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Jacob Frenkel, an inflation hawk who was Bank of Israel governor in the 1990s, will be returning to the helm of the central bank, Prime Minister Benjamin Netanyahu and Finance Minister Yair Lapid said on Sunday.
They appointed Frenkel to replace Stanley Fischer, who is stepping down at the end of June after eight years on the job, having guided Israel's economy through the global financial crisis.
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Frenkel, 70, beat deputy governor Karnit Flug, who will likely be acting central bank chief until Frenkel starts. The date of his arrival was not announced.
"He is a world renowned figure, which is what Netanyahu was looking for," said HSBC economist Jonathan Katz.
As governor between 1991 and 2000, Frenkel was credited with reducing inflation, liberalising financial markets and removing foreign exchange controls.
He is currently chairman of JPMorgan Chase International and also served as vice chairman of insurer American International Group as well as chairman of Merrill Lynch International. Frenkel also is the head of the Group of Thirty, a private consulting group on international and financial issues.
"We are certainly talking about a governor who will act as the responsible adult, who will fill the position of Fischer with quality and authority," said Joseph Fraiman, chief executive at Prico Risk Management and Investments.
"No less important, Frenkel will benefit from the international credit that is greatly needed for the Israeli economy, especially in the current period," he added.
Frenkel, whose appointment needs cabinet approval, will face several challenges including continuing Fischer's insistence that the government stick to responsible policies and working to halt fast-rising home prices.
Israel's economy grew 3.2 percent in 2012, but is expected to slow to a 2.8 percent this year excluding the start of natural gas production.
Inflation, which ranged between 1.3 and 18 percent in the 1990s, was at an annual rate of 0.9 percent in May. At the same time, the shekel is strong.
To encourage economic growth and keep exports competitive, the Bank of Israel reduced its benchmark interest rate twice in May, to 1.25 percent. The central bank next decides on Monday and analysts largely believe the key rate will stay unchanged.
When Frenkel was last in the job, the governor alone made interest rate decisions. Now, there is a six-member monetary policy committee with the bank chief as chairman.
"Frenkel will need to work harmoniously with the monetary council he inherited from Fischer," said Yaniv Pagot, chief strategist at the Ayalon Group. "This is not a simple challenge that could, in a certain situation, bring the first cracks."
He said that, with Israel's foreign exchange reserves nearing $80 billion, it would be interesting to see whether Frenkel would continue intervening in the foreign exchange market and buy dollars to defend Israel's exports if the shekel continues to appreciate.
(Additional reporting by Tova Cohen and Allyn Fisher-Ilan; Editing by Robin Pomeroy)


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Drum Dump Feeder Discharges, Feeds Volumetrically To Equipment
Flexicon's Self-contained Drum Dump Feeder discharges bulk material from drums and feeds it volumetrically to downstream equipment.
An all-new TIP-TITE Drum Dump Feeder from Flexicon seals drums against a discharge cone, tips the drum and feeds bulk material into downstream equipment, dust-free at controlled rates.
The drum platform is raised by a single hydraulic cylinder, creating a dust-tight seal between the rim of a drum and the underside of the discharge cone. A second hydraulic cylinder tips the platform-hood assembly and drum, stopping at dump angles of up to 90 degrees with a motion-dampening feature. Material flowing through the discharge cone charges the intake adapter of a cantilevered flexible screw conveyor that feeds downstream equipment volumetrically.
Available in stationary and mobile configurations, the Drum Dump Feeder is offered with cantilevered flexible screw conveyors in custom lengths oriented horizontally (shown), or at an incline, for the purpose of elevating, as well as metering, the material.
Gentle rolling action of the flexible screw conveyor in an enclosed tube reduces agglomerates discharged from drums, improving feed rate accuracy.

subset: commoncrawl


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A similar Alrose vase is on Ebay, there is no label on mine. :arrow: http://cgi.ebay.co.uk/ws/eBayISAPI.dll?ViewItem&item=7343117962&rd=1&sspagename=STRK%3AMEWA%3AIT&rd=1
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This next one, I am certian it is ultra modern. I've seen "Cello" stickers on some of them. On ebay, I see these attributed to Murano but I'm suspicious about that. Some are priced at £25 but I can buy new one's for the same price or less
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Link to my Instagram of what I winged up to note
Veggies and Vermicelli noodles - Soup
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LitFic for People Who Hate LitFic
Cheryl Morgan has posted Emerald City #124, which includes a feature article by me, "Literary Fiction for People Who Hate Literary Fiction", a piece I'm rather fond of because it ended up taking a lot more work than I had thought it would, and got me thinking about some assumptions of my own that I hadn't adequately questioned. I'm not sure much of that comes out in the article, which is pretty straightforward, but the process of revising it a few times for Cheryl forced me to have to consider some things I hadn't about the differences between readerly expectations within marketing categories. These ideas still feel vague and inchoate, but eventually I will probably explore them here or at Strange Horizons or elsewhere. We shall see. For now, though, there's the article, which is not comprehensive at all, but is, instead, an invitation for people to explore writers they might otherwise think are not their sort of thing.


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|I used this Bobrovsky illustration by @PREDSmyth again cause I like it.
Thinking about the time leading up to the trade deadline, and I felt 'gosh, they win a game or two here, and they might be buyers at the deadline'. Well, they won those games. Then there was the incredible road trip to end the season in which they went 5-1. I don't know how many times before that road trip that I said 'stick a fork in them, they're done'. But the teams resiliency and belief came through time and again, to build up to the fantastic crescendo at the finale.
So now what?
I remember well after the 2008-09 season we were all certain that our core of young players was ready to move forward, and we would be going deeper into the playoffs. We all know that in that Olympic year, with a compressed schedule, and little or no practice time (sound familiar?), that after a franchise record (at the time) hot start, the team went on a disastrous December swoon, and soon started tuning Hitch out. That was the beginning of a three year regression, with intermittent bright spots. And there is a part of me that fears the same thing might happen next year. On the other hand, there are also some real differences.
For instance, how do you chop the head off an amoeba?
In the 2009-10 team it was clear that opposing teams had the mantra, stop Nash and you can beat the rest. Faced with that relentless gauntlet, Nash was unable to pull the whole team along with him, and the house of cards collapsed in December. It didn't help that the goal tender had decided that 'hey, this NHL stuff is easy' and reported to camp in less than Olympic athlete condition, which began Mason's long regression.
So there is a deep, primal hockey fan fear in me that this could turn out the same next year, that this team regresses instead of moving forward. Look at the Florida Panthers this year. They won the SouthLeast last year, but are picking second this year, having lost the lottery. So what are some things that I look for to find hope, instead of fear?
One, I rely on Bob's relentless work ethic, that has been an evident part of his character for years. I don't think that is going to change. I believe he will take his No. 1 goal tender status into the summer as a precious jewel because he knows how it can change (see re: Bryzgalov). I think he will want to take things to another level next year, and I think he will be motivated to make the playoffs. There will be a pretty spirited battle for the number 2 slot behind Bob between Curtis McHelinney down in Springfield and Michael Leighton, who is not as bad as those people from the desert planet of Philadelphia would have you believe. We may have a pretty good netminder as number 2 next year, not to mention the young talent in the pipeline (Anton Forsberg, I'm talkin' to you).
Another thing I rely on is the fact that Nick Foligno is saying that this is the most fun he's ever had playing hockey. Winning is fun. If we had the first or second pick, he might not be singing the same tune. This team had a taste of both sides of that coin, losing and working through that to winning. It gives one hope to know that the core of this team knows that if you buckle down, work hard, and stick with it, that the good things will come on the other side.
The other thing, is this team has great character depth, a subject for a future blog, but relevant here as well. The 2009-10 team was relying on RJ, Boll, and Dorsett to provide character. The 2013-14 team has character throughout the lines and pairings. Its not just Nash trying to lead the way, its everyone (hence the earlier amoeba reference). This is a large buffer against regression.
I hope JD and Jarmo bring back Vinny, and Aucoin for that matter. Go that one year contract route. I thought those guys provided an awful lot to what is still going to be a very young team. Oakes will miss some time due to injury, its part of the package, but that's just opportunity for the young guys.
So at the end of the day, there are some distinct differences between the 2009-10 team, an the 2013-14 team. That is what gives me hope that this year was a foundation, instead of an improbable bright spot in a sea of darkness.


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As satisfying as it is to come up with a recipe and then blog about it, it can sometimes be almost as delicious to let someone else do all the hard work for you.
So this week, I tried out two recipes from other blogs that I had been eying for a while. Suganya's Carrot Halwa-Flavored Muffins and Pavithra's Turnip Greens Curry.
Suganya's Carrot Halwa Muffins
The minute I saw this recipe, I wanted to make it. Carrot Halwa is one of my favorite dishes, and cardamom is just about my favorite spice in the world. I often flavor sweets, including muffins, with cardamom, such as in my Applesauce Mini Muffins, but the combination of cardamom and carrots was hard to resist.
I followed Suganya's instructions faithfully, except that I subbed half the all-purpose flour with whole-wheat to make them even healthier. I also did not add raisins because I didn't want them to be any sweeter, but the muffins turned out just delicious even without them. These muffins do not rise much, but maybe the fact that I used some whole-wheat flour had something to do with that.
These were a real treat– in fact they were almost cupcakey with the distinct flavor of gajar halwa, thanks to the cardamom. And the fact that they had carrots and pineapple in them made them fairly guilt-free. Despite all of Desi and my resolutions to cut down on sweets, these didn't last too long in our kitchen.
Pavithra's Turnip Greens Curry:
I picked up a huge bunch of turnip greens at the grocery store this week because they were on sale. I have never tried turnip greens before, so I was also a little curious about them.
I wanted an Indian recipe, preferably a curry, to serve these up on a weeknight. And when I came across Pavithra's post, it hit the spot.
I used small lima beans in the curry rather than the rajma, only because I didn't have any rajma on hand. Otherwise I was faithful to Pavithra's recipe, and I'm glad I was, because it was an absolute winner.
The turnip greens cooked up light and flavorful and delicious, and the spicy-sour flavor of the curry paired beautifully with just some boiled rice.
I have not posted the recipes because I barely deviated from them, but you can find them here and here.
Thanks, Suganya and Pavithra, for your delicious and inspiring cooking. Toques off!


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In watching the unfolding events of 2009, it has come to my attention the importance and relevance of the 10th Amendment within our Constitution. There are several federal issues that can drastically affect the American constituent and consumer. Two, that immediately come to mind are:
HR-3200, America's Affordable Health Choices Act of 2009
HR 2755 – The Federal Reserve Abolition Act
I am 27 years old. Five years ago I was planning on opening a restaurant. Today, I am trying to figure out how to help win the Country back to the way its Founders intended. If I were preparing for the government to
- Overtake Healthcare
- Continue monopolizing the dollar so that is has absolutely no value whatsoever
I would focus on State Sovereignty, and the powers that the States have to protect their citizens from the far-reaching and detrimental effects of attacks on our Constitutional rights.
This is the power of the 10th Amendment. And we encourage our readership to learn about this, and what your State is doing to protect you.
Please visit: The Tenth Amendment Center for additional information.


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NFL Catch Of The Week: Brandon Marshall Makes 2 Defenders Look Like Sh*t!
"BRANDON MARSHALL IN THE 2012 PRO BOWL MAKES A CIRCUS CATCH" - eraymond49
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We Chat with Pastry Chef Thiago Silva of The General and Catch
"For me the guest relation is important. Obviously it's great when you hear something through a server, but when you give someone a cake you've been working on for two weeks and see their reaction, it's priceless."
Thiago Silva does some pretty fun things with sugar. At EMM Group's The General, he's got a hot doughnut station out in the front of the restaurant and molds coconut sorbet into a shell alongside sticky coconut cake. At Catch he's plating up buckets of warm cookies. And on the side, he makes celebration cakes that explode graffiti or, recently, one with sugar bubbles and a giant rubber ducky for his wife, with whom he just had his first child.
Silva has a fun laugh, despite the stress of running gigantic kitchens and huge teams. Maybe it's the creative choice in kitchen music (see below). Or maybe it's because he was raised with an inclination for hard work and a strong drive to succeed. We caught up with Silva on how family brings things full circle and how his Brazilian roots seep their way into every plate he crafts.
Let's go back to the beginning for a minute. I want to talk about your mom... My mom!
Your mom. Because you're a little gushy sometimes about your mom. Yeah, I love my mom. Ha!
Your mom had been living here for two years before she brought you and your sister up from Brazil. You were young, right? The first time she came over I was six.
Do you remember a lot about that? I remember her leaving and us staying with my grandparents. It was two years but it seemed like it flew by. I do remember when she came back and how emotional that was. When she came back she said, "We're going to Disney!" In reality we were coming to Queens.
How did that shape you? My mom was a single parent and was always working. So it's not like we saw her all the time because she was always trying to improve our lives. And I was so in synch with my grandpa, who was like my dad, and my grandma, so that void was kind of taken care of. But after we saw her again after that time apart, it was really emotional. I cried like a baby.
Your mom was obviously a really hard worker. Did that impress something on you? She was always trying to progress and always put us ahead of herself. Whenever there was another little stupid job she could do she took it for the extra money, not for herself but to buy us a shirt or something. And she didn't care what it was; she would always just try to do it the best she could do. That said a lot to me.
Do you feel like you take on too much now, with that background? Yes, yes, yes! I've been working on holding back a bit and delegating.
You're also a singer—do you sing in the kitchen? I do not... Okay, I do. But I always have to have a stereo on.
What kind of music's in your kitchen? Well, now I'm bouncing around restaurants and I let my sous chefs choose. And most of my sous chefs are women. And they love to listen to Disney! It drives me bonkers.
Moving onto your restaurants; what excites you about what you get to do? At Catch I do something that's common to the American palate but with a modern twist to it whereas as the General it's an Asian restaurant. So, yeah, it's like, "Who's this Brazilian guy doing Asian desserts?" But it's kind of pushing me to my limits. I play around with common things with a little difference in flavor, so more like Asian-inspired desserts.
Example? Like a cheesecake put in a spring roll with yuzu and Thai basil. It's just a bit different and Asian-ized.
Does your heritage play into your menu? I feel like I put a little of me in everything. I don't think it's necessarily noticeable but I always try to put a little Brazil into my desserts.
Like where? Like the sticky coconut cake at The General. Coconut's a big thing in Asia but it's also big in Brazil, and I use the same soak that I use in my Brazilian cakes. Sweetened condensed milk is in Brazilians' cabinets everywhere and I love to use it. You can't go wrong. Even the custards in the doughnut are Brazilian-style custard that I used to do when I was little.
You have two very big restaurants with a high volume of plated desserts, and you build massive celebration cakes on the side. Why both? They're so different. With plated desserts you need speed and finesse. When you do a cake you need to hold back—it's more detail-oriented.
What about celebration cakes do you like so much? I'm working with another person to do it. Somebody had this thought, like, "Hey, can I get a Harley Davidson cake?" It's not like it's my idea and it went on a menu—it's our idea. It's more personal.
Pastry chefs are often a bit removed from the guests in a restaurant. Does this bridge that gap for you? For me the guest relation is important. Obviously it's great when you hear something through a server, but when you give someone a cake you've been working on for two weeks and see their reaction, it's priceless. And I never found a company or restaurant that I could do that with until I came to EMM Group. They really invested in it. I was always trying to do that, to have that connection with people, with my guests.
You also do the construction and mechanical things. I saw that crazy exploding confetti cake. Are you ever afraid that something's not gonna work? Always! I don't think there's anything I could tell you that would make you understand how much pressure is on me when I do these because every cake is a first timer. Every time.
So you didn't make a test "blow-up-confetti-cake" before to try it out? No, I had never tested that confetti cake. It was crazy. A tremendous amount of pressure. Because that's it. If you mess that huge project you can't go back and fix it.
How much do you take into consideration how the cake is going to taste? Because after being manhandled so much—brushed, sprayed, molded, moved—I usually wonder if the cake inside has been given the same amount of love. Yeah, one thing that pisses me off is when I make this massive cake, and they don't eat it. I do take a lot of pride in making a cake that your guests are going to eat and enjoy. It's really important to me.
So, you've been baking since you were little. Since I was thirteen.
Do you recall a moment of paying your mom back or making her proud, that you felt like you've made it to some degree? I don't think there's anything I could do to make her not proud of me, knowing my mom. But I always want to do more, and eventually I want her to stop working. I want to be able to help out. That's what I'm trying to do.
You just had your first child, baby James! What do you want food to mean to him most prevalently? Well, I don't want him to be like his mother; I want him to eat everything.
Your wife is a picky eater? She's the worst. You can put that in, I tell her all the time. I definitely want my son to try everything once—"don't say you don't like it if you haven't tried it". And I want my kids to know how to cook.
What, to you, is the most important thing about knowing how to cook? It's just so gratifying. Not only when you've had a rough day and you make yourself something but also when you do that for your family or a friend—they come home and are miserable and you see how much better it makes them feel. No matter what happens, or how bad life is, people always want to go out and eat. It's just something that you have to be able to know how to do—to cook for people and see how they feel, how gratifying it is. I think if you're a chef, that's why you do it—it's a lot of hard work, but it all pays off. I just want my son to eat everything.
This post may contain links to Amazon or other partners; your purchases via these links can benefit Serious Eats. Read more about our affiliate linking policy.


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Printer Sharing for Windows XP Printer sharing is a great tool when you have several computers but only one printer. With printer sharing, you can have your printer connected to only one computer, and allow all computers on the network (computers connected to the router) the ability to print to the printer. Not only will computers that are hardwired into the network be able to print, but also if you have a wireless router, those computers with wireless cards both desktops, and laptops can print "wirelessly" to the printer as well. Your Windows XP based computer has everything you need to do this already built in.
Step 1.
Share the Printer
You will need to get onto the computer that has the printer connected to it. On that computer, simply go to Start –> Control Panel –> Printers and Faxes.(You may have to enable classic view in order to view this icon) Here you will see a listed of installed printer imaging devices attached to your computer. If you have more than one printer attached to the computer, such as an inkjet printer and a laser printer, you will see a black circle with a white checkmark; this indicates which printer is set as the default. Right click on the printer that you want to share, then click on properties. When the new window appears, you want to click on the "Sharing" tab at the top of the window. You will notice two radio buttons, you will want to click the radio button that says "Share this printer". Once that button is pressed, the "Share name" box will automatically appear with a name that will refer to your printers shared name. I would recommend changing this to your printer brand with a space and then its model number, for example BROTHER 7820. Once your printer has been shared, and given a shared name, click apply at the bottom of the window.
Step 2.
Connect to the shared printer.
Once the printer has been shared, you can now get onto your other computer that you want to be able to print from. Now we need to install the printer on the computer that it is not connected to. On the computer that is not connected to the printer, go to Start –> Control Panel –> Printers and Faxes. In the blue pan to the left, you will see a box that the top that says Printer Tasks, and below that is Add a printer. Click on Add a printer, and this will show the Add Printer Wizard, and click next at the bottom of that screen. On the next screen, you want to select the option "A network printer or printer attached to another computer", and click next. The next screen asks, what printer do you want to connect to, and keep the option selected on Browse for a printer, and click next. Now, if you properly shared your printer in step 1, it should appear with the name that you gave it, and the printer that it is connected to. Simply select the printer, and click next. The computer will now attempt to install the drivers for your printer, if it does not have the drivers available, you will need to download them, or insert your installation cd, and point the installer were to find the printer drivers. Once the drivers have installed, you will see a screen asking if you want this new installed printer to be the default printer, it more than likely will be.
Step 3.
Test the printer
Since you have now connected to the shared printer, you should test the connection and make sure everything is installed correctly. Go again to Start –> Control Panel –> Printers and Faxes and right click on the shared printer you just installed, and click on properties. You will see a button just above the Ok and Cancel buttons, which says Print Test Page. Go ahead and click on that, and it as long as everything is setup properly, you will have a test page laying in your printers output tray.


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Reviewed by Catherine C. (age 8)
I like this book because it has a lot of pictures of cute animals and a lot of facts. My favorite part of this book was about learning about cats. There was one picture of a cat that looked like a cat that I own. This book reminded me of a cat I used to have but I had to give it away because I was allergic to it.
The people I would recommend this book to are people who love pets and want to learn facts about them.


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PROSERVE Pizza Delivery Bag, 21-1/2" L x 19-3/4" W x 7-3/4"H, four-16" or three-18" pizza capacity, 2" of polyester insulation, nylon construction, labeling window, red, S.O.S. (Special Order Smallwares) product; see SOS document for details
Deep fryers dish out punishment to kitchen equipment that's not properly designed for them. This Four Mesh Basket, constructed of Nickle plated steel, is designed for deep frying's heat, as well as for keeping small pieces of food conveniently together both when they are put in and removed from the oil.
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text: Mark Hahn wrote: >> PS Pentium 4 sustained performance from memory is about >> 5% of peak (stream triad). > >that should be 50%, I think. > Nope ... not "from memory". A 2.8 GHz P4 using SSE2 instructions can deliver two 64-bit floating point results per clock or 5.6 Gflops peak performance at this clock. The stream triad (a from-memory, multiply-add operation) for a 2.8 GHz P4 produces only 200 Mflops (see stream website). The arithmetic is then: 200/5600 = .0357 or 3.57% (so 5% is a gift) This is a worse-case, from-memory, scenario which include for little or no cache re-use. It asks the question, "what part of peak can my memory sub-system sustain?" On the Cray X1 (and most vector machines), the same worst-case, from-memory, scenario yields 25% of peak. This is why Cray is still making custom vector computers. As you suggest, the P4 will (as does the Cray X1) do significantly better when cache use/re-use is a significant factor. Regards, rbw #--------------------------------------------------- # Richard Walsh # Project Manager, Cluster Computing, Computational # Chemistry and Finance # netASPx, Inc. # 1200 Washington Ave. So. # Minneapolis, MN 55415 # VOX: 612-337-3467 # FAX: 612-337-3400 # EMAIL: rbw at networkcs.com, richard.walsh at netaspx.com # rbw at ahpcrc.org # #--------------------------------------------------- # "Without mystery, there can be no authority." # -Charles DeGaulle #---------------------------------------------------


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Thank You
Take a look at the delicious menu that was on offer for Father's Day 2018
Prawn cocktail†
Atlantic prawns with Marie Rose sauce, bloomer bread and butter
Peppered chicken goujons
breaded chicken with garlic & rosemary mayo
Oak-smoked chicken liver pâté | New
with caramelised red onion chutney, lamb's lettuce, toast and butter
Homemade smoked mackerel pâté† | New
with lamb's lettuce, toast and butter
panko-coated with garlic & rosemary mayo
Courgette & harissa flavoured rice skewers (ve) | New
with houmous and lemon oil
Shropshire Blue® Salad (v)(n) | New
crisp chicory, fresh watercress, radish, sweet pear, candied walnuts and creamy Shropshire blue cheese® tossed in a honey & mustard mayo
All roasts are served with buttered seasonal veg, homemade Yorkshire pudding, sage & onion stuffing, garlic & rosemary goose fat roast potatoes or minted baby potatoes and our premium gravy.
Roast topside of beef
with horseradish sauce
Roast pork loin
with crackling and roasted Red Delicious apple
Roast turkey breast
with a pig-in-blanket
Trio of roasts
topside of beef, turkey breast and pork loin with crackling and roasted Red Delicious apple
Roast nut wellington (v)(n)
with vegetarian roast potatoes, homemade Yorkshire pudding, seasonal veg and vegetarian gravy
Slow-cooked rib of beef (£1 supplement)
8-hour slow-cooked rib of beef served on the bone
Slow-cooked lamb shoulder (£1 supplement)
with roasted red onion and fresh mint
Children's roasts £4.99
choose from topside of beef, turkey breast, pork loin or roast nut wellington(v)(n) with roast potatoes, homemade Yorkshire pudding, buttered seasonal veg and gravy
Burgers are served in a brioche bun with skin-on fries, house slaw and barbecue dip.
Our steaks are served with grilled tomato, sautéed mushrooms, lamb's lettuce and onion rings. Plus, a choice of triple-cooked chips, mashed potato, jacket potato or salad.
Gourmet beef burger
topped with smoked Cheddar, smoked streaky bacon, free-range fried egg and signature burger sauce
Gourmet chicken burger
grilled chicken breast topped with smoked Cheddar and smoked streaky bacon
Hog roast burger | New
beef burger topped with pulled pork, stuffing, melted smoked cheese, crumbled crackling, apple sauce with mayo and watercress. Served with apple sauce
Ultimate vegan burger (ve) | New
a delicious meat-free burger, topped with fried onions and a melting vegan slice, in a toasted poppy seed bun with mayo and shredded iceberg lettuce. Served with house slaw, barbecue dip and chips.
Swap your chips (ve) for skin-on fries (v)
9oz Rump steak
firmer texture for fuller flavour
8oz Sirloin steak (£2 supplement)
beautifully tender with marbling for a greater depth of flavour
Cod and chips†
hand-battered Atlantic cod with garden or mushy peas and tartare sauce
Add bloomer bread and butter for £1.29
Signature mixed grill (£3 supplement)
28-day aged rump steak, chicken breast, 7oz gammon steak, pork sausage, black pudding, free-range fried egg, grilled tomato, onion rings and a choice of triple-cooked chips, mashed potato, jacket potato or salad
Hunter's chicken
with grilled back bacon, topped with melted smoked Cheddar and barbecue sauce. Served with onion rings, triple-cooked chips, house slaw and dressed side salad
Sea bass and seared scallops† (£1 supplement)
two grilled sea bass fillets and pan-fried scallops served on a prawn, pea & chive risotto
Chef's Summer garden bowl (ve) | New
warm salad of new potatoes, asparagus, garden peas, baby gem, Tenderstem™ broccoli and spring onion dressed with lemon oil
Choose your topping halloumi (v), courgette & harissa flavoured rice skewers (ve), rump steak, salmon†, chicken or sea bass†
Steak & red wine pie
slow-cooked farm-assured British beef in a rich red wine gravy, with roasted baby onions and mushrooms in a hot water crust pastry. Served with triple-cooked chips or mashed potato, buttered seasonal veg and premium gravy
Eton mess | New
whipped double cream tossed with crushed meringue, raspberry coulis, and fresh strawberries and raspberries
Summer fruit sundae (n) | New
fresh pineapple and raspberries, mango sorbet, clotted cream ice cream, peach and pear pieces, raspberry coulis and toasted almonds
Also available as a vegan option
Millionaire's cheesecake
with salted caramel sauce and whipped double cream
Kentish Bramley apple & blackberry crumble pie
shortcrust pastry with apples & blackberries and a crumble topping, served with custard, double cream or ice cream
Chocolate fudge cake
served warm or cold with double cream, ice cream or custard
Sticky toffee pudding
with dates and sultanas, served with custard, double cream or ice cream
Lemon and Earl Grey drizzle cake (n) | New
with white chocolate mousse, strawberries, raspberries and toasted flaked almonds
Chocolate torte (ve)(n)
a date & nut base, Belgian chocolate & coconut milk torte with vanilla ice cream
When you buy this pudding, we will donate 20p on your behalf to Macmillan Cancer Support.‡ We are proud to support Macmillan.
Sun's Out
If the sun decides to make an appearance this Father's Day, don't worry we've got you covered! Head outside and enjoy family-time in our beautiful beer garden. Enjoy the sunshine and dine Al-fresco whilst discovering our great range of drinks that are the perfect way to toast a day full of togetherness.
*All Fathers Day bookings for 17th June 2018 must be secured with a £5 deposit per person. Once you have booked with us for Father's Day you will be entered into our competition to win a £100 Red Letter Day voucher or five runners-up will receive a £30 gift card. The deposit should be paid before 12 noon on Thursday 14th June 2018, otherwise the booking will be cancelled and the table released. If you booked before the 22nd May please email us at firstname.lastname@example.com to request to be added to the competition.
Summary Terms & Conditions
Promotion open to UK residents only, aged 18+. Entrants must have booked a table for Father's Day (17th June) and paid the £5 deposit. Promotion closes at 23:59 on 16th June 2018. One winner will receive a £100 Red Letter Day voucher. 5 x runners up will also receive a £30 Greene King gift card. Full terms and conditions are available at https://www.chefandbrewer.com/terms-and-conditions/ Promoter: Greene King Brewing and Retailing Limited, Sunrise House, Ninth Avenue, Burton upon Trent, Staffordshire, DE14 3JZ.
Full Terms & Conditions
- This promotion is open to residents of the United Kingdom aged 18 or over only. Employees of Greene King, their families, agencies, or anyone else professionally connected with this promotion are not eligible to enter.
- This promotion opens on 22nd May 2018 and closes at 23:59 on 16th June 2018. Booked before the 22nd May and want to be entered into the competition please email us at email@example.com to request to be added to the competition for your chance to win £100 Red Letter Day voucher. 5 x runners up will also receive a £30 Greene King gift card
- Entrants must make a booking via chefandbrewer.com/fathers-day and pay the deposit to enjoy the Father's Day set menu. The deposited reservation must be made by 23:59 on 16/06/2018.
- One winner and 5 runners up will be selected at random by 30/06/2018.
- The prize is a £100 Red Letter Day voucher.
- 5 x runners up will also be chosen and will each receive a £30 Greene King gift card.
- Reasonable efforts will be made to contact the winners using the details on entry. However, if a response has not been received within 7 days, or if the selected winner or runner up is ineligible, otherwise in breach of these terms and conditions, or unable to take up the prize for any other reason, the Promoter reserves the right to select an alternative winner or runner up using the same process referred to above in these terms and conditions.
- The Promoter accepts no responsibility for failed delivery due to the provision of incorrect contact details by the entrant.
- The terms and conditions of any third party supplier will also apply to the prize where applicable. If there is a conflict between third party terms and conditions and these terms and conditions, these shall take precedence.
- The prize is non-transferable and cannot be sold or auctioned. No cash or other alternative to the prize will be offered save for in the event of unforeseen circumstances, in which case the Promoter reserves the right to offer an alternative prize of equal or greater value than the original.
- The Promoter is required to comply with the provisions of the Data Protection Act 1998 and the General Data Protection Regulation in relation to the processing of any personal information obtained from you, including when you take part in this promotion. The Promoter is a member of the Greene King group of companies (the "Group"), and the Group takes the protection of your personal information seriously.
- By entering this promotion, you have provided your personal information (name, email address, phone number and booking details) to the Promoter who is the Data Controller. Your personal information will be processed by the Promoter in performing the contract you have entered into with the Promoter by entering the promotion.
- Any personal information collected may be shared with other companies in the Group and will be used for administrative or operational reasons connected with the promotion, including to communicate with you. Your personal information will also be shared with Chef & Brewer in order that they may administer the promotion, arrange prizes and discuss any specific requirements with the winner/s on behalf of the Promoter. The Promoter will not pass your personal information outside of the EEA or to any other external organisation without your prior permission.
- Your personal information will be retained for 4 months from the closing date to enable the Promoter to complete administration of the promotion and to comply with its obligations under the Advertising Standards Authority CAP Code.
- You have the right to object to processing of personal information and to have inaccurate personal data rectified, blocked, erased or destroyed. If you have a concern about the way the Promoter is collecting or using your personal data, please raise your concern with the Data Protection Officer in the first instance at data email@example.com. Alternatively, you can contact the Information Commissioner's Office at https://ico.org.uk/concerns/.
- The Promoter may download cookies to your computer when you log onto the Promoter's website. For more information about the Promoter's commitment to your privacy and details of how the Promoter uses cookies please refer to the Promoter's Privacy Notice and Cookie Notice at https://www.chefandbrewer.com/cookie-policy/ and https://www.chefandbrewer.com/privacy/
- No bulk, machine generated consumer group or third party entries will be accepted. Entries are restricted to one entry per person.
- The Promoter reserves the right to disqualify incomplete, altered or illegible entries. No responsibility will be accepted for entries lost, damaged or delayed, technical or telecommunications faults. Proof of submitting is not proof of receipt.
- The Promoter reserves the right, in its absolute discretion, to verify the winner [and/or runner up], including but not limited to, proof of identity and/or age, as required, and to withdraw a prize where there are reasonable grounds to believe there has been a breach of these terms and conditions or otherwise where an entrant has gained advantage in participating in the promotion or has won using fraudulent means.
- The Promoter's decision is binding in all matters relating to this promotion, and no correspondence shall be entered into.
- Owing to exceptional circumstances outside its reasonable control and only where circumstances make this unavoidable, the Promoter reserves the right to cancel or amend the promotion or these terms and conditions at any time but will always endeavour to minimise the effect to participants in order to avoid undue disappointment.
- To the extent permitted by law, the Promoter accepts no liability for any damage, loss or injury suffered (including loss of opportunity) whether direct, indirect, special or consequential, arising in any way due to entering this promotion or taking up a prize. The Promoter is not responsible for any third party acts or omissions.
- Entrants will retain ownership of any content, submissions and other material they submit as part of this promotion. However, entrants grant the promoter (and its agents and affiliates) a non-exclusive, worldwide, irrevocable, perpetual licence to use any such content, submissions and other material for the purposes of this promotion.
- The winner may be asked to take part in publicity relating to this promotion. This will be discussed with the winner before taking place.
- The name and county of the winners will be available for 3 months following the closing date upon application with a SAE to Chef & Brewer Father's Day Competition. Greene King Brewing and Retailing Limited, Sunrise House, Ninth Avenue, Burton upon Trent, Staffordshire, DE14 2WF.
- By entering this promotion entrants will be deemed to have accepted, and will be bound by, these terms and conditions.
- These terms and conditions (and any non-contractual disputes/claims which arise out of or in connection with them) will be governed by English law and entrants submit to the exclusive jurisdiction of the English courts.
- Promoter: Greene King Brewing and Retailing Limited, Sunrise House, Ninth Avenue, Burton upon Trent, Staffordshire DE14 3JZ.


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For this month's Mixology Monday, I decided to try something new–the Plum Royale.
I came to this with a melange of inspiration:
- Anita's post on the Rosemary Five got me thinking about pairing fruit and spice in a champagne drink.
- A day after I read her post, I had a Gin Royale at brunch and decided to riff on that.
- Finally, Jen brought home some beautiful black plums.
photograph by Jennifer Hess
So with three ingredients already in mind–gin, champagne, and plum–I had to find my spice.
In Googling around to find inspiration, I came across an article about Plymouth gin that discussed, among other things, the botanicals in Plymouth–angelica root, cardamom pods, coriander seeds, lemon peel, orange peel, orris root, and juniper berries. Hm, cardamom. Turns out that cardamom and plums are a popular pairing, so I chose to go that way.
I made up a variation on this Cardamom Lime Syrup, sans lime this time. I also made a plum puree. The puree, gin, and syrup formed the basis for the drink, which I topped with champagne.
Plum Royale (a.k.a. the Eve Plum)
makes two drinks
- 4 oz. Plymouth gin
- 2 oz. plum puree
- 1 oz. cardamom syrup
- Mint sprig, for garnish
Technique: Shake over ice and divide between two champagne flutes. Top with champagne and garnish with a sprig of mint. (The mint is more for presentation than for flavor, so feel free to leave it out.)


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WFO variation on Sandwich Buns
Today I fired up my wfo oven to make pizza and this morning I made the recipe for my 'Sandwich Buns'. I needed hot dog buns for Mondays cookout and since the wfo was hot I retarded the shaped hot dog buns in the refrigerator until tonight when the oven had reached a temperature of apx. 400F and falling. I removed them for about one hour to finish proofing and placed them into the wfo for 20 minutes to bake. I wanted to get them into the oven right away because they had proofed a little more than I wanted, so as I brushed them with an egg yolk glaze and asked my husband to sprinkle on the seeds..I think he actually enjoyed it and I enjoyed watching him enjoying it ;) I will post a crumb shot later.
Beginning to brown
20 minutes baked
Added crumb photo
Ready for tomorrows hot dogs...I haven't had a hot in ages and looking forward to toasting these on the grill!


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Samsung 'Next Galaxy' Teaser Site Appears
With less than two weeks remaining before Samsung's next flagship phone is unveiled in London, it seems we're beginning to see the start of the marketing campaign for the device. The image you see above comes from tgeltaayehxnx.com, the address of which is an anagram of "The Next Galaxy". The URL was first outed in a tweet from Samsung Mobile earlier today. And the page's title refers to a "whole new universe", with additional clues hidden in the page's metadata -- "Discover how Samsung is about to challenge the way you view the GALAXY once more."
A quick WHOIS lookup for the domain reveals it's owned by marketing agency The Upper Storey, which has been involved in campaigns for the likes of Nokia, Intel and LG in the past. The agency has also registered thenextgalaxy.com, an unscrambled version of the URL above. That site is currently password-protected, however.
The focus of the teaser site is a giant clock counting down to 12 noon UK time tomorrow, April 23 (7am EDT, 4am PDT). With the London event still a good 10 days away at that point, it's unlikely we'll see an official announcement, but some more clues about the
Galaxy S III next Galaxy could be unveiled. One thing's for sure -- we'll be watching with interest come noon tomorrow.
Source: Androidcentral ; via: AllAboutSamsung


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HIV and Hormones
Summer 2004
IntroductionThe term "hormone" broadly refers to any type of chemical messenger, but is most often used to denote chemicals produced by the endocrine glands. Hormones play a key role in maintaining homeostasis (a steady state of equilibrium) and regulating many bodily processes -- everything from growth and metabolism to sexual function and reproduction. Over- or underproduction of endocrine hormones can contribute to a wide variety of medical conditions. Diseases such as HIV that affect the whole body can interfere with proper endocrine function, and hormones, in turn, can affect HIV disease progression.
The Endocrine SystemWhile exocrine (e.g., sweat, salivary, digestive) glands secrete chemicals directly to their site of action, endocrine (or ductless) glands release hormones into the bloodstream to be transported throughout the body. The major endocrine glands are the hypothalamus, pituitary, thyroid, parathyroids, adrenal glands, Islets of Langerhans in the pancreas, and the gonads (testes in males and ovaries in females); see illustration below. Other cells (for example, in the gastrointestinal tract and the brain) also secrete chemicals that exert endocrine effects.
The Hypothalamus and PituitaryThe hypothalamus, located in the lower middle part of the brain, is the primary link between the endocrine system and the nervous system. The hypothalamus relays information about the body's external and internal environment from the brain to other glands. The hypothalamus secretes releasing hormones that direct the pituitary to increase or decrease production of its own hormones, which in turn stimulate subsidiary glands such as the thyroid, adrenal glands, and gonads. The major hypothalamic hormones are growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), corticotropin-releasing hormone (CRH), gonadotropin-releasing hormone (GnRH), and prolactin-releasing hormone (PRH).
The pituitary, a pea-sized gland located at the base of the brain, is often called the body's "master gland." The anterior (frontal) lobe of the pituitary produces growth hormone (GH, also called somatotropin), which promotes normal growth and development (especially in children) and regulates metabolism; thyroid-stimulating hormone (TSH, or thyrotropin), which controls the activity of the thyroid gland; adrenocorticotropic hormone (ACTH, or corticotropin), which stimulates the adrenal cortex; two gonadotropins -- follicle-stimulating hormone (FSH) and luteinizing hormone (LH) -- which regulate the activity of the testes and ovaries; and prolactin, which stimulates mammary gland development and milk production. The posterior (rear) portion of the pituitary secretes antidiuretic hormone (ADH, or vasopressin), which helps regulate the body's fluid balance, and oxytocin, which triggers uterine contractions during labor and the release of milk.
The Thyroid and Parathyroid GlandsThe thyroid, a butterfly-shaped gland located at the base of the neck, produces triiodothyronine (T3) and thyroxine (T4), two hormones that regulate basal metabolic rate. These hormones increase heart rate and blood vessel dilation, affect mood and metabolism, and are necessary for reproduction; they also play an important role in growth and development in children. Overproduction of thyroid hormones (hyperthyroidism) causes rapid metabolism, insomnia, anxiety, weight loss, and heat intolerance. Conversely, underproduction (hypothyroidism) is characterized by slow metabolism, fatigue, depression, weight gain, muscle and nerve dysfunction, and cold intolerance. The thyroid also secretes calcitonin, which helps regulate the body's calcium and phosphorus balance.
Located near the thyroid are four small parathyroid glands, which secrete parathyroid hormone (PTH). Along with calcitonin, PTH helps regulate levels of calcium, which is required for proper neural transmission and muscle function. PTH increases the concentration of calcium in the blood by promoting the release of calcium from bones, decreasing calcium excretion by the kidneys, and enhancing calcium absorption in the intestines. Calcitonin, in contrast, inhibits the release of calcium from bones and increases its excretion in the urine.
The Adrenal GlandsThe two adrenal glands sit on top of each kidney. These glands are comprised of two parts, the medulla (inner part) and the cortex (outer part). The adrenal medulla produces two complementary hormones, epinephrine (adrenaline) and norepinephrine (noradrenaline). In response to physiological or psychological stress, the medulla releases epinephrine, which prepares the body for the "fight or flight" response by increasing heart and breathing rate, enhancing muscle contraction, and stimulating the release of fatty acids and glucose (sugar) for energy. In general, norepinephrine has the opposite effects.
The adrenal cortex produces three types of hormones: mineralocorticoids, glucocorticoids, and androgens. Mineralocorticoids such as aldosterone help regulate the body's fluid and electrolyte balance. Glucocorticoids such as cortisol are often called the body's "stress hormones." Cortisol depresses the immune system and influences glucose and lipid (fat) metabolism, promoting the delivery of glucose to cells to supply energy. Finally, the adrenal cortex produces androgens in both men and women (see the "Sex Glands" section, below).
The Endocrine PancreasThe pancreas as a whole is an exocrine gland that secretes digestive chemicals directly into the small intestine. But patches of tissue within the pancreas called the Islets of Langerhans produce endocrine hormones that regulate the metabolism of glucose and lipids. After a meal, islet beta cells secrete insulin, which enables cells to take up glucose and causes the liver and other tissues to store sugar, thus lowering the blood glucose level. Alpha cells secrete glucagon, which has the opposite effect, causing the release of stored sugar and an increase in blood glucose. Other endocrine cells produce somatostatin, which limits the release of GH and inhibits the secretion of insulin and glucagon. (See "Insulin Resistance and Diabetes," BETA, Winter 2004.)
The Sex GlandsBoth men and women produce "male" hormones (androgens) and "female" hormones (estrogens). All steroid hormones, derived from cholesterol, are synthesized through a complex pathway that ultimately leads to estrogen. Androgens (from either the gonads or the adrenal cortex) may be converted to estrogens by an enzyme called aromatase.
The testes, or male gonads, are located in the scrotum. When stimulated by LH from the pituitary, the testes produce androgens including testosterone. Testosterone has two types of effects on the body: anabolic effects, which promote muscle building; and androgenic effects, which promote the development of the male sex organs, expression of male secondary sexual characteristics, and normal libido (sex drive). The gonadotropins LH and FSH also control sperm production in the testes.
The ovaries, or female gonads, are located in the pelvic cavity. These glands secrete estrogens and progesterone, as well as a small amount of testosterone. Estrogens promote the expression of female secondary sexual characteristics such as breast development. The ovaries are also the sites of ovum (egg) maturation. A complex interplay of hormones regulates the menstrual cycle and allows for pregnancy. FSH from the pituitary promotes the maturation of an ovum in an ovarian follicle and the secretion of estrogen, which causes cells lining the uterus to proliferate. The rise in estrogen triggers the secretion of LH, which causes the follicle to burst and release the mature ovum, a process known as ovulation. The remains of the burst follicle form a structure called the corpus luteum, which secretes progesterone. If fertilization occurs, the placenta continues to produce progesterone throughout pregnancy. If not, the progesterone level drops, menstruation occurs, and the cycle begins anew.
How Do Hormones Work?Most endocrine activity is governed by a series of feedback loops involving the hypothalamus and the pituitary. When receptors in the hypothalamus sense a decreased level of a specific hormone in the blood, the gland secretes a releasing hormone that tells the pituitary to signal the appropriate subsidiary gland to ramp up its activity. Conversely, as blood levels of a hormone increase, the hypothalamus decreases production of the releasing hormone, in effect "turning off" the subsidiary gland.
For example, when the body is under physical or emotional stress, the hypothalamus relays this information by releasing CRH into a bed of capillaries that feeds the pituitary. CRH causes the anterior pituitary to increase its production of ACTH, which in turn stimulates the adrenal cortex to produce more of the stress hormone cortisol. As cortisol levels rise, the hypothalamus senses this change and stops producing CRH. Without CRH, the pituitary stops secreting ACTH, and the lack of ACTH, in turn, shuts down production of cortisol by the adrenal glands. This negative feedback loop is called the hypothalamic-pituitary-adrenal axis. Similar regulatory pathways exist for the thyroid and the gonads.
Endocrine function can go awry in several ways. The hypothalamus and/or pituitary can produce too much or too little of the hormones that stimulate the activity of other glands. Subsidiary glands may also produce too much or too little hormone, a condition known as primary gland failure. In addition, cell receptors may fail to respond appropriately to a hormone.
Hormones and HIV/AIDSBecause hormones are involved in so many different bodily processes, it is no surprise that a systemic disease like HIV can affect endocrine function, and vice versa. The first wave of research on endocrine dysfunction in people with HIV occurred in the late 1980s and early 1990s, before the advent of highly active antiretroviral therapy (HAART). Autopsy studies of people who died from AIDS-related conditions often revealed direct infection of endocrine glands by opportunistic pathogens such as cytomegalovirus (CMV), Pneumocystis carinii, or Mycobacterium avium. In addition, several drugs used to treat opportunistic illnesses (OIs) can contribute to endocrine dysfunction (see table above). Today, it is clear that serious endocrine dysfunction occurs more often in people with AIDS or symptomatic HIV disease than in those with early-stage disease and mild immune suppression.
Some endocrine disorders are associated with serious illness in general. For example, many severe systemic illnesses, including AIDS, are associated with reduced thyroid hormone production, a condition known as euthyroid sick syndrome (meaning the thyroid gland itself is normal, but its function is impaired). In various studies, decreased T3 has been associated with lower CD4 cell counts, active OIs, and severe weight loss.
The endocrine, nervous, and immune systems are interrelated in complex ways that are not yet fully understood. The neuroimmune-endocrine connection is most evident in the hypothalamic-pituitary-adrenal axis, which regulates cortisol production in response to bodily stresses such as infection, inflammation, pain, fear, or emotional distress. Cortisol suppresses many aspects of the immune response, including the proliferation of lymphocytes; the activity of natural killer cells, macrophages, and neutrophils; and the production of certain cytokines. High cortisol levels are seen in individuals with many types of severe acute or chronic illness, and AIDS is no exception.
Not long after HAART came into widespread use, physicians began noticing similarities between certain metabolic manifestations associated with antiretroviral therapy -- such as abdominal obesity and dorsocervical fat pad ("buffalo hump") -- and an uncommon form of excessive cortisol production known as Cushing's syndrome. But researchers determined that most individuals with asymptomatic HIV disease did not have inappropriately high cortisol levels. Indeed, by slowing disease progression, HAART likely restrains the release of cortisol. Nevertheless, some researchers believe cortisol may play an as yet unknown role in lipodystrophy syndrome (metabolic and body fat disturbances).
It can be challenging to diagnose endocrine problems in people with HIV because certain symptoms may be associated with altered levels of more than one hormone. For example, fatigue and depression may be due to low levels of thyroid hormone, cortisol, growth hormone, or testosterone. In addition, multiple endocrine mechanisms may interact in complex syndromes such as wasting, lipodystrophy, and other metabolic abnormalities.
While severe endocrine problems are seen less often since HAART became widely available, some experts believe that subtle endocrine disorders are still common in people with HIV. Such subtle imbalances may have a major impact on quality of life, and many people with HIV may benefit from testing of hormone levels and supplementation, if appropriate.
Sex HormonesIn the HAART era, sex hormone imbalances may be the most common endocrine disorders in HIV-positive people. Hypogonadism -- low testosterone in men and decreased levels of estrogen, progesterone, and/or testosterone in women -- can lead to a variety of symptoms including fatigue, anemia, depression, loss of libido, impaired sexual function, and decreased fertility. In women, altered sex hormone levels can cause disturbances in the menstrual cycle. Sex hormones also affect body composition, including the synthesis of muscle tissue and the relative distribution of muscle and fat. Both testosterone and estrogen protect the bones, and the risk of bone loss (osteopenia or osteoporosis) rises as levels of these hormones decrease with age. As people with HIV live longer due to effective antiretroviral therapy, they are subject to the same age-related conditions -- including naturally declining sex hormone levels -- as their HIV-negative counterparts.
Hypogonadism in HIV-Positive MenSevere hypogonadism is seen most often in men with advanced HIV disease. For example, in an early study of HIV-associated endocrine problems, Adrian Dobs, M.D., of Johns Hopkins University in Baltimore and colleagues reported in the March 1988 issue of the Annals of Internal Medicine that 6% of asymptomatic HIV-positive men, about 40% of men with symptomatic HIV disease, and 50% of men with AIDS were hypogonadal; lower testosterone levels were correlated with weight loss and lower CD4 cell counts. Likewise, Steven Grinspoon, M.D., and colleagues from Massachusetts General Hospital (MGH) reported in the November 1996 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM) that in a study of 75 men with AIDS wasting, about one-half had free (bioavailable) testosterone levels below the normal range for men their age.
In contrast, Julio Collazos, M.D., of Hospital de Galdakao in Vizcaya and colleagues reported in the April 12, 2002 issue of AIDS that in a study of nearly 200 clinically stable HIV-positive men (average CD4 cell count 451 cells/mm3; 64% with undetectable viral load), most subjects had testosterone levels within the normal range. Men receiving no anti-HIV therapy had the lowest testosterone, while those using a regimen combining three classes of antiretroviral drugs had the highest levels. Among the 15 men who had both pre- and post-treatment testosterone measurements, levels increased after starting HAART. But because testosterone levels normally begin to decline around age 40 (a phenomenon known as "andropause"), the beneficial effects of HAART on hypogonadism may be offset as treatment enables HIV-positive men to live to older ages.
Altered testosterone levels have been linked to wasting and other changes in body composition, but the cause and effect relationship is unclear. Severe weight loss can lead to decreased production of the gonadotropins that direct the production of testosterone; in turn, low testosterone, which stimulates the buildup of muscle, contributes to wasting. (Wasting and body composition changes are also associated with growth hormone abnormalities; see table.)
Other symptoms associated with low testosterone include fatigue, depression, loss of libido, and impaired sexual function (e.g., erectile dysfunction, or impotence). For example, in the January 2000 issue of JCEM, Grinspoon and colleagues reported that in a study of 52 hypogonadal and ten eugonadal (normal testosterone level) men with HIV-related wasting, those with lower testosterone levels had higher scores on the Beck Depression Inventory (that is, they were more depressed).
To help diagnose hypogonadism, researchers from St. Louis University devised a questionnaire called Androgen Deficiency in Aging Men, or ADAM; though it was developed to assess normal decreases in androgen levels as men age, the symptoms of testosterone deficiency are the same regardless of cause (see table below).
Androgen Supplementation in MenDiagnosing hypogonadism can be difficult because normal levels vary greatly from person to person. To get a complete picture, different forms of testosterone may be measured. Normally, most testosterone is bound to carrier proteins in the blood; only about 2% is unbound. A total testosterone test measures both bound and unbound hormone. A free testosterone test measures only unbound, or bioavailable, testosterone. A typical normal range for total testosterone is 250-1,200 nanograms/deciliter (ng/dL), while a normal free testosterone range is about 100-200 ng/dL. Total testosterone levels of 250-400 ng/dL are considered borderline low, and may have functional consequences. However, testosterone levels depend on age; older men have lower normal levels than younger men.
When diagnosing endocrine problems it is important to look not just at absolute levels of specific hormones, but also at the balance between them. For example, if a man begins to convert more testosterone to estrogen, his androgen/estrogen ratio will shift and he may begin to experience "feminizing" symptoms such as breast growth, even if his testosterone remains within the statistically normal range. Also, a testosterone level within the normal range may be inadequate for a given individual if his usual level is higher. Some experts recommend getting a baseline testosterone measurement soon after HIV is diagnosed, against which later measurements may be compared.
Hypogonadal men can be treated with supplemental testosterone or synthetic androgens. Testosterone may be administered in several forms. Testosterone cypionate or enanthate are injected intramuscularly, usually every 2-4 weeks. While this is the least expensive method, cyclical injections provide fluctuating blood levels of the hormone, peaking soon after administration and decreasing over time. Transdermal testosterone patches provide a more steady level. The Testoderm patch is applied daily to the scrotum, while the newer Androderm patch is applied daily to the back, abdomen, upper arm, or thigh. Testosterone gel (AndroGel) and creams are also available. Oral testosterone pills are not commonly used since they can cause liver toxicity.
Injected testosterone may increase overall body weight and especially lean body mass. In the July 1, 1998 issue of the Annals of Internal Medicine, Grinspoon and colleagues reported that hypogonadal men with HIV-associated wasting gained muscle mass and reported improved appearance and quality of life after six months of testosterone therapy (one injection every three weeks). Grinspoon's team also found that Beck Depression Inventory scores decreased (indicating improvement) in men treated with testosterone. Judith Rabkin, Ph.D., M.P.H., and colleagues from the New York State Psychiatric Institute reported in the February 2000 issue of the Archives of General Psychiatry that 74% of HIV-positive men receiving biweekly testosterone injections reported increased libido, 59% had improved energy levels, and 58% of men with depression reported improved mood.
Testosterone skin patches are also effective. Shalender Bhasin, M.D., of the University of California at Los Angeles and colleagues reported in the September 1998 issue of JCEM that men using Androderm patches experienced greater increases in lean body mass, larger decreases in fat, and more improvement in quality of life compared with men using placebo patches.
More recently, testosterone has been studied as a treatment for lipodystrophy and other metabolic manifestations associated with HAART. In individuals with mixed lipodystrophy (loss of fat from the limbs and face accompanied by abdominal fat gain), the hormone may both decrease fat and increase lean tissue mass. In the January 2000 issue of JCEM, Colleen Hadigan, M.D., and colleagues (part of the MGH team) reported that in a study of 52 HIV-positive hypogonadal men with wasting, those who received supplemental testosterone experienced improved insulin sensitivity as their lean body mass increased. Further, Wesley Fairfield, M.D., from MGH and colleagues reported that testosterone therapy led to increased bone density in eugonadal HIV-positive men with osteopenia.
In addition to testosterone, synthetic androgenic steroids may also be used. Some have a more androgenic (masculinizing) effect, while others have a more anabolic (muscle-building) effect. The latter may provide some of the benefits of testosterone without unwanted virilization, which is especially important for women, as discussed below. Steroids with more anabolic effects include nandrolone decanoate (Deca-Durabolin), which is injected every 1-2 weeks, and oxandrolone (Oxandrin), which is taken orally every day. Julian Gold, M.D., and colleagues from Prince of Wales Hospital in Sydney reported in the June 1996 issue of AIDS that nandrolone increased lean body mass, enhanced exercise performance, and improved quality of life in HIV-infected hypogonadal men. Oxandrolone, too, has been shown to improve wasting in HIV-positive men, and the drug is FDA-approved for this indication. For example, Joseph Berger, M.D., and colleagues reported in the December 1996 issue of the same journal that daily treatment with either 5 mg or 15 mg of oxandrolone had a positive impact on the weight and well-being of men with HIV.
The potential side effects of testosterone and its synthetic analogs include acne, elevated liver enzymes, altered blood lipids (especially decreased HDL, or "good" cholesterol), mood changes, painful erections, gynecomastia (breast enlargement in men), sleep apnea, edema, excess red blood cell production, high blood pressure, and virilizing effects such as male pattern baldness. In addition, supplemental androgens influence the hypothalamic-pituitary-gonadal axis and shut down natural production of testosterone, which can lead to testicular atrophy (shrinkage). Side effects are less likely when using physiological doses to approximate natural levels, as opposed to supraphysiological doses that exceed the normal range (e.g., for bodybuilding). When using patches, gels, or creams, which deliver a steady dose of testosterone, blood levels should be measured soon after supplementation begins and regularly (every 6-12 months) during the course of therapy.
The long-term effects of androgen therapy in HIV-positive men are unknown. Because androgens can lower the level of cardioprotective HDL cholesterol, there is concern that they may increase the risk of heart disease, especially when combined with antiretroviral drugs that also cause dyslipidemia (altered blood fats). But in the September 1, 2003 Clinical Infectious Diseases supplement, Bhasin suggested that by reducing visceral fat and improving glucose metabolism, androgen therapy may actually decrease the risk of cardiovascular disease in HAART-treated men. Increased cancer risk is another concern, and men taking supplemental androgens should receive regular prostate cancer screening.
Grinspoon recommends that all men with HIV-related wasting should be screened for testosterone deficiency and given supplements if their levels are low. Douglas Dieterich, M.D., of Mt. Sinai School of Medicine in New York City suggests that men with symptoms of hypogonadism should be tested and treated even if they have not experienced severe weight loss.
While testosterone replacement therapy is beneficial for HIV-positive men with hypogonadism, it is unclear whether extra testosterone offers additional benefit for men who already have normal levels. While some studies have shown that supplemental androgens can increase lean body mass, reduce fat, and improve well-being even in eugonadal men, such use remains controversial since the long-term effects of supraphysiological testosterone are unknown.
Sex Hormones in HIV-Positive WomenSince the beginning of the epidemic, women with HIV have reported missed periods, unusually light or heavy periods, severe premenstrual syndrome (PMS), and early menopause. These can be caused by altered sex hormone levels, but other factors -- such as opiate use, certain psychiatric medications, or stress -- may also be responsible for such changes. (For a discussion of fertility in women with HIV, see "Fertility, Conception and HIV" in this issue.)
Despite the frequency of anecdotal reports, controlled studies of menstrual irregularities in HIV-positive women have yielded inconsistent results. Some research suggests that HIV has little or no impact on menstrual function. Based on interviews with 197 HIV-positive and 189 HIV-negative women, Tedd Ellerbrock, M.D., of the Centers for Disease Control and Prevention (CDC) and colleagues reported in the June 1996 issue of Obstetrics and Gynecology that the number and duration of menstrual cycles did not differ significantly between the two groups. In the March 1994 issue of the same journal, P. Shah and colleagues reported no significant differences in rates of amenorrhea (lack of periods), sparse or heavy menstruation, or menstrual cramps between HIV-positive and HIV-negative women. In addition, no association was seen between CD4 cell count and menstrual irregularities, nor were there differences between symptomatic and asymptomatic HIV-positive women. In another study Susan Cu-Uvin, M.D., of Brown University and colleagues found no significant differences in progesterone and estradiol (a form of estrogen) levels based on CD4 cell count, baseline viral load, or type of antiretroviral therapy.
In contrast, Keith Chirgwin, M.D., of the State University of New York Health Science Center and colleagues reported in the August 1996 issue of the Journal of AIDS (JAIDS) that HIV-positive women without AIDS were more likely than HIV-negative women to go longer than six weeks between periods and were more likely to have amenorrhea for more than three months. And based on a large study of 802 HIV-positive and 273 HIV-negative women, Sioban Harlow, Ph.D., of the University of Michigan in Ann Arbor and colleagues reported in the May 2000 issue of JAIDS that women with HIV were slightly more likely to have unusually short (less than 18 days) or very long (more than 90 days) menstrual cycles, and that higher viral load and lower CD4 cell count were associated with increased cycle variability and unusually frequent periods.
According to Kathleen Squires, M.D., of the University of Southern California in Los Angeles, menstrual irregularities, intensified premenstrual symptoms, and early menopause likely have more to do with advanced illness and wasting than with HIV per se. (Among HIV-negative women, it is well known that young women with anorexia nervosa and women athletes with low body fat percentages may stop menstruating.) Indeed, in a study of 43 HIV-positive women with a range of CD4 cell counts published in the May 1997 issue of JCEM, Grinspoon and colleagues found that women with wasting were more likely to have sparse or absent periods compared with those who had stable weight or only mild weight loss; among women with serious wasting, 38% were amenorrheic compared with 17% of women without weight loss. In addition, the euthyroid sick syndrome (described above) is associated with irregular menstruation.
Menstrual problems in HIV-positive women are seen less often since the advent of HAART, but anti-HIV treatment itself may sometimes contribute to such irregularities. For example, Henrik Nielsen, M.D., of Aalborg Hospital in Denmark reported in the March 6, 1999 issue of The Lancet on four cases of hypermenorrhea (unusually heavy periods) in women taking ritonavir (Norvir); hypermenorrhea is a concern because it can lead to anemia due to excessive blood loss.
Much remains to be learned about how female sex hormones and the immune system interact. For example, hormonal factors appear to influence women's vulnerability to HIV infection (see table below). Studies have shown that HIV-positive women have higher CD4 cell counts than men who have been infected for a similar length of time, and show greater disease progression than men with the same CD4 cell counts. Hormonal factors may also help explain differences in how women and men metabolize antiretroviral drugs.
Hormone Replacement Therapy for WomenAs HIV-positive women live longer, they are subject to the same age-related hormonal changes as their HIV-negative counterparts. The use of hormone replacement therapy (HRT) in women with or without HIV is currently controversial. Once routinely recommended both for ameliorating acute menopausal symptoms and for preventing problems such as osteoporosis, heart disease, and cognitive decline, long-term HRT has fallen out of favor in the wake of studies showing that estrogen, with or without progesterone, appears to confer more risks than benefits.
Menopause typically ensues between the late thirties and late fifties. During menopause and the preceding period known as peri-menopause, declining estrogen levels can cause symptoms such as hot flashes, night sweats, insomnia, fatigue, depression, irritability, forgetfulness, and vaginal thinning and dryness. The more intense symptoms typically improve over two to three years as hormone fluctuations even out. A careful differential diagnosis is necessary to avoid confusing symptoms of menopause with those related to HIV itself, OIs, or antiretroviral therapy.
For young women who experience premature amenorrhea before the normal age of menopause, oral contraceptives may be used to restore levels of estrogen and progesterone and re-establish normal menstrual cycles. For older women undergoing menopause, physicians have traditionally offered HRT using either oral estrogen (e.g., Premarin) or estrogen plus progesterone (e.g., Prempro).
In July 2002 the estrogen/progesterone arm of the Women's Health Initiative (WHI) HRT study, which included more than 160,000 post-menopausal women, was discontinued after data showed that combination HRT increased the risk of breast cancer, heart attacks, and strokes (although the absolute risk was small). HRT did lower the risk of hip fractures and colon cancer, but the researchers concluded that the overall risks outweighed the benefits. This past March the estrogen-only arm of the study was also halted after seven-year data revealed that estrogen not only failed to provide the hoped-for cardiovascular benefits, but also appeared to slightly raise the risk of strokes. (Because estrogen without progesterone increases the risk for uterine cancer, this arm included nearly 11,000 women who had undergone hysterectomies.)
The WHI results were "earth-shaking," according to Lori Kamemoto, M.D., of the University of Hawaii in Honolulu. In the wake of the WHI news, Kamemoto's planned ACTG study of HRT in postmenopausal HIV-positive women was put on hold. As it stands, the risks and benefits of HRT in women with HIV remain unknown. HIV-positive women could conceivably benefit from the bone-preserving effects of estrogen, especially since some studies suggest that HAART or HIV itself are associated with a higher risk of osteoporosis. At the same time, women on HAART may be at higher risk for HRT-related heart attacks or strokes due to dyslipidemia and other side effects associated with antiretroviral therapy, and may be at greater risk for cancer due to immune suppression.
Despite this uncertainty, many physicians believe that HRT remains a viable short-term strategy for relieving disabling menopausal symptoms. "I give the same recommendations to women with HIV as I do to HIV-negative women," says Kamemoto. "If you have severe, intractable post-menopausal symptoms, and you've tried waiting it out, perhaps you're one of those who need HRT."
But most experts now agree that routine, long-term use of HRT solely to prevent heart disease or osteoporosis is inappropriate. Medications such as alendronate (Fosamax) and risendronate (Actonel) may help prevent bone loss without the risks of HRT.
For women with low levels of estrogen and/or progesterone, there are other options beside oral hormone supplements. Estrogen and progesterone are also available in creams, patches, and vaginal rings that deliver lower doses and thus may not carry the same risks. Several natural remedies are sometimes recommended as alternatives to HRT, but these generally have not been studied in controlled trials. Soy, which contains plant-derived estrogens, and black cohosh both appeared to relieve menopausal symptoms in clinical studies. Vitamin E, vitamin B complex, magnesium, and evening primrose oil may help ameliorate symptoms such as hot flashes, cramps, bloating, and mood swings.
Androgen Therapy for WomenHIV-positive women may also experience some of the same problems as their male counterparts: muscle wasting, fat gain, fatigue, depression, loss of libido, and impaired sexual function. And, as in men, these symptoms may be due to low testosterone. Normal testosterone levels vary widely from woman to woman; a typical normal range is 20-100 ng/dL for total testosterone or 1-2 ng/dL for free testosterone.
Low testosterone levels appear to be common in HIV-positive women, especially those with wasting syndrome. In Grinspoon's 1997 study of women with HIV, 66% with severe wasting, 50% with early wasting, and 33% with no wasting had free testosterone levels below the normal range for healthy women of the same age. Likewise, in the February 15, 2003 issue of Clinical Infectious Diseases, Jeannie Huang, M.D., and colleagues from MGH reported that about one-half of HIV-positive women in another study had low free testosterone levels, compared with 8% of uninfected women; among the HIV-positive women, 58% of those with severe wasting had low free testosterone, compared with 24% of those with less significant weight loss.
Testosterone supplements may be used in women, but require caution to avoid unwanted, and possibly irreversible, virilizing side effects such as excessive facial or body hair growth (hirsutism), hoarseness or deepening of the voice, and clitoral enlargement. For this reason, testosterone patches, creams, or gels are preferred over higher-dose testosterone injections. Compounding pharmacies can prepare creams that contain the desired dose. If virilizing side effects or menstrual changes occur, doses should be lowered or therapy discontinued. Testosterone is contraindicated in women who are pregnant or trying to become pregnant.
In a study published in the August 1998 issue of JCEM, Karen Miller, M.D., and colleagues, also part of the MGH research group, reported that in a study of 53 HIV-positive women with wasting and low testosterone levels, administration of physiological doses of testosterone (one patch twice weekly) was associated with weight gain and improved quality of life without virilizing side effects. In the April 26, 2004 issue of the Archives of Internal Medicine, Sara Dolan, NP, and colleagues from the MGH team reported that twice-weekly testosterone patches improved muscle function in this population. Importantly, however, more testosterone is not necessarily better. In Miller's study, the same benefits were not seen in women who received supraphysiological doses of testosterone (two patches twice weekly).
Some researchers think anabolic steroids with less androgenic effects, such as nandrolone and oxandrolone, may be a better option for women, although these agents may not provide the same benefits in terms of improving libido or relieving depression. At the 8th Retrovirus conference in February 2001, Kathleen Mulligan, M.D., from San Francisco General Hospital presented results of a study of 38 HIV-positive women with wasting randomly assigned to receive nandrolone or placebo. The women in the nandrolone arm experienced increased total weight and lean body mass, while virilizing side effects were rare. To date, however, neither nandrolone nor oxandrolone has been adequately studied in women with HIV. Grinspoon recommends only natural testosterone, since synthetic anabolic steroids may adversely affect the liver. Another option is combined testosterone/estrogen therapy (e.g., Estratest). For some women, supplementing both androgens and estrogens appears to improve menopausal symptoms, energy, and libido more than either alone.
ConclusionEven in the HAART era, endocrine disorders and hormone imbalances are common in men and women with HIV. Several symptoms frequently seen in HIV-positive individuals -- such as wasting, metabolic abnormalities, fatigue, and depression -- may be associated with multiple endocrine abnormalities.
Much remains to be learned about the use of hormone therapy in people with HIV, especially in conjunction with HAART. "Using testosterone or anabolics may help with the body habitus changes in lipodystrophy, but it may exacerbate the lipid disorders. Using growth hormone may also counteract the body changes, but it may exacerbate the insulin resistance seen in these patients," Dieterich wrote in a commentary in the December 9, 1998 issue of the Journal of the American Medical Association. "What is the answer?"
The answer awaits further research, including more studies of how the endocrine and immune systems interact in the context of HIV disease.
In the meantime, people with HIV who have symptoms of hormonal problems should seek a provider or medical team that has experience treating both HIV and endocrine disorders. If hormone supplements are used, levels should be checked soon after therapy is started and regularly thereafter. Other tests, including liver enzymes and blood lipids, also should be performed regularly to monitor potential side effects of hormone therapy.
People with HIV and their providers should be alert to the possibility of interactions between hormones and antiretroviral drugs. It has been demonstrated that several protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) interact with the ethinyl estradiol and/or norethindrone in oral contraceptives, either raising or lowering blood levels. However, it is not yet clear how antiretroviral drugs interact with other types of hormone therapy, or how they affect natural hormone levels. Because drug interactions primarily occur in the liver when oral medications are used, administering hormones in the form of patches, creams, or gels may alleviate this concern.
As Squires notes, in the era of HAART, people with HIV and their clinicians now must think about the general health conditions associated with aging in addition to HIV-specific concerns. Although declining hormone levels are part of the natural aging process, supplementation can play an important role in improving functional capacity and quality of life for individuals experiencing clinical symptoms associated with hormone deficiencies.
Liz Highleyman (email@example.com) is a freelance medical writer and editor based in San Francisco.
Selected Sources
Endocrine Society Calls for Medicare Coverage of DXA Bone Density Testing to Be Extended to Men With Testosterone Deficiency
This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.


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|Art: Heidi Malott
Rebbe Menachem Mendel of Riminov [1745-1815], a disciple of the Holy Rebbe Elimelech of Lizhensk, instructed everyone to read "Parshat HaMann" specifically on the Yom Shlishi [Tuesday] of Parshat Beshalach in the "Shnayim Mikra v'Echad Targum" format, i.e. reading the Hebrew verses twice and the Aramaic translation of Onkelos once. This year it will occur today Tuesday 23 January.
Not to be confused with the evil villain of the Purim story, Parshat haMann [The Chapter of the Manna] is found in the 16th Chapter of the Book of Exodus: verses 4-36. This Chapter details the episode of the miraculous "Manna" [bread from heaven] that sustained the Children of Israel during their 40-year journey in the desert.
Rav Yosef Caaro, the "mechaber" [compiler] of the monumental Halachic text, the Shulchan Aruch Orach Chaim 1:5, instructs us to recite it daily. Other giants of Halacha also point to the importance of reciting it daily: The Tur 1; Aruch Hashulchan 1:22; Shulchan Aruch HaRav 1:9.
By so doing, every Jew acknowledges that his/her livelihood comes from only from Hashem. Reciting the Parshat HaMann daily strengthens one's Emuna and Bitachon [belief and trust] in HASHEM, and is a "Segula for Parnassa" [auspicious for having a healthy income].
To read Parshat haMann in Hebrew [with the Aramaic translation of Onkelos], please visit: Tefillos.com
English version here: Ou.org
Read more at: Zchus Avos and Why Parshas Hamon is recited on Tuesday