text:
every night in college
damn i wonder how i gained my freshman 15??
maybe it was the thousands of gallons of beer??
maybe it was the thousands of gallons of beer??
от headycheese 15 февруари 2006
the perfect addition to marijuana, and the second best thing to hard alcohol.
a homeless man passed out on the sidewalk
от Jefe 27 април 2005
A type of food that tastes good and is good for you.
Drink more beer. Your body will thank you for it.
от Frogbutt 30 ноември 2004
what we drink everyday after work, its gods gift to us mankind (on par with hemp)
4 quarts of double brown seems cool but 5 is always better.
от brother_number_one 27 юли 2003
My mother told me that beer is my enemy, but Jesus told me to love my enemy
Jesus > Mother
Beer > Water
Beer > Water
от SurpriseButtSecks69 15 май 2010
An beverage invented by the Ancient Egyptians 7000 B.C. It is a common misconception that Beer was first invented by the Sumarians. In fact the Egyptians began brewing beer 1000 years before the Sumarians
S: The Sumerians invented beer
C: Actually, it was the Egyptians in 7000 B.C.
C: Actually, it was the Egyptians in 7000 B.C.
от Christophercolumbus 01 февруари 2006
A potion created by the devil and consumed by man. Causes a misconstrued perception of reality and loss of short term memory. Also, makes that 300 pound fat bitch in the corner with hairy pits look like a good idea.
Devil: Want a beer, and a 300 pound fat bitch with hairy pits?
Man: Why yes, yes I do!
Man: Why yes, yes I do!
от bdawg25 04 ноември 2010


text:
How could my ex move on so fast?
Me and my girl was going out for three and half years almost four years. Our relationship wasn't perfect like most relationship but it wasn't a dull... Show More
Most Helpful Opinion
In my opinion? It looks like she's moving on fast now that you see it, but she probably decided to more or less give up on the relationship and moved on a long, long time ago.
not really...cause about 4 months ago everything was just great. we just went to Orlando in June for my Birthday and like a month later we got into a really stupid argument and that's when everything changes
There's a difference between "I think everything was great" and "everything was great." All I'm saying is that there's a very strong possibility she wasn't seeing the relationship in as good terms as you were.
You might be right but she's the type of person that would tell me but I really and trully believe that the last fight that we got into and didn't talk for months just ruin everything
What Girls Said 3
I'm in the same boat...I'm trying to figure it out too. I'm speaking from my experience that she may have been so tired of you treating her the way you were and maybe she was already checking out of the relationship before you broke up. I hope everything works out for you. Good Luck!
Feel free to read all of my posts and maybe my situation will make you feel better. :( Mine really sucks!
Yeah I mean I really love her..I would do anything to make up for what I did..its not like our relationship was awful or abusive or anything. I mean we had some really great times. I mean we just went to Orlando at universal for my birthday and that was just in June. I poured my heart out to this girl on Sat night but she just kept saying..she don't know if she has anything else to give. on Friday she said she would forgive me then Sat she changed her mind and said she has nothing left to give
She might have moved on so fast, just becasue she was hurting too and she didint want to feel or go through the pain. Becasue you guys went out for such a long time she probably does still have that feeling for you. She just moved on to distract herself from the really dealing with her heart break and pains.
yeah you might be right but.. still not sure. I was young and immature and sometime it does take longer then usual for some of us to realize certain things not just in relationship but in life in general
What Guys Said 0
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subset: commoncrawl


text:
Originally written on Fox Sports Southwest | Last updated 10/27/12
Oklahoma City general manager Sam Presti couldn't wait. The new NBA collective bargaining agreement wouldn't let him. In a bold move that several franchises shied away from in recent years, Presti traded away an Olympian who potentially might have been the most coveted free agent on the market next summer. Presti dealt Harden, along with center Cole Aldrich and forwards Daequan Cook and Lazar Hayward, to the Houston Rockets for guards Kevin Martin and Jeremy Lamb, two first round picks and a second rounder. Harden, the reigning Sixth Man of the Year, was an integral part of the Thunder's run to the Western Conference title and the NBA Finals last season. The 23-year-old former third overall pick was seen as part of Oklahoma City's long-term program alongside All-Stars Kevin Durant and Russell Westbrook, and the rapidly-improving Serge Ibaka. Instead, Harden begins his fourth season with arguably one of the worst teams in the West. The decision to move the bearded guard comes down...
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text:
Genetic Testing, Including Chromosomal Microarray (CMA) Analysis and Next-Generation Sequencing (NGS) Panels, for the Evaluation of Children with Developmental Delay/Intellectual Disability or Autism Spectrum Disorder
Effective Date December 8, 2014
Revision Date(s) 12/08/14; 12/09/13; 02/14/12
Chromosomal microarray analysis (CMA) may be considered medically necessary for diagnosing a genetic abnormality in children with apparent nonsyndromic cognitive developmental delay/intellectual disability (DD/ID) or autism spectrum disorder (ASD) according to accepted Diagnostic and Statistical Manual of Mental Disorders-IV criteria when all of the following conditions are met (see Policy Guidelines for definitions):
Chromosomal microarray analysis is considered investigational in all other cases of suspected genetic abnormality in children with developmental delay/intellectual disability or autism spectrum disorder.
Chromosomal microarray analysis to confirm the diagnosis of a disorder or syndrome that is routinely diagnosed based on clinical evaluation alone (see Policy Guidelines) is not medically necessary.
Panel testing using next-generation sequencing (NGS) is considered investigational in all cases of suspected genetic abnormality in children with developmental delay/intellectual disability or autism spectrum disorder
Genetic Testing for FMR1 mutations (including Fragile X Syndrome)
Chromosomal Microarray Testing for the Evaluation of Early Pregnancy Loss and Intrauterine Fetal Demise
Definitions, from the American College of Medical Genetics Guideline, Evaluation of the Newborn with Single or Multiple Congenital Anomalies (1):
In some cases of CMA analysis, the laboratory performing the test confirms all reported CNVs with an alternative technology such as FISH analysis.
Chromosomal microarray (CMA) testing has been proposed for detection of genetic imbalances in infants or children with characteristics of developmental delay/intellectual disability (DD/ID) or autism spectrum disorder (ASD). G-banded karyotyping has for many years been the standard first-line test for this purpose. G-banded karyotyping allows visualization and analysis of chromosomes for chromosomal rearrangements including genomic gains and losses. CMA analysis performs a similar, although nonvisual, analysis at a much higher resolution. As a result, CMA has the potential to increase the diagnostic yield in this population and change clinical interpretation in some cases. However, the diagnostic yield remains low in unselected populations without accompanying signs and/or symptoms. In individuals with apparent nonsyndromic DD/ID, or suspected ASD and accompanying malformations, the diagnostic yield is much higher and is higher than the yield of karyotype testing.
Children with signs of neurodevelopmental delays or disorders in the first few years of life may eventually be diagnosed with intellectual disability or autism syndromes, serious and lifelong conditions that present significant challenges to families and to public health. Cases of DD/ID and of ASD may be associated with genetic abnormalities. For children with clear, clinical symptoms and/or physiologic evidence of syndromic neurodevelopmental disorders, diagnoses are based primarily on clinical history and physical examination, and then may be confirmed with targeted genetic testing of specific genes associated with the diagnosed syndrome. However, for children who do not present with an obvious syndrome, who are too young for full expression of a suspected syndrome, or who may have an atypical presentation, genetic testing may be used as a basis for establishing a diagnosis.
Current guidelines for these patients, such as those published by the American Academy of Pediatrics (AAP) and the American Academy of Neurology (AAN), recommend cytogenetic evaluation to look for certain kinds of chromosomal abnormalities that may be causally related to their condition. AAN guidelines note that only in occasional cases will an etiologic diagnosis lead to specific therapy that improves outcomes but suggest the more immediate and general clinical benefits of achieving a specific genetic diagnosis from the clinical viewpoint, as follows (2):
AAP and AAN guidelines also emphasize the importance of early diagnosis and intervention in an attempt to ameliorate or improve behavioral and cognitive outcomes over time.
Most commonly, genetic abnormalities associated with neurodevelopmental disorders are deletions and duplications of large segments of genomic material, called copy number variants, or CNVs. For many well-described syndromes, the type and location of the chromosomal abnormality has been established with the study of a large number of cases and constitutes a genetic diagnosis; for others, only a small number of patients with similar abnormalities may exist to support a genotype-phenotype correlation. Finally, for some patients, cytogenetic analysis will discover entirely new chromosomal abnormalities that will require additional study to determine their clinical significance.
Conventional methods of cytogenetic analysis, including karyotyping (e.g., G-banded) and fluorescence in situ hybridization (FISH), have relatively low resolution and a low diagnostic yield (i.e., proportion of tested patients found to have clinically relevant genomic abnormalities), leaving most cases without identification of a chromosomal abnormality associated with the child's condition. CMA analysis is a newer cytogenetic analysis method that increases the chromosomal resolution for detection of CNVs, and, as a result, increases the genomic detail beyond that of conventional methods. CMA results are clinically informative in the same way as results derived from conventional methods, and thus CMA represents an extension of standard methods with increased resolution.
NGS has been proposed to detect single gene causes of autism and possibly identify a syndrome that involves autism in patients with normal array-based testing.
CMA Analysis to Determine Genetic Etiology
CMA analysis detects CNVs by comparing a reference genomic sequence ("normal") with the corresponding patient sequence. Each sample has a different fluorescent label so that they can be distinguished, and both are co-hybridized to a sample of a specific reference (also normal) DNA fragment of known genomic locus. If the patient sequence is missing part of the normal sequence (deletion) or has the normal sequence plus additional genomic material within that genomic location (e.g., a duplication of the same sequence), the sequence imbalance is detected as a difference in fluorescence intensity. For this reason, standard CMA (non-single nucleotide polymorphisms (SNP), see following) cannot detect balanced CNVs (equal exchange of material between chromosomes) or sequence inversions (same sequence is present in reverse base pair order) because the fluorescence intensity would not change.
CMA analysis uses thousands of cloned or synthesized DNA fragments of known genomic locus immobilized on a glass slide (microarray) to conduct thousands of comparative reactions at the same time. The prepared sample and control DNA are hybridized to the fragments on the slide, and CNVs are determined by computer analysis of the array patterns and intensities of the hybridization signals. Array resolution is limited only by the average size of the fragment used and by the chromosomal distance between loci represented by the reference DNA fragments on the slide.
There are some differences in CMA technology, most notably in the various types of microarrays. They can differ first by construction; earliest versions were used of DNA fragments cloned from bacterial artificial chromosomes. These have been largely replaced by oligonucleotide (oligos; short, synthesized DNA) arrays, which offer better reproducibility. Finally, arrays that detect hundreds of thousands of SNPs across the genome have some advantages as well. Oligo/SNP hybrid arrays have been constructed to merge the advantages of each. Regardless of the array components used, all microarrays allow the deposition of many thousands of short, DNA probe sequences on a small, solid surface in an orderly fashion. The location of each known probe sequence allows the identification of the test sequence bound to it, and when compared with a control sequence, the identification of missing sequences or sequences with extra copies (i.e., copy number variants).
Microarrays may be prepared by the laboratory utilizing the technology, or, more commonly by commercial manufacturers, and sold to laboratories that must qualify and validate the product for use in their assay, in conjunction with computerized software for interpretation. The proliferation of in-house developed and commercially available platforms prompted the American College of Medical Genetics (ACMG) to publish guidelines for the design and performance expectations for clinical microarrays and associated software in the postnatal setting.(3)
Targeted CMA analysis provides high-resolution coverage of the genome primarily in areas containing known, clinically significant CNVs. The ACMG guideline for designing microarrays recommends probe enrichment in clinically significant areas of the genome to maximize detection of known abnormalities but also recommends against the use of targeted arrays in the postnatal setting. Rather, a broad genomic screen is recommended to identify atypical, complex, or completely new rearrangements, and to accurately delineate breakpoints.
Whole-genome CMA analysis has allowed the characterization of several new genetic syndromes, with other potential candidates currently under study. However, the whole-genome arrays also have the disadvantage of potentially high numbers of apparent false-positive results, because benign CNVs are also found in phenotypically normal populations; both benign and pathogenic CNVs are continuously cataloged and to some extent made available in public reference databases to aid in clinical interpretation. Additionally, some new CNVs are neither known to be benign nor causal; these CNVs may require detailed family history and family genetic testing to determine clinical significance and/or may require confirmation by subsequent accumulation of similar cases and so, for a time, may be considered a CNV of undetermined significance (some may eventually be confirmed true positives or causal, others false positives or benign).
To determine clinical relevance (consistent association with a disease) of CNV findings, the following actions are taken:
ACMG has also published guidelines for the interpretation and reporting of CNVs in the postnatal setting, to promote consistency among laboratories and CMA results. (11) Three categories of clinical significance are recommended for reporting: pathogenic, benign, and uncertain clinical significance.
In 2008, the International Standards for Cytogenomic Arrays (ISCA) Consortium was organized (Available online at: https://www.iscaconsortium.org/index.php); it has established a public database containing de-identified whole genome microarray data from a subset of the ISCA Consortium member clinical diagnostic laboratories. Array analysis was carried out on subjects with phenotypes including intellectual disability, autism, and developmental delay. As of November 2011, there were over 28,500 total cases in the database. Additional members are planning to contribute data; participating members use an opt-out, rather than an opt-in approach that was approved by the National Institutes of Health (NIH) and participating center institutional review boards. The database is held at the National Center for Biotechnology Information/NIH and curated by a committee of clinical genetics laboratory experts.
A 2012 update from the ISCA summarizes their experience as a model for ongoing efforts to incorporate phenotypic data with genotypic data to improve the quality of research and clinical care in genetics. (12)
Use of the database includes an intralaboratory curation process, whereby laboratories are alerted to any inconsistencies among their own reported CNVs or other mutations, as well as any not consistent with the ISCA "known" pathogenic and "known" benign lists. The intralaboratory conflict rate was initially about 3% overall; following release of the first ISCA curated track, the intralaboratory conflict rate decreased to about 1.5%. A planned interlaboratory curation process, whereby a group of experts curates reported CNVs/mutations across laboratories, is currently in progress.
The Consortium recently proposed "an evidence-based approach to guide the development of content on chromosomal microarrays and to support interpretation of clinically significant copy number variation." The proposal defines levels of evidence (from the literature and/or the ISCA and other public databases) that describe how well or how poorly detected mutations or CNVs are correlated with phenotype. The consortium will apparently coordinate a volunteer effort to describe the evidence for targeted regions across the genome.
The consortium is also developing vendor-neutral recommendations for standards for the design, resolution, and content of cytogenomic arrays using an evidence-based process and an international panel of experts in clinical genetics, clinical laboratory genetics, genomics, and bioinformatics.
Commercially Available Tests
Chromosomal Microarray
CMA testing is commercially available through many laboratories, and includes targeted and whole genome arrays, with or without SNP microarray analysis.
Next-Generation Sequencing
Emory Genetics Laboratory offers a NGS ASD panel of 61 genes that target genetic syndromes that include autism or autistic features. These genes have been associated with nonsyndromic autism and genes associated with conditions involved in the differential diagnosis of Rett syndrome and/or Angelman syndrome. The panel is offered as tier 2 testing after tier 1 cytogenetics, molecular and biochemical testing which includes array testing, fragile X CGG repeat analysis and biochemical testing for some metabolic conditions.
Greenwood Genetics Center offers a NGS panel that includes 62 genes and flanking introns. The panel includes autosomal and X-linked genes that represent the most common single gene etiologies associated with a syndrome that includes autism as a significant clinical feature. The test is offered as an option for patients with syndromal autism and normal cytogenetic/array-based testing, or as a second tier test for patients with a phenotype that resembles Rett or Angelman syndrome.
Both the Emory and Greenwood Genetics panels use RainDance technology, and the Greenwood Lab panel was developed jointly with Emory.
The Department of Genetics and Genomic Sciences at the Mount Sinai School of Medicine offers a 30-gene sequencing panel.
Regulatory Status
CMA analysis and NGS are commercially available from several laboratories as laboratory-developed tests. Laboratory-developed tests performed by laboratories licensed for high complexity testing under the Clinical Laboratory Improvement Amendments do not require U.S. Food and Drug Administration (FDA) clearance for marketing.
At a meeting hosted by FDA in July 2010, FDA indicated that the Agency will in the future require microarray manufacturers to seek clearance to sell their products for use in clinical cytogenetics.
On January 17, 2014, FDA cleared for marketing the Affymetrix CytoScan® Dx Assay. FDA reviewed the Affymetrix CytoScan Dx Assay through its de novo classification process. For the de novo petition, FDA's review of the CytoScan Dx Assay included an analytic evaluation of the test's ability to accurately detect numerous chromosomal variations of different types, sizes, and genome locations when compared with several analytically validated test methods. FDA found that the CytoScan Dx Assay could analyze a patient's entire genome and adequately detect chromosome variations in regions of the genome associated with intellectual and developmental disabilities.
Medical policies are systematically developed guidelines that serve as a resource for Company staff when determining coverage for specific medical procedures, drugs or devices. Coverage for medical services is subject to the limits and conditions of the member benefit plan. Members and their providers should consult the member benefit booklet or contact a customer service representative to determine whether there are any benefit limitations applicable to this service or supply. This medical policy does not apply to Medicare Advantage.
This policy was created in 2010, and has been updated regularly with a search of the MEDLINE literature, with the most recent search through March 2, 2014.
This policy is based on a TEC Special Report on array comparative genomic hybridization (aCGH). (13) Since that Report was written, the technology has rapidly increased in resolution, and chromosomal microarray (CMA) has become the term of general use to accommodate all variations in the technology. Increased resolution arrays have been quickly translated to clinical services with a resulting increase in diagnostic yield, but also an increase in the potential for results of undetermined significance. Surveys conducted 2 to 3 years ago indicated that there is a lack of consensus between laboratories in the interpretation and reporting of copy number variants (CNVs), particularly those that are challenging. (14) The International Standards for Cytogenomic Arrays (ISCA) database now offers increased standardization and classification of CNVs that have been previously reported and should improve consensus in reporting.
Diagnosis of Developmental Delay/Intellectual Disability or Autism Spectrum Disorder
The diagnosis of developmental delay (DD) is reserved for children younger than age five years who have significant delay in two or more of the following developmental domains: gross or fine motor, speech/language, cognitive, social/personal, and activities of daily living. (15) The diagnosis implies DD that may be significant and may predict life-long disability, although not all children diagnosed with DD will later be diagnosed with intellectual disability (ID).
ID is a life-long disability diagnosed at or after age 5 years when intelligence quotient (IQ) testing is considered valid and reliable. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, defines patients with ID as having an IQ less than 70, onset during childhood, and dysfunction or impairment in more than two of areas of adaptive behavior or systems of support.
According to the DSM-IV, pervasive developmental disorders (PDD) encompass five conditions: autistic disorder, Asperger disorder, pervasive developmental disorder‒not otherwise specified (PDD-NOS), childhood disintegrative disorder, and Rett syndrome. While the term autism spectrum disorder (ASD) is not mentioned in the DSM-IV, it is now accepted to include the first three in this list. However, ASD, PDD, and autism are often used interchangeably. (16) These conditions are characterized by varying degrees of restrictions in communication and social interaction, and atypical behaviors.
Some children present with features of both DD/ID and of autism. For example, Yeargin-Allsopp et al. (17) reported that nearly 70% of children with a validated diagnosis of ASD, sampled from five metropolitan Atlanta counties, had cognitive impairment. The evaluation pathway depends on the pediatrician, consulting specialists, and their consensus on the primary neurodevelopmental diagnosis.
Review of Evidence
Chromosomal Microarray
Several studies (see Appendix B13) have conducted CMA analysis on samples with known chromosomal abnormalities by standard karyotyping. In general, currently available CMA clinical services achieve near 100% sensitivity for known chromosomal abnormalities. False-positive rates (i.e., CNVs of undetermined clinical significance) on known normal samples were inconsistently reported and could not be summarized. One study evaluated the analytic validity of an oligo array and reported 99% sensitivity and 99% specificity, with a resolution of 300 to 500 kilobases (Kb) for 10 selected cases with different known chromosomal abnormalities. (18)
Several studies reported the diagnostic yield of CMA analysis in DD/ID or ASD patients with normal standard karyotype and in several cases normal FMR1 gene analysis and/or subtelomere FISH screening (see Appendix C in (13)). Overall, diagnostic yield ranged from 5% to 16.7% in DD/ID patients and from 3.4%to 11.6% in patients with ASD; for this compilation, studies differed considerably in array resolution and in patient selection criteria. This compares well with a synthesis of studies recently published by the ISCA Consortium, reporting an average diagnostic yield of 12.2% across 33 studies. (7) Hochstenback et al. reported a CMA diagnostic yield of 19% for 36,325 DD/ID cytogenetic referrals in the Netherlands (19); and Shen et al. reported a 7% diagnostic yield among 933 ASD referrals. (20) Cooper et al. studied CMA analyses from over 15,000 individuals with DD/ID, ASD, and/or various congenital abnormalities and compared them with CMA analyses from over 8,000 unaffected controls, finding a significant excess of large CNVs among cases compared with controls. (21) Using a common cutoff for CNV size, about 26% of cases had a CNV larger than 400 kb compared with about 12% of controls, suggesting that CNVs of this size account for approximately 14% of cases. CNVs larger than 400 kb were also significantly more common among cases with multiple congenital abnormalities.
Since the introduction of CMA analysis in about 2005, 18 new genomic disorders have been described, more than doubling the number of disorders described in the previous 20 years. (22) Using CMA in place of conventional cytogenetic testing would have missed 0.6% to 0.8% of all cases, i.e., those with balanced translocations. (19, 23)
A portion of the increased diagnostic yield from CMA analysis comes from the discovery that some chromosomal rearrangements that appear balanced (and therefore not pathogenic) by G-banded karyotype analysis are found to have small imbalances with greater resolution. It has been estimated that 40% of apparently balanced de novo or inherited translocations with abnormal phenotype are associated with cryptic deletion if analyzed by CMA. (24) This contradicts earlier assumptions about inherited, apparently balanced rearrangements and shows that microarray analysis can allow for a less subjective and more accurate interpretation of an abnormal banding pattern. (25)
Neither standard cytogenetic nor CMA analysis have been systematically studied for impact on clinical outcomes other than diagnosis (26, 27); Schaefer and Mendelsohn (28) acknowledge, for example, that a genetic diagnosis "typically will not change interventions for the [autism] patient." Rather, clinical utility of genetic testing is primarily inferred based on the value of diagnosis to the family, estimation of recurrence risk, and on the importance of early detection and early intervention. (27) Two studies indirectly addressed clinical outcomes other than diagnosis as a result of CMA analysis.
Saam et al. (29) interviewed 14 physicians (two neurologists, 12 medical geneticists) regarding management changes as a result of positive CMA test results from the University of Utah Cytogenetics Laboratory for 48 patients with DD or ID and normal karyotypes. Only 29% of patients had no management changes reported. For significant proportions of patients, the diagnostic odyssey was ended. However, this study was only a survey and did not attempt to quantitate the diagnostic tests avoided. Saam et al. (29) also reported that 14.6% of patients with genetic diagnoses were referred to medical specialists, and 25% had improved access to insurance and educational services, but the study did not assess the benefits of specialist referrals or screening for comorbidities on patient outcomes, or describe and quantitate the improvement in access to community services.
Coulter et al. identified and reviewed, over the course of 1 year, the medical records of all patients at a tertiary children's hospital who had CMA results showing an abnormal variant or a variant of possible significance. (30) A board-certified medical geneticist reviewed the clinical notes from the ordering provider and abstracted recommendations for clinical actions (a specialist referral, imaging study, diagnostic test, or medication prescription) made specifically as a result of the CMA result. Of 1,792 patients for whom CMA was ordered during the year reviewed, 131 had an abnormal variant and 104 had a variant of possible significance. Of these, 121 and 73 patients were included in the analysis. Overall, patients with an abnormal variant had a significantly higher rate of recommended clinical action (54%) than patients with a variant of possible significance (34%; p=0.01). Among patients with an abnormal variant and a diagnosis of DD/ID or congenital anomalies, about two-thirds of patients were referred for additional clinical action based on the CMA results, whereas referrals were made for 27% of patients with ASD and an abnormal variant. Referral rates were similar for patients with a CMA result of a variant of possible significance, with the exception of patients with congenital anomalies, who were referred for additional clinical action only 17% of the time. Patients younger than 2 years were significantly more likely to have clinical anomalies and were significantly more likely to have abnormal variants. Cases were described in which ancillary CMA results suggested clinical interventions for the present or future regarding possible co-morbid conditions. In no patients, however, were referrals linked to actual patient outcomes; the authors report that this study is ongoing.
Risk estimates for recurrence of disease in future births can be altered considerably by information from the genetic diagnosis. For example, the average sibling recurrence risk in ASD is 5%. (31) However, if the cause is a dominant single gene disorder with full penetrance and a parent is a carrier, the sibling risk is 50%. If the disorder is recessive but characteristics are otherwise the same, the sibling risk is 25%. If the cause is Fragile X, the recurrence risk in a brother is 50%, while a sister may be only mildly affected but will have a carrier risk of up to 50%. However, in the case of a de novo CNV (i.e., not carried by either parent), the sibling risk remains low, at the population average.
Knowledge of recurrence risk is expected to lead to improved future reproductive decision-making in families with children affected with DD/ID or ASD associated with specific mutations. Turner et al. (32) studied the reproductive decisions of women from 38 families characterized by male members with and a pattern consistent with chromosome X-linked transmission. Most of the women in these families spent many years knowing that they were at some risk of being carriers and of having a boy with mental retardation. Before the availability of pathogenic mutation analysis, the birth rate for these families was below average for the district (United Kingdom-New South Wales), one in 27 versus one in 11 per year, respectively. After pathogenic mutation status was determined, both carriers and non-carriers (previously thought to be at risk) of the mutation had children at the same rate, with 74% of carriers choosing prenatal genetic evaluation. While the results of this study are suggestive, they do not show that knowledge of recurrence risk directly affected reproductive decisions. Saam et al., (29) in the survey described previously, reported that recurrence risk evaluation was possible in about one-third of families after positive aCGH results but did not study the impact of recurrence risk evaluation on reproductive planning.
As noted in the Description, guidelines emphasize the importance of cytogenetic evaluation to look for certain kinds of mutations that may be linked to specific conditions for early diagnosis and intervention. However, the benefits of early intervention for these disorders are uncertain. Few randomized trials have been conducted, and the interventions differ considerably in the available studies, indicating that the field is still early in researching the critical elements of effective early intervention. For well-characterized genetic syndromes, it may be important to incorporate monitoring for comorbidities known to be associated with the condition. For example, 22q11 microdeletion syndrome (includes diGeorge and velo-cardio-facial syndromes) is associated with development of hearing impairment in a significant proportion of patients and subsequent delayed speech. (33) Velo-cardio-facial syndrome is also associated with heart defects. (31) Klinefelter syndrome may first be detected as developmental delay in early childhood; androgen treatment is an important component of therapy. (31) CMA analysis may also predict future conditions for which interventions are possible. In a report of 3 cases, one patient had a chromosomal deletion that included a gene associated with autosomal dominant Peutz-Jeghers syndrome (PJS); tumor screening protocols for males with PJS generally begin with upper and lower endoscopy with small-bowel follow-through radiographs beginning at age 8 years. (34) Two other patients had a de novo deletion of chromosome 17p encompassing the TP53 tumor suppressor gene responsible for Li-Fraumeni syndrome (LFS); tumor screening protocols for LFS also begin in childhood. In another report, a child presenting to a neurology service with unusual behaviors was found to have a deletion that included exons of the DMD gene associated with Becker muscular dystrophy (BMD). Additional testing revealed a markedly elevated creatine kinase, and a thorough physical exam was consistent with BMD. This diagnosis explained some of the child's behavior and prompted a plan for future surveillance for cardiac and other complications of BMD, as well as carrier testing and surveillance of the child's mother. (30)
Ellison et al. reported on the clinical utility of CMA in a total of 46,298 postnatal patients. (35) Testing was for a variety of indications, including DD/ID, congenital anomalies, dysmorphic features and neurobehavioral problems. The authors tallied the detection of abnormalities associated with actionable clinical features (i.e., diagnoses which would likely lead to changes in clinical management). A total of 2,088 diagnoses were made of 118 clinically actionable disorders; of these, it was estimated that 94% would likely have been missed by routine karyotyping. Examples of clinically actionable responses to the diagnoses included an electrocardiogram and cardiology referral for those at risk for long QT syndrome, glucose monitoring and endocrine referral for those at increased risk of diabetes, renal ultrasound for those at risk for renal pathology, and platelet count monitoring for those at risk for thrombocytopenia. A subset of cases was monitored for physician response to the microarray finding, and appropriate clinical action was taken more than 90% of the time.
Next-Generation Sequencing
Analytic Validity
Analytic validity is the technical accuracy of the test in detecting a mutation that is present or in excluding a mutation that is absent.
No peer-reviewed, full-length publications on the analytic validity of the commercially available next-generation sequencing (NGS) ASD panels are identified.
Clinical Validity
Clinical validity is the diagnostic performance of the test (sensitivity, specificity, and positive and negative predictive values) in detecting clinical disease.
No peer-reviewed, full-length publications on the clinical validity of the commercially available NGS ASD panels are identified. According to 1 laboratory's website, this type of sequencing will pick up more than 97% of DNA mutations at the level of a few base pairs, but that for most genes on the panel, the clinical sensitivity of the assay cannot be estimated individually, because each gene is a rare cause of ASD. (36)
Clinical Utility
Clinical utility is how the results of the diagnostic test will be used to change management of the patient and whether these changes in management lead to clinically important improvements in health outcomes.
No peer-reviewed, full-length publications on the clinical utility of the commercially available NGS ASD panels are identified. Importantly, no published data on the rate of variants of unknown significance using NGS panels for autism have been identified.
Clinical Input Received from Physician Specialty Societies and Academic Medical Centers
While the various physician specialty societies and academic medical centers may collaborate with and make recommendations during this process through the provision of appropriate reviewers, input received does not represent an endorsement or position statement by the physician specialty societies or academic medical centers, unless otherwise noted. In response to requests, clinical input was received through 3 physician specialty societies and 2 academic medical centers while this policy was under review in early 2010. Those providing input supported use of targeted CMA analysis in children with DD/ID or ASD in several situations. There was less support for whole-genome array testing. However, targeted array testing is now primarily available for prenatal analysis, whereas whole-genome arrays are recommended as standard.
In 2011, clinical input was obtained with emphasis on the clinical utility of CMA testing. As in 2010, reviewers supported the use of CMA testing for the diagnosis in patients with development disorders and autism spectrum disorder. Reviewers acknowledged the lack of evidence in the literature on clinical utility, such as the lack of literature demonstrating improved outcomes as a result of testing. Reviewers cited multiple anecdotal and theoretical clinical situations in which management changes resulted from results of CMA testing. Reviewers also agreed that this test was widely used in standard care with the support of the genetics community.
Summary of Evidence
Chromosomal microarray analysis
Chromosomal microarray (CMA) testing has been proposed for detection of genetic imbalances in infants or children with characteristics of developmental delay/intellectual disability (DD/ID) or autism spectrum disorder (ASD). G-banded karyotyping has for many years been the standard first-line test for this purpose. G-banded karyotyping allows visualization and analysis of chromosomes for chromosomal rearrangements including genomic gains and losses. CMA analysis performs a similar, although nonvisual, analysis at a much higher resolution. As a result, CMA has the potential to increase the diagnostic yield in this population and change clinical interpretation in some cases. However, the diagnostic yield remains low in unselected populations without accompanying signs and/or symptoms. In individuals with apparent nonsyndromic DD/ID, or suspected ASD and accompanying malformations, the diagnostic yield is much higher and is higher than the yield of karyotype testing.
Evidence on the clinical benefit of CMA testing is largely anecdotal. Cases have been documented in which the information derived from testing ends a long diagnostic odyssey, aids in planning for surveillance or management of associated comorbidities, and assists in future reproductive decision making. While systematic studies of the impact of CMA analysis on patient outcomes is lacking, the improvement in diagnostic yield has been well-demonstrated, and feedback from physician specialty societies, academic medical centers, and in respected guidelines is consistent in supporting the clinical benefit of CMA testing for defined populations. As a result, CMA may be considered medically necessary in individuals with developmental delay or ASDs who meet the clinical criteria defined the policy statement.
Next-Generation Sequencing Panels
Next-generation sequencing (NGS) panel testing allows for simultaneous analysis of a large number of genes and has been proposed as a way to identify single gene causes of syndromes that have autism as a significant clinical feature, in patients with normal CMA testing.
Published data on analytic and clinical validity, clinical utility and variants of unknown significance using NGS panels in this setting are lacking, and therefore, panel testing using NGS is considered investigational in all cases of suspected genetic abnormality in children with DD/ID or ASD.
Practice Guidelines and Position Statements
The American Academy of Neurology and the Practice Committee of the Child Neurology Society updated their guideline regarding the evaluation of unexplained global DD/ID with information on genetic and metabolic (biochemical) testing in order to accommodate advances in the field. (2) The guidelines conclude that CMA testing has the highest diagnostic yield in children with DD/ID, that the often complex results require confirmation and careful interpretation, often with the assistance of a medical geneticist and that CMA should be considered the first-line test. The guidelines acknowledge that "Research is sorely lacking on the medical, social, and financial benefits of having an accurate etiologic diagnosis."
The American College of Medical Genetics (ACMG) published guidelines on array-based technologies and their clinical utilization for detecting chromosomal abnormalities. (37) Chromosomal microarray testing for copy number variation is recommended as a first-line test in the initial postnatal evaluation of individuals with the following:
ACMG also recommends against use of CMA in cases of multiple miscarriages.
Additional ACMG guidelines have been published for the design and performance expectations for clinical microarrays and associated software (3) and for the interpretation and reporting of CNVs, (11) both intended for the postnatal setting. A 2013 update includes recommendations for validation of microarray methodologies for both prenatal and postnatal specimens. (38)
The International Standard Cytogenomic Array Consortium published a Consensus Statement in which they recommend offering CMA as the first-tier genetic test, in place of G-banded karyotype, for patients with unexplained DD/ID, ASD, or multiple congenital anomalies (MCA). "Except in special cases, such as those involving family history of multiple miscarriages, a karyotype is not cost effective in a child with DD/ID, ASD, or MCA and a negative array study. CMA testing is not inexpensive, but the cost is less than the cost of a G-banded karyotype plus a customized FISH test such as subtelomeric FISH, and the yield is greater." (7)
A 2013 guidelines update from the ACMG states that a stepwise or tiered approach to the clinical genetic diagnostic evaluation of autism spectrum disorder is recommended, with the recommendation being for first-tier to include fragile X syndrome and CMA, and second tier to include MECP2 and PTEN testing.39 The guideline states that
"this approach will evolve with continued advancements in diagnostic testing and improved understanding of the ASD phenotype. Multiple additional conditions have been reported in association with an ASD phenotype, but none of these has been evaluated in a large prospective cohort. Therefore, a future third tier of evaluation is a distinct possibility. Further studies would be needed to elevate the evidence to the point of recommended testing. Alternatively, advances in technology may permit bundling of individual tests into an extended, more readily accessible, and less expensive platform". The accumulating evidence using next-generation sequencing (third tier testing) "will increase the diagnostic yield even more over the next few years."
Medicare National Coverage
There is no national coverage determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of local Medicare carriers.
Cytogenetic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (e.g., Bacterial Artificial Chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis)
Cytogenetic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities
Comparative genomic hybridization (CGH) microarray testing for developmental delay, autism spectrum disorder and/or mental retardation
Type of Service
Place of Service
Add to Pathology/Laboratory section. - New Policy. Published on 2/1/11 following 90-hold for provider notification.
Replace Policy – Policy updated with literature search; references 1, 2, 6, 10, 19, 20, 24, 29, 30, 33, 35 added. Term "array comparative genomic hybridization (aCGH)" changed to "chromosomal microarray (CMA) analysis" in title, policy statements, and text. Policy statements changed to medically necessary for infants and children with developmental delay, intellectual disability, or autism spectrum disorder under certain conditions; investigational for all other indications. Modified statement about specific types of genetic counselors to a more general description and the term "mental retardation" changed to "intellectual disability" throughout and in the title.
Policy renumbered to 12.04.59 (previously 2.04.59) and reassigned to new Genetic Testing category.
Update Related Policies – Add 12.04.83.
Coding update. CPT codes 83890 – 83913 deleted as of 12/31/12; CPT codes 81200 – 81479 and 81599, effective 1/1/13, are added to the policy.
Update Related Policies. Add 12.04.91.
Update Related Policies. Add 12.04.305.
Replace policy. Policy updated with literature search; references 11, 35, 37, 38 and 40 added. No change in policy statements. CPT codes 81200-81479, 81599, and 88384-88386 removed as they are not specific to this policy; 83890-83913 removed because they are now deleted.
Update Related Policies. Remove 12.04.91.
Annual Review. Policy statement added that NGS panel testing is considered investigational in all cases of suspected genetic abnormality in children with developmental delay/intellectual disability or autism spectrum disorder. Title changed to include NGS. No change to postnatal policy statements. Prenatal testing removed from this policy and added to new policy on Invasive Prenatal (Fetal) Diagnostic Testing. Remove ICD-9 and ICD-10 diagnosis codes; these are not utilized in adjudication of the policy.
Update Related Policies. Add 12.04.116 and 12.04.122.
Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The Company adopts policies after careful review of published peer-reviewed scientific literature, national guidelines and local standards of practice. Since medical technology is constantly changing, the Company reserves the right to review and update policies as appropriate. Member contracts differ in their benefits. Always consult the member benefit booklet or contact a member service representative to determine coverage for a specific medical service or supply. CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA).


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Coffee and conversation , Gardening/Landscaping , Hobbies and crafts , Movies/Videos , Museums and art , Music and concerts , Performing arts , Travel/Sightseeing , Volunteering
Other types of exercise, Swimming, Walking / Hiking, Weights / Machines
I exercise 3-4 times per week.
Don't display my sign
I like Cats, Dogs, Fish, Horses
Catalina, the Sequoias, Amsterdam, London, Washington D.C. (museums!), Sedona, anywhere with good chocolate (dark). A good book.
making pancakes, van Gogh, Picasso, Dali, spicy food, the air after it rains, sea lions, biographies, Santana, Tony Bennett, Simply Red, David Bowie, The Beatles, John Donne, Emily Dickinson, the Coen brothers, TED, dark chocolate and red wine.
scuba diving, snorkeling, walking in torrey pines, going to the movies, watching dvds, prowling tiny bookstores (so few left) for mystery novels, people watching, writing things in all lower-case letters
The Forever War, New York Times, Slate, Pygmalion, the wrapper on a piece of dark chocolate.
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What he is looking for
|5'10" (177cms)
|5'0" (152cms) to 6'0" (182cms)
|Body type:
|About average
|Slender, About average, Curvy, Athletic and toned
|Black, Blue, Brown, Grey, Green, Hazel
|Dark brown
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|Social Drinker
|Never, Social Drinker
|Technical / Science / Computers / Engineering
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|Widow / Widower, Divorced
|Have kids:
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|Yes, and they sometimes live at home, Yes, and they live at home
|Wants kids:
|No, but it's OK if my partner has kids
|No, No, but it's OK if my partner has kids
|White / Caucasian
|Asian, Middle Eastern, White / Caucasian
My heritage requires that I consume dark chocolate whenever the opportunity arises.
|Spiritual but not religious
|No preference
... which means, by definition, I am spiritual, not religious too. Or not. It's a Zen thing.
|Dutch, English
|Graduate degree
|Bachelors degree, Graduate degree, PhD / Post Doctoral
I am an engineer and I have an MBA. I have done post-graduate studies of chocolate and red wine.


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In This Section
Journal Forum
Audibility of a CD-Standard A/DA/A Loop Inserted into High-Resolution Audio Playback - September 2007
13 comments
Sound Board: Food for Thought, Aesthetics in Orchestra Recording - April 2015
2 comments
Reflecting on Reflections - June 2014
4 comments
AES Journal Forum
Spatial Impulse Response Rendering II: Reproduction of Diffuse Sound and Listening Tests
Spatial impulse response rendering (SIRR) is a method for reproducing room impulse responses over multichannel loudspeaker setups. The applied analysis and synthesis methods were introduced in a companion paper. Time–frequency analysis is used to obtain directional and diffuseness information from the recorded sound field. Nondiffuse sound is then reproduced as pointlike virtual sources, and diffuse sound is synthesized with a decorrelation technique. The proposed synthesis methods for diffuse sound are examined in more detail and a hybrid method is derived. The relationship between diffuseness and interaural coherence is also studied. In addition, results of two listening tests are presented. It is shown that with a large loudspeaker setup under anechoic conditions, SIRR reproduction is at best indistinguishable from the original sample. Furthermore, in a listening test conducted in a standard listening room with real measured responses, SIRR reproduction is evaluated as the most natural one of the systems studied.
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They are going ahead with a Justice League movie
View Single Post
September 22 2012, 01:51 AM
Nerys Myk
Fleet Admiral
Location: A boat on a river
Re: They are going ahead with a Justice League movie
CorporalCaptain wrote:
Here's what the wiki has to say on the subject [
Because Siegel and Shuster were both Jewish, some religious commentators and pop-culture scholars such as Rabbi Simcha Weinstein and British novelist Howard Jacobson suggest that Superman's creation was partly influenced by Moses,[48][49] and other Jewish elements. More recently, this interpretation has been endorsed by biographer Larry Tye.[50] For example, Superman's Kryptonian name, "Kal-El", resembles the Hebrew words קל-אל, which can be taken to mean "voice of God".[51] The suffix "el", meaning "(of) God," is also found in the name of angels (e.g. Gabriel, Ariel), who are flying humanoid agents of good with superhuman powers. Tye suggests that this "Voice of God" is an allusion to Moses' role as a prophet.[50] Moreover, Kal-El's parents send him away in a vessel, delivering him to new adoptive parents in an alien culture in order to save him from impending doom, just as Moses' parents do.[50] "The narratives of Krypton's birth and death borrowed the language of Genesis."[50]
On the other hand, Superman has been seen by others as being an analogy for Jesus, being a savior of humanity.[41][49][50][52][53] Furthermore, the surname Kent, in early 20th century real life, was a common Americanization of "Cohen," and Clark Kent's wimpy, bumbling persona strongly resembled the classic Yiddish schlemiel.
Never heard of the Kent/Cohen connection before. Interesting.
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Eating Out
Party hosting help!
I need some help from you awesome serious eaters. I'd like to host a surprise party for my father's 60th birthday coming up in a few months, but don't know where to begin to look for restaurants. I would like to stay out of the city and in either Brooklyn or Queens. It's going to be between 50 and 60 people. And I'd really like to stay below $4,000, all inclusive.
I'm completely drawing a blank! My dad's always been a very adventurous eater but some of my family is not. But he IS a big foody. So basically the requirements are, seat up to 60 people, less than $4k, and must have AWESOME food. Any ideas for me?
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Originally written on Fox Sports West | Last updated 2/13/13
TEMPE, Ariz. -- An MRI test has showed mild inflammation but no significant damage to Ryan Madson's surgically repaired elbow, a huge relief for the Angels reliever. However, Madson will not resume throwing for at least another week, and he is expected to open the regular season on the disabled list. "I was pointing toward the season opener, and I think that maybe got me into a little bit of trouble," said Madson, the former Philadelphia Phillies closer who missed the 2012 season because of Tommy John surgery. "Now, I don't have a set date in mind. I'm just going to listen to the trainers and let my arm do its thing." Madson had thrown off a mound four times before being shut down because of elbow soreness after a Feb. 1 bullpen session in Anaheim. He will spend at least a week strengthening his arm and will be reevaluated before resuming his throwing program. "I'm not disappointed that I have to wait another week to throw," Madson said. "This gives me peace of mind. It's just a...
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2K47 coming soon…
Tag Archives: Carl
Chatterbox drops in June.
The homie Netherfriends drops his latest EP.
4Kings EP is dropping soon..
Carl of Hurt Everybody drops an EP!
Hurt Everybody's next EP drops early 2015.
Hurt Everybody's next project "4Kings" drops Jan 4th.
Two dope releases from Hurt Everybody
Some new Hurt Everybody and Chandler London over a Mulatto Beats production.
The Chicago collective continues to grind and put out singles following the release of their debut project.
Hurt Everybody EP drops July 4th!
Three Chicago upstarts giving you a lyrical dose of DOPEness.
SolarFive and Everybody on an OnGaud production.
Two songs for one, we'll take that!
The force is strong with this one!
Jarred A.G.'s CANVAS project dropping soon!


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text:
|Table of Contents
|Vol. 47, No. 2, 2014
Issue release date: March 2014
|Section title: Short Report
Self-Perceived Stigmatization in Female Patients with Anorexia Nervosa - Results from an Explorative Retrospective Pilot Study of AdolescentsMaier A.a · Ernst J.-P.a · Müller S.c · Gross D.a · Zepf F.D.b,d,e · Herpertz-Dahlmann B.b · Hagenah U.b
aInstitute of History, Theory and Ethics in Medicine, and bDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Aachen, RWTH Aachen University, Aachen, cDepartment of Psychiatry and Psychotherapy, Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Berlin, dInstitute for Neuroscience and Medicine, Jülich Research Centre, Jülich, and eJARA Translational Brain Medicine, Aachen and Jülich, Germany
Received: 12/12/2012 12:13:00 PM
Accepted: 3/6/2013
Published online: 7/5/2013
Issue release date: March 2014
Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 0
ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)
For additional information: http://www.karger.com/PSP
Background: The stigma of mental illness has been identified as an important barrier to treatment and recovery. Previous research reported the stigmatization of individuals with eating disorders by both health professionals and the general public. The aim of this pilot study was to empirically assess the previous stigmatization and discrimination experiences of young female patients with anorexia nervosa (AN) using a retrospective explorative approach. Methods: An in-house questionnaire that was developed to survey experiences of stigmatization was mailed to 75 former adolescent patients with AN. The mean time of assessment after discharge was 5.6 ± 1.2 years. The patients were asked to respond anonymously. The response rate was approximately 48% (n = 36). Results: Feelings that society held negative stereotypes of individuals with AN, concrete experiences of stigmatization and discrimination, and rejection by peers were reported. A remarkable degree of self-stigmatization, as indexed by high rates of agreement to stigmatizing statements, was detected. Approximately one third of the participants reported delayed initiation of treatment due to fear of stigmatization and discrimination. Conclusion: Stigmatization plays a decisive role in young patients with AN and impacts their motivation to seek professional help and engage in treatment. Clinicians should be aware of the stigmatization related to eating disorders and its burden for affected patients.
© 2013 S. Karger AG, Basel
Dr. J.-P. Ernst
Institute of History, Theory and Ethics in Medicine
RWTH Aachen University
Wendlingweg 2, DE-52074 Aachen (Germany)
E-Mail email@example.com
A. Maier and J.-P. Ernst contributed equally to this work.
Received: December 12, 2012
Accepted after revision: March 6, 2013
Published online: July 5, 2013
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 0, Number of References : 33
Additional supplementary material is available online - Number of Parts : 1
Psychopathology (International Journal of Descriptive and Experimental Psychopathology, Phenomenology and Psychiatric Diagnosis)
Vol. 47, No. 2, Year 2014 (Cover Date: March 2014)
Journal Editor: Herpertz S.C. (Heidelberg), Fuchs T. (Heidelberg)
ISSN: 0254-4962 (Print), eISSN: 1423-033X (Online)
For additional information: http://www.karger.com/PSP
Received: 12/12/2012 12:13:00 PM
Accepted: 3/6/2013
Published online: 7/5/2013
Issue release date: March 2014
Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 0
ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)
For additional information: http://www.karger.com/PSP


text:
Juan Miro
Distinguished Teaching Professor, School of Architecture
- E-mail: email@example.com
- Phone: 512.471.0182
- Office: GOL 4.116
LAS 381 • Mexican Architectural History
40420 •
Spring 2012
show description
M 630pm-930pm SUT 2.102
A survey of Mexican architecture from its origins in pre-Columbian times to the 21st century.
Objectives: This course is devoted to the study of Mexican architecture and place making. Architecture will be understood as a cultural expression intricately connected to its historical context and the landscape that supports it. Mexican Architecture is recognized worldwide as a cultural expression with distinctive and significant contributions to the global realm of architecture. What are those contributions? This course doesn't aim to cover exhaustively Mexican architecture. The objective is to present the most interesting contributions of Mexican architecture to the world of architecture in general, focusing on the most significant ideas, places and architects that have shaped Mexican architecture and urbanism during the pre-Columbian and Colonial periods, and all the way to the 21st century.


text:
Photo by Michael Graydon + Nikole Herriott
YIELD: Makes about 1 3/4 cups (about 10 servings)
ACTIVE TIME: 10 minutes
TOTAL TIME: 10 minutes
Cook garlic in a medium saucepan of boiling salted water until slightly softened, about 30 seconds. Using a slotted spoon, transfer garlic to a bowl of ice water; let cool.
Return water in saucepan to a boil. Cook watercress, mint, and parsley just until wilted, about 15 seconds; drain. Transfer watercress and herbs to ice water; let cool. Drain watercress, herbs, and garlic and squeeze between paper towels to remove as much moisture as possible; coarsely chop.
Purée watercress, herbs, garlic, tahini, lemon juice, 1 teaspoon salt, and 3/4 cup water in a blender until smooth, thinning with more water as needed to reach desired consistency; season with salt and more lemon juice, if desired.
DO AHEAD: Sauce can be made 3 days ahead. Cover and chill. Shake before using.
Per serving: 80 calories, 6 g fat, 1 g fiber
Nutritional analysis provided by Bon Appétit


text:
Adrian Gonzalez isn't out of town yet, but he's gone from shelves around Fenway Park. A worker at the Twins souvenir shop across the street from Fenway was spotted taking down a poster of Gonzalez on Friday, likely with the expectation that the Red Sox first baseman is heading to Los Angeles. T-shirt vendors inside the stadium were also seen taking down the Gonzalez t-shirt jersey from stalls. Since nothing is official yet, we can only assume that the stores are just trying to get ahead of the curve on this one. After all, throwback jerseys are more valuable, right?...
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Including the final score.
Kentucky 24, Cincinnati 11.
It was 15 years ago today, Kentucky vs. Cincinnati in the building then known as Riverfront Coliseum. In 40 minutes of basketball, the teams attempted just 31 shots and made 15 field goals. Mostly, they dribbled and passed and stood on the court.
They set basketball back 50 years and maybe moved it forward, as well. It was a game that had a lasting effect on the sport and on the UK-UC rivalry, such as it is, and still is debated as often as any of the 467 games the Bearcats have played since.
Kentucky brought in 7-foot-1 Sam Bowie, 6-10 Melvin Turpin, 6-8 Kenny Walker and 6-7 Winston Bennett, all of whom played in the Final Four later that season and in the NBA after leaving Lexington. First-year Bearcats coach Tony Yates looked at his squad, which went on to finish 3-25, and determined the Bearcats would play a stall game
To the mods: original statement was comparing this game to reds offense so not trying to deviate off topic.


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Indian Cauliflower
3 Jun 2009
Indian Cauliflower is rich with the aroma of butter. This is the favorite for the kids at home and I am sure that your little ones too will adore this. Just give this yummy Indian Cauliflower a try.
|Light butter/Margarine
|1 Tablespoon
|Ground coriander
|1 Teaspoon
|Curry powder
|1⁄2 Teaspoon
|Ground ginger
|1⁄4 Teaspoon
|Finely chopped onion
|1⁄2 Cup (8 tbs)
|1⁄4 Cup (4 tbs)
|Cauliflower florets
|8 Cup (128 tbs)
|Cooking spray
Combine first 4 ingredients in a microwave-safe dish, and microwave at HIGH 30 seconds.
Stir in onion and ketchup, and microwave at HIGH 1 minute.
Place cauliflower in a 2 quart casserole coated with cooking spray.
Spoon onion mixture over cauliflower; toss to coat.
Cover and microwave at HIGH 9 minutes, rotating dish a half-turn after 4 minutes.
Rate It
0 Comments
Indian Cauliflower Recipe


text:
2 arrested after being linked to death of gator in Port St. Lucie
PORT ST. LUCIE — Two men were arrested Thursday after the Florida Fish and Wildlife Conservation Commission charged them with killing a 7-foot gator, possibly with a nine iron.The two reported the gator had chased them on a golf course before they killed it, according to affidavits released Friday.
Cecil Lamon Pollock Jr., 22, and 20-year-old Bradley Warren Jones each were arrested on an illegal killing of alligator charge, while Jones was arrested on additional charges of possession of a controlled substance without a prescription, reckless drive damage person or property and fail to obey police or fire department.
A Port St. Lucie police officer early Thursday saw a vehicle pull into an undeveloped area in the area of Southeast Westmoreland Boulevard and Southeast Via Tagliamento. A person got out and dumped something on the ground before the vehicle started driving off.
The officer tried to stop the vehicle, but it started to speed up and the officer lost sight of it. The officer found it had crashed near Southeast Treasure Island Road and Southeast San Jeronimo Road.
Jones, of the 3000 block of Southeast Overbrook Drive in Port St. Lucie, said they'd dumped an alligator.
"He said that the gator chased them on the golf course and they went back and killed it," an affidavit states.
Pollock, of the 8700 block of Southwest Fox Brown Road in Indiantown, said he killed the alligator and cut off the tail.
Jones had two Xanax pills for which he said he did not have a prescription.
Police notified the Florida Fish and Wildlife Conservation Commission.
An officer from that agency appears to have arrested Jones and Pollock on the illegal killing of alligator charge.
A report of the incident from Port St. Lucie police was not available Friday.
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Originally written on The 6th Sens | Last updated 2/21/13
That black cloud hanging over the Ottawa Senators season has nothing to do with mounting injuries. Nor is it the possibility that this could be Daniel Alfredsson's last with the Senators. No, the real cause for concern is the likelihood that Craig Anderson's numbers should regress. Of the NHL goalies who have more than one game appearance, only two goalies have even-strength and penalty-kill save percentages that are both greater than .930. One is Anderson and the other guy, Corey Crawford, plays for a team that is undefeated in regulation. Since Lockout 2 (04/05), of the goaltenders to play in more than a handful of games, only Braden Holtby (14 GP in 2010/11), Cory Schneider (33 GP in 2011/12) and Josh Harding (19 GP in 2008/09) have been able to exceed .930 marks in both save percentage thresholds. Each of these goaltenders was a backup at the time whose numbers surely benefitted from the small sample of games each played in. Given the brevity of this lockout shorte...
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quddous's Profile
|Last Reply
Monday night in March - Restaurant AG or Pirouette?
What is the difference between Pirouette and Zebulon?
(as in, food style and quality, restaurant style and price points)
So far the best options are Zomato (which recently bought Urbanspoon) and TripAdvisor. Timeout is the best magazine style website.
I visited Ravi's and though the gravy flavours were really good, the chicken meat itself was precooked/overcooked. The bread for their Qeema nan reminded me more of the Chinese Shaobing than a typical stuffed nan - Very enjoyable. Their mutton biryani and the sauce that came with it were delicious as well. I would probably go with their bbq dishes + stuffed nan + biryani on my next visit. Total bill was 75 dirhams (25usd) for two curries, biryani, stuffed nan, regular nan, raita and two drinks.
Feb 09, 2015quddous in Middle East & Africa
In case anyone wasn't sure - I am looking for recommendations in Dubai. The restaurants I listed above are the ones I found in my earlier research and have some good reviews.
I have researched some more lately.
Ravi's is recommended quite often for Pakistani food.
Other's I will read up on more are -
Jan 14, 2015quddous in Middle East & Africa
T&T and most Indian grocers carry it.
Jan 13, 2015quddous in B.C. (inc. Vancouver)
making your own vinegar mother
Raw apple cider vinegar has active mother. That is why you use it. If you have your own mother from previous vinegar making then you can just use that instead of raw apple cider vinegar. The mother converts alcohol to acetic acid.
You don't need to feed anything.
You add raw apple cider vinegar to your wine once and you leave your wine until it becomes vinegar. If you don't see mother forming in your wine after a few weeks, you can add more raw apple cider vinegar.
Jan 12, 2015quddous in Home Cooking
That is a very interesting way of cooking rice. Iranians do something similar but still very different. Thry start by cooking the rice in boiling water until 90% cooked; they will then drain the rice, wash off excess starch and cook the rice at low temperature until fully cooked.
making your own vinegar mother
Unfiltered Raw Cider Vinegar. Braggs is an example but I didn't get a mother using it the first time. I bought another brand and it worked.
You want to use a wide mouth jar, Fill with your wine then add a few tablespoons of cider vinegar, cover the top of the jar with cheesecloth and use a rubberband to secure it. Leave it in a dark room temperature area. My vinegars have taken anywhere from a few weeks to a few months to develop. Smell and taste until it tastes good to you.
My favorite vinegar so far has been a Pedro Ximenez sherry vinegar. So amazing.
Why did my polenta corn grits get watery when I added cream?
I've never had that problem. You may have just added too much liquid for the amount of grains you had. I wouldn't recommend adding more grains after the fact. Your best bet would have been to put the grits/polenta on low heat until it thickened up.
I typically make mine thicker to begin, then when serving I will heat the grits/polenta and add water slowly until I get the consistency that I want.
When making fried rice, only use the meat/vegetable ingredients, day old rice and salt. Do not add soy sauce.
kochujang + sugar + sesame oil is a delicious sauce for any quick meal.
Froze udon noodles are super quick and easy as one poster noted. Soak the noodles in warm water until pliable. Fry ingredients for udon, add udon and add soy/butter mixture. Guu (Izakay) uses a butter/soy mixture as their base for their noodles.
Nobu Miso sauce works for chicken/fish
1/4 cup sake
I like making sichuan chili oil.
My ratios are approximately
Grind the spices
I like to add a touch of sesame oil to the chili oil.
I keep the oil in my fridge - I think it preserves the flavors better.
I like making a Sichuan cold noodle dish using this chili oil.
Garlic, sugar, chili oil, chinese black vinegar, soy sauce
I also use a similar sauce for chargrilled eggplants or cucumbers.
Chinese five spice is also really delicious and can be used in many dishes. Cinnamon, sichuan peppercorn, cloves, fennel, star anise.
Jan 11, 2015quddous in Home Cooking
Best wood for a cutting board?
Haha, agreed. Luckily, it is from Costco and I will probably be returning it sometime (they have the best return policy ever).
Help with a Southern Style Supper
White barbecue sauce with smoked turkey. Yum.
Jan 11, 2015quddous in Home Cooking
Help with a Southern Style Supper
I did that turkey gravy recently and it was phenomenal.
I typically make my own cajun/creole seasoning - paprika, cayenne, cumin, thyme. I usually add garlic too but didn't for the gravy.
Best wood for a cutting board?
Agree with all the posters above. I have quite a few different cutting wood boards and don't really notice a difference between them (I'm too busy cooking to worry really). I actually tend to use my large epicurean the most because I care about it the least and it is lighter than my wood cutting boards - easiet to move around and easier to clean. My recommendation - get something that isn't too heavy for you but is still large enough to handle the amounts you cut.
PS I have an 18" Boos which looks amazing but is so heavy that I barely use it.
I recommend Nanxiang over DTF for a few reasons, first being their xlb are better (though Din Tai Fung was phenomenal the last time I went). Secondly, Din Tai Fung is everywhere now. If you go to Nanxiang, there are three floors with prices and quality increasing at each floor and decreasing in line length. The area around it is very nice to see as well.
I really love one Dimsum restaurant in Shanghai - it is called Tang's in Dickson Center Mall. They are chain and this particular location seems to be a higher end location. I've included a link.
Other restaurant recs -
Jan 11, 2015quddous in China & Southeast Asia
I personally only dislike shows which aren't about the food. Ie drama instead of food. You don't learn anything, you just waste time. That is really what I don't like about current food shows and tv shows in general.
Search for Bites of China on YouTube.
Jan 08, 2015quddous in Food Media & News
Please help me shorten my list!
I don't know if that really makes sense. It is a large sausage. I am a big guy (6' 200lbs) and it was good for me.
I liked Bestie but I would have liked it more if they made their own sausages and did more unique things (from what I last read, their sausages are from Oyama). I still liked it overall.
Jan 08, 2015quddous in B.C. (inc. Vancouver)
Middle eastern wise - I prefer Jam Jar, Babylon, East is east. I am not too fond of Nuba.
I like Persian food too but it's basically the same as you will find in LA.
I wouldn't go for a tasting menu in Vancouver but that's just me.
Please help me shorten my list!
We haven't been to Mr Red yet. Deciding between that and Bao Bei for dinner actually.
Maenam doesn't always have the crispy rice salad so I would check with them before going in.
Espana is very, very good. Don't be scared that they call themselves a tapas restaurant - they are much better than the rest. Their fried chickpeas are salty, crispy, smoked paprika dusted. Their patatas bravas is the only one I have ever liked, and loved. The potatoes are perfectly fried, the tomato sauce thick and smoky, the cream balances it all out and adds richness. It's basically a Spanish poutine - what's not to love? Their beet salads have been some of the best I have had. Basically everything on the menu is delicious. I really like scotch eggs too and their version is quite good using chorizo instead of regular sausage.
Jan 07, 2015quddous in B.C. (inc. Vancouver)
Please help me shorten my list!
Haha. I thought you were going to say "Not your mothers Chinese food" which I would have agreed to too.
Most dished are very Chinese but have something different/better about them compared to the original dish. Or the dish isn't as common in Vancouver - one example being the shaobing, a sesame flat bread filled with cumin beef. Peaceful has a similar dish which is good but not as good as Bao Bei's version.
I really get annoyed by Blis - their products might be great but I think they could be quite a bit cheaper.
That does sound really amazing though. That's some very good intel that you have superhunk. Do you work in restaurants?
Kale is really good if done right. Terrible if done improperly.
Have you had it at a good restaurant? The Acorn used to have a very good kale caesar.
The problem with making kale at home is that it is very tough and sometimes bitter. It needs to be massaged/cooked to tenderize it. I think younger kales tend to be less bitter.
I personally prefer black kale, which is much more tender and hardly bitter at all. I tend to fry it with a small amount of good extra virgin olive oil and just finish with some salt. Otherwise I will throw it into the sauce around my Italian style meatballs and let it simmer in the sauce.
Please help me shorten my list!
This is the first time I seem to be at odds with you on more than one thing.
Red Wagon - Greased up American food. Their food reminds me of typical "let's throw bacon on this until it tastes good" restaurants. Everything around that area is overly hyped. The best out of the bunch is Tacofino and it is still just "pretty good" most of the time. We did have some kind of sandwich there last time that was really amazing though. Tacofino's prices are quite high even compared to downtown.
Phnom Penh - Definitely hyped but you can't get many of their dishes anywhere else. Their chicken wings are amazing. The Beef Luc Lac is not anything like any other beef luc lac I have had. Their butter beef is also very good and different. I agree that many of the other restaurants.
I have been to Burdock and Co, three times now, and though we have some good dishes there, there are just as many that are disappointing. Highlights on the last visit include an oxtail agnolotti with celeriac puree, and a milk custard dessert (I could have had two).
Farmer's Apprentice was all I wanted Burdock/Fable/The Parker to be and more. I have only been once so will need to go back to rejudge.
Maenam is good. Sometimes I love it, sometimes I wonder why I went. Highlights include the thai crispy rice and sausage salad, and the mint chicken salad with crackling (seems I like crispy salads).
We eat Chinese food very often, are very picky with our asian food and still really like Bao Bei (I just might end up going there tonight).
Pidgin had one good dish, I would possibly drop in for that one dish and then head over somewhere else. The space is very nice and they have some very interesting cocktails. Highlight - Uni with cauliflower mousse.
La Quercia - I have had really amazing meals here. Best Italian in the city. I think it can compete with Spinasse in Seattle, which is my other favourite Italian within driving distance.
Jan 07, 2015quddous in B.C. (inc. Vancouver)
Madras Dosa - not to be recommended.
Vij's is great. Even solo dining, but beware of the wait.
I really love Babylon for their rice plates - I get their brown rice which is spiced and has beans added.
Espana is very good for Tapas - I have not liked Tapas anywhere else including Barcelona (the city) and Toro Bravo (Portland).
I have been hounding these boards and there do not seem to be very many recent threads on restaurants in Dubai.
Possibilities so far include
Zuma (Timeout #1 Japanese 2014/San Pellegrino Top 100 #77)
I would really like to find more middle eastern/arabic restaurants to visit.
Jan 07, 2015quddous in Middle East & Africa
As long as it is dry, it should be fine. If there is any weird smell (other than the overly strong flavour of kashk) then I would not eat it. If there is any mold growing, I would not eat it.
Most dry products do not really expire. Bacteria and Mold can't grow on them because they do not have enough water to live.
I would store it outside of the fridge in a lidded container in a dry area.
Jan 07, 2015quddous in Middle East & Africa
How to Make Hummus and Baba Ghanoush - Savvy Ep. 7: http://youtu.be/kZOAEsRLguQ
This episode features Einat Admony who owns Taim (and Balaboosta) in NYC, a falafel joint which has my favourite hummus.
Jan 03, 2015quddous in Home Cooking
That sounds delicious
Seafood medley appetizer - one of my favorite dishes of the past few years. A variety of raw seafood and caviar on a light egg custard (chawan mushi) topped with a yuzu dashi. (This was all from memory so I may be a bit off)
Best Food & Cookbooks 2014 — Goodreads Choice Awards
Voting by number of votes means popularity and not best. McDonald's sells more burgers than anyone else, I don't think anyone would ever call them the best burger of 2014.
I prefer seriouseats and eater's lists but even those have some weird choices.
Jan 02, 2015quddous in Food Media & News
How do you pronounce your foreign food phrases?
I think as long as you are understandable then it is fine.
Some words which are widely recognized in the foreign pronunciation should be pronounced that way - jalapeno should never be pronounced with a hard j.
I don't like it when the word is pronounced completely differently in the other language or is butchered somehow in the translation. Ie calling a macaron a "macaroon" - these are completely different things.
Jan 02, 2015quddous in Food Media & News


text:
Anime Fans of modDBFans & Clans group with 2,214 members, open to all members
This group has been formed to gather the people who enjoy Japanese anime and all of its facets, to salute the people from the land of the Rising Sun.
I'm pretty much a loner as people tell me, you probably already know that I love anime and manga, and as you can see, Furi-Kuri is my favorite. lived in Lebanon, Spain, Yugoslavia and I currently reside in Sweden. Add me on steam if I know who you are. My name is MuminTrollet^^ イチゴ死.
9 comments by Haruko on May 26th, 2010
Take a scene from a movie and corrupt it with internet language and L33t speak. Its great fun!
Saruman: "If the sentries are breached, RED will fall."
"But Even IF the sentries are gone it will will take a number beyond
reckoning, THOUSANDS to capture the point!"
Saruman: "Tens of
thousands of L33TS"
Wormtongue:"But my lord there is no such force!"
buff banner horn*
A hl2 Breen speech: W3lcome to c17 you have chosen or been chosen to connect to one of our finest s3rv3rs, whether your here to frag, or a n00b passing thru, w3lcome to the c17 s3rv3r.
This one is from Lord Of The Rings: The Two Towers
Wormtounge: How can hax destroy stone?
Saruman: If the wall is breached the noobs will fall.
Wormtounge: But even if the server is disconnected it will take thousands of pros to take control
Saruman: Tens of thousands of L33ts
Wormtounge: But my admin there is no such force!
This group has been formed to gather the people who enjoy Japanese anime and all of its facets, to salute the people from the land of the Rising Sun.
hah! then I wish , I wish...
I could be like you bro!
(but too bad im not) trollface
havent change your waife sadly I did "trollface"
Fine, fine as usual :)
And there at Sweden? a bit cold i bet :P
aaaaa seraaas hyaaaaaa.....
heh, OpYum which is name meme started by my schoolmates... hehe... my schoolmates have FB names such as OpYumAmiel, OpYumAlyssa...
you know...
it's just for random!!
OpYum which is Randomnesz!
no, not opium, OpYum!
moar OpYum!
Not for me, lol!
Only Pedo-Junior doesn't approve.
I am sorry.
For what btw? O.o


text:
There is no better test to start the season than facing the defending Stanley Cup Champions who swept you on the way to glory.
The new-look Flyers passed that test.
The orange and black defeated the black and gold Boston Bruins 2-1 to start their season on the right foot. Claude Giroux and new comer Jakub Voracek netted the goals for the Flyers, both in the first period.
The team was outplayed and outmatched early by the team that raised its Stanley Cup banner tonight, and it seemed like they may need some time to work on their chemistry. However, 39-year-old active points leader Jaromir Jagr and young phenom Claude Giroux helped change that quickly.
Jagr set up Giroux on a highlight reel power play goal in the first period to get the Flyers' scoring underway. When Giroux received the pass, he kicked it from his skate to his stick (which he was holding with one hand), and scored on Tim Thomas as he was crashing forward into the net. It's obvious that Jagr and Giroux are on the same page and will be a big threat in the offensive end all season long. Chris Pronger got the secondary assist on the goal.
The Flyers second goal came from Jakub Voracek, who found the puck on his stick in the slot and just threw it on net. The puck went through the five-hole of Thomas and put the Flyers up 2-1 with less than 5 seconds left in the first period. Andrej Mexzaros and Wayne Simmonds assisted on the goal, which was the eventual game winner.
Ilya Bryzgalov was spectacular in net, stopping 22 of 23 shots in his first game, and victory, as a Philadelphia Flyer. He finished with a .957 save percentage, and allowed his only goal on a Brad Marchand breakaway. His glove save on Marchand later in the game was a highlight save that will most likely make its way on Sportscenter tomorrow.
Claude Giroux's goal in the first period, the first of the Flyers' season
You can find Buzz on Broad Flyers Beat Writer on Twitter at @CJBurns215
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Hi Fellow Riders,
Let's celebrate the holidays at the drive-in burger joint and chow down on some ice cream too.
This is a social gathering without a ride, however I thought it could be family and friends event. Bring those that you're close to or not but it will fun!
It was nice chatting with a good group of people. We had some nice machines in attendance too.
0 · December 12, 2012
Awesome people! Looking forward to future meet ups.
0 · December 12, 2012
Ok everyone settle down!! ....... I'm signed up now ;)
2 · December 11, 2012
I started the group because there wasn't any other type of group like this. I've met some great folks in the group who have become close friends and have also met some amazing business owners.
— Bill, started New York City Gay Craft Beer Lovers
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