text:
Aspirin Exacerbated Respiratory Disease (AERD)
Updated: October 2013
Originally Posted: May 2006
Marek L. Kowalski, MD, PhD
Professor and Chairman
Department of Immunology, Rheumatology and Allergy
Medical University of Lódz
Lódz, Poland
A subpopulation of asthmatic patients reacts with acute dyspnea usually accompanied by nasal symptoms, rhinorrhea and/or nasal congestion within two hours after ingestion of aspirin or other non steroidal anti-inflammatory drugs (NSAIDs) (1,2). These patients have the "aspirin triad," which consists of chronic rhinosinusitis, complicated by polyps, severe bronchial asthma, and intolerance to aspirin and other NSAIDs. The term Aspirin-Exacerbated Respiratory Disease (AERD) has been accepted to describe this clinical entity and to replace previously used terms: Aspirin-Triad, Aspirin-Sensitive Asthma, Aspirin-Induced Asthma or Samter's Syndrome.
The incidence of AERD varies from 5%-10% in mild asthmatics and up to 24% in patients with more severe asthma in Europe and Australia, but may be much lower in some regions, for example, a prevalence of 0.57% has been reported in patients with chronic rhinosinusitis (CRS) in China (3,4,5).
Clinical characteristics of aspirin triad
AERD patients usually suffer from moderate or severe forms of asthma requiring chronic treatment with moderate to high doses of inhaled glucocorticosteroids; oral glucocorticoids are necessary to control asthma in many of these patients (2). In addition, the majority of aspirin-intolerant asthmatics have nasal and sinus symptoms. The incidence of rhinosinusitis, as demonstrated by CT scans, is up to 100%, and the frequency of nasal polyps may be as high as 90% (6). Rhinosinusitis is protracted and the nasal polyps tend to recur following polypectomy: the recurrence rate for nasal polyps in AERD patients is several times higher than in aspirin-tolerant asthmatics after standard polypectomy but also after Functional Endoscopic Sinus Surgery (FEES). Polypoid hypertrophy of the mucosa is not just limited to the nasal cavity; it usually involves all sinuses and is more extensive in ASA-intolerant compared to Acetylsalicylic Acid (ASA) - tolerant patients with nasal polyposis. There is also clinical evidence that uncontrolled chronic rhinosinusitis often aggravates the course of asthma in these patients.
Pathophysiology of ASA-hypersensitivity
The mechanism of aspirin-hypersensitivity in asthmatic patients is not immunological but is related to pharmacological properties of ASA and other NSAIDs. As originally documented in 1975 by Andrew Szczeklik et al (7), only NSAIDs that are strong or at least moderate inhibitors of prostaglandins (more specifically, inhibitors of COX-1, an enzyme that converts arachidonic acid into prostaglandins, thromboxanes and prostacycline), can cause reactions in ASA-intolerant patients. It is postulated that inhibition of COX-1 by aspirin or other NSAIDs triggers a biochemical cascade which causes asthma. In fact, a local deficiency in prostaglandin E2 synthesis was found in nasal polyps, epithelial cells and bronchial fibroblasts from ASA-hypersensitive patients, suggesting a basal defect in this regulatory mechanism which may be further exacerbated by aspirin (8, 9).
In addition, ASA-induced reactions involve release of mast-cell and eosinophil-derived mediators including enhanced production of cysteinyl leukotrienes, increased amounts of which can be detected post-challenge in bronchial or nasal fluid or in urine. Cysteinyl leukotrienes may also be important mediators of persistent airway inflammation since basal levels of these metabolites are elevated compared to ASA-tolerant asthma (10). Furthermore, LTC4 synthase, an enzyme involved in transformation of arachidonic acid to cysteinyl leukotrienes, is over-expressed in the bronchial mucosa and leukotriene receptors are over expressed in the nasal mucosa. More recently, it has been documented, that platelet-adherent leukocyte interaction may drive the production of cysteinyl leukotriene in these patients (11). However, for unknown reasons, leukotriene receptor antagonists or 5-lypoxygenase inhibitors only partially prevent ASA-induced reactions and are not more effective in improving bronchial or nasal symptoms in ASA-intolerant than ASA-tolerant patients, thus questioning the pivotal role of leukotrienes in this form of asthma.
Other arachidonic acid metabolites generated by the 5-lipoxygenase pathway have been associated with aspirin-hypersensitivity. For example, aspirin triggers 15-HETE generation in nasal polyp epithelial cells and peripheral blood leukocytes from aspirin-intolerant but not aspirin-tolerant patients suggesting the presence of a specific abnormality of the 15-LOX pathway in these patients. Upregulation of 15-lipoxygenase and decreased production of lipoxin A4, an anti-inflammatory 15-LO metabolite found in leukocytes and nasal polyp tissue from ASA-intolerant patients, further points to a distinctive but not yet understood role for the 15-lipoxygenase pathway.
The pathogenesis of chronic eosinophilic inflammation in the airway mucosa and of nasal polyps in ASA-intolerant asthmatics is not fully understood but is not related to exposure to aspirin or other NSAIDs, because simple aspirin avoidance does not improve the course of the asthma. Impairment in regulation of local apoptosis of eosinophils and/or involvement of Staphylococcus aureus enterotoxin has been implicated in the pathophysiology of the eosinophilic inflammation in the airway mucosa of these patients (12).
Several single nucleotide polymorphisms in candidate genes coding molecules related mainly to the arachidonic acid metabolic pathway, for example, LTC4 synthase, 5-LOX, prostaglandin EP or leukotriene LT1 receptors, were found to be associated with ASA-intolerance (13). More recently a differential gene expression profile with potent discriminative power has been reported in leukocytes of AERD patients (14). Therefore, a genetic component may be important in the pathogenesis of the disease.
Diagnosis of ASA-hypersensitivity
The diagnosis of ASA-intolerance is based usually on a history of adverse reactions caused by the ingestion of NSAIDs. Although the majority of ASA-hypersensitive patients have a convincing history of NSAID-induced adverse reactions, in some patients confirmation by controlled aspirin challenge is necessary. Oral aspirin challenge is the gold standard to confirm the diagnosis. Nasal or bronchial provocation with lysine-ASA, which is available in Europe, may be a valuable alternative diagnostic tool (15). Nevertheless, oral, bronchial or intranasal challenges are time consuming and require special equipment and expertise, which is not always available.
In vitro tests which could distinguish aspirin-tolerant from aspirin-intolerant individuals are currently under investigation. Although a few studies demonstrate that aspirin triggers the release of LTC4 from peripheral blood leukocytes (PBL), the differences between ASA-intolerant and ASA-tolerant subjects are only quantitative and not always reproducible. Similarly, basophil activation test based on cytofluorimetric measurement of surface CD63 or CD203c molecules upon stimulation with aspirin or other NSAIDs do not yield consistent results in discriminating AERD from ASA-tolerant asthmatics (16). Aspirin triggers 15-HETE generation in nasal polyp epithelial cells and peripheral blood leukocytes from aspirin-intolerant but not aspirin-tolerant patients suggesting the presence of a specific abnormality of the 15-LOX pathway in these patients (17). Preliminary reports suggested that The Aspirin Sensitive Patient Identification Test (ASPITest®), based on 15-HETE release measurement from PBL, may be also useful to confirm the history of aspirin-intolerance; however, further studies are required to confirm a discriminative value of this test (18, 19).
Management of a patient with aspirin triad
Management of asthma and rhinosinusitis in an ASA-hypersensitive patient is similar to treatment of other forms of asthma and rhinosinusitis. However, there are several important additional treatment modalities to be considered when aspirin-hypersensitivity is diagnosed (20).
Avoidance of NSAIDs and use of alternative analgesics
Patient education and careful avoidance of ASA and other NSAIDs which are strong COX-1 inhibitors is important because COX-1 inhibitors can cause severe asthma leading to hospitalization in an intensive care unit and even intubation. Therefore, ideally, the aspirin-hypersensitivity should be confirmed by a challenge test.
In general three groups of NSAIDs can be distinguished based on their capacity to induce hypersensitivity reactions in AERD patients (15). Table 1
Alternative antipyretic or analgesic drugs, such as acetaminophen (less than 1000 mg given once every six to eight hours) are preferred. Preferential COX-2 inhibitors, such as nimesulide and meloxicam, are tolerated by most, but not all, ASA-intolerant subjects. Selective preferential COX-2 inhibitors, such as celecoxib or valdecoxib, are tolerated by almost all aspirin-intolerant subjects. However, oral challenge (tolerance test) in the office is recommended to ensure that patients are able to tolerate COX-2 inhibitors.
Mangement of chronic rhinosinusitis and nasal polyposis
Successful management of chronic rhinosinusitis is essential and may result in the improvement of asthmatic symptoms (21). Topical steroids are quite effective in controlling symptoms of rhinitis and may slow down recurrence of nasal polyps. Antibiotics should be used whenever infectious component is evident. Although antileukotriene drugs (ALD) may also alleviate symptoms of chronic rhinosinusitis and improve nasal patency in AERD patients, they are not more effective than in ASA-tolerant patients (22). Surgical procedures (polypectomy, functional endoscopic sinus surgery or ethmoidectomy) are usually needed to relieve symptoms of chronic rhinosinusitis at certain stages of the disease and to remove polypoid tissue from sinuses. Assessment of the outcome of endoscopic surgery in ASA-sensitive patients with chronic rhinosinusits and ASA-tolerant controls revealed that patients with ASA-triad responded less well to surgical intervention (23). Because surgery does not affect the underlying inflammatory component of rhinosinusitis, medical treatment with topical steroids is also necessary post-surgery. Antileukotrienes and/or chronic oral aspirin after desensitization may also be considered as the follow up treatment after surgery.
Management of asthma
Inhaled glucocorticosteroids in relevant doses, often in combination with long acting beta-2 agonists are the most effective drugs for controlling asthmatic inflammation and asthma symptoms in patients with AERD. In some patients chronic treatment with oral prednisone may be necessary to control the disease. Addition of a leukotriene receptor antagonist such as montelukast to standard anti-inflammatory therapy (inhaled glucocorticosteroids, theophyline, short acting β2-agonists) improved respiratory function and alleviated clinical symptoms over the 4-week treatment period in a group of aspirin sensitive asthmatics (24). In another study 6 weeks of treatment with zileuton in patients with AERD resulted in improvement in pulmonary function, although the magnitude of improvement did not exceed that observed in ASA-tolerant patients in other studies (25).
Available data indicate that although ALDs may be effective in relieving symptoms and improving respiratory function in some patients with AERD the degree of improvement is similar in ASA- sensitive and tolerant asthmatics (26). However, AERD patients bearing variant C allele of LTS4 synthase and HLA DRB1*301 allele seem to respond better to antileukotrienes, thus pointing to the importance of a pharmacogenetic approach to treatment of this apparently heterogenous population of asthmatic patients (27).
Desensitization to asthma
Most patients with AERD can be desensitized to aspirin: following the initial adverse reaction, repeating of the dose is tolerated by more that 50% of patients, and further incremental aspirin challenges lead to a tolerance (28). Once the patient tolerates 600 mg of aspirin he is considered "desensitized" and then can take aspirin on a daily basis indefinitely without further adverse respiratory reactions. Desensitization can be also achieved silently, for instance, without evoking initial adverse reaction providing the challenge starts with a sub threshold dose and then the dose is slowly increased in appropriate intervals (29). In order to maintain the tolerance a patient has to ingest aspirin on regular, usually daily basis – the tolerance state disappears after 2-5 days without aspirin with the full hypersensitivity returning after 7 days. Several protocols of desensitization have been proposed allowing for completing the procedure usually within 3 to 5 days. The standard protocol of desensitization is an extension of the oral aspirin challenge protocol and all the safety precautions recommended for the challenge should be employed.
The ingestion of aspirin after desensitization results in alleviation of chronic upper and lower airway symptoms (30). When the patients were treated with aspirin for 6 months to 6 years a significant reduction in hospitalization, emergency room visits, outpatient visits, and need for nasal/sinus surgery were observed, and in some patients, a reduction in daily oral prednisone doses could be achieved (31). In some patients, significant improvement in nasal and asthma symptoms and reduction in the dose or even discontinuation of oral steroids were already observed (32) within the first four weeks of treatment with aspirin. The clinical benefit is usually seen within the first 6 months of desensitization and continues to be effective for up to 5 years of follow-up. The potential effect of aspirin desensitization and treatment may be limited because: a) not all patients can be desensitized because of the severity or non-stability of underlying asthma, b) desensitization is contraindicated because of concomitant gastric/peptic ulcer disease, c) patients' drop-out related to gastric intolerance of aspirin, and d) clinical improvement can be achieved in some but not all patients. Considering these limitations, only a fraction of patients with AERD will benefit from aspirin desensitization, and at present it is not possible to identify these patients before the procedure is implemented. Aspirin given after desensitization may be also a valuable solution for ASA-hypersensitive patients requiring chronic treatment with aspirin for rheumatoid diseases or coronary heart disease (33). Table 2 summarizes indications for ASA-desensitization in patients with asthma and hypersensitivity to NSAIDs.
Desensitization can also be achieved after repeated intranasal application of lysine aspirin (34). It has been reported that intranasal desensitization and prolonged treatment with soluble intranasal aspirin (Lysine-aspirin) has a beneficial effect on CRS, reducing recurrency rate for nasal polyps in ASA-treated groups as compared to placebo treated patients (35). However, such beneficial effects of nasal route were not confirmed by other studies and similar improvement in nasal symptoms after intranasal aspirin could be obtained in ASA-tolerant patients with nasal polyps questioning specificity of this approach for patients with AERD.
AERD is a distinct phenotype of bronchial asthma characterized by increased risk of uncontrolled upper and lower airway disease (36). Patients with AERD require comprehensive diagnostic and therapeutic approaches and pose a significant challenge for an allergist.
TABLE 1: NSAIDs tolerance in patients with cross-reactive type of hypersensitivity
(from Kowalski et al 2011r) (15)
Group A: NSAIDs cross-reacting in majority of hypersensitive patients (60–100%)
Mefenamic acid
Group B: NSAIDs cross-reacting in minority of hypersensitive patients (2–10%)
Rhinitis/asthma type
acetaminophen (doses below 1000 mg)
Urticaria/angioedema type
selective COX-2 inhibitors (celecoxib, rofecoxib)
Group C: NSAIDs well tolerated by all hypersensitive patients*
Rhinitis/asthma type
selective cyclooxygenase inhibitors (celecoxib, parvocoxib)
trisalicylate, salsalate
Urticaria/angioedema type
new selective COX-2 inhibitors (etoricoxib, pavocoxib)
*Single cases of hypersensitivity have been reported
TABLE 2: Potential indications for aspirin desensitization in aspirin hypersensitive asthmatics
- Coronary heart disease –
- need for chronic treatment with aspirin
- need for chronic treatment with aspirin
- Aspirin hypersensitive asthma/rhinosinusitis
- patients with severe nasal polyposis
- patients not responding to pharmacological treatment
- significant corticosteroid-induced side effects
- Indications for anti-inflammatory treatment
- rheumatoid arthritis
- osteoarthrosis
- Samter M. Beers RF. Intolerance to aspirin: Clinical Studies and consideration of its pathogenesis. Ann Intern Med 1968;68:875-883.
- Szczeklik A, Stevenson DD . Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. Allergy Clin Immunol 2003 111: 913-21.
- Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ. 2004 Feb 21;328(7437):43
- Bavbek S, Yılmaz I, Celik G, Aydın O, Erkekol FÖ, Orman A, Kurt E, Ediger D, Dursun B, Abadoğlu O, Ozşeker F, Akkaya E, Karakış GP, Canbakan S, Yüksel S, Mısırlıgil Z. Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: A cross-sectional survey. Allergol Immunopathol (Madr). 2012 Jul;40(4):225-30
- Fan Y, Feng S, Xia W, Qu L, Li X, Chen S, Ding M, Lai Y, Shi J, Xu G, Li H. Aspirin-exacerbated respiratory disease in China: a cohort investigation and literature review. Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e20-2
- Kowalski ML, Bienkiewicz B, Kordek P, et al.: Nasal polyposis in aspirin-hypersensitive patients with asthma (aspirin triad) and aspirin-tolerant patients. Allergy Clin Immunol Int - J World Allergy Org 2003, 6:246-250.
- Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G. Relationship of inhibition of prostaglandins biosynthesis by analgesics to asthma attacks in aspirins-sensitive patients. Br Med. J 1975; 1: 67-69
- Kowalski ML, Pawliczak R, Wozniak J, Siuda K, Poniatowska M, Iwaszkiewicz J, Kornatowski T, Kaliner MA. Differential metabolism of arachidonic acid in nasal polyp epithelial cells cultured from aspirin-sensitive and aspirin-tolerant patients. Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):391-8
- Pierzchalska M, Szabó Z, Sanak M, Soja J, Szczeklik A. Deficient prostaglandin E2 production by bronchial fibroblasts of asthmatic patients, with special reference to aspirin-induced asthma. J Allergy Clin Immunol. 2003 May;111(5):1041-8
- Gaber F, Daham K, Higashi A, Higashi N, Gülich A, Delin I, James A, Skedinger M, Gyllfors P, Nord M, Dahlén SE, Kumlin M, Dahlén B. Increased levels of cysteinyl-leukotrienes in saliva, induced sputum, urine and blood from patients with aspirin-intolerant asthma. Thorax. 2008 Dec;63(12):1076-82
- Laidlaw TM, Kidder MS, Bhattacharyya N, Xing W, Shen S, Milne GL, Castells MC, Chhay H, Boyce JA. Cysteinyl leukotriene overproduction in aspirin-exacerbated respiratory disease is driven by platelet-adherent leukocytes. Blood. 2012 Apr 19;119(16):3790-8
- Pérez-Novo CA, Kowalski ML, Kuna P, Ptasinska A, Holtappels G, van Cauwenberge P, Gevaert P, Johannson S, Bachert C. Aspirin sensitivity and IgE antibodies to Staphylococcus aureus enterotoxins in nasal polyposis: studies on the relationship. Int Arch Allergy Immunol. 2004 Mar;133(3):255-60
- Shrestha Palikhe N, Kim SH, Jin HJ, Hwang EK, Nam YH, Park HS Genetic mechanisms in aspirin-exacerbated respiratory disease. J Allergy (Cairo). 2012;2012:794890. Epub 2011 Aug 7
- Shin S, Park JS, Kim YJ, Oh T, An S, Park CS. Differential gene expression profile in PBMCs from subjects with AERD and ATA: a gene marker for AERD. Mol Genet Genomics. 2012 May;287(5):361-71
- Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Niżankowska-Mogilnicka E, Romano A, Sanchez-Borges M, Sanz M, Torres MJ, De Weck A, Szczeklik A, Brockow K. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy. 2011 Jul;66(7):818-29
- De Weck AL, Sanz ML, Gamboa PM, Aberer W, Blanca M, Correia S, Erdman S, Jermann JM, Kanny G, Kowalski M, Mayorga L, Medrala W, Merk A, Sturm GJ, Sainte-Laudy J, Schneider MS, Sczczeklik A, Weber JM, Wedi A Nonsteroidal anti-inflammatory drug hypersensitivity syndrome. A multicenter study. I. Clinical findings and in vitro diagnosis. J Investig Allergol Clin Immunol. 2009;19(5):355-69
- Lewandowska-Polak A, Jedrzejczak-Czechowicz M, Makowska JS, Jarzebska M, Jankowski A, Kowalski ML. Lack of association between aspirin-triggered 15-hydroxyeicosatetraenoic acid release and mast cell/eosinophil activation in nasal polyps from aspirin-sensitive patients. J Investig Allergol Clin Immunol. 2011;21(7):507-13
- Kowalski M.L., Ptasinska A, Bienkiewicz B Pawliczak R, L. DuBuske. Aspirin-triggered 15-HETE generation in peripheral blood leukocytes is a sensitive and specific and Aspirin Sensitive Patients Identification Test (ASPITest). Allergy 2005, 60:1139-45.
- Jedrzejczak-Czechowicz M, Lewandowska-Polak A, Bienkiewicz B, Kowalski ML. Involvement of 15-lipoxygenase and prostaglandin EP receptors in aspirin-triggered 15-hydroxyeicosatetraenoic acid generation in aspirin-sensitive asthmatics.Clin Exp Allergy. 2008 Jul;38(7):1108-16
- Lee RU, Stevenson DD. Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res. 2011 Jan;3(1):3-10
- Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012 Mar;50(1):1-12
- Ragab S, Parikh A, Darby YC, Scadding GK. An open audit of montelukast, a leukotriene receptor antagonist, in nasal polyposis associated with asthma. Clin Exp Allergy. 2001 Sep;31(9):1385-91
- Awad OG, Lee JH, Fasano MB, Graham SM. Sinonasal outcomes after endoscopic sinus surgery in asthmatic patients with nasal polyps: a difference between aspirin-tolerant and aspirin-induced asthma? Laryngoscope. 2008 Jul;118(7):1282-6
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- Dahlen B, Nizankowska E, Szczeklik A, Zetterstrom O, Bochenek G, Kumlin M, Mastalerz L, Pinis G, Swanson LJ, Boodhoo TI, Wright S, Dube LM, Dahlen SE. Benefits from adding the 5-lipoxygenase inhibitor zileuton to conventional therapy in aspirin-intolerant asthmatics. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1187-94.
- Mastalerz L, Nizankowska E, Sanak M, Mejza F, Pierzchalska M, Bazan-Socha S, Bestynska-Krypel A, Cmiel A, Szczeklik A. Related Articles, Clinical and genetic features underlying the response of patients with bronchial asthma to treatment with a leukotriene receptor antagonist. Eur J Clin Invest. 2002 Dec;32(12):949-55.
- Park HS, Kim SH, Sampson AP, Lee KW, Park CS. The HLA-DPB1*0301 marker might predict the requirement for leukotriene receptor antagonist in patients with aspirin-intolerant asthma. J Allergy Clin Immunol. 2004 Sep;114(3):688-9
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Nev Schulman Explains What "Catfish" Means
What to Know Before Dating Online, According to Catfish's Nev Schulman
Catfish is in the middle of its third season on MTV, and host Nev Schulman promises a new approach to the program. During a recent visit to our New York studio, Nev took us back to basics by defining what catfishing is and gave his best advice for those looking to embark on an online adventure of their own.
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FORT CARSON, Colo. (AP) — Military officials say two soldiers based at Fort Carson in Colorado have died of injuries from a vehicle accident in Kuwait.
The Department of Defense said Friday that 25-year-old Spc. Trinidad Santiago Jr., of San Diego, and 21-year-old Pfc. Charles P. McClure, of Stratford, Okla., died Thursday in Camp Buehring, Kuwait.
They were assigned to the 4th Battalion, 42nd Field Artillery Regiment, 1st Brigade Combat Team, 4th Infantry Division at Fort Carson.
Fort Carson officials say Santiago joined the Army on Oct. 13, 2009, while McClure joined the Army on Nov. 1, 2011. Santiago had previously deployed to Afghanistan.
(© Copyright 2013 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)
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text: Re-underwriting would be prohibited under a bill introduced in the House and Senate on Oct. 16. Under the legislation, insurers would not be allowed to increase or reclassify premiums "based on a health-status-related factor," says Sen. Bob Graham, one of the sponsors.... Health benefits for part-time workers were the focus of a labor dispute between a union representing janitors and 30 cleaning companies in Boston. Under a tentative deal ending a three-week strike, about 1,000 part-time employees who work in the largest buildings and who are members of Boston Local 254 of the Service Employees International Union will get health insurance through employers. About 75 percent of the union's 11,000 members are part-time workers.... Meanwhile, a former editor of the New England Journal of Medicine says that the only way to help the working poor and all other segments of society is to switch to a single-payer health care system. In a New York Times opinion piece, Marcia Angell says that the fatal flaw in today's system is that medical care is treated "as a commodity." She adds that "the criterion for receiving it is ability to pay, not medical need."


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Tuesday, 20 December 2011
candied and vanilla-salted pecans and walnuts
I'm surprising myself here. Two blogposts within a fortnight. Good grief.
Anyway. It's THAT time of year again. Time for a bit of ho ho ho and goodwill to all men. Or something.
Over the past few Christmases, I've been ditching the shop-bought snackage and making more and more festive titbits at home. Frankly, they taste so much better, and usually cost a fraction of the price.
These here nuts are now part of our household's newer Christmas traditions. Every year, I try to find a spare few minutes to have some sticky, nutty fun.
Once they're made, I break them up into manageable bite-sized clusters, and bag them up, ready for tucking into stockings for Christmas morning.
Like most of the recipes on this blog, these candied nuts are quick and easy to make, and ridiculously tasty. And, happily, they give a yielding, crumbly, not tooth-shattering crunch, so even Granny can have some. It's also a highly adaptable recipe, so you can add whatever you fancy by way of spices and the like. But I have to say, I like them just as they are. The secret, I think, is good vanilla salt - I use Halen Mon's.
To make them, you'll need (adapted slightly from here):
125g pecans or walnuts, or a mixture
115g unrefined caster sugar
0.25 tsp vanilla salt
First, roast the nuts for 5 minutes or so at 180C/350F/Gas 4, until they're just starting to toast. Keep a close eye on them, because you don't want them to start catching. Once they're done, take them out of the oven and set them aside.
In a heavy-based saucepan, melt the sugar over a gentle heat. Once it's turned liquid, throw in the pecans, and stir quickly to ensure the nuts are covered thoroughly.
Tip the nutty-sugary combo out onto a baking sheet covered with parchment paper or a silicone mat. Working as quickly as you can, spread the nuts out - I use a couple of forks. While the sugary syrup is still warm, scatter the vanilla salt over.
Leave the nuts to cool. Once they're completely cold, break into bite-sized clusters and keep in an airtight container or bag them up for presents.
* Want savoury snackage for Christmas as well? Some equally simple-to-make and super-tasty cheese biscuits are over on my other blog, here.
16 comments:
- Jacqueline said...
Oh my those look good. I had to stumble and pin them as soon as I saw them. I love the close up shot where you can see the sugary caramel stretching. Yum!
Have a great Christmas
- 20 December 2011 at 18:17
- The Ginger Gourmand said...
As if my ever increasing belly needed another festive snack idea...! They look gorgeous in the little bags - perfect for gifts. I'm not a huge fan of salty sweet things but Mr GG is. I see two different batches of candied nuts on our horizon.
- 21 December 2011 at 10:45
- Pia K said...
looks delish! in sweden we have the "burnt almonds" sold at fairs and streetcorners aorund xmas, which i suppose are just sugary candied kind of almonds. far from as pretty as these though.
i hope you had a lovely xmas and that your new year will be a fun, good and caring one!
- 8 January 2012 at 23:42
- robert said...
i like this blog...
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- 5 February 2012 at 14:35
- Choclette said...
I made some candied nuts for the first time this Christmas. They were pretty damn good, but yours sound even better. I'd love to find a bag tucked down one of my stockings or even several of my stockings ;-)
- 10 February 2012 at 19:46
- England Furniture Company said...
Thank you for sharing your recipe! Some could find this useful around the holidays.
- 23 February 2012 at 16:52
What a neat idea. Even though the holidays are over, I think I want to make a
plate today! What a yummy treat. Thanks!
- 27 March 2012 at 16:41
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The FBI has admitted defeat in attempts to break the open source encryption used to secure hard drives seized by Brazilian police during a 2008 investigation.
The Bureau had been called in by the Brazilian authorities after the country's own National Institute of Criminology (INC) had been unable to crack the passphrases used to secure the drives by suspect banker, Daniel Dantas.
Brazilian reports state that two programs were used to encrypt the drives, one of which was the popular and widely-used free open source program TrueCrypt. Experts in both countries apparently spent months trying to discover the passphrases using a dictionary attack, a technique that involves trying out large numbers of possible character combinations until the correct sequence is found.
Brazilian reports mention that the authorities had no means of compelling the makers of TrueCrypt to help them though it is hard to see how its creators could have helped.
If a complex passphrase has been used - a random mixture of upper and lower case letters with numbers and special ASCII characters throw in - and the bit length is long, formidable computing power and time would be required to chance upon the correct passphrase.
TrueCrypt also uses what is termed a 'deniable file system' approach to encrypting whole hard drives. Under this design, the existence of the encrypted partition will not be obvious to anyone examining the drive allowing the individual using such encryption to plausibly deny its existence.
The logic is persuasive. If an encrypted partition or files is detected by investigators is puts the person using the encryption in the difficult position of having to refuse to disclose the passphrase, a potentially incriminating stance.
By interesting coincidence, around the time of the arrest of Daniel Dantas in 2008, a team including encryption celebrity Bruce Schneier found weaknesses in Truecrypt 5.1's implementaion of the technology that could compromise the plausible deniability design.
Although 'data leakage' of the sort noted by the team examining TrueCrypt would not allow investigators access to the encrypted files it is possible that this flaw betrayed the fact that encryption had been used by the defendant.
Return to security news headlines
View Security News Archive


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Throughout the past several months, I have written a couple of articles that explained the importance about why you should review your life insurance policy. It's one of those things that we get for the "just in case" moment, and then sometimes forget about it. You'd be surprised how often unexpected slip-ups occur with life insurance policies. That's why it's so important to review your policy … to ensure that you're not paying too much or too little for coverage, and to ensure that your policy is working properly for you.
All that said, here are six important questions you should ask when reviewing your life insurance policy:
Has my life situation or needs changed since I purchased my policy
Back in January, I wrote an article that outlined six common life changes that should cause you to stop and review your life insurance policy. These life changes ranged from the purchase of a new home to the changing of your job to the death of your spouse. If your life situation has changed since you originally purchased your policy, you'll want to evaluate whether you need to increase or decrease coverage.
Have assumptions, such as interest rates, related to my policy change?
When you first purchased your life insurance policy, your insurer made some assumptions based on the market conditions at the time of your policy purchase. But as market conditions change, so can the assumptions your insurer originally made. By reviewing your policy, you'll be able to determine if you need to make some policy adjustments that will help you receive the best benefits possible for your policy.
Do I have too much or too little life insurance coverage?
When you first took out a life insurance policy, you may have been making a lot less than you're making now. If you're making more now, you may find the need to increase your coverage. If you just said "Adios" to your youngest child who left your nest, you may find that you need less life insurance coverage now. It's important to align your life insurance coverage with your needs and consider whether you're paying for too much or too little of coverage.
Are my beneficiaries properly identified?
If you were to pass away while your life insurance policy is in effect, do you know who would receive the money? Many individuals name their spouses, children or parents as the beneficiaries. But if it's been awhile since you purchased your policy, you might want to review it to ensure that your beneficiaries are properly identified. Make sure that your life insurance money will go to the individuals you really want it to go to.
How reliable is my insurer?
When you first purchased your life insurance policy, how well did you research the life insurance company you did business with? If you can't recall spending a lot of time figuring out whether the company solid and reliable, you may want to evaluate the reliability of your insurer. The industry is rapidly changing, and with industry changes come concerns over whether certain insurers can continue to provide reliable service. If you question or are concerned about this, you'll want to consider whether you need to change insurers.
Is my life insurance policy aligned with my estate/business plan?
Believe it or not, the lack of alignment between a person's life insurance policy and their estate/business plan is seen more often than not. There are tax consequences for your beneficiaries if these two items don't align, so in order to provide your beneficiaries with the maximum amount of money, ensure that your policy aligns with your estate/business plan.
Life Insurance Review Help
Not sure where you and your life insurance policy stand? Don't wait any longer. Get a review of your life insurance policy. Contact Rea & Associates, and we can help connect you to individuals who can help you with a life insurance review. You and your family will be glad you did.
Author: Don McInstosh (New Philadelphia office)


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Context of the question: I am a nursing student that was given a case study of alcoholism. The subject of the study claims to be atheist.
Question: What are some therapeutic options for alcoholism (including physical dependance) that would be acceptable to an atheist? (Side question, should atheist be capitalized like Deaf person is?)
I can defend my reasoning why the client should not be required to attend AA. I need other treatment options that would be acceptable that do not include the 12 steps.
Thank you.
Views: 1193
In grammar, you would be absolutely correct. In the context of Deaf culture, it is supposed to be capitalized. I personally think it is rather conceited for Deaf persons to insist on the capitalization, but that is their culture and the way they do it. Thank you for the input. The cat is safely killed on this side subject :-)
http://alcoholism.about.com/od/non/a/secular.htm - Might be a useful starting place for finding a secular program.
as an atheist in early recovery (5 months), i can say that it is rough in aa. its not that its not helpful, it often is, but their culture is an "all or nothing" approach to recovery. i was told numerous times that i needed to find that higher power, or i'd likely fail. (not a good thing to tell someone in their first few weeks. it tends to freak us out.)
as nelson said, smartrecovery is an option, and a good one. the trouble is how small they are. in my area, there is only one meeting a week within a two hour drive. so i find myself going to aa to fill in the gaps. i find that aa is better than nothing, as there seems to be no real replacement for a supportive community of recovering addicts. but if its at all feasible, using smartrecovery (or some secular equivalent) as the basis of that community is definitely preferable.
I have been sober for 11 years with AA, being an open atheist since 4 years. I have found very difficult to continue the game of the "high power" to be happy and aware about what is going on with the alcohol's problems, but my recovery under this new perspective has taken a very long way for a couple years specially in relation with the opposition from some AA's members, but eventhough I dont care what they say today, I dont recommend to anybody who is trying the very first time to quit the drinking stay away from AA if there is not another options around his area.
I came out at my NA home group around three years clean. Kind of a mixed response. Most have been supportive. I tried to capital B Believe for years. Guess I ask too many of the wrong sort of questions. I'm in a small community and I definitely appreciate the support group and 'holding each other accountable' aspects of the program. I still go, mostly in case any other 'outcasts among outcasts' come through the door they aren't shamed back out by the Old-Timers.
My doctor in the u.k said to me when I had a really heavy drink problem about going to the A.A for help,but as soon as he mentioned it I said no- way as I knew what they were about,I don't know about the U.S but in the U.K we have Community Drug and Alcohol Team (C.D.A.T)who after an initial chat will take you on as long as it's you who wants to give up,not because someones told you too.I had to bring my drinking down on my own to about 50 units per week then I could do their 5 day detox(no alcohol,was just given valium whenever I got the shakes and sweats)but over that week had to start to take a medication called campral to help reduce cravings and antibuse(Disulfiram) which is a big deterrent ,which you have to sign for as it could kill you if you had a drink while on it,any type of alcohol could make you feel ill even if you used aftershave!if and you didn't check it was alcohol free it would react with the antibuse and in 5mins you would have a banging headache so imagine actually having a drink,I did once,I had half a can and by the time I had slowly drank the half I was violently ill(and i really mean violently),never did again.I stayed on the antibuse(by choice)for 2 years,that was 6years ago.I know some people then abstain for life but I go out with my friends now once a month to catch up and I'm able to have a couple of beers but that's all ! As I know that if i got drunk it could all start again,and I know that it's just not worth it.
Humanist Steps
Below is another version of secularized steps created by the renowned behavioral psychologist B. F. Skinner and first published in "The Humanist".
1. We accept the fact that all our efforts to stop drinking have failed.
2. We believe that we must turn elsewhere for help.
3. We turn to our fellow men and women, particularly those who have struggled with the same problem.
4. We have made a list of the situations in which we are most likely to drink.
5. We ask our friends to help us avoid those situations.
6. We are ready to accept the help they give us.
7. We honestly hope they will help.
8. We have made a list of the persons we have harmed and to whom we hope to make amends.
9. We shall do all we can to make amends, in any way that will not cause further harm.
10. We will continue to make such lists and revise them as needed.
11. We appreciate what our friends have done and are doing to help us.
12. We, in turn, are ready to help others who may come to us in the same way.
First step in AA is "We admitted we were powerless over alcohol." I kept asking, "If I'm powerless over alcohol, how come I'm voluntarily in rehab?"
I agree completely with Holland's statement, "contact with previous friends will lead to relapse. even the ones who are not abusers will lead to contact of old bad habits. it is the whole old familiar environment that will lead to relapse." It is vital to remove yourself completely from the previous environment of social and not-so-social drinking. At my AA group I came out as atheist and gay and I ignored the "Higher Power" nonsense. It was the compassion of the group and the commonality of our lives that helped me quit. Any kind of god was simply unnecessary. That was a dozen years ago and still the smartest decision I have ever made.
This and other papers seem to show rather clearly that no one should go to AA. While it may not be directly detrimental, it entails a great deal of effort for no apparent benefit.
As a former addict my opinion is that addiction is not an illness, it's a compulsion based on fear of being without a crutch. Remove the fear and you remove the desire for the drug. It needs a subtle psychological shift from 'How will I survive without it?' to 'Life is going to improve beyond recognition without it and I can't wait to get free". To do this you need to examine all the reasons/myths you imbibe and explode them one by one. The panic addicts feel is akin to hunger. To get a clearer understanding I suggest you take a look at Allen Carr's "The Easy Way To Stop Smoking" and substitute "smoking" for "alcohol". It's how I freed myself and in my opinion it's the way forward in treatment of all addictions. Hope this helps!


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Gold medal pizza? Thai pie vies for prize
When Bistro 151 owner Anna Wallaker entered her Thai pie in the International Pizza Contest at the eleventh hour, she didn't expect to win a free trip to Vegas. But on March 25 she and pizza chef Gerald Wright will leave the quaint community of Nellysford for the glitzy Strip, to compete in a rigorous three-day "Pizza of the Year" contest.
As one of only five finalists from around the world, Bistro 151's challenge will be to prepare up to eight perfect pies a day and persuade a panel of discriminating international judges that their "winged" (chicken) pizza is superior to competitors representing "exotic," "seafood," "traditional," and "vegetarian" categories.
What's the prize? More valuable than the plaque and $1,500 prize (pennies in casino-land) are the bragging rights. They'll get a spot on the cover of the industry bible, Pizza Today. Heck, we'd drive a lot farther than the Wintergreen valley to taste the "Best Pizza of 2003."
So what exactly is Thai pie? A far cry from your traditional tomato and mozz, undoubtedly.
"It's an extremely hot and spicy pie that's not at all ordinary," says Wallaker, who inherited the pizza's name and a few ingredients from the bistro's original owner, Jim Green. "I can't publish the recipe just yet, but I will say that fresh ginger and lemon grass are essential." Rice noodles, an innovative peanut satay Riesling sauce, and, of course, spicy chicken are just a few of the other fixings in this thin-crust, brick oven-baked delicacy.
Pizzas with pedigrees are nothing new to Nellsyford. Thai pie is just the latest in a long list of award-winning Bistro 151 offerings. Previous titles earned include "best vegetarian," "best traditional," and "best pizza in the Northeast." 2004 contenders? Could be another Asian-inspired white pie, the "lucky duck": duck medallions, caramelized onions, scallions. and a lingonberry sauce.
If you're in the mood for something without a crust, ask Anna to make you some of her famous homemade manicotti with "gravy," or choose from a diverse menu that offers everything from she crab soup to steak.
How does a world famous food originate in a village so small it doesn't even have a Food Lion? Dish had to ask.
"The people here are amazing," Wallaker explains with heartfelt enthusiasm. "I've lived in New York, traveled the world, but Nellysford is my absolute favorite place to live. When something happens here, the entire community pulls together."
In that case, she'd better have enough lemon grass on hand for a supersize celebratory pie.
Supersize sushi?
Speaking of supersize, the new Fuji Sushi & Grill Buffet is now officially open. Dish stopped by the former site of The Wood Grill Buffet last Thursday– the official grand-opening– to check out the latest Asian buffet to line traffic-heavy Route 29. We weren't alone– though after surveying the scene, we realized that there were just as many kimono-clad employees (chopping, rolling, pouring, re-filling) as customers.
Buffets, or "Vikings," are big business in Japan. But because fresh seafood prices are so high there, "all you can eat" is generally not an option at sushi and sashimi bars. Apparently, no such price restrictions apply at Fuji. This is sushi for bottomless appetites. "All you can eat" prices start at 6.95 for lunch and 12.95 for dinner. Wad of wasabi, anyone?
Another thing you probably wouldn't find in a traditional Japanese sushi bar– or at most other Asian buffets in Charlottesville–is mashed potatoes. But Fuji offers something for every taste– in addition to the sushi bar and hibachi grill, there's a salad bar, a kid-friendly "American food" bar (pasta, burgers, fried chicken), and a cocktail bar serving $4 scorpion bowls complete with straws and umbrellas.
A black stone fountain makes an imposing statement in the entryway.
"In Japan, fountains symbolize money," manager Ann Chan says. Judging from the size of this "mountain of a fountain," expectations at Fuji are sky-high.


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March 11, 2005
LOS ANGELES - Walt Mossberg, columnist for the Wall Street Journal, was the keynote speaker at the 2005 Venture Capital Roundtable held March 2, 2005. The Venture Capital Roundtable is hosted annually by the Entrepreneurs Association, UCLA Anderson's largest student association. The round table allows members the opportunity to network with a variety of entrepreneurial professionals in an informal setting. It also affords students the opportunity to soak in words of wisdom from speakers like Mossberg, who writes three times a week for the Journal, aiming his columns at consumers – both personal and professional – which are "not under the thumb of IT department at large corporations.
From his vantage point, the personal computer is no longer the dominant digital device – "the PC's reign is over" – as cell phones and other devices become more useful and more ubiquitous. But what's really replacing the personal computer is a type of convergence, where one's television and cell phone, one's living room and one's office and, yes, one's personal computer and all networked together. The whole concept of being online will become antiquated as more and more everyday experiences migrate organically to the experience we now think of as being "online." Another reason the personal computer is losing its share of the public's attention is that, as a business, what was once a vibrant and creative atmosphere has become moribund, with Intel and Microsoft "sucking out the profits."
The cell phone, Mossberg believes, is a product with much more potential. Holding his own Palm Treo aloft, he noted that the device is no longer just a phone, but also a computer, a digital camera, a vehicle for email with video and mp3 music capabilities. With hard disks coming to cell phones in the very near future, he jokes that "you will soon be able to store thousands of crappy photos," but underlying the humor was the implicit fact that the device we once thought of as just phones with poor reception are fast becoming portable communication units with a variety of uses.
The greatest issue standing in the way of what could be a very profitable and interesting business are what Mossberg refers to as "the Soviet Ministries," aka the telephone carriers, who exert control over the technology while they dominate the industry. "They prevent progress and don't advance the technology," Mossberg said. "They are essentially old utility companies, monopolists who failed to adopt a single standard for the technology even though it was done in every other technology." Europe, Mossberg notes, has no such problems and new uses for "cell phones" are always being innovated. In the United States, "all new hardware goes through the Soviet Ministries and they distort and prevent innovation and profits."
The biggest problem facing the online world is security, Mossberg says. Microsoft – which enjoys a near monopoly – offers an operating system that is fundamentally insecure. There is, he says, a group of international criminals, vandals and thieves that do everything from identity theft to the forcing of advertising on to everyone's computer. Mossberg consider security a crisis at this point and sees no immediate solution to the issue.
About UCLA Anderson School of Management
UCLA Anderson School of Management is perennially ranked among the top-tier business schools in the world. Award-winning faculty renowned for their research and teaching, highly selective admissions, successful alumni and world-class facilities combine to provide an extraordinary learning environment. UCLA Anderson students are part of a culture that values individual vision, intellectual discipline and a sense of teamwork and collegiality.
Established in 1935, UCLA Anderson School of Management provides management education to more than 1,400 students enrolled in MBA and doctoral programs, and some 2,000 executives and managers enrolled annually in executive education programs. Recognizing that the school offers unparalleled expertise in management education, the world's business community turns to UCLA Anderson School of Management as a center of influence for the ideas, innovations, strategies and talent that will shape the future.


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Narrow Results
When selecting the right speakers for your boat, it is necessary to make sure that they are specifically made to be near water. At Abt, we offer a variety of marine audio speakers, that deliver the most dynamic and powerful sound quality. With options from brands such as JL Audio, Kenwood, WetSounds, and more, you are sure to find the perfect option for your boat. When selecting the right marine speakers to go with your boat's system, we encourage you to contact one of our marine audio specialist at 888.228.5800.


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JERSEY CITY, N.J. – Jimmy Fallon couldn't contain his admiration.
While the Tonight Show host has never been one to censor his overwhelming joyfulness, he vocalized what was obvious to anyone in attendance who had just watched Rory McIlroy perfectly drive a golf ball 150 yards in the direction of the New York City skyline.
"Ooh, that's gorgeous," Fallon exclaimed as the ball remained in midair.
"That's a Tiger Woods shot," McIlroy replied, with Woods himself standing just several feet to the right, the trio all on stage at Liberty National Golf Club Monday night to promote Nike's new line of Vapor iron clubs.
But while Woods' day-to-day happenings continue to generate headlines in the golf world, it's the Rory McIlroy shots that continue to be the story of the summer. The 25-year-old heads into this weekend's The Barclays tournament at The Ridgewood Country Club in nearby Paramus having won his past three tournaments, two of them being his third and fourth career major titles.
It doesn't sound like McIlroy would rather be anyone other than himself on the course right now.
"Once you get on a roll and you start to get confidence, I think that's all it really was," he told USA TODAY Sports of his past month's work. "I've played well all year, I really have. It seemed like the start of the year it was just a bad nine-hole stretch that would prevent me from winning. I finished eighth at the Masters and it felt like it could've been so much better. It's been a good year overall since the start of the year but it just seems like this summer I got on a roll and got confident. I just tried to keep it going. I've done that for the past few weeks and there's still some big tournaments coming up and I want to keep it going. I won three tournaments In a row and I'll try to make it four this week."
While McIlroy now has to wait until the Masters in April 2015 for the opportunity to win a fifth career major (and third consecutive one), his impressive recent wins at the British Open and PGA Championship have now generated questions about whether he could eventually make a run at Jack Nicklaus' 18 total majors before he's done. Nicklaus himself called McIlroy an "unbelievable talent" in an ESPN Radio interview two weeks ago, saying that he has the opportunity to win "15 or 20 majors or whatever he wants to do if he wants to keep playing."
"It's inevitable that there's going to be these comparisons. It's hard to avoid and I've seen what Jack Nicklaus has said," McIlroy said. "It's a compliment. It's very flattering that Jack thinks so highly of my golf game but saying that, I've got four majors right now and I want to try to get my fifth as soon as possible. And then when I do that I'll try to get my sixth. I don't have any sort of number in my head because it places unfair expectations on you. I just don't want to do that to myself. Four is a great number where I'm at in my career at 25 years of age. If I can get to five soon then that's great and if it takes me a little while then so be it. I'm really happy with where I'm at and it's flattering all these compliments but at the same time I have to play some good golf just to get that fifth."
And while McIlroy may be mimicking his fellow Nike endorser's shots on stage, he makes it clear that the best lessons he's learned from Woods have been by his example.
"I never go and seek out advice from him," McIlroy said. "But just observing him and seeing how he's handled [things], especially the success that he's had and being able to keep it going. The dominance that he's had and the work that he's put in. I find that really impressive because I've only had a little taste of it over the past few weeks and he's done that so much throughout his career. That's what I find so impressive about him. If I was to seek out any advice it would be how to keep that going."


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METRO VANCOUVER -- He was lucky 16 months ago when he survived a targeted hit outside a Mr. Lube automotive centre in Coquitlam.
But Jaskaran Singh Sandhu's luck ran out this week when he was found slain on a rural south Surrey road — the victim of another targeted attack.
Sandhu, 26, had loose gang affiliations all over the Lower Mainland, but was not considered to be aligned with one specific criminal organization.
Cpl. Adam MacIntosh of the Integrated Homicide Investigation Team said police are looking at all possible motives, including whether Sandhu's murder is linked to recent gang slayings in Surrey.
"We haven't made any direct links to any other investigations at this time. We are looking at, obviously, that potential. We are looking at his history with police and his associates," MacIntosh said. "But right now it is too early for us to know for certain what exactly [was] the motive for him getting killed."
Sandhu's body was found at the side of the 12300-block Colebrook Road about 9:20 a.m. Monday. Surrey RCMP called in IHIT because of indications that the dead man had met with foul play.
After IHIT made the identification, they had to notify Sandhu's family.
A police tactical team spent Tuesday poring over the area where Sandhu was found.
Investigators don't know if he was killed on Colebrook Road or simply dumped there.
MacIntosh said Sandhu, who most recently was living in Coquitlam, was known to police throughout the Lower Mainland.
"He has a lot of associations to a lot of different investigations and we are trying to determine whether or not his behaviour, and what he was involved in, ended up having to do with why he got killed," MacIntosh said.
Sandhu was charged in Delta in May 2010 with two firearms counts. But the charges were later stayed. He had other criminal convictions as well.
He was also expected to be a witness against Sukhdeep Singh Poony, a Surrey man charged last March with attempted murder and several other counts in connection with the Mr. Lube shooting on Sept. 28, 2011.
Poony's case is in Port Coquitlam Provincial Court Feb. 6 to fix a hearing date. A preliminary inquiry had been scheduled for this month, but was adjourned after Poony switched lawyers, Crown spokesman Neil MacKenzie said Tuesday.
MacKenzie said he couldn't really comment on whether Sandhu's murder will have any impact on the Crown's case against Poony, who remains in pre-trial custody.
"I can't say at this point what impact the death of Mr. Sandhu will have on the outstanding case," MacKenzie said.
read my blog at vancouversun.com/therealscoop
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Ugh,i knew this 60 mins would take long.
I still can't get over "Joey Fitness"!
Quote from: racer on February 19, 2012, 07:38:51 PMI still can't get over "Joey Fitness"! IKR?! I mean, what's up with that?
How did Joey and Danny end up on the second flight when they were one of the first (or the first?) to get the clue?
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Pots & Potting Mix
Potting-up plants is fun and easy but you want to make sure that you use good quality pots and potting mix to ensure that your efforts are rewarded. Enjoy seasons of colour, fragrance, structure and style in any garden situation – be it your garden, courtyard or balcony. With Yates your potted plants will thrive and survive.


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Etymology of the word atheist
Definition of Etymology[edit]
Etymology is the study of the history of words and how their form and meaning have changed over time.
History of Atheist Etymology[edit]
In early ancient Greek, the adjective atheos (ἄθεος, from the privative ἀ- + θεός "god") meant "godless". It was first used as a term of censure roughly meaning "ungodly" or "impious". In the 5th century BCE, the word began to indicate more-intentional, active godlessness in the sense of "severing relations with the gods" or "denying the gods", instead of the earlier meaning of "impious". The term ἀσεβής (asebēs) then came to be applied against those who impiously denied or disrespected the local gods, even if they believed in other gods. Modern translations of classical texts sometimes render atheos as "atheistic". As an abstract noun, there was also ἀθεότης (atheotēs), "atheism". Cicero transliterated the Greek word into the Latin atheos. The term found frequent use in the debate between early Christians and Hellenists, with each side attributing it, in the pejorative sense, to the other.
In English, the term atheism was derived from the French athéisme in about 1587. The term atheist (from Fr. athée), in the sense of "one who denies or disbelieves the existence of God", predates atheism in English, being first attested in about 1571. Atheist as a label of practical godlessness was used at least as early as 1577. Related words emerged later: deist in 1621, theist in 1662; theism in 1678; and deism in 1682. Deism and theism changed meanings slightly around 1700, due to the influence of atheism; deism was originally used as a synonym for today's theism, but came to denote a separate philosophical doctrine.
Karen Armstrong writes that "During the sixteenth and seventeenth centuries, the word 'atheist' was still reserved exclusively for polemic ... The term 'atheist' was an insult. Nobody would have dreamed of calling himself an atheist". Atheism was first used to describe a self-avowed belief in late 18th-century Europe, specifically denoting disbelief in the monotheistic Abrahamic god. In the 20th century, globalization contributed to the expansion of the term to refer to disbelief in all deities, though it remains common in Western society to describe atheism as simply "disbelief in God".


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In less than a month, pitchers and catchers will begin reporting to spring training, and another baseball season will be unfolding before our very eyes.
In less than a month, pitchers and catchers will begin reporting to spring training, and another baseball season will be unfolding before our very eyes. We will be mesmerized by the sights and sounds of our beloved game, and I simply can't wait.
In less than a month, the Boston Red Sox will begin defending their World Championship title. Twenty-eight other teams will begin working to get where the Red Sox currently are, while the Houston Astros will be trying to figure out how to not finish in last place.
The offseason has been full of blockbuster trades and contract signings of this year�s All-Star pool of free agents. We have seen our fair share of fireworks and drama, just as we do every single winter.
It seems there is always one team who stands out the most during the offseason. Trying to figure out which team that was this winter has been a challenge and not an easy one mind you. This is me putting my best foot forward in naming the champion of 2013-14 offseason.
Without question, the New York Yankees have made the most noise this offseason. The Yankees had a much needed wake-up call after the departure of closer Mariano Rivera and narrowly missing the 2013 postseason. As if the struggle wasn't enough for the Yankees, things certainly were put into perspective when All-Star second baseman Robinson Cano signed a lucrative deal with the Seattle Mariners. However, the baseball Gods didn't stop there. Last week, the Yankees lost third baseman Alex Rodriguez for the entire 2014 season.
The Yankees were rewarded with signing four All-Star free agents. Both Jacoby Ellsbury and Carlos Beltran will give the Yankees a very competitive outfield. This will make extra base hits and RBIs harder to come by when playing against the pinstripes. Acquiring second baseman Brian Roberts will be a plus for the Yankees, given the injury plagued veteran can stay healthy. Brian McCann will add what has been missing to the Yankees defensive set up since Jorge Posada retired in 2011.
If the Yankees are successful in signing Masahiro Tanaka, the right-handed pitcher from Japan, they will be leading the discussion for postseason talks while simultaneously improving upon their rotation. While I still believe they are not the World Championship-caliber team they want to be, they certainly have made themselves contenders.
Hats off the Joe Girardi & Co. for all the hard work this offseason. The Yankees have not left a single stone unturned. Will the Yanks be able to live up to the hype? After all, the Blue Jays and Nationals were expected to do big things in 2013, and neither team had the slightest presence in the postseason. Only time will tell.
I am just as ready for spring training as every other baseball fan is. I'm ready to watch the games, make the memories and hopefully walk away with a good story or two. Each and every season brings new and exciting stories, and I hope 2014 is in every way as exciting as the rest of them.
Until next time: here is to a great season, and an even better story.
Paul Whittington is a marketing student at East Carolina University. Follow his live blog on Twitter @MLBwithPaul.


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Over the years, CD Projekt Red has made a name for itself with the Witcher series. The Polish developer has gone from relative obscurity to high acclaim through its action role-playing game based on Andrzej Sapkowski's fantasy novels. They've managed to impress fans with their lush visuals and complex combat system, but the team has really outdone themselves with The Witcher 3: Wild Hunt.
At E3 2014, they showed off a short mission where Geralt of Rivia had to get help from the Ladies of the Wood in order to locate a mysterious woman with ashen hair. The trio spoke through a medium and gives the witcher a quest: He has to speak to the Ealdorman and get something from him. But that's easier said than done as the village leader tasks Geralt with another quest, where the hero has to investigate an evil emanating from a tree in the distance.
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Brix...ah, Terrace Cafe on Pantops has closed
Restaurant owners tend to preen like cats when they first open, but when they close the
Restaurant owners tend to preen like cats when they first open, but when they close they tend to slink away like them. So kudos to Brix... ah, Terrace Cafe owner Karen Laetare for contacting Dish to let us know that she's decided to close her Pantops restaurant. Not an easy thing to do. The reason? Well, it's clear that the economy hasn't been helping any–- almost any restaurant owner you talk to these day will tell you the same thing–- and that trying to maintain a big, high volume establishment had become a challenge.
"It's time to downsize," Laetare admits. The restaurant closed on Friday, November 12.
Meanwhile, she wants to remind her customers that her decade-long Brix brand, which the newly opened franchise Brixx: Wood Fired Pizza in the Barracks Road Shopping Center forced her to change before they arrived, is still going strong on a much smaller scale at the Martha Jefferson Hospital outpatient facility on Pantops, where she has been operating the Terrace Cafe @ Martha J since April. Also, Laetare wants to assure folks that her decision to close had nothing to do with the Brixx pizza place trying to force her to change her name.
"It's a little sad," says Laetare, who admits that opening the big space on Pantops had been years in the making. "But I have to do what I have to do."
Laetare knows of no plans for the Pantops space, which is owned by the shopping center, but she says her loss could be someone else's opportunity. "It's a great building, has a great kitchen set up," she says. "And there's a lota love in it."
As for her decision to announce the closing, Laetare says it was a no-brainer.
"My customers deserve it," she says, "because they've been phenomenal."
–story last updated 10:21am, Tuesday, November 16
–original headline: Brix Terrace Cafe on Pantops to close
40 comments
Thank you AC, well said. We are all fine and thank you for your kindness.
here is my opinion of your opinions: if you would just leave your opinion of the restaurant that would be great! brix was meant to be great. too bad what happened.
Why don't you all just wish Karen and the employees well and cease with all the other unnecessary hurtful comments. I'm sure this is hard enough for those associated with Brix. The last thing they need to see are hurtful comments that will serve no purpose or benefit now. Karen, to you and your staff: I wish you the best in your new endeavors and hope things work out for the best for you all.
Dem brownies at Brixx be da bomb yo!
The Pantops restaurant name is spelled "Brix," whereas the newfangled pizza joint at Barracks spells it "Brixx." Despite the spelling difference, the pizza joint still managed to make Brix change its name to "The Terrace Cafe."
I'm normally all for the little guy, but finding fault with the company that registered its name BEFORE the local one is pretty silly. The Hook's own article acknowledges that Brixx registered their name a year before Karen. Why is Brixx in the wrong?
By the way, I always wanted to like Brix, but it always took soooo long to get anything out of their kitchen. Even when the place looked empty, it would take at least 20 minutes to get a sandwich from them. I only went there three times before I couldn't stand the wait anymore.
Food was poor and overpriced! Good riddens
We went just once. The wait was awful! The food was OK. The acoustics and glare were terrible. I'm surprised it lasted as long as it has. When we get over that side of town, it's Tip Top for us!
I love Brix's food and am always looking for good places to eat on Pantops. Sadly, my several visits to Brix restaurant in Pantops left me frustrated with the very long waits for a sandwich and frequent order mistakes. The newer Terrace Cafe in the hospital is just as slow and disorganized! I have had to wait for 15 minutes to have a sandwich made at MJH when there were no other customers in the cafe! I finally stopped going to both places. It makes me sad, but I don't see a successful future for this business because of the ongoing problem of extremely slow service!
we'll really miss Brix - our favorite stop for a really good lunch outside with the dog after play time at Darden Towe, without needing to go downtown
and I've always loved the way a few changed made the whole environment different for dinner
so sorry to see you go!
we'll really miss Brix - our favorite stop for a really good lunch outside with the dog after play time at Darden Towe, without needing to go downtown
and I've always loved the way a few changes made the whole environment different for dinner
so sorry to see you go!
I do feel it was very expensive to eat there. The menu selection was limited as well.
I can agree with you that this place never seemed to me, to bring out the best in Lataer's line up. I am not sure why, but the events I ate at she catered always felt more zesty, and her little shop always felt more friendly.
However, Steve has a valid point about the location. A place like Brix relies on a good deal of casual walk in client, looking for a bite to eat after doing a degree of shopping. The folks that shopped there, as a whole, were not likely able to afford her fare, or necessarily value it. I don't look down my nose at the patrons of the area, but that is the way it is.
Additionally, it was located in a way that those who might like it, would not want to drive there to simple get a quick bite. She might have found it much easier to cater out of, but with catering in the area certain to be way down, and establishment in that location is just going to struggle.
I am a fan of Brixx and find it sad they are closing. I think any restaurant owner faces challenges in this economic climate. But to be fair and put things in perspective, Chef Laetare is an excellent chef and she always held herself to a high degree of integrity in her business as well as creativity in her cooking. She is the type of small business owner we need in our community.... always held in mind the highest good of the customer and the employees. Brixx was an excellent restaurant and the owner a wonderful, talented cook and person. I'm very glad that Martha Jefferson Hospital has such a high degree talent in their midst. Kudo's to Brixx, Karen Laetare and MJH...... I hope Brixx Cafe reincarnates at some time in the future with their wonderful menu, food, ambiance, creativity and fun atmosphere. I can't say enough wonderful things about Brixx Cafe.
Brix' food is excellent and the restaurant interior was comfortable and inviting. They out-classed a significant portion of the pantops shopping area clientelle, as evidenced by some of the comments.
When Brix used to be over on 53 across from Jefferson Vineyards, it was the best place around for sandwiches, cookies, and brownies. The ambiance was great too. Moving to a location hidden back in a shopping center was the death knell for me. I made the trip a few times but the location was a real problem.
All very true, David. I only felt compelled to comment in reply to Steve's outright snobbery. However, I did experience what I experienced. If others' experiences were similar, no amount of "class" would persuade them to return.
Steve, don't try to spin business mistakes by the owner of this restaurant into some snobbish statement about the people that shop at pantops.
If the restaurant were as good as you say, the people would come. Regardless, the location WAS awful.
I went there once and spent over $7 for admittedly tasty slivers of meat and spread in some airy bread. It was not markedly better than more satisfying sandwiches I could get elsewhere in far more convenient locations and for a lower price. It did, however, arrive quickly, no doubt due to the fact that no one else was in the restaurant.
The reason this business failed is not due to the "pantops shopping area clientelle [sic]" but due to a failed business plan and a failure to execute a successful business plan.
You may resent the people that shop in the other businesses at pantops all you want, but that resentment will only continue to fuel your delusions regarding the failure of a restaurant you claim to have enjoyed. I feel sorry for you.
Dave, How do these negative comments benefit your advertisers or the readers of this blog? What is the purpose of allowing such negative comments regularly on this site? I understand that there is freedom of expression in America, but what did you think was going to happen when you write this drivel about a failed business? And the Arby's Slonaker story, too?
Very sad to see Chef Laetare loose yet another presence of her creative culinary delights in the C'ville area. Brix Market on 53 was a comestible oasis next to the vineyard, and a fantastic beginning or end to visiting Monticello, where, at the time, there was virtually a nonexistent eating establishment of note. Her stint at the newly renovated Monticello was a godsend for me and my family. Many tourists with whom I have spoken in the last two years throughout my travels in the US have told me of their experiences at Mr. Jefferson's estate, mostly commenting on how they enjoyed a coffee, a sweet, Panini or wine and beer from Chef Laetare. It's a crying shame that the Monticello Foundation politics may have played her a bad hand in her demise from there, as I hear they are known to do. Sorry Mr. Jefferson, for they know not what they did. As for BRIX MARKETPLACE AT PANTOPS, another culinary oasis in a desert of fast food chains and regular fare will be missed (don't get me wrong, ââ?¬Å?ain't nothing bad" about the local eateries). Surely the current economy, with all its social and cultural ramifications played a role. Chef Laetare deserves better. Charlottesville deserves her talent. I am confident that Chef Laetare will rise from the ashes of our broke down palace, as the economy improves.
Huh, I'm sorry to learn that Brix is closing. I'm glad she didn't just 'slink away!' I've only eaten there twice but I would have loved to go back again and again. It did feel a little big/cavernous --- I'd vote for a smaller cozier space for her next venue. Loved the food, and the desserts were divine. This is a loss for this part of town. It sure was tucked away in there; I'm don't doubt that the location contributed to the slow traffic. Thanks to Dave for keeping the community up to date on restaurant comings and goings. Good article, the opening sentence grabbed me and I thought you said a lot, concisely. Thanks!
I didn't know you were a cat person Dave,How many do you have?
Dave has only a few cats, Tom. They are good cats. Why do you ask?
In reply to Dave...Dude, you only have one chance to make a first impression. That's especially true in the restaurant business. All the folks who have judged and commented on Brix per one visit, rock on! No restaurant can claim to be a everyone's fav, that's why we have such variety.
Give the woman a break! Being one of the original BRIX chicks, I know how much time, energy, hard work, blood, sweat, tears, heart, soul and love Karen put into her business. Karen gave her all to provide this town with her culinary delights. Anyone who critisizes her accomplishments, obviously has none of their own. The only mistake she made was believing that folks knew what good food was. Rock on, Mamasita!
I am not sorry to see it close. I felt the sandwiches were just fair for all the fancy names....and the help were NOT helpful. I am handicapped and originally, my first time there, the gal who took the order said they would be happy to bring my order to the table if they were not busy. The next time I went there, they were NOT busy at all and the girl refused to bring my sandwich to the table.. I felt foolish and rather sorry I ever came there. When another waitress felt sorry for me, she brought me my coffee and left the cream and sugar back on the table/bar for me to get up and use....it was far from our table. I never went back to the restaurant..........................service was terrible!! They were NOT nice!!
When a small business is forced to grow, problems do arise. Trusting your employees to deliver your product is a very delicate situtation. The bigger you get sometimes product is compromised. The owner then, who is also the product has to make a decision and that is what Karen has done. She needed to bring back her quality and down size. Finding employees who have the same vision and that care about their jobs is very difficult. Karen's food style is by far the best that I have ever seen and I will respect her and follow her. She has cooked in my home and I will have her return. I think before anyone can judge a small business they should own one. Dealing with employee theft, financial devistation and a location that did not fullfil their promise is just one layer of difficulties that small business faces. There could have been many variables behind the scene causing delays in food service but Karen is the fastest sandwich maker that I have ever seen. I have just spoken to her and she is asking if anyone had a problem with wait time to come to the Terrace Cafe @ MJ and she will deliver to you her perfect product they way it should have been. If there is a line out the door, one can only prepare so fast so please keep that it mind or call ahead. Please do not let C'vill become a chain resturant city. If you love your small business then keep them open by going there. The phone number to the Terrace Cafe at the MJ Pantops complex is 654-8592 they are open 7am-4pm Mon-Fri. Karen's breakfast savory rolls are off the chart delicious. I used to buy them at the 53 store and crave them and you will not have to wait 20 minutes to be served.
Thank you Karen for your support to C'vill and all the donations to charities that you support. You will always be my number one BRIX Chix (yes one X)and I look forward to you catering my Christmas party.
Our family LOVED Brix out next to Jefferson Vineyards....then we loved it on Pantops....never thought the location was a good one for Karen...but I know one thing for sure--the folks at Martha Jefferson are brilliant to have her!! And...I for one have already booked her for catering a private party. We look forward to Karen's talent for a long time to come!!
BRIX did not fail, the shopping center failed her. Homeless people do not want to buy panini's or lemoncello cake. When you are the fanciest house on the block it doesn't work. Good luck Karen and the Terrace Cafe at MJ.
I wish the best to any small business in this day. But sometimes things aren't the way they seem.
I am not sad at all to see brixx go. i feel it was over priced and dinners were extremely overpriced!!!I feel karen put on a front to the customers and they never really saw the real karen latare. She had her ways im sure, i guess its all smoke and mirrors!!!
I am not usually one to speak out and make comments, I do not believe that too many people care what I have to say and that is usually true for me about others. When I read all the negative comments about Brix, I was compelled to say my piece. My wife and I have been going there since it opened and it wasn't due to proximity, it was because Brix supplied the most unique and wide selection of food, not the typical crap you can find on any street corner in this crowded town. I may be different than most of these jerks but my life is not so terribly busy that I have to complain when it takes a bit longer to get really good food and enjoy it in an atmosphere that's relaxing and pleasant. I will miss the atmosphere but not the food because I will make the trip a bit further up the road to keep on enjoying her food! Megan is the best and always had a beautiful smile and kind words to greet us with, she will go far and if Karen, who is equally beautiful and kind, knows what's good for her she will keep hold of Megan, they make a wonderful team! You guys hang in there and don't listen to these jerks, you have always been wonderful, a pleasure to see, chat with and I love your food! Maybe these other people didn't have a good experience because they are all too self involved and selfish to truly enjoy the smaller joys in life! Congrats to you Karen, you are an amazing woman with great passion and strength. I know bunches of people that feel like I do and will miss you tons! Best wishes to you in your new endeavor!! I look forward to seeing you and Megan at Martha Jefferson while eating the same great food!
"we are closing in a week, sorry employees" - Guess Who.
That is wrong.
My wife and I were truly saddened last Friday when we went to our favorite restaurant, the best in town in our opinion, to learn from Karen that she was closing and this was the last night that Brix would be open. We have always enjoyed the friendly staff, the pleasant open atmosphere and chatting with Karen when time permitted. The food was always excellent, the service warm and friendly and the space itself very relaxing. While I understand that opinions will vary, the sheer meanness of some of the posts in this thread is appalling. Running a small business is never easy, but in the present economic environment it's especially tough. I think that trashing the small business person for trying hard is pretty harsh. In the end my wife and I were the last customers served at Brix, but we intend to go to the Terrace Cafe at MJH. We wish Karen success and hope that she is able to reopen Brix in another location in the very near future. We look forward to being the first customers served there.
Wow!!Dave was right when he said that free speech was messy! True dat!
I went to Brix three times and each time came away wondering how this restaurant survived. The menu was adequate and the food adequate as well, nothing special. The wait for food was way too long. I am surprised that so many felt the food was beyond the locals' expectations. I'm not a local, but do business in the area. Do you have inferior locals here? Some of the comments seem to imply they wouldn't know a good meal from a burger--interesting.
Usually when I enter a "high end" establishment for a meal I do not have to order at the counter, nor do I have to carry my own food, and most especially I do not have to clean my own table.
If you want to have a quality establishment, then you must also have quality service. I ate there three times because I did not want fast food, my comments are consistent for each visit.
That said, I am sorry to see any business go under. Perhaps lessons learned, if they are, will lead to a greater success in the future.
Food was basically good, service was great, as long as you didnt see the occasional drunken vagrant passing by towards the woods then the view was great. Karen is a sweet woman. always took the time to speak to each customer , and answer questions about anything. tragic loss....who says charlottesville craves class anyway


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This is the tale that began in 2006 in my first year of beekeeping in Atlanta, GA. ...there's still so much to learn.
Welcome - Explore my Blog
I began this blog to chronicle my beekeeping experiences. I have read lots of beekeeping books, but nothing takes the place of either hands-on experience with an experienced beekeeper or good pictures of the process. I want people to have a clearer picture of what to expect in their beekeeping so I post pictures and write about my beekeeping saga here. Along the way, I've passed a number of certification levels and am now a Master Beekeeper Enjoy with me as I learn and grow as a beekeeper.
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Sunday, July 29, 2007
Small Hive Beetle trap is Working
I was relieved to find only SHBs in my trap - the holes are obviously the right size although I need to clean out some of the propolis.
5 comments:
I am glad that it is working, but only count 6. Do you have any idea if it is working enough to make a difference?
There were only 6, but I don't have a huge problem with SHB. I'm satisfied with that number as a measure of the trap's effectiveness. I'm waiting to see the trap in Proteus which has been off the hive for a while and is now back on. I also need to make a new batch of lure since this is still my original lure and has lost some of its potency!ReplyDelete
I don't really know if I have a problem yet. I am so new and it was only the last time I inspected that I was able to confirm eggs in the hives. So looking for SHB was not on the priority list although I had a few fall on me as I was inspecting.
Also, I just added a med super with wax foundation and I know that an empty super can lead to SHB finding more places to hide but post on beemaster, everyone suggested I add one as one of my hives seems to be bursting.
My inspector is coming out on Thur and I think I am going to try to be ready with the trap if he says I have a problem.
Have you had much of an issue with bur comb?
- Anonymous10:51 PM
Linda, Thanks for your blog. I am a relatively new beekeeper. i enjoy reading your news and find it very informative. Keep up the good work!ReplyDelete
I just posted my preliminary results on beemaster. Thanks for making us aware of this.