given that, there's nothing other than blind hope for the Mets to expect anything productive from Davis. The season ended with Davis needing a lot of work to become a viable major leaguer let alone a good one. He didn't get that work over the winter.
Satish R. Says: You know, if you asked me a couple days ago what I thought the organizational opinion was on Ike Davis — I'd tell you that they had no faith in him whatsoever. When they mentioned that first base is a position they wanted to upgrade at, it felt like the Mets were saying they had no confidence in Lucas Duda or Ike Davis — which is the feeling of most of the fanbase as well. But then I read this tweet from Jon Heyman that said the Mets passed on Abreu because of Davis, Duda, and guys like Josh Satin, Daniel Murphy, and Wilmer Flores. Talk about your mixed signals, right?
If Sandy Alderson meant anything that he said about spending this offseason, and the team turns out to be in a better position — you have probably seen the last of Ike Davis in a Mets uniform. But honestly, if we're not going to make any actual moves this winter, the Mets might as well tender Ike a contract and give him one last chance. As I always say, players don't hit 32 home runs by accident, especially 22 in one half — so there's potential there. I just don't know if he'll be able to tap into it again…
TOMORROW: Lucas Duda


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Truro, MA21 Crestview Circle
Est. Mortgage: $/month
MLS Number 21713781
- Single Family
- Village North Truro
- Year Built 2010
- Bathroom 6
- Full Bathrooms 5
A Modern Masterpiece. Logic, art & nature harmonize in a striking bluff-top dwelling overlooking Cape Cod Bay. Located in Truro on the Outer Cape, this 21st Century-Modern beach home is warm & comfortable...bold & avant-garde. Clad in luminous red cedar, the home's horizontal, abstract lines embrace grand yet intimately scaled interiors that offer panoramic views of bay & coast. Graced by a natural palette of materials (limestone, honed granite, Tabu ash, walnut), accented by subtly rich colors & textures (chenille, faux suede) & powered by cutting-edge technology (Savant Home operating system), the home offers an unusual sense of comfort & well-being. Superb views, private beach, unparalleled luxury. Harmonious master strokes of architecture, landscape & interior design have resulted in a bold & beautiful beach home that is in a class by itself.
Listed by Fran I Schofield of Robert Paul Properties, Inc.
Save FavoriteSchedule A VisitAsk A QuestionMore Details
|Down Payment
|Interest Rate
Est. Mortgage: $/month
Federal 30-year interest rate: 4.35% last updated on 2019-02-21
This product uses the FRED® API but is not endorsed or certified by the Federal Reserve Bank of St. Louis.


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eddysnake wrote:canaan wrote:Lego undercover keeps sucking me in for long stretches...im starting to entertain going for 100%
did the recent update make load times better or is that on the game? I might have asked before, but I forgot.
the startup/game save load is still pretty long, but the in-game ones are faster, imo.


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Start: 12:10:08
Seventies: mornin' Daviss
Daviss: afternoon to you!!
Seventies: thank ya! How y'all doing in the AZ?
Daviss: Well as of now, no idea lol. I just rolled out of bed just in time to make coffee
Seventies: Hope that you can make this more of a habit...
Daviss: ok go ahead what do you want to say lol I was all set to ask if you got your computer
Seventies: wellll..... okay so I'm trying to prep for this trip to Washington, D.C. I already have one record set that I'm going to look at and copy (I still have a few dollars on my NARA card)
Daviss: ok my question....Can you add dollars to your card
Seventies: Yes, I will be adding a few dollars... but I am having a fundraiser if you want to send me some money... lol
Daviss: how much a copy
Seventies: from microfilm 50 cents
Daviss: oh goodie!! what kind of fundraiser....I may take you up on that
Seventies: A fundraisers to put money to put on my Nara card! lol
Daviss: naw naw naw.. You have to run so many miles for so much money, sell tacos , or something like that
Seventies: IT works like this, you send me money and I put it on my NARA card... lol
Daviss: HA! thats not a fundraiser, thats a gimmie
Seventies: Its a way to raise funds, no? lol
Daviss: what will you be looking to copy in the record set may I ask?
Seventies: U.S. Serial Set for interviews from Natchez District
Daviss: any particular people or all interviews
Seventies: Also some docs from M1907 in RG105 Well I plan on reading through to see what would be pertinent to me. I suspect most of it will be.
Daviss: so how many days will you actually be looking
Seventies: 3 days I plan to do some friends and family visiting.
Daviss: Wonderful!! Well I hope you will be very successful
Seventies: Me too!
Daviss: so when is your trip and are the boys going?
Seventies: Friday the 21st and yes this is a family vacation. Our bi-annual vacation
Daviss: ok
Seventies: Our next vacay will be in the summer
Daviss: brb gotta grab the last cup
Seventies: okay afternoon vkn
vkn: Howdy
Seventies: How are you faring today?
vkn: Faring and you lol
Seventies: :} just good. Breathing, walking and talking. And somewhat in my right mind.. lol
vkn: grrrrreat
Seventies: Daviss is off drinking her coffee.
Daviss: ok back, lol
vkn: oh i c
Seventies: welcome back Daviss.
Daviss: I hate it when I have to reheat coffee
Seventies: it doesn't taste the same as freshly dripped.
Daviss: Hello there vkn!
Seventies: hello di!
di: hi all
vkn: hello di and daviss
Daviss: its fresh but for some reasons after I drink one cup its not as hot as I like it for the second one
Seventies: You should get a Keurig one cup maker....
Daviss: Thats the reason why I would rather have a Percolator Hello Di!!
vkn: what is the word di
Daviss: If she says Thunderbird I will ROF vkn
vkn: and I would say "not your mail program" lol
Daviss: lol lol lol oops
vkn: oops
Seventies: WB di
Daviss: wb di
di: ok hit that calendar button (that i knew nothing about!) by accident.
Seventies: lol
Daviss: How have you been di?
di: as for "thunderbird" that is so over my head....and nothing much just treading along.i did some research on my moms paternal side and was surprised how far i was able to get in 2 days so now i am just looking for the meat and potatoes and filling in where i can
Seventies: okay
Daviss: lol thunderbird is old time riddle di
di: for the bulk of my years of research i have been focused on Georgia and just knocking down my mothers brick walls so this for me is my contribution to her tree because all she had was her grandparents names
Daviss: good to hear that you are treading right along..thats good
di: trying Daviss
Daviss: so you are knocking down walls and not chipping them, thats even better
di: ok your words sound more accurate!
Seventies: that's great di.
Daviss: what are your GA names?
vkn: Meat and potatoes is good. Best wishes. Save the bones for Henry Jones cause Henry don't eat no meat lol
di: in ga --ååRespess, Alford, Atwater, Worthy, (Rose), (Howell),
Seventies: Y'all I gotta go...
di: lol vkn i did know that one.
vkn: okies
Seventies: Everyone enjoy their weekend, I will! :}
vkn: lol
di: rose and howell are the lines i am treading blindly as they are the names of the slave owners for one of my lines
Daviss: Alford, hmmm I know someone researching Alford
di: what area
Daviss: hold on a min
vkn: I have a worthy married into my King tree
di: cant get far on my worthy name to tell you if we are related.
vkn: and lives in AZ in a nursing home
Khathu: Hello everyone
di: my grandmother is/was an Alford whose mother was an Atwater whose mother was a Respess
vkn: Howdy Khathu
Khathu: Daviss have you heard of Robert D. Ealey
vkn: What counties in GA di
Daviss: I cant tell where di, but do you know Shirley Whitmore
di: my grandmothers father was was the product of an Alford and supposedly a Worthy...oral history and (found so far written docs) don't add up hi Khathu
Daviss: hello khathu!
Khathu: Hello di
Daviss: Shirley has Alfords in her line
di: Sorry Daviss I do not know of her, and my family is in Upson and pike areas of georgia
Daviss: Not sure khathu
Khathu: Well he was a blues singer born in Bowie County, Texas
di: looks like her alfords are in va
Khathu: I just discovered that he was my grandmother's second cousin
di: actually in Louisiana
Daviss: ahhh I see Kathu di I think shirley also has LA roots
Khathu: I will be purchasing some of his music soon. ttyl
Daviss: I love Blues, I have to look in my stash khathu I may even have something where is he from Khathu in Bowie Do you have any Marks in your tree di?
di: nope-not yet
Daviss: ok
di: just to put it out there i am working on a marshall line in martinsberg, berkley county west virginia connected lines so far are lee, brown, saunders and blakely/blakey (and kinda a wilson)
Daviss: Any Arizona marshalls di?
vkn: running y'all
Daviss: later
di: not yet, this is my moms fathers maternal line and they pretty much stayed in that one place for years except when she left for a decade --married a man from philadelphia divorced and moved right back to that same town and then remarried until she died in that same town
Daviss: khathu is Ealey a new name for you or did you just get it when you found out about Robert?
di: brb
Daviss: ok
di: back
Daviss: ok I sent Shirley a msg asking about her Alfords...Hoping she will answer soon
di: ok i googled her posts on afrigeneas that is where i saw her pictures and posts
Daviss: ahhhh ok
di: when i first started i followed a whole line of alfords to my dismay after a lot of digging i found there was no relation, and my aunt was sure to tell me that "them ALFORDS down the road" was no kin to us
Daviss: hahahahaha thats what I have been hearing re the Taylors living next door to each other but they sure look alike Go figure I wish I could get one of them to take a dna test lol lol di did you get in on the 23&Me free test
di: nope they did it again?
Daviss: not yet but I am keeping my eyes open they have had a couple of specials though
di: i still have my 5 kits from the last time. i asked my family to do and they said yeah.....but never did it and before i knew it the deadline passed and i didnt even get in mines!
Daviss: whoa, do you have them in your possession?
di: yeah i want to do it with my uncle while he is still around and fully aware so we can talk about the results. i think he would love it yes i have the kits
Daviss: Someone I know recently sent hers in and it was accepted
di: what!!!!!!!!!!!!!!!!!!!!!!
Daviss: yes!!! i even sent out a call to see if someone wanted to gift theres
di: i am sending mine in this weekend screw my family who did not commit. and i am going to see my uncle on the 11th.. yes sir! we will be sending in those kits! crossing our legs, eyes, fingers and toes!
Daviss: yes!!
di: what do you mean gift it?
Daviss: well some ordered kits and did not use them.. They can give them to someone else who would want them They can contact 23 and have the number changed to them
di: besides this was only for black people. they know we dont be on time! lol. well do you know anyone who is still looking for a kit?
Daviss: oh yes, I do lol I think that the problem was that people who were not supposed to get in on it overwhelmed them and they had to weed them out that took eons of time I dont think that they got the 10,000 AA's they wanted because of this close to 8000 I think
di: i put them up and if i can remember where the other two are I will most certainly gift them. just got excited. just recently i was connected with my grandfathers brother who is in his late 80s (lives 4 blocks from me!) i can get him and me and my moms maternal uncle to do it and that is 3 kits which means i should still have 2 kits left to gift! --and i can see if my mom and dad are going to do theirs (dad was skeptical) they have two with them in sc! ok well me and you have to get in before the other 2000!!!! brb today was report card day at the school. gotta be there at 1:30
Daviss: ok take care and I will chat later happy hunting di


text:
A Guide to the Kentucky Derby Seating Chart
Pia Catton joins Lunch Break with a look at another notable race at the Kentucky Derby: the race for the most exclusive seats. She breaks down who sits where and why, and what they're paying. Photo: Getty Images.
This transcript has been automatically generated and may not be 100% accurate.
... I ... I am twenty doubts the twenty eight shots at the Kentucky Derby Rotman peak that she covers the race every year for the Wall Street Journal ... she's got the school and a price tag attached I spoke to her little bit earlier and ... positions said ... she ... went to the big shots at the Kentucky Derby barangay captain she covers the race every year for the Wall Street Journal and she has the scoop as well as the price tags attached to the cc's with the now PPI Kate ... hard to fully dig into this because they're so pretty intense politics involved who sits where he stood in a range five cents range should the five women looking at the lowest price is about forty dollars the highest you're lookin' at two hundred thousand dollars I think I suppose that the forty dollars range ... our seats are you standing seats and its infancy financing to the site that sells like the most fun place to be back and eighty C Venture you've seen the photos there's loads of people that having great time to come bringing cool if they are standing they may not get to actually see you read this because there's such a huge that it can be a hundred thousand people in the infield night but they didn't have once again if that's a good time to be known as the in field seats whatever ... reason you're out there he just get wet and muddy and slippery live to see a new ad ... by defense uncertain but Friday ... the damage along ... here are now I'm thinking of me and said let let's talk about what to get financing nine thousand to ten thousand dollars for this for us eat yes it's ... designed to look like a private home ... in this area gets to be the press box so I can say what the view is like and and it's fantastic I know this elevated there's an elevator that takes you directly there the separate wine cellar that the ... concierge to help you ... I'm but a course like everything and you get leave me forget which if it were so what types of people either celebrities going in the seats was going to mention will re now we know is that a former NBA player and festive Nike junior Bridgend has bought about half of the seats and he spent one point five million dollars ... it's also part of a cherry effort and a lot of what goes on around the Derby is ... charity fundraiser so one Friday night there are several bands ... and you might buy a ticket to back off the vent sit with your cookies to the contest setting it up close to buying activity ... that has to be tarred and at the finish line and I think they want the finish line to see the big moment is not cheap TV there is ninety cents euro and ... the finish line suites are on the fifth floor and they are they run about two hundred up to two hundred thousand ... now box rights ... add and you can get enough sleep for people in the am but I am one and here you can fit weighed more people than the twenty four am ... and spiked and this is another We of corporate sponsors that do this and yes they bring in their clients and this image around the fact that there are ... many millionaires row somewhat affordable even though says millionaires row seats and seventy five dollars a seat with them and was later this week the range quite a bit because of course there's get their different locations and the seats kind of ten ten fifty pm The social gatherings and ... because they want the every here you see this thing people in Korea seven becomes and its own community it becomes a one day and Universite seeing everybody that haven't seen for year and partying ... in the interview ... I'm just a couple of the debt trap love and tears the seats around twenty two hundred ... I still lots of LEDs are invited to sit there the jockey Club suites about a hundred gram ... the steeper than the Athens lines in the sector and across the paddock said the essential building then there's the paddock in and there's another central building an incident that building is can it be referred to as the new building sometimes ... have been good to be cut off from the main use of social second guess or NOK socializing again as the Fed and thirty four boxes with a spoonful boxes in a country ... that's really where the heart of the industry it's you know if this industry has the power brokers send Turton ... though whiskey by sitting in a three hundred boxes and specifically ... the seventeen three eighteen both are really right on the finish line you aren't looking out over and ... cannot believe that that finished but then due to the winner's circle ... too proactive is like picking your table the four Seasons restaurant called thinks it is ... alright your and your from your man's point in your just expertise what's the best in the house with a few hundred bucks at three seventeen that everyone in it that that that would be my audio


text:
Given the recent rumors about an iWatch, we wanted to take a moment and you, the smartest iOS enthusiast community on the planet, what features you'd like to see in such a device, were Apple ever to release such a thing. Assuming it could link to our iPhones and iPads via Bluetooth 4.0 or similar technology, and exchange information back and forth with our constantly connected, larger capacity iOS devices, how would you like to see that used?
Would you want a Siri pass-through, so anything you said to the mic on your iWatch would be carried out by your iPhone and iPad, and the response sent back to the speaker on your wrist? That would let you send messages, place calls, add appointments, set alarms, and many other things.
Notification Center could display alerts on your iWatch, so you could casually glance at which apps are trying to get attention on your iPhone or iPad, and then follow up when and as needed. Widgets, like those included in Notification Center or Siri could allow for glance-able data, especially if they can be smart and predictive about it. Maybe even dedicated iWatch "companion" apps?
If the iWatch has a FaceTime camera built in, it could use Wi-Fi or piggy-back on your iOS 4G/3G connection to place video calls, right from your wrist. If the iWatch has iCloud built in, you could listen to iTunes music or videos streamed right to it, just like an Apple TV. Passbook integration could let your iWatch show your Starbucks card, movie ticket, or boarding pass without even having to reach into your pocket and pull out your iPhone.
Make all the maps jokes you want, but what about GPS directions show right on your watch? Or fitness features like Nike+ or the iPod nano pedometer?
Unless you're completely against the idea of an iOS iWatch, there are all sorts of features that aren't just intriguing, but downright compelling. Vote in the poll up top, and give us your grand vision and dreams in the comments below! (Or if you don't want it, tell us why!)


text:
Trash & Burn Festival
Trash & Burn Festival
Sveti Martin na Muri
Trash & Burn festival is an international get-together of fans of the American cars, motorbikes and the American retro life-style, first of its kind in Croatia, which is being held for the ninth year in a row. So far, around 520 American cars and 300 Harley Davidson motorbikes from Austria, Hungary, Switzerland, Germany, Italy, the Netherlands, France, Slovenia and from all over Croatia and more than 10,000 visitors from Croatia and the neighboring countries took part in the event, as well as visitors from Australia and the United States.
The meeting hosts numerous international bands, DJs, artists, pin-up models, presenters who are closely related to this setting.
The program consists of the international display of the American cars, motorbikes, custom-made bicycles, old vintage objects, furniture, paintings, prints, photographs, a fair of old vinyl records, parts of old-timer vehicles and a whole host of shows of custom artists, rockabilly band performances, DJs, swing dance classes, burlesque shows, film screenings, international pin-up photo contest – pin-up model photo shoot, free rides on Harley Davidson motorbikes, burn-out shows, raffle with prizes such as an American car and American custom bicycles…


text:
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