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Where These 51 CEOS Went to CollegeSee where the world's richest business leaders went to school.
Warren Buffett has said he doesn't stress higher education in the hiring process, and yet he went to some of the most prestigious schools in the country. One common thread among the world's most successful and inspiring entrepreneurs and business leaders is that most went to college — even if only for a short while.
Click through to learn about the academic histories of the world's most important business leaders.
Mark Zuckerberg
College: Harvard University
Facebook founder and CEO Mark Zuckerberg is under fire and scrambling to control the damage of a data-mining scandal enveloping the social media giant. But in 2004, he was a computer programmer and recent Harvard dropout focused on spreading his emerging online platform from Harvard to campuses across the country and, eventually, the world. He has a net worth of $50 billion.
Jeff Bezos
College: Princeton University
Amazon CEO Jeff Bezos, who has a net worth of $124 billion, is the richest person in the world and, according to Forbes, is the first billionaire to break the 12-figure mark. The son of a single mother, Bezos earned early admission to Princeton, originally intending to practice theoretical physics. After graduation, however, he realized the power of the internet and began selling books online, a small business venture that grew into the world's most powerful online retailer.
Warren Buffett
College: University of Pennsylvania, University of Nebraska and Columbia University
Warren Buffett followed his father's advice and went to the University of Pennsylvania's prestigious Wharton School of Business — but only reluctantly. The man who would go on to become the "Oracle of Omaha," arguably the most successful investor of all time, completed his undergraduate education at the University of Nebraska before attending graduate school at Columbia University. Despite many years of schooling, Buffett doesn't think college is for everyone and doesn't base his hiring decisions on degrees, according to CNBC. The Berkshire Hathaway CEO and global philanthropist has a net worth of $82 billion.
Elon Musk
College: University of Pennsylvania and Stanford University
Elon Musk is the co-founder of PayPal, the creator of SpaceX and the CEO of Tesla. In 1989, however, the South African immigrant entered Queen's University in his mother's native Canada and eventually transferred to the University of Pennsylvania, graduating with a degree in physics and economics in 1995. Musk then enrolled at Stanford University but left after just two days to start his first company, Zip2. Musk has a net worth of $22 billion, but he works for cheap.
Tim Cook
College: Auburn University and Duke University
Tim Cook earned a bachelor's degree in industrial engineering from Auburn University and an MBA from Duke University, where he was a Fuqua Scholar. Today, he's the CEO of Apple.
Before reaching the executive level at Apple, Cook, who has a net worth of $650 million, worked for Compaq and IBM.
Marc Benioff
College: University of Southern California
Marc Benioff, who has a net worth $6.7 billion, was a pioneer of cloud computing and now serves as the chairman and CEO of Salesforce. He earned a bachelor's degree in business administration from the University of Southern California in 1986. He enjoyed college so much that he never severed ties — he currently serves on the school's board of trustees.
Bob Iger
College: Ithaca College
Disney CEO Bob Iger has a net worth of $350 million. Before he saved Disney, Iger graduated from Ithaca College in 1973, where he cut his teeth in one of the toughest gigs in show business. Intent on landing a television career, Iger spent five hard winter months working as a local weatherman in notoriously frigid Ithaca, N.Y.
Jamie Dimon
College: Tufts University and Harvard University
Harvard graduate Jamie Dimon runs America's largest bank as the CEO of JPMorgan Chase. He's famous — or infamous — for protecting that bank by dumping $12 billion in subprime mortgages in 2006, which helped the bank survive the Great Recession. Dimon graduated from Tufts University in 1978 and later enrolled in Harvard Business School. He parlayed the MBA he earned there in 1982 into a billion-dollar career. According to MarketWatch, Dimon was paid $28.3 million in 2017 — or 364 times the amount earned by the median JPMorgan employee. He has a net worth of $1 billion.
Mary Barra
College: Kettering University and Stanford University
Mary T. Barra — one of the world's richest female CEOs — became the first woman to lead a major automaker when she was named CEO of General Motors in 2014. In 2016, she was the highest-paid auto CEO in the world, earning $22.58 million in total compensation at GM. She graduated from Kettering University in 1985 — it was called General Motors Institute then — and earned an MBA from the Stanford Graduate School of Business in 1990.
Sundar Pichai
College: Stanford University and University of Pennsylvania
Sundar Pichai interviewed with Google on the day the company launched Gmail in 2004 — now he is the company's CEO. The metallurgical engineering student did so well at the Indian Institute of Technology Kharagpur that he won a scholarship to Stanford. After earning his Master of Science, he earned an MBA from the University of Pennsylvania's Wharton School. He has a net worth of $600 million.
Satya Nadella
College: University of Wisconsin and University of Chicago
Microsoft CEO Satya Nadella is credited with moving the software giant away from a failed mobile strategy and toward winning endeavors such as augmented reality, cloud computing and the purchase of LinkedIn. Nadella, who has a net worth of $180 million, has two master's degrees. He earned a Master of Science degree from the University of Wisconsin and an MBA from the University of Chicago's Booth School of Business.
Jensen Huang
College: Oregon State University and Stanford University
Fortune's 2017 Businessperson of the Year, Nvidia founder and CEO Jensen Huang, is "leading an AI revolution in Silicon Valley," according to the publication. His company pioneered computer gaming in the 1990s and invented the GPU card. He earned a BSEE degree from Oregon State University and, like so many others on this list, a master's degree from Stanford. Also known as Jen-Hsun Huang, he has a net worth of $6.6 billion.
Shantanu Narayen
College: University of California at Berkeley and and Bowling Green State University
Shantanu Narayen earns more than $20 million a year as CEO of Adobe, the company that gave the world Photoshop and the PDF. A native of India, Narayen earned an undergraduate degree in electronics engineering, a master's in computer science from Bowling Green and an MBA from Berkeley.
Mark Parker
College: Penn State University
Nike CEO and chairman Mark Parker has a net worth of $250 million. In 1977 he graduated from Penn State with a degree in political science. He joined Nike two years later as a footwear designer and worked his way up the corporate ladder.
John Legere
College: University of Massachusetts-Amherst, MIT, Fairleigh Dickinson University and Harvard University
T-Mobile CEO John Legere has more than 30 years of experience in the telecommunications industry — and he built his career on an impressive academic resume. According to his UMass alumni page, he earned a bachelor's degree in business administration from UMass Amherst, a master's degree as an Alfred P. Sloan Fellow at the Massachusetts Institute of Technology and an MBA from Fairleigh Dickinson University — all before completing Harvard Business School's Management Development Program.
John Hammergren
College: University of Minnesota and Xavier University
John Hammergren already had earned a world-class education as an Eagle Scout before he completed a bachelor's degree in business administration from the University of Minnesota and an MBA from Xavier University. He now is chairman and CEO of healthcare giant McKesson. His net worth isn't known, but his total compensation in 2017 was $131.2 million.
Meg Whitman
College: Princeton University and Harvard University
A self-made woman, Meg Whitman has a resume that would put most business leaders to shame. The former CEO of eBay and Hewlett-Packard, Whitman has a net worth of $3.3 billion and is the CEO of media startup NewTV. She's a member of Princeton University's class of 1977 and went on to earn an MBA from Harvard Business School.
Larry Page
College: University of Michigan and Stanford University
Larry Page didn't wait until graduation to achieve greatness — the Alphabet CEO formed Google in 1998 with Sergey Brin, who also was a grad student at Stanford. Page, who has a net worth of $53 billion, graduated with a bachelor's degree in engineering from the University of Michigan in 1995. He shocked instructors by announcing his senior project would be to hack a Palm Pilot.
Howard Schultz
College: Northern Michigan University
Howard Schultz graduated from Northern Michigan University in 1975. He was the first person in his blue-collar family to graduate from college, going to Northern Michigan on a football scholarship. Schultz is the executive chairman of coffee giant Starbucks. He acquired the company in 1987 when it had 17 stores, and by mid-2015, it had grown to 22,519 worldwide. Schultz has a net worth of $3 billion.
Ginni Rometty
College: Northwestern University
Before she spent more than 30 years climbing the corporate ladder before reaching the top of IBM in 2011, Ginni Rometty earned a bachelor of science degree from Northwestern in 1979. Rometty, the first female CEO of the iconic company, studied computers and electrical engineering and graduated with high honors. She has a net worth of $90 million.
Jack Dorsey
College: Missouri University of Science and Technology; and New York University
After a brief stint at the Missouri University of Science and Technology, Jack Dorsey transferred to NYU, where he dropped out. At the age 29, he was out of work, living in a tiny apartment and unable to find a job — even at a local shoe store. He dabbled in fashion, and then the self-taught coder went on to found Twitter. That final act made him one of the richest CEOs in Silicon Valley with a net worth of $2.1 billion.
Brian Halligan
College: University of Vermont and MIT
Brian Halligan graduated from the University of Vermont with a bachelor's degree in electrical engineering and earned a master's from MIT in 2005. Just one year later he formed inbound sales and marketing company HubSpot with fellow MIT grad student Dharmesh Shah.
Richard Fairbank
College: Stanford University
With a net worth of $1.1 billion, Richard Fairbank recently joined the vaunted three-comma club. One of the country's longest-serving bank CEOs, Fairbank leads Capital One Financial Corp. Long a CEO who shuns the limelight, Fairbank graduated with an MBA from prestigious Stanford University, where he also studied as an undergraduate.
Reed Hastings
College: Bowdoin College and Stanford University
Reed Hastings is an entrepreneur with a net worth of $4 billion. He studied mathematics at Bowdoin College and graduated with a bachelor's degree in 1983. Afterward, he joined the Marine Corps and traveled the world with the Peace Corps. If you've ever binge-watched movies or TV shows from beginning to end, you probably have Hastings to thanks — he founded mail-order DVD service Netflix in 1997.
Marillyn Hewson
College: University of Alabama, Columbia Business School and Harvard Business School
One of the most powerful women in business, Marillyn Hewson is the CEO of Lockheed Martin. Her more than three decades with the company came on the heels of one of the most impressive academic careers in the business world. She earned a B.S. in business administration and a master's degree in economics from the University of Alabama. She went on to complete both the Columbia Business School and Harvard Business School executive development programs.
Jeff Weiner
College: University of Pennsylvania
In the decade of leadership under Jeff Weiner, LinkedIn has ballooned from 33 million subscribers to more than 467 million, and a company with a few hundred employees became one that employed 10,000 people. Weiner, who is worth about $200 million, graduated from the University of Pennsylvania's Wharton School with a degree in economics.
Bill McDermott
College: Northwestern University and University of Pennsylvania
Bill McDermott is the CEO of software giant SAP — and the grandson of basketball great Bobby McDermott. He's also a man who overcame a host of traumas and challenges, both in childhood and as an adult, and went on to earn an MBA from Northwestern University and to complete the Executive Development Program at the University of Pennsylvania's Wharton School. The way he financed his education, however, might be more impressive than his academic record — he bought a deli when he was just 16, which earned him enough to pay for college. McDermott's net worth isn't known, but he earned about $14 million in 2016, according to Money Inc.
Laurence D. Fink
College: UCLA
Laurence D. Fink graduated with a bachelor's degree from UCLA in 1974 and earned an MBA in 1976. Twelve years later he founded BlackRock, which holds $5.4 trillion in assets and dominates the global ETF market. His efforts have earned him a net worth of $340 million.
Dominic Barton
College: University of British Columbia and Oxford University
Dominic Barton is the managing partner of McKinsey & Co., a global management consulting firm, and the author of more than 80 articles. He's also an adjunct professor at Beijing's Tsinghua University. His international college credentials, however, began as a student, not as a teacher. He graduated with honors as an undergraduate economics student at the University of British Columbia and was a Rhodes Scholar at Oxford.
Oscar Munoz
College: University of Southern California and Pepperdine University
In 2017, United Airlines CEO Oscar Munoz was in the spotlight for all the wrong reasons when a passenger was dragged off a flight in a violent, videotaped incident. The oldest of nine children, the former soda executive was the first in his blue-collar family to attend college. He credits a guidance counselor with pushing him to apply to colleges he never thought would accept him. USC eventually did, and he graduated with a business degree before earning an MBA from Pepperdine.
Thomas Rutledge
College: California (Pa.) University
In 2017, Money magazine crowned Charter Communications CEO Thomas Rutledge as the highest-paid boss in business. The $98.5 million he commanded in the previous year was more than double the salary of the next-highest-paid CEO. Before he was a member of the Broadcasting and Cable Hall of Fame, however, he studied economics as an undergraduate at California (Pa.) University and graduated in 1977.
Brian L. Roberts
College: University of Pennsylvania
Like Thomas Rutledge, Brian L. Roberts is a well-paid media chief. The CEO of Comcast earned a bachelor 's degree from the University of Pennsylvania's Wharton School. His father was one of the founders of the company, and Roberts started with Comcast as an intern at age 15.
Doug McMillon
College: University of Arkansas and University of Tulsa
The youngest Walmart CEO since founder Sam Walton, Doug McMillon began his career at the world's largest retailer unloading trucks as a teenager. Like Walmart, McMillon's education was based in Arkansas. He completed his undergraduate work at the University of Arkansas and then enrolled in the MBA program at the University of Tulsa. Before he finished, he enrolled in Walmart's buyer-training program and, upon graduation, started as an assistant manager at store No. 894 in Tulsa. McMillon's net worth is $100 million.
Alex Gorsky
College: West Point and University of Pennsylvania
Johnson & Johnson CEO Alex Gorsky is a military veteran who was accepted to the elite United States Military Academy at West Point. After graduating in 1982, he joined the Army Rangers. In 1996 he returned to school to earn an MBA from the University of Pennsylvania's Wharton School.
Spencer Rascoff
College: Harvard University
Zillow CEO Spencer Rascoff has a long resume that includes work in private equity, Wall Street investment banking and the founding of Hotwire.com. In high school, according to Bloomberg, Rascoff was an "overachiever" who was an athlete, the president of the student body and the editor of his school's newspaper. His efforts earned him a spot at Harvard, where he graduated in 1997. Rascoff's net worth is not public.
Pat Gelsinger
College: Lincoln Technical Institute, Santa Clara University and Stanford University
VMware has nearly doubled in size since Pat Gelsinger took over in 2012. Gelsinger, who is credited with developing the original 80486 processor while working at Intel, didn't start his academic career at Harvard or Penn's Wharton School, like so many of his contemporaries. Gelsinger, who holds seven patents, started studying electrical engineering at Lincoln Technical Institute. After earning his associate degree in 1979, he graduated magna cum laude from Santa Clara University in 1983 before earning a master's degree in 1985 from Stanford.
Mark Hurd
College: Baylor University
Oracle Corp. CEO Mark Hurd graduated from Baylor University in 1979. After earning a bachelor's degree in business administration, he remained active with his alma mater. A member of the school's board of regents, Hurd received the 2012-13 Baylor Legacy Award, and he even has a few buildings named after him. He has a net worth of $70 million.
Leonard Schleifer
College: Cornell University and the University of Virginia
Regeneron Pharmaceuticals CEO Leonard Schleifer has impressive academic bona fides in business and medicine. He was accepted to Cornell on a scholarship and pursued a career in medicine. After graduating with a bachelor's degree, he earned his medical degree at the University of Virginia, where he also was awarded a Ph.D. He has a net worth of $1.1 billion.
Wesley Bush
College: MIT and UCLA
The chairman and CEO of Northrop Grumman, Wes Bush earned a bachelor's degree and a master's degree from MIT. After that, he went to the University of California at Los Angeles, where he entered the school's executive management program. He earns a fairly modest salary for a CEO — about $1.53 million a year. His net worth isn't known.
W. Craig Jelinek
College: San Diego State University
Costco chief W. Craig Jelinek graduated from San Diego State University with two degrees: a bachelor's in business and another in marketing, both earned in 1975. When he took the job of Costco CEO in 2012, Jelinek's starting salary was $650,000, plus a bonus of as much as $200,000. By that time, however, he already had earned millions as company president and COO. Jelinek's current net worth isn't known.
Robert A. Kotick
College: University of Michigan
Longtime Activision Blizzard CEO Robert A. Kotick has served at the company's helm since 1991. His alma mater is the University of Michigan, but he serves on the boards of both the Center for Early Childhood Education and Harvard Westlake School. Under Kotick's tenure, Activision Blizzard has developed hit franchises such as "Call of Duty," "Candy Crush" and "World of Warcraft."
Richard K. Templeton
College: Union College
Richard Templeton is the boss of Texas Instruments, and he's been with the company since 1980 after earning his bachelor's degree from Union College in Schenectady, N.Y. In his private life, he's a major player in advancing education, including his push to improve access to STEM (science, technology, engineering and math) education.
Under his stewardship, Texas Instruments has given $150 million to the cause. Templeton's net worth isn't known, but he made about $15 million in total compensation in 2016, according to Salary.com.
Dara Khosrowshahi
College: Brown University
Uber CEO Dara Khosrowshahi, who has a net worth of $200 million, graduated from prestigious Ivy League school Brown University in 1991 — but getting there wasn't easy. At age 9, the future Expedia CEO escaped Iran with his family in 1978 on the eve of the country's Islamic revolution. His father returned to care for an ailing relative, only to be captured and held for six years while his family was in America.
Indra Nooyi
College: Madras Christian College, Indian Institute of Management and Yale University
The president and CEO of PepsiCo since 2006, Indra Nooyi held several executive jobs with the company before taking the helm. She earned a bachelor's degree from Madras Christian College, an MBA from the Indian Institute of Management in Calcutta and another master's degree from Yale. Nooyi has a net worth of $80 million.
Phebe Novakovic
College: Smith College and the University of Pennsylvania
The CEO of defense giant General Dynamics, Phebe Novakovic earned her undergraduate degree from Smith College in Northampton, Mass., and then, like so many of her contemporaries, earned an MBA from the University of Pennsylvania's Wharton School. Forbes considers her one of the most powerful women in the world.
Ursula Burns
College: Polytechnic Institute of NYU and Columbia University
Former Xerox CEO Ursula Burns is a classic American rags-to-riches story. Raised in the projects on Manhattan's Lower East Side, Burns excelled at math and was accepted to the prestigious Polytechnic Institute of NYU in Brooklyn, N.Y. She went on to earn her master's degree in mechanical engineering at Ivy League school Columbia and joined Xerox via an internship that paid for part of her schooling. Burns' net worth isn't known, but she earned $13.1 million in total compensation in 2016, according to Salary.com. She left Xerox in 2017 and now is the executive chairperson of Amsterdam-based VEON.
Michael Wirth
College: University of Colorado
In 2017, Michael Wirth was named CEO of Chevron after the departure of longtime leader John Watson. Wirth earned a bachelor's degree in chemical engineering from the University of Colorado in 1982. That same year, he joined the energy giant as a design engineer.
Darren W. Woods
College: Texas A&M and Northwestern University
Darren Woods has been the chairman and CEO of ExxonMobil since Jan. 1, 2017. He joined the company as an analyst in 1992 after earning a bachelor of science degree in electrical engineering at Texas A&M. Following that, he earned an MBA from the Kellogg School of Management at Northwestern University.
Carlos Brito
College: Universidade Federal do Rio de Janeiro and Stanford University
As the CEO of Anheuser-Busch InBev, Brazil native Carlos Brito is the brewmaster of the world — and he also is a man who earned college degrees on two continents. He received his undergraduate degree in mechanical engineering at Universidade Federal do Rio de Janeiro and went on to complete an MBA at Stanford University.
Steve Easterbrook
College: Durham University
Control of the world's largest restaurant chain has been firmly in the hands of Steve Easterbrook since he took the job as McDonald's CEO in 2015 — but he'd worked for the company since 1993. An accountant by trade, he played cricket during his time as a student at Durham University in the United Kingdom and also was a visiting fellow of the Oxford University Centre for Corporate Reputation.
Brian Cornell
College: UCLA
In 2017, Target CEO Brian Cornell took a massive pay cut of about one-third as the troubled company struggled to perform. He'll now have to get by on $11.3 million a year. He joined the retailer in 2014 after gaining more than 30 years of experience with retailers and other companies around the world. Before that, he earned a bachelor's degree from UCLA in 1981 and also went to the university's Anderson School of Management.
More on Business People
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- 10 Billionaires Like Oprah Winfrey Who Grew Up Poor
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About the Author
Andrew Lisa
Andrew Lisa has been writing professionally since 2001. An award-winning writer, Andrew was formerly one of the youngest nationally distributed columnists for the largest newspaper syndicate in the country, the Gannett News Service. He worked as the business section editor for amNewYork, the most widely distributed newspaper in Manhattan, and worked as a copy editor for TheStreet.com, a financial publication in the heart of Wall Street's investment community in New York City.
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This blog post was provided by Charles Dimov, an experienced marketing professional and one of our former clients.
As marketers, we know that communications and public relations are important. They are part of a sound marketing mix. It's good for the brand and helps drive awareness. But, what is it doing for qualified leads and lead generation? Of course, we all understand that it helps. If someone has heard of your brand from a third party article, they are more willing to interact with you online. Wonderful, but that's all wishy-washy qualitative stuff! Is there tangible proof that public relations drives qualified leads? As a convert, here is my story that answers this question. Spoiler – the answer is YES, it does.
Startup Struggles
For the past three and a half years, I have led global marketing for a small retail software firm, OrderDynamics. In all regards, the company was a startup with a serious challenge. Four years ago, it was a 40-person firm, spun off from a larger organization. It had no discernible market presence. For the most part, no one in the industry had heard of us. There was no significant brand presence, compared to several goliaths in the industry like IBM, Oracle, and SAP. The flow of inbound leads was sporadic at best. To approximate, we had about 30 inbound raw leads per month.
These were certainly not marketing qualified leads (MQL), nor sales qualified leads (SQL). The inside sales process was completely focused on outbound efforts (events, list calling, followup). To top it off, web traffic dropped 75% in the year following the spinoff. Sales thought of marketing as an unengaged team working on its own. In hindsight, this was by no means a picture of success.
Public Relations & Qualified Leads
Starting with a vision, and marketing strategy (content centric – inbound), we added a communications / PR plan to the marketing mix. With buyer personas in hand, we focused on creating high-quality content, and on an ongoing public relations push. For a fast start, we outsourced this expertise.
Publishing educational, non-promotional content on a consistent basis was part of the plan. Content included white papers, topic briefs, data sheets, brochures, webinars, podcasts and ground-breaking industry research (developed in-house).
Through these initiatives, we established an ideal platform for a blogging strategy, using SEO to catch the interest of ideal buyers.
Good content gave us a chance to drive press releases, provide media quotes, submit non-paid bylines to industry publications, offer guest posts, and even interview on podcasts. These third-party public relations efforts started driving an influx in inbound raw leads. On the marketing funnel, raw leads converted to qualified leads with a growing number of prospective customers.
After ramping up our PR efforts, page views grew from less than 6,000 per month to peaks just shy of 18,000 per month. More importantly, the marketing department grew inbound leads to as high as 400 per month. Over three years, more than 240 third-party industry publications referenced OrderDynamics. This in just over three years. Twelve of these were quotes in Forbes magazine, with one full unpaid article written about our research in the publication.
Certainly, the sales team was engaged, and excited. Consistent, high-quality content marketing – supported by a strong SEO blogging strategy, and solid ongoing PR – completely turned around the business. Sales and marketing were now working together to fill the sales funnel. Additionally, sales reps saw and appreciated the clear benefit of marketing's contributions.
Proof in the Qualified Leads
You may wonder, did PR really provide sales-ready qualified leads? I wanted to know this answer too. So, we closely watched our inbounds in the stages in the sales process, in sales calls, and through our qualification process. Over the past two years, from close to 300 qualified leads analyzed, most were attributed to SEO (organic search), at 36%. We found the next largest category to be the 'Direct' sourced qualified leads, the people who directly typed in our website address, at 33%. However, as a small firm starting with an almost completely unknown brand, these sources must be largely attributed to our public relations efforts.
If there is any doubt in your mind – public relations does work! And there are results to prove it. For instance, solid public relations execution drove 33% of our sales accepted leads (SAL – qualified leads).
Don't skimp on this part of your budget. Work with a professional, communications-savvy and well-networked team like Ketner Group Communications. They are experts at gaining media coverage for your company, which in turn drives leads. Our work together helped me completely turn around our marketing efforts and business. All in all, investing in good public relations management just makes good business sense!

subset: commoncrawl


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Also found in: Thesaurus, Medical, Encyclopedia, Wikipedia.
Any of various ritualistic geometric designs symbolic of the universe, used in Hinduism and Buddhism as an aid to meditation.
[Sanskrit maṇḍalam, circle.]
man·dal′ic (mŭn-dăl′ĭk) adj.
mandala(ˈmændələ; mænˈdɑːlə)
1. (Hinduism) Hindu & Buddhist art any of various designs symbolizing the universe, usually circular
2. (Buddhism) Hindu & Buddhist art any of various designs symbolizing the universe, usually circular
3. (Psychology) psychol such a symbol expressing a person's striving for unity of the self
[Sanskrit: circle]
man•da•la(ˈmʌn dl ə)
n., pl. -las.
1. a schematized representation of the cosmos in Hindu and Buddhist iconography, usu. a concentric configuration of geometric shapes each of which contains an image or attribute of a deity.
2. (in Jungian psychology) a symbol representing the effort to reunify the self.
[1855–60; < Skt maṇḍala circle]
ThesaurusAntonymsRelated WordsSynonymsLegend:
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|mandala - any of various geometric designs (usually circular) symbolizing the universe; used chiefly in Hinduism and Buddhism as an aid to meditation
Hindooism, Hinduism - a body of religious and philosophical beliefs and cultural practices native to India and based on a caste system; it is characterized by a belief in reincarnation, by a belief in a supreme being of many forms and natures, by the view that opposing theories are aspects of one eternal truth, and by a desire for liberation from earthly evils
Buddhism - the teaching of Buddha that life is permeated with suffering caused by desire, that suffering ceases when desire ceases, and that enlightenment obtained through right conduct and wisdom and meditation releases one from desire and suffering and rebirth


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Welcome to the Crypto Zoo!
Cryptozoology is official known as a 'pseudoscience and subculture that aims to prove the existence of entities from the folklore record'. It looks at creatures such as Bigfoot, the chupacabra, or the Loch Ness monster and attempts to locate, document, and study them. Cryptozoologists refer to these entities as cryptids – obscure, undocumented creatures typically … Continue reading Welcome to the Crypto Zoo!


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Insights Into Echo-Attenuated Plaques, Echolucent Plaques, and Plaques With Spotty CalcificationNovel Findings From Comparisons Among Intravascular Ultrasound, Near-Infrared Spectroscopy, and Pathological Histology in 2,294 Human Coronary Artery Segments
Author + information
- Received October 21, 2013
- Revision received February 18, 2014
- Accepted February 25, 2014
- Published online June 3, 2014.
Author Information
- Jun Pu, MD∗,†,‡,
- Gary S. Mintz, MD†,
- Sinan Biro, MSc†,
- Jin-Bae Lee, MD∗,†,
- Stephen T. Sum, PhD§,
- Sean P. Madden, PhD§,
- Allen P. Burke, MD||,¶,
- Pei Zhang, PhD||,
- Ben He, MD‡,
- James A. Goldstein, MD#,
- Gregg W. Stone, MD∗,†,
- James E. Muller, MD§,
- Renu Virmani, MD¶ and
- Akiko Maehara, MD∗,†∗ (amaehara{at}crf.org)
- ∗Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
- †Cardiovascular Research Foundation, New York, New York
- ‡Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- §InfraReDx, Burlington, Massachusetts
- ||University of Maryland Medical Center, Baltimore, Maryland
- ¶CVPath Institute, Gaithersburg, Maryland
- #Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Columbia University Medical Center, New York-Presbyterian Hospital, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
Objectives Three intravascular ultrasound (IVUS) signatures have been associated with coronary artery disease instability: echo attenuation, an intraplaque echolucent zone, and spotty calcification. The aim of this study was to investigate the substrates responsible for these IVUS signatures in a relatively large series of post-mortem human coronary samples.
Background The exact mechanisms and pathological correlates underlying echo attenuation, an intraplaque echolucent zone, and spotty calcification remain poorly understood.
Methods IVUS was compared with near-infrared spectroscopic detection of lipid core plaque and histopathology in 2,294 vessel segments from 151 coronary specimens from 62 patients at necropsy using the modified American Heart Association classification.
Results IVUS detected echo-attenuated plaques in 18.3% of segments, echolucent plaques in 10.5% of segments, and spotty calcification in 14.4% of segments. Histopathologically, 91.4% of echo-attenuated plaques corresponded to either a fibroatheroma (FA) with a necrotic core (NC) or pathological intimal thickening with a lipid pool; almost all segments with superficial echo attenuation indicated the presence of an FA with an advanced NC. Echolucent plaques indicated the presence of a relatively smaller lipid or NC compared with echo-attenuated plaques (thickness: 0.51 mm [interquartile range (IQR): 0.35 to 0.64 mm] vs. 0.70 mm [IQR: 0.54 to 0.92 mm] [p < 0.001]; arc: 74.5° [IQR: 59.0° to 101.0°] vs. 90° [IQR: 70.0° to 112.0°] [p < 0.001]), although 82.8% of superficial echolucent zones indicated an NC-containing FA. IVUS spotty calcification, especially when superficial in location (72.6%), was often associated with an FA with calcium deposits and had smaller arcs of calcium in the setting of FA compared with fibrocalcific plaques (37.5° [IQR: 23.0° to 53.0°] vs. 59.0° [IQR: 46.0° to 69.0°]; p < 0.001). Comparisons between IVUS and near-infrared spectroscopy revealed that echo-attenuated plaques contained the highest probability of near-infrared spectroscopy–derived lipid core plaque, followed by echolucent plaques and spotty calcifications.
Conclusions This study demonstrated that echo-attenuated plaque, especially superficial echo attenuation, was the most reliable IVUS signature for identifying a high-risk plaque (i.e., an FA containing a large NC).
- atherosclerosis
- attenuated plaque
- intravascular ultrasound
- near-infrared spectroscopy
- spotty calcification
Intravascular ultrasound (IVUS) has played an important role in understanding the pathology and treatment of atherosclerotic disease in humans. Several grayscale IVUS features have been associated with either clinical instability or a high risk for cardiovascular events in patients with coronary artery disease undergoing percutaneous coronary intervention. These include atherosclerotic plaque with ultrasonic attenuation (echo-attenuated plaque) (1,2), an intraplaque echolucent zone (echolucent plaque) (3), and scattered spotty calcification (4,5). To date, however, the exact mechanisms or pathological correlates underlying these IVUS signatures and the associated risk for ischemic events remain poorly understood. More recently, near-infrared spectroscopy (NIRS) has been developed to detect lipid core plaque (LCP) (6,7); NIRS has been fused with IVUS in the first combined imaging system (8). In the present ex vivo study, we investigated the substrates responsible for echo-attenuated plaques, echolucent plaques, and IVUS spotty calcification on the basis of the modified American Heart Association histological classification scheme in a relatively large series of post-mortem human coronary samples.
Human coronary specimens were obtained over a 2-year period from autopsied patients. With approval from the institutional review board, hearts were acquired from the National Disease Research Interchange (Philadelphia, Pennsylvania) or the International Institute for the Advancement of Medicine (Edison, New Jersey), which also provided information regarding age, sex, medical history, and cause of death. The following terms were designated as indicating a cardiovascular cause of death: "myocardial infarction," "cerebrovascular accident," "cardiac arrest," and "other cardiovascular." Hearts were received within 48 h of death, maintained on ice at 4°C, and imaged within 96 h of death. The major coronary arteries were harvested after in situ angioscopic screening to exclude occluded segments impassable by the IVUS catheter. Side branches were ligated to prevent loss of blood during perfusion; adventitial fat surrounding the arterial segments was kept intact. Each coronary specimen was mounted in a unique custom fixture with vertical guideposts at 2-mm intervals to be used as reference points when comparing imaging with histological studies. Both ends of the arterial segment were attached to Luer connectors that allowed fluid flow and catheter entry. A varistaltic pump (Manostat, Barnant Corporation, Barrington, Illinois) supplied pulsatile flow at 60 cycles/min and a flow rate of approximately 130 ml/min, with pressure inside the coronary artery maintained at physiological levels (80 to 120 mm Hg) at a body temperature of 37.0°C. IVUS, NIRS, and histopathologic analyses were performed without knowledge of the findings obtained from the other 2 methods.
IVUS image acquisition and analysis
An Atlantis SR Pro 40-MHz catheter attached to an iLab system (Boston Scientific Corporation, Fremont, California) was advanced along a 0.014-inch guidewire through the coronary specimen mounted in the fixture. IVUS imaging was performed using motorized pullback at 0.5 mm/s to include proximal and distal Luer connectors. Image data were archived onto a CD-ROM and sent to an independent IVUS core laboratory (Cardiovascular Research Foundation, New York, New York) for off-line analyses. Every IVUS frame was matched to its comparable histopathologic slice using vessel shape, side branches, perivascular structures, and distances from the Luer connectors.
IVUS analyses were performed using validated planimetry software (echoPlaque, INDEC Medical Systems, Santa Clara, California). Quantitative analyses were performed according to criteria from the American College of Cardiology consensus statement on IVUS (9). Echo-attenuated plaque, echolucent plaque, and IVUS spotty calcification were defined as previously published (1–5,10).
Echo-attenuated plaque was identified by the absence of the ultrasound signal behind plaque that was either hypoechoic or isoechoic to the reference adventitia but contained no bright calcium (10). The arc of attenuation was measured in degrees with a protractor centered on the lumen. The interobserver variability of this arc of attenuation measurement was 4.9 ± 2.8°. The location of attenuation was defined as superficial (leading edge of attenuation closer to the lumen than to the adventitia) or deep (leading edge of attenuation closer to the adventitia than to the lumen).
Echolucent plaque contained an intraplaque zone of absent or low echogenicity (lower than that of the reference adventitia) surrounded by tissue of greater echodensity (3,10). The arc of echolucent zone was measured in degrees with a protractor centered on the lumen. The interobserver variability of the arc of echolucent zone was 5.8 ± 3.4°. The location of the echolucent zone was defined as "superficial" if the leading edge of the echolucent zone was closer to the lumen than to the adventitia or "deep" if the leading edge of the echolucent zone was closer to the adventitia than to the lumen (3).
Calcification was brighter than the reference adventitia and caused acoustic shadowing with or without reverberations (9). The arc of calcium was measured with a protractor centered on the lumen. The interobserver variability of the arc of calcium measurement was 4.1 ± 1.9°. Spotty calcification contained small calcium deposits within arcs of <90° (4,5). The location of calcium was superficial (closer to the lumen than to the adventitia), deep (closer to the adventitia than to the lumen), or mixed (both superficial and deep) (9).
All IVUS determinations were based on the observations of 2 independent experienced reviewers (J.P. and A.M.) who were blinded to other data; lesions for which these 2 observers disagreed were excluded. Interobserver and intraobserver variability yielded good concordance for the diagnosis of echo-attenuated plaque (κ = 0.90 and κ = 0.93, respectively) and spotty calcification (κ = 0.93 and κ = 0.96, respectively), with moderate concordance for the diagnosis of echolucent plaque (κ = 0.74 and κ = 0.77, respectively).
Near-infrared spectroscopic image acquisition and analysis
Using the same protocol as for IVUS imaging, a 3.2-F InfraReDx (Burlington, Massachusetts) near-infrared spectroscopic catheter was advanced into the distal coronary vessel (6,10). Automated mechanical pullback was performed at a speed of 0.5 mm/s and 240 rpm. Raw spectra were acquired at a rate of 40 Hz (1 spectrum every 25 ms). Spatial filtering and image processing of the raw data produced an image with data points every 0.1 mm and every 1°.
During catheter pullback, the probability of LCP was displayed as a "chemogram," a digital color-coded map of the location and intensity of lipid viewed from the luminal surface, with the x-axis indicating the pullback position in millimeters (every 0.1 mm) and the y-axis indicating the circumferential position in degrees (every 1°) as if the coronary vessel had been split open along its longitudinal axis. Spectroscopic information at each pixel was transformed into a probability of LCP, which was then mapped to a 128-point (7-bit) red-to-yellow color scale with the lowest probability of lipid shown as red and the highest probability of lipid shown as yellow. The "block chemogram" was a summary metric that displayed the probability that was present for all measurements using the top 10th percentile pixel information (i.e., the 90th-percentile value) of the corresponding 2-mm chemogram segment. If the probability of the top 10th percentile was ≥0.98, the entire block was yellow.
Near-infrared spectroscopic image analyses were performed off-line using in-house, MATLAB-based software programmed at the Cardiovascular Research Foundation (10). The presence of LCP required 1 yellow block. Yellow pixels (pixels above the preset threshold for the detection of LCP) within the analyzed segment were divided by all pixels in the chemogram to generate the lipid core burden index (LCBI) per mille.
Histopathologic analysis and definitions
After the IVUS and near-infrared spectroscopic images were obtained, segments were pressure fixed in formalin. To obtain histopathologic sections corresponding to the IVUS and near-infrared spectroscopic cross sections, vessels were divided into consecutive 2-mm–long arterial segments using the fixture's guideposts. Histological preparation and analysis were performed at the CVPath Institute (Gaithersburg, Maryland). Histopathologic slides 5-μm thick were prepared from the distal side of each 2-mm block and stained with hematoxylin and eosin and Russell-Movat's pentachrome, as previously described (11). With Movat pentachrome, elastic fibers stain black, collagen fibers stain yellow, proteoglycan stains green, and smooth muscle cells stain red. Each histopathologic slide was digitized using a standard microscope. Histological features were classified using the Virmani-modified American Heart Association plaque classification scheme on the basis of the agreement of 2 pathologists from the CVPath Institute (A.P.B. and R.V.), who were blinded to the IVUS and near-infrared spectroscopic findings (12–15).
In brief, pathological intimal thickening (PIT) was characterized by the formation of extracellular non-necrotic lipid pools within a structured matrix typically adjacent to the media. Early fibroatheromas (FAs) had early necrotic cores (NCs) characterized by small cholesterol clefts and cellular debris with structured matrix. Late FAs had late NCs characterized by increased cellular debris and cholesterol clefts but complete degradation of extracellular structured matrix. Thin-cap FAs had large late NCs covered by thin fibrous caps (<65 μm). Examples are shown in Online Figure 1. Nonlipidic plaques were lesions lacking NCs or lipid pools, including adaptive intimal thickening, smooth muscle cell–rich plaque, bland fibrous plaque, intimal xanthoma, calcified fibrous plaque, and calcified nodules. Using custom software (IPLab, Scanalytics, Rockville, Maryland), contours were drawn on each image to identify fiduciary markers retained by the tissue preparation inking scheme, luminal boundary, lipid pools at sites of PIT, and NC in FA. Quantitative assessment of the thickness, arc, and size of lipid/NC was determined using an automatic computer-assisted technique, and the size of lipid/NC was expressed as the percent cross-sectional area of the total plaque, as previously described (11). On the basis of the report that the mean size of NCs was 23% in thin-cap FAs (15), we defined "large" lipid/NC as >20%.
Statistical analysis
Data analyses were performed using SPSS for Windows version 15.0 (IBM, Armonk, New York) and SAS version 9.13 (SAS Institute, Cary, North Carolina) (16). Categorical data are expressed as absolute values and percents and were compared using chi-square or Fisher exact tests, and continuous data are reported as median (interquartile range [IQR]) and were compared using Kruskal-Wallis/Wilcoxon rank sum tests. For segment-level analyses, a model with a generalized estimating equation approach was used to compensate for any potential cluster effect of multiple segments in the same subject. Intraobserver and interobserver variability was assessed using Cohen's kappa statistics, which correct for the chance of simple agreement and account for systematic observer bias. A kappa value of 0.81 to 1.0 indicates good agreement, and a value of 0.61 to 0.80 indicates moderate agreement. The correlation of the IVUS measurements with histologic findings was calculated using the Spearman correlation coefficient. p values were adjusted using the generalized estimating equation method for repeated measures. Inferential statistical tests were conducted at a significance level of 0.05. The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the report as written.
Demographic data and lesion population
The median lengths of the coronary specimens imaged were 46 mm (IQR: 42 to 50 mm) in the left anterior descending coronary artery, 46 mm (IQR: 38 to 52 mm) in the left circumflex coronary artery, and 50 mm (IQR: 42 to 58 mm) in the right coronary artery. From these imaging runs and subsequent histopathologic analyses, a total of 2,294 2-mm–long segments from 151 coronary specimens from 62 autopsied hearts were used for the present study. Of these, 1,234 segments (53.8%) were classified as plaques containing NCs or lipid pools: 788 (34.4%) were FAs containing NCs, and 446 (19.4%) were PIT containing lipid pools. Donors' median age was 64 years (IQR: 51 to 77.5 years; range 39 to 83 years), 66.1% were men, and 77.4% had cardiovascular causes of death (Table 1).
Echo-attenuated plaque
Overall, 419 segments (18.3%) contained echo attenuation; the median arc of attenuation was 80° (IQR: 60° to 104°; range 29° to 360°), and 99.3% of the cross sections demonstrating attenuated plaque had >30° of attenuation (Fig. 1). On pathological analyses, 91.4% of segments with echo attenuation contained NCs or lipid pools at the site of echo attenuation (Fig. 2): 67.1% were FAs containing NCs (21.2% early NCs and 45.8% late NCs), and 24.3% were non-FAs (i.e., PIT) containing lipid pools.
The prevalence of echo attenuation was highest in FAs with late NCs (39.5%), followed by FAs with early NCs (28.1%) and PIT with lipid pools (22.8%) (p < 0.001). The prevalence of echo attenuation also increased with the size of the NC or lipid pool (Figs. 3A to 3C). When histopathology was considered the gold standard, IVUS echo-attenuated plaque had a sensitivity of 56.2% and a specificity of 94.7% for the detection of a large lipid/NC (Table 2). Histopathologically, the arc of lipid/NC that produced echo attenuation measured 90° (IQR: 70° to 112°; range 31° to 360°), and the arc of IVUS attenuation was significantly correlated with the arc of histopathologic lipid/NC (Spearman ρ = 0.637, p < 0.001) (Fig. 1D). The median thickness of lipid/NC that produced ultrasonic attenuation was 0.70 mm (IQR: 0.54 to 0.92 mm; range 0.30 to 2.57 mm). Echo attenuation in the absence of an NC or a lipid pool was seen in only 8.6%, mainly at a histological branch point (6.7%) or in association with a calcium deposit (1.9%).
Overall, 52.3% of echo attenuation was superficial in location and 47.7% was deep in location. Attenuation was almost always (96.9%) concordant to the maximal plaque plus media thickness. When classified by location, 96.3% of superficial attenuation indicated an FA containing an NC; none indicated PIT with a lipid pool (Fig. 3D). Conversely, 52.8% of deep attenuation indicated PIT containing a lipid pool, whereas only 31.5% indicated an FA containing an NC (Fig. 3E). Compared with plaques with deep attenuation, those with superficial attenuation were more often associated with an FA or an FA with a late NC (p < 0.001 for both) (Fig. 3F). PIT containing a lipid pool only caused attenuation closer to the adventitia than to the lumen (i.e., deep) regardless of the size of lipid pool and never attenuation closer to the lumen than to the adventitia.
Echolucent plaque
Overall, 241 segments (10.5%) contained IVUS echolucent zones. The median arc of the echolucent zone was 70° (IQR: 55° to 88°; range 31° to 162°). The frequency distribution of the arc of the echolucent zone is shown in Figure 4A.
On pathological analyses, 76.8% of segments with echolucent zones contained NCs or lipid pools; 48.1% were FAs with NCs (28.2% late NCs and 19.9% early NCs), and 28.6% were PIT with lipid pools. Examples are shown in Figure 5. The prevalence of echolucent plaques was highest when the lipid/NC represented 20% to 40% of plaque area, with no significant difference in the prevalence of echolucent plaques between NC plaques (14.7%) and lipid pool plaques (15.5%) (p = 0.723), and between FAs with early NCs (15.1%) and those with late NCs (14.4%) (p = 0.784) (Figs. 4C to 4E). When histopathology was considered the gold standard, IVUS echolucent plaque had a sensitivity of 20.5% and a specificity of 90.4% for the detection of a large lipid/NC (Table 2). The median histopathologic arc of lipid/NC that produced an echolucent zone was 74.5° (IQR: 59.0° to 101.0°; range 34.0° to 188.0°); the arc of the echolucent zone correlated with the arc of histopathologic lipid/NC (Spearman ρ = 0.556, p < 0.001) (Fig. 4B). The median thickness of lipid/NC that produced an echolucent zone was 0.51 mm (IQR: 0.35 to 0.64 mm; range 0.29 to 1.79 mm). In 23.2% of segments, echolucent zones did not indicate histopathologic NCs or lipid pools but were associated with intraplaque hemorrhage (9.5%), nonlipidic plaque containing loose collagen (8.3%), or artifacts of the pathological preparation process (5.4%).
Overall, 48.1% of echolucent zones were superficial in location and 51.9% were deep in location. The echolucent zone was almost always (90.9%) concordant to the maximal plaque plus media thickness. When classified by location, most (82.8%) superficial echolucent zones indicated FAs containing NCs (56.0% late NCs and 26.7% early NCs); none indicated PIT with a lipid pool. Deep echolucent zones mostly indicated PIT containing lipid pools: 55.2% were PIT, and only 16.0% were FAs with NCs. Compared with deep echolucent zones, superficial echolucent zones less often represented PIT (0% vs. 55.2%, p < 0.001) and more often represented FAs (82.8% vs. 16.0%, p < 0.001) and FAs with late NCs (56.0% vs. 2.4%, p < 0.001).
Compared with echo-attenuated plaques, echolucent plaques had a significantly smaller thickness (p < 0.001) (Fig. 6A) and arc (p < 0.001) (Fig. 6B) of histological lipid/NC. In addition, echolucent plaques less often represented FAs (p < 0.001) (Fig. 6C) or FAs with late NCs (p < 0.001) (Fig. 6D) compared with echo-attenuated plaques.
The cut point for thickness of lipid/NC that differentiated attenuated plaques from echolucent plaques measured 0.60 mm, with a sensitivity of 67% and a specificity of 71% (area under the curve = 0.74). The cut point for arc of lipid/NC that differentiated attenuated plaques from echolucent plaques measured 75.5°, with a sensitivity of 66% and a specificity of 59% (area under the curve = 0.64).
Spotty calcification
IVUS detected calcification in 735 segments (32.0%). The median arc of calcium was 93.0° (IQR: 54.0° to 140.0°; range 9.0° to 360.0°), and 44.9% of these segments had <90° arc of calcium with a spotty pattern. Overall, 69.9% of all IVUS-detected calcifications were superficial in location, 10.2% were deep in location, and 19.9% were mixed. On pathological analyses, 54.6% of segments with IVUS calcification were calcified fibrous plaques, 40.4% were FAs with calcium deposits, and 5.0% were calcified nodules (Fig. 7). IVUS did not detect calcium in 14.8% of segments containing histopathologic calcium; reasons included deep calcium hidden behind a large NC that produced echo attenuation (5.4%) and microcalcium deposits (9.4%).
In the setting of IVUS-detected spotty calcification, 62.4% were FAs with calcium deposits and 32.7% were fibrocalcific plaques; the median arc of calcium was 52.0° (IQR: 37.0° to 70.0°; range 9° to 89°), with smaller arcs in the setting of FA compared with fibrocalcific plaques (p < 0.001) (Fig. 8A). The frequency distribution of the arc of spotty calcification in FAs and fibrocalcific plaques is shown in Figure 8B. When histological results were considered the standard, IVUS spotty calcification had a specificity of 71.7% and a sensitivity of 69.4% for the detection of an FA with calcium deposits (Table 2). In addition, plaques with IVUS spotty calcifications were more often FAs, compared with IVUS extensive calcification (p < 0.0001) (Fig. 8C).
Overall, 67.6% of IVUS spotty calcifications were superficial in location, 13.0% were deep in location, and 19.4% were mixed; 76.3% of IVUS spotty calcifications were concordant to the maximal plaque plus media thickness. When classified by location, 72.6% of IVUS superficial spotty calcifications were seen in FAs with calcium deposits (45.3% late NCs and 27.3% early NCs). Conversely, 67.4% of IVUS deep spotty calcifications were seen in fibrocalcific plaques without NCs, and only 32.6% of IVUS deep spotty calcifications were seen in FAs. In addition, deep IVUS spotty calcifications, when seen in FAs, were uncommonly associated with FAs containing large NCs (12.5% containing large NCs [size >20%] and 87.5% containing smaller NCs) because large NCs often produced echo attenuation, hiding deeper calcific deposits (Fig. 7E).
IVUS versus NIRS findings
On NIRS analyses, 83.5% of echo-attenuated segments contained LCP, as identified by the presence of the yellow block chemogram (Fig. 9A). Compared with echo-attenuated plaques, echolucent plaques were associated with less NIRS-derived LCP (p < 0.001) (Fig. 9B) and a smaller NIRS-derived LCBI (p < 0.001) (Fig. 9C). In plaques with calcifications, IVUS spotty calcifications were associated with more NIRS-derived LCP (47.9% vs. 15.6%, p < 0.001) and a larger NIRS-derived LCBI (95.3 [IQR: 30.6 to 183.6] vs. 44.5 [IQR: 1.4 to 129.4]; p < 0.001) than IVUS extensive calcification (Fig. 10). In the setting of IVUS spotty calcification, the arc of calcification was negatively correlated with the NIRS-derived LCBI (Spearman ρ = −0.417, p < 0.001) (Online Fig. 2).
Association between plaque characteristics and cardiovascular events
As shown in Table 3, patients in this autopsy series who died of cardiovascular causes had more echo-attenuated plaques (p = 0.025) and more superficial echo-attenuated plaques (p = 0.023) compared with those who died of noncardiovascular causes. The frequency of echo-attenuated plaque involving multiple (2 or 3) epicardial vessels was 47.9% in cardiovascular death versus 21.4% in noncardiovascular death (p = 0.077). Although there were no significant differences in the frequency of echolucent plaques (p = 0.346) and spotty calcifications (p = 0.120) between the 2 groups, superficial echolucent plaques (p = 0.052) and superficial spotty calcifications (p = 0.049) tended to be more frequent in patients who died of cardiovascular causes.
The novel findings of the present study include the following: 1) IVUS attenuation indicated the presence of a large NC or lipid pool, and the closer the attenuation was to the lumen, the more likely it indicated the presence of an advanced NC; 2) an intraplaque echolucent zone indicated the presence of a relatively smaller NC or lipid pool, especially compared with echo attenuation, although most superficial echolucent zones indicated NC-containing FAs; and 3) IVUS spotty calcification, especially superficial in location, was often associated with an FA with calcium deposits and had smaller arcs of calcium in the setting of FAs compared with fibrocalcific plaques. These findings were supported by a comparison of patients who died of cardiovascular causes and those who died of noncardiovascular causes.
Echo-attenuated plaques
Ultrasonic attenuation in the absence of associated calcium (i.e., echo-attenuated plaque) was a novel IVUS imaging finding that has not been described in the existing IVUS guidelines from the American College of Cardiology or the European Society of Cardiology (9,17). Recent clinical studies have shown that echo-attenuated plaques were associated with ST-segment elevation myocardial infarction and periprocedural myonecrosis or no-reflow in patients with coronary artery disease undergoing percutaneous intervention (1,2,18). However, histopathologic analyses of a small number of specimens yielded inconsistent results, and echo attenuation has been variously related to microcalcification, hyalinized fibrous tissue, cholesterol crystals, or organized thrombus (19–22). Hara et al. (19) reported a patient who died of acute myocardial infarction and suggested that echo attenuation was caused by the presence of stratified microcalcification. Tsunoda et al. (20) examined material retrieved during atherectomy of an attenuated plaque and reported hyalinized fibrous plaque with expansive remodeling. Kimura et al. (21) examined retrieved atherectomy specimens from 30 attenuated plaques and found advanced atherosclerosis consisting predominantly of cholesterol clefts, macrophage infiltration, and microcalcification. Based on the modified American Heart Association histological classification in a relatively large series of postmortem human coronary samples, the present study demonstrated that IVUS attenuation was indicative of either an FA containing a large NC or PIT with a large lipid pool, and the prevalence of echo attenuation increased with the size of the NC or lipid pool.
The size of the lipid/NC has been significantly associated with the likelihood of plaque rupture (12,23). Davies et al. (24) estimated that when >40% of the plaque consists of lipid/NC, an atheroma is at high risk for rupture. In the present study, the prevalence of ultrasonic attenuation was highest when the lipid/NC represented >40% of plaque area. Furthermore, superficial echo attenuation was seen almost exclusively in the setting of an NC-containing FA; and the closer to the lumen, the more likely the attenuation indicated an advanced NC. Conversely, attenuation from a lipid pool in PIT always appeared closer to the adventitia than to the lumen, especially near the intimal-medial border. It is believed that PIT, characterized by the formation of extracellular non-necrotic lipid pools within the plaque, is the first progressive lesion of atherosclerosis and represents a precursor lesion to FA (14). An NC within an FA is thought to arise from macrophage infiltration of lipid pools and cell death ("early" NC), followed by secondary necrosis ("late" NC) whereby cholesterol clefts, microcalcification, and intraplaque hemorrhage likely contribute to its enlargement (13). Previous studies have speculated that microcalcification and cholesterol crystals within an advanced plaque are responsible for ultrasonic attenuation by reflecting and dispersing ultrasonic wave signals (1,21). However, in the present study, the appearance of echo attenuation in PIT without microcalcification or cholesterol crystals suggests that lipid pool alone can cause ultrasonic attenuation and that the presence of other plaque components (i.e., cholesterol crystals or microcalcifications in FA) was not necessary for the appearance of this IVUS signature. However, the more advanced the atherosclerotic plaque, the more complex and heterogeneous the plaque components that contribute to enhancing attenuation of ultrasound (i.e., closer to the lumen).
Echolucent plaques
One prospective clinical study with 2-year follow-up found an increased risk for acute coronary events in patients with IVUS superficial (but not deep) echolucent zones within coronary plaques (3). In the present study, an intraplaque echolucent zone indicated the presence of an NC or a lipid pool that was smaller than that seen with echo-attenuated plaques. Moreover, most superficial echolucent zones were seen in the setting of an FA containing an NC, whereas deep echolucent zones indicated PIT containing a lipid pool. The exact mechanism for grayscale IVUS echolucent zones remains debated (25). It has been postulated that echolucency should be a sign of homogeneous tissue (lipid pool), whereas NC tissue is heterogeneous with multiple tissue interfaces and therefore should be hyperechoic but not hypoechoic. However, the results of the present histopathologic study show that echolucent areas actually indicated areas of high lipid content within either a preserved (lipid pool) or degraded (NC) extracellular matrix. In addition, the present data also indicate significant limitations when echolucent zones alone are used to identify lipid-rich plaques. Compared with echolucent plaques, echo-attenuated plaques had a significantly greater thickness and arc of lipid/NC on histopathology. In addition, the prevalence of echolucent plaques was highest when the lipid/NC represented 20% to 40% of plaque area, whereas the prevalence of echo-attenuated plaques was highest in plaques with a percent core of >40%. Thus, a relatively small area of lipid/NC most likely produced an echolucent area on IVUS, whereas a larger lipid/NC produced echo attenuation.
Spotty calcification
Although extensively calcified lesions are assumed to be clinically quiescent, spotty calcification has been associated with an increased incidence of ischemic cardiovascular events (4,5,26). Recent clinical studies have shown that: 1) the pattern of calcification is different in patients with acute coronary syndromes compared with those with stable angina (4,27); 2) IVUS-identified spotty calcification is more likely to be found in culprit lesions in patients with myocardial infarctions than in patients with stable angina (4); 3) IVUS spotty calcification identifies patients with an active state that has accelerated disease progression (5); 4) ruptured coronary plaques are associated with spotty calcification, particularly in deep locations, and the number of deep calcium deposits was an independent predictor of culprit plaque ruptures in patients who had acute coronary syndromes (27); and 5) IVUS superficial spotty calcification patterns are associated with very late stent thrombosis after bare-metal stent implantation (28). However, studies on the histological plaque composition of IVUS-detected spotty calcified lesions are lacking.
The present histopathologic study supports the association between spotty calcification and unstable plaque. First, IVUS detected spotty calcium more often in an FA than in fibrocalcific plaque. Second, in the setting of IVUS spotty calcification, FA with calcium deposits was characterized by smaller arc of calcium deposits versus fibrocalcific plaques. Conversely, the present histopathologic study does not support the concept that IVUS-detected deep spotty calcium is associated with unstable plaque characteristics that predict future rupture. Rather, deep calcium behind a large NC was often not detected by IVUS because of echo attenuation produced by the overlying NC. Compared with the gold standard of histopathology, IVUS deep spotty calcifications were more likely to be seen in plaques without large NCs. It is more likely that deep spotty calcium behind a large NC was detected by IVUS at the bottom of a cavity after, rather than before, plaque/NC rupture.
Pathological studies have demonstrated that calcium is a frequent feature of ruptured plaques underlying sudden cardiac death and that a few scattered small calcium deposits are often present in the fibrous cap of an FA (29–31). The development of scattered small calcium around the NC appears to result from the induction of osteogenic changes by inflammatory factors and oxidized lipids in NC (32,33). The contribution of spotty calcification to plaque vulnerability is likely related to mechanical instability introduced by coherent focal calcium deposits at the interface with noncalcified plaque components (30,31).
Study limitations
First, this study was autopsy based, in comparison with the gold standard of histopathology. Although vessels were studied as soon as possible, such ex vivo study was limited by possible tissue changes induced by histopathologic preparation and lacking the dynamic motion and tortuous anatomy of the coronary vasculature.
Second, we could not assess very severe stenoses not passable by the IVUS or NIRS catheter. These segments were excluded by in situ angioscopic screening before examination.
Third, IVUS qualitative analysis may be subject to poor reproducibility (34). Qualitative assessment of echogenicity is performed on the cross-sectional view using the adventitia as a reference; however, the echogenicity of the adventitia may change from frame to frame.
Fourth, the present observations might be valid only for the 40-MHz IVUS catheter, because different IVUS frequencies have different penetrations that might affect qualitative plaque characteristics, especially attenuation. Similarly, ultrasound attenuation might be affected by the position of the IVUS catheter relative to the maximal plaque thickness.
Finally, hearts were obtained from 2 research tissue procurers and may not be representative of the general population or a specific subset of patients.
The present study in a relatively large series of human coronary autopsy specimens from victims of both cardiovascular and noncardiovascular deaths suggests that standard grayscale IVUS can provide more ultrasound information on plaque characterization than previously considered. Echo attenuation indicates a relatively larger lipid/NC than an echolucent zone, and IVUS spotty calcification is closely related to the presence of an NC, also indicating plaque instability. Those ultrasonic signatures, especially when superficial in location, are likely associated with an advanced FA with an NC and, thus, greater biologic instability than when seen to be deep in location.
The authors thank Jennifer B. Lisauskas, MS, for her technical contributions to this report.
For supplemental figures and their legends, please see the online version of this article.
Dr. Pu has received research grants from the National Natural Science Foundation of China (81170192/81270282) and Boston Scientific. Dr. Mintz has received consulting fees from Boston Scientific Corporation, InfraReDx, and Volcano Corporation; and has received research grant support from Volcano Corporation. Mr. Biro is a current employee of Volcano Corporation. Drs. Sum, Madden, and Muller are current employees of InfraReDx. Dr. Madden is a shareholder in InfraReDx. Drs. Burke and Virmani were consultants to InfraReDx for histological studies. Dr. Goldstein is a consultant to and an equity owner in InfraReDx. Dr. Stone is a consultant to Boston Scientific Corporation, Volcano Corporation, and InfraReDx. Dr. Muller has equity ownership in InfraReDx. Dr. Virmani is a consultant for and/or has received honoraria and/or research support from Abbott Vascular, Atrium, Biosensors International, Boston Scientific Corporation, CeloNova, Cordis Corporation, GlaxoSmithKline, Kona Medical, Lutonix, Medtronic, Microport Medical, Orbus Neich, ReCor Medical, SINO Medical Technology, Terumo Corporation, Merck, 480 Biomedical, and W.L. Gore. Dr. Maehara is a consultant to and has received research and grant support from Boston Scientific Corporation; and has received lecture fees from St. Jude Medical and Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- fibroatheroma
- interquartile range
- intravascular ultrasound
- lipid core burden index
- lipid core plaque
- necrotic core
- near-infrared spectroscopy
- pathological intimal thickening
- Received October 21, 2013.
- Revision received February 18, 2014.
- Accepted February 25, 2014.
- American College of Cardiology Foundation
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text:
Konza LTER Publications
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Journal Article
The diet of upland sandpipers (Bartramia longicauda) in managed farmland in their neotropical non-breeding grounds. Ornitología Neotropical. 2015;26(4):337-347..
Habitat selection and space use of Upland Sandpipers at nonbreeding grounds. Avian Conservation and Ecology. 2019:14:art18..


text:
Thanks for all the positive feedback on the new album everyone! We worked extremely hard to bring it to you, glad to see all the hard work paid off (judging from fan feedback so far as well as reviews).
We've posted a new medley from the album for those that have still not picked up your copy, check it out! http://www.myspace.com/kamelot
You can still order your copy online at www.poetryforthepoisoned.com or hit your local music shop and ask for it there as well.
If you would like to order the digital version please use the button link below!


text:
The Battle for Raqqa
"Daesh is using boats and ferries to transport weapons and fighters. Do not use ferries or boats, airstrikes are coming."
U.S.-led coalition warning leaflets, Raqqa, Syria
"They tell people ... It is a Battle against Islam, all nations are attacking us and the Prophet says e should be united."
"They are putting psychological pressure on residents."
Hussam Eesa, founder, Raqqa is Being Slaughtered Silently
|ISIL marching in Raqqa, Syria, © AP Photo/ Public Domain
"I've seen the pictures on the Internet and the control and operations room had been fully burned, which means there is no control of the water coming into the dam."
"This will lead to a real catastrophe, because there is no way from inside the dam to get rid of the water. The situation will escalate because as more cubic metres come in, the situation becomes more dangerous."
"We need someone to interfere to stop this catastrophe, because water will overcome the dam and we don't know what we could do and how many days it would take to collapse - people living along there along the Euphrates are in danger."
Hakam Tawfik, structural engineer who worked on the construction of the dam
The danger of the Tahqa Dam collapsing appears entirely plausible. The dam which supplies the entire region with electricity has been vulnerable to collapse through shoddy design and workmanship for a lengthy period of time. Before the outbreak of civil war in Syria, the dam's engineers took great care in its upkeep and stabilizing work pouring tons of cement into the bulwarks, required on an ongoing basis, since neglected when Islamic State took possession of the dam for the last two years.
Now, water levels have risen to the extent of threatening collapse, since area fighting put the dam out of service. ISIL itself took the precaution of ordering residents of Tabqa and Raqqa to leave, informing them that U.S. airstrikes was responsible for the vulnerability of the dam to imminent collapse.
According to the United Nations, damage to the dam could lead to "massive scale flooding" inundating Raqqa and downstream cities. Haytham Bakkour who operated the dam for a decade as an accredited dam engineer, warned that a "critical overflow" could occur within 30 days if the area was not made safe for staff to enter and work on manoeuvring the floodgates.
Which makes the SDF forces assault against Raqqa all the more desperate. The prevailing situation of ISIL defences are formidable, however, given that landmines and militant checkpoints encircle the city, and within the city itself hundreds of thousands of residents are trapped, useful to Islamic State as a human shield and detaining the opposition forces from a full-on invasion. All males were ordered to wear the traditional ISIL clothing, making it impossible to distinguish civilians from the jihadis.
Thousands of Syrians who had left other areas in Syria for Raqqa live in the streets, in tents, hapless targets of airstrikes as well as any ground fighting. ISIL has erected immense tarpaulins, stretched over city blocks as aerial screens, to shield their activities from air reconnaissance. It is inevitable that civilians will be struck by U.S.-led coalition airstrikes. Fear arises among civilians, never knowing whether a strike will hit them, and knowing that ISIL is on the lookout for "spies" among them.
Most European fighters with ISIL have been evacuated, dispatched to the east, deeper in more securely held ISIL territory. The theory is that their value lies in returning back to the European and North American countries from where they originated, to infiltrat as ticking time bombs. Local reinforcements are on track to arrive in Raqqa from Mosul and parts of Iraq, to defend Raqqa, Islamic State's so-called capital. An estimated four thousand ISIL fighters are in Raqqa, with an expected additional two thousand on the way.
Those in Raqqa have begun to shelter themselves among the civilian residents. And the residents have been deployed to dig trenches and build earthen berms in defence of the city. There is no shortage of food yet, while hospitals have few doctors left and equipment and medications are in short supply. Loudspeakers have been mounted on mosques and vehicles for the religious police to warn the estimated 300,000 Raqqa residents that the battle is approaching.
Labels: Conflict, Iraq, Islamic State, Raqqa, Syria


text: Arizona seems custom-made for basketball. Players have the advantage of being able to play outside year-round, unlike less fortunate players in more northerly climes. Playing basketball offers Arizonan kids an opportunity to build skills that help them both on and off the courts. Not every lesson learned during basketball practice is physical. A good basketball player has to practice, but mental attitude is at least as important as physical talents. Team work, sportsmanship and an ability to learn from mistakes transform an average player into a true athlete. Embrace Team Work We live in a culture that values and worships individual talent. The quintessential American hero is the loner who wins the day relying only on his own wit and talent. Even the military slogan "Army of One" emphasizes this love of the self-reliant hero. Basketball isn't immune to this trend. The media talk of stars like Jordan and Bryant as though they've single-handedly won games. Of course they didn't: each was part of a team that functioned as a whole. You may have more or less talent than other members of your team, but that isn't as important as being part of the team. In a match between talented players with no sense of teamwork and average players who work well together, teamwork wins out every time. What does this mean for you as a player? Sometimes it means giving up a shot because a teammate has a better position. Sometimes it means giving up a chance to be the game hero to ensure a team victory. The ability to work as part of a team serves you well in life, both on and off the courts. Show Respect and Sportsmanship Sportsmanship is a direct measure of your worth as a person, despite the fact that "being a good sport" seems to have fallen out of vogue these days. Poor sportsmanship can, unfortunately, always be found. It's present in dirty tricks on the court, and in coaches who holler and complain at every official call. It's present in players who resent a teammate's success, and in parents who yell abuse at their child's coach. A good sport respects her teammates, her coach, the officials and her opponents. Perhaps more importantly, a good sport respects herself. Good sportsmanship makes you a better player, but more importantly, makes you a better person. Get Active in Many Ways Basketball provides a fantastic cardiovascular workout that gets you in shape and keeps you fit. So why would you need any other physical activity? Other physical activity improves your game. Running and swimming improve endurance. Weight training adds strength. Yoga, tai chi and similar exercise increase flexibility and improve balance. Any type of physical activity off the basketball court adds to your overall fitness and makes you a more versatile athlete. Learn From Losing Losing can make you a better basketball player. When you lose you have the opportunity to step back and, without casting blame, ask why. Identify what caused the loss, and how you would handle the same problem if it happened in another game. Resolve not to make the same mistakes in the next game. When Chuck Norris actively competed in karate he had a rule about losing matches: He promised himself never to lose a match the same way twice. Norris turned every defeat into a chance to become a better competitor. While basketball's emotional and mental lessons can be learned in any situation, kids are most likely to develop these skills at basketball camps. Basketball camps emphasize team work and the critical mental attitudes need for success on the courts and in the classroom where academic requirements are part of the formula for a successful career. References: None Sidebar: Early Registration for Basketball Camps Summer basketball camps fill up quickly. Basketball is, after all, one of the most popular sports in the U.S. While you can still find openings for basketball camps in the early summer, parents who want their kids to go to the best basketball camps are advised to look into registration in the spring.


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The Pose Fair returns this week, and it promises to be a bumper round with some awesome props and poses to make your pictures come alive. Like the Weasel Glade backdrop and pose by Joplino I'm using in my picture today. The pose fair runs from 4th to 25th May, and I'll be showing you... Continue Reading →
all a dream
Were there monsters in your room? Or were they ghosts? What was it that had you running scared? Afraid for your life. We all have nights like that, when you experience something so real, so scary, that you are almost sure you are going to die. Your worst fears have actually come true.... And then... Continue Reading →
going down…
Whatever you do don't take the lift, they said, always use the stairs! Psft! as if, who is, in all honesty going to opt for climbing the stairs over taking the easy route? On second thoughts, I think I'd rather take my chances on the stairs... More scary stuff today in the form of this... Continue Reading →
they're not coming…
...they are already here! By day they walk amongst us, taking a human form, and if like me, you are an avid people watcher, you can spot them if you look closely. All you have to do is pick a spot, a bench in the middle of a busy street or park, and sit for... Continue Reading →
silver lady
All I can say is TFIF! Another long week that's gone way too fast, and yes, I know that is a contradiction in terms but I'm sure you get what I mean. I don't mind admitting that I've struggled this week, tiredness and sickness have bought me down and I'm so far behind on my... Continue Reading →
empty rooms
Loneliness is your only friend. A broken heart that just won't mend is the price you pay. It's hard to take when love grows old. The days are long and the nights turn cold when it fades away. You hope that he will change his mind, but the days drift on and on. You'll never... Continue Reading →
I've heard many people talk about 'that' website, but I have never visited myself. Today I did, just to see what all the fuss was about. I am ashamed to say I spent over an hour reading utter and total rubbish. Do people really have nothing better to do with their lives? Seriously it was... Continue Reading →
"So you're a little weird? Work it! A little different? OWN it! Better to be a nerd than one of the herd!" The all new August round of PocketGacha goes live today, and, this round marks the 1st anniversary of this fabulous event. I have a few nice things to show you, like the... Continue Reading →
are you gonna go my way?
So many lovely things already this month and it's only the 3rd! I just have no idea how I'm gonna keep up, but I'll try my very bestest! My outfit today comes from SassyAF, they never fail to disappoint lately, not that they ever do, of course, but the Romance outfit I'm showing off here... Continue Reading →


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Proceeds from the event went toward Nelson's charity Young Life, which pairs middle, high school and college students with young adults for guidance. In 2017, the game raised $130,000.
Jenkins noticed how Trump agreed to sit down recently with Kim Kardashian and discuss prison reform, yet he has criticized the the Eagles' activist players.
If you can meet with a Kardashian, there are some other activists that you can meet with as well, Jenkins said.
Jenkins was also frustrated to see Fox News air a segment that implied Eagles players were kneeling to protest the national anthem when, in reality, the players were praying.
Bullcrap, he said of the Fox News piece, for which the network has apologized.
His reaction was typical Judge, who smiled telling how he already was turning the page on going 0-for-9 with eight strikeouts and a walk Monday in the Yankees' doubleheader split with the Detroit Tigers.
Patriots workouts thus far everything from contract speculation to rumors of being peeved at coach Bill Belichick. Perhaps we'll get some answers this week. Unlikely, but perhaps.
Position group to watch: Receiver. The Patriots have an abundance of players at receiver with overlapping traits: Julian Edelman, Chris Hogan, Jordan Matthews, Malcolm http://www.saintsshopfootballonline.com/Authentic-Michael-Hoomanawanui-Jersey Mitchell, Philip Dorsett, Cordarrelle Patterson, Kenny Britt, Braxton Berrios, Riley McCarron and Cody Hollister. Who Michael Hoomanawanui Youth Jersey will stand out? Will Edelman's return be seamless? Who will provide the field-stretching element? Will Mitchell be healthy enough to secure a role? Will a full http://www.bearsofficialnflproshop.com/Authentic-Bryce-Callahan-Jersey offseason unlock Dorsett's potential or is he heading into training camp on the roster bubble? The first work with Brady this offseason could provide us the start of some answers.
One lingering question: How will the Pats offensive line shake out? Can first-round pick Isaiah Wynn help replace Nate Solder at left tackle? Will newly acquired Trent Brown find a role or simply play swing backup? If Wynn doesn't Bryce Callahan Jersey win the left tackle job would he be better inside where many scouts projected him leading up to the draft?


text: "Brain Trainer 2 Free" - is an application for the development of Your memory and intellectual abilities. We have collected in a single application the most interesting and effective intellectual games. Memory games: - "Remember the number" - a game for the development of the ability to remember long numbers - "Watch for them" - and remember the correct sequence of actions to restore - "Mind Matrix" - will help to develop the ability to remember a static images - "Remember Color" - find all pairs of table cells of the same color Perception games: - "Time perception" - the game will help to develop your perception of time - "Stroop test" - a game for the development of color perception - "Tables Schulte" - a game for the development of the perception of peripheral vision Reaction games: - "Try to catch" - the game helps to develop a response to recurring events In the future we will add even more intelligent games. Enjoy intellectual development!


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I can't open it! How to open it? I've been trying I've been trying to find a button of some sort to open it but i cant find one. I need to open it!
If you're talking about a CD/DVD drive, first try "Eject" from the right-click menu in which ever version of Windows you have. Otherwise check pages 24-28 of this:
"Channeling the spirit of jboy..."
Presuming you mean the dvd drive... Usually theres a button somewhere on the tray face; and also there will be small hole where one can insert a paper clip to open the drive if it has a disc stuck inside. And you can often "eject" a disk by right-clicking on the drive icon/letter in Explorer or My Computer and there may/will be the eject option. If there isn't a disc inside... logically eject probably won't respond.
And this photo clearly shows the drive (it's on the right end/side when viewing laptop from the front). The button to open the drive is clearly shown... The drive tray face is moulded to match the rest of the lapto, and the button is just below the curve of the tray face...
message edited by trvlr


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text:
Lost review for October 4, 2006
Lost has returned, and so has my Lost reviews (even though I'm on vacation). I was lucky enough to be able to do my presentation and get back in time to watch the premier.
The episode began with what appears to be a nice suburban setting. A women who is obviously unhappy in general is leading a book club. All of a sudden there is an earthquake and she runs out, along with other people along the street. We see Henry from the Others, and the original Other we met (forgot his name), and then we see the plane with the original cast aways breaking. I thought I saw something odd about the plane, but it was hard to tell.
So a lot right away: The Others have a very nice, suburban style neighborhood. The Others were not expecting the plane crash, but seemed unsurprised by it. Henry said it was a "good" one. We know Dharma used the island due to it's "special" properties, so maybe this is just what it does - draws things to it.
The rest of episode shows the prisons for Jack, Sawyer, and Kate. Jack is a glassed in cell that is underwater. A location known as the Hydra. Sawyer is in a prison outside. Did anyone catch the Dharma logo there? It looked like it could be a Hydra. Anyway, the scenes with Sawyer were a bit to short. As for Kate, well, she had a dinner with Henry, and he just warned her that the next two weeks would be difficult.
So I'm leaving out some of the details - but I'm tired and it's my vacation, so this one will be short. I'm very happy that this season is focusing on the Others as I absolutely love them, especially Ben (Henry's real name as we find out by the end of the episode). The back story this time was a bit weak. I don't know why but I just didn't care for it a lot. Ok - that's it. As a general reminder for my readers, I'm on vacation all this week so won't be back to regular postings till next Monday.