text:
Number: 0295
Aetna considers mechanical or laser peripheral atherectomy (atheroablation) medically necessary in members who meet all of the following criteria:
Aetna considers mechanical or laser peripheral atherectomy experimental and investigational for all other indications, including peripheral atherectomy of the renal artery, visceral artery, abdominal aorta, brachiocephalic trunk and branches, and iliac artery, because its effectiveness for these indications has not been established.
Aetna considers isolated segmental pharmacomechanical thrombolysis (Trellis Peripheral Infusion System) experimental and investigational for treatment of deep venous thromboses, Paget-Schroetter syndrome (also known as venous thoracic outlet syndrome) and other indications because there is inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness.
Aetna considers a drug-eluting balloon for mechanical or laser peripheral atherectomy experimental and investigational for the treatment of in-stent restenosis of peripheral arteries because there is inadequate evidence in the peer-reviewed published clinical literature regarding the effectiveness of this approach.
The preferred technique for mechanical atherectomy involves the use of the Simpson Atherocath (directional atherectomy). Peripheral atherectomy/atheroablation with other mechanical or rotational devices or rotational aspiration atherectomy devices has not been shown to be effective.
Peripheral laser atherectomy is also known as peripheral laser angioplasty.Background
Atherectomy was introduced in 1985 to improve upon the limitations of balloon angioplasty, primarily, abrupt reclosure and restenosis. Atherectomy devices cut and remove atherosclerotic plaque from a vessel wall or grind the atheroma into small particles, allowing them to embolize distally. Elastic recoil is reduced after atherectomy because the lumen is widened without stretching of the arterial wall.
Several types of atherectomy devices have been cleared by the U.S. Food and Drug Administration for peripheral use and primary success rates have been favorable with various devices; however, the Simpson Peripheral Atherocath has been the most widely used. This device has a circular cutter that spins at 2,000 rpm inside a metal housing with a window. Balloon inflation on the opposite side of the housing forces the plaque through the window where it is cut by advancing the rotating cutter in the housing. This device is best suited for short, discrete, eccentric stenosis. The catheters are bulky and stiff to use in the tibial or tortuous vessels. Primary success rate have been 82 to 100 % with few complications.
Data support the use of atherectomy as effective in the peripheral vessels in patients who meet the following criteria:have symptomatic peripheral vascular disease (limb-threatening ischemia or functionally limiting claudication); andcannot be treated by standard angioplasty techniques alone, i.e., balloon angioplasty would be ineffective or is contraindicated; and havean eccentric lesion that does not dilate with conventional balloon angioplasty, or vein bypass graft stenosis.
Until the problem of restenosis can be solved, atherectomy is a reasonable treatment for symptomatic peripheral vascular disease (limb-threatening ischemia or functionally limiting claudication) only when balloon angioplasty may be ineffective or contraindicated.
Zeller et al (2007) reported a safety and efficacy study of the first rotational aspiration atherectomy system (Pathway PV) for the treatment of arterial lesions below the femoral bifurcation. A total of 15 patients (9 men; mean age of 71 +/- 9 years) with Rutherford stage 2 to 5 lower limb ischemia were enrolled at 3 study sites. Target lesions were in the superficial femoral (n = 7, 47 %), popliteal (n = 7, 47 %), and posterior tibial (n = 1, 6 %) arteries. Mean diameter stenosis was 97 % +/- 10 %; mean lesion length was 61 +/- 62 mm (range of 5 to 250). The primary study endpoint was the 30-day serious adverse event (SAE) rate. Interventional success (residual stenosis les than 30 %) was achieved in all lesions (100 %). Stand alone atherectomy was performed in 6 (40 %) patients, adjunctive balloon angioplasty in 7 (47 %), and stenting/endografting in 2 (13 %). The SAE rate at 30 days was 20 % (3/15), including 1 perforation due to an unrecognized displacement of the guidewire (sealed with an endograft), 1 false aneurysm at the puncture site (successful duplex-guided compression therapy), and 1 dissection in conjunction with a distal embolism (stent implantation and aspiration thrombectomy). Primary patency rates measured by duplex ultrasound at 1 and 6 months were 100 % and 73 %, respectively; the target lesion revascularization (TLR) rate was 0 % after 6 months. The ankle-brachial index increased significantly from 0.54 +/- 0.3 at baseline to 0.89 +/- 0.16, 0.88 +/- 0.19, and 0.81 +/- 0.20 (p < 0.05) at discharge, 1 month, and 6 months, respectively. Mean Rutherford categories were 2.92 +/- 1.19 (range of 1 to 5), 0.64 +/- 1.12 (range of 0 to 1), and 0.83 +/- 1.33 (range of 0 to 3) at the same time points (p < 0.05). The authors concluded that the application of this new atherectomy device was feasible in all cases. The serious adverse event rate was moderate; however, all events were solved during the index procedure. The 0 % 6-month TLR rate is promising.
Mahmud et al (2007) noted that over the past decade, percutaneous revascularization therapies for the treatment of patients with peripheral arterial disease (PAD) have evolved tremendously, and a great number of patients can now be offered treatment options that are less invasive than traditional surgical options. With the surgical approach, there is significant symptomatic improvement, but the associated morbidity and mortality preclude its routine use. Although newer percutaneous treatment options are associated with lower procedural complications, the technical advances have outpaced the evaluation of these treatments in adequately designed clinical studies, and therapeutic options are available that may not have been rigorously investigated.
Bunting and Garcia (2007) stated that atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal PAD experiences physiological stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Re-stenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for PAD require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance.
Biskup et al (2008) noted that a new atherectomy device (SilverHawk) has recently been approved by the Food and Drug Administration, but the results with its use are unclear. These investigators analyzed a series of consecutive patients undergoing atherectomy. They retrospectively reviewed the charts of 35 patients undergoing infra-inguinal (IF) atherectomy in 38 limbs. The Trans-Atlantic Inter-Society Consensus (TASC) classification and Society of Vascular Surgery run-off scores were calculated. Time to event analysis was performed using Kaplan-Meier estimates. Risk factors affecting patency were analyzed with a multi-variate Cox model. Mean patient age was 70 +/- 9.6 years. Indications for intervention were claudication (26 %), rest pain (21 %), and tissue loss (53 %). Femoro-popliteal (FP) atherectomy was performed in 68 % and tibial atherectomy in 32 %. For FP lesions, the TASC distribution was A, 42 %; B, 23 %; C, 4 %; and D, 15 %. The average lesion treatment length was 9.4 +/- 10.6 cm (range of 1 to 40), and the run-off score was 5.1 +/- 3.5. For tibial lesions, the TASC distribution was A, 0 %; B, 17 %; C, 8 %; and D, 75 %. The average lesion treatment length was 9.2 +/- 6.0 cm (range of 2 to 20), with a run-off score of 5.4 +/- 2.4. A total of 39 % of patients had prior IF interventions. Adjunctive angioplasty of the atherectomized lesion was performed in 55 % of cases, stenting in 0 %, and adjunctive therapy for tandem lesions in 39 %. The post-operative ankle-brachial index increased by 0.30 +/- 0.14 and toe pressures increased by 40 +/- 32.4 mm Hg. Mean follow-up was 10 +/- 8 months (range of 0.3 to 23). During the studied period, 7 patients required major limb amputation and 5 open surgical re-vascularization. Total primary and secondary patency rates were 66 % and 70 % at 1 year, respectively. Primary and secondary patency rates for FP atherectomy were 68 % and 73 % at 1 year, respectively. The limb salvage rate was 74 % at 6 months. Patients with prior interventions in the atherectomized segment had an almost 10-fold decrease in primary patency. Atherectomy produces acceptable results, similar to those in reported series of conventional balloon angioplasty/stenting. Patients with prior IF interventions had a nearly 10-fold decrease in primary patency. A greater than 6-fold decrease in patency rates was noted in patients who underwent simultaneous inflow or outflow procedures, but this finding did not reach statistical significance (p = 0.082). The authors stated that future studies should focus on cost comparisons with other treatments such as angioplasty and stenting, and prospective randomized trials should be performed to compare these treatment alternatives.
Garcia and Lyden (2009) noted that compared to conventional percutaneous transluminal angioplasty (PTA) and stent implantation for arterial occlusive diseases, atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the, rate of restenosis. Historically, however, neither rotational nor directional atherectomy, whether used alone or with adjunctive PTA, has shown any significant long-term benefit over PTA alone in the coronary or peripheral arteries. However, the SilverHawk Plaque Excision System has produced positive results in single-center prospective registries of patients with FP and IF lesions, with reduced adjunctive PTA, minimal adjunctive stenting, and competitive 6-month and 12-month patency rates. In the observational non-randomized TALON (Treating Peripherals with SilverHawk: Outcomes Collection) registry, freedom from target lesion re-vascularization was 80 % for 87 patients at 12 months. Questions remaining for further research with this device include more accurate determination of an event rate for distal embolization, the appropriate use of distal protection, the value of and appropriate circumstances for adjunctive angioplasty, and definitive patency and clinical outcomes.
Indes et al (2010) evaluated the outcomes of atherectomy versus subintimal angioplasty (SIA) in patients with lower extremity arterial occlusive disease. From September 2005 through July 2006, 27 patients (17 women; mean age of 65 years, range of 37 to 85) underwent atherectomy of 46 lesions (11 TASC C/D occlusions) with the SilverHawk device. Results were compared to 67 patients (34 men; mean age of 69 years, range of 46 to 92) undergoing SIA for 67 lower extremity arterial occlusions from July 1999 through June 2004. Technical success in the atherectomy cohort was 100 %. In the 11 patients with occlusions, symptoms improved in 10 and worsened in 1, but 9 (82.0 %) of the 11 patients required re-intervention, and 8 (72.7 %) patients with occlusive lesions re-occluded. Endovascular re-intervention was required to maintain primary patency in only 2 (12.5 %) of 16 patients treated for stenotic lesions. At 1 year, the assisted primary patency was 37.7 % in the atherectomy group. In the 11 patients with occlusive lesions, the patency rates were 36.8 % and 12.3 % at 6 and 9 months, respectively, versus 100 % and 83.3 % at the same time intervals in patients with stenotic lesions. Subintimal angioplasty was technically successful in 56 (83.6 %) of 67 occlusions. The assisted primary patency and limb salvage rates of the entire group (intention-to-treat) at 12 and 24 months were 59.2 % and 45.0 %, respectively, while the assisted primary patency of the 56 technically successful SIAs at 12 and 24 months were 70.7 % and 53.8 %, respectively. Limb salvage for the entire group (intention-to-treat) was 90.6 % and 87.9 % at 12 and 24 months, respectively. The authors concluded that atherectomy may yield acceptable primary patency and limb salvage in patients with stenotic lesions. Many of the patients treated for occlusive lesions require re-intervention. Based on patency and limb salvage, SIA appears superior to atherectomy for the treatment of lower extremity occlusive disease.
Sixt and co-workers (2010) reported the acute and long-term outcome of Silverhawk- assisted atherectomy for femoro-popliteal lesions. In this prospective study, de novo and re-stenotic lesions of the femoro-popliteal segments were treated with the Silverhawk device. A total of 161 consecutive patients (164 lesions) with PAD Rutherford classes 2 to 5 were included from June 2002 to October 2004 and October 2006 to June 2007 (59 % male, mean age of 67 +/- 11 years, range of 40 to 88) and the outcome analyzed according to the TASC II classification. Directional atherectomy alone was performed successfully in 28 % (n = 46), adjunctive balloon angioplasty in 65 % (n = 107) and stenting in 7 % (n = 11). The overall technical success rate was 76 % (124/164) and the procedural success rate 95 % (154/164). At 12 months primary patency rate was 61 % (85/140) and the secondary patency rate was 75 % (105/140) in the entire cohort, being less favorable in TASC D compared to TASC A to C lesions (p = 0.034 and p < 0.001, respectively). Furthermore, the re-stenosis rate differed trendwise (p = 0.06) between de novo and re-stenotic lesions. Changes in the ABI and the Rutherford classes were significantly in favor of TASC A to C lesions compared to TASC D after 12 months (p = 0.004). The event free survival (myocardial infarction, transient ischemi attack, or re-stenosis) was 48 % at 12 months and 38.5 % at 24 months. Predictor for re-stenosis in the multi-variable analysis was only male gender (p = 0.04). The authors concluded that the results in TASC D lesions are inferior to those in the lesser stages. Directional atherectomy of femoro-popliteal arteries showed a trend to better long-term technical and clinical outcome in de novo lesions compared to re-stenotic lesions.
Jaff et al (2010) analyzed therapeutic strategies, outcomes, and medical cost of treatment among Medicare patients with PAD. Patients who underwent therapy for PAD were identified from a 5 % random sample of Medicare beneficiaries from Medicare Standard Analytic Files for the period 1999 to 2005. Clinical outcomes (death, amputation, new clinical symptoms related to PAD) and direct medical costs were examined by chosen re-vascularization options (endovascular, surgical, and combinations). One-year PAD prevalence increased steadily from 8.2 % in 1999 to 9.5 % in 2005. The risk-adjusted time to first post-treatment clinical outcome was lowest in those treated with PTA or atherectomy and stents (hazard ratio [HR], 0.829; 95 % confidence interval [CI]: 0.793 to 0.865; p < 0.001) and stents only (HR, 0.904; 95 % CI: 0.848 to 0.963; p = 0.002) compared with PTA alone. The lowest per patient risk-adjusted costs during the quarter of the first observed treatment were associated with "PTA and stents" ($15,197), and stents only ($15,867). Risk-adjusted costs for surgical procedures (bypass and endarterectomy) were $27,021 during the same period. Diabetes was present in 61.7 % of the PAD population and was associated with higher risks of clinical events and higher medical costs compared with PAD patients without diabetes. The authors concluded that clinical and economic burden of PAD in the Medicare population is substantial, and the interventions used to treat PAD are associated with differences in clinical and economic outcomes. They stated that prospective cost-effectiveness analyses should be included in future PAD therapy trials to inform payers and providers of the relative value of available treatment options.
Guidance from the National Institute for Health and Clinical Excellence (NICE, 2011) concluded that "current evidence on the efficacy of percutaneous atherectomy of femoropopliteal arterial lesions with plaque excision devices is inadequate in quality. Evidence on safety is inadequate, specifically with regard to the risk of distal embolisation. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research." The NICE guidance stated that further research into percutaneous atherectomy of femoropopliteal arterial lesions with plaque excision devices should take the form of well-conducted trials, which should define patient selection, treatment protocols and location and types of arterial lesions treated, and report long-term patency outcomes.
An interventional procedure consultation document on percutaneous laser atherectomy for peripheral arterial disease from the National Institute for Health and Clinical Excellence (2011) concluded: "The evidence on percutaneous laser atherectomy for peripheral arterial disease raises no major safety concerns. Current evidence on its efficacy is inadequate in quantity and quality (in particular, the technical indications for the procedure are not well described in the published literature). Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research." The consultation document stated that further research should describe the criteria for selection of patients and report clearly whether percutaneous laser atherectomy was used instead of conventional balloon angioplasty (and the reasons for this) or whether balloon angioplasty was attempted but found not to be feasible. In addition, reports should specify whether the procedure was used alone to recanalize arteries or with adjunctive balloon angioplasty and/or stenting. When percutaneous laser atherectomy is used instead of balloon angioplasty, then studies should compare the outcomes of the two procedures. Reported outcomes should include objective evidence of arterial patency and blood flow in addition to clinical effects. The consultation documents noted that long-term follow-up (2 years and beyond) would be useful.
Guidance from the National Institute for Health and Clinical Excellence (NICE, 2012) on percutaneous laser angioplasty concluded: " Current evidence on the efficacy and safety of percutaneous laser atherectomy as an adjunct to balloon angioplasty (with or without stenting) for peripheral arterial disease is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit." The guidance stated that patient selection should be carried out by a vascular multidisciplinary team including a vascular surgeon and a vascular interventional radiologist. The guidance stated that the multidisciplinary team should consider carefully whether using percutaneous laser atherectomy as an adjunct to balloon angioplasty (with or without stenting) for peripheral arterial disease is likely to have any benefits over conventional recanalization by balloon angioplasty (with or without stenting) alone. The specialist advisers to NICE listed key efficacy outcomes as an increase in arterial diameter and blood flow, tissue healing, symptom relief, improvement in quality of life, amputation-free survival and reintervention rates. The NICE committee noted that much of the evidence on this procedure is not recent, and that a limited amount of the older evidence described using laser alone for atherectomy but more recent evidence focused on its use as an adjunct to balloon angioplasty (with or without stenting). This more recent evidence and the advice of specialists underpinned the decision to evaluate laser recanalization as an adjunctive procedure. The NICE guidance noted, while the committee considered the evidence adequate to recommend normal arrangements for the use of percutaneous laser atherectomy as an adjunct to balloon angioplasty (with or without stenting), it remained uncertain about whether its use confers any advantages over balloon angioplasty alone and, if so, in which patients.
The Trellis® Peripheral Infusion System has been developed as a percutaneous mechanical thrombectomy treatment for deep vein thrombosis (DVT) that does not respond adequately to anticoagulant and/or thrombolytic therapy. This system consists of a specially designed catheter that is connected to a handheld motorized control unit. Guided by ultrasonographic images, the Trellis catheter is inserted into an appropriate vein and advanced to the thrombosis. A guidewire is threaded through the clot; next the catheter is advanced into the clot so that the distal end of the catheter passes completely through the clot but the proximal end of the catheter does not enter the clot. At this point in the procedure, balloons in the proximal and distal ends of the catheter are inflated to seal off the section of the vein containing the clot, a thrombolytic agent is injected through the catheter into the clot, and the motor is activated, which causes rotation of a sinusoidally shaped wire that lies between the inflated balloons. The combined action of the thrombolytic agent and rotating wire disrupt the clot, and the disrupted material can be aspirated through the catheter. After clot removal, the balloons are deflated and the catheter is removed. The procedure using the Trellis system has been referred to as isolated segmental pharmacomechanical thrombolysis.
The Trellis Infusion System received FDA 515(k) clearance (K013635) on December 11, 2002. According to the clearance summary, the Trellis Infusion System is intended for controlled and selective infusion of physician-specified fluids, including thrombolytics, into the peripheral vasculature.
The Trellis Plus Infusion System received 510(k) clearance (K021958) on July 3, 2002. The system is intended for controlled and selective infusion of physician-specified fluids, including thrombolytics, into the peripheral vasculature.
The Trellis Reserve Infusion System received 510(k) clearance (K023514) on December 2, 2002. The Trellis™ Reserve Infusion System is intended for controlled and selective infusion of physician-specified fluids, including thrombolytics, into the peripheral vasculature.
A "Modification to the Trellis Reserve Infusion System" received 510(k) clearance (K032261) on August 22, 2003. According to the clearance summary, the Trellis™ Reserve Infusion System is intended for controlled and selective infusion of physician-specified fluids, including thrombolytics, into the peripheral vasculature. The Trellis Reserve Infusion System is equivalent to the predicate product, the original Trellis Reserve Infusion System. The indications for use, function, methods of manufacturing, and materials used are substantially equivalent. Bacchus Vascular, Inc. believes the Trellis Reserve Infusion System is substantially equivalent to existing legally marketed devices.
The Trellis-8 Peripheral Infusion System received 510(k) clearance (K050147) on February 3, 2005. According to the clearance summary the Trellis™-8 Peripheral Infusion System is intended for controlled and selective infusion of physician specified fluids, including thrombolytics, into the peripheral vasculature.
The Trellis-6 Peripheral Infusion System received 510(k) clearance (K071664) on July 13, 2007. According to the clearance summary the Trellis™-6 Peripheral Infusion System is intended for controlled and selective infusion of physician specified fluids, including thrombolytics, into the peripheral vasculature. The system enables the physician to isolate a treatment region, infuse a physician-specified fluid, and disperse the fluid by means of oscillation of a Dispersion Wire. The Isolation/Infusion component is a multi-lumen catheter with two compliant balloons at the distal end and infusion holes located between these balloons. The device also has a central through-lumen that is compatible with a 0.035" guidewire. The Dispersion Wire provides oscillation when activated. The Dispersion Wire is connected to an integral Oscillation Drive Unit that oscillates the Dispersion Wire within the isolated region to further disperse the infused fluid. If desired by the physician, post procedure aspiration of the isolated area between the occluding balloons may be accomplished through the catheter by using the guidewire lumen.
Papantoniou et al (2013) stated that Paget-Schroetter syndrome (PSS) is a rare form of thoracic outlet syndrome caused by axillo-subclavian vein thrombosis that typically presents in healthy young adults. Prompt therapy, traditionally by means of catheter-directed thrombolysis (CDT) prior to definitive surgery, can prevent the subsequent onset of post-thrombotic syndrome (PTS) and considerable disability. As CDT is associated with major hemorrhage and high overall treatment cost, pharmaco-mechanical thrombectomy (PMT) seems to be an attractive alternative that combines pharmacological thrombolysis with mechanical clot disruption. The Trellis-8 peripheral infusion catheter is an example of such a treatment, which provides topical thrombolysis in an isolated zone. These investigators described the use of the Trellis-8 PMT system in the successful management of 3 patients with PSS.
Furthermore, an UpToDate review on "Primary (spontaneous) upper extremity deep vein thrombosis" (Goshima, 2014) states that "Mechanical thrombolysis (e.g., Trellis, AngioJet, EKOS catheter) is often used in combination with pharmacologic thrombolysis. There are limited data involving the use of these devices to treat upper extremity thrombosis". Moreover, mechanical thrombolysis is not mentioned in the "Summary and Recommendations" of this review.
In a Cochrane review, Wasiak and colleagues (2012) examined the effects of percutaneous transluminal coronary rotational atherectomy (PTCRA) for coronary artery disease in patients with non-complex and complex lesions (e.g., ostial, long or diffuse lesions or those arising from in-stent re-stenosis) of the coronary arteries. For the original review, these investigators searched the Heart Group Specialised Register; The Cochrane Library to Issue 2, 2001; and MEDLINE, CINAHL, EMBASE and Current Contents to December 2002 and reviewed reference lists for relevant articles. For the current review, they searched the same registries from 2002 to 2012 and reviewed reference lists for relevant articles. These researchers included randomized and quasi-randomized controlled trials of PTCRA compared with placebo, no treatment or another intervention and excluded cross-over trials. Two review authors independently extracted data and assessed the risk of bias of the studies identified. Data were extracted independently by 2 review authors. They asked authors of trials to provide information when missing data were encountered. Statistical summaries used risk ratios (RR) and weighted mean differences. These researchers included 12 trials enrolling 3,474 patients. The overall risk of bias was unclear for the majority of articles due to a lack of reported data; however, the authors determined that this would be unlikely to impact negatively as most data outcomes were objective (e.g., death versus no death). There was no evidence of the effectiveness in improving patient outcomes of PTCRA in non-complex lesions. In complex lesions, there were no statistically significant differences in re-stenosis rates at 6 months (RR 1.05; 95 % confidence interval (CI): 0.83 to 1.33) and at 1 year (RR 1.21; 95 % CI: 0.95 to 1.55) in those receiving PTCRA with adjunctive balloon angioplasty (PTCA) (PTCRA/PTCA) compared to those receiving PTCA alone. Morphological characteristics distinguishing complex lesions have not been examined in parallel-arm randomized controlled trials. The evidence for the effectiveness of PTCRA in in-stent re-stenosis was unclear. Compared to angioplasty alone, PTCRA/PTCA did not result in a statistically significant increase in the risk of major adverse cardiac events (myocardial infarction (MI), emergency cardiac surgery or death) during the in-hospital period (RR 1.27; 95 % CI: 0.86 to 1.90). Compared to angioplasty, PTCRA was associated with 9 times the risk of an angiographically detectable vascular spasm (RR 9.23; 95 % CI: 4.61 to 18.47), 4 times the risk of perforation (RR 4.28; 95 % CI: 0.92 to 19.83) and about twice the risk of transient vessel occlusions (RR 2.49; 95 % CI: 1.25 to 4.99) while angiographic dissections (RR 0.48; 95 % CI: 0.34 to 0.68) and stents used as a bailout procedure (RR 0.29; 95 % CI: 0.09 to 0.87) were less common. The authors concluded that when conventional PTCA is feasible, PTCRA appears to confer no additional benefits. There is limited published evidence and no long-term data to support the routine use of PTCRA in in-stent re-stenosis. Compared to angioplasty alone, PTCRA/PTCA did not result in a higher incidence of major adverse cardiac events, but patients were more likely to experience vascular spasm, perforation and transient vessel occlusion. In certain circumstances (e.g. patients ineligible for cardiac surgery, those with architecturally complex lesions, or those with lesions that fail PTCA), PTCRA may achieve satisfactory re-vascularization in subsequent procedures.
An UpToDate review on "Specialized revascularization devices in the management of coronary heart disease" (Cutlip, 2014) states that "Rotational atherectomy summary -- The American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) guideline update for PCI concluded that there is no evidence that rotational atherectomy improves late outcomes in lesions that can be safely treated with stenting or angioplasty alone. When rotational atherectomy is being considered, the weight of evidence or opinion was in favor of the efficacy of IVUS for establishing the presence and distribution and coronary calcium. However, in our practices, IVUS is rarely used for this indication".
Beschorner and Zeller (2014) stated that mechanical atherectomy for in-stent restenosis (ISR) appeared to be limited by a low patency rate. This might be due to the mechanical trauma that induces an inflammatory response leading to recurrent ISR. Addition of drug-eluting balloon (DEB) angioplasty could overcome these challenges while preserving the advantages of a better acute result. However, the authors concluded that due to lack of clinical data, combination of atherectomy and DEB remains an experimental procedure for ISR 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 :
|Other CPT codes related to the CPB:
|Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
|Bypass graft, with vein; subclavian-subclavian
|axillary- axillary
|brachial- brachial
|axillary-femoral- femoral
|femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels
|tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial
|popliteal-tibial, -peroneal atery or other distal vessels
|In-situ vein bypass; femoral-popliteal
|femoral-anterior tibial, posterior tibial, or peroneal artery
|popliteal-tibeal, peroneal
|Bypass graft, with other than vein; aortoiliac
|37211 - 37214
|Transcatheter therapy, arterial or venous infusion for thrombolysis
|37220 - 37223
|Revascularization, endovascular, open or percutaneous; iliac artery
|37224 - 37227
|femoral, popliteal artery(s)
|37228 - 37235
|tibial, peroneal artery
|Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
|visceral artery (except renal), each vessel
|abdominal aorta
|brachiocephalic trunk and branches, each vessel
|iliac artery, each vessel
|HCPCS codes not covered for indications listed in the CPB:
|Catheter, transluminal angioplasty, drug-coated, non-laser [drug-eluting balloon in combination with mechanical or laser peripheral atherectomy]
|ICD-10 codes covered if selection criteria are met:
|Isolated segmental pharmacomechanical thrombolysis (Trellis Peripheral Infusion System):
|No specific code
|ICD-10 codes not covered for indications listed in the CPB (not all inclusive):
|Acute embolism and thrombosis of deep veins of lower extremity
|Acute embolism and throbosis of other specified veins [Paget-Schroetter syndrome]
Trellis Peripheral Infusion System


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Wolfensohn: Trust between Israelis and Palestinians at a 10-year low
The western wing of the American Colony Hotel in East Jerusalem has been transformed over the past few days into the improvised office of the Quartet's envoy overseeing the disengagement plan, James Wolfensohn. The rooms have been furnished with desks, computers and filing cabinets; cartons of paper for the printer fill the bathtub; and the envoy has a bulletproof BMW, a diplomatic staff and security guards from the U.S. State Department to ferry and accompany him to and from the Prime Minister's Office in Jerusalem, the Defense Ministry in Tel Aviv, and meetings with senior Palestinian Authority officials and Israel and Palestinian businessmen.
Wolfensohn, until recently the president of the World Bank, is charged with overseeing the economic and civilian coordination of Israel's withdrawal from the Gaza Strip and northern West Bank, as well as forwarding initiatives to rehabilitate and develop the Palestinian economy. He is working in conjunction with the U.S.'s security coordinator, General William Ward; but unlike Ward, who spends most of his time in the region, Wolfensohn prefers to stop over every few weeks rather than to remain more permanently.
He believes it is better for him not to be dragged into dealing with the small details, but to oversee things from the outside.
In an interview yesterday with Haaretz, Wolfensohn spoke of distinct progress in the talks on coordinating the pullout between Israel and the PA. "In the first weeks, all the negotiations were on the agenda... What we've managed to do in the last couple of weeks is to say that we're actually getting into negotiations on the specifics," he commented.
Wolfensohn spoke of a number of key issues slated for discussion, with the list headed by the matter of the crossings between "the Palestinian areas" and Israel. "To the Palestinians, as well as for the Israelis, it's clear that you cannot create a prison in Gaza, or the northern West Bank, and if you do that, there is no possibility for either hope or peace," he said. "So it's in the interest of both sides, both economically and in terms of the future, to have appropriate methods of moving people and goods in a secure way."
The second key issue, according to the envoy, is that of the link between Gaza and the West Bank, with Wolfensohn noting the need for a physical connection between the two areas, as well as interim arrangements until this connection - a road, or rail line - is in place.
Wolfensohn believes the solutions vis-a-vis the crossings, the link between Gaza and the West Bank, and the easing of restrictions on movement in the West Bank itself must strike a balance between preserving Israel's security and the need to facilitate the passage of people and goods on the Palestinian side.
"They're all the same issue of how to build confidence, trust and security in order to free up economic and social progress," Wolfensohn said. "And the sad thing is that the level of confidence between Israelis and Palestinians at this moment is at its lowest in the past 10 years, so it's not an easy task to reestablish confidence."
"The problem I have in this part of the world, which I love, is that everybody is so hyped up about the other side that these irrational rumors emerge in the debate. And everybody has an angle," he continued.
"The principle for Israelis is clearly security, and we need to find solutions that within the framework of security enable a better life for the Palestinians - and I believe it is possible. I also believe that a better life for the Palestinians is one of the more important elements in Israeli security." He added: "If you have a people that have a sense of hope, they're much less likely to go out and shoot you."

subset: commoncrawl


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Would you be able to pronounce these names?
DS March 2011 - Got my GOLD ( . )( . )!
DD October 2012
Yes, I'd say them both "zah-rah". But, I'm also the errant weirdo who consistently pronounces Cara/Kara "kah-rah", Mara "mah-rah", & Lara "lah-rah". I'd guess it's a regional thing.
Zahra would probably be mispronounced less, and is the usual transliteration, right? That GMV, but thanks to Zara Phillips, I can't imagine people messing up Zara too much.
Shan: Jonas(8), Bridget(6), Daphne(3), Malcolm(1.5)
Roses and Cellar Doors (name nerdery)
"Though it be not written down, forget not that I am an ass."
I'd pronounce both as Zah-rah. I think Zara would be pretty intuitive, and most people would get it right, but you might have trouble with people skipping the h in Zahra.
me + him = him
acronyms and such ( o Y o )
I thought they were the same thing! So is Zara pronounced Zare-ah? I like the spelling of Zahra better.
DS March 2011 - Got my GOLD ( . )( . )!
DD October 2012
Zara gmv. I would have said it correctly. Very pretty.
I pronounced these Zah Rah.
Jackson Carl. Nov. 4th, 2010. 9 lbs 9 oz, 22.5 inches long.
I would say them both as Zah rah. Like PP I also pronounce Mara, Kara and Sara the same way.
SAHM to Liam 10/29/08 Caleb 4/12/10 and
Owen 3/29/13
I say them both like zahr-uh. Not like Sara. Do not like either.
- Molly
★ Audrey 1.20.07
★ Gabriel 5.21.10
★ Wyatt EDD 2.25.13


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ANALYSIS / What does Nasrallah mean by 'defense strategy'?
Having completed the prisoner swap, Hezbollah seeks new justification for continued military activity.
In his latest speeches Hezbollah leader Sheikh Hassan Nasrallah has resumed using the term "defense strategy" in reference to future military action by his organization.
"We are always ready to discuss the defense strategy. We are not afraid of discussion," Nasrallah said in his speech in Beirut Wednesday, "... because Lebanon is not out of danger."
What did he mean? "Defense strategy" is in effect the justification for Hezbollah's continued military activity within Lebanon and vis-a-vis Israel.
In the domestic sphere, Nasrallah was indicating Hezbollah's response to its political rivals' demand that it disarm or merge with the Lebanese Army, which the organization is loth to do.
The demand to disarm has been increasing since May, when Hezbollah militants attacked rivals from various sects throughout Lebanon.
Nasrallah claims that Hezbollah's weapons are only part of a broad defense system that Lebanon should set up.
On Wednesday he hinted that members of all sects in Lebanon would be required to contribute to the country's defense from now on. He did not say whether he meant that all Lebanese citizens will have to serve in the army, but he made it clear that Hezbollah would continue to act alongside the army as the Shi'ite defense force.
Israel is following Nasrallah's moves and statements closely.
Nasrallah said that now his organization's mission is to free Lebanese lands still occupied by Israel - the Shaba Farm area, Kfar Shuba (Har Dov) and the northern part of Ghajar village, from which Israelis forces did not withdraw after the Second Lebanon War.
Recent reports in the Lebanese media suggest that completing the prisoner exchange with Israel may bring about a change in Hezbollah's military actions.
The Israel Defense Forces, meanwhile, fears that Hezbollah will now seek ways to act against the IDF in Lebanon.
It could attack Israeli military aircraft, ships or soldiers entering Lebanese space or territory, in violation of the UN resolution that ended the 2006 war.
Nasrallah could also use the "defense strategy" to legitimize Hezbollah activity in Lebanese villages.
In the past two years Hezbollah has been bolstering its underground infrastructures in South Lebanon, despite villagers' fears that they could be hurt in a future confrontation.


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Top Definition
Iain Meadows is one of the coolest guys ever. He is cool as a spider monkey. His name means - The one with orange hair and large cock
IainMeadows is a cool guy with orange hair and a big cock
af SEXYGIRL101 23. november 2007
Skriv din email-adresse nedenunder for at få Dagens Urban Ord gratis hver morgen!
Emails sendes fra firstname.lastname@example.com. Vi lover ikke at spamme dig.×


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Undercover at an Obama health care meet-up
Conservative blogger Dan J. at Falling Panda reports on what's going on at those Obama health care meet-ups.
Check out his account here.
Bottom line: Hope for defeating the Obamacare behemoth lives:
I came away from this meeting with a renewed confidence that Obama would not be able to rely on his loyal activist army to sell nationalized health care. While these individuals are passionate and are perfectly capable of handing out flyers and talking about "hope" and "change" during an election cycle, they were clearly grossly under prepared to answer questions about an issue as complex as health care from concerned citizens.
Perhaps I'm wrong. I'll find out on June 27 when the Obama army takes to the streets and we see the results of the brainstorming sessions in action. However the entire time I was at the meeting, for all of the talk of "Health care for all" and how "meaningful reform can't wait" there was not a single question or mention of the programs potential costs to the taxpayer. If these well meaning activists are under the impression that they won't be confronted by individuals who are already incensed with Obama's proclivity to spend large sums of money and his failure to propose any realistic way of paying for it all, then they have another thing coming.
Concerned citizens have a good chance of killing this ill conceived health care overhaul. I'm convinced of this after seeing first hand those who Obama has fighting for him on the ground.
Obamacare's tax-time torment
March 16, 2016 07:08 AM by Michelle Malkin
Of course: Obama admin, media report 'unprecedented demand' for mandated product
December 16, 2015 12:03 PM by Doug Powers
Obama says there's been lots of 'misinformation' spread around about Obamacare (hey, he's right!)
November 5, 2015 12:03 PM by Doug Powers
Doctors agree: Obama's electronic medical records mandate sucks!
October 23, 2015 04:48 AM by Michelle Malkin
Hillary's such an 'enemy' of drug companies that she's the #1 recipient of the industry's donations (a Sunday open thread)
October 18, 2015 09:11 AM by Doug Powers
Categories: Health care, Politics, Barack Obama, Hillary Clinton, 2016 Campaign


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The method specified applies for temperatures within the range from 5 to 80 °C. The property is determined with an uncertainty not exceeding 3 % r. h. The method is restricted to wet-bulb temperatures not lower than 1 C, dry-bulb temperatures not higher than 80 °C, and pressures not differing from standard atmospheric pressure by more than 30 %.
Document published on: 1985-10-24 Edition: 1 (Monolingual) ICS: 19.020 Status: Withdrawn Stage: 95.99 (2015-05-29) TC/SC: ISO/TMBG Number of Pages:
No revision information available
No corrigenda or amendments available


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NBA exhibition notebook: Misleading merchandise
Former Oklahoma standout and reigning NBA Rookie of the Year Blake Griffin was unable to participate in Sunday's exhibition game at the Cox Convention Center after reportedly cutting his foot swimming in the ocean.
The event initially was dubbed as a showdown between Griffin and the Thunder's Kevin Durant.
Though Griffin was not in attendance, T-shirts promoting "Durant Versus Griffin Showdown" were sold in the arena.
The crowd was estimated at 13,000, which is roughly 400 shy of a sellout at the Cox Convention Center. It is the largest crowd for any NBA exhibition game in the United States this summer. The previous high being 4,800 at Morgan State in Baltimore.
Players are not allowed to hold exhibitions in NBA facilities during the lockout.
Other no-shows included Amar'e Stoudemire of the New York Knicks, Monta Ellis of the Golden State Warriors, John Wall of the Washington Wizards and the Thunder's Kendrick Perkins.
Rudy Gay of Memphis arrived in the fourth quarter, but did not play. Thunder first-round draft choice Reggie Jackson of Boston College was a late addition to the White Team roster.
"KD told me this is just how the fans were, so it was fun," Jackson said. "I got to be around a bunch of All-Stars. I had fun just watching for the most part."
With 2:56 remaining in overtime, Durant picked up his fifth personal foul, which is one short of disqualification in an NBA game.
Asked if he was afraid he was going to foul out, Durant smiled and drew laughter by saying, "No, it's my game. I can't foul out."
Chris Paul: "He couldn't foul out, but he couldn't shoot without getting fouled."
Durant: "Nah, it's all good."
Former Oklahoma State great and 10-year NBA veteran Desmond Mason helped organize the event and served as coach of the Blue Team. Comedian DeRay Davis coached the White Team.
Thunder guards Eric Maynor and Daequan Cook watched from the front row. Also in attendance was WNBA star Tina Thompson.
"You don't understand how much I miss this place. To see the fans and how much support we have out here, it's unbelievable. I have flashbacks and memories, but hopefully we can get this lockout over and this deal done so we can get back on the court." – Thunder guard James Harden
When the Thunder's Russell Westbrook air-balled a wide open 3-pointer from the right corner, public address announcer Miles Rawls quipped, "Twenty-five push-ups, Russ," as Westbrook ran down court. … At halftime, Durant presented a $100,000 donation to the Single Parent Support Network, a charity for which his mother, Wanda Pratt, serves as chairman. … Players were introduced by their colleges, not their NBA teams. … Several players didn't play at full-speed, which made Westbrook even faster. … Paul had an array of remarkable assists, including a one-handed, alley-oop bounce pass from 30 feet away to a streaking Harden.


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Category: Android
HKC sells 2.2 Million Tablets per year
HKC shows their tablets, they're selling 2.2 Million tablets per year at the moment, through stores like Walmart in the USA.
JSR Innos Qualcomm Smartphones (even Windows Phone soon they say)
JSR is a 4 years old company that makes smartphones. Most of their smartphones run on Qualcomm processors, have plenty of RAM memory and come with different optional color designs.
Their smartphone market is branded "Innos". The smartphones are Dual-Sim and use IPS display viewing angles and OGS (One Glass Solution) touchscreen technology with HD and FHD resolution. Their smartphone models are claimed to be very stable and are 3G compatible. On the coming months they are releasing a smartphone with LTE compatibility.
JSR is on negotiations with mobile service operators in Indonesia, Sri Lanka and Philippines for maybe making custom made devices. JSR already has a widespread market all around the world. Microsoft has sold a Windows Phone Software license to JSR for being able to make Windows Phone smartphones which are coming later by JSR. JSR sells more than 300,000 devices per month.
Finwe and vrAse show how the Smartphone-in-your-face powers the mass market virtual reality media of the future, it works!
I discovered the awesomeness that are Finwe and vrAse which quite simply made me understand the whole VR segment for the first time. The idea that we will simply use our Smartphones and Tablets to power really advanced mass market heads-up augmented reality applications, this is awesome. There isn't need for Facebook's $2 Billion Oculus VR.
So you have been seeing all the news about Finwe and vrAse right here on ARMdevices.net consider that websites TheVerge, CNET and co don't even know yet that this awesomeness exists.
ARM Set-top-box industry overview by Informa analyst
ARM overtakes MIPS in the Set-top-box market as most of the Set-top-box SoC makers are showing ARM solutions, it's about the ecosystem, about the platform, Android, Google TV, RDK, Wyplay, all of these user interfaces are being optimized for ARM, bringing cheaper and better more advanced and more powerful devices all at the same time. The TV market is bigger than the Web, as people still spend a lot more time watching TV than browsing the web in average. And the new features enabled by ARM, Android and other platforms, enable a lot more video-on-demand and other forms of interactivity on the TV.
Entropic EN7310 ARM SoC for Set-top-box with HEVC and MoCA 2.0
Entropic shows their latest EN7310 ARM Cortex-A9 SoC with IP-STB and HDMI Stick features, integrated multi-tuner dual DVB-S/S2 cable reception, advanced security and DRM, HEVC decode and transcoding with Multimedia over Coax Alliance (MoCA) 2.0 home networking.
Entropic is a fabless semiconductor company recognized for inventing the MoCA (Multimedia over Coax Alliance) home networking technology, creating Direct Broadcast Satellite (DBS) Outdoor Unit (ODU) single-wire technology, and developing the industry's first ARM processor and OpenGL graphics Set-top box (STB), System-on-a-Chip (SoC).
This video also features Eagle Kingdom Technologies (EKT) who launches DCP5205 world`s first Entropic powered hybrid PowerPlug Set-top-box combining the functionality of a Set-top-box into a plug socket, thus eliminating the need for a separate power adapter commonly required in today's hybrid STBs.
Sigma Designs SMP8756 ARM for Android Set-top-boxes
Sigma Designs, a leading provider of System-on-Chip (SoC) solutions for home entertainment, control, connectivity and converging multimedia delivery, launches its new High Efficiency Video Coding (HEVC)-capable SMP8750 family ARM Processors for Set-top-boxes. Combining the HEVC compression standard with a high performance ARM Cortex A9, ARM Mali-400 GPU, the SMP8756 enables Sigma Designs to offer more performance, a better user experience and full video quality for the Set-top-box market.
Sigma SMP8756 features HEVC's Main-10 profile allowing processing of up to 10 bit color samples accepted as the standard for 4Kx2K, OTT (over the top) and IPTV content. The SMP8750 family will support FHD and 4K resolutions. The new SMP8750 family offers SoCs at multiple cost and performance combinations allowing each SoC to offer optimal performance to price ratio for multiple STB platforms from zappers, PVR capable, Hybrid-broadcast and IPTV STBs.
The SMP8750 family migrates robust STB SoC components like broadcast TS processing, OTP and security infrastructure paired with an ARM A9 CPU and Mali GPU. The single-core ARM A9 CPU and 3000 DMIPS of application processing along with a Mali GPU combine to provide a dramatic performance profile for new 3D user interfaces, over-the-top and casual gaming applications. Incorporating Sigma's industry-proven technologies such as secure media processing, multi-format Full-HD video decoding, VXP display processing, and field-proven AV software core, the SMP8756 is able to provide premium quality video experience. A software SDK is available for either Linux or Android platform development. Future certification of CAS technologies like Verimatrix and Nagravision are planned.
The chipset also demonstrates ecosystem compatibility, leveraging the widely supported ARM processing core, OpenGL ES, HTML-5 and others to ensure that a broad range of existing applications will run including a wide range of hardware and software extensions to support the system solutions; including global tuner/demodulator standards, wired and wireless network controllers, DTV middleware stacks and IPTV middleware ports, such as Wyplay and OpenTV.
The SMP8756 comes with a full Software Suite, including libraries and services packaged under both Linux and Android development kits for rapid development. It incorporates managed power consumption, developed for both US and European regulatory compliance and is developed to a minimal R-BOM to allow smaller footprint and lower cost implementations.
STMicroelectronics Set-top-box ARM Processors: STiH312 Cannes and STiH412 Monaco
ST's latest ARM Powered System-on-Chips supporting Android, Google TV (now Android TV), rdk, ST presents their STiH312 client-box and STiH412 server-box product families, codenamed 'Cannes' and 'Monaco,' respectively, they integrate Faroudja technology to decode and display video up to Ultra HD 4K (2160p) and the next-generation H.265 / HEVC video compression. Even supporting video transcoding (for local and remote streaming from the Set-top-box to Tablets, Smartphones, etc) STMicroelectronics presents their Dual core ARM Cortex-A9 (on 28nm process) with quad-core Mali-400 GPU does Quad-HD Ultra HD 4K HEVC video decoding, combined with Faroudja video processing technology (decoding on Cannes, decoding and transcoding on Monaco), advanced security supporting concurrent conditional access and DRM, wide connectivity, including USB 3.0, PCI-e, SATA and Gigabit Ethernet, Dedicated interfaces to a range of companion front-end solutions, including MoCA 2.0, DOCSIS 3.0, satellite and 802.11ac WiFi and more.
Zopo Headquarters Shenzhen R&D Tour
Tour at the Zopo headquarters in Shenzhen China, where the Zopo R&D team are putting final touches to the design of the upcoming Zopo ZP1000 ultra-thin and impressive 7.2mm Octa Core MediaTek MT6592 phone.
Shenzhen ZOPO Communications-equipment Co Ltd was founded in 2012 engaging in R&D, production, marketing and service of MediaTek based smartphones. I filmed my first video with Zopo Mobile at its founding when they launched the Zopo ZP100 (2). ZOPO ZP200 was "China's first Glasses-Free 3D dual sim smartphone". ZOPO was the first company to manufacture and deliver a Linux Sailfish OS smartphone to the Indian market. Zopo sells a lot of phones to China, Germany, Benelux, Netherlands and a lot of other European countries.
Zopo ZP990+, 6″ FHD, MT6592 Octa Core
Selling for $321 on the Chinese market.
Zopo ZP980+, 5″ FHD, MT6592 Octa Core
Selling for $241 on the Chinese market.


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A Gottschalk Festival / Abravanel, Utah SO
3 CD / Musical Concepts / 2014-09-30Works: Louis Moreau Gottschalk: Symphony no 1; Le Banjo, esquisse américaine for piano, Op. 15, D. 15 (RO 22); The Dying Poet, meditation for piano, D. 45 (RO 75); Souvenir de Porto Rico, marche des ...
Performers: Esteves, Jose Alberto; Garcia, Pablo [Vocals]; Lewis, Cary; List, Eugene [Piano]; Nibley, Reid; Paniagua, Trinidad; Werner, Joseph
Conductors: Abravanel, Maurice; Buketoff, Igor; Adler, Samuel
Ensemble: ; Utah Symphony Orchestra
Louis Moreau Gottschalk was America's first musical superstar, a virtuoso pianist and sensation not unlike his contemporary Liszt.
His compositions were very popular in his...continue...
Sibelius: Symphonies Nos. 1-7 / Maurice Abravanel
3 CD / Musical Concepts / 2011-10-11Works: Jean Sibelius: Symphony no 1 in E minor, Op. 39; Symphony no 4 in A minor, Op. 63; Symphony no 2 in D major, Op. 43; Symphony no 3 in C major, Op. 52; Symphony no 5 in E flat major, Op. 82; Symphony ...
Conductors: Abravanel, Maurice
Ensemble: Utah Symphony Orchestra
Coming off the great success of its Mahler Symphonies box set by Abravanel and the Utah Symphony, Musical Concepts presents the complete symphonies of Jean...continue...
Recording information: Mormon Tabernacle, Salt Lake City, Utah (05/1977)....continue...
Tchaikovsky: Swan Lake / Utah SO
2 CD / Musical Concepts / 2004-11-09Works: Pyotr Il'yich Tchaikovsky: Swan Lake
Conductors: Abravanel, Maurice
Ensemble: Utah Symphony Orchestra


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Joined: 03 May 2012
Posts: 68
Smart, sexy and suave Kunwar Amarjeet Singh that is currently seen is Dil Dosti Dance as Reyansh Singhania has ended his 2 year relationship with Charlie Chauhan. The reason behind the break-up details aren't out as Kunwar does not want to talk about it .But sources are to believe that Kunwar had been having a lot of problems with Charlie since they have been eliminated from Nach Baliye, Kunwar blames Charlie for his elimination from Nach Baliye but Charlie doesn't want to accept the fact that the elimination happened because of her .
We trying getting in touch with Kunwar and Charlie but both where unavailable
Whatever it is hope both of them sort it out there misunderstanding
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It's a reunion of old friends...
Zing's popular show Pyaar Tune Kya Kiya 4 will bring back the hit jodi ...
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LONDON - The National Magazine Company has poached Jeremy Langmead, the editor-in-chief of IPC's Wallpaper, to edit its men's monthly Esquire.
Langmead replaces Simon Tiffin, who left NatMags a month ago to explore new projects.
He has been Wallpaper's editor-in-chief for four years and in September led the magazine's 10th birthday celebrations.
Jackie Newcombe, managing director of IPC SouthBank, said: "Jeremy is a hugely talented editor who has been at the helm during Wallpaper's most successful period since its launch in 1996."
Esquire has lost 17.6% of its circulation over a year, with its latest figure covering January-June this year standing at 52,437 copies.
Jessica Burley, managing director of NatMags, said: "We are delighted that Jeremy will be the new editor of Esquire. Not only does he have exceptional fashion credentials and an impressive features background, he also inspires those around him -- the perfect combination for one of the most exciting roles in the industry."
If you have an opinion on this or any other issue raised on Brand Republic, join the debate in the Forum.


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Taking Social Security Private
Mitchell, Daniel J., The World and I
Less than five years ago, Social Security was not part of the policy debate in Washington. Yes, there was a small handful of privatization advocates in think tanks and academia, but skittish policymakers viewed the program as the "third rail" of politics.
But in the last few years, there has been a remarkable turnaround. Republicans and Democrats today are proposing sweeping reforms, and the president has been leading a nationwide series of town hall meetings with the American people.
This noteworthy shire in the public debate is largely due to the growing recognition that the program is suffering from two crippling crises.
The first is financial. The baby boom generation will begin to retire in about 10 years, and Social Security will not have nearly enough payroll tax revenue to pay promised benefits. The program's total inflation-adjusted shortfall between 2010 and 2075 is more than $20 trillion, more than four times the size of the national debt. This is a lot of money, even by Washington standards.
This $20 trillion figure also represents the transition cost that would have to be made up by the government through higher payroll taxes or other devices if it wants to maintain today's 60-year-old pay-as-you-go Social Security system.
The system also suffers from a second crisis, one that some view as equally grave. Simply stated, the program is no longer a good investment for workers. Regardless of workers' age, income, ethnicity, or marital status, Social Security offers them very low old-age benefits compared with the amount of payroll taxes they are forced to contribute.
Because of complicated redistribution formulas, some groups lose more than others. Blacks and working women, for instance, are most likely to suffer negative returns. Younger workers of all backgrounds, needless to say, also fare poorly.
Social Security will begin paying out more than it collects in just 12 years. The cash deficit in 2010 will be less than $1 billion, but the numbers will quickly climb to dramatic levels. More specifically:
* Social Security's annual cash shortfall will reach $90 billion in 2015.
* By 2025, the trust fund has promised to pay nearly $500 billion more than it will collect in taxes.
* Just 10 years after that, the yearly deficit will be more than $1 trillion.
* In 2075, the last year for which the Social Security Administration provides numbers, the total shortfall will be a staggering $7.5 trillion.
* Even after adjusting for inflation, the deficits will be immense, reaching $200 billion in 2025, $300 billion in 2035, $400 billion in 2056, and $500 billion in 2068.
These huge deficits, added together, measure the total unfunded liability of the current Social Security system.
Unfortunately, the interaction of these two crises creates an even bigger problem. In short, Social Security is burdened with a giant catch-22. Almost anything lawmakers do to delay the trust fund's bankruptcy will make the program an even worse deal for workers. Proposals to make Social Security a better investment, by contrast, will simply cause the program to run out of money even sooner.
Consider, for example, the various ideas to fix the trust fund's shaky finances. Some argue that a 2.2-percentage-point increase in the payroll tax rate would solve the problem (the current tax is 12.4 percent on the first $68,400 of wages). That increase, which many argue will still leave the program deeply in the red, will make Social Security a much worse deal for workers.
Take the case of an average-income, two-earner couple born in 1970. Under current law, these workers are getting an inflation-adjusted return on their payroll taxes of only 1.2 percent. Requiring them to pay more without any increase in their benefits would mean that a wretchedly low return would become a negative return. …


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Poverty and Wealth: India versus Hong Kong
Skousen, Mark, Ideas on Liberty
From The President"Vs Desk
"The government of India regulates nearly everything, so there's very little progress; whereas in Hong Kong the government keeps its hands off ... and the standard of living has multiplied."
The mutual fund magnate John Templeton traveled around the world during the 1930s, noting in particular the extreme poverty in two Asian nations under British control, India and Hong Kong. Forty years later, in the 1970s, Templeton returned. Once again he witnessed the incredible poverty in India. But Hong Kong had changed tremendously. "The standard of living in Hong Kong had multiplied more than tenfold in forty years, while the standard of living in Calcutta has improved hardly at all."2
Today neither country is under British rule, but the contrast is even more clear. Hong Kong enjoys the greatest concentration of wealth in the world. India suffers the greatest concentration of poverty in the world.3
Twenty years ago, development economist P.T. Bauer wrote a famous little essay in which he pondered, "How would you rate the economic prospects of an Asian country which has very little land (and only eroded hillsides at that), and which is indeed the most densely populated country in the world; whose population has grown rapidly, both through natural increase and large-scale immigration; which imports all of its oil and raw materials, and even most of its water; whose government is not engaged in development planning and operates no exchange. controls or restrictions on capital exports and imports; and which is the only remaining Western colony of any significance?"4
Indeed, the prospects for Hong Kong were dismal. Yet by making cheap products for export to the faraway West, it managed to become the powerhouse of Southeast Asia. Today its citizens' incomes rival the Japanese, despite its teeming seven million people crowded into 400 square miles. What broke the vicious cycle of poverty? According to Bauer, Hong Kong's economic miracle did not depend on having money, natural resources, foreign aid, or even formal education, but rather on the "industry, enterprise, thrift and ability . . . of highly motivated people."5 Hong Kong's "overpopulation" turned out to be an asset, not a liability.
Equally important, Britain did not interfere in private decision-making. It adopted a laissez-faire economic policy, except in the area of subsidized housing and education. Communist China has pursued a largely noninterventionist approach since it took over in 1997. Hong Kong continues to flourish with a stable currency, free port, and low taxes. Its maximum income tax rate is 18 percent, and it imposes no capital-gains tax. In its economic freedom index, the Fraser Institute has always ranked Hong Kong number one in the world.6
Tragic India
India is an entirely different story. Its population of one billion remains relatively poor. Unlike Hong Kong, India has valuable natural resources-forests, fish, oil, iron ore, coal, and agricultural products, among others. It has achieved self-sufficiency in food since independence in 1947, yet deep poverty persists.
Many pundits blame India's anti-capitalist culture, its fatalistic caste system, its overpopulation problem, and its hot and humid climate (it reached 117 degrees when we visited the Taj Mahal last June). But Milton Friedman identified the real culprit when he wrote, "The correct explanation is . …


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Your First Name of: Ripsy - What does it mean?
Below is a brief analysis only of the first name of
For an analysis of your full name and destiny, see our
free Name and Birth Date Report service for further details.
- Your name of Ripsy contains many fine qualities: musical and artistic ability, good business judgment, and a sense of responsibility for the welfare of others.
- This makes you warm-hearted and understanding in your response to the needs and interests of those around you.
- You are always ready to help those in less fortunate circumstances.
- Your insistence on becoming involved in the affairs of others can cause them to regard you as interfering, even though you are only trying to help.
- A weakness lies in the fact that you are deeply affected through your feeling for others and could suffer through worry and disturbed thoughts over matters that you can do nothing about.
- While you have an appreciation for the finer things of life and could be successful along inspirational as well as business or professional lines of endeavour, there is a tendency to become involved in the needs and interests of others to the detriment of your own progress.
- Home and family are important to you and you desire to establish a settled home environment where you can enjoy the congenial companionship of friends and family.
- Mental tension could result through worrying too much over your problems or the problems of others, with an adverse effect on your nervous system.
Find out more—Free Name and Birth Date Report
In your free Name and Birth Date Report you will find out how your life is created and shaped by the powerful energies contained in your:
- first name
- last name
- combined names
- legal names
- business signatures
- nickname
- life purpose and inner potential measured from your date of birth
- destiny
Your report will cover:
- the mental strengths and weaknesses your names have created in your thinking.
- the key issues in your life shaped by your names that might be holding you back.
- the health weaknesses related to the tensions created by improper names and name combinations.
- the effect of your names on your ability to be happy and create long-term relationships.
- and most importantly, how your names affect your ability to fulfil your inner potential as measured by your birth date.
Your report will be emailed to you as a link to a web document (with an optional PDF download link) within 5 minutes. There is a limit of 6 free reports sent to one email address.
Security of Your Names and Birth Date
The names, birth date, and email you give us are used only in the preparation of your report. We do not share or give this information to anyone.
As well, the information you send us is sent in an encrypted form over a secure internet connection to our server and is totally protected. If you are under 18 be sure to obtain your parent(s) or guardian(s) permission before you order. [Full Privacy and Security Policy]
We only use your email once to send you your Name Report unless you decide to subscribe to our weekly newsletter below.
Order Form - Free Name and Birth Date Report
We Are Here To Help
We thank you for your interest and we look forward to talking with you further about the Kabalarian Philosophy after you have read your free Name and Birth Date Report. If you require further assistance, please call our head office using our toll free number of 1-866-489-1188 (or 604-263-9551 outside of North America.)
Thought for the Day


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Hardin County farmer David Mackey directed a $2,500 donation to Hardin County 4-H through America's Farmers Grow Communities. The donation will help the group provide camp scholarships for low-income youth, and for adults who attend camp as a volunteer. It will also fund volunteer leadership development through trainings and certifications, in order for them to help the youth through their skills and knowledge.
Fundraiser deadline
The deadline to turn in all Webb's butcher block fundraiser orders is April 7.
4-H Council meets
The 4-H Council will meet 6:30 p.m. April 7 at the LaRue County Extension office.
The 4-H Wranglers Horse Club will meet 7 p.m. April 8 at the LaRue County Extension office.
Most culinary herbs are perennials. Perennials live more than two growing seasons. Herbs will do well in pots, if adequate drainage is provided. Use a good-quality potting mix with fertilizer.
Container herbs will require more moisture than garden-grown herbs, and many will benefit from after-noon shade.
FREE CLASS: Tips for Growing and Using Herbs
Farmers and ranchers who plan to participate in FSA programs should register in advance. Producers are encouraged to report farm records and business structure changes to the Hardin/LaRue FSA Service Center before April 15. Enrollment for the disaster programs authorized by the 2014 Farm Bill, including the Livestock Indemnity Program and the Livestock Forage Disaster Program will begin by April 15.
Updates or changes to report include:
New producers or producers who have not reported farm records to FSA.
The Kentucky Agricultural Development Board, chaired by Gov. Steve Beshear, approved $555,026 for 11 agricultural diversification projects across the state during its March board meeting at the Franklin County Cooperative Extension Office.
The deadline is approaching for farmers to nominate rural public school districts to compete for a grant of up to $25,000, through America's Farmers Grow Rural Education, sponsored by the Monsanto Fund. Nominations will be accepted until April 6. Eligible farmers can nominate their school district by visiting www.GrowRuralEducation.com or by calling 1-877-267-3332. Grants are awarded based on merit, need and community support.
Musk or nodding thistle is the most common type of thistle locally. The primary growth period is in the spring and summer. However, most seed germinate in the fall and form a rosette which grows close to the ground, often growing unnoticed until spring.
The most important step in long-term control of thistle is to prevent flowering, and the production and spread of new seed (which is carried by wind). This can be done by mechanical or chemical control.
With summer just around the corner, it is time for Kentucky 4-H teens to register for the Kentucky 4-H Teen Conference.
The Conference takes place at the University of Kentucky June 9-12 and is open to all 4-Hers who have graduated eighth grade through the age of 18.
During the conference, 4-H members have the opportunity to experience dorm life in UK residence halls, attend educational and recreational workshops and meet new friends from across the state.
Copyright © 2016
The LaRue County Herald is your source for local news, sports, events and information in LaRue County, KY, and the surrounding area.


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NDSU's 2015 Assurance Argument: Feedback Needed
The NDSU Accreditation Report Writing Team (ARWT) is seeking feedback from NDSU faculty, staff, and students on the first draft of the 2015 NDSU Assurance Argument for reaffirmation of accreditation. The Assurance Argument is a critical component of reaffirmation of accreditation; it is an opportunity for NDSU to tell its story. NDSU faculty, staff, and students are invited to provide feedback at Open Forums on the following dates:
- Tuesday, April 14th, 9 - 10:30 a.m., Meadow Lark Room, Memorial Union
- Monday, April 20th, 2 - 3:30 p.m., Rose Room, Memorial Union
Accreditation at NDSU
Institutional accreditation by the Higher Learning Commission (HLC), also known as regional accreditation, provides assurance to current and prospective students and other stakeholders that credits and degrees earned from North Dakota State University meet quality standards of higher education. Accreditation is a requirement for federal financial aid and may be a requirement for some employment opportunities, professional licensure, and graduate education.
To ensure continued commitment to educational quality, accreditation requires periodic institutional and program reviews. The accreditation process provides an opportunity for NDSU to assess our own successes and challenges over time and make planning decisions for the future. NDSU last received reaffirmation of accreditation in July of 2006 and the next comprehensive evaluation is scheduled for October 2015.
NDSU's Accreditation History
North Dakota Agricultural College (NDAC) was first accredited in 1915 by the North Central Association (NCA) as an institution that awarded four-year and master's degrees. After a time when the (then) Board of Administrators became overly involved in the institution's activities, accreditation was withheld from April 7, 1938 until March, 1939. Five doctoral programs were initiated in 1959 and in 1960 NDAC became North Dakota State University. The NCA extended NDSU's accreditation in 1966 to include these doctoral programs. After our February 1996 comprehensive visit, the Higher Learning Commission of the North Central Association re-accredited NDSU on July 12, 2006. NDSU's current "Statement of Affiliation Status with the Higher Learning Commission is at: https://www.ncahlc.org/component/com_directory/Action,ShowBasic/Itemid,/instid,1520/
Photo from:
University Archives, 701-231-8914
Published by the University Archives, NDSU
The Higher Learning Commission has a helpful introduction to its Criteria for Accreditation at https://www.youtube.com/watch?v=c1J6-eS8a1U
NDSU Accreditation Self-Study Reports
2006 NDSU Accreditation Self-Study
1996 NDSU Accreditation Self Study HLC Strengths and Concerns


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Military parenting website assists communication
Military parenting website assists communication
Posted 10/23/2013 Updated 10/23/2013
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by Amaani Lyle
American Forces Press Service
10/23/2013 -
-- Service members who deploy or are otherwise separated from their families due to mission needs now have an online resource allowing them to hone their parenting skills as they reconnect with their children.
Pam Murphy, the Defense Department's lead psychologist for the website, said the launch of
offers unprecedented, comprehensive and free computer-based training from a service member's perspective on parenting and building strong relationships with their children.
A clinical psychologist with more than 20 years of experience in community and private practice, Murphy said the Integrated Mental Health Strategy Program is a collaborative initiative between the Veterans Affairs Department and DOD.
"We initially did an environmental scan of everything within the DOD as well as commercially available, and one of the areas that seemed to be at a deficit was a comprehensive parenting program that looks at the basics," Murphy said.
She noted that while a plethora of parenting information exists online, it was difficult to identify a free, private "military-centric" program.
"This is one of the first of its kind," Murphy said. The interactive site, she explained, develops and reinforces parenting skills to help families reconnect through in-depth technology solutions that appeal to younger parents.
"Many of the parents in the service member population are generally younger," she said. "Prominent age groups of their children are typically 5 or below."
Murphy added that the site goes beyond the job and hits home in terms of affecting family relationships, building resilience and helping service members to be happy with their lives within the military.
She also noted that service members' personalized accounts interwoven into the site make the situations and solutions relatable.
"We included videos of real service personnel ... to talk about their real-life experiences with parenting, reintegrating and making those everyday decisions," Murphy said.
The website consolidates and simplifies information that was previously accessible across multiple resources, said Senior Airman Matthew Siegele, a protocol specialist, and his wife, Staff Sgt. Sabrina Siegele, NCO in charge of knowledge operations, both of whom work at Joint Base Lewis-McChord, Wash.
"We've been through so many parenting classes, counseling and therapy, and a lot of the resources and advice is mirrored on this site," Sabrina said. "This website is excellent -- it's a one-stop shop instead of jumping around to multiple appointments."
During family separations, Murphy said, applications such as Skype and Facetime can help in keeping families connected, but the military parenting website provides ideas for technology-based activities that can help in reuniting parents and children after a deployment. "A lot of times, kids don't know what to talk about with their parents when they are on the phone or on the computer with them," she said.
Murphy said the website can help military parents to reconnect with their children.
"Parents can benefit from this site, and I believe they want their kids to grow up to be happy, healthy, fully functioning adults," she said. "Here, they'll find strategies and ideas to (get) even better in terms of helping kids to grow, mature and blossom."
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jaylemurph, on 15 February 2010 - 02:50 AM, said:
Jayle, note that I did not say the simple ancient cults being incapable of undertaking large scale building projects. Egyptians, Minoans, Sumers, Babylonians... But in all these cases we are talking about a developed civilizations with intensive urbanization and agriculture, well-structured power systems and control position of the priesthood as keepers of Knowledge, including Engineering knowledge. As I mentioned they had MONEY and all associated infrastructure - treasuries, budgets, taxes, records, archives, files etc.
But in Nazca we have a primitive culture with highest technological achievement as early post-neolithic ceramics with no glaze, not a civilization.


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The Great Xbox Shortage of 2005
Why you can't buy the one present you really need.
Gaming enthusiasts camp outside electronics stores, desperate to buy the hot new game console. Corporate flacks are deployed to fend off PR calamity: "Consumer demand for the new console has exceeded our expectations, and we are doing all we can to fulfill the wish lists of people who want a new console under their tree this holiday season."
Video-gamers are clamoring for the new Xbox 360 console, but that statement didn't come from Microsoft: It came from Sony at the beginning of last year's buying frenzy for the new slim-line PlayStation 2. In 1996, parents wrestled to get hold of a Tickle Me Elmo. 1988 saw parental panic sparked by shortages of Nintendo game cartridges. And we're now celebrating the 20th anniversary of the Cabbage Patch Kid craze: They sold $600 million of those things in 1985, and that was in the days when $600 million was worth something.
These spectacular sellouts have become as much of a holiday staple as turkey and stuffing. And, of course, they have inspired conspiracy theories. Isn't it a little odd that the same story comes round year after year? Is Microsoft really running short of consoles? Yet, for economists, the Xbox 360 crisis is more alarming than a conspiracy, because these supply shortages make no economic sense whatsoever. Despite their suspicious regularity, the shortages benefit nobody.
It isn't the scarcity of supply itself that is puzzling. That is almost inevitable for some of these seasonal toys. In any given year, many toys will be unloved and oversupplied, but a few lucky ones will be in unexpectedly high demand. We shouldn't be surprised any more than we're surprised that the champion of a knockout tennis tournament won all his matches. Somebody had to.
In Microsoft's case, the Xbox 360 can be produced only gradually, but all the demand is there at once. Plentiful supply would be possible only if Microsoft made millions of consoles in advance and stored them without releasing them, or if it built vast production lines that only ran for a few weeks—both economically unwise strategies. It makes more sense to ship the consoles as they are made—and that means gradually. The steady supply can't match peak December demand.
So, supply shortages are a fact of life. The puzzle is somewhere else: Why don't companies raise prices when supply is short and demand is frenzied? Leaving aside oxygen and a few other essentials, there is no such thing as an absolute shortage of anything: There is only a shortage if the price is too low. At the moment, Microsoft is easily selling out the half-million or so Xbox 360 units (there's no official number) for prices starting at $300 for the basic package. Why doesn't Microsoft price them at $700 instead? That's the figure that the consoles are fetching on eBay. (Back in the days of the Cabbage Patch Kids, we could only speculate how much parents would have been willing to pay for guaranteed delivery. Thanks to eBay we can now put a price on customers' frustrations.)
Perhaps the sellouts are supposed to generate free publicity. By deliberately giving Xbox consoles away too cheaply today, Microsoft gets the column inches before Christmas, and that may boost demand and sell more in the long run. If you had put that theory to me last year I might have believed it, but after all the hot air over gasoline prices this fall, no longer. It's now obvious that you can get just as much publicity by raising prices as you can by selling out at low prices. But raising prices makes money, and creating lines of frustrated customers who can't get the product doesn't.
Maybe Microsoft is worried that this would be the wrong kind of publicity, because customers would dislike a price hike. That's possible, but the publicity is already bad: Many empty-handed customers seem convinced that Microsoft has a secret hangar in Roswell stuffed full of Xboxes that they've decided not to release just yet.
In any case, strange as it may seem, even if the consoles sold out at a higher price, the average Xbox aspirant wouldn't be any worse off: The increased price should be exactly balanced by the shorter lines, reduced aggravation, and greater chance of getting a console. Customers are infuriated by the shortage itself, whether that shortage is expressed in lines (as it is today) or in high prices (as it could be if Microsoft raised them). If Microsoft is going to aggravate its customers, why doesn't it at least make a buck out of it?
So, this is all something of a headache for the dismal science. Over dinner with a friendly local economics department, I challenged them to explain the puzzle of why prices stay low in the face of such shortages. They cited a number of ingenious explanations, all of them unlikely.


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Watch This Fan Get Hit In The "Junk" At The Rangers Game Last Night!
Dallas Could Be Making A Play To Bring The Rangers Downtown!
This Is What The Rangers Have To Do To Make The Playoffs
Watch 103-Year-Old Rangers Fan Toss First Pitch
LISTEN: Ryan Cabrera Talks Celebrities, Music, And Hair!
VIDEO: DFW Reporter Gets A Powerade Bath During Rangers Interview(Not pictured.)
BREAKING: It's Official, Josh Hamilton Is Coming Back! Press Conference At 3:30!
BREAKING: Josh Hamilton Could Be Coming Back To The Texas Rangers
Real Housewife With DFW Ties Splits From Pro Athlete HubbyThis drama will probably make for an interesting season!
Live From Rangers' Opening Day...Follow along with 1037's adventures!
It's Rangers Home Opening Day! Candied Bacon, Other New Food And Changes To Globe Life Park
#WeekendRewind: Rangers Turn New Leaf; Daredevil, Rush Hour Hit Small Screen; DFW FTW


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Aug 18 Plastic Has Holes Bad Actors Can Squeeze Through
Europe Records All-Time Card-Fraud Losses While More Genuine User Transactions Blocked
According to an article on cardnotpresent.com (link to article), overall losses to card fraud in the U.K. are the highest since 2008 and, "like many other countries that have migrated to chip-and-PIN, card-not-present fraud leads the way." In one year, U.K. CNP losses jumped from $414 million to more than $505 million. In fact, when it came to losses from fraud, the U.K. and Russia led the way. Click this link for a European map of card fraud.
Blocking good customers
Martin Warwick, a principal fraud consultant at FICO, noted, "When fraud losses peaked in 2008, U.K. issuers sharply reduced card fraud through chip and PIN and fraud analytics. However, tougher fraud detection policies and thresholds also block more genuine transactions, and now the focus for U.K. banks and regulators is very much on improving the customer experience."
ThreatMetrix® builds trust on the Internet by offering market-leading advanced fraud prevention and frictionless context-based security solutions. These solutions authenticate consumer and workforce access to mission critical applications using real-time identity and access analytics that leverage the world's largest trusted identity network.
ThreatMetrix secures enterprise applications against account takeover, payment fraud, fraudulent account registrations, malware, and data breaches. Underpinning the solution is the ThreatMetrix® Global Trust Intelligence Network, which analyzes over 500 million monthly transactions and protects more than 160 million active user accounts across 2,500 customers and 10,000 websites.
The ThreatMetrix solution is deployed across a variety of industries, including financial services, enterprise, e-commerce, payments, social networks, government and insurance.
For more information, visit www.threatmetrix.com or call 1-408-200-5755.
Join the cybersecurity conversation by visiting the ThreatMetrix blog, Facebook, LinkedIn and Twitter pages.


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Lieff Cabraser Heimann & Bernstein, LLP Announces Class Action Lawsuits Against Arena Pharmaceuticals, Inc. (Nasdaq: ARNA)
Lieff Cabraser Heimann & Bernstein, LLP announces that class action lawsuits have been brought on behalf of purchasers of the securities of Arena Pharmaceuticals, Inc. ("Arena" or the "Company") (Nasdaq: ARNA) between December 8, 2008 and September 16, 2010, inclusive ("Class Period"). If you purchased Arena securities during the Class Period, you may move the Court for appointment as lead plaintiff by no later than November 19, 2010. A lead plaintiff is a representative party who acts on behalf of other class members in directing the litigation. Your share of any recovery in this action will not be affected by your decision of whether to seek appointment as lead plaintiff. You may retain Lieff Cabraser, or other attorneys, as your counsel in this action.Arena shareholders that wish to learn more about this action and how to seek appointment as lead plaintiff should visit Lieff Cabraser's website at http://www.lieffcabraser.com/cases.php?CaseID=345 or contact attorney Sharon Lee toll free at (800) 541-7358. Background on Arena Securities Class Litigation The actions, pending in the United States District Court for the Southern District of California, were brought against Arena and certain of its officers for violations of federal securities laws. Arena, headquartered in San Diego, California, is a clinical-stage biopharmaceutical company focused on discovering, developing, and commercializing oral drugs that target G protein-coupled receptors. Arena's principal drug under development is Lorcaserin, an experimental weight loss drug. The complaints allege that throughout the Class Period, defendants made materially false statements regarding Lorcaserin. Specifically, during the Class Period, defendants allegedly touted Lorcaserin's purported efficacy, safety, and tolerability but failed to disclose certain health risks associated with the drug. On September 14, 2010, the Food and Drug Administration ("FDA") issued a briefing document in advance of its advisory panel meeting that questioned the safety and efficacy of Lorcaserin and revealed, among other things, that the drug was associated with malignant tumors in rats. On this news, the price of Arena common stock fell $2.72 per share, or nearly 40 percent, to close at $4.13 per share on September 14, 2010. On September 16, 2010, the FDA advisory panel reportedly rejected Lorcaserin due to concerns with the drug's efficacy and potential safety problems. On the following day, September 17, 2010, Arena's stock fell another $1.75 per share, or approximately 47 percent, to close at $1.99 per share.
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Friday, July 29, 2011
5 comments
Just wanted to update my personal challenge that I posted the other day.
Family fun was successful...one boardgame played twice, a few books read per kid, even playdates! That is pretty darned good considering I too also am lacking in the p... Read more
Tuesday, July 26, 2011
5 comments
....for about the 10000000 time!
I stink at challenges...so I decided today that my challenge will be to just challenge myself a bit more than normal.
This is going for more than just exercise, it's about everyday things as well...and ... Read more
Sunday, July 17, 2011
2 comments
We are going CAMPING!!!
WE haven't been in a month and the whole crew is excited to go...I even think our pop-up was getting lonely at this point!
We had a great 2 days prior to this,....hubby and I had a pre-Anniversary date night and... Read more
Thursday, July 14, 2011
5 comments
Ever get to thinking and then your brain will not shut off when it is time to go to sleep?
Well, for me, this is one of those times. Honestly, it has been happening a lot in the past few months...I guess I have a lot on my mind.
I kee... Read more
Friday, July 01, 2011
5 comments
I've been reading a lot of blogs about the battle between body image and what our body's actually look like now after exercising and dieting (EWWW! I hate that word 'diet' but in this case, I will leave it alone.) I've touched on it before...bu... Read more
Saturday, June 25, 2011
3 comments
Well, woohoo...um, yay...hey kids, please pick up the family room.....please stop wrestling, someone is going to get hurt....can you pleeeasse stop repeating everything that he is saying?....Did you hear me??...Do I need to come in... Read more
Tuesday, June 21, 2011
4 comments
as rare as sighting a unicorn!!
I don't know what possessed me to get my gear on early and actually go... Read more
Friday, June 17, 2011
6 comments
Yuppers! I have been SO off track and off the radar here....it is NOT EVEN FUNNY!!! Things are slowing down a bit now that school is ending so, WHEW! I think I can finally breathe a bit easier!
I hate it when things get crazy, but crazy is ... Read more
Saturday, June 11, 2011
6 comments
Yesterday was a rough day for me...not disasterous, but rough as in the "hectic" sense of the word rough.
On Monday I noticed my right front tire for some reason....it looked a little flat, so I checked out the treads...pretty worn down & t... Read more
Tuesday, June 07, 2011
4 comments
Hi everyone!!! Feel like it's been AGES since I blogged about anything...well, that is not true, I deleted a b-blog yesterday, but that is beside the point. Sometimes b-blogs are good to vent, but even better to delete when one gets it out of on... Read more
Friday, May 27, 2011
3 comments
I am Pisces...I even have the symbol tattoo'd on my body...and I check my horoscope everyday...and seriously, some days it seems more like a 'horror'scope! LOL
So this is what I read today:
"As the real Pisces that you are, you are not i... Read more
Monday, May 23, 2011
5 comments
I was in the waiting room of the Pediatric Therapy office while my youngest was in his speech lesson....and the conversation between the receptionist and another mom was about weightloss.
The receptionist started WW about 9 weeks ago...was ... Read more
Saturday, May 21, 2011
12 comments
And they lived happily ever after....
Great way to start a blog huh? at the end!
Well this blog has taken a long time to come about, hasn't it?!? It's been a whirlwi... Read more
Saturday, April 30, 2011
8 comments
So my sister is getting married next Saturday!!!! So excited for her and her fiance! Consider this our "royal" wedding - she is the youngest and the last to get married...so this is a big one for so many reasons, not only for her, but for so m... Read more
Wednesday, April 13, 2011
10 comments
yupper..my buddy wine.
When I was heavy, I had reactions to it. No kidding! I would get hives, so basically I stayed away from it because I thought I was "allergic".....in reality, it is an intolerance, but you get my drift. This... Read more