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Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe
Consensus opinion characterizes dementia with Lewy bodies (DLB) as a progressive dementing illness, with significant fluctuations in cognition, visual hallucinations and/or parkinsonism. When parkinsonism is an early dominant feature, consensus opinion recommends that dementia within the first year is necessary for a diagnosis of DLB. If dementia occurs later, a diagnosis of Parkinson's disease with dementia (PDD) is recommended. While many previous studies have correlated the neuropathology in DLB with dementia and parkinsonism, few have analysed the relationship between fluctuating cognition and/or well‐formed visual hallucin ations and the underlying neuropathology in DLB and PDD. The aim of the present study was to determine any relationship between these less‐studied core clinical features of DLB, and the distribution and density of cortical Lewy bodies (LB). The brains of 63 cases with LB were obtained over 6 years following population‐based studies of dementia and parkinsonian syndromes. Annual, internationally standardized, clinical assessment batteries were reviewed to determine the presence and onset of the core clinical features of DLB. The maximal density of LB, plaques and tangles in the amygdala, parahippocampal, anterior cingulate, superior frontal, inferior temporal, inferior parietal and visual cortices were determined. Current clinicopathological diagnostic criteria were used to classify cases into DLB (n = 29), PDD (n = 18) or parkinsonism without dementia (n = 16) groups. Predictive statistics were used to ascertain whether fluctuating cognition or visual hallucinations predicted the clinicopathological group. Analysis of variance and regressions were used to identify any significant relationship(s) between the presence and severity of neuropathological and clinical features. Cognitive fluctuations and/or visual hallucinations were not good predictors of DLB in pathologically proven patients, although the absence of these features early in the disease course was highly predictive of PDD. Cases with DLB had higher LB densities in the inferior temporal cortex than cases with PDD. There was no association across groups between any neuropathological variable and the presence or absence of fluctuating cognition. However, there was a striking association between the distribution of temporal lobe LB and well‐formed visual hallucinations. Cases with well‐formed visual hallucinations had high densities of LB in the amygdala and parahippocampus, with early hallucinations relating to higher densities in parahippocampal and inferior temporal cortices. These temporal regions have previously been associated with visual hallucinations in other disorders. Thus, our results suggest that the distribution of temporal lobe LB is more related to the presence and duration of visual hallucinations in cases with LB than to the presence, severity or duration of dementia.
- Keywords: cortical Lewy bodies; dementia with Lewy bodies; fluctuating cognition; Parkinson's disease; visual hallucinations
- Abbreviations: CDR = clinical dementia rating; DLB = dementia with Lewy bodies; LB = Lewy bodies; NPV = negative predictive value; PDD = Parkinson's disease with late dementia; PPV = positive predictive value
Received April 12, 2001. Second revision September 27, 2001. Accepted October 4, 2001
Dementia with Lewy bodies (DLB) is a clinicopathological diagnosis for a progressive dementing illness with fluctuating cognition, visual hallucinations and/or parkinsonism in association with Lewy bodies (LB) in the brain (McKeithet al., 1996). However, LB pathology in the midbrain has been most closely associated with idiopathic Parkinson's disease and is currently mandatory for a definitive clinicopathological diagnosis of this disease (Gelbet al., 1999). While there is still debate concerning the pathological overlap between these distinct clinical phenotypes, midbrain LB accumulate independently from those found in the cortex in DLB (Gómez‐Tortosaet al., 1999) and high densities of temporal lobe LB differentiate Parkinson's disease from cases with dementia (Harding and Halliday, 2001).
The consensus criteria for DLB require progressive cognitive decline, but do not require dementia as the initial symptom (McKeithet al., 1996, 1999). The criteria state: 'The central feature required for a diagnosis of DLB is progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function. Prominent or persistent memory impairment may not necessarily occur in the early stages, but is usually evident with progression' (McKeithet al., 1996). DLB is differentiated from Parkinson's disease with late developing dementia (PDD) by the early presentation of cognitive decline within a year of the initial presentations of the disease (most often parkinsonism) (McKeithet al., 1996; McKeith, 1999).
Our recent comparison of the distribution and density of cortical LB in DLB, PDD and Parkinson's disease revealed considerable overlap between DLB and PDD, suggesting that the timing of the onset of dementia does not relate to the quantity or distribution of cortical LB (Harding and Halliday, 2001). Surprisingly, there have been very few studies of the relationship between the early presence of other differentiating clinical features of DLB (visual hallucinations and/or fluctuating cognition) and the amount of cortical LB. In the absence of a dominant dementia syndrome at presentation, these additional features reliably predict the clinicopathological phenotype of DLB. However, visual hallucinations are also found in approximately 25% of patients with Parkinson's disease (Aarslandet al., 1999a, b; Fénelonet al., 2000). It may be that the distribution and amount of cortical LB pathology relate more to additional and overlapping clinical features in such patient groups.
The present study analyses a large cohort of cases with LB pathology. Homogeneous clinicopathological groups of patients with DLB, PDD and Parkinson's disease were segregated and the predictive value of visual hallucinations and/or fluctuating cognition assessed. Correlations between the distribution of cortical LB and these clinical features were also performed. The literature would predict a close association between these variables. Recent analyses of specific hallucination categories identify three psychosyndromes that reflect activation of specific visual pathways (Santhouseet al., 2000). In particular, the ventral temporal lobe is specialized for complex features relating to people, objects and landscapes (Tanaka, 1996; Halgrenet al., 1999; Santhouseet al., 2000)—features characteristic of the well‐formed visual hallucinations in DLB and some Parkinson's disease patients. It is well known that LB concentrate in the ventral temporal lobe in DLB, particularly in the amygdala (Mattilaet al., 1998, 1999, 2000; Hamilton, 2000), an area of the ventral temporal lobe activated by emotional facial interactions (Morriset al., 1996). Additionally, our recent analysis of cortical LB densities in DLB, PDD and Parkinson's disease highlights the importance of parahippocampal LB in distinguishing cases with dementia from those with clinical Parkinson's disease (Harding and Halliday, 2001). In this study, we assess whether this distribution of cortical LB reflects the presence of these additional core features of DLB in homogeneous groups of cases followed to autopsy.
Brains were obtained over a 6‐year period from participants in a number of clinical population‐based studies of dementia (Broeet al., 1990; Reidet al., 1996a; Waiteet al., 1996) and parkinsonian syndromes (Helyet al., 1999; Reidet al., 1996b) in the Sydney area. For all participants, regular annual clinical assessments using protocols devised from internationally standardized assessment batteries were available for analysis. Cases with ocular abnormalities were excluded. Immediately following death, information on the presence and severity of all clinical features was verified using standardized questionnaires completed by the subject's specialist and general medical practitioners and a relative/carer/friend. Patients who significantly declined between their last assessment and death were excluded. Procedures for all studies (including consent) have been approved by the ethics review committees of the Central and South Eastern Sydney Areas Health Services and the Universities of Sydney and New South Wales.
For each case, the brain was removed, weighed and fixed by immersion in 15% buffered formalin for 2 weeks. The brain was routinely prepared for neuropathological analysis using current diagnostic criteria (Braak and Braak, 1991; Mirraet al., 1991; McKeithet al., 1996; National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease, 1997; Gelbet al., 1999; Harding and Halliday, 1998, 2001). Cases with prior head injury, cerebral infarction, frontotemporal dementia or progressive supranuclear palsy were excluded. Only cases with brainstem LB (McKeithet al., 1996; Harding and Halliday, 1998, 2001) were included (98 of 185 participants coming to autopsy). Of the 98 LB cases, 32 had additional neuropathology excluding them from further analysis. Cases were then assessed clinicopathologically using our new screening algorithm to separate cases with Parkinson's disease only from those with dementia (Harding and Halliday, 2001). Of the cases with a maximum parahippocampal LB density of >1/field (n = 42), three cases were not demented (all with maximum of two LB/field). These cases were excluded in order to define homogeneous clinicopathological groups of both non‐demented and demented patients. Sixty‐three cases satisfied all criteria and were included in the study.
Quantitation of cerebral pathology
Five cortical regions [frontal (Brodmann area 9), temporal (area 20), parietal (area 39), occipital (areas 17 and 18) and anterior cingulate (area 24) cortices], as well as the hippocampus and parahippocampus at the level of the lateral geniculate nucleus and the amygdala at its greatest cross‐sectional area were assessed quantitatively. Standard application of the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) method was initially used to determine the semi‐quantitative levels of neuritic plaque within the cortex of each case (Mirraet al., 1991).
In each region of each case, the assessment of neurofibrillary tangles in adjacent sections stained with antibodies to tau enabled the semi‐quantitative assessment of the distribution of tangles for Braak staging of Alzheimer's disease (Braak and Braak, 1991). Additionally, this ensured no globose tangles were inadvertently included as LB in the analyses. Alzheimer's disease (National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease, 1997) was a permissible pathological diagnosis, although cases with Alzheimer's disease but without brainstem LB were excluded.
In each region LB were identified in immunohistochemically stained sections using antibodies to ubiquitin or α‐synuclein and formic acid pre‐treatment (Takedaet al., 1998). Sites of greatest LB density were determined at ×100 magnification; the magnification was then increased to quantify the number of LB/×200 field (field diameter of 1 mm). Paired Student's t‐tests revealed no significant differences in the number of LB identified in sequential sections using either ubiquitin or α‐synuclein antibodies (Fig. 1A and B; P > 0.14). Counts from sections containing the highest densities of LB were used.
Evaluation of clinical signs and symptoms
For each case, assessments were performed routinely throughout the disease course, including assessments for the presence or absence of spasticity, brisk reflexes, ankle clonus and/or extrapyramidal features (tremor, bradykinesia, cogwheeling, stooped posture and glabellar tap). The clinical response and dosage of levodopa therapy were documented. The clinical severity of parkinsonism was assessed using the Hoehn and Yahr score (Hoehn and Yahr, 1967). Cases were diagnosed with dementia using the NINCDS–ADRDA (National Institute for Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for probable or possible Alzheimer's disease (McKhannet al., 1984). Severity and progression of dementia were assessed according to the Mini–Mental State Examination and the Clinical Dementia Rating Scale (Morris, 1993). Functional impairment was rated by the Instrumental Activities of Daily Living (Lawton and Brody, 1969). The Neuropsychiatric Inventory (Cummingset al., 1994) was used to record psychiatric features, including depressive symptoms, hallucinations, disinhibition and apathy. Hallucinations are an under‐reported phenomenon (Ballardet al., 1997), and therefore careful repeated enquiries were made regarding this clinical feature. The average interval ± standard deviation from last examination to death was 10 ± 7 months—substantially shorter than in previous analyses (Gómez‐Tortosaet al., 1999). The last assessments prior to death (verified or modified by the information received after death from the specialist, general medical practitioners and carers) were used in all correlations. Given all the clinical information available for each case, the present study concentrated on analysing the core clinical features of DLB (McKeithet al., 1996, 1999), including bradykinesia and rigidity, fluctuations or clouding of consciousness, well‐formed recurrent visual hallucinations and dementia. If these features were present, the date first noted was included in the analysis.
Visual hallucinations were noted when reported in the presence of the examiner on at least one occasion and/or when there were consistent reports by the subject to a carer. Flashing lights and similar phenomena reported to occur on hallucinogenic drugs (Fénelonet al., 2000) were not considered well‐formed visual hallucinations. The types of visual hallucinations considered were mostly complex features relating to people, objects and landscapes. Because there has been some discussion on the difficulty with the reliability of fluctuations in cognition (Inceet al., 1998; McKeithet al., 1999), transient reductions or loss of consciousness were recorded as fluctuations in cognition. These resembled transient ischaemic attacks or delirium. Because of poor reproducibility and reliability, episodic periods of confusion were not considered sufficient to be recorded as true fluctuations in cognition.
Case classification and statistics
Cases were classified according to their clinical presentations. Four cases had no evidence of parkinsonism throughout their course (DLB‐PD group in Table 1). Because of their small number, this group was not evaluated in the statistical analyses. All remaining cases (n = 59) had a clinical history of parkinsonism, and were grouped into those without dementia (PD‐only group in Table 1), those with early dementia (DLB group, Table 1) and those with late dementia (PDD group, Table 1). All Parkinson's disease‐only and PDD subjects had good clinical improvement with high‐dose levodopa therapy as required for a diagnosis of Parkinson's disease (Gelbet al., 1999). The majority (14 out of 25) of cases in the DLB group were also on dopamine replacement therapy at their last assessment.
|Number of cases
|Age (years)
|73 ± 10
|78 ± 3
|72 ± 11
|76 ± 7
|70 ± 13
|Disease duration (years)
|11 ± 6
|7 ± 5
|8 ± 5
|15 ± 7
|12 ± 4
|Duration (years)
|4 ± 4
|6 ± 5
|7 ± 5
|3 ± 2
|Fluctuating cognition
|Duration (years)
|10 ± 8
|5 ± 3
|15 ± 7
|12 ± 4
Groups are divided into: DLB without parkinsonism (DLB‐PD); DLB (dementia before or within two years of developing parkinsonism); PDD (dementia developing at least 2 years after parkinsonism); and PD‐only (parkinsonism without dementia). Severity of dementia and parkinsonism are reported as measured by the clinical dementia rating (CDR) scale and the Hoehn and Yahr scale (H&Y), respectively. Results are expressed as mean ± standard deviation.
Most statistics were generated using the Statview programme (Abacus Concepts, Berkeley, Calif., USA) and a P value of 0.05 was taken as the level of significance. Differences between clinical groups were analysed using ANOVA (analysis of variance) and post hoc protected t‐tests. Positive and negative predictive values were calculated to ascertain whether other core clinical feature(s) predicted the clinicopathological group(s). Positive predictive values (PPVs) refer to the probability of having the clinical feature(s) for a particular clinicopathogical diagnosis, while negative predictive values (NPVs) refer to the probability of not having the clinical feature(s) for a particular clinicopathological diagnosis. As parkinsonism was common to all groups subjected to statistical assessment, no significant relationships were found for this clinical feature. Separate analyses were conducted using the presence or absence of early features (within 2 years of the first clinical symptom or sign). For pathological correlations, a separate series of ANOVA (feature early/first, late or never) were performed. A similar group analysis was performed for dementia severity correlates with cortical LB densities. Regression analyses were performed to relate the duration of any clinical feature/s to cortical LB densities.
Clinical findings
After applying all exclusion criteria, 63 cases with a mean age of 73 ± 10 years were assessed (47 males, 16 females, age range 42–89 years). A total of 47 cases had a clinical diagnosis of dementia (75% of the sample), and 59 cases (94%) had a clinical diagnosis of parkinsonism. Overall disease duration was significantly shorter for cases with clinical DLB than for those with clinical Parkinson's disease (Table 1; ANOVA = 11.7, P < 0.0001, protected t‐test P values for DLB versus PDD < 0.0001, DLB versus Parkinson's disease‐only = 0.007, PDD versus Parkinson's disease‐only = 0.10). As expected, the average clinical dementia rating (CDR) score was significantly different for demented versus non‐demented cases (Table 1; ANOVA = 48.5, P < 0.0001; protected t‐test P values for Parkinson's disease‐only versus clinical DLB, P < 0.0001; Parkinson's disease‐only versus PDD, P < 0.0001; clinical DLB versus PDD, P = 0.00003). Cases with DLB had a significantly longer duration of dementia than cases with PDD (Table 1; t = 3.02, P = 0.004). There was no significant difference in the average Hoehn and Yahr score prior to death for any group (Table 1; ANOVA = 0.52, P = 0.60).
Only four cases had no clinical evidence of parkinsonism (DLB‐PD group in Table 1). One case had sufficient plaques and tangles to reach NIA–Reagan (National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease) criteria for the diagnosis of Alzheimer's disease. The remaining cases in this group all had short disease durations without any evidence of parkinsonism, even though they had significant midbrain cell loss and LB (required for study entry). All remaining cases (n = 59) had a clinical history of parkinsonism. Fifty‐eight per cent of dementia cases were classified as DLB (Table 1), 19 with probable DLB and six with possible DLB (McKeithet al., 1996). In terms of dementia severity, six DLB cases had only a mild dementia, six cases had moderate dementia and 13 cases had severe dementia (52% of DLB group; Table 1). In contrast, the majority of PDD cases had only a mild dementia (67%; Table 1). 72% of DLB cases (n = 18) and 89% of PDD cases n = 16) had early parkinsonism, severe in 52% and 67%, respectively (Hoehn and Yahr scores of 4–5; Table 1).
Eleven cases had parkinsonism as their only feature (69% of Parkinson's disease‐only group). As most cases with parkinsonism were at end‐stage, parkinsonism was severe in most (Table 1). Fifty cases (85%) had parkinsonism early in the disease course. Of the two remaining DLB core symptoms, recurrent visual hallucinations were present in 35 cases (31 with dementia), an early symptom in 11 cases (31% of hallucinating cases, all with dementia). There were four Parkinson's disease‐only cases that had visual hallucinations during their disease—although this was a feature only late in the disease course. Two of these four cases also had fluctuating cognition, including one case where fluctuating cognition was an early sign. Fluctuating cognition was recorded in 25 cases overall (22 with dementia) and was an early feature in 13 (52% of cases with this feature; Table 1).
Frequency of core DLB features in the clinicopathological groups
As dementia and parkinsonism were used for clinical grouping, these features will not be considered further. The presence of the other core clinical features of DLB (i.e. fluctuating cognition and visual hallucinations) were examined within each group to determine diagnostic profiles. The majority of DLB (56%) and PDD (78%) cases had visual hallucinations, an early sign in 43% and 21%, respectively. In contrast, only 25% of the Parkinson's disease‐only group had hallucinations, and none was early. The majority of DLB cases had cognitive fluctuations (52%), an early sign in 69%. In contrast, 39% of PDD and 19% of Parkinson's disease‐only cases had recorded cognitive fluctuations, an early sign in only a minority (Table 1).
To analyse whether visual hallucinations and/or cognitive fluctuations were better predictors for either DLB or PDD, positive and negative predictive values were calculated using the proportion of cases with or without these features in each dementia group. Of these two symptoms, cognitive fluctuations had the best overall predictive power for DLB (PPV = 52%, NPV = 61% compared with PPV = 56%, NPV = 22% for hallucinations). The combination of these two features did not improve this predictive power (PPV = 32%, NPV = 67%). When the onset of the clinical feature was early, NPV improved for PDD (89% for fluctuations, 83% for hallucinations, 94% for both features occurring early) at the expense of PPV for DLB (36% for fluctuations, 24% for hallucinations, 4% for both features occurring early). These data show that, although neither of these features are good predictors of DLB in pathologically proven patients, the absence of these features early in the disease course is highly suggestive of PDD.
Distibution and densities of cerebral pathology
Across all groups, only six DLB cases had rare parietal lobe LB and fewer had LB in occipital cortex. LB in these regions were not considered further. Frontal association cortex had relatively low LB densities (2.1 ± 0.5 LB/field) with only 30% of cases having a maximum density of two or more LB/field. The greatest densities of LB were found in the amygdala (6.8 ± 0.6 per field), anterior cingulate (4.4 ± 0.5 per field), inferior temporal (3.9 ± 0.6 per field) and parahippocampal (3.8 ± 0.6 per field) regions. Over 60% of cases had two or more LB per field in these cortical regions, with approximately half of these cases having seven or more LB per field. With the exception of the amygdala, where high densities of LB were present in the vast majority of cases, high densities of LB in one region usually predicted high densities in other regions (multiple regression analyses, P < 0.001, r2 range = 0.64 to 0.81). These densities and distributions are similar to those reported by Mattilaet al. (1998).
Comparing between the groups, Parkinson's disease‐only cases were screened to exclude cases with significant cortical LB (Harding and Halliday, 2001) and all demented cases had significant densities of cortical LB. As described for both DLB and PDD (Samuelet al., 1996; Haroutunianet al., 2000; Mattilaet al., 2000), the combined sum of the maximum LB density across all regions examined was significantly greater in cases with DLB compared with PDD, and significantly greater in PDD compared with the Parkinson's disease‐only cases (Fig. C; P < 0.0001). However, further analysis of the contribution of each individual region to this result shows that there were significantly higher LB densities only in the inferior temporal cortex of DLB cases compared with those with PDD (Fig. D; P = 0.017). Surprisingly, LB densities in all other regions examined were not significantly different between the dementia groups (Fig. D).
Twenty‐seven cases (43%) had neuritic plaque densities sufficient for a CERAD diagnosis of probable or definite Alzheimer's disease. These criteria for Alzheimer's disease were reached by 72% of DLB cases and 33% of PDD cases. The cases with dementia and CERAD Alzheimer's disease had more cortical LB only in the parahippocampus (LB/field) compared with the demented cases without Alzheimer's disease (6.4 ± 5.1 LB/field versus 2.8 ± 2.2 LB/field, P = 0.011). Six cases had significant numbers of neurofibrillary tangles (Braak stages 4–6, all demented). One DLB case had significant tangles but rare plaques, whereas the remaining five cases reached NIA–Reagan criteria for the diagnosis of Alzheimer's disease (National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease, 1997). LB concentrations within the amygdala (12 LB/field) were significantly higher in these cases with Braak stages 4–6 (P = 0.0002), even though the overall LB burden did not differ (P = 0.96). Together these data show that cases with DLB are more likely to have plaque pathology and higher temporal lobe LB compared with cases with PDD. Neurofibrillary tangles are rare in both groups using the exclusion criteria outlined. However, those cases with tangles that achieve all criteria for Alzheimer's disease (likely to contribute to or cause the dementia itself) concentrate LB in the amygdala.
Relationship between clinical features and cerebral Lewy bodies
The sum of the combined maximum LB densities across all regions did not differentiate cases with mild dementia from those with more severe dementia (P > 0.3), although cases with DLB had more LB overall compared with both Parkinson's disease groups (Fig. C). There was no correlation between overall cortical LB burden and the duration of dementia (P = 0.96). As described above, DLB cases had significantly higher LB densities in the inferior temporal cortex (Fig. D), although there was no correlation between LB density and the duration of dementia (P = 0.2). This shows that high LB densities in the inferior temporal neocortex relate to the presence of early dementia and a diagnosis of DLB. In the PDD group, cases with moderate to severe dementia had higher densities of LB in the frontal cortex than those with mild dementia (t = 5.6, P = 0.04), as previously shown (Samuelet al., 1996; Mattilaet al., 1998, 2000). However, this relationship did not hold true for cases with DLB (t = 0.9, P = 0.3) and was not related to the duration of dementia (P = 0.7).
The majority of cases with hallucinations (28 out of 32) had dementia (either DLB or PDD). Cases with hallucinations had significantly more LB/field on average than those without hallucinations in the parahippocampus (P = 0.028) and amygdala (P = 0.046), but not in the frontal (P = 0.88), anterior cingulate (P = 0.74) or inferior temporal (P = 0.25) cortices (Fig. F). The overall cortical LB burden was significantly greater in those cases hallucinating initially or within the first years of disease onset regardless of diagnostic group (Fig. E and G; P = 0.03). This association was due to significantly more LB within the temporal cortices (Fig. H; P = 0.009 for parahippocampus, P = 0.03 for inferior temporal cortex). This indicates that LB pathology in medial temporal regions predisposes to hallucinations with the increasing involvement of more inferolateral temporal cortices ensuring the presence of hallucinations in cases with LB.
Fluctuating cognition
No significant statistical relationships were found between the summed or regional LB densities and fluctuations in cognition.
The present study compares the clinical and pathological features of patients with parkinsonism and either early (DLB) or late (PDD) dementia. Our recent work revealed marked overlap between these clinical groups in the concentration and distribution of cortical LB (Harding and Halliday, 2001). This prompted us to question the correlation between cortical LB and dementia. In order to address this issue, the analysis of any associations between other core clinical features and the degree of LB pathology is required. A direct comparison of the presence or absence of well‐formed visual hallucinations between patient groups revealed that significant numbers of patients with either DLB or PDD had visual hallucinations. There is some suggestion in the literature that dopamine replacement therapy contributes to or exacerbates this clinical feature. However, all our Parkinson's disease and PDD cases had clinical benefit from high‐dose levodopa therapy, regardless of the presence or absence of hallucinations, supporting the majority of studies showing no major association between levodopa therapy and hallucinations (Fénelonet al., 2000; Aarslandet al., 2001; Barnes and David, 2001; Holroydet al., 2001). Visual hallucinations were an early feature for 21% of the PDD group analysed, even though these patients did not reach criteria for dementia until much later in their disease (some 10–12 years later). The visual hallucinations reported by patients were mostly well‐formed landscapes and figures (people and animals), with no significant difference in the form of hallucination experiences between groups. This finding is consistent with the recent reports on the incidence of well‐formed visual hallucinations in Parkinson's disease (Manford and Andermann, 1998; Aarslandet al., 1999a, b; Fénelonet al., 2000; Holroydet al., 2001). Thus, the overlap in the pathological distribution of cortical LB may relate more to this clinical feature than to the diagnosis of dementia or brain dopamine levels.
The clinical information used in the current study was collected prospectively in a standard manner (Waiteet al., 1996; Reidet al., 1996a, b; Helyet al., 1999). The structured nature of this data collection ensured that all core symptoms were considered in all patients studied. Patients were followed throughout their disease until close to death (last assessment 10 ± 7 months prior to death). Thus, it is unlikely that core features were missed (false negatives) in the repeated (annual or biannual) clinical examinations. The well‐formed, recurrent visual hallucinations were the only feature that may have relied on patient or carer reporting. In instances where visual hallucinations were not evidenced by the examiner at any stage, consistent reports by the subject of visual hallucinations, corroborated by a carer, were mandatory for inclusion as a disease feature. While visual hallucinations are considered an under‐reported phenomenon (Ballardet al., 1997), we believe that the repeated assessments over many years in these cases are likely to have revealed that the vast majority of patients experiencing this clinical feature. The significant relationship between LB densities and such visual hallucinations implies that the reporting of this clinical feature was reliable in this sample.
Previous prospective (Hohlet al., 2000) and retrospective (Litvanet al., 1998) studies have suggested that a more accurate diagnosis of DLB could be achieved if greater weight were given to the feature of visual hallucinations. Well‐formed visual hallucinations help differentiate DLB from other dementia syndromes (Hironoet al., 1999). Our analysis comparing DLB and PDD suggests that this sign is not a good isolated predictor of DLB in patients with parkinsonism, as it occurs early in a proportion of Parkinson's disease patients who will dement much later. Recent studies have suggested that fluctuations in cognition give greater accuracy of diagnosis for DLB (McKeithet al., 2000a; Walkeret al., 2000). While our results suggest that this feature concentrates in DLB, particularly as an early feature, our statistics show that this feature is also a poor isolated predictor in patients with parkinsonism.
Histopathological differences
Apart from our recent work (Harding and Halliday, 2001), few studies have compared the neuropathology of patients with DLB versus those with PDD. For such a comparison, we standardized our methods for analysing LB, plaques and tangles comparing the maximal densities for all lesions—as now widely adopted (Mirraet al., 1991; Harding and Halliday, 1998; Newellet al., 1999). Our data show that cases with DLB are more likely to have cortical plaque densities similar to those seen in Alzheimer's disease. This association is well‐known (Hansenet al., 1993; McKenzieet al., 1996; Armstronget al., 1997, 1998; Samuelet al., 1997; Brownet al., 1998; Mattilaet al., 1998, 2000; Haroutunianet al., 2000), although few studies have compared DLB with PDD cases. Our results suggest that the vast majority of cases with PDD do not have sufficient densities of cortical plaques to suggest Alzheimer's disease. Our previous analysis showed that, in DLB patients, both LB and plaques independently contributed to the dementia process (Harding and Halliday, 2001). We speculated that the combinations of these pathologies may account for the rapidity of the disease process in DLB (Harding and Halliday, 2001).
The present study also shows that patients with DLB have higher densities of LB in temporal neocortex compared with cases with PDD. This suggests that abnormal protein deposition in temporal neocortex relates to onset of cognitive decline and dementia in DLB rather than the stage or duration of dementia. A recent study suggests otherwise, reporting that the only clinicopathological relationship in cases with DLB is an increase in global LB burden with the duration of dementia (Gómez‐Tortosaet al., 1999). However, this study did not evaluate many of the temporal lobe structures analysed in the present study and included dementia cases who had parkinsonism for >2 years (PDD in the present study). Increasing pathology within the temporal neocortex relating to dementia onset may have been predicted based on multiple studies in cases with Alzheimer's disease (e.g. Braak and Braak, 1991) where increasing temporal neocortical pathology relates to dementia onset, stage and disease duration (Gertzet al., 1996; Berget al., 1998; Delacourteet al., 1999). Our results show that high densities of LB in the inferior temporal neocortex differentiate cases with DLB, and that cases of PDD have increasing frontal LB densities with increasing dementia severity. We have previously shown that increasing densities of frontal LB are associated with significant frontal lobe atrophy (Cordatoet al., 2000), and others have shown increasing frontal LB burden relates to increasing cognitive impairment (Samuelet al., 1996; Mattilaet al., 1998, 2000). This dichotomy of regional pathology suggests that the disease processes driving DLB and PDD differ.
In the present study, neurofibrillary tangles were rarely seen in either DLB or PDD. However, in those cases with sufficient neuritic pathology to reach all criteria for Alzheimer's disease (likely to contribute to or cause the dementia itself), LB concentrated in the amygdala. It has been noted that LB occur in the amygdala in the majority of cases with diverse neurodegenerative disorders, including familial and sporadic Alzheimer's disease (Lippaet al., 1998; Hamilton, 2000; Maruiet al., 2000; Mukaetova‐Ladinskaet al., 2000), Down's syndrome (Lippaet al., 1999), Hallervorden–Spatz syndrome (Saitoet al., 2000) and the parkinsonian–dementia complex of Guam (Yamazakiet al., 2000). These diseases have tau deposition in the amygdala in common with LB formation, suggesting that the formation of neurofibrillary tangles appears to precipitate LB within the amygdala independently of Parkinson's disease and/or DLB.
Clinicopathological correlates
We found no associations between cortical LB pathology and fluctuations in cognition, consistent with previous reports (Gómez‐Tortosaet al., 1999). In the present study, transient reductions or loss of consciousness were required for this feature to be positively identified. Reliable identification of this clinical feature is an acknowledged problem (McKeithet al., 1999). Previous studies describe excessive daytime drowsiness and other milder features as consistent with cognitive fluctuations (McKeithet al., 1996), and we may have chosen an arbitrarily severe cut‐off for case inclusion. The prospective use of operational criteria for less severe fluctuations in cognition (Walkeret al., 2000) may reveal relationships not identified in the present study. Additionally, the measurement of subcortical pathology may relate better to this clinical feature than the cortical pathology we analysed.
High LB densities in the amygdala and parahippocampal cortex were associated with visual hallucinations. Furthermore, increasing numbers of temporal lobe LB were associated with the earlier onset of this clinical feature. Although not significant, higher average LB densities have been previously observed in paralimbic cortices in patients with hallucinations compared with those without (Gómez‐Tortosaet al., 1999). The larger numbers of cases analysed in the present study (35 out of 63 compared with 12 out of 25) are likely to have contributed to identifying this relationship as the numerical densities of cortical LB are relatively low. It should be noted that four of the 35 cases with recurrent visual hallucinations did not have dementia, but still had higher densities of temporal lobe LB. This frequency of visual hallucinations in patients with Parkinson's disease is consistent with recent reports (Aarslandet al., 1999a, b; Fénelonet al., 2000). The amygdala and parahippocampus are regions commonly affected by pathology in dementing disorders, being the initiating sites for the pathology of Alzheimer's disease (Braak and Braak, 1991), which possibly precipitates amygdala LB formation (Lippaet al., 1998; Hamilton, 2000; Maruiet al., 2000; Mukaetova‐Ladinskaet al., 2000). Previously about 30% of cases with Alzheimer's disease were thought to experience similar well‐formed visual hallucinations (Ballardet al., 1997). However, recent studies suggest significantly fewer cases of Alzheimer's disease have this clinical feature (<5%) compared with the majority of cases with DLB (Hironoet al., 1999). Parkinsonism and exaggerated cognitive decline are significant predictors of visual hallucinations in patients meeting criteria for probable Alzheimer's disease (Paulsenet al., 2000), with prospective studies showing cortical LB in such cases (McShaneet al., 1995). This suggests that a similar distribution of cortical LB in cases with Alzheimer's disease may contribute to the clinical manifestation of visual hallucinations.
Few other neuropathological changes have been associated with well‐formed visual hallucinations. Ocular pathology can precipitate visual hallucinations possibly via abnormal cortical release phenomena (Manford and Andermann, 1998; Santhouseet al., 2000). Brainstem vascular lesions in the midbrain reticular formation can also cause complex visual hallucinations (Manford and Andermann, 1998). Although speculative, this is possibly due to the involvement of ascending noradrenergic, cholinergic and serotonergic pathways which are also associated with sleep disturbances (Manford and Andermann, 1998; Arnulfet al., 2000; Turneret al., 2000). To our knowledge, we have described the first consistent association between the presence of visual hallucinations and a structural pathology in the cortex. As isolated lesions of the temporal lobe do not cause such visual hallucinations, the participation of other brain pathways is highly likely. In this regard, greater reductions in choline acetyltransferase activity in the temporal lobe have been associated with a higher prevalence of hallucinations in Parkinson's disease, PDD and DLB (Perryet al., 1991; Tiraboschiet al., 2000). Thus, visual hallucinations are associated with two biological changes in the temporal cortex in LB disease—LB formation and decreased choline acetyltransferase activity. It will be important to determine the time course of the loss of presynaptic acetyl choline to reveal whether this pathology is a consequence of LB formation in the postsynaptic cortical neurones or a contributor to such intracellular pathology. This has important implications for long‐term treatment benefit with cholinesterase inhibitors currently reported in cases with DLB (McKeithet al., 2000b, Rojas‐Fernandez, 2001).
The underlying brain activation patterns of people undergoing complex visual hallucinations have recently been described. In particular, patients with Charles Bonnet syndrome, who report similar visual hallucinations to patients with LB, activate the anterior temporal projection of the ventral visual pathway when hallucinating about landscapes, figures, and vehicles with appropriate emotional context (ffytcheet al., 1998; ffytche and Howard, 1999; Santhouseet al., 2000). These hallucinations are thought to occur because of a lack of occipital stimulation due to ocular pathology (ffytcheet al., 1998; ffytche and Howard, 1999; Santhouseet al., 2000). Downstream ventral association cortices increase their activity as a result of cortical disinhibition with this abnormal activity in visual processing regions activating complex visual hallucinations. It would appear more than coincidental that the same brain regions concentrating LB in our patients with visual hallucinations were those activated by visual hallucinations in patients with the Charles Bonnet syndrome (Santhouseet al., 2000), particularly as decreased occipital glucose metabolism also occurs in patients with LB (Imamuraet al., 1999, 2001; Lobotesiset al., 2001). The reduction in occipital metabolism occurs without underlying pathological inclusions, with a recent study suggesting that white matter abnormalities contribute to this metabolic deficit (Higuchiet al., 2000). In addition, DLB patients have preserved glucose metabolism in ventral temporal lobe regions, particularly those cases with visual hallucinations (Imamuraet al., 1999; Higuchiet al., 2000; Lobotesiset al., 2001). These data suggest that activity in ventral visual pathways in association with underactivity of the primary visual cortices contributes to the well‐formed visual hallucinations reported in cases with LB.
While it is generally believed that intracytoplasmic inclusions are a sign of neurodegeneration, several studies quantifying cortical neuronal loss in patients with DLB have shown a remarkable neuronal preservation (Gómez‐Islaet al., 1999; Broeet al., 2001), suggesting that cortical LB may not signify neurodegeneration. If these cortical inclusions do not disrupt neuronal metabolism sufficiently to cause degeneration, they may disrupt cell mechanisms sufficiently to cause an increase in metabolic demand for neuronal survival. This may contribute to the association between the concentration of temporal lobe LB and well‐formed visual hallucinations found in the present study. In fact, the overall pattern of temporal lobe LB formation appears to be more relevant to the onset of visual hallucinations than to the onset of dementia in cases with cortical LB disease.
We wish to thank the many brain donors and their families who have made this work possible. This work was funded by a donor who wishes to remain anonymous (with no potential for conflict of interest), the National Health and Medical Research Council of Australia, the Australian Brain Foundation and Parkinson's NSW, as well as by equipment grants from the Ian Potter Foundation, the Clive and Vera Ramaciotti Foundation Equipment and the National Health and Medical Research Council of Australia.


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Overhead and underneath concerns will be taken care of at a Gander long-term care facility as the provincial government announces more than $450,000 in funding.
Lakeside Homes
In the latest round of government funding announcements Thursday, Lakeside Homes, a Central Health long-term care facility in Gander, is being provided $425,000 to replace roofing on the two nursing units
An additional $27,500 is allocated to purchase new adjustable geriatric chairs designed for long-term care settings that reduce sitting pressure, preserve independence, reduce falls, and improve the quality of life for the resident. Also included in this funding are upgrades to the common seating area for patients and visitors.
Gander's MHA Kevin O'Brien and Central Health's president and CEO Rosemarie Goodyear see government's investment into Lakeside Homes as more than just into a physical structure.
"Providing care for our loved ones as they age is an important priority of the provincial government. Upgrading Lakeside Homes is more than an investment in a building, it is about ensuring that we provide comfortable settings for our families while they receive quality and essential care," said O'Brien in Thursday's news release.
Goodyear couldn't agree more.
"Long-term care is certainly an area where we are seeing an increased demand for services, so I am very pleased to see government make this investment in long-term care infrastructure," she said. "For the 102 residents of Lakeside Homes, that facility is truly their home and infrastructure investments such as this one will ensure that care continues to be provided in surroundings that are well-maintained."

subset: commoncrawl


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Friday, February 10, 1911:
• "Manufacturers and dealers in soda water, ginger ale and soft drinks generally are pronounced in their condemnation of a measure which, it is reported, is contemplated ... calling for a special tax or license upon the business of manufacturing and handling carbonated drinks of every description, including all kinds of concoctions usually sold at soda fountains."
• "Arrangements have been completed for the construction of three sections of sample highway, beginning at One Mile creek on the Telegraph road, north of the city and extending for, possibly, three miles."
• "C.E. Mauldin of the pure food and animal industry department of the United States bureau of agriculture spent a few hours in Mobile Wednesday on business. While in this city, Dr. Mauldin inspected the Mobile Abattoir and suggested several minor changes, which will be made."
• "Montgomery, Ala. -- By a vote of 53 to 45 the house of representatives at 5 o'clock this afternoon passed the Parks local option bill (eliminating prohibition of alcohol), after a debate lasting five hours and after a continuous session of seven hours and a half."
Monday, February 10, 1936:
• "Harold Sherman of Mobile was among the 96 priests who were ordained in Rome, Italy, Sunday by Cardinal Marchetti, vicar of Rome, according to Associated Press dispatches. ... Sherman's three sisters, Agnes, Genevieve and Cecile Sherman, were in attendance at the ordination services.
"He was a member of the McGill Institute class of 1928. He also was a graduate of Spring Hill College."
• "Little, rotund Dr. E.V. Cupero, who first noticed the talents of Al Jolson and sent the mammy-vender to dizzy heights of public acclaim, has achieved another success.
"He brought a brilliant version of the Gilbert and Sullivan operetta, 'Pinafore,' to Mobile, using local cantorial talent, and the glowing reports of the first-nighters and those who saw the performances Saturday caused the production to be held over for a fourth presentation tonight at the Murphy High auditorium. ...
"Dr. Cupero also played an important role in the development of Vitagraph pictures, the forerunner of the modern Vitaphone productions.
The Hill professor, who long conducted in the pit for DeWolff Hopper company ... with a repertoire of Gilbert and Sullivan productions, is directing the Murphy performance."
• "Many civic problems of Spring Hill, including suggestions of changing the name of Old Shell Road, will be debated at a meeting of citizens of the community which was called by A.C. Tonsmeire, president of the Spring Hill Community Association, for Tuesday. ... The name of College Drive, which has been suggested for Old Shell Road, will be discussed. ... Some complaints of cows eating azaleas brought about the desire for more strict... enforcement of the stock law."
Friday, February 10, 1961:
• "Two Guatemalan ships, the frigate Jose Francisco Barrundia and the presidential yacht, Salvador Mendieta, arrived in Mobile Thursday afternoon for operational repairs at Bender Ship Repair. ... Aboard the frigate is Francisco Sosa, commander of the Guatemalan Navy."
-- Compiled by Cammie East Cowan


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Tracy Letts made his name with an act of one-upmanship: August: Osage County, which earned Letts both a Pulitzer and a Tony, is the dysfunctional family drama to end them all, an emotionally draining three-hour opus that draws upon Faulkner, Williams, O'Neill, Albee and Shepard. Letts throws all his predecessors' most lunatic characters into a sweltering three-story manse and lets them gnaw one another into submission; it is not better than Cat on a Hot Tin Roof or Long Day's Journey Into Night, but it is louder and meaner, and it is impossible to imagine anyone trying to top it. With August, Letts declared an entire genre of American dramatic literature finished, roaring, "I'm in charge now!"
His follow-up, which plays through Feb. 12 at Artists Repertory Theatre, is less noisily ambitious. Superior Donuts is an odd-couple comedy of familiar form: Arthur Przybyszewski, a burnt-out, emotionally stunted former radical and draft-dodger who now runs the Chicago donut shop his father founded, hires Franco Wicks, an exuberant, uninhibited black 21-year-old with dreams of literary stardom, to work the counter. They banter, hilariously, as Franco tries to draw his reticent boss out of his shell, bluntly appraises his appearance ("Let me tell you who looks good in a ponytail: Girls. And ponies.") and proposes he add poetry readings ("Poets can't pay the rent, but they drink coffee like a motherfucker").
It's a comfortable, entertaining, even heart-warming character comedy, directed without fireworks by Allen Nause. Bill Geisslinger, who last appeared at Artists Rep as the burnt-out middle-aged cynic Sharkey in the company's 2009 production of The Seafarer, incorporates some of that character into Arthur, by way of The Dude and maybe Harvey Pekar. Vin Shambry, a veteran of New York productions of Hair and Rent with few nonmusical credits in his bio, is immediately likeable as Franco. He is constantly in motion and endlessly curious, part grifter, part eager student. We love him as soon as we see him.
Letts knows this and, because he's an emotional terrorist, abruptly saddles Wicks with implausible gambling debts, collected by a pair of anachronistic Irish thugs borrowed straight from 1970s Mamet, and sends the plot spinning off into unearned tragedy. It's a silly, self-indulgent move, and brings with it enough stupidity—some really offensive Russian stereotypes, a badly choreographed fight scene and body horror that will come as no surprise to anyone who's seen Artists Rep's ads for the show—to nearly sink the ship. Most of the second act is disappointing, but Shambry and Geisslinger build up a strong enough head of steam in the first that even the final scene, a blunt allusion to The Cherry Orchard, cannot completely overwhelm my good feelings about the show. Adjust your expectations accordingly.


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Tuesday 3:00am - 4:00am
Hosted by: Dred Scott Keyes
Web Site:
Dred Scott Keyes
is a producer and journalist based in New York City.
He produced "The Gospel Truth: The Sam Cooke Story", "Sweet Soul Music: The Roots of Southern Soul Music", "Malcolm X Speaks to the Midnight Ravers", all of which won awards from the National Federation of Community Broadcasters.
Keyes was also the co-producer of "Drilling and Killing: Chevron and Nigeria's Oil Dictatorship", which won the George Polk award in 1998.
He has written for the Amsterdam News in New York City and the Jackson Advocate in Jackson Mississippi and appeared in the 2005 documentary "Sweet Honey In The Rock: Raise Your Voice", seen on the American Masters series on PBS.
In 2004, he was invited by the Rock and Roll Hall of Fame to participate in a three- day conference on the life of Sam Cooke. Keyes is also a graphic artist, specializing in collages on such subjects as the blues, jazz, Afro-Cuban music and Malcolm X.


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Originally published at: http://www.howtogeek.com/177105/how-to-securely-transfer-files-to-someone-else-with-sftp/
We've previously written about hosting your own FTP server, but data is transferred in cleartext, making it unsuitable for confidential file transfers. In this guide we'll go over the secure version of FTP – SFTP, and why it makes for an excellent way of transferring files to other people across the internet.
Another program to use as an SFTP server is Filezilla
The FileZilla Wiki says it can't be used for an SFTP server. "Support for SFTP (SSH File Transfer Protocol) is not implemented in Filezilla Server."
Is there any way to limit user permissions with this software? For example, I want myself to have full read-write-delete-append permissions, but I only want certain people to have read permissions.
With this software, I don't believe so. You could lock down each user to a separate directory, but I think that's the most control this software is going to offer you. If you're sharing some files with someone you don't trust, you can give them their own directory so they don't have free reign over all your other SFTP directories and files.
On Linux this would be much easier, because you can install SSH server and just lock each user to their home directory, and assign permissions as root. With Windows, you'll need a different program, and the majority of ones I came across in my research aren't free.
This topic was automatically closed after 9 days. New replies are no longer allowed.


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Enterprise mobility is not a new concept. IT has delivered email and other information to mobile devices for a while now. That said, the devices that make up today's enterprises are no longer fully known and controlled.With BYOD, mobility has introduced both risks and opportunities within the enterprise, driving IT to adopt mobility strategies and solutions that can keep pace with these vulnerabilities.
Device security and trust are not only main concerns for IT, but for users as well (albeit in different ways). Enterprise mobility management (EMM) solutions help IT ensure that data is delivered safely across devices and that consumers are offered the privacy and personalization of features that they crave.Yet, as we see time and time again with things like shadow IT, users don't always have the same level of appreciation for, or understanding of, why we need (and should love!) device management tools.
In this slideshow, Manoj Raisinghani, vice president, global product marketing, mobile platforms group at Citrix, has distilled consumer perceptions vs. the reality of enterprise mobility.
Related Topics : In Their Own Words: The Four Dark Horses for the Third Major Mobile OS Speak, HTC, Mobile Search, 3G, Location-Based Services
Digital innovation is by far the biggest influencer, changing the way we do just about everything, from shopping to communication to running a business. ... More >>
In order to attract Gen Z talent, employers will need to take into account that this group of the workforce may expect a different set of benefits. ... More >>
Enterprise app stores provide a single "shopping experience" for employees and support both a BYOD model and a self-service IT model. ... More >>


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Make the clean choice with this custom microfiber cleaning cloth featuring your full color imprint edge to edge.
Transform any smartphone screen into an impressive virtual reality experience and transport yourself anywhere in the world with these virtual reality custom goggles.
Always keep your larger electronics devices charged while on the go with this power bank custom charger.
The smiley guy promotional stress ball is a stress reliever that will put a smile on your face or hold your cell phone when not in use.
Bring immediate attention to your cause and brand with these fun MopTopper Breast Cancer Awareness ribbon custom stylus pens.
These promotional ear buds come packaged in a custom imprinted case.
Celebrate Christmas this year with the gift of music together. Comes with a promotional greeting card and CD with religious music tracks.
Flexible silicone macaroon shaped promotional earbud holder with keyring is the must have travel accessory.
Keep your cool under pressure when you are in the office or at home all year long with these USB flexible custom fans imprinted with your logo.
A unique custom microfiber cleaning cloth displays a full calendar year that can also clean smudges from all your electronic devices.
This custom microfiber cleaning cloth not only is essential to clean smudges from all your electronic devices, it doubles as a full year calendar and arrives packaged in a tube.
Ultra-portable custom speaker provides size defying sound from any Bluetooth-enabled device
These promotional ear buds come packaged in a custom imprinted case.
Keep your cords or earbuds from tangling by wrapping them around a customized cord wrap that's the perfect size for mailing campaigns.
Keep your cords or earbuds from tangling by wrapping them around a customized cord wrap that's the perfect size for mailing campaigns.
This unique cylinder shaped promotional cell phone holder is a convenient office accessory.
A convenient promotional lap desk with a slot for holding your eReader as you work.
A great interactive, technological Promotional Calculator for your message.


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There are rumours circulating that the Labour Party would like Sir Alan Sugar to become their candidate for the London Mayor contest in 2012
London Mayor: you're fired!
I have to say that when one of my students told me this story, I thought they were pulling a fast one.
Sugar was vague about this when he was asked about this possibility in a radio interview, saying only that he believed in "sticking to what you know".
If Sugar were to run then it would suggest that politics had finally fallen under the umbrella of celebrity culture. It's true that Sugar has a successful record as a businessman and other entrepreneurs have run major cities, such as Mike Bloomberg New York. But I would suggest that Sugar is better known for his TV appearances than his business acumen. How many people could actually recognise one of his products?
British politics has slowly been moving in the direction of the cult of celebrity, with much greater emphasis being put on media image than ever before. At the moment, for instance, we have an electorate that apparently wanted a change from the Blair era of spin, welcomed Gordon Brown initially as PM before going off him because it turns out that he is a master of the dark arts. Worse, they now want a government led by David Cameron, a man who spins more that anyone ever thought possible.
There is something of a precedent for Sugar running, if we consider that the current incumbent, Boris Johnson, also had a higher profile for his TV work than his success as MP for Henley.
If voters want to treat politics as some sort of reality TV show, it makes one wonder if the universal franchise is such a good idea.
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A full copy of all the teaching & learning resources (print and digital) provided to delegates attending the New to Teaching A Level Politics course
Your students will love these editable PowerPoint-based game-based lesson activities. Just add your own questions! Or get your students to come up with the Qs!


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Nuttall facing charge of attempted murder
APPLE RIVER - Two Cumberland County men charged with firearms-related offences, and one with attempted murder, were released from custody during a court appearance Tuesday afternoon.
Joshua Robinson Nuttall, 24, and Nicholas Owen Phinney, 26, were released on strict conditions.
Nuttall is facing one count each of attempted murder, assault with a weapon, using a firearm in the commission of an offence, pointing a firearm and possession of a weapon.
Phinney is facing one count each of assault with a weapon, uttering threats, using a firearm in the commission of an offence and possession of a weapon.
Cumberland District RCMP community policing officer Const. Dal Hutchinson said members of the Amherst, Parrsboro and Oxford detachments responded to an Apple River residence when the call came in at approximately 11:54 p.m. Sunday.
"It appears that the accused were at the victim's residence on Sunday and at some point, I'm not sure how it came about, they were asked to leave and an argument ensued," Hutchinson said, noting the two accused did leave the residence.
"After they left the victim's residence, they went to another residence before coming back to the victim's place. There, there was another argument, a firearm was pointed at the victim and threats were uttered."
A press release issued shortly after the accused appeared in court said the two men returned to the victim's residence with a shotgun.
"I can say that the shotgun was not discharged," Hutchinson added.
Hutchinson said tensions are running high in the tight-knit community, where everyone either knows everyone else or is related to them.
"All parties, including the witnesses, are known to one another," Hutchinson said.
At the time of the complaint, Hutchinson said officers, assisted by the Northeast Nova Major Crime and Forensic Identification Unit and the Cumberland Street Crime Enforcement Unit, tried unsuccessfully to locate the accused.
The accused were located at a nearby residence and taken into custody late Monday morning.
Nuttall and Phinney were released on a number of conditions, including not having any contact with the victim or witnesses, abstain from alcohol and drug consumption, abide by a curfew and to keep the peace and be of good behaviour.


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No minimum purchase. First time buyers only. Click here to activate.
Honest Kitchen Zeal Grain-Free Dehydrated Dog Food is specifically for sensitive dogs. What was left out of this diet is almost as important as what is in it. Zeal doesn't contain corn, soy, rice, beet pulp or wheat. It is also grain-free, gluten-free and free of flaxseed and white potatoes. This food is suitable for adult maintenance, sensitive dogs or dogs with moderate activity levels.
About The FishThe fish is guaranteed Ethoxyquin-free because it is 100% human-grade. The food grade Icelandic Haddock is wild caught using a line and hook, in the cold clean waters off the coast of Iceland with all natural antioxidants for freshness. The Blue Whiting is wild-caught in the waters of Scandinavia and the Arctic. It is one of the most abundant fish stocks in the semi-pelagic water masses of the northeast. The wild-caught Atlantic Salmon is freeze-dried to preserve the naturally high oil content; salmon is a wonderful source of essential fatty acids.
Honest Kitchen uses eco-friendly packaging! A fine, recyclable 'minimalist' and unprinted barrier bag that efficiently protects the food inside helps reduce materials usage and waste. The bag is enclosed in a 100% recycled box made from unbleached kraft paperboard. The box is printed with soy-based inks and the finished product is 100% biodegradable or recyclable again after use, too.
The Honest Kitchen makes wholesome, natural food for dogs using gentle dehydration, a unique new approach to canine nutrition. These foods help you create delicious and nutritious meals made with real, recognizable, and human-grade ingredients that are ready to prepare and serve at home. Simply add warm water to rehydrate, and you have a complete meal with USDA meat, fresh fruits and vegetables, organic flaxseed, herbs, vitamins, minerals.
The Honest Kitchen's dehydrated food offers many of the benefits of a biologically appropriate raw pet food diet, combined with the convenience and peace of mind of a nutritionally balanced, ready-blended product. Dehydration simply removes the moisture, which prevents decomposition. As an ancient form of preserving food, virtually all of the nutrients are left intact. This is a much "fresher", and therefore healthier, approach than the extrusion process that dry kibble undergoes. See below for a description of each formula.All of Honest Kitchen's dog food and dehydrated raw dog food products are formulated to meet the AAFCO nutrient profiles for dogs and you don't have to add anything to make them 'complete'. However, the original idea behind these diets was as a base for a raw or other fresh homemade diet and to facilitate that, they are somewhat 'lite' in terms of fat and protein, so that your own choice of raw, or cooked, meat can be added, if desired.
It is entirely a matter of personal choice (and your dog's taste!) whether you add in extra meat and other ingredients, or not. Most people with younger and more active dogs like to mix in the additional meat, and those with senior or overweight animals usually prefer to feed the organic dog food alone. The Honest Kitchen supplies pet owners with the best in fresh dehydrated raw dog food and other organic dog food products.
About Dehydration
Dehydration or drying, is one of the oldest and gentlest methods of food preservation. Food dehydration works by removing only the water content from the ingredients. All other nutrients remain, and become highly concentrated. Dried foods are extremely nutritious, easy to prepare and store, and light weight to ship.
Because dehydration takes place at moderate temperatures, the ingredients are still considered raw. The only exceptions are the meat and egg ingredients, which are dehydrated at high enough temperatures to kill any bacteria present and are therefore essentially considered 'cooked'. This is because they must be human-edible grade, to enter our manufacturing facility.
The removal of moisture prevents enzymatic activity, which can lead to browning and decomposition of foods, and also prevents the growth of bacteria, yeast and molds. Dehydration does not actually destroy or kill the food enzymes, as occurs in baking and freezing or high pressure processing such as extrusion. Enzyme activity in dehydrated foods is simply suspended, until the food is rehydrated.
A remarkable example of the way dehydration preserves without destroying, is in Africa, where scientists have discovered live fish being hatched from fish eggs, that have been dehydrated in the sun, during droughts that sometimes last for years. When the rains fall, the lakes and rivers refill with water to rehydrate the eggs - and live fish emerge. The eggs are actually preserved and remain viable throughout the natural dehydration that takes place.
Country of Origin: USA
Manufacturer: Honest Kitchen
Ingredients - Dehydrated white fish (Haddock, Whiting), sweet potatoes, eggs, organic coconut, alfalfa, apples, green beans, parsley, cabbage, bananas, Salmon, cranberries, garlic, rosemary, tricalcium phosphate, choline chloride, zinc amino acid chelate, vitamin D3 supplement, vitamin E supplement, potassium iodide, potassium chloride, iron amino acid chelate, copper amino acid chelate
Feeding Guidelines
The following suggested dry-measured amounts should be adjusted to suit your own dog's unique nutritional requirements, which will vary according to age, breed, level of activity and what other ingredients are added. Embark may be fed ad-libitum during growth, gestation or lactation.
The reviews below are presented for informational purposes only and are not intended as an endorsement of any product. The information is not intended to be a substitute for visits to your local veterinarian. Instead, these testimonials offer the reader information and opinions written by pet owners and/or veterinarians concerning animal health and products that they have used.
(based on 22 reviews)
Ratings Distribution
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Dog will not eat this
By Charlie's mom
from Seattle WA
About Me Long-time Pet Owner
Comments about Honest Kitchen Zeal Grain-Free Dehydrated Dog Food:
My 15 year old golden already eats kindly with meat and fish so I thought this would make my life easier, but my dog ate around it and got sick afterwards after the first try. He always eats everything in his bowl and has not been sick for years so this is very strange.We went back to meat and kindly but now he will not even eat the kindly mix anymore. Not even after I added peanut butter and goat milk to it.I guess I will have to go back to cooking him the vegetable and yam portion of his meals again.
Bottom Line No, I would not recommend this to a friend
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Excellent food!
By SmokeyandPebbles
from Tacoma, WA
People may complain about the price but I would rather pay more for an excellent dog food then purchasing the poorer quality dog foods that are out there. I want to thank the company for providing such a good healthy food for my dogs! They love it and I love it!
Bottom Line Yes, I would recommend this to a friend
Images shared by SmokeyandPebbles
(2 of 2 customers found this review helpful)
My dog loves this food!!!!
By Barbarella
from Temecula, CA
My dog loves this food!!! She is prone to struvite crystals and this food has all the ingredients that she CAN eat. I don't want to give her the food the vet recommends as it contains a lot of fat and she gains weight. This food keeps the crystals away and keeps her from plumping up. Bonus is that she absolutely loves it!!!
(1 of 2 customers found this review helpful)
No more acid reflux problem :)
By AK
from White Plains. NY
About Me New Owner
I adopted Winchester (a black Lab mix) a year ago. Through the year I changed so many dog food for his acid reflux problem. But none of them working.I been give him this product for 3 month now, so far he has no acid reflux again, and his poop is so firm, his coat is so shinny.
(0 of 1 customers found this review helpful)
Excellent food
By AZdogperson
from Glendale,AZ
Quality product, like everything but the price.
My dog loves this food!
By Barbarella9
from Las Vegas,NV
I purchased this food for my dog because she cannot have grains or white potatoes. She eats this right up as soon as I put the bowl down. I think it smells bad but it doesn't stop her from inhaling it. I wish it were less expensive and I am always looking for other foods that her dietary restrictions will allow. For now, she seems to love it and it's keeping her healthy.
Love this food!
By Dog Mom
from Phoenix, AZ
This food has made such a difference for our itchy GSD. His weight and energy have never been better, as well. A few have commented that it doesn't rehydrate well. I think it just rehydrates differently from the other recipes mentioned because it does not contain white potato or grains. We soak longer than recommended, just because... We wait 10 min and feed. We also make their diets very soupy, no matter which HK diet we are using simply because we live in the desert and none of us get enough water! I have recommended this to several friends who have food-sensitive dogs and I am happy to say it has made a difference in their pets as well. It is expensive but hopefully a good diet will prevent vet visits :)
Happy dog!
By InkedMarie
from Gilford, New Hampshire
My pbgv has allergies/sensitivities and does best on a potato/grain free food. He loves THK, since he can't have chicken, Zeal is the best choice. The only downfall to the Zeal is the cost. He loves it, does best on it so we just buy it.
Zeal is Fabulous
By Joannie
from Millbrae, CA
Zeal is low calorie and my Senior Dog has lost pounds in a month. He also has no more food alergies or hot spots. Great human quality food.
(0 of 3 customers found this review helpful)
Excellent results
By Mari
from Northcental Iowa
I mixed about a cup of dry food with chicken broth until it was a nice consistency. I am wary of new foods because the small dogs can be picky about their food. There was no hesitation on their part, they dug right in. It was easy on their digestion too. I have one with Ibs and he is difficult to feed. This food was perfect and he did well on it as are the younger pups. I would recommend this food.
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Killeshin Union is made up of four churches: Castletown, Cloydagh, Killeshin and Mayo.
Mayo church is located 8 miles from Carlow, 6 miles from Castlecomer and 1.5 miles from the village of Crettyard. It is situated in the ancient parish of Kilabban in the Diocese of Leighlin. It is believed that an older church originally stood on the site of the present church, possibly the location of a pre-Reformation place of worship. The church of Mayo was built in 1812, designed to be a chapel of ease to Castletown church. The building costs were £738, borne by the Board of First Fruits[i]. It seats 130 persons and its wall memorial plaques bear witness to the Carter, Edge and Stapleton families. The parish then became known as Kilabban Union. (ie Castletown and Mayo) In 1813 the population of Kilabban Parish was recorded as being 8996 Roman Catholics of 1525 families and 474 Protestants of 68 families. The older graves in the graveyard included the last resting place of the Hovendons, the Goulds and Lord Galmoy of Garrendenny Castle.
According to the Ecclesiastical Report 1837 there was one rector and two curates in the parish . Church services were held in each church twice on Sundays in summer, once a Sunday in winter and on every principal festival. The Sacrament was administered monthly and on the festivals.
The use of curates ceased in 1915 with the rector living near Ballickmoyler. In the vestry minutes of 12th November 1959, it is stated that the Commission for Sparsely Populated Areas had finally decided that Killabban should be joined with the Luggacurran district of Timahoe Parish. Luggacurran was amalgamated with Mayo and Castletown. Reverend A. E. Crawford was instituted in Luggacurran on November 23rd 1961. Fourteen years later, the Diocesan Council decided that there should be yet another arrangement of parishes. Luggacurran became part of Stradbally Union.
The amalgamation of Killabban Union with Killeshin and Cloydagh parishes took place in 1978 with the Rev Dermot McKenna as rector. This new group became known as the Killeshin Group of Parishes.
In 2011 the group became Killeshin Union, there is now one vestry for the whole union.


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This deal has ended.
These Barbados Hammocks drop from the list price of $89.99 to $59.90 at Rue La La. Plus, the shipping is free. That's the best price we could find on them by $30. These loose hanging hammocks measure 58in x 134in, can support up to 330 lbs and are available in 3 colors. Sales tax is not charged in most states.No longer available


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Back in action…
And we're back!
Our little vacation was just what the doctor ordered. It was filled with sunshine, pina coladas, family, Kyle time, reading, sleeping in, eating out and REST. Our summer has been wonderful, but it's been anything but relaxing, so a trip to Maui with family was just what my soul needed. I'll share photos later this week, although I'm afraid there's nothing too exciting to share. Relaxing days = many uneventful photos. Kyle and I did celebrate our two year anniversary this past weekend, so that's sorta exciting, right? Here's us all dolled up and ready for a night on the town in Hawaii in honor of two years of marriage…
Alrighty then, back to blogging!
Perhaps I have soap on the brain because my whole house needs a serious scrub, but I just can't get over these beautiful bon bon soaps from Murphy & Daughters. It's all about the packaging, and boy is it pretty!
How perfect would these be for a little housewarming gift or a sweet pal's birthday? Or in a guest room welcome basket? So perfect!
As for purchasing these darling bon bon soaps, I'm still hunting down a shop online. Anthropologie recently sold these soaps, but it appears they are out of inventory. I did stumble upon a store overseas that sells them – visit Lark here. I'm still on the lookout for a U.S.- based store – any ideas, friends?
Cheers to August and the sunshine this month brings!


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He has become almost a forgotten man, despite the fact he was expected to be a focal point of the offense.
Philadelphia Eagles wideout Jeremy Maclin has not played a snap this season for the Eagles, after tearing his ACL during a drill in training camp. The injury could not have come at a worst time for the young wideout, who was expected to have a breakout season under Chip Kelly.
After a long season of rehab, however, Maclin is finally ready to return -- at least he will be when next season starts.
According to Jeff McLane of the Philadelphia Inquirer, Maclin is expected to be ready to go when the Eagles kick off next season's spring practices on April 21st. That is a positive sign for Maclin, and if there is one bright side to the timing of his knee injury, it is that he will start next season at 100%.
The question now becomes where he will start his season at.
Maclin is a free agent, and before he was injured, the question was only how much the Eagles would have to give him. After watching Riley Cooper -- also a free agent -- have a breakout season, however, the Eagles must now decide if they want Maclin back.
As with anything, whether or not Maclin comes back will likely have to do with money. If another team decides to break the bank and take a chance on Maclin, it's hard to imagine the Eagles matching. If the market for Maclin is not great, however, the wideout could decide to take less money and a one-year, hoping once again that a big season under Kelly leads to a big contract.
Only time will tell what is going to happen, but one thing is at least known -- and that is that Maclin will be ready for it.
Follow Eliot Shorr-Parks on Twitter at @EliotShorrParks


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Portland Public Schools officials said talks have stalled after the union presented a significantly different proposal in a mediation session on Thursday.
"We believed we were close to agreement last week, but the gap has widened today," Superintendent Carole Smith said in a statement. "Tonight we informed the Association that we are not able to move beyond the frameworks that had us close to a settlement last week."
No further mediation talks have been scheduled, and the district reported the state mediator has recommended the two sides not meet without her.
District officials have said they do not want to go beyond what they offered in frameworks presented to the union last week, which committed to hiring 88 additional teachers to reduce teacher workload by about 4.6 percent.


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5 Sound Facts To Know For 2014
1. The Sounds have a new manager.
With former Sounds manager Mike Guerrero having received the call up, Nashville welcomes a new skipper to Greer's home clubhouse. Taking over the ship for Nashville will be 61-year-old Rick Sweet, who begins his 24th managerial season and the first season within the Brewers farm system. Sweet last wore a manager's cap with the Louisville Bats (2005-2011), who he led to division championships in three of his last four seasons. After the 2011 season, he left Louisville as the franchise's winningest manager in franchise history (539-465). Sweet will need 321 wins to claim that title in Nashville, currently held by Trent Jewett's 320 wins and .513 average.
2. The Sounds have changed divisions.
Sweet and the Sounds will both be charting new waters this spring as they join the American Conference's Southern Division after spending the last nine season's in the Pacific Coast League's American Northern. The division consists of the previous cross-state rival Memphis Redbirds (STL) and new division foes the New Orleans Zephyrs (MIA) and the Round Rock Express (TEX). All in all, the realignment does not change a whole lot at the divisional level: the Sounds have always played these teams 16 times each year. But at the conference level, the Colorado Spring Sky Sox (COL) and Albuquerque Isotopes (LAD) have switched, which will pit the Rockies Triple-A affiliate against the Sounds 16 times a year (eight in Nashville) and the Dodgers PCL club only four times a season (rotating homestands every other year).
3. The PCL's newest team is named the El Paso Chihuahuas.
Easy there lap dog lovers, the Sounds won't get to see these perilous pups in Nashville until 2015, though tickets to this year's series in Texas are most likely available here.
4. The Sounds will play 72 scheduled games in their final season at Greer Stadium.
The 2014 season schedule will mark the Sounds final season at Greer Stadium. To honor the 37-year-home, the Sounds have created a commemorate Greer Stadium mark featuring the iconic scoreboard and outfield wall with the slogan '37 Years of Hits'. The mark, pictured below, will be used on select giveaway items and merchandise. And any fan that celebrates Greer's final year by purchasing full or half season tickets will be given priority purchasing for the new ballpark at Sulphur Dell.
5. Greer will host 22 fireworks extravaganzas at the Big Guitar.
Every Friday and Saturday home game on the schedule (21 total) will be followed by a postgame fireworks show, beginning with the Sounds home opener on Friday, April 11. A bonus Independence Day show will take place after the game on Thursday, July 3rd. There's even a 'Deluxe Fireworks' ticket plan for fans who don't want to miss a show. More Sounds promotions and giveaways will be announced as the season nears.


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A while back in January, we told you the Giants were potentially one of eight NFL teams in the running to be filmed for HBO's "Hard Knocks" if a franchise didn't step forward to volunteer.
According to a report on Tuesday from Fox Sports Radio's Tomm Looney, the list is now down to three teams -- and the Giants are one of them:
HBO and the NFL have narrowed down the HARD KNOCKS teams to a list of three: Bears, Giants, Steelers.— LooneyaboutSports (@LooneyonFox) April 29, 2014
This would probably count as bad news for Giants co-owner John Mara, who once told The Daily News' Mike Lupica that the team would announce they were allowing cameras to invade training camp "when I'm next to my father in Gates of Heaven cemetery."
An NFL spokesperson called the report inaccurate:
NFL's Greg Aiello on report that Bears, Giants, Steelers are finalists for Hard Knocks: "totally inaccurate."— mike freeman (@mikefreemanNFL) April 29, 2014
Would you want the HBO show to focus on the Giants? Maybe you've wanted to see what head coach Tom Coughlin's training camps are like behind the scenes, but there's also the possibility that the show will be a huge distraction that will cause unnecessary stress and turn into bad headlines. Take our poll on the right and tell us what you think.


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Four Alma College students, including one from Saginaw Township, are attending the United Nations Climate Change Conference which begins today in Copenhagen, Denmark.
The students, Adam Ellsworth, Ben Roberts of Saginaw Township, Samantha LaChance and Renee Willoughby, are there along with faculty members Murray Borrello and Micheal Vickery.
They're representatives in a delegation sent by the University of Michigan.
The students will have "observer" status at the conference, where a framework for climate change mitigation beyond 2012 is to be addressed by representatives from close to 200 countries.
The students have launched a blog to keep people connected to the events they witness at COP15.


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Gymnasts set for annual All-City meet
Gymnasts from Decatur, Federal Way, and Jefferson are set to square off tonight in the annual All-City gymnastics meet.
Its the final meet of the regular season and it gives gymnasts a chance for bragging rights for the rest of the year.
Decatur, winner of last years All-City trophy, is hosting this years event at 7 p.m. today.
Were looking to bring that trophy back here,said Federal Way coach Bev McIrvin. It will be a good meet with good head-on competition. Were feeling pretty good going into it as long as we can stay healthy this week. I feel good about my team going into it.
McIrvin has reason for high hopes. The Eagles set a school record of 176.85 points in last weeks meet against Sumner, Kentridge and Port Angeles.
Thats not just one or two of our kids, McIrvin said. Thats the whole team. They did very well.
At last years All-City meet, Federal Ways team score was 167, nearly 10 points lower than the mark it set last week.
Al three high schools teams are improved over last years teams.
Last year, Decatur scored a 169.7, Federal Way posted a 167 and Jefferson scored a 164.55.
This year, Decatur has scored as high as 173.15, Federal Way has scored a 176.85 and Jefferson scored a 169.7.
Five out of the top six all-around placers at last seasons All-City meet are returning this year, including Jeffersons Alyssa Fox, who won last years all-around title.
Fox will be challenged by Federal Way sophomore Lauren Webb, who is coming off last weeks meet where she won all four events en route to the all-around title.
I knew she was an outstanding gymnast coming in, McIrvin said. For the first couple of weeks, she was testing the waters. But she is coming on stronger and stronger with every meet. She is a very nice girl who works very hard. Were looking for her to do big things at state.
Other gymnasts to watch include Decaturs Kelly Miller and Kelly McKay, Federal Ways Kellie Horrocks, Brianne Hall and Robin Luedke, and Jeffersons Danielle Freeman.
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Cathy Horyn Tired of Calling Ugly Vests 'Pieces'
Hear, hear.
Cathy Horyn's delightful story in today's Times details her experience shopping for spring clothes or, as she puts it, "searching for a ball in the weeds." She could have also called it "burning the contents of one's bank account," because that's essentially what it's like to walk into Céline. But it's also a chance for her to air a few grievances that have clearly been brewing for some time now.
Horyn pads her gripes with some concessions, noting:
As a critic, I get irked by many things about fashion, and this necessarily influences what I end up buying (or not) for myself. I'm also completely inconsistent about my personal likes, so don't take anything I say here seriously.
And with that, fire away! Mainly, she's tired of people referring to clothes like they're rarified objets to be stared at instead of worn.
Here's what really gets my goat: When did people start getting precious-sounding about clothes, as though they were handling the Dead Sea Scrolls and not an ugly vest?
"This is the runway collection," a salesman at Céline said, with cut-glass delicacy, having followed me to a rail in the middle of the store, where a dozen or so garments hung. I suppose he was merely adopting the language of art-infused retail, and couldn't be faulted for saying of a nice-looking black dress, "This piece is $3,000." This piece. Still, it's kind of shame that one of my favorite spring collections, its vibe free and relaxed and elegant, should be turned into an art object with armholes.
She also made a thinly veiled dig at Hedi Slimane's latest Saint Laurent collection: "Maybe because grunge doesn't qualify as high fashion or even a new idea, it's easy to improvise." Hoho. But this article's main point is a good one, and easily forgotten when you're constantly bombarded by pictures of celebrities and models: When normal people buy clothes, they are meant to be put on your body, not gawked at as isolated entities. This doesn't mean you shouldn't buy fun, non-practical things from time to time just because you like looking at them. But as you commence the hunt for that magical item to add je ne sais quoi to your summer wardrobe, don't be seduced by the "piece" factor. Buy what looks good on you, not the hanger.


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Forgot to include a Geoffry Fieger update in today's Around the Web entry. Jury selection ended, opening arguments were Thursday, and the tedium commenced today.
Mind-Numbing, Indeed
Related Entries:
- "The Great Debate: Does America Need More Trial Lawyers?"
- The John Edwards indictment
- Around the web, June 5
- NASA exonerates Toyota on sudden acceleration
- Around the web, October 29
- "Paying-To-Play in Securities Class Actions: A Look at Lawyers' Campaign Contributions"
- California trial lawyer generosity, cont'd
- "Big, late $ from trial lawyer-backed group"
- Trial Lawyers, Inc.: K Street -- Federal Government Relations (I)
- Trial Lawyers, Inc.: K Street -- Foundations
- How the Plaintiffs Bar Bought the Senate
- "Pay to play with AGs"
- Trial lawyers prepare ad campaign on med-mal
- Richard Weekley on Texas reforms
- California trial lawyer generosity
|Isaac Gorodetski
Project Manager,
Center for Legal Policy at the
Manhattan Institute
|Katherine Lazarski
Press Officer,
Manhattan Institute


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Reviews by rancidskunk
Lipodissolve to Double Chin. Minimal Pain, Huge Swelling but Well Worth It!
I had a family inherited double chin. I am fairly active and hated my chin and profile. I started a course of lipotherapy in October 2007. The first set of injections left me with a burning sensation for a few hours and my chin was huge (aka Jabba the Hut) for 2 to 3 days and then it started... READ MORE


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Stella Gates
Stella Gates, 102, the oldest resident of Garvey Manor and Our Lady of the Alleghenies Residence, Hollidaysburg, formerly of Altoona, died Saturday at Garvey Manor.
She was born in Coupon, daughter of the late George and Cora (Litzinger) Donoughe. She was preceded in death by her husband, Kenneth, on Nov. 7, 2000; a son, Glenn; an infant grandson; an infant granddaughter; a granddaughter, Corinne Sick; sons-in-law: Dan Minori and Emil Minori; brothers and sisters: Norma Eckenrode, John, Ralph, Patrick, Robert, Edna Stump, Iva Dougherty, Thelma Booterbaugh, Ita Donoughe, Mary Cogan, Ethel Malone and Reba Kenner; and a special nephew, Bernie Lytle.
She is survived by her children: Colleen Minori of Mechanicsburg, Jo Ann Minori of Syracuse, N.Y., Wayne (Jean Rourk) of Fort Walton Beach, Fla., Marian Mentch (Bill) of Altoona; 17 grandchildren; 39 great-grandchildren; 16 great-great-grandchildren; special nephews: Bob Lytle and Pat Lytle; special niece, Eleanor Berger; and numerous other nieces and nephews.
She was the last member of her immediate family.
Stella worked as a housekeeper for St. Mark's Catholic Church for 18 years.
She was a former member of Juniata Senior Citizens and oldest member of St. Mark's Catholic Church, where a funeral Mass will be celebrated at 10 a.m. on Thursday, the Rev. Ronald Osinski, Celebrant. Committal will be at Calvary Cemetery. Friends will be received from 1 until 5 p.m. Wednesday at the Stevens Mortuary, where a vigil service will be held.
Contributions may be made to Garvey Manor Nursing Home in Stella's memory.
Stella Gates
Stella Gates, 102, a resident of Garvey Manor and Our Lady of the Alleghenies Residence, Hollidaysburg, died Saturday, Oct. 12, 2013, at Garvey Manor. Arrangements are by Gibbons Funeral Home, Ashville. A full obituary will appear in Monday's Mirror.


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A few spices and herbs deliver a big payoff.
Aliwaks has you first toast all the spices: coriander, salt, black peppercorns, fennel seeds and red pepper flakes.
We hate our jobs.
Toasting the spices.
They're done when you can smell them. They go from pleasantly fragrant to burnt in a flash so it's a good idea to hover. This was our second batch; first batch went in the garbage!
Merrill zests oranges while Amanda takes the challenging/ill-advised route of grinding the spices by hand. You can get it done in a matter of seconds in a coffee grinder. Either way, keep the spices a little coarse. You want some pebbly bits in your porchetta.
Merrill adds olive oil to the spices, garlic, orange zest and chopped rosemary to make a paste.
A boned pork shoulder is a large and unwieldy hunk of meat. Amanda attempts to tame it.
Rubbing the paste into the meat.
We didn't have a baggie large enough to hold the pork so we heaped it in a bowl and covered it for its day-long resting time.
Too many cooks in the kitchen? We never think so!
Merrill skillfully rolls the shoulder into a log. A giant log.
Next, we tied it at 1-inch intervals.
We slipped the bay leaves under the twine, and in place of the pork skin we used pancetta and just laid 9 slices over the top of the porchetta like fish scales.
The pancetta curls up like butterfly wings in the oven. We thought it looked pretty fabulous.
Merrill reduced the pan juices with some vinegar.
Truly one of the most gorgeous and satiny pan sauces we've seen.
Before slicing, you remove the pancetta and if you're a virgo, you arrange it in a perfect overlapping row.
Here's we're debating the thickness of slices. Aliwaks says 1/4-inch thick slices. So does Merrill. Amanda says thin, thin, thin! She loses.
Don't forget to serve the pancetta (or skin if using it) with the porchetta. Enjoy!
The marinade starts with just a little bit of rum...
The garlic seemed to cause a chemical reaction when we added it to the rum.
Amanda adds the cider.
Plenty of salt is the key to any brine.
Juniper berries and peppercorns -- crushed in the handy-dandy mortar and pestle.
Once all of the ingredients are added, you bring the marinade to a simmer and stir just until the salt dissolves.
Once the marinade is cool, you just put it in a zipper bag with the pork shoulder and refrigerate it for 18 to 24 hours.
We had a pork shoulder that had been brining since the day before, so we rinsed and dried it thoroughly and were ready to go!
Browning the pork shoulder in a bit of oil gives it a nice golden crust.
We transferred the pork to a cast iron pan to roast it. (We needed the other pan for something else!)
While the pork is in the oven, you can start on the apples, which are sautéed with minced red onion...
...and fresh rosemary.
Wonder if Amanda's smile has anything to do with that half-empty bottle of rum nearby...
or with the fact that she's about to pull off this nifty trick.
We cut the apples into chunks rather than thin slices, inspired by Kevin's photo.
They browned perfectly on both sides.
In goes the red onion.
And why not add some more run while we're at it?
A little cider, a quick simmer, and the apples are ready!
The pork was perfectly cooked in an hour and a half.
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Stephen F. DeOreo 1920-2013
HOWLAND – Stephen F. DeOreo, 92, passed away Thursday, Feb. 7, 2013, at his residence.
Stephen was born March 8, 1920, in East Liverpool, the son of Stephen and Vivian DeOreo.
Stephen came to Howland in the early 1970s from Youngstown. He retired from Packard Electric as a tool and die maker after 22 years.
He was a member of Queen of the Holy Rosary Church in Vienna.
He belonged to Austintown Eagles and Warren SCOPE. He had performed in leading roles in their Follies for years, and also performed in entertaining for area senior citizens groups and nursing homes.
He served in the U.S. Army during World War II.
Stephen is survived by his wife, Ethel DeOreo, whom he married May 3, 1941; two children, Stephen (Cheryl) DeOreo of North Canton and Carolyn (Edwin) Kirkland of Cortland; four grandchildren, William (Lori), Chris (Stacey), Shawn (Michelle) Fagan and Steve J. (Heather) DeOreo; and five great-grandchildren, Adrian, Conner and Hannah Fagan, and Brandon and Harmony Sampson.
He was preceded in death by his parents and a brother, Harold DeOreo.
A Mass of Christian Burial will be held 10 a.m. Tuesday at the Queen of Holy Rosary Parish, with the Rev. Denis Bouchard officiating. Family and friends may call from 4 to 6 p.m. Monday and from 9 to 9:30 a.m. Tuesday at the Peter Rossi and Son Memorial Chapel in Warren.
Burial will be in All Souls Cemetery, Cortland, with full Military Honors.
In lieu of flowers, contributions may be made to Queen of the Holy Rosary, 291 Scoville Road, Vienna, OH 44473.
(special notice)


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RoboHead is a project management tool ready to help you conquer the challenges of task management, team collaboration, and digital asset management.
Many organizations have tried it all: spreadsheets, advanced project management software, home-built databases. But, they've found that these tools usually don't meet the needs of their marketing organization. What's the most glaring thing missing from these tools? They don't manage the deliverable! With RoboHead, not only do you manage dates, deadlines, time, and resources, you also manage digital assets, creative pieces, collaboration, approvals, notification, and finances. All this in a solution that's fast to implement and easy to learn.
RoboHead was specifically designed for Marketing and Creative users and the type of projects that they manage every day. These capabilities include:
• Initiating projects quickly by either copying an existing project or using project templates
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• Sharing files using a Library function to only those users with the proper permissions
• Reviewing and collaborating on creative pieces using on-line annotation tools
• Initiating and tracking approvals on-line, with a complete audit trail (the user, approved / not approved), all time and date stamped
• Reporting on those metrics that are important to running your business using the on-line report writer