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High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young Adults
Evidence From Intravascular Ultrasound
Background—Most of our knowledge about atherosclerosis at young ages is derived from necropsy studies, which have inherent limitations. Detailed, in vivo data on atherosclerosis in young individuals are limited. Intravascular ultrasonography provides a unique opportunity for in vivo characterization of early atherosclerosis in a clinically relevant context.
Methods and Results—Intravascular ultrasound was performed in 262 heart transplant recipients 30.9±13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population consisted of 146 men and 116 women (mean age of 33.4±13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed. Sites with the greatest and least intimal thickness in each CASS segment were measured in multiple coronary arteries. Sites with intimal thickness ≥0.5 mm were defined as atherosclerotic. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in subjects ≥50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis averaged 1.08±0.48 mm and 32.7±15.9%, respectively. For all age groups, the average intimal thickness was greater in men than women, although the prevalence of atherosclerosis was similar (52% in men and 51.7% in women).
Conclusions—This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.
Although patients with coronary artery disease typically become symptomatic after age 40 years, necropsy studies have demonstrated that atherosclerotic changes in the vessel wall begin early in life.1 2 3 4 5 Characterization of coronary disease through postmortem examination of young subjects has important limitations, however, particularly the presence of nonphysiological conditions (arteries not pressure-distended) and fixation artifacts.6 Few in vivo data have documented the extent and severity of atherosclerosis in young, healthy subjects.7 8
Miniaturization of high-frequency transducers has allowed the development of intravascular ultrasound (IVUS), a unique imaging modality that permits direct examination of the vessel wall in living humans.9 10 11 12 Comparative studies have documented a close correlation between ultrasound measurements of atherosclerosis performed in vitro and histological measurements performed in pressure-distended arteries.8 13 14
We sought to determine the prevalence of atherosclerosis in subjects with no clinical or angiographic evidence of significant coronary disease. The population for this investigation consisted of patients who had recently undergone cardiac transplantation. We used IVUS to determine the presence, extent, and distribution of atherosclerosis in the donor coronary arteries within weeks of transplantation. Because most donors are relatively young, this approach provided the opportunity to characterize the early atherosclerotic disease process.
Patient Population
Between December 1992 and May 1999, IVUS examination was performed in 262 heart transplant recipients 30.9±13.2 days after transplantation. The donor population consisted of 116 women (44%) and 146 men (56%) with a mean age of 33.4±13.2 years. None of the patients had known coronary artery disease because potential donors were screened for heart disease before proceeding with transplantation. The hospital's Institutional Review Board approved the study protocol. All participants provided informed consent.
IVUS Examination
The method of IVUS imaging has been reported previously in detail.7 After coronary angiography, patients received anticoagulation with heparin, and 100 to 200 μg nitroglycerin IC was administered. A 30-MHz, 3.5F monorail ultrasound catheter (Boston Scientific) was advanced over an angioplasty guidewire to a distal location in the coronary artery, and the position of the transducer was documented by angiography. Ultrasound images were displayed with a dedicated scanner (Hewlett-Packard Corp) and recorded on S-VHS tape during a slow, distal-to-proximal manual pullback. During pullbacks, voice annotation and frequent angiography were used to document the location of imaging sites of interest.
Offline IVUS Analysis
Images were reviewed on a video monitor in the IVUS core laboratory. Using an image-processing computer, a technician digitized full-motion IVUS sequences (30 frames per second) at a 640×480 pixel matrix with 24 bits per pixel. Images were considered suitable for analysis if they were free of ultrasound artifacts, such as extreme catheter angulation or nonuniform rotational distortion. For each segment, defined according to Coronary Artery Surgery Study (CASS) classification, the operator selected 2 sites, one with the least intimal thickness and another with the greatest intimal thickness.15
Although single frames were selected for analysis, the operator examined the full-motion sequence to facilitate optimal border delineation. The lumen and external elastic membrane (EEM) borders of the selected frames were manually traced to yield measurements of maximum intimal thickness, minimum intimal thickness, and both luminal and EEM cross-sectional areas.
The following definitions were used to describe lesion characteristics and severity:
Atherosclerotic lesion: Any site with an intimal thickness ≥0.5 mm.
Normal site: Within any CASS segment, the site with the least intimal thickness among the sites without atherosclerosis.
Eccentric lesion: A lesion was classified as eccentric if the maximum intimal thickness was more than twice the value for the minimum intimal thickness.
Calcified lesion: A lesion containing an echogenic structure that blocked penetration of ultrasound, thereby producing acoustic shadowing.
Percent area stenosis: EEM area−lumen area/EEM area×100
Angiographic Analysis
Coronary angiography was performed by standard techniques. Angiograms were reviewed on a screen at a fixed distance with a rear projection system (Tagarno 35 Ax) and classified as normal or abnormal by experienced angiographers blinded to the donor clinical data and ultrasound findings. For each vessel, the CASS segment classification system was used to identify the most distal site imaged by ultrasound. In abnormal angiograms, stenosis severity at sites showing any luminal narrowing or abnormality was measured with a digital caliper system (Sandhill Scientific, Inc). For each identifiable lesion, the operator determined vessel diameter at the stenosis site and at an adjacent angiographically normal reference site to quantify percent diameter stenosis.
Statistical Analysis
Normally distributed data were reported as mean±SD, and categorical variables were expressed as number and percentage of the cohort.
Patient Population and Extent of Imaging
All donors in the study were free of known heart disease, the mean age was 33±13.2 years, and 56% were male. Other donor characteristics are listed in the Table⇓. In the 262 subjects, 574 major epicardial coronary arteries other than the left main trunk were imaged (2.2 arteries per patient). The left anterior descending coronary artery (LAD) was visualized in 238 patients (90% of the cohort), the left circumflex (LCx) in 180 (69%), and the right coronary artery (RCA) in 156 (56%). All 3 arteries were imaged in 97 patients (37% of subjects), 2 arteries in 118 (45%), and only 1 vessel in 47 (18%). From these arteries, ultrasound images were analyzed for a total of 2014 sites within 1477 CASS segments.
Intimal Thickness at the Normal Sites
Figure 1⇓ shows the frequency distribution of the normal site with least intimal thickness in each patient for different age cohorts. If the donor was <40 years of age, the smallest intimal thickness in each patient was always <0.3 mm. Even when the donor age was >40 years, the normal intimal thickness was always <0.5 mm. Therefore, in the present study, we used the threshold of 0.5 mm to define the presence of an atherosclerotic lesion and to determine the prevalence of atherosclerosis. We also present the data according to the less stringent criterion of 0.3 mm.
Prevalence of Atherosclerosis
Of 262 individuals, 136 (51.9%) had ≥1 atherosclerotic site (intimal thickness >0.5 mm) (Figure 2⇓). In these 136 subjects, the intimal thickness at the lesion was 1.08±0.48 mm, and percent stenosis averaged 32.7±15.9%. Figure 3⇓ shows the frequency distribution of greatest intimal thickness in each patient for different age groups, demonstrating that intimal thickness increases progressively with advancing age. In all age groups, a portion of the cohort had ≥1 site with intimal thickness exceeding the 0.3-mm or 0.5-mm thresholds used for the definition of atherosclerosis (Figure 4⇓). Strikingly, when the more stringent definition of >0.5 mm was used, even the 12- to 19-year-old age group showed atherosclerosis in 17% of subjects. By age 40 years, >70% of individuals showed ≥1 coronary site with an intimal thickness >0.5 mm. With a less conservative threshold of 0.3 mm, 21% of teenagers and 91% of individuals >40 years old had ≥1 atherosclerotic lesion.
Intimal Thickness and Stenosis Severity
From each of the 1477 CASS segments, the sites with the largest value for intimal thickness, whether normal or diseased, were selected. The intimal thickness and percent area stenosis at these sites were 0.35±0.34 mm and 12.4±11.8%, respectively. The distribution of these values by age group is shown in Figure 5⇓. The intimal thickness and percent area stenosis at these sites correlated with donor age (r=0.55, P<0.001 and r=0.56, P<0.001, respectively).
Angiographic Findings
Coronary arteriography was completely normal in 241 patients (92%). In 21 patients (8%), an angiographic luminal irregularity was identified by the blinded observers. These were typically subtle findings with an average percent diameter narrowing of 23%. None of the donors <30 years of age had angiographic evidence of atherosclerosis; all 21 donors with an angiographic disease were >30 years old.
Lesions in Patients With 3-Vessel Imaging
To assess the distribution patterns of atherosclerosis in the young, lesions were investigated separately in the subgroup of 97 patients (1026 sites) in whom ultrasound imaging was performed in all 3 epicardial coronaries. The mean age of these patients was 32.4±13.2 years, and 58% were male (similar to entire cohort). A lesion was present in the LAD in 41 patients (42%), the RCA in 38 (39%), and the LCx in 26 (27%). The proportion of segments with a lesion was 19±25% for the LAD, 12±23% for the LCx, and 18±26% for the RCA.
Distribution and Composition of Lesions
Atherosclerotic lesions were identified in proximal segments more frequently (59%) than mid and distal segments, and the vast majority of lesions were eccentric (91%). The most diseased site involved a coronary bifurcation in 43% of patients. Calcification at ≥1 site by ultrasound was observed in 33 patients (12.6%).
Atherosclerotic coronary disease is the leading cause of death and a major source of morbidity in developed countries, resulting in nearly 1 million deaths and $100 billion in annual costs in the United States alone.16 Necropsy studies have demonstrated that atherosclerosis begins at a very early stage in life. The present study provides unequivocal in vivo evidence of atherosclerosis in young asymptomatic individuals with no evidence of clinical coronary artery disease (Figure 3⇑). This study is unique because it provides detailed, clinically relevant, quantitative, in vivo information on early atherosclerosis from an asymptomatic young population.
Necropsy studies dating back to 1948 describe coronary atherosclerosis in a young population, but none have provided quantitative measures of disease severity.1 2 3 4 5 In Korean and Vietnam war victims, the degree of obstruction was judged by gross inspection and microscopic examination performed without pressure fixation. Stary, in an elegant study,17A performed light and electron microscopy on pressure-fixed segments of the proximal LAD and LCx in 565 subjects <29 years old. The focus of this careful investigation, however, was lesion morphology, not measurement of plaque thickness, area stenosis, or lesion distribution. In the Pathological Determinants of Atherosclerosis in Youth (PDAY) study, the RCA was the only vessel examined.4 In the Korean War study, as well as the Bogalusa and PDAY studies, dissection of coronary arteries was longitudinal, not cross-sectional.1 3 17B In contrast to these studies, the present investigation assessed atherosclerosis in vivo and quantified lesions with methods used in clinical practice.
Limited data are available to describe the range of normal intimal thickness in humans. Using vessels that were not pressure-fixed, a necropsy study showed an age-related dependency of intimal thickness, averaging 0.21 mm for ages 21 to 25 years, increasing slightly to 0.25 mm for ages 36 to 40 years.18 Other small studies report normal intimal thickness ranging from 0.1 to 0.35 mm and medial thickness from 0.15 to 0.25 mm.7 12 19
In the present study, we thought it particularly important to rigorously define the threshold for presence of atherosclerosis. Previous ultrasound studies have established that intimal thickness detected within 8 weeks of transplantation represents preexisting coronary atherosclerosis in the donor.7 20 21 Furthermore, there was no difference in the prevalence and severity of intimal thickness in hearts that were examined 2 to 4 or 6 to 8 weeks after transplantation. Because all of the 262 subjects showed ≥1 site with an intimal thickness <0.5 mm, we felt justified in using this threshold as a conservative definition of atherosclerosis. Because all patients <40 years of age showed ≥1 site with intimal thickness <0.3 mm, this latter value may actually represent a less stringent but more reasonable definition for atherosclerosis. It is important to recognize, however, that intimal thickness is a continuous variable and that defining atherosclerosis as a categorical variable has limitations. Furthermore, intimal thickness does not necessarily indicate atherosclerosis. Morphological characteristics of intimal thickening observed in this study helped to identify the atherosclerotic origin of these findings. The majority of the areas with intimal thickening were eccentric, located proximally, adjacent to bifurcations.
Ultrasound techniques for quantification of intimal thickness measure different boundaries than classic necropsy studies. An ultrasound reflection occurs at a tissue interface whenever there is an abrupt change in acoustic impedance. Normally, 2 strong acoustic interfaces are visualized by ultrasound: the leading edge of the intima (at the interface between the blood-filled lumen and the endothelium) and the outer border of the media (at the junction of the media and the EEM). Accordingly, ultrasound techniques measure intimal thickness from the intimal leading edge to the EEM, thus including the media. This practice is used routinely in all other ultrasound techniques, such as carotid or peripheral vascular imaging, for quantification of atherosclerosis.22
Few lesions were detected by angiography, the traditional "definitive" method for in vivo evaluation of the vascular lumen. Angiograms were abnormal in only 8% of the full cohort of 262 patients. No angiogram was abnormal in any patient <30 years old, yet 28% of these subjects had ultrasound evidence of atherosclerosis. Angiography provides excellent resolution but does not depict the vessel wall.7 23 24 25 Because compensatory remodeling is evident in many early lesions, the lumen is usually preserved in the early phase of the disease.26 Accordingly, angiography is insensitive for early detection and estimation of lesion severity. The greater sensitivity of IVUS is a result of its ability to provide tomographic images of the vessel wall, which permits detection of disease before the onset of luminal narrowing.8 9 11 13 14
The present study represents a thorough interrogation of the epicardial coronary arteries, including distal coronary segments. No statistically significant differences were observed in distribution of lesions within the different coronary arteries, although there was a trend toward higher prevalence in the LAD and the lower prevalence within the LCx, with intermediate probability for the RCA. We were also able to confirm the finding of previous necropsy studies that most early lesions occur in proximal segments.27 28 Early disease is highly eccentric (91% of lesions), with a strong predilection for involvement at bifurcation sites (nearly half of lesions). These findings suggest that flow patterns in the coronary arteries may be particularly important in the genesis of the early lesion.
Our findings regarding the high prevalence of atherosclerosis in young people are consistent with those of most other studies, including 2 small IVUS investigations. Examining only the proximal LAD, St Goar et al8 reported a 24% prevalence in 40 patients but no atherosclerosis in donors <25 years old. We previously reported on multivessel imaging in 50 patients with a prevalence rate of 56%.7 Gross inspection of coronaries of the American soldiers killed in the Korean and Vietnam wars demonstrated atherosclerosis in 77% and 45% of autopsies, respectively.12 In the Bogalusa Heart Study, the prevalence in children <15 years old was 8%, reaching 69% in adults between 26 and 40 years old.17A 17B With a conservative definition of disease and imaging in vivo, the prevalence rates in our study were similar, showing unequivocal evidence of atherosclerosis in 28% of subjects <30 years old and 17% of individuals <20 years old. It is possible that incidence of atherosclerosis in the young population is even higher because many potential donors were rejected during pretransplant screening on the basis of clinical or angiographic evidence of coronary artery disease. It is important to recognize that coronary atherosclerosis described in these studies represent early phases of a continuous process. Some of those with atherosclerosis later develop clinical coronary artery disease, frequently as a result of a complication, such as plaque rupture.
In this study, the risk factor information was incomplete. Thus, the impact of the risk factors other than age on the development of atherosclerosis could not be adequately assessed. In the PDAY and Bogalusa studies, however, the strong correlation between the conventional risk factors and coronary atherosclerosis was documented.29 30 31 It remains unproven whether early intervention to curtail atherosclerosis in this young population can limit the development of symptomatic disease. The compelling in vivo data from this study, however, along with previously published necropsy data, emphasize the need to focus societal strategies to limit death and disability from coronary heart disease on the young population.
- Received December 11, 2000.
- Revision received March 14, 2001.
- Accepted March 15, 2001.
- Copyright © 2001 by American Heart Association
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- High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young AdultsE. Murat Tuzcu, Samir R. Kapadia, Eralp Tutar, Khaled M. Ziada, Robert E. Hobbs, Patrick M. McCarthy, James B. Young and Steven E. NissenCirculation. 2001;103:2705-2710, originally published June 5, 2001http://dx.doi.org/10.1161/01.CIR.103.22.2705
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- High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young AdultsE. Murat Tuzcu, Samir R. Kapadia, Eralp Tutar, Khaled M. Ziada, Robert E. Hobbs, Patrick M. McCarthy, James B. Young and Steven E. NissenCirculation. 2001;103:2705-2710, originally published June 5, 2001http://dx.doi.org/10.1161/01.CIR.103.22.2705
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Paper Plane by Massimo Giangrande
Paper Plane, a song by Massimo Giangrande. Video directed and animated by Gianluca Maruotti, and illustrated by Felicita Sala. Next, watch this lovely behind the scenes video about how they put it all together:
Jim Guthrie – Lobby Music
Lobby Music, a song by Jim Guthrie with animation by Nicolas Ménard, who we've featured before.

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Cathedral Of Chartres Literature
A selection of articles related to cathedral of chartres literature.
Original articles from our library related to the Cathedral Of Chartres Literature. See Table of Contents for further available material (downloadable resources) on Cathedral Of Chartres Literature.
- History of the Egyptian Religion, part III: The Wisdom Literature
- It may seem that religion in ancient Egypt was mainly concerned with preserving the status of kingship and of a powerful priesthood. However, at all levels of society relationship with a deity through prayers and offerings on a daily basis was of great...
Religions >> Egyptian
- Celtic Gods and Heros: Introduction to Celtic Mythology
- Youngsters of school age almost effortlessly learn about the gods and heroes of Greek and Roman mythology. Names like Zeus, Hercules, Diana, Ulysses, Mercury, Venus, and others become widely familiar. Paintings, popular movies, and books trace their stories...
Deities & Heros >> Celtic, Welsh, Irish & Brittish
- The Celtic Vedic Connection, Part I
- Of all the great ancient cultures perhaps no two share more parallels than those of the Celtic and Vedic peoples. A deep rooted affinity runs between them, what is present in one is mirrored in the other. Myths, Gods, Goddesses, even fairy tales bear a...
Religions >> Druidism
- The Rise Of The Rede
- A Change In Emphasis The Wiccan Rede currently enjoys an extremely visible role in Paganism. As of this writing, a browser search using the term "Wiccan Rede" will generate no less than 4,000 listings. Go to a specific Web site with a "basics...
Paganism & Wicca >> The Wiccan Rede
- Story of the Celts: The Celts of Ireland
- The Celts of Ireland [ 33 ] The Celts arrived in Ireland by 350 B.C (some say earlier) and they thrive there to this day. A claim might be made that the Celtic Irish are among the world's oldest nationality groups. Despite periods when foreigners tried in...
History & Anthropology >> Celtic & Irish
Cathedral Of Chartres Literature is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Cathedral Of Chartres Literature books and related discussion.
Suggested News Resources
- Polymath Author And Teacher Umberto Eco Passes
- Rome: The Italian writer, intellectual, philosopher, semiologist, sociologist, university professor, Umberto Eco, sometimes referred to as the man who knew everything, died the evening of February 19 in his home in Milan at age 84.
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- In fairness, though, it may be that it just feels unfamiliar—an extra figure painted in "Guernica," or an extra spire on the Chartres Cathedral.
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Our representative to Congress thinks Eric Holder is perfectly within his rights to lie to Congress and then stonewall them. "This is a nakedly political moment," Himes said. "Never in the 240-year history of the United States has the Congress done this. Not during Watergate. Not during FDR. Frankly, it's trading the remaining honor of this institution to score some political points."
Well Jim, that's just not true. Not even close to true. It is so false, in fact, that you're either a complete bald faced liar or completely, completely ignorant of US history. There are those might think that either of those possibilities should be enough to bar you from political office, but not me: I think it proves that you are superbly qualified to be a politician.
A sample:
If he won't resign, he should be impeached: NYT, 5/03/07 (AG Gonzales)
Former Attorney General says Bush should be impeached.
Here's a list of every high ranking cabinet officer and elected officer against whom impeachment proceedings were initiated and/or accomplished. Everyone who's anyone is there, from Buchanan to Bush, from War Department Secretaries to – ahem, Attorney Generals.


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Tom McHenry
Tom McHenry is a cartoonist and game designer from Chicago, Illinois. His comics and strange drawings are posted regularly to his site, http://www.noncanon.com. His game Horse Master: The Game of Horse Mastery was named one of the 50 Best Free Games on PC by RockPaperShotgun.com and one of the Top Interactive Fiction Games of All Time by the Interactive Fiction Database.


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Click on a thumbnail to go to Google Books.
Heat and Dust (original 1975; edition 1987)
by Ruth Prawer Jhabvala
Work details
Heat and Dust by Ruth Prawer Jhabvala (1975)
No current Talk conversations about this book.
Unnamed narrator, in the 1970s is searching for information about her grandfather's first wife, Olivia Rivers, in 1920s India. The book takes us back and forth from the 1970s through the narrator's diary entries back to the 1920s in Raj India and Olivia's story. The book contrasted Raj and the India of the present. The strongest element of the story was the evocation of India, especially through its descriptions of the climate--mostly "heat and dust." This also served as a metaphor for the heating up and consummation of the affair between Olivia and the Nawab , a minor prince. I disliked all of the characters: Olivia was a whiner and the present-day woman was just...there. But both were mesmerized by India and chose different outcomes as solution to the same dilemma. I liked the author's simple, spare style, clipped and terse dialogue and evocation of the country.
I like the way the two strands of the story were woven together. One the story of the British grandmother who ran away from her husband and married an Indian prince. The second story of the grandmother trying to piece together this story. Both are stories about the power of India. Both women are drawn into the culture in ways that estrange them from their own English stories. Neither can really go back.
The book was read in a lovely way by Julie Christie. I would recommend the book just for the reading.
An eloquent and beautifully poised novella comparing and contrasting the experiences of two English women in India. The unnamed narrator travels to India to investigate and tell the story of her father's first wife, a bored housewife who has an affair with a local prince. Their two stories are alternated and have many parallels, as well as contrasts between colonial and independent India. It is easy to see why this book won the Booker prize.
I listened to this book which was narrated by the actress Julie Christie. Christie also played the main character in the movie made from the book. I thought she did an excellent job as the narrator.
The book is about an English woman, Anne, who goes to India to discover more about her grandfather's first wife, Olivia. Her grandfather and Olivia lived in Satipur in the 1920s shortly after their marriage. Olivia fell under the charm of the local Indian ruler, the Nawab. With not much to fill her days Olivia spends her time with the Nawab and an English man attached to the Nawab's household, Harry. When the hot season comes and the other English women go to the hill stations Olivia stays behind.
We learn all this in a series of flashbacks from letters that Olivia wrote at the time. In the present time Anne also falls under the charm of India and an Indian man. The narrator seems to be fated to duplicate Olivia's life but perhaps her life will be more successful than Olivia's.
The women's stories are the main thrust of the book but the background of India under imperial Britain and then under home rule is fascinating. Only 50 years have passed between the parallel stories but what a difference in a country. I thought this was at least as interesting as what Olivia and Anne experienced.
The narrator of this novel is a young woman who is exploring the footsteps of her Grandfather's first wife, Olivia in India. The story unfold of how Olivia fell in love with a local prince in 1923 and there is some mirroring in the 1923 story and the 1960/70s story in the places they visit, things that happen. I enjoyed the novel although it lacked engagement on some level. The narrative flits between the 'present' and 1923 and the story kept moving enough for it to be interesting. The heat and dust of summer in this part of India was well depicted.
References to this work on external resources.
Wikipedia in English (1)
Amazon.com Product Description (ISBN 0671646575, Paperback)Set in India, HEAT AND DUST is the story of Olivia, a beautiful, spoiled, bored English colonial wife in the 1920s who is drawn inexorably into the spell of the Nawab, a minor Indian prince deeply involved in plots and intrigues. Olivia outrages the tiny, suffocating town where her husband is a civil servant by eloping with the captivating Nawab. It is also the story of Olivia's step-granddaughter who, fifty years later, is drawn to India by her fascination with the letters left behind by the now dead older woman, and by her obsession with solving the enigma of Olivia's scandal. A penetrating and compassionate love story, this brilliant novel immerses the reader in the heat, dust, and squalor of India, while providing a compelling mixture of the spiritual and the sensual.
(retrieved from Amazon Thu, 12 Mar 2015 18:16:48 -0400)
Set in India, HEAT AND DUST is the story of Olivia, a beautiful, spoiled, bored English colonial wife in the 1920s who is drawn inexorably into the spell of the Nawab, a minor Indian prince deeply involved in plots and intrigues. Olivia outrages the tiny, suffocating town where her husband is a civil servant by eloping with the captivating Nawab.… (more)
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Technical Assistance is required in view of the complexity related to introducing social and environmental safeguards into the process for screening and approving investments in the sector, and for properly conducting financial and economic appraisals of proposed investments, as well as to better incorporate intensifying global and regional issues related to food security into sectoral policy-making and planning Furthermore, the limited experience of provincial agencies to manage sector development as implementing agencies of an international development grant, and the limited technical expertise to support agriculture and natural resources sector management at all levels of government, will necessitate technical assistance and support. An advisory technical assistance will be utilized for incorporation and the application of safeguards into project activities.
Latest Project Documents
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
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General Aviation figures up 40% in July
Traffic at Cagliari Airport General Aviation Terminal hits new record: aircraft movements rose by 40% in July on the same period a year ago. Cagliari Airport ranked 1st in Italy and 5th in Europe for general aviation traffic growth (WINGX ranking). In the last few years Cagliari Airport managing company has invested in a brand new General Aviation Terminal (TAG), improved significantly the quality of general aviation dedicated services and attended international trade fairs and forums in order to promote its TAG; the strategy has proven effective so far.
Passengers with Reduced Mobility: new leaflet by ENAC
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Volotea to fly to Catania and Turin during winter
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Cagliari Airport accredited at Lvl. 1 for CO2 reduction
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Grand opening for the ISOLA boutique at the airport
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Cagliari Airport now also on Facebook
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Harvard Summer Program in Scandinavia
NOTE: 2016 program information is currently displayed. This program is expected to run in 2017 and updated information will be published in mid-October.
"The Vikings conquer all in their path and nothing resists them." So wrote a Frankish chronicler about the northern pirates whose collective name has come to represent the European ninth, tenth, and eleventh centuries. This Viking studies program in Scandinavia offers the opportunity for you to explore the rich archaeological, cultural, and literary heritage of northern Europe in the early Middle Ages.
Itself founded during the Viking Age, the lovely Danish city of Århus and its modern university are our principal hosts. From this charming seaside location, we visit significant sites and collections throughout northern Europe, and participate in an archaeological dig connected with the Viking Age site on Samsø. Specialists in many different aspects of Viking culture lecture and guide classes.
The Viking studies program is ideal if you:
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Professor Mitchell manages a website for the Scandinavia program where you can learn more about this study abroad experience.
You take both of the following courses.
ANTH S-1095 Study Abroad in Scandinavia: Viking Studies—History and Archaeology ( 31953)
This course introduces the material legacy of the Vikings, whose dramatic expansion circa 750–1100 transformed not only their own society but also much of the entire northern world. Through lectures, visits to museum collections and archaeological sites, and participation in an archaeological dig for three weeks, students encounter the richness of the Viking heritage.
SCAN S-150 Study Abroad in Scandinavia: Viking Studies—Lore and Literature ( 32407)
This course considers the narrative legacy of the Viking era. Through close readings and discussions of eddic poems and other materials, we examine religious life and the medieval view of the Viking Age, especially as reflected in the Icelandic sagas, which present their heroes as warriors, kings, poets, outlaws, and adventurers. In addition to considering the construction of a heroic ideal, we explore how the descendants of the Vikings used the past.
Prerequisite: none.
Course credit
Before applying, review the Admission and Policies and FAQs pages.
You must be at least 18 years old and have completed at least one year of college or be a first-year student in good academic standing to apply.
The application materials, outlined below, are due April 1, 2016:
- A completed online application (available in early December) that includes:
- A $50 nonrefundable application fee
- A statement of interest in the program, including information on relevant coursework and travel experience abroad (previous travel is not a prerequisite)
- Transcripts (Harvard students may submit an unofficial transcript accessed from my.harvard.edu.)
Program directors may ask for interviews.
You will be notified of admissions decisions by mid- to late-April.
There is a nonrefundable $50 application fee. The program cost includes the following:
- Tuition
- Room
- Opening banquet and final banquet
- Excursions (including meals when appropriate)
In addition to the program fee, you are responsible for:
- A health insurance fee (waived if you have US insurance that provides coverage outside the United States)
- Transportation to and from Denmark
- Most meals
- The cost of passports and visas (if the latter is needed)
- Any immunizations
Suggested budget
See a sample budget for estimated expenses.
How to pay and funding options
See Payment and Funding for payment deadlines, deposit amounts, and more information, including funding options for Harvard College students.
You stay in student housing in Åarhus and in youth hostels and hotels on excursions.
Additional information
Contact Stephen Mitchell, email@example.com.
Scandinavia program information session: Tuesday, January 26th from 1 to 3pm in the Kates Room in Warren House
Watch this video where Andres Dobat discusses the fieldwork they conduct in Scandinavia.
Students with disabilities
Contact the Accessibility Services Office as soon as possible. See Students in Need of Accommodations for more information.
- Stephen A. Mitchell, PhD, Professor of Scandinavian and Folklore, Harvard University
- Lise Frost, PhD, Archaeologist and Curator, Moesgaard Museum
- Pernille Hermann, PhD, Associate Professor, Scandinavian Department, Aarhus University
- Peter H. Mikkelsen, PhD, Head of the Department of Conservation and Natural Sciences, Moesgaard Museum


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Mukesh Ambani's Wealth At $22.7 Billion Equals This Nation's GDP: Forbes
Press Trust of India | Sunday October 23, 2016
According to Forbes, the total wealth of India's top five billionaires, which stands at a whopping $83.7 billion, is more than the cost of 1,230 Mars Orbiter 'Mangalyaan' Missions and is more than 18 times the cost of hosting the 2016 Rio Olympics.
Mangalyaan Still Going Strong, To Have Course Correction: ISRO
India News | Press Trust of India | Thursday August 11, 2016
Nearly two years after it was launched, 'Mangalyaan' is still functioning well, and with a planned course correction next January to extend its battery life, it would keep going for many years, ISRO chairman AS Kiran Kumar said today.
Nasa Invites India to Jointly Explore Mars, Send Astronauts
Press Trust of India | Monday February 29, 2016
India's maiden mission to Mars, Mangalyaan, has opened the eyes of the world on Isro's capabilities at undertaking low cost, high value inter-planetary mission.
For Trip To Mars, NASA Wants To Ride With ISRO
India News | Written by Pallava Bagla | Sunday February 28, 2016
The change of heart is complete it seems. Shunned by the American space agency for long, the Indian Space Research Organisation or ISRO is now the subject of exceptional adulation.
France, India Charting New Orbit To Jointly Explore Mars, Venus
India News | Press Trust of India | Sunday January 31, 2016
With Mangalyaan already an orbiter, putting a lander on Mars would be an interesting prospect and France is ready to work with India on it, says the chief of French Space Agency.
India's Next Mars Mission Will Have A French Connection
India News | Reported by Pallava Bagla, Edited by Shuchi Shukla | Tuesday January 26, 2016
India's next mission to Mars will have a French connection and the two countries could together attempt to put a lander on the red planet.
Here's Mars Orbiter's Stunning New Year's Gift For Earthlings
India News | Written by Pallava Bagla | Saturday January 2, 2016
India's Mars Mission, Mangalyaan, sent a special message to Earth on New Year. It was accompanied by a special New Year gift for "earthlings".
China Unveils its Mars Satellite, 2 Years After India's Launch
World News | Written by Pallava Bagla | Wednesday November 4, 2015
China has for the first time unveiled a model of what would be China's mission to Mars. Called Yinghuo-2, it is likely to be launched in 2020 and will have an orbiter and a lander.
After US, India Mars Missions, China Aims for Deep Space
World News | Press Trust of India | Thursday October 15, 2015
Under criticism that its well developed space programme focussed more on the Moon while the US and India stole a march over China by branching out into outer space with voyages to Mars, Chinese space experts are now planning missions deeper into the solar systems.
Isro's Mars Orbiter Mission Turns One
Press Trust of India | Thursday September 24, 2015
MOM aka Mars Orbiter Mission is now expected to last many more years.
On Its First Birthday, Mangalyaan Flaunts Stunning Images of Mars
India News | Written by Pallava Bagla | Thursday September 24, 2015
Mangalyaan, India's maiden mission to Mars, completed a year in space today and as part of the first anniversary celebrations, the Indian Space Research Organisation (ISRO) has launched a 'Mars Atlas' in Bengaluru.
Isro Says 6-Month Mars Mission Will Now Last for 'Many Years'
Press Trust of India | Tuesday September 22, 2015
Mangalyaan launch first anniversary will be celebrated on Thursday.
Isro's Mangalyaan Sends Back Stunning 3D Images of Mars
Indo-Asian News Service | Tuesday August 18, 2015
The images taken by Mars Colour Camera (MCC) reflects the Ophir Chasma terrain, part of the Valles Marineris.
These Pictures Are Mangalyaan's Gift on Independence Day
India News | Written by Pallava Bagla | Friday August 14, 2015
Lovely images of Mars - that's the tribute from Mangalyaan for India's Independence Day. It was exactly three years ago that the nation first got to know that India was heading for Mars - from the ramparts of the Red Fort during the speech of former Prime Minister Manmohan Singh.
ISRO Now Eyes Venus as its Next Big Destination
India News | Written by Pallava Bagla | Monday July 13, 2015
After a hugely successful mission to Mars where India beat China in reaching the Red Planet's orbit, the Indian space agency ISRO is not sitting back on its laurels. It now seeks to foray more into the Solar System with missions being planned for exploring Venus, a revisit to Mars and trip to an asteroid.
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I want to congratulate you for publishing the story about Yitzchak Oshry, and I also want to congratulate his parents, especially his mother, Aleeza, for choosing what was best for her son and [for being] smart enough to ignore pressure from her … friends ("School Choice," Aug. 16). I don't know if most people in… Read More
That Is Kosher To Me
Regarding "The Kosher Machine" (Aug. 9): I come from a kosher, OU upbringing, having lived in Florida, Boston, New York and now here in Baltimore. … I do not run a restaurant or cater or have any family connection to the kashrut industry. But I watch [here in Baltimore] and see how [this hashgacha] …… Read More
The West Just Doesn't Get It
Regarding the many articles the JT has run on issues in the Arab world, most recently "Another Syria?" (Aug. 23): While the so-called reforms in Tunisia, the hopeful beginnings of what were understood to be the Arab Spring, withers into a conspiracy of failure, unrest and ongoing intrafratricidal self-destruction, and Syria degenerates into a who's… Read More
House-Proofing Against Falls
Jewish Holiday celebrations offer us the opportunity to reconnect with loved ones. For many, this means opening our homes to family members, many of whom are older. One false step down a staircase or in the shower has the potential to change the life of an elderly person forever. Falls are the leading cause of… Read More
Is Jewish Education Jewish?
When I enrolled my first child in Jewish day school almost 20 years ago, I was enthralled with the prospect that he would be educated "Jewishly." I imagined that the wisdom of the Torah would illuminate his mind through a Judaic curriculum of Jewish history and Torah subjects. I believed that Jewish schools would reflect… Read More
Be An Innovator
Back in the early 1950s, a large shoe consortium with stores across the U.S. and Canada decided to take its business venture into the emerging continent of Africa. They sent two of their salesmen there. After just one week, they received a cable from the first salesman, "I am returning at once. No hope for… Read More
What's Your New Year's Eco-Footprint?
Shifting gears out of summer mode is extra challenging this year due to the early arrival of the High Holy Days. As such, many of us will be looking for shortcuts to ease the scheduling mayhem. But these shortcuts don't need to come at the expense of our pocketbooks or the environment. Making mindful choices… Read More
Do Not Sit In Judgment
In just a few days, voters in New York City will decide a primary election for the positions of comptroller and mayor. Prominent Jewish candidates are running for both offices, but they are not the sort of Jewish candidates most of us in the Jewishcommunity would wish were running for public office. Each has won… Read More
Hamas' Sudden Vulnerability
The chaotic changes in the Middle East have had at least one positive result at the moment: the weakening of Hamas, the terrorist organization that rules the Gaza Strip. Because of alignment decisions made by the Islamist group in both Egypt and Syria, Hamas has emerged as a big loser. (See related story, "The Mideast… Read More
Do Jews Need A White House Liaison?
When Matt Nosanchuk was appointed associate director of the White House Office of Public Engagement for Jewish Outreach last month, the former defense department staffer became the fourth in a series of President Obama's "Jewish liaisons." It is a role that goes back officially or unofficially to FDR and Harry Truman. The Jewish liaison is… Read More
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A Family That Gambled On Dreams Together
Lonnie Smith, 67, was working as a janitor when he heard that his wife's ticket had won the lottery. Smith had been employed by the same Phoenix company for more than thirty years.
The lottery ticket which his wife played was worth $5.8 million.
"Will you retire?" I asked.
"I already did," Smith said. "I retired as soon as they told us we had the right numbers."
Smith grinned. It was as though he was contemplating this private joke, one the rest of us knew nothing about.
But we were all in on it, too. For a couple of days last week, everyone was obsessed with lottery fever. There were long lines in all the places where lottery tickets are sold.
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Most people bought the tickets and took their chances on the numbers. But Smith and his wife, Gertrude, and the rest of his family picked their own numbers.
They had been picking their own numbers for years. Anything that came to mind. They were a family that gambled on dreams together. They regularly played the dog races, which is, of course, nothing else but picking numbers. So why not pick their own lottery numbers?
And so they bought not one ticket, but two with this same set of numbers and, of course, both of them won. So all five members of the family come away with a total of more than $10 million.
And now they were sitting here at this press conference in the lottery offices. They had been presented with two checks totaling nearly $600,000, which will be their yearly payoff for the next twenty years.
Lonnie Smith will be 86 when the payments stop.
"Will you buy a car?" "Might do that," he said.
There are five family members who must find a way to share these yearly checks for the next twenty years.
The mother and stepfather are retired. That leaves three who are in the prime of their lives and have life expectancies of close to forty more years.
Lamich Casey had worked building floors, driving his 1973 Ford F-250 all over the western part of the country, looking for jobs.
"Will you buy a new car?" He smiled.
"Not a car," he said. "I don't have any use for a car in my line of work. I might buy a truck, though." He said he might start his own flooring business now and give jobs to his friends.
His sister, Pamela Kemp, 26, had worked as a clerk-typist for the Department of Economic Security.
"Will you continue working for DES?" she was asked.
"I've quit that job," she said. "I'm going to pursue my dream now. I want to become an international model." Tommie Casey had worked with his sister Pamela at DES. He was an eligibility interviewer. Now he's going to invest in his own business.
All five drove down to the lottery office together in a mid-1970s Caddy with a paint job long flattened out by the Arizona sun. The vinyl top was peeling.
Despite the efforts of a dozen media people, there really was not much to ask the winners about their money. They were headed on a journey which might take some strange turns.
Lonnie Smith, at just three years short of seventy, had been around long enough to know the things life can hand out.
He came to Arizona decades ago, trying to get away from a small town in Oklahoma and its extremes of heat and cold. He had worked for one company here most of his adult life.
At the end, he had been a janitor because the work was easier on him physically. And now, suddenly, he was a millionaire. He could go anyplace he wanted and buy just about anything he desired. It was a tremendous challenge.
Lonnie Smith smiled.
"First, let's go out and get something to eat," he said.
"I retired as soon as they told us we had the right numbers."
"I'm going to pursue my dream now. I want to become an international model."
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Latest Blog Entries
EU and Legal Reform Summer School 2016
Workshop on International Constitutional Law
When Science Trumps Law – Prof. Alan McHughen
Contemporary History and Institutions of the Mediterranean Seminar Series: Judicial Activism against Austerity in Portugal
Constitutional History: Comparative Perspectives
Center for Constitutional Studies and Democratic Development
The CCSDD is a research partnership between the School of Law of the University of Bologna and the Johns Hopkins University Paul H. Nitze School of Advanced International Studies in Bologna, Italy (SAIS Europe).
Internships are offered by the CCSDD to SAIS Europe and University of Bologna students to work on research and teaching-related projects. Student research assistants are hired in September for both semester and year-long positions. For SAIS Europe students, applications for the positions are posted on the SAIS Insider Portal. University of Bologna students may write directly to email@example.com.
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2 dozen
+ Add To Shopping List
1/2 cup shortening
1 cup sugar
1 egg
2 cups all-purpose flour
1/2 cup cocoa
1 1/4 teaspoons baking soda
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Cream shortening in a large mixing bowl; gradually add sugar, beating well. Add egg, beating well.
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Created date
February 2010


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Real Name: Tanya Taylor Joined: October 2014
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Top 15 Most Quotable Movies Ever
Here are 15 films with great lines that we can pretty much recite from memory, whether or not we remember anything else about them.
Here are 15 films with great lines that we can pretty much recite from memory, whether or not we remember anything else about them.
The Blu-ray market was made for reissues, but not all reissues are created equal. With that in mind, here are four recent Blu-ray sets that bring some hit films of the past into the hi-def era. Which ones take advantage of the technology's expanded storage limits? Which ones were put together with the fans in mind? Read on to find out: American Beauty is the latest addition to Paramount's Sapphire Series collection, and in terms of critical stature and awards, it fits right in alongside previous Sapphire titles such as Gladiator, Saving Private Ryan, and The Godfather. Sadly, Beauty also fits in in terms of missed opportunities; Sapphire titles have started to gain a reputation for being problem-plagued (Private Ryan's audio errors) or just plain uninspired (the straight Godfather repackages), and this one is no different. First, the good stuff: Beauty's 1080p AVC encode does all right by cinematographer Conrad L. Hall's gorgeous work, giving the film's rich colors a noticeable boost over the '99 DVD release. It isn't perfect — various bits of speckles …


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Abercrombie House is a heritage treasure of the Bathurst Region.Built in the 1870s by Bathurst pioneers the Stewart family, today it is the home of the Morgan family who have spent many years restoring the magnificent house and its outbuildings and grounds.Abercrombie House is open to the public. Come on a guided tour or take a self-guided walk through the house and gardens. The house is also available for functions and numerous events throughout the year.
Contact us for details


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It's been a number of days now since USA Today released the preseason coaches poll for the 2011 season. We've all had time to pour over the teams listed, determine what selections we agree with and with which ones we disagree.
But even if you think the Top 25 is perfect the way it is, it still has one inherent flaw—it's based totally on guessing.
There isn't a single team that has played a game yet, and there isn't a single team that returns all 22 starters. Suffice it to say, each team will be very different this year from last.
There are reasons why each team might not belong in the Top 25 or shouldn't be ranked as high as they are. But what about the unit responsible for scoring points? What about the offense? Are they as good as their team's ranking suggests, or are there linger questions?
Here's a rundown of the most suspect offenses for teams ranked in the Top 25.


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Authorities are re-examining whether a Maplewood Manor resident found dead outside the nursing home early Saturday morning climbed out a window, as first thought. Both the village police department and the state Department of Health are continuing to investigate the death of Carlton Decker, 85, who had lived at the Saratoga County-run facility for several years. An autopsy conducted Sunday at Saratoga Hospital attributed the death to heart attack, but an official report including a ...
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A stay at Hanoi Golden Hotel places you in the heart of Nha Trang, walking distance from Sailing Club Nha Trang and Nha Trang Night Market. This hotel is within close proximity of April 2 Square and Tram Huong Tower.
Make yourself at home in one of the 88 air-conditioned rooms featuring refrigerators and minibars. LCD televisions with cable programming provide entertainment, while complimentary wireless Internet access keeps you connected. Private bathrooms with bathtubs or showers feature complimentary toiletries and hair dryers. Conveniences include phones, as well as safes and desks.
Pamper yourself with onsite massages or enjoy recreation amenities such as an outdoor pool. This hotel also features complimentary wireless Internet access, a television in a common area, and tour/ticket assistance.
Grab a bite to eat at the hotel's restaurant, which features a bar, or stay in and take advantage of room service (during limited hours). Quench your thirst with your favorite drink at a bar/lounge. A complimentary buffet breakfast is served daily.
Business, Other Amenities
Featured amenities include a business center, limo/town car service, and complimentary newspapers in the lobby. For a surcharge, guests may use a roundtrip airport shuttle (available on request) and a train station pick-up service.


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Welcome to the Michigan Trapshooting Association. Located in the heart of the beautiful Great Lakes State, the MTA home grounds are easily accessible on a major highway, with restaurants, motels, airports, stores, and a wide variety of cultural and recreational opportunities nearby. MAP
The MTA, one of the country's premier trap facilities, has 40 program and 3 practice fields, all with Pat-Traps and voice releases. The MTA Board of Directors, volunteers, and paid staff work hard to throw the finest, most consistent targets possible. We're dedicated to providing the best trapshooting competition available anywhere.
Please check the "Clubs and Shoots" tab above for the shooting schedules and addresses of the almost three dozen Michigan local clubs throwing ATA registered targets. These clubs are truly the backbone of our sport.
For information on camping and other use of the MTA grounds between shoots, please contact Ann Shirkey, 517-740-6418.