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VANTAS® (histrelin acetate) implant is a sterile, non-biodegradable, diffusion-controlled hydrogel polymer reservoir containing histrelin acetate, a synthetic nonapeptide analog of the naturally occurring gonadotropin releasing hormone (GnRH). VANTAS is designed to deliver approximately 50 mcg histrelin acetate per day (equivalent to approximately 41 mcg histrelin per day) over 12 months.
The sterile VANTAS implant looks like a small thin flexible tube and consists of a 50-mg histrelin acetate drug core inside a 3.5 cm by 3 mm, cylindrical hydrogel polymer reservoir (Figure A). The implant may appear partially to completely full with variation in color from off-white to light brown. The color may be uneven within the core.
Figure A: VANTAS Implant diagram (not to scale)
Histrelin acetate is chemically described as: 5-oxo-L-prolyl-L-histidyl-L-tryptophyl-L-seryl-L-tyrosyl-Ntbenzyl-Dhistidyl-L-leucyl-L-arginyl-N-ethyl-L-prolinamide acetate (salt) [C66H86N18O12 (1.7-2.8 moles) CH3COOH, (0.6-7.0 moles) H2O], with the molecular weight of 1443.70 (or 1323.50 as histrelin base).
Histrelin acetate has the following structural formula:
The drug core also contains the inactive ingredient stearic acid NF. The hydrogel polymer reservoir is a hydrophilic cartridge composed of 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, trimethylolpropane trimethacrylate, benzoin methyl ether, Perkadox-16, and Triton X-100. Each implant is packaged hydrated in a glass vial containing 2 mL of sterile 1.8% sodium chloride solution. The implant is primed for immediate release of the drug upon insertion.
A single use, sterile Insertion Tool is provided along with the implant that may be used for the placement of the implant into the subcutaneous tissue of the inner aspect of the upper arm. The Insertion Tool is enclosed in a sterile bag and is provided separately from the implant in the Implantation Kit [see DOSAGE AND ADMINISTRATION].
VANTAS is indicated for the palliative treatment of advanced prostate cancer.
Recommended Dose
The recommended dose of VANTAS is one implant for 12 months. Each implant contains 50 mg histrelin acetate to deliver 41 mg histrelin. The implant is inserted subcutaneously in the inner aspect of the upper arm and provides continuous release of histrelin (50 mcg/day) for 12 months of hormonal therapy. VANTAS should be removed after 12 months of therapy (the implant has been designed to allow for a few additional weeks of histrelin release, in order to allow flexibility of medical appointments). At the time an implant is removed, another implant may be inserted to continue therapy.
Recommended Procedure For Implant Insertion And Removal
This procedure section is intended to provide guidance for the insertion and removal of VANTAS.
Insertion of a new implant can proceed using the following Insertion Procedure. If a previous VANTAS implant must first be removed, please see the Removal Procedure instructions below.
Insertion Procedure
Many of the supplies necessary to insert the implant, including the Insertion Tool and local anesthetic, are provided in a separate Implantation Kit that is shipped along with the implant. Please note that the implant, in its sealed vial, pouch, and carton, must be kept refrigerated (2°C to 8°C) until needed for the procedure. Once removed from refrigeration, the vial containing the implant (still in its unopened pouch and carton) may remain at room temperature for up to 7 days, if necessary, before being used. If not used in that time, the packaged implant may again be properly refrigerated until the expiration date on the carton.
The Implantation Kit is to be stored at 20°C to 25°C (68°F to 77°F) [See USP Controlled Room Temperature] only.
Insertion of the VANTAS implant is a surgical procedure. Sterile gloves and aseptic technique must be used to minimize any chance of infection.
Setting Up The Sterile Field
Using proper aseptic technique, the sterilized components of the Implantation Kit needed for the insertion procedure, including the Insertion Tool, are to be carefully dispensed from their packaging onto the Sterile Field drape (non-fenestrated) provided. NOTE THAT THE KIT BOX AND ALL PACKAGING, INCLUDING THE SURFACE OF THE VIALS, ARE NOT STERILE and should be kept off of the Sterile Field drape.
The implant vial should not be opened until just before the time of insertion. Open the vial by removing the metal band and carefully pour the sterile contents (implant and sterile saline) onto the Sterile Field drape. The implant can then be handled with sterile gloves or with the sterile mosquito clamp provided. AVOID bending or pinching the implant.
Preparing The Patient And The Insertion Site
The patient should be on his back, ideally with the arm least used (e.g., left arm for a right-handed person) positioned either bent or extended so that the physician has ready access to the inner aspect of the upper arm. Propping the arm with pillows may help the patient more easily hold the position. The suggested optimum site for subcutaneous insertion is approximately half-way between the shoulder and the elbow, in line with the crease between the biceps and triceps muscles.
Swab the insertion area with topical antiseptic, then overlay with the fenestrated Sterile Field drape provided, so that the opening is over the insertion site (for clarity of illustration, the following images do not show the drape).
The method of anesthesia utilized (i.e., local, conscious sedation, general) is at the discretion of the healthcare provider.
If local anesthesia is selected: a vial of a local anesthetic (e.g., lidocaine HCl 1% with epinephrine or lidocaine HCl 1%)(note that the exterior of the vial is not sterile) has been provided along with a sterile hypodermic needle for injection. After determining the absence of known allergies to the anesthetic agent, inject anesthetic into the subcutaneous tissue, starting at the planned incision site, then infiltrating along the intended subcutaneous insertion path, up to the length of the implant (a little more than one inch).
Loading The Insertion Tool
The sterile Insertion Tool is comprised of a fixed handle attached to a retractable, bevel-tipped cannula, into the chamber of which the implant is placed for subcutaneous insertion. Inside the fully extended cannula, up to the level of the black marking, is a fixed piston upon which the implant rests. During the final step of the insertion procedure, the cannula will be retracted into the handle using the slide mechanism (green button), thereby exposing and leaving the implant to remain in the subcutaneous tissue.
When first grasping the sterile Insertion Tool, confirm that the cannula is fully extended. Verify this by inspecting the position of the green retraction button. The button should be locked in position all the way forward, towards the cannula, farthest from the handle.
The implant can be picked up using sterile gloves or with the sterile mosquito clamp provided. Avoid bending or pinching the implant. Note that the implant may come out of its vial slightly curved and/or partially flattened after refrigerated storage.
To help make the implant more symmetrical prior to loading into the Tool, you can roll the implant a few times (using a sterile glove) between the fingers and thumb.
Insert the implant into the cannula of the Insertion Tool manually or using the mosquito clamp. When inserting the implant into the cannula, DO NOT FORCE the implant. If resistance is felt, the implant should be removed and manually manipulated or rolled as needed, and re-inserted into the cannula.
When fully inserted, the implant rests inside the cannula so that just the tip of the implant is visible at the beveled end of the cannula.
Making The Incision
Using the sterile scalpel provided, make an incision transverse to the long axis of the arm, and of a size adequate to allow the bore of the cannula to be inserted into the subcutaneous tissue.
Inserting The Implant
The insertion may be easier if a "pocket" for the implant is first created by blunt dissection through the incision, subcutaneously along the path of the anesthetic, using the cannula of the loaded Insertion Tool, or using a sterile hemostatic clamp or equivalent surgical tool.
Be sure to VISIBLY RAISE THE SKIN (known as tenting) at all times during the pocket-making and insertion procedures to ensure correct subcutaneous placement ("just under the skin") of the implant. Note that the cannula of the Insertion Tool, or whatever tool is being used to create the pocket, SHOULD NOT ENTER MUSCLE TISSUE. Deep insertion of the implant will not affect the performance of VANTAS, but may cause difficulty in the later removal of the implant.
If using the cannula of the loaded Insertion Tool to create the pocket, carefully insert the tip of the cannula into the incision and advance through the subcutaneous tissue, while visibly raising the skin along the length of the cannula up to, but no farther than, the inscribed black line on the cannula. DO NOT DEPRESS THE GREEN RETRACTION BUTTON ON THE TOOL WHILE INSERTING OR ADVANCING THE TOOL INTO THE INCISION.
Pull the Tool back, almost to the beveled tip of the cannula, and advance the Tool forward again, so that the cannula re-enters the pocket completely, but no farther than the inscribed black line. Be sure to keep the insertion path just immediately subcutaneous.
If another tool was used to create the pocket, now insert the loaded cannula of the Insertion Tool containing the implant through the incision, up to the inscribed black line.
Hold the Insertion Tool in place with the base against the patient's arm as you carefully move your thumb to the green retraction button. Depress the button to release the locking mechanism, then slide the button back toward the handle until it stops, all the while holding the body of the Insertion Tool in place.
Retracting the button causes the cannula to withdraw from the incision, leaving the implant in the subcutaneous tissue. DO NOT FURTHER ADVANCE THE CANNULA ONCE THE RETRACTION PROCESS HAS STARTED. Likewise, do not withdraw the Insertion Tool until the button is fully retracted or the implant may be pulled partially out of the incision. Once the retraction is complete, the Tool can be fully withdrawn.
It is helpful during the process of retraction and withdrawal of the cannula to apply pressure to the skin over the implant, to help ensure that the implant remains in the subcutaneous pocket.
If there is a need to re-start the process at any time during the insertion procedure, withdraw the Insertion Tool, carefully extract the implant from the cannula and reset the retraction button on the Tool to its forward-most position. Examine the implant before reloading the implant into the Insertion Tool, and start again.
Placement of the implant should be confirmed by palpation. Note that the tip of a properly-placed implant may not be visible through the incision.
After implantation, briefly cover the site with a sterile gauze pad and apply pressure to ensure hemostasis.
Closing The Incision
To close the incision, you can use the absorbable sutures and/or the sterile adhesive surgical strips provided. To improve adhesion of the strips, you can apply benzoin tincture antiseptic (provided) to the skin, and let it dry, before applying the adhesive strips.
Once closed, cover the incision site with sterile gauze pads and secure the dressing with the bandage provided.
Please provide the patient with a Patient Information Leaflet, which includes information about the implant and instructions on proper care of the insertion site.
Removal Procedure
VANTAS should be removed after 12 months of therapy. Most of the supplies necessary to remove the implant, including the local anesthetic and the sterile mosquito clamp, are provided in the Implantation Kit that is shipped along with a new VANTAS implant. Note that the Implantation Kit is to be stored at 20°C to 25°C (68°F to 77°F) [See USP Controlled Room Temperature] only. See the Insertion Procedure above for further instructions.
Removal of the VANTAS implant is a surgical procedure. Sterile gloves and aseptic technique must be used to minimize any chance of infection.
Setting up the Sterile Field
Using proper aseptic technique, the sterilized components of the Implantation Kit needed for the implant removal procedure are to be carefully dispensed from their packaging onto the Sterile Field drape (non-fenestrated) provided. NOTE THAT THE KIT BOX AND ALL PACKAGING, INCLUDING THE SURFACE OF THE VIALS, ARE NOT STERILE and should be kept off of the Sterile Field drape.
Preparing the Patient and The Site
The patient should be on his back, with the arm containing the implant positioned, either bent or extended, so that the physician has ready access to the inner aspect of the upper arm. Propping the arm with pillows may help the patient more easily hold the position.
The implant to be removed should first be located by palpating the inner aspect of the upper arm, near the incision from the prior year.
Generally, the previous implant is readily palpated. In the event the implant is difficult to locate, ultrasound may be used. If ultrasound fails to locate the implant, other imaging techniques such as CT or MRI may be used to locate it (plain films are not recommended as the implant is not radiopaque).
Swab the area above and around the previous implant with topical antiseptic. Overlay the area with the fenestrated Sterile Field drape provided, so that the hole is over the previous insertion site (for clarity of illustration, the following images do not show the drape).
The method of anesthesia utilized (i.e., local, conscious sedation, general) is at the discretion of the healthcare provider.
If local anesthesia is selected: a vial of a local anesthetic (e.g., lidocaine HCl 1% with epinephrine or lidocaine HCl 1%) (note that the exterior of the vial is not sterile) has been provided along with a sterile hypodermic needle for injection. After determining the absence of known allergies to the anesthetic agent, inject anesthetic into the subcutaneous tissue at and around the site of the intended incision (the site of the previous implant).
Making the Incision and Removing the Implant
Using the sterile scalpel provided, make an incision of a size adequate to allow the implant to be easily removed and, if a new implant will be inserted, large enough for the bore of the cannula of the Insertion Tool provided.
Generally, the tip of the implant will be visible through the incision, possibly covered by a pseudocapsule of tissue. In order to facilitate the removal of the implant, it may be necessary to palpate the head of the implant through the incision using your smallest finger, especially if the head of the implant is not readily visible. In addition, you may need to push down on the distal end of the implant and "massage it forward" toward the incision.
Carefully nick the pseudocapsule to reveal the polymer tip of the implant. It may be beneficial to insert the sterile mosquito clamp provided into the hole created in the pseudocapsule and expand by opening the clamp. Widening the opening of the pseudocapsule may ease the extraction of the implant.
Gently but securely grasp the implant with the sterile mosquito clamp and extract the implant.
Dispose of the implant in a proper manner, treating it like any other biowaste.
Briefly cover the site with a sterile gauze pad and apply pressure to ensure hemostasis.
If inserting a new implant, see the Insertion Procedure instructions provided above. Note that you can insert the new implant into the same "pocket" as the removed implant, or make a new incision at a different site in the same arm or in the contralateral arm.
If a new implant is not to be inserted, proceed to close the incision.
Closing the Incision
To close the incision, you can use the absorbable sutures and/or the sterile adhesive surgical strips provided. To improve adhesion of the strips, you can apply benzoin tincture antiseptic (provided) to the skin, and let it dry, before applying the adhesive strips.
Once closed, cover the incision site with sterile gauze pads and secure the dressing with the bandage provided.
Dosage Forms And Strengths
VANTAS® (histrelin acetate) implant is a sterile, non-biodegradable, diffusion-controlled hydrogel polymer reservoir containing histrelin acetate, a synthetic nonapeptide analog of the naturally occurring gonadotropin releasing hormone (GnRH). VANTAS is designed to deliver approximately 50 mcg histrelin acetate per day (equivalent to approximately 41 mcg histrelin per day) over 12 months.
Storage And Handling
VANTAS (NDC 67979-500-01) is supplied in a carton containing 2 inner cartons, one for the VANTAS implant and one for the VANTAS Implantation Kit:
The VANTAS implant contains 50 mg of histrelin acetate. The VANTAS implant carton contains a cold pack for refrigerated shipment and a small carton containing an amber plastic pouch. Inside the pouch is a glass vial with a Teflon-coated stopper and an aluminum seal, containing the implant in 2 mL of sterile 1.8% sodium chloride solution. (Note: The 3.5 mL vial is not completely filled with saline.)
Upon receipt, refrigerate the small carton containing the amber plastic pouch and glass vial (with the implant inside) until the day of insertion. The implant vial should not be opened until just before the time of insertion.
Store the implant refrigerated, 2°C to 8°C (36°F to 46°F), in the unopened glass vial with the sterile 1.8% sodium chloride solution, overwrapped in the amber plastic pouch and carton, until the expiration date provided. Excursion permitted to 25°C (77°F) for 7 days. Protect from light. Do not freeze.
Store the VANTAS Implantation Kit at room temperature only.
The VANTAS Implantation Kit carton contains one each of the following (individually wrapped in sterile packaging): implant insertion tool, #15 disposable scalpel, syringe with 18 gauge needle, 25 gauge 1.5" needle, SS mosquito clamp, benzoin tincture antiseptic, alcohol swabs (2 packages), fenestrated drape, non-fenestrated drape, skin antiseptic swab, gauze sponges, surgical closure strips, coated absorbable sutures, cohesive bandage, and a local anesthetic (e.g., lidocaine HCl 1% with epinephrine or lidocaine HCl 1%).
Distributed by: Endo Pharmaceuticals Inc. Malvern, PA 19355. Revised: Oct 2019
Adverse Reactions In Clinical Trials
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety of VANTAS was evaluated in 171 patients with prostate cancer treated for up to 36 months in two clinical trials. The pivotal study (Study 1) consisted of 138 patients, while a separate supportive study (Study 2) consisted of 33 patients.
VANTAS, like other GnRH analogs, caused a transient increase in serum testosterone concentrations during the first week of treatment. Therefore, potential exacerbations of signs and symptoms of the disease during the first few weeks of treatment are of concern in patients with vertebral metastases and/or urinary obstruction or hematuria. If these conditions are aggravated, it may lead to neurological problems such as weakness and/or paresthesia of the lower limbs or worsening of urinary symptoms [see WARNINGS AND PRECAUTIONS].
In the first 12 months after initial insertion of the implant(s), an implant extruded through the incision site in eight of 171 patients in the clinical trials (see the Recommended Procedure for correct implant placement).
In the pivotal study (Study 1) a detailed evaluation for implant site reactions was conducted. Out of the 138 patients in the study, 19 patients (13.8%) experienced local or insertion site reactions. All these local site reactions were reported as mild in severity. The majority were associated with initial insertion or removal and insertion of a new implant, and began and resolved within the first two weeks following implant insertion. Reactions persisted in 4 (2.8%) patients. An additional 4 (2.8%) patients developed application-site reactions after the first two weeks following insertion.
Local reactions after implant insertion included bruising (7.2% of patients) and pain/soreness/tenderness (3.6% of patients). Other, less frequently reported, reactions included erythema (2.8% of patients) and swelling (0.7% of patients). In this study, two patients had events described as local infections/inflammations, one that resolved after treatment with oral antibiotics and the other without treatment.
Local reactions following insertion of a subsequent implant were comparable to those seen after initial insertion.
The following possibly or probably related systemic adverse events occurred during clinical trials of up to 24 months of treatment with VANTAS, and were reported in ≥ 2% of patients (Table 1).
Table 1: Incidence (%) of Possibly or Probably Related Systemic Adverse Events Reported by ≥ 2% of Patients Treated with VANTAS for up to 24 Months
|Body System
|Adverse Event
|Vascular Disorders
|Hot flashes*
|112 (65.5%)
|General Disorders
|Fatigue Weight increased
|17 (9.9%) 4 (2.3%)
|Skin and Appendage Disorders
|Implant site reaction
|10 (5.8%)
|Reproductive System and Breast Disorders
|Erectile dysfunction*
|6 (3.5%)
|7 (4.1%)
|Testicular atrophy*
|9 (5.3%)
|Psychiatric Disorders
|5 (2.9%)
|Libido decreased*
|4 (2.3%)
|Renal and Urinary Disorders
|Renal impairment**
|8 (4.7%)
|Gastrointestinal Disorders
|6 (3.5%)
|Nervous System Disorders
|5 (2.9%)
|* Expected pharmacological consequences of testosterone suppression.
** 5 of the 8 patients had a single occurrence of mild renal impairment (defined as creatinine clearance ≥30 <60 mL/min), which returned to a normal range by the next visit.
Hot flashes were the most common adverse event reported (65.5% of patients). In terms of severity, 2.3% of patients reported severe hot flashes, 25.4% of patients reported moderate hot flashes and 37.7% reported mild hot flashes. In addition, the following possibly or probably related systemic adverse events were reported by < 2% of patients using VANTAS in clinical studies.
Blood and Lymphatic System Disorders: Anemia
Cardiac Disorders: Palpitations, ventricular extrasystoles
Gastrointestinal Disorders: Abdominal discomfort, nausea
General Disorders: Feeling cold, lethargy, malaise, edema peripheral, pain, pain exacerbated, weakness, weight decreased
Hepatobiliary Disorders: Hepatic disorder
Injury, Poisoning and Procedural Complications: Stent occlusion
Laboratory Investigations: Aspartate aminotransferase increased, blood glucose increased, blood lactate dehydrogenase increased, blood testosterone increased, creatinine clearance decreased, prostatic acid phosphatase increased
Metabolism and Nutrition Disorders: Appetite increased, fluid retention, food craving, hypercalcaemia, hypercholesterolemia
Musculoskeletal and Connective Tissue Disorders: Arthralgia, back pain, back pain aggravated, bone pain, muscle twitching, myalgia, neck pain, pain in limb
Nervous System Disorders: Dizziness, tremor
Psychiatric Disorders: Depression, irritability
Renal and Urinary Disorders: Calculus renal, dysuria, hematuria aggravated, renal failure aggravated, urinary frequency, urinary frequency aggravated, urinary retention
Reproductive System and Breast Disorders: Breast pain, breast tenderness, genital pruritus male, gynecomastia aggravated, sexual dysfunction
Respiratory, Thoracic and Mediastinal Disorders: Dyspnea exertional
Skin and Subcutaneous Tissue Disorders: Contusion, hypotrichosis, night sweats, pruritus, sweating increased
Vascular Disorders: Flushing, hematoma
Changes in Bone Density: Decreased bone density has been reported in the medical literature in men who have had orchiectomy or who have been treated with a GnRH agonist analog. It can be anticipated that long periods of medical castration in men will have effects on bone density.
The following adverse reactions have been identified during post approval use of VANTAS. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Pituitary Apoplexy
Cases of pituitary apoplexy (a clinical syndrome secondary to infarction of the pituitary gland) have been reported after the administration of gonadotropin-releasing hormone agonists. In a majority of these cases, a pituitary adenoma was diagnosed with a majority of pituitary apoplexy cases occurring within 2 weeks of the final dose, and some within the first hour. In these cases, pituitary apoplexy has presented as sudden headache, vomiting, visual changes, opthalmoplegia, altered mental status, and sometimes cardiovascular collapse.
Immediate medical attention has been required.
Drug-Induced Liver Injury
Severe liver injury has been reported in association with VANTAS. The toxicity was reversible with the removal of the VANTAS implant.
Nervous System Disorders
No pharmacokinetic-based drug-drug interaction studies were conducted with VANTAS [see CLINICAL PHARMACOLOGY].
Drug-Laboratory Test Interactions
Therapy with histrelin results in suppression of the pituitary-gonadal system. Results of diagnostic tests of pituitary gonadotropic and gonadal functions conducted during and after histrelin therapy may be affected.
Included as part of the "PRECAUTIONS" Section
Transient Increase In Serum Testosterone
VANTAS causes a transient increase in serum concentrations of testosterone during the first week of treatment. Patients may experience worsening of symptoms or onset of new symptoms, including bone pain, neuropathy, hematuria, or ureteral or bladder outlet obstruction.
Spinal Cord Compression And Urinary Tract Obstruction
Cases of spinal cord compression, which may result in paralysis, and ureteral obstruction, which may cause renal impairment, have been reported with GnRH agonists. Patients with metastatic vertebral lesions and/or with urinary tract obstruction should be closely observed during the first few weeks of therapy.
Difficulty Locating Or Removing Implant
In all clinical trials combined, an implant was not recovered in 8 patients. For two of these [see Clinical Studies], serum testosterone rose above castrate level and the implant was neither palpable nor visualized with ultrasound. These two implants were believed to have been extruded without appreciation by the patients. In the other six, serum testosterone remained below the castrate level, but the implant was not palpable. No further diagnostic tests were conducted. One of these patients underwent in-clinic surgical exploration that did not locate the implant. Implant insertion is a surgical procedure. Careful adherence to the Recommended Procedure for Implant Insertion and Removal [see DOSAGE AND ADMINISTRATION] is advised to minimize the potential for complications and for implant expulsion. In addition, patients should be instructed to refrain from wetting the arm for 24 hours and from heavy lifting or strenuous exertion of the inserted arm for 7 days after implant insertion.
Hyperglycemia And Diabetes
Hyperglycemia and an increased risk of developing diabetes have been reported in men receiving GnRH agonists. Hyperglycemia may represent development of diabetes mellitus or worsening of glycemic control in patients with diabetes. Monitor blood glucose and/or glycosylated hemoglobin (HbA1c) periodically in patients receiving a GnRH agonist and manage with current practice for treatment of hyperglycemia or diabetes.
Cardiovascular Disease
Increased risk of developing myocardial infarction, sudden cardiac death and stroke has been reported in association with use of GnRH agonists in men. The risk appears low based on the reported odds ratios, and should be evaluated carefully along with cardiovascular risk factors when determining a treatment for patients with prostate cancer. Patients receiving a GnRH agonist should be monitored for symptoms and signs suggestive of development of cardiovascular disease and be managed according to current clinical practice.
Laboratory Tests
Response to VANTAS should be monitored by measuring serum concentrations of testosterone and prostate-specific antigen periodically, especially if the anticipated clinical or biochemical response to treatment has not been achieved.
Results of testosterone determinations are dependent on assay methodology. It is advisable to be aware of the type and precision of the assay methodology to make appropriate clinical and therapeutic decisions.
Effect On QT/QTc Interval
Androgen deprivation therapy may prolong the QT/QTc interval. Providers should consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities, and in patients taking drugs known to prolong the QT interval. Electrolyte abnormalities should be corrected. Consider periodic monitoring of electrocardiograms and electrolytes.
Patient Counseling Information
"See FDA-approved patient labeling (PATIENT INFORMATION)"
An information leaflet for patients is included with the product and should be given to the patient.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Carcinogenicity studies were conducted in rats for 2 years at doses of 5, 25 or 150 mcg/kg/day (up to 22 times human exposures using body surface area comparisons, based on a 65 mcg/day dose in adults) and in mice for 18 months at doses of 20, 200, or 2000 mcg/kg/day (up to 150 times human exposure using body surface area comparisons, based on a 65 mcg/day dose in adults). As seen with other GnRH agonists, histrelin acetate injection administration was associated with an increase in tumors of hormonally responsive tissues. There was a significant increase in pituitary adenomas in rats. There was an increase in pancreatic islet-cell adenomas in treated female rats and a non-dose-related increase in testicular Leydig-cell tumors (highest incidence in the low-dose group). In mice, there was significant increase in mammary-gland adenocarcinomas in all treated females. In addition, there were increases in stomach papillomas in male rats given high doses, and an increase in histiocytic sarcomas in female mice at the highest dose.
Mutagenicity studies have not been performed with histrelin acetate. Saline extracts of implants with and without histrelin were negative in a battery of genotoxicity studies. Studies examining fertility following withdrawal of histrelin acetate have been conducted in rats and monkeys given subcutaneous daily doses of histrelin acetate for 6 months, at doses of up to 180 mcg/kg/day (up to 27-times [rat] and 54-times [monkey] adult clinical exposures using body surface area comparisons, based on a 65 mcg/day dose in humans). Full reversibility of fertility suppression was demonstrated. The development and reproductive performance of offspring from parents treated with histrelin acetate has not been investigated.
Use In Specific Populations
Pregnancy Category X. [See CONTRAINDICATIONS]
VANTAS is contraindicated in females who are or may become pregnant. VANTAS can cause fetal harm when administered to a pregnant woman. The possibility exists that spontaneous abortion may occur. Major fetal abnormalities were observed in rabbits but not in rats after administration of histrelin acetate throughout gestation. There were increased fetal mortality and decreased fetal weights in rats and rabbits. These effects on fetal mortality are expected consequences of the alterations in hormonal levels brought about by this drug. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
Nursing Mothers
VANTAS is not indicated for use in women. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from VANTAS, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use
VANTAS is not indicated for use in pediatric patients.
Histrelin acetate injection of up to 200 mcg/kg (rats, rabbits), or 2000 mcg/kg (mice) resulted in no systemic toxicity. This represents 20 to 200 times the maximal recommended human dose of 10 mcg/kg/day. Adverse event profiles were similar in patients receiving one, two or four VANTAS implants.
VANTAS is contraindicated in patients with hypersensitivity to GnRH, GnRH agonist analogs, or any of the components in VANTAS.
Anaphylactic reactions to synthetic GnRH agonist analogs have been reported in the literature.
VANTAS can cause fetal harm when administered to a pregnant woman. VANTAS is contraindicated in women who are or may become pregnant. Effects on fetal mortality are expected consequences of the alterations in hormonal levels brought about by this drug. The possibility exists that spontaneous abortion may occur. There are no adequate and well-controlled studies in pregnant women. In nonclinical studies, histrelin was teratogenic and fetotoxic. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. [see Use In Specific Populations].
Mechanism Of Action
Histrelin acetate is a gonadotropin releasing hormone (GnRH) agonist that acts as a potent inhibitor of gonadotropin secretion when given continuously in therapeutic doses. Both animal and human studies indicate that following an initial stimulatory phase, chronic, subcutaneous administration of histrelin acetate desensitizes responsiveness of the pituitary gonadotropin which, in turn, causes a reduction in testicular steroidogenesis.
In humans, administration of histrelin acetate results in an initial increase in circulating levels of luteinizing hormone (LH) and folliclestimulating hormone (FSH), leading to a transient increase in concentration of gonadal steroids (testosterone and dihydrotestosterone in males); however, continuous administration of histrelin acetate results in decreased levels of LH and FSH due to a reversible down-regulation of the GnRH receptors in the pituitary gland and desensitization of the pituitary gonadotropes. In males, testosterone is reduced to castration levels.
These decreases occur within 2 to 4 weeks after initiation of treatment.
Histrelin acetate is not active when given orally.
Following subcutaneous insertion of one VANTAS implant in advanced prostate cancer patients (n = 17), peak serum concentrations of 1.10 ± 0.375 ng/mL (mean ± SD) occurred at a median of 12 hours. Continuous subcutaneous release was evident, as serum levels were sustained throughout the 52 week dosing period (see Figure 1). The mean serum histrelin concentration at the end of the 52 week treatment duration was 0.13 ± 0.065 ng/mL. When histrelin serum concentrations were measured following a second implant inserted after 52 weeks, the observed serum concentrations over 8 weeks following the second implant were comparable to the same period following the first implant. The average rate of subcutaneous drug release from 41 implants assayed for residual drug content was 56.7 ± 7.71 mcg/day, over the 52 week dosing period. The relative bioavailability for the VANTAS implant in prostate cancer patients with normal renal and hepatic function compared to a subcutaneous bolus dose in healthy male volunteers was 92%. Serum histrelin concentrations were proportional to dose after one, two or four 50 mg VANTAS implants (50, 100 or 200 mg as histrelin acetate) in 42 prostate cancer patients.
Figure 1: Mean Serum Histrelin Concentration versus Time Profile for 17 Patients Following Insertion of First and Second VANTAS Implants. (Note that only four patients underwent intensive pharmacokinetic sampling during the first 96 hours following the second implant.)
The apparent volume of distribution of histrelin following a subcutaneous bolus dose (500 mcg) in healthy volunteers was 58.4 ± 7.86 L. The fraction of drug unbound in plasma measured in vitro was 29.5% ± 8.9% (mean ± SD).
An in vitro drug metabolism study using human hepatocytes identified a single histrelin metabolite resulting from C-terminal dealkylation. Peptide fragments resulting from hydrolysis are also likely metabolites. Following a subcutaneous bolus dose in healthy volunteers the apparent clearance of histrelin was 179 ± 37.8 mL/min (mean ± SD) and the terminal half-life was 3.92 ± 1.01 hr (mean ± SD). The apparent clearance following a 50 mg (as histrelin acetate) VANTAS implant in 17 prostate cancer patients was 174 ± 56.5 mL/min (mean ± SD).
No drug excretion study was conducted with VANTAS implants.
Special Populations
The majority (89.9%) of the 138 patients studied in the pivotal clinical trial were age 65 and over.
VANTAS is not indicated for use in pediatric patients. [see Use In Specific Populations].
When serum histrelin concentrations were compared for 7 Hispanic, 30 Black and 77 Caucasian patients, average serum histrelin concentrations were similar.
Renal Insufficiency
When average serum histrelin concentrations were compared between 42 prostate cancer patients with mild to severe renal impairment (CLcr: 15-60 mL/min) and 92 patients with no renal or hepatic impairment, levels were approximately 50% higher in those patients with renal impairment (0.392 ng/mL versus 0.264 ng/mL). These changes in exposure as a result of renal impairment are not considered to be clinically relevant. Therefore, no changes in drug dosing are warranted for these patient subpopulations.
Hepatic Insufficiency
The influence of hepatic insufficiency on histrelin pharmacokinetics has not been adequately studied.
Drug-Drug Interactions
No pharmacokinetic-based drug-drug interaction studies were conducted with VANTAS.
Clinical Studies
In one open-label, multicenter, Phase 3 study (Study 1), 138 patients with prostate cancer were treated with a single VANTAS implant and were evaluated for at least 60 weeks. Of these, 37 patients had Jewett stage C disease, 29 had stage D disease, and the remaining 72 patients had an elevated or rising serum PSA after definitive therapy for localized disease. Serum testosterone levels were assessed as the primary efficacy endpoint to evaluate both achievement and maintenance of castrate testosterone suppression, with treatment success being defined as a serum testosterone level ≤ 50 ng/dL. At Week 52, the study included the option for removal and insertion of a new implant, with evaluation for an additional 52 weeks (the "extension phase"). A total of 120 patients completed the initial 52-week treatment period. Reasons for discontinuation were: death (n=6), disease progression (n=5), implant expulsion (n=3), hospice placement (n=2), and patient request/no specific reason given (n=2). Of the 120 patients who successfully completed 52 weeks of treatment, 111 were evaluable for efficacy. A total of 113 patients underwent removal of the first implant and insertion of a second implant for another year of therapy.
In a subset of 17 patients, serum testosterone concentrations were measured within the first week following initial implantation. In these 17 patients, mean serum testosterone concentrations increased from 376.4 ng/dL at Baseline to 530.5 ng/dL on Day 2, then decreased to below baseline by Week 2, and to below the 50 ng/dL castrate threshold by Week 4 (see Figure 2). Serum testosterone concentrations remained below the castrate level in this subset for the entire treatment period.
Figure 2: Mean Serum Total Testosterone Concentrations for all PK Patients, n=17. (Note that in this group, sampling began minutes after insertion of VANTAS.)
In the overall treatment group (n=138), mean serum testosterone was 388.3 ng/dL at Baseline. At the time of first assessment of testosterone (at the end of Week 1), the mean serum testosterone concentration was 382.8 ng/dL. At Week 2, mean serum testosterone was 92.2 ng/dL. At Week 4 it was 15 ng/dL. At Week 52, the final mean testosterone concentration was 14.3 ng/dL (see Figure 3).
Figure 3. Mean Serum Total Testosterone Concentrations (+SD) for All Patients (n=138) Who Received One VANTAS Implant. (Note that in this group, sampling began at the end of Week 1.)
Of 138 patients who received an implant, one discontinued prior to Day 28 when the implant was expelled on Day 15. Three others did not have an efficacy measurement for the Day 28 visit. Otherwise serum testosterone was suppressed to below the castrate level (≤ 50 ng/dL) in all 134 evaluable patients (100%) on Day 28. All three patients with missing values at Day 28 were castrate by the time of their next visit (Day 56).
Once serum testosterone concentrations at or below castrate level (≤ 50 ng/dL) were achieved, a total of 4 patients (3%) demonstrated breakthrough during the study. In one patient, a serum testosterone of 63 ng/dL was reported at Week 44. In another patient, a serum testosterone of 3340 ng/dL was reported at Week 40. This aberrant value was possibly related to lab error. In two patients, serum testosterone rose above castrate level and the implant could neither be palpated nor visualized with ultrasound. In the first patient, serum testosterone was 669 ng/dL at Week 8 and 311 ng/dL at Week 12. This patient reported strenuous exertion after insertion of the implant and a large scab formed at the insertion site. The implant may have been expelled without the patient's appreciation of the event. The other patient developed erythema at the insertion site at Week 22 and was treated with oral antibiotics. At Week 26, the implant was not palpable and was not visualized with ultrasound. At Week 34, the serum testosterone rose to 135 ng/dL. The implant may have been expelled without the patient's appreciation of the event. A new implant was inserted.
Of 120 patients who completed 52 weeks of treatment, a total of 115 patients had a serum testosterone measurement at Week 52. Of these, all had serum testosterone ≤ 50 ng/dL. In patients without a Week 52 value, castrate levels were achieved by Day 28, were maintained up to Week 52, and remained below the castrate threshold after Week 52.
In all 18 patients who prematurely discontinued prior to Week 52 – except one (implant expulsion on Day 15) – castrate levels of serum testosterone were achieved by Day 28 and were maintained up to and including the time of withdrawal.
A total of 113 patients had a new implant inserted for a second year of therapy following removal of the first implant. Of this group, 68 patients had measurement of serum testosterone on Day 2 or Day 3 and on Day 7 after insertion of the second implant in order to assess for the "acute-onchronic" phenomenon. No acute increase in serum testosterone was seen in any patient in this group following insertion of the new implant.
Serum prostate specific antigen (PSA) was monitored as a secondary endpoint. Serum PSA decreased from baseline in all patients after they began treatment with VANTAS. Serum PSA decreased to within normal limits by Week 24 in 103 of 111 evaluable patients (93%).
Prior to conducting the pivotal study, a Phase 2, dose-ranging study was performed in 42 patients with advanced prostate cancer. Efficacy was assessed by serum testosterone levels as the primary efficacy endpoint. Patients received 1, 2 or 4 implants. The use of 2 or 4 implants did not confer any additional benefit in suppression of testosterone beyond that produced by the single implant.
(histrelin acetate)
Read the Patient Information that comes with VANTAS before it is inserted and each time another VANTAS is inserted. There may be new information. This information does not take the place of talking with your doctor about your medical condition or treatment.
What is VANTAS?
VANTAS is a drug-delivery system that contains the medicine histrelin and is placed under the skin. It looks like a small, thin flexible tube. After it is placed under the skin, VANTAS delivers histrelin to your body continuously for 12 months. VANTAS may help relieve the symptoms of prostate cancer. VANTAS is not a cure for prostate cancer.
Who should not use VANTAS?
Do not use VANTAS if you:
- are allergic to the medicine histrelin or other medicines called GnRH agonists.
- are a woman. VANTAS has not been studied in women and is not for use in women. VANTAS can harm the unborn baby in a woman who is pregnant or may become pregnant. VANTAS may cause a pregnant woman to lose her baby (miscarriage) if used while pregnant.
Before using VANTAS, tell your doctor about all the medicines you take, including prescription and non prescription medicines, vitamins and herbal supplements.
It is not known if VANTAS and other medicines can affect each other.
How is VANTAS used?
- VANTAS is placed under the skin of the inside of your upper arm. Your doctor will numb your arm, make a small cut (incision), and then place VANTAS under the skin. The cut will be closed with stitches and special surgical tape and covered with a bandage. Keep your arm clean and dry for 24 hours. Do not bathe or swim for 24 hours. Keep the bandage in place for a few days until the cut heals. Avoid heavy lifting and exercise for 7 days. Avoid bumping the site for a few days. Your doctor will give you complete instructions.
- After it is placed under the skin, VANTAS will give your body histrelin for 12 months. After 12 months, VANTAS must be removed. Your doctor may insert a new VANTAS at this time to continue your treatment.
- Your doctor will do blood tests to check on your response to treatment with VANTAS. For example, your doctor may check your prostate specific antigen (PSA) or testosterone levels.
What are the possible side effects of VANTAS?
VANTAS can cause an increase in testosterone during the first week after it is inserted. Your symptoms may get worse during the first few weeks of treatment. You may get new symptoms. Call your doctor right away if you:
- get new or worse bone pain
- get weakness or lose feeling in your legs
- have blood in your urine
- have trouble urinating or cannot urinate
VANTAS can cause a loss in bone mineral density. Low bone mineral density can lead to thinning of the bones (oesteoporosis).
The most common side effects of VANTAS are:
- hot flashes
- tiredness
- skin reactions at the implant insertion site
- testicles become smaller
- urination problems
- breasts become larger
- erectile dysfunction (impotence)
- constipation
You may have some pain at the insertion site during and after VANTAS is inserted and removed. You may get some bruising and redness at the site. These usually go away without treatment within 2 weeks. Call your doctor if you have unusual bleeding, redness or pain at the insertion site.
These are not all the side effects of VANTAS. For more information, ask your doctor or pharmacist.
What else do you need to know about VANTAS?
VANTAS can be expelled from your body through the original incision site. This occurs infrequently. You may actually notice the system being expelled, or rarely, the system may be expelled without your noticing it. If you believe VANTAS has been expelled from your body, call your doctor. Also, remember to see your doctor for routine checks on your condition to ensure that VANTAS is present and functioning in your body.
VANTAS may be difficult to feel under your skin. If VANTAS cannot be felt under your skin at the time for removal, your doctor may order special tests, such as ultrasound or CT scan, in order to locate it for removal.
General information about VANTAS
This leaflet summarizes the most important information about VANTAS. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about VANTAS that is written for health professionals.
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This made me Laugh Out Loud for reals...Simone Rovellini doctors clips from movies to make actresses' heads explode. The first clip features Dirty Dancing, When Harry Met Sally, Pretty Woman, and Ghost:
And this one features a bunch of Disney princesses:
More videos and animated GIFs on the Exploding Actresses Tumblr. (via @scottlamb)

subset: commoncrawl


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Of the area drycleaning shops we evaluate on our ratings tables, many were rated "superior" overall by at least 90 percent of their surveyed customers, but some others were rated "superior" by fewer than half of their surveyed customers.
We also found big shop-to-shop price differences. Several area shops charge prices more than double those charged by their nearby competitors. But using a shop with low prices doesn't mean you'll settle for low-quality work. Among the shops that got our top rating for quality, about half had below-average prices.
Our ratings tables will help you select a good shop. But keep your own eyes on quality: Clerks should ask about any stains when you drop off garments; the shop should have a good system to track your clothes; and, of course, the clothes should be ready on time, look great, and smell good when you pick them up.
To get the best results, give the clerk all the information you can about stains and spills. When you pick up your clothes, take a few minutes to make sure they are fully cleaned, undamaged, and properly pressed.


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Easy to adjust & rotate in 3-dimensions, and designed to fit the range of body types, the Goldtouch V2 USB or PS2 Goldtouch Split Ergonomic Keyboard for PCs helps maintain a neutral wrist posture to reduce RSI (Repetitive Stress Injuries). It lessens the pressure on the muscles involved in carpal tunnel syndrome. The soft key touch, low activation force and full key travel distance provides keying comfort and reduces risk from "bottoming out" when keying.
The short footprint of this keyboard allows you to keep your mouse close to your body; this reduces reach that causes shoulder and elbow injuries. The horizontal adjustment on this ergonomic keyboard reduces ulnar deviation by straightening the arm, wrist and hand relationship. The vertical adjustment moves palms from a horizontal plane to a more vertical, inclined plane – the natural resting position.
Drop your hands by your side letting your hands relax. Notice the natural curve of your hand. This is natural resting position. The more relaxed your hand is, the less chance that you'll develop hand pain. The intuitive design of the Goldtouch for Mac Adjustable Keyboard will allow you to type in a more relaxed posture. Try it today!
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Rate How Well Known The Above User Is [VI]Yes, it's back :3 Credit goes to whoever made this thread first, many many years ago.
How To Play:
Rate the above user on how well known they are, on a scale of 1-10.
Poster 2 -
8/10 - I've seen you around the Misc section a fair bit.
Poster 3 -
1/10 - Never seen you before.
Poster 1 -
5/10 - I've seen you a bit in the Banned Thread, but that's it.
(i) All SPPf/Games rules apply.
(ii) This is not a chat thread.
This is a Rate How Well Known The Above User Is thread. Sure, having conversations with your friends is great, but this isn't what this thread is for and that's one of the reasons this thread keeps getting closed.
(iii) Don't post all the time.
This isn't a YPPY game, but nobody wants to keep rating the same person over and over again. It gets quite boring. So don't post all the time.
(iv) Have fun.
It is a game, after all.


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3 Ways Your Neighbors Affect Your Home's Value
Here's some context for the old adage that home values are based on location, location, location: We identify three ways in which your neighborhood affects your home's value, and how you can turn those factors to your favor.
The Importance of Location
A study recently released by Nabewise.com, which quantifies neighborhood characteristics for house hunters, found that 54% of Gen X homeowners reported that the house and the neighborhood were equally important in their decision-making. House hunters trusted personal observation more than information from an agent, with 79% cruising neighborhoods to detect 'fit'; 64% researching online; and 62% asking friends and family for input.
Takeaway: Putting your neighborhood on the map can support housing values. If your neighborhood doesn't already have a community group and website, it might be worthwhile to establish one. Simple, straightforward information like maps that show schools, shopping, and parks—and/or a calendar of local events (e.g., block parties)—give house hunters a glimpse of what life is like in your area.
Logistics Rule
The same Nabewise study found that buyers are a pragmatic lot. Safety and the logistics of everyday living far outweigh aesthetics and style. The study reported that buyers ranked these neighborhood characteristics as their top five:
• Safety
• Commute
• Real estate prices
• Cleanliness
• Public transit
Takeaway: Help buyers get a glimpse of everyday life in your neighborhood—community activity can be a tip factor. A neighborhood watch conveys that neighbors truly look out for each other. Car pools from your block to the train station or to an office park could offset the need for a second car. Neighborly courtesies quickly become part of the fabric of everyday life, but buyers can't value what they don't know about. Take pains to list such amenities on a separate sheet for buyers to review.
Early Foreclosure Impact
A new working paper from the Federal Reserve Bank of Atlanta found that the value of nearby properties drops the most (and the fastest) right before foreclosure. That's when your worried neighbors aren't investing in their home, and the whole world can tell. Shaggy landscaping, peeling paint, broken gates—nobody wants to be next door to any of that. On the bright side, by the time the house down the block has been foreclosed, sold, and owner-occupied for a year, the negative effect on your home's value will have evaporated.
Takeaway: If you are headed for a refinance or sale, research the exact ownership status of houses in question. Give your appraiser your analysis to support the case for your home's value.
For more on buying and selling homes, consider:
Buy for Your Buyer
Leap Over the Top 3 Market Obstacles
Put an Appraiser on Your Remodeling Team


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You have attempted to reach a site through an address that no longer exists. The Internet address for the website that you have attempted to reach https://www.gargia-fjellstue.no/advokatsteenstrup, has been moved to http://www.mamut.net/advokatsteenstrup/. If you used a bookmark in order to reach the site, please update the bookmark with the correct address.
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For webmaster information, click here.
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Prague , Czech Republic
Relatively unscathed by the ravages of WWII, Prague is beloved as a magical city where you can go back in time and lose yourself in a medieval world along the shores of the Vltava River. Enjoy a moment of awe when you enter the square in Old Town, a UNESCO World Heritage Site. This main square houses the most dramatic gathering of centuries-old structures, including the Astronomical Clock in the Old Town Tower. It has been ticking since 1410, making it the oldest still-functioning astronomical clock in the world. The pedestrian-only Charles Bridge leads you to the enchanting heart of Prague, where you will lose yourself in its splendor.Read More


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Lindholm Sports Column: Marco … Scutaro: The Giants win the World Series
This past Sunday night Marco Scutaro knocked in the winning run for the San Francisco Giants in the deciding game of the World Series. Before that, he was the MVP of the National League Championship Series with a .500 batting average and a lot of big hits.
Why can't the Red Sox get a player like that?
Oh yes, we had him for two years before banishing him to Colorado this past offseason.
Marco joined other diminutive second basemen, Bobby Richardson and Bill Mazeroski, as World Series heroes.
I am reminded of the game my kids played for hours at Lake Dunmore. One would be "it," close her eyes, and yell "Marco," whereupon all the others replied, "Scutaro," and scattered.
On Tuesday, this week, this much-traveled Venezuelan, a spare part for many years, turned 37. Happy birthday, Marco …
This is a likable Giant team, a motley crew of personalities, without an abundance of high-priced talent.
They were dead last in the majors in home runs. Their best hitter, Melky Cabrera, starred in the All-Star game in July, but then was suspended for 50 games for testing positive for illegally high levels of testosterone.
He was eligible to return late in the season, but the Giants said, "no thanks, Melky. Stay home."
Good for them.
Free spirit Hunter Pence, picked up halfway through the summer from the Phillies, inspired his teammates with an emotional pregame speech before Series Game Three, a pep talk one teammate called "terrifying" and his manager Bruce Bochy described as "powerful."
It was all about playing for "the name on the front of the uniform, and not the name 'on the back.'" Pitcher Barry Zito said, "we were all kind of speechless. It was like, 'wow, who is this guy?'"
When I hear the name "Hunter Pence," I think of a preppie from the Northeast, a lax player perhaps: "goal by Hunter Pence, from South Kent, Connecticut!"
Buster Posey, the Giants' best player, also has a bad sports' name. Buster? Posey?
But that boy can hit (and catch!) and will soon be named the Most Valuable Player in the National League.
He looks just like a member of the British Royal family: Buster's the one married to Kate Middleton, right?
Giant pitcher Ryan Vogelsong, as one wag said, put the "journey" in "journeyman": his journey covers 14 years and 15 teams, and included three years in Japan and winter ball in Venezuela. He was 10-22 (5.86 ERA) with the Pirates for five years from 2001-2006, and 11-14 in Japan after that. Not very good.
Now, at age 35, Vogelsong's an All-Star, all but unhittable, 27-16 the last two years. He gave up just one run in four starts in the post-season, including huge wins in Game Six of the NLCS and Game Three in the World Series.
Pablo Sandoval is the "Kung Fu Panda" because, well, he looks like a giant panda. In the past he has been benched for being overweight and out of shape. Now they just say, "get a hit, Fat Boy."
He blasted three homers in Game One of the Series and was the Series MVP with 10 hits in 20 at bats.. Only three other players have hit three homers in a Series game: Babe Ruth, Reggie Jackson, Albert Pujols. Good company.
Panda batted .364 for the post-season: his 24 hits included six homers.
Tim Lincecum has won two Cy Young awards but resembles not at all a professional athlete, unless you count pro skateboarding. With stringy shoulder-length hair, he looks like he got lost on his way to the X-Games.
He lost his starting role this season, but was lights out in the playoffs, pitching in relief. In the Series, he pitched 4 2/3 innings, giving up no hits and striking out eight.
Lefty Barry Zito mastered Tiger ace Justin Verlander in Game One of the Series with a two-hit beauty, setting the stage for the Giants' sweep.
Zito, a Cy Young Award winner in the AL, has been best known with the Giants as the undeserving beneficiary of one of the worst contracts in baseball. He was left off the Giants' post-season roster in 2010, a humiliation for a player making $19 million a year.
He can't break a pane of glass with his fastball, yet he redeemed himself this season (15 wins), capped off by two masterpieces in the post season.
Venezuelan President Hugo Chavez was not the only happy camper (the Giants have seven Venezuelans on their 40 man roster, three starters) — the Giants' triumph also played well in our house.
Brett, the matriarch of the Vermont Lindholms, is a giant Giant fan. Her graduate school job was running the scoreboard at Candlestick Park in the mid-1980s.
She worked more than 200 games in three seasons. Her favorite players of course are no longer in the game but she still roots for "the laundry" (whoever's wearing the uniform).
If not the Red Sox, the Giants will do nicely.
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See when your favorite high school team is competing in the fall sports playoffs.


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algebraic topology – application of higher algebra and higher category theory to the study of (stable) homotopy theory
The construction of Čech homology used coverings of the space by families of open sets. The way the open sets overlap gives 'combinatorial' information on the space.
This has been abstracted and extended to homotopy and also in the direction of algebraic geometry. This article aims to introduce some of the main ways this idea has interacted with some of the many themes in the nLab.
The term 'nerve of a covering' has been used from the late 1920s for a construction that starts with a space and an open cover of it and builds a simplicial complex. Historically these data were organized as a simplicial complex, rather than a simplicial set. The idea had been independently worked out by Čech and P. S. Aleksandrov so one often talks about Aleksandrov–Čech (co)homology. There was an alternative approach described by Vietoris (1927), which led to what is known as Vietoris homology? There are separate entries in nlab for Čech homology and Čech cohomology. The first is not exact, and so is not really a homology theory in the sense of Steenrod–Eilenberg axioms. It is also not the (Alexander–Spanier) dual of Čech cohomology. The two problems can be avoided at the same time using coherent homotopy theory. The resulting homology is one which is exact. It also is one that satisfies the wedge axiom, and then it is the unique such theory, nowadays sometimes called strong homology and in special cases it reduces to what was called Steenrod-Sitnikov homology (but which was originally constructed in a different way).
(Pavel Sergeevič Aleksandrov, 1926) Given a (compact) space and a (finite) open cover, , of , we can form a simplicial set, , called the nerve of the cover whose -simplices are -strings of open sets from , i.e. , each , satisfying .
If is another cover such that for each , there is a with , then the assignment in this case defines a map
dependent on the choice of for each , but independent 'up to homotopy' (see below).
Applying one's favourite homotopy functor, , to each and to these homotopy classes of induced transition maps, yields an inverse system of objects in , i.e., a pro-object in , but the by themselves do not define a pro-object in the category of simplicial sets. They do form a pro-object in , or alternative, a 'coherent pro-object' in , (see Čech homotopy for more discussion on this point.)
Aleksandrov and Čech in the 1930s, applied homology and cohomology in this situation to extend simplicially-based homology to a much wider class of spaces. Lefschetz, without the language of category theory, studied, again in the 1930s, the formal properties of inverse systems of polyhedra and maps between them and his student Christie looked at the homotopy groups in this setting.
Borsuk (1968) developed shape theory, which although initially very geometric in flavour turned out also to be described in terms of Christie's theory of the "Čech extensions" of homotopy theory.
The first papers on this approach were by Tim Porter. They used the Vietoris complex of a space relative to an open cover as well as the Čech nerve itself. (By Dowker's Theorem the two complexes give the same information up to homotopy, but the Vietoris complex is a functor on the category of covers, having values in the category of simplicial sets, whilst the Čech complex does not give so nice a structure as most naturally it takes values in the homotopy category of simplicial sets. In fact, that functor can be rigidified but this requires a certain amount of work.)
Porter also gave a partial solution to the problem of the stability of a space, that is whether it has the same Čech homotopy as a polyhedron. The methods developed for that problem then suggested the existence of a homotopy theory for pro-simplicial sets related to homotopy coherence. That observation was also made by Edwards and Hastings, who proposed a strong shape theory based on what they termed Steenrod homotopy?. This relates to Steenrod-Sitnikov homology.
(See shape theory and Čech homotopy for references and more on this area).
The use of modified Čech methods in algebraic geometry was well established when Grothendieck and his collaborators in Paris started adapting it to work with a Grothendieck topology. Verdier in SGA4, introduced hypercoverings and in Artin and Mazur (SLN 100), you can find their use in homotopy theory. (The work of Lubkin (1967) should also be mentioned here as it contains much that is parallel to the development by Verdier, Artin and Mazur and is sometimes much easier to decipher for the non-specialist algebraic geometer. A summary of his construction is given under Lubkin's construction?.)
Given that a Grothendieck topology is essentially about abstracting a notion of 'covering', it is not surprising that modified Čech methods can be applied. Artin and Mazur used Verdier's idea of a hypercovering to get, for each Grothendieck topos, , a pro-object in (i.e. an inverse system of simplicial sets), which they call the étale homotopy type of the topos (which for them is 'sheaves for the étale topology on a variety').
Applying homotopy group functors gives pro-groups such that is essentially the same as Grothendieck's algebraic fundamental group, . (Here you need to know that the category of profinite groups in the topological sense, is equivalent to the category of pro-objects in the category of finite groups (as explained in profinite group). (If you remove 'finite' the result does not hold, but you can recover it in part by working with "pro-discrete localic groups" instead of topological groups, i.e. take limits of finite groups within the category of 'localic' rather than 'topological' groups, remembering that 'locales' are almost 'spaces without points'.
Grothendieck's nice has thus an interpretation as a formal limit of a Čech type, or shape theoretic, system of s of 'hypercoverings'.
Can shape theory (or its more powerfully structured 'strong' or 'homotopy coherent' version, cf. Lisica and Mardešić, Edwards and Hastings, Porter (papers 1976–78) be useful for studying étale homotopy type? Not without extra work, since the Artin–Mazur–Verdier approach leads
one to look at inverse systems in , i.e. inverse systems (diagrams) in a homotopy category not a homotopy category of inverse systems as in strong shape theory. Attempts to 'rigidify' the hypercovering approach, so as to get into have been made (e.g. by Lubkin, (1967) or using simplicial schemes in Friedlander, (1982), but it is not completely clear if one of them is the definitive method.
What is the consensus on this here? I have sometimes seen talks which claim to have THE method but none has been clearly THE ONE. Perhaps I did not go to the right conferences! (Some is needed here, e.g. for more ways of getting around the difficulty.)
One of the difficulties with this hypercovering approach is that 'hypercovering' is a difficult concept and to the 'non-expert' seem non-geometric and lacking in intuition. Thankfully for us, there is an alternative approach put forward by Ken Brown (1973), (see BrownAHT).
As the Grothendieck topos 'pretends to be' the category of , but with a strange logic, we can 'do' simplicial set theory in as long as we take care of the arguments we use. To see a bit of this in action we can note that the object in will be the constant simplicial sheaf with value the ordinary , "constant" here taking on two meanings at the same time,
(a) constant sheaf, i.e. not varying 'over ' if is thought of as , and
(b) constant simplicial object, i.e. each is the same and all face and degeneracy maps are identities. Thus interpreted as an étale space is the identity map as a space over . Of course not all simplicial objects are constant and so can store a lot of information about the space (or site) .
One can look at the homotopy structure of . Ken Brown in BrownAHT showed it had a fibration category structure and if we look at those fibrant objects in which the natural map
is a weak equivalence, we find that these are exactly the hypercoverings. Global sections of give a simplicial set, and varying amongst the hypercoverings gives a pro-simplicial set (still in not in unfortunately) which determines the Artin–Mazur pro-homotopy type of
This makes it clear there is a link between Čech methods and derived category theory. In the first, the 'space' is resolved using 'coverings' and these, in a sheaf theoretic setting, lead to simplicial objects in that are weakly equivalent to ; in the second, to evaluate the derived functor of some functor , say, on an object , one takes the 'average' of the values of on objects weakly equivalent to , i.e. one works with the functor
(where has objects, , a weak equivalence, and maps, the commuting 'triangles', and this has a 'domain' functor , and is the composite ).
This is in many cases a pro-object in – unfortunately standard derived functor theory interprets 'commuting triangles' in too weak a sense and thus corresponds to shape rather than strong shape theory – one thus, in some sense, arrives in instead of in . This problem has been in part resolved with Grothendieck's theory of Derivateurs (see the volume by Maltsiniotis.)
Last revised on May 22, 2022 at 15:03:41. See the history of this page for a list of all contributions to it.


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Abstract: Given that both S&P 500 index and VIX options essentially contain information on the future dynamics of the S&P 500 index, in this study, we set out to empirically investigate the informational roles played by these two option markets with regard to the prediction of returns, volatility and density in the S&P 500 index. Our results reveal that the information content implied from these two option markets is not identical. In addition to the information extracted from the S&P 500 index options, all of the predictions for the S&P 500 index are significantly improved by the information recovered from the VIX options. Our findings are robust to various measures of realized volatility and methods of density evaluation.
C. San-Lin, W.-C. Tsai, Y.-H. Wang, P.-S. P. Weng. The Information Content of the S&P 500 Index and VIX Options on the Dynamics of the S&P 500 Index. http://ssrn.com/abstract=1711036.


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Inspired by Marina And The Diamonds's "Primadonna Girl", this collection is to portray the confidence in expressing own feelings and the want-it-all attitude. Together with the celebration of Women's Day, we want to empower women to be unapolegitcally bold in achieving what they want in life. Dress up your look with this stunning piece, you know you deserve the best in the world!
- 100% handcrafted using polymer clay
- Lightweight
- As this piece is fully handmade, there may be some imperfections visible due to the organic nature of production. Please note that colour may vary due to different monitor colour settings.
- Measurement: approx. 1 x 1cm (Width x Length)
- 18k Gold plated S925 silver U hook
- When not in use, store your jewellery in a clean, dry place away from direct sunlight and other sharp objects.
- Avoid getting oils, aerosol sprays, perfumes, or chlorinated water on your jewellery, as this may discolour or deteriorate the finish.
- To clean your clay jewellery from make-up stains, very gently buff the surface with rubbing alcohol.


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Tags Desperation and passion
Tag: Desperation and passion
'90 Minutes of the Fever' looks at martial law, computer viruses...
One of my favorite feature films in the San Francisco Black Film Festival is a futuristic film called "90 Minutes of the Fever." The film is about a family who has to deal with a major computer virus, martial law and the ramifications that these catastrophes have on personal relationships within a family. It is a funny story about endurance, patience, acceptance, unconditional love and more. I talked to filmmaker Joan Carlson about her career in film as well as her power work of cinema art. Check her out in her own words.


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Tasty Tasty Tacos (Zocalo - Sacramento, CA)
Tuesday, May 8, 2007
After a little wining over at L, some fellow food bloggers and I stumbled over to Zocalo just down the street to grab a quick nosh. We all needed the food and were deliriously hungry. You probably know the place. On 18th and Capitol, it's the ginormous Mexican place that has the groovy decor and the line that might make you go to Aioli or Dragonfly. I'm not one for lines and deafening levels of noise, but on a quiet Sunday night, I'm more than happy to head down for some tacos, which is the only thing I've really had there.
Other dishes have been raved about but I loved my tacos. Steak that was well prepared served on soft tortillas with lots of cilantro and some spicy tomatillo salsa? So shibby. So simple. So good.
I did nosh some of the guac which was okay, but I always prefer my own recipes for it, so I can't really shame them for it. It was still quite good. The black bean dip though is... well, my words to my dining companions were "I want to have sex with this black bean dip." Yeah, I put away a few things of it on my own. I need to recreate this at home. The cilantro rice was yummy as well.
Other people had various dishes that they all pronounced as equally tasty-licious and we all dug in.
We later parted ways, satiated and satisfied.
(Pics by Jennifer, Ann, and Kristy)
18th and Capitol
Downtown Sacramento
7 comments:
Cilantro rice: long grain rice, chicken stock, sauted onions. Cook rice and onions in the chicken stock. When rice is done add a lot of finely chopped cilantro, season with salt and pepper to taste.ReplyDelete
Oooo, thanks Eileen!ReplyDelete
Okay. You absolutely. POSITIVELY. HAVE TO try my favorite dish there: Tacos de Cazuela. It's this baked dish of chicken (or steak) sauteed with chorizo, onions, mushrooms and completely COVERED in queso Menonita.ReplyDelete
When Ken and I go, we both have to order it because we end up eating the other's food if only one of us order it. NOTHING on that menu compares.
I love chunky guacamole and that one looks chunky enough and good! Have you posted your guacamole recipe on here yet? And I am so stealing that " I want to have sex with this (insert delicious food here) " line!ReplyDelete
I would have to say that the guacamole looked like it had a little "filler" in it.ReplyDelete
What some restaurants will do is to use colored instant mashed potato and just add the chunks of avocado to it. This cuts costs down on the number of avocados they need while they can still give you a big serving for little cost.
That's why home made is usually best.
Cook Mexican Food Recipes
I'm totally going to call Ernesto Jimenez and accuse him of using instant mashed potatoes. I can't wait to see what come back he has for that. Fluffy guac indeed!ReplyDelete
Linda & Greg - Lordy I have no idea. I just thought it had too little citrus. I like a lot of lemon or lime juice in my guac.ReplyDelete
Hey, you're leaving a comment! That's pretty darn cool, so thanks. If you have any questions or have found an error on the site or with a recipe, please e-mail me and I will reply as soon as possible.
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Moose Filter Test #1
Originally uploaded by Dalantech.
To be really good as a photographer you have to understand light, that it has different qualities, and how to take advantage of the light when it's good or modify it when it's bad. The light, more than any other aspect, will make or break an image. Given the choice between great light and an average lens or terrible light and a great lens I'll choose the former every time –the resulting images will be infinitely better.
Granted I'd rather have great light and gear because I'll have to do less post processing, and I think that's what motivates some people to compliment others on their equipment.
Another important aspect of photography is knowing how to use the gear that you have, so you don't have to rely heavily on post processing. The computer with never be able to replace data that you do not capture with the camera –it will never be that smart. So there's a lot to be said for getting it right with the view finder and doing the majority of your post processing before you press the shutter release Take the image included with this post: I used a warming polarizing filter to get the detail you see in that dragonfly –something that isn't possible with the filters in Photoshop…
In other news: If you've asked me for my help and I haven't gotten to you yet please be patient -I wasn't expecting the huge response that I got to my mentoring offer! I will get to you though, promise :)


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24/7 Online Scheduler | Book Your Home Inspection Here
THIS IS NOT A QUOTE CALCULATOR ~ By using this online scheduler, you are truly scheduling an appointment with the information you are entering. When you select "Schedule This Inspection" at the end of the process, you will be confirming your inspection.
If you need to schedule an inspection for the same day or next morning, please call our office 877-369-6870 and speak with one of our Customer Care Coordinators.
Scheduling Online Is Simple ~ Pick the One Below That Best Describes You | Follow The Steps | Schedule Your Inspection!


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In 1959, at just 19, Harry Jerome was Canada's most promising track and field star on his way to the Olympics in Rome. By 1962, after suffering a gruesome leg injury, there was every reason to think that his racing days were over. But Jerome was not just a champion on the track; he was doubly determined off it. And so began his climb to what his coach, Bill Bowerman, called "the greatest comeback in track and field history."
Through years of unparalleled political turbulence, racial conflict and his own personal challenges, Harry Jerome kept his head down and ran, displaying strength of character and willful perseverance every bit as impressive as his record-setting athleticism.
Filmmaker Charles Officer uses gorgeous monochrome imagery, impassioned interviews and astonishing archival footage to tell the runner's triumphant story, from his early days in North Vancouver, through his three Olympics and his unequalled streak of records, to his sudden and tragically premature death. Family, friends and teammates recall a man who forever changed the Canadian sports landscape and made an indelible mark upon the world.
Compelling, surprising and urgently paced, Mighty Jerome will electrify sports fans, history buffs and all those with an appreciation for tales of courage and redemption.
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A Japanese climate information company that wants to track just about every cloud in the sky in its own data cloud is handing out atmospheric sensors for smartphones that could improve forecasting.
Weathernews is distributing the sensors to users of its Weathernews Touch, a crowdsourced weather info app that has been downloaded more than 13 million times.
The hexagonal, palm-sized WxBeacon sensors can detect changes in temperature, barometric pressure and humidity and automatically upload them to the Weathernews cloud.
The aim is to improve weather forecasting with more granular, local information and to encourage more people to contribute to crowdsourced weather data, a Weathernews spokeswoman said. The company, which calls itself the world's largest private weather data firm, believes the data gathered by the beacons could be particularly useful when typhoons strike Japan.
The WxBeacon, developed with Tokyo-based Internet of Things (IoT) company Aplix IT Holdings, is a bit bulky but light enough to be carried around, weighing about 40 grams. It's simpler than other hardware approaches to weather crowdsourcing, such as BloomSky weather stations.
The beacon's temperature, humidity and pressure readings can be uploaded along with photos and commentary to Weathernews Touch, and the observations can be seen in real time.
Thousands of WxBeacons will be distributed to users who have accumulated a certain level of points, which are awarded for contributions.
Weathernews Touch relies on local weather reports generated across Japan. Users upload photos and personal observations about the weather, such as how hard it's raining or how hot it feels in a given location. It's aimed at getting a more detailed view of local conditions than traditional weather reports. The app has 8 million users across Japan, according to Weathernews.
The company has long experimented with weather crowdsourcing, including a feature on the app called Sakura Channel that forecasts when Japan's beloved cherry blossoms will bloom at 700 spots in Japan based on user reports.
Weathernews also has a network of about 1,000 spherical "pollen robot" sensors that can detect airborne pollen, another widely reported seasonal phenomenon that affects the many hay fever sufferers in Japan. The sensors are kept in homes across the country and data they collect goes into pollen alerts issued by the company.
Last month, Weathernews expanded its global reach, which began with the release of its Sunnycomb app for iOS and Android, when it announced its acquisition of Weathermob, a Boston-based developer of a crowdsourced weather app of the same name.


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Dedicated to UNIX system managers, the book covers all there is to know about Samba (as of version 3.0.22), how it relates to Microsoft's Active Directory networking (shares, accounts, printing) and to UNIX's networking.
Samba itself started in 1991 as a reimplementation of SMB by Andrew Tridgell. The project is under the GNU GPL and now allows any POSIX system out there to behave as a Windows machine in pretty much any role it would play on a network: from Active Directory domain controller to simple client, with all kinds of shares: per user, per group, files, printers...
The contents
450 pages (cover included), with 12 pages of preamble and 13 of index—no, it won't fit in a pocket.
The book itself is heavy, with a classic paperback-type cover, and monochromatic—even the hornbill's cover picture—and follows usual O'Reilly pagination. Another note, it's big!
It's an administrator's handbook as well as a commentary on how things stand on the POSIX side of things and how they should evolve. The writing is done to make you use as much hands-on practice as you can. It assumes you're running on a GNU/Linux system; however, it should be usable by anybody running a BSD clone or any other UNIX.
Using Samba, 3rd Ed., contains pretty much everything you need to download, configure, compile, set up and manage a Samba client or server
Using Samba, 3rd Ed., contains pretty much everything you need to download, configure, compile, set up and manage a Samba client or server.
It starts with a brief history of Samba and of the evolution of CIFS to SMB to Active Directory, and how they relate to equivalent POSIX systems.
Then, it gets you started on downloading and installing Samba, with a choice of getting your distribution's precompiled packages or compiling your own. The install process from sources described as example is voluntary light, but it gives you some advice to make it into a lasting implementation if you so desire. Some light introduction to config files and log rotation is given.
A small part is dedicated to describing to the hapless UNIX guru what strange beasts those "Windows" machines are. Most versions and revisions of Windows clients are also examined to understand their quirks and default behaviours, and how they impact Samba.
The book then moves on to exploring Samba's daemons, config files and settings, including user management (and how they relate to UNIX users), normal and special shares, user groups and privileges, then filesystems, name resolution and network browsing in much finer detail.
Once those are covered, heavy practical stuff arrives: Printer sharing, configuring a Samba-based Primary Domain Controller, using Winbind...
More details are then given on specific Samba implementations: the Linux smbfs and cifs modules, FreeBSD's smbfs, Mac OS X's client, and then the all-around useful smbclient command gets a part. The Windows-based net command usage comes then.
Problems? An in-depth description of Samba log files is provided, as well as a Fault Tree and some Troubleshooting.
Appendices cover Samba daemons and commands, how to download Samba through Subversion, and compile-time options.
Who's this book for?
Anybody who needs to use Samba would find this book very useful. If you need to create a simple share, provide backup systems on a Windows-dominated domain, or merge UNIX and Windows networks together, then this is the book for you. The book would also be useful for those who need to create a UNIX-based network with an Active Directory-shaped structure.
The book can be used as a self-teaching manual and as a technical reference in a lesser measure (it's too big to be hauled around much, and isn't THAT resilient).
However, you'll do well familiarising yourself with TCP/IP basics, and with the command-line. A text editor will also come in handy. Please note that no distribution-specific configurations are taken into account, so don't use this book to experiment on a running or production system, you're likely to screw up somewhere. While the solution is somewhere in the book, Samba is not an easy beast to play with!
Relevance to free software
Well, since the book describes the inner workings of a GPLed major product, of very high profile, and is aimed at replacing a proprietary set of features in networking, I'd say it is very pro-FOSS. Although, not overtly so. I would say it is very pro-standards and uses FOSS when most relevant (that is, pretty much all the time).
Use of Windows machines is minimized: most are used as clients and to illustrate how transparently a Samba server behaves from a Windows user's point of view. The Mac OS X part is extremely bare.
This book, an up-to-date GNU/Linux (or BSD) system and some free time would allow you to duplicate the functionalities of a much pricier proprietary product, without user licences limitations and with recognised durability
- This book, an up-to-date GNU/Linux (or BSD) system and some free time would allow you to duplicate the functionalities of a much pricier proprietary product, without user licences limitations and with recognised durability.
- It is also the best way to put your GNU/Linux machine in network with other (kinds of) computers transparently.
- Methodology is good enough for most readers. Subject is covered in a very thorough manner, with useful screen captures at key points.
- The book suffers from some typos, strange text inserts, and some unnecessary repetitions. These make reading the book difficult sometimes, and may leave the reader a bit puzzled.
- The progressive methodology is not compartmented enough to allow experienced users to jump through the book rapidly when looking for specific information—use man instead. The book's exterior markings are bare (only the index stands out). I would have appreciated clearer external marking of parts.
|Using Samba—3rd Edition
|Gerald Carter, Jay Ts & Robert Eckstein
|CD included
|FS Oriented
|Over all score


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Jeb Brugmann: Can India's Cities Be Made to Work?VIEW EVENT DETAILS
ConocoPhillips Environmental Lecture Series
Cities in India, which has a population of 1.2 billion people, have been starved of planning and investment for decades. Many lack formal public transport systems and suffer heavy congestion. Uncontrolled expansion has led to the creation of large slum areas in some of the most prosperous centers.
Jeb Brugmann argues that instead of clearing slums, India should use them for its poverty reduction strategy. Brugmann also states that Indian cities are currently copying Western city models blindly but instead should focus on developing on the basis of their own uniqueness.
Join Jeb Brugmann at Asia Society Texas Center as he explains what can be done to make Indian cities work.
Registration and Reception: 6:30 pm
Program: 7:00 pm
Click here to purchase a member ticket.
Click here to purchase a nonmember ticket.
About Jeb Brugmann
Jeb Brugmann, with professional experience in 28 countries, is the founding partner of The Next Practice. Brugmann is a strategist and innovation expert in the fields of business and development, serving major corporations, local governments, and non-profit organizations worldwide. In addition to using a tested, disciplined innovation process developed with leading business thinker Prof. C.K. Prahalad, he focuses on innovation in market analytics, product development, and business modeling to increase local responsiveness and customization as a source of competitive advantage and global problem-solving. He served as ICLEI Secretary General from 1991-2000, and as interim executive director of ICLEI USA in 2009. In 2004, he co-founded The Next Practice innovation consultancy with Prof. Prahalad. He is speaker to business, government, civic, and academic audiences worldwide and provides executive education as a Senior Associate with the University of Cambridge (UK) Program for Sustainability Leadership. He has received a variety of distinctions and awards for his international initiatives and publications. He is the author of Welcome to the Urban Revolution: How Cities Are Changing the World published in 2009.


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What's in millenials' wallets? Fewer credit cards
Ringed by the posh shops of Beverly Center, Tim Ratliff said no — he didn't have a credit card. He didn't need one.
"I just hear so many horror stories about people being in debt," said Ratliff, 21, who studies psychology at Ohio State University. "When you have a credit card, you feel like you have a lot of money when you don't."
Ratliff is like many young adults, emerging data show. His generation, dubbed millennials by academics and marketers, grew up during the boom and bust cycles of the U.S. economy over the last decade and a half — crises that appear to have reshaped their attitudes toward spending and debt.
Millennials, who range from teenagers to people in their early 30s, are more financially cautious than the stereotype of the spendthrift twentysomething, several studies suggest. Many embrace thrift.
For the complete Los Angeles Times story, go here.


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Man, 20, injured after being set on fire while sleeping under Campbell River bridge
Man recovering from serious burns in hospital
B.C. transportation minister will not seek re-election
Claire Trevena has held the position since 2017
Family of B.C. Instant Pot expert starts endowment in her honour
Ruth 'Rootitoot' McCusker Wilkowski Memorial Bursary Endowment Fund to benefit NIC culinary students
Entangled humpback whale found dead on remote Vancouver Island beach
WARNING: Story contains graphic images
B.C. family's sidewalk chalk messages lift spirits in a time of social distancing
Campbell River's Weavers are encouraging others to 'spread as much positivity as we can'
Western Forest Products and union reach tentative deal to end 7-month-long strike
USW Local 1-1937 membership still has to vote on the terms
VIDEO: Missing cat reunited with Vancouver Island family after three months
'It was like one day she was there, the next day she was gone,' said owner
No tsunami threat after multiple earthquakes off the coast of northern Vancouver Island
No tsunami threat: Emergency Info BC
Weather balloon from California rescued near Campbell River
Search led rescuers to remote wilderness on Quadra Island
Campbell River mom enters B.C.-themed design into Vans shoe contest
Cape Mudge Lighthouse, Big Rock and Quadra ferry all featured
Attempts to disentangle humpback off north Vancouver Island fail
PHI, a regularly seen in the Campbelll River area, was last seen heading north from Port Hardy
Man found dead in Revelstoke linked to Calgary homicide
Mohammadali Darabi was pulled over on Victoria Road last fall and died on-scene
B.C. cyclist races to first win of the season in New Zealand
Casey Brown captures Enduro title by more than two minutes at Crankworx Rotorua
Body of missing skier found
Man's truck found in Revelstoke Mountain Resort's parking lot covered in 'several days' snow'
UPDATE: The Trans-Canada Highway is now open through the Alberta border
Expect delays tomorrow as work crews perform avalanche debris removal
Hwy. 1 to be closed overnight between Golden and Alberta border
High avalanche danger forces closures along Trans-Canada Highway
Justin Trudeau hits the slopes in Golden
Family had spent a few days in Revelstoke
Family suspends search for missing Alberta couple, plane near Revelstoke
Due to bad weather, families of missing Albertan couple say they will resume in the spring
Suspect in Revelstoke standoff killed himself: RCMP
Mohammadali Darabi, suspect in the Calgary homicide of his roommate, was stopped in Revelstoke
Revelstoke silversmith receives thank-you letter from 24 Sussex Drive
Arleigh Garratt's snowflake earrings were gifted to Sophie Grégoire Trudeau during July visit


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Every once life one is the time when he/she have his own game to play. In today's market you can see allover digital games are more popular like xbox360, play station and Nintendo games capture the game markets. But can you think it why everyone like to play online ? And this the base idea of dedicated server games theme.
Everyone cannot afford to buy Xbox 360, play-station or Nintendo. But current games versions available on Internet is better than to play alone. There quality,display,speed are specially made to give you a high quality excitement, and these kinds of things are possible through dedicated servers.
If you buy a game DVD, how much time you play? At one stage, to play that game getting so boring, This is the main reason behind popularity of online games. With the help of dedicated game servers people can play against someone else there is no need of same play station. This is the main reason, the online game providers never end the demand of dedicated game servers.
Network bandwidth is one the essential part in gaming business, because it must be required always in upstream. Here home or office broadband Internet connection is not sufficient. Normally with these type of connection, player does not get upstream bandwidth to host dedicated game servers more than five to ten clients, but in the past years this is the only option was available for game hosting.
Couple of years before, the player who have the game, host the server and also run the client. However, on another side, the bandwidth provider of latest broadband service, handle the outgoing traffic at same time, therefore the host computer struggled to provide a good quality of service to the players on the network, while at the same time running the game on the same computer.
However, the online game providers realized, the importance of dedicated servers, because they need professional server to read data and transferring huge amounts of data as fast as players need it, therefore they purchased rack mounted server machines and colocated them inside Data Center Services to host their games Website. They paid monthly charges for it and the services they got is invaluable, these set ups improved the quality of their games.
Nowadays, the online multi-player gaming become so popular, and renting dedicated game servers are the common thing in online gaming.


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The Lodge Room
King  Bed / Full  Bath                Check   Price   &   Availibility
The Lodge Room has pine crown moldings and a western theme to give the room a rustic country feel. Open the window and listen to the water flowing in the fish pond. The Country Walk-Out Level is on the lower floor with no steps to the back yard and parking lot. This level has five total rooms with a large common sitting area, stone fireplace and a kitchenette.
The Big Yellow Inn, Cedar City, Utah 435:586-0960 Follow me - Become a fan