text:
Stomping Grounds, Buzzards Bay
Posted by Gina and The Big Dog in Good Wine/Beer Selection, Outdoor Dining, Restaurant Review on August 10, 2015
We recently had our first meal, and possibly our last, at Stomping Grounds. The food was excellent and inventive, and the outside seating atmosphere was as expected when along Main Street in Buzzards Bay, but the service was so flawed that under ordinary circumstances we would not provide a review, especially without a second visit.
However, we concluded that there are so few optimal days, weather-wise, for a restaurant with outdoor seating in our region, so when those optimal days occur, we have every reason to expect the restaurant staff to be on its "A" game. We visited Stomping Grounds on what had to be one of the nicest Saturday afternoons this summer, and we didn't expect the 150-minute ordeal it became.
First, the good news: the Stomping Greens salad ($12) is hands-down one of the better salads we've had this year. It included generous additions of sliced green grapes, toasted pine nuts, chick peas, and roasted brussels sprouts. We marveled at how much prep time that dish must have taken, and wondered why no one else had come up with this delicious combination. It's tossed with a light lemony parmesan dressing that makes all the ingredients sing. Twelve dollars for a salad? When your licked-clean plate is taken away from you, we promise, you will be thinking you got a great deal.
We also ordered an appetizer called "Spuds MacKenzie" ($8), described as "our twist on a classic favorite and a must try." We did try, and while we have no clue what "classic favorite" this was twisting and found the presentation kind of weird, we liked it. Thin wedges of roasted red bliss potatoes were served with a a little bowl of dipping sauce that included gorgonzola blended with ground walnuts and bacon. Gina initially objected, saying it was too rich, but in no time was slathering it on the end of her salad.
We also enjoyed the Mediterranean Fish Stew ($16), another unexpected bargain. Served in an oversized bowl — too big, really, and it was difficult to get the spoon at the right scooping angle as a result — the soup had a rich tomato broth in which we found giant shrimp, scallops, tuna, mussels, carrots, celery, and potatoes. It came with grilled pita bread with a subtle curry topping, excellent to dip into the soup. This was Gina's entree, and she took half home after sharing much with the Big Dog.
The Dog's lunch was a Buzzards Bay Reuben ($10), which seemed like a regular Reuben. There's a choice of corned beef or turkey, and it comes with Cape Cod brand potato chips and some crisp, fresh, slaw made of red and green cabbage.
We ordered a bottle of Josh Cellars cabernet ($34), as it's one of our favorites, and this proved to be a wise move, because we were able to pour ourselves a second glass while we were waiting for our food to arrive.
It took a bit for our waitress to make her way to our table, and she apologized excessively for the delay, and then for the fact that she had not brought menus. When that finally happened, we selected the Josh from the short but carefully considered list of beer and wine options, plus artisanal spirits. Soon, the wine was delivered, opened, and ceremoniously poured by a young man in a grubby tee-shirt who we assumed to be a bus boy but who we later learned was the chef-owner. Note to chefs everywhere: Call us old fashioned, but we've chosen to spend a special occasion with you, and we think you should be dressed as if it's a special occasion for you too. We want to believe you're working magic in the kitchen, and if you feel more comfortable wearing a stained hoodie or a flour handprint on your pants, please don't dash our illusions — stay in the kitchen.
(Rant over. You know we believe that chefs and other restaurant staff are the hardest-working humans and we hate to criticize them.)
Our appetizers were delivered with another round of apologies, and this time, the Big Dog stepped in and asked the waitress to stop doing that. We were enjoying a relaxing afternoon on a beautiful patio with a nice glass of wine, and the waitress' implication that something was going terribly wrong was detracting dramatically from our enjoyment. The young couple sitting near us snickered audibly, clearly having thought the same thing.
Twenty minutes later, with the sun beating down mercilessly, the wine bottle nearly empty, and our entrees yet to arrive, we regretted saying anything. The waitress returned again empty handed, said she really needed to apologize now, and blamed someone else for losing our order.
Entrees arrived, we thought they were excellent, packed half for home, and that was that.
We realized, driving away, why this scene seemed not just unpleasant but inappropriate: because in the universal language of restaurants, the second "I'm so sorry" is followed immediately by, "… Save room for one of our outstanding desserts, on the house!" or "… We've taken that weird potato thing off your bill." None of that here.
Will we return? Too soon to tell. The food was excellent, but the fact remained that we spent $99, with beverage, tax, and tip (yes, 16.5 percent despite the flaws, mostly because Gina is not good at math) on a lunch that consisted of soup and salad, a sandwich, and an appetizer. We thought the food was a great value, but we did not get anything close to hundred-dollar service.
A Multitude of Mussels
Posted by Gina and The Big Dog in Roundup, Seafood Restaurants on July 24, 2015
Recently, Gina and the Big Dog went on a mussel-eating binge. In two weeks or so, we ordered mussel appetizers off five different menus in the northeastern corner of Buzzards Bay and came away with the conclusion that there's something for everyone here.
We were surprised by the diversity. The basic strategy, we believe, is to saute fresh and clean mussels, typically from Prince Edward Island, in a tasty sauce just to the point of doneness. Add some bread for dipping in the sauce and you've got a hearty and simple appetizer. Each of our local restaurants interpreted all of that differently.
Our first stop was at Mezza Luna in the village of Buzzards Bay. This institution is a favorite destination of ours when we are looking for consistent, good food in a comfortable yet white-tablecloth atmosphere. The bar is typically packed with people who make for interesting eavesdropping, but on this Tuesday evening, it was unexpectedly quiet.
The mussels appetizer ($13) inspired our little journey with four parenthetical, challenging words on the menu: "We're famous for them." So we chose the standard preparation, which the menu describes as being "in our delicious garlic and wine parmesan cream sauce." Mussels are also available with marinara or fra diavlo sauce.
The generous bowl of fresh mussels arrived topped with slivers of garlic and a delicious, creamy, cheesy sauce. This was hands-down Gina's favorite dish of the odyssey, as much for its careful presentation as its flavor. The bread for dipping was served on the side. The dish came topped with a bowl for shells. The sauce was delicious and the mussels were fresh.
Heading west (on a different day), we stopped at Lindsey's Family Restaurant in East Wareham, where "Mussels Sambuca" were available as a special ($14.99). Now, we know that the folks at Lindsey's are extremely smart and very responsive to their clientele, and this dish is offered as a special relatively frequently, so it must be popular. But the combination of flavors seemed odd to us. Sambuca liqueur laced a creamy sauce, served with a hunk of garlic bread on top.
We agreed that the shellfish, also described as hailing from PEI, at Lindsey's, was the best prepared of the four mussel dishes we enjoyed. They were clean and fresh and cooked just to the point of doneness.
A bit farther down Route 6/28 is Bailey's Surf & Turf, another favorite spot where the Big Dog found his preferred mussels dish.
This scampi version, offered as a special that day ($11.95), was the classic preparation that many think of as the way to prepare mussels. A little white wine, a lot of butter, a healthy toss of fresh garlic, maybe some parsley, and you've got yourself a classic. Given the odd adornments we saw during our journey, the simplicity here was welcome.
And the oddest were yet to come.
Venturing to the region's other end of Route 6, we went to Brew Fish in Marion, another favorite spot with a nice bar and good wine and beer selection. We like the food there.
Not this time.
We saw the word "mussels" ($11) and ordered. Had we continued reading the description, we would have gotten to "fennel." One thing we agree on is that we don't like fennel. If you like fennel more than you like shellfish, you would love this dish. If you like fennel at all, you might like this — it's unusual and creative.
Our last stop (for a while) was another local favorite, the Stonebridge Bistro in Onset. This dish ($11) was dubbed "Pan Roasted Mussels" and described as PEI mussels sautéed in white wine, garlic, onions, and tomatoes. It's on the regular appetizer menu. We don't know why, but these mussels were in ordinary-sized shells, but the morsels inside were very small. It was a hearty serving, though, and with a Caesar salad and small flatbread pizza, was plenty of food for the two of us. (And inexpensive too, considering the quality. We also ordered a bottle of Toasted Head cabernet, and the whole thing came to just 52 bucks.)
The bread served with the mussels was the best of our tour. The bread has to hold its own in the sauce, and can't arrive soaking in it. The Bistro serves a delicious grilled sourdough with many of their dishes, and it really shines in this one.
The one complaint we had at every stop but the Mezza Luna was that our mussels were not served with a bowl for shells. At a couple of restaurants we didn't even get side plates. We assumed that steamed mussels would be served just like steamed clams. Maybe other folks have a different approach to eating steamed mussels, but we can't imagine steamers coming without a shell bowl and side plates. Maybe we should find out, in our next odyssey.
The Cabin, Middleboro
Posted by Gina and The Big Dog in Family Dining, Pub on June 5, 2015
If you view dining out as entertainment, and also like us feel that a thoughtfully planned meal is like a well directed movie with preparation, setting and service all a part of the exquisite cinematography, then you must dine at the bar at The Cabin.
It has all of those elements, plus the outstanding choreography of a well managed kitchen, all on display.
We were prompted to visit The Cabin by all the positive reviews on a fun, homey Facebook page called Lakeville/Middleboro Dining Out (Gina is a huge fan and encourages you to apply for membership to the group). As the Big Dog has roots in that area, we entertained the possibility that the positive reviews were the result of Lakeville/Middleboro residents being among the nicest people in the world, and never negative.
But they were being totally honest, not just nice, about The Cabin. The food was very good, the service was attentive and friendly, and the interplay of the kitchen kept us entertained for our entire visit.
It was a warm evening and we were in summer mode, so Gina started with a Mezzacorona pinot grigio ($7) and the Big Dog ordered an Ultimate Margarita featuring Jose Cuervo 1800 ($8.95). Both choices were good.
We like fried oysters and these, a special served with a spicy aoili, were very good ($10.95). Our affable bartender/waitress, Rachael, tracked down their origin and seemed as surprised and disappointed as we that they were not local, but rather from Virginia. But as much as we like to support our local farmers, we also like clean oysters fried in a light batter, like these were.
We watched dish after dish of the special swordfish ($17.95) flying out of the kitchen towards the small and far less entertaining dining room, so the Big Dog ordered that. Gina chose the menu's baked seafood trio ($19.95), which Rachael gladly matched with two vegetable sides (broccoli and the evening's special, green beans).
We suspect that a restaurant owner, especially one present like the Cabin's, regrets his open kitchen a hundred times on a busy Saturday night. He'll see flaws and hear muttered obscenities that the rest of us miss. In our case, we watched Gina's distinctive dish simmer under a heat lamp while the Big Dog's swordfish remained in the queue, and we could sense the stress level elevating.
But not ours. We remained entertained and distracted by the kitchen — the cool pizza maker to our right, the seasoned fry guy, the line, the efficient expediter, and their interplay with the rest of the staff.
When it arrived, Gina's delight in finding a restaurant finally having removed the tails from delicious shrimp outweighed the slight delay and any other conceivable flaw we could have found. The fish and scallops were cooked perfectly, as were the beans and broccoli.
The Big Dog knew going into it that he wasn't going to like the pineapple salsa atop the pan blackened swordfish, so he scooped it off and enjoyed the dish without it. The balance included mashed sweet potatoes and delicious asparagus.
When we first sat, the couple next to us greeted us like regulars; over the course of the evening, another couple took their place and they too acted like they knew us. The Middleboro/Lakeville vibe is part of the entertainment at The Cabin, and really added to our enjoyment of our positive experience there.
The Cabin
114 East Grove Street, Middleboro
Seafood Shanty, Bournedale
Posted by Gina and The Big Dog in Outdoor Dining, Seafood Restaurants on May 28, 2015
We're on a quest to find the best lobster roll in the region, and before we even started the quest, a friend told us the best lobster rolls are at the Seafood Shanty, located on the Bourne Scenic Highway opposite the Herring Run on the Cape Cod Canal.
Despite our focus on food, our view of local restaurants is often affected by ambiance, service, and the quality of the beer and wine list. None of those come into play here — the Seafood Shanty is a walk-up window; grab your tray and soft drink, and do your best finding a suitable picnic table.
To be honest, that setup barely qualifies as a dining experience for us. If we went to the salad bar at the Stop n Shop, we would not trouble you with our commentary about it, and a take-out window on a busy four-lane highway isn't much better than a grocery lunch.
But the Shanty is a popular spot, and we can imagine that patrons flock there for someone's proclaimed best lobster salad rolls ($20.50), the best scallop roll ($14.95), the best fish sandwich ($8.95), or any of the other standards they have to offer.
We're certain all of those items are quite good. But we're equally certain that the flocking is caused not by the main course, but by the french fries.
We each ordered lobster rolls, and like many of the sandwiches, they came with fries. Now, we're the kind of people who see fries as high-calorie superfluousness, and we'll often ask for a substitute on principle.
At the Seafood Shanty, we were glad we didn't. Each fry was the crisp-on-the-outside, soft-on-the-inside ideal, and they were liberally crusted with salt. You can buy them on their own, at $4.95 for a large side, and we could easily imagine doing that. They were outstanding. We can think of none better in the Southcoast region.
Our thoughts on the lobster rolls were more mixed. They tasted good, with big chunks of lobster tossed with mayonnaise, laid atop some crisp green leaf lettuce and a saucy dollop of mayo inside a buttery bun.
Our issue was with the structure, and this is one time we're hoping that the ownership will read and heed: We would have been happier with the same generous serving of lobster, or maybe even a little less, spread over two buns. We would cheerfully have paid $14.95 for half the lobster in one bun.
Here's the thing: It's not a sandwich if you can't pick it up to eat it. And we couldn't with these overstuffed fellas, until we had forked out a healthy serving of overflowing lobster. Many, if not most, of our fellow diners may subscribe to the 16-inch plate of pasta theory of dining value, but we just don't. A great lobster roll is not one that has lobster on the plate next to it: it's one that contains bite after bit of bread, sauce, and filling, all working together. The restaurant has been around since the early 1990s and is clearly quite successful, but we're thinking a slightly different approach might work even better for them.
Seafood Shanty
803 Scenic Highway (Route 6)
Celebrating Wareham Oysters at Stonebridge Bistro
Posted by Gina and The Big Dog in Dining with a Great View, Pub, Seafood Restaurants on April 30, 2015
As part of this year's Wareham Oyster Festival week, we had the opportunity to spend some time in the kitchen of the Stonebridge Bar and Grill with chef/owner Justin Hadley.
Hadley, who has run this kitchen for a dozen years, has gained a widespread reputation for creativity, while recognizing that diners value food that is consistent, fresh, and a great value. It's an unusual combination for a restaurant that also offers an idyllic waterfront view, with a deck perched over the Stonebridge Marina in Onset.
On the night of our visit, Hadley was experimenting with an oyster special that displayed his special twist on the classic Rockefeller treatment.
He opened a pair of oysters and sat them, bowl side down, in a bed of kosher salt. "It infuses a little flavor, maybe, and keeps them upright," he noted.
On these, he placed some chunks of bleu cheese, the element which kept this from being a true Rockefeller recipe, but which added a rich earthiness which clearly enhanced the original.
He then added a layer of scallions sautéed with spinach. While we were surprised at the tangle of scallion, Justin said many oysters Rockefeller recipes call for it in lieu of chopped onion or shallot.
Then came a generous, course crumble of cooked bacon.
Finally, Hadley hauled out a tray of a toasted panko concoction and insisted that we sample a pinch, then another. We could imagine eating this stuff by the buttery fistful from a cardboard tub at the movies, it was that good. The crumbs were mixed with butter, parmesan, butter, a hint of red pepper, and butter. He topped each oyster with the crumbs, then put them in the convection oven for five minutes.
The result was rich, bright, cheesy, salty, and crunchy – all of the characteristics of a perfect bar snack. He served the pair of oysters on a bed of organic baby spinach with two grilled half lemon quarters
The Stonebridge Bistro's specials were part of the second annual Wareham Oyster Festival. A week of culinary and educational offerings centered around the oyster culminate annually in a street fair on the first Sunday in May on Main Street.
For more information about the Wareham Oyster Festival, visit warehamvillage.org.
The Stonebridge Bistro is located at Five East Boulevard in Onset; visit stonebridgebarandgrill.com for information.
Wareham Oyster Festival
Posted by Linda Burke in Uncategorized on April 26, 2015
Gina and the Big Dog are pleased to support the second annual Wareham Oyster Festival, which kicks off today in this beautiful seaside town.
Through the next seven days, some of our favorite Wareham restaurants will offer delicious oyster specials. Several informational talks are planned. The organizer, Wareham Village Association, will hold a fundraising gala at the new Rosebrook Event Center on Friday evening. A 5K road race is planned for Sunday morning, and the activities culminate on Sunday, May 3, from 11 a.m. to 5 p.m., with a fun street fair on Main Street. There will be plenty of oysters, beverages from our friends at Westport Rivers Vineyard and Buzzards Bay Brewery, two dozen crafters and artisans, music by the Southcoast Jazz Orchestra and our friend Mikelyn Roderick, and more!
It's an event you don't want to miss, and an example of the local food and shellfish industries coming together to promote several important aspects of the local economy.
Visit the Wareham Village Association website to learn more.
P.S. We kicked off the week with a lunchtime plate of fried oysters at Bailey's Surf and Turf. Yum!
Martinis, Plymouth
Posted by Gina and The Big Dog in Pub, Restaurant Review on April 12, 2015
We went to Martinis because we had one of those Living Social coupons and it was about to expire. We'd heard that they had pretty good food, and on Tuesday nights, live jazz. But it was really about the $15 coupon value we were soon to lose, so we were delighted when Martinis turned out to be a great dining experience, one chock-full of pleasant surprises.
First surprise: the restaurant was packed on a Tuesday night, with all eyes on a stage at the back of the long, narrow space. We were led to a high-top near the windows on Main Streeet by the same Jimmy who'd taken our call earlier and told us the kitchen was serving until 10. A young server, who turned out to be his daughter, Meg, brought us menus, then returned promptly to take our drink order. No waiting here, despite the crowd. We were treated like regulars.
Thinking that one should order a martini in an establishment called Martinis, The Big Dog chose a tiramisu concoction ($12) that was very sweet. Surprise Number Two came later, when we learned that the name comes not from the increasingly tarted-up classic beverage, but rather from the name of the restaurant in "It's A Wonderful Life." Gina selected a Carnivor cabernet ($8).
The menu offers all kinds of interesting items, which can be good and bad. Often, what sounds like a good idea is actually not good at all. We decided to start with something called a Boursin Cheese Artichoke ($10), described as a "long-stemmed artichoke stuffed with house boursin cheese, baked with panko crumbs and aged balsamic drizzle." It was heavenly. A baby artichoke was sliced in half, piled with a delicious boursin, and made crunchy with a layer of crumbs. Yes, it was a small portion for the price, but if that's your standard for food, may we suggest the whopper junior with fries? We could see Surprise Number Three shaping up: excellent, creative food in a space entirely dominated by a bar.
The Big Dog called for a Sunflower Salad ($8), a fresh little plate of what others might call a Greek salad, whose twist was a sunflower oil vinaigrette and a scattering of sunflower seeds, along with some arugula mixed with the usual Greek components.
Gina ordered the roasted Statler chicken breast ($16), a classic preparation accompanied by a tasty sausage stuffing, mashed potatoes, and baby carrots (real youngsters, not those giant carrots pared into pellets on a lathe). It was very good. For that price, one would expect a far more ordinary dish.
The Big Dog's entree was "bistro meatloaf" ($17). It was ground veal wrapped with bacon and topped with a tomato-y sauce and smoked cheddar. It too was served atop mashed potatoes and carrots.
Surprise Number Four? Host Jimmy returned a bit later and confided that the very nice jazz music was not your average has-beens, but rather the quartet who ordinarily supports a classic crooner who these days spends his time with a singer named Lady Gaga. Their artistry was an excellent compliment to the outstanding food.
We believe downtown Plymouth is one of the coolest places in southeastern Massachusetts, and once again were not disappointed.
Martinis Bar and Grill
50 Court Street, Plymouth
Lobster Trap, Monument Beach
Posted by Gina and The Big Dog in Dining with a Great View, Good Wine/Beer Selection, Outdoor Dining, Seafood Restaurants on March 7, 2015
We have had many outstanding meals at the Lobster Trap in recent years.
Generally speaking, it's our kind of place Stretched along scenic Shore Road is first a wholesale fish market, then a retail market, then a room for takeout, then a delightfully rustic dining room, then a pub area with a handful of hightop tables on one side and a copper-surfaced bar on the other, then an outdoor patio, then the brackish Back River, which flows forcefully to and from Buzzards Bay with each tide.
Some come for the lively bar scene with periodic live music, some for the off-the-boat fresh fish in the market, some for the reasonably priced yet inventive meals in a dining room that's as comfortable for toddlers as for Gramma.
We come for the water fowl, and we're never disappointed.
Sure, the fish tacos featuring corn and black bean salsa ($12) are excellent. We love the beet napolean salad ($9) a composed structure of beets with blue cheese and not much else. The seafood stew ($8 for a 12-ounce cup) is rich and creamy, and the lobster roll ($21, but often available as part of a lunch special) makes you glad you live in New England even when it snows every day for two months. We like our Cabernet Sauvignon, and they have two good ones by the glass: Josh ($9) and Five Rows ($7).
But if you have any interest in wildlife, you'll want to visit the Lobster Trap for lunch or an early dinner during the summer, and the food will take a back seat to the scene playing out before you at the bar.
The Back River is a tidal estuary which flows into a protected area known as Phinney's Harbor. During our visits, we've watched heron, egrets, osprey, swans, hooded mergansers, buffleheads, black ducks, and more. Most recently, we watched two flocks of Canada geese converge upon one another as if they were playing out a scene from "West Side Story." The undertow is vicious, and the birds take full advantage, propelled inland under Shore Road, then bobbing back under the railroad bridge.
Others, we're sure, come for the unusually pleasant staff. This being a seasonal community — one we tend to avoid in the season — many patrons are greeted with a cheerful, "When did you get back!?"
During our most recent lunchtime visit, we experienced a rare misstep: the oversized "house-made brioche croutons" accompanying the caesar salad were like bricks. The Big Dog's topping of very good steak tips saved his salad, and Gina thought the classic dressing on her side version offset the crouton debacle. And the slightest expression of dismay on our part drew effusive apologies from our server, and complimentary wines for each of us. Things go wrong even at the best establishments, and the front-line staff's handling of a complaint makes the difference between a customer who won't return, and one who enthusiastically recommends the place. As we recommend The Lobster Trap.
The Lobster Trap
290 Shore Road, Bourne
Brazilian Grill, Hyannis
Posted by Gina and The Big Dog in Restaurant Review on February 28, 2015
A Brazilian grill, as a generic term, is a style of restaurant known as a churrascaria. At a churrascaria, there are typically two all-you-can-eat things going on: acres of an outstanding, fresh, inventive salad bar with familiar favorites and some more exotic dishes; and a barbecue where a parade of waitstaff haul huge hunks of meat to your table and slice off pieces to order.
Yes, it sounds over the top, but it really isn't. We went with friends to the Brazilian Grill in Hyannis for lunch recently… and let us tell you about the music first, to set the tone.
The charming hostess, who like the rest of the staff seemed to be Brazilian, thought for a few moments about which of the few remaining tables — this at 2 p.m. on a Sunday — would be most comfortable to us, then led us to one directly in front of where a man with a large collection of keyboards and amplifiers was setting up. Gina cringed, anticipating a wall of noise that would ruin our lunch.
Instead, the music, by jazz singer Ravi Melo, was perfect. Most of the songs were Brazilian Portuguese standards, with the likes of James Taylor interspersed, at a perfect volume.
We ordered a bottle of wine — a Silver Palm cabernet sauvignon for the table at $34 — from a list that includes a lot of Portuguese choices that might have been a better pairing but sadly, we're just not familiar with them.
By the time the wine arrived, we'd already received three or four items from the parade of meats: some succulent hunks of filet mignon wrapped in bacon, moist pork tenderloins, and chicken hearts. There was flank steak stuffed with chunks of cheese, and little medallions of beef topped with mozzarella. And little sausages. And crispy chicken wings. And lamb. And more.
The ladies, well beyond protein overload, ventured to the salad bar and found a surfeit of green treats. Start with mixed greens, a fistful of watercress, a premixed Caesar, or Gina's favorite, delicate Boston lettuce. Add cool roasted carrots, hearts of palm tossed in a creamy dressing, a julienne of radishes, grilled summer squashes, and any vegetable you can imagine pickled. Or soups! Or an array of sushi! Or hot dishes, with or without seafood! Or even a mounded platter of cracklings.
Our orders were classified as the Dinner Rodizio at $32.95 apiece. That's the deal throughout the weekend, and evenings during the week. The weekday lunch portion, at just $17.95, is available until 4 p.m. There is a soup and salad option, which does not include the more exotic hot buffet options, available weekdays for just $10.95. We witnessed lots of people lining up at the grill with their takeout containers. For just $8.99 a pound, you can fill up a Styrofoam box with your choice of salad items then add your favorite meats.
And while takeout may be a good deal, we imagine the price of the box escalates pretty quickly with the juicy meats and saucy salads. You're really better off hanging out in the lovely restaurant. The cordial waitstaff and the pleasant atmosphere, not to mention the music when available, combine for a special dining experience.
In the near future, we'll find out — and let you know — whether other Brazilian grills spotted in Plymouth and Dartmouth are similar. In the meantime, we can assure you that the Brazilian Grill in Hyannis is fun, unusual, and delicious.
Brazilian Grill
680 Main Street, Hyannis
Antonio's, New Bedford
Posted by Gina and The Big Dog in Family Dining, Good Wine/Beer Selection, Inexpensive Dining on January 31, 2015
Spend enough time in the Southcoast region of Massachusetts, and you almost become an honorary Portuguese citizen. Most local restaurants have kale soup and some sort of Mozambique dish on their menu. We like traditional Portuguese dishes and the zing that the colonies, notably Cape Verde and Brazil, have introduced.
That said, we must acknowledge that we're a coupla pale-skinned Irish kids, and no Avo ever made us bacalhau. That can be good and bad when visiting an ethnic restaurant like Antonio's. On the plus side, it means that we didn't grow up with a single preparation of a traditional dish and find all others just plain wrong. Conversely, we don't know when something has strayed so far from the traditional preparation as to be offensive to some.
Antonio's has a very good reputation, and we're pretty sure it doesn't stray from tradition. It has been around for 25 years. At 2 p.m. one recent Saturday, every seat in the house was filled, which is weird — as you know, that's our favored lunchtime, and we have never, ever, had to wait for a seat at that time anywhere, until we visited Antonio's.
We were joined by Gina's mom, brother, and sister-in-law, for a late Christmas get-together and gift exchange. They all live in the New Haven, CT, area, where ethnic restaurants are so common that you can choose not just the continent of origin, but the specific country — if you don't care for the Ethiopian style of sambusa, you can find a Somalian restaurant instead, for example. But apparently New Haven doesn't have any Portuguese restaurants, so our choice was simple.
The beer and wine list set the tone. Gina chose an Esporao Reserva from the Alentejo region of Portugal, while the Big Dog and Gina's brother chose a Buzzards Bay Brewery IPA from the Westport region of Massachusetts. Everyone was happy with their selection.
For those new to Portuguese cuisine: It is carb-intensive. Most of our entrees came with a yummy yellow rice AND potatoes. AND a delicious bread basket of fresh rolls and bread slices. AND we ordered soups thickened by potato and/or beans. AND we ordered dizzyingly delicious custards in puff pastry for dessert. We were all ready to run a marathon the next day, and we're sure some people do that.
The kale soup ($2.99) was delicious, but Avo would probably be opposed. Most of the preparations we've seen feature an oily beef broth with red kidney beans, sliced kale leaves, and hunks of chourico. This soup base was velvety, creamy, and thick, unlike anything we had seen. There were white AND red beans in evidence. AND macaroni. AND we're sure there were some potatoes involved in the broth, all carrying on the carb tradition. This version had some strips of kale leaves, but the unusual addition of cabbage, cut from the stem end in a manner that invited the curly leaves to hang together in a very appealing way. We loved this soup, and will go back just for that.
We'll hope for bread with our soup. The overflowing basket included some slices of white bread, and a half dozen "pops," the Portuguese rolls officially known as papo secos.
Gina's mom ordered the Chicken Algavaria ($14.99), and it stole the show. We should have known what was in store when the affable waitress brought the rest of us silverware, and Mom a shovel. The dish arrived in an aluminum vessel the size of a child's wading pool. It was chock full of shrimp, littleneck clams, and chunks of boneless chicken tossed with saffon rice. We're kidding about the shovel and the wading pool, but after Mom ate her portion and shared oversized tastes with the rest of us, she asked for the leftovers to be divided into two separate to-go containers, and the one we took home weighed four pounds. Four pounds! This was A BIG PORTION. At lunch!
Gina ordered the grilled swordfish ($13.99) which came with hunks of peeled white potatoes and broccoli, and took more than 60 percent of the fish and potatoes home. Big Dog ordered a lamb skewer ($13.99) which came with the saffron rice and a delicious salad, and took 70 percent of the lamb and rice home. Gina's brother ordered Steak Tips Diane ($15.99), a creamy preparation that came with rice and french fries of which he took home 55 percent. Slim sister-in-law ordered a crab cake dish ($9.99) and managed to finish it, which made us assume it was an appetizer portion.
Bottom line: the five of us ended up with 13 meals averaging less than $6 apiece.
We all ended the meal with a Nata Custard Tart, a special for $1.25 apiece. We're thinking it was a puff pastry pressed into a muffin tin and filled with a thin custard. When we come back for our kale soup and pops, please add one of these to our order. It was delicious and fun.
The decor at Antonio's is pleasant and clean but not fancy. The service is suited to a white tablecloth setting, not the stacking-chair-and-paper-placemat scene we got. Overall, we felt our expectations were exceeded throughout our visit, and there is no higher compliment to a restaurant.
Antonio's Restaurant
267 Coggeshall Street, New Bedford


text:
Read Books Online, for Free
|Damaged Goods
|Upton Sinclair
Chapter V
|Page 5 of 9
But the doctor cried, "No, no, sir! Do not make a new law. We have too many already. There is no need of it. It would suffice that people should know a little better what syphilis is. The custom would establish itself very quickly for a suitor to add to all the other documents which he presents, a certificate of a doctor, as proof that he could be received into a family without bringing a pestilence with him. That would be very simple. Once let the custom be established, then the suitor would go to the doctor for a certificate of health, just as he goes to the priest for a certificate that he has confessed; and by that means you would prevent a great deal of suffering in the world. Or let me put it another way, sir. Nowadays, before you conclude a marriage, you get the lawyers of the two families together. It would be of at least equal importance to get their two doctors together. You see, sir, your inquiry concerning your son-in-law was far from complete. So your daughter may fairly ask you, why you, being a man, being a father who ought to know these things, did not take as much care of her health as you took of her fortune. So it is, sir, that I say to you, forgive!"
But Monsieur Loches said again, "Never!"
And again the doctor sat and watched him for a minute. "Come, sir," he began, finally, "since it is necessary to employ the last argument, I will do so. To be so severe and so pitiless-- are you yourself without sin?"
The other answered, "I have never had a shameful disease."
"I do not ask you that," interrupted the doctor. "I ask you if you have never exposed yourself to the chance of having it." And then, reading the other's face, he went on, in a tone of quiet certainty. "Yes, you have exposed yourself. Then, sir, it was not virtue that you had; it was good fortune. That is one of the things which exasperate me the most--that term 'shameful disease' which you have just used. Like all other diseases, that is one of our misfortunes, and it is never shameful to be unfortunate-- even if one has deserved it." The doctor paused, and then with some excitement he went on: "Come, sir, come, we must understand each other. Among men the most exacting, among those who with their middle-class prudery dare not pronounce the name of syphilis, or who make the most terrifying faces, the most disgusted, when they consent to speak of it--who regard the syphilitic as sinners--I should wish to know how many there are who have never exposed thenselves to a similar misadventure. They and they alone have the right to speak. How many are there? Among a thousand men, are there four? Very well, then. Excepting those four, between all the rest and the syphilitic there is nothing but the difference of chance."
There came into the doctor's voice at this moment a note of intense feeling; for these were matters of which evidence came to him every day. "I tell you, sir, that such people are deserving of sympathy, because they are suffering. If they have committed a fault, they have at least the plea that they are expiating it. No, sir, let me hear no more of that hypocrisy. Recall your own youth, sir. That which afflicts your son-in-law, you have deserved it just as much as he--more than he, perhaps. Therefore, have pity on him; have for him the toleration which the unpunished criminal ought to have for the criminal less fortunate than himself upon whom the penalty has fallen. Is that not so?"
|Who's On Your Reading List?
Read Classic Books Online for Free at
Page by Page Books.TM
|Damaged Goods
Upton Sinclair
Home | More Books | About Us | Copyright 2004

subset: commoncrawl


text:
UK news this week features a report about the City of London police designating members of the Occupy Movement as 'domestic terrorists', a label that groups them with the likes of al-Qa'ida and other 'terrorist' groups (see footnote).
The move has come under criticism from various quarters who are possibly worried that the designation potentially means that now, as with other what are labelled terrorist groups and/or individuals, movement members can be snatched off the streets, detained indefinitely without access to legal advice, tortured, et cetera, et cetera.
The following is some little known information from a variety of sources that puts the move in the context of what Arundhuti Roy would call 'the beast' that the movement is confronting.
The late Henk Ruyssenaars, an independent journalist with a keen eye for the behind-the-scenes dealings of those he acerbically labelled 'global crooks' drew attention to the book "Descent into Slavery" by Des Griffin in which the real meaning of the term "City of London" is explained. The following is an excerpt from that article.
"To the majority of people the words "Crown" and "City" in reference to London refer to the queen or the capital of England.
This is not the truth. The "City" is in fact a privately owned Corporation – or Sovereign State – occupying an irregular rectangle of 677 acres and located right in the heart of the 610 square mile 'Greater London' area. The population of 'The City' is listed at just over four thousand, whereas the population of 'Greater London' (32 boroughs) is approximately seven and a half million.
"The Crown" is a committee of twelve to fourteen men who rule the independent sovereign state known as London or 'The City.' 'The City' is not part of England. It is not subject to the Sovereign. It is not under the rule of the British parliament. Like the Vatican in Rome, it is a separate, independent state.
"The City", which is often called "the wealthiest square mile on earth," is ruled over by a Lord Mayor. Here are grouped together Britain's great financial and commercial institutions: Wealthy banks, dominated by the privately-owned (Rothschild controlled) Bank of England, Lloyd's of London, the London Stock Exchange, and the offices of most of the leading international trading concerns. Here, also, is located Fleet Street, the heart and core of the newspaper and publishing worlds.
The Lord Mayor, who is elected for a one year stint, is the monarch in the City. As Aubrey Menen says in "London", Time-Life, 1976, p. 16:
"The relation of this monarch of the City to the monarch of the realm [Queen] is curious and tells much."
It certainly is and certainly does!
When the Queen of England goes to visit the City she is met by the Lord Mayor at Temple Bar, the symbolic gate of the City. She bows and asks for permission to enter his private, sovereign State. During such State visits
"the Lord Mayor in his robes and chain, and his entourage in medieval costume, outshines the royal party, which can dress up no further than service uniforms."
The Lord Mayor leads the queen into his city.
The symbolism is clear. The Lord Mayor is the monarch. The Queen is his subject.
The small clique who rule the City dictate to the British Parliament. It tells them what to do, and when. In theory Britain is ruled by a Prime Minister and a Cabinet of close advisers. These 'fronts' go to great lengths to create the impression that they are running the show but, in reality, they are mere puppets whose strings are pulled by the shadowy characters who dominate behind the scenes. As the former British Prime Minister of England during the late 1800s Benjamin D'Israeli wrote:
"So you see… the world is governed by very different personages from what is imagined by those who are not behind the scenes"
(Coningsby, The Century Co., N.Y., 1907, p. 233).
This fact is further demonstrated by another passage from Menen's book:
"The Prime Minister, a busy politician, is not expected to understand the mysteries of high finance, while the Chancellor of the Exchequer is only expected to understand them when he introduces the budget. Both are advised by the permanenet officials of the Treasury, and these listen to the City. If they suspect that some policy of the government will back-fire, it is of no use their calling up British ambassadors to ask if it is so; they can find out more quickly from the City. As one ambassador said: "Diplomats are nowadays no more than office boys, and slow ones at that. The City will know. They will tell the Treasury and the Treasury will tell the Prime Minister."
Woe betide him if he does not listen. The most striking instance of this happened in recent history. In 1956 the then Prime Minister, Sir Anthony Eden… launched a war to regain the Suez Canal. It had scarcely begun when the City let it be known that in a few days he would have no more money to fight it; the Pound would collapse. He stopped the war and was turned out of office by his party. When the Prime Minister rises to address the Lord Mayor's banquet, he hopes that the City will put more behind him than the gold plate lavishly displayed on the sideboards."
The British government is the bond slave of the "invisible and inaudible" force centred in the City. The City calls the tune. The "visible and audible leaders" are mere puppets who dance to that tune on command. They have no power. They have no authority. In spite of the outward show they are mere pawns in the game being played by the financial elite.
It is important to recognise the fact that two separate empires were operating under the guise of the British Empire. One was the Crown Empire and the other the British Empire.
The colonial possessions that were white were under the sovereign – i.e. under the authority of the British government. Such nations as the Union of South Africa, Australia, New Zealand and Canada were governed under British law. These only represented thirteen percent of the people who made up the inhabitants of the Britsh Empire.
All the other parts of the British Empire – nations like India, Egypt, Bermuda, Malta, Cyprus and colonies in Central Africa, Singapore, Hong Kong and Gibraltar were all Crown Colonies. These were not under British rule. The British parliament had no authority over them.
As the Crown owned the committee known as the British government there was no problem getting the British taxpayer to pay for naval and military forces to maintain the Crown's supremacy in these areas.
The City reaped fantastic profits from its operations conducted under the protection of the British armed forces. This wasn't British commerce and British wealth. The international bankers, prosperous merchants and those members of the aristocracy who were part of the "City" machine accumulated vast fortunes .
About seventy years ago Vincent Cartwright Vickers stated that :
…."financiers in reality took upon themselves, perhaps not the responsibility, but certainly the power of controlling the markets of the world and therefore the numerous relationships between one nation and another, involving international friendship and mistrusts… Loans to foreign countries are organised and arranged by the City of London with no thought whatsoever of the nation's welfare but solely in order to increase indebtedness upon which the City thrives and grows rich…"
In "Empire of the City" E. C. Knuth said:
" This national and mainly international dictatorship of money which plays off one country against another and which, through ownership of a large portion of the press converts the advertisement of its own private opinion into a semblance of general public opinion, cannot for much longer be permitted to render Democratic Government a mere nickname. Today we see through a glass darkly: for there is so much which it would not be in the public interest to divulge."…
The battle for power and riches is an ancient one, but any attempt to make sense of the present world situation where the bulk of humanity is being herded like sheep into a corral without some knowledge of history is a difficult if not impossible task.
At present names have been replaced by groups, capitalists, republicans, democrats, terrorists, corporations, NATO, UNO, NAFTA, EMI, ECB, ASEAN. Names that are spewed out like confetti in an endless list of anonymity.
In spite of modern technology the figures in the background remain blurred.
I mentioned al-Qa'ida in the context of terrorist organisations, referring to the 'official' rhetoric view. In my, and some other researchers opinion al-Qa'ida, like Black Bloc, is a way of working, not an actual organisation or group.
Filed under: Resistance | Tagged: #Occupy London, City of London, OLSX |


text:
Superior Police Looking for Volunteers to Help With National Night Out Gatherings in your Neighborhood
"National Night Out" is August 6th, and the Superior Police Department is looking for volunteers to help with gatherings in your neighborhood.
"National Night Out" is an event that promotes neighborhood unity, safety, and helps community awareness. It's a good chance for you to get to know your neighbors and talk about what is going on in your neighborhood.
If you'd like to be a part of a gathering in your community, call Officer Bonnie Beste 715-395-7401


text:
You ought to in all probability *drink one thing like cranberry juice, ginger ale, or gatorade.
-Cranberry juice may help overpower different tastes in a single's mouth
-Ginger ale supposedly helps nauseated stomachs
-Gatorade typically clears sinuses for some folks.
*Note: If the best way you threw up was painful or extraordinarily violent, i.e. you threw up for greater than ten minutes, then DO NOT drink OR eat ANYTHING. You could be very sick and even consuming water may make you vomit once more. And should you noticed darkish crimson blood (or blood in any respect really) in your vomit, go see a doctor as quickly as attainable. Like inside the subsequent couple of hours.


text:
Steve Wariner's emotional "Holes in the Floor of Heaven" has become his signature song, winning him awards for singing and composing, and it also is often played on the radio during times of tragedy. But it hasn't been totally without a downside for Wariner.
When Capitol Records tried to follow it with a couple of newer singles, "Holes" kept them both from getting anywhere because radio people "let us know real quickly, `Hey, we're not finished playing this one yet,' " Wariner recalls. Then as he worked on his next album, Capitol executives kept telling him, "We need another `Holes.' "


text:
Ath-le-brities All OverNovember 14, 2009
Ath∙le∙brity – (1) one that plays collegiate or professional sports while capitalizing on the media's coverage of the team and his/her performance for personal benefit (2) Chad Ochocinco (3) Terrell Owens
We might as well define the term that seems to pervade our sports world these days. From the Falcon's tight end Tony Gonzalez posing nude with his wife in a PETA ad, to the Bengal's Ochocinco promising a shipment of mustard to the rival Pittsburgh Steelers because they can't "ketchup" to the Bengals in the standings, the gimmicks of professional athletes are officially a bit over the top.
It wasn't that long ago when we thought a Terrell Owens touchdown celebration was a bit much. Now, it seems more and more athletes are using the media outlets, and opportunities around them, to capitalize on their fame. Why else would we care about mentioning a naked man in a PETA ad, much less a shipment of mustard?
While society continues to progress, and technology continues to bring us closer and closer to the athletes we love, sometimes we should take a line out of the movie Angels in the Outfiel d and state "Less is more, Ranch, less is more."
It's true that media methods are changing these days. Just recently ESPN.com's No. 1 college basketball recruit Harrison Barnes (Ames, IA) committed to North Carolina via Skype with head coach Roy Williams. I guess it only makes sense that the same tool we get all of our sporting information, YouTube videos, and access to our favorite teams is the same tool being chosen by the actual recruit himself.
Athletes are certainly recognizable in the general public these days, thus resulting in their celebrity status. You think Florida quarterback Tim Tebow can enjoy a nice pizza at the local parlor in Gainesville without getting hounded by autograph seekers? Forget about it.
My only question is, when is enough…enough? Shouldn't athletes be a little more concerned about their game and team rather than coming up with the next buzz topic on sports radio and blogs? Ochocinco gets paid $3,550,000 to practice at most 3-4 hours per day, and play football on Sundays. In essence, he's a product of our own making, because we can't seem to get enough of sports these days.
Don't misunderstand me; it's not the athlete's fault. Who in their right mind wouldn't want to be an Athlebrity? More attention equals more money over the long run, and more attention also fills stadiums and boosts television ratings. I just find it somewhat disappointing that many professional and college games are preceded by WWE-like talking by players and coaches in the media.
And all of the talking before games? Again, a product of our own making. It's intriguing that a few words in the media from our favorite Athlebrities make us want to tune into the big game in the same way we wanted to witness a showdown slugfest at recess in grammar school. We reward talk.
Sometimes Athlebrities' talk to each other ,and what they hear from their influences comes back to haunt them. Take for example Texas Tech head football coach Mike Leach's latest interview after a recent loss to Texas A&M. In his post-game interview with the media Leach said that the players needed to stop listening to their "fat little girlfriends", and instead heed the advice his coaching staff (the interview itself is of a complex nature especially considering that Leach is an Athlebrity himself among college football head coaches for his hilarious interviews with the media).
While Leach may have a point about his team, the truth is that Athlebrities will only become even more commonplace in the sports media if the current trends continue. If you want to continue to hear their ridiculousness in the daily news, buy their jersey and support their cause. If you care enough about Gonzalez's nude body, go picket for PETA (or do whatever else you can do to support their cause). As for me though, I think I'll just watch my favorite athletes on the field and leave it at that.


text:
Statistics for occurrence #1 of "Major Cook" in chapter 112, page 456 of Rebellion Record: a Diary of American Events: Documents and Narratives, Volume 8.:
...own and take possession of all the roads leading, therefrom, in order to gobble up any persons that might attempt to escape, and also to reconnoitre and ascertain what was going on in the vicinity. Major Cook , with a detachment of the First Mississippi cavalry, went out on the Benton road, leading west from Yazoo City. When out about six miles, he came upon what he supposed to be a small scouting party,...
|Max. Freq.
|Min. Freq.
† This entity has been selected by the automated classifier as the most likely match in this context. It may or may not be the correct match.


text:
MOSCOW, October 3 (Itar-Tass) - The fire broke out, according to updated reports, at the building housing the Moscow district authorities attached to Sovetskaya Hotel, but not at the hotel on Leningradsky Avenue in central Moscow on Thursday. The fire area makes up to 150 square metres, the press service of the Moscow emergency situation department told Itar-Tass.
"The fire broke out at the building housing the Begovaya district authorities that is attached to Sovetskaya Hotel. Fifteen fire brigades are fighting the fire, no injured people were reported," the emergencies department said.
The traffic on Leningradsky Avenue near the apartment block number 30 in the direction of Moscow Region is strongly complicated.


text:
Carvedilol Inhibits Clinical Progression in Patients With Mild Symptoms of Heart Failure
Jump to
Background We tested the hypothesis that carvedilol inhibits clinical progression in patients with mildly symptomatic heart failure due to left ventricular (LV) systolic dysfunction.
Methods and Results Patients (n=366) who had mildly symptomatic heart failure with an LV ejection fraction (LVEF) ≤0.35, had minimal functional impairment (defined as the ability to walk 450 to 550 m on a 6-minute walk test), and were receiving optimal standard therapy, including ACE inhibitors, were randomized double-blind to carvedilol (n=232) or placebo (n=134) and followed up for 12 months. The primary end point was clinical progression, defined as death due to heart failure, hospitalization for heart failure, or a sustained increase in heart failure medications. Clinical progression of heart failure occurred in 21% of placebo patients and 11% of carvedilol patients, reflecting a 48% (P=.008) reduction in the primary end point of heart failure progression (relative risk, 0.52; CI, 0.32 to 0.85). This effect of carvedilol was not influenced by sex, age, race, cause of heart failure, or baseline LVEF. Carvedilol also significantly improved several secondary end points, including LVEF, heart failure score, NYHA functional class, and the physician and patient global assessments. Carvedilol reduced all-cause mortality but had no effects on the Minnesota Living With Heart Failure scale, the distance walked in 9 minutes on a self-powered treadmill, or cardiothoracic index. The drug was well tolerated.
Conclusions Carvedilol, when added to standard therapy, including an ACE inhibitor, reduces clinical progression in patients who are only mildly symptomatic with well-compensated heart failure.
Most trials in patients with heart failure have focused on patients with moderate and severe symptoms who demonstrate continued disability and limitations despite the use of optimal medical therapy. In such patients, the relief of symptoms and improvement in the quality of life is an important goal of therapy. However, the majority of patients with heart failure have only mild symptoms and respond well to medical therapy. These patients manifest little disability and few limitations and therefore are generally not considered candidates for additional treatment. Yet, patients with mild symptoms (eg, NYHA functional class II) remain at risk for clinical progression, despite optimal use of available medications.1
One of the most important mechanisms that may be responsible for progression of heart failure is activation of the sympathetic nervous system.2 3 4 5 This neurohormonal system is activated early in the disease and is the principal system activated in patients with mild symptoms.6 This observation suggests that drugs that interfere with the actions of the sympathetic nervous system in heart failure (eg, β-blockers) may reduce the risk of disease progression in patients with only mild symptoms. However, previous studies of β-blockers in heart failure have focused on patients with established symptoms with the intent of improving symptoms and the quality of life.7 8 9 10 11 12 No study has been specifically designed to determine whether β-blockers can prevent disease progression in patients with mild symptoms who are responding adequately to medical therapy.
Consequently, when the US Carvedilol Heart Failure Program was being developed to evaluate the effects of the β-blocker carvedilol, one of the four component trials was specifically designed to test the hypothesis that long-term treatment with this drug inhibits clinical progression in patients with mild symptoms of heart failure and minimal functional limitation on standard therapy consisting of an ACE inhibitor, diuretics, and digitalis. The study reported here is thus one of four prospectively designed trials that shared a common screening procedure but otherwise were independent with regard to their study populations and primary end points.
Carvedilol is a nonselective β-adrenergic receptor antagonist that also blocks α1-adrenergic receptors and is a potent antioxidant.13 14 Previous studies have demonstrated that carvedilol can improve the clinical status of patients with symptoms of heart failure that had not responded adequately to medical therapy,15 16 17 18 but these studies did not address the potential utility of the drug in clinically stable, well-compensated patients.
Study Population
Patients 18 to 85 years old with chronic symptomatic heart failure, defined as dyspnea or fatigue at rest or on exertion for ≥3 months, and a left ventricular ejection fraction (LVEF) ≤0.35 by radionuclide ventriculography were enrolled at 54 centers across the United States. Symptoms had to be present for at least 2 months despite treatment with diuretics and an ACE inhibitor (if tolerated). Treatment with digoxin, hydralazine, and nitrates was allowed but not required. During the 1 month before study enrollment, there could be no change in NYHA class, no change in medications or dosages, and no hospitalization for heart failure.
Patients were excluded if any of the following were present: uncorrected primary valvular disease or nondilated or hypertrophic cardiomyopathy; symptomatic or sustained ventricular tachycardia not controlled by antiarrhythmic agents or an implantable defibrillator within the previous 3 months; a myocardial infarction, unstable angina, or coronary artery bypass graft surgery within the previous 3 months; the likelihood of percutaneous transluminal angioplasty, coronary artery bypass graft surgery, or heart transplantation within 12 months; sick sinus syndrome or second- or third-degree heart block unless treated with a non–fixed-rate pacemaker; any condition other than symptomatic heart failure that could limit exercise, such as peripheral vascular disease, pulmonary disease, angina, cor pulmonale, or arthritic, orthopedic, or neurological conditions; a sitting systolic blood pressure <85 mm Hg or uncontrolled hypertension (systolic blood pressure >160 mm Hg or diastolic blood pressure >100 mm Hg); clinically significant hepatic or renal disease; or any illness or disorder that could preclude participation or limit survival. Women with heart failure in the 12 months after childbirth were excluded. Patients treated with any of the following drugs within the 2 weeks before screening were excluded: disopyramide, flecainide, encainide, moricizine, propafenone, sotalol, calcium channel blockers, α-adrenergic blockers, β-adrenergic blockers, labetalol, flosequinan, and monoamine oxidase inhibitors. Patients treated with amiodarone within 3 months before screening were excluded. The study was approved by the institutional review board of each investigative site, and all the patients provided written informed consent.
Study Procedures
Eligibility was determined during a 3-week screening phase during which inclusion and exclusion criteria were determined, and enrollment was stratified by use of a 6-minute corridor walk test.19 Initially, patients who walked between 425 and 550 m were entered into the trial, and patients who walked <425 m were entered into other protocols.20 21 22 Early in the trial (after ≈9% of patients were entered), the lower cutoff point for walk distance was increased to 450 m. During the screening period, the LVEF was measured by radionuclide ventriculography, the NYHA functional classification was determined, quality of life was assessed by the Minnesota Living With Heart Failure Questionnaire,23 and the distance walked in 9 minutes on a self-powered treadmill24 was measured. Heart failure symptoms were quantified by use of a symptom score that was determined by patients' answers to seven questions that ranked the severity of their heart failure symptoms and level of well-being on a scale of 0 to 3.16
Screening was followed by a 2-week challenge phase during which patients received open-label carvedilol (6.25 mg BID). The challenge dosage could be reduced to 3.125 mg BID if the 6.25-mg dosage was not tolerated. Patients who tolerated a carvedilol dosage of 6.25 mg BID during the challenge phase were randomized in a 2:1 ratio of carvedilol to placebo and underwent a 2- to 6-week double-blind up-titration phase, beginning at 12.5 mg BID and proceeding in weekly steps to either the maximum tolerated dosage or the maximum dosage allowed by the protocol (25 mg BID for patients weighing <85 kg; 50 mg BID for heavier patients). Patients then entered a maintenance phase and continued on the established dosage for an additional 12 months. Patients were seen monthly for the first 4 months and then at 6, 9, and 12 months. During the maintenance phase, background therapy of heart failure medications was held constant whenever possible. However, if adverse events occurred, concomitant drug dosages could be adjusted. At each visit, body weight and NYHA classification were ascertained, and the heart failure symptom self-assessment and global patient and physician assessments were performed. At 6 and 12 months, LVEF, quality of life, and 9-minute self-powered treadmill assessments were completed.
The study was terminated early by the Executive Committee on the recommendation of the Data Safety Monitoring Board on the basis of the finding that in the overall trial program, a survival advantage was demonstrated by the patients receiving carvedilol.
Statistical Analysis
The primary end point, progression of heart failure, was defined as (1) death due to heart failure, (2) hospitalization for heart failure (as indicated by investigators on the case report forms), or (3) the need for a sustained increase in heart failure medications. An increase in heart failure medications was defined as a 50% increase in the dosage of diuretic, ACE inhibitor, or vasodilator or the addition of a new class of heart failure medications that was sustained for at least 30 days. The components of the primary end point were scored in a hierarchical order (death took precedence over hospitalization, hospitalization took precedence over an increase in medications) so that patients with more than one of the end points were counted only once. The secondary end points, as specified in the original protocol, were LVEF, NYHA functional class, heart failure score, physician and patient global assessments, quality-of-life assessment, distance walked in the 9-minute self-powered treadmill test, and heart size on chest radiograph. The power calculation for the study was based on the assumption that 25% of the patients in the placebo group would meet the criteria for worsening heart failure and that carvedilol would reduce this risk by 50%.
The analysis of the primary end point was performed on an intention-to-treat basis. The proportion of patients with worsening heart failure was analyzed by the Cochran-Mantel-Haenszel procedure25 stratified by center. All-cause mortality was summarized by treatment group on an intention-to-treat basis by construction of Kaplan-Meier curves for each group and comparison of the distribution of the groups by a log-rank test. The progression of heart failure was also summarized by Kaplan-Meier curves. The analyses of the secondary end points were performed on a per-protocol basis with the last observation carried forward. When the protocol was terminated, the 12-month evaluation was performed whenever possible on patients who had not completed the trial. The change from baseline for all continuous variables was analyzed by an ANOVA that included the effects of study center, treatment group, and their interaction.
Patient Characteristics
At the time of study termination, 389 patients had received at least one challenge dose of carvedilol. Of these, 366 patients completed the challenge phase and were randomized to placebo (n=134) or carvedilol (n=232). The two groups were balanced with regard to age, sex, race, cause of heart failure, duration of heart failure, NYHA functional class, and LVEF (Table 1⇓). The large majority of patients (84%, placebo; 86%, carvedilol) were in NYHA functional class II, reflecting the entry requirement that they be able to walk 450 to 550 m in a 6-minute walk test. The 6-minute walk distance was similar in the two groups. Essentially all patients in both groups were receiving an ACE inhibitor (98% overall), and the large majority were receiving digitalis (89% overall) and a loop-active diuretic (92% overall).
Patient Disposition
Of the 389 patients who entered the open-blind challenge phase, 23 (5.9%) did not complete this phase. One patient died of worsening heart failure, 2 other patients had worsening of heart failure, and 13 had an adverse experience other than worsening heart failure, most often dizziness or hypotension. The other reasons for not completing the challenge phase were protocol deviation (2 patients), being lost to follow-up (2 patients), and early termination of the study (3 patients).
Of the 366 patients who entered the double-blind phase, 89.6% of placebo and 92.7% of carvedilol patients were still receiving double-blind medication at the time the study was terminated. The mean and median follow-up periods were 213 and 209 days, respectively. Of the 189 carvedilol patients who completed the up-titration phase, 85% achieved their target dosage of 25 mg BID (or 50 mg BID for patients weighing ≥85 kg). During the double-blind up-titration period, 19.6% of placebo patients and 17.4% of carvedilol patients required an increase in dosage or the addition of a heart failure medication.
Progression of Heart Failure
Clinical progression of heart failure occurred in 20.9% (28/134) of placebo patients and 11% (25/232) of carvedilol patients, reflecting a 48% (P=.008) reduction in the primary end point (Fig 1⇓). The relative risk of heart failure progression was 0.52 (CI, 0.32 to 0.85). The reduction in the overall progression of heart failure end point was paralleled by similar reductions in each of the component end points. No deaths in the carvedilol group were attributed to heart failure, whereas 4 placebo patients (3%) died of heart failure (sudden death, 2; pump failure, 2). Hospitalization for worsening heart failure occurred less often in carvedilol patients (4%, 9/232) than placebo patients (6%, 8/134). Likewise, the need to increase heart failure medications occurred less often in carvedilol patients (6.9%, 16/232) than placebo patients (11.9%, 16/134). The most common increases in heart failure medications were as follows. Diuretics were increased or added in 6% of placebo patients and 5.8% of carvedilol patients; the dosage of ACE inhibitor was increased in 4.5% of placebo patients but no carvedilol patients; other vasodilators were increased or added in 1.5% of placebo patients and 1.3% of carvedilol patients. The beneficial effect of carvedilol continued to be significant even if the increase in heart failure medication component was removed from the analysis (P=.049).
Kaplan-Meier analysis demonstrated that the beneficial effect of carvedilol was evident early in therapy (after ≈50 days) and increased gradually to the end of the trial (Fig 2⇓). The beneficial effect of carvedilol on the progression of heart failure was not affected by sex, age, race, cause of heart failure, or LVEF (Table 2⇓).
All-Cause Mortality
Analyzed on an intention-to-treat basis, 4.0% (5/134) of placebo patients and 0.9% (2/232) of carvedilol patients died during double-blind therapy (risk ratio, 0.231; CI, 0.045 to 1.174; P=.048). Three placebo patients and one carvedilol patient underwent cardiac transplantation and were censored from the data.
Functional Classification
From baseline to the study end point, the NYHA functional class improved in 12% of carvedilol patients versus 9% of placebo patients, whereas it worsened in 4% of carvedilol patients versus 15% of placebo patients (Table 3⇓). The distribution of the changes in NYHA functional classes from baseline to study end point was more favorable in carvedilol than in placebo patients (P=.003).
Heart Failure Symptom Score
Changes in the heart failure symptom score over the course of the trial differed directionally in the treatment groups (Table 3⇑). The symptom score worsened in placebo patients but improved in carvedilol patients (P=.006).
Patient and Physician Global Assessments
Throughout the study, more carvedilol patients than placebo patients rated their heart failure symptoms as improved (Table 3⇑). The difference between carvedilol and placebo was significant at the study end point (P=.013). Likewise, the physician global assessment indicated a greater improvement in carvedilol than placebo patients from baseline to study end point (P<.001). Importantly, for both the patient and physician assessments, the percentage of patients rated as worse was less in the carvedilol group.
Quality of Life
All scores (total, physical, and emotional dimensions) on the Minnesota Living With Heart Failure Questionnaire at study end point improved more in carvedilol than in placebo patients, but none of these differences reached statistical significance (Table 3⇑).
Ejection Fraction
The LVEF was available at 12 months or the time of study termination in 266 patients. At baseline, the mean LVEF was similar in the placebo (0.22) and carvedilol (0.22) patients. The mean change in LVEF was larger in carvedilol (0.10) than in placebo (0.03) patients (P<.001) (Fig 3⇓).
Nine-Minute Self-Powered Treadmill
The distances walked in 9 minutes on the self-powered treadmill decreased slightly from baseline to study end point in both placebo and carvedilol patients but did not differ between the treatment groups.
Heart Size
There were no changes in the cardiothoracic index in either group.
Adverse Experiences
The most common adverse experiences during all phases of the trial were dizziness, fatigue, dyspnea, and heart failure. During the open-label challenge phase, dizziness, fatigue, and dyspnea occurred in 15%, 12%, and 12% of patients, respectively. The other most common adverse experiences during the challenge phase were chest pain (7%), diarrhea (5%), headache (5%), hypotension (5%), nausea (5%), cardiac failure (4%), and weight increase (4%).
The most frequent adverse experiences during the double-blind up-titration and maintenance phases are shown in Table 4⇓. Adverse experiences were the reason for withdrawal in similar proportions of placebo (5%) and carvedilol (5%) patients (Table 5⇓). The most frequent adverse experiences leading to withdrawal during the double-blind up-titration and maintenance phases were heart failure and fatigue, both of which were more common in the placebo group.
The major new finding of this study is that therapy with carvedilol reduced the clinical progression of heart failure in patients who were only mildly symptomatic. We prospectively defined clinical progression as the occurrence of death due to heart failure, hospitalization for heart failure, or the need for a sustained increase in heart failure medications. Carvedilol treatment reduced the occurrence of clinical progression, so defined, from 21% to 11%, a decrease of 48%. The beneficial effect of carvedilol on clinical progression was independent of patient age, sex, or race, cause of heart failure, and baseline LVEF. In addition, the beneficial effect of carvedilol remained significant even if the medication change component was removed from the analysis.
The individual components of this composite primary end point were assessed in a hierarchical order, so that only the most serious end point was counted for each patient. Thus, the occurrence of death took priority over the need for hospitalization, which in turn took priority over the need to increase heart failure medications on an outpatient basis. Carvedilol caused parallel reductions in all three components of the primary end point: death due to heart failure, hospitalization for heart failure, and the need to increase heart failure medications. Thus, the beneficial effect of carvedilol was due to comparable effects on three measures of clinical disease progression. This congruence of the individual components of the composite end point adds credence to the conclusion that carvedilol exerted an overall beneficial effect on disease progression.
Although the number of patients who died was small and does not allow conclusions about the effect of carvedilol on mortality in this study, the reductions in mortality due to heart failure and all-cause mortality are qualitatively and quantitatively consistent with the effect of carvedilol observed in the 1094 patients enrolled in the overall stratified trial program.20 21 22 26 This observation provides evidence that the improvement in the other components of the composite primary end point and secondary end points (eg, LVEF, symptoms) did not occur at the expense of an adverse effect on survival.
Many but not all of the secondary end points were improved by carvedilol treatment. Consistent with observations in several earlier studies,15 16 17 18 carvedilol increased the LVEF. The magnitude of this effect, an average increase of 10%, is comparable to that observed with carvedilol and other β-blockers in more symptomatic populations.15 16 17 18 20 21 22 Carvedilol improved several measures of clinical status, including NYHA functional classification, heart failure symptom score, and both patient and physician global assessments. The congruence of these distinct measures of clinical status strongly supports the conclusion that carvedilol exerted a beneficial effect on clinical symptoms. Perhaps most important, for each of these clinical measures, carvedilol reduced the number of patients who were rated as worse over the course of the study. This finding further suggests that carvedilol reduced the progression of clinical heart failure.
The quality of life, as assessed by the Minnesota Living With Heart Failure Questionnaire, showed small improvements that favored the carvedilol patients, but these did not achieve statistical significance. Given the consistent improvements in several other measures of clinical status, the reason for the failure to detect a treatment effect on quality of life is not clear. It is possible that because of the mild functional limitation of this study population, baseline quality of life was relatively good and therefore difficult to improve. The premature termination of this study may have contributed as well by limiting both the numbers of patients available for analysis and the duration of treatment. When a β-blocker is used in patients with heart failure, the first several weeks of therapy may be associated with adverse experiences (eg, dizziness) that often subside and do not preclude a good long-term outcome.27 Since the benefits of these agents (eg, increase in LVEF) may require months to become manifest,28 29 patients followed for only a few weeks may not have sufficient time to experience an improvement in quality of life.
Two other objective end points, exercise duration on the self-powered treadmill and cardiothoracic index, were not improved. Although the 9-minute self-powered treadmill test was initially viewed as a measure of submaximal exercise capacity, it is now apparent that this test often results in a maximal effort in patients with heart failure.30 It is therefore not surprising that it was unable to detect a treatment effect of carvedilol, since heart rate response to exercise, an important determinant of maximal exercise capacity, is reduced by β-adrenergic antagonists. The lack of change in the cardiothoracic index suggests that there was not a marked change in heart size.
Carvedilol therapy was well tolerated in this population. Of the patients randomized to carvedilol, the major adverse effects were related to β-adrenergic blockade and/or α-adrenergic blockade and included hypotension, bradycardia, and dizziness. Approximately 4% of patients did not tolerate carvedilol during the open-label challenge phase. Therefore, the results of this study do not reflect patients who were not able to tolerate a low challenge dose of the drug. During the subsequent double-blind up-titration and maintenance phases, these effects were generally mild, were manageable by adjustment of the medical regimen, and did not necessitate withdrawal from the study. Thus, patients who tolerate a challenge dose of carvedilol have a high likelihood of being successfully initiated on the drug. However, it is important to emphasize that in this study, carvedilol was administered under highly controlled conditions by a relatively small number of experienced heart failure investigators. By design, patients were seen frequently during the initiation of therapy, close attention was paid to any deterioration in heart failure signs and symptoms, and appropriate adjustments in the medical regimen were made quickly.
A potential limitation of this study is that events during the open-label challenge period were not included in the primary end-point analysis. During this period, 1 patient died of heart failure and 3 were hospitalized for heart failure. However, even when a worst-case analysis was performed and all events occurring during the run-in period were assigned to carvedilol, treatment with the drug was still associated with a significant reduction in the risk of the primary end point (P=.002).
In summary, this study demonstrates that carvedilol, used in conjunction with digitalis, diuretics, and an ACE inhibitor, reduces the clinical progression of heart failure in patients with mildly symptomatic heart failure. The ability of carvedilol to reduce the progression of clinical heart failure in patients receiving an ACE inhibitor suggests that this drug may play an important part in the therapeutic regimen of patients with mild heart failure.
The following investigators and institutions participated in this trial.
Kirkwood A. Adams, Chapel Hill, NC (University of North Carolina); John A. Bowers, Las Vegas, Nev (Heart Institute of Nevada); Michael R. Bristow, Denver, Colo (University of Colorado Health Sciences Center); Edward Brown, Israel Freeman, East Meadow, NY (Nassau County Medical Center); Samuel Butman, Tucson, Ariz (University Medical Center); William Carlson, Boston, Mass (Harvard Community Health Plan); Wilson S. Colucci, Evan Loh, Boston, Mass (Brigham and Women's Hospital); Robert Cody, Columbus, Ohio (Ohio State University Hospital); G. William Dec, Boston, Mass (Massachusetts General Hospital); Eduardo deMarchena, Miami, Fla (University of Miami); Vincent DeQuattro, Los Angeles, Calif (University of Southern California School of Medicine); Eric Eichhorn, Dallas, Tex (Dallas Veterans Administration Medical Center); Salah Eddin El Hafi, Houston, Tex; Rodney Falk, Boston, Mass (Boston City Hospital); Michael B. Fowler, Stanford, Calif (Stanford University Cardiovascular Medicine); E. Michael Gilbert, Salt Lake City, Utah (University of Utah); Alan Gradman, Pittsburgh, Pa (Western Pennsylvania Hospital); John J. Gregory, Summit, NJ (Overlook Hospital); Ray Hershberger, Portland, Ore (Oregon Health Sciences); Robert Hobbs, Cleveland, Ohio (Cleveland Clinic–South); Henry Ingersoll, San Diego, Calif (Sharp Rees-Stealy Medical Group Center); Frederic Kahl, Winston-Salem, NC (Bowman-Gray School of Medicine); Niki Kantrowitz, Elmhurst, NY (Elmhurst Hospital Center); Ronald Karlsberg, Beverly Hills, Calif; Edward Kasper, Arthur M. Feldman, Baltimore, Md (The Johns Hopkins Hospital); Joseph Kiernan, John O'Brien, Peter E. Carson, Falls Church, Va (INOVA Health System Institute of Research and Education); Vithal Kinhal, Gross Point Farm, Mich (Pierson Clinic); Marc Klapholz, New York, NY (St Luke's Hospital); Steven Krueger, Lincoln, Neb (Nebraska Heart Institute); Spencer H. Kubo, Jay N. Cohn, Minneapolis, Minn (University of Minnesota Medical School); Thierry LeJemtel, Bronx, NY (Albert Einstein College of Medicine); Forrester Lee, New Haven, Conn (Yale School of Medicine); Chang-Seng Liang, Rochester, NY (University of Rochester Medical Center); Andrew J. Lonigro, Henry Stratmann, St Louis, Mo (St Louis University Medical Center School of Medicine); George Mallis, Northport, NY (Northport Veterans Administration); Barrie Massie, San Francisco, Calif (Veterans Administration Medical Center); Henry Meilman, David Goldscher, Baltimore, Md (Bay Cardiovascular Associates Union Memorial Hospital); Leslie W. Miller, Stephen H. Jennison, St Louis, Mo (St Louis University); Kenneth A. Narahara, Torrance, Calif (Harbor-UCLA Medical Center); Gerald Neuberg, Milton Packer, New York, NY (Columbia Presbyterian Medical Center); John O'Connell, Jackson, Miss (University of Mississippi Medical); Lyle James Olson, Rochester, Minn (Mayo Medical School); Ilena Pina, Philadelphia, Pa (Temple University); Peter S. Rahko, Madison, Wis (University of Wisconsin); Richard P. Sorkin, Park Ridge, Ill (Lutheran General Hospital); Richard Steingart, Mineola, NY (Winthrop University Hospital); Udho Thadani, Oklahoma City, Okla (University of Oklahoma); James E. Udelson, Boston, Mass (New England Medical Center); Barry Uretsky, Pittsburgh, Pa (Presbyterian University Hospital); George W. Vetrovec, Richmond, Va (Medical College of Virginia); John R. Wilson, Tiong-Keat Yeoh, Nashville, Tenn (Vanderbilt University Medical Center); Clyde W. Yancy, Dallas, Tex (University of Texas Southwestern Medical Center); Laurence Yellen, San Diego, Calif (Cardiology Associates Medical Group of East San Diego, Inc); and James Young, Houston, Tex (Baylor College of Medicine).
This study was supported by a grant from SmithKline Beecham Pharmaceuticals, King of Prussia, Pa, and Boehringer Mannheim Therapeutics, Mannheim, Germany.
Reprint requests to Dr Wilson S. Colucci, Cardiomyopathy Program, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118.
*The Carvedilol Heart Failure Study Group Investigators are listed in the "Appendix."
- Received August 5, 1996.
- Revision received October 7, 1996.
- Accepted October 7, 1996.
- Copyright © 1996 by American Heart Association
- ↵
- ↵
Francis GS, Goldsmith SR, Olivari MT, Levine TB, Cohn JN. The neurohormonal axis in congestive heart failure. Ann Intern Med.. 1984;101:370-377.
- ↵
- ↵
Colucci WS, Braunwald E. Pathophysiology of heart failure. In: Braunwald E, ed. Heart Disease. 5th ed. Philadelphia, Pa: WB Saunders Co; 1997:394-420.
- ↵
- ↵
Francis GS, Benedict C, Johnstone DE, Kirlin PC, Nicklas J, Liang CS, Kubo SH, Rudin-Toretsky E, Yusuf S. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. Circulation.. 1990;82:1724-1729.
- ↵
Woodley SL, Gilbert EM, Anderson JL, O'Connell JB, Deitchman D, Yanowitz FG, Renlund DG, Bristow MR. Beta-blockade with bucindolol in heart failure caused by ischemic versus idiopathic dilated cardiomyopathy. Circulation.. 1991;84:2426-2441.
- ↵
Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss FG, Hjalmarson A, for the Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet.. 1993;342:1441-1446.
- ↵
Fisher ML, Gottlieb SS, Plotnick GD, Greenberg NL, Patten RD, Bennett SK, Hamilton BP. Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial. J Am Coll Cardiol.. 1994;23:943-950.
- ↵
Eichhorn EJ, Heesch CM, Barnett JH, Alverez LG, Fass SM, Grayburn PA, Hatfield BA, Marcoux LG, Malloy CR. Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol.. 1994;24:1310-1320.
- ↵
CIBIS Investigators and Committees. A randomized trial of β-blockade in heart failure: the Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation.. 1994;90:1765-1773.
- ↵
- ↵
Ruffulo RR, Gelai M, Heible JP, Willette RN, Nichols AJ. The pharmacology of carvedilol. Eur J Clin Pharmacol. 1990;38(suppl 2):S82-S88.
- ↵
Yue T-L, Cheng H-Y, Lysko PG, McKenna PJ, Feuerstein R, Gu JL, Lysko KA, Davis LL, Feuerstein G. Carvedilol, a new vasodilator and beta-adrenoceptor antagonist, is an antioxidant and free radical scavenger. J Pharmacol Exp Ther.. 1992;263:92-98.
- ↵
Metra M, Nardi M, Giubbini R, Dei Cas L. Effects of short- and long-term carvedilol administration on rest and exercise hemodynamic variables, exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol.. 1994;24:1678-1687.
- ↵
Krum H, Sackner-Bernstein JD, Goldsmith R, Kukin ML, Schwartz B, Penn J, Medina N, Yushak M, Horn E, Katz SD, Levin H, Newberg GW, DeLong G, Packer M. Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in severe chronic heart failure. Circulation.. 1995;92:1499-1506.
- ↵
Olsen SL, Gilbert EM, Renlund DG, Taylor DO, Yanowitz FD, Bristow MR. Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study. J Am Coll Cardiol.. 1995;25:1225-1231.
- ↵
Australia-New Zealand Heart Failure Research Collaborative Group. Effects of carvedilol, a vasodilator–β-blocker, in patients with congestive heart failure due to ischemic heart disease. Circulation.. 1995;92:212-218.
- ↵
- ↵
Bristow MR, Gilbert EM, Abraham WT, Adams KF, Fowler MB, Hershberger R, Kubo SH, Narahara KA, Ingersoll H, Krueger S, Young S, Shusterman N, for the MOCHA Investigators. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation.. 1996;94:2807-2816.
- ↵
Packer M, Colucci WS, Sackner-Bernstein JD, Liang C, Goldscher DA, Freeman I, Kukin ML, Kinhal V, Udelson JE, Klapholz M, Gottlieb SS, Pearle D, Cody RJ, Gregory JJ, Kantrowitz NE, LeJemtel TH, Young ST, Lukas MA, Shusterman NH, and the PRECISE Study Group. Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure: the PRECISE Trial. Circulation.. 1996;94:000-000.
- ↵
Cohn JN, Fowler MB, Bristow MB, Colucci WS, Gilbert EM, Kinal V, et al. Effects of carvedilol in severe chronic heart failure. J Am Coll Cardiol. 1996;27(suppl A):169A. Abstract.
- ↵
Rector TS, Kubo SH, Cohn JN. Patients self-assessment of their congestive heart failure, pt 2: content, reliability and validity of a new measure, the Minnesota Living With Heart Failure Questionnaire. Heart Failure.. 1987;3:198-209.
- ↵
Sparrow J, Parameshar J, Poole-Wilson PA. Assessment of functional capacity in chronic heart failure: time-limited exercise on a self-powered treadmill. Br Heart J.. 1994;71:391-394.
- ↵
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst.. 1959;22:719-748.
- ↵
- ↵
Sackner-Bernstein J, Krum H, Goldsmith RL, Kukin ML, Medina N, Yushak M, Packer M. Should worsening heart failure early after initiation of beta-blocker therapy for heart failure preclude long-term treatment? Circulation. 1995;92(suppl I):I-395. Abstract.
- ↵
Waagstein F, Caidahl K, Wallentin I, Bergh C, Hjalmarson A. Long term β-blockade in dilated cardiomyopathy: effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol. Circulation.. 1989;80:551-563.
- ↵
- ↵
Hart DJ, Katz SD, Lee SH, Ahern D, DeLong G, Whelan J, Packer M, Goldsmith RG. Characterization of the 9-minute self-powered treadmill walk, a new submaximal exercise test in patients with heart failure. J Am Coll Cardiol.. 1994;23:384A. Abstract.
This Issue
Jump to
Article Tools
- Carvedilol Inhibits Clinical Progression in Patients With Mild Symptoms of Heart FailureWilson S. Colucci, Milton Packer, Michael R. Bristow, E. Michael Gilbert, Jay N. Cohn, Michael B. Fowler, Steven K. Krueger, Ray Hershberger, Barry F. Uretsky, John A. Bowers, Jonathan D. Sackner-Bernstein, Sarah T. Young, Terry L. Holcslaw and Mary Ann LukasCirculation. 1996;94:2800-2806, originally published December 1, 1996https://doi.org/10.1161/01.CIR.94.11.2800
Citation Manager Formats
Share this Article
- Carvedilol Inhibits Clinical Progression in Patients With Mild Symptoms of Heart FailureWilson S. Colucci, Milton Packer, Michael R. Bristow, E. Michael Gilbert, Jay N. Cohn, Michael B. Fowler, Steven K. Krueger, Ray Hershberger, Barry F. Uretsky, John A. Bowers, Jonathan D. Sackner-Bernstein, Sarah T. Young, Terry L. Holcslaw and Mary Ann LukasCirculation. 1996;94:2800-2806, originally published December 1, 1996https://doi.org/10.1161/01.CIR.94.11.2800


text:
- MrsM2010
- 8 years ago
- Wedding: July 2010
Hello. Maybe a stupid question here but here goes:
I just got the tote bag I'd ordered from Lands' End with my soon to be new monogram on it-I ~really~ like it-so cute saddle brown with satin pink stitching-anyways…. We're meeting with our officiant tonight to go over things with the ceremony and I was wondering if it would be in bad taste to go ahead and use the bag-I'll be needing to take a few things with me-notepads, pens, laptop, ipod touch so I ~will~ need something to carry all of that in but would it be a major faux pas to do so?
I'd also really like to be able to use it for a trip we're taking to go to my friend's convalidation-would make a great catch all for books etc.


text:
Product Availability: Mohawk Digital Fine Papers Portfolio
The Mohawk Digital Fine Papers Portfolio includes leading brands and grades engineered for maximum performance on today's state-of-the-art digital presses.
Mohawk's selection of premium digital papers is available in strategic sheet sizes suitable for a wide variety of digital equipment. The portfolio includes the combination of whites, colors, recycled grades, as well as numerous finishes including smooth, textured, and many others suitable for HP Indigo or Xerox iGen presses.
The following Mohawk digital fine paper grades are included in the portfolio:
- Mohawk Loop an environmental paper when sustainability is a concern.
- Mohawk Options featuring Mohawk's proprietary Inxwell treatment
- Mohawk Studio Collection featuring rich colors suitable for use with HP Indigo
- Mohawk Superfine known for its elegant smooth or eggshell digital printing surfaces.
- Mohawk Via an economical collection of premium textures and colors.
- Strathmore Writing one of the finest cotton stationery papers in the world.
- Mohawk Chromolux a high gloss choice for outstanding print performance.
For additional assistance contact your Paper Mart Sales Specialist at http://www.papermartinc.com/contact-us


text:
Vacancy Report Card 2011
Vacancies are one of the biggest cost drivers for me. The combination of the loss in rental income and the new rent ready expenses make vacancies a double whammy. I tracked my days vacant for each of our properties for last year. We started off rough right away in January, but overall the full year results were not too bad. The table below shows the total days vacant for each of our 6 properties.
We had 100% occupancy for 4 of our properties, but I certainly plan to do better than 42 days in 2012. Property 5 was last year's disaster. You can read about this vacancy here.
Property 2 was vacant in April, but this one only lasted 14 days despite no notice. Property 6 was our old primary that we converted to a rental. My wife had this place rented after only 9 days. She had the new tenants moving in on the day we left so I am showing zero days vacant.
I took advantage of the vacancy in Property 2 and raised the rent to $795. I kept the rent at $995 on Property 5 due to the January vacancy.
Related Post:
How to Lower your vacancy rate


text:
Being emotionally and mentally healthy are huge plus. People with good emotional health: Believe that there is a good balance to their life between leisure time, activity, and work. Feel good about themselves, and don't suffer from self-esteem issues. Believe that there is a purpose to their lives. Are able to accept changes better and just go with the flow. Enjoy living, and know the value of fun and laughter. Have less stress, and are better equipped to deal with stress. Have better relationships with others. Are contented with their lives.. The ability to enjoy well being and mental health give you the happiness without any price tag. So we all can pay as much as we can.
Zaira Khan


text:
Wedding Photographer
Wedding photography produces some of the most beautiful images that you will ever see—the gorgeous bride in her dress, the handsome-as-ever groom in a tux or suit, and their friends and family gathered around. It is a very special day, and you want someone who knows what they are doing to ensure that you have creative images that will be treasured for years to come. We want to make sure that your day runs as smoothly as possible, so our wedding photographer in Redding, CA goes over planning with you!
Engagement photography is where the process begins. This allows us to get a close-up look at the couple that we are working with and really get a sense for how they interact with each other. It also helps our clients see what we can come up with and gives them a chance to build a rapport with their photographer. The more we get to know about our clients, the better the wedding photos will be, as we will be able to catch things with special meaning to the couple while we are photographing the event.
If you are unsure as to what kind of photos you would like for your wedding, we have some great online galleries that you can view. You can see the traditional wedding poses or get some new ideas from the photos. We do on site photography, so all you have to do is choose the place that you want for your bridal photography session and we will make the arrangements. This is a day that is all about you.
Let us take traditional wedding photos and turn them into personalized memories of your special day.
Business Address:
Redding, CA 96002
Call Now !
Business Hours
Sun 12:00am-5:00pm


text:
EcoDog is now offering a fun, new eco-friendly Tug Toy for dogs and puppies!
These fun, new Tug Toys are hand-braided tightly with "upcycled" old t-shirts! EcoDog Tug Toys are perfect for dogs off all sizes and age – choose from MiniTugs to Triple Braid or Tuff UpCylced Jean Tug Toys!
*Durable, Machine Washable
Visit the EcoDogStore.com for Online Shopping and more info. on Upcycled T-Shirt Tug Toys for dogs and puppies!