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Welcome to the forum:
Welcome to the iThemes forum. We've created several tutorial video's to help you get you started with using the forum, please check them out!
Also take note of the forum guidelines.
Support hours:
Our moderators actively respond to forum support requests during normal business hours which are Monday-Friday, 8am - 5pm Central Standard Time, typically within one business day. Although some moderators choose to work during the weekends, we can not guarantee immediate attention to your requests. Thanks for understanding.
What is included with support:
Premium support includes theme/plugin issues such as: bugs encountered under normal operation, how to use basic features, basic WordPress help, and basic help with customization (meaning we point you to resources and will help in more depth as time allows). More information.
Changes to Builder license renewal.
Posted 30 August 2011 - 11:04 AM
My license for builder does not expire until 01/21/2012. Are you telling me you want/need my money now for me to be able to renew something that doesn't expire for almost 6 months to keep what I was promised when I bought it?
I bought Builder, with the unlimited child themes and an annual renewal for the same. Are you taking that away from me unless I pay you $97 now, before renewal, or if I wait then charging me a higher rate later of $197 when reneewal comes along, AND no more unlimited themes to boot???
Posted 30 August 2011 - 01:32 PM
Thanks for posting this! To clarify: your license will remain unchanged until 01/21/2012 � you don't have to do anything now and you do NOT have to pay the higher price now.
All current license holders stay with their current license and do NOT have to pay anything extra for the remainder of their license.
We were only suggesting people to upgrade now if they wish. I think our wording on the post came out wrong and gave the wrong impression that current license holders have to pay the new fees before their license expires? Does it clearly give that wrong impression to you ( and others ) also?
Again, your license will remain untouched and continue fully, like it is, until your license expires. Only then ( in 01/21/2012 ) will the new fees take into effect.
Does that make sense? Please let me know.
Edited by Bes Zain, 30 August 2011 - 10:04 AM.
Posted 30 August 2011 - 05:31 PM
As a matter of clarification on Dan's question, taking his expiration date of 1/21/2012 for example, if he decides to wait until 1/15/2012 to renew his annual license instead of doing so now before this pricing shift, would he be subject to the $197 fee?
Posted 30 August 2011 - 05:45 PM
Welcome to the forums!
Yes, the new priceswill go into effect for all future customers and also all future license renewals on September 1st. License prices that you pay apply to the current term of the license. You do not have to pay anything extra for your current licenses, since you already paid for your existing license.
If you renew now, before September 1st, you'll get locked into the current prices for another term year. As mentioned on the Facebook post (https://www.facebook.com/notes/ithemescom-premium-wordpress-templates/new-ithemes-builder-packages-coming-september-1st-renewpurchase-now-at-current-r/10150294960654406) "(This means you can still purchase � or renew � the currentall-inclusive iThemes Builderpack at the super-low price of $97 through the end of August.)"
So any prices changes (like last year we reduced them, and we just announced the price increase for September this year) affect new licenses or license renewals on the new price deadline date (which is September 1st for this new price change).
Does that make sense? Please let us know.
Edited by Bes Zain, 30 August 2011 - 01:18 PM.
Posted 30 August 2011 - 06:38 PM
- If someone misses the renewal deadline of Aug 30th for the $97, I take it that the renewal option for the current package will be removed, so will people have to wait until the end of their current term to buy into the $197 developers package?
- If someone decides to renew the current package at the $97 price but then purchases a LoopBuddy license at a later point (something I'm considering), then comes up against the $197 annual renewal later, can arrangements be made to reconcile the whole thing together?
- Where do the Billboard and Rotating Images plugins sit in the new packages?
Posted 31 August 2011 - 01:18 PM
Thanks for posting back. Let's go through these one by one:
1 : The special renewal price of $97 will be removed after the deadline, yes. After that (today), you can always renew or extend stuff by emailing email@example.com - however, to renew at the special price of $97 after the deadline, you can ask via that email if it's possible. They'll work with you on it to see if that's (or what's) possible.
2 : Good question. Unless I'm mistaken, the $97 (or any current renewal/purchase of that package) gets you LoopBuddy. So you won't have to purchase LoopBuddy later. If you do purchase LoopBuddy later, it will be treated as a separate license. You can always email email@example.com to clarify this more regarding your exact purchase dates and the number of sites you would like LoopBuddy on.
3 : Billboard and Rotating Images are separate from these 2 new Builder packages, and can be purchased/treated as separate licenses in your Member's Panel. So basically they're completely separate (and alsopart of PluginBuddy bundles).
Does that help? Please let me know! Thank you again for being with us.


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Patricia "Patty" Austin, 57, formerly of East Clark Street, Ilion, passed away on Nov. 9, 2012, at MUSC, Charleston, SC.
Patricia "Patty" Austin, 57, formerly of East Clark Street, Ilion, passed away on Nov. 9, 2012, at MUSC, Charleston, SC.
She was born on Oct. 13, 1955, in Ilion. Patty graduated from Ilion High School in 1974. She was married to Robert "Bob" Austin on Oct. 27, 1973, in Frankfort. Mrs. Austin attended Ilion United Methodist Church. She enjoyed going out with her daughters and friends.
Survivors include her loving husband, Robert "Bob" Austin, who was by her side for two months, twenty-four hours a day; her children, Heidi Pettengill and her husband, Russell, Todd Austin and his wife, Michele, William Singer, Richard Austin, and Connie Varieur and her husband, Shawn; her grandchildren, Sean, Joshua, Alexis, Gabrielle, Michael, Todd, Jr., Marissa, Paige, Julia, Katlyn, Gavin and Jace; her siblings, Carol and Ron Gillette, Sharon Putnam, Robert and Donna Adams, Donna and Doug Rockwell and Gary Ray; her in-laws, Grace McDonough, Jean Suiter, John and Vicki Austin and Brian Muzzy; several aunts, uncles and cousins; many special nieces and nephews; and her close friends, Kim, Corky and Jean, just to name a few.
She was predeceased by her parents, Paul Adams and Jean and Frank Laventure; a sister, Judy Ray; sisters-in-law, Margaret "Peggy" Everson and Evie Muzzy; brothers-in-law, Kenneth Putnam, Donald Suiter and Elmer "Skip" Austin.
A Memorial Service will be held 2 p.m., Saturday, May 11, 2013, at Armory Hill Cemetery, Benedict Avenue, Ilion, with Rev. Robert Wollaber, pastor of Morning Star United Methodist Church, officiating. A dinner celebration of Patty's life will follow at the Herkimer VFW Post in Herkimer.
Anyone wishing to share a memory of Patty, or add to her online memorial, may go to www.applegateandday.com on the Internet.
The Austin family has entrusted all service arrangements to Applegate-Day & Enea Family Funeral Home, Ilion, Don Applegate, funeral director.
Location, ST | website.com

subset: commoncrawl


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A Very Merry Christmas
By Various
A Very Merry Christmas composed by Various. For Piano/Vocal/Guitar. Piano/Vocal/Guitar Songbook. Christmas and Sacred. SMP Level 5 (Intermediate). Songbook. Vocal melody, piano accompaniment, lyrics, chord names and guitar chord diagrams. 168 pages. Published by Hal Leonard (HL.310536).
ISBN 0634009389. With vocal melody, piano accompaniment, lyrics, chord names and guitar chord diagrams. Christmas and Sacred. 9x12 inches.
38 classic and contemporary songs of the season, including The Christmas Song, Do They Know It's Christmas?, Jingle-Bell Rock and more.
About SMP Level 5 (Intermediate)
Seventh chords and melodies in both hands. More difficult note reading with ledger lines above and below the staff.
- Let It Snow Composed by Wanya Morris, Brian McKnight, F
- Share Love Composed by Nathan Morris, E Major
- Cold December Nights Composed by Michael McCary, Shawn Stockman, C Major
- All I Want For Christmas Is You Composed by Mariah Carey, Walter Afanasieff, G Major
- Miss You Most At Christmas Time Composed by Mariah Carey, Walter Afanasieff, D Major
- Miracles Composed by Kenny G, Walter Afanasieff, G Minor
- Christmas Is All In The Heart Composed by Steven Curtis Chapman, G Major
- Going Home For Christmas Composed by Steven Curtis Chapman, James Isaac Elliot, A Major
- Please Come Home For Christmas Composed by Charles Brown, Gene Redd, A Major
- As Long As There's Christmas Composed by Rachel Portman, Don Black , Bb Major
- The Gift Composed by Tom Douglas, Jim Brickman, Bb Major
- Carol For A Christmas Tree Composed by Lee Holdridge, F Major
- Noel: Christmas Eve, 1913 Composed by Lee Holdridge, Robert Bridges, G Major
- Blue Christmas Composed by Billy Hayes, Jay Johnson, F Major
- The Christmas Song (Chestnuts Roasting on an Open Fire) Composed by Mel Torme, Robert Wells, Eb Major
- Do They Know It's Christmas? Composed by M. Ure, B. Geldof, C Major
- Do You Hear What I Hear Composed by Noel Regney, Gloria Shayne, C Major
- Feliz Navidad Composed by Jose Feliciano, D Major
- Grandma Got Run Over by a Reindeer Composed by Randy Brooks, E Major
- The Greatest Gift Of All Composed by John Jarvis, G Major
- Happy Xmas (War Is Over) Composed by John Lennon, Yoko Ono, A Major
- I Saw Mommy Kissing Santa Claus Composed by Tommy Connor, C Major
- I'll Be Home for Christmas Composed by Kim Gannon, Walter Kent, C Major
- Jingle-Bell Rock Composed by Joe Beal,Jim Boothe, C Major
- Last Christmas Composed by George Michael, C Major
- Merry Christmas, Baby Composed by Lou Baxter, Johnny Moore, F Major
- The Most Wonderful Time Of The Year Composed by Eddie Pola, A Major
- Grown-Up Christmas List Composed by David Foster, Linda Thompson-Jenner, Bb Major
- Pretty Paper Composed by Willie Nelson, G Major
- Rockin' Around the Christmas Tree Composed by Johnny Marks, C Major
- Rudolph the Red-Nosed Reindeer Composed by Johnny Marks, C Major
- Santa, Bring My Baby Back (To Me) Composed by Claude DeMetruis, Aaron Schroeder, C Major
- Santa Claus Is Back In Town Composed by Jerry Leiber,Mike Stoller, Bb Major
- Shake Me I Rattle (Squeeze Me I Cry) Composed by Hal Hackady, Charles Naylor, Bb Major
- Silver Bells Composed by Jay Livingston,Ray Evans, Bb Major
- There's A New Kid In Town Composed by Curly Putman, Don Cook, Keith Whitley, C Major
- Wonderful Christmastime Composed by Paul McCartney, Bb Major
- O Joyful Children Composed by Lee Holdridge, Mary Huckaby, C Major
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A Very Merry Christmas
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A Very Merry Christmas
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More by this Composer: Various Sheet Music Various Piano, Vocal, Guitar Sheet Music Various Voice Sheet Music Various Guitar Sheet Music
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Palin's Rapture
Should we be upset over her support for Israel?
A bit of a brouhaha has erupted regarding Sarah Palin and the Jews. It seems that the former governor of Alaska went on television to promote her new book, Going Rogue, and was asked by Barbara Walters what she thought of Israel's West Bank settlements. "I disagree with the Obama administration on that," Palin replied. "I believe that the Jewish settlements should be allowed to be expanded upon, because that population of Israel is, is going to grow. More and more Jewish people will be flocking to Israel in the days and weeks and months ahead. And I don't think that the Obama administration has any right to tell Israel that the Jewish settlements cannot expand."
When I read her reply, I thought that it was wonderful. In the two generations in which I've been covering the Middle East debate, it was one of the few times a public figure gave in response to a question about the settlements an answer that I would call ideal. It seemed to me courageous, in that Palin was going against not only the administration but many in her own party and the gods of political correctness. There was no shilly-shallying about the Oslo process and the Quartet and the United Nations. Palin didn't seem particularly worried one way or another about how she might be perceived. She is just on Israel's side.
But it turns out that one of the shrewdest reporters on the Middle East beat, Jeffrey Goldberg, finds the governor's language alarming. He put up a post on his Atlantic blog under the headline, "With Friends Like Sarah Palin…"—a phrase that one expects to be finished with the question, "…who needs enemies?" Goldberg wants to know who, exactly, she reckons is going to be flocking to Israel and whether her view grows from her analysis of Jewish demography. Or whether she anticipates a sudden upsurge in Zionist sentiment among American Jews, who are, he points out, the only sizable Jewish community outside Israel.
"Or," Goldberg asks, "is this an indication that Palin buys into creepy End Times thinking, in which the ingathering of the Jews, and their mass death, presage the return of Christ?"
That is a vision in which Christians are to be gathered up in something called the Rapture. Goldberg was so determined to get to the bottom of the question that he called the executive director of the Pre-Trib Research Center at Liberty University, Thomas Rice, who heads what Goldberg calls "one of the pre-eminent evangelical institutions in this country arguing for the literal Bible prophecy." Goldberg asked him whether he thought Palin's statement on Jewish settlements was informed by the belief about a Jewish ingathering to Israel in advance of Armageddon.
Rice, Goldberg reports, said that he'd heard the governor "has been part of an apparently unique movement" whose pastor "believed based on some personal revelation he claims to have gotten from God" that during the Tribulation "the Jews would move to Alaska." But Rice also expressed his "understanding" that Palin actually holds what he called "fairly typical Protestant Zionist beliefs, and one of those beliefs is the regathering of the Jews in Israel." He suggested that Palin "may just have a general geopolitical belief that the world is going to be increasingly anti-Semitic."
I've been reading Goldberg long enough to have developed an abiding regard for his reportorial instincts. It turns out that he's not the only writer worrying about Palin and the Rapture. Frank Rich echoed Goldberg's worries over the weekend. And last year Alexander Cockburn's Counterpunch, which specializes in attacking Israel from the left, ran its own warning about the possibility that Palin believes in the Rapture. Its writer, Raymond J. Lawrence, expressed the fear that a "believer in the Rapture with his or her fingers on the nuclear trigger might even be tempted"—apparently in the hope of advancing the Second Coming—"to bring on the Rapture."
Lawrence reckoned that while Americans were prepared to accept reassurances from John Kennedy that he wouldn't be taking orders from Rome, it's not so easy to get around what he sees as the danger of a president who believes in the Rapture. "The problem is both more simple and more worrisome. The public must presume that Palin believes in the Rapture, since it is one of the central doctrines of her church. Furthermore, the American people should assume that Palin's personal religious beliefs will have consequences in her decision-making as a President."
Continues Lawrence: "The press and much of the public seem reluctant to engage Palin on her religious views, considering them to be a personal matter. In certain respects that is admirable restraint. We do not want candidates for office grilled on their private religious views as long as those views do not impinge upon the public welfare…. However, a belief in the Rapture as an historic event toward which history is rapidly moving, is a belief with potentially catastrophic political implications. Do the American people want a believer in such a fantasy to hold in her hands the nuclear power to destroy civilization?"
In other words, what Lawrence has done is set up, even while suggesting he is loath to do so, a classic religious test.
Now I don't believe for a moment that it is distaste for the Rapture that animates Counterpunch; rather, it's distaste for Israel and the prospect that Jews might settle in Judea and Samaria. That Palin is prepared to leave to the judgment of Israel and its democratic government is what seems to animate the Counterpunch camp. The thing to remember is that if we start allowing religious tests in politics, such tests will eventually be used, as they so often have, against the Jews.
Goldberg's blog post sent me to the bookstore, and I spent the weekend reading Going Rogue. It turns out to be a marvelous memoir by a very smart, high-spirited woman, who is handling the messiness of family life and the challenges of a public life in a way that is inspiring millions. She may not be a veteran of, say, the anti-communist battles of the free-trade union movement that made Ronald Reagan a sage on the biggest issue of his time, Soviet communism. But she has the kind of clarity of commitment on key themes that he had and the same kind of wholesome optimism—and she's still young. I couldn't find anything in the book that made me worry about the fact that even on the difficult issues she supports Israel.
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Fogo Island Inn
Raw beauty.
Todd Saunders has made his mark by turning the middle of nowhere into somewhere. His architecture—bare, sculptural, conductive—amplifies place like a microphone set in the landscape, making both built space and the place it's in palpably present. Designed by Saunders, the Fogo Island Inn opened last summer on a beautiful Newfoundland island. Read More


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Hearts and Crafts
Edit Page Last Edit: 3 years 3 months ago
Hearts and Crafts is the special set of levels in the free version of the game made especially for Valentine's day. It consists of 10 unique never seen before levels.
This set of levels originally started with only one level on February 14th, with a new level becoming available every day for 9 days.
- I Heart U
- Split Stream
- Switch Which Switch?
- Downpour
- A-maze-ing
- Beanstalk
- Shoots and Spirals
- Combination Lock
- To Grow or not to Grow
What Links Here
2-1 I Heart U | Swampy's Story | The Lost Levels | Walkthrough
From Around The Web
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Standing Rigging: Some Questions
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Telstar 28
Join Date: Mar 2006
Location: New England
Posts: 43,290
Thanks: 0
Thanked 14 Times in 12 Posts
Rep Power:
I'd point out that a boat that is stored for part of the year, used only on weekends and such could easily have rigging that old that was in relatively decent shape.
The chronological age of the rig is not the only determinant of condition. Hotter climates, saltier waters, etc will generally accelerate the aging of the rig, and cooler climates, fresh water, etc, will delay it. Hard use, like bluewater sailing or racing will accelerate the aging as well.
I'd recommend shipping the rigging off to Riggingonly.com and having them make up replacements.
I also recommend using Hayn Hi-Mod mechanical fittings over StaLok or Norseman, as they're usually far less expensive and better quality IMHO. I also recommend that the top fittings be swaged and the lowers be mechanical fittings. This is because the lower fittings generally need the ability to be inspected and re-built more often, due to the greater exposure to the water.
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Telstar 28
New England
You know what the first rule of sailing is? ...Love. You can learn all the math in the 'verse, but you take
a boat to the sea you don't love, she'll shake you off just as sure as the turning of the worlds. Love keeps
her going when she oughta fall down, tells you she's hurting 'fore she keens. Makes her a home.
Cpt. Mal Reynolds, Serenity
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The Superdiners, close-up
Bios, revelations about the U-T food-and-drink panel
Andrew Spurgin, consulting chef and event architect, andrewspurgin.com
Spurgin is obsessive about food, already imagining dinner during breakfast, and never happier than having spent a goodly amount of time (and sometimes money) over a long lingering lunch. Born a few thousand years too late to become a Legatus Legionis, he commands a kitchen instead, using passion and education as his weapons in the battle for sustainable, responsible food sources.
Randee Stratton, real estate broker, avid diner
I was in the food and wine industry for many years. I was employed at the Chart House for 15 years and worked at many locations throughout California. After CH, I had my own catering business before I embarked into the commercial real estate industry. I currently am a Broker that specializes in restaurant/retail tenant representation throughout San Diego and Orange County, assisting with site selection and lease negotiations. I am always on the look out for up and coming chefs/restaurants that are looking to open their first restaurant, or expanding into other submarkets.
Do you remember Crescent Heights Kitchen & Lounge? Chef David McIntyre worked at Spago for many years and wanted to open his own restaurant in San Diego. I negotiated their lease on Broadway and unfortunately they opened the day the market crashed. They were voted Best New Restaurant in "San Diego Magazine" and McIntyre won "Chef of the Fest" and then they closed due to the economy.
Other restaurants/chefs I have negotiated on their behalf are Oceanaire Seafood Room, Urbane Cafe, Sushi Freak, Dolce Pane e Vino, Pappalleco, a variety of bakeries and many others. I truly seek out the small, out-of-the-way unknown spots (similar to my winery preference, under 1,000 case production and mostly cabs). Some of my favorites are Q'ero, Spread, Urban Solace, Blue Ribbon Artisan Pizzeria and Dolce Pane e Vino. On the more well known side, I enjoy Amaya, Searsucker, Market and Addison.
I shop most Farmer's Markets and seek the latest and greatest farm to table menus when I dine out, which is often. I do attend an Outstanding in the Field's dinner yearly. I travel to Napa quite often (we got married there) and have dined at most of their restaurants, as well as many in L.A. and Orange County.
I love being in the know about up-and-coming restaurants/chefs and am the "go to" person among my friends and co-workers when they are looking for a specific dining experience.
Bill Sysak, beverage supervisor at Stone Brewing World Bistro & Gardens
Bill Sysak, or "Dr. Bill," as he's known in the inner circle of craft-beerdom, is a master of zymurgical knowledge and general beer wizardry. A certified cicerone and collector of rare beers, his personal cellar currently houses more than 1,400 bottles. In 2009, he joined Stone Brewing Company as the beverage supervisor for Stone Brewing World Bistro & Gardens. He puts on unparalleled beer and food pairing events and has become one of the most knowledgeable craft beer experts in the industry. He has been a connoisseur of craft beer, fine wine and spirits for more than 33 years.


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Focal chondral defects of the knee, due to trauma or other conditions such as osteochondritis dissecans, often fail to heal on their own and may be associated with pain, loss of function, disability and the long-term complication of osteoarthritis. The ideal resurfacing technique would eliminate the symptoms, restore normal biomechanics of the knee joint, and prevent the long-term emergence of osteoarthritis and the necessity for total knee replacement. Various methods of cartilage resurfacing have been investigated including marrow-stimulation techniques, such as subchondral drilling, microfracture, and abrasion arthroplasty, all of which are considered standard therapies and all of which attempt to restore the articular surface by inducing the growth of fibrocartilage into the chondral defect.
The use of both fresh and cryopreserved allogeneic osteochondral grafts has been encouraging. Cryopreservation decreases the viability of cartilage cells and fresh allografts may be difficult to obtain. There are concerns regarding infectious diseases when using allografts (from a donor other than the recipient). For these reasons, autologous (one's own tissue from one location to another) grafts have been under investigation as an option to increase the survival rate of the grafted cartilage and to eliminate the risk of disease transmission. Autografts have been limited by the small number of donor sites; thus allografts are typically used for larger lesions. Single grafts have been harvested from the patella, femoral condyle, and proximal part of the fibula. In an effort to extend the amount of available donor tissue, investigators have used multiple, small osteochondral cores harvested from various non-weight-bearing sites of the knee. Several systems are available for performing this procedure, the MosaicPlasty System™ (Smith and Nephew) and Osteochondral Autograft Transfer System® (OATS®, Arthrex, Inc.), and the COR™ and COR2™ Systems (DePuy-Mitek). Although MosaicPlasty and OATS may use different instrumentation, the underlying principle is similar; i.e., the use of multiple osteochondral cores harvested from a non-weight-bearing region of the femoral condyle and autografted into the chondral defect. These terms have been used interchangeably to describe the procedure. In contrast to autologous chondrocyte implantation (ACI), in which separate surgical procedures are required to harvest and then transplant the cultured chondrocytes, with osteochondral autografting the harvesting and transplantation can be performed during the same surgical procedure.
Preparation of the chondral lesion involves debridement and preparation of recipient tunnels. Multiple individual osteochondral cores are harvested from the donor site, typically from a peripheral non-weight-bearing area of the femoral condyle. Donor plugs range from six-mm to 10 mm in diameter. The grafts are press fit into the lesion in a mosaic-like fashion into the same-sized tunnels. The resultant surface consists of transplanted hyaline articular cartilage and fibrocartilage, which is thought to provide "grouting" between the individual autografts.
Although each system may use different instrumentation, the underlying principle to obtain the autografts is the same and to transfer the cartilage or bone plugs from one area to another damaged area. These procedures may be performed with either an open approach or arthroscopically. The resurfacing concept is similar to a hair transplant. Clinical studies have begun by using osteochondral grafts to repair chondral defects of the hip, patella, tibia, and ankle.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
Medically Necessary
BCBSMT may consider osteochondral allografting medically necessary as a technique to repair large (e.g., 2-10 cm2) full-thickness chondral defects caused by acute or repetitive trauma.
Osteochondral autografting, using one or more cores of osteochondral tissue, may be considered medically necessary for the treatment of symptomatic full-thickness cartilage defects caused by acute or repetitive trauma in the knee, when all of the following criteria are met:
Outerbridge Grading
Grade 0
Normal appearing cartilage
Grade I
Swelling and Softening or Articular Cartilage
Grade II
Fissuring within softened areas
Grade III
Grade IV
Destruction of articular cartilage and exposed bone
Outerbridge Grading
Grade 0
Normal appearing cartilage
Grade I
Swelling and Softening or Articular Cartilage
Grade II
Fissuring within softened areas
Grade III
Grade IV
Destruction of articular cartilage and exposed bone
BCBSMT considers osteochondral autograft or allograft transplantation for joints other than the knee experimental, investigational and unproven, including but not limited to the patellar (knee cap) and talar (ankle).
Osteochondral autograft or allograft transplantation is considered experimental, investigational and unproven when the patient selection criteria cited above are not met.
Federal Mandate
Federal mandate prohibits denial of any drug, device, or biological product fully approved by the FDA as investigational for the Federal Employee Program (FEP). In these instances coverage of these FDA-approved technologies are reviewed on the basis of medical necessity alone.
The current medical literature regarding osteochondral allografting of the knee shows that this procedure has demonstrated acceptable long-term results measured by reduction in pain, improved physical function, and sustained osteochondral graft viability. Several long-term studies have demonstrated long-term donor osteochondral grafts viability up to 10-years and in one study as long as 14-years with a success rate reported at 63%. Shorter term studies have reported success rates of between 75 to 80%. The evidence indicates that osteochondral allografting has been highly successful in patients with chondral defects resulting from trauma or osteochondritis dissecans, but less so in patients with osteonecrosis or steroid induced lesions. Finally, the literature is unanimous in emphasizing the importance of proper patient selection including adequate joint stability and alignment.
Peer reviewed medical literature pertaining to osteochondral grafting and mosaicplasty of the knee consists mostly of single-institution case series focusing on chondral lesions of the knee. These studies include heterogeneous populations of patients, some of whom are undergoing treatment for additional abnormalities such as ligament or meniscal repair. Therefore, it is not known whether improvement in symptoms can be attributed to the osteochondral autografting or other components of the surgery. In addition, there are very few studies currently available comparing the results of osteochondral autografting with other established therapies. However, there is a large collection of small studies that demonstrated that osteochondral autografting procedures, including mosaicplasty, confer significant benefit in terms of both functional improvement and pain relief in a population where alternative therapies are limited. Several studies have evaluated the long term viability of osteochondral autografts with histological examinations at up to three-years post-transplant. The vast majority of these studies report finding stable hyaline cartilage at the operative site. In almost all articles published, patients with misalignment, arthritis, unstable knees, and missing or compromised meniscus, were excluded from the studies due to concerns regarding suitability for the procedures. Finally, there is little agreement on any limitations regarding the size of chondral defects that are appropriate for these procedures. The medical literature suggests that mosaicplasty might be appropriate for lesions ranging from as little as 1.5 cm2 to as large as 16 cm2. Most recent evidence supports the position that the larger the chondral defect, the higher the complication rate and rates of donor site morbidity. Thus, at this time it may be appropriate to limit these procedures to small to moderate lesions, between 1.1 cm2 and 2.5 cm2, until further evidence is available to fully evaluate this issue.
Contraindications for osteochondral grafting and mosaicplasty of the knee include those patients with a systemic metabolic degenerative disease, arthritis of the knees, flattening of the femoral condyles or severe degenerative changes (greater than 50% joint space narrowing, bone on bone, or erosion to subchondral bone). Osteochondral grafting is not indicated for patients who have undergone partial or total meniscectomy and do not have symptoms or problems with their knee. It is evident that osteochondral grafting is a viable option for the treatment of symptomatic patients provided rigid inclusion criteria are met. Patients with appropriate indications should expect to do well postoperatively in terms of a predictable reduction in pain and an ability to increase activity levels. Only further study will clarify the long-term results of osteochondral grafting as well as their role in preventing the progression of secondary osteoarthritis in the involved compartment.
Wang reported the results of 15 patients with 16 knees undergoing osteochondral autograft to repair focal full thickness articular cartilage defects of the knee. Minimum follow-up in this study was two-years. Evaluations of patient outcomes were based on functional assessments, which included pain, giving way, locking, recurrent effusion, knee scores, functional scores, and Lysholm scores, statistically significant improvements were achieved in all. The overall results were excellent in seven (43.75%), good in six (37.50%), fair in two (12.50%), and poor in one (6.25%). The latter three had lesions larger than 600 mm2. Radiographs showed mild degenerative changes in seven knees preoperatively and in eight knees postoperatively; however, seven of eight knees showed no progression of degenerative changes postoperatively. No data was reported regarding the donor site.
Osteochondral allograft transplantation is appealing because it provides the ability to resurface larger and deeper defects with mature hyaline articular cartilage and addresses the underlying bone deficit in a single procedure. The appropriate size and surface contour can be matched when the graft is obtained from an appropriately selected organ donor. The biology of articular cartilage makes it ideal for transplantation. It is both aneural and relatively avascular, receiving its nutrition by diffusion from synovial fluid. Furthermore, it is a relative immuno-privileged tissue. The chondrocytes are protected from the host immune surveillance by the surrounding matrix. Therefore, this allows mature living chondrocytes to survive for many years after transplantation without the need for tissue matching or immunosuppression.
Williams and colleagues prospectively followed 19 patients with symptomatic chondral and osteochondral lesions of the knee who were treated with fresh osteochondral allografts between 1999 and 2002. The mean age at the time of surgery was 34-years. The mean duration of clinical follow-up was 48-months (range 21- to 68-months). The mean score (and standard deviation) on the Activities of Daily Living Scale increased from a baseline of 56 +/- 24 to 70 +/- 22 at the time of the final follow-up (P< 0.05). The mean Short Form-36 score increased from a baseline of 51 +/- 23 to 66 +/- 24 at the time of final follow-up (P < 0.005). At a mean follow-up interval of 25-months, cartilage-sensitive magnetic resonance imaging demonstrated that the normal articular cartilage thickness was preserved in eight of the eighteen grafts. The authors concluded that fresh osteochondral allografts that were hypothermically stored between seventeen and 42-days were effective in the short term both structurally and functionally in reconstructing symptomatic chondral and osteochondral lesions of the knee.
The indications for autografts are the small focal lesions that are 1 cm2 to 2.5 cm2 in size. For larger defects, over 2.5 cm2 allografts are preferred. The knee must be stable, not arthritic, and have normal alignment. Current contradictions for the use of allografts include osteoarthritis that has advanced to Outerbridge grade IV, exposed subchondral bone, inflammatory arthritis, obesity, previous infection, multiple lesions, ligamentous instability, severe lower extremity malignancy and significant axial malalignment.
2009 Update
A search of peer reviewed literature through August 2009 identified a number of small case series (five to 30 patients) describing use of osteochondral autografts for cartilage defects of the knee, elbow, and ankle, along with literature on uncontrolled case series with limited (e.g., two-years or less) follow-up.
A 2008 systematic review by Magnussen et al assessed whether "advanced" cartilage repair techniques (osteochondral transplantation or autologous chondrocyte transplantation) showed superior outcomes in comparison with traditional abrasive techniques for the treatment of isolated articular cartilage defects. Finding a total of five randomized controlled trials and one prospective comparative trial that met their selection criteria, Magnussen and colleagues concluded that no one technique had been shown to produce superior clinical results for treatment of articular cartilage defects. They stated that, "any differences in outcome based on the formation of articular rather than fibrocartilage in the defect may be quite subtle and only reveal themselves after many years of follow-up. Similarly, complications such as donor site morbidity in osteochondral grafting may be late in their presentation and thus not be detected at short follow-up." Relevant studies are described below.
Hangody, who first reported use of the mosaicplasty technique in humans in 1992, has authored a number of summaries and case series. It is likely that these reports contain overlapping populations of patients, and few details are reported. In a 1997 article, Hangody and colleagues refer to a 1992 to 1994 comparison study of mosaicplasty and abrasion arthroplasty. No details of this study are provided, except to note that the mosaicplasty patients had significantly improved Hospital for Special Surgery (HSS) knee scores, compared to those undergoing abrasion arthroplasty. A 2008 summary paper includes descriptions of a prospective multicenter comparison of 413 resurfacing procedures and follow-up from 1,097 mosaicplasties at the author's institution. Although the authors report that the comparative study found hyaline-like resurfacing to result in a better clinical outcome than other techniques, the cited study is not available as a publicly available peer-reviewed publication. For the retrospective analysis, Hangody and colleagues reported 789 implantations on the femoral condyles, 147 in the patellofemoral joint, 31 on the tibia condyles, 98 on talar domes, eight on the capitulum humeric, three on humeral heads, and 11 on femoral heads. About two-thirds of the patients were reported to have had a localized cartilage lesion, and the remainder underwent surgery because of osteochondral defects. In 81% of patients concomitant surgical interventions were performed; these included reconstruction of the ACL realignment osteotomies, meniscus surgery, and patellofemoral realignment procedures. Clinical scores found good to excellent results in 92% of patients with femoral condylar implantations, 87% of tibial resurfacings, 74% of patellar and/or trochlear mosaicplasties, and in 93% of talar procedures. Moderate and severe donor-site disturbances were reported in 3% of patients. Ninety-eight second-look arthroscopies were done for persistent or recurrent pain, swelling or postoperative intraarticular bleeding (31 patients at two-months to 11-years), second trauma (26 patients at one- to nine-years) or to evaluate recovery in professional athletes (41 patients, four- to seven-months). Although at least 57 (58%) second-look arthroscopies were associated with clinical symptoms, the report indicates that 81 (83%) of the evaluations indicated good gliding surfaces, histologically proven survival of the transplanted hyaline cartilage, and acceptable fibrocartilage covering of the donor sites. Slight or severe degenerative changes were seen at the recipient and/or donor sites in 17 cases (17%). The association between clinical symptoms and histological results was not discussed. Painful hemarthroses were observed in 56 (5%) of patients. The authors note that although these results are encouraging for use of autologous osteochondral mosaicplasty as an alternative treatment for small- and medium-sized focal defects, postoperative bleeding from the empty donor tunnels represents a possible postoperative complication, and donor-site morbidity remains an open question. Based on their extensive experience with this procedure, Hangody and colleagues consider the optimal indications to be a lesion size of 1 to 4 cm2, patient age of 50-years or younger (due to decreased repair capacity with aging), and correction of instability, malalignment, and meniscal or ligamental tears.
Osteochondral autografts in comparison with microfracture
One study from Lithuania was a well-controlled and blinded comparison of mosaic osteochondral autologous transplantation versus microfracture for lesions of the femoral condyle (one to 4 cm2) in 60 athletes between 15- and 40-years of age (mean, 24.3-years). Follow-up on 95% of the athletes for up to three-years following surgery showed that more athletes returned to sports activities (mean, 6.5-months) following osteochondral autograft (93% versus 52%), and fewer required revision (one of 28 versus nine of 29). Overall, 96% of patients treated by osteochondral autograft had an excellent or good result compared with 52% treated by microfracture. At one-year follow-up, scores on the International Cartilage Repair Society (ICRS) cartilage grading system improved from a baseline of 51 to 86 in the osteochondral autograft group and 76 in the microfracture group. At three-year follow-up, scores from Hospital for Special Surgery questionnaires improved from a baseline of 77 to 91 in the osteochondral group and 81 in the microfracture group. No donor-site morbidity was observed. Blinded arthroscopic and histological assessment in a subset of patients showed hyaline cartilage of normal appearance following transplantation, whereas microfracture was frequently observed to result in surface fibrillation and soft fibroelastic tissue.
Another group from Italy randomized 32 patients with osteochondral lesions of the talus to chondroplasty, microfracture, or osteochondral autograft. This small study found similar improvements (approximately 40 points) for the three treatment groups as measured by the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (baseline score of 31 to 37) and the Subjective Assessment Numeric Evaluation (baseline score of 35 to 36). Complication rates were also similar, with persistent pain reported by one patient following chondroplasty, by two patients following microfracture, and by two patients following osteochondral autograft. Postoperative pain, measured by Numeric Pain Intensity Scores, was greater following osteochondral autograft (5.25) than chondroplasty (3.3) or microfracture (3.4).
Osteochondral autografts in comparison with chondrocyte implantation
Horas and colleagues reported two-year follow-up on a study of 40 patients (between 18 and 42 years of age) with an articular lesion of the femoral condyle (range of 3.2 to 5.6 cm2) who were randomly assigned to undergo either ACI or osteochondral autografting. Eleven (28%) had received prior surgical treatment. The authors reported that both treatments resulted in an improvement in symptoms (85% of each group), although those in the osteochondral autografting group responded more quickly. Histomorphological evaluation of five biopsy specimens at two-years or less after transplantation indicated that the osteochondral cylinders had retained their hyaline character, although the investigators noted a persistent interface between the transplant and the surrounding original cartilage. Evaluation of autologous chondrocyte implants indicated a rigid, elastic tissue, with partial roughening and the presence of fibrocartilage.
Bentley and colleagues randomized 100 consecutive patients with symptomatic lesions of the knee (average 4.7 cm2, range of 1 to 12 cm2) to ACI or mosaicplasty. Seventy-four percent of lesions were on the femoral condyle, and 25% of lesions were on the patella. Ninety-four patients had undergone previous surgical interventions and the average duration of symptoms before surgery was seven-years. Clinical assessment at one-year showed excellent or good results in 98% of the ACI patients and 69% of the mosaicplasty patients. The mosaicplasty plugs showed incomplete healing of the spaces between the grafts, fibrillation of the repair tissue, and disintegration of the grafts in some patients. This finding may be related to both the relatively large lesion size and the unusual prominent placement of the plugs in this study, which was intended to allow contact with the opposite articular surface.
Dozin et al reported results from a multicenter randomized clinical trial in which ACI was compared to mosaicplasty. Forty-four individuals (61% male, 39% female) age 16- to 40-years (mean 28.7 ± 7.8), who had a focal, symptomatic chondral injury of Outerbridge grade III or IV with no previous surgical treatment, were randomly assigned to ACI or mosaicplasty six-months after undergoing arthroscopic debridement. The average lesion size was 1.9 cm. Only 12 of 22 (54%) in the ACI group and 11 of 22 (50%) of the mosaicplasty group actually underwent the assigned procedure. Dropouts comprised 14 patients (32%) who reported spontaneous improvement following arthroscopy and did not undergo subsequent surgery, five who did not show up at the pre-surgery examination and could not be further traced, and two who refused surgery for personal reasons. Because of the substantial dropout rate, the original primary outcome measure, the mean Lysholm Knee Scoring Scale (LKSS) assessed 12-months post-surgery was converted into a scale in which improvement was categorized by proportions of responders (LKSS < 60, LKSS 60-90, LKSS 90-100). With this scale, and including 10 patients who were cured by debridement (intention-to-treat analysis) the percentages of patients who achieved complete success were 89% (16 of 18 evaluable cases) in the mosaicplasty arm versus 68% (13 of 19 evaluable cases) in the ACI arm (test for trend P = 0.093). The high rate of spontaneous improvement after simple debridement raises questions about the appropriateness of additional surgical intervention in patients with small lesions similar to those included in this trial.
Longer-term follow-up
Laprell and colleagues reported six- to 12-year follow-up from 29 of 35 patients (83%) with severe osteochondral defects (77% with osteochondritis dissecans) who were treated by autologous osteochondral transplantation. The average age of the patients at the time of surgery was 26 years. Clinical evaluation at an average eight-years after the procedure found 12 patients (41%) to be normal, 14 (48%) as nearly normal, and three (10%, all of whom refused correction of malalignment) as abnormal. No patient was assessed as severely abnormal. In contrast, no patients considered their functional status to be normal, three (10%) considered function to be nearly normal, 20 (69%) thought their function abnormal, and six (21%) considered their functional status to be severely abnormal.
Another report described seven-year follow-up on 30 patients who had been treated with osteochondral autologous transplantation for symptomatic Outerbridge grade III to IV chondral lesions (average 1.9 cm, range of 1.0 to 2.5 cm). Nineteen patients received other procedures (ACL reconstruction, meniscectomy, medial collateral ligament repair) at the same time, and it is therefore not possible to assess the contribution of the osteochondral transplantation to the functional results reported. Magnetic resonance imaging at seven-years showed complete bone integration in 96% of patients, complete integration of the grafted cartilage in 75% of cases, complete filling of the cartilage defect in 63% of the patients, and congruency of the articular surface in "some" patients. Subchondral bone changes (edema or sclerosis) were noted in 71% of patients. The donor sites were filled with a tissue of different density than the surrounding bone, presumed to be fibrous tissue. No patients reported anterior knee pain. Non-painful patellar crepitus was observed in three (10%) patients.
Adverse Events
One study reported donor site morbidity in 11 patients of 15 who had undergone graft harvest from the knee (mean of 2.9) for treatment of osteochondral lesions of the talus. At an average 47-month follow-up (seven- to 77-month range), five patients were rated as having an excellent Lysholm score (95 to 100 points), two as good (84 to 94), and four as poor (64 or less). Reported knee problems were instability in daily activities, pain after walking a mile or more, having a slight limp, and difficulty squatting.
In summary, only one relatively small randomized controlled trial from Europe has demonstrated improved clinical outcomes when compared with microfracture. Data regarding the long-term viability of the transplanted osteochondral hyaline cartilage is also limited. However, controlled studies demonstrate similar benefit to other cartilage resurfacing procedures in appropriately selected patients, and a number of uncontrolled studies indicate that osteochondral autografts can improve symptoms in some patients with lesions of the femoral condyle who have failed prior surgical treatment. These patients have limited options. Therefore, based on the clinical input received and additional literature reviewed, it is concluded that osteochondral autografts may be considered an option for symptomatic full-thickness chondral lesions of the femoral condyle caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical repair procedure. Evidence is currently insufficient to evaluate the efficacy of osteochondral autografts in comparison with other surgical repair procedures as a primary treatment of small lesions, or to evaluate the efficacy of osteochondral autografts for joints other than the knee. Questions also remain about the natural history of asymptomatic lesions found incidentally during other surgical procedures. Additional controlled trials with longer follow-up are needed to demonstrate that use of osteochondral autografts as a primary treatment results in improved clinical outcomes in comparison with traditional marrow-stimulating procedures.
Other Guidelines
The Interventional Procedures Advisory Committee of the United Kingdom's National Institute for Health and Clinical Excellence (NICE) conducted a 2005 review of mosaicplasty for knee cartilage defects. The corresponding NICE Guidance on mosaicplasty, released in 2006, is in agreement with conclusions listed above, stating that "There is some evidence of short-term efficacy, but data on long-term efficacy are inadequate."
An additional search of peer reviewed literature through August 2009 identified no new clinical trial publications or any additional information that would that would alter or change the conclusions reached above.
Disclaimer for coding information on Medical Policies
Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.
Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member's benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.
81.96, 717.7, 717.7, 732.7


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BLOODY-DISGUSTING - View Single Post - Horror Media Project - Audience Data Needed
Horror Media Project - Audience Data Needed
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Rotting Corpse
is singing Believe! BY CHER!
Join Date: Dec 2008
Location: England
Posts: 2,027
The questions above will help me with designing a 2D Flash game for my client. The genre of this game is "point-and-click", however, it will have a horror theme and storyline.
For those of you who may not know what a point-and-click game is, it is a game that involves the player investigating rooms and areas by using the mouse. For example, you can use the mouse to click on objects in a room. The items that you find in the room will allow you to solve puzzles or uncover more of the storyline.
The game will be 2D with some animation to make it look more dynamic and interesting.
1. If you were going to play a 2D point-and-click horror game, how would you make it frightening? what would you put in it to scare you, personally?
I think tension needs to be built up to a really shocking jump scare. "The Scary Maze Game" haunted me for weeks! It should be something as terrifying as that.
In a 2D game, there are limitations. For example, a designer may only be able to use simple "jump scare" moments, or using sounds to try and make the player scared of something they cannot see yet. This is because the designer would not be able to have creatures or dangers sneak up on the player like they can on a 3D game, such as Resident Evil.
2. Would the use of jump scares or sounds affect your enjoyment of a 2D horror game like the one described above?
I think it would make it much scarier as you don't know what's going to happen next. I think jump scares and sound effects are a must.
3. What kind of puzzles would you like to see in a horror game? What kind of puzzles would convince you to at least try the game?
Hmm, puzzles can frustrate me so it'd need to be funa nd rewarding. I can't think what though at this moment in time.
4. The game I described earlier will have realistic graphics. Do you think realistic graphics would increase the feeling of horror in a game?
Definitely. Realism puts you in that situation and you can't escape!
"I was perfect"- Nina Sayers
Have a looky at my new horror movie blog!
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Delicious Treats in Elegant Buffets
Simply Catering is noted for their inimitable culinary expertise, delightful dishes and palatable food presentation. They cater to several events such as wedding receptions, baby showers, rehearsal dinners and corporate retreats. They constantly communicate with their clients before and after the event to ensure customer satisfaction.
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We work towards meeting and developing new relationships with clients through our social media outlets such as Facebook, Twitter, and LinkedIn, as well as our Monthly Bridal Tastings.
Check out Simply Catering if you need a reputable full-service caterer for your event.


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Weekend Top 10
By Sarah Story, Citizen Events Editor 03/01/12
Enjoy an evening of Celtic music with Poisoned Dwarf and Lilt at 7 p.m. at The Cultural Arts Center at Glen Allen, 2880 Mountain Rd. The concert is part of CACGA's 2nd Stage Performance Series, which highlights a different musical genre on the first Friday of each month. Tickets are $10 in advance and $12 at the door. For details, call 261-ARTS or visit http://www.artsglenallen.com .
Henrico County Recreation and Parks will present "Waterwalk: A Passage of Ghosts" from 7:30 p.m. to 8:30 p.m. in the Henrico County Administration Board Room. Steven Faulkner, a professor at Longwood University, will discuss the 1,000 mile voyage he and his son Justin took in their 16-foot canoe, Natty Bumpo. Admission is free and seating is on a first-come, first-serve basis. For details, call Dee Donnelly at 501-5147.
The Autism Society of Central Virginia will hold its 5th annual Recreation Resource Fair from 6:30 p.m. to 8:30 p.m. at River Road United Methodist Church, 8800 River Rd. Organizations providing recreational and social opportunities to children, youth and adults with autism spectrum disorders will be on hand to share information about their programs. For details, visit http://www.asacv.org .
The film "Superman: The Movie" will play at 7 p.m. March 2 and at 2 p.m. and 7 p.m. March 3 at Henrico Theatre, 305 E. Nine Mile Rd. Tickets are $1 and can be purchased at the door. For details, call 328-4491 or visit http://www.henricorecandparks.com .
Henrico County's annual Kite Festival will be held from 10 a.m. to 4 p.m. at Dorey Park, 2999 Darbytown Rd. The event, hosted by the Richmond Air Force Kite Club, will feature kite flying demonstrations, exhibits, contests and games and live family entertainment provided by Henrico County Public Schools and local band Sky Run. Concessions will be available for purchase. Admission is free. Rain date is March 4. For details, visit http://www.henricorecandparks.com .
The 12th annual Kids' Carniball – Destination France will take place from 10 a.m. to 4 p.m. at the Children's Museum of Richmond-Central, 2626 W. Broad St. There will be French flag-themed art projects, face painting, balloon giveaways, a moon bounce, magicians, a cheese and juice tasting, French toast provided by Silver Diner and more. Carniball is included with museum admission. For details, call 474-7000 or visit http://www.c-mor.org .
The Cultural Arts Center at Glen Allen, 2880 Mountain Rd., will present a Rock & Roll Jubilee at 7 p.m. Journey back to 1958 and be a part of the studio audience for the live broadcast of a fictitious radio station as they channel the spirits of the founding fathers of rock n' roll. Featured artists include Elvis, Buddy Holly, Ricky Nelson, Roy Orbison, The Everly Brothers and more. The Jubilee includes 1950s' period advertisements, skits and more. Tickets are $20. For details, call 261-ARTS or visit http://www.artsglenallen.com .
The Modlin Center for the Arts will present Cirque Mechanics' "Boom Town" at 2 p.m. and 7:30 p.m. in Alice Jepson Theatre at the University of Richmond. Cirque Mechanics brings together veterans of world-renowned companies such as Cirque du Soleil and the Moscow Circus to continue the exploration of performers and machines through acrobatics, dance, aerial work, trampolines and more. Tickets are $38. For details, call 289-8980 or visit http://www.modlin.richmond.edu .
In celebration of the 40th anniversary of Amtrak, America's Railroad® is offering the public an opportunity to view an Exhibit Train, a unique traveling display showcasing the railroad's history, from 10 a.m. to 4 p.m. March 3-4 at Amtrak's Staples Mill Road station. Memorabilia, such as vintage advertising, past menus and dinnerware and period uniforms will be on display. Children can also visit Chuggington Depot, based on the popular children's animated television series on Disney Junior, for train-themed kids' activities. For details, visit http://www.amtrak40th.com .
The Harvesters will perform at 6 p.m. at Pioneer Baptist Church, 3140 Darbytown Rd. Admission is free. For details, call 795-1051 or visit http://www.pioneerbaptistrichmondva.org
Holman student named Miss Va. Coed Junior Teen
Holman Middle School student Victoria Nguyen recently was named Miss Virginia American Coed Junior Teen after competing in the Miss Virginia American Coed pageant in Williamsburg. She was the youngest competitor in her division. Nguyen now will advance to represent Virginia at the 2015 Miss American Junior Teen Pageant at Walt Disney World in Florida in November. > Read more.
Companion Extraordinaire to honor veterans May 14
Companion Extraordinaire Home Care and Skilled Services will be honoring veterans and current military members May 14 at 11 a.m. The event will take place at 5311 Lakeside Avenue.
Companion Extraordinaire dedicated a hall in its new Lakeside office as a "Wall of Honor" and will be presenting 13 military service men and women with certificates as well as placing their service photos on the wall.
> Read more.
Henrico student among 3 vying for national $10,000 scholarship
Public vote open through Friday to select winner
Citizen Staff Reports
Henrico resident Haley Malloy is one of three national finalists for a $10,000 scholarship, whose winner will be determined by the vote of the public.
Malloy is a finalist for The Goddard School Anthony A. Martino Scholarship, which is open annually to any high school junior or senior who graduated from a Goddard School pre-kindergarten or kindergarten program. Applicants are evaluated based upon the work ethic and perseverance they have demonstrated – two key characteristics of Martino, the founder of the Goddard School franchise system. > Read more.
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More than monkey business
Disneynature's 'Monkey Kingdom' is its strongest yet
"Did you know monkeys could swim?" asks Tina Fey in Monkey Kingdom. While she's asking, a toque macaque (a two foot-long monkey with red-white fur and great hair) breast-strokes under the surface of a pond, yanking out lily pad flowers by her teeth and dragging them ashore to munch later.
Turns out monkeys can swim. And slide down telephone poles. And do the thing from Flashdance where you bring down a cascade of water on your head and shake it off in slow-motion.
All will happen in Monkey Kingdom, the eighth film in nine years from Disneynature, Disney's wildlife documentary outlet. > Read more.
Weekend Top 10
Relax this holiday weekend with Fridays Uncorked at Southern Season – taste wines from the Roman Empire! Or at James River Cellars who is hosting "Experience Virginia" – sample Virginia wine, beer, cider and mead. And what goes better with wine than strawberries – an annual tradition in Varina, the Gallmeyer Farms' Strawberry Fields Festival is tomorrow. Other fun happenings this weekend include: "A Little Princess" at The Cultural Arts Center at Glen Allen; weekly dance at American Legion Post 125; and National Theatre Live's "Man and Superman" at the University of Richmond. For all our top picks this weekend, click here! > Read more.
CAT Theatre announces 2015-16 schedule, new partnership
Final performance of 2015 season – 'Quartet' – starts this week
CAT Theatre's final show of its 51st season – Quartet by Ronald Harwood – will open May 22 and run through June 6. It will be the show's Richmond-area premiere.
The theatre also announced its four-show schedule for its 52nd season, which will begin in October and continue into June 2016, and announced a new partnership with The Bifocals Theatre Project, an outreach program into senior communities in the Richmond region. > Read more.
Barshinger, Fones seek Republican Clerk of Court nomination
Martin's to close Staples Mill store
Middle school student creates app for Henrico schools
Business in brief
Three vie for Republican nomination in Commonwealth's Attorney race
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May. 21, 2015Click here to read the print edition.
More than monkey business
Weekend Top 10
CAT Theatre announces 2015-16 schedule, new partnership
Weekend Top 10
Dance Studio plans performances May 15-16
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Obituary – Howard Luck
Obituary – Delores Ann "Sally" Crigger
Obituary – Ruth Bacon Rogers
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Holman student named Miss Va. Coed Junior Teen
Companion Extraordinaire to honor veterans May 14
Henrico student among 3 vying for national $10,000 scholarship
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All hail to mothers and the hardest job of all
Cabin fever cures - and blessings
Getting schooled
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Steward School senior named Gatorade Virginia Baseball Player of the Year
Athlete of the Week – May 22: John Woolley
Athlete of the Week – May 15: Devin Barnes
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ClassifiedsATTENTION DIABETICS with Medicare. Get a FREE talking meter and diabetic testing supplies at NO COST, plus FREE home delivery! Best of all, this meter eliminates painful finger pricking! Call… Full text
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CalendarOn the Air Radio Players will present "You Heard It Here First" at 7:30 p.m. June 2-3 at The Cultural Arts Center at Glen Allen, 2880 Mountain Rd. This old-time… Full text


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Leigh's Syndrome (Leigh's Disease) Center - Castle Rock, CO
WebMD Physician Directory
Castle Rock, Colorado
Leigh's Disease (Leigh's Syndrome)
What is Leigh's Disease?
Leigh's disease is a rare inherited neurometabolic disorder that affects the central nervous system. This progressive disorder begins in infants between the ages of three months and two years. Rarely, it occurs i...
Other Related Leigh's Syndrome (Leigh's Disease) Articles
Emergency Contact for Castle Rock
Nearby Castle Rock Hospitals *
Skyridge Medical Center
Children's Hosp Outpatnt Spec
Parker Adventist Hospital
Littleton Adventist Hospital
Craig Hospital
Swedish Medical Center
Colorado Mental Health Inst
Porter Adventist Hospital
Medical Center Of Aurora-South
Jefferson Hills
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Kindred Hospital Aurora
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Spalding Rehabilitation Hosp
Rose Medical Center
Denver VA Medical Center
Denver Health Medical Center
University Of Colorado Hospital
Children's Hospital Colorado
Exempla Saint Joseph Hospital
Kindred Hospital-Denver
RMHC Prsby St Lks Mdcl Cntr
Select Specialty Hospital
St Anthony Hospital
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Memorial Hospital North
West Pines Behavioral Health
Exempla Lutheran Medical Center
Select Long Term Care Hospital
St Francis Medical Center
Pikes Peak Regional Hospital
Vibra Hospital
St Anthony North Hospital
North Suburban Medical Center
*Provider Directory Terms of Use:
The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval.


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We are an integrated acute and community Trust providing healthcare across County Durham and Darlington and surrounding areas, in hospital, at home and in community settings.
You can shape the future of health services in County Durham and Darlington by becoming a Foundation Trust member.... Find out more
Find out more about the Friends and Family Test. CLICK HERE for more.
Virtual maternity tours - Thinking about where you would like to have your baby? Take a tour around our maternity units in Durham and Darlington. CLICK HERE for more information.
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The Purple Heather
Real Reviews
Real reviews from fellow travellers
These are trusted reviews from guests who have actually stayed here. We hope you find them helpful.
Note: we only give a property a rating once it has received a minimum of 3 reviews.
- Page:1/1
- " Wonderful accomodation and host. The only problem is that it is far enough away from town that a vehicle is required. "
- 08 Sep 2013 Anonymous USA


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When design student Shay meets the American dental student Zach Alexander, the first item on the agenda is a full mouth analysis. Zach explores the depths of Shay's throat with his tongue, before feasting his mouth on his chiseled six-pack, and finally his Calvin Klein-enclosed bulge. He climbs on top and pokes Shay's mouth with his stiff cock and Shay willingly obliges it. Zach flips the adorable Israeli over to dive into his supple, tattooed boy butt. Shay takes his own time with Zach's gorgeous uncut shaft, playing with the foreskin in his mouth. Soon he sits atop it for a bumpy, bucking ride! Shay rides Zach's cock like a rodeo cowboy, until Zach turns him over and pounds him until he cums.
Website: CLICK HERE
Added: 02 Jul 11
Views: 9970


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BIG BANG TAEYANG Lockscreen
5,000 - 10,000 downloadsAdd this app to your lists
+ By KpopStar Ent.
Please Download Official Lockscreen app 'Mydol'
Download URL : m.mydol.co.kr/goMarket.php
or Search on Google Play 'Mydol'
Do you belive it? Each time I turn on my cell phone, BIGBANG give message to me
It is possible to see pictures of BIGBANG at any time from the lock screen. The member who I like gives message to me
In the Image setting, you can add image to lockscreen continuously
Please tell me your age and name what you want to be called. Then the member give message to you calling the name
you can download BIGBANG group Lockscreen or each member's Lockscreen
Features will be added: bulletin board where you can share image, conversation. Schedule of BIGBANG
BIGBANG - YG Entertainmnet
G-Dragon, Taeyang, Seungri, T.O.P, Daesung
tag: BIGBANG, YG Entertainment, lockscreen, lockscreen, boaring, Idol group, theme, schedule, photo
Feedback or Contact twitter @KpopStarENT1
This version is beta. so Shutdown in 11/18.
Please Download Official Lockscreen app 'Mydol'
Download URL : m.mydol.co.kr/goMarket.php
or Search on Google Play 'Mydol'
v.1.3 Bug fix
- On the Lock screen, Move community site when slide to the left
- On the setting, Move PHOTO download page in community site
(74 stars)
Wohoooooooo . :D
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I like it but everytime i use it, the password i use cannot be applied... how should i put it? I put passewords because if my files... but because of the lockscreen it cannot be activated. Can you fix that? Or you can put something or a setting where you input passwords by pattern. Please... thanks...
(74 stars)
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With the Applied Magic 4 Target Blu-Ray Duplicator Tower your high-definition digital files are ready to live on through duplication and replication. With a four bay interface, you don't even need a computer to download your source files - just pop a source disk in one tray, and voila!, you'll be presented with crisp, clean copies of your data on multiple discs.
Because of the high storage capacity of Blu-ray discs - 25GB compared to the 4.7GB of a standard single-layer DVD - you can fit more high-quality audio, high definition video, and massive amounts of text files into one place. Add to that the reduction in price for Blu-ray players, and you now have an encroaching disc format king. It makes sense to have a one-button solution to replicate your hard work, and the Applied Magic 4 Target Blu-Ray Duplicator Tower is just what you'll need.
Drop in a source disc and the unit automatically recognizes the format, whether it's DVD, CD, or Blu-ray. Blu-ray storage is approximately 9 hours of HD video, so now you can shoot your summer memories, replicate your summer memories, and share your summer memories, too!
- Faster Than A Speeding Camera
- 8x write speed for Blu-ray discs is quickly going the way of the dodo. Now the 12x speed barrier is being pushed, ensuring faster transfer and less time wasted.
- SATA is Where It's At
- Using the thin and flexible SATA cable system means that information is easily and more readily routed, and there is less heat inside the duplicator chassis, which means more reliable end product.
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- Supports BD-R, BD-RE, BD-R Dual Layer, BD-RE Dual Layer, DVD+/-R, DVD+/-RW, DVD+/-R Dual Layer, CD-R, and CD-RW blank media standards, which gives you more options when making copies.
- Recognition
- Automatic recognition of the source format takes the complicated guess work out of your schedule.
- Support
- System is upgradeable via firmware.


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Volvo Villa is located just west of Yonge Street on Steeles avenue, you will find the largest selection of new and pre-owned Volvo Cars in Toronto, Ontario and Eastern Canada.
Volvo Villa is proud to serve automotive enthusiasts throughout the Greater Toronto Area since 1988. We are located 220 Steeles Avenue West in Thornhill Ontario. Our dedication to the Volvo Brand is built on integrity, product knowledge, quality, detailed workmanship and, above all being customer centric.
New Vehicles:
Redesigned from front to back, with some performance upgrades you see, and others you just feel. World's first pedestrian and cyclist detection that helps you keep an eye on the road, along with even lower fuel consumption.
The pinnacle of Scandinavian design and Canadian performance – from its elegant front end, grille and headlights to its exceptional handling and innovative safety technology.
Unboxed. Featuring a stunning new design, incredible handling, amazing versatility and innovative safety features, this Sportswagon is sure to impress drivers, passengers and jealous pedestrians alike.
Featuring a bold redesign that focuses on better performance like integrated exhaust, better safety features like world's first pedestrian and cycling detection and better fuel consumption. It's the perfect example of how rugged can also be ravishing.
From crosstown traffic to cross-country trekking, this premium crossover vehicle is Scandinavian style and Canadian performance at its best – rugged enough to traverse any terrain and luxurious enough to make any journey effortless.
The only SUV designed in Sweden – where good design is a way of life, not a luxury. It's bold, yet not brash. It exudes power and confidence with subtlety. Its imposing presence is elegant and understated. Meet the all-new XC90.
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Parts Specials
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Sheraton Krabi Beach Resort
Spacious and comfortable, all of our guest rooms and suites feature modern amenities and private balconies in a Thai contemporary design. All rooms are harmoniously spread out in eight units of low-rise buildings intertwined beautifully with tropical gardens and ponds.
Deluxe Rooms are tastefully decorated in modern design and have a separate bath and shower. They offer views of natural vegetation and mangrove gardens.
Deluxe Sea-Facing Rooms offer a partial view of the Andaman Sea across the mangrove landscape, as well as upgraded amenities.
Deluxe Club Rooms include a spacious shower, a separate bathtub, and a private balcony.
Premium Sea-Facing Rooms offer a view of the Andaman Sea across the mangrove landscape from a private balcony.
Premium Sea-Facing Studio Suites feature a contemporary ambience setting with a partial sea view. These suites have an elegant living area and a private balcony or terrace.
Premium One-Bedroom Suites feature two separate rooms. Total luxury fills the elegant open living area, one bedroom with a private terrace, and a bathroom with a separate shower and an oversized bathtub.
The Premium Suite with Private Pool offers a contemporary setting. This suite has a separate living area and bedroom, a private pool, and a bathroom with a separate shower and an oversized bathtub.
Deluxe Club Room, Premium Sea-Facing Room, and all suite guests have special access to the Sheraton Club Lounge. A relaxing, upscale space, the Club Lounge offers complimentary breakfast, refreshments throughout the day, and a variety of beverage options. Take advantage of the private Club Lounge where you can connect with friends, meet with your team, or simply relax by catching your favorite TV show. Need to get some work done? A copier/fax/printer, complimentary office supplies, and complimentary High Speed Internet Access are ready to go.
Adjacent to the lobby, the Sheraton Club Lounge is open to Club guests aged 13 and over. An alternate lounge for guests with younger children is located at Coco Vida adjacent to the main pool, and features all of the same benefits as our main Sheraton Club Lounge.
After a day of friends, family, or business, there is one more thing to savor at this Sheraton: the welcome of our guest rooms, which are completely smoke-free.
- Bathroom Telephone
- Separate Bathtub and Shower
- Bathrobes & Slippers
- Deluxe Bath Amenities
Bed Features
- Rollaway Beds
- Cribs (Upon Request)
- 24-Hour Room Service
- Mini Bar
- Coffee and Tea Maker
- Satellite Channels
- International Direct Dialing
- Outlet Adaptors
Room Amenities & Services
- Wake-up Service
- Individual Climate Control
- Iron/Ironing Board by Request
- In-Room Electronic Safe
- Escort to Guest Room at Check-In
- Radio/Alarm Clock
- SPG® Kids Pass
Room Features
- Adjoining Rooms
- Balcony
- Connecting Rooms Available
- 100% Non-Smoking Guest Rooms
- Accessible Room
- Starwood Preferred Guest Room
Internet Access
Free internet is available via a variety of our brands, booking channels and membership tiers. Learn more
- Wired High Speed Internet Access in All Guest Rooms 450 THB per day
To explore the full lemeridien.com experience, Flash Player Version 6.39 or higher is required. Click here for a free download. Alternatively click here to experience the non-flash version of lemeridien.com. Enjoy


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the cost and the impossibility of completeness are evident, given the vast movements of people and things that global commerce and tourism entail.
The attractiveness of the end-of-the-line strategy is the promise of direct security, but the multiplicity of possible targets (and the adaptive capacity of terrorists to shift them under changing circumstances) also raises the issues of cost and the impossibility of completeness.
Considerations of strategic prudence and the force of public opinion will probably dictate that the country pursue all three lines of prevention, albeit imperfectly, and settle for as much reduction in the probabilities of attack as possible. This will come at great cost to the nation. Prospects for continuing governmental budgetary surpluses over the next several years have all but evaporated, and even if assisted by other nations, the United States will likely bear the greatest part of the economic burden.
Within the United States, the question of who pays will be a continuous one. Even under normal circumstances, U.S. politics is fraught with ambiguities and conflicts over the respective costs to be borne by federal, regional, state, and local authorities. The defense against terrorism promises to make the uncertainties even more salient. Furthermore, while the fight against terrorism is manifestly a public and governmental responsibility, many if not most of the targets of terrorism are in the private sector. Given all these intersections, who prepares and who pays? More rational and less rational solutions to these dilemmas can be designed, but the nation must expect a significant residue of tugging and hauling, jockeying for position, and resentments over perceived off-loading.
Two other sets of derived consequences, also of uncertain dimensions, lie on the horizon. The first is the effect of a continuous, quasi-wartime effort on the balance and strength of the U.S. economy. Such an effort will involve significant reallocation of public expenditures and capital among different industrial sectors (especially those connected with defense), the prospect of governmental budgetary deficits, some impact on the pattern of imports and exports, and perhaps a greater sensitivity to inflation.
The second is the prospect of giving lower priority to some expenditures for programs in education, health, welfare, environmental protection, and other areas in the face of more urgent demands for military and homeland and defense expenditures. War efforts typically slow the progress of social programs (demands for which often follow wars in a flurry). The quasi-wartime exigencies associated with counterterrorist activities promise to be no exception.
The natural history of recovery from disaster involves a diminution of emotional responses, a denial of the possibility of recurrence, and a return to routine activities, events, rhythms, and conflicts. These are, by and large, reasonable and


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Amelia Earhart Park
401 East 65th Street, Hialeah, FL 33013Map
+1 305 685 8389
There are not many farms to be found in urbanized Miami these days, so this is a particularly delightful diversion for those in search of a little country atmosphere. Children in particular will enjoy this family-oriented park, with its pony rides and petting zoo (housed in a barn). Located in Hialeah, the park includes five lakes that have plenty of fishes. Visitors can also find picnic facilities, playgrounds, and an old-fashioned country store.
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The NDP government announcement reversing unpopular education cuts is a signal of what's to come for education in Alberta, says the province's new education minister. David Eggen said he will work in his new role to give school boards "a sense of security and stability" so they can make longer-term plans that strengthen Alberta's K-12 education system.
Great travel photos from around the world
It covers only a small patch of the planet but with more than 7,000 islands, the Caribbean is a potpourri of languages, cultures and activities.
Watching the sun rise over Barbados from a private balcony on the Caribbean Princess, it's easy to forget stresses at home.
The Caribbean draws on a rich culinary history and a host of ingredients you seldom find elsewhere. But, in order to sample it, you have to step out of...
A navigational mistake led to the British setting foot on the Caribbean island of Barbados in 1627.


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First Female Artistic Director at the Abbey Theatre
To celebrate their 110th anniversary, the Abbey Theatre have launched an interactive website marking 110 moments in their history, both on and off-stage. Alongside this project, RTÉ Archives is taking its own look back at Ireland's national theatre.
Lelia Doolan was the first woman to become artistic director of the Abbey. She had previously worked in RTÉ as a producer, director and head of light entertainment. Doolan took up her Abbey position in December 1971 and announced her artistic policy the following year, at a press conference in the Peacock Theatre on 30 August 1972.
In this RTÉ News report from the night, Doolan explains the "creative fusion" she hopes to create between actor, audience and author. Her three-year plan envisages a first year of classics and revivals, with a new field of endeavour in the second year. She also hopes to bring the national theatre to the people of Ireland. Theatre manager John Slemon outlines the challenges of taking the theatre on the road to reporter Paddy Smith.
Lelia Doolan in 1963. The photographer was Roy Bedell


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Criminology & Criminal Justice
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In This Guide
Criminology and Criminal Justice are multidisciplinary fields. They depend heavily upon research in fields such as: psychology, law, economics, sociology, politics, and public administration. Because of this multidisciplinary nature, you may need to consult literature in many different fields when doing your research.
Whether you're looking for books, articles, or reports, you'll need to learn how to narrow and broaden your searches, and you'll need to know how to use the various tools to find these items.
This guide will help you with all of these things, but you might also consult Library DIY to brush-up on your library and research skills.
Use the tabs above to navigate through the following pages of the guide:
Find Books - find print and eBooks and learn how the library can get you books we don't have in our collection.
Find Articles - search for articles online and in print. Recommends the best resources for finding criminal justice and criminology articles.
Find Statistics - find the best places for statistics useful for research and study of Criminal Justice and Criminology.
Crime - find the best places for Crime research.
Corrections - find the best resources for Corrections research.
American Justice - find the best resources for American Justice research.
Evidence-Based - find the best resources to find evidence-based information.
Citing Sources - find guidance on how to appropriately cite your sources.
Library DIY: Quick Research Help When You Need It!
Do you have a research question? Try Library DIY, find answers to your research questions!


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Saturday, May 23, 2015
Eisner's Tornante Seals Multi-Year Deal with Universal
Former Disney CEO Michael Eisner is back in the big studio features game. The Hollywood Reporter had the scoop this morning that Eisner's Tornante Company has signed a multi-year ... Continue Reading →
Disney's Lost Oswald Short Surfaces at Telluride
Walt Disney Animation Studios (WDAS) debuted a newly restored digital print of the once-thought-lost 1928 Oswald the Lucky Rabbit animated short Hungry Hobos at the Telluride Film Festival ... Continue Reading →
3-D 'Lorax' Comes to 269 IMAX Screens
The latest 3-D CG flick from Universal Pictures/Illumination Entertainment, Dr. Seuss' The Lorax, will come to IMAX March 2, opening on 269 domestic screens simultaneously, according ... Continue Reading →
Universal Buys MacGuff for Illumination Ent.
Universal Pictures has bought French animation studio Mac Guff Ligne for Illumination Entertainment, according to Deadline.com. Illumination and Mac Guff worked together on CG-animated ... Continue Reading →


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Everyday FREE SHIPPING for Orders Over $80 | U.S. Postal Service 3 Day
Officially Licensed Collegiate Merchandise
Shop the The Citadel Apparel Store for a wide selection of Bulldogs merchandise, gear, sportswear and clothing. Whether you are a student, parent, teacher, alumni or just a fan, your customized The Citadel clothing shows your pride and support when cheering on your favorite team during the big game, studying at the library or just lounging around. For all your Bulldogs gear, shop our Campus Team Shop today!