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Perfect In Case of Slips or Falls
Get Security and Protection for Yourself or Your Loved ones with our Medical Alert Systems.
Stay Safe in Your Own Home.
Don't Delay – Call Today for More Info!
Call hours – Open 24/7
This advanced GPS-enabled mobile personal emergency response system empowers you to live an active, independent life, in or outside your home. In the event of an emergency, you're one press of a button away from talking directly with an Emergency Hotline Agent, who can track your location, alert your family and caregivers, and ensure help is on the way.
Unlike any other GPS personal emergency response system, GPS Guardian Connect is integrated with MedicAlert protection, so you'll get the utmost in security and assurance " inside or out, 24/7.SOS Emergency Button
A press of a button signals for help and allows you to speak with an Emergency Hotline Agent directly through your device.
Real Time GPS Location Tracking
Help is always close at hand, even if you're lost or unable to communicate your location. Our GPS technology will detect your location in real time so help can reach you as quickly as possible. Your personal emergency contacts will also be able to locate you on their computers and mobile devices.
24/7 Response Centre
An Emergency Hotline Agent is available to assist you any time, day or night. These trained professionals can contact Emergency Responders such as paramedics and police, and notify your personal emergency contacts on your behalf.
Auto Alerts to Family & Friends
You can choose up to four contacts to receive alerts in the event of a personal emergency, either through email or text messages " whichever suits your needs.
Fall Detection Technology
When your device detects a fall it automatically sends an alert to our 24/7 Response Centre and to your personal emergency contacts – without having to press a button.
Geo-Fence Alerts
For those living with dementia, autism and many other conditions, wandering can be a constant concern. With Geo-Fence alerts, you'll be notified if your family member wanders outside of the safe areas designated by you.
Benefits of Medical Alert System in Waite Maine
The experts we consulted recommend looking for a medical alert system that meets all or most of these criteria.
It works for a user's specific disability. For example, a stroke survivor may need a device he or she can activate with one hand.
It offers a choice of a wristband and/or neck pendant. Cords worn around the neck can pose a strangulation risk; wristbands may irritate those with skin ailments.
It includes help buttons that can be wall-mounted near the floor in multiple rooms in case the user falls and isn't wearing the pendant.
It offers multiple choices for whom to contact if you need help, from emergency services to a friend or relative who lives nearby.
It has a battery backup in case of a power failure.
The base station can be contacted from anywhere on your property"even in your yard or at your mailbox.
The company has its own monitoring center, in the U.S., and employs its own trained emergency operators (rather than contracting that function out).
The monitoring center has been certified by Underwriters Laboratories (UL), a nonprofit safety and consulting company.
Waite Medical Alert System
Waite Medical Alert System
10 out of
10 with
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Questions about the Personal Emergency Response System
Does the medical alert system come with other services? Some medical alert systems come with additional services such as medication reminders, glucose monitoring reminders, and the like. It's good to know what other services can be included with the purchase of your services, so make sure you ask what's included.
7. What happens if something goes wrong with my equipment? Most of us hate reading the fine print. I challenge anyone out there to read the "terms and conditions" of the 5 or 6 medical alert devices you want to evaluate (gives me a headache even thinking about doing that again). So that in mind, I would encourage anyone making a decision on a particular device to ask; What happens if your system goes down? Does someone come out to fix it? Will they send you another one asap? Do you need to send the dysfunctional system back? etc. Also, one other point… when you have narrowed down your choice, read the fine print by looking up the terms-and-conditions of the particular provider on their websites.
8. Does the medical alert system include "automatic fall detection"? Medical alert systems have come a long way in the last 5 years. Today's advanced systems can detect when a user has fallen automatically. It's all in the advanced algorithms developed by brilliant engineers and embedded into small devices which are saving lives everyday. These smart-systems can distinguish (in most cases) between when someone has actually fallen, and when someone has decided to sit down abruptly. "The big three" that (currently) offer automatic fall detection are Halo Monitoring Systems, Wellcore Personal Emergency Response, and Philips Lifeline with auto alert.
9. Am I purchasing these devices, or leasing them, or neither? Goes back to my prior suggestion about reading the fine print… Find out (ahead of time) whether the equipment is yours or not. What happens if you no longer require the equipment? What happens if you damage the equipment?
10. What is my total yearly cost? This gets down to "brass tax"… How much does this cost me each year (total cash outflow). Enough said.
Nearest Medical System to You In Washington County 04492
How to pick the right one in ME
As the population ages, the range of services for seniors increases. The medical alarm is one of those pieces of technology that has grown in popularity. Where there were once only a few businesses offering medical alert systems, there are now dozens. So, how does one choose the best medical alarm out of the many options available?
One of the most important features of a medical alarm is the monitoring service. If an individual has made the decision that they need an alert system, then they have made the decision that they may need outside help in case of an emergency. If the monitoring system fails or is unsatisfactory, then the alert system is inadequate. A monitoring system should be a monitoring centre, not be a direct call to 911. Many people who utilize medical alert systems simply require outside support such as a friend or family member, not emergency services. A monitoring service can provide this support. Secondly, the provider of the medical alarm should own the monitoring service. This way, the professionals who answer the alarm are qualified by the standards of the medical alarm company.
Medical alert systems should be easy to install. Most should take a matter of minutes to set up. If a system's set-up seems too onerous or complicated, then the company has not fully considered the needs of their clientele. The installation should be easy or provided free-of-charge. They should also provide long-term, 24/7 technical support.
Another element to consider is the company's history and reputation. There are companies who have been in the business of medical alert systems for decades. These companies know their business and are more likely to have proven equipment. The company that only started offering medical alarms in the past couple of years is less likely to thoroughly understand the needs of their clients. The new company is also less likely to have amassed positive testimonials – do a simple Google search to find out what others say about the company and the services offered.
How a Medical Alert System helps you?
Medical alert systems have become synonymous with the elderly, and for good reason. These wise individuals fully understand the repercussions of falling and injuring themselves. They know that installing a medical alert system will only aid them if they become injured.
But medical alert system could be used for many different age groups to address differing physical and emotional needs.
The medical alert system has not always been designated just for elderly use. In fact, the system was not originally established to aid older generations. A doctor whose daughter was suffering from a reaction to a tetanus vaccination realized something needed to be done to aid those debilitated by illness but who desired to remain independent.
Today, medical alert systems continue to have the same purpose: They provide clients with the independence they desire while also giving family members peace of mind.
Medical alert systems are also useful devices for the handicapped. Perhaps you have a child who has Down syndrome. You know that he is capable of taking care of himself. But what if he injures himself or is in need of help? The alert system is a good solution to squelching these concerns. He can wear the medical alert device – which is 100 percent wireless and is easy to track – either as a wristband or as a pendant attached to a necklace. If he is in dire need, he can press the safety button to notify the monitoring system. That way, you will not have to feel as if you need to be near him at all times for his protection.
The same can be said for the disabled. For example, if you have a spouse who is paralyzed, you might be worried something terrible could happen when you're away. With a medical alert system, if your loved one is in a situation where they are injured but can't respond verbally, they can press a button on the alert device and a dispatcher will immediately call the authorities.


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|Egypt's Muslim Brotherhood
The geopolitics of Egypt has both been debated and on the outside has been stirring trouble in the community.
The debate is based on the usual divisions of labour and the gap between poverty and the middle classes in Egypt. To the Brotherhood this may appear radical. On the outside it does seem radical, but from the inside it is a different story unfolding.
Political parties are pitting there wits to find some solutions to current issues and later issues that may also arise, many of these issues are spoke about in the article below. Stirring Trouble Internationally contributor James Anderson writes all the information he has gathered from the inside of Cairo's archives and current news.
Here is a quote with this weeks post -
The radicals, who range from liberals to Trotskyites, accuse the Brotherhood of seeking an accommodation with the Supreme Council of the Armed Forces (SCAF).The Egyptian Muslim Brotherhood Is Divided. Who Will Benefit?

subset: commoncrawl


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156 members74 Comments 7 Likes
425 members110 Comments 51 Likes
587 members111 Comments 28 Likes
Carol Novack has not received any gifts yet
Carol, did you mean to post some of your writing over in the Writers' group? Maybe you changed your mind, but if not, it didn't appear.
Welcome to Think Atheist, Carol! It is great to have you here.
Here's a list of useful links to get you started:
Shop Think Atheist Apparels - Bracelets - Dog Tags
Search the Groups to find members interested in the same topics as you, or the Forums to find debates on all kinds of issues.
Any suggestions or questions you might have, don't hesitate to message me or tweet me, or contact any of the Moderators.
~ Monica


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In years gone by, evil was said to walk the earth in its many forms. Strange beasts lived in dark places, and the dead came alive and feasted on the living. Standing between the human race and the abyss of evil were the famed secret societies. You may have heard of them; the Knights Templar and the Illuminati, to name two of the more well-known.
In this modern age, an age of science fact and enlightenment, we know these myths and legends are just that - or are they? What if the battle between good and evil was not only real, but has continued to this day?
The secret societies we thought had been cast aside in the annals of history have been fighting a secret war. A war against evil, and a war against each other. Welcome to The Secret World, an exciting and innovative MMORPG from Funcom.
"Wah - not another MMO," I can almost hear you say.
While some release fatigue is valid, The Secret World does actually promise something different, and not just in its modern day setting; it also does some bold new things with the way it handles character progression.
Departing from the traditional leveling system that is stock and trade for most other games in the genre, The Secret World promises not to restrict you to a set of predefined character classes and skill progression trees. Instead, you can build your character any way you want, by unlocking hundreds of skills and then combining them in a way that matches the style of play you prefer.
Another appealing feature is the combination of modern day weapons, science fiction, and magic. The latter comes in the form of elemental power: "A power to match the dark shadows who have chosen today to come from the dark and claim the light." Arm yourself with rifles, shotguns, fireballs, and chainsaws - to name just a few.
As you would expect from a game of this type, there are quests, crafting, and items to loot. Quests, however, are not your usual run of the mill "go here and kill eight of these", but rather they are designed around an overarching plot that promises to challenge not just your combat skills but also your gray matter.
The world is changing above the ground and now you'll get to see the underground world that is only whispered about in the bright light of day. Expect to explore London and other cities of the world while you hunt down the things that squirm, shuffle, and crawl in the dark. Zombies, the walking dead, are mere troopers of an army that includes the stuff of nightmares. Boogeymen, golems and Jack 'o' Lanterns are familiar enough, but there are other things; things with claws, burning eyes, and a thirst for flesh.
This looks like it is going to be quite an innovative game, that - if the hype is to be believed - will refresh and energise the genre.


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Well I'm personally not 100% happy with the build-in spam filtering in Barca and PocoMail.
I've been marking a bunch of mails as good and as bad but it still seems to mark valid messages as bad (like the Debian newsletter for example) and certain bad mails as good.
Now I've been wondering if there is a plugin that can be used with Barca like there is AntiSpamSniper for the bat! and some other clients.
I've read on a Dutch forum that SPAMfighter is a good product (has a free and pay version) but it doesn't support that much clients.
The advantage of this software seems that it syncs the reports so when I mark a message as SPAM all other users will also get an updated blacklist and the mail will automatically be marked as spam for them aswell. It's also said to be more accurate.
Anyway, Spamfighter support says they are not working on support for PocoMail/Barca but they have an SDK that can be used to integrate their service into the final product.
I think it's their OEM section or something like that ?
~ Moved from Barca ... Eric ~


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- STI Background
- STI for Management of Possible Antiretroviral-Related Toxicity
- STI to Stimulate HIV-Specific Immune Response -- "Autoimmunization"
- SIT to Reduce HAART Exposure
- STI on a Variable Schedule With CD4-Count-Driven Treatment
- STI for Multidrug-Resistant Patients to Promote Reversion to "Wild Type" and Improve Virologic Response
- Treatment Fatigue -- Unstructured Treatment Interruption
- General Precautions With STIs
- Conclusion
- References
- Part II: Case Studies
STI Background
Strategic or structured treatment interruptions (STIs) are one of the most controversial and interesting topics in HIV medicine. And, whether we like it or not, patients will continue to ask for them even if the data regarding them is unclear. With the life span of someone living with HIV expected to be measured in decades, it is clear that even with once-a-day medications, patients can experience burnout. However, patient burnout is only one of a multitude of reasons for an STI. In order to properly discuss this subject, it helps to differentiate between the general types of STIs. Once the kind of STI is clearly described, the data that support or refute the stratagem may be considered. For the sake of this CME, I have separated STI into the following categories, which I'll discuss at length later:
STI for the evaluation of possible HIV-related side effects.
STI on a fixed schedule to purposefully allow cycles of HIV replication and stimulate a heightened immune response against HIV -- known as "autoimmunization" or "autovaccination."
STI on a fixed schedule (long or short) in order to reduce a patient's exposure to antiretroviral agents. This will actually be renamed SIT, or structured intermittent therapy, in the discussion.
STI on a variable schedule with CD4-count-driven treatment in order to reduce a patient's exposure to antiretroviral agents.
STI in a salvage setting to produce reversion to wild-type virus and enhance the patient's response to subsequent antiretroviral treatment.
STI because of treatment fatigue. This would actually best be described as an unstructured treatment interruption. Many patients facing a lifetime of taking medications may experience treatment burnout and stop medications on their own.
STI for Management of Possible Antiretroviral-Related Toxicity
Many clinicians would not consider this to be an STI. Instead, it would be considered a temporary treatment interruption undertaken with the intention to determine if a patient's symptoms are related to HIV medications. Some medication-related side effects have an insidious onset and may be quite nonspecific. The only way to determine if troublesome symptoms are related to an antiretroviral cocktail is to interrupt therapy and see if the symptoms recede or resolve. If a question remains about the relationship between symptoms and medication, some clinicians conduct a re-challenge with the same regimen to see if the symptoms recur (however, an abacavir [ABC, Ziagen] re-challenge is strictly proscribed because of the possibility of hypersensitivity).
The prompt resolution of a patient's symptoms during this kind of treatment interruption will typically lead to the selection of an alternate medication for the most likely offending agent. Often it's quite clear which drug is causing all the problems based on the known side effect profiles of certain agents (i.e., nausea from zidovudine [ZDV, Retrovir] or diarrhea from nelfinavir [NFV, Viracept]). On the other hand, if a patient's symptoms remain unchanged off therapy, then another explanation for these symptoms can be pursued and the identical regimen resumed.
However, it may not be necessary to interrupt treatment in cases of probable medication toxicity. When one agent is highly likely to be causing symptoms (i.e., neuropathy from stavudine [d4T, Zerit]), a single agent switch with continuation of the other medications in the combination, may be the most appropriate course of action.
One of the more common HIV management errors is to continue antiretroviral therapy in the face of medication-related side effects affecting a patient's quality of life. Given the expansion of treatment options in recent years, there are few patients who must stay on a prescribed treatment course that is causing them distress.
STI to Stimulate HIV-Specific Immune Response -- "Autoimmunization"
STI in Acute Infection (Autoimmunization)
An early pilot study, and one of the most successful in this category, was published in Nature in 2000 by Dr. Eric Rosenberg from Massachusetts General Hospital. It suggested the potential usefulness of an STI with patients experiencing acute HIV infection.1 In this study, there was evidence of increased virus-specific cytotoxic T lymphocytes and maintained T-helper-cell responses in patients who had one or two STIs after they were treated for acute infection. In this cohort, there also was a suggestion that patients were more likely to maintain lower viral load levels (below 5,000 copies/mL) off therapy and manifested a slower viral rebound after the second STI.
A study with the acronym PRIMSTOP2 was designed to examine the role of STI in primary HIV infection utilizing hydroxyurea as part of the HAART regimen. In this trial, the combination of nelfinavir, stavudine, didanosine (ddI, Videx) and hydroxyurea was given to 29 patients with primary HIV infection. After 32 weeks of continuous treatment, a series of three STIs of two, four and eight weeks (all separated by 12 weeks) was performed. HAART was stopped 12 weeks after the last STI and patients were followed for an additional 24 weeks. Overall, three patients were lost to follow up, three developed genotypic resistance to nelfinavir, and 52% had hydroxyurea discontinued due to side effects. At the 24-week endpoint, 7/26 patients (27%) had a viral load less than 1,000 copies/mL and one patient had a viral load less than 50 copies/mL. This study suggests that there may be limited benefit in early treatment of primary HIV infection with STI strategy.
Other studies of STI in acute HIV infection have not demonstrated consistent immunologic benefit.3,4 These studies utilized different treatment schemes. In one cohort3 treatment often was begun after seroconversion and in another4 a therapeutic vaccine was administered in conjunction with one treatment interruption. Significant immune control was not observed in these trials.
Recent reports have shown that even when favorable short-term outcomes were observed, virologic control eroded with longer-term follow up. In February 2004, at CROI, Bruce Walker presented data from his original Massachusetts General cohort with greater than five-year follow up. There was evidence of immune escape and rising viral loads despite previously well-controlled viremia and only one out of 14 of the patients in the study maintained a viral load below 5,000 copies/mL.5 Unfortunately, no randomized and controlled trials of STI in primary HIV infection are yet available.
STI in Chronic Infection (Autoimmunization)
The great majority of HIV-infected individuals are diagnosed beyond the window of acute infection, so studies of "autoimmunization" in chronic infection have more pragmatic implications. The landmark study that provided a number of important distinctions regarding STIs was the Swiss-Spanish-Intermittent-Treatment-Trial (SSITT). This study included 133 subjects with chronic HIV infection who received antiretroviral treatment on a schedule of eight weeks on therapy, followed by two weeks off.6 Although there was evidence of an expanded CD8+ lymphocyte response to HIV antigens as a result of the interruptions, this was not associated with viral load reductions. In fact, subjects with higher numbers of HIV-specific CD8+ lymphocytes had higher viral load increases during their interruptions. It is quite possible that during the STI and viral rebound, the destruction of CD4 cells by viral growth was the dominant effect, which overwhelmed any beneficial immune response. As expected, during treatment interruptions, CD4 counts fell. The negative results of this large, carefully performed study, makes a strong case against the "autoimmunization" theory of STI in chronic HIV infection.
Of course, a concern with any STI is the risk of developing viral resistance. However, one of the important findings from the SSITT study was that the risk of developing drug-resistant virus was quite low. In over 500 treatment interruptions, drug-resistant virus developed in only two cases. This low rate of development of viral resistance may largely have been a result of the relatively short two week time period off treatment. Other studies with longer treatment interruption times have been complicated by higher rates of viral resistance.8
Another significant finding from a sub-study of the SSITT study7 was that 14 of the subjects in the study had frequent blood sampling during the 14-day STI in order to determine the tempo and trajectory of viral rebound with the interruption. Viral load testing was performed during the STI at day 4, 8 and 14. There was minimal evidence of viral rebound seen at day 4, with less than 10% of the viral load test results greater than 100 copies/mL. However, by day 8 almost half of the subjects had viral loads above 100 copies/mL and by day 14 all but two subjects consistently had viral loads greater than 100 copies/mL. These data suggest that an STI lasting more than a few days will pose a significant risk for the development of viral resistance with repetitive cycles of replication. In fact, eight of 14 patients in this sub-study were found to have minor variants of the m184v mutation. However, the clinical relevance of these minor populations is of uncertain clinical significance. These findings are quite pertinent to the design of structured intermittent therapy studies, and suggests that with current antiretroviral agents, interruptions of greater than several days may be problematic.
SIT to Reduce HAART Exposure
The primary focus of structured intermittent therapy (SIT) is to reduce long-term exposure to antiretroviral therapy, thereby lowering a patient's risk for toxicity as well as reducing medication costs. It is also hoped that with this strategy patients may experience an improved quality of life as a result of a break from the pressure of daily medications and associated treatment fatigue. The main risk of an SIT is the premature development of drug resistance with the attendant compromise of future treatment options because of cross-resistance.
One of the primary educational messages regarding HIV management has been the importance of a patient's strict adherence to his or her antiretroviral therapy. The link between missed doses and the development of viral resistance has been well established. Although the following SIT data are interesting, this strategy of purposefully skipping doses on a schedule will require careful study in large, randomized trials.
Long-Cycle SIT
Dr. Mark Dybul from the U.S. National Institutes of Health reported the results from a study on long-cycle SIT which was designed to compare eight weeks on therapy followed by four weeks off with a control population on continuous therapy.8 The results were disappointing; an unacceptable rate of viral resistance occurred in the SIT group (three of eight patients receiving efavirenz [EFV, Sustiva, Stocrin] developed resistance) and so the study was terminated prematurely.
Although this long-cycle SIT study was not designed to test for autoimmunization, there was neither evidence of progressive reduction in viral load during the series of interruptions nor enhancement of HIV-specific CD4 cells in the SIT group. Also, there were no significant differences in lipid levels between the SIT and control groups. As a result of this study, enthusiasm for long-cycle SIT has waned, but short-cycle SIT still beckons.
Short-Cycle SIT
In fact, it looks as if short cycles of interruption may still have a future. The first short-cycle SIT report was a pilot study, also by Dr. Dybul, of one week on, one week off therapy with ritonavir (RTV, Norvir)-boosted indinavir (IDV, Crixivan)-based therapy in 10 subjects.9 This strategy was surprisingly successful, with controlled viral levels seen at 52 weeks of follow up. An additional benefit of this approach was the improvement in patients' cholesterol and triglyceride levels compared to baseline determinations.
Another small study of week on, week off therapy was also reported by Dr. Dybul -- in this case with eight subjects treated with an efavirenz-based regimen.10 There was no evidence of viral rebound or viral resistance at more than 52 weeks of follow up. In addition, no overall changes were observed in lipid levels. Of course, this may be due to the fact that efavirenz is known to have less of an impact on lipid levels compared to the boosted indinavir in the first trial.
A failed study of week on, week off SIT was the Staccato study. This study was different from prior studies in that it was performed in Thailand and most of the subjects received ritonavir (100 mg) together with 1,600 mg saquinavir (SQV, Invirase, Fortovase) once daily with two NRTIs. More than half of the subjects (19/36) randomized to week on, week off therapy had virologic failure, most within the first 12 weeks, so this study was terminated prematurely.11 The PI-treated patients with virologic failure had genotypic testing performed and no PI mutations were noted. All patients, except for one, were re-suppressed after resuming continuous therapy with the same regimen.
Of interest, seven of the eight subjects on the efavirenz-based therapy maintained virologic control (mean 19 weeks). The one person failing had a large body mass and a low efavirenz trough level prior to the change to intermittent therapy.
The results of the Staccato study may curb the interest for this investigational week on, week off strategy (at least for saquinavir-based therapy) for the management of HIV infection. However, as newer, more potent agents with better pharmacokinetics and longer half lives become available, this situation may change.
The first study utilizing a five-day on, two-day off SIT format was recently reported.12 In this trial from Uganda, 31 subjects were randomized to either a week on, week off regimen, a five-days on, two-days off schedule or continuous therapy. The majority of subjects received an efavirenz-based combination. There were three cases of virologic failure overall, two in the continuous-therapy group and one in the 5/2 group; all virologic failures were related to non-adherence. Additional studies of this nature are underway and the results will determine if a 5/2 strategy has merit.
The 5/2 stratagem is interesting because it fits with a typical work schedule. This may appeal to some patients who would welcome a weekend free from HIV treatment. It also might reduce one of the logistical obstacles to expanding directly observed therapy (DOT) programs. DOT for HIV infection holds some promise to help difficult-to-reach populations who are at high risk for non-adherence. Weekend coverage by medical staff for DOT is problematic; it would be beneficial if DOT could be accomplished within the confines of a standard Monday through Friday work week.
STI on a Variable Schedule With CD4-Count-Driven Treatment
One of the pressing questions in HIV management is what to do about patients who began therapy with lower CD4 counts, but, following immunologic recovery, have CD4 counts now in the normal range. Are these patients obligated to continue life-long therapy or is it reasonable for them to stop at some point? An additional group to consider is the numerous patients who began antiretroviral therapy when the U.S. government treatment guidelines recommended therapy at higher CD4-count thresholds. Is it safe and advisable to discontinue treatment in these cases?
One of the proposed strategies to deal with this thorny issue is CD4-count-driven therapy. The notion is to start or resume antiretroviral therapy when a patient's CD4 count falls below a critical threshold and then to interrupt therapy when the patient's CD4 count rises above a specified point. Depending on the CD4-count parameters selected for starting and stopping therapy, this strategy usually translates into relatively long periods of time off therapy, often months to years.
BASTA Study
One such trial, BASTA (meaning "stop" or "enough" in Italian), has helped clarify this issue.13 This is an ongoing, prospective, randomized and controlled trial that originally enrolled subjects with CD4 counts more than 800 cells/mm3 and plasma HIV-RNA less than 50 copies/mL on HAART. Subjects were randomly assigned (2:1) to either interrupt HAART or continue continuous therapy. In the STI arm, the goal was to maintain a CD4 count of greater than 400 cells/mm3. The primary endpoint of the study was the proportion of patients whose CD4 count remained above 400 cells/mm3. Secondary endpoints included predictors of time off therapy, metabolic changes, tolerability, costs and virologic resistance. There were 114 patients enrolled in the study (76 STI, 38 control). After a mean of 18 months of follow up, 21% of the STI group restarted therapy because their CD4 counts fell below 400 cells/mm3. The nadir CD4 count was the only predictor of the need to resume therapy; those with a nadir below 200 CD4 cells/mm3 restarted within 10 months.
|Nadir CD4
|Mean Duration of First Treatment Break
|<200 cells/mm3
|6.9 months (not over 10 months)
|200-350 cells/mm3
|14.1 months
|351-500 cells/mm3
|17.8 months
|>500 cells/mm3
|all continue off therapy
BASTA is a proof of concept for CD4-count-driven therapy. Results show that HAART may safely be discontinued in patients with more than 800 CD4 cells/mm3 who show no evidence of the development of virologic resistance. There is a caveat though: Those with nadir CD4 counts below 200 cells/mm3 will likely have to resume sooner rather than later.
SMART Study
Another variable-schedule STI study underway and still enrolling is the "Strategies of Management of Antiretroviral Therapy" (SMART) study.14 This large CPCRA-sponsored trial is planning to enroll 6,000 subjects and is scheduled to run for nine years. The intention is to compare the maintenance of viral suppression on continuous antiretroviral therapy versus on a CD4-driven STI strategy. Subjects with greater than 350 CD4 cells/mm3 are eligible for enrollment. The study design calls for treatment to be stopped in the STI group and then resumed when CD4 counts dip below 250 cells/mm3. The viral suppression group will be treated with HAART for the duration of the study with the goal to maintain an undetectable viral load. A number of sub-studies in SMART are planned; a partial list includes an evaluation of cardiovascular complications, risk of HIV transmission and neurologic complications.
STI for Multidrug-Resistant Patients to Promote Reversion to "Wild Type" and Improve Virologic Response
Some patients with multidrug-resistant virus have limited or no treatment options. An STI may lead to partial or complete reversion to wild-type virus over the course of weeks or months. The hope is that by allowing this to occur, such patients may have a better response to salvage therapy, even though they have had prior documented virologic resistance to the regimen.
The French GIGAHAART Study suggested that a pre-salvage STI approach had potential merit.15 This randomized trial with 68 participants looked at patients who had drug-resistant virus and median CD4 counts of 27 cells/mm3. Those who received an eight-week STI prior to restarting an aggressive salvage regimen (with a mean of 7.3 drugs) had a significantly better response to therapy. Patients in the STI group experienced a mean viral load reduction of 1.91 log copies/mL compared to an only 0.37 log copies/mL reduction in the control group of patients who were switched straight off to the salvage regimen.
The much larger CPCRA trial 064 (270 vs. 68 participants) came to a different conclusion.16 However, the design of this trial was different in a number of ways. Although the subjects had multidrug-resistant virus, their median CD4 count of 144 cells/mm3 was substantially higher than that of the GIGAHAART study. In addition, the STI duration was longer at 16 weeks and the salvage regimen contained fewer medications (mean 3.6). The results were divergent as well; there were no differences in the viral load changes between the STI and immediate therapy groups at 12 weeks of follow up. This study was terminated prematurely due to a higher rate of adverse clinical outcomes in the STI group. There was the same number of deaths in both groups (eight each), but higher rates of opportunistic infections in the STI group. Presumably, the higher rate of infections in the STI group was related to the considerable decline in CD4 counts during the 16-week STI. We still don't understand the underlying reasons for the disparate results of GIGAHAART and CPCRA 064. The differences may be due to the shorter time off of therapy in the GIGAHAART study or its more aggressive regimen.
More pre-salvage STI studies are underway or in the planning phase in order to better understand the dynamics of viral rebound and resistance and to clarify the differing results of prior studies. However, based on the negative results of CPCRA 064, this strategy is not recommended outside of research trials unless individual patient considerations require a temporary treatment interruption.
Treatment Fatigue -- Unstructured Treatment Interruption
Although the topic of this article is structured interruptions, it must be recognized that in the real world of HIV clinical care, patients are interrupting therapy on their own. These patient-mediated interruptions occur despite strenuous efforts by HIV-treating clinicians to encourage their patients to have a high level of adherence to continuous antiretroviral therapy. Many of these interruptions also happen without the medical team's knowledge and are first recognized when viral breakthrough is noted on a routine follow up of blood testing.
One of the least appreciated factors in patient-driven treatment discontinuation is the influence of medication-related side effects. Although antiretroviral therapy has improved significantly in the last several years, drug-related toxicity is still common. Even in the absence of a definite relationship between symptoms and a medication, some patients will discontinue therapy because of a perceived association. In fact, it may simply be a media report about a newly discovered problem with an antiretroviral agent that will trigger someone to stop therapy.
There are economic factors that also influence treatment interruptions. Even individuals with private health insurance are impacted by financial considerations in HIV treatment. There are considerable costs related to medication co-pays and deductible and non-covered medical fees. There are also travel expenses and time lost from work that have an adverse financial impact. For other patients who access care through the public systems, there are costs involved as well in negotiating the system and sustaining benefits.
Psychological issues also have a dramatic impact on the decision by individuals to remain on or discontinue therapy. Many people with HIV are overwhelmed by the challenges of accessing healthcare, keeping up with doctor visits, blood testing and the necessity to take medications on a daily basis.
Moreover, the warning that viral resistance will be the penalty for missing doses is a major deterrent for those patients that question their ability to stick with a program. As a result of these concerns, some patients simply opt out of treatment for a while in order to take a break from the responsibilities that are required to participate in treatment. These patients are not necessarily nonadherent, in fact some of them never miss a dose of medications while "on treatment." After a period of time off medication in which they have had a chance to enjoy a less regimented life, they are ready to marshal their personal and emotional resources and resume treatment.
General Precautions With STIs
There are additional considerations and precautions for STI use in clinical practice and research studies.
HBV Coinfection
One important issue is hepatitis B (HBV) coinfection, which occurs in 5 to 10% of patients with HIV infection, depending on the population considered. Several commonly used antiretroviral medications have potent activity against HBV. These include lamivudine (3TC, Epivir), emtricitabine (FTC, Emtriva) and tenofovir (TDF, Viread). Many clinicians select therapy for coinfected patients with the intention to treat HBV infection as well as HIV. Data are limited, but in one small sub-study the combination of lamivudine and tenofovir in HBV coinfected patients led to an average 4.7 log decline in HBV DNA at 48-weeks follow up.17
The concern is that if a patient coinfected with HBV goes on an STI there will be a spike in HBV replication shortly after treatment is withdrawn. There have been cases of acute hepatitis, even fatal, after the discontinuation of lamivudine in coinfected patients.18 Thus, there should be careful consideration of STI in coinfected patients because of the potential for a flare up of HBV upon withdrawal of lamivudine, emtricitabine or tenofovir.
Increased Risk of Sexual Transmission of HIV
The public health ramifications represent another dimension that must be considered in the study of STIs. HIV-RNA levels are one of the strongest predictors of the rate of sexual transmission of HIV infection.19, 20 Therefore, the risk of HIV transmission would likely be enhanced during an STI, based on increased viral load levels in plasma and genital secretions.
Clearly the toxicities of antiretroviral therapy will be the driving desire behind continuing research into STI. But in addition to the potential for life-threatening toxicity from antiretroviral therapy, there are also the financial costs, especially apparent in underdeveloped parts of the world where treatment is not available, even with substantial price reductions.
This past summer at the International AIDS Society conference, Dr. Bernard Hirschel presented this theoretical model to gauge the financial impact of antiretroviral therapy on a modern industrialized country versus a developing country.21
|Total Population
|7 million
|12 million
|1.5 million
|Gross National Product
|$245 billion
|$6.8 billion
|Antiretroviral Therapy Cost/Year/Patient
|Antiretroviral Therapy Cost/Year
|$144 million
|$450 million
|% Gross National Product for Antiretroviral Therapy
Since a country typically spends about 10% of its Gross National Product (GNP) on total health expenditures, 6.6% for antiretroviral therapy alone is not within the realm of possibility based on historical precedent.
If antiretroviral costs could be reduced further through a SIT program, this would allow more patients to be treated in locales with limited financial resources. This in not only the case in underdeveloped countries; currently in the United States there are financial shortfalls in state Medicaid and ADAP programs and some patients on waiting lists do not have access to medications.
If proven effective, SIT would offer the prospect for reduced antiretroviral toxicity and expansion of treatment slots in financially-challenged regions of the world.
In general, STI or SIT should still be considered experimental and not be performed in clinical practice. One exception would include patients who began antiretroviral therapy when treatment was recommended at higher CD4 count cut-offs. These patients may safely discontinue therapy and restart based on contemporary guidelines.
Another group of patients who may consider an STI outside of a trial are those who have immunologic reserve (based on CD4 counts above 350) and who are experiencing medication-related toxicity. Especially if nadir CD4 counts were not below 200 and pre-treatment viral load levels were not high, these patients may be able to safely stop therapy for an extended period of time. The decision to withdraw treatment in this setting depends on the severity of side effects, presence of viral resistance and availability of antiretroviral options. Based on patterns of antiretroviral use from observational cohorts, it appears that more patients are on treatment interruptions.22 It is likely that many of these patients off therapy fit into one of these categories with higher CD4 counts and/or medication-related side effects.
Summary Regarding STIs in Other Circumstances
Recent studies have raised serious doubts about the short- and long-term effectiveness of an STI in acute or chronic infection for autoimmunization.
Only future studies (the SMART and BASTA trials) will give definitive answers regarding whether SIT holds promise utilizing either a fixed schedule with short course (5/2) treatment or a CD4-count-driven treatment approach.
The bulk of evidence available up until now does not support STI as pre-salvage approach because of clinical progression that may occur in the more advanced patients that this approach focuses on.
And finally, one of the most passionate arguments for STI still will come from HIV-infected patients, many of whom are worried about the long-term toxicities of antiretroviral therapies, or from others who just need a break from daily treatment adherence. Although we do not yet have clear answers, ongoing studies promise to advance our understanding and define the appropriate place for STI in HIV practice.
For Structured Treatment Interruptions Part II: Case Studies, click here.
Rosenberg E. S., Altfeld M., Poon S. H. et al. Immune Control of HIV-1 After Early Treatment of Acute Infection. Nature. 2000 Sept 28;407(6803):523-526.
Hoen B., Fournier I., Charreau I. et al. Structured Treatment Interruptions in Primary HIV Infection: Final Results of the Multicenter Prospective PRIMSTOP Pilot Trial. Presented at: 11th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2004; San Francisco, Calif. Abstract 395.
Miro J. M., Plana M., Garcia F. et al. Structured Treatment Interruptions (STI) in Patients Receiving HAART Within 90 Days After Onset of Primary HIV-1 Infection (PHI) Symptoms: Spontaneous Control of Viremia in Only One Third of Cases After Four Cycles Off Therapy. Presented at: XIV International AIDS Conference; July 7-12, 2002; Barcelona, Spain. Abstract ThOrB1437.
Markowitz M., Jin X., Hurley A. et al. Discontinuation of Antiretroviral Therapy Commenced Early During the Course of Human Immunodeficiency Virus Type 1 Infection, With or Without Adjunctive Vaccination. J Infect Dis. 2002 Sept 1;186(5):634-643.
Kaufmann D., Lichterfeld M., Altfeld M. et al. Limited Durability of Immune Control Following Treated Acute HIV Infection. Presented at: 11th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2004; San Francisco, Calif. Abstract 24.
Fagard C., Oxenius A., Gunthard H. et al. A Prospective Trial of Structured Treatment Interruptions in Human Immunodeficiency Virus Infection. Arch Intern Med. 2003 May 26;163(10):1220-1226.
Fischer M., Hafner R., Schneider C. et al. HIV RNA in Plasma Rebounds Within Days During Structured Treatment Interruptions. AIDS. 2003 Jan 24;17(2):195-199.
Dybul M., Nies-Kraske E., Daucher M. et al. Long-Cycle Structured Intermittent Versus Continuous Highly Active Antiretroviral Therapy for the Treatment of Chronic Infection With Human Immunodeficiency Virus: Effects on Drug Toxicity and on Immunologic and Virologic Parameters. J Infect Dis. 2003 Aug 1;188(3):388-396.
Dybul M., Chun T.-W., Yoder C. et al. Short-Cycle Structured Intermittent Treatment of Chronic HIV Infection With Highly Active Antiretroviral Therapy: Effects on Virologic, Immunologic, and Toxicity Parameters. Proc Nat Acad Sci. 2001 Dec 18;98(26):15161-15166.
Dybul M., Nies-Kraske E., Dewar R. et al. A Pilot Study of Short Cycle Intermittent ARV Therapy Utilizing a Once Per Day Regimen of Didanosine, Lamivudine and Efavirenz. Presented at: 2nd IAS Conference on HIV Pathogenesis and Treatment; July 13-16, 2003; Paris, France. Abstract 597.
Ananworanich J., Nuesch R., Le Braz M. et al. Failures of 1 Week On, 1 Week Off Antiretroviral Therapies in a Randomized Trial. AIDS. 2003 Oct 17;17(15):F33-F37.
Kityo C. et al. A Randomized, Controlled Trial of Short Cycle Intermittent Versus Continuous HAART for the Treatment of Chronic HIV Infection in Uganda. Presented at: 13th International Conference on AIDS and STIs in Africa; September 21-26, 2003; Nairobi, Kenya. Abstract LB 1098929.
Maggiolo F., Ripamonti D., Gregis G. et al. Individualized Structured Treatment Interruptions: Results of a Randomized, Controlled Study (BASTA). Presented at: 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 14-17, 2003; Chicago, Ill. Abstract H-448.
Smart Trial, www.smart-trial.org. Accessed January 25, 2004.
Katlama C., Dominguez S., Duvivier C. et al. Long-Term Benefit of Treatment Interruption in Salvage Therapy (GIGHAART ANRS 097). Presented at: 10th Conference on Retroviruses and Opportunistic Infections; February 10-14, 2003; Boston, Mass. Abstract 68.
Lawrence J., Mayers D. L., Hullsiek K. H. et al. Structured Treatment Interruption in Patients With Multidrug-Resistant Human Immunodeficiency Virus. N Engl J Med. 2003 Aug 28;349(9):837-846.
Cooper D., Dore G., Pozniak A. L. et al. Tenofovir Disoproxil Fumarate and Lamivudine Combination Therapy Compared to Lamivudine Alone for HBV in Therapy-Naive HIV/HBV Co-Infected Patients: 48 Week Interim Results. Presented at: 10th Conference on Retroviruses and Opportunistic Infections; February 10-14, 2003; Boston, Mass. Abstract 825.
Bessesen M., Ives D., Condreay L. et al. Chronic Active Hepatitis B Exacerbations in Human Immunodeficiency Virus-Infected Patients Following Development of Resistance to or Withdrawal of Lamivudine. Clin Infect Dis. 1999 May;28(5):1032-1035.
Quinn T. C., Wawer M. J., Sewankambo M. B. et al. Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1. N Engl J Med. 2000 Mar 30;342(13):921-929.
Wawer M. J., Serwadda D., Li X. et al. HIV-1 Transmission Per Coital Act, by Stage of HIV Infection in the HIV+ Index Partner, in Discordant Couples, Rakai, Uganda. Presented at: 10th Conference on Retroviruses and Opportunistic Infections; February 10-14, 2003; Boston, Mass. Abstract 40.
Hirschel B, Havlir D. There Is More Risk Than Value in Treatment Interruptions. Presented at: 2nd International AIDS Society Conference on HIV Pathogenesis and Treatment; July 13-16, 2003; Paris, France. Controversy 194, 195.
Friis-Møller N. et al. Combination Antiretroviral Therapy and the Risk of Myocardial Infarction. N Engl J Med. 2003 Nov 20;349(21):1993-2003.


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This is a story about the Doctor and Harry Potter,...
Hermione's Seventh Year213846631
- by sophiejane1999
- Rating:
- Published: 8 Nov 2014
- Updated: 25 Apr 2015
- Status: In Progress
After the war Hermione is going back to Hogwarts without Ron, Harry and Ginny. Will she cope with the memories the castle brings back? And how will she react when an unexpected visitor turns up?
Cover by JustAsSaneAsLuna
Cover by JustAsSaneAsLuna
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Phone: (512) 776-7261
Fax: (512) 776-7332
XLS & PDF file viewing information
Population projections were updated on this site on Wednesday, 12/17/14, including population for 2014. Population projection models are revised biennially based on the latest information on births, deaths, and special populations. Most areas did not change substantially in any given year, but be aware that some figures are now different from the previous projection series created in 2012. For more information, please see the Texas Population Projections Program.
The Center for Health Statistics maintains a population database for all Texas counties that serves many purposes in public health analysis and planning. In addition to providing denominators for the calculation of rates of disease, fertility, and mortality, the dataset supports the understanding of demographic indicators such as birth rates, life expectancy, number of women of childbearing age, population density, and aging of the population. Population projected into the future assists in planning for changes in demand for health services and workforce requirements.
Data Downloads in Excel
A single series of population data for the period 1990 through 2050 has been assembled from several sources encompassing three main types of data: census counts (1990, 2000, 2010), estimates (1991-1999, 2001-2009, 2011-2013), and projections (2011-). Data for all years since 1999 have been provided by the Texas State Data Center for all Texas counties by single year of age up to age 85. For more detail and documentation of race/ethnicity categories, see the "Sources and Updates" button at left.
Summary tables of total population by race/ethnicity are accessible from the menu at left. Databases containing the information of these summary tables and others that provide additional age and sex detail have been provided in the form of downloadable data files for a selected range of years.
For a selected set of age groups, data tables can be requested through the dynamic query system, Texas Health Data. You'll find other published tables of population information in reports hosted on this website and through additional links available through the "More Information" button at left.
Staff of the Center for Health Statistics can provide custom built tables and datasets from the population database on request. (See contact information at left).
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WBEZ News
Beyond the Vote: A Community Discussion on Voice, Power, and Participation (North Side Bureau)
With the November elections right in front of us and all around us, consider joining your fellow Chicagoans to think and talk about how we participate -- and what we hope for when we do. Voting is one way to get involved and be heard, but how does it stand next to other forms of involvement and action? How should we act to improve our city and our world, and what, however we express ourselves, are we hoping to get done?
Join Chicago Public Media, Mikva Challenge, and the Project on Civic Reflection for a participatory discussion about the power and the limits of participation in all its forms -- October 25th at the WBEZ West Side Bureau, October 30th at the WBEZ South Side Bureau, and November 1st at the WBEZ North Side Bureau.
Online registration is now closed, but walk-ups are welcome for this November 1st North Side Bureau event.
Support for Chicago Public Media's Community Bureaus is provided in part by Dr. Scholl Foundation, Met Life Foundation, and Crown Family Philanthropies.
The Project on Civic Reflection's mission is to strengthen community and deepen understanding by helping people and organizations think and talk about the meaning of their work in the world. Through the practice of reflective discussion, which utilizes provocative readings, images, and video, PCR helps people consider the beliefs and values that underlie their commitments—leading to clarity about their work, stronger relationships, and more committed, effective action.
A non-partisan organization, Mikva Challenge was founded in 1999 on the simple premise that youth voice and participation matter, and that our civic and political life will be stronger when youth participate and help shape their own destinies! By promoting positive youth development and providing access to the democratic process, Mikva aims to develop young people's civic identities as change agents in their communities.


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As a drummer, Ari Hoenig's success has been unprecedented. Growing up in Philadelphia, his parent's influence exposed Ari to a variety of alternative musical experiences. His father is ...Artist profile
Gilad Hekselman has been developing a reputation as one of the most promising guitarists in New York since his arrival in 2004. After only a few years this ...Artist profile
Among the most proficient and accomplished bassists in the field of contemporary jazz, Orlando le Fleming's virtuoso technique, boundless creativity and powerful beat are those of a musician ...Artist profile
Tenor Sax
Tivon Pennicott was born in Marietta, Georgia at the end of December in 1985. He began studying tenor saxophone while attending high school in Atlanta, garnering recognition as ...Artist profile


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RAYMOND WEIL celebrates Live from the Artists Den partnership
Swiss watchmaker RAYMOND WEIL celebrated its continued partnership with the Artists Den on October 17th, in Austin, Texas, with a special performance by the French rock group, Phoenix.
In a taping of an episode of Live from the Artists Den, a televised concert series that features popular artists playing in non-tradition settings, Phoenix performed for an intimate crowd of Artists Den lottery winners as part of show's 7th Season which will air in 2014.
As with every Live from the Artists Den concert, this performance was a one of kind event that is memorable and inspiring. Following a main-stage set at the Austin City Limits Festival, Phoenix put on a spectacular show in the gymnasium at Austin's own LC Anderson High School for 800 invited guests. They played jaw dropping renditions of their hits such as "Lisztomania" and "If I Ever Feel Better" as well as new songs from the most recent release "Bankrupt." The evening closed out with the audience joining lead Thomas Mars on stage for thrilling performances of "1901" and "Rome."
Since its launch on U.S. public television in 2009, Live from the Artists Den has become a three-time New York Emmy-nominated series which has rapidly expanded online and internationally. The Artists Den shows are unique in that they are invitation-only and free. Audience members are selected randomly from the Artists Den's mailing list.
This concert was the 2nd installment in RAYMOND WEIL's partnership with the Artists Den which also includes a Sheryl Crow performance at the Plaza Hotel in New York and an upcoming secret show featuring Sara Bareilles on October 24th in California.


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Russia slammed by US for sending anti-ship missiles to Syria
The Obama administration denounced Russia on Friday for providing Syrian President Bashar Assad's regime with anti-ship missiles, saying the weapons would only worsen a war that Washington and Moscow have been promising to work together on stopping.
Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, criticized what he called an "unfortunate decision that will embolden the regime and prolong the suffering." He spoke at a news conference after the New York Times reported that Russia recently delivered an advanced version of Yakhont anti-ship cruise missiles to Syria.
"It's ill-timed and very unfortunate," Dempsey said.
Defense Secretary Chuck Hagel also urged Russia to rethink its military aid, saying that the U.S. and Russia both wanted to stabilize Syria after more than two years of civil war but that the Kremlin's military support makes the situation even more dangerous.
"What we don't want to see happen, the Russians don't want to see happen, is for Syria to erupt to the point where we may well find a regional war in the Middle East," Hagel said.
"So we continue to work with the Russians on their interests and everything we can do to convince the powers that are involved in the region to be careful with escalation of military options and equipment," he said, adding that the U.S. was planning for every military contingency.
Dempsey's comments, in particular, seemed to contradict that of the State Department, where spokeswoman Jen Psaki said earlier Friday that the U.S. was aware of no "new shipments" of the weapons.
For the Obama administration, the anti-ship missiles are the second such worrying report in as many weeks at a time when Secretary of State John Kerry and Russian Foreign Minister Sergey Lavrov say they are coordinating closely to try to get Syria's government and rebels into the start of a peace negotiation. They are hoping the talks begin next month in Geneva.
Almost immediately after last week's announcement by Kerry and Lavrov of a new peace push, Israeli officials warned that Moscow was preparing to give Assad state-of-the-art ground-to-air missile systems in the coming months.
Both sets of missiles would only add to the administration's reservations as it evaluates a range of options, including military ones, to break the stalemate in Syria's civil war and respond to evidence that Assad's forces used small amounts of chemical weapons in two attacks in March. Obama previously declared chemical weapons use his "red line" for a more forceful American intervention, though Kerry and other U.S. officials have since suggested that no such step would be taken while the new peace push still has hope.
The cruise missiles and the new surface-to-air batteries would significantly upgrade the Assad regime's capacity to target manned planes, drones and incoming missiles after its systems were easily circumvented in 2007 when Israeli jets bombed a suspected nuclear reactor site along the Euphrates River in northeastern Syria.
Apparently successful Israeli strikes in recent weeks on weapons convoys to Hezbollah show the Syrian defenses are still far from impregnable, but the new weaponry would make it harder for United States to consider enforcing a no-fly zone in the country or otherwise intervening militarily.
Dempsey also warned specifically about the surface-to-air missiles, saying they provide Syria with defenses at higher altitude and longer range, and with better tracking capability.
"It pushes the standoff distance a little more, increases risk, but not impossible to overcome," he told reporters. "What I really worry about is that Assad will decide that since he's got these systems, he's somehow safer and more prone to a miscalculation."


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Celebrating 15 Years In Durham's Historic Brightleaf District
914 W Main St Durham, NC, 27701 United States
The Federal first opened in March of 2004, after three guys got together and saw a need for a solid neighborhood bar that celebrated Durham. But not just any neighborhood bar, one that served simple but fantastic food, that would exceed expectations. And with this good food came good beer – 14 micros from around the country and a solid bottle selection.


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So you think you have found a bug and would like to report the problem? Before reporting a bug please ensure you have applied all applicable updates to your build environment and also search the MinGW archives and issues ticket system, to ensure the bug has not already been reported, or if a temporary workaround has been suggested.
To ensure that your report will be given the utmost attention, please read and follow the guidelines below. These are provided for your benefit, as non-compliance may result in rejection of your bug report. Although they apply, in this specific context, to MinGW, these recommendations are typical of any bug reporting process.
For general guidance on How to Report Bugs Effectively, you are encouraged to read this treatise by Simon Tatham. Do note, however, that to report MinGW bugs, you should use the reporting facilities documented below; do not report MinGW bugs to Simon -- he is unlikely to be interested.
When reporting a bug to one of the MinGW mailing lists or to the MinGW Issues ticket system on OSDN.net, please include as much as possible of the following information, pertinent to the problem:
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Under certain circumstances you may find a bug in a base package, such as gcc, that is platform independent (i.e. it can be reproduced on another platform other than a Windows operating system). In this situation please generate a simple test case that illustrates the bug using only standard headers and libraries and submit the bug report, following the procedure detailed above, prior to submitting it to the primary maintainers.
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10 Global Elections to Watch in 2014
Forget the midterms: From India to Iraq, Cairo to Kabul, these are the races that will really matter in Washington this year.
While all eyes may be on the 2014 U.S. midterm races, it's important not to forget that often the most significant elections take place beyond U.S. borders. After all, the midterms are likely to be fought over a handful of seats, and few analysts expect a wholesale shakeup of Congress. But for the 10 global elections on this list, all slated to take place in the New Year, the stakes could hardly be higher. The results could mean the difference between war and peace, prosperity and economic chaos—and, in places like Iraq and Afghanistan, where the United States has spent billions to stand up fragile quasi-democracies, might produce dangerous outcomes that will resonate loudly in Washington. We'll be watching closely.
Story Continued Below
Referendum, January
In January, Egyptians will vote on a new draft constitution to replace the one enacted by President Mohammed Morsi in December 2012, just six months before the military forcibly removed him from power. Given how poorly the last constitution turned out for Egypt, a key American ally that has received billions in U.S. economic and military aid, the world will be curious to see how the population reacts to this new draft, which, once approved, will pave the way for presidential and parliamentary elections. Things already don't look so good: The Muslim Brotherhood has rejected the draft constitution; the interim government has labeled the Muslim Brotherhood a terrorist organization; and violence and protests continue to plague cities across the country. Interim government officials think that the new constitution, even though it has been rejected by Egypt's largest opposition group, will mark "once and for all the end of the dark, hated past." But most outside analysts are harshly critical of the military-backed government's crackdown on dissent, and many have lacerated the Obama administration in recent weeks for soft-pedaling its response.
Referendum, Sept. 18
In September, Scotland will decide whether or not to become an independent country for the first time since 1707, when Scotland united with England to form the Kingdom of Great Britain. Recent polls show that more Scots want to remain part of today's UK than want to leave it; but, with the campaign for independence (led by First Minister Alex Salmond of the pro-independence Scottish National Party) yet to kick off in earnest, a third of the population is still undecided. We should expect to see a fair amount of patriotic celebration from the Scots in 2014, and not just because of the vote: June will mark the 700th anniversary of the Battle of Bannockburn, in which, against all odds, Robert the Bruce effectively won Scotland's independence from England. The nationalists argue that independence will improve economic growth and give Scotland more influence on the world stage. In the end, however, sincere doubts about the economic viability of an independent Scotland and its place in the European Union may very well trump nationalistic sentiment. If not, a Scottish secession could reverberate across the whole of Europe: Will it prompt Catalonia to secede from Spain? Will the British House of Commons lurch to the right without the left-leaning Scottish MPs? How will Britain divvy up the oil resources in the British North Sea?
South Africa
General elections, April
The coming year's elections, the first since the death of Nelson Mandela, might shake things up quite a bit in Africa's largest economy. Though the ruling African National Congress (ANC) is expected to remain in power, as it has for the past 20 years, public discontent over corruption scandals, poor access to social services and decaying infrastructure means that the ANC will likely lose ground to other parties, such as the opposition Democratic Alliance and a new populist group, the Economic Freedom Fighters. Further shaking things up, this election will be the first in which the "Born Free" generation, those born after 1994 , will be eligible to vote. With no memory of life under apartheid, the Born Frees are significantly less loyal to Mandela's ANC than older generations, and they care more about unemployment and poverty than race relations. If these youngsters turn out in fairly large numbers, 2014 might be the most exciting elections South Africa has seen in two decades.


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Need for Speed: Most Wanted is the first from the Need for Speed stable to appear on the PS Vita and the transition has managed to retain the excitement of a top class, no holds barred, open world racing game boasting a large range of customizable high performance cars.
Super Gamer Dude
PS Vita
Although Need for Speed Most Wanted is yet another installment of the long running Need for Speed series this is its first outing on the PS Vita system and the designers have done their utmost to make such a transition worthwhile.
The first question that players are almost certain to ask concerns the graphics. Rest assured that although the graphics are not as good as those on the console versions they are still quite effective and players will not be disappointed. The system puts up quite a spectacular visual show when the game is first powered up showing just what the Vita is capable of. There are some minor problems such as pixelation in the oncoming car headlight beams and a similar problem in some of the poorly lit areas, but this sort of problem is also encountered in other games and does nothing to detract from the overall quality.
Another problem with the relatively small Vita displays, though not really a graphics quality problem, is that too much needs to be crammed into a small space limited by resolution. The maps for navigating the large game world are a little too small to read easily while trying to drive at the same time. That is a shame because there is so much to see in the games arena that lots of time can be spent just looking around and becoming familiar with the different areas and the racing possibilities and the map is useful here. Another aspect of the lack of screen resolution is that some fine detail that would be visible on a larger screen is lacking here, bur overall there is more than enough detail on the vehicles to make them interesting.
No matter how good or poor the graphics, within reason, it is the game which matters. The mechanics of the game itself is pretty much what you would expect from Need for Speed. The cars handle well and give a good feeling of realism but some might find the controls a little touchy. There are all the expected no holds barred competitions where you can write off other cars, or anything else that gets in your way, while breaking every traffic law, except parking in a restricted area, on your way to achieving the epithet of most wanted.
The menus are sensibly thought out and items on the menus can be accessed via the touch screen facility. The basic ideas of the game are just variations on a racing theme with competitors to beat and the law to stay one step ahead of, and it would be a disaster if a racing game presented poor racing action. The developers have been in the game long enough to have got the racing fundamentals pretty much sewn up.
The multiplayer mode provides the most competitive excitement in a racing game, as nothing compares with a competitor with a brain instead of an AI. There is only provision for 4 players compared with 8 on the consoles but that is enough to put an edge on the races. Between races the players can roam around at will but when the next race starts there is then another sort of race by default to get to the start point quickly. There are the usual trophies to be had and upgrades to be earned but this stuff is the staple of any competitive game. There is of course an autolog which keeps track of your racing achievements and broadcasts them inviting suitable matches.
The list of available cars is impressive and includes Lamborghini Aventador LP 700-4, Ford Mustang Boss 302, and Subaru Cosworth Impreza STI CS400, Porsche 911 Carrera S, BMW M3 Coupe and many more. Some top rated cars for a top rated game.


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the Shoe Department
Hours And Locations for Shreveport, Louisiana
Category: Shoes-Retail
About SHOE SHOW, INC.
Founded in 1960 in Kannapolis, NC, SHOE SHOW, INC.'s success has been based on a simple formula of providing quality products, service and value.
Over the past fifty-six years SHOE SHOW, INC. has continued to grow with stores named SHOE SHOW, SHOE DEPT. and Burlington Shoes. Currently SHOE SHOW, INC. has 1151 locations in 44 states.
SHOE SHOW, INC. has maintained its formula of success through technological advances and operating efficiencies; such as, standard store design, an efficient distribu ...
There are over 1,000 the Shoe Department locations in the US.
the Shoe Department Hours And Locations for Shreveport, Louisiana LA
9530 Mansfield Road
Hours — Tue: 9:30am-9:00pm
Hours — Tue: 9:30am-9:00pm
1133 St Vincent Ave #280
Hours — Tue: 10:00am-9:00pm
Hours — Tue: 10:00am-9:00pm
3703 Jewella Rd
Hours — Tue: 10:00am-8:00pm
Hours — Tue: 10:00am-8:00pm
Locations currently open are Green and those currently closed are Red.
As of:6:42 am (CDT) Tue Oct 22. [Change]
As of:6:42 am (CDT) Tue Oct 22. [Change]
See all the Shoe Department locations nationwide.


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Possible Duplicate:
Correct position of "only"
Should I use only before or after the pronoun?
If only I had a chance
If I only had a chance
Both sentences bring a lot of results and both seem to be the name of songs. Are both correct? Is there a rule for similar sentences?


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I am a Smith faculty member; may I schedule a class visit outside of regular Museum hours?
Yes. With two to four weeks' advance notice, the Museum can make arrangements for Smith College classes to visit the galleries or the Cunningham Center for the Study of Prints, Drawings, and Photographs outside of their normal open hours. Information about scheduling a visit is available here.
I am bringing a group to the Museum, but I do not want a guided tour. Do I still need to call and schedule the visit?
Yes. If you plan to bring more than 10 people to the Museum, please contact us three to four weeks in advance, to arrange your visit. This helps us to welcome and accommodate your group. More information about scheduling your visit is available here.
How can I learn about opportunities to volunteer or to work at the Museum?
Smith students interested in working or volunteering at the Museum can find detailed information about the available options here.


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Octavo, paper covers, 122 pp. In Hebrew. Bookseller Inventory # 65066
Title: Horev: Me'asef mukdash le-toldot Yisra'el ...
Publisher: Alumni Fund Teachers Institute of Yeshiva University
Publication Date: 1935
Binding: Softbound
Book Condition: Very Good
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RYTARY is contraindicated in patients who are currently taking or have recently (within 2 weeks) taken a nonselective monoamine oxidase (MAO) inhibitor (e.g., phenelzine, tranylcypromine). Hypertension can occur if these drugs are used concurrently.
Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with levodopa (a component of RYTARY) have reported falling asleep while engaged in activities of daily living, including the operation of motor vehicles, which sometimes resulted in accidents. Although many of these patients reported somnolence while on levodopa, some perceived that they had no warning signs (sleep attack), such as excessive drowsiness, and believed that they were alert immediately prior to the event. Some of these events have been reported more than 1 year after initiation of treatment. Before initiating treatment with RYTARY, advise patients of the potential to develop drowsiness and specifically ask about factors that may increase the risk for somnolence with RYTARY, such as concomitant sedating medications or the presence of a sleep disorder. Prescribers should consider discontinuing RYTARY in patients who report significant daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., conversations, eating). If a decision is made to continue RYTARY, patients should be advised not to drive and to avoid other potentially dangerous activities that might result in harm if the patients become somnolent.
Withdrawal-Emergent Hyperpyrexia and Confusion: A symptom complex that resembles neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology, has been reported in association with rapid dose reduction of, withdrawal of, or changes in dopaminergic therapy. Avoid sudden discontinuation or rapid dose reduction in patients taking RYTARY. If the decision is made to discontinue RYTARY, the dose should be tapered to reduce the risk of hyperpyrexia and confusion.
Cardiovascular Ischemic Events: Cardiovascular ischemic events have occurred in patients taking RYTARY. In patients with a history of myocardial infarction who have residual atrial, nodal, or ventricular arrhythmias, cardiac function should be monitored in an intensive cardiac care facility during the period of initial dosage adjustment.
Hallucinations/Psychosis: There is an increased risk for hallucinations and psychosis in patients taking RYTARY. Hallucinations present shortly after the initiation of therapy and may be responsive to dose reduction in levodopa. Hallucinations may be accompanied by confusion, insomnia, and excessive dreaming. Abnormal thinking and behavior may present with one or more symptoms, including paranoid ideation, delusions, hallucinations, confusion, psychotic-like behavior, disorientation, aggressive behavior, agitation, and delirium. Because of the risk of exacerbating psychosis, patients with a major psychotic disorder should not be treated with RYTARY. In addition, medications that antagonize the effects of dopamine used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of RYTARY.
Because of the risk of exacerbating psychosis, patients with a major psychotic disorder should not be treated with RYTARY. In addition, medications that antagonize the effects of dopamine used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of RYTARY.
Impulse Control/Compulsive Behaviors: Case reports suggest that patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications, including RYTARY, that increase central dopaminergic tone and that are generally used for the treatment of Parkinson's disease. In some cases, although not all, these urges were reported to have stopped when the dose was reduced or the medication was discontinued. Because patients may not recognize these behaviors as abnormal, it is important for prescribers to specifically ask patients or their caregivers about the development of new or increased gambling urges, sexual urges, uncontrolled spending, or other urges while being treated with RYTARY. Consider a dose reduction or stopping the medication if a patient develops such urges while taking RYTARY.
Dyskinesia: RYTARY can cause dyskinesias that may require a dosage reduction of RYTARY or other medications used for the treatment of Parkinson's disease.
Peptic Ulcer Disease: Treatment with RYTARY may increase the possibility of upper gastrointestinal hemorrhage in patients with a history of peptic ulcer.
Glaucoma: RYTARY may cause increased intraocular pressure in patients with glaucoma. Monitor intraocular pressure in patients with glaucoma after starting RYTARY.
Melanoma: Patients with Parkinson's disease have a higher risk of developing melanoma than the general population. Patients and providers are advised to monitor for melanoma frequently and on a regular basis when using RYTARY.
Clinical Trials Experience:
- Early Parkinson's Disease: Most common adverse reactions (incidence ≥ 5 % and greater than placebo) are nausea, dizziness, headache, insomnia, abnormal dreams, dry mouth, dyskinesia, anxiety, constipation, vomiting, and orthostatic hypotension.
- Advanced Parkinson's Disease: Most common adverse reactions (incidence ≥ 5 % and greater than oral immediate-release carbidopa-levodopa) are nausea and headache.
Postmarketing Experience: Reported adverse reactions identified during post approval use of RYTARY include suicide attempt and ideation. Because these reactions are reported voluntarily from a population of unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to RYTARY exposure.
Monitor patients taking selective MAO-B inhibitors and RYTARY. The combination may be associated with orthostatic hypotension. Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, risperidone, metoclopramide), isoniazid, and iron salts or multivitamins containing iron salts may reduce the effectiveness of RYTARY. Monitor patients for worsening Parkinson's symptoms.
Pregnancy and nursing mothers: RYTARY should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Caution should be exercised when RYTARY is administered to a nursing woman.
Pediatrics: Safety and efficacy in pediatric populations have not been established.
The acute symptoms of levodopa/dopa decarboxylase inhibitor overdosage can be expected to arise from dopaminergic overstimulation. Doses of a few grams may result in CNS disturbances, with an increasing likelihood of cardiovascular disturbance (e.g., hypotension, tachycardia) and more severe psychiatric problems at higher doses.
See Full Prescribing Information for instructions for starting levodopa-naïve patients on RYTARY and converting patients from immediate-release carbidopa and levodopa to RYTARY (Table 1). The dosages of other carbidopa and levodopa products are not interchangeable on a 1:1 basis with the dosages of RYTARY.
RYTARY should not be chewed, divided, or crushed. Swallow RYTARY whole with or without food. A high-fat, high-calorie meal may delay the absorption of levodopa by about 2 hours.
For patients who have difficulty swallowing capsules, administer RYTARY by carefully twisting apart both halves of the capsule. Sprinkle the entire contents of both halves of the capsule on a small amount of applesauce (1 to 2 tablespoons) and consume the mixture immediately. Do not store the drug/food mixture for future use.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. To report SUSPECTED ADVERSE REACTIONS contact Impax Laboratories, Inc. at 1-877-994-6729.
Please see Full Prescribing Information.
RYTARY is a combination of carbidopa and levodopa indicated for the treatment of Parkinson's disease, post-encephalitic parkinsonism, and parkinsonism that may follow carbon monoxide intoxication or manganese intoxication.
|RYTARY [package insert]. Hayward, CA: Impax Laboratories, Inc.; 2016.
|Pahwa R, Lyons KE, Hauser RA, et al; APEX-PD Investigators. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease.
Parkinsonism Relat Disord. 2014;20(2):142-148.


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Times are looking tough for Ivory Coast.
While Senegalese President Abdoulaye Wade lobbies for a West African-led military invasion in Ivory Coast, the Ivorian military is threatening to mount a devastating defense on behalf of incumbent President Laurent Gbagbo, who just about every major world leader considers the clear loser of the Nov. 28 election.
But the real battle for the world's No. 1 cocoa producer isn't happening on the streets of the commercial capital, Abidjan. It's unfolding in the bank corridors where cocoa revenues are wired, where tax reserves are cashed, where government debt is issued, and where government debtors come to collect their "coupon."
Understanding Ivory Coast's financial war is key to fathoming the calm exuded by supporters of President-elect Alassane Ouattara, who have been playing cards at the Golf Hotel where their candidate, an economist and former deputy managing director of the International Monetary Fund, has been living off helicoptered-in food for weeks.
Some rosy day, Ivory Coast may have a president – or its version of a 38th parallel – but until that dawn, here are the five questions that should determine the outcome of what must be the most convoluted conflict of the year.
1.) Who controls the Central Bank?
Unlike Kenya or Zimbabwe, Ivory Coast's power struggle is taking place in an economy that was never set up for full-fledged independence from its colonial power, in this case, France. The country's currency – the West African CFA Franc, a banknote used in eight West African countries – serves as a nummary expression of how geopolitically pegged the country is to France and the other West African nations she colonized.
What that means for the two men who would be president is that the currency they use to pay their shadow governments isn't born in Ivory Coast. It's born in Dakar, Senegal, where, on Christmas Eve, the Central Bank told journalists that it will no longer recognize Mr. Gbagbo as president.
It could take an epoch before that principle becomes a bureaucratic reality. Last Friday, the Burkina Faso-based monetary union that sets policy for the bank brought bank officials to an orientation session in Mali with a "get a move on it" message.
But for Gbagbo, the bank's decision means he is essentially cut off from the financial apparatus of his own country. If he wants to take out a government bond – essentially a giant IOU to investors looking for a risky buy – he'd need the central bank to advertise, auction, manage, and sell it. If he wants to make a withdrawal from Ivory Coast's tax reserves, he'd have to practice forging Mr. Outtara's signature.
2.) Who's responsible for the government's debt?
But there's a catch: Ivory Coast doesn't just need money. It owes money.
In fact, the country owed a $29 million interest payment on a $2.3 billion bond that was due Dec. 31 – and it still hasn't paid.
"The bill should be paid only when the international community recognizes Laurent Gbagbo," the incumbent's spokesman Ahoua Don Mello told Bloomberg News last week. "I think it would be curious to ask our government to pay while the international community doesn't recognize it."
On Tuesday, however, Gbagbo's Finance Ministry reversed that tone, and said they'd make the payment before a 30-day grace period triggered a default that would essentially excommunicate Ivory Coast from the global finance community.
But Gbagbo's government, as bond analyst Samir Gadio wrote in an e-mail, "would probably be unable to do so even if the political will existed and the treasury authorized the transaction. Indeed, the payment would have to be channeled via the Central Bank of West African States which now recognizes Outtarra as president."
3.) How long can Gbagbo pay his government?
"Although Gbagbo appears to be backed by the Army at this stage, this will be conditional on his ability to pay the security forces in the coming months," Mr. Gadio added.
He leaves out the part where soldiers pay themselves, or rather, coerce innocent people crossing borders and roadblocks to dash a little something from the bottom of their hearts/wallets. Among West African soldiers, Ivory Coast's fighting force has a reputation for masterful extortion, but it may not be enough to keep an entire government grinding on in the face of international isolation.
Salaries alone cost Gbagbo's administration $170 million a month, according to British newspaper The Guardian. Expect the military to enjoy first dibs on whatever wage money the government scrounges up. And since the election, it's been able to scrounge up enough to pay some of its servants some of their money, even if it's a few days late.
4.) How much control does Gbagbo have over cocoa and oil?
If Gbagbo has been able to keep his troops fed and his functionaries paid, it's in no small part because the lush, tropical stretch of Ivory Coast he controls happens to be the cocoa basket of the planet. The most fertile cocoa hills of Ivory Coast stretch right through sections controlled by Gbagbo's supporters.
But that industry has been nearly milked dry: Up to 40 percent of the export price of Ivorian cocoa consists of the government's take, both formally and informally. In coming chaotic months, as soldiers, ruffians, and bureaucrats skim more and more revenue off cocoa farmers, truckers, and traders, expect to see more cocoa smuggled across the Ghanaian border, where farmers earn nearly twice the $2 a kilogram they fetch in Ivory Coast.
But Gbagbo's government need not live on chocolate alone: The IMF suspects that state revenue from Ivory Coast's oil reserves may actually exceed the $1 billion a year it fetches from the cocoa harvest. How he'll manage, keep, invest, and pay out that revenue could help determine how long he can hold on to the Ivorian throne.
5.) Is the Idea of a new Ivorian currency for real?
In the last-minute drive to keep their government fed, Gbagbo's closest advisers are rushing to build the apparatus of a self-sufficient state – something intrinsically different from the Ivory Coast envisioned by Francophiles that founded it.
The notion of tossing up a strident, self-isolated Ivory Coast that more closely resembles Zimbabwe (where Gbagbo has sought advice) than, say, Senegal, may seem like a wide-eyed, midnight hour-idea meant to stave off an impending regime collapse. But it's closer to the entire raison d'être of Gbagbo's movement.
"They have an obsession with autarky," meaning economic self-dependence, International Crisis Group analyst Rinaldo Depagne told The New York Times. And it's an obsession that's had a long time coming.
Much is mind-boggling about the Ivorian conflict, but this much is clear: The country was founded with limited economic independence from France, from which it benefited from 40 years of stability, impressive growth, and French aid, while neighboring Ghana, now a rising world market, suffered the madness of military coups and banknotes that dove in value like pogs.
Today, not Ivory Coast, but rather Ghana leads West Africa, and the French ties seem more a disadvantage than a safety precaution. Growth in the eight countries that use the West African CFA franc, which is tied to the euro, has lagged behind the sub-Saharan African average.
The Gbagbo era has marked a perhaps inevitable backlash to Ivory Coast's French-friendly policy, and the latest expression of that resentment is the Gbagbo's Currency of the Ivoirian Resistance. It's the bills that Gbagbo's team has proposed printing as a way to pay civil servants and soldiers. As a currency, analysts say the MIR would almost surely be a disaster. But the irony is that, whenever the ruckus dies down, it might not be such a terrible idea.
"A large chunk of Africa is tied to the least adaptive zone in the world," African Development Bank Chief Economist Mthuli Ncube told Bloomberg News in June. "Surely, that's a disadvantage."
If there's hope for whatever comes out of this political crisis, it's that the conflict – messy and destructive as it has been – may offer this nation a fresh chance to reclaim its place as an economic leader in West Africa.
RELATED: Ivory Coast, Sudan referendum: Africa stories to look out for in 2011