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From Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at University of California, Los Angeles, and Center for the Study of Digestive Healthcare Quality and Outcomes, Los Angeles, California; and Mount Sinai School of Medicine, New York, New York.
Acknowledgments: The authors thank Sun J. Kim for his assistance in conducting this study.
Grant Support: Dr. Kanwal is supported by a Veterans Administration Health Services Research & Development (VA HSR&D) Ambulatory Care Fellowship Award and an American Association for the Study of Liver Diseases Advanced Hepatology Fellowship Award. Dr. Gralnek is supported by a VA HSR&D Career Development Award and a VA HSR&D Merit Award (IIR 01-191-1). Dr. Dulai is supported by a National Institutes of Health NCRR K23 Award (RR-16188). Dr. Spiegel is supported by a VA HSR&D Career Development Award.
Potential Financial Conflicts of Interest: Consultancies: P. Martin (Gilead Sciences), B.M.R. Spiegel (Novartis); Honoraria: P. Martin (GlaxoSmithKline, Schering-Plough); Grants received: P. Martin (Schering-Plough, GlaxoSmithKline), B.M.R. Spiegel (Gilead Sciences).
Requests for Single Reprints: Brennan M.R. Spiegel, MD, MSHS, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, CA 90073; e-mail, firstname.lastname@example.com.
Current Author Addresses: Drs. Kanwal, Gralnek, Dulai, Farid, and Spiegel: VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, CA 90073.
Dr. Martin: Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029.
Author Contributions: Conception and design: F. Kanwal, I.M. Gralnek, P. Martin, G.S. Dulai, B.M.R. Spiegel.
Analysis and interpretation of the data: F. Kanwal, B.M.R. Spiegel.
Drafting of the article: F. Kanwal, B.M.R. Spiegel.
Critical revision of the article for important intellectual content: F. Kanwal, P. Martin, G.S. Dulai.
Final approval of the article: F. Kanwal, I.M. Gralnek, P. Martin, G.S. Dulai, M. Farid, B.M.R. Spiegel.
Provision of study materials or patients: B.M.R. Spiegel.
Statistical expertise: F. Kanwal, B.M.R. Spiegel.
Administrative, technical, or logistic support: I.M. Gralnek.
Collection and assembly of data: F. Kanwal, I.M. Gralnek, M. Farid, B.M.R. Spiegel.
Interferon, lamivudine, and adefovir are the 3 agents currently approved for treating chronic HBV infection. The cost-effectiveness of these therapies has not been previously evaluated. We therefore performed a comprehensive decision analysis to identify the most cost-effective therapeutic approach under varying clinical and budgetary conditions. Our analysis has 3 key findings. First, the use of up-front adefovir in HBV is unlikely to be cost-effective under any circumstance. We found that adefovir monotherapy is less effective yet more expensive than competing strategies in HBeAg-positive patients and has an incremental cost of more than $90 000 per QALY gained in HBeAg-negative patients, a value that exceeds the cost of many commonly accepted medical interventions (126). Second, our data reveal that continuing lamivudine therapy in patients who develop viral resistance is not cost-effective, regardless of HBeAg status. Third, despite our finding that lamivudine is not cost-effective in the setting of viral resistance, our analysis reveals that up-front lamivudine may be highly cost-effective, assuming that patients developing viral resistance cross over to adefovir instead of continuing long-term lamivudine therapy. The adefovir salvage strategy seems highly cost-effective across a range of health care budgets, from the most liberal to the most conservative (Figure 2).
The horizontal axis displays the willingness-to-pay budgetary thresholds to gain 1 additional quality-adjusted life-year (QALY) when using the adefovir salvage strategy instead of interferon, and the vertical axis displays the percentage of 1000 patients that fall within the available budget. There are 3 curves: 1) curve assuming that cohort is 55% HBeAg-negative (base-case analysis) (dashed line); 2) curve assuming that cohort is HBeAg-negative (solid line); and 3) curve assuming that cohort is HBeAg-positive (dotted line). For example, if a third-party payer had a budget of $17 500 per QALY gained to substitute adefovir salvage for interferon (vertical line), more than 99% of the HBeAg-positive cohort would fall within the budget, whereas only 2% and 60% of the HBeAg-negative and base-case cohorts, respectively, would fall within the budget. In contrast, the adefovir salvage strategy becomes cost-effective for close to 90% of all patients in health care systems willing to pay at least $35 000 per QALY, regardless of HBeAg status.
The results presented assume that the entire cohort is HBeAg-negative (top) or HBeAg-positive (bottom). The vertical axes display the lifetime cumulative cost, and the horizontal axes display the quality-adjusted life-years (QALYs) gained. The "do nothing" strategy is the least expensive of the 5 competing strategies in both analyses. When the cohort is entirely HBeAg-negative (top), the lamivudine strategy is dominated as it falls above and to the left of the concave border that outlines the 4 competing strategies composing the cost-effectiveness frontier. When the cohort is entirely HBeAg-positive (bottom), the adefovir salvage strategy becomes the dominant strategy because it is the most effective and least expensive of the 5 competing strategies.
The base-case patient has chronic hepatitis B virus (HBV) infection, elevated aminotransferase levels, no clinical or histologic evidence of cirrhosis, and no previous treatment for HBV infection. The clinician treats with 1 of 5 competing strategies. Within each strategy, patients are stratified by hepatitis B e antigen status (not depicted). In all strategies, patients are eligible to develop cirrhosis, in which case they enter a Markov model governing the downstream events of cirrhosis. See text for details about specific assumptions governing patient management and probability estimates for individual branch points.
Patients enter the model with chronic hepatitis B virus (HBV) infection. During each 1-year cycle, individual patients either remain in their assigned health state (curved arrow) or progress to a new health state (straight arrow). Patients may develop cirrhosis, in which case they move from the precirrhosis submodel to the cirrhosis submodel. Transition rates between health states were derived from a systematic review of the literature (Table 2). Refer to the Appendix for additional information.
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In the cost effectiveness analysis by Kanwal and colleagues(1), concluding that a hybrid salvage strategy for chronic hepatitis B (lamivudine with crossover to adefovir upon resistance) is more cost- effective than adefovir monotherapy, the consequences of lamivudine resistance are not sufficiently taken into account. Entecavir (Baraclude, Bristol-Myers Squibb, New York, NY), is a newly approved nucleoside analog with greater antiviral potency than lamivudine in large comparative trials(2), and in 48 week trials in treatment naïve patients no resistance has been demonstrated. However, its potency is diminished in the presence of lamivudine-resistant HBV, with only 22% of lamivudine refractory patients becoming HBV DNA negative by PCR compared with 83% of treatment native patients(3). Moreover, the presence of pre-existing lamivudine- induced mutations has been associated with the emergence of several additional signature mutations in patients on entecavir, resulting in still further loss of potency. Given that >70% of patients will develop lamivudine resistance after 4 years of therapy, we contend that any strategy utilizing lamivudine as a first line drug has the potential to undermine the future efficacy of an entire class of potent nucleoside analogs which are already available (entecavir) or in the late phases of development (e.g. telbivudine). Adefovir is a nucleotide analog without cross resistance to lamivudine, but an increase in resistance to adefovir from 0-2% at one and two years, respectively, to 18% after four years was reported recently(4). This underscores the need for our therapeutic choices to preserve the maximum possible potency of alternative drugs.
Additionally, the authors contend that the use of interferon therapy may be preferred in health care systems with limited resources. However, we believe that the authors' interferon arm in their model is equivalent to an unacceptable "do nothing strategy" for >70% of patients, and that few clinicians would not try other alternatives in the event of nonresponse to interferon. This shortcoming of the study is acknowledged by the authors and should be amended in any future analyses.
Our greatest concern is that third party payers will impose constraints on the therapeutic regimens available to clinicians and patients based upon studies such as the present one.. The conclusion of Kanwal et al (1) comes precisely at a time when the poor resistance profile of lamivudine and its adverse implications for the subsequent use of other nucleoside analogs should be leading us away from the use of lamivudine as a first-line drug.
1. Kanwal, F., Gralnek, I. M., et al. Treatment alternatives for chronic hepatitis B virus infection: a cost-effectiveness analysis. Ann Intern Med, 142: 821-831, 2005. 2. J.L. Dienstag, L. J. W. et al. Entecavir (ETV) is superior to lamivudine and adefovir in trials of HBeAg-positive and negative chronic hepatitis B infection: A cross-study analysis with published reports. (Abstract 481) In: The European Association for the Study of the Liver. April 13-17, 2005. Paris, France 3. Baraclude ® (entecavir) [product information]. Princeton, New Jersey: Bristol-Myers Squibb, March 2005. 4. S. Locarnini, X. Q., S. Arterburn, et al. Incidence and predictors of emergence of adefovir resistant HBV during four years of adefovir dipivoxil (ADV) therapy for patients with chronic hepatitis B. (Abstract 36) In: The European Association for the Study of the Liver. April 13-17, 2005. Paris, France
Dr. Jacobson is an Advisory Board member and speaker for Gilead Sciences and Bristol-Myers Squibb
TO THE EDITOR: With interest we read the cost-effectiveness analysis by Kanwal and colleagues on the treatment alternatives in chronic hepatitis B [1].
In this study, the authors state that interferon therapy in chronic hepatitis B may save costs by avoiding prolonged therapy like with nucleoside analogues such as lamivudine and adefovir. With nucleoside analogue treatment lifelong therapy may well be needed to achieve a maintained virologic response and the life time safety effects of nucleoside analogues are still unknown.
Kanwal et al. calculated an adefovir resistance of 1.3% annually. This percentage is not confirmed by Locarnini et al. [2], who showed a cumulative probability of 15% after 192 weeks of adefovir treatment in 67 naïve or lamivudine resistant chronic hepatitis B patients. Thus, this higher percentage of viral resistance to adefovir will most likely lead to a less favorable outcome for both adefovir monotherapy and adefovir salvage strategy in this cost-effectiveness analysis.
Furthermore, only the cost-effectiveness of standard interferon therapy for 4 months in HBeAg-positive and 12 months for HBeAg-negative chronic hepatitis B was analyzed. The authors advised that interferon therapy is especially an option in health care systems with limited budgetary resources. In our opinion, interferon could be the first line treatment in chronic hepatitis B in patients without contra-indications to interferon and independent of the budget of the health care system. Especially with the new pegylated interferons, which are even less expensive than standard interferons since they only need to be administered once weekly, a durable virologic response with a limited amount of side-effects can be achieved. This further underlines the importance of pegylated interferon in the current armamentarium to treat chronic hepatitis B.
Martijn J. ter Borg MD, Hajo J. Flink MSc, Harry L.A. Janssen MD PhD Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
References 1. Kanwal, F., et al., Treatment alternatives for chronic hepatitis B virus infection: a cost-effectiveness analysis. Ann Intern Med, 2005. 142(10): p. 821-31. 2. Locarnini, S., et al., Incidence and predictors of emergence of adefovir resistant HBV during four years of adefovir dipivoxil therapy for patients with chronic hepatitis B. Journal of Hepatology, 2005. 42(Suppl. 2): p. 17. 3. Janssen, H.L., et al., Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: a randomised trial. Lancet, 2005. 365(9454): p. 123-9.
None declared
The cost-effectiveness analysis by Kanwal and colleagues (1) addressing treatment options for chronic hepatitis B contains several biases against the nucleos(t)ide analogues. First, the authors assume that patients who develop resistance to nucleoside analogues revert to the natural history demonstrated by untreated patients. However, Lai et al. (2) showed that histological improvement persists even in patients who develop resistance. Second, the rate of clinical progression in patients with advanced fibrosis/cirrhosis is assumed to be uniform among all strategies, despite evidence that continued treatment with nucleoside analogues reduces both the rate of hepatocellular carcinoma and hepatic decompensation (3). Third, although the authors account for costs and discontinuation rates associated with interferon side-effects, it is unclear if they consider the decrement in quality of life during treatment for those patients who stay on interferon for 6 to 12 months. A study of maintenance interferon for melanoma used a relative value of 0.8 (4), but reliable patient-derived values are lacking.
The comparison between lamivudine and adefovir may also need to be re -examined; it is unclear if the authors account for acute hepatitis flares and/or hepatic decompensation associated with the emergence of lamivudine resistance (5). We also found it surprising that among HBeAg positive patients, the effectiveness of adefovir as initial therapy was lower than that of the hybrid salvage strategy (lamivudine with crossover to adefovir upon resistance) despite the fact that durable virological response rates were assumed to be the same for both agents, and lower resistance rates would be expected in the adefovir-only arm. We suspect that the impact of lamivudine resistance has been underestimated in this analysis.
Entecavir (Baraclude, Bristol-Myers Squibb, New York, NY) is a nucleoside analogue that was recently approved by the FDA for treatment- naïve (0.5 mg/day) and lamivudine-refractory (1.0 mg/day) patients with chronic hepatitis B. Entecavir is the most potent drug available in United States for chronic hepatitis B. However, mutations associated with lamivudine use can result in up to a 70-fold reduction in entecavir phenotypic susceptibility (Package Insert, Baraclude, Bristol-Myers Squibb, New York, NY). At 48 weeks, entecavir genotypic resistance was 7.4% in lamivudine-refractory patients versus 0% in treatment-naïve patients. We recommend that Kanwal and colleagues' analysis (1) be revisited, and that lamivudine be avoided as first-line therapy for treatment-naïve chronic hepatitis B patients.
Ahmad Kamal, MD
Aijaz Ahmed, MD
Stanford University School of Medicine, Stanford, CA 94305
1. Kanwal F, Gralnek IM, Martin P, Dulai GS, Farid M, Spiegel BM. Treatment alternatives for chronic hepatitis B virus infection: a cost- effectiveness analysis. Ann Intern Med. 2005;142:821-31.
2. Lai CL, Chien RN, Leung NW, Chang TT, Guan R, Tai DI, et al. A one -year trial of lamivudine for chronic hepatitis B. Asia Hepatitis Lamivudine Study Group. N Engl J Med. 1998;339:61-8.
3. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351:1521-31.
4. Hillner BE, Kirkwood JM, Atkins MB, Johnson ER, Smith TJ. Economic analysis of adjuvant interferon alfa-2b in high-risk melanoma based on projections from Eastern Cooperative Oncology Group 1684. J Clin Oncol. 1997;15:2351-8.
5. Liaw YF. Impact of YMDD mutations during lamivudine therapy in patients with chronic hepatitis B. Antivir Chem Chemother. 2001;12 Suppl 1:67-71.
Aijaz Ahmed, MD is a consultant and speaker for Gilead Sciences and Bristol-Myers Squibb
To the Editor:
Drs Weitzman and Jacobson identify some key issues in the management of chronic HBV in an era where several agents are now licensed for this indication. In particular, both entecavir and peyglated interferon have been approved for chronic HBV since our manuscript was accepted for publication. Our model did not include these agents. Drs. Weitzman and Jacobson rightfully point out that the effectiveness of entecavir is diminished in the presence of lamivudine resistance, and argue that this finding should dissuade clinicians from using lamivudine as a first-line agent. We agree that this observation should give pause to routinely using lamivudine to treat chronic HBV. However, our model did not evaluate "entecavir salvage," but instead evaluated the "adefovir salvage" (i.e. using up-front lamivudine followed by adefovir in case of resistance). Our systematic review of the literature (published as an online appendix with the manuscript) found no published data to support a decrement in the effectiveness of adefovir in the presence versus absence of lamivudine resistance. Therefore, we believe that our results regarding "adefovir salvage" are valid. In contrast, it seems unlikely that "entecavir salvage" will be cost-effective, largely because of the data highlighted by Drs. Weitzman and Jacobson. Moreover, the higher price of entecavir (current average wholesale price roughly 20% higher than adefovir) may not offset its low rate of viral resistance, and up- front entecavir may ultimately be less cost-effective than competing, less expensive therapies.
Additionally, it is important to recognize the difference between patients without evidence of advanced fibrosis or cirrhosis (the subject of our analysis), and those with more advanced disease. In patients without advanced disease, viral progression is slow, poor outcomes are infrequent, and overall survival is not different than matched controls without chronic HBV. This is not an argument to avoid treatment, but instead underscores the importance of rational therapeutic decision-making in the face of health economic realities. In the case of cirrhosis or advanced fibrosis "" health states plagued by the specter of impending clinical complications "" patients may develop resource intensive, morbid, or mortal complications in short order. Although antiviral resistance is never a goal of therapy in either group of patients, the development of resistance has less severe health economic consequences in non-cirrhotics than cirrhotics, since patients with cirrhosis can ill-afford the emergence of viral resistance and subsequent viral flares.
In short, our analysis only applies to patients without advanced disease, and cannot be generalized to telbivudine, entecavir, or pegylated interferon. We agree that future analyses must account for these newer agents. As data evolve, the results of future models may indeed marginalize lamivudine in lieu of alternative agents. Until then, we are left with the constant presence of health economic restraints, and the fact that most HBV patients without cirrhosis never develop complications of chronic liver disease. These factors preclude any cut-and-dry proclamations about how best to treat non-cirrhotic HBV in a resource- limited environment. We look forward to updating our model to reflect this rapidly changing field as new data emerge.
Brennan M.R. Spiegel, MD, MSHS Paul Martin, MD Fasiha Kanwal, MD, MSHS
Consultant for Novartis. Reserach grants from Novartis and Gilead.
Antiviral Regimens for Chronic Hepatitis B Virus Infection
The summary below is from the full report titled "Treatment Alternatives for Chronic Hepatitis B Virus Infection: A Cost-Effectiveness Analysis." It is in the 17 May 2005 issue of Annals of Internal Medicine (volume 142, pages 821-831). The authors are F. Kanwal, I.M. Gralnek, P. Martin, G.S. Dulai, M. Farid, and B.M.R. Spiegel.
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The Story
We created this film for SisterMentors, a DC-based nonprofit that challenges minority women to excel in school and in life. At the post-graduate level, women are offered support and encouragement while earning their PhD degrees. It is these same women who in turn mentor elementary, middle and high school-aged girls, encouraging them to not only stay in school but to excel beyond expectations set for them by family and peers. Most of these women go on to college and beyond, often earning post-doctorate degrees.
"Still Life Projects created a short film for us way beyond our expectations ... but what we valued most of all was the remarkable collaboration they forged with us from the very beginning. It was a collaboration based on respect and appreciation for the work we do in our community. We highly recommend this extremely talented and personable film crew."
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Michigan played its spring game three weeks ago.
The defensive line looked sharp, the offensive line looked off balance and Devin Gardner, the quarterback, wasn't very impressive.
That's about it, really.
Fall can't come soon enough.
This spring, unlike the past few, has been relatively uneventful and devoid of positive excitement for the Wolverines, who absolutely need to win nine games in 2014 to satisfy their hungry fanbase.
This slideshow will hit some of the topics from the spring game. But it'll also take a look at other lessons and information that we have learned during recent weeks.


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I've been trying to find a way to put a positive spin on a 1-4 record, but it can't be done. With a 2-3 record, I could say something like, "They're only 1 game from being a .500 team," but I just can't do anything of the sort with a 1-4 team.
The Jaguars' losses have been hard to watch, not in the same way that last season's blowout losses were, but difficult none-the-less. The Jaguars are certainly trying, but the results just aren't there.
I said earlier in the day that this is the time where a team will either show it's resolve or it will crumble under the weight of disappointment, and I'm hearing about some encouraging things.
For one, I'm reading that the Jaguars had a "players only" meeting sometime Monday. While the contents of the meeting are being debated, I can say this with certainty. Players are stepping up and taking charge. That's the first step to rebounding.
The Jaguars will have a tough time getting a win this weekend against the defending AFC champions, the Pittsburgh Steelers. A win isn't out of the question, however. The Steelers have struggled to run the ball as effectively as they have in the past, and their offensive line is shaky at best. When it comes down to it, the Jaguars just need a win. It doesn't matter how ugly or how pretty it comes. They just need the "W." That's all we, as fans, want; that's all the Jaguars want; And, that's all that Wayne Weaver wants. As the late Al Davis would say, "Just win baby."
So, as we move towards the Steelers game, a game that could very likely kill any hope left in the Jaguars' season, just don't stop believing. That's all we've got left.


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Tuesday, June 10, 2014
Larry Eugene Parker
Larry Eugene Parker of Summerville passed away Thursday, June 5, 2014. He was 64.
Funeral services were set for Tuesday morning, June 10, 2014 at 11 a.m. in Parks Funeral Home Chapel, with burial at 3 p.m. at Old Piney Grove Cemetery (Hebron) in Lake City, SC.
Memorials may be made in Mr. Parkers name to VFW of Summerville, 10154 Bellwright Road, Summerville, SC 29483.
Mr. Parker was born on Aug. 14, 1949, the son of the late Marvin Eugene Parker and the late Lillian Mary Miles Parker, in Hebron, SC. He was a U.S. Army Ranger and also served in the National Guard in Kingstree.
While serving in the Army, he earned two Purple Hearts, one during the Vietnam War and the other during Operation Desert Storm. He was the Chief of Police in Jamestown, and retired from the Charleston Naval Supply Center as a transportation specialist. He was an avid fisherman and loved music. He also enjoyed traveling the world, and was known for his generosity and wonderful sense of humor.
Mr. Parker is survived by two daughters, Jennifer Parker Holmes and husband Brian, of Mount Pleasant, and Tracy Lynn Parker-Reynolds of Jacksonville, FL; one sister, Marylene Nelson of Ladson; and two grandchildren, McKenzie Taylor Reynolds and Parker Elizabeth Holmes. He was predeceased by four sisters, Perline Turner, Margaret Orie Gause, Bertha Mae Price, and Alvalee Ayers.
Arrangements by Parks Funeral Home, 130 West 1st North Street, Summerville, SC 29483. www.parksfuneralhome.com.
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There are a million folk and bluegrass bands out there - what makes Mumford & Sons so special?
The London quartet have always had a thing for building seemingly humble songs towards rapturous, arena-ready climaxes. Now, in the new video for "I Will Wait," off their upcoming sophomore release Babel, they've actually got an arena–the Red Rocks Amphitheatre in Colorado, to be exact.
Directed by Fred & Nick, the video showcases the group in a recent performance of their grand, foot-stomping single in front of thousands of exuberant fans. Even in the cavernous space, the group sound like they might bust right through the rock walls:
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Articles on this page are available in 1 other language: Chinese (Simplified) (4) (learn more)
Range Description
Photographs of several muntjacs from Kaeng Krachan National Park (Thailand) appear to be of this species (R.J. Timmins pers. comm. 2008, based on Dusit Ngoprasert/WCS unpublished data). Camera-trapping in the western forest complex of Thailand has apparently documented the species on several further occasions, and animals have also been observed in the field (Anak Pattanavibool pers. comm. to R.J. Timmins 2008; R. Steinmetz pers. comm. to R.J. Timmins 2008), but identification of these animals could be considered provisional because it has been assumed that only two muntjac species inhabit this part of Thailand (M. feae and M. vaginalis); this might not be the case. Animals have usually been identified on the basis of dark pelage and especially the blackish tail (Anak Pattanavibool pers. comm. to R.J. Timmins 2008; R. Steinmetz pers. comm. to R.J. Timmins 2008), but such characters do not rule out some other muntjac species confirmed from neighbouring areas, including ,i>M. gongshanensis and some animals in the ,i>M. rooseveltorum species complex (R.J. Timmins pers. comm. 2008). The most northerly of the recent records assigned to this species is from Mae Wong National Park in montane forest at 1,450 m asl (16 4' 46'' N, 99 7' 4'' E) (Anak Pattanavibool pers. comm. to R.J. Timmins 2008).
One photograph from 1,250 m asl in Hponkanrazi Wildlife Sanctuary in northern Myanmar shows a male with some features similar to M. feae (R.J. Timmins pers. comm. 2008, based on WCS unpublished data), and may refer to this species, particularly in the light of suggestions that the species is in China (see taxonomic note). This site lies far from the generally accepted Myanmar range of M. feae and raises the possibility that the species might have a much wider range in Myanmar than generally assumed. This record is not included in the distribution map (which should be considered highly provisional in any case). This record would also indicate sympatry with M. gongshanensis.
Fea's muntjacs are found in Thailand and the southernmost region of Myanmar that lies directly to the west of Thailand, known as Tenasserim. Some reports include Laos, Vietnam, and southern China as part of the former range of this species.
Biogeographic Regions: oriental (Native )
- IUCN, 2004. "The 2004 IUCN Redlist of Threatened Species" (On-line). Accessed February 24, 2006 at www.iucnredlist.org.
- Whitehead, G. 1972. Deer of the World. London: Constable & Company Ltd..
Northern Thailand, Burma
Physical Description
Fea's muntjacs, Muntiacus feae, are similar in size to Indian muntjacs, Muntiacus muntjak, which measures 57 cm at shoulder height. Unlike Indian muntjacs, in which males are taller than females, M. feae females are taller than males by 6 to 7 cm. The average weight of an adult M. feae is 22 kg. This small deer is uniformly brown in color with light stripes down the back of the legs and yellow hair at the crown of the head and around the pedicles. Tufts of hair on the forehead may be lighter in color. The relatively long tail is fringed with white hair. The elongated pedicles of males' antlers converge and each has a black line running up its center. The antlers are slightly longer than those of other barking deer (e.g. black muntjac Muntiacus crinifrons, which has antlers that do not exceed 60 mm in length). The long pedicles of muntjacs may be an adaptation to minimize the energy required to regrow antlers after they are shed, as the tropics are relatively nutrient-poor. Males have tusk-like canines that are 1 to 2 cm long.
Average mass: 22 kg.
Other Physical Features: endothermic ; homoiothermic; bilateral symmetry
Sexual Dimorphism: female larger; ornamentation
- Geist, V. 1998. Deer of the World. Mechanicsburg, Pennsylvania: Stackpole Books.
Habitat and Ecology
Towards the centre of their known Thai range, in Kuiburi National Park, Feas appears to be relatively common in evergreen forest, being camera-trapped more frequently than northern red muntjac even at elevations of 300 m asl. In open forest types, however, northern red muntjac clearly dominates, and Feas doesnt appear to use deciduous forest types much (if at all), for example in Kuiburi NP they come right to edge of open habitat but dont cross the line out of evergreen forest. In contrast, northern red muntjac overlaps with Feas in evergreen forest, including high elevation, although Feas may be the more common in montane evergreen forest above 1000 m asl (R. Steinmetz pers. comm. to R.J. Timmins 2008; but see note under Distribution about provisional status of such records). Further north in Thung Yai Wildlife Sanctuary the species appears to be commoner (based on cameras, sightings and interviews) than northern red muntjac in forest habitats up to at least 1,000 m asl (there has been little survey work at higher altitudes), although sign abundance of muntjac species certainly declines with increasing altitude, especially above 1,000 m asl (R. Steinmetz pers. comm. to R.J. Timmins 2008). In contrast within Huai Kha Khaeng WS which lies at a similar latitude to Thung Yai WS, but further east, Feas muntjac is rare even in montane evergreen forest. This may be due to a rain shadow effect which leaves forest in the east drier than forests in Myanmar or close to the border in westernmost Thailand (R. Steinmetz pers. comm. to R.J. Timmins 2008).
- Terrestrial
Fea's muntjacs are woodland dwellers, preferring moist sub-tropical forests. They live in evergreen forests as well as teak forests, and rarely leave dense vegetation to forage in fields. They are found at elevations of less than 1500 meters.
Range elevation: 0 to 1500 m.
Habitat Regions: tropical ; terrestrial
Terrestrial Biomes: forest ; rainforest
- Asean Regional Centre for Biodiversity Conservation, 2006. "Biodiversity information sharing service" (On-line). Accessed February 24, 2006 at http://arcbc.org.
Trophic Strategy
Muntiacus feae, like other muntjacs, is a generalist omnivore, feeding on herbs and leaves, bark, mushrooms, fruits, and possibly even bird eggs, bird young, and small mammals. Muntiacus feae individuals tend to stick to densely wooded areas, preferring more digestible vegetation over grass. Their rumen has two blind sacs, and food is passed through the digestive system relatively quickly in comparison to grass-eating artiodactyls. Foraging occurs primarily at night; small mammals and birds may be killed with the hooves and tusk-like incisors.
Animal Foods: birds; mammals; eggs
Plant Foods: leaves; roots and tubers; wood, bark, or stems; fruit
Primary Diet: herbivore (Folivore , Frugivore )
Fea's muntjacs are important predators of plants and, possibly, small birds and mammals, in the ecosystems in which they live. Their grazing impacts vegetational community composition.
Predators of these muntjacs include humans, tigers, leopards, dholes, wild dogs, and pythons, among others. Muntjac young may also be killed by wild boars. Muntiacus feae may bark to let a predator know it has been detected or to alert conspecifics to danger. Foraging at night in dense forest may provide some protection from predation.
Known Predators:
- humans (Homo sapiens)
- tigers (Panthera tigris)
- leopards (Panthera pardus)
- dholes (Cuon alpinus)
- wild dogs (Canis lupus familiaris)
- pythons (Python)
Anti-predator Adaptations: cryptic
- Karanth, K., M. Sunquist. 1995. Prey selection by tiger, leopard, and dhole in tropical forests. Journal of Animal Ecology, 64(4): 439-450.
Life History and Behavior
Muntiacus feae individuals make barking noises when startled by predators, possibly to alert conspecifics to danger or to let the predator know it has been detected. During mating, Chinese muntjacs (Muntiacus reevesi) make clicking noises with their teeth. The primary mode of communication in M. feae is likely chemical, as it has frontal glands and can evert preorbital glands to mark territory.
Communication Channels: acoustic ; chemical
Other Communication Modes: scent marks
Perception Channels: visual ; tactile ; acoustic ; chemical
Life Expectancy
Muntiacus feae, like other muntjacs, has a relatively short lifespan compared to other cervids. Few data are available on the longevity of M. feae, but one wild-born specimen lived to nearly 12 years of age in captivity. Given its rapid maturation and generalist tendencies, M. feae is assumed to fill a duiker-like role in ecosystems and would likely have a similar lifespan of a decade or less.
Range lifespan
Status: captivity: 11.6 (high) years.
Typical lifespan
Status: wild: up to 10 (high) years.
- Weigl, R. 2005. Longevity of Mammals in Captivity; from the Living Collections of the World. Stuttgart, Germany: Kleine Senckenberg-Reihe 48. Accessed February 24, 2006 at http://genomics.senescence.info/species/biblio.php?id=0671.
Lifespan, longevity, and ageing
Males may compete for access to females by sparring with antlers or fighting using their fang-like canines, although little is known directly about M. feae mating. Males likely defend a territory that encompasses that of several females.
Mating System: polygynous
Muntiacus feae likely breeds year-round as do other subtropical muntjacs, but breeding may be concentrated in winter months. The thinner pedicles compared to other members of subfamily Cervinae suggest that intraspecific fighting with antlers in males may have a less important role in competition for mates than in other muntjacs. Little is known about the reproduction of M. feae, but there are likely many similarities to other muntjacs. Chinese muntjacs Muntiacus reevesi have a gestation period of 243 days, with most females reaching sexual maturity by twelve months of age. In Chinese muntjacs, half of conceptions studied in one captive population occurred during the two-week long estrus period that females undergo immediately after giving birth. As is common for most deer, M. feae females usually give birth to one fawn which is darkly colored and remains with the mother until it reaches maturity.
Breeding interval: Breeding occurs throughout the year.
Breeding season: Breeding may be concentrated in the winter months.
Range number of offspring: 1 to 2.
Average number of offspring: 1.
Average gestation period: 8.1 months.
Average age at sexual or reproductive maturity (female): 12 months.
Key Reproductive Features: iteroparous ; year-round breeding ; gonochoric/gonochoristic/dioecious (sexes separate); sexual ; viviparous ; post-partum estrous
Young M. feae stay with their mother until they reach maturity. Fathers have little to do with raising the young, as they remain very territorial throughout the year. The male's territory may encompass that of several females, but competition for resources may occur between males and females. Little is known regarding the involvement of the parents in the raising of young.
Parental Investment: altricial ; pre-fertilization (Provisioning, Protecting: Female); pre-hatching/birth (Provisioning: Female, Protecting: Female); pre-weaning/fledging (Provisioning: Female, Protecting: Female); pre-independence (Protecting: Female)
- Asean Regional Centre for Biodiversity Conservation, 2006. "Biodiversity information sharing service" (On-line). Accessed February 24, 2006 at http://arcbc.org.
- Geist, V. 1998. Deer of the World. Mechanicsburg, Pennsylvania: Stackpole Books.
Conservation Status
IUCN Red List Assessment
Red List Category
Red List Criteria
Year Assessed
- 1996Data Deficient (DD)
The United States Fish and Wildlife Service listed Muntiacus feae as endangered in 1979. The IUCN Red List formerly described M. feae as endangered, but changed its listing to 'data deficient' in 1996 due to a lack of information on population size and range. Fea's muntjacs are not listed in CITES Appendices.
US Federal List: endangered
CITES: no special status
IUCN Red List of Threatened Species: data deficient
- United States Fisheries and Wildlife Service, 2006. "USFWS Threatened and Endangered Species System" (On-line). Accessed February 24, 2006 at http://ecos.fws.gov/tess_public/TESSSpeciesReport.
Status: Endangered
Date Listed: 07/27/1979
Lead Region: Foreign (Region 10)
Where Listed: Northern Thailand,Burma
Population detail:
Population location: Northern Thailand,Burma
Listing status: E
For most current information and documents related to the conservation status and management of Muntiacus feae , see its USFWS Species Profile
Population Trend
The Thanintharyi (= Tensasserim) region of Myanmar is currently relatively intact, but the ongoing and projected conversion of forests to oil palm plantation in southern Myanmar (Leimgruber et al. 2005) is some level of threat. Such conversion could destroy all large blocks of forest in the lowlands and adjacent lower hills, which includes some of the elevation range of the species. Forest and thus deer at higher elevations would probably remain secure. Altitudinal distribution of the species is too little understood to allow adequately assessment of this threat.
In northern Myanmar (not confirmed to be within the species' range), muntjacs are commonly hunted, particularly for pelts (Than Thaw pers. comm. 2006); hunting levels in the known Myanmar range can also be assumed to be high. In Thailand, Feas muntjac is apparently not specifically targeted by hunters, perhaps because of scarcity relative to M. vaginalis in many of the areas supporting most of the hunting, and its primary range in higher elevations which are not visited frequently by hunters (Anak Pattanavibool pers. comm. to R.J. Timmins 2008).
Conservation Actions
There is a need for taxonomic work, including a re-evaluation of recent field and captive animals (there is a small captive population within Thai zoos) presumed to be M. feae with reference to the holotype, to determine that such animals are indeed this species. Diagnostic characters for the species also need to be clarified in light of recent discoveries of other muntjacs superficially similar in various morphological characteristics. Confirmation in particular is needed of camera trap records from Thailand and Myanmar as referring to this species rather than to any other darkish muntjac, and suggestions of the species' occurrence in China and far northern Myanmar need to be investigated (R.J. Timmins pers. comm. 2006). The species' status, habitat associations, and elevational limits need to be established (R.J. Timmins pers. comm. 2006).
Relevance to Humans and Ecosystems
Muntiacus feae can cause damage to trees meant to be harvested as timber crops by eating their bark. Some reports indicate that muntjacs have taken snared game birds.
Negative Impacts: crop pest
Fea's muntjaca, like other muntjacs, almost certainly provide meat and skins to the people that live within its range.
Positive Impacts: food ; body parts are source of valuable material
Fea's muntjac
The Fea's Muntjac or Tenasserim muntjac (Muntiacus feae) is a rare species of muntjac native to China, Laos, Myanmar, Thailand and Vietnam. It is a similar size to the common muntjac (adult weight is 18 – 21 kg (40 - 46 lb)). It is diurnal and solitary, inhabiting upland evergreen, mixed or shrub forest (at an altitude of 2500 m (8200')) with a diet of grasses, low-growing leaves, and tender shoots. The young are usually born in dense vegetation, remaining hidden until able to travel with the mother.
It is named after zoologist Leonardo Fea. Its other name comes from the Tenasserim Hills, between Burma and Thailand.
- ^ Timmins, R.J., Steinmetz, R., Pattanavibool, A. & Duckworth, J.W. (2008). Muntiacus feae. In: IUCN 2008. IUCN Red List of Threatened Species. Retrieved 5 April 2009. Database entry includes a brief justification of why this species is of data deficient.


text:
Increasing Physical Activity: Environmental and Policy Approaches
Environmental and policy approaches are designed to provide opportunities, support, and cues to help people be more physically active. They may involve:
- The physical environment
- Social networks
- Organizational norms and policies
- Laws
- Public health professionals, community organizations, legislators, departments of parks, recreation, transportation, and planning, and the media
Task Force Recommendations and Findings
This table lists interventions reviewed by the Community Guide, with a summary of the Task Force finding (definitions of findings). Click on an underlined intervention title for a summary of the review, and where available, Research-tested Intervention Programs (RTIPs).
|Task Force Finding
|Community-Scale Urban Design and Land Use Policies
June 2004
|Creation of or Enhanced Access to Places for Physical Activity Combined with Informational Outreach Activities
May 2001
|Street-Scale Urban Design and Land Use Policies
June 2004
|Transportation and Travel Policies and Practices
|Insufficient Evidence
February 2004
|Point-of-Decision Prompts to Encourage Use of Stairs
June 2005
Presentations and Promotional Materials
Action Guides
Places for Physical Activity: Facilitating Development of a Community Trail and Promoting Its Use to Increase Physical Activity Among Youth and Adults — An Action Guide
Developed by Partnership for Prevention with the Centers for Disease Control and Prevention
Community Guide In Action: Stories from the Field
Creating Walkable Communities in Rural North Carolina [PDF - 588 kB]
Walkable Communities: Video – 8:55
Evidence-Based Recommendations Get Minnesotans in the Groove [PDF - 542 kB]
Investing in Worksite Wellness for Employees [PDF - 455 kB]
It Takes a Village: Rural Residents Help Make Their Community Healthier [PDF - 587 kB]
Putting the Community Guide to Work at Workplaces: Partnering to Reach Employers [PDF - 415 kB]
Rural Community Works Together to Stay "Fun and Fit" [PDF - 604 kB]
What Works – Fact Sheets
What Works: Increasing Physical Activity – brochure and insert [PDF - 859 kB]
For More on this Topic
CDC, Division of Nutrition, Physical Activity and Obesity
Recommended Community Strategies and Measurements to Prevent Obesity in the United States
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Obesity Prevention and Control
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
Sample Citation
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing physical activity: environmental and policy approaches. www.thecommunityguide.org/pa/environmental-policy/index.html. Last updated: MM/DD/YYYY.
- Page last reviewed: February 4, 2016
- Page last updated: February 4, 2016
- Content source: The Guide to Community Preventive Services


text:
Financial Visibility and the Decision to go Private
Hamid Mehran
Federal Reserve Bank of New York
Stavros Peristiani
Federal Reserve Bank of New York
June 1, 2009
FRB of New York Staff Report No. 376
A large fraction of the companies that went private between 1990 and 2007 were fairly young public firms, often with the same management team making the crucial restructuring decisions both at the time of the initial public offering (IPO) and the buyout. Why did these public firms decide to revert to private ownership? To answer this question, we investigate the determinants of the decision to go private over a firm's entire public life cycle. Our evidence reveals that firms with declining growth in analyst coverage, falling institutional ownership, and low stock turnover were more likely to go private and opted to do so sooner. We argue that a primary reason behind the decision of IPO firms to abandon their public listing was a failure to attract a critical mass of financial visibility and investor interest. Consistent with the findings of earlier literature, we also find strong support for Jensen's free-cash-flow hypothesis, which argues that these corporate restructurings are a useful tool in capital markets for mitigating agency problems between insiders and outside shareholders.
Number of Pages in PDF File: 56
Keywords: financial visibility, LBOs, going private, analyst coverage, institutional investor, insider ownership
JEL Classification: G00, G30
Date posted: June 11, 2009
Suggested Citation
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Acts, 2016 Reg. Sess., Ch. 106
(b) It is the purpose of this article to create the office of explosives and blasting within the division of environmental protection, and to vest in the office the authority to enforce all the rules and laws established to regulate blasting consistent with the authority granted in this article.
Acts, 2016 Reg. Sess., Ch. 106
(b) As of the effective date of this article, the office of explosives and blasting shall assume responsibility for the enforcement of all the rules and laws established to regulate blasting consistent with the authority granted in this article.
(c) Terms used in this article shall have the definitions set forth in article three of this chapter, unless used in a context that clearly requires a different meaning or as otherwise defined herein.
Acts, 2016 Reg. Sess., Ch. 106
(a) Regulating blasting on all surface-mining operations;
(b) Implementing and overseeing the pre-blast survey process, as set forth in section thirteen-a, article three of this chapter;
(c) Maintaining and operating a system to receive and address questions, concerns and complaints relating to mining operations;
(d) Setting the qualifications for individuals and firms performing pre-blast surveys;
(e) The education, training, examination and certification of blasters; and
(f) Proposing rules for legislative approval pursuant to article three, chapter twenty-nine-a of this code for the implementation of this article.
Acts, 2016 Reg. Sess., Ch. 106
disciplinary procedures for certified blasters.
(a) The office of explosives and blasting shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code, for the purposes of implementing this article. The rules shall include, but not be limited to, the following:
(1) A procedure for the review, modification and approval, prior to the issuance of any permit, of any blasting plan required to be submitted with any application for a permit to be issued by the director pursuant to article three of this chapter, which sets forth procedures for the inspection and monitoring of blasting operations for compliance with blasting laws and rules, and for the review and modification of the blasting plan of any operator against whom an enforcement action is taken by the division of environmental protection;
(2) Specific minimum requirements for pre-blast surveys, as set forth in section thirteen-a, article three of this chapter;
(3) A procedure for review of pre-blast surveys required to be submitted under section thirteen-a, article three of this chapter;
(4) A procedure for the use of seismographs for production blasting which shall be made part of the blasting log;
(5) A procedure to warn of impending blasting to the owners or occupants adjoining the blasting area;
(6) A procedure to limit the type of explosives and detonating equipment, the size, the timing and frequency of blasts based upon the physical conditions of the site so as to: (A) Prevent injury to persons; (B) prevent damage to public and private property outside the permit area; (C) prevent adverse impacts on any underground mine; (D) prevent change in the course, channel or availability of ground or surface water outside the permit area; and (E) reduce dust outside the permit area;
(7) Provisions for requiring mining operators to publish the planned blasting schedule in a newspaper of general circulation in the locality of the mining operation; and
(8) Provisions for requiring mining operators to provide adequate advance written notice of the proposed blasting schedule to local governments, owners and occupants living within the distances prescribed in subsection (a), section thirteen-a, article three of this chapter.
(b) The office of explosives and blasting shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code. The rules shall include, but not be limited to, the following:
(1) Provisions for establishing a process for the education, training, examination and certification of blasters working on surface-mining operations; and
(2) Provisions for establishing disciplinary procedures for all certified blasters responsible for blasting on surface-mining operations conducted within this state in violation of any law or rule promulgated by the division of environmental protection to regulate blasting.
Acts, 2016 Reg. Sess., Ch. 106
(b) Claims which may be filed and determined under the provisions of this section shall be those arising from both of the following:
(1) Damage to property arising from blasting activities conducted pursuant to a permit granted under article three of this chapter; and
(2) The damage is incurred by a claimant who is the owner or occupant of the property.
(c) The claims process established by the office of explosives and blasting shall include the following:
(1) An initial determination by the office of the merit of the claim; and
(2) An arbitration process whereby the claim can be determined and resolved by an arbitrator in a manner which is inexpensive, prompt and fair to all parties.
The office shall propose rules for legislative approval in accordance with article three, chapter twenty-nine-a of this code for the development of standards for establishing rules relating to the initial claim determination and the arbitration process provided in this subsection.
(d) If the operator disagrees with the initial determination made by the office and requests arbitration, then the following shall apply:
(1) Any party may be represented by a representative of their choice;
(2) At the request of the claimant, the office shall provide the claimant with representation in the arbitration process, which representation shall not necessarily be an attorney-at-law; and
(3) If the claim is upheld in whole or in part, then the operator shall pay the costs of the proceeding, as well as reasonable representation fees and costs of the claimant, in an amount not to exceed one thousand dollars.
(e) Participation in the claims process created by this section shall be voluntary for the claimant. However, once the claimant has submitted a claim for determination under the provisions of this section, it is intended that the finding of the office, if not taken to arbitration, shall be final. If arbitration is requested, it is intended that the results of such arbitration shall be final. The office shall provide written notification to the claimant of the provisions of this subsection and shall secure a written acknowledgment from the claimant prior to processing a claim pursuant to the provisions of this section.
(f) The operator shall pay any claim for which the operator is adjudged liable within thirty days of a final determination. If the claim is not paid within thirty days, the director shall issue a cessation order pursuant to section sixteen, article three of this chapter for all sites operated by the operator.
(g) No permit to mine coal shall be granted unless the permit applicant agrees to be subject to the terms of this section.
(h) To fulfill its responsibilities pursuant to this section, the office may retain the services of inspectors, experts and other persons or firms as may be necessary.
Acts, 2016 Reg. Sess., Ch. 106
proceedings not affected.
(a) All orders, determinations, rules, permits, grants, contracts, certificates, licenses, waivers, bonds, authorizations and privileges which have been issued, made, granted or allowed to become effective prior to the enactment of this article shall remain in effect according to their terms until modified, terminated, superseded, set aside or revoked pursuant to this article, by a court of competent jurisdiction, or by operation of law.
(b) Any proceedings, including notices of proposed rule-making, or any application for any license, permit or certificate pending before the division are not affected by this enactment.
Acts, 2016 Reg. Sess., Ch. 106
(b) The office shall propose a legislative rule for promulgation in accordance with article three, chapter twenty-nine-a of this code establishing the fees required by this section. The fees shall be calculated to generate sufficient money to provide for the operation of this office and the Division of Energy as provided for in article two-f, chapter five-b of this code. These fees cannot be increased except by legislative rule and cannot be used to fund additional positions in the Division of Energy in future years.
(c) The office shall deposit all moneys received from these fees into a special revenue fund to be known as the Mountaintop Removal Fund in the State Treasury to be expended by the offices and the Division of Energy in the performance of their duties. The expenditure of moneys in the fund is not authorized from collections, but shall be appropriated by the Legislature.
Acts, 2016 Reg. Sess., Ch. 106
Acts, 2016 Reg. Sess., Ch. 106
Acts, 2016 Reg. Sess., Ch. 106
(1) Ground vibrations associated with blasting and how the vibrations impact protected structures;
(2) The proper size and shot parameters to assure protection of protected structures;
(3) The necessity of expanding the parameters where blasting is prohibited in relation to protected structures to assure that the shots do not cause damage to protected structures;
(4) The appropriateness of modifying pre-blast survey requirements that reflect a pattern of excessive ground vibration and air blast has occurred within a measured distance;
(5) Analysis of the appropriate air blast limitations to determine damage criteria; and
(6) Any other data or recommendations the office deems appropriate.
(b) The office shall report the data and recommendations to the joint committee on government and finance on or before the first day of January, two thousand one, and annually thereafter or as otherwise required.
Acts, 2010 Reg. Sess., Ch. 32.
Note: WV Code updated with legislation passed through the 2016 Regular Session
The West Virginia Code Online is an unofficial copy of the annotated WV Code, provided as a convenience. It has NOT been edited for publication, and is not in any way official or authoritative.


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Oklahoma's first black Supreme Court Chief Justice will be sworn into office Friday.
Just Tom Colbert was originally appointed to the Supreme Court by Gov. Brad Henry in 2004.
Colbert will be sworn in at the state Capitol at 1:30 p.m. Friday.
Everyone is invited to witness the historic event.


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YOUNGSTOWN - Two people were shot to death Thursday night in Youngstown, police said.
Police were called about 9 p.m. to the 1400 block of Willow Court, off Dogwood Lane, on the city's East Side, according to Tribune Chronicle news partner WYTV 33 News. Identities of the victims had not yet been released late Thursday, and details of the shootings remained under investigation.
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From Scripps Mercy Hospital and University of California, San Diego, Medical Center, San Diego, California; and State University of New York at Buffalo, Buffalo, New York.
Acknowledgments: The authors thank Mr. David Cloutier for assistance with randomization sequencing and statistical analyses and Dr. Beatrice Golomb, Assistant Professor of Medicine, University of California, San Diego, for assistance with the analysis and development of epidemiologic evidence.
Potential Financial Conflicts of Interest:Grants pending: P.S. Phillips, R.H. Haas, S. Bannykh, S. Hathaway, N.L. Gray, B.J. Kimura.
Requests for Single Reprints: Paul S. Phillips, MD, Interventional Cardiology, Scripps Mercy Hospital (MER 74), 4077 Fifth Avenue, San Diego, CA 92103; Web site, impostertrial.com; e-mail, firstname.lastname@example.com.
Current Author Addresses: Dr. Phillips: 4060 Fourth Avenue, Suite 205, San Diego, CA 92103.
Dr. Haas: University of California San Diego Medical Center, 9500 Gilman Drive, La Jolla, CA 92093-0935.
Dr. Bannykh: Division of Neuropathology, University of California San Diego Medical Center, 225 West Dickenson Avenue, San Diego, CA 92103.
Ms. Hathaway and Ms. Gray: Cardiology Research, Scripps Mercy Hospital (MER 74), 4077 Fifth Avenue, San Diego, CA 92103.
Dr. Kimura: 230 Prospect Place, Suite 250, Coronado, CA 92118.
Dr. Vladutiu: University at Buffalo, 936 Delaware Avenue, Buffalo, NY 14209.
Dr. England: Blue Mountains Hospital, Great Western Highway, Katoomba, NSW 2780, Australia.
Author Contributions: Conception and design: P.S. Phillips, R.H. Haas, S. Hathaway, N.L. Gray, B.J. Kimura, J.D.F. England.
Analysis and interpretation of the data: P.S. Phillips, R.H. Haas, S. Bannykh, B.J. Kimura, G.D. Vladutiu, J.D.F. England.
Drafting of the article: P.S. Phillips, R.H. Haas, S. Bannykh, J.D.F. England.
Critical revision of the article for important intellectual content: P.S. Phillips, R.H. Haas, S. Bannykh, S. Hathaway, N.L. Gray, B.J. Kimura, G.D. Vladutiu.
Final approval of the article: P.S. Phillips, R.H. Haas, S. Bannykh.
Provision of study materials or patients: R.H. Haas, B.J. Kimura, J.D.F. England.
Obtaining of funding: S. Hathaway, N.L. Gray.
Administrative, technical, or logistic support: S. Hathaway, N.L. Gray.
Collection and assembly of data: P.S. Phillips, R.H. Haas, S. Hathaway, N.L. Gray, G.D. Vladutiu.
Background: Muscle symptoms in patients who are treated with statins and have normal creatine kinase levels are not well understood.
Objective: To report biopsy-confirmed myopathy and normal creatine kinase levels associated with statin use.
Design: Case reports from preliminary analysis of an ongoing clinical trial.
Setting: Clinical research center in a community hospital.
Patients: Four patients with muscle symptoms that developed during statin therapy and reversed during placebo use.
Measurements: 1] patients' ability to identify blinded statin therapy and 2) standard measures of functional capacity and muscle strength.
Results: All four patients repeatedly distinguished blinded statin therapy from placebo. Strength testing confirmed weakness during statin therapy that reversed during placebo use. Muscle biopsies showed evidence of mitochondrial dysfunction, including abnormally increased lipid stores, fibers that did not stain for cytochrome oxidase activity, and ragged red fibers. These findings reversed in the three patients who had repeated biopsy when they were not receiving statins. Creatine kinase levels were normal in all four patients despite the presence of significant myopathy.
Conclusion: Some patients who develop muscle symptoms while receiving statin therapy have demonstrable weakness and histopathologic findings of myopathy despite normal serum creatine kinase levels.
*For members of the Scripps Mercy Clinical Research Center, see the Appendix.
These oil red O stains show lipid as red-staining bodies. All specimens obtained from trial patients 1, 2, and 3 during statin therapy ( , respectively) showed an unusual accumulation of lipid in type 1 fibers. These lipid accumulations had resolved upon repeated biopsy done when the patients were no longer receiving statins ( , respectively). (Oil red O stains; original magnification, ×20).
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Muscle Abnormalities in Four Patients Taking Statins To Treat Unfavorable Cholesterol Levels
The summary below is from the full report titled "Statin-Associated Myopathy with Normal Creatine Kinase Levels." It is in the 1 October 2002 issue of Annals of Internal Medicine (volume 137, pages 581-585). The authors are PS Phillips, RH Haas, S Bannykh, S Hathaway, NL Gray, BJ Kimura, GD Vladutiu, JDF England, and the Scripps Mercy Clinical Research Center.
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The selection of an animal model for the collection of biomedical data should be based on a careful analysis of research requirements and the specific characteristics of the different animal species available for use.1 There are many examples in which a disease does not naturally occur in animals but can be induced by appropriate manipulation. But how does one select the appropriate model? Once it is chosen, how does one obtain the animals, keep them healthy, and handle them properly in a laboratory environment? An excellent source of information is the Proceedings of a Workshop on Animal Models for Perinatal Research, sponsored by the Perinatal Biology and Infant Mortality Branch, National Institute of Child Health and Human Development.2 I will present models involving maternal nutrient deprivation and its effects on the fetus and young animal.
Congenital Hydrocephalus
Models for the study of congenital hydrocephalus have been generally unphysiologic
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'Oklahoma' to be presented
MARTINSBURG - The Apollo Theatre is holding open auditions for its production of "Oklahoma." Needed are additional males for roles and ensemble. Performance dates are Feb. 28, March 1, 2 and 7-9.
For more information or to schedule an appointment, call 304-263-6766 or email email@example.com during the week of Dec. 30.
'Talent Show Extravaganza' set
MARTINSBURG - The Apollo Civic Theatre has announced auditions for its tenth annual "Community Talent Show Extravaganza" will be held from noon to 2 p.m. Wednesday and from 6 to 8 p.m. Jan. 7.
For more information, visit www.apollo-theatre.org.


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Legislative leaders and the governor say everything is on the table, but really it's not, because no one will look at the revenue side' where the state gets its money, and how to get more. Think of a family around the kitchen table figuring how to make ends meet in tough times. Sure, they will look for easy ways to spend less. But they'll also look for more income.
When Louisiana's leaders rule out revenue, we all lose because a cuts-only approach risks failing to meet the growing needs of struggling families and also damaging the state's economy for when prosperity returns.
We need a balanced approach that includes revenue, recognizing there's no single answer to a problem this big. If the money it would produce isn't enough to change the governor's and Legislature's minds about considering revenue, another good reason is Louisiana's tax system badly needs repair.
For one thing, it's one of the nation's most unbalanced. Low- and middle-income Louisianans pay a far higher share of their income in state and local taxes than do the state's richest families. That was the grim conclusion of a recent nationwide study by the Washington DC-based Institute on Taxation & Economic Policy. The breakdown: Families making under $15,000 a year pay 10.4 percent of their income in state and local taxes; those making between $29,000 and $46,000 pay 9.9 percent; and the richest 1 percent of households -- with average incomes just over $1 million -- pay 5.7 percent of their income.
A primary reason for this is Louisiana's heavy reliance on sales and excise taxes and its more limited use of income tax. Low- and moderate-income families must spend most of their income, unlike wealthier families who can save and invest. So taxes on purchases fall heaviest the lower you are on the income ladder.
The state income tax, with graduated rates, works the other way; higher income households pay a greater share of what they make in a year. It's the only tax based on ability to pay, but Louisiana doesn't use it enough to undo the impact of other taxes on low- and middle-income households.
Louisiana's reliance on sales and excise taxes is 65 percent above the national average, according to ITEP. Its reliance on income taxes is 14 percent below. A straightforward strategy to get money to meet public needs and address its woeful tax fairness record would be for Louisiana to rely more on income taxes and less on sales and excise taxes. Instead, we're moving the other way. In 2007 and 2008, income taxes were reduced, giving the biggest break to the wealthiest.
Another problem is Louisiana's array of tax exemptions, projected in this year's budget to cost the state $6.5 billion in lost revenue. Some serve good purposes, like having no sales tax on necessities like groceries and medicine.
But others are questionable, like a two-year exemption from severance taxes for wells drilled in north Louisiana's Haynesville Shale. Experts estimate this geological formation might contain the largest accumulation of natural gas ever discovered, with companies competing fiercely for leases to drill. The tax break, created in 1994 to encourage drilling during a bust, today is an unjustified windfall.
It's a cliche' that problems are opportunities, but Louisiana's financial situation presents a historic chance to realign the state's revenue-raising system so everyone -- individuals and corporations alike -- pays their fair share and the state has the money it needs.
Governor Jindal told the opening session of the state Streamlining Commission, "It's time to make the hard choices...The time for real reform is now."
Fixing Louisiana's unfair, unbalanced taxing system would be a good start.
Edward Ashworth Director Louisiana Budget Project Louisiana Association of Nonprofit Organizations firstname.lastname@example.com


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Comment Re:A REAL digital native (Score 1) 553
What's wrong with using freeDOS? http://www.freedos.org/
I used it to replace old failing machines before, with no problems running the original DOS programs. Plus you can boot it from a CD, which are a lot more common than floppy drives/disks nowadays (still have a usb 3.5 floppy drive if I ever need it though).


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Conceptual Challenge Problems
These rigorous, thought-provoking problems integrate conceptual learning with problem solving and are suitable for group work.
CP1.A (Section 1.3) Some people use expressions such as "a rolling stone gathers no moss" and "where there is no light there is no life. "Why do you believe these are "laws of nature"?


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Note: The Play is showing at The Port Columbus Naval War Center in Columbus,
Georgia (Click here for
information) July 13 & 14th 2001.
By: DOTTIE ASHLEY Of the Post and Courier staff
Originally Published on: 5/27/01
William Thomas-Moore in the play "Romancing the Hunley" this weekend on the Yorktown. The two-person play is presented in docudrama style.
With new discoveries revealed almost daily concerning the H.L. Hunley Confederate submarine, it is fitting that "Romancing the Hunley," an historically based, but original one-act play, will be performed on board the USS Yorktown this weekend.
Local actors and writers William G. Thomas-Moore and Diane Scher created this two-person play, which is presented in docudrama style. Over the past year, they have performed it for audiences at the College of Charleston, Grace Episcopal Church, the S.C. Aquarium, The Citadel and other venues in the area.
The action takes place Feb. 20, 1864, three days after the sinking of the federal blockade ship USS Housatonic in Charleston Harbor. After signaling Confederate sailors on Sullivan's Island that it had rammed the Housatonic with a 90-pound explosive charge, the Hunley mysteriously disappeared.
"Romancing the Hunley" is set in the parlor of the Charleston home of the fictional character Dr. Moore, the town physician who takes care of the medical needs of the Hunley crew. Thomas-Moore and Scher have used a bit of time travel, as Scher portrays a female reporter from the year 2001, who has arrived to interview the doctor about the Hunley's crew members and the submarine's disappearance. This staging contrasts what actually happened in 1864 to the present-day perceptions of what happened in the Civil War.
Scher says the hour long play is reminiscent of the 1950s and 1960s television program, "You Are There," with host Walter Cronkite.
Thomas-Moore, a local longtime Civil War aficionado, has acted in the films, "The Patriot," "The Hunley," and "The Legend of Bagger Vance," all filmed in the Lowcountry. He has been lecturing on the Hunley and the Civil War since 1997, and for 35 years has been a professional master model shipbuilder and historian.
After researching the construction of the Hunley, Thomas-Moore discovered that the full-scale model of the Hunley in front of the Charleston Museum, the State Museum and the Square in Mobile, Ala., were not actually patterned after the Hunley at all, but another vessel, the Pioneer II.
Thomas-Moore has created a number of models of the Hunley, one of which has been on display on the second floor of the Charleston Museum and one presented by Friends of the Hunley to state Sen. Glenn F. McConnell, Hunley Commission chairman. Thomas-Moore also has his models of the Hunley on permanent display around the country, including the Department of Internal Revenue in Washington, D.C., and the Carter Presidential Library in Atlanta.
Scher, who worked as an artist in California for many years, is making her first stage appearance, but has used her right-brain drawing techniques to conduct stress-management workshops around the Lowcountry for the past four years.
"Romancing the Hunley" will be presented by Patriot's Point Naval and Maritime Museum at 7:30 p.m. Friday and Saturday in the Smokey Stover Memorial Theater on board the USS Yorktown. Tickets are $12 general admission and $8 for children ages 11 and younger. To reserve tickets, call 881-5976 or purchase them at the Patriot's Point Naval & Maritime Museum.
Revised: 31 Jul 2006 18:41:04 -0400


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Liverpool manager Rafael Benitez is reportedly expected to arrive in Turin this summer, bringing with him a revolution of such magnitude, that it is promised to breathe new life into the Old Lady. Ahead of the Spaniard's alleged move, this Juventino, much like a candidate in the current Prime Ministerial election race in the UK, will attempt to sway your opinion and assist me in setting up a hypothetical barricade at Aeroporto di Torino, preventing Mr Benitez and his transfer merry-go-round from taking over what is already a sinking ship.
As the season draws to a close, two of Italy's powerhouses are set to go head-to-head in what will be a season defining clash. With Inter chasing Scudetto glory, and Juve ultimately playing catch-up to both Palermo and Sampdoria in the race for fourth, the Bianconeri will be looking to pull off a shock result in Milan in the Derby d'Italia to give themselves a fighting chance of seeing Champions League football next year.
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Candlewood Suites West Little Rock
Candlewood Suites West Little Rock
Get Comfortable in Hotel's Suites in Little Rock, AR
The Candlewood Suites® West Little Rock hotel is in a prime part of town for anyone traveling for business or leisure. The amenities and well-appointed suites will exceed your expectations. With us, there is no need to leave a member of your family at home while you are away, as we are a pet friendly hotel.
Little Rock is home to many large corporations, such as Welspun Tubular, Stephens Inc. and FIS. We are also near the center of the hospital district in West Little Rock. The hotel's access to I-430 and I-630 is convenient to Baptist Heart Hospital, Arkansas Children's Hospital and St. Vincent Hospital. We also have a complimentary Business Center, free Wi-Fi access and USPS shipping services available to all of our guests to ensure easy business travel.
For those here on vacation, you'll find our pet policy, friendly hotel staff and the city of Little Rock to be inviting and hospitable. Browse through the Clinton Presidential Library, shop along the River Walk or go to a concert at the Verizon Arena. There is too much to do in just one visit!
West of downtown Little Rock, the hotel's location is great for guests who want an alternative to corporate apartments or for a temporary relocation. Ask about our accommodation packages. Buy a meal at the Candlewood Cupboard, borrow a DVD from our library and relax in the suite while you "Consider Us Home" during your visit to Little Rock!
Quick Info
- Check In: 3:00 PM
- Check Out: 12:00 PM
- Minimum Check-In Age: 21
- Late Check Out Available
- Parking: Free
- Print Fact Sheet
- Chat With Us
- On-site Guest Self-Laundry Facilities
- Standard Wireless Internet service is free for all members
- On-site Fitness Center Available
It's hard to leave your best buddy at home when you're traveling for extended periods, so we provide a pet friendly experience. Restrictions and fees apply.
Whether you are booking suites for a family reunion or suites for your company's training needs, Candlewood Suites hotels can accommodate your group.
Workout whenever you want: Candlewood Gym always has an open door and lots of aerobic and cardio equipment to make it easier to stick to your exercise routine, no sweat.
The IHG Green Engage system is an online tool that gives our hotels the means to measure their day-to-day environmental impact.
Getting Here
Guest Reviews
Overall Experience
Standard Candlewood
September 19, 2016
This is a 'standard' old-version Candlewood. The room was clean and quiet. The staff was very friendly and attentive. The WiFi was intermittent at best.
Best extended stay hotel in Little Rock
September 19, 2016
Love my room. So nice to have a full kitchen to use while I am in town. Just like being at home. I always have leftovers when I go out to eat, so it's nice to be able to heat it up for a later snack or even get some groceries to cook up a dish. There are even washers and dryers for me to use to clean my laundry before I head home for the weekend.
Awesome facility! The staff members are so sweet and helpful. Michael and Thuy are always ready with some great suggestions for places to visit and restaurants to try out while I am in town.
Clean rooms, great amenities, accommodating staff! Definitely, the best place in town to stay at a great value.
Great Value
September 15, 2016
I stayed at this facility in anticipation of an early morning appointment at UAMS. From the first call to make a reservation to checkout, the staff was excellent and professional.
Great stay
September 08, 2016
The front desk staff was very friendly and helpful. The room was a good size and had comfortable furniture. The bathroom was very clean and well-lit. The shower had lots of hot water.


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Celeb Snaps! Hottest Star Sightings – Monday 02.04.13
Loraine Pavich
| February 4, 2013 - 11:15 am
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Sources: Nielsen [press release], [methodology]
quote: The point I wanted to make is that many current Android powered phones will receive the ICS OS update. This will be a huge number.
quote: Froyo and Gingerbread updates were very inconsistent, and good luck if you happened to buy a Samsung phone. If an update happened, then it was often 3-6 months after the OS was "officially" released.


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Tubbs Storm
Where to Buy
Manufacturer's Description
Visit Tubbs's Boys' Storm page.
Retailers' Descriptions
Here's what other sites are saying:
With a tapered frame shape, easy QuickLock bindings and fun graphics, Tubbs Storm snowshoes are a true kid-friendly model. They're best suited for kids aged 6 - 10 years old.
- REI refers to the boys' version
Free Shipping. Tubbs Boys' Storm Snowshoe SPECIFICATIONS of the Tubbs Boys' Storm Snowshoe Weight: per pair: 2 lbs / 0.91 kg Length: 19in.
- Moosejaw refers to the boys' version
Setting your kid up with a pair of Tubbs' Storm Snowshoes is a great way for him or her to experience the snowy outdoors. The 19-inch aluminum frame is durable and large enough to support munchkins weighing up to 90 pounds. The tapered design helps keep junior from tripping (it's a challenge to adjust to walking on snow). The QuickLock binding is easy for your kid to operate, so you can encourage independence as your adventurer learns to appreciate walking through winter landscapes. These snowshoes work well on flat or rolling terrain, and the crampons excel in hardpack conditions.
- Backcountry.com refers to the boys' version
CLOSEOUTS . Head into winter feet first with Tubbs' Storm snowshoes! Durable design with a fixed toe cord keeps snowshoes close to the boot for gliding ease on packed trails. Available Colors: PURPLE, NAVY, TEAL/PURPLE.
- Sierra Trading Post refers to the boys' version
Tubbs Storm
currently retails for:
$57.99 - $84.95
MSRP: $69.95 (boys')
$57.99 - $84.95
MSRP: $69.95 (boys')


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Is it wrong to reduce twin pregnancies?Jane Roper
This week's New York Times Magazine ran a piece about the growing trend of twin pregnancy reductions — people choosing to reduce a twin pregnancy to a singleton pregnancy, not because of known health risks or fetal abnormalities, but because they just don't want twins.
Holy controversy, right? But the article poses an interesting question: "What is it about terminating half a twin pregnancy that seems more controversial than reducing triplets to twins or aborting a single fetus? After all, the math's the same either way: one fewer fetus."
I never wanted or hoped for twins — even when it was clear that we were going to have difficulty getting pregnant. When we found out I was pregnant with two, I was shocked. (Even with the fertility drugs I was taking, my body still was loathe to ovulate. ) And I wasn't terribly happy about the news. In fact, I was terrified.
It makes me shudder to admit this now, knowing and loving my girls as I do, but there even were times right at the beginning when I thought it wouldn't be the worst thing in the world if one of the fetuses didn't make it, as very frequently happens with twins in the first trimester. ("Vanishing twin syndrome")
But it never once occurred to us to reduce the pregnancy. Whereas I think if I'd conceived triplets — and definitely quads or more — we would have. Not that it would have been an easy decision, or one we wouldn't have had moral qualms about. We would not have done it lightly. But for the sake of my health and the babies' health, if nothing else, it would have seemed like the way to go.
With our twin fetuses, though, even as disappointed / apprehensive as I initially was, I would not have been able to morally justify "terminating" one of them. We'd done fertility, we'd taken our chances, and we got what we got. We were grateful. (And, of course, now, with two daughters that I know and love deeply, the thought of having terminated one of them is just abhorrent.)
It was, naturally, difficult not to project my feelings and experiences as a mother of twins onto the women I read about in the article. (Who, let's remember, weren't mothers of twins when they made their decisions; they were women carrying two fetuses). I had a hard time sympathizing with their decisions. I found it especially difficult to understand how people who entered willingly into fertility treatments could justify reducing a twin pregnancy. To me, that's one of the chances you take. And, assuming it's not a major risk to your health or the children's, then you should go ahead and have those two babies.
On the other hand, I haven't walked in any of those women's shoes. I haven't talked with them about their decisions. I don't know who they are, or what demons they wrestle with. I don't know what else is going on in their lives. And I am pro-choice, which means I believe in women making their own decisions in reproductive matters, even if I might find the choices they make repugnant.
So while I may feel, on a gut level, that what they did was wrong, I'm not going to jump on the condemnation train as most of the commenters over at the NYT have. (And I am most definitely disgusted by the "fertility treatments should be outlawed" and "why don't these people just adopt" comments. Arggggh.)
I don't know. Maybe I'm too forgiving. A wishy-washy bleeding heart. Or maybe it's the fiction writer in me, but when it comes to complex moral/ethical situations like this, I just can't bring myself to make a one-size-fits-all moral judgement. It has to be case by case.
Your thoughts? (Please keep it respectful.)
P.S. — Answers to last week's Quiz: 1.)C or E 2.)E 3.) a-3, b-1, c-2, d-4 4.)E 5.) a- Elsa, b-Clio, c-Elsa, d-Clio, e-Elsa, f-Clio, g-Both 6.) E: the memoir title is DOUBLED OVER.
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Swimming Announces Six Newcomers for 2014-15
April 30, 2014
Duquesne University swimming coach David Sheets recently announced the addition of six new swimmers for the 2014-15 season. Joining the Dukes will be Kaitlyn Bentzel (Mechanicsburg, Pa./Cumberland Valley), Michelle Heim (Greensboro, N.C./Ragsdale), Kayla Owens (Youngstown, Pa./Greater Latrobe), Alexandra Santer (Wilmington, Dela./Charter School of Wilmington), Gabrielle Sibilia (Wooster, Ohio/Wooster) and Abby Watson (Chesterfield, Mo./Marquette).
Bentzel is a three-year high school swimmer and 11-year YMCA swimming competitor. She has qualified and competed at the YMCA short course nationals and has also qualified and placed at her high school Mid Penn conference meet and district meet.
Heim joins the Dukes as a team MVP and three-time All-Conference honoree in high school. She is also a five-year competitor for the GCY Swim Team where she is a team record holder, 2012 Coach's Award winner and a member of the National swim team.
Owens was a three-year letter-winner for a high school team that finished fourth in the state and was Westmoreland County champions. She was a two-time All-American in the 200 IM, 100 breaststroke and 200 medley and 400 freestyle relays. She was also a Westmoreland County champion in the 200 IM and 100 breast.
Santer was a YMCA short course national championship finalist in the 200 backstroke, 100 back, 200 IM, 400 IM and various relays. She was a three-year high school participant for her state championship team and holds the school record in the 100 backstroke and several relays.
Sibilia swam for a high school team which had two consecutive undefeated seasons, was conference champions and finished 10th in the state and fifth in the district. The Ohio Cardinal Conference Swimmer of the Year was a state qualifier and All-Ohio in the 50 free, 200 medley relay and 400 free relay.
Watson is her high school's school record holder in the 100 backstroke and 200 medley. A three-time varsity letter-winner and team co-captain as a senior, she was the team's MVP in 2012. In addition, she competed with the Rockwood Swim Club where her team won the Region VIII team championship in 2011.


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Time for love
Spend a wellness weekend for two in Solothurn with love and romance.
Our offer includes: 1 x night incl. RAMADA MORNINGS breakfast buffet, 1 x welcome drink, 1 x bottle of mineral water in your room, 1 x 3-course choices menu/buffet at the Restaurant Schänzli, 1 x exotic milk bath in the Venus bath (30 min.), free use of the Finnish sauna, aroma steam bath, Kneipp foot baths, adventure showers and fitness room.
Prices per room/package:
Double room "Comfort": starting from CHF 310.– (CHF 310.–)*
Double room "Deluxe": starting from CHF 340.– (CHF 340.–)*
Excl. resort tax CHF 3.00 per person/night
Available from Friday. Saturday and Sunday
(subject to availability)
starting from CHF 310.–
1 Night, Price per double room
instead of CHF 340.–you save CHF 30.–


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Northwest NEWS
eptember 25, 2000
Harvest Festival at Remlinger Farms
Remlinger Farms opens their gates on Sept. 30 for a full month of old-fashioned harvest entertainment. In addition to the Farm Market Fall Specials, the Gift and Craft Shops, the Farm Restaurant and the U-Pick pumpkin fields, the Northwest's largest Fall Harvest Festival is open every weekend in October from 10 a.m. to 6 p.m. Festival admission is $9 for children under 12 years, $8 for adults 12 years and older, and $7 for disabled and seniors 60 years and over.
Festival admission provides a full day of old fashioned fun. There will be hay mazes, giant hay jumps, hay pyramids to climb, and a corn maze to hunt for a pumpkin - find your pumpkins in the maze and purchase them for only 10 cents per pound (with paid festival admission). There will be over 20 rides and attractions available at the festival including the new Flying Pumpkin ride and Mine Twister roller coaster.
For the first time this year the farm will open the festival gates Monday through Friday from 3-6 p.m. for a mini festival beginning Monday, Oct. 10. Admission is only $5.00 per person.
O n Sunday, Oct. 1, festival guests can attend a concert featuring the Kingsmen - the 1960s group of Louie Louie fame - Los Orchids with The Valley Girrrls, and the Tolt Middle School band.
Proceeds from the concert will help raise money for the Carnation Fourth of July Committee, the PTSA, Sno Valley Senior Center, Tolt Band, Tolt Multi Age program, and the Parade program.
With paid festival admission, the concert is only an additional $7 dollars for adults and $2 for seniors. Children under 12 are free with paid adult concert ticket. Festival guests need not purchase concert tickets.
And if you are looking for extra cash for the holidays, but don't want a real job - just a few hours in the evenings or on weekends, call Remlinger Farms at 425-333-4135 ext. 100 to join the "Festival Fun Team."