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|Taking a Break from Things...
|Tweet Topic Started: Jan 13 2012, 01:06 AM (2,228 Views)
|Jan 13 2012, 01:06 AM Post #1
Anthony walked through the Inner Zone looking around. It was packed as usual people buying and selling people trying to make a living with the world going to hell outside of this place. Someone walked up to Anthony "Sell you some food sir?" he asked. Anthony shook his head "Not right now thanks" he said as he kept walking, he was sure Drake was following behind him but he couldn't be sure.
There was somewhere Anthony wanted to go, the Drunken Warlord. It was his favorite pub, and the only one with well to do Mead. They had their farm on this land for years made it easier to get their own wheat. Anthony walked in and went over to the bar.
"Adrian" Anthony said sitting down. "Give me two tall ones for me and my friend here." he said "Put it on my tab" the bar tender turned around smirking "Sure thing Anthony, have a good trip this time? Can you talk about it or is your mission still all hush hush?" he asked him as he started to pour the mead.
|Jan 13 2012, 01:11 AM Post #2
Dragon of Hell
Drake followed behind Anthony, he was shocked to see that the Zone looked the way it did actually. He was sure everyone here was going to be living miserably just barely scrapping by. But these people, they were living like they didn't have a freakin care in the world. Like the world right outside this place wasn't hell. Drake sighed at the thought, he wondered where the Evans lived more than anything else. As soon as he got his chance he'd kill them and leave.
Until then he'd bied his time and get to know the area. He followed Anthony into the pub and looked around the place was a hole, but it was better than the dungeons in the Black City. Drake sat at the bar then took his mead and drank it, it had a sweet taste to it. "So, what was your mission exactly anyway?" Drake asked Anthony, he wasn't sure if the guy would talk about it here or not. The way he seemed to be keeping it secret it would seem he wouldn't.
Drake took another drink waiting for his response.
|Jan 13 2012, 02:35 AM Post #3
Anthony took a drink from his glass and laughed some at what Drake had said. It would seem like him talking to the Hell Guard then not explaining things to Adrian that the mission he was on was super secret. "To be honest" Anthony started to say as he took another sip of mead "The mission is really just a request from a friend, it isn't that big of secret..." he told Drake, "Though I mean they did ask me not to tell too many people about it, but since you're going to be going with me I guess you should know too"
Anthony put his now empty glass down and asked for another before turning back to Drake. "A few months back the Sechs Hell Guard, Altanero went out on a mission. No one knows what for, said it was a call from Tyrael." He said as he grabbed his renewed mead "Only issue is not even Uriel has heard from Tyrael in months either...if not years. So Altanero hasn't come back yet. And seeing as how I have the most free time Ulriel asked me to find him. If I could" he finished explaining. He then took another drink.
"So, Paradisio eh? My Old Man was stationed there..." he started to say to Drake.
|Jan 13 2012, 02:40 AM Post #4
Dragon of Hell
Drake took another drink himself when Anthony started to explain his mission. Or rather his request from a friend as he put it. "Why?" he asked Anthony "Why would the angels send a human to do that, instead of you know going themselves" he questioned taking another drink. "I mean wouldn't it be easier if one of them went searching, hell Vanita just asked to go with us. Why didn't they go themselves?" he said, it was just the ramblings of someone who was tired, but he figured those questions needed to be answered.
Before he realized it Drake had gone through his first glass as well. The bar tender Adrian put another down for him the same time he put Anthony's down. Drake picked up his glass "You don't have to answer those questions, I was just thinking outloud" Drake said to him taking another drink as Anthony asked about Paradisio. "Yeah, born and raised, was there for the fall of it too" he told him. "Your father, Nathanial?" he asked he recognized the last name. "I was stationed under his command in the final days of the seige, before we lost that is..." he said to Anthony.
"Your father was a brave man, he fought to his last breath..." Drake took another drink.
|Jan 14 2012, 12:09 AM Post #5
Dark Sorceress
Isabella stood at the entrance to the city with her arms well hidden under the cloak, which was pulled tight to cover most of her body. Samuel was right, being herself could be very dangerous here. The fog had disoriented her and made her head hurt. Pain was the last thing that she would be showing the guards. There was sure to be something extremely repellent to demons or dark forces that would cause the effect. She bit into her lip again, wincing in pain,"Thank you for bringing us here, but I meant what I said before. I have no idea what to do with myself in this place."
She looked at the guards, mumbling under her breath,"If they let me in the city..."
|Jan 14 2012, 01:14 AM Post #6
Anthony looked at Drake strangely when he began to ask all of the questions he did. Most of them made sense, Anthony didn't even really bother to ask those questions himself for the most part. He just went along with it, like he said it was more so about helping out a friend in his mind than anything else. Drake then dismissed everything as just him thinking outloud "Lots of thoughts you had there buddy" Anthony responded with a slight chuckle and a drink from his glass.
He stopped when Drake explained about being from Paradisio, when he mentioned his father Anthony looked down "I guess thats good to hear, when we arrived the place was already destroyed" he explained to Drake, "So the Evans are from Paradisio right?" Anthony asked "What do you think of them? I mean they are one of the groups running this place"
|Jan 14 2012, 01:45 AM Post #7
Dragon of Hell
Drake laughed some when Anthony said those were a lot of thoughts he was having "Hey what can I say I'm a thinker" Drake joked taking another drink from his glass "Or a drinker, either way" he said shrugging. He put his glass down when Anthony mentioned the Evans "I don't have much of an opinion on them...to be perfectly honest" he said having to lie through his teeth. He didn't want to give away his true intentions though, so he had to play along this time. "Another drink?" Drake asked.
At the gates the guards looked at the lady that had just walked up. She didn't seem out of the ordinary for the most part "You can pass" they said to her, they looked at her two companions "You may as well, enjoy your stay in the inner zone" he said to them.
|Jan 14 2012, 02:02 AM Post #8
Samuel smiled at her. "No worries, just relax. This is a safe zone for humans. Just don't go around advertising that you wield demon magic." He whispered.
He gave the 'whats up' nod to one of the guards before walking Coltis through the gate. "Lets go find a shop to sell some of this stuff and get some coin. Life is always easier with a heavy coin purse."
|Jan 14 2012, 02:08 AM Post #9
Gray gave a not to the guards before him before fallowing the other two in. He had himself shrouded in his black cloak, which was hiding his armor, and what weapons he had on him, as well as warding off the cold.
"In all my travel's, I don't think I have ever been here before."
|Jan 15 2012, 01:02 AM Post #10
Dark Sorceress
Isabella nodded her head to the guards as they passed through the gate. The city made her stop short. Everything looked as it would have before the fall. People were walking around freely. There were no soulless humans standing around awaiting orders. Civilians weren't in chains. It felt wrong to her on some level. A place like this should not be able to exist in this new world run by demons and ruled by fear. Her face maintained the look of shock without revealing all the other thoughts about this place,"I have everything under control. It will be when I move the cloak that we might start attracting attention."
Bella nodded her head,"Sure, you are the one that deserves the profit though."
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Texas Tech professor helps bring new wave to cattle feeding industry
By Marlena Hartz | Avalanche-Journal | Monday, April 21, 2008
The machine's steel bars, built like a Venus flytrap, clenched the steer, holding him still on a chilly morning so a team of Texas Tech researchers could accurately measure his weight.
The steer – tagged number 737 – is a resident of the university's farm in New Deal. At about 9-months-old, he weighs 733 pounds, according to this massive scale, commonly referred to as a "squeezer."
Later this month, the steer will begin a new diet, consuming ethanol by-products called wet distillers grains.
Here in the Panhandle, the ethanol industry is burgeoning and fresh distillers grains from the ethanol-making process are a sudden feed option for farmers and ranchers.
"The benefit of having these (ethanol plants) in our backyard is … the ability to use some of these distillers grains, which will hopefully reduce the cost of our rations," said Ben Weinheimer, vice president of the Texas Cattle Feeders Association.
But knowing exactly how much fresh distillers grain to feed livestock and how it affects their health is still a guessing game for regional feed lot owners, who have turned to Texas scientists for answers.
One of those scientists is Michael Galyean, a distinguished animal science professor at Tech. He and his students will monitor the weight-gain of No. 737 and some 200 other cattle to be fed an even mixture of wet corn and sorghum distillers grains.
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Collectively, they will have the capacity to produce more than 600 million gallons of ethanol per year, and thousands of pounds of distillers grains.
State lawmakers in the last legislative session gave Texas A&M $850,000 to study the grains, and the money has been passed on to Galyean and other scientists, Galyean said.
Dry distillers grains are not wholly unfamiliar to regional cattle feeders. Some ship in the dried by-products from Midwestern ethanol plants, Weinheimer said. But the still-wet distillers grains that will likely come from Pandhandle ethanol plants are much trickier to handle.
The wet grain has a short shelf life, molding and drying quickly in the West Texas heat, said Galyean, who stores the pungent grain in long, white bags at the university's farm in New Deal.
He grabbed a handful of molasses-colored sorghum distillers grain from a bag at the farm. It fit in his palm like a ball of clay. A few stray granules clung to his fingertips.
Wet distillers grains, he explained, are about two-thirds water. Gauging the grains' nutritional value to livestock, therefore, can be difficult, he said.
"Water can really mess you up is what is boils down to," he said.
"Texas cattle feeders and others really wanted (research) done locally, under our conditions so that people could see … how it works," he said.
Distillers grains are cheaper than corn and sorghum. But calculating the actual cost savings can be tricky, too, Galyean said.
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Livestock that are fed the distillers grains consume the concentrated chemicals, which wind up in their manure. Then, the manure is used to fertilize crops and the chemicals inside could potentially pollute water and food supplies, Galyean said.
What impact this could have on human and animal health, if any, is largely unknown, he said.
"There's a lot of work that needs to be done," he said.
To comment on this story: firstname.lastname@example.com 766-8753
Profile: Michael Galyean
• Earned his bachelor's degree in agriculture from New Mexico State University in 1973 and his master's and doctorate's in animal nutrition from Oklahoma State University in 1975 and 1977.
• Has a chaired Thornton professorship in beef nutrition and management in the Tech College of Agricultural Sciences and Natural Resources since 1998.
• Named a Tech Horn professor, the highest honor professors can receive at the university, in 2006
• Has, with colleagues, published 387 articles, papers and book chapters, proceedings, reports.
Source: Texas Tech and the American Feed Industry Association


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Richard Childress Racing
Recent News
Sprint Cup Series Post Race Report for Dover
September 30, 2013
NASCAR Sprint Cup Series
Dover International Speedway
September 29, 2013
Race Highlights:
•Richard Childress Racing teammates finished sixth (Kevin Harvick), 14th (Jeff Burton), and 18th (Paul Menard) in the AAA 400.
•Following the event at Dover International Speedway, Harvick is fourth in the NASCAR Sprint Cup Series driver championship point standings, 39 markers behind the leader, while Menard is 17th and Burton sits 20th.
•The No. 29 Chevrolet SS team ranks fourth in the Sprint Cup Series owner championship point standings, with the No. 27 team 18th and the No. 31 team 21st.
•According to NASCAR's Post-Race Loop Data Statistics, Harvick completed 53 Green-Flag Passes, 39 of which came while running in the top 15 (Quality Passes), positioning him second and third in the loop data categories.
•Harvick was the seventh-Fastest Driver Late in a Run, eighth in the Closers category after gaining two positions during the final 10 percent (40 laps) of the race, had the eighth-fastest Speed in Traffic, spent 95.5 percent of the laps in the Top 15, ranking him ninth, and was the 10th-Fastest Driver Early in a Run.
•Burton gained one position during the final 10 percent (40 laps) of the race, placing him the 10th in the Closers category and was the 10th-Fastest Driver Late in a Run.
•Menard completed 37 Green-Flag Passes during the 400-lap event.
•RCR teammates Burton, Harvick and Menard posted nine of the Fastest Laps Run with four, three and two laps, respectively.
•Jimmie Johnson earned his fifth victory of the 2013 Sprint Cup Series season and was followed to the finish line by Dale Earnhardt, Jr., Joey Logano, Jeff Gordon and Kyle Busch.
•The next Sprint Cup Series race is the Kansas 400 at Kansas Speedway on Sunday, Oct. 6. The 30th race of the 2013 season is scheduled to be televised live on ESPN beginning at 1 p.m. Eastern Time and broadcast live on the Motor Racing Network and SiriusXM NASCAR Satellite Radio, channel 90.
Menard Finishes 18th at Dover International Speedway
Paul Menard started the 400-mile event at Dover International Speedway from the 21st position and struggled with handling issues throughout the day to finish 18th on Sunday afternoon. A long green-flag run in the early laps of the race, coupled with a loose-handling condition, caused Menard to fall a lap down to the leader at lap 130. The No. 27 pit crew made a variety of chassis adjustments during the ensuing pit stops in hopes of providing some relief to the Eau Claire Wis., native. After a lap-231 pit stop for four tires, fuel and multiple chassis adjustments, Menard was running in 18th and relayed to the No. 27 crew that the car was the best that it had been all day and the loose-handling condition was tightening up. Continued long green-flag runs and persistent handling issues contributed to Menard falling two laps down to the leader toward the latter portion of the race. The Richard Childress Racing driver and team never gave up and Menard was running lap times comparative to the leader, but the caution flags never fell in his favor. Unable to gain any laps back, Menard ultimately finished the 400-lap event in the 18th position and sits in 17th in the NASCAR Sprint Cup Series driver championship point standings heading into Kansas Speedway.
Start - 21 Finish - 18 Laps Led - 0 Points - 17th
PAUL MENARD QUOTE: "It was a tough day for the No. 27 CertainTeed/Menards crew. We struggled with handling all weekend at Dover (International Speedway), and never seemed to hit on the right setup until the end of the race. The crew worked hard making adjustments all day to try and get the car to handle better. Track position is everything at Dover. Once you fall a lap down to the leader it's hard to gain any ground, especially with the long green-flag runs we had today."
Harvick Finishes Sixth at the Monster Mile
Kevin Harvick and the No. 29 Budweiser team finished sixth in the NASCAR Sprint Cup Series event at Dover International Speedway on Sunday afternoon after battling handling issues throughout the race. The California native started the 400-lap event from the 12th position and maintained a spot in the top 15 while battling a simultaneously tight and loose-handling red and white machine during the early laps. The Gil Martin-led pit crew made adjustments to the Budweiser Chevrolet during scheduled four-tire pit stops throughout the first half of the race, but Harvick continued to battle an ill-handling machine. As the race progressed, the pit crew continued to work to improve the handling of the Richard Childress Racing entry, allowing the 21-time Sprint Cup Series race winner to gain valuable track position, crossing the finish line sixth and picking up his 15th top-10 finish of the 2013 race season. Following the 400-mile event, Harvick gained two positions and now sits fourth in the Sprint Cup Series driver championship point standings.
Start - 12 Finish - 6 Laps Led - 0 Points - 4th
KEVIN HARVICK QUOTE: "This was a tough one for us. We struggled most of the weekend to find the right balance on the Budweiser Chevrolet and battled handling issues during the race. The team did a great job bouncing back today and it resulted in the solid finish we needed."
Burton Finishes 14th at Dover International Speedway
Jeff Burton and the No. 31 Caterpillar Chevrolet team battled back to a top-15 finish of 14th at Dover International Speedway on Sunday afternoon. Starting the 400-lap event from the 25th position, the 21-time NASCAR Sprint Cup Series race winner battled a tight-handling condition on his black and yellow machine early, entering the top 20 just before lap 100. On two occasions, the Richard Childress Racing driver was trapped one lap down to the leader during long green-flag runs, receiving the "Lucky Dog" free pass award both times when the caution flag was displayed to get back onto the lead lap. Restarting with a top-20 position on lap 236, Burton struggled throughout another long green-flag run and once again dropped one lap down to the leader. The Caterpillar team didn't give up over the course of the race, making several air pressure and chassis adjustments to remedy the tight-handling condition and Burton cracked the top 15 with less than 100 laps remaining. The South Boston, Va., native maintained that top-15 running position for the remainder of the event and brought home a 14th-place finish. Burton remains 20th in the Sprint Cup Series driver championship point standings.
Start - 25 Finish - 14 Laps Led - 0 Points - 20th
JEFF BURTON QUOTE: "Everyone on this Caterpillar Chevrolet team put in a solid effort all weekend. We weren't where we needed to be on the speed chart, but we never gave up throughout the race and ended up with a top-15 finish. When things are tough, you find out what people are made of. I am proud of these No. 31 guys."


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Kid's Fashion Center
Everyone has their own fashion sense. This is a good thing, because it allows each of us to express our own sense of creativity - and our children are certainly not left out of this. After all, who among us hasn't seen a child dressed in public, and smiled to ourselves, knowing that the child must have dressed himself? Or gone to the grocery store with a little girl wearing a tutu, tiara, frog rain boots and a super hero cape?
Sometimes, it's just not worth the battle. It doesn't matter, in the long run, if your child wears the same pants for a month - as long as you can wash them, of course - or refuses to wear the color orange.
There may be some times, though, that you have to fight the good fight. You may be going to visit grandma, and you just know that grandma will make a fuss if Junior isn't in a suit and tie. So, you have to compromise. How can you meet the fashion needs and desires of your child without squashing their individuality, and help them to stay appropriately clothed in a non attention grabbing fashion?
- Pick your battles - Be stubborn about something else. Not everything is a battle. Is it really super important that your child go to church dressed nicely? Then maybe you can let go of the control when the child goes to the park. You can't be in charge every single time - your child has to feel a sense of autonomy in order to develop a sense of self.
- Be willing to compromise - Sometimes, you have to let go and allow your child to wear that purple tie with a yellow shirt. Maybe you will be insistent that your daughter wear a dress, but you can let her wear brightly colored tights and boots.
- Understand that they aren't trying to be difficult - Your child is learning to develop a sense of self and not trying to make you mad. Well, not in this instance, probably. So don't take it personally when your son tells you that your choices stink. He doesn't really mean it. (I hope.)
- Go with the flow - It's a true testament to parenting that there's always going to be something going on, something to get annoyed about, something that will need your effort and attention. Clothing probably isn't worth it - unless it's morally offensive or completely against your ethical values, it's probably not worth the argument.
How do you help your child learn to develop a sense of style without having an enormous argument?
by mrswillieNovember 19, 2012 at 7:44 AM
I let mine be their self as long as it is appropriate. I have teens.
by ZamariaNovember 19, 2012 at 8:11 AMWith my oldest, I give him guidelines as to what he needs to wear and let him choose his outfit himself, example, I'll tell him "you need a sweater or collared shirt and nice jeans or khakis" or "you need to wear a suit and tie" or "you can wear nice jeans and a nice hoodie or tee shirt" and he usually does ok with that. The younger two, I choose two or three things and let them pick from those things. I don't buy them clothes that I don't like, I don't buy things that I would consider inappropriate, and they are aware that costumes are for Halloween or playing dress up and occasionally they can wear them to the park. That's it. My middle son does have some iron man rain boots that he tries to wear a lot, but I just tell him "it's not raining so we need to save those for a rainy day" and he's ok with that. I don't usually get arguments from them.
by cara124November 19, 2012 at 8:38 AM
as long as they are covered and its tasteful I'm ok letting them be their selves . Having teenage Daughters sometimes you have to "guide" things in a direction the is going to be respectful of themselves.
by natesmom1228November 19, 2012 at 9:01 AM
I only buy clothes that I like. I hate skulls so I don't buy anything with them on it.
by goddess99November 19, 2012 at 9:26 AM
I've learned to just make it easy. I only buy jeans and khakis, that way all shirts, sweaters match no matter what.
I do believe that if it isn't illegal, immoral or going to hurt someone, that kids should be able to do it. It is sometimes hard to practise that though! Not sure I'll be able to agree to a mohawk or colored hair, for example.
But I do let the boys pick out what they want & usually just go with it. I keep "Mommy's perogative" for things like church & holidays.
I will sometimes tell them something doesn't match (since they likely don't know) but if they still insist, we go with it.
by .Angelica.November 19, 2012 at 10:33 AM
i let my son dress himself as long as it's weather appropriate and clean. lol
November 19, 2012 at 10:47 AM
I give them a choice between 2-3 differant outfits, that way they can still feel like they are making their own choice.
by sukainahNovember 19, 2012 at 10:50 AM
So far my kids are okay with what I give them to wear.
by gacgbakerNovember 19, 2012 at 11:07 AM
I make recommendations and let them know why I recommend it- ultimately I let them make choices for themselves though, as long as they are modest- modesty is something I draw a harder line with- no compromise on that one.


text:
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Ferradini, Laurenta,b; Laureillard, Didierb,c; Prak, Naromd; Ngeth, Chanchhayad; Fernandez, Marcelob; Pinoges, Loretxua; Puertas, Gloriaa; Taburet, Anne-Mariee; Ly, Naryf; Rouzioux, Christineg; Balkan, Sunab; Quillet, Catherineb; Delfraissy, Jean-Françoish,i
From the aEpicentre, Paris, France
bMédecins Sans Frontières, Paris, France
cImmunological Department, Georges Pompidou, European Hospital, Paris, France
dInfectious Disease Department, Khmero-Sovietic Friendship Hospital, Phnom Penh, Cambodia
eClinical Pharmacy Department, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, France
fInstitut Pasteur du Cambodia, Phnom Penh, Cambodia
gHIV/Hepatitis laboratory, CHU Necker, EA 3620 Université Paris-Descartes, Paris, France
hClinical Immunology Department, Bicêtre Hospital, Kremlin Bicêtre, France
iAgence Nationale de Recherches sur le Sida, Paris, France.
Received 11 February, 2007
Revised 7 May, 2007
Accepted 11 May, 2007
Correspondence to Laurent Ferradini, Médecins Sans Frontières, 8 rue Saint-Sabin, 75011 Paris, France. E-mail: email@example.com
Objectives: African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings. The long-term virological outcome and clinico-immunological criteria of success remain important questions. We report the outcomes at 24 months of antiretroviral therapy (ART) in patients treated in a Médecins Sans Frontières/Ministry of Health programme in Cambodia.
Methods: Adults who started HAART 24 ± 2 months ago were included. Plasma HIV-RNA levels were assessed by real-time polymerase chain reaction. Factors associated with virological failure were analysed using logistic regression.
Results: Of 416 patients, 59.2% were men; the median age was 33.6 years. At baseline, 95.2% were ART naive, 48.9% were at WHO stage IV, and 41.6% had a body mass index less than 18 kg/m2. The median CD4 cell count was 11 cells/μl. A stavudine–lamivudine–efavirenz-containing regimen was initiated predominantly (81.0%). At follow-up (median 23.8 months), 350 (84.1%) were still on HAART, 53 (12.7%) had died, six (1.4%) were transferred, and seven (1.7%) were lost to follow-up. Estimates of survival were 85.5% at 24 months. Of 346 tested patients, 259 (74.1%) had CD4 cell counts greater than 200 cells/μl and 306 (88.4%) had viral loads of less than 400 copies/ml. Factors associated with virological failure at 24 months were non-antiretroviral naive, an insufficient CD4 cell gain of less than 350 cells/μl or a low trough plasma ART concentration. In an intention-to-treat analysis, 73.6% of patients were successfully treated.
Conclusion: Positive results after 2 years of advanced HIV further demonstrate the efficacy of HAART in the medium term in resource-limited settings.
African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings [1–8]. Adherence to treatment in these settings was found to be as good or even better than that observed in northern countries [1,2]. Even if early adherence to HAART appears to be a crucial factor to ensure immunovirological success [9], however, adherence remains a dynamic process [10] and concerns about its long-term maintenance at optimal levels in sub-Saharan Africa have recently been raised [11]. In addition, the occurrence of progressive antiretroviral drug side effects might also impair long-term adherence and virological outcomes of the patients.
Reports on medium or long-term cohorts of patients on HAART in resource-poor settings are still scarce [6,7], and are still performed on only a limited number of patients.
With an estimated HIV prevalence of 1.9% of the adult population (15–49 years) at the end of 2003 and 126 000 individuals living with HIV, Cambodia presents one of the highest HIV prevalences in south-east Asia [12,13]. Access to antiretroviral therapy (ART) is still limited, and up to end of June 2006, almost 16 000 of the 30 000 patients supposed to be in immediate need effectively received ART [14]. The present study aimed to assess patient outcomes 24 months after HAART initiation in a Médecins Sans Frontières (MSF)/Ministry of Health (MoH) observational cohort in Phnom Penh, Cambodia, by analysing survival indicators, CD4 cell count evolution, virological response and pharmacological characteristics.
In collaboration with the MoH of Cambodia, MSF began an HIV programme in 1997 supporting the Infectious Disease Department of the Khmero-Sovietic Friendship (KSF) Hospital in Phnom Penh. The project involved MoH staff (eight physicians, 17 nurses) and MSF staff (two physicians, one nurse, four counsellors, two pharmacists), training, patient education, social support, and adherence consultations for information and education about HIV/AIDS disease and treatment. A peer support group was created to support patient advocacy issues and to participate in the activities of the clinic. Since 2001, HAART was offered free of charge to patients either at World Health Organization (WHO) stage IV (AIDS) irrespective of CD4 cell count or at WHO stages I, II or III with CD4 cell counts of 200 cells/μl or less according to WHO recommendations [15]. Preparation for HAART initiation is accomplished by three pre-HAART counselling visits. The initial first-line regimen proposed was the association of stavudine, lamivudine and efavirenz. Patients with intolerance to this combination were offered other alternative first line regimens. Clinical follow-up visits were performed monthly for the first 6 months then bimonthly. The CD4 T-cell count was monitored every 6 months and no individual viral load monitoring was available. Adherence support was provided at each visit by counsellors through individual interviews or 'talk' groups. In the case of treatment failure, a protease inhibitor-based second-line treatment was available as recommended by WHO [15].
At the end of March 2005, 2048 HIV-infected adult patients were still on HAART in the programme.
All adults, aged 18 years or more, who had initiated HAART for 24 ± 2 months at the date of analysis (31 March 2005) were eligible for the study. Medical background and follow-up information were routinely collected at each consultation and entered into FUCHIA monitoring software (Follow-Up and Care of HIV Infection and AIDS, Epicentre, Paris).
Between 13 December 2004 and 31 March 2005, a cross-sectional survey was conducted to assess the clinical, adherence and virological status of all patients who had been receiving HAART for 24 ± 2 months and presented to the HIV clinic during the study period. CD4 cell counts were performed using flow cytometry (Facscount; Beckton Dickinson, Franklin Lakes, New Jersey, USA) at the Institut Pasteur du Cambodge. Plasma viral load measures were performed on −80°C frozen samples at the HIV/Hepatitis laboratory, Necker Enfants Malades Hospital (Paris, France), using real-time polymerase chain reaction technology, which allows the quantification of HIV-1 non-B subtypes including those circulating in Asia [16–18]. Positive samples from Thailand and Cambodia have been studied in parallel with the Cobas Amplicor HIV-1 Monitor v1.5 test (Roche Diagnostic Systems, Pleasanton, California, USA) and gave highly correlated results (data not shown). For viral loads above 400 copies/ml, HIV-1 reverse transcriptase (RT) genotyping was performed at the Institut Pasteur du Cambodge [19]. The resistance profiles to antiretroviral molecules were defined according to Agence Nationale de Recherches sur le Sida (ANRS) algorithms [20].
Trough plasma concentrations of nevirapine and lopinavir or 12 h post-dose concentrations of efavirenz were measured at the Clinical Pharmacology Department, Bicêtre Hospital (Kremlin Bicêtre, France) using validated high performance liquid chromatography assay [21,22]. Patients were classified by to their trough plasma concentrations according to the following therapeutic windows: nevirapine (3000–8000 ng/ml), efavirenz (1000–4000 ng/ml) and lopinavir (3000–8000 ng/ml) [23].
The survey was approved by the National Ethics Committee for Health Research of Cambodia on 3 December 2004. All participants gave their written informed consent.
Product-limit estimates (Kaplan–Meier) of survival were determined for all patients on an intention to treat basis. Patients alive and in care on 31 March 2005 were right-censored on the date of their last visit before this date. Patients who had not attended services for 2 months or more beyond their last scheduled appointment were classified as being lost to follow-up, and statistically considered on their last recorded visit to the clinics. CD4 cell gains were calculated every 6 months after HAART initiation. Logistic regression analysis was performed to identify factors associated with viral loads greater than 1000 copies/ml 24 months after HAART initiation. Variables with a P < 0.05 were included in the multivariate analysis. Receiver operating characteristic (ROC) curve analysis was performed to define the threshold of percentage CD4 cell gain between month 12 and month 24, which gives optimum sensitivity and specificity for the detection of viral load greater than 1000 copies/ml. Analyses were performed using STATA 8.2 software (Stata Corp., College Station, Texas, USA).
Among the 2048 HIV-infected patients who were on HAART up to 31 March 2005 in the programme, 416 adults had started 24 ± 2 months earlier and were included in the analysis (M24 cohort, Fig. 1). A total of 247 (59.2%) were men and the median age was 33.6 years [interquartile range (IQR) 30.1–38.2; Table 1]. Almost all (396/416, 95.2%) were ART naive. Most were already at an advanced stage of HIV disease when entering the programme: 192 (46.0%) were at WHO stage III and 204 (48.9%) were at WHO stage IV. The body mass index (BMI) was below 18.0 kg/m2 for 161 out of 387 patients (41.6%) and was below 15.0 kg/m2 for 40 out of 387 patients (10.3%). Patients were severely immunocompromised, with a median baseline CD4 cell count of 11 cells/μl (IQR 3–60, n = 416) and 297 out of 416 patients (71.4%) had a CD4 cell count below 50 cells/μl. A total of 337 patients (81.0%) received a first-line antiretroviral regimen associating stavudine, lamivudine and efavirenz, whereas 64 (15.4%) received stavudine, lamivudine and nevirapine, and 15 (3.6%) received another first-line regimen (Table 1).
The median time of follow-up was 23.8 months (IQR 22.8–24.0). Among the 416 patients included, 53 patients (12.7%) had died, seven (1.7%) were lost to follow-up, six (1.4%) were transferred and 350 (84.1%) still remained on HAART.
Estimates of survival given by the Kaplan–Meier method were 0.87 at 12 months [95% confidence interval (CI) 0.83–0.90] and 0.85 at 24 months (95% CI 0.81–0.88) when death events were taken into account exclusively (Fig. 2). Two-thirds of the deaths (35/53, 66.0%) occurred within the first 6 months after HAART initiation (median time to death 3.6 months, IQR 1.7–9.8).
Among patients with available CD4 cell counts at baseline (n = 416), the median CD4 cell gain was found to be +101 cells/μl (IQR 62–137) at 6 months (n = 344), +154 cells/μl (IQR 95–217) at 12 months (n = 337) and +233 cells/μl (IQR 156–332) at 24 months (n = 346; Table 2). Alhough they presented with a very low baseline CD4 cell count, 259 out of 346 patients (74.9%) had a CD4 cell count greater than 200 cells/μl at 24 months.
Among the 350 patients still on treatment after 24 ± 2 months at the date of analysis, four could not be included (three refusals, one out of time) and 346 were assessed virologicaly (Fig. 1). Among them, 86 (24.8%) were on stavudine–lamivudine–efavirenz, 74 (21.4%) were on zidovudine–lamivudine–efavirenz, 115 (33.2%) were on stavudine–lamivudine–nevirapine, 50 (14.4%) were on zidovudine–lamivudine–nevirapine and 10 (2.9%) were on other alternative first-line regimen. Only 11 patients (3.2%) were on a protease inhibitor-based regimen (lopinavir/ritonavir).
Viral loads were below 40 copies/ml for 276 out of 346 patients (79.8%), were below 400 copies/ml for 306 (88.4%) and below 1000 copies/ml for 315 (91.0%). Among the 40 patients with a viral load above 400 copies/ml (11.6%), only 15 (4.3%) were above 30 000 copies/ml, corresponding to major virological failure (Table 3).
Overall, in intention-to-treat analysis of the whole M24 cohort (n = 416) taking into account both deaths, loss to follow-up and missing data (Fig. 1) as treatment failures, 66.3% (95% CI 61.5–70.8) and 73.6% (95% CI 69.0–77.7) of treatment successes were observed when considering viral loads as failures when above 40 copies/ml or 400 copies/ml, respectively.
HIV reverse transcriptase genotyping was performed for the 40 patients with viral loads above 400 copies/ml. Among interpretable sequences (n = 39), 10 (25.6%) did not show any drug-resistance-associated mutations, 23 (59.0%) presented with nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations, and 28 (71.8%) presented with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations. The most frequent NRTI mutation was the lamivudine-induced M184V mutation (23/39), the stavudine-induced T215Y/F mutation (9/39), the T69D/N (7/39) and the D67N (7/39) mutations. Among NNRTI mutations, K103N (15/39), Y181C/I (8/39) and G190A/S (8/39) were most frequently observed (Fig. 3). According to ANRS algorithms [20], 12 patients with a viral load greater than 400 copies/ml were resistant to both zidovudine, lamivudine, stavudine and nevirapine/efavirenz.
The median concentration of efavirenz for 169 patients was 2946 ng/ml (range < 50–31 559 ng/ml), with seven patients (4.1%) having efavirenz levels either undetectable (n = 4) or less than 1000 ng/ml (n = 3) and 47 (27.8%) having levels greater than 4000 ng/ml. Median trough nevirapine concentrations in 165 patients were 5643 ng/ml (range < 25–16 971 ng/ml), with two patients undetectable (1.2%), six patients (3.6%) with nevirapine levels less than 3000 ng/ml and 21 (12.7%) with levels greater than 8000 ng/ml. For the 11 patients on lopinavir/ritonavir at the time of the study, the median trough plasma concentration of lopinavir was 4962 ng/ml (range 2215–8797 ng/ml) with only one patient less than 3000 ng/ml.
Among the 15 patients with low NNRTI trough or 12-h concentrations at month 24, seven had a viral load greater than 1000 copies/ml (47%). Among them, three displayed a wild-type HIV strain with neither NRTI nor NNRTI-induced RT mutations and had a viral load greater than 30 000 copies/ml. On the other hand, when considering patients with high trough plasma antiretroviral concentrations, none among the 21 patients who had high nevirapine concentrations and three out of 47 patients (6.4%) with high efavirenz levels were found to have a virological failure.
As a result of drug intolerance, nine patients from the M24 cohort (2.2%) stopped zidovudine (eight for anaemia, and one for anaemia and neutropenia), 131 (31.5%) stopped stavudine (50 for neuropathy, 71 for lipodystrophy, nine for both neuropathy and lipodystrophy, and one for mitochondrial toxicity), and four stopped HAART because of mitochondrial toxicity. Considering NNRTI, three patients (0.7%) stopped efavirenz (one for neuropsychiatric disorders and two for gynaecomasty), and 13 (3.1%) stopped nevirapine (one for hepatitis, eight for hypersensibility and three for severe cutaneous rash). The median duration before stopping the drug was 93 days (IQR 63–140) for zidovudine, 13.9 months (IQR 11.8–16.7) for stavudine, 22 days (IQR 12–28) for nevirapine and between 10 and 674 days for efavirenz (n = 4).
In order to identify patients at risk of having a detectable viral load, we analysed the association of distinct factors present either at baseline, at 12 or at 24 months with a viral load greater than 1000 copies/ml at 24 months. The aim here was more to identify the group of patients potentially needing a decision to switch their treatment than describing factors associated with virological failures. For this reason, and because of the well-known existence of virological blips, we chose 1000 copies/ml as a reasonable threshold. Higher viral load thresholds could not be tested because of too small sample sizes.
Using univariate logistic regression analysis, the following factors were found to be associated with viral loads greater than 1000 copies/ml at 24 months: age greater than 35 years (P = 0.008), previous antiretroviral exposure (P = 0.004), CD4 cell count less than 200 cells/μl (P = 0.001) or between 200 and 350 cells/μl (P = 0.041), an opportunistic infection between months 9 and 24 (P = 0.041), low plasma antiretroviral concentrations at month 24 (P < 0.001) and an insufficient percentage CD4 cell gain at month 24 (P < 0.001). On the other hand, hospitalization between months 9 and 24, antiretroviral drug stops, weight loss between months 12 and 24, BMI at month 24 or being on HAART second line at month 24 were not statistically associated with a viral load greater than 1000 copies/ml (Table 4). Other factors such as sex (P = 0.7) or being a smoker (P = 0.57) were also not associated. Finally, no criteria present at month 12 among the following were found to be predictive of a viral load greater than 1000 copies/ml at month 24: CD4 cell count (P = 0.68), CD4 cell gain (P = 0.7), percentage CD4 cell gain (P = 0.14), weight gain between months 0 and 12 (P = 0.16) or between months 6 and 12 (P = 0.1).
In the multivariate logistic regression model, evident interactions between CD4 cell level at month 24 and percentage CD4 cell gain between months 12 and 24 (M12–M24%CD4 gain) were taken into account and a new variable combining both CD4 cell count and percentage CD4 cell gain was introduced in the model (Table 4). Finally, three independent factors at month 24 remain positively associated with a viral load greater than 1000 copies/ml (Table 4): previous antiretroviral exposure [odds ratio (OR) 12.6, 95% CI 2.6–62.8, P = 0.002], low plasma antiretroviral concentrations at month 24 (OR 11.1, 95% CI 2.6–48.4, P = 0.001), and having both a CD4 cell count less than 350 cells/μl and a M12–M24%CD4 gain of +23% or less (OR 10.6, 95% CI 2.2–51.7, P = 0.003).
ROC curve analysis was used to define this cut-off of M12–M24% CD4 gain giving the highest sensitivity and specificity for the detection of viral loads greater than 1000 copies/ml. The percentage CD4 cell gain cut-off at 23% gave optimal sensitivity (66.7%, 95% CI 46.0–83.5) and specificity (73.4%, 95% CI 68.0–78.3).
When combining such criteria to improve the detection of patients with viral loads greater than 1000 copies/ml at 24 months, we found that the following association was optimal: previous exposure to ART, or CD4 cell count at month 24 less than 350 cells/μl and a M12–M24%CD4 gain of +23% or less. Using such combined criteria greatly improved the sensitivity (74%, 95% CI 53.7–88.9) with a similar specificity (75%, 95% CI 69.3–79.4). The positive and negative predictive values were 20.6% (95% CI 13.1–30.0) and 97% (95% CI 93.9–98.8), respectively.
The present analysis of 416 patients performed 24 months after HAART initiation in Cambodia found 75% of treatment successes (patients still followed with a viral load < 400 copies/ml) in an intention-to-treat analysis and a 0.85 probability of survival at 24 months. Such favourable outcomes are similar or even better than those reported so far in western cohorts [24,25], and are remarkable given the extreme severity of the disease at HAART initiation (see Table 1) in such a resource-limited setting.
Intensive therapeutic education, counselling and psychosocial support might explain the very low rate of lost-to-follow-up patients observed. Such a result was obtained given an important investment in the recruitment and training of counsellors. Human resources remain a key factor in resource-limited settings. As already reported by other studies in similar settings [6,26–31], most of the deaths occurred during the first 6 months after HAART initiation. Advanced clinical stage and low CD4 cell counts might explain such an increased early mortality. Difficulties in managing opportunistic infections as a result of late presentation or limited diagnostic and therapeutic tools as well as malnutrition or immune reconstitution syndrome might also have played a role in worsening the prognosis of such patients [31–34]. Noteworthy is the fact that 20.4% of the patients analysed had either nevirapine or efavirenz concentrations above the therapeutic range without apparent impairment of their tolerance to the antiretroviral regimen. The reasons for such high concentrations are still unclear and do not seem to be related to the low weight of Asian patients compared with western patients [35,36].
Progressive immune restoration was observed over time (Table 2) similar to that reported in similar settings [6,26–28,37] or even in high-income countries for similar patients [26,38]. It is, however, noteworthy that after 2 years a quarter of the patients remained below 200 CD4 cells/μl probably partly because of late HAART initiation with very low baseline CD4 cell counts. It has been reported that patients with poor immune reconstitution at 6 months (CD4 cell count < 100 cells/μl) have a high risk of an AIDS-defining event or progression to death at 5 years [39]. As in our case, the long-term outcomes of patients still below 200 CD4 cells/μl at 24 months remain largely unknown. Further studies are clearly warranted in resource-limited settings in order to determine the long-term outcomes of these patients and understand the factors governing such poor immune restoration.
The virological results of the M24 cohort revealed that among 346 patients, 40 (11.6%) presented with a detectable viral load (> 400 copies/ml), and only 15 (4.3%) were above 30 000 copies/ml. Overall, among patients with detectable viral loads, 25.6% did not have any ART-induced RT HIV mutations and three had low NNRTI trough plasma concentrations corresponding to non-adherent patients. The mutations observed for the other patients were those expected under the first-line regimen used, and the great majority of patients were already resistant to nevirapine/efavirenz (93%) or lamivudine/emtricitabine (79%) (Fig. 3). Overall, these observations are similar to other first-line cohort studies in resource-limited settings describing HIV-1 RT mutation patterns [7,27,40]. This stresses the importance of keeping available several distinct second-line molecules in such settings, and calls upon the international community to make them really and rapidly affordable. In this study, genotyping analysis allowed the detection of non-adherent patients and the selection of appropriate second-line regimens when necessary. Empiric second-line regimens given according to the type of first-line treatments will have to be evaluated through HIV genotyping pilot studies.
In any case, the decision of when to switch remains critical in order to avoid the accumulation of HIV mutations and preserve the efficacy of the limited number of second-line molecules available. In resource-poor settings where access to viral load is largely limited, better identifying groups of patients at risk of treatment failure might help design accurate viral load monitoring strategies. For operational reasons and because of the existence of potential virological blips, we have chosen 1000 copies/ml as a reasonable threshold in order to identify the group of patients potentially needing to switch to a second-line regimen. Logistic regression analysis revealed that previous ART exposure or CD4 cell counts still less than 350 cells/μl with a CD4% gain of less than +23% between months 12 and 24 were two factors strongly associated with viral loads greater than 1000 copies/ml at 24 months. It is noteworthy that no other characteristics of the patients either at baseline, and specifically the CD4 cell count, or at 12 months of follow-up were found to be associated with viral loads greater than 1000 copies/ml at 24 months. A test using both criteria to identify patients with viral loads greater than 1000 copies/ml gave a 74% sensitivity, a 74% specificity and a 21% positive-predictive value. Using more stringent criteria closer to those recommended by WHO (a decrease in CD4 cell gain > 30% between months 12 and 24) gave a lower sensitivity (26%, 95% CI 11–46) with a higher specificity (98%, 95% CI 96–99) and only a 54% (95% CI 25–81) positive-predictive value. Therefore, if a decision to switch was made only according to such stringent criteria, half of the patients would have been switched inappropriately, and most patients with viral loads greater than 1000 copies/ml would have been missed. These observations clearly emphasize that deciding to switch solely on the basis of immunological criteria is not an acceptable option and might even be costly to the programme. Using less stringent criteria allows the identification of a larger group of patients including most patients with a viral load greater than 1000 copies/ml and for whom viral load tests could be proposed in order to help appropriate decision making. Such a strategy clearly strengthens the need to improve access to affordable viral load testing in resource-limited countries [41].
Data from all patients on HAART for more than 24 months (N = 1036) in this MSF/MoH HIV programme indicate that almost 25.9% (n = 218) would have fulfilled the criteria defined above and would have been proposed a viral load. Among them, approximately 50 viral loads greater than 1000 copies/ml would have been detected, whereas other patients would have had undetectable viral loads. In settings where viral load access is limited, such a strategy identifying patients at risk of failure could be useful to restrict the number of viral loads proposed. Our analysis is still preliminary, however, and needs to be strengthened by further studies on larger numbers of patients. In addition, it appears that the criteria for suspecting failure might vary greatly according to the duration of follow-up. Studies analysing success/failure criteria at distinct timepoints after HAART initiation are on the way in other MSF programmes.
A model to monitor the virological efficacy of HAART in resource-limited settings has recently been proposed by Colebunders et al. [42]. This interesting proposal, mainly based on patients' clinical history, remains to be validated and will have to take into account that a large number of patients still have CD4 cell count less than 200 cells/μl with WHO stage III or IV manifestations even after 2 years of follow-up. Cost-effectiveness analyses would also be important to compare the 'selective viral load' approach with a 'systematic viral load' approach (proposing a viral load once a year for all patients, for example) in settings where viral load access and second-line regimen availability are limited. As a result of the still high cost of second-line regimens and the complete lack of a third line in resource-poor settings, further studies are clearly warranted to determine the appropriate timepoint for switching to second line, not too early (being aware of poor adherence) but not too late (precluding the accumulation of HIV mutations, which impairs the choice among the limited number of second-line molecules). The efficacy of second-line regimens chosen without genotyping information is currently being assessed in Cambodia.
The authors thank Dr Jean-Marc Reynes who was the co-supervisor of N.Ly.'s PhD thesis. They would also like to thank all the people involved in the study and in the implementation of the programme at the KSF Hospital including the MoH of Cambodia, the personnel of the KSF Hospital, the MSF staff and MSF headquarters. They would also like to thank the patients and their families for their participation in the study.
Contributors: D. Laureillard, L. Ferradini, S. Balkan and J.F. Delfraissy contributed to the study concept and design. L. Ferradini was the study coordinator. N. Prak, C. Ngeth, M. Fernandez and G. Puertas actively collected data in the field. C. Rouzioux and N. Ly performed the virological evaluation. A.M. Taburet performed the pharmacological analysis. L. Ferradini and L. Pinoges performed the statistical analysis. D. Laureillard, C. Quillet, L. Ferradini, and J.F. Delfraissy led the writing of the paper, and all investigators participated in its final writing and editing.
The results were presented in part at the International AIDS Society Conference, Rio de Janeiro, Brazil, in July 2005.
Sponsorship: The study was funded by Sidaction (grant no. 617-001-00/A015-2) and Médecins Sans Frontiéres.
Conflicts of interest: None.
antiretroviral therapy; Cambodia; HIV; observational cohort; outcomes
© 2007 Lippincott Williams & Wilkins, Inc.
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A RESOLUTION of the City Council of the City of Lakewood, Washington declaring certain property as surplus and authorizing its disposal to public entities and charitable non-profit organizations or as otherwise available under the law
WHEREAS, the City of Lakewood has a number of items of equipment which have been used by various departments of the City and which are no longer needed for use by the City; and,
WHEREAS, because the property could be used by other public sector entities and charitable non-profit organizations and/or neighborhood associations in the Lakewood area to benefit the citizens of the City, which would promote public and governmental purposes, it would be appropriate to declare this property surplus and authorize its disposal to such entities and organizations as a first priority; and,
WHEREAS, if the surplus property is not reasonably usable or made available to such entities, then it should be disposed of by appropriate means according to legally permissible methods and pursuant to RCW 35A.11.010.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF LAKEWOOD, WASHINGTON HEREBY RESOLVES as follows:
Section 1. That the items of property identified and described on the attached list of Surplus/Salvage Items, marked as Exhibit "A" and incorporated herein by this reference, are declared to be surplus, and the City Manager or designee is authorized to dispose of such property in a manner designed to provide for its use by other public sector entities and charitable non-profit organizations in the Lakewood community, or, alternatively, surplus property should be disposed of in accordance with legally permissible methods.
Section 2. That this Resolution shall be in full force and effect upon passage and signatures hereon.
PASSED by the City Council this 6th day of September, 2011.
Douglas G. Richardson, Mayor
Alice M. Bush, MMC, City Clerk
Approved as to Form:
Heidi Ann Wachter, City Attorney
Exhibit A
7 particle board desks (with one desk having the City ID number 101552)
1 broken paper shredder
2 four-drawer lateral file cabinets (with one cabinet having the City ID number (101181)
3 printer stands
1 three-drawer legal file cabinet
2 four-drawer legal file cabinets
18 desk chairs (mostly broken)
7 fabric covered conference room chairs
1 two-drawer cabinet
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Follow Bryanwww.rhodsey.com
Bryan Rhodes
4 x Ironman winner Bryan Rhodes hails from New Zealand. Anyone who has watched him race can tell that Bryan started out in the water. Competing at the national level as a swimmer and a surf lifesaving competitor is how Bryan got his start as a competitive athlete. Bryan eventually transitioned to triathlon and competed as a junior on the 1990 New Zealand Commonwealth Games Triathlon Team.
By 1992 Bryan saw his first big success, finishing 5th at the World Junior Triathlon Championships in Canada, before winning the World Junior Team Championship title with his teammates Paul Amey & Cameron Brown. By 1993 Bryan was racing on the European triathlon circuit for a spell, and then Bryan headed to Boulder Colorado to hit the American circuit. Bryan raced his first Iron-distance race in 1996 at Ironman New Zealand.
Bryan's seen success at numerous races over the years. He's a 'fan favorite' who always receives a warm welcome from the crowd and the event organizers. Team CLIF Bar and Bryan Rhodes have worked together for a long time. Bryan's one of those guys who races for all the right reasons and seems to always have a smile on his face, whether crossing the finish line first or rehabbing from an injury.
Here at Team CLIF, unlike Bryan, we've certainly spent more time rehabbing from injuries than we've spent winning races - but we like smiling as much as Bryan does. When Bryan's hanging out at one of the Team CLIF Bar lairs, you can bet there are plenty of good stories and smiles to go around.
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Join us as we chat with Team CLIF Bar athlete, runner, and most recently, a...


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The scene was set, and so was Tom Harvey's opinion. The father of a beautiful 19-year-old daughter, Harvey had serious reservations about his little girl dating that most dangerous of men: the professional athlete.
"My initial fatherly reaction kicked in, which was, 'Hmm, not good,'" said Harvey, whose Mansfield job — risk control insurance specialist — fits well with the concerns he had in 2007 when Ellie Harvey began dating the 17-year-old golfer from Australia.
It did not help that Daddy had never heard of the guy.
"My initial reaction was that I didn't know who he was," Harvey said.
He knows now, as does the entire golfing world. The Aussie who had his eye on Ellie — and married her in 2009 — is Jason Day, the world's 17th-ranked golfer who in his past nine major tournaments has finished second three times (twice in the U.S. Open and once at the Masters) and third once.
Day looks for his first major win this week at the British Open, which begins on Thursday at Muirfield in Scotland. His best Open finish is a tie for 30th in 2011.
"Flash forward to 2013 and it has worked out pretty well," Harvey said, chuckling. "Jason and I turned out to be good friends, and we have a lot of fun together."
Harvey doesn't have to go far to fun it up with his son-in-law. The couple lives on five acres in Westerville, with their 1-year-old son, Dash, mostly to be closer to family and friends but also because the semi-rural life provides relative peace and privacy.
"I like the quiet. I've always liked it. You can't hear any traffic," Day said last year, adding that Columbus has plenty to do. "We've lived in the South before, but it hasn't been the greatest."
Day craves privacy, which can make him seem aloof, Harvey said.
"He's very private and protective of his sphere, but he's very approachable, as long as you're not a stalker," Harvey said, adding that his son-in-law is adjusting to his surroundings.
"He has taken up trap and skeet shooting and is working with a compound bow and arrow," Harvey said. "He does snowboarding. He's acclimating to the area. What's that quote from Eric Clapton (who lives in Columbus)? Something like he loves Columbus because he can walk around in stores and nobody knows him? And the people are nice. That's Jason, although he's a little more recognizable when he talks. The Aussie accent gives him away."
Day's golf mirrors his Ohio home life, in that he is becoming more comfortable each week. On the links, he is the only player this year to own at least a share of the lead on the final nine holes of both majors.
"I've only won once out here on tour (the 2010 Byron Nelson), but I've come close, very, very close a few times now," Day said last month. "Everyone talks about that comfort level. Across the board, from when I was a junior to amateur to professional, it's always taken me a little bit to feel comfortable in myself, in my own shoes. I think it's coming along nicely."
It took Day nearly a year to get comfortable enough to text Ellie, much less ask her out. The couple met in Twinsburg, near Cleveland; Ellie was waitressing at a pub and Day was playing in a Nationwide (now Web.com) Tour event. The romance blossomed. In 2007, Ellie drove to Columbus to watch Day play in the Nationwide Children's Hospital Invitational.
Their first date included dinner at Applebee's.
"She calls me to say they're going out to eat and I say, 'Well, don't go to Applebee's. Go someplace nice.' I gave her the name of a nice steak joint. They went to Applebee's. While he had money in his pocket, he still had juvenile tastes," Harvey said.
Soon after came what Harvey describes as the "Robert De Niro/ Meet the Parents moment," in which father sets suitor straight.
"I told him, 'Until you get married, she's mine. I take care of her. I protect her. Anyone who messes with her answers to me. I'm not threatening you. I'm just telling you, dude, that's how it is,'" Harvey said.
"To put a capstone on it, at their wedding they asked me to say the invocation, to bless the food," he said. "I put my hands on Jason's shoulders and said, 'Now I'm turning her over to you.'"
Through it all, the two men never experienced a testy relationship, said Harvey, who admires Day for his golf but even more because he is a down-to-earth gentleman.
"He's not a silver-spoon guy, so there's not that elitist (pro athlete) mentality," Harvey said.
As for the golf part of it, Harvey said he has followed Day around courses enough to know the 25-year-old is one of the PGA Tour's better ball strikers.
"It's just a matter of him putting it all together," he said of Day's chances of winning a major.
Day agrees.
"It takes time. Some guys get there quicker than others," he said. "But it all boils down to how much do you want it? If you really want it, and there's nothing else in your life other than wanting to win majors, then you're going to do it. That's just what winners do."
Day already has won, as far as Harvey is concerned. After all, he already married the best woman in the world.