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Each week we tell viewers what they can get for free. This week's free list: 1) The Defibulators ART Gallery 2) Lindor truffles giveaway
Come out to Chelsea Market to see the "Everybody's Got A Banjo" photo gallery show. Last month, "roots-rocking punk iconoclasts" The Defibulators packed out Brooklyn Bowl for their record release concert, a curated night of Brooklyn country music that hosted some of the borough's best banjo pickers (the finale featured 6 onstage together at once). As fans streamed in all night, many paid a visit to the live "Everybody's Got A Banjo" photo booth, where fashion/music photographer Teddy Telles shot hundreds of portraits. The best are hanging now as a special gallery in Chelsea Market through the end of October.
The Defibulators' new album, 'Debt'll Get'em,' has been earning raves everywhere from CMT to My Old Kentucky Blog. Esquire hailed their video for "Let Me See That Ponytail Run" in an exclusive premiere, and TIME featured their tongue-in-cheek track "Everybody's Got a Banjo," which playfully skewers the instrument's recent ubiquity in their home borough and pop culture more broadly.
WHO: The Defibulators & their fans
WHAT: "Everybody's Got A Banjo" photo gallery
WHERE: Chelsea Market
WHEN: Open now until the end of October
TICKETS: Free to the public
The Defibulators' official website is http://thedefibulators.com/
Two lucky viewers will be able to win a copy of their latest CD. All you have to do is follow and tweet them #FREEFRIDAY and why you want love them, today between the hours of 12 noon and 2 pm.
Winners can only enter once and will be randomly selected.
Winners will be notified via DM and will have to provide their contact info to receive the cd.
Good luck.
– – – –
Lindt is teaming up with celebrity chef and "Top Chef Masters" host, Curtis Stone, to educate chocolate lovers about the importance of innovation, quality ingredients and expert craftsmanship to produce delicious dishes and products. There are lots of ways for your viewers to "taste the difference" through this program. First, Lindt and Stone are unveiling a series of educational vignettes to show consumers the impact these elements have on everyday indulgences. Furthermore, to give chocolate lovers – like those among your readers – the opportunity to actually taste the difference for themselves, Lindt is sharing two million coupons for its products via its Facebook page (https://www.facebook.com/LindtChocolate).


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subset: commoncrawl


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6 Observations on Investment, Mergers and Acquisitions in Healthcare
1. Merger and acquisition activity has increased significantly over the past year. According to Mr. Mercier, mergers and acquisitions slowed considerably in 2009 due to the debate over healthcare reform and the difficulty of obtaining credit. "I think there was an incorrect sense that the healthcare sector would be somewhat shielded from the downturn in M&A activity," Mr. Mercier says. Over the past year, however, credit has started flowing again, and the effects of healthcare reform — including regulatory measures, reimbursement cuts and other financial burdens — are clearer.
"The major reform effort caused a lot of uncertainty with regard to the future environment, and it became challenging for business owners to predict cash flows," Mr. Mercier says. "It was difficult for buyers to get comfortable with what the outlook would be, and they were forced to stand on the sidelines." In 2010, the dollar volume of healthcare services transactions spiked dramatically, indicating a much healthier M&A environment, Mr. Mercier says. He expects merger and acquisition activity to continue over the next few years as credit continues to flow, ancillary service providers seek to gain scale, and hospital chains pursue acquisitions of smaller facilities.
2. Hospitals are looking to acquire physician practices; practices may be hesitating. Mr. Mercier and Mr. Sullivan see a strong desire on the part of hospitals to acquire physician practices and align their providers with organizational goals. Practices, on the other hand, may be hesitating. "In terms of a knee-jerk reaction [to healthcare reform], there's certainly a higher level of interest among hospitals," Mr. Sullivan says. While hospitals stand to gain by protecting their referral stream, physicians in a group practice have to adjust to the idea of selling their business and working more closely with the hospital. "I think that at a high level, it's clear there are benefits to both sides, but the physician has to sit across the table from his partners and say, 'we're going to sell this business that we built together,'" Mr. Sullivan says. "That's a process that can be like herding cats because there are a lot of different viewpoints. It often takes a long time for a group of independent physicians to achieve consensus." He says that while hospital acquisition is probably inevitable for many physician practices, it may take a few years for practices to seek out hospitals with the same enthusiasm.
3. Visibility of future reimbursement cuts makes M&A activity more likely. Healthcare reform put a damper on M&A activity as hospitals, health systems, and other providers paused to consider their next move. But as the economy improves and future reimbursement patterns become clearer, Mr. Mercier and Mr. Sullivan expect to see increased M&A activity — already in evidence based on the 20 percent growth in reported deals in 2010. While reimbursement rates are scheduled to drop over the next few years, Mr. Mercier says mergers and acquisitions will likely continue because lenders, private equity groups and strategic acquirers can plan for the future. "As long as they can get their arms around what reimbursement is going to look like over a three- to five-year period, they can adjust for those rate cuts and develop a business case that makes sense," Mr. Mercier says.
4. Outpatient rehab and hospice are growing. Mr. Mercier and Mr. Sullivan expect that outpatient rehab will continue to grow as an industry in the coming years, as a result of cost-containment measures by healthcare payors — which are resulting in higher patient volumes in low-cost settings of care — the aging population, greater focus on wellness and preventative medicine, and patient preference.
The aging population also means that hospice services that treat end-of-life patients should experience growth over the next several years, according to Mr. Mercier. "When patients are nearing the end of life, they would certainly rather be at home with their loved ones than spending their final days in an acute-care facility or nursing home," Mr. Mercier says. "You do see macro trends suggesting that hospice growth will continue." While home health reimbursement has run into challenges, Mr. Mercier has had recent conversations with a number of private equity investors looking for platforms in the hospice space. The value of such businesses is compounded by the lack of sizeable hospices available for sale.
5. Technology-enabled cost containment services are expected to experience a surge. While the healthcare reform effort made major strides in providing coverage to millions of uninsured Americans, it lacked clear plans to manage increasing costs, Mr. Mercier says. "There is a recognition that there is going to have to be heavy pressure on reimbursement, and the only way to maintain profitability is to ensure that care is being provided in the most cost-effective way possible," Mr. Mercier says.
The current options for cost containment technology are somewhat limited, but Mr. Mercier expects the market for such technology and related services to increase significantly in the next few years. He adds that the growth should not be limited to software products; while technology is important, providers have to use technology effectively rather than just purchase a piece of software. "It's one thing to put in a new IT system, and it's another thing to make sure it's being used appropriately, in order to maximize its potential," Mr. Mercier says.
6. ASC acquisition activity is increasing. According to Mr. Sullivan, ASC acquisition activity increased significantly in 2010, although to a lesser extent than other physician practice acquisitions. "There was a long hiatus in terms of hospitals acquiring physician groups," Mr. Sullivan says. "It was a very popular practice in the 90s, but a lot of those deals didn't work out. Over the past year or two, however, the regulatory and reimbursement environment has evolved in such a way that activity has increased dramatically." He says the ASC market is different; while ASC acquisitions and partnerships have experienced an increase in the past year, the level of activity has been robust for a while.
Read more on transactions and valuation:
-5 Steps Surgery Centers Should Take Before Selling to a Hospital
-Pennsylvania Surgery Center in Stroudsburg to Undergo Significant Expansion
-Connecticut Surgery Center Ophthalmologists Under State Review for Required Hospital Coverage
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Book Review: "Max Baer and the Star of David"
Neugeboren the novelist is more interested in what's below the biographical facts of wins tallied and punches thrown…
Jay Neugeboren has written twenty-one books, which in boxing terms makes him a seasoned professional. His work, fiction and non-fiction, has covered a spectrum of life's big topics, love and lust and ambition and loss, but Neugeboren started his writing career with a sports novel titled Big Man about a basketball star brought down by a point-fixing scandal. In his most recent novel, Max Baer and the Star of David, Neugeboren turns to boxing for his inspiration.
Max Baer was a larger-than-life character in real life, a man with insatiable appetites blessed with a beautiful body and a vicious punch. He was responsible for two deaths in the ring. He dated movie stars and starred in movies. He reigned briefly as heavyweight champion. If the cliché that truth is stranger than fiction rings true, then Baer trumped the cliché—his biography was more Hollywood than Hollywood. Max Baer and the Star of David goes deeper than Hollywood and enlightens more than biographical facts. While Neugeboren's novel follows the trajectory of the famous fighter's life, with quick attention to Baer's most celebrated bouts, Neugeboren is far more interested in exploring Baer's life outside the ropes.
The narrator of this story is Horace Littlejohn, who begins the novel as a young man living with his sister Joleen in San Francisco. They've escaped a harsh family past, hidden their identities by pretending to be husband and wife, and, out one night, are spotted by Max Baer. The young heavyweight is smitten with Joleen's beauty and makes an offer to the young black couple: He will put them up at his ranch in exchange for services rendered. Some of these services are work-related—Horace, a boxer himself, will work out and travel with Max as he fights across the country; Joleen, a teacher by trade, will help educate Max's family. The non-work-related services are more intriguing—Max enters an already illicit love affair (the incestuous relationship between brother Horace and sister Joleen) to create an unlikely threesome. Baer's appetites are never sated, he continues to live his heightened life away from Horace and Joleen, dating and/or marrying one white woman after another, but away from the spotlight, his clandestine relationship with this black couple becomes a steady if immoral compass. Their connection is sealed when, after the birth of Max's legitimate son, Joleen bears a child, the illegitimate Horace Littlejohn, Jr. While the boy has Littlejohn's name, his genes are Baer's. Joleen's motives to have a child with Max may not be pure, theirs is a complex relationship and Joleen lives "in the unlit caves of her melancholic disposition," but Max's love for his secret son is pure and good. Through Horace's formal-sounding narration, for Horace is a man who studies and knows the bible, Neugeboren highlights the heart of heavyweight champ Max Baer, not his fighting heart but his loving heart. Baer's words often seem simple, his wit is often sophomorically crude, but his allegiances are mighty.
The fight scenes themselves are quick, painted with enough detail to suggest Max Baer's ring prowess. But again, Neugeboren the novelist is more interested in what's below the biographical facts of wins tallied and punches thrown, namely the expressions and origins of violence. Bridging the seeming discrepancy between Baer's deadly fists and Baer's innocent, almost childlike love of life, Horace Littlejohn tells us, "I believe he (Max Baer) loved being lost in an elemental passion for hitting and being hit…and he also loved the gratification that came with practicing a craft at which he was master, and which like the act of love, and the ecstasy of being in love, fed his desire to take as much pleasure from life as possible, so that the extended moments in which he could give free reign to his power and his desires, whether in the ring or in his romances, served to enhance and heighten his love of life itself."
Horace and Max are brothers in spirit if not blood. Intimate friends, they are connected by one woman and so connected biblically. While their lust mostly happens offstage, their physicality onstage takes the form of playful sparring. They never engage in the death hugs featured in George Bellows paintings; instead, their embraces are loving, akin to two fighters holding each other after a fight. This pure bond between two men, a love beyond violence and lust, almost post-coital in its peacefulness, is part of the "heightened" life-love Horace describes.
Max Baer was only a quarter Jewish, but he wore a Star of David on his trunks, smart marketing in the 1930s when many Jews fought professionally, especially smart when Baer fought and pummeled German heavyweight Max Schmeling. But the symbolic star resonates beyond a marketing ploy in this novel. The lusty connection between black Horace and Joleen and white Max, champion of and for the Jews, suggests a larger racial connection. Blacks and Jews, the slaves of the United States and the original slaves in Egypt, two oppressed races forced to do hard labor and too-often forced to hide their identities or watch their words, are united physically and symbolically in Neugeboron's novel. Only once does Max's in-ring violence enter his daily life, and it's to defend his brother Horace. While enjoying a night out, a belligerent customer confronts the two friends and points to a We Serve Whites Only sign above the bar. At first, Max counters the racist with humor: "So you're okay then. They can serve you here." But when the altercation escalates and the bartender pulls out a baseball bat to enforce the whites-only rule, Max, not a young man anymore, flexes his muscles. Another patron recognizes Max as the great Max Baer, and when his identity is revealed, the mere mortals back down. Horace Littlejohn infers the race-connection when he wraps up the tale, "The man who had confronted Max backed away, told Max he didn't mess with killers or kikes, and hurried out the door." The black man and the man representing the Jews remain in the bar. The racist is banished. Max buys everyone a round of drinks and, if only for a moment, unity trumps hate and divide.
Max Baer and the Star of David is a novel first, a boxing novel second. And that's how it should be for a novel whose title character may have been more famous for his out-of-ring escapades than his pugilistic career. The real fighters in this novel are the people that surround Max, Horace and Joleen and a woman Horace falls for as a middle-aged man, a woman who teaches the handicapped how to hear without hearing and see without sight. Novelists fill in the senses; they make the unreal real. Jay Neugeboren takes old fight-film footage, removes the graininess, introduces color, helps us hear and see the men and women behind the man, as well as the man himself, Max Baer, whose life was as colorful as the deep blue star emblazoned on his trunks.
Adam Berlin is the author of the recently published boxing novel Both Members of the Club (Texas Review Press/winner of the Clay Reynolds Novella Prize). His other novels are The Number of Missing (Spuyten Duyvil), Belmondo Style (St. Martin's Press/winner of The Publishing Triangle's Ferro-Grumley Award) and Headlock (Algonquin Books of Chapel Hill). For more, please visit adamberlin.com.


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text: This is an automated email from the git hooks/post-receive script. It was generated because a ref change was pushed to the repository containing the project "The Open Source GSM Base Band stack". The branch, laforge/virtphy-gprs has been created at fabf8091adc0e60019c795e035131d87399ace7d (commit) - Log ----------------------------------------------------------------- http://cgit.osmocom.org/osmocom-bb/commit/?id=fabf8091adc0e60019c795e035131d87399ace7d commit fabf8091adc0e60019c795e035131d87399ace7d Author: Harald Welte <laforge at gnumonks.org> Date: Sat Mar 3 12:30:01 2018 +0100 WIP: virtphy: Add L1CTL_DATA_ABS_REQ support L1CTL_DATA_ABS_REQ is used for transmitting single uplink blocks at pre-determined frame numbers. This is required as part of the "polling" procedure for UL ACK of DL control blocks, which works irrespective of any USF. Change-Id: I77b168791cf972d8e625df54c4653b23f4abcb82 ----------------------------------------------------------------------- hooks/post-receive -- The Open Source GSM Base Band stack


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thumb the button:Of a female, to masturbate . See masturbation-female for synonyms.
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The Wee Art Studio is run by art teacher Caroline Bennett in her studio in Clarkston.
Caroline has over 20 years' experience in working in all fields of education including mainstream primary, secondary and additional support needs. She holds additional qualifications in both Nurture and Additional Support For Learning, is fully registered with the General Teaching Council for Scotland (GTC)
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• The Wee Art Studio is moving in July to Clarkston Road. We will keep you Posted!
Term 4 Saturday Kids Art Class, Adult and Teenage Art Classes 2019
Saturday Kids starting 27th April, (8 weeks) £78. Thursday Adult art classes, 7-9pm, start 2nd May 2019, (7 weeks) £135.
Teenage Art classes start Wednesday 24th April, 6.30pm-7.45pm, (8 weeks), £78.
- Classes can be booked on website or contact Caroline for more information or want to be informed if future spaces.
You can book Summer Kids Classes NOW!


text:
From: Alexander Peshkov (email@example.com)
Date: Mon Dec 15 2003 - 01:58:44 PST
Hello Lars,
LW> Hello,
LW> I want to create a document with tables mirrored horizontally on even
LW> pages.
LW> Defining the writing-mode directly in the page-sequence-tag works (for
LW> all pages unfortunately).
LW> When I tried to set the writing-mode in the region-body-tag in the
LW> layout-master-set it does not work.
XSL FO specifications states that when writing-mode set on
fo:region-* it defines the column-progression within each region. This
property would not be inherited by the content of the flow.
LW> Is it possible to define the writing-mode for a page-sequence and the
LW> content in the layout-master-set?
No, it's not. Setting "writing-mode" on the simple-page-master defines
only the placement of the five regions on the master.
LW> Many thanks in advance,
LW> Lars Weinrich
Best regards,
Alexander Peshkov mailto:firstname.lastname@example.com
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you are subscribed from.
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This archive was generated by hypermail 2.1.5 : Mon Dec 15 2003 - 02:02:42 PST


text:
This sweater features a round neck, contrast rib trims and curve hem. Made from viscose/polyester, this sweater is available in multiple colours and in sizes XS to L. Golden Tan is paired with the Mid Rise Skinny Jean and Amy Loafer, and Cloud Cream is styled with the Side Stitch Jean, Half Moon Belt Bag, Georgia Block Heel Boot. Bold Fuchsia is paired with the High Waist Pleat Pant and Billie Flatform Sneaker. Our model wears size XS and is 179cm tall. Please wash as per care instructions found on garment.
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To get the best possible experience using our website we recommend that you upgrade to a newer version or other web browser. IE8 and lower is no longer supported. A list of the most popular web browsers can be found below. Click on the links to get to the download page.
This form shows us that you are interested in studying at Kaurilands School and would like more information. Once your form has been processed we will contact you about further steps for International Student Enrolment.


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Concentrate to the lights while in the places where you should put in security cameras. Look for features like night time vision and movement-activated floodlights—specifically for outdoor security cameras.
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Thursday, May 17, 2018
Just One Thing
44 comments:
- AnonymousMay 17, 2018 at 9:13 AM
MY THING: 100% VOTER TURNOUT IN BOG ELECTIONS!ReplyDelete
Andrew Craner*
Jessica Goodey*
Terry Coffing
Casey Quinn*
Cory Santos, Sr.*
Jay Shafer*
Paola Armeni
John "Jack" Howard, Jr.
Kari Stephens
Ryan Works
Statement by challenger Jay Shafer here: https://lasvegaslawblog.blogspot.com/2018/05/procedurally-improper.html?showComment=1526081354206#c6929486821478588602
Bios here: https://www.nvbar.org/about-us/board-of-governors/board-governors-elections/2018-board-governors-candidates/
*Candidates have publicly stated opposition to random audits of trust accounts.
CHECK SPAM FOLDER FOR EMAIL LINK it comes from firstname.lastname@example.com
- AnonymousMay 17, 2018 at 9:31 AM
Keep posting, 9:13. Oh, Dina Titus refuses to release her tax returns.Delete
- AnonymousMay 17, 2018 at 9:14 AM
Appointed judges (with some type of workable checks and balances component)ReplyDeleteReplies
- AnonymousMay 17, 2018 at 9:32 AM
At the very least there should be no money changing hands between attorneys and the judges they're appearing in front of.Delete
- AnonymousMay 17, 2018 at 12:06 PM
I agree with 9:32 am. I'm not sure that having appointed judges would fix the problems we have. But at the very least we should be avoiding the appearance of bias on the part of judges who accept campaign donations from attorneys who appear in front of them.Delete
- AnonymousMay 17, 2018 at 2:25 PM
I believe that judges who have to campaign and solicit donations is the source of so many problems. The quality of statutes and the quality of justices and the effectiveness of oversight for administrative agencies (including whatever the Bar is).Delete
- AnonymousMay 17, 2018 at 7:45 PM
The O'Conner appointed judges plan is just as political, if not more so than a pure election system. You don't necessarily get better qualified candidates, you simply have a different group of individuals in control of the selection among the candidates. If you want the bar elites in control then the appointment process is your best process. If you want to bring change and shake up the status quo then the election model is for you.Delete
- AnonymousMay 17, 2018 at 9:20 AM
Better judges on the Nevada Supreme Court - ones who are smart, honest, hard-working, and professional.ReplyDelete
- AnonymousMay 17, 2018 at 9:35 AM
Vote StiglichReplyDeleteReplies
- AnonymousMay 17, 2018 at 11:08 AM
Not a chance in hellDelete
- AnonymousMay 17, 2018 at 2:26 PM
Harter is a lazy dullard. Stiglich in a landslideDelete
- AnonymousMay 17, 2018 at 4:47 PM
Stiglich makes me nervous. I have heard good things about her, then bad. No judge should ignore facts.Delete
- AnonymousMay 17, 2018 at 7:48 PM
Facts are an interesting animal. One person's facts is another's fiction... Over the last generation we seem to have lost the ability to discern fact from fiction, thus the concept of "alternate facts"Delete
- AnonymousMay 18, 2018 at 2:32 PM
@2:26 PMDelete
Not sure why you would hold that perception. All my cases with Harter are resolved/decided very timely. Sounds like you do not even dabble in Family Court since Harter has the reputation of being extremely efficient.
- AnonymousMay 18, 2018 at 2:45 PM
And I'm sure the issues before Harter are quite complex.Delete
- AnonymousMay 17, 2018 at 9:37 AM
That the State Bar become more than a star chamber for large law firms persecuting solo practitioners for smallest perceived infractions while ignoring documented proof of misdeeds by those working for a large firm.ReplyDeleteReplies
- AnonymousMay 17, 2018 at 10:07 AM
Im no fan of the state bar, but you have no credibility on the "documented proof of misdeeds" claim unless and until you post said documents.Delete
- AnonymousMay 17, 2018 at 10:14 AM
Yeah I see these vague allegations against big firms on here all the time without corroboration. Despite the fact that I mainly practice against lawyers from big firms, probably 95% of the unethical conduct I have come across has been from solos and firms with <5 lawyers.Delete
And, when I have seen such conduct, I have reported it to the bar in line with my professional ethical obligations. Have you reported these "misdeeds" of which you are aware, 9:37?
- AnonymousMay 18, 2018 at 10:06 AM
Consider Justice Cherry's comments during the random audits discussion that he perceived that the State Bar targets smaller firms while allowing big firms to escape scrutiny.Delete
- AnonymousMay 18, 2018 at 11:42 AM
Equal protection, the court cannot treat one party differently than the other, two uncons. Unconstitutional and unconscionable. I agree with Cherry.Delete
- AnonymousMay 17, 2018 at 10:46 AM
9:37 here, I was not trying to make a blanket statement on the "big firms" but rather the perspective of the Bar that if it relates to a "big firm" it is viewed with less suspicion than if a grievance is against a smaller firm. Please read my post carefully, it was not toward "big firms" but toward the Bar. It has become institutionalized in Nevada to the point that 10:14 says (with I doubt any empirical evidence or research) that it's "probably 95%" which kind of proves my point. Re: posting, do you really think I would post that online? In a blog full of anonymous users we debate with some assumed credibility - and if that's not good enough, don't know what to do. Simply stated, my point is this, if two exact grievances were sent to the Bar, one toward a large firm and one toward a solo, there is no doubt at least in my mind, the Bar would take the one toward the solo much more aggressively. My background is in a mid-sized firm so I don't have a dog in the fight in either case but I have been around the Bar enough to believe this. I suppose blog users can take it or reject it as they will.ReplyDelete
- AnonymousMay 17, 2018 at 1:31 PM
More judicial holidays!ReplyDelete
- AnonymousMay 17, 2018 at 2:19 PM
ECCs via phone conference allowed. Remind me why I have to drive 30 minutes to Plaintiff counsel's office to agree to 12 months of discovery following all the normal rules? As a lowly insurance defense attorney I appreciate the billing oportunity, but it's just a waste.ReplyDelete
- AnonymousMay 17, 2018 at 2:53 PM
As Neil Galatz (may he rest in peace) would have said, let's get rid of discovery.ReplyDeleteReplies
- AnonymousMay 17, 2018 at 3:16 PM
A lot of it is really unnecessary. You could certainly set up a system with less discovery.Delete
Certain firms would go out of business if they couldn't depose my client's third-grade teacher to find out if there had ever been any prior complaints of back pain.Delete
2:53 -- What a great idea. While we're at it, let's just settle every dispute with pistols at dawn.Delete
- AnonymousMay 18, 2018 at 11:33 AM
Dawn is way too early... high noon would be a much more agreeable time for me.Delete
- AnonymousMay 17, 2018 at 3:17 PM
"Word to your mother" on: 1) more judicial holidays and 2) big firms get away with things and small firms or solo practice lawyers get sanctioned or disciplined.ReplyDelete
- AnonymousMay 17, 2018 at 3:23 PM
Violation of Constitutional rights claims should be allowed against State judges in Federal Court.ReplyDelete
- AnonymousMay 17, 2018 at 4:16 PM
We don't know what you're talking about that the BOG isn't transparent. Look, our website has all of our upcoming meetings listed on it (including next year's annual meeting in Vail, Colorado)! https://www.nvbar.org/about-us/board-of-governors/ReplyDelete
Upcoming Meetings
July 11, 2018: Chicago, IL (Annual Meeting)
Sept. 11-12, 2018: Fallon, NV
November 15, 2018: Las Vegas, NV
Jan. 23-24, 2019: Carson City, NV (Meeting with Nevada Supreme Court)
April 11, 2019: Reno, NV
June 26, 2019: Vail, CO (Annual Meeting)Replies
- AnonymousMay 17, 2018 at 4:28 PM
Send me the link for Noel Gate's book, Kari. ThanksDelete
- AnonymousMay 17, 2018 at 4:29 PM
- AnonymousMay 17, 2018 at 4:37 PM
Why so many two day meetings?Delete
- AnonymousMay 18, 2018 at 10:08 AM
That you (ummmm I mean "they") are meeting and what is being discussed are very different things. No one would say that the Grand Jury process is transparent just because it is pretty easy to figure out when it convenes.Delete
- AnonymousMay 18, 2018 at 2:36 PM
Bring back the apprenticeship path as an alternative to law school.ReplyDelete
Boyd school of law classes of 2011 and 2012. Thank you to Meg Schmidt for being the meanest b*tch to me during my 2L year. I'll never forget what a nasty person you were to me. I seriously hope you have a terrible life.ReplyDelete


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Home About me MFT Addiction Abuse Entertainment Ind Specialties Faith-Based How to?-FAQ Medications Ethics Payments/Insurance Appointments
See also Substance/Alcohol Addiction
Sex/Love Addiction
When the word addiction is mentioned, most people think of illegal material such as Heroin, Cocaine, or other similar habit forming substances. In recent years new forms of addiction have surfaced. Terms such gambling, food, and sex addiction have become more popular. Therefore addition is not just about substances, but there are other addictive behaviors that are just as destructive to our lives as these substances.
One of the major problems we are facing in our modern society is Love and/or Sex Addiction. These can be more damaging than any substance. This form of addiction not only hurts the addict, but their families including wife/husband, children and grandchildren, their jobs, their friends and the circle just gets wider and wider.
Treating sex addiction involves teaching the patient new ways of behaving as well as new ways of thinking, since sex addiction is both a behavioral disorder and a thought disorder. One of my specialties is treating love/sexual addiction. Through the years, I have attended group meetings, interviewed sex addicts, read dozens of research material and treated tens of individuals with this type of addiction. I have produced my own program of treatment which has proven to be very successful. Using this program I interview the patient with very specific questions. I will then produce a specific treatment plan for that particular patient and in a very directive way teach the patient how to use the plan. These plans are patient specific based on the interviews that I have had with them.
I also try to involve partners in this treatment. Partners of Love/Sex addicts have been hurt and need their own treatment. Helping the addict member of the family with their treatment will become a part of their own recovery and treatment. This in turn will help get family ties closer, and ensure the minimization of relapse.
Are you suffering with Sex Addiction
Here are a few guidelines. Do you ever have these thoughts or feelings:
These are just some of the traits of a sex addict. Sex takes over and controls everything.
� Copyright 2011, Alex Karimi


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Video-surveillance system
Since the end of 90`s we have seen an revolution in the use and variety of applications for CCTV systems in the security industry. This happened because people seem to find it easier to manage machines than than other people. Hiring, managing, and monitoring the performance of guards takes time and effort, but a well-designed CCTV system will significantly reduce your manpower requirements. Many CCTV systems will even pay for their installation in saved payroll costs within 2-3 months.
The heart of today's CCTV system is DVR (digital video recorder ) which replaced the old tape based VCR. No more TAPES to change! The built in 500 or more gigabyte hard drive, network card, and included software allows you to connect from any internet PC to view live and recorded data, or remotely Pan, Tilt, and Zoom the ADEMCO Rapid Dome or similar cameras. You can then save your data as another format (mpeg or jpeg) and e-mail that to the police, your client, loss prevention office etc.
Tricom security provides all the types of the CCTV system, from a simple backyard camera connected to the house TV right up to internet based 64-camera commercial systems. Tricom security is using one of the best known Honeywell CCTV systems. For many applications our customers ask for night vision cameras to get more security through the night. Our CCTV prices start from $2000 for 4 cameras with the internet access feature . Some of the our DVR systems come with free X10 automation panels preinstalled and free IPphone adapter**.
CCTV system price list
So if you need a Best CCTV system , you've come to the right place.
The HD6 Series offers the highest performing PTZ domes on the market.
Honeywell Video Systems� HD3VM4A indoor monochrome dome camera is a versatile, cost effective, integrated surveillance solution.
The HRDE 4x4 is a high-quality stand alone and/or networked digital video recorder (DVR) with built in audio recording capabilities.
Comments ?
*Ademco and Honeywell is property of Honeywell International Inc 2004-2005
**2 year contract may be required for free VOIP adapter


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Debbie, a working class single mother from Leeds, moves her family to Bradford, where they find themselves in an ethnic minority. Daughter Leah must adapt to being the only white girl at school.
White Girl (2008)
Studio: Tiger Aspect Productions
Director: Hettie Macdonald
Writer: Abi Morgan
Cast: Anna Maxwell Martin, Daniel Mays, Melanie Hill
For more classic movies and clips, subscribe to Retrospective: https://www.youtube.com/channel/UCibOdW_Yj0-pj5SQGZxZIgA?sub_confirmation=1
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Recently I was standing at a friend's open kitchen window drinking a cup of tea while she was at the barn talking to the farrier who had put special shoes on her 35 year old horse, Charles. Sound travels easily across pasture, and I heard the farrier say, "I don't know… sometimes I stop and notice the day and think it's a beautiful day to die." I had no idea what was being discussed, but he had my attention.
Later during dinner my friend mentioned the conversation with the farrier. They had been talking about Charles, who struggles to get to his feet after lying down as a result of severe arthritis. She then said what I had heard earlier: "the farrier said sometimes he stops and notices the day and thinks it's a beautiful day to die."
Tears welled in her eyes as she added, "Well, it is another perspective, isn't it?"
Yes, it is a different perspective and possibly one to thoughtfully explore
Because California is in a drought, we have had one beautiful day after another this winter, and I often catch myself saying out loud "what a beautiful day!" Since hearing the farrier's words I find myself adding "and it would also be a beautiful day to die." While I am certainly not eager to die, I have noticed the words bring a sense of peace.
There comes a time when there is no U-turn or bypass
Without realizing it, you have practiced all of your life for your final day on earth.
From childhood on your life falls apart. You have no easy answers. You feel broken. And then life rearranges itself and you adapt. Eventually, what seemed unbearable becomes a bittersweet memory, and you are stronger and more resilient for having had the experience.
This is not a crass process. It takes guts.
At some point, when you least expect it, you are forced you to come to terms with the daunting and often paralyzing fact that your life is coming to an end. Unfortunately our contemporary perspective views death as the failure to stay alive, and so we sign up to extend our life medically and fight to remain alive.
Does the day you die have to be the end of a battle?
You might not be able to control when you die, but you could consider that the day you die is not the end of a battle, but the end of years when everything that happened belongs, and everyone who has come and gone belongs. Yes, everything that was good, bad, sad, hare-brained, half-witted, baffling, bewildering and unfathomable belongs… and it's a beautiful day to die.
And until that day, doesn't it make sense to get out "into it"—get out into the beautiful days you have left. Become aware of what a beautiful day is—and ask if your expectations of life are reasonable—or are they getting in the way of another beautiful day.


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Dundalk District Court
Dundalk man fined for having no lights on bike
Dundalk courthouse
An 18 year old man who had no lights on his bike when he was stopped by a gardai in Dundalk, was fined €50 at the local district court.
John Keenan with an address at Glenwood, Dundalk was summonsed for having no front or rear lamps on his bicycle, at Roden Place on February fifth last.
The investigating garda told the court he had stopped the defendant at 5.37pm and while a fixed charge penalty notice had been issued, it had not been paid.


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Praying with the Saints: It Works
The saints form an integral part of Catholic life. This was highlighted by the recent Saints of Italy pilgrimage. GUNTHER SIMMERMACHER reflects on our relationship with the saints.
The weather forecast for Venice was dismal: dark skies, rain. And, as our local tour director assured me, if it rains in the morning in this region, it will rain all day. "Pack your umbrellas", we were told.
We had enjoyed a week of glorious weather on our Southern Cross/Radio Veritas Saints of Italy pilgrimage in September. But now, in beautiful Venice, it was raining.
By the time we emerged from our morning Mass in St Mark's basilica, the vast piazza in front of it was flooded. We had to enter the basilica for our tour by navigating hastily erected planks.
But when we came out again, the sun had emerged. And we ended up with a day of glorious sunshine.
I give the credit for that to St Scholastica. In the morning I had asked the patron saint for rain for her intercession to stop the rain, and invoked her twice on the bus. Clearly St Scholastica came through for us.
The scientists may refer to meteorological phenomena that conspired to deceive the weather forecast and conventional wisdom. Whatever those might be, they doubtless were God's tool.
Even the most cynical Catholic will have at least one story of prayer for a saint's intercession producing unexpected results. My personal favourite story involves St Anthony of Padua.
Some years ago I had lost my ID book. Evidently being a careless individual where the prudent management of important documents is concerned, a few years after that I couldn't find my passport days before I was due to leave on an overseas journey.
We had turned the house upside down to find the passport, to no avail. Then my wife prayed for St Anthony's assistance. The very next place she looked was in an old briefcase: and, lo, there were the passport and the long-lost ID book.
I have no rational explanation how these items happened to be in that briefcase. Had I put the passport there, I would then have found my lost ID book. I don't know by what circumstances these two items came together, but I do know that within seconds of asking St Anthony, my wife found them.
When the saints help us, there is a temptation to give all credit to them. Of course, they only intercede for us before God, therefore it is to him that the glory must be given.
So it is not really correct for us to say we're praying "to" a saint – though that terminology is common usage'as if the saint is an officer of God performing heroic deeds. Rather, we might say that we pray with the saints, as we might ask our priests or family or friends or community to pray with us in times of need.
Still, it is good to have saints at hand to help us find lost travel documents or to change the weather, or to pray with us when we have other petitions. It's one of the great benefits of being Catholic that we have recourse to the saints as intercessors.
Sometimes they act as a useful buffer which enables us to pray better. I'd have felt quite foolish going straight to God to pray for the rain in Venice to stop. It's trivial, and quite possibly selfish, if there were farmers in the Veneto region who actually needed buckets of rain that particular day. It was easier to go to St Scholastica first (she probably also knew all about the agricultural needs of the local farmers from their petitions).
Going through the saints might be likened to asking your mom or older sibling to put in a word for us with dad. Sometimes even in our prayer we want a go-between. Other times we may feel quite comfortable to go straight to our Heavenly Father. Either way, God hears our prayers-sometimes he just says no.
Some Protestants criticise the Catholic devotion to the saints as a medieval superstition, or, worse as a heresy, assuming that we see the saints, including Our Lady, as mediators. They are wrong, of course. There is only one mediator: Christ.
The practice of asking the saints to pray for us is, in fact, as old as the Church itself. And there is proof for that.
When the house of St Peter in Capernaum at the Sea of Galilee was excavated, archaeologists found inscriptions from early pilgrims in different languages, asking Peter to pray for them. One of these languages was Hebrew, the theological language of Jews in apostolic times. The obvious conclusion is that this graffito dates to the very early times of the Church, when it was still a sect within Judaism.
Ancient graffiti found in the Roman catacombs further show that praying with the saints was a normal practice in the ancient Church.
The Saints of Italy pilgrimage placed a particular emphasis on the portfolios of patronages held by the various saints we visited. If our prayer petitions concerned an instance of marital problems, for example, the Umbrian town of Cascia was a good place to present them to God through St Rita, patron of troubled marriages.
In Cascia I had an uncanny experience which might indicate that some saints don't have a good sense of humour'or perhaps too much of it.
As we explored the monastery of St Rita we saw the holes made in a wall between the saint's cell and her old tomb by what tradition holds are miracle bees which moved in there some 200 years after St Rita's death.
I joked that the holes looked more like my misadventures with a powerdrill. Instantly, a bee appeared and circled above my head, as if to admonish me for my flippancy. You might say that nature just favoured my sweet head; I suspect St Rita sent this solitary bee to send me a stern, or playful, message, perhaps knowing my phobia of bees.
We do build relationships with saints, albeit in different ways. One might relate differently to the fifth-century saint Scholastica as one might to the 20th-century saint John XXIII. The former's life is distant and abstract, the latter's life is recent, concrete and well-documented. We can identify with St John XXIII because he lived in a world we recognise.
So where St Scholastica is a welcome intercessor on weather-related matters whose sanctity we take for granted without knowing much about it, St John XXIII inspires us by visible example.
The observable holiness of the saints is what motivated John Paul II, now himself one of them, to accelerate the process of canonisation. In his 26-year pontificate he created a record 110 saints.
The example of holiness inspired the Saints of Italy pilgrims: going to the places of saints, seeing their tombs or birthplaces or the arena of activity or their relics showed that these men and women were real people living in the real world, not just names on churches and pictures on prayer cards.
St Francis was real; St Scholastica was real; St Rita of Cascia was real; St John XXIII was real. All faced challenges in life, as do we. They contended with temptation and battled with sin. In the end, they won and are confirmed residents in the presence of God, in what we call heaven.
Canonisation is just that, though: an official confirmation that a person is in heaven. But just because your granny hasn't been canonised doesn't mean that she cannot be a saint in the presence of God in heaven. It means that the Church has not confirmed this to be so.
That implies two things: firstly, it would be inappropriate for you to involve the whole Church community in maintaining a devotion to Granny, unless your bishop thinks her witness of faith was so extraordinary as to justify a popular devotion.
But it also means that you are free to invoke Granny's intercession with God on your behalf.
On the feast of All Saints we are called to remember all the saints in heaven, known and unknown.
In that spirit: Granny and all the saints, pray for us.
Next week: Gunther Simmermacher reflects on Italy's churches.
Latest posts by Gunther Simmermacher (see all)
- Where the Risen Christ Walked - May 21, 2019
- Is This the Holy Grail? - April 16, 2019
- The Catholic Faith in Cuba - April 2, 2019


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Express. Home of the Daily and Sunday Express.
Man Utd reportedly willing to meet Neymar's release clause: This is what fans really think
EXPRESS SPORT brings you all the best tweets as Manchester United are reportedly willing to meet Neymar's release clause.
Manchester United have been repeatedly linked with the Barcelona hitman in recent months.
And Spanish newspaper Sport claim Jose Mourinho's side have made him a priority for the summer window and are willing to meet his £173m [€200m] release clause.
But what to the Old Trafford faithful think of the latest transfer rumour?
Click through the gallery above to find out!


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text: Thank you Sri Ramakrishna ji for the efforts in bringing out the ITRANS version after several rounds of verification/correction. The notes are also apt. This is a fine stotram composed by the present Jagadguru of the Sringeri PeeTham, HH Sri Bharati Tirtha MahaswaminaH. The stotram can be recited in the manner of the famous 'mudA karAttamodakam ...' of Shankaracharya: http://www.mp3gangster.com/mp3/id1557272 Regards, subrahmanian.v > > Thanks to Shri Subbu-ji, Shri LalitaalaalitaH-ji and Shri Sunder > Hattangadi-ji for the corrections. Attached is the corrected version > along with some notes. > > bhava shankara deshika me sharaNam! > namaste > Ramakrishna > > > > > =========================== > > OM shrI gurubhyo namaH > > shrImajjagadgurushaMkarabhagavatpUjyapAdAchAryastavaH > > mudA kareNa pustakaM dadhAnamIsharUpiNaM > tathA.apareNa mudrikAM namattamovinAshinIm | > kusuMbhavAsasAvR^itaM vibhUtibhAsiphAlakaM > natAghanAshane rataM namAmi sha~NkaraM gurum ||1|| >


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Members include all major physician specialties, physical therapists, psychologists and other health care providers who practice throughout Arizona. Plans need only contract with ASPA to access a comprehensive provider network. More than 1,000,000 individuals are eligible to receive care from ASPA members through various payor agreements.
Our Mission
Maximize revenue and minimize costs by assisting physicians manage the business component of their practices and by making state-of-the-art software, practice management and other needed services available to members at competitive prices.
Elevate the status of physicians in the health care industry.
ASPA's Management
Understanding the many factors that drive talented individuals to focus their life's work in a particular area may not be fully understood. What is known is that commitment to an area of concentration is an essential ingredient of success. Commitment to serve the interests of physicians is the foundation of ASPA's management staff.
ASPA Staff
Director of Operations
Phone: 602-265-2524 ext. 212
Email: email@example.com
Direct Fax: 623-999-1057
Physician Liaison
Phone: 602-265-2524 ext. 210
Email: firstname.lastname@example.com
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Provider Relations – Data Entry
Direct Fax: 623-999-1055
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Policy and decision making authority is entrusted to ASPA's Board of Directors and implemented by the management staff. IPA members elect ASPA's board members for three-year overlapping terms with representation from each of five divisions. The officers of the organization consist of a president, vice president and secretary/treasurer who are elected annually by the board members. The Board of Directors meets every month.
Affiliate Member Since 12-04-2000
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ASPA is organized as a cooperative whose members own a single share of capital stock. Shares of membership stock are not transferable and no person may own more than one share.


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I know it just turned to spring but I feel like summer is vastly approaching. Spring just happens to be one of my favorite seasons with the weather, flowers and there isn't the excruciating heat beating down my back. I need to get outside more because my skin has been pale for the past couple of summers. Luckily, I have a daughter who could live outside she likes it so much. She is discovering puddles, mud, rocks, dirt and the wildlife. Oh to be a kid again.
I am sharing this super easy and delicious tilapia recipe on behalf of Hidden Valley. Tilapia is a big favorite of mine and I love to make a good crust on it. I'm always putting ranch or buttermilk dressing on salads, pizzas, sandwiches and a ton of other things that I decided why not fish. Typically you have eggs and flour to help crust a filet but this edition of crusted fish is buttermilk ranch and kettle chips. I also highly suggest the added chopped strawberries for an extra punch.
My lunch breaks are when I typically get everything done for the blog. I've got about a 2 hour window while my little one naps to edit, write posts, answer emails and that doesn't leave much time for eating my actual lunch. These filets take less than 20 minutes and full of crunch and flavor. Take a break from the sandwiches and salad to enjoy a nice fish dish for lunch.
Buttermilk kettle chip crusted tilapia
1/2 teaspoon olive oil
2 tilapia filets
3 cups kettle chips
1 tablespoon bread crumbs
1/4 teaspoon salt
2 tablespoons buttermilk hidden valley dressing
2 tablespoons diced strawberries
Add olive oil to a skillet over medium heat.
Add chips, bread crumbs and salt to a large zip lock bag and crunch with your fingers.
Brush the buttermilk to all sides of the tilapia and then coat with chips and bread crumbs. Place in the skillet and cook of 3-4 minutes on each side.
Top with diced strawberries.
From dressings and dips to sandwich spreads and side dish solutions, the special blend of herbs and spices makes Hidden Valley the perfect addition to any recipe. For more delectable ranch recipes, visit www.hiddenvalley.com.
This is a sponsored conversation written by me on behalf of Hidden Valley Ranch. The opinions and text are all mine.


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Special Adviser to President Muhammadu Buahri on Media and Publicity, Femi Adesina, says the President is still in control of the nation's security despite the security challenges facing the nation.
He noted that the government has a responsibility to protect the lives and property of the citizens and that is exactly what they are doing.
Adesina, who believes the nation would overcome its challenges soon, added that it is only a matter of time before the people start to notice the government's efforts in addressing the security challenges.
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Building scalable websites in the cloud
- May 17, 2019
17 May'19
Microsoft hands developer advocates keys to the kingdom
Microsoft views developers as key to not only maintaining its customer base, but expanding it through interaction with open source communities.
- May 16, 2019
16 May'19
Apptio buys Cloudability for cloud cost optimization
Apptio looks to strengthen its cloud cost optimization services with the addition of Cloudability, as the industry continues to coalesce around hybrid and multi-cloud management.
- May 15, 2019
15 May'19
VMware's Bitnami buy targets multi-cloud deployments
VMware has inked a deal to buy Bitnami, maker of a catalog that vets and packages up popular software, such as MySQL, for quick, secure multi-cloud deployments.
- May 10, 2019
10 May'19
Microsoft to reduce Azure outages with Project Tardigrade
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- May 08, 2019
08 May'19
Microsoft gives developers a sneak peek into Azure updates
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- May 07, 2019
07 May'19
Microsoft expands Azure cloud database options
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- May 06, 2019
06 May'19
Microsoft Build shows Azure's path for big data, open source
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- April 30, 2019
30 Apr'19
New Azure-VMware integration means more hybrid cloud options
Rivals Microsoft and VMware joined forces this week, signing a deal to allow VMware to run natively on Azure, further complicating the coopetition among the top cloud vendors.
- April 19, 2019
19 Apr'19
Steep Google Anthos pricing geared toward large enterprises
Google Anthos is the company's multi-cloud management play, but customers and prospects should mull the full picture when it comes to cost.
- April 15, 2019
15 Apr'19
Kroger buys into Google Cloud migration, despite challenges
It wasn't easy for Kroger to migrate its customer-facing search engine to Google Cloud, but it happened fast, thanks to proper planning and the right mix of talent.
- April 12, 2019
12 Apr'19
Google Cloud Code extends VS Code, IntelliJ for the cloud
Google Cloud Code's plugins for IntelliJ and Visual Studio Code aim to make Google Cloud Platform more attractive for developers that build cloud-native apps.
- April 11, 2019
11 Apr'19
Google expands Windows support with managed SQL Server
Google's decision to add SQL Server to its Cloud SQL family of managed database services is an appeal to Google Cloud Platform customers with ample Windows workloads.
- April 10, 2019
10 Apr'19
Google's multi-cloud platform goes GA as Anthos
Google's Cloud Services Platform, now called Anthos, aims to make waves for hybrid and on-premises cloud management, but customers should be aware the GA tag has its limitations.
- April 09, 2019
09 Apr'19
Google, open source vendors join for cloud managed services
Google has partnered with seven prominent open source software providers, including MongoDB and Redis, to tap customer demand for managed OSS services in the cloud.
- April 04, 2019
04 Apr'19
Optimized Google Cloud VMs target cutting-edge workloads
Google Cloud's latest set of instances, optimized for compute- and memory-intensive workloads, underscore customer demand for more powerful cloud infrastructure choices.


text:
Rolando is a bit before my time as a mobile game player, let alone writer. I didn't even have an iPhone until about 2013, and by that point the App Store had already exploded into something worth keeping an eye on.
Developers HandCircus seem to think it's too long since the game launched too, and now it's getting the remaster treatment with a beefed up version of the original title called Rolando: Royal Edition. … [MORE]


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I have been told that All revolvers need firelapping, especially new Rugers, to remove the constriction caused by threading the barrel to the frame, and it makes them more accurate.
So, My revolver cylinder throats are all very close to .358 A .358 ZZ minus pin gauge will just fit with some oil and gentle persuasion. About equal resistance is met in each chamber throat. However, a .356 ZZ minus gauge will not enter the muzzle. O.K., the cylinder throat is supposed to be the critical measurement, right?
Slugging the bore won't work, because it has 5 lands, and I don't have or don't know anyone with the proper(and expen$ive) tool to do that.
I have some Hornady swaged 158 gr. semi-wadcutters, which are said to be very soft, and measure ~.358. So, If I do decide to firelap, could I seat them backwards over a light load of Trailboss, using JB Bore compound, and do a reasonable job, at the same time, not changing the diameter of my cylinder throats?


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To find out how many carats in "x" ounces or ounces in "x" carats, enter an ounce or a carat value into the converter and the result will be displayed.
► carats to ounces
► weight conversion
1 Ounce = 141.747616 Carats
1 Troy Ounce = 155.517384 Carats
Ounce is an imperial and US Customary mass unit. Troy ounce is used for the measurement of precious metals, gold, silver etc. The abbreviation is "oz".
Carat is a unit of mass and used to describe the weight of diamonds, gemstones, pearls. 1 grams equals to 5 carats and 1 ounce is 141.747616 carats. It is abbreviated as "ct".
2005 - asknumbers.com. All rights reserved. Privacy and TermsContact Us


text:
One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy vs. Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation - STOPDAPT-2
Contribution To Literature:
The STOPDAPT-2 trial showed that 1-month DAPT was superior to 12-month DAPT at preventing net adverse ischemic events.
The goal of the trial was to evaluate 1-month dual antiplatelet therapy (DAPT) compared with 12-month DAPT among patients undergoing percutaneous coronary intervention (PCI).
Study Design
- Randomized
- Parallel
Patients undergoing PCI were randomized to 1 month of DAPT followed by clopidogrel monotherapy for 5 years (n = 1,523) versus 12 months of DAPT followed by aspirin monotherapy for 5 years (n = 1,522).
- Total number of enrollees: 3,045
- Duration of follow-up: 1 year
- Mean patient age: 68 years
- Percentage female: 21%
- Percentage with diabetes: 39%
Inclusion criteria:
- PCI with a cobalt chromium everolimus-eluting stent
- No plan for staged PCI
Exclusion criteria:
- Need for oral anticoagulation
- History of intracranial hemorrhage
Other salient features/characteristics:
- Stable coronary artery disease: 62%
Principal Findings:
The primary outcome, death, myocardial infarction (MI), stent thrombosis, stroke, TIMI major/minor bleeding at 1 year, occurred in 2.4% of the 1-month DAPT group compared with 3.7% of the 12-month DAPT group (p for superiority = 0.04). There was evidence of possible treatment interaction favoring 12 months of DAPT among those with chronic kidney disease.
Secondary outcomes:
- Death, MI, stent thrombosis, or stroke at 1 year: 2.0% of 1-month DAPT group compared with 2.5% of 12-month DAPT group (p for noninferiority = 0.005)
- TIMI major/minor bleeding at 1 year: 0.4% of 1-month DAPT group compared with 1.5% of 12-month DAPT group (p for superiority = 0.004)
- Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year: 0.5% of 1-month DAPT group compared with 1.8% of 12-month DAPT group (p for superiority = 0.003)
Among patients undergoing PCI for stable and unstable cardiovascular disease, 1-month DAPT followed by clopidogrel monotherapy was superior to 12-month DAPT followed by aspirin monotherapy at preventing net adverse clinical events. One-month DAPT was noninferior to 12-month DAPT at preventing major adverse ischemic events and superior to 12-months DAPT at preventing TIMI major/minor bleeding. BARC 3 or 5 bleeding was low, but 1-month DAPT was also associated with a reduction in this outcome compared with 12-month DAPT. The design of this trial is like the GLOBAL LEADERS trial.
Presented by Dr. Hirotoshi Watanabe at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 18, 2019.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Anticoagulation Management and ACS, Interventions and ACS, Interventions and Coronary Artery Disease
Keywords: ACC19, ACC Annual Scientific Session, Acute Coronary Syndrome, Anticoagulants, Aspirin, Chromium, Cobalt, Coronary Artery Disease, Drug-Eluting Stents, Hemorrhage, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Renal Insufficiency, Chronic, Secondary Prevention, Stents, Stroke, Thrombosis, Vascular Diseases
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