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MOSCOW — While Edward J. Snowden has remained mysteriously hidden from sight during his visit to Russia this week, Russian television has been making him a hero.
On programs that were hastily arranged and broadcast on the two largest federal channels, he was compared to the dissident Andrei Sakharov, to Julius and Ethel Rosenberg, and to Max Otto von Stirlitz, a dashing fictional double agent from Soviet television. He was described as "the man who declared war on Big Brother and got stuck in the transit zone," and as "a soldier in the information war, who fights, of course, on the side of Russia, or maybe the side of China."
For as long as he remains here, one program's host said, "the pulse of world history is beating here in Moscow."
Since Mr. Snowden landed in Moscow on Sunday, the likelihood that he will remain in Russia has steadily crept up.
Though President Vladimir V. Putin said this week that "the sooner he chooses his final destination, the better for us and for him," Mr. Snowden shows no sign of leaving.
The chance that Russia will turn him in has all but vanished, as evidenced by Thursday's television programs, which were almost certainly produced under Kremlin orders and have a powerful effect on public opinion. Officials here have signaled an openness to granting him political asylum, and each passing day would seem to narrow Mr. Snowden's options, giving the United States time to negotiate with Ecuador and Venezuela, other countries that may grant him asylum.
"I think the main thing for him right now is to guarantee his security," said Igor Korotchenko, a former specialist in Russia's top military command who now edits the magazine National Defense. "Already he cannot live his former life. The United States of America will look for him all over the world in order to punish him as an example to potential traitors and so that the political elite in Washington will be satisfied. They want his blood."
"Whose protection does he want: Ecuador, Venezuela or Russia? It is hard to judge right now," Mr. Korotchenko said. He added, "In Russia, he will find a country capable of guaranteeing his security because I think in Latin America the United States would find much opportunity to solve the problem, so to say."
So far, there is no consensus among Russian elites on whether Russia should grant Mr. Snowden asylum, a step that would advertise the country, cold-war-style, as a haven for Western dissidents. Russia's upper house of Parliament has invited him to testify about the impact of spying by the National Security Agency on Russian citizens, and about the activities of giant Internet companies that may have shared information with the agency.
Though Mr. Putin has made it a central goal to challenge American dominance in world affairs, the potential cost of granting Mr. Snowden asylum has come into sharper focus over the past few days. Russia will host President Obama in September, and would be stung if the visit were called off. Powerful figures like Igor I. Sechin, who as chairman of Rosneft has struck a series of bold deals with Western oil companies, may also be worried about the potential repercussions. Mr. Putin and many of those around him are former intelligence officers, and they may see Mr. Snowden as a traitor, and an unpredictable player.
Igor M. Bunin, the director of the Center for Political Technologies in Moscow, said that by far the best solution for Moscow would be to send Mr. Snowden to another country, "to Ecuador, Venezuela, to Cuba, wherever."
"Snowden is like a hot meat pie in your hands: even if you want to eat it very much, it's very hot and maybe it's better to throw it on the floor," Mr. Bunin said. "To make a deal with America to turn Snowden over would be a slap in the face of public opinion because he is already a hero in Russia and part of the West. On the other hand, not turning him over destroys your relationship with America."
Unlike Ecuador and Venezuela, Russia has avoided staking out a position on political asylum for Mr. Snowden, and in his remarks at a news conference on Tuesday, Mr. Putin said he hoped not to become personally involved.
But on Wednesday the Kremlin apparently decided to hastily arrange two hourlong talk shows devoted to the case. Each focused less on Mr. Snowden himself than on the flaws of the United States and the threat posed by its intelligence apparatus. Aleksandr I. Shumilin, a political analyst who was invited to appear, said he had turned down the request, sensing that the result would be a "mighty propagandistic blow: not a shot from a pistol, but a shot from a cannon."
One program featured a panel of legendary counterintelligence agents, including a man famous for meeting with Lee Harvey Oswald a few months before the assassination of President John F. Kennedy. Their discussion often turned to the subject of American spying on Russia. Mr. Korotchenko, one of the guests, made the case that most of the major American consulting firms in Moscow were actually "structural units of American intelligence," including the National Security Agency.
"The N.S.A. is a global electronic vacuum cleaner, which monitors everything," he said "Look at the top two floors of the new building of the U.S. Embassy — it's a huge antenna, which listens to the Moscow air."
Similar themes were sounded a few hours later on Channel 1, when the pro-Kremlin analyst Vyacheslav A. Nikonov warned that the United States, through its dominance over the Internet, could "strongly undermine the security of other states."
"The Internet is an invention of the U.S. Ministry of Defense," Mr. Nikonov said. "Where is the Internet? Physically, it is in the United States. What is the Internet? It's an American nongovernmental organization which is, of course, connected with the intelligence services of the United States."
Many speakers argued that Mr. Snowden's case should neutralize, once and for all, Western criticism of Mr. Putin's domestic policies. Convincing Russian citizens of this point is especially crucial now, when Russian courts have brought serious charges against several dozen Russians who led or took part in a wave of antigovernment protests.
Aleksandr Prokhanov, a nationalist ideologue who has emerged as a leader in conservative thought, called Mr. Snowden "a soldier of the information war," stripping the United States of its right to criticize other countries.
"For Americans, human rights is a powerful tool for influencing other countries," Mr. Prokhanov said. "A country 'violates human rights,' and its president becomes a devil incarnate, the society destabilizes, the human rights issue is followed by attack planes, and the country is wiped out from the face of the earth."
Others speakers, like Veronika Krasheninnikova, urged Russians to rally around Mr. Snowden, noting the 60th anniversary this month of the execution of Ethel and Julius Rosenberg, who were convicted of conspiracy to commit espionage.
"I remind you that the death penalty still exists in the United States, so it's not something impossible," Ms. Krasheninnikova said. "One has to remember it."
Nikolai V. Zlobin, a political analyst and writer who often appears on Russian television to articulate an American perspective and was invited to appear on both shows, said he believed Russian leaders were weighing the cost and benefit of different outcomes to Mr. Snowden's case. In the end, he said, they can secure a propaganda coup without the participation of Mr. Snowden himself, and without granting him political amnesty.
"What happens now doesn't matter because public opinion in Russia has already been shaped. America is lying, dishonest, and has double standards," Mr. Zlobin said. "It's a Christmas gift. They are trying to find the most deft way to use it, but it is unexpected, and they don't know how to handle it."


text:
Speaker - Maurice Lee lll, 7 Continent Ultra Runner & RRCA Certified Running Coach
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text:
Kwon Alexander
49ers seek to bounce back from 1st loss when hosting Cards
By Josh Dubow Nov. 14, 2019 06:57 PM EST
Plenty of blame to go around following 49ers' 1st loss
By Josh Dubow Nov. 12, 2019 07:52 PM EST
49ers vs Seahawks, with Sherman on other side of rivalry
By Rob Maaddi Nov. 07, 2019 11:43 PM EST
Seahawks-49ers rivalry on center stage after dormant stretch
By Josh Dubow Nov. 07, 2019 07:47 PM EST
49ers lose heart and soul of defense in Kwon Alexander
By Grant Cohn Nov. 05, 2019 08:28 PM EST
SANTA CLARA, Calif. (AP) — Kwon Alexander wasn't just the 49ers' best linebacker. He was the heart and soul of their defense. And now they must replace him...
49ers reach midpoint at 8-0 just 2 years after 0-8 start
By Josh Dubow Nov. 01, 2019 04:33 PM EDT
49ers LB Kwon Alexander to miss rest of season with torn pec
Nov. 01, 2019 03:55 PM EDT
SANTA CLARA, Calif. (AP) — San Francisco 49ers linebacker Kwon Alexander will miss the rest of the season after tearing his pectoral muscle. ...
Garoppolo throws 4 TD passes, 49ers beat Cardinals 28-25
By David Brandt Oct. 31, 2019 11:38 PM EDT
49ers defense ready for new and improved Christian McCaffrey
By Grant Cohn Oct. 24, 2019 08:12 PM EDT
49ers beat Redskins in ugly 9-0 game to improve to 6-0
By Stephen Whyno Oct. 20, 2019 03:47 PM EDT
San Francisco 49ers at Washington Redskins 10/20/2019
Oct. 20, 2019 01:24 PM EDT
Undefeated 49ers looking formidable after 1st division win
By Grant Cohn Oct. 14, 2019 09:20 PM EDT
Cleveland Browns at San Francisco 49ers 10/7/2019
Oct. 07, 2019 08:29 PM EDT
Garoppolo throws 3 TDs, 49ers roll over Bengals 41-17
By Joe Kay Sep. 15, 2019 04:20 PM EDT
A whole lot of everything on first weekend of 100th season
By Barry Wilner Sep. 09, 2019 03:05 AM EDT
NFL Today, Week 1
By The Associated Press Sep. 08, 2019 09:23 PM EDT
SCOREBOARD Monday, Sept. 9 Houston at New Orleans, 7:10 p.m. EDT. The Texans have won three of the past four AFC South titles. J.J. Watt...
Sherman, 49ers upend Winston, Buccaneers 31-17
By Fred Goodall Sep. 08, 2019 07:56 PM EDT
Chiefs beat Jaguars, lose Hill; Jags lose Foles (shoulder)
By The Associated Press Sep. 08, 2019 05:20 PM EDT
San Francisco 49ers at Tampa Bay Buccaneers 9/8/2019
Sep. 08, 2019 02:48 PM EDT
The Latest: Pats unveil 6th Super Bowl banner
By The Associated Press Sep. 08, 2019 01:16 PM EDT


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Some older versions of Windows may show the description as "LOADER_BLOCK_MISMATCH".
This is a fatal Windows error, typically called a Stop message, Bug Check, or more commonly the Blue Screen of Death (BSoD). The system is in a forced reboot state. Any unsaved work is likely lost.
A problem has been detected and Windows has been shut down to prevent damage to your computer.
The loader block is invalid or does not match the system being loaded.
If this is the first time you've seen this Stop error screen, restart your computer. If this screen appears again, follow these steps:
Check to make sure any new hardware or software is properly installed. If this is a new installation, ask your hardware or software manufacturer for any Windows updates you might need.
If problems continue, disable or remove any newly installed hardware or software. Disable BIOS memory options such as caching or shadowing. If you need to use Safe Mode to remove or disable components, restart your computer, press F8 to select Advanced Startup Options, and then select Safe Mode.
Technical Information:
*** STOP: 0x00000100
Beginning dump of physical memory
Physical memory dump complete.
Contact your system administrator or technical support group for further
Install the latest Windows software updates. Don't forget to check for non-critical updates too!
To manually get updates, open Internet Explorer (you can't use a non-Microsoft browser for updates).
For IE 8 and later: Click on Safety, then Windows Update. Follow the instructions.
For IE 7 and older: Click on Tools, then Windows Update. Follow the instructions.
Using an Anti-Virus product with the latest pattern files, scan the system for viruses and malware. Often this is called a deep-scan where it looks at every file in the system.
Several software products that handle the detection and removal of Viruses and Malware include Avanquest's Fix-It Utilities Professional and SystemSuite Professional. Other commonly available Anti-virus products are available from Computer Associates, F-Secure, Kaspersky Labs, McAfee, Sophos, Symantec, Trend Micro and others.
Also see our list of common Fatal Error Solutions.
Check out what others say about this issue and review or add your own comments and solutions!
either the loader block is invalid, or it does not match the system that is being loaded.
After the Stop code will be 4 hex values: {Parameter 1, Parameter 2, Parameter 3, Parameter 4}.
Parameter 1 is set to 3.
Parameter 2 specifies the size of the loader black extension.
Parameter 3 specifies the major version of the loader block.
Parameter 4 specifies the minor version of the loader block.
Parameter 1 is set to 3.
Parameter 2 specifies the size of the loader black extension.
Parameter 3 specifies the major version of the loader block.
Parameter 4 specifies the minor version of the loader block.


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Chief Officer NPCC portfolios
National policing work through ACPO is conducted through national policing business areas, each taking lead responsibility for a broad area of policing and headed by a serving chief officer.
The national policing business areas lead the direction and development of policing in that area, working with government and external stakeholders. Under each business area sit portfolios, led by an individual officer who acts as the national lead for a specific issue.


text:
Nystia Nightshade
My New OC
Age: 129 earth years
Species: fairy
Race: caucasian
Height: 5' 8"
Weight: 135 lbs
Eye color: blue
Hair color: violet gradient
Orientation: Heterosexual
Class: Dark Mage
Job: Alchemist
Bio: Nystia wasn't born a normal fairy. She must feed on blood of other fairy, elf, human, etc instead of flower nectar. She was born of high status to socially important parents. They were both slain in a vicious war between fairys and goblins. After they were slain, Nystia was made an outcast in the fairy country where she resides after her need for blood became known. However, she is taken care of since she is one of the few alchemists in the city. The high council provided a small cottage for her on the outskirts of the fairy town Lunari.


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Deciding to adopt an EMR is one of the most important decisions made by any practice. The transition to an EMR from a paper system can be challenging due to the fact that it will change the way everyone works. EMR's can change current documentation method(s), workflows, billing practices, scheduling, patient follow-up methods, communication/messaging, etc.. EMR adoption usually requires reengineering current systems and can dramatically change the way practice's runs. Considering the vast changes that have to occur to adopt an EMR, extensive planning must occur for a successful implementation. Continue reading: A Successful EMR Implementation
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In order to provide perioperative analgesia in patients who need to go through thoracic surgery, the thoracic epidural analgesia is considered. A very uncommon life threatening complication that may arise is if the catheter causes pleural puncture.
Channels: Medical
Tags: Thoracic Epidural Placement Paramedian Approach
Uploaded by: topeto ( Send Message ) on 29-11-2011. Dnatube suggest users to have interest in drug testing, mesothelioma, insurance, medical lawyers.
Duration: 7m 8s


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Extremists are destroying our party
When George W. Bush won 49 percent of the Hispanic vote in Texas in 2004, I was hopeful for the future of the Republican Party.
But ever since, a coalition of Tea Party groups and other hard-line organizations that believe individuals of Mexican heritage are genetically inferior or incapable of understanding how to live in a representative democracy have controlled the GOP's stance on immigration.
At no time was the destructive force of these ideologically bankrupt extremists clearer to me than at last weekend's state Republican convention, where I was one of 31 platform committee members.
Initially, I was happy to see opposite ends of our party come together to craft language on immigration. Even more so than in 2012, our "Texas Solution" was influenced by the grassroots. It had an agreed-upon trigger that limited provisional visas, called for securing the border first and made clear that Texas, not Washington, should be able to decide when the border was secure.
The goal in developing our plan this year was party unity. A Tea Party leader named Doc, wearing a "Don't tread on me" yellow shirt, stretched out his arms and told us he was willing to work with us for the good of the party. We agreed that both sides had to give and take. If we could strike an agreement on immigration, we could send a powerful message across the nation that would tell the Democratic operatives pouring into the state: Don't mess with Texas.
I walked out of that meeting with tears in my eyes. I work with the Republican National Committee on Hispanic engagement. Texas leading on immigration makes it easier for me to reach out to the Hispanic community. In 2012, when a group of us from the Texas GOP were invited to appear on Spanish-language television, we put Democrats to shame as we brought up stark differences between our parties, noting that they were deporting Hispanics in record numbers while we had just come out for a guest-worker program. When we block-walked, phone-banked or organized community service projects in Hispanic communities, we were welcomed because, unlike the Democrats, we were not there to cart people off and send them back to Mexico.
Yet after working with my fellow committee members for more than 45 hours, our compromise immigration language was stripped from the platform and would not even be debated. It was replaced by a humiliating document filled with elements of Arizona's disastrous Senate Bill 1070, including giving police the power to inquire about a person's legal status while in custody. The immigration plank that was eventually approved also contains the destructive ending of in-state tuition for illegal immigrants and a mass-deportation-by-attrition framework. The rest of the details are humiliating — the work of charlatans claiming to be conservative, parading around our great state with no concern for our party's future.
The GOP is at a crossroads. Will it embrace true free-market solutions and support its own bootstrapping principles and the American dream, or will it allow dinosaur politics to lead us to extinction? Maybe Dan Patrick and others enjoy the thought of reading 20 years from now on Wikipedia about what the Texas Republican Party once was. Not me.
During the last few days, I have been bombarded by emails and texts from leaders, activists and fellow Republicans who are waking up to the fact that we need to change the direction of our party. And if Texas wants to lead the nation, we first have to lead on immigration.


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Retirement. We can't escape the topic. Television, radio, internet and even billboard ads remind us that we're [...]Read more
Over 40? Not to Worry!
In case you haven't noticed, America is getting older. Some experts call these days the "Silver Tsunami"—there's [...]Read more
Of Rainbows and Ordinances
The law of the Lord is perfect, converting the soul. Psalm 19:7 On June 26, 2015 the Supreme Court [...]Read more
What Makes a Life Valuable?
It's been a month since Dr. Ezekiel Emanuel's controversial article, "Why I Hope to Die at 75" [...]Read more
Weight Loss Medications
When wisdom enters your heart, and knowledge is pleasant to your soul, discretion will preserve you; understanding [...]Read more
The "Sandwich Generation"
Then He said to the disciple, "Behold your mother!" And from that hour that disciple took her [...]Read more
A Spiritual Harvest, Part 3
In this three part series, we've looked at how God operates in the natural world, and applied [...]Read more
A Spiritual Harvest, Part 2
We started this series about a month ago on the topic of seeds, sowing and reaping. So [...]Read more
A Spiritual Harvest
t's summertime! Now is the season for longer days, outdoor fun and one of my favorite pastimes—gardening. [...]Read more
Aligning Your Taste Buds To The Bible
A few years ago, I taught the book of Genesis for Bible Study. Now even though I [...]Read more


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Safety and Efficacy of Commercially Available Ultrasound Contrast Agents for Rest and Stress EchocardiographyA Multicenter Experience
Author + information
- Received May 16, 2008
- Revision received August 14, 2008
- Accepted August 25, 2008
- Published online January 6, 2009.
Author Information
- Melda S. Dolan, MD⁎,⁎ (melda{at}tetranet.net),
- Simil S. Gala, MD⁎,
- Saritha Dodla, MD†,
- Sahar S. Abdelmoneim, MD‡,
- Feng Xie, MD†,
- David Cloutier, MS†,
- Michelle Bierig, MPH, RDCS, RDMS⁎,
- Sharon L. Mulvagh, MD, FACC, FRCP‡,
- Thomas R. Porter, MD, FACC, FASE† and
- Arthur J. Labovitz, MD, FACC, FACP, FCCP, FASE⁎
- ↵⁎Reprint requests and correspondence:
Dr. Melda S. Dolan, Division of Cardiology, Saint Louis University, 3635 Vista Avenue, 14th Floor, St. Louis, Missouri 63110-0250
Objectives The authors sought to define the risks versus benefits of ultrasound contrast agents in patients undergoing stress echocardiography.
Background The Food and Drug Administration recently placed a "black box" warning on the ultrasound contrast agents Definity (Bristol-Myers Squibb Medical Imaging, Billerica, Massachusetts) and Optison (GE Healthcare, Princeton, New Jersey) after their use was temporally related to 4 deaths. The safety of contrast has not been systematically evaluated.
Methods We retrospectively analyzed 42,408 patients at 3 different institutions who had baseline suboptimal images and/or underwent myocardial perfusion imaging and received contrast agents; 18,749 of these underwent stress echocardiography. The outcomes (death and myocardial infarction [MI]) within 30 min, 24 h, and during long-term follow-up were recorded.
Results No deaths or MIs were observed within 30 min; 1 death and 5 nonfatal MIs were observed within 24 h. This was not different from a matched cohort of 15,989 patients not receiving contrast. At 1 h and at 30 days after contrast administration, no significant differences in death rates or MIs were observed between patients who did and did not receive contrast during their stress echocardiogram. Endocardial border visualization in patients with suboptimal images resulted in comparable sensitivity (81% vs. 73%, p = NS) and diagnostic accuracy (82% vs. 77%, p = NS) for wall motion analysis compared with patients with optimal image quality. At long-term follow-up, abnormal wall motion and/or myocardial perfusion predicted adverse outcomes (20.6%) when compared with patients with normal studies (3.7%).
Conclusions Despite recent warnings regarding echocardiographic contrast, our findings indicate it is a safe and useful diagnostic tool in assessment of patients suspected of having coronary artery disease.
Transthoracic echocardiography has long been recognized as a safe, noninvasive, and reproducible tool that has been used to gain valuable information about cardiac structure and function. Unfortunately, up to 30% of studies are deemed technically difficult due to poor image quality, making these studies very challenging to interpret (1). Patients with large body habitus, chest wall deformities, and severe chronic lung disease are at higher risk of having suboptimal image quality (1–3). Furthermore, bedside echocardiograms are frequently ordered to identify the cause of hemodynamic instability and respiratory failure in critically ill patients. Since these patients cannot be turned on their side, the imaging windows are suboptimal and the diagnostic information obtained is limited (1–4).
In 1997, the Food and Drug Administration (FDA) approved the use of ultrasound contrast agents (UCAs) to improve the diagnostic accuracy of echocardiography after reviewing safety and efficacy data. Before approval, studies showed no significant changes in systemic or pulmonary hemodynamics, myocardial contractility, or regional myocardial blood flow (5). Phase III studies subsequently confirmed the absence of safety concerns and led to the approval of UCAs (6,7). The approved indication was for left ventricular (LV) endocardial border delineation.
In October 2007, the FDA mandated that a "black box" warning be placed on Definity (perflutren lipid microsphere [Bristol-Myers Squibb Medical Imaging, Billerica, Massachusetts]) and Optison (perflutren protein type A microsphere [GE Healthcare, Princeton, New Jersey]) after 11 deaths (4 within 30 min of administration) were temporally related to but not clearly caused by contrast injection. The warning stated that the use of these agents was contraindicated in patients with an unstable cardiopulmonary status, including those with acute coronary syndromes, acute myocardial infarction (MI), and worsening or unstable heart failure, as well as in patients with cardiac shunts, ventricular arrhythmias and prolonged QT interval corrected for heart rate, severe emphysema, and pulmonary emboli (8). As a result of this warning, many institutions stopped using these agents. Despite the decision by the FDA, the overall risk versus benefit profile of UCAs has not been clearly defined. A recent single-center experience described the background mortality of patients undergoing transthoracic contrast echocardiography and demonstrated that it is not significantly higher than that in patients undergoing noncontrast echocardiography during short-term follow-up (9). The FDA recently modified their original warning, but an examination of a multicenter experience regarding the safety of UCAs is needed. This study was designed to examine the short- and long-term safety profiles associated with the use of UCAs during stress echocardiography at 3 medical centers. The incremental value of UCA use in this setting was also assessed.
Patient characteristics
We retrospectively analyzed 42,408 consecutive patients from 1999 to 2007 at 3 academic medical centers (Saint Louis University, University of Nebraska, and Mayo Clinic Rochester–Minnesota) who underwent echocardiographic evaluation with contrast. Figure 1 summarizes the categorical comparisons performed in these 42,408 patients. A total of 23,659 patients had resting contrast echocardiography, with short-term follow-ups at 30 min and 24 h after contrast use. These patients were then compared with a matched group of 5,900 consecutive patients who underwent echocardiographic examination without contrast (Table 1).
A total of 18,749 patients underwent stress echocardiograms for suspected coronary artery disease (CAD), with 13,056 patients (70%) undergoing dobutamine stress echocardiography (DSE) and 5,693 (30%) undergoing treadmill exercise stress echocardiography (ESE). The indication for UCA use was either for suboptimal images or to assess myocardial perfusion. All patients received UCAs at rest and peak stress, with 5,947 (32%) receiving Optison in bolus doses of 0.2 to 0.3 ml and 12,802 (68%) receiving Definity as either bolus injections of 0.1 ml or as a 3% continuous infusion. Contrast-enhanced images from apical views (2-, 3-, and 4-chamber) were obtained and digitized at rest and maximal stress (≥85% predicted maximum heart rate) or a defined test end point. In a cohort of 6,513 patients who underwent DSE with contrast, safety outcomes were compared with those from a matched group of 6,249 patients who underwent DSE without contrast. Likewise, a subgroup of 4,275 patients who underwent ESE had similar outcomes compared with a matched group of 9,740 consecutive patients who did not receive contrast.
In 4,011 patients who received UCA for suboptimal imaging during DSE, we evaluated whether wall motion analysis using enhanced LV opacification with contrast agents led to improvements in sensitivity, specificity, and diagnostic accuracy by comparing results with those from 1,923 matched patients who had optimal images without UCAs during stress echocardiography. Quantitative angiography was used as the reference standard, using a >50% diameter stenosis in at least 1 major epicardial vessel as the definition of significant CAD.
Short-term follow-up consisted of examination of the patient within 30 min of contrast use and at 24 h. Long-term follow-up (2 to 92 months) was conducted in 6,075 patients. It was performed through review of the electronic medical record and data collection through telephone interviews. Nonfatal MI, as defined by a trend in cardiac specific enzymes according to European Heart/American College of Cardiology/American Heart Association guidelines, and death due to any cause were considered end points (10). If more than 1 event was noted during follow-up, the event occurring first was considered the end point.
In the 6,075 patients who underwent DSE with long-term follow-up, the added benefits of myocardial perfusion imaging (MPI) were analyzed by recording the number of adverse outcomes in patients who had abnormal myocardial perfusion (MP) and/or wall motion (WM) compared with patients with normal studies (although contrast use for MPI is not currently FDA approved).
Stress echocardiography protocols
Dobutamine and Exercise Stress Echocardiography Protocols
Dobutamine was infused intravenously at a starting dose of 5 μg/kg/min followed by increasing doses (10, 20, 30, and 40 μg/kg/min) up to a maximal dose of 50 μg/kg/min, in 3- to 5-min stages (11). Atropine (up to 2 mg) was injected in patients without symptoms or signs of ischemia to achieve the target heart rate, calculated as 220 minus age in years. The end points included achievement of target heart rate (85% of predicted maximal heart rate), maximal dobutamine/atropine doses, ST-segment elevation of ≥2 mm at an interval of 80 ms after the J point in non–Q-wave leads, sustained arrhythmias, severe chest pain, or intolerable adverse effects considered to be due to dobutamine or atropine (2,11). The tests were considered nondiagnostic if the patient failed to achieve the target heart rate without inducible ischemia.
For ESE, Bruce (90%) or modified Bruce (10%) protocols were used. Images were obtained at rest and immediately after peak stress. End points included achievement of target heart rate, horizontal or downsloping ST-segment depression of ≥1.4 mm at an interval of 80 ms after the J point in non–Q-wave leads, sustained arrhythmias, and symptom-limiting chest pain and/or shortness of breath.
Real Time Perfusion
Real time myocardial perfusion was performed using High Definition Imaging 5000 (Philips, Andover, Massachusetts), SONOS 5500 (Philips), iE 33 (Philips), Sequoia 512 (Siemens, Malvern, Pennsylvania), and Vivid 7 (GE Healthcare). All scanners were equipped with low-mechanical index real time pulse sequence schemes. During continuous infusions of microbubbles, intermittent high mechanical index impulses (4 to 40 frames) were administered to deplete capillary microbubbles and allow for the visual assessment of myocardial contrast replenishment (12). The equipment was adjusted to achieve a maximal nonlinear signal from contrast. Mechanical indexes were set to <0.3 and the frame rate to between 20 and 25 Hz. Time gain compensation and 2-dimensional gain settings were adjusted to suppress nonlinear signals from the myocardium before contrast injection and remained unchanged throughout the study.
Contrast-enhanced images from the apical window (2- to 4-chamber) were obtained and digitalized at rest, low dose dobutamine (if necessary), and maximal stress (85% age-predicted maximum heart rate), or a defined test end point. Each contrast bolus injection was followed by a slow 3- to 5-ml saline flush. After bolus injections, a minimum of 15 s of image acquisition was performed after appearance of peak myocardial opacification until the disappearance of contrast from the myocardium. For continuous infusions, ultrasound contrast was infused at a rate of 4 to 8 ml/min until perfusion images were obtained.
Echocardiographic analysis
Baseline ejection fraction (EF) was visually estimated and/or calculated by single or biplane method of discs using contrast-enhanced 2-dimensional images. Contrast-enhanced WM abnormalities and, if done, MP assessments, were interpreted using a 17-segment model according to the joint recommendations of the American Society of Echocardiography (13). Segmental MP and WM in each of the 3 coronary artery territories were analyzed at rest and during peak stress and classified as normal, fixed, or inducible, as previously described (8,14,15). In this study, patients with either inducible or fixed WM abnormalities or perfusion defects were considered abnormal.
Statistical analysis
Resting echoes with contrast in the nondiagnostic group versus the noncontrast group with good quality images were compared and differences in characteristics were assessed by unpaired t test. Likewise, groups of patients undergoing DSE with contrast versus without contrast were compared for differences in characteristics and hemodynamic responses. The differences in these variables were assessed by unpaired t test. For continuous variables such as heart rate, Student t tests were used for univariate comparison between contrast and noncontrast DSE. Continuous variables were expressed as means and standard deviations. Categoric variables were expressed as proportions. Calculations of sensitivity and diagnostic accuracy of DSE for detection of coronary artery disease were performed with reference to angiograms as a gold standard.
Kaplan-Meier curves were used to estimate the distribution of time to death or nonfatal MI. The concordance of WM and MP analyses during stress real time-myocardial contrast echocardiography (RT-MCE) was calculated as percent agreement and kappa statistics. Differences between time-to-event curves were compared with log-rank testing. Clinical variables considered for univariate and multivariate predictors analyses were age older than 70 years, diabetes mellitus, hypercholesterolemia, hypertension, cigarette smoking, previous MI, earlier history of coronary artery bypass graft, and percutaneous coronary intervention. Analyzed echocardiographic parameters included EF <50% and WM and MP responses. Multivariate predictors of events were determined by Cox proportional hazards model. A value of p < 0.05 was considered significant. Interobserver variability was defined as the absolute difference between 2 blinded observations divided by the mean and expressed as a percentage.
Short-term follow-up
Resting Echocardiography
There were no events within 30 min among 23,659 patients who received contrast for suboptimal resting studies and/or MPI. Three nonfatal MIs and 1 death occurred within 24 h. In the matched group of 5,900 consecutive patients with optimal resting studies and no contrast use, no events occurred within 30 min, but 7 nonfatal MIs and 1 death occurred within 24 h (p = NS compared with event rates in groups receiving contrast).
Stress Echocardiography
Among 18,749 patients who underwent stress echocardiograms, no deaths or MIs were observed within 30 min; 1 death and 5 nonfatal MIs were observed within 24 h. Among the 5 nonfatal MIs, 3 occurred after use of Definity and 2 after use of Optison. In the first case, a DSE with RT-MCE demonstrated inducible inferolateral ischemia. Catheterization demonstrated >50% stenosis in the left circumflex artery and right posterior descending artery, which were revascularized. Sixteen hours after intervention, the patient had significantly elevated cardiac enzymes. In the second case, a patient exhibited inducible ischemia during a DSE with RT-MCE, but proceeded to cadaveric renal transplant surgery the same day. Post-operative cardiac enzymes demonstrated a non–Q-wave infarction. In the third case, the patient had inducible ischemia during a DSE with RT-MCE and elevated cardiac enzymes 7 h after DSE. The patient subsequently underwent percutaneous coronary intervention of a 90% stenosis in an obtuse marginal vessel. In the fourth case, a patient had ventricular tachycardia 9 min into recovery after DSE, had inducible septal ischemia, and underwent percutaneous transluminal coronary angioplasty to a 100% occluded distal left anterior descending. In the fifth case, the patient had no ischemia or electrocardiogram changes during stress testing, but had persistent chest pain and an elevated troponin level. Coronary angiography demonstrated a 60% obtuse marginal and 50% posterior descending artery lesion.
One death within 24 h was noted in the stress echocardiography subgroup. This patient was transferred from a local hospital due to dyspnea and required continuous vasopressors for hypotension. He developed frequent runs of ventricular tachycardia requiring intravenous antiarrhythmic therapy. The patient eventually developed disseminated intravascular coagulation. In an attempt to determine whether there was myocardial viability, the patient underwent DSE with RT-MCE using intravenous Optison on hospital day 11. The procedure was performed without complication, but within the next 24 h, the patient developed recurring ventricular tachycardia and died 22 h after contrast administration. In all of these cases, there was no reason to believe contrast use contributed to the events.
Thirty-day follow-up
Stress Echocardiography
At 30 days, in a subgroup of 10,788 patients who received contrast for DSE or ESE, 37 (0.34%) patients died and 68 (0.63%) patients had an MI; this compared with a temporally matched cohort of 15,989 patients undergoing stress echocardiography and not receiving contrast agents, in which 62 (0.39%) patients died and 73 (0.46%) had an MI. There were no statistically significant differences between the 2 groups with respect to nonfatal MI or death.
CAD detection with contrast-enhanced LV opacification in patients with suboptimal images
In a subgroup of 4,011 patients who received UCA for suboptimal images, we evaluated whether WM analysis using enhanced LV opacification led to improvements in sensitivity, specificity, and diagnostic accuracy by comparing these values with those from 1,923 patients who had optimal images during stress echocardiography and did not require UCAs. There were no differences between the 2 groups with respect to age, sex, history of MI, or prevalence of resting WM abnormalities (Table 2). There were no significant differences between the groups with respect to hemodynamics and heart rate responses to dobutamine (Table 3). Likewise, there were no statistically significant differences between the group that received contrast and the noncontrast group with respect to the number of affected vessels, stenosis severity, or stenosis distribution (Table 4).
Sensitivity of DSE was slightly higher in patients who received contrast compared with those who did not. However, this did not reach a statistically significant level (81% vs. 73%, p = NS). The diagnostic accuracy of DSE was slightly improved with contrast in the suboptimal image group versus the noncontrast group. However, no statistically significant difference was found (82% vs. 77%, p = NS) (Table 5).
Long-term follow-up
Among 6,075 patients with long-term follow-up, the mean baseline LV EF was 56 + 10%. There were 352 patients (5.8%) with baseline EF <50%. Contrast agent was administered in a continuous infusion in 1,944 (32%) patients and via bolus injections in 4,131 (68%) patients. Median duration of follow-up was 25 months (range 2 to 92 months, standard deviation 22). A total of 510 (8.8%) patients had events during follow-up. Events occurred at a median of 21 months (range 1 day to 88 months). Nonfatal MIs occurred in 237 patients (3.9%), and death occurred in 273 patients (4.4%).
MPI Results
DSE was interpreted as normal in 4,251 (69.9%) and abnormal in 1,824 (30%) patients. Both WM and MP were abnormal in 1,458 (24%) patients. All patients with abnormal WM also had abnormal MP. There were 668 patients (11%) with normal WM but abnormal MP. Of the 510 events that occurred during long-term follow-up, 133 (3.7%) events occurred in patients with normal WM and MP responses during RT-MCE, 291 (16%) events occurred in patients with abnormal WM and MP, and 86 (13%) events were noted in patients with normal WM but abnormal MP.
Univariate and multivariate predictors of follow-up events are depicted in Table 6. By univariate analysis, age >70 years, previous coronary artery bypass grafting, previous percutaneous coronary intervention, previous MI, resting EF <50%, abnormal WM, and abnormal MP were predictors. By multivariate analysis, the only independent predictors were EF <50% (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 1.0 to 1.8), previous MI (OR: 0.6; 95% CI: 0.4 to 0.9), and abnormal MP (OR: 2.4; 95% CI: 1.0 to 5.9). After adjustment for MP, the analysis of WM no longer had predictive value (Table 6).
By sequential Cox regression, an EF <50% increased the risk for adverse outcomes at long-term follow-up over other clinical and risk factors (chi-square: 11.4; p < 0.05); WM analysis increased this further over clinical variables and EF <50% (chi-square: 21.8; p < 0.01). Abnormal MP increased the predictive value over EF <50% and WM (chi-square: 39.4; p < 0.001), adding significant incremental value in predicting outcomes. Event-free survival in patients with normal WM and MP was significantly better than in those with normal WM and abnormal MP and abnormal WM and MP responses (chi-square: 19.686, p = 0.0001).
Interobserver agreement
The average interobserver agreement for the 3 institutions was 80% for MP (λ = 0.63) and 88% for WM (λ = 0.64) analysis.
The recent FDA mandated "black box" warning reported a total of 11 deaths related to contrast administration: 10 following Definity and 1 following Optison (8). Although 4 occurred during or within 30 min of Definity use, mitigating factors could have explained the deaths.
Before the black box warning, there were multiple studies that demonstrated the safety of these contrast agents (16,17). Recently presented data suggested that contrast use in echocardiography is safe, and the FDA modified the professional labeling for Optison and Definity contrast agents originally announced in November 2007. The warning currently states that it is contraindicated to administer contrast to patients with R→L, bidirectional, or transient R→L cardiac shunts and to patients with hypersensitivity to perflutren. This study was designed to evaluate the safety profile and incremental benefit of UCA use during stress echocardiography in a multicenter setting. As has been the case, serious adverse events (death or nonfatal MI) within 24 h of contrast use could be easily explained by the patient's underlying condition at the time of the study or to induced ischemia during stress echocardiography. This was confirmed by the similar incidence of adverse events in the patients who did not receive contrast during their stress echocardiography.
It is important to note the significant incremental value of contrast that was observed at the 3 participating centers. Enhanced LV opacification (an approved indication) in patients with suboptimal windows resulted in a sensitivity and specificity in detecting coronary artery disease that were equivalent to those in whom image quality was optimal. The ability of stress echocardiography to detect coronary artery disease is clearly related to the ability to visualize all myocardial segments in each coronary artery territory (18). Suboptimal windows when contrast is not used usually results in the study being cancelled and an alternative noninvasive or invasive study being performed. These alternative tests often involve the use of ionizing radiation, with the patient incurring additional risks and costs. In this study, we demonstrated that ultrasound contrast in patients with suboptimal windows has the ability to improve test accuracy to the level seen only in patients with optimal endocardial border delineation.
Myocardial perfusion imaging (not yet approved by the FDA) added significant incremental value to DSE, identifying patients at risk for death or nonfatal MI. Although the FDA has not approved the use of ultrasound contrast to assess MP, most ultrasound scanners now offer real time perfusion pulse sequence schemes that allow one to examine myocardial contrast enhancement during stress echocardiography. This confirms single center findings regarding prognostic value (19), and emphasizes the potential for perfusion imaging in this setting. MPI has become especially useful not only in detecting stress-induced ischemia, but also in detecting acute coronary syndromes in the emergency department (20) and predicting patient outcomes after MI (21).
Study limitations
The number of patients analyzed in this study is a great strength. We have included both short- and long-term follow-up as part of our safety analysis. Furthermore, we have provided evidence of the obvious advantages of contrast agent use. We do recognize, however, that this is a retrospective analysis with intrinsic limitations. In addition, the matched cohorts of patients who did not receive contrast were not the same size as the group receiving contrast.
In the current study, patients with suboptimal images in whom contrast was used were compared with patients with good echocardiographic windows in whom no contrast was used. However, technically difficult patients were not studied with and without contrast. This approach was selected so that we could compare 2 groups in which 17 segments were adequately visualized, either with or without contrast.
This study examined, in a large multicenter experience, the safety and incremental value of contrast use in the clinical practice of stress echocardiography. The risks of both short-term and long-term events, defined as nonfatal MI and death, after contrast administration are very low and are no different than in patients not receiving contrast during stress echocardiography. Contrast use in patients with suboptimal images improves feasibility and accuracy of stress echocardiography testing. Failure to use contrast agents in patients with suboptimal images may result in a misdiagnosis and/or additional alternative imaging techniques with greater inherent risks. MPI was shown in this study to provide significant incremental value to DSE in predicting patient outcomes. Based on this study and recent comparisons of resting ultrasound contrast use in hospitalized patients (9), which results in a combined experience of more than 60,000 patients, there is no evidence to suggest a causal relationship between the use of commercially available contrast use and serious adverse events. The findings in this study provide physicians with the confidence to use contrast agents during stress testing when clinically indicated.
Dr. Labovitz was recently appointed as a blinded reader for Bristol-Myers Squibb.
- Abbreviations and Acronyms
- coronary artery disease
- dobutamine stress echocardiography
- ejection fraction
- exercise stress electrocardiography
- Food and Drug Administration
- left ventricular
- myocardial infarction
- myocardial perfusion
- myocardial perfusion imaging
- real time-myocardial contrast echocardiography
- ultrasound contrast agent
- wall motion
- Received May 16, 2008.
- Revision received August 14, 2008.
- Accepted August 25, 2008.
- American College of Cardiology Foundation
- ↵
- ↵
- Geleijnse M.L.,
- Fioretti P.M.,
- Roelandt J.R.
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- ↵U.S. FDA prescribing information for Definity approved October 10, 2007. http://www.fda.gov/cder/foi/label/2007/021064s007lbl.pdf. Accessed November 15, 2007.
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- Kusnetzky L.L.,
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- British Cardiac Society Working Group
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- Armstrong W.F.,
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- ↵
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- Senior R.


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H.R.4033 - Living Equitably: Grandparents Aiding Children and Youth Act107th Congress (2001-2002)
BillHide Overview
|Rep. Capuano, Michael E. [D-MA-8] (Introduced 03/20/2002)
|House - Financial Services
|Latest Action:
|House - 04/15/2002 Referred to the Subcommittee on Housing and Community Opportunity. (All Actions)
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Subject — Policy Area:
- Housing and Community Development
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Summary: H.R.4033 — 107th Congress (2001-2002)All Information (Except Text)
There is one summary for H.R.4033. Bill summaries are authored by CRS.
Shown Here:
Living Equitably: Grandparents Aiding Children and Youth Act - Directs the Secretary of Housing and Urban Development to carry out demonstration programs to provide: (1) intergenerational family housing in connection with the supportive housing program; and (2) section 8 rental assistance to grandparent-headed or relative-headed covered families.
Introduced in House (03/20/2002)
Makes such covered families eligible for the following programs: (1) family unification assistance under the United States Housing Act of 1937; (2) cottage housing opportunity units under the Cranston-Gonzalez National Affordable Housing Act; and (3) fair housing initiatives program education, and outreach under the Housing and Community Development Act of 1987.
Amends the Department of Housing and Urban Development Act to provide Department of Housing and Urban Development personnel with training respecting covered family issues.


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Buffalo Chicken BLAT Wraps are low on carbs, but big on taste!
One of the most challenging parts of starting a new job, in my experience, is learning all the crazy acronyms the new company uses more than what seems like actual words in their everyday conversations.
"Kristin, we're so happy to have you on board here at Company XYZ! Now, did you happen to get the CRUD forms in your email this morning? I know the BURP section looks long, but you can find the HAM numbers for the FLAM fields in the PURR database. Oh, don't forget we have that meeting to go over the DORP results and HACK strategies at 2pm, mmkay?"
Uhhh, IHNIWYJS (I have no idea what you just said!)
Fast forward several weeks later and I'm usually slingin' TPS reports with the best of 'em but still, a glossary on the first day would be nice. ;)
One acronym that thankfully needs no explanation in my known world is BLT – Bacon, Lettuce & Tomato.
Layers of crispy bacon, cold tomato, and iceberg lettuce smooshed between two slices of toast is certainly good, but a kicked up BLT in the form of a Buffalo Chicken BLAT Wrap is even better!
Let me help you decipher: keep the bacon and tomato then add creamy avocado slices and spicy buffalo chicken, and wrap it all up in crunchy, romaine lettuce leaves instead of bread. CYHT (can you handle that?!)
Start the Buffalo Chicken BLAT Wraps with the chicken. One pound of it. You could use chicken breasts cut into bite-sized pieces, ground chicken, or chicken tenderloins, which is what you see here. I like Smart Chicken brand because the tenderloins are perfectly trimmed and ready to go which, let's face it, rules.
Next, sprinkle on a little Ranch Dip Mix.
Add a little or a lot – it's your call. I bet I used 1 Tablespoon of mix for 1lb of chicken tenderloins. Rub the spices into the chicken with your hands. It's the best way!
Next, heat 2 teaspoons vegetable oil in a large skillet over medium-high heat, and saute the chicken tenderloins for 3-4 minutes a side, or until they're no longer pink in the middle. If you're not sure, use a sharp knife to slice one tenderloin partway open and check.
Remove the cooked chicken to a plate then, when it's cooled a bit, chop half into bite-sized pieces and mix with buffalo wing sauce, then slice the remaining tenderloins in half lengthwise, and set aside. I did halfsies because Ben didn't want buffalo sauce on his wraps. Riddle me that?!
Meanwhile, get a few slices of chopped bacon sizzling in a skillet next door. I used Trader Joe's Applewood Smoked Bacon Ends & Pieces, so I'm not 100% sure how many slices this was, but if I had to guess I'd say about 4 or 5.
Tip: To get super crispy bacon on the stove top without burning it, cook it low and slow over medium heat. All the fat gradually renders out and you're left with perfectly chewy crispy hunks of salty bacon. It's the best!
Drain the bacon onto a paper towel-lined plate.
While the chicken and bacon are doin' their thang, turn your attention to 2 tomatoes.
Cut each tomato in half, then thinly slice each half, saving the ends for snacks.
IS THERE ANYTHING BETTER THAN FRESH TOMATOES & SALT, I ask you?!
Next take on 1 avocado. Simply slice it open, remove the seed, then peel and slice like I showed here.
Finally, take romaine lettuce hearts, chop off the stem, then rinse and pat the leaves dry.
Fill the lettuce leaves with buffalo or seasoned chicken, bacon, avocado & tomatoes, then wrap & roll!
Low carb wraps that are BIG on taste!
Buffalo Chicken BLAT Wraps
Buffalo Chicken BLAT Wraps are low on carbs, but big on taste!
- 1lb chicken tenderloins
- 1-2 Tablespoons Ranch dip mix
- 2 teaspoons vegetable oil
- Buffalo Wing Sauce (I like Frank's)
- 4-5 slices bacon, chopped
- 2 tomatoes
- 1 avocado
- hearts of romaine
- Heat oil in a large skillet over medium-high heat. Season chicken with ranch dip mix and rub in with your hands. Add chicken to hot skillet and cook for 3-4 minutes a side, or until no longer pink in the middle. Remove chicken to a plate and let cool for a few minutes. Chop half or all into bite-sized pieces and mix with buffalo wing sauce. Slice the remaining chicken in half lengthwise.
- Cook bacon in a skillet over medium heat until crispy. Drain on a paper towel-lined plate and set aside.
- Cut tomatoes in half, then thinly slice. Slice avocado in half, pop out the seed, peel, and thinly slice. Cut core off of romaine hearts, then rinse and pat dry.
- Assemble wraps by placing chicken, bacon, tomato, and avocado inside romaine lettuce leaves.
This recipe is courtesy of Iowa Girl Eats, http://iowagirleats.com.
Ben described the Buffalo Chicken BLAT wraps as way tastier than a salad. He also said the bacon was the jump off. I think that means he liked them.
I dug 'em – especially the buffalo chicken, but especially the bacon. The fact that this wrap was light and lower-carb than using bread or a flour tortilla was the icing on the cake – PLUS, hello, edible vessel. WNTL (What's not to like?!)
Hope you enjoy!


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Event detail
To Pay or Not to Pay: WWI and WWII Reparations and their Impact on European (Dis)Integration
Lecture | November 28 | 12-1 p.m. | 201 Moses Hall
Spero Simeon Z. Paravantes, University of Luxembourg, Centre for Contemporary and Digital History (C2DH)
Due to the separation between the historical and legal fields which have examined the issue of WWII reparations, no generally accepted definition of their current status exists either in the historical, legal or political spheres. This lack of clarity has greatly contributed to this issue remaining unresolved until the present. In his talk, Spero Paravantes looks at the way the issue was used by the Big Three in their dealings with each other after WWII. In light of the Greek governments continued pursuit of WWI and WWII debts it claims are owed by Germany, and the recent claims made by the Polish government, this talk summarizes the historical, legal and political scholarship on the issue and also comments on its effect on relations between members of the Eurozone and the way in which responses to the issue of WWII reparations, and indeed the legacy of the war itself, have brought political and cultural divisions within the Eurozone again to forefront.
email@example.com, 510-643-4558


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Friday, December 22, 2006
Corporate blogging supports Christmas retail and sometimes bumps press releases
Many companies to encourage their own managers to create "corporate blogs" rather than using just formal press releases in a conventional "professional" manner. Look at http://blogs.sun.com/jonathan and http://www.hp.com/blogs/marcello . In 2004 there was a brief legal scuffle instigated by hp over Sun's blog. The article is Amy Joyce, March 19, 2005 The Washington Post, "More PR Than No-Holds-Barred On Bosses' Corporate Blogs; Most Corporate Bloggers Don't Deviate from Company Line."
Jen Haberkorn has an article in the Dec 21, 2006 Washington Times, "Retailers get personal with blogs from inside," here. Sometimes, as with Wal-Mart, these blogs have been written even by low-level employees. This has been particularly effective during the Christmas season, and in 2006 blogs have become important for the first time.
Because of possible conflicts, I would think that companies should not ask lower-level employees to user their own names when blogging in behalf of their employers. In some jobs, I believe that gradually employers will want to manager their associates' contact with the public space through the web, but this is appropriate mainly when associates use their own names or identities in a public manner in behalf of the company.
Nancy Flynn has a lot of discussion of the legal issues for corporate blogs in her 2006 AMA book, Blog Rules, review here.
The Washington Times tech-watch on April 24, 2006 encouraged job seekers to study blogs about companies that they apply to (especially Microsoft). A state employee in North Carolina started a blog about Wal-Mart's environmental violations, at this link.
Posted by Bill Boushka at 4:19 PM
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Robert Henke Artist Interview: Engineering Artistic Solutions
"I see a lot of similarities between fascinating engineering and fascinating art. Both have to do with craftsmanship; both have to do with finding a simple solution for a complex problem. And it has to do with elegance and needs inspiration." - Robert Henke


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In 1957, Mr. Paul E. Eleazar had the foresight to organize a locally owned bank to better serve the Kaplan community and surrounding area. He and other investors contributed $350,000.00 in capital and opened Vermilion Bank & Trust Company in March of 1958. The Bank was organized to give the residents of Kaplan and people in the area an option to do banking with more than one bank in the Community.
The founding directors were; Feray Clark, Paul E. Eleazar, Jack Kaplan, Billy Matthews, Louis Roy, Peter Paul Trahan, Laines Vincent, & Lyman Vincent. We take this opportunity to express gratitude and thanks to the founders, co-founders, and investors of Vermilion Bank for making dreams become reality. It is because of their firm belief and dedication that Vermilion Bank has grown to an average of $110 million in assets.
Vermilion Bank supports its community in many ways with many of our staff members actively involved in local civic organizations. We have loaned more of our assets to the community and surrounding area than any local bank in Kaplan. We provide top quality service to our customers at a reasonable price.
Our philosophy remains the same: that banking is about relationships, not just about products and technology. That being said, our Online Banking and Bill Payer services are some of the best offered by any bank, and will suit most all your banking needs. Come by and experience the difference in community banking.Back to Top


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After my treatment yesterday...we got home at about 2:00...I walked upstairs, took a shower, got in bed and slept until 6:15...when Den literally had to shake me to wake me up! I don't remember dinner at all! OMG! I think that a part of the treatment is an infusion of Benedryl which gives me really twitchy legs there and knocks me out when I come home.
Today I went to make a reconnection visit with our primary doctor. He made time for us to talk about all that has happened to me since surgery in July. He answered every one of my questions so patiently. I barely cried! He again...stressed that positive attitude that I have to have and its effect on my immune system...I think I am positive but every now and then there are tears...sad tears...pitiful tears for me that I try to get past. How sweet is it when your doctor hugs you and kisses your head before you leave! Of course I cried again!
Plus...certain parts of my life are on hold for now. I can't really travel...I am about 75% of my old self...I am often not hungry...I can't use my normal toothpaste...I can't use my normal mouthwash. I can't be around children. I can't get manicures or pedicures...I can't go to movie theatres. I get steroids once a week, too, and I think I have "roid rage". It's just petty stuff that won't be forever...but...I miss it. I won't miss the steroid rage...neither will Den. I cry really hard when I talk to my sister Paula...especially when she says she knows my mom is watching over me. I cry when I talk to my brothers. I know it embarrasses them but I still cry. I cry when I talk to my sister in law Betsy because she always is so calm and has great advice. I cry when I talk to my sister in law Kathy because she just keeps telling me how much she loves me. I cried when I talked to my brother in law Chris yesterday just because he says sweet things. Hmmm...I think I might cry a little no matter whom I talk to...that's what my neighbor Jane says...so I just warn everyone that I am going to cry! Debbie the Nurse at the treatment center says it's ok to cry...but I am trying not to overdo it! Sigh!
Writing this post today is making me cry...just a little!
Reading and loving this book! I think it's YA but it reads a bit older...I guess being at a boarding school is most definitely a sign of YA. Watson is a boy...Holmes is a girl and it's in our time and they are generations removed from their Watson and Holmes relatives. The writing is fun! The writing is delicious. The characters are cool. The plot is fascinating!


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Toca-Toca animals is a very enriching activity that involves the interaction of people with animals of different species, having, if physical contact with them is desired. Its main objectives are to take advantage of proven therapeutic effects exerted by the animals over humans.
How does the Toca-Toca work?
- Animals travel in cages.
- Upon arrival monitors take the place reserved for the activity, which may be inside (room) or outside (outdoor or garden).
- Participants are arranged in a circle, they are given a brief explanation of the animal and then they can, if they wish, pick it up or touch it, following the instructions of the monitor. It is not mandatory to touch any animal, of course.
We start with the most common animals (rabbits, chickens, …) and gradually give pas to the most exotic ones.
List of animals:
- Birds (Eagle and Eagle Owl)
- dwarf rabbit
- Guinea pig
- Hedgehog
- Frog
- Iguana
- Water turtle
- Giant tortoise
- chicks
- Little Kids
We can also bring more exotic animals like chameleons, snakes, spiders, etc.
- The touch-touch activity can be performed at any point of Catalonia (animals and monitors are moved to the place).
- The list of animals available will vary somewhat depending on the life cycle of each species and weather conditions.
- Duration of activity: 45 minutes to 1 hour (maximum), enough to keep the group's attention and respect animals (minimum).
- Maximum 25 people per group.


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From Africa Legal Brief- The article below is worth reading, entirely.
The Assassination of Mummar Gaddafi illegal under international Law
On the 18th of October, United States Secretary of State Hillary Clinton was in Tripoli, Libya. She stated in unusually blunt terms that she would like to see 'Mummar Gaddaffi dead'. Two days later she got her wish. Mummar Gaddafi was bombed by NATO aeroplanes as he attempted to leave Sirte and rebels from the National Transitional Authority (NTC) pulled from the drainage pipe an injured Gaddafi who had taken cover to avoid the bombardment coming from NATO Aeroplanes.
-Gaddafi was pulled from the drainage pipes alive as video footage has shown and was summarily executed using his own personal golden gun.
-This was extra judicial killing supported by a whole Secretary of State Hilary Clinton.
-This was a clear violation of the Geneva Conventions in the acceptance of surrender and the treatment of prisoners of war; military necessity, along with distinction and proportionality.
The issue in Libya is not so much about Gaddafi, but that his murder symbolises the final occupation of Libya. The re-colonisation of Libya by America and NATO forces. It is now a question of America and Europe doing exactly what they please in that country. Not only do they have access to the large oil and gas reserves, but also something the media rarely covers the large water reserves under the Libyan soil.
-Under international law there is no rational for the assassination of Mummar Gaddafi. The original reason, which was resolution 1973 which authorised the protection of civilians, was turned into a regime change instrument. The assassination of Mummar Gaddafi is a blunt admission by America, France and Britain that this crusade was not about protecting civilians, but about regime change. This was a breach of the UN regulations. This was a NATO/US operation in a scramble for Libyan oil.
-What NATO and America do not realise is that they have now created a very chaotic situation, probably similar to the one in Iraq if not worse. In the competition for the Libyan oil and Gas, the NTC and the crusading countries risk fanning more conflict amongst the Libyans themselves. Sooner rather than later the Libyans will realise that they have jumped from the frying pan into the fire. The imperial solidarity shown when taking over Libya will surely disintegrate as the scramble for these resources begins.
And what was Gadaffi's crime?
Gadaffi's principle crime was that he refused to take any loans from institutions like the IMF etc. He refused to join the club of International bankers and decided to set up his own Pan-Africanist bank that would have provided loans to African countries. Gaddafi's Libya was the only African/Arab country that did not owe any country or institution any money.
The Assassination of Mummar Gaddafi is part of a bigger plot by America to establish US AFRICOM. The United States Africa Command. Africa Command protects and defends the national security interests of the United States by establishing its 'defence capabilities' on African soil and taking over regional organizations. To date no African country except Liberia has co-operated with America in having AFRICOM bases on their soil. It is now quite clear that AFRICOM will now move into Libya. The re-colonisation of Libya will then be complete.
Gadaffi's Burial after assassination
Authorities now have the dilemma of what to do with the body of Muammar Gaddafi, now in the town of Misrata where it was paraded in the streets on Thursday.
"They have said they will conduct a secret burial and there is some speculation that they might even try to bury him at sea, as al-Qaeda leader Osama Bin Laden was buried, to prevent any grave being turned into a shrine, she adds.
Mr Tarhouni told Reuters that Col Gaddafi's body - currently in Misrata - was not going to be released for burial immediately.
"I told them to keep it in the freezer for a few days... to make sure that everybody knows he is dead," he said.
Asked about the burial arrangements, he said: "There is no decision yet."
Reuters also quoted an unnamed official as saying there was disagreement within the National Transitional Council (NTC) over what to do with the body.
Waiting for orders from NATO?
After the body was paraded about? Burial at sea?
Meanwhile, questions are mounting as to exactly what happened in Col Gaddafi's last moments following his capture.
Officials have denied he was executed.
-Gadafi, if he is indeed dead, was never going to be taken alive
Dead men tell no tales and a talking Gadaffi would have been a serious embarrassment to the West.
That said the inability of Gadaffi to speak will make him no less a heroic figure to the vast percentage of Libyans who do not wish to be occupied.
The abuse of his lifeless corpse and the sickening crowing and cackling (see below) from Western Leaders will be looked upon by the Libyans as an insult. Who can blame them?
The bloodlust demonstrated by Hilary Clinton is palpable.
She could barely contain hereself.
Something else? Though she says to the others in the room "unconfirmed" "reports unconfirmed" , she looks as if she knows it is true, she is practically beaming.
Did she already have the assassination confirmed through unofficial channels?
Young rebel shot Gaddafi in the head


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If you are experiencing a radiating, numbing, or tingling pain sensation in the lower back, legs, buttocks or arms, you may have a herniated disc, also known as a disc bulge. Our Westlake chiropractor Dr. Michael Darr understands just how frustrating it can be to get effective, drug-free and non-surgical treatment for a herniated disc. Dr. Darr has more than 30 years of experience using non-invasive chiropractic treatments to manage herniated disc pain. Our treatment options include spinal manipulation, the Flexion-distraction Technique for herniated discs, and spinal decompression therapy. These treatments bring correct alignment to the spine, relieve nerve compression from disc herniation, and support the body's natural healing process following an injury.
Herniated Disc Pain Management in Westlake: Why Chiropractic Care Works
A herniated disc occurs when one of the rubbery cushions (discs) between the vertebrae slips or ruptures. A spinal disc has a soft center encased in a hard exterior, a lot like a jelly donut. When the soft center slips through the tough exterior, this can irritate nearby nerves, causing numbing and radiating pain sensations along the length of the nerve. Herniated discs are most common in the lumbar spine (lower back), but they can still occur in the cervical spine (the neck). Sciatica is one of the most common pain conditions associated with a herniated disc. This condition occurs when a disc in the lumbar spine compresses the sciatic nerve, triggering pain along the length of the nerve, which runs from the lower back down through the buttocks and the legs.
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The Flexion-distraction Technique for herniated discs is one of our most popular, evidenced-based treatment options for neck pain and back pain relief. The goal of Flexion-distraction treatment is to achieve a 50% relief in pain within 30 days. Studies show that nine out of 10 patients are satisfied with the outcome of their Flexion-distraction treatment 90 days after initiating treatment. Flexion-distraction is a relaxing, gentle treatment with no quick moves or noise. Treatment lowers intradiscal pressure, widens the spinal canal area, and also restores motion to the spinal joints.
Spinal decompression therapy is a treatment that uses precise, computerized movements to slowly traction the spine and creates space between the vertebrae. Decompression therapy relieves pressure on nearby nerves, pulling nutrients, oxygen and nourishing moisture back inside the injured disc. The gentle, relaxing treatment sessions are a natural complement to chiropractic adjustments for enhanced pain relief.
The right herniated disc treatment will safely relieve your pain without the need for invasive surgery or medication. Schedule an appointment with our Westlake chiropractor to learn more about your treatment options today.


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Boston's once-toxic river flows to your beer mug
Would you drink a beer originating in what used to be one of the most polluted rivers in the country?
In early August, Newton, Massachusetts-based water technology company Desalitech withdrew 4,000 gallons from Boston's Charles River. After purification, the water was delivered to six local breweries for a beer-making competition.
"The Charles River is one of the biggest icons of Boston. Being able to drink it is really tapping in one of the biggest symbols of the town," said Nadav Efrati, Desalitech's CEO. "Our company has reinvented the purification and reuse process in a way that enables us to almost completely eliminate the waste of water."
The company upgraded a traditional process called reverse osmosis to treat the water and clean it for reuse. Reverse osmosis uses special membranes to block salts and contaminants, producing purified water and a stream of concentrated pollutants.
Reverse osmosis systems typically operate around 75% water efficiency, wasting about 25 gallons for every 75 gallons of purified water, according to Efrati. For the Brew the Charles project, he said, there was 98% efficency.
According to Bob Zimmerman, executive director of the Charles River Watershed Association, swimming or boating in the river was once unheard of, let alone drinking from its waters.
"Fifty years ago, when my organization was formed, the Charles literally ran in colors" stemming from local industry waste, he said. "If someone were to offer me a beer that had been made in the 1970s from Charles River water, my reaction would have been 'No way; that's death in a bottle.' "
As recently as 1996, raw sewage pollution in the river was severe enough that it failed state swimming standards up to 80% of the time over the course of the year, Zimmerman recalled.
Then, authorities launched efforts including preserving wetlands to filter out pollutants; promoting construction of modern wastewater plants, reducing sewage discharges; and enforcing the 1972 Clean Water Act.
Thanks to the ongoing efforts of the Watershed Association and local authorities, the US Environmental Protection Agency gave the river a B+ in 2015, up dramatically from its D in 1995.
According to Renata von Tscharner, founder and president of the Charles River Conservancy, about $500 million has been invested over the years to clean up the water and bring the region's main waterway back to life.
"It's still got its issues, but you can boat on it safely, occasionally swim in it safely, and we're working hard to get it the rest of the way," Zimmerman said.
The shift in the way locals perceived the river was captured by the 1966 song "Dirty Water" by the Standells. Once a gloomy depiction of the city and its river, it is now the closing song for victories when baseball's Red Sox win at Fenway Park. Zimmerman sees it as "an anthem of rejuvenation and restoration for the city."
In September, about 1,000 people attended the closing party for Boston's HUBweek innovation festival, tasting beers made from the Charles' water.
Adam Romanow, founder and president of Castle Island brewing company -- which won the People's Choice Award -- grew up in the Boston area and typically uses the Quabbin Reservoir in Central Massachusetts as his brewery's main water source.
"We don't normally use the Charles River, but we got lucky this time," Romanow said. "The water that we got was actually slightly better than the quality of water that we usually get straight out of the tap."
Tasters appeared mostly intrigued and undaunted by the beers' origins. "Why would I be concerned? It tastes great," Rachel Motz said.
The event was also part of an initiative to create a permanent swimming area in the Charles.
"There used to be swimming in the Charles River until the 1950s. So, many people have fond memories of swimming in the river," von Tscharner said.
Until then, fans will have to settle for drinking it.


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To anyone observing reality with regular eyes, there is a distinct difference between the ways in which the threat of violence is combatted by law enforcement and communicated by news media, the control variables being: race, ethnicity, and religious background.
These differences illustrate the privilege associated with the race and religious background of the same men who fashioned this country, manipulating their resources to create and benefit from the marginalization of minorities: gays, women, those of different faiths and Indigenous people. In short, acts of terror committed by those of white skin, particularly those with a conservative political and/or religious background are covered with a level of humane sensitivity by the media and appear to be handled by police and the judicial system with less severity.
Oregon Bundy Militia vs. MOVE vs. Ferguson vs. Islamophobia
Imagine, a group of armed men, encouraging others who share their beliefs to join them, against a perceived miscarriage of justice, trespassing upon and occupying government property in protest. Hashtag #BLM? #TheNewBlackPantherParty? #TheOldBlackPantherParty #IslamicTerrorism?
No no, no. This wasn't a case of BlackLivesMatter protesting against a verdict that seemed to sanction state sponsored violence after the mortality of another unarmed African American. The above events were a response to a verdict levied against two ranchers accused of arson after setting fire to government grazing land.
What would follow was a standoff including threats to kill police, calls to arms by the group via social media and shoot outs with police ending with the fatality of Robert "LaVoy" Finicum who reached for his weapon twice. 19 "armed, anti government protesters" were ultimately arrested at the conclusion of the 41 days.
The bias in reporting and police response was illustrated across social media, with hashtags such as #YallQaeda illustrating the stark difference in the way these criminals were defined, covered by the media, and dealt with by law enforcement. Many pointed to the two seconds it took a Cleveland police officer to gun down a black 13 year old carrying a bb gun and the aggressive response of the NYPD against Eric Garner, an African American cited for selling loose cigarettes. Others imagined the inevitable spin and response the media and law enforcement might have employed had these "anti government militia" been a gang of Islamic fundamentalists calling for jihad.
Historians noted the parallels between the Oregon occupation of 2016 and the firebombing of a residence housing members of a naturalist group, MOVE, made up mostly of African Americans. In 1985, after a 2 day standoff with Philadelphia police in which shots were exchanged, a helicopter dropped a bomb over the MOVE headquarters. The residual results of the attack which included 500 police officers and over 10,000 rounds of ammunition, was the destruction of 61 homes. The destruction left 250 residents, of a middle-class black community, homeless. The final body count included 11 people, five of which were only children.
Similarly referenced was the pre-emptive deployment and militarization of police at Ferguson, after the death of Michael Brown. Tear gas and rubber bullets were fired at crowds of protesters for violating city curfew, crowds that included women and children.
When Ethan Crouch, a Caucasian male of financial privilege, killed 4 men while driving drunk, violated his parole, and fled the country, he received a sentence of less than 3 years. Young black men on the other hand are subject to 5 year minimums for distribution of less than 28 grams of crack cocaine. Can we deny the existence of white, conservative privilege when William Celi, a conservative white american, was found to have an active bomb in his basement after threatening those of Islamic faith at their house of worship, was given a 90 days sentence after agreeing to a plea deal? Really, ok. If one prefers to observe reality with their crazy eyes it is their right, but it doesn't negate the fact that the 1+1=2 and the sky is blue.
Although these events have circumstantial differences they make it impossible to ignore the extreme bias. Oregon militia men would have been depicted and dealt with differently had they been armed members of Black lives Matter, a group that FOX news contributors have often labeled a terrorist group, or. perhaps Syrian Refugees?
Latest posts by Dominick Fils-Aime (see all)
- Paid Patriotism - October 3, 2016
- Chicago PD Declines Invite to ESPN'S Town Hall On Race And Violence - September 10, 2016
- How Racism Made and Might Be Keeping Marijuana Illegal - June 20, 2016


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ALGIERS, Aug. 30 (Xinhua) -- Algeria would hand over Muammar Gaddafi to the International Criminal Court if the embattled Libyan leader attempted to enter the North African country, Algerian local media reported Tuesday.
Local Arabic-language daily Echorouk quoted well-informed sources as saying that the government made the decision according to the arrest warrants issued by the International Criminal Court for Gaddafi, his son Seif al-Islam Gaddafi and intelligence chief Abdullah al-Senussi.
Algeria would be committed to all international regulations issued regarding the situation in Libya, it said.
The Algerian Foreign Ministry confirmed that Gaddafi's wife and three children entered Algeria Monday morning, the nation's official news agency APS reported. However, it did not mention the whereabouts of Gaddafi himself.
The Algerian government has informed the United Nations and the Libyan rebel National Transitional Council about the Gaddafis' arrival, the statement said.
Algerian security services will receive an instruction to close the southern border with Libya in view of the fragile security situation in the Sahel region and Libya, Algeria's French-language newspaper El Watan reported on its website, quoting a government source as saying.
Algeria has hundreds of kilometers of borderline with Libya, stretching through vast expanses of sparsely peopled desert.


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This makes me miss TK.
Chi_Chi:You would think TK & TN would operate in somewhat the same manner/format.
nah, that'd be too simple.
FutureMrsDudley55:Oh wow, my avatar and siggy are wayyyy old. I forget how to update it. Halp?
oh hi! Now I remember who you are, Dudley
Yay, it worked! Bleh. So how's everyone doing?
Heels- Thanks! I'm really excited to see it... in two weeks! She said she'll just recreate that photo as close as possible.
Suc- this is why I'm ok with having different sigs on TK/TN/TB