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'I was born three weeks late – and I've been catching up ever since'. By Mark Palmer
It was on the way to Bra, where Slow Food was launched in a small restaurant on a Saturday afternoon in 1986, that I decided to change the habit of a lifetime. Or, rather, it was after finally reaching Bra and eating in that same restaurant that I tried to implement some changes that might just bring me more in line with the principles of Slow.
My wife and I had left London at 7.30am and were due to rendezvous with one of Gatwick Airport's meet-and-greet parking people at 8.30am, leaving enough time to check in for our 9.50am flight. Well, just enough time and certainly more than enough for someone who had always regarded arriving early at an airport as tantamount to weakness.
The parking man didn't turn up. We missed our flight and there was no other direct service to Genoa for 24 hours. It happened to be our wedding anniversary and my wife's birthday. Because it was the Friday of a bank holiday weekend there were no seats on flights to Turin, Milan or Pisa. I even tried Rome and Nice.
If my wife had said: "Less haste and more speed" at that moment, I think I might have done something silly and found myself on the British Airways blacklist.
Instead, I told her to get into the car because we were off to London City Airport to catch an Air France flight to Paris Orly that was leaving in just over an hour. It would need a 100mph dash around the M25. On arrival in France, we would take a high-speed taxi to Paris Charles de Gaulle in the hope of boarding a 5pm flight to Genoa, which would only be possible if the plane was delayed.
The irony of that mad dash (we made it and dinner was delicious, if a little fractious) was not lost on either of us - researching a story about the Slow movement while almost spinning off the metaphorical track. And it required something of an explanation on my part.
I was born three weeks late and I feel I've been trying to catch up ever since. On the whole, rushing has served me well. It has got things done. But the moment had come to change tack. You can take statins to thin the blood but there's no pill for the virus of speed. When I went to see Carl Honoré he made a number of suggestions. He said it might be helpful to make a list of things that need to be done, write them down in order of priority and then cut from the bottom. He thought it wise to keep an eye on the speedometer. Are you going fast because you need to be going fast? Or because your foot is stuck on the accelerator?
My meeting with Satish Kumar was instructive. I arrived late, hot and bothered. He arrived early, calm and collected. Later, he told me that he always aims to arrive 10 minutes early for everything and that he uses that time to sit and think. This struck a chord because it used to bother me when I saw people on the train, bus or Tube just staring out of the window. Why weren't they reading? Or doing the crossword? Or texting a friend? But now I'm not so sure.
I love sport. I work out, furiously but obviously not effectively because my waist measurement has been going up an inch every two years. So I joined a Pilates class and am now a paid-up member of the less-is-more exercise fraternity because the belt on my trousers has already tightened a notch. And when it comes to weights, the Super Slow people in America will tell you that to get maximum benefit, you should take 20 seconds to lift and lower a weight, compared with the normal six seconds. What this slowness does is eliminate momentum, forcing the muscles to work harder.
I hate emptying the dishwasher. A pre-nup for my second marriage would have exempted me from ever having to do it. But I do it now because I perform the task slowly and, dare I say it, piously. It's no longer just a chore but a meditative ritual that slows me down but strengthens the resolve. But maybe it's best to leave all of this in the capable hands of a 14th-century English proverb, which said with such obvious clarity: Time is a great healer. MP


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Theodore Earl Carter, 71, of Homerville, passed away Wednesday, January 9, 2013, at Lodi Community Hospital. Mr. Carter was born January 22, 1941, in Lodi, to Theodore Ralph Carter and Gertrude Brinker.
He was a resident of Homerville, Medina County, most of his life, owning Tender Care Landscaping. Mr. Carter served with the U.S. Navy, coached softball, and baseball, and loved hunting and fishing.
Mr. Carter has been married 47 years to Barbara Plank, who survives. Also surviving are children, Steven Carter of Barnesville, and Royanna Jordan of New London; one grandson, Tyler Jordan of New London; two sisters, Rebecca Farnsworth of Malvern, and Dora Hinkle of Mansfield; four brothers, Robert (Terri) Carter of West Salem, John (Kathy) Carter of Ashland, David Gray of Ashland, and George (Linda) Gray of West Salem; and a sister-in-law, Gladys Carter of Ashland.
Mr. Carter was preceded in death by his parents, Theodore Carter and Gertrude Gray; brothers, Kenneth Carter, Gary Gray; brother-in-law, Robert Farnsworth; and sister-in-law, Mae Gray.
The family will have visitation Monday evening, January 14, 2013, from 5 until 7 P.M., at Heyl Funeral Home, 227 Broad St., Ashland, with John Carter conducting a service at 7 P.M., at the funeral home. The Ashland Veterans Honor Guard, will present military honors also, at 7 P.M.
An online register book is available for family and friends to express condolences at www.heylfuneralhome.com

subset: commoncrawl


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Daimler 1897 veteran car photo images.
Car information and facts: The different car galleries have a great variety of knockout car photo images. Luxury eco friendly cars are the BMW 730 D, Audi A8 2.8FSI, Mercedes Benz S 320 CDi, Jaguar XJ6 2.7 D, Lexus LS600h. Classic car photos include the famous E-Type Jaguar and Aston Martin DB5 There are many car photos in this car site that are suitable for use as car wallpaper such as this Daimler 1897.
This car picture of the vintage Daimler 1897 is copyright to autovehicle.org.uk
The vintage Daimler 1897 car photo image is free to use for non-commercial use only, subject to terms and conditions
Great car photo images of all types of automobiles from used, sports, luxury, classic, vintage and old cars
This colourful car photo image of the vintage Daimler 1897 would make a great image for a website
Free pictures of automobiles, there are many knockout images on this site that are for non-commercial use only. If you wish to use a picture such as the Daimler 1897 from this site then please read the terms of use. For more information read the copyright page.


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Mickey expected to join parade
NEW YORK Organizers of the 74th annual Macy's Thanksgiving Parade are hoping high winds won't ground Mickey Mouse and his friends.
A brand new Mickey Mouse balloon, the star of this year's holiday parade, and three other towering entries Cassie of the PBS series "Dragon Tales," the Internet butler Jeeves and Ronald McDonald are scheduled to make their debuts on Thursday.
But if wind speed exceeds 23 mph or gusts are stronger than 34 mph, the balloons won't be allowed to lift off. The guidelines were adopted after a 1997 accident that left a parade spectator comatose for 24 days.
The National Weather Service was predicting winds of 15 to 20 mph close enough to the limit to ensure that a final decision on the balloons won't be made until Thursday morning.
Weather permitting, the parade will mark the first appearance by Mickey Mouse since 1982. He will be joined by 13 other helium-filled characters.
Ex-con arrested for boy's murder
FREDERICK, Md. A 9-year-old boy whose naked body was found in a baseball field dugout was beaten, strangled and sexually assaulted, police said Wednesday.
A mentally retarded homeless man with a history of sexual offenses was charged with first-degree murder in the death of Christopher Ausherman. The suspect, Elmer Spencer Jr., had been released from prison less than a week before the killing.
Spencer, 44, was arrested at a homeless shelter Monday night. He had been released from prison after serving about four years of a 10-year sentence for assaulting a woman and escaping from the arresting officer.
Spencer, who was on probation, had served two previous prison terms for child sexual assault and battery convictions, according to court documents. His record also includes charges of sexually assaulting a 7-year-old girl in 1996 and assaulting, with intent to murder, an 8-year-old boy in 1995. Both cases were dropped.
Leonard Sipes, a spokesman for the state corrections department, said Spencer was released early from his latest prison term because of good behavior credits accrued over the 13 years he served on a 22-year sentence for sexually assaulting a child in 1981.
Police said Spencer was tracked down through an acquaintance who identified him as the man seen with the boy in surveillance videotapes taken at two convenience stores.
Judge allows woman holiday home
EDWARDSVILLE, Ill. A woman jailed for more than a year after ignoring court-ordered visits between her daughter and her dead husband's mother will get to spend Thanksgiving at home.
Julie Mehring, of Columbia, will be free Thursday and Friday by order of Madison County Associate Judge Barbara Crowder.
Mehring was first jailed Nov. 17, 1999, after defying a court order allowing visits between her 8-year-old daughter, Jenna, and the girl's paternal grandmother. She contends Ella Mehring has played no role in Jenna's upbringing and should not be allowed visits over her objections.
"I'm elated that I'll have Thanksgiving with my family," Mehring said. "Jenna will definitely be happy."
In January, Crowder ordered Mehring to remain at home on evenings and weekends for Jenna's sake. She is the county's only daytime prisoner.
Mehring filed for divorce from Michael Mehring in 1996. He died of congestive heart failure at 39, before the divorce was final.
A hearing on whether she should be freed while awaiting the case's outcome was set for Dec. 8.
Compiled from wire reports
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Whether you are celebrating her birthday, graduation or another milestone event this lovely ID bracelet will be a hit. Featuring a beautiful double leather cord design, this sleek bracelet can be personalized.


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Opinion Noun Synonyms: belief, judgment, thought, sentiment, (point of) view, viewpoint, conviction, way of thinking, perception, idea, impression, notion, conception, theory, id'e re‡u, mind
Health / Disease / Plague Of Justinian: (541-542) The Plague of Justinian was a pandemic that afflicted the Byzantine Empire, including its capital Constantinople, in the years 541–542 AD. It has been speculated that this pandemic was cau MORE
Entertainment / Literature / Place Of Articulation: The point in the oral cavity where the position of speech organs (lips, teeth, tongue, etc.) Is most important for a particular sound. MORE
Business / Finance / Pie Model Of Capital Structure: A model of the debt-equity ratio of the firms, graphically depicted in slices of a pie that represent the value of the firm in the capital markets. MORE
Entertainment / Football / Picked Off: Intercepted. MORE
Business / Agriculture / Plant Variety Protection Act Of 1970: P.L. 91-577 (December 24, 1970) was enacted to provide patent-like protection for new non-hybrid seed varieties. The ultimate goal was to create an incentive for public and private research on new com MORE
Life Style / Painting / Plaster Of Paris: A quick setting, pure white powder, used to set bathroom wall fixtures such as towel racks or used by craft groups for pouring molds and making plaster objects. MORE


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On Father's Day, Obama attends daughter's recital
President Obama spent part of his Father's Day attending a dance performance by his younger daughter, Sasha.
The Washington Times' political blog.
President Obama spent part of his Father's Day attending a dance performance by his younger daughter, Sasha.
There's a big difference between God's and the world's standard of perfection, Sarah Palin, her voice cracking with emotion, told a Faith & Freedom Coalition audience in Washington on Saturday.
A Florida congressman said Friday he is "fed up" with the U.S. government's extensive spy programs, arguing he can't even call his own mother without federal agents having a record of it.
First lady Michelle Obama and daughters Sasha and Malia will accompany President Obama on his trip next week to Northern Ireland and Germany, the White House announced Friday.
House Democrats enjoyed the spoils of victory on Friday after shutting out the Republicans, 22-0, at Nationals Park late Thursday in Congress' annual baseball game for charity.
Two Democratic senators who have been critical of the U.S. government's recently disclosed surveillance programs will file legislation that would limit the government's ability to collect data on Americans if it can not show a demonstrated link to terrorism or espionage.
Sen. Ron Johnson said Friday the Obama administration's new offer to assist Syrian rebels fighting the Assad regime may be "too little, too late."
Former President Bill Clinton said reports the United States will intervene in the Syrian conflict, based on evidence the regime used chemical weapons against the rebels, show the debate over American involvement "is trending in the right direction now."
A new poll shows about nine in 10 American lesbian, gay, bisexual and transgender adults say society has become more accepting of them in the past decade.
Lawmakers in Arizona have approved Gov. Jan Brewer's plan to expand Medicaid access under President Obama's health care law, capping a months-long battle between the conservative governor and members of her own party.
As Congress spars over what types of health care coverage to extend to illegal immigrants, a new report Thursday says immigrants overall are less likely than native-born Americans to go to the doctor or show up in the emergency room.
Washington's non-voting member of Congress on Thursday asked the National Park Service to ban smoking on all of its property in the city, including the National Mall and trails such as Rock Creek Park.
Sen. Marco Rubio said Thursday that if Democrats expand his immigration bill to extend benefits to gay spouses, he'll have to scuttle the legislation.
President Obama on Thursday will meet with key Democratic senators to discuss the ongoing push for immigration reform, his spokesman said.
House Speaker John A. Boehner released a video on Thursday that previews the dedication of abolitionist leader Frederick Douglass' statue next week at the Capitol Visitor Center.
© Copyright 2017 The Washington Times, LLC
3600 New York Avenue NE, Washington, DC 20002


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Homer nodded; Shakespeare gave Bohemia a seacoast; Michelangelo painted Adam with a navel. Last week the august New York Times slipped and fell. Readers of the Times read a pathetic story about a deer, frightened, running for its life through the streets of Brooklyn. Circumstantial was the Times reporter. Said he: "The wanderer was not a large deer, as deer go. It had a manner that plainly showed it expected very little from life", According to the Times, the deer was small, had no antlers. The story spoke of children and Santa Claus. The deer's fate was tragic; a policeman encountered...
The Press: Queer Deer
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I have a 2000 Civic DX with 110 000 hwy miles on it. I has recently developed some transmission noises. The first I know is the throwout bearing, it's noisy when It sits in neutral until I push the clutch pedal in, and the noise returns as soon as I release it.
In addition to that the transmission is very noisy, it is noticeable at all rpm ranges and gears but seems worst at slow speeds in first and second gears. It goes away if the clutch pedal is depressed, but when the clutch is in I still here a faint clicking sound, that I am pretty positive is NOT from the CV joints.
I have been told many different things, from shims between syncros making the clicking noise, to worn syncros, to internal bearing wear, and even that the throwout bearing may be responsible for everything.
Any help is aprreciated,
have the same problem?
Sunday, March 26th, 2006 AT 6:56 AM


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Imagine Greater Tucson launched on Thursday with a kickoff celebration at Hi Corbett Field during the Oktoberfest festivities.
What is Imagine Greater Tucson? It is a community-based effort bringing together citizens, businesses, organizations and regional leaders to share values and work together to create a common vision and action plan for the future of the Tucson region.
A diverse group of approximately 200 people attended the kickoff event and filled out cards to share what they valued about the greater Tucson region. Some of those values included:
• Outdoor recreational opportunities
• Family
• Inclusion
• Cultural diversity
This fall, beginning with a booth at Tucson Meet Yourself, Friday through Sunday, we will participate in various community events and festivals to learn what you value. Collecting your values is our first step. We will further validate your values at community conversations and find out what you would like to see different or improved in the greater Tucson area that one day could impact the quality of life of future generations.
We will then build a baseline future scenario to show us what our region will look like if we continue to make decisions as we are today. Using your values, we will build alternative future scenarios and build a vision to help shape our future after you help select a preferred scenario to implement.
We invite you to visit our website at imaginegreatertucson.org to take an online survey or learn more about the events where we will have a table or booth and how you can help. Also, stay tuned to learn more about the upcoming community conversations in your neighborhoods throughout the region.
What's different about this process is its grassroots nature, involving citizens, businesses, nonprofits, government and any other organization that wants to participate. In other words, it's an open-ended process and we want you to be at the table.
The success of Imagine Greater Tucson over this 18-24 month process will solely be dependent on your voice to provide us with direction.
We believe that the outcome of Imagine Greater Tucson will lead to better decision-making with everyone coming to a better understanding of how we want to shape our future.
Our initial efforts are supported through public and private funding sources, both cash and in-kind. Pima Association of Governments provided seed funding of $500,000 through a federal planning grant, which can only be used for the planning/research process and does not take away from any designated road project work or transit services. The PAG grant requires a 20 percent match from the community through private funds.
In addition to many small and in-kind contributions, the Brown Foundation has provided us with $25,000 and Tucson Young Professionals provided a $20,000 challenge to encourage others to match their funding level.
As strategies are identified, they may be implemented as part of existing planning activities or we expect champions will arise through this process to support specific items identified in the preferred future scenario.
Other regions across the country have been engaged in such efforts for more than a decade. These regions have witnessed great success with improvements in sustainable living, new infrastructure and preservation of key environmental areas. Other funding sources they have used include grants and legislative appropriations.
By establishing a vision and action plan, we will put ourselves in a better position to leverage grants or legislative appropriations as well as to help local leaders prioritize use of money based on our shared vision.
This is your opportunity to help shape our future. We hope to see you soon.
Eileen Fagan is director of Imagine Greater Tucson. She may be contacted at email@example.com


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Guide To Medieval and Renaissance Manuscripts in the Huntington Library
View all images for this manuscript
REGISTER OF WRITS, fragmentff. 1-8v: Register of writs, beginning with a writ of right dated 26 November, 25 Henry [VI], 1447 brought by John Shirland against William Asthill for a messuage in "N.," and ending defectively with a Recordari addressed to the council of Dover castle. Parchment, ff. 8; 275 × 195 (195 × 130) mm. 18, signed "a iiii" on f. 4 and with a catchword on f. 8. 39 long lines, ruled in ink with an additional set of double rules in the 3 outer margins. Written in a secretary script with anglicana forms. 8-line gold initial on a particolored blue and maroon ground with white patterning; from the initial, a black ink spray with green leaves and gold trefoils; alternating red and blue paragraph marks. Running headline on all leaves, "capitulum primum." Contemporary foliation, i-viii. Bound, s. XIX, in Middle Hill blue pasteboards. Written in England in the second half of the fifteenth century. In the lower margin of f. 1, in a textura hand in blue ink with a red initial, the name "Folbery," possibly the Robert Folbery/Fulberry of Newcastle (1420-85) admitted to Lincoln's Inn in 1443-44; see J. C. Wedgwood and A. D. Holt, History of Parliament, Biographies…1439-1509 (London 1936) 343. Belonged to Sir Thomas Phillipps; his n. 11002. Phillipps sale, Sotheby's, 24 June 1935, lot 250, at that time bound with a fragment of a year book, now shelved separately as HM 15241. Acquired by the Huntington Library in 1935. Bibliography: Chronica, 2.
England, s. XV2
C. W. Dutschke with the assistance of R. H. Rouse et al., Guide to Medieval and Renaissance Manuscripts in the Huntington Library (San Marino, 1989). Copyright 1989.
Henry E. Huntington Library and Art Gallery, San Marino, California.
Electronic version encoded by Sharon K, Goetz, 2003.
All rights to the cataloguing and images in Digital Scriptorium reside with the contributing institutions.


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White House: Obama has 'faith' in Gen. Allen
White House press secretary Jay Carney said that President Obama is standing behind his nominee to be Supreme Allied Commander Europe, Gen. John Allen.
"He has faith in Gen. Allen," White House press secretary Jay Carney told reporters Tuesday.
The Department of Defense announced late Tuesday that Allen was snared in the same investigation that brought down former CIA head David Petraeus, and that Allen allegedly exchanged inappropriate emails with a woman in Florida.
Carney said that Obama "thinks very highly of Gen. Allen" and remains committed to his foreign policy goals.
"He's focused on his policy agenda," Carney said about the president.
On the big picture situation of two top military leaders involved in sex scandals, Carney said: "He's not going to make grand pronouncements or decisions" based on just two situations.
"I really would ask you to not extrapolate broadly. The president has great confidence in the military, great confidence in his commanders," Carney said.


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ASICS delivers another solid colorway of their popular Gel Lyte V silhouette for the upcoming fall season. The sneaker features an Atomic Blue mesh and neoprene upper alongside sandy suede panels, and a black ASICS Stripe. Additional details include a cushioned white midsole and reflective 3M material at the heel tab. The ASICS Gel Lyte V "Atomic Blue/Black" is now available at Feature Sneaker Boutique for $110 USD.
ASICS Gel Lyte V "Atomic Blue/Black"
Highsnobiety Sneakers


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Bedford Blues director of rugby Mike Rayer was left disappointed with his side's performance despite coming from behind to beat Nottingham in a thrilling encounter at Goldington Road on Saturday, writes Michael Hann.
The Blues were behind throughout the match against the Green and Whites, but a Ben Ransom try in the dying seconds gave them their third win of the season.
Speaking after the game Rayer said: "We are disappointed with some of our basic skills today and we left a few tries out there.
"We made basic errors and Nottingham punished us – they looked a good side today.
"They defended well but because we weren't recycling the ball quickly and weren't efficient enough we couldn't get in behind them and we had to dig deep."
The Blues struggled in the first half of the game and were behind 22-3 at half time, but Rayer says it isn't always easy in the opening period. "Everyone is fresh at the start of the game, it takes time to break sides down," he said.
"You can't just go out and turn a tap on and suddenly score a try, it doesn't happen like that. You have got to break sides down and you have to work hard."
In spite of the performance there were still some positives Rayer could take out of the game.
"We are really pleased with the win because we had to dig deep there," he continued.
"The character again has come through and that is absolutely fantastic for us.
"Obviously you have to look at the first half, but I think the overriding thing is that we will take the win at this stage."
Rayer was also encouraged with his side's scrum and in particular the work of Paul Tupai.
He said: "I thought we scrummed particularly well which was great and that got us a bit of field position and territory.
"Toops was incredible. He summed up why we won that game because of his effort.
"He was magnificent amongst the pack and was a great example."
And he added: "I tell you what you can't fault - value for money when you come here!"
He's not wrong!


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LOS ANGELES (CBS) — After getting sliced and diced for their school food program, Los Angeles Unified school officials said they had good reasons to keep a reality TV chef off their campuses, including a bad experience with another reality show.
"What we ended up was a bill $106,000 taxpayer money for work that they did, shoddy work that they did," LAUSD Spokesman Robert Alaniz said of another reality show called "School Pride."
KNX 1070 Newsradio's Jon Baird reports that LA school officials say they couldn't find out how things went when "Food Revolution" taped in West Virginia because the authorities back East were sworn to secrecy. So L.A. said… no taping.
"We're just not interested in the conflict or the drama," Alaniz added.
The district insists it did invite Chef Jamie Oliver to come work with them without the cameras, but have not heard back.
Meantime, school officials feel they've made plenty of progress on making their menu healthier and they use kids for taste-testing.


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Ultra Light Beam is one of the standout tracks on Kanye's T.L.O.P and Chance The Rapper does the most on the record. In the video you are about to watch Chance performs his verse on Ultra Light x the crowd responded well to the performance.
Peep the track after the jump


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Students ages 11-18 are invited to the Oconee County Library at 6 p.m. Thursday for a program featuring Percy Jackson trivia, Greek mythology and Greek food as one "greektastic" experience.
Perseus "Percy" Jackson is the hero in Rick Riordan's popular Percy Jackson and the Olympians book series. For more information, call the library at (706) 769-3950.
Also students ages 11-17 are invited to celebrate Valentine's Day and Library Lover's Month at 6 p.m. Monday. On tap are making Valentine's Day bookmarks and heart-themed snacks.
The library is offering the computer class Introduction to Microsoft Word at 11 a.m. Friday. The teacher will discuss the basics of the word-processing program, including creating and saving files, formatting and editing. The class is limited to four participants, and registration is required.
© 2017. All Rights Reserved. | Contact Us


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Sebring-1 Bedroom for only $295 week
1 Bedrooms, 1 Bathrooms, Capacity: 2
Photo Gallery
Property Description
Bedrooms: 1. Bathrooms: 1
Owner Contact Information
milford, ohio 45150
Click here
|Click here
|Member Since:
|May. 2nd, 2004
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|View here
Rental Rates
- $295 Week
- 3 Months -- Jan-Feb-March $995 MONTH
Amenitieslake near , Lake Beach close by
1 Bedrooms, 1 Bathrooms, Capacity: 2
Beds: 1 Queen
Minimum Stay: 3 night
Further Information
Some pets-No smoking
Nearby Attractions: - Golf-water skiig-boating-swimming-club house-Lake Beach-Close to Lake Jackson
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Rockets' Red Glare: Missile Defenses and the Future of World Politics
Rockets' Red Glare: Missile Defenses and the Future of World Politics
"Even deployment of highly capable missile defenses does not displace deterrence as the basis of U. S. national security policy, if for no other reason than the opponents can still deliver weapons of mass destruction to American territory, using unconventional methods such as terrorism."
In ROCKETS' RED GLARE: Missile Defenses and the Future of World Politics, James J. Wirtz and Jeffrey A. Larsen have compiled a balanced collection of essays from leading defense and technology experts to address the United States' decision to develop missile defense technology.
This decision, made official by President Clinton's signing of the 1999 National Missile Defense Act, has placed America's participation in the Anti-Ballistic Missile (ABM) Treaty of 1972 in jeopardy, as the ABM Treaty prohibits implementation of any system designed to defend against an enemy's missile attack.
ROCKETS' RED GLARE contributors worked with three possible premises in relation to the ABM Treaty. (1) What if the U. S. could negotiate minor changes, major changes or abandon altogether the prohibitive treaty? (2) How would any of these change the global geopolitical landscape? (3) What technologies would be involved in each scenario, and what new alliances or enmities would ensue?
The quality of evidence to support the pros and cons of missile defense is compelling, given that a range of experts, from senior scientists in fields relating to missile and defense technology to prominent policy advisors in international and foreign affairs contribute to the book. Their efforts to broaden views of national missile defense (NMD) are clear and concise to the lay reader.
Richard J. Harknett, whose essay contributes to the opening excerpt, is the only author who mentions the awful alternative available to a country with limited military capabilities. "Instead," he posits, "states with small missile arsenals would try to avoid a direct confrontation with American military capabilities. This would increase the search for alternative delivery strategies --- for instance, terrorism."
As you read this, remember Harknett's premise is that low-tech attacks against a high-tech defense would become the standard for striking the United States when the actual implementation of NMD occurs under the National Missile Defense Act.
Reviewed by Chuck Tyler on September 14, 2001
Rockets' Red Glare: Missile Defenses and the Future of World Politics
- Publication Date: September 14, 2001
- Genres: Nonfiction
- Hardcover: 368 pages
- Publisher: Basic Books


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A decade ago, the six-block Ansonborough district in downtown Charles ton, S.C., was a virtual slum. Most of its two-and three-story town houses, once the fashionable city residences of 19th century planters, tradesmen and aristocrats, were in varying stages of decay. Some were tenements occupied by as many as a dozen families. Any one without a keen eye for early-American architecture could easily have strolled Ansonborough's streets and missed its charm, which included the city's oldest house and first public high school. Indeed, the stroller might have considered the area a fine...
The City: Bringing Back the Heritage
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Chancellor Angela Merkel's government criticised Turkey on Friday for blocking access to social media platform Twitter, saying it did not fit with Germany's view of freedom of expression.
"What we are hearing from Turkey does not comply with what we in Germany understand as free communication," said Merkel's spokeswoman Christiane Wirtz. "It doesn't fit with our idea of freedom of expression to forbid or block any form of communication." (Reuters)


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Serv-U equipment company moves to new building
CHAMPAIGN – When Wayne Hemming and Mike Ciolli moved to the Champaign-Urbana area to take jobs at Hobbico, they brought along shared knowledge of a different business: the restaurant supply industry.
Both men had worked for Superior Products in St. Paul, Minn., one of the largest restaurant supply companies in the nation.
A few years after moving to Champaign, they set up a similar business: Serv-U, which itself has become a major supplier to food service businesses.
Serv-U, which recently moved to a new office/warehouse in Champaign's Apollo Industrial Park, supplies bars and restaurants with virtually everything they use – except food, said Sean Hemming, one of Wayne's sons and the company's vice president and general manager.
Virtually all Serv-U's sales are either to online or catalog customers, he said, with goods shipped throughout the United States.
"We do more catalog than Internet, but Internet is the fastest-growing segment of our business," said Chad Hemming, Sean's brother and Serv-U's vice president of marketing.
Serv-U's products come from about 350 vendors. The products run the gamut from glassware to dining tables and chairs to commercial refrigerators and dishwashers. The company also carries simple supplies such as swizzle sticks and cash register tape.
"To be full-service, you have to carry all the products," Chad Hemming said.
Serv-U is particularly strong in the furniture area, Sean Hemming said.
"Commercial furniture has been a strong growth category for Serv-U," he said. "We import approximately 100 containers a year of furniture from China."
The company, now at 3201 Apollo Drive, employs about 40 and is hiring more.
Serv-U began moving into the new building in April and plans to complete the move by the end of this month, when its lease at 301 E. Mercury Drive, C, runs out.
The new office/warehouse gives Serv-U about 62,500 square feet, up from the 30,000 square feet it occupied on Mercury Drive.
"We built the building on Apollo Drive to accommodate our growth," Sean Hemming said. "The larger facility allows us to increase our inventory levels, which improves our ship times."
Serv-U keeps about 8,000 products in stock in the warehouse, he said. Most small items are shipped out by UPS, while larger items are transported by truck.
The company publishes two 300-page catalogs each year. Each catalog weighs 14 ounces, and when copies of the catalogs are shipped out, it takes 25 to 30 trucks to transport them, he said.
Serv-U figures it has sold merchandise to more than 100,000 bars and restaurants, Sean Hemming added.
"Our catalog goes to virtually every independent-owned bar and restaurant in the U.S, as well as fraternal organizations, country clubs, bakeries, caterers and small restaurant chains," he said.
Serv-U also provides restaurants with "turnkey" solutions in which the company arranges for the design and installation of equipment.
Among food service equipment distribution companies, Serv-U is "one of the larger players in the Internet that has carved a niche in Web-based sales," said Jim Hanson, president of the Foodservice Equipment Distributors Association.
"I understand that they are one of the top five in this Internet/catalog market," said Hanson, whose own firm, Best Restaurant Equipment & Design, is based in Columbus, Ohio. "I don't know their figures, but it does appear that they do very well with both the hard-copy catalogs and the Web catalog, and with their contract project work as well."
The manufacture and distribution of food service equipment in the United States is a $9.5 billion industry, with sales growing about 4 percent a year, Hanson said.
Sean Hemming said Champaign's central location allows Serv-U to ship packages to most parts of the country in two days at competitive cost. The company ships to many states, he said.
"Illinois is the strongest, but we have a lot of customers in California, North Carolina, Wisconsin, Texas and New York," he said.
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Los Angeles Kicks Off 2016 Campaign at San Francisco The Rams kickoff their 50th season in Los Angeles on the road as they square off against NFC West foe, San Francisco 49ers. The Rams posted a 7-9 record during the 2015 campaign and finished third in the NFC West. The 49ers went 5-11 and finished fourth in the division a season ago. The Rams and 49ers split the 2015 series, as each team captured wins on their home field.
The Rams posted a 27-6 win over San Francisco at home a season ago behind a 133-yard showing from RB Todd Gurley in a Week 8 contest. San Francisco snapped the Rams three-game winning streak with a Week 17 overtime win, 19-16, to end the 2015 campaign at Levi's stadium. The Rams franchise is 40-38 alltime in season openers, while Los Angeles Head Coach Jeff Fisher is 12-8 in his Week 1 match-ups. Fisher's 12 wins in season openers is the second-highest total among active coaches, trailing only Bill Belichick, who has 14 Week 1 victories. The 49ers are the Rams most frequented opponent historically with San Francisco holding a 66-64-3 advantage over Los Angeles in a series dating back to the 1950 season.
Leading the Way Rams rookie RB Todd Gurley needed one game to get his feet under him in 2015. After that, he was among the most productive offensive players in the NFL in 2015. Gurley gained just nine yards on six carries in his NFL debut in Week 3. Then he took off and took the league by storm. With 1,106 rushing yards, Gurley led all rookies and ranked third among all players in 2015 in the category. His final total is the third highest by a rookie in franchise history. Gurley's 10 rushing touchdowns tied for the fifth most in the NFL last season. All that came despite the fact that Gurley played in just 13 games. He missed the first two as he continued to recover from a knee injury suffered during his senior year of college, and he was inactive for Week 17 due to a toe injury. Finishing Moves Gurley was at his best when the Rams needed him most.
In the team's Week 16 win at Seattle, Gurley rushed for 55 yards and a touchdown in the fourth quarter to help the Rams put away the Seahawks. He gained 42 yards and a touchdown in the final quarter of a Week 14 win over Detroit. In the Rams' Week 4 win at Arizona, Gurley ran nine times for 106 yards in the fourth quarter with runs of 52, 30 and 20 yards. His 106 rushing yards were the most in the fourth quarter by a Rams player since Eric Dickerson's 124 on Nov. 25, 1984. His total was the most by a Ram in any quarter since Marshall Faulk posted 143 in the first quarter of a contest on Nov. 11, 2001. Despite missing three weeks due to injuries, Gurley finished second among NFL running backs in fourth quarter rushing.
A Case for the Job Coach Fisher announced at his season-ending press conference that Case Keenum will enter the offseason as the team's 2016 starting quarterback after posting a 3-2 record in 2015. Keenum completed 60.8 percent of his passes and threw four touch Week downs and just one interception. He was sacked just four times in five starts. Over his last seven starts, Keenum is 5-2. After the Rams dropped Keenum's first start with the franchise—a Week 11 contest in Baltimore—the Texas native led the team to consecutive wins over Detroit, Tampa Bay and Seattle before falling to San Francisco in the finale. He started the final two games of the 2014 campaign for Houston and won both contests— home games over Baltimore and Jacksonville. Keenum was particularly impressive in the win over Tampa Bay as he recorded single-game career highs in completion percentage (82.4) and passer rating (158.0) while tossing a pair of touchdown passes, including a 60-yarder to WR Kenny Britt, under the play calling of then-interim offensive coordinator Rob Boras. A University of Houston alum, Keenum spent his first two NFL seasons with the team that shares his college town. He was released at the end of training camp last year and the Rams claimed him off waivers. He spent seven weeks on the team's practice squad before injuries at the quarterback position opened the door for a return to the Texans to complete the 2014 season. The Rams traded a seventh-round pick to the Texans to re-acquire him during the 2015 offseason. In college, Keenum set NCAA records for career passing yards (18,312), touchdown passes (150) and completions (1,460).


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The Facilities Budget and Financial Analyst provides full time financial and budgetary support to the Executive Director of Facilities Management and Facilities Department staff. This position will work closely with university departments such as financial operations, and IT. Working with many different software packages, the analyst will forecast capital and operational expenditures, and generate various reports as requested. This position assists the Executive Director in long term capital planning and manages the deferred maintenance and capital renewal programs.
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Peer reviewer: Dr. Kaye M Reid Lombardo, MD, Assistant Professor, Department of General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55 905, United States
S- Editor Tian L L- Editor Stewart GJ E- Editor Ma WH
AIM: To examine trends in and correlates of liver disease and viral hepatitis in an human immunodeficiency virus (HIV)-infected cohort.
METHODS: The multi-site adult/adolescent spectrum of HIV-related diseases (ASD) followed 29 490 HIV-infected individuals receiving medical care in 11 U.S. metropolitan areas for an average of 2.4 years, and a total of 69 487 person-years, between 1998 and 2004. ASD collected data on the presentation, treatment, and outcomes of HIV, including liver disease, hepatitis screening, and hepatitis diagnoses.
RESULTS: Incident liver disease, chronic hepatitis B virus (HBV), and hepatitis C virus (HCV) were diagnosed in 0.9, 1.8, and 4.7 per 100 person-years. HBV and HCV screening increased from fewer than 20% to over 60% during this period of observation (P < 0.001). Deaths occurred in 57% of those diagnosed with liver disease relative to 15% overall (P < 0.001). Overall 10% of deaths occurred among individuals with a diagnosis of liver disease. Despite care guidelines promoting screening and vaccination for HBV and screening for HCV, screening and vaccination were not universally conducted or, if conducted, not documented.
CONCLUSION: Due to high rates of incident liver disease, viral hepatitis screening, vaccination, and treatment among HIV-infected individuals should be a priority.
As highly active antiretroviral therapy (HAART) has improved the health of people living with human immunodeficiency virus (HIV), acquired immure deficiency syndrome (AIDS)-related morbidity and mortality have decreased and mortality from other illnesses, including hepatitis and liver disease, has grown[1-4]. Among HIV-infected individuals, chronic co-infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) are associated with excess morbidity and mortality[1,4,5]. Liver disease, from HBV/HCV or other etiologies, is now one of the most frequent causes of death among HIV-infected people[6,7].
Current care treatment guidelines for people living with HIV include HBV screening, plus vaccination as indicated, and HCV screening[8]. However, it is not known how widely these guidelines are followed, nor are there clear recommendations regarding the frequency of repeat screening following a negative test for HBV and HCV when risk of infection remains present. Screening for HBV is particularly important before initiating antiviral therapy for HIV, because several therapeutic agents are active against both viruses and use of these agents may cause HBV resistance and subsequent hepatitis flares, if the provider is unaware of HBV infection. Similarly, initiation of HBV treatment without the protection of HAART can lead to HIV antiretroviral resistance.
It is also important to follow trends in HBV, HCV, and hepatic disease diagnoses among people living with HIV for care planning purposes, prevention, education, and treatment of preventable and modifiable factors contributing to liver disease. Although most serious liver morbidity among people living with HIV is attributed to HBV and HCV[9,10], other factors contributing to liver morbidity may include the HIV virus itself, HIV-induced immunosuppression and/or inflammation, cirrhosis, hepatic carcinoma, alcohol use, aging, injection drug use, and hepatotoxic therapies-including some antiretroviral therapies.
To examine trends in, and factors associated with, both incident and prevalent liver disease and hepatitis diagnoses and screening in a modern HAART-era cohort, we analyzed data from a longitudinal medical record review cohort study, the national adult/adolescent spectrum of HIV-related diseases project 1998-2004.
The adult/adolescent spectrum of HIV related diseases (ASD) project was a multicenter medical record review surveillance project funded by the centers for disease control and prevention (CDC) and conducted in Atlanta, Detroit, Seattle, Denver, Houston, Dallas, San Antonio, Puerto Rico, New Orleans, Los Angeles, and New York City[11]. HIV-infected persons of at least 13 years of age who attended participating clinics were eligible for inclusion. ASD began data collection in 1990 and continued until 2004. Data for this manuscript were left truncated to start in 1998 due to protocol revisions at that time-including the addition of hepatitis screening-which remained in place through the project end in 2004. Medical records of ASD enrollees were retrospectively reviewed for the 12-mo period prior to their enrollment date, and at subsequent six month intervals until death, relocation, or loss to follow-up (no contact for 18 mon). Information collected included basic demographic data, mode of exposure to HIV, prescription of antiretrovirals and other medications, CD4+ T-lymphocyte (CD4+) counts, HIV RNA viral load, complete history of AIDS-defining opportunistic illnesses (OIs)[12], other infections, selected medical and psychosocial conditions, and behaviors of medical importance. Over 100 medical facilities participated in ASD, including HIV specialty clinics, private practitioners' offices, and community clinics, both hospital-based and freestanding. Men of color and women were oversampled at selected sites. All data were collected by trained abstractors; sites conducted a variety of quality assurance activities, including duplicate record abstraction audits and double data entry.
To describe the mode of HIV infection, we used four categories: men who have sex with men (MSM), injection drug users (IDU), individuals with both exposures (MSM-IDU), and other, including heterosexual exposure to an individual with HIV infection or with a known HIV risk and blood/blood product exposure (transfusion, blood products to treat hemophilia, organ transplant recipient, health care workers with needle stick exposure). For these analyses, substance use included those with a history of IDU as an HIV risk factor, and those with ongoing IDU, non-injection use of illicit drugs (including cocaine and marijuana), and problem alcohol use (defined as a diagnosis of alcoholism or treatment for past or current alcoholism). Cigarette smoking and other tobacco use was not collected in the national ASD project.
HBV and HCV screening for each year was defined as screening conducted up to and including each year individuals contributed follow-time to the project. A prior diagnosis of HCV or HBV was also considered indicative of screening for each infection. To examine trends in prevalence over time and overall death rates, individuals with a prior diagnosis of chronic HBV or any diagnosis of HCV or liver disease were considered to have these conditions in their diagnosis year and all subsequent years of follow time. Acute and chronic HBV and HCV infection were defined by provider diagnosis or laboratory evidence. IgM anti-HBc was considered diagnostic of acute HBV and IgG anti-HBc, or other characteristic antigen and antibody combinations, distinguished chronic HBV. Age at entry was coded as 14-29, 30-39, 40-49, 50-59, and 60 years and greater. Nadir CD4+ was aggregated to < 200, 200-499, and 500+ CD4+ cells/μL. Indicator (dummy) variables were used for mode, race/ethnicity, and nadir CD4+ cell count with MSM, Blacks, and CD4+ ≥ 500 cells/μL as reference groups. Intensity of health services utilization was measured with a grouped continuous variable of the total number of outpatient visits (in 10 visit increments).
An aggregate variable, "liver disease", was created and included cirrhosis (both alcoholic and non-alcoholic), necrosis, abscess, primary liver cancers and liver failure. Liver disease included International Classification of Diseases 9th Revision (ICD-9) codes 570 (acute and subacute necrosis of liver), 571 (chronic liver disease and cirrhosis), 572 (liver abscess and sequelae of chronic liver disease), 573 (other disorders of liver), 572.3 (portal hypertension), 277.1 (α 1 antitrypsin deficiency), 456.0-456.2 (esophageal varices), 789.5 (ascites), and 275.1 (Wilson's disease). Esophageal varices and ascites may not be specific for liver disease; therefore, we compared characteristics of individuals with liver disease including and excluding these additional diagnoses, and found the populations were nearly identical before making the decision to include these with liver disease. HBV and/or HCV alone, when we were able to distinguish these, were not sufficient to define liver disease. A dichotomous variable used only through 1999 indicating liver failure was also included with liver disease. Liver failure was defined by medical practitioner diagnoses recorded in the medical record and supported by abnormal liver function tests, jaundice, and/or special hepatic dietary management. Liver neoplasms and morphology codes of malignant and not-otherwise-specified (NOS) neoplasms were collected.
Follow time from 1/1/98 or start of observation until death or censure was calculated overall and for individuals diagnosed with chronic HBV, HCV, or liver disease-starting from the follow-up interval of diagnosis if after 12/31/1997. Death rates were calculated due to any cause and separately for deaths that may have been due to liver disease. Deaths that may have been due to liver disease were defined as those listing liver disease as a contributing factor on a death certificate or individuals with a diagnosis of liver disease during follow-up interval during in which death occurred (thus including individuals with a new or ongoing diagnosis of liver disease at the time of death or within six months of death).
Demographic characteristics of individuals with chronic HBV, any diagnosis of HCV, and liver disease were compared to individuals without these diagnoses by χ2 testing (SAS version 9.1, Cary NC). Multivariate Cox proportional hazards analyses were performed to calculate estimates of the relative risks (proportional hazards ratio) of HCV, chronic HBV, and liver disease (excluding those with prevalent diagnoses at baseline) and simultaneously adjusting for HIV risk mode (specifically, IDU, MSM, and hemophiliac), race/ethnicity, nadir CD4+ group (nadirs of < 200 cells/μL and 200-499 cells/μL), age, gender, alcohol use, IDU, antiretroviral use, intensity of health services utilization, and year entered cohort. Ninety-five percent confidence intervals are given for the proportional hazard ratios; intervals that do not include the value "one" are considered statistically significant. Individuals included in the multivariate analyses were required to have two or more outpatient visits documented in follow-up intervals ending in 1998 or later to minimize the contributions of persons unlikely to be assessed for any of the potential risk factors for liver disease (hepatitis, alcohol use, etc.). In the multivariate analyses examining liver disease as an outcome, all exposures were limited to those occurring prior to the diagnosis of liver disease. For chronic HBV and HCV, co-variates could be simultaneous with infection.
From January 1, 1998 to June 30, 2004, 29 490 individuals were followed for an average of 2.4 years per person, and for a total of 69 487 person-years. The proportion of the 29 490 observed each year from 1998 to 2004 was 56% in 1998, gradually declining to 42% in 2003; in 2004 (due to project end) 5% were followed. Liver disease was diagnosed in 3% of the cohort, HCV in 19%, and chronic HBV in 8% (Table 1). Individuals diagnosed with HBV, HCV, and liver disease were more likely to be male (P < 0.001), have a history of IDU (P < 0.001), use other illicit drugs (P < 0.001), be diagnosed with problem alcohol use (P < 0.001), and have more advanced HIV disease as measured by diagnoses of AIDS, including low nadir CD4 counts (P < 0.001). Sixty-five percent of individuals diagnosed with HCV had a history of IDU, relative to 25% overall. Twenty-five percent of HCV infected individuals were current IDU (medical records documented ongoing IDU over the course of observation) relative to 8% overall. Over half (57%) of individuals diagnosed with liver disease died over the period of observation, compared to a 15% overall mortality rate (P < 0.001).
|Chronic hepatitis B
|Hepatitis C
|Liver disease
|= 29 490
|= 23321
|= 54632
|= 8321
|White non-Hispanic
|Black non-Hispanic
|Asian/Pacific Islander non-Hispanic
|< 1
|Native American non-Hispanic
|< 1
|< 1
|< 1
|Age (yr)
|HIV transmission mode:
|IDU and MSM
|Other (i.e. heterosexual or blood product exposure)
|Ever prescribed HAART
|Nadir CD4 count in cells/µL
|≥ 500
|< 200
|Highest viral load in copies per mL
|Undetectable to 9999
|10 000-99 999
|100 000-999 999
|1 000 000 and higher
|Vital status
|AIDS diagnosis
|Never diagnosed with AIDS
|Substance use
|Alcohol use/problem drinking
|Ongoing IDU
Cumulatively, 38% of the cohort was documented to have been screened for HBV and 37% had been screened for HCV. Screening increased significantly over the seven years (P < 0.0001 χ2 for trend test for HBV and HCV, Figure 1). Repeat screenings were uncommon, even in the presence of ongoing risk. For example, for individuals without any documented HBV vaccination and with ongoing injection drug use noted in their medical record, only 12% of those followed for two or more years had two or more HBV screenings documented.
The proportion of the cohort diagnosed with chronic HBV (at any time up to and including the observation year) increased from 7% in 1998 to 8.5% in 2004 (P < 0.0001). Similarly 9% were diagnosed with HCV in 1998, increasing to 24% in 2004 (P < 0.0001). Over the course of follow-up, chronic HBV was diagnosed at a rate of 1.8 per 100 person-years, and HCV was diagnosed in 4.7 per 100 person-years (Table 2). Between 1998 and 2003, vaccination for HBV among those without a prior diagnosis of HBV increased from 10% to 28%.
|Present at baseline
|(% of 29 490)
|[rate per 100 person-years (py)]
|(% of 29 490)
|All liver disease
|832 (3)
|621 (0.9/100 py)
|212 (1)
|Chronic hepatitis B
|2332 (8)
|1212 (1.8/100 py)
|1120 (4)
|Hepatitis C
|5463 (19)
|3129 (4.7/100 py)
|2334 (8)
|Acute hepatitis B
|862 (3)
|575 (0.8/100 py)
|287 (1)
Among the 832 individuals diagnosed with liver disease, 262 (31%) were diagnosed with non-alcoholic (or alcohol not specified) cirrhosis, 165 (20%) with alcoholic cirrhosis, 3% with a primary liver cancer, 3% with liver failure not otherwise specified, (these numbers and percents include 7% with two or more of these conditions diagnosed), and 244 (29%) with other liver diseases (Table 3). Of the 832 with liver disease, 212 individuals (25% of those with liver disease, 1% of the cohort) had a liver disease diagnosis present at baseline (prevalent disease) and 621 individuals (75% with liver disease, 2% of the cohort) had new or incident diagnoses over follow-up (Table 2). Between 1998 and 2004, the proportion of individuals followed each year with a diagnosis of liver disease increased from 1.8% to 2.2% (χ2 for trend P value = 0.03, Figure 1). Overall, 496 of the 5005 people who died (9.9%) had a diagnosis of liver disease. This ranged from 8.6% to 11.0% over the seven years of the study, with no significant trend (data not shown).
|Liver diseases diagnosed
|Not exclusive categories
|All liver disease
|832 (100)
|All cirrhosis
|389 (47)
|Non-alcoholic cirrhosis
|262 (31)
|Alcoholic cirrhosis
|165 (20)
|38 (5)
|Other alcoholic liver disease excluding cirrhosis
|39 (5)
|Liver cancer
|25 (3)
|Liver failure (not otherwise specified)
|22 (3)
|Other liver diseases
|244 (29)
Table 4 presents the death rates per 1000 person-years observed among the entire ASD cohort from 1998-2004, and separately for people with diagnoses of liver disease, chronic HBV, HCV, and none of these diagnoses. Death rates ranged from 61/1000 for individuals without liver disease, HCV, and chronic HBV diagnoses to 74/1000 for people diagnosed with HCV. About 1% of overall deaths may have been due to liver disease among the entire cohort. Among those with HCV or chronic HBV, about 2% of deaths may have been due to liver disease (defined as liver disease as a contributing illness on a death certificate or as a new or ongoing diagnosis within six months of death). Death rates potentially attributable to liver disease ranged from 3/1000 for the entire cohort to 31/1000 among those with a prior diagnosis of liver disease.
|Number of deaths
|Overall death rate [Per 1000 person-years (py)]
|Potential liver disease death rate [(Per 1000 person-years py)]1
|Entire cohort
|Liver disease
|Chronic hepatitis B
|No HCV, no chronic HBV
Figure 2 presents the cumulative number and proportions of individuals with HCV, HBV, liver disease, overlapping diagnoses, and none of these three conditions. Cumulative death rate per 100 persons and 95% confidence intervals for HCV, HBV, liver disease, and overlapping diagnoses are presented in Figure 3. Death rates were similar for individuals with only HBV and only HCV, but increased with dual HBV & HCV infection. The highest death rates occurred among individuals with liver disease regardless of HBV, HCV, and dual HBV/HCV infection status.
Correlates of incident liver disease were examined by proportional hazards regression among 29 279 individuals (excluding the 212 with prevalent disease; Table 2). All demographic and clinical characteristics from Table 1 were included as covariates with the exception of AIDS as it was redundant with AIDS-defining CD4+ cell count categories. We also adjusted for intensity of health services utilization and year of enrollment. IDU and hemophiliacs had more than double the risk of liver disease relative to those without these risk factors (Table 5). Relative to Blacks, all other racial/ethnic groups had a two to three-fold higher risks of a liver disease diagnosis. Risk of liver disease also increased with increasing age, with AIDS-defining nadir CD4+ cell counts (< 200 cells/μL), alcohol use, and a prior diagnosis of HBV or HCV. Once these other factors were adjusted for, neither HAART in aggregate nor any specific antiretrovirals were associated with excess risk of liver disease.
|Proportional hazards ratio1-an estimate of relative risk (95% CI)
|Liver disease
|Chronic HBV
|Male gender
|1.2 (1.0-1.5)
|1.7 (1.4-2.0)
|1.3 (1.1-1.4)
|White non-hispanic
|1.9 (1.6-2.3)
|1.0 (0.9-1.1)
|1.3 (1.1-1.4)
|2.2 (1.8-2.7)
|0.7 (0.6-0.8)
|1.4 (1.3-1.4)
|Asian/pacific islander non-hispanic
|2.3 (1.1-5.0)
|1.0 (0.5-1.8)
|1.0 (0.6-1.7)
|Native American non-Hispanic
|3.1 (1.5-6.3)
|0.3 (0.1-1.3)
|1.4 (0.9-2.1)
|Each increase in decade of age relative to those 13-29 yr
|1.4 (1.3-1.5)
|1.0 (1.9-1.1)
|1.3 (1.2-1.3)
|0.9 (0.7-1.1)
|1.4 (1.2-1.7)
|0.7 (0.7-0.8)
|2.2 (1.8-2.6)
|1.2 (1.1-1.4)
|4.7 (4.4-5.1)
|2.6 (1.0-6.5)
|0.9 (0.3-2.8)
|7.0 (4.8-10.2)
|1.0 (0.8-1.2)
|0.1 (0.1-0.2)
|0.4 (0.4-0.4)
|CD4 < 200 cells/microliter
|1.8 (1.2-2.6)
|3.9 (2.9-5.2)
|1.6 (1.4-1.9)
|CD4 200-499 cells/microliter
|1.0 (0.7-1.5)
|2.0 (1.5-2.7)
|1.3 (1.1-1.5)
|Alcohol use/problem drinking
|1.4 (1.1-1.6)
|0.7 (0.6-0.8)
|1.1 (1.0-1.2)
|Chronic HBV
|1.4 (1.1-1.7)
|1.3 (1.1-1.4)
|1.6 (1.3-1.9)
|1.6 (1.4-1.8)
Correlates of chronic HBV and HCV diagnoses were also examined by multivariate proportional hazards regression analyses, excluding those with prevalent chronic HBV (n = 1120) and HCV (n = 2334), respectively. IDU and hemophiliacs were 4.7-fold and seven-fold more likely to be diagnosed with HCV relative to those with other HIV risk factors. Men, Whites, Latinos, and those co-infected with HBV were all more likely to be diagnosed with HCV. HCV risk also increased with age among individuals 30 years of age and older relative to those less than 30 years of age. Factors associated with chronic HBV diagnosis include male gender, MSM, IDU, lower CD4+ cell count nadir, alcohol use, and co-infection with HCV.
There were 25 diagnoses of liver cancer in the cohort. All of these patients were documented to have died, excluding three individuals lost to follow-up. Fifteen of the 25 had hepatocellular carcinoma, four had other specified morphologies (one diagnosis each of sarcoma, hepatoblastoma, lymphoma, and giant cell type), and six were unspecified. Of the 25, 13 were diagnosed with HCV and 10 with chronic HBV (this includes two diagnosed with both). Of the four diagnosed with neither virus, none had evidence of HBV or HCV screening documented in their medical chart.
We found that chronic HBV, HCV, and liver disease were frequent diagnoses among HIV-infected people followed in the ASD project from 1998 to 2004. Roughly one person out of a hundred people followed for a year was diagnosed with liver disease, two per 100 followed for a year were diagnosed with chronic HBV, and five out of a hundred were diagnosed with HCV. We observed relatively low rates of HBV and HCV screening, especially in earlier years of observation, despite consistent recommendations that all HIV-infected patients be screened for both infections in the guidelines for the treatment of HIV and prevention of opportunistic illness (including screening of HBV prior to administration of vaccine) covering 1998-2004[13]. Fortunately, over the observation period, increasing proportions of individuals were screened for HBV and HCV. Diagnoses of HBV and HCV also increased over the seven years of the study. Among individuals who died, liver disease was present at any point in nearly 10%, and liver disease was listed as a contributing factor or as a new or ongoing diagnosis within six months of death in 1% of deaths. The overall prevalence of liver disease was about 1% each year-this increased only slightly over the seven years. As expected, IDU was associated with all three outcomes examined by multivariate analyses (chronic HBV, HCV, and liver disease). Hemophilia, and thus an exposure to unscreened blood products, was most strongly associated with HCV, and alcohol use was associated with liver disease.
Other researchers have found high rates of liver diseases and viral hepatitis among HIV-infected persons, especially HIV-infected hemophiliacs and injection drug users. The prevalence of HBV and HCV infection varies within HIV-infected cohorts largely due to the underlying prevalence of these infections in the general populations from which the cohorts are drawn and the proportion of IDU included. Relative to the 8% with chronic HBV and the 19% with HCV in our cohort, a New York City HIV clinic following 5639 people living with HIV from 1999 until 2007, found that 4% were HBV-infected and 25% were HCV infected[14]. The HIV Outpatient Survey (HOPS) conducted at 10 facilities in eight U.S. cities followed 7618 HIV-infected individuals 1996-2007 and found a 24% prevalence of HCV[15]. In a serological study of incarcerated individuals in three U.S. cities, of those who were HIV-infected, 38% were co-infected with HCV and 8% were HBsAg positive[16].
The D:A:D Study followed 23 441 individuals on three continents between 1999 and 2004, finding a 23% prevalence of HCV and a 7% prevalence of active HBV[17]. In this study, HCV was associated with a seven-fold excess risk of liver-related deaths (e.g. hepatocellular carcinoma, end stage liver disease, or hepatic failure) and active HBV was associated with a four-fold excess risk of liver-related deaths. This compares to our similar finding of liver related deaths occurring over four times more frequently among individuals infected with HCV or chronic HBV relative to uninfected individuals. In the Swiss HIV Cohort Study, 37% of 3111 people living with HIV were HCV-infected; this included 92% of IDU and 7% of those with other HIV risks[18]. In this study, 9% of HCV-co-infected individuals died relative to 4% of those without HCV. Of the deaths among HCV-infected individuals, 16% were possibly to definitely associated with end-stage liver disease relative to 5% of deaths among HIV-infected individuals without HCV[18]. In the Multicenter Cohort Study of MSM, about 8% of HIV-infected men followed between 1984 and 2000 were HBsAg positive, and liver-related mortality was about seven times higher (14 deaths per 1000 person-years) among HBsAg positive men relative to HBsAg negative men (two deaths per 1000 person-years)[19].
Of 755 people living with HIV evaluated following initiation of antiretrovirals at one Italian HIV clinic, 3% developed severe hepatotoxicity (4/100 person-years). Nearly all (96%) of these patients had evidence of HCV infection (relative to 67% without hepatotoxicity), 19% had evidence of HBV, and 19% had a history of alcohol abuse (relative to 7% and 13% prevalence of these diagnoses among those without hepatotoxicity, respectively)[20]. This is consistent with our finding of no excess risk of liver disease for individuals prescribed antiretrovirals once these other factors (HCV, HBV, alcohol use, etc.) were controlled for by multivariate analyses. In a Veteran's Affairs cohort with comprehensive evaluations of 299 HIV-infected individuals over 6 mo, 27% had abnormal liver functions and for 51% of these, no underlying cause was established. Among the remainder, 30% had non-alcoholic fatty liver disease as a diagnosis, alcohol was attributed to 13%, chronic HBV to 9% and chronic active HCV to 5%[21].
Studies of HIV-infected hemophiliacs include a cohort study of 158 HIV-infected hemophiliacs followed in the pre- and post-HAART eras[22]. The predominant cause of non-AIDS mortality in both periods was end-stage liver disease (ESLD). Of 223 HIV-infected hemophiliacs without clinical AIDS, 9% of those co-infected with HCV developed liver failure after 10-20 years[23]. In Germany, 144 HIV and HCV co-infected hemophiliacs were examined, and the authors concluded that declining immune function may be associated with progression of liver failure[24].
Relative to the increase in HCV screening that we observed (from 11% to 69%), the HOPS study documented a very similar trend-HCV screening increasing from 11% to 77% from 1996 to 2007[15]. However, even if patients are screened, few receive ongoing screening despite ongoing risk, fewer than half are evaluated, and a minority are treated, reflecting the many hurdles that HIV and HCV and HIV and HBV co-infected patients must surmount to be appropriately managed and treated for HBV and HCV when indicated[25,26].
Although the number of liver cancers we observed was small (n = 25), all 21 with hepatitis screening documented were HBV or HCV-infected. Our study was not designed to compare the occurrence of liver cancer among people living with HIV relative to the general population, but other researchers have found three to six fold excess risk of liver cancer associated with HIV infection[27,28].
Limitations of our analyses included that the data were collected solely by medical record review. Collecting data by chart review rather than targeted medical examinations, may have introduced errors. Exposures and diagnoses may have been missed, especially if an individual sought medical care at facilities other than those included in ASD. Other diseases recorded may have been in error, such as mistaking a "rule out" diagnosis with a true diagnosis. Further, the use of ICD-9 codes to define liver disease likely resulted in some losses of sensitivity and specificity (for example, including a code such as 571.4-chronic hepatitis-which might have included viral hepatitis infections without any known liver damage). Similarly ICD-9 code 571 includes both fatty liver and nonalcoholic steatohepatitis (NASH), which could not be distinguished from each other without additional information. Information on performance of liver biopsy was not collected, and biopsies were not likely to have been frequently performed, leaving us to rely upon broad clinical diagnoses rather than histological diagnoses. HBV and HCV were particularly difficult diagnoses to ascertain through chart review because of under-diagnosis-especially of asymptomatic infections, false negative screening tests due to low or transient antibody production[29-31], and abstractor (and practitioner) confusion regarding distinguishing markers of acute, chronic, and chronic active or chronically persistent infection. Observed trends in HBV and HCV diagnoses could have been caused by increases in screening, not increases in incidence and prevalence. Some known predisposing conditions of certain liver disease (such as obesity) were not routinely collected. Deaths and causes of death may have been under-ascertained as well, as some ASD sites linked to core surveillance and national death index data and others did not. Finally, although ASD data collection ended in 2004, we believe there have been no major changes in hepatitis screening, HBV vaccination, or liver disease trends among HIV-infected individuals and that our findings remain highly relevant today.
Despite its limitations, ASD provided a large single cohort in a contemporary HAART era, collected with a consistent protocol and including a wealth of data on the screening and diagnosis HBV and HCV and liver disease and mortality as outcomes. Although HIV case reporting was not required throughout the U.S. during the period of our study, the socio-demographic characteristics (age, gender, race-ethnicity, and HIV risk category) of 38 398 newly diagnosed HIV cases in 2004 for the 34 states and five dependent areas, with name-based reporting at that time, were highly similar to the characteristics of ASD, suggesting ASD was largely representative of national HIV cases at this time[32].
In conclusion, patients with HIV and liver disease had a much higher mortality compared to those with HIV without a liver disease diagnosis. Although HBV vaccination rates have improved and screening rates for HBV and HCV have climbed steadily, they are still inadequate, and efforts are needed to improve vaccination and screening rates. The high rates of incident HCV (5/100 person-years) indicate that individuals at risk should be screened and while remaining at risk, re-screened on a regular basis. Similarly, a sizable HBV incidence (2/100 person-years) supports improved screening and vaccination[33]. Further studies are needed to determine the optimal frequency of repeated HCV screening among those with ongoing risk, as well as a frequency to re-visit HBV vaccination among unvaccinated individuals. Until better data are available, annual screenings for HCV and HBV vaccination discussions are suggested. Treatment of HBV and HCV should be considered for all HIV co-infected individuals.
Despite widespread availability of antiretroviral treatment in the U.S., over 17 000 people living with human immunodeficiency virus (HIV) are estimated to die each year. Although increasing, the median age at death among HIV-infected people was 46 years in 2006, indicating most HIV deaths occur among relatively young individuals. Hepatitis and liver disease are major causes of premature death among people living with HIV. The authors conducted this review of liver disease and hepatitis screening and diagnoses to describe preventive care and the impact of these conditions among HIV-infected individuals receiving medical care in the U.S.
In this report, the authors examined hepatitis and other hepatic diseases in a dynamic medical record review cohort of over 29 000 HIV-infected people. The authors found, over the study period of 1998 to 2004, improvements in hepatitis screening and hepatitis B vaccination, but the authors also saw there was much room for improvement in screening and vaccination coverage. On average, among 100 HIV-infected people followed for a year one person had a diagnosis of acute hepatitis B infection, two were diagnosed with chronic hepatitis B, five were diagnosed with hepatitis C, and one person with liver disease. Fewer than one-third (28% in 2003) of those without a documented diagnosis of hepatitis B had evidence of any hepatitis B vaccination.
The authors examined hematological diagnoses and risk factors in nearly 30 000 HIV infected individuals from a broad range of HIV risk groups and geographic locations within the U.S. Among other findings, the authors saw elevated death rates among people with chronic hepatitis B, hepatitis C, and liver disease, but mortality rates were elevated the most among individuals with liver disease, with or without chronic hepatitis B and hepatitis C. When the authors conducted a multivariate analysis, the authors saw that Blacks were at lower risk of liver disease than individuals with other racial/ethnic identities, older individuals, injection drug users, alcoholics/problem drinkers, and individuals with AIDS all had increased risks of liver disease. Antiretroviral use was not associated with liver disease.
The authors' results highlight a need for improved hepatitis screening and vaccination. All HIV-infected individuals should be screened for hepatitis and, if at risk, vaccinated for hepatitis B. Uninfected individuals should be counseled in hepatitis risk reduction strategies, and individuals with chronic hepatitis infections should be assessed for treatment. It is likely that the authors' estimates for hepatitis screening and vaccination are low, and that documentation of prior screening and vaccinations may have been missed, for example if they occurred at medical facilities not participating in ASD.
A series of experiments are well-planned and well-performed and this manuscript is well written.
Peer reviewer: Dr. Kaye M Reid Lombardo, MD, Assistant Professor, Department of General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55 905, United States
S- Editor Tian L L- Editor Stewart GJ E- Editor Ma WH
|Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006;44:S6-S9.
|Lifson AR, Belloso WH, Carey C, Davey RT, Duprez D, El-Sadr WM, Gatell JM, Gey DC, Hoy JF, Krum EA. Determination of the underlying cause of death in three multicenter international HIV clinical trials. HIV Clin Trials. 2008;9:177-185.
|Sulkowski MS. Viral hepatitis and HIV coinfection. J Hepatol. 2008;48:353-367.
|Tedaldi E, Peters L, Neuhaus J, Puoti M, Rockstroh J, Klein MB, Dore GJ, Mocroft A, Soriano V, Clotet B. Opportunistic disease and mortality in patients coinfected with hepatitis B or C virus in the strategic management of antiretroviral therapy (SMART) study. Clin Infect Dis. 2008;47:1468-1475.
|Ribes J, Clèries R, Rubió A, Hernández JM, Mazzara R, Madoz P, Casanovas T, Casanova A, Gallen M, Rodríguez C. Cofactors associated with liver disease mortality in an HBsAg-positive Mediterranean cohort: 20 years of follow-up. Int J Cancer. 2006;119:687-694.
|Hooshyar D, Hanson DL, Wolfe M, Selik RM, Buskin SE, McNaghten AD. Trends in perimortal conditions and mortality rates among HIV-infected patients. AIDS. 2007;21:2093-2100.
|Salmon-Ceron D, Lewden C, Morlat P, Bévilacqua S, Jougla E, Bonnet F, Héripret L, Costagliola D, May T, Chêne G. Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol. J Hepatol. 2005;42:799-805.
|Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services, 2008. .
|Sulkowski MS. Management of hepatic complications in HIV-infected persons. J Infect Dis. 2008;197 Suppl 3:S279-S293.
|Thomas DL. The challenge of hepatitis C in the HIV-infected person. Annu Rev Med. 2008;59:473-485.
|Farizo KM, Buehler JW, Chamberland ME, Whyte BM, Froelicher ES, Hopkins SG, Reed CM, Mokotoff ED, Cohn DL, Troxler S. Spectrum of disease in persons with human immunodeficiency virus infection in the United States. JAMA. 1992;267:1798-1805.
|1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41:1-19.
|1997 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. USPHS/IDSA Prevention of Opportunistic Infections Working Group. MMWR Recomm Rep. 1997;46:1-46.
|Kim JH, Psevdos G, Suh J, Sharp VL. Co-infection of hepatitis B and hepatitis C virus in human immunodeficiency virus-infected patients in New York City, United States. World J Gastroenterol. 2008;14:6689-6693.
|Spradling PR, Richardson JT, Buchacz K, Moorman AC, Finelli L, Bell BP, Brooks JT. Trends in hepatitis C virus infection among patients in the HIV Outpatient Study, 1996-2007. J Acquir Immune Defic Syndr. 2010;53:388-396.
|Hennessey KA, Kim AA, Griffin V, Collins NT, Weinbaum CM, Sabin K. Prevalence of infection with hepatitis B and C viruses and co-infection with HIV in three jails: a case for viral hepatitis prevention in jails in the United States. J Urban Health. 2009;86:93-105.
|Weber R, Sabin CA, Friis-Møller N, Reiss P, El-Sadr WM, Kirk O, Dabis F, Law MG, Pradier C, De Wit S. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006;166:1632-1641.
|Greub G, Ledergerber B, Battegay M, Grob P, Perrin L, Furrer H, Burgisser P, Erb P, Boggian K, Piffaretti JC. Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet. 2000;356:1800-1805.
|Thio CL, Seaberg EC, Skolasky R Jr, Phair J, Visscher B, Muñoz A, Thomas DL. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002;360:1921-1926.
|Puoti M, Torti C, Ripamonti D, Castelli F, Zaltron S, Zanini B, Spinetti A, Putzolu V, Casari S, Tomasoni L. Severe hepatotoxicity during combination antiretroviral treatment: incidence, liver histology, and outcome. J Acquir Immune Defic Syndr. 2003;32:259-267.
|Crum-Cianflone N, Collins G, Medina S, Asher D, Campin R, Bavaro M, Hale B, Hames C. Prevalence and factors associated with liver test abnormalities among human immunodeficiency virus-infected persons. Clin Gastroenterol Hepatol. 2010;8:183-191.
|Katsarou O, Touloumi G, Antoniou A, Kouramba A, Hatzakis A, Karafoulidou A. Progression of HIV infection in the post-HAART era among a cohort of HIV+ Greek haemophilia patients. Haemophilia. 2005;11:360-365.
|Eyster ME, Diamondstone LS, Lien JM, Ehmann WC, Quan S, Goedert JJ. Natural history of hepatitis C virus infection in multitransfused hemophiliacs: effect of coinfection with human immunodeficiency virus. The Multicenter Hemophilia Cohort Study. J Acquir Immune Defic Syndr. 1993;6:602-610.
|Rockstroh JK, Spengler U, Sudhop T, Ewig S, Theisen A, Hammerstein U, Bierhoff E, Fischer HP, Oldenburg J, Brackmann HH. Immunosuppression may lead to progression of hepatitis C virus-associated liver disease in hemophiliacs coinfected with HIV. Am J Gastroenterol. 1996;91:2563-2568.
|Scott JD, Wald A, Kitahata M, Krantz E, Drolette L, Corey L, Wang CC. Hepatitis C virus is infrequently evaluated and treated in an urban HIV clinic population. AIDS Patient Care STDS. 2009;23:925-929.
|Jain MK, Opio CK, Osuagwu CC, Pillai R, Keiser P, Lee WM. Do HIV care providers appropriately manage hepatitis B in coinfected patients treated with antiretroviral therapy? Clin Infect Dis. 2007;44:996-1000.
|Engels EA, Biggar RJ, Hall HI, Cross H, Crutchfield A, Finch JL, Grigg R, Hylton T, Pawlish KS, McNeel TS. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008;123:187-194.
|Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009;52:611-622.
|Chamie G, Bonacini M, Bangsberg DR, Stapleton JT, Hall C, Overton ET, Scherzer R, Tien PC. Factors associated with seronegative chronic hepatitis C virus infection in HIV infection. Clin Infect Dis. 2007;44:577-583.
|Cohen Stuart JW, Velema M, Schuurman R, Boucher CA, Hoepelman AI. Occult hepatitis B in persons infected with HIV is associated with low CD4 counts and resolves during antiretroviral therapy. J Med Virol. 2009;81:441-445.
|Thomson EC, Nastouli E, Main J, Karayiannis P, Eliahoo J, Muir D, McClure MO. Delayed anti-HCV antibody response in HIV-positive men acutely infected with HCV. AIDS. 2009;23:89-93.
|Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. URL: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/default.htm. .
|Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, Havens P, Nesheim S, Read JS, Serchuck L. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from -CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. 2009;58:1-166.
|Centers for Disease Control and Prevention. HIV Surveillance Report, 2008; vol. 20. Published June 2010. Accessed 11/29/2010. Available at: URL: http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/table12a.htm. .
|Centers for Disease Control and Prevention. HIV Mortality (through 2006) slide set. Accessed 11/29/2010. Available from: URL: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/mortality/slides/mortality.pdf. .


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In April 2007, I took what I thought would be my last horseback ride in Central Park ("Return of Central Park Horseback Riding," May 4).
Parks Commissioner Adrian Benepe is to be congratulated for bringing horses back to Central Park.
There will be those who believe that horses do not belong in a city. But our parks were created to be enjoyed by horseback. The bridle paths wind past cherry blossoms and under arching bridges.
Adults and children alike are awed as a horse canters past them, and seeing Central Park and its surrounding skyline on horseback is truly majestic.
Unlike in many places, horseback riding will be available to all New Yorkers, not just an elite few, and guests can experience the New York of the past. It is truly an eco-friendly activity.
Unfortunately, not only have the bridle paths fallen into disrepair, but they have also become de facto jogging and walking paths.
Hopefully, those using the paths will yield to the horses and riders. Not only will they be safer, but they will also get to enjoy the grace and beauty that is equine.
John C. Jeannopoulos, Manhattan
Benepe's idea will only work if the bridle paths are restricted to horses. But they won't be.
Joggers, people with baby strollers and even bike riders have taken over the trails. This makes it dangerous for both horse and rider. What does a horse do when it gets freaked? It runs away out of control and probably dumps its rider.
I rode out of the Claremont stables for 20 years and stopped once the bridle paths became overrun with folks who didn't have the sense to give horses a wide berth.
Melanie Coronetz, Manhattan


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Contact the Medical Review UnitIf you have questions regarding medical review that you would like to discuss before filing a report, please contact us by phone or fax. You may also wish to consult with a driver rehabilitation specialist, the driver's physician or eye care specialist.
By phone
(609) 292-7500 ext. 5032
By fax
(609) 292-7504


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July 7, 2012 BY Aaron Hope
Opening Ceremony has been mentioned more times on Sneaker News as a source for hot sneakers than a designer, though the New York fashion mainstay has indeed popped up with a few Keds collabos over the years. OS has since moved on to a bigger stage, where notions of modern luxury, cycling culture and 1990s streetwear converge on the latest adidas Originals release. This Opening Ceremony x adidas Boat Swim Shoe will make Snoop Dogg happy with its blue paisley upper, and arguably the defining feature of this shoe is how the grey/silver elements within the pattern and outside on the piping serve to blend with the black mudguard perfectly. Add a pristine white sole and these are bold enough to make you do a double-take without even an inkling of 'bright'. Click through to see more of this masterfully unique colorup and grab yours from select retailers like End.
Filed under: Adidas Collaboration Just Released


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We wont be able to make everybody happy, says Daniel Windfeld Schmidt. Hes the lead level designer on Eidos Montreals Thief relaunch, and hes right. I recently played the first-person stealth game, and some people arent going to be happy.
This Thief game has third- person climbing sections. It makes minor use of quick time events. It has Focus mode, which gifts master thief Garrett with limited time-slowing combat abilities. It has context-sensitive controls that mean you can only jump when the game says you can jump.
Unhappy yet? Im not. After playing the game for over an hour at this years E3, and putting all my concerns about the above to Schmidt, Ive settled on being cautiously optimistic. Thief has changed, but not in the ways that matter.


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Dance Departments 2001-02
The following is a list of selected dance departments at colleges, universities, and conservatories in the United States offering degrees or certificates. Those that are members of NASD (National Association of Schools of Dance) are listed as such. Schools are listed alphabetically within each state.
Back Stage sent out questionnaires to schools that were listed in our 2000 guide and additional names which we found in the NASD directory. If the school did not respond to the questionnaire, we placed an asterisk (*) next to its name, denoting the fact that information is from the 2000 listing. Listings for schools that have advertisements within this section include website, department chair, and degrees offered. For more specific information, contact the schools directly.
The National Association of Schools of Dance, founded in 1981, aims to "develop a closer relationship among schools and programs of dance for the purpose of examining and improving practices and professional standards in dance education and training." NASD is located at 11250 Roger Bacon Dr., Reston, VA 20190, phone (703) 437-0700, email: firstname.lastname@example.com., website: www.arts-accredit.org.
For access to this listing


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Commerical Break: Ambi Pur own perfume ads
Perfume adverts aren't mocked nearly enough. If anyone deserves wholesale damnation, it's the arseholes at fragrance marketing firms.
To do the job for us, Ambi Pur are on it, with this tremendous pastiche, with the catchline 'pour lavatory' to cap things off!
TOPICS: Advertising Not The Onion
1 comment
- David H.Would you mind posting the commercial(s) please?


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Robotics, battling robots, trains and similar Futaba Equipment uses
I did not find the answer to my question here. How do I get further assistance?
The signals that go from the receiver to the servo are in the same format whether using AM, FM or PCM. The signals may differ in the length of the frame, number of channels, etc, but the FORMAT is the same. These are ANALOG signals in PULSE-POSITION modulation. Each CHANNEL within every frame may vary in length anywhere from about 1000 microseconds to 2000 microseconds, with center usually being around 1500 microseconds. Most servos are analog, but now DIGITAL servos are making their way into our industry. Please see /servos/digitalservos.pdf
Frame lengths vary depending on the number of channels. Futaba typically can be anywhere from 19-22 milli-seconds. In any frame, the channels are bundled together at the BEGINNING. Any extra room in the frame it will come at the END.
The voltage of the pulses will vary depending on the voltage of the DC power source to the Rx, with an absolute minimum operational voltage usually in the 4.0V range.
The rotation of the servo output IS directly proportional to the width of the respective pulse (channel). The minimum width of any pulse (channel) will be about 1000 microseconds, never 0 seconds. The maximum width of any pulse (channel) will be about 2000 microseconds.
PCM modulation ONLY refers to how signals are converted to digital when sent out of a transmitter, then decoded and converted back to analog by receiver.
The receiver draws only the current it needs to operate, as do the servos.
Additional helpful information:
If you wish to utilize an RC aircraft radio with 6 or more channels to operate a Battle bot, you must do so utilizing a ground (75MHz) legal frequency and PCM modulation. For more information on frequency use please visit:
If you are seeking battlebot sponsorship, regrettably the U.S. sponsorship program is full at this time and we are not currently accepting applications.
Using a 9C, the radio we strongly recommend for this task, the following programming is required:
You will need to use the elevon programming in your 6X, 7U, 8U, 9C, or 9Z to set up single stick control which gives you 2 motors forward = forward, left/right gives one motor forward the other reverse, and back = both motors backwards.
We do not have extensive experience using RC systems for train applications. The information provided here is as much as we have available to offer you, to give you some starting ideas.
Before we begin, one important note—trains are ground control models and MUST be operated on the designated 75MHz, 50MHz (HAM license required) or 27MHz frequencies. It is against FCC regulation and potentially dangerous to use model aircraft frequencies in the 72MHz range or any other frequencies not specifically designated to models.
Back to main FAQ/Contact Info page


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Outside linebacker extraordinaire Kyle Williams from Bolingbrook, Illinois is now up to 22 offers from some of the nations top programs.
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women's Christmas Jumpers
Embrace the cold and get into the festive spirit with a snug Christmas jumper. Sweet novelty knits work perfectly with a leather pencil skirt for Christmas parties, while our range of chunky cable knits and Fair Isle patterned jumpers brings you cute wintertime style. Our collection Christmas Jumpers will certainly keep your knitwear the right side of cool.
Click here for our selection of Men's Christmas Jumpers.


text: I'm going to build a smoker. I will either modify a Char Broil charcoal grill by adding an outside firebox and other mods, or I will start from scratch with the tank from an old vertical air compressor. I'm leaning toward the compressor tank because of its thickness, but I'm concerned as to whether its large enough n diameter. The tank is 28 in. long and about 16 in. in diameter. I just need a small smoker as we don't entertain, but is the diameter of that tank big enough? Is so, where do I cut it? I assume I want to cut it a little off center making the bottom half bigger than the lid, but I don't know. Please give me your wisdom and advise. Thanks Steve


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Adult Book Club
The Hubbard Book Club meets on the 3rd Saturday of the month from September through May from 11:00 a.m. - 1:00 p.m. in the branch meeting room. The May title to be discussed is: "The New Jim Crow: mass incarcerations in the age of colorblindness" by Michelle Alexander. We hope you'll join us for another lively book discussion.
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Playing a ruthless Miami exec sent to Minneapolis to close a factory in New in Town, Zellweger could relate to the experience on two levels: Always filming on new locations, "I am perpetually new in town," she points out, and she's familiar with non-urban life. "I grew up in a small town. I know this community of eclectic folk. I recognize their values and support systems," she says.
She enjoyed working with co-star Harry Connick Jr. but the frigid temperatures in Winnipeg, Manitoba, where the movie was shot, took some getting used to. "Who knew pantyhose could be so very important?" asks Zellweger, who wore four pairs at a time. "They were essential. I would not be here if it were not for Hanes, I promise you."
"Dave is inspiring the heck out of me," says Kelley, who recycles, trades bottled water for reusable metal bottles, but hasn't done any composting yet. "Worms freak me out," she explains.
Schiff adds that their home has solar panels, which cuts their energy bill, and he's encouraged by the new administration's green policies, especially where technology is concerned. "There's no other way out of the economic doldrums," he believes.
Now in Last Chance Harvey as Dustin Hoffman's boss, Schiff will appear opposite Michael Douglas in Solitary Man and is slated to go to London to shoot the comedy Who's Solly Now, about an Iranian who discovers he's actually Jewish and goes to his Jewish cab driver neighbor (Schiff), a former enemy, for advice. He also plans to do a Broadway revival of Talley's Folly, date to be determined pending casting of the leading lady.
These days Kelley is focusing on the S Factor, the movement method she teaches that incorporates stripper pole dancing. "It's about women embracing the holistic body and sensuality," she says. "It's the best workout I've ever done. I have seven studios around the country and I'm opening more."
Stay tuned for next week's Ecollywood column. In the meantime, check out our Ecollywood videos.


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One of many Android implementations includes pulling down on the top of the screen to present controls for Bluetooth, Wi-Fi and other radios for easy toggling. Managing communications and battery life is possible on Windows Phone too, but its toggles are tragically buried deep in the settings menu. Solving that problem is Network Dashboard, a 99-cent app (with an unlimited trial period) by Purity Consulting.
Network Dashboard acts as a switchboard for most network radios, affording quick access to Wi-Fi, Bluetooth and the carrier-network radio, and it acts as a catch-all for Airplane Mode. Best of all, it allows creation of individual live tiles on the home screen for the various radios it covers for fine grain, easily accessible radio controls. However, while the app runs on Windows Phone 8, it has yet to be updated for WP8, and runs at a lower-resolution than that of the new crop of devices.
This useful app also has another glaring issue; it doesn't control the GPS or NFC radios. We've reached out to Purity Consulting to see if an update to WP8 is planned. If so, this app would rank among our first recommendations to Windows Phone owners and be well worth a buck.