text:
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The ATHEROMA (Atorvastatin Therapy:
Effects on Reduction of Macrophage Activity) Study
Evaluation Using Ultrasmall Superparamagnetic Iron
Oxide-Enhanced Magnetic Resonance Imaging in Carotid Disease
Tjun Y. Tang, MB, BCHIR,*† Simon P. S. Howarth, BMBCH (OXON),*‡ Sam R. Miller, MSC,?
Martin J. Graves, MSC,* Andrew J. Patterson, PHD,* Jean-Marie U-King-Im, PHD,* Zhi Y. Li, PHD,*
Stewart R. Walsh, MSC,† Andrew P. Brown, BSC,¶ Peter J. Kirkpatrick, FMEDSCI,‡
Elizabeth A. Warburton, DM,§ Paul D. Hayes, MD,† Kevin Varty, MD,† Jonathan R. Boyle, MD,†
Michael E. Gaunt, MD,† Andrew Zalewski, PHD,# Jonathan H. Gillard, MD*
Cambridge, Harlow, and London, United Kingdom; and East Hanover, New Jersey
The aim of this study was to evaluate the effects of low-dose (10 mg) and high-dose (80 mg) atorvastatin on
carotid plaque inflammation as determined by ultrasmall superparamagnetic iron oxide (USPIO)-enhanced ca-
rotid magnetic resonance imaging (MRI). The hypothesis was that treatment with 80 mg atorvastatin would
demonstrate quantifiable changes in USPIO-enhanced MRI-defined inflammation within the first 3 months of
Preliminary studies indicate that USPIO-enhanced MRI can identify macrophage infiltration in human carotid
atheroma in vivo and hence may be a surrogate marker of plaque inflammation.
Forty-seven patients with carotid stenosis ?40% on duplex ultrasonography and who demonstrated intraplaque
accumulation of USPIO on MRI at baseline were randomly assigned in a balanced, double-blind manner to either
10 or 80 mg atorvastatin daily for 12 weeks. Baseline statin therapy was equivalent to 10 mg of atorvastatin or
less. The primary end point was change from baseline in signal intensity (?SI) on USPIO-enhanced MRI in carotid
plaque at 6 and 12 weeks.
Twenty patients completed 12 weeks of treatment in each group. A significant reduction from baseline in USPIO-
defined inflammation was observed in the 80-mg group at both 6 weeks (?SI 0.13; p ? 0.0003) and at 12
weeks (?SI 0.20; p ? 0.0001). No difference was observed with the low-dose regimen. The 80-mg atorvastatin
dose significantly reduced total cholesterol by 15% (p ? 0.0003) and low-density lipoprotein cholesterol by 29%
(p ? 0.0001) at 12 weeks.
Aggressive lipid-lowering therapy over a 3-month period is associated with significant reduction in USPIO-defined
inflammation. USPIO-enhanced MRI methodology may be a useful imaging biomarker for the screening and as-
sessment of therapeutic response to "anti-inflammatory" interventions in patients with atherosclerotic lesions.
(Effects of Atorvastatin on Macrophage Activity and Plaque Inflammation Using Magnetic Resonance Imaging
[ATHEROMA]; NCT00368589) (J Am Coll Cardiol 2009;53:2039–50) © 2009 by the American College of
Cardiology Foundation
Atherothrombosis is a major cause of morbidity and mor-
tality in the Western world and is now widely accepted as a
chronic systemic vascular inflammatory disorder. Inflamma-
tion is a recognized risk factor for the vulnerable atheroscle-
rotic plaque and is fundamental to lesion progression and
destabilization. The macrophage is one of the key cellular
mediators of this process (1), and histological studies have
shown that the degree of macrophage infiltration increases
From the *University Department of Radiology, †Cambridge Vascular Unit, ‡Aca-
demic Department of Neurosurgery, and §Department of Clinical Neurosciences,
Cambridge University Hospitals NHS Foundation Trust, Cambridge, United King-
dom; ?Discovery Biometrics, GlaxoSmithKline, Harlow, United Kingdom; ¶Glaxo-
SmithKline Clinical Imaging Centre, Imperial College, Hammersmith Hospital,
London, United Kingdom; and #Novartis Pharmaceuticals Corporation, East
Hanover, New Jersey. Mr. Miller and Mr. Brown are employees of GlaxoSmithKline.
Dr. Gillard is a consultant to GlaxoSmithKline and Pfizer. Dr. Zalewski is a former
employee of GlaxoSmithKline and is currently employed by Novartis Pharmaceuti-
cals. This study was funded by GlaxoSmithKline.
Manuscript received September 15, 2008; revised manuscript received January 22,
2009, accepted March 2, 2009.
Journal of the American College of Cardiology
© 2009 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 53, No. 22, 2009
Page 2
the risk for plaque rupture and
subsequent thromboembolism
(2). Detection of macrophage ac-
tivity, and hence inflammation
within atheroma, could poten-
tially distinguish between vulner-
able and more stable states and
remains one of the key goals of
atheroma imaging.
See page 2053
It has recently been possible to
identify carotid plaque inflam-
mation noninvasively with ul-
trasmall superparamagnetic iron
oxide (USPIO)-enhanced mag-
netic resonance imaging (MRI)
in both animal (3) and in vivo
human studies (4). The concept
that the USPIO contrast me-
dium Sinerem (Guerbet, Roissy,
France) may be useful in the
assessment of inflammatory ac-
tivity in atherosclerotic plaque is strongly supported by the
endothelial dysfunction theory (5). Dysfunctional endothe-
lium initiates and sustains an inflammatory reaction within
the arterial wall and allows the accumulation of plasma
components, such as low-density lipoproteins (LDLs), into
the subendothelial space. Oxidized LDL particles are then
phagocytosed by macrophages, ultimately forming foam
cells. The USPIO particles, of a diameter similar to that of
LDL (15 to 25 nm), enter atherosclerotic plaques with an
increased endothelial permeability and accumulate in ath-
eroma with high macrophage content. This has been shown
by experimental investigations in an atherosclerotic animal
model (6) using hyperlipidemic rabbits. Histology and
immunohistochemistry colocalized USPIO to activated
macrophages in the plaque. These changes were not ob-
served in animals that did not receive USPIO. It was
concluded that USPIO was phagocytosed by macrophages
in atherosclerotic plaques in a quantity sufficient to cause
susceptibility artifact detectable by MRI.
Since the first statin was approved by the Food and Drug
Administration (FDA) in 1987, these lipid-lowering agents
have quickly become the gold standard for treatment of
hypercholesterolemia and the cornerstone of therapy for
primary and secondary prevention of atherosclerotic disease
(7). Statins exert their benefits primarily by inhibiting de
novo cholesterol synthesis and increasing the expression of
low-density lipoprotein cholesterol (LDL-C) receptors,
which result in significant reductions of total cholesterol and
LDL-C plasma levels. Furthermore, a recent meta-analysis
demonstrated a dose-dependent relationship between statin
therapy and cardiovascular outcome (8), and high-dose
statin therapy may even decrease the size of atheromatous
plaques over time (9). It remains controversial whether
LDL-C lowering is the only mechanism underlying the
clinical benefit of statins, and it has been postulated that
statins may also exert their positive clinical effect by LDL-C
independent or pleiotropic mechanisms (10,11). One of
these is attenuation of inflammation, because statins have
been shown to decrease systemic inflammatory markers
(12,13). To date, the only noninvasive evidence that statins
reduce plaque inflammation in clinical practice has been
with18fluorodeoxyglucose positron emission tomography,
but the associated radiation exposure limits the number of
positron emission tomography studies that patients can
undergo, reducing its potential contribution in assessing
therapeutic interventions.
The aim of this study was to evaluate the effects of
low-dose (10 mg) and high-dose (80 mg) atorvastatin
(Lipitor, Pfizer, New York, New York) on macrophage
activity and carotid plaque inflammation as determined by
USPIO-enhanced carotid MRI. The hypothesis was that 12
weeks of treatment with atorvastatin would reduce USPIO-
enhanced MRI signal loss (marker of plaque inflammation)
as compared with baseline and that the reduction in signal
loss would be greater in the high-dose group.
Study design. THE ATHEROMA (ATORVASTATIN THERAPY: EF-
FECTS ON REDUCTION OF MACROPHAGE ACTIVITY) STUDY. The
evaluation using USPIO-enhanced high-resolution MRI in
carotid disease was done as a prospective, randomized, single-
center, double-blind clinical trial (ISRCTN64894118) (14).
The Institutional Review Board at the study center approved
the protocol, and all participating patients provided written
informed consent.
Forty-seven subjects were randomly assigned to a high-
or low-dose statin group. The high-dose statin group
received 80 mg atorvastatin once daily, and the low-dose
group received 10 mg atorvastatin once daily for 12 weeks.
The USPIO-enhanced MRI was performed at baseline (i.e.,
before randomization) and at 6 and 12 weeks. Blood
samples including fasting lipid profile, creatine kinase, liver
function tests, and serum creatinine levels were obtained at
each pre-USPIO infusion visit to ensure patient safety.
Blood samples for atorvastatin pharmacokinetics and car-
diovascular biomarkers, including highly specific C-reactive
protein, myeloperoxidase, and lipoprotein-associated phos-
pholipase A2 (Lp-PLA2) activity were also collected at
these visits and were outsourced for independent analysis
(Quest Diagnostics, London, United Kingdom). Transcra-
nial Doppler monitoring of the middle cerebral artery was
performed to measure thromboembolic signals at baseline
and at 6 and 12 weeks.
Patients were eligible if they had clinically documented
atherosclerotic carotid disease and had demonstrated the
presence of inflammation within their carotid lesions on
and Acronyms
ES ? emboli signal
HDL-C ? high-density
lipoprotein cholesterol
LDL ? low-density
LDL-C ? low-density
lipoprotein cholesterol
Lp-PLA2 ? lipoprotein-
associated phospholipase A2
MRI ? magnetic resonance
ROI ? region of interest
?SI ? ultrasmall
superparamagnetic iron
oxide-enhanced magnetic
resonance imaging signal
TCD ? transcranial Doppler
USPIO ? ultrasmall
superparamagnetic iron
2040 Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Page 3
USPIO-enhanced MRI regardless of symptomatic status
and met the inclusion criteria and exclusion criteria. The
patients were randomly allocated after the initial carotid
ultrasound had shown at least 40% stenosis and the MRI
demonstrated signal loss on USPIO-enhanced MRI con-
sistent with inflamed lesions. Inclusion criteria were as
follows: 1) male or female 18 to 80 years of age at baseline;
female subjects had to be of nonchildbearing potential
(post-menopausal women who have been amenorrheic ?1
year or pre-menopausal women with a documented hyster-
ectomy or bilateral oophorectomy); 2) positive USPIO-
enhanced MRI of carotid plaque confirmed by an attending
neuroradiologist (J.H.G.); this was defined as a signal
decrease of ?10% in 2 or more quadrants between pre- and
post-USPIO MRI studies (see Image Analysis section); and
3) must either have been statin naïve or have been on a
stable dose of a statin for ?4 weeks before screening, with
no evidence of statin intolerance; permitted statins and total
daily dose were as follows: atorvastatin ?10 mg, simvastatin
?40 mg, pravastatin ?40 mg, fluvastatin ?80 mg, and
rosuvastatin ?10 mg.
A subject was not eligible for inclusion in this study if any
of the following criteria applied: 1) required continued use
of nonstatin lipid-modifying therapies (e.g., fibric acid
derivatives, niacin, resins, ezetimibe, fish-oil supplement) or
therapy with any other lipid-regulating medications not
specified (dietary supplements or multivitamins containing a
daily dose of niacin ?250 mg were allowed); 2) history of
statin intolerance; 3) history of chronic viral hepatitis
(including presence of hepatitis B surface antigen or hepa-
titis C antibody) or other chronic hepatic disorders, alanine
aminotransferase or aspartate aminotransferase ?1.5 times
the upper limit of normal, or alkaline phosphatase or total
bilirubin ?1.5 times the upper limit of normal of laboratory
reference range at screening; 4) renal impairment with
creatinine clearance ?50 ml/min; 5) history of myopathy or
inflammatory muscle disease, or elevated total serum crea-
tine kinase (3 times upper limit of normal) at screening visit;
6) Doppler assessment of ?40% stenosis or carotid occlu-
sion during screening assessment; 7) history of clinically
significant atopy (e.g., anaphylaxis, skin rash to medication
or topical therapies, hypersensitivity to iodinated contrast
media, allergies to food such as shellfish, bronchial asthma)
and allergies to dextran and iron salts; 8) clinical contrain-
dications to MRI including but not limited to intracranial
aneurysm clips (except Sugita) with an appropriate operative
conformation, history of intraorbital metal fragments, pace-
makers and non-MRI compatible heart valves, inner ear
implants, or history of claustrophobia in MRI; 9) planned
carotid surgery or endovascular intervention within 10
weeks of the study period; 10) serum triglycerides ?400
mg/dl (4.52 mmol/l) at screening; 11) untreated or uncon-
trolled hypothyroidism or thyrotoxicosis; 12) patients with
poorly controlled diabetes mellitus with hemoglobin A1c
?8.5%; 13) patients with poorly controlled hypertension
(systolic blood pressure ?160 mm Hg and/or diastolic
blood pressure ?100 mm Hg); 14) history of malignancy
within the past 2 years, other than nonmelanoma skin
cancer; 15) evidence of recent (?4 weeks) severe infection
(e.g., pneumonia, cellulitis); 16) current life-threatening
condition other than vascular disease (e.g., very severe
chronic airways disease, human immunodeficiency virus
positive, life-threatening arrhythmias) that may prevent
subject from completing the study; 17) history of myocardial
infarction or cerebrovascular accident within the previous 2
weeks of screening; 18) concomitant use of potent CYP450
3A4 inhibitors (e.g., clarithromycin, grapefruit juice [?240
ml daily], itraconazole, ketoconazole); 19) chronic use of
nonsteroidal anti-inflammatory drugs and oral steroids ther-
apy ("cardiovascular" doses of aspirin up to 325 mg daily
were allowed); 20) chronic use of immunosuppressants
(cyclosporine, methotrexate, and so forth); 21) use of an
investigational drug within 30 days or 5 half-lives (which-
ever is the longer) preceding the first dose of study medi-
cation; 22) inability to give informed consent; 23) prior
ipsilateral carotid endarterectomy or neck irradiation; and
24) alcohol or drug abuse within the past 6 months.
The conduct of the MRI studies did not cause a delay in
surgical intervention of any of the enrolled subjects because
planned carotid surgery or endovascular intervention earlier
than 10 weeks within the study period was an exclusion
criterion. Patients who withdrew from the study for safety
reasons or otherwise were replaced with new patients with a
corresponding treatment unit number so that the final
number in each group would be balanced (n ? 20).
High-resolution multisequence MRI. Multicontrast im-
aging of both the left and right internal carotid artery was
acquired at 1.5-T before USPIO infusion and 36 h after
infusion, using a whole-body MRI system (Signa HDx, GE
Diagnostic Imaging, Waukesha, Wisconsin) and a custom-
designed 4-channel phased-array neck coil (PACC, Mach-
net BV, Elde, the Netherlands) to improve signal-to-noise
ratio. Movement artifact was minimized using a dedicated
vacuum-based head restraint system (VAC-LOK Cushion,
Oncology Systems Limited, Crawley, United Kingdom) to
fix the head and neck in a comfortable position and allow
close apposition of the surface coils.
After an initial coronal localizer sequence, axial 2-
dimensional time-of-flight MR angiography was performed
to identify the location of the carotid bifurcation and the
region of maximal stenosis on each side. Axial images were
acquired through the common carotid artery 12 mm (4
slices) below the carotid bifurcation to a point 12 mm (4
slices) distal to the extent of the stenosis identified on the
time-of-flight sequence. This method ensured that the
entire carotid plaque was imaged and also facilitated image
coregistration during repeat imaging.
The following 2-dimensional electrocardiography-
triggered, fat-suppressed fast spin echo pulse sequences
employing double-inversion recovery blood suppression
with a voxel size of 0.4 ? 0.4 ? 3mm were used in each
case: T1-weighted (repetition time [TR]/effective echo time
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
Page 4
[Teeff]/echo train length [ETL]: 1 R-R/7.8 ms/12), short
T1inversion recovery (STIR) (TR/TEeff/TI/ETL: 2 R-
R/40 ms/150 ms/24), intermediate T2-weighted (TR/
TEeff/ETL: 2 R-R/40 ms/24). T2*-weighted imaging was
performed using a 2-dimensional multishot spiral acquisi-
tion employing a spectral-spatial excitation pulse (TR/TE:2
R-R/5.6 ms). The multishot spiral sequence involved the
acquisition of 22 spiral interleafs each comprising 4,096 data
points, resulting in an effective in-plane pixel size of 0.42 ?
0.42 mm, 2 signal averages were performed, and a quadruple
inversion recovery (QIR) preparation was utilized to null the
signal from blood before and after USPIO. Slices were
acquired sequentially with a 3-mm thickness and no inter-
slice gap.
The use of a small field of view means that there are no
pure noise regions with which to adjust the measurements.
The apparent tissue-free regions in the images actually
contain structured noise, probably due to subtle patient
motion such as swallowing. Because we are using spiral
imaging sequences, these artifacts are diffusely spread
around the image rather than being coherent ghosting
artifacts as would be expected in Cartesian acquisitions. The
usual method of obtaining noise estimates is to take a region
well away from any tissue to ensure that ghosting artifacts
do not contribute to the measurement. The images in the
figures are windowed such that these artifacts are not
apparent, but that does not mean that the tissue-free regions
provide valid estimates of background noise.
MRI contrast medium. The USPIO compound, Sinerem,
was supplied as a dry powder and initially made up to a
volume of 15 ml with normal saline. The contrast medium
was further diluted in 100 ml of normal saline and given as
a slow infusion through an in-dwelling large-bore intrave-
nous cannula over 30 min. The dose used was 2.6 mg/kg.
The physiochemical properties and safety data for this
contrast agent have been published previously (15). Docu-
mented contrast reactions, albeit rare, include headache,
nausea, vomiting, backache, and hypersensitivity reactions.
T2*-weighted quantitative image analysis. All MRI scans
were analyzed by 2 experienced independent readers
(T.Y.T. and S.P.S.H.). The readers were blind to the
patients' demographic data and statin dose. The sequence
order of images on the pre-infusion images was maintained
on each set of post-infusion images, but the latter was
viewed in a random order.
Before and after USPIO, MRI scans were manually
coregistered according to plaque morphology and distance
from the carotid bifurcation at the time of imaging. After
this, images were manually segmented into quadrants, using
pre-defined rules, and therefore less susceptible to interob-
server error, excluding the luminal blood pool (CMR Tools,
London, United Kingdom). A horizontal line was con-
structed across each image and through the lumen center.
Likewise, a perpendicular line was constructed ensuring that
the "cross hairs" were centered through the lumen. These
quadrants were defined as regions of interest (ROIs), and
mean signal before and after USPIO infusion was reported
within the CMR Tools software. For each patient, only the
slices containing plaque were analyzed.
Because the neck coil was always in a slightly different
position between imaging sessions, there was not only
spatial but also temporal variation to consider. Hence, signal
intensities in each quadrant were normalized to the adjacent
sternocleidomastoid muscle before and after USPIO, which
does not take up Sinerem in any appreciable amount. We
have attempted to address the issue of coil positioning
variability by normalizing to the adjacent muscle. Although
there is still a coil inhomogeneity effect, we consider that the
variation across the diameter of the vessel is not a major
influence. Signal intensity change (?SI) was then calculated
as the difference (after minus before) in these normalized
quantities. Note that the greater the USPIO concentration
(i.e., the greater the macrophage activity), the more negative
the resultant value for ?SI. It follows that a reduction over
time in macrophage activity will reduce the post-USPIO
concentration, and result in a positive change in ?SI with
Assessment of cerebral emboli. The Embo-Dop transcra-
nial Doppler (TCD) system (Compumedics Germany
GmbH, Singen, Germany) was used (version 2.1, Multi
X-Laboratory, Compumedics Germany GmbH). This in-
sonates simultaneously at 2.0 and 2.5 MHz, and the
standard system settings designed to optimize emboli signal
(ES) detection as recommended in the Consensus criteria
(16) were adhered to. Mean depth was 51.1 mm (SD 4.6).
A sample volume of 5 mm3was routinely employed,
although in a few cases, this had to be increased to obtain an
adequate signal. Power was 64 to 100 mW. Bilateral
recordings were performed for 1 h, although if there were
problems with insonation, preference was given to the
ipsilateral middle cerebral artery. The transducers were held
in place by a proprietary headpiece supplied with the system.
The Embo-Dop system uses an event detector system using
a previously published algorithm (17) to identify potential
candidate events. No distinction was made between whether
the system categorizes ES into solid or gaseous emboli, as it
was likely that all emboli were solid in nature. The spectra
from all saved ES were recorded onto the hard drive of the
computer, and all signals were later reviewed offline in
consensus by 2 experienced observers in ES detection who
were blinded to the patients' demographic and lipid profiles.
These ES were used for further statistical analysis.
Statistical methods. SAMPLE SIZE CALCULATION. A sample
size of 40 patients randomly allocated 1:1 to high (80 mg) or
low (10 mg) doses of atorvastatin was expected to provide
90% power overall to detect a difference (with 5% type-1
error) between the groups in USPIO-enhanced MRI signal
change at 12 weeks. Assumptions used in this calculation
were based on the results of a study comparing a group of
symptomatic to a group of asymptomatic patients (18) that
estimated the difference between these groups to be 0.097,
with a between-subject standard deviation of 0.093.
2042Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Page 5
UNBLINDING. The trial database was transferred from the
trial center to the sponsor once all end points had been
analyzed. Unblinding of the treatment assignment occurred
only after this had happened to avoid bias, and permitted
independent confirmation of the analyses.
For continuous variables with a normal distribution, the
mean and SD were reported. For log-normally distributed
variables (e.g., laboratory parameters), the geometric mean
and coefficient of variation (%CV) were calculated. For
count data, the median and range were reported. Baseline
balance was not tested statistically. Interobserver and in-
traobserver agreement for reproducibility and repeatability,
respectively, were determined for quadrant analysis for
USPIO signal change using the Bland-Altman method.
Statistical modeling for estimation and hypothesis testing
was carried out as described in the following text. All
reported p values were 2-sided and not adjusted for multiple
testing. A value of p ? 0.05 was considered to indicate
statistical significance.
USPIO-enhanced MRI signal change (?SI) was analyzed
using a repeated-measures mixed model with change from
baseline in ?SI as the outcome variable. Group (low
dose/high dose), visit (week 6/week 12) and baseline signal
change were fitted as fixed effects and patient as a random
effect. Estimates of mean signal change within each group
were calculated with appropriate 95% confidence interval
(CI), adjusting for the correlation between measurements
made on the same subject. Note that a significant change in
1 group and a nonsignificant change in another group do
not necessarily imply that the groups changed differently.
To address this directly, an estimate of the difference
between groups with an appropriate 95% CI was also
calculated, together with a p value testing the hypothesis of
no difference between groups. Other end points were
analyzed using similar models, but assuming a Poisson
rather than a normal distribution for count data. Model
assumptions regarding homogeneity of variance were veri-
fied by inspection of residual plots. Distributional assump-
tions regarding normality were verified by assessment of
normal probability plots.
Patient population. Recruitment started in July 2006, and
the last subject visit was in August 2007. Sixty-four patients
were screened, and 47 patients were enrolled into the study.
Seven patients did not complete the study because of an
adverse event (n ? 2; both patients were in the high-dose
group and had deranged liver function tests during the study
that were outside the limits of acceptability from the
protocol), withdrawn consent (n ? 1), or other reasons not
associated with this specific study (n ? 4). All patients
remained asymptomatic during the study, although 1 pa-
tient on the low-dose statin regimen had a completed
ipsilateral hemispherical stroke 3 weeks after finishing the
trial. All 40 patients completing the study had, by definition
of trial design, matched baseline and 6- and 12-week
USPIO-enhanced MRI studies for identification of the
vessel boundaries and compositional analysis. These 40
patients comprised the analysis population (Online Figure).
No enrolled patient had a high-grade symptomatic stenosis,
as they would have been operated upon within 2 weeks of
presentation according to local protocol.
Patient demographics are shown in Table 1. A compar-
ison of laboratory measures, image analysis, and TCD end
points at baseline is presented in Table 2. In general,
differences between the high- and low-dose groups were
small. The 6-year difference in age between the groups was
not considered clinically relevant.
Imaging analysis. Patients had between 3 and 8 MRI
slices, providing cross-sectional images of the carotid
plaque. This resulted in a mean of 4.6 slices per high-dose
patient (range 3 to 6), and 4.75 slices per low-dose patient
(range 3 to 8). Two patients (1 high dose, 1 low dose) had
bilateral carotid disease. Both sides from these patients were
included for analysis.
Agreement. Interobserver agreement was high for USPIO
signal change calculations. The intraclass correlation coef-
ficient (1-way random effects) was 0.90. The 95% limits of
agreement were ?0.146 to 0.168. This was based on 10
patients, 24 paired patient visits, 118 slices, and 906
matched quadrants. There was some evidence that for
quadrants with a relatively large signal, 1 reader derived a
less extreme value than the other, although the number of
quadrants affected by this was ?3%. Repeatability was also
based on 10 patients, 58 slices, and 232 matched serial
quadrants. The intraclass correlation coefficient was 0.85
between 0 and 6 weeks and 0.81 between 6 and 12 weeks on
the pre-USPIO imaging scan.
Primary analyses. Results of the statistical analysis of the
change from baseline in image analysis, microemboli counts,
Patient Demographics
Table 1Patient Demographics
n 4020 20
Age, yrs 67.6 ? 7.7 64.7 ? 7.6 70.8 ? 6.7
Male36 (90)18 (90)18 (90)
Percent luminal stenosis
Body mass index, kg/m2
61.7 ? 11.464.2 ? 12.159.2 ? 10.3
27.2 ? 4.326.5 ? 4.027.6 ? 4.7
Hypertension 37 (93)18 (90)19 (95)
Diabetes mellitus 4 (10)2 (10)2 (10)
Peripheral vascular operations 7 (18) 4 (20) 3 (15)
Prior myocardial infarction 7 (18)5 (25) 2 (10)
Current or former smoker 30 (75)14 (70)16 (80)
Family history of heart disease 9 (23)4 (20)5 (25)
Hypercholesterolemia11 (28)6 (30)5 (25)
Statin use before enrollment39 (98)20 (100) 19 (95)
Antiplatelet agent 38 (95)19 (95)19 (95)
Values are n (%) or mean ? SD.
JACC Vol. 53, No. 22, 2009
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Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
Page 6
laboratory measures, and biomarkers are presented in Table 3.
Significant differences were seen between groups at 12
weeks for ?SI, microemboli count, LDL-C, total choles-
terol, and plasma Lp-PLA2 activity. Atorvastatin concen-
trations in the 2 groups are also presented. The mean
concentration was approximately 5-fold higher in the high-
dose group, though the range of concentrations was very
Examples of the imaging obtained from a low- and high-
dose patient are shown in Figures 1 and 2, respectively.
Figure 3 is another example of a high-dose patient at baseline
and at 12-week imaging. It also depicts the quadrant analysis
approach used in the image analysis. Figures 4 and 5 show the
change in signal intensities and microemboli count, respec-
tively, at 6 and 12 weeks.
Post hoc analysis. Although the following was not iden-
tified as a primary or secondary end point before trial
initiation, we evaluated our results for possible associations
between changes in serum cholesterol levels and changes in
USPIO-enhanced MRI-defined inflammation and other
measurements. We observed a number of moderate corre-
lations (Spearman |r| ? 0.4 to 0.6), including between
relative changes in ?SI and LDL-C (Spearman r ? ?0.48,
p ? 0.0036), between changes in ?SI and change in
microemboli count (Spearman r ? ?0.58, p ? 0.0004), and
between changes in LDL-C and change in microemboli
count (Spearman r ? 0.55, p ? 0.0018).
Baseline Characteristics
Table 2 Baseline Characteristics
?SI, mean ? SD
?0.075 ? 0.126
?0.151 ? 0.128
Microemboli count,
median (range)*
2 (0?7)3 (0?10)
LDL-C, mmol/l,
geometric mean (%CV)†
2.27 (30%)2.51 (38%)
HDL-C, mmol/l,
geometric mean (%CV)†
1.23 (29%)1.30 (34%)
Total cholesterol, mmol/l,
geometric mean (%CV)†
4.07 (21%)4.51 (26%)
Triglycerides, mmol/l,
geometric mean (%CV)†
1.11 (51%) 1.22 (61%)
Highly specific C-reactive
protein, mg/l,
geometric mean (%CV)
1.65 (130%)1.53 (162%)
Plasma MPO, pmol/l,
geometric mean (%CV)
490 (50%)425 (54%)
Plasma Lp-PLA2 activity, ?mol/min/l,
geometric mean (%CV)
152 (20%)147 (15%)
Atorvastatin equivalent dose, mg,
mean ? SD
12.8 ? 5.713.6 ? 7.1
Atorvastatin concentration, ng/ml,
at 6 weeks, geometric mean (range)
2.0 (0.1?8.6) 9.5 (1.2?195.4)
Atorvastatin concentration, ng/ml,
at 12 weeks, geometric mean (range)
2.0 (0.8?6.8)11.9 (1.8?79.4)
*3 subjects in each group did not have evaluable transcranial Doppler data. †1 subject in each
group did not have clinical chemistry measured.
lipoprotein-associated phospholipase A2; MPO ? myeloperoxidase; %CV ? coefficient of variation;
?SI ? change in signal intensity.
Change in Magnetic Resonance Imaging SignalIntensity, Microemboli Count, and Lipid Profiles
Change in Magnetic Resonance Imaging Signal
Intensity, Microemboli Count, and Lipid Profiles
Table 3
?SI (change)60.048
(?0.018to0.114) (0.065to0.198)(?0.012to0.179)
(?0.111to0.036) (0.129to0.276)(0.134to0.347)
Total cholesterol62%
(?26%to13%) (?23%to17%)(?23%to39.%)
0.43950.2979 0.8584
Plasma MPO6 1%
0.8473 0.1809
Plasma Lp-PLA2
Values are presented as change or percentage change with the associated 95% confidence interval
(in parentheses) and p values in italics; bold values highlight statistically significant values.
Abbreviations as in Table 2.
2044Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Page 7
Macrophage infiltration has been identified as one of the
leading risk factors for plaque rupture. USPIO-enhanced
MRI has been shown to be potentially able to identify
macrophage-rich plaques in vivo in human carotid arteries
(4), and once a vulnerable plaque is found, sequential
follow-up of this is important to ensure that effective
medical or surgical therapy is instituted to prevent cerebral
events. Monitoring lipid therapy alone is insufficient for
determining the therapeutic effect of drugs because although
statins can reduce plasma cholesterol, they do not always
decrease macrophage infiltration (19). To study change in
plaque morphology after a therapeutic intervention, an
imaging method is required that can provide accurate
assessment of plaque tissue components and activity. Several
imaging methods including X-ray angiography, ultrasonog-
raphy, and computed tomography have been used to study
the arterial wall and assess atherothrombosis, but none of
these modalities can adequately characterize plaque macro-
phage infiltration. Recent developments in MRI have made
it possible to robustly identify and measure plaque tissue
composition in vivo (20,21).
The findings presented herein represent the first prospec-
tive molecular MRI study on the in vivo effects of statin
therapy on carotid plaque inflammation. We found a
significant reduction from baseline in USPIO-enhanced
MRI-defined plaque inflammation in the high-dose ator-
vastatin group at both 6 and 12 weeks. No difference was
observed with the low-dose regimen. At 12 weeks, there was
a significant mean signal difference between the 2 groups.
Atorvastatin-induced LDL-C lowering was moderately
correlated with both attenuation of plaque inflammation
and a clinical correlate—a reduction in microemboli count
on TCD. These findings provide in vivo evidence that
high-dose statin therapy might have a beneficial effect on
plaque stability.
High-resolution MRI has also previously been used for
plaque burden regression assessment. In the case of statin-
induced atherosclerotic plaque modulation, these effects
have been consistently reported only after at least 1 year of
therapy: Corti et al. (22) showed a decrease in carotid and
aortic plaque size and increase in luminal area after 2 years
of simvastatin monotherapy. In a follow-up study, they
extended their observations to note that aggressive dosing of
simvastatin compared with conventional therapy did not
result in a greater change in plaque size, and concluded that
changes in vessel wall parameters are more related to the
LDL-C reduction rather than to the dose of statin given
Figure 1Example of a Low-Dose Patient
T2*-weighted imaging at the carotid bifurcation, before (1) and after (2) ultrasmall superparamagnetic iron oxide (USPIO) infusion at the 3 time points of (A) 0, (B) 6,
and (C) 12 weeks. Plaque demonstrating USPIO uptake can clearly be seen in the right upper quadrant in all cases (yellow arrowheads). Pre-USPIO imaging remains
very similar at all 3 time points. No USPIO uptake is seen in the pre-USPIO imaging at 6 or 12 weeks, indicating that the Sinerem has been cycled out of the plaque, an
important aspect if repeated infusions are to be used for multiple time point imaging and assessing progression of USPIO-defined inflammation in response to a drug
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
Page 8
(23). The recently reported ORION (Outcome of Rosuv-
astatin Treatment on Carotid Artery Atheroma: a Magnetic
Resonance Imaging Observation) trial found a significant
reduction in the proportion of carotid plaque composed of
lipid and a significant increase in fibrous tissue over the
course of 2 years treatment with rosuvastatin (24), but again,
did not observe a measurable difference as a consequence
of using a higher dose of rosuvastatin. Lima et al. (25)
demonstrated statin-induced plaque regression in the
thoracic aorta 6 months after the onset of MRI-
monitored statin therapy, although the temporal differ-
ence in the onset of documented plaque modulation
could be explained by the difference in vascular bed under
We measured an effect after only 6 weeks with high-dose
atorvastatin, and rather than targeting plaque area/volume
changes, which has been shown to take months to years to
detect a difference, we have looked at change in macrophage
infiltration and inflammation. Our results are in keeping
with previous data that intensive treatment with atorvastatin
decreases the inflammatory activity of carotid plaques at 1
month (26). Furthermore, Crisby et al. (27) demonstrated
that patients after 12 weeks of statin treatment had less lipid
and oxidized LDL-C and fewer macrophages and T cells in
their endarterectomized carotid samples compared with
patients without statin therapy. In the MIRACL (Myocar-
dial Ischemia Reduction With Aggressive Cholesterol Low-
ering) trial (28) and the PROVE-IT (Pravastatin or Ator-
vastatin Evaluation and Infection Therapy) trial (29),
significant benefits, namely, decreased incidence of unstable
angina, occurred within the first month of treatment.
Hence, our study may support the hypothesis that damp-
ening of plaque inflammation rather than morphological
regression plays a role in the mechanism underlying the
early beneficial effects of statins seen in clinical practice. The
fact that we did not observe a measurable signal difference
with the low-dose group may have been because most of the
patients were statin-primed before enrollment, and there-
fore did not show a strong serological response to low-dose
atorvastatin. Many of the patients in the other trials de-
scribed were either statin naïve or had their lipid-lowering
drugs discontinued during the lead-in period of the study
and were therefore more likely to be more sensitive to
low-dose statin administration than were participants in the
current trial. Placebo was not considered ethical in our
Figure 2Example of a High-Dose Patient
T2*-weighted imaging of a left common carotid artery before and after ultrasmall superparamagnetic iron oxide (USPIO) infusion at the 3 time points of (A and B) 0,
(C and D) 6, and (E and F) 12 weeks. (B) USPIO uptake can clearly be seen in the plaque at baseline (yellow arrowhead). (C and E) Pre-USPIO imaging remains very
similar at all 3 time points with Sinerem having been cycled out of the plaque before reimaging (red arrowhead). (D) The plaque begins to enhance at 6 weeks (blue
arrowhead). This signifies that there is a predominant T1effect, indicating minimal USPIO uptake and a lack of activated macrophages (minimal inflammation). (E) No
residual USPIO signal is also seen in the pre-USPIO imaging at 12 weeks, and (F) signal enhancement post-USPIO can be seen with no evidence of signal voids (blue
2046 Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Page 9
The effects of high- or low-dose atorvastatin on the
systemic inflammatory markers, except for Lp-PLA2, were
not significant, which may have been due to the small
sample size used. We were also surprised to find that
reduction in plaque inflammation was not correlated with
the increase in high-density lipoprotein cholesterol
(HDL-C) in the high-dose group. Previous studies have
found that increasing HDL-C with statin therapy may have
a positive impact not only on the morphology (24), namely,
reduction of lipid core, but also on attenuation of plaque
inflammation (30). However, it is also possible that pleio-
tropic effects other than an HDL-C–dependent mechanism
mediate the anti-inflammatory effect of atorvastatin.
Methods must be reproducible as well as accurate if they
are to be useful in clinical practice. We have shown that
interobserver reproducibility of USPIO signal change on
high-resolution MRI as a marker of plaque inflammation
was high. That stems from the method of segmenting the
plaque into quadrants using pre-defined objective rules, as
described in the methodology. In fact, in the sample of
plaques investigated in this study, agreement was better
than for the different measurements of luminal stenosis used
and for identification and quantification of carotid athero-
sclerotic plaque components on MRI (31). An intraclass
correlation coefficient of ?0.8 between signal data for
matched quadrant data before USPIO at 0, 6, and 12 weeks
suggests that the technique is repeatable. No USPIO uptake
was seen in the pre-imaging at either 6 or 12 weeks.
Therefore, it is likely that USPIO particles have been cycled
out of the plaque. This finding clearly has implications for
future prospective sequential studies to assess inflammatory
activity because evidence of residual USPIO signal at 6 or 12
weeks before infusion would limit the usefulness of the
Atorvastatin therapy itself is unlikely to affect USPIO-
based macrophage detection by MRI, a prerequisite for the
use of this contrast material to examine lesion macrophage
burden during lipid-lowering therapy. A recent study
showed that nontoxic concentrations of atorvastatin did not
affect the amount of USPIO taken up by macrophages in
Figure 3 A High-Dose Patient, Further Example and Quadrant Analysis Approach
T2*-weighted imaging of a right common carotid artery before and after ultrasmall superparamagnetic iron oxide (USPIO) infusion at the 2 time points of (A and B) 0 and
(C and D) 12 weeks. (B) USPIO uptake can clearly be seen in the plaque at baseline (yellow arrowheads). (C) Sinerem has been cycled out of the plaque before reinfu-
sion at 12 weeks (red arrowheads). (D) The plaque enhances at 12 weeks (blue arrowheads), indicating that the high-dose statin treatment has damped the USPIO-
defined inflammation. Plaque segmentation was performed using a combination of multicontrast sequences. The cross hairs centered through the middle of the lumen
divide the vessel into quadrants. Signal from artifact, extravascular structures, and the luminal blood pool (green asterisks) are excluded from the analysis.
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
Page 10
vitro (32). Furthermore, the intracellular distribution of iron
oxide nanoparticles and the resulting MRI signal intensities
remained unchanged by statin treatment.
Study limitations. Our study should be interpreted in
light of certain limitations. The sample size is relatively
small but was adequately powered for the primary end
point. Although this and other earlier studies (4,33,34)
have demonstrated the technical feasibility of USPIO-
enhanced MRI, the diagnostic accuracy and potential
effect on clinical management are yet to be defined in
larger-scale studies. Moreover, the disadvantages with
USPIO-MRI include the fact that at least 2 MRI studies
are required before and after infusion of contrast me-
dium. In times of low budget and a demand for fast
patient throughput, a test with immediate results would
be desirable. Recently, ultrashort echo time subtraction
imaging has shown promise, which may remove the need
to perform the pre-infusion MRI study (35).
The relatively modest mean percentage reduction in a
signal loss can sometimes only be appreciated with the
use of dedicated quantitative algorithms and can be
masked, for instance, in plaques with heavy calcification
(4). New image-acquisition methods, for example, gra-
dient echo acquisition for superparamagnetic particles
with positive contrast, that allow USPIO to be detected
as a strong positive contrast enhancement have been
developed in vitro with promising results but are yet
to be implemented in human carotid atheroma imag-
ing (36).
Although T2*-weighted imaging does allow the visual-
ization of the effect of USPIO particles, there has been
much debate in the literature as how best to quantify this
and whether the degree of signal loss is in any way
proportional to the inflammatory load within the plaque.
Trivedi et al. (37) used manually delineated ROIs and
calculated the normalized signal change between before and
after USPIO images. The signal was normalized to the
signal in the adjacent sternocleidomastoid muscle and any
ROI drawn that showed an actual normalized signal drop
were taken to indicate USPIO uptake; this showed only a
moderate correlation with macrophages staining positively
for USPIO on Perls staining (Pearson's product moment
0.6). Although useful, this technique has an inherent
problem of bias and observer error, leading to some question
as to its usefulness in the quantification of inflammatory
A more recent approach has been to arbitrarily divide
the vessel wall in each slice into quadrants by construct-
ing perpendiculars to the horizontal axis across the
image. This technique, which has been adopted in this
study, has the advantage that data points come from the
whole vessel and every section that has plaque, rather
than the rather biased population of ROI. Thus, a
quadrant showing signal loss, once normalized to adja-
cent muscle, is taken to mean USPIO uptake in that
While eliminating operator bias, this technique has a
number of problems associated with it. First, small focal
areas of signal loss may be lost in a quadrant when regions
of signal enhancement are found around it, limiting the
spatial resolution of the analysis. Second, any statistical
analysis needs to consider the quadrants as populations
and compares 1 population with another (e.g., quadrants
from symptomatic patients against quadrants from
asymptomatic patients). For parametric statistics to be
useful, a number of assumptions are made. A simple
2-tailed t test assumes that the quadrants are normally
distributed and that each quadrant represents a totally
independent observation. However, the assumption that
Figure 4 Signal Change
Change from baseline in signal intensity (?SI) is plotted for the 2 treatment
groups, low dose (red solid line) and high dose (blue broken line), at 6 and
12 weeks with 95% confidence intervals.
Figure 5 Transcranial Doppler Data
Relative change from baseline in microemboli count is plotted for the 2 treat-
ment groups, low dose (red solid line) and high dose (blue broken line), at 6
and 12 weeks with 95% confidence intervals.
2048 Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50
Page 11
each quadrant represents a completely independent ob-
servation is obviously overly simplistic.
One quadrant is likely to depend on another to some
extent, not only within the slice but also between the slices.
Data will therefore be clustered, and simple parametric
statistics will therefore falter because the number of degrees
of freedom for a simple t test will be related to the number
of quadrants rather than to the number of patients, and
therefore the overall test statistic will be calculated to be
artificially high. Thus, any p value will be artificially low. In
an attempt to tackle these problems, a complex repeated-
measures mixed model was used to model true variances in
quadrant data.
Another study limitation is that, by design, we in-
cluded patients who were not symptomatic from their
carotid disease, and it might therefore be argued that our
population did not cover the whole spectrum of disease
severity, bringing into question the generalizability of our
results. However, patients included in this study are those
for whom the benefit of carotid endarterectomy is still
controversial and for whom much is to be expected from
noninvasive imaging techniques and intervention.
There is an increasing desire to formulate surrogate end
points for clinical trials, with biomarkers and imaging
being possible candidates for assessing underlying dis-
ease. Such surrogates might allow more timely assess-
ment of the efficacy or futility of a proposed intervention.
The problem that pharmaceutical companies and regula-
tory authorities face is that, to demonstrate a clinical
benefit using accepted outcome measures such as stroke
or death, clinical studies need to recruit thousands of
patients and rely on them undergoing such an event (38).
Imaging of arterial disease that can detect changes in vessel
structure or function could hasten the development process on
smaller number of patients and allow intervention at an earlier
stage in the disease process. There is increasing evidence from
the coronary literature that imaging can be used to monitor the
effects of interventions such as statin therapy. Measures of
carotid intima-media thickening using ultrasonography have
been validated and have been approved by the FDA to be used
in clinical trials. The literature concerning the assessment of
interventions using MRI is somewhat less mature.
This is, to our knowledge, the first study of a targeted
MRI contrast agent used in humans to assess therapeutic
response in an interventional drug trial. Simultaneously, it
facilitated the enrichment of a trial population so that only
subjects with plaque inflammation were selected for enroll-
ment into the study. Aggressive lipid-lowering therapy over
a 12-week period is associated with a significant reduction
in USPIO-defined inflammation. As validation continues,
USPIO-enhanced MRI methodology may be a useful im-
aging biomarker for the screening and assessment of ther-
apeutic response to anti-inflammatory interventions in pa-
tients with carotid atherosclerotic lesions. Serial studies
involving a larger population of patients are needed to
determine whether attenuation of plaque inflammation as
defined by USPIO-enhanced MRI can be correlated with a
reduced risk of developing clinical symptoms.
Reprint requests and correspondence: Dr. Jonathan H. Gillard,
Box 219, Level 5, University Department of Radiology, Cam-
bridge University Hospitals NHS Foundation Trust, Hills Road,
Cambridge CB2 2QQ, United Kingdom. E-mail: jhg21@cam.
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Key Words: carotid stenosis y atherosclerosis y USPIO y MRI y
inflammation y statin y plaque vulnerability.
For a complete list of acknowledgments and a diagram of the
atheroma trial consort, please see the online version of this article.
2050 Tang et al.
USPIO-Enhanced MRI Evaluation of Carotid Disease
JACC Vol. 53, No. 22, 2009
June 2, 2009:2039–50


text:
So for my birthday i decided to go all natural with my nails and do just top coat with a lil jewels lol not the best but i think they're cute lol
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Replies (1-10):
by Bronze Member on Jul. 28, 2012 at 10:33 AM
Happy birthday! Cute nails
Sometimes simple is good too! they are simply nice :),simple touch of bling,not too over powering!
Cute! . . Love the flower!
Happy Birthday!! :)
Happy Birthday!! :)
Happy birthday ;) you have very nice natural nails.
you're lucky you have such pretty natural nails! and again, happy birthday!
:) heehee i need to whiten them lol but thank you everyone!!!
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Geocaching Events for November 2014
As the weather turns colder & colder until the warming trend next week… cachers seem to be staying close to home, except when they aren't. So what's going on in November? Not much as of today… If you were caching … Continue reading
Posted in events Tagged Geocaching Events Comments Off
Geocaching Events for October 2014
We used to direct you to clicking on the "Newest in Indiana" link on your profile page, but it looks like the powers that be at Groundspeak have decided to pull a Facebook style update to their site and make … Continue reading
Posted in events Tagged Geocaching Events, Indiana, October 2014 Comments Off
Geocaching Events for September 2014
So the month kind of begins with an ending. As the Fall Picnic Planning Team put it on the cache page "All good things must come to an end. We've all heard it before but the Planning Team has been … Continue reading
Geocaching Events for August 2014
I'm a little nostalgic for the old days when summer actually lasted until September… but for many families August marks the start of school (for some July). As many people head home let's hope for some more exciting caching events. … Continue reading
Geocaching Events for July 2014
Another slightly late posting… but since it looks like most people are on vacation there really isn't a lot to choose from, so enjoy the nice weather (if you've got nice weather) and go out and find some caches. Challenge … Continue reading
Geocaching Events for June 2014
Better late than never… Something about other things getting the way (like the end of school, the Indy PopCon, and just stuff (like my cat falling asleep on the keyboard). The biggest thing happening this month is probably the World … Continue reading


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Lehigh...all they have had to celebrate since march 2012
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Hosscat Oct 20, 2013
The thread title says it all. That is why there continues to be a lot of angry losers here
Prof. Swahili Oct 20, 2013
Sports Legend
Lehigh and don't forget women's soccer.
KT suspended indefinitely Oct 27, 2013
MoDukev3 Oct 27, 2013
.....and by the looks of things, it may be another decade or so before they have anything other than Lehigh to celebrate.
Womens NCAA Elite 8
The DA Show
The Jon Stashower Show
Hoops Headquarters: Final Four Special
Friday at 7:00 pm on WRAL-TV
CBS Sports Spectacular: NCAA March Madness Confidential
Sunday at 5:00 pm on WRAL-TV
NCAA Basketball Tournament Championship
Monday at 9:00 pm on WRAL-TV
Our Take
Look for UNC, NC State atop preseason pollsCaulton Tudor
Duke's glue guy keeps title run in tactAdam Gold
Always-improving Blue Devils earn Final Four spotErin Summers
Bad matchups could leave ACC with single team in Final FourLauren Brownlow
Undramatic win over Utah sends Duke to Elite 8Erin Summers
Duke_WBB: Great to see #Duke signee Kyra Lambert in the @McDAAG skills competition tonight on @ESPN2. Finished 2nd. #GoDuke http://t.co/SXKUduAunL
— Mon 8:19 p.m.
— Mon 8:19 p.m.
Duke_ATHLETICS: .@BigJah15 earns first team All-America honors from @AP. http://t.co/CWD63JVMC7
— Mon 8:06 p.m.
— Mon 8:06 p.m.
dukeblueplanet: What did @matt13jones_ do on the plane ride home after having a career game? Took a test. #studentathlete https://t.co/8nBCbfsD1r
— Mon 7:52 p.m.
— Mon 7:52 p.m.
Duke_WLAX: [PREVIEW] Duke and Wildcats Match Up Tuesday in Davidson - http://t.co/6JoyMSKQqV #GoDuke http://t.co/gM8D6OoZGv
— Mon 6:41 p.m.
— Mon 6:41 p.m.
steve_wojo: RT @si_mlb: The Orioles expect J.J. Hardy (shoulder) will start the season on the DL http://t.co/8KOu2VFXkh http://t.co/d2XPJ2Vp1g
— Mon 6:20 p.m.
— Mon 6:20 p.m.
dukeblueplanet: On to Indianapolis! https://t.co/mTyYZ5o18q #herecomesduke #StillDancin
— Mon 6:07 p.m.
— Mon 6:07 p.m.
WSFDuke: Final Four gear selling fast on Duke campus http://t.co/zCNAQ30Qqx
— Mon 5:18 p.m.
— Mon 5:18 p.m.
Duke_ATHLETICS: .@duke_mbb scored 65+ points against #Gonzaga so you score with @PapaJohns today! 50% off all online orders. Use code BlueDevils65!
— Mon 4:58 p.m.
— Mon 4:58 p.m.
Duke_ATHLETICS: Find out what @Duke_ROW senior Sophia Staal will miss most about @DukeU. http://t.co/zmUXxvQupt
— Mon 4:50 p.m.
— Mon 4:50 p.m.
Duke_MSOC: We vote Grella! RT @ESPNFC: Allen, Grella, Kaka, McInerney or Pontius. Who scored @MLS goal of the week? Watch them: http://t.co/N2uRW8w2Fo
— Mon 4:42 p.m.
— Mon 4:42 p.m.
jhairston15: RT @ESPNCBB: THIS JUST IN on @SportsCenter: Tennessee has offered former Texas coach Rick Barnes its head coaching job (via @GoodmanESPN).
— Mon 4:16 p.m.
— Mon 4:16 p.m.
bluedevilsvoice: RT @IMGAudio: Great @Duke_MBB sound from last night's #Elite8 win HERE: http://t.co/p3NoImERYf ✔ Coach K ✔ AD Kevin White ✔ @QCook323 …
— Mon 4:01 p.m.
— Mon 4:01 p.m.
Duke_MGOLF: Matlari birdie try slides left on 18 http://t.co/nJbLPRbYhm
— Mon 3:54 p.m.
— Mon 3:54 p.m.
Duke_ATHLETICS: .@Duke_BASE returns to Jack Coombs Field for mid-week match up against #Campbell. #GoDuke http://t.co/OHNsSW2Aah
— Mon 3:41 p.m.
— Mon 3:41 p.m.
Duke_MGOLF: Solid play by @Jake_ShumanGolf with 70 after birdie on 17. Birdie try on 18 just missed. http://t.co/T0AkVad4ED
— Mon 3:38 p.m.
— Mon 3:38 p.m.
Duke_WBB: #Duke alumna Vicki Krapohl listed No. 1 on list of top 25 players from Michigan. #DukeFamily http://t.co/MYrjtrWuFF
— Mon 2:55 p.m.
— Mon 2:55 p.m.
Duke_WBB: RT @crazietalknet: Weekend @Duke_WBB oversea alum update Player-Coach Jess Foley now 4-0 Shay Selby wins trophy, Chloe Wells season over ht…
— Mon 2:38 p.m.
— Mon 2:38 p.m.
bluedevilsvoice: RT @dukebasketball: Read why senior Quinn Cook has become Duke's defensive ace in hole this season: http://t.co/nRwUseQKhr
— Mon 2:25 p.m.
— Mon 2:25 p.m.
Duke_MGOLF: Sun finally peaks out as the wind howls here with @tdluten & Alex Matlari on par 5 13th hole http://t.co/eungGfX03h
— Mon 2:20 p.m.
— Mon 2:20 p.m.
dukeblueplanet: Time to get the Banner Guy on the horn. 2015 Final Four going up. 📞📱☎ http://t.co/vyDCp0Gjkq
— Mon 2:15 p.m.
— Mon 2:15 p.m.


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AfterStep 1.3.1
AfterStep 1.3.1 already includes user-friendly configuration and "look sharing". Here are some examples of the new features already working:
Take your personal look file, rename it to look.your-name and post it to your friends. They can put it in desktop/looks and select it in the start menu to easily get the appearance of your desktop without losing their own menus, configuration or bindings.
The start menu is simply a directory in ~/gnustep/Library/AfterStep in which each subdirectory is a menu entry and each file a menu option. If you want to add Ghostview, just type:
echo "gv &" >\ ~/gnustep/Library/AfterStep/start/Programs/Ghostview
Spaces are allowed and you can specify command-line options. When you restart AfterStep, Ghostview will be added to the start menu.
Backgrounds are put in the directory ~/gnustep/Library/AfterStep/desktop/backgrounds. Put the picture you want there and when you restart AfterStep, the Desktop/Backgrounds/Pictures menu will contain this option. Of course, if you select it, AfterStep will remember it for the next session, just like colors (in desktop/colors) and look files.
An included patched rxvt called xiterm allows pictures to be displayed in the background with Offix DnD compatibility (just like the Wharf). Select a file in xfm, drag it to xiterm, and its name will appear on the command line you're typing. It's lighter than xterm, supports color and will be more linked with AfterStep in version 1.3.2, becoming a standard part of its GUI, like title bars, Wharf and Pager. Configure-time options are made via menuconfig (just like the Linux kernel); this will also be true for future versions of AfterStep.
Four 2x2 pagers (that's sixteen screens, but you can configure it if you want more or less space on your desktop) with individual background pixmaps and names to allow you to use many programs at the same time (the task-list is very useful too).
Jump button allows you to focus on the next window by clicking on the right triangle in the right part of the title bar.
As you have learned in this article, AfterStep is strongly linked to the FVWM family but is no longer restricted to NeXT GUI emulation. Before moving to totally new concepts, we're first trying to put in all the nice features that already exist without making AfterStep hard to use. I hope you'll find 1.3.1 as simple to use as I think it is. But remember, if you think of a missing option, code it and send in the patch. With look files and other configuration files, AfterStep can turn into anything you want it to be.
Tools and Technologies for Scale and Reliability
by Linux Journal Editor Bill Childers
Sponsored by IBM
Scheduling Crontabs With an Enterprise Scheduler
11am CDT, April 29th
Moderated by Linux Journal Contributor Mike Diehl
Sponsored by Skybot
Trending Topics
Webinar: 8 Signs You're Beyond Cron
11am CDT, April 29th
Join Linux Journal and Pat Cameron, Director of Automation Technology at HelpSystems, as they discuss the eight primary advantages of moving beyond cron job scheduling. In this webinar, you'll learn about integrating cron with an enterprise scheduler.Join us!
|March 2015 Issue of Linux Journal: High-Performance Computing
|Apr 01, 2015
|April 2015 Video Preview
|Apr 01, 2015
|Not So Dynamic Updates
|Mar 30, 2015
|Users, Permissions and Multitenant Sites
|Mar 26, 2015
|New Products
|Mar 24, 2015
|Flexible Access Control with Squid Proxy
|Mar 23, 2015
- March 2015 Issue of Linux Journal: High-Performance Computing
- Not So Dynamic Updates
- Users, Permissions and Multitenant Sites
- April 2015 Video Preview
- New Products
- Flexible Access Control with Squid Proxy
- Security in Three Ds: Detect, Decide and Deny
- Non-Linux FOSS: MenuMeters
- DevOps: Everything You Need to Know
- Tighten Up SSH


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A ranch wife's basic Christmas list
As the season progresses to Christmas, advertisements bombard with suggestions for the perfect gifts; custom-designed fountains, hand-crafted boats, new cars with big bows, or lots of big jewels. The ranch wife, however, is not so easily swayed by other's take on the perfect gift; they tend toward the more practical.
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Fireworks bill still has spark at Capitol
ST. PAUL, Minn. (AP) — A bill to legalize fireworks sales in Minnesota survived a House committee vote and could be back up for House and Senate votes later this month.
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What's New?
Ultimate Beauty Companies Donates to Working WardrobesDec 10 2009
Ultimate Beauty Companies (UBC) recently donated $3,000 worth of professional haircare products to Working Wardrobes, an independent, nonprofit organization that helps men and women in crises, re-...Read more >
Tangles & Knots Donate to Breast Cancer Awareness ProgramsDec 10 2009
Tangles & Knots staff presenting a check to aid breast cancer awareness. In observance of Breast Cancer Awareness Month, the Tangles & Knots staff in New Bern, N.C., donated $1....Read more >
Matrix Announces Elisa Fischer as New Vice President of MarketingDec 07 2009
Elisa Fischer is the new vice president of marketing for Martrix US. In her role, Fischer will lead the marketing division, drive business and continue to secure Matrix's position as one of the...Read more >
Enter to Win Pureology Merchandise!Dec 04 2009
From now through January 31, readers can enter the Showcase Pureology in Your Salon II contest for a chance to win $80 worth of Pureology merchandise. Dress up your stylists and clients in exclusive...Read more >
Arrojo Launches YouTube ChannelDec 01 2009
Arrojo recently launched their new YouTube channel, "Arrojo TVâ€, to present videos on trends, products, hairstyling tips and the Arrojo team. Also on the channel, Nick Arrojo, who is best known as...Read more >
NCA Announces Linda Whitehurst as LGFB National Project DirectorNov 23 2009
The National Cosmetology Association (NCA) recently appointed Linda Whitehurst as the new NCA Look Good…Feel Better (LGFB) National Project Director. Whitehurst has been a NCA member since 1988...Read more >
Beauty Bus Foundation Recognized for Community ServiceNov 19 2009
The Beauty Bus Foundation (BBF), a nonprofit organization dedicated to enhancing the quality of life for homebound, terminally, or chronically ill people and their primary caregivers, was recognized...Read more >
TIGI Inspirational Youth Team Appears at Salon LiveNov 18 2009
TIGI Inspirational Youth Team Models TIGI Inspirational Youth, a team that receives training and mentoring on hairdressing techniques, presentation skills and trends from senior members of...Read more >
Pureology Wins Gold in Web AwardsNov 16 2009
Pureology and its website, pureology.com, recently won Gold at the International Academy of Visual Art's (IAVA) annual W3 Awards in the beauty and cosmetics category. The W3 Awards...Read more >
Make-Up Designory Launching Tool SchoolNov 13 2009
Make-Up Designory (MUD) is launching Tool School, a make-up tutorial, on its website Mudshop.com. Tool School will offer step-by-step tutorials on using each MUD product, and carefully explain the...Read more >


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Formula One Cameraman Gets Absolutely Annihilated By Bouncing Tire (VIDEO)
Formula One driver Mark Webber (sponsored by Red Bull) left the pit before all his tires were secured, causing one of them to spin off, bounce down the crowded track, blindsiding an unsuspecting cameraman, who was then airlifted to a nearby hospital. What we know so far: The cameraman's name is Paul Allen, he suffered a concussion and is experiencing chest pains, and the British spelling of "tire" is "tyre" — which is complete Poppycock.
He's expected to fully recover, however.


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The state Department of Transportation is notifying motorists that repairs on the ZipMobile near the Honolulu International Airport has been successful Wednesday afternoon.
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Chapman University's Spring Dance Concert
Chapman University's Spring Dance Concert Featuring Student Work
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The Department of Dance at Chapman University presents its Spring Dance Concert at the school's intimate Waltmar Theatre. Comprised of 11 fully produced works of choreography by the school's student dance majors, this show represents the culmination of a semester-long exploration and rehearsal process. Directed by award-winning Chapman University alumna Jennifer Backhaus, the pieces in the Spring Dance Concert's program deal with such diverse themes as self-image, competition, isolation, conspiracy, interpersonal relationships, elements of movement and contemporary ballet technique.
* Additional fees apply. No coupon or promo codes necessary to enjoy the displayed discount price.
All offers for Chapman University's Spring Dance Concert have expired.
The last date listed for Chapman University's Spring Dance Concert was Saturday May 12, 2012 / 2:00pm.
Currently at Waltmar Theatre - Chapman University
Comedy Rosencrantz and Guildenstern Are Dead Gives Another View of Hamlet
- Full Price:
- $20.00
- Our Price:
- $10.00
Tom Stoppard's acclaimed absurdist tragicomedy turns the focus on the lives and limited adventures… More
Venue Details
We went to Ways and Means Oyster House. It's "way" overpriced - making the happy hour there not so happy.star this tip starred
The venue is charming since it isn't too big, but parking is a bear. Try to park on a side street but watch for posted signs. Refeshments in theater are minimal.star this tip starred
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Original reporting and analysis
Out & About
From the open publishing newswire: Out & About With The Troublemakers! 3/13/2015
Going backwards is always my way. We attended the County Meeting on 3/12/2015 and offered the position of Individuals For Justice, (IFJ) on the problem of cell phones for the homeless. When your phone goes dead or you need a jump for it to continue working you plug it into your computer or outlet and you are good to go. What do you do if you live on the streets\? Street Roots did a wonderful job reminding us that José Serrica, a member in good standing, spoke of these a few months ago. So we used our 3 minutes of communication time to tell the Commissioners that it costs less than a penny to charge a cell phone from dead to let's make some calls. They seem to know what we were talking about, maybe because we sent them the article and gave them a heads up that we would be pressing them on this. We also sent copies to the 5 sh-ts at city hall and did receive a note back from our favorite of the 5, Comm. Amanda Fritz, who says they are working or talking about working or thinking of doing something to help. She is one of the few who try and in most cases answers her messages, we like that. "Trust what a politician says and you will get screwed, praise them only when they actually do something." (Joe Walsh 1971) Here is the video of our testimony/communication with the good county commissioners:
This day only two of us spoke and I am about 4 minutes in, the woman who talked before me is worth listening to because she also is talking about the homeless/houseless. We will keep the pressure on but you can call the chair of the commissioners here and just ask how they are doing with offering a safe place to allow citizens to charge their cell phone. Thank you Street Roots again for reminding us of this important issue. Chair of County Commissioners Kafoury's number: 503- 988-3308 City Commissioner Fritz's number: 503-823-3008
We went to the City Council Gathering of the 5 sh-ts on 3/11/2015 and had a time; they are so weird! The morning session was kind of boring, except for the wonderful kids who came from Harrison Park Elementary school to talk about leadership and the arts, we enjoyed their presence. We also did speak on item 258 concerning the Park Ranger Program. We like the rangers in general and ask that they act as ambassadors and not as cops, we objected to them excluding people from the parks for 30-60-90 days, somebody else should make that decision and not them. There are only 7 permanent rangers for over 200+ parks, we thought that was shameful, we need more rangers, less cops. On to the afternoon session which surprised me with the large number of people coming out to express their views on item 266 commonly called "Remove the Box" [...]
two snatched by Portland police at rally Tuesday 3/10 for Africa, recent victim of LAPD
From the open publishing newswire: Two people were arrested by police at the end of tuesday evenings solidarity rally and march downtown in honor of Africa, shot and killed by the LAPD.
In the longer ustream video the two people targeted were standing calmly nearby, without provocation the police arrest both, they say for disorderly conduct. Earlier an officer attempts to coerce someone's identity by threatening to give a citation for being in the street. Seems to me they were targeted for concealing their identity. What do you think\\\?
Clip of arrest: http://youtu.be/2zNQYQN\\\_UeI
Better context: http://www.ustream.tv/recorded/59762313
Relate pimc video post: http://portland.indymedia.org/en/2015/03/429362.shtml#441796
Here's a better quality shot of the arrests yesterday https://youtu.be/pgWdHLL5hD0 , thanks for being there videographers.
(A-Radio) Interview with Radical Theory and Practice about its Emma Goldman project
From the open publishing newswire: The Anarchist Radio Berlin made an interview with the Russian-speaking anarchist publishing cooperative Radical Theory and Practice (RTP) about the cooperative, its recent project of translating Emma Goldman's memoires into Russian and a lot more.
You'll find the audio (to listen online or download in different sizes) here: link to aradio.blogsport.de
Length: 29:35 min
You can find other English and Spanish language audios here.
[ http://aradio.blogsport.de/englishcastellano/ ]
out and about
From the open publishing newswire: My new t-shirt says:
Front---Individuals For Justice
Endorses Back---Anyone but Hales, novick.
I will be wearing it a lot for the next two years.
I am reminded of the saying,* "Beware of the Ides of March" as I look back to last week, which for me started by watching a foreign leader tell our congress of these United States that we are fools, and he did it to standing ovations, a lot of standing ovations by our representatives and senators; it was shameful. My sincere hope is that bibi natanyahu goes home to Israel, gets defeated, and goes the way of g.w. bush. The 15th of March is only a few days away, maybe a week depending on when you read this and I fully expect Caesar, AKA char-lie the hales, will announce he will become emperor of Rome. I know he is raising lots of money to screw over us for four more years, yes "Beware of the Ides of March" my friends. [...]
The second event was the city council meeting on the 5th seemed like a boring meeting unless you were hoping that the plan for the West Quadrant would be to your liking, on Thursday one of my friends asked me to join him and then did not show up, but I did learn some stuff. I learned that four of the five sh-ts were in the pockets of the big developers; deep in those pockets. The only person standing with the people, who testified, about 30 of them, was once again Commissioner Amanda Fritz. It was fascinating to watch, [...]
Next Thursday we will be going after the lack of opportunities for the homeless to charge their cell phones. There was a good article in Street Roots about this last week and we will be yelling about it to the commissioners who have a hand in this nonsense. Here is the street Roots article. http://news.streetroots.org/2015/03/06/homeless-phone-charging-thief-wanted-security
Video Instruction for "What is Cascadia\?" Zine
From the open publishing newswire: How to assemble the "What is Cascadia\?" Zine
double sided single sheet zine:
[pdf download] http://media.portland.indymedia.org/media/2015/01/429041.pdf
We now have a simple video explaining how to cut and fold (assemble) the booklet "What is Cascadia\?"
Please go to link, print out the double sided single sheet of the booklet and follow the video instructions (2 cuts and 4 folds and then staple on the spine of the your newly assembled "What is Cascadia\?" Zine)
[ link to freecascadia.org is to be mass printed hand distributed at events, gatherings, public places or handed to friends and the bioregionally curious.
Previous post on pimc: http://portland.indymedia.org/en/2015/01/429040.shtml
homepage: http://freecascadia.org/media/cascadia-booklets
The Shortwave Report 03/06/15 Listen Globally!
From the open publishing newswire:
Updated Post: 3.13.15 | 3.20.15 | 3.27.15
A weekly 30 minute review of international news and opinion, recorded from a shortwave radio and the internet. With times, frequencies, and websites for listening at home. 3 files- Highest quality broadcast, regular broadcast, and slow-modem streaming. NHK World Radio Japan, Radio Havana Cuba, Sputnik Radio, and Radio Deutsche-Welle.
The latest Shortwave Report (March 6) is up at the website http://www.outfarpress.com/shortwave.shtml in 3 forms- (new) HIGHEST QUALITY (160kb)(33MB), broadcast quality (13MB), and quickdownload or streaming form (6MB) (28:59) Links at page bottom [...]
Video: Health Care for All Oregon Salem Rally 2.11.15
From the open publishing newswire: Filmed in Salem Oregon on 2.11.15 on the steps of the State Capital
Health Care For All Oregon
This video is the complete rally and speeches
There was a gathering a few blocks away prior to the rally for organizing and workshop.
The video starts with a group from the workshop heading to the rally
The event had music provided by The Raging Grannies, Norman Sylvester, David Rovics, Dr. Atomic, Peter Bergel, Bob Wickline, Bajo Salario/Collective. and others
The video is 2 hours and 35 minutes: http://youtu.be/wenyi216uDQ
The speeches start around 59:54 in the video.
Around 1:45:49 Sen Demral announce the new bill SB 631 for "Single Payer"
The Shortwave Report 2/20/15 Listen Globally!
From the open publishing newswire:
Updated Post: 2.27.15.
A weekly 30 minute review of international news and opinion, recorded from a shortwave radio and the internet. With times, frequencies, and websites for listening at home. 3 files- Highest quality broadcast, regular broadcast, and slow-modem streaming. NHK World Radio Japan, Radio Havana Cuba, Radio Deutsche-Welle, Sputnik Radio.
The latest Shortwave Report (February 20) is up at the website http://www.outfarpress.com/shortwave.shtml in 3 forms- (new) HIGHEST QUALITY (160kb)(33MB), broadcast quality (13MB), and quickdownload or streaming form (6MB) (28:59) Links at page bottom [...]
From the open publishing newswire: "Just Say No"
We all knew it would be a long night; there were almost 30 people who signed up to go on the record concerning whether Portland, Oregon should join the JTTF. Our status with the Feds now seems to be, on call or as needed and the US Attorney wanted us in or out. We had to listen to the US Attorney go on forever, (30 minutes +) about how the JTTF would save our city from all invasions from ISIS and the Martians. You must look up and get the video of the hearing because you will have your mouth open most of the time Amanda Marshall was speaking, she is a very sick person, in my opinion, and should be removed as our US Attorney.
After Marshall finished, even Commissioner Fish looked worn out by her bizarre testimony and Commissioner Saltzman would have been bored to tears if he was there, but he was AWOL. We only had four people present at 5:00 PM to listen to the community tell them do not rejoin, join or even get near the FBI because our police are having their own problems and do not need this action. All but one person spoke against joining the JTTF. I was very proud of those who testified, including a very young girl who read a message she and her mom wrote about the 14th Amendment to the ACLU who gave a wonderful presentation that made me wonder what to say. All the groups were stunning; they spoke with a wonderful intelligence that made the walls move. They spoke of freedoms, they spoke of dignity, and they pointed out the terrible history both far and near of the FBI. One could see the effect it was having on the three Commissioners and the Mayor and at the end I was proven wrong, the city government seems to be heavily learning towards saying no to JTTF. Wow, it was a wonderful night for this activist; I just love to be proven wrong. We now have two weeks and a vote will happen, so if you went and offered your opinion, thank you so much, if you could not get there you can e-mail or make a phone call because the record will remain open for most of the two weeks. You do not have to live in Portland to offer your opinion and as one of our leaders said last night, "The rest of the country is watching what we do."
To contact the mayor's office go here:
Stop these fucking sweeps hales
From the open publishing newswire: what you can do
Individuals For Justice has been fighting with city hall, county and the state of Oregon for only a few years yet has shed enough tears to fill Mt. Tabor Reservoirs.
Homelessness/Houselessness touches all of us, adults with jobs, children who are thrown away or run away, veterans, wives, husbands, sons, and daughters. We are still the richest country in the world and yet we still have this terrible plague with us in 2015. When oh when will you yell with us about this injustice\\\\\\\\\\\\\\\? Please stop to say hello in front of city hall each and every Wednesday, as we stand & protest for the people on the streets. We will be there about 0800, we will always go into the building and let our feelings be known. We ask/demand that the sweeps end immediately, we ask that the city council stop talking and do something like creating storage areas, and how about safe places where people can put their head down at night without being arrested by our police for being poor. Join us or call the mayor's office and ask that the sweeps be stopped now!
More info:
homepage: homepage: http://IndividualsForJustice.com
The Shortwave Report 02/06/15 Listen Globally!
From the open publishing newswire:
A weekly 30 minute review of international news and opinion, recorded from a shortwave radio and the internet. With times, frequencies, and websites for listening at home. 3 files- Highest quality broadcast, regular broadcast, and slow-modem streaming. Radio Deutsche-Welle, Radio Havana Cuba, Sputnik Radio, and NHK World Radio Japan.
The latest Shortwave Report (February 6) is up at the website http://www.outfarpress.com/shortwave.shtml in 3 forms- (new) HIGHEST QUALITY (160kb)(33MB), broadcast quality (13MB), and quickdownload or streaming form (6MB) (28:59) Links at page bottom [...]
Video: 15 Now! rally and march in Salem 1.24.15
From the open publishing newswire: A rally with speeches and songs on the Capital steps. A skit with 2 clowns: Wallie Walmart & Ronnie Mac D. A march to nearby McDonald's for a protest call for 15 Hour, fair wages for the workers Then into the streets for an unpermitted march to a nearby meeting / lunch area
The organizers, 15 Now Portland, protest income inequality and say they are dedicated to making Oregon the first state to enact a $15 minimum wage. Rally on the Capital steps Jan 24 at noon. 15 Now Portland is fighting to raise the minimum wage to $15 per hour in the City of Portland. We are also helping to lead a coalition of almost 50 other 15 Now chapters, labor unions, and community organizations across the state that are dedicated to making Oregon the first state to enact a $15 minimum wage.
https://www.youtube.com/ [1 hour 15 min]
Oregon Needs a Raise! Rally at the Capitol Building
Saturday, Jan. 24, Noon1 pm in Salem, OR
Bills for a $15 minimum wage are being introduced in the State House and Senate for the 2015 session. Low-wage workers, union members, faith and community allies ALL OUT for $15 !
-video out take-
15 Now! Salem Capital Rally with Ronnie and Wallie https://www.youtube.com
Video: Hands Up - Dont Shoot Portland - MLK 2015 March 1.18.15
From the open publishing newswire: Hands Up PDX march on Jan 18 2015
Hundred + show up in the rain to bring awareness to the police shooting people of color ...and to make the public aware that we citizens say; Black Lives Matters, and we do care about these concerns.
Tiny URL link to the YouTube video: http://tinyurl.com/py57zdy (1 hour 34 min video)
Hands Up (Don't Shoot) PDX held a march on the day before Martin Luther King's Birthday. The march was in unity with "Black Lives Matter, and police accountability, it was in Solidarity with struggles in Ferguson, NY, Portland and around the US. The march was a unified voice of the community to end racism and violence. And to gather in the streets on Dr Martin Luther Kings birthday in memory of his fight for justice as we still face the current struggles today in our own communities. [...]