text:
Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction
- Matthew E Cove1Email author and
- Graeme MacLaren1, 2
DOI: 10.1186/cc9229
© BioMed Central Ltd 2010
Published: 14 October 2010
Acute myocardial infarction is one of the 10 leading reasons for admission to adult critical care units. In-hospital mortality for this condition has remained static in recent years, and this is related primarily to the development of cardiogenic shock. Recent advances in reperfusion therapies have had little impact on the mortality of cardiogenic shock. This may be attributable to the underutilization of life support technology that may assist or completely supplant the patient's own cardiac output until adequate myocardial recovery is established or long-term therapy can be initiated. Clinicians working in the intensive care environment are increasingly likely to be exposed to these technologies. The purpose of this review is to outline the various techniques of mechanical circulatory support and discuss the latest evidence for their use in cardiogenic shock complicating acute myocardial infarction.
The in-hospital mortality for acute myocardial infarction (AMI) is currently around 7% [1]. Death is related predominantly to the development of cardiogenic shock, which affects 5% to 10% of all cases of AMI and has a mortality rate of 50% to 90% [2, 3]. Patients who develop cardiogenic shock frequently require critical care services, and AMI is one of the 10 leading causes for admission to adult critical care units [4]. Over the past three decades, revascularization therapy has revolutionized care for these patients. Recent studies support prompt percutaneous coronary intervention (PCI) when there is electrocardiographic evidence of an AMI [5], and if PCI is not available within 90 minutes, fibrinolysis should be delivered within 30 minutes [6, 7].
Despite these developments, there has been little progress in reducing mortality from cardiogenic shock complicating an AMI [8]. Part of the reason for this is that impaired cardiac contractility may persist many hours after revascularization, an observation described as myocardial stunning [9]. Interventions that can assist or completely supplant the patient's own cardiac output may support these patients until the stunned myocardium recovers (bridge to recovery). Recovery can be predicted using peak serum creatinine kinase levels [10] or contrast echocardiography [11], but even when recovery does not occur, mechanical circulatory support may provide time to determine whether longer- term therapies are appropriate (bridge to decision). In this review, we will outline the various techniques of mechanical circulatory support and discuss the evidence for their use in cardiogenic shock complicating AMI.
Initial management
Cardiogenic shock criteria
Hemodynamic criteria
Systolic blood pressure (SBP) of less than 90 mm Hg for greater than 30 minutes
SBP drop of greater than 30 mm Hg below basal for greater than 30 minutes in patients with hypertension
Use of vasopressors and inotropes to keep SBP greater than 90 mm Hg
Cardiac index of less than 2.2 L/min per m2
Pulmonary artery occlusion pressure of greater than 15 mm Hg
Signs of tissue hypoperfusion
Pale, cool, and clammy peripheries
Prolonged capillary refill times
Altered mental status/confusion
Pulmonary congestion
Elevated lactate
Mixed venous saturation of less than 65%
Intra-aortic balloon pumps
Inflation timing is determined using either the electrocardiogram or the arterial pressure waveform. In the latest devices, inflation timing can be controlled with a physiologic timing algorithm that predicts aortic valve closure. When combined with R wave or pressure predictive deflation, this method maintains balloon synchrony even in patients with severe tachyarrhythmias [17].
As well as providing improved synchrony, modern IABPs have reduced vascular complications. Data from the Benchmark registry, which has collected outcomes for over 37,000 patient episodes [18], demonstrate that smaller (8 to 9.5 French) catheter sheaths have reduced the total complication rate to 2.6% and cut major complications, including limb, bowel, and renal ischemia, to under 0.5%. As a result, mortality directly attributable to IABP use is currently less than 0.05% [19]. Owing to a higher risk of limb ischemia, these devices, even with smaller catheters, should be used cautiously in patients with severe peripheral vascular disease. IABPs are not suitable for all patients and are specifically contra-indicated in those with severe aortic regurgitation, aortic dissection, or large aneurysms.
Clinical evidence supporting intra-aortic balloon pump in cardiogenic shock
Attempts to study IABP use in cardiogenic shock have been affected by poor recruitment. This may reflect the difficulty of obtaining timely consent and randomization in the critically ill. For example, the SMASH (Swiss Multicenter Evaluation of Early Angioplasty for Shock Following Myocardial Infarction) study was stopped after recruiting only 55 patients during a 4-year period [20]. Similarly, the TACTICS (Thrombolysis and Counter-pulsation to Improve Survival in Myocardial Infarction Complicated by Hypotension and Suspected Cardiogenic Shock) trial was stopped after 3 years when only 57 out of a planned 538 patients were randomly assigned [21].
Mortality evidence supporting intra-aortic balloon pump use in cardiogenic shock complicating an acute myocardial infarction
No IABPa
P value
O'Rourke et al. [22] (1981)
Flaherty et al. [23] (1985)
Thrombolysis era
Kovack et al. [25] (1997)
Reperfusion by PCI
In 1997, Kovack and colleagues [25] demonstrated that patients who developed cardiogenic shock complicating an AMI were twice as likely to survive when an IABP was used in conjunction with pharmocological reperfusion strategies (Table 2). In the same year, the GUSTO-I (Global Utilization of Streptokinase and Tissue Plasmino-gen Activator for Occluded Coronary Arteries) trial reported that early IABP use was associated with a trend toward lower 30-day (47% versus 60%; P = 0.06) and 1-year (57% versus 67%; P = 0.04) mortality rates in patients who presented with cardiogenic shock complicating an AMI [26]. Analysis of the larger SHOCK (Should We Emergently Revascularize Occluded Coronary Arteries for Cardiogenic Shock) trial (1,190 patients) confirmed this benefit, demonstrating statistically significant lower in-hospital mortality for cardiogenic shock patients who received IABP verses those who did not (50% versus 72%; P ≤0.0001) [27]. However, a significant confounding factor in these studies was a higher number of revascularization procedures in the IABP group.
To eliminate confounding, the SHOCK data were re-evaluated comparing IABP plus fibrinolysis with fibrinolysis alone. In this analysis, in-hospital mortality was still improved by 25% (47% versus 63%; P = 0.007) [27]. A similar benefit was observed in the larger National Registry of Myocardial Infarction 2 (NRMI-2) (n = 23,180 patients), in which the use of IABP as an adjunct to fibrinolysis, in cardiogenic shock, reduced in-hospital odds of death by 18% (odds ratio (OR) 0.82, 95% confidence interval (CI) 0.72 to 0.93) [28]. A recent meta-analysis by Sjauw and colleagues [29] demonstrated that this benefit remains statistically significant beyond the in-hospital period, with an absolute decrease in 30-day mortality of 18% (95% CI 16% to 20%; P < 0.0001).
IABP benefits are less clear for cardiogenic shock patients who undergo primary PCI. In the SHOCK trial, revascularization with PCI resulted in a significant reduction of mortality when compared with medical therapy, including fibrinolysis. Importantly, IABP use was 86% in both groups, and mortality in the medical therapy group was lower than expected [8]. This suggests that IABP plus medical therapy may result in lower mortality and that IABP plus PCI further improves mortality. In contrast, the NRMI-2 study observed that IABP as an adjunct to primary PCI resulted in a higher mortality (OR 1.27, 95% CI 1.07 to 1.50) in patients with cardiogenic shock complicating an AMI [28]. This negative association is also evident in the recent meta-analysis by Sjauw and colleagues [29]. However, for this part of their analysis, only two registries were used: the NRMI-2 study and the data of Sjauw and colleagues. In the absence of randomization, the trend may be confounded since patients receiving both PCI and an IABP in the NRMI-2 study were more likely to have cardiogenic shock complicated by previous PCI (OR 1.85, CI 1.64 to 2.09) and experience an inter-hospital transfer (OR 2.57, CI 2.40 to 2.75) [28].
A more recent study that randomly assigned patients with AMI complicated by cardiogenic shock to either IABP plus PCI or PCI alone did not demonstrate significant improvement in APACHE II (Acute Physiology and Chronic Health Evaluation II) scores or mortality over the first 4 days of admission (36.8% in the IABP group versus 28.6%) [30]. However, this study was not powered to assess mortality. Large randomized clinical trials are required to resolve this issue and address whether the current American Heart Association and American College of Cardiology guidelines recommending PCI and IABP in the setting of cardiogenic shock complicating AMI require revision [31]. In the meantime, we recommend IABP use in any patient meeting the criteria for cardiogenic shock in the setting of an AMI when inotrope therapy has been initiated, whether the patient has received PCI or thrombolysis or neither. IABPs are more widely available than more complex forms of mechanical circulatory support, have a low complication rate, and decrease myocardial oxygen demand. IABPs should be routinely available at centers treating patients with AMI.
Extracorporeal membrane oxygenation
When there is evidence of inadequate tissue oxygen delivery despite IABP, invasive ventilation, and inotropes, full circulatory support should be considered. Extracor-poreal membrane oxygenation (ECMO) can subsume the function of both heart and lungs and was first successfully used in adults in 1972 [32]. De-oxygenated blood is removed from the body, pumped through an artificial oxygenator, and returned to the circulation. Modern oxygenators consist of multiple, small hollow fibers lined with polymethylpentene and allow gas but not liquid transfer. Oxygen and carbon dioxide exchange is achieved as blood runs through the center of the fibers and an oxygen/air mix flows on the outside. Blood flow is generated by a centrifugal pump, where a rotating impeller spins blood outwards, creating centrifugal acceleration. Since no compression is involved, high flow rates can be generated with minimal trauma to blood components.
Peripheral ECMO is less invasive, is easier to place, and can be placed percutaneously by surgeons or intensivists. It can be initiated quickly, making it more appropriate in emergencies. However, the cardiac output of the failing heart competes with retrograde ECMO flow from the femoral aortic cannula, producing admixing in the thoracic aorta and an increase in left ventricular wall tension. If there is concomitant respiratory failure, this can result in the delivery of inadequately oxygenated blood to the coronary and cerebral circulations and hinder recovery [34]. Central ECMO is not associated with this problem but is slower to initiate and may have a higher complication rate with bleeding and infection. It is usually confined to the support of patients after surgical revascularization. Peripheral VA-ECMO is adequate for most forms of cardiogenic shock, but frequent echo-cardiography is necessary to monitor for progressive ventricular dilatation. If this develops, the left atrium can be vented either by changing the ECMO circuit configuration or by performing a percutaneous atrial septostomy [35–37].
VA-ECMO is associated with bleeding in 30% to 60% of cases [38, 39], sometimes requiring massive transfusions. New pumps and improved circuit biocompatibility allow lower levels of anticoagulation to be used and should reduce the impact of this complication. Clotting abnor-malities predispose to hemorrhagic stroke, which, combined with circuit embolic complications such as air bubbles or clots, results in an overall stroke rate of 3% to 12% [33, 40, 41]. Other complications include nosocomial infection in 50% to 60% [40, 41] and multi-organ dysfunction in 33% [39], although the contribution of ECMO is not easy to separate from the complications of severe critical illness. Device and circuit complications appear to be declining [33].
Evidence supporting extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction
Evidence supporting extracorporeal membrane oxygenation use in cardiogenic shock complicating an acute myocardial infarction
The variable survival rates reflect that fact these are small single-center studies. The Extracorporeal Life Support Organization (ELSO) registry addresses this limitation by recording the experience of over 170 ECMO centers worldwide. ELSO has accumulated data on over 40,000 ECMO cases, of whom approximately 3,000 are adults. In 2009, ELSO reported a survival rate of 39% for adult cardiogenic shock [33].
Contraindications to full mechanical circulatory support
Prolonged cardiopulmonary resuscitation with inadequate perfusion
Advanced age
Advanced malignancy
Existing organ dysfunction
Advanced chronic obstructive pulmonary disease
Interstitial lung disease
Liver cirrhosis
Previous stroke with significant disability
End-stage renal failure (relative)
Contraindication to anticoagulation (relative)
Contraindication to transplant (relative)
Ventricular assist devices
Classification of ventricular assist devices
Ventricular support
TandemHeart (CardiacAssist, Inc., Pittsburgh, PA, USA)
Impella 2.5L (Abiomed, Aachen, Germany)
Impella 5L (Abiomed)
CentriMag (Levitronix LLC, Waltham, MA, USA)
Bio-Medicus (Eden Prairie, MN, USA)
DeltaStream (Medos Medizintechnik AG, Stolberg, Germany)
HeartMate II (Thoratec Corporation, Pleasanton, CA, USA)
Jarvik 2000 (Jarvik Heart Inc., New York, NY) and Incor(Berlin Heart AG, Berlin, Germany)
HeartAssist 5 (MicroMed Cardiovascular, Inc., Houston, TX, USA) and DuraHeart (Terumo Heart Inc., Ann Arbor, MI, USA)
Percutaneous left ventricular assist device
In acute cardiogenic shock complicating an MI, percutaneous LVADs (pLVADs) hold the most promise. They can be initiated quickly and do not require a sternotomy. The two most studied devices are the TandemHeart (CardiacAssist, Inc., Pittsburgh, PA, USA) and Impella (Abiomed, Aachen, Germany).
Comparative data of studies into ventricular assist device use in cardiogenic shock complicating an acute myocardial infarction.
Δ Cardiac output, L/min
30-day survival, percentage
P value
TandemHeart (pLVAD)
Thiele et al. [52] (2005)
Burkhoff et al. [53] (2006)
Impella (pLVAD)
Seyfarth et al. [54] (2008)
Centrimag (eBiVAD)
John et al. [61] (2007)
Titrated for cardiac index > 2.2 L/min per m2
When these three studies are combined in a meta-analysis, it is still not possible to detect a mortality benefit [55]. However, it is arguable that an overall number of 100 patients is still too small. In addition to offering no clear survival benefits, pLVADs provide only left ventricular support. Thus, they are inappropriate for cardiogenic shock due to right ventricular ischemia, and although successful cases of percutaneous right ventricular assist [56, 57] and even biventricular assist [58] have been reported, they required substantial modification of existing technology. Despite this, the improved hemo-dynamics are impressive and percutaneous devices are set to become increasingly important in the management of acute cardiogenic shock [59, 60], especially if larger studies demonstrate that these hemodynamic benefits translate into significant survival benefits.
Surgically placed ventricular assist device (extracorporeal and implantable)
In the acute setting of cardiogenic shock complicating AMI, surgical VAD placement has proven to be challenging. The additional trauma of surgery com-pounds the multi-organ dysfunction and coagulopathy associated with extracorporeal circuits. However, third-generation pumps have been successfully surgically placed in the acute setting by means of cannulas tunneled through the chest wall. In one study, the Centrimag (Levitronix LLC, Waltham, MA, USA) was used to provide temporary BiVAD for 12 patients presenting with refractory shock following AMI. Eight patients were successfully bridged to an implantable VAD, and two patients recovered allowing device explantation. Overall 1-year survival was 62.5% [61].
Implantable VADs allow patients to be discharged home, providing a bridge to transplant, bridge to recovery, or destination therapy. Destination therapy is particularly attractive since transplant demand greatly exceeds donor availability. Studies in the last decade have demonstrated that implantable pulsatile LVADs are superior to medical therapy in end-stage heart failure patients who are ineligible for a transplant [62, 63]. Recently, it was demonstrated that third-generation devices result in decreased mortality and greater reliability when compared with pulsatile LVADs [64].
VADs are susceptible to complications similar to those experienced with ECMO. Neurological insults affect 4% to 12% of patients, infection 20% to 30%, and bleeding 30% to 40% [52, 53, 65]. Device malfunction rates are improving; over a 2-year period, less than 10% of implantable third-generation pumps require replacement [64].
The decision to initiate VAD therapy should be made under the same circumstances as those described above for ECMO. The precise modality chosen depends on institutional experience and patient factors. For isolated left ventricular failure, with minimal respiratory disturbance, a pLVAD may be sufficient. Where there is concomitant respiratory failure or high ventilatory settings or when biventricular support is desired through a percutaneous approach, ECMO is more appropriate (Figure 3). Occasionally, the two may be used together [66]. In patients between these extremes, the factors of institutional experience, likelihood of recovery, and whether surgical revascularization is required will dictate choice. Finally, pursuing this technology is not without controversy in terms of resource allocation and ethics [67]. These issues vary substantially depending on healthcare infrastructure, financing sources, and donor (as well as blood product) availability.
When cardiogenic shock complicating AMI is refractory to medical therapy, the only options available for survival are mechanical support strategies. Mechanical support can be applied in a stepwise progression starting with IABP support, followed by either ECMO or an LVAD. In the acute setting, these devices may provide circulatory support until the benefits of revascularization are realized. In the event that weaning is not possible, these devices serve as a bridge to decision or transplant. In patients who are ineligible for transplant, implantable VADs hold the promise of viable destination therapy.
acute myocardial infarction
- BiVAD:
biventricular assist device
confidence interval
extracorporeal membrane oxygenation
Extracorporeal Life Support Organization
intra-aortic balloon pump
left ventricular assist device
National Registry of Myocardial Infarction 2
odds ratio
percutaneous coronary intervention
- pLVAD:
percutaneous left ventricular assist device
Should We Emergently Revascularize Occluded Coronary Arteries for Cardiogenic Shock
ventricular assist device
veno-arterial extracorporeal membrane oxygenation
veno-venous extracorporeal membrane oxygenation.
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- Haynes S, Kerber RE, Johnson FL, Lynch WR, Divekar A: Left heart decompression by atrial stenting during extracorporeal membrane oxygenation. Int J Artif Organs 2009, 32: 240-242.PubMedGoogle Scholar
- Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J: Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 2008, 36: 1404-1411. 10.1097/CCM.0b013e31816f7cf7View ArticlePubMedGoogle Scholar
- Formica F, Avalli L, Martino A, Maggioni E, Muratore M, Ferro O, Pesenti A, Paolini G: Extracorporeal membrane oxygenation with a polymethylpentene oxygenator (Quadrox D). The experience of a single Italian centre in adult patients with refractory cardiogenic shock. ASAIO J 2008, 54: 89-94. 10.1097/MAT.0b013e31815ff27eView ArticlePubMedGoogle Scholar
- Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson-Hansen C, Blackstone EH, Cosgrove DM: Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg 2001, 122: 92-102. 10.1067/mtc.2001.114351View ArticlePubMedGoogle Scholar
- Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, Ackermann H, Zwissler B, Kleine P, Moritz A: Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg 2008, 135: 382-388. 10.1016/j.jtcvs.2007.08.007View ArticlePubMedGoogle Scholar
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- Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS: Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 2002, 73: 538-545. 10.1016/S0003-4975(01)03330-6View ArticlePubMedGoogle Scholar
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- DeBakey ME: Left ventricular bypass pump for cardiac assistance. Clinical experience. Am J Cardiol 1971, 27: 3-11. 10.1016/0002-9149(71)90076-2View ArticlePubMedGoogle Scholar
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- Burkhoff D, Cohen H, Brunckhorst C, O'Neill WW, TandemHeart Investigators Group: A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 2006, 152: 469. e1-8 10.1016/j.ahj.2006.05.031View ArticlePubMedGoogle Scholar
- Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, Dirschinger J, Kastrati A, Schomig A: A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 2008, 52: 1584-1588. 10.1016/j.jacc.2008.05.065View ArticlePubMedGoogle Scholar
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- Samoukovic G, Rosu C, Giannetti N, Cecere R: The Impella LP 5.0 as a bridge to long-term circulatory support. Interact Cardiovasc Thorac Surg 2009, 8: 682-683. 10.1510/icvts.2008.199208View ArticlePubMedGoogle Scholar
- John R, Liao K, Lietz K, Kamdar F, Colvin-Adams M, Boyle A, Miller L, Joyce L: Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure. J Thorac Cardiovasc Surg 2007, 134: 351-358. 10.1016/j.jtcvs.2007.01.085View ArticlePubMedGoogle Scholar
- Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL, Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group: Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 2001, 345: 1435-1443. 10.1056/NEJMoa012175View ArticlePubMedGoogle Scholar
- Rogers JG, Butler J, Lansman SL, Gass A, Portner PM, Pasque MK, Pierson RN: Chronic mechanical circulatory support for inotrope-dependent heart failure patients who are not transplant candidates: results of the INTrEPID Trial. J Am Coll Cardiol 2007, 50: 741-747. 10.1016/j.jacc.2007.03.063View ArticlePubMedGoogle Scholar
- Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH, HeartMate II Investigators: Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009, 361: 2241-2251. 10.1056/NEJMoa0909938View ArticlePubMedGoogle Scholar
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text:
25741 / 45011 Adverts
Villa Detached, 3 floors, in a private property
from $27/Night (rates)
14 people
7 bedrooms
7 bedrooms
Swimming poolDirect access to the beach
Benefits : Direct access to the beach
- View : Sea/ocean, street/avenue
- Kids welcome
- Setting : Waterfront, Calm
- Spa
Touristic region : discover Calabria Coast
Advert No. 24071
Contact the owner
For your guidance
45009 rentals over 179 countries
- Ad verified, documents requested
- Booking request in real time
- Lowest price, direct contact with the owner
- No commission is charged for the contact between proprietor and tenant or the transaction
Reviews about the Advert 24071
Be the first to provide a review about this advert!
Advert details 24071
Assets Villa
Swimming pool : Private swimming pool, outside shower
Benefits : Direct access to the beach
Interior Villa with View: sea/ocean, street/avenue
Receive up to : 14 person(s)
Interior layout : 7 bedroom(s), tv den
Guest facilities : T.V.
Appliances : Crockery/flatware, gaz stove, refridgerator
Exterior Vacation rental in Setting: waterfront, calm
Outside setting : Yard
Outside amenities : Sun recliner(s), outside shower facilities
Rates Calendar Availability Vacation rental in Fuscaldo
Seasons & Availability Villa in Fuscaldo
Rates Villa in Fuscaldo
Season Night Weekend week 2 weeks Month
Low season - - - - -
Mid season$27* - - - -
High season$32* - - - -
Festive specials - - - - -
Promotional period - - - - -
ServiceFrequencyIncluded / SuppliedSupplementRates
For your guidance
Information :
Kids welcome
Cell phone network coverage
Booking conditions
Reservation :
Payment made upon reservation : 30% of rental sum
Payment balance : 1 day before the stay
rentals :
Day tax included
Accepted methods of payment :
International Money Order
Bank transfer (wire)
Leisure, Surroundings, Location Home 24071
Leisure Fuscaldo - Cosenza Province
Specific activities on site or less than 3 miles :
SPA Fuscaldo
SurroundingsOcean - Cosenza Province
Locality :
Shingle beach
Amenities :
Village center
Mail office
Location AccessVilla Fuscaldo
Via Gondoliere
87024 FuscaldoCalabria
GPS coordinates of the city
Latitude 39°24'51.876"N
Longitude 16°1'41.52"E
Access routes Vacation rental 24071
at 43,5mi. / 1h 15min.
Freeway (exit) A3
Praia a Mare, Cosenza Province, Calabria, Italy
at 3mi. / 10min.
Railroad station Paola
Paola, Cosenza Province, Calabria, Italy
Close to Cozzo Cervello, Botte Donato, Fiume Lao, Stazione Camigliatello Silano, Monte Cocuzzo, Torrente di Mavigliano, La Mula, Torrente Torboli, Capo Bonifati, Valle Colonci, Torrente Campagnano, Bocca di Piazza, Sant'Elia, Fermata Sant'Ianni, Fiume Abatemarco, Passo di Crocetta, Stazione di Torano Lattarico, Passo Acquabona, Fiume Oliva, Lago Arvo, Stazione Castrovillari
Cities close by
Nearby places
Photos Villa 24071
Return to the rental listingsContact

subset: commoncrawl


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Pineapple Chicken
|3 1⁄2 Pound, cut into pieces
|All purpose flour
|1⁄2 Cup (8 tbs)
|2 Tablespoon
|Canned pineapple rings
|16 Ounce, drained with juice reserved
|2 Tablespoon
|1 Large, finely chopped
|Chicken broth
|1 1⁄4 Cup (20 tbs)
|Bouquet garni seasoning
|1 Teaspoon
|Dairy sour cream
|1⁄4 Cup (4 tbs)
|To Taste
|To Taste
1) Set the oven to 350°.
2) Take a paper bag and put flour into it seasoned with salt and pepper.
3) First put half the chicken pieces into it and shake until well coated.
4) Repeat the same procedure for the remaining chicken pieces and save the excess flour.
5) Take a large skillet and melt butter in it.
6) Stir in the pineapple rings and fry over gentle heat, tossing carefully, until each side is golden brown.
7) Take off the rings from the skillet and drain and keep aside.
8) In the skillet, sauté the onion for 5 minutes over gentle heat until translucent and lightly colored.
9) Move the onion to one side and increase the heat a bit.
10) Add the coated chicken pieces to this and fry for about 5 minutes, tossing until browned on all sides.
11) Take a large casserole and transfer the chicken pieces and onion to it with a slotted spoon.
12) Make pineapple juice to 2 cups by pouring the chicken broth to it.
13) Add this to the casserole with the bouquet garni seasoning and salt and pepper.
14) Cover and cook the casserole in the oven for 30 minutes.
15) Take off from the oven and arrange the pineapple rings over the chicken.
16) Again cover and cook for a further 15 minutes till the chicken is tender (Take a fine skewer and pierce the meat in the thickest part so that the juices should run clear).
17) Minimize the oven temperature to 225°.
18) Take a serving platter and place the chicken pieces and pineapple rings on it and keep warm.
19) Use paper towel to blot the excess fat from the surface of the cooking liquid.
20) Take a saucepan and transfer the liquid to it and heat gently.
21) In a small bowl, combine 1 tablespoon of the saved seasoned flour with the dairy sour cream till smooth.
22) Mix this into the hot cooking liquid in the pan and stir until it is thickened slightly, yet not allowing boiling.
23) Add more salt and pepper, if necessary.
24) Pour a little of the sauce over the chicken and the pineapple and serve with the left over sauce separately.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 532 Calories from Fat 272
% Daily Value*
Total Fat 30 g46.6%
Saturated Fat 9.5 g47.7%
Trans Fat 0 g
Cholesterol 144.8 mg48.3%
Sodium 285.7 mg11.9%
Total Carbohydrates 21 g7%
Dietary Fiber 1.4 g5.5%
Sugars 12.2 g
Protein 42 g83.6%
Vitamin A 6.8% Vitamin C 14.6%
Calcium 4.1% Iron 11.3%
*Based on a 2000 Calorie diet


text:
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Emails Show Obama Administration Using Goldman Sachs Lobbyists to Pass TPP
– Emails Show Obama Administration Using Goldman Sachs Lobbyists to Pass TPP:
(COMMONDREAMS) A series of emails released Friday show what activists describe as "collusion" between U.S. Trade Representative Michael Froman and Wall Street executives to push for the passage the controversial Trans-Pacific Partnership (TPP).
The emails (pdf), obtained through a Freedom of Information Act (FOIA) request by the group Rootstrikers, which organizes against money in politics, include a message to Froman from a managing director at Goldman Sachs urging him to push for "robust commitments" on Investor-State Dispute Settlement (ISDS) provisions—which allow private corporations to sue governments for perceived loss of profits—to be included in the divisive trade deal. Continue reading »
Tags: Barack Obama, Freedom of Information Act, Global News, Goldman Sachs, Government, Lobbyists, Obama administration, Politics, TPP, U.S.


text:
Rates in USD (taxes & fees included), shown as:
Nightly Average
Valencia Hotel San Antonio
Valencia, 23, San Antonio, Sant Antoni de Portmany, San Antonio 07820, Spain
Find Hotel Rates
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Valencia Hotel San Antonio Hotel Reviews
Based on reviews from across the web.
Valencia Hotel San Antonio Hotel Details
Founded in 1964 and renovated in 2008, this hostel offers its guests a welcoming environment and home-from-home treatment, which makes it the ideal spot from which to get to know the island of Ibiza better. It comprises a total of 21 rooms and facilities on offer to guests include a lobby area with a 24-hour reception and check-out service, a currency exchange facility, a cloakroom, lift access and a TV lounge. There is a caf
Valencia, 23, San Antonio Sant Antoni de Portmany, San Antonio 07820, Spain


text:
Sunday, June 26th, 2016 – Noon to 5pm All Tickets: $15 The 2016 Ypsilanti Heritage Foundation Annual Historic Home Tour will take place on Sunday, June 26th from noon to 5 p.m. A portion of this year's...Learn More
This stately home in the Queen Anne Style was built in 1894 by Jehiel J. Strang. We know nothing about him except that he liked the design well enough to build a similar house one hundred yards up the street....Learn More
This charming bungalow, originally built in Willow Run in the 1930s, was moved to its present location on East Forest by Robert Lloyd. A young man who worked as a civil engineer at Willow Run Airport, Lloyd...Learn More
Near the end of World War I Ypsilanti carpenter Frank Lidke built several houses in the Oak-Forest neighborhood. Among them was the charming bungalow at 192 Oak Street. In 1920 he sold the new house to George...Learn More
This stately Italianate house was built between 1851, when the property was deeded to grocer Frederick Andrews, and 1856, when it first appeared on the city map. It retains its characteristic...Learn More
Ypsilanti developers and landlords Eric and Karen Maurer purchased 120, 122, and 124 West Michigan Avenue in March 2010. With the rich history of the buildings in mind, they renamed them the Mellencamp...Learn More


text:
Libbey 5134 4 oz. Side Water Glass - 72/Case
- To save more: Mix and Match
- Quantity Discounts!
|Buy 1 - 2
- Hefty base creates a bold look
- Thick glass walls ensure durability
- Crystal clear construction
- Perfect for small servings of water
- Can be used as a unique dessert glass
- Ideal for bars and catered events
|3 1/8 Inches
|Bottom Diameter
|2 Inches
|Top Diameter
|2 3/8 Inches
|4 oz.
|Water Glasses
Customer questions about this product
- Is this piece of Libbey glassware made in America?
- Yes, this item is made in America. However, Libbey reserves the right to ship items from other factory locations if needed. Regardless, all products will meet the high standards expected of a Libbey item.
Thanks to its perfectly petite size, the Libbey 5134 4 oz. side water glass makes an ideal addition to meal service at any catered event or restaurant. It's perfect for serving water alongside coffee, tea, or hot chocolate, or use it prior to dinner at catered events. With straight sides and a thick base, this simple yet boldly designed piece is ideal for matching any decor. It also makes for a unique dessert glass to show off your mouth watering mousse and parfaits.
Since 1818, Libbey has been a leading distributor of glassware, providing a wide selection of durable and elegant products to suit your many needs. In that grand tradition, the high-quality form and feel of this side water glass make it a perfect addition to any restaurant, hotel, or bar. Offering unparalleled brilliance and clarity, this glass makes it instantly clear that your customers are receiving the best product and service possible.
Overall Dimensions:
Top Diameter: 2 3/8"
Bottom Diameter: 2"
Height: 3 1/8"
Capacity: 4 oz.
Dishwasher Safe
This item can safely be cleaned in a commercial dishwasher.
Made in America
This item was made in the United States of America.
Lead Free
This item is free of lead-based products.
A PDF viewer is required to view this product's information. Download Adobe Acrobat software
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Customer Reviews
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These are little cute glasses. They work perfectly for a splash of wine or beer, and also as a 4oz taster for a taster flight of beer. Pretty thick, so they don't crack that easy, and you can stack them as high as you want.
Aaron C. from Plan 9 Alehouse Posted on 03/10/2016
Great taster glass
We use these in the bar for water or whiskey backs. We also use these for dressing from the kitchen on our large salads. They are easy to clean. They have held up well to washing, dropping, etc.
Katrina C. from Big Eddy's Deck Bar Posted on 03/07/2016
We ordered these glasses because they were so inexpensive. Hoping to use them at the bar instead of traditional rocks glasses. Our event bartenders and event planner didn't like how they looked. Unfortunately, shipping cost back is almost as much as the case of glasses. Live and learn. Our own fault.
John A. from Inne of the Abingtons Posted on 01/28/2016
We use our Libbey 5134 4 oz. Side Water Glass 72 / Case for sampler glasses in our brewery. The perfect size for a sample glass.
Christopher S. Posted on 12/22/2015
These are perfect for the beer tasting flights that we made. The flare on them us just right to lift and hold the flight and they won't fall through. Perfect beer samplers.
Craig W. from Bru, Inc. Posted on 07/29/2015
I shopped around for a long time trying to find an affordable option for beer sampling "flights" for my wedding reception. I ordered a case of these 4 oz Libbey "water" glasses and couldn't be happier. The home-made flight paddles went perfectly with the homebrew and these little glasses were the perfect way to show them off!
Andrew H. Posted on 02/08/2014
Homemade Beer Flights with 4oz Libbey glasses
We use them for Happy Hour's cold sake glass. Also we use them beer or sake samplers too. These glasses are very useful for us. It was a good buy.
Akiko T. from UZAK CREATIVE INC Posted on 08/29/2013
I purchase this glass set for my church to use in a religious ceremony and I have to say we are well please. The glasses were just the right size not too large and not to small. They are perfect for other events if you want to serve a dessert or some some sort of beverage in them. You just can't go wrong and the price was was amazing and not to mention the fast shipping. I love the Webstaurantstore you guys are great keep up the excellent work.
Trudy B. Posted on 05/31/2013
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text: Baby Quotes For Baby Cards Whether it's a New Baby Card, a Baby Shower Card or even a Baby Announcement telling the world about your new born, you can use a baby quote on it. I have found a few which I think are quite nice. If I come across anymore baby quotes then I will add them here. A baby has a special way of adding joy in every single day. A sweet new blossom of humanity. Babies are a link between angels and man. A new baby is like the … [Read more...]


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There's no doubt about it: Florida is a paradise for both novice and experienced paddlers.
More than 1,000 miles of coastline call out to sea and surf kayakers, while countless inland rivers, creeks and streams beckon to those seeking a watery adventure through some of the most remote and scenic locations in the Sunshine State. Saltwater bays and protected estuaries teeming with wildlife are a favorite destination for photographers and birding enthusiasts.
Sopchoppy River
A true wilderness experience awaits you on the Sopchoppy, a 47-mile tea-colored river with steep limestone banks and outcroppings situated almost completely within the Apalachicola National Forest. The waterway twists and turns, with a current that will push canoes and kayaks along at a moderate rate.
The forest surrounding the Sopchoppy is home to many wildlife, especially along the section passing through the Bradwell Bay Wilderness. Keep a lookout for red-cockaded woodpeckers and black bears. The banks are lined with stands of cypress, titi, tupelo trees (which produce world famous Tupelo Honey) and numerous species of rare plants.
The 15-mile Sopchoppy River Paddling Trail is part of Florida's statewide system of Greenways and Trails, passing through remote wilderness areas in the uppermost portion and ending near the town of Sopchoppy, known for its annual Worm Gruntin' Festival. Three access points provide entrance along the trail, starting at Oak Park Cemetery Bridge on Forest Road 346, five miles south at Mt. Beasor Church Bridge on Forest Road 343 and 3.5 miles south of the town of Sopchoppy at the U.S. 319 Bridge.
The Sopchoppy depends on local rainfall to maintain high levels in the upper portions of the waterway, and it may be impassable – check with the U.S. Forest Service at 850-926-3561 before you go.
Withlacoochee River (South)
There are two Withlacoochee Rivers in Florida, and to avoid confusion they are referred to as North and South. The only similarities they share are part of their name and the black color of the water.
The Withlacoochee is one of only a few rivers in the United States that flow in a northerly direction. The river receives the majority its water input from springs, outlets from Lake Panasoffkee and the Tsala-Apopka chain of lakes, and a large surge from Rainbow Springs as the Rainbow and Withlacoochee Rivers join and continue northwest.
The Withlacoochee South begins as a small stream in the heart of central Florida, the Green Swamp, which is an important recharge area for the Florida aquifer. The drainage from this area creates the headwaters for three other major waterways: the Hillsborough River, the Ocklawaha River and the Peace River.
With more than 75 miles of the officially designated paddling trails to enjoy, the Withlacoochee twists and winds its way through both protected a state forest and small communities before finally spilling into the Gulf of Mexico at Yankeetown in southern Levy County. Fishing and birding are outstanding along all parts of the Withlacoochee.
Fishermen will appreciate the abundance of largemouth bass in the Lake Rousseau area, and the world record 18.88-pound white catfish was caught on the Withlacoochee in 1991.
For birders, several species of heron, ibis, and double-crested cormorant are a common sight. Turkey and deer frequent the shoreline, emerging from both pine hardwood hammocks and cypress swamps.
Access the most scenic and remote section of the Withlacoochee west of Bushnell on the Sumter and Citrus County border. Launch your craft at the SR-48 bridge, heading north through Bonnet Lake. The paddling is easy, with no noticeable current. One mile past Bonnet Lake, a primitive camping area is available at Board Island; this is the last public camping area for many miles, so be prepared to paddle another 13 miles past this point to the SR-44 bridge.
Peace River
Another outstanding central Florida paddling opportunity can be found on the Peace River. Like the Withlacoochee, the headwaters of the Peace River are located in the Green Swamp. The officially designated paddling trail starts at Fort Meade, where the river flows south to Arcadia in DeSoto County. Eleven public access points are located along the way, so finding a launch point is easy, and paddler can create trips of different lengths. With a slow to moderate current, high banks and varied widths, the Peace River is an excellent choice for paddlers who want to experience a classic Florida river.
Wildlife is abundant all along the river – deer are frequently spotted in the early mornings. Herons, cranes, and a multitude of other bird species are plentiful, making the Peace River an excellent choice for photography.
Since there are a number of access points along the Peace River, paddlers can easily plan a day or weekend trip. The section between Zolfo Springs and the Gardner boat ramp is especially scenic. Launch at the FL 64 bridge in Zolfo Springs in Hardee County, and paddle up to 23 miles to the Gardener boat ramp.
Loxahatchee River
The Loxahatchee is one of two waterways in Florida that received designation as a Wild and Scenic River (the other being the Wekiva River). Although it passes through some heavily populated areas, the Loxahatchee has very beautiful undeveloped sections that make it a wonderful paddle.
The river has a sand bottom, with dark colored water and its banks along the upper portion are lined with ancient cypresses. The official 10.3-mile paddling trail runs from Riverbend Park to Jonathan Dickinson State Park and is abundant with wildlife along the entire route. Peninsula turtles and several species of heron can be seen frequently.
For a classic Florida canoe or kayak day trip, paddle the 10.3-mile official paddling trail, starting at Riverbend Park on State Road 706 in Jupiter and concluding at Jonathan Dickinson State Park 12 miles south of Stuart on U.S. 1.
For more details on these four outstanding Florida paddling trips, or to find out more information on other Florida rivers, visit the Florida Greenways and Trails online guide.


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A first half equaliser from Jimmy Bullard cancelled out Benjani's opening strike for City as both sides played out a tight draw at Craven Cottage.Match Result (First Team) Saturday 6 December 2008, 12:45
Jimmy Bullard controlled the tempo of Fulham's game against Aston Villa at Villa Park, and made sure the team headed back to SW6 with a point.Match Result (First Team) Saturday 29 November 2008, 15:00
A solid display from the Whites on Saturday afternoon meant the points were shared at Anfield after neither Liverpool or Fulham could break the deadlock.Match Result (First Team) Saturday 22 November 2008, 15:00
An excellent display from Fulham was enough give the Whites all three points on Saturday and end Spurs' recent run of form. Simon Davies' first goal of the season and another strike from Andy Johnson secured the win.Match Result (First Team) Saturday 15 November 2008, 15:00
Fulham jumped into 10th position in the Barclays Premier League after goals from Andy Johnson and Danny Murphy handed the Whites all three points in a pulsating match at Craven Cottage on Sunday.Match Result (First Team) Sunday 9 November 2008, 16:00
Continuing a tradition of not winning at Goodison Park, Fulham lose 1-0 to Everton in a close encounter.Match Result (First Team) Saturday 1 November 2008, 12:45
A comfortable game and a clean-sheet was good news for Fulham as they overcame Wigan in a 2-0 win on Saturday afternoon.Match Result (First Team) Wednesday 29 October 2008, 19:45
Clint Dempsey netted a late equaliser as Fulham came back from a goal down to share the points at Fratton Park.Match Result (First Team) Sunday 26 October 2008, 17:00
Fulham and Sunderland battled in an evenly-contested encounter at Craven Cottage that saw the points shared as the match ended 0-0. The visitors hit the woodwork on two occasions whilst Fulham kept Craig Gordon active throughout.Match Result (First Team) Saturday 18 October 2008, 15:00
A second-half Roman Bednar strike for West Bromwich Albion was the difference in Fulham's match at the Hawthorns, as the game ends 1-0 to the home side.Match Result (First Team) Saturday 4 October 2008, 15:00
Two goals late in the first half and the sending off of Andy Johnson ensured that Fulham suffered their first home defeat of the season – but the Whites went down fighting.Match Result (First Team) Saturday 27 September 2008, 15:00
Fulham were knocked out of the Carling Cup on Tuesday evening after a tight game at Turf Moor.Match Result (First Team) Tuesday 23 September 2008, 19:45
A late goal from substitute Matt Derbyshire handed Blackburn the win in a scrappy encounter at Ewood Park. The Whites created a number of half-chances with Bobby Zamora looking dangerous in the air and Andy Johnson going close with a good second half effort but the home side netted the crucial strike on 84 minutes.Match Result (First Team) Saturday 20 September 2008, 15:00
Goals from Bobby Zamora and Zoltan Gera ensured three points for the Whites on Saturday afternoon.Match Result (First Team) Saturday 13 September 2008, 15:00


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Relax after a long day in this plush recliner for the perfect place to unwind. Pull the easy to use handle to put your legs up for the ultimate relaxing position to watch TV or read a book in. This amazingly comfortable recliner is available in in multiple colors so you can choose the one that suits your style. The overstuffed look of these recliners gives them a beautiful casual look that you will love in your home.
The 133-91 Casual Rocker Recliner with Overstuffed Biscuit Back Design by Comfort Living from Rotmans. We proudly serve the Worcester, Boston, MA, Providence, RI, and New England area. Product availability may vary. Contact us for the most current availability on this product.
Add this plush, casual reclining living room collection to your home for a plush look that you are sure to love. Each piece has an overstuffed biscuit back design and pillow top arms for one of the most comfortable collections you have ever sat in. Gather you family and friends to watch the big game atop this plush, casual, collection for a look that is perfect for your living room.
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The bad beginning
Format: Book
Summary: After the sudden death of their parents, the three Baudelaire children must depend on each other and their wits when it turns out that the distant relative who is appointed their guardian is determined to use any means necessary to get their fortune.
Series: Snicket, Lemony. Series of unfortunate events ; bk. 1.
Current Holds: 29
System Availability: 0 (of 11)
Call Number: J SNICKET
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Well I have eaten at IHOP three times in a couple years. Wasn't impressed before. Food was greasy...overly greasy. But the worst was the crepes the last time I was there. They were rubbery and just plain gross...
we like ihop but this one needs an overall cleaning. our server was amazing....I wish I could remember her name....the food was not warm at all....eggs have to be hot...but the reserved food was good. the place just needs to be totally cleaned...booths wiped down and floors power scrubbed. pet peeve.....sticky syrup containers. wipe them off after each customer!
Restaurant was clean, food was very good, hot and plenty of it.
Mevlida did a great job. Personality was on even though it was later in the evening and we had 2 tired kids. Orders were right and drinks refilled. Smiles and checking on us. Great job!
I enjoy good pancakes, and IHOP has them. Their omelettes are great as well. I'll go their for a breakfast meal at night. Their plain buttermilk pancakes are just plain perfect.
Our service was good but the food was cold and lousy won't be back. Took our food back and microwaved it but the flavor was lacking
This was actually the first time I had been to an IHOP - so I was a little skeptical. However, I was very wrong. The restaurant was very clean and nice - moreso than I would have expected. Obviously their specialty is pancakes and pretty much every meal comes with them. They were amazing by themselves, let alone the rest...
My parents and I stopped here for breakfast. The restaurant was not very busy, and we were greeted and seated immediately. Our server was very friendly and attentive, we never had an empty beverage. We all agreed that the food was excellent. I would stop at this location again when I'm passing through Waterloo.
IHOP is one of the trashiest, worst restaurants i have ever been in. The managers that we dealt with were rude, arrogant and pompous. We were threatened to be kicked out for using language that we were accused of using. We have been long standing customers and were not given the benefit of the doubt.
They were rock stars! They got the team in & served in record time. We couldn't have asked for better service. Thank you IHOP team!!!
Waterloo Crossroads area seems to be lacking in many family restaurants so Ihop is a good option. Always good pancakes and french toast and the combos are large enough to share.
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Some liver function tests check the levels of certain enzymes that are essential to chemical reactions that help the liver function normally. These tests include:
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These enzymes are involved in processing proteins. Too high levels of ALT and/or AST can signal that the liver is injured or damaged.
- Alkaline phosphatase (ALP). ALP levels that are higher than normal can be a sign of liver diseases,blocked bile ducts, or other conditions.
- Gamma-glutamyl transpeptidase (GGT) is an enzyme found in large amounts in your liver, bile ducts and pancreas. High levels of GGT in the blood may signal liver or bile duct damage.
- Bilirubin tests. Bilirubin is a byproduct of the normal breakdown of red blood cells. If your liver is damaged, bilirubin can leak out of your liver into your blood, causing your skin and eyes to appear yellow (jaundice).
- Globulin and albumin are proteins made in the liver. Low levels of these proteins may indicate liver damage.
- An alpha-1 antitrypsin test measures the amount of a protein that helps protect the liver (and the lungs) from damage. A deficiency in alpha-1 antitrypsin may signal a rare form of cirrhosis. An alpha-1 antitrypsin deficiency can be inherited.
- Prothrombin time (PT) test. Prothrombin is a protein made in your liver that helps with normal blood clotting. A prothrombin time test measures how long it takes for the liquid portion of your blood (plasma) to clot. A high prothrombin time can be a sign of liver damage.


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The Jabra Speak 810 is a premium grade, professional speakerphone designed to offer USB, Bluetooth (NFC/MFI) and 3.5m Jack for Smartphone or Tablet connectivity for conference calls. The broadest range of connectivity in the Jabra Speak Series, ideal for a hassle free simple conference call set up in seconds, for collaboration with up to 15 attendees in the same meeting room for perfect sound.
Using ZoomTalk microphones for excellent audio quality, uniquely detect the human voice and not the ambient room noises (such as people eating or keyboard tapping) making the Jabra Speak 810 the ideal choice for those empathetic to those working remotely and dialing in to the call. ZoomTalk makes it easy to hear, and easy to be heard no matter where you are located.
With a USB charge out port for charging your tablet or smartphone the Jabra Speak 810 offers you the full flexibility to connect however you want to without the worry of battery life. A/C powered yet lightweight, the Jabra Speak 810 is portable from room to room. However the Kensington lock keeps it securely in place for a more traditional fixed meeting room collaboration solution.
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Jerry Errico
Another dessert cocktail made with oatmeal stout, the Oatmeal Cookie gets a spicy edge from Goldschläger, a Swiss cinnamon schnapps that has thin flakes of gold leaf floating in it.
- Yield
- Serves 4
- Ice cubes
- 3 ounces molasses
- 3 ounces ruby port
- 1 1/2 ounces Goldschläger
- 12 ounces oatmeal stout
- 1. Fill a cocktail shaker halfway full with ice cubes. Add the molasses, port, and Goldschläger. Shake until cold.
- 2. Strain into four old-fashioned glasses. Top with the oatmeal stout, and serve.


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After experimenting with Narendra Modi tea and fish stalls, the Bharatiya Janata Party plans to rope in poets to boost its prime ministerial candidate's prospects in the upcoming general elections.
It was learnt the saffron party plans organising 30 to 35 Kavi Sammelans, poetry recitation sessions, across the country, where poets are expected to eulogise Modi as a "savior and only leader who could turn things around".
Some poets, among them Hari Om Panwar, are being approached for these events.
"No BJP leader will attend these events. It will be purely a cultural activity. The only difference will be that poets would propagate Modi's ideas and messages. Some stars would also be attending these sessions," BJP vice president Mukhtar Abbas Naqvi told HT.
He is also the convener of BJP's Central Programme Implementation and Coordination Committee.
In addition to the poetry sessions, the party's strong publicity machine plans to dispatch about 50 vans fitted with 3D screens to various places, mostly rural areas, to play out Modi's recorded speeches.
"The idea is to take Modi to far flung areas where he cannot reach personally. We plan to cover nearly 300 Lok Sabha seats through these publicity vans before the election. We may increase the number of publicity vans according to the need," said a BJP leader on the condition of anonymity.
Thirty separate teams being trained currently will be performing street plays in rural and tribal pockets to spread Modi's message.


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For the first time since coming to office in 1997, Mr Blair let it be known that he intends to serve a full, five-year second term if returned to power.
He will then lead New Labour into a third election and could challenge Baroness Thatcher's record 11 years at Number 10.
The move knocks on the head Westminster speculation that he would stand down mid-way through a second term, and sounds the death knell for Gordon Brown's dreams of becoming party leader.
The Chancellor, who will be in his late 50s if Mr Blair wins his decade in power, looks doomed to become the Prince Charles of politics.
Most Labour MPs now accept that having beaten him in Labour's leadership contest after the death of John Smith, Mr Blair has consigned Mr Brown to be "always the bridesmaid".
The Prime Minister's official spokesman ended speculation about Mr Blair's future plans ahead of the party's centenary conference in Bournemouth this week. He said: "The Prime Minister certainly doesn't take a second term for granted ... he remains eternally vigilant against complacency."
But asked if Mr Blair would ask voters to trust him for a full, second term and back the Labour party with him in charge of it, the spokesman replied: "He certainly will. Yes."
Mr Blair, whose personal poll rating leaves all rivals in the shade, intends to heap praise on Mr Brown in his platform speech to conference on Tuesday. "It is widely acknowledged, rightly, and supported by indicators that Gordon has done a brilliant job and the tough decisions early on have paid off," Mr Blair's spokesman said.
Both have pledged to make Labour the party of "economic competence". A tough line on spending will be the main thrust of their conference message.
Sources close to Mr Brown were last night stressing the united front between Chancellor and Prime Minister. One said: "As far as Gordon is concerned, Tony is going to stay on forever, or at least until he decides not to go on anymore.
"There was never a deal between them that Tony would step down to give Gordon a go. The only deal was that he would be Chancellor."
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La Batie, Meylan 04250, France
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A few minutes from Grenoble enjoy a spacious comfortable studio in a characterful building a former relay point for the Chartreuse monks in the 17th century. First-floor renovation kitchen-come-dining room with lounge and sleeping area 2 beds 90x200 bathroom and toilet central heating pretty private terrace with trees and flowers and garden furniture washing machine in out-building courtyard and shared garage. Nearby public transport Chartreuse natural park Grenoble Parc des Etangs site des Capucins wine production and sale Hébert Museum Parc de l Ile d Amour etc.
La Batie Meylan 04250, France


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The death of Oral Roberts brings to a close one of the more colorful chapters in American religious history. Born into rural poverty in Pontotoc County, Oklahoma, Granville Oral Roberts became one of the best-known televangelists of the twentieth century. He translated pentecostalism from the sweaty tents of the revival circuit to the cool professionalism of the television studio.
Roberts was among the first to figure out that television solved forever the riddle of itinerancy. The miracle of television allowed preachers to be everywhere at once. Itinerancy was never the same. Preachers flocked to the television studios the way that the faithful had flocked to the revival tents, and the age of the televangelist was born.
In a sense, Roberts' challenge was far more daunting than that faced by Billy Graham, Roberts' contemporary. Graham was a mainstream evangelical, everything from his boyish good looks and media savvy to his barely discernible touch of Carolina drawl. Graham's "crusades," as he called them, attracted celebrities and extensive media coverage. Although Graham's preaching was energetic, especially in his younger years, it was also measured.
Roberts, on the other hand, was an Okie with a bit of Cherokee blood. His brand of evangelicalism, known as pentecostalism, featured "glossolalia" (speaking in tongues), ecstatic worship and divine healing. Yes, Roberts eventually toned down some of his tent-revival antics for television, but pentecostalism was undeniably a tougher sell than Graham's smooth, corporate-style evangelicalism.
Roberts migrated to television in 1955, just as pentecostalism itself was about to burst onto public consciousness. Roberts himself had been influenced by Kathryn Kuhlman, a healing evangelist; Roberts in turn influenced such "Seed Faith" preachers as Kenneth Copeland and Kenneth Hagin, who promised riches to the faithful if they sent money to whichever televangelist was making the appeal.
In the 1980s Roberts was part of the trifecta of televangelist scandals, although he really didn't belong in that company. Whereas Jim Bakker had a tryst with (you can't make this up) a church secretary from Long Island and sought to cover it up with hush money from ministry funds and Jimmy Swaggart was frequenting Louisiana motel rooms for voyeuristic encounters with prostitutes, Roberts' notoriety in 1987 was a very different sort. He informed his followers that God would "call him home" unless God's people ponied up something like $4.5 or $8 million (accounts differ).
This may have been the first time in history that God had taken a hostage and demanded ransom.
Roberts survived the incident and the embarrassment - and he got his money. The funds were supposed to support his City of Faith hospital, an ill-fated venture that turned out to be financially disastrous, especially in Tulsa, Oklahoma, which already had a surfeit of hospital beds.
Roberts was more successful in setting up a university in 1963, although he initially resisted the eponymous designation. A few institutions of higher education in America are named after individuals. Harvard, Yale and Brown come to mind, and Duke and Vanderbilt and Stanford. Oral Roberts University, by some measure, must be included in that roster - along with Bob Jones University. Oral Roberts University had an NCAA division one basketball team in the 1980s, and several of the players went on to careers in the NBA; the joke at the time was that, with Roberts' skills as a healer, the team didn't need a trainer. Some of the university's graduates include Copeland, Ted Haggard (former head of the National Association of Evangelicals) and Michelle Bachman (member of Congress from Minnesota).
Not bad for an Okie who himself never graduated from college.
Any retrospective about religion in the twentieth century must include prominent mention of Oral Roberts, this son of a preacher who became a preacher himself. And beside his name should be included words like minister, educator, pentecostal and one of the pioneers of televangelism.
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Achievements & Accolades: May/Jun 2013
Investigator Awards in Health Policy Research
2011 Investigator awardee Susan Shapiro, PhD, received the John J. Regan Writing Award (PDF - 539 KB) for her article, "Advance Directives: The Elusive Goal of Having the Last Word," published in the Fall 2012 NAELA Journal.
Read More Achievements & Accolades >>
- Clinical Scholars
- Executive Nurse Fellows
- New Connections: Increasing Diversity of RWJF Programming
- Nurse Faculty Scholars
- Scholars in Health Policy Research
Clinical Scholars
Margaret Gourlay, MD, MPH, ('02) won the Top 10 Clinical Research Achievement Award from the Clinical Research Forum for her study on bone density screening for older women.
Rhonda Mattox, MD, ('08) has been selected as the 2013 American Psychiatry Association Jeanne Spurlock Congressional Fellow.
RWJF/U.S. Department of Veterans Affairs Clinical Scholar Gordon Sun, MD, ('11) was selected as a recipient of the 2013 Presidential Scholarship for New Health Services Researchers for AcademyHealth's 2013 Annual Research Meeting.
Clinical Scholars Anita Vashi, MD, ('11) and Nurit Harari, MD, ('11) described their opinions on using disaster preparedness strategies in communities where urban violence, specifically gun violence, is prevalent in order to "build resilience" in a recent op-ed piece in the CT Mirror.
Arjun Venkatesh, MD, MBA, ('12) was awarded the 2013 Alice S. Hersh Scholarship to attend AcademyHealth's 2013 Annual Research Meeting, as well as to present the following papers at the conference: "Variation in U.S. Hospital Emergency Department Admission Rates by Clinical Condition, 2009" and "Use of Observation Care for ED Patients With Chest Pain: A Statewide Analysis of Society of Chest Pain Centers Metrics in Georgia, 2009."
Ilse Wiechers, MD, MPP, ('12) was recently named chair of the Board of Trustees for the American Association for Geriatric Psychiatry Political Action Committee.
Executive Nurse Fellows
Jean Giddens, PhD, RN, ('11) has been named dean of the Virginia Commonwealth University School of Nursing, effective June 30. Giddens currently serves as professor and executive dean of the College of Nursing at the University of New Mexico. She succeeds Nancy F. Langston, who was dean for 22 years and will retire this summer.
Legal Issues Confronting Today's Nursing Faculty: A Case Study Approach, written by Mary Ellen Glasgow, PhD, RN, ACNS-BC, ('09) was selected for the 2012 Book of the Year Award by the American Journal of Nursing. Glasgow is dean and professor at the Duquesne University School of Nursing.
Deborah Gross, DNSc, MS, BSN, FAAN, ('06) was profiled by the American Journal of Nursing as an American Academy of Nursing's Edge Runner in its March 2013 issue. Gross is a driving force behind the Chicago Parent Program, a best practice in prevention that recently was added to the National Registry of Evidence-Based Programs and Practices of the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration.
Dennis Sherrod, EdD, RN, ('03) nursing professor and Forsyth Medical Center endowed chair of recruitment and retention, was chosen by the University of North Carolina's Board of Governors to receive this year's Excellence of Teaching Award. Sherrod was nominated by Kineka Hull, the director of academic services in the School of Health Sciences, and will receive a bronze medallion and $7,500 at the university's commencement ceremony.
Shelly Buck-Turner, MBA, BSN, RN, CCRN, ('11) has been selected as one of Virginia Commonwealth University School of Nursing's 120 Visionary Leaders, recognized as part of the school's 120th anniversary. She was honored at a gala dinner on May 30.
Laura Wood, DNP, MS, RN, ('12) was named chief nursing officer at Boston Children's Hospital, taking over the post on May 13. Prior to taking the post, she was the Vice President and National Director of Clinical Solutions for Siemens Healthcare.
New Connections: Increasing Diversity of RWJF Programming
Alumna Monique Clinton-Sherrod, PhD, ('08) was elected to the Executive Board of the American Psychology Association Division 35 (Psychology of Women).
Marilyn Nanney, PhD, ('08) New Connections—Healthy Eating Research alumna, received an R01 grant from the National Institutes of Health. The grant, titled "Improving High School Breakfast Environments," has been funded for $759,120 for fiscal year 2013.
Kimani Paul-Emile, PhD, ('11) was promoted to associate professor with tenure in May 2013 at the Fordham University School of Law.
Program alumna Niñfa Pena-Purcell, PhD, ('06) was promoted to associate professor at Texas A&M AgriLife Extension.
Nurse Faculty Scholars
Adejoke Ayoola, PhD, RN, ('12) has been selected as a Top 20 Medical and Nursing Professor in Michigan.
Maren Coffman, PhD, RN, ('09) has been selected by the University of North Carolina's Charlotte Office of International Programs to receive its 2013 International Education Faculty Award. Coffman is an assistant professor in the College of Health and Human Services' School of Nursing. She impressed the award's selection committee members with her international work and significant contributions to the international study experience.
Elizabeth Cohn, DNSc, RN, ('12) has been selected as a judge for the Patient-Centered Outcomes Research Institute Challenge.
Laurie Theeke, PhD, RN, ('10) was inducted into the Academy of Excellence at the University of West Virginia School of Nursing as a result of her participation in the Teaching Scholars Program.
Scholars in Health Policy Research
Christopher Bail, PhD, ('11) discussed immigration reform after the Boston Marathon bombings on Huffington Post Live on April 24.
John Cawley, PhD, ('99) was quoted in a CNN article, "Coming to a Workplace Near You: Fines for Being Fat?" for his study of a workplace program that offered financial incentives for losing weight. The article was published on April 15, 2013.
Dino Falaschetti, PhD, ('01) co-authored an article, "Does Climate Change Worry You? How About Insurance to Cover Its Consequences?" published in Forbes, April 25, 2013.
Alumnus Michael Greenstone, PhD, ('98), director of the Hamilton Project, co-authored an opinion piece, "Better Living Standards," published in the New York Times on April 16. The article suggests that evidence on the direct effects of immigration—higher wages, lower prices, and net taxes—shows that immigration raises standards of living for Americans.
Colin Jerolmack, PhD, ('08) has authored a book, The Global Pigeon, which shows how our interactions with pigeons offer surprising insights into city life, community, culture, and politics. The ethnography was published by the University of Chicago Press.
In his blog published on the Huffington Post, Mark Sawyer, PhD, ('03) discussed the claim that Beyonce and Jay Z are race traitors for taking a trip to Cuba. "Beyonce and Jay Z Are Race Traitors for Going to Cuba !?!?" was published on April 15, 2013.
Boris Shor, PhD, ('11) has been awarded the 2013–2014 Rutgers Center on the American Governor Research Award.
Craig Volden, PhD, ('01) was interviewed on MSNBC on April 9, 2013. Volden explained his research published in the American Journal of Political Science, which found that female lawmakers are better than their male counterparts at reaching across the aisle and could be more effective at their jobs.