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December 2010 HCV Advocate
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In This Issue:
AASLD 2010 Conference Part 1 Alan Franciscus, Editor-in-Chief IL28B Gene Highlighted at AASLD Liz Highleyman HealthWise: 2010 Liver Meeting Update Lucinda Porter, RN HCV Snapshots Lucinda Porter, RN HCV Advocate Eblast Stay informed on the latest news ..click here to register for email alerts
Back to top AASLD 2010 Conference – Part 1 —Alan Franciscus, Editor-in-Chief
In late October the American Association for the Study of Liver Diseases (AASLD) held their annual conference—the largest and most important liver conference held in the United States. This year provided much information on direct-acting antivirals (DAAs) being studied to treat hepatitis C. In fact there were over 50 presentations and posters released on DAAs. The posters and presentations included results from early studies of the DAAs in healthy volunteers and in later stage studies in people who are infected with hepatitis C. Part one of the AASLD report will on focus on those drugs that were actually studied in people with hepatitis C. In addition to the DAAs listed below there was quite a bit of data released about telaprevir and boceprevir—the new information will be incorporated into our HCSP Fact Sheets. Boceprevir and telaprevir, which have completed phase III studies, are expected to be approved by the Food and Drug Administration (FDA) in the middle part of 2011.
DAA medications to treat hepatitis C are drugs that work by interfering or blocking the replication process of the hepatitis C virus. The DAAs that are currently under study include HCV inhibitors such as polymerase, protease, and a new first-in-class HCV NS5A inhibitor. The studies below represented combination trials of a DAA(s) with the current standard of care (pegylated interferon plus ribavirin) and early studies of the combinations of DAAs with and without interferon/ribavirin.
Note: Pegylated interferon plus ribavirin will be listed below as Standard of Care (SOC) since standard doses are given when combined with the study drugs or as the control or comparator group. However, the treatment period of SOC varies from study to study.
#81: RG7128 is an HCV polymerase inhibitor that was given to 408 HCV genotype I and 4 treatment naïve patients in doses of 500 or 100 mg twice a day (BID) for either 8 or 12 weeks combined with SOC. If patients were HCV RNA negative (<15 IU/mL) from week 4 to week 22 all treatment was stopped at week 24. The patients who did not meet the criteria above were randomized into an RG7128 arm or SOC arm and treated for a total treatment duration of 48 weeks. Sixty-eight to eighty-seven percent of people were HCV RNA negative at week twelve (cEVR) compared to 49% in the SOC group.
Comments: The triple combination looks very encouraging for the following reasons: (1) the combination was safe and well-tolerated when given for twelve weeks to patients with and without cirrhosis; (2) RG7128 has a high barrier to resistance that will make it a good choice for future treatment and possibly for use with another HCV inhibitor; (3) there is a potential for a shorter treatment duration of 24 weeks compared to the current SOC; and (4) the results are more meaningful since there is a relatively large patient population.
Vaniprevir (MK-7009)
# 82: Vaniprevir (MK-7009) is an HCV protease inhibitor. The study included 94 HCV genotype 1 treatment-naïve patients who were administered 1 of 5 regimens—300 mg BID, 600 mg BID, 600 mg QD (once a day), 800QD or placebo combined with SOC for 4 weeks followed by an additional 44 weeks of pegylated interferon. The sustained virological response or SVR (undetectable HCV RNA 24 weeks after stopping treatment) was 61% to 84% in the groups that received vaniprevir. No serious side effects were shown—vomiting was noted more in the vaniprevir groups but did not lead to treatment discontinuation.
Comments: The increased rates of response when vaniprevir is combined with SOC are encouraging especially the SVR rates in the 800 mg once-a-day dose. It would certainly make adherence easier compared to taking it three times a day, but hopefully more studies will be conducted that will look at using vaniprevir to reduce treatment duration by response guided therapy and/or in combination with another DAA.
# 806: PSI-7977 is an HCV polymerase inhibitor that is dosed once a day (100, 200 and 400 mg) in combination with SOC. Sixty-three treatment-naïve HCV genotype 1 patients were enrolled in the study. Eighty-eight to ninety-four percent of the patients who received PSI-7977 plus SOC for 28 days achieved undetectable HCV RNA at week 4 compared to 21% in the group that received SOC but without PSI-7977. No differences in response were seen between genotypes 1a or 1b (subtypes). The drug was generally safe and well-tolerated.
Comments: Although this is a small study the results are impressive. It was also noted that PSI-7977 is pan genotypic—that is, it has antiviral activity against all genotypes. A larger 12-week study is being planned that will hopefully duplicate these results and provide more information about treatment duration, antiviral response and safety.
#LB-5: Interim 24 week results for a study of TMC435 (75 and 150 mg QD), an HCV protease inhibitor, combined with SOC given for up to 24 weeks to HCV genotype 1 treatment-naïve patients produced significant viral load reductions. In the 130 patients who completed 24 weeks of treatment and in patients who stopped treatment for any reason by week 24—88% to 97% achieved an SVR12 (HCV RNA undetectable 12 weeks after stopping treatment). So far there is a low rate of viral breakthrough and the drugs were generally safe and well-tolerated with few treatment discontinuations and the side effects were similar to the group that received the SOC.
Comments: The interim results of 88% to 97% are very impressive in the groups that received TMC 435 for 12 or 24 weeks plus SOC and continued SOC for a total treatment duration of 24 weeks. So far the drug has a good safety profile, low viral rebound and the majority of patients were able to stop treatment at week 24 because they were HCV RNA negative at the time points specified in the study design.
Related news: In November 2010 top-line interim 24 week results to evaluate TMC435 at either a 100 mg or 150mg dose QD for either 12, 24, or 48 weeks in combination with SOC to treat 462 HCV genotype 1 patients who did not achieve an SVR (relapsers, partial responders and null responders) with a previous course of pegylated interferon plus ribavirin were released. After the initial period with TMC and SOC, the study participants were continued on SOC for a total treatment duration of 48 weeks. The percentage of patients who became HCV RNA undetectable ( <25 IU/mL) are listed in the table below:
TMC435 was safe and well-tolerated with a similar safety profile as the study of TMC435 in treatment- naïve patients.
Comments: The top-line information release is encouraging for a population of people with hepatitis C who are in the most need for an effective treatment.
#LB-10: ABT-450 is a protease inhibitor that is being tested in HCV treatment-naïve genotype 1 subjects as a combination therapy that includes ritonavir (boosting agent) and SOC. For three days the trial participants were given ABT-450 (boosted with ritonavir) at doses ranging from 50 to 200 mg QD followed by quadruple therapy of ABT-450 (with ritonavir) plus SOC for 12 weeks followed by 36 weeks of SOC alone At the end of the 4th week, 21 of 23 (91.3%) patients were HCV RNA negative (<25IU/mL) compared to only 1 of 8 (12.5%) of those who received the placebo (plus SOC). The medications were safe and well-tolerated.
Comments: ABT-450 produced very high rates of patients who became HCV RNA negative after 4 weeks of treatment. The drugs were safe and well-tolerated. SVR rates will likely be higher and hopefully future studies will be designed to study shortening the total treatment duration.
GS-9256 Plus GS9190
#LB-1: The combination study of GS-9256 (HCV protease inhibitor) BID plus tegobuvir (GS-9190 – polymerase inhibitor) BID with and without ribavirin or SOC to treat HCV genotype 1 treatment-naïve patients was presented at AASLD. In the group that received the quadruple therapy for 4 weeks followed by 44 weeks of pegylated interferon plus ribavirin 14 out of 14 patients (100%) were HCV RNA negative by day 28. The quadruple therapy was generally well-tolerated with typical SOC type side effects. There is an ongoing 4 month study of the quadruple therapy.
Comments: The quadruple therapy produced the highest response rates at day 28 of therapy compared to the groups that did not include pegylated interferon or the control arm (SOC). Seventy-one percent of the quadruple group was HCV undetectable (≤ 25 IU/mL) by day 14 so it would be interesting to find out if treatment duration can be shortened from the 48 week duration in this study.
BMS-790052 Plus BMS-650032
# LB-8: In an important study the combination of BMS-790052 (NS5A inhibitor) and BMS-650032 (protease inhibitor) was given alone or in combination with SOC to treat HCV genotype 1 null-responders to a prior course of therapy. The interim 12-week results (total study duration is 24 weeks) produced early potent antiviral activity, but 6 out of the 11 people treated had viral breakthrough. When the two inhibitors were combined with pegylated interferon and ribavirin 9 out of 10 patients became HCV RNA undetectable by week 12. Final results are expected in 2011.
Comments: BMS-790052 (QD) is a new first in-class inhibitor that has been shown to have potent antiviral activity against HCV genotypes 1a and 1 b. BMS-650032 is an HCV protease inhibitor (BID) that when combined with BMS-790052 plus SOC produced high complete early virologic response rates (cEVR) at 12 weeks. The combination therapy was safe and well-tolerated. The viral breakthrough of the 6 out of 11 patients who received just the inhibitor combination indicates that pegylated interferon and/or ribavirin may be needed to completely suppress HCV when the two inhibitors are used alone—at least in this study design. The study design is being expanded to include more arms so stay tuned. Back to top IL28B Gene Highlighted at AASLD —Liz Highleyman
In 2009 researchers first reported that certain variations in the human genetic code near the IL28B gene can help predict which people with hepatitis C virus (HCV) will spontaneously clear acute infection and who will respond well to interferon-based therapy for chronic infection.
Discovery of the IL28B link has spurred a change in thinking about hepatitis C and its treatment. Some experts believe these human gene patterns may prove to be as important as HCV viral genotypes (1, 2, 3, etc.) in predicting outcomes. More than 50 oral and poster presentations at the 61st American Association for the Study of Liver Diseases (AASLD) "Liver Meeting" last month in Boston looked at various aspects of IL28B and its relation to hepatitis C.
As background, the relevant variations—known as single nucleotide polymorphisms (SNPs), or substitution of a single building block at a specific position in the DNA chain—are located on chromosome 19 near the IL28B gene. The IL28B gene encodes instructions for making interferon lambda (a.k.a. interleukin 28). Interferons produced by the body are key to the immune system's response against hepatitis C and B; interferon therapy strengthens this natural response.
Each individual carries two copies of every gene, one from each parent. The IL28B rs12979860 SNP—which has been implicated most often—has two variations, or alleles, known as "C" and "T." Hepatitis C patients with the C/C pattern—that is, two copies of the "C" allele have the best outcomes. People with the T/T pattern (two "T" alleles) have the least favorable response, while those with the C/T pattern (one copy of each variation) fall somewhere in between.
By now numerous studies have shown that hepatitis C patients with the C/C pattern have much higher rates of sustained virological response (SVR) to pegylated interferon plus ribavirin than those with the T/T pattern. C/C is more common among people of European descent, which helps explain why white patients respond better than black patients to interferon. For more information, see the August 2010 HCV Advocate.
HCV Genotypes 2 and 3
Initial IL28B studies looked at individuals with hard-to-treat HCV genotype 1. Researchers at the Liver Meeting reported associations for people with genotypes 2 and 3. In a study of 267 patients with either genotype 2 or 3, German researchers (abstract 904) found that the rs12979860 protective C/C pattern was significantly associated with both rapid and sustained virological response, but did not see a significant influence for two other SNPs, rs8099917 and rs12980275.
Japanese researchers (abstract 798) who studied nearly 800 hepatitis C patients reported that the rs8099917 protective pattern was a significant predictor of SVR for genotype 2 overall and for genotype 2b (but not for 2a). And a Scandinavian team (abstract 898) looking at 269 Northern European genotype 3 patients found that the protective pattern for either rs12979860 or rs8099917 significantly predicted RVR but not SVR.
Given these conflicting findings, more research is needed in this area.
Interferon Treatment Response
Turning to treatment, R. Roomer from Erasmus University Medical Center and colleagues (abstract LB-13) reported that increasing the dose of interferon alfa-2b (Intron A, the type used in PegIntron) may help overcome poor interferon sensitivity in people with the unfavorable rs12979860 T/T pattern who did not respond to prior combination therapy.
Patients in this small study received continuous infusions of interferon at doses of 6, 9, or 12 million units (MU) per day using a modified insulin pump. Regardless of dose, people with the protective C/C pattern experienced a larger decrease in HCV viral load by week 4 than those with the C/T or T/T patterns (averages of 2.9, 1.7, and 1.3 log, respectively). All C/T and T/T participants who received the highest dose, however, achieved early viral load drops greater than 2 log. Nevertheless, while two of the three C/C patients achieved SVR (using 6 or 9 MU), only four of 20 C/T patients (all receiving 12 MU) and none of the six T/T patients did so.
In a related study, S. Chevaliez from Henri Mondor Hospital in Paris and colleagues (abstract 129) assessed whether IL28B influences response to high-dose pegylated interferon (360 mcg/week) plus ribavirin (1000-1200 or 1200-1600 mg/day) in 83 genotype 1 prior null responders. Only three people in this treatment-resistant population had the rs12979860 C/C pattern. Looking at the other two groups, C/T patients had larger viral load decreases than T/T patients at weeks 2, 4, 12, and 24, and were significantly more likely to achieve undetectable HCV RNA by week 24 (33% vs 12%, respectively). IL28B gene pattern, therefore, could help predict the likelihood of responding to retreatment.
Direct-Acting Antivirals
IL28B genetic variations may also influence response to new direct-acting antiviral agents used in combination with pegylated
interferon and ribavirin, but some of these drugs may be potent enough to overcome poor interferon sensitivity in people with unfavorable gene patterns. Researchers presented data stratified by IL28B status from studies of the HCV polymerase inhibitors PSI-7977 (abstract 815) and ANA598 (abstract 1852).
J. McHutchison from Duke University and colleagues (abstract 810) devised a mathematical model showing how uneven distribution of the protective rs12979860 C/C pattern might bias results in clinical trials of new drugs. They found that the likelihood of IL28B genotypes being unequally represented in different treatment arms was quite high, reaching about 30% for smaller Phase I trials.
"Knowledge of IL28B genotype distribution is important for interpreting early phase clinical trial results, particularly dose-finding studies where dose-related antiviral potency must be weighed against toxicity," they concluded. "Confounding by IL28B genotype imbalance between treatment arms might affect the decision to advance a compound from proof-of-concept to the next stage of clinical development."
Disease Progression
Several teams presented findings linking IL28B gene pattern and disease progression. D. Bitetto from the University of Udine in Italy and colleagues (abstract 230) looked at the same rs12979860 SNP in 548 hepatitis C patients categorized according to liver disease severity. The likelihood of having the unfavorable T/T pattern rose as liver disease worsened from mild fibrosis (9%) to more advanced disease (17%) to hepatocellular carcinoma (24%).
In contrast, A. Thompson and fellow investigators with the IDEAL study (abstract 229), who analyzed more than 1300 genotype 1 patients treated with Pegasys or PegIntron plus ribavirin, saw no association between rs12979860 pattern and advanced fibrosis
But another IDEAL analysis (abstract 1893) found that the protective C/C pattern was associated with higher preteatment alanine aminotransferase (ALT) levels and moderate-to-severe (A2-A3) necroinflammatory activity. The researchers suggested that the commonly reported association between higher ALT and SVR might be explained by IL28B variations.
A smaller Spanish study (abstract 892) looking at 129 genotype 1 patients treated with standard therapy again saw no link between rs12979860 variations and liver fibrosis. Frequencies of the protective C/C pattern were 30% among people with absent to mild (F0-F1) fibrosis, 41% among those with moderate (F2) fibrosis, and 36% among those with advanced (F3-F4) liver disease—not a significant difference.
This study, as well as others presented at the conference (e.g., abstract 1899), showed an association between IL28B gene pattern and glucose metabolism or insulin resistance. Some teams (e.g., abstracts 232, 1879) found an association with low-density lipoprotein (LDL) cholesterol levels. More research is needed to learn about the relationship between IL28B, metabolic abnormalities, and liver disease progression.
Finally, M. Charlton from the Mayo Clinic and colleagues (abstract 1) reported that thers12979860 C/C pattern in either the recipient or the donor liver was associated with delayed HCV recurrence and greater likelihood of sustained response to interferon-based therapy after liver transplantation¾although it did not significantly improve survival. A Spanish study (abstract 1140) likewise saw better post-transplant outcomes among patients who received new livers with the rs12979860 or rs8099917 protective gene patterns. "The data suggest that C/C donor livers might be preferentially allocated to patients with HCV infection," Charlton's team concluded.
Hepatitis B
Turning to hepatitis B, a set of studies suggested that while IL28B may influence outcomes, the link is not as straightforward as it is for hepatitis C. With regard to natural clearance, F. Kurbanov from Johns Hopkins University and colleagues (abstract 1408) found that that people who spontaneously cleared HBV were no more or less likely to carry the rs12979860 "C" allele than those who developed chronic infection.
In a second study, H. Reesink from the University of Amsterdam and colleagues (abstract LB-21) assessed whether the rs12979860 SNP predicts outcomes among chronic hepatitis B patients treated with pegylated interferon plus adefovir (Hepsera). There was a trend toward greater likelihood of SVR among HBeAg negative patients with the C/C pattern (57% vs 36% for C/T and T/T combined), but the difference did not reach statistical significance. In contrast, HBeAg seroconversion among initially HBeAg positive patients was somewhat less likely in the C/C group (22% vs 54%, respectively). Hepatitis B surface antigen (HBsAg) loss rates were similar regardless of IL28B pattern.
However, in a third study, P. Lampertico from Universita degli Studi di Milano and colleagues (abstract 237), looking at 101 HBeAg negative chronic hepatitis B patients (most with HBV genotype D) treated with either conventional or pegylated interferon, found that HBsAg clearance was significantly more likely in people with the T/T pattern than in those with either C/C or C/T (36%, 29%, and 7%, respectively).
Reesink's team concluded that "the heterogeneity of HBV patients, viral genotypes, and definitions of outcome make [hepatitis B] more challenging for evaluation of host genetics" than hepatitis C.
Tailoring HCV Treatment
While IL28B genetic testing could provide useful information about which people with hepatitis C are most likely to respond to interferon, its greatest value may lie in helping to tailor treatment for individual patients.
A. Mangia and colleagues (abstract 897) presented an IL28B gene analysis of about 400 genotype 1 participants in an Italian study of individualized duration of pegylated interferon plus ribavirin. They showed that the rs1279860 C/C pattern was a strong predictor of rapid response, and concluded that, "duration of treatment may be safely reduced" in C/C and C/T patients who achieve RVR.
While RVR remains the best predictor of SVR, they added, only a minority of patients have such good early responses. But among C/C patients, a majority without RVR nevertheless will go on to achieve SVR, so they should not stop treatment prematurely. A Spanish study of HIV/HCV coinfected patients (abstract 131) also found that C/C carriers without RVR still had a good chance of achieving sustained response.
Austrian researchers (abstract 923) also found that people who achieved RVR had a high likelihood of SVR regardless of IL28B pattern. But among slower responders with C/T or T/T, extending treatment to 72 weeks significantly lowered the post-treatment relapse rate.
Taken together, these studies indicate that IL28B genetic variations may be a key factor in ensuring that hepatitis C patients are treated long enough, but no longer than necessary. Back to top Healthwise: 2010 Liver Meeting Update —Lucinda K. Porter, RN
The first week of November, I enjoy something even more than eating leftover Halloween candy—the annual Liver Meeting hosted by the American Association for the Study of Liver Diseases (AASLD). The Liver Meeting conjures up images of livers gathering in a convention hall, shooting the breeze about the latest gall bladder medications. Actually, the Liver Meeting is an international assembly of liver specialists who meet to network and exchange the latest research on liver diseases.
Before commenting on the Liver Meeting, I want to remind readers to apply critical thinking when looking at research results. Never make health decisions based on something you read. My mother was famous for taking various dietary supplements because she read something in a magazine. If a study reported that people who didn't have eyebrows had better memories, my mother might have shaved her brows. It would not have occurred to her that people without eyebrows might have had better memories because they slept more every night and were more prone to rubbing their brows on their pillows. So talk to your medical provider before pulling out your eye brows or trying something because you read it somewhere.
Don't make conclusions from observational studies. A good example of this is found in the study "Mild Alcohol Consumption is Not Associated with Increased Fibrosis in Patients with Chronic Hepatitis C" by Cheung and colleagues mentioned in this month's HCV Snapshots. This is an observational study in which participants are grouped by a behavior that they already have; they were not randomly assigned to a no, low, or high drinking group. On the surface it appears that mild alcohol consumption is not harmful to the livers of those with HCV, but perhaps moderate drinkers with HCV have other habits that protect them from liver damage.
Humans tend to look for cause and effect relationships. We want to know if what we are doing is harming or helping us. Research informs us, and gives us data that we can use or discard. We may welcome certain information, particularly if it tells us something that we want to hear. For instance, wouldn't it be wonderful to read that potato chips are good for us? The person who liked potato chips would be thrilled to learn that a study reported that people who eat potato chips live longer. However, the person who hated potato chips is unlikely to even read the chip research, let alone run out and buy a bag of Ruffles.
With nearly 2000 posters, papers, classes, and press releases, it may be overly simplistic to summarize the entire Liver Meeting, but the word optimism comes to mind. The hope that we will find a cure for everyone with hepatitis C virus (HCV) is now within reach. The word cure was officially uttered by the president of AASLD, Arun Sanyal, M.D. When asked about the future of HCV in an interview by Michael Smith of MedPage Today, Sanyal said, "We finally believe that cure is possible."
This optimism stokes my hope, particularly with all the reports that HCV treatments are getting better results. Since the latest HCV-related drugs are abundantly reported on by the press and my colleagues at the HCV Advocate, I am going to highlight two observational studies from the 2010 Liver Meeting that focus on matters other than the latest drug treatments.
The first may particularly interest women, but despite the title, this research also applies to men. This study titled, Menopause Is Associated with Relapse in Chronic Hepatitis C Patients Treated with Pegylated Interferon plus Ribavirin was conducted by French researchers Christiane Stern, Michelle Martinot-Peignoux, Marie-Pierre Ripault,Nathalie Boyer, Ana Carolina Cardoso, Ahmed El Ray, Tarik Asselah,Dominique Valla, and Patrick Marcellin. The purpose of the study was to examine factors associated with relapse after HCV treatment.
There were 249 treatment-naïve participants (no previous HCV treatment) who were treated with peginterferon and ribavirin according to the current standard of care. One third of the study population was genotype 1; the average age was 47 years old; more than a quarter of those enrolled had liver cells with more than 30% fat (marked steatosis); ten-percent were obese with a body mass index of more than 30%. (Apparently there are obese people in France.) Menopause was noted in approximately 59% of the women in the study, so treatment response rates were compared between genders and between those under and over 50 years old.
Approximately one-third of the patients relapsed from HCV treatment. Obesity, genotype 1, marked steatosis, and peginterferon dose reduction were the factors most closely associated with treatment relapse. Menopause was an added factor for women. A closer look at the data showed a relapse rate of 22% for men under age 50; 28% for those over 50. The relapse rate was 14% for women under age 50 and 37% for those over 50.
These findings add fuel to the argument that patients may improve their odds of responding to treatment if they seek treatment earlier while they are younger; this may be particularly true for women.
The second study I'll discuss may be particularly relevant to me in the future if I don't get enough sleep. Reporting on findings from the Hepatitis C Long-Term Treatment against Cirrhosis Trial (Halt-C) Neal D. Freedman, Teresa M. Curto, Karen Lindsay, Elizabeth C. Wright, Rashmi Sinha, and James E. Everhart looked at coffee consumption and response to HCV treatment (peginterferon and ribavirin). This study enrolled 885 participants who did not respond to previous interferon treatment. Participants completed a food survey that included questions about coffee intake from the year prior to retreatment. Coffee intake was classified as none (133 patients), < 1 cup (253 patients), 1 to <3 cups (367 patients), or ≥ 3 cups per day (132 patients).
Among all groups, higher coffee intake was associated with an increased likelihood of response to retreatment. The title of this report is Coffee Is Associated with Virologic Response in Chronic Hepatitis C: Findings from the Hepatitis C Long-Term Treatment against Cirrhosis Trial (Halt-C). Since I want to be in good shape for my next round of HCV treatment, I think I will go drink a cup of java. But since this is an observational study perhaps I better talk to my doctor first.
Note: Those who want to read the latest findings from the Liver Meeting may find abstracts and posters on the HCV Advocate website—www.hcvadvocate.org/news/reports/ AASLD%202010/AASLD%202010%20TOC.htm, or at the AASLD website at www.aasld.org. The link to the viral hepatitis section is http://trs.scivee.tv/node/986.
If you are new to reading medical literature, I recommend reading:
HCV Advocacy: A Simple Guide to Reading an Abstract by Alan Franciscus www.hcvadvocate.org/hepatitis/factsheets_pdf /reading_abstract.pdf or
Making Sense of Hepatitis C Research and Medical Literature www.hcvadvocate.org /hepatitis/factsheets_pdf/ Making%20sense_2011.pdf Back to top HCV Snapshots —Lucinda K. Porter, RN
Article: Flexible and Individualized Treatment to Achieve Sustained Viral Response for Recurrent Hepatitis C in Liver Transplant Recipients, W.C. Lee, T.J. Wu, H.S. Chou, C.F. Lee, K.M. Chan, S.S. Cheng Source: Journal of Viral Hepatitis November 2010 Volume 17, Issue 11, pages 770–777
A huge challenge for hepatitis C patients who receive liver transplants is the fact that after the transplant, hepatitis C virus (HCV) usually re-emerges and is a major cause of transplant failure. Researchers have long been interested in improving the prognosis for these patients. This study enrolled 35 patients with HCV after they had received liver transplants. Of these 35 patients, 25 had recurrent HCV. Every two weeks, they were treated with 180 mcg. of peginterferon and a low daily dose of ribavirin (200–400mg). However, the duration of treatment was tailored to each patient's tolerance and response to the medication regimen. Anti-rejection medications were gradually decreased. Three patients (12%) died from infections during the study and one patient (4%) was withdrawn from this trial. 18 (72%) of the patients were HCV negative at the end of treatment, dropping to 16 (64%) at the 6-month follow-up point.
The Bottom Line: This small, but important study of typically difficult to treat patients, showed a sustained viral response rate of 64%. This was achieved by using a flexible, individualized treatment regimen.
Editorial Comment: When HCV medications were first used, liver transplant patients were usually not treated, primarily for safety reasons. As our experience and understanding of HCV has expanded, so have our options. In this study, not only were transplant patients treated, the majority of them responded to the medications. Look how far we have progressed in such a relatively short period of time.
Article: Pain Management in the Cirrhotic Patient: The Clinical Challenge, N. Chandok and K. D. S. Watt Source: Mayo Clinic Proceedings May 2010 Vol. 85, No. 5, pages 451-458
Patients with cirrhosis often have difficulty taking pain medications due to the liver's reduced ability to metabolize drugs. Cirrhotic patients who take pain medications are at risk for gastrointestinal bleeding, worsening of their liver disease, kidney failure, hepatic encephalopathy (a type of dementia related to end-stage liver disease), and death. This scientific paper reviewed the medical literature, looking at the safety of pain medications. They found that nonsteroidal anti-inflammatory drugs (such as ibuprofen and naprosyn) and opiates (such as morphine, codeine, oxycodone, and hydrocodone) should be avoided. The safest pain medication appears to be acetaminophen (2 to 3 g daily for two weeks). Further, it appears that patients with cirrhosis who drink alcohol regularly can safely take up to 4 g on a short-term basis.
The Bottom Line: The researchers concluded that acetaminophen is likely safe for patients with cirrhosis if taken within prescribed doses. However, they cautioned that these doses may not be safe or suitable for all patients.
Editorial Comment: This literature review is a good start and may be the basis for future, scientific research, such as a randomized, double-blind placebo-controlled study. If the results of a study interest you, discuss this with your medical provider. Never take or stop taking a medication or supplement just because you read about it; talk to your medical provider first.
Article: Alcohol Impairs Interferon Signaling and Enhances Full Cycle Hepatitis C Virus JFH-1 Infection of Human Hepatocytes; L. Ye, S. Wang, X. Wang, Y. Zhou, J. Li J, Y. Persidsky, W. Ho Source: Drug and Alcohol Dependence: An International Journal on Biomedical and Psychosocial Approaches Volume 112, November 2010, Pages 107-116
There has been a fair amount of research examining the impact of alcohol on the liver and general health of individuals with chronic hepatitis C virus (HCV) infection, and this laboratory study adds more to this body of knowledge. A group of scientists at Temple University School of Medicine investigated the relationship of alcohol and HCV, primarily, looking at how alcohol affects the liver cell's immune response, and whether alcohol affects HCV replication (multiplication of HCV). They found that:
The Bottom Line: Based on their findings, the researchers theorize that there is a good possibility that alcohol use may contribute to the chronicity of HCV infection, may inhibit interferon's efficacy and may explain why current HCV treatment does not always have a favorable outcome.
Editorial Comment: This is an in vitro study, which means that the research was performed in a lab, not using humans. Most studies start in the laboratory before tests are conducted using humans. Since a fair number of studies show that alcohol damages liver cells, it could be difficult to conduct a randomized, double-blind placebo-controlled study testing the relationship between alcohol and HCV. This is because the goal of research is to help patients, and since there is a risk that HCV patients could be harmed by alcohol, it may be too risky for those who were assigned to any arm that required them to drink alcohol. Also, it would be difficult to conceal the placebo.
Article: Mild Alcohol Consumption is Not Associated with Increased Fibrosis in Patients with Chronic Hepatitis C; O. Cheung, R.K. Sterling, J. Salvatori, K. Williams, S. Hubbard, V. A. Luketic, T.R. Stravitz, A.J. Sanyal, M. J. Contos, S. Mills, M.L. Shiffman Source: Journal of Clinical Gastroenterology published online September 2010
This research is an interesting contrast to the in vitro study mentioned in the previous section. This trial looked at mild-to-moderate alcohol consumption. These researchers chose this study because there is evidence showing that excessive alcohol use increases the risk for HCV-related disease progression and cirrhosis, but little is known about the use of smaller quantities of alcohol by HCV patients.
This study enrolled 857 participants. They were divided into 4 groups based on their average lifetime daily alcohol consumption: those that basically didn't drink any alcohol, those that averaged <1 daily drink, those that consumed 1 to 3 daily drinks and those that drank >3 drinks per day. Participants were also subdivided into groups based on how long it was presumed that they had HCV: <23 yrs, 23 to 31 yrs., 31 to 38 yrs., or >38 yrs. The designation of mild alcohol use was 1 to 3 drinks daily (< less than 30 grams).
The Bottom Line: The amount of alcohol consumption between those with little or no fibrosis was roughly 2.2 daily drinks compared to those with cirrhosis or advanced fibrosis was 3.2 daily drinks. The researchers felt this was not a significant difference. They did note that there was a significant amount of fibrosis the longer the participants had HCV, independent of mild to moderate alcohol use.
Editorial Comment: This may seem to contradict the previous study, but in fact you can't compare the two. It may appear that both studies are looking at the affect of alcohol on the HCV patient, but each is radically different. First, one is looking at cells rather than humans. Second, one is looking at the immune response and the virus while the other is examining liver tissue. There is no discussion about HCV symptoms. Neither study is a randomized, double-blind placebo-controlled study. Finally, and most importantly, until there is more research to confirm or contradict this study, the prudent course is to abstain from alcohol use. Studies like this look at a group of people, but don't take into account the fact that the average woman is unable to metabolize the same amount of alcohol that the average man can. Also, the amount of alcohol one can metabolize varies between individuals. A single study is usually not a compelling reason to make medical decisions. Back to top Back to Newsletters
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© 2010 Hepatitis C Support Project a project of the Tides Center


text:
An Excerpt by Beverly Straube From Jamestown Rediscovery 1994-2004 by William M. Kelso with Beverly Straube:
The inclusion of a tobacco pipemaker in the first groups of craftsmen is as enigmatic to researchers today as it apparently was to John Smith when Robert Cotton, "tobacco-pipe-maker," arrived on the Phoenix in April 1608.1 No other mention is made of Cotton, so it is not known how long he remained at Jamestown; he is not listed in the muster of 1624-25, so presumably Cotton had either perished or returned to England by then. With archival information lacking, the material evidence of very accomplished mold-made clay tobacco pipes, fabricated from the Virginia red clay and decorated on the stem with European stamps, provides the sole documentation for this early craftsman's work. These distinctive pipes only occur in the early James Fort features that date around 1610 and have not yet been recorded on any other early Virginia sites.
The design of the stamp on the pipe stems consists of four fleur-de-lis forming a cross within a diamond. The sides of the diamond are incurving as on the 1580-1610 pipes documented in England and thought to be the product of London pipemaker, William Batchelor.2 Robert Cotton must also have been a London pipemaker because pipemaking was almost entirely restricted to that city by monopoly, until the second decade of the 17th century.3 Other aspects of Cotton's stamp reflect decorative motifs of late 16th-and early 17th-century London pipes, which most often include incuse "diamond patterns enclosing initials, crosses or fleur-de-lis on the stems."4
1 Philip L. Barbour, ed., The Complete Works of Captain John Smith (1580-1631) (Chapel Hill: The Univ. of North Carolina Press, 1986), 2:325.2 Adrian Oswald, Clay Pipes for the Archaeologist, British Archaeological Reports 14 (1975), 76.3 Colin Andrew Tatam "The Clay Tobacco Pipe Industry in the Parish of Newington, Southwark, London," The Archaeology of the Clay Tobacco Pipe XIII. Ed. By Peter Davey, ed., BAR British Series 239, (1994), 5; D.J. Markell "The Clay Tobacco Pipes," Excavations in Poole 1973-1983, Ian P. Horsey, ed. (Dorchester: Dorset History and Archaeological Society, 1992), 159.4 Oswald: 96

subset: commoncrawl


text:
I'm not afraid.
I'm not afraid to take a stand.
It's been a ride.
I guess I had to--
go to that place to get to this one. Now, some of you likes to be in that place if you're trying to get out.
You're not alone.
Turn it up.
You can try to read my lyrics off of this paper before--
In the sheets, we got 46 of the guys injured that we-- that were able to make it here and their family members in the-- will be in the front rows of this event. Those are the ones I'm gonna have them rise and I'm sure it gets you a lot of applause.
This is a combination of so many things. All the sacrifices that have been made. These young men and women who have done so much, but we also honor the dead and not the wounded. And this is a night to celebrate what they've done for us and to help raise them good money for their recovery.
I'm so excited to see the talent, but also just to honor the military here because at Woman's Day, it really is something we care very deeply about.
We'll raise a lot of money tonight and it goes-- 90% of all the dollars raised goes to help families and I think it's a really great cause. I'm proud to be part of it.
I'm really excited about bringing awareness to just the general public about the military does and how important it is and I think it's just an-- an amazing night to honor, you know, our soldiers and to thank them really for all they've done.
Who will be the most exciting to see tonight?
Bruce Springsteen.
Bruce Springsteen?
Well, [unknown] is pretty great too.
But don't help coming here except to be first.
How does it feel to be honored tonight? I mean this is such an exciting event. I mean so much going on.
Yeah. Are you kidding me? This is-- This is pretty-- This is over the top good.
I think for both of us we're humbled maybe because I am getting to see a lot more of other people that have gone through similar things as my son and my son because he sees the outpouring of love from so many people.
Consider it done.
You're not alone. Holla if you feel like you've been down the same road. Same road. Same--
Special Offer


text:
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Sunday, January 20, 2013Wisconsin
Out on my birthday, on a cold cold day, to find a few caches. WOW, that was tough. I removed my heavy jacket while I attempted this one. Love the series. This was my favorite and deserves a fav pt. #6610, TFTC.
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text:
The Sounds of Silent Q Tonight at Mara's
Wednesday, August 20, 2014 • 7:10am
FANWOOD, NJ -- Accoustic trio Silent Q performs at Mara's Cafe (250 South Ave.) on Wednesday, August 20th at 7:00 p.m.
Silent Q features Shelby "Slim" Jackson (guitar, vocals), Ralph "Opie" Heiss (bass, vocals), and Marc "Herb" Gattuso (guitar, vocals). Their song list includes classic rock favorites such as Brown Eyed Girl, Listen to the Music, and Tequila Sunrise, and alternative hits such as Wrapped Around Your Finger and You Spin Me Right Round.
TAP into your town! Get Your Town's News In Your Inbox: Click here to sign up.


text:
Keep track of all the delicious Slow Food URBAN San Diego events here!
And look at our blog for some past events!
Categories ▾
SoNo Fest and Chili Cook-Off11:00 am – 5:00 pm
SPONSORSClick here for details.
11:00 amSoNo Fest and Chili Cook-Off
December Nights in Balboa Park5:00 pm – 9:00 pm
Balboa Park December Nights, the nation's premier holiday festival, will take place for the 35th consecutive year on Friday, Dec. 6, 3-11pm, and Saturday, Dec. 7, noon-11pm. As always, the event brings families and friends together to spread holiday joy, learn more about the cultural value of Balboa Park and kick-off the "most wonderful time of the year."
Participating Balboa Park museums open their doors free of charge from 5-9 pm both evenings and more than 350,000 visitors are expected to experience the joy of San Diego's largest free community festival. Those who attend will participate in a truly multicultural experience, enjoying food, music and entertainment from around the world.
Revelers can watch top-notch musical and dance performances, enjoy delicious and diverse food choices and help spread a heavy dose of holiday cheer. Some of the more well-known traditions include food from around the globe at the International Christmas Festival at the House of Pacific Relations Cottages; the annual Santa Lucia Procession at the Plaza de California; unique gift shopping at the museum stores and with the artisans of Spanish Village; and musical and dance presentations from the San Diego Junior Theatre, San Diego Civic Youth Ballet, Del Cerro Baptist's Christmas Story Tree, and more.
5:00 pmDecember Nights in Balboa Park
Garden of Lights 2013 at San Diego Botanic Gardens (all-day)Dec 7 – Dec 30
Watch the GOL video – click here
The San Diego Botanic Garden brings your favorite elements of the winter season all to one location. Leave the hustle and bustle of the malls behind and enjoy a relaxing evening strolling through the lighted Garden. The San Diego Botanic Garden is a dazzling winter wonderland filled with over 100,000 sparkling lights illuminating the Garden for a magical holiday experience. Adding to the sparkle is the "Poinsettia Garden," festively decorated with many varieties of poinsettias.
Live music fills the air nightly from 6:00 pm – 8:00 pm. One night there will be the Peace on Earth Christmas Carolers, while another night features lively Mariachis. *A complete lineup will be released in November.
Got Snow? WE DO! It will be snowing at the Garden December 7, 9, 11, 26, and 28. Please bring your own disc or sled (no metal runners please). Weather permitting.
A team of beautiful Blonde Belgian draft horses will provide wagon rides through the lower area of the Garden on December 14, 15, 18 – 23, and 27 – 30.
Santa will greet young and old alike each night from December 7 – 23 from 5:30 pm – 8:30 pm,
in the brightly lit Gazebo, providing a terrific photo opportunity.Guests can stay warm at the campfire while roasting marshmallows. There will also be hot mulled wine in the Lawn House Garden for purchase, and the Coffee Hut will be offering hot coffee and cocoa, and supplies to make s'mores to enhance your marshmallow roasting experience.
Food provided daily by Divine Fresh Foods serving Gyros, Kabobs, Soups and Salads and Baklava!
A variety of special holiday crafts that children can create to take home.
Nutcracker Exhibit displaying a collection of over 50 Nutcrackers.
"Alice and Friends at the Holidays", a display of gourd figures of Alice in Wonderland characters from the original book.
After December 25 when Santa will have departed back to the North Pole, we will have a rotating International Program of Puppet Productions in the Ecke Building.
- Dec. 26 "Harambee", an African folktale in honor of Kwanza about family working together.
- Dec. 27 and 28 "Little Blue and the Trees" from Europe on friendship about birds and why trees lose their leaves in winter.
- Dec. 29 and 30 "The Emperor's Choice": an Asian folktale about seeds and the value of honesty (includes the appearance of large "Gourdeous" green /gold dragon).
Senior Group Visits
- Special Group Rates $7 per person
(30% savings off regular admissions price) - Reserved Bus Parking
- Complimentary Group Photo for Each Participant
- Discounts on Mulled Wine, Hot Cocoa and Spiced Cider
- Call 760-436-3036 x201 to make a reservation
Admission prices:
Members: $8
Non-members: Adults $14; Seniors, Active Military & Students $10
All Children 3-12: $6
Children 2 and under: FREE
Parking: FREESome activities require additional fees.
December 7 – 23 and 26 – 30
5 – 9 pmFor more details, click here.
Garden of Lights 2013 at San Diego Botanic Gardens (all-day)
Christmas in the Valley at Bates Nut Farm (all-day)Dec 13 – Dec 14Description: Start a new Christmas tradition at Bates Nut Farm with "Christmas in the Valley". There will several children's activities. Food will be available for purchase. Santa arrives by fire truck; children can board the Polar Express hayride for a special meeting with St. Nick. Enjoy Christmas shopping at Bates, Farmer's Daughter, and with the vendors who will set up for the 2-day event. There will be plenty of unique gifts for each person on your gift list.
5:30 Santa arrives by fire truck
6:00 Tree lightingChristmas in the Valley Hours:Fri, 4:00 – 8:00 & Sat, 10:00 – 4:00Click here for more details.
Christmas in the Valley at Bates Nut Farm (all-day)
Hands On Italian Trattoria at Great News!6:00 pm – 8:30 pm
Instructor: JENNIFER FELMLEY
Date: Wednesday, January 22, 2014
Time: 6:00 PM – 8:30 PM
Cost: $49.00Recipes: Tuscan White Bean Soup; Creamy Polenta; Polpette Rifatte (beef roulades with crispy pancetta stuffing and red wine tomato sauce); Spinach and Kale with Garlic and Golden Raisins; Tiramisu. This hands on class is limited to 32 people. Please bring an apron and wear closed toe shoes.
6:00 pmHands On Italian Trattoria at Great News! -
The Art and Science of Cuisine at the Salk Institute6:00 pm – 8:00 pm
From event website:
Salk is setting the table and you're invited…
An inaugural culinary event at the Salk Institute certain to whet appetites. Fusing the most recent scientific discoveries with novel kitchen theory, this celebration of food and science will reinvigorate lifestyle choices and usher in a new year of wellness.
Meet San Diego's freshest-thinking chefs and learn how to optimize the nutrition in your home meals
Mingle with Salk scientists who can explain the latest research into the links between nutrition and health—and learn how they've altered their own habits
Sample an extraordinary array of delicious foods
Above all, be inspired!
Please join us for this one-of-a-kind exchange of food and ideas.
For more information, please contact firstname.lastname@example.com or 858-453-4100 ext. 1846.
Featured Chefs
Deborah Szekely – Honorary Chair
Nathan Coulon – Featured food station
Isabel Cruz – Featured food station
Joy Houston – Featured chef
Michelle Lerach – Featured dessert station
Denise Roa – Featured food station
Su-Mei Yu – Featured food station6:00 pmThe Art and Science of Cuisine at the Salk Institute
Truffle Tuesday at Hess North Park5:00 pm – 10:00 pm
Hess Brewing Company North Park will be offering an early Valentine's Day beer & truffle paired flight. This special will include three beers paired with three of Andrea's Truffles made specially for the event. Flights will be $14 and will be available in a limited quantity.
Get here early Tuesday Night and enjoy the excellent pairing. Andrea will be here if you have any questions, if you're looking for a Valentine's gift idea, or if you just want to meet the mind behind the desserts.
Click here for more details!
5:00 pmTruffle Tuesday at Hess North Park -
Cooking Seafood with Catalina Offshore at Great News!6:00 pm – 8:30 pm
Cooking Seafood with Catalina Offshore
Instructor: GOMES & FELMLEY
Date: Tuesday, February 4, 2014
Time: 6:00 PM – 8:30 PM
Cost: $49.00Recipes: Baja Stone Crab Cakes; New England Style Clam Bake; Pan Roasted Halibut with Citrus Herb Butter; Poached Salmon Salad with Green Goddess Dressing. *Tommy will be donating his teaching fee to Urban Slow- Foods San Diego. Recipes subject to change due to availability.
6:00 pmCooking Seafood with Catalina Offshore at Great News!
Hands On: Wine Lovers at Great News!11:00 am – 1:30 pm
Hands On: Wine Lovers
Instructor: JENNIFER FELMLEY
Date: Saturday, February 15, 2014
Time: 11:00 AM – 1:30 PM
Cost: $49.00Recipes: Baby Spinach Salad with Shiraz Vinaigrette, Dried Cherries and Toasted Almonds; Crème Fraiche Mashed Potatoes; New York Strip Steak with Blue Cheese Butter and House Made Steak Sauce; Dark Chocolate Mousse with Raspberries.
This hands on class is limited to 32 people. Please bring an apron and wear closed toe shoes.
CALL FOR AVAILABILITY 858-270-1582. See website for more details.
11:00 amHands On: Wine Lovers at Great News!
February SlowSips at Alchemy Restaurant6:00 pm – 8:00 pm
This month's Slow Sips gathering will be at Alchemy Restaurant! There will be a cash bar and of course, if you show your Slow Food Urban SD membership card, you receive 15% off any food and beverage purchases.
6:00 pmFebruary SlowSips at Alchemy Restaurant


text:
The Cape Fear Community College Bond Referendum was another issue voted on in the election Tuesday. The 164 million dollar bond will expand the college and add 3 new buildings, at a cost of 5 cents for every 100 dollars of assessed values for New Hanover County property owners.
Almost 88,000 people voted on the bond. 62% voted yes and 38% voted no. It was a large margin despite mixed emotions on the tax hike.
In 2005, when the economy was fine, Cape Fear Community College could not get a 27 million dollar bond passed to reduce over-crowding. Remarkably, this year when the economy is struggling, they were able to pass a 164 million dollar bond easily.
"The last time in 2005, we had a 9% voter turn out. When 9 % of the voters turn out 5% can defeat you, and this time we had 2/3rds of the registered voters turn out, that can make a tremendous difference," said CFCC president Eric McKeithan.
Adam Ray is a local who voted for the bond. He fully supported the future benefits of the bond. "Being able to get a solid job in our economy is a price that people are willing to pay to have a better future."
Last semester, 1,000 students were turned away from CFCC. The bond will pay for the constructions of 3 new buildings so the school can accommodate more students.
Not everyone thinks the bond should have passed however. "People are losing their jobs and I just can believe that people will vote to give a school 164 million dollars to take care of its needs when the city needs so much more," said Anecia Smith.
The first building will be a general education building built on the corner of Front and Red Cross
streets, and should be completed by 2012. The other two buildings will be completed by 2016...
The building on North Front Street will be designed to look like a historic building. The next building will be for health care training and will be on 3rd and Walnut streets.
The 3rd building will be at the North Campus and will be designed to train what any new industry that is coming to the area.


text:
Where: Zoo
When: Monday-Friday, 12:30 p.m. – 4 p.m.June 8-12, 22-26 or July 13-17 From the Arctic to the Amazon, you'll explore amazing habitats to find out which animals call each place "home." What's the connection between orangutans and candy? How does hippo dung support an entire ecosystem? What's so important about frogs? Join us for a global adventure to discover the answers to these questions and more! You'll also find out what you can do to help protect animals from around the world.
BioPark Education staff and volunteers look forward to seeing you at Camp BioPark. We will email additional details to you the week before your camp. If you have questions, please contact BioPark Education at 505-848-7180 or email@example.com.
Thank you!
Purchasing a "drop-in" date allows you to attend this class just once (or as many times as you like) without having to enroll in the class full-time.
To purchase a drop-in date, enter the date you wish to purchase below. You can enter additional dates by clicking the "add another date" link. When you're ready to purchase your dates, click the Purchase Dates button.


text: tqbfjotld wrote: > I noticed that runit calls /usr/bin/nALFS whereas it is located in > /usr/local/bin/nALFS. Yes, there are some in the LFS-5.0 profile that need to be corrected, this is one of them. > > It is true that list of packages in package.ent and in the tarball with > all packages differs. Some are .tar.gz in the first and .tar.bz2 in the > other one. I will work with David to get the profile updated to match the "standard" tarball. > -: make[2]: *** [/tools/build/glibc-build/intl/tst-gettext.out] Error 1 > -: make[2]: Leaving directory `/tools/build/glibc-2.3.2/intl' > -: make[1]: *** [intl/tests] Error 2 > -: make[1]: Leaving directory `/tools/build/glibc-2.3.2' > -: make: *** [check] Error 2 This is not an ALFS-related problem, it's actually an LFS build failure. Check the FAQ/list archives to see if this problem has been reported, and if not report it to lfs-support.


text: Results 1–10 of 508 for "women"X Refine Your Search Refine Your SearchX TopicTherapy (143)Emotional health (90)Women & men (56)Education (45)Children (34) 51 more... 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(1)APA Center for Organizational Excellence (1)APA Task Force on the Psychosocial Effects of War on Children and Families Who Are Refugees From Armed Conflict Residing in the United States (1)APA Working Group on Assisted Suicide and End-of-Life Decisions (1)Hide details Contact APA Publications Results 1–10 of 508 Previous 1 2 3 ... Next Relevance Title A-Z Title Z-A Newest First Oldest First Sort by: 1.No Safe Haven: Male Violence Against Women at Home, at Work, and in the CommunityThis book offers an in-depth systematic examination of male violence against women by focusing on the physical abuse, sexual assault and sexual harassment that many women endure at home, at work, at school, and in the community.Book/Monograph (July 1994)2.Psychological Practice With Women: Guidelines, Diversity, EmpowermentThis book presents and illustrates practice guidelines for working with diverse groups of women.Book/Monograph (September 2014)3.Health Care for Women: Psychological, Social, and Behavioral InfluencesThis APA book, geared for medical and mental health professionals, integrates psychosocial, behavioral, and medical perspectives to encourage health promotion and disease prevention for women.Book/Monograph (June 1997)4.Abused Women and Survivor Therapy: A Practical Guide for the PsychotherapistThis state-of-the art treatment manual contends that traditional psychotherapies for trauma victims have been insufficient in treating abused women. The author describes critical modifications to traditional practice that will allow practitioners to work more effectively with female victims of abuse.Book/Monograph (November 2000)5.The Best of Intentions: Predicting Managers' Intentions to Hire, Develop, and Promote Women in Science, Engineering, and Technology FieldsIn this issue, researchers report the results of their investigation on the intentions of managers to hire, develop, and promote women in science, engineering, and technology professions.Web Page (July 2014)6.Relationships Among Asian American WomenThis APA book brings insight into Asian American women's lives by a scientific exploration of the relationships they form together.Book/Monograph (June 2000)7.Understanding Depression in Women: Applying Empirical Research to Practice and PolicyThe book surveys the findings of experts in depression in women and explores the latest findings on treatment, prevention, and service delivery.Book/Monograph (April 2006)8.HIV/AIDS and Ethnic Minority Women, Families, and CommunitiesSpecial issue of the APA journal Cultural Diversity and Ethnic Minority Psychology, Vol. 5, No. 3, August 1999. Includes articles about gynecological, reproductive, and sexual health; motherhood; sexual risk taking; disclosure of HIV infection; trauma, substance use, and HIV risk; psychiatric disorders; relationship violence; male partners of HIV-positive women; and HIV/STD prevention research.Journal Special Issue (August 1999)9.The Psychology of Women's Health: Progress and Challenges in Research and ApplicationThis edited volume examines the most pressing health concerns of women from a psychosocial perspective and points the way toward the next decade of research in this long-neglected area.Book/Monograph (July 1995)10.Why Aren't More Women in Science? Top Researchers Debate the EvidenceThe most reliable and current knowledge about women's participation in science is presented in this collection of fifteen essays written by top researchers on gender differences in ability.Book/Monograph (November 2006) Previous 1 2 3 ... 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text:
Family finance lessons: Author Amy Tan
Dec 4, 2013
"Joy Luck Club" author Amy Tan tells us what money lessons she learned from her family, growing up in China.
Outsourcing giant Infosys faces record immigration fine
Oct 29, 2013
Infosys allegedly used the wrong type of visa to bring thousands workers into the country.
'Bed mandate' ensures 34,000 immigrants are detained each day
Interview by
Oct 18, 2013
The measure keeps the government paying billions to fund immigrant detention centers.
Immigrant entrepreneurs benefit by improving credit scores
Oct 14, 2013
A San Francisco group helps launch small business owners with micro-loans, which in turn create a path to mainstream credit when they are ready to expand.
Farm workers march for immigration reform
Aug 14, 2013
Thousands of farm workers marched today in favor of promptly legalizing undocumented immigrants. Some farmers, however, want to hold out for a better deal.
How immigration reform advocates are trying to sway lawmakers' opinions right now
Aug 13, 2013
Activists on both sides of the immigration debate use the Congressional recess to pressure lawmakers.
Britain's immigration crackdown sparks anger
Aug 8, 2013
In Britain, a recent government crackdown on illegal immigration has had trucks touring immigrant neighborhoods with signs inviting undocumented immigrants to go home or face arrest. Some say this is heavy-handed.
Professional video gamers eligible for athlete visas
Interview by
Jul 16, 2013
Riot Games says it has successfully lobbied immigration services to provide visas for competitive gamers -- the same kind usually reserved for professional athletes.
Lawmakers look to America's northern border
Jul 12, 2013
The U.S. border with Mexico may get all the attention, but the Senate's examining security issues along our border with Canada.
Have lobbyists spent too little on immigration reform?
Jul 10, 2013
It's crunch time for lobbyists pushing immigration reform. How much should lobbyists spend to get legislators on board?


text:
SAFE Director Margaret Morton said the two groups are going to join forces to promote the city of Sylacauga.
"We want to join forces as we grow, gain momentum, to advance Sylacauga," Morton said. "We need to get the word out that Sylacauga is a wonderful place to live, play, worship, and do business."
"There has been a real interest on part of the business community to create a downtown block party," Morton said.
Rather than have two separate events, the two groups will focus upon having a block party that will feature vendors, activities for children and special guest and "home town hero," Troy Jones.
Jones is a successful songwriter for Carnival Music in Nashville and performers including George Strait, Alan Jackson, Billy Currington, Kenny Chesney, Tim McGraw, Jake Owens have recorded his songs.
Jone's hit "People are Crazy," received a Grammy nomination in 2009 and was nominated by both the CMA (Country Music Association) and ACM (Academy of Country Music) for Song of the Year.
Morton said the event will "celebrate our youth" and focus upon youth events.
To help promote Sylacauga as part of the Nation's "100 Best Communities for Young People," Morton said Chamber of Commerce Director Carol Bates is looking into purchasing flags to promote "100 Best" to be distributed in strategic locations throughout city.
Morton also said merchants in town were requesting stickers promoting the city to place on their customers' bags.
The block party will be followed by a Sylacauga Education Foundation event at Harvey's on Noble. The event will feature jazz performer Eric Essix.
Morton announced another meeting will convene Feb. 13 at the Hickory Street Café at Coosa Valley Medical Center to continue planning for the block party.
"We want to move forward on developing a plan and assign responsibility for the block party," Morton said.
Morton shifted interest away from the block party to emphasize the work of Alabama Childhood Food Solutions directed by Jim and Linda Jones.
"Many of us involved in feeding our children in our community," Morton said, "and it is nice to hear what has been going on in their [the Jones'] work and their working in schools."
Jim Jones said 19,400 meals were served in 2012 and 5,700 carry out meals have been distributed to children in Sylacauga city schools, as well as B.B. Comer and Fayetteville, during January.
Jones said as funds become available the program wants to expand to include Childersburg and Sycamore.
"God is blessing as we need," Jones said. "We give it away and there is no need for a warehouse."
Morton said the plan was to start small and then expand. She said approximately 20 students at each school receive meals in their backpacks and will not have to go through the weekend hungry.
Morton said plans for the summer include community food stations and with assistance from Jones and The Sanctuary Church of God meals will be prepared and available in the early evening.
"This will be the first time the Sylacauga Board of Education will have the capacity to assist us in doing this very thing," Morton said. "It will not only be kids, but also walk-ups."
Morton said the education board will be able to assist because education will be included in the food distribution. Anyone receiving food will also receive teaching and materials regarding healthy eating.
This spring the healthy snacks program will expand to include meals. Morton said food will be distributed at Sylacauga's First Methodist and First Presbyterian Churches.
Until The Sanctuary is able to serve, Morton said Sylacauga Housing Director will temporarily assist in the program. Eventually The Sanctuary will prepare and deliver meals to be distributed by volunteers.
Attending the meeting were representatives from Cheaha Regional Mental Health, Coosa Valley Medical Center, the Sylacauga Chamber of Commerce, members of Sylacauga Promise Committee, SAFE staff, and Sylacauga Mayor Doug Murphree.
Contact Mark Ledbetter at email@example.com


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I am researching the Gavel family of Gavelton, Nova Scotia. John Gavel & Sarah Gavel started it all, having landed in Roseway, Nova Scotia (Shelburne), after fleeing New York at the end of the Revolutionary War. But, where John Gavel was born remains a mystery. Some believe that he was Dutch or German, while others think he may have been French or English. Hopefully, some day, we will find the answers to this puzzle. |
The Gavel's of Gavelton, Nova Scotia, Canada
Updated August 17, 2001 |
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The Great Comic Book HeroesFantagraphics is proud to publish Jules Feiffer's long out-of-print and seminal essay of comics criticism, The Great Comic Book Heroes, in a compact and affordable size. In 1965, Feiffer wrote what is arguably the first critical history of the comic book superheroes of the late 1930s and early 1940s, including Plastic Man, Batman, Superman, The Spirit and others. In the book, Feiffer writes about the unique the place of comics in the space between high and low art and the power which this space offers both the creator and reader. The Great Comic Book Heroes is widely acknowledged to be the first book to analyze the juvenile medium of superhero comics in a critical manner, but without denying the iconic hold such works have over readers of all ages. Out of print for over 30 years, Feiffer's book discusses the role that the patriotic superhero played during World War II in shaping the public spirit of civilians and soldiers, as well as the escapist power these stories held over the zeitgeist of America. With wit and insight Feiffer discusses what the great comic book heroes meant to him as a child and later as an artist. |
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Review: The Great Comic Book Heroes
Recensione dell'utente - TrumanCoyote - GoodreadsThis was at its best when it was personal and rather lyrically whimsical (both regarding his time as a fan and as a laborer in the field). Unfortunately though--Feiffer being Feiffer--he couldn't help ... Leggi recensione completa
Review: The Great Comic Book Heroes
Recensione dell'utente - Jason Cytacki - GoodreadsShort and to the point. For its length and date of publication it contains some really great insights into the superhero myth. Jules spends only a little time reflecting on his own memories and ... Leggi recensione completa


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Support the "Teaching Geography Is Fundamental Act (TGIF)"
This is a great initiative. If you have been following the news lately, you have discovered that we are facing a crisis in Geographic Literacy in the United States. Please take the time to send your representatives a letter in support of funding in this area. The GeoSpatial Industry is growing at a rapid rate and is beginning to find itself embedded in various industries. Young students need to develop these skills further which will only assist them in the career paths they are beginning to choose. This website is very easy to use. The letters are already written and it will send them for you. Just click the Take Action button below to get started. Your support is very much appreciated. Thanks, GEO-Jobe GIS
from the http://speakupforgeography.rallycongress.com website:
Geography has long been recognized as a "core academic subject" in federal education legislation. However, unlike all the other core academic subjects, including history, civics, economics, foreign languages and the arts, there is no dedicated federal funding stream to advance geography education. As a result, our nation is facing a crisis in geographic literacy that is jeopardizing our global competitiveness, our position of diplomatic leadership, and our ability to fill and retain over 150,000 jobs in geospatial technology in the next decade.
The Teaching Geography Is Fundamental Act (TGIF) is federal legislation which would authorize grants to universities and nonprofit organizations for programs to expand geographic literacy among American students and improve the teaching of geography at the K-12 level.
TGIF authorizes $15 million per year for five years.
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Stormwind City
Fish that can be caught in Stormwind City.
About Stormwind City
Fishing in Stormwind City
Open Water Skill:
75 to fish open water without junk. Pools can be fished effectively with skill 1.Notes:
Azeroth Daily Fishing Quests (Alliance) in Stormwind start from Catherine Leland, standing by the Canals.Commentary:
For a guide to fishing in the opposing faction's capitals, read Cross-Faction Fishing. Billy and Adam, a pair of human children, run around Stormwind to fish. They were discussing Mr. Pinchy a long time before any angler caught it, so you might wish to listen to their stories.Achievements:
- Fish or Cut Bait: Stormwind: Complete all 5 of the Stormwind fishing daily quests. Alliance only.
- The Fishing Diplomat: Fish something up in Orgrimmar and Stormwind City. Fishing in Stormwind Harbor will complete the Stormwind part. Horde can fish the coast near the harbor without ever dodging a guard.
- 4.0.3: Several new lakes at the northern end of the canal system. New Azeroth Daily Fishing Quests. Harbor reverts to inland fish.
- 3.0: Stormwind Harbor added, with the same inland fish as Stormwind City. Coastal fish appeared in the harbor during November 2008.
Water and Area | Fish | Catch Rate | Notes | Other Catches | ||
% of Catch | Sample | |||||
Open Water - Coastal and Inland | Raw Longjaw Mud Snapper | 55% | 2049 | - | Armor, weapons, and certain ("world drop") professions recipes | |
Raw Bristle Whisker Catfish | 25% | - | ||||
Raw Brilliant Smallfish | 20% | - | ||||
17-32 Pound Catfish | <1% | - | ||||
Bloated Mud Snapper | <1% | - | ||||
Lesser Healing Potion | <1% | - | ||||
Lesser Mana Potion | <1% | - | ||||
The 1 Ring | <1% | - | ||||
Baby Crocolisk | - | Quest Only | ||||
Crystal Bass | - | Quest Only, Olivia's Pond only | ||||
Gigantic Catfish | - | Quest Only, City, Stormwind Lake and Canals only | ||||
Hardened Walleye | - | Quest Only, Stormwind Lake only | ||||
Royal Monkfish | - | Quest Only, Valley of Heroes only |
Learn More
- Achievements - Achievements that involve fishing.
- Cross-Faction Fishing - Guide to fishing in the opposing faction's capitals - Ironforge, Orgrimmar and Stormwind. Required for The Fishing Diplomat, Old Crafty, and Old Ironjaw achivements.
- Azeroth Daily Fishing Quests (Alliance) - Guide to completing the Alliance Azeroth daily fishing quests.
- Outland Daily Fishing Quests - Walkthrough for all the level 70 daily fishing quests, with rewards.
Comments about Stormwind City
Below are readers' comments about "Stormwind City":
Phased Stormwind
Basill, December 2010
It seems that the daily fishing "rock lobster" from SW cant be completed if you have the "Call to duty" quest to Vashjír due to Phasin...
Astragal, December 2010
That's unfortunate. I have noticed quite a few issues with phasing while mining and even seen fishing pools , notably in Uldum which will appear on the mini-map and you can see them, but then disappear when you get close. I can give coords if interested.
There is a lot if unhappiness on this and also confusion with talk of ground botters etc. But mostly it is phased nodes with people being able to mine/ fish in one phase but not another etc.
Also with the constant "In Combat', 'Leaving Combat' randomly happening just flying around hopefully they can resolve it and work out how nodes/ pools are displayed and or available.I can't remember examples in WotLK of this with fishing pools.
Trokair, January 2011
Moonraker wrote:
That's unfortunate. I have noticed quite a few issues with phasing while mining and even seen fishing pools , notably in Uldum which will appear on the mini-map and you can see them, but then disappear when you get close.
Has anyone ever touched upon this subject again, or got any more information on it?
Currently fishing in Uldum and it is driving me nuts. There's like 4 nodes in Schnottz Landing that disappear in this fashion when you get close to them. Phasing fishing pools FTL!
Expand 5 more comments
from "Phased Stormwind".
Astragal, January 2011
The Stormwind phasing issue was fixed but phasing in other zones including notably Uldum has not and it is causing quite a bit of protest also with herb and mining nodes. No word from Blizzard yet on this.
It is really a silly situation because in Uldum no matter if you have not done any quests or completed them all it is the same issue and those fishing pools around Schnotzzs' Landing can never be fished out and reduce the available pools on the coast because of this.
They really just need to make nodes available at any phase, or at least state if not, why not and for what purpose.
Turin, January 2011
Well fishing pools that are not visible in your phase, can be fished, but it is rather difficult, therefore someone may take nice screenshots to see where these pools are, to reliably cast your line to the pools. They count towards the fishing guild achievements, and are empty after some catches, you can locate the near phasing nodes by flying at high speed (you need to fly in the same direction for about 5 sec so that the searching for nodes programming searches for nodes before you, so you can see where all nodes are and take the pics to see where you have to fish for those nodes.
This icreases the chances that you find fishing pools at other locations.
Issues to solve:
We need pictures (i can't take them)
Koregoth, March 2011
Heres a video link to youtube of a Angler fishing phased Fathom Eel pools with the raid marker tool in Uldum i found that the mark would phase away with the pool but they def can still be fished!
Thalen, September 2011
/delurks and necros this thread
Was just out there fishin' up some eels, and I was able to both see and fish in the pools in Schnottz's Landing, looks like they're either fixing or have fixed this issue. Phasing issues seemed to be completely gone there. Will have to check out other areas (and mining nodes as well...that would be nice!)
Astragal, September 2011
Thalen wrote:
/delurks and necros this thread
Was just out there fishin' up some eels, and I was able to both see and fish in the pools in Schnottz's Landing, looks like they're either fixing or have fixed this issue. Phasing issues seemed to be completely gone there. Will have to check out other areas (and mining nodes as well...that would be nice!)Most of the phasing issues in Uldum were fixed with 4.2 including the fishing pools you mention and mining nodes.
to "Phased Stormwind".
Comments are posted on the forums. To comment you can reply to the topic above, or start a new topic: Use the page's name (Stormwind City) as the topic title, or tag the topic with that name. To edit a comment, view the original forum thread (while logged in), and make changes there. New comments or changes take a few minutes to appear here.


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Up for sale is a Brown Kobra Carry all stainless, I have the bag two mags and two sets of grips the G10 one that are on it in my avatar pic and a set of Esmeralda's. The gun has about 600 rounds thru it. I also have a Milt Sparks Versa Max II trimmed in shark all black. $2100 takes it all. Will post pics soon, MSG me if you want pics before I can get them up here.
Would like to do face to face in KC aera but will ship to your FFL for $25.


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The reality star reveals to her sister Kourtney and stepbrother Brandon that getting pregnant has been much more stressful than she anticipated, and she's worried it may never happen for her. Watch the emotional clip.
Khloe Kardashian has been vocal about her struggles to get pregnant, but on the March 31 episode of Kourtney & Kim Take Miami, the 28-year-old, who has been married to her NBA hubby Lamar Odom for more than three years, reveals just how hard it has been to conceive the baby she so desperately wants.
Khloe visits with her stepbrother Brandon Jenner and his wife, Leah Felder, and opens up just how difficult it has been to welcome a baby.
"How long have you guys been trying?" Brandon asks. "Since I married Lamar," Khloe says.
Khloe Kardashian Reveals Her Fertility Treatments
When Leah suggests Khloe just take a break from worrying about getting pregnant and letting it happen naturally, the X Factor host says she and her hubby have done just that before.
"About a year ago, we were like, 'Let's just see what happens.' And then when it didn't happen, [sister] Kim [Kardashian] was like, 'Let's go to the doctor. I found out I don't ovulate, and now my uterus lining isn't thick enough and I have to take pills to make my uterus lining thicker. If that doesn't get thicker, then I cannot carry a baby."
Kourtney Kardashian 'Sad' Khloe Can't Get Pregnant
Her older sister Kourtney Kardashian was at the table for the discussion, but says in her private interview that she feels bad for her little sister:
"I overhear Khloe talking about her pregnancy drama, and she never really talks to me about it anymore. I kind of don't really ask her, because I don't want to always bother her. It just makes me sad that she has to struggle with getting pregnant."
Kourtney suggests that she may serve as a surrogate for Khloe. Of course, Khloe asks her if she'd really push her baby "out of her vag."
WATCH: Khloe Kardashian Discusses Her Fertility Struggles
– Christina Stiehl
More On Khloe's Fertility Struggles:
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- Khloe Kardashian On 'GMA': I Never Knew It'd Be So Hard To Get Pregnant
- Khloe Kardashian: I Am Sure I Will Get Pregnant One Day
View Comment
Posted at 6:44 PM on April 17, 2013
Going thru infertility is the most heartbreaking silence pain a woman can go thru, you can not understand it until you live it..you are happy for others having babies but can't go to their showers because you have this overwhelming cry waiting to come out, espcially when you see unmarried, younger not ready to appreciate the beauty and miracle of life being given these little miracles and you are a stable married woman with all in place just waiting for a child to love..I pray she has a child and know that she will be a great mom, she definetly will value the miracle of life than her sisters and will embrace all that pregnacy brings instead of whining as her sisters have. Never give up the fight, its the hardest fight but the most rewarding fight.
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Posted at 8:51 PM on April 20, 2013
Posted at 1:30 PM on March 30, 2013
I love khloe and lamar and fully and truly believe they are meant to have a big family no matter how it happens, IVF, surrogocy, naturally, or even by adoption. Their are so many beauiful babies in the world that khloe and lamar can make their own and give ALL of their love to and I'm more than sure with the BIG hearts of he whole Kardashian/Jenner family that they will easily follow suit. Love u guys! Keep your heads up. ;-)


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Commissioners waive moratorium
Published on -6/2/2008, 11:43 AM
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E-Mail This Story
By KALEY LYON
Hays Wind LLC's plans for a wind farm south and southwest of Hays will continue, and sooner than originally anticipated.
A year-long moratorium required by Ellis County's zoning regulations regarding a conditional-use zoning permit was waived by county commissioners in a 2-1 vote at this morning's meeting, with Commissioner Perry Henman dissenting.
Commissioner Vernon Berens and Chairman Dennis Pfannenstiel both spoke in favor of wind energy development within the county and granting the waiver to speed up the process.
"Without a doubt, Iberdrola has made some changes in the application," Berens said. "Without a doubt, wind energy will take place in Kansas, in the U.S., in the future. ... Without a doubt, I'm supportive of it, and Mr. Chairman, I would make the motion for the waiver."
Because the waiver was granted, the company's application officially will be filed with the Ellis County zoning office, starting the public hearing process. After the joint planning commission makes a recommendation for the permit, the issue will be back before county commissioners for final vote.
The year-long moratorium went into effect when the conditional-use permit was denied by the county commission in September. Had the waiver not been granted today, the company could have proceeded regardless in three months.
Henman, however, was again the lone dissenter, repeating concern about the timing of the issue and the fact the joint planning commission has not yet finished making its revisions to zoning regulations.
"Again, I come back to the deal that the zoning board has not completed its process," Henman said. "They can refile this without a waiver in three months, so why are we stepping on their toes? Let's give them a chance to do this."
Henman also said, while the second application is better than the original, he does not believe the company has made a substantial change to its application.
"I think a substantial change, a good cause would be if the people that are protesting withdrew their protest," he said. "And I don't think that's happened."
Henman also pointed out there are three other projects being considered in the county and said he would like to see a moratorium on all development until the revised regulations have been established.
"I'd hate to fight this battle over and over again," he said.
"Our regulations will never be perfect. I'm looking at the economics of this county," Berens interjected. "I think it's up to the zoning board to work out the details. I don't think it's up to us."
"At this point, all we're concerned about is the waiver," Berens added. "Three months doesn't make a difference. I think we need to get started with it. And that's why I made this motion."


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Below you will find points of interest for many different activities in Athens, Ohio. Use the interactive map to plan your visit. Plot restaurants, attractions and hotels by selecting from any of the categories below. Use the map controls to zoom in close to town, or zoom out to get the big Athens County picture.
Partial matches will be found; you do not need to enter the entire name. Do not use single or double quotes unless you are searching for those characters within a name.


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The family of an elderly Florida woman is furious that she was hauled off a commuter train because she was singing spirituals and are considering legal action.
The family of Emma Anderson, 82, claim she was injured by a Metro-Dade Transit security guard who they said roughly yanked her from a train seat and escorted her off the train on Feb. 20.
Anderson of Miami-Dade, was singing spiritual hymns from her train seat when a security guard asked her to stop. The security guard told Anderson that she was being disruptive.
"I was beating my little beads with the bottle and I was singing a song, and he came up to me and said, 'Ma'am, you're making too much noise,'" Anderson told ABC News affiliate WPLG.
A passenger started recording Anderson and the guard's interaction on his cell phone. The video shows Anderson being forcibly removed from the train.
"By what we saw on the footage, she was dragged off the train. She wasn't escorted," Anderson's son, Kenny Anderson, 42, told ABC News. "She was just singing to the Lord, preaching to the Lord, and he grabbed her bag and drug her off the train."
Kenny says the security guard pulled the bag his mother was holding so hard that she fell backwards and hurt herself.
"We took her to the hospital and they took X-rays. Doctors say she has a bruised hip and shoulder," Anderson said.
One of the witnesses is heard on tape demanding the name of the security guard.
A spokesperson for Miami-Dade Transit told WPLG in a statement, "The elderly passenger, Ms. Anderson, who was escorted from a Metrorail train, was initially asked by a security guard to refrain from singing loudly and playing an instrument while on the train. She refused to comply."
The spokesperson said singing, dancing or playing an instrument are prohibited without permit.
"Ms. Anderson's singing was causing a disturbance to other passengers and impeding important train announcements from being heard. We regret that Ms. Anderson had to eventually be escorted out, but regardless of age, all passengers need to abide by the rules associated with using transit," the statement said.
The Anderson family said they have hired an attorney and plan to pursue legal action for their mother's injuries.


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bio | website | |
location | Israel | |
age | 28 | |
visits | member for | 2 years, 1 month |
seen | Mar 10 '13 at 11:20 | |
stats | profile views | 3 |
I have 5 years experience in web and database development, full dev lifecycle from UX to takedown. Have worked for some interactive agencies, plus freelance projects.
Experienced with PHP/LAMP, advanced SQL development including MySQL, Posgres, dabbled in Oracle; Wordpress, Joomla, JS/CSS/HTML5, JQuery, Webwork, Spring including the MVC stack, Maven 1 & 2, Groovy, social APIs (Twitter, YouTube, etc.), Google APIs. Linux OSs: CentOS, Ubuntu. Recently getting into development and management of SharePoint server, following demand from a few of my clients.
I'm a big fan of Jazz and Israeli folk rock (yes, there is such a thing) and play some guitar myself. Unfortunately there is a clear winner in the battle between music and web development, and it's not music :)
"Do androids dream of electric sheep?" Asimov