text:
Lonafarnib for Chronic Hepatitis D
This study has been completed.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) )
ClinicalTrials.gov Identifier:
First received: December 16, 2011
Last updated: July 18, 2016
Last verified: July 2016
- Full Text View
- Tabular View
- Study Results
- Disclaimer
- How to Read a Study Record
Detailed Description:
- Chronic hepatitis D is a severe disease of the liver caused by infection with the hepatitis D virus. The hepatitis D virus can only infect a person who also has hepatitis B; therefore, people with delta hepatitis have both hepatitis B and hepatitis D virus infection. Most people with hepatitis D eventually develop cirrhosis, which causes scarring and damage to the liver. There is currently no effective treatment for chronic hepatitis D.
- Lonafarnib is a drug that was originally designed to treat different types of cancer. It may be able to prevent the hepatitis D virus from reproducing itself. However, it has not been tested on people with hepatitis D. Researchers want to study different doses of lonafarnib to see how they affect virus levels and other symptoms of hepatitis D.
- To test the safety and effectiveness of lonafarnib as a treatment for chronic hepatitis D.
- Individuals at least 18 years of age who have chronic hepatitis D.
- Participants will be screened with a medical history and physical exam. They will have blood and urine tests, eye exams, and imaging studies of the liver and gall bladder. A liver biopsy may also be performed.
- Participants will receive either lonafarnib or placebo twice a day for 28 days. For the first 3 days, participants will stay in the hospital to have frequent blood tests. Participants will have four more clinic visits (on days 7, 14, 21, and 28) for blood and urine tests. Eye exams and heart function tests will also be given. Men may be asked to provide sperm samples for further testing.
- After the 28 days of treatment, participants will stop taking the drug or placebo. They will have regular followup visits for up to 6 months after stopping treatment....
|Hepatitis D
|Drug: Lonafarnib Other: Placebo
|Phase 2
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary Purpose: Treatment
|Official Title:
|Treatment of Chronic Delta Hepatitis With Lonafarnib
Resource links provided by NLM:
MedlinePlus related topics: Hepatitis Hepatitis AU.S. FDA Resources
Further study details as provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):
Primary Outcome Measures:
- Change in Quantitative Serum HDV RNA Levels After 28 Days of Lonafarnib Therapy. [ Time Frame: 28 days ]
Secondary Outcome Measures:
- ALT Levels [ Time Frame: 7 months ]
|Study Start Date:
|December 2011
|Study Completion Date:
|April 2015
|Primary Completion Date:
|April 2015 (Final data collection date for primary outcome measure)
|Assigned Interventions
Placebo Comparator: Placebo
Placebo control
Other: Placebo
Placebo control
Experimental: Group 1
lonafarnib 100mg
Drug: Lonafarnib
Commercially approved products used to test the research hypothesis
Experimental: Group 2
lonafarnib 200mg
Drug: Lonafarnib
Commercially approved products used to test the research hypothesis
Detailed Description:
Chronic delta hepatitis is a serious form of chronic liver disease caused by infection with the hepatitis D virus (HDV), a small RNA virus that requires farnesylation of its major structural protein (HDV antigen) for replication. We propose to treat between 12 and 14 patients with chronic delta hepatitis using the farnesyltransferase inhibitor (FTI) lonafarnib for a duration of twenty-eight days. Farnesyltransferase inhibitors have not been used in the therapy of delta hepatitis. Patients with HBsAg and HDV RNA in serum, elevated aminotransferases, or moderate-to-severe chronic hepatitis and HDV antigen on liver biopsy will be enrolled. Before receiving therapy, patients will be monitored for at least three months with regular testing for alanine aminotransferase (ALT) levels and will undergo Clinical Center admission for medical evaluation and percutaneous liver biopsy. Two dosing groups of lonafarnib will be assessed, with a placebo cohort in each group. At each clinic visit, patients will be questioned about side effects and symptoms, undergo focused physical examination, and have blood drawn for complete blood counts, HDV RNA, and routine liver tests (including ALT, AST, alkaline phosphatase, direct and total bilirubin, and albumin). At two-week intervals, for a period of 28 days, patients will also be tested for HBsAg, anti-HBs, HBV DNA, and prothrombin time. At the end of 28 days of treatment, patients will undergo repeat physical examination, assessment of symptoms (using a symptom scale questionnaire), complete blood counts, routine liver tests, and hepatitis B and D viral markers. The primary therapeutic endpoint will be an improvement in quantitative serum HDV RNA levels after 28 days of lonafarnib therapy. The primary safety endpoint will be the ability to tolerate the drug at the prescribed dose for the 4 week duration. Several secondary endpoints will be measured, including side effects, ALT levels, and symptoms. Therapy will be stopped for intolerance to lonafarnib (which will be carefully defined). This study is designed as a phase 2a study assessing the safety, tolerance and antiviral activity of two dose levels of lonafarnib, a farnesyltransferase inhibitor.
|Ages Eligible for Study:
|18 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
- Age 18 years or above, male or female.
- Serum alanine or aspartate aminotransferase activities above the upper limit of normal (ALT > 41 or AST > 31 U/L) on an average of three determinations taken during the previous 6 months. The mean of the three determinations will be defined as baseline levels.
- Presence of anti-HDV in serum.
- Evidence of chronic hepatitis on liver biopsy done within the previous 12 months with a necroinflammatory score in histology activity index of at least 5 (out of a maximum of 18) and at least 1 for hepatic fibrosis (out of a maximum of 6).
- Presence of HDV antigen in liver tissue or HDV RNA in serum.
- Written informed consent.
- Decompensated liver disease, defined by bilirubin > 4mg/dL, albumin < 3.0 gm/dL, prothrombin time > 2 sec prolonged, or history of bleeding esophageal varices, ascites or hepatic encephalopathy. Laboratory abnormalities that are not thought to be due to liver disease may not necessarily require exclusion. Patients with ALT levels greater than 1000 U/L (> 25 times ULN) will not be enrolled but may be followed until three determinations are below this level.
- Pregnancy or inability to practice adequate contraception, in women of childbearing potential or in spouses of such women. Adequate contraception is defined as vasectomy in men, tubal ligation in women, or use of two barrier methods such as condoms and spermicide combination, birth control pills, an intrauterine device, Depo-Provera, or Norplant.
- Significant systemic or major illnesses other than liver disease, including, but not limited to, congestive heart failure, renal failure (eGFR < 50 ml/min), organ transplantation, serious psychiatric disease or depression (only if felt to be at high risk by the NIH psychiatric consultation service), and active coronary artery disease.
- Systemic immunosuppressive therapy within the previous 2 months.
- Evidence of another form of liver disease in addition to viral hepatitis (for example autoimmune liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson disease, alcoholic liver disease, nonalcoholic steatohepatitis (but not steatosis), hemochromatosis, or alpha-1-antitrypsin deficiency).
- Active substance abuse, such as alcohol, inhaled or injection drugs within the previous year.
- Evidence of hepatocellular carcinoma.
- Evidence of concurrent hepatitis C infection with positive serum HCV RNA.
- Any experimental therapy apart from pegylated interferon within 6 months prior to enrollment.
- Diagnosis of malignancy in the five years prior to the enrollment with exception granted to superficial dermatologic malignancies.
- Evidence of HIV co-infection; HIV (Omega) antibody positivity on serum testing.
- Concurrent usage of statins as these drugs inhibit mevalonate synthesis which reduces protein prenylation.
- Concurrent usage of moderate and strong CYP3A inhibitors and inducers.
- Inability to understand or sign informed consent.
- Any other condition, which in the opinion of the investigators would impede the patient s participation or compliance in the study.
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01495585
Please refer to this study by its ClinicalTrials.gov identifier: NCT01495585
|United States, Maryland
|National Institutes of Health Clinical Center, 9000 Rockville Pike
|Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
|Principal Investigator:
|Theo Heller, M.D.
|National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
More Information
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 21, 2017
Additional Information:
Glenn JS, Marsters JC Jr, Greenberg HB. Use of a prenylation inhibitor as a novel antiviral agent. J Virol. 1998 Nov;72(11):9303-6.
Rizzetto M, Ponzetto A, Forzani I. Hepatitis delta virus as a global health problem. Vaccine. 1990 Mar;8 Suppl:S10-4; discussion S21-3. Review.
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Koh C, Canini L, Dahari H, Zhao X, Uprichard SL, Haynes-Williams V, Winters MA, Subramanya G, Cooper SL, Pinto P, Wolff EF, Bishop R, Ai Thanda Han M, Cotler SJ, Kleiner DE, Keskin O, Idilman R, Yurdaydin C, Glenn JS, Heller T. Oral prenylation inhibition with lonafarnib in chronic hepatitis D infection: a proof-of-concept randomised, double-blind, placebo-controlled phase 2A trial. Lancet Infect Dis. 2015 Oct;15(10):1167-74. doi: 10.1016/S1473-3099(15)00074-2. Epub 2015 Jul 16.
|Responsible Party:
|National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
|ClinicalTrials.gov Identifier:
|NCT01495585 History of Changes
|Other Study ID Numbers:
12-DK-0046 ( Other Identifier: NIH Clinical Center )
|Study First Received:
|December 16, 2011
|Results First Received:
|April 28, 2016
|Last Updated:
|July 18, 2016
|Individual Participant Data (IPD) Sharing Statement:
|Plan to Share IPD:
|Plan Description:
|De-identified data with outside collaborators
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):
Hepatitis D
Additional relevant MeSH terms:
Hepatitis A
Hepatitis D
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
ClinicalTrials.gov processed this record on September 21, 2017


text:
So I asked my trainer if it is possible to improve balance. He said, of course. You can improve any skill you possess.
Babies develop balance. It is hard to believe that at some point your balance becomes static. We know balance can become worse. Why could it not also become better?
Some people have superb balance. How did they get it if not by training and practice?

subset: commoncrawl


text:
COLUMBUS (AP) -- Republican congressmen won Ohio's two hotly contested U.S. House races Tuesday, with one ousting a Democrat in a battle of incumbents and the other knocking off a challenger in a rematch.
In northeast Ohio, first-term Rep. Jim Renacci defeated Democratic Rep. Betty Sutton, whose district was eliminated as a result of redrawn political maps. It was one of the nation's costliest, most closely watched House races and one of two matchups of House incumbents.
Republican U.S. Rep. Bill Johnson defeated former U.S. Rep. Charlie Wilson in eastern Ohio to win a second term. Democrats seeking to take back control of Congress had hoped to pick up the 6th District, which covers much of Ohio's Appalachian region.
Outside groups had poured millions of dollars into television advertising in the two contests. Republicans counted on dissatisfaction with President Barack Obama and the economy to help them keep both seats.
Only a handful of Ohio's 16 congressional districts were competitive this year after Republicans redrew the state's political map to reflect population shifts and came up with districts that tilted heavily toward one party or the other. Because of slow population growth, Ohio lost two of its 18 congressional districts.
Republicans outnumber Democrats in Ohio's delegation 13-5. The GOP was all but assured of keeping a majority of the state's seats. Democrats were heavily favored in just four contests.
At least nine Republicans and three Democrats won Ohio congressional seats Tuesday. That includes two first-term congressional Republicans -- Reps. Bob Gibbs and Steve Stivers.
Meanwhile, a heavily favored Democratic candidate also captured a new U.S. House seat. Former Democratic state Rep. Joyce Beatty took the new district in central Ohio, which was added after Democrats sought more representation for African-Americans.
U.S. House Speaker John Boehner won a 12th term, as he ran unopposed in his southwest Ohio district.
Samuel "Joe" Wurzelbacher, who was thrust into the political spotlight four years ago as Joe the Plumber, was beaten by congressional veteran Marcy Kaptur, the longest-serving Democratic woman in the House. Wurzelbacher ran as a Republican in Ohio's 9th U.S. House district in his first shot at public office.
There will be two other new faces in Ohio's congressional delegation.
Iraq war veteran Brad Wenstrup, a Republican, was victorious in a southern Ohio district that stretches east from Cincinnati into Appalachia. He surprised U.S. Rep. Jean Schmidt in the GOP primary.�
In a GOP-leaning district in the state's northeast corner, Geauga County Prosecutor David Joyce beat Democrat Dale Virgil Blanchard.
Republicans chose Joyce to run after nine-term U.S. Rep. Steven LaTourette, a Republican, announced in July that he wouldn't seek re-election because of his frustration over political gridlock in Washington.


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text:
HERCULES — A 60-year-old woman was airlifted to a hospital Friday morning after she was hit by a driver, then rolled over the vehicle, at an intersection in Hercules, authorities said.
The woman, who was not identified, was alert, according to Battalion Chief Brian Lowry of the Hercules-Rodeo Fire District. She had numerous abrasions and reported "significant" hip pain, he added.
No one else was injured.
The crash happened about 8:18 a.m. near a shopping center at the intersection of Sycamore Avenue and Refugio Valley Road, Lowry said. The woman was hit by the car and rolled over the vehicle's windshield.
Officals did not know the cause of the accident. Lowry said that cars moving through the intersection on a green light are typically moving at about 15 mph to 20 mph.
The driver stopped immediately and cooperated with investigators, Lowry said.


text:
Hey guys I need a bit of advice. I'm a pretty noob player and today I lost my favorite disc. I'd like to buy it again but I'm not 100% sure Im buying the right thing.
It was a JLS by Millenium and I've posted a picture of exactly what I had. A google search shows me a ton of JLS discs but not the same design. My main question is how different are the discs? Just cosmetic or what.
Thanks for any help.


text:
Aerial Gypsy Moth Spraying Begins in May
April 27, 2009
News Highlights
More Information
Fairfax County will begin its annual aerial spraying program to suppress gypsy moth caterpillars starting in early May.
Helicopters will spray a naturally occurring insecticide in 20 infested areas across the county. A detailed map showing these treatment areas is available at all public library branches, county government centers and online. Treatment areas are chosen through an annual county survey of the gypsy moth population. This year the county will treat approximately 1,000 acres.
Because weather conditions are unpredictable, county officials do not know the exact days when spraying will be conducted. Once spraying begins, it may take 10 days or more to complete, depending on the weather. Typically, spraying is done in the early morning and at dusk. However, it may continue all day if weather conditions permit.
The county will use a naturally occurring bacteria — Bacillus thuringiensis or Bt. — as an insecticide. Extensive research has shown that Bt. is not harmful to people, pets, plants or beneficial insects, such as honeybees. The spray will not harm painted surfaces, and residues can be removed with soap and water.
Bt. is registered with the U.S. Environmental Protection Agency for use in forests and residential areas. In addition, Bt. is sanctioned by the U.S. Department of Agriculture and Virginia Department of Agriculture for use against gypsy moths.
Gypsy moth caterpillars can kill trees by defoliating them. The caterpillars feed on many different types of trees but especially like native hardwoods, such as oak. Because they have few natural predators in this country, the gypsy moth must be suppressed with insecticides. Native to Eurasia, it was accidentally released in the U.S. in the 19th century by a scientist.
More information about the treatment program, affected areas or gypsy moths, can be found online, or call the county's Forest Pest Program at 703-324-5304, TTY 711.
Contact: Merni Fitzgerald, Director, Office of Public Affairs
703-324-3189, TTY 711, Media Pager: 703-324-NEWS (6397)
To request this information in an alternate format, call 703-324-3187, TTY 711


text:
Dainese T-Shirt Born Ready Lady White: Features: Material: - Cotton...
Dainese T-Shirt Born Ready Lady White:
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Rocket Centre are so much more than an online retailer, we are Lancashire's largest Motorcycle dealers, with our Blackburn showroom including on road and off road franchises from some of the biggest names around and a team of friendly, enthusiastic and expert staff. We also have a dyno room, 6 bay workshop, offer motorcycle trainingand even have an on site cafe!
All built up over 25 years!
Finance options are available on a large range of our products. Contact our team for more information.


text:
President Obama has created millions more of those since taking office in 2008, and this does not help the person or society. Many people, while having good intentions, don't understand that the government cannot mandate compassion. Compassion is an individual choice to help and bless another person.
The problem with a helping hand is it too often becomes a way of life. There are people who deserve our compassion for circumstances beyond their control. But when someone finds themselves in a difficult situation because they made poor choices, it is not compassion to swoop in and take their free will away by providing everything for them but what they really need and that is learning from their mistakes.
True compassion teaches people to feed themselves, support themselves and utilize what they already have instead of giving them what they don't have.
Laura J. Smyser


text:
ADHEPTA Study: Adherence Questionnaire in Hepatitis C (ADHEPTA)
This study has been completed.
Fundacion IMIM
Information provided by (Responsible Party):
Fundacion IMIM
ClinicalTrials.gov Identifier:
First received: October 19, 2009
Last updated: October 14, 2015
Last verified: October 2009
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Main objective: To study and validate a questionnaire measuring treatment adherence in patients with Hepatitis C virus (HCV) infection.
Design of the study: Multicentric, prospective, epidemiological study in the field of usual clinical practice.
|Hepatitis C, Chronic HIV Infection
|Other: Adherence questionnaire
|Study Type:
|Study Design:
|Time Perspective: Prospective
|Official Title:
|Development and Validation of a Questionnaire Measuring Treatment Adherence in Patients With Hepatitis C
Resource links provided by NLM:
MedlinePlus related topics: HIV/AIDS Hepatitis Hepatitis A Hepatitis CU.S. FDA Resources
Further study details as provided by Fundacion IMIM:
Primary Outcome Measures:
- Main objective of the study is the development and validation of a Questionnaire measuring treatment adherence in patients with HCV infection. [ Time Frame: 2 years ]
Secondary Outcome Measures:
- Adherence will be measured according to 80/80/80 rule. [ Time Frame: 2 years ]
- Establish a relationship between adherence, virological response (VR) and Sustained virological response (SVR). [ Time Frame: 2 years ]
|Study Start Date:
|October 2009
|Study Completion Date:
|January 2013
|Primary Completion Date:
|September 2010 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Hepatitis C infection
Other: Adherence questionnaire
Adherence questionnaire
|Hepatitis C + HIV infections
Other: Adherence questionnaire
Adherence questionnaire
|Ages Eligible for Study:
|18 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Non-Probability Sample
Study Population
Patients with HCV and with HCV + HIV
Inclusion Criteria:
- Ambulatory patient infected by HCV according to diagnosis criteria used en usual clinical practice.
- Patient no treated previously and beginning a treatment for HCV.
- Patient that signed the informed consent to participate in the study.
- Group A: patient with HCV monoinfection.
- Group B: patient with HCV and HCV co-infection (according to diagnosis criteria used en usual clinical practice).
Exclusion Criteria:
- Patient that received previous treatment for HCV.
- Patient that is going to participate in a clinical trial Turing the HCV treatment period.
- Patient with cognitive impairment or patient unable to understand and answer the auto-administered questionnaire.
- Patient unable to read or write Spanish.
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00998621
Please refer to this study by its ClinicalTrials.gov identifier: NCT00998621
|Hospital del Mar
|Barcelona, Spain, 08003
Sponsors and Collaborators
Fundacion IMIM
More Information
Keywords provided by Fundacion IMIM:
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 25, 2017
|Responsible Party:
|Fundacion IMIM
|ClinicalTrials.gov Identifier:
|NCT00998621 History of Changes
|Other Study ID Numbers:
|Study First Received:
|October 19, 2009
|Last Updated:
|October 14, 2015
Keywords provided by Fundacion IMIM:
Hepatitis C, Chronic
HIV Infection
Medication Adherence
Questionnaire Design
Treatment experienced
Additional relevant MeSH terms:
Hepatitis A
Hepatitis C
HIV Infections
Hepatitis C, Chronic
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Lentivirus Infections
Retroviridae Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Hepatitis, Chronic
ClinicalTrials.gov processed this record on September 25, 2017


text:
Heavy rains in a community served by CFCA's project in Cali, Colombia, caused a river to overflow in January, causing major damage to the homes of 17 sponsored friends and their families.
Many people from this community were evacuated after the Cauca River flooded. The river crosses more than 40 percent of the community and is the main source of income for residents.
Families in the CFCA sponsorship program often earn a living by extracting river sand for construction. That has not been possible since the heavy rains.
As part of CFCA's outreach to those affected, staff members visited families in the sponsorship program who live in the affected areas as well as in shelters.
They also helped coordinate efforts with local authorities to rescue some of the families' possessions and provide food and other items according to their needs.
Here are the thoughts and perspectives from two parents of sponsored children.
Carlos' story
I was at home when the river began to rise. I had to go to work.
I warned my family about the situation and asked if it kept rising to call me. At 3 p.m. I came back from work; the river was already inside my house, so I put up all the equipment, jars and other utensils over bricks so they wouldn't get wet.
I told my wife and children to go to a shelter elsewhere and I would stay at home, but none of them wanted to leave.
We borrowed a boat and stayed at home, asking God to lower the water level. The house remained in a very poor condition: the foundation was disintegrating, walls were cracked and the house was tilted. I had to put bamboo to hold the front wall of the house.
Laura (Maria Sotelo, CFCA staff member and volunteer coordinator) came to visit us, not inside because she couldn't (laughs).
In these difficult times Bertha (Duran, CFCA project coordinator in Cali) and other staff members visited my house. That meant a lot; you don't feel alone.
Just a prayer from good people counts a lot; you know that in the good and bad times they are there for you.
Laura does not leave us alone; she gives us words of encouragement and speaks to encourage us to move forward.
My children's sponsorship is helping me with their future and because we are motivated to manage resources to improve our homes, in addition to all the sponsorship benefits received for my children. This helps us move forward.
Gloria's story
(Before the flooding) we were told that the river was rising too fast. We placed a stick to mark the rise of water.
Half an hour later the stick was already covered. We began to worry at home and although we did not want to alarm our daughters, we began to prepare things because we did not know what could happen.
Around 9 p.m. the house began to rattle, the bamboos to sound. We couldn't sleep.My husband decided to stay up and take care of our daughters while they were sleeping.
The following day we realized the water level was too high, and the stability of the house was very weak. With tears in our eyes we decided to evacuate our belongings.
There is a ranch in front of our house and the caretaker is a good friend of ours. He offered us a space to stay there.
We have received visits from CFCA staff members. The project coordinator came to us and talked to us. We can see their concern in this situation.
Laura visited us and talked to us. Ana Solarte (a CFCA volunteer) also has visited and given us words of encouragement to succeed. They have been good to us; we feel that helping hand.
Continuing challenges
Although the heavy rains have dropped in intensity, the community still faces challenges related to the flooding.
"Summer has helped the water level decrease, but now we are seeing more insects, rodents and dangerous reptiles from the flooding," said Laura Maria Sotelo, CFCA staff member and volunteer coordinator.
Laura also said the CFCA project is working with the community and government to manage state resources to benefit the poorest families, especially to construct decent and safe housing.


text:
Shifting the focus specifically to pharma, we might wonder if it was both the best of times and the worst of times. The industry began the decade with revenue growth close to 10 percent, and ends it with a growth rate of barely 1 percent, according to IMS Health. On the other side of the ledger, pharma's much-maligned R&D machine produced major medical breakthroughs, including the triple-drug cocktail for the global HIV epidemic and the first vaccine for cancer.
Looking ahead, the new year promises no respite from the radical disruptions pharma faces, according to the experts we spoke with. If there's one common theme, it's that market forces are mostly out of pharma's control, so the best M.O. is to go with the flow—or risk not going at all. "Globalization, healthcare reform, enabling technology, rising consumerism, and the focus on health outcomes rather than products are changing the incentives in the healthcare ecosystem," says Ernst & Young's Global Pharma Head, Carolyn Buck Luce. "And when you change the incentives, you change the system. Old players leave, new ones come in."
But not everyone is on board with this new realism. "Turning to emerging markets and buying very expensive biotech revenue streams are not strategies for long term success," says Michael Russo, partner at the Bruckner Group. "There needs to be a fundamental reset of the industry."
Over the past decade, pharma has been colonized by venture capitalists who invested in "revolutionary technology," along with advertising agencies that preached consumerism and selling Nexium Part 5, according to Russo. "The future has arrived, but the revolution has not," he notes. "We need to wrestle the industry back to making science central."
Is it possible to go back to your roots and look to the future at the same time? That and more will be required of pharma CEOs in the next decade.


text:
Prepare for winter in style with this Armani black waffle knit scarf. Crafted from wool, this knitted scarf with frayed edge is sure to be warm and comfortable in the chillier months.
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text:
Moustakas sidelined by flu for finale against Rays
ST. PETERSBURG -- Third baseman Mike Moustakas joined the growing roster of medically afflicted Royals players on Wednesday.
Moustakas was bumped from the starting lineup against the Rays because of flu.
"He was throwing up all night," manager Ned Yost said before the rubber game.
Moustakas' left-handed bat was supposed to be in the lineup against Rays right-hander Alex Cobb, but Moustakas' right-handed counterpart, Danny Valencia, took his spot.
"Moose is in the training room looking like death warmed over," Yost said.
Left fielder Alex Gordon was also scratched because of a sprained right wrist and starting pitcher Jason Vargas was in the hospital, awaiting appendix surgery.
"I heard [Vargas] was sick, then Moose came in sick and now I'm like, 'Oh, Lord, I hope this isn't an epidemic,'" Yost said. "But everybody [else] is doing OK."
Dick Kaegel is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


text:
This is a guy whose only fear, while being trapped with his wife and friends in
the midst of a horrific storm at seas, minutes away from capsizing and death,
was in not having enough Quaaludes. Okay, he was bazonkered out of his mind on
his daily over-the-top regimen of drugs and alcohol. But just the same, can you
imagine being fixated by thoughts about little pills to maintain your high (plus
being ecstatic about getting rid of the 170-foot yacht you bought on a whim and
hated) when your lifes got only about five to ten minutes left in its savings
account? Irrational? Yes. You can make a case that fright or outright panic over
your impending death might consume your thoughts.
But then again, youre not Jordan Belfort, whose audacious life-optioned for
film with Leonardo DiCaprio slated to star and Martin Scorsese to direct-was one
of stuff too crazy to be fiction.
He had a prodigious appetite for drugs and the things an endless supply of money
can do. He feared little-and why should he when he got away with everything?
From head-on car crashes, sunk yachts, and drugged-out helicopter flights where
he dozed off, to his brazen behavior in the face of the SEC, who was
investigating him for all sorts of fraudulent activities-in his very office, no
less-Belfort emerged unscathed. Either through buying his way out of problems
(money is often the best medicine for lifes ills as Belfort would readily
attest) or simply having luck as miraculous as his life, Belfort survived and
Until it all came crashing down.
In an excerpt from his fascinating book, The Wolf of Wall Street, we learn how
Belfort illegally and unethically manipulated the stock market and earned
hundreds of millions of dollars to feed his debauchery (often within the rules
of the system) through Stratton Oakmont, the brokerage firm he founded and built
up into the proverbial 800-pound gorilla.
* * *
I nodded sadly. "Dont get me wrong, Im not trying to belittle your
relationship with Steve. But were talking about eight million bucks here, on
the low side. Depending on what happens with the company, it could be ten times
that." I shrugged. "Who really knows whats gonna happen? I dont have a crystal
ball in my pocket-although I do have six Ludes there, and Ill gladly split them
with you after the market closes!" I raised my eyebrows three times in rapid
Danny smiled and gave me the thumbs-up sign. "Im in like Flynn!"
I nodded. "Anyway-in all seriousness-I will tell you that I got a really good
feeling about this one. I think this companys got a shot of hitting it out of
the park. And if it does, we have two million shares. So do the math, pal: At a
hundred bucks a share thats two hundred million bucks. And that kind of money
makes people do strange things. Not just Steve Madden."
Danny nodded and said, "I understand what youre saying, and theres no doubt
that youre the master at this stuff. But Im telling you, Steve is loyal. The
only problem is how to get that kind of money from him. Hes a slow payer as it
It was a valid point. One of the problems with ratholes was figuring out how to
generate cash without raising any red flags. It was easier said than done,
especially when the numbers went into the millions. "There are ways," I said
confidently. "We could work some of it out with some sort of consulting
contract, but if the numbers go into the tens of millions well have to consider
doing something with our Swiss accounts, although Id like to keep that under
wraps as much as possible. Anyway, the way things are going we have bigger
issues than just Steve Madden Shoes-like the fifteen other companies in the
pipeline just like Madden. And if Im having trouble trusting Steve, well, most
of the people I hardly even know."
Danny said, "Just tell me what you want me to do with Steve and Ill get it
done. But Im still telling you that you dont need to worry about him. He sings
your praises more than anyone."
I was well aware of how Steve sang my praises, perhaps too aware. The simple
fact was that I had made an investment in his company and taken eighty-five
percent in return, so what did he really owe me? In fact, unless he was the
reincarnation of Mahatma Gandhi, he had to resent me-at least somewhat-for
grabbing such a large percentage of his namesake.
And there were other things about Steve that bothered me, things that I couldnt
share with Danny-namely, that Steve had made subtle intimations to me that he
would prefer to deal directly with me than through Danny. And while I had no
doubt that Steve was simply trying to earn brownie points with me, his strategy
couldnt have been more off the mark. What it proved was that Steve was cunning
and manipulative-and, most importantly, in search of the Bigger Better Deal. If
somewhere down the line he found a Bigger Better Deal than me, all bets would be
Right now Steve needed me. But it had little to do with Stratton raising him $7
million and even less to do with the approximately $3 million Danny had made him
as his rathole. That was yesterdays news. Going forward, my hold on Steve was
based on my ability to control the price of his stock after it went public. As
Steve Maddens dominant market maker, virtually all the buying and selling would
occur within the four walls of Strattons boardroom-which would afford me the
opportunity to move the stock up and down as I saw fit. So if Steve didnt play
ball, I could literally crush the price of his stock until it was trading in
It was this very ax, in fact, that hung over the heads of all Stratton Oakmonts
investment-banking clients. And I used it to ensure that they stayed loyal to
the Stratton cause, which was: to issue me new shares, below the prevailing
market price, which I could then sell at an enormous profit, using the power of
the boardroom.
Of course, I wasnt the one whod thought up this clever game of financial
extortion. In fact, this very process was occurring at the most prestigious
firms on Wall Street-firms like Merrill Lynch and Morgan Stanley and Dean Witter
and Salomon Brothers and dozens of others-none of whom had the slightest
compunction about beating a billion-dollar company over the head if they chose
not to play ball with them.
It was ironic, I thought, how Americas finest and supposedly most legitimate
financial institutions had rigged the treasury market (Salomon Brothers);
bankrupted Orange County, California (Merrill Lynch); and ripped off grandmas
and grandpas to the tune of $300 million (Prudential-Bache). Yet they were all
still in business-still thriving, in fact, under the protection of a WASPy
Penny-stock firms were notoriously decentralized, having dozens of small offices
spread throughout the country. Yet, Stratton had only one office, which made it
easier to control the negativity that would spread throughout a sales force
after the SEC filed a lawsuit. Usually that alone was enough to force a
penny-stock firm out of business. And penny-stock firms would target
unsophisticated investors, who had little or no net worth, and convince them to
speculate with a couple of thousand dollars, at most. Stratton, on the other
hand, targeted the wealthiest investors in America, convincing them to speculate
with millions. In consequence, the SEC couldnt make their usual claim that
Strattons clients werent suitable to risk their money in speculative stocks.
But none of this had occurred to the SEC before they filed their lawsuit.
Instead, they mistakenly assumed that the bad press would be enough to drive
Stratton out of business. But with only one office to manage, it had been easy
to keep the troops motivated, and not a soul left. And it was only after the SEC
had already filed their lawsuit that they finally got around to reviewing
Strattons new-account forms and it dawned on them that all Strattons clients
were millionaires.
What I had done was uncover a murky middle ground-namely, the organized selling
of five-dollar stocks to the wealthiest one percent of Americans, as opposed to
selling penny stocks (priced under a dollar) to the other ninety-nine percent,
who had little or no net worth. There was a firm on Wall Street, DH Blair, that
had danced around the idea for more than twenty years but had never actually hit
the nail on the head. In spite of that, the firms owner, J. Morton Davis, a
savage Jew, had still made a bloody fortune in the process and was a Wall Street
But I had hit the nail on the head, and by sheer luck Id hit it at exactly the
right moment. The stock market was just beginning to recover from the Great
October Crash, and chaos capitalism still reigned supreme. The NASDAQ was coming
of age and was no longer considered the redheaded stepchild of the New York
Stock Exchange. Lightning-fast computers were appearing on every desk- sending
ones and zeroes whizzing from coast to coast-eliminating the need to be
physically located on Wall Street. It was a time of change, a time of upheaval.
And as volume on the NASDAQ soared, I, coincidentally, was embarking on an
intensive three hour-a-day training program with my young Strattonites. From out
of the smoldering ashes of the Great Crash, the investment banking firm of
Stratton Oakmont was born. And before any regulator knew what hit, it had ripped
through America with the force of an atomic bomb.
Just then an interesting thought occurred to me, and I said to Danny, "What are
those two idiots from the SEC saying today?"
"Nothing really," he replied. "Theyve been pretty quiet, talking mostly about
the cars in the parking lot, the usual shit." He shrugged. "Ill tell you, these
guys are totally fucking clueless! Its like they dont even know were doing a
deal today. Theyre still looking at trading records from 1991."
"Hmmm," I said, rubbing my chin thoughtfully. I wasnt all that surprised at
Dannys response. After all, Id been bugging the conference room for over a
month now and was gathering counterintelligence against the SEC on a daily
basis. And one of the first things Id learned about securities regulators
(besides them being completely devoid of personality) was that one hand had no
idea what the other hand was doing. While the SEC bozos in Washington, D.C.,
were signing off on the Steve Madden IPO, the SEC bozos in New York were sitting
in my conference room, entirely unaware of what was about to transpire.
"Whats the temperature in there?" I asked with great interest. Danny shrugged.
"High fifties, I think. Theyve got their coats on."
"For Chrissake, Danny! Why is it so fucking warm in there? I told you-I want to
freeze those bastards right back to Manhattan! What do I have to do, call a
fucking refrigeration guy in here to get the job done? I mean, really, Danny, I
want icicles coming out of their fucking noses! What about this dont you
Danny smiled. "Listen, JB: We can freeze em out or we can burn em out. I can
probably get one of those little kerosene heaters installed right in the
ceiling, and we can make the room so hot theyll need salt pills to stay alive.
But if we make the place too uncomfortable, they might leave, and then we wont
be able to listen to them anymore."
And as part of their long-standing practice of having their heads up their
asses, they reserved the distinguished honor of setting the price for the
opening tick for me, the Wolf of Wall Street. It was just another in a long line
of ill-conceived trading policies that were so absurd that they all but assured
that every new issue coming out on the NASDAQ would be manipulated in one way or
another, regardless of whether or not Stratton Oakmont was involved in it.
Just why the NASD had created a playing field that so clearly fucked over the
customer was something Id thought about often, and Id come to the conclusion
that it was because the NASD was a self-regulatory agency, "owned" by the very
brokerage firms themselves. (In fact, Stratton Oakmont was a member too.)
In essence, the NASDs true goal was to only appear to be on the side of the
customer and to not actually be on the side of the customer. And, in truth, they
didnt even try too hard to do that. The effort was strictly cosmetic, just
enough to avoid raising the ire of the SEC, who they were compelled to answer
So instead of allowing the natural balance between buyers and sellers to dictate
where a stock should open, they reserved that incredibly valuable right for the
lead underwriter, which in this particular case was me. I could choose whatever
price I deemed appropriate, as arbitrary and capricious as it might be. In
consequence, I decided to be very arbitrary and even more capricious, and I
opened the units at $5.50 per, which afforded me the glorious opportunity of
repurchasing my one million rathole units just there. And while I wont deny
that my ratholes would have liked to hold on to the units for a weeeee bit
longer, they had no choice in the matter. After all, the buyback had been
prearranged (a definite regulatory no-no), and they had just made a profit of
$1.50 per unit for doing nothing and risking nothing-having bought and sold the
units without even paying for the trade. And if they wanted to be included in
the next deal, they had better follow the expected protocol, which was to shut
the fuck up and say, "Thank you, Jordan!" and then lie through their teeth if
they were ever questioned by a federal or state securities regulator as to why
they sold their units so cheaply.
Either way, you really couldnt question my logic in the matter. By 1:03
p.m.-just three minutes after Id bought back my rathole units at $5.50 per-the
rest of Wall Street had already driven the units up to $18. That meant I had
locked in a profit of $12.5 million- $12.5 million! In three minutes! Id made
another million or so in investment-banking fees and stood to make another three
or four million a few days from now-when I bought back the bridge-loan units,
which were also in the hands of my ratholes. Ahhhh- ratholes! What a concept!
And Steve himself was my biggest rathole of all. He was holding 1.2 million
shares for me, the very shares NASDAQ had forced me to divest. At the current
unit price of $18 (each unit consisting of one share of common stock and two
warrants), the actual share price was $8. That meant that the shares Steve was
holding for me were now worth just under $10 million! The Wolf strikes again!
It was now up to my loyal Strattonites to sell all this inflated stock to their
clients. All this inflated stock-not just the one million units they had given
to their own clients as part of the initial public offering but also my one
million rathole units that were now being held in the firms trading account,
along with 300,000 bridge-loan units I would be buying back in a few days
then some additional stock I had to buy back from all the brokerage firms that
had pushed the units up to $18 (doing the dirty work for me). They would be
slowly selling their units back to Stratton Oakmont and locking in their own
profit. All told, by the end of the day, I would need my Strattonites to raise
approximately $30 million. That would more than cover everything, as well as
give the firms trading account a nice little cushion against any
pain-in-the-ass short-sellers, who might try to sell stock they didnt even own
(with the hopes of driving the price down so they could buy it back cheaper in
the future). Thirty million was no problem for my merry band of brokers,
especially after this mornings meeting, which had them pitching their hearts
and souls out like never before.
At this particular moment I was standing inside the firms trading room-looking
over the shoulder of my head trader, Steve Sanders. I had one eye on a bank of
computer monitors directly in front of Steve, while my other eye looked out a
plate-glass window that faced the boardroom. The pace was absolutely frenetic.
Brokers were screaming into their telephones like wild banshees. Every few
seconds a young sales assistant with a lot of blond hair and a plunging neckline
would come running up to the plate-glass window, press her breasts against it,
and slip a stack of buy tickets through a narrow slot at the bottom. Then one of
four order clerks would grab the tickets and input them into the computer
network- causing them to pop up on the proprietary trading terminal in front of
Steve, at which point he would execute them in accordance with the current
Before I left the trading room, my final instructions to Steve were that under
no circumstances was he to let the stock drop below $18. After all, I wasnt
about to shaft the rest of Wall Street after theyd been kind enough to
manipulate my stock for me.
Oh, yes, Stratton Oakmont had the power, all right. In fact, Stratton Oakmont
was the power, and I, as Strattons leader, was wired into that very power and
sat atop its pinnacle. I felt it surge through my very innards and resonate with
my heart and soul and liver and loins. With more than eight million shares
changing hands, the units had closed just below $19, up five hundred percent on
the day, making it the largest percentage gainer on the NASDAQ, the NYSE, the
AMEX, as well as any other stock exchange in the world. Yes, the world-from the
OBX exchange way up north in the frozen wasteland of Oslo, Norway, all the way
down south to the ASX exchange in the kangaroo paradise of Sydney, Australia.
Right now I was standing in the boardroom, casually leaning against my offices
plate-glass window, with my arms folded beneath my chest. It was the pose of the
mighty warrior after the fray. The mighty roar of the boardroom was still going
strong, but the tone was different now. It was less urgent, more subdued.
It was almost celebration time. I stuck my right hand in my pants pocket and did
a quick check to make sure my six Ludes hadnt fallen out or simply vanished
into thin air. Quaaludes had a way of vanishing sometimes, although it usually
had more to do with your "friends" snatching them from you-or you getting so
stoned that you took them yourself and simply didnt remember. That was the
fourth phase of a Quaalude high and, perhaps, the most dangerous: the amnesia
phase. The first phase was the tingle phase, next came the slur phase, then the
drool phase, and then, of course, the amnesia phase.
Anyway, the drug-god had been kind to me, and the Quaaludes hadnt vanished. I
took a moment to roll them around in my fingertips, which gave me an irrational
sense of joy. Then I began the process of calculating the appropriate time to
take them, which was somewhere around 4:30 p.m., I figured, twenty-five minutes
from now. That would give me fifteen minutes to hold the afternoon meeting, as
well as enough time to supervise this afternoons act of depravity, which was a
female head-shaving.
One of the young sales assistants, who was strapped for cash, had agreed to put
on a Brazilian bikini and sit down on a wooden stool at the front of the
boardroom and let us shave her head down to the skull. She had a great mane of
shimmering blond hair and a wonderful set of breasts, which had recently been
augmented to a D cup. Her reward would be $10,000 in cash, which she would use
to pay for her breast job, which shed just financed at twelve percent. So it
was a win-win situation for everyone: In six months shed have her hair back,
and shed own her D cups debt free.
I couldnt help but wonder if I shouldve allowed Danny to bring a midget into
the office. After all, what was so wrong with it? It sounded a bit off at first,
but now that Id had a little time to digest it, it didnt seem so bad.
In essence, what it really boiled down to was that the right to pick up a midget
and toss him around was just another currency due any mighty warrior, a spoil of
war, so to speak. How else was a man to measure his success if not by playing
out every one of his adolescent fantasies, regardless of how bizarre it might
be? There was definitely something to be said for that. If precocious success
brought about questionable forms of behavior, then the prudent young man should
enter each unseemly act into the debit column on his own moral balance sheet and
then offset it at some future point with an act of kindness or generosity (a
moral credit, so to speak), when he became older and wiser and more sedate.
Yet, on the other hand, we might just be depraved maniacs-a self-contained
society that had spiraled completely out of control. We Strattonites thrived on
acts of depravity. We counted on them, in fact; I mean, we needed them to
It was for this very reason that, after becoming completely desensitized to
basic acts of depravity, the powers that be (namely, me) felt compelled to form
an unofficial team of Strattonites-with Danny Porush as its proud leader-to fill
the void. The team acted like a twisted version of the Knights Templar-whose
never-ending quest to find the Holy Grail was the stuff of legend. But unlike
the Knights Templar, the Stratton knights spent their time scouring the four
corners of the earth for increasingly depraved acts, so the rest of the
Strattonites could continue to get off. It wasnt like we were heroin junkies or
anything as tawdry as that; we were unadulterated adrenaline junkies, who needed
higher and higher cliffs to dive off and shallower and shallower pools to land


text:
Steenhuysen was named the Summit League Tournament MVP as IPFW out-hit the Summit League regular season champions IUPUI .225 to zero. In addition, the Mastodons held the Jaguars to a negative attack percentage in the first two games.
The Mastodons (25-6, 12-4 Summit League) had two players finish with at least 10 kills in its championship victory. Outside attacker and the 2012 Summit League Player of Year Emily Spencer had a match-high 15 kills, while middle attacker Jessie Manwaring added 11 kills.
Libero Tessa McGill, the Summit League Defensive Player of the Year, led all players with 20 digs against IUPUI (22-10, 13-3 Summit League). McGill also had a match-high four aces in the victory.
IPFW out-blocked IUPUI 11-8 with outside attacker Hailie Ripley finishing with a match-high six blocks.
The Mastodons closed out the third game on a 13-9 run to complete the sweep — one week after IUPUI defeated IPFW in five games in the regular season finale to win the conference regular season title.
IPFW in the second game held IUPUI to a match-low attack percentage and led by as many as 13 points to take a two-game lead.
With the opening game tied at 10, McGill had two aces as part of a 7-0 IPFW run to jump start the Mastodons' 10-point win. Spencer also finished the first game leading all players with eight kills.
This is the second time in their program history that the Mastodons have won the Summit League Tournament and earned a berth to the NCAA Tournament. IPFW last appeared in NCAA Tournament in 2009 and lost to Louisville in the first round.
IPFW's first-round opponent and the entire 64-team NCAA Tournament field will be announced at 4 p.m. Sunday, Nov. 25 on ESPNU.
The NCAA tournament first-round matches will be played at 16 campus sites located around the nation Nov. 29-30.Megan Steenhuysen, IPFW (MVP)
Tessa McGill, IPFW
Emily Spencer, IPFW
Meghan Bray, Oakland
Emily Lucas, Kansas City
Kaitlyn Hickey, IUPUI
Bethany Fogler, IUPUI


text:
PAUL Starke will lead Cradley into the defence of their National League title.
Starke, from Malvern, was a big hit in his first season with the club last year and he takes over from Ashley Morris, who is no longer available for National League racing.
He admits Morris will be a hard act to follow – but he's excited by the challenge.
He said: "I'm absolutely delighted to get the chance to be captain this year, and it's a real honour.
"As a club we had a great season in 2013, so I have big shoes to fill, but if I can take over the role Ashley (Morris) did then I'll be chuffed.
"Last year we had an incredible year, so to try to emulate what we did is going to be a real challenge.
"But we look like we have a strong team, and we have a few riders who could make big strides in the sport at the moment.
"Personally I'll be looking to just help as much as I can as captain and try to score as many points as possible at No.1 to take some pressure off the lower order.
"It's nice to have some people pushing me in the team as well, with Steve Worrall and Tom Perry both capable of challenging for the No.1 race jacket as well. I want to be at No.1 all season so I'll have to be on the top of my game."


text:
By Varietal
When we go to visit my grandparents in Bellingham, Washington we go to a local cheese farm to buy cheese.
This is my first time entering in any kind of cooking contest. I am very excited and nervour at the same time. I enjoy cooking for my family and coming up with new recipes.
My love of Chinese and Asian foods and ingredients inspired this recipe.
This beef burger is combined with sauteed vegetables and wine, then topped off with a sun-dried tomato pesto and spinach leaves on a grilled onion roll.
I wanted to create a burger that had a gourmet appeal and old school burger toppings.
I love a burger with lots of ingredients, but hate the mess of trying to bite into a huge burger. I thought it would be great if every thing was on the inside!
The outskirts of Philly are teeming with country farms offering a wide range of seasonal produce. In getting into the autumn months apples and (especially) mushrooms reign supreme!
Although I prefer natural lump charcoal for its smokey flavor, there are times when I need to fire up the gas grill for convenience sake.
My middle son says at my age I need to stay mobile. I love puttering around my kitchen and backyard.
Most of my cooking at home is best by instantaneous creative efforts. Whatever we have is usually thrown together in an explosion of taste.
This burger recipe is inspired by my passion for Asian flavors and textures.
This succulant burger combines a few ingredients you don't typically find in a burger ... brown sugar, sesame seeds and cocoa powder.
Juicy big beef burgers and grilled Chanterelle mushrooms are topped with a tasty cheese fondue and then sprinkled with Chipotle Chili Barbeque spiked shallots in crusty French bread.


text:
|February 2, 2005
Volume 7, Issue 3
|Midwifery Today E-News
"Induction of Labor"
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Quote of the Week
"Midwifery is ecologically attuned, involving the wise utilization of resources and respect for the balance of nature."
— Elizabeth Davis
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The Art of Midwifery
If you watch laboring women who don't have a cheering section, they may push a little at the peak of contractions sometimes, but not every time. They are bringing a high head down. When it is time, they have an overwhelming urge to push. Get ready, because she is going to have a baby, ready or not. Not letting mom be in an upright position for fear of causing swelling, as many nurses do, may cause swelling. Try to get mom to be upright, and bargain with nurses about dilation checks. Put mom on the toilet and stall for time.
— Caudia Toms, Midwifery Today Forums
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Research to Remember
The prevalence of low birthweight in the United States showed little improvement during the data-collection period 1993 to 2002, revealing a rate of 7.7%. The prevalence is highest for black infants and lowest for Hispanic infants, when compared among racial and ethnic groups (white, black, Hispanic, Asian). Factors contributing to low birthweight other than race/ethnicity are mother's age, prepregnancy weight, weight gain during pregnancy and smoking during pregnancy.
— Centers for Disease Control
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Induction of Labor
Postdates, by itself, is not associated with poor pregnancy outcome. Extreme postdates or postdates in conjunction with poor fetal growth or developmental abnormalities does show an increased risk of stillbirth. But if growth restriction and birth defects are removed, there is no statistical increase in risk until a pregnancy reaches 42 weeks and no significant risk until past 43 weeks. The primary "evidence" of a sharp rise in stillbirth after 40 weeks—often misquoted as "double at 42 weeks and triple at 43 weeks"—seems to come from one study based on data collected in 1958 (1). ... Modern statistics show an almost flat rate of stillbirth from 40 weeks to 42, with a slight rise at 43 weeks (all numbers being close to 1/1000) (2).
There is a creeping overreaction in dealing with postdates pregnancies. It is true that stillbirth and fetal distress rates rise more sharply after 43 weeks, but it is also true that less than 10% of babies born at 43 weeks suffer from postmaturity syndrome (more than 90% show no signs). We should react to this rise by monitoring postdate pregnancies carefully and inducing if problems arise. But the rise in problems at 43 weeks does not imply a similar risk at 42 and 41 weeks. Postmaturity syndrome is a continuum. It becomes more likely as weeks progress past the due date but does not start on the due date. And the risks must be compared to the risks of interventions. Induction is not risk free. In addition to the risks of prematurity, induced labors have higher rates of cesarean section, uterine rupture, cord prolapse, meconium aspiration, fetal distress, neonatal jaundice, maternal hemorrhage and even the rare but disastrous amniotic fluid embolism.
Large studies have shown that monitoring pregnancy while waiting for spontaneous labor results in fewer cesareans without any rise in the stillbirth rate. One retrospective study of almost 1800 postterm (past 42 weeks) pregnancies with reliable dates compared this group with a matched group delivering "on time" (between 37 and 41 weeks). Perinatal mortality was similar in both groups (0.56/1000 in the postterm and 0.75/1000 in the on-time group). The rates of meconium, shoulder dystocia and cesarean were almost identical. The rates of fetal distress, instrumental delivery, and low Apgar were actually lower in the postdate group than in the on-time group (3). This is only one of several studies showing postdate pregnancies can be monitored safely until delivery or until indications arise for induction. Even the famous Canadian Multicenter Post-term Pregnancy Trial Group (Hannah) of 1700 postdates women showed no difference in perinatal outcome among women who were monitored past their due date, as compared with those who were induced at term (4).
In some studies, postterm births have shown a higher cesarean rate for suspected fetal distress. However, when a group of researchers conducted a case-matched review of nearly 300 postdates pregnancies, they concluded that the increased rate of obstetric and neonatal interventions "does not appear to be a result of underlying pathology associated with post-term pregnancy." They suggest that "a lower threshold for clinical intervention in pregnancies perceived to be 'at risk' may be a significant contributing factor." In other words, the perceived risk is greater than the actual risk and can become a self-fulfilling prophecy (5)!
When monitoring demonstrates that fetal growth, activity and amniotic fluid levels remain within expected norms, the baby can safely wait for spontaneous labor to begin. Spontaneous labor gives the greatest chance for vaginal birth, even though the baby may be slightly larger than if the mother were induced at 40 weeks.
— Excerpted from "A Timely Birth," by Gail Hart, Midwifery Today Issue 72
Labour Induction Epidemic and Autism Epidemic: Is There a Link?
There are many reasons why further studies about labour induction as a possible risk factor for autism are urgently needed. The first one is that the authors of the oldest studies included in our database came across risks associated with induction, whereas the most recent studies could not take into account this variable. "Labour induction" should be explicitly taken into consideration, because it can be associated either with birth by the vaginal route (with or without intervention such as forceps), or with caesarean birth. Another reason is that the epidemic of autism and the epidemic of induction seem to have developed side by side. Most importantly, a third reason is that the results of recent studies suggest that children with autistic disorder show alterations in their oxytocin system.
The first clues came from a study of midday blood samples from 29 autistic and 30 age-matched normal children, all prepubertal (1). It appeared that the autistic group had significantly lower blood oxytocin levels than the normal group. Oxytocin increased with age in the normal but not the autistic children. These results inspired an in-depth inquiry of the oxytocin system of autistic children. In recent years it has become clear that oxytocin can appear in the brain in several forms. There is the nonapeptide oxytocin (OT) and the "C-terminal extended peptides," which are described together as OT-X. The OT-X represent intermediates of oxytocin synthesis that accumulate due to an incomplete processing machinery. Twenty-eight male children, diagnosed with autistic disorder were compared with 31 age-matched non-psychiatric control children: there was a decrease in blood OT, an increase in OT-X and an increase in the ratio of OT-X/OT in the autistic sample, compared with control subjects (2). In other words autistic children show alterations in the oxytocin system: there are deficits in the processing machinery of oxytocin.
Such findings are of paramount importance at a time when an accumulation of data from animal studies confirm the potent effects of oxytocin (and the parent hormone vasopressin) on social behaviour, communication and rituals. Furthermore we are currently learning that oxytocin brain receptors undergo major changes during development. Among humans, the period surrounding birth is considered a period of dramatic reorganization of central oxytocin binding. We must add that, when reaching a certain degree of maturation, the oxytocin system of the fetus probably participates in the physiological initiation of labour. Artificial induction of labour in general, particularly the use of drips of synthetic oxytocin, create situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period. This fact alone is a reason for further epidemiological studies focusing on labour induction as a possible risk factor. It would be useful to know also how autistic children release oxytocin. Oxytocin is more effective when released rhythmically, in a succession of fast pulsations. Today it is not impossible to measure the rhythmicity or pulsatility of oxytocin release.
— Primal Health, by Michel Odent, MD
Order MIDWIFERY TODAY ISSUE 72.
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Forum Talk
I have been dealing with vaginal yeast infections for as long as I can remember! The only thing that ever kept them away was, back in college, to use a douche of thyme infusion combined with a few drops of tea tree oil 3 times per day for 3 weeks. I went without a problem for over a year. I am now 30 weeks pregnant and dealing with vaginal yeast (it's varied in intensity throughout the pregnancy) and I want to know if this same douche would be safe to use while pregnant? Also I am still nursing my toddler. I am so sick of the itching!
— Anon.
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Question of the Week
Q: I recently had a c-section for twins because twin A was a footling breech. Unfortunately, I had to be put under general anesthesia because my platelet levels were too low to safely have an epidural. Is there any sort of homeopathic or herbal remedy that I might try to build up my platelets? My platelets generally are around 70 and have been that way for years, with 50 being the point where treatment is needed, but 100 is the cutoff to get an epidural. When I have another child, I would like to have a VBAC, but if it doesn't work, I don't want to have to be knocked out again.
SEND YOUR RESPONSE to firstname.lastname@example.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message. Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
It has been my experience that preterm labor is a cry for help—a cry from the baby or a cry from the mother. Sometimes a woman is doing too much, and the baby shouts, "Hey mom, take a rest!" In these situations, bed rest is probably a good idea.
But I feel the most important thing we are missing in these cries for help is the absolute necessity for the mom and baby to be pampered. Pregnant women should be treated with the utmost respect and valued for the incredible job they are doing growing their babies. Our culture doesn't recognize this, sadly. Pregnant women should receive the highest quality and most delicious foods—especially towards the end of pregnancy. Massage should be a weekly routine, as well as competent, woman-centered prenatal care (which I think includes care with a chiropractor and/or a cranial sacral therapist). Her dreams should be listened to and her fears addressed.
Where can women get this type of care? Doula? Grandma? Sister? Partner? Neighbors? Friends? Co-workers? The answer is, all of these people. Our society has a duty to its future citizens to create an environment that fosters optimal growth.
Besides the fact that tocolytics have many side effects, the worse thing they offer is a false sense of security. I am not judging women who have taken them to stop preterm labor. What I mean is, the idea that a pill will fix a problem like this is insulting to the woman, and most importantly, ignores the real reason for the cry. It covers up the issue instead of getting to the root of it.
— Ruth Trode, Minneapolis, MN
Editor's Apology: As the result of an e-mail address malfunction, letters to E-News bounced back to their senders during the month of January. If you have written to E-News after January 1 and have received your correspondence back, please try again! The problem is fixed, and we greatly look forward to hearing from you!
I was stunned to see this in the Art of Midwifery section from Gloria Lemay [Issue 7:2]:
"One of the reasons we have so much interference in North American birth right now is that young women are overly dramatic."
I would like to know what evidence Gloria has regarding this statement. This sounds like unsubstantiated opinion and mother-blaming to me. I am disappointed that you published this and spread it further. What were you and Gloria thinking?
— With respect and surprise,
The author replies:
Of course, there are no randomized controlled trials on drama in young women. All one has to do is turn on the TV or sit in a booth at an after school coffee shop. Perhaps young women have always been dramatic, but there were older women to tone them down and teach them priorities, conduct and smart behaviour. Maybe it's not the young women being dramatic but the older women abdicating their responsibility to show them the way. I actually have no idea what is creating this jabbering din in the world but I do know that it doesn't help to have a smooth birth at all, and the evidence I have that things are not working is the 28% nationwide c-section rate. "Being nice and politically correct is not helping one bit either." One of my favourite expressions is "The truth shall set you free, but first it will make you mad."
— Gloria
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Midwifery Today: Each One Teach One!


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Cambodia Trips
Cambodia is perhaps the most beguiling of all the countries of South-east Asia. Long associated with the brutal Khmer Rouge, the country has risen above its blood-tinted history to finally take its place as one of the region's pre-eminent tourist destinations. Home to a truly rich mix of travel experiences from ancient monuments and powdery beaches to remote ethnic minority villages and city life, Cambodia never fails to excite the senses. And, for most visitors, Cambodia's tranquil and, dare one say it, timeless way of life is its greatest appeal.
Ancient Cambodia produced one of world's greatest civilizations at Angkor. Renowned Angkor Wat is the largest religious monument in the world but is merely one temple lying at the heart of a thousand others.
An enormous and elaborately detailed complex, this ancient temple city has remained the heart and soul of Cambodia for almost two millennia. And, despite its popularity with ever-growing throngs of visitors, this is still a historical site that exceeds expectation. Included in the gargantuan complex lie legions of magical temples which attest to the ability of bygone artisans, from the intricate Banteay Srei, with its detailed carvings to the beaming faces of the Bayon. Visitors also flock to jungle-clad Ta Prohm, where tentacle-like foliage entwined around the temple provides an insight into how the whole site must have looked when it was first explored by Western adventurers in the 19th century.Â
The town of Siem Reap has graduated from being Angkor's service centre to become an international hotspot, teeming with modern restaurants and upmarket hotels. Fortunately, the settlement still retains much of its original charm, with old colonial shop fronts, misty lamp-lit streets and a bustling market area. It also offers access to the floating villages on the Tonlé Sap, the largest freshwater lake in South-east Asia.
In the south, Cambodia's capital, Phnom Penh, may not be the most sophisticated metropolis, but it is a charming, bustling town, with a good selection of early 20th-century modernist architecture, a strong sense of history and delightful restaurants and bars. What's more, it offers the sort of cityscape most travellers dream of: a skyline punctuated by royal and religious spires, turrets and pinnacles rather than by office blocks. The Royal Palace and Silver Pagoda are the highlights of the capital and provide a welcome counterpoint to unavoidable reminders of Khmer Rouge atrocities.
Places of interest in Cambodia
It is not hard to imagine Phnom Penh in its heyday, with wide shady boulevards, beautiful French buildings and...
The nearest town to Angkor, Siem Reap is a bustling tourist hub that has developed substantially in the past few...
Activities in Cambodia
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Hello and welcome! This is a group for Brits, family, friends, anglophiles, brit-curious and generally anyone who might occasionally get the urge to have a natter with some friendly sorts, maybe over a cuppa, who knows. Sign up and come meet up!
The groups needs a few more assistant organisers to set up the regular events. Please let me know if you are willing to host even just 1-2 events per year.
We try to have monthly events at the various Brit-related eastablishments around Seattle including the G&D, Three Lions, Elephant & Castle, Atlantic Crossing, Bengal Tiger, India Express to name but a few. Even if you don't want to be an assistant organiser, but would be willing to host a single event, please get in touch!
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Hicks to begin rehab stint today at Double-A
BOSTON -- Center fielder Aaron Hicks is set to begin a rehab assignment with Double-A New Britain on Wednesday, the Twins announced.
Hicks was placed on the 15-day disabled list Friday, retroactive to June 10, with a right shoulder strain. It came after he flew to Minnesota to have his shoulder checked out by team doctors Thursday.
He originally injured his shoulder while making a diving catch in center June 7. He served as a pinch-runner June 9, but the injury limited his ability to throw.
"We've talked about it and he's going to play center field, but also play in the corners," Twins assistant general manager Rob Antony said.
There's a good chance Hicks could remain in the Minors once his rehab stint is over, as the Twins want him to continue getting experience batting from the right side against right-handers now that he's dropped switch-hitting.
Rhett Bollinger is a reporter for MLB.com. Read his blog, Bollinger Beat, and follow him on Twitter @RhettBollinger. This story was not subject to the approval of Major League Baseball or its clubs.


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Keep kids learning
Worried your kid forgets everything they've learnt when not at school? Here's how to keep their brain sharp. more
Head lice and their removal has become one of the hottest topics in the playground. Along with the overwhelmingly large number of products available, talk to any group of mums and you'll find that almost every one of them will have some homebrew remedy.
If you're new to the lice game, try a range of products and settle on something that you're comfortable with.
There are a number of strong chemical products on the market. These seem to appeal and revolt parents in equal numbers. While some don't like the idea of strong chemicals in such close contact with their child's skin, others find it reassuring for the very same reason - if there's chemicals involved, they must be doing a thorough job.
Also available are natural products based on essential oils and pyrethrin, which smell a lot better than the chemical-based products. Because these products aren't as strong as the chemical-based ones, they usually need to be left in the hair longer to take effect.
Like all good homebrew recipes, everyone has a different one that they swear by. Mostly though, they are made up of things that you could find in the kitchen or bathroom. Almost all are bulked out with thick conditioner. Popular recipes usually include: tea-tree oil, eucalyptus oil, vinegar, olive oil, orange oil, lavender oil.
Regular combing is the key to keeping lice under control. Apply a thick, white conditioner (it makes it easier to see the nits and lice against white) and using a nit comb, section the hair and carefully comb, wiping each comb-full of conditioner, nits and lice onto a paper towel. Keep combing until you can't see any more eggs or lice in the conditioner. Repeat after seven days.
Thoroughly douse your child's hair with vinegar and leave for 15 minutes to allow the vinegar to kill the lice. Apply the white conditioner treatment.
During an infestation of nits, spray your child's hair with hairspray, or comb through hair gel to make it more difficult for the lice to attach to their hair shafts.
Last revised: Friday, 20 June 2008
This article contains general information only and is not intended to replace advice from a qualified health professional.


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THE Chippenham Open Monday Evening match produced a close finish as Kevin Williams scooped top prize with 7 lb 5 of roach.
He was just clear of Gary Etheridge, from Devizes, with 7 lb 2 oz of roach, perch and skimmers, with Kevin Rowles, from Devizes, third with 5 lb 12 oz of roach and perch.
Other placings: 4. Ian Liddell Chippenham 5 lb 5 oz; 5. Steve Palmer Chippenham 5 lb 4 oz; 6. Alex Hyde Chippenham 5 lb 2 oz.
APART from the winner, weights were even in the Trowbridge Seniors Tuesday match at Ivy House Fishery.
Jim Escott, from Melksham, had a great day to take top honours with 50 lb 10 oz of carp and skimmers.
Some way adrift in second was Ken Gingell, from Trowbridge, with 15 lb 10 oz of carp and skimmers.
Roger Green, from Trowbridge, was third with 15 lb 6 oz of roach and skimmers.
Other placings: 4. Pete Craig Devizes 15 lb 1 oz; 5. Ernie Jones Trowbridge 13 lb 12 oz; 6. Gordon Hayward Lavington 13 lb 9 oz.
COMPETITORS struggled to find fish in the Calne Tuesday Evening match at Hazeland where Martin Dolman, from Calne, took top spot with 3 lb 3 oz of tench and roach.
Brian Johnson, from Calne, was runner up with 2 lb 12 oz of roach and dace, followed by Simon Fear, from Calne, with 1 lb 11 oz of roach and dace.
Other placings: 4. Gary Dodson Calne 12 oz; 5. James Yates Calne 4 oz; 6. Tim Carr Calne 2 oz.
THE Trowbridge Wednesday Evening Open match on the Bristol Avon at Staverton was won by Pete Zymiak, from Trowbridge, with 10 lb 9 oz of perch and eels.
Pete Wilkinson, from Chippenham, was runner up with 5 lb 5 oz of roach and Gerald Lugg, from Beckington, third with 4 lb 4 oz of perch.
Other placings: 4. Jeff Matthew Trowbridge 3 lb 12 oz; 5. Gary Etheridge Devizes 3 lb 11 oz; 6. Pete Mills Devizes 2 lb 14 oz.
THERE was mixed sport in the Thursday Evening Wilts Angling Open match at Rood Ashton, where Tony Gilbert, from Melksham, won with 64 lb of carp.
Terry Fell, from Devizes, took runner up spot with 30 lb of carp, with Bill Gilbert, from Melksham, next with 22 lb and Ben Ludwell, from Ashton, fourth with 20 lb 8 oz of carp.
THE Bristol Avon at Whaddon was in sparkling form for Saturday's Avon SCC match, which was won by Pete Townsend, from Swindon, with 33 lb 3 oz of bream.
Alan Hiller, from Westbury, took runner up spot with 24 lb 5 oz of bream, roach and perch.
Other placings: 3. LGB O'Neil, Melksham, 22 lb 13 oz; 4. Marcus Crook Melksham 22 lb 2 oz; 5. Ian Stainer Trowbridge 14 lb 0 oz; 6. Brian Haigh Melksham 9 lb 4 oz.
SUNDAY'S Devizes match at Crookwood Lake was won by Matt Skyrme, from Trowbridge, with 6 lb 15 oz of bream and skimmers.
Pete Neate, from Holt, was runner up with 5 lb 5 oz of tench and skimmers, with Pete Craig, from Devizes, third with 3 lb 14 oz of roach and skimmers.
Other placings: 4. Neil Hounsell Trowbridge 3 lb 10 oz; 5. Dean Adams Bradford 2 lb 14 oz.
SUNDAY'S Calne match on the Bristol Avon at Christian Malford was won by Simon Fear, from Calne, with 7 lb 3 oz 8 dm of roach.
Calne's Andy Trudgian and Simon Knotman tied for runner up prize with 4 lb 13 oz.
Other placings: 4. Nigel Smith Calne 4 lb 10 oz; 5. Martin Dolman Calne 4 lb; 6. Will Tapper Calne 2 lb 10 oz.
THE Sunday Airsprung match at Leech Pool was won by Tom Ince, from Trowbridge, with 90 lb of carp.
Richard Whitmarsh, from Frome, was runner up with 48 lb 4 oz of carp, with Kevin Hanson, from Trowbridge, third with 47 lb of carp.
Other placings: 4. Andy Fox Trowbridge 39 lb 14 oz; 6. Craig Knight Trowbridge & Tim Martin Frome 35 lb 12 oz each.
Future events
Saturday July 26: Chippenham Open match at Chippenham; Avon SCC match at Whaddon.
Sunday July 27: Lavington match at Baldham Mill; Airsprung match at Cuckoos Rest.
Tuesday July 29: Trowbridge Seniors match at Pockeridge.
Wednesday July 29: Trowbridge Open match at Staverton.
Thursday July 31: Bathampton Over 55s/Disabled match at Withy Pool.


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Truck Masters Final 2005 - 13th Annual Japanese Custom Truck Show
Mini Truckin' Draggin In Japan
The 13th Annual Truck Masters Final was the perfect way to bust out big with our very first full issue dedicated to worldwide mini-truck coverage. This huge truck-only show took place at the Sagami-ko Picnic Land in Kanagawa-ken, Japan, on Nov. 6th, 2005, and brought out nearly 500 custom trucks and more than 3,500 spectators. This giant truck show is organized by Blue Panic (www.bluepanic.jp - Good luck reading it!) and continues to be one of the world's finest "custom-truck only" shows. Even the very first Truck Masters, which was held thirteen years ago, was a huge success, bringing out more than 200 of Japan's finest custom trucks, and the show has only gotten bigger and better year after year. For the first ten years, Blue Panic only held one Truck Masters show a year, but in 2002 Mr. Kaneko, President of Blue Panic, decided to spread the show and wanted to hold it all over Japan for the 10th anniversary of the show. In 2002 Truck Masters spread to Osaka, Sendai, and Kanagawa. In 2005 the show took place in Kyusyu, Osaka, Sendai, and Kanagawa (which is the largest of the four and the one we covered).
Truck Masters is known as "The Mecca of all truckers" because it has been open to all trucks and truck fans since it began way back in 1993. In Japan (as well as here in the States) 95% of shows are not geared towards just the truck enthusiast, and there are almost no "truck only" shows. This makes Truck Masters very respected as the biggest truck show in Japan. Now Japanese truck guys all around Japan can enjoy the show because Blue Panic holds the show four times a year: the South=Kyusyu, the West=Osaka, the North=Sendai, and the East=Kanagawa (final). The final round is known as a "must-see event," so many trucks attend no matter how far away they live. This year there were over 350 minis (which is one of the largest turnouts of mini-trucks anywhere in the world).
Getting to see a completely different side to the custom mini-truck world is awe-inspiring! We had to bring it to you first-hand so that you could see how much our lifestyle has affected so many cultures around the globe! It's amazing to see something that started in the garages of America could become something that can bring the world together and unite quite a few cultures under one family banner: mini-truckin'! This year, in 2006, Blue Panic will add a far north Hokkaido round on their calendar, so there will be 5 shows, with the final being held on Nov. 12th, 2006. Look for more coverage from our Far East mini-truck brothers in Japan each and every year!


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First DateLogic puzzles require you to think. You will have to be logical in your reasoning.
Six couples at a party were talking about where they met and what they did on their first date. However, at the end of the night all the items were in the correct column, but only one item was in the correct row. Find the correct husband and wife, where they met, and what they did for their first date.
Husband Wife Met Date
Mike Kenya High School Dance
Tommy Kristin College Boating
Daniel Casey Blind-date Riding
Quentin Rose Work Concert
Aaron Daisy Neighbors Play
Henry Janet Class Skating
1- Quentin is one place above Janet.
2- Boating is one place below Kristin, but one above Daniel.
3- Work was two places below Tommy, but three places below Casey.
4-Tommy is not adjacent to Aaron.
5- Blind-date is one place below Play.
6- Aaron is one place above Skating but two below High School.
7- Kenya is one place above Concert but three above Neighbors.
AnswerHusband Wife Met Date
Henry Kenya College Play
Quentin Casey Blind-date Concert
Tommy Janet High School Dance
Mike Kristin Neighbors Riding
Aaron Rose Work Boating
Daniel Daisy Class Skating
What Next?
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Barmes effusive with praise for Sanchez
DETROIT -- Clint Barmes admits having been spoiled by all the seasons he spent in Colorado making his throws from shortstop to three-time Gold Glove-winning first baseman Todd Helton.
"With Helton I knew if I had to rush a throw, all I had to do was throw it hard at his feet. If the ball was close to him, he'd get it," said Barmes, who is finding the same security in Gaby Sanchez.
Garrett Jones, the Bucs' other frequent first baseman, can pick it himself. In particular, Jones made two terrific digs of throws in the dirt by third baseman Pedro Alvarez on difficult plays during a 1-0 victory over the Cubs last Wednesday.
But Sanchez has stood out during this road trip by repeatedly scooping up low throws from shortstop. Barmes owes his error-free trip to Sanchez's quick hands.
"He definitely has great hands," Barmes said. "He's saved me a ton of times this season. It's so important to have someone so solid at the position. He makes you relax, and gives you confidence when you have to make a play in a hurry."
Tom Singer is a reporter for MLB.com and writes an MLBlog Change for a Nickel. He can also be found on Twitter @Tom_Singer. This story was not subject to the approval of Major League Baseball or its clubs.