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Voters in different parts of Menifee will elect members to two school boards Tuesday.
The races for seats on the Menifee Union and Romoland school district boards are the only ones on the ballot in Southwest County.
Polls will be open from 7 a.m. through 8 p.m.
Five people are running for two seats on the Menifee Unionboard: incumbents Bob O'Donnell , 64, a retired postmaster; and Rita Peters , 61, a retired community activist; and challengers Pat Cahill , 63, an educator; Scott Mann , 48, president/CEO of the Wildomar Chamber ofCommerce; and Carol "Red" Sullivan , 68, a retired businesswoman.
Menifee Union educates almost 10,000 students in kindergarten through eighth grade at 11 elementary and middle schools. Trustees are paid $265 per month, and benefits are available.
Four newcomers are running for two seats on the Romoland board:Andrew Enriquez, 40, a computer technician; Brady McCarron, 42, ahost and producer for American Forces Radio and a substituteteacher; David Sperry, 47, a businessman; and Sandra Tusant, 49, aclassified substitute support worker in the district.
The Romoland School District has three elementary schools and one middle school, all within Menifee. There are 3,045 students in the district, which covers 22 miles east of Interstate 215 on either side of Highway 74. It draws students from Menifee, Romoland, Perris and Hemet.
Board members do not earn a stipend, although they are eligible for district-paid health insurance for themselves and their family.
Both elections are for four-year terms that begin in December.
To find your assigned polling place, visit www.voteinfo.net or call951-486-7200.


text:
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The invisible computer: why good products can fail, the personal computer is so complex, and information appliances are the solution
In this book, Norman shows why the computer is so difficult to use and why this complexity is fundamental to its nature. The only answer, says Norman, is to start over again, to develop information appliances that fit people's needs and lives. To do this companies must change the way they develop products. They need to start with an understanding of people: user needs first, technology last - the opposite of how things are done now. Companies need a human-centered development process, even if it means reorganizing the entire company. This book shows why and how.
Includes bibliographical references (p. [285]-289) and index. 1. Drop Everything You're Doing -- 2. Growing Up: Moving from Technology-Centered to Human-Centered Products -- 3. The Move to Information Appliances -- 4. What's Wrong with the PC? -- 5. There Is No Magical Cure -- 6. The Power of Infrastructure -- 7. Being Analog -- 8. Why Is Everything So Difficult to Use? -- 9. Human-Centered Development -- 10. Want Human-Centered Development? Reorganize the Company -- 11. Disruptive Technologies -- 12. A World of Information Appliances -- App. Examples of Information Appliances.
- Dewey Decimal: 004.16
Book Details
- Language: eng
- Physical Description: xii, 302 p. : ill. ; 24 cm.
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- Amazon.com -- Business & Investing -- Marketing & Sales -- Advertising
- Amazon.com -- Computers & Internet -- Digital Business & Culture -- Future of Computing
- Amazon.com -- Computers & Internet -- Hardware -- PCs
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- High technology industries -- Marketing
- Human-computer interaction
- Design, Industrial
- Human engineering
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Avril Lavigne Gone Wild!
Well, she's definitely not pregnant.
For the second night in a row, Avril Lavigne partied at the VIP Room nightclub in Saint Tropez. She chugged booze like a sailor, checked out men like she was single, danced with women like she was Lindsay Lohan, but failed to fully live up to true promise of a Girl Gone Wild by not flashing a boob.
Gallery Info: Avril Lavigne partying in Saint Tropez.


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Rita Rae Baravetto
March 21, 2013
It is with profound sadness that we announce the passing of Rita Baravetto, resident of Grass Valley, Calif., March 10, 2013. She was 56.
A family service will take place, and Rita will be interred in Mosinee, Wis.
Rita was born in Wausau, Wis., and graduated from Mosinee High School and the University of Wisconsin, Stevens Point. She received her master's degree from Golden Gate University in San Francisco, where she lived and worked for 30 years and cherished the beauty of the "City by the Bay."
Rita is survived by her husband, Thomas Venz; mother Esther Baravetto; sister Annette Salamone; brother and sister-in-law John and Beth Baravetto; niece Sarah Baravetto; nephews Jeff Baravetto and Jeff Salamone; stepchildren Steve and Beth Venz (and their three children).
Donations in her memory can be made to the Society for the Prevention of Cruelty to Animals, Attn: Development Office, 6201 Florin Perkins Road, Sacramento, CA 95828, or any other animal charity or Hospice of the Foothills, 11270 Rough and Ready Highway, Grass Valley, CA 95945.


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JERUSALEM (Jun. 25)
Israel today asked the Israel-Jordan Mixed Armistice Commission for an emergency meeting to discuss Jordanian attacks yesterday on Israeli personnel and property in the Kfar Saba area. Two Israelis were killed, one was wounded and a train and trucks were brought under fire in the incidents.
Announcing the Israel demand for a meeting, a Foreign Ministry spokesman noted that since April 26 when Jordan gave United Nations Secretary General Dag Hammarskjold its word to maintain the peace, Jordan has been condemned three times for violating the armistice pact. Four Israelis have died and six have been wounded in the attacks and raids which led to these condemnations, the spokesman added.
A Jordanian royal decree today made it unnecessary for Jordanians or Syrians to obtain passports for traveling between the two countries, except for Syrian Jews, it was reported today in a Jordan radio broadcast monitored here.


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Even we summer-lovers have had that moment of heat-induced ennui, in which we run out of things to do and contemplate just sitting inside, watching the full 16-hour Lord of the Rings trilogy (with extra footage) on Blu-Ray. But wait! Your friends at SFR have come up with a painstakingly curated, totally awesome list of the 50 must-do activities in Santa Fe this summer. A six-pack of beer to the first person who can prove to us that you've done them all (ie provide photographic evidence)—not to mention, of course, the glorious feeling of a summer well spent. Ready…go!
1. Sip a margarita at La Fonda's Bell Tower Bar
2. Play outdoor chess at the stone tables on Don Gaspar Avenue, across from the Hotel St. Francis
3. Go to a Friday afternoon art opening on Canyon Road
4. See a band (any band!) at Sol Santa Fe Stage & Grill
5. Lie in the grass and watch the clouds float by at Patrick Smith Park
6. Spend a lazy afternoon listening to live music at the Cowgirl
7. Crash the never-ending party at the Bicentennial Pool
8. Raft the Rio Grande
9. Hike the Atalaya Mountain Trail
10. Bike the Rail Trail
11. Sample Ecco Espresso & Gelato's many flavors of gelato, or walk down the block to Dedo's FroYo for a healthier option
12. Pretend you're a pirate on the Railyard Park's ropes course
13. Loll in the Plaza, listening to the summer Bandstand live music series
14. Host a highbrow tailgate party at the Santa Fe Opera
15. Hike Ski Santa Fe—you'll be amazed how pretty it is in summer
16. Paint a plein-air masterpiece, even if you suck at art
17. Plant something—a flower, a zucchini plant, anything
18. When it rains, dance in it
19. Go barefoot
20. Make plans for September's SFR arts festival
21. Eat an heirloom tomato from the Santa Fe Farmers Market
22. Attend St. John's Music on the Hill
23. Watch a sunset
24. Slurp a watermelon mojito at Coyote Cantina
25. Hang out with your (or your friend's) four-legged friend at the Santa Fe Animal Shelter and Humane Society dog park
26. Try a new spice from The Spice Lady on West Cordova Street
27. Check out a picture-book from your local public library
28. Don't just drive by Camel Rock; stop and explore it
29. Visit Bandelier National Monument
30. Check out the strange, almost-useful items at Design Warehouse
31. Breakfast burrito: Handheld? Posa's. Smothered? The Pantry.
32. Sip an iced latte from Betterday Coffee
33. Take the Rail Runner Express down to Albuquerque (or just Sol Santa Fe, if you're feeling a bit less ambitious)
34. Attend a class at REI
35. Visit the Bataan Military Museum
36. Find the best sopapilla in town
37. Stage a water-balloon fight
38. Sample the tripas tacos at one of Airport Road's many taco trucks
39. Have sex outside (yes, you read that right)
40. Convince a friend (or that cute guy at REI) to take you rock-climbing
41. Go camping in the Valle Vidal
42. Attend an environmental cleanup of the Santa Fe River
43. Start a compost pile
44. Attend a lecture at Travel Bug
45. Save water; shower with a friend
46. Get your hands dirty: help out at a community garden
47. Ride a motorcycle (with full protective gear, please)
48. See a Miyazaki film at CCA
49. Watch a movie being filmed in downtown Santa Fe
50. Have a barbecue and invite your neighbors


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(WASHINGTON) — Former President Bill Clinton will play a central role at the Democratic National Convention this year, assuming the stage for a prime-time address in a slot normally reserved for an incumbent vice president.
Clinton will speak Wednesday, Sept. 5, in Charlotte, N.C., the evening before President Obama will formally accept the nomination in Bank of America Stadium, campaign and Democratic National Convention Committee officials tell ABC News.
Vice President Joe Biden will share the stage with Obama on Thursday, Sept. 6, delivering his own solo address before the president speaks, the officials said.
The formal announcement of Clinton's role is expected Monday morning from the DNCC. News of the speaker line-up was first reported by The New York Times.
Clinton's role at the convention comes as Obama increasingly invokes his popular Democratic predecessor on the campaign trail in part as a defense of his economic plan. The two have also conducted joint fundraisers in the past few months to help rouse the Democratic base.
Copyright 2012 ABC News Radio
EastIdahoNews.com staff
Nate Eaton, EastIdahoNews.com
Mike Price, EastIdahoNew.com
Mike Price, EastIdahoNews.com


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DENVER, May 7, 2003 ? Today 114 employees of Qwest Communications International Inc. will visit Green Valley Elementary School and Martin Luther King Middle School to talk to students about making informed choices regarding future education, careers, budgets and other personal economic decisions.
As Junior Achievement volunteers, Qwest employees each will commit six hours to conduct ?JA in a Day,? a program that reinforces the value of education and teaches elementary and middle school students about the economic benefits of staying in school. The fun and interactive hands-on lessons in free enterprise, business and economics aim to give young people the desire to stay in school and the tools to succeed in the business world. Typically, volunteers schedule five 45-minute classroom visits, but this concentrated effort allows busy business professionals to impact students in one school day.
?Simply put, Junior Achievement is an invaluable asset to America?s future, and Qwest is proud to be a part of the program,? said Joni Baird, Qwest vice president of corporate social responsibility. ?Demonstrating our Spirit of Service, Qwest is committed to the communities we live in, and we certainly understand the role children play in our neighborhoods ? today they?re learning to read and write, tomorrow they?re the driving force of the American economy.?
WHAT: ?JA in a Day? brings the business world to the classroom. Volunteers will use innovative lesson plans to teach students about free enterprise, business and economics. They will use their success to inspire kids to reach their full potential
WHO: Employees of Qwest
WHEN: May 7
WHERE:Green Valley Elementary School ? 8:30 a.m. to 2:30 p.m.; Martin Luther King Middle School ? 7:30 a.m. to 2:30 p.m. (Both schools are located at I-70 and Tower Rd.)
About Qwest
Qwest Communications International Inc. (NYSE: Q) is a leading provider of voice, video and data services to more than 25 million customers. The company?s 50,000-plus employees are committed to the ?Spirit of Service? and providing world-class services that exceed customers? expectations for quality, value and reliability. For more information, please visit the Qwest Web site at www.qwest.com.
About Junior Achievement
Junior Achievement relies on the success of business professionals to inspire students to reach their full potential. Junior Achievement?s K-12 business and economic curriculum comes to life when volunteers from the business community lead students through the innovative, hands-on lesson plans. Volunteers act as invaluable role models for students and provide relevance to what students learn; showing students the link between education and future opportunity. This year, Junior Achievement?s proven programs will reach 75,000 young people in 400 schools in Denver and Northern Colorado, and will be taught by more than 2,000 volunteers. Share your success and inspire kids to reach their full potential. Visit www.jacolorado.org or call (303) 534-JAJA.
This release may contain projections and other forward-looking statements that involve risks and uncertainties. These statements may differ materially from actual future events or results. Readers are referred to the documents filed by us with the Securities and Exchange Commission, specifically the most recent reports which identify important risk factors that could cause actual results to differ from those contained in the forward-looking statements, including but not limited to: the duration and extent of the current economic downturn in our 14-state local service area, including its effect on our customers and suppliers; the effects of our anticipated restatement of historical financial statements including delays in or restrictions on our ability to access the capital markets or other adverse effects to our business and financial position; our substantial indebtedness, and our inability to complete any efforts to de-lever our balance sheet through asset sales or other transactions; any adverse outcome of the SEC's current investigation into our accounting policies, practices and procedures; any adverse outcome of the current investigation by the U.S. Attorney's office in Denver into certain matters relating to us; adverse results of increased review and scrutiny by Congress, regulatory authorities, media and others (including any internal analyses) of financial reporting issues and practices or otherwise; the failure of our chief executive and chief financial officers to provide certain certifications relating to certain public filings; rapid and significant changes in technology and markets; any adverse developments in commercial disputes or legal proceedings, including any adverse outcome of current or future legal proceedings related to matters that are the subject of governmental investigations, and, to the extent not covered by insurance, if any, our inability to satisfy any resulting obligations from funds available to us, if any; our future ability to provide interLATA services within our 14-state local service area; potential fluctuations in quarterly results; volatility of our stock price; intense competition in the markets in which we compete; changes in demand for our products and services; dependence on new product development and acceleration of the deployment of advanced new services, such as broadband data, wireless and video services, which could require substantial expenditure of financial and other resources in excess of contemplated levels; higher than anticipated employee levels, capital expenditures and operating expenses; adverse changes in the regulatory or legislative environment affecting our business; and changes in the outcome of future events from the assumed outcome included in our significant accounting policies.
The information contained in this release is a statement of Qwest's present intention, belief or expectation and is based upon, among other things, the existing regulatory environment, industry conditions, market conditions and prices, the economy in general and Qwest's assumptions. Qwest may change its intention, belief or expectation, at any time and without notice, based upon any changes in such factors, in Qwest's assumptions or otherwise. The cautionary statements contained or referred to in this release should be considered in connection with any subsequent written or oral forward-looking statements that Qwest or persons acting on its behalf may issue. This release may include analysts' estimates and other information prepared by third parties for which Qwest assumes no responsibility.
Qwest undertakes no obligation to review or confirm analysts' expectations or estimates or to release publicly any revisions to any forward-looking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events.
By including any information in this release, Qwest does not necessarily acknowledge that disclosure of such information is required by applicable law or that the information is material.
The Qwest logo is a registered trademark of, and CyberCenter is a service mark of, Qwest Communications International Inc. in the U.S. and certain other countries.
|Contact Information
|Media Contact
Vince Hancock
|Investor Contact
Stephanie Comfort


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Between 1780 and 1810, many French women painters reached impressive heights of artistic achievement and professional success. Despite a cap on the number of women admitted to France's prestigious Académie Royale de Peinture et de Sculpture, and restrictions that barred women from the life drawing classes attended by young men aspiring to paint historical narratives, women ranked among the most sought-after artists in Paris in the 1780s. Three of the Académie's four female members—Adélaïde Labille-Guiard (1749–1803), Anne Vallayer-Coster (1744–1818), and Élisabeth Louise Vigée Le Brun (1755–1842)—regularly exhibited at the biennial Salons.
Royal women were the most important patrons for many women artists. Vallayer-Coster, who joined the Académie in 1770, painted portraits and scenes from everyday life, but was chiefly admired for her still lifes of flowers (07.225.504), seashells, and fruit. However, it was her figural painting that won her the patronage of Queen Marie Antoinette and Mesdames Adélaïde and Victoire, the powerful daughters of King Louis XV. These same patrons supported Labille-Guiard (53.225.5) and Vigée Le Brun, who were both admitted on May 31, 1783; Marie-Antoinette played an important role in the admission of Vigée Le Brun, one of her favorite portraitists, and in 1787 Labille-Guiard was named First Painter to Mesdames.
The simultaneous admission of Labille-Guiard and Vigée Le Brun caused a stir in the art world and beyond, and the press immediately cast them as rivals, pitting Vigée Le Brun's "feminine" style (loose brushstrokes, high-toned color, and flattering renderings of her sitters [49.7.53; 50.135.2]) against the "masculine" characteristics (crisp handling, muted tones, and truth to nature) of Labille-Guiard's paintings. Although many critics applauded their new prominence, others lamented the immodesty of women who would display their skills so publicly. Indeed, pamphleteers frequently conflated the exhibition of these women's paintings with the display of their bodies, and they were hounded by salacious rumors.
The onset of the French Revolution in 1789 created difficult conditions for the artists who had established their reputations with assistance from the royal family. Vigée Le Brun and Vallayer-Coster fled the country, joining many of their aristocratic patrons at the courts of England and Russia, and elsewhere in continental Europe. Labille-Guiard, in contrast, remained in France and attempted to redefine herself as an artist in the new Republic. Not only did she exhibit the portraits of Robespierre and other leaders of the Revolution at the 1791 Salon, but she also built on her reputation as a teacher of young women by proposing a new system for educating girls. Yet in 1793, during the height of the Terror, a government committee ordered the destruction of several of her portraits. She survived the Revolution, but her career never recovered.
Lesser-known female artists, however, benefited greatly from the newly open Salons of the 1790s. In a marked shift from the ancien régime tradition that permitted only members of the Académie to exhibit at the Salon, the exhibitions held in the Louvre's Salon Carré began to welcome all artists in 1791. Rose Adélaïde Ducreux (67.55.1) (1761–1802), a daughter of the pastellist Joseph Ducreux, was among hundreds of artists who first saw their works on Salon walls in 1791. Ducreux's oeuvre, like those of the sisters Marie Victoire Lemoine (57.103) (1754–1820) and Marie-Denise (Nisa) Villers (1774–1821), who also emerged in the 1790s, is slowly coming to light. For instance, Villers has recently been identified as the painter of the Metropolitan Museum's Young Woman Drawing. In this significant work, which was well received at its first exhibition, the artist combines the sensuously curving lines and dramatic backlighting that characterize the paintings of her teacher, the male history painter Anne-Louis Girodet-Trioson (1767–1824), with a subject appropriate to her gender. Indeed, many paintings, especially portraits of young women, which were formerly attributed to Jacques Louis David or Élisabeth Vigée Le Brun, now appear to have been painted by women who established their reputations in the 1790s and early 1800s.
Auricchio, Laura. "Eighteenth-Century Women Painters in France." In Heilbrunn Timeline of Art History. New York: The Metropolitan Museum of Art, 2000–. http://www.metmuseum.org/toah/hd/18wa/hd_18wa.htm (October 2004)
Kahng, Eik, ed. Anne Vallayer-Coster: Painter to the Court of Marie-Antoinette. Exhibition catalogue. New Haven: Yale University Press, 2002.
Sheriff, Mary D. The Exceptional Woman: Elisabeth Vigée-Lebrun and the Cultural Politics of Art. Chicago: University of Chicago Press, 1996.
Auricchio, Laura. "Claude Monet (1840–1926)." (October 2004)
Auricchio, Laura. "The Nabis and Decorative Painting." (October 2004)
Auricchio, Laura. "The Transformation of Landscape Painting in France." (October 2004)


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Fill the signin form and go to your private zone.
SCFS Puts On Dance Workshops In Coos Bay
The South Coast Folk Society announces the South Coast Folk Dance
Festival, a day-long event celebrating dances from around the world. On Saturday, August 10th, dance teacher Loui Tucker of San
Jose, will instruct a morning workshop (9:30 to noon) with dances
from various countries, and an afternoon workshop (1:30 to 4:00)
focusing specifically on Israeli folk dances. In the evening,
Eugene-based Balkan band Kef will provide live music for more dancing
beginning at 7pm. A potluck lunch is planned at Noon, followed by
a Balkan singing workshop. Admission to workshops is $15 each; the
evening dance party admission is $15. Package deals are available.
All activities will take place at the Harding Learning Center
gymnasium at 755 South 7th Street in Coos Bay. The doors open at 9am.
This festival is made possible thanks to Oregon Garden Art, Cedar Electric & Construction, Congregation Mayim Shalom, La Costa Restaurant, Macduff Design, and The Liberty Pub.
For a schedule of festival activities, visit http://moourl.com/dancefest or call 541-808-1002 for
more information.


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Not the typical roadside memorial in National City
"Yeah, eight years. We come out every year on the night it happened."
Edward Magdaleno noon, Sept. 21
(Page 2 of 2)
On the more delicate side of the "Land," Lemon Verbena Ricotta Ravioli are thinly rolled green-colored stuffed pasta with bashful shreds of leeks, bright red splashes of tomato confit, and a rich tarragon-vermouth cream sauce — another winner in the easy-deliciousness contest. It's maximal comfort food. The green color of the pasta comes from lemon verbena, a sweet and fragrant old-timey herb that's nearly forgotten nowadays but shouldn't be. (Only problem with growing it yourself: in about two years it can become a big, disorderly shrub. But just give it space and prune it back yearly. Smells great and is fun to cook with.)
What didn't we like so much? Two items that were slightly overcooked. Potato-Thyme−Crusted Local Halibut is — crust or no, local or no — still halibut, chicken breast of the sea. It's lean white-meat diet food, and I only like it swamped in rich, fattening sauces. Potato-crusted fish were a big trend in the '80s and '90s, but they typically involved richer species, such as John Dory, with the potato decoratively applied like fish scales and then sautéed to crisp, like hash browns. Here the coating was pale, soft, and herbed. The fish was only a tad overcooked, but with halibut I'm unforgiving because it has so little to offer but tenderness and neutrality.
Also, sadly, the Vande Rose Farm Apricot Glazed Pork Chop was overcooked. We asked for rosy medium-rare. It came a pinky-brown medium-well. Vande Rose is one of the highest-quality hog farms in America, and its meat does not need to be cooked brown. (Once again, the litany: there's no trichinosis in American commercial pork. It's ideally cooked to 130–135 degrees Fahrenheit, then set aside for five minutes to rest, to complete internal heating to the rosy pink of about 140 degrees.) Everybody ate a few bites of the pork but gave up soon. The sides were good, though. I loved the mascarpone polenta, minty carrots, onion jam, and sage-flavored jus.
For our appetizers, I chose a pleasing Paso Robles Bootjack Ranch Sauvignon Blanc. Good enough. Luckily, Lisa showed up at our table in time to relieve me of the stress of choosing wine for a combination of seafood and meat entrées. From the half-carafe list, she brought a rosé (Mi Sueño from Napa) and, for the meaty entrées, a new, almost undiscovered Argentine grape, Bonarda from Ichanka. It was plummy, velvety, deep, and passionate, but, unlike Argentina's more typical Malbec variety, not too tannic — a graceful tango-dancer of a wine, memorable, and worth remembering for future imbibing.
I'm not all that fond of sweets right after a meal, and this was a big meal. We were only mildly tempted by the Carlsbad strawberry shortcake, key lime pie, passion fruit brûlée, and several dreamy-sounding but heavier concoctions. What I hated to miss was the cheese plate with its four superb California artisanal cheeses, plus fig jam and crostini. But the body has its limits, even if mental appetites are infinite.
With all the changes, I now envy Bobbie and Roy their neighborhood restaurant. In fact, the prices are really about the same as most of the better neighborhood places in areas like Kensington, Little Italy, Banker's Hill, et al. The food at the Shore rivals any of them and is better than many. Do we believe in change? Yes, we do!
Hot Specials in Foodland
I love the artisanal cuisine of Christian Graves at J-Six, and right now there's a special, daily from 5:30–6:00 p.m. and 9:00–9:30 p.m.: half-size portions of entrées for half price. From now until Labor Day, you can get free corkage when you BYO wine to dinner. Time to whip out those aged Bordeaux in your closet before they turn brown!
Meanwhile, at the Prado (that ever-so-pretty place in the park to take your visitors in summer), there's an art-and-food bargain: for $80 per couple, you get a three-course prix-fixe meal and a bottle of wine (with a few choices for the wine, and for all the courses), plus tickets to the Museum of Photographic Arts' rockin' 'n' rollin' Taking Aim exhibition. This event runs Thursday nights only, June 17–September 2. ■
The Shores
★★★½ (Very Good to Excellent)
La Jolla Shores Hotel, 8110 Camino del Oro, La Jolla, 866-644-2630; theshoresrestaurant.com
HOURS: Breakfast daily 7:00–11:30 a.m.; à la carte Sunday brunch 11:30 a.m.–2:30 p.m.; lunch Monday–Saturday 11:30 a.m.–2:30 p.m.; dinner nightly 5:00–10:00 p.m.
PRICES: Dinner appetizers, soups, salad, $6–$11; entrées, $17–$26; sides, $5; desserts and cheese plate, $9–$10.
CUISINE AND BEVERAGES: Seasonal "Neighborhood American Cuisine" with Mediterranean and global influences. Adventurous, intelligent wine list, mainly under $50, plenty by the glass and by the generous ½-bottle carafe. Classic and creative cocktails; beers include three local brews on draft.
PICK HITS: Forest Mushroom Bisque; Carlsbad mussels in beer; Baja shrimp fritters; ahi poke; diver sea scallops; bacon-wrapped monkfish; roast rack of lamb; Lemon Verbena Ricotta Ravioli. Good bet: cheese platter.
NEED TO KNOW: Validated parking in underground hotel garage. One lacto-vegetarian entrée, but chefs can put together interesting veggie plates upon request. Trustworthy sommelier. Resort-casual dress.
I am so happy to read this review. The Shores always had the advantage of the great view (and maybe a walk on the beach after the meal), but when I last dined there--about 2 years ago--nothing on my plate was particularly good. Edible yes--memorable, no. But now, the bisque, the mussels, the rack of lamb, the stuffed avocado, the wine possibilities--it all sounds great: just in time for late summer sunsets. Thanks, Naomi (and I hope to thanks the chef in person).
I am so happy to read this review. The Shores always had the advantage of the great view (and maybe a walk on the beach after the meal), but when I last dined there--about 2 years ago--nothing on my plate was particularly good. Edible, yes--memorable, no. But now, the bisque, the mussels, the rack of lamb, the stuffed avocado, the wine possibilities--it all sounds great: just in time for late summer sunsets. Thanks, Naomi (and I hope to thanks the chef in person).


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In the current trade and acquisition talk now re-emerging, a major factor to the discussion is the question of whether Hibbert will continue to seriously improve.
I have my doubts. I have been a major Roy fan since the beginning but have waned in the past year or so, mainly because it is appearing to me that Roy's issues are not skill and physical development, where he will improve due to his work ethic. They are mental and psychological. When the game is on the line, and in big games like the playoffs, Roy just doesn't seem to be able to play well. He does not seem to be clutch, not a "gamer."
If so, as much as I love him, I'd rather invest elsewhere.
Yes, those mental and psychological matters could be improved as well, I suppose. But here is my question:
What do we know about this question from Roy's past? At Georgetown, did he become more of a factor late in games as a junior and senior? Did he win games in the last minute? Did he help the team become a winner?
Or, instead, did he put up better numbers each year but not show up during big games and key moments?
Same with high school. What do we know about Roy's past that will help us with seeing the future?


text: Where can I find a bomber jacket like this, either real leather or fake, with the fur lining? I saw it in "Tonight You're Mine" worn by Luke Treadaway and had to have one. It's distressed dark brown leather or faux leather, with fake fur lining, belt at waist, as depicted below in the attached photos. Any suggestions are most welcome--thank you very much for any advice. .


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HALF MOON BAY — An elderly woman was hospitalized Monday morning after being dragged outside her vehicle as it rolled down an embankment near Tunitas Creek Open Space Preserve, the California Highway Patrol said.
The woman was taken to Stanford University Medical Center with multiple broken bones in her leg and back, CHP Officer Art Montiel said. She remained hospitalized Tuesday with moderate to major injuries.
About 8:15 a.m. Monday, the 75-year-old woman parked her car on Tunitas Creek Road near Highway 35 and got out to open a roadside gate that opened to her private driveway, Montiel said. The woman reached back inside through her open window to turn off the engine and retrieve the gate keys, and instead nudged the gear selector into drive.
The 2000 GMC Jimmy began rolling down the incline with the woman's arm still lodged inside, Montiel said, and she was dragged about 12 feet before breaking free from the runaway vehicle.
Moments later, the car gained momentum and rammed through the closed gate and barreled across Tunitas Creek Road before plummeting 300 feet down an embankment.
"At the point it started rolling, she couldn't really get her arm out," said Montiel, who added that the car tumbled over the embankment within seconds of the woman breaking free. "It's a very good thing she did not stay with the vehicle."
Contact Erin Ivie at firstname.lastname@example.com. Follow her at Twitter.com/erin_ivie.


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Reducing Barriers to Drug Abuse Treatment Services (RBP)
This study has been completed.
Wright State University
National Institute on Drug Abuse (NIDA)
Information provided by:
Wright State University
ClinicalTrials.gov Identifier:
First received: January 5, 2006
Last updated: February 23, 2009
Last verified: February 2009
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
No Study Results Posted on ClinicalTrials.gov for this Study
|Study Status:
|This study has been completed.
|Study Completion Date:
|May 2008
|Primary Completion Date:
|May 2008 (Final data collection date for primary outcome measure)


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The gift shops and speciality gift shops always have themed chocolate covered rice krispie treats for sale and I recently saw a few for Easter. When we were making our St. Patrick's Day Lucky Charm Bars, I made an extra batch of Rice Krispie treats to create these fun Easter Rice Krispie Treats. Make your favorite Rice cereal treat recipe and allow to cool completely. It really is a lot of fun, its easy and saves money from buying one at a store. Not to mention it is going to be a lot fresher than the ones you buy there.
Use a 3 inch Bunny Cookie Cutter, we had a bunny head cookie cutter buy you could use an Easter Egg Cookie cutter too. Cut out your shape with the cookie cutter out of your Rice Krispies.
Melt your Chocolate discs and allow to cool slightly. We found that if we dipped our shape when the chocolate came out of the microwave, was too warm and made our shape crumble.
Dip both sides and place on a cookie sheet with parchment paper.
While the chocolate is still drying, add your Pink Bunny Nose (Candy coated peanuts work great), eyes and ear sprinkles.
When the chocolate is set, melt some chocolate chips in a plastic bag and cut a small piece from the corner and add your mouth accents. Allow to cool.
This is such an easy dessert idea, you can make this themed for any event, just need to change up the cookie cutter.
They would be so perfect placed in a cellophane bag and used as a party favor or Easter Brunch place card. Be sure to check out all the yummy chocolate covered Easter Treats we made last year.


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Get an overview of this hotel5-star beach resort with a full-service spa
Popular property highlights
Located in Mai Khao, this beachfront resort is in a national park, 1.3 mi (2.1 km) from Turtle Village, and within 16 mi (25 km) of Splash Jungle Water Park and Blue Canyon Country Club.
Resort Features
Catch some rays at the beach or spend the day relaxing at Renaissance Phuket Resort & Spa's full-service spa. Then enjoy a meal at one of the resort's 3 restaurants.
Room Amenities
All 180 soundproofed rooms provide free WiFi, free wired Internet, and iPod docks. Guests can enjoy deep soaking tubs, and other standard amenities include sofa beds, 24-hour room service, and flat-screen TVs.Information missing or incorrect? Tell us!Opens in a new window
Renaissance Phuket Resort & Spa
Hotel Amenities
Hotel Amenities
In addition to a full-service spa, Renaissance Phuket Resort & Spa features a lazy river and a waterslide. Dining is available at one of the resort's 3 restaurants and guests can grab coffee at the coffee shop/café. Guests can unwind with a drink at one of the resort's bars, which include a poolside bar and a bar/lounge. A computer station is located on site and wireless Internet access is complimentary.
Business-related amenities at this 5-star property consist of a business center and meeting rooms. Event facilities measuring 2917 square feet (271 square meters) include conference space. This Art Deco resort also offers an outdoor pool, a children's pool, and a 24-hour health club. An area shuttle within 2.00 km and a shopping center shuttle are complimentary for guests. Onsite self parking and valet parking are complimentary.
Renaissance Phuket Resort & Spa has designated areas for smoking.
- Pool sun loungers
- Pool umbrellas
- 24-hour front desk
- Babysitting or childcare (surcharge)
- Children's club (free)
- Supervised childcare/activities (surcharge)
- Airport transportation (surcharge)
- Total number of rooms - 180
- Number of floors - 4
- ATM/banking
- Bar/lounge
- Breakfast available (surcharge)
- Business center
- Coffee shop or café
- Concierge services
- Conference space
- Dry cleaning/laundry service
- Elevator/lift
- 24-hour health club
- Full-service spa
- Free shopping center shuttle
- Gift shops or newsstand
- Hair salon
- Lazy river
- Waterslide
- Designated smoking areas
- Free WiFi
- Computer station
- Tours/ticket assistance
- Spa treatment room(s)
- Meeting rooms 3
- Multilingual staff
- Free valet parking
- Terrace
- Poolside bar
- Porter/bellhop
- Luggage storage
- Conference space size (meters) - 271
- Number of meeting rooms - 3
- Year Built 2010
- Free area shuttle
- Number of restaurants - 3
- Conference space size (feet) - 2917
- Free long-term parking
- Free self parking
- Sauna
- Number of buildings/towers - 7
- Garden
- Spa services on site
- Spa tub
- Steam room
- Children's pool
- Outdoor pool
- Wedding services
Available in all rooms: Free WiFi , Free wired Internet
Available in some public areas: Free WiFi
Free long-term parking, Free self parking, Free valet parking
Room Amenities
- Premium TV channels
- DVD player
- Premium bedding
- Air conditioning
- Soundproofed rooms
- Phone
- Refrigerator
- Free bottled water
- Daily housekeeping
- Turndown service
- Designer toiletries
- Private bathroom
- Bathrobes
- Free toiletries
- Hair dryer
- Slippers
- Deep soaking bathtub
- Rainfall showerhead
- Separate bathtub and shower
- Iron/ironing board
- Desk
- Sofa bed
- Cable TV service
- Flat-panel TV
- Free WiFi
- Free wired Internet
- In-room safe (laptop compatible)
- iPod docking station
- Blackout drapes/curtains
- Room service (24 hours)
- Down comforter
- Connecting/adjoining rooms available
- Free cribs/infant beds
- Rollaway/extra beds (surcharge)
Where to Eat
Buffet breakfasts are available for a surcharge and are served each morning between 6:30 AM and 11 AM.
Takieng - This poolside restaurant specializes in Thai cuisine and serves dinner only. Open daily.
Sand Box - This poolside restaurant specializes in pizza and serves lunch, dinner, and light fare. Guests can order drinks at the bar and enjoy alfresco dining (weather permitting). Open daily.
Loca Vore - This fine-dining restaurant specializes in international cuisine and serves breakfast, lunch, and dinner. A children's menu is available. Open daily.
Doppio - This cafe serves lunch and light fare. Open daily.
The Lounge - This lobby lounge overlooks the garden. Happy hour is offered. Open daily.
24-hour room service is available.
Nearby Things to Do
A 24-hour health club and complimentary bicycles are featured at the resort. An outdoor pool, a children's pool, and a spa tub are on site. Other recreational amenities include a lazy river, a waterslide, and a sauna.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Surfing/boogie boarding nearby
- Kayaking nearby
- Sailing nearby
- Water skiing nearby
- Rafting nearby
- Windsurfing nearby
- Free bicycles on site
- Scooter/moped rentals nearby
- Hiking/biking trails nearby
- Parasailing nearby
- Ecotours nearby
- Golf lessons available nearby
- Fitness classes on site
- Pilates classes on site
- Yoga classes/instruction on site
- Beach yoga on site
Spa Services
Quan Spa has 7 treatment rooms including rooms for couples. Services include hot stone massages, Thai massages, massages, and facials. A variety of treatment therapies are provided, including aromatherapy. The spa is equipped with a spa tub.
The spa is open daily.
- Number of treatment rooms 7
- Body wraps
- Body scrubs
- Massages
- Hot stone massage
- Thai massage
- Aromatherapy treatments
- Spa tub in spa
- Couples treatment rooms
- Body treatments
- Facial treatments
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time starts at 2 PM
Minimum check-in age is 18
Special check-in instructions:
Check-out time is noon
Payment types
Children and extra beds
- Children are welcome.
- Kids stay free! Up to 2 children 12 years old and younger stay free when using existing bedding.
- Rollaway/extra beds are available for THB 1900.00 per day.
- Free cribs (infant beds)!
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Optional extras
- Fee for buffet breakfast: THB 800 for adults and THB 400 for children (approximately)
- Airport shuttle fee: THB 1500 per vehicle (one way)
- Rollaway bed fee: THB 1900.00 per day
Hotel Name
- Phuket Renaissance
- Phuket Renaissance Resort
- Renaissance Phuket
- Renaissance Phuket Resort
- Renaissance Phuket Resort Thalang
- Renaissance Phuket Thalang
- Renaissance Resort Phuket
- Renaissance Phuket Hotel Mai Khao
- Renaissance Phuket Resort & Spa Mai Khao
- Renaissance Phuket Resort And Spa
- Renaissance Phuket Resort Mai Khao
- Renaissance Phuket Mai Khao
We should mention
This property offers transfers from the airport (surcharges may apply). Guests must contact the property with arrival details 24 hours prior to arrival, using the contact information on the booking confirmation. Up to 2 children 12 years old and younger stay free when occupying the parent or guardian's room, using existing bedding. Only registered guests are allowed in the guestrooms. The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.


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Merle Haggard – Enduring Spirit
Merle Haggard plays a pivotal role in the evolving definition of country music.
Merle Haggard grew up in the classic American situation. Coming from a lower class family, Merle had to learn to depend on his inner resilience to reach his American Dream. Having some sporadic trouble with the law at an early age, and having spent some time in the San Quentin jail, Merle Haggard had a lot of difficulties making it at first. At one point in his career, he was actually digging ditches to make money for his family. Playing guitar with small music groups finally got him noticed by the right people and his career really began to take off after he signed a record contract with Capitol Records in 1965. His songs started climbing to the top ten list by the late sixties.
Merle continues his feverish pace of song writing throughout his career, even until today. His songs have breached new ground several times through his career, a fact that has led many budding country musicians to take a page from Merle Haggard's song book.
Merle Haggard recently announced a green music tour where he will be using trains exclusively to get to his gig locations. Read more in the story Musical Green Train to Make National Whistle-Stop Tour [www.sundance.tv].
If you are so inclined, you can find a more comprehensive biography on CMT [www.cmt.com].


text:
Artist description:
ahh..i finally got a TABLET!took about 45mins with tablet! so this is Haruhi!~hope u all like it!^^
Flash Draw Created Dec 28, 2007 470 x 338px Unless noted Copyright 2007 silvercoral.
We encourage you to submit a comment and let the artist know what you think of this drawing. Please log in or join to post a comment.
Post a comment
Yay!!!!! *10* *and throws confetti in the air!!!!*
Love it! You are so good! xD
Kya~!! She's so kawaii! x3 Congrats, Silvercoral~ :3 ♥♥10
cute! I wish I had a tablet. 10
Whoo~ I like her eyes C: Cool coloring.
first* lol
love he hair :) is this ur friend tablet drawing?


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IT'S not such a good idea to measure your life out in possibilities.
If you think about all the things you'd still hope to do and to achieve, compared with the restraints of time ... well, I quake afore it.
Countries to travel to and foods to try and songs to hear, it all makes me realise how limited a time we have to do it in. Books, books are the worst. At the moment I'm only averaging one a fortnight. That's 26 a year. If I live to my average life expectancy, 80, that only allows time for another 1300 books. I shouldn't have read A Town Like Alice five times. What a waste.
Loading article content
Choose wisely, is the motto here. That, or spritzing.
Spritzing is a nifty scheme invented by a Boston-based company that works with text streaming technology. It's a way to read without moving your eyes and, therefore, wasting valuable reading time.
Your eyes read by looking for a point in a word, the "optimal recognition point", or ORP, and, when the ORP is found (slightly left of the centre of each word), the brain can process the meaning of the word it's looking at.
Spritz lines the words up with the eye's natural reading motion, it identifies the ORP of each word, makes that letter red and presents all of the ORPs at the same space on the screen.
With 20% of reading time spent processing content and 80% spent moving your eyes around, Spritz speeds up reading.
It is intended for email, social media and ... digital books. "Atlas Shrugged in a day? You betcha," says the Spritz website. The developers boast a novel reading time of 90 minutes.
From one a fortnight to, say, three a week. That's 7800 books. That has to be a boon, doesn't it, stretching my literary lifespan until I'm just about immortal.
The thing is, rereading Nevil Shute doesn't feel like a waste. Neither does the delayed gratification of easing a novel gently through 14 days.
The whole thing puts me in mind of The Little Prince (read carefully and at leisure) in the chapter where the wee fellow meets a merchant who sells pills that quench thirst. Swallow one pill a week and you will never need to drink anything again. They are, the merchant explains, a time saving device. Experts have computed that not drinking will save a man 53 minutes every week.
"If I had fifty-three minutes to spend as I liked," says the Little Prince, "I should walk at my leisure toward a spring of fresh water."


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Out & About
DSI Comedy Theater
426 West Franklin Street, Chapel Hill, NC 27516
(919) 338-8150
Visit Their Website
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DSI Comedy Theater entertains audiences in North Carolina and across North America with a unique and energetic approach to the alternative comedy scene and its critically acclaimed performance of improv, sketch and standup comedy as an artform. Support Your Local Comedy. Support Dirty South.
Located in the Carr Mill Mall between Elmos and Southern Rail.
Is this your business? Update your free WRAL Out & About business profile by emailing us your logo or a picture of your business now.


text:
is to proclaim the good news, directing our entire lives toward that oneness for which Jesus Christ was sent for which God calls all. As Jesus was sent to show God's love to the world, we are sent to make Christ, to make God, visible by our very being, by sharing our love, faith, and hope.
You Are SentConstitution of the School Sisters of Notre Dame
Sister Leetta Hammack's story of becoming a sister is similar to many, but a tragedy, a dream and God's call made her story one of hope, excitement and internationality. She is from St. Louis, but followed a calling to Latin America and currently serves in Paraguay. What do you do when God calls?
Join us as we commemorate the 2017 Jubilarians who celebrate 25, 50, 60, 70, 75, 80 and 85 years of service and ministry. Explore profiles, share stories, send an eCard or give a gift to honor these sisters during their Jubilee year. Which Jubilarians do you remember? How will you celebrate them?
The passion and courage of Mother Caroline Friess, the American foundress of the School Sisters of Notre Dame, can be seen in the ministries of sisters today. More than 100 years later, sisters continue her efforts to educate and aid immigrants and those less fortunate. Who inspires you to show courage?
~ Stay Connected ~
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© 2017 School Sisters of Notre Dame, 320 East Ripa Avenue, St. Louis, MO 63125 | Phone: 314-561-4100 | Email: firstname.lastname@example.com


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It's in the ForumRole.php hence the post in here,
new CheckableOption('CompanyPublic', new TextField('Address', _t('ForumRole.COMPANY', 'Company')), true),
I'm guessing that it tests for the existence of a Constant (which as far as I can see isn't set anywhere in v2.5) and so returns Company in the call above.
I'd like to know where this function/method called _t is?
should it be used in other places? is it a relic from version 0.0.0.1? I've read it could be a private method but don't know where to look.
possible answer = I think it's something to do with internationalization - i18n


text:
Roy Westover, who was accidently killed while icing cars here September the 17th, was buried from the Methodist church the Tuesday following. Rev. Pratt conducting the funeral services.
Discover your
family's story.
Enter a grandparent's name to get started.
Mrs. Strause of Paha, Wa., Mr. Westover's mother came down to attend the funeral.
Card Of Thanks
We wish to thank all who kindly assisted us in the burial of our beloved son and brother, Roy Westover, and for the beautiful flowers contributed.
Philo Westover
Mrs. Maybel Hess
Mrs. Mary Strouse
Alice Westover
North Powder News
Saturday September 22, 1917


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F.I.S.H. encourages clients to try unusual dishes, provides recipes and info about available food
Especially during the summer and fall, Newberg F.I.S.H. (Friends In Service to Humanity), receives fresh produce donations to provide for those in need. But these fresh vegetables and other not-as-common foods can be discouraging to clients because they are unsure of how to prepare them. So, Judith Labadie, F.I.S.H. volunteer coordinator, and others, started a food tasting program at the end of each month where clients can try foods prepared with the unusual or weird looking ingredients available to them.
We noticed that especially this time of year when theres so much produce, but sometimes looks odd squash can be a little scary sometimes we notice a lot of the less familiar vegetables arent selected, Labadie said.
She said from talking with clients, they might not know what the item is, how to fix it or if their children will eat it.
People are passing on food thats delicious and nutritious, so (we said) lets take some of the food and serve some samples, she said. We give out recipes and see if its inspiring.
She said the program really came about thanks to a grant offered from First Federal Savings and Linfield College.
Together they sponsored a grant to pay an intern to do something with a nonprofit for a semester, Labadie said. I applied for the grant to get this off the ground.
She added that the program was built around the work their intern did.
Volunteer Forrest Freed said the idea originated with a United States Department of Agriculture shipment of bags upon bags of soy beans.
Freed said although they decided the soy beans were too involved as they require soaking before cooking can begin the idea continued with squash, zucchini, rice and other vegetables.
Last month, for example, they made a butternut squash soup.
It turned people off looking at, but if they taste it, Oh, this is good, he said. It turned a lot of people around.
Labadie said the impact of the program, in its third month, is light but at least its introducing people to the different vegetables and supplies they have available.
Freed said its not all odd shaped vegetables F.I.S.H. has available. Last month they also had boxes of apples and almond butter.
That was real popular with kids and adults, he said.
Sometimes the federal government sends odd things that they arent sure what to do with, he said, such as a shipment of aluminum cans labeled simply as pork.
Who knows what kind of pork it is, or the consistency, he said. Thats why the almond butter did well. Its in a clear jar, you can see it.
Beth Wasson, one of three F.I.S.H. executive directors, said with an average of 1,200 individuals and 350 households using the food box service, they want to ensure even the odd food gets used.
We do have avenues to move the produce; YCAP (Yamhill County Action Program) helps us with that so it goes to other places where needy can use it, Wasson said. Its our intentions not to waste. We want people here to benefit as well, so we try very hard to make sure they can use (the supplies) nicely.
To get involved or for more information about the program, visit www.newberg fish.com.


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Eighteen-year-old "Camp Rock" cutie Demi Lovato has been stylishly making the rounds promoting her latest adventure with the Jonas Brothers, "Camp Rock 2: The Final Jam." While Demi's "Camp" fashions may be a favorite of tweens and teens, her red carpet style is age appropriate, but a bit more grown up, landing her in plenty of magazines. Today she shares her fashion and beauty must-haves with Glam Slam.
1. Blazers:
"Alice + Olivia has these amazing fitted blazers. They are great for dressing up or dressing down - and they're super comfortable which is important to me when wearing a blazer."
2. Sunglasses:
"I love my Ray-Bans. They fit my face perfectly and come in so many fun styles."
3. Skinny jeans:
"Who doesn't love skinny jeans?!"
4. Nail polish:
"My favorite nail polish is Essie, because it lasts for a long time and I love the shades they offer."
5. Spiked jewelry:
"CC SKYE makes the greatest spiked jewelry. It always goes with my outfit no matter what I'm wearing."
"Camp Rock 2: The Final Jam" airs tonight on the Disney Channel and Demi will also be on Radio Disney's pre-show from 6 – 8 PM EDT.
How excited am I? One of my favorite designer labels, Lanvin, is designing a collection for H&M, which will be sold in about 200 stores in the U.S. when the collection launches November 23.
Can't wait!


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You Are Here: AHRQ Archive Home > Technology Assessment Archive > Vulnerable Plaques > Proposed Methods To Diagnose Vulnerable Plaque
This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Imaging modalities that have been used to study plaques within the current concept of vulnerable plaque (VP) are summarized in this section. Under the current concept of VP, most CVD events are caused by plaques at high risk of rupture. Therefore, studies of biomarkers predicting CVD events might be useful to identify the presence of "VP." We reviewed studies that examined the association between serum biomarkers and the occurrence of ACS events. Since these are not studies of specifically defined "VP" populations, their inclusion here is merely to suggest possible roles of these biomarkers.
The evaluation of a diagnostic test requires a reference standard. Given the lack of a reference standard for VP, we discuss some issues concerning such a definition. This discussion is followed by summaries of peripheral blood biomarkers and imaging modalities. We provide one table for blood biomarkers (Table 1) and another for imaging tests (Table 2). Appendix 1 and Appendix 2 provide detailed descriptions of each biomarker and imaging test, respectively.
The current concept of VP focuses on the characterization of the structure and behavior of the plaque lesion. Given the location of the plaques and the need to accurately characterize intra-luminal plaque features, an invasive imaging technology will most likely be used as the reference standard for VP. It will be necessary to conduct natural history studies (as discussed earlier in Section 4) to compare these tests to determine the technology that most accurately predicts the occurrence of acute coronary syndrome (ACS) or acute ischemic neurological events.
Assuming the validity of the concept of VP, a peripheral blood marker could potentially be used for diagnostic purposes if it was unique to the VP features and if it was sufficiently elevated to be detected by a laboratory method before the plaque ruptures. Considering that most cellular markers are far from being specific because they usually come from more than one part of the human body, it would be difficult to distinguish whether the increased level of a marker was due to these plaques or to some other process such as inflammation unrelated to the coronary arteries.
Additionally, complex techniques might be required for the detection of certain markers. Furthermore, a plaque with vulnerable features must be identified reasonably quickly to allow for effective therapies to be instituted. Traditional risk assessment predicts long-term outcome, but does not provide information about whether a specific plaque will rupture in 1 month, 6 months, or 1 year. This raises the question of how the diagnostic threshold value of a marker would be established.
Ideally, to evaluate a peripheral blood marker to diagnose the condition, we would need a prospective study of subjects that would be followed for outcomes attributable to plaque rupture (ACS or sudden death). In this ideal study, baseline measurements of the marker with the properties already described, as well as the results of the imaging technique, should be obtained. The imaging technique would allow us to focus on certain segments of coronary arteries that may correspond to VPs and which would serve as a reference standard to test the proposed marker. After an outcome, new imaging studies (or autopsy) would confirm whether the event was due to the rupture of one of those segments that was initially characterized as VP. At the end of follow up, the data would be analyzed to determine whether there was a relationship between the baseline values of the cellular marker and the outcomes that were attributed to VPs.
Such a prospective cohort study would face several barriers. These include the need to use invasive techniques in an apparent healthy population, the difficulty of obtaining complete followup data on the study population, the lack of a reference standard for imaging techniques as well, and the difficulty of selecting one of the proposed markers to be tested since none meets all the requirements.
Candidate markers have been evaluated by prospective studies for predicting clinical outcomes—ACS or cerebrovascular events, or death. Since they may identify singly or in combination only those patients at risk for those outcomes, their association with plaque vulnerability must be inferred.
The paradigm for peripheral blood biomarker detection for "VP" is predicated on the principle that cytokines and other biologic factors within the plaques can enter or leave the bloodstream, and be detected circulating in peripheral blood. Alternatively, "VP" may cause unique cell types, cytokines, or a combination of substances and cells to appear in the peripheral blood of affected patients (Schwartz 2003). Finally, certain types of patients, i.e., those with a systemic inflammatory state or those prone to producing inflammatory markers, might be more likely to form "VP."
Although unique identifying substances that would permit high sensitivity and specificity have not yet been characterized, several candidate markers have been proposed that may be used to estimate the "VP" risk in populations (Schwartz 2003). This non-invasive assessment of risk could be used to identify patients for future non-invasive or invasive imaging studies.
Table 1 summarizes inflammatory and other cellular markers that have been evaluated by prospective studies for predicting cardiovascular or cerebrovascular events. A narrative descriptive of these markers is included in Appendix 1.
Several studies described below investigated prospectively whether cellular and inflammatory markers are associated with progression of ACS.
Blankenberg et al. (2002) evaluated serum concentration of IL-18 and other markers of inflammation in 1,229 patients with CAD and found IL-18 to be a strong independent predictor of cardiovascular disease (CVD) death in patients with CAD; the authors suggested that IL-18mediated inflammation leads to accelerated vulnerability of atherosclerotic plaques.
Blankenberg et al. (2001) evaluated the effect of soluble adhesion molecules on the risk of future cardiovascular events among 1,246 patients with CAD with a mean 2.7 years of follow-up. They concluded that soluble adhesion molecules level of sVCAM-1, sICAM-1 and sEselectin were significantly related to future death from cardiovascular causes among patients with CAD.
Chakhtoura et al. (2000) evaluated 25 patients (17 with unstable angina and 8 with stable angina) and found that patients who had unstable complex lesions had a fivefold higher expression of the platelet activation epitope CD63 than patients with stable angina. In addition, patients with unstable angina had 15 percent more glycoprotein IIb/IIIa aggregation sites expressed on their platelet membrane. A direct relationship was observed between the morphology of ruptured plaque and platelet activation in patients with unstable angina.
Considering the studies available in the published literature, the hs-CRP measurement appears to be the strongest marker for future clinical events (i.e., MI, unstable angina, and stroke) due to arterial inflammation in both diseased and apparently healthy, asymptomatic patients (Morrow 2000; Koenig 1999; Tracy 1997; Reuben 2000; Biasucci, Liuzzo, and Fantuzzi 1999; Ridker 1998; Kuller 1996; Taaffe 2000; Danesh 2000; Lowe 2001). The CRP plasma level is also suggested as the best method of risk assessment in patients with either stable or unstable angina (Liuzzo 1994; Heeschen 2000; Biasucci, Liuzzo, and Grillo 1999; Sabatine 2002; Morrow 1998; Toss 1997) and for long term assessment after MI (Ridker, Rifai, Pfeffer, et al. 1998).
Furthermore, significant lipid elevation occurs in fewer than 50 percent of patients with ACS, MI, and unstable angina. For this reason, cholesterol and lipid measurement alone do not seem to be satisfactory markers for those at risk of sudden vascular events. One study (Ridker, Stampfer, and Rifai 2001) showed CRP and Total/HDL cholesterol ratio as the only cardiovascular risk indicators, using multivariate and age adjusted analysis. If CRP, IL-6 and ICAM-1 levels are added to lipid levels, risk assessment can be improved over lipids alone (Ridker, Stampfer, and Rifai 2001). Appendix 1 describes each marker and its potential association with clinical outcomes in detail.
In summary, although there is some indication that cellular markers might be correlated with ACS risk (i.e., they suggest the presence of VP), there is no evidence from studies specifically designed to evaluate whether such markers can accurately predict the presence of "VP."
Development of clinically useful imaging techniques for identifying "VP" has been an active area of research in the last decade. Table 2 lists non-invasive and invasive imaging modalities which have been proposed and studied to assess these plaques. Appendix 2 describes each modality and its potential association with clinical outcomes in detail.
Despite the rapidly growing support for the VP concept among the research community, current clinical practice has not been substantially altered by this concept. This is largely because there is not yet a consensus on the operational definition of a VP, and there is no readily available imaging or laboratory test that would allow clinicians to diagnose the presence of a VP in routine clinical practice. Moreover, even if such a diagnostic test were available, too little is known about the natural history of "VP," so it is difficult to see how such a diagnostic test would inform clinical decisionmaking at this time. Further, there are substantial barriers to the development of accurate diagnostic methods of the plaques. One major barrier derives from the fact that the description of the plaques was based largely on histopathological descriptions of culprit lesions. This gold standard is only available after a plaque becomes a culprit plaque, and indeed only after the patient dies. Large-scale studies of the natural history of plaques are needed, to identify what characteristics on the various imaging modalities are most important in prospectively predicting plaque rupture. These studies have not been done to date.
Among the imaging techniques described above, a clear consensus has not emerged about which method should be the reference standard, nor has a unique identifying substance such as CRP been identified that would uniquely identify these plaques with any reasonable sensitivity or specificity. Therefore, it is our opinion that large scale, prospective studies employing serial imaging of the coronary arteries of asymptomatic high-risk patients, or of patients with stable angina, is required before an estimate of the risk of an acute coronary event can be made either in asymptomatic patients or in patients with stable angina with plaques of a particular morphology.
In summary, the clinical diagnosis of VP remains problematic. Currently, neither invasive nor non-invasive imaging technology can reliably identify VP prospectively, i.e., before rupture.
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Led-Zep Experience rocks Dolphins' tailgate
Published: December 21st, 2010 | Tags: Led Zeppelin, Buffalo Bills, Jason Bonham, Miami Dolphins
We teased you last week with a promo for Jason Bonham's Led-Zeppelin Experience live before the Week 15 Bills-Dolphins game. You didn't think we'd go without sharing, did you?
Enjoy the above video, a tasty treat from Bonham's rockin' set from the Land Shark Tailgate Stage on the AT&T Grand Plaza outside Sun Life Stadium.