text:
October 1999
New safety data and monitoring guidelines clarify role of the lone nucleotide analog
Adefovir is a novel reverse transcriptase inhibitor that is classified as a nucleotide analog. This classification reflects the presence of an additional phosphate group in the compound, one that makes intracellular activation simpler with adefovir than with nucleoside analogs like ZDV and 3TC. Adefovir has a long intracellular half-life, which makes once-daily dosing possible.
Miller et al. have analyzed data from a subset of patients enrolled in an ongoing Phase III study of adefovir (1). This group of 142 patients had genotypic evidence of resistance to ZDV or to both ZDV and 3TC. Interestingly, patients with mutations conferring resistance to both ZDV and 3TC had stronger reductions in viral load after 24 weeks of adefovir therapy than patients who lacked these mutations, although responses were seen in 86% of all patients. By 48 weeks, the antiretroviral effects of adefovir were still evident -- suggesting that both genotypic and phenotypic analyses may be needed to predict which treatment-experienced patients will respond to an adefovir-containing regimen.
Adefovir has also been studied in combination with several other regimens that contained nucleoside analogs (2). In this trial, patients in all of the adefovir-containing arms experienced significant reductions in HIV RNA levels after 20 weeks of combination therapy, confirming earlier indications that this novel compound would prove to be effective when combined with other antiretroviral agents (see "The Next Generation of Antiretroviral Agents," Vol. 3, No. 3).
Because administration of adefovir has been associated with significant nephrotoxicity (specifically, proximal renal tubular dysfunction, or PRTD), clinicians will be particularly interested in the safety data amassed when adefovir was provided to qualified patients under an expanded-access program (3). The study included 5,640 patients who had failed prior therapy with at least two nucleoside analogs and one protease inhibitor. More than 1,500 of these patients were treated for at least 24 weeks. The doses employed were 60 or 120 mg of adefovir once daily. All participants also received L-carnitine 500 mg once daily, because adefovir has been shown to decrease blood levels of this molecule.
Numerous other antiretrovirals were used by the participants in this expanded-access program. Gastrointestinal complaints caused 3% to leave the trial, and 2.5% (141) of treated patients discontinued treatment because they developed nephrotoxicity. At least 30 of these patients had serious renal toxicity that did not completely resolve. In subjects who did develop PRTD, 2% had elevations in creatinine greater than 2.0 mg/dL, but these elevations resolved with dose reduction, interruption, or discontinuation.
Another study, one that randomized 505 patients with CD4 counts less than 200 cells/mm3 to adefovir (120 mg daily) or placebo, revealed a 22% incidence of PRTD at 12 months in the adefovir arm, compared with 0.5% in the placebo arm (4). The first case of PRTD in this trial was seen after four months of treatment. The authors of this study report that 61% of the patients with PRTD experienced resolution of their nephrotoxicity, with a median time to resolution of 17 weeks after adefovir therapy was discontinued.
Dr. Judith A. Aberg, a member of the editorial advisory board of HIV Newsline, comments:
Overall, 2% of patients treated with adefovir develop serious nephrotoxicity. Common electrolyte abnormalities in patients treated with adefovir include decreases in phosphate, bicarbonate, and potassium -- abnormalities that may herald the development of PRTD. For this reason, every patient who is assigned to an adefovir-containing regimen must be scrupulously monitored for changes in kidney function.
The current recommended dose of adefovir is 60 mg daily, as this may reduce the incidence of nephrotoxicity. Electrolytes, BUN, creatinine, phosphate, and urinalysis tests should be conducted monthly on all patients who receive adefovir as part of their antiretroviral regimen. Individuals who experience a rise of more than 0.5 mg/dL in creatinine -- in combination with any two of the following: bicarbonate < 19 mEq/L, proteinuria > 2+, glycosuria > 1+, potassium < 3.0 mEq/L -- should discontinue adefovir therapy for four weeks. (In my own clinical practice, I withhold adefovir if a patient's creatinine rises by more than 0.3 mg/dL.) If laboratory values return to baseline after four weeks, the patient may be rechallenged with adefovir.
The same holds for patients whose creatinine level falls by more than 0.5 mg/dL in combination with a rise in phosphate level of more than 2 mg/dL. If creatinine returns to baseline after four weeks, these patients may also be restarted on adefovir therapy -- but they must be carefully monitored thereafter. The current treatment guidelines call for providers to check the L-caratine levels of all adefovir-treated patients at 16-week intervals, although the clinical significance of low caratine levels is unclear.
In weighing whether to add adefovir to the therapeutic regimen of a heavily pretreated patient, the clinician should take into account that this agent, alone among the antiretrovirals, has activity against a number of herpes viruses as well as HIV. As a result, its use may confer protection against HIV, HHV-6, and CMV as well as against HIV-1 and HIV-2.
Screening programs may save lives and resources
There is a growing literature on the incidence of anal neoplasms and human papilloma virus, or HPV, in HIV-infected gay and bisexual men, and on HPV as the cause of cervical cancer in women. Last year, we covered the former topic in a newsline item that focused on the epidemiology of HPV and anal neoplasms (see "Human papilloma virus and anal cancer: More evidence of an association, especially in HIV-positive men with persistent infection," Vol. 4, No. 4). That study compared the incidence of high-grade squamous intraepithelial anal lesions in HIV-positive and HIV-negative homosexual and bisexual men. HPV can cause benign lesions (such as warts or collections of atypical cells of unknown significance), low-grade squamous intraepithelial lesions (SIL), or high-grade SIL.
The natural history of high-grade SIL is not completely clear, but it is felt that these lesions are very likely to progress to cancer. Cervical neoplasms associated with HPV are widely viewed as a logical model for anal lesions caused by the same group of viruses, and this presumption was reinforced by the report from Palefsky et al. that we covered last year. Those investigators found that HIV-infected men with HPV lesions were significantly more likely than HIV-negative men to develop high-grade SIL.
Motivated by the accumulating evidence that HIV-infected gay and bisexual men are at higher risk of anal HPV infection -- and the presumed sequelae of such infections, high-grade SIL and squamous cell carcinoma of the anus -- Goldie et al. decided to evaluate a proposed screening program for individuals with anal HPV. They employed a mathematical model to calculate lifetime costs, life expectancy, and quality-adjusted life expectancy for no screening program versus screening with Pap smears every three years, every two years, or every six months.
These hypothetical strategies were evaluated in populations of HIV-infected gay and bisexual men with CD4 counts under 200 cells/mm3, between 200 and 500 cells/mm3, and above 500 cells/mm3. The results strongly endorsed the efficacy and cost-effectiveness of a screening program. Screening for SIL in these populations increased quality-adjusted life expectancy at all stages of HIV disease. The authors' calculations suggest that screening every two years or annually would increase quality-adjusted life expectancy in persons with early HIV disease (CD4 counts > 500 cells/mm3) and would be cost-effective. Annual screening was judged to be the most effective strategy in men with CD4 counts less than 500 cells/mm3; increasing the screening frequency to every six months provided little additional benefit.
Goldie SJ, Kuntz KM, Weinstein MC, Freedberg KA, Welton ML, Palefsky JM. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA 1999; 281 (19): 1822-29.
Dr. James O. Kahn, a member of the editorial advisory board of HIV Newsline, comments:
Clinicians who treat HIV-infected men are seeing more and more cases of anal cancer among these men, and among men who are at high risk for HIV infection, so it is hardly surprising that there is a heightened interest in diagnosing and treating HPV lesions -- before they lead to high-grade SIL or squamous cell carcinoma. Much of the original work in this area has been done by my colleague Dr. Joel Palefsky at UCSF. The targeted screening program that Goldie et al. have proposed is a natural outgrowth of Dr. Palefsky's initial contributions to our understanding of the sinister relationship between HPV, SIL, and anal cancer.
Goldie's analysis suggests that such a program would be both effective and affordable, saving both lives and health-care dollars. However, this analysis was limited by certain assumptions. For one thing, we don't know the full natural history of high-grade anal SIL, although these lesions are considered likely precursors to squamous cell carcinoma. For another, there are no published figures on the cost of treating anal cancer, so Goldie and coworkers chose to base their estimates on the known cost of treating colorectal cancer. In my experience, this is probably a conservative estimation, given that the treatment for anal cancer, which combines radiation and chemotherapy, is associated with significant clinical toxicities. The authors also acknowledge that the potential effect of maximally suppressive antiretroviral therapy on the incidence of anal neoplasms is difficult to assess at this point.
When it was necessary to make assumptions, however, the authors made it a point to err on the conservative side, so that screening would seem less cost-effective. This decision makes their core finding -- that an annual screening program would save both lives and money -- all the more significant. If history is any guide, the real battle will be to convince third-party payers that it is in their best interests to work with providers, so that they become proficient with the simple and safe procedure, and to work with pathologists, so that they become familiar with the descriptive lesions. And, finally, third-party payers and their care providers need to work with patients -- to educate and empower them, so that they understand that they have a right to insist that this crucial screening tool be a part of their examinations.
Viral suppression in the real world
It is easy to get excited by the encouraging data that are routinely presented at major medical conferences these days. Then the care provider goes home and puts those new findings into practice . . . and finds that his or her results fall far short of what the controlled trials achieved. This is the real world of clinical practice. Because the most notable results of these controlled trials get intense media attention, as sensational as it is superficial, the general public knows about the successes being achieved with multidrug antiretroviral therapy . . . but not about the realities of implementing these complex treatment regimens.
What the mainstream media generally fail to report is how infrequently the results of clinical trials are replicated in the clinic itself. Any clinician who treats large numbers of HIV-infected patients is well acquainted with the disparity between glowing media reports about the miraculous effects of combination antiretroviral therapy and clinical reality, which is that a significant percentage of patients do not thrive on these new combinations.
Lucas and colleagues carefully studied a group of patients newly started on combination therapy in an attempt to determine if there are predictable factors associated with lack of optimal response. They enrolled 273 patients, all of whom were protease-inhibitor-naïve, and followed their viral load measurements over 14 months (median length of follow-up: 454 days). These patients were recruited from the Johns Hopkins HIV Clinic in Baltimore, which is an inner-city facility. Sixty-six percent of the patients had no prior exposure to at least two of the drugs started at baseline. The protease inhibitors used were ritonavir, indinavir, and nelfinavir. Mean CD4 count at baseline was 217 cells/mm3. The predominant risk behavior was IV drug use. Most (74%) participants were non-white; within this group, the participants were overwhelmingly African-American. Males constituted 72% of the entire cohort.
In clinical trials, maximally suppressive antiretroviral therapy has reduced HIV RNA to undetectable levels in 60% to 90% of subjects. Lucas et al. report that only 42% of the patients in their cohort had undetectable HIV RNA levels (< 500 copies/mL) within the first 90 days of the study. During months three through seven, this figure was 44%, and it had declined to 37% by 14 months. Only 23% of participants had undetectable levels during all three time periods.
Univariate analysis showed the following parameters to be associated with optimal HIV suppression at all three periods: age greater than 40 years, white ethnicity, and compliance with clinic appointments. On the other hand, a history of injection drug use was linked to poor response. No correlations were found during the observation period between level of viral suppression and sex, education, male-male sexual exposure, history of antiretroviral use, or adverse reaction to protease inhibitors.
The authors also performed a logistic regression analysis. This exercise indicated that only poor clinic attendance was statistically correlated with failure to achieve and maintain an undetectable viral load. The authors therefore view missed appointments as a "surrogate marker" for poor compliance with medication. At the Johns Hopkins HIV Clinic, a rigorous program is now in place to identify and work with patients who miss large numbers of clinic appointments.
Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999; 131: 81-87.
Dr. James O. Kahn, a member of the editorial advisory board of HIV Newsline, comments:
This study provides additional evidence that HIV-infected patients who regularly fail to attend inner-city clinics do not respond as well to combination antiretroviral therapy as do participants in clinical trials or patients who do keep their appointments. Although this may seem to be a painfully obvious observation, the authors have isolated a contributing factor that may respond well to community-based intervention efforts. The notion that patients who chronically miss appointments are also likely to chronically miss taking their assigned medications makes intuitive sense, and Lucas et al. have developed strong evidence of a link. If ways can be found to improve clinic attendance, adherence might be enhanced as well -- to the benefit of the individual patient and the community at large.
Some practical solutions to this problem have been offered by Dr. Margaret Chesney. They include: provisions for day care; providing food, so that patients are assured of a meal whenever they keep a clinic appointment; and providing one-stop care, so that a patient can see a dentist, podiatrist, and social worker -- and can get prescriptions filled in the clinic pharmacy -- on the same day that he or she is seen in the clinic.
Providing patients with some symbol, however nominal, that indicates that they are "part" of the clinic and its team of dedicated care providers, is also important. Patients who feel that they have a place in the healthcare system are more likely to keep scheduled appointments and adhere to their assigned regimens.
Weight gains seen in treated patients, who find eating easier
Oral and esophageal ulcers not caused by any identifiable organism or other pathology are common in HIV-infected patients. The etiology of these lesions, called aphthous ulcers, is obscure. Over the past few years, researchers have been studying thalidomide as a potential treatment for these ulcers. A cohort of AIDS Clinical Trials Group investigators recently published the results of a double-blind, placebo-controlled trial of thalidomide as treatment for esophageal aphthous ulcers.
Jacobson et al. randomized 24 patients with low CD4 counts (median value < 30 cells/mm3) and biopsy-proven aphthous ulcers involving the esophagus to receive thalidomide (100 mg twice daily) or a look-alike placebo. Originally, investigators had planned to recruit 82 patients. However, poor accrual forced them to analyze data from the 24 subjects who did complete the trial.
Given thalidomide's history of severe teratogenic effects, pre-menopausal women were required to use adequate contraception or to abstain from heterosexual intercourse for a defined period. In addition, these women had pregnancy tests weekly. All patients were closely monitored throughout the study, and they underwent repeat esophagoscopy after four weeks.
Eleven patients were randomized to thalidomide. Of these, eight (73%) had a complete response after four weeks of treatment. By contrast, only three of 13 patients who received placebo (23%) were judged to have had a complete response at the same point. Quality-of-life questionnaires revealed similar differences, with thalidomide recipients reporting greater improvements in symptoms such as pain, trouble eating, and general health.
Furthermore, treated patients experienced an average weight gain of 1.0 kg over the four weeks of the study, compared with an average loss of 1.8 kg in the placebo group. Paradoxically, tumor necrosis factor alpha (TNF-a), TNF receptors, and HIV RNA all increased over baseline values in patients who received thalidomide rather than placebo. None of the differences in these markers were deemed to be significant, however.
Not surprisingly, thalidomide recipients suffered more adverse effects, and five patients required dose reduction or cessation due to toxicity. Three patients developed new peripheral sensory neuropathy or noted a worsening of extant neuropathy. Four patients experienced somnolence, which was not unexpected given that thalidomide was originally developed as a tranquilizer. Additionally, two patients developed rash. No clinically significant neutropenia was seen.
As part of the baseline workup, all lesions were tested for CMV, which was part of the exclusion criteria. Three subjects who tested negative for CMV at entry were diagnosed with cytomegalovirus infection on subsequent biopsy. One of them had been assigned to thalidomide and had not responded to treatment. The other two had been assigned to placebo. All analyses were performed on an intent-to-treat basis.
Jacobson JM, Spritzler J, Fox L, Fahey JL, Jackson JB, Chernoff M, et al. Thalidomide for the treatment of esophageal aphthous ulcers in patients with human immunodeficiency virus infection. J Infect Dis 1999; 180: 61-67.
Dr. Marc K. Hellerstein, the author of "Update: Treatment of HIV-Associated Body-Composition Abnormalities" in this issue, comments:
This group has previously published data showing that thalidomide helps heal oral ulcers (see "Thalidomide returns," AIDS Care, Vol. 1, No. 4). Here, they augment the evidence that thalidomide is an effective drug for aphthous ulcers of the mouth and esophagus. This is welcome news for providers who treat HIV-infected patients afflicted with these painful lesions -- which can profoundly compromise patients' quality of life, make eating difficult, and thereby contribute to weight loss. Treating aphthous ulcers in these patients should be part of an integrated overall program to combat wasting syndrome in patients with advanced HIV disease.
Local plus systemic ganciclovir provides potent protection against new lesions
HIV Newsline has covered the treatment of cytomegalovirus infection since our inaugural issue. That issue included a lead article on prophylaxis against CMV retinitis; two Newsline reports on what were then brand-new treatments for this AIDS-related OI, oral ganciclovir and intraocular implants; and a color insert, "CMV Retinitis as Seen Through the Ophthalmoscope," a pull out and save feature designed to help clinicians recognize what was, at the time, the most common viral pathogen seen in patients with advanced HIV infection.
Over the past five years we have provided our readers with frequent updates on the treatment of CMV infection: "Intravitreal cidofovir arrests progression of CMV retinitis" (Vol. 1, No. 3), "F.D.A. approves new and more convenient treatment for CMV retinitis" (Vol. 2, No. 2), "Combination of ganciclovir and foscarnet better than monotherapy for retinitis" (Vol. 2, No. 2), "Update: CMV prophylaxis with oral ganciclovir" (Vol. 2, No. 3), "Cidofovir for CMV retinitis: Therapeutic option for patients who develop resistance to ganciclovir" (Vol. 3, No. 2), "Improved Treatment of CMV Retinitis" (Vol. 4, No. 1), "Withdrawing secondary CMV prophylaxis" (Vol. 4, No. 4), "Better treatment for CMV retinitis: An Update" (Vol. 4, No. 4), and, most recently, "Secondary prophylaxis for CMV retinitis: When is it safe to discontinue maintenance therapy?" (Vol. 5, No. 3). All of these feature articles and news items can be accessed at our Web site, hivnewsline.com.
The widespread use of multidrug antiretroviral therapy has put a palpable dent in the number of new cases of CMV infection, but this once-common OI has not gone away. There are anecdotal reports of patients who have experienced breakthrough infections despite significant immunologic rebound on combination therapy, so it is imperative that care providers perform periodic fundoscopic examination on patients who had low nadir CD4 counts, even those whose counts are now well above 200 cells/mm3.
Ganciclovir, the first-line drug for CMV retinitis, has been available in three forms for some time: intravenous, oral, and as intravitreal inserts. Martin et al. constructed a novel study comparing these different modalities alone or in combination. They enrolled patients who had newly diagnosed CMV retinitis in one eye only and had received no more than six months of prior antiretroviral treatment.
The primary endpoints of the study were development of disease in the contralateral eye or extraocular manifestations of CMV. A total of 337 patients were entered in the study and randomized to one of three arms:
Patients were followed for one year or until an endpoint was reached, and fundoscopic photographs were taken at each visit. Regimens B and C both proved superior to GCV implants alone in preventing new CMV lesions at six months. The incidence of new CMV disease among patients in arm A was 44.3% halfway through the study, compared with 24.3% and 19.6%, respectively, among patients in arms B and C.
GCV implants also proved to be superior to intravenous therapy in preventing progression of existing lesions (Figure). After 66 days of treatment, half of the patients receiving IV GCV had experienced progression. The median time to progression -- that is, the time by which half of all patients in a given treatment arm had experienced progression of existing lesions -- was never reached among those using implants. Twenty-five percent of those randomized to arm A had experienced progression by 180 days; the comparable figure for arm B was 267 days.
While oral GCV plus implants had the edge in terms of efficacy, there was a statistically higher percentage of patients who developed severe neutropenia among those receiving oral GCV plus an implant. Another significant finding of this study was that the incidence of Kaposi's Sarcoma was lower among patients who received systemic GCV, either orally or intravenously. GCV has demonstrated in vitro activity against human herpes virus type 8, the presumed etiologic agent of KS, which may explain this finding.
Martin DF, Baruch DK, Wolitz RA, Palestine AG, Li H, Robinson CA, et al. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. New Engl J Med 1999;340 (14): 1063-70.
Dr. William G. Powderly, a member of the editorial advisory board of HIV Newsline and the author of "Prophylaxis of OIs in the Age of Protease Inhibitors -- An Update" (Vol. 4, No. 5), comments:
Although the advent of maximally suppressive antiretroviral therapy has resulted in a dramatic decrease in major opportunistic infections like CMV, we still see isolated cases of CMV retinitis -- some of them in patients whose CD4 counts have rebounded well above the theoretical threshold for breakthrough infections. And the grim but inescapable truth is that we will begin to see more and more cases of CMV and other OIs as treatment veterans with few remaining options begin to develop resistance to the regimens they are now on. These individuals will need aggressive treatment when they develop CMV, to prevent the ravages of end-organ retinal disease, and Martin et al. have demonstrated that the combination of local and high-dose systemic anti-CMV treatment is potent protection against new CMV lesions.
They have also shown that this combination is superior to IV GCV in preventing progression of CMV retinitis -- a particularly important finding given how cumbersome, unpleasant, and activity-limiting intravenous therapy can be.
It is worth noting, however, that the progression rate with either therapy was remarkably low when patients also received effective multidrug antiretroviral therapy. This suggests two things: 1) that it may be possible to get away with relatively short courses of IV treatment for CMV retinitis in patients whose HIV RNA levels are suppressed to undetectable levels by combination therapy; and 2) that maximally suppressive antiretroviral therapy should be the standard of care in the management of any opportunistic infection.
More evidence that immunologic rebound confers protection against pneumocystis in patients who respond well to maximally suppressive anti-retroviral therapy
In the early, chaotic, catastrophic days of the HIV epidemic, the first ray of hope came with the discovery that PCP could be prevented in susceptible persons with trimethoprim-sulfamethoxazole -- and this prophylaxis regimen became one of the first paradigms in the treatment of people with AIDS. The only controversial aspect of PCP prophylaxis over the years was which drug to use (see "Does PCP Prophylaxis Improve Survival in Patients with HIV Infection?" in Vol. 2, No. 1).
With the advent of maximally suppressive antiretroviral therapy, achieved with drug combinations that usually included two nucleoside analogs and at least one protease inhibitor or one of the potent new NNRTIs, immune reconstitution became possible -- and, with it, the prospect of stopping prophylaxis against the most common HIV-associated OIs. It was only a matter of time before physicians and their better-informed patients began to question the need to continue PCP prophylaxis.
Dr. William G. Powderly, a member of the editorial advisory board of HIV Newsline, has been asking -- and attempting to answer -- that very question in the pages of this publication since June of 1996, when we published his first editorial on the subject, "Prophylaxis of OIs in the Age of Protease Inhibitors" (Vol. 2, No. 3). This same clinical question has been addressed by Dr. Hansjakob Furrer and the Swiss HIV Cohort Study. Their large-scale study included approximately 70% of all patients in Switzerland with advanced HIV disease. From that study population the researchers enrolled 262 patients on combination antiretroviral therapy (which included at least one protease inhibitor for 88% of the subjects). All of the participants had experienced an increase in their CD4 absolute counts to at least 200 cells/mm3 as a result of therapy (or had registered an increase in their CD4 percent to at least 14%). These values had to have been sustained for at least 12 weeks before the patients were eligible for enrollment. The prior median nadir CD4 count for the group was 110 cells/mm3.
None of the participants had suffered a prior episode of PCP. Most (85.5%) had been on TMP/SMX for a median time of 24 months. Over the course of about one year, during which participants stopped taking TMP/SMX, not a single case of PCP occurred in any of the participants.
As a secondary end-point, investigators also monitored the incidence of toxoplasmosis, as TMP/SMX also provides protection against this infection. No cases of toxoplasmosis were observed during the follow-up period, even though 46.2% of the study subjects had positive IgG titers for Toxoplasma gondii. Nine patients resumed PCP prophylaxis during the observation period because their counts fell to a level that put them at theoretical risk for PCP. Their data were censored from the final analysis.
Furrer J, Egger M, Opravil M, Bernasconi E, Hirschel B, Battegay M, et al. Discontinuation of primary prophylaxis against Pneumocystis carinii pneumonia in HIV-1-infected adults treated with combination antiretroviral therapy. New Engl J Med 1999; 340: 1301-6.
Dr. William G. Powderly, a member of the editorial advisory board of HIV Newsline and the author of "Prophylaxis of OIs in the Age of Protease Inhibitors -- An Update" (Vol. 4, No. 5), comments:
We know that maximally suppressive antiretroviral therapy leads to significant increases in CD4 count in most treated patients. What we do not know, with the same certainty, is how effective these "recovered" lymphocytes are against serious opportunistic infections like P. carinii pneumonia. The data collected by Furrer et al. indicate that combination antiretroviral therapy not only increases CD4 counts but produces a degree of immune reconstitution sufficient to prevent PCP and toxoplasmosis in patients who respond well to multidrug therapy. This observation is supported by recent cohort studies that reached very similar conclusions (1, 2).
These findings are in concordance with the observation that patients on combination antiretroviral therapy have fewer opportunistic infections than would be expected in a similar cohort of HIV-infected patients not taking the new, powerful anti-HIV medications. On the other hand, in vitro studies show that, at least initially, the vast majority of the new CD4 cells generated in patients on multidrug therapy are so-called memory cells, not pluripotent naïve T cells. Naïve cells do begin to appear after three to four months of therapy, however, so while there may be limitations to the protection one can expect from such therapy-induced immune reconstitution, the degree of protection does improve over time.
In the Swiss HIV Cohort Study, a sustained increase in absolute CD4 count (or an increase in the percent of CD4 cells) provided as much primary protection against PCP as TMP/SMX would have, for the year of the study. We do not yet know how durable this protection will prove to be; that answer awaits further data from the Swiss group. But the findings of this study do provide evidence that some degree of immunocompetence is restored in patients who see their CD4 levels rebound on combination antiretroviral therapy. Indeed, this and similar reports have led the U.S. Public Health Service to change its recommendations regarding PCP prophylaxis. Those guidelines now suggest that primary prophylaxis can be discontinued in patients who evidence sustained rises in CD4 counts as a result of maximally suppressive antiretroviral therapy (3).
This revision of the U.S.P.H.S. guidelines is by no means the final answer to this vexing question, however. There are isolated anecdotal reports that pneumocystis is being seen in patients who stop PCP prophylaxis when their CD4 counts rebound, and because primary prophylaxis against PCP is inexpensive, effective, and uncomplicated, clinicians should give careful consideration to terminating this therapy in patients whose nadir CD4 counts were below 50, irrespective of how high they have rebounded.
Nonetheless, the findings of Furrer and his colleagues should provide significant encouragement to patients with advanced HIV disease who have responded well to maximally suppressive antiretroviral therapy. Immunocompetence may not be as complete in these individuals as their most recent CD4 counts would indicate, but that does not mean that significant and sufficient immune reconstitution has not occurred.
U.S. Bioscience Inc. recently announced that it had suspended a Phase 2 study of the company's antiretroviral agent, lodenosine, after one patient in the study died and several others showed signs of possible liver and kidney damage. A separate Phase 1 study of the drug, involving about 60 patients and being conducted by the National Cancer Institute, has also been suspended pending review of all trial data. The placebo-controlled U.S. Bioscience trial, which involved 176 patients at 27 clinical centers, was studying three different dosages of lodenosine, a nucleoside analog, in combination with two additional antiretroviral agents. Effective immediately, all patients have been taken off lodenosine, and they are being closely monitored for signs of hepatic or renal damage.
Back to the October 1999 HIV Newsline contents page.
This article was provided by San Francisco General Hospital. It is a part of the publication HIV Newsline.


text:
Sunday, March 25, 2012
72 comments:
- martinealison said...
J'aperçois un éléphant !! Est-ce que je me "trompe" !!!
Une oeuvre remplie d'intérêt et je retournerai l'admirer après avoir laissé mon commentaire...
Du mouvement et de la magie...
Gros bisous
- March 25, 2012 at 9:10 AM
- Ces said...
- March 25, 2012 at 9:11 AM
- Ces said...
I shall return after I recover from awe...
- March 25, 2012 at 9:12 AM
- rachel awes said...
the layers of what you know + how you show us sends my heart into delightlands. lovelovelove xoxox
- March 25, 2012 at 9:28 AM
- Funaek said...
I love the juxtaposition of these two worlds - I want to see more of the shadow world!
- March 25, 2012 at 9:52 AM
- Kathi said...
A poodle doodle! Love it! :D
- March 25, 2012 at 10:13 AM
- Ces said...
Your illustration is just awesome but your words are even more tantalizing! Hehehehe.
- March 25, 2012 at 10:17 AM
- Sophia said...
Bella, I love it. And I really like how you created the leaves on your trees. Brilliant! :)
- March 25, 2012 at 10:29 AM
- Shirley said...
Brilliant, brilliant, brilliant, my dear Bella!!! Wow! I am blown away..this is marvelous..in concept, in execution. Your work just keeps astonishing me..from such a lovely heart comes images that brings joy to all of us and make us all want to live in that fine space..how do you do it?! I LOVE the little tiny monkey shadow. : )
- March 25, 2012 at 11:47 AM
- Indigene said...
Now this is a shadow land filled with endless possibilities! Love it!
- March 25, 2012 at 1:48 PM
- encaracolada said...
- This comment has been removed by the author.
- March 25, 2012 at 1:56 PM
- Draffin Bears said...
Hi Bella,
Beautiful work, love everything about this fabulous piece.
I will say it again, you are so talented. Love the little French poodle.
Have a happy week ahead
- March 25, 2012 at 2:51 PM
- Janine said...
That is a great idea, to give the shadows an own life.
It´s great what you made in the shade ;0)
Have a great week
- March 25, 2012 at 3:40 PM
paint me into the shadows
And let me see the shades of grey...
- March 25, 2012 at 7:23 PM
- fizzyjinks said...
this is just wonderful!! What a fantastic illustration :)
- March 26, 2012 at 1:04 AM
- Nicky Linzey said...
WOWWWW - I love your imagination Bella!
- March 26, 2012 at 3:16 AM
- Linda Hensley said...
This is wonderful! So imaginative, and so pretty too!
- March 26, 2012 at 6:25 AM
- brandi said...
~do you think you could plant me some eye candy dandy trees in my yard...i would be sitting in the shade day after day...these is beautifully sweet...be well and much love light and blessings~
- March 26, 2012 at 8:27 AM
- Amalia K said...
Awesome, awesome, AWESOME!!
Oh, this is too much. I think I shall go and lie down for a while now....
- March 26, 2012 at 10:16 AM
- Xovika said...
I love it's background colors and candy shadows.,
- March 26, 2012 at 12:41 PM
- Tammie Lee said...
oh my my
you are so fun
and cleaver
and i love
yep LOVE this piece!
- March 26, 2012 at 1:37 PM
- k.h.whitaker said...
oooooooh, Bella I love this! What a cool idea. All the extra shadow elements are awesome. The trees are pretty wonderful too. :)
- March 26, 2012 at 3:37 PM
- laughingwolf said...
wowsers! :)
- March 26, 2012 at 6:00 PM
- tera said...
I LOVE LOVE LOVE this! :) I think it's my new favorite....
- March 26, 2012 at 6:32 PM
- Michaele Razi said...
So gorgeous and fun!
- March 26, 2012 at 6:43 PM
- Eric Barclay said...
I love it.
- March 27, 2012 at 4:17 AM
- yoborobo said...
You are some kind of genius. I'll meet you in the shadows! :)
- March 27, 2012 at 6:28 AM
- Ces Adorio said...
Yes! You are the sharpest knife in the drawer! :)
- March 27, 2012 at 6:58 AM
- Rabbit Town Animator said...
I LOVE THIS!!!! The shadows, the colours...the theme! Love!
- March 27, 2012 at 7:10 AM
- Cindy D. said...
Beautiful, lovely and amazing trees. I would like to plant them all right outside my window! I love the haughty attitude of the woman and poodle.
And just wow with those circus shadows. So great! I love it!
- March 27, 2012 at 3:16 PM
- Carrie said...
I ADORE THIS PICTURE! You totally ROCK! xxx
- March 27, 2012 at 3:24 PM
- Andrea said...
Love the shadow world! I wonder what fun alternate universe exists when I walk out in the sunshine! The trees are adorable!
- March 27, 2012 at 6:53 PM
- Steve E said...
Bella, I am expert on candy, -eye or otherwise (HERSHEY BARS!). But as for shady stuff-- "only the SHADOW knows!"
Ya know i like this art piece even before it was a drawing. Precisely, when it was yet in the mind of its Creator, Bella! For THAT is the part of you which God made like Herself/Himself!
And He gifted you so well!!
- March 27, 2012 at 8:15 PM
- yoon see said...
Lovely as always but this creation is superb! Your interpretation of such is top north and heart engaging!
The beauty of a land is made more beautiful with the interplay of light & shadow.
Glad that you have such visual ability to transforming it into the image here.
Brilliant and loving it, loving it!
I feel the double happiness is on now, do you feel it too Bella?
- March 27, 2012 at 9:04 PM
- Ben Clanton said...
Awesome! and really captivating.
- March 28, 2012 at 8:20 AM
- Cindy said...
this one has a different look from your other work - i love it!
- March 28, 2012 at 11:02 AM
- theartofpuro said...
It's magical:)The idea is fantastic and the style so beautiful:)
- March 28, 2012 at 1:11 PM
- Andrew Finnie said...
Bella! Well you are showing us the outer and the inner, the icing and the cake, the meringue and the cream...so it's true you are really an advertising physiological diligent Dillinger dillitente (diligent and Dillinger came up when I tried to spell dilitent :) )
Hey, well this marks something in your work, it's scary eh? Those deep recesses of where you are a little girl locked away inside - I know how you feel, quite often I wake up in the night screaming, let me out, let me out aaarghh .
Of course I studied poetry long enough to realise that is a persona you are portraying...
Okay, enough rambling.
Bella, this is beautiful and thought provoking and also just the right amount of sadness and joy - it's like when you make sweet and sour apricot curry - but there's nothing curry or sour or even aprocity in this at all :)
see you
as you can see I am practicing my typing :)
- March 28, 2012 at 4:42 PM
- Andrew Finnie said...
Oh, if you are wondering - I like this a lot.
- March 28, 2012 at 4:43 PM
- Silke said...
Fun, fun, fun! And so clever, but then I'd expect nothing less from you! Your art so often reflects your amazing sense of humor... I hoe you are doing well!! Hugs, Silke
- March 29, 2012 at 2:07 AM
I just love the lady and the dog! If one day I´ll have a dog again, that´s the one by the way. I like the different "hairstyles" you can make and I think this one looks very elegant! :-)
- March 29, 2012 at 9:19 AM
- Amy C said...
so lovely Bella, I'm off to shadowland for tons of fun - I rather like the looks of those strong weightlifting bunnies!!
- March 29, 2012 at 11:57 AM
- Ann Pilicer said...
love this! amazing worlds you create! I will never get tired of popping in to see what you are up to! always can make me smile.....:)
- March 29, 2012 at 2:59 PM
- Jack Foster said...
To quote Ces... "Oh my gosh!" ... I mean "OH MY GOSH!" This really ticked my delight bone (which is right next my funny bone) Made in the shade :o)
- March 29, 2012 at 5:46 PM
- Vicki Smith said...
I love images of women walking their dogs. Don't know quite what there is about it. Nice lights and darks!
- March 30, 2012 at 7:39 AM
- Andrew Finnie said...
Heh thank you for the poem :) I took your advice I went for a surf :) Then I came home and taught my computer Speech Recognition. This is what it came up with :)
Little rate had hoped her AT THE had heard be that the boys would be happier hugging the rapper expressly, words as a Sunday, nights she was certain that several of them in the imagery then issued a statement that all was not well back from, disturbs for this callers, this was my first goal is speech recognition Mr. Thank you I intellectual are I intellectual are very much well
Obviously speech r ecognition has come a long way :) :)
- March 30, 2012 at 11:00 PM
- Faruffa said...
wonderful wondeful Bella, it's magic!
- March 31, 2012 at 4:32 AM
- Elizabeth Rose Stanton said...
Definitely a TREAT for the eye!!
- March 31, 2012 at 9:36 AM
- Lori ann said...
where have i been? ooh gee whiz bella, miss master of imagination. you have topped yourself with this one. and i do love reading all your delightful comments too. your the best! xoxo lori
- March 31, 2012 at 5:38 PM
- Ted Blackman said...
Yes but, what about shadow people? They gotta be all over Shadowland. Doesn't that creep you out?
The giant ornament trees are in full bloom, that's a good sign, and comforting. I like that proud poodle, too. No fear in Shadowland! Yeah, I'd go there for a visit.
- April 1, 2012 at 1:38 PM
- ❦TattingChic said...
EYE WOW is HEART POW
but gut pow can make you barf
okay not quite the same effect but your stuff is amazing.
Thank you for stopping by my blog to say hello hello hello you wonderful bloggy friend you!
~TattingChic ♥
- April 1, 2012 at 4:47 PM
- kj said...
Bella, I don't think anyone's mentioned the amazing shadows and activity when this is turned upside down, which is a triple clever accomplishment. Just fantastic xoxo
- April 1, 2012 at 9:12 PM
- Barbara said...
Now that is one amazing drawing, Bella! Shadow worlds hold all sorts of secrets.
- April 2, 2012 at 4:14 AM
- Deepa Gopal Sunil said...
This is extremely brilliant, Bella dear!!!! I am in AWE!!!! I have never seen so many shades in one pic... there appears to so many layers of it...
And the colours are so brilliant as well...I love almost every shade of the elephant...the jelly balloons, the bubbles turning into fish (are they like it or just my imagination!!!)...JUST WOW!!!
Adore you Bella:))))))))))))))
- April 2, 2012 at 8:03 AM
- Deepa Gopal Sunil said...
Hey KJ has mentioned what I just did, the first thing on seeing your illo...I was reading what others felt about this illo and I am glad that some have done that as well:)))
You are BRILLIANT!!!!!!!!!!
I am feeling really short of words... happens everytime I am here:)
- April 2, 2012 at 8:06 AM
- Deepa Gopal Sunil said...
O forgot to mention the quote goes superbly well with it:)))))
- April 2, 2012 at 8:08 AM
- Perrine Renoir said...
this is playful hope you don't mind me following you
- April 2, 2012 at 11:39 PM
- Andrew Finnie said...
ahh Brown Eyes? So many songs about Brown eyes, even by Frank Sinatra - I think he was jealous.
How was the sun? :)
Ahh imagine lasering off iritic pigment! I wonder if it would cause closed angle galucoma? (The pigment blocks off the drainage and the intra ocular pressure builds up)
You know, having blue eyes is like going bald. People always walk upto balding men and say "Hey Frank! You are losing your hair!" And poor old Frank thinks - 'yeah, I know, why do people keep telling me?"
Not hat I am losing my hair - just my marbles ... :)
- April 3, 2012 at 2:48 AM
- Valerie Lorimer said...
This is so incredibly wonderful, Bella! I adore everything about it. Great atmosphere and a hint of mystery too. Love it.
- April 3, 2012 at 9:52 AM
- Shirley said...
Hi dear Bella! Thank you for your sweet visit..I've been terrible at catching up with everyone. I hope your world is full of thin mints, and dark chocolate easter eggs..oh, maybe that's too much sugar. Let's see..throw in some fresh-outta-the-garden veggies and some crusty sourdough, then the chocolates and cookies. : ) Keeping busy here...working on a painting that is up to 29 characters now. Sheesh! My hand is cramping!! Have a great week, Bella..and hope you and your little ones are enjoying the spring!
- April 3, 2012 at 12:46 PM
- Tammie Lee said...
hello Bella,
revisiting this piece
again loving your creative imagination!
thinking i want to also see this piece upside down
i wonder if our shadows have a life of their own;-) and we are their shadows.....
- April 3, 2012 at 7:30 PM
- Claudio Cerri said...
Hi bella!! This illustration is really great! I love your colors palette!
- April 4, 2012 at 12:57 AM
- AtelierBrigitte said...
- April 5, 2012 at 11:55 AM
- Megan Coyle said...
I LOVE this :) what a fantastic idea. It blows my mind how you manage to come up with these clever illustrations. so good!
- April 5, 2012 at 4:38 PM
- Rubin Pingk said...
This is simply perfect. The end.
- April 7, 2012 at 6:46 PM
- Kathie Brown said...
So imaginative! It made me smile!
- April 7, 2012 at 10:11 PM
- Mauricio said...
This is beautiful work, Bella! Glad I found your blog - Cheers!
- April 9, 2012 at 12:31 AM
- Amanda Dilworth said...
What a brilliant idea and illustration. Love it!
- April 12, 2012 at 8:55 AM
- Anne said...
Whimsical and ingenious! <3
- April 16, 2012 at 10:40 PM
- otto björnik said...
So this is how you and Oz look like while taking a walk in the morning!haha
- April 18, 2012 at 5:59 AM
- laughingwolf said...
oh, man! that's just so fine :)
sorry i've not been around; some weeks ago, while deleting 'dead' contacts from my pals+ list, somehow i deleted the whole list in my sidebar... of course, that was also my set of links
today, i thought i'd try to see if i could find you in my 'to' line, and there you were, luckily i had not purged my history...
- April 18, 2012 at 4:50 PM
- Owl Eng said...
Wow Wow Wow
so unique and cool. it draws me go inside it
- May 2, 2012 at 7:47 AM

subset: commoncrawl


text:
CHARLESTON — The Spoleto Festival USA opens its 35th season this week paying homage to festival founder Gian Carlo Menotti on the 100th anniversary of the composer's birth.
One of three operas during the new season is Menotti's "The Medium." It will be the first time the festival has staged a Menotti opera since the composer left 18 years ago in a dispute over his successor. He died in 2007 at age 95, still estranged from the festival he founded here.
"It seemed if not now, then when? It seemed appropriate," said festival General Director Nigel Redden.
"It would be disingenuous of me to say I didn't have mixed feelings," added Redden, who left the festival, along with some board members, after a 1991 dispute with Menotti. Redden was brought back to Spoleto after Menotti left.
Menotti started the Charleston festival in 1977 as a companion to the arts festival he started in Spoleto, Italy, almost two decades earlier.
"There were times when I didn't get on with Gian Carlo but there were a lot of times when I did. Gian Carlo changed my life and he changed the lives of others," said Redden, who has a portrait of the composer in his office in the 18th Century building that houses the Spoleto headquarters.
Menotti also changed Charleston. The festival sparked a rebirth of the arts in the city at the same time the downtown area underwent a renaissance. A quiet street near the Spoleto headquarters is now named for the composer.
"He was an extraordinary impresario," Redden said. "He was the most charming man you could find and he also could be difficult. He was a larger than life character."
This year's festival opens Friday with the traditional brass fanfare and speeches on the steps of Charleston City Hall.
It continues through June 12 with a program including the American premiere of Kaija Saariaho's opera "Emilie" as well as a production of Wolfgang Amadeus Mozart's opera "The Magic Flute," conducted by Spoleto's former music director Steven Sloane.
Among other events, Spoleto includes the Australian circus "Circa" with its dancing, acrobatics and cheeky humor. Dean Wareham and Britta Phillips blend indie-pop music with large video projections of Andy Warhol's silent-film portraits in "13 Most Beautiful... Songs for Andy Warhol's Screen Tests."
Although commemorations marking the 150th anniversary of the start of the Civil War were held in Charleston last month, there are no Spoleto performances noting the war.
"Because so much was going to be focused in April it seemed that we were going to be an afterthought by the time May rolled around," Redden said. He added that the festival is thinking about events in 2015 to mark the anniversary of the end of the war and the reunification of the nation.
It's also an important year for the festival because a planned $142 million makeover of the city's Gaillard Municipal Auditorium is expected to be finished. The venue is used yearly by Spoleto.


text:
March 6, 2006
The Wabash College Glee Club kicked off its spring tour by combining voices with the legendary Morehouse College Glee Club Saturday night in Indianapolis.
It marked the first time since 1977 that singers from two of the three remaining all-male colleges had joined voices in song. Both colleges are on spring break and are on tour; the Wabash Glee Club will spend the rest of spring break traveling the midwest. The Morehouse men departed Indianapolis for a concert in Cincinnati.
Saturday night's performance at the North United Methodist Church featured many of the tunes the Wabash Glee Club will sing when it tours the British Isles this summer. The Morehouse Glee Club sang a wide range of music, from traditional to authentic African music, complete with instrumentalists.
The highlight of the evening came when the two glee clubs sang their schools' alma maters, inviting alumni from Wabash and Morehouse to join in song. A tradition at Morehouse is to lock arms while singing the alma mater and, of course, Wabash men joined in the celebration.
Check out photos from the event:
Photo Album One
Photo Album Two


text:
MISENHEIMER, N.C. - In her final collegiate home game, Sarah Hebberd notched a game-high five goals to lead 15th-ranked Pfeiffer University to a 16-11 Conference Carolinas women's lacrosse victory over Queens on Saturday afternoon. The win gives Pfeiffer the #2 seed in next week's tournament improving to 10-5 overall, 5-1 in league play. The Royals who host next week's post-season event drops to 8-7, 4-2.
Both teams went back-and-forth early in the first half until the Lady Falcons registered the final seven goals to create the game's separation. Liz Melesh and Jessica Moulton put Pfeiffer up 2-0 in the first 8:10 of the contest until Queens responded with a tally from Brittany Philip at 21:11. After Hebberd hit on her first of the day just after Natalie Marvin, the Royals would again stop the run with goals from Shannon Casey and Arika Zimmerman for a 4-3 Pfeiffer lead.
From there, Pfeiffer would close out the half on their 7-0 starting with two more from Hebberd. Hebberd would add one more in the stretch while Moulton would assist on two of the three for an 11-3 lead at the break.
After a free position goal by the Lady Falcons' Alex Cook at 16:43 of the second, Queens would rattle off the next three for a 14-6 contest. Marvin would stop the first stretch by the Royals at 7:36 while Zimmerman and Kristi Kemp finished off another three-goal streak with 2:12 to play in a 15-9 game. Despite a pair of Amanda Martin goals in the final 71 seconds, Hebberd would help the Lady Falcons move on to their five goal win to clinch the tournament's number two seed.
Queens held the shots advantage 33-30 and draw controls 15-14. Pfeiffer led 33-31 in groundballs and 11-9 in caused turnovers. Kaitlin Booth made 13 saves in net for the Lady Falcons while Chelsea Lancashire made nine for the Royals.
Pfeiffer will wrap up its 2011 regular season on Tuesday with the conference finale at Erskine beginning at 3:00 p.m.


text:
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Sabre is available in these colors:
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Exposing 5 Energy Related Myths
Myth #1, It is OK to allow governments and environmentalists to restrict clean energy development.
Excess CO2 causes changing climate and ocean acidification. Fossil fuels are being burned at ever faster rates because developing countries are rapidly developing their infrastructure. Fossil fuels cause pollution and adverse health effects and tar sands are converting forests into wastelands. Fossil fuels will not last very long. Therefore, in order to DEAL with these problems, we need a VAST supply of clean energy! We can NOT allow any organization to impose laws that restrict the ability for any clean energy development. Future prosperity depends on cheap clean energy.
Myth #2, Solar and wind can do it all at this time.
Solar and wind can NOT power "everything", however, they can power a lot. Solar and wind could supply up to 20% of global power needs, right now, if machine mass produced for cheap. After that, very affordable and efficient energy storage will be needed. Machine automation is a must for inexpensive electric car batteries, as well. Nevertheless, we MUST promote machine made solar and wind because they have AWESOME potential and are almost cheap enough (already) to not need subsidies. Thousands of square miles of solar and millions of wind turbines are little detriment compared to fossil fueled depletion into an over heated biosphere. We will, however, need a more powerful baseload source of clean energy to provide for the needs of a growing planetary civilization.
Myth #3, Conservation and efficiency will solve all the problems.
Efficiency and conservation (demand side) can reduce up to 50% of global power needs, however, the developing world will still need about FIVE TIMES what the West consumes now. Thus efficiency and conservation, although necessary, can NOT prevent depletion in a fossil fueled world. We MUST promote efficiency and conservation but NOT at the expense of clean energy development!
Myth #4, Nuclear can not safely power the world.
Nuclear energy, despite being generated in the old fashioned, inefficient and inherently dangerous water reactors, have the best safety record by far over each of: coal, oil, natural gas and hydroelectric. Even though, there are better ways to split the atom. The Molten Salt Reactor (and other closed cycles) have already been proven to the demonstration level decades ago. Closed cycle molten salt reactors are inherently melt down proof. Now, MSR's (or better alternative) MUST be re-developed and produced by the thousands in a factory setting. Wastes from the closed cycle constitute just 1% of that from today's water reactors and decay back down to natural levels in about 300 years, and thus must be isolated for only about 1/1,000ths of the time required by today's "spent fuel". Fast reactors and MSR's fission their fuel on the order of 100 times more efficiently than today's water reactors! Also, liquid fuels can be synthesized from water and air by the high process heat of the MSR.
A world devoid of abundant clean energy is a world at war.
Humanity in depletion mode will be FAR more detrimental to the environment than lots of wind, solar, batteries and nuclear. Thus any organization or government that seeks to limit clean energy development is against humanity AND the environment!
Promote machine mass produced wind, solar and electric vehicles.
Promote factory produced closed cycle molten salt reactors.
Don't just kill a watt – Megawatt !
Awareness is essential – please copy and distribute.


text:
lol...was just in my work breakroom and i was reading SI. The Oct 20th issue had Ty Conkin (Red Wings G) and Rob Scuderi (Penguins D) in the "Pop Culture Grid".
How do sports stars fit in?
My Advice To Wall Street:
Scuderi: "Get something right"
Conklin: "Stop losing me money"
Favorite thing to drink at night:
Scuderi: "Crystal light"
Conklin: "I should probably say water"
_ _ _ _ _ just cracks me up:
Scuderi: "The guys"
Conklin: "Teammate Chris Osgood"
Favorite piece of clothing
Scuderi: "My Converse sneakers"
Conklin: "My Carhartt pants"
Three people I'd love to have over for dinner:
Scuderi: "Mickey Mantle, Denis Potvin, Byran Trottier"
Conklin: "Tiger Woods, Napolean, Martin Luther King"
I don't think this was posted before...but whatever.


text:
Blakelock accused's 'chop him' rap – Beverley Guardian
Blakelock accused's 'chop him' rap
A man accused of stabbing Pc Keith Blakelock during the 1985 Tottenham riots wrote a rap, saying we chop him all over, his murder trial has heard.
A prison officer found the poem while searching Nicky Jacobs's cell at a youth custody centre in 1988.
Jacobs, who was 16 at the time of the attack, had been serving a sentence for affray following the riots on October 6, 1985.
The hand-written poem was read out on the second day of the trial by prosecutor Richard Whittam.
It stated: As long as I live I remember it was 1985 the 6th October.
Me have de chopper we have intention to kill an police officer Pc Blakelock de unlucky f***er him dis an help de fireman.
Who did an out an fire de fireman see we av come and decide to scatter but Pc Blakelock him never smell the danger but when we fly down upon him he start scream and holla everybody gather round and av pure laughter he try to head out but we trip him over he start beg for mercy bit it didn't matter him try to play super man.
We chopper we start chop him on his hand we chop him on him finger we chop him on him leg we chop him on his shoulder him head him chest him neck we chop him all over when we done kill him off lord er feel much better.
Mr Whittam also described to the Old Bailey statements from key witnesses to the attack.
Jacobs denies murder.
Pc Blakelock's widow, Elizabeth, was in the courtroom to hear harrowing evidence about the horrific wounds he suffered during the attack.
The jury was shown police photographs taken during the riots, some featuring Jacobs, who is now 45, on the Broadwater Farm estate.
The jury was also shown pictures of Pc Blakelock's injuries, and the knife which lodged in the officer's neck up to the hilt.
Mr Whittam said a number of different weapons were used, including single and double-bladed knives.
The most devastating wound was to the side of his face, caused by a machete or an axe, the court was told.
Jacobs was first arrested by officers investigating the riots on October 11 1985, five days after the disturbances took place, the court heard.
He claimed that he had been at home when Pc Blakelock was attacked and had only watched the rioting, but was convicted of affray in November 1986.
One witness at that trial, who was himself convicted for his part in the riots and admitted kicking Pc Blakelock, told police that he had seen Jacobs at the scene and then talked to him days later.
Mr Whittam said the witness told police: I can't remember exactly what he said but it was obvious from what he was saying that he was involved in the murder of the policeman.
Speaking to a renewed investigation into the killing in 1993, the witness went further and described the defendant as a nutter who was out to get blood.
The witness, a former member of the Park Lane Boys gang, said he had seen Jacobs carrying a curved machete or scythe. The defendant had plunged the weapon crazily into Pc Blakelock's shoulders as the mob shouted Kill the beasty and Get his f****** head on a pole, the witness told officers.
Describing the murder he said: They all had weapons and were involved in killing him.
I know because I saw it with my own eyes. I have had to live with this for the past eight years, it's always on my mind.
The witness also claimed that the riots had been pre-planned and that the Park Lane Boys had stockpiled weapons and petrol bombs.
And he told police that he had nearly got killed last time for helping you lot during the original investigation.
A second witness, known in the trial as Rhodes Levin, told the renewed investigation in the early 1990s that he had seen Jacobs stabbing Pc Blakelock twice in the top half of his body with a fairly small knife.
Levin, a drug dealer with convictions for selling heroin and crack cocaine, also claimed that the defendant had patted Pc Blakelock's body down, looking for money or property.
When the pair were in Pentonville prison together in 1992, the witness claimed Jacobs told him: I got a good couple of stabs in on the officer.
Mr Whittam also told the jury of seven men and five women that when he was held by police in May 2000, Jacobs allegedly told the arresting officer: F*** off, I was one of them who killed Keith Blakelock.
It was only after Levin was given the promise of immunity that he admitted having kicked Pc Blakelock himself five or six times.
During a third investigation into the murder which began in 2000, police left a note for another key witness known as Q, a long-term heroin user who had been living on the Broadwater Farm estate at the time of the riots.
In a witness statement given to police in July 2009, Q said he had known Jacobs all his life and saw him with a mini-sword or machete type thing during the attack, the court heard.
Pc Blakelock was on his back, the witness told police.
I know this because his feet were pointing upwards.
I was about 15 feet to the left of his body at the time of the murder.
I saw Nicky Jacobs making repeated stabbing motions to the top half of Pc Blakelock's body.
The trial was adjourned until tomorrow.
Copyright (c) Press Association Ltd. 2014, All Rights Reserved.
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Chicago Symphony Orchestra conductor Riccardo Muti
Maestro Riccardo Muti was named the music director of the Chicago Symphony Orchestra in 2008, joining the symphony ahead of its 2010-'11 season. The Italian-born conductor had been the music director of the Philadelphia Orchestra and a guest conductor with the New York Philharmonic.
Copyright © 2019, Chicago Tribune


text:
Tuesday, July 24, 2012
Lime Crime Chinchilla Lipstick
I wanted to share this lipstick here. Lime Crime Controversy 2010 aside, (I wasn't even sure of the full deets until writing this review), I wanted this product for its uniqueness -- hello unicorns and purple packaging!--and quirky colors. When I heard about Chinchilla, I expected a concrete gray lippie. I tried it on and saw that it was tinged with purple/lavender and a bit more wearable than I expected... and I love it! (This lipstick tends to photograph this color, but is a bit darker in person.)
The formula is creamy enough to spread easily, but stiff enough to last on the lips. I don't use a liner when wearing this because I can pull of the color alone with no bleeding at the lip line! This is one of my favorite lipsticks, when I was a different lip color/ statement lip, without the shock value.
I have Cosmopop as well, but I haven't worn that yet. I'm thinking about it ;)
Do you own any Lime Crime lipsticks? Which is your favorite color?
Labels: lipstick, product review
2 comments:
- 1xellus1 said...
Beautiful pic!
- La said...
I swear you can do no wrong!!! This is amazing!
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California Department of Transportation
Date: October 11, 2013
District: 10 - Stockton
Contact: Angela DaPrato
Phone: (209) 948-7176
MERCED – Caltrans has completed a $35 million project on State Route 99 in Merced that replaced an outdated bridge with a modern structure while seismically retrofitting two more key bridges, making them more likely to withstand an earthquake.
The new West Merced Bridge on SR-99 over 16th Street is now better suited to take the daily pounding from heavy trucks loaded with agriculture that regularly cross it. On average, more than 50,000 vehicles traverse the bridge daily. To improve safety, Caltrans leveled off the incline of the new structure, giving motorists a better view of traffic incidents or slowdowns ahead.
Caltrans also seismically retrofitted two Bear Creek Bridges on SR-99 in Merced.
"This project is a great example of how federal dollars are being used to invest in critical transportation infrastructure," said Caltrans Director Malcolm Dougherty. "Caltrans would like to thank the city of Merced, Merced County, and the traveling public for their cooperation and patience during the construction of this project."
The project received $29 million in funding support from the Recovery Act. Since 2009, California has put about $2.5 billion in Recovery Act funds to work on nearly 1,000 highway, local street, and job training transportation projects statewide.
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Escape Engines
Ford Escape offers three engines: The 2.5L with independent variable cam design (iVCT). The available 1.5L EcoBoost® iVCT, the most fuel-efficient Escape engine.* And for more punch at the pedal, the available 2.0L EcoBoost with twin-scroll turbocharger. Both EcoBoost engines feature fuel-saving and emissions-conscious Auto Start-Stop Technology.
|Smarter Than Ever.
2017 Escape is smarter than ever. Available technology can alert you to unintentional lane drift, warn you of a vehicle in your blind spot, auto-maneuver you into (or out of) a tight parking spot, or open the available hands-free, foot-operated liftgate with just a gentle kick under the rear bumper. And the EcoBoost® engines feature Auto Start-Stop Technology to help save fuel when you're driving in the city.
|Our most powerful engine fits in the palm of your hand. Introducing FordPass.
FordPass™ is a one-stop shop that makes any journey better.163 2017 Escape equipped with optional SYNC® Connect allows you to check your fuel level or remotely unlock and start your vehicle. Schedule maintenance, request Roadside Assistance, locate your vehicle.166 And we're just getting started.
FordPass takes care of the details so you can just enjoy the drive. Learn more at FordPass.com or download it right now for iOS or Android™.
| SYNC® 3 with SYNC® Connect
SYNC® can keep you connected to your world with advanced communications and infotainment features. Upgrade to available SYNC 3 and enjoy enhanced performance, voice-recognition technology, larger 8-inch LCD touch screen and interface.27
With a SYNC® Connect-equipped vehicle, you can use FordPassTM to track your vehicle's location and remotely access vehicle features such as start, lock and unlock and vehicle status including fuel level and approximate mileage. You can also schedule specific times to remotely start your vehicle so it's ready to hit the road as soon as you are.*
Learn more at www.ford.com/sync
To learn more about where FordPass can take you, visit FordPass.com.
*SYNC Connect is an optional feature on select 2017 model year vehicles and includes service for five years from the vehicle sale date as recorded by the dealer. FordPass is available through a free download via the App Store® or Google Play™ store, late availability Spring 2016. Message and data rates may apply. Service may be limited by mobile phone network coverage area. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android, Google Play and the Google Play logo are trademarks of Google Inc.
|Maximum 3,500-Lb. Towing
The available 2.0L EcoBoost® engine delivers more than high performance with its Twin-Scroll turbocharger technology. EcoBoost power enables another important capability for the adventurous Escape - a maximum 3,500 lbs. of towing (with the Class II Towing Package) to complement this versatile SUV's spacious cargo capacity of up to 68 cu. ft.
|Sport Appearance Package
As if Escape isn't stylish enough, the Sport Appearance Package available on Escape SE or Titanium takes it to another eye-catching level. Unique black-out trim, sport seats, leather-trimmed shift lever and steering wheel, and more. Turbocharge the looks of your Escape with the Sport Appearance Package.


text: Job Discussion Forums :: View topic - Another stupid question Get TEFL Certified & Start Your Adventure Today! Job Discussion Forums"The Internet's Meeting Place for ESL/EFL Students and Teachers from Around the World!" FAQ Search Memberlist Usergroups Register Profile Log in to check your private messages Log in Another stupid question Job Discussion Forums Forum Index -> Italy View previous topic :: View next topic Author Message FGTJoined: 14 Sep 2003Posts: 762Location: Turkey Posted: Thu Jan 22, 2004 10:28 pm Post subject: Another stupid question Notwithstanding the lack of response to my previous query, I was wondering if anybody currently based in Italy could give me a rough idea of the cost of living. Here in Turkey, I can take a taxi to a decent restaurant, eat well, drink well and taxi home, all for the equivalent of about 35 Euros. Cigarettes, 1.5 Euros a packet; a beer, 2 euros; a cheap meal 2 euros; cinema ticket, 3 Euros etc. What are the equivalents in Italy? Back to top Teacher in RomeJoined: 09 Jul 2003Posts: 1286 Posted: Fri Jan 23, 2004 12:27 pm Post subject: Quote: Here in Turkey, I can take a taxi to a decent restaurant, eat well, drink well and taxi home, all for the equivalent of about 35 Euros. Cigarettes, 1.5 Euros a packet; a beer, 2 euros; a cheap meal 2 euros; cinema ticket, 3 Euros etc. A meal for two (with wine) in a family-run restaurant costs about 25 euro and up. I don't smoke - no idea how much cigarettes cost. A decent bottle of wine in a supermarket is around 5 euros, and cinema tickets are about 6 or 7 euro. I eat very well, and shop at supermarkets, open-air markets (and wine emporiums.) For two people, all our food and household needs (excluding electricity and telephone bills, rent etc) come to about 130 euro a week. But we eat a lot of organic food and drink good wine. Hope this helps! Back to top SueHJoined: 01 Feb 2003Posts: 1022Location: Northern Italy Posted: Fri Jan 23, 2004 11:20 pm Post subject: I'd be interested to know what wine you drink. I lived in Rome from the age of 4 to 11 and started drinking itsy bitsy drops of wine in my aqua minerale with the proportion of wine getting larger as I got older. In those days trattoria wine was pretty bad - it didn't even make the journey from Frascati or the Colli very well. Good wine aplenty in the UK - just I can't afford the ggod stuff! Back to top Teacher in RomeJoined: 09 Jul 2003Posts: 1286 Posted: Mon Jan 26, 2004 8:29 pm Post subject: I really like the dry white wines from Campania: Falanghina and Greco di Tuffo. I also like Frascati wine, but I'm not sure it "travels" that well. I don't think that much beats eating a good meal in Frascati in summer, with the Frascati superiore on tap... There are some nice red wines from Tuscany, and some highly rated red wines from the north of the country. The wine emporiums have a great range here, and the wine in trattorias is generally good. It's pretty dodgy in some of the bars, though. How much does wine cost in the UK? Is it prohibitively expensive to drink wine with your meal? Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First Job Discussion Forums Forum Index -> Italy All times are GMT Page 1 of 1 Jump to: Select a forum Where to Begin----------------General DiscussionNewbie ForumCurrent Events ForumTechnology ForumOnline Teaching Forum Africa Forums----------------General Africa Forum Asia Forums----------------CambodiaChina (Job-related Posts Only)China (Off-Topic)Hong KongIndiaIndonesiaJapanMalaysiaPhilippinesSingaporeTaiwanThailandGeneral Asia ForumVietnam Caribbean Forums----------------General Caribbean Forum Europe Forums----------------Czech RepublicFranceGermanyGreeceItalyMacedonia and the BalkansPolandRomaniaRussia & C.I.S.SpainTurkeyUkraineUnited KingdomGeneral Europe Forum Latin America Forums----------------ArgentinaBrazilChileColombiaCosta RicaMexicoMexico (off-topic)PeruGeneral Latin America Forum The Middle East Forums----------------BahrainEgyptIsraelKuwaitOmanQatarSaudi ArabiaUnited Arab EmiratesGeneral Middle East Forum North America Forums----------------General North America Forum Oceania----------------Australia/New Zealand You cannot post new topics in this forumYou cannot reply to topics in this forumYou cannot edit your posts in this forumYou cannot delete your posts in this forumYou cannot vote in polls in this forum This page is maintained by the one and only Dave Sperling. Contact Dave's ESL Cafe Copyright © 2018 Dave Sperling. All Rights Reserved. Powered by phpBB © 2001, 2002 phpBB Group Teaching Jobs in China


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John Miller
Class of 1964
Major/Minor: Economics
Retired Development Specialist Makes Home In African Bush
After a career in international development that took him to 30 countries on four continents, John Miller '64 could have retired anywhere. He chose the African bush. From his 2400-acre reserve in South Africa's Waterberg Mountains, the former USAID consultant is now helping his rural community grapple with issues of environment/conservation vs. development/growth and higher education. His expertise is highly appreciated but, John confesses, the woman he met on a horse safari in 2000 had much to do with his decision to settle in this beautiful, sparsely populated region.
Together, he and Wendy Adams purchased land in the African bush three hours northwest of Johannesburg with stunning vistas and abundant wildlife. Equus Reserve is home to the riding operation, Equus Horse Safaris, as well as John's community activities. Through the Equus Waterberg Fund, the couple is raising money to help needy students from the local high school continue their education. At Meetsetshehla Secondary School, John sits on a committee that reviews student applications for financial assistance. The scholarships typically cover 80% of educational expenses for five students each year; these students have gone on to study mechanical and electrical engineering, information technology, water purification, accounting and medicine—skills very much in demand in this remote region.
Meetsetshehla School is an exception to the "indifferent" educational approach found at most farm schools in South Africa, John says. Established in 1986 near the town of Vaalwater, the state-aided independent school for 700 students receives support from the Northern Education Trust. Thanks to the high standard of education they receive, Meetsetshehla students are motivated to excel academically and achieve graduation rates well above provincial and national averages—as high as 100% in 2006.
"All of these students are very, very poor," says John. "The fact that they want to do anything beyond high school is surprising and of course wonderful. Our Equus Waterberg Fund, raising money in dollars, can really have an impact because school costs are nothing like they are in the U.S., particularly for vocational training."
With his background in urban planning and development, John also makes a significant impact in his community as chairman of the Waterberg Nature Conservancy. The organization of more than 50 landowners is devoted to conservation issues and is contesting proposals for two development projects that the landowners believe are misguided. "At one extreme, there is a proposal for a holiday resort featuring two golf courses, two 30-bed hotels and 800 housing units," says John. "At the other extreme is a proposal to build a 200-unit residential development on pristine land located within UNESCO's Waterberg Biosphere Reserve. The conservancy is paying close attention to both of these projects, as well as nearly 20 others of varying environmental impact."
An economics major at Washington College who earned a graduate degree in urban planning, John launched his international career with the Peace Corps. Assigned to the region of Bahia in Brazil, John worked on community development projects in the city of Salvador. His USAID work later took him to Quito, Ecuador, for two years, where he helped government officials plan and build a new community for thousands of low-income inhabitants. He assisted the Bolivian ministry in formulating national housing policy, and was part of teams working on solar energy housing in northeast Brazil, urban analyses in Guatemala, disaster relief in the Caribbean, and housing polices and projects in Honduras, Chile, Jamaica and St. Lucia.
Over a period of several years in Portugal, he assisted in the design and implementation of low-income housing projects. "The Portuguese l learned in Brazil was indispensable to my work there, as well as later projects in Mozambique and other Portuguese-speaking countries in Africa."
His international work also took him to Asia, the Middle East and West Africa. In Southern Africa, John managed a technical team that drafted regional protocols for the Southern Africa Transport and Communication Commission. He carried out an evaluation of housing projects in Zimbabwe, and worked on the privatization of the Malawi Railways. His work in Botswana focused on integrating HIV/AIDS awareness into local planning.
In 2000, from his post with Abt Associates in Johannesburg, John directed a staff of consultants working on a variety of development projects in 11 Southern African nations—primarily in urban development and public health. Since his retirement in 2002, John appreciates the peace and beauty of their mountain reserve. In addition to his community activities, he enjoys tennis, genealogy, reading, writing, walking, counting the daily egg production, and harvesting vegetables from Wendy's organic garden. Read his article about Meetsetshehla Secondary School in The Sunday Independent.


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I have been neglecting my stereo duties and trying to keep my car running for a while now.
I have some new 'properly sized' injectors ordered for my car, that should be here soon. My starter will be ordered soon as its working on taking a crap on me, and I'm still trying to track down some new seats as mine are falling apart.
Anyhow, I've got a 91 Audi Coupe Quattro (awd), and sometime in the distant future, I'm going to be building a complete tube frame for this car, which hopefully means fabbing everything forward of the firewall to give me more strength and more room for stuffing a big motor into my car.
I've decided that I would like to use a racing suspension that will fit the 2000ish Audi A4/S4. At some point, I would like to get one of those cars, take the suspension parts off, and take a negative of the mounts so that I can move the negative to my car and fab mounts that will line up on my car and let me put the suspension from the newer cars onto my car.
What kind of reference points should I use? I'm wanting to keep the same wheelbase, so I'm assuming I can probably use the centerline of the wheels as a reference point, and swap only one end of the car at a time so that I still have something solid and from the original car to work from. I realize this will be a complete *****, probably much more than I can imagine, but I've got it in my head to learn how to do this stuff, and I intend on doing it.
Any comments?
Suspension transplant?
Come here to discuss the performance side of our vehicles.
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clb, yes I'm a member of several Audi forums. I haven't shared my ideas yet with them as its a LONG way from even starting...I just feel more comfortable sharing my ideas with the guys here.
Adam, you ought to know by now that I'm not a BB kinda guy. Give me a decent little motor and a big turbo and I'll be happy.
Adam, you ought to know by now that I'm not a BB kinda guy. Give me a decent little motor and a big turbo and I'll be happy.
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> select price
Holiday Bouquet
Product DescriptionA Christmas arrangement adds a fresh touch at holiday parties and get-togethers, and is one of the best last-minute gifts around. Send hand-delivered Christmas flowers, along with your warmest holiday wishes for the Christmas season.
You might also be interested in these arrangements
When you order custom designs, they will be produced as closely as possible to the picture. Please remember that each design is custom made. No two arrangements are exactly alike and color and/or variety substitutions of flowers and containers may be necessary. Prices and availability of seasonal flowers may vary.
Our professional staff of floral designers are always eager to discuss any special design or product requests. Call us at the number above and we will be glad to assist you with a special request or a timed delivery.


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"The concept is as easy as nailing a piece of rubber to a barn door," says Heinz Mariacher, SCARPA's storied shoe designing prophet, or – more formally – climbing line manager.
But don't let his casual theorizing about what he calls 'Active Randing' fool you. There's more going on than Mariacher would lead you to believe. After all, the guy's had a one-track focus on climbing shoes for well over three decades.
So what is Active Randing? And what difference does it make in SCARPA's rock shoes?
Said (somewhat) simply, Mariacher's concept of Active Randing employs rubber rands that wrap around the shoe in different configurations (for different types of climbing), designed to support climbers' feet in the movements critical to climbing at top levels. These active rands are tensioned in ways that engage and disengage to support the foot, storing and re-releasing energy. They dynamically adapt to the foot while it loads and unloads body weight, effectively storing and releasing power—similar to the way a barn door slams shut with a rubber tether.
Visually, you can see it SCARPA's rock shoes. If you look at, say, a Vapor V or an Instinct, the shoes have structure that makes them look like there's a foot in them when there isn't. Active rands give the shoe that structure. They also do a lot more that you can't see, but you can feel …


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Antiques Societies and Clubs Northwest UK
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Easy Bricks Quilt Tutorial
21 Comments
manybooksMay 13, 2011 at 11:06 pm
What a great tutorial! I love that it is simple in piecing and will show off fabrics really nicely. THANK YOU for the work you put into this and sharing 🙂
prsd4tim2May 14, 2011 at 12:18 am
I love both quilts! And I love the 2 for 1 aspect too. Thanks for the tutorial. Can't wait to try it. And congratulations on being on MBS.

It was nice to meet you today at Quilt Market.
MandaMay 14, 2011 at 12:56 am
Fabulous quilt! I will head over to look at the tut!
KathrynMay 14, 2011 at 7:47 am
Awesome tutorials – I love them both!
SherryMay 14, 2011 at 7:57 am
Both quilts are gorgeous. Thanks for sharing!
Caitlin T.May 14, 2011 at 2:39 pm
such a gorgeous quilt! i'm definitely adding this to my to-do list!
Live a Colorful LifeMay 14, 2011 at 4:14 pm
You're a very fine baker, Amy!
LydiaMay 14, 2011 at 4:57 pm
Thank you, Amy! I have it bookmarked for future reference!
JudyMay 14, 2011 at 5:55 pm
I want to say Thank You. I love so many quilts I see and wonder how many more patterns I need to buy. Thank you very much for your kindness to give us one of your beautiful quilts. I'm looking forward to making that Strawberry Fields quilt that you show there, another favorite!
Funky KimMay 14, 2011 at 8:24 pm
I cannot buy one more quilt kit. Not until I finish up a few (HAH!) that are in my sewing room. I am easily distracted. My only downfall!

It was fun seeing you today at the meet up! I'll see you again in the fall! Woot!
Paula and MelMay 14, 2011 at 10:47 pm
What a great quilt and easy also. I am a new quilter and have a question.. How can I make this queen size?
Thanks for the great tutorial.
Paula
MaimieMay 15, 2011 at 6:46 am
I loved this quilt. Simple, but really eye-catching. I had a Collection for a Cause layer-cake and some cream charms that I am going to use.

Must say I do not go to too many blog sites – your's is very interesting – thank you for the tips and great patterns. I will be back – I have saved your blog to my favorites.
StephanieMay 15, 2011 at 9:47 am
Love your blog and this tutorial! I am going to have to make several of these-fast!
Melissa {polkadot chair}May 15, 2011 at 6:59 pm
It's so pretty!! I must say I love seeing the snow capped peaks in the background ! I really miss those mountains.
Melissa
TrudiMay 16, 2011 at 1:25 am
Love the Easy Bricks Pattern Amy, mine went together in an afternoon! Thanks for such clear and great instructions 🙂
TahelMay 16, 2011 at 11:03 am
Hi AMy Thanks for shering those tutorial, i love both! Tahel fromIsrael
Beginning Quilting NowMay 16, 2011 at 11:54 pm
This is one of the easiest to follow tutorials I have found online. I think this quilt is very pretty and I'm sure that a lot of quilters out there will have a fun and stress-free time in making this quilt. 🙂
GreenstylemomMay 26, 2011 at 11:17 am
I made a variation of this quilt as a gift for our kindergarten teacher. I blogged about it today. Come check out what you inspired!
notes of sincerityJune 19, 2011 at 6:43 am
Thank you *so* much for this tutorial. I made this quilt with the Sew Cherry fabric line, yesterday, and posted. I will post the quilt in the next day or so. I can hardly wait to order the batting and complete the quilt. :o)
I will certainly use this tutorial again! Thanks again!! :o)
Melissa CliffordAugust 7, 2011 at 9:09 am
I just finished! I'm so geeked I hope my BFF likes it.

I wasn't sure where to post that I made this one. I went to the Moda Bake Shop as well.

I will try to post a pic in the Flickr group.
How to Make a Wedding Guestbook Quilt - Grace Elizabeth'sOctober 28, 2015 at 8:38 am
[…] and friends. The rectangular pieces, the bricks, would be a collection of rich, fall colors. Here is a tutorial of this Easy Bricks Quilt by Amy Smart over at Diary of a Quilter which was Courtney's […]


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As I looked back over my blog entries for 2012 I realized that it has been a long and interesting year.
I have learned a lot about myself and more importantly about all of you and what you find interesting and what you can relate to.
My most-read post of the year was my letter, "Dear Beyonce" which was posted after she rented an entire floor of a hospital in New York City to give birth to her child.
I actually received a lot of hate comments for that one, as well as praise. If you review the comments you will notice some insane Beyonce lovers chimed in…..
Was this post so popular because those of us who are mothers like to warn new moms what to expect?
Or is it sadly that we have become a celebrity-obsessed culture that reads US Weekly as regularly and whole-heartedly as generations before us would read Time and Newsweek? That we are just so obsessed with every minute detail of the lives of the rich and famous that we tune in to read about anything diva-related?
Sadly, as an avid US Weekly reader, I think it's the latter.
In the beginning of last year, I was grappling with how to work and maintain my household, my sanity and not let looks go completely down the toilet.
In the spring, I hadn't much headway in the looks department, but I had at least stopped working as much so I had time to sleep. I shared how I still am trying to catch up on sleep I lost when I was breastfeeding.
I also, shared a tale of how I was sleeping so soundly that I didn't wake up in time to save my poor brother from seeing my boob hanging out of my shirt one morning.
I have mentioned before how my boobs have really become deformed since the children destroyed my body from head to toe….my poor, poor brother.
This spring, as 50 Shades of Grey hit the shelves, I learned a lot about trends in America for women. First, I was shocked to discover that apparently everyone just has oodles of time to sit home and masturbate all day while they fantasize about being handcuffed and beaten.
Who knew?
Then, just as I was recovering from this news, I had to find out that women right and left were chowing down on their own placenta.
As if that wasn't offensive enough, "ways of feeding American children" reached a new low when Alicia Silverstone was all over the news demonstrating how she chews up food and spits it into her child's mouth.
This kind of weird parenting could result in children that are complete freaks.
They could end up being total cry babies, that whine and complain about everything….
This was the behavior that basically every child exhibited on my son's baseball team this summer.
Oh and while the boys roam the fields looking for mushrooms and shit their pants while they are running to the wrong base, their parents could care less.
It was absolutely astonishing. Hopefully next season will be better!
After baseball was over, we went on a crazy "vacation" with my in-laws, and then went to the beach for the rest of the summer, which was lovely.
Then we started to get ready for back-to-school, which is when I noticed how offensive the Pottery Barn Kids catalogue was…..
In the classic Pottery Barn style which aims to make us feel badly about our homes, bedding, and lives….the PB Kids version, now aims to make us feel bad about our kids lunches and what we put them in……
In October, we were yet again devastated by a storm.
You would think we would be prepared since the last storm, but we weren't.
So I had to brave the stores searching for batteries and water. It wasn't pretty.
We survived with minimal damage, but I hosted my Thanksgiving run and raised money for victims of Storm Sandy in New York.
In December, I have taken a lot of time to reflect on life and the world that we live in after the absolutely heart-breaking school shooting that happened here in Connecticut.
We have a lot to think about and change to make sure that our children can grow up safe and happy and healthy.
But when I had a spare moment during the holidays, I did have time to make fun of people who decorate their vehicles with antlers and noses.
In closing, it has been a great year for Lady Goo Goo Gaga, and I hope to continue learning and growing and sharing my stories.
Thank you all for reading every week!! And for CLICKING ON THE BANNER BELOW!!!!
Please leave me a comment letting me know what was your favorite post of 2012….BESIDES "DEAR BEYONCE!!!"
Happy New Year!! XO, LADY GOO GOO GAGA


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Flight Ready Pioneer DDJ-SR DJ Controller Case*Controller not included
Odyssey presents the Flight Zone FRPIDDJR case specifically made for the Pioneer DDJ-SR DJ controllers. It features their exclusive, patent pending, high-density bevel foam interior that neatly angles upward raising the controller for an efficient control surface. The stylish V-Cut removable panel allows for easy access to the front controls and headphone/mic jacks. A spacious ventilation pit under the controller is ideal for storing cables and other accessories.Features:


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Lice Removal Atlanta Ga Plain and simple, having lice is no fun. Lice infestations, are not only very common, but also easy to get rid of when you have the right help.Lice can make your skin itch a lot and they can also cause sores due to the continuous scratching of your head if not taken care of immediately. If you you or one of your family members is a victim of lice, visit a specialist who is skilled in treating lice, such Lice Happens, a Mobile ice removal Atlanta ga company. Lice Happens is composed of professionals and highly skilled experts who can end the whole cycle of lice.The professionals at Lice Happens mobile service in Atlanta use a broad approach when removing lice from your head. Just one of the methods they use is combing your hair together with a specialized non-toxic product which will help remove lice from your head.
Finding the right people to treat a lice infestation when you need it the most can be difficult if you do not know where to look. At Lice Happens, their professionals are discrete and they will also educate you and your loved ones on how to prevent any future infestations. Lice can happen to anyone! If you or someone you love needs a discrete way to get rid of these little critters, give us a call! You can also visit: http://www.youtube.com/watch?feature=player_embedded&v=3m3dKDJdNU4 source= https://storify.com/rambunctio292/lice-removal-atlanta-ga-mobile-lice-treatment#publicize