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A Closer Look At Tissue And Cell Regeneration In CLI
Given the severe complications associated with critical limb ischemia (CLI), this author offers a revealing look at the research on tissue regeneration and stem cell therapy, and potential therapeutic applications in the future.
Critical limb ischemia (CLI) is an end-stage disease that is provoked by progressive obstruction of the peripheral arteries. It is often associated with long segments of involvement at multiple sites with distal vessel disease. The ischemic insult results in rest pain, which progresses to skin breakdown and gangrene unless ischemia is reversed immediately.
Treatment includes risk factor modification, medical treatment for the vascular symptoms, prevention of systemic complications and revascularization measures. The goals of therapy include restoration of straight line, pulsatile blood flow to relieve ischemia, achieve wound healing, relieve rest pain and avoid major amputation.
However, despite aggressive treatment, many patients with CLI either die or eventually have to undergo a major amputation. Surgical or endovascular (angioplasty and stenting) revascularization approaches are usually not possible due to the diffuse involvement and poor distal vessel reformation. Furthermore, comorbid conditions may adversely affect the outcome of surgical procedures.
Despite the technical advances in interventional and surgical revascularization procedures, a substantial number of patients with peripheral arterial occlusive disease (PAOD) and CLI remain. When it comes to these patients, amputation may be the only option.
Assessing The Research On Tissue Regeneration
Tissue regeneration via the use of stem/progenitor cells has been recognized as a maintenance or recovery system for many organs in adults. The isolation of endothelial progenitor cells (EPCs) derived from the peripheral blood was one of the amazing discoveries for the recognition of "neovessel formation" in adults that occurs as physiological and pathological responses.
These findings that EPCs are home to sites of neovascularization and differentiate into endothelial cells in situ are consistent with the notion of "vasculogenesis."
Vasculogenesis is a critical paradigm that has been well described for embryonic neovascularization and was proposed recently for adults in whom a reservoir of stem or progenitor cells contributes to vascular organogenesis. On the basis of the regenerative potency, these stem cells/ progenitor cells are expected to be a key factor in therapeutic applications for ischemic diseases.1
The induction of therapeutic angiogenesis by stem cell implantation could provide therapeutic benefits and may help in limb salvage in patients with CLI. One can achieve angiogenesis (collateral formation) either through growth factors or gene encoding for these proteins. Asahara, et al., and Prockop showed that marrow stromal cells secrete many angiogenic cytokines and also have characteristics of stem cells for mesenchymal tissues. 2,3
Several investigators have reported beneficial effects of injecting bone marrow derived stem cells for those with coronary artery disease. 4-13
Using animal models with hind limb ischemia, Iba, et al., injected peripheral blood mononuclear cells (MNCs) or polymorphonuclear leukocytes along with platelets into ischemic limbs via intramuscular injection. Follow-up imaging revealed significant collateral vessel formation. 13,14
Al-Khaldi, et al., investigated the effect of autologous marrow stromal cells on neovascularization and blood flow in rat models with CLI. They detected an increase in vascular density, collateralization and increased blood flow in the ischemic limb. 15 Healing of skin ulcers has occurred in animal models with diabetes following stem cell injection. 16
Yamamoto, et al., evaluated the EPC content in different stem cell sources for the efficacy of therapeutic angiogenesis in limb ischemia in four patients. They quantified the mRNA expression of EPC specific molecules in autologous bone marrow derived or peripheral blood-derived MNCs, and then injected cells intramuscularly in the affected limb for each patient. Researchers observed that transplantation of autologous marrow MNCs increased circulating EPCs in patients and improved ischemic symptoms. 17
Recently, Tateishi-Yuyama, et al., reported that the autologous transplantation of bone marrow mononuclear cells was safe and effective for the achievement of therapeutic angiogenesis in patients with ischemic limbs. The authors also found that injections of bone marrow mononuclear cells could significantly improve the clinical status of these patients. 18
Various researchers have used both bone marrow derived and peripheral blood stem cells with CD34+ endothelial progenitor cells in small studies with good results. (See "A Pertinent Overview Of Studies On The Use Of Stem Cells For CLI" on page 60.)
However, there is need for more randomized trials on the use of stem cells in these patients to determine the safety and efficacy of this therapy.
What The Early Findings From One Recent Study Suggest
Researchers at Sir Ganga Ram Hospital (SGRH) in New Delhi, India conducted a pilot study which was aimed at assessing the "safety, feasibility and efficacy of transplantation of granulocyte colony stimulating factor (G-CSF)–mobilized peripheral blood mononuclear cells (PBMNCs) for the treatment of Buerger's disease with CLI."
The study involved patients who were diagnosed with Buerger's disease (based on digital subtraction angiography (DSA) findings) of the lower limbs with pedal ulcers. Patients were randomized to either the transplant group or the control group. All patients received conventional care for their ulcers.
In the transplant group, the patients received treatment with 600 µg/day of recombinant human G-CSF via subcutaneous injection for five days to mobilize stem/progenitor cells. These patients also received a subcutaneous injection of 5,000 U of dalteparin every 12 hours to avoid the possible risks of embolism due to a G-CSF–induced increase of circulating blood cells.
Using flow cytometry with anti-CD34 antibody staining, researchers assessed the proportion of peripheral blood CD34+ cells in peripheral blood leukocytes after G-CSF treatment. The study authors took measurements every day between the third and fifth days of treatment. When researchers saw an increase in the ratio to >0.10, the G-CSF treatment stopped and researchers harvested peripheral blood stem cells on the next day.
Using a blood cell separator with a concentration to 1 x 108 mononuclear cells/mL, researchers collected a 30 to 50 mL suspension of blood circulating PBMNCs from patients treated with G-CSF. Three hours later, each diseased lower limb received an intramuscular injection (40 sites, 1 to 1.5 cm deep) into the calf under regional anesthesia.
The study authors prospectively collected clinical data, medication and safety laboratory data, and performed follow-up visits for six months. Researchers assessed lower limb blood perfusion via the ankle-brachial index (ABI), TcPO2 and laser Doppler.
The study authors also employed DSA to assess patients one week before and six months after treatment. Researchers assessed the angiographic scores for the formation of new collateral vessels as +0 (no collateral development), +1 (slight), +2 (moderate) and +3 (rich). 18
At the end of the six-month follow-up, the main manifestations, including lower limb pain and ulcers, significantly improved for patients in the transplant group. Their laser Doppler blood perfusion of lower limbs, mean ABI and TcPO2 (peri-ulcer) values increased significantly. Most of the patients in the transplant group demonstrated complete wound healing after cell transplantation in comparison to the control group. Some of the patients in the transplantation group with persistently non-healing ulcers ended up with below knee amputations after six months.
Researchers observed no adverse effects, specifically due to cell transplantation, and only minor toe amputation(s) occurred in the patients who underwent transplants. In contrast, an equal number of control patients had to undergo a lower limb amputation within six months.
Analysis via DSA revealed a significant formation of new vessels after cell transplantation. At the end of the visit, the number of ischemic limbs with rich new collateral vessels (+3) in the transplant patients was statistically significantly higher in comparison to the control patients.
During a six-month follow-up period, researchers observed no side effects specifically due to transplantation after analysis of ECG or dynamic ECG, ultrasound cardiogram, liver and kidney function testing, blood and urine testing, etc.
Key Points For Consideration On The Mechanism Of Action
Previous studies have shown that EPCs can be isolated from the peripheral blood of adult humans, mice and rabbits. Researchers have also found that G-CSF can mobilize peripheral blood CD34+, CD133+ and KDR+ cells with the capacity to differentiate into EPCs that are further able to incorporate into newly forming blood vessels in pathological and non-pathological conditions. 30-34
It has been established that G-CSF mobilization is a viable approach to collect stem/progenitor cells from peripheral blood for autologous transplantation for many diseases such as leukemia and solid cancer. 35
The objective in the aforementioned pilot study was to achieve therapeutic angiogenesis using similar techniques. We observed that pedal wounds in the transplanted patients significantly improved after autologous transplantation of PBMNCs and objective parameters such as ABI, angiographic scores and laser Doppler perfusion scores improved. In a six-month follow-up period, we did not detect angina pectoris, pulmonary embolism and other similar complications due to G-CSF mobilization and adverse effects specifically as a result of transplantation. 36,37
These results indicate that the autologous transplantation of mobilized PBMNCs is an effective and safe therapeutic approach for patients with CLI and Buerger's disease. For the patients, the development of this potential treatment option would be significant as they may not be able to have conventional surgical bypasses or benefit from endovascular options for revacularization.
In comparison with the method of Tateishi-Yuyama, et al., which requires a large amount of marrow (500 mL), the autologous transplantation of G-CSF–mobilized PBMNCs reported here is a novel alternative for Buerger's disease with CLI. 18
It has been suggested that G-CSF by itself causes some neovascularization and wound healing in people with ischemic diseases because of its ability to mobilize EPCs into peripheral blood. 38 The G-CSF augments the differentiation of marrow cells into endothelial cells of blood vessels. 39
There are at least two possibilities to explain why G-CSF mobilization plus the transplantation of PBMNCs into ischemic local muscles can result in an excellent therapeutic effectiveness.
The first is that the intramuscular injections of G-CSF–mobilized PBMNCs into ischemic legs directly bring a number of EPCs into ischemic foci, where the EPCs can initiate angiogenesis. The second is that a large number of transplanted PBMNCs can secrete in vivo in the injected sites several angiogenic factors to activate the EPCs nearby ischemic tissues to form new vessels and repair impaired vessels. 40 The two possibilities may coexist in this therapeutic approach.
In the aforementioned pilot study, 50 percent of the transplant patients demonstrated remarkable improvement in all the parameters. Therefore, one can conclude that GCSF mobilized PBMNCs constitute simple, safe and effective therapy for patients with Buerger's disease and CLI.
Future studies are obviously needed to evaluate the precise efficacy of this therapy in a large number of patients and to determine the particularities of their mechanism of action in provoking therapeutic angiogenesis.
What About The Future Of Regenerative Medicine In CLI?
As evident from the current literature, the isolation of endothelial progenitor cells (EPCs) derived from peripheral blood, autologous adult bone marrow (BM) and most recently from the human umbilical cord blood is an epoch-making event for the recognition of neovessel formation.
In regard to stem cell therapy, Kim, et al., examined the use of umbilical cord blood-derived multipotent stem cells for Buerger's disease and ischemic limb disease in an animal model. 41
In Kim's study, four men with Buerger's disease who had already received medical treatment and surgical therapies received transplanted human leukocyte, antigen-matched human umbilical cord blood (UCB)-derived mesenchymal stem cells (MSCs). After the stem cell transplantation, ischemic rest pain suddenly disappeared from their affected extremities. The necrotic skin lesions healed within four weeks. In the follow-up angiography, digital capillaries increased in number and size. In addition, vascular resistance in the affected extremities, in comparison with the preoperative examination, was markedly decreased due to improvement of the peripheral circulation.
Since an animal model of Buerger's disease is absent, athymic mice with hind limb ischemia received transplants of human UCB-derived MSCs. Up to 60 percent of the hind limbs were salvaged in the animals with a ligated femoral artery. With in situ hybridization, researchers detected the human UCB-derived MSCs in the arterial walls of the ischemic hind limb in the treated group. These findings suggest that human UCB-derived MSC transplantation may be a new and useful therapeutic option for Buerger's disease and similar ischemic diseases.
At our institution in India, we are about to commence a comparative study to assess the safety and efficacy of bone marrow derived MSCs and umbilical cord derived MSCs with the standard treatment in patients with ischemic limb disease.
Clarifying The Unanswered Questions
The current literature does not describe a definite number of cells that one should apply to obtain a certain benefit. Until now, no correlation between the applied cell number and clinical outcome is known. 42,43
To date, most studies of progenitor cell application do not elucidate which cell type is involved in the process of neovascularization. Other researchers have reported that the cell suspension used contained a heterogeneous population of circulating blood driven progenitor cells. 44,45 Approximately 50 percent of the cells showed endothelial characteristics as demonstrated by the expression of kinase insert domain (KDR) and Ve-cadherin.
Additionally, the cells expressed cell surface markers of stem/progenitor cells and the panleukocyte marker CD45, which is consistent with the literature. 46,47
Given the variant clinical nature of the many studies performed so far, little is known about the fate of the injected cells and one can only speculate about the amount of endothelial differentiation, cell fusion or migration into other tissue layers.
As there is a lack of control groups in some studies, the observed changes cannot be unambiguously attributed to the bone marrow driven or CPC administration. Other contributing factors might be spontaneous improvement, placebo effect and medical therapy.
Dr. Sodhi is a Consultant In Charge at the Diabetic Foot Care Centre in the Department of Vascular and Endovascular Surgery at Sir Ganga Ram Hospital in New Delhi, India.
For further reading, see "How To Address Vascular Complications With Lower Extremity Wounds" in the July 2008 issue of Podiatry Today, "Emerging Vascular Approaches For Healing Diabetic Ulcers" in the July 2007 issue or "Current Concepts In Treating Ischemic Foot Ulcers" in the March 2007 issue.
Also, visit www.podiatrytoday.com for the archives or to get information on reprints.
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17. Yamamoto K, Kondo T, Suzuki S, et al. Molecular evaluation of endothelial progenitor cells in patients with ischemic limbs-therapeutic effects by stem cell transplantation. Arterioscler Thromb Vasc Biol. 2004;24:e192-e196.
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19. Huang P, Li S, Han M, Xiao Z, Yang R, Han ZC. Autologous transplantation of granulocyte colony-stimulating factor-mobilized peripheral blood mononuclear cells improves critical limb ischemia in diabetes. Diabetes Care. 2005; 28: 2155-60.
20. Lenk K, Adams V, Lurz P, et al. Therapeutical potential of blood-derived progenitor cells in patients with peripheral arterial occlusive disease and critical limb ischaemia. Eur Heart J 2005; 26:1903-9.
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22. Bartsch T, Falke T, Brehm M, Zeus T, Kogler G, Wernet P, et al. Intra-arterial and intramuscular transplantation of adult, autologous bone marrow stem cells. Novel treatment for therapy-refractory peripheral arterial occlusive disease. Dtsch Med Wochenschr 2006;131:79-83.
23. Nizankowski R, Petriczek T, Skotnicki A, Szczeklik A. The treatment of advanced chronic lower limb ischaemia with marrow stem cell autotransplantation. Kardiol Pol 2005; 63:351-60.
24. Yang XF, Wu YX, Wang HM, et al. Autologous peripheral blood stem cells transplantation in treatment of 62 cases of lower extremity ischemic disorder. Zhonghua Nei Ke Za Zhi 2005; 44: 95-8.
25. Kawamura A, Horie T, Tsuda I, Ikeda A, Egawa H, Imamura E, et al. Prevention of limb amputation in patients with limbs ulcers by autologous peripheral blood mononuclear cell implantation. Ther Apher Dial 2005; 9: 59-63.
26. Yang BH, Qin JH, Zhu LQ, Chen L, Lu H, Liu FT, et al. Treatment of lower limb ischemia with combination of traditional Chinese medicine and transplantation of autologous bone marrow mononuclear cells: a report of 23 cases. Zhong Xi Yi Jie He Xue Bao. 2005; 3: 28-30.
27. Kudo FA, Nishibe T, Nishibe M, Yasuda K. Autologous transplantation of peripheral blood endothelial progenitor cells (CD34+) for therapeutic angiogenesis in patients with critical limb ischemia. Int Angiol. 2003; 22: 344-8.
28. Huang PP, Li SZ, Han MZ, Xiao ZJ, Yang RC, Qiu LG, et al. Autologous transplantation of peripheral blood stem cells as an effective therapeutic approach for severe arteriosclerosis obliterans of lower extremities. Thromb Haemost. 2004; 91: 606-9.
29. Tateishi-Yuyama E, Mastsubara H, Murohara T, et al. therapeutic angiogenesis for patients with limb ischaemia by autologus transplantation of bone-marrow cells: a pilot study and a randomized controlled trial. Lancet 2002; 360:427-35.
30. Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. A comparison of two diabetic foot ulcer classification systems. Diabetes Care 24:84–88, 2001.
31. Sivan-Loukianova E, Awad OA, Stepanovic V, Bickenbach J, Schatteman GC. CD34+ blood cells accelerate neovascularization and healing of diabetic mouse skin wounds. J Vasc Res 40:368–377, 2003.
32. Szmitko PE, Fedak PW, Weisel RD, Stewart DJ, Kutryk MJ, Verma S. Endothelial progenitor cells: new hope for a broken heart. Circulation 107:3093–3100, 2003.
33. Lin Y, Weisdorf DJ, Solovey A, Hebbel RP. Origins of circulating endothelial cells and endothelial outgrowth from blood. J Clin Invest 105:71–77, 2000.
34. Peichev M, Naiyer AJ, Pereira D, Zhu Z, Lane WJ, Williams M, Oz MC, Hicklin DJ, Witte L, Moore MA, Rafii S. Expression of VEGFR-2 and AC133 by circulating human CD34 (+) cells identifies a population of functional endothelial precursors. Blood 95:952–958, 2000.
35. Gordon PR, Leimig T, Babarin-Dorner A, Houston J, Holladay M, Mueller I, Geiger T, Handgretinger R. Large-scale isolation of CD133+ progenitor cells from G-CSF mobilized peripheral blood stem cells. Bone Marrow Transplant 31:17–22, 2003.
36. Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T. Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation 104:2057–2062, 2001.
37. Fukumoto Y, Miyamoto T, Okamura T, Gondo H, Iwasaki H, Horiuchi T, Yoshizawa S, Inaba S, Harada M, Niho Y. Angina pectoris occurring during granulocyte colony-stimulating factor-combined preparatory regimen for autologous peripheral blood stem cell transplantation in a patient with acute myelogenous leukaemia. Br J Haematol. 1997 Jun;97(3):666-8.
38. Seiler C, Pohl T, Wustmann K, Hutter D, Nicolet PA, Windecker S, Eberli FR, Meier B. Promotion of collateral growth by granulocyte-macrophage colony-stimulating factor in patients with coronary artery disease: a randomized, double-blind, placebo-controlled study. Circulation 104:2012–2017, 2001.
39. Minamino K, Adachi Y, Okigaki M, Ito H, Togawa Y, Fujita K, Tomita M, Suzuki Y, Zhang Y, Iwasaki M, Nakano K, Koike Y, Matsubara H, Iwasaka T, Matsumura M, Ikehara S. Macrophage colony-stimulating factor (M-CSF), as well as granulocyte colony-stimulating factor (G-CSF), accelerates neovascularization. Stem Cells 23:347–354, 2005.
40. Iba O, Matsubara H, Nozawa Y, Fujiyama S, Amano K, Mori Y, Kojima H, Iwasaka T. Angiogenesis by implantation of peripheral blood mononuclear cells and platelets into ischemic limbs. Circulation 106:2019–2025, 2002.
41. Kim SW, Han H, Chae GT, et al. Successful stem cell therapy using umbilical cord blood-derived multipotent stem cells for Buerger's disease and ischemic limb disease animal model. Stem Cells. 2006 Jun;24(6):1620-6.
42. Assmus B, Schächinger V, Teupe C, et al. Transplantation of progenitor cells and regeneration enhancement of acute myocardial infarction (TOPCARE-AMI). Circulation 2002;106:3009–3017.
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46. Rehman J, Li J, Orschell CM, March KL. Peripheral blood "endothelial progenitor cells" are derived from monocyte/ macrophages and secrete angiogenic growth factors. Circulation 2003;107:1164–1169.
47. Peichev M, Naiyer AJ, Pereira D, Zhu Z, Lane WJ, Williams M, Oz MC, Hicklin DJ, Witte L, Moore MA, Rafii S. Expression of VEGFR-2 and AC-133 by circulating human CD-34+ cells identifies a population of functional endothelial precursors. Blood 2000;95:952–958.
Additional References
48. Asahara T, Murohara T, Sullivan A, Silver M, van der Zee R, Li T, Witzenbichler B, Schatteman G, Isner JM. Isolation of putative progenitor endothelial cells for angioneogenesis. Science 1997;275:964–967.
49. Hristov M, Erl W, Weber PC. Endothelial progenitor cells: isolation and characterization. Trend Cardiovasc Med 2003;13:201–206.


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Curious about the newer model? Check out the 2016 Dodge Journey
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KBB Expert Rating: 6.0
The 2012 Dodge Journey SUV fits comfortably between a full-size and compact SUV, giving it the room to hold up to seven passengers in a package that is not unruly to drive or park. Fresh from a complete overhaul last year, the 2012 Dodge Journey SUV offers families a roomy and versatile environment with cabin styling and features more commonly found in high-end luxury cars. Crew models, for example, offer a choice of colorful leather seat trim, UConnect touch-screen radio with available Garmin navigation and keyless entry and start. But perhaps the best thing about the 2012 Dodge Journey is its available V6 engine, which is not only one of the most powerful engines in its class, but also one of the most fuel-efficient.
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260 lb-ft of torque @ 4,300 rpm
EPA city/highway fuel economy: 17/25 (FWD), 13/18 (FWD, E85)
To compare current market prices, check out KBB.com's car classifieds to view the new and used Dodge Journey vehicles for sale near you.
Based on 382 Ratings for the 2009 - 2016 models.Review this car
By JA Roberts on Saturday, August 29, 2015
I own this car - My approximate mileage is 2,000overall rating 10 of 10rating details
Pros: "Great overall"
Cons: "Fuel Mileage"
Likely to recommend this car? (1-10): 10
"I have purchased many, many new cars and this is by far the best car for the money that I have every bought. I am retired and have teenage kids. The third row set is roomy enough for them and the quality is great. I would be another today if I had to. Great Car!!!!"
4 people out of 9 found this review helpful
Was this review helpful to you? yes | no | report abuse
By Starkey on Thursday, August 06, 2015
I own this car - My approximate mileage is 140,000overall rating 9 of 10rating details
Pros: "Good price and great ride"
Cons: "none"
Likely to recommend this car? (1-10): 9
"I purchased my 2009 SXT Dec. 08. Other then water pump replaced under warranty and routine maintenance ( brakes, wipers and tires), this has been a great ride. I will purchasing a 2015 Journey Crossroad this week and my daughter will take over the 09."
6 people out of 11 found this review helpful
Was this review helpful to you? yes | no | report abuse
By mom on Thursday, July 23, 2015
I own this car - My approximate mileage is 49,000overall rating 9 of 10rating details
Pros: "electronics, bluetooth, sunroof"
Cons: "traction on snow, blind spots"
Likely to recommend this car? (1-10): 8
"overall is great car. hate the tires, too expensive! blind spots a problem, loved sun roof, back seats uncomfortable, loved the computerized dash, not good on snow"
13 people out of 23 found this review helpful
Was this review helpful to you? yes | no | report abuse
By Chi-Town Willie on Friday, June 26, 2015
I own this car - My approximate mileage is 41,300overall rating 7 of 10rating details
Pros: "comfort, remote start, heated seats, uconnect"
Cons: "gas mileage, AWD eats tires"
Likely to recommend this car? (1-10): 3
"Purchased this vehicle as a replacement for an early model Ford Escape. Since this vehicle is larger, the ride felt much more comfortable. Purchased the SXT with the third row seat. The third row seat is really only designed for smaller passengers. Vehicle consistently gets 26+ MPG on the highway, however in city driving it barely hits 17 MPG. As time has gone on, there are some fit/finish quality issues that have popped up, which for a car that is only 3 years old is rather disappointing."
26 people out of 50 found this review helpful
Was this review helpful to you? yes | no | report abuse
By Shelly on Friday, June 19, 2015
I own this car - My approximate mileage is 17,000overall rating 10 of 10rating details
Pros: "3rd row seat option and good cargo room"
Likely to recommend this car? (1-10): 10
"This is the best SUV I have owned. Very versatile,nice comfy ride,great in the snow, 3rd row seat option very handy. Great value!"
18 people out of 24 found this review helpful
Was this review helpful to you? yes | no | report abuse
By Linda on Monday, June 15, 2015
I own this car - My approximate mileage is 47,000overall rating 9 of 10rating details
Pros: "A totally wonderful driving experience!"
Cons: "None"
Likely to recommend this car? (1-10): 10
"This is an exceptional vehicle. It is a joy to drive; totally comfortable- no matter how long the trip. The third row seat hasn't been used too many times, but when it is needed, it is a terrific added feature! The sound system is awesome; the keyless entry has spoiled us rotten. This vehicle has hauled more items that I can list here - so versitile! I LOVE this Journey!"
15 people out of 21 found this review helpful
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text:
ADP Research Institute Study: Employee Income is a Determining Factor in Health Benefits Participation
If Current Patterns for Participation Rates Based on Income Persist in 2014, a Significant Portion of Newly Eligible Employees May Opt to Remain Uninsured
ROSELAND, N.J., March 5, 2013 /PRNewswire/ — ADP®, a leading provider of employee health care benefits administration and human capital management (HCM) services, today announced the findings of a new ADP Research Institutesm study indicating that if 2012 health benefit participation rate patterns persist into next year, then a portion of newly eligible employees may opt to remain uninsured because they perceive the cost of insurance is too significant a percentage of their annual income.
Access to Report
ADP's "Planning for Health Care Reform: How Income Impacts Employee Health Benefits Participation," is a companion study to the previously published "ADP's 2012
The new study provides a comprehensive examination of the impact of income on employee health benefits participation.
Income / Participation Level
Specifically, the ADP Research Institute study findings show that employees with W-2 wages greater than 400% of the
However, as income declines below 400% of the FPL, health plan participation rates decline sharply to just 37% for single employees earning between $15,000 and $20,000 per year.
"While no one can predict the future, the ADP Research Institute findings suggest that lower income employees may avoid participation in a health plan that consumes a significant percentage of their income," said Tim Clifford, president of ADP Benefits Administration Services.
"Clearly, employer to employee communications will be essential in explaining the options moving forward."
Other key findings of the ADP Research Institute study include…
ER Penalties
Across the entire study population, approximately 8.6% of single, full-time employees pay 9.5% or more of their W-2 earnings to obtain health coverage.
However, among a certain subset of employers, nearly 25% of employees spent more than 9.5% of their wages on health coverage.
According to the ACA, beginning in 2014, employers may begin paying an annual penalty of $3,000 (calculated monthly) for every employee for which the premium for self-only coverage exceeds 9.5% of their wages (with respect to
ER's Group Health Plan Favored
Employees earning $22,340 or more per year (200% of the FPL for a single wage earner) may still be better off obtaining coverage through their employer's group health plan, despite affordability issues, rather than participating in a public health exchange with government-provided subsidies.
"While many project that the impact of the ACA will be most significant upon small businesses, certain industries, such as retail, hospitality, construction and business services, could face a dramatic increase in the number of employees that are newly eligible for health benefits," notes Clifford.
"In some cases, employers could face a sharp increase in the number of covered employees and subsequent costs, and if they choose to stop offering employer-sponsored benefits, they may face a significant tax penalty."
"How employers choose to comply with ACA requirements can have a very significant impact upon multiple aspects of their business and their human capital management strategy," Clifford adds.
"While increases in total health care benefit plan costs and potential penalties can have a direct impact upon revenue, employers also need to consider the full business implications of their benefits decisions, as they can affect employee compensation, company reputation, and recruitment and retention."
Copy of Report
Upcoming Webinar
Entitled: Health Care Reform: How Income Impacts Participation in Employee Health Benefits, the webcast will be available at 11:00 a.m. ET (-5 GT) on Thursday, March 28. To register and attend, please visit http://www.hr.com/stories/1362424920044.
What Are Your Thoughts??
As with anything, there is cost versus 'costly' factor — namely, at what point is it more economical NOT to have something than it is to have it. Risk is sometimes part of this consideration. The exemption of pre-existing conditions has raised some eyebrows, especially from the younger adults. They are least likely to have a health problem but are being 'sequestered' into paying for a public health plan that is supposed to cover everyone (the irony is it will cover an additional 10 million, leaving 36 million without coverage). The penalities they face are LOWER than the cost of having coverage. As most are just starting their lives as adults, can anyone really blame them for wanting to save a buck or two, especially with something they most likely will not use (but are being required to enroll in per government regulations). The catastrophic insurance is still around, many will enroll in this to save a dollar as well. There are other considerations that are beyond the scope of this article, feel free to share in the comments below.
✔ Rationing and price increases have started already and we are one year from implementing the system. What are you going to do if the prices do not come down? Have you even thought about this?
✔ The history of nationalizing a healthcare system is not pretty, and none have been implemented without rationing going into effect as well as costs increasing. President Obama promises this won't happen. Truth?
✔ There are always some positives to any situation, what positives do you see with the PPACA going into affect?
Please share your thoughts with our audience in the comments section below!
More on This Topic from Our ADP Playlist in Our YouTube Channel
About the ADP Research Institute
The ADP Research Institute provides insights to leaders in both the private and public sectors around issues in human capital management, employment trends, and workforce strategy.
About ADP
ADP, Inc. (NASDAQ: ADP), with more than $10 billion in revenues and approximately 600,000 clients, is one of the world's largest providers of business outsourcing and human capital management solutions. Leveraging over 60 years of experience and a global footprint spanning more than 40 countries, ADP offers a wide range of human resource, payroll, talent management, tax and benefits administration solutions from a single source, and helps clients comply with regulatory and legislative changes, such as the Affordable Care Act. ADP's easy-to-use solutions for employers provide superior value to companies of all types and sizes. ADP is also a leading provider of integrated computing solutions to auto, truck, motorcycle, marine, recreational vehicle, and heavy equipment dealers throughout the world. For more information about ADP or to contact a local ADP sales office, reach us at 1.800.225.5237 or visit the company's Web site at www.adp.com.
Jim Larkin, ADP; +1 (973) 407-9714; email@example.com
Web Site : http://www.adp.com
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In case you missed it, Europe's highest court has set a new precedent: Individuals in 28 European countries can now they consider harmful. Is this ruling a big win for the individual? Or does this break the Internet?
Big Questions Now That Europeans Can Edit Google Search Results
Companies like Google already routinely field takedown requests for material that violates defamation or copyright, but this is different. The Tuesday by the European Court of Justice requires search engines to consider takedown requests that are merely embarrassing or harmful.
"Data belongs to the individual, not to the company," said EU Commissioner Viviane Reding, . "Unless there is a good reason to retain this data, an individual should be empowered — by law — to request erasure of this data."
See this story on www.npr.org


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Title: ST-362-20-62. Guests Attend Jazz Concert for White House Seminar
Participants of the White House Summer Seminar attend an American jazz concert on the Ellipse, President's Park, Washington, D.C. White House staff assistant and Director of the Seminar, Dorothy H. Davies, and Press Secretary, Pierre Salinger, sit in front row at left.
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Having grilled some of the top minds in the software business, this installment of Testing the Limits will deviate slightly from the norm. With us this month is John Winsor – author, entrepreneur and crowdsourcing expert.
After a successful career as a journalist and magazine publisher, John founded Radar Communications in 1998, where he implemented a variety of academic-based market intelligence tools to help some of the country's most progressive companies learn from key voices in their communities. Today, he offers that same advice as the VP/Executive Director of Strategy and Product Innovation at Crispin, Porter + Bogusky.
John has written extensively on the subject of crowdsourcing, having published the popular 2005 book Spark: Be more Innovative through Co-Creation. With his latest book Baked In: Creating Products and Businesses That Market Themselves now hitting the shelves, John was kind enough to sit down with us to discuss the future of crowdsourcing, the premise of his new book, and the best (or worst) rock-climbing movies of all-time.
uTest: The hottest debate in crowdsourcing right now is the "fall" of traditional advertising or design firms and the "rise" of crowdsourced services. In your opinion, what does the future of crowdsourcing look like? Is the world ready for what you call the "digital tsunami?"
JW: Well the future of crowdsourcing is definitely bright, but there are still a lot of unanswered questions in people's minds. Those who are skeptical of crowdsourcing question its ability to truly connect people. With crowdsourcing, you no longer have all of these professionals working together in the same building – that alone is often too much for some people to come to terms with. The idea of a crowd aggregating to solve business problems in a virtual environment is entirely new to most people, even though the underlying trend has been developing for years. The difference now is that it simply can't be ignored.
uTest: So you see crowdsourcing as eventually obtaining mainstream acceptance?
JW: Absolutely. People are starting to see the full potential of this model, especially on the client side of the equation. There was a time when most people viewed crowdsourcing as chaos – like the inmates running the asylum, and that's no longer the case for a growing number of people. So I think we're just getting started.


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There is increasing evidence that cities offer externalities that raise labour productivity. This column looks at the contribution of US cities to productivity growth at the turn of last century. The findings show that increased specialisation, promoted by improved transportation, was the key to productivity growth. Today's policymakers should heed this lesson.
Nicholas Crafts, Alex Klein, Thursday, July 30, 2015
Marius Brülhart, Helen Simpson, Friday, June 12, 2015
The evidence on how industry-level agglomeration affects government taxation is mixed. This column argues that local governments offer subsidies to favour pre-existing employment in locally agglomerated industries. This finding is in line with theories of policy capture rather than government taxation of agglomeration benefits.
Trevon D. Logan, John M. Parman, Monday, March 9, 2015
Racial disparities in socioeconomic conditions remain a major policy issue throughout the world. This column applies a new neighbour-based measure of residential segregation to US census data from 1880 and 1940. The authors find that existing measures understate the extent of segregation, and that segregation increased in rural as well as urban areas. The dramatic decline in opposite-race neighbours during the 20th century may help to explain the persistence of racial inequality in the US.
Neil Lee, Andrés Rodríguez-Pose, Tuesday, February 17, 2015
Creativity is assumed to be the mother of invention, but research testing whether this is the case is surprisingly rare. This column addresses this gap in the literature by assessing whether firms in creative industries in the UK are more innovative than firms outside creative industries. The authors also examine whether the location of creative-industry firms in creative cities – and the size of creative cities – matters for the innovative capacity of these firms.
Hiroyasu Inoue, Kentaro Nakajima, Yukiko Umeno Saito, Wednesday, February 11, 2015
Despite vast improvements in information and communications technology, the tendency of firms in related industries to cluster together hardly changed between 1985 and 2005. This column examines the relationship between geographic clustering and innovation using establishment-level data from Japan. Research establishments – especially those in high-technology industries – are more localised than average. The degree of localisation is greater when establishments are weighted by their creativity, as measured by the number of patents created and the number of citations received.
Masayuki Morikawa, Sunday, November 23, 2014
The appropriate level of public sector wages is debated frequently in every country, and the debate has intensified in the wake of the global financial crisis. This column presents evidence that regional wage differentials in Japan are greater in the private sector than in the public sector. In regions where public sector wages are relatively high, skilled individuals may self-select into public sector jobs. At the same time, public sector employers in metropolitan regions such as Tokyo may have difficulty in hiring high quality employees.
Gabriel M. Ahlfeldt, Stephen Redding, Daniel M. Sturm, Nikolaus Wolf, Wednesday, August 20, 2014
Economic activity is highly unevenly distributed across space. Understanding what drives the agglomeration and dispersion is important for many economic and policy questions. This column describes a theoretical model of internal city structure incorporating agglomeration and dispersion and heterogeneity in local fundamentals. The authors use the division and reunification of Berlin as a natural experiment. Their findings show that both heterogeneity in locational fundamentals and agglomeration forces are important in shaping a city's internal structure.
Hongyong Zhang, Monday, July 21, 2014
The Chinese government has been actively promoting innovation via policies such as R&D subsidies, tax relief, and location policies. Since 1995, central and local governments have established more than 100 clusters in over 60 cities. This column presents new evidence on the effect of the concentration of firms on product innovation (new products) in the manufacturing industries.
Coen Teulings, Friday, July 11, 2014
The financial crisis and the Great Recession have led to calls for more economic history in economic education. This column argues for a much broader use of history in economics courses, as a device for teaching both the logic and the empirical relevance of economics. A proposed curriculum would include the rise of agriculture, urbanisation, war, the rule of law, and demography.
Chris Forman, Avi Goldfarb, Shane Greenstein, Friday, May 23, 2014
The diffusion of the internet has had varying effects on the location of economic activity, leading to both increases and decreases in geographic concentration. This column presents evidence that the internet worked against increasing concentration in invention. This relationship is particularly strong for inventions with more than one inventor, and when inventors live in different cities.
Shahid Yusuf, Danny Leipziger, Monday, March 3, 2014
Urbanisation and GDP per capita are positively correlated across countries. However, when the sample is restricted to developing countries, urbanisation and growth are more loosely related – particularly in Africa. CEPR Policy Insight 71 argues that the low share of manufacturing in developing-country cities may help to explain this discrepancy. Strengthening urban finances, embracing technology, improving skills, and stimulating the formal sector will help cities to promote growth. Since decisions affecting urban development can have lasting impact, longer-term planning deserves greater attention than it is currently receiving.
Danny Leipziger, Shahid Yusuf, Monday, March 3, 2014
Urbanisation and GDP per capita are positively correlated across countries. However, when the sample is restricted to developing countries, urbanisation and growth are more loosely related – particularly in Africa. This column argues that the low share of manufacturing in developing-country cities may help to explain this discrepancy. Strengthening urban finances, embracing technology, improving skills, and stimulating the formal sector will help cities to promote growth. Since decisions affecting urban development can have lasting impact, longer-term planning deserves greater attention than it is currently receiving.
Takatoshi Tabuchi, Thursday, November 28, 2013
Two important long-run trends in economic geography are steady urbanisation and agglomeration to the big cities. This column presents recent research on population trends focusing on fixed regions over time. In seven of the eight countries studied, the region containing the largest metropolitan area significantly increased in population share at the expense of the rest of the country over the past few centuries. A 'new economic geography' model with multiple, asymmetric regions can replicate this new stylised fact.
Nicholas Crafts, Nikolaus Wolf, Tuesday, October 22, 2013
Europeans worry about competition from low-wage economies. This column looks at the basis of the success of the 19th-century Lancashire cotton industry faced with a similar situation. The message is that the productivity benefits of a successful agglomeration can underpin both high wages and competitive advantage in world trade. Policymakers can support such agglomerations by easing land-use restrictions, promoting investments in transport, and providing local public goods.
Clément Bosquet, Pierre-Philippe Combes, Friday, June 21, 2013
Every academic has an opinion about what makes a good department. This column brings evidence from French economics departments. It suggests that larger departments are associated with slightly more but no better publications per academic. And while diversity in terms of researcher quality lowers average publication quality, diversity in research topics increases it.
William Kerr, Oliver Falck, Christina Günther, Stephan Heblich, Monday, February 11, 2013
Governments around the world are fostering industrial 'clusters', hoping to create agglomeration economies. Using the political division of Germany in 1949, this column argues that heightened firm density can raise costs for incumbent firms in addition to the often-cited agglomeration benefits. This is important for policymakers contemplating efforts to promote their local areas by targeted cluster initiatives and bidding to attract large firms. Policy efforts that are neutral in orientation – such as physical infrastructure investments or improving the generation and dissemination of knowledge – may be more effective alternatives.
Jose Enrique Garcilazo, Joaquim Oliveira Martins, William Tompson, Saturday, November 20, 2010
The World Bank's Indermit Gill recently argued that economic growth will naturally be spatially unbalanced and that to try to spread it out – too thinly or too soon – would discourage it. This column responds by pointing out that economic concentration is neither necessary nor sufficient for growth.
Sergey Lychagin, John Van Reenen, Margaret E Slade, Joris Pinkse, Monday, October 25, 2010
Why do local policymakers fight so hard to attract research and development labs to their area? This column provides a possible explanation. Using patent data, it finds a strong link between R&D and growth caused by knowledge spillovers between firms.
Laura Alfaro, Maggie Chen, Friday, January 8, 2010
Agglomeration effects are important but difficult to measure. This column uses a new database with precise geographical information to investigate the locational interdependence of multinational firms. Knowledge spillovers and capital- and labour-market externalities exert a significant effect on the co-agglomeration of multinational headquarters, while input-output linkages also play a significant role in the case of subsidiary co-agglomeration.
Peter Debaere, Joon H. Lee , Myungho Paik, Wednesday, June 3, 2009
Gains from agglomeration may explain why investors choose the same location when going abroad, but why do firms from the same country cluster together? This column examines evidence from South Korean firms investing in China and finds that investors of the same nationality benefit from stronger forward and backward linkages with each other.


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Bayer CropScience changes management structure
May 3, 2013 | Natasha Alperowicz
Bayer CropScience is changing its management structure following the retirement at the end of May of Rüdiger Scheitza, head of strategy and business management (SBM) and labor director. The SBM function will be split into two separate units: strategy and business management, with the strategy unit to be headed by Mathias Kremer, currently head of seeds at Bayer CropScience. Business management, meanwhile, will be headed by Gavin Marchant, currently Japan head at Bayer CropScience. In their new functions, Kremer and Marchant will become members of the...
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Honor Roll - Haleyville, AL
in Non-Specific Veteran Memorials
The Honor Roll honors those Haleyville residents who lost their lives in WWI, WWII, Korea, Vietnam, and Afghanistan.
posted by: hummerstation
location: Alabama
date approved: 1/31/2015
last visited: never
Campbellford Cenotaph - Campbellford, ON
Fully refurbished War Memorial in Campbellford, ON.
posted by: jiggs11
location: Ontario, Canada
date approved: 1/26/2015
last visited: 8/15/2015
Trail Cenotaph - Trail, BC
This cenotaph is located in the centre of Eldorado Street, just west of Pine Avenue, beside Trail's Knox United Church. Eldorado becomes a dead end street here, allowing one to drive around the island or park at the end of the street.
posted by: BK-Hunters
location: British Columbia, Canada
All Conflict s War Memorial - South Perth , Western Australia
The South Perth War Memorial is in Memorial Park outside the Council offices
posted by: blingg
location: Western Australia, Australia
date approved: 1/23/2015
Natchitoches Parish War Memorial -- Natchitoches LA
A small memorial along the Cane River in downtown Natchitoches LA honors those who have died in war from Natchitoches Parish
posted by: Benchmark Blasterz
location: Louisiana
date approved: 1/21/2015
last visited: 1/22/2015
Flame of Freedom - Cartersville, GA
Eternal flame for all who served
posted by: YoSam.
location: Georgia
date approved: 1/20/2015
Memorial Fountain - Ozark, MO
American Legion though that as they quenched your thirst you could remember why it was there.
location: Missouri
Veterans Memorial (2 of 2) - Veterans Memorial Hall - Corning, CA
This veterans memorial is one of two located in front of veterans Memorial Hall.
posted by: thebeav69
location: California
date approved: 1/18/2015
Veterans Memorial (1 of 2) - Veterans Memorial Hall - Corning, CA
11,13, 15th and 16th Iowa (skirmishers) marker - Vicksburg National Military Park
This marker is located at the southeastern portion of the South Fort Reserve - north of the Ameristar parking along South Washington Avenue.
posted by: iconions
location: Mississippi
Michigan Troops in the Army of the Tennessee Memorial - Vicksburg National Military Park
This light grey and bronze memorial is located along Union Avenue across from the Michigan Memorial.
Texas - Johnston's Army Monument - Vicksburg National Military Park
This granite and bronze marker is located south of the large Texas Memorial at Tour Stop #13.
The Cenotaph - Hedley BC
The small town of Hedley sent its fair share of soldiers off to fight in the first world war. This cenotaph was originally erected to remember the eleven who fell in the war.
date approved: 1/17/2015
American Legion Post 28 Honor Wall - Grants Pass, OR
This Honor Wall resides in front of the American Legion Post 28 building on the corner of F and 5th Streets.
location: Oregon
date approved: 1/13/2015
Tennessee AmVets Memorial - Unicoi County TN
AmVets memorial placed at the I-26 north welcome center in Unicoi County, TN
posted by: cycle4ever
location: Tennessee
Riverside Park Veterans Memorial - Kamloops, BC
Riverside Park in Kamloops was begun in 1905, on the former site of a lumber mill and a pig farm. Since its inception it has been the major park in the city, with the greatest number of amenities. It is far and away the most used park in the city.
date approved: 1/12/2015
Sallisaw Veteran's Memorial - Sallisaw OK
A dignified multi-war memorial recognizing Sequoyah County men who fought and died in wartime stands proudly outside of the Sallisaw Public Library on Cherokee Parkway.
location: Oklahoma
last visited: 1/13/2015
Prince Edward Old Boys Memorial Entrance - Picton, ON
Entrance to Prince Edward County Fairgrounds dedicated to the "Old Boys" veterans of the Boer War and World War I.
date approved: 1/11/2015
Malaya and Borneo Memorial - Cairns, QLD, Australia
The Malaya and Borneo Memorial is part of the Memorial Gardens located just beside the Cenotaph on the Cairns Esplanade.
posted by: denben
location: Queensland, Australia
Australian Army Memorial - Cairns, QLD, Australia
The Australian Army Memorial is part of the Memorial Gardens located just beside the Cenotaph on the Cairns Esplanade.
Royal Australian Air Force Memorial - Cairns, QLD, Australia
The Royal Australian Air Force Memorial is part of the Memorial Gardens located just beside the Cenotaph on the Cairns Esplanade.
date approved: 1/8/2015
War Memorial - Endicott, NY
A multi-war memorial in a small park area in the center of Endicott near village buildings.
posted by: ripraff
location: New York
date approved: 1/7/2015
Memorial Flagpole - Riverside Park - Grants Pass, OR
This memorial flagpole resides within the heart of Riverside Park.
Korean/Vietnam/Persian Gulf War Memorial - Riverside Park - Grants Pass, OR
This multi-war memorial is located in the heart of Riverside Park.
Multi-War Peace Memorial - Riverside Park - Grants Pass, OR
This peace / multi-war memorial is located in the heart of Riverside Park.
date approved: 1/6/2015
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Debian Project Wants User Art for "Squeeze" OS
Contribute your own Squeeze Artwork and it may become the default background for the next version of Debian.
Contribute your own Squeeze Artwork and it may become the default background for the next version of Debian.
As the Debian Project readies Debian 6.0, (codename: Squeeze), project leader Stefano Zacchiroli has implemented a contest to decide the next desktop and boot theme. The aptly named Squeeze Artwork Contest, allows artists to submit their designs to the Debian wiki where members of the community can view the theme and access the SVN.
Two submissions have been made. The first theme, Nightly , features a starry night sky with the trademark Debian swirl in the center of the screen. The second proposal, Space Fun, features an illustration of the planet Saturn, with the Debian swirl made of stars and the trail of a Saturn rocket. The tagline, "The Universal Operating System" is present in the splash.
To create a wiki entry for your Debian theme, head to wiki.debian.org/DebianArt/Themes/. For art requirements, click here.
Issue 180/2015
Buy this issue as a PDF
Dyreza Malware is Back
Powerful man-in-the-middle attack is now targeting online shopping.
Kernel Developer Matthew Garrett Forks the Linux Kernel
Another high-profile coder says the kernel team needs a kinder, gentler culture.
Bugzilla Bug
Bug database has a bug of its own that could allow an intruder to create an unauthorized account.
US Launches New Strategy for Broadband Access
Report focuses federal resources on achieving universal Internet access.
RC4 Finally Gets the Fork
Leading browser makers say "no" to porous encryption algorithm
IBM Says TOR Network a Vehicle for Ransomware
Report from the X-Force group says attackers are using TOR to hide their crimes
Mozilla Announces new Firefox API
Future Firefox extensions will be compatible with Chrome.
Weird Security Flaw Affected Intel Chips for 16 Years
Better read this if you bought your computer before 2011
OpenSSH 7.0 Secure Shell Arrives
Users should upgrade to the new version as soon as possible
Qemu Flaw Lets the Guest Escape
Xen project announces a privilege escalation problem for Qemu host systems


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Yuuka Nanri
Yuuka Nanri (南里 侑香, Nanri Yūka?, born March 13, 1984 in Nagasaki, Japan), commonly referred to as YUUKA, is a seiyū and also a known Japanese pop singer. She is contracted to Space Craft Entertainment of Space Craft Group. She is the lead vocalist for FictionJunction YUUKA and a former member of tiaraway.
No stations playing Yuuka Nanri now
No albums found


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Written on: 18/03/2013 by LydiaBlackburn (4 reviews written)
An OK restaurant with some very nice dinner options. The reservations are way too hard to book than they should and the service is not the fastest... However, the food is great and the wine list is full enough so the restaurant is worth the try, if you're in the area.
As rated by our community of reviewers
" A good place. " Read More
Written by lindaadele
" Really bad " Read More
" Kings Road Steakhouse " Read More
Written by rdmckenzie
" Fabulous Food, Family Friendly Very Reasonable Prices " Read More
Written by normanLinux
" Overrated and overpriced " Read More


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- Filed Under
Clinton businessman Bob Norman has announced his candidacy for Ward 1 alderman in spring elections. Norman, who owns the Sesame Seed nutrition center in the Springridge Shopping Center, believes that 36 years of owning and operating a business has afforded him the financial responsibility, well-rounded knowledge and ability needed for office. The Ward 1 seat is now held by Tony Hisaw, who is a candidate for mayor. Norman is the only announced candidate for Ward 1.
ALSO: Vicksburg police recently arrested a Clinton man believed to have stalked a 76-year-old woman and stolen her purse from her walker after she left a Vicksburg casino. Salvatore John Digennaro, 23, is charged with grand larceny. Clinton police helped lead Vicksburg police to a drug treatment facility in Copiah County where they believed he admitted himself.


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You may also like
Rate Dr. Mark Popkin
Dr. Mark Popkin's Ratings
Was this rating useful? 0 [[ userState['ratings'][2850104].votes_count ]]
The office staff is not the best and can be abrupt, curt, down right rude; wouldn't give you a dime for any one of them -- they don't answer your questions eitherso maybe they need a lesson in listening skills. If Dr. Popkin wasn't such a good doctor I'd have left him years ago. Took care of my daughter when she was very young and quite terrified -- he's awesome with kids! and now I see him about once a year for my own needs. Office runs pretty close to schedule - although you have to ask for the Saturday hours.
Was this rating useful? 0 [[ userState['ratings'][2458976].votes_count ]]
At first, he seems caring and knowledgeable but then i kept coming back for the same diagnosis and treatment (molluscum). The scalpel process is straightforward but because lack of time or else, he left me with a blood stain on my skin permanently. he rushes and rushes..he should know better that the puss in the molluscum is contagious and should be quarantined..obviously he uses the same scapel for every wart and doesnt clean it...
Was this rating useful? 0 [[ userState['ratings'][1965179].votes_count ]]
If you're looking for a great, no nonsense dermatologist who will give you great medical care, look no further than Dr. Popkin. I've been to a lot of derms, and he is the best.
Was this rating useful? 1 [[ userState['ratings'][1965178].votes_count ]]
Had multiple contacts with Dr. Popkin. On one occasion I had to wait a month and a half to see him - had to go to a wedding looking freakish. When he finally saw me he said to just keep taking the medicine I was taking (which obviously wasn't working). I asked him if oranges could exacerbate roseacea and he said, "No". When I looked on-line, they cited citrus fruits as a factor in roseacea. Why would he not know this? I arrived at one appt. and was told I didn't have one, not on that day and time and not at any other either. Made me wait one hour since someone else had "a real appointment". Then he saw me for 3 minutes. One time when I went to a follow-up appointment, he looked at me and said, "what the hell happened to you?" - I had to tell him HE had burned something off. If he hadn't have been so highly recommended, I would have switched much sooner. While his staff can be blamed for a lot of the problems, I would not recommend him ever.
Was this rating useful? 0 [[ userState['ratings'][1965177].votes_count ]]
Dr. Popkin is the best and I need not say more. However, the reception group is a bit of a mess. Their actual hours do not even come close to being what their recording states-if it says be back from lunch at 1:00-maybe someone will answer by 1:30-if it says open until 4:00, at 3:00 you get the service because they are closed. But I will put up with all of it because Dr. Popkin is the best. Patient, knowledgeable, he's got it all.
Was this rating useful? 0 [[ userState['ratings'][1965176].votes_count ]]
Simply the best. Very intelligent and compassionate. Although the wait is generally long, I never feel rushed once I'm with him.
Was this rating useful? 0 [[ userState['ratings'][1965175].votes_count ]]
Very helpful doctor. Takes his time and I never feel rushed. Overall, a great medical experience.
Was this rating useful? 0 [[ userState['ratings'][1965174].votes_count ]]
I have finally had to switch to a new dermatologist, and I am so glad I did. Dr. Popkin would prescribe the same thing repeatedly despite mediocre results, and the visit would be short and abrupt. This was especially frustrating because it would take me several tries to even get through to the office, since they often are not there to pick up the phone, even during their business hours (which are sporadic to begin with). Multiple frustrating experiences made me go look elsewhere.
Was this rating useful? 0 [[ userState['ratings'][1965173].votes_count ]]
He's great!!! He has helped my acne problem and is very thorough in in his examinations. I would definitely recommend him.
Was this rating useful? 0 [[ userState['ratings'][1965172].votes_count ]]
Top Hospitals in Morristown, NJ
Top Urgent Care Centers in Morristown, NJ
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Faculty & Staff
Faculty of Applied Health Sciences
Faculty & Staff
The faculty and staff of our Faculty of Applied Health Sciences are now a large and complex group with more than 110 full time and hundreds of part time members of our community of scholars. In a family that big, it's not easy to know what everyone is doing all the time.
This page is the family room of our website where we can gather to keep up with what is happening.
Visit often for the most recent information relevant to our vision, mission, goals, the activities of your friends and colleagues.
Carly Cameron (MSc – Kinesiology) thesis defence: Thursday, October 8, 2015
October 8, 2015 - 2:00pm - 5:00pm
Stephanie Pyke (MA – Nursing) thesis defence: Wednesday, November 11, 2015
November 11, 2015 - 10:00am - 1:00pm
Matthew Ventresca (MSc – Health Sciences) thesis defence: Thursday, September 24, 2015
September 24, 2015 - 1:00pm - 4:00pm


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A stunning announcement out of Florida this week. The state that was exhibit A for economic disaster two years ago is now experiencing a tremendous rebound thanks to Gov. Rick Scott's pro-growth policies. Washington should take a page – no several pages – out of Scott's book.
Since December 2010, one month before Scott took office, the unemployment rate in Florida has dropped from 11.1 percent to 7.8 percent – that rate is lower than the national average. After two years of Scott's policies, 282,000 private sector jobs have been created; in the previous four years the state had lost 825,000 jobs.
The past two years have set records for tourism, Florida's biggest industry. In 2012, 89.3 million people visited Florida; up 2.3 percent from the previous record-setting year.
Conservatives remember the awkward embrace former Gov. Charlie Crist gave to President Obama in accepting the ill-advised "stimulus package." Florida's economy only got worse, the jobs kept disappearing, and no one knows where the money went.
When Scott took over he was handed an economy in the tank, large debts and budget deficits – a complete mess. Then he went to work.
· Reforming state government: He oversaw a reduction in over 2300 needless regulations and 12,000 government positions.
· Cutting taxes: He cut property taxes by more than $210 million and eliminated the state for 63 percent of the businesses that paid it when he was elected. He is doubling down in the current legislative session by proposing to eliminate the tax for all manufacturing companies – which would mean that 70 percent of all Florida businesses would no longer pay the tax. He intends to make that 100 percent before he's done.
· Personal income has also risen by 6.6 percent in Florida since Scott took office, going against a national trend where the family dollars are being stretched razor thin.
Conservatives are also right to raise his decision to expand Medicaid as a point of contention. Candidly, I wish he and several other Republican governors would've not gone this route. At least Gov. Scott, unlike the other GOP governors, was able to exact waivers from the Obama Administration that will allow him to privatize Medicaid.
When looking at the whole record, however, Scott has now made Florida exhibit A for how pro-growth policies work. In addition, he has remained true to conservative principles on other key issues.
· On the sanctity of life, he signed bills that will: prohibit the use of state funding for abortions, require an ultrasound for all patients before an abortion procedure, and strengthen parental notification laws.
"Dilbert" creator Scott Adams: Trump is landing "linguistic kill shots" that will sweep him to the presidency | Allahpundit
Revealed: Russian incursion into Syria that caught U.S. intelligence off-guard was, er, planned months ago | Allahpundit


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Narrow your search
Not satisfied with activity and workout results on the Apple Watch? Calibrate it for better accuracy.
The Audiophiliac's highlights from the Rocky Mountain Audio Fest in Denver.
One size or setting does not fit all. By adjusting the picture modes that your TV offers, you can improve the image quality for your various entertainment pursuits.
ELAC America's Andrew Jones talks about his new Debut Series speakers with the Audiophiliac.
The first major update to the multiroom audio system brings products from new partners as well as support for more services, such as multiroom Spotify Connect.
An Arduino-powered DIY project uses a colour sensor to automatically sort and separate Skittles.
Learn how to tweak your desktop or laptop display using free test patterns or the built-in utility in Windows or Mac OS X.
The Sharpness control on your TV doesn't actually add Sharpness. In fact, it actually reduces it. Learn about this misleading control, and turn it down, to get your TV looking its best.
This smooth camera slider can be paired with an optional motor to raise your time-lapse game or add a flexible, lightweight tool to your filmmaking repertoire.
CNET's Dan Graziano tested the step and distance accuracy of the Apple Watch. See how it stacks up against the competition.


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October 8, 2015
Problems began for the Dothan City School Board in July, when members voted to buy out the contract of Dr. Leon Hobbs, then their superintendent. The move cost the school system about $440,000. When pressed for answers, school board members gave News 4 different stories, the most controversial subject being District 5's David Morales, who on July 26 said if an independent audit is performed, "I would say it would be so interesting, chances of people going to jail would be good."
After seeing that interview on News 4, incoming school board chairman Dr. Steve Stokes called for an investigation into all school board practices and procedures. The audit's results were revealed Monday night, suggesting Morales was completely false.
"The one thing I wanted to make sure of, to clear the air" said Stokes, "Is that in the audit [the firm] very clearly stated there was no evidence of criminal wrongdoing, no evidence of any misappropriation of funds."
Morales was not at the meeting Monday, it would have been his last, along with outgoing chairman Jim Hemby and District 1's Earl Jones. CPA David Parsons and his firm conducted the audit, revealing, at the most, some sloppy book-keeping on the part of the Northview High School Athletic Department.
The school system's Chief Financial Officer, Mike Manuel, describes the problems as, "Not getting authorization for a purchase before goods are being bought, not canceling inventories when they're paid, nothing major."
Parsons described the Northview problems as, "People doing things in the wrong sequence without prior approval."
But with an otherwise stellar rating from the accounting firm, Monday could mark the official end of the Dothan City School Board controversy, with new faces on the board coming next month.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or firstname.lastname@example.com.


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Political Hay
An Equal Opportunity to Die
Will it make any difference if Zarqawi's network targets American servicewomen?
The Washington Times reports that terrorists "in the Abu Musab Zarqawi network in Iraq are specifically trying to kidnap an American female service member" to rattle America into pulling out of Iraq. What is Zarqawi's assumption here? That American leaders will treat the abuse of female soldiers differently from the abuse of male ones? Hasn't Zarqawi heard that the only aspect of the war in Iraq the Democrats won't question is the exposure of women soldiers to violence there? The death of women soldiers in Iraq is proof of progress for them -- not a reason to pull female soldiers off the battlefield but to place more of them on it in the name of equality.
Look at the liberal reaction to Lori Ann Piestewa's death. She was an Army private first class that an Iraqi thug shot and killed in early 2003. Liberals used her death to advocate more female soldiers on the front lines. "The Best Way To Honor This Warrior-Mother Is To End An Outdated Combat Ban," ran the headline over a piece by Pittsburgh Post-Gazette national bureau chief Ann McFeatters. She argued that no restrictions on American women in combat in Iraq should exist. "It's an outmoded vestige of a bygone era that only hurts women who want to serve by keeping them from getting the promotions they should have a chance to earn."
Piestewa was a single mother with two preschoolers back home. But her death didn't even make the left reconsider the wisdom of exposing moms to the risk of capture. On the contrary, Piestewa's death was regarded as some sort of monument to egalitarian liberalism and self-actualization. McFeatters praised her "for both supporting her children and following her dream." Stanford University's Peggy Drexler reported with perverse pride that "it was a mother who was the first U.S. woman soldier killed in the war," and that "mothers in risky professions are establishing new roles for women that we must finally accept and even embrace…Only when we accept that the mothers can keep the home fires burning and fight oil fires in Iraq will we truly honor motherhood."
Under the insane cultural conditioning of the left, Americans aren't supposed to blanch at the brutalizing of women soldiers in captivity. To do so is chauvinistic. Those public service announcements about "Violence Against Women" don't apply to war. Then enlightenment requires that society not care if women are exposed to a culture of violence. And if you do, you are a chauvinist who fails to see that violence against women in war is an acceptable consequence of equality.
Liberals rejoiced when Les Aspin, Bill Clinton's hapless defense secretary, eliminated the phrase "substantial risk of capture" as a consideration in determining where the military could place women on the battlefield. The debate over placing women on the battlefield actually turned in part on an issue Zarqawi evidently hopes to exploit: that exposing women to abuse and death could demoralize a nation and lead it to turn against war at a critical moment.
The left pooh-poohed this possibility. Liberals argued confidently that Americans would learn to accept with equanimity the sight of women in captivity and women returning from the battlefield in body bags or as amputees. Americans, they said, could be conditioned out of their chauvinism, just like male soldiers trained not to feel distressed when women are brutalized in captivity next to them.
"If a policy change is made and women are allowed into combat positions, there must be a concerted effort to educate the American public on the increased likelihood that women will be raped, will come home in body bags, and will be exploited. The consequences of not undertaking such a program would be a large scale disillusionment with the military should the United States get in a protracted military engagement," said trainers at the Survival, Evasion, Resistance and Escape training center at Fairchild Air Force Base in Spokane, Washington, in testimony before a presidential commission studying the issue of women in combat in the early 1990s.
Exposing female GIs to the Zarqawis of the world is an experiment in equality the left won't abandon no matter what that savage does in the coming days.


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LS polls near, BJP forms election panel
- Pay Rs 100 to attend Modi's Kolkata rally
- Pay Rs 100 to attend Narendra Modi's Kolkata rally
- Kar seva Chandigarh style: Councillor gets 'Modi bricks' to build government project
- Kar seva Chandigarh style: Councillor gets 'Modi bricks' to build government project
- Pay Rs 100 to attend Modi's Kolkata rally
- Pay Rs 100 to attend Narendra Modi's Kolkata rally
Top Stories
- India to grow at 7.5 per cent in 2016, faster than China: IMF
- Lalu Yadav, Amit Shah booked for 'Narbhakshi', 'Chara chor' comments
- Nehru's niece returns Sahitya Akademi Award, questions PM's silence on 'reign of terror'
- Delhi MLAs may get 400 per cent hike in salary
- American Airlines plane makes emergency landing after pilot dies mid-flight
The Chandigarh BJP has constituted its election committee in the run up to the Lok Sabha polls. The incharge of the city unit, Aarti Mehra, along with senior functionaries, on Wednesday held deliberations on the strategy for fighting the elections in the city. The party has also called upon all disgruntled leaders to come back into the party fold.
The state election committee would comprise Sanjay Tandon, Satya Pal Jain, Harmohan Dhawan, Prem Kaushik, Chandershekhar, Arun Sood, Jairam Joshi, Yash Pal Mahajan and Kamla Sharma. The committee would also have the ex-officio members Arti Mehra, Ajay Jamwal and Sunita Dhawan.
Raghubir Lal Arora was appointed as parliamentary seat guardian, a concept recently introduced in the BJP. Arun Sood and Ramvir Bhatti would be the parliamentary conveners. A disciplinary committee under the presidentship of Desraj Tandon with Om Prakash Goyal, Satinder Singh, Parveen Goyal and Mukesh Kaushik as members was also announced by her.
Mehra said that people see a ray of hope in Narendra Modi. Keeping the mission of 272+ in mind several party workers who were not happy with the party or due to some disappointment had been alienated from party mainstream have announced their unconditional return to the party. She exhorted the party workers to go door to door, get the people into the party ideology and make Mission 272+ a success. She said that in the coming elections all party workers would be united and ensure win in Chandigarh.
It was decided that Anil Dubey, who had been removed from the post of convener of the labour colony cell of the party, would be given back the charge.
Talking about the election issues in Chandigarh, she said that besides the rail bribery scam involving former union minister Pawan Kumar Bansal, there are several unresolved and unaddressed problems of the industrialists, traders, employees, housing board houses, tenements, slum dwellers etc, which will ensure the victory of the BJP candidate.
... contd.


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Papers for Mac3.3.3
editor's review
buy now $79.00
Papers is an OS X app suitable for anyone that wants to read as well as manage scientific documents and articles from the comfort of their desktop.
On top of that, Papers allows you to find, organize, archive and download articles with a single tool, without having to rely on multiple utilities for these jobs.
Multiple-filter powered search engine for rapidly pinpointing any article in the database
The Papers tool also comes bundled with a unique search feature that allows you to add multiple filters in order to find the article you need.
What's more, the application allows you to read your articles in full-screen, add notes to them and even send copies to your friends or family.
Inbuilt synchronizing engine for always being able to access your documents from wherever you are
Furthermore, Papers enables you to add your own PDF articles and it enables you to sync your home and work libraries, if needed.
In addition, with the help of Papers you can enter and modify citations, from one of the 6000+ styles available. The full-screen reading mode enables you to switch between multiple documents using tabs, making it much easier to work with multiple data sources.
Moreover, Papers provides you with a very handy interface and multiple navigation modes that will help you organize your work easier and faster.
Makes it easy and fast to manage your papers' metadata
As an added benefit, the Papers app allows you to annotate and view supplemental files, download PDF when importing articles and it includes powerful metadata matching and discovery techniques.
Papers also provides you with the means to change the list text size, enable or disable animations and visual effects or reopen tabs from the last session upon start-up.
All in all, Papers proves that it has been designed from the ground up to help you effortlessly customize multiple reading and importing aspects like marking papers as read or creating collections upon importing two or more items in a lot less time than you've ever thought it's possible.


text: The closest I come to digi things is the flatbed scanner-) It's a shutter with basically a piece of pipe behind it. The pipe has set screws that fasten to the outside of a barrel lens. Shutter actually has an aperture to but I never use it. One of mine is in pretty good shape the other one is slow at some speeds. No flash sync.


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|Football alumni "part of the family"
|Sunday, 18 November 2007 22:44
Kevin Richardson wasn't the only one to get recognition at Saturday's football game.Mountaineer football alumni from as early as 1986 were on hand to be part of the victory.
Chancellor Peacock told Mark Harvey, a former Mountaineer safety, that football alumni are part of each victory. Harvey's been especially proud to be a Mountaineer lately.
"When we were here, we were not very good, so being part of the ASU family, it's huge for us," Harvey says.
Harvey wasn't alone. A group of fifteen former players spent the weekend reminiscing.
Former defensive back Jeff Vincent says Boone's full of memories.
"My favorite memory here is these guys," Vincent says of his former teammates.
Some of the men haven't been in Boone since they were students.
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