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Mohamed Coulibaly is an advisor on law and agriculture for the Economic Law and Policy Program. His expertise is in responsible investment in agriculture and land laws and policies. He has worked on several topics related to sustainable development and agriculture and has conducted research on the legal, social and environmental aspects of development projects, land policies, seed laws and other agricultural issues in Mali and Africa.
Based in Bamako, Mali, Mohamed provides training and advisory services to developing country governments, primarily in Africa. This legal and policy advice focuses on issues related to foreign investment in agriculture, such as the negotiation, drafting and implementation of agriculture investment contracts and national/regional laws and policies aiming at maximizing the benefits and minimizing the risks from foreign investment in the agriculture sector.
His work also entails research on emerging trends and issues at the intersection of investment, agriculture and sustainable development. An area of focus is reflecting on legal instruments that can support the transformation of African agriculture through increased private investments. He recently published with other colleagues a policy brief on the rise of agricultural growth poles in Africa, also known as agropoles, which are key tools for this transformation.
Mohamed is also an assistant professor of law at the University of Bamako, where he teaches and conducts research activities on land law, environmental law, administrative law and international legal studies.
All Publications
- Burkina Faso Adopts a New Agricultural Investment Code: How does it contribute to sustainable development?
Blog - October 22, 2018The strengths and growth potential of Burkina Faso's new Agricultural Investment Code.
- The Rise of Agricultural Growth Poles in Africa: Investment in Agriculture Policy Brief #6
Policy Brief - September 27, 2017Africa has seen the emergence of 36 agricultural growth poles and 9 corridors over the past 15 years. They cover at least 3.5 million hectares of land in 23 countries. Ensuring that the new wave of agropoles and growth corridors is effective requires robust policies, laws and practices to ensure that a possible new trend of investment helps Africa achieve the sustainable development goals the continent has set.
- Une nouvelle loi pour sécuriser les terres au profit des paysans maliens
Blog - June 28, 2017Le 11 avril 2017, le Président malien a promulgué la loi foncière agricole (LFA) adoptée par l'Assemblée nationale 10 jours plus tôt. C'est la première fois dans l'histoire législative du Mali qu'une loi est spécifiquement adoptée pour traiter des terres agricoles.
- Historic New Law Secures Land for Malian Farmers
Blog - June 15, 2017Farmers in Mali have gained critical new rights to their traditional land—and rural communities have gained much-needed economic stability—as a result of a historic new law.


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subset: commoncrawl


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Bernanke Says Size Alone Doesn't Make Too-Big-To-Fail
Former Federal Reserve chairman Ben Bernanke said Wednesday that the size of a financial firm is only one factor in determining whether it has reached too-big-to-fail status.
Mr. Bernanke argued at an event at the Brookings Institution that a lot of factors come into play when regulators try to determine if a firm has reached a status where its failure would threaten the functioning of the financial system. Too-big-to-fail firms played a starring role in fueling the financial crisis, and while there's been a huge push by regulatory authorities to reduce ongoing risks, almost all agree the process is not yet complete.


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damn thats one badass Ithaca.
This member has provided no bio about themself...
damn thats one badass Ithaca.
LOL. Kinda funny looking >_>
Only registered members can share their thoughts. So come on! Join the community today (totally free - or sign in with your social account on the right) and join in the conversation.


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Peace Of Mind
It may be you are caring for someone who needs your help due to a health condition, disability or frailty. Are you concerned about what will happen to them should an emergency arise?
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Supportive Housing & Residential Care Homes
Residential facilities for older adults and/or people with disabilities who are unable to function in an independent living environment because they need assistance with toileting, bathing, dressing, medication management and administration, meals and housekeeping and other activities of daily living, but do not require nursing care on a regular basis. Living options range from institutions to settings that enable individuals with disabilities to live in their own homes or apartments with supportive services from community-based supported living providers. (From AIRS BH-8400.6000)
If you know of a Service that should be listed but isn't, please Suggest a New Provider. If you find errors in a listing, please let us know by using the "Suggest an Edit" form on the provider's detail page.


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1. Re: Can you limit ticket priority settings by submitter?Carl Wilson Jan 15, 2020 12:29 PM (in response to Kathy Martinez)
Hi Kathy,
not without customisation.
2. Re: Can you limit ticket priority settings by submitter?Stefan Hall Jan 15, 2020 12:33 PM (in response to Kathy Martinez)
This is not possible without Customizing.
How do customers create their tickets? If you are using SRM or DWP, you can separate this very cleanly by configuration.
3. Re: Can you limit ticket priority settings by submitter?Stefan Hall Jan 15, 2020 12:39 PM (in response to Carl Wilson)
Damn, why are you so fast? Give me a few more minutes
4. Re: Can you limit ticket priority settings by submitter?Sinisa Mikor Jan 16, 2020 6:30 AM (in response to Stefan Hall)2 of 2 people found this helpful
If SRM or DWP is used for submittal, it is possible to limit user's choice of priority, even to the point of introducing blacklisting specific users, but if this needs to be dynamic, it would take a bit to set up additional form(s), populate data and it might require periodic management of that list; static restrictions are fairly simple -- one way of implementing static restrictions is via SRD's actions by using one of available fields in CTM:People (or adding one if nothing can be repurposed) to tag account as restricted and restricting priority menu on submittal form based on it.
On the other hand, priority on customer's side could be mentally and actually decoupled from priority on support's side -- in my experience, a lot of people (instinctively?) consider those as (separate views of) the same attribute (and often attach service level targets to it, as well, which then influences conditions of service level compliance), instead of using customer's priority from submittal form to inform support about that particular customer's priorities (which may or may not align with those of support) and priority from support application (e.g. Incident Management) to handle internal prioritization and ordering.
5. Re: Can you limit ticket priority settings by submitter?Kathy Martinez Jan 27, 2020 10:53 AM (in response to Stefan Hall)
Thank you for your reply. We are using SRM.
6. Re: Can you limit ticket priority settings by submitter?Stefan Hall Jan 27, 2020 12:42 PM (in response to Kathy Martinez)
Then you have everything you need. Offer your SRM customers something more abstract than impact/urgent (priority), e.g. number of affected users or individual cases, team, department, company.
Then you don't transfer the values 1:1 but as your support organization sees it or your contracts require it.


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Mechanisms for Spontaneous Termination of Monomorphic, Sustained Ventricular TachycardiaResults of Activation Mapping of Reentrant Circuits in the Epicardial Border Zone of Subacute Canine Infarcts
Author + information
- Received July 9, 1997
- Revision received October 9, 1997
- Accepted October 30, 1997
- Published online February 1, 1998.
Author Information
- Heiko Schmitt, MDA,
- Andrew L Wit, PhD, FACCA,*,
- James Coromilas, MD, FACCA and
- Bernd Waldecker, MDB (alw4{at}columbia.edu)
- ↵*Dr. Andrew L. Wit, Department of Pharmacology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032.
Objectives. The objective of this study was to determine why sustained ventricular tachycardias (VT) sometimes stop without outside intervention.
Background. Sustained, monomorphic VT in patients with ischemic heart disease is often caused by reentrant excitation. These tachycardias can degenerate into rapid polymorphic rhythms or occasionally terminate spontaneously.
Methods. Sustained VT was induced by programmed stimulation in dog hearts 4 to 5 days after ligation of the left anterior descending coronary artery. Activation in reentrant circuits in the epicardial border zone of the infarct was mapped using 192 to 312 bipolar electrodes.
Results. Spontaneous termination of sustained VT always occurred when the reentrant wave front blocked in the central common pathway in reentrant circuits with a figure-of-eight configuration. Two major patterns of termination were identified from activation maps of the circuits that were not distinguishable from each other on the surface electrocardiogram: 1) Abrupt termination was not preceded by any change in the pattern of activation or cycle length. It could occur at different locations within the central common pathway, was not related to the directions of the muscle fiber orientation and was not caused by a short excitable gap. 2) Termination caused by premature activation (after a short cycle) either resulted from shortening of the functional lines of block around which the reentrant impulse circulated or was caused by wave fronts originating outside the reentrant circuit. In only one episode were oscillations of cycle length associated with termination.
Conclusions. The mechanisms for termination of reentry in functional circuits causing VT are different from those in anatomic circuits where oscillatory behavior precedes termination.
Sustained ventricular tachycardia (VT) can occur in patients with ischemic heart disease [1–3], where the major mechanism for the arrhythmia is reentrant excitation [4]. Although often lasting for many minutes or occasionally changing into more rapid polymorphic rhythms, sustained tachycardias may also terminate suddenly and for no apparent reason after they have attained a relatively stable rate and QRS configuration for many cycles [5]. The reason for spontaneous termination is not well understood.
The mechanisms for termination of sustained reentry have been studied in detail using experimental models of reentry around an anatomic obstacle [6]. Activation mapping has revealed "oscillations" of local cycle length before termination [6]. The refractory period lengthens after a long cycle length, followed by conduction block in the refractory myocardium during the subsequent short cycle length. However, other mechanisms might be involved in the termination of sustained reentry caused by functional reentrant mechanisms, because functional circuits are able to undergo changes that cannot occur in anatomic circuits, such as alterations in size or shape, which might lead to termination of reentry [7].
Sustained VT in a canine model of healing myocardial infarction has many similar characteristics to tachycardias in humans [8–11], including spontaneous termination. These tachycardias are often caused by functional (anisotropic) reentry [9]. In this study we investigated the mechanisms responsible for spontaneous termination by mapping impulse propagation in the reentrant circuits. A preliminary report of our results has been presented in abstract form [12].
1 Methods
1.1 Canine Model of Myocardial Infarction
Myocardial infarcts were produced in adult mongrel dogs weighing 30 to 40 kg by ligation of the left anterior descending coronary artery (LAD) near its origin [9, 13]. Four to 5 days after the operation, the dogs were reanesthetized (pentobarbital sodium, 20 to 30 mg/kg) and ventilated with a positive-pressure respirator for electrophysiologic study. At this time VT can often be induced and reentrant circuits identified by mapping the epicardial border zone [8, 9]. Blood pressure was recorded through a cannulated left femoral artery and displayed along with leads II and III of the electrocardiogram (ECG) on an Electronics for Medicine DR12 oscillographic recorder. The left femoral vein was cannulated for administration of fluids. The chest was opened through a median sternotomy, and a mapping electrode array was sutured on the infarcted anterolateral left ventricular surface.
1.2 Electrophysiologic Study
1.2.1 Electrode Array and Recording Instrumentation
In some of the experiments, the epicardial electrode array consisted of 196 bipolar electrodes arranged in a 9 × 13-cm flexible polymer sheet that covered the entire left ventricle, with the exception of part of the posterior wall. The electrodes were made from silver disks 1 mm in diameter. The distance between poles in the bipolar pairs was 2 mm, and the distance between bipolar pairs was 5 to 10 mm [14]. In other experiments, the electrode array consisted of 312 bipolar electrodes covering an area similar in size to the first electrode array. The electrodes were also made from silver disks with a diameter of 1 mm. The distance between poles in the bipolar pairs was 3.2 mm, and the distance between bipolar pairs was 4.8 to 6.4 mm.
The electrode leads for the studies with the 196-electrode array were led into preamplifiers with automatic gain controlled by a microprocessor. The electrograms were filtered (bandpass of 10 to 1,000 Hz), multiplexed, sampled (2,000 samples/s) and digitized by an 8-bit analog-to-digital converter [9, 10, 14]. For experiments with the 320-electrode array, the electrograms were filtered with a bandpass of 15 to 500 Hz, sampled at 1,000 samples/s and digitized by a 16-bit analog-to-digital converter. All digitized signals were pulse code modulated and stored on a wide-band tape recorder (Ampex).
1.2.2 Experimental Protocol
For induction of VT, standard programmed stimulation protocols with single, double or triple extrastimuli (2 ms in duration, two to three times the diastolic pacing threshold) delivered during basic drive of the ventricles were used. Tachycardia induction was attempted from stimulating electrodes located on the right ventricle adjacent to the LAD, from electrodes along the basal or lateral margins of the electrode array or from electrodes in the center of the electrode array. Activation patterns during pacing from this central site were also used to determine the orientation of the long axis of the myocardial fibers [9, 10]. In this study we included only VT episodes that had 1) a monomorphic QRS pattern on the ECG; 2) a duration of at least 30 s, a standard criterion for sustained tachycardia [1–3]; 3) spontaneous termination unrelated to pacing or pharmacologic intervention; and 4) a complete reentrant circuit identified by epicardial mapping.
1.2.3 Data Analysis
The magnetic tapes from each experiment were replayed afterward for off-line data analysis. A detailed description of our methods for determining activation times and constructing activation maps has been reported [9, 10, 14].
2 Results
2.1 Characteristics of Sustained, Monomorphic VT
Seventeen episodes of sustained, monomorphic VT in 11 hearts in which the complete reentrant circuit could be mapped in the epicardial border zone, stopped spontaneously after 30 to 215 s (mean duration 81 ± 49 s) and did not require electrical stimulation for termination [10](Fig. 1). In all experiments, tachycardia termination resulted from conduction block of the reentrant wave front in the circuit. Two major patterns of spontaneous tachycardia termination were identified from analysis of the activation maps. The first was abrupt termination not preceded by any change in the pattern of activation around the reentrant circuit, nor by a change in the circuit cycle length >5 ms (<2%, which is within the error of our ability to accurately mark activation times) during the last five tachycardia cycles (Fig. 1, A and B). This pattern occurred in six tachycardia episodes with a mean cycle length of 248 ± 25 ms and a mean duration of 108 ± 73 s. The second pattern of termination was termination that followed a short cycle length (premature activation) in the reentrant circuit, resulting from changes in the route of impulse propagation in the circuit. This pattern occurred in 11 episodes with a mean cycle length of 209 ± 15 ms and a mean duration of 67 ± 22 s. This type of termination is not evident from the surface ECG because each tachycardia is characterized by abrupt termination on the ECG with little or no change in the cycle length (Fig. 1, C and D), with the exception of the tachycardia shown in Fig. 1E, which had oscillating cycle lengths from the beginning. An additional five episodes of sustained tachycardia, during which reentrant circuits could not be mapped, also terminated spontaneously without previous changes in cycle length on the ECG.
2.2 Abrupt Termination without Changes in Activation Pattern or Cycle Length
An example of one of the episodes of VT classified as abrupt termination and that lasted 57 s is shown in Fig. 1A. Activation maps at various times during this tachycardia are shown in Fig. 2. In panels A and B of Fig. 2, at the beginning of tachycardia, two separate wave fronts move toward the lateral margin (LL) of the electrode array—one from the LAD toward the apex at the left (isochrones 10 to 80) and one along the base at the right (isochrones 10 to 50). These wave fronts unite close to the lateral border of the map at isochrone 80 and enter the central common pathway of the circuit, the region between the two lines of functional block (the thick black lines, which were not present during sinus rhythm or ventricular pacing). The wave front conducts through the central common pathway (isochrones 90 to 180) and then splits into two, returning to the regions where activation began in this time frame to complete the two reentrant circuits with a figure-of-eight pattern [15]. The activation maps shown in panels C and D of Fig. 2also have the same pattern; panel C is 20 cycles before termination and panel D is the last complete reentrant cycle before termination. The last isochrone that completes the circuit in each cycle that is shown in Fig. 2, including the last complete cycle, is at 230 to 240 ms, the cycle length of the tachycardia.
Fig. 3A shows the sudden termination of reentry that caused this tachycardia to stop. In the map showing termination of reentry, the united wave front enters the central common pathway as in all previous cycles, with no obvious change in the activation pattern (compare with maps in Fig. 2). However, conduction block then occurs in the central common pathway, as indicated by the double bars after isochrones 100 to 120, which causes reentry to stop. The lack of any significant changes within the circuit before termination is further indicated by the electrograms displayed to the right of the map (Fig. 3A). Electrograms 1 and 2 were recorded outside the central common pathway, electrogram 3 from the proximal part and electrograms 4 and 5 from the middle part of the central common pathway. It is evident from the local cycle lengths above the recordings and from the constant electrogram configurations that there is no detectable change in epicardial activation before termination. Termination of reentry results because of conduction block between electrodes 3 and 4. Note that the input into the central common pathway during the next to last (Fig. 2D) and last (Fig. 3A) cycle was not different from that in previous cycles in terms of timing (cycle length of electrograms 2 and 3 does not change) and direction (electrogram configuration is constant). Thus, termination of reentry was abrupt.
There was not just one specific site or "weak link" that caused abrupt termination of reentry, as shown by analysis of another episode of sustained VT that terminated after 215 s in the same heart in which the reentrant circuits described in Figs. 2 and 3A occurred. The tachycardia cycle length was 275 ms, longer than that in the previous episode. During this tachycardia there was also a stable activation pattern almost identical to the pattern shown in Fig. 2. The activation pattern during the termination of this episode of reentry is illustrated in Fig. 3B. When reentry terminated, the two separate wave fronts conducting clockwise and counterclockwise became blocked just as they entered the central common pathway after isochrone 100 (indicated by the two thick horizontal lines). The recording sites shown in Fig. 3B are identical to the sites in Fig. 3A. Conduction block terminating reentry occurs between electrodes 2 and 3, in the very proximal part of the central common pathway. Local cycle lengths at each of the recording sites (numbers below the electrograms at the right) change very little during the last six cycles shown before termination. Electrode 2 shows a double potential during reentry with a smaller component (arrows) preceding the dominant component. The timing of that smaller component relative to the bigger deflection varies throughout the tachycardia, and this component persists after termination of reentry (small arrows at right). Therefore, it is unlikely that this deflection is related to the termination of reentry. The change in configuration of the bigger deflection in electrogram 2 during termination most likely reflects conduction block near that site because of its uniphasic characteristic. Thus, termination of reentry in this episode of tachycardia is classified as abrupt. This site of block occurred in a different position when compared with the example in Fig. 3A from the same heart, where block occurred between electrodes 3 and 4 (also indicated by the row of asterisks in Fig. 3B).
In the reentrant circuits described in Figs. 2 and 3, conduction block occurred when the wave front was propagating in the direction of the long axis of the myocardial fiber bundles (from the apex toward the LAD margin [9, 10]), which has been shown to have a low safety factor [16]. This direction of block occurred in five of the six tachycardias with abrupt termination. However, abrupt conduction block was not entirely dependent on the direction of wave front propagation, because the reentrant wave front causing the tachycardia in Fig. 1B, with a duration of 78 s, was blocked in the transverse direction relative to the long axis of the myocardial bundles as shown in Fig. 4. Panel A of Fig. 4depicts a characteristic, random example of the activation pattern during this VT. In the time window that is shown, activation starts at the center of the electrode array (isochrone 10) and splits into two wave fronts. One moves counterclockwise (upward) toward the base and LAD (isochrones 10 to 100) and the other one pivots clockwise (downward) around the line of functional block (thick black line) toward the lateral margin (LL) of the electrode array (isochrones 10 to 70). The clockwise wave front moves along the lateral margin toward the apex (isochrones 70 to 90), turns toward the LAD and arrives at the entrance of the central common pathway between 100 and 110 ms. The wave front then moves between the two lines of functional block (isochrones 110 to 260) toward the base and arrives at its origin after 260 ms, completing the circuit. There is a region of very slow transverse activation between isochrones 110 and 150. The counterclockwise traveling wave front does not complete a reentrant circuit. A large area between the upper line of functional block (thick black line) and the LAD margin within isochrones 100 to 110 is activated nearly simultaneously by a wave front that comes from either outside the epicardial border zone or transmurally. In this reentrant circuit, the lines of functional block and the central common pathway that they delineate were oriented transverse to the long axis of the myocardial fiber bundle [9, 10]. This pattern occurs in <15% of the figure-of-eight circuits that we have mapped. Panel B of Fig. 4shows the last complete reentrant cycle before termination. The activation pattern and the cycle length were very similar compared with those in panel A. Panel C at the left shows the activation pattern during termination of reentry (incomplete cycle). The wave front arrives at the beginning of the central common pathway at the same time as in panels A and B (isochrones 10 to 100). However, during this last incomplete cycle, conduction block occurs in this region, the area of slow transverse conduction, indicated by the two thick black lines. No obvious changes in the timing or spatial activation pattern occur before termination. This is further illustrated by panel C at the right, where conduction block occurs between electrograms 4 and 5 (thick black line). Neither changes in the local cycle length (numbers above the tracings) nor changes in the electrogram configuration occur before termination of reentry.
One possible cause of the abrupt termination of reentry was that the head of the reentrant wave front traveled close to the refractory tail in the region where conduction block occurred without the presence of a fully excitable gap. Any small changes in conduction velocity might then cause the wave front to become blocked in the refractory myocardium. To test this hypothesis, premature stimuli were applied in two experiments during other episodes of tachycardia in the same hearts with identical reentrant patterns, before they terminated spontaneously. For example, to evaluate the excitable gap in the central common pathway at the site of spontaneous conduction block in the experiment described in Fig. 3B, single premature stimuli with increasing prematurity were introduced every 10 to 20 cycles from the stimulating electrodes at the LAD margin (pulse symbol) during another episode of sustained tachycardia with the same QRS configuration, cycle length and reentrant activation pattern. Fig. 5A shows a premature stimulus (S) introduced 210 ms after the preceding QRS interval (top trace) and 214 ms after local activation at the stimulation site (bottom trace, P). This premature impulse conducted toward the apical and lateral margins following the exact same pathway as the one the two wave fronts followed in Fig. 3B and entered the central common pathway from the apical end (collision with the reentrant wave front at the LAD end of the central common pathway prevented entry from this direction). It then conducted through the central common pathway, activating electrodes 1 to 9 in sequence from the apical toward the LAD/basal margin (electrode locations are shown in Fig. 3B). The region of conduction block causing spontaneous termination in Fig. 3B (between electrodes 2 and 3) was activated 40 ms earlier than it would have been by the reentrant wave front without block (Fig. 5A); electrodes 4 to 9 distal to this site are still activated in sequence and reentry continued. Shortly thereafter, another premature stimulus from the same site but with a prematurity of 200 ms on the ECG (S) and 205 ms at the stimulus site (trace P) terminated the tachycardia (Fig. 5B). This premature impulse also entered the central common pathway from the apical end and activated sites 2 and 3 (Fig. 3B) 49 to 52 ms earlier than they would have been activated by the reentrant wave front without block (Fig. 5B). Block occurred between electrodes 7 and 8 (thick horizontal black line above trace 7 in Fig. 5B) at the LAD end of the central common pathway (see Fig. 3B for location of electrode 7). Therefore, there was a large excitable gap in the region where reentry stopped spontaneously in Fig. 3B, between electrodes 2 and 3, because preexcitation of this region by as much as 50 ms did not cause block, so it is unlikely that spontaneous termination of reentry was caused by propagation of the reentrant wave front into refractory myocardium.
2.3 Termination after Spontaneous Premature Activation of the Reentrant Circuit
Premature activation, evident by a cycle length decrease >5 ms in part of the reentrant circuit that can be detected with certainty, preceded termination in 11 episodes of tachycardia. In eight of these episodes, premature activation was a result of a change in the extent of the functional line of block (Fig. 6). The cycle length of this tachycardia, which terminated after 56 s, was 180 to 184 ms (Fig. 1C). The premature activation of parts of the reentrant circuit that preceded termination did not lead to a perceptible decrease of the last tachycardia cycle length on the ECG. The reentrant activation pattern during this tachycardia is shown in the map in Fig. 6A, which is a map of the last complete cycle before termination. Activation maps of cycles randomly chosen throughout the tachycardia had identical patterns and cycle lengths. Activation is in the form of a single reentrant circuit, although this pattern of termination also occurred in figure-of-eight circuits. In the middle of the electrode array, there is a large region that is electrically silent (dotted area) because infarction extended in this area all the way through the left ventricular wall to the epicardial surface. The reentrant circuit is to the right of this region in the basal/lateral part of the electrode array. The reentrant wave front moves through a narrow pathway bounded on the left side by the infarct-related and electrically silent epicardium and on the right side by a functional line of block (thick black line) (isochrones 10 to 110). Distal to this region, activation splits into two wave fronts. The reentrant wave front turns to the right (isochrones 110 to 180) to complete the reentrant circuit. The other wave front moves to the left (unfilled arrow) and does not lead to a reentrant activation pattern in the epicardial border zone. The final, incomplete cycle shown in Fig. 6B is the continuation of panel A; isochrone 10 in panel B follows isochrone 180 in panel A. It shows conduction block at the 100-ms isochrone (indicated by two thick black horizontal lines) terminating reentry. Fig. 6C reproduces and enlarges part of the map in panel B. In panel C, the original length of the functional line of block during the sustained period of reentry (Fig. 6A) is indicated by the combined solid and dashed bar. During this last cycle, the lateral extension of the line of block, indicated by the dashed part of the bar, disappeared, leaving only a short segment of the original block line shown by the solid bar (Fig. 6B). The general direction of activation is highlighted by the large, curved arrows. However, activation along the two smaller straight arrows is important. Local activation times suggest that in this last (incomplete) cycle, activation crosses the distal extension of the former line of apparent block (indicated by two straight arrows) and preexcites the entrance of the narrow pathway. This interpretation of the activation map is supported by the electrograms at the right in Fig. 6C. During continuous reentry, activation moves from the base to the lateral region of the array (Fig. 6A). After passing electrodes 1 and 2, the wave front pivots around the original line of apparent block and electrodes 2 to 5 are then activated, followed by electrodes 6 to 9 located in the narrow pathway. Electrogram 3 occurs about 67 ms after electrogram 1 and 35 ms later than the sharp deflection of electrogram 2 throughout all cycles. The reason for the alternation in configuration of electrograms 1 and 3 is not known. During the final cycle, however, the previous, consistent and continuous sequence is altered. Electrode 3 is activated 60 ms prematurely with a cycle length of 121 ms, 5 ms after electrogram 1 and before electrode 2, consistent with movement of the wave front across this region of previous block. This interpretation is also supported by a change in electrogram configuration. Note also that a second distinct deflection in electrogram 2 is now lost during this last cycle. Electrodes 4 to 6 are also preexcited, although to a lesser degree (by 13 to 28 ms), with some change in configuration, followed by conduction block between electrodes 6 and 7 (thick horizontal black line above electrogram 6 and double horizontal black lines on the map).
Fig. 7shows another example of premature activation leading to termination of a sustained tachycardia after 104 s. The premature activation and termination is not related to alterations in conduction across lines of functional block as in the previous example. The corresponding surface ECG is shown in Fig. 1D, which does not reflect this premature activation as a short last cycle. In Fig. 7A, during stable VT with a cycle length of 220 ms, two different wave fronts travel from the lateral margin (LL) toward the base at the right (isochrones 10 to 50) and from the apical margin toward the LAD at the left (isochrones 20 to 60). Both wave fronts unite and enter the central common pathway between two lines of functional block (thick black lines) (isochrones 80 to 120), returning to the site of origin in this time window to complete the reentrant activation pattern (isochrones 120 to 220). The activation pattern in Fig. 7B, during the last complete reentrant cycle before termination, shows essentially no changes. Fig. 7C at the left side shows the last incomplete cycle during termination of reentry. The time window begins at the end of the time window in panel B. The first 60 ms of activation of the counterclockwise circuit at the right and the first 40 ms of activation of the clockwise circuit at the left are essentially unchanged. The area toward the apical and LAD sites of the electrode array between isochrones 40 and 60 (the region indicated with dashes), however, is activated 10 to 20 ms earlier than in previously described cycles. Because a large part of this area activates very rapidly and almost simultaneously, conduction from deeper cell layers is a possible cause. The earlier activation in that area results in premature activation at the entrance of the central common pathway where conduction block occurs (marked by two thick lines). To the right in panel C of Fig. 7, electrograms 1 and 2, recorded in the area that shows altered activation during the last incomplete cycle (dashed zone), activate 18 and 20 ms earlier than in the preceding cycles (numbers above the tracing) with an altered configuration. Electrograms 3 to 6, located proximal to the area where conduction block occurs, are activated 22 to 7 ms earlier and also show changes in configuration during the last activation before termination. Conduction block occurs between electrodes 6 and 7 (thick black line between traces 6 and 7).
In one experiment, oscillations in conduction time and cycle length in the central common pathway developed during tachycardia and progressively increased. The ECG of this episode of tachycardia and its spontaneous termination after 70 s is shown in Fig. 1E. The tachycardia cycle length oscillates between 184 and 200 ms, although the increased magnitude of oscillations in the reentrant circuit as the tachycardia progressed cannot be seen on the ECG. Fig. 8A shows activation of the reentrant circuit during tachycardia. During reentry, two wave fronts, one moving clockwise from the apex and the second one moving counterclockwise from the base, merge near the LAD margin (isochrones 10 to 50) and enter the central common pathway between a line of functional block at the right (thick black line) and a region of block at the left formed partly by an inexcitable area (stippled area) and a line of functional block (thick black line). After passing through this pathway (isochrones 70 to 150), the united wave front moves toward the lower right, where it splits and activation returns to the regions of origin to complete the reentrant circuits. This pattern is similar to the reentrant pattern throughout the episode of tachycardia, except for oscillations in conduction time at the entrance and through the central common pathway. The electrograms at the right in panel A were recorded during the early period of tachycardia. Oscillations in cycle length of 2 to 14 ms can be seen at recording sites 1 to 4 leading into the central common pathway. In the central common pathway (electrograms 5 to 7), the oscillations in cycle length are much smaller and within the margin of error for making measurements (<5 ms) (the cycle length of electrogram 4 is plotted in the inset). The conduction time in the narrowest region of the central common pathway between electrodes 4 and 6 is circled and shows small, insignificant changes at this time in the tachycardia. Panel B of Fig. 8shows the termination of reentry and tachycardia. Complete conduction block occurs at the entrance of the common pathway, indicated by two black lines. The electrograms at the right are from the same recording sites as in panel A and were recorded during the last 1600 ms of tachycardia. The sequence of activation of cycles 1 to 5 in panel B is identical to that in panel A, but the oscillations in cycle length at sites 1 to 4 have increased substantially to a range of 12 to 21 ms (see plot of oscillations at electrode 4), as have the oscillations in conduction times between electrodes 4 and 6 (circled). The amplitude of the oscillation (21 ms) is greatest just before termination, when the longest local cycle length (203 ms) is followed by a short local cycle (182 ms) just before block. The site of block is located between electrode 4 (proximal) and electrodes 6 and 7 (distal).
3 Discussion
3.1 Spontaneous Termination of Sustained VT in an Animal Model of Reentry
Sustained VT in patients with chronic ischemic heart disease often requires an intervention such as electrical stimulation or antiarrhythmic drugs to be stopped [17–20]. Spontaneous termination of long-lasting tachycardia, however, can also occur in the absence of such interventions [5]. In the present study we investigated the mechanisms of spontaneous termination of sustained, monomorphic VT in a canine infarct model. Although it is uncertain whether the electrophysiologic mechanisms causing reentry in this model are the same as those in the human heart [21], information obtained from animal models is often useful for elucidating physiologic mechanisms that may be applied to clinical events.
Two major patterns of spontaneous termination of reentry were identified from analysis of the activation maps—abrupt termination and premature activation, neither of which involved a major role for oscillations in conduction and cycle length, the mechanism previously identified as the primary cause of spontaneous termination in experimental anatomic and functional atrial reentrant circuits [6, 22]. Beat to beat alternation in action potential duration causing cycle length oscillations has also been shown to be an important factor in causing spontaneous termination of reentry in a computer model of anatomic reentry [23].
3.2 Abrupt Termination of Reentry: Possible Mechanisms
This pattern of termination has not been previously described in experimental studies on termination of reentry in anatomic circuits [6, 24, 25]or in functional circuits in the ventricle [7]or atria [22]. Small changes in cycle length <5 ms often were measured throughout these episodes of tachycardia as well as during the last five cycles. We believe that these changes often result from inaccuracies inherent in determining activation times from bipolar electrograms, but they also may sometimes be real and reflect small changes in conduction or the reentrant pathway beyond the resolution of our activation maps. However, there were no obvious relations between these small changes and termination of reentry.
In tachycardias with abrupt termination, reentry always stopped because of complete conduction block of the wave front while entering or within the central common pathway, the region of figure-of-eight reentrant circuits that is crucial for the maintenance of reentry, because it is the only region of the circuit used by both reentrant wave fronts [15]. The reason for the block is uncertain; we know neither the mechanism for block nor why it should occur suddenly. One mechanism that may cause block is related to the curvature of the reentrant wave front [26, 27]. It has been shown that the greater the convexity of a propagating wave front, the slower the conduction, and if the convexity exceeds a critical value, block occurs [26, 27]. In the reentrant circuits we described, curvature should be greatest around the turning points at the ends of the lines of block where the reentrant impulse is either entering or leaving the central common pathway. These regions might, therefore, be expected to be the most vulnerable to conduction block. In the experiments illustrated in Fig. 3BFig. 4, block did occur at the entrance to the central common pathway. Although block may have been related to wave front curvature, why it occurred suddenly is not explained, unless the critical curvature that causes block suddenly occurred without being detected because of the limited spatial resolution of our mapping electrode array. In other experiments, however, the site of block was not in the regions where the greatest curvature is predicted to occur (see Fig. 3A and next paragraph).
Another mechanism that might be postulated to contribute to block is the directional differences in safety factor for conduction in anisotropic myocardium. The safety factor for propagation in the longitudinal direction of fiber bundle orientation has been postulated to be lower than that in the transverse direction and has been shown to facilitate block [16]. According to this concept, the most vulnerable region to block would be predicted to be in the central common pathway when the lines of functional block are oriented parallel to the long axis of the myocardial bundles, and not at the pivot points (regions of greatest curvature) where propagation is usually in the transverse direction. In the tachycardias that we mapped, block sometimes occurred in the longitudinal direction within the central common pathway (Fig. 3), but the abrupt nature of block is still not explained. In the experiment illustrated in Fig. 4, however, block occurred in the transverse direction where the safety factor is predicted to be much greater [16]. Block in the longitudinal direction, as in Fig. 3, where conduction is more rapid than in the transverse direction [9, 16], also shows that regions of very slow conduction in epicardial border zone circuits are not always the most vulnerable to block, unlike reentry in a model of stable atrial flutter where spontaneous termination always occurred in an area of slow conduction [22].
The presence of a very small local temporal excitable gap in a region of a reentrant circuit is another property of a reentrant circuit that might predispose to sudden conduction block [28]because a small change in cycle length might cause the head of the reentrant wave front to run into its refractory tail. However, a very small excitable gap was not always related to spontaneous termination, because we found in the experiment shown in Fig. 5that the region where block occurred had a large excitable gap.
Other possible mechanisms that may contribute to the occurrence of conduction block involve intracellular or extracellular ionic changes predicted to occur during the rapid rates of action potential generation during tachycardia. For example, increases in intracellular calcium that might occur at rapid rates [29–31]may lead to decreased gap junctional coupling and block [32, 33]because the sarcoplasmic reticulum in muscle cells of the epicardial border zone cannot sequester calcium as well as normal myocardium [31]. Intracellular sodium accumulation [34]or extracellular potassium accumulation [35, 36]during rapid activity, because of deficiencies in the sodium/potassium pump, may decrease membrane potential or upstroke velocity, also leading to block.
Therefore, although each of the factors discussed earlier may sometimes contribute to conduction block that occurs abruptly, a completely adequate explanation for abrupt block is still lacking. The mechanism may be multifactorial and vary from one heart to another.
3.3 Premature Excitation: Possible Mechanisms
In these tachycardias, conduction of the reentrant wave front became blocked in regions that were suddenly excited earlier than expected, so we assume that the premature excitation caused propagation into refractory myocardium. This was an important mechanism for termination of ventricular reentry in the experiments of El-Sherif et al. [7]. Conduction block also occurred in the narrowed central common pathway of the circuits, even when part of the boundaries of this region was formed by anatomic block (Figs. 6 and 7). Because only part of the circuit was prematurely excited during the last incomplete cycle of tachycardia, a short last cycle length was not observed on the ECG.
One cause of premature excitation was a change in the length (shortening) of the functional line of block (Fig. 6). Small changes in the extent of functional lines of block, either lengthening or shortening, occurring during sustained tachycardias are not rare (unpublished observations) but are not usually associated with termination of reentry. These changes may result from the nature of functional block, which may be caused by a relatively unstable process. The exact mechanism for block is controversial [9, 37]. When shortening of the line of block fortuitously causes the reentrant wave front to impinge on refractory myocardium in the central common pathway, reentry stops. This mechanism would not be expected to occur in anatomic reentrant circuits. In addition, we observed premature excitation of the circuit not related to changes in the functional lines of block (Fig. 7). When this occurred, there was a decrease in the time for activation of part of the circuit, as shown in Fig. 7, resulting in early arrival of the wave front into the central common pathway. We interpret this pattern to indicate that the premature excitation may have arisen outside the mapped reentrant circuit, most likely from intramyocardial surviving cells, because there was nearly simultaneous activation of a large region. A similar pattern was described by El-Sherif et al. [7], except that in their experiments, there was shortening of several cycles before termination. The decrease in cycle length was interpreted to result from acceleration of conduction in the normal myocardium abutting the epicardial border zone, possibly due to changes in autonomic tone and circulating catecholamines [7]. However, we propose that an alternative mechanism may be operative—the breakdown of refractory barriers that occur outside functional reentrant circuits and that are necessary to protect these circuits from extraneous wave fronts. In experimental studies on atrial reentry, secondary wave fronts leaving the original reentrant pathway have been shown to collide outside the reentrant circuit, extinguishing each other and thus being prevented from entering excitable regions of the circuit, colliding with the reentrant wave front and terminating reentry. Slight alterations of conduction, such as those observed after antiarrhythmic drug administration, resulted in breakdown of this functional barrier, causing a shortcut of the secondary wave front into the reentrant pathway, leading to preexcitation and termination of reentry [24, 25, 38]. According to this concept, alterations of conduction even outside the reentrant circuit might lead to termination of reentry.
In only one episode of tachycardia, which we have included among those terminated by premature excitation, was termination possibly related to oscillatory cycle lengths in the reentrant circuit (Fig. 8). As tachycardia proceeded, oscillations in conduction and cycle length increased in magnitude and involved the termination site. Eventually conduction became blocked after a short cycle length that followed the longest cycle length oscillation in the circuit [6]. Block may have resulted from propagation of the reentrant impulse into myocardium with a long refractory period caused by the previous long cycle length. The reasons for the appearance of enhanced oscillations in conduction and cycle length during this tachycardia are unknown. Therefore, the mechanism shown by Frame and Simson [6]to be responsible for termination of reentry in atrial anatomic circuits and that shown by Ortiz et al. [22]for termination of reentry in atrial functional circuits may have occurred but is relatively rare in this mechanism for ventricular reentry.
An additional pattern of activation associated with spontaneous termination of sustained VT described by El-Sherif et al. [7], but which did not occur in any of the tachycardias in our series, was conduction block in the original circuit, causing tachycardia with the formation of a new circuit and continued reentry for several more cycles.
3.4 Relation between Experimental Results and Clinical Observations
The mechanisms for termination of unsustained VT have been investigated in several clinical studies, both from analysis of the ECG and from activation mapping [39, 40]. Evidence for cycle length oscillations and possible impingement of the conducting wave front on refractory myocardium, causing termination of these arrhythmias, has been obtained. Similar oscillations did not occur during sustained tachycardia, although spontaneous termination was not observed. However, in one study [5]there was an increase in cycle length variability before spontaneous termination of sustained tachycardia. The last cycle was either shorter, longer or unchanged compared with the preceding cycles before termination. No clear explanation for termination was obvious, including impingement of the reentrant wave front on refractory myocardium because of oscillations. The relation of our results to the termination of clinical sustained VT, therefore, awaits more clinical data, especially activation maps of reentrant circuits.
☆ This study was supported by Grant R37-HL31393 and by Program Project Grant HL 30557 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Dr. Schmitt was supported by a grant from the Deutsche Forschungsgemeinschaft, Bonn, Germany.
- Abbreviations
- electrocardiogram, electrocardiographic
- left anterior descending coronary artery
- ventricular tachycardia
- Received July 9, 1997.
- Revision received October 9, 1997.
- Accepted October 30, 1997.
- The American College of Cardiology
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text:
HUNTSVILLE, Ala. (WHNT) - This election is turning into a political dogfight. If you turn on your tv tonight, you'll probably get caught watching the last presidential debate.
But it seems like everyone gets so caught up in supporting their candidate, it's easy to feel like the debates are a battle between good and evil.
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So how can candidates win over those in the middle?
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As for the president, Dr. Brown adds, "He needs to do very well in this debate, because the first debate was just devastating for him."
We're closing in on this election, and candidates are targeting those last few votes heavily.


text:
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access online journal, published quarterly by the Universiti Sains Malaysia Press. The journal encompasses all fundamental, application, and clinical aspects of medical, biomedical, and health sciences.
Authors are welcomed to submit original articles, review articles, brief communications, special communications, case reports or letters to Editor for consideration of publication in MJMS.


text:
Cosimo Restaurant & Wine Bar Open in MalvernJanuary 20th, 2007
Malvern/Frazer's newest restaurant, Cosimo, is now open for lunch and dinner. As many as 40 wines are offered by the glass, along with five craft beers and a bar menu (including cheese plate) priced at $9 to $15. The more extensive, American dinner menu is on the expensive side — expect to pay $25 to $34 for entrees.
Located where Yamashiro used to be: 209 Lancaster Avenue, Malvern PA, 610.647.1233
19 Responses to "Cosimo Restaurant & Wine Bar Open in Malvern"Submit your review now -->
We are planning to try cosimo soon. Any current feedback? Thanks
I have lived in NYC, Chicago, and Los Angeles, and have been proclaimed "foodie" (others initailly tagged the descrptive on me and it stuck)so it was refreshing for me to find a restaurant in the suburbs of Philadelphia that was not Italian and where the waiters had an actual working knowledge of wine. Now don't go getting offended with me about this comment; if you've traveled out of the area you know exactly what I am talking about! ;)If you want to expand outside of the usual the flights give you a taste without the commitment. Cosimo has excellent cuisine, albiet the portions are small compared to other restaurants in the area, the quality of the fish and meat excellent, and the service good. It's in my top five if I'm not heading up to NYC that is, so if you love food and wine and don't want just Italian cuisine(they do have a pasta dish or two on the menu for the enthusiasts), Cosimo is the place for you.
Jon Responds,
I've read all postings to date and I have to say that owning a restaurant must be at least as difficult as owning any other business dealing with the public. That accounting for different levels of expectation, I must say that I haved wined and dined at least three dozen times at Cosimo with great enjoyment and pleasure. My personal cellar contains about 3500 bottles of wine, and I dine out probably four times weekly. That is not stated to impress, but to let you know that I can be a real challenge to satisfy. I really think that if you take the time to "wine speak" with the bartenders, work through the wine list (high-end by the glass), order the duck or the pork entree, and finish with any of the crazy-good dessert concoctions, you will find this place a wonderful spot to match great food and wine. If you look around on any given night, you will probably see the sommeliers from the some of the finest restaurants in the area sitting around the bar tasting Cosimo's wines. Does that tell you something?
Well i will admit after reading the reviews i was undecided..but my friend and i try to go somewhere new on birthdays and i wanted to try cosimo..i warned her there were some iffy reviews but she was game to try….We loved it…I cannot say a single negative thing about our visit…it was a very nice setting,the server was excellent…informed us of anything we might want to know,checked on us just enough,cleared the table at proper times…we had calimari to split..plenty for 2 people..e both had the baby spinach salad…very good and we both had the duck and i must say i never had such tasty duck…we really wanted to do dessert but alas..no room so we didn't get to try any dessert but we will definitely be coming back to eat here again!
After my friend went to Cosimo on a dinner date, he told me I had to take my wife. So we went on Saturday for the first time. The dining experience was real good and the food was prepared well. Gotta say that was the best Salmon dish I've eaten (besides the one I cooked myself on a camping trip in Alaska). Would definetly be back and it's a must try on the main line.
Jill Says: Jill am I reading you right–you said that you had a salad an entree, desset and wine for two for $80. Sounds like the biggest bargain on the main line even with small portions– must be something I'm not getting right.
My husband and I had a great dining experience. The wine tasting options can't be beat with the 3 or 5 oz. glass, whole bottle or wine flights.
All the food we had was delicious including an arugula salad, gnocchi and duck entree. The dessert options were unique with a grouping of small bites of various treats.
My only complaint would be that it's expensive and the portions are on the light side. We spent about $80 before tip and we left feeling hungry for something more substantial.
My husband and I went to Cosimo on Monday night for dinner, what a great experience we had, (surprisingly). Been told to check out Cosimo from some friends and have to tell ya that the food and wine we had were very good. Mueller Pinot Noir paired with Duck recommended by our server was perfect. Also, the desserts were a small tasting from categories (chocolate, tropical). What we had was very good. Will be back again and recommend to others to try.
I've been to Cosimo a few times with clients and each time has been very good. Our server (Simon) was very friendly and the food was outstanding. I recommend Cosimo to everyone in my office, it's worth a try.
Went to Cosimo on Saturday evening. Overall service, food and wines were very good. Will be back with friends soon.
What a disappointment this place was! I went for lunch with two co-workers and ordered the shrimp salad. It arrived on a three sectioned plate; one section had some shrimp salad (about a full spoonful), but the other two sections had barely edible tablespoon-sized portions of cous cous and polenta. For $12? It was outrageous. I won't go back. And judging from the lack of other diners in the place at 12:30 on a friday, I'm guessing lots of people feel the same way.
We dined there this past Friday (9-14-07) and we very surprised by our experience. I truly believe the negative comments are very valid but they are also close to the restaurants opening date, and I think they may have opened the doors a little before "prime time".
We entered through the back door with thoughts of the previous entrance criticisms in our mind but found everything to be in nice, ultra clean shape. We were also ultra impressed by the "non smoking establishment" sign we saw on the door – this was an added bonus as I was afraid of cigar smoke ruining the food. Our maitre de was very nice and cute, professional but not at all stuffy as certain fine establishments seem to hire "stuck up" maitre de s only (note to restaurant owners- stop with the maitre de attitude – these people can still have pride and be nice t the same time with out knocking your places "perception" down)
After being seated we were promptly greeted by the bartender (we sat in the bar section) who was covering for the waiter, who took our drink orders – Nice batch of Vodka Martinis as our cocktail test. Served promptly and tasted perfect. Major points to the Dirty Vodka Martini they made.
Our waiter was perfect with a nice, perfect level of attention to what we wanted and reacted wll to the pace at which we wanted to dine(something I cannot seem to get out of Alba after 4 visits).
We ordered first course which consisted of a wonderfully prepared and just as pretty Shrimp and Lobster Gazpacho -it was out of this world, perfect in both visual and digestive terms. The other appetizer was the Tune Poke -again another perfect dish, beautiful to look at and more so to eat. It had the perfect balance of spice from the wasabi but softened with a wonderful mango relish that accompanied it.
We then moved on with a Flight Tasting of wines from a few different regions, white and red – presented well and fun too. As we were putting in our main courses we had a few questions and every member of the staff was well educated in the types, regions and flavors of the foods we asked about.
Main course was great – I had the Surf and Turf – scallops with braised beef – both very tender, both strong enough to stand alone as separate dishes. My dining guest had the NY Strip – done perfect also.
Desserts – perfect, nicely themed plates of 3 or more small portions of different types of pastries, custards, cookies cakes and pies. Everything there was great, from the flavor to the accompanying drinks.
Again we were very very pleased given the reviews and our own personal levels of expectations, with every aspect form the service, to the food, down to the decor (which was not over the top at all- i assume the critics of the decor have not traveled out of the USA too much).
The true test will be if we can get a similar experience on the 2nd and 3rd visits.
I believe your experience at Cosimo was the exception and not the rule. We have eaten at Cosimo several times and have immensely enjoyed the experience. It seems to exceed our expectations each time we visit. It's unfortunate that it apparantely was a bad day for service the day you visited. That can happen. You are right about the food and look of the restaurant. A+ on both these counts, based on our repeated experiences and the opinion of many press articles. I disagree with your opinion on Cosimo's longevity. This restaurant will be around for a long time. This is a "City Restaurant" in the suburbs.
I went with my family to celebrate my mother's birthday on July 11, 2007. We had reservations for nine people at 7:30 p.m. and were promptly seated, but 50 minutes passed from our arrival until we finally got bread served. By the waiter's own admission, there were only two wait staff working that night because as he noted, "We weren't expecting so many people" — that's not the best promotional statement I've heard.
We finally got our appetizers served at 8:30 p.m., but several salads which we specifically ordered without bacon came with bacon. We were too frustrated to complain. When our main course arrived at 9:00 p.m., an hour and a half after we sat down, my order was prepared with bacon, even though the menu didn't mention bacon anywhere in this dish (I'm a vegetarian). They took back my dish and brought me another one.
We all enjoyed the quality and presentation of the food, and the decor of the restaurant was very appealing, but the service was atrocious. The waiters should have been honest with their time estimations when we arrived, and management should have planned much better. Cosimo has only been around for about half a year, but its future doesn't look bright if this poor service and insufficient attention to detail continue. Needless to say, Cosimo lost the business of nine people tonight. We are not going back.
My experience at Cosimo has been very positive. I have visited several times for both lunch and dinner. Each time the food was excellant and so was the service. The winebar is unique with it's preservation and dispensing system. I like it because I can try different wines in small portions. The interior design appears to have been done professionally. The colors and finishes are very well coordinated. The rear entry I agree does not do justice to the inside. I am told by the management that this will be completed soon. Overall, I think Cosimo is a breath of fresh air, filling a void between a "stuffy" restaurant and the chain restaurants or pubs where you can have fun and enjoy good food in a cool chic place.
Sorry TommyJohn, I will have to agree with Katie on this one. My husband and I had a very similar experience. We were immediately disappointed by their menu or lack thereof. The wine selection on the other hand was very good. The tasting glasses are a good touch but Cosimos presentation falls short. The server knew nothing about the wines and admitted to not knowing which one was which when he arrived with the glasses at our table. So we never knew exactly which of the wines we were tasting. The decoration appears to be trying oh so hard to look trendy but comes off looking cheesy. The pictures on the walls were even crooked. Cosimos is desperate to appear pretentious and upscale but they don't quite cut it. We left being completely unsatisfied and still hungry after our expensive, small portioned dinner. I must add to TommyJohn, there is nothing wrong with going to a "chain" restaurant once in a while for a good nachos kick! They are what they are and aren't pretending to be in a class that they aren't, ie. Cosimos.
It is unfortunate that you had one bad experience at Cosimo and decided to write it off. While I do not doubt you had a bad experience there, my group of friends and I have had no less than half a dozen great nights there. Granted, we are into good wine and food, and "Katie's" comment that the wine was "pretty good" incline's me to believe this place was a little above her tastes. The wine list at Cosimo is superb. For example, they have Penfold's Grange ($400 a bottle at The Dilworthtown Inn) BY THE GLASS! Cakebread Chardonnay, Jordan Cabernet Sauvignon, and Zind-Humbrecht Pinot Gris BY THE GLASS sounds "pretty good" to you? Even on the inexpenside of the list, they have a Pinot Grigio by Bertani and an Orvieto by Bigi.
The beer list is as impressive. Their draft beers are Delirium Tremens, Allagash, Dogfish head IPA and 2 Victory beers (Storm King and Pils).
My friends and I have had great luck with the entrees. Sure, they don't have a cheese list as impressive as Tria's in the City, but I have found the food to be excellent, the temperatures of the meat spot-on, and the seafood very fresh. I had a dry bread pudding there one time, but aside from that, no complaints at all. Revisit Cosimo's, unless you are more of a "Bennigan's" girl.
Yuck! My friends and I went to this place to check it out. At first we almost turned back because we entered through the downstairs door, closests to the back parking lot. When we entered through that door we were not even sure if we were in a warehouse or what. We walked up the stairs and entered Cosimo…we walked across the bar area and went over to the hostess and asked to be seated in the bar area.
We were very confused when we received the menus because there were two and they were both extremely limited. We had gone for drinks and appetizers. We reviewed the choices and decided on the Scallops, Cheese Plate and Mussels.
The cheese plate came out first. The cheese selection was average in quality but small in quanity. Next came the mussels. The mussels were fresh but the sauce was boring and tasteless. But the worst of the worst was the SCALLOPS or should I say scallop….After finishing our first two app. choices, about 20 min later our third selection came out. Since we waited so long we were expecting some amazing scallops….As the waiter placed it on our table we all roared with laugher.
There was one very rubbery scallop placed in front of us. Yes ….one!
The decor was cheesey, the food was horrible and expensive. The wine was pretty good.
Do not go to this place unless you want to be ripped off!


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Indicative Rate * AU$34 to AU$34
SeaLink Queensland is your one-stop-shop for your visit to North Queensland. From day tours, accommodation, transport and activities, specialising in Townsville and Magnetic Island, SeaLink Queensland can help you plan the ultimate holiday in this stunning region!
Enjoy a half day snorkel tour around Magnetic Island, dine on a bush tucker breakfast with the koalas at the island's Koala Sanctuary or be entertained with a dinner and show at Magnetic Island's very own Theatre Restaurant. Find SeaLink Queensland in two locations - Breakwater Terminal, Townsville and Nelly Bay Terminal, Magnetic Island.
SeaLink Queensland are award winning ferry service providing the quickest link to Magnetic Island (20 minutes) with 18 daily return services between Townsville and Magnetic Island. Cruise over in air-conditioned comfort and enjoy a relaxing drink at the bar.
From May to October be sure to check out SeaLink's seasonal North Queensland Adventure series as they discover more of beautiful North Queensland. Visit the historic Cape Cleveland Lighthouse, explore what lies beneath the sea at gorgeous Yanks Jetty on Orpheus Island or spot Humpback Whales as these gentle giants pass Townsville and Magnetic Island on their annual migration. There really is something for everyone!
SeaLink Queensland has been an award winning transport service since 1997, providing the quickest link between Townsville and Magnetic Island and is proudly Australian owned and operated. Operating with four vessels and over 70 staff SeaLink is one of the most significant transport and tour operators in the region.
Conducting up to 18 daily return services to Magnetic Island, SeaLink can have you in paradise in only 20 minutes on one of our state-of-the-art, high-speed catamarans.
Note: Information on listed products and services are provided by the operator and were correct at the time of publishing. Rates are indicative based on the minimum and maximum available prices of products and services. Please visit the operator's website for further information. All prices quoted are in Australian dollars (AUD).


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South Lake Tahoe, CA (July 18, 2013) – The attached pictures are of a missing 16-year-old juvenile named Autumn Ellison. She is a white female, 5'-1" tall, 100 pounds, with long brown hair and blue eyes. Ellison has been missing from Mt. Pleasant, South Carolina since July 7th, 2013. She has no vehicle or cell phone. South Carolina investigators advise Ellison is likely in our area, associating with friends she knows locally and in the Reno area. Mt. Pleasant police believe Ellison does not want to be located or identified, and will likely provide a false name and/or ID documents to authorities. They also believe she may be at risk, but details related to what type of risk have not yet been specified to SLTPD. There has been a social media page dedicated to communicating information regarding Autumn Ellison: www.facebook.com/findautumnellison . We are asking for the public's assistance in locating Autumn Ellison. If you have information regarding Autumn, please call the South Lake Tahoe Police Department or Detective Corporal Daniel Eckert of the Mt. Pleasant PD in South Carolina at 843-884-4176.
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- What a great conference you put on. Excellent topics, panelists and participation. I was impressed with the preparation by all.
Thank you so much for a fantastic conference! Everything was perfectly organized, thought out and presented well. I thoroughly enjoyed the speakers, sessions, outings and networking with both new and old friends! .
Perrin Conferences are by far the industry leaders in putting together thought provoking topics and well qualified speakers to present fairly both sides of the aisle. The subject matter is timely and the speakers are well prepared. There is an intimacy that permeates the conferences although they are very well attended. Because of this, the ability to network and share industry concerns and knowledge is easily accomplished.
Perrin Conferences First Annual Diversity Conference was nothing short of awe-inspiring. The dialogue and engagement amongst panelist and attendees was productive and more importantly, it felt organic. Overall, the Perrin team struck the right balance between forced introspection and call to action to raise awareness for issues impacting diversity in the legal community.
As a first time attendee, this program was very educational in every possible way.
Having just presented at a Perrin Diversity & Inclusion Conference, I know why hundreds of people applied to do so. The audience is amazing! Presenting at a Perrin Conference instantly connects you with, and communicates your message across to, the country's leaders in the field. People literally came up to me and told me they will be putting the tools I gave them to use in their organizations. It doesn't get any better than that.
I was extremely impressed with the level of professionalism and organization throughout the process of preparing for the panel, as well as the degree of communication. As a panelist, I knew precisely the goals of the conference, how panelists could best contribute to and publicize the conference, and the logistics were communicated clearly. So, thank you again for the opportunity, and I will be a willing advocate for people to attend Perrin conferences in the future.
From all corners, the reactions about the conference I have received or heard about was how much it was a success. I personally was able to solidify and broaden a number of relationships particularly "across the aisle," something that I had heard was so much a part and a goal of these conferences Perrin puts together. My firm is known for its thought leaders and it was great to meet with other thought leaders and colleagues with whom we have worked to resolve disputes in innovative and principled ways.
Your programs have quickly become the best in the industry. This is a tribute to the hard work that you and your staff put in, as well as keeping your eye on what is significant in the litigation world today.
Just a short note to tell you that I found the NYCAL conference to be "among the best"! It was a virtual "Who's Who" of NYCAL-from judges to plaintiffs' attorneys to defense counsel-and the topics were real live issues we confront.
The San Francisco conference is a remarkable gathering of defense lawyers, plaintiffs' lawyers, judges, along with company and insurance carrier representatives. It is a "must attend" for all asbestos litigation practitioners.
Thank you, Lynnsey for your great organising skill, energy and vision for putting the conference together. I enjoyed it a lot and took away some valuable insights.
Your seminar was one of the best asbestos seminars I've attended in the last 5 years. I look forward to seeing your next endeavor.


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A Blueprint for Effective Character Development
A convincing Character Arc consists of two key appreciations of story structure.
Wants. Needs. Character Arc and Backstory. When it comes to developing a strong central character, many do the best they can with these simple-to-grasp, yet disparate concepts of story. Effective character development calls for a system of story points that function as a cohesive whole.
The seventy-five or so story points found in a Dramatica storyform work together.[^storyform] Bouncing off one another and cooperating in narrative space, these appreciations of story help formulate a holistic image of what it is an Author is trying to say. Regarding the last article "The Problem with Problems of Character":
Taking just one of these story points out of context destroys the whole purpose of the storyform.
Several story points within the storyform help define the Main Character's Throughline. The Main Character's Domain, Concern and Issue help illustrate in the broadest sense the kind of personal struggles the central character experiences while the Main Character's Problem, Solution, Focus and Response fine-tune the focus of narrative drive.
Many struggle to see how these narrative appreciations play nicely together. When faced with a Story Engine Settings report such as this:
Many Authors unfamiliar with Dramatica paints the theory as too scientific and obtuse. They label the theory a tool for analysis rather than a springboard for creativity. And while the Dramatica theory book does an excellent job of introducing the concepts, it fails to suggest techniques for moving from storyform to blank page. The following examples illustrate one way of transforming Dramatica's cold hard terminology into an outline for character development.
Change Characters
Main Characters split into two groups: those that Change their Resolve and those that Remain Resolute. The series Character and Change explores this concept in greater detail, but for now it's important to understand that these two camps handle problems differently. Change Main Characters think they know where their problem is, when in reality they're blind to the actual source of their trouble.
A Change Character With a Chip on his Shoulder
Consider these Dramatica story appreciations for a potential Main Character Throughline:
- Domain: Situation
- Concern: Future
- Issue: Choice
- Problem: Temptation
- Solution: Conscience
- Focus: Feeling
- Response: Logic
In this story, the Main Character will think that his problem comes from feelings and thinks the solution to his problem is to be more rational. Only at the end of the story will he realize that he is really driven by temptation and discover that abstaining will possibly resolve his personal issues.
For example, William the butler does not like the fact that his heart skips a beat when the lady of the house approaches and responds by coming up with several reasons why he shouldn't fall for her. As a Stop character he tries too hard to make things better when backing off would make his feelings less obvious. After a couple of acts and a lot of resistance William finally gets to the point where he recognizes that the temptation to indulge complicates his position as head servant and influences the choices he makes as a leader. At a crucial moment in his personal struggle, William chooses to follow his conscience, quit, and live out the rest of his days concentrating on his career.
This is the same kind of personal throughline that happens in Election. Jim McAlister (Matthew Broderick) finds all kinds of reasons to rationalize away his feelings for his student Tracy. It's not until the end that he finally realizes that the temptation of high school is too great, and that a new job in a new city is just what the doctor ordered.
A Change Character With a Hole in his Heart
- Domain: Manipulation
- Concern: Being
- Issue: Desire
- Problem: Expectation
- Solution: Determination
- Focus: Test
- Response: Trust
In this story, the Main Character thinks that her problem comes from constant scrutinizing and thinks that the solution to her problem is to build greater trust. Only at the end of the story will she realize that she is driven by meeting other people's expectations and discovers that determining for herself the reason possibly resolve her personal issues.
For example, Laura hates it when her managers scrutinize her performance and responds by finding ways to convince her bosses that she is someone that can be trusted. Laura thinks that as long as she works on building those bridges she can keep from disappointing others. As a Start character she holds back when a bit of effort on her part could help the constant examinations. After a couple of acts and a lot of resistance, Laura finally gets to the point where she can recognize that her fundamental drive to meet other people's expectations sits at the heart of her need to be wanted and her willingless to be manipulated. Realizing why she spends so much time trying to be what other people want her to be, Laura chooses to determine for herself the reasons why her managers look down on her.
This is what happens in the 1960 Billy Wilder classic, The Apartment. Eager to climb the corporate ladder, C.C. "Bud" Baxter (Jack Lemon) lets his managers walk all over him. It's only once he starts determining for himself the reasons why people think less of him that he begins to take back control of his life.
Steadfast Characters
Steadfast Main Characters operate a little differently. Instead of focusing narrative energy on what happens within them, stories that feature resolute central characters harness their attention towards what happens around the Main Character. Rather than having them grow by shedding a hurtful trait or gathering some new technique, Authors showcase these characters holding out for something to start or something to stop. The focus remains on the external.
A Steadfast Character Holding out for Something to Stop
- Domain: Situation
- Concern: Present
- Issue: Attempt
- Problem: Protection
- Solution: Inaction
- Focus: Re-evaluation
- Response: Evaluation
In this story, the Main Character sees problems in the world coming from people refusing to change their impressions and sees the solution to those problems to get others to simply open their eyes. At the end of the story he'll realize he's driven to protect others and that not doing anything could possibly make his life easier.
Frank hates it when the other wranglers treat the cows like dumb animals and responds by pointing out the wrangler's individual shortcomings. Frank thinks that as long as he continues to bring up how dumb humans can be that he'll keep the pressure off his bovine friends. As a Stop character he focuses on all the bad things people do, when backing off might ease tension. After a couple of acts and a lot of resistance, Frank finally recognizes that his drive to protect the cows comes from his struggles with his own weight. Understanding that his passion stems from issues with what others say he can and cannot do, Frank considers giving in the next time he witnesses an episode of animal abuse. At a crucial moment in his personal struggle, Frank stands in front of the cows and challenges the wranglers to see man and animal as the same.
How To Train Your Dragon tells a similar story. Hiccup finds himself driven to protect the dragons because he looked into their eyes and saw himself. Challenging the other Vikings to see dragon and human as the same overcame the option to simply give up.
A Steadfast Character Holding out for Something to Start
- Domain: Fixed Attitude
- Concern: Impulsive Responses
- Issue: Worry
- Problem: Result
- Solution: Process
- Focus: Non-accurate
- Response: Acccurate
In this story, the Main Character sees herself as not being good enough and sees the solution to her problem as directing effort towards becoming more acceptable. At the end of the story she'll recognize that she is too results-driven and that focusing on the journey might make her life easier.
Amanda does not like it when her girlfriend's parents tell her she doesn't live up to their standards and responds by trying to fall into line with what they deem acceptable. Amanda believes that the more she can be tolerable the less she has to worry about being good enough. As a Start character, Amanda waits for others to ease her personal conflict when focusing on what she can do would ease tension. After a couple of acts and a lot of resistance, Amanda finally gets to the point where she realizes that it is her drive to get results immediately that is at the heart of her panicked nature and her constant consternation. If she could understand that sometimes these things take a little time, then she could perhaps avoid leaping before she looks. Unfortunately, at a crucial moment in her personal struggle her impatience wins out and her obsession with her girlfriend leads her to do something she ultimately regrets.
This is Romeo from Romeo and Juliet. Struggling against the standards set by Juliet's parents, Romeo leaves town in the hopes that eventually his presence will be tolerated. Unfortunately his desire to be with Juliet without haste leads him to impulsively take his own life.
The Creative Impulse
The individual story points within the Main Character Throughline work in concert to define and encapsulate a personal approach to solving problems. By delineating points of narrative that work in harmony, the Dramatica theory of story offers Authors the chance to write complex and emotionally full central characters. As it presents an objective take on the dramatics within story, the theory can sometimes come off cold and uninviting. Discovering new ways to play with the theory and to transform the scientific elements into a solid familiar compound can help a writer unleash their creativity.
[^storyform]: A storyform combines seventy-five thematic elements together and provides the message of the story.


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Share your thoughts with Gimp on the Go!
If you would like to submit images with your story or letter, please use the upload feature.
If you have more images than I do upload buttons, simply refresh the page after you submit your form and submit again adding a (2) after your subject.
For example, my trip to florida (2) then add your additional images.
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Ladue News
Bryan A. Hollerbach
Over the course of a five-week series, LN has been profiling the 10 artists recently announced as the Regional Arts Commission's (RAC) 2015 Artist Fellowships, who each received $20,000 to further his or her work. These are the ninth and tenth profiles. To read the previous profiles, click here.
Christopher Limber
Christopher Limber ranks not as a paltry artistic triple threat, but as a quadruple threat, with experience as an actor, a composer, a director and a playwright.
"My degree is in acting," Limber relates regarding his Bachelor of Fine Arts from State University of New York at Purchase, due north of Manhattan Island, "but I come from musical and literary roots as a child… Most everyone in the arts will have a main discipline and then augment [his or her] income. I am just lucky I can do that with an artistic variety of activities."
Despite his three-plus decades of such artistic eclecticism, which has involved activities and accolades in St. Louis, elsewhere in the U.S. and around the globe, Limber will channel most of the funds from his RAC fellowship into altruism, in his capacity as director of Adult Prison Programs at Missouri's Prison Performing Arts.
Travis Mossotti
"Poetry is a better vehicle for questions than for answers, and I suppose I've always thrived in uncertainty – most artists do," Travis Mossotti says.
In the simplicity of that anything-but-uncertain declaration, Mossotti strongly suggests why the RAC awarded him a fellowship, despite the fact that his published and collected poetic output has appeared only since 2011.
Mossotti's credentials note that his first collection of poems, About the Dead, winner of the May Swenson Poetry Award, with a foreword from Garrison Keillor of A Prairie Home Companion fame, was issued as the 15th volume of a Utah State University Press series just five years back.
Mossotti described About the Dead online as "a throwback to some of my favorite early collections written by authors like James Tate, Philip Levine, Frank Stanford, Donald Justice, Marvin Bell, James Wright and many others," adding they were "poets [who] wrote with a sense of humility, fearlessness and discovery that set their work apart from their contemporaries'."
Read the full article here.
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Professor Angus Hawkins
Profile details
Research interests
Angus Hawkins's research examines aspects of modern British politics, particularly the Victorian party system and constitutional change during that period. His publications have discussed the function of political parties, ideas of representation and voting behaviour. Most recently, he has published an essay on Ministerial by-elections in the 19th century and a two-volume biography of the longest-serving Conservative party leader and three times prime minister, the 14th Earl of Derby entitled The Forgotten Prime Minister. Published by Oxford University Press, volume 1 ''Ascent'' appeared in October 2007 and volume 2 ''Achievement'' appeared in October 2008.
Praise for the two volumes included the following:
''The most significant book on Victorian politics in half a century; all existing histories of Victorian politics and of the Conservative Party will need rewriting to take account of Hawkins''s magisterial two volumes on the fourteenth Earl of Derby.'' - Professor John Charmley, History Today
''This is real history. Unlike so many biographers, Hawkins has really mastered the archives. There is much in this book that is new, much that will permenantly change interpretations of the period. It is about real politicians, not caricatures or faceless abstractions.'' - Leslie Mitchell, The Literary Review
''Readers will enjoy this book for its subtley and insights into the generic political mind....The next volume is eagerly awaited. This, the first full-length biography of Derby will be the only one needed this century.'' - Andrew Roberts, The Sunday Times
''Hawkins's high political analysis is almost invariably compelling. He has a great goft for narrative exposition, which he makes look deceptively easy, and his 500 pages race along like one of Stanley's fillies.'' - Professor Boyd Hilton, The English Historical Review
''It is an impressive and serious piece of work that reminds us of the value of the scholarly monograph.'' - George Osborne, The Spectator
''Hawkins sustains his clear, cogent, and winning prose throughout, never flagging across his work's entire compass....In sum, The Forgotten Prime Minister is a magnigicent contribution to a ganre that many may have given up for dead.'' - Professor D. A. Smith, Victorian Studies
''Without a study of Derby...the political history of the years between the first two parliamentary Reform Acts (in 1832 and 1867) remains seriously incomplete...Hawkins has supplied the need with comprehensive scholarship and lucid exposition.'' - Professor Paul Smith, The Times Literary Supplement
''Hawkins, as we know from his previous books, is the leading expert on parties and politics in the whole period covered by this biography. We are very fortunate to have him guide us through it, which otherwise might resemble being dropped in the jungles of the Amazon without a compass.'' - Professor Richard Davis, The Journal of British Studies
''This, the first full-length biography to be written with access to the archives, will be the only one needed this century.'' - Dr Andrew Roberts, The Sunday Times.
Angus Hawkins The Forgotten Prime Minister: Achievement, 1852-1869 (Oxford, 2008)
Angus Hawkins The Forgotten Prime Minister: Ascent, 1799-1851 (Oxford, 2007)
Angus Hawkins ''The Disraelian Achievement 1868-1874.'' Recovering Power: The Conservatives in Opposition since 1867 (London, 2005), ed. Stuart Ball and Anthony Seldon
Angus Hawkins ''The 14th Earl of Derby, 1799-1869.'' The Oxford Dictionary of National Biography (Oxford, 2005)
Angus Hawkins ''"A Host in Himself": Lord Derby and Aristocratic Leadership.'' Parliamentary History (Edinburgh, 2003)
Angus Hawkins British Party Politics, 1852-1886 (London, 1998)
Angus Hawkins and John Powell The Journal of John Wodehouse, First Earl of Kimberley, 1862-1902 (Cambridge, 1997)
Angus Hawkins ''Lord Derby.'' Lords of Parliament: Studies 1714-1914 (Cambridge, 1995), ed. R. W. Davis
Angus Hawkins ''Of "Interior Matters": Gladstone''s Diary, Disraeli''s Letters and Recent Biographical Studies'' Nineteenth Century Prose (1995)
Angus Hawkins ''Victorian Popular Politics and Post-Modernism.'' Archive (1994) Angus Hawkins ''"Parliamentary Government" and Victorian Political Parties, c.1830-c.1880.'' The English Historical Review 104 (1989), pp.638-669 Parliament., Party and the Art of Politics in Britain, 1855-59 (1987)
Angus Hawkins ''Lord Derby and Victorian Conservatism: A Reappraisal.'' Parliamentary History 6 (1987), pp. 280-301
Angus Hawkins ''British Parliamentary Alignment and the Indian Issue, 1857-8.'' The Journal of British Studies 23:2 (1984), pp. 79-105
Angus Hawkins ''A Forgotten Crisis: Gladstone and the Politics of Finance during the 1850s.'' Victorian Studies 26:3 (1983), pp. 287-320
Reviews in The English Historical Review,Victorian Studies, Parliamentary History, Archive, Nineteenth -Century Prose and other journals.