text:
West Germany 1972
What do you get if you cross Total Football with tiki-taka? Ramba Zamba fussball, the name given to the colourful, vibrant style of West Germany in the early 1970s. The positions in their 1-3-3-3 formation were little more than a basis for negotiation. No one demonstrated the fluidity of the team better than Franz Beckenbauer, who was sort of the original John Stones. He had moved back from midfield to create the position of attacking sweeper and was so cool he played international football with a resting heart rate.
Beckenbauer was one of three superstars in the side, along with Günter Netzer and Gerd Müller; indeed the three were a vote away from sharing the Ballon d'Or that year. The first goal in the final showed the best of all three: Beckenbauer's run from the halfway line, Netzer's improvised volley off the bar and Müller's finish. Müller was not a natural goalscorer; he was a supernatural goalscorer, with an eerie awareness in the penalty area. He subjected opposing goalkeepers to Tor(!)-ture by scoring the scruffiest goals imaginable. Any temptation to say he was lucky had disappeared by the time he scored the last of his 735 goals for club and country.
Even though Müller scored twice in both the semi-finals and the final, the tournament belonged to Netzer. He was a playboy off the field and a playmaker on it; an heroically decadent individual who had a different concept of exercise to everyone else. In short, Netzercise involved other people doing his running. It was stunningly arrogant, and entirely justified. His performances should have permanently obliterated the joyless tripe about not picking luxury players. In that form he was essential, and elevated a great side into possibly the greatest international side of all.
He inspired the almost mythical 3-1 win at Wembley in the first leg of the quarter-final (the actual finals tournament consisted of only four teams in those days), which is still regarded as Germany's best and most important victory. They beat the hosts Belgium 2-1 in the semi-final, and – in what many good judges think was their best performance of all – walloped a good USSR 3-0 in the final.
West Germany were wrongly fingered as the villains when, without the out-of-form Netzer, they won the World Cup in 1974, but two years earlier they had been hailed as the saviours of football. "Football from the year 2000," said l'Équipe. It was an almighty compliment at the time, even if, as Scott Murray pointed out,: "nobody could have possibly anticipated the horrors of Carsten Jancker, Paulo Rink and Jens Jeremies. "
West Germany were the neutrals' darlings. After the final, as German fans trolleyed pints of Happy until the small hours, residents of Brussels complained to one policeman about the noise. They felt the short shrift of the law. "With a team like Germany," he said, "there's good reason to celebrate."
France 1984
France had a man sent off in the first and last games of Euro '84. Many will tell you it was no hardship, because they were a four-man team anyway. Or perhaps a one-man team. Such was the influence of Le Carré Magique (The Magic Square), their charming midfield, and especially Michel Platini – who scored nine times in five matches to help France, the hosts, win their first major tournament. Nobody has scored as many European Championship goals in an entire career, never mind a tournament.
The narrow focus is harsh on some excellent players, particularly the goalkeeper Joël Bats, the classy defender Maxime Bossis and the left-back Jean-François Domergue, who did a Thuram before Lilian Thuram by scoring the only two goals of his international career in the semi-final. (Thuram played 142 times and Domergue nine, mind you.) There were other echoes of 1998 in the strikers; the five centre-forwards scored only one goal between them, in the last minute of the tournament, and most – good players though they were – would make decent answers on Pointless.
That could never be said of the midfield, which has a case for being the greatest of all time. They played together for the first occasion only four months before the tournament, in a friendly win over England, even though Jean Tigana and Platini were 28 and Alain Giresse 31. Luis Fernández, 24, completed a midfield quartet who moved the ball around with the same languor of slackers passing around a bong. Giresse's goal against Belgium was the most beautiful evidence of that.
Platini scored all types of goals, including a brilliant diving header as part of a perfect hat-trick against Yugoslavia, his second in two games after another in the 5-0 thrashing of Belgium. He also scored the 118th-minute winner in the 3-2 semi-final victory over Portugal, a match for which the word "epic" feels inadequate; the BBC commentator John Motson lost it more than at any other time in his career. That goal came from yet another surge from the brilliant Tigana; he and Fernández should donate their lungs to the Fifa museum when they die.
The final was a nervy 2-0 win over Spain but no one could argue with France's triumph.
Holland 1988
After the World Cup misery of the 1970s, the Dutch had an understandable fear of finals, which made it even crueller that they had to play two of them to win Euro '88. The historical importance of the semi-final against West Germany was such that, to some of the players and most of the country, the final against the USSR was almost an afterthought. They won it anyway, and in a manner that wowed the world.
The celebration of that Dutch team is fractionally over the top; they did not always have the substance to match their obvious style. They had significant moments of luck in all four of their victories – even England hit the post twice at 0-0 before losing 3-1 to Marco van Basten's hat-trick – but when they were good, they were breathtaking. It's hard not to be charmed by the memory of Van Basten, Ruud Gullit, and Frank Rijkaard and Ronald Koeman wiping his backside with Olaf Thon's shirt.
Besides, few could deny they were due a bit of luck. The tournament was full of payback for the 1970s. Wim Kieft's freakish 82nd-minute goal to beat Ireland – without which Holland would have gone out at the group stage – spun off the pitch like a leg-break, just as Rob Rensenbrink's goalbound shot did in the final minute of the 1978 World Cup final before hitting the post. Van Basten was offside as well.
The semi-final against West Germany had weird echoes of the 1974 final, and not just because of the second world war; there were penalties at both ends and the winners got back into the match through a dodgy spotkick. Even the winning goals resembled each other. It was, wrote David Winner in Brilliant Orange, "A night of dark memories and seeming redemption unfolded, with the intensity of a final duel in a Sergio Leone revenge western."
Yet Van Basten's last-minute winner was could have been scripted by Hitchcock; a sudden, shocking thrust after a seemingly innocuous move. It came from the back, where Holland won Total Football bingo throughout the tournament by playing a central-defensive pair of Koeman and Rijkaard. At a time when everyone else had stoppers at the back, they had starters – as Koeman showed with the penetrative pass to Jan Wouters that led to Van Basten's goal.
There was little of the cliched Dutch infighting. So much of that was down to the players' respect for the coach Rinus Michels. They gave him a present of a gold watch on the day before the game and then Van Basten gave him an even bigger present during the final. His astonishing volley left Michels staggering around dazed on the touchline, his hand over his face in gratitude and disbelief. He was the Godfather of Total Football and a culture obsessed with striving for perfection, but not even he thought it could actually be achieved.
That final, against the last great USSR side, who had beaten Holland in the opening game, was even throughout yet felt preordained. Such was the mind-altering power of Van Basten's goal. It didn't just change our perception of the game, it changed our perception of that team. You never get a second chance to make a last impression; the one made by Holland in 1988 will last forever.
France 2000
First the world, then Europe. France may have done things the wrong way round when it came to global domination but the way they developed their team was so logical as to verge on cliche.
At the 1998 World Cup they relied largely on one of the great defences. Two years later they had found a comparable attack. Better still, they played with the freedom of a team that had established themselves as winners – and who didn't have to endure the mixed blessing of being hosts.
Although they often played three tacklers – Didier Deschamps, Emmanuel Petit and Patrick Vieira – France were a much more attacking side. A lot of the names were the same as in 1998 but Vieira and Thierry Henry, who Arsène Wenger had just converted into a centre-forward, were regulars and represented a serious upgrade. Zinedine Zidane, whose contribution in 1998 is wildly overrated, was also, in his own words, "at the pinnacle of my art". One piece of control and balance in the semi-final against Portugal still looks astonishing 16 years later.
For all that, France had a very good view from the precipice for most of the knockout stages. Raúl missed a last-minute penalty in their 2-1 win over Spain in the quarter-finals, and they would have lost both the semi and the final but for Fabien Barthez's reactions.
Zidane ignored an almighty rumpus to win the semi-final with a nerveless golden penalty, three minutes before a shootout; and Sylvain Wiltord equalised against Italy in the 93rd minute of the final. Then Robert Pirès set up David Trezeguet to wallop a golden goal. Wiltord, Pirès and Trezeguet were all substitutes. The final was a perfect demonstration of so many of France's qualities: strength in depth, enormous mental strength, and the aura of a team who had got better since becoming world champions.
Spain 2008-12
The memories of Spain's greatest era are still fresh: Iniesta and Xavi, taka and tiki. Yet in many ways they were two different sides. The evolution between Euro 2008 and Euro 2012 was stark and the two teams – though both defined by one phrase, tiki-taka – had many differences.
The 2012 team were harder to beat but the 2008 side may be remembered more fondly – they had significantly less possession but were far more progressive. And they were new. The freshness made Spain more exciting, and meant that opposing teams were not putting 10 men behind the ball. Time has partially forgotten players such as Marcos Senna, the defensive midfielder who had a wonderful tournament, and Carlos Marchena. Sergio Busquets and Gerard Piqué could not get a game for their club never mind their country, and the 1-0 win over Germany in the final came two days before Pep Guardiola officially took over as Barcelona manager.
Spain went into the tournament fancied by many, but with that came the fear they would be the underachieving joke of the tournament (England didn't qualify). Instead, theychanged perceptions of the Spanish national team forever, and redefined football with the sheer volume of their passing. Two wallopings of a good Russian side – 4-1 in the opening game, 3-0 in the semi-final – stood out. They even had not one but two centre-forwards in Fernando Torres and David Villa.
In 2012, they mainly used Cesc Fàbregas as a false nine and, as wonderful as their 4-0 demolition of Italy in the final was, their legacy was not a performance but a philosophical debate: whether it was OK to win boring, the aesthetic equivalent of winning ugly, as Spain did for most of the tournament. That was only partially their fault, though there were certainly times when tiki-taka became tiki-takanaccio. It worked, however: Spain concede only one goal in the tournament.
The 2008 side were a lot more fun to watch – and, you suspect, to play in – but the 2012 team, though verging on an art project with their indulgent passing, dominated games like no international side in history, with almost 70% of possession in the tournament. Their technical accomplishment was astonishing, and they had the most intimidating aura. Opposing teams could barely get out of their third, never mind their half.
(Guardian services)


text: Good Education is something that nurtures the innate abilities of a child. It ensures that the child grows aesthetically, mentally, physically, socially and emotionally. Good education should foster creativity, sensitivity, compassion and care. It is a value - based asset that leads to growth of socially responsible, environmentally conscious and innovative human beings. Education is not just a passport to good life, but a potent and prominent institution used to empower a process that enables children to develop holistically. The mission of our schools is to make education a relevant, meaningful and interesting activity so that our students are ready to face the challenges of the world.

subset: commoncrawl


text:
The Ministry of Foreign Affairs and Regional Integration (MoFARI) has outlined a week-long activities to mark the 54th African Union (AU) Day, on the theme: "Harnessing the Demographic Dividend through Investment in the Youth".
Activities to mark the Day, which falls on Thursday, May 25, include a Health Walk from the premises of MoFARI, on Saturday 20, through the Liberation Road to the Flagstaff House and back to the MoFARI through the Switchback Road, Civil Aviation Social Centre and the Airport Round About.
There would also be a What Do You Know Quiz Programme in the studios of Ghana Television on Sunday, May 21, and sustained Media Engagement on the celebration through radio and television talk-show from Monday, 22 to Wednesday, 24 May.
The events would culminate in a Flag Raising Ceremony at the Fore Court of the State House on the morning of May 25, by President Nana Addo Dankwa Akufo-Addo and the Dean of the Diplomatic Corps.
The curtain would be drawn on the celebration with a cocktail reception in the evening of Thursday, May 25, at the Accra International Conference Centre, where the Africa Diplomatic Corps is invited to come along with their country dishes to share with all participants.
The Organisation of African Unity (OAU), the predecessor of the AU, was founded on May 25, 1960, in Addis Baba, Ethiopia.
Ghana's first President, Osagyefo Dr Kwame Nkrumah, was a pillar as one of the Founding Fathers of the OAU, which was formed in the week of the collective quest by African leaders, at the time, to work together in seeking the political emancipation of the African continent from the shackles of colonialism and the ills of imperialism.
Mr Mohammed Habibu Tijani, Deputy Minister, MoFARI, speaking at a media launch of the event, said the celebration of the AU's 54th Anniversary would afford member countries the opportunity to take stock of the achievements and failures of the Organisation.
He said the OAU was a very bold and successful initiative by African leaders in response to the aspirations of the African people to achieve their quest for self-self governance. "In championing the cause to totally liberate the Continent from the shackles of colonialism, the Body has encountered huge challenges to state formation and nation building that found expression in various conflicts on the Continent," he stated.
"Africa has also had its fair share of the ills of dictatorships and bad governance that have not augured well for the attainment of the progress desired by the Continent.
"Subsequently, the African Union was formed in July 2001, with a shift in focus from political to socio-economic emancipation of the African Continent.
"In all this, it has always been underscored that the conditions of peace, security, democracy, and good governance are the fundamental requirements for successfully pursuing the new vision for the socio-economic renewal of the African Continent."
Mr Tijani explained that these reflections towards achieving the Pan-African vision of "an integrated, prosperous and peaceful Africa, driven by its own citizens and representing dynamic force in the global arena", culminated in the adoption of the framework of the New Partnership for Africa's Development (NEPAD) and its flagship programme the African Peer Review Mechanism (APRM) in the early 2000.
He said these initiatives were meant to foster democracy and good governance as well as deepen regional cooperation and integration on the African Continent.
"Subsequently and during the 50th anniversary of the OAU/AU in 2013, African leaders adopted a solemn declaration in agenda 2063, which is a set priority areas for the development of the Continent over a 50 year-horizon".
He urged Ghanaians to be conscious of this fact in order to avail themselves of the mindset and interventions necessary to actualise the collective vision of the OAU/AU in their lives.
Mr Francis Albert Yankey, the Chief Director, MoFARI, said over the past 54 years, the AU, despite its shortcomings, had chalked some successes such as the promotion of continental integration , peace and security.
Join GhanaStar.com to receive daily email alerts of breaking news in Ghana. GhanaStar.com is your source for all Ghana News. Get the latest Ghana news, breaking news, sports, politics, entertainment and more about Ghana, Africa and beyond.


text:
Oscillations in the southern extent of the Indo-Pacific Warm Pool during the mid-Holocene
Abram, Nerilie J.; McGregor, Helen V.; Gagan, Michael K.; Hantoro, Wahyoe S.; Suwargadi, Bambang W.. 2009 Oscillations in the southern extent of the Indo-Pacific Warm Pool during the mid-Holocene. Quaternary Science Reviews, 28 (25-26). 2794-2803. https://doi.org/10.1016/j.quascirev.2009.07.006Full text not available from this repository. (Request a copy)
The Indo-Pacific Warm Pool (IPWP) is thought to play a key role in the propagation and amplification of climate changes through its influence on the global distribution of heat and water vapour. However, little is known about past changes in the size and position of the IPWP. In this study, we use a total of 48 modern and fossil coral records from the Mentawai Islands (Sumatra, Indonesia) and Muschu/Koil Islands (Papua New Guinea) to reconstruct oscillations in the extent of the IPWP since the mid-Holocene. We show that reliable estimates of mean sea surface temperature (SST) can be obtained from fossil corals by using low-resolution Sr/Ca analysis of a suite of corals to overcome the large uncertainties associated with mean Sr/Ca-SST estimates from individual coral colonies. The coral records indicate that the southeastern and southwestern margins of the IPWP were cooler than at present between similar to 5500 and 4300 years BP (similar to 1.2 degrees C +/- 0.3 degrees C) and were similarly cool before similar to 6800 years BP. This mid-Holocene cooling was punctuated by an abrupt, short-lived shift to mean SSTs that were warmer than at present between similar to 6600 and 6300 years BP (similar to 1.3 degrees C +/- 0.3 degrees C), while similarly warm conditions may have also existed after similar to 4300 years BP. We suggest that mid-Holocene cooling at our study sites was related to contractions of the southeastern and southwestern margins of the IPWP, associated with the more northerly position of the Inter-tropical Convergence Zone (ITCZ) that accompanied mid-Holocene strengthening of the Asian summer monsoon. Conversely, intervals of abrupt warming appear to correspond with widespread episodes of monsoon weakening and accompanying southward migrations of the ITCZ that caused the IPWP to expand beyond our coral sites. Intervals of a strengthened Asian monsoon and cooling in the southwestern IPWP during the mid-Holocene appear to correspond with a more positive Indian Ocean Dipole (IOD)-like mean configuration across the tropical Indian Ocean, suggesting that the Asian monsoon-IOD interaction that exists at interannual time scales also persists over centennial to millennial scales. Associated mean changes in the Pacific ENSO modes may have also occurred during the mid-Holocene. The dynamic and inter-connected behaviour of the IPWP with tropical climate systems during the mid-Holocene highlights the fundamental importance of the warm pool region for understanding climate change throughout the tropics and beyond. (C) 2009 Elsevier Ltd. All rights reserved.
|Item Type:
|Publication - Article
|Digital Object Identifier (DOI):
|BAS Programmes > Polar Science for Planet Earth (2009 - ) > Chemistry and Past Climate
|NORA Subject Terms:
|Marine Sciences
Meteorology and Climatology
Ecology and Environment
|Date made live:
|15 Oct 2010 13:01 +0 (UTC)
Actions (login required)
|View Item
Document Downloads
Downloads for past 30 days
Downloads per month over past year


text:
If you have a project that you would like a quotation for or if you would simply like to discuss a project to determine what is possible then fill in the form on this page.
Try to provide as much information about your project as you can including things like:
You can also attach a briefing document or script using the file upload option.
We will endeavour to respond to your enquiry quickly - usually within a few hours.


text:
Good morning, friends! Happy Monday!! Anyone else counting down the days before Spring Break? I can't believe how fast this school year has gone. Once Spring Break is over, I feel like the countdown to summer begins. And we LOVE summer around here.
This morning I wanted to share a little bit of my heart. I shared this quote on my Instagram stories last week and so many of you commented on it.
It's so easy to get wrapped up in what everyone else is doing and how seemingly perfect their life seems to be.
I actually just did that today as I read a blog post from another blogger. She always seems to have it all together and she's incredibly organized. I allowed my mind to go there. You know where there is…the pit of "I wish I could be her."
I began to wish that I was more organized, more efficient with my time, a better mom, a better cook… you get the picture. I began to wish for better and more.
Thankfully my husband quickly bounced me back by reminding me that nothing is as perfect as it seems.
And not to say her life isn't great! She just has strengths that are different than mine. And that's ok!
We are all different. God did not make us the same. And thank goodness He didn't because how boring would that be?
But even though He didn't make us the same, guess what? He does love us the same!
He loved us all enough to send His only son to take our place and die for our sins.
For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. John 3:16
And this love, we don't have to work for it. We don't have to earn it. We don't have to do one thing. God loves us just because. And He offers us a gift. A gift that we don't have to work for. And that gift is eternal life. All He asks of us is to choose Him. And when we do, He promises us a life with Him for eternity.
For it is by grace you have been saved, through faith—and this is not from yourselves, it is the gift of God— not by works, so that no one can boast. Ephesians 2:8-9
I know that it's easy to compare our life to those that we see on social media. It's easy to go down that road of saying our lives aren't as good as so and so. But I'm here to tell you that your life is exactly what God has designed it to be. And when we look at someone's life and wish for what they have, it keeps us from seeing all of the blessings that God is pouring into our life.
There's a difference in being encouraged by someone's life and being envious of someone's life. And being encouraged is where I want to be.
I heard something a while ago that I've tried to put into practice when I feel comparison begin to steal my joy. It's super easy to do and I want to encourage you to do the same.
It's quite simple actually, when you feel yourself begin to get jealous or envious choose to compliment that person instead. Choose to be a cheerleader. It forces your brain to turn those negative thoughts into positive ones and it completely changes your mindset.
Instead of ignoring their post or stories, choose to comment and cheer them on instead. It may feel forced at first, but it will become second nature. I promise, I've done this and it's changed my life so much. I suffered for years with discontent. And I refuse to allow myself to go down that hole again.
Sure, I still have my moments like I had today but I'm able to bounce back a lot quicker. I'm able to say, "gosh, she's such an amazing mom and wife but so am I. Our lives just look different." I'm able to believe that God may have given us different strengths and talents, but his love for both of us is the same.
And it also allows me to ask her for advice in the areas that she's good at. I've learned so much from this particular blogger. Her posts about organization and time management have helped me tremendously.
And that wouldn't have happened, had I let comparison get in the way.
Comparison not only steals joy. It has the power to steal friendships and families.
It's ok to want to better our life just don't convince yourself that your life right now isn't great. Work towards goals while enjoying your journey.
So today I want to challenge you to be a cheerleader. When that post pops up in your feed that makes your skin crawl with envy and jealousy comment something positive. Compliment that person. Just do it once and see how it makes you feel. I can promise you that instead of dwelling on how much better their life is for the rest of the day…you will actually think about it only for a second and then it will be gone.
We have to be content. We have to work on our families and our lives. The grass isn't always greener on the other side. It's greener where you water it.
Stop trying to be her. Be you. Work on you. Do you. Water your family and choose to look for the good every single day.
I can promise you that her kids are throwing tantrums, too. She has bad days, too. She needs encouragement, too. Nobody is perfect.
I know that this post is all over the place, but I really hope that I was able to truly get my point across this morning.
If anything, I just want you to know that you are loved by the King. Joseph shared a song with me yesterday that's on repeat right now. And one of the phrases that stuck with Joseph was this, "I'll never be more loved than I am right now."
Friend, He loves you. He loves you so very much. He created you and designed you for a purpose. Don't devalue your purpose by trying to be someone else. Be who God made you to be. And if you feel like you aren't there yet, then join the club. This life is not a sprint, it's a marathon. We are all working towards our purpose. A purpose we will not achieve until we are in glory with Him!
Fight the fight. Fight YOUR fight.
I have fought the good fight, I have finished the race, I have kept the faith. Now there is in store for me the crown of righteousness, which the Lord, the righteous Judge, will award to me on that day—and not only to me, but also to all who have longed for his appearing. 2 Timothy 4:7-8
I love y'all!! Click here to listen to the song Joseph shared with me. Make sure you listen to the lyrics. They are powerful!


text:
By Felicia
In Motherhood, Titus LowPosted
Half Cup Full
My son is quite a sensitive boy, always needing hugs, cuddles and kisses. As I looked at him, I wonder is what I am doing enough for him? Are my hugs and kisses enough? Is my love good enough for [...]


text:
By Berhane Kahsay
Tigrai Onlne - July 07, 2014
Andargachew Tsege who is the second in command of G7 is safely behind bars after his extradition from Yemen and will have his day in court very shortly. Dr Berhanu has now been left alone and it is just a matter of time before the terror entity is consigned to the dustbin of history.
A statement has been released by the leader of the proscribed organisation stating that retaliatory measures would be instituted against high officials of the Yemeni and Ethiopian governments. A warning emanating from a dead duck is very comical indeed. Have we not heard this sort of nonsense and emotional chit-chat before? The good doctor who is full of hot air may have a short memory, but six years ago he publically informed his gullible followers that his organisation would dislodge the EPRDF administration within six months.
Trying to punch above one's weight is not advisable as it usually ends in disaster. In any case, ''Woyane'' is still in power and the indications are that it is likely to receive a further five years mandate from the electorates in the forth coming general election scheduled to take place in May 2015
The painful truth is that, G7 is a spent force and doesn't have what it takes to see through its threats. Since its creation in 2008, the outlawed outfit has miserably failed to make its mark on Ethiopian politics. As a result of its rejection, the organisation that is allegedly struggling for ''justice and democracy'' is serving an Eritrean dictator who loathes pluralism and the rule of law. And for this, the terrorist unit is paid millions of dollars collected from the sale of Eritreans to Egyptian Bedouins for their organs.
Leaving the terror group aside-- how was it possible for the Yemeni security to establish that Andargahew who has never been on their wanted list was on board the plane that was heading to Asmara? The only plausible answer for this is that the Ethiopian Intelligence Services must have received a tip-off from its operatives inside Eritrea which was then relayed to Yemeni government resulting in the arrest and extradition of the deputy leader of G7. Yemeni government should be applauded for observing the 1999 extradition treaty it signed with the Ethiopian government led by the visionary late Premier Meles Zenawi.
Dr Berhanu pleaded with the Yemeni authorities not to extradite his partner but received scant attention from those concerned. As a British citizen, Andergachew wouldn't have been repatriated without the tacit approval of her Majesty's government. Soon, Esayass's coolie will face the full force of the law, and he is very likely to end up in Kaliti where he will join his old partners in crime who have been erased from the memories of the Ethiopian people. You can run, but you can't hide. One down, one to go.
Andargachew Tsige, the Secretary General of Ginbot 7 is lecturing us about Isaiass Afewerki the President-for-life of Eritrea. Andargachew Tsige says Ethiopians ought to learn from the exemplary leader of Eritrea. We wonder what the Eritrean people would say about that?
Andargachew Tsige extradited to Ethiopia, welcome home
Andargachew Tsige, the Secretary General of the terrorist group Ginbot -7 is in prison in Yemen
Ethiopia's stride towards industrialization: Textile and Leather in the front line
Al-Shabaab and its Desperate Attempt
Ethiopian mobile phone assembly plants flourish while other African companies close down
Tekleberhan Ambaye Construction PLC won a quality award in New York


text:
$799.00 $0.00
*Shipping available to the 48 contiguous US states ONLY
Cuddle up and stay awhile in the superior comfort of the Tuba Glider with a soft gliding, 360-degree swivel base. This lovably large, chair-and-a-half is perfectly sized for feedings (roomy enough for nursing twins). It's a stylish but also more sustainable choice for the modern nursery. Upholstered by hand in our eco-performance fabric, that is stain resistant, water repellent, and made with at least 30% recycled materials.
- GREENGUARD GOLD CERTIFIED: The Tuba has been tested for over 10,000 chemical emissions and VOCs, undergoing rigorous scientific testing to meet some of the world's most stringent chemical emissions requirements. It contributes to cleaner indoor air, creating a healthier environment for your baby to sleep, play, and grow.
- SPACIOUS SEAT: Extra wide 26" seat for superior comfort and roomy enough for nursing twins.
- SMOOTH SWIVEL & GLIDE BASE: The brushed silver metal swivel base allows you to swivel a full 360° and gently glide back and forth.
- ECO-PERFORMANCE FABRIC: We want to help you make more sustainable choices in your home. At least 45 recycled plastic bottles were used in the making of this eco-performance fabric utilizing LiveSmart performance fabric + 30% REPREVE® recycled yarn.
- WATER REPELLENT & STAIN RESISTANT: Life with a babe can be messy! Our eco-performance fabric is made for real-life, it's water repellent, stain-resistant, and durable.
- EMISSIONS-TESTED: Foam used in the seat meets all CA TB117-2013 flammability requirements and is CertiPUR-US® certified, certifying the foam is made without PBDE or Tris flame retardants, heavy metals, formaldehyde, CFCs, and phthalates regulated by the CPSC.
- FSC® CERTIFIED WOOD: Wood used in the frame of this product comes from well-managed, FSC®-certified forests. The FSC® label means that wood has been harvested to benefit communities, wildlife, and the environment.
- EASY SETUP: A few simple steps with no tools required.
- COMPLETE THE LOOK: For ultimate comfort and relaxation pair with the Tuba Swivel Gliding Ottoman M10185 (sold separately)
Assembled Dimensions: 39.75"L x 35"W x 38"H
Assembled Weight: 91lbs
Seat Dimensions: 21.25"D x 25.5"W
Seat Height: 18.25"H
Arm Rest to Seat Height: 10"
Seat Back Height: 24.5"
300 lbs


text:
Functional Neurocognitive Disorders
Brain Health
Functional Neurocognitive Disorders
Are you suffering from anxiety, depression or foggy thinking? Are you unable to sleep, concentrate, remember everyday details, or focus your thoughts?
Dr. Powell has the programs and therapies to help you have more peace in your life.
ADD Therapy
Therapy to help you identify your strengths and weaknesses, build skills and learn ways to reduce the intensity of symptoms.
Anxiety & Depression Therapy
EEG Guided RTMS
Functional EEG Brain Mapping
Insomnia Therapy
Mindful Stress Reduction
Post-Concussion & Brain Trauma
How to Live Healthier
& Pain Free
Call and Schedule a Consultation
Participate in our Services and Programs
Start Living Healthy and Pain Free
Dr. Powell is the best doctor I have ever had. I have a back injury that happened 20 yrs ago that I still deal with. 2yrs ago I started to see Dr. Powell because after back surgery, fractured vertebrae, and a back fusion my back still wasn't better. With constant appointments at first and then tapering off after that I see him about once every couple of months. After 18yrs of pain all day, every day, I finally found the solution and have never felt better. I've been able to go back to the gym, get back in shape, and I can almost run again without pain. This is the man to see if you're in constant pain.
Dr. Powell will go above and beyond for his patients. Exceptional doc and great guy! If you are looking for acupuncture or natural medicine call him ASAP for an appointment. You won't be disappointed.
Dr. Powell is a person that I know my son and I will both look back on as someone who had a huge impact on each of our lives. After receiving treatments for ADD, my son is a whole new kid. His quality of life has increased in a way I never knew was possible! I myself have been searching for solutions to my neck pain for 13 years and until visiting Infinity Wellness, have never found anything that helped for more than a couple of hours. I'm finally feeling more like my normal self!
I feel a sense of trust and honesty with Dr. Powell. Also, I can deeply discuss my health and feel I'm actually listened to. Rare in the health care arena.
I have been suffering from hip bursitis for years and although I had never tried acupuncture it is now a benefit on my health insurance, so I decided to give it a try. Dr Powell was thorough in my consultation and then explained everything in detail during my therapy appointments. I had four appointments in two weeks and I'm feeling great. I would definitely recommend Infinity Wellness and Dr Powell for all different types of therapies.
Dr. Powell is wonderful and attentive. He takes time to really listen to the issues I'm having with my neck and shoulders, and he knows just what to do to help fix the issue. His medical knowledge is amazing and was able to explain everything to me in a way that I would understand.
Doctor Powell is the best. Extremely sensitive to how you feel. And has made my depression and pain a lot better. He has done wonders for my back and neck pain. I recommend him to all.
I love coming in to get acupuncture here. He is so educational with what he does and I appreciate that more than most people. I have never felt so energetic, balanced, and clear-minded. I will continue to see Dr. Powell. My body, mind, and spirit are calm and clear. It will be cool to see the other points of acupuncture when we get there.


text:
The Pear Cut White Sapphire Diamond Ring is inspired by the Victorian Era and carefully hand-crafted with our own modern spin. This intricate 14K gold ring is decorated with a pear-cut white sapphire in an east-west setting decked with 0.06ct of sparkly diamonds.
• Center stone 0.22CT 5x3mm pear-cut, AAA lab-grown white sapphire.
• Side stones- 0.06CTW. natural, conflict-free white diamonds (GHSI).
• Solid 14K gold.
• 1.5mm round band.
• This item is made to order.
• Current production time: 14 business days.
Remove when washing, showering, swimming or using any chemicals, perfumes, hair or skin care products. Avoid making hard contact with solid surfaces.
Mix a small amount of dish soap with seltzer water in a bowl, then soak jewelry pieces in the solution for 5-10 minutes. Use a soft toothbrush to remove grime.
Store in a sealed plastic bag or a ring box. Ultrasonic and steam cleaner safe.


text:
Afro Hip-hop artiste Shakez comes through with this banging trap anthem titled 'SAUCE'.
Produced by Seven and engineered by Spane5, 'Sauce' showcases Shakez in his element as the rapper combines brilliant lyricism and a catchy trap-influenced flow to deliver this highly infectious hip-hop offering. 'Sauce' is sure to be a fan favorite and is guaranteed to grow on you with every listen.
Follow on twitter and IG @shakezdavinci
DOWNLOAD MP3: shAKez – SAUCE (Prod. by Seven)


text:
Lake County Emergency Rental Assistance
Thank you for your interest in the Lake County Emergency Rental Assistance program. Due to fund availability, the program is now closed to new applicants. The last day to apply for the program was December 31, 2021.
Geminus administers the emergency rental assistance program on behalf of Lake County.
Important Updates
Dec. 31, 2021 was the last day to apply for emergency rental assistance program through Lake County.
Applications submitted but not yet awarded are not guaranteed financial assistance due to low funds.
Regularly log into your Submittable account to check your application status.
Our Partners
Thank you to our partners for helping us with this program. To view our partners, or to receive help from a partner agency, click here.
Geminus is a member of the Regional Care Group.


text:
Softech softboard 7'6″
Surfboard length
Fins setup
Surfer's level
Softech softboard 7'6″. Hand shaped with a generous outline and loads of volume. Stable and easy to ride for learners gaining confidence in riding waves and starting to performing basic turns. These board pack heaps of volume making it easy for learners to paddle into small waves, while providing a large stable platform so they can confidently jump to their feet. Screw in your favourite FCS fins for additional drive and response.
|Rental fees
|Daily rate
|€ 10 / day
|Long term daily rate Applies after the 14th day
|€ 5/day
|Fixed fees For pickup and return: applies only once per rental.
|€ 15/rental
|Deposit Returned upon surfboard return
|€ 100
Find a place to stay near OdeceixePowered by Shakabay
Surfboard accessories
Similar listings
How rental works on Surfy Nomads
- Surfy Nomads helps you find the right surfboard for your surf trip and get in contact with the surfboard owner.
- Once you're in contact via email, you manage the rental details directly with the owner: dates, pickup and return location, payment...
- When you submit the "Request booking" form, an email will be sent to the owner with all the booking details: check your email inbox for the answer.
- Once you're in contact with the surfboard owner, you can choose to keep communicating via email or exchange your mobile numbers and chat via WhatsApp.
- Surfy Nomads doesn't apply any extra fee, the service is currently free.


text:
You are hereDisappointed
Hit Awaba for a hot lap after work and had a shocker. I had a huge over the bars just at the very first section so dusted myself off and walked back to the trail entry to try again. It knocked by confidence though as I was some 5km/h slower than my quickest recorded speed and had shockingly bad technique (taking too much speed into corners and braking hard whilst in the corners threw me off the bike again at around the 6km mark).
Lost the mental battle on this one and really need to focus on my technique more
- Login to post comments
- Bookmark & share
Sounds like one of those days when you're just not in the groove ... we all have those occasionally. Better to pull back slightly and ease your way in. Technique before speed, as you say...
Wise words Hawkeye I'll be sure to remember and act on them next time I'm out of sorts. My elbow is now infected as it didn't take too kindly from the 7inch gravel graze I gave it... Must remember to use the elbow and knee pads my wife bought me for xmas... think I might get some good value for money
Yeah, but then you won't fall off and the investment will be wasted
I'm good with the words, eh - maybe I should follow my own advice and I wouldn't do stupid things like take myself out for three months with a broken collarbone.
Give the elbow a real good scrub with the brush and strong disinfectant, you don't want a dirt tattoo. I got a few too many of those on me shins from bloody Manly Dam rocks jumping up from behind the front wheel and biting me
Good and bad things come from wearing pads.
I was wearing my pads last week (thanks Rob ) and they gave me extra confidence to go faster and take more agressive lines. This worked fine until I got a bit big for my boots and ended up going OTB.
I didn't get any cuts though!
@Hawkeye... I dread every shower
@Pete B.... So the pads worked then! I've had far too many crashes at late due to getting fitter but not better at technique and for me with fitness comes speed which = crashes and weeks of discomfort


text:
We had a long weekend down at Tekapo this week. A little bach. No phone or internet. Lots of fresh air and paddling. Amazing skies. Both day and night. The lake was freezing cold but it didn't stop madam from paddling away happily. She even convinced the dog to get his feet wet.
The evenings light was wonderful and there was a zip wire to play on and poles with climbing grips on them. Awesome food – I"m now a certified fan of pulled pork. We drank cider and ate pizza by the lake.


text:
|NBABrothers Thoughts & Theories
Kyle Anderson Interview!
Recently at JR Inman's Rocktown Academy camp, Kyle Anderson made a guest speech and talked about his journey to the NBA. It was a very interesting story and I was really hooked in. Anyway, after the lecture he allowed autographs on any object of clothing or paper. My brother and I chose our sneakers to get signed. Here they are below:
This was my interview with Kyle Anderson at JR Inman's Rocktown Monarchs camp. It was lots of fun and he is a really great guy. Anyway, I will be returning to Big Strick Classic interviews soon. So for now, thanks for reading and please comment!
Mike V.
My name is Mike V. I am an enormous basketball fan. I also am a die-hard Knicks fan. After graduating 5th grade, I started writing this blog at the age of 10 in the summer of 2012.
November 2021


text:
BY Susan Hash, Contact Center Pipeline
There is no question that skilled agents offer the best opportunity to save unhappy customers who are at risk of leaving. But how do you help customers, and retain them, if you never hear from them?
Today's tech-savvy customers prefer self-service over phone calls, and they're more likely to seek answers to their questions within the social and digital communities where they spend their time, regardless of whether or not the business has a presence there. While companies have been expanding their service operations to include more digital channels, many are handling only basic transactions and lack the omnichannel capabilities to ensure a seamless experience for customers.
As products and services grow increasingly complex, siloed channels are adding multiple steps into a customer journey that often ends in frustration. In the past, customers demonstrated their dissatisfaction by taking their business elsewhere. Today, the impact is twofold—lost business and potential damage to the brand from the negative buzz on social media.
Care About the Process, Not the Channel
YOEL KNOLL agrees that offering a convenient service option is key. "Users today want to choose the channel in which they do business. They also want to choose the time of day.
We have to give them the ability to stop and continue later and pickup where they stopped." Knoll is VP of marketing for CallVU, which provides a mobile digital engagement platform that blends rich digital and interactive media with the voice channel.
"Companies are investing millions in e-commerce websites, applications and in digitizing their point of sales, but they're not tying all of these channels together," he adds. "If you start the journey on an app and then you call an agent, you want to continue the same journey, but you cannot. You have to start all over again."


text:
Incredible Health Benefits of Pumpkin (Kaddu)
Pumpkin is a fruit that belongs to the cucurbita family. It comes in various shapes and sizes and packs an interesting flavour when you use it in your dishes. Let's take a look at its health benefits and more below.
Nutritional Profile of Pumpkin
Is pumpkin good for health? Here's a glimpse into its nutritional profile to understand what you get in a cup of cooked pumpkin.
|Amount (per cup of cooked pumpkin)
|0.2 grams
|2 grams
|12 grams
|3 grams
|Vitamin A
|245% of RDI
|Vitamin C
|19% of RDI
|Vitamin B2
|11% of RDI
|Vitamin E
|10% of RDI
|8% of RDI
|16% of RDI
Surprising Health Benefits of Pumpkin
There are numerous pumpkin benefits for skin, weight loss, and your overall well-being. Here's what you need to know.
1. Promotes Weight Loss
Although pumpkin is a fruit, it's 94% water – this means it's very low in calories!
If you've been trying to lose weight, adding some pumpkin to your diet will help. Since it is nutritionally dense, it also means you'll be feeling nourished with fewer calories, thus packing on little to no pounds. This is one of the best advantages of pumpkin consumption.
2. Rich Source of Antioxidants
Your body produces free radicals to fight against stress, harmful bacteria, and other elements inside the body which lead to illnesses. However, the presence of too many free radicals in the body can lead to oxidative stress – a condition that is linked to cases like heart disease and cancer. Since pumpkin is high in antioxidants, it neutralises free radicals in your body, thus preventing oxidative stress.
There are a few studies done on humans and animals which show how a higher intake of antioxidants is linked to lower instances of eye illnesses, cancer, protection from sun damage, and other possible medical conditions. However, more research is required in those areas.
3. Boosts Immunity
Pumpkin is high in beta-carotene, a nutrient known for boosting immunity. Beta-carotene is converted into Vitamin A in the body which is used to strengthen your immune system. There's also a high amount of Vitamin C in pumpkin which boosts your white blood cell production.
A higher white blood cell count means you'll be less likely to fall sick from infections, heal wounds faster, and in general, stay a lot healthier. Besides Vitamin A and C, there is folate, Vitamin E and iron in pumpkin which play a role in building a strong immune system. Due to its nutrient profile and high-fibre content, there are pumpkin benefits for babies too, so feed them pumpkin puree!
4. Shields Your Eyesight
Macular degeneration, glaucoma, and cataracts are common eye problems people face as they grow older. The good news is that eating a cup of cooked pumpkin is a good way of preventing them. Pumpkin contains two essential nutrients for maintaining healthy vision – lutein and zeaxanthin.
The high amounts of Vitamin A in pumpkin have also been shown to prevent blindness. Add to that the Vitamin C and E content and you've got a nutrient-dense food that protects your eye cells from free-radical damage.
5. Is Anti-ageing by Nature
Since pumpkin has high levels of vitamin C and various antioxidants, it protects your skin from the harmful effects of UV rays. Besides this, pumpkin juice for skin is known to boost collagen production, which plays a huge role in improving its texture, tone, and elasticity. More collagen in your body also means fewer wrinkles, fine lines, and more flawless looking skin. Collagen is synthesised from high levels of Vitamin C, and research proves that.
6. Protects Your Heart
Pumpkin is known to protect your heart by freeing up your arteries from any build-ups and plaque-deposits. One of the many white pumpkin juice benefits is that it reduces incidences of heart attacks and strokes. The high levels of antioxidants in pumpkin are known to prevent atherosclerosis, and pumpkin is also known to regulate blood pressure levels in the body. A regulated blood pressure also means your cholesterol levels are kept in check, which is something you definitely want.
7. It Flushes out Toxins
Amongst the many pumpkin juice benefits, one great one is that it naturally detoxifies your body and cleanses your internal organs. In fact, it is a natural diuretic, which means it helps your kidneys filter and function optimally. Yellow pumpkins are known to be a natural cure for peptic ulcers and they also provide relief to your gastrointestinal tract.
8. Beats Depression
When your body is lacking in a nutrient known as tryptophan, you're more likely to be depressed. Pumpkin is naturally high in this, so if you're stressed, you know what to eat! Besides that, high tryptophan levels in pumpkin are known to prevent insomnia and promote restful sleep.
9. Prevents Inflammation
Eating pumpkin on a regular basis is known to treat inflammation and prevent conditions like rheumatoid arthritis. If your muscles get inflamed a lot from hard workouts, you can help relieve or de-stress them by eating some cooked pumpkin.
10. Improves Prostate Health
Low levels of zinc and antioxidants are known to contribute to poor prostate health, and poor prostate health equals infertility and poor sexual performance. Pumpkin helps combat this and also prevents the enlargement of your prostate at the same time, giving you just what you want.
11. Protects Your Bone Health
Pumpkin has high levels of Vitamin K, a nutrient known for protecting your bone health. If you've been struggling to meet your recommended RDI for this nutrient, eating some cooked pumpkin will get you there.
Other Uses of Pumpkin for Everyday Life
Are you curious to know what you can do with a giant pumpkin? Here are the top uses of pumpkin in your everyday life.
1. Use It As a Pumpkin Planter
You can literally use your pumpkins as planters in which you can grow new plants. It not only looks fantastic, but it will also add a creative touch to your backyard. Simply scoop out the flesh and guts from the inside and fill up 1/3 of it with potting soil. Plant your seeds, set them up in the backyard, and watch new life spring into action. The pumpkin will also act as a natural compost and fertiliser for the plant, which is a win-win.
2. Make Pumpkin Puree
From desserts to pancakes, ice creams, sandwiches and salads, purees have a myriad of uses. If you're tired of eating canned pumpkin puree, it's time you make your very own fresh batch. Just cut the pumpkin and scoop out the edible flesh and seeds. Cook the cut pumpkin with a cup of water for 30 minutes until the flesh turns tender. Run this through a food processor, and your delicious puree is ready!
3. Beautify Yourself
You can use pureed pumpkin to make your skin glow or exfoliate it naturally. Just mix pumpkin puree with brown sugar and a bit of milk. Apply this on your skin, let it sit for a while, and rinse. The vitamins A, C, E, and zinc will seep in and naturally cleanse your skin. If you do this skincare regime every day, you'll have flawless skin!
4. Halloween Treats
Want to make delicious Halloween treats for your kid's party? Use pumpkin! To make a Halloween dessert, all you need is a vegetable peeler, water, a few spices, and brown sugar.
Start off by cutting up the pumpkin and removing the seeds and guts. Cut it up into bite-sized pieces and let it boil in water in a saucepan. Cover the lid and wait until the flesh softens a bit. Now, add in the spices (we recommend a mix of ginger, nutmeg, cinnamon, and turmeric) with the brown sugar and boil until the sugar becomes a syrup. Remove this mix from the heat and let this mixture sit overnight so that the pumpkin bits have the time to soak it in. You could eat this fresh in the morning – just sprinkle some brown sugar or add some chocolate sauce, and your Halloween treat is ready!
5. Feed Your Pets
If you've got any pets in the house, you can feed them unused pumpkin seeds and guts. To them, the leftovers are tasty treats. You can also use the skins to feed wildlife, since birds, deer, and other wild animals love feasting on them -and other parts of the pumpkin too!
6. Make Pumpkin Vodka
If you're having an adults-only party, you can make pumpkin cocktails for the crowd. Just add a tablespoon of pumpkin puree to two ounces of vanilla or cinnamon vodka. Shake it up well and add some lime juice and honey for a little zest. Add ice cubes and voila! It's done.
If you have any kids coming to the party, you can make pumpkin puree milkshakes for them. For this, you'll need a blender. Take two scoops of an ice cream of your choice, half a cup of milk, 3 tbsp of the puree and a teaspoon of ginger or cinnamon. Run this mix through a blender and your milkshake is ready.
7. Use the Shells As Serving Bowls
Don't throw out those pumpkin shells! You can use them as serving bowls for guests if you're feeling creative or if it's Halloween. Not only will they make your dining space a fun spot, but they are also an eco-friendly option.
8. Make Pumpkin Butter
If you're looking for a delicious spread for your fruit bowls and sandwiches, look no further. You can make pumpkin butter by mixing the puree with brown sugar, apple cider vinegar, and a few spices like nutmeg, cloves, and ginger. Just stir in the ingredients and bring them to a boil. Let them sit for 25 minutes and just stash the mix away in an airtight jar for later use.
How to Incorporate Pumpkin in Your Diet
Want to add some pumpkin to your diet but don't know how? Here's what you can do:
1. Make an Oatmeal Bowl out of It
Add pumpkin puree to your oatmeal and top it with spices and crunchy almonds. It makes for a delicious breakfast, we promise.
2. Make Pumpkin Soup
If you're feeling adventurous and you're down with the cold, try making some pumpkin soup. It's a terrific way to boost your immunity and enjoy a tasty treat at the same time. Garnish with ginger and cloves for a strong pick-me-up at the end of the day.
3. Make Pumpkin Ice Cream
Can't stand the summer heat? Just get some bananas, ice cream, pumpkin puree, and spices. Throw them in a blender with ice cubes, whisk well and serve with chocolate chips for the garnish.
4. Make a Salad
If your salads are lacking in flavour, you can spruce them up by adding in pureed pumpkin. You can throw in some quinoa too for a nutritional boost.
5. Make Pumpkin Juice
You can juice your pumpkins and make fresh smoothies out of them to keep yourself hydrated in the summers.
Here are a couple of frequently asked questions about pumpkins and what we have to say about them.
1. Can I Eat Pumpkin Every Day?
Yes, you can. But don't eat more than one cup since you don't want your skin to turn yellow from the high beta-carotene levels.
2. Does Pumpkin Make Me Sleepy?
Yes, because of the tryptophan content in it.
3. Which People Shouldn't Eat Pumpkin?
People who have allergies or take any medication that can interact with the nutrients in pumpkin, should not be eating it. Consult your doctor for more info on this.
Eating pumpkin can be a great way to boost your health and metabolism. Now that you know of its benefits and uses, it's time to start enjoying its goodness!
Also Read:
Benefits of Jowar for Health
Healthy Foods to Eat When You are Sick
Reasons Why You Should Eat With Your Hand


text:
- This event has passed.
The Spot Festival
September 29, 2012 - September 30, 2012
Event Navigation
On September 29th and 30th, the LPNC will host a booth at The 49th annual Spot Festival in Hampstead, NC, where we will promote our wonderful candidate for Governor Barbara Howe as well as our national Johnson/Gray ticket. This event should have great turnout and be lots of fun. If you'd like to volunteer, please get in touch with Ashley Teeter


text: Check in regularly to view upcoming events related to the field of sexual abuse prevention and treatment. If you have an event you would like us to publicize, please send us an email with the details including how interested parties can learn more. (Subject to our approval of the event).


text:
Today, January 15th, is the feast day of Saint Paul the hermit. This is a sweet and delicate Oatmeal Bread topped with rolled oats and naturally sweetened with agave.
Saint Paul was the first hermit. This saint left the comfort of home to enter and stay in the desert to contemplate and pray. He did this during a very difficult time in christian history. Hermits like Saint Paul set the stage for the rise of religious orders in the Catholic Church. One of the legends about Saint Paul the hermit was the day Saint Anthony who was 90 at the time came to visit him. Even though Saint Anthony hadn't previously met this hermit, he know exactly who he was.
While they were conversing, a raven brought the hermit a loaf of bread and few away. Paul said, "See, the lord, who is truly good and merciful, has sent us food. Everyday for sixty years I have received half a loaf, but with your arrival Christ has sent a double ration." Giving thanks they ate the bread.
1/2 cups sour dough starter
1 cup warm milk
2 tablespoons melted butter cooled slightly
1 medium egg beaten
3 tablespoons agave
1 tablespoon salt
1 1/2 cups rolled oats
3 cups all purpose
Combine starter, milk, butter egg and agave in your stand mixer using the paddle attachment. Let set in mixer while you measure and combine in another bowl the salt, oats and flour. Add your dry ingredients to your wet until dough comes together. Cover bowl with plastic wrap and allow to rise in mixer bowl for 2 hours. Punch down and put back on stand this time incert the dough hook and kneed until no longer sticky adding more flour if needed about 5 minutes. Divide dough into two equal pieces and put in prepared bread pans. Allow bread to rise again about 2 hours.
Bake bread in a 375 degree oven for about 45 minutes.
Allow to rest about 15 minutes before slicing.
Peace be with you,


text:
Enhancing Your Beauty
Without Surgery
Beauty has
No Limits
Age is just a
Feel Rejuvenated with
Non Surgical, Quick and Safe Treatments
We take extra precautions and are fully licensed professionals in the field. You are in safe hands. All our procedures have the fewest possible side-effects.
All of our procedures are very light on the body with very low risk of side effects. No need to undergo drastic surgeries to achieve a healthier and rejuvenated look.
We provide lifestyle advise alongside our procedures to promote optimal results. We aim to keep it as natural as possible.
Enjoy fast results through our specialised procedures. No need to experience a long and painful recovery period.
Customer's Testimony
"I found my treatment to be pain free with a natural look. The clinic was clean with welcoming staff. I am very happy with the outcome as in the past the fillers have looked slightly obvious"
- Jodie, London
"I have had filers 4 times before, but they never get the shape I requested. Really happy she got it the first time with much less injections needed!"
- Robyn, Kent
"Previously, I have been to a few clinics for filler treatment however I was mostly disappointed with the service, they were always trying to sell me other treatments that I simply did not need and made me feel uncomfortable. I have had the best experience with V&A! They make you feel at ease and listen to you! They are very professional and I'm very happy with my treatments."
- Illkay, London
"I just want to say thank you for my lips today. I absolutely love them. You did a brilliant job shaping them and plumping them perfectly. Also thanks for making me feel so at ease about it. I was so nervous the first time."
- K, London
"I'm so impressed. Amazing, first class team."
- Katie, Kent


text:
In our culture we are often brought up with this lofty idea of being in peace with everyone. At it's best we should avoid hate at all costs and resolve all our conflicts and toxic relationships with people in order to live a harmonious life.
And because most people have the fundamental need to feel loved and accepted, they tend to often proritize the needs of others more over their own needs. It's the typical image of the 'nice guy' who ranks so high in the personality trait of agreeableness, that he would probably wipe your ass if you asked him to.
Okay, all jokes aside. I see it every goddamn day. People doing things for other's they don't actually care about. They do it just to feel a little better about themselves. Or should I say – to feel a little less worse about themselves. 😉
They are afraid to say NO to someone and reject people they don't actually give a damn about because they think they're being more altrustic and ya know… 'love is all we need'… apparently.
Here is the harsh truth most people don't like, and when they read it, they immediatley start to find reasons of why it could not be true, when in fact, it is.
You can't ever be truly loved by anyone, if you're not truly hated by others.
If you look up Love in the Collins Dictionary one of the first synonyms you will find, is the word passion. And when are we most passionate about something? That's right, when we're doing something where we can be ourselves and be authentic.
The same principle goes for love. If you're doing stuff for people you don't actually care about, if you have difficulty giving someone a big fat NO, then you don't only have a boundary issue, but you're also not being authentic. It doesn't matter who it is – your mom, friends, partner or whoever.
Now, before I go on, let me clarify that sacrificing your own desires and needs for someone else, occasionally, is perfectly fine. In fact, that's what makes relationships so great!
But when it comes to your self-respect, dignity, physical body, or your lifes ambitions, you certainly shouldn't sacrifice anything for anyone. Ever.
And because we have all been confronted with some major decisions we had to make for ourselves when someone else was involved we either sacrificed our own self-respect for them, or, if we did it right, we didn't.
And if we didn't, then it usually involved disappointing that person you just rejected. It may even involve emotionally hurting people! And yes, these people will not like you for doing it. And that's totally fine.
Because look, risking to share your opinion openly or committing to some sort of action with your full time and energy, is likely to offend at least ONE person in this world. This planet is full of seven billion goddamn people, and the odds of you offending someone by openly speaking your truth, are pretty high.
In fact, the more honest you are with the world, the more people you will offend and the more people will not like you!
Because speaking the blunt truth is polarizing. When you speak your truth, people will very quickly know if they will like you and go into a foxhole with you, or not like you and call you an asshole.
The reason why the above saying, I believe, is doubted by many, is because it's very difficult to polarize people. It takes guts, it takes courage, and most importantly, it takes the truth.
Speak your truth, openly and freely. Don't be afraid someone isn't gonna like you. Life's not about making others happy. It's about making yourself happy, and by that, I mean it as I say it. The truth is the way forward.
Thanks for reading my article,


text:
Nous utilisons des cookies pour améliorer votre expérience et pour nous donner un aperçu de la façon dont les gens utilisent notre site Web. Pour en savoir plus, lisez notre politique de cookies.
Both my parents and my older brother played tennis. That's how I got hooked. I used to go to the courts with them and they'd throw me a few balls to play with at the end of the game. I loved it right away and wanted to be just like my parents and my big brother. So it was a real family affair. We also grew up near the Arthur Ashe stadium. So every year I went with my Dad or my friends to watch the US Open. So that helped feed my passion and years later the US Open became my favourite tournament as a player.
I loved the challenge of trying to reach my potential and always trying to find ways to improve. I loved the feeling of being totally prepared for tournaments as well. When I knew the hard work was done and I was ready to compete were my favourite times.
The pinnacle of that was winning the Davis cup. It was such a special experience to share that with Andy Roddick and the Bryan twins. We'd been through so much as a team. We loved the journey and I care about those guys because we shared so much.
When it was no longer possible to stay at that level, to keep improving, I knew it was time to call it a day. I still play once a month or so. But I have different priorities now.
Right Handed, One Handed Backhand
"My advice to anyone starting to play the game is always to have fun. If it's fun, you'll keep playing."
What made the transition away from the sport so smooth was my life situation. We already had one daughter, with another one on the way. So I had plenty to keep me busy. Tennis takes up so much of your energy and focus that it was actually really nice to change that pattern and have something more important to focus on. Having that singular focus switch from tennis to my family was a real joy.
I still love watching the game. It keeps getting better and better. Players are getting more physical and taking even better care of themselves. It's fun to watch because I know how much hard work it takes for them to be ready to compete at that level every time they step on the court. For me, a good match has a variety of points or styles. I like watching players who can do different things on the court.
There are some great young players coming through. My advice to anyone starting to play the game is always to have fun. If it's fun, you'll keep playing and that's the biggest hurdle.
Just getting kids to play and to enjoy it is the first step. That would have been good advice to my younger self too. To take it a little bit easier on myself. I tended to be pretty hard on myself and could have maybe lightened up a bit at times.
That mental side, staying balanced in your head is so important. In my career, there were plenty of people who had as much, or more athleticism, than I ever did. But I had great mental strength. That's what sets the top athletes apart.
There are some great young players coming through. My advice to anyone starting to play the game is always to have fun. If it's fun, you'll keep playing and that's the biggest hurdle.
It's important for kids to have role models too. My dad inspired me with how he raised me and led by example that hard work pays off. As an athlete, Arthur Ashe and Michael Jordan were my two biggest inspirations.
There's a great quote from Robert Hastings – "Regrets over yesterday and fears of tomorrow are the twin thieves that rob us of the moment." I tend to not have many regrets or too many worries about the future and just think if I do the things necessary in the moment, the rest will fall into place.
Maintenant que vous faites partie de la communauté Dunlop, nous vous tiendrons au courant de nos dernières nouvelles et offres.


text:
Report: Uber knowingly leased defective cars to Singapore drivers
Last year, Uber rented out Honda cars it knew were defective to Singapore drivers, according to a report from the Wall Street Journal. This culminated in one of the cars catching on fire this January, though there were no injuries. The cars were part of an initiative by Uber to purchase vehicles and rent them out to get more drivers on the road in a region where few own cars.
Explained: Fundamentally, purchasing cars and renting them out goes against Uber's business model, which hinges on the company not owning assets like vehicles. It attempted to cut corners by purchasing the cars from auto importers for about 12% less than through authorized Honda dealers, per Uber's estimates. And of course, this meant that Honda wouldn't help fix the cars (nor was it obligated to), and Uber was left to deal with the importers to get the cars fixed and the subsequent delays and contingency plans after one car caught on fire.


text:
Update on my spaceship WIP. I've changed the texture and cross-section, and I think it looks a little less toy-like now. The little flying things are ship-busters. The one in the foreground is just a primitive that I didn't delete. The novel itself is over 60k, and has gone out to a couple …
May 2015 archive
May 28
Work continues
May 17
Starting Alpha Readers
I've now gotten myself a couple of alpha readers for Legion. The story is at 60K words, and I want to see if there are parts that I've skimped on. Ideally I'd like to have it at 80K for release, but in the end it'll be the size that it needs to be. Postings have …
May 03
Blurb for "We are Legion"
Here's the blurb for We are Legion (We are Bob), final or close to it. Bob Johansson has hit the jackpot. He's just sold his software company and is looking forward to a life of leisure. There are places to go, books to read, and movies to watch. So it's a little unfair when he …


text:
Sign up to receive the latest news and exclusive offers from Shilling & Fitz
Garter (Kilt) Flashes are designed to be worn on the outside of your kilt hose. Made from 100% Pure New Wool woven ribbon, hand dyed to create a wonderful range that coordinates with tartan or tweed kilts. We also have a range of matching ties available.
Dry Clean Only.
Choose from: Black, Stealth Grey, Bottle, Purple Garter, Navy, Maroon, Ancient Blue, Weathered Green, Ancient Green, Weathered Blue, Weathered Red, Ancient red, Scarlet, Gold, Off White.
Allow 2-4 days to dispatch. Some colours in stock are available for immediate dispatch.
For bespoke flashes email: email@example.com
Weathered Blue 100% Pure New Wool Garter Flashes


text:
Customize your JAMA Network experience by selecting one or more topics from the list below.
Schulman SP, Becker LC, Kass DA, et al. L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial. JAMA. 2006;295(1):58–64. doi:10.1001/jama.295.1.58
© 2023
Author Affiliations: Division of Cardiology (Drs Schulman, Becker, Kass, Champion, Ernst, Kelemen, Hare, and Gerstenblith and Mss Townsend and Capriotti), Johns Hopkins Medical Institutions, and Maryland Medical Research Institute (Dr Terrin and Ms Forman), Baltimore. Dr Terrin is now at the Department of Epidemiology and Dr Kelemen is at the Division of Cardiology, University of Maryland School of Medicine, Baltimore, and Dr Ernst is now at the Division of Cardiology, Stanford School of Medicine, Stanford, Calif.
Context The amino acid L-arginine is a substrate for nitric oxide synthase and is increasingly used as a health supplement. Prior studies suggest that L-arginine has the potential to reduce vascular stiffness.
Objective To determine whether the addition of L-arginine to standard postinfarction therapy reduces vascular stiffness and improves ejection fraction over 6-month follow-up in patients following acute ST-segment elevation myocardial infarction.
Design and Setting Single-center, randomized, double-blind, placebo-controlled trial with enrollment from February 2002 to June 2004.
Patients A total of 153 patients following a first ST-segment elevation myocardial infarction were enrolled; 77 patients were 60 years or older.
Intervention Patients were randomly assigned to receive L-arginine (goal dose of 3 g 3 times a day) or matching placebo for 6 months.
Main Outcome Measures Change in gated blood pool–derived ejection fraction over 6 months in patients 60 years or older randomized to receive L-arginine compared with those assigned to receive placebo. Secondary outcomes included change in ejection fraction in all patients enrolled, change in noninvasive measures of vascular stiffness, and clinical events.
Results Baseline characteristics, vascular stiffness measurements, and left ventricular function were similar between participants randomized to receive placebo or L-arginine. The mean (SD) age was 60 (13.6) years; of the participants, 104 (68%) were men. There was no significant change from baseline to 6 months in the vascular stiffness measurements or left ventricular ejection fraction in either of the 2 groups, including those 60 years or older and the entire study group. However, 6 participants (8.6%) in the L-arginine group died during the 6-month study period vs none in the placebo group (P = .01). Because of the safety concerns, the data and safety monitoring committee closed enrollment.
Conclusions L-Arginine, when added to standard postinfarction therapies, does not improve vascular stiffness measurements or ejection fraction and may be associated with higher postinfarction mortality. L-Arginine should not be recommended following acute myocardial infarction.
Clinical Trial Registration ClinicalTrials.gov Identifier: NCT00051376
The amino acid L-arginine, the substrate for nitric oxide synthase (NOS), is widely available and publicized as having benefits for patients with hypertension, angina, heart failure,1 and sexual dysfunction. It is estimated that 40% of US residents take some type of dietary supplement.2 A recent statement from the Institute of Medicine called for applying the same principles and standards of evidence of treatment effectiveness and safety to all therapies, whether currently labeled as conventional medicine or complementary and alternative medicine.3
We conducted a double-blind, randomized, placebo-controlled trial to test the efficacy of L-arginine following a first ST-segment elevation myocardial infarction (STEMI). The rationale was based on the established increased risk posed by elevated vascular stiffness, a hallmark of aging.4-7 The age-associated increase in arterial stiffness is attributed not only to structural changes in the arterial wall4 but also to an age-associated decline in endothelial function.8-11 The administration of L-arginine improves endothelial function in healthy elderly individuals and patients with vascular disease,10,12 in addition to improving noninvasive measures of vascular stiffness.13
The Vascular Interaction with Age in Myocardial Infarction (VINTAGE MI) clinical trial was designed to test whether the addition of L-arginine to standard postinfarction therapy in patients following a first STEMI over a 6-month period would decrease vascular stiffness and improve left ventricular function. Secondary outcomes included clinical events.
The VINTAGE MI study enrolled patients at least 30 years of age within 3 to 21 days of a first STEMI. Cardiac catheterization was performed for clinical reasons. Patients with prior documented Q-wave MI, present cardiogenic shock, active acute coronary syndrome, severe underlying noncardiac disease limiting predicted life span to less than a year, poorly controlled diabetes mellitus, or significant renal (creatinine >3.0 mg/dL [265.2 μmol/L]) or hepatic disease were excluded. The study was approved by the institutional review board at the Johns Hopkins Medical Institutions, and all participants gave informed written consent.
In addition to standard demographic variables, peak creatine phosphokinase, and troponin I values were collected, as well as the number of leads on the admission electrocardiogram (ECG) with at least 1 mm ST-segment elevation, the sum of ST-segment deviation, and medical therapies administered. Catheterization variables assessed included initial and final Thrombolysis in Myocardial Infarction (TIMI) flow grade in the infarct vessel, whether a percutaneous coronary intervention was performed, the number of vessels with a 70% or greater stenosis, and the Duke Coronary Artery Disease score.14
Evaluation of left ventricular function and vascular stiffness were performed at a mean of 5.9 days (median, 4; 25th percentile, 3; 75th percentile, 8; range, 3-21 days) following admission for acute myocardial infarction. These included:
Gated blood pool scan: Supine and upright resting gated blood pool scans were obtained after in vivo labeling of red blood cells with 25 to 30 mCi of technetium 99m as previously described.15 All scans were read by one of the investigators (L.C.B.), who was blinded to treatment assignment, patient age, identity, and time of study. Global left ventricular ejection fraction was calculated from time activity curves generated from left ventricular regions of interest. Infarct zone and remote zone ejection fraction and absolute cardiac volumes were determined as previously described.15
Pulse pressure: Pulse pressure was calculated as the difference between sitting systolic and diastolic blood pressures measured at the time of the gated blood pool scan. The average of 3 measurements by cuff sphygmomanometry was used.
Arterial compliance: Arterial compliance was measured with an automated tonometry device that was positioned over the radial artery (CR-2000, Hypertension Diagnostics Inc), which has been validated with invasive studies.16 The tonometer was calibrated with sphygomanometric blood pressures. Steady state 30-second pressure recordings were recorded and digitized for each patient. Steady state aortic pressure waves were reconstructed using transfer functions. Total arterial compliance was calculated using the area under the diastolic portion of the pressure decay curve, a method also previously validated.17
Pulse wave velocity: Flow waves were recorded from the right common carotid and right femoral arteries using pulse wave Doppler flow probes (model HP5500, Phillips Inc, Andover, Mass). Measurements were made with participants in the supine position after a 15-minute equilibrium period. The pulse wave velocity was determined by the quotient of a distance and a time measure with simultaneous ECG recordings as previously described.18
Arterial elastance: Arterial elastance was calculated from the noninvasive estimation of end systolic pressure and stroke volume from the gated blood pool scan. End systolic pressure was estimated by 0.9 × arterial systolic pressure.19
Once baseline data were obtained, all patients were randomized in a double-blind fashion to study drug, consisting of L-arginine (MK Health Food Distributor, Nature's Life, Larkspur, Calif) or matching placebo. High-performance liquid chromatography of separate lots of active study drug revealed between a 509- and 516-mg L-arginine capsule. Stratification was made by age (<60 years and ≥60 years) and sex. Within any age group, stratification was also made by pulse pressure (<50 mm Hg or ≥50 mm Hg).
Block sizes were randomly selected among sized 2, 4, and 6 within each stratum.
Participants started the study drug, 1 g three times daily for 1 week, increasing to 2 g three times daily in week 2, followed by 3 g three times daily in week 3. Patients were maintained at this dose for 6 months. If adverse effects occurred during dose titration, the dose was lowered to the prior dose that was tolerated. All patients were followed up in our study clinic at 1 month, 3 months, and 6 months. In all patients, capsule counts for adherence were determined at each visit.
Assessment by an investigator at each visit was also made for new clinical heart failure and new ischemic events. A blinded clinical events committee adjudicated admissions for heart failure, new myocardial infarction, and death from the medical record. At each visit, the investigator also assessed the occurrence of any adverse events and medication adverse effects. After 6 months of follow-up, repeat vascular and ventricular function testing were performed. At baseline and at 6 months, plasma L-arginine levels were measured by high-performance liquid chromatography, as previously described.20
Baseline comparability of demographic and other covariates between the treatment groups was checked. For treatment comparisons, a 2-tailed P value of <.05 was considered significant in the primary analysis, and in secondary analyses a P value of <.01 was considered significant. For the primary analysis, a composite ranking based on 6-month mortality and change in ejection fraction between baseline and the 6-month visit was used.21,22 Patients who died prior to the 6-month follow-up were ranked on their time to death and were ranked worse than all survivors. Patients surviving 6 months were ranked by the difference between their ejection fractions at baseline and 6 months with those exhibiting the most deterioration in ejection fraction ranked worst. The Wilcoxon rank test was used to compare the placebo and L-arginine groups. The primary end point analysis involved those patients randomized (analysis by intention to treat) who were 60 years or older. Event rates for the combined and individual clinical outcomes of death, hospital admission for heart failure, and hospitalization for myocardial infarction were estimated using the Kaplan-Meier life-table method and compared by the log-rank statistic.
Means of pulse pressure, arterial compliance, pulse-wave velocity, arterial elastance, ejection fraction, and cardiac volumes at baseline and 6 months within the placebo and L-arginine groups were determined. Baseline and 6-month variables between the 2 treatment groups were compared using the unpaired t test. Data are expressed as the mean and standard deviation.
We planned to enroll 180 patients aged 60 years or older, which allowed for nonadherence and dropout as high as 20%, and mortality as high as 10%, to obtain power of about 0.90 to detect an absolute difference in 6-month change in ejection fraction of 6% between the 2 groups. We also planned to enroll 100 patients from ages 30 to 59 years with an estimated dropout as high as 10% to detect any association of baseline arterial stiffness and age with a power of 0.90. The study planned for data and safety monitoring reports compiled every 6 months during patient enrollment. The data and safety monitoring committee recommended stopping patient enrollment at 2.5 years after the start of recruitment due to excess mortality in patients in the L-arginine group. All statistical analyses were conducted using SAS version 9.1 (SAS Institute Inc, Cary, NC).
One hundred fifty-three patients with a first STEMI and meeting all entry criteria were enrolled from February 2002 through June 2004 (Figure). Patient characteristics according to randomization assignment are presented in Table 1. Seventy-seven patients were 60 years or older, and 89 patients had baseline pulse pressure of 50 mm Hg or higher. The majority of patients had percutaneous coronary intervention of the infarct vessel with restoration of TIMI 3 flow. The number of patients with single-, double-, and triple-vessel coronary disease, as well as the infarct site and the coronary artery disease prognostic score, were similar between the 2 groups. Estimates of infarct size by cardiac enzymes and ECG were also similar between the 2 groups. At the time of randomization (mean 5.9 days from admission; median, 4; 25th percentile, 3; 75th percentile, 8; range, 3-21 days), the majority of patients were treated with standard postinfarct therapies.
Baseline vascular properties measured on standard postinfarct therapies are presented in Table 2. There were no baseline differences between measurements of vascular stiffness in the 2 study groups, including pulse pressure, arterial elastance, pulse wave velocity, and radial artery compliance. Gated blood pool scan measures of left ventricular function, including global and regional ejection fraction and cardiac volumes, were also similar (Table 2).
Interim analyses for safety end points were performed every 6 months, and the data and safety monitoring committee terminated the study early for safety concerns. Six-month studies were obtained in 55 participants in the L-arginine group and 59 in the placebo group (Figure). By capsule counts, the percentage of patients adherent with the study drug at 1, 3, and 6 months ranged from 80% to 90% in both L-arginine and placebo groups. Two thirds of patients at the 6-month follow-up were taking L-arginine or matching placebo at the goal dose of 3 g three times a day. L-Arginine plasma concentrations are shown in Table 3. Baseline L-arginine levels were within the normal range (60-100 μmol/L)23 in both groups. Following 6 months of therapy, levels went up slightly in both randomized groups, with no difference between plasma L-arginine concentrations in patients in either group. Neither the change in L-arginine levels from baseline to 6 months nor stratification by the amount of L-arginine taken at the 6-month visit showed any effect of study drug on L-arginine concentrations.
L-Arginine therapy was generally well tolerated. As shown in Table 4 adverse effects were generally minor and equally common among patients in both groups.
Six-month vascular property values are presented in Table 2. Arterial elastance, arterial compliance, pulse pressure, and pulse wave velocity were similar between placebo and L-arginine treated patients. The 6-month vascular stiffness values in patients 60 years or older and patients with a baseline pulse pressure 50 mm Hg or higher were also similar between patients in either group.
The primary outcomes (6-month median change in ejection fraction, with death as the worst response, in patients 60 years and older) were −1.0% in the L-arginine group and −1.0% in the placebo group (P = .63 by Wilcoxon test). The median change in ejection fraction from baseline to 6 months with deaths counted as the worst outcome in the entire population was 0.0% in the L-arginine group and −1.0% in patients in the placebo group (P = .89 by Wilcoxon test). There were no ejection fraction differences between L-arginine and placebo in patients who had baseline pulse pressures of at least 50 mm Hg.
Changes in cardiac volumes and ejection fraction in patients with paired baseline and 6-month studies are also presented in Table 2. Cardiac volumes and ejection fraction at 6 months were similar between patients in both groups. Additionally, 6-month noninfarct and infarct zone ejection fraction were not different in the 2 groups. In patients 60 years or older, L-arginine therapy had no impact on left ventricular volumes or ejection fraction.
Six-month clinical events, including death, myocardial infarction, and hospitalization for heart failure, occurred in 12 (16.7%) patients in the L-arginine group compared with 7 (10.1%) patients in the placebo group. Death occurred in 6 patients (8.6%) in the L-arginine group and none in the placebo group (P = .01). Five of the patients who died were 60 years or older (15.5%, P = .02 compared with placebo in this age group). The 5 deaths included a patient dying of myocardial rupture following a recurrent anterior infarction, 2 patients were found dead at home without prior symptoms, and 2 patients died of presumed sepsis. After termination of the study treatments, a sixth patient in the L-arginine group died. The patient died suddenly 4 months following his acute anterior myocardial infarction and 3 weeks following cessation of study drug.
The VINTAGE MI study demonstrated that 6 months of L-arginine added to standard postinfarct medications did not reduce noninvasive measures of vascular stiffness, improve ejection fraction, or improve clinical outcomes. To the contrary, we noted a possible increased risk of death in older patients after infarction while taking L-arginine compared with those taking a placebo, leading to the early termination of the study. These findings have broad public health implications given the increasing availability and use of L-arginine in patients with and without established cardiovascular diseases.3
Advanced age is a powerful independent predictor of short-term morbidity and mortality in postinfarct patients.24-26 This increased risk may be due in part to the age-associated changes in the cardiovascular system, which alter the substrate upon which the infarct occurs. One such age-associated change is an increase in vascular stiffness, which increases left ventricular afterload.4,6 The increase in vascular load is likely causally related to an age-related increase in left ventricular wall thickness, a decrease in exercise reserve, and an increased risk of cardiovascular morbidity and mortality in healthy men and women.6,7,27 In patients with left ventricular dysfunction, increased vascular load relative to ventricular contractility results in depression of myocardial efficiency.28,29 Following a myocardial infarction, increased load contributes to left ventricular dilatation and ultimately, poor prognosis.30,31 The attenuation of left ventricular remodeling by angiotensin-converting enzyme inhibitors, partly by reducing vascular load, reduces morbidity and mortality.32
Endothelial dysfunction is another age-associated change that may impact prognosis in older patients following myocardial infarction. It is common in seemingly healthy elderly subjects,9 as well as in patients with coronary artery disease.33 Since endothelial dysfunction affects conduit as well as arteriolar vessels, it likely contributes to the age- and disease-associated increases in peripheral vascular resistance, arterial stiffness, and vascular load.11,34,35 The mechanisms for endothelial dysfunction are likely multifactorial36-38 although the result is a loss of available nitric oxide.
One mechanism to increase nitric oxide synthesis by vascular endothelium is to provide more substrate for the endothelial-specific isoform of nitric oxide synthase (eNOS).38L-Arginine is an important substrate for this enzyme.39 Although the availability of intracellular L-arginine for eNOS does not appear rate limiting,40 coronary and brachial endothelial function improves12,41,42 in addition to improved measurements of arterial compliance following supplemental L-arginine administration in doses similar to those used in this trial.13
The VINTAGE MI study is the largest prospective study of L-arginine in patients with coronary artery disease and the first, to our knowledge, testing whether L-arginine administration in a postinfarct population improves measures of vascular stiffness and left ventricular remodeling following a first STEMI. In this study, 6 months of L-arginine therapy failed to decrease several vascular stiffness measurements. This lack of effect was also evident in prespecified subgroups with elevated baseline vascular stiffness, including patients at least 60 years of age and those with baseline pulse pressure higher than 50 mm Hg.
Plasma L-arginine levels were normal at baseline, and increased similarly following 6 months of therapy with L-arginine and placebo. Although plasma levels convey little about intracellular effects, the lack of any change in vascular or ventricular measurements between L-arginine and placebo treated patients suggests that any decrease in vascular stiffness by L-arginine may be possible only in patients with preexisting L-arginine deficiency.43 The adaptive change in L-arginine catabolism by hepatic arginase activity with increased dietary intake of L-arginine likely explains the small changes in L-arginine concentration in our patients following 6 months of therapy.44,45 Furthermore, the potential benefits of supplemental L-arginine on enhancing nitric oxide production may be inhibited by the age-associated increases in arginase levels and endogenous NOS inhibitors.37,46 Our findings are consistent with those of Blum and coworkers,47 who reported that the addition of L-arginine (9 g daily) to standard anti-ischemic therapy had no effect on nitrogen oxides, serum adhesion molecules, or flow-mediated brachial artery dilation in 30 patients with stable coronary disease.
There are several potential mechanisms by which L-arginine therapy may be harmful in post–myocardial infarction patients. In the setting of NOS cofactor tetrahydropbiopterin deficiency, instead of generating nitric oxide, eNOS becomes a source of reactive oxygen species generation that could be enhanced with L-arginine supplementation.48 In an animal model of pressure overload, tetrahydropbiopterin levels were reduced resulting in marked generation of reactive oxygen species, metalloprotease production, fetal gene expression, and left ventricular dilatation.49 All these adverse cardiac responses to pressure overload were ameliorated in eNOS knock-out mice or by providing dietary tetrahydropbiopterin. L-Arginine supplementation also leads to an increase in homocysteine production, which can result in worsening, not improvement, of endothelial function and atherosclerosis.38 Furthermore, in the setting of atherosclerotic disease, the inducible isoform of nitric oxide synthase (iNOS) is expressed, resulting in production of peroxynitrite and consumption of nitric oxide, potentially worsening atherosclerosis.38,48,50 Whereas decreased availability of L-arginine inhibits iNOS protein expression, increased cellular uptake of L-arginine results in increased iNOS protein expression and enzyme activity.51 High levels of iNOS, nitric oxide, and peroxynitrite contribute to the myocardial dysfunction and systemic vasodilatation that occur in both septic and cardiogenic shock.52 These potential consequences of L-arginine supplementation may explain, in part, the worse clinical outcomes in the older patients in this study randomized to L-arginine. It is important to note that trials are currently under way testing the hypothesis that inhibition of NOS may be beneficial after myocardial infarction (see http://www.clinicaltrials.gov, NCT00112281); the current findings are consistent with the thesis of these trials.
A potential reason for the failure of L-arginine to reduce vascular stiffness measurements was that L-arginine levels were normal to begin with. The lack of any dose response in plasma L-arginine levels from 0 to 9 g suggests that higher doses of L-arginine would not have resulted in any biological effect in this population. Additionally, a large majority of patients were already taking medications that improve vascular function, including angiotensin-converting enzyme inhibitors and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.53,54 The lack of change in ejection fraction over 6 months and lack of remodeling may be related to the large proportion of patients receiving early percutaneous coronary intervention with establishment of coronary patency.
This study has several limitations. Due to the early termination of VINTAGE MI, we enrolled about half of the planned study population. Nevertheless, the small change in ejection fraction observed among the 153 enrolled patients makes it unlikely that a benefit of L-arginine on ejection fraction following STEMI would have been found, even if the entire planned population were enrolled. Post hoc power calculations to detect a 6-unit difference between L-arginine and placebo assigned groups in change in ejection fraction from baseline to 6-month follow-up based on the enrolled population was 0.71 for participants 60 years and older and 0.94 for the entire study population. Mortality was not an a priori primary end point. The excess mortality was an unexpected safety monitoring concern and the results could be due to (small but nonzero) chance. Nevertheless, we concurred with the data and safety monitoring committee's independent recommendation for early termination of treatment with L-arginine.
In conclusion, L-arginine therapy should not be given to patients following a myocardial infarction. It neither alters noninvasive measures of vascular stiffness nor improves left ventricular function. L-Arginine therapy in older patients with diffuse atherosclerosis may worsen clinical outcomes.
Corresponding Author: Steven P. Schulman, MD, Halstead 500, Johns Hopkins Hospital, Baltimore, MD 21287 (email@example.com).
Author Contributions: Drs Schulman and Gerstenblith had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Schulman, Becker, Kass, Terrin, Kelemen, Gerstenblith.
Acquisition of data: Schulman, Becker, Champion, Ernst, Kelemen, Townsend, Capriotti, Gerstenblith.
Analysis and interpretation of data: Schulman, Becker, Champion, Terrin, Forman, Capriotti, Hare, Gerstenblith.
Drafting of the manuscript: Schulman.
Critical revision of the manuscript for important intellectual content: Schulman, Becker, Kass, Champion, Terrin, Forman, Ernst, Kelemen, Townsend, Capriotti, Hare, Gerstenblith.
Statistical analysis: Terrin, Forman.
Obtained funding: Schulman, Kass, Gerstenblith.
Administrative, technical, or material support: Schulman, Kass, Champion, Terrin, Ernst, Kelemen, Townsend, Capriotti, Hare, Gerstenblith.
Study supervision: Schulman, Becker, Terrin.
Financial Disclosures: None reported
Data and Safety Monitoring Committee: Edward K. Kasper, MD (Chair), Edward G. Lakatta, MD, Joel Vertner, PhD, Marie Nolan, DNSc, RN.
Clinical Events Committee: Dale Renlund, MD, Ilan Wittstein, MD, Shawn Robinson, MD.
Data Coordinating Center: Sharon Fick.
Nuclear Cardiology Core Group: Jon Clulow, Terry Frank, Rosalie Cosgriff.
Funding/Support: The study was supported by National Heart, Lung, and Blood Institute grant HL70059.
Role of the Sponsor: The funding agency had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.
Acknowledgment: We thank the members of the data and safety monitoring committee and the clinical events committee for their commitment to the trial.