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20 Of The Worst Parents Who Should Be Reported Immediately [Photos]
- In: Baby Buzz
Parenting is without-a-doubt the most challenging and rigorous job a person will ever have. Raising a child is hard work. It takes patience, dedication, the ability to function with little to no sleep and the willingness to admit it when a mistake has been made. No parent is perfect. Despite having the best of intentions, every mother and every father will undoubtedly make parenting mistakes. Many, many mistakes.
All progenitors have moments when they are fully aware that they aren't doing a completely stellar job. Some days are rough. There are times when Mom or Dad will be in complete survival mode, just trying to make it until bedtime. Giving a child candy or letting him watch too many cartoons is one thing. Putting his life in danger is quite another.
What is considered "bad parenting" to one person may seem completely fine to another. Of course, every parent is free to choose how to take care of his or her children. Most of the time, mother or father really do know best. Despite this notion, there are a few parents out there who aren't making the best choices when it comes to taking care of their kiddos. When a parent's decisions put the safety of a little one entrusted to his or her care at risk, it's simply not okay.
The 20 parents found in the images below are taking things just a bit too far. It may be time for someone to report them to Child Protective Services, or, at the very least, give them a lesson on what is and isn't alright to do when taking care of a child. If nothing else, the images that follow will remind you that, compared to these parents, you are doing a damn fine job.
20 Carry-on Confusion
19 Don't Ever Let Go, Jack!
18 Um…What?!
17 Looks Cozy
16 Bathtime Buddies
15 Safety First
14 Cool Kid
13 Too Soon
12 Just…No!
11 Weeeee!
10 Pucker Up
9 Well Done, Mom
8 They Lost His Binkie
7 The Little Girl With The Inappropriate Tattoo
6 Way Too Many Wheels
5 Thanks For the Lift, Pop
4 Strike a Pose
3 Front Seat Fiasco
2 What Height Requirement?
1 Look, Kids! Tigers!
Sources: ParentFailure.com, UpliftingDaily.com
- Ad Free Browsing
- Over 10,000 Videos!
- All in 1 Access
- Join For Free!


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Re: [midatlanticretro] One last time: whos attending work day this Saturday
Expand Messages
- your new friends might require a little bit of
cooperation, just like your old ones John.
--- firstname.lastname@example.com
<allain@...> wrote:
> > Im pretty sure Ive already used those for kindlingmake friends.
> It's OK Chris, I'll still be looking for ways to
> Other ways or other friends, I'm not sure whichyet... <g>
> John A.
Yahoo! Mail - PC Magazine Editors' Choice 2005
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subset: commoncrawl


text:
GraphicRiver Two Green Leaves 11457152
Stock Vector \ Conceptual \ Nature \ Flowers & Plants
Illustration \ Concept \ Single \ Recycling \ Season \ Spring \ Summer \ Vector
Stock Vector - Two Green Leaves 11457152 by tassel78 @ GraphicRiver
Stock Vector \ Conceptual \ Nature \ Flowers & Plants
Ecology concept icon with green leaves. Vector illustration
Layered: No; Graphics Files Included: JPG Image, Vector EPS; Minimum Adobe CS Version: CS.
Gold Cup With Metal Realistic Dumbbells.; Two Wooden Paddles. Sport Oars.; Magnifying Glass Over The Yellow Folder; Silver Cup With Metal Realistic Dumbbells.; Metal Realistic Dumbbells; Nautical Emblem With Golden Anchor, Vector; Gold Cup With Golden Realistic Dumbbells..
Keywords: art, color, concept, design, drop, ecology, element, environment, environmental, flower, freshness, graphic, green, herbal, icon, illustration, leaf, life, nature, organic, plant, recycling, season, shape, sign, single, spring, summer, symbol, vector.


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Manufacturer demonstrates commitment to workplace and environmental safety{{1481648924537| date:'MMM d, yyyy hh:mm a'}} REDWIRE is news you can use from leading suppliers. Powered by FRASERS.
Posted by L & M Precision Products Inc
Post your own REDWIRE news Subscribe
Free REDWIRE e-newsletter
L. & M. Precision Products Inc. is committed to workplace safety. The leading Canadian producer of high-quality, precision-machined products understands that, as an employer and good corporate citizen, it is responsible for ensuring the safety of its workers and the environment, and takes the proper steps to remain compliant with current safety and environmental regulations.
Safety first
L. & M. is up-to-date with WHMIS (Workplace Hazardous Materials Information System), Canada's requirements for workplace chemicals, and is working on upgrading to the new Global Harmonized System (GHS) version of WHMIS. The Toronto-based company is also current with the latest WSIB (Workplace Safety and Insurance Board) requirements.
Environmental practices
To ensure it's not contributing to harmful environmental practices, L. & M. remains current and compliant with annual environmental reporting to the National Pollutant Release Inventory (NPRI), Canada's legislated, publicly accessible inventory, as well as Toronto's CHEMTrac environmental reporting. L. & M. also complies with the Toxic Reduction Act (TRA), with an approved toxic reduction plan, and it maintains its licence every year with the Ministry of Environment's Hazardous Waste Information Network (HWIN).
A top employer
In addition to workplace safety and good environmental practices, L. & M. is committed to product quality and customer satisfaction. This is one of the many reasons L. & M. Precision Products has been a desirable place to work and do business with since it was founded more than 50 years ago. The privately held company is 100 per cent Canadian owned and operated by employees. More than half of its workforce have been with the company for 20-plus years.
To learn more, contact L. & M. Precision Products.


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With First Tutors you can find a private japanese teacher in Evesham and anywhere in the UK. Local japanese tuition is an excellent way to bolster confidence while increasing grades and doesn't have to be boring! Please use our service to find Evesham japanese tutors and select which best meets your requirements.
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DHA Gujranwala is a complete Housing Project located nearby Army Cantt. The main GT Road is approachable within 5 minutes drive. As DHA has a name regarding providing the qualitative housing projects, so people are very curious about the upcoming most fascinating Housing Scheme of Gujranwala.
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Copyrights 2012, Wall Real Estate. All Rights Reserved. Developed by
INTELLISOFT Solutions


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can we watch anything from disney jr?
i have a two year old who loves anything thats on disney jr., can we get any of there shows on the apple tv?
- Asked by Danielle W from Cedar City
No Answers have been submitted
Be the first to answer this question. Answer now


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A SWAT for trying to outlaw what's already illegal
Threatening someone is mean-spirit, malicious and wrong. It is illegal, as well it should be.
So why is it that when we attach "cyber" to an action that wouldn't be illegal if done face to face that there's a sudden rush to make it a crime just because it happened online?
In the case of U.S. Rep. Loretta Sanchez, it's tempting to say the rush is an effort to make political hay out of a tragic case that drew national attention. Or it could be yet another attempt by someone who doesn't understand online to regulate that modern boogyman the Internet.
Let's assume Sanchez isn't ignorant. She's at least Net savvy enough to issue a press release condemning the Vietnamese government for censoring bloggers.
Yet, with a bill she's sponsored that would outlaw "cyberbullying," Sanchez wants to trample on at least two different provisions of the Constitution and create a law that regulates an outlier.
The outlier in this case is Lori Drew, who was convicted of computer fraud in the death of 13-year-old Megan Meier. Drew, if you'll remember, was the Missouri woman who humiliated the teen by creating a fake MySpace account and posing as a boy. Meier ultimately killed herself.
Prosecutors went after Drew in a complicated federal case that came down to an allegation that Drew violated MySpace terms of service by creating an account under a false name, hence the fraud. Drew's conviction ultimately was overturned.
Enter Sanchez - and a number of folks in other states who have rushed in with similar proposals. She wants to make it a crime to make "electronic bullying" a crime. Ay, but it's not a crime if it's done face to face.
In trying to craft a bill with a prayer of passing constitutional muster, Sanchez has narrowed her definition of "electronic bullying" to "serious, repeated and hostile communications made with intent to harm." That's already a crime in California and in many other states. It's called "terrorist threats."
Except, by all accounts, Drew doesn't appear to have threatened anyone. She slowly drove a young girl mad, but she never threatened her. That's where existing stalking and harassment laws come in. Most states already have extended those to cover online actions.
So that leaves us with a bill that would make something illegal that's already illegal and wouldn't have punished anyone had it been in effect at the time of the incident that inspired it.
Rep. Sanchez, Stop Wasting America's Time. Virtually every time Congress involves itself in online regulation, it screws up. Remember the law a few years back that made it a federal crime to "annoy" someone on the Internet?
Yes, many states need to update cyberstalking laws, which were tailored too narrowly to begin with and limit the crime to emails. But we don't need a federal law prohibiting "serious, repeated and hostile communications made with intent to harm." Any political opponent could easily fall under that definition.
Know of someone who deserves a SWAT? Click here to make a nomination.
Copyright 2009 Debra Legg. All rights reserved.


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General Motors (NYSE: GM) says it will proceed with the shutdown of the HUMMER brand, but TheCarConnection has confirmed that an American company has twice expressed interest in a HUMMER deal--both before and after a failed bid from a Chinese company. Raser Technologies (NYSE: RZ) is a...Read More»
NUMMI (New United Motor Manufacturing Inc.), the manufacturing plant set up in the 1980s as a revolutionary venture between GM and Toyota, has closed its doors, with the last vehicle, a Toyota Corolla, rolling off the line last week. Over the years, the plant has assembled a number of vehicles...Read More»
A couple of cancelled 2009 pickup models are still on dealer lots and could represent a bargain for prospective shoppers looking for a good deal! Automobile Magazine recently published a list of eight 2008 and 2009 model-year cars, trucks, and SUVs that have each hit the end of their respective...Read More»
We're all about empowerment here at TheCarConnection. We give you a voice in the car world by asking you to write for High Gear Media Web sites--and we're also here to answer the questions that come up while you're researching, shopping and driving your new car. Which brings us to the Dodge...Read More»
Sometimes the dead just won't stay dead. If you see some slightly ghoulish looking HUMMER H3s or Saturn Outlooks haunting your neighborhood, it's because each one has risen from the grave and re-entered production ... briefly. Though Saturn production ended last October, General Motors actually...Read More»
The Ford Mustang is one of a handful of cars rightfully called icons. Since its first spin on a car-show turntable at the World's Fair in 1964, it's been the auto industry's standard measure of overnight success. And for at least some of its wild youth, it was the cautionary tale of what happens...Read More»
Last summer we wrote briefly about the Mercedes-Benz ESF-2009 experimental safety concept vehicle, including its remarkable under-car airbag, which deploys only during a crash to help slow it down. It's a 2009 Mercedes-Benz S400 Hybrid full-size luxury sedan that's been fitted with several new and...Read More»
General Motors has just added Saturn models from the 2005 through 2010 model years to its Certified Used Vehicles program. Although the brand is no more, and most Saturn showrooms have closed, you'll find the certified Saturn models wherever GM Certified Used Vehicles are on offer—that's at 3,400...Read More»
The National Highway Transportation Safety Administration is investigating 1,132 customer complaints about the Chevrolet Cobalt. Drivers have reported a sudden loss of power steering in the 2005-09 Cobalt and the 2008-09 Cobalt SS, which has "resulted in difficulty controlling the vehicle, such as...Read More»
While the rest of the world recently got a new generation Ford Ranger compact pickup, the U.S. soldiers on with the long-in-the-tooth Ranger that many Ford fans know and love. But what can we in the U.S. expect with regard to a replacement for this venerable compact workhorse? Recently, fellow High...Read More»
Here we thought Toyota was just halting sales and production of all recalled Toyota Tundra pickups and other affected models out of concern for customer safety. Now it looks like Toyota actually had to suspend sales and production per National Highway Traffic Safety Administration regs. The...Read More»
In theory, the MINI should do well as an electric car: not only is its small size appropriate for a battery electric vehicle, but its target market of youthful, adventurous drivers are exactly the kind of eco-friendly early adopters who'd dig a plug-in ride. Unfortunately, when the MINI E arrived...Read More»
Toyota has announced a halt to sales and production of all recalled Toyota Tundra pickups. As a follow-up to a recent post HERE at AllPickupTrucks.com regarding Toyota's recent recall of 2007-2010 Toyota Tundra pickups for repairs to the accelerator pedal assembly, the company has now...Read More»
Gearheads and their tech cousins, propellerheads, often run in the same circles. Both are possessed by a love of tinkering, futzing, and generally crafting bits of metal and plastic into useful and/or awesome stuff. Honda's (NYSE:HMC) research team is no exception to the rule, being known not only...Read More»
There's no doubt that 2009 was a disastrous year overall for the U.S. auto industry. In spite of that, some automakers have a less bleak story to tell. Ford reported definite glimmers of hope with December 2009 sales gains. The company's sales were up a third from December 2008 and up a whopping 50...Read More»
Over 65,000 Hyundai Azeras from model years 2006 - 2009 are being recalled due to a malfunction in the driver's-side seatbelt, which can affect deployment of the driver's airbag. In a nutshell: the wiring harness on the seatbelt's tension sensor may get damaged over time, and if the tension sensor...Read More»
As the auto industry prepares for another year of auto shows, new-car introductions and crossed fingers, sales numbers for 2009 will be announced today, by most major automakers. The question rolling around in CEO offices from Tokyo to Stuttgart to Detroit: have we hit bottom dead center yet? It's...Read More»
If you are into collecting, need a new SUV and want to save some money, then you may just want to take a look at the 2009 Saab 9-7X. Introduced only three years ago, the 2009 model is likely to become a classic in the not-too-distant future. If you can still find one, the 9-7X, which really has...Read More»
Large SUVs and minivans have fallen on the hardest of times in the industry's late downturn, and casualties of the recession mount daily. Nissan today confirmed in an email to TheCarConnection that it would be bringing U.S. production of the Quest minivan to an end later this year, and will not...Read More»


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When do you use the formulas of the Coefficient of Variation? Can you set an example to justify your answer?
CV is best suited when the intrinsic distributions are exponential rather than Gaussian or other. When this is the case, the mean will equal the SD. Since it is a dimensionless ratio estimator, it is more suitable for processes that employ ratio scale units (eg Kelvin). Queuing theory uses CV quite frequently since Markovian processes are typical. Markov process are typically exponential.
Another good example where CV is the best choice are predator-prey or birth-death type problems where solutions are usually exponentially distributed.


text: I bought this great amp right here on TB. Only reason I'm getting rid of it is because the band broke up and I can't see myself needing this much power for a long, long time. Still in great shape. Haven't had a single issue with it. Looking to get [DEL]$400[/DEL] $375 shipped for it. I purchased this from Dee-Man, I hope he doesn't mind me using what he wrote about it. "Howdy TB. I've been shopping for a power amp, got a few, A/B'd them, now have to sell the ones I'm not keeping. So, for sale only is an excellent condition Crown K1 I recently got off ebay from a 100% positive seller. This discontinued amp gets lots of love here on TB, and for good reason. It is powerful, clean, very balanced sounding to my ears, has power-saving functions, 1.4V or +26db input sensitivity selection, bridges to mono and has NO FAN so it is dead quiet. 350w at 8 ohms 550w at 4 ohms 750w at 2 ohms 1500w at 4 ohms bridged mono. 2 rack spaces high. Weighs 32 pounds. I'll try to post a pic soon but it looks like a new one, except for some minor rack rash (front panel is very clean, and a cool blue)." Here's a link to the manual: www.crownaudio.com/media/pdf/legacy/102010.pdf Thanks and Merry Christmas!


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Marvel fans are taking to Twitter to demand an addition to the next "Captain America" movie — namely a boyfriend for the superhero.
Fans made the simple request using the hashtag #GiveCaptainAmericaABoyfriend. By early Tuesday morning, it was trending worldwide and as of this post, there are over 120,000 tweets with the hashtag.
Some chimed in with who they thought it should be. While many of the requests were to see Captain America paired with Sergeant James Buchanan "Bucky" Barnes (aka the Winter Soldier), there were also some suggestions for Tony Stark aka Iron Man in the mix as well.
Stony or Stucky??? #GiveCaptainAmericaABoyfriend pic.twitter.com/F5yMyw4y79— doritõ (@skisprincess) May 24, 2016
#GiveCaptainAmericaABoyfriend named Tony Stark or Bucky Barnes, please— magnus bane (@theoriginvls) May 24, 2016
I wake up and #GiveCaptainAmericaABoyfriend is trending,,,,,,ye Bucky Barnes or Tony Stark pls thx xo— harley is a fag (@spideysbucky) May 24, 2016
Many fans added to the discussion to explain why they believed Steven Rogers aka Captain America should have a boyfriend.
#givecaptainamericaaboyfriend because people just like me aren't fairly represented and this is the perfect chance to show diversity— rach (@rachbanks_) May 24, 2016
#GiveCaptainAmericaABoyfriend because kids deserve to know that not being straight doesn't mean you can't be a superhero— flic (@alecmagnvs) May 24, 2016
#GiveCaptainAmericaABoyfriend okay whatever 2016 we get it but like that's not how it is in the comics, he's with agent peggy carter soooo— Emchilada (@emjodway) May 24, 2016
Are you freaking kidding me!? #GiveCaptainAmericaABoyfriend trends on Twitter. Just no.— Aubrey Blankenship (@aubreynb) May 24, 2016
Don't #GiveCaptainAmericaABoyfriend @Marvel stick to the comic books like you do, let them create their own gay heroes— VM14 (@thaReal842) May 24, 2016
Y'all wanna #GiveCaptainAmericaABoyfriend when he JUST got out of a bad relationship pic.twitter.com/XZ4C7ektXc— /-\ | \/ /-\ (@_A1va) May 24, 2016
#GiveCaptainAmericaABoyfriend Give me a boyfriend first.— Meg (@Meg_Nerdfighter) May 24, 2016
people against the #givecaptainamericaaboyfriend hashtag be like pic.twitter.com/WgXXx4NYEK— carli b (@bilrac) May 24, 2016
I'm watching the amazing spiderman 2 with my dad 🌝🌌 #sebastianstan #bucky #buckybarnes #wintersoldier #jamesbuckhananbarnes #romaniangod #sebstanfans #chrisevans #steverogers #captainamerica #stucky #evanstan #marvel #teamcap #theavengers #civilwar #thewintersoldier #aou #thefirstavenger #theavengers #stucky #ironman #spiderman #blackwidow


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Welcome to CuteClothesstore.com!
At CUTEClothes we love to dress all women. Dressing Mothers, Daughters, Friends, Sisters, young or old, big or small is a job we embrace. We hand pick and wear every style we sell to insure your personal satisfaction. A long term relationship with you is our priority. Whether buying Hardtail Forever for your workout, or Ella Moss for your work day, our goal is to be sure you feel confident, attractive, and comfortable. We sell a variety of AG, J Brand, Current Elliott and Paige jeans to promise flattering styles for every body type. Our Splendid tops, tees, and our Vince Sweaters guarantee style galore. We've Got Your Style!


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News By Tag
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Industry News
Advertising Agencies - An Innovation And Presentation to the Masses
Advertising is a big word which has a large scope and can take different forms. It is the most popular method to sell out your product to the masses.
Kruse Media is one such advertising agency with brands both big and small and is the fastest growing. It is truly an Australian owned company. The company feels pride as it has a talented team to cater to its clients. The team works really hard. Strategic planning and creative thinking is their USP. It is one of the fastest growing advertising agencies in Melbourne. To understand or to know more about the Kruse Media please visit the site at http://www.krusemedia.com.au/
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Amazing charity with over 80% of all monies going straight to those in need. They help families of first responders. Also have helped with special needs. (please ignore the trolls leaving hate!) check for yourself!
Do not be mislead by the other negative comments for this foundation. They are ignorant people trying to hurt families which have benefited from this foundation directly. The foundation has a noble cause that impacts families directly in the time of need. Their arguments stem from unrelated issues and personal vendettas. I have donated in the past and continue to do so with the confidence that they do the right thing.
Review from Guidestar
This charity is supposed to help families of fallen officers yet he gives money to callers on his radio show. The financials aren't current, he's a know cheater & liar, why would anyone send their hard earned money to Bubba's foundation.
Review from Guidestar
Such a great charity. A good friend of mine was shot in the line of duty in charlotte county fl and this foundation held a fundraiser and donated the proceeds to his family. GREAT CHARITY. Unfortunately I can't donate as much as I like to but what I can donate I want to make sure it goes to good use in a local setting if possible (so you can see your money going to good use). This is where I donate what I can. Thank you btls
Review from Guidestar
Truly do try to help toward a good cause instead of trying to make a profit.
Review from Guidestar
I donated but now wondering the validity of the BTLS foundation. Bubba says more than 10% overhead means it's a shady charity & past returns show way more than 10% plus info missing from past returns.
I know of a family who was helped by this organization and I can honestly say that the compassion, the amount of money and the personal involvement was just incredible! isFor the people who are saying bad things, please just look up the charity on GuideStar.org and you will see that almost ALL the money is given to these families at their time of need. Just because the owner of this organization has a "public persona" that he uses to make a very successful career does not mean that this is who he is. Obviously, he is a person with a heart and is very philanthropic. Get real people, do your homework and then make your comments.
I have donated in the past, but this is starting to look questionable.
Bubba has always told his listeners to look up charitys on guidestar and look at their expenses vs. the amount that goes toward the cause and if it was more than 10% expenses it was a scam.
It appears that in 2012 that his expenses were almost 50% of the amount that was given away.
The 2012 report also says that there was almost 70 thousand left in reserves at the end of the year but early into 2013 he was calling for fundraisers so he could give some money away.
This sounds very fishy to me.
What happened in 2013 with this foundation with 'transparent and open' financials?
We may never know, it appears that he is no longer filing the tax forms.
Review from Guidestar
I hear great things about this organization. I always hear about checks being presented to families of slain officers, etc. But I'm curious why the financials have not been turned over to Guidestar for all to see? Bubba talks about how every cent minus operational overhead goes to charity. I'd like to see those numbers.
Review from Guidestar
I'm very picky about what non-profit orgs. I send my hard earned money to. I've heard Bubba talk about his foundation alot and all of the great stuff that he and his foundation do for the families of fallen police and other public service men and women. They fall into my criteria of at least 75% of all moneys donated is given back to the ones in need that his foundation was started to help.
Review from Guidestar


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GraphicRiver - 15 Logo Mock-Ups v4
Photoshop PSD | 3000x2200 | CS3+ | 627 MB
15 Logo Mock-Ups v.4
This item consist of 15 different background mock-ups to showcase your logo / identity design in a vintage photo-realistic appearance. These mockups are full layered PSD and used smart object feature so you can easily and quickly replace current logo template with your own just in few seconds.
15 PSD files
Photo realistic and real background/texture used
Smart object feature. Very easy to edit
Fully PSD's layred and well organization files
3000×2200px (300dpi)
PDF help
Logo not included
Home Page
Download link:
Links are Interchangeable - Single Extraction - Premium is support resumable
GraphicRiver - 15 Logo Mock-Ups v4 Fast Download via Rapidshare Hotfile Fileserve Filesonic Megaupload, GraphicRiver - 15 Logo Mock-Ups v4 Torrents and Emule Download or anything related.


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Silk Eggnog Bzzagent campaign!
As the air gets crisp that's when you know Fall is here and the Holidays are right around the corner.
The Silk milk company now makes their seasonal almond nog and egg nog in original, pumpkin spice and almond nog original.
I'm on the Silk Nog Bzzagent campaign and I found the nog drinks at my local stop&shop and since I'm a lover of all things pumpkin I chose pumpkin spice almond nog!
Pumpkin spice silk almond nog offers a taste like no other holiday drink I've tried before with the perfect blend of spices of the holidays, the essence of pumpkin and toasty almonds.
I've tried many Silk products before and loved them they are always so creamy and versatile in many ways whether you bake with them, pour over cereal, add to oatmeal, in a smoothie or drink it out of a glass either way it's tasty.
It was sweet, creamy, nutty, offered the right amount of spice and so delicious.
Silk Pumpkin Spice almond nog only contains 50 calories per serving, contains no saturated fat or cholesterol
Silk Pumpkin Spice contains no carrageenan, egg, soy, lactose, dairy,
gluten,and MSG
There's also no artificial colors or flavors
When there's a chill in the air I like to put myself to work in the kitchen making all sorts of recipes to warm up with on a cold Autumn night from soups, to hearty meals, cookies, pies or even breads.
The other day I whipped up a batch of coconut bread and I thought it would be perfect with a drizzle of maple syrup over it so infused it with some Silk pumpkin spice almond nog and then carefully poured it over the bread.
The syrup gave the bread a great pumpkin flavor with the essence of seasonal spices and a smooth nuttiness from the almonds.
The silk brand provided me with a sample of egg nog free of charge for testing purposes only, however all opinions expressed here in fact my own.


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Provider Name: COOK COUNTY
Doing Business As: PROVIDENT HOSPITAL OF COOK COUNTY
Classification: General Acute Care Hospital - 282N00000X
Entity Type: Organization
Address: 500 EAST 51ST STREET CHICAGO, IL ZIP 60615
Phone: (312) 572-1200
COOK COUNTY is a general acute care hospital in Chicago, IL. The provider is an acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. COOK COUNTY NPI is 1487664561. The provider is registered as an organization entity type. The provider Is Doing Business As Provident Hospital Of Cook County.
The provider's business location address is:
500 EAST 51ST STREET CHICAGO, IL ZIP 60615-494 Phone: (312) 572-1200 Fax: (312) 572-1294
The provider's authorized official is Robert Vais . The authorized official title is Director Of Cost And Reimbursement and has the following contact phone number (312) 864-4665.
The enumeration date for this NPI number is 8/9/2006 and was last updated on 7/27/2012.
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
What is NPI?
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider's speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.


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The Obama administration's persistent and unrelenting assault on Texas continues. In one of the most breathtaking examples to date, U.S. Attorney General Eric Holder announced on Thursday an effort to forbid Texas from making any improvements or reforms to our state election laws — such as voter ID laws and other laws to combat voter fraud — without the advance permission of the Obama administration.
Holder is doing this despite the fact that the U.S. Supreme Court just told him last month that this outdated and unconstitutional preclearance requirement is an affront to the "dignity" and "equal sovereignty" of the state of Texas. Holder himself was the losing party in that case, a 5-4 ruling issued in late June called Shelby County vs. Holder.
What's more, Holder is doing to Texas what he is not doing to liberal states like Massachusetts. Consider the following exchange between Chief Justice John Roberts and the Obama administration's top lawyer, Donald Verrilli, before the U.S. Supreme Court during the Shelby County oral arguments:
Roberts: Do you know which state has the worst ratio of white voter turnout to African-American voter turnout?
Verrilli: I do not.
Roberts: Massachusetts. Do you know what has the best, where African-American turnout actually exceeds white turnout? Mississippi.
The exchange continued:
Roberts: Which state has the greatest disparity in registration between white and African-American?
Verrilli: I do not know that.
Roberts: Massachusetts.
Why is the Obama administration discriminating against Texas — when Chief Justice Roberts has made so clear that a fair preclearance formula would have to cover Massachusetts before any other state? Why does the Obama administration insist on presuming that Texas is guilty of racial discrimination?
The reason for this gross insult to the people of Texas is simple. This is really about the Obama administration's partisan opposition to voter ID laws and other efforts to combat voter fraud.
Last August, a federal district court in Washington struck down our state's voter ID law. The U.S. Supreme Court's recent Shelby County vs. Holder ruling protects Texas from the lower court's erroneous decision. But now the administration is fighting back and attempting an end-around against the Supreme Court's decision.
This is not the first time Texas has had to fight judicial activism. As a young lawyer in 1985, I recall reading about a U.S. Supreme Court decision called Wallace vs. Jaffree. The state of Alabama passed a moment-of-silence law, so that students would have the right and the opportunity to pray and to reflect on their creator at the beginning of each school day. Six unelected members of the U.S. Supreme Court struck down that law.
That ruling had a profound effect on me. How can unelected judges in Washington purport to tell the people of Alabama or Texas or any other state that they cannot start each day with the opportunity to pray? I vowed that if I ever had the chance to fight back against the forces of judicial activism, and against the forces of hostility to people of faith, I would do it.
So in 2003, during my very first term as a member of the Texas House of Representatives, I sponsored legislation to return a daily moment of silence and opportunity for prayer — as well as the recitation of the U.S. and Texas pledges of allegiance — to our public school classrooms. We enacted that bill into law. The law was then, predictably, attacked in federal court. This time, Texas won — thanks to the leadership of our state's attorney general, Greg Abbott, a leading constitutional conservative.
And just recently, Abbott succeeded in getting rid of the federal court ruling striking down the Texas voter ID law. It is that ruling that the Obama administration is now trying to revive. So the fight for Texas continues.
State Rep. Dan Branch, R-Dallas, is a candidate for Texas attorney general and may be contacted at Dan. firstname.lastname@example.com.


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Paris suburb burns over rape and abuse allegations on cops
A picture taken on February 7 shows the wreckage of a burnt car in suburban Paris, owing to the violence. Pic/AFP
Paris: Violence spread in Paris's northern suburbs for a fourth night and French police arrested a dozen people, police said on Wednesday, amid accusations that police officers raped and beat a man they were detaining.
Dozens of vehicles and a nursery school were set on fire by youths during standoffs with police in an area of Paris. While damaging the nursery school and a car sales outlet, youths had also used a shopping trolley full of petrol bombs, police said.
The trouble began in Aulnay-sous-Bois on February 2, where four police officers were accused of using excessive force while arresting a 22-year-old man, including raping him with a baton. The four police officers have been suspended pending an inquiry and one has been placed under formal investigation for suspected rape and three others for unnecessary violence. The victim, a young black man, has himself called for calm, and he and his family say they trust the justice system will deal properly with the affair.


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Guwahati, Dec 1 (UNI) The Assam government today announced that transport expenses of poor HIV positive patients coming to anti-retroval therapy centres would be borne by the government, besides the already available free-of-cost medicines.
Moreover, it was also pumping in additional money to blood banks so that it can install latest technology to ensure that infected blood is not transfused.
The announcement was made during a function organized on the occasion of World AIDS Day, organized by the Assam State AIDS Control Society, today.
Addressing the function, state Chief Minister Tarun Gogoi said the disease had been contained to a great extent following a slew of measures and the scenario was also fast improving at the national level.
He maintained that the stigma attached to HIV/AIDS remained the greatest hurdle in fighting the disease and added that rapid urbanization and ignorance had led to fast spread of the disease.
State Health and Family Welfare Minister Himanta Biswa Sharma, also addressing the function, announced that anti-retroval therapy for HIV/AIDS patients would be available in Silchar Medical College from today, besides the ones existing in Guwahati and Dibrugarh medical colleges.
He also said that the state government would allocate funds from its own resources to meet the travelling expenses to anti-retroval therapy centres for needy patients.
He also disclosed that the state government has allocated Rs 4 crore for equipping the blood banks with latest technology so as to stop the spread of the disease through blood transfusion.
The Health Minister informed that the process for identification of persons with HIV and AIDS was on and 2,026 persons afflicted with the virus have been found out of the 22,000 blood screenings done so far.
Other dignitaries from various walks of life also participated in the function.


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Solar Heat at this Getaway!26 RHINDRESS WAY - Wonderful 6.9 acre homestead. This Cape has been lovingly maintained and upgraded with new windows and cedar shake siding. Enjoy playing basketball on your own half court or just sit back and relax on the deck. All that's left for you is to move in!
Listing information
- Year Built: 1973
- Status: Sold on 10/12/2011
- Total Square Footage: 1,720 ($114.83 per sq. foot)
- County: Rensselaer
- Property ID: 101549557
- Beds: 3
- Total Rooms: 7
- Lot Area: 6.90
- School District: Berlin
- Style: Cape Cod
- Baths: 2 (Full: 2 3/4: 0 1/2: 0 Other: 0)
- New Construction: No
- Estimated Annual Taxes: $4,714
Age Description Estimated
Basement Full
Condition Very Good
Exterior Cedar
Exterior Features Deck
General Taxes Description Estimated
Heat Fuel Electricity, Solar
Heat System Baseboard
Interior Features Sump Pump
Living Rm Fireplace Type Wood Stove
Lot Description Level, Privacy, Rolling Hills, Secluded, Sloped
Other General Taxes - 1654, School Taxes - 3060, Tax Id Section - 185, Tax Identification Block - 1, Tax Identification Lot - 15
Roof Asphalt Shingle
School Taxes Description Estimated
Sewer Septic
Sign Yes
Total Taxes Description Estimated
Water Well Except Dug
Den Main Level
Dining Room Main Level
Kitchen Main Level
Living Room Main Level
Bedroom 2nd Level
Bedroom 2nd Level
Bedroom 2nd Level
Listed by Kayel Buffaline of Coldwell Banker Prime Properties


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Maximizing the durability of viral suppression is a key goal of antiretroviral therapy. The objective of AIDS Clinical Trials Group Study 372A was to determine whether the intensification strategy of adding abacavir to an effective indinavir-dual nucleoside regimen would delay the time to virologic failure.
Zidovudine-experienced subjects (n=229) on therapy with indinavir + zidovudine + lamivudine with plasma HIV-1 RNA levels <500 copies/mL were randomized to abacavir 300 mg twice daily or placebo. The primary endpoint was the time to treatment failure, defined as a composite of confirmed virologic failure (2 consecutive HIV-1 RNAs >200 copies/mL) and treatment discontinuation.
At baseline, the study population was 88% male with a median age of 41 years and median CD4 cell count of 250/mm3. Median follow-up was 4.4 years. The primary endpoint was reached in 61/116 of abacavir versus 62/113 of placebo recipients (P = .77); virologic failure occurred in 34/116 and 42/113 patients, respectively (P = .22). There were no differences in the proportions of subjects with plasma HIV-1 RNA levels below 50 copies/mL, in CD4 cell count increases, nor adverse events between the arms. In the study, 17% of subjects developed nephrolithiasis, 2% experienced abacavir hypersensitivity, and 4.8% experienced at least 1 serious cardiovascular event (7 [6%] in the abacavir arm, 4 [3.5%] in the placebo arm). In additional secondary and post hoc analyses, rates of intermittent viremia, suppression below a plasma HIV-1 RNA level of 6 copies/mL, and HIV-1 proviral DNA levels in peripheral blood mononuclear cells were not significantly different in the 2 arms.
The strategy of intensification with abacavir in patients who are virologically suppressed on a stable antiretroviral regimen does not confer a clinical or virologic benefit. As antiretroviral regimens have become more potent since this trial was completed, it will be even more difficult to prove that late intensification of already virologically suppressed patients will add benefit. However, studies are warranted with drugs with new mechanisms of action to determine whether the level of persistent viremia below 50 copies/mL can be further reduced and what influence this may have on latent HIV reservoirs.
Effective antiretroviral therapy is dependent upon the ability of combination drug therapy to suppress viral replication, as measured by the plasma HIV-1 RNA, to levels below the detection limit of the most sensitive assays commercially available.1,2 In practical terms, suppression of viremia is associated with durability of the virologic response, prevention of the emergence of drug resistance mutations, and immunologic and clinical benefit.3 The sustainability of a therapeutic response to a particular antiretroviral regimen is important with respect to maintenance of future treatment options given the long-term management of HIV-1 disease that can now span decades.4 One of the strategies proposed to achieve this goal is treatment intensification, that is, the addition of one or more drugs to an already existing regimen. Intensification of regimens in the setting of moderate levels of viremia with drugs such as abacavir or tenofovir has proven to be effective,5–9 but the efficacy of intensification in the setting of already successful plasma viral suppression has not been demonstrated in a randomized trial. AIDS Clinical Trials Group Study 372A was designed to answer the question of whether intensification with abacavir in this setting would delay the time to treatment failure.
ACTG 372A was a randomized, double-blind, placebo-controlled trial of abacavir intensification in patients with plasma HIV-1 RNA levels below 500 copies/mL on a regimen of indinavir, zidovudine (or stavudine), and lamivudine. The study was originally designed as a rollover study to ACTG 320, which proved the superiority of the combination of indinavir, zidovudine (or stavudine), and lamivudine over the dual nucleoside combination of zidovudine (or stavudine) and lamivudine.10 Subjects who were originally randomized to the indinavir-containing arm, or who received indinavir during the course of the ACTG 320 trial after reaching a study endpoint, and whose plasma HIV-1 RNA level was <500 copies/mL at the end of the study were eligible for screening for ACTG 372A. During the enrollment period, patients meeting similar criteria as the original ACTG 320 study population were also eligible for screening.
The primary objectives of the study were (a) to compare the time to the composite endpoint of virologic failure or permanent treatment discontinuation between the study arms and (b) to evaluate the safety and tolerability of the treatment arms. Virologic failure was initially defined as 2 consecutive plasma HIV-1 RNA values >500 copies/mL as determined by the standard Roche assay (Branchburg, New Jersey, USA). Early during the course of the trial, the virologic failure definition was revised to 2 consecutive plasma HIV-1 RNA values >200 copies/mL as measured by the ultrasensitive Roche Amplicor HIV-1 Monitor assay. Permanent treatment discontinuation was defined as discontinuation of one or more components of the regimen except for the substitution of stavudine for zidovudine. The secondary objectives were to compare the following between the treatment arms: time to virologic failure; CD4 cell count responses; AIDS-defining events and death; drug resistance profile of virus at the time of virologic failure; and, in subsets of subjects, plasma virus suppression using an assay with a level of detection of 6 RNA copies/mL, quantitative proviral DNA in peripheral blood mononuclear cells (PBMCs), and the frequency of intermittent viremia.
The patients were recruited from 31 adult AIDS Clinical Trials Units in the United States. For prior participants in ACTG 320, the inclusion criteria were original randomization to indinavir, zidovudine (or stavudine), and lamivudine; receipt of indinavir during the course of the trial after reaching a study endpoint (ie, an AIDS-defining illness); a plasma HIV-1 RNA level <500 copies/mL at the end of ACTG 320; and maintenance of the ACTG 320 study regimen until entry into ACTG 372A. For non-ACTG 320 volunteers, the inclusion criteria were documented HIV-1 infection; documentation of a CD4 cell count ≤200/mm3 at the time of initiation of indinavir, zidovudine (or stavudine), and lamivudine; at least 3 months of therapy with this regimen prior to entry into ACTG 372A; a Karnofsky performance ≥70; and age ≥16 years. The study was approved by the institutional review boards of the participating institutions, and all patients gave written, informed consent. ACTG 320 and non–ACTG 320 patients were excluded if they had an AST or ALT >5 times the upper limit of normal or a serum creatinine >3 times the upper limit of normal. Non–ACTG 320 volunteers were also excluded if the hemoglobin was <9.1 g/dL for men or 8.9 g/dL for women, the absolute neutrophil count was <750/mm3, the platelet count was <55,000/mm3, the total bilirubin was >1.5 times the upper limit of normal, or the total serum amylase was >1.5 times the upper limit of normal.
The patients received open-label indinavir 800 mg every 8 hours, zidovudine 300 mg twice daily (or stavudine 40 mg twice daily [30 mg twice daily if the patient's weight was <60 kg]), and lamivudine 150 mg twice daily and were randomized in a double-blind fashion to abacavir 300 mg twice daily or matching placebo.
The patients were monitored at weeks 2, 4, and 8 and every 8 weeks thereafter until the closure of the study for clinical symptoms and signs, routine hematology, serum chemistries, liver enzymes, CD4 cell counts, and plasma HIV-1 RNA levels; formal adherence monitoring was not assessed. Enrollment began on October 9, 1997, and closed on January 20, 1998. The status of the study was reviewed 4 times by an independent Interim Review Committee in January 1999, January 2000, February 2001, and February 2002. Each time, the Committee's recommendation was for the study to continue with no substantive changes.
Genotype analysis of plasma virus was performed using the Viroseq kit (Celera, Alameda, California, USA). In those patients who remained on original study treatment and exhibited sustained virologic suppression (HIV-1 RNA <50 copies/mL) throughout the study, plasma HIV-1 RNA levels were determined by a modification of the Roche ultrasensitive assay that permitted HIV-1 RNA quantitation down to a level of 6 copies/mL. Proviral DNA in PBMCs was quantitated by a polymerase chain reaction method previously described.11
The distributions of all time-to-event endpoints were estimated using the method of Kaplan and Meier and were compared using a log-rank test. Patients without events were censored at the time of their last available HIV-1 RNA measurement. All P values and confidence intervals are nominal and unadjusted for multiple comparisons and interim analyses. All reported P values are 2-sided. All safety analyses were as-treated with data censored 8 weeks after permanent discontinuation of treatment.
Analyses of virologic responses included time-to-event analyses of virologic failure at HIV-1 RNA level >200 copies/mL and >50 copies/mL and proportions of patients with HIV-1 RNA levels <50 copies/mL. The impact of intermittent viremia during the first 48 weeks of follow-up (single HIV-1 RNA level >50 copies/mL) on subsequent risk of virologic failure (>200 copies/mL) was evaluated using Cox proportional hazards models in the subgroup of patients at risk for virologic failure at 48 weeks. A chi-square test compared the number of patients with at least one intermittent viremia episode by treatment arm.
In post hoc analyses, the proportions of patients with plasma HIV-1 RNA levels <6 copies/mL and quantitative proviral HIV-1 DNA levels in PBMCs in the 2 study arms were compared in a subset of patients who remained on initial study treatment with plasma HIV-1 RNA levels consistently <50 copies/mL throughout the course of the study.
CD4 cell counts are presented using mean changes from baseline; Wilcoxon rank sum tests were used to compare the CD4 distributions by treatment arm at yearly intervals. Unless otherwise stated, HIV-1 RNA and CD4 analyses presented were intent to treat.
SAS Versions 6 and 9 (SAS Institute Inc, Cary, North Carolina, USA) were used for all analyses.
There were 229 patients randomized to the study (Figure 1). Of these, 207 (90%) had received indinavir on enrollment into ACTG 320, 18 (8%) received indinavir in ACTG 320 after reaching a study endpoint, and 4 (2%) were non–ACTG 320 patients. Eighty-eight percent were male; 64% white, non-Hispanic; 15% black, non-Hispanic; 17% Hispanic; and 3% Asian Pacific Islander, American Indian, or Alaskan. The median age was 41 years and the median CD4 cell count was 250/mm3. The baseline characteristics were well balanced across the study arms (Table 1). A total of 36 patients were receiving stavudine in place of zidovudine at the start of the study (18 in each arm).
The median duration of follow-up was 277 weeks (range, 30–285). One hundred seventy-nine patients (78%) completed the study, and 124 (54%) completed the study on their original treatment assignment. The median duration of randomized treatment was 272 weeks (range, 3–283). Of the 105 patients prematurely discontinuing study treatment prior to study completion or discontinuation, 17 discontinued for protocol-defined toxicity. Low-grade toxicities (14 patients), virologic failure (21 patients), and non–protocol-defined clinical events (n=13) were the other predominant reasons for patients or clinicians deciding to prematurely discontinue study treatment among those patients completing follow-up (Figure 1). Three subjects switched from zidovudine to stavudine during the course of the study for zidovudine-related toxicity. There were no differences between the arms with respect to study follow-up or duration of study treatment (P = .82).
Sixty-one (53%) of 116 patients and 62 (55%) of 113 patients in the abacavir and placebo arms, respectively, reached the primary study endpoint (Figure 2A; P = .77). Thirty-four (29%) of 116 patients and 42 (37%) of 113 patients in the abacavir and placebo arms, respectively, reached the virologic failure endpoint of 2 consecutive plasma HIV-1 RNA levels >200 copies/mL (Figure 2B; P = .22). There was also no significant difference in the distribution of time to virologic failure at the HIV-1 RNA level >50 copies/mL (Figure 2C; P = .65). At week 240, the estimated probability of continued plasma HIV-1 RNA levels <50 copies/mL was 52% (95% confidence interval [95% CI], 42–61) in both the abacavir and the placebo arms.
Forty-nine of the 192 patients at risk for virologic failure at week 48 experienced at least one episode of intermittent viremia during the first 48 weeks of the study, with no significant differences between the study arms (P = .13). Compared to patients with HIV-1 RNA levels continually <50 copies/mL, intermittent viremia was not significantly associated with subsequent virologic failure (hazard ratio [HR], 1.06; 95% CI, 0.38–3.01; P = .91).
Samples in the 98 patients who remained on initial study treatment and whose plasma HIV-1 RNA levels were consistently <50 copies/mL throughout the course of the study were reassayed at baseline and at weeks 2, 4, and 48 using a modification of the Roche ultrasensitive plasma HIV-1 RNA assay that lowered the limit of detection from 50 to 6 copies/mL. In the abacavir arm, 51% (23/45), 56% (19/34), 47% (17/36), and 49% (22/45) of samples were below 6 copies/mL at baseline and weeks 2, 4, and 48, respectively. In the placebo arm, 51% (20/39), 62% (21/34), 50% (17/34), and 52% (24/46) were suppressed below 6 copies/mL. In this same subset of patients, 82 had results for quantitation of proviral HIV-1 DNA in PBMCs. After a median of 252 and 246 weeks on study, the median (1st, 3rd quartile) log10 DNA copies per 107 PBMCs in the abacavir arm was 3.72 (3.48, 3.95) and in the placebo arm it was 3.78 (3.60, 4.03), respectively.
Sequencing of the HIV-1 reverse transcriptase and protease genes from plasma was successful in 69 of the 76 instances of virologic failure (28 of 34 failures in the abacavir arm, 41 of 42 failures in the placebo arm). Table 2 lists the amino acid substitutions in reverse transcriptase and protease by codon site for the abacavir and placebo arms using the mutations listed in the International AIDS Society–USA table (www.iasusa.org). There were no differences in the types or frequencies of amino acid substitutions seen. The M184V/I lamivudine-associated mutation was detected in 46% (13/28) and 45% (18/41) of the plasma samples derived from virologic failures in the abacavir and placebo arms, respectively. Thymidine analog (zidovudine)–related mutations (TAMs) were present at codons 41, 67, 70, 210, 215, and 219 at comparable rates in both arms. Their detection was expected because all original ACTG 320 subjects were required to be zidovudine experienced for inclusion into that study. Supportive data for this were provided by genotyping baseline ACTG 320 samples that were available for 58 patients who subsequently enrolled in ACTG 372A (23 in the abacavir arm, 35 in the placebo arm) and experienced virologic failure. In patients for whom paired samples existed, a high proportion of the patients with TAMs detected at the time of virologic failure in ACTG 372A were found to have had the same mutations at entry into ACTG 320. For each of the following mutations, the number of patients with that mutation at ACTG 320 baseline divided by the number of patients with the same mutation detected at the time of virologic failure in ACTG 372A, grouped across study arms, were as follows: M41L (20/23 [87%]), D67N (23/27 [85%]), K70R (22/23 [96%]), L210W (12/14 [86%]), T215Y/F (32/35 [91%]), and K219Q/E (10/12 [83%]). In contrast, M184V/I was not detected in any of the ACTG 320 baseline samples sequenced.
The mean increases in CD4 cell counts from baseline at week 240 in the abacavir and placebo arms were 189/mm3 (range, −124 to 648/mm3) and 177/mm3 (range, −446 to 720/mm3), respectively, with no significant difference in the distributions between treatment arms (P = .37).
Two AIDS-defining events (1 in each arm) and 10 deaths (6 in abacavir arm, 4 in placebo arm), of which 2 reflected HIV disease progression, occurred during the course of the study.
The overall proportion of patients with at least one new grade 3 and 4 sign and symptom in the study population over the course of the study was 32%, with general body, gastrointestinal, and neurologic complaints predominating. The overall proportion of patients with at least one new grade 3 and 4 laboratory abnormality was 64%, with elevations in creatine phosphokinase, triglycerides, bilirubin, aspartate aminotransferase, alanine aminotransferase, and amylase predominating. There were no significant differences between the study arms in the overall distribution of the time to first adverse event (P = .48, signs and symptoms; P = .43, laboratory events).
The overall rate of nephrolithiasis was 17%, with 14 events seen in the abacavir arm and 26 in the placebo arm (P = .037). Abacavir hypersensitivity was identified retrospectively as the syndrome had not been fully defined at the initiation of the study. Two cases, yielding a rate of 2%, were identified in the abacavir arm; this rate is lower than that seen in prospective studies before the advent of HLA-B*5701 testing and may relate to the retrospective nature of the case finding.
Eleven patients experienced serious cardiovascular events during study follow-up: 7 (6%) in the abacavir arm and 4 (3.5%) in the placebo arm. The median age at study entry of these 11 patients was 49 years, and 100% were male. Myocardial infarction occurred in 4 and 3 patients, unstable angina in 1 and 0, and cerebrovascular accident in 2 and 1 in the abacavir and placebo arms, respectively. One subject had discontinued study treatment 2 years prior to the event. For the remaining subjects, the time on study (and study treatment) at the time of the event was 99 and 163 weeks in the 2 arms, respectively.
Current guidelines for the treatment of HIV-1 infection emphasize the importance of maximal viral suppression to achieve durability of the immunologic and clinical responses and to prevent the emergence of drug resistance.1,2 Operationally this has translated into achieving suppression of plasma HIV-1 RNA to <48 to 75 copies/mL as this is the lower limit of detection of commercially available assays. However, in persons whose plasma HIV-1 RNA levels are consistently suppressed below this level, residual viremia can be detected in most, and replication-competent HIV-1 remains in the memory, resting CD4+ lymphocyte pool. In addition, other viral reservoirs may exist, and viral evolution, albeit limited, may continue.12–21 This raises the question of whether the strategy of intensifying an already successful antiretroviral regimen would yield a clinical benefit in terms of reducing the likelihood of subsequent treatment failure. ACTG 372A was designed to answer this question.
Abacavir was chosen as the drug with which to intensify the indinavir, zidovudine, and lamivudine regimen because efficacy had been demonstrated in other intensification studies in which abacavir had been added to patients with persistent viremia.5,7 The use of a non–ritonavir- boosted, indinavir-containing regimen is outdated by current standards but may have provided a greater likelihood of seeing a benefit from intensification given the superior antiviral potency of ritonavirboosted versus nonboosted protease inhibitors.22
This study is notable for its substantial follow-up (median 4.4 years) and relatively high patient retention (79%). The study was event- rather than time-driven, with the original event target being 80 virologic failures. The study duration, well over 4 years during which 76 virologic failure endpoints accrued, demonstrates how well this originally advanced disease population did on a potent antiretroviral drug combination over the course of several years.
The primary efficacy endpoint of this study was a composite of virologic failure and premature treatment discontinuation in order to reflect clinical practice. A total of 123 endpoints were accrued during the course of the trial, with no significant difference between the abacavir and placebo arms. Similarly, there was no significant difference between the study arms when the virologic endpoints of a confirmed rise in plasma HIV-1 RNA to above 200 copies/mL and virologic suppression below 50 copies/mL during the course of the study were analyzed.
The negative results of the first-order analyses led us to explore other virologic parameters to determine whether a more subtle difference between treatment arms could be detected. Four approaches were taken. These included analyzing the proportion of subjects suppressed to below 6 HIV-1 RNA copies/mL by a modification of the Roche ultrasensitive assay through 48 weeks, quantification of proviral HIV-1 DNA in PBMC after long-term suppression (median 246–252 weeks), the frequency of intermittent viremia ("blips"), and the patterns of drug resistance mutations appearing at the time of virologic failure. None of these analyses revealed differences between the 2 treatment arms, providing additional data in support of the primary analysis.
CD4 cell count increases were substantial and similar across both study arms. No differences in clinical endpoints (AIDS-defining events and deaths) were seen between the arms, but the study was not powered for this comparison.
Overall rates of grade 3 and 4 signs and symptoms and laboratory abnormalities were not significantly different between the 2 treatment arms and no unexpected toxicities were seen. Nephrolithiasis is a well-recognized complication of indinavir therapy. Fewer nephrolithiasis events were seen in the abacavir arm, but there is no evidence for a pharmacokinetic interaction between indinavir and abacavir.23
Subsequent to the closure of ACTG 372A, an association between abacavir and risk for myocardial infarction was reported,24 although this association and any causal relationship remain under debate.25 The placebo-controlled addition of abacavir to a prior regimen, in combination with the long-follow-up in this study, provided an opportunity to examine this question in a retrospective, post hoc fashion. Eleven patients were reported to have experienced serious cardiovascular events during study follow-up: 7 in the abacavir arm and 4 in the placebo arm. These data are presented descriptively; although there were more of these events in the abacavir arm, the numbers are too small to draw comparative conclusions. Overall, the incidence of serious cardiovascular events was low.
Our virologic results differ from the reports of Havlir et al26 and Ramratnam et al.27 In the Havlir et al report, 14 patients treated with indinavir and efavirenz who had plasma HIV-1 RNA levels <50 copies/mL for more than 5 years were studied. Of these 14 patients, 5 were intensified with abacavir. Four of 5 patients with detectable plasma HIV-1 RNA who intensified with abacavir demonstrated a decline in residual viremia with an estimated infected cell half-life of 6.7 days. No differences in CD4 cell count changes were seen. In the Ramratnam et al study, 5 patients on long-term protease inhibitor–containing combinations had their regimens intensified with abacavir or abacavir plus efavirenz. Three of these 5 patients were noted to have a decrease in the size of the memory, resting CD4+ cell latent reservoir. The frequency of intermittent viremia decreased in 4 of 5 of these patients. Both of these studies were small, and there are notable differences from our study in design, drug regimen, assays performed, and duration of follow-up.
In contrast, our findings are supported by the report of Maldarelli et al that the viral set point below 50 copies of HIV-1 RNA/mL in patients on antiretroviral therapy is related to the level of pretherapy viremia and not the potency of the treatment regimen.28 Our results are also consistent with a number of well-powered studies that failed to show that initial therapy with 4 versus 3 drugs provides additional benefit.29–33 Prolonged release of virus from chronically infected cells has been proposed as the origin of residual viremia below 50 HIV-1 RNA copies/mL despite reverse transcriptase inhibitor– and protease inhibitor–based therapies.14 Current therapies, including abacavir, block new cycles of viral replication but do not affect virus production from long-lived chronically infected cells. The lack of effect of abacavir on persistent viremia in our study is consistent with this paradigm.
Interest in intensification strategies has recently been renewed in parallel with the approval of antiretroviral agents with mechanisms of action different from reverse transcriptase and protease inhibitors, specifically, raltegravir, an integrase strand transfer inhibitor, and maraviroc, a CCR5 antagonist. Single-arm and randomized trials of raltegravir intensification ranging from 4 to 48 weeks in individuals virologically suppressed on potent antiretroviral regimens have consistently shown that low-level plasma viremia is not reduced,34–39 a finding compatible with the absence of ongoing viral replication. However, in 2 of these studies, Yukl et al37 reported a decrease in HIV RNA and immune activation in the ileum and Buzon et al38 reported an increase in 2-LTR HIV DNA circles in PBMCs in 29% of patients in the raltegravir arm, suggesting that some individuals may have ongoing viral replication in cell or tissue reservoirs.
Studies of intensification with maraviroc have yielded consistent results: no demonstrable decrease in low-level plasma viremia but some decrease in markers of immune activation in PBMCs and gastrointestinal tract tissue.39–41
Thus, novel strategies will be needed to reach the cellular reservoirs responsible for the irreducible level of detectable viremia.42 Approaches being considered include pharmaco- or immunotherapeutic interventions targeted to disrupt HIV proviral DNA latency in cellular reservoirs, including histone deacetylase inhibitors (more potent than valproic acid43), kinase antagonists (eg, hexamethylbisacetamide), phorbol esters (eg, prostratin), and interleukin-7 (see ref. 42 for review).
Despite its limitations, ACTG 372A is important in that it tested the strategy of late intensification in a virologically suppressed population, and it is the largest and longest randomized trial of this strategy reported to date. This study lends strong support to the current practice of using a potent regimen capable of suppressing plasma HIV-1 RNA levels to <50 copies/mL, but that once this goal is achieved, further intensification of the regimen provides no demonstrable benefit.
Acknowledgments for ACTG 372A
The authors have received the following support: Clinical Trials Unit (CTU) grant AI069470 and Clinical and Translational Science Award (CTSA) RR024156 (Dr. Hammer); CTU grant AI069494-03S1 (Dr. Mellors); CTU grant AI068636 (Dr. Morse); ACTG Pharmacology Specialty Laboratory grant BRS-ACURE-Q-06-00140-T001 (Social and Scientific Systems).
Additional protocol team members: Michael Robertson (Merck Research Laboratories), Steven Schnittman (Bristol-Myers Squibb), Marjorie Dehlinger (Division of AIDS, NIAID), and Ann Walawander (Frontier Science & Technology Research Foundation).
Clinical site personnel and grant support: Judith Feinberg and Sharon Kohrs (University of Cincinnati College of Medicine), CTU grant AI-069513; Michael Para and Kathy Watson (Ohio State University), CTU grant AI069474; Jorge Santana Bagur and Santiago Marrero (University of Puerto Rico), CTU grant AI069415; David Ragan, Cheryl Marcus, and Joseph Eron (University of North Carolina), CTU grant AI069423, GCRC grant RR00046, CTSA grant RR025747, CFAR grant AI50410; Hector Bolivar and Sandra Navarro (University of Miami), CTU grant AI069477 and AI027675; CFAR grant AI073961; Ge-Youl Kim and Michael Klebert (Washington University at St. Louis), CTU grant AI069495; Ilene Wiggins and Andrea Weiss (Johns Hopkins University), CTU grant AI069465, GCRC grant RR023561; Dee Dee Pacheco and Jill Kunkel (University of California San Diego), CTU grant AI 69432; Karen Cavanagh and Janet Forcht (New York University/Bellevue Hospital Center), CTU grant AI027665 and AI069532; Charles Hicks and Joan Riddle (Duke University Medical Center), CTU grant AI069484; Barbara Gripshover and Jane Baum (Case Western University), CTU grant AI069501; Kenneth Fife and Beth Zwickl (Indiana University), CTU grant AI025859; Melinda Robertson and Rebecca Creamer (University of Alabama at Birmingham), CTU grant AI069452; Henry Balfour, Jr and Heather Vezina (University of Minnesota), CTU grant AI2766; William O'Brien and Gerianne Casey (University of Texas, Galveston), CTU grant AI032782; Mary Albrecht and Carol Silver (Beth Israel Deaconess Medical Center); CTU grant AI069472; Sadia Shaik and Mario Guerrero (Harbor-UCLA Medical Center), CTU grant AI069424; Mussolini Africano and Luis M. Mendez (University of Southern California), CTU grant AI069428; Nancy Hanks and Scott Souza (University of Hawaii), CTU grant AI032853; Rob Roy MacGregor and Isabel Matozzo (University of Pennsylvania), CTU grant AI-069467; CFAR grant AI045008; Jane Reid and Carol Greisberger (University of Rochester), CTU grant AI069511, GCRC grant RR 024160; Juan Lertora and Erin Plaia (Tulane University) GCRC grant RR05096; Kim Whitely and Robert Kalayjian (Metrohealth Medical Center, Cleveland) CTU grant AI069501; Lisa Dasnoit and Tim Lane (Moses Cone Memorial Hospital, Greensboro, NC), CTU grant AI069423; Beverly Putnam and Graham Ray (University of Colorado), CTU grant AI69450, GCRC grant RR025780, CFAR grant AI54907; Michael Morgan and Janet Nicotera (Vanderbilt University), CTU grant AI069439; Susan Swindells and Frances Van Meter (University of Nebraska Medical Center), CTU grant AI027661; Sharon Hewitt and James Horton (Carolinas Medical Center, Charlotte); Melody Palmore and Betsy Hall (Emory University), CTU grants AI069418 and AI050409; Valery Hughes and Todd Stroberg (Cornell University), CTU grant AI069419, GCRC grant RR-024996; Jeffery Meier and Jack Stapleton (University of Iowa Hospitals and Clinics), CTU grants AI027661 and AI058740; Donna Mildvan and Gwendolyn Costantini (Beth Israel Medical Center), CTU grant AI046370; Harold Kessler and Ruth Davis (Rush Presbyterian/St. Luke's Medical Center), CTU grant AI069471; Joseph Pulvirenti (Cook County Hospital); Timothy Cooley and Ruth Haivanis (Boston Medical Center), CTU grant AI069472; Jane Norris and Patricia Cain (Stanford University), CTU grant AI069556; Debbie Slamowitz and Sandra Valle (San Mateo County AIDS Program), CTU grant AI069556; Tamara O'Hara (State University at Buffalo); Robert Murphy and Baiba Berzins (Northwestern University), CTU grant AI069471; Neel French (Louis A. Weiss Memorial Hospital).
Study Sponsor
This study was performed by the AIDS Clinical Trials Group and was sponsored by the Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases, National Institutes of Health. Data management and analysis were performed under the auspices of the ACTG, and all authors had access to original datasets. Drugs were supplied by GlaxoSmithKline, Merck Research Laboratories, and Bristol-Myers Squibb through clinical trials agreements with DAIDS. This study is registered as NCT00000885 at ClinicalTrials.gov.
Financial Disclosure
Dr. Hammer serves as consultant to Merck and Progenics and served on a Data Monitoring Committee for Bristol-Myers Squibb. Dr. Mellors is a consultant to Merck, Gilead Sciences, and RFS Pharma and is owner of stock options in RFS Pharma. Dr. Demeter's spouse receives royalty income from GlaxoSmithKline and Merck related to HPV vaccines. Dr. Demeter has no HIV-related conflicts. Dr. Coombs is a consultant to Merck. Dr. Gerber is a consultant to Merck. Dr. Spreen is a GlaxoSmithKline employee and shareholder. Dr. Squires receives grant support from Biocryst, Gilead Sciences, GlaxoSmithKline, Merck, and Tibotec and is consultant to and receives honoraria from Gilead Sciences, GlaxoSmithKline, Merck, Schering-Plough, Tibotec, and Tobira.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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It's been less than a year since we opened our campus in Detroit, and since then we've met and worked with tons of inspiring people in the Detroit tech industry. Today we're introducing you to one of our current students, Chris Newby. Chris had dabbled in coding here and there, but he never considered it a career path. After high school, he took a few college classes, but never finished.
He landed a job at a parts plant and worked there for three years before finding The Iron Yard. It didn't take long for Chris to make the decision to enroll. We recently sat down with him and talked a bit more about his journey, how class is going, and where he wants to go from here.
Check out the rest of our conversation with Chris below (transcript follows video). Read More


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Bard Build Guide by linkydw
Not Updated For Current Season
This guide has not yet been updated for the current season. Please keep this in mind while reading. You can see the most recently updated guides on the browse guides page.
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Bard Build
Starting Items
First Back (Option 1)
First Back (Option 2)
Core Items
Ability Sequence
Not Updated For Current Season
The masteries shown here are not yet updated for the current season, the guide author needs to set up the new masteries. As such, they will be different than the masteries you see in-game.
Threats to Bard with this build
Play maker in right hands
Can tower dive with ease
can force/stall team fights
Improves team mobility and map presence
Lane sustain
Passive allows him to scale in to late game
Low cooldown cc abilities
Champ is only as good as his team is
Requires decisive player
Hard to play due to high skillcap
Item explanation
Starting items
Spell thief's edge is the best item for bard as it provides the best gold income out of the support items as an auto attack with an empowered meep consumes 2 stacks of the passive, it also makes your auto attacks hurt more. However I do not recommend upgrading this item as the extra damage is not required outside of the laning phase.
First Back
Option 1: Buy boots on first back if you are playing aggressively (poking and harassing a lot in lane) as the extra movement speed lets you get in and out of auto attack range quickly allowing you to outrade the bootless adc/support. The ruby crystal also makes you a bit tankier further allowing you to win trades.
Option 2: If you are forced to play passively, a sight stone is the way to go as it is part of your core build.
Core Items
By mid game you should have either lucidity boots or mobility boots and a one or two of the recommended defensive items based on whether you require health, magic resist or armour.
Late game
By late game you should sell your boots for ninja tabi or mercurial treads, you should also decide whether you require a banner of command or a locket depending on which active you need more. If they have a heavily attackspeed based comp take frozen heart, zekes harbinger is also extremely useful for boosting your adcs damage. Take righteous glory if your team lacks hard engage and a mikaels crucible if they have game changing cc abilities.
Bard Passive (Travellers Call)
Bard's passive, Traveler's Call will make chimes appear on the map every 50 seconds. When you pick up one, you will get mana based on your missing mana, 20 xp and a stackable movement speed buff, which makes it very easy to collect chimes which are close to eachother and placing some deep wards in the enemy jungle. Important to note, chimes will despawn after 10 minutes, they will turn red on the minimap if they are close to despawning. The extra mana you get from your chimes when you collect them is really useful in the early game because you have to place alot of Caretaker's Shrine wich cost alot of mana. Each chime gives about 50 mana back, this increases when you level.
There are some important numbers considering your stack, which if you can, reach as soon as possible. They are the blue, green and yellow ones. These are increasing your width of attack, slow rate and max number of meeps. You dont take Bard for his dmg, altough you can clear one big wave after mid game if you picked up most of your chimes.
As your meeps alter your autoattack, they will be able to slow, do area effect+damage and more. If you put slow on attack+area effect together, you get a very useful passive which works great in teamfights as you can slow multiple enemies multiple times, and though his damage is still not great, in later stages of the game meeps will hurt the enemy carries. Also note that empowered meeps count as a single spell thus procing slows from rylais and also has the extremely useful ability of removing spellshields such as sivir's shield, nocturne's shield as well as banshees.
Bard Q (Cosmic Binding)
This skillshot is only slightly faster than morgana's q which makes it an extremely slow and easy to dodge skillshot. However as it works like a lux binding, you can double your distance if you fire it off into a minion or another opponent before landing on your desired target. However the range is fixed so if you fire it point-blank the second part of the skill won't go very far. Always aim to stun the opponent however the slow is also beneficial especially when paired with your passive slow (beginning when you acquire 25 meeps).
If someone followed you through your tunnel, you can easily stun them, as they will exit next to a wall, if more follows, wait a bit so you will stun two. You may even ult in to set up a very good team fight for your team, or just to get away if noone is near.
If you managed to catch somebody with your ult, get in range (with E or just walk), so that when your ult wears off, you can insta-stun them. If you have close to 40% cdr and a level 5 skill you can also q stun an opponent, ult then q them as they come out of statis allowing you to lock down an opponent for an enormous 5.1 seconds
You can try to stun through minions, but keep in mind that if the minions are cramped up, your Q will probably hit another minion as the width of it is pretty big.
Bard W (Caretaker's Shrine)
It takes 10 seconds for the shrines to build up in power and you can only place 3 of these shrines on the map which remain unless consumed. Stepping on the shrine allows the ally or Bard to consume it providing a 50% speed boost which decays over 1.5 seconds instantly however enemy champions stepping on the chime consume it with no effect.
You can place 3 shrines on the map and then proceed to place a 4th chime over an ally or Bard instantly consuming the chiime and providing the unempowered heal and 50% speed boost without destroying the original 3 chimes.
Bard E (Magical Journey)
You can use it on the walls of the spawn area to get to lane faster or get back to spawn quicker when sieging inhibibtor towers.
Pretend you are fake roaming in lane when your jungler is ganking and portal in behind the enemy unexpectedly.
If you are caught, place your e first before flashing in to it for quick get aways.
Use your q ability for a free stun if an enemy follows you in to the tunnel, wait a few seconds if there are two enemies as you can stun both.
When traversing through the portals you can collect chimes that your body nicks.
Traveling through the portal does not mean you are not target-able.
Your team travels faster than your opponents in your tunnels (even faster when you level the ability).
Use this ability on small walls/towers to dodge skillshots.
When sieging adjacent two inhibitor towers at once you can place a portal tunnels in the wall between the inhibitors and rotate faster than your opponents can blink.
Bard R (Tempered Fate)
A very strong ultimate that is hit or miss. This ultimate is extremely hard to use and when used wrong can end up benefiting the enemy team instead of your own team. It has a large range of 3400 meaning you can make plays from a distance, however the land time is not set (e.g. Ziggs ultimate) and depends on the range of the ability making it extremely harder to hit at max range.
Example Uses:
One main strength of Bard is catching people out of position or fleeing opponents and so, this ultimate can be treated as a 2.5 sec stun with a very long range. Great tool to make sure your enemy cant farm alone, or they face you and a carry getting a kill.
Whenever you see your enemy out of position, you must take the initation and hit their team with your ult, if you manage, that 2.5 second will give you enough time to position yourself for a quick clean up fight or an easy follow up by more cc champs, usually resulting in a dead team on the enemy side, and praising people on yours.
As this ultimate can even stun towers, turret diving with it is not a gamble, but an easy kill for your team if done right. If your jungler comes to gank, but the enemy managed to get under turret, depending on their champions, you can dive them easily. Place the tower in stasis, sometimes its even better if you manage to hit the enemy as well, because then you can walk as close to them as you want, and when the effect wears of, they wont be able to run away. Just make sure you kill them fast.
Also with this ult you can put Baron or Drake in stasis, which gives a very good opportunity to your team to engage on the enemy, if they are already doing it or set up steals from your jungler.
If one of your teammates is caught, throw your ultimate on them, and try to close in for a fast heal and stun to save, and potentially turn the fight. If he/she has Zhonya and uses it, then he/she will have time to get away while your ultimate wears off,
You can also use it to zone ,when fleeing for example.
A good way to force a teamfight when you feel tanky enough, is to make a tunnel directly into the enemy team, they will either jump on you, or run away from you, so you either use the ultimate on them plus covering you (if they have jumped on you), or you land your ultimate on the fleeing enemy team, be sure that you can survive and your team can follow.
Save your team mates by ulting them when targeted by telegraphed abilities such as Karthus Ult and Caitlyn Ult.
You can counter engages when champions such as amumu and ori ult your team by throwing your ult on the enemy team just as they are about to ult, thus preventing the enemy team from following up.
During fights you can ult their backline so that it becomes a 5v(4-1) and also cutting their damage in half.
You can ult your own towers so your team can position to save it as well.
When opponents are in melee range of you and you are trying escape, you can place a magical journey through a long wall and ult yourself allowing you to travel through the wall whilst in statis leaving the enemies in statis behind you.
Laning Phase
I like to start q on bard as it provides more kill potential and harass, you can also start w if you feel like your lane needs the sustain. If so you can place 3 shrines in the jungle for your jungler making sure you back before 1:25 to ensure you can regenerate mana and walk back to leash/lane.
Attempt to obtain all 3 spawned chimes before 1:50, I recommend standing in your jungle close to lane so that the chimes spawn nearby, this will grand you increased exp meaning you hit level 2 faster than your opponents and also allow you to reach 5 chimes quicker which means your empowered meeps provide a 25% slow.
As soon as you enter lane you should attempt to auto attack your opponents with your empowered meeps and throw out your q allowing you to harass and zone the opponents, also always try to aim the adc over the support especially when they are going for a last hit as they will then have to decide whether they want to trade with you or get the last hit. Paired with your adc you will usually be able to zone the opponent or go all in after a few won trades with your ignite which will most likely secure the skills as it cuts the opponents heal in half.
Place shrines behind your minions close to the walls as the speed boost is extremely useful for escaping and it also means if the opponent wants to remove the shrines they will have to tank the minions and standing next to a wall allows you to stun them for free with your q.
When low on mana get the shrines in the existing lane when there is no danger. Only roam to get chimes when you have wards to protect your adc and have killed the opposing adc or both opponents, or you have pushed your lane and your adc is backing however this means you must be healthy enough and have enough wards to stay in lane after your roam as you should not leave your adc alone. When it is safe to roam, you can collect chimes through the river and the speed boost allows you to roam mid and attempt or gank and also allow you to place wards for your mid laner or deep wards in the enemy jungle however make sure you have your e as an escape if you encounter the enemy jungler.
Team Synergy
If your team is early-mid game focused and you arent behind too much to loose the teamfight, Bard can force the teamfights and close out the game sooner, of course its much easier if you have won the laning phase.
If your team is late game focused, Bard can prolong the game by increasing your teams mobility/map presence, making those nasty split pushers dead in the water when you get in ultimate range.
If your team is behind, Bard can decide whether the teamfight will, or will not happen by making a good tunnel or by landing a good ultimate. Of course loosing objectives is no fun, so you cant win without wining teamfights, but Bard has the ability to stall, if you just need time.
Good Adc's to be paired with are those with burst combos as your long stun and ultimate allows them to set up their combos usually resulting in kills.
Changes to Bard
Q - Cosmic Binding
DAMAGE 75/100/145/180/215 magic damage ⇒ 80/120/160/200/240 magic damage
REMOVEDCOSMIC COINCENDENCE Cosmic Binding can no longer tether to unusual units such as Jarvan IV's Demacian Standard, Syndra's Dark Sphere, Jayce's Acceleration Gate, and Wards
E - Magical Journey
COOLDOWN 26/24/22/20/18 seconds ⇒ 20/19/18/17/16 seconds
SPIRITED AWAY Clicking on a Magical Journey portal is now more forgiving
TRAVEL GUIDE Allies that go on a Magical Journey will grant Bard an assist on their kills for a short time afterwards
MAGICAL EQUALITY Clones (such as those created by Shaco, LeBlanc, Mordekaiser and Yorick) can now be commanded to take a Magical Journey
R - Tempered Fate
TEMPERED MONSTERS Neutral Monsters will no longer have their health reset while under stasis
Passive - Traveler's Call
MEEP RESPAWN TIME 12/11/10/9/8 seconds (with chimes) ⇒ 10/9/8/7/6 seconds (with chimes)
CHIME MANA RESTORE 15 + 8% missing mana ⇒ 12% of Bard's maximum mana
Q - Cosmic Binding
BASE DAMAGE 80/120/160/200/240 (+0.5 ability power) ⇒ 80/125/170/215/260 (+0.65 ability power)
Passive - Traveler's Call
SAFE AND SOUND Chimes will avoid spawning in the enemy jungle before 5 minutes
EXPERIENCE PER CHIME 20 flat XP ⇒ 20 + 1 XP per minute (after 5 minutes)
W - Caretaker's Shrine
COST 100/105/110/115/120 mana ⇒ 90 mana at all ranks
E - Magical Journey
COOLDOWN 20/19/18/17/16 seconds ⇒ 18/17/16/15/14 seconds


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Frequently Asked Questions – Spain
What is the difference between what buying agents in Spain do and what an estate agent does?
An estate agent is engaged by the seller to achieve the highest possible price for their property. They will only be able to offer properties they have listed, usually in a well defined area. Property finders and buying agents are engaged by the buyer to find the right property at the lowest possible price. We are not restricted to one area and can compare and contrast alternatives across regions. An estate agent wants to sell and doesn't really care whether it suits the buyer or not. They always try to show properties in the most favourable light. A common trick in Spain is trying to disguise the fact that a property does not enjoy afternoon sun by only showing it in the morning. Pushing for weekend viewings if the property is on a busy road during the week is another. A buyer's agent does the exact opposite and we make sure our clients aware of any negative aspects related to the property or its surroundings.
We often find that people are not really sure exactly where they want to be. We are able to offer balanced and impartial advice about a variety of locations and we use our intimate local knowledge to pinpoint the most likely options for each individual's requirements. In contrast, real estate agents are only interested in selling in their area and often make disparaging and negative comments about other locations. After listening to our clients, we have often helped them to buy property many miles from where they originally thought they wanted to be.
What is the first step?
If possible we like to arrange a meeting at which we take a very detailed brief. However, our clients come from around the globe and if a face-to-face meeting isn't an option then we set up a conference call . We consider all the issues. What is the purpose of the purchase; relocation, investment, business opportunity, rental income, holiday property? What is the budget? We help people stay focused and realistic. While that dream farmhouse property down a 5km track seems like perfection, getting the children to school on time in driving rain should take priority! Once potential areas are defined we get to work researching and assessing what is currently available, reporting our findings and short-listing whatever is appropriate. Then, and only then, does our client need to travel. No time is wasted viewing unsuitable properties meaning the trip can be just a couple of days or less.
How do you source property?
In the more established coastal areas we may use estate agents whom we know and trust as well as our extensive network of contacts to see what properties might be available privately, often coming up with properties that are not actually 'for sale'. In the more rural areas we find out who is the local runner, or 'corredor' as they are called in Spanish, in that particular area. We scan international as well as local press and have even done targeted mailings to find potential sellers in specific developments in which our clients are particularly interested.
But why should I pay you to find a property when I don't have to pay anything to an Estate Agency?
There is no such thing as a free property finding service. If the fee comes from the seller then the ability to give independent and impartial advice is lost. Because we work exclusively for the buyer, there is no conflict of interest between buyer and seller. And estate agencies will not actively search for a property on your behalf regardless of promises. In almost every case, our clients find that we save them money. Add up the cost of a few wasted viewing trips, never mind the time it all takes. Best of all, we know how the system works; we know the right people to use and we are convinced we will always be able to negotiate a better price than our client would have been able to achieve on their own. We regularly save our clients considerably more than the value of our fees in this aspect alone. In Spain, discrepancies in title deeds and the issue of declared values cause most of the problems for buyers and it is not the estate agent's responsibility to resolve these issues for the buyer; trying to rectify discrepancies after completion is often difficult or impossible and usually expensive. We do not take the place of a lawyer and always recommend one is used – but we do double check everything and if a problem with the title has been identified we make sure that the strategy to correct it is in place before the contract is signed. The disaster stories given such prominence in the media are always the result of failure to do good research and thorough investigation of all the issues.
How does the buying process in Spain go?
In spite of what all the horror stories in the media imply the property buying process in Spain is actually very simple and transparent. Once you have settled on a particular property the normal practice is to pay a small reserve deposit to ensure the property is taken off the market while legal enquiries are made. This can be as little as 1,000 € in the country areas or as much as 5,000 € in the prime coastal areas. Meanwhile, your lawyer will request the Nota Simple, a reduced version of the Title Deed or escritura, and raise a draft contract. Signing private contracts is not legally required in Spain; in fact, many Spaniards dispense with this stage and go straight to the notary to sign the escritura, but as most overseas property buyers will need time to arrange transfer of funds or organize a Spanish mortgage, it has become the norm in transactions involving a purchaser from abroad for a private contract between the seller and buyer to be signed, usually within 21 days, at which time the buyer pays 10% of the agreed price, less the reserve deposit amount. At this stage, the transaction is binding on both sides; should the buyer subsequently default, the 10% is forfeit while if the seller pulls out Spanish law requires that double the 10% deposit is returned and it is very important for this to be specified in the contract.
All property purchase completions in Spain must take place in front of a notary, with both the seller and purchaser present or represented by means of a power of attorney. The escritura will be signed, the keys and monies will be handed over and that's it. Many property buyers from overseas choose to give their lawyer a power of attorney which covers things like applying for the NIE, the fiscal identity number which must be issued before completion can take place, and transferring utilities after completion, otherwise you are required to do this in person.
If I am non-resident in Spain is rental income liable to tax?
Yes, and the Spanish tax authorities, Hacienda, are determined to stop evasion. The flat rate is 25% of the net rental income.
Are non-residents liable for Capital Gains Tax in Spain when they sell?
Yes, Capital Gains Tax is now applied at 19% for all E.U. non-residents while it is 35% for non-E.U. individuals or entities. And if you decide to become resident in Spain it will still be 19%, irrespective of nationality.
I have been told that money is held back when I sell. What is that for?
This only applies to non-residents, to ensure that Capital Gains Tax is paid even though the seller may no longer have any address in Spain. The retention, set at 3% of the amount declared in the escritura at the time of sale, is deemed to be a down payment of the Capital Gains Tax due. In these cases it is the responsibility of the buyer, via their lawyer, to lodge the retention with the tax authorities, Hacienda, within 30 days of signing the escritura in front of the notary. Hacienda then has 6 months in which to calculate the actual CGT due and to return any overpay. Of course, they can also claim any underpay.
Is it true that money laundering controls have been tightened?
Yes, and the one that will most affect property buyers is the obligation to include the method of payment within the escritura. Previously, buyer and seller simply had to swear to the notary that the full purchase price had been paid and received. Now they have to state in the deeds how it has been paid and failure to do so will mean that the property cannot be registered in the new owner's name.
If you have a specific question about buying property in Spain that we haven't covered here please fill in the form below and we'll get back to you.