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For the most current version of this Note, see Background Notes A-Z.
Democratic People's Republic of Korea
Area: 1122,762 sq. km. (47,918 sq. mi.), about the size of Mississippi.
Cities: Capital--Pyongyang. Other cities--Hamhung, Chongjin, Wonsan, Nampo, and Kaesong.
Terrain: About 80% of land area is moderately high mountains separated by deep, narrow valleys and small, cultivated plains. The remainder is lowland plains covering small, scattered areas.
Climate: Long, cold, dry winters; short, hot, humid, summers.
Nationality: Noun and adjective--Korean(s).
Population (2009): 22.7 million.
Annual growth rate: About +0.42%.
Ethnic groups: Korean; small ethnic Chinese and Japanese populations.
Religions: Buddhism, Confucianism, Shamanism, Chongdogyo, Christian; autonomous religious activities have been virtually nonexistent since 1945.
Language: Korean.
Education: Years compulsory--11. Attendance--3 million (primary, 1.5 million; secondary, 1.2 million; tertiary, 0.3 million). Literacy--99%.
Health (1998): Medical treatment is free; one doctor for every 700 inhabitants; one hospital bed for every 350; there are severe shortages of medicines and medical equipment. Infant mortality rate--51.34/1,000 (2009 est.). Life expectancy--males 61.23 yrs., females 66.53 yrs. (2009 est.).
Type: Highly centralized communist state.
Independence: August 15, 1945--Korean liberation from Japan; September 9, 1948--establishment of the Democratic People's Republic of Korea (D.P.R.K., or North Korea), marking its separation from the Republic of Korea (R.O.K., or South Korea).
Constitution: 1948; revised in 1972, 1992, 1998, and 2009.
Branches: Executive--President of the Presidium of the Supreme People's Assembly (chief of state); Chairman of the National Defense Commission (head of government). Legislative--Supreme People's Assembly. Judicial--Central Court; provincial, city, county, and military courts.
Subdivisions: Nine provinces; two province-level municipalities (Pyongyang, Nasun, or Najin-Sonbong free trade zone); one special city (Nampo), 24 cities.
Political party: Korean Workers' Party (communist).
Suffrage: Universal at 17.
GDP (2008 estimate): $26.2 billion; 43.1% in industry, 33.6% in services, 23.3% in agriculture and fisheries.
Per capita GDP (2008): $1,700.
Agriculture: Products--rice, corn, potatoes, soybeans, cattle, pigs, pork, and eggs.
Mining and manufacturing: Types--military products; machine building; chemicals; mining (gold, coal, iron ore, limestone, magnesite, etc.); metallurgy; textiles; food processing; tourism.
Trade (2007): Exports--$1.684 billion: minerals, non-ferrous metals, garments, chemicals/plastics, machinery/electric and electronic products, animal products, wood products, vegetable products, and precious metals. The D.P.R.K. is also thought to earn hundreds of millions of dollars from the unreported sale of missiles, narcotics, and counterfeit cigarettes, and other illicit activities. Imports--$3.055 billion: minerals, petroleum, machinery/electronics, vegetable products, textiles, chemicals, non-ferrous metals, plastics, vehicles, and animal products.
Major trading partners (2007): (1) China, (2) R.O.K., (3) Thailand, (4) Russia, and (5) India.
*In most cases, the figures used above are estimates based upon incomplete data and projections.
The Korean Peninsula was first populated by peoples of a Tungusic branch of the Ural-Altaic language family, who migrated from the northwestern regions of Asia. Some of these peoples also populated parts of northeast China (Manchuria); Koreans and Manchurians still show physical similarities. Koreans are racially and linguistically homogeneous. Although there are no indigenous minorities in North Korea, there is a small Chinese community (about 50,000) and some 1,800 Japanese wives who accompanied the roughly 93,000 Koreans returning to the North from Japan between 1959 and 1962. Although dialects exist, the Korean spoken throughout the peninsula is mutually comprehensible. In North Korea, the Korean alphabet (hangul) is used exclusively.
Korea's traditional religions are Buddhism and Shamanism. Christian missionaries arrived as early as the 16th century, but it was not until the 19th century that major missionary activity began. Pyongyang was a center of missionary activity, and there was a relatively large Christian population in the north before 1945. Although religious groups exist in North Korea today, the government severely restricts religious activity.
By the first century AD, the Korean Peninsula was divided into the kingdoms of Shilla, Koguryo, and Paekche. In 668 AD, the Shilla kingdom unified the peninsula. The Koryo dynasty--from which Portuguese missionaries in the 16th century derived the Western name "Korea"--succeeded the Shilla kingdom in 935. The Choson dynasty, ruled by members of the Yi clan, supplanted Koryo in 1392 and lasted until Japan annexed Korea in 1910.
Throughout its history, Korea has been invaded, influenced, and fought over by its larger neighbors. Korea was under Mongolian occupation from 1231 until the early 14th century. The unifier of Japan, Hideyoshi Toyotomi, launched major invasions of Korea in 1592 and 1597. When Western powers focused "gunboat" diplomacy on Korea in the mid-19th century, Korea's rulers adopted a closed-door policy, earning Korea the title of "Hermit Kingdom." Though the Choson dynasty recognized China's hegemony in East Asia, Korea was independent until the late 19th century. At that time, China sought to block growing Japanese influence on the Korean Peninsula and Russian pressure for commercial gains there. The competition produced the Sino-Japanese War of 1894-95 and the Russo-Japanese War of 1904-05. Japan emerged victorious from both wars and in 1910 annexed Korea as part of the growing Japanese empire. Japanese colonial administration was characterized by tight control from Tokyo and ruthless efforts to supplant Korean language and culture. Organized Korean resistance during the colonial era was generally unsuccessful, and Japan remained firmly in control of the Peninsula until the end of World War II in 1945. The surrender of Japan in August 1945 led to the immediate division of Korea into two occupation zones, with the United States administering the southern half of the peninsula and the U.S.S.R. taking over the area to the north of the 38th parallel. This division was meant to be temporary until the United States, U.K., Soviet Union, and China could arrange a trusteeship administration.
In December 1945, a conference was convened in Moscow to discuss the future of Korea. A five-year trusteeship was discussed, and a joint Soviet-American commission was established. The commission met intermittently in Seoul but deadlocked over the issue of establishing a national government. In September 1947, with no solution in sight, the United States submitted the Korean question to the UN General Assembly. Initial hopes for a unified, independent Korea quickly evaporated as the politics of the Cold War and domestic opposition to the trusteeship plan resulted in the 1948 establishment of two separate nations with diametrically opposed political, economic, and social systems. Elections were held in the South under UN observation, and on August 15, 1948, the Republic of Korea (R.O.K.) was established in the South. Syngman Rhee, a nationalist leader, became the Republic's first president. On September 9, 1948, the North established the Democratic People's Republic of Korea (D.P.R.K.) headed by then-Premier Kim Il-sung, who had been cultivated and supported by the U.S.S.R.
Korean War of 1950-53
Almost immediately after establishment of the D.P.R.K., guerrilla warfare, border clashes, and naval battles erupted between the two Koreas. North Korean forces launched a massive surprise attack and invaded South Korea on June 25, 1950. The United Nations, in accordance with the terms of its Charter, engaged in its first collective action and established the UN Command (UNC), to which 16 member nations sent troops and assistance. Next to South Korea, the United States contributed the largest contingent of forces to this international effort. The battle line fluctuated north and south, and after large numbers of Chinese "People's Volunteers" intervened to assist the North, the battle line stabilized north of Seoul near the 38th parallel.
Armistice negotiations began in July 1951, but hostilities continued until July 27, 1953. On that date, at Panmunjom, the military commanders of the North Korean People's Army, the Chinese People's Volunteers, and the UNC signed an armistice agreement. Neither the United States nor South Korea is a signatory to the armistice per se, although both adhere to it through the UNC. No comprehensive peace agreement has replaced the 1953 armistice pact.
North Korea has a centralized government under the rigid control of the communist Korean Workers' Party (KWP), to which all government officials belong. A few minor political parties are allowed to exist in name only. Kim Il-sung ruled North Korea from 1948 until his death in July 1994. Kim served both as Secretary General of the KWP and as President of North Korea.
Little is known about the actual lines of power and authority in the North Korean Government despite the formal structure set forth in the constitution. Following the death of Kim Il-sung, his son--Kim Jong-il--inherited supreme power. Kim Jong-il was named General Secretary of the KWP in October 1997, and in September 1998, the Supreme People's Assembly (SPA) reconfirmed Kim Jong-il as Chairman of the National Defense Commission and declared that position as the "highest office of state." However, the President of the Presidium of the Supreme People's Assembly, Kim Yong-nam, serves as the nominal head of state. North Korea's 1972 constitution was amended in late 1992, September 1998, and in April 2009.
Three key entities control the government of the D.P.R.K. The Cabinet, formerly known as the State Administration Council (SAC), administers the ministries and has a significant role in implementing policy. The Cabinet is headed by the premier and is the dominant administrative and executive agency. The National Defence Commission (NDC) is responsible for external and internal security, and under the leadership of Kim Jong-il the NDC has assumed a significant role in influencing policy. The Politburo of the Central People's Committee is the top policymaking body of the Korean Workers' Party (KWP), which also plays a role as the dominant social institution in North Korea.
Officially, the legislature, the Supreme People's Assembly (SPA), is the highest organ of state power. Its members are elected every four years. Usually only two meetings are held annually, each lasting a few days. A standing committee elected by the SPA performs legislative functions when the Assembly is not in session. In reality, the Assembly serves only to ratify decisions made by the ruling KWP.
North Korea's judiciary is "accountable" to the SPA and the president. The SPA's standing committee also appoints judges to the highest court for four-year terms that are concurrent with those of the Assembly.
Administratively, North Korea is divided into nine provinces and two provincial-level municipalities--Pyongyang and Nasun, or Najin-Sonbong. It also appears to be divided into nine military districts.
Principal Party and Government Officials
Kim Jong-il--General Secretary of the KWP; Supreme Commander of the People's Armed Forces; Chairman of the National Defense Commission; son of North Korea's founder Kim Il-sung
Kim Yong-nam--President of the Presidium of the Supreme People's Assembly; titular head of state
Sin Son-ho--Ambassador to D.P.R.K. Permanent Mission to the UN
Pak Ui-chun--Minister of Foreign Affairs
North Korea has one of the largest armies in the world. It has an estimated active duty military force of up to 1.2 million personnel, compared to about 680,000 in the South. Military spending is estimated at as much as a quarter of GNP, with up to 20% of men ages 17-54 in the regular armed forces. North Korean forces have a substantial numerical advantage over the South (around 2 to 1) in several key categories of offensive weapons--tanks, long-range artillery, and armored personnel carriers. The North has one of the world's largest special operations forces, designed for insertion behind the lines in wartime.
North Korea's navy is primarily a coastal navy, with antiquated surface and submarine fleets. Its air force has twice the number of aircraft as the South, but, except for a few advanced fighters, the North's air force is obsolete.
The North deploys the bulk of its forces well forward, along the demilitarized zone (DMZ). Several North Korean military tunnels under the DMZ were discovered in the 1970s. Over the course of several years, North Korea realigned its forces and moved some rear-echelon troops to hardened bunkers closer to the DMZ. Given the proximity of Seoul to the DMZ (some 25 miles), South Korean and U.S. forces are likely to have little warning of attack. The United States and South Korea continue to believe that the U.S. troop presence in South Korea remains an effective deterrent. North Korea's nuclear weapons program has also been a source of international tension (see below, Reunification Efforts Since 1971; Denuclearization of the Korean Peninsula).
In 1953, the Military Armistice Commission (MAC) was created to oversee and enforce the terms of the armistice. Over the past decade, North Korea has sought to dismantle the MAC in a push for a new "peace mechanism" on the peninsula. In April 1994, it declared the MAC void and withdrew its representatives.
North Korea's relationship with the South has determined much of its post-World War II history and still undergirds much of its foreign policy. North and South Korea have had a difficult and acrimonious relationship from the Korean War. In recent years, North Korea has pursued a mixed policy--seeking to develop economic relations with South Korea and to win the support of the South Korean public for greater North-South engagement while at the same time continuing to denounce the R.O.K.'s security relationship with the United States and maintaining a threatening conventional force posture on the DMZ and in adjacent waters.
The military demarcation line (MDL) of separation between the belligerent sides at the close of the Korean War divides North Korea from South Korea. A demilitarized zone (DMZ) extends for 2,000 meters (just over 1 mile) on either side of the MDL. Both the North and South Korean governments hold that the MDL is only a temporary administrative line, not a permanent border.
During the postwar period, both Korean governments have repeatedly affirmed their desire to reunify the Korean Peninsula, but until 1971 the two governments had no direct, official communications or other contact.
Reunification Efforts Since 1971
In August 1971, North and South Korea held talks through their respective Red Cross societies with the aim of reuniting the many Korean families separated following the division of Korea and the Korean War. In July 1972, the two sides agreed to work toward peaceful reunification and an end to the hostile atmosphere prevailing on the peninsula. Officials exchanged visits, and regular communications were established through a North-South coordinating committee and the Red Cross. These initial contacts broke down in 1973 following South Korean President Park Chung-hee's announcement that the South would seek separate entry into the United Nations, and after the kidnapping of South Korean opposition leader Kim Dae-jung--perceived as friendly to unified entry into the UN--by South Korean intelligence services. There was no other significant contact between North and South Korea until 1984.
Dialogue was renewed in September 1984, when South Korea accepted the North's offer to provide relief goods to victims of severe flooding in South Korea. Red Cross talks to address the plight of separated families resumed, as did talks on economic and trade issues and parliamentary-level discussions. However, the North then unilaterally suspended all talks in January 1986, arguing that the annual U.S.-R.O.K. "Team Spirit" military exercise was inconsistent with dialogue. There was a brief flurry of negotiations that year on co-hosting the upcoming 1988 Seoul Olympics, which ended in failure and was followed by the 1987 bombing of a South Korean commercial aircraft (KAL 858) by North Korean agents.
In July 1988, South Korean President Roh Tae-woo called for new efforts to promote North-South exchanges, family reunification, inter-Korean trade, and contact in international forums. Roh followed up this initiative in a UN General Assembly speech in which South Korea offered for the first time to discuss security matters with the North. Initial meetings that grew out of Roh's proposals started in September 1989. In September 1990, the first of eight prime minister-level meetings between North Korean and South Korean officials took place in Seoul. The prime ministerial talks resulted in two major agreements: the Agreement on Reconciliation, Nonaggression, Exchanges, and Cooperation (the "Basic Agreement") and the Declaration on the Denuclearization of the Korean Peninsula (the "Joint Declaration").
The Basic Agreement, signed on December 13, 1991, called for reconciliation and nonaggression and established four joint commissions. These commissions--on South-North reconciliation, South-North military affairs, South-North economic exchanges and cooperation, and South-North social and cultural exchange--were to work out the specifics for implementing the basic agreement. Subcommittees to examine specific issues were created, and liaison offices were established in Panmunjom, but in the fall of 1992 the process came to a halt because of rising tension over North Korea's nuclear program.
The Joint Declaration on denuclearization was initialed on December 31, 1991. It forbade both sides from testing, manufacturing, producing, receiving, possessing, storing, deploying, or using nuclear weapons and forbade the possession of nuclear reprocessing and uranium enrichment facilities. A procedure for inter-Korean inspection was to be organized and a North-South Joint Nuclear Control Commission (JNCC) was mandated to verify the denuclearization of the peninsula.
On January 30, 1992, the D.P.R.K. finally signed a nuclear safeguards agreement with the International Atomic Energy Agency (IAEA), as it had pledged to do in 1985 when it acceded to the Nuclear Non-Proliferation Treaty (NPT). This safeguards agreement allowed IAEA inspections to begin in June 1992. In March 1992, the JNCC was established in accordance with the Joint Declaration, but subsequent meetings failed to reach agreement on the main issue of establishing a bilateral inspection regime.
As the 1990s progressed, concern over the North's nuclear program became a major issue in North-South relations and between North Korea and the United States. The lack of progress on implementation of the Joint Declaration's provision for an inter-Korean nuclear inspection regime led to reinstatement of the U.S.-R.O.K. Team Spirit military exercise for 1993. The situation worsened rapidly when North Korea, in January 1993, refused IAEA access to two suspected nuclear waste sites and then announced in March 1993 its intent to withdraw from the NPT. During the next two years, the United States held direct talks with the D.P.R.K. that resulted in a series of agreements on nuclear matters, including the 1994 Agreed Framework (which broke down in 2002 when North Korea was discovered to be pursuing a uranium enrichment program for nuclear weapons--see below, Denuclearization of the Korean Peninsula).
At his inauguration in February 1998, R.O.K. President Kim Dae-jung enunciated a new policy of engagement with the D.P.R.K., dubbed "the Sunshine Policy." The policy had three fundamental principles: no tolerance of provocations from the North, no intention to absorb the North, and the separation of political cooperation from economic cooperation. Private sector overtures would be based on commercial and humanitarian considerations. The use of government resources would entail reciprocity. This policy set the stage for the first inter-Korean summit, held in Pyongyang June 13-15, 2000.
R.O.K. President Roh Moo-hyun, following his inauguration in February 2003, continued his predecessor's policy of engagement with the North, though he abandoned the name "Sunshine Policy." The R.O.K. and D.P.R.K. held a second inter-Korean summit October 2-4, 2007 in Pyongyang. Inter-Korean relations have declined since the inauguration of R.O.K. President Lee Myung-bak in February 2008, as the D.P.R.K. has criticized Lee's policy of seeking greater reciprocity in inter-Korean relations.
The United States supports engagement and North-South dialogue and cooperation. Major economic reunification projects have included a tourism development in Mt. Kumgang, the re-establishment of road and rail links across the demilitarized zone (DMZ) and a joint North-South industrial park near the North Korean city of Kaesong (see further information below in the section on the Economy).
Relations Outside the Peninsula
Throughout the Cold War, North Korea balanced its relations with China and the Soviet Union to extract the maximum benefit from the relationships at minimum political cost. In the 1970s and early 1980s, the establishment of diplomatic relations between the United States and China, the Soviet-backed Vietnamese occupation of Cambodia, and the Soviet occupation of Afghanistan created strains between China and the Soviet Union and, in turn, in North Korea's relations with its two major communist allies. North Korea tried to avoid becoming embroiled in the Sino-Soviet split, obtaining aid from both the Soviet Union and China and trying to avoid dependence on either. Following Kim Il-sung's 1984 visit to Moscow, there was an improvement in Soviet-D.P.R.K. relations, resulting in renewed deliveries of Soviet weaponry to North Korea and increases in economic aid.
The establishment of diplomatic relations by South Korea with the Soviet Union in 1990 and with China in 1992 seriously strained relations between North Korea and its traditional allies. Moreover, the fall of communism in eastern Europe in 1989 and the disintegration of the Soviet Union in 1991 resulted in a significant drop in communist aid to North Korea. Despite these changes and its past reliance on this military and economic assistance, North Korea continued to proclaim a militantly independent stance in its foreign policy in accordance with its official ideology of "juche," or self-reliance.
Both North and South Korea became parties to the Biological Weapons Convention in 1987. (North Korea is not a member of the Chemical Weapons Convention, nor is it a member of the Missile Technology Control Regime, or MTCR.)
North Korea has maintained membership in some multilateral organizations. It became a member of the UN in September 1991. North Korea also belongs to the Food and Agriculture Organization; the International Civil Aviation Organization; the International Postal Union; the UN Conference on Trade and Development; the International Telecommunications Union; the UN Development Program; the UN Educational, Scientific, and Cultural Organization; the World Health Organization; the World Intellectual Property Organization; the World Meteorological Organization; the International Maritime Organization; the International Committee of the Red Cross; and the Nonaligned Movement.
In the mid-1990s, when the economic situation worsened dramatically and following the death of D.P.R.K. founder Kim Il-sung, the North abandoned some of the more extreme manifestations of its "self reliance" ideology to accept foreign humanitarian relief and create the possibility, as noted below, for foreign investment in the North. In subsequent years, the D.P.R.K. has continued to pursue a tightly restricted policy of opening to the world in search of economic aid and development assistance. However, this has been matched by an increased determination to counter perceived external and internal threats by a self-proclaimed "military first" ("Songun") policy.
During the present period of limited, extremely cautious opening, North Korea has sought to broaden its formal diplomatic relationships. In July 2000, North Korea began participating in the ASEAN Regional Forum (ARF), with Foreign Minister Paek Nam-sun attending the ARF ministerial meeting in Bangkok. The D.P.R.K. also expanded its bilateral diplomatic ties in that year, establishing diplomatic relations with Italy, the Philippines, Australia, Canada, the U.K., Germany, and many other European countries.
In the September 19, 2005 Joint Statement issued at the end of the fourth round of Six-Party Talks, the United States and the D.P.R.K. committed to undertake steps to normalize relations. The D.P.R.K. and Japan also agreed to take steps to normalize relations and to discuss outstanding issues of concern, such as abductions. The February 13, 2007 Initial Actions agreement established U.S.-D.P.R.K. and Japan-D.P.R.K. bilateral working groups on normalization of relations, which have both met several times since their creation (see below, Denuclearization of the Korean Peninsula).
The D.P.R.K. is not known to have sponsored terrorist acts since the 1987 bombing of KAL flight 858. Pyongyang continues to provide sanctuary to members of the Japanese Communist League-Red Army Faction (JRA) who participated in the hijacking of a Japan Airlines flight to North Korea in 1970.
The D.P.R.K. has made several statements condemning terrorism. In October 2000, the United States and the D.P.R.K. issued a joint statement on terrorism in which "the two sides agreed that international terrorism poses an unacceptable threat to global security and peace, and that terrorism should be opposed in all its forms." The United States and the D.P.R.K. agreed to support the international legal regime combating international terrorism and to cooperate with each other to fight terrorism. The D.P.R.K. became a signatory to the Convention for the Suppression of Financing of Terrorism and a party to the Convention Against the Taking of Hostages in November 2001. In June 2008, the D.P.R.K. Foreign Ministry issued an authoritative statement providing assurances that the D.P.R.K. supports international efforts to combat terrorism and opposes all forms of terrorism.
In the February 13, 2007 Initial Actions agreement, the United States agreed to begin the process of removing the designation of the D.P.R.K. as a state sponsor of terrorism. On June 26, 2008, following the D.P.R.K.'s submission of its nuclear declaration and progress on disablement, President George W. Bush announced that the United States would no longer apply the Trading with the Enemy Act to North Korea. Additionally, on October 11, the Secretary of State rescinded the United States' designation of North Korea as a state sponsor of terrorism. (see U.S. POLICY TOWARD NORTH KOREA: Denuclearization of the Korean Peninsula)
In the past, the D.P.R.K. has also been involved in the abduction of foreign citizens. In 2002, Kim Jong-il acknowledged to Japanese Prime Minister Koizumi the involvement of D.P.R.K. "special institutions" in the kidnapping of Japanese citizens between 1977 and 1983 and said that those responsible had been punished. While five surviving victims and their families were allowed to leave the D.P.R.K. and resettle in Japan in October 2002, 12 other cases remain unresolved and continue to be a major issue in D.P.R.K.-Japanese relations. In October 2005, the D.P.R.K. acknowledged for the first time having kidnapped R.O.K. citizens in previous decades, claiming that several abductees, as well as several POWs from the Korean War, were still alive. In June 2006, North Korea allowed Kim Young-nam, a South Korean abducted by the North in 1978, to participate in a family reunion. In June 2008, the D.P.R.K. agreed to reopen the investigation into the abduction issue. In August 2008, the D.P.R.K. and Japan agreed to a plan for proceeding with the abduction investigation. However, the D.P.R.K. has not yet begun the investigation. The United States has continued to press the D.P.R.K. to address Japan's concerns about the abduction issue.
U.S. Support for North-South Dialogue and Reunification
The United States supports the peaceful reunification of Korea on terms acceptable to the Korean people and recognizes that the future of the Korean Peninsula is primarily a matter for them to decide. The United States believes that a constructive and serious dialogue between the authorities of North and South Korea is necessary to resolve outstanding problems, including the North's nuclear program and human rights abuses, and to encourage the North's integration with the rest of the international community.
Denuclearization of the Korean Peninsula
North Korea joined the Nuclear Non-Proliferation Treaty (NPT) as a non-nuclear weapons state in 1985. North and South Korean talks begun in 1990 resulted in the 1992 Joint Declaration for a Non-Nuclear Korean Peninsula (see, under Foreign Relations, Reunification Efforts Since 1971). However, the international standoff over the North's failure to implement an agreement with the International Atomic Energy Agency for the inspection of the North's nuclear facilities led Pyongyang to announce in March 1993 its intention to withdraw from the NPT. A UN Security Council Resolution in May 1993 urged the D.P.R.K. to cooperate with the IAEA and to implement the 1992 North-South Denuclearization Statement. It also urged all UN Member States to encourage the D.P.R.K. to respond positively to this resolution and to facilitate a solution to the nuclear issue.
The United States opened talks with the D.P.R.K. in June 1993 and eventually reached agreement in October 1994 on a diplomatic roadmap, known as the Agreed Framework, for the denuclearization of the Korean Peninsula. The Agreed Framework called for the following steps:


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Things to see and do - Fort Lauderdale
Leaving for USA
Things to do nearby
Private Tour: Florida Everglades Airboat Adventure and Wildlife Encounter Ticket
- 40 €
- Book
Mai-Kai Polynesian Dinner Show
- 40 €
- Book
- 21 €
- Book
Nearby hotels
By Eddy Motel from98 $Book
Hampton Inn Ft. Lauderdale /Downtown Las Olas Area from97 $Book
Jungle Queen Riverboat Dinner Cruise :
Nearby tourist sites
Jungle Queen Riverboat Dinner Cruise
Jungle Queen Riverboat Dinner Cruise
Take an old fashioned riverboat cruise on the New River in Fort Lauderdale, where you'll be treated to an all-you-can-eat shrimp and barbecue dinner followed by a hilarious variety review stage show.
- Tour is wheelchair accessible
- Travel by boat and see the sights from the water
- Dinner included
Then, with a friendly "All Ashore" by the captain, you will be directed to the dining room where a delicious all-you-can-eat dinner of BBQ ribs, chicken, and shrimp with all the trimmings will be waiting for you.
Be prepared for some after dinner laughs as the all new Hilarious Variety Revue, acclaimed by press and public alike, takes center stage, and then enjoy a moonlit return ride.

subset: commoncrawl


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Kickoff Countdown - Skylanders SWAP Force Toys and Gadgets
- Toys and Gadgets Your selected format is Toys and Gadgets
- Join Kick Off Countdown in a new adventure in Skylands, as part of the new range of Skylanders SWAP Force figures.
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- Suitable for people aged 3 and over.
Release Date30/05/2014
GenresFigurines & Sets
Kickoff Countdown - Skylanders SWAP Force Product Details
Please Note: This is not a swappable character but the figure will still work with the Skylanders SWAP Force game.
In Skylanders SWAP Force, Portal Masters embark on an all new adventure in the mysterious Cloudbreak Islands, home to a mystical volcano that erupts every hundred years to replenish the magic in Skylands. During an epic battle, a brave group of Skylanders were caught in the volcano's eruption, which blasted them apart and sent them to earth. But, the magic of the volcano gave these heroes a remarkable new power - the ability to swap halves – turning them into a special team known as the SWAP Force. Meanwhile, Kaos is back with a new evil plan. And now, Portal Masters everywhere must reassemble the SWAP Force - in their original form or in new combinations - and send them back to Cloudbreak to save Skylands!
These aren't just toys - they're toys with brains. Skylanders figures unlock their own heroic challenges and remember all their in-game experiences, so they can be played on and across all major gaming consoles!
Skylanders SWAP force - Kick Off Countdown
Element - Tech
Countdown was discovered by a group of Yetis who were snowboarding one particularly chilly morning when they came across a big bomb encased in ice. After bringing it back to their cabin, they were shocked when it actually came to life. No one, not even Countdown himself, has any memory of where he came from or how he ended up frozen in the mountains. Since becoming a Skylander, Master Eon has been graciously trying to help piece together fragments of his past. But this has proven difficult, as Countdown loses some of his memory every time he explodes - which happens a lot. In the meantime, Countdown has enjoyed working with Eon and fighting alongside the Skylanders to defend their world against evil - even though he occasionally forgets what he is doing.
Skylanders Swapforce Interaction Figures
- Bring your Skylanders to life by placing them on the Portal of Power
- Interaction Figures with Brains – The Skylanders figures remember their in-game experiences and upgrades
- Each character has unique abilities and powers, play more and unlock special moves and superpowers
- Skylanders Interaction Figures work across all consoles and PC.


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shadowhive, on 30 January 2013 - 04:13 PM, said:
shadowhive, on 30 January 2013 - 04:13 PM, said:
What if God, desiring to show his wrath and to make known his power, has endured with much patience vessels of wrath prepared for destruction, in order to make known the riches of his glory for vessels of mercy, which he has prepared beforehand for glory-- even us whom he has called, not from the Jews only but also from the Gentiles?
~ Romans 9:22-24
What if those who weren't called were created so that those who were knew what it meant to not be called? Kind of like a pro-footballer who trains their entire lives to make the Cut for first-team selection, how can they appreciate making the team if they didn't have to beat three other players for their starting position. Would a footballer really respect their place in the squad if they just walked up and took their place? No. In fact, the opposite happens - those who are naturally gifted at sport when they are young don't need to work to make the first team, so when they reach the Pro's, they also think they just need to turn up and make it. They don't understand that at the top they actually need to work for it, and those who are most gifted are often those who fall hardest and never make it at all.


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in Problem solving
Moneys a little tight having only recently moved in to my own house (I'm 24 btw).
I bought some cheap home and garden compost from poundstretcher and it's full of sticks and bits of trees.
Is this a good thing or a bad thing and should I be picking the sticks out when putting the compost into my pots like I have been doing?
That's what I do, but I also have compost bins to dump the reject stuff into.
Take care though - last year in cheap compost I found a couple of pieces of glass. Buy a cheap plastic garden seive and get rid of the lumps that way
Thats two more things to add to the shopping list then. A compost bin and a seive haha.
Cheers guys


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As if volcanic eruptions weren't flashy enough on their own, volcanologists have added more flare to their research by using lasers to scan lava flows. The results not only produce compelling 3-D images of lava flows, but also help hazard-mitigation teams prepare vulnerable communities for future flows, researchers say.
Lava flows are inherently tricky to study by foot because, unsurprisingly, they are dangerously hot when fresh — topping 1,000 degrees Fahrenheit (538 degrees Celsius) — and difficult to traverse when cool, becoming brittle and glasslike.
To overcome these challenges, volcanologists have traditionally turned to satellite imagery to study flows from above. But these aerial images often lack the resolution required to study the flows in close detail, particularly when clouds or trees block the view. [In Images: Hawaii's Mount Kilauea Erupts]
Now, researchers have honed laser scanning technology — also called lidar, a combination of the words "light" and "radar" — to produce much-higher-resolution aerial images that, among other things, allow scientists to digitally extract trees and other obstructive objects from their images.
Monitoring Lava Flows
To collect the data, researchers equip airplanes with hundreds of thousands of lasers that scan the terrain at a perpendicular angle to the ground. The lengths of the laser beams indicate the height of the flow, and when multiplied hundreds of thousands of times, the scans can be compiled into 3-D models that recreate the internal structure of the flow.
Geologists at the University of Oregon recently used this technology to create high-resolution 3-D models of the remains of Hawaii's 1974 Kilauea and 1984 Mauna Loa eruptions.
"When you go down to the meter-scale resolution, all of a sudden, it is possible to start analyzing flows in a way that we have never been able to do before," said Kathy Cashman, a geologist at the University of Oregon who is involved in this research. "So it is opening up new ways of studying old flows and new opportunities for monitoring active flows."


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Had Rossi not made such a hash of the qualifying he was on for the win!! He got very badlly held up behind slower riders at the start. Dovi well done for his first time one the bike no better than Vale on his first outing though!


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Featured News
January 13, 2014
We Eat Meat
Notes on Humanely Raised, Ethically Slaughtered Heritage Breed Animals
At Publican Quality Meats, We eat meat. This means, no matter how you finesse it, there must be a moment when a living animal is killed. Before the linquica, ribeyes, 'nduja, chops, mica and harissa pate can fill our bountiful butcher cases, a death must occur.
We choose to eat meat but acknowledge that death as respectfully as possible. We deal with farms and purveyors where animals are free range, uncaged, fed natural diets, are given no antibiotics or steroids and are slaughtered as humanely and painlessly as possible. But they ARE slaughtered. There is a death.
This is why we do not waste a molecule of these beautiful animals. We process them into headcheese, marrow bones, cured meats, cooked meats, ham hocks, regular cuts, blood sausage. We feel this honors the life of the animal and is the right way to do this kind of work.
The Animal Rights Activist group PETA put up a billboard (pictured) across the street from PQM and Publican. It features a picture of a suckling pig and the slogan "You can live without those ribs. I can't" and the proviso 'Try Vegan'.
Anyone who has read this far and thinks we're going to mock or belittle PETA or their mission will have to go shopping somewhere else. We respect any serious and intelligent personal philosophy and admire PETA's knack for provocation and creative chutzpah. We are, and this might seem odd to say unless you really think about it, also people who are for the ethical treatment of animals with one gigantic difference; We do choose to eat animal flesh. We also choose not to ignore the reality of the choice.
About a month ago PQM organized a trip for our staff to one of our farmer/purveyors. The trip entailed an overview of the whole operation but included witnessing the slaughter. Our staff, our butchers in particular, are serious about their craft and sincerly idealistic about how they execute it. They were, to a person, profoundly moved by the experience. This post was already in the works and was only slightly prompted by the appearance of the billboard; a dialogue with Cosmo, Publican Sous-Chef and PQM Butcher and D, PQM manager about that trip, our philosophy and that undeniable death.
D: Why did we do the farm trip?
Cos: It's important to see it. It's important not to...put it in parentheses. It's a hard job that someone does, even in the best of circumstances.
D: Have you ever slaughtered an animal?
Cos: Yes. Lambs. At a very small farm. It becomes...it's hard to say...ritualistic, kind of religious. You calm the animal. We actually said a prayer to each one.
D: How did you kill it?
Cos: We slit their throats. It's about making it as quick and painless as possible. That may not sound quick or painless but it is very quick, especially if the animal isn't being herded into a chute and can smell and hear what's happening.
D: When I saw the billboard I thought, perversely, that we actually kinda line up with these guys in most regards...with, you know, one glaring exception.
Cos: Yeah, what I thought was that cute suckling pig...people need to realize...that pig is older than any chicken you've ever eaten. Commodity chickens that you buy in the grocery store...they're about 9 days old, socked full of steroids and fed completely gross shit to plump them up. Ours are 21 days old at least, live on a natural light cycle, no cages...there are pens where the chickens can hide from the other chickens. In chicken terms that's Quality of Life.
D: We did a bit about the American Livestock Conservancy a few weeks back. They're salvaging disappearing heritage breeds of animals and are addressing the seeming contradiction - if we don't eat these breeds they'll cease to exist. It's pretty much 'Eat the Pig, Save the Breed', and I thought about that when I saw the billboard too. The suckling pig petitioning to keep his ribs wouldn't exist if it wasn't produced for food. On the other hand, if it's Commodity Meat production, that's probably not a bad thing. He'd be better off not existing.
Cos: A lot of people will just never care but if you give me Commodity Meat next to any of our farmer's meat I will know which is which 100% of the time. Ours is natural and delicious and real and the other stuff is...stuff.
D: Why? How do you quantify and explain it to people?
Cos: We're, pretty much, a venue for the farmers. They raise the animals the right way and we just try to get out of the way in presenting them to our guests. They do all the work. We're the forum. Some people buck at the price but I say...you buy an organic apple, it costs twice as much as a regular apple. You buy pork that's being fed organic apples...it is a choice, but it's worth it. You can Taste the Difference.
D: I don't know if it's the timing of my commute or it's just there all the time but I frequently pass the rendering truck at the packing plant around the corner coming off the Green Line. The rendering truck does not have to visit PQM
Cos: We waste NOTHING. We use 100% of the animal. With pigs we use the skin, we make head cheese, we make stock from the bones, the tails end up in the Bolognese at Publican. We waste Nothing. That's how we honor the animal. We don't throw any of its Life away. Here's something to take away. If you go to the freezer at PQM and buy some of our packaged Publican hamburger patties...those are from ONE COW. If you get a burger at McDonald's there ismeat from over 1000 cows in it. Dramatize that in your head.
D: Yeesh.
Thanks for reading through this long piece. Don't make fun of PETA. Support the Livestock Conservancy.


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I want to personally invite each and every one of you to experience the "New" DEA that puts "Education before Competition".
We at DEA are very excited to share the educational opportunities with you and your students. You can be assured that at each of our events we supply the best teachers in the country. These teachers are "Educators" first. They want to share their passion with each and every student that attends. They are hands on and will make individual corrections to help the students.
We treat competition as a part of the "Educational Process". Our judges give great verbal critiques. They embody the philosophy of DEA which is "most students are not dancing at that 98 to 100 level". The judges give a variety of medal placements from High Silver through Platinum. We pride ourselves that each student receives the tools that they need to become a better dancer and performer. As we are all Educators, this process is very important to the development of each and every student. We realize that there are many choices in competition events but by choosing DEA, you are striving to offer your students an event that offers them the opportunity to be become "the best that they can be".
If you have any questions or need any other information on events or membership do not hesitate in contacting me personally at firstname.lastname@example.com or call 914-636-3200. I look forward to seeing each and every one of you at a DEA event this season.


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Top Definition
Adj. meaning all-out; with every effort; complete.
Why live life half-assed when you can live it full-assed?
by Shera Princess of Power August 17, 2003
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Top Definition
Unexpected joy from a nearly invisible source.
I didn't expect to enjoy that new Roland Emmerich film so much, but the experience was certainly a ninja reacharound.
af vernacular_ninja 12. november 2009
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September 2001
The National Minority AIDS Council is pleased to announce the third year of its partnership with the National Institute of Health's Office on AIDS Research (OAR; http://www.nih.gov/od/oar) to provide 100 CBOs in the U.S., its territories and possessions with computer equipment and Internet access to enhance HIV/AIDS knowledge on research, prevention and treatment programs for people living with HIV/AIDS, through the Equal Access Computer Grants Initiative.
The Equal Access Computer Grants Initiative is intended to help minority CBOs tap into the Internet's potential to enhance opportunities for learning, collaboration, technical assistance and the distribution of HIV/AIDS prevention and treatment information. Unfortunately, many minority HIV/AIDS organization have been unable to develop the resources and skills to use the Internet effectively. Internet content for these organizations and their clients has been sorely lacking.
The Equal Access Computer Grants Initiative seeks to address these problems by:
We anticipate another successful year working with you in the Equal Access Computer Grants Initiative. For more information, please contact William Johnson at 202-483-6622 ext. 357 or email@example.com. Visit: http://www.nmac.org/equal_access/eai_info.htm.


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Crash.Net F1 News
F1 POLL result: Fans back Schumacher to succeed
13 January 2010
Last month,
asked you to vote on if Michael Schumacher will regret his decision to return to F1 with Mercedes.
Voting closed on Tuesday, with a clear majority, 68.07 per cent, backing the record-breaking multiple F1 world champion to succeed in F1 2010. Indeed only 31.93 per cent said that his decision to come out of retirement was a mistake.
The full results are as follows...
Poll results: Will Michael Schumacher regret his decision to return to F1 with Mercedes?
Yes, he is too old now: 4.83 per cent
Yes, he's been out of F1 too long: 7.71 per cent
Yes, Hamilton et al will easily beat him: 6.71 per cent
Yes, he has nothing to prove or gain: 12.68 per cent
No, he is still the best: 16.63 per cent
No, he still has a lot to offer: 34.60 per cent
No, he will blitz rivals: 6.44 per cent
No, age is but a number! 10.40 per cent


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Bird may have brought down F-16
Friday, June 28, 2013
GLENDALE, Ariz. (AP) — An F-16 fighter jet that went down near Luke Air Force Base in suburban Phoenix most likely hit a bird before it crashed, an Air Force spokeswoman said Thursday.
Two pilots who were practicing landings and takeoffs at the base Wednesday evening ejected safely and the fighter crashed in a farm field near the base.
Base spokeswoman Lt. Candice Dillitte said Thursday that there's nothing to indicate a fleet-wide problem with the jets, but the Air Force will investigate the cause. The Air Force has more than 1,000 of the single-engine fighters.
The base, 15 miles west of Phoenix in Glendale, Ariz., trains pilots and has more than 130 F-16s. An instructor and a student were flying the jet that crashed.
Witnesses said they heard the jet's engine sputtering and popping just before the plane went down. Video from a TV helicopter showed plumes of smoke rising from the crash scene.
At a press briefing late Wednesday, 56th Operations Group commander Col. John Hanna said the pilots from the 309th Fighter Squadron needed to get out fast.
"It was severe enough to where the pilots on board the aircraft realized that they were not going to be able to execute a safe landing," Hanna said.
Bird strikes can severely damage jet engines. US Airways Flight 1549 lost both engines shortly after takeoff. from LaGuardia Airport in January 2009 but landed safely in the Hudson River.
An inspector general's audit last year criticized the Federal Aviation Administration for not doing enough to stop bird strikes. The report cited a five-fold increase in bird strikes over the last two decades, from 1,770 reported in 1990 to 9,840 reported in 2011, due in part to growing bird populations. The strikes have led to at least 24 deaths and 235 injuries in the United States since 1988.
The report said the FAA's oversight and enforcement efforts were insufficient.
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The Samurai Swordsman: Master of War
Tuttle Publishing, 2008 - History - 208 pages
Filled with dozens of woodblock prints and photographs, this Samurai history is an authoritative text on Japan's most fearsome warriors.
Samurai—the word alone evokes intense images of expert swordsmen fighting against overwhelming odds and emerging victorious. But the popular image of the samurai only scratches the surface of these complex warriors. The Samurai Swordsman: Master of War brings the reality to life.
Through fascinating stories and full-color historical images that show the samurai in mesmerizing detail, military historian Stephen Turnbull provides an invaluable guide to an enduring legacy.
Most readers may imagine the samurai as a lone wanderer, owing allegiance to none but himself, only relying for his survival on his skill with the sword. As The Samurai Swordsman reveals, however, that image masks the diversity of the samurai's long history.
The earliest samurai warriors were actually aristocratic mounted archers, not swordsmen. Only as the archer gave way to the mounted spearman did swordsmanship came into play. Turnbull details how the history and the legacy of the samurai developed over centuries into a multifaceted, richly elaborate tapestry of martial and societal traditions.
From the first recorded use of the word samurai in the eighth century to the final wars waged in resistance to the Meiji government in the late nineteenth century, The Samurai Swordsman recounts the complex history of these warriors and demonstrates why the samurai continue to fascinate the world today.
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My slogan has always been, if it's printed, I can design it!
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I normally guarantee a two week turn around time with most apparel products. All work requires a signature of final proof before release.
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Special special teams: Not only did Seth Wedemeyer make a school record four field goals in Friday's win over Lindsay, he was also proficient on kickoffs. On five kickoff returns, Lindsay averaged just 12 yards per return and didn't get past the 25-yard line. Punter Zach Richey had three punts for a 36-yard average, including pinning Lindsay at its own 2.
Sack attack: Trevor Stephens had two sacks to break the single-season school record set just last year by J.J. Santa Cruz. He had help pressuring the quarterback. C.J. Cambra recorded a sack and Peter Flores and Hunter O'Brion had a half-sack each.
Get back here: Against Lindsay, a team that averages more than 35 points per game, the Cardinals scored just 10 on the Hawks. After scoring a field goal and a touchdown within their first three drives, the Cardinals didn't get a sniff of the end zone the rest of the game. The closest Lindsay got was to the Liberty 40-yard line.
Records watch: Zach Richey passed Chase Cullins for most passing yards in a season with 1,424 yards despite missing the first two games of the season … Both running backs Wade Wallace and Richie Brandt are, practically, in a dead heat after 12 games, but both reached the 1,000 yard mark. Wallace leads Brandt by three yards with 1,030 yards … With a touchdown Friday, Brandt has 13 rushing touchdowns and is fifth all-time...


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Out Here: Annoying? Only for a good cause
When looking to buy a car, do you want to find out its gas mileage? Do you like to go for a spin? Take a look under the hood? I'm betting you do. That's understandable. When you're paying for something, you want to know about it beforehand, not afterward.
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Carolina-based Band of Horses have found massive success for most of their tenure, beginning with their first album Everything All the Time. The album's first single, "The Funeral" appeared in video games, television shows, and commercials, cultivating tremendous attention for a group only just finding their footing and still cementing a lineup.
Lead by multi-instrumentalist and vocalist Ben Bridwell, the band relocated from Seattle to Bridwell's native South Carolina after Everything All the Time and have since released three more albums; toured North America, Europe, Australia, and headlined some of the world's largest festivals; and have continued to build a dedicated fan base through evolving their signature Southern dream-rock sound.
By popular demand, their sold-out stop in Nashville was given a second night at the legendary Ryman Auditorium. Tickets are still available for the second show on April 28th. Be sure to check them out at this landmark venue.
*Saturday April 27, 2013 - 8:00 PM
Sunday April 28, 2013 - 8:00 PM
Ryman Auditorium
16 Fifth Avenue NorthNashville, TN


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Tags: aquarius, cro-magnon, Dorian Concept, eddy ramich, gilles peterson, jana valdevit, jazzy sport, jose james, kontrapunkt, tom wieland
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May 4, 2016
A circuit court has vacated a district court's ruling that a ban on feeding deer in the Lower Peninsula was "unconstitutionally vague" in a case against a Gaylord man.
The 46th Circuit Court has ruled that the lower court failed to examine facts specific to the case against Ken Borton, and that the ban on feeding deer remains in effect.
Borton was cited in 2009 for illegally feeding deer from bird feeders. Borton has said he only was trying to feed birds.
Defense attorney Paul Slough said Wednesday that a prosecutor dismissed the charge against Borton last week after the original ruling was sent back to district court.
Slough says the state law on deer feeding "is just not clear."
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Cassie W.
Hunter College, pursuing degree
Childcare Experience
Part-time Babysitter
Brooklyn, NY, 01/14 - Present
Girl, age 9-11 months
Full-time Nanny
New York, NY, 07/12 - Present
Girl, age 4 months-2; boy, age 3-5
Part-time Babysitter
Brooklyn, NY, 05/10 - 11/13
Boy, age 5 months-3
Full-time Nanny
New York, NY, 03/11 - 07/12
Three girls, ages 4-5, 2-3, 1-2
Full-time Nanny
New York, NY, 09/10 - 01/11
Girl, age 2-6 months; boy, age 2 years
Full-Time Nanny
New York, NY, 09/07 - 06/10
Girl, age 3-6; boy, age 6-9
Professional Experience
Office Assistant
Brooklyn, NY, 09/13 - 12/13
Sales Associate
New York, NY, 07/07 - 09/07
Catering Waitress
Long Island, 09/05 - 02/06
Book Seller
Riverhead, NY, 09/04 - 07/05
Moriches, NY, 10/01 - 09/04
About Me
I grew-up out on Long Island, moving to the city in 2006. Living in the city was always a big dream of mine since I was 9 years old. I also wanted to experience some independence while figuring out exactly what I wanted to do with my life. I was fortunate enough to be able to find creative, fun, meaningful and amazing work as a nanny. I was originally working towards a degree in Anthropology, but working with kids allowed me to discover a new passion: Early Education. I've always enjoyed babysitting, and I have been babysitting since I was 14 in one form or another. As a full-time nanny, I experienced a new opportunity to not only nurture, but to teach and watch a child's personality grow.
I grew up in a very large and chaotic family, as the center middle child of five kids. Mostly thanks to my mother, the master of organizing chaos, I understand the need for structure but I also know that life gets chaotic. I find myself able to adjust quickly to any set-backs or things that come up out of the blue. My patience is pretty much endless, and I try to understand others limits as well as my own. I love to cook, draw, and be outside doing some kind of activity, such as a simple walk or even hiking, climbing or playing soccer.
- I have professional childcare experience with…
Infants, Toddlers, Pre-school aged children, Elementary school aged children, Middle school aged children, Children with special needs, Multiples
- I will be SmartSitting while…
Working on finishing school. I'm hoping to earn a degree focused on Early Child education.
- In 5 years, I hope to be…
Healthy, and possibly working my way to earning my masters.
- Activities & skills I love to teach & share with children…
Arts and crafts projects are some of my favorite things to do. From simple things with crayons, to knitting and making up projects of my own. I used to be wrestle in high school, and while I don't anymore, I still love to work out. I also used to play soccer and hockey. I also greatly enjoy rollerblading and ice skating.
I love making up stories with kids, or silly games to keep them amused even while doing something as simple as walking home from school. I love to cook, but I am not very skilled at baking. It can be fun even if they don't turn out perfectly!


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Submitted by Maureen Clare Murphy on Wed, 05/02/2012 – 16:02
Nowhere Left to Go: The Jahalin Bedouin, a new short documentary, can now be watched in its entirety on YouTube. In the film, Jahalin Bedouin community members explain how the Israeli government plans to forcibly displace them yet again — the community was originally displaced to the periphery of Jerusalem from their historic lands in the Naqab (Negev) desert during the 1948 ethnic cleansing of Palestine.
or here: http://electronicintifada.net/blogs/maureen-clare-murphy/watch-alice-walker-narrates-new-documentary-jahalin-bedouin-roger-waters


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Tuesday, March 15, 2011
Wolski, Gilroy healthy scratches; Boogey update
Left wing Wojtek Wolski and Matt Gilroy, along with the recuperating Derek Boogaard - who skated with teammates for the first time since suffering a concussion on Dec. 9 - were the extras on the ice with assistant Mike Sullivan. Which means Wolski will be a healthy scratch for the first time in 28 games since being acquired from the Coyotes.
Gilroy comes out of the lineup for the first time since Jan. 2. Defenseman Steve Eminger and left wing Sean Avery will be back in the lineup. Also at today's morning optional, Brandon Prust said he would be able to play after not practicing yesterday to rest his bruised body.
"I don't know if that's even a question I can answer," Wolski said when asked whether he was surprised to come out, even after scoring a crucial goal in the third-round of the shootout to allow the Rangers to eventually win 3-2 at San Jose on Saturday. 'I guess you're always surprised. You don't want to be out of the lineup. You want to be in the lineup. But I don't think that (the shootout goal) is a good enough reason to keep me in the lineup. I've got to play better. He (coach John Tortorella) is holding me accountable. The only one to blame is myself. I have to play better and have more of an impact on the game. Obviously, I realize I have a lot of upside and potential. I'm happy they realize it too. The team is battling for a playoff spot and I'm not playing as well as I could be. They're going to hold me accountable. It was a quick conversation (with Tortorella). It wasn't anything too big. We've got to win and I've got to be a part of it. If I'm not contributing, I'm not going to play."
Wolski has five goals and 11 assists with the Rangers but has gone scoreless in his last two games, the shootout goal notwithstanding, and has gone eight games without a goal.
Based on yesterday's practice, here are the projected lines:
Vinny Prospal-Erik Christensen-Marian Gaborik
Brandon Dubinsky-Artem Anisimov-Ryan Callahan
Sean Avery-Derek Stepan-Mats Zuccarello
Ruslan Fedotenko-Brian Boyle-Brandon Prust
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As for Boogaard, he said he knows it's a long shot for him to return to the lineup, at least in the final 12 regular-season games, as he tries to regain his conditioning.
Boogaard said he just has to take it on a day-by-day basis, skating as much as possible. While he was able to participate in an optional morning skate, he's not sure whether he'd be able to get through a full practice yet.
"I'm not sure," he said. "I've still got some work to do to keep up with the guys."
Boogaard skated each day on his own as the Rangers were in California last week. Today, he was on the ice for 50 minutes and the plan is to try and do a little bit more each day. Boogaard said except for one instance, which he did not specify, there have been no setbacks and he continues to see the Rangers' doctors at each game. Boogaard went out of his way to praise the work of the Rangers' medical staff as well as their training staff.
"Reggie's great, top notch," Boogaard said of Reg Grant, the Rangers' strength and conditioning coach.
"It's been three and a half months, the rust is going to be there," Boogaard said. "But just to be around the guys (is great). You've got to help out the team as much as you can.
"To be with teammates in a structured practice, it's unbelievable, that's why you play the game, to be around teammates. They're like family. It's tough when you're injured and you've got to stay away. It was awesome today skating.
"It sucks when you're in idle mode," Boogaard added. "It's a mental battle. Once you get a concussion, you appreciate what the other guys have gone through and the perseverance they've had to get through it. People think it's an easy thing and you're just laying around all day and waiting for the headache to go away. There's to it than that."
Boogaard said he approves of the NHL's five-point plan to bolster player safety with regards to head injuries, as outlined by Commissioner Gary Bettman yesterday at the General Manager's meeting in Florida.
"I think everyone is taking the right steps," he said.


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Special rates require proof of eligibility at check-in.
You're one step closer to paradise...
By: Kim Steutermann Rogers
For Polynesians, kalo, the Hawaiian word for taro, is what rice is to Asians and what the potato is to Europeans and Americans: A food staple. Its vegetable leaf is used in cooking, much like spinach; whereas, its cooked form is mashed and made into poi. In the days when a calabash of poi was passed around, the ritual required scooping out the starchy food with fingers. Depending on the consistency of the batch, it might be called "two-finger" or "three-finger" poi.
Whatever the texture, poi represents more than just dietary nourishment to Native Hawaiians. According to the Kumulipo, the Hawaiian creation chant, kalo is the elder brother of the Hawaiian people. That explains the familial and sacred relationship Hawaiians enjoy with taro.
While poi may have lost its staple status around the dinner table in Hawaii today, it is found at grocery stores and the many luau open for visitors around the state. Too, more and more communities and families are clearing overgrown loi, ponds, and growing taro again.
That's why I had signed up to help weed a taro patch. Learning about a Hawaiian way of life sounded like an interesting way to spend a Saturday morning, especially for a malihini, newcomer, like me. I'd lived in Hawaii for almost 10 years but had yet to step foot in a loi. Except it wasn't raining when I'd agreed to help.
Located on Kauai's north shore just past the town of Hanalei, Waipa is a 1,600-acre ahupuaa, land division, one of the smallest on Kauai. In 1982, the owners of the land announced plans for a high-end agricultural estate development. In response, a group of kupuna, elders, from the north shore organized. Their mission: "To restore the ahupuaa of Waipa as a Native Hawaiian community and learning center, as a sustainable, culturally- and community-based model for land-use and management." After four years, the landowners—Kamehameha Schools—agreed to halt development and lease the land to the Waipa Foundation (www.waipafoundation.org).
Since then, the group has started a native reforestation program. They are restoring a native fishpond. And they are growing kalo in centuries old loi. They host a weekly poi-pounding day and operate a weekly farmers market. Plus, they run an active learning center with programs for keiki, children, and kupuna alike.
But I didn't know all that yet. I learned it with every weed I pulled. In the end, I braved the wet weather. I joined the hands-on executive director of the Waipa Foundation, Stacy Sproat, and a dozen other people.
When I stepped into the loi, my feet sunk deep into the cool mud while fresh water diverted from a nearby stream circled my calves. I slipped my hand in the water at the base of a weed and pulled. It popped right out of the mud. Weeding the loi was easy work.
When I tried to take a step, though, my foot slipped right out of the shoes I was wearing—neoprene sandals made for water sports—so I proceeded barefoot. On one side of me, a neighbor weeded. I hadn't seen her in a while, and she told me about the lush produce growing in her garden at home. She reported that her daughter was working with Malama Kauai, a community group with a mission to implement sustainability practices on the island.
On the other side of me, a visitor from Vermont pulled weeds. She called herself a recovering lawyer and a cancer survivor. Turns out, she was staying just down the road from where I lived.
We chatted and pulled, chatted and pulled, while I caught up with an old friend and met a new one. This is like my grandmother's quilting bees, I thought. We come together to work, and it turns into a social event. What's more, within 30 minutes, we had finished weeding the taro patch.
I drove home happy with the choice I'd made. It never did rain and the work was easy—and satisfying. I remembered a saying I'd first heard long ago, maybe from my grandmother: Many hands make light work. There must be a Hawaiian proverb that expresses that concept, I thought.
Indeed, there is. Aohe hana nui ka aluia translates to English as "No task is too big when done together."
A few weeks later, on May 14, 2008, Acting Governor James "Duke" Aiona signed a bill into law that made kalo the official state plant. Taro joins pua aloalo, yellow hibiscus, as the state flower and kukui, candlenut, as the state tree. All three are native plants.
Find inspiration for your journeys to Outrigger's exotic locations.
Read our travel blog.


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Sly and shrewd Ross Brawn definitely knew what he was doing and took a calculated risk. He is used to doing similar stuff in his Ferrari days with the current FIA president Jean Todt, Bridgestone comes to mind....
Guess he thinks they can get away with it or the advantage Merc gained far outweighs whatever penalty the FIA might impose.
1000km is more or less 3GP races, they should be given a 3 race ban starting from Canada, so other teams can get the equivalent of data Merc gleaned from this testing.


text:
Number: 0731
Aetna considers convection-enhanced delivery of drugs into brain parenchyma experimental and investigational because the safety and effectiveness of this approach has not been established.Background
Convection-enhanced delivery (CED) is a method of directly administering drugs into the brain in order to enhance the distribution of drugs throughout the brain parehcyma. It involves the stereotactic placement through cranial burr holes of several catheters into brain parenchyma and the subsequent infusion of antineoplastic agents or other therapeutic agents via a microinfusion pump.
This technique has been described in published pre-clinical and early clinical studies. Although CED has been primarily evaluated for administering anti-neoplastics, this technique can be used for administering a wide range of agents, such as for treatment of Alzheimer's disease and epilepsy.
Standard methods of local delivery of most drugs into the brain, either by intravenous injection and passage through the blood brain barrier (BBB), or intra-ventricular injection, has relied on diffusion, which results in a non-homogenous distribution of most agents. Intravenous administration of drugs to the brain has been hampered by the BBB, which prevents the passage of large molecules. The BBB is characterized by tight junctions between vascular endothelial cells, which prevent or impede various naturally occurring and synthetic substances (including anti-cancer drugs) from entering the brain.
Blood brain barrier disruption (BBBD) techniques have been used in chemotherapy of brain tumors to disrupt the BBB, in order to increase the concentration of chemotherapy drugs delivered to the tumor and prolong the drug-tumor contact time. Chemotherapy may be administered in conjunction with mannitol to cause osmotic disruption of the BBB, or disruption may be attempted through other mechanisms with other substances.
Although BBBD techniques have been used for over 20 years, the efficacy of this technique has been questioned (ICSI, 2001; CMS, 2007), as the long-term effects of BBBD chemotherapy are unknown, and no randomized controlled trials have established the superiority of BBBD chemotherapy over conventional chemotherapy. In addition, BBBD with chemotherapy is associated with a higher risk of complications than conventional chemotherapy. Complications associated with BBBD include seizures, obtundation, focal neurologic deficits, cerebral herniation, strokes, death, as well as the side-effects related to the chemotherapeutic agents themselves. Based upon a review of the evidence, CMS has issued a National Coverage Determination that stated that the use of osmotic BBBD is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors (CMS, 2007).
In contrast to techniques that rely on diffusion, CED uses a pressure gradient established at the tip of an infusion catheter to push a drug into the extra-cellular space. The intention is to distribute the drug more evenly, at higher concentrations, and over a larger area than when administered by diffusion alone.
Convection-enhanced delivery of anti-neoplastic agents may occur after craniotomy with tumor resection, once the patient is stable. A separate hospital admission (apart from admission for tumor resection) is expected for CED for catheter placement and infusion of the therapeutic agent by means of a microinfusion pump. Once the infusion is complete, the catheters are removed and the patient is discharged.
Novel, targeted anti-neoplastics are in development for brain tumors. However, their administration has been hampered by the BBB, which prevents passage of large molecules.
One such targeted anti-neoplastic that is administered by CED is cintredekin besudotox, a novel cytotoxin-based therapy that is being investigated for the treatment of recurrent glioblastoma multiforme (GBM). Cintredekin besudotox is a recombinant protein consisting of a single molecule composed of 2 parts: (i) interleukin-13, which binds to receptors on tumor cells; and (ii) pseudomonas exotoxin (PE), a cytotoxin, which causes destruction of the tumor cell once the molecule is absorbed. Interleukin-13 receptors are present in substantial numbers on malignant glioma cells, but only a minimal amount on healthy brain cells. Hence, cintredekin besudotox has the potential to target tumor cells, with minimal impact on surrounding normal brain tissue.
Because of its large size, cintredekin besudotox can not cross the BBB. In clinical studies, cintredekin besudotox has been administered by CED. Catheters are placed following tumor resection, in areas of microscopic tumor spread or at risk of tumor spread around the tumor resection cavity. Because of the need to achieve homogenous distribution of cintredekin besudotox throughout the tumor infiltrated tissue, the catheters can not be placed in any previous resection cavity.
Once the patient is stable, approximately 2 weeks following craniotomy with tumor resection, the patient is admitted for catheter placement and anti-neoplastic infusion. Catheters are strategically placed by neurosurgeons, taking into account the location of residual non-resectable tumor, brain anatomy, and fluid dynamics. Anywhere from 2 to 4 catheters are placed during a surgical procedure lasting several hours. Cintredekin besudotox is then slowly infused through the catheter directly into the brain over 96 hours.
Available phase I/II clinical studies of cintredekin besudotox suggest that this is a promising agent for treatment of recurrent glioblastoma multiforme. A phase III trial (PRECISE) is currently underway. Cintredekin besudotox has been granted fast-track development designation and orphan drug designation by the U.S. Food and Drug Administration (FDA), and may be approved by the FDA as early as 2007.
At present, the pharmacokinetics of CED are poorly understood (Sampson et al, 2006). More research is needed to determine the optimal catheter location to distribute a drug to target tumor cells within the tumor mass and in the infiltrated adjacent parenchyma. Optimal catheter design is being researched to minimize backflow, to maximize distribution in the brain, and to account for the need to maintain patient mobility.
Raghavan et al (2006) explained that, although CED has been under investigation since the early 1990's, "this technique remains experimental because of both the absence of approved drugs for intraparenchymal delivery and the difficulty of guaranteed delivery to delineated regions of the brain."
Sampson et al (2008) determined the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and intra-cerebral distribution of a recombinant toxin (TP-38) targeting the epidermal growth factor receptor in patients with recurrent malignant brain tumors using the intra-cerebral infusion technique of CED. A total of 20 patients were enrolled and stratified for dose escalation by the presence of residual tumor from 25 to 100 ng/ml in a 40-ml infusion volume. In the last 8 patients, co-infusion of (123)I-albumin was performed to monitor distribution within the brain. The MTD was not reached in this study. Dose escalation was stopped at 100 ng/ml due to inconsistent drug delivery as evidenced by imaging the co-infused (123)I-albumin. Two DLTs were seen, and both were neurological. Median survival after TP-38 was 28 weeks (95 % confidence interval: 26.5 to 102.8). Of the 15 patients treated with residual disease, 2 (13.3 %) demonstrated radiographical responses, including 1 patient with glioblastoma multiforme who had a nearly complete response and remains alive for over 260 weeks after therapy. Co-infusion of (123)I-albumin demonstrated that high concentrations of the infusate could be delivered over 4 cm from the catheter tip. However, only 3 of 16 (19 %) catheters produced intra-parenchymal infusate distribution, while the majority leaked infusate into the cerebrospinal fluid spaces. Intra-cerebral CED of TP-38 was well-tolerated and produced some durable radiographical responses at doses less than or equal to 100 ng/ml. The authors concluded that CED has significant potential for enhancing delivery of therapeutic macromolecules throughout the human brain. However, the potential efficacy of drugs delivered by this technique may be severely constrained by ineffective infusion in many patients.
Fiandaca and colleagues (2008) stated that CED of substances within the human brain is becoming a more frequent experimental treatment option in the management of brain tumors, and more recently in phase 1 trials for gene therapy in Parkinson's disease (PD). Benefits of this intracranial drug-transfer technology include a more efficient delivery of large volumes of therapeutic agent to the target region when compared with more standard delivery approaches (i.e., biopolymers, local infusion). These researchers developed a reflux-resistant infusion cannula that allows increased infusion rates to be used. They also described their efforts to visualize the CED process in vivo, using liposomal nanotechnology and real-time intra-operative MRI. In addition to carrying the MRI contrast agent, nanoliposomes also provide a standardized delivery vehicle for the convection of drugs to a specific brain-tissue volume. This technology provides an added level of assurance via visual confirmation of CED, allowing intra-operative alterations to the infusion if there is reflux or aberrant delivery. These investigators proposed that these specific modifications to the CED technology will improve efficacy by documenting and standardizing the treatment-volume delivery. Furthermore, they believe that this image-guided CED platform can be used in other translational neuroscience efforts, with eventual clinical application beyond neuro-oncology and PD.
In a review on novel drug delivery strategies in neuro-oncology, Bidros and Vogelbaum (2009) stated that an important impediment to finding effective treatments for malignant gliomas is the presence of the BBB, which serves to prevent delivery of potentially active therapeutic compounds. Multiple efforts are focused on developing strategies to effectively deliver active drugs to brain tumor cells. Convection-enhanced delivery and BBBD have emerged as leading investigational delivery techniques for the treatment of malignant brain tumors. Clinical trials using these methods have been completed, with mixed results, and several more are being initiated.
Bidros et al (2010) stated that CED has emerged as a leading investigational delivery technique for the treatment of brain tumors. Clinical trials utilizing these methods have been completed, with mixed results, and several more are being initiated. However, the potential effectiveness of drugs delivered by CED may be severely constrained by poor durg distribution.
Sampson et al (2010) retrospectively analyzed the expected drug distribution based on catheter positioning data available from the CED arm of the PRECISE trial. BrainLAB iPlan Flow software was used to estimate the expected drug distribution. Only 49.8 % of catheters met all positioning criteria. Still, catheter positioning score (hazard ratio 0.93, p = 0.043) and the number of optimally positioned catheters (hazard ratio 0.72, p = 0.038) had a significant effect on progression-free survival. Estimated coverage of relevant target volumes was low, however, with only 20.1 % of the 2-cm penumbra surrounding the resection cavity covered on average. Although tumor location and resection cavity volume had no effect on coverage volume, estimations of drug delivery to relevant target volumes did correlate well with catheter score (p < 0.003), and optimally positioned catheters had larger coverage volumes (p < 0.002). Only overall survival (p = 0.006) was higher for investigators considered experienced after adjusting for patient age and Karnofsky Performance Scale score. The authors concluded that potential effectiveness of drugs delivered by CED may be limited by ineffective delivery in many patients.
Buonerba et al (2011) stated that GBM is the most frequent and aggressive malignant glioma (MG), with a median survival time of 12 to15 months, despite current best treatment based on surgery, radiotherapy and systemic chemotherapy. Many potentially active therapeutic agents are not effective by systemic administration, because they are unable to cross the BBB. As intra-cerebral administration bypasses the BBB, it increases the number of drugs that can be successfully delivered to the brain, with the possibility of minor systemic toxicity and better effectiveness. These researchers summarized the results of the extensive clinical research conducted on intra-cerebral therapy. Biodegradable drug carriers, implantable subcutaneous reservoirs and CED represent the main techniques for intra-cerebral delivery, while conventional chemotherapy agents, radiolabeled antibodies and receptor-targeted toxins are the main classes of drugs for intra-cerebral therapy. At the present time, biodegradable carmustine wafers, commercialized as Gliadel, are the only FDA-approved treatment for intra-cerebral chemotherapy of MG, but intra-cavitary delivery of mitoxantrone and radiolabeled anti-tenascin antibodies via implantable reservoirs has yielded promising results in uncontrolled trials. The pressure-driven flow generated by CED can potentially distribute convected drugs over large volumes of the brain, independently on their intrinsic diffusivity. Nevertheless, prominent technical problems, like back-flow, are yet to be properly addressed and contributed to the disappointing results of 2 phase III trials that investigated CED of cintredekin besudotox and TransMid in patients with recurrent GBM.
In a prospective, dose-escalation phase Ib study, Bruce et al (2011) examined the safety profile of topotecan via CED in the treatment of recurrent MGs and assessed radiographical response and survival. Significant anti-tumor activity as described by radiographical changes and prolonged overall survival with minimal drug-associated toxicity was demonstrated. A MTD was established for future phase II studies. The authors concluded that topotecan by CED has significant anti-tumor activity at concentrations that are non-toxic to normal brain. The potential for use of this therapy as a generally effective treatment option for MGs will be tested in subsequent phase II and phase III trials.
Lam et al (2011) stated that CED is a promising neurosurgical technique for the delivery of potential therapeutic agents to the PD-affected striatum. Convection-enhanced delivery utilizes stereotactic insertion of a catheter to the striatum and continuous infusion to distribute agents in the brain parenchyma. Insufficient attention to the details of CED may have contributed to early failures of translating candidate therapeutic agents from the laboratory to PD patients. A literature review was performed to examine the factors that govern CED in the laboratory as well as translation in PD and these researchers found that although there have been significant developments in implant design, infusion parameters and infusate composition, there have not been enough comparative trials of different technologies. Further optimization of CED is needed before it can be applied in the clinical setting and this will require a step-by-step breakdown of the different elements of delivery for independent testing. The authors concluded that CED is a promising technique for delivering therapeutic agents to the striatum for the treatment of PD; but further refinements are necessary for successful clinical translation.
Barua et al (2012) examined if the peri-vascular distribution of solutes delivered by CED into the striatum of rats is affected by the molecular weight of the infused agent, by co-infusion of vasodilator, alteration of infusion rates or use of a ramping regime. These investigators also wanted to make a preliminary comparison of the distribution of solutes with that of nanoparticles. These researchers analysed the peri-vascular distribution of 4, 10, 20, 70, 150 kDa fluorescein-labelled dextran and fluorescent nanoparticles at 10 mins and 3 hrs following CED into rat striatum. They investigated the effect of local vasodilatation, slow infusion rates and ramping on the peri-vascular distribution of solutes. Co-localization with peri-vascular basement membranes and vascular endothelial cells was identified by immunohistochemistry. The uptake of infusates by peri-vascular macrophages was quantified using stereological methods. Widespread peri-vascular distribution and macrophage uptake of fluorescein-labelled dextran was visible 10 mins after cessation of CED irrespective of molecular weight. However, a significantly higher proportion of peri-vascular macrophages had taken up 4, 10 and 20 kDa fluorescein-labelled dextran than 150 kDa dextran (p < 0.05, ANOVA). Co-infusion with vasodilator, slow infusion rates and use of a ramping regime did not alter the peri-vascular distribution. Convection-enhanced delivery of fluorescent nanoparticles indicated that particles co-localize with peri-vascular basement membranes throughout the striatum but, unlike soluble dextrans, are not taken up by peri-vascular macrophages after 3 hrs. The authors concluded that the findings of this study suggested that widespread peri-vascular distribution and interaction with peri-vascular macrophages is likely to be an inevitable consequence of CED of solutes. The potential consequences of peri-vascular distribution of therapeutic agents, and in particular cytotoxic chemotherapies, delivered by CED must be carefully considered to ensure safe and effective translation to clinical trials.
White et al (2012) described a single-center, phase I, dose-escalation clinical trial of carboplatin administered by CED to patients with recurrent or progressive GBM despite full standard treatment. This trial will incorporate 6 cohorts of 3 patients each. Cohorts will be treated in a sequential manner with increasing doses of carboplatin, subject to dose-limiting toxicity not being observed. This protocol should facilitate the identification of the maximum-tolerated infused concentration of carboplatin by CED into the supratentorial brain. This should facilitate the safe application of this technique in a phase II trial, treating patients with GBM, as well as for the treatment of other forms of malignant brain tumors, including metastases.
Anderson et al (2013) noted that CED for the treatment of malignant gliomas is a technique that can deliver chemotherapeutic agents directly into the tumor and the surrounding interstitium through sustained, low-grade positive-pressure infusion. This allows for high local concentrations of drug within the tumor while minimizing systemic levels that often lead to dose-limiting toxicity. Diffuse intrinsic pontine gliomas (DIPGs) are universally fatal childhood tumors for which there is currently no effective treatment. In this report the authors described CED of the topoisomerase inhibitor topotecan for the treatment of DIPG in 2 children. As part of a pilot feasibility study, the authors treated 2 pediatric patients with DIPG. Stereotactic biopsy with frozen section confirmation of glial tumor was followed by placement of bilateral catheters for CED of topotecan during the same procedure. The first patient underwent CED 210 days after initial diagnosis, after radiation therapy and at the time of tumor recurrence, with a total dose of 0.403 mg in 6.04 ml over 100 hours. Her Karnofsky Performance Status (KPS) score was 60 before CED and 50 post-treatment. Serial MRI initially demonstrated a modest reduction in tumor size and edema, but the tumor progressed and the patient died 49 days after treatment. The second patient was treated 24 days after the initial diagnosis prior to radiation with a total dose of 0.284 mg in 5.30 ml over 100 hours. Her KPS score was 70 before CED and 50 post-treatment. Serial MRI similarly demonstrated an initial modest reduction in tumor size. The patient subsequently underwent fractionated radiation therapy, but the tumor progressed and she died 120 days after treatment. Topotecan delivered by prolonged CED into the brainstem in children with DIPG is technically feasible. In both patients, high infusion rates (greater than 0.12 ml/hr) and high infusion volumes (greater than 2.8 ml) resulted in new neurological deficits and reduction in the KPS score, but lower infusion rates (less than 0.04 ml/hr) were well-tolerated. While serial MRI showed moderate treatment effect, CED did not prolong survival in these 2 patients. The authors concluded that more studies are needed to improve patient selection and determine the optimal flow rates for CED of chemotherapeutic agents into DIPG to maximize safety and efficacy.
Barua et al (2014) stated that CED describes a direct method of drug delivery to the brain through intra-parenchymal micro-catheters. By establishing a pressure gradient at the tip of the infusion catheter in order to exploit bulk flow through the interstitial spaces of the brain, CED offers a number of advantages over conventional drug delivery methods -- bypass of the BBB, targeted distribution through large brain volumes and minimization of systemic side-effects. Despite showing early promise, CED is yet to fulfill its potential as a mainstream strategy for the treatment of neurological diseases (e.g., Alzheimer's disease, high-grade glioma, and Parkinson's disease). Substantial research effort has been dedicated to optimizing the technology for CED and identifying the parameters that govern successful drug distribution. It seems likely that successful clinical translation of CED will depend on suitable catheter technology being used in combination with drugs with optimal physicochemical characteristics, and on neuropathological analysis in appropriate pre-clinical models.
Xia and colleagues (2014) examined a novel drug delivery system for the treatment of malignant brain gliomas; DOX complexed with nanodiamonds (ND-Dox), and administered via CED. Drug retention and toxicity were examined in glioma cell lines, and distribution, retention and toxicity were examined in normal rat parenchyma. Efficacy was assessed in a bioluminescence rodent tumor model. NDs markedly enhanced DOX uptake and retention in glioma cells. ND-Dox delivered via CED extended DOX retention and localized DOX toxicity in normal rodent parenchyma, and was significantly more efficient at killing tumor cells than uncomplexed DOX. The authors concluded that outcomes from this work suggested that CED of ND-Dox is a promising approach for brain tumor treatment.
|CPT Codes / HCPCS Codes / ICD-10 Codes
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":
|ICD-10 codes will become effective as of October 1, 2015:
|CPT codes not covered for indications listed in the CPB:
|Stereotactic placement of infusion catheter(s) in the brain for delivery of therapeutic agent(s), including computerized stereotactic planning and burr hole(s).
|ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):
|Malignant neoplasm of brain
|Secondary malignant neoplasm of brain and other parts of nervous system
|Alzheimer's disease
|Epilepsy and recurrent seizures
|Post traumatic seizures
|Unspecified convulsions


text: September 20, 2013 - Pope Francis on Friday urged Catholic doctors and health care workers to fight today's anti-life culture, stressing that there is no true development without openness to life. The Pope's appeal came in his talk to participants in the 10th international conference of Matercare International (MCI) being held in Rome Sept. 18-22, on the theme "Catholicism and Maternal Health Care." Matercare is an international group of Catholic obstetricians and gynecologists, with a preferential option for mothers and babies, both born and unborn, especially in developing countries. Pope Francis noted that in today's "paradoxical situation" a doctor risks losing his/her natural identity as the servant of life. The Pope lamented that while attributing to the person new rights, that sometimes are also presumed, life is not always safeguarded as the primary and primordial right of every person. "The final objective of doctor is always the defence and promotion of life," the Pope said, calling on professionals and health workers, especially gynecologists to collaborate in the birth of new life. The Pope noted that a widespread mentality of utility and the 'culture of waste" that enslaves the heart and intelligence of many, calls for the elimination of human beings especially if they are physically and socially very weak. Stressing that "the first right of a human person is his life" the Pope said that human life in its totality has become a priority of the Catholic Church, particularly those largely defenceless, such as the disableds, the sick, the unborn, the child and the elderly. In this anti-life mentality, the Pope reminded the conference participants that the credibility of a healthcare system is not measured only on its efficiency, but above all for its attention and love for persons for people whose life is always sacred and inviolable.