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Operator: Good day, everyone, and welcome to the Copart Incorporated Third Quarter Fiscal 2013 Earnings Conference Call. As a reminder, today's call is being recorded.
For opening remarks and introductions, I'd like to turn the call over to Mr. Jay Adair, Chief Executive Officer of Copart Incorporated. Please go ahead, sir.
A. Jayson Adair - CEO: Good morning. As you can tell, I'm a little hoarse from a pretty heavy week of talking a little too much. So, this morning I'm going to turn it over to Will Franklin who'll go through his prepared remarks. And then, he'll turn it back over to me. I'll go through some of the stuff on our deal, and then, I want to point as well that Vinnie Mitz, who is our President on the call today to answer some of the questions, because, as you can tell, I need to let my voice rest a little bit.
So, with that, I'm going to turn it over to Will. Thank you.
William E. Franklin - SVP and CFO: Thank you Jay, and good morning, everyone. Before we begin our comments, I'd like to remind everyone on the call that our remarks will contain forward-looking statements, including statements concerning our views or trends in our business. These statements are neither promises nor guarantees and are subject to certain risks and uncertainties that could cause final results to differ substantially from those projected or implied by our statements and comments. The Company expressly disclaims any obligation to update or revise these statements and comments. For a more complete discussion of the risks that could affect our business, please review Management's Discussion and Analysis, and the risk factors contained in our 10-Q, 10-K and other SEC filings.
With that, I'll begin to give some comments about our financial results for the quarter. Total revenue grew by $33.5 million. Vehicle sales revenue grew by $9.7 million. About half of the increase came from growth in purchase case activity in North America. The balance came from changes in mix in the U.K.
Service revenue increased by $23.8 million. We estimate incremental Sandy volume represented $12.8 million of that increase. The balance came primarily from the increased volume, from market wins and volume from growth in the overall salvage market. In North America, volume grew by over 13%. Approximately half of that came from Sandy. We estimate that approximately 90% of the incremental Sandy volume was sold by the end of the quarter.
Despite the continued growth in our dealer program, total non-insurance volume declined as a percentage of total volume due to the significant growth in the insurance cars from Sandy and market wins. Revenue per car was down marginally from the same quarter last year due primarily to the decline in used car pricing and commodity pricing. The impact was offset by significant growth in inventory as we recognized total (toe in) revenue and titling revenue around the time of the assignment usually 50 to 60 days before the car is sold.
In the U.K., volume grew by almost 4%. We had a change in mix between cars sold on a principal basis and cars sold on an agency basis due to the normal fluctuations in volume supplied by the insurance companies and due to a direct purchase program initiated in the U.K. this year. Purchase car volume grew from 30% to 34% of total U.K. volume. Both net revenue per purchased car and average service revenue per agency car remain relatively consistent with the same quarter last year. Yard and fleet costs grew significantly due primarily to the incremental costs associated with Sandy as the direct and indirect cost of processing the Sandy volume virtually absorbed the incremental revenue. In addition, we added the incremental cost of the international operations and we added resources to continue to the growth in our dealer and direct purchase programs. Further, due to recent seller contract activity, volume was redistributed between yards in our national network requiring additional transitional cost.
Finally, on a year-over-year basis, our North America inventory grew by almost 21%. When vehicles are added to inventory, we incur and recognize majority of the total cost to process the car. However, majority of the revenue is recognized in the quarter in which the car is sold. General and administrative costs grew by $5.1 million over the same quarter last year. The increase was due primarily to additional cost tied to international expansion which totaled $1.4 million, the additional costs associated with product and technology development like our new mobile app and the rollout of our ERP system has totaled $2.7 million, and increased spend on marketing and professional services.
In addition, we accelerated the depreciation of our data centers in Reno and Las Vegas in anticipation of their expected shutdown in fiscal 2014. This acceleration resulted in an increase in depreciation of $2 million and will continue until the second quarter of 2014.
We ended the quarter with over $139 million in cash. In the quarter, we generated almost $130 million in operating cash flow. We expended $28.6 million on CapEx including a lease buyout of $8.6 million. During the quarter, we had no open market share repurchases. We have almost 48 million shares remaining in our current repurchase authorization. That concludes my comments.
I'll turn the time back over to Jay Adair. Thank you, Jay.
A. Jayson Adair - CEO: Thank you, Will. Also in the quarter, we announced the acquisition of (QCA Holdings), QCA own Quad Cities Desert View Auto Auctions, and Crashed Toys, a specialty division of the Company, selling jet skis and motorcycles and specialty product of that nature. We're excited about it. The Company has 39 yards currently covering 14 states and processes well over 100,000 units a year.
The top customers are (State Farm, Progressive Farmers), (indiscernible). So they've got a wide breadth of customers, and the most exciting part is their management team. The Company has been around for over a decade and has been very successful in competing against ourselves and insurance auto auctions. And so, this acquisition brings that whole leadership team into the Company.
John Lindle who is the CEO of the Company said it best when we were talking to customers that he had a choice of merging with one of the other large players or hooking up with another private equity company. And after he saw what Copart's working on, what we're doing, he said, there was no question in his mind he want to hitch his horse to Copart. And that's really exciting for us. We're looking forward to all the things that they do and learning about that and integrating it into our Company.
Some other points that I would just make about the Company is that John will remain CEO of Quad Cities, and we're going to be sitting down with all of our customers and finding out what they like best about Copart and what they like best about Quad Cities and raising the bar in terms of the level of service that we bring to all of our customers. So, it really is a win-win across the board on that. We also announced or I should say we also acquired in the quarter – or not in the quarter but in the recent month Gainesville salvage at Georgia and that gives us another location in the Georgia market. So, I'm sure there's a ton of questions. As I said, Vinnie Mitz, our President is here. And so, he is going to step in, do some of the questions as well.
And at this time, I'll turn it over to the operator for questions.
Operator: Robert Labick, CJS Securities.
Robert Labick - CJS Securities: Just wondering if you could maybe give us a little more history of the acquisition, how long you were talking to them, was it an auction or a negotiated deal, why did they sell now? You talked a little bit about why to Copart, but why now? And obviously, with (indiscernible) of the terms of the deal or how big they are and then that kind of stuff if you would tell us that?
Vincent W. Mitz - President: Sure. This is Vinnie. The deal came together very, very quickly. After some recent national RFPs market share throughout the country had been suddenly redistributed and the owners of Quad Cities, including John, we're looking what is best for their strategic future. And they were looking to team up to continue and accelerate their growth; and actually we're looking for a partner who will be able to help and assist in the growth of their Company separate from a normal acquisition integration and that opportunity came together very quickly once we agreed philosophically how to handle the transaction. It was just a matter of working out the financials. So, it only took probably three to four months for the whole thing to come together.
William E. Franklin - SVP and CFO: Bob, this is Will. Let me add just a little color to that too. Quad City is a serious player in our space. We compete with them all the time and we (lose certainly). The insurance companies use them because they like what they do. So we think this is a win for us to be able to understand what they do well in their corporate debt and into our offerings as well.
Robert Labick - CJS Securities: Could you maybe give some specifics on what they do well better than Copart and how you can bring that to the rest of your yards?
A. Jayson Adair - CEO: Well, that's exactly what we're doing right now. We're in a period where we're going to be analyzing all their process and then we're going to be looking at what we want to incorporate. So we don't plan on changing anything for the foreseeable future right now until we get all that figured out.
William E. Franklin - SVP and CFO: Bob, this is similar to what happened in the U.K. We went to the U.K. and we took what they did really well and what we do really well and combined to arrive at the best offering that we could to provide and that's exactly what we intend to do with QCSA.
Robert Labick - CJS Securities: And then the terms for the deal, any information you will share with us on that?
Vincent W. Mitz - President: No, not this time. Honestly, there will be some disclosure in the 10-Q and other public filings, but at this time, we'll not talk about the specific terms of this deal.
Robert Labick - CJS Securities: Then just quickly on to the quarter, the very strong inventory build, the 21%, can you maybe give us some color in terms of how much of that's related to – you had to sell out Sandy cars, you were building inventory; how much was the easy comp from no winter? And how much was really growth that you're seeing where we should expect that growth on a go-forward basis?
Vincent W. Mitz - President: Well, it's interesting. It's a good question. So, some of it is Sandy, obviously. We've got about 10% of Sandy cars remaining in inventory. The majority of that comes from market wins, so we've been successful in the last 12, 18 months and expanding our presence in the market. But we're also seeing growth in the market on an overall basis. So, 2009, '10, and '11 we've basically had headwinds in every element of our market management. So, when we look at our market and what drives it, we look at basically four different elements. We look at the number of cars on the road. We look at how often are those cars involved in accidents. How those cars involved in accidents? How often are they salvaged as opposed to repaired. And then finally, we started looking after 2009 at unemployment, because unemployment drove uninsured motorists. So, while the uninsured motorists may be involved in accident, we didn't necessarily get cars because they didn't know about Copart or salvage pools. So, for three years, everyone one of those drivers have been negative. And now they're starting to turn. And so we're seeing the best of that – you're seeing that reflected in our inventory.
Robert Labick - CJS Securities: And then one last one and I'll jump out. In terms of the increased yard and fleet, I think you mentioned this, but I just wanted to check. You said roughly, I think, $12 million, $13 million in sales from Sandy and roughly that much incremental Sandy expense. Is that accurate? And then also, can you quantify maybe the incremental yard expense from that 21% inventory build as you said because you're getting all the towing expenses upfront in this quarter. So we can kind of get a normalized yard expense on a go-forward basis.
Vincent W. Mitz - President: Yeah. It makes it very difficult to get a normalized yard expense on a go-forward basis. Historically, we used to put all of our costs on the balance sheet and then release them in the same period in which we recognize all revenue and that's no longer the case. So, it's very difficult to predict our yard and fleet expense until you are able to predict our growth and changes in inventory. So, getting back to your specific question, from Sandy, we said last time that we didn't expense anymore losses from Sandy and I think that – we think that that's what we saw this quarter. So, of the roughly $13 million of Sandy sales almost none of that came through as a benefit. It was all absorbed by direct and indirect costs. And we'll have some of that costs continue into our fourth quarter. So, we still have people displaced, we still have properties that we're leasing and some of that's going to flow through. In terms of revenue, I think the impact of a change in inventory, I think we'll just leave it with the comments we've already made in that we recognize a majority of our expenses when we pick up the car and the majority of our revenue when we sell it and they can be one or two quarters apart.
Operator: Scott Stember, Sidoti & Company.
Scott Stember - Sidoti & Company: Could you maybe talk about with the Nationwide contract? I know that as of last quarter we were – the second quarter on a full run rate basis. Are we on a full run rate basis, apples-to-apples going forward from here with that contract?
Vincent W. Mitz - President: Yes. This is Vinnie. We are absolutely fully integrated with Nationwide and that is a apples-to-apples run rate now.
Scott Stember - Sidoti & Company: And just shooting over to the acquisitions you guys announced last night with Quad City. Can you maybe talk about how they process their business, is it more of a purchase versus an agency type of model and how much of it is a fixed or percentage kind of deal versus (not or) fixed? Maybe just talk about some of the details there.
Vincent W. Mitz - President: Sure, sure. They have different divisions as does Copart. They have a charity division which strictly processes charity cars with sales to the public. That's the brand Desert View Auto Auctions. They do some purchase cars similar to Copart Direct, and the vast majority of their insurance work is on the agency business exactly the same as Copart, and, of course, the specialty division are all individually negotiated contracts but also all on agency.
Scott Stember - Sidoti & Company: And last question, can you maybe just give an update on how things are going down in Brazil and some of the other areas that you entered over the last couple of quarters?
Vincent W. Mitz - President: Yeah, all the investments we've made internationally are considered strategic investments for the future. We are in the process of consolidating the operations into the Copart model, implementing our operational procedures and looking forward to growth. Right now, there obviously is a cost drag on them as we go through that process. But the investment in the future is hopeful. I mean, we are extremely excited about it. We see a great growth opportunity in the international markets, and benefit is yet to come, obviously.
Operator: Bret Jordan, BB&T Capital Markets.
Bret Jordan - BB&T Capital Markets: A couple of quick questions. And I guess, as we look at the acquisition and the productivity of these sites compared to your core business, could you give us a feeling sort of what the volumes being done, and ideally sort of by line between Quad City and Crashed Toys and the Desert View just we can sort of try to figure out how to model this versus your existing business?
Vincent W. Mitz - President: Sure. The charity business is about 60,000 automobiles. Crashed Toys represent a minority business less than 5,000 and the rest is the insurance business under Quad Cities.
Bret Jordan - BB&T Capital Markets: And as you look at this, is it – incremental G&A is going to be built in, it sounds like you're keeping a lot of the existing management team given their skills. Is this – if you look at the impact on your aggregate margins, do you see a lot of near-term overhead reductions or is it going to run sort of as a standalone business side-to-side with Copart?
Vincent W. Mitz - President: No, at this point it's standalone. There's no leverage there. And as you can tell, they run fewer cars through more facilities. So, it's not as efficient as ours. So that'll have an impact on our overall margin.
Bret Jordan - BB&T Capital Markets: And then I guess a question on the core business and the inventory growth year-over-year, up 21%, how does that compare to prior quarters. Is that an acceleration of the inventory growth? And I guess, if you could call about Sandy versus core inventory growth in that description?
William E. Franklin - SVP and CFO: Even excluding Sandy, that's better growth than we've seen in maybe 12 or 16 quarters.
Bret Jordan - BB&T Capital Markets: On a relative basis, if we were to go back into Q1 and Q2 what would the growth rates been there? Are we accelerating significantly out of the first half? It seems like one of – full recovery here, is it a ramping cyclical recovery?
William E. Franklin - SVP and CFO: No, I don't think so. I think we've hit a run rate that I don't anticipate to grow anymore. If you exclude Sandy, we're about 16% up in our inventory and I wouldn't expect that to accelerate.
A. Jayson Adair - CEO: It's a really big number. Let's call it what it is. It's a really big number. So, to expect that to go to 20% I think is unreasonable.
Operator: Bill Armstrong, C.L. King & Associates.
William Armstrong - C.L. King & Associates: Just to clarify then – so three months ago you said you didn't expect any further losses from the Sandy vehicles and it sounds like that was in fact the case then that (the words) that you were I guess roughly breakeven on those vehicles in Q3?
William E. Franklin - SVP and CFO: Yeah, Bill, that's exactly right. I was just going to reiterate. We model this out fairly close in our expectations. And in fact, we're about breakeven this quarter.
William Armstrong - C.L. King & Associates: Could you discuss the pricing trends, vehicle pricing trends during the quarter and maybe subsequent to the quarter excluding Sandy? I'm not sure if you're able to break that out, but overall pricing trends in the salvage lane?
William E. Franklin - SVP and CFO: Yeah, it's real simple. Our pricing is linked to commodity pricing and used car pricing. So if you see those movements in those indexes, you can see what the impact will have on our pricing. But we had just very little change over the last year.
William Armstrong - C.L. King & Associates: Very little change in pricing or in the trend?
William E. Franklin - SVP and CFO: Very little change in pricing. I mean, the element that has affected our commodity pricing, used car pricing like we've already talked about. The other element is product mix. So to the extent we sell more noninsurance cars, then we have an increase in revenue per car. To the extent we process more charity cars, then we have a detrimental impact on our overall average revenue, and it's hard to predict all of those elements.
William Armstrong - C.L. King & Associates: What was the noninsurance percentage this quarter?
William E. Franklin - SVP and CFO: It was under 20%.
William Armstrong - C.L. King & Associates: That sounds like it's less than last year or…?
William E. Franklin - SVP and CFO: It is. It is. But we didn't have Sandy last year and we didn't have the market wins that we had on the insurance side.
Operator: Craig Kennison, Robert W. Baird.
Craig Kennison - Robert W. Baird: Regarding the inventory build, how much of that non-Sandy growth, I think you said it was 16%, is a function of deferred activity because you were so busy processing Sandy cars?
William E. Franklin - SVP and CFO: I wouldn't know how to measure that. I don't think any; zero. I can't think of anything that we didn't sell because of Sandy, clearly because those are different processes. We have auctions going on in Florida when there's a hurricane going on in Florida.
Vincent W. Mitz - President: Part of the power of BB2, our sales platform is, it doesn't impede volume enhancements. As soon as we can plug volume into it, we can sell instantaneously. It doesn't rely on a physical sale and a bunch of logistics to get car sold. And Sandy, even though we have 16 different sub-lots, we were able to sell Sandy cars every day from different sub-lots in multiple sales per week. They weren't relying on buyers getting to facilities to attend sales and auctioneers and then the hardcore logistics of it. So we didn't have any delay in sale because of Sandy or any other facilities nor at the Sandy locations.
Craig Kennison - Robert W. Baird: And I know these catastrophes are a money loser for the event itself but you also often take that opportunity to follow up with your insurance partners and maybe win bigger deals because of the service you provided during the catastrophe. Is that the case or are you seeing any impact on the good side?
Vincent W. Mitz - President: I guess we can comment as those discussions are ongoing, and absolutely if we get a generally positive and exceptional review actually out of our Sandy performance, yes. As part of our recent advisory board, we did a full cat wrap-up on our Sandy handling and even improvements we can make in the plan for subsequent events and that was received with a tremendous amount of positive feedback from our clients. So, building and improving that plan and working with the industry, I think, has been a tremendous benefit, yes.
Craig Kennison - Robert W. Baird: And then regarding your capital structure, I know you keep a solid balance sheet with a lot of cash. Has the philosophy on capital structure changed at all, and would you consider introducing more leverage to the model if the share price, for example, were to become attractive?
Vincent W. Mitz - President: Yeah, Craig, we talk about capital structure all the time. But our policy is to make no comment. And when I say talk about, we're talking about at the executive and Board level.
Craig Kennison - Robert W. Baird: And then last question just cleaning up on the acquisition. I assume those all closed post-quarter?
William E. Franklin - SVP and CFO: That's correct.
Operator: Gary Prestopino, Barrington Research.
Gary Prestopino - Barrington Research: Quad Cities, I guess, you're talking about what they do best, what you do best. Is the plan to totally put them on VB2 or are you going to allow them to maybe do a hybrid model with actual auctioneers?
Vincent W. Mitz - President: I guess, Gary, the good news is we don't have a plan yet. The plan is to come up with a plan by actually sitting down with both management teams and both management groups and figuring out what's going to best of our customers. The point is, they've been an attractive option in the marketplace. They had been growing as a standalone independent when many of others haven't been. So, clearly, they are doing something that's attractive for the marketplace and we're certainly not going to rush in to some mass integration and lose that uniqueness. There is a customer perspective here that we have to take into account and really look hard at why they've been able to grow in this hypercompetitive market.
Gary Prestopino - Barrington Research: Do they have internet auction capabilities right now and what percentage of their cars were being pushed through sold over the net, do you know that?
Vincent W. Mitz - President: I do not have that number handy, but yes, they do have that ability.
Gary Prestopino - Barrington Research: It's a great acquisition for you guys. And then, I just want to talk about just the way I look at it, just the erosion in the gross margin overall, almost similar to Q2. A lot of that attributed to those Sandy cars that basically went out with no gross margin in the sales, or is that really attributed to the fact that you've changed your accounting somewhat and since you're building inventory you're expensing that all upfront and then we should see a better gross margin in Q4 and maybe into Q1 of next year?
William E. Franklin - SVP and CFO: Well, if you ask me to size the impact, the different impacts, I would say that Sandy had the largest impact. The next would be the increase in our purchased car revenue. So that's why it's hard to predict our gross margin percentage because whenever we increase our purchased car revenue, it's going to have a detrimental impact on that. And then third would be like you described, it's just the change in our inventory volumes.
Operator: Bret Jordan, BB&T Capital Markets.
Bret Jordan - BB&T Capital Markets: I think in the last quarter conference call, you did comment that you're reevaluating this REIT prospect and could you give us an update on where that stands?
William E. Franklin - SVP and CFO: Just like the comment I gave to Craig Kennison, we talk about capital structure at the executive board level, but we just don't make any public comment unless we have a conclusion or something to share. So we have no comments (just now).
Bret Jordan - BB&T Capital Markets: Is that ongoing or is that, there's no conclusion reached on that process yet?
William E. Franklin - SVP and CFO: There is no comment until we have something that we're ready to publicly announce to everyone.
Operator: This concludes our question-and-answer session today. I would now like to turn the conference back over to management for any further or closing remarks.
A. Jayson Adair - CEO: Okay, thank you. Thank you for your participation in our call. We look forward to Q4 and reporting our Q4 and full fiscal year results on our next call. Thank you very much for attending.
Operator: And this does conclude our conference for today. We thank you once again for your participation.


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Tuesday, July 29, 2008
You may have tried everything - treatments, physical therapy - and your joint is still feeling stiff and in pain. Can surgery help? What are the pros and cons? We discuss the role of surgery in RA treatment, what you need to know before and after the procedure, and how it could improve joint mobility and quality of life.
Welcome to this HealthTalk webcast. Before we begin, we remind you that the opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.
Gina Tuttle:
Hello, and welcome to Arthritis Talk. I'm Gina Tuttle. You may have tried everything - treatments, physical therapy, and your joint is still feeling stiff and in pain. Could surgery help? When should you consider surgery? What are the pros and cons? What are the different types?
Two joint surgery experts from the University of Washington Department of Orthopaedics and Sports Medicine, are going to discuss the role of surgery in RA treatment, what you need to know before and after the procedure, and how it could improve joint mobility and quality of life.
I am happy to introduce my co-host, Dr. Michael Schiff, medical director of the Denver Arthritis Clinic Research Unit, and professor of clinical medicine at the University of Colorado School of Medicine, Rheumatology Division. Mike, is it common for RA patients to have at least one surgery over time?
Dr. Michael H. Schiff:
Surgery is not uncommon in our RA patients and the very important thing to note is that when one needs an operative procedure for rheumatoid arthritis, its success has been a major advance in the care of our patients.
That is encouraging. Thanks Mike. We have a lot of cover, but first, we are happy to tell you that support for this program is provided to HealthTalk by Amgen and Wyeth Pharmaceuticals. We thank Amgen and Wyeth for their support and commitment to patient education. And before we get too far, I would like to remind you the opinions expressed on this program are solely the views of our guests and not necessarily the views of HealthTalk Interactive, our sponsors, or any outside organization. Please consult your own doctor for medical advice most appropriate to you.
Dr. Schiff:
I am happy to introduce our first expert for today's program: Dr. Seth Leopold. Dr. Leopold specializes in hip and knee surgery and is an associate professor in the Department of Orthopaedics and Sports Medicine at the University of Washington in Seattle. He has authored several publications about hip and knee surgery and has participated in numerous interviews about the topic as well. Dr. Leopold, before we get to hip and knee surgery, let's start with the basics of joint surgery overall. At what point should a patient consider surgery?
Dr. Seth Leopold:
It is usually reasonable to try some type of non-operative treatment before considering surgery of any kind. That is almost always the case in orthopaedics. With respect to rheumatoid patients, that usually would include some kind of management of the whole body effects of rheumatoid arthritis as well as some type of treatment for the joint problem itself, either non-steroidal anti-inflammatories, some type of non-narcotic pain pills, or joint injections.
Some patients can modify their activities or lose some weight. If the arthritis is unusually progressive and doesn't get better on its own, sometimes you are still faced with the possibility of needing something done surgically. The decision to undergo either a knee replacement or a hip replacement or a procedure of that sort, it is a quality-of-life choice, and patients will usually have that type of procedure when they find themselves avoiding activities that they used to enjoy, because of pain in the joint. If their basic daily activities like walking, shopping, or recreation are inhibited or prevented by the joint pain, then it becomes time to think about getting something done for most people.
Dr. Schiff:
Dr. Leopold, [could] a patient wait too long before considering or discussing surgery? What are the pros and cons of going forward with the surgery?
Dr. Seth Leopold:
Those are two good questions. With respect to whether they could wait too long, it is often on a patient's mind, "If I don't get this done right away, will the damage progress beyond the point where it can be fixed?" That is very seldom the case. Sometimes, in a severely involved rheumatoid patient, you can develop ligament problems down the road. For example, around the knee is a very bad knock-kneed-type deformity, for instance, but most of the time, it is just a matter of just putting up with it, and getting to a point where you don't want to put up with it anymore. Almost always it is possible to reconstruct the joint in a way that is satisfactory, so usually waiting doesn't prejudice the final result.
As far as the pros and cons of surgery, really you're talking about what type of procedure that is in question. There are a lot of procedures that are done for patients with arthritis, but when you are talking about hips and knees in rheumatoid arthritis patients, you are almost always talking about joint replacement, and that is the standard against which the other procedures are measured. Those kinds of procedures - joint replacements - are usually for middle-aged or older people who don't tend to go back to labor or high-impact sports.
The principle advantage is pain relief and the second advantage would be restoration of function. The disadvantage is that when you are talking about surgery, there are a number of things to consider. Surgical risk is almost always an issue, depending on the overall medical condition of the patient, and then there is a question about the postoperative recovery and the rehabilitation, physical therapy, and the life inconvenience associated with going through an intervention. But most patients, by the time they are substantially impaired by the arthritis, are willing to make that trade-off.
We are going to be talking about the different areas of joint surgery - hip and knee, foot, hand, wrist - but briefly, what are the different types of surgery a patient can have?
Dr. Leopold:
All of the operations that you have heard of for other types of arthritis are potentially available. So you have to run down the risks. Things like arthroscopy and synovectomy are very occasionally done for rheumatoid patients, but really those are the rare operations. Resection of a joint is very occasionally done, but that is usually for somebody who has failed a prior surgery. The most common procedures that are done for rheumatoid patients in the hips and the knees are total joint replacements. Although there doesn't seem like there is a lot of choice in terms of the different kinds of operations, it actually doesn't work out to be a bad thing.
Joint replacement, compared to the other procedures that are done for other arthritis patients, is usually the definitive treatment after some of the other ones don't work anyway. So it winds up being the gold standard against which other procedures are measured, and is very successful most of the time in rheumatoid patients.
Let's talk about knee surgery specifically, and hip surgery. How common is hip surgery in RA and who should consider it?
Dr. Leopold:
Total hip replacement turns out to be the second most common large joint that we replace, and it follows behind total knee replacement, so it winds up being very common. If you look at theories that are published in scientific journals about joint replacements, you find that about 10 percent of the patients who have the procedures have rheumatoid arthritis. It doesn't seem like a very large number until you consider how uncommon rheumatoid arthritis actually is in the population, so a disproportionate number of rheumatoid sufferers will get something done. But overall, it is not a huge number of procedures done for that diagnosis.
And [as for] who should consider it - it really is, as we said before, a quality-of-life choice that a patient makes. The patient has to weigh the surgical risks against the potential for relief of pain and restoration of function. Overall, though, hip replacement surgery winds up being extremely reliable and the large majority of people who have it are happy that they did so.
Dr. Schiff:
Dr. Leopold, are there different kinds of hip joint replacements? The question we always get asked [is], "Can we go skiing, jogging, play tennis after hip replacement? And is one hip replacement different than another hip replacement?"
Dr. Leopold:
Those are all important questions and worth discussing in the context of an individual's condition. The answer is, "Yes, there are a variety of types of procedures," and lately people are talking more about different surgical approaches to less invasive types of surgical approaches that are sometimes available for hip patients. But, in general, we are talking about total joint replacement for rheumatoid arthritis patients, not some type of a partial replacement, and certainly not an arthroscopy.
What I would say is that those questions wind up best being answered in the context of an individual patient. When I am looking at an individual patient, those are the decisions that I am making and it is based on the patient's expected activity level, the patient's bone quality, and other factors that are really particular to an individual. But the answer probably to your question is "Yes, those are all available, those are all in common use." With respect to the activity questions that you mentioned earlier - skiing, or jogging - we could run down the risks, and when I am [meeting] with a patient, that is exactly what I do. I ask the individual patient what is important to them.
But briefly, things that involve impact are things that you ought to avoid. So, jogging really is out. Walking for exercise is fine, [and] bicycling and swimming [are] excellent. I have a lot of patients who ask me about skiing, and I bet in Colorado you have even more. What I tell patients who ski - and I don't think there is complete agreement among surgeons on this - but what I tell patients is that if they were really expert skiers before, and they feel that they are able to control their environment while they are skiing, by choosing easier trails than they would have otherwise skied back when they were in their prime, it is possible to go back to downhill skiing, and certainly possible to go back to Nordic or cross country skiing. But somebody who to begin with was a beginner or an intermediate skier, and really risked falling when they were in their good days, probably should think about not going back to skiing, because if you fall after a joint replacement, it is possible to get yourself hurt.
How effective is this, and I am thinking in terms of once a hip is replaced, does it feel like a person felt before they had the arthritis at all?
Dr. Leopold:
There are different ways to measure effectiveness, but by almost any standard you apply, hip replacement scores well, it is extremely effective. One way to think about effectiveness is the risk-to-benefit ratio. So you look at the number of complications, or how often they occur, and it's almost always less than 5 percent chance of a real complication. The proportion of patients who describe their pain as gone or nearly gone is high, well above 90 percent, and then the chance that a well-performed hip replacement would still be of service 10 years after the operation is also above 90 percent.
When people have studied different surgical interventions that were in use in the late 20th century, it scores in almost every report, second only to cataract surgery, as the operation offering the best risk-to-relief ratio and the ability to improve somebody's quality of life. They don't always feel completely normal, but many times they do; I would say more times with hip replacement than say knee replacements, which patients always know on one level that they have got them. A certain proportion of patients will say that they really forget that it has been replaced if it is a good job and it has come out well.
What does it take to get there - what is the rehabilitation process like?
Dr. Leopold:
Every patient is a bit different, so generalizing can get tricky, but I would say that limiting it to the practice that I see, and limiting the comments to patients who are able to walk independently, that is without a cane, before the surgery, it usually would go like this: about three days in the hospital, then maybe a few days in an inpatient rehab unit, practicing your exercises, doing some physical therapy, and then home. Most patients will walk with crutches or a walker for a few weeks, then a cane for another few weeks, and by six to eight weeks, and often faster, the majority of patients who are walking independently before, are going to be walking independently again. Patients will typically take some type of a pain medication for a few weeks after the operation.
Dr. Schiff:
Dr. Leopold, you said that knee surgery actually is done more often than hip surgery. Do you want to comment about the different types of knee surgeries that might be done in rheumatoid arthritis, the rehab program that would be expected in those, and the different kinds of results that you have seen?
Dr. Leopold:
As far as the frequency, the knee is the most common large joint that gets operated on in rheumatoid patients, as well as in patients with other types of arthritis, like osteoarthritis. In this country, several hundred thousand knee replacements are done every year. The decision to have it, much like the hip surgery, is quality-of-life based, and you make it in consultation with a joint replacement surgeon who has a sense of that patient's medical history and their goals.
As far as the types of surgery, once in a great while we'll do an arthroscopy on a rheumatoid patient to do a synovectomy and that would be done if there is not very much damage to the joint surface or the cartilage itself. It is mostly an inflammatory process of the joint lining, but that is quite rare.
What is a synovectomy?
Dr. Leopold:
A synovectomy is when you remove the joint lining, the synovium, and that is in a very early stage of rheumatoid arthritis. It is very seldom done, because almost always by the time the rheumatoid arthritis patient gets to a surgeon, the damage is beyond that and it has already affected the [weight]-bearing surface of the joint. So for that reason, they wind up getting joint replacements, almost always. It is worth mentioning that there is a lot of popular press lately about minimally invasive or partial knee replacements. These were not designed for rheumatoid patients, and they are very unreliable. Whereas they are sometimes good operations for osteoarthritis patients, the rheumatoid arthritis affects the whole joint, so just replacing just a portion of it doesn't wind up being a good solution for the rheumatoid arthritis patient.
On the other side of that, though, is that total knee replacement in rheumatoid arthritis patients actually seem to work better than total knee replacements work in other patient populations. My rheumatoid patients turn out to be among my happiest patients of all the joint replacements that I do, and I think that it winds up really being a quality-of-life improvement for most of them who have it.
Dr. Schiff:
And the rehab process?
Dr. Leopold:
The rehab, after a knee replacement, is typically several days in the hospital, and then possibly a few more days in an inpatient setting. Most patients, after a total knee replacement, who were independent walkers before, will be walking with crutches or a walker for about three weeks, and a cane for a couple of weeks after that, but at six weeks, most patients are walking without even a cane, and a lot of times it is faster than that. The major rehab issue in a knee replacement patient is range of motion, the ability to bend and straighten the knee, and so physical therapy and a positive attitude about their recovery are really the helpful elements to a good successful knee replacement.
And let me ask about knee and hip replacements. They sound like pretty major steps. Do you think that more people should be getting them than do?
Dr. Leopold:
I don't think so. Ultimately you are talking about an elective operation; it is a big improvement in the large majority of patients quality of life when they have it, but to say that more people be getting them is a is a value judgment that I wouldn't project. It is really a very individual question and it's important for the patient to find somebody that they trust who can help guide them through that decision process; who can estimate the risk for their particular circumstances, estimate their recovery period, [and] estimate the benefit so that the patient then can take that information and make a good decision for his or her own body.
Dr. Schiff:
Dr. Leopold, you have mentioned that the risk for knee surgery, for significant risk, is less than 5 percent. What kind of risks are patients thinking about when they go forward with considering this kind of operation?
Dr. Leopold:
What I would describe are sort of two types of what I call major complications, which I define as complication large enough that either the patient or I regret the decision that we went ahead [with], and then what I would call minor setbacks. Major complications, the things that are really big enough to get your attention, include infection, nerve injury, some type of stiffness or instability or persistent pain, any of which could affect the patient's ability to enjoy the joint later on, or some type of a medical complication that continues to affect the patient's life after they leave the hospital, like a heart attack or a stroke or some such [complication].
It sounds like a lot, but again, if you lump all those things together, taken together, in a typical patient who doesn't have a great deal of medical problems in other areas, it is less than 5 percent. The other types of complications, what I would call setbacks, might be something like a bladder infection or a small blood clot; something that is treatable and doesn't wind up either compromising the result or prolonging the hospital stay in any meaningful way. So those may be another few percent beyond that, but people usually forget them and doesn't wind up being a big issue. Major complications that we get concerned about, and 5 percent [is] about one in 20, so 19 out of 20 usually either skate through or have what we call a setback and then get over that.
I would like to [introduce] our next expert from the University of Washington, Department of Orthopaedics and Sports Medicine, Dr. Thomas Trumble. Dr. Trumble is a professor at the university and chief of the hand and microvascular surgery service. Dr. Trumble, let's talk more about hand and wrist surgery. How common are these procedures in RA?
Dr. Trumble:
[RA] particularly attacks the small joints, so the hands and the feet are two areas that are commonly affected. The large joints - the hip and the knee - can have a major effect; but often the first place you recognize rheumatoid arthritis, and one of the classic areas to make the diagnosis, is actually the swelling that occurs in the hand. It occurs in a certain pattern, so it's relatively common, particularly you know so that it is one of the first areas that involves the patient. And then over the life span of the patient, the chance that one procedure or another is needed is moderately high.
Dr. Schiff:
Dr. Trumble, [say] a rheumatoid arthritis patient has gotten a consultation from their rheumatologist, and they have done the best they can for their rheumatoid arthritis. At what point would the patient and the rheumatologist consider a hand or wrist surgical consultation?
Dr. Trumble:
You bring up a good point, and that is that the rheumatologist has really done a thorough evaluation of their medical management. As you have mentioned earlier, a number of medications have really dramatically changed the way the rate at which the disease affects the patient and sometimes could almost bring people to a complete remission. But the patient [can] still [be] noticing problems with either pain in the hand or wrist, a functional problem, or a third area, synovitis. Synovitis is an inflammation of the normal synovium. That is the normal material that is supposed to nourish the joints and provide the nutrition for the joints, but that is the whole nature of rheumatoid arthritis. Something happens in the immune response, and the synovium ends up attacking the joints, and if it is not removed, it can actually do extensive damage in the small joints. It will actually erode or eat through the tendons and cause them to rupture. It can [be very effective to] remove that tissue and prevent a tendon rupture, so a fairly small surgery can avoid fairly major problems with loss of function.
So what types of surgery do you use in the hand and wrist area?
Dr. Trumble:
Again, I think it was kind of a nice lead in from Dr. Leopold in that we use a fairly similar type, although the spectrum is somewhat different for the small joints. Dr. Leopold had mentioned that synovectomies are performed, and that is fairly common, [which] is removal of the synovium. It is also common to fuse the very small joints in the hand that that are painful and deformed, and, finally joint replacement is an area that can be very helpful, but it is not a big a portion of hand and wrist surgery as it is for the large joints.
Dr. Schiff:
So a patient, Dr. Trumble, can expect what kinds of results from hand surgery - improvement of pain, improvement of function? And what would the risks be of hand surgery, and are they different from the risks from knee and hip surgery?
Dr. Trumble:
I guess in aggregate, they are similar. Again, the things that you worry about are infection, [which is] fairly low in the hand because the [it] has got such a good vascular supply, and stiffness for the joints that have a lot of motion. It is very important that you preserve as much motion as possible in order to preserve function.
Finally, there can be a mechanical failure of a joint replacement or a fusion, which goes in the category that Dr. Leopold mentioned for large joints. [These are] the large complications versus the minor setbacks such as a wound being slow to heal, a joint fusion where you actually stiffen a joint that is small and deformed, taking a longer time than one would expect would fall in the category of the minor setbacks - [the] things that can be addressed and that patients usually overcome and forget, versus the more significant complications of infection, wound breakdown, or loss of mechanical stability. And again, those are extremely rare.
The joint surgery for the hand and wrist, because there is a much wider variety, it is not as easily probably categorized and even amongst the joint replacements that you see people mention, rheumatoid arthritis is a smaller population so that the numbers may not be quite as precise. But overall, complication rate for hand and wrist surgery is probably even far lower than total joint surgery, maybe the rewards are lower; the difference between someone not being able to walk versus being able to walk after a knee replacement. But, being able to grab and hold objects without wrist pain can be an enormous benefit, with a complication rate that is somewhere in the order of 1 percent or less.
What might happen if a patient doesn't consider surgery? You indicated that sometimes early surgery can prevent the need for more extensive surgery, but is there a way to quantify the risk of that?
Dr. Trumble:
It may not be so much quantitative as qualitative, that is, if someone is having persistent problems. Their rheumatologist has managed their medications well, and they ask for a consultation and oftentimes the hand surgeon will see them, and frequently in conjunction with a hand therapist, [who] is a big part of the team, managing hand and wrist problems. The hand therapists, particularly ones that are certified in treating hand disorders, can have an amazing impact. For example, one of the problems with someone who does not get evaluated early may be something as simple as a progressive deformity that a night splint could address, that a therapist could make. If someone has a problem with a painful joint, but after the consultation with X-rays, it appears that the joint is not going on to more deformity, it is a quality-of-life decision, similar to the large joints, and the patient can decide when and where to have that treated. That would fall into one category.
Another category is the person who has more of a soft tissue disorder; that is, a lot of swelling with the dangerous synovitis that can erode into tendons or a problem of a loss of balance and function in the hand that early surgery can correct and prevent a deformity that would not be possible to correct at the end stage, the final component of deformity, then those would be in the category of one where early intervention would be helpful.
It is good to have the patient complete a consultation and have the advice that their problem is either one fairly stable and more quality of life, versus more of one of a functional alignment, a one of a progressive disease that can't be controlled by medication, [and] earlier surgery can actually prevent long-term complications.
Dr. Schiff:
Dr. Trumble, what is a typical post-op rehabilitation process look like to a patient?
Dr. Trumble:
It would be much more highly varied because the number of different procedures, unlike for a total joint where replacement whereas Dr. Leopold mentioned they really kind of funnel down. Although there are other adjunct procedures that can be done, total joint remains the gold standard. There is a variety of different types whether it is reconstructing soft tissues or fusing a joint or replacing a joint. But let's say in the instance of someone with a painful joint and they elect to have surgery, either a wrist replacement or a wrist fusion. Depending on their particular circumstances, they would have the surgery, it is usually an outpatient surgery they would have a brace or a splint that they would use for approximately six weeks, and they would be followed in the office to make sure that their X-rays demonstrate that they are having the type of healing response that that the surgeon would expect. They would probably have therapy during that course, and by about three months, would be pretty much independent and using their hand free of braces.
Dr. Trumble, we also wanted to touch upon foot surgery in rheumatoid arthritis. Is that common? What kind of surgery is involved, and who should consider it?
Dr. Trumble:
We have mentioned that the rheumatoid arthritis is a particularly aggressive disease that affects the small joints, so the feet are in the same category as hand surgery. They are commonly affected, and the patients that are having problems with balance or alignment of their foot; pain with walking. The other problem that some of the other deformities create is that the bony structure of the foot is so far imbalanced that it actually puts excess pressure on the skin, and ulcerations can occur in the feet. So skin breakdown, persistent pain that really limits walking and alignment that makes again walking difficult - even if it is not painful - may be areas where foot surgery would be very helpful to the patient.
Dr. Schiff:
Dr. Trumble, in my career, the foot surgery has been one of the most pleasing things for patients. They can walk again, they can get shoes. What is the benefit risk that you have seen with this?
Dr. Trumble:
You have touched on a benefit - being able to get shoes that are not custom made can be extremely helpful. To be able to walk without pain is clearly a benefit for the patient and, finally, by correcting the alignment and taking the pressure off the skin can avoid ulcerations that could lead to deep infection and a really serious problem. The risk I think in foot and ankle surgery is the contrast to the hand where there is a much richer blood supply and it is much easier to protect it.
The foot and ankle are at risk the minute you start weight bearing. There is a lot of pressure, and the other problem is that the foot and ankle have a have a overall lower blood supply - less vascularity to the skin around the foot and ankle - so that problems with wound healing, in particular, can be a significant factor. That is why it is important for the surgeon to take those factors into account when designing the type of surgery the patient would benefit from.
At our institution, we have surgeons that really dedicate themselves to foot and ankle surgery to be able to properly address those risks and to get the best outcomes for the patients. So, when I see someone who has foot and ankle problems, I am usually taking care of them for wrist or hand problems, I will usually work quite closely with the foot and ankle surgeon because you want to work in conjunction. I don't want to do a very delicate operation for the hand or wrist, and only to find out that the patient needs crutches or walkers for support on their hands.
So we'll work in conjunction to make sure that we get a good stable foot that can walk without pain, and then actually do their corrective surgery for their hand.
It sounds like rehabilitation might be a little difficult with the foot; learning to walk again, and trying to figure out how to make it work correctly?
Dr. Trumble:
The big thing is just that they need to be protected for a long time. The soft tissues around the foot and ankle can be slow to heal and it is important that the patients don't accelerate at too rapidly a pace. Then just with all the areas that you have touched on, it is important for the physicians to work in conjunction, so you want to make sure that the patient who presents with a knee problem, a foot problem, and a hand problem, are addressed in the correct sequence, and this is all designed with the rehabilitation that will work the best for them.
Now that we have heard all about the different types of surgery in RA, what kinds of questions should an RA patient ask the doctor before they decide to have surgery? Dr. Trumble?
Dr. Trumble:
The key things, as in with any surgery, [are] what are the options, and what are the goals, and finally, what are the risks? I think the rheumatoid patients are often the most pleased because they go into the operation with the most practical goals. They don't go in saying "I want to ski the slalom slope." They go in saying "I want to be able to walk without pain," or "I want to be able to drive a car with a stable wrist."
What should the patient expect after surgery overall?
Dr. Trumble:
If we don't relieve pain and improve function, I don't think that we physicians have benefited the patient, so that is the overall goal. Then, in other cases, there can be the goal of decreasing the risk of associated problem. I've touched on the synovitis that can occur in the hand and wrist, if by removing that, one of the goals is to avoid rupture of tendons and loss of function long term. For the foot surgeon, it might be balancing the foot to avoid ulcerations that can cause serious infections. So there can actually be the practical questions that the patient wants addressed today, and then the long-term concerns that the surgeon knows can be a significant problem for that patient over their lifespan.
Dr. Trumble, thank you. We are almost out of time but before we go, I would like to ask Dr. Mike Schiff, Dr. Leopold, and Dr. Trumble for their final thoughts.
Dr. Schiff:
As a rheumatologist, the treatment for rheumatoid arthritis over the last five years, especially with some of the new biologic agents, really has come a long way to stop and slow down the changes. However, despite this, there is a time and a place for surgery. The orthopaedic joint replacement, and the hand and foot surgery, all of these have been major advances for the rheumatoid patients in the last few decades, and I think we have heard a very nice discussion of that.
Dr. Leopold?
Dr. Leopold:
I would like to make two very short points. One is that joint replacement surgery, and the hand surgery that Dr. Trumble was describing, are complex procedures, and although it is a little bit sensitive topic, I think it is important to consider the background of the individual who is doing it. It is worth asking whether this person who is going to do the surgery has some type of advanced training in that particular area of surgery, which is often called the fellowship or fellowship training.
Secondly, whether that individual does an ample volume of that kind of work to be good at it. There are areas in general orthopaedics where being able to do a wide variety of different procedures is advantageous. But when you start to get into treating rheumatoid patients with complicated problems, it is often very worthwhile to consult with a specialist or a sub-specialist in that type of work, joint replacement, hand surgery, or foot surgery; each has specialty trained orthopaedists who focus only on that one area.
The second thing is I think that information has a therapeutic value in itself. [We have] an educational and noncommercial Web site at the University of Washington that is designed for patients with arthritis called The Arthritis Source and it has hundreds of articles on this and related topics.
Thank you very much. Dr. Trumble?
Dr. Trumble:
Well, Dr. Leopold made some very good points. The key thing is having a coordinated approach to the management of arthritis, and I think that one of the things the patient wants to look at is, do the physicians treating this problem work in a coordinated way between rheumatologists, between orthopaedic surgeons and other specialists. Unlike the patient with primary arthritis or osteoarthritis, they'll often need many different physicians and the goal is to keep them out of the hospital as much as possible and up moving. The goal is to get them out, back into life, and enjoying life.
Absolutely. Dr. Michael Schiff, Dr. Seth Leopold, and Dr. Thomas Trumble, thank you each for such an informative program. And to our listeners, if you would like to join one of our discussions or if you have questions or comments, please contact us at the Rheumatoid Arthritis Information Network. We invite your input.
Dr. Schiff:
Keep in touch with all the new programs on HealthTalk by signing up for the free newsletter, just follow the links on the top of the page, and the link that Dr. Leopold gave you. Until then, I am Dr. Michael Schiff.
And I'm Gina Tuttle. If you found this program helpful, tell a friend. From all of us at HealthTalk Interactive in Seattle. Thank you for joining us. We wish you the best of health.
Last Updated: 5/3/2004


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The Timeless Reign of Carole King
Singer and songwriter Carole King wrote '60s hits such as "Up on the Roof" and "Will You Still Love Me Tomorrow?" In the '70s, she achieved lasting fame performing her own material, such as "Natural Woman" and Tapestry, the best-selling album of the decade. Carole King's new album is titled The Living Room Tour. It was recorded live in Chicago, Los Angeles, and Hyannis, Mass. (This interview originally aired June 19, 1989.)
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Let us consider a real-valued r.v. $X$ such that $\mathsf E X > 0$ and $X>x_0$ a.s. Denote $$ g(x,y) = \frac{x}{y(y+x)}. $$ It is right that for any $X$ there exists $y_0>-x_0$ such that for all $y>y_0$ one have $\mathsf E g(X,y)>0$?
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For every $x$ and $z$ such that $1+zx$ is positive, let $h(x,z)=x/(1+zx)$. For every positive $z$ such that $z\le1/(2|x_0|)$, one has $1+zx_0\ge\frac12$, hence $|h(X,z)|\le2|X|$. Furthermore, $h(X,z)\to X$ when $z\to0^+$. By Lebesgue dominated convergence theorem, $E(h(X,z))\to E(X)$ when $z\to 0^+$.
Since $E(X)$ is positive, this implies that there exists a positive $z_0$ such that for every $z$ in $(0,z_0)$, $E(h(X,z))\ge E(X)-\frac12E(X)$ hence $E(h(X,z))$ is positive.
Note finally that $g(x,y)=h(x,1/y)/y^2$ hence for every positive $y$, $E(g(X,y))$ is positive if and only if $E(h(X,1/y))$ is. This happens at least for every $y\ge1/z_0$.


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This pair of Prps men's woven denim is lighter on the fade effect than the dark denim it mirrors, but keeps the indigo hue intact. Subtle brush-stroke fades of green and yellow make for jeans that show loving wear. An interchanging stripe detail on the inside shows the intricacy of the weave of this complicatedly beautiful selvedge denim jean. Available in the Fury fit, a cleanly tapered silhouette. Complete with coin, waist and back pockets, our Prps leather logo tag and colored button fly closure.
- Fury
- 100% Cotton, 13 Oz.


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If you've seen the 1964 Teshigahara film you've already experienced Abe's brilliance (he wrote the screenplay as well). If you haven't, read this first. The haunting story of a vacationing entomologist trapped in a sand-pit with an enigmatic woman, while the villagers mock his predicament, stands on its own; but in the pantheon of existential narratives it towers above the earlier, cruder attempts by Camus and Sartre. —Recommended by Jeff, City Lights Books
One of the premier Japanese novels of the twentieth century, The Woman in the Dunes combines the essence of myth, suspense, and the existential novel. In a remote seaside village, Niki Jumpei, a teacher and amateur entomologist, is held captive with a young woman at the bottom of a vast sand pit where, Sisyphus-like, they are pressed into shoveling off the ever-advancing sand dunes that threaten the village.
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Down a flight of stairs and you're there. Smack in front of a piece of history. The Fountain Coffee Room at the Beverly Hills Hotel. Designed by architect Paul Williams in the late 1940's and renovated to its near original condition in 1995, complete with the Don Loper designed banana leaf wallpaper (available for purchase at the Pacific Design Center), it's centerpiece is the undulating circular counter that runs the length of the tiny, nineteen seat coffeeshop.
Jam packed with celebrities, socialites and high-powered businesspeople, the Fountain Coffee Room is a fun scene to behold.
Though the original wrought iron bistro chairs are now bolted to the ground and the formica counter is a newer more industrial material, the Fountain Coffee Room still maintains it's unique charm. It had to.
It's a home away from home to it's very loyal customers, some of whom have literally grown up there. When Nancy Jacobs was sixteen, she sang at the hotel. Later, she was married at the hotel and now goes for a meal there virtually every day. Her preference? The Belgian Waffles. And, why do they keep coming? "You never have to ask here. It just appears," says Madison Goritsan, who started coming there with his family when he was a little boy.
And appear it does. When a regular takes a place at the counter, the staff already their favorites waiting for them (ruffle like chips, blue cheese bread (ask for it grilled) are some of the special items). For these people, the Fountain Coffee Room is not just a coffee shop; it's a way of life.
But enough about the regulars, let's talk food! The menu has a lovely selection of breakfast, lunch and dinner comfort foods. The produce is organic, selected from the Farmer's Market. The meats are cut and prepared at the Hotel's on site Butcher Shop. There is a "fit and healthy" section with a selection of no fat, healthier items. Even the delicious French fries have no trans fat.
The portions are large. And the desserts are made on site. Try the Mary J. Blige pie, a whip cream, banana and caramel concoction made from Mary J's own recipe. The coffee is Trinidad. Velvety smooth and rich tasting. Any items from the Polo Lounge menu can be delivered to you within minutes (McCarthy salad anyone?).
In fact, they will make you anything you want and then ask you if you liked it. At the Fountain Coffee Room the staff cares about you (and your meal). Blink and your food appears. It's that fast. So, it's easy to slip in and out, satiated. The perfect bit of peace and downtime in between a busy day.
Go to the Fountain Coffee Room, and no doubt, you too, will become a regular.
If you can find a seat…
Open 7 days a week from 7 am to 7 pm. The busiest times are 12-1 and 4-6. There can be a wait at those times.
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Having quality schools is a priority, necessity and challenge for all school districts throughout Florida and across the nation due in part to some misappropriate and/or non-funding of progressive, positive programs and the securing of professional faculty and staff that can deliver the educational package daily to the students that need academic and vocational involvement in their learning to prepare themselves for the worldwide economy which starts with good parents in good schools in thriving communities.
The prestigious LEED® Green Building Certification was recently awarded to Heritage Elementary as announced by the School District of Palm Beach County. Heritage Elementary School has been awarded LEED® - Existing Buildings, Operations & Maintenance (EBOM) certification as established by the U.S. Green Building Council and verified by the Green Building Certification Institute (GBCI).
"Heritage Elementary is only the second K-12 elementary school in the entire State of Florida to achieve USGBC -EBOM certification; a tremendous distinction and team accomplishment. This project will provide long-lasting benefits to the District including significant energy savings, demonstrate our commitment to environmental stewardship, and strengthen student & staff engagement in environmental conservation principles" said the School District's LEED certification team leader, Paul Strauss.
Quality schools mean quality in the academic and/or vocational endeavors as well as the facility structure and maintenance of the schools. LEED is the nation's preeminent program for the design, construction and operation of high performance green buildings.
According to an article by Thomas C. Frohlich and Michael B. Sauter, 24/7 Wall St., Education news and research publication Education Week recently released its 18th annual survey of the status of education in all 50 states. The K-12 Achievement Index is one indicator in Education Week's "Quality Counts" report that measures key education outcomes and provides ranks and grades for each state based on their commitment to improve educational policies and practices. 24/7 Wall St. reviewed the states with the best and worst scores for K-12 achievement.
The following information was listed (as reviewed by 24/7 Wall St.) showing Florida ranked as #7 as one of the best amongst the 50 states with: State score of 75.8, high school graduation rate: 72.9% (17th worst), per pupil expenditure: $9,752 (15th lowest), preschool enrollment: 50.8% (tied for 11th highest).
Florida was one of just a few states to receive an A in the transitions and alignment category, which measures how schools manage students' transitions between the school systems and secondary education or employment. To smooth transitions between school, postsecondary institutions and the workforce, Florida uses high school assessments to aid postsecondary decisions, one of a few states to do so. Florida school systems received among the highest marks in the country in equity and spending indicators, indicating that funds are well distributed across school districts in the state.
REF: Click here to view the slideshow for full details, States with the best schools
REF: SDPBC (Press Release) Public Affairs Office Jan. 2014


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Welcome to NewFirst National Bank
NewFirst National Bank is a privately-owned financial organization offering over 109 years of continuous ownership and banking experience along with products, services and technology to meet today's financial needs of our customers.
NewFirst National Bank is proud to deliver the highest level of security to our E-Banking and E-Corp customers. This will help ensure that your information is secure, protecting you from fraud and identity theft. Click here for more information.


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KPMG Baltics OÜ
Narva mnt 5
Tallinn 10117
Tel: +372 6 268 700
Fax: +372 6 268 777
Email: firstname.lastname@example.com
Registry code: 10096082
© 2016
KPMG Baltics OÜ, an Estonian limited liability company and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ("KPMG International"), a Swiss entity. All rights reserved.
KPMG International Cooperative ("KPMG International") is a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-a-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm.


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George Hamilton, known as much for his bronze complexion as his film career, doesn't seem an obvious source for a larger than life biopic.
"My One and Only" begs to differ, zeroing in on his early years under the indifferent parenting style of his feisty ma.
The new film looks back at a teen-age Hamilton, long before he adopted his sun-kissed persona.
And the only Gay Blade here is Hamilton's flamboyant brother, the one who first dreams of a big screen career.
"My One and Only" is a tribute to Anne Deveraux (Renee Zellweger), a spirited woman of the 1950s who leaves her philandering husband (Kevin Bacon) and takes her two teen sons George and Robbie (Logan Lerman, Mark Rendall) with her.
The fractured family has little money, but Anne has a crush of ex-boyfriends she intends to ring up ASAP.
But each old flame flickers out before he can say, "will you marry me and let me financially care for your sons."
All the while the boys suffer by moving from one city to the next, missing their father and unsure if their mom has any real plan for survival. Robbie dreams of becoming an actor while George is too worried about his family making the next rent payment.
"My One and Only's" breezy tone, which can't help but feel forced initially, carries all the way through this candy-colored yarn.
The bouncy soundtrack, snappy banter and authentic period details help the narrative rattle along, even while every other scene seems too strange to have happened.
Lerman is just fine as George's younger self, showing the seeds of a charismatic performer still nurturing some emotional wounds.
Zellweger can do moxie in her sleep by now, and her gentle southern accent hints at an inner strength we often don't always see in Anne's actions.
Still, the film feels a tad slim — and casting Bacon as the boys' husky-voiced father seems a mistake. It's only during his final scenes that he manages to make the character his own.
"My One and Only" could use smarter dialogue and a few more oversized performances to close the deal. But as an unconventional tribute to a flawed but fascinating woman, the film delivers precisely as intended.
(Photo: Logan Lerman plays a young George Hamilton in "My One and Only" – Photo Credit: Bill Gray (c) Runaway Home Productions LLC)
Related posts:


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Comedy Actor Roundtable: The 'Friends' Era Vs. Now
Former Friends star Matthew Perry recalls working on the hit comedy, "Doing single-camera work is a completely different type of acting. It certainly breeds playing to the last row in the audience. It's a slightly bigger performance. I've gotten a kick out of being able to play something a little bit more real, but it really is so different."


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I want to change the proofing language of all my slides in a Powerpoint. I've tried setting the language via the Language Preferences menu, however this only changes it for new powerpoints.
I know an answer has already been accepted, but that only changes the proofing language of a single text box, and requires you to change all of them manually.
To change the language of the entire power point easily, open the View tab and select the Outline view.
Now press
Likewise while you have everything selected you can change other things like fonts, colours etc. Although of course in many case this is better done by changing the slide master, a presentation that has had many editors may have lots of 'hard' formatting set which deviates from the underlying master and needs resetting to be consistent. You can also reset individual slides to the master style, but this may result in placeholders moving as well, which may be undesirable in some situations.
PowerPoint 2013:
As for me - PowerPoint restart was needed. Probably because I also did changed Editing Language:
Using Powerpoint 2010 I opened the Outline menu -
Selected all text (Ctrl+A), opened the language menu and set my proofing language
And it worked!
The language menu is located on the Review ribbon tab (after the Slide Show tab and not visible on the screenshot).
The existing answers work for text that is present in the outline. Unfortunately in my case this didn't cover a significant part of the text, including figures, tables, etc.
This macro solved the problem for me :
The "msoLanguageIDEnglishUS" which is used in the above macro can be replaced by any desired language. The full list of languages can be found in this article
(Credit goes to Ganesh Kumar who posted the original macro here. I added support for first level of shape grouping. To further improve it the macro can be made recursive to look for groups which contain other groups, etc.)
I improved upon Inigo's answer to provide a recursive version that changes all items to the desired language.
This version will recursively investigate each shape that is a group type. Some experimentation suggests that
The version of Duncan works well for everything but tables. I found another code which seems to also work with tables: http://stackoverflow.com/questions/4735765/powerpoint-2007-set-language-on-tables-charts-etc-that-contains-text
protected by Community♦ May 25 '14 at 22:07
Thank you for your interest in this question.
Because it has attracted low-quality or spam answers that had to be removed, posting an answer now requires 10 reputation on this site (the association bonus does not count).
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I already asked this question at http://www.rpls.com/forums/viewtopic/8/1276880, but didn't get any answer so far. Maybe here someone can help...
I have a question about the use of Trimble Products. I didn't find a specific forum for that, so I hope that I might get some help here. If I'm in the wrong forum, maybe anybody could point out where I could find help?
We have the following devices: GPS Pathfinder Pro, Handheld with TerraSync and a TruPulse 360b Laser Rangefinder.
In a (dense) forest, we want to map all trees with 13 hectares (~3000 trees). Some gaps in this forest allow measurements with the dGPS, but mostly there is no reception. By measuring distances, azimuths and slopes between neighboring trees, we could calculate coordinates for all trees, based on the few GPS measurements we take in the gaps.
For this, I can create a feature (without position --> no reception) for each measurement and take an offset measurement from one tree to another with the Rangefinder. I can than export the data file to GPS Pathfinder Office software (V4.2). In the software, I can see the offset for each feature (distance, azimuth, slope) by clicking on it. But then there's a problem: In order to use the offset for the calculations, I'd have to export it. In this isn't working. It is possible to export a lot of attributes for each feature, but apparently not the offset.
So here are my questions: - Is it somehow possible to export the offset measurements with GPS Pathfinder Office (V4.2)? - If not: Is this possible with the newest version of this software? - If not: Could any other software accomplish this?
Any help would be greatly appreciated! I really wouldn't like to copy thousands of measurements by hand.


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Where Have You Gone, Atticus Finch?
Where have you gone, Atticus Finch? And you, Perry Mason? What about Clarence Darrow and F. Lee Bailey and Gerry Spence?
Of course, there are still famous trial lawyers out there, masters of the opening statement and the cross-examination. David Boies; John Keker; Ted Wells; Mark Lanier; Cris Arguedas, to name a few.
But the truth is that fewer and fewer cases go to trial these days, so a dwindling number of lawyers are making livings in the courtroom. Click here for a story on the trend, from the Tennessean.
According to the story, U.S. District courts had 5,325 civil and criminal jury trials in 2008, down from 6,839 in 2000 and 9,844 in 1990.
The reasons for the decline in trials are fairly straightforward: the cost of pushing litigation all the way to a jury verdict has gotten unbelievably expensive. In the meantime, alternative dispute resolution has made its way to the mainstream. And corporations, risk averse creatures that they are, hardly ever push lawsuits to trial.
But it's leaving some courtroom specialists on the side, according to the story.
Nancy Jones left Bass Berry & Sims' office in 2007 to lead the Tennessee Board of Professional Responsibility. Part of the reason for her split: she wasn't getting enough courtroom action.
"What it really boiled down to is, when you wake up in the morning, and you haven't had a trial in nine years, can you look at yourself in the mirror and call yourself a trial lawyer?" she told the Tennessean.
Others may cheer the development on grounds that fewer trials means less time spent fighting publicly, and less money spent on lawyers.
But some disagree. Todd Campbell, chief judge of the U.S. District Court for the Middle District of Tennessee, said the lack of jury trials is not only a concern for lawyers and firms but also the general public.
"There's an important social function to people having an open forum to air their grievances in a democracy," said Campbell to the Tennessean.


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MIAMI -- The day after the New Orleans Saints traded up in the draft to select him in the fifth round, rookie punter Thomas Morstead couldn't wait to read all about it.
The words weren't too kind.
Saints Coach Sean Payton and General Manager Mickey Loomis were lambasted for shipping their 2009 seventh-round pick and their 2010 fifth-round pick to select a punter when so many draft-day observers were hoping the team would select a running back.
Morstead was told not to bother reading the draft analysis, but he couldn't resist.
"People tell me don't read your own newspaper clippings, but I like to because it motivates me whether it's positive or negative, " Morstead said. "So I definitely kept up with all that stuff. There weren't too many people saying this is why the Saints are taking a punter; there were a lot of people questioning why are they taking a punter."
Those questions have ceased.
Morstead enjoyed a stellar season, proving to be one of the team's best special teams players and serving as a key reason the Saints are preparing for the Indianapolis Colts in Super Bowl XLIV on Sunday at Sun Life Stadium in Miami.
During the regular season, Morstead averaged 43.6 yards a punt and had 18 of his 58 attempts downed inside the 20-yard line. He has been even better in New Orleans' two playoff wins, averaging 48.2 yards on 11 punts -- with a long of 66 yards.
But Morstead has been even more impressive on kickoffs, a duty the Saints' coaches weren't aware Morstead could handle before he was drafted. In the regular season, Morstead booted 58 of his 99 kickoffs into the end zone, with 27 going for touchbacks.
His right leg never seemed as powerful as it did in the Saints' 31-28 overtime victory against the Minnesota Vikings in the NFC championship game Jan. 24 at the Superdome.
Going against Vikings Pro Bowl kick returner Percy Harvin, Morstead routinely kicked the ball deep into the end zone, preventing Harvin any chance at a return.
Morstead has 10 touchbacks in 13 kickoffs during the postseason.
"He's done a good job, " New Orleans special teams coordinator Greg McMahon said. "He's a rookie, so he's had a learning curve. But he's done a good job for us, punting-wise and kicking off, which is something we didn't realize he would be able to do. He didn't kickoff in college."
Morstead was a good punter at Southern Methodist University, averaging 41.8 yards per punt while pinning opponents inside the 20-yard line 20 times as a senior. He ranked sixth in Conference USA in punting in 2008 and was a consensus All-C-USA punter as a sophomore when he led the conference with a 44.6-yard average and set a conference record as a place-kicker by hitting all 43 extra points.
In his career at SMU, he averaged 43.3 yards per punt and downed 58 inside the 20. That average ranks third in school history and sixth all time in C-USA.
But not many outside of the offices at the Saints' training facility in Metairie knew Morstead would be this good so soon.
"It has worked out awesomely, " Loomis said. "We got second-guessed on that draft choice. But I think when you go through a few years and you have inconsistency at that position and you are talking about a second-day draft pick, you are looking for somebody who can make a contribution to your team on the second day because that's not easy to find. It's hit or miss.
"When we had an opportunity to get what we felt was the best punter in the draft, we said let's go get him. That's why we made that move, and it has really worked out better than expected because he has been an excellent punter. But frankly, we didn't realize how good of a kickoff guy he would be."
The Saints also didn't realize Morstead would be awarded five game balls this season, and that by the end of the season Payton would tout Morstead for the Pro Bowl.
If Morstead continues down his current path, the Pro Bowl just might be in his future.
In the meantime, McMahon said they will continue to work on refining Morstead's skills.
"It's an ongoing skill development, " McMahon said. "He still has a lot of work to do, and that's the good thing about him. He knows he's a rookie, and it's a developmental position. He knows that he has to continue to get better and better and better."
Morstead also knows he wasn't a favorite of many on draft day.
"I don't think they were against me, but it is a good story, " Morstead said. "It's not very common to get traded up. The Saints made their choice, and it was my job to go and prove them right."
. . . . . . .
Nakia Hogan can be reached at firstname.lastname@example.com or 504.826.3405.


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The Guitar Trio: Le Monast×re Dans Les Montagnes
Le Monastere Dans Les Montagnes
The Guitar Trio
The Guitar Trio (Verve 314 533 215-2)
John McLaughlin (acoustic guitar), Paco De Lucia (acoustic guitar), Al Di Meola (acoustic guitar).
Composed by John McLaughlin.
Recorded: England, summer 1996
Rating: 94/100 (learn more)
It's such a shame. Despite a growing personal rift between Paco De Lucia and John McLaughlin and their trio partner Al Di Meola, The Guitar Trio's music seemed to be only getting better. The trio really shot off fireworks on their early 1980s efforts Friday Night in San Francisco and Passion Grace & Fire. For this reunion, the band still had plenty of those fireworks. But a refinement of approach and taste had been added in the ensuing years of experience. Despite the simmering acrimony, the guitarists managed to create some off-the-scale beauty on The Guitar Trio album. A tour followed the CD. But the behind-the-scenes arguments ruined the magic. These gifted guitarists will never perform as a trio again. McLaughlin and De Lucia will certainly continue their longstanding history of collaboration at some point. But Di Meola is the odd man out.
"Le Monast×re Dans Les Montagnes" is a reverential exercise. McLaughlin, who studies Buddhist writings, had Zen in mind when he wrote this composition. For that reason, it is centered. The players occasionally add fiery lines, sometimes played in unison, but the overall vibe is one of virtuosic restraint. (Restraint from these guys is great exertion for others.) For a few minutes you can forget about the world's problems, the Guitar Trio's and your own. Close your eyes and you can feel the pulse of life in this music.
Reviewer: Walter Kolosky
Tags: 1990s jazz · guitar
Comments are closed.


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Soldiers from Joint Base Lewis-McChord left last week for an "undisclosed location" in the Middle East.
While officials at JBLM won't say where the 60-some Soldiers of the 17th Field Artillery Brigade are headed, they did say Iraq or Afghanistan is not their destination. The Soldiers were secreted off post late Thursday night.
These Soldiers will be joining a subordinate unit already deployed to the unnamed country.
Some 300 soldiers from this brigade deployed in December to the same region. At that time they came under the flag of the "1st Battalion, 94th Artillery Regiment" according to a spokesperson from the Army post.
This small group of Soldiers should complete their mission by January of 2015.
It was not mentioned in the news report from the Tacoma News Tribune if family members will know where their Soldier is, if they are sworn to secrecy, or if there will be a social media/media "blackout" during the nine-month deployment.
The National Military Examiner publishes military and law enforcement-related content on this site and here on Facebook. "Like" the page for additional news from around the globe.
Please email me at firstname.lastname@example.com if you find errors with content information or spelling. Thanks for reading and thanks for supporting the troops.


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Narrative Strategies for Resistance and Protest in Eastern European Animation
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- Details
Radians Rad-Apocalypse™ Safety Eyewear
- Safety neck cord included
- Meets ANSI Z87.1 standards
SpecificationsSelect options above to see specifications.
Adjustable Temple No Anti-Fog Yes Anti-Static No Brand Rad-Apocalypse Description Hard Coated Smoke Lens Easy Reorder Eligible Yes Enables Industry Compliance ANSI Z87.1 Eye Type Safety Glasses Frame Style Frameless Hard Coating Yes Includes Neck Cord Lens Coating Hard Coat Lens Color Smoke Lens Color Family Gray Magnification Properties No Manufacturer RADIANS Manufacturer Part Number AP1-20 Meets CSA Z94.3 No Meets High Impact Standards No Meets Military Standards No Meets Z87.1 Yes Mirror No Over The Glass No Polarized No Scratch Resistant No Size One Size Fits All Temple Color Black UV Protection Yes
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