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Stay and Pay Accommodation Package in Airlie Beach
Have you got a large or extended family you'd like to take on holiday to Airlie Beach and the Whitsundays?
With a maximum occupancy of eight guests, this is the luxury destination and package to make it all happen in Airlie Beach, and it won't break the bank. Keep your family together on holiday when you Stay 5 Nights and only Pay for 4 nights in one of the best Penthouses in Airlie Beach. You also receive Chocolates and a Bottle of Champagne on arrival.
This is accommodation in our luxurious 2 storey penthouse which offers 4 bedrooms, 3 bathrooms, formal dining, luxury kitchen, extensive outdoor entertaining area, with an upper level terrace that is complete with a jacuzzi and BBQ on the terrace. Completing the picture, are magical views that overlook the Whitsundays. This penthouse is one of the highest in Airlie Beach, with commanding 270 degree views. We promise you that nothing else compares in Airlie Beach.
Go ahead, treat the family, or get a group of like minded couple together for holiday in Airlie Beach. With a fully equipped kitchen, a dining room and a view to die for, get set for a dinner party and starlight BBQs on the roof. Go on, make some memories.
For an inexpensive day outing there is the Great Whitsundays Walk. The Great Whitsundays Walk starts in Proserpine and traverses a 30km trail back to Airlie Beach with views looking back to the Whitsundays on the coastal aspects of the path. Med Resorts is also a perfect place to stay if you are bringing your car, as we have secure lockup garaging for the duration of your stay.
Further inland, Lake Proserpine, which is also known as Peter Faust Dam is situated 26 kilometres from Proserpine is a freshwater fisherman`s dream. Peter Faust Dam has more giant barramundi than any other fishing spot in Australia! The combination of tropical climate with long summers and mild winters creates an ideal environment to nurture 1m plus barramundi. The barramundi can be fished all year round and is annually restocked with over 20,000 barramundi fingerlings. There's other species like sooty grunter, sleepy cod and saratoga that make excellent game. Local fishing tackle stores and guided trips are available all year round.
Yet more adventure awaits on the waters of the Whitsundays, but take your pick, there is a smorgasbord of activity to choose from using Airlie Beach as your base of operations. Or you may choose to do very little and enjoy the luxurious environs of the Med Resorts. Book your Stay 5 and Pay 4 Accommodation Package in Airlie Beach. It's altogether better together.
For that tropical Queensland holiday to recharge your romantic life, Mediterranean Resorts have the Special Romance Package for you. Just pack your summer suitcase, we've got the essentials for your Airlie Beach escape covered. Let us take care of the transfer and accommodation headaches when you come to stay at Airlie Beach.
Getting to Airlie Beach is a breeze. Jetstar and Virgin Australia provide direct daily flights to & from Brisbane and connections to southern ports e.g. Sydney, Adelaide and Melbourne) are also available through Brisbane to the Whitsundays. Tiger Airways provides direct flights to and from Sydney three times a week. We include a pick up and return by limousine to Proserpine Airport, with a welcome of champagne and a hamper of chocolates, cheeses, dips, crackers and other seriously delicious treats when you arrive. You will be accommodated in a One-bedroom apartment with a jacuzzi on the terrace, so you can soak up the star-filled and fairy light views of the magnificent view of the Whitsunday Islands.
Relax — an in-room massage awaits you. Book this at any time you like over your stay. We'd like to get you into a Whitsundays state of mind…
We will transport you to Langford Reef on a private helicopter charter. Langford Reef, the beautiful sand and coral spit that extends from Langford Island in the Whitsundays is where you will get to snorkel off the tiniest sliver of beach you can imagine, and then refresh yourselves with champagne before your return flight to Airlie Beach.
Also included is a three course dinner and champagne at De ja Vu Restaurant — modern Australian cuisine — served up in darling bali huts. A boutique dining experience with tropical seaview dining over Airlie Beach and the azure Whitsunday Islands. The owners Sarah and Patrice Duverger will ensure no detail is overlooked. Conveniently located at the base of Airlie's most famous hillside accommodation strip, Orchid Drive, the restaurant is only a 200 metre walk from the Med Resort apartments.
This is just the beginning of your Airlie Beach romance. Let us recommend to you some further tours and activities from our Tour Desk when you arrive. Your holiday will sparkle with possibilities in the Whitsundays.
Come and romance the tropics when you book your Accommodation Packages at Mediterranean Resorts, Airlie Beach.
This is the ultimate family Whitsunday Adventure accommodation package. Make your choice between a three, five or seven day adventure in the tropical Airlie Beach.
The package includes a two bedroom self-contained seaview apartment, and a couple of must see Whitsunday experiences, including a cruise on the stunning Whitsunday Islands to experience the outer Great Barrier Reef. Prepare to be amazed as you visit Queensland's largest and most spectacular underwater viewing chamber. There you will get the opportunity to snorkel, lounge or sunbathe on this floating outer reef complex. There's also a water slide on the reef pontoon.
The package also includes a half day tour exploring the iconic Whitehaven Beach where you'll experience the crystal clear aqua waters and 7 kms of pristine, white silica sand — a deserted tropical island paradise — but you do get to go back to Airlie Beach.
Continue your adventures on land as there's a multitude of other activities and spots to visit — the Great Whitsundays Walk is a 30km walk or trek on mountain bikes through the Conway National Forest, experience the picturesque Whitsunday Islands from the forest as the route leads you back to Airlie Beach for a well deserved plunge in our wet-edge pools.
How about ocean rafting, kayaking or further snorkeling? There is even a quadbike tour available for the gear enthusiasts. Whitsunday Crocodile Safaris in Proserpine is also a fun encounter with the local wildlife. For a more comprehensive list of Airlie Beach activities and tours take a look here.
Feel free to see us at our Tours Desk, there's a whole lot of adventure waiting for your family in the Whitsundays.
Trip Advisor Airlie Beach Resort Reviews are your go to when deciding where to stay on your next holiday in the Whitsundays providing reliable feedback from guest who have enjoyed their resort accommodation in Airlie Beach. A large number of visitors have enjoyed their Airlie Beach accommodation in this resort and have provided reviews commenting on such things as :
1. The stunning views – all apartments feature spacious balconies from which to enjoy views over Airlie Beach, the Coral Sea and towards the Whitsundays.
2. Spacious apartments – this resort features spacious open plan apartments with plenty of room for all guests.
3. Great Resort – Great accommodation, great resort facilities, great view, great holiday atmosphere and just a great resort
4. Location - We are situated on a hill in Airlie Beach a short 10 minute walk to the village. Easy walk down and bound to burn some calories on the way back or a short taxi ride.
5. Close to the Whitsunday Islands – we are close to the Abel Point Marina where the day trips to the Great Barrier Reef depart. Enjoy a day out on the reef and return to enjoy a spa on the balcony or a dip in the wet edge pool….of course both with stunning Coral Sea views.
What are you waiting for? Ring us today at Mediterranean Resorts to book your next Airlie Beach Resort accommodation. You will be assured of fantastic spacious accommodation with stunning views and great resort facilities.
For that special once-in-a-lifetime honeymoon experience, Mediterranean Airlie Beach Resorts have the Special Honeymoon Package for you. Just pack the suitcase, we've got all the vital arrangements for your Airlie Beach honeymoon covered. Let us take care of the transfers and accommodation headaches when you come to stay at Airlie Beach — the Whitsundays destination of choice. We have a number of packages perfect for you…please call to discuss.
We include a pick up and return by limousine from Proserpine Airport, with a welcome of champagne and a hamper of chocolates, cheeses, dips, crackers and other seriously delicious treats when you arrive. You will be accommodated in a One-bedroom apartment with a jacuzzi on the terrace, so you can soak up the star-filled and fairy light views of the magnificent view of the Whitsunday Islands.
An in-room massage awaits you. Book this at any time you like over your stay to put you in a most relaxed state of mind and body for your honeymoon in the Whitsundays.
We transport you to Langford Reef on a private helicopter charter. Langford Reef is a beautiful sand and coral spit that extends from Langford Island in the Whitsundays. Surrounded by coral reef, it is a favored promotional location for the Whitsundays. On the high tide, there is only a small spit of sand left to walk along. There you will get to snorkel off the tiniest sliver of beach you can imagine, and then refresh yourselves with champagne before your return to Airlie Beach.
We also include a three course dinner and champagne at De ja Vu Restaurant — modern Australian cuisine — served up in sublime tropical settings. A boutique dining experience with tropical seaview dining over Airlie Beach and the azure Whitsunday Islands. You'll receive exquisite service from the current owners Sarah and Patrice Duverger.
This is just the beginning of your Airlie Beach honeymoon. Let us recommend to you some further tours and activities from our Tour Desk when you arrive. Your honeymoon will sparkle with possibilities in the Whitsundays.
Come and book your adventure of a lifetime when you book your Honeymoon and Accommodation Packages Airlie Beach at Mediterranean Resorts.
Stay 5 nights Pay 4 nights in our 3 bedroom luxury penthouse on the hill at Mediterranean Resorts in Airlie Beach. This special accommodation deal is available between October and November 2014.
Indulge yourselves in the spacious three bedroom luxury penthouse, one king bed, one queen bed, and two single beds, fully self-contained with two living areas. This arrangement sleeps up to 6 people.
Four balconies avail you of spectacular views of the Coral Sea and islands, and on the main terrace is a spa for you to enjoy the relaxing waterborne delights with the view. Go ahead, treat the family, or get a group of like minded couple together for holiday in Airlie Beach. With a fully equipped kitchen, a dining room and a view to die for, get set for a dinner party to remember for a very long time.
The Whitsundays holds many pleasures, with the view only the entree to the fun and adventure you can have in the Whitsundays playground. There are unlimited fishing opportunities with beach, boat, estuary or freshwater fishing formats to choose from, not to mention the abundance of qualified tour operators who can take you on half, full or multi-day fishing expeditions to catch a multitude of different species. Coral trout, sweetlip, barramundi, queenfish, trevally, mangrove jack, fingermark, garfish and herring to name but a few.
There are also charters to take you on a leisurely cruise around the Whitsundays and to the outer Great Barrier Reef for viewing or closer interaction with the underwater world by snorkelling, scuba or semi-submersible underwater platforms if you wish to keep your feet dry.
You shouldn't limit yourself to marine based adventure either, a world of sights and activities can be experienced in and around Proserpine, with the Conway National Forest and Crocodile Adventures. Take a closer look at our Airlie Beach Tours page for even more ideas.
With some foresight and planning, you can bag a luxury accommodation package in Airlie Beach for a good rate, and also enjoy the tropical Whitsundays without the crush of peak season holiday makers.
Looking for great Airlie Beach accommodation for the upcoming Whitsunday Reef Festival? Mediterranean Resorts is the ideal accommodation choice in Airlie Beach with fully furnished apartments suitable for singles, couples and families. This year`s Airlie Beach event (held from the 1st of August to the 7th) promises something for everyone with starlight movies, a street parade, fashion shows, live entertainment, food and fireworks on the foreshore. This family friendly event is expected to attract large crowds to celebrate Airlie Beach and the north Queensland lifestyle.
Airlie Beach Accommodation
Med Resorts offers a great range of fully furnished 2, 3 and 4 bedroom apartment and penthouse accommodation. All apartments are fully self-contained, individually furnished and spacious with generous balconies overlooking the stunning Coral Sea and beyond. You will love the onsite facilities which include 2 private saltwater pools which offer stunning ocean views, spa and adjacent bbq ares perfect for relaxed dining.
Airlie Beach and Med Resorts is the perfect location to base yourself for your Whitsunday holiday. With easy access to the Whitsunday Islands and the Great Barrier Reef, a holiday here will leave you relaxed as well as inspired. Ring us today to secure your Airlie Beach Accommodation for the upcoming Whitsunday Reef Festival and help celebrate…….Whitsundays style.
Take a trip to Airlie Beach this winter and you can be sure that you'll get a great deal at Mediterranean Resorts, Airlie Beach. With apartments ranging from one to four bedrooms, the most intimate of holidays to the largest of family parties can be accommodated in style.
We've put together a range of accommodation packages that will allow you to get the most out of your Airlie Beach holiday. We have tailored these packages with their accompanying tours so you can get to have a full-flavoured Whitsundays experience using the luxurious Airlie Beach Mediterranean Resorts as your home base.
We have dedicated packages for honeymooners, romantics, extreme adventurers, families and groups. Just hop on the packages link for more information.
Just in case you are you thinking about a wedding in the tropical paradise of Airlie Beach and there is not quite the package to suit, feel free to call us to find out how we can help. We are Airlie Beach accommodation specialists and can tailor a package to accommodate your wedding party, no matter how large or small.
The 25th annual Airlie Beach race week is due to set sail from the 8th to the 15th of August. With more than 100 yachts competing, it is sure to be a vibrant and fun event both on and off the water. With the social aspect of Airlie Beach Race week a draw card you can expect a diverse range of people converging on the local Whitsunday Sailing Club beachfront at the end of each day to share stories, catch up with old friends and meet new ones. This event takes place from Airlie Beach with sailing throughout the picturesque Whitsunday Islands. Why not be a part of this fantastic Airlie Beach event, enter your own yacht, be a part of the crew, volunteer or just visit Airlie Beach in August to soak up the atmosphere. Don't forget to organise your Airlie Beach accommodation, Mediterranean Resorts would love to welcome you. Ring us today to discuss your Airlie Beach accommodation needs.
Airlie Beach Accommodation
Mediterranean Resorts offers luxury accommodation options in Airlie Beach. Choose from a range of fully self-contained and individually furnished 1, 2 and 3 bedroom villas, honeymoon suites plus a choice of 3 or 4 bedroom penthouses. All feature full kitchen and laundry facilities, most have 2 bathrooms, air conditioning and generous balconies with stunning ocean views over the Coral Sea.
With so much to see and do in Airlie Beach and the Whitsundays, it is the ideal holiday destination at any time, combine this with the fun of the annual Airlie Beach race week and you can be assured or a holiday to remember.

subset: commoncrawl


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Residents gather at the site of a car bomb attack in the Ameen district in Baghdad February 17, 2013. REUTERS/Mohammed Ameen
BAGHDAD: A series of car bombs exploded within minutes of each other in and around Baghdad on Sunday, killing at least 28 people and wounding dozens in overwhelmingly Shiite areas.
The attacks come amid rising sectarian discord in Iraq. The explosions, mostly in outdoor markets, struck at the start of the local work week and appeared aimed at causing mass casualties among residents going about their morning shopping.
Violence in Iraq has fallen since the height of sectarian fighting in 2006 and 2007, but insurgents still launch lethal attacks frequently against security forces and civilians in an attempt to undermine the Shiite-led government.
There was no immediate claim of responsibility for the attacks, but similar ones have been orchestrated by Sunni extremists, such as al-Qaida's local arm. The group, known as the Islamic State of Iraq, favors large-scale, coordinated attacks. It frequently targets Shiite Muslims.
Police and hospital officials provided the death toll, and said more than 80 people were wounded. They spoke on condition of anonymity because they weren't authorized to brief reporters.
The detonation of a parked car loaded with explosives in the sprawling Shiite district of Sadr City heralded the start of the attacks late Sunday morning. Two more parked cars later exploded elsewhere in the poor neighborhood.
Other blasts erupted in the Baghdad neighborhood of al-Amin, in an open-air market in Husseiniya, just northeast of the capital, and in the Kamaliya area in Baghdad's eastern suburbs.
As sectarian strife mounts, protesters drawn overwhelmingly from Iraq's Sunni community have been staging weekly demonstrations and sit-ins since late December to rally against the government, which is led by Shiite Prime Minister Nouri al-Maliki. The protesters have rejected calls for violence and distance themselves from extremists groups such as al-Qaida.
There are also concerns that Sunni insurgents could step up attacks ahead of provincial elections scheduled for April 20. The ballot would be the first country-wide vote since the U.S. troop withdrawal more than a year ago.
Sunday's attacks bring to more than 100 the number of people killed in violent attacks in Iraq since the start of the month. A total of 178 were killed in January attacks, according to an Associated Press count.
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Josh Groban Kicks Off East Coast Summer Tour Today
Internationally celebrated performer and recording artist Josh Groban is set to embark on a new North American tour in promotion of his chart-topping ALL THAT ECHOES album later this year with a new East Coast Summer tour.
The dates and locations announced so far for the tour are as follows:
- 8/16 Cary, NC: Cary's Booth Amphitheatre (w/North Carolina Symphony)
- 8/19 Vienna, VA: The Filene Center at Wolf Trap (w/Filene Center Orchestra)
- 8/20 Vienna, VA: The Filene Center at Wolf Trap (w/Filene Center Orchestra)
- 8/22 Canandaigua, NY: Constellation Brands Marvin Sands PAC (w/Orchestra)
- 8/23 Bethel, NY: Bethel Woods Center for the Arts (w/Orchestra)
- 8/26 Scranton, PA: Toyota Pavilion at Montage Mountain (w/Musicians of the Northeast Pennsylvania Philharmonic)
- 8/27 Philadelphia, PA: Mann Center for the Performing Arts (w/Mann Festival Orchestra)
- 8/29 Uncasville, CT: Mohegan Sun Arena (w/Don Trenner Orchestra)
- 8/30 Lenox, MA: Tanglewood (w/Boston Pops w/Keith Lockhart)
More information on Josh Groban is available at his official site here.
Additionally, check out my recent InDepth InterView with Josh Groban all about ALL THAT ECHOES and much, much more, available here.
About Author
- SOUND OFF World Premiere Exclusive: Joel Grey In GEORGE M! On THE ED SULLIVAN SHOW
- SOUND OFF: Four Fabulous Features Of This Week's GLEE
- New Rehearsal Sneak Peek Of SOMETHING ROTTEN! Featuring Christian Borle
- Christian Borle & Brian D'Arcy James Talk SMASH Reunion In Rehearsal For SOMETHING ROTTEN!
- GLEE's Darren Criss & Chris Colfer Explain The Klainomenon
- SHAKESPEARE UNCOVERED: SERIES 2 DVD Out Today
- Behind The Scenes With Matthew Morrison In FINDING NEVERLAND Rehearsals
- Ultra-Glam New KINKY BOOTS Academy Awards Social Media Image
- Darren Criss Says Goodbye To GLEE With Emotional Message To Fans
- Lea Michele, Darren Criss & More In Group Photo Of Cast & Crew At GLEE Finale


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Expanding the Reach of Research
During the third week of October this year, libraries around the world hosted lectures, workshops, webcasts, and video contests. At the University of Minnesota, librarians used old-fashioned posters and newfangled "tweets" to get the word out. Their message? "Throwing open the locked doors that once hid knowledge," according to the organizers of the first international Open Access Week. The event has been expanded from previous years, when organizers marked a single day, to accommodate growing interest in the open access movement. But open access to what?
As the event Web site describes, proponents of open access share the belief that "all research should be freely accessible online, immediately after publication." Momentum is on their side, as research funding agencies, policy makers, and universities have begun formalizing their support.
In 2008, The National Institutes of Health implemented a brief but powerful policy. Division G, Title II, Section 218 of PL 110-161 (Consolidated Appropriations Act, 2008) states:
What does this mean for health science researchers? Simply, according to University of Minnesota health sciences librarian Wayne Loftus, that researchers funded by the National Institutes of Health will have to deposit a digital copy of their research publications in an open-access repository, in this case the National Library of Medicine's PubMed Central database. "All of them. Authors need to prove they are meeting this requirement in all future applications and progress reports, and NIH may withhold funds in the case of non-compliance," says Loftus.
The mandate, which originated from a 2004 voluntary recommendation, was bolstered in March 2009 when the Omnibus Appropriations Act turned the mandate into law. This has great implications for University of Minnesota researchers, as 44.3% of University research funding for fiscal year 2008 came from the National Institutes of Health. The University of Minnesota Libraries support the regulation and are active in helping researchers comply with the mandate. Loftus states that "people are taking it seriously, and NIH, the U's Sponsored Projects Administration, and unit grants administrators are sending out reminders to complete the requirements."
Some believe deposit of pre-publication manuscripts is only a first step, advocating for new models of open-access publishing that would make the content freely available online immediately upon publication. Not all researchers are convinced, often due to misconceptions about open-access publishing. U librarians have collected some of these myths at www.lib.umn.edu/scholcom/top5myths.phtml. The list includes fears that the cost of running open access will cut into funds for research; that researchers and the public already have all the access to research that they could possibly need; and that scientific integrity is compromised by the fact that authors are charged to publish in open access publications (though they often are in traditional journals as well).
"Open access works to prevent 'silo-ing' of information in a world where our faculty increasingly work across institutional lines."
The site handily refutes these fears, but there is also an unstated but pervasive prejudice that "open" may actually mean "inferior." To be clear, open-access publishing is definitely not blogging, vanity publishing, or rogue science. Innovators of open-access publishing, like BioMed Central and the Public Library of Science (PLOS), subject the research results to the same rigorous peer review as subscription-based journals. E-resources Associate librarian James Stemper points out that "many mainstream outlets such as Reuters, BBC, and The New York Times were citing these journals because they are so easy to find on the Web," adding that "a recent study of PLOS articles by faculty authors from Big Ten institutions reveals that the number of University of Minnesota-published articles went up 122% from 2007 to 2008; University of Minnesota authors published 20 articles in PLOS journals in 2008, tied with Northwestern and behind only University of Michigan; three out of four of these 20 articles were published in PLOS One, the publisher's new peer-reviewed journal 'for the swift publication of original research in all areas of science and medicine, with innovative user tools for post-publication commenting, rating, and discussion.'"
So who benefits?
Mathematics librarian Kristine Fowler commented, "Research depends on the flow of ideas—a lab in Japan will extend an experiment done in the Netherlands, then a research group in Brazil will play off that, and so on. Since open access makes research results available to all researchers everywhere, it provides an overall stimulus to research." Stemper makes a telling point about subscription fees. "Researchers will benefit from greater access for university members—not all universities (not even Harvard, MIT, or UC-Berkeley) can afford to subscribe to all scholarly journals. Further, we cannot rely on interlibrary loan for journals, as many academic libraries are moving to electronic-only subscriptions with restrictive licenses that do not always allow them to provide loans of articles to non-subscribers. Open access works to prevent this 'silo-ing' of information in a world where our faculty increasingly work across institutional lines." The subscription fees for scholarly journals, especially those in the health sciences, can indeed be staggering enough to discourage schools, even those with deep pockets. The Journal of Comparative Neurology and Brain Research each cost over $20,000 for an annual subscription, and they are by no means unique in this eye-popping price range.
The subscription cost is even higher if you are ordering from outside the U.S., Canada, and Mexico. Researchers in developing countries simply cannot keep up with the prices of these journals, despite the efforts of initiatives like HINARI (Health InterNetwork Access to Research Initiative), which make some journals available to the poorest countries for free. When you consider the important research being done on infectious diseases like malaria and HIV/AIDS, it seems essential that researchers in countries where these diseases are rampant have a quick and lower-cost means of accessing and contributing to the body of knowledge on these illnesses.
The Journal of Comparative Neurology and Brain Research each cost over $20,000 for an annual subscription.
Faculty researchers aren't the only ones constrained by their institutions' inability to keep up with skyrocketing subscription prices. According to the Scholarly Publishing and Academic Resources Coalition (SPARC), "students on campuses across the country are in danger of losing access to journals that provide them with cutting edge research—research crucial for a complete education in any field of study." Open-access publishing democratizes students' ability to read the latest and most up-to-date research. As Fowler says, "Open access helps even the playing field for students at institutions with varying resource levels—there is less segregation into 'haves' and 'have-nots.'"
Members of the Public
Should the general public be allowed access to medical research? "Speak to people in the medical profession," wrote one respondent to BioMed Central's inquiry on people's perception of open-access publishing, "and they will say the last thing they want are people who may have illnesses reading this information, marching into surgeries and asking things. We need to be careful with this very, very high-level information." Biomed Central calls the idea "elitist;" Fowler more temperately responds that public access benefits the general public by making it possible "to gather information about a medical issue affecting them or their family members, which otherwise might be behind barriers of subscriptions only held by institutions to which they don't belong."
Moreover, the better people understand their ailments the more in control of their care they feel. As relationships between doctors and patients become demystified and more partner-like, healthcare providers may very well have to answer patients' questions about "high-level" information whether they want to or not. Finally, as indicated in "The Road to Health," there are real costs associated with low health literacy.
Beyond Following Mandates
What, besides the NIH mandate, might motivate a scholar to ensure their work is available in an open-access format, either through deposit of manuscripts in an open-access repository or by choosing an open-access journal for publication of their work? "There are practical reasons," says Fowler. "Some studies suggest that more people will read and cite the work if it's open access; and also philosophical ones—there's an argument that scholarship should be treated as a public good that anyone can use, rather than a market good that must be bought."
What does the future hold for open-access publishing? Perhaps the question should be reframed: what does open-access publishing hold out to the future? Fowler responds that "The proportion of open-access research reports will only increase, as more researchers are affected by the NIH mandate; as more government agencies enact similar mandates currently under discussion, such as FRPAA (Federal Research Public Access Act); as acceptance grows of Web sites that make it easy to freely share papers; and as more authors become aware of the benefits of broader access to their work." Fowler cautions, however, that open access "poses a fairly dramatic change in the publishing cultures of some disciplines." Loftus concludes that "The hope, obviously, is that 100% of these articles will ultimately be publicly accessible. We're not there yet."


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I have always thought about investing in a home security system, but most of the solutions I have been looking at are too expensive or too robust for my needs. I want a solution that allows me to monitor my home from anywhere and record video to an offsite location in case someone got the bug to take my stuff ...Read More »
Home | Reviews | Audio & Video | Cameras
Olympus C-5050 Digital Zoom Camera
Introduction Those of you familiar with Olympus already know the high quality with which their imaging products are manufactured. For those still living under a rock, allow me to elucidate. Olympus began life as Takachiho Seisakusho, a Japanese company started in 1919 to produce, what else, Japan's first microscope. Yes, that's right, microscope. It's not as big a stretch as ...Read More »


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Cooking and Baking
Question of the Day: What surprises your friends most to hear that you make yourself?
I make my own yogurt, which always elicits responses like "oh, you're such a gourmet" and "where do you find the time?" - even after I explain that I only do it to save on plastic containers, and my total time investment in the process is about fifteen minutes (thanks to my Salton automatic yogurt warmer that looks like R2D2). What commonly-bought food items do you make yourself that your non-food-obsessed friends are surprised about?
Talk is closed, but that doesn't mean the conversations have to stop!
Check out this post for a more thorough explanation, and jump onto our Facebook page or our Twitter feed to keep the conversations going!


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Dr. Goldin is a medical doctor with board certification in both internal medicine and dermatology. A Summa Cum Laude graduate of the University of Cincinnati, Dr. Goldin was elected to Phi Beta Kappa. He received his medical degree from the University of Kentucky Medical School, and served a residency in internal medicine at Michael Reese Hospital followed and a second residency in dermatology at Cook County Hospital, where he was the chief resident in dermatology. Following his second residency, Dr. Goldin remained at Cook County Hospital and became a senior attending physician, training many dermatology residents.
As a current member of the Chicago Dermatological Society, the Illinois Dermatological Society, the Great Lakes Dermatological Society, the Chicago Medical Society, the Illinois State Medical Society and the American Medical Association, Dr. Goldin stays involved in his field at all times. He has been a faculty member in the dermatology departments of both University of Illinois and Rush University, and is currently a fellow of the American Academy of Dermatology and the American Society for Dermatologic Surgery.
Since 1993, Dr. Goldin has hosted monthly meetings for the Great Lakes Dermatological Society. He is a past president of both the Chicago Dermatological Society and the Illinois Dermatological Society.
Dr. Goldin participates in ongoing continuous medical education programs and has authored papers on medical literature and published newspaper editorials about healthcare issues.
An Evanston resident, Dr. Goldin lives with his wife, an ex-film producer and current author. Click here for a link to her latest book, Interfaith Solutions. They have two grown children.
Download Harry Goldin, M.D.'s curriculum vitae


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Boone Hall Fright Nights 2013
Join the folks at Boone Hall Plantation for the biggest, scariest haunted attraction in town!
September 27 through November 2, 2013
Fridays and Saturdays - Dark Until Midnight
All Other Nights - Dark Until 10 pm
See all 4 attractions for $27 or pay per attraction
Thursdays and Sundays, portion of the proceeds from each ticket goes to MUSC Children's Hospital!
Get all the information you need HERE at BooneHallFrightNights.com!
(Warning, this site may be too intense for younger viewers.)


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PJ's was founded in 1977, and over the
years has grown to become one of the leading precision fabricators
with state of the art CNC equipment. Today we occupy a 40,000
square foot facility in Canton, Ohio with capabilities in
CNC laser cutting, punching and forming. With our comprehensive
fabricating facility, powder-coating department, warehouse
and shipping operation, we can provide you a modern single
source to meet all your fabricating and finishing needs.
PJ's can assist you with its experienced, dedicated staff
and wide range of processing capabilities. We can help turn
your rough sketches into engineering drawings, build your
prototypes and then meet your production requirements. The
final product, whether delivered to you or drop shipped
directly to your customer, will be of excellent quality,
documented and shipped to your specifications. At PJ's,
we strive to responsively meet our customer's needs
in all that we do.
We currently supply parts and assemblies to all types of
users, large and small, local and international. We welcome
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Should Lane Splitting be legal in all 50 States
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That's MR. Toothless
Joined: May 2004
Location: NoVA for now...
Oddometer: 28,818
Originally Posted by
ray h
For you to "win" this, you must change my mind.
You probably won't do that.
The poll was asking about the U.S. It didn't ask about Europe.
I think filtering, splitting etc is disrespectful and encroaches of the space cushion of other people.
See my last post. THIS is the attitude we need to change. ...and its coming from 'one of us.'
I highly recommend spending some time in CA before you start making blanket statements. It will literally change your mind about the whole filtering/sharing thing.
I'll start debunking the filtering thing. How many motos do you know that can't out accelerate a car? Even Hardleys can... If you can out accelerate a car, how are you disrespectful and/or encroaching on someone's space cushion by filtering?
IME filter to the front, out accelerate the car next to you, and you've done a few things: A. you're not in the queue at the light. B. you're out of the way even before you get thru the intersection. C. you've facilitated smooth movement thru the intersection by ALL those behind you 'cause they didn't have to wait for yet one more vehicle to go thru the intersection. etc etc etc.
Feelings have nothing to do with any of that.
I'm a cyclist that rides motos, not a moto rider that rides bicycles.
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'Running With Romney' Series: House Budget Committee Chairman Paul Ryan
Tonight on Special Report's series "Running With Romney," Bret Baier spoke to House Budget Committee Chairman Paul Ryan (R-WI). Romney campaigned with the congressman in Wisconsin and has also embraced Ryan's budget plan.
Republican strategist Mike Murphy noted a downside if Romney chooses Ryan as his vice presidential nominee, saying, "Paul Ryan budget genius, very important in the Congress, good guy, Romney's close to him, talks to him a lot. The downside is you nominate Paul, one, you take a real player out of the Congress. And two, you're going to re-litigate the Ryan plan which has policy advantages but some political baggage."
Ryan reiterated what he has previously stated when asked about becoming Romney's running mate. "If they ask me to consider it, then I'll consider it. But that's months away from that kind of decision being made as far as I know.
I like my job. I think I can make a big difference doing what I'm doing."
At age 28, Ryan was elected to Wisconsin's 1st congressional district but he quickly moved up to become the youngest chairman of the House Budget Committee in 2011. Speaking about his budget plan, Ryan says, "We knew that if we offered solutions, that they were going to demagogue those solutions. But we feel that we have a moral and a legal obligation, that if we don't like the direction the president's taking the country, we should do something about it."
President Obama has criticized Ryan's budget in regards to student loans, saying that it cuts back on Pell Grants and essentially turns its back on young people. Ryan addressed the issue, saying, "I think every week we're going to see the president pander to various groups in this country in order to try and build an election coalition … and apparently if we're not increasing as much as the president proposes that's considered a huge cut."
It's not all about budgets for the married father of three who says his favorite thing to do is playing with his kids. Ryan quips that he's got making it to the airport on time down to a science, "I don't have a place out here in D.C. I'm here four days a week, after the last vote I head home, go to Milwaukee … I'll make it home for dinner tonight."
Watch the rest this 'Running With Romney' segment below:


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Number: 0585Policy
Implantable Cardioverter-Defibrillators
Aetna considers Food and Drug Administration-approved implantable cardioverter-defibrillators (thoracotomy and non-thoracotomy systems) medically necessary for any of the following groups of individuals, except where contraindicated:
Members with familial or inherited conditions with a high-risk of life-threatening ventricular tachyarrhythmias, including:
Long QT syndrome with either of the following:
Asymptomatic with one or more of the following risk factors for sudden cardiac death:
Family history of sudden death
Hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy (ARVC) with one or more of the following risk factors for sudden cardiac death:
At least one episode of unheralded syncope within the previous 12 months.
LV non-compaction cardiomyopathy with either of the following:
Impaired left ventricular ejection fraction (less than 50 %)
* Note: Ischemic cardiomyopathy is defined as left ventricular systolic dysfunction associated with marked stenosis (at least 75 % narrowing) of at least 1 of the 3 major coronary arteries, or a documented history of myocardial infarction.
Note: Aetna considerrs replacement of an implantable cardioverter defibrillator pulse generator and/or leads medically necessary when damaged, malfunctioning, when replacement is recommended according to the manufacturer's instructions in the product labeling, or due to a change in the member's medical condition.
Aetna considers implantable cardioverter-defibrillators experimental and investigational for other indications because its safety and effectiveness has not been established.
Subcutaneous Cardioverter-Defibrillators:
Aetna considers FDA-approved subcutaneous cardioverter-defibrillators medically necessary for persons who meet medical necessity criteria for an implantable cardioverter defibrillator listed above and who do not have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing.
Aetna considers subcutaneous cardioverter-defibrillators experimental and investigational for all other indications because their effectiveness and safety have not been established.
Cardioverter-defibrillators are not considered medically necessary when other disease processes are present that clearly and severely limit the member's life expectancy.
Notes: Electronic analysis of defibrillator systems is required for long-term routine follow-up care of cardioverter-defibrillators. Automatic defibrillator monitoring is considered medically necessary. Electrophysiologic assessment is a more complex evaluation of cardioverter-defibrillators, and is considered medically necessary.
Note: Intracardiac electrophysiological procedures performed before implantation of cardioverter-defibrillator may be done as an outpatient.
See also CPB 0579 - T-Wave Alternans, and CPB 0610 - Biventricular Pacing (Cardiac Resynchronization Therapy)/Combination Resynchronization-Defibrillation Devices for Congestive Heart Failure.
Wearable Cardioverter-Defibrillators
Aetna considers wearable cardioverter-defibrillators (WCDs) (automatic external cardioverter-defibrillators that are worn under the member's clothing) medically necessary durable medical equipment (DME) only for members who meet any of the following criteria:
Aetna considers WCDs experimental and investigational for other indications because its safety and effectiveness has not been established.
For Aetna's policy on automatic external defibrillators (AEDs) for home use, see CPB 0623 - Safety Items.Background
Cardiovascular mortality as a consequence of ventricular fibrillation (VF) or ventricular tachycardia (VT) continues to be a major health problem despite advances in the overall management of cardiovascular disease. Sudden cardiac death kills approximately 400,000 people per year. About 10 to 15 % of individuals who experience life threatening VT or VF recover, usually with an external cardiac defibrillator. These survivors have various therapeutic options such as anti-arrhythmic drugs, radiofrequency or surgical ablation of VT focus, or implantable cardioverter-defibrillators (ICDs).
Available literature indicates ICDs are now widely used for the secondary prevention of sudden cardiac death due to VF or VT. Ventricular tachycardia or VF can be secondary to a variety of conditions: progression in underlying pathology (i.e., deterioration of left ventricular [LV] function or worsening of coronary artery disease), autonomic imbalance, electrolyte abnormalities or even pharmacological intervention. The ICD is generally accepted as treatment for patients who have experienced an episode of VF not accompanied by an acute myocardial infarction or other transient or reversible causes (e.g., drug toxicity, electrolyte abnormalities, and ischemia). Additionally, accepted guidelines prefer this treatment in patients with sustained VT causing syncope or hemodynamic compromise. As primary prevention, the literature shows the ICD is superior to conventional anti-arrhythmic drug therapy in patients who have survived a myocardial infarction and who have spontaneous, non-sustained VT, a low ejection fraction, inducible VT at electrophysiological study, and whose VT is not suppressed by procainamide.
A number of well-designed studies have shown the effectiveness of the ICD in high-risk patients who have already experienced a myocardial infarction (MI). Schlapfer and colleagues (2002) compared the long-term survival rates of patients with sustained ventricular tachyarrhythmia after MI who were treated according to the results of EP study either with amiodarone or an ICD. They found that the long-term survival of patients with sustained ventricular tachyarrhythmias after MI, with depressed LV function, is significantly better with an ICD than with amiodarone therapy, even when stratified according to the results of the EP study. In a randomized controlled study (n = 1,232) to evaluate the effect of an implantable defibrillator on survival of patients with reduced LV function after MI, Moss et al (2002) concluded that in patients with a prior MI and advanced LV dysfunction, prophylactic implantation of a defibrillator improves survival and should be considered as a recommended therapy.
The Multi-center Autonomic Defibrillator Implantation Trial II (MADIT II) was stopped early because of a 30 % reduction in mortality in patients randomized to receive an ICD (Coats, 2002). The 4-year multi-center trial of 1,200 patients was terminated early after an independent board observed that the post-MI patients with impaired LV function receiving the implantable defibrillator had improved survival rates compared to those receiving conventional treatment.
The Center for Medicare and Medicaid Services (CMS) determined that the evidence is adequate to conclude that an ICD is reasonable and necessary for the following: (i) patients with ischemic dilated cardiomyopathy (IDCM), documented prior MI, and a measured LVEF of less than or equal to 35 %; (ii) patients with non-ischemic dilated cardiomyopathy (NIDCM) greater than 9 months with a measured EF less than or equal to 35 %.
In addition, according to CMS, several additional criteria must be met. Patients must not have: New York Heart Association (NYHA) Class IV heart failure; cardiogenic shock or symptomatic hypotension while in a stable baseline rhythm; coronary artery bypass graft or percutaneous transluminal coronary angioplasty within the past 3 months; acute myocardial infarction (AMI) within the past month; clinical symptoms or findings that would make them a candidate for coronary revascularization; irreversible brain damage from pre-existing cerebral disease; or any disease, other than cardiac disease (e.g., cancer, uremia, liver failure) associated with a likelihood of survival less than 1 year.
The Center for Medicare and Medicaid Services expanded coverage of ICDs to persons with NIDCM, based primarily on the results of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), a prospective randomized trial to determine whether amiodarone or an ICD will improve survival compared to placebo in patients with NYHA Class II and Class III heart failure and reduced LVEF less than 35 %. The study included persons with NIDCM and patients with ischemic dilated cardiomyopathy. A total of 2,521 patients were enrolled, 847 of whom were assigned to placebo plus conventional heart failure therapy, 845 to amiodarone plus conventional heart failure therapy, and 829 to single lead ICD plus conventional heart failure therapy. There was a significant reduction in all-cause mortality in the ICD group compared to the placebo group (hazard ratio compared to control = 0.77; 97.5 % confidence intervals [CI]: 0.62 to 0.96, p = 0.007). For patients with ischemic dilated cardiomyopathy, there was a reduction in mortality hazard ratio compared to control but it was not statistically significant (hazard ratio 0.79; 97.5 % CI: 0.60 to 1.04). For patients with NIDCM, there was a reduction in the mortality hazard ratio for ICD therapy compared to control but it was also not statistically significant (hazard ratio 0.73; 97.5 % CI: 0.50 to1.07). CMS noted that the absolute reduction in mortality was modest for a trial with a median follow-up of 45.5 months.
Patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are characterized by progressive degeneration of the right ventricular myocardium, ventricular arrhythmias, fibrous-fatty replacement, and increased risk of sudden death. Mutations in 6 genes, including 4 encoding desmosomal proteins (junctional plakoglobin, desmoplakin, plakophilin 2, and desmoglein 2), have been identified in patients with ARVD/C. The potential use of genetic screening for desmoglein 2 mutations is for identifying persons at increased risk of ARVD/C who are candidates for prophylactic ICD. Currently, there are no prospective studies of the use of desmoglein 2 genetic testing for selecting ICD candidates. About one-third of individuals with ARVD/C have been reported to have mutations in the desmoglein 2 gene or other associated mutations (Franz et al, 2001), and it is unknown what proportion of asymptomatic persons who have desmoglein 2 mutations go on to develop ARVD/C. Thus, the risks and benefits of prophylactic ICD implantation in persons with mutations of this gene are unknown.
Marenco et al (2001) conducted a systematic review of the literature on the use of automatic external defibrillators (AEDs). Most of the literature on AEDs discusses their use by emergency medical technician or ambulance staff. The authors summarized the literature on use of AEDs by non-medical persons in the home:
Because the majority of cardiac arrests occur at home, several studies have examined the use of AEDs by family members of high-risk patients. Although these studies demonstrated the feasibility of training laypersons (e.g., family members) to use an AED, researchers had difficulty with patient recruitment and obtained disappointing results. There is mounting evidence for the efficacy of ICDs in patients at increased risk for sudden cardiac death. This has limited enthusiasm for the placement of AEDs in the home of high-risk patients and primarily limited the role of the AED in the home to high-risk patients who either refuse an ICD or have a contraindication to ICD placement. However, these studies used earlier-generation AEDs and, given the lower costs and ease of use of the current devices, further study with the newer technology is warranted.
An assessment of AEDs for home use by the Canadian Coordinating Centre for Health Technology Assessment (CCOHTA) (Murray and Steffensen, 2005) found: "No prospective studies demonstrate that the use of AEDs in the home by untrained persons improves health outcomes. Further investigation is needed to determine the benefit and harm of AEDs in the home".
Because there are no prospective clinical studies demonstrating that use of AEDs by non-medical persons for home use improves health outcomes, Aetna considers wearable automatic external cardioverter defibrillators (wearable cardioverter-defibrillators or WCDs) medically necessary only on an exception basis for high-risk patients who meet the criteria for an ICD and who either refuse an ICD or have a contraindication to ICD placement.
Epstein et al (2013) described usage of the WCD during mandated waiting periods following MI for patients perceived to be at high-risk for sudden cardiac arrest (SCA). These researchers evaluated characteristics of and outcomes for patients who had a WCD prescribed in the first 3 months post-MI. The WCD medical order registry was searched for patients who were coded as having had a "recent MI with ejection fraction less than or equal to 35 %" or given an International Classification of Diseases, 9th Revision 410.xx diagnostic code (acute MI), and then matched to device-recorded data. Between September 2005 and July 2011, a total of 8,453 unique patients (age of 62.7 ± 12.7 years, 73 % male) matched study criteria. A total of 133 patients (1.6 %) received 309 appropriate shocks. Of these patients, 91 % were resuscitated from a ventricular arrhythmia. For shocked patients, the LVEF was less than or equal to 30 % in 106, 30 % to 35 % in 17, greater than 36 % in 8, and not reported in 2 patients. Of the 38 % of patients not re-vascularized, 84 % had a LVEF less than or equal to 30 %; of the 62 % of patients re-vascularized, 77 % had a LVEF less than or equal to 30 %. The median time from the index MI to WCD therapy was 16 days. Of the treated patients, 75 % received treatment in the first month, and 96 % within the first 3 months of use. Shock success resulting in survival was 84 % in non-re-vascularized and 95 % in re-vascularized patients. The authors concluded that during the 40-day and 3-month waiting periods in patients post-MI, the WCD successfully treated SCA in 1.4 %, and the risk was highest in the first month of WCD use. The WCD may benefit individual patients selected for high risk of SCA early post-MI. The main drawback of this observational study was the lack of a control group. Additionally, quality-of-life data, cost-effectiveness and survival were not available in this study.
In an accompanying editorial of the afore-mentioned study, Zei (2013) stated that "A major limitation to this study is the selection bias inherent in the database used …. Another important limitation of this study is the lack of data about potential arrhythmia under-detection with the WCD … [T]his study still does not quite answer the elusive question of how to best risk-stratify post-MI low-EF patients in the early days after infarction".
In a review on "Wearable cardioverter-defibrillators", Adler et al (2013) stated that "The wearable defibrillator was not subjected to such rigorous trials, and it is not clear whether this device will significantly decrease total mortality (and not merely arrhythmic death) in patients with recent MI …. [W]hen the prescription of a wearable defibrillator is being considered, it should be kept in mind that there are no randomized, controlled studies showing that it provides survival benefit".
The first multi-center randomized controlled clinical study to examine the use of at-home AEDs found that the devices do not improve overall survival when compared to conventional resuscitation methods, such as cardiopulmonary resuscitation (CPR). Bardy et al (2008) randomly assigned 7,001 patients with previous anterior-wall MI who were not candidates for an ICD to receive 1 of 2 responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing CPR) or the use of an AED, followed by calling emergency medical services and performing CPR. The primary outcome was death from any cause. The median age of the patients was 62 years; 17 % were women. The median follow-up was 37.3 months. Overall, 450 patients died: 228 of 3,506 patients (6.5 %) in the control group and 222 of 3,495 patients (6.4 %) in the AED group (hazard ratio, 0.97; 95 % CI: 0.81 to 1.17; p = 0.77). Mortality did not differ significantly in major pre-specified subgroups. Only 160 deaths (35.6 %) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed. Automatic external defibrillators were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks. The authors concluded that for survivors of anterior-wall MI who were not candidates for ICD, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods.
Exner (2009) stated that most sudden cardiac death (SCD) events occur in patients with less severe LV dysfunction, yet past trials and guidelines focus on those with severe LV dysfunction. Given the large pool of patients with less severe LV dysfunction and a modest risk of SCD, methods to identify those who might benefit from an ICD are needed. Observational studies indicate that abnormal cardiac repolarization and impaired autonomic function, especially in combination, appear to identify patients with less severe LV dysfunction at risk of SCD. Extensive scarring also appears to identify patients at risk. Ongoing and planned studies will better define the role of using non-invasive tests to select patients for ICD therapy. The author concluded that non-invasive measures of cardiac structure, autonomic function and myocardial substrate appear to be promising in identifying patients with less severe LV dysfunction at risk of SCD. However, it is unclear if ICD therapy will improve survival in these patients. Until definitive data from prospective, randomized trials are available it is premature to recommend use of these tools to guide ICD therapy.
Tsai et al (2009) noted that SCD among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for ICDs in this population is not well-established. These researchers examined if ICDs are effective in preventing SCD in high-risk heart transplant recipients. They retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. A total of 36 patients were included in this study. The mean age at orthotopic heart transplant was 44 +/- 14 years, the majority being male (n = 29). The mean age at ICD implantation was 52 +/- 14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 +/- 6 years. The main indications for ICD implantation were severe allograft vasculopathy (n = 12), unexplained syncope (n = 9), history of cardiac arrest (n = 8), and severe left ventricular dysfunction (n = 7). Twenty-two shocks were delivered to 10 patients (28 %), of whom 8 (80 %) received 12 appropriate shocks for either rapid VT or VF. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8 %) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100 % (8 of 8) of patients who received appropriate ICD therapy. The authors concluded that use of ICDs after heart transplantation may be appropriate in selected high-risk patients. They stated that more studies are needed to establish an appropriate prevention strategy in this population.
The U.S. Food and Drug Administration (FDA) has approved the Subcutaneous Implantable Defibrillator (S-ICD) System (Cameron Health, San Clemente, CA) "to provide defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, incessant ventricular~tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with antitachycardia pacing." The Subcutaneous Implantable Defibrillator (S-ICD) System uses a lead that is implanted just under the skin along the bottom of the rib cage and breast bone. The S-ICD System consists of: a titanium case containing a battery and electronic circuitry that provides defibrillation therapy and pacing at a rate of 50 beats per minute up to 30 seconds after a shock; a subcutaneous electrode which has a proximal and distal ring electrode on each side of a 3 inch (8 cm) defibrillation coil electrode; and accessories include an electrode insertion tool, programmer, telemetry wand, magnet, suture sleeve, torque wrench, and memory card. The FDA approval was based upon the results of a 321-patient study in which 304 patients were successfully implanted with the S-ICD System. At the time of implantation, the investigator tested the effectiveness of the device by inducing heart arrhythmias. The S-ICD System was successful at converting all abnormal heart rhythms that it detected back to normal rhythms. Investigators followed these patients for six months following implantation, during which time the device detected and recorded 78 spontaneous arrhythmias in 21 patients; all arrhythmias were either successfully converted back to normal by the defibrillator or resolved on their own. The FDA noted that, because the S-ICD System memory stores data from only the 22 most recent arrhythmia episodes, there may have been other detected episodes that could not be analyzed by investigators. The FDA reviewed safety data based on the entire 321-patient study population to identify complications that can occur during and after implantation of the S-ICD System. The most common complications included inappropriate shocks, discomfort, system infection, and electrode movement, which required repositioning. The FDA reported that 8 patients died during the study; however, experts (who were not involved with the study) could not definitively attribute the deaths to the S-ICD System. Eleven patients required the removal of the device, and 18 had discomfort that was resolved without repositioning the device or surgery. At the end of six months, more than 90 percent of patients had no complications. As part of the approval, FDA is requiring the manufacturing company to conduct a postmarket study to assess the long-term safety and performance of the device and to assess differences in effectiveness across genders. The study will follow 1,616 patients for five years. There is currenty insufficient published evidence of the effectiveness and safety of this device (Bardy et al, 2010; Gold et al, 2012; Jarman et al, 2012; Kobe et al, 2012).
Jarman and Todd (2013) described the early phase United Kingdom (UK) clinical experience with the S-ICD. A questionnaire was sent to all UK hospitals implanting S-ICDs. Nineteen of 25 (76 %) hospitals responded with the details of 111 implanted patients (median 5/hospital [range of 1 to 18]). Mean duration of follow-up was 12.7 ± 7.1 months. Median patient age was 33 years (range of 10 to 87 years). Underlying pathology was primary electrical disease in 43 %, congenital heart disease 12 %, hypertrophic cardiomyopathy 20 %, ischemic cardiomyopathy 14 %, idiopathic dilated cardiomyopathy 5 %, and other cardiomyopathies 7 % patients. Nineteen (17 %) patients required 20 re-operations, including permanent device explantation in 10 (9 %). Twenty-four appropriate shocks were delivered in 13 (12 %) patients, including 10 for VF. One patient suffered arrhythmic death, but there were no failures to detect or terminate ventricular arrhythmias above the programmed detection rate. Fifty-one inappropriate shocks were delivered in 17 (15 %) patients; 41 (80 %) were for T-wave over-sensing and 1 (2 %) for atrial flutter-wave over-sensing. The 11 patients who received inappropriate shocks due to T-wave over-sensing were significantly younger than patients who did not (24 ± 10 versus 37 ± 19 years; p = 0.02). The authors concluded that the S-ICD is an important innovation in ICD technology. However, these data indicated that adverse event rates were significant during early clinical adoption. Important lessons in patient selection, implant technique, and device programming could be learnt from this experience.
In a prospective, non-randomized, multi-center trial, Weiss et al (2013) evaluated the safety and effectiveness of the S-ICD System for the treatment of life-threatening ventricular arrhythmias (VT/VF). Adult patients with a standard indication for an ICD, who neither required pacing nor had documented pace-terminable VT, were included in this study. The primary safety end-point was the 180-day S-ICD System complication-free rate compared with a pre-specified performance goal of 79 %. The primary effectiveness end-point was the induced VF conversion rate compared with a pre-specified performance goal of 88 %, with success defined as 2 consecutive VF conversions of 4 attempts. Detection and conversion of spontaneous episodes were also evaluated. Device implantation was attempted in 321 of 330 enrolled patients, and 314 patients underwent successful implantation. The cohort was followed for a mean duration of 11 months. The study population was 74 % male with a mean age of 52 ± 16 years and mean LVEF of 36 ± 16 %. A previous transvenous ICD (TV-ICD) had been implanted in 13 %. Both primary end-points were met: The 180-day system complication-free rate was 99 %, and sensitivity analysis of the acute VF conversion rate was greater than 90 % in the entire cohort. There were 38 discrete spontaneous episodes of VT/VF recorded in 21 patients (6.7 %), all of which successfully converted. Forty-one patients (13.1 %) received an inappropriate shock. The authors concluded that the findings of this study supported the safety and effectiveness of the S-ICD System for the treatment of life-threatening ventricular arrhythmias. The main drawbacks of this study were the lack of a control group and the short duration of the follow-up.
In an accompanying editorial of the afore-mentioned study, Saxon noted that "Over the follow-up interval reported in this study, the subcutaneous ICD terminated spontaneously occurring VT/VF in 6.5 % of the patients implanted (21 patients). There were a total of 22 episodes of spontaneously occurring monomorphic VT and 16 episodes of VF treated. First and second shock success rate was 92 % and 97 %, respectively. Two patients had multiple successful shocks for VT storm. Although these data are reassuring and comparable to TV-ICD success rates, the overall number of treated episodes is incredibly small in comparison with the data on transvenous defibrillator therapies delivered outside the hospital, over the life of the device, that are available for analysis in tens of thousands of patients. Without the ability to remotely collect episodes in all subcutaneous device recipients, it is difficult to know how the learning around spontaneous VT/VF episodes and treatment will occur, other than the old-fashioned way, through case reports and post-approval registries. This is a significant limitation from a clinical learning and safety advisory perspective …. Without remote monitoring capability, it will be difficult to track the occurrences of these episodes in the population of patients who receive the subcutaneous ICD. This is concerning, because the population enrolled in the subcutaneous ICD study were 10 to 20 years younger than the standard transvenous ICD recipient. The age of the subcutaneous ICD recipients indicates that they may be a more active and more prone to over-sensing owing to subcutaneous sensing challenges or T-wave double counting …. Although the subcutaneous ICD is de-featured and exists only to defibrillate, it does represent a major engineering feat for an entirely subcutaneous system. Yet, the most profound technology advances in the past decades, particularly in the case of devices, allow for an enhancement of capability (and complexity) to the backend architecture and a simplification of design features and user interface. The subcutaneous ICD does not encompass these features nearly as much as the transvenous device. In the best of all possible worlds, the subcutaneous ICD will grow and evolve into a device whose design supports the growth of features and capabilities that can evolve with the patient's condition. This includes integrating wirelessly with other hardware- and software-based healthcare solutions that will enhance the device and the device recipient's overall medical condition. The enhancements will provide multiple reasons for subcutaneous ICD to exist".
Akerstrom et al (2013) stated that the S-ICD has recently been approved for commercial use in Europe, New Zealand and the United States. It is comprised of a pulse generator, placed subcutaneously in a left lateral position, and a parasternal subcutaneous lead-electrode with 2 sensing electrodes separated by a shocking coil. Being an entirely subcutaneous system it avoids important peri-procedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (TV-ICD) systems as well as the need for fluoroscopy during implant surgery. Suitable candidates include pediatric patients with congenital heart disease that limits intra-cavitary lead placements, those with obstructed venous access, chronic indwelling catheters or high infection risk, as well as young patients with electrical heart disease (e.g., Brugada Syndrome, long QT syndrome, and hypertrophic cardiomyopathy). Nevertheless, given the absence of intra-cavitary leads, the S-ICD is unable to offer pacing (apart from short-term post-shock pacing). It is therefore not suitable in patients with an indication for anti-bradycardia pacing or cardiac resynchronization therapy, or with a history of repetitive monomorphic VT that would benefit from anti-tachycardia pacing. Current data from initial clinical studies and post-commercialization "real-life" case series, including over 700 patients, have so far been promising and shown that the S-ICD successfully converts induced and spontaneous VT/VF episodes with associated complication and inappropriate shock rates similar to that of TV-ICDs. Furthermore, by using far-field electrograms better tachyarrhythmia discrimination when compared to TV-ICDs has been reported. The authors concluded that future results from ongoing clinical studies will determine the S-ICD system's long-term performance, and better define suitable patient profiles.
Pettit et al (2013) compared the performance of S-ICD and TV-ICD systems in children and teenagers. These researchers studied consecutive patients less than 20 years of age who received an ICD over a 4-year period in 2 Scottish centers. Baseline characteristics, complications, and ICD therapy were recorded. The primary outcome measure was survival. The secondary outcome measure was survival-free from inappropriate ICD therapy or system revision. A total of 9 S-ICD were implanted in 9 patients; 8 TV-ICD were implanted in 6 patients; 2 were redo procedures. Baseline characteristics were well-matched. Median duration of follow-up was lower for S-ICD (20 months) than for TV-CD (36 months, p = 0.0262). Survival was 100 % in both groups. Survival free of inappropriate therapy or system revision was 89 % for S-ICD and 25 % for TV-ICD systems (log-rank test, p = 0.0237). No S-ICD were extracted, but 3 TV- ICD were extracted due to infection (n = 1) and lead failure (n = 2). The authors concluded that in real-world use in children and teenagers, S-ICD may offer similar survival benefit to TV-CD, with a lower incidence of complications requiring reoperation. They stated that in the absence of randomized trials, S-ICD should be compared prospectively with TV-ICD in large multi-center registries with comparable periods of follow-up.
Majithia et al (2013) noted that randomized clinical trials support the use of implantable defibrillators for mortality reduction in specific populations at high-risk for sudden cardiac death. Conventional transvenous defibrillator systems are limited by implantation-associated complications, infection, and lead failure, which may lead to delivery of inappropriate shocks and diminish survival. The development of a fully subcutaneous defibrillator may represent a valuable addition to therapies targeted at sudden death prevention. The PubMed database was searched to identify all clinical reports of the subcutaneous defibrillator from 2000 to the present. These investigators reviewed all case series, cohort analyses, and randomized trials evaluating the safety and effectiveness of subcutaneous defibrillators. The subcutaneous defibrillator is a feasible development in sudden cardiac death therapy and may be useful particularly to extend defibrillator therapy to patients with complicated anatomy, limited vascular access, and congenital disease. The subcutaneous defibrillator should not be considered in patients with an indication for cardiac pacing or who have VT responsive to anti-tachycardia pacing. The authors concluded that further investigation is needed to compare long-term, head-to-head performance of subcutaneous defibrillators and conventional transvenous defibrillator systems.
Furthermore, the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines on "The management of ST-elevation myocardial infarction" (O'Gara et al, 2013) mentioned ICD therapy; but not subcutaneous ICD.
New York Heart Association Functional Classification of Cardiac Disability:
Class I: Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.
Class II: Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
Class III: Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.
Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
Source: Adapted from Goldman et al (1981).
|CPT Codes / HCPCS Codes / ICD-9 Codes
|Implantable Cardioverter-Defibrillators:
|CPT codes covered if selection criteria are met:
|Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator
|Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator
|Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator
|Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator
|Relocation of skin pocket for implantable defibrillator
|Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)
|Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure)
|Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)
|Insertion of implantable defibrillator pulse generator only; with existing dual leads
|with existing multiple leads
|Insertion of implantable defibrillator pulse generator only; with existing single lead
|emoval of implantable defibrillator pulse generator only
|Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy
|by transvenous extraction
|Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber
|Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system
|dual lead system
|multiple lead system
|Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming
|single chamber or wearable cardioverter-defibrillator system, with reprogramming
|dual chamber, without reprogramming
|dual chamber, with reprogramming
|Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of ssytem, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events
|Other CPT codes related to the CPB:
|Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;
|with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator
|Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
|HCPCS codes covered if selection criteria are met:
|Cardioverter-defibrillator, dual chamber (implantable)
|Cardioverter-defibrillator, single chamber (implantable)
|Lead, cardioverter-defibrillator, endocardial single coil (implantable)
|Cardioverter-defibrillator, other than single or dual chamber (implantable)
|Lead, cardioverter-defibrillator, endocardial dual coil (implantable)
|Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)
|Lead, pacemaker/cardioverter-defibrillator combination (implantable)
|Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing
|Automatic external defibrillator, with integrated electrocardiogram analysis, garment type
|HCPCS codes not covered for indications listed in the CPB:
|External defibrillator with integrated electrocardiogram analysis
|Other HCPCS code related to the CPB:
|Injection, amiodarone HCL, 30 mg
|ICD-9 codes covered if selection criteria are met:
|Chagas disease with heart involvement
|Sarcoidosis [cardiac]
|Idiopathic myocarditis
|Hypertrophic obstructive cardiomyopathy
|Other hypertrophic cardiomyopathy
|Other primary cardiomyopathies [arrhythmogenic right ventricular cardiomyopathy (ARVC)][ LV non-compaction cardiomyopathy]
|Paroxysmal supraventricular tachycardia
|Paroxysmal ventricular tachycardia [catecholaminergic polymorphic]
|Paroxysmal tachycardia, unspecified
|Ventricular fibrillation
|Ventricular flutter
|Cardiac arrest
|Other specified anomalies of heart [Brugada syndrome]
|Mechanical complication of cardiac device, implant, and graft due to automatic implantable cardiac defibrillator
|Infection and inflammatory reaction due to cardiac device, implant, and graft
|Fitting and adjustment of automatic implantable cardiac defibrillator [end of life of the implantable cardiac defibrillator]
|Other ICD-9 codes related to the CPB:
|140.0 - 208.91
|Malignant neoplasms
|Electrolyte and fluid disorders not elsewhere classified
|Anoxic brain damage
|410.00 - 412
|Myocardial infarction
|414.00 - 414.9
|Other forms of chronic ischemic heart disease
|Long QT syndrome
|428.0 - 428.9
|Heart failure
|430.00 - 438.9
|Cerebrovascular disease
|458.0 - 458.9
|Acute and subacute necrosis of liver
|Other sequelae of chronic liver disease
|585.1 - 585.9
|Chronic kidney disease (CKD)
|Renal failure, unspecified
|Syncope and collapse
|Cardiogenic shock
|Abnormal electrocardiogram
|Instantaneous death
|Personal history of sudden cardiac arrest
|Family history of ischemic heart disease
|Family history of other cardiovascular diseases
|Organ or tissue replaced by transplant, heart
|Automatic implantable cardiac defibrillator
|Aortocoronary bypass status
|Percutaneous transluminal coronary angioplasty status
|Subcutaneous cardioverter-defibrillators:
|CPT codes covered if selection criteria are met:
|Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed
|Insertion of subcutaneous implantable defibrillator electrode
|Removal of subcutaneous implantable defibrillator electrode
|Repositioning of previously implanted subcutaneous implantable defibrillator electrode
|93260 - 93261
|Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional
|Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
|HCPCS codes covered if selection criteria are met:
|Cardioverter-defibrillator, other than single or dual chamber (implantable) [subcutaneous cardioverter-defibrillators]
|ICD-9 codes covered if selection criteria are met:
|Chagas disease with heart involvement
|Sarcoidosis [cardiac]
|Idiopathic myocarditis
|Hypertrophic obstructive cardiomyopathy
|Other hypertrophic cardiomyopathy
|Other primary cardiomyopathies [arrhythmogenic right ventricular cardiomyopathy (ARVC)][ LV non-compaction cardiomyopathy]
|427.41 - 427.42
|Ventricular fibrillation and flutter
|Cardiac arrest
|Other specified anomalies of heart [Brugada syndrome]
|Mechanical complication of cardiac device, implant, and graft due to automatic implantable cardiac defibrillator
|Infection and inflammatory reaction due to cardiac device, implant, and graft
|Fitting and adjustment of automatic implantable cardiac defibrillator [end of life of the implantable cardiac defibrillator]
|ICD-9 codes not covered for indications listed in the CPB:
|427.0 - 427.2
|Paroxysmal ventricular tachycardia [not covered for incessant ventricular tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing]
|Other specified cardiac dysrhythmias [symptomatic bradycardia]


text:
Many palm fronds turn yellow and die, from the bottom up. On coconut palm, all the nuts usually drop. The nuts are black where they were attached to the flower stalk. New flower stalks are blackened and do not set any fruit. After several monhs, all the fronds and the bud have been killed. Shortly thereafter the entire palm top falls off, leaving only the bare trunk. No insects are visible.
Planthoppers are difficult to detect and control. Lethal yellowing cannot be cured. Avoid planting susceptible palms. Remove infected palms to avoid spreading the disease.


text:
The Government of Liberia (GoL) through the Ministry of Commerce & Industry has cautiously warned major rice importers in the country to refrain from engaging in negative public relations that would undermine the efforts of the GoL. As rice remains the most politically sensitive commodity on the market, the GoL also warned strongly against all unnecessary media propaganda and the play of politics in the sector, as in the case of the Swiss Rice Firm mentioned about in the local newspapers.
The GoL, which caveat was contained in a strong worded press release .In a strong worded press release issued in Monrovia over the weekend, the GoL pointed out that competition in an open market system is measured by the natural forces of supply and demand and not undue actions that could lead to the artificial and/or real scarcity of the commodity on the local market.
The Government assured the public that the Ministry of Commerce and Industry will do all within its powers to vigorously protect the market from any form or shape of misconduct that has the potential to undermine national food security in keeping with its statutory mandate.
Meanwhile, the Ministry of Commerce and Industry has announced the issuance of an Executive Order, extending the suspension of tariff on rice. The decision, the Ministry disclosed, was taken by the President Ellen Johnson-Sirleaf, in furtherance of her commitment to bring relief to the people of Liberia.
By this action, the Ministry added, the import tariff on rice as classified under tariff nos. 1006.30.00 (in package of more than 5kg or in bulk) 1006.30.00 (in packing of at least 5kg); and 1006.40.00 (broken rice) under Revenue Code of Liberia Act 2000 has been suspended.


text:
As with many of my work-related examples, I have to keep the details confidential and generalize the situation a bit. In this case, we conducted a study where there was a baseline group receiving no treatment, and then several possible categories of treatment received by other groups. We were looking to understand the difference in impact these various treatments would have on a given outcome.
Here was the original data viz (slightly generalized from the original form):
- Nice use of preattentive attribute (color) to draw your audience's attention to where you want them to focus.
- The graph needs a title. The legend should be closer to the data it's describing.
- If baseline is what the audience is meant to compare to, put that first and make that clear - think of adding a summary stat on the right side of the bars that is "increase vs. baseline" or similar.
- I'm not sure the grey bars are adding value? If they represent 100% minus Outcome observed, stack them on the green bars to add to 100% and make that clear.
After discussing live, I spent a little time with the visual and ended up here:
Note that we aren't done at this point - the story still needs to be put around this data. In this case, the story could be something like "Treatment A results in highest increase over baseline" and a recommendation for rolling this treatment out more broadly. But note how some relatively minor formatting changes and the addition of a few words makes the information easier to consume.
The Excel file for the latter version is downloadable here.


text:
Created: 07/18/2014 12:05 PM WHEC.com
By: Associated Press
Two attorneys general from the Northwest have sued the companies responsible for the popular 5-Hour Energy drink, alleging they engaged in deceptive advertising.
The Oregon lawsuit filed Thursday in Portland contends 5-Hour Energy falsely claims customers get extra energy and focus from a unique blend of ingredients, when the boost actually comes from a concentrated dose of caffeine.
The suit also targets claims that users don't experience a crash when the effects subside and that the product is OK for adolescents.
Oregon has been part of a group leading a 33-state investigation into the accuracy of the product's claims. Washington state's attorney general filed a similar lawsuit Thursday in King County Superior Court in Seattle.
Other states are expected to file suit as well, said Kristina Edmunson, a spokeswoman for the Oregon Department of Justice.
The lawsuits name Living Essentials LLC and Innovation Ventures LLC as defendants.
5-Hour Energy spokeswoman Melissa Skabich said the company will defend itself against what Skabich called civil intimidation.
"When companies are being bullied by someone in a position of power, these companies roll over, pay the ransom, and move on," Skabich said in a statement. "We're not doing that."
Oregon Attorney General Ellen Rosenblum said 5-Hour Energy violated the state's Unlawful Trade Practices Act. The lawsuit seeks monetary penalties as well as refunds to all Oregon buyers of the decaffeinated version of the product, which, according to the lawsuit, provides no extra energy or alertness.
"Plainly and simply, in Oregon you cannot promote a product as being effective if you don't have sufficient evidence to back up your advertising claims," Rosenblum said.
She and 5-Hour Energy have been in a tug-of-war over that evidence for more than a year, with her department seeking unredacted information showing how the formula for 5-Hour Energy provides its asserted benefits.
The heavily advertised energy drink was introduced a decade ago, and the lawsuit estimates it is sold at more than 100,000 retail locations in the United States.
The state officials investigating 5-Hour Energy say they are concerned about safety. The Food and Drug Administration said in November 2012 that it had received more than 90 reports over four years about illnesses, hospitalizations and deaths after the consumption of 5-Hour Energy.
The FDA said, however, that the reports did not prove that the energy drink caused the problems.
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text:
Author Martha Grimes Donates Book Proceeds to PCRM
Best-selling writer Martha Grimes, author of the internationally popular Richard Jury murder mystery series, is generously donating a portion of the royalties from her new novel, Dakota, to PCRM. Ms. Grimes spoke to PCRM supporters and book lovers at book signings in Los Angeles and Washington, D.C.
Dakota is the story of Andi Oliver, a young woman who takes a job at a massive pig-farming facility in North Dakota. As she uncovers the dark truth about the slaughterhouse, Andi must contend with two men who are on her trail. The book offers a searing indictment of cruelty to animals on modern factory farms.
Ms. Grimes discussed and signed Dakota on February 19 at Book Soup in Los Angeles and on February 26 at Olsson's bookstore in Washington, D.C. PCRM president Dr. Neal Barnard joined Ms. Grimes at the D.C. event to discuss vegetarian diets and factory farming.
While readers of Dakota had already learned about the cruelty that takes place on factory farms, Dr. Barnard explained that meaty diets are also hard on health. People who follow plant-based diets have lower rates of heart disease, diabetes, obesity, and some forms of cancer than meat-eaters.


text:
TURKANA South MP Josephat Koli Nanok and his Turkana Central counterpart David Ekwee Ethuro yesterday appeared refused to plead to a charge of incitement to violence claiming parliamentary immunity.
Nanok and Ethuro say the words they were accused of uttering were made in Parliament buildings which gives MPs privileges of immunity. They asked chief magistrate Waweru Kiarie to refer the matter to the High Court for constitutional interpretation.
Nanok said through his lawyer Jotham Aruwa, the Parliamentary Privileges and Immunity Act "takes away the criminal quality" of the charge he and his co-accused are facing.
He asked the court to "respect the separation of powers" as it was improper to charge them for an offence that took place at the precincts of Parliament.
Last Thursday, the two MPs told a press conference at Parliament Buildings those who ambushed and killed 42 policemen in Suguta valley, within Baragoi area in Samburu County were doing so to defend themselves from a 'state sponsored attack. Also present during the press conference was Labour minister John Munyes. The three read mischief in the police operation.
The prosecution alleges that the words they uttered implied that it was desirable to bring death or physical injuries to police officers in Baragoi.
Ethuro's lawyer Katwa Kigen, challenged the validity of the charge and wondered whether the two accused had "uttered the words in chorus" since the prosecution alleges that they uttered the offending words, 'jointly'.
He said the charge did not disclose an offence and urged the court reject it or refer matter to the High Court. He said that the charge sheet was "terribly wrong" and the court process should not be abused.
Another lawyer Tom Kajwang said the case was unconstitutional and was a breach of the MPs fundamental rights and freedoms. He said there was nothing stopping the magistrate from referring the matter to the High Court.
Prosecutor Onesmus Towett said the two MPs were rightly in court and asked that the court only listen to their application after pleading to the charge. The MPs can still go the High Court and stop the trial if they wished. "But as for now, there is nothing stopping the court from proceeding with the case," he said
Kiarie released the two MPs on cash bail of Sh50,000 each and will tomorrow decide whether to refer the matter to the High Court or have the MPs plead to the charge.
Nanok has been in police custody at the Kileleshwa Police station for the last two days while Ethuro, who was on Saturday questioned by the CID, was released on a police bond and ordered to appear in court yesterday.
The CID had last week summoned the two MPs, together with Munyes. Nanok ignored summons by the police prompting his arrest by officers from the Flying Squad last Friday shortly after appearing on a television talk show. He claimed the police locked him up after he refused to sign a statement which he had not authored.


text:
American Apparel Unisex Fitted Tee Black
One glimpse of this design and everyone will know exactly how you feel. Before you know it, you'll have everyone running to the coffeemaker like it's a true emergency! Great for physicians, nurses, paramedics, or virtually any medical or healthcare professional.
Shop More Designs in Geek Nirvana


text:
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