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Health Care Overhaul
This was the third in a series of roundtable hearings intended to bring health care policy and industry experts together to inform the development of comprehensive health care reform…581 views
This was the third in a series of roundtable hearings intended to bring health care policy and industry experts together to inform the development of comprehensive health care reform…581 views
Panelists discussed the future of Medicare and the trustees' report which was released the previous day. Topics included how different parts of Medicare are financed, the assumptions…135 views
The American Enterprise Institute held a forum on "The Outlook for Medicare and Social Security." Richard Foster, the chief actuary for the Centers for Medicare and Medicaid…79 views
Dr. Wilensky discussed the fiscal year 2005 federal budget and the costs of the new Medicare prescription drug program. She responded to telephone calls, faxes, and electronic…87 views
Participants talked about recently enacted Medicare reform legislation. Among the topics they addressed were prescription drug benefits, various plan choices, and premium…48 views
Ms. Wilenski and Ms. Moon talked about health care insurance, the number of uninsured Americans, and potential solutions to the problem of underinsurance. They also responded…58 views
The guests talked about Medicare, including President Bush's plan for Medicare and prescription drug benefits. They responded to audience telephone calls, faxes, and electronic…59 views
Experts talked about the state of health care and future needs for doctors. Among the issues they addressed were potential doctor shortages, the need for continued training throughout…81 views
In one of eight break-out (concurrent) sessions at an economic forum sponsored by the White House, President Bush, Health care professionals, and others talked about health care policy and…94 views
The panelists discussed the financial health of the Medicare Trust Fund, whose annual report was released yesterday. They analyzed the report, noting the increase in Medicare…75 views
Ms. Wilensky talked about the Bush administration plans to provide prescription drug coverage to seniors. She also responded to audience phone calls, faxes, and electronic mail.57 views
Ms. Wilensky talked about the prescription drug plan proposed by Texas Governor George W. Bush. He also responded to audience telephone calls, electronic mail, and faxes.59 views
Participants talked about various measures to improve Medicare to be included in the Republican Party platform. Among the issues they addressed were measures to make Medicare more…54 views
Witnesses testified regarding the effect on Medicare as a result of the Balanced Budget Act. Government officials talked about the President's Medicare reform plan and how under…63 views
Witnesses testified about a proposed plan to expand Medicare coverage to provide prescription drug coverage for seniors. Among the issues discussed were the high costs of prescription…102 views
Participants talked about President Clinton's plan to provide pharmaceutical benefits through Medicare and Social Security. They discussed the need for the program, its potential…49 views
Participants talked about President Clinton's Medicare proposals and the plan's potential impact on consumers and the business community. Among the issues discussed were…47 views
Committee members heard testimony on the state of the government's Medicare and Medicaid programs. Medicare provides health care to more than 36 million senior citizens and…73 views
Senator Bennett met with health care executives and specialists to discuss health care issues, focusing on reforming Medicare, health care management, and last year's health care…71 views
Panel members discussed health care reform issues federal, state and administrative perspectives. They focused on Medicaid and managed health care reform. Sen. Frist is the…59 views


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Changes related to "Mystery:Did Party Bosses Start the Media Bullying of Akin"
From Conservapedia
This is a list of changes made recently to pages linked from a specified page (or to members of a specified category).Pages on your watchlist are bold.
Legend: New! - new page, m - minor edit, b - bot edit.

subset: commoncrawl


text: "Samba 4 DosEmu" project is supposed to provide access to samba resources from within DosEmu without extra drivers and extra DOS software. It should be a good substitute for using Novell network resources thanks to the locking support being implemented. So far second beta was released and is available for download.


text:
Idk what else he needs to do?
Printable View
Idk what else he needs to do?
How about a name change. Then a King of the Ring win, maybe by then he'll be at the main event level.
CM Punk, John Cena, Big Show, Daniel Bryan, Sheamus, Alberto Del Rio, Rey Mysterio, Chris Jericho, Randy Orton, Dolph Ziggler, Wade Barrett (when he comes back), Cody Rhodes, Kane (plus you have The Rock hovering around for another 6 months).
I've probably left someone out there, but all of the above are ahead of Kofi in the 'pecking order' so to speak. Kofi's not going to get ahead of any of those in the foreseeable future IMO.
If he's going to do it though, he needs another feud with a top level guy, similar to the feud he had with Orton. I'm still not sold on his mic skill. When was the last time he cut a promo? He needs a top level feud with a Jericho or Kane or someone where he goes over to establish himself as a serious player at the top of WWE.
Oh so they give Jerry Lawler, Ziggler (last year) and John Morrison WWE/WHC matches out of the blues and they can't give Kofi one? Why not? Lawler was an announcer, who should be retired by now, Ziggler wasn't ready (he sucked on the mic back then) and Morrison couldn't cut a face promo to save his life. Kofi is decent at promos, and is a decent wrestler too. Plus the fact that people really like him despite him being a midcarder is good for business.
I wouldn't mind the WWE having a throwaway feud for a PPV or two where a midcarder gets a shot at the WWE/WHC. Maybe now isn't the best time though, as Punk's heel turn is something huge, and he'll likely be facing main eventers to keep the momentum going.
So im not disagreeing with you, but the face pecking order isnt that deep.


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Schumacher's method is to use a lighter touch, to stay closer to the cartoon that Bob Kane created for DC Comics in 1939 and to temper Burton's nightmare world with an accessible, brightly colored TV palette. show more
It's an art-direction, Dolby-sound, special-effects extravaganza, a grand-scale effort that's more awe-inspiring than completely successful as entertainment. show more
With an ace pop mechanic like Joel Schumacher now in charge of our hero's bruised psyche, the patient not only survives but thrives in the garishly garnished but never groaningly gruesome Batman Forever. [16 Jun 1995, Pg.01.D] show more
July 18, 2011 bullseye787
Report This User
Ridiculous, convoluted and often BORING. If not for Jim Carrey I\'d give it zero stars.
February 05, 2012 Dry Master
Report This User
Sice Joel came, the series began to look like the comics and had too many characters. I didn't really like it. The casting was weak except for Riddler and Two-Face.


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33 year old woman | San Jose, CA, USA | Seeking men 27-42 within 50 miles
a glass of wine, or a bonfire on the beach is a perfect end to a great night.
I am a Registered Nurse. I absolutely LOVE being a Nurse, I think it is the best job out there. ( for me ) I am an energetic, fun and very loving person. I love to get out and find new things to do. I enjoy being outside, snowboarding/skiing in the winter, or enjoying the sun in the summer. My family is very important to me as well. Most of my family lives here in the Bay Area, and I spend a lot of time with them. I love cooking and baking, and a glass of good wine or a nice dark beer. Oh, and I BBQ as much as I can :-). I have a 3 year old daughter who lives with me 90% of the time. She is absolutely beautiful, and I love her more than anything! I am looking for a guy who can make me laugh, be trust worthy, and have a good time with. Someone who can keep up with my energy, but also relax with me at the end of a crazy day.
Camping , Coffee and conversation , Cooking , Dining out , Gardening/Landscaping , Movies/Videos , Museums and art , Music and concerts , Exploring new areas , Performing arts , Playing cards , Religion/Spiritual , Travel/Sightseeing , Video games , Volunteering , Watching sports , Wine tasting
Dancing, Other types of exercise, Skiing, Swimming, Walking / Hiking, Yoga
I exercise 1-2 times per week.
Middle of the Road
I Love hanging out with my friends and family. I love to be outdoors and go hiking or camping. A good movie and a glass of wine, or a bonfire on the beach is a perfect end to a great night. I also secretly like to play Duty, or Gears of War :-)
its a guilty pleasure, but i loved the Hunger Games series. Alcohol and tweeting
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Japanese team buys Bryan LaHair from Cubs for $950,000, signs LaHair to $4.5 million deal
Nov 22, 2012, 11:25 AM EDT
When the Cubs designated Bryan LaHair for assignment earlier this week it was reportedly because they were working on a deal to send the first baseman to Japan and now we have the details of that agreement.
According to ESPN Chicago he'll get a two-year, $4.5 million contract to join the Fukuoka Softbank Hawks and the Cubs will get $950,000 in cash to part with LaHair.
LaHair slumped horribly after making the All-Star team as a 29-year-old rookie, but he's still a .260 hitter with 21 homers and a .764 OPS in 195 total big-league games and has consistently crushed Triple-A pitching for years.
I'll be very surprised if he doesn't put up huge numbers in Japan and, who knows, maybe in a couple years another MLB team will feel like taking a flier on him as a cheap bench bat or platoon starter.
- Gordon - Nov 22, 2012 at 11:54 AM
How does a player get traded to Japan? Doesn't he have to sign off on this deal?
- biasedhomer - Nov 22, 2012 at 11:57 AM
He did sign a deal with that team. It's not like he would get $4.5M in the MLB. He's pretty much set for life now.
- dcfan4life - Nov 22, 2012 at 12:06 PM
Set for life, hardly. $4.5 Million is easy for pro athletes to spend. Not only that, he is in the most expensive country in the world now in Japan. Even if he is excellent at saving his money id expect that $4.5 million will feel a lot more like $2 million after taxes and all the high priced necessities and expenses.
- dodger88 - Nov 22, 2012 at 12:31 PM
The Cubs simply traded his rights, most likely after LaHair expressed interest in going to Japan. If for some reason he did not want to go, he wouldn't have to.
- cur68 - Nov 22, 2012 at 12:21 PM
Good luck in Japan, kid. Say "hi" to Hector Luna and Wily Mo Pena when you see them.
- mophatici - Nov 22, 2012 at 1:28 PM
good luck bryan. i hope you learn to hit a curveball over there. or at least an outside fastball.
- chill1184 - Nov 22, 2012 at 3:32 PM
I'm surprised that the Cubs didn't try to flip to get some decent prospects.
- tuberippin - Nov 22, 2012 at 6:40 PM
I'm sure they tried, as Epstein shopped pretty much everyone in the Cubs' system over the past season, but it's hard to shop a guy who hit .202/.269/.303 with a .572 OPS after the ASB and who hit (and I use the term "hit" lightly here) .063 with a .292 OPS against lefties.
Besides, he's going to make significantly more money in Japan than he would have made on a minor-league deal here. That is unless, of course, the Red Sox were interested, since Cherington seems set on overpaying mediocre platoon power hitters by several million dollars (looking at you, Jonny Gomes).
- paperlions - Nov 22, 2012 at 10:49 PM
I'm sure the Cubs tried to trade him after his hot streak early last year….no one in MLB is dumb enough to give up anything for a guy that spent nearly 6 entire seasons in AAA for multiple organizations….AAA was his ceiling, everyone could see it, therefore, he had no value.
- modellforprez - Nov 23, 2012 at 12:05 AM
listen listen skank you know I don't speak that shit. its ok baby me love you long time. isn't this the home of chi chi mon funeral a.k.a oodles n oodles on the streets money. you know where I'm is
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Originally written on 60 Max Power O | Last updated 7/5/13
Seattle Seahawks WR Golden Tate admitted earlier this offseason he was a little puzzled by the acquisition of fellow WR Percy Hawkins, but was assured that his role in the offense wouldn't be reduced by coach Pete Carroll. Tate will now see if those words ring hollow entering the final year of his contract, he won't worry about contracts until after the season is over. He wants to stay in Seattle where he came into his own in the second half of the 2012 season. Tate should be an integral part of the offense as Harvin will play his natural position as the 'slot,' while Tate will play his original position as the number two receiver as the 'flanker'. He'll get plenty of opportunities due to the attention Harvin will garner. Tate say he thinks his team could be special for years to come and he hopes he'll be around to enjoy it. "For me, I'm not treating it any different than any other year," Tate said, via Josh Alper of Profootballtalk.com. "I'm gonna show up to work, work hard. I'm not worried about any contract talk. I'm just gonna pray on it and hopefully it works out and I'm in Seattle for a long time."
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Article ID: 886968 - View products that this article applies to.
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Microsoft has released the Outlook 2002 post-Service Pack 3 hotfix package for Microsoft Outlook 2002. This article describes the following items about the hotfix package:
This article describes the Outlook 2002 issue that is fixed in the Outlook 2002 post-Service Pack 3 hotfix package that is dated October 8, 2004.
Issues that the hotfix package fixesThis hotfix package fixes the following issue that was not previously documented in a Microsoft Knowledge Base article:
Hotfix informationA supported hotfix is now available from Microsoft, but it is only intended to correct the problem that this article describes. Apply it only to systems that are experiencing this specific problem.
To resolve this problem, contact Microsoft Product Support Services to obtain the hotfix. For a complete list of Microsoft Product Support Services telephone numbers and information about support costs, visit the following Microsoft Web site:
http://support.microsoft.com/contactus/?ws=supportNote In special cases, charges that are ordinarily incurred for support calls may be canceled if a Microsoft Support Professional determines that a specific update will resolve your problem. The usual support costs will apply to additional support questions and issues that do not qualify for the specific update in question.
Restart informationYou must restart your computer after you apply this hotfix.
Hotfix replacement informationThis hotfix is not replaced by any later hotfix.
Registry informationYou do not have to create or modify any registry keys to use any hotfixes that this package contains.
Hotfix file informationThis hotfix contains only those files that are required to correct the issue that this article lists. This hotfix may not contain all the files that you must have to fully update a product to the latest build.
The global version of this hotfix has the file attributes (or later file attributes) that are listed in the following table. The dates and times for these files are listed in coordinated universal time (UTC). When you view the file information, it is converted to local time. To find the difference between UTC and local time, use the Time Zone tab in the Date and Time tool in Control Panel.
After you install the hotfix, the global version of this hotfix has the file attributes (or later file attributes) that are listed in the following table.
Date Time Size File name -------------------------------------------------------------------------- 08-Oct-2004 09:16 7,837,696 Outlookff.msp (full-file/administrative) 08-Oct-2004 05:44 3,643,904 Outlookop.msp (optimized)
Note For additional information about how to install this hotfix, see the Readme.txt file that is included in the hotfix package.
Date Time Version Size File name ------------------------------------------------------------ 08-Apr-2004 02:24 10.0.6711.0 80,584 Dlgsetp.dll 08-Apr-2004 02:24 10.0.6711.0 39,624 Dumpster.dll 26-Apr-2004 19:27 10.0.6712.0 109,256 Envelope.dll 30-May-2003 18:08 10.0.5328.0 253,952 Exchcsp.dll 27-Aug-2004 04:52 10.0.6729.0 346,824 Exsec32.dll 09-Aug-2002 03:22 10.0.4406.0 137,800 Impmail.dll 17-Sep-2004 22:27 10.0.6732.0 207,552 Msoutl.olb 05-May-2004 03:47 10.0.6713.0 187,072 Oladd.fae 05-May-2004 03:47 10.0.6713.0 170,688 Olappt.fae 05-May-2004 03:47 10.0.6713.0 137,920 Oljrnl.fae 08-Apr-2004 02:24 10.0.6711.0 133,824 Olmail.fae 05-May-2004 03:47 10.0.6713.0 166,592 Oltask.fae 08-Apr-2004 02:24 10.0.6711.0 543,424 Outlcm.dll 04-Dec-2003 00:54 10.0.6501.0 92,688 Outlctl.dll 07-Oct-2004 21:43 10.0.6735.0 6,335,176 Outllib.dll 08-Apr-2004 02:24 10.0.6711.0 92,872 Outlmime.dll 07-Oct-2004 21:43 10.0.6735.0 47,816 Outlook.exe 08-Apr-2004 02:24 10.0.6711.0 129,728 Outlph.dll 08-Apr-2004 02:24 10.0.6711.0 47,816 Outlvbs.dll 25-Nov-2002 18:50 10.0.4721.0 47,688 Recall.dll
For additional information about the terminology that Microsoft uses when it corrects software after it is released, click the following article number to view the article in the Microsoft Knowledge Base:
(https://support.microsoft.com/kb/824684/ )Description of the standard terminology that is used to describe Microsoft software updates
Article ID: 886968 - Last Review: October 27, 2013 - Revision: 2.1


text:
STOCKTON – He's revived asphalt racing in San Joaquin County, introduced a dirt track to its fans and may one day lay down a drag strip.
Mike Drake grew up with dreams of becoming a race car driver. The allure of finely tuned machines, high speeds, and cheering fans excites most young boys, but the source of Drake's racing dreams didn't stem from TV or the movies, it came from watching his father circle the track at the Merced Speedway.
LODI – Back in the 1970s, Kingdon Drags was the place where Corvettes, Challengers, GTOs, Camaros, Firebirds, Mustangs and other muscle and fast cars of those days were in abundance.
Jason Webb knows high performance machines.
LOS ANGELES (AP) - Prolific documentary-maker Alex Gibney delivers a gripping account of the wins and losses of hard-charging idealism on the front lines of the information wars in "We Steal Secrets: The Story of WikiLeaks." Exhaustively researched and balanced in its view of the controversial key player, the film slips in ahead of DreamWorks' dramatic take on the exploits of Julian Assange, "The Fifth Estate," which is currently shooting.
By CHRISTY LEMIRE
By JOCELYN NOVECK
SONORA - When dance teacher Michael Minetti first meets his elderly student Lily Harrison in her Florida-coast high rise, it seems pretty clear these two will barely make it past 'Hello,' let alone their first full lesson. Besides their 30-year age difference, they clash at every turn. A former teacher and minister's wife, she's guarded, uptight and suspicious. A former Broadway dancer, he blurts out jokes and insults and swings from glib to desperate to nonchalant in 10 seconds flat. It's fun to watch, but how will they make it through a six-week dance course? That's the ...
TUOLUMNE – It's a month of great tribute shows at Black Oak Casino Resort.
STOCKTON - Jerry Seinfeld is appearing on stage on Thursday, July 25, at 7 p.m. at the Bob Hope Theatre in downtown Stockton.
STOCKTON - Frankie & Annette are in concert Saturday, June 8, at 7 p.m. at the Emerson Coffee House at the First Unitarian Universalist, 2737 Pacific Ave.
LODI – One of the larger wineries in the Central Valley rises from the fields east of Highway 99 like a stainless steel behemoth.
MODESTO - In California, when one thinks of the production of wine, the first place that comes to mind is the Napa Valley. However, 80 miles from the illustrious wine mecca of Napa, located in the heart of the Central Valley is the city of Modesto. For those familiar with the area, Modesto is host to Gallo Winery, one of the largest winemakers in the world and also one of the city's largest employers. However, in the shadow of the grandeur of Gallo is the small wine company Silkwood, that produces rich, mature and award winning wines that both residents ...
MURPHYS - Part of the history of wine country in the Sierra Foothills can be traced back to 1948.
Whoever said that you had to go to Napa to get the true wine experience?
Page 34 of 80
Getting young children involved with summer activities in Manteca is fairly easy for two reasons.
As a shy, introverted little girl, scared of her own shadow, Jolynda Lyon grew up feeling as if it wasn't safe to express her thoughts and feelings for fear of being judged or rejected but then she committed her heart to God and things began to change.
Although this year marks the first time that Backstage Academy of Dance students have competed in the Rainbow National Dance Competition in Sacramento, audience members probably could not have guessed as the dancers stole the spotlight and secured a number of awards.
Dance is alive and kicking in the 209.
SONORA – The Bureau of Reclamation is offering summer interpretive programs and activities at New Melones Lake, located in Calaveras County.
Redwoods in California's coastal mountains get more of the glory including being the official state tree but they are babes and petite in terms of age and girth compared to their giant sequoia cousins in the Sierra.
ARNOLD - Three miles north of Arnold off Highway 4, the colossal trees of Calaveras Big Trees State Park stand in quiet testimony to prehistoric times.
People who think that being a stay-at-home mom is not considered a job obviously have never met Jennifer Gonzales.
One set of great grandparents stands tall in their family for giving their all to a pair of great grandsons.
Rachel Castillo and her husband were well on their way to an empty nest.
She's a mother but she also fills the role of the father.
Page 3 of 3
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The Volkspark (people's park) Rehberge is another rare green area in grey Wedding and thus very popular with locals and not-so-locals, and popular at all seasons. Among the bigger parks in Berlin with about 110 ha, it has a viviarium with wild boars (which tend to freak out my friend's dog when visiting), sunbathing areas, four lakes, playing fields, an open-air cinema in summer and even a toboggan run for winter times.
Volkspark Rehberge is liked and used by all sorts of people all year round – and especially by dog owners, as this is one of the few Berlin parks were dogs allowed to roam free. Right in the centre of the park there's the replica of a 1930s monument to writer and former foreign minister Walther Rathenau, the so-called 'Rathenau Brunnen' (Rathenau foutain) which the Nazis had destroyed and which was re-instituted here in 1987.
Volkspark Rehberge | Relaxing | Free
Volkspark Rehberge
open all year round


text:
Super Sherpa KL250G '00-'09
Super Sherpa KL250G '00-'09
Barkbusters VPS Handguards for 7/8" or 1-1/8" (22mm or 28.5mm) HandlebarsVersatile full-wrap handguards that blend tough obstacle protection with moderate weather coverage. Learn More$119.99
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Barkbusters Blizzard Universal-Fit Cold Weather Handguards
Extend your riding season with Blizzard handguards from Barkbusters. These semi-rigid handguards block wind, rain, snow and keep you hands warm and controls dry.Learn More$114.95


text:
TV Info
Episode PremiereSeptember 26, 2010
GenreAnimation, Comedy
Show Period2009 - 2013
Production CompanyFuzzy Door Productions, 20th Century Fox
Cast and Crew
DirectorIan Graham
ScreenwriterMatt Murray
Main Cast
- Mike Henry
- Sanaa Lathan as Donna Tubbs (voice)
- Kevin Michael Richardson
- Seth MacFarlane as Tim the Bear / Additional Voices (voice)
- Arianna Huffington
- Nia Long as Roberta Tubbs (voice)
- Reagan Gomez-Preston as Roberta Tubbs
Additional Cast
Kenny West is a single dad and struggling rapper whom Cleveland takes under his wing in attempt to prove his own prowess after receiving some surprising news about his childhood basketball camp nemesis. Together, Cleveland and Kenny write, record and perform a new hit single, "Be-Cleve in Yourself." The track burns up the charts and ignites Kenny's new rap career, but leaves Cleveland behind in the dust.


text:
Standpoint Futures Residencies 2014 - Tom Varley
19 Feb 2014
Event times
- 45 Coronet Street
- London
- United Kingdom
- www.standpointlondon.co.uk
Travel Information
- Old Street / Liverpool Street
Screening and artist talk
AboutDuring his residency at Standpoint, Tom has been developing new work exploring speech perception and âmultisensory-integration'; the way information from the different senses is integrated by the nervous system. The final work will be a video and sound installation, shown at Tramway in Glasgow during March 2014. For this event, Tom will present a special preview of the work in progress, which revisits techniques associated with Lettrism and concrete poetry in the light of subsequent developments in linguistics and cognitive psychology. Tom will also show recent video work 'Violence. Silence.', 2013. Tom Varley (based in Glasgow) is currently on residency at Standpoint Gallery, as part of Standpoint Futures Residencies 2014. Taking place at Standpoint Gallery, London, Standpoint Futures Residencies are for emerging/mid career artists, designed to be flexible and responsive to the project, needs and desired outcomes of individual participants. The residency's chief aims are to provide high quality, individualized opportunities to develop the artist's practice and career, and to integrate London and the regional UK art world to promote access and the exchange of ideas. Standpoint Futures is supported by Arts Council England, Arts Council Wales, Creative Scotland and the Fenton Arts Trust. In addition Tom Varley's residency is supported by Art Trust Scotland and The Hope Scott Trust. We would also like to acknowledge our regional partners with whom we run the programme and select artists: G39, Chapter, Peacock Visual Arts, Exeter Phoenix and The Royal Standard.
Have you been to this event? What do you think? Join the discussion here!
Remember, you can include links to your instagram pictures and to videos.


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2nd and Seven –It
wasn't supposed to be like THIS – So, this is how it works under
Pete Carroll at USC. Former Heisman Trophy winner Carson Palmer
graduates. Former Heisman Trophy winner Matt Leinart takes over.
Leinart graduates, another stud QB is ready to take over – another
Heisman possibly in the offing. Three months ago, it seemed as though
the script would be followed, it was just a matter of whom – John David
Booty or Mark Sanchez. Flash forward to April 27th, 2006 and
things aren't so clear. Booty injured himself during spring practice
giving Sanchez the opportunity to showcase his skills with the number
one group. Then, two days ago, Sanchez was arrested and suspended after
a sexual assault charge was pinned on him. So, what looked to be a
slam-dunk months ago is now as unclear as ever. Hopefully, both QBs can
have their 'situations' cleared by the fall, such that they can compete
for the starting position. However, the ambiguity won't help (duh) the
Trojans as they attempt to rebound from last year's Rose Bowl loss.
3rd and Three –
Lawrence's Wake – Although most people remember the USC defense for
what they didn't do last year, they still have at least one All-American
candidate, in particular stud defensive end Lawrence Jackson. The 6'5"
265 pound All-Pac-10 junior defensive end registered 10 sacks last
season and 13 tackles for a loss. Jackson gets a strong upfield rush
and can play the run fairly well, the Texas game notwithstanding. He'll
see additional blockers this year if a threat can't develop from the
other side with Frostee Rucker out of eligibility. Regardless,
Jackson's continued growth and presence at the defensive end position is
key to their defensive performance in 2006.
4th and One – LBs in
Peril – If there was one play in the Rose Bowl when USC fans really
knew that they had to be in trouble, it had to be Vince Young's
touchdown off of the zone read in the third quarter. Sure, there were
other key plays in the game, even as Young marched the Horns up and down
the field, but that touchdown in the third quarter epitomized USC's
seeming ineptitude at one key position. As Young pulled the ball from
the back's belly, true freshman linebacker Brian Cushing was in what
seemed to be perfect position to make the play, only to have to have
Young run by him for a 14 yard touchdown. Granted, as mentioned,
Cushing was a true freshman (and who really tackled Young in the open
field?) playing a lot of downs, but he was playing because the
linebacking corps had been decimated by injury. Dallas Sartz was a two
year starter who was lost all year due to injury. Keith Rivers and
Oscar Lua battled nagging injuries as well. And, the inconsistency at
linebacker could be traced back to the inconsistent nature of them being
in the lineup or not. With Rivers, Sartz and Lua fully healthy and
Cushing, Rey Maualuga and Thomas Williams available to give them rest,
the Trojans defense would've been a completely different animal. Alas,
that wasn't the case in 2005. But, 2006 is a new year, so keep an eye
on this group this year as all of them return, and hopefully, they'll
stay healthy.


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We're not saying they're open to the public, and we're not saying you'll necessarily be able to get in if you show up. But here are the big-name parties on tap for tonight. Expect to hear about them in the next few days' gossip columns.
• Hennessy Artistry. Capitale, 130 Bowery, at Grand St., 7:30 p.m. Confusingly truncated event title, highly enticing event schedule: Kanye West and the Strokes will perform. Kate Bosworth and Jamie-Lynn Sigler are scheduled to observe. In our notes, we had jumbled together the names of West and Strokes drummer Fabrizio Moretti as "Kanye Fabrizio." If a mad scientist were actually to combine those two people, that would be one fashionably unholy hybrid.
• Iconoclasts launch party, courtesy of Grey Goose. Baryshnikov Arts Center, 450 W. 37th St., nr. Ninth Ave., 7 p.m. Iconoclasts is a TV show on the Sundance Channel that pairs up celebrities, vintage-Interview style, for weird effect (our favorite: Michael Stipe and Mario Batali). Mikhail Baryshnikov, Alice Waters, and ultimate iconoclast badass Les Moonves are expected to attend.
• Cosmopolitan's 50 Hottest Bachelors of 2006. The Pink Elephant, 527 W. 27th St., nr. Tenth Ave., 7 p.m. There's one from every state! But only the fully certified ones. It's tough to be Puerto Rico.
• Young Patrons Society benefit. The Allen Room, Frederick P. Rose Hall, Broadway at 60th St., 7:30 p.m. Featuring a performance by the Mad Hot Ballroom cast. "The Allen Room, Frederick P. Rose Hall" is such an unwieldy and confusing name. The phrase "you mean that one place above the mall with the huge window?" will be spoken into many a cell phone tonight.
Looking for something lower-key and more accessible? Check out all our Agenda listings for tonight, selected by New York's culture editors.


text:
Intel® Core i5-4590 3.3GHz Quad-Core CPU/Gigabyte B85M-HD3 mATX MB/4GB DDR3 1866 Kingston HyperX Fury Red Memory/1TB WD Blue 7200rpm SATA HDD/Cougar Spike Case w/TT TR2 500W PSU BarebonesItem#: B69-10230 | Model#: BX80646I54590 Bundle
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INTEL 4590/GB B85/8GB/1TB/500W/CS Product Details
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Manufactured by: Intel
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text:
TEMPE, Ariz. Arizona State University researchers have made a breakthrough in understanding the effect on climate change of a key component of urban pollution. The discovery could lead to more accurate forecasting of possible global-warming activity, say Peter Crozier and James Anderson.
Crozier is an associate professor in ASU's School of Materials, which is jointly administered by the College of Liberal Arts and Sciences and the Ira A. Fulton School of Engineering. Anderson is a senior research scientist in the engineering school's Department of Mechanical and Aerospace Engineering.
As a result of their studies of aerosols in the atmosphere, they assert that some measures used in atmospheric science are oversimplified and overlook important factors that relate to climatic warming and cooling.
The research findings are detailed in the Aug. 8 issue of Science magazine, in the article "Brown Carbon Spheres in East Asian Outflow and Their Optical Properties," co-authored by Crozier, Anderson and Duncan Alexander, a former postdoctoral fellow at ASU in the area of electron microscopy, and the paper's lead author.
So-called brown carbons a nanoscale atmospheric aerosol species are largely being ignored in broad-ranging climate computer models, Crozier and Anderson say.
Studies of the greenhouse effect that contribute directly to climate change have focused on carbon dioxide and other greenhouse gases. But there are other components in the atmosphere that can contribute to warming or cooling including carbonaceous and sulfate particles from combustion of fossil fuels and biomass, salts from oceans and dust from deserts. Brown carbons from combustion processes are the least understood of these aerosol components.
The parameter typically used to measure degrees of warming is radiative forcing, which is the difference in the incoming energy from sunlight and outgoing energy from heat and reflected sun
|Contact: Joe Kullman
Arizona State University


text:
La Roche Posay Effaclar Purifying Gel Cleanser
218 reviews
65% would repurchase
Package Quality: 3.9
Price: $$$
Package Quality: 3.9
Price: $$$
INGREDIENTSAqua / Water, Decyl Glucoside, Sodium Laureth Sulfate, Peg-120 Methyl Glucose Dioleate, Polyglyceryl-3 Hydroxylauryl Ether, Peg-4 Dilaurate, Peg-4 Laurate, Zinc Pca, Disodium Edta, Citric Acid, Polyquaternium-7, Iodopropynyl Butylcarbamate, Peg-4, Parfum / Fragrance.
on 6/27/2015 1:10:00 PM
Age: 19-24
Skin: Sensitive, Medium, Not Sure
Hair: Black, Other, Other
Eyes: Black
The best face wash I have ever used. I've tried every cleanser from high end brands like kiehls paulas choice, first aid beauty, lush, clinique, kaya skin clinic to name a few to drugstore brands like clean and clear, burts bees, cetaphil, cerave etc but everything I used made my skin red irritated more prone to breakouts. This is the first face wash that has no drying effects on my skin. It also helps in reducing breakouts.
on 5/20/2015 3:45:00 PM
Age: 25-29
Skin: Acne-prone, Olive, Warm
Hair: Brown, Straight, Coarse
Eyes: Brown
I've been using this for several months in conjunction with the clarifying toner. The overall effect: drying, and it doesn't prevent breakouts AT ALL. I really expected more from this brand.
on 4/26/2015 3:28:00 PM
Age: 44-55
Skin: Combination, Fair-Medium, Neutral
Hair: Brunette, Wavy, Medium
Eyes: Blue
I've always had combination, acne-prone skin and used proactive with limited results. I was so sick of not being able to get rid of the bumpy cystic type acne on my forehead and to a lesser extent the rest of my face. Finally, I threw out the proactive and took a chance on the effaclar gel cleanser, toner, duo and effaclar k products. Within days my skin was completely clear and the texture was smoother than I ever imagined it could be! This line really worked for me and I am a huge advocate of the line. I know how bad skin can impact your self-confidence and happiness and I am pleased to say the Effaclar products have changed my life for the better!
on 4/2/2015 11:47:00 AM
Age: 18 & Under
Skin: Sensitive, Medium, Not Sure
Hair: Black, Wavy, Medium
Eyes: Brown
I love this cleanser (and brand) so much that I had to come on here and review it! I use the Effaclar 3 Step System (cleanser, toner, duo+) and this has really impressed me. I have mild acne, with breakouts usually on my forehead area and t zone but occasionally on the rest of my face and most products that claim to help acne actually break me out, I think that they contain too many chemicals or something. This, however, is totally suited for sensitive skin. My face is normal to combo- I sometimes get oily but not excessively, and this really feels like it cleans my skin.
It probably won't get rid of acne by itself, but used in conjunction with other products- especially the effaclar duo+, I've now got a 90% blemish free face. The price isn't as cheap as some drugstore cleansers but I do think it's worth it. Also I prefer the pump packaging but that's also something I can overlook. Already repurchased this twice because I love it!
on 2/11/2015 3:54:00 PM
Age: 30-35
Skin: Acne-prone, Other, Neutral
Hair: Other, Wavy, Other
Eyes: Green
The bottle with the pump gives just enough
Nice and foamy
Good smell
Large bottle
Company is really wonderful about reimbursements
Easily available at my pharmacy
Dried out my skin
Didn't help with acne
Price is a bit high
I just didn't find this did anything wonderful for my skin. It foamed up well, had a pleasant smell, and I do not believe it contributed to more breakouts. It did contribute to dry skin.
on 2/11/2015 12:06:00 PM
Age: 19-24
Skin: Very Oily, Fair, Not Sure
Hair: Brown, Other, Other
Eyes: Green
I quite liked this product at first but after using it for about two weeks, I noticed it started to dry my skin out. My face felt tight after using it and it didn't help keep my pores clear at all.
On a positive note, it was great at removing my make up but for the price, I saw no real difference in the condition of my skin and it just felt like I was using something like Clearasil.
on 2/9/2015 3:44:00 PM
Age: 19-24
Skin: Combination, Fair, Neutral
Hair: Black, Wavy, Medium
Eyes: Brown
A pharmacist recommended this to me to fight a breakout I couldn't explain at the time. It made my face feel extremely tight from the first use. I tried to stick to it for a while as I thought I would get used to it but it overdried and sensitised my skin and no moisturiser could counteract its effects. This is the worst I have ever felt my face. It also didn't help me at all with my breakout. It was caused by a starch containing blush(korres zea mays) I was using; I later found out starch in makeup can encourage bacterial growth if not thoroughly removed by the end of the day. Since my breakout didn't clear up while using this product for cleansing day and night for about a month I can only assume it is not 100% effective in removing makeup. I hate doing this but I threw the rest of it away...
on 2/8/2015 8:47:00 PM
Age: 30-35
Skin: Combination, Fair, Warm
Hair: Blond, Wavy, Fine
Eyes: Blue
Firstly i hate the grassy scent this has. But the gel itself does its job. Removes make up well. I don't think it does anything to decrease sebum. I haven't been using this long enough to say if it dries my skin. I have noticed that my skin dries more than in my 20's but this doesn't leave my skin feeling tight. So all in all a good cleanser but i won't miss this once i've finished this.
on 1/29/2015 4:09:00 PM
Age: 25-29
Skin: Oily, Fair, Not Sure
Hair: Brown, Other, Other
Eyes: Brown
I like to use this during spring till autumn. Having combination/oily skin I'm looking for products which decreases production of sebum, but doesn't overdry my skin at the same time. And this is especially what I found in Effaclar cleanser. I also use Effaclat Mat which is great as primer, hides enlarged pores and keep skin matte.
on 12/1/2014 2:38:00 PM
Age: 30-35
Skin: Acne-prone, Other, Not Sure
Hair: Brunette, Other, Other
Eyes: Brown
I like this cleanser. I have acne-prone / oily-combo skin, so I like something that seems to "dry" that up a bit, without overdrying.
I also have the Effaclar Deep Cleansing Foaming Cream....I prefer the lather of the cream version (which is similar in texture to another favorite cleanser, Origins "Checks and Balances"). As a plus, a little goes a long way for both the Effaclar Deep Cleansing Foaming Cream and the Effaclar Purifying Gel Cleanser.
I'd recommend the cream version over the gel, but that's personal preference.
Popular Cleansers


text:
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1957 Ford Skyliner #D7FW249211, 60,340 miles. Retractable hardtop, needing front clip and restoration.... More
This is the top of the line model for 1954, the Skyliner Victoria Glass Top. The car is exceptionally original. The original owner held... More
BARNFIND RUST FREE This is a very solid car New chrome bumpers Paint and body are very nice but interior needs to be done Retractable top works New brakes,... More
1959 Ford Fairlane 500 Skyliner - 292 V8, automatic, power steering, power brakes, power seat, wide whitewall tires - Clean Older Restoration - Solid &... More
I purchased this Ford while I was in the Navy in San Diego and drove it out there, but towed it home to Ohio... More
The My Hot Cars Team is excited to be able to offer at our Livermore, CA showroom this unique and beautiful 1954 Crestline Skyliner... More
1957 Ford Skyliner retractable,a very solid Midwestern car,,just out of lengthy museum storage.It is finished in the factory correct Raven Black,with a complimenting interior,in... More
FORD: 1959 Skyliner, needs restoration finished, $10,000. 712-370-1898, IA.... More
Ford 1957 Skyliner retractable, red & white, V8, pb, retractable top, gauges all work, good tires, 69,000 miles, runs and drives great, very nice... More
Ford 1954 Skyliner, original engine, 3-spd w/overdrive, amateur restoration, some new wiring, new brakes, radiator, clutch & pressure plate, universals and restored gas tank;... More
1957 FORD FAIRLANE 500 SKYLINER RETRACTABLE!! BUT WAIT -- IT LOOKS LIKE AN EDSEL. I DIDN'T KNOW THEY MADE ONE! I bought this car in... More
1959 Ford Skyliner, project condition, seldomnly seen Fairlane script car, early and low code, originally styletone raven black, torch red, now solid red, Tennessee... More


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Write a
4dr SUV
(4.4L V8 AWD 6-speed Automatic)
I cannot get mine to work with the garage door opener but the instructions are in the manual.
The problem may be with the type of garage door opener you have as well.
I know that is the problem with mine.
So, I just use the garage door opener supplied with my garage door.
I would be nice to use the ones over the visor though.
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text:
armistice lines (and more occupied territories) are still the de facto barriers between Israel and Lebanon and Syria.
The borders of Israel between 1949 and 1967, created by armistice agreements, were even less acceptable to the party.
He further proclaimed that the 1949 armistice lines "between us and Egypt are vanished and dead."
1707, from French armistice (1680s), coined on the model of Latin solstitium (see solstice), etc., from Latin arma "arms" (see arm (n.2)) + -stitium (used only in compounds), from sistere "cause to stand" (see assist).
The word is attested in English from 1660s in the Latin form armistitium. German Waffenstillstand is a loan-translation from French. Armistice Day (1919) marked the end of the Great War of 1914-18 on Nov. 11, 1918. In Britain, after World War II, it merged with Remembrance Day. In U.S., Armistice Day became a national holiday in 1926. In 1954, to honor World War II and Korean War veterans as well, it was re-dubbed Veterans Day.


text:
Book Search
Strategic Narratives
Communication Power and the New World Order
Series: Routledge Studies in Global Information, Politics and Society
Communication is central to how we understand international affairs. Political leaders, diplomats, and citizens recognize that communication shapes global politics. This has only been amplified in a new media environment characterized by Internet access to information, social media, and the...
Published August 26th 2014 by Routledge
The Politics of the New Germany
2nd Edition
The Politics of the New Germany continues to provide the most comprehensive, authoritative and up-to-date textbook on contemporary German Politics. The text takes a new approach to understanding politics in the post-unification Federal Republic. Assuming only elementary knowledge, it focuses on a...
Published September 29th 2011 by Routledge


text:
Two-up, Two-wheels, Two-gether in: Switzerland
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Studly Adventurer
Joined: Jul 2007
Location: Ellijay & Suwanee, Georgia
Oddometer: 551
Monday #3
The next several miles was an adventure in itself. We passed several cars in which there was barely enough room for both of us. After coming across a truck at one point in front of us, there was several times where the oncoming car backed up so it could pass. The scenery & riding was worth it all.
In lokking around at this area, I realized there did not seem to be a lot of off road opportunites in the area, only paved roads. We did see a few in some places, but not as many as I expected.
We could see a bright green lake in the distance. The closer we got to it, the more it seemed to glow.
We knew Route 66 was a long highway, but never thought about it going all the way to Switzerland
As we head towards the next small town, you can see the Church once again above all the other structures.
...and one of the first views of a sweeper.....
It does make me wonder how far you could travel down in the valley, from town to town before you have to go up and over a mountain to get out.
Another Church up on a hill, above the rest.
Endless riding opportunities as far as the eye can see.
This little area was a stopping point for a lot of riders. Once you had your helmet off, you were greeted my the sounds of cow bells everywhere.
After this stop, you start back up and over the mountain you could see the fun stuff in a distance.
At the top of this mountain was snow, but also a glacier.
The waterfall at the bottom was from the melting glacier. How many millions of years has this process be going on, that helped carve out this landscape.
David & Ellen
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Tuesday, November 5, 2013
Screening of "Why We Fight"
Presented by the Politics Department as part of the weekly film series for Politics 101.
Why We Fight (99 min) describes the rise and maintenance of the United States military-industrial complex and its more than 50-year involvement with the wars led by the United States, including the 2003 invasion of Iraq.
Tuesday, November 5, 2013
Washington University School of Social Work Info Session
Interested in social work post-Oxy? Come here from this elite institution.
Social work and public health students at Washington University's Brown School are united by a passion to help others and a need to make change happen. Learn more about their graduate social work degree, graduate degree in public health, and doctoral degree programs.
Wednesday, November 6, 2013
Amsterdam: A History of the World's Most Liberal City
Amsterdam: A History of the World's Most Liberal City
Russell Shorto is the bestselling author of Descartes' Bones and The Island at the Center of the World and a contributing writer at The New York Times Magazine. His books have been published in fourteen languages and have won numerous awards. From 2008-2013, he was the Director of the John Adams Institute in Amsterdam.
Wednesday, November 6, 2013
Talk: Hawai'ian Food Heritage, Community Empowerment, and Sustainable Development
Hawai'i Club brings Daniel Anthony, a taro farmer from O'ahu, to Oxy to speak on Hawai'ian food heritage, community empowerment, and sustainable development.
Wednesday, November 6, 2013
Is Iran About to Become Our New Best Friend?
Occidental College political scientist Hussein Banai, Asia Society vice president of global policy programs Suzanne DiMaggio, Occidental historian Thaddeus Russell, and former NBC foreign correspondent George Lewis discuss whether we may be entering a new era in the relationship between the U.S. and Iran in this Zocalo Public Square/Occidental event.
This fall, for the first time since the days of disco, the president of the United States and the leader of Iran spoke directly by phone. Iran's newly elected president, Hassan Rouhani, is taking steps to end his country's international isolation. But it's hard to tell if Rouhani and his moderate allies are serious about effecting change, or if they're merely making promises in order to get economic sanctions lifted. What might it mean for both countries–and for the dynamics of the Middle East—if the United States and Iran were, once again, to become real allies? How would a relationship reset affect oil prices, our relationship with Israel, and life for Iranian-Americans here?
Please RSVP here. The Museum of Contemporary Art is at 250 S. Grand Avenue in downtown Los Angeles. Parking ($9) is available in the Disney Concert Hall garage. Enter from Second Street, just west of Grand Avenue.
Wednesday, November 6, 2013
Discussion: Race & Sex: Intersectionality at Oxy
Join us for a community discussion.
How do our varying social identities interact and impact our experiences? What would it mean to create a truly intersectional movement for social justice and liberation? How do we build solidarity across difference? Cosponsored by CGE.


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Money - Page 12
Airlines Are Now Getting Less Money from Checked Bags — Dollars and Sense
When fuel prices hit an all-time high a few years ago, many airlines began charging passengers to check their bags. The fees are unpopular, so there are probably lots of frequent fliers happy that airlines are now raking in less money from them.
But don't laugh too hard — what they're getting still isn't chump change.
Babe Ruth's New York Yankees Jersey Smashes Record By Selling for $4.4 Million at Auction
How much would you pay for a piece of baseball history? In the case of a Babe Ruth jersey, a buyer shelled out $4.4 million — making it the most expensive sports memorabilia item ever sold.
What Is 'Drip Pricing' and Why Is the FTC Cracking Down on It? — Dollars and Sense
Have you ever bought a cheap airline fare, only to be hit with fees later on that turned it into a far more expensive ticket? Congratulations — you're a victim of 'drip pricing.'
And the problem, which spawns several industries, has gotten so pervasive that the Federal Trade Commission is stepping in.
Do You Cook at Home to Save Money? — Survey of the Day
Accountant Sues After Being Paid $1,200 in Coins — Dollars and Sense
A man in the UK who was upset with his accountant chose a rather unusual way to express his irritation: he paid off his $1,200 bill for services rendered in coins. But the accountant got the last laugh by taking his client to court.
Looking for the Best Prices on Flights? Follow These Simple Tips
Which States Have the Highest and Lowest Minimum Wage?
With the unemployment rate being what it is, a lot of people these days are being forced to work for minimum wage. But exactly how much you get could depend largely on what state you're in.
Is Your Credit Score Good Enough for the Best Rates? — Dollars and Sense
Here's the good news: Americans have better credit scores now than we have in the past few years. But there's bad news, too: credit standards are now so high that it may not matter much.
Australian Council Considers Crazy 400 Percent 'Fat Tax' Against Fast Food Joints [VIDEO]
As part of an effort to fight obesity, Darebin Council in northern Melbourne, Australia, is considering a "fat tax" which would impose whopping rate increases on fast food giants like McDonald's and KFC.


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Tom, finding one of the Lapham girls quite charming, asks his father to visit Lapham. Bromfield decides to do it immediately the next morning.
Considering the Laphams move to the New Land, Bromfield asks Tom if the Laphams will be a great addition to society.
"No one can help feeling that they are all people of good sense and — right ideas," Tom replies.
"Oh, that won't do. Society is a very different sort of thing from good sense and right ideas. It is based upon them, of course, but the airy, graceful, winning superstructure which we all know demands different qualities. Have your friends got these qualities — which may be felt, but not defined?"
Tom must admit that the Laphams do not have these "felt" qualities.
When Bromfield visits Lapham's office, Silas' treatment of him is condescending, reducing Bromfield to the father of the boy to whom he generously gave employment.
At home that evening, Silas suggests inviting the Coreys to a housewarming, and his wife completely upbraids him for suggesting to take the first step. Their quarrel causes him sleeplessness, and he remains at home the next day. Tom Corey calls to see if Silas is well and is left alone in the parlor with Irene. He pays another visit later in the week and, again, is left alone with her. When he asks about Penelope, Irene persuades her sister to join them. Afterward Mrs. Lapham asks Penelope if Tom ever says anything about Irene. Penelope says that he has never mentioned Irene to her.
Confronting Silas with the problem, Persis says, "I can't make out whether he cares for her or not."
Even now, when unknowingly Lapham is on the road to destruction, he is prideful to the point of insulting Bromfield Corey by his condescending attitude. His tragic fall is near, and, yet like other tragic figures, he is not aware of his fate until it happens. Only at the moment of his defeat will Lapham realize his tragic flaws of pride and greed.
Leaving Tom Corey and Irene alone advances the romantic love affair that has been built up in the minds of the Laphams. Still, Mrs. Lapham, who is somewhat perceptive, notes that Tom is not making the usual overtures about Irene.
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At the conclusion of the novel, which of the following statements is not true?
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A bioactive/biodegradable nucleus implant for repairing degenerated intervertebral discs that is inflated inside the nucleus space after the degenerated nucleus has been removed to re-pressurize the nuclear space within the intervertebral disc. The implant is inflated with a high molecular weight fluid, gel or combination of fluid and elastomer, preferably an under-hydrated HA hydrogel/growth factor mixture with or without host cells. The implant includes an internal, integral, self-sealing valve that allows one-way filling of the implant after it is placed within the disc, and is made from a material that allows fibrous in growth thereby stabilizing the implant. A variety of substances can be incorporated into the implant to promote healing, prevent infection, or arrest pain.
1. A method for repairing an intervertebral disc, said disc comprising an annulus that substantially surrounds a nuclear space and is located between first and second adjacent vertebrae, said annulus having a wall, said method comprising:
inserting an inflatable implant in a collapsed configuration through a passageway formed across the annulus wall and into the nuclear space;
wherein said inflatable implant comprises,
an inflatable membrane,
said membrane having an internal chamber,
said membrane having an internal self-sealing fill valve located within the internal chamber; and
inflating said implant within the nuclear space from the collapsed configuration to an expanded configuration that a first portion of the membrane is located adjacent the first vertebra, a second portion of the membrane located opposite the first portion is positioned adjacent the second vertebra;
wherein said internal self-sealing fill valve comprises internal opposing walls that are disposed relative to the membrane so as to collapse as a result of a compressive load between the first and second vertebrae, and thus between the first and second membrane portions, and thereby disposed on said internal chamber.
2. A method as recited in
3. A method as recited in
4. A method as recited in
5. A method as recited in
6. A method as recited in
7. A method as recited in
8. A method as recited in
a nucleophilic "8-arm" octomer (PEG-NH2, MW 20 kDa); and
a "2-arm" amine-specific electrophilic dimer.
9. A method as recited in
10. A method as recited in
11. A method as recited in
12. A method as recited in
This application is a divisional of application Ser. No. 10/154,857, filed on May 24, 2002, now U.S. Pat. No. 7,156,877, incorporated herein by reference in its entirety, which claims priority from U.S. provisional application Ser. No. 60/301,882, filed on Jun. 29, 2001, incorporated herein by reference in its entirety.
Not Applicable
Not Applicable
1. Field of the Invention
The present invention pertains generally to repairing intervertebral disc disorders, and more particularly to an implant and surgical procedure for repairing a degenerated intervertebral disc.
2. Description of the Background Art
An estimated 4.1 million Americans annually report intervertebral disc disorders, with a significant portion of them adding to the nearly 5.2 million low-back disabled. Though the origin of low-back pain is varied, the intervertebral disc is thought to be a primary source in many cases, and is an initiating factor in others where a degenerated disc has led to altered spinal mechanics and non-physiologic stress in surrounding tissues.
The intervertebral disc is a complex structure consisting of three distinct parts: the nucleus pulposus; the annulus fibrosus; and the cartilaginous end-plates. The nucleus pulposus is a viscous, mucoprotein gel that is approximately centrally located within the disc. It consists of abundant sulfated glycosaxninoglycans in a loose network of type II collagen, with a water content that is highest at birth (approximately 80%) and decreases with age. The annulus fibrosus is that portion of the disc which becomes differentiated from the periphery of the nucleus and forms the outer boundary of the disc. The transition between the nucleus and the annulus is progressively more indefinite with age. The annulus is made up of coarse type I collagen fibers oriented obliquely and arranged in lamellae which attach the adjacent vertebral bodies. The fibers run the same direction within a given lamella but opposite to those in adjacent lamellae. The collagen content of the disc steadily increases from the center of the nucleus to the outer layers of the annulus, where collagen reaches 70% or more of the dry weight. Type I and II collagen are distributed radially in opposing concentration gradients. The cartilaginous end-plates cover the end surfaces of the vertebral bodies and serve as the cranial and caudal surfaces of the intervertebral disc. They are composed predominately of hyaline cartilage.
The disc derives its structural properties largely through its ability to attract and retain water. The proteoglycans of the nucleus attract water osmotically, exerting a swelling pressure that enables the disc to support spinal compressive loads. The pressurized nucleus also creates tensile pre-stress within the annulus and ligamentous structures surrounding the disc. In other words, although the disc principally supports compressive loads, the fibers of the annulus experience significant tension. As a result, the annular architecture is consistent with current remodeling theories, where the �60� orientation of the collagen fibers, relative to the longitudinal axis of the spine, is optimally arranged to support the tensile stresses developed within a pressurized cylinder. This tissue pre-stress contributes significantly to the normal kinematics and mechanical response of the spine.
When the physical stress placed on the spine exceeds the nuclear swelling pressure, water is expressed from the disc, principally through the semipermeable cartilaginous end-plates. Consequently, significant disc water loss can occur over the course of a day due to activities of daily living. For example, the average diurnal variation in human stature is about 19 mm, which is mostly attributable to changes in disc height. This change in stature corresponds to a change of about 1.5 mm in the height of each lumbar disc. Using cadaveric spines, researchers have demonstrated that under sustained loading, intervertebral discs lose height, bulge more, and become stiffer in compression and more flexible in bending. Loss of nuclear water also dramatically affects the load distribution internal to the disc. In a healthy disc under compressive loading, compressive stress is created mainly within the nucleus pulposus, with the annulus acting primarily in tension. Studies show that, after three hours of compressive loading, there is a significant change in the pressure distribution, with the highest compressive stress occurring in the posterior annulus. Similar pressure distributions have been noted in degenerated and denucleated discs as well. This reversal in the state of annular stress, from physiologic tension due to circumferential hoop stress, to non-physiologic axial compression, is also noted in other experimental, analytic and anatomic studies, and clearly demonstrates that nuclear dehydration significantly alters stress distributions within the disc as well as its biomechanical response to loading.
The most consistent chemical change observed with degeneration is loss of proteoglycan and concomitant loss of water. This dehydration of the disc leads to loss of disc height. In addition, in humans there is an increase in the ratio of keratan sulphate to chondroitin sulphate, an increase in proteoglycan extractability, and a decrease in proteoglycan aggregation through interaction with hyaluronic acid (although the hyaluronic acid content is typically in excess of that needed for maximum aggregation). Structural studies suggest that the non-aggregable proteoglycans lack a hyaluronate binding site, presumably because of enzytruitic scission of the core protein by stromelysin, an enzyme which is thought to play a major role in extracellular matrix degeneration. These proteoglycan changes are thought to precede the morphological reorganization usually attributed to degeneration. Secondary changes in the annulus include fibrocartilage production with disorganization of the lamellar architecture and increases in type II collagen.
Currently, there are few clinical options to offer to patients suffering from these conditions. These clinical options are all empirically based and include (1) conservative therapy with physical rehabilitation and (2) surgical intervention with possible disc removal and spinal fusion. In contrast to other joints, such as the hip and knee, very few methods of repair with restoration of function are not available for the spine.
Therefore, there is a need for a minimally invasive treatment for degenerated discs which can repair and regenerate the disc. The present invention satisfies that need, as well as others, and overcomes the deficiencies associated with conventional implants and treatment methods.
The present invention comprises an implant and minimally invasive method of treating degenerated discs which can repair and regenerate the disc. More particularly, the present invention comprises a bioactive/biodegradable nucleus implant and method of use. The implant is inflated inside the nucleus space after the degenerated nucleus has been removed to re-pressurize the nuclear space within the intervertebral disc. Nuclear pressure produces tension in the annular ligament that increases biomechanical stability and diminishes hydrostatic tissue pressure that can stimulate fibro-chondrocytes to produce inflammatory factors. The device will also increase disc height, separate the vertebral bodies and open the spinal foramina.
By way of example, and not of limitation, an implant according to the invention comprises a collapsible, textured or smooth membrane that forms an inflatable balloon or sack. To inflate the implant, the implant is filled with a high molecular weight fluid, gel or combination of fluid and elastomer, preferably an under-hydrated HA hydrogel/growth factor mixture with or without host cells. Integral to the membrane is a self-sealing valve that allows one-way filling of the implant after it is placed within the disc. The implant membrane is made from a material that allows fibrous in-growth thereby stabilizing the implant. A variety of substances can be incorporated into the device to promote healing, prevent infection, or arrest pain. The implant is inserted utilizing known microinvasive technology. Following partial or total nucleotomy with a small incision, typically annular, the deflated implant is inserted into the nuclear space through a cannula. The implant is then filled through a stem attached to the self-sealing valve. Once the implant is filled to the proper size and pressure, the cannula is removed and the annular defect is sealed.
One of the main difficulties in repairing the degenerated disc is increasing the disc height. The disc and surrounding tissues such as ligaments provide a great deal of resistance to disc heightening. For this reason it is unlikely that placing a hydrogel alone into the nuclear space will be able to generate enough swelling pressure to regain significant disc height. The present invention, however, addresses this problem by allowing initial high pressures to be generated when the implant is inflated in the nuclear space. The initial high pressure is sufficient to initiate the restoration of the original disc height. This initial boost in disc height facilitates the later regeneration stages of this treatment.
In the long term, having a permanent pressurized implant is not likely to be ideal because it may not be able to mimic the essential biomechanical properties of the normal disc. However, the invention also addresses this issue by using a biodegradable sack. The initially impermeable membrane permits high pressurization. When the membrane biodegrades, it allows the hydrogel mixture to take action in playing the role of the normal nucleus pulposus with its inherent swelling pressure and similar mechanical properties.
A variety of growth factors or other bioactive agents can be attached to the surface of the implant or included in the hydrogel mixture that is injected inside the implant. The membrane could be reinforced or not reinforced with a variety of fiber meshes if necessary. Furthermore, a variety of materials could be used for the membrane; the only requirement is that they be biodegradable such that the membrane is impermeable when initially implanted and until it biodegrades. A variety of materials could be injected into the sack such as cartilage cells, alginate gel, and growth factors.
An advantage of the invention is to provide for minimally invasive disk repair.
Another advantage of the invention is to provide a biodegradable implant.
Another advantage of the invention is to provide for restoration of disc height and normal disc biomechanics.
Another advantage of the invention is to provide for disk repair with no loss of mobility.
Another advantage of the invention is to provide for strong integration of an implant with surrounding tissue.
Another advantage of the invention is to provide for disk repair through the use of a very small incision in the annulus.
Another advantage of the invention is to provide an implant that has a bioactive surface.
Another advantage of the invention is to provide for disk repair with very low risk of re-herniation.
Another advantage of the invention is to provide a minimally invasive treatment for degenerated discs which can repair and regenerate the disc.
Another advantage of the invention is to provide a bioactive/biodegradable nucleus implant which can be inflated inside the nucleus space, such as after the degenerated nucleus has been removed.
Further advantages of the invention will be brought out in the following portions of the specification, wherein the detailed description is for the purpose of fully disclosing preferred embodiments of the invention without placing limitations thereon.
The invention will be more fully understood by reference to the following drawings which are for illustrative purposes only:
For illustrative purposes, the present invention is embodied in the method and apparatus described herein and generally shown in
Referring first to
Table 1 compares certain characteristics of the inner annulus to a number of commercially-available elastomers that were considered for the membrane material. Key design requirements were biocompatibility, stiffness, and elongation-to-failure. While any of these materials, as well as other materials, can be used, our preferred material was aliphatic polycarbonate polyurethane (HT-4) which has a stiffness that closely approximates that of the inner annulus, can be fabricated into complex shapes using dip molding, possess significant failure properties, and has a track-record for in vivo use.
The peripheral surface of the implant is preferably coated with one or more bioactive substances that will promote healing of the inner annulus and integration of the implant with the surrounding annular tissue. Also, the top and bottom surfaces of the implant are preferably coated with one or more bioactive substances that will promote healing of the cartilaginous endplates and integration of the implant with the endplates.
To limit the amount of lateral bulging when the implant is axially compressed, the peripheral surface of the implant can be reinforced with a fiber matrix if desired. In that event, the angle of the fibers relative to the vertical axis of placement should be approximately �60� to closely approximate that of the native collagen fibers in the inner annulus.
Implant 10 includes an integral, internal, self-sealing, one-way valve 16 that will allow the implant to be inserted in a deflated state and then be inflated in situ without risk of deflation. Valve 16 functions as a flapper valve to prevent leakage and maintain pressurization of the implant when pressurized with the nuclear filler material. Because valve 16 is internal to the implant, compression of implant 10 will place internal pressure on valve 16 to keep it in a closed position. Due to the self-sealing nature of valve 16, the same pressure that might be sufficient to allow the nuclear filler material to escape will cause valve 16 to remain closed so as to create a barrier to extrusion.
To better understand the operation and configuration of valve 16, reference is now made to
To inflate the implant, a needle-like fill stem is inserted through entrance port 32 so as to puncture the distal end 34 of valve 16 and extend into the interior chamber of the implant. The implant is then filled with a fluid material, such as a high molecular weight fluid, gel or combination of fluid and elastomer which has a viscosity that will permit its introduction into the implant through, for example, an 18-gauge needle. The specific properties of filler material 14 should allow the material to achieve and maintain the desired osmotic pressure. The filling takes place after the implant is placed within the disc. Preferably filler material is a cross-linkable polyethylene glycol (PEG) hydrogel with chondroitin sulfate (CS) and hyaluronic acid (HA) with or without host cells as will now be described.
Table 2 shows the characteristics of a number of commercially-available hydrogels that were considered for filler material 14. While any of these materials, as well as other materials, can be used, we selected an in situ cross-linkable polyethylene glycol (PEG) gel because of its bio-compatibility and physical properties. The PEG gel is a two component formulation that becomes a low-viscosity fluid when first mixed and which cross-links to a firm gel after insertion. The cross-link time depends on the formulation. A key feature of the gel is its osmotic pressure. We sought to formulate a gel that would possess an osmotic pressure of near 0.2 MPa which is that of the native nucleus pulposus.
The preferred PEG gel comprises a nucleophilic "8-arm" octomer (PEG-NH2, MW 20 kDa) and a "2-arm" amine-specific electrophilic dimer (SPA-PEG-SPA, MW 3.4 kDa), and is available from Shearwater Corporation, Huntsville, Ala. The addition-elimination polymerization reaction culminates in a nitrogen-carbon peptide-like linkage, resulting in a stable polymer whose rate of polymerization increases with pH and gel concentration. The range of pH (approximately 10 for the unmodified gel) and concentration (approximately 0.036 g/mL to 0.100 g/mL) investigated resulted in a polymerization time of approximately 10 minutes to 20 minutes. To fortify the hydrogel's inherent swelling due to hydrogen bonding, high molecular weight additives chondroitin sulfate (CS) and hyaluronic acid (HA) with established fixed charged densities were incorporated into the gel matrix.
The swelling pressures of the hydrogel filler (cross-linked polyethylene glycol (PEG) hydrogels and derivatives incorporating HA and CS) were measured by equilibrium dialysis as a function of gel and additive concentration. Polyethylene glycol (Molecular Weight 20 kDa available from Sigma-Aldrich Corporation) was also used as the osmotic stressing agent, while molecularporous membrane tubing was used to separate sample gels from the dialysate. Gels were formed over a broad concentration range (0.036 to 0.100 g/mL), weighed, placed in dialysis tubing (Spectra/Por Membrane, Molecular Weight Cut Off of 3.5 kDa available from Spectrum Medical Industries), and allowed to equilibrate for 40 to 50 hours in the osmotic stressing solution, weighed again to determine hydration, then oven dried (at 60 degrees Celsius) and weighed once again. Hydration values taken at various osmotic pressures allowed the construction of osmotic pressure curves. By adjusting the concentrations of CS or HA we were able to meet our design criteria, successfully achieving swelling pressures above 0.2 MPa. A potential deleterious interaction between the elastomer and hydrogel was noted. One PEG-CS specimen aged in saline demonstrated breakdown of the elastomer shell. This may have been due to the relatively low-molecular weight CS penetrating into the membrane material (polyurethane) leading to an increased rate of hydrolysis.
Referring now to
An inner passage 52 extends through inner annular buttress 42 for attachment to buttress positioner 40 and insertion of fill stem 38 through inner annular buttress 42 into implant 10. Inner passage 52, head portion 44 and body portion 46 are preferably coaxial. Buttress positioner 40 and inner annular buttress 42 are coupled together using mating threads 54 a, 54 b or another form of detachable coupling that allows buttress positioner 40 to be easily removed from inner annular buttress 42 after placement. Note that inner annular buttress 42 can be attached to implant 10 using adhesives, ultrasonic welding or the like, or can be separate and unattached from implant 10.
Fill stem 38 includes a collar 56 for attachment to a syringe 58 or other device to be used for inflating the implant with the filler material. Fill stem 38 and syringe 58 are coupled together using threads (not shown) or another form of detachable coupling. Preferably, syringe 58 includes a pressure gauge (not shown) for determining the proper inflation pressure. The implant and delivery system would be deployed into the nucleus pulposus space by being inserted into a conventional catheter, cannula or the like (not shown) having a retractable cover (not shown) that protects the implant during insertion.
As shown in
The referred protocol for creating a nuclear space for the implant comprises making a small puncture within the annulus with a pointed, 3 mm diameter probe. This pointed probe serves to separate annular fibers and minimize damage to the annulus. Next, a portion of the nucleus is removed using standard surgical instruments. The Coblation probe is then inserted. Suction and saline delivery are available with the probe, although we have found that suction through another portal using, for example, a 16-gage needle, may be required. A critical feature of device success is the method of creating a nuclear space while minimizing trauma to the outer annulus fibrosus. The outer annulus should be preserved, as it is responsible for supporting the implant when pressurized.
Next, as shown in
The catheter and delivery system (e.g., fill stem 38 and buttress positioner 40) are then removed, leaving inner annular buttress 42 in place and implant 10 sealed in position as shown in
It will be appreciated that the implant can be inserted using other procedures as well. For example, instead of performing a discectomy (posterolateral or otherwise), the implant could be inserted into a preexisting void within the annulus that arises from atrophy or other form of non-device-induced evacuation of the nucleus pulposus, such as for, example, by leakage or dehydration over time.
Prototype implant shells were fabricated by Apex Biomedical (San Diego, Calif.). The fabrication process included dip molding using a custom-fabricated mandrel. The mandrel was dipped so that the elastomer thickness was between 5 and 7 mils (0.13-0.17 mm). After dipping, the implant was removed from the mandrel, inverted (so that the stem was inside the implant) and heat-sealed at the open end. This process resulted in a prototype that could be filled with the PEG gel, which when cross-linked could not exit through the implant stem. The stem effectively sealed the implant by functioning as a "flapper valve". This means that by being placed within the implant, internal pressures (that might serve to extrude the gel) compress and seal the stem, creating a barrier to extrusion. This sealing mechanism was verified by in vitro testing.
Elastomer bags filled with PEG were compressed to failure between two parallel platens. The implants failed at the heat seal at approximately 250 Newtons force. These experiments demonstrated that under hyper-pressurization, the failure mechanism was rupture at the sealed edge, rather than extrusion of gel through the insertion stem. When the device is placed within the intervertebral disc, support by the annulus and vertebral body results in a significantly increased failure load and altered construct failure mechanism.
Ex vivo mechanical testing were performed with human cadaveric spines to characterize the performance of the device under expected extreme in vivo conditions. We conducted a series of experiments that consisted of placing the device in human cadaveric discs using the developed surgical protocols and then testing the construct to failure under compressive loading. The objective of these experiments was to characterize the failure load and failure mechanism. The target failure load was to exceed five times body weight (anticipated extremes of in vivo loading). Importantly, the failure mode was to be endplate fracture and extrusion of the implant into the adjacent vertebra. This is the mode of disc injury in healthy spines. We did not want the construct to fail by extrusion through the annulus, particularly through the insertion hole, since this would place the hydrogel in close proximity to sensitive neural structures.
Load-to-failure experiments demonstrated that the implant may sustain in excess of 5000 N (approximately seven times body weight) before failure, and that the failure mode was endplate fracture. These preliminary experiments demonstrate that the implant can sustain extremes in spinal compression acutely.
Referring now to
Referring to
Referring now to
As can be seen from
Although the description above contains many specificities, these should not be construed as limiting the scope of the invention but as merely providing illustrations of some of the presently preferred embodiments of this invention. Those skilled in the art will appreciate that other materials, structures, components, and configurations can be employed without departing from the invention. For example, collagen could be used instead of polymer, and polylysine or type 2 collagen with a cross-linking agent could be used instead of hydrogel. Therefore, it will be appreciated that the scope of the present invention fully encompasses other embodiments which may become obvious to those skilled in the art, and that the scope of the present invention is accordingly to be limited by nothing other than the appended claims, in which reference to an element in the singular is not intended to mean "one and only one" unless explicitly so stated, but rather "one or more." All structural, chemical, and functional equivalents to the elements of the above-described preferred embodiment that are known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the present claims. Moreover, it is not necessary for a device or method to address each and every problem sought to be solved by the present invention, for it to be encompassed by the present claims. Furthermore, no element, component, or method step in the present disclosure is intended to be dedicated to the public regardless of whether the element, component, or method step is explicitly recited in the claims. No claim element herein is to be construed under the provisions of 35 U.S.C. 112, sixth paragraph, unless the element is expressly recited using the phrase "means for."
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Jarome Iginla talks about his overtime goal
(Boston.com) Bruins forward Jarome Iginla talked about his overtime goal that lifted Boston over the Red Wings, 3-2. (Video by Zuri Berry, Boston.com Staff)
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