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I've started a new project: Letter Extravaganza '09. For those of you who use Facebook, you already know that you accumulate a number of "friends" who you don't actually ever talk to or write to or anything to really. To combat this problem I made an offer to all of them to send a real, honest-to-God letter to whoever requests one. I have 102 Facebook "friends", which means that if they all responded I'll be doing quite a lot of letter writing, which sounds pretty cool to me. Although so far the response rate is about 32%.
This whole project would go pretty fast, but I've also been doing envelope art for all the letters which significantly slows things down...that and laze. For once I've actually been remembering to scan the envelopes before I send them out, so that means I can post them here (Sans addresses of course). The images I do usually have something to do with the person I'm sending it to, but like an inside joke I won't bother explaining them. So without further ado here's the first five.
Wednesday, November 25, 2009
3 comments:
- AnonymousNovember 25, 2009 at 2:16 PM
Love the flute...
But they are all delightful!
- AnonymousDecember 2, 2009 at 6:14 PM
Where's mine? Mine is awesome.ReplyDelete
Also, I agree with Rose. The flue one is grand.
Also, I'm surprised that Death Cab hasn't sued Owl City for ripping them off in unforgivable ways. Once I finally listed to that one Owl City song with headphones, the autotune is nearly unbearable.
Ban the autotune!
Word up, couz.
I'm putting them up in waves of 5, and thus yours will be in the next wave. I'm glad you liked it. I wasn't sure with that one, because it ended up as one of the ones I stared at too long and then all I could see was my mistakes.ReplyDelete
Autotune! *spit*
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One of the best things about working in digital is the availability of almost immediate feedback. Without feedback in its various forms we are less capable of performing our best, be it as individuals or organisations.
Online and specifically related to content, this feedback frequently takes the form of data generated by users, and is often collected by the analytics package used to help measure the effectiveness of a site.
As digital marketers we can capitalise on this seamless collection and subsequent analysis of data to help us achieve our goals – offering us evidence to support our suggestions for what the audience want to see and why something is or isn't effective.
That's how we know that our audience and clients are interested in hearing more about what we've been working on, what we are capable of and what results we get – so, without keeping you in suspense any longer, here's some of our most recent work for your perusal.
Our new site:
One conclusion we could draw from the aforementioned interest is that perhaps we don't shout about our achievements enough. With that in mind, showcasing our new site would be a good place to start. Although, as you're reading this, you probably noticed that already. Nice, eh?
Have you visited our brand new website yet? #Digital #WebsiteGoals #FridayFeeling https://twitter.com/YardDigital/status/959356734765756416/video/1
— Yard (@YardDigital) February 2, 2018
The art of luxury watchmaking:
Drawing on a combination of available data sources we identified a demand, and therefore an opportunity, to create a piece of long-form content for our client ROX that tells the story of the art of luxury watchmaking.
Prior to the creation of this content there were lots of great articles and resources out there covering facets of this fascinating subject, but nothing telling the entire compelling story with the richness it deserves.
Working with some key partners, we created a piece highlighting the skill and craftsmanship that goes into luxury watches. It was important that we were able to visually match the beauty and reflect the detailed complications of these watches, all while managing to appeal to watch aficionados as much as those just dipping their toe (or perhaps wrist) into the world of haute horlogerie.
Sweating the small stuff:
Here's a very different campaign and content style – recently we've been working as part of a cross-functional, international project team with Sage on their Sweating the Small Stuff campaign.
A study into the administrative burden faced by SMEs presented an opportunity to create an effective showcase of the results. Creating a visual asset making it easy for busy SME owners and employees to quickly assess the results of the study was key since, as the results show, they would likely be juggling a number of time consuming administrative tasks.
You may be thinking that a study into small business inefficiency from an accountancy software provider isn't as sexy as luxury watches. As someone who works in a digital marketing agency, I can assure you that there is a certain beauty in a well-crafted, nicely-formatted, effective spreadsheet – and reducing unnecessary administrative burdens to make delivering great results more straightforward is perhaps even more joyous.
If you've read this (thanks by the way, we've captured the data and we'll use that to inform future content) and want to find out how we can help your brand, get in touch!

subset: commoncrawl


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I told you in my last post how excited I was about my super fun weekend & it did not disappoint! I left town Friday morning {my sweet friend Alli took me to the airport!} and made it to Houston in time to get to the hotel, get a snack, and refresh a bit before heading to the game!
I had a fun time talking to my cousin Fay about photography stuff & even ran into Eli {our puppy!} sisters grandparents -haha, my friend Kate & her husband got one of Eli's sisters this weekend and we had fun talking about the pups!
{I'm sorry but MH is too pretty, I had to show you two!}
{my dad – always on the go!}
Made it to the game – ran into Scarlett & fam going into the game which was amazing to get to hug my fave's neck real fast! Our section was full of Waco/Baylor people and even a few more family members – so fun to catch up. I think it's funny that at any out of town Baylor sporting event I can pretty much guess who I will run into. There is a fun group that follows Baylor around the country for sports & I always love to be a part of that! AND I got to see my sweet Brynn during half time!! So fun to see 2 great Baylor friends at the game 🙂 The game was A-MAZING and we were so thrilled with our win. I am so proud to be a Baylor Bear even if we didn't win our Elite 8 game. After the game my dad treated us to an amazing meal at Del Frisco's! It's a family favorite everytime we go to New York City & we were thrilled that they had one at the Galleria! Yummy yummy!!
Enjoy the pics 🙂
{me and my fave, Scarlett}
{don't know them-just love the green & gold they are sporting}
{me & my Brynn!!}
{Go Bears!!!}
PS- at least the Lady Bears are in the Final 4!!!!!


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Family Law
Contested and Uncontested Divorces
All parties entering into a divorce have the same ultimate goal: to get what they "deserve" from their marriage. They want a resolution that enables them to provide for themselves and their family in a safe and stable environment. When children are involved, their best interest is what should be paramount.
I will guide you through this often complicated legal process using negotiation, mediation and/or collaborative law to reach an amicable and lasting resolution. I have seen some of the ugliest divorces end amicably. If, on the other hand, it is not possible to reach agreement out of court, I am prepared to go to trial and present your case; the judge will determine the final outcome.
A sum of money is paid by one spouse to help support the other as a result of a divorce or separation. Many factors are considered when determining whether alimony is paid, and the amount paid. Alimony can be paid on a monthly basis, in a lump sum, and/or by having one spouse pay certain expenses for the other spouse. The person receiving alimony is responsible for paying taxes on it since it is treated by the Internal Revenue as income. The spouse paying alimony can deduct it from his/her gross income. Alimony is subject to modification by either spouse.
Child Custody and Visitation
Custody matters are always very emotionally charged for my clients and their families. During a divorce action or post-divorce modification, the court makes decisions based on what is in the best interest of the children. Working with both juvenile and family matters for many years, I am highly experienced in this area and will strive to create a lasting agreement that is in the best interest of your children while trying to avoid long and costly litigation.
Child Support
Child support issues arise in many different types of family law actions, including divorce, modification of child custody or support, legitimation and paternity. Georgia law requires both parents to contribute to the support of their children. The amount each parent contributes is determined by his/her monthly earnings as well as the amount of money each parent pays toward other child related expenses. Other factors that may be considered when determining each parent's support obligation are: the amount of time each parent cares for the children; a parent's support obligation for other children from a different relationship; and travel costs to visit with the children. Child support is subject to modification by either parent based on a significant change in circumstances.


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REVIEW THE CLINICAL MANAGEMENT OF DIABETIC RETINOPATHY — Arthur D. Fu, MD,* Sam S. Yang, MD,† and H. Richard McDonald, MD‡ ABSTRACT The diagnosis of diabetic retinopathy carries several negative implications. The disease may lead to loss of visual acuity and blindness and is often associated with the systemic complications of diabetes (eg, nephropathy and neuropathy), in addition to hypertension and hyperlipidemia. Individually, each of these conditions is detrimental to the patient's health, but they can also worsen retinopathy. Therefore, not only is it important to screen, diagnose, and treat diabetic retinopathy, it is also important to screen, diagnose, and treat the comorbid conditions. The complexity of dealing with these comorbid conditions has led to recommendations for routine, multidisciplinary, team-based diabetes care. Landmark studies have demonstrated the benefit of blood glucose management in preventing and treating diabetic retinopathy. Clinical studies also support the benefit of treating hypertension and hyperlipidemia in reducing progression of the disease. Evidence from the Diabetic Retinopathy Study, the Early Treatment Diabetic Retinopathy Study, and the Diabetic Retinopathy Vitrectomy Study has provided insight into how best to use effective interventions, such as photocoagulation and vitrectomy, in patients with significant diabetic retinopathy, diabetic macular edema, vitreous hemorrhage, and diabetic traction retinal detachments. *West Coast Retina Medical Group, San Francisco, California. †Fellow, California Pacific Medical Center, West Coast Retina Medical Group, San Francisco, California. ‡Associate Clinical Professor, Department of Ophthalmology, University of California, San Francisco, California. Address correspondence to: H. Richard McDonald, MD, West Coast Retina Medical Group, 1 Daniel Burnham Court, Suite 210C, San Francisco, CA 94109. E-mail: [email protected] S702 Meanwhile, research continues for pharmacologic interventions that prevent or interfere with the pathogenesis of diabetic retinopathy, including vascular endothelial growth factor inhibitors (eg, pegaptanib), protein kinase C-β inhibitors (eg, ruboxistaurin), intravitreal triamcinolone acetonide, pigment-epithelium–derived factor, and growth hormone release inhibition. (Adv Stud Med. 2004;4(9A):S702-S713) iabetes mellitus is a disease with significant negative implications for the patient. Although ophthalmologists are primarily concerned with the ocular complications resulting from macular edema and proliferative diabetic retinopathy, decades of clinical trials and longitudinal studies indicate that people with diabetes are also at higher risk for the systemic complications of nephropathy and neuropathy.1-8 In addition, the comorbid conditions of hypertension and hyperlipidemia are common in patients with diabetes and may influence the severity and progression of diabetic retinopathy.9-13 Landmark clinical trials have demonstrated the correlation between the severity of retinopathy and elevated levels of serum glucose and hemoglobin A1c.1-6,14-16 These multicenter clinical studies also indicate that intensive glycemic control can help reduce ocular and systemic complications. Macular edema and proliferative diabetic retinopathy are important indicators of systemic organ involvement, which suggests that a multidisciplinary teambased approach to treatment is needed to reduce ocular and systemic complications. In addition, certain systemic risk factors are thought to independently exacerbate the progression of retinopathy.17,18 D Vol. 4 (9A) ■ October 2004 REVIEW Therefore, treating only ocular conditions without awareness of the myriad systemic implications can lead to reduced efficacy of therapy and increased comorbidity. Intensive multiorgan system therapy is the paradigm on which the multidisciplinary team-based strategy is based.10 THE MULTIDISCIPLINARY TEAM-BASED APPROACH What is the multidisciplinary team-based approach? How is it used to prevent and treat patients at high risk for diabetic retinopathy? This treatment strategy is based on frequent patient visits to the internist and the ophthalmologist and increased vigilance in detecting diabetic retinopathy in patients with elevated serum glucose levels, elevated hemoglobin A1c levels, or in patients who have recently been initiated into intensive control that occasionally results in the short-term exacerbation of diabetic retinopathy.2,10 Furthermore, treatment of coexisting conditions, such a hypertension and hyperlipidemia, by the appropriate specialists reduces the severity of diabetic retinopathy.19,20 The appropriate monitoring and referral of patients for diabetic microvascular complications by the ophthalmologist may minimize other significant systemic effects. The multidisciplinary approach to treatment involving ophthalmologists and other specialists starts with maximizing glycemic control. Two landmark studies, the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), documented the benefit of aggressive intensive control of serum glucose levels.1,4,21,22 The results of these studies form the basis for the strategy of tight control to maintain glucose levels near normal. The DCCT, a multicenter prospective study, randomly assigned 1441 patients with type 1 diabetes mellitus to conventional treatment or to intensive treatment.4-6 Intensive treatment included the use of an insulin pump or 3 or more insulin injections daily, self-monitoring of blood glucose 4 or more times daily, frequent insulin dosage adjustments, initial hospitalization to implement treatment, and weekly to monthly clinical visits with frequent telephone contact. After 6.5 years, the mean hemoglobin A1c level was 7.2% in the group receiving intensive therapy versus 9.1% in the group receiving conventional therapy. Of the patients receiving intensive therapy, the relative risk for developing diabetic retinopathy was reduced by 27%, the relative risk for developing proliferative diabetic Advanced Studies in Medicine ■ retinopathy or severe levels of nonproliferative diabetic retinopathy was reduced by 47%, the rate of photocoagulation treatment was reduced by 56%, and relative rates of diabetic macular edema were reduced by 23%.4,5,23 Additional endpoints included a reduction in incidences of diabetic nephropathy by 34% to 57% and a lessened clinical risk of other diabetic microvascular complications. Complications of tighter control did not lead to increased death or macrovascular complications. A significant finding in the group receiving intensive therapy was that patients may experience an initial deterioration in diabetic retinopathy that occasionally requires ophthalmologic intervention.1,4 The UKPDS randomly assigned 4209 individuals newly diagnosed with type 2 diabetes mellitus into treatment groups similar to the DCCT, with the intensive therapy cohort receiving oral sulfonylureas and metformin therapy, along with insulin injections as recommended by physicians.21,22 Additional randomizations related to blood pressure control. Primary endpoints included rates of development of diabetic retinopathy, diabetic peripheral neuropathy, diabetic nephropathy, and cardiomyopathy. These patients were followed for a median of 10 years. At the conclusion of the study, the relative risk of diabetic retinopathy decreased by up to 76%, laser photocoagulation rates decreased by 29%, and the rate of legal blindness decreased by 16%. Relative risk reduction for diabetic nephropathy rates ranged from 34% to 57%.22-25 Better blood pressure control also improved outcomes. The collective recommendations from these 2 landmark trials (ie, UKPDS-33 and UKPDS-34) indicated that patients diagnosed with type 1 or type 2 diabetes mellitus who made frequent visits to physicians with the goal of maximizing insulin therapy, diet, and exercise significantly decreased ocular and systemic diabetic microvascular complications. Therefore, attempts by ophthalmologists to successfully treat diabetic retinopathy are inextricably linked to control of serum glucose levels (Figure 1).9 Adequate control of serum glucose levels is only one of many therapies that modulate the risks and course of diabetic retinopathy. In addition to increased hyperglycemia as an increased risk factor for progression of diabetic retinopathy, comorbid conditions such as systemic hypertension, nephropathy, pregnancy, anemia, and even gastroparesis may exacerbate diabetic retinopathy.4,10,12,23,25-32 Prevention or better management of these conditions can positively affect the prognosis of diabetic retinopathy. S703 REVIEW A significant finding of the UKPDS-38 was the fact that systemic hypertension was an independent risk factor in the progression of diabetic retinopathy.23,25 Hypertensive retinopathy can occur even in the absence of diabetic retinopathy and has similar retinal findings, including microaneurysms, flame-shaped hemorrhages, cotton wool spots, and macular exudates. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) also supported the role of hypertension in the progression of retinopathy.9 Patients with the lowest degrees of systolic and dia-stolic pressures had a significantly lower risk of progression to proliferative diabetic retinopathy compared to patients with higher levels of hypertension (Figure 2).9 The UKPDS-38 evaluated the effects of the treatment of systemic hypertension on diabetic retinopathy.33 Patients were placed in an intensive control group (maintain blood pressure levels below 144/82 mm Hg) or a less-controlled group (achieve blood pressure levels below 154/87 mm Hg). Individuals in the intensive control cohort had a 34% relative risk reduction in diabetic retinopathy progression, a 47% reduction in deterioration of visual acuity, and a 37% reduction in need for photocoagulation.33 These benefits were noted regardless of the type of antihypertensive medication used. The Appropriate Blood Pressure Control in Diabetes Trial34 found a similar lack of significant differences between the efficacy of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers in the rates of diabetic retinopathy progression. However, with the evidence supporting the benefits of ACE inhibitors in reducing diabetic microvascular complications in patients with renal compromise, additional clinical trials examining their effects on diabetic retinopathy are likely.35 The association between diabetic nephropathy and diabetic retinopathy has long been postulated.11,13,36 However, the association between proteinuria and the progression of retinopathy is complex because of multiple confounding factors.37 Similar to patients with diabetic retinopathy, patients with diabetic nephropathy are likely to have chronic hyperglycemia, elevated hemoglobin A1c levels, and hypertension (independently, each condition can be a cause of retinopathy).4,5,13,38 The WESDR indicated increased severity of diabetic eye disease as a risk factor for proteinuria.9 Conversely, studies have suggested that proteinuria is a predictor for future S704 diabetic retinopathy.39 Severe proteinuria is correlated with a 95% increase in the risk of developing diabetic macular edema.40 A large percentage of patients with end-stage renal disease who are receiving dialysis have concomitant retinopathy, with most of these cases Figure 1. Relationship Between Hemoglobin A1c and Retinopathy Progression* *P < .001. Data from Klein et al.9 Figure 2. Relationship Between Blood Pressure and Retinopathy Progression* *P < .05. Data from Klein et al.9 Vol. 4 (9A) ■ October 2004 REVIEW being proliferative diabetic retinopathy.41 It has been noted that once patients begin receiving dialysis, retinopathy tends to stabilize.41,42 The observation that the use of ACE inhibitors reduces renal microangiopathy has spurred increased interest in the use of ACE inhibitors and their potential benefits for reducing diabetic retinopathy.33,40,43-45 Other factors are associated with diabetic retinopathy. Hyperlipidemia has been reported to increase the exudation seen in diabetic macular edema.19,46 According to analysis from the WESDR, although serum cholesterol levels were not predictive of severity of diabetic retinopathy, they were associated with severity of hard exudates.20 Other cross-sectional studies in patients with type 1 diabetes mellitus have suggested an association between total serum cholesterol levels and diabetic retinopathy.47 In the Early Treatment of Diabetic Retinopathy Study (ETDRS), serum levels were measured in 2709 patients. Elevated serum cholesterol, low-density lipoprotein, and triglyceride levels correlated with an increased rate of hard exudation in these patients.48 The severity of diabetic exudation was also correlated with high-density lipoprotein levels.49,50 Although elevated triglycerides at baseline have been reported as a risk factor for proliferative diabetic retinopathy,11,27,47 the WESDR did not confirm any association with serum cholesterol levels and diabetic macular edema.20 Studies examining the effects of pregnancy on the progression of diabetic retinopathy have allowed clinicians and investigators an opportunity to examine the complex interactions between diabetes and pregnancy-induced hormonal and metabolic changes affecting serum glucose levels. Progesterone, vascular endothelial growth factors (VEGF), and changes in systemic hemodynamics are hypothesized to contribute to alterations in retinal vasculature.10,26,51-59 Also, elevations in hemoglobin A1c levels in early pregnancy are associated with an increased risk in progression of diabetic retinopathy.60 Additional risks for progression in pregnant women with diabetes include increased duration of diabetes, amount of retinopathy at conception, and presence of comorbid conditions, such as hypertension.10,54,60 Progression of diabetic retinopathy in patients with anemia has also been studied.10,27-29,61,62 In the ETDRS analysis, a low hematocrit level was determined to be an independent risk factor for development of high-risk proliferative diabetic Advanced Studies in Medicine ■ retinopathy and severe visual loss.27 A study that recorded hemoglobin levels in a large population of Finnish patients revealed an increased risk of retinopathy when hemoglobin levels were less than 12 g/dL.28 The clinical trials and series discussed earlier in this paper have confirmed the strong correlation between diabetic retinopathy and other systemic complications. However, despite overwhelming evidence that aggressive surveillance and treatment prevent severe visual loss and complications secondary to diabetic retinopathy, the number of patients with diabetes referred for ophthalmic care is far below what it should be, according to the guidelines of the American Diabetes Association (ADA)63 and the American Academy of Ophthalmology (AAO).6468 AAO guidelines are summarized in the Table.64 For example, in a series of 2000 patients with diabetes mellitus, 7% to 11% of patients with high-risk proliferative diabetic retinopathy had not been examined by an ophthalmologist within the past 2 years.69 Complicating the difficulties of appropriate team management is the lack of standardization of terms used to characterize degrees and severity of diabetic retinopathy. Recently, efforts have been made to standardize terminology to a simplified international disease severity scale.70 The ADA has established treatment goals based on the evidence showing that glycemic control reduces the risk of diabetes-related complications.71 The target for patients with diabetes should be a hemoglobin A1c level below 7.0%.63 Normoglycemia is the ideal goal for most patients, but it is often difficult to achieve. Table. American Academy of Ophthalmology Guidelines Diabetes Type First Exam Recommended Follow-up Recommended* Type 1 5 years after onset Yearly Type 2 At time of diagnosis Yearly Prior to pregnancy (type 1 or type 2) Prior to conception or No retinopathy to mild or early in the first trimester moderate NPDR: every 3–12 months; severe NPDR or worse: every 1–3 months *Abnormal findings may dictate more frequent follow-up examinations. NPDR = nonproliferative diabetic retinopathy. Adapted with permission from the American Academy of Ophthalmology. Diabetic retinopathy preferred practice pattern. Available at: http://www.aao.org/aao/education/ library/ppp/dr_new.cfm. Accessed May 4, 2004.64 S705 REVIEW Glycemic control should be individualized after considering the patient's medical and social issues. Factors to consider include life expectancy at the time of diagnosis, presence of microvascular complications, ability to understand and administer a complex treatment regimen, and level of social support. CURRENT TREATMENT STRATEGIES DIABETIC RETINOPATHY IN When diabetic retinopathy is detected, guidelines for intervention to interrupt the natural progression of diabetic retinopathy are derived from the Diabetic Retinopathy Study (DRS), the ETDRS, and the Diabetic Retinopathy Vitrectomy Study (DRVS).72-82 These studies form the basis for predicting the natural course of diabetic retinopathy and the foundation for offering photocoagulation and vitrectomy to patients with significant diabetic retinopathy, macular edema, vitreous hemorrhage, or diabetic traction retinal detachments. Additional refinements in surgical technology, surgical techniques, and novel intravitreal pharmacotherapies offer promise in adding to the ophthalmologist's armamentarium in the treatment of diabetic retinopathy. The DRS and the ETDRS provided clinical outcomes in patients treated with scatter photocoagulation and focal or grid photocoagulation to reduce the risk of long-term severe visual loss.72-74,76,77,83 The significance of these studies is based on their empiric, evidence-based study designs. In addition, through these studies, current terminology such as proliferative diabetic retinopathy and severe nonproliferative diabetic retinopathy was introduced. The DRS included patients with proliferative diabetic retinopathy or bilateral severe nonproliferative diabetic retinopathy. In one eye, patients received photocoagulation with panretinal photocoagulation, direct treatment of neovascularization, or focal treatment (small-sized burns used to seal leaking microaneurysms in the posterior fundus). Photocoagulation was found to reduce the risk of severe visual loss by 50%, with only moderate risk for decreases in visual acuity or constriction in the treatment groups. In patients with high-risk proliferative diabetes, the 5year rate of severe visual loss was reduced from 50% to 20%.72-74,76,77,84-87 The ETDRS criteria included patients with mild to severe nonproliferative diabetic retinopathy or non– S706 high-risk proliferative diabetic retinopathy, who had one eye that was treated by early photocoagulation and treatment that was deferred in the other eye. The major endpoints confirmed that focal photocoagulation in the macular area for direct leaks and grid for diffuse diabetic macular edema reduced the risk of doubling the visual angle by 50%. Early scatter and deferred scatter groups experienced similar rates of severe visual loss (2%–6% in the early scatter group vs 2%–10% in the deferred group). The study authors concluded that panretinal photocoagulation was not indicated for mild and moderate nonproliferative diabetic retinopathy but could be considered for severe nonproliferative retinopathy and for patients approaching high-risk proliferative diabetic retinopathy. The benefits of treatments were likely to be more significant in patients with long-standing type 1 and type 2 diabetes mellitus.72-74,76,77,84-87 In patients with vitreous hemorrhage secondary to proliferative diabetic retinopathy, the DRVS established the benefits of vitrectomy.79,81,82,88 Patients with vision loss greater than 5/200 secondary to vitreous hemorrhage and no macular retinal detachment were assigned to early vitrectomy or conservative management (vitrectomy only if detachment of the macula was noted or vitreous hemorrhage persisted for 1 year). The chance of significant visual improvement (>10/20) was noted in patients with type 1 diabetes mellitus who were younger, thus they had more severe proliferative diabetic disease. An additional group of patients with extensive, active neovascular proliferative retinopathy was randomly assigned to deferred versus immediate vitrectomy. These patients were also found to benefit from early vitrectomy, specifically in patients with eyes that had severe new vessels. Since the publication of the DRVS in 1990, several innovations in vitrectomy surgery, including bimanual delamination and endolaser, have altered the timing of surgery for many patients, thus a greater number of patients with vitreous hemorrhage may show benefits from early surgical intervention. In all cases, appropriate detection and treatment relies on appropriate referral to ophthalmologists whenever diabetic retinopathy is a possible diagnosis. These current treatment paradigms of scatter laser photocoagulation for severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy, focal and grid photocoagulation for diabetic macular edema, and vitrectomy for vitreous hemorrhage and traction retinal detachment serve as the foundation for current photocoagulation techniques and treatment. Vol. 4 (9A) ■ October 2004 REVIEW The National Eye Institute (Bethesda, MD) is sponsoring a series of additional clinical trials (Diabetic Retinopathy Clinical Research Network) elucidating whether certain changes in laser delivery techniques may benefit patients with diabetic retinopathy. As a comparison to the initial ETDRS grid laser techniques, a pilot study is enrolling patients with a milder intensity but more confluent pattern of laser application to areas of macular edema. In addition to visual acuity, ocular coherence tomography will be used to assess efficacy of treatment. A second trial is investigating the safety and efficacy of intravitreal triamcinolone acetonide (TA) to treat diabetic macular edema. NEW DEVELOPMENTS IN THERAPY Several new treatment possibilities are being explored that may prevent the development and progression of diabetic retinopathy. These efforts are based on new understanding of the underlying biochemical processes. VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS Growth factors, particularly VEGF, are postulated to be mediators in the development of late-stage diabetic retinopathy.89 The VEGFs are a family of peptides with several isoforms produced from a single gene by alternative splicing. They are potent mitogenic factors for vascular endothelial cells and induce breakdown of blood-retinal barriers.90,91 VEGF plays a critical role in the development of the fetal vascular system,92 decreasing significantly after birth. However, neural retina, choroid, and retinal pigment epithelium continue to secrete VEGF.93 In patients with diabetes, hyperglycemia results in a loss of pericytes and endothelial cells, slowing the blood flow and causing progressive hypoxia of the retinal tissues.94 The localized hypoxia promotes expression and secretion of VEGF,95,96 subsequently leading to proliferation of retinal capillary endothelium and neovascularization, in addition to increased vascular fenestrations and macular edema.91 In animal studies, exogenous VEGF injected into monkeys' eyes caused neovascularization of the iris and retina.97,98 Other animal studies demonstrated that interventions to block VEGF synthesis with intravitreal injection of anti-VEGF antibodies, VEGF-receptor– binding chimeric immunoglobulin, or antisense VEGF DNA appear to prevent retinal neovascularization.99-101 These strategies appear promising for Advanced Studies in Medicine ■ humans. However, therapy must be localized, perhaps by direct intravitreal injection. Systemic anti-VEGF therapy precludes the benefit of angiogenesis to compromised coronary and peripheral circulations, which is less than ideal. Pegaptanib, a VEGF aptamer consisting of a 28-base oligonucleotide that binds to VEGF protein, is being studied in a clinical trial for the treatment of exudative age-related macular degeneration involving choroidal neovascularization.102 This aptamer may also be a potential treatment for diabetic retinopathy. Another strategy to prevent the action of VEGF is to block specific VEGF receptors and their subsequent signal transductions.100,103 Although 3 VEGF receptors have been identified,104,105 VEGF receptor-2 (VEGFR2) appears to be most important for the mitogenic action in the retinal vascular endothelium.105 A VEGFR-2 blocker has already undergone preliminary tests as an angiogenesis inhibitor for cancer and may prove useful for diabetic retinopathy.106 PROTEIN KINASE C INHIBITORS The protein kinase C (PKC) family comprises a large group of enzymes that transfer the terminal high-energy phosphate group of adenosine triphosphate to a site on a target protein. This reaction may activate other enzymes, cell membrane receptors, or ion transport channels.107 Protein kinase C-β isoform is present at high levels in the retina and is thought to play a crucial role in the pathogenesis of diabetic retinopathy.108-110 In patients with diabetes, hyperglycemia triggers an increase in the concentration of diacylglycerol (DAG), an essential cofactor for PKC.109 This increase in DAG leads to increased activation of PKC. Subsequently, the higher level of PKC acts in concert with hypoxia to upregulate the production of VEGF in retinal tissues.108 The binding of VEGF to its receptor on a vascular endothelial cell activates a variety of signaling molecules, including PKC β, to initiate angiogenesis or blood-retinal barrier breakdown leading to macular edema.111 By interfering with the biochemical pathway, PKC inhibitors may prevent the development and progression of diabetic retinopathy. However, because PKC is found throughout the body, a specific inhibitor for the PKC β acting locally in the retina would be preferable.104 Recent data from transgenic mouse models support the hypothesis that PKC β is involved in mediating retinal neovascularization. In mice in which PKC is overexpressed, the retinal neovascular response to preproendothelin promoter is substantially increased. In S707 REVIEW mice in which the PKC-β gene has been "knockedout," exposure to retinal ischemia results in reduced retinal neovascularization.111 In addition, in vivo studies have shown that selective inhibition of the PKC-β isoform prevents VEGF-mediated growth.112 In the animal model, selective inhibition of PKC β reduces ischemic retinal revascularization.113 Selective inhibition of the PKC-β inhibitor ruboxistaurin has also been shown to block VEGF-induced increases in retinal vascular permeability in animals and humans to normalize changes in blood flow that typically occur as a result of diabetic retinopathy.114,115 Preliminary data from animal studies suggest PKC inhibition can normalize diabetes-induced retinal vascular permeability in animals, even if diabetes has been established for as long as 1 month before therapy has been initiated.116 These studies have furthered interest in the PKC-β inhibitor ruboxistaurin, a highly selective dimethylamine analogue.117 In the initial testing of the oral form of ruboxistaurin, it appears well tolerated.113 Two extensive phase III clinical trials for severe preproliferative diabetic retinopathy and diabetic macular edema are being conducted.113 INTRAVITREAL TRIAMCINOLONE ACETONIDE The ETDRS demonstrated that focal or grid laser photocoagulation is beneficial for treating patients whose eyes have been diagnosed as having clinically significant diabetic macular edema.76 However, Lee and Olk reported that despite treatment with grid-pattern laser photocoagulation, 25% of eyes of patients diagnosed with diffuse diabetic macular edema lost more than 2 lines of vision within 3 years.118 Corticosteroids have been used to suppress intraocular inflammation by reducing extravasation from leaking blood vessels and inhibiting fibroblast proliferation. Early research efforts by Machemer et al, Graham and Peyman, and Tano et al suggest that an intravitreal injection of corticosteroid can safely and effectively suppress intraocular inflammatory pathologies, such as persistent uveitis and proliferative vitreoretinopathy.119-121 Machemer also advocated using a crystalline form of cortisone, which has an intravitreal absorption time of 2 months, to provide longer antiinflammatory effect.122 TA, a crystalline corticosteroid suspension, has been shown experimentally to reduce breakdown of the blood-retinal barrier.123 In an uncontrolled study, Martidis et al used an intravitreal injection of 4 mg of TA to treat refractory S708 diffuse diabetic macular edema.124 They reported a reduction in macular thickness, which was measured by optical coherence tomography, at follow-up visits of 1 month (55%), 3 months (58%), and 6 months (38%). Follow-up visits also revealed mean visual acuity improvements of 2.4 Snellen lines at 1 month and at 3 months, and 1.3 at 6 months. Jonas et al also reported similar favorable results using a dose of 25 mg intravitreal TA injection.125 In both studies, the improvement in visual acuity declined after 3 to 6 months with a recurrence of diabetic macular edema. Therefore, these results suggest that the efficacy of the intravitreal TA injection may be limited in duration and repeated treatments may be required. Massin et al reported the first prospective controlled trial of intravitreal TA injection versus observation in eyes with diffuse diabetic macular edema that failed previous conventional laser treatment.126 They found that one intravitreal injection of 4 mg of TA improved retinal thickness in one eye relative to the untreated eye at 4week and 12-week follow-up, but there was no statistically significant difference in visual acuity between the treated and untreated eye. By 3 months, there was improved visual acuity in the eyes that had received injections. By 24 weeks, the benefit of the single injection diminished considerably, with a recurrence of diabetic macular edema in 5 of 12 eyes that had been treated; this result was consistent with prior studies. The safety of intravitreal TA is supported by prior animal studies and by human trials.123,127 The main adverse effect observed was intraocular pressure (IOP) elevation, which was reported in 20% to 80% of the patients.124,128-130 Most patients with elevated IOP levels were successfully treated with topical antiglaucoma therapy, and pressure levels returned to normal within 6 months without further medication. However, intravitreal TA injection may be contraindicated in the eyes of patients with glaucoma or a history of corticosteroid-induced IOP elevation.126 Another potential adverse effect is cataract progression; however, because of the relatively short length of follow-up studies, few cataract formations were reported. Other potential injection-related complications include retinal detachment, vitreous hemorrhage, and endophthalmitis.131 In a retrospective multicenter case series, Moshfeghi et al reported 8 of 922 cases of culture-positive, acute, postinjection endophthalmitis, resulting in an incidence rate of 0.87%.132 To decrease the risk of some injection-related complications and reduce the need for periodic reinjec- Vol. 4 (9A) ■ October 2004 REVIEW tion, sustained drug delivery devices containing steroids that maintain a constant intraocular drug level for an extended period are being investigated.133 The mechanism of action of corticosteroids on diabetic macular edema remains unclear. One hypothesis proposes that corticosteroids reduce retinal capillary permeability by increasing the activity or density of the tight junctions in the retinal capillary endothelium.134 Another hypothesis suggests that corticosteroids inhibit the arachidonic acid pathway from producing prostaglandins (known endogenous vascular permeability mediators).124 Also, corticosteroids downregulate the production of VEGF, which may reduce the vascular permeability and macular edema.135 The Diabetic Retinopathy Clinical Research Network, sponsored by the National Eye Institute, is conducting a large prospective, randomized, multicenter clinical trial comparing intravitreal TA injections to macular laser photocoagulation in the treatment of diabetic macular edema. The study is also comparing 1-mg and 4-mg intravitreal TA. The results of the study will help to solidify the role of intravitreal TA injection as a modality in the management of diabetic macular edema. PIGMENT-EPITHELIUM–DERIVED FACTOR Pigment-epithelium–derived factor (PEDF) was first isolated from fetal retinal pigmented epithelial cells.136 Experimental studies show that it inhibits retinal neovascularization in mice.137 Evidence suggests PEDF and VEGF have a reciprocal relationship that becomes imbalanced with uncontrolled diabetes, as PEDF levels fall and VEGF levels rise.138 VEGF and PEDF play an important role in maintaining the normal anatomy and function of the retinal and choroidal blood vessels.139 In an animal experiment model, the intravitreal injection of adenovirus vector containing the PEDF gene resulted in the inhibition of retinal and choroidal neovascularization,140 suggesting the possibility of using gene therapy to treat diabetic retinopathy in humans. A phase I study of this strategy in patients with advanced neovascular age-related macular degeneration is under way.141 INHIBITION OF GROWTH HORMONE ACTION Growth hormones secreted by the pituitary gland are thought to play a part in the pathogenesis of diabetic retinopathy.142 Hypophysectomy, once considered beneficial in inhibiting the production of growth hormone and its action for the treatment of diabetic retinopathy, Advanced Studies in Medicine ■ has been abandoned because of the high rates of mortality and morbidity associated with its use.143 Later studies identified the insulin-like growth factor 1 (IGF1) as a mediator for the actions of growth hormone in the development of diabetic retinopathy.144 IGF-1 is thought to be a permissive agent necessary for the occurrence of neovascularization, although IGF-1 must be accompanied by other molecules, such as VEGF, to induce neovascularization.145 Octreotide, a somatostatin analogue that inhibits the release of growth hormone, was shown at a high concentration to prevent the progression of diabetic retinopathy to the proliferative stage over a 15-month period.146 A multicenter clinical trial is in progress that may offer a possible treatment to prevent or delay the progression of diabetic retinopathy to proliferative diabetic retinopathy.146 REFERENCES 1. 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Ophthalmology. 2004;111:218-224; discussion 224-225. 127.McCuen BW 2nd, Bessler M, Tano Y, et al. The lack of toxicity of intravitreally administered triamcinolone acetonide. Am J Ophthalmol. 1981;91:785-788. 128.Wingate RJ, Beaumont PE. Intravitreal triamcinolone and elevated intraocular pressure. Aust N Z J Ophthalmol. 1999;27:431-432. 129.Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol. 2003;87:24-27. 130.Antcliff RJ, Spalton DJ, Stanford MR, et al. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001;108:765-772. 131.Benz MS, Murray TG, Dubovy SR, et al. Endophthalmitis caused by Mycobacterium chelonae abscessus after intravitreal injection of triamcinolone. Arch Ophthalmol. 2003;121:271-273. 132.Moshfeghi DM, Kaiser PK, Scott IU, et al. Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2003;136:791-796. 133.Jaffe GJ, Ben-Nun J, Guo H, et al. Fluocinolone acetonide sustained drug delivery device to treat severe uveitis. Ophthalmology. 2000;107:2024-2033. 134.Antonetti DA, Wolpert EB, DeMaio L, et al. Hydrocortisone decreases retinal endothelial cell water Advanced Studies in Medicine ■ and solute flux coincident with increased content and decreased phosphorylation of occludin. J Neurochem. 2002;80:667-677. 135.Fisher S, Renz D, Schaper W, Karliczek GF. In vitro effects of dexamethasone on hypoxia-induced permeability and expression of vascular endothelial growth factor. Eur J Pharmacol. 2001;411:231-243. 136.Ogata N, Wada M, Otsuji T, et al. Expression of pigment epithelium-derived factor in normal adult rat eye and experimental choroidal neovascularization. Invest Ophthalmol Vis Sci. 2002;43:1168-1175. 137.Stellmach V, Crawford SE, Zhou W, Bouck N. Prevention of ischemia-induced retinopathy by the natural ocular antiangiogenic agent pigment epithelium-derived factor. Proc Natl Acad Sci U S A. 2001;98:2593-2597. 138.Gao G, Li Y, Zhang D, et al. Unbalanced expression of VEGF and PEDF in ischemia-induced retinal neovascularization. FEBS Lett. 2001;489:270-276. 139.King GL, Suzuma K. Pigment-epithelium-derived factor: a key coordinator of retinal neuronal and vascular functions. N Engl J Med. 2000;342:349-351. 140.Mori K, Duh E, Gehlbach P, et al. Pigment epitheliumderived factor inhibits retinal and choroidal neovascularization. J Cell Physiol. 2001;188:253-263. 141.Rasmussen H, Chu KW, Campochiaro P, et al. Clinical protocol: an open-label, phase I, single administration, dose-escalation study of ADGVPEDF.11D (ADPEDF) in neovascular age-related macular degeneration (AMD). Hum Gene Ther. 2001;12:2029-2032. 142.Growth Hormone Antagonist for Proliferative Diabetic Retinopathy Study Group. The effect of a growth hormone receptor antagonist drug on proliferative diabetic retinopathy. Ophthalmology. 2001;108:2266-2272. 143.Lundbaek K, Malmros R, Andersen HC, et al. Hypophysectomy for diabetic angiopathy: a preliminary report. Diabetes. 1962;11:474-479. 144.Van Wyk JJ, Underwood LE, Hintz RL, et al. The somatomedins: a family of insulin-like hormones under growth hormone control. Recent Prog Horm Res. 1974;30:259-318. 145.Smith LE, Shen W, Perruzzi C, et al. Regulation of vascular endothelial growth factor-dependent retinal neovascularization by insulin-like growth factor-1 receptor. Nat Med. 1999;5:1390-1395. 146.Grant MB, Mames RN, Fitzgerald C, et al. The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy: a randomized controlled study. Diabetes Care. 2000;23:504-509. S713
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The Sleeper and the Bust Episode: 513 – I Never Forget Bush
The latest episode of "The Sleeper and the Bust" is brought to you by Out of the Park Baseball 18, the best baseball strategy game ever made – available NOW on PC, Mac, and Linux platforms! Go to ootpdevelopments.com to order now and save 10% with the code SLEEPER18!
Follow us on Twitter
- @sporer
- @enosarris
- @jasoncollette
- @justinmasonfwfb – Producer
Notable Transactions/Rumors/Articles/Game Play
- Zach Britton Ruptured Achilles (5:10)
- Orioles no longer expect to trade Manny Machado (7:35)
- Evan Longoria traded to SF (15:00)
- Martin Perez gets *bulled* over (28:45)
- Matt Moore traded to TEX (30:00)
- Mitch Moreland back to BOS (35:00)
- Matt Adams to WAS (39:55)
- Yonder Alonso to CLE (43:00)
- Yovani Gallardo, Jhoulys Chacin to MIL (51:00)
- J.T. Realmuto requests trade (55:45)
As usual, don't hesitate to tweet us or comment with fantasy questions.
You can subscribe to the podcast on iTunes or via the feed. Please rate & review the show in iTunes letting us know what you think!
Approximately 66 minutes of joyous analysis.
Podcast: Play in new window | Download


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Three teenagers have been arrested following a pursuit across Tuggeranong early this morning (September 11).
Around 1.25am, officers from Tuggeranong General Duties were called to a burglary at the Gowrie Discount Pharmacy, Gowrie Shops. A short time later, police received a telephone call from a member of the public about a burglary at the Banks Shops on Pockett Avenue.
The member of the public reported seeing three people leave the shop, carrying a cash register and getting into a white vehicle. Police conducted an extensive search around the area and were unable to locate the white vehicle.
Around 2.30am, officers were conducting a proactive patrol around the Erindale Shops when they saw a white Subaru Impreza exit the car park at high speed. Police attempted to stop the vehicle, but the vehicle accelerated away and a pursuit commenced.
The pursuit lasted 18 minutes reaching a top speed of 120 km/h and travelled through the suburbs of Wanniassa, Monash, Gowrie, Chisholm, Theodore and Gordon. As is standard ACT Policing practice, Police Operations continually monitored the pursuit, and at no time was there any danger to members of the public or other road users.
The white Subaru finally came to a complete stop on Woodcock Drive, Gordon. The three occupants inside the vehicle were arrested and taken into custody. Enquiries made by police indicate that the vehicle was stolen from a house in Kambah last Saturday (September 8).
The three teenagers, aged 17, 16 and 15, were taken to the ACT Watch House and were charged with driving and riding in a stolen motor vehicle.
The three teenagers received bail from the ACT Watch House, and are expected to face the ACT Children's Court at a later date
NewsCanberra's most creative
residential property specialists


text: Tamarachena Pshigoda in Perryton, Texas, loves all her new Energy Guard Midwest products! Her home got a new roof, insulated siding, window awnings, and a deck cover; the garage got new siding and a new roof; and the well house got new siding and a new roof. She says, "All of the crews were fantastic! They worked hard, put in long days and were very efficient! It turned out perfect!"


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A couple of weeks ago Brian and I went to Mariners Restaurant at the Cruising Yacht Club of South Australia with good friends Jo and Kate. All four of us were looking forward to a great night out and good food as we had heard good things about this restaurant. What a disappointment it turned out to be, it took forever for our entrées to arrive and there was hardly anyone else in the restaurant, we could only assume they had a function going on somewhere.
For entrée I ordered Oysters Grilled, Japanese Style with Soy, Mirin, Pickled Ginger and Caviar, I absolutely love oysters and I love Japanese food, so I thought I was onto a winner. The oysters were pathetically small but I could look past that except that they had no taste. The pickled ginger was shriveled and looked like it had been under a griller, first strike. I complained to the maitre'd and he gave me a free drink, and although I appreciated the gesture I would rather have enjoyed my oysters.
Main course and I ordered Twice Cooked Pork Belly with Scrumpy Cider Jelly, Cauliflower Florets, Basil Crisps and Cherry Vinegar Glaze, pork is my favourite meat and I couldn't wait to tuck in. The cauliflower was roar and the pork belly was stone cold so I complained yet again, and again the maitre'd made his apologies. Brian had Sous vide Atlantic Salmon Cutlet with Cauliflower Puree, Grilled Asparagus & Butter Glaze, and he also sent that back.
Take two and this time my pork belly was hot, fresh from the microwave, but alas no cauliflower or jelly. That was it for me and when the maitre'd asked if we were ready for dessert I politely explained that he was not getting the opportunity of a third strike and we asked for the bill.
I have to say that the maitre'd handled it all very well, he was only young and it was not his fault. We were not charged for my meals and will not be going back.


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Click below for full training packages from NFL players
Must Be Trusted
In today's game, everyone wants to be a Receiver. Its a position filled with freak athletes that have the ability to change the game at any second.
No matter if your game is based on speed, physicality or something in between, all Receivers must do one thing well; catch the ball consistently. The Receiver that has the Coach and Quarterback's trust to make the catch is going to get the ball thrown their way when the game is on the line.
Here are a few things Receivers can do to make sure they make the play when their number is called.
Practice Without Gloves
Receiver gloves make catching the ball significantly easier, hence why almost every Receiver wears them today.
Click below for full training packages from NFL players
One technique to improve your catching skills is to practice each day without gloves. This will force you to have stronger hands and look the ball in every single time. Without the forgiveness that gloves provide, you'll be forced to perfect the fundamentals of catching the ball and will see a major improvement.
This will feel uncomfortable at first if you're used to wearing gloves, but it will be well worth it when its game-time and you break out a fresh pair of stickies.
Your confidence will be through the roof and you'll be in a much better position to make big plays. If you really want to get better, ignore the idea that the no glove look isn't as sharp and do what it takes to take your game to the next level.
Increase Dexterity In Your Hands
A Receiver's greatest tool is his hands. Although there isn't much you can do to increase the size of your hands, you can work on improving the dexterity or flexibility of your hands every day.
Consistently bending your fingers and violently massaging the webbing between them will work wonders in improving hand dexterity. Receivers with better hand dexterity are able to absorb the football with their hands more easily which leads to an increased ability to make tough catches.
Click below for full training packages from NFL players
This is an exercise that the Apex staff learned directly from NFL Hall of Famer Cris Carter. Check out the video below to see CC teaching DeAndre Hopkins the safe way to improve hand dexterity.
Catch Eggs
Soft hands are key to being a top Receiver. One way to learn how to have soft hands is to have someone toss you eggs to catch. This exercise can get messy so make sure to do it somewhere that this is acceptable. Initially, have a partner toss the eggs gently. If your hands are too stiff, the eggs will break.
As you get more comfortable, increase the speed of the eggs and continue to focus on having soft hands so the egg doesn't break. Eventually, replace the eggs with a football and continue to focus on having soft hands to make the catches. If done consistently, this exercise will go a long way towards improving your catching ability.
For more exclusive content from NFL players, register with Apex today.
Click below for full training packages from NFL players


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Publisher's Letter
Starting A New Chapter In 2017 With A January Issue That's Filled With Inspirational Individuals
One of my favorite sayings hangs above my desk on a hand-painted plaque, lovingly crafted by my niece, Ashley. It reads, "Aspire to Inspire before you Expire."
I love this quote because it's a constant reminder that life is about aspiring to do great things and inspiring others to do the same before this one brief and precious life of ours is over. It speaks volumes about what's truly important and how we should selflessly share our gifts.
I can't think of a better assemblage of individuals who epitomize this philosophy than the 20 youngsters we chose for our "20 Under 20" feature. They include amazing athletes, musical marvels and philanthropic phenoms who have overcome extreme obstacles, roadblocks and hurdles to get where they are in their endeavors and in a very short time frame. These standouts are all under 20 years of age, mind you. From performing in "America's Got Talent," to appearing in TIME magazine and on "Shark Tank," to aspiring for the Olympics, these inspiring kids are no slackers. It's reassuring to know these adolescents have our future in their capable little hands and are all poised for greatness. We wish them well and will say "we knew them when!"
Capable is Judy Mitchell's middle name. As the CEO of The Kravis Center For the Performing Arts, she has successfully led her team for the past quarter of a century, breaking the glass ceiling and being the type of leader all look up to. Congratulations to her and the Kravis Center for their silver anniversary this year!
Here in the Palm Beaches, we are fortunate to have national guests and speakers espouse their experience and wisdom to inspire us, and this month is no exception. See Dr. Jennifer Ashton, OB-GYN and ABC medical correspondent at the H.O.W. luncheon on Jan. 26 at Mar-a-Lago, and hear firsthand her healthy advocacy tips. Former Boston Police Commissioner Ed Davis will speak at FAU's Lifelong Learning Center in Jupiter on Feb. 2 about the new movie "Patriots Day," opening in theaters Jan. 13, and the true meaning behind #BostonStrong. Starring John Goodman, who portrays Davis, this inspiring movie intensely portrays the horrific aftermath of the 2013 Boston Marathon bombings.
In our "Fast & Fashionable" fashion feature, Celine Pelofi, Ms. United States 2015, inspires us with retro glam looks worthy of a second glance. More than just a pretty face, Celine is a registered dietician and an advocate for hunger relief through her involvement in Feeding America's South Florida Chapter and No Kid Hungry. She is also the brand ambassador for Braman Motorcars, whose extensive line of luxury autos like Porsche, Rolls Royce, Bentley and BMW provided the perfect vehicles to transport us back in time circa 1950s Hollywood glamour. No destination is more bespoke of glamour than our own Worth Avenue in Palm Beach, which served as the backdrop for our photo shoot on a breezy, balmy afternoon. Just another day in paradise!
Wishing all our readers in print and online a Happy New Year. It's a new year, a new chapter, with 365 blank pages to go. Who will you inspire this year?
Related articles
Meet Jupiter Magazine's 20 Under 20, Featuring Young Leaders From All Over South Florida
Jennifer Ashton Shares The Biggest Mistakes Women Make When It Comes To Their Health
Palm Beach Gardens Resident Celine Pelofi Evokes Vintage Glamour And Automotive Oomph


text: Posted by howard August 15, 2013 Club motorbikes BMW / Cape Town / r50/2 / speeding / ticket Speeding R50/2 1963 Hard evidence that a 1963 bmw r 50/2 can do at least 77 km/h through a robot ! I was test riding Mike's machine on a sunny Tuesday morning and now we are famous as the only know bike speed transgressor over 50 years old. Am holding back on paying ticket for now; story could develop . Howard


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Rayanne Painter
April 21, 2019
The room was silent as the request was posed: "I'd like you to stand if you know of someone close to you who has experienced sexual assault."The students in the room looked around at each other in horror as most of them stood up."Now, I want you to stay standing if you know that...
Brotherhood and bashing cars: How many frat guys does it take to destroy a car?
Brooke Martin
October 2, 2018
Every year students rush fraternities and sororities hoping to become a new member of Greek life. While there are many recruitment events that take place, one stands out. It involves sledgehammers, lots of testosterone and an old PT Cruiser (this semester's victim).Chico State's Sigma Nu fraternity has a long-standing tradit...
The truth about Greek Life
Karen Limones
April 10, 2018
I can't say I am too fond of the idea of joining a sorority. It's because I see how much of the party life they are involved in that has led me to believe all other stereotypes. One of my biggest fears when thinking about joining the Greeks is the pressure of consuming alcohol or drugs. Resear...
Chico State embraces unity at the annual Multicultural Night
Niyat Teferi
November 15, 2017
On Friday, the Diversity Affairs Council hosted the Multicultural Night in the BMU Auditorium. The event featured performances from various multi-ethnic organizations on campus. The theme for the night was unity and each performance represented just that. Greek organizations performed various acts of s...
Stop drinking tequila for Cesar Chavez
Nicole Henson
March 31, 2017
Edit: An interview and photo of Tabitha Schempp has been removed. An opportunity to party outweighs being a racist. Or at least that is the vibe some students and Greek affiliations are demonstrating with their Chavez-themed parties. Cesar Chavez Day has been recognized as a student holiday since 2014 wh...
10 tips for Rush week
Katherine Feaster
February 10, 2017
1. Be yourself. The best way to find your home away from home is by being true to yourself. Pick the house that makes you feel like you are at home. Choose the sorority that says, "Thank you for being you". 2. Go in with an open mind. Don't go in with the mindset that you already know ...
It's all Greek to me and maybe it shouldn't be
September 27, 2016
Editor's note: This article was updated to reflect funds spent on dues. When media depicts college, typically the Greek system is right up there with wacky philosophy professors and toga parties. Every year hundreds of men and women at Chico State dedicate a week of their life to impress older st...
CCLC hosts diversity advocacy workshop
Christine Zuniga
February 17, 2016
The Cross-Cultural Leadership Center started a "Diversity Advocacy Certification" program in an effort to help participants become aware of social injustice issues and teach them to become effective activists. The program consists of seven workshops scheduled throughout the remainder of the semester,...
Living the not-so-Greek life
September 19, 2015
All I want to do is get to class. Then I get to the tabling lane and boom: Greek life is everywhere. I almost feel like a rarity on campus sometimes. There are so many people walking around with letters across their shirts, it's hard to keep track of how many sororities and fraternities our school actual...
Live story doubles as marketing hub
Cheyanne Burens
September 19, 2015
Students have yet another social media platform they can use to share every aspect of their lives while also navigating the lives of their peers. Snapchat's college-centric "Our Campus Story" feature arrived to Chico State just weeks ago and it has already made its mark on the campus.The...
In focus: Greek students still rich, want to go to prom
Dylan Dewit
May 12, 2015
This is a satirical portrayal of the Greek formal culture. This May, students coping with the stress and demands of their final exams might be pleased to find that not everyone is sharing in their turmoil. Sources and social network information has confirmed that this weekend was not all dedicated to...
Greek life gives back, shares charity activity with new recruits
Katherine Feaster
February 10, 2015
On Feb 7. the Panhellenic sororities of Chico State spent the day sharing their charity plans with the young women going through Recruitment Week. The day was dedicated to telling the women about what the sororities do to give back to the community. The philanthropies cover organizations of all kinds that include; ...


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We're used to thinking that businesses should be willing to accept payment in any form that suits us, but the reality is a little more complicated.
Picture by reverb
I started thinking about the issue of how you should be allowed to pay for purchases recently after the fairly intense debate over Woolworths' decision to stop accepting debit credit cards. Clearly, the big issue there was that customers felt Woolworths was forcing them to pay extra costs simply to buy goods — a bad idea for any retailer.
However, tied in with those arguments was the notion that if a customer wants to pay, a retailer is obliged to accept that payment method. As one reader put it:
Woolworths is in the wrong for not accepting a credit facility your card has a right to use.
Or as another asked:
Doesn't Australian law say that you can't artificially limit payment options in this way?
Similar questions sometimes arise about Tiger Airways, which only takes credit card payments:
Tiger Airways refuse cash for purchases; are they allowed to refuse currency of the realm?
While there apparently isn't a lot of actual case law on this issue, the reality is that a business can set itself up to accept whatever payment methods it chooses. If you don't want to pay using that method, you can of course take your business elsewhere, but you haven't got grounds for legal action. In reality, few businesses choose to operate that way, precisely because it does annoy customers so much, but it doesn't give you grounds for complaint.
Some payment decisions can become more complicated: eBay's attempts to make PayPal the sole payment method available to buyers faltered on anti-competitive grounds, and the auction giant is now planning to expand its options. However, that was a more complex decision in which choice of payment methods intersected with other issues such as its dominant position in the marketplace.
Indeed, the Reserve Bank points out that in the strict sense, businesses aren't even obliged to accept a cash payment. In a page dedicated to the topic on its site, it says:
It is the Reserve Bank of Australia's understanding that, although Australian currency has legal tender status, it does not necessarily have to be used in transactions and that refusal to accept payment in legal tender banknotes and coins is not unlawful.
The same page also has a handy guide to just how much small change you're obliged to accept in payment as a business (assuming you're generally willing to accept cash). The rule is actually pretty simple: up to $5 in total for coins smaller than 50 cents, and not exceeding 10 times the face value for coins worth more than that. Again, that doesn't mean businesses can't accept larger amounts of change, but they can't argue that those amounts aren't legal tender.
Lifehacker's weekly Loaded column looks at better ways to manage (and stop worrying about) your money.


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This is another request from my son, a koala bear bento.
I made a chocolate round sandwich with 2 slices of raisin oatmeal bread as the koala's face. Then, cut another round bread and cut into half as the koala's ears. To make the ears '3D' style, I put a half piece of chicken burger pattie on the top of the bread. For the nose, I cut the small sausage into half and wrapped it with a piece of nori, and use spaghetti stick to stick it on the bread. Last but not least, put in 2 raisins as eyes.
My son requested more seedless grapes for his bento yesterday night. So, again, I included the grapes for him. The grapes are super nice and taste sweet. We love it so much. 🙂
Have a wonderful weekend.


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Community Journalism Champion Scott Wilson Enters COM Hall of Fame
Over his 40 years in journalism, Scott Wilson (B.A., 1978 | M.A., 1986) has been a champion for independent media, open government, tough journalism, early adaption of digital media, and opening doors to young journalists. "I think every journalist should start here," he says. "Working for a community paper means that you will be thrown into the process right away. You'll experience total immersion in the field because you'll be assigned two to three beats, work closely with senior staff, and write for multiple platforms. The challenge is that because you are truly up close and personal with members of the community, you damn well better do good journalism."
Since 1989, Wilson and his wife Jennifer were co-owners, and then the sole owners, of the Port Townsend & Jefferson County Leader. "Good journalism has a deep and rapid impact on a community," Wilson explains. "In Washington state, there are about 120 community newspapers, all of which are closely read and have a greater influence on what happens locally than any of the larger publications. Moreover, when a local story appears in a regional, state, or national publication, chances are that its point of origin was the local weekly. Community journalists may be casting a smaller net, but they have the potential to make a big difference."
During his decades-long career, Wilson served in the roles of investigative reporter, editor, publisher, marketer, delivery boy and sidewalk sweeper. He won three dozen community media awards for journalism, photography, editorials, marketing and community service, and sustained the Leader as one of Washington's best independent community media companies. "At the Leader, I was not only a 'newspaper man,' but also a small business owner," Wilson says. "What I learned during that time was the importance of treating my staff like family. We tried to be as generous as we could, encouraged collaboration at every level, and as a result, everyone was very loyal to the Leader and the journalistic cause."
Wilson graduated from the UW School of Communications with a B.A. in 1978, where he was editor of the UW Daily. "You have to remember that this was the Watergate era," he says. "There was a driving energy on campus, a great deal of political activity; many people at the time were ready to topple governments and challenge the administration. As student journalists, none of us were backing away from the controversy, but it was really important to me that The Daily be respectful in how we operated. We had a good relationship with University leaders because I didn't want The Daily to be used as a juvenile 'gotcha' toy. However, I take pride in the fact that media was, and still is, a true check to power."
Wilson returned to the UW for the master's program, advised by Professors Richard Kielbowicz and the legendary Bill Ames, and graduating in 1985. "I was fortunate to have the support of really good professors, both as an undergraduate and graduate student." In addition to Kielbowicz and Ames, he names Don Pember, Richard Carter, Dick Conrad, Bill Johnston, and Roger Simpson as important educational influences. "What I learned as a journalist has also been invaluable," Wilson explains. "It's knowing how to talk to a variety of people, do the research I need to get the best information I can, and then presenting it in a way that is interesting and succinct."
Wilson was Olympia Bureau chief of the Tacoma News Tribune, leaving to return to his roots in community media and joining Frank Garred at the Leader in 1989. "I realized that what I wanted as a journalist was to have that connection with readers," he says. "Through that, I was able to access the feedback cycle that sustains community journalism." On balancing his roles as journalist and publisher, Wilson insists that his intent was always to be "an honest friend of the community. I was there to make sure we told the stories while being transparent about our operations. Community journalists do the same type of work as any other; they report the news as best and as fearlessly as they can. What makes the work exceptional, is the fact that they have a very attentive and active audience."
He adds that this intimate relationship between the press and the public means that it's even more important for community journalists to have "a fire in the belly to find out the truth and not get blown off course" by subjects who would prefer they stop asking questions. Wilson recalls a particular instance where the Leader went up against multiple institutions that had failed one young man who had been incarcerated for assault with a deadly weapon. "One of my journalists, Fred Obee, revisited the case and learned that the man had acted in self-defense. We than ran a series of articles that looked into all the institutions that had failed to help him; from the school where he was bullied, to the sheriff's office and those involved in his trial. Of course, everyone we interviewed was defensive, but when the story reached the governor's office, the jailed man received a pardon two months later. I am proud of having contributed to that," Wilson says. "As a community journalist, I try not to make enemies, but you have to be willing to go after the bad actors when you need to. Often the press is the last chance a community has to address its problems. Sometimes you just have to hang in there and see it through."
In mid-1995, the Leader was also Washington's first newspaper company to launch a news website. "Most community weeklies didn't know how to manage digital versus print publication cycles," Wilson says. "I decided it was best for us to be friends with the internet."
Wilson was a founding board member and early president of the Washington Coalition for Open Government; was president of the Washington Newspaper Publishers Association and the longtime chair of its Foundation and scholarship program for college journalists; and his peers gave him community journalism's highest honor, the Miles Turnbull Master Editor/Publisher Award.
"Whether online or in print, the heart of community journalism is integrity," Wilson insists. "In every story we publish, we still have to get to the root of what's happening, verify what we learn, keep going in the face of adversity, and see that it gets out there." When asked what he wants today's journalism students to know, Wilson pauses, deep in thought. "I want them to know that good, fearless, independent journalism is more important than ever," he begins. "I want young, morally strong people to enter into this profession, and I expect and trust the UW to produce them." After another moment's consideration, he smiles. "That gives me more hope than anything else I can think of."