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They swab the cheeks of strangers and pluck hairs from corpses. They travel hundreds of miles to entice their suspects with an old photograph, or sometimes a free drink. Cooperation is preferred, but not necessarily required to achieve their ends.
If the amateur genealogists of the DNA era bear a certain resemblance to members of a "CSI" team, they make no apologies. Prompted by the advent of inexpensive genetic testing, they are tracing their family trees with a vengeance heretofore unknown.
"People who realize the potential of DNA," said Katherine Borges, a co-founder of the International Society of Genetic Genealogy, "will go to great lengths to get it."
Unlike paper records, which can be hard to come by and harder to verify, a genetic test can quickly and definitively tell if someone is a relative. But not all potential kin are easily parted from their DNA. Some worry about revealing family secrets. Some fear their sample could be used to pry into other areas of their lives. Some just do not want to be bothered.
Those cases inspire tactics that are turning the once-staid pursuit of genealogy, perhaps second only to gardening among American hobbies, into an extreme sport.
Derrell Teat, 63, a wastewater coordinator, recently found herself staking out a McDonald's. The man she believed was the last male descendant of her great-great-great grandfather's brother had refused to give her his DNA. So she decided to get it another way.
"I was going to take his coffee cup out of the garbage can," said Ms. Teat, who traveled to the Georgia mountains from Tampa, Fla., with her test kit. "I was willing to do whatever it took."
At one time, she might have been satisfied with a cousin's census research, which revealed that they had descended from one John B. Hodgins living in South Carolina in 1820. But a DNA test of an Oklahoma Hodgins, who was found through the phone book, confirmed they were related. Now Ms. Teat wants to identify all of John B.'s living descendants by July, when she will preside over a Hodgins family reunion.
Alas, cornered in his garage, Ms. Teat's quarry refused to listen to her pitch. Perhaps he thought she was seeking a paternity test. In any case, he did not show at his usual breakfast spot.
"It drives me nuts," Ms. Teat said. "Knowing I can get to the bottom of it, if people would just cooperate."
By next year, close to half a million people will have taken a DNA genealogy test, according to estimates from companies that provide them. The tests detect genetic markers that distinguish the descendants of an individual and reveal if two people share a recent common ancestor.
Seeking to expand their family trees, thousands of amateur family historians have begun asking people with the same last names to compare genes, even though most are total strangers. That is where the free drinks come in.
"I always say, never ask for DNA on a first date," said Georgia Bopp, 65, a retired banker in Kailua, Hawaii. "A courtship is involved."
Ms. Bopp woos with family tree diagrams from Web sites like Ancestry.com. Only after several e-mail exchanges does she mention DNA, and then she is quick to clarify that the test does not involve needles.
But when a detour on a recent trip brought her within miles of the only living male descendant of her maternal great-grandfather, she went for the direct approach. Determined to get the purest sample, she grabbed his glass at a local restaurant before the waitress filled it.
"Have you had anything to eat or drink in the last hour?" Ms. Bopp asked, whipping out the DNA kit stashed in her purse.
"She wanted my saliva, basically," said Warren Lenhart, 60, a foreign policy analyst whose test confirmed that they both had descended from a man who emigrated to Philadelphia from Germany in 1748. "There was no time for small talk."
DNA genealogy tests hold out new hope for adoptees like Paul Gilbert, 77, of Los Angeles. Searching for his biological relatives, Mr. Gilbert uncovered his birth mother's name in records, which pointed him to a man he believed to be his half-brother. But the man was not eager to verify it through a DNA test. "I can't imagine my father consorting with a woman like that," he wrote to Mr. Gilbert of his mother.
When the man finally came around, Mr. Gilbert, a retired lawyer, was just as glad that there was no genetic match. "He didn't sound very nice," he said.
Since learning that she shares some markers with St. Luke the Evangelist, Kathy Johnston, 54, a dermatologist in Torrance, Calif., has been lobbying to have the saint's remains more thoroughly analyzed.
She believes St. Luke's mother was Celtic, as is her own lineage, not Syrian, as previous genetic tests on remains in Padua, Italy, have suggested. She is willing to pay for the test, but scientists at the University of Ferrara and the Roman Catholic Church have ignored her theories.
The basic tests are sold for $99, a small fraction of what they might have cost a decade ago. But test 40 relatives, and costs can add up.
To her husband's dismay, Melissa Robards, nee Springer, has spent more than $1,000 testing Springers around the country to see if they are related. She has been known to send flowers to stubborn holdouts.
More drastic measures may be necessary to secure DNA from the talk-show host Jerry Springer, who has so far ignored her three e-mail messages. Ms. Robards, a 55-year-old mother of two in Sparks, Nev., has not entirely dismissed posing as a cross-dresser to get on his show.
There is, after all, only so much time. DNA may be the essence of life, but it is the fear of impending death that drives the current genetic genealogy frenzy. "If you don't catch the people before they die," Ms. Robards said, "you're out of luck."
Not necessarily. Susan Meates, a retired business executive, has discovered dozens of cousins because of her campaign to salvage her brother's DNA in the hours after his death in a car crash.
Ms. Meates prevailed on her brother's former wife to retrieve his clothes from the funeral home and put them in her refrigerator. From North Carolina, she instructed the medical examiner in Maryland to save blood from the autopsy and persuaded the mortician to take a cheek swab.
Some funeral homes now offer post-mortem DNA collection. But Linda Jonas saw no need for professional help when she tugged several hairs from her grandmother's head as she lay in her casket.
She made sure to get the root.
"Obviously, it's not going to hurt her," said Ms. Jonas, a family historian in McLean, Va. "I had a little Ziploc."
Genetic testing companies encourage the use of cheek cells whenever possible, but that does not stop customers from dispatching DNA in a multitude of forms. For a premium, Family Tree DNA, a provider of the tests, has extracted genetic material from toothbrushes, hearing aids, nail clippings and postage stamps. (Hair remains tricky).
The talismans come mostly from people trying to glean genealogical information on dead relatives. But they could also be purloined from the living, as the police do with suspects. The law views such DNA as "abandoned."
"If you won't give me your DNA but I run after your cigarette butt and I don't contaminate it, can we get your DNA?" said Bennett Greenspan, president of Family Tree DNA, which nearly doubled its kit sales last year. "The answer is yes."
But that does not mean genetic genealogy companies want to encourage the practice.
Mr. Greenspan invited a bioethicist to speak at the company's third annual genetic genealogy conference in Houston last fall. "Don't do anything you wouldn't do in broad daylight," the speaker told the audience.
The message did not resonate, according to several attendees.
"We're all like, 'I'd pick up the cup in broad daylight,' " one recalled.
For now, genetic genealogists are striking their own ethical balance.
Rebekah Lloyd, 53, of Denver wrestles with her conscience as she plots to visit an 86-year-old aunt, who has dementia. "I feel a little like a DNA vampire," Ms. Lloyd said. But her aunt's cells, Ms. Lloyd believes, may hold crucial confirmation of her own American Indian ancestry.
Bob Grieve, 55, stores a DNA kit in his refrigerator to use upon his father's death.
After testing his own DNA at the request of a distant cousin, Mr. Grieve was shaken to discover that he did not match any of his extended family, including his first cousin, the son of his father's brother.
That could only mean an occurrence of what genetic genealogists call a "nonpaternal event." Either his father was not his father, or his grandfather was not his father's father. But the elder Mr. Grieve has refused to surrender to the swab.
"I don't put blame on anybody," said Mr. Grieve, an engine design checker in Dearborn, Mich. "It would just be nice to know where I came from."
Roberta Estes, for her part, is contemplating exhumation. After three decades researching the Estes family tree, and recruiting 70 Esteses for DNA testing, Ms. Estes found reason to question whether her father was, in fact, an Estes.
He has been dead for 43 years.
Ms. Estes, a technology consultant in Brighton, Mich., recently got a $20,000 estimate for digging him up.


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Temporary Hero – the self-proclaimed love child of Thom Yorke + Madonna after a weekend of Depeche Mode – joins the Sidetrak Records ranks with his haunting and wide-ranging electronic single'Ballet'. A stunningly intoxicating and emotional remix by André Lodemann looks to be an Ibiza classic in the making with support already received from Robert Owens, Mousse T, Giom and Jon Cutler. People Get Real add a growling bass and choppy piano to their tech-tinged remix, while Blackhill take things in a groovy, bumping and funky house direction.
Temporary Hero has collaborated with the likes of Mac Quayle (remixer of New Order, Depeche Mode and Donna Summer), Jerome Isma-Ae, Andre Lodemann, The Slips, Chus + Ceballos, James Teej, Andrew Galea, Pete Gooding and Jeremy Sylvester. His previous releases on the Object Permanence imprint include 'Youth', 'Hate Sux', 'Savin' up 2 Be a Rock + Roll Star' and 'Blasphemy'. Nothing is deliberate. But it is all temporary.


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College of Education Alumni Volunteer to Mentor Student Teachers
UNIVERSITY PARK, Pa.—Giving back to Penn State can simply mean getting involved. The Alumni Student Teacher Network (ASTN) is a means of linking alumni with current Penn State student teachers and allowing them to impart their knowledge of education, while learning about new ways of teaching. Dee Stout, the immediate past chair of the ASTN, Penn State graduate, retired middle school teacher, and past student-teacher supervisor, said she believes that it is this act that makes the ASTN a worthwhile experience."Giving back to Penn State through the ASTN is a great experience. You have the opportunity to encourage student teachers to become the best teachers they can be," said Stout.
The ASTN, which has locations in Pittsburgh, Philadelphia, and the Centre region (all locations with a significant group of Penn State student teachers), has seminars on numerous topics. Student-teacher supervisors work with the alumni to plan three seminars each semester for student teachers, offering a variety of speakers and experiences.
One topic that each location seeks to offer is job interview assistance. These sessions often include mock interviews, reviewing resumes and cover letters and listening to a panel of professionals who give advice and answer questions.
These seminars are not limited to alumni who are teachers. Administrators, principals and lawyers attend the sessions, providing attendees with a wealth of professional knowledge. A recent seminar dealt with appropriate conduct when attending to parents who are upset or challenging.
"My favorite part is being with student teachers who are confident that they will solve all the problems we have in education," said Stout. "We need positive approaches in education, and I feel our Penn State students are prepared to be excellent teachers."
At the end of each semester, the ASTN holds a reception for the student teachers and their mentors.
"The reception is our chance to individually congratulate the student teachers by giving each one a pin that he or she can wear proudly to remember Penn State," said Stout.
"I feel that teaching is a wonderful profession," said Stout. "By giving my time to the ASTN, I feel I can share my love of teaching and hopefully inspire the student teachers to take pride in their work."
--by Amanda Dash (August 2014)


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We're beyond excited about Frank Darabont's adaptation of Robert Kirkman's brilliant zombie-apocalypse comic The Walking Dead. This could be the best TV zombie series ever made - unless they cast Lee Adama over Jacob, in which case we're doomed.
Big Shiny Robot has a very interesting scoop about who is going to play cop turned zombie killer Rick Grimes in AMC's new television series The Walking Dead. According to their sources Jamie Bamber (Apollo from BSG) is "in the running" for Grimes. But Mark Pellegrino, Jacob from Lost and THE DEVIL from Supernatural, is on said list as well. And Stuart Townsend is a last resort. AMC, please cast Pellegrino, we beg of you.
Jamie Bamber is great and all, but isn't he a bit too pretty for the role of blood-soaked Rick Grimes? It's not that Bamber is a bad actor, we just don't see his acting style slipping into this particular character. Plus his Pulse 2 performance just soured this actor for us. Also, we're not ready to gamble with a major role like Rick Grimes on an actor who can't keep up with the cast of Dollhouse. Pellegrino, on the other hand, can do gritty. Plus, isn't Bamber dedicated to the UK's Law & Order-type show?
But that's not the only name being thrown around - Stuart Townsend is also getting tossed around as a possible Rick, which kind of makes us want to cry. We're still pretty raw about his Lestat/Dorian Grey roles, so let's just say Townsend is a worst-case scenario.
Honestly when we heard Pellegrino, we were sold. I mean, look at this Rick Grimes drawing, they're practically brothers!


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From: Associated Press
By MICHAEL FELBERBAUM AP Tobacco Writer
Lawmakers are aiming to impose harsher penalties on cigarette traffickers in Virginia, where officials say low excise taxes have made it an attractive base for smugglers who can sell smokes on the black market in nearby states and funnel the profits to organized crime.
Virginia is home to cigarette giant Philip Morris USA and the nation's most prolific cigarette factory — as well as the country's second-lowest excise tax at $3 a carton. That means smugglers can easily buy hundreds or even thousands of cartons and resell them in the Northeast, undercutting retailers and skirting the higher taxes imposed there to boost public revenues and curb smoking rates. New York City, for example, taxes cartons at $58.50 apiece — nearly $6 a pack. Just a short drive away in Washington, D.C., the tax is $25 a carton.
Cigarettes also can be trafficked from neighboring North Carolina, which is home to cigarette maker R.J. Reynolds Tobacco Co. and also imposes low excise taxes.
Arkansas — a neighbor to low-tax Missouri — is among the states that have passed legislation aimed at cigarette smuggling in recent years, and others have stepped up enforcement efforts. But most rely on the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, which has prosecuted several high-profile smuggling cases in recent years.
"A lot of states are focusing on it more than they have in the past because they're realizing that a lot of their tobacco control efforts, as well as their revenues, are not working as robustly," said Maggie Mahoney, deputy director of the Tobacco Control Legal Consortium, a program that's part of the nonprofit Public Health Law Center in Minnesota.
Smuggling enough cigarettes can lead to an enormous payday. ATF estimates that a car can carry 10 cases of cigarettes — there are 60 cartons in a case — with an estimated profit of $34,000.
Upgrade to a van, and 50 cases can turn a $170,000 profit, said Virginia State Crime Commission legal affairs director G. Stewart Petoe. A large truckload can haul 800 cases and net a profit of $4 million. The Justice Department says the lost tax revenues can add up to several billion dollars.
"There's no other legal product in the United States where this type of money can be made within a thousand-mile drive," said Paul Carey, chief of enforcement for the Northern Virginia Cigarette Tax Board, which works with 17 area jurisdictions to combat cigarette smuggling.
Authorities are confident that disrupting the smuggling rings can stem the flow of money to terrorist groups, though few federal trafficking cases end up leading to terror charges. In one notable case in 2002, a federal jury in North Carolina convicted two Lebanese citizens of diverting millions of dollars in cigarette smuggling proceeds to the radical Islamic group Hezbollah. Possible ties to terror groups have also been raised in other cigarette trafficking cases.
Sen. Janet Howell, D-Fairfax, who is carrying the legislative package addressing illegal cigarette trafficking, said some people might say "so what," but the problem is that it is "bringing organized crime into Virginia and also we've had some cases where the profits of the illegal trafficking are going to terrorists."
The package is wide-ranging and covers everything from "smurfing" — buying cigarettes at Virginia retailers to resell elsewhere — to forged tax stamps, selling cigarettes off the books and importing counterfeit cigarettes. The penalty for a first "smurfing" offense would double to a year in prison under state law, while repeat offenders caught smuggling at least 500 cartons could face up to 10 years.
Among the legislation's supporters is the Virginia Association of Chiefs of Police. Executive director Dana Schrad said he hopes harsher penalties will serve as a deterrent, given that some criminals turn to cigarette smuggling because the penalties are less severe than those for drug dealing and other crimes. It will also give police officers in the field more tools to rein in criminal operations.
"Without the tools, they're not going to go anywhere," Carey agreed.
While increased penalties can help, police also have to step up enforcement efforts to make a dent in criminal enterprises, said John W. Colledge III, a consultant who once ran large-scale cigarette smuggling investigations for the U.S. Customs Service.
"If you're just running around beating up on the little guys who are making money off this, that's one thing," Colledge said. "I'm a firm believer in you follow the trail wherever it leads you, but just jamming up these people that are driving one carload, one truckload at a time, that really doesn't do much in the overall scheme of things."


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In addition to overseeing a slew of restaurants and authoring bestselling cookbooks, the Scottish-born Gordon Ramsay juggles three programs on FOX — "Hell's Kitchen," "MasterChef "and "Kitchen Nightmares." A fourth, due out later this year also on FOX, is "Hotel Hell," which will unleash the irascible host on failing hotels and inns in an effort to rescue them from ruin.
Here, the enfant terrible of cooking shows holds forth on what's wrong with most restaurants, why people should avoid honeymoon suites and what leaves him foaming at the mouth.
You have a reputation for having a terrible temper. Do you think the image of you as this angry person is deserved?
Very few chefs would do what I do, because they want to keep this cool facade so their customers will keep buying that $20,000 bottle of wine. Every top chef in the world has a fiery temper and a passion that is second to none. I'm one of the very few that doesn't have an agenda when it comes to TV.
Have you mellowed at all?
I don't think I've mellowed. I still get upset. A lot of people like to smile for the camera, and they're like total assholes when the cameras are gone. I don't give a fuck. I am what I am, and that's what it is. You know, I have a rough side. I have a smooth side. But underlining all that is an honest side. I have an earnest desire to get things absolutely right.
Is it part of your method on shows like "Hell's Kitchen" to break down contestants and then build them back up again?
Yes, I motivate them and become a mentor, but at the same time you have a firm hand on them.
Do you ever worry that you're too hard on the people that come on your show?
Definitely. I wouldn't have a conscience if I didn't.
What bothers you? Why do you find yourself exploding sometimes?
Laziness. There's laziness everywhere, whether it's JPMorgan not checking where its $2 billion went or whether it's a waiter taking for granted his 20 percent tip so he doesn't have to bust his ass at his tables.
How successful are the restaurants that you rehabilitate on "Kitchen Nightmares?" Do most make it?
Between 65 and 70 percent of them last. I treat these places like my own. I show up, I get rid of the dead wood and I motivate the talent. Whatever happens inside these places, we leave them with the remedy.
You came under fire in 2010 after a former "Hell's Kitchen" contestant Joseph Cerniglia committed suicide. Do you think that was fair?
When you get blamed for the sadness and deaths like that—individuals taking their own lives—it really hurts, because it's a tragedy. But it's also a very selfish thing to do—to jump off a bridge and to leave that restaurant and your family behind with all the mess.
You've talked frankly about your father's alcoholism and your brother's drug addiction. Do you ever worry you're sharing too much?
I'm just fed up with all the bad influences out there. I want to try to turn a negative into a positive. Growing up in Glasgow, at the time I thought it was an amazing upbringing because there was always food on the table. Now I look at it and it was a shit storm, and I was fighting to get out of there. I got dealt a dysfunctional card. Not just my father being an alcoholic, but the level of potential failure going against me.
How were you able to overcome that rough upbringing?
I found myself at a very fortunate position at the age of 22, where I got my ass kicked in France and learned how to cook. And I always say to my young chefs wherever they may be, become vulnerable. Get yourself out of your comfort zone. It's a great learning experience. I think today everyone plays it safe too much.
"Hotel Hell" looks at failing inns and hotels. Any advice for travelers?
If they turn around and say, "Mr. and Mrs. Ramsay, we're going to upgrade you to the honeymoon suite," decline it. For some bizarre reason everyone thinks it's the most romantic place. I did a black light search [for germs] on the honeymoon suite at one of these hotels. I swear to God, it was like a fucking galaxy.
What about restaurants? Is there anything that we should be concerned about?
The American public should have the right at any time to walk into the kitchen and see how the food is being prepared. You go into a dentist's office and you look around and you're so comfortable with the pristineness. Kitchens should be the same way.
The biggest problem today is that anybody can open up a restaurant with no qualifications. It's just ridiculous, and there should be stringent laws. You can't just open up a restaurant because you have these stupid little dinner parties and all your mates blow smoke up your backside and say, "Hey this is great, you should open a restaurant." Running a restaurant and having a dinner party is fucking night and day.
How do you think the recession has changed the food industry?
It was a breath of fresh air, because it removed the arrogance. We were saying to the customers, "We will do [what we want]." Now the customers are saying, "We will tell you," and that's the way it should be. The customers are king. They vote with their feet. At the end of the day, it all comes down to what's happening on that plate.
What would winning an Emmy mean to you? I'm happy with what we've just produced on a phenomenal season of "MasterChef," but the Emmys to me would be like a Michelin star. It's the Oscars of the TV world. For me it's the shining jewel in the crown I haven't got yet.


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Rapid 2012 - a major US annual gathering of people, designers, companies, and providers in the 3D rapid prototyping markets - kicks off today in Atlanta, GA. The event demonstrates the growing trend of how artists and creators are utilizing 3D technologies for their expression, while highlighting leaders in manufacturing who are changing our world using 3D. As an event which, successfully, mingles art with science, the diverse groups of people attending treat it as a unique opportunity to learn from each other.
Geomagic and Sensable teams are exhibiting at RAPID 2012, of course, but our teams are vastly outnumbered by the amount of customers showing and presenting designs, products and artwork created using Geomagic and Sensable.
Here are just a few already being featured at the event today:
(Image above) The bust of the Knight of Levis is part of a full 7'9" model created by Charles-Olivier Roy of Artisans Du Passage, for a new, scaled-up bronze cast based on an original statue situated at the National Assembly of Quebec building. Using a Creaform Handyscan and Geomagic Studio, the artist split the scan data into 110 parts in Geomagic, reassembled into 6 large components, 3D printed the components using a 3D Systems Zprinter, and the physical model was then used to create ceramic bronze casting parts.
Artist Heather Gorham has an exhibit at the event called Lost Dog, Found'. One of this artist's strengths is in presenting figurative art using animal imagery. The two conjoined greyhounds were created using Freeform, and printed on an EOS SLS printer. (Image below)
The Twist exhibit by Shawn Smith uses both Geomagic Studio and Freeform to create a new twist on one of his old sculptures. According to Smith, he scanned the original pixillated rabbit head sculpture and twisted the entire piece using Freeform before 3D printing the sculpture. (Image below)
In addition, customers, partners and resellers including Schneider Electric, eQualityTech Inc., Wenzel and a host of others are giving presentations on Geomagic and Sensable software throughout the event.
Geomagic Industrial products for 3D Imaging and Metrology can be seen at Booth #320 and the Geomagic Sensable technologies for touch-enabled design are on hand at booth #200.(Image below: Our new Sensable booth before the crowds turn up.)
We hope to see you all there


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what we do
The purpose of RUF is to build a community on the college campus that reaches students of divergent beliefs and doubts with the message of the gospel and equips them to love and serve Jesus and his church. As we shape our lives around the gospel we have the opportunity to participate in God's work of changing lives, healing our world, building community, and engaging our culture. We aim to do this by pursuing the following goals:
Growth in Grace
The way in which we grow in the Christian life is the same way in which we enter it - by receiving Jesus and relying on what he has done for us by his grace. That is why we are devoted to helping one another use the means of grace God has given us to promote our growth in Christ-likeness. We affirm that deep, lasting change occurs by studying the Bible, developing a prayer life, participating in worship, and forming authentic relationships with others.
Evangelism and Missions
We believe the gospel is true, and, therefore, it cannot be kept to ourselves. We are committed to thoughtfully and respectfully communicating the gospel through the words we speak, the deeds we perform, and the community we embody so that we might give others the opportunity to discover the true story of God's grace. And since the salvation Jesus brings is comprehensive and affects the whole person, we are committed to tangibly expressing God's care for the world by seeking wholeness for the poor, justice for the oppressed, and restoration for creation.
Fellowship and Service
Jesus not only calls us to follow him as individuals, but also gathers us into a community in which we learn to apply the gospel to every aspect of our lives. In our relationships with one another, we strive to reflect the countercultural values of the gospel, and as we do we provide the world around us with a glimpse of who God is and what his coming kingdom entails. In light of the fact that God calls us to himself in order to be a vehicle of blessing to others, we are committed to sacrificially serving others on our campus and in our world.


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ESA's new scientific heart inaugurated by Spanish royalty
ESA PR 06-2008. Their Royal Highnesses The Prince and Princess of Asturias inaugurated this afternoon ESA's European Space Astronomy Centre (ESAC), located on the outskirts of Madrid, Spain.
The event was also attended by the Spanish Minister for Industry, Joan Clos; the Head of the Spanish Delegation to ESA, Maurici Lucena; and the Major of Villanueva de la Cañada, Luis Partida. On behalf of ESA, the dignitaries were welcomed by ESA's Director of Science, David Southwood; ESA's Director of Operations, Gaele Winters and the Head of ESAC, Vicente Gómez. In representation of the aerospace sector was the General Director of INTA, Fernando González.
Among the distinguished guests to mention also, were two Prince of Asturias Award winners, Amable Liñán and Pedro Duque the Spanish ESA astronaut.
ESAC is ESA's new base for astrophysical and Solar System missions, and is a centre of excellence for space science, and meeting point for scientists and researchers from all over the world.
ESAC hosts the Science Operations Centres of the following missions: XMM-Newton, Integral, Akari (a Japanese-led mission), Herschel, Planck, Gaia, LISA Pathfinder, Mars Express, Venus Express and Rosetta. ESAC also houses the scientific archives of IUE, ISO, XMM-Newton and Integral, together with precious scientific data from Mars, Venus and Titan obtained by ESA's Mars Express, Venus Express and Huygens spacecraft.
In the near future, ESAC will also be the scientific centre of ESA's mission to Mercury, BepiColombo. Other future programmes at ESAC will include the NASA-led James Webb Space Telescope, the successor to Hubble.
Beyond its fundamental scientific role, ESAC will also take part in ESA's space application programmes. SMOS (Soil Moisture and Ocean Salinity), an ESA Earth Observation mission to measure soil and sea characteristics, will be launched this year, and ESAC will host the data centre for this satellite, thus embarking on a new role in the field of Earth Observation.
Prince Felipe and Princess Letizia arrived at ESAC at noon. In front of over 120 distinguished guests and after a few words by the Minister and ESA's Director of Science, Prince Felipe unveiled a plaque, engraved with the words 'Their Royal Highnesses The Prince and Princess of Asturias inaugurated the European Space Astronomy Centre of the European Space Agency. 7 February 2008'. ESAC Director Vicente Gómez, as host of the celebration, graciously thanked the Prince and the Princess for their visit.
The Prince and Princess were given a brief tour of the facilities, escorted by the dignitaries and ESA experts. Prince Felipe and Princess Letizia visited the ESAC Planning Room and the Control Room of ESA's X-ray space telescope XMM-Newton. XMM-Newton's observations of black holes (stars that have died as supernovae), and energetic astrophysical phenomena in general, are opening entirely new fields in astronomy.
The Prince and Princess then signed ESAC's Honoured Guest Book before ending their visit meeting with guests and ESAC staff during a cocktail party.
For further information:
Mrs Monica Oerke
Public Relations
Tel.: +34 91 813 1327
Mobile: +34 6 36 49 95 26
E-mail: monica.oerke @ esa.int


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24 December 2005
25 November 2005
24 November 2005
Les publications de l'APROGEDby lola2k
Les publications
23 November 2005
1 (7 marks)
Founded in late 2003 and heartquartered in France, we are non-profit and independant.
We believe in the open web, think internet services should be sustainable, build for the long term.
While we are re-launching the service, we only accept new members through invitation.
last mark : 24/12/2005 10:47


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Re: ViEmu/VS 2.0.27 ready
I have just uploaded ViEmu for Visual Studio 2.0.27:
It needs a manual uninstall of previous 2.0.x versions before installing this one.
These are the issues addressed in this release:
- :noh[lsearch] implemented
- hlsearch setting wasn't honored on startup, even if it was shown fine in Tools|Options|Viemu
- The desired-cursor-col was not reset after moving the cursor by left-clicking
- :set gdefault would not work in .viemurc
- Pasting in VB would lead the language service into "partial" corrections and lead to syntax errors
- The \| operator in regular expressions didn't work fine (would only match the second branch)
- Keyboard management should now support the Japanese version of Visual Studio
Let me know if something's not right. I will keep working in the other pending issues.
Thanks for all the feedback!
- Jon


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Pension Quandary: Lump Sum or Annuity?
Carefully mull your options when deciding how to receive your pension payout.
EDITOR'S NOTE: This article was originally published in the March 2011 issue of Kiplinger's Retirement Report. To subscribe, click here.
After 40 years of toiling away, you're finally retiring. You can't wait to kick back and enjoy your hard-earned savings. But the quality of your retirement will be greatly affected by how you choose to receive money from your pension. Should you take a lump sum, monthly annuity payout or a combination of the two? It's a critical decision: Once you make your choice, you'll have to live with it the rest of your life.
Today's low interest rates make the decision tricky. If you choose an annuity, you'll be locking in low rates indefinitely. Even lump-sum payments have been reduced because the Pension Protection Act of 2006 changed the type of interest rates that plans use in calculations. Beyond simple math, you have to take into account your risk tolerance, income from other sources, and your health and the health of your spouse.
Start by tallying all your income sources. If Social Security payments and income from other retirement plans cover your basic expenses for food, clothing, shelter and medications, you might want to consider a lump sum that you can invest in higher-yielding securities to beat inflation. If you and your spouse need the money urgently for health care or other pressing needs, a lump sum might be right as well.
If you think you can match or exceed the defined-benefit plan's monthly payouts, or if you have a multimillion-dollar portfolio, take the money. Roll it into an IRA to defer the tax bill; you'll be taxed as you draw money from the IRA.
A 2007 Vanguard Group study shows that 73% of employees ages 55 and over chose a lump-sum payment over an annuity in a traditional pension. The study found that people like the flexibility of having money at hand rather than locked up for a long time. They also want to leave something for their heirs. Certainly, the recent demise of big banks and bankruptcies of major automakers have made people more wary of leaving their money with their employer.
But taking a lump sum means you'll be responsible for funding your retirement. "Most studies show that individuals who take the lump sum do worse than those who take the annuity," says Rande Spiegelman, vice-president of financial planning at the Schwab Center for Financial Research. "Most people do a pretty lousy job of saving. How much more difficult would it be to manage a portfolio for sustainable withdrawals over a long time horizon?"
Annuities Better for Most Retirees
Let's say you've hit your retirement age of 65. Your company gives you a choice of a $300,000 lump sum or $2,000 a month in a single-life annuity. If you take the lump sum and expect to live another 18 years, you have to generate a 4.16% return annually to receive $2,000 a month as you draw down the interest and principal, Spiegelman says. A portfolio of 20% stock, 50% bonds and 30% cash should return 4.1% a year on average. But if you think you'll live another 30 years, you'll need a return of 7.31% a year. That's tougher to do without taking on much more risk.
Moreover, you have to be able to ride out market volatility. Can you hold back from selling your stocks if the market plunges? With an annuity, you'll get the same payout every month until you die, regardless of market conditions.
The tricky part with managing your own money is guessing how long you'll live. People tend to underestimate their life expectancy, says Ethan Kra, chief actuary of benefits consulting firm Mercer. For a married couple, both age 65, the odds are greater for a spouse to reach 100 than for their house to burn down, he says. When you choose a lump sum, you take the risk that your money will run out before you and your spouse die.
If you are married and go the annuity route, you must choose between payments that end when you die or a joint-and-survivor option that starts with lower payouts but continues payments as long as either you or your spouse is alive. To cover yourself only, your spouse must provide a written consent that is notarized or witnessed by the plan administrator, says Rebecca Davis, legislative counsel at the Pension Rights Center. With the joint-and-survivor option, the spouse must get at least 50% of the monthly payout upon the retiree's death, although plans can boost the survivor benefit to 75%.
If you don't trust the health of your employer, consider that annuities from company pensions are insured by the government-backed Pension Benefit Guaranty Corp. (www.pbgc.gov), for up to $54,000 in 2011. About 85% of folks who end up being covered by the PBGC are made whole, says Davis. So in the unlikely event your company goes belly up and the pension is underfunded, the PBGC will give you up to $4,500 a month if you're 65 when you start receiving benefits. The monthly payment will be lower if you retire earlier or elect survivor benefits.
With interest rates still low, you could consider delaying your retirement. "The longer you wait, the better the deal," says Steve Utkus, who runs the Vanguard Center for Retirement Research. But if you want to retire on schedule, and your company offers the option, then consider taking your benefits in a combination of a lump sum and annuity payouts. That way, you won't be locking in your entire pension at a low interest rate. If your employer does not offer the combination option, you could take the lump sum and buy annuities with all or part of it later when interest rates are higher. You could ladder your annuity purchases, investing a portion at a time so you'll lock in different interest rates.
However, if you decide to buy annuities with part of your lump sum, be aware that buying annuities -- such as from banks, brokerages and insurance companies -- will cost more in fees and commissions than if you choose the annuity option from your company's pension, Utkus says. And the annuity is only as good as the health of the firm that sells it to you. To minimize risk, spread your investments among companies highly rated by A.M. Best, Fitch Ratings, Moody's Investors Service or Standard & Poor's, Spiegelman says.
Not all retirees get the lump sum option. Some plans simply don't offer it. And, even if the option is spelled out, plans that are less than 60% funded are prohibited from paying lump sums. If the plan is between 60% and 80% funded, the lump sum can equal only half of a retiree's benefit or the amount the retiree is entitled to under the PBGC, whichever is less. The rest is annuitized. Pension sponsors in bankruptcy cannot pay lump sums unless the plans are fully funded.


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I'm always on the hunt for "grown and sexy" hair accessories. I've been lucky with some brands like Kinkabands and I've also been lucky with goodies from Scunci. Believe me, one too big bow or pastel flower in my hair and I look like a 30 year old trying to be 15!
I had the chance to try out Scunci's new Bendini Hair Clips. You just bend and snap and you have a really pretty touch added to your hair.
Check out this video on how to wear a Bendini.....
Now, I'm going to giveaway a Scunci Bendini Prize Pack, which will include some Bendinis for your use and play!!! Let's go!!
Win a Scunci Bendini Prize Pack!!!!
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Pre-Gala Shopping
Text: Natasha Stagg
Last night, we went shopping at the Zero + Maria Cornejo store on Bleecker and Mott. Cocktails were served for a pre-gala event celebrating an upcoming Relâche celebration: a black and white party on Thursday November 29th, hosted by Julie Blakeslee, John Spong, RoseLee Goldbern, Wendy Fisher, Amanda and Glenn Fuhrman, Jeanne Greenberg Rohatyn and Cindy Sherman.
A benefit for the expertly curated Performa series, the 5th of which will take place in November of next year, the gala, Performa 13, will be a tribute to the original 1924 Relâche organizers, Francis Picabia and Erik Satie–two artists without whom the performance art movement absolutely would not have been the same. Performa organizer RoseLee Goldberg gave a lively speech urging attendees to transport to the days of Dada, when experimental performance was young, while a video installation was projected over ZERO + Maria Cornejo's striking digital print collection.


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Show me your fur baby pics
Our brand new guinea pigs, five weeks old! Still a little shy, the second one (Minnie) is hiding!
So cute! Has she climbed to the top yet?
@Maja, so cute! I had guinea pigs growing up as our first pets (Runt & Squeaker). We used our blocks, duplos, & fisher price playsets to make little mazes for them. I'm biased but I really think they are some of the best "first pets." hehe
No, they are pretty much hiding in the moment and haven't climbed anything so far. My daughter (10) spends her afternoon reading in front of them so that they get used to her. They are only five weeks old and haven't had much contact with humans so far, so I guess it will take some time until they fully trust us...
@ Lizanne: yes, we do think she's pretty, thanks!
There is a really great petstore by us that handles the animals alot. They always have guinea pigs I want one!
She is beautiful! I think tabby cats are my favorites. They have so much personality.
Lol, I could finally put pics of all my cats in a single image! I haven´t post they here yet, because, as I have 5, I´d flood you :
Wow! As I'm looking at all of these adorable guys & gals, I didn't even realize I'm thinking, "Gee, maybe I could get a hedgehog, he's so little, must be easy to care for", then I'm thinking, maybe it's time for another doggie, and then I came around! They are so darn cute, each and every one of them! I'll post a photo of my whining weiner dog one of these days, recently lost my pomeranian welsh corgi, she was 16 1/2 yrs. old. You never get over them. I lost a dachsie 16 1/2 yrs. ago, and there are times I still get upset about it!
You are so right, Cindy. We never do get over them. They bring such a special quality to our lives but they just don't live as long as we do.
The small one is Madeline and the larger one is her daughter, Isabella. They are my babies.
@Jodi I am not a dog person but I adore your dogs. My sister has one just like it and she is a protector so I cannot even pet her! Their previous dog was named precious same type but "black" and she was a sweet as her name! If I ever had a dog it would be one like yours. My biggest problem was when I took Precious on a walk and boy did she take her time....Don't think I have the patience. Thanks so much for sharing your two beautiful babies!
Aww Jodi, they are really cute
Love all of the photos of everyone's sweet "Fur Babies". This is Mika when she was only a couple of months old. She is an Akita and belongs to our granddaughter. They lived with us for about 3 years and we miss them both terribly.
Awww, so sweet! I would miss her too!
I adore most animals so I love all these pictures! Jessica, we also had a hamster that came when we called and he would sit in my shirt pocket. Never had another like him though. The second one used to terrify the puppy by rolling at her in its plastic ball. SO funny.
Here is Lily our miniature schnauzer. She's 16 1/2 and had 2 strokes last year so she is not as sprightly as she used to be. Her tongue is out because she has lost teeth on that side. We adore her.
She's our only domestic pet but we have a lot of wild native hedgehogs, birds, squirrels, pond goldfish and frogs in the garden that we look after and feed.
What a sweet looking dog!
Love the pics of Lily and Mika!
I have the cutest little chihuahua mix. She's such a sweet little dog and so well behaved. We just love her to death. Here she is sitting on my lap while I was working on the computer.
I also have a cute little cat. She's a munchkin breed so she's tiny. Munchkin cats have the gene for dwarfism, so she has short little legs and a big head. My friend use to call her a "low rider". Here's a paper layout I made of her quite a while ago:
And lastly, my sweet little Kinko. I had to put her to sleep last year because she developed kidney trouble and she was old (16) and wouldn't have had very good quality of life if I let her linger on. It really make me sad. She was so pretty. Here a layout I did of her:
Cat, they are all adorable. I love that your dog is on your lap at the computer. After Lily had her stroke she would not be parted from me and she had a cushion next to the keyboard. Makes for some strange keystrokes at times but so sweet! I have never heard of a munchkin cat - off to google that! I see you lost Kinki almost a year ago - so sad. They give such sweet memories, our little furry ones.
this must be my favorite thread, with all the cute fur babies! so sad when they are gone. i dread it!
any more fur baby pics? here's one of my Instagram pics of Truffles, just so this thread get bumped up!
So cute!! We can never have too many cute photos.
I am so glad you said that Marisa, although I might have gone overboard. My first try at Scrapbooking was one with my dogs, unfortunately it got ruined when the fish tank leaked and I have not got round to making another one. Going through my photographs was lovely! These are my beautiful dogs. Currently we have four: Megan, now 16: Holly now 8; Jack, now 4; and Annie just over a year.
They are all so sweet! Thanks for sharing!
awwww, your dogs are so pretty Angela
Thank you. I enjoyed creating these previews so much, remembering all my precious ones and celebrating my present much loved pets.
If you go to my gallery you'll see a LO where I have a couple pictures of our dog... I still haven't gotten around to scrapping our latest siameses - they're hard to get pictures of (they run fast!).


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US: Hidary-led group to acquire Everlast for $146m
Everlast Worldwide Inc on Friday (1 June) agreed to be acquired and taken private by an investment consortium headed by The Hidary Group for US$146m.
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NEW YORK (MainStreet) — With new and substantial upgrades in technology and communication, U.S. health care consumers are generally OK with virtual doctor appointments.
That's a pretty big deal given the expected shortage of qualified doctors once health care reform is rolled out fully in 2014 and reaching out to a physician by either phone, email or video could become more common.
On the professional side, evidence is mounting that a virtual doctor's appointment can be just as effective as being there in flesh and blood.
According to a Jan. 14 article in the Archives of Internal Medicine, patients seeking treatment for afflictions such as sinus infections and bladder problems were given a proper and accurate diagnosis by physicians online after patient descriptions and updates to their online medical profiles.
A study out Thursday shows that 74% of Americans are "open" to such virtual doctor visits. The study, the Cisco Customer Experience Report, surveyed 1,547 consumers and health care professionals across 10 countries to find that 75% of consumers say they "are comfortable with the idea of communicating with doctors using technology instead of seeing them in person."
In addition:
- Cisco says that in China, Russia and Mexico, approximately 75% of consumers "would be comfortable communicating with a specialist using virtual technology (e.g. video chatting, text messaging) for a health condition."
- Another 60% of consumers from Germany, Japan and the U.S. say they are open to being treated by a health care specialist using virtual technology.
- By and large, Cisco adds, health care consumers "will give up anything, including cost, convenience and travel, to be treated at a perceived leading health care provider to gain access to trusted care and expertise."
- Another 25% say they would like health care "reminders" to be made available to them over emails and texts.
Also, about 50% of health consumers worldwide are amenable to sharing personal health information across social media channels, with about 65% of health care professionals in agreement. Yet only 60% of Americans believe data protection is "adequate" across digital channels.
That isn't stopping technology companies and health care professionals from bringing more digital health care options to the table (or smartphone).
"Due to the increasing convergence of the digital and physical, there is an opportunity to provide increased collaboration and information sharing among providers to improve the care experience and operate more efficiently," says Kathy English, of public sector and healthcare marketing at Cisco.


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There is something really thrilling about the countdown from 5 to 1. Just
like with Miss America, you are honored to be one of the finalists, but you
really want to be number one.
Imagine our delight when our phone rang off the hook when Top 5 on the Food
Network did a show on the "Top 5 Tasty Tours." We knew we were in the top 5, but
little did we know that we were the winner—number one.
To be listed with companies like Jelly Belly and Celestial Seasonings is
quite an honor. To be picked above them is a real tribute to our people,
products and heritage. Check out this show when it airs again and come to Eli's
Cheesecake World for a tour.
Episode TP1B13
TOP 5: Tasty Tours
Hop on the Top Five Tour Bus as we visit some of our favorite food factories. Stops will include a St. Louis standard, Teatime in the Rockies, and a Chicago factory where cheesy is a good thing! All this and more as we countdown the Top Five: Tasty Tours.
Where to Find
Jelly Belly Candy Company
Celestial Seasonings
Eli's Cheesecake World
Wolfgang Candy Company
Utz Quality Foods
Snyders Of Hanover


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Doors and Windows That Set Trends
From contractors and designers to builders and homeowners, Pella Windows and Doors has long been known for a tradition of quality products with style that makes headlines.
Last year was no surprise, with Pella products catching the recognition of newspapers, magazines and professional publications across the country. If you're looking to bring the latest looks to your Owensboro home when remodeling, check out how the experts placed Pella front and center in their designs.
Large, scenic glass windows were a major design trend in 2017. So when The Wall Street Journal wrote about the trend, it was no shock that Pella windows were highlighted as a popular choice for designers, architects and owners of some of the most fabulous ski homes in the country.
When award-winning contemporary architecture and design magazine AZURE wanted to highlight new hardware for "sleek and seamless openings," they looked to the wide-ranging portfolio of contemporary hardware options on Pella's Architect Series doors. The November article reflected Pella's style to the designers, architects and other trend-setting developers that make up their readership.
House Beautiful, "the magazine of style to inspire your own," was itself inspired by a red craftsman Architect Series door. The magazine featured it in their section, suitably named "The Best," a November feature looking at exterior decorating products.
When Period Homes magazine wanted to report on the trend of wood doors for their "Making an Entrance" article in November, Pella's Architect Series found itself featured yet again.
Meanwhile, when Washington Post Resident Products Editor Nigel F. Manyard shared a firsthand account of his home remodeling experience, the increased energy efficiency that Pella replacement windows offered his home was a highlight of his project.
Pella even had a starring role on television, showing up in four separate episodes of HGTV's "Property Brothers: Buying and Selling," where host Drew Scott praised the value Pella's windows brought to the redesign of a home, while home owners thought the windows "gorgeous."
A strong history may be at the core of Pella products, but the future will continue to look bright as tastemakers look to Pella quality and style again in 2018.
Find out how Pella of Owensboro can help create a dynamic, headline-grabbing look of your own in your home.https://www.pellaofbeltsville.com/corporate/images/Pella-windows-and-doors-on-front-porch-header-1576.jpg


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Honor the Heroes of the Game, Preserve Its History, Promote Its Values & Celebrate Excellence Everywhere
I happen to be a very emotional person. Whatever I get into, I get in over my head…I'm the type of guy who has confidence in what I believe in, which is key to the whole thing."
(Texas)...Texas Earnest Schramm, Jr ... Cowboys president-general manager, 1960-1989 ... His Dallas teams had 20 straight winning seasons, 1966-1985 ... Significant force in AFL-NFL merger, 1966 ... Promoted six-division, wild-card playoff concepts for merged NFL ... NFL competition committee chairman, 1966-1988 ... Major advocate of instant replay, special field markings, offense-enhancing rules changes ... Born June 2, 1920, in San Gabriel, California ... Died July 15, 2003, at the age of 83.
Tex Schramm, except for a three-year stint as assistant director of sports for CBS television in the late 1950s, played a dynamic role in professional football throughout a 44-year span between 1947 and 1990.
He began his NFL career as publicity director of the Los Angeles Rams and finished as president and chief executive officer of the World League of American Football. In between, he served the Rams for 10 seasons and the Dallas Cowboys for 29 years.
Schramm earned his journalism degree at the University of Texas. After two years as a sports writer with the American-Statesman in Austin, Texas, Schramm moved to Los Angeles to join the Rams. He advanced through the ranks and was general manager of the team when he joined CBS in 1957.
Tex joined the Cowboys at the time of the team's inception in 1960. In a 29-year tenure that ended after the 1988 season, Schramm fashioned the Cowboys into one of the showcase franchises of all professional sports. His Cowboys teams played in five Super Bowls, winning two, had 20 consecutive winning seasons, and 18 playoff appearances in those 20 years.
Schramm's contributions to pro football did not stop with the Cowboys however. For 23 years, he was the chairman of the influential NFL competition committee. Along with Lamar Hunt, he was a leading force in the AFL-NFL merger that was culminated in 1970.
Schramm introduced the concept of three divisions in each of two conferences with wild-card playoff teams. He led the fight for instant replay as an officiating tool and a fan-interest enhancer. He was a leading advocate of such innovations as a referee's microphone, a 30-second clock between plays, extra-wide sideline borders, wind-direction strips on goal post, uprights and multicolor striping for 20- and 50-yard lines.


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'Blink Hotels' Travel App Acquired by Groupon
If you've been keeping up with all that has been going on with the online coupon company Groupon over the past couple of years, then you know that it's been a bit of a bumpy ride for them. As a matter of fact, just earlier this year, it received quite a bit of unfortunate media press stating that it was losing millions of dollars on a monthly basis due to high turnover and poor pricing. Plus, with competitive companies such as Living Social on its heels, they have also had to fight to remain relevant.
But thanks to a recent announcement that they made, their luck may be about to change. That's because they have made the acquisition of the travel app, Blink Hotels. Continue reading this post ->


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SAMJ: South African Medical Journal
versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.99 no.6 Cape Town Jun. 2009
Clinical, legal and ethical implications of the intra-ocular (off-label) use of bevacizumab (Avastin) a South African perspective
Rita-Marié JansenI, *; Chris GouwsII
IBSocSc (Hons) Nursing, BIur, LLB, LLM, LLD (UFS), Department of Private Law, University of the Free State, Bloemfontein
IIMB ChB, MMed Ophth, FCS Ophth (SA), Bloemfontein Eye Centre, Hospital Park, Bloemfontein
Choroidal neovascularisation is a potentially visually devastating element of various forms of eye pathology. Recent research has focused on neurovascular age-related macular degeneration (AMD) as a cause. AMD can be classified as being exudative (wet) or atrophic (dry). Wet AMD is characterised by a pathological process in which new blood vessels develop in the choroids, causing leakage of fluid and haemorrhage under the retina and leading to localised serous detachment and loss of central vision. Vascular endothelial growth factor (VEGF) stimulates growth of neovascular membranes. Treatments have until recently yielded disappointing results.
Ophthalmologists are using intra-ocular injections of bevacizumab (Avastin), an anti-VEGF, to treat AMD. Avastin appears to be safe and effective in the short term, but its intra-ocular administration is entirely off-label. Avastin is registered for treating metastatic colorectal and breast cancer.
The off-label use of medication is an important part of mainstream, legitimate medical practice worldwide. Lawyers representing plaintiffs injured by drugs increasingly encounter off-label use claims. From a legal/ethical point of view the off-label use of medication represents a delicate balance between the statutory regulation of medication and a physician's prerogative to prescribe medication that in his or her medical opinion will be beneficial to the patient. The main reason for the controversy created by the off-label use of Avastin is that there are anti-VEGF drugs on the market that have formal approval for the treatment of AMD (and other eye conditions). Lucentis, for example, is extremely expensive, with treatment cost approximately 50 times that of Avastin. Many patients suffering from AMD and macular oedema cannot afford the registered product.
The off-label use of Avastin has passed the innovative or experimental stages, as ophthalmologists have used it regularly and openly for a long time, with good success. Such use therefore cannot be considered careless, imprudent or unprofessional. We submit that an ophthalmologist who omits to inform a patient of the availability of Avastin for this form of treatment may be found to be negligent.
Protocols developed by the South African Vitreoretinal Society and endorsed by the Ophthalmological Society of South Africa for administering Avastin and other intra-ocular medication intravitreally should be strictly adhered to.
Clinical background
Bevacizumab (Avastin) is registered for the treatment of metastatic colorectal and breast cancer. Avastin blocks vascular endothelial growth factor (VEGF) and was the first clinically available angiogenesis inhibitor in the USA. Blocking or inhibiting VEGF prevents further growth of blood vessels, thus impeding the tumour's blood supply.1
Ophthalmologists are using intra-ocular (intravitreal) injections of Avastin to treat neurovascular age-related macular degeneration (AMD). Choroidal neovascularisation is a potentially visually devastating element of various forms of eye pathology. Research has focused on AMD as a cause and has attracted significant funding in Europe and the USA because of their ageing populations.
AMD can be classified as exudative (wet) or atrophic (dry). Dry AMD is slowly progressive and rarely leads to total blindness. Wet AMD is characterised by a pathological process in which new blood vessels develop in the choroids,2 causing leakage of fluid and haemorrhage under the retina and leading to localised serous detachment and loss of central vision. AMD is the leading cause of blindness in people over 50 years of age. Wet AMD may initially be reversible, but without treatment permanent loss of vision may be quick and severe.3
Treatment options have until recently yielded disappointing results. Treatment with Argon laser can cause shrinkage and atrophy of the offending choroidal vessels, but with unacceptable collateral damage.4 Photodynamic therapy with verteporfirin only slows down disease progression. Surgery, involving removal of the sub-foveal neovascular complex or rotation of the whole or part of the retina to effectively translocate the macula, has had disappointing results and significant complications.5
Enter the anti-VEGFs. VEGF stimulates growth of neovascular membranes. The intravitreal injection of anti-VEGF antibodies reduces the amount of VEGF and interrupts the pathological process.
Intra-ocular administration of bevacizumab (Avastin) is entirely off-label. It is formulated for intravenous infusion, not intravitreal injection, and the Food and Drug Administration (FDA) approved its use for colon cancer in February 2004. In 2005 Philip Rosenfeld first injected Avastin into a human eye and two case reports showed benefit; the first patient had neovascular AMD and the second had central retinal vein occlusion. After this its intra-ocular use spread rapidly around the world.6
However, there is no long-term safety and efficacy information for intravitreal bevacizumab based on large randomised trials and no true dose escalating/ranging studies. There is therefore no scientifically determined optimal dose and dose frequency,1 but bevacizumab appears to be safe and effective in the short term.6-9 Besides, ophthalmologists frequently use medications off-label. Intra-ocular triamcinolone is a typical example.
Pegaptanib (Macugen) and ranibizumab (Lucentis) were two anti-VEGF contenders in the race to get a registered drug on the market via the obstacles of the FDA.
Legal implications of the off-label use of medication
'Off-label' means that the medicine is used in another way or for an indication other than those specified in the conditions of its registration and reflected in its labelling.10 This does not necessarily imply that the medication is not effective or is unsafe to be used in this way.11 Off-label use is an important part of mainstream, legitimate medical practice and is a worldwide phenomenon.12 According to the American Medical Association, 40 - 60% of all prescriptions in the USA are off-label. The off-label use of medication is common practice, especially in oncology, obstetrics, paediatrics, infectious diseases (notably HIV) and rare diseases.13 Lawyers representing plaintiffs injured by drugs increasingly encounter off-label use claims.14 Off-label use of medication can vary from being experimental or controversial to standard practice and even state-of-the-art treatment.12
When will off-label use of medication be negligent and when not?
From a legal/ethical point of view the off-label use of medication represents a delicate balance between the statutory regulation of medication (to safeguard patients) and the physician's prerogative to prescribe medication that in his or her medical opinion will benefit the patient.15 This freedom to prescribe is not unsupervised; fear of delictual liability and medical malpractice claims are a check on the prescribing of physicians, who must balance the benefits against the risks.11
Physicians learn about off-label uses of medication through professional medical literature, presentations and peer lectures at conferences, medical research and advice from colleagues. They cannot prescribe or administer medication off-label with the same confidence as with registered medication. Information regarding possible side-effects, correct dosage and route of administration is normally unavailable, and anecdotal evidence is not the equivalent of clinical tests.15 Side-effects occur more often where medication is used off-label.16
Prescribing or administering medication off-label is acceptable medical practice when done by an informed, competent and experienced physician. Reasonable and acceptable medical practice was described as follows:17 'In deciding what is reasonable the court will have regard to the general level of skill and diligence possessed and exercised at the time by the members of the branch of the profession to which the practitioner belongs.'
A patient may successfully sue the practitioner if it can be proved that the off-label use of the medication in the circumstances was negligent, namely that harm was reasonably foreseeable and preventable. If off-label use of the specific medication has taken place regularly and openly and colleagues have also been doing it, over a period of time, with a reasonable degree of success and without patients being harmed, it would be almost impossible for a prospective patient to establish that harm was reasonably foreseeable.10 'Physicians may be found negligent if their decision to use a drug off-label is sufficiently careless, imprudent or unprofessional.'18
In a law-suit the defendant doctor is required to provide sound scientific evidence, from medical literature and expert evidence, that the off-label use is acceptable, effective and without known harmful side-effects. Strong scientific evidence for the safe use of off-label uses of medication exists in only 28% of cases; in 72% there is little or no scientific evidence.19 The risk of liability is heightened when the medical practitioner relies exclusively on his own experience and the experience of his or her colleagues. These cases often end up as a battle of experts. Experts for the plaintiff will try to prove that the defendant's conduct deviated grossly from the standard practice set out in the labelling. Experts for the defendant doctor will try to demonstrate conduct in accordance with what other doctors are doing and therefore in accordance with ordinary protocol.14 In Durr v. ABSA Bank Ltd20 the Supreme Court of Appeal emphasised that although the court will pay much attention to the views of the profession, it is not bound to adopt them. The court must ultimately decide what is reasonable in the circumstances.
The court will take the package insert and other information, such as that in the South African Medicines Formulary, into consideration when determining the proper use of the medication. There is no case law in South Africa where a finding on the evidentiary value of the package insert and other labelling was made. We submit that because medical discovery runs ahead of the Medicines Control Council (MCC)'s registration process, the labelling should not per se be regarded as an indication of standard practice. As in most judgments in the USA18 it should, however, be an important factor to take into account.
Where off-label use is the standard of care, failure to follow this standard may be grounds for malpractice claims.11
It is highly recommended that medical practitioners keep a separate file of the latest professional information and medical literature regarding the off-label use of medication.
Must the patient be informed that the medication is used off-label?
The doctrine of informed consent requires the medical practitioner to give a patient the material information regarding the proposed treatment, alternatives, potential risks and benefits of each potential treatment, and the result of no treatment. Most judgments in the USA21 view that use of medication off-label pertains to the regulatory status of the medication only and is not relevant medical information that must be disclosed to the patient, but this remains a contentious topic.
The opposing argument is that off-label use lacks the assurances of safety and efficacy that an approved indication has, which is important information the reasonable patient would want to know before making a decision.15 Because there is no case law on this in South Africa the court may hold that a finding of lack of informed consent cannot be based solely on the off-label status of the medication not being revealed. Circumstances may also play a deciding role: if a medication is prescribed at a higher than approved dose, and it is standard practice to do so, it will be difficult to convince the court that this was material information. However, this will differ when the medication is used for a different condition and in a different manner to that approved, even if it is regarded as standard practice to do so, e.g. the intravitreal injection of a medication to treat AMD that was approved to be given intravenously for the treatment of metastatic cancer of the colon.
Generally speaking it would be good medical practice to reveal the off-label use of medication. If not revealed it could, for instance, confuse the patient should he or she read the package insert. This information can also be important to determine whether the medical aid fund will pay for the treatment. To safeguard against possible litigation it is highly recommended that practitioners should discuss the off-label use of medication with their patients and document the discussion. Informed consent is imperative if there is little research or other evidence of current practice, or if the use of the medicine in this way is innovative.
The 'off-label' use of bevacizumab (Avastin)
The 'off-label' use of bevacizumab (Avastin) for medical, retinal and vitreo-retinal treatment has been controversial mainly because two anti-VEGF drugs are on the market, specifically developed and with formal approval (e.g. USA, Switzerland and South Africa) for treating AMD (and other eye conditions), namely ranibizumab (Lucentis) and pegaptanib (Macugen).
Genentech developed bevacizumab (Avastin) and ranibizumab (Lucentis), and because of lack of economic incentive has little interest in getting Avastin registered for ophthalmic use. Bevacizumab is derived from the same mouse monoclonal antibody precursor as ranibizumab. It neutralises VEGF when injected into the eye at a dose of 1.25 mg, normally in 0.05 ml.6 The company has explained its position on the use of intra-ocular Avastin: 'We have a huge database suggesting that Lucentis is very effective and very safe, so we are just not sure of the value of taking something that is not formulated for the eye and subjecting patients to a randomized trial when there is, in our opinion, a very low likelihood of it being superior ...', but acknowledged: 'If people have a hypothesis that it would be better or safer, one could certainly test that.'6 Ranibizumab was developed after bevacizumab and is a small portion of the bevacizumab molecule, which has helped to lower the overall risks such as arterial thrombo-embolic events.1,6
However, the cost of treatment with Lucentis is approximately 50 times that of treatment with Avastin. Costs can effectively make certain drugs unavailable to patients. In South Africa the price difference between drugs of comparable efficacy is significant in the choice of drug.1,3,6
Avastin is produced in 100 mg vials. For colorectal cancer a dosage of 5 - 10 mg per kg body weight every 14 days is prescribed. A person weighing 60 kg would therefore receive 3 - 6 vials every 14 days. The commonly used dose for the treatment of AMD is 1.25 mg per injection. It can be injected into an eye repeatedly, at intervals of 1 month to 6 weeks, or as clinically indicated. Most patients need only 2 or 3 injections.22 The larger Avastin ampoule is often fractionated for use in multiple eyes, and the cost to the ophthalmologist per injection then varies between US$17 and US$50. The cost of a single vial of Lucentis (0.5 mg in 0.05 ml) is US$1 950.6 The view has been expressed that Avastin might well be safer than the multiple injections used with Lucentis or Macugen. Injections carry the inherent risk of causing glaucoma, endophthalmitis, damage to the structures of the eye and bleeding.6,23
Genentech raised concerns about the compounding of Avastin into smaller doses for intra-ocular use, as it was unapproved and patients could accordingly be at a higher risk, and notified physicians that it would not sell Avastin to compounding pharmacies. The ophthalmic community, led by the American Academy of Ophthalmology and the American Society of Retinal Specialists, reached an agreement with Genentech whereby the company would provide Avastin to retinal surgeons, who could get compounding pharmacies to 'cut' the dose to the appropriate ophthalmic dosage.24
The need for large randomised control trials is obvious. Trials comparing the efficacy, safety and optimal dosing of Avastin and Lucentis are underway in the UK25 and the USA.26
Conclusion and recommendations
Ophthalmologists have access to a reportedly effective and safe drug to treat a serious disease, but without the backing of randomised controlled trials, without the blessing of the manufacturer of the drug, and without registration for intra-ocular use by the MCC. In the event of a complication, would the ophthalmologist have a legal leg to stand on? On the other hand, if a patient lost sight due to AMD, could negligence by the ophthalmologist who had access to Avastin be suggested?
Off-label use of medication carries a higher risk for the patient and the practitioner than its registered use, so extra care should be taken. The off-label use of Avastin has passed the innovative or experimental stages, and its use by ophthalmologists is widespread in South Africa and elsewhere in the world. It has been used regularly and openly over a long time, with a high degree of success and without undue harm to patients. The off-label use of Avastin for AMD and macular oedema is also well documented.3,6,7,27-29 The off-label use of Avastin cannot therefore be branded as careless, imprudent or unprofessional. It is submitted that an ophthalmologist who omits to inform a patient of the availability of Avastin for this form of treatment may be found to be negligent.
The protocols developed by the South African Vitreoretinal Society and endorsed by the Ophthalmological Society of South Africa for administering Avastin and other intra-ocular medication intravitreally cover aspects such as informed consent, possible complications such as endophthalmitis, the off-label use of the drug, and pre-injection management.3 If it is affordable, patients should be given the option of choosing Lucentis. These protocols should be strictly adhered to.
From a legal/ethical point of view, patients suffering from AMD and macular oedema who cannot afford the registered product should be given the opportunity to be treated with the off-label product, especially to prevent functional blindness. Funders should cover the costs associated with the off-label use of Avastin. Owing to financial pressures many funders in the UK commission 'Avastin only' services for these eye conditions. To act in the best interests of their patients, ophthalmologists must be empowered by having this cost-effective alternative medication available.
1. Royal College of Ophthalmologists. The intravitreal use of bevacizumab (Avastin) in age related macular degeneration. 2007. http://188.8.131.52/search?q=cache:x9sr6dWw_LUJ:www.rcophth.ac.uk/docs/publications/published-guidelines/AVASTIN (accessed 11 September 2008). [ Links ]
2. Yanoff M, Duker J. Ophthalmology. 2nd ed. St Louis: Mosby, 2004: 925. [ Links ]
3. South African Vitreoretinal Society (SAVRS). Motivation for the off label use of bevacizumab (Avastin) and triamcinolene acetate (Kenalog) as intravitreal injections. http://www.ossa.co.za (accessed 23 October 2008). [ Links ]
4. Arnold J, Heriot W. Eye disorders: Age related macular degeneration, thermal laser photocoagulation. http://clinicalevidence.bmj.com/ceweb/conditions/eyd/0701/0701_I1.jsp (accessed 13 November 2008). [ Links ]
5. Charles S, Katz A, Wood B. Vitreous Microsurgery. 3rd ed. New York: Lippincott Williams & Wilkins, 2002: 182. [ Links ]
6. Steinbrook R. The price of sight ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med 2006; 355(14): 1409-1412. [ Links ]
7. Rosenfeld PJ. Intravitreal Avastin: the low cost alternative to Lucentis? Am J Ophthalmol 2006; 142(1): 141-143. [ Links ]
8. Bashshur ZF, Bazarbachi A, Schakal A, Haddad ZA, El Haibi CP, Noureddin BN. Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol 2006; 142(1): 1-9. [ Links ]
9. Deupree DM. Avastin injection for macular degeneration. http://www.maculacentre.com/Procedures/Avastin.htm (accessed 15 July 2008). [ Links ]
10. Strauss SA. 'Off-label' use of medicine: Some legal and ethical implications SA Practice Management 1998; 19(1): 12-19. [ Links ]
11. O'Reilly J, Dalal A. Off-label or out of bounds? Prescriber and marketer liability for unapproved uses of FDA-approved drugs. Ann Health Law 2003 12: 295-324. [ Links ]
12. Henry V. Off-label prescribing. The Journal of Legal Medicine 1999; 20: 365-383. [ Links ]
13. Bradford GE, Elben CC. The drug package insert and the PDR as establishing the standard of care in prescription drug liability cases. Journal of the Missouri Bar 2001; 57(5): 233-242. [ Links ]
14. Rheingold PD, Rheingold DB. Offence or defence? Managing the off-label use claim. Trial 2001; March: 52-57. [ Links ]
15. Mehlman MJ. Off-label prescribing. 2005. http://www.thedoctorwillseeyounow.com/articles/bioethics/offlabel_11/ (accessed 18 September 2008). [ Links ]
16. Breton DW. Off-label drug use in WOC nursing: Issues related to use of mafenide acetate to treat infected chronic wounds. Journal of the Wound, Ostomy and Continence Nurses 2001; September: 253-258. [ Links ]
17. Van Wyk v. Lewis 1924 AD 438, 444. [ Links ]
18. Richardson v. Miller 44 S.W.3d 1 13, n.11 (Tenn. Ct. App. 2000). [ Links ]
19. Radley D, Stafford R, Finkelstein S, Cockburn I. Off-label prescription among outpatient physicians. 2004. www.academyhealth.org/2004/radley.pdf (accessed 1 September 2008). [ Links ]
20. Durr v. ABSA Bank Ltd 1997 3 SA 448 (SCA). [ Links ]
21. Alvaraz v. Smith 714 So.2d 652 (Fla.Ct. App 1998). [ Links ]
22. The IVAN trial. http://www.ivan-trial.co.uk (accessed 29 July 2008). [ Links ]
23. Folk JC. Age-Related Macular Degeneration. Iowa City: Med Rounds Publications, 2005. http://www.medrounds.org/amd/2005/10/avastin.html (accessed 15 July 2008). [ Links ]
24. Genentech. Letter to physicians 29-10-2007. http://www.gene/features/avastin/letter-to-physicians.html (accessed 7 August 2008). [ Links ]
25. US National Institutes of Health. Comparison of age-related macular degeneration treatments trials: Avastin Trial. http://www.clinicaltrial.gov/ct2/show/NCT00593450 (accessed 15 July 2008). [ Links ]
26. http://www.clinicaltrial.gov/ct2/show/NCT00593450 (accessed 15 July 2008). [ Links ]
27. Mason JO 3rd, Albert MA jnr, Mays A, Vail R. Regression of neovascular iris vessels by intravireal injection of bevacizumab. Retina 2006; 26(7): 839-841. [ Links ]
28. Spandau UH, Ihloff AK, Jonas JB. Intravitreal bevacizumab treatment of macular oedema due to central retinal vein occlusion. Acta Ophthalmol Scand 2006; 84(4): 555-556. [ Links ]
29. Rich RM, Rosenfeld PJ, Puliafito CA, et al. Short-term safety and efficacy of intravireal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina 2006; 26(5): 495-511. [ Links ]
Accepted 24 February 2009.
* Corresponding author: R-M Jansen (email@example.com)


text:
George McCabe says he fell in love with Barbara Grubbs the moment he saw his future wife more than 60 years ago.
His love for the game of tennis took much longer to develop.
"I saw her during orientation for college. She caught my eye and I told somebody then that I was going to marry her," McCabe said Thursday afternoon while he and his wife sat side by side at the Payne Park Tennis Center in Sarasota.
The two met at New York's Concordia State in 1951 and McCabe made certain she didn't get away. Earlier this month they celebrated their 54th wedding anniversary with a dinner at the Charthouse Restaurant on Longboat Key.
"I have known that woman more than 60 years," McCabe said.
That is far longer than he knew how important tennis — a game where the word love has a different meaning — would become to him.
Now 81, McCabe didn't get serious about tennis until he was in his 40s, and didn't begin to play tournament tennis until much later than that.
Though he initially picked up the game while serving in the military in the Philippines in the early 1970s, his tennis playing was restricted to a couple months in the summer each year while teaching school in Ohio for nearly two decades.
Yet once McCabe turned to tennis as a fulltime sport after retiring in 1996, he quickly made up for the slow start and is now one of the top tournament players in the world in his age group.
"Tennis is truly a lifetime sport," McCabe says about the game he believes has kept him young.
Currently ranked No. 1 in the 80s in the U.S. in singles and doubles, No. 4 in the world in singles, and No. 2 in the world in doubles, McCabe is playing this week on his adopted home courts at Payne Park in the West Coast Super Senior Grand Prix at Sarasota.
Two weeks ago, McCabe swept through the Super Senior tournament stop at University Park, losing just nine games in three mismatches.
This week McCabe waited five days after the start of the Payne Park tournament to play his first match, then made quick work of Canada's Brahm Faber 6-0, 6-0 to reach today's final against Longboat Key's David Rothgaber.
It is far easier to shrug off delays now that he lives in Sarasota during the winter. The long-time Oxford, Ohio residents bought a home in The Meadows last year and spend their winter months here while George plays the Florida circuit of senior events.
It was tennis that brought the McCabes to the area for the first time in 2002 to play a tournament.
The introduction to Sarasota is easy to remember, says Barbara, because they celebrated their anniversary here by going to a restaurant on Feb. 2.
"That's 02-02-02. You don't forget a date like that," Barbara said.
And George McCabe doesn't forget the moment his game went from good to great. He happened to pick up a Sports Illustrated magazine with a photo of Roger Federer on the cover. It showed Federer focusing on the point of impact between tennis ball and racket.
"The ball was already gone, out of the photo," McCabe said. "But Federer's eyes were still on the point where it would have hit his racket."
The photo obviously had a huge impact on McCabe.
"I said, 'That's it.' And it changed my game," McCabe said. "People couldn't believe it. The minute I started focusing on the tennis ball at impact I started hitting the ball better than I ever had."
Suddenly he became a terror in the 75-over age division.
Now he has five national titles in singles and eight more in doubles. He has represented the U.S. in an international team event five of the past six years.
"He loves to play tennis," Barbara says.
Loves it to the point where he plays four or five days a week and competes in three age divisions (65-70-75) in league play.
Affable off the court, McCabe is serious once the match starts. He says he rarely even talks to his opponent once they reach the court.
"But he talks to himself all the time," Barbara offers.
"I do," George McCabe admits. "But I rarely hear any answers."
He lets his game do most of the talking.
McCabe earned honorable mention All-America recognition at Concordia in soccer. He also played three years varsity basketball and was team captain his senior season in college. He played baseball there as well.
McCabe is in the Concordia Athletic Hall of Fame and this past year was named to the Cincinnati Tennis Hall of Fame.
And where once he had trouble beating anybody in tennis, McCabe is a champion.
"I used to get whipped a lot," McCabe says. "I mean everybody used to beat me. You have to pay your dues."
NOTEStartHe says he gets a chuckle when players come up to him and say, "Geez George, I used to beat you.
"I say, 'I remember.' "
Late bloomer in tennis, octogenarian a force on the court now


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Harvest Journal: Consider The People Who Make Your Wine
Work at the winery has slowed and we had our first two-day weekend since Labor Day. The extra free hours gave me some time to reflect on the whirlwind of my harvest experience. I have spent almost three months coming home physically exhausted and absolutely drained at the end of the day, and I am left with a feeling of accomplishment and pride in what my coworkers and I have accomplished. But, does anyone who is going to buy the wine care?
Making wine is difficult (always demanding, sometimes grueling, occasionally dangerous) work—but I wonder how often the person popping the cork considers that. Many Serious Eaters are concerned with the provenance of their food and the well-being of those who grow or prepare it. We go to farmers' markets, buying seasonal produce and supporting small local farms. We seek out artisanal bread and chocolate and salumi. But this attitude often doesn't extend to wine.
Wine is an agricultural value-added product, not all that different pickles or pie. We have the choice between a big brand version—frequently at a lower price but perhaps of compromised quality—and a smaller producer, maybe one with more sustainable goods and practices, maybe with more of the profits going directly to the product and the workers who make it. Many factors go into purchase decisions like these, but I have found anecdotally that many people who would prefer the sustainable and traceable pickles and pastries do not give wine origins a second thought.
But why not?
A cheap bottle from a big company can get you drunk (just like a prepackaged cupcake can get you fat), and that purchase should be as conscious a decision as supporting the local bakery over the multinational food corporation. (We've mentioned some of the things that affect the price of wine before: here and here.) I consider where my wine comes from in part because I want my dollars to go toward the actual liquid, not fancy advertising or product placement on Top Chef. But there are other reasons, too.
I've decided to consider the people behind each bottle. The winery where I worked was by no means small (they produce around 100,000 cases a year across two facilities), but it focuses on sustainable agriculture and keeps the vast majority of its staff year-round so that workers are not forced into the difficult position of being unemployed off-season. The winery pays its staff appropriately, and has overtime pay rather than stocking up on more employees at a lower price who have to be shed at the end of harvest.
Large or small production, an actual person has to prune the vines and watch the progress of the grapes, and an actual person has to monitor the fermentation of every barrel. Before choosing between two bottles of wine, I wish more people would stop to learn about where the wine comes from—the company and its practices, how the grapes are grown and how they take care of their staff.
When you get home from work and pour yourself a glass, remember that wine isn't just about taste, or alcohol, or going well with food. It's about people, too.
About the Author: Sarah Chappell is a winemonger and writer living in
Brooklyn Napa. She holds the Advanced Certificate with Distinction from the Wine and Spirit Education Trust and has contributed to Foodista, Palate Press and WineChap. Follow her on Twitter @chapsholic.
All products linked here have been independently selected by our editors. We may earn a commission on purchases, as described in our affiliate policy.


text:
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