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Image B shows pontine hyperintensity (arrowhead) increased in size compared with baseline image (A). Image D shows new hyperintensities (arrowheads) compared with baseline image (C). Image F shows additional hyperintensities (arrowheads) compared with baseline image (E).
The upper 2 rows display hyperintensities per study group at baseline and follow-up separately; the lower rows show the difference (ie, progression) between baseline and follow-up in 3 directions. For visualization purposes, lesions are displayed after correction for group size, by adjusting their transparency level with a factor 0.69 for women in the migraine group with migraine with aura (n = 52/n = 75) and 0.91 for female participants with migraine without aura (n = 52/n = 57), using women in the control group as a reference.
Palm-Meinders IH, Koppen Hille, Terwindt GM, et al. Structural Brain Changes in Migraine: A Population-Based 9-Year MRI Follow-up Study. JAMA. doi:10.1001/jama.2012.14276
eTable 1: Baseline characteristics of follow-up participants and nonparticipants
eTable 2: Migraine characteristics in relation to MRI outcome measures as compared to controls
eTable 3: Mean cognitive performance
Customize your JAMA Network experience by selecting one or more topics from the list below.
Palm-Meinders IH, Koppen H, Terwindt GM, et al. Structural Brain Changes in Migraine. JAMA. 2012;308(18):1889–1896. doi:10.1001/jama.2012.14276
© 2023
Author Affiliations: Departments of Radiology (Drs Palm-Meinders, Konishi, van Buchem, and Kruit and Ms Moonen), Division of Image Processing (Mr van Lew), Neurology (Drs Koppen, Terwindt, and Ferrari), and Neuropsychology (Dr Middelkoop), Leiden University Medical Center, the Netherlands; Department of Neurology, Haga Hospital, The Hague, the Netherlands (Dr Koppen); Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland (Dr Launer); Department of Radiology, Slingeland Hospital, Doetinchem, the Netherlands (Dr Bakkers); and Department of Radiology, Academic Hospital Maastricht, the Netherlands (Dr Hofman).
Context A previous cross-sectional study showed an association of migraine with a higher prevalence of magnetic resonance imaging (MRI)–measured ischemic lesions in the brain.
Objective To determine whether women or men with migraine (with and without aura) have a higher incidence of brain lesions 9 years after initial MRI, whether migraine frequency was associated with progression of brain lesions, and whether progression of brain lesions was associated with cognitive decline.
Design, Setting, and Participants In a follow-up of the 2000 Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis cohort, a prospective population-based observational study of Dutch participants with migraine and an age- and sex-matched control group, 203 of the 295 baseline participants in the migraine group and 83 of 140 in the control group underwent MRI scan in 2009 to identify progression of MRI-measured brain lesions. Comparisons were adjusted for age, sex, hypertension, diabetes, and educational level. The participants in the migraine group were a mean 57 years (range, 43-72 years), and 71% were women. Those in the control group were a mean 55 years (range, 44-71 years), and 69% were women.
Main Outcome Measures Progression of MRI-measured cerebral deep white matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions. Change in cognition was also measured.
Results Of the 145 women in the migraine group, 112 (77%) vs 33 of 55 women (60%) in the control group had progression of deep white matter hyperintensities (adjusted odds ratio [OR], 2.1; 95%CI, 1.0-4.1; P = .04). There were no significant associations of migraine with progression of infratentorial hyperintensities: 21 participants (15%) in the migraine group and 1 of 57 participants (2%) in the control group showed progression (adjusted OR, 7.7; 95% CI, 1.0-59.5; P = .05) or new posterior circulation territory infarctlike lesions: 10 of 203 participants (5%) in the migraine group but none of 83 in the control group (P = .07). There was no association of number or frequency of migraine headaches with progression of lesions. There was no significant association of high vs nonhigh deep white matter hyperintensity load with change in cognitive scores (−3.7 in the migraine group vs 1.4 in the control group; 95% CI, −4.4 to 0.2; adjusted P = .07).
Conclusions In a community-based cohort followed up after 9 years, women with migraine had a higher incidence of deep white matter hyperintensities but did not have significantly higher progression of other MRI-measured brain changes. There was no association of migraine with progression of any MRI-measured brain lesions in men.
Migraine affects up to 15% of the general population.1-3 One-third of patients with migraine have associated symptoms of neurological aura.2,3 Previous work in the cross-sectional community-based Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis (CAMERA-1) study demonstrated a higher prevalence and greater volume of magnetic resonance imaging (MRI)–measured deep white matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions in participants with migraine.4-6 A higher volume of deep white matter hyperintensities7 and increased prevalence of posterior circulation territory infarctlike lesions has also been demonstrated in women with migraine with aura8 and the prevalence of deep white matter hyperintensities was increased among patients with migraine identified from neurology clinics.9
White matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions are believed to be of ischemic origin. In particular, white matter hyperintensities are associated with atherosclerotic disease risk factors,9 increased risk of ischemic stroke,10-12 and cognitive decline.13 The associations of migraine with these MRI-measured lesions and clinical ischemic stroke7,14 are consistent with the hypothesis that recurring migraine headaches may be associated with cerebral ischemia and that migraine-associated cerebral ischemia may be attack related. In the current study, we report associations of migraine and migraine subtype with the progression of MRI-measured cerebral ischemic lesions at the 9-year follow-up of the original CAMERA study population. In exploratory analyses, we report associations of migraine frequency, total number of migraine attacks during follow-up, and presence of current migraine headache symptoms with progression of brain lesions. In additional exploratory analyses, we determined whether progression of brain lesions was associated with cognitive decline and whether the presence of migraine headache influenced any association of brain lesion progression with cognitive decline.
The original participants of the CAMERA-1 study included 295 well-characterized individuals with migraine3 and 140 age- and sex-matched controls who were randomly selected from a community-based study of the general population.1 The MRI scans were completed in 2000.4 All participants were invited to return for follow-up scan in 2009. In 2000, the mean age of the sample was 48 years (SD, 7.8 years) and 71% were women (eTable 1).
The CAMERA-2 study, conducted in 2009, included a structured computer-guided telephone interview (programmed using Ishell software, World Health Organization), brain MRI, physical examination, and cognitive testing similar to the CAMERA-1 protocol. Participants were administered questionnaires to determine previous, current, and newly developed migraine attacks since 2000. The interview was structured so that participants could recount their history of migraine using personal benchmarks (eg, pregnancy) for when a different pattern started and stopped. These benchmarks were used to define periods. Information was collected on migraine prophylaxis and treatment. All nonimaging data were collected blinded to diagnosis and MRI findings. To avoid introduction of false-positive differences due to upgraded MRI techniques, we used the same scanners and protocols that were used for CAMERA-1.4 The protocol was approved by the local medical ethics committees. All participants gave written informed consent.
Primary outcome measure of this study was change in number and volume of MRI-measured deep white matter hyperintensities in individuals with migraine vs controls during follow-up. In addition, progression of posterior circulation territory infarctlike lesions as well as infratentorial hyperintensities was evaluated.
Results of automatic segmentation of white matter lesions (QBrain 1.1 software) were, if necessary, corrected manually in a conservative manner by 1 rater, in anonymized baseline and follow-up scans separately, blinded for scan order and diagnosis. Reproducibility data include (random, n = 40 of participants reanalyzed): 1.0T-scanner: ρ, 0.999 (P < .001) and 1.5T-scanner: ρ, 0.963 (P < .001). Periventricular white matter hyperintensities were attached to the lateral ventricle; other supratentorial hyperintensities were deep white matter hyperintensities, which were calculated by number, total, and mean volume for each participant. Geographical location was evaluated by normalizing the individual MRI scans with segmented lesions to standard Montreal Neurological Institute–space, and projecting the lesions (weighted for group size) of all participants per diagnostic group in a transparent 3- dimensional map (glass brain).
Infratentorial hyperintensities were hyperintense on T2- and proton-density-weighted and not hypointense on fluid attenuated inversion recovery images. Presence and progression of lesions was assessed by 1 rater, who was blinded to diagnosis, by comparing baseline and follow-up scans side by side. Reproducibility data (random, n = 40 [14%]; baseline, κ = 0.908; P = .09 and follow-up, κ = 1.000; P < .001). Lesion progression was defined as an increase in size, number, or both (Figure 1).
Infarctlike lesions were nonmass parenchymal defects with a vascular distribution, isointense to cerebrospinal fluid signal on all sequences, and, when supratentorial, surrounded by a hyperintense rim on FLAIR images.4 Virchow-Robin spaces were excluded based on typical location, shape, and absence of a hyperintense rim. In the basal ganglia, only parenchymal defects larger than 3 mm in diameter were considered in order to exclude nonspecific lesions. Location and vascular territory of new and preexisting infarcts were read by 2 neuroradiologists, who were blinded to diagnosis (κ = 0.87, P < .001). All sequences of baseline and follow-up scans were presented side by side (angulation corrected and position linked). A third senior neuroradiologist made the final diagnosis in the 9 cases in which the 2 raters disagreed.
An exploratory outcome measure of this study was the changes in cognition related to white matter hyperintensities at baseline and at follow-up. Similarly, the change in cognition between baseline and follow-up was evaluated as function of baseline and follow-up lesion volume as well as lesion volume change. For each participant, normalized test scores (Z scores of separate tests in domains of memory, executive function, attention, visuospatial ability, and speed) were summed to achieve a total composite cognitive score for each time point. Change in raw test scores (follow-up minus baseline) were normalized by Z scores. The tests, evaluating cognitive performance in the domains of memory, concentration, and attention, executive functioning, psychomotor, and processing speed, organization, fine motor skills, fluid intelligence, and visuospatial skills, consisted of the 15-word Verbal Learning Test15; abbreviated Stroop test,16 consisting of 3 subtasks; verbal Fluency test17; Letter Digit Substitution Test,18 which is a modified version of the Symbol Digit Modalities Test; and the Purdue pegboard test.19 In follow-up investigation, the Block Design Test from the Wechsler Adult Intelligence Scale III test battery20 was added. Further details on cognition testing are provided in eTable 3.
Sociodemographic and medical history characteristics were assessed by interview. Educational level was dichotomized into low, primary school or less than vocational education, and high, more than higher vocational or professional education, college, or university. A diagnosis of diabetes or hypertension was based on patient report of a physician's diagnosis.
Differences in the distributions and means of measured characteristics among the study groups were assessed with χ2, 2-tailed Fisher exact, unpaired t, and Mann-Whitney U tests and 1-way analyses of variance where appropriate. Using logistic regression, the risk for MRI outcome measures was examined by migraine diagnosis (yes/no) and subtype of migraine (with and without aura vs controls), controlling for age, sex, educational level, hypertension, and diabetes. Statistical interactions of hypertension and diabetes for associations of migraine and MRI-measured outcomes were tested for by adding the interaction terms to the models. Analyses of deep white matter hyperintensity volumes were a priori stratified by sex, based on earlier findings of increased association of migraine with MRI lesions only among women.4 Likewise, infarct analyses were a priori stratified by anterior or posterior vascular territory. In logistic regression models, exploratory analyses were conducted on the effects of several migraine characteristics on measures of lesion progression. Associations between deep white matter hyperintensity load and normalized scores of the baseline and follow-up cognitive tests were assessed using linear regression models, adjusting for age, sex, and educational level (model 1) and additionally for migraine (model 2) to assess the effect of migraine diagnosis. Data were analyzed using the statistical software package for social sciences (SPSS, version 17.0. for Windows).
A total of 411 of 435 (95%) of baseline participants were successfully recontacted; 14 participants had moved, 4 were lost to civil registry information, and 6 had died (eTable 1). Two hundred eighty-six participants (66%) underwent follow-up MRI scan (114 migraine with aura, 89 migraine without aura, 83 controls). Mean follow-up was 8.5 years (range, 7.9-9.2; SD, 0.24 years). Reasons for nonparticipation were no interest (n = 51), inability to visit the research center (n = 30), claustrophobia (n = 8), and nonneurological illness (n = 36). There was no association between responder rate and diagnosis of migraine (response rate in both migraine groups was 203 of 296 (69%) vs 83 of 139 (60%) in the control group (P = .07). Compared with nonparticipants, participants were younger at baseline (48 vs 50 years; P = .01), more often reported high educational level (52% vs 40%; P = .01), smoked fewer pack-years (8 vs 14 years; P < .001; eTable 1), had a similar prevalence of posterior circulation territory infarctlike lesions (4%), brain infarcts (6% vs 9%; P = .24), and a high load of deep white matter hyperintensities (based on semiquantitative measures at baseline; 19% vs 22%; P = .44). At follow-up, participants in the migraine group were slightly older than those in the control group (57 vs 55 years; P = .03) and had a higher prevalence of diabetes (9% vs 2%; P = .05; Table 1).
There were no differences in baseline and follow-up white matter hyperintensities between men in the migraine group and those in the control group (Table 2). However, among women, both at baseline and follow-up, deep white matter hyperintensity volume was higher in the migraine group than in the control group (baseline: 0.02 mL vs 0.00 mL; P = .009; follow-up: 0.09 mL vs 0.04 mL; P = .04). Women in the migraine group also had a higher median increase in volume of deep white matter hyperintensities (mL), as well as a higher incidence of progression (defined as > 0.01 mL) than women in the control group (yes/no, ≥0.01 mL) (77% vs 60%; P = .02). The incidence of deep white matter hyperintensity progression was highest among women with migraine without aura (83%; Table 2). In multivariate logistic regression analyses involving only women, migraine was independently associated with deep white matter hyperintensity progression (adjusted odds ratio [OR], 2.1; 95% CI, 1.0-4.1; P = .04; Table 3). Similarly, women in the migraine group had a higher incidence of high progression than women in the control group (23% vs 9%; P = .03; Table 2). Hypertension was not associated with a higher incidence of white matter hyperintensity progression (P = .06). Interaction terms for hypertension (P = .90) and diabetes (P = .60) were not significant. Further exploratory analyses showed no association of the number of migraine attacks, migraine attack duration, migraine frequency, type of attack, or migraine therapy with lesion progression (eTable 2).
The increase in total deep white matter hyperintensity volume among women with migraine was related to an increased number of new lesions rather than an increase in the size of preexisting lesions. The mean size of individual hyperintensities at follow-up did not differ between groups (P = .97). Participants in the migraine group had a higher incidence of 10 or more new lesions among 43 of 145 participants (30%) vs 5 of 57 in the control group (9%) (adjusted OR, 3.5; 95% CI, 1.3-9.6; P = .01). Among women with migraine, deep white matter hyperintensities were more diffusely distributed in the deep white matter than among controls (Figure 2).
Progression of periventricular white matter hyperintensities did not differ between participants with migraine and controls. There was no association of sex, aura status, or migraine frequency with progression.
The prevalence of infratentorial hyperintensities at follow-up was 21% among women with migraine and 4% among controls (adjusted OR, 6.5; 95% CI, 1.5-28.3; P = .01; Table 3). Progression of infratentorial hyperintensities was not significantly higher among women with migraine (15%) than women in the control group (2%; adjusted OR, 7.7; 95% CI, 1.0-59.5; P =.05; Table 3). There was no relationship between migraine aura and number or frequency of migraine attacks with progression of infratentorial hyperintensities. Among men there were no differences in infratentorial hyperintensity prevalence or progression.
None of the infarctlike lesions present at baseline had disappeared. No significant association of migraine with new posterior circulation territory infarctlike lesions existed between groups (migraine group, 5% vs control group, 0%; P = .07; Table 2). Among participants in the migraine group, 18 (8.9%) with posterior circulation territory infarctlike lesions had a less favorable cardiovascular risk profile than the 185 participants (91.1%) without it. Those with infarctlike lesions were older (mean age, 62 vs 57 years; P = .006); had higher prevalences of clinically diagnosed stroke (22% vs 3%; P < .001) or hypertension (67% vs 33%; P = .005), and were more likely taking statins (39% vs 17%; P = .03) or platelet inhibitors (33% vs 6%; P < .001). There was no difference between groups for new non–posterior circulation territory infarctlike lesions (migraine group, 2.5% vs control group, 3.5%; P = .69; Table 2). Of those with infarcts, 21% of those in the control group vs none in the control group reported a history of clinical stroke (P = .10).
There were no differences in cognitive functioning between groups at follow-up (mean composite Z score, migraine group, 1.2 vs control group, 0; adjusted P = .90; 95% CI, −2.0 to 2.0). At follow-up, deep white matter hyperintensity load was not associated with cognitive performance (mean composite Z score high load, −3.7 vs low load, 1.4; adjusted P = .07; 95% CI, −4.4 to 0.2; men and women were analyzed together, see also eTable 3 for original clinical scores of the separate subtest domains). Presence of migraine did not influence this association (adjusted P = .30; 95% CI, −2.0 to 2.1). Individuals with a high deep white matter hyperintensity load at baseline did not experience greater change in cognitive function at the 9-year follow-up than those without a high load at baseline (mean composite Z score, −0.5 vs 0.2; adjusted P = .4; 95% CI, -1.7 to 0.7). Similarly, there were no significant differences between groups with respect to tests of individual cognitive domains eTable 3
We prospectively evaluated associations of migraine with structure and function of the brain at the 9-year follow-up. Among men, we found no association of migraine with progression of MRI-measured brain lesions. Women in the migraine group had a higher prevalence and a greater increase of deep white matter hyperintensities than women in the control group. Although migraine was associated with a higher prevalence of infratentorial hyperintensities at follow-up, there were no significant associations of migraine with progression of infratentorial hyperintensities or posterior circulation territory infarctlike lesions among women. In addition, the number of migraines, frequency of migraines, migraine severity, type of migraine, and migraine therapy were not associated with lesion progression. Increase in deep white matter hyperintensity volume was not significantly associated with poorer cognitive performance at follow-up.
This study has several strengths, including the longitudinal study design, length of follow-up, the relatively well characterized cohort, use of standardized International Headache Society criteria–based diagnosis of migraine by headache experts, and sensitive and reproducible methods of MRI reading. The sensitive MRI techniques used allowed for a more detailed analysis of the brain, in particular the cerebellum.
Approximately one-third of the original baseline population could not be reinvestigated. This may have introduced selection bias. However, there were no differences in baseline MRI parameters between participants and nonparticipants and there was no imbalance between the proportions and demographic and clinical characteristics of nonparticipating individuals with migraine and controls. Because of differences between the semiquantitative baseline reading of deep white matter hyperintensities and the current quantitative volume measurements that were not available for the nonresponders, additional imputation analyses to support the sensitivity of the current results could not be performed. An additional study limitation is that confidence intervals are wide (Table 3).
The number of migraine attacks, frequency of migraines, migraine severity, type of migraine headaches, and migraine therapy were not associated with lesion progression. In contrast, our baseline data showed that more frequent migraine headaches were associated with a higher prevalence of MRI findings.4 However, our findings at baseline regarding frequency-related difference in MRI findings was most pronounced among those in the migraine group who were 50 years or younger and less so in older patients. Thus, with increasing age of the study population, when attacks generally diminish,1 other migraine disease-related conditions leading to white matter hyperintensities are possibly increasing, complicating the detection of migraine attack-related associations. A similar, age-dependent mechanism is also seen for the risk of stroke in participants with migraine, which is increased in young patients only.14,21 At older age, other risk factors such as hypertension may obscure or overcome any potential role of migraine. In the present case, we hypothesize there are at least 2 different types of vascular mechanisms that may cause structural brain changes in migraine: one, which is primarily related to attacks and mainly present at younger age, and another, which is probably ongoing as part of having the disease migraine. The observation of migrainous stroke, with stroke occurring during a migraine attack, would support the hypothesis that ischemia may occur during attacks.22 However, our finding that migraine was not significantly associated with progression of all evaluated types of brain lesions at the 9-year follow-up raises questions about the role of cerebral ischemia over time in people with migraine.21,23
Possible explanations for an association of migraine headache with structural brain changes include a chronic procoagulatory or proinflammatory state due to endothelial dysfunction24,25 or elevated homocysteine levels,26,27 or recurrent paradoxical (micro-) emboli due to right-to-left shunts.28 Increased incidence of brain lesions among people with migraine headaches and atherosclerotic risk factors such as hypertension, diabetes, or other cardiovascular risk factors is also possible, but we did not identify any significant interactions for hypertension or diabetes. A relation with headache in general7 cannot be excluded. Finally, sex differences seem to play an important role because progression of deep white matter hyperintensities was only found in women. This finding is in line with results from another study8 and consistent with the higher risk of brain infarcts in women with migraine.14 Our sample size was too small for a proper analysis of sex-relateddifferential interaction between migraine and cardiovascular risk factors. Participants in the migraine group with posterior circulation territory infarctlike lesions, however, did have a less favorable cardiovascular risk profile than those without posterior circulation territory infarctlike lesions. Further research is needed to unravel the pathogenesis and relevance of migraine-related structural brain changes and their possible relation with ischemic events.
White matter hyperintensities have been associated with cognitive deficits in the elderly29,30 and some studies found evidence for worse cognitive performance in individuals with migraine.31-34 We tested memory, speed, and attention35 in all participants at baseline and follow-up and found no significant association between deep white matter hyperintensity volume and cognitive dysfunction. Most prior studies were conducted in older participants with larger deep white matter intensity volumes; this cohort is rather young with relatively little volume.7
In summary, in a community-based cohort followed up for 9 years, migraine was associated only with a higher incidence of deep white matter brain changes among women. There were no significant associations of migraine with progression of other brain lesions among women, and there were no associations of migraine headache with progression of any brain lesions among men. These findings raise questions about the role of migraine headaches with progression of cerebral vascular changes. The functional implications of MRI brain lesions in women with migraine and their possible relation with ischemia and ischemic stroke warrant further research.
Corresponding Author: Mark C. Kruit, MD, PhD, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands (firstname.lastname@example.com).
Author Contributions: Drs Palm-Meinders and Kruit had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Palm-Meinders and Koppen contributed equally. Drs Ferrari and Kruit share last authorship.
Study concept and design: Palm-Meinders, Koppen, Launer, van Buchem, Ferrari, Kruit.
Acquisition of data: Palm-Meinders, Koppen, Bakkers, Hofman, Middelkoop, van Buchem, Kruit.
Analysis and interpretation of data: Palm-Meinders, Koppen, Terwindt, Launer, Konishi, Moonen, van Lew, Middelkoop, van Buchem, Ferrari, Kruit.
Drafting of the manuscript: Palm-Meinders, Koppen, Moonen, Middelkoop, van Buchem, Kruit.
Critical revision of the manuscript for important intellectual content: Palm-Meinders, Koppen, Terwindt, Launer, Konishi, Bakkers, Hofman, van Lew, Middelkoop, van Buchem, Ferrari, Kruit.
Statistical analysis: Palm-Meinders, Koppen, Launer, Moonen, Middelkoop.
Obtained funding: Palm-Meinders, Koppen, van Buchem, Ferrari, Kruit.
Administrative, technical, or material support: P alm-Meinders, Koppen, Bakkers, Hofman, van Lew, Middelkoop, van Buchem.
Study supervision: Palm-Meinders, Koppen, Launer, Terwindt, van Buchem, Ferrari, Kruit.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Ferrari reported receiving grants and consultancy or industry support from Almirall, Coherex, Colucid, Eisai, GlaxoSmithKline, Linde, MAP, Medtronic, Menarini, Merck, Minster, Pfizer, and St Jude, and independent support from the Netherlands Organisation for Scientific Research (NOW). Dr Terwindt reported receiving consultancy support from Merck, Janssen-Cilag, Almirall, and Menarini. Dr Koppen reported consultancy or industry support from Allergan, Benecke congres, Pfizer, and In circulation website. The other authors reported no financial disclosures.
Funding/Support: This work was supported by grants 1R01NS061382-01 from the National Institutes of Health, 2007B016 from the Netherlands Heart Foundation, and 903-52-291, VICI 918-56-602, and Spinoza 2009 from the Netherlands Organisation for Scientific Research, and 907-00-217 and Vidi 917-11-319 from the Intramural Research Program at the National Institute on Aging.
Role of the Sponsor: None of the funding bodies had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health or the Netherlands Heart Foundation.
Online-Only Material: Author Video is available here.
Additional Contributions: We thank the research students and MR technicians for their assistance in screening and care of participants in this study.


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text:
Into the Wild Irminger Sea
WHOI ship, scientists, and crew probe strategic oceanic gateway
In the Denmark Strait, Oct. 7, 2008
Maybe it's lubberly to talk about those waves in the language of aesthetics, as if they were natural attractions like alpine peaks, but objective nautical numbers didn't suffice. Were they running 10 meters? Higher. Fifteen?
The 55-knot wind gusted into the high-60s, once hitting 72, but the research vessel Knorr met the waves confidently, bow climbing skyward on the crests, easing down into the troughs. Endless three-story walls of blue-black water, white snakes of foam fleeing down their faces, breakers plunging from their crests.
This was a seascape of exquisite violence, heartlessly beautiful, a privilege to witness—from the safety of Knorr's bridge. Capt. Kent Sheasley, Second Mate Derek Bergeron, the expedition's chief scientist Bob Pickart, and a few others still ambulatory discussed the waves in hushed, respectful tones. We watched monsters and thought them wonders of nature.
The Denmark Strait separates Iceland from the east coast of Greenland by 250 miles of tough water. South of the strait, stretching from Iceland down to the latitude of Cape Farewell at Greenland's southern tip, is the Irminger Sea—the windiest stretch of salt water on the globe. Though neither comes up very often in dinner-party conversation, the Denmark Strait and Irminger Sea comprise one of the most climatically significant and vulnerable regions in the world ocean.
Pickart, a physical oceanographer at Woods Hole Oceanographic Institution (WHOI), and other ocean scientists have been probing the Irminger for the past decade. Yet much about these mean waters remains unknown. No one aboard Knorr was surprised that we were hove-to studying nothing but the aesthetics of waves. But not only storms bedevil scientists and seamen in these seas. Their powerful, dizzyingly complex currents, convoluted seafloor topography, and tendency to freeze also challenge those seeking to comprehend these northern watery realms.
Kyle Covert, bosun of the WHOI-operated Knorr, came on the bridge with a damage report. A boarding sea had stove in a steel container mounted on the starboard side. Another boarding wave carried away one of the 2,000-pound mooring balls strapped to a stout rack welded to the deck. The straps didn't tear; the wave ripped out the welds.
"Also," said Covert, "the cover on that ventilator on the O-2 deck blew away. We're taking water."
We could see the ventilator in question—and the frozen spray on the O-2 deck—from the warm bridge. "Want me to go replace it now?" He was already suited up for battle.
"No," said Capt. Sheasley, "I don't want you to go out there."
But of course he was going.
A chokepoint on the intersea highway system
How does water pass through the Denmark Strait? Where does it come from and how does it exit? These were the primary questions Pickart meant to address on this cruise. Neither is merely a pure-science matter of curiosity relevant only to subscribers of academic journals like Deep-Sea Research. What happens in the Denmark Strait and Irminger Sea matters to us all.
This narrow passage on the doorstep of the Arctic Circle is a bottleneck on what Pickart refers to as a "superhighway" in the oceans' global circulation. It is the main route for waters flowing southward from the Arctic Ocean to the North Atlantic Ocean—a component of what is often referred to as the Ocean Conveyor.
Every second of every day, the North Atlantic Current, an offshoot of the Gulf Stream, transports about 15 million cubic meters of warm, highly saline water past the western shores of Britain and Ireland, cosseting those latitudinally incongruous palm trees in Cornwall. The North Atlantic Current "becomes" the Norwegian Current as it flows along that country's coast, where it surrenders heat to the atmosphere, and in collaboration with the prevailing westerly winds, guarantees ice-free harbors in winter four degrees above the Arctic Circle. Together, these currents and their tributaries comprise the main highways bringing water northward through the Atlantic into the Arctic in the upper limb of the Ocean Conveyor.
If a certain quantity of water flows north, then an equal quantity must flow south. To keep the circle unbroken and the Conveyor turning, the ocean performs a unique trick. When the formerly Gulf Stream waters give up their heat, they become colder, and therefore denser, and sink to the depths in the deep basins of the Norwegian, Greenland, and Iceland Seas north of the Denmark Strait.
An oceanic gateway
Beneath the water in the Denmark Strait, shallow continental shelves, only several hundred meters deep, extend east from Greenland and west from Iceland and nearly join. They create a seafloor barrier separating the seas to the north and the Irminger Sea to the south, all of which are more than 2,000 meters deep.
Cold, dense water fills the depths of the seas north of the Denmark Strait and then plunges down an increasingly steep bottom slope into the depths of the Irminger Sea. Though not as abrupt as Niagara, this submarine waterfall is thousands of times greater in volume than all terrestrial waterfalls combined. If visible, it would be a World Heritage site.
As the cold, dense water sinks into the depths of the Irminger Sea, the ocean performs another trick: It pulls in surrounding water and marshals it into a vast current that flows southward at depth. The current eventually crosses under the Gulf Stream near Cape Hatteras, then flows seaward of the Bahamas, into the Southern Hemisphere. This is the Deep Western Boundary Current (postulated in 1960 by the eminent WHOI oceanographer Henry Stommel before it had ever been observed in nature).
Thus the Denmark Strait/Irminger Sea is at once the southbound superhighway of the Ocean Conveyor and the headwaters of the Deep Western Boundary Current. And that's why we need to know how water navigates the strait.
A newly discovered ocean current?
In 2004, Icelandic oceanographers Steingrimur Jonsson and Hedinn Valdimarsson overturned previous thinking about how water enters the strait when they observed an entirely new current. They found that the old model was partly correct—the East Greenland Current flows into the strait from the north. However, they argued that most of the water that flowed over the Denmark Strait arrived via a deep, dense current flowing eastward along the northern border of Iceland. They called this deep current the Northwest Icelandic Jet.
Naturally, the new paradigm introduced more questions than it answered. Just what kind of water was contained in the Northwest Icelandic Jet? Where did it come from? How did it negotiate the submarine mountain ranges in its path?
To understand the net flow in the Northwest Icelandic Jet, Pickart needed to stop the ship every two miles to lower and retrieve a package of instruments called a "CTD," which measures seawater conductivity (a proxy for salinity) and temperature at various depths. Then the ship moved to the next "station" to do it again. And again.
"The CTD operators probably want to throw me over the side," Pickart would say later in the trip. "But there's no other way."
The second question—how water exits the strait—also brought a new twist to conventional thinking. Recent evidence suggested that some of the dense water passing out of the strait actually remains up on the outer portion of the shallow Greenland shelf, thus bypassing the big waterfall in the deeper regions of the strait.
Addressing this question required Pickart to raise his gaze from the deep ocean to the surface and above, to the atmosphere. The notion was that the wind might be driving water off the shelf into the deeper Irminger Sea basin. And in this case, terrestrial geography, in the form of Greenland, was enhancing the wind. This expedition provided us firsthand experience of the exquisite interconnectedness of nature's great systems.
In the Denmark Strait, Oct. 10
The storm system moved eastward, as all eventually do; another weaker one followed, and another, like pearls on a necklace. We came to think of 40 knots as calm. One morning on the bridge, the captain, peering critically over a field of whitecaps, said, "You know what I hate?"
"What, Cap?"
"When shoreside weathermen say, 'The storm passed safely out to sea.' "
Research-cruise routine slipped into its 24-hour-a-day, watch-on/watch-off pattern. Raw data poured in. Pickart and his graduate student, Kjetil Våge, sat 14 hours a day at their computers processing data from the CTD and another instrument called an Acoustic Doppler Current Profiler, or ADCP. This sonar-based device mounted in Knorr's hull constantly pinged the water to yield measurements of current velocity.
Watch passed seamlessly to watch on the bridge and in the engine room. When the decks were dry, the bosun and his crew chipped rust, painted, and welded. The galley team turned out three square meals a day, two entrées for lunch and dinner, a total of 1,400 meals by the time the trip was through.
It depended on your watch schedule whether you saw in these waters and this weather only relentless gloom or something richer in Arctic character. The cloud formations are different here. So are the colors of sunrise and sunset, splintered as they strain through the murk. The very look of the ocean is different. But romantic day-workers, free from sleep deprivation and quite willing to fall under the spell of the Arctic, didn't talk much about such things around the graveyard-watch standers.
Tools of the trade
To determine just how much water originating from the north flowed onto the shallow shelf in the Denmark Strait, Pickart extended some of his CTD lines all the way across the passage to within one mile of the Greenland coast. But to document how the dense water subsequently vacates the shelf farther south required more than a pass-over by a ship.
To record the shelf-to-basin transfer, Pickart and members of the WHOI Mooring Group had, during a cruise the year before, set seven closely spaced moorings astride the shelf break. The first order of business on this cruise had been to retrieve them and their year's worth of data. As we neared their position in hopeful weather, Pickart explained the risk: Worst case, all were gone.
The moorings were armed with a WHOI-developed instrument called a Moored Profiler, a stout plastic pod housing temperature and salinity sensors and a current meter. The new wrinkle is that the Profiler chugs up and down the vertical mooring wire by means of a tiny traction motor, thereby collecting hundreds of measurements throughout the water column and throughout the year. If the ocean gives them back.
The strong local currents are quite capable of blowing down the moorings, even carrying them away. They can be disrupted by bottom trawlers that fish the area, and then there are icebergs the size of shopping malls marching over the mooring site. On the plus side, Pickart said, he had the best mooring team in the business working on the technical problems.
Led by WHOI senior engineering assistant Jim Ryder, the team snatched back all seven moorings in two Arctic-short days while the wind blew hard and snow accumulated on the pitching aft deck. Meanwhile, the bridge officers maneuvered the ship brilliantly. All of the profilers had survived the ocean's onslaught.
But what about the data? Outwardly calm after a year's wait, Pickart sat down at his computer and inserted a data-recording disc. The following morning, the verdict was in. The "ridiculously strong currents," as Pickart put it, had broken four profilers, but not all at once. Each had lived long enough to capture precious data. Not a stellar survival rate, but quite impressive, given the woeful beating they'd incurred from the very forces they were laid to measure.
"It could have been far worse," he said, relieved.
Kangerdlugssuaq Fjord, 68° N , Oct. 13
The East Greenland coast strains credulity. Utterly pristine, it seems more the work of some Arctic-besotted Romantic scene painter than the natural result of orogeny and glaciation. Equally unlikely, the sky was blue, blue, and the sea was dead flat.
As Oct. 13 dawned buttery-yellow, the snowy mountains glowed as if with some internal illumination. By noon, the light had turned starkly white, visibility unlimited. Pointed peaks, hollow cirques, and pyramidal mountainsides skirted by skree marched inland after soaring straight out of the deep blue water. A turquoise-veined iceberg, like a toppled high-rise, clogged the mouth of one nameless fjord.
Giddy as kids nearing our holiday destination, crew and science staff lined the port rail of the highest deck trying to capture it with cameras or simply take it in. No one lives here; no one ever has, and no one ever comes to this remote coast so hostile to human ambition. There is no flat land except on the glacier faces, no vegetation, nothing but rock and ice and ocean, Earth in its younger days.
We chugged northward at reduced speed, dodging growlers and bergy bits, to Kangerdlugssuaq Fjord on the eastern Greenland coast. The team laid a picket fence of CTD measurements across its mouth in blazing sunlight, while the rest of us watched Greenland's snowy mountains and bergs go by.
After dinner, Pickart remarked that the CTDs were sampling water that could be traced back to remote places, including the Gulf Stream.
The Greenland Shelf, 69° N, Oct. 20
The bridge watch and visitors spotted a strange reflection just above the horizon. The radar had already seen it: sea ice athwart our desired course, and we were coming up on it fast.
Capt. Sheasley peeled off speed as we approached. Ice as far as you could see. He calculated his alternatives. It would take untold hours to detour around it, but it was new ice, still thin and slushy. The captain decided to drive through it—gingerly.
Silently, we watched and listened to ice scrape Knorr's hull. And then we were past it. But then the ship sagged to a stop.
"Uh-oh," said Capt. Sheasley before we understood what had happened. "The phone's going to ring. It'll be the engine room. I'm going to apologize profusely."
The phone rang. The Cap apologized profusely for not informing the engine room that we were entering ice before it clogged the raw-water intakes. No harm done, we were soon under way. At dinner that evening, engineers offered snow cones straight from the engine intakes. No one ate any.
A savage storm
"URGENT: Please pay attention to strong storm low with winds of hurricane force. We recommend you to stay out of area between 19°W and 26°W and if possible seek shelter," said the fax from the Denmark Meteorological Institute. We were at 20°W, where 80-knot winds, gusting to 100, with 40-foot seas, were expected—for the next 50 hours.
Those among us obsessed with the ocean wanted to stay to see the extreme show, and Capt. Sheasley admitted that it hurt his professional pride a bit to leave, but the only sensible decision, given the storm's power and duration, was to make a run for it. In consultation with Icelandic colleagues ashore, he chose Eyjafjordur Fjord, a long crack in the north coast of Iceland 100 miles away. After three more uneasy CTD casts, we hauled in, battened down, turned on our heel, and bolted.
Dawn on Oct. 24 found us hunkered behind Hrisey Island with its tiny Christmas-card town near the mouth of the fjord. The weather map arrived. It was both frightening and thrilling. The isobars, those concentric rings of decreasing barometric pressure, were so tightly packed on the Greenland side they looked like a fingerprint.
The barometer would plummet 35 millibars in the next 24 hours, to a bestial 946 mb. Now we could see it: a towering, bulbous mass of night-black cloud plowing, like an island that had slipped its geologic moorings, over the mouth of the fjord. The wind sprang from two knots to 34, then to 55 knots—and we were in the lee of the island.
"Imagine what it must be like out there," said the ocean obsessives.
Where wind, water, and land conjoin
Spinning counterclockwise around their centers of lowest pressure, autumn/winter cyclones track northeastward across the North Atlantic from Newfoundland, pass south of Cape Farewell at the southern tip of Greenland, and charge into the Irminger Sea region. Up in the northwest corner of our storm, hundreds of miles in diameter, hurricane-force winds were encountering the high, vertical coast of Greenland—an insurmountable barrier. The mountain wall bends the wind sharply southward, and the "squeezing" effect causes the winds to accelerate, like rapids in a narrow river gorge. This is called a "barrier wind," and you could see it on the meteorological map in the smudge of isobars along the Greenland coast, where 90 knots prevailed.
As the barrier wind blows over the ocean's surface, a basic principle of physical oceanography called "Ekman transport" takes charge of the actual flow. Influenced by the force exerted by Earth's rotation, the net transport of water bends 90 degrees to the right of the wind direction in the Northern Hemisphere (to the left in the southern). It's a law of physics. Here, however, the water cannot indefinitely bend to the right—because Greenland is in the way. Yet it has to go somewhere; it can't defy the law.
In this case, the water gets forced downward, then seaward, likely pushing any dense water at the shelf's edge into the deep Irminger basin. This wind-forced mechanism "perhaps" (Pickart's prudent word) solves the riddle of how dense water that lingers on Greenland's shelf eventually sinks to join the southerly flow of the Ocean Conveyor.
The biting irony aboard Knorr was that this storm, even now inflicting its will on the Irminger Sea circulation, was too powerful to allow us to measure it—or anything else. Though he took it like a pro, Pickart had lost almost two days during the first storm, another day while we fled from the second one, and three more hiding from its hurricane-force winds.
Now, as the scheduled end of the trip loomed, he'd lose still another day steaming back to the study area for one final CTD line. Pickart never expected, nor even wanted, gentle weather, but this was egregious, October being only the beginning of the storm season.
Nonetheless, between the Oct. 3 morning when we passed the Reykjavik sea buoy outbound and saw it again 28 days, 14 hours, 36 minutes later, we had covered 2,786 miles, retrieved seven moorings, and completed 263 CTD casts. Ignoring seasickness, we sustained no injuries, the ship no breakdowns.
And though Pickart, at this early stage, would not claim to know exactly how water enters and exits the Denmark Strait, he and his staff have acquired critical data. On a subsequent short research cruise, Pickart and his Icelandic colleagues continued measurements farther upstream and saw compelling new evidence for the existence of the Northwest Icelandic Jet and its role in feeding the deep overflow through the Denmark Strait.
He will need to return to these cold, violent waters again to elucidate the circulation in this strategic strip of ocean. That will take years, he predicts; there are few eureka moments in contemporary oceanography. However, sooner or later, the investigation continuing, questions will be resolved, and we'll have learned a bit more about how the ocean system works.
This research was supported by the National Science Foundation.
Related Articles
Featured Researchers
See Also
- The Irminger Sea: Where the Arctic meets the Atlantic A Web site with dispatches and information from the October 2007 research cruise.
- Robert Pickart's Homepage
- Research Vessel Knorr
- A Mooring Built to Survive the Irminger Sea from Oceanus magazine
- Adventure in the Labrador Sea An article by Bob Pickart on a Labrador Sea research cruise, from Oceanus magazine.
- Ocean Conveyor's 'Pump' Switches Back On from Oceanus magazine
- Reaching Up into Perilous, Icy Waters An article by Bob Pickart on the Arctic Winch in Oceanus magazine


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The iPhone 5 launch is just days away. Excitement is reaching its peak. Anything is possible. OK, well not anything, specifically not this.
Taylor Lorenz Talks "Extremely Online"
So maybe not all the features in this (obviously fake) video by Aatma Studio are impossible, but the best one is, despite how soul-crushingly bad you yearn for it. You'll know which one I'm talking about when you see it, but for the impatient, it happens around the minute mark.
Normally this is when I'd wrap up by saying "maybe someday" or something, but no. Maybe never because I am pretty sure this kinda sorta defies the law of conservation of mass. But LTE would be cool I guess...[Youtube via AllThingsD]


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New NBC News Poll Delivers Scathing Results for Donald Trump
A Strong Majority of the Nation Opposes Everything Trump Is Doing
A new NBC News/SurveyMonkey poll released Thursday morning is serving up scathing results for President Donald Trump.Â
It shows six out of a 10 Americans oppose the president's pardoning of former sheriff Joe Arpaio, with just one in three saying they support it.Â
It shows that 68 percent of Americans think the issue of undocumented immigrants in this country is serious – and 71 percent say undocumented immigrants should be offered the opportunity to to apply for legal status.
Contrary to Trump's policy, just 26 percent think undocumented immigrants should be deported.
Then there's DACA, which Trump is expected to end any day now.
NBC News asked: "Do you support or oppose the DACA (Deferred Action for Childhood Arrivals) policy, which protects those who were brought in the United States as undocumented children from being deported?"
64 percent of Americans say they support DACA – they do not want it dismantled. Just 30 percent don't support it.
And 57 percent of Americans believe immigration helps more than it hurts the country.Â
Naturally, almost six in 10 Americans (59%) say they disapprove of the way President Trump is doing his job.
These numbers echo the disastrous Fox News (yes, Fox News) poll released Wednesday night, which shows 56 percent oppose building the wall, 56 percent disapprove of his handling of Charlottesville, 56 percent say Trump does not respect racial minorities, and 56 percent say Trump is "tearing the country apart."
To comment on this article and other NCRM content, visit our Facebook page.
Image by Andrew Dallos via Flickr and a CC license
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'Scared to Death': Trump's Prison Panic Admission Means He Knows He's Doomed Says Legal Expert
Reacting to a report that Donald Trump has been quizzing his attorneys about what type of prison he likely will be sent to, former federal prosecutor Glenn Kirschner stated that is not only an indication that he knows he's going to be convicted but also an admission of guilt.
Speaking with MSNBC host Jonathan Capehart, the attorney was asked about a recent Rolling Stone report about Trump's prison panic.
As Rolling Stone reported, Trump asked if he's "be sent to a 'club fed' style prison — a place that's relatively comfortable, as far these things go — or a 'bad' prison? Would he serve out a sentence in a plush home confinement? Would government officials try to strip him of his lifetime Secret Service protections? What would they make him wear, if his enemies actually did ever get him in a cell — an unprecedented set of consequences for a former leader of the free world."
POLL: Should Trump be allowed to run for office?
According to the attorney, Trump is revealing himself by asking for so many details.
"What does this tell you about Trump's mindset?" host Capehart asked.
"It tells me he is scared to death" Kirschner quickly answered. "It tells me he has overwhelming consciousness of guilt because he knows what he did wrong and he knows he is about to be held accountable for his crimes. So it is not surprising that he is obsessing."
"If he was confident that he would be completely exonerated, would he have to obsess about what his future time in prison might look like?" he suggested. "I think the last refuge for Donald Trump can be seen in a recent post where he urged the Republicans to defund essentially the prosecutions against him. which, to this prosecutor, Jonathan, smells a lot like an attempt to obstruct justice."
Watch below or at the link.
Image via Shutterstock
'Vulgar and Lewd': Trump Judge Cites Extremist Group to Allow Drag Show Ban
A federal judge in Texas known for a ruling that attempted to ban a widely-used abortion drug is citing an extremist anti-LGBTQ group in his ruling allowing a ban on drag shows to stay in place.
U.S. District Judge Matthew Kacsmaryk, a former attorney for an anti-LGBTQ conservative Christian legal organization, and a member of the Federalist Society, in his 26-page ruling dated Thursday cited the "About" page of Gays Against Groomers to claim, "it's unclear how drag shows unmistakably communicate advocacy for LGBT rights."
Judge Kacsmaryk, appointed by Donald Trump twice before finally assuming office in 2019, suggests the First Amendment does not provide for freedom of expression for drag shows, calls drag "sexualized conduct," and says it is "more regulable" because "children are in the audience."
READ MORE: 'The Public Deserves to Know': Abortion Pill Banning Judge Redacted Details About Millions of Dollars in His Stock Portfolio
Slate's Mark Joseph Stern adds, "Kacsmaryk's conclusion that drag is probably NOT protected by the First Amendment conflicts with decisions from Texas, Florida, Tennessee, and Montana which held that drag is constitutionally protected expression. It also bristles with undisguised hostility toward LGBTQ people."
Calling the judge "a proud Christian nationalist who flatly refuses to apply binding Supreme Court precedent when it conflicts with his extremist far-right beliefs," Stern at Slate writes that Kacsmaryk ruled drag "may be outlawed to protect 'the sexual exploitation and abuse of children.' In short, he concluded that drag fails to convey a message, while explaining all the reasons why he's offended by the message it conveys."
Stern does not let Kacsmaryk off the hook there.
"From almost any other judge, the ruling in Spectrum WT v. Wendler would be a shocking rejection of basic free speech principles; from Kacsmaryk, it's par for the course. This is, after all, the judge who sought to ban medication abortion nationwide, restricted minors' access to birth control, seize control over border policy to exclude asylum-seekers, and flouted recent precedent protecting LGBTQ+ equality," Stern says.
READ MORE: Far-Right Judge Under Fire for Failing to Disclose Interviews on Civil Rights – but LGBTQ Community Had Warned Senators
"He is also poised to bankrupt Planned Parenthood by compelling them to pay a $1.8 billion penalty on truly ludicrous grounds. And he is not the only Trump-appointed judge substituting his reactionary beliefs for legal analysis. We have reached a point where these lawless decisions are not only predictable but inevitable, and they show no sign of stopping: Their authors are still just settling into a decadeslong service in the federal judiciary."
West Texas A&M University President Walter V. Wendler penned the letter that sparked the lawsuit.
Titled, "A Harmless Drag Show? No Such Thing," Wendler wrote: "I believe every human being is created in the image of God and, therefore, a person of dignity. Being created in God's image is the basis of Natural Law. James Madison and Thomas Jefferson, prisoners of the culture of their time as are we, declared the Creator's origin as the foundational fiber in the fabric of our nation as they breathed life into it. Does a drag show preserve a single thread of human dignity? I think not."
Journalist Chris Geidner concludes, "It's an extremely biased ruling by a judge who has established that he does not care about being overturned — even by the most conservative appeals court in the nation."
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Gaetz Praises GOP Congressman Who Echoes His Call for Change 'Through Force'
U.S. Congressman Matt Gaetz (R-FL). largely seen as pushing Speaker Kevin McCarthy's Republican-majority House of Representatives toward shutting down the federal government, is praising and promoting remarks made by a freshman GOP lawmaker that appear to suggest the use of violence. U.S. Rep. Eli Crane's comments, posted Friday (below), call for change "through force," remarks echoing Congressman Gaetz's recent comments which were denounced by an expert on authoritarianism as fascistic.
"The only way we're going to see meaningful change in this town is through force," wrote Congressman Crane, Republican of Arizona atop a three-minute video in which he frames what is now an almost guaranteed government shutdown as a "spending fight." In his video he says, "the only way you're gonna get any change in this town is through force." Gaetz in August had said, "we know that only through force do we make any change in a corrupt town like Washington, D.C."
Congressman Crane is a former Navy SEAL. He has promoted the false "Big Lie" conspiracy theory that there was massive fraud in the election President Joe Biden won, and called "on the state legislature to decertify the 2020 election." He is one of six House Republicans who voted against McCarthy's speakership all 15 times in January.
READ MORE: White House Mocks GOP With 'Worst Person You Know' Meme After Matt Gaetz Blames McCarthy for Shutdown
"Congressman Eli Crane is a fountainhead of political courage," said Rep. Gaetz Friday afternoon. "He holds the line."
Crane recently came under fire for calling Black people "colored," during debate on his legislation that would force the U.S. Armed Forces to not use any diversity requirements in its hiring practices.
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Just days before he won his House seat last year, The Washington Post reported Crane had urged an "audience to look up an antisemitic sermon at a recent campaign stop."
"Crane said that he was motivated to run because of 'radical ideologies that are destroying this country' and that he was most concerned about 'Cultural Marxism,' which the Southern Poverty Law Center has described as an antisemitic baseless claim gaining traction on the American right."
"He encouraged the audience to watch a speech by a right-wing pastor who blamed cultural change on a group of German Jewish philosophers and condemned Barack Obama for having a 'homosexual agenda.'"
"If we don't wake up," Crane said, according to the Post, "if we don't study what they're doing, and if we don't put people in influential positions that understand what this war is all about, what they're trying to do and have and have the courage to call it out, we're going to lose this country."
In August, while standing next to Donald Trump at a campaign rally, Congressman Gaetz said, "Mr. President, I cannot stand these people that are destroying our country. They are opening our borders. They are weaponizing our federal law enforcement against patriotic Americans who love this nation as we should."
"But we know that only through force do we make any change in a corrupt town like Washington, D.C. And so to all my friends here in Iowa, when you see them come for this man, know that they are coming for our movement and they are coming for all of us."
At the time, Raw Story reported, "historian and author Ruth Ben-Ghiat called Gaetz comments alarming."
READ MORE: Pete Buttigieg Just Testified Before Congress. It Did Not Go Well for Republicans.
"What he is saying is that they are not going to have change through elections or through legislation or through reform. They are going to have change through violence," she warned.
"And that's how fascists talk," Ben-Ghiat added. "So, even if Trump is out of the picture, these are people who have adopted methods very familiar to me as a historian of fascism, that violence and corruption and lying that's what the party is today."
Image via Shutterstock
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Shop and save on tax-free holidays
Keep track of the things you need that match your state tax holiday and wait for that holiday to come around again before buying, Hamm writes.
On the first Friday and Saturday of August each year, Iowa has a sales tax holiday on "select clothing and footwear," which actually translates into "virtually all clothing and footwear."
It's at a great time of the year. A lot of parents are ready to start shopping for back-to-school clothes for their growing children and may be looking for new fall and winter items for themselves, as the weather starts to cool off starting in September here in Iowa.
Thus, the savvier shoppers in Iowa tend to do much of their clothes shopping on that weekend.
Of course, smart retailers recognize that there will be a lot of clothes shoppers out and about that weekend, so they advertise hard for their business. They usually run pretty strong sales to get those savvy shoppers into their stores.
Add those two together and you end up with some pretty steep discounts on clothing. In fact, the only time each year that I buy clothes (other than emergencies) is that weekend.
Thes sales tax holidays happen in many other states at various points throughout the year, and they include many different items, including computers, school supplies, firearms, energy efficient products, and hurricane preparedness materials (though clothes are the most common item). Most of the time, these holidays are on consistent dates from year to year – check your local state for more details.
My experience with other state sales tax holidays has been much like my experience in Iowa: savvy shoppers waiting until the holiday and retailers fighting for customers with big sales.
So, what can you do to maximize this?
If your state or an adjoining state has a sales tax holiday, be patient. Keep track of the things you need that match your state tax holiday and wait for that holiday to come around again before buying.
Plan ahead a little. If you know you're going to need new winter clothes for your little one, buy them early during the holiday and stick them in storage until you need them.
Save up. Buying a wardrobe refresh for everyone in the family at once can be pricy. Don't go into credit card debt for it. Sock away a few dollars each month so that you have a healthy budget of cash to spend when the tax free holiday comes around.
Planning ahead can save you a lot of money.
This post is part of a yearlong series called "365 Ways to Live Cheap (Revisited)," in which I'm revisiting the entries from my book "365 Ways to Live Cheap," which is available at Amazon and at bookstores everywhere.


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Lying, and other kinks in relationship communication
CJ replies:I caught my partner lying about his past. It was a few weeks ago and we "cleared it up" yet I still feel out of place. At first he told me that he was a virgin (I didn't really believed him since he was 24 and he told me his ex was "kinky") but as I continued to question him he said that there was penetration. I was pissed at that moment but I decided to ask him what is it to have sex to him and he told me he considered penetration sex. Yet he applied a few excuses and I can't find to believe him, could he be lying about more?
Well, the only person who knows for sure if your partner is being honest with you would be your partner. I think that is just one reason why it sounds pretty important that you revisit this discussion with him, particularly if he doesn't know you're still feeling unsettled or uncomfortable even after things supposedly got cleared up. Feeling like you can't trust someone—or questioning their honesty—definitely puts a damper on a relationship. The best and healthiest relationships are built from a place of trust and mutual understanding between partners.
But let's step back for a second because, that said, it sounds like there's a lot going on with what you've written and the situation you described. When your partner told you he was a virgin, you mentioned that you didn't believe him right off the bat. You noted his age (24) and the fact that he'd said his ex was "kinky" as reasons that you didn't think he could possibly be a virgin. You didn't mention whether he'd ever done anything before to make you question whether he's telling the truth or how you feel that the two of you communicate about other aspects of your relationship, but it seems to me like those two reasons (age and having a former partner who is kinky) aren't necessarily, in and of themselves, reasons that he couldn't be a virgin. People develop sexually on different timelines, and there are certainly 24 year olds out there who have chosen, for whatever reason, not to have sexual contact with other people. Depending on how you define virgin (which is probably a pretty important question to ask—I've learned in lots of years of sex ed never to assume I know what someone means when they say "virgin"), he could easily be one, at any age. As for kink, that's another word that people can define in different ways. For some people, kink is about erotic power exchange, and that may not having anything to do with genital contact or activities that bear relationship to whether someone—by their definition—identifies as a virgin.
It's great that you were able to ask him some more questions about how he defines sex since that, too, is something for which people can have vastly different definitions.
With all of this confusing language, and the inability to be certain for yourself about how someone might use particular language (without asking them directly, which I'd highly recommend), I think it can be helpful to think a bit for yourself about how you define those terms for yourself, and the meaning you place in them.
When people talk about "virginity" it can be for lots of reasons. Some people were taught to believe that virgins are "pure" or "clean" or were somehow better than other people. Some people believe that you need to stay that way until you reach some outside milestone (a particular age, marriage, etc.). There can be millions of reasons—cultural, personal, and religious to name a few—for people to view virginity in a particular way. Other people talk about virginity with respect to risk, like how if both partners are virgins there must not be any risk for STIs if they do have sex (not true, but people still believe it).
If you're someone who is concerned about risk, I think it can often be more helpful to talk about risks specifically rather than try to ask about "sex" or "virginity". You might want to know if they've had any genital contact with another person (and if there was protection used), if they've ever had oral-genital contact, if they've had any kind of anal sex or oral-anal contact…stuff like that, that's more specific than just asking about sex. That can help assess your risk. It's amazing how many people may still identify as virgins, for whatever reason and through whichever definition they feel is best, but still have had plenty of risks for sexually transmitted infections.
So that's one piece of it, which might help you figure out what questions you want to talk about with your partner, but the other big piece just seems to be around whether you feel like you can trust him, and what to do with those feelings.
I don't think this is something that you can solve by yourself. Keeping those feelings inside—even if you feel like they should have already been resolved—will probably only lead to more resentment. If you have more questions about what he's told you, I think the only way to move forward is to let him know that you still want to talk about this and to share how you're feeling. It can take a long time to build trust in a relationship, but a really short time to break it. Some people can work through that and rebuild trust, but sometimes we know in our gut that a trust violation isn't something that we can move through. You know yourself the best—and know your relationship the best—so you're in the best position to figure out whether this is something that you want to put the energy into working on with your partner (assuming he's willing) or whether it doesn't feel possible or worth it to you.
It may be that he felt he was giving an honest answer to the question being asked, or he may have known he wasn't being completely forthcoming in telling you about his past. If he knew he wasn't being completely forthcoming, it might help to ask him about his reasoning for that, and why he felt that he could not be honest with you about his previous relationships. It's hard for me to take a wild guess about his motivations, but I definitely know that we can think up plenty of horrible reasons that other people might act in certain ways or say specific things…but only the person in question can speak for themselves.
If this is a person with whom you are hoping to be sexual or with whom you are having any kind of sex, you may want to have more conversations about protection and STI screenings so that each of you can stay as healthy as possible.
Being in a relationship where you feel like you can't trust the word of the other person is generally a pretty crappy feeling. It can take time to rebuild trust and that process takes investment and hard work from all involved people in the relationship. Thinking for yourself about what you want and need from your relationships will give you a foundation to work from when you approach your partner to talk more about what happened and figure out whether this is something that can be resolved in a way that feels good for both of you.
Here are some other articles that might be helpful for you:


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The Halloween Celebration
Samhain, All Souls Day, The Day of The Dead - No matter what you call it, we got the costumes. We have been around for 20 years to help people celebrate this historical holiday with Curly Bob Wigs among many other costume accessories. Mainly we do a flapper costume really well. Short Bob Wigs have came a long way since the time people gave out Soul Cakes to the poor in England, they all wore this hair for real! . Yep, that's right. Trick 'r' Treat was originally a way for English peasants to get free food. They wore the short wigs and went out with the long bob. Although the name of the holiday has changed through the years, we all know the love of free junk food transcends time and continents.
Curly Bob Wigs provide a variety of fashionable looks and accessories for everyone. If you're anything like us, then you probably like to hide your identity while pigging out on free candy wearing these short wigs. This is the very reason we keep items like our short bob wig in stock all the time! Halloween stores know it's cold in October, but you can always be glamourous.
Try not to get caught pilfering all the chocolate wearing these short wigs like in England. If you get found out, then our Ball and Chain will compliment those prison stripes quite nicely. Private Island Party is always looking out for the customers! Even if you don't have your hand in someone's candy bag, you can use a Ball and Chain to tell your significant other that you need more "Me Time". Our on-line Halloween stores provide relationship help and really cool costumes too!
While some people prefer a lighter touch, this short bob wig will always provide the traditional scares that the holiday is known for even if you are trying to look sexy. Imagine the look on everyone's face when you pretend to attack the household pet with a Retractable Disappearing Knife. It's a family photo moment only made possible looking like a hot mess at the club.
Halloween stores also provide masks for the more modern fright seekers. The Scream Ghost Face Mask is a great way to surprise your neighbors when they skimp out on the good stuff for Trick 'r' Treat. Put the mask on, call them up and in a scary voice say, "Do you like crappy candies?". Next year you'll either get better candy or nobody will answer the door. Our great curly bob wigs can help you get awesome treats looking like a sexy flapper... or a police visit regarding prank phone calls.
If you're looking for something a bit more gory, then Blood Capsules may be what you've been looking for. You can either combine them with Glow In The Dark Fangs for a radioactive vampire look or use them to do an impersonation of Gene Simmons from KISS. Whether you're after fun, fright or shear terror, our large Halloween stores inventory will help make this scary holiday more memorable than ever. Are you a big party enthusiast? If so we offer wholesale Halloween party accessories just for you. The more you buy the more you save!
We offer something for all holidays, including Thanksgiving, Channukah, New Years and more!


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The SparkFun Lumenati 8-pack is a coin-sized board equipped with seven APA102C LEDs surrounding the outer edge of the board, with one in the center. Designed to give your projects an edge in their lighting capacity, the 8-pack board can be daisy-chained with other Lumenati boards, thanks to the multiple SMD pads on the back allowing for multiple design options and formations. Additionally, we have labeled the APA102C LEDs on each board with numbers indicating their position in the sequence to help you write code more easily. We especially love using the Lumenati boards to give our flying race drones a bit of style and panache.
The APA102C addressable LEDs operate on +5V power input, as well as 0–5V logic levels for clock and data, and employ a 2-wire communication protocol consisting of a clock line and a data line. While this requires one more wire than standard WS2812B LEDs, the advantage is that the communication with the LEDs becomes somewhat timing-independent, allowing you to run these directly off of a Raspberry Pi or other single-board computer that doesn't normally allow for a long, precisely timed data stream without the use of additional hardware.
Note: This product only includes one board, not eight. The term "8-pack" refers to there being eight APA102C LEDs equipped to the Lumenati.


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Ghost Town - Manor, Texas
This J.LORRAINE ghost town is located in Manor, TX. It is about 12 miles away from Austin. They hold weddings, party, rent barn, movie night, etc all the time. They serve beer, soda, hamburger, hot dog, and etc..Read More
Check this out at http://ghosttownaustin.com/
Check this out at http://ghosttownaustin.com/
© Copyright 2016 Ellen Yeates Photography


text: 159362_3535 THE GOOD DOCTOR - âVengaâ â During part one of the two-part season finale, the St. Bonaventure team travels to Guatemala on a surgical mission to help patients at a rural hospital. Once there, the team faces a small community that is in desperate need of their help but are assigned the daunting task of identifying who they can help most. And while Shaun seems to be thriving in Guatemala, Lea is still struggling with the loss of her baby on the season finale of âThe Good Doctor,â MONDAY, MAY 31 (10:00-11:00 p.m. EDT), on ABC. (ABC/Jeff Weddell) ANTONIA THOMAS, WILL YUN LEE


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Pages: 230
Binding: hardcover
Cultures and Religions in Dialogue (Opera Omnia VI.2)
By: Raimon Panikkar
This new offering in the complete works of the internationally renowned philosopher of religion Raimon Panikkar brings together in the second of two volumes the English-language version of Panikkars important work on Cultures and Religions in Dialogue. As always, Panikkar seeks to bring together East and West without compromising the integrity of the traditions of each.Raimon Panikkar (1918-2010) made pioneering contributions in the areas of interreligious dialogue, comparative theology, and the phenomenology of religion, while bridging different religions and cultures (Christianity, Buddhism, Hinduism), and effected insightful conversation between the so-called sacred and secular worlds. These diverse contributions were tied together in a unifying vision he called his cosmotheandric intuition, the deep interconnection of the Divine, the Cosmic, and the Human.
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Snack Bar is an outdoor Chinese food and drinks stall located within the courtyard of the Paseo San Francisco shopping center in Cumbaya, Ecuador.
The project was designed to be comfortable, secure, transparent, and easy to assemble. We avoided enclosing the space, due to the hot and dry local climate, as well as the heat radiating from the cooking equipment. The design had to be open air, but security was also a factor. A cage was wrapped around the work space, allowing for plenty of natural ventilation, while simultaneously providing a security barrier. The transparency of the cage additionally benefited the client, who also owns a sit-down restaurant across the hallway, and wanted to maintain an unobstructed visual connection between both restaurants.
Snack Bar's design is simple; a box within a box. The interior core is dark and blends in with the surrounding surfaces of the mall, while the outer shell stands out in sharp contrast. Steel bars were welded into a bamboo forest latticework, and then sprayed with glossy white auto paint to maximize the visual pop. The security screen doubles as a form of signage. Snack bar is fully visible to visitors on the upper levels of the mall as well as anyone using the neighboring glass elevator and escalator. For this project, the roof was especially significant, as it acts as the 5th, and most important facade.
The project was mostly built offsite with ease of onsite assembly in mind. The construction schedule was accelerated by using detailed 3D assembly drawings, as well as full scale drawings of the bamboo pattern for the steel welders to work off of directly.
Photographs by Hou de Sousa and Jay Vandermeer


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Office of the President, Lee C. Bollinger
Fall Report on Campus Dialogue and Community Activities
December 6, 2005
To the Columbia Community:
Once again, as with my letter at the beginning of the semester, I find myself with many important events and developments to share. At the very least, the letter's length reflects the impressive scale and significance of activities currently underway at the University. I hope that what follows contains some common points of interest to people throughout our community.
Last April, I announced the Kraft Family Fund for Interfaith and Intercultural Awareness, which was created to expand campus discussion about issues of faith and culture. Student programming supported by the Kraft family's generous gift has been ongoing since the start of the academic year, and hundreds of students have participated. Upcoming student programs include performances exploring the three Abrahamic faiths of Christianity, Judaism, and Islam; a benefit concert and panel discussion about HIV/AIDS, poverty, and human rights; and a one-day workshop to foster greater understanding among racial and ethnic groups.
The theme for the inaugural University programming series of the Kraft Fund will be "Religion in the Public Sphere," which will commence with a campus visit and lecture early next semester by Ecumenical Patriarch Bartholomeos I, one of the world's great spiritual leaders. His All Holiness is the "primus interpares," or the first among equals, of the world's Orthodox Church leaders. He has gained international recognition for raising awareness of environmental and social issues. I can think of few people better suited to usher in the start of this new interfaith and intercultural program at Columbia, and I am grateful to have him join us here.
The University programming reflects the hard work of a committee of distinguished faculty: Carol Gluck, the George Sansom Professor of History and professor of East Asian languages and cultures; Eric Kandel, Nobel Laureate and University Professor; Nicholas Lemann, dean of the Graduate School of Journalism and Henry R. Luce Professor of Journalism; and Robert O'Meally, the Zora Neale Hurston Professor of English and Comparative Literature and director of the Columbia University Center for Jazz Studies. These faculty members have worked closely with students this semester to develop program themes and content.
This fall, two new presidential advisory bodies were established - the President's Council on Student Affairs and the President's Advisory Committee on Diversity - to increase dialogue and collaboration among students and senior administrators on key issues affecting the University. The President's Council on Student Affairs, which met for the first time on December 5, includes Provost Brinkley and me, student representatives from our undergraduate, graduate, and graduate professional programs, and deans of students and other administrators. The President's Advisory Committee on Diversity adds another dimension to our ongoing efforts to promote diversity at Columbia. At the first meeting, the students were most interested in the work being done by Jean Howard, William B. Ransford Professor of English and Vice Provost for Diversity Initiatives, and specifically her efforts to work with the faculty at SEAS. This work will be formally started with a lecture by Charles Vest, MIT's President Emeritus. The details will be announced soon, and I hope you will be able to join us at President Vest's upcoming lecture.
There have been numerous informal gatherings, as well, for discussions of University issues. In October, I met with a small group of undergraduates at the President's House to talk about their thoughts and concerns, in the first of several fireside chats planned for the year. The topics included community service, the University's proposed expansion into Manhattanville, the Core Curriculum, University business practices, and financial aid. The next fireside chat is planned for Thursday of this week.
While the search for Columbia University Medical Center's new Executive Vice President for Health and Biomedical Sciences and Dean of the Faculties of Health Sciences and Medicine continues, I, together with the search committee, have held town hall meetings at CUMC. In these discussions, faculty, students, and staff have illuminated challenges and opportunities at the Medical Center that have helped to inform the search process. I will continue to report on the search as progress is made.
As is always the case at Columbia, our community has responded generously to national and global challenges. In the wake of the recent earthquake in South Asia, it was heartening to see green donation boxes sprout up around our campus, as what began as a single relief committee formed by Columbia's Organization of Pakistani Students spawned a host of coordinated efforts. This kind of outreach speaks powerfully to our students' compassion, sense of personal responsibility, and predisposition for thoughtful action.
And then there has been the devastation wrought by Hurricane Katrina. With Tulane, Loyola, Dillard, and Xavier each planning to reopen in January, I want to recognize just once more how Columbia was among the first universities in the nation to enroll students from these schools. Provost Brinkley recently hosted a town hall meeting with Tulane President Scott Cowen and Tulane students at Columbia and their parents to update them on developments and answer questions about the school's reopening. President Cowen also took the opportunity to thank Columbia for taking good care of Tulane students this semester. I, too, wish to thank everyone from across the University who worked to accommodate these visiting students and make them feel at home during their stay at Columbia.
I also would like to acknowledge and thank the many individuals throughout our community for their support of the hurricane relief effort. Irwin Redlener, M.D., the director of the Mailman School of Public Health's National Center for Disaster Preparedness, came to personify Columbia's contribution through his intellectual leadership and that of the Mailman School in delivering health care to people in devastated areas. In the same spirit of compassion and involvement, nearly 50 different student groups on campus, including CU Relief and Barnard Unites for Katrina 2005, also have pitched in, raising money and collecting relief supplies.
The Earth Institute at Columbia University and Columbia's School of International and Public Affairs held a half-day conference in November to examine a broad range of scientific, political, and economic issues raised by Katrina. In October, the Graduate School of Architecture, Planning and Preservation, the Urban Technical Assistance Project, and the Institute for African American Studies hosted a day-long symposium that convened more than a hundred panelists comprised of practitioners and academics from a wide range of fields to discuss the implications of the hurricane for U.S. urban policy decisions.
Columbia Law students Laila Hlass and Anna Arceneaux - from Mississippi and Louisiana respectively - helped launch the Student Hurricane Network, a national movement to address the numerous difficulties faced by evacuees, raise awareness, and inform policy-making decisions on housing, economic development, voting rights, and other issues. The network includes law students at Columbia, Brooklyn Law School, New York Law School, the Benjamin N. Cardozo School of Law, New York University, Fordham, Rutgers, Harvard, and Yale. During the upcoming holiday break, about 25 Columbia students will be among a group of approximately 100 law students from the Northeast traveling to Louisiana and Mississippi to work with community organizers.
Helping improve education at all levels in society also has been an important theme this fall. In October, I announced our commitment to collaborate with the City of New York in developing an innovative new public science, math, and engineering secondary school on the site of our proposed Manhattanville campus in West Harlem. Work on this important initiative will begin in earnest in the spring to ensure that the school will be ready to open in September 2007 in transitional space. And Teachers College sponsored a two-day symposium on the "Social Costs of Inadequate Education" as part of its extraordinary efforts to focus on the deep inequities that continue to undermine our educational system. Lastly, I also would like to acknowledge the School of Business's Class of 2005 for pledging its class gift of more than $500,000 to the School's Loan Assistance Program, which helps business school graduates who pursue careers in the public and nonprofit sectors pay their student loans. Through this generous gift, the Class of 2005 is helping to ensure that their classmates who wish to apply their learning in service to the public are not precluded from doing so by the financial burden they have incurred in the course of their studies.
As we enter the holiday season, I would like to point out that there are countless ways to address needs in our own neighborhood through Columbia's many community service programs. I would like to take a moment to mention one here - the Columbia Community Service Campaign. Each year from November to May, this campaign raises funds from Columbia faculty and staff that go directly to local organizations, which serve thousands of people in our neighborhood, including the elderly, the infirm, single mothers, families with low incomes, the homeless, and the hungry. More information about the Columbia Community Service Campaign can be found at http://www.columbia.edu/cu/annualappeal/. Please be generous.
I wish everyone the very best in the final weeks of the fall semester.
Lee C. Bollinger


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Classic Bond with a contemporary feel; Skyfall, the most beautiful looking substantive, and the 23rd splendid adventure in the 007 film series, impressively takes a deep dive into the tormented psyches of James Bond and M and the villain, and is regarded as the cleverest and most psychologically gripping of all the Bond epics. Playing Ian Fleming's secret agent 007 in the film, macho-actor Daniel Craig impressively takes the Bond's character to another level with not only his die-hard loyalty to M and Britain, but also with the Tom Ford designed body-hugging Tuxedos and tab collar shirts, Aston Martin DB5, Omega Seamaster watch, and the beautiful yacht Chimera. Now, the very same yacht on which 007 sailed with the Bond girl Severine 'Berenice Marlohe' to reach the villain on an isolated island, is now being offered on sale at 11 million Euro, and is also on charter at a price of 90,000 Euro per week to let you live the life 007 style.
Click the links below to see details of sale and charter;
You can also contact us for more details by sending an email to: firstname.lastname@example.com
Referred to as Chimera in the film Skyfall and used during filming in the picturesque Turkish bays of Fethiye, the beautiful yacht which is actually one of the finalists of the 2012 World Super Yacht Awards, is 56 meter sail yacht Regina, launched in 2011 by Pruva Yachting.
Built in Bodrum, Turkey, the Regina is a modern, high-performance schooner-type superyacht that incorporates classic design.
This superyacht that offers a new dimension to cruising boasts 6 master cabins that have a separate dressing room, satellite TV, and music systems, along with 3 guest cabins, large saloon, spacious deck areas, and separate crew quarters.
Further, every detail on the yacht has been considered for the charter's comfort.
Further, speaking about the role of the yacht Regina in the Skyfall, it was sailing at half speed, when the yacht was shot at her all grace and beauty both from the air, at a side and on the decks.
Notably, the producers of the film Mr. Michael Wilson & Ms. Barbara Broccoli, along with Dennis Gassner, Daniel Craig had a dinner on board Regina.
They were about 20 guests and it was not a planned in advance.
After the Skyfall shooting, Regina has become the charter choice of the celebs and ultra-elites, including the requests from famous star Salma Hayek.
Here you can check more pictures of Regina;
Source: bornrich.com