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Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery DiseaseThe NXT Trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps)
Author + information
- Received October 18, 2013
- Revision received November 21, 2013
- Accepted November 27, 2013
- Published online April 1, 2014.
Author Information
- Bjarne L. Nørgaard, MD, PhD∗∗ (bnorgaard{at}dadlnet.dk),
- Jonathon Leipsic, MD, PhD†,
- Sara Gaur, MD∗,
- Sujith Seneviratne, MBBS‡,
- Brian S. Ko, MBBS, PhD‡,
- Hiroshi Ito, MD, PhD§,
- Jesper M. Jensen, MD, PhD∗,
- Laura Mauri, MD, PhD‖,
- Bernard De Bruyne, MD, PhD¶,
- Hiram Bezerra, MD, PhD#,
- Kazuhiro Osawa, MD§,
- Mohamed Marwan, MD, PhD∗∗,
- Christoph Naber, MD, PhD††,
- Andrejs Erglis, MD, PhD‡‡,
- Seung-Jung Park, MD, PhD§§,
- Evald H. Christiansen, MD, PhD∗,
- Anne Kaltoft, MD, PhD∗,
- Jens F. Lassen, MD, PhD∗,
- Hans Erik Bøtker, MD, DMSci∗,
- Stephan Achenbach, MD, PhD∗∗,
- on behalf of the NXT Trial Study Group
- ∗Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
- †Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ‡MonashHeart, Monash Medical Center and Monash University, Victoria, Australia
- §Department of Cardiology, Okayama University Hospital, Okayama, Japan
- ‖Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- ¶Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- #Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
- ∗∗Department of Cardiology, Erlangen University Hospital, Erlangen, Germany
- ††Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Essen, Germany
- ‡‡Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
- §§Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- ↵∗Reprint requests and correspondence:
Dr. Bjarne Linde Nørgaard, Department of Cardiology, Aarhus University Hospital Skejby, Skejby DK-8200 Aarhus N, Denmark.
Objectives The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).
Background FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated.
Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFRCT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80.
Results The area under the receiver-operating characteristic curve for FFRCT was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFRCT versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFRCT remained high.
Conclusions FFRCT provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFRCT led to a marked increase in specificity. (HeartFlowNXT–HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678)
- computational fluid dynamics
- coronary CT angiography
- fractional flow reserve
- invasive coronary angiography
Invasive coronary angiography (ICA) is the established clinical standard for detecting coronary artery disease (CAD). The correlation between angiographic and physiological stenosis severity, however, is poor (1,2). Because coronary physiology trumps anatomy for clinical outcome (3,4), current guidelines for the management of stable CAD recommend documenting ischemia by using a noninvasive functional test (e.g., single photon emission computed tomography, stress echocardiography, cardiac magnetic resonance [cMR]) before considering ICA or coronary revascularization (4,5). Shortcomings of current noninvasive diagnostic strategies in CAD, however, are apparent from the frequently inaccurate selection of patients for ICA (6). Fractional flow reserve (FFR), which assesses the ratio of flow across a stenosis to putative flow in the absence of a stenosis, has been shown to be a powerful tool for detecting lesion-specific myocardial ischemia. Several randomized trials have shown that an FFR threshold of 0.80 distinguishes patients and coronary lesions that will benefit from coronary revascularization (7) from those that will not (8). Consequently, FFR is the accepted reference standard for assessing the functional significance of CAD in a lesion-specific manner (4). Noninvasive anatomic assessment by coronary computed tomography angiography (CTA) is being increasingly used as an accurate tool for detecting or excluding CAD (9–12). Although the absence of coronary stenoses according to coronary CTA is associated with an excellent prognosis and obviates the need for any further diagnostic evaluation (11), the correlation of stenoses detected by using coronary CTA to downstream myocardial ischemia is poor (13). Recently, a method using computational fluid dynamics to calculate coronary blood flow, pressure, and FFR based on routinely acquired coronary CTA datasets at rest (FFRCT) has been described (14–16). FFRCT combines anatomic and functional information to enable appropriate therapeutic decision making. This method has tremendous potential because noninvasive determination of FFR may be a unique, useful test to differentiate individuals who will or will not benefit from revascularization, and thus FFRCT has the potential of being a reliable gatekeeper to the pathway of ICA.
The aim of the present study was to assess the diagnostic performance of FFRCT by using invasive FFR as the reference standard. Compared with previous studies (15,16), a substantially refined version of the FFRCT technology was used, and the emphasis on coronary CTA acquisition quality was strengthened.
Study design
The rationale and design of the NXT (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps) study have been described previously (17). The study was designed to characterize FFRCT diagnostic accuracy in patients suspected of having CAD by using invasive FFR as the reference standard, and it reflects improvements in FFRCT technology (updated proprietary software with quantitative image quality analysis, improved image segmentation, refined physiological models, and increased automation), as well as emphasis on the coronary CTA image acquisition protocol to reflect current guidelines (18). The study protocol was approved at each of the 10 participating centers (Online Appendix) by the local institutional review board. All study subjects provided written informed consent.
Study population
Coronary CTA performed <60 days before scheduled nonemergent ICA was required for inclusion. As pre-specified (17), the first 100 patients included in the study had no requirements with regard to coronary stenosis severity. Beginning with patient 101, at least 1 stenosis with luminal diameter reduction between 30% and 90% in a vessel segment ≥2 mm in diameter according to coronary CTA was required. Exclusion criteria included previous coronary intervention or coronary bypass surgery; contraindications to beta-blocking agents, nitroglycerin, or adenosine; suspected acute coronary syndrome; previous myocardial infarction <30 days before coronary CTA or between coronary CTA and ICA; and body mass index >35 kg/m2.
Coronary CTA acquisition and analysis
Coronary CTA was performed by using single- or dual-source computed tomography (CT) scanners with a minimum of 64 detector rows (temporal resolution 75 to 175 ms). Both prospective triggering and retrospective gating were used for scan acquisitions. Filtered back-projection was used for image reconstruction to ensure the broadest applicability of our findings given that this is the current clinical standard of care. Laboratories followed quality standards as defined in guidelines (18). Oral and/or intravenous beta-blockers were administered targeting a heart rate of <60 beats/min, and sublingual nitrates were administered to ensure coronary vasodilation. Data acquisition was performed with 100-kV tube voltage in patients weighing ≤70 kg and 120 kV in subjects weighing >70 kg. Coronary CTA images were transmitted to a central FFRCT core laboratory (HeartFlow, Inc., Redwood City, California), where image artifacts (e.g., motion, noise, contrast, blooming) were independently evaluated by using a predefined scoring system for selection of cases appropriate for FFRCT analysis (17,19). Experienced local investigators evaluated luminal diameter stenosis in each coronary artery segment ≥2 mm in diameter by using an 18-segment coronary model before ICA (18). The strategy of stenosis quantification was at the discretion of the local investigator. Significant obstruction was defined as stenosis >50% in a major epicardial coronary artery segment ≥2 mm in diameter.
ICA and FFR measurement
ICA was performed according to standard practice (20). Angiograms were transferred to the angiography/FFR core laboratory (Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio) for quantitative angiography analysis by independent, blinded readers. Per protocol, measurement of FFR (PressureWire, St. Jude Medical, St. Paul, Minnesota) was performed during ICA in at least 1 vessel segment with diameter ≥2 mm and stenosis ≥30% (17). Consistent with previous studies (1), segments showing angiographic total or subtotal occlusion were assigned an FFR value of 0.50. The angiography/FFR core laboratory evaluated the complete FFR tracings for achievement of steady-state maximal hyperemia, pressure drift, and other artifacts that could compromise FFR interpretation.
FFRCT computation
Using the most recent generation of FFRCT analysis software, analysis was performed in a blinded fashion at HeartFlow (Fig. 1) (14,17). For each patient, a quantitative 3-dimensional anatomic model of the aortic root and epicardial coronary arteries was generated from coronary CTA images. Coronary blood flow and pressure were computed under conditions simulating maximal hyperemia. The results provide FFRCT throughout the coronary arterial tree. Occluded arteries were assigned FFRCT values of 0.50 (1). The FFRCT analysis required 1 to 4 h per examination depending on the CT image quality and atherosclerotic disease burden.
Integration of coronary CTA and FFR data
The angiography/FFR core laboratory received a blank 3-dimensional computer model of the coronary anatomy from the FFRCT core laboratory; on this model, they indicated location(s) corresponding to the FFR pressure sensor location(s) at the time of FFR measurement(s). The blinded integration core laboratory (HeartFlow) received the FFR measurement location indication(s) and reported corresponding FFRCT data. Integration of FFR and FFRCT data occurred only after all FFRCT analyses for all patients were complete.
Endpoints and statistical analysis
The primary study endpoint was per-patient diagnostic performance as assessed by the area under the receiver-operating characteristic curve (AUC) of FFRCT (≤0.80) versus coronary CTA (stenosis >50%) for the diagnosis of hemodynamically significant stenosis (FFR ≤0.80) in patients with coronary CTA stenosis of 30% to 90%. FFR ≤0.80 was the reference standard. Secondary endpoints included assessment of diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FFRCT and coronary CTA for all patients, patients with intermediate stenoses (30% to 70%), vessel-based analyses, and comparison of accuracy measures of FFRCT, coronary CTA, and ICA by using invasive FFR as the reference standard. Furthermore, diagnostic performance was assessed on a per-patient basis by using a stenosis threshold of 70% for coronary CTA and ICA and in the setting of a high Agatston score (threshold 400). Sample size calculations with assumptions have been described previously (17). Pre-test likelihood of CAD was determined by using the updated Diamond-Forrester risk score algorithm (4,21). AUC comparisons in patients with stenoses 30% to 90% were performed on per-patient and per-vessel levels according to the method described by DeLong et al. (22). Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were calculated as simple proportions with 95% confidence intervals (CIs). Nonevaluable segments on coronary CTA in vessels >2 mm were assumed not to be stenotic. A patient was considered positive for the presence of ischemia if any evaluable vessel ≥2 mm in diameter had an FFR value ≤0.80. Similarly, a patient was considered negative if no vessel ≥2 mm in diameter had an FFR value ≤0.80. The same rules applied for the assessment of FFRCT. Patient-level comparison of diagnostic performance characteristics (accuracy, sensitivity, specificity, PPV, and NPV) was performed by using the McNemar's test for paired samples or percentile bootstrap with 100,000 resamples as appropriate. To account for potential correlation between multiple vessels in the same subject, the generalized estimating equation method with an exchangeable correlation structure was used to compare paired samples at a per-vessel level. All analyses were performed by using SAS version 9.3 (SAS Institute, Inc., Cary, North Carolina).
Patient characteristics
Among 365 patients undergoing study screening between September 2012 and August 2013, a total of 8 patients were excluded immediately after coronary CTA, and 47 (13%) did not pass the CT image quality acceptance criteria (Fig. 2). After coronary CTA acceptance, 56 patients were not eligible for inclusion; Figure 2 provides the reasons for their exclusion. Thus, 254 patients were available for intention-to-diagnose analyses. Three subjects did have a coronary stenosis between 30% and 90%. Hence, 251 subjects formed the basis for the primary endpoint analysis. Comparison of FFR and FFRCT was performed in 484 vessels. FFR was directly measured in 468 vessels, and an FFR value of 0.50 was assigned to 16 occluded vessels (3%). In 22 (4.5%) vessels, a nondiagnostic segment on coronary CTA was found proximal to the segment in which the pressure wire was placed. Baseline characteristics of the study cohort are listed in Table 1, and characteristics related to coronary CTA acquisition are provided in Table 2. The mean Agatston score (measured in 214 patients) was 302. The mean interval between coronary CTA and ICA was 18 days (range 1 to 55 days). Serious adverse events included 1 patient with coronary dissection during invasive FFR measurement requiring percutaneous coronary intervention and 2 patients with transient cerebral ischemic attacks after ICA and invasive FFR measurement. The per-patient and per-vessel characteristics of coronary CTA, ICA, FFRCT, and FFR are presented in Table 3.
Diagnostic performance of FFRCT, coronary CTA, and ICA for diagnosis of ischemia
Per-patient and per-vessel AUC for FFRCT were 0.90 (95% CI: 0.87 to 0.94) and 0.93 (0.91 to 0.95), respectively. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV for FFRCT on a per-patient basis were 81%, 86%, 79%, 65%, and 93%, respectively (Table 4). On a per-vessel basis, the values were 86%, 84%, 86%, 61%, and 95%. In analyses restricted to patients with intermediate stenoses ranging from 30% to 70% (n = 235), these values were 80%, 85%, 79%, 63%, and 92% (Table 5). There was good direct correlation of per-vessel FFRCT to FFR (Pearson's correlation coefficient 0.82; p < 0.001), with a slight underestimation of FFRCT compared with FFR (Fig. 3). Figure 4 displays representative cases of patients with coronary obstructions without ischemia or with ischemia. Measures of diagnostic performance for coronary CTA and ICA are shown in Table 4. Raising the per-patient diameter stenosis threshold for anatomic test positivity to 70% resulted in lower sensitivity and higher specificity: 70% (95% CI: 60% to 79%) and 84% (95% CI: 79% to 90%) for coronary CTA. For ICA, the respective values were 35% (95% CI: 25% to 46%) and 100% (95% CI cannot be calculated). In patients with an Agatston score >400, accuracy, sensitivity, and specificity of FFRCT were 75% (95% CI: 62% to 84%), 88% (95% CI: 64% to 97%), and 69% (95% CI: 54% to 81%) versus 44% (95% CI: 31% to 56%), 94% (95% CI: 79% to 100%), and 23% (95% CI: 11% to 37%) for coronary CTA, respectively.
Diagnostic performance of FFRCT versus coronary CTA for diagnosis of ischemia
The AUC of FFRCT was higher than for coronary CTA interpretation on both a per-patient and a per-vessel level (Fig. 5). Per-patient and per-vessel diagnostic accuracy, specificity, and PPV for FFRCT were higher than for coronary CTA (Table 4). These findings were consistent also in patients with intermediate coronary stenoses (Table 5). FFRCT correctly reclassified 68% of patients with coronary CTA false-positive findings and 67% of those with coronary CTA false-positive vessels as true negative findings (Fig. 6).
This large study convincingly found that noninvasive determination of FFR is possible on the basis of standard coronary CTA datasets acquired under resting conditions with no additional radiation, contrast, or medication. In patients suspected of having CAD, FFRCT exhibited a very high diagnostic performance compared with invasively measured FFR. Particularly noteworthy was the high specificity of FFRCT, which was markedly better than in a previous evaluation of FFRCT (16). Moreover, compared with coronary CTA, FFRCT led to a marked reduction in false-positive results. Of note is the fact that patients with stenoses in the intermediate range (30% to 70%) comprised >90% of the overall study population. In clinical practice, such patients present a particular challenge because the relationship between angiographic stenosis severity and ischemia is poor (1,13).
The results of our study expand on findings and clinical implications from previous studies of FFRCT (15,16). The pilot DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) trial enrolled 103 subjects, validated against invasive FFR, and reported a per-vessel sensitivity of 88% and a specificity of 82% (15). The more recent DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography) trial enrolled 252 patients, validated against FFR, and demonstrated a per-patient sensitivity of 90% but a specificity of only 54%, which did not meet the pre-specified primary endpoint of a lower 95% CI border for diagnostic accuracy of >70% (16).
The improved diagnostic performance of FFRCT in the present study, in particular with regard to specificity, importantly reflects substantial refinements in FFRCT technology and physiological modeling (14,17), as well as an increased focus on CT image quality (17) and adherence to official recommendations regarding coronary CTA acquisition (18). Refinements in technology evaluated in this study included improved automated image processing methods to more accurately identify the luminal boundary and improved physiological models to reduce the bias observed in previous studies (15,16). In particular, improvements in physiological models of microcirculatory resistance were implemented that demonstrated substantial improvement in diagnostic performance when evaluated retrospectively by using data from the DISCOVER-FLOW and DeFACTO studies. The importance of CT image quality and patient preparation in coronary CTA has been well established (18). The diagnostic performance of both coronary CTA and FFRCT have been shown to improve with adherence to established best practices for image acquisition, particularly by heart rate control and use of pre-scan nitroglycerin (23). In the DISCOVER-FLOW and DeFACTO trials, adherence to coronary CTA acquisition guidelines was neither required nor controlled. In contrast, in the present study, strict adherence to these guidelines was mandatory. Accordingly, >99% of the patients in this study received sublingual nitrates before coronary CTA compared with only 75% of patients in the DeFACTO trial (16). In addition, the present study used local site reading of coronary CTA stenosis degree to provide a real-world scenario and wider generalizability of the findings (24). Moreover, as indicated by differences in the proportion of FFR measurements ≤0.80 (21% of vessels in this study compared with 37% in the DeFACTO study), pre-test likelihood of CAD may have been different between the 2 studies. Notably, the pre-test probability of significant CAD in this study was intermediate (4,21) and thus reflective of the type of patients in whom noninvasive imaging is best used (4).
Established noninvasive functional diagnostic tests, such as single photon emission computed tomography, cMR, or stress echocardiography, do not directly visualize the coronary arteries or assess the functional significance of individual coronary lesions; however, they do provide meaningful information on prognosis and thus are recommended in guidelines for the diagnostic evaluation of symptomatic patients (4). The ability of these tests to correctly identify ischemia-producing stenoses by using FFR as the reference standard has been evaluated in several 1- and 2-center studies (25–27). In 1 study, cMR was compared with FFR ≤0.80 in 103 patients with suspected angina, with high reported per-vessel diagnostic performance (i.e., sensitivity of 82% and specificity of 98%) (25). However, FFR was directly measured in only 207 vessels (or 69% of the 300 coronary segments included in this analysis). Another study compared cMR with FFR ≤0.80 in 67 patients with multivessel disease and reported a per-vessel sensitivity of 61% and a specificity of 69%, with direct measurement of FFR in 154 vessels (77%) supplying 201 vascular territories included in the analysis (26). A third study investigating the diagnostic performance of dobutamine stress echocardiography in 70 patients measured FFR in all 70 vessels included in the analysis and reported a sensitivity of 48% and a specificity of 73% (27). Inclusion of a sizable number of vessels with assigned rather than measured FFR values may introduce error because vessels with normal or minimal disease according to CT or angiography may have measured FFR ≤0.80 (2,13), and severely stenosed vessels by angiography may have measured FFR >0.80 (1,13). In the present, large, multicenter study, FFR values were directly measured in 97% of the 484 vessels included in the analysis, and per-vessel sensitivity and specificity for FFRCT were 84% and 86%, respectively.
In an era of rising healthcare costs, great attention is placed on cost-effectiveness of procedures. Current clinical algorithms for therapeutic decision making in stable CAD often require 2 separate tests for assessment of coronary anatomy and ischemia (4,5). Despite extensive use of noninvasive testing, ICA continues to play a major role in diagnostic pathways (4–6). As a result of inadequate diagnostic discrimination with the use of noninvasive tests, up to 60% of subjects suspected of having CAD and referred for ICA do not have obstructive vessel narrowing (6), and the proportion without functionally significant myocardial ischemia would be expected to be even higher. A single noninvasive test with high diagnostic performance for both anatomy and lesion-specific ischemia would provide a major advantage in assessment of CAD. Our data firmly establish that myocardial ischemia is unlikely in patients tested negative by using FFRCT (NPV of 93%). Moreover, FFRCT revealed substantially improved specificity compared with coronary CTA. The present findings supporting the potential role of coronary CTA with FFRCT as a reliable gatekeeper to ICA and revascularization, together with the worldwide, ever-expanding access to coronary CTA (12), may have major health and economic implications. Indeed, simulation analyses based on historical data indicate that use of FFRCT to guide selection of ICA and revascularization may reduce costs and improve clinical outcomes in patients suspected of having CAD (28). The ongoing multicenter PLATFORM (Prospective Longitudinal Trial of FFRCT: Outcome and Resource Impacts; NCT01943903) trial compares the effect of FFRCT-guided testing versus standard diagnostic evaluation on clinical outcomes, resource utilization, costs, and quality of life in patients suspected of CAD.
Study limitations
In the present study, 13% of patients were judged to have nonevaluable coronary CTA images on the basis of a pre-defined image quality score (17,19). This proportion may diminish with further improvement of CT acquisition techniques and refinement of the FFRCT technology. The number of patients eligible for study inclusion (having ICA performed after coronary CTA) but not recruited was not recorded; therefore, site-level selection bias on the basis of coronary CTA findings cannot be excluded. However, the pre-test risk of CAD, as well as the spectrum and prevalence of disease (e.g., with regard to Agatston scores, as well as coronary CTA and FFR positive results), in this trial support the generalizability of the findings. Patients with acute coronary syndromes and previous coronary intervention or bypass surgery were excluded from the present study. Thus, generalizability of FFRCT to these specific populations of patients with CAD is unknown.
This study found that FFRCT has high diagnostic performance compared with invasively measured FFR, identifying patients with hemodynamically relevant obstructions with high sensitivity and specificity. Compared with anatomic interpretation by using coronary CTA, FFRCT led to a marked increase in diagnostic specificity. The addition of FFRCT to coronary CTA may allow for a comprehensive anatomic and functional assessment of CAD in a manner potentially promoting beneficial clinical and cost outcomes, which remain to be definitively proven in appropriately designed prospective trials.
Funding for the study was provided by HeartFlow, Inc. Dr. Mauri has received research grants from Abbott Vascular, Boston Scientific, Cordis, Medtronic, HeartFlow, Eli Lilly, Bristol-Myers Squibb, Daiichi Sankyo, and Sanofi-aventis; and serves as a consultant for St. Jude Medical, Biotronik, and Medtronic. Dr. Achenbach has received research grants from Siemens, Guerbet, and Abbott; and is a consultant for Siemens, Biotronik, and HeartFlow. Dr. Christiansen has received research grants from St. Jude Medical, Boston Scientific, Radi, Terumo, and Volcano. Dr. Leipsic has received research grants from GE Healthcare; and serves as a consultant for Edwards Lifesciences and HeartFlow. Dr. Seneviratne has given lectures at meetings organized by Toshiba. Dr. Nørgaard has received research grants from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to di disclose.
- Abbreviations and Acronyms
- area under the receiver-operating characteristic curve
- coronary artery disease
- confidence interval
- computed tomography
- computed tomography angiography
- cMR
- cardiac magnetic resonance
- fractional flow reserve
- fractional flow reserve derived from coronary computed tomography angiography datasets
- invasive coronary angiography
- negative predictive value
- positive predictive value
- Received October 18, 2013.
- Revision received November 21, 2013.
- Accepted November 27, 2013.
- 2014 American College of Cardiology Foundation
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text:
No go for "MP" in Finnish Eurovision
HELSINKI - As we previously reported, Mats "MP" Persson wrote a song for the Finnish selection of Eurovision Song Contest 2004. The song did make it to the national final, but not to the European final. The winner was Jari Sillanpää with his ill-titled song "Takes 2 To Tango".
The song contest will continue with semi-final on May 12 and final in Istanbul on May 15.
This article was written for an earlier version of The Daily Roxette.
Technical errors may occur.
Technical errors may occur.
★ The author:
★ Publishing date:
January 25th, 2004
Internal reference code for TDR's Good Reporters: [tdr 110769]
This article was posted here on TDR in these categories:
Archive, TDR:Misc, vintage.

subset: commoncrawl


text:
South Sudan warring parties urged to sign ceasefire deal
ADDIS ABABA - East African mediators are urging South Sudan's warring parties to sign a ceasefire deal to end conflict and atrocities that have devastated the young nation, according to a draft accord.
A separate draft deal urges President Salva Kiir to pardon and release 11 key political detainees, one of the key sticking points of deadlocked talks in Ethiopia mediated by the East African regional bloc IGAD.
Thousands have been killed and half a million civilians have been forced to flee the fighting between troops loyal to President Salva Kiir and rebels allied to his sacked deputy Riek Machar.
The draft ceasefire accord, presented to peace delegates meeting in Addis Ababa, notes the "scale of human suffering... with great loss of human life, destruction of property and massive displacement" since fighting broke out on December 15.
The proposal demands an end to "all military actions", but also specifically highlights both sides must "refrain from attacks on the civilian population", including summary executions, use of child soldiers as well as "rape, sexual abuse and torture".
The United Nations says that atrocities including war crimes are reported to have been committed by both sides.
Both sides would have to "freeze their forces" in their positions and allow aid corridors in, with half a million civilians now having fled their homes.
They would also have to agree to an IGAD-led team including members from both sides and regional nations to monitor the deal.
The draft deal on political detainees urges Kiir to pardon them to allow their participation in an "all-inclusive national reconciliation process."
African Union Commission chief Nkosazana Dlamini-Zuma flew to the South Sudan capital Juba on Monday to meet Kiir in a bid to help broker a peace deal.
Sudan's President Omar al-Bashir is to visit Thursday, at the invitation of IGAD chairman, Ethiopian Prime Minister Hailemariam Desalegn.


text:
Each week, I highlight ten things each week that inspired me to greater financial, personal, and professional success. Hopefully, they will inspire you as well.
1. Jenna McCarthy on what you don't know about marriage
This is a wonderful talk about what actually makes marriage work.
I think there's quite a lot to what she's saying here, based on my own experience.
2. Robert Yates on work and credit
Some of the most amazing things I've ever done in my life were ones where no one really cared about who received the compliments or rewards later. So many things in life really come down to people positioning themselves for credit.
It is amazing what can be accomplished when nobody cares about who gets the credit. – Robert Yates
The best coworker I ever had truly didn't care whose name appeared on documents or anything else.
3. Freerice
I've visited this so many times over the years.
It's simple. You learn vocabulary words. Rice gets donated to the hungry. It's a clever way to see the World Food Programme at work while also expanding your language.
4. Winston Churchill on carrying forth
This one has really inspired me a lot lately.
Success is not final, failure is not fatal: it is the courage to continue that counts. – Winston Churchill
The thing that really matters, above all else, is that you keep trying. You keep moving forward, trying to get better at what you do, and making effort to produce something worthwhile.
5. Neil Young singing Heart of Gold
I've been able to sing along with this since I was a kid, and I still can.
I actually sang this to my kids the other night as they were going to sleep. My daughter held my hand and told me I wasn't old yet.
6. Benjamin Disraeli on hope and preparation
There is never a reason not to prepare for bad things, even when things are going well.
I am prepared for the worst, but hope the best. – Benjamin Disraeli
Never, ever allow yourself to be blinded by the light.
7. The first hints of spring
They're just starting to pop up here and there. I heard a bird recently that I hadn't heard in months. I saw a bit of green in the field behind our house.
The snow melts, and life grows. Thanks to Anthony Easton for the image.
8. Henry Adams on teaching
Although this is a great teaching quote, I think it applies to a lot of things.
A teacher affects eternity; he can never tell where his influence stops. – Henry Adams
Whenever you do something that has an impact on someone else's life, there's a snowball effect that you never see.
9. The Garden of St. Paul's Hospital (1889) by Vincent van Gogh
I am astonished by all of van Gogh's later works. There's something so incredibly alive about them, something I've never seen in other paintings.
The mix of reds and greens here is amazing.
10. The Tao Te Ching on desire
If you want something, your perspective on things is distorted by your own desire.
The secret waits for eyes unclouded by longing.
The less desire you have, the easier it is to see situations for what they really are.


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Outside the EU £916.67
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A couple of weeks ago I had a Skype conversation with Tony Jones and the class he was teaching for the Missional Leadership graduate program at Rochester College (directed by my good friend Mark Love).
Before we got into the conversation Tony started me off with a question about why I was a member of the Churches of Christ. On the surface, it doesn't seem like I'm a good fit for the Churches of Christ. Is that impression right?
Here's the answer I gave Tony.
To begin, there are two kinds of Churches of Christ. Some people call these "liberal/progressive" or "conservative/traditional" Churches of Christ. This split isn't formal, but it's widely recognized within the movement. However, I don't like these labels as they aren't very descriptive.
Here are the labels I prefer. There are ecumenical Churches of Christ and there are sectarian Churches of Christ. The ecumenical Churches of Christ have a sense of church history and about where they fit within that history. Consequently, ecumenical Churches of Christ see themselves as just one part of the church universal and, thus, extend the right hand of fellowship to other Christian communities. By contrast, sectarian Churches of Christ don't have a sense of church history and, thus, feel that they are a faithful replication of the 1st century church (e.g., many of these churches have "Founded in AD 33" inscribed on their cornerstones). As such, sectarian Churches of Christ feel that they are the true and only apostolic church. All other churches are forms of heresy and disobedience, a willful refusal to worship according to the New Testament pattern. Consequently, it is widely believed in sectarian Churches of Christ that all Christians outside of the Churches of Christ are in a state of rebellion against God. Thus my label "sectarian."
A lot of people, when they hear "Church of Christ", think of the sectarian Churches of Christ. And as should be obvious if you read my blog, I don't fit into that mold. Thus the questions like the one Tony asked me: Why are you a member of the Churches of Christ?
However, I don't worship with a sectarian Church of Christ. I worship with an ecumenical Church of Christ. And, as I've said on many occasions, I find the ecumenical Churches of Christ to be one of the best places to be within contemporary Christianity. Not that we don't have our problems, but I think the ecumenical Churches of Christ have a lot going for them. Of course, I'm biased in this assessment as my history and biography are a huge part of this.
With that backdrop in mind, here are the three reasons I gave to Tony (plus one extra) as to why I like the Churches of Christ.
1. Keeping it Local: Congregational Structure
Churches of Christ are radically congregational in structure. Each church is independent. There is no hierarchy, conventions, or bureaucracies. Each church is left to govern itself as it sees fit.
The benefit of this, for me at least, is that my church life is very local. I don't give any attention, say, to how the evangelicals and emergents are getting along, or to how the Southern Baptists are receiving the newest version of the NIV, or to how Rome is getting along with the American bishops. All I have to focus on is my life with the Highland Church of Christ that meets on 425 Highland Avenue in Abilene, TX. I'm not a part of a larger movement, conversation, or organization.
I'm just a guy with a blog who goes to the Highland Church of Christ. That's it.
And here's the deal. Truth be told, finding a church home is all about your experience at the local level. If the people in a church love you and you love them I don't think it matters much if that church is Catholic, Church of Christ, Baptist, or Episcopalian. At root, the question "Why are you a member of the Churches of Christ?" (or anything else for that matter) really isn't that critical of a question. If you're happy at the local level then a lot of the global stuff can slide. In fact, a lot of complaints about the global level are really complaints about the local level. When you hear someone say, for instance, "I hate the Churches of Christ" this person is more likely saying that they hate the Churches of Christ they have had experiences with. We don't hate (or love) abstractions. It's all local. The loving and the hating.
2. The Noble Bereans: Biblical but Non-Creedal
The Churches of Christ are non-creedal. We don't have a statement of faith. Nor, incidentally, do Church of Christ universities. According to most Churches of Christ creeds are "the teachings and traditions of men" and, thus, highly suspect. We just use the bible as our guide for faith and practice.
Theologians in the audience are now scratching their heads. How, it might be asked, do you regulate your doctrine without a creed? Good question. Answer: Mainly via tradition and an unspoken creed. The creed is more implicit than explicit.
But an unspoken creed leaves a lot room for diversity. For example, while most members of the Churches of Christ believe in the Trinity (at least implicitly), there is a strong Unitarian strain within our movement. Why? Well, the word "Trinity" isn't in the bible you see. That word, and by implication that doctrine, is a "teaching of man." The examples can abound here. Members of the Church of Christ are generally amillennialists. But you do run into people who believe in the Left Behind stuff. Historically we're Arminian but more and more Church of Christ folk are adopting Reformed beliefs.
It's getting to be a bit of a mess. And that's the point. This theological elbow room works for me. I just add my mess to the mix.
What holds the mess together (at least for now), and is a distinctive mark of our movement, is the consistent and ubiquitous appeal to Scripture. If there is one verse that describes the Churches of Christ it might be this:
Acts 17.11What truly marks the Churches of Christ is this: we examine the Scriptures daily to see if what is taught is true.
Now the Bereans were of more noble character than the Thessalonians, for they received the message with great eagerness and examined the Scriptures every day to see if what Paul said was true.
So that's what I shared with Tony. What marks me as Church of Christ isn't theology or doctrine. Again, we're non-creedal. What marks me as Church of Christ the centrality of Scripture. How I keep going back to Scripture, day after day.
For example, think about this blog. Have you not noticed that this is a Church of Christ blog? If you can't see this conduct the following experiment. Scroll down to the end of this page and count up the number of Scripture references you see across the posts. Go back a couple of weeks and count them all. Then go to a favorite Christian blogger of yours and do the same, counting up all the Scripture references and quotations.
If you do this you'll see the difference. As best I can tell, as I mentioned to Tony, I quote Scripture more than any other Christian blogger I know. Shoot, I quote more Scripture than a lot of fundamentalist bloggers. Do you know why?
I'm Church of Christ.
3. No Flag Waving
The third reason I find the Churches of Christ congenial is that we're not nationalistic. We don't have flags in our churches and we don't have patriotic displays on the Fourth of July or other national holidays. Of course, this practice varies from church to church. But generally speaking, we don't wave flags.
(Note: In the last decade or so there do seem to be a few Churches of Christ who are drifting toward evangelicalism. Consequently, these churches are slowly becoming politicized and, thus, are starting to wave flags and obsess about election cycles. This is a new and worrying trend.)
In short, there a bit of an Anabaptist and anarchist thread running through our movement. Largely due to people like David Lipscomb, an early leader in the Churches of Christ (and founder of one of our schools, Lipscomb University, where I once taught) who was a pacifist and advocated that Christians shouldn't vote or serve on juries.
So, in a world where Christianity is becoming more and more politicized and where "God and Country" idolatry is an increasing problem, I find the Churches of Christ to be a nice oasis from the political madness of contemporary Christianity.
4. "Welcome each other, as Christ has welcomed you": Open Communion
I didn't mention this to Tony, but I think he would have liked (see his post here) this fourth reason about why I prefer the Churches of Christ: Open communion.
If you attend a Church of Christ you are welcome to take communion. To be honest, I don't think the Churches of Christ have thought much about this topic, but that's our practice. If you are sitting in our pews on Sunday you are welcome to take communion as the trays are passed. The implicit theology is clear: You are welcome at the Lord's Table. No one is left out.
(A story about this. I think this practice of open communion in our churches was one of the most profound and affecting things that the SoulForce--an LGBT advocacy group--riders experienced when they visited our campus in 2006. When SoulForce arrived on a Sunday night they had dinner at a local Church of Christ where there was a communion service afterward for our college students. The SoulForce riders attended the service and, per our practice, were welcomed to partake of communion with everyone in attendance. As I remember it, this act of welcome, and the implicit theology it incarnated, was the most profound experience of the visit for the SoulForce riders.)
To be sure, there are good things and bad things about open communion (as there are good things and bad things to closed communion). But given the vision of radical hospitality I paint in Unclean it should be obvious that I prefer open communion.
So there you have it. That was my answer to Tony. Why do I like the Churches of Christ? Four reasons: congregational/local structure, non-creedal but biblical, strains of Anabaptist/anarchism, and open communion.
I also like the acapella music, the Arminian soteriology, the high view of baptism (and that it's believer's baptism), the taking of commuion every Sunday, the use of Sunday school, the lack of clergy, and the amillennialism/preterism (which keeps us clear of the Left Behind stuff and zany ideas about the state of Israel).


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The diet plays an important role in the depression. There are some factors which causes the depression. The diet and nutrition can have a strong power on your depression. What is the relationship between the diet and depression? The brain is the central factor in the development of depression. There are many exogenous and endogenous factors that can cause depression. The functioning of the brain is disturbed which causes the depression. The deficiency of Vitamin B1, Vitamin B2, Vitamin B3, Vitamin B6, Vitamin B12, Biotin, Pantothenic acid, Folic acid, Vitamin C causes the depression. The certain foods improve neuro transmitter stages and can useful to fight with depression. The self confidence is very important factor which can give great attitude towords the problems of depression. The diet-related conditions such as obesity and anorexia can be responsible for causing depression. The stimulants which increase anxiety should be avoided. Some times High-protein diets can also cause vitamin and carbohydrate deficiencies. There are a number of dietary factors that can help with depression.
How the diet is useful treatment in depression? The human beings need a healthy, balanced diet to give sufficient quantity of B-complex vitamins, amino acids and minerals to assurance a healthy nervous system. The depression can be controlled by using some yourself techniques such as do exercise, read your favourite books, watch tv programs. Now a day there are some advanced therapies also used for the depressuon managament. Some doctor will give you advice about natural treatment such as nutrition, herbal and mind-body therapies.
Magnesium deficiency causes anxiety. Eating a high carbohydrate diet boosts the production of serotonin in the brain which makes you feel more positive.
The sugar and caffeine give you a quick lift.
The diet rich in omega-3 fatty acids such as found in seafood, can be good for postpartum depresson
The B vitamins such as B12, B6 and folic acid, can help combat psychological disturbances.
To maintain constant blood sugar levels. The diet rich in carbohydrates is thought to lead to a brighter disposition, as it increases levels of seratonin in the brain. The appropriate vitamins, amino acids, herbal extracts and enzymes will reduce the depression. To do proper diet which can improve weight problems.
What are the dietary reasons of depression?
Deficiencies of vitamins
Nutrient deficiencies
Unstable high-energy molecules in your body
Unbalanced slimming diets
The air that you breath is polluted.


text: +FshngGC 1 Posted May 28, 2019 I am preparing a mystery cache. In order for the cacher to find it they will have to find three other caches. I am planning on placing these caches in the list as Traditional Caches, as each will have it's own log sheetand it's own entry on geocaching.com. However on the back of each log sheet will be one of three parts of the answer to a "riddle" that will be asked in the mystery cache. I believe that these should be listed as four separate caches. I have been told by a fellow cacher that I presented it to that it should be placed as a multi-cache but I disagree. However, I have no experience with placing either a mystery cache or a multi cache and would appreciate any feed-back. Quote Share this post Link to post


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He glides down on midnight wings to the Oceans edge where he watches the woman sift the grains of sand through her delicate hands finding a perfect pearl He watches her day after day as she watches the waves day… Read More ›
Day: January 3, 2018
Inspiration Call: Why We Write Wednesday
Inspiration Call: Why We Write Wednesday Describe in the comments—in under 500 words (and in this case, brevity is best)—the reason why you love writing. Share your written piece by dropping it in the comment section. #WritingPrompt #WritersChallenge #Poetry #Writing… Read More ›
Heat Wave – Author William Wright, Jr.
Steamed To the brink of madness The mere urge to walk Is singed away The endless parting streams Are the daily scourge Of my sunbathed And sweltering Span of flesh Heat encompasses My sliver of earth A devilish… Read More ›


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Why Is it Important for HR Management to Transform From Administrative to Strategic Contributors?
Human resource management can be approached in two fundamentally different ways. Human resources employees can fill purely administrative roles, simply facilitating the paperwork involved for tasks such as hiring new employees and handling workers' compensation insurance. Or HR employees can become strategic contributors to company success. Transforming the HR function into a strategic contributor can take your workforce strategies to the next level, increasing the value of your human capital to accrue distinct competitive advantages.
Competitive Advantages
Strategic human resource management is all about creating a competitive advantage through a company's workforce. Employing dedicated, experienced, motivated and well-trained employees can increase efficiency and productivity in operations, as well as enhancing product quality and the customer experience.
Strategic HR managers are concerned with hiring employees with high potential for professional growth, then giving employees ample opportunity to learn and grow in their job roles. Developing employees with top-level expertise in their fields can grant you access to the brightest minds in the industry, putting you on the leading edge of innovation.
Executive Succession
Small business success can be inseparably tied to the expertise, passion and personal contacts of company owners. Because of this, executive succession planning can be vital in small businesses. Purely administrative HR managers do not think about a replacement for top managers or company owners until it is too late. Thus an interim manager may have to step in while company ownership is formally transferred.
Strategic HR managers work with company owners to spot potential successors early, grooming them through years of experience, advancement and mentorship to be ready to take the reins of the company when the owner passes away or decides to retire. Strategic succession planning can keep a company heading in the right direction after a major leadership change.
Labor Cost-Efficiency
Administrative HR departments dispense pay raises almost as a matter of course, using arbitrary metrics such as the number of years an employee has been with the company to determine compensation. Strategic HR departments learn to promote and compensate their top performers -- those who contribute the most to organizational goals and long-term company success. A strategic HR philosophy ensures that the highest compensation is being paid to employees with the largest contributions to the firm, rather than those who have warmed a chair in the office longer than others.
Legal Compliance
Purely administrative human resources departments handle legal issues reactively, putting policies in place to prevent costly incidents from re-occurring. Strategic HR managers proactively put policies in place to keep their companies on the right side of employment laws, including workplace discrimination issues and equal employment opportunity laws. A strategic HR department would identify the fact that a building does not provide access for handicapped individuals before a problem arises, for example.
Photo Credits
- female boss and employee image by jimcox40 from Fotolia.com


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The P-I error that changed Seattle history
Seattle lawyer, amateur genealogist helped set record straight
Occasionally, newspapers report factual errors. A well-intentioned interview subject gives bad information, a name is spelled wrong, a breaking news story is inadvertently peppered with grammatical errors.
But no incorrect newspaper story has had a bigger impact on Seattle history than one published June 7, 1889.
The previous day, a glue pot tipped over at what is now the corner of First Avenue and Madison Street. Though nobody died, the resulting fire destroyed Seattle's business district, consuming more than two-dozen blocks of wooden buildings, most of the city's wharves, nearly a dozen brick buildings and Seattle's railroad terminals.
The Post-Intelligencer presses were destroyed, but the newsmen set up a temporary shop on property owned by publisher Leigh "Alphabet" Hunt on Fourth Avenue. Reporters rushed to find people who knew where the blaze began.
"The fire was caused by the overturning of a glue pot in Jim McGough's paint shop, under Smith's boot and shoe store, at the corner of Front and Madison streets, in what was known as the Denny block," the P-I wrote.
For nearly a century, that was repeated by some historians and authors who wrote books about the fire.
They missed the correction published nearly two weeks later in the P-I.
"My shop was in the flat just over where the fire occurred," McGough told the P-I for that article, published June 21, 1889. "At that time I was at work in a building at the corner of Fourth and Terrace streets, and hearing the alarm and being a fireman of Company No. 1, I quit work and hastened to join my company, not knowing the locality of the fire."
The Great Seattle Fire actually started in the Clairmont and Company cabinet shop, below McGough's shop in the basement of the Pontius building.
RELATED: Back to the future: Photos show Capitol Hill then, and now
But the inaccuracy continued.
When the P-I published its centennial edition in 1963 it republished historic front pages, including the one from the day after the Great Seattle Fire. But it didn't mention that the McGough reference was incorrect. A book published in the 1970s of historic P-I front pages also forgot to mention the mistake.
It didn't help that in multiple history articles, both the P-I and Seattle Times continued to say the fire had started at McGough's paint shop. The Times even mentioned it in the 1965 obituary for McGough's second daughter, Ella.
The mistake was repeated in Murray Morgan's classic Seattle history book "Skid Road," published in 1951. Sales of the book through 1999 totaled nearly a quarter million, according to Historylink.org.
"The History of Seattle Washington," published two years after the fire, also inaccurately said the fire started in McGough's paint shop, and the "History of Washington" made the mistake again in its 1893 publication.
How did the P-I story become so prevalent? The Seattle Times wasn't around when the Great Seattle Fire happened, and no other daily publications were published the day after it started.
The best article noting the inaccuracies and corrections to the story was done by Hugh McGough, a prominent Seattle attorney who roughly 10 years ago authored an article, "The Great Seattle Fire – Don't Blame Jimmy McGough." His full article can be read here.
Hugh McGough, who says he's not a close relative of James McGough but is probably related through family in Ireland, notes that Nard Jones' 1972 book "Seattle" makes the mistake, as do more than a half-dozen others. Even the "History of the Seattle Fire Department" incorrectly states that McGough's paint shop was the source of the fire, Hugh McGough said.
The effort to clear James McGough's name was first led by James R. Warren when he was director of the Museum of History and Industry. He had the correct facts in his 1989 book on the fire, as did Clarence Bagley in his earlier "History of Seattle," and as J. Willis Sayre had done in "This City of Ours."
RELATED: Seattle spots: What they once were and what's there today
In the years since Hugh McGough published his work, he's noticed more people have corrected the fire accounts, he said Wednesday. McGough said he understands how people came up with the initial mistake and repeated it.
The 24-year-old worker who tipped the glue pot in the Clairmont and Company cabinet shop that afternoon of June 7, 1889 – first identified in the P-I as "an old Swede named Berg" – was John E. Back. Two weeks after the fire, a P-I reporter found and interviewed him about the massive blaze.
"I cut some balls of glue and put them in the glue pot on the stove," Back said. "I put in some shaving where there was little fire, and then went to work about twenty-five feet away, near the front door.
"After a while somebody said 'Look at the glue.' Another fellow, a Finlander from New York, then took a piece of board and laid it on to smother the glue, but the board caught fire. Then I run and took the pot of water to smother the fire and poured it over the pot of glue, which was blazing up high. When I throw the water on, the glue flew all over the shop into the shavings and everything take fire."
Back is believed to have left Seattle shortly after the story was published. No record of him exists here after 1889.
Each year after the fire, McGough would object when the newspapers continued to blame him for the fire. One of the Times articles from June 1895 is included in Hugh McGough's account.
"I'm getting mighty tired of all this notoriety," James McGough said. "Every year the papers come out and say that the fire started in my shop and the story is all told over again. As a matter of fact, the fire did not start in my shop at all, and every year I have gone around and made the correction for the benefit of the newspapers."
Born in 1850, McGough came to Seattle from San Francisco in 1883 and married his wife, Sarah, here in 1890, according to the P-I's archive.
He continued his painting business after the fire and amassed property at Three Tree Point in Vancouver, Queen Anne Hill, Smith Cove and his home at what's now 23rd Avenue South and South Norman Street near Judkins Park.
On Jan. 20, 1910, riding a horse and buggy, he tried to cross the intersection at what is now Eighteenth Avenue South and South Jackson Street. But McGough's horse shied and motorist R.L. Fitts hit the buggy. McGough was thrown under the car, dragged for roughly 200 feet and killed.
McGough, who was survived by six children and his wife, is buried at Calvary Cemetery near University Village. His wife was buried beside him in 1943, survived by five grandchildren and one great-grandchild.
About four months after the Great Seattle Fire, the city created a professional fire department. McGough's second son, Thomas, became a captain in the Seattle Fire Department. His grandson, James H., became a battalion chief.
Hugh McGough, also an amateur genealogist, said some of James McGough's descendents now live in Tacoma.
And the glue pot that started the Great Seattle Fire? It's on display at the Museum of History and Industry.


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George Lucas eats noodles in Australia like a regular guy
The smoke has disappeared and the mirrors have shattered. George Lucas has been spotted eating noodles in an Australian food court like he isn't even God.
It is finally proof that George Lucas is just one of us.
On Wednesday, the legendary Star Wars creator was spotted chilling around Adelaide, Australia, reading the newspaper, eating in a food court and drinking Diet Coke.
It's like discovering Darth Vader is your father and the galaxy isn't far far away — it is actually just down the road and Santa Claus isn't real. All in one terrifying, life-changing moment.
that moment u realise Jar Jar Binks was an abomination, and your noodles have gone cold #GeorgeLucas #Adelaide pic.twitter.com/VQmNnlXmEf
— Gabrielle Fusco (@GAFAtape) March 16, 2016
The force is awake and it is hard to swallow.
Lucas is in Australia with his wife, the high-profile investment fund manager Mellody Hobson, who is also real. She is speaking at a conference for the Australian Institute of Superannuation Fund Trustees. Hobson, who runs Ariel Investments group and holds lead positions at DreamWorks Animation, Starbucks and Estee Lauder, opened an office in Sydney last year.
While she is busy with work, Lucas has been spotted greeting fans and destroying our fantasies. "Your eyes can deceive you. Don't trust them." - Obi-Wan Kenobi.
Have something to add to this story? Share it in the comments.


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Welcome to Lake Garda Italy!
Here you can get useful travel information for Northern Italy. This travel guide is built with Desenzano del Garda, Lake Garda Italy, as the base and it shows you daytrips you can take from there.
Lake Garda Italy
The Garda Lake has five islands namely, Isola del Garda, Isola San Biagio, Isola dellOlivo, Isola di Sogno and Isola di Trimelone.
Thanks to the Mediterranean climate, you will notice a lot of lemon trees, magnolias, oleanders and bougainvillea. The cultivation of vineyards and olive groves produces good wines and olive oil. This beautiful place has a lot to offer and a lot to do take some time to look through brochures at your travel agent or online and start making notes of what types of things you want to do and see while you visit. This will help ensure that you dont miss out on anything and regret it later.
Lake Garda is surrounded by many small towns. Each town is like a piece of a puzzle that completes the Garda region. Theres a large number of historical buildings and ruins in the towns dating back centuries. Its amazing to see those places in front of you walking on the steps that so many have centuries before you. The beautiful churches and cathedrals is definitely one of the biggest treats. Many of them house beautiful paintings done by Italian masters. Art enthusiast will definitely enjoy this but its also perfect for someone with a passion for history.
During December, there are many events schedules to prepare for Christmas and spread the holiday cheer. Christmas concerts, musical bands, choirs and outdoor theatrical performances. Lake Garda is a beautiful and magical place to celebrate Christmas, with a warm and inviting atmosphere.
If you like theme parks then you must go to Gardaland. In the Garda area, between Peschiera and Lazise you will find this amazing theme park. It first opened in 1975 and has slowly expanded to become one of the biggest. It has four roller coasters and another 54 other rides. The roller coasters are called Magic Mountain, Blue tornado, Sequoia Adventure, Orto Bruco and Fuga da Atlantide. Each one giving you great adrenalin rush and leaving you wanting more!
In Sirmione sul Garda you can visit the Virgilio and Catullo spa complexes or see the Scaliger castle that dates back to the 13 century. This is a beautiful town that is a very popular holiday destination for Italians and tourists. It has many great restaurants, bars and hotels. There are quite a few shops selling the latest fashions, shoes and bags. Friends and family always want gifts if you take a overseas trip and you are bound to find a few things in the shops. This is only naming and describing one of the many towns, imagine what all the others have the offer!
The fleet of the ferry service on Lake Garda consists of 20 boats with restaurants, bars and sun decks. The ferries normally only operate during summer and you are able to take a morning or evening trip. They travel between quite a few of the towns around the lake, but you will need to get a full route plan and timetable from the ferry ticket office. Should you have any questions, they will happily explain everything to you. Plan ahead if you want to take a ferry trip and buy your tickets in advance to avoid disappointment.
The ferries are quite popular during summer. If you have been looking for the perfect destination for a family holiday, then Garda is the perfect place. Its absolutely beautiful, educational and it offers you so many different things to enjoy. The area is popular for fun activities like hiking, sailing, windsurfing and waterskiing. Its things you can do as a family and spent time bonding. If you are interested in doing a few of those but have no idea how, then take a few lessons! You will leave Lake Garda happy and ready to get back to your normal life at home.
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Tuesday, September 17, 2013
What: Kimchi #267
What: Kimchi #267 Hare: Juicy Pearl Time: 2ish, Saturday September 21, 2013 (but come early to pre-lube with some tasty brews as Great Storm is hosting Oktoberfest!) Where: Great Storm Brewing 204 Mt View Ln #3, COS, CO 80907 - East side of North Nevada between Fillmore and Garden O' Gods. Bring: $5, virgins, love of lager. Shag bag, ID, headlamps, and possibly hip waders recommended. Based on current weather conditions, expect to get wet and muddy as well as additional biblical calamities including swarms of locusts, rivers of blood, etc. On-before is not dog friendly, trail is semi dog friendly (bring a leash and some judgement). On-in is alright for a properly supervised canine whose owner doesn't mind dealing with a dirty, wet, cactus-scarred, shiggy scratched and otherwise traumatized hash hound. You know, like normal.
Posted by Starship at 8:22 AM 4 comments:
Hapi Coat Update.
The Lady at the All-n-One (B-street and Lashelle; 1605 Lashelle Way) has agreed they can make the coats (just the coats) for $60. Currently, she is working to figure out how much the Kimchi Yeti patch will cost (we must be 12 at a time). Once complete she is going to give me a price for the full kit-n-kaboodle: Hapi Coat made (they are providing the materials) the patch, the patch affixed and the embroidery of said hasher's name in English and Koren along the front lapels. I know she is going to cut us a decent deal. However, for those of us who have the illustrious "beer coats" (as she calls them) it would do us good to have her add patches, etc. (or any other dry cleaning/mending needs), just to help build the relationship/rapport. I know Sam took his coat and wanker clothes there, as do I. I SHOULD have more information at the next Kimchi Trail this Saturday from Great Storm. Stay tuned for updates!
Posted by Starship at 8:17 AM 3 comments:
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The AM Tripod Dolly by Hague Camera Supports has been designed for the new range of Manfrotto tripod kits that have the new style feet. This camera tripod dolly is ideal for the Manfrotto MVK500AM and the MVK502AM tripod kits.
The Hague D11 AM Tripod Dolly is a sturdy dolly which has large 100mm diameter individually braked swivel wheels, which enables the dolly to be moved with ease. The tripod legs simply attach into the slots, securing it to the dolly. The tripod can be used at any height within its range.
The dolly is only suitable for Manfrotto MVK500AM and MVK502AM tripod kits and the Manfrotto MVT502AM tripod legs.
The dolly is made from aluminium and folds down for easy transportation.
Price includes:- Dolly with 100mm diameter swivel braked wheels.
Price does not include the tripod. Size:- 62cm x 18cm x 16cm.
Colour - Black.
Weight:- 3.5kg.
Only suitable for Manfrotto tripods MVK500AM and MVK502AM.
Designed and manufactured by Hague Camera Supports | Nottingham | England


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Talk about stuff specific to the site -- bugs, suggestions, and of course praise welcome.
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I feel I should know this answer, but I don't. How is it that I can log in to MozillaZine [as perhaps with some other sites] by simply clicking inside the username field? Once I do that, both username and password are filled in for me. That being the case, what's the purpose of requiring those credentials at all?
At some point you allowed Firefox to remember your username and password for this forum. When you go to enter the username, it gets filled in for you for your convenience.
Either remove the saved username and password from Options -> Privacy and Security, or set a master password.
Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime.
I like poetry, long walks on the beach and poking dead things with a stick.
Please do not PM me for personal support. Keep posts here in the Forums instead and we all learn.
Thanks, smsmith. As I said, I should have known that answer.
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Lemongrass Spa November/December SpecialsPosted by Moira on Nov 2, 2018 in Featured Slider, Lemongrass Spa Monthly Specials | 0 comments
November and December bring blessings and thanksgiving, gift giving and time for friendship. I would be honored to help you choose the right gifts for your friends, family, co-workers, teachers, neighbors, and service providers.
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"Creativity is allowing yourself to make mistakes. Design is knowing which ones to keep."
– Scott Adams
Trifecta Design was established in 2013 when my desire for "something more" became a reality. At that time I was on my maternity leave from work and had been missing my creative outlets that design had offered me. I had shared my idea of starting my own business with my family and friends and the support I received was overwhelming. It was at that point I realized that owning/operating my own small design business is not only what I loved to do, but what I was meant to do.
You may be asking yourself where the name Trifecta came from. Well, there are a number of reasons, how about I give you three.
I am a Christian, and I believe in the Holy Trinity. My family and I know that the Father, the Son and the Holy Spirit have blessed us with so many reasons to be thankful, this business is just one of them.
At the time of establishment my family was made up of three individuals my husband James, my new born son and myself. We have since been blessed with 2 more handsome little guys, giving us 3 wonderful boys.
There are three primary colours blue, red, and yellow. It fascinates me to see how three simple colours are the base for an unimaginable amount of more beautiful colours.
Let's just say the best things in life come in packages of three!
With a diploma in Graphic Design from Mohawk College and seven years working in the printing and publishing field I have gained a wealth of experience. I have a passion for design and as my motto says I love "Making Pretty Things". I have the ability to take an idea and make it into a reality. One of the best parts of my job is that I have the ability to design for anyone anywhere! We can have consultations over the phone or email, sending proofs along the way until you are 100% happy with your product. We can send you your files and have them printed yourself, we can have your product shipped to your nearest store or potentially shipped right to your door! It is my promise to not settle for anything but the best product that I can create for you.
What this designer is made of…
- Photoshop 92% 92%
- Coffee 95% 95%
- Social Media 33% 33%
- Black rimmed eyeware 50% 50%
- Wife, momma and graphic designer 100% 100%
- Apple 82% 82%
Graphic Designer
Mother by day graphic designer by night. Blessed with three little boys, Kelli enjoys spending her days chasing them around, playing outside and reading stories. When the kids are in bed her creative juices flow.
Social Media Guru
Husband, father, landscaper and social media guru, James is one busy man! He loves spending time with his family, playing baseball, going for walks and just being a little bit crazy.
Miles, Ollie and Luc
Professional Distractors
These three little trouble makers have the special gift of distraction, but are also their mommies inspiration. They love hanging out with their mommy and daddy. They especially like to get into trouble like leaving LEGO on the floor, leaving the toilet seat up and tracking dirt through the house.
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Healthy, delicious tuna salad seasoned with dill and green onion. This easy lunchtime solution is flavorful but not loaded with mayo.
Do you remember when lunch involved a jar of peanut butter and some yummy jam? It seems life is more complicated now. Peanut butter's reputation is keeping it out of schools and other public venues these days. Who knew PBJ's would become the bad boy of lunch?
Back-to-school is in the air and I know some of you are packing lunches all around. Mornings before work can be very busy and I need handy food that is delicious, easy, fast, healthy and holds well until lunch if not all week. Tuna salad should be that food, but sometimes it's not.
The first rule of yummy tuna salad is picking good tuna. This fish can have a very strong fishy flavor when it is canned; not appetizing at all. Some varieties are also high in mercury which is harmful even in small amounts. Home canned tuna is amazing but hard to come by. My favorite store brand is Wild Planet, which I was buying it at Costco until they replaced it with Kirkland tuna. Amazon has a six pack of Wild Planet Albacore but it is a bit more expensive than the Costco sale price.
When you pick a out a can of tuna read the ingredients and make sure it only has tuna and salt. Tuna should be packed in its own juice and not water or oil.
The second rule of tuna salad is to be wise about the fat. Tuna already has plenty of healthy fat for flavor. I like add a dash of mayo to make it creamier but no more than a dash. Add some flavorful onion, fresh dill and ground pepper – it's a home run. This salad keeps well in the refrigerator for the work week and is perfect for topping crackers or bread. I have been enjoying it with gluten free rice crackers. They are low calorie, add a satisfying crunch. The savory ones are a perfect match for this flavorful salad.
I have been loving this tasty salad in my lunches of late. I hope you enjoy it too!!!
Dilly Tuna Salad
- 1 can Albacore Tuna in juice ingredients should be just tuna and salt
- 4-5 Tablespoons minced sweet onion or green onion
- 1 Tablespoons minced fresh fernleaf dill
- 2 Tablespoons reduced fat mayo
- 15 grinds or so of black pepper to taste
- salt if desired
- savory rice crackers or bread to serve
- Empty the tuna and juice into a small mixing bowl. Break up the tuna with a fork until it is fluffy.
- Add onion, dill, mayo, and pepper. Taste and add salt if desired.
- This can be eaten right away or saved for up to a week in the refrigerator.
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Author : Karl Christian
Title : Rudolf Steiner Handbook
Year : 2015
Link download : Karl_Christian_-_Rudolf_Steiner_Handbook.zip
Preface. The original German version of this handbook appeared as printed book in 1991/1993. Since 2007, the electronic version was set into the web as PDF file which everybody can download free of charge. This collection of summaries and quotations was originally intended to provide a view of Rudolf Steiner's Complete Works (CW, German Gesamtausgabe = GA) for those who wanted to study Steiner's insights and statements and especially for those who did not have them at their disposal. However, the author does not regard this overview as a kind of "Reader's Digest." In cases of doubt, he recommends reading the original text or rather translation to recognise the context and its meaning. The abstracts contain quotations of the so-called memory literature in some cases and comments and references to Blavatsky's works. The reader should be familiar with the program Adobe Reader and able to surf within the text to find the abstracts and headwords of interest and benefit of this book that way (see next page). Several volumes of the Gesamtausgabe are not yet translated, and some translations were not available to the author. In these cases, the author translated the quotations literally. Since the author is not a professional translator, he has to apologise for grammatical mistakes and unsuitable words or phrases. That is why the one or the other sentence may sound strange or be German English. However, the German reader has also often to read sentences or paragraphs several times. For Steiner formed nonce words here and there and used a style intentionally that is sometimes hard to read and somewhat old-fashioned after a hundred years so that some passages are not less difficult to comprehend for Germans. Nevertheless, the author hopes that this book is a useful means for all who want to study Steiner's works more or less intensely. ...
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All transactions requiring citizenship verification will be deferred for state review. Documentation must be received before the license will be
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text: If you're looking to show your school spirit, this University of Michigan wristlet is perfect for any Wolverines football game, tailgater, or sporting event this season. Stand with the Wolverines with this University of Michigan wristlet and show your Michigan pride! Showcase your Wolverines spirit and style while beating out the competition with this wristlet. This Michigan wristlet (style number #MIC-WR068-1) looks great at any University of Michigan event.


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Did you know that a venue claiming to be the world's smallest restaurant is in Italy? Solo Per Due is a two seater restaurant in the village of Vacone, around 70 km from Rome, housed with a historic Roman villa.
Two lucky guests are treated to a special meal within a private room in the estate where they are waited on hand and foot, In true aristocratic style waiters are called with a small bell.
Food consists of an Italian feast with little details given on exact dishes because each meal, costing 250 a person, is customised for every guest.
It certainly joins this list of 5 Unique Restaurants to Add to Your Bucket List.
Solo Per Due
Via Villa di Orazio
02040 Vacone Rieti
Tel: 0746 676873


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Posted by Bob on 4/17/2011, 8:50 pm
All I can say is WOW!! Super WOW!! You made that show....others were good but you were fantastic. My wife and I were absolutely blown away with your singing. We're looking for CDs from you as we write this. I'm sure we'll see more of you - lets hope you do a show sometime in Scottsdale! We'll bring a crowd! Best wishes in your career aND LIFE. Bob
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Flat Rock Performance - Bob 4/17/2011, 8:50 pm
Re: Flat Rock Performance - Ted 4/18/2011, 7:30 pm
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|New Zealand
|Antony Payyapilly
|Philip John
|Sr. Rosy Jose
|Saudi Arabia
|Philip Maniyalil
|Joshy Mathew
|South Africa
|K J John
|Sri Lanka
|Francis Pereira
|Fr. Joshy Mukkada
|Mary Varghese Thottan
|Jiju Jose
|Fr. Tomy Chirakkal Manavalan
|Fr Emmanuel Pazhayapura


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Here it is, our new 2017 BMW 330i xDrive "Sports Wagon" in all of its longroof glory. We decided that we needed a bigger car to replace our 3 Sedan, thinking about the X3 and the like. But then the correct answer suddenly hit me: why not go with a wagon?
Although the F30-generation of models will soon be phased out in favor of the new G20 style, BMW has already confirmed that the next wagon/Touring/Sports Wagon will not be making it to our shores. That fact alone deemed it worthy to get a wagon while they lasted.
And this wagon packs a punch. Although it only has a 4-cylinder, it is rated at 248 hp thanks to its twin-scroll turbocharger, along with other parts. This, coupled with a kerb weight of just 200 or so more pounds than the sedan, results in sedan performance as well as sedan fuel economy. Plus, since the trunk is practically the same size as that of the X3, we also get SUV space. This makes the wagon the best of all worlds.
After one week with this new car, I'm glad to say that I'm extremely happy with it. BMW iDrive navigation, along with the 8.8" screen, is incredibly intuitive, and looks great. The panoramic moonroof is one feature that I never knew that I wanted... yet I love it as it provides the interior with a more airy feel, which is no small feat with a black headliner and black seats.
The aluminum trim is refreshing compared to the Burl Walnut wood of our last car, along with the black leather with red stitching—a nice touch. The rear camera and Park Distance Control are also nice to have too, along with the many other odds and ends which will take me much time to go over.
Suffice to say, choosing a wagon was a great decision to make. This will sound extremely clichéd, but I would gladly recommend this car to anyone in the market for a new midsize SUV. Its sedan dynamics and fuel economy, paired with the space of an SUV, make for an unbeatable combo.
Oh, and by the way, I realized that I never got any good shots of the interior with my camera, so I took that photo with my iPhone.


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Pride Voices presented five personal journeys
People from various backgrounds discussed LGBT issues around the world
Most people are familiar with the Prague Pride March, which will start Saturday, Aug. 12, at Wenceslas Square with people gathering at 11:30 am and going through the city to Letná park.
But Prague Pride is an entire week of events. One of the other highlights is Pride Voices, where several international guests relate their experiences. This was the fourth year for Voices, and five speakers addressed an audience at the French Institute on Aug 10.
The first was Irina Roldugina, who has been researching LGBT history in Russia and the Soviet Union. She said that the common idea is that there is no such history, and there were only one or two LGBT figures such as Pyotr Tchaikovsky. And even he is often described as a bachelor who never found the right woman to marry, even though his own writings and published diaries make it clear he was gay.
Roldugina said that she has found that there were active LGBT communities in the Soviet Union in the 1920s, but the situation changed under Stalin and people were forced back underground. She showed a rare photo of a drag ball from 1921 as evidence. It is important for the LGBT community in Russia today to know that there is a history, she said, as they are again facing oppression.
The next speaker was Dutch police officer Ellie Lust, who is chairman of the police group Pink in Blue. Members of the LGBT community often see the police as the enemy, or perhaps just indifferent. As a result, violence against LGBT people often goes unreported. Ellie Lust said that the police in Amsterdam tried to address that situation by creating a special phone line where people from the LGBT community could reach a sympathetic officer. One case she recounted involved a meetup gone wrong, ending in robbery with the victim handcuffed. The victim would have been too embarrassed to report it to the standard police line but was willing to call the special Pink in Blue number.
The Dutch police also now have a big presence at Pride events including the annual Canal Parade. The first year they participated only eight officers were in the event, but they got such a positive response that the Pink in Blue barge is now filled and even has visiting officers from other countries.
Lust hopes that one day a special unit to help the LGBT community won't be needed but right now the phone line gets calls every day.
The third speaker was Osamu Okamura, a Czech-Japanese architect who is not an LGBT activist. He is one of three brothers. If the last name sounds familiar, it is because his older brother Tomio leads a right-wing party. Osamu related his own tale of having to come out to himself, told alongside a somewhat humorous account of the architecture he grew up with and the projects he worked on. The highrise houses where he was born in Tokyo and the bridge over his new home in Prague's Nusle area were both known for suicides, for example.
He now works with Re-Site, a project to make cities more livable. He pointed out that the city is a shared space and the LGBT community has a right to use it with events like the Pride March, but that people with opposing views also have the rights to use the city. Respect for different points of view can help minimize conflicts.
The current situation in Asia was explored by Jennifer Lu, who has been involved with the Taiwan Tongzhi Hotline Association for LGBT rights for about 15 years, and she has been a key player in advancing the idea of marriage equality. This year, the Constitutional Court ruled that the current marriage laws were discriminatory and the legislature has two years to change the law. Three drafts are currently being considered. This will make Taiwan the first country in Asia to have marriage equality.
She also showed a video that displayed the diversity of the LGBT community in Taiwan, and photos showing the unexpectedly large turnout at a rally in support of LGBT rights.
On a personal note, she said that the older generation still does not respect LGBT rights and has a negative attitude. Negative attitudes to LGBT issues are common in Asia, she said.
When Jennifer Lu held a large symbolic marriage celebration with her partner, her father did not come. He said he had to play golf that day. Lu said that she will get married again once the marriage law is finalized, but it will be a smaller ceremony.
The final speaker was Jayne Ozanne, who talked about being LGBT in the evangelical Christian church. The ideas are not incompatible, she said. And to someone who is religious, the idea of changing your religion is the same as the idea of changing your orientation, she said. Neither is possible.
She struggled for a long time with accepting that she was a lesbian, and went through quite an ordeal that included a stay at a mental hospital.
She discussed conversion therapy, saying it does not work because you can't fix things that shouldn't be changed, and it is not a mistake to be a member of the LGBT community.
Finally she had to accept that she was both LGBT and religious. Since then, she has been working to make that possible for more people.
She has been active in getting the Anglican Church to accept that the LGBT community is an important part of the religious community, and has been getting senior Church officials to come to her side. She has also written a book with contributions from other religious figures with explanations of how religion and being LGBT work together. The book is meant to help LGBT members have useful discussions with relatives and other people who think the two things are not compatible.
A few days before Pride Voices, there was a cocktail reception at Lichtenstein Palace in Kampa, and one of the speakers was Prague Mayor Adriana Krnáčová (ANO), who spoke about the difference between simply tolerating LGBT people and respecting them. She voiced her support for marriage equality in the Czech Republic, rather than just registered partnerships, which are not the same.
She also said that in an election year politicians show their true colors, and she is disappointed at the politicians who are promoting narrow definitions of what a family should be and other restrictive ideas that hurt the LGBT community.
Related articles
Mezipatra festival covers LGBTQ themes by Raymond Johnston - Prague.TV (Foto: Mezipatra)
The 19th edition of the festival takes place in three Prague theaters
Prague Pride to focus on families by Raymond Johnston - Prague.TV (Foto: Prague Pride FB)
The eighth year of the LGBT festival promotes acceptance at home
Mezipatra Queer Film Festival coming to Prague by Svetlana Kirichenko - Prague.TV
The 18th edition of Mezipatra presents Czech and foreign LGBTQ movies
Prague Pride through the eyes of a Taiwanese activist by Svetlana Kirichenko - Prague.TV (Foto: Raymond Johnston)
Jennifer Lu shares her impressions of the LGBT situation in Europe and Asia
Prague Pride 2017 has over 100 events by Prague Pride - Prague.TV
The Pride March is just one part of a program to show that prejudice still exists
Prague Pride 2017 urges acceptance by Prague Pride - Prague.TV
The festival wants to push people beyond simple tolerance
Mezipatra Queer Film Festival starts by Raymond Johnston - Prague.TV (Foto: Johana Němečková)
The festival presents new films in competition plus shorts documentaries and classics
Pride Voices presents several tones of the rainbow by Raymond Johnston - Prague.TV
Six people discussed their experiences and lives as members of the LGBT community worldwide
Pride Week starts with a concert by Raymond Johnston - Prague.TV
A diverse group of musicians and some speakers opened a week of LGBT events
Prague Pride week starts Aug. 8 by Raymond Johnston - Prague.TV
The Pride Parade will be Aug. 13 and follow the same route as last year to Letná
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"I've gotten these free things because of how I look, not who I am," says Russell. "And there are people paying a cost for how they look, not who they are."
As Russell explains, physical beauty — or at least the brand of it that we see in fashion magazines — is very carefully constructed. To hear about how Photoshopping is just the beginning of how models are built into the images we see, watch her talk. And below, check out five more talks about physical beauty.Richard Seymour: How beauty feels
How do we know when a face — or object, for that matter — is beautiful? In this talk from TEDSalon London Spring 2011, designer Richard Seymour says that we simply feel it. Here, he takes a look on the power that feeling has over us. Aimee Mullins: It's not fair having 12 pairs of legs
Having prosthetic legs isn't a disability. For athlete and model Aimee Mullins, they are a source of great superpowers. In this talk from TED2009, Mullins shares how having prosthetics has granted her speed, height and, yes, beauty. Dennis Dutton: A Darwinian theory of beauty
Beauty is not in the eye of the beholder, says Dennis Dutton, nor does it simply come down to our specific cultural coding. In this talk from TED2010, Dutton shares that our experience of beauty has evolutionary origins, and takes it back to Darwin. Virginia Postrel on glamour
What is glamour? Cultural critic Virgina Postrel gives a broader definition than sequins and movie stars. In this talk, she shares that the word goes back to the idea of casting spells, and is anything with a carefully polished image created to dazzle.
Rick Guidotti: From stigma to supermodel
Fashion photographer Rick Guidotti was used to shooting models. However, he was also sick of being told who counts as beautiful. In this talk from TEDxPhoenix, Guidotti reveals how he broke out — by recognizing the incredible beauty of teens with albinism and creating a stunning series of images of them.