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Bradykinin Receptor Antagonism During Cardiopulmonary Bypass (BRAC)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT00223704
Recruitment Status : Completed
First Posted : September 22, 2005
Results First Posted : October 11, 2013
Last Update Posted : November 25, 2013
- Study Details
- Tabular View
- Study Results
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- How to Read a Study Record
|Condition or disease
|Cardiopulmonary Bypass Inflammation Fibrinolysis Surgery
|Drug: HOE 140 Drug: Aminocaproic Acid Drug: Placebo
|Phase 2 Phase 3
Hide Detailed Description
Morbidity of cardiopulmonary bypass. Each year more than a million patients worldwide undergo cardiac surgery. Nearly all cardiac surgeries are performed on unbeating hearts supported by CPB. Although the use of off-pump coronary artery bypass surgery procedures are increasing, concerns regarding incomplete revascularization and reduced venous graft patency limit the use of this technique to specific patients. CPB activates various humoral cascades including the coagulation cascade, the KKS, the fibrinolytic cascade, and causes a systemic inflammatory response syndrome. Activation of these systems can lead to hypotension, fever, disseminated intravascular coagulation, diffuse tissue edema, or, in extreme cases, to multiple organ failure. Activation of the KKS contributes to the hemodynamic perturbations, fibrinolysis and inflammatory response observed in patients undergoing CPB. Aprotinin, a non-specific serine protease inhibitor, that works in part by decreasing bradykinin generation, decreases fibrinolysis, hypotension and the systemic inflammatory response associated with CPB. Aprotinin decreases blood loss and transfusion requirements, however, its use is mainly limited to redo-cardiac surgery because of cost. Other factors that may limit the widespread use of aprotinin include an increased risk for renal dysfunction, allergic reaction and non-specificity of the drug. Bradykinin mediates most of the effects of the KKS. Thus, bradykinin receptor antagonism has the potential to modulate the effects of KKS activation during CPB. The purpose of this proposal is to test the hypothesis that endogenous bradykinin contributes to the hemodynamic, fibrinolytic and inflammatory response to CPB and that bradykinin receptor antagonism will reduce hypotension, inflammation and transfusion requirements. The proposed studies promise to lead to novel therapies to reduce morbidity associated with CPB.
Cardiopulmonary bypass activates the kallikrein-kinin system (KKS). Several groups, including ours, have reported that bradykinin concentrations increase during CPB. For example, Campbell et al demonstrated that bradykinin levels increase 10 to 20-fold during the first 10 minutes of CPB, returned to basal levels by 70 minutes of CPB and remained 1.7 to 5.2-fold elevated after CPB. Plasma and tissue kallikrein were reduced by 80 and 60% respectively, during the first minute of CPB. Similarly, we have demonstrated that bradykinin increases significantly during CPB and that ACE inhibition and smoking potentiate the kinin response during CPB.
Fibrinolytic response to cardiopulmonary bypass. CPB increases t-PA antigen and activity in a time-dependent manner. The fibrinolytic response during CPB is heterogeneous, with t-PA levels varying as much as 250-fold. The mechanism of t-PA release during CPB is likely multifactorial. As outlined above, we and others have shown that CPB increases bradykinin, a potent stimulus to t-PA release. In addition, thrombin or complement generated during CPB may stimulate the release of t-PA from endothelium. In addition to the changes in t-PA concentrations during CPB, PAI-1 activity falls because of hemodilution and the rise in t-PA release which consumes active PAI-1. Plasmin generation increases over 100-fold while D-dimer generation increases 200-fold within 5 minutes of CPB initiation. For the remainder of the CPB, average plasmin and D-dimer levels remain 20-fold to 30-fold above baseline levels. The postoperative period is marked by a systemic inflammatory response caused by a combination of CPB and surgery producing an acute -phase response that results in increased PAI-1 production. PAI-1 levels begin to rise about 2 hours after surgery. Once CPB is over, PAI-1 levels continue to rise and peak during the first 12-36 hours postoperatively and return to normal by the second postoperative day. Thus, the fibrinolytic response to CPB is characterized by an initial hyperfibrinolytic phase that begins with a rapid rise in t-PA, plasmin, and D-dimer concentrations followed by a postoperative hypofibrinolytic phase associated with a rise in PAI-1 secretion and a fall in t-PA concentrations.
Interaction between the renin-angiotensin system (RAS), the KKS and fibrinolytic system. There is evidence that fibrinolytic balance is regulated by the RAS and the KKS. ACE is strategically poised to control fibrinolytic balance by promoting the breakdown of bradykinin and the conversion of Ang I to Ang II. Ang II causes the release of PAI-1 thus inhibiting fibrinolysis. Bradykinin stimulates t-PA release through its B2 receptor. ACE inhibition decreases PAI-1 antigen levels and increases endothelial t-PA release through endogenous bradykinin. In addition, ACE inhibition enhances exogenous bradykinin-mediated vasodilation and t-PA release. The augmentation of bradykinin-induced vasodilation, the increase in t-PA and the decrease in PAI-1 described with ACE inhibition in patients with ischemic heart disease may contribute to the primary mechanism of the anti-ischemic effects associated with chronic ACE inhibitor therapy. We have demonstrated that inpatients undergoing coronary artery bypass grafting (CABG) requiring CPB, not only did ACE inhibition increase fibrinolytic activity by decreasing PAI-1 antigen and increasing t-PA activity, but also enhanced the kinin response. Increased PAI-1 concentrations in the perioperative period are associated with acute vein graft thrombosis. Thus, ACE inhibitors have a potential to reduce the risk of acute graft thrombosis through their effects on Ang II generation by attenuating the PAI-1 response after CABG. As opposed to the beneficial effects of ACE inhibition on PAI-1, the augmentation of the kinin response during CPB may have detrimental effects including increased fibrinolysis with consequent bleeding and hypotension. The effect of angiotensin II type 1 (AT1) receptor antagonist on the fibrinolytic response to CPB is not known. Inpatients with essential hypertension AT1 receptor antagonist decreases PAI-1 antigen in some but not other studies. In Specific Aim 1 we will test the hypothesis that angiotensin-converting enzyme inhibitors and AT1 receptor antagonist modulate the fibrinolytic and inflammatory response to CPB differently.
Bradykinin receptor antagonism could reduce the hypotensive response to CPB. Low systemic vascular resistance (SVR) commonly occurs during and early after CPB. It is usually transient and easy to treat. Occasionally, patients have a more severe and persistent fall in SVR, referred to postoperative vasodilatory shock. Risk factors for vasodilatory shock includes the preoperative use of ACE inhibitors, low left ventricular ejection fraction and heart failure syndrome. Treatment is frequently required to maintain adequate perfusion pressure during CPB and to establish satisfactory hemodynamics when ready to separate the patient from bypass. This usually entails counteracting the effect of the vasodilatory mediators by administration of drugs such as norepinephrine or phenylephrine. Although usually effective and safe, these drugs can redistribute blood flow in such a way as to compromise the splanchnic and renal circulation. Several mediators are thought to be responsible for producing postoperative shock, including bradykinin. For example, there is an inverse correlation between bradykinin concentrations and mean arterial pressure during CPB, suggesting that bradykinin is an important mediator in the decrease in SVR. We and others have shown that bradykinin induces vasodilation through its B2 receptor. In contract, B1 receptor stimulation does not cause vasodilation. As outlined under PRELIMINARY STUDIES, we have demonstrated that endogenous bradykinin contributes to protamine-related hypotension following CPB and that bradykinin receptor antagonism administered just prior to protamine attenuates this hypotensive response. In Specific Aim 2 we will test the hypothesis that bradykinin receptor antagonism modulate the hemodynamic changes observed during CPB.
Bradykinin receptor antagonism could reduce hyperfibrinolysis and CPB-associated blood loss. Inhibiting hyperfibrinolysis during CPB reduces blood loss and blood product requirements. On the other hand, modulating the hypofibrinolytic phase after CPB has the potential to reduce thrombotic complications. We and others have shown that bradykinin stimulates t-PA release from human forearm vasculature and the coronary circulation through a NO synthase-independent, and cyclooxygenase-independent pathway. As with vasodilation, bradykinin-stimulated t-PA release is mediated via the B2 receptor. Several groups have reported that bradykinin concentrations increase during CPB. We demonstrated a direct correlation between bradykinin and t-PA concentrations during CPB suggesting that bradykinin plays an important role in activating the fibrinolytic response during CPB. As outlined under PRELIMINARY STUDIES we have shown that HOE 140 (a B2 receptor antagonist) administered prior to CPB blunts the increase in D-dimer similar to e-aminocaproic acid. Thus, B2 receptor antagonism has the potential to reduce bradykinin-mediated fibrinolysis during CPB. In Specific Aim 2 we will test the hypothesis that bradykinin receptor antagonism modulate the fibrinolytic response observed during CPB.
Bradykinin receptor antagonism could reduce the inflammatory response to CPB. During CPB, exposure of blood to bioincompatible surfaces of the extracorporeal circuit, as well as tissue ischemia and reperfusion associated with the procedure, induce the activation of several major humoral pathways of inflammation. Bradykinin produces many of the characteristics of the inflammatory state, such as changes in local blood pressure, edema, and pain, resulting in vasodilation and increased microvessel permeability. Bradykinin activates NF-kB and upregulates interleukin(IL)-1b and TNFa-stimulated IL-8 production through the B2 receptor. In addition, bradykinin stimulates the release of IL-6 from a variety of cells. The growing knowledge of the biological role of kinins, in particular in inflammation, has fueled the development of potent and selective kinin receptor antagonist as potential therapeutics. For example, the bradykinin antagonist, deltibant (CP-0127) showed a significant improvement in the 28-day risk-adjusted survival of patients with gram-negative sepsis. In an animal model of intestinal ischemia-reperfusion injury, B2 receptor antagonism inhibited reperfusion induced increases in vascular permeability, neutrophil recruitment and expression of B1 receptor mRNA. The role of B2 receptor antagonist in myocardial ischemia-reperfusion injury is more controversial. Kumari et al demonstrated a protective effect of HOE 140 during in vivo ischemia-reperfusion injury, whereas in isolated rabbit heart studies, CP-0127 impaired recovery from acute coronary ischemia. This contradictory results may be the result of different antagonist used, differences in species sensitivity or different experimental protocols. The role of B1 receptor antagonist in inflammation is unclear. In contrast to the constitutively expressed bradykinin B2 receptor, bradykinin B1 receptor expression is upregulated following an inflammatory insult or ischemia-reperfusion injury. It appears that each kinin receptor subtype mediates different aspects of the inflammatory response. However, B1 receptor antagonism administered prior to CPB may be detrimental. For example, Siebeck et al demonstrated that B2 receptor blockade attenuates endotoxin-induced mortality in pigs, whereas additional B1 receptor blockade seemed to reverse these beneficial effects. Taken together, B2 receptor antagonism may decrease the acute inflammatory response whereas additional B1 receptor blockade may be harmful. These studies, and also the fact that aprotinin exerts part of its beneficial effects through a reduction in bradykinin concentrations, suggest the hypothesis that pharmacological strategies to block the bradykinin B2 receptor may be superior to reducing bradykinin concentrations in modulating the inflammatory response to CPB.
The RAS, KKS and inflammation. Activation of the RAS exerts proinflammatory effects. For example, Ang II activates the transcription factor nuclear factor (NF)-kB, which in turn regulates genes involved in cellular recruitment and the inflammatory cytokine cascade. Ang II induces the synthesis and secretion of the inflammatory interleukin (IL)-6. As mentioned above, bradykinin produces many of the characteristics of the inflammatory state and upregulates IL-1b and TNFa-stimulated IL-8 and stimulates the release of IL-6. Thus, both Ang II and bradykinin stimulates the release of IL-6. ACE inhibitor treatment is associated with a reduction in IL-6 response to CPB. In a randomized non-blinded study, Trevelyan and colleagues20 demonstrated that ACE inhibition produced a highly significant decrease of 51% in the release of IL-6 in patients identified as high producers of IL-6 by the -174 G/C polymorphism, whereas losartan had a similar but less marked effect. Potential mechanisms for this variation in IL-6 response between ACE inhibitors and angiotensin receptor blocker may be due to their differential effect on Ang II formation and bradykinin degradation. Furthermore, bradykinin-induced increases in IL-6 protein and total mRNA are inhibited by the selective B2 receptor antagonist HOE-140 but not by a selective B1 receptor antagonist. In Specific Aim 1 we will test the hypothesis that angiotensin-converting enzyme inhibitors and angiotensin II type 1 (AT1) receptor antagonist modulate the fibrinolytic and inflammatory response to CPB differently.
|Study Type :
|Interventional (Clinical Trial)
|Actual Enrollment :
|150 participants
|Intervention Model:
|Parallel Assignment
|Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
|Primary Purpose:
|Official Title:
|Bradykinin Receptor Antagonism During Cardiopulmonary Bypass
|Study Start Date :
|May 2006
|Actual Primary Completion Date :
|June 2012
|Actual Study Completion Date :
|June 2012
Experimental: HOE 140
Bradykinin receptor antagonist
Drug: HOE 140
HOE 140 (a bradykinin B2 receptor antagonist) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery. HOE 140 was given as an intravenous bolus of 22 µg/kg over one-half hour followed by an infusion of 18 µg/kg/hr.
Other Name: Icatibant
Active Comparator: Aminocaproic Acid
Drug: Aminocaproic Acid
Aminocaproic acid (an antifibrinolytic drug) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery. Aminocaproic acid was given as an intravenous bolus of 100 mg/kg over one-half hour followed by an infusion of 30 mg/kg/hr.
Other Names:
Placebo Comparator: Placebo
Drug: Placebo
Normal saline (placebo) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery.
Other Name: Placebo/Normal Saline
- Allogenic Blood Product Transfusion Risk [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ]Blood product transfusion during hospitalization that included packed red blood cells, plasma, platelets and cryoprecipitate.
- Units of Packed Red Blood Cells Transfused During Hospitalization [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ]Units of Packed Red Blood Cells Transfused
- Units of Plasma Transfused During Hospitalization [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ]Units of plasma transfused
- Inflammatory Response as Measured by Interleukin-6 [ Time Frame: Patients were followed from the start of surgery until postoperative day 2 ]Interleukin-6 was measured at baseline, post-bypass and on postoperative day 1 and 2.
- Fibrinolytic Response as Measured by D-dimer [ Time Frame: Patients were followed from the start of surgery until postoperative day 1 ]D-dimer concentrations were measured at baseline, 30min and 60min of bypass, post-bypass and postoperative day 1
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|18 Years to 80 Years (Adult, Older Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Subjects, 18 to 80 years of age, scheduled for elective CABG requiring CPB
- For female subjects, the following conditions must be met:
postmenopausal for at least 1 year, or status-post surgical sterilization, or if of childbearing potential, utilizing adequate birth control and willing to undergo urine beta-hcg testing prior to drug treatment and on every study day
Exclusion Criteria:
- Evidence of coagulopathy (INR greater than 1.7 without warfarin therapy)
- Preoperative hematocrit less than 30%
- Preoperative platelet count less than 100X109ml-1
- GPIIb/IIIa antagonist within 48 hours of surgery
- Emergency surgery
- Impaired renal function (serum creatinine >1.6 mg/dl)
- Pregnancy
- Breast-feeding
- Any underlying or acute disease requiring regular medication which could possibly pose a threat to the subject or make implementation of the protocol or interpretation of the study results difficult
- History of alcohol or drug abuse
- Treatment with any investigational drug in the 1 month preceding the study
- Mental conditions rendering the subject unable to understand the nature, scope and possible consequences of the study
- Inability to comply with the protocol, e.g. uncooperative attitude and unlikelihood of completing the study
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00223704
|United States, Tennessee
|TN Valley Healthcare System
|Nashville, Tennessee, United States, 37212
|Vanderbilt University
|Nashville, Tennessee, United States, 37232
|Principal Investigator:
|Mias Pretorius, MBChB
|Vanderbilt University
Publications of Results:
|Responsible Party:
|Mias Pretorius, Associate Professor, Vanderbilt University
|ClinicalTrials.gov Identifier:
|NCT00223704 History of Changes
|Other Study ID Numbers:
|First Posted:
|September 22, 2005 Key Record Dates
|Results First Posted:
|October 11, 2013
|Last Update Posted:
|November 25, 2013
|Last Verified:
|October 2013
Keywords provided by Mias Pretorius, Vanderbilt University:
Coronary Artery Bypass
Blood Transfusion
Bradykinin Receptor Antagonism
Anti-Inflammatory Agents
Antifibrinolytic Agents
Additional relevant MeSH terms:
Pathologic Processes
Aminocaproic Acid
Antifibrinolytic Agents
Vasodilator Agents
Cysteine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Fibrin Modulating Agents
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Bradykinin B2 Receptor Antagonists
Bradykinin Receptor Antagonists
Complement Inactivating Agents
Immunosuppressive Agents
Immunologic Factors


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Recall Details
A propellant with an incorrect specification may have been used during assembly of the side curtain airbags. As a result, one or both side curtain airbags may not deploy in the event of a crash, which can increase the risk of injury. Dealers will inspect and replace the side curtain airbag assembly as necessary to correct this concern. The Subaru recall number is WVZ-36.
Our Quick Take
In the event of a crash, one or both of the side curtain airbags may not deploy.
What Should You Do?
Subaru will notify owners of affected vehicles beginning in April 2012. There are no symptoms related to this recall. If don't receive notification and you feel you should have, please contact your dealer. It's helpful to have your vehicle identification number (VIN) handy when you call.


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The grade school building at Wallingford following the passage of the tornado of
August 9, 1878. In: "History of the Wallingford Disaster," by
John B. Kendrick. 1878. Frontispiece. Library Call Number F104.W28 K435.
Image ID: wea02260, NOAA's National Weather Service (NWS) Collection
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Photo Date: 1878 August 9
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By ,
Published November 25, 2016
The higher the skirt, the lower the bill.
That's the motto at Yang Jia Hot Pot, a restaurant in China's Jinan city.
According to Next Shark , translated from Sina News, female customers are awarded meal discounts based on the lengths of their skirts. Women wearing relatively modest dresses or skirts—revealing just three inches of leg above the knee—are given a 20 percent discount. But for those who dare to bare, specifically female customers whose hems are measured at least 12 inches above the knee, are offered a whopping 90 percent off their entire meal.
The promotion reportedly brought in dozens of women to be measured in exchange for free food over the weekend.
"This is the low-season for hot pot restaurants. We wanted to start a promotional campaign that could attract our core audience," owner Eason Yang told the Daily Mail. "The promotion brought us around 50 tables of customers on Sunday."
For women who happen to be in Jinan city this weekend, Yang is offering the short-skirt discounted-meal promotion on May 23 and 24.
Last winter, a different restaurant in China was providing deep meal discounts to overweight men and slimmer women.


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Owing a great deal of it, to the arrive at and quality of Search Engines, rummage engine optimization is evolving as a sub sphere (not accurately) of it. The more than touristy the investigate engines get the more severe, is the human action of SEO going to be.
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Stax here with a Special "Jesse James" Edition of The Stax Report! Today marks the 121st anniversary of the slaying of notorious Wild West outlaw Jesse Woodson James by that "dirty little coward" Bob Ford. As with Billy the Kid, filmmakers have depicted the life and crimes of Jesse James in different ways through the years.
Filmmakers often use Jesse James as a metaphor for whatever is going on in America at that time. He's been portrayed as a heroic everyman, a frontier Robin Hood, a juvenile delinquent, a madman, an embittered veteran and a happy-go-lucky ne'er-do-well. Obviously, the truth about the man lies somewhere in between.
Here then are some of Hollywood's most notable films about the outlaw:
Jesse James, 1939, dir. Henry King. This huge hit cast Tyrone Power and Henry Fonda as Jesse and Frank James, respectively. For the downtrodden moviegoer of the Depression era, good-natured desperadoes like Jesse and Frank James retaliated against the same kind of capitalistic forces that were threatening their own meager lives. Jesse James robbed the railroads that ran farmers off their land while contemporary outlaws like John Dillinger and Pretty Boy Floyd robbed the banks that foreclosed on poor people's farms and homes. Jesse James depicts Jesse and Frank as decent young lads forced into a life of crime after the ruthless railroad went after the family farm.
The Return of Frank James, 1940, dir. Fritz Lang. I think this is the only sequel Henry Fonda ever appeared in. Reprising his role from the 1939 hit Jesse James, Fonda stars as Frank James, brother of the slain outlaw (played in the prior film by Tyrone Power). This completely fictitious oater has Frank retired from crime and now making his living as a farmer. He returns to his violent ways when Jesse's assassin, Bob Ford (John Carradine), is exonerated. Now Frank will have to get justice James Gang-style. The Return of Frank James is also noteworthy for marking the screen debut of Gene Tierney and for being directed by the great Fritz Lang (M).
The Great Northfield, Minnesota Raid, 1972, dir. Philip Kaufman. This gritty, revisionist Western reflects the moral ambiguity and social disorder of the Vietnam War era. Robert Duvall's self-righteous, off-kilter Jesse James is a Scripture-quoting, manipulative firebrand at odds with his laconic, thoughtful cousin/partner-in-crime, Cole Younger (Cliff Robertson). The hawkish but misguided Jesse leads his men to a disastrous outcome on their last bank robbery in 1876. The film's bleak tone and industrial imagery suggest that the James-Younger gang are creatures who have already outlived their day.
The Long Riders, 1980, dir. Walter Hill. Hill's detractors may call The Long Riders a Peckinpah rip-off bolstered by the effective stunt casting of actual actor-brothers (The Keaches, the Carradines, the Quaids, and the Guests) as the James-Younger gang. But I liked how this post-Vietnam Western portrayed them as embittered war veterans who attained revenge against their victors by becoming outlaws. The Long Riders remains the Jesse James movie to beat.
American Outlaws, 2001, dir. Les Mayfield. This comedic Young Guns-esque romp follows Jesse James (Colin Farrell) from the closing days of the Civil War, when he rode with Quantrill's Rangers alongside his brother Frank (Gabriel Macht) and their cousins Cole and Bob Younger (Scott Caan and Will McCormack, respectively), until the peak of his celebrity as a Robin Hood-like outlaw. Returning home to their mother's (Kathy Bates) farm after the South's surrender, Jesse and Frank find that ex-Confederate families are being forced off their farms by the Yankee juggernaut that is the Rock Island and Pacific Railroad.
After the railroad kills Ma James (in reality she survived), Jesse and Frank reunite with their cousins, the Youngers, to begin a new war versus the Yankees, this time targeting their vast corporate interests. To protect his railroad and their payrolls, Rock Island baron Thaddeus Rains (Harris Yulin) hires legendary detective Allan Pinkerton (Timothy Dalton) and his agency to stop Jesse James at all costs. Plenty of gunfights, mayhem and mischief ensue.
Tell me what your favorite Jesse James films are. &#Array; STAX


text:
|The dose-dependent effects of halothane on right ventricular contraction pattern and regional inotropy in swine.
MedLine Citation:
|PMID: 8638783 Owner: NLM Status: MEDLINE
|The right ventricle (RV) is comprised of two embryologically distinct units, the inflow and outflow tracts, which normally contract sequentially and differ in the magnitude of increased inotropy during sympathetic nervous stimulation. The present study examined the dose-response effects of halothane on the RV contraction pattern and regional contractility in seven open-chest pigs instrumented for measurement of inflow and outflow tract pressures and segment lengths. The RV contraction pattern was evaluated by comparing the phase of inflow and outflow tract shortening, and regional contractility was determined by calculation of preload recruitable stroke work (PRSW) slope. Using this methodology, an inflow-outflow tract contraction phase difference of -27 degrees (inflow tract shortened earlier) was evident at baseline, but was abolished by 1.0 and 1.5 minimum alveolar anesthetic concentration (MAC) halothane; PRSW slope of both the inflow and outflow tracts, however, demonstrated similar dose-related change. To determine whether alterations in cardiac sympathovagal balance played a role in the RV response to halothane, an additional four animals were studied after pretreatment with hexamethonium, propranolol, and atropine. In these animals, there was no difference in the regional contraction phase either at baseline or during halothane administration, and dose-related depression of PRSW by halothane was again similar in both regions. However, when halothane effects on regional PRSW in animals with autonomic blockade were compared to those of neurally intact animals, a 20% greater depression of outflow tract PRSW by 0.5 MAC halothane was evident. This study demonstrates that halothane abolishes the normal sequential pattern of RV contraction without exerting markedly variant negative inotropic effects within different regions of the RV, and provides evidence to suggest that alterations in cardiac sympathovagal balance may contribute to the effect of halothane on RV contraction dynamics.
|P M Heerdt; B E Pleimann
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Publication Detail:
|Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
Journal Detail:
|Title: Anesthesia and analgesia Volume: 82 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1996 Jun
Date Detail:
|Created Date: 1996-07-11 Completed Date: 1996-07-11 Revised Date: 2007-11-15
Medline Journal Info:
|Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES
Other Details:
|Languages: eng Pagination: 1152-8 Citation Subset: AIM; IM
|Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
Anesthetics, Inhalation
Cardiotonic Agents / pharmacology*
Dose-Response Relationship, Drug
Halothane / pharmacology*
Hemodynamics / drug effects
Myocardial Contraction / drug effects*
Ventricular Function, Right / drug effects*
Reg. No./Substance:
|0/Anesthetics, Inhalation; 0/Cardiotonic Agents; 151-67-7/Halothane
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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Ask the diabetes expert
Here is something new I noticed on my home page this evening. I found toward the upper right hand of home page beneath the my profile, friends and inbox links.
the experts are 2 RNs and 1 MD from Joslin diabetes center.
This looks to be a very welcome addition to Diabetic connect! I would expect that we'll be getting an announcement shortly about the addition to this site. I have been there and there seems to be no activity so far.
This looks to be another valuable resource for us in our struggle to manage our diabetes. Thanks to Alliance Health for providing this to us!
6 replies
I just asked them a question and learned that not every question may be answered, and I will be notified when my Q is A. Now all I need do is wait, I guess.
Next Discussion: Drug abuse being a diabetic »


text:
The iPhone 5 32Gb and 64GB models are being discontinued at Canadian network carrier Telus, leaving smartphone owners with a rather limited selection of choices this month.
According to Mac Rumors, the discontinuation of the models will get underway beginning September 28th, eight days after the suspected launch of the new iPhone 5S and the iPhone 5C.
So what prompted for the discontinuation of the mid-tier iPhone 5 units? Well, it comes courtesy of a leaked image from Telus, but no one knows if other iPhone 5 units will be discontinued at a later date. It could be that they're axing out the lower-selling units of the iPhone 5?
For now, everyone is focusing on clearing out stock and prepping for the immediate consumer storm of sales when the iPhone 5S and iPhone 5C launches, arriving after their announcement date on September 10th.


text:
Leighton Meester
Birth Name: Leighton Marissa Claire Meester
Age: 32, born 9 April 1986
Born and residing in: United States
Height: 5' 4"
Relationship Status: Married
Partner: Adam Brody
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Description: Leighton Marissa Meester (born April 9, 1986) is an American actress and singer. Meester first garnered attention for playing Blair Waldorf in the CW television series Gossip Girl. She most recently appeared in the 2010 country drama film Country Strong, the 2011 thriller The Roommate, and the 2011 romantic-comedy Monte Carlo. Early life and personal life: Meester was born in Fort Worth, Texas, to Constance (née Haas) and Douglas Meester and lived most of her life in New York City and Los Angeles. Meester's last name means "master" or "teacher" in Dutch. Her mother was serving time in a federal pris ... (more)
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"Sassy," 6" x 8", Golden Open acrylics on panel, commissioned pet portrait, private collection (THANK YOU!). Inquiries (seriously, it is NOT too early to begin thinking of holiday gift-giving - portraits start at $29 and my calendar is already filling) may always come to me.
Tonight the 50th Annual Thumb Area Artists Exhibition opened. This is a show, a great tradition, that the Romeo Guild of Art puts on every year for artists working in Southeastern Michigan. RGA members coordinate the exhibition space, put out a call for entries, hire a juror, recruit sponsorship (we awarded over $1000 in prizes tonight!), handle all the press and facilitate a grand opening party. There's lots of other tasks that go on behind the scenes - it is a tremendous amount of work, putting such an event together. This was my 3rd year being an intrinsic part of the show committee, and while it is hard work, it is also incredibly rewarding.
Of course, being out of the studio for almost 4 days this week means I have lots of catching up to do with other chores. But I made sure to soak up enough enthusiasm and inspiration to carry me through. To stand in the gallery tonite, surrounded by uber talent and over 100 smiling faces, to be a part of that energy, well that was all the payback necessary. I feel invincible!!
And if you are in need of some inspiration yourself, I invite you to stop by Margot's Gallery in Oxford during the month of August. She's got that market cornered.
Thanks, as always, for looking at - and sharing - my artwork and musings with your friends and family.
FACEBOOK: Kimberly Kelly Santini
TWITTER: ksantini
SHOP ORIGINALS & LIMITED EDITION GICLEES: at my Etsy shop
ORDER CUSTOMIZED NOTECARDS & REPRODUCTIONS: at Imagekind
COMMISSION A PET PORTRAIT: contact me
GIFT CERTIFICATES AVAILABLE: contact me
READING MATERIAL: Preview and order each of the Dog a Day books at the publisher's website: The First Year (2006-2007) and That's 14 in Dog Years (2008). If you would like your copy personalized, order them through me.


text:
Core Record
|Portrait of Antonio Canal (1567 - 1650)
|Birmingham Museum and Art Gallery
| Attributed to Dyck, Daniel van den (Flemish painter and etcher, ca. 1610-1670, active in Italy)
Attributed to Regnier, Nicolas (Flemish painter, ca.1590-1667)
Previously attributed to Italian School
|1647 (dated)
|The sitter is Antonio Canal di Giovanni and he was 81 years of age when his portrait was painted wearing the red robes and stole of the Procurator di S. Marco di Citra. The Office of Procurator was one of high honour in Venice and there were normally only nine holders of the title. Traditionally, Procurators had their portraits painted at the time of their election and these were exhibited in public on the day they made their ceremonial entry into office.
Daniel van den Dyck was a Fleming by birth and training who settled in Venice where he painted portraits and history paintings. In 1658, he moved to Mantua to become Inspector of the Duke of Mantua's art collection.
|Current Accession Number
|Former Accession Number
|front cl (on plaque) 'ANTONIUS CANALIS/ D.M. PROC.r. A.o. 1647/ AETA.s SUEA 81'
|portrait (Canal, Antonio)
|113.0 x 98.4 cm cm (estimate)
|oil on canvas
|Acquisition Details
|Purchased from Agnew's 1958.
|Oliver Vernon Watney, Cornbury Park; by descent to his daughter; Agnew's.
|Principal Exhibitions
|Seicento Venezia, Venice, 1959, cat. no. 90 as Niccolo Regnier; Primitives to Picasso, Burlington House, London, 1962, cat. no. 93; Venetian Seventeenth Century Painting, National Gallery, London, 1979, cat. no. 32.
|Ivanoff, N., 'I Ritralti dell Avogaria', Arte Veneta, 1954, p. 276; Burlington Magazine, vol. 100, June 1958, p. 91; Pallucchini, R., Pantheon, vol. 1, 1960, p. 8; Donzelli, C. and G. M. Pilo, I Pittori del seicento Veneto, Florence, 1967, pp. 404 - 407, pl. 448; Luigi Fantelli, P., 'Nicolo Renieri' Pittor Fiamengo', Saggi e Memoire di storia dell 'arte, vol. 9, 1974, p. 93; Foreign Paintings in Birmingham Museum and Art Gallery, A Summary Catalogue, 1983, no. 54, ill.
|This painting was not included in the 1915 catalogue of the Watney Collection.
Attributed to Daniel van den Dyck by Fiocco and exhibited at Venice in 1959 as a Regnier. Opinion over the attribution remains divided. Pallucchini, Ivanoff, Donzelli and Pilo favour Van den Dyck. Fantelli favours Regnier. The catalogue entry for the National Gallery Venetian Seventeenth Century Painting exhibition in 1979 argues persuasively for an attribution to Van den Dyck.
|Rights Owner
|Birmingham Museum and Art Gallery
|Dr Patricia Smyth
about contact terms of use image credits © 2018


text:
Edmond OK White Fillings
We call them silver fillings, but a more accurate name would be silver-amalgam fillings. Silver fillings are mixed up as a paste of a silver alloy and mercury that is pressed into the tooth, where it hardens. In recent years, there has been more concern about the safety of placing mercury in a patient's mouth.
Dr. Bender doesn't use amalgam fillings. Instead, we, at Creative Edge Dentistry, use tooth-colored composite, or white fillings. These fillings are made of a combination of glass or quartz and resin materials which are blended to create the tooth fill medium. They are tooth-colored, so they have a much more natural appearance than traditional amalgam fillings.
Here are photographs showing old, corroded amalgam fillings on the left, replaced with tooth-colored composite fillings on the right.
Amalgam Fillings left picture and Composite Fillings right picture
White fillings have several distinct advantages. The strongest advantage is that their resin chemistry makes it possible for them to bond to the teeth. If you examine the photograph of the amalgam fillings on the upper left, you will see that there are some places where there is a gap between the filling and the tooth. With composite, this tooth/filling interface is sealed, leaving no gap. In addition, the bonding process strengthens the tooth.
White Fillings Versus Amalgam Fillings
White fillings:
- Because they are bonded to the tooth, composite fillings restore most of the tooth's original strength.
- They require less of the natural tooth be removed than amalgam.
- They are particularly well suited to small cavities.
- They have a much more natural appearance.
- Since they require more time and skill to place, they tend to cost more than amalgam.
- Since many dental schools don't teach the placing of white fillings on back teeth, dentists often need additional dental training in order to place them correctly. When dentists don't have that extra training, the fillings tend to have problems such as premature failure or extreme sensitivity.
Amalgam Fillings:
- They are simpler and require less time to place. All dentists are trained in dental school in the proper placement of amalgam fillings.
- Amalgams are generally less expensive than composite.
- Their mercury content is a safety concern to some.
- Over time, they will corrode, and their appearance becomes dark, almost black.
- They are subject to metal fatigue and corrosion, and over time the fillings can crack, or they can cause cracks in the teeth.
If you're interested in tooth-colored composite fillings, Dr. Bender has the training necessary to provide that service with expertise. Call our office today and we'll be happy to schedule you for an examination.


text:
The World's Largest Pheromone Community
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|November 9th, 2017, 06:30 PM
Pheromone Cadet
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High dose of IH whilst keeping attraction aspect
I like high dose of instant Honesty like at least 4+ sprays of regular.
And I am wondering if there is a way I could keep the "attraction" level high also?
For example if I like Ammo at say 2 sprays and I add 2 sprays of IH , then that is still alright, attraction wise.
But I like the high dose of IH where people tell secrets and then wonder why they told you that stuff and I notice it more on the higher doses.
So if I take IH and Ammo for example, If I wanted to use say 4 sprays IH and instead of 2 ammo would 3 sprays of ammo be better at keeping the attraction aspect pheromone wise in the mix?
It would be nice if I could have the high dose effect of IH and the attraction/confidence aspect of Ammo .
It is possible to have both of the things I want at the same time?
|November 9th, 2017, 07:39 PM
Pheromone Sorcerer
Join Date: Jun 2010
Location: Scotland
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Re: High dose of IH whilst keeping attraction aspect
It is indeed - I don't use it so much since the price of 4x IH went stellar but high-dose IH mixes are fantastic for those ladies who need to magick-up a reason/justification to themselves. i.e. "The connection between us was so strong - it was just meant to be" kind of ladies.
I rarely used Ammo though, except maybe a spray just for scent as it is already pretty well balanced and can get lost under all the Nols. TUTH is the way to go here, or even IJ if your IH dose is particularly high. Remember that all your IH will provide a very substantial amount of social moderation.
A steering-level dose of P83 to help with physical disinhibition is also useful, or P96 to help ease their emotions and arousal into the same direction. or even IS for the feelgood frission but you don't want to use too many products here as the purity of the IH connection needs to be paramount.
Do be aware that you need to be conveying attractive personality/body-language traits whilst using this - If you don't, when a woman starts spilling her secrets, it can be that she sees you as safe - and there is often no bigger passion-kliier than being"safe".
|Thanked by:
AWEsome (November 13th, 2017), Jdub (November 29th, 2017), Roy Dillon (November 10th, 2017), ScentHound (November 22nd, 2017), unknown0001 (November 10th, 2017)
|November 13th, 2017, 05:37 PM
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Re: High dose of IH whilst keeping attraction aspect
Would you say instead of Ammo or TUTH , A314 + IH would enhance "The connection between us was so strong - it was just meant to be"?
What about for "Spiritual" girls that are into Yoga, Meditation etc?
If I didn't want to attract the girl per say, but I wanted a really deep connection so she get the vibe "The connection between us was so strong"
Would that be possible with IH without adding more none? Would adding 2 drops of A314 enhance that effect?
For example 2 drops of A314 and 6 sprays of IH ?
|November 13th, 2017, 10:46 PM
Team JdubNtime469
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Re: High dose of IH whilst keeping attraction aspect
It can be done what you are looking for no doubt, but will take a lot of testing to dial things in for you and I will share what has worked for me.
I typically use A314 2 drops and 1 spray of TUTH for my base pheromone package for respect/status/ and attraction.
Then I typically use B -nol at 5MCG and P96 at around 20MCG and TAA at 5-10MCG.
This is just what I have been using lately, but it is a balancing act what you are trying to do and when you combine a bunch of things it is really easy to get the mix off balance.
As far as attraction status I might look at testing IG and find your sweet spot and then also maybe a small amount of TUTH also like 1/2 spray to 2 sprays of IG should be really close for you and of course you will have to test this.
Then to take IH to the next level instead of using a bunch of sprays as it is expensive I would look at P96 would probably be my first choice and around 7.5-10MCG would be best, but you could probably make 5MCG work also.
I would try this with your IH and think you will find what you are looking for.
My Personal journal
The guide to my journal is on page 33 and is Post#325
Project JdubNTime469 Race Code Journal
Single Molecule Mix Journal
Women`s Phero Effects on Men Journal
|November 14th, 2017, 01:42 AM
Pheromone Sorcerer
Join Date: Jun 2010
Location: Scotland
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Re: High dose of IH whilst keeping attraction aspect
A314 / IH is indeed a good connection mix but it is also one that builds with repeat exposure - Also, some women, esp younger may not tune-in on an attraction level so well.
If you are looking for a faster/more sudden connection, then IH as the primary with sexual steering is the way to go.
A314 is not an alternative to None in any mix, Androsterone it its primary with only a small/steering level quantity of None that will be barely noticeable in a high/ IH mix.
|November 15th, 2017, 07:42 PM
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Re: High dose of IH whilst keeping attraction aspect
I've a repeat hookup coming over tomorrow afternoon for an assignation.
I'll try IH plus some NPA.
I don't want love and neither does she. We want red-hot monkey love.
UPDATE: She was a bit weird before but last night she sounded and acted like a chimpanzee in heat.
So I got my red hot monkey love but I'm not going to extrapolate yet to other women.
"Never be haughty before the humble and never be humble before the haughty."
- General Robert E. Lee
Last edited by Whitehall; November 17th, 2017 at 05:22 PM.
|November 29th, 2017, 02:27 AM
Team JdubNtime469
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Re: High dose of IH whilst keeping attraction aspect
The Ammo + IH or TUTH + IH looks like the best options to me
|aspect , attraction , dose , high , ih , keeping , whilst
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Nicholas Brothers
Nicholas Brothers, African-American tap dance team consisting of
Fayard Antonio Nicholas, 1914–2006, b. Mobile, Ala., and Harold Lloyd Nicholas, 1921–2000, b. Winston-Walem, N.C. Performing on stage and in films, they combined dance genres—tap, jazz, and ballet—in polished routines that spotlighted their elegantly sophisticated style, fine timing, complex step patterns, and superb athleticism—particularly their spectacular mid-air splits. Sons of vaudeville musicians, they made their debut in 1928 on their parents' show circuit. Four years later they opened at Harlem's Cotton Club and appeared in their first film short. In 1934 they danced in Kid Millions, the first of their many Hollywood movies, which also include The Big Broadcast of 1936 (1935), Down Argentine Way (1940), Sun Valley Serenade (1941), Stormy Weather (1943, in which they performed their famous
Jumpin' Jiveroutine), and The Pirate (1948, their last movie together). The brothers also appeared in many stage productions, including Broadway's Ziegfield Follies (1936) and Babes in Arms (1937), and on television. Late in their careers, both brothers did solo work as dancers and in dramatic roles.
See C. V. Hill, Brotherhood In Rhythm: The Jazz Tap Dancing of the Nicholas Brothers (2000).
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.
See more Encyclopedia articles on: Dance: Biographies
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Excited about Counter-Strike: Global Offensive? So are we. That's why we had to share this video we found on RockPaperShotgun with you. Watch the US and Europe face off in two videos in more than an hour of footage.
The second video is considerably shorter, but instead has Valve's Chet Faliszek giving commentary over gameplay footage. Faliszek if one of Valve's lead writers, with credits on franchises like Portal and Left 4 Dead.


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Simon Bird News
News about Simon Bird continually updated from thousands of sources around the net.
Simon Bird news is powered by NewsRank ®
Quiz: Can You Match The Sitcom Couple To The Sitcom?
Exclusive Interview: 'Walking Dead' Star Lennie James Chats About Morgan's Journey
Then And Now: 29 Hot Daytime Soap Opera Stars From The Past
27 Surprising Celebrity Godparents And Their Famous Godchildren
27 Hilariously Lame Music Artists That Hipsters Love
Then And Now: See How 33 World-Class Olympians Have Held Up
You Won't Believe What These 33 American Idol Stars Look Like Now
33 Shocking Celebrities Who Are Actually Poor
QUIZ: Can You Name A Movie From Only Three Clues?
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29 Celebrity Marriages That Happened In Secret
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End-of-life care
About end-of-life care, including palliative and medical assistance in dying.
Services and information
Palliative care
Care that aims to improve the quality of life for those living with a life-threatening disease.
Options and decision making at end of life
Options available to those who are making end-of-life care decisions.
Medical assistance in dying
About medical assistance in dying and the new legislation.
Contact information and links
Provincial and territorial contact numbers and links for end-of-life care, including palliative care and medical assistance in dying.
Report a problem or mistake on this page
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text:
David Murphy hit an RBI triple in the second inning and scored on an Ian Kinsler base hit to give the Rangers an early 2-0 lead before Nelson Cruz busted out his boomstick. The outfielder led off the fourth with a solo shot, taking Justin Verlander deep on an 0-2 fastball which turned out to be the deciding factor in his team's win. Good for Cruz too, cause he was in quite a slump so far throughout the postseason, sporting an .067 batting average entering the series.
Rangers starter C.J. Wilson had a rather rough outing, lasting just 4.2 innings. The lefty walked five and coughed up two runs, including one a wild pitch that scored a run between rain delays. However, the relief corps cleaned up the mess and stomped the Tigers' rally. Five Texas relievers combined for eight strikeouts, with only Neftali Feliz allowing a hit while getting clocked at 101 mph for his fourth postseason save.
I suppose Detroit's loss could be partly attributed to the absence of Delmon Young -- we swear that's an impostor -- who batted .316 with three homers against the New York Yankees in the ALDS before suffering an oblique injury during Game 5. The left fielder now has to watch the best-of-seven series from the bench.
Game 2 is set for Monday night at 4:19pm ET on FOX with Derek Holland starting for the Rangers against Tigers right-hander Max Scherzer. The contest was postponed a day since there was a 60 percent chance of rain over the Arlington area just before Sunday's game time.
[SB Nation]


text:
Linked by Thom Holwerda on Mon 2nd Jul 2007 22:23 UTC, submitted by Mattias
Patrick Volkerding has released Slackware 12.0. From the changelog: "Released as Slackware 12.0 with no changes since the last batch. Big Thanks again are due to the CREW, without whom this just wouldn't be possible to do with the level of quality that Slackware users demand. We had a lot of help this time, and I hope it shows in project output that you'll enjoy. Thanks for the support of the Slackware community, because without your support I wouldn't be able to keep leading this project."
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American IronHorse, a Fort Worth, Texas-based luxury motorcycle manufacturer, expanded its dealership network by 18 in 2002. When the company began scouting locations, it had one major criterion in mind: areas with a large concentration of high-income households. Ultimately, it settled on San Leandro, Calif.; West Palm Beach, Fla.; Scottsdale, Ariz.; and the Indianapolis suburbs of Fisher, among other tony locales. With new dealerships located in wealthy metros, the company has confidence that its marketing pitch (which includes costly endorsements from professional race car drivers) will reach the consumers the campaign is targeting — those who have the means to plunk down about $30,000 for a motorcycle, says company spokeswoman Oné Musel-Gilley.
Now companies like American IronHorse, which are making crucial business decisions based on income data, have a new weapon at their disposal: the first comprehensive update of American household income in a decade. With the release of data from Census 2000's long form, a detailed questionnaire that went to 1 in 6 households, businesses across the nation are getting their first, fresh look at how incomes have changed between 1990 and 2000. It's information that companies can use to locate new retail stores, determine the best product mix and craft media strategy, says Katharine Day Bremer, general manager at advertising agency Porter Novelli's Atlanta office. "Income data is the price of entry,� she says. "Could these people possibly afford this product or service?�
In a decade that started with a recession and ended with the largest peacetime economic expansion in the nation's history, the latest income data shows that consumers can probably afford more than they did circa 1990. Median household income climbed to $41,994 in 1999, from an inflation-adjusted $39,008 in 1989. (The census measures income data for the last full year prior to the survey.) As median household income climbed, so too did the share of affluent households. Today, 12 percent of households have an annual income of $100,000 or more, compared with 4 percent a decade ago.
While most Americans were doing better at the end of the 1990s than they were at the beginning, the demographic breakdown of each income group stayed remarkably stable. For instance, despite all the hype about twentysomethings' raking in six-figure incomes from the Internet boom, the share of households headed by a person under the age of 25 who earned more than $100,000 a year was about the same in 2000 as it had been a decade before. (In 2000, there were 88,000 households headed by a person under the age of 25 that claimed a household income of $100,000 a year or more.) Indeed, far from know-it-all kids controlling the nation's wealth, nearly 6 in 10 households with an income in the six figures (or higher) are headed by a person between the ages of 35 and 54, roughly the same as it was in 1990. On the other hand, racial and ethnic minorities appear to have made some gains in income throughout the 1990s. Although the data isn't exactly comparable, due to a change in census methodology, there was slightly more diversity at the top of the income ladder in 2000 than there was at the start of the 1990s.
As you'll see in the pages that follow, the low, middle and high income groups are far from perfectly culled representative samples of the U.S. population. The lowest income group — the 56 million households that have an income less than $45,000 annually — is the most "demographically democratic.� It includes the most representational slice of the nation's population by race, ethnic background and age. As household members climb the income ladder, they become far less like the population as a whole: They are more likely to be white, to be middle-aged and to hug the coasts. The metro areas with the largest share of affluent households include the traditional powerhouses of New York City and Washington, D.C., as well as the more scenic West Palm Beach, Fla., and Santa Barbara, Calif.
A few words about our methodology: The Census Bureau's data on household income is divided into as many as 16 separate categories, with reported annual earnings that range from under $5,000 to $200,000 and above. For this report, American Demographics created five income groups from the Bureau's 16. We've also focused on households with incomes that are more than the U.S. median of $41,994, as many businesses dedicate their marketing efforts to reaching these groups.
Readers who are interested in more details about the demographics of households with incomes that are less than the U.S. median can find them via the Census Bureau's American FactFinder, at http://factfinder.census.gov/servlet/BasicFactsServlet.
What do we mean by income?
For this report, income includes wage or salary income; net self-employment income; interest, dividends, or net rental or royalty income; income from estates and trusts; social security or railroad retirement income; Supplemental Security Income (SSI); public assistance or welfare payments; retirement, survivor or disability pensions; and all other income. What is not included in income: capital gains; money received from the sale of property (unless the recipient was engaged in the business of selling that property); the value of income "in kind� from food stamps, public housing subsidies, medical care, employer contributions for individuals, etc.; withdrawal of bank deposits; money borrowed; tax refunds; money exchanged between relatives living in the same household; and gifts and lump-sum inheritances, insurance payments, and other types of lump-sum receipts. For more details, go to www.census.gov .


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Pelayo Vida
Reto Pelayo Vida + Aviva Vital
Original idea, creativity, design and production of the advertising campaign, the "Seguro de Vida que se Vive" –"the life insurance that you live" – presentation event and the "Reto Pelayo Vida 2016" ship departure ceremony, that will lead five women that have get over breast cancer to cross the Atlantic Ocean in less than 15 days in a sailing boat of 73 meters of length. The advertising campaign includes television (Eurosport) and radio (thematized programs and ads).
This post is also available in: Spanish


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Maricopa County Sheriff Joe Arpaio has legally challenged the eligibility of Barack Obama to serve as President of the United States. He has the final authority to verify Obama's qualifications to be placed on the 2012 ballot in Arizona's most populous county.
Instead of providing the evidence of Obama's legal birth certificate from Hawaii, the White House's Gestapo, otherwise known as the Department of Justice has been given the task to discredit Arpaio in any manner they can.
Maricopa County is only a 2 ½ hour drive north of the Mexican border. It is a proven fact that it is one of the busiest centers for the trafficking in illegal drugs and illegal immigrants coming into the country from Mexico. Sheriff Joe has a police task force whose sole purpose is to stop as much of the illegal trafficking as possible. It has become one of the most dangerous jobs in the nation as drug runners and coyotes (traffickers of illegal immigrants) have no qualm with shooting law enforcement officers.
Trending: College Expels Disabled Boy Over Sex Assault Despite Girl Admitting SHE Molested HIM!
With the proximity to the Mexican border, Latinos make up over 95% of those moving drugs into the country through Maricopa County as well as over 95% of the illegal immigrants pouring across the border.
So let me ask you a question: If you were the top cop for securing and protecting a population of nearly 4 million people from a threat that is made up of over 95% Hispanics, would you not place the majority of your focus on that ethnic group? Is it any different from the soldiers that served in Iraq targeting Arabs? If 95% of the criminal element is Latino, would it be realistic to target Asians or Africans?
The reason I ask is that the Department of Justice has prepared a 22 page report claiming that Sheriff Joe is unduly targeting Hispanics and his actions are unconstitutional. Assistant Attorney General for Civil Rights Thomas E Perez says that he hopes that Sheriff Joe will cooperate with the DOJ in their efforts to turn the sheriff's department around.
Arpaio has responded by saying that he vows to never resign or give in to the fed's pressure. He admits that he is a compassionate person, but that his commitment to law enforcement overrides his compassion for people. He also says the actions being taken by the DOJ will lead to the release of hundreds of illegal immigrants who have been jailed for committing crimes and that,
"President Obama and the band of his merry men might as well erect their own pink neon sign at the Arizona-Mexico border saying 'Welcome all illegals to your United States, our home is your home,'"
He has also come under attack from other Democrats who seem to be doing the President's bidding. Their complaints have prompted another grand jury investigation looking into allegations of abuse of power and corruption. Arpaio has faced similar charges in the past and says he is not too worried about the current charges.
All this prompts me to ask why doesn't Obama just provide the documentation to prove he was born in Hawaii and end all of the controversy? Sending his DOJ henchmen after Sheriff Joe just makes him look more guilty of being unqualified to serve as President. It also lends more credence to the signs of him taking dictatorial control of the US if he is re-elected in 2012.


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HE 500: Health Care Educator
This course is designed to examine the professional role of health practitioner as educator. Health practitioners facilitate learning for clients and their families as they work to overcome the challenges that health, disease, prevention, and rehabilitation bring. They also share their experience, disseminate new knowledge and guide colleagues and students alike as they acquire new skills. This course is designed to examine these 'educator' roles in the health context and stimulate a critical analysis of taken-for-granted assumptions about this integral aspect of practice.
Throughout the course, learning will be situated in the health environment and focus on the provision of prevention service through education of clients and families, and instruction of colleagues and students. In completing course readings and interacting with others, participants will apply current learning theories and effective teaching strategies to the design, implementation, and evaluation of creative, innovative and positive learning experiences for these targeted learners. The course is based on the assumptions that instruction is learner-centered and that effective learning is the outcome of a collaborative process between learner and facilitator. Contact hours of education= 30. Course Code = HE 500.
This course is approved for re-certification contact hours of education for the following specialties: meditation instructor, holistic-integrative health care, stress management consulting, health care life coach, crisis intervention counseling, nurse-patient educator and attention deficit disorder consulting.
The American Institute of Health Care Professionals, Inc. is a licensed Continuing Education Provider in the State of California, Board of Registered Nursing, Provider # CEP 15595. Access Info
Instructor/Course Author: Marco Meneses, MSc, CHES, CFLE, AASECT
Link to resume
Email: firstname.lastname@example.com
AIHCP BLOG: Please visit our interactive web blog. Here you will find frequently added information on our programs, articles and news by practice speciality, and much more. Register and become a part of our professional health care community.
TIME FRAME: You are allotted two years from the date of enrollment, to complete all of the continuing education courses in the substance abuse practitioner program. There are no set time-frames, other than the two year allotted time. If you do not complete the courses within the two-year time-frame, you will be removed from the course and an "incomplete" will be recorded for you in our records. Also, if you would like to complete the courses after this two-year expiration time, you would need to register and pay the course tuition fee again.
TEXTBOOKS: There is one (1) required textbook for this course.
"Health Professional as Educator: Principles of Teaching and Learning", Bastable, Gramet, Jacobs, Sopczyk, 2010. ISBN-13: 878- 0763792787
You are required to order your own copy of the textbook. Please be sure to order your book as soon as possible so that you can begin your course of study.
Link to Purchase on Amazon.com: click here
GRADING: You must achieve a passing score of at least 70% to complete this course and receive the 30 hours of awarded continuing education credit. There are no letter grades assigned. You will receive notice of your total percentage score. The American Institute of Health Care Professionals will contact those who score below the minimum of 70%, and options for completing additional course work to achieve a passing score, will be presented.
ONLINE COMMUNITY MESSAGE BOARDS: Enrolled students have full access to our online Student Community Message Boards. These message boards allow students in our CE courses to meet each other, communicate online, share information, discuss topics of study and interest and much more. Full access is provided via the online classroom.
ONLINE COMMUNITY MESSAGE BOARDS: Enrolled students have full access to our online Student Community Message Boards. These message boards allow students in our CE courses to meet each other, communicate online, share information, discuss topics of study and interest and much more. Full access is provided via the online classroom.
MESSAGE BOARDS: each specialty program has an area to "post" on the message board. Students may post messages at any time. Posting allows students to converse with those in the same specialty practice and to discuss issues/course content etc. Instructions for posting are provided in the online classrooms.
CHAT ROOMS: each specialty has its own unique "chat room." Inside of the classroom there is a schedule for "chat time" with students in your specific specialty practice. Participating in "chats" is voluntary. The chat sessions are used as means for students to come together and discuss course content or anything related to the courses and/or certification specialty.
EXAMINATION ACCESS: there is link to take you right to the online examination program where you can print out your examination and work with it. All examinations are formatted as "open book" tests. When you are ready, you can access the exam program at any time and click in your responses to the questions. Full information is provided in the online classrooms.
STUDENT RESOURCE CENTER: there is a link for access to a web page "Student Resource Center." The Resource Center provides for easy access to all of our policies/procedures and additional information regarding applying for certification. We also have many links to many outside reference sites, such as online libraries that you may freely access.
ONINE EVALUATION: there is a link in the classroom where you may access the course evaluation. All students completing a course, must, without exception, complete the course evaluation.
FACULTY ACCESS INFORMATION: you will have access to your instructor's online resume/biography, as well as your instructor's specific contact information.
ADDITIONAL LEARNING MATERIALS: some of our faculty have prepared additional "readings" and /or brief lecture notes to enhance your experience. All of these are available in the online classrooms.
Our site also provides specialty practice blogs, an online health care directory where members may voluntarily post information about themselves, and a health care articles blog.
COURSE OBJECTIVES: Upon completion of this course, you will be able to:
1) Analyze the education role of the health professional in providing rehabilitation services.
2) Apply adult learning theories to the rehabilitation health care environment.
3) Utilize education research 'evidence' in facilitating adult learning in health care settings.
4) Assess educational need(s) in collaboration with a learner or group of learners in rehabilitation.
5) Assess, and discuss the implications of different learning styles and multiple intelligences in developing learning experiences.
6) Develop instructional plans for educating clients, families, colleagues, or students in a range of informal and formal learning contexts.
7) Use a variety of strategies to promote and foster client, family, colleague, or student learning.
8) Implement instructional strategies that reflect the age, culture, language, and learning style(s) of the learner(s) in face-to-face, distance, and e-learning contexts.
9) Apply the principles and purposes of authentic evaluation in education in evaluating the effectiveness of learning experiences.
10) Discuss the concept of lifelong learning and the role of continuing professional education in promoting this concept to health professionals.
1). Overview of Education in Health Care.
2). Ethical, Legal. And Economic Foundations of the Educational process
3). Applying Learning Theories to Healthcare Practice.
4). Determinants of Learning.
5). Developmental Stages of the Learner.
6). Compliance, Motivation, and Health Behaviors of the Learner.
7). Literacy in the Adult Client Population.
8). Gender, Socioeconomic, and Cultural Attributes of the Learner.
9). Educating Learners with Disabilities.
10). Behavioral Objectives.
11). Instructional Methods and Settings.
12) Instructional Materials
13) Technology in Education
14) Evaluation in Health Care Education


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"That which is overdesigned, too highly specific, anticipates outcome; the anticipation of outcome guarantees, if not failure, the absence of grace."
-- William Gibson, All Tomorrow's Parties
-- William Gibson, All Tomorrow's Parties
Flushing OS X's DNS cache.
I was whining about OS X and caching, and Rik bothered to think for two seconds:
<@rjbs> lookupd -flushcache
November 8, 2004 1:51 PM


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Ask yourself these questions:
- To build your business, are you required to recruit people into any kind of downline?
- Would you as a new recruit, by permitted and even encouraged to recruit other participants, who would in turn be encouraged to recruit still others, and they still more, etc. – from whom you could collect commissions and /or bonuses on what they buy or sell?
- Visualize yourself recruiting a chain of recruiters recruiting recruiters, including friends and loved ones, just to enrich yourself. Wouldn't you rather preserve and protect, rather than exploit, those relationships?
Note for persons using GOOGLE CHROME: If answer is YES, CLICK HERE.
Important Background for Red Flag #1
All multi-level marketing programs (MLMs), no-product pyramid schemes, and chain letters have this unlimited recruitment characteristic in common.
You would be wise to avoid any program in which you are recruited without limit into chains of participants (distributors, agents, representatives, etc.), which are organized into multiple levels, especially where the position in the chain or hierarchy of participants is determined by timing of entrance into the program and/or by success at recruiting a downline of participants. While a few earn substantial profits, the vast majority (at least 99%) of participants in such programs lose both time and money.
In at least four studies, chain selling schemes that feature unlimited recruitment in endless chains of participants have been found to be profitable only for a tiny percent (less than 1%) of participants at or near the top of their respective pyramids. Yet MLM promoters typically present their programs as outstanding business or income opportunities This fallacy is at the heart of a maze of misrepresentations used in MLM recruitment. Whether or not law enforcement interprets the endless chains of recruitment as an illegal pyramid scheme, it can be considered an unfair and deceptive trade practice – or unjust enrichment of a few at the top of a pyramid of participants at the expense a downline of misled participants, the vast majority of whom are mathematically pre-determined to lose money.
It should also be noted that quality and/or prices of products or services often becomes questionable when incentives are tied to recruitment.
This would apply to such products and services as health products, investments, or internet services. But even if the products are of exceptional quality, it is the inherently fraudulent design of the chain-selling program that misleads people into participating against their own best interests. The vast majority of recruits are destined to lose both time and money.
For most chain selling programs (multi-level or network marketing, etc.), income is dependent primarily on downline recruitment of participants who will buy (or subscribe to) products to "play the game." As a general guideline in evaluating MLM programs, if you must recruit to be successful, or if the primary emphasis in the compensation plan is on building a downline, it is not a viable income opportunity except for those at or near the top of the pyramid – who are usually those who joined at the beginning of the chain of recruitment. And you must decide if your success at the expense of so many victims will leave you with a clear conscience.
In summary, MLM is dependent on unlimited recruitment of endless chains of participants as primary customers. It assumes infinite expansion in a finite market. It also assumes relatively virgin markets. As a business model, MLM is therefore inherently flawed, fraudulent, and unprofitable except for a few at or near the top of a pyramid of participants. It is also extremely viral and predatory, preying on the most vulnerable among us.
To better understand market saturation in MLM, read the following:
Like territorial franchises, MLM companies could conceivably limit recruiting in a given area. But limiting the number of participants is uncharacteristic of MLM because it would dampen the illusion of the potential for huge incomes for new recruits. Such limitations would render any pyramid scheme impotent.
So while total saturation is never reached, when enough people are brought into the scheme that prospects perceive little remaining opportunity to sell or recruit, perceived or de facto market saturation has taken place. Market saturation would lead to collapse of the scheme, except that promoters typically expand to other geographical areas or set up new product divisions to survive and grow.
Some MLM proponents argue that continual dropouts justify replacement through ongoing recruitment, much as in other direct sales businesses. But this is a fallacy. Later recruits never have the same opportunity as earlier entrants due to facto saturation.
All MLMs allow for unlimited recruitment of participants. The fact that an MLM compensation plan limits the number of levels upon which any distributor can be paid overrides from the company does not negate the "endless chain" feature of the scheme. The mathematical impossibility of later recruits enjoying the same financial benefit as earlier participants is apparent.
NOTE: For the most thorough treatment on the topic of saturation in MLM, read Chapter 3 of the ebook Multi-level Marketing Unmnasked, which can be downloaded in whole or in part from our website.


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This I Believe
Throughout my entire life I have strived to be perfect: To have the best grades, to be the best athlete, to have many friends, to be strong in the church, to eat the right foods, to play an instrument, to listen to the right music, even to wear the right clothes. But the older I become, the more I realize that this goal of perfection rests on a very flawed theory. Because we are human, we make mistakes, so we cannot be perfect. However, through the mistakes we get closer to perfection. I make mistakes every day of my life. Some mistakes are minor, but there are also the major ones that have lasting effects that make us change, helping us inch toward perfection. I received a D in my sophomore year in an accelerated algebra class for one quarter. My parents told me this would hinder me from getting into a good college. I felt like my life was coming to an end. But I worked hard, pulled the grade up for the semester, and I have not received nearly that low of a grade for the semester since then. My mistake taught me to study and work harder.
Another big mistake I made was not listening to my wise parents. I was once cleaning out my garage with my mother. The smooth finish of the floor was covered with a layer of water. I was running and sliding across the floor like an ice skater, and my mom asked me to stop because she did not want me to fall. I, of course, knowing everything, went right ahead skating. No less than 30 seconds after my mom asked me to stop, I fell back, hit the concrete, and split open my head. I had to get five staples in my scalp to put it back together. From this mistake that came with physical pain I learned to try my very best to listen to my parents when they advise me.
Perhaps the biggest mistake I ever made has been not spending enough time with my older sister, Claire. She was severely handicapped, and was very limited in what she could do. I loved her, but when she was here I feel like I did not spend enough time with her. There was so much more that I could have done for her, and so much more time I had that I could have spent with her instead of wasting it on pointless things. Now she is gone, after being in my life for 16 years, and I cannot ever have that time back. I now spend time with my family whenever I can, and spend every moment with them as if it were the last.
I have come to a conclusion on this matter of perfection. I have made many mistakes, and I am not perfect. I am far from it. Perfection is something that cannot be achieved because we are humans; however, because we cannot be perfect in life we learn to be successful in life. To learn from the mistakes that I make is the key to striving for perfection. From our mistakes we learn to move on, improve, and to not make the same mistake twice. In this, I believe with all of my heart and soul.
If you enjoyed this essay, please consider making a tax-deductible contribution to This I Believe, Inc.


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You have lived all your life as a proud Texan in the home of your ancestors. You have a lot of cherished memories associated with this home. At the same time, you are aware of the problems associated with the home. As this home was constructed many decades back in time, it does have its share of problems. The age of the building is causing problems and you are seeing cracks in some places. Now, it is high time to either rebuild it or purchase a new home. Boerne TX homes provide you with a great opportunity to own a nice home with in your cherished Texas back ground.
Texas is a state known for the family values that are highly cherished here. This is the state with the largest number of marriages in the entire country. Thus, this would be a great state to grow old with your beloved family members and pass on the history of your family. As you have lived all your life in this cow boy country, it would be better for you to continue your life here in the same neighborhoods.


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Although we don't believe in timing the market or panicking over market movements, we do like to keep an eye on big changes -- just in case they're material to our investing thesis.
What: Shares of VMware (NYSE:VMW) have jumped today by as much as 10% after the company announced plans alongside parent company EMC (NYSE:EMC) to spin off a business unit.
So what: The two companies said they will create a Pivotal company that will include VMware's Cloud Foundry service as well as EMC's Greenplum data analytics software offerings. Pivotal, which EMC acquired last year for an unknown price, will target big data trends in the enterprise. VMware also said it was targeting 20% annual revenue growth by 2016.
Now what: EMC CEO Joe Tucci said that Pivotal could "potentially" be an acquisition target, but that'd be in the distant future. Pivotal is nowhere near ready to do an IPO, and while that is the intended end result, it's still far away. Factoring in the Pivotal announcement, VMware said revenue this year is expected to be in the range of $5.12 billion to $5.24 billion.
Interested in more info on VMware? Add it to your watchlist by clicking here.
Fool contributor Evan Niu, CFA, has no position in any stocks mentioned. The Motley Fool recommends VMware. The Motley Fool owns shares of EMC and VMware. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.


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Micah Richards is looking to be back in action for Manchester City by February.
The 24-year old right-back has not played since the end of October because of a knee injury but is now on the road to recovery following surgery and should be back in a couple of months.
"I am not putting a date on when I will be back because these things are never exact but I am hoping it will be in early February," he told the club's official website.
"There is still not too much I can do but I am now on one crutch instead of two so that is progress.
"Of course it is frustrating and there is nothing more I would like than to be out there playing but I am being well looked after, the injury is responding and the knee getting stronger every day."
Click here to reach the No1 destination for hard news and exciting gossip on Manchester City