What do you get when you combine horchata?the sweet, rice-based drink popular in Mexico, and a shot of espresso? Echo Park will soon find out when Taza of Echo Park opens in October. The take-out cafe will be shoe-horned into a tiny cube of a storefront on Sunset Boulevard, next to Herb?s Lock & Key, said co-owner Christina Byun of Highland Park. The space, which is not much larger than a living room, is small but it has required a lot of work and time to get ready to meet city building and health department standards.
?My partner and I started this project over a year and a 1/2 ago,? Byun said via email. ?We faced many obstacles with converting the space to a food/beverage establishment and can?t believe that we are only a few months away from opening our dream business.?
There are no shortage of coffee houses in Echo Park these days. In fact,? in addition to Taza, some former employees of Intelligentsia coffee are said to be looking to open ?a high-concept coffee bar? in Echo Park.
How will Taza set itself apart?? Taza will sell coffee and espresso drinks and food with what Byun describes as a ?Latin twist,? including horchata latte and espresso and guava cheese pastries. ?We are both native Angelinos and it was important to us to be a part of a community that represents Los Angeles, this is why we were so committed to opening in Echo Park,? Byun said.
Orange Poland has added to the Nokia 808 PureView and Samsung Galaxy Beam i8530 smartphones to its range. They are available with the tariffs Dolphin, Pelican and Panther and Orange for Businesses.
Nokia 808 PureView is suitable for customers who often use a phone with a camera as it includes Carl Zeiss optics and pixel over-sampling technology. In addition, it has an AMOLED screen, ClearBlack 4 coating and 1.3 GHz processor.
The Samsung model has a built-in projector and allows viewing of any multimedia content from the phone or the internet on a wall or other flat surface.
The Nokia 808 PureView costs PLN 1,989 in Orange's e-shop or PLN 2,039 at its 'salons' on the Dolphin tariff for calls, with a monthly subscription of PLN 39.90 for 24 months. It costs PLN 39 from the e-shop or PLN 239 in its salons on the Panther tariff for the internet, with a monthly subscription of PLN 199.90 for 36 months. It costs PLN 1,509 in the e-shop or PLN 1,599 in salons on the tariff Pelican for SMS with a monthly subscription of PLN 79.90 for 24 months.
The Samsung Galaxy Beam i8530 costs PLN 1,539 in the e-shop (PLN 1,589 in salons) with the tariff Dolphin at a monthly subscription of PLN 39.90 and a 24-month commitment; It costs PLN 49 in the e-shop (PLN 149 in salons) with the tariff Panther at a monthly subscription of PLN 199.90 for 36 months; and PLN 1,059 in the e-shop (PLN 1,149 in salons) with the tariff Pelican with a monthly subscription of PLN 79.90 for 24 months.
For businesses, Orange is offering the Nokia 808 PureView for PLN 659 plus VAT and the Samsung Galaxy Beam i8530 for PLN 499 plus VAT with the tariff More for Less, for example, at a monthly subscription of PLN 99 for 24 months.
AMSTERDAM (AP) ? Fears that a passenger plane had been hijacked en route from Malaga in Spain to Amsterdam's Schiphol Airport appear unfounded and a passenger says there is no hostage situation, Dutch and Spanish media reported Wednesday.
Spanish newspaper El Pais cited a spokesperson from the Spanish carrier Vueling as saying there was no hijacking and blaming the incident on a communication problem between the pilot and control tower.
National Dutch broadcaster NOS spoke by phone with a person it identified as one of the passengers on board who said that the plane was calm and there was no hostage situation.
The Vueling plane was parked at a remote corner of Schiphol, about two kilometers (1.5 miles) from the main terminal, surrounded by security personnel and several ambulances, according to photographers at the scene.
News website Nu.nl had reported that the plane was escorted to Schiphol by two F16 fighter jets. The report cited the Defense Ministry.
Airport authorities and security services did not immediately return calls seeking comment.
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Q: Why do many slow cooker recipes call for layering the ingredients? Even in stew-like recipes where everything will be mixed up in the end.
Sent by Emily
Editor: Emily, two thoughts. Number one, many recipes with meat call for laying the meat on top so that the fat trickles down as it renders, along with the juices, and infuses the rest of the ingredients. Number two, ingredients that need the most moisture to cook, like potatoes, are best left at the bottom as a stew simmers, so they can soak up the broth to soften.
When was the last time you heard, or said, ?Hey, lets go to the store an rent a movie??
We all know that DVD rental stores seem to be heading the way of the dinosaur. A once vast international empire of video rental stores, like Blockbuster or the now bankrupt Hollywood Video, are now a rarity among communities in The United States. It seems that the convenience of online video streaming has changed the landscape of the film entertainment industry forever.
Convenience vs Content
Unfortunately, there are some serious drawbacks to online video rentals that have yet to be addressed. With traditional the rental system, you typically had 3 to 5 days to watch your movie. Now, if you choose to rent a movie for streaming online, you only get 24 hours to watch it and have to pay again if you don?t finish it in a day.
I remember when part of the experience of watching a DVD included special features, bonus tracks, secret menus with outtakes, and many other interactive features. Sadly, none of the DVD special features are available via any online video store. Don?t forget, if you have a slow internet connection, or if internet service is disrupted for some reason, your not going to be able to watch your video at all!
Possibly the biggest limitation of all is the content that?s available, or more importantly, not available, on these online streaming platforms as stated in this quote from an article by Scientific American, How Hollywood Is Encouraging Online Piracy.
?Yet, perhaps most important, there?s the availability problem. New movies aren?t available online until months after they are finished in the theaters, thanks to the ?windowing? system?a long-established obligation that makes each movie available, say, first to hotels, then to pay-per-view systems, then to HBO and, only after that, to you for online rental.?
Online Piracy, Yo Ho!
There?s only one solution if you missed that new summer smash in the theater but its not available for online rental yet? Illegal video piracy! Yes, the despicable practice of watching movies for free on the internet illegally seems to be supported by the red tape imposed by Hollywood studio lawyers. The trend of online piracy has been rising ever since it became possible to ?rip? DVD?s and put them on a website for everyone to enjoy as unpaid entertainment. The sad thing is that most people would choose to pay for these movies if they were given the opportunity, but because of all of the Hollywood legal so-and-so, people are forced into the seedy criminal activity of pirated media streaming.
Want it, Love it, Own it!
Either way, nothing will ever beat actually buying a DVD that you love. Remember, when you own a DVD you can watch the media and all the features as many times as you want, anytime you want. Online streaming, whether legal or illegal, means that if the website is down, your not watching, if your internet is out, fat chance, and if you want Blu-Ray quality, fat chance getting your stream to play without interruption.
Tags: Business, DVD, hollywood, Illegal, Online, Piracy, Rental, streaming, Video
New Orleans Saints quarterback Drew Brees passes during the first half of an NFL preseason football game against the Houston Texans in New Orleans, Saturday, Aug. 25, 2012. The Saints won 34-27. (AP Photo/Bill Feig)
New Orleans Saints quarterback Drew Brees passes during the first half of an NFL preseason football game against the Houston Texans in New Orleans, Saturday, Aug. 25, 2012. The Saints won 34-27. (AP Photo/Bill Feig)
Houston Texans coach Gary Kubiak, right, greets New Orleans Saints acting coach Joe Vitt, left, after an NFL preseason football game in New Orleans, Saturday, Aug. 25, 2012. The Saints won 34-27. (AP Photo/Bill Feig)
METAIRIE, La. (AP) ? The New Orleans Saints changed their practice and travel plans Monday, heading for Cincinnati as Tropical Storm Isaac headed for the Gulf Coast.
Interim coach Joe Vitt called off practice and meetings so players could evacuate their families. The Saints also contacted the Cincinnati Bengals and got approval to practice at Paul Brown Stadium on Tuesday afternoon.
The Saints are scheduled to play their final preseason game Thursday in Tennessee. The team considered flying there directly ahead of the storm, but couldn't work out the logistics. Instead, they decided to make a stop in Cincinnati.
"Joe (Vitt), who's kind of running the show now, has been a good friend for a long time," Bengals coach Marvin Lewis said after his team's practice Monday. "So it works out well. We've talked a couple of times already."
Lewis offered to hold a joint workout with the Saints, but New Orleans decided on a separate practice. The Bengals will practice in the morning before heading to Indianapolis for their final preseason game against the Colts on Thursday night.
The latest National Weather Service forecast has Isaac coming ashore on the Mississippi Gulf Coast just east of Louisiana on Tuesday night or Wednesday morning with maximum sustained winds of about 100 mph. Each updated forecast has had the storm landing farther west than the previous one.
Louisiana governor Bobby Jindal declared a state of emergency on Sunday afternoon.
Vitt decided to give his players time to take care of their families. The Saints haven't practiced since their 34-27 preseason win over the Texans on Saturday night in New Orleans. Drew Brees was sharp in that game, going 17 of 25 for 179 yards with a pair of touchdowns.
New Orleans has been scrambling since the path of the storm changed.
"They haven't had an opportunity to have their team back together," Lewis said. "They haven't even looked at the tape of their players (from the preseason game) yet. So they're going to get in here tonight and try to get some of their evaluation done from the last game."
Linebacker Will Herring tweeted a photo of himself cleaning out his freezer in preparation for leaving town.
It'll be the second time the Saints have visited Ohio this month. They opened their preseason in Canton in northern Ohio, beating Arizona in the Hall of Fame game.
It's not the first time a storm has forced the Saints to alter practice plans since Hurricane Katrina devastated the Gulf Coast in 2005, forcing them to play the entire season away from New Orleans. In 2008, they practiced at the RCA Dome in Indianapolis the week before their regular-season opener at home against Tampa Bay due to a mandatory city-wide evacuation for Hurricane Gustav.
"That's the way this team is built," Vitt said. "That's the way this organization's built. I think that it really just shadows the resiliency of our community. This community faces these types of things it seems every year. We stand beside our community, encourage them to take shelter and everybody can be safe in this thing."
___
AP Sports Writer Joe Kay in Cincinnati contributed to this report.
Summary ? Would have required undefined environmental impactreview and development alternatives analysis prior to approval of stormwater and other environmental permits
Summary ? Would have prohibited non agricultural uses of more than 5 acres in Rural Legacy Areas
HB 1050 ? Construction Permits ? Expiration Dates ?Failed
Summary ? Would have extended provisions of industry sponsored legislation that tolled or extended development permits and approvals from 2008 through 2012
Summary ? Increases penalty for damaging property markers
SB 261 / HB 718 ? Commercial Buildings ? Energy Benchmarking and Disclosure ? Failed
Summary ? Would have required all commercial buildings over 10,000 square feet to annually benchmark energy use, disclose results to prospective tenants and buyers and grant them the right to rescind leases and purchase contracts
SB 781 / HB 976 ? Displaced Building Service Worker Protection Act ? Failed
Summary? Would have required retention of workers whenbuilding services contracts are awarded to another company
Summary ? Would have required public utilities to enter into 20 year contracts to purchase electricity from off shore wind farm. Total increased cost capped by statute at 2.5% per month to be determined by the Public Service Commission
?
Taxes and Fees
SB 215 / HB 1349 ? Community Enhancement Transit Oriented Development Fund ? Failed
Summary ? Would have established development impact fee system to pay for infrastructure and operations of social services organizations near TOD
Summary ? Would have applied the recordation tax to Indemnity Deeds of Trust Valued at more than $5 million
HB 1064 ? Watershed and Restoration Protection Act ? Failed
Summary ? Would have required that local government establish an impervious surface fee and that commercial property pay at a higher rate than other classes of property
Summary ? Expands semi annual tax payment schedule to include business property
Tax Liability Threshold ? Total property taxes (local, state, special taxing districts) do not exceed $50,000 for the taxable year ($100,000 after June 30,2012)
Eligible Business Property ? Must be assigned a commercial use code by the State Department of Assessments and Taxation (SDAT)
Retail, office, commercial, industrial, recreational, apartment, hotel, parking lots, daycare, warehouse, nursery, bar, restaurants, auto dealerships
Transportation
SB 451 ? Transportation ? Sales and Use Tax ? Funding for Mass Transit ? Failed
Summary ? Would have applied sales tax to gasoline sales state-wide and dedicated revenues in specific counties to mass transit balance of revenues to the transportation trust fund
SB 714 / HB 1001 ? Transportation Trust Fund ? Financing ? Use of Funds ? Failed
Summary ? Would have increased titling fees and gas tax by 10 cents. Future rate would have been indexed to the Construction Cost Index and diversion of Transportation Trust Fund to other purposes were limited.
HB 109 ? Outdoor Signs on Scenic Byways and Federal Aid Highways ? Passed
Summary ? Prohibits SHA from issuing permit for signs on designated scenic highways
?
Construction and Building Codes
SB 387 / HB 910 ? High Performance Buildings Act ? Applicability to Recipients of State Aid ? Failed
Summary ? Would have required that all projects with more than $100,000 in state grants build to LEED Silver
HB 972 ? Building Codes ? International Green Construction Code ? Passed
Summary ? Authorizes DHCD and local governments to adopt the International Code Congress Green Building Code as a supplement to the standard building code. Local adoption and use by builders is optional.
I thought this very apt when I saw it on my Facebook timeline this morning!
Some of you couldn?t? wait to get started with this challenge of celebrating the ordinary. Nancy of The Pink Underbelly got started straight away, closely followed by Philippa of A Feisty Blue Gecko and both Sinead and Jamie sent me adorable pictures of their pets which I have posted to Facebook.
I really love how you have embraced this challenge, and I was so happy when I read? Philippa?s words that the biggest challenge will be only finding one thing to post each day. Isn?t that a wonderful way to look at life?!
My picture..a bunch of hydrangea freshly picked from my garden and gracing my kitchen window sill today.
There are various things outside your control when pregnant, but there are various positive changes that you can make to have a smoother pregnancy for your baby and you. The following tips can be used to help you do the most to stay healthy.
Be sure that you understand what all the indications of a premature labor are. This will enable you to touch base with your doctor quickly if you experience similar signs.
Even before you conceive, you should take prenatal vitamins. In the first trimester, your baby?s neural cord is already developing. This eventually becomes the spinal cord and brain. Starting right at conception, it?s very important you get the required amounts of nutrients, including iron, calcium and folic acid.
Your OB/GYN or family doctor will recommend that you take a prenatal vitamin while you?re pregnant. Make certain you take them daily. These will give vitamins to your body that you do not get from the food that you eat, and it will enable your baby to be healthy while in your womb.
It?s a good idea for you, together with your partner, to visit your doctor for a checkup before you?re pregnant. At this appointment your doctor will be able to ascertain whether any other tests should be scheduled. This also lets you ask questions about potential pregnancy.
If there is a cat living in your household, draft a family member to change the litter box while you are pregnant. Litter and cat feces are both harmful to a woman and her unborn child. Have your spouse, neighbor, friend or family member change the litter in your home until the baby is born.
When you become pregnant, it is vital to take the time and put in the effort to educate yourself. There is a great deal of vital information you need to know, and the more knowledgeable you are about your condition, the more prepared and relaxed you?ll feel. Knowing the familiar aspects of pregnancy can quell later anxiety and stress.
Refrain from smoking and drinking alcohol when you are pregnant to make sure that your baby is healthy. Smoking, alcohol, illegal drugs and even prescriptions can hurt your fetus. For this reason you should only consume healthy foods during pregnancy and avoid things that could potentially cause harm to your child.
While pregnant, swelling in many parts of your body may become an issue. Reduce the amount of salt you consume.
Snack on more neutral foods like dry crackers during pregnancy. Bland foods, such as crackers, will calm the nausea and vomiting. Also, it is important that you avoid greasy and acidy foods as this will make your nausea worse and give you heartburn.
If you get diarrhea while you are pregnant, drink lots of clear fluids. The risk of dehydration from diarrhea can complicate your pregnancy or cause you to have to spend time in the hospital.
You should think about swimming when you are pregnant. Sometimes, putting a bathing suit on can be undesirable, but swimming offers some rewards that are worth it. When you are swimming you normally feel weightless, this lessens the pain in your body. It is also a great form of exercise.
As you read in the tips above, avoid sitting and just letting the pregnancy happen. Use the advice offered above to take your pregnancy experience into your own hands and have the kind of pregnancy you want and deserve.
Get Quick and uncomplicated Manual and useful information on getting pregnant
In order to save money while you seek to get your electrical related concerns resolved and to keep your safety, you need to ask your domestic electrician a number of important questions. Your current Myrtle Beach electrician has all of the understanding you need to advise you on the different electrical related cabling, outlets and items in your home that run off electrical energy. If your electrician is in your residence performing a task, you should definitely ask him questions on what he's doing and the way it works. He will most likely possess some beneficial pointers and strategies for you that may help you save money ultimately.
Inquire about safety from your Myrtle Beach electrician
One real question you should ask of your Myrtle Beach electrician could be the basic safety of the electrical circuitry inside your property. Ask whether you can apply a specific thing to enhance the safety factor. If you need to know, electrical wiring is essential in our safety and comfort within our homes; therefore, it is crucial that we realize specific things about it. An expert electrician will check the electrical wiring and will explain to you if you have a need for maintenance or adjustment. Now, besides safety measures, it's also wise to ask the one question that almost all house owners rarely ask: Are you able to do something to reduce your utility bill? There are unquestionably strategies to this question that you've quite possibly never thought of, so make sure to question your Myrtle Beach electrician at the up coming opportunity!
Additionally, it might be important for you to find out about the security of your residence from natural disasters. Think about the location where your house is located and look at the disasters which might be prone to happen there. Folks that live on the coast ought to plan for severe weather. As such, you are able to ask about ways to improve your electrical system to get ready and prepare for severe weather. Take into account the outlets, lighting fixtures, etc.
Consult a Myrtle Beach Electrician How You Can Spend Less
Ask your current Myrtle Beach electrical contractor in relation to other small approaches to save money on your next power monthly bill. Such things as making use of one electronic devise at a time, unplugging certain things when not being used, (plugged in items still pull a small amount of electrical power when plugged in, even though they're off) and various handy suggestions that an domestic electrician is aware of. These are free recommendations available from your domestic electrician who is presently doing work in your house. Therefore, make sure you ask whichever specialist Myrtle Beach electricians may be in your home with regards to conserving money and continuing to keep your house safe and sound.
You'll discover various other very good tips on our website at Myrtle Beach Electricians. Always keep checking back because we post regularly.
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ScienceDaily (Aug. 24, 2012) ? When aggressive, malignant tumors appear in more than one location in the brain, patient survival tends to be significantly shorter than when the disease starts as a single tumor, even though patients in both groups undergo virtually identical treatments, according to research at Cedars-Sinai Medical Center's Maxine Dunitz Neurosurgical Research Institute.
"We've known that certain independent factors, such as age at diagnosis, amount of residual tumor after surgery, and the patient's functional status are useful in predicting outcomes in patients with glioblastoma multiforme, but multifocal disease at time of onset has rarely been examined in this context. Two small previous studies were contradictory. Our study appears to confirm observations that disease in patients with more than one lesion is particularly challenging and that these patients tend to have worse outcomes. Matched survival analysis demonstrated that multifocal disease is a strong and negative independent prognostic factor," said Chirag G. Patil, MD, director of the Center for Neurosurgical Outcomes Research in the Department of Neurosurgery at Cedars-Sinai Medical Center.
The researchers compared outcomes of 47 patients who had multiple tumors with 47 who had a single lesion, matching them for age, functional impairment scores, extent of tumor removal and radiation therapy and chemotherapy. Median overall survival for the multifocal group was six months, compared to 11 months for those in the single tumor group.
Patil, first author of an article in the Aug. 24 Journal of Neurosurgery, noted that a comparatively large percentage of tumors in the multifocal group appeared to be "treatment resistant," continuing to grow even after patients underwent radiation therapy.
Unlike earlier studies, nearly all of these patients were diagnosed and treated during the "temozolomide era," beginning in 2005 when this drug joined radiation therapy as the mainstay of glioblastoma treatment. Even so, 11 of the 47 patients in the multifocal group did not receive temozolomide because, the researchers suggest, disease progression is so quick that many patients are unable to start or complete standard therapies.
Patil said researchers believe cells of multifocal tumors may have an increased ability to migrate in the brain and invade normal tissue, leading to more rapid patient decline; recent advances in therapies for glioblastomas have not improved survival in these patients.
"A thorough investigation of the unique biology of these tumors and their invasive and migratory mechanisms is needed so we may develop a new generation of targeted therapies," said Patil, who received a Cedars-Sinai grant that will fund the study of genetic and biological differences between single tumors and those originating at multiple sites.
Glioblastoma multiforme is the most common and aggressive malignant tumor occurring in the brain, and patients typically survive 15 months when undergoing standard treatments. Other single-tumor patients in the larger pool from which those in this study were derived, had median survival of 16 months. The shorter 11-month survival of study patients is believed to result from the matching process: Because many of those with multiple-site tumors could not undergo complete tumor removal, their corresponding single-site patients had tumors with locations or characteristics that made them appropriate for biopsy only.
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The above story is reprinted from materials provided by Cedars-Sinai Medical Center, via Newswise.
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Journal Reference:
Patil et al. Prognosis of Patients with Multifocal Glioblastoma: A Case-Controlled Study. Journal of Neurosurgery, August 24, 2012
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Diagnostic test shows potential to noninvasively identify significant coronary artery diseasePublic release date: 26-Aug-2012 [ | E-mail | Share ]
Contact: Sally Stewart sally.stewart@cshs.org 310-423-4768 JAMA and Archives Journals
CHICAGO Among patients with suspected or known coronary artery disease, use of a method that applies computational fluid dynamics to derive certain data from computed tomographic (CT) angiography demonstrated improved diagnostic accuracy vs. CT angiography alone for the diagnosis of ischemia, according to a study being published online by JAMA. The study is being released early to coincide with its presentation at the European Society of Cardiology Congress.
"Coronary computed tomographic angiography is a noninvasive anatomic test for diagnosis of coronary stenosis [narrowing of a blood vessel] that does not determine whether a stenosis causes ischemia [inadequate blood supply]. In contrast, fractional flow reserve (FFR) is a physiologic measure of coronary stenosis expressing the amount of coronary flow still attainable despite the presence of a stenosis, but it requires an invasive procedure. Noninvasive FFR computed from CT (FFRCT) is a novel method for determining the physiologic significance of coronary artery disease (CAD), but its ability to identify ischemia has not been adequately examined to date," according to background information in the article.
James K. Min, M.D., of the Cedars-Sinai Heart Institute, Los Angeles, and colleagues conducted a study to evaluate the performance of noninvasive FFRCT compared with an invasive FFR reference standard for diagnosis of ischemia. The study included 252 patients with suspected or known CAD from 17 centers in 5 countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFRCT between October 2010 and October 2011. About 77 percent of patients had experienced angina within the last month. Ischemia was defined by certain criteria. Anatomically obstructive CAD was defined by a stenosis of 50 percent or larger on CT and ICA. Among 615 study vessels, 271 had less than 30 percent stenosis and 101 had at least 90 percent stenosis.
Among study participants, 137 (54.4 percent) had an abnormal FFR as determined by ICA. The researchers found that the diagnostic accuracy for FFRCT plus CT was 73 percent, which did not meet a prespecified primary end point for accuracy (as pre-specified based on the lower limit of a calculated 95 percent confidence interval). By comparison, diagnostic accuracy of CT alone for detecting coronary lesions with stenosis of 50 percent or greater, was 64 percent. When comparing FFRCT alone with CT alone for detecting these lesions, FFRCT demonstrated superior discrimination.
"On a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT plus CT were 73 percent, 90 percent, 54 percent, 67 percent, and 84 percent, respectively," the authors write. They note that the sensitivity and negative predictive value of FFRCT were high, indicating a low rate of false-negative studies. "These diagnostic features of FFRCT may encourage a greater sense of diagnostic certainty that patients who undergo CT who have ischemia are not overlooked, such that clinicians may be confident in not proceeding to invasive angiography in patients with stenoses on CT when FFRCT results are normal."
"Taken together, these study results suggest the potential of FFRCT as a promising noninvasive method for identification of individuals with ischemia."
(doi:10.1001/2012.jama.11274. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by HeartFlow Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: Detecting Obstructive Coronary Disease With CT Angiography and Noninvasive Fractional Flow Reserve
In an accompanying editorial, Manesh R. Patel, M.D., of Duke University Medical Center, Durham, N.C., writes that future studies with the FFRCT technology "should be aimed at diagnostic strategies involving patients with varying pretest risks, thereby providing information on the incremental benefit from the test."
"Additionally, important comparison technologies beyond invasive angiography are needed, although improved access techniques and safety of invasive FFR may make it a plausible comparator. In addition to diagnostic performance, other outcomes of interest such as resource utilization and clinical outcomes should be captured. Finally, future studies will need to have local sites rather than core laboratories perform, analyze, and interpret the images to provide a sense of real-world function. It is with these types of continued rigorous studies that noninvasive technologies such as FFRCT plus CT may move the clinical community closer to the holy grail of a high-quality combined anatomic and functional test for detection of CAD that improves efficiency and patient outcomes."
(doi:10.1001/2012.jama.11383. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
To contact James K. Min, M.D., call Sally Stewart at 310-423-4768 or email sally.stewart@cshs.org. To contact editorial author Manesh R. Patel, M.D., call Sarah Avery at 919-660-1306 or email sarah.avery@duke.edu.
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Diagnostic test shows potential to noninvasively identify significant coronary artery diseasePublic release date: 26-Aug-2012 [ | E-mail | Share ]
Contact: Sally Stewart sally.stewart@cshs.org 310-423-4768 JAMA and Archives Journals
CHICAGO Among patients with suspected or known coronary artery disease, use of a method that applies computational fluid dynamics to derive certain data from computed tomographic (CT) angiography demonstrated improved diagnostic accuracy vs. CT angiography alone for the diagnosis of ischemia, according to a study being published online by JAMA. The study is being released early to coincide with its presentation at the European Society of Cardiology Congress.
"Coronary computed tomographic angiography is a noninvasive anatomic test for diagnosis of coronary stenosis [narrowing of a blood vessel] that does not determine whether a stenosis causes ischemia [inadequate blood supply]. In contrast, fractional flow reserve (FFR) is a physiologic measure of coronary stenosis expressing the amount of coronary flow still attainable despite the presence of a stenosis, but it requires an invasive procedure. Noninvasive FFR computed from CT (FFRCT) is a novel method for determining the physiologic significance of coronary artery disease (CAD), but its ability to identify ischemia has not been adequately examined to date," according to background information in the article.
James K. Min, M.D., of the Cedars-Sinai Heart Institute, Los Angeles, and colleagues conducted a study to evaluate the performance of noninvasive FFRCT compared with an invasive FFR reference standard for diagnosis of ischemia. The study included 252 patients with suspected or known CAD from 17 centers in 5 countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFRCT between October 2010 and October 2011. About 77 percent of patients had experienced angina within the last month. Ischemia was defined by certain criteria. Anatomically obstructive CAD was defined by a stenosis of 50 percent or larger on CT and ICA. Among 615 study vessels, 271 had less than 30 percent stenosis and 101 had at least 90 percent stenosis.
Among study participants, 137 (54.4 percent) had an abnormal FFR as determined by ICA. The researchers found that the diagnostic accuracy for FFRCT plus CT was 73 percent, which did not meet a prespecified primary end point for accuracy (as pre-specified based on the lower limit of a calculated 95 percent confidence interval). By comparison, diagnostic accuracy of CT alone for detecting coronary lesions with stenosis of 50 percent or greater, was 64 percent. When comparing FFRCT alone with CT alone for detecting these lesions, FFRCT demonstrated superior discrimination.
"On a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT plus CT were 73 percent, 90 percent, 54 percent, 67 percent, and 84 percent, respectively," the authors write. They note that the sensitivity and negative predictive value of FFRCT were high, indicating a low rate of false-negative studies. "These diagnostic features of FFRCT may encourage a greater sense of diagnostic certainty that patients who undergo CT who have ischemia are not overlooked, such that clinicians may be confident in not proceeding to invasive angiography in patients with stenoses on CT when FFRCT results are normal."
"Taken together, these study results suggest the potential of FFRCT as a promising noninvasive method for identification of individuals with ischemia."
(doi:10.1001/2012.jama.11274. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by HeartFlow Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: Detecting Obstructive Coronary Disease With CT Angiography and Noninvasive Fractional Flow Reserve
In an accompanying editorial, Manesh R. Patel, M.D., of Duke University Medical Center, Durham, N.C., writes that future studies with the FFRCT technology "should be aimed at diagnostic strategies involving patients with varying pretest risks, thereby providing information on the incremental benefit from the test."
"Additionally, important comparison technologies beyond invasive angiography are needed, although improved access techniques and safety of invasive FFR may make it a plausible comparator. In addition to diagnostic performance, other outcomes of interest such as resource utilization and clinical outcomes should be captured. Finally, future studies will need to have local sites rather than core laboratories perform, analyze, and interpret the images to provide a sense of real-world function. It is with these types of continued rigorous studies that noninvasive technologies such as FFRCT plus CT may move the clinical community closer to the holy grail of a high-quality combined anatomic and functional test for detection of CAD that improves efficiency and patient outcomes."
(doi:10.1001/2012.jama.11383. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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To contact James K. Min, M.D., call Sally Stewart at 310-423-4768 or email sally.stewart@cshs.org. To contact editorial author Manesh R. Patel, M.D., call Sarah Avery at 919-660-1306 or email sarah.avery@duke.edu.
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A work of art is the product of the freedom of the artist which encourages more freedom on the part of others. Art becomes more of a moral act because it implores on the morality of the people. A good piece of art is almost always political in nature because a moral issue is explored and a moral stand is taken. This would demand that viewers of the art displayed at the Jackman Gallery in Melbourne would also do the same.
Existentialism
Existential efficacy in art is established when it would provoke the morality of people and has effectively shown the expression of the artist. From the point of view of the existentialists, the world is also a form of art. The world is the product of the human imagination. The world is full of symbols that are subject to interpretation and meaning. There is an existential efficacy in art when the work itself would awaken the minds of the people to improve something around them.
It is in this type of art that it seeks to promote the existential autonomy. It may also be possible with interpreting the objects that were represented in art with an impression of a myth or a fable. The truth that will be represented in the art would take on another meaning that is different and new. The represented object in the form of art will become the truth if it will incarnate because of the proper representation given to it. It would also be effective when it will take on an existential character and also including the qualities that are appropriate for it.
Expressionism
Expressionism may be considered as the existentialist form of art. Paintings for example, make a replica of the primordial encounter of the individual in the world. The main idea of this concept is that the body has a role on the basis of one's experience. The subject will always be a subject that has embodiment. The experience contains the relationship with the body and the environment. The subject of the art that has been embodied is always with the world having an aesthetic relationship with the environment. Art duplicates the functions of the body. The painting will repeat and reflect the intertwining of the world and the subject. The artist can bring about change in the world through paintings by lending his body. The painting also has the same characteristics as the gestures and the expressions that are found on the human body. The entire body becomes the centre of the whole encounter. This is part of portraiture and the definition of the self in art. The painting is understood as a whole and not by parts.
Art takes on many forms. There are various objects that can be turned into subjects. Existentialism in art is present in how artists define themselves and express that through self-portraits. It is not only the physical aspect, attributes and characteristics of the artist that is being reflected but also the essence of the artist as a human being.
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COQUITLAM, British Columbia, Aug. 23 (UPI) -- World No. 1 Yani Tseng, trying to break out of a recent slump, shot a 6-under 66 Thursday that gave her a one-shot lead at the Canadian Women's Open.
Tseng won three times early in the season, but went through a five-tournament stretch during the summer in which she finished no better than 50th and missed the cut three times.
She showed signs of regaining her form last week when she wound up 11th at the Safeway Classic and looked like her old self Thursday at the Vancouver Golf Club.
Her low round was put together despite a double-bogey at the par-4 first hole, her 10th of the day.
U.S. Women's Open champion Na Yeon Choi was alone in second at 67 while Inbee Park and amateur Lydia Ko shared third at 68.
Moira Dunn, Mindy Kim, Jee Young Lee and Angela Stanford were all at 69. Rookie Sydnee Michaels, who shot the low round of her career last week while posting her first Top 10 finish, backed up that showing by shooting a 70 to tie for ninth place after the opening round.
When you?re young, it?s very difficult to stay calm when you prove one of the unlucky teens to lose their hair without an acceptable explanation. Somehow, society forgives the young who lose their hair because of chemotherapy for cancer or as a result of some other natural accident. But any other hair loss marks you out as uncool. The really unlucky catch one of the fungal infections like ringworm which leaves swatches of hair on the ground as people walk around. This is deeply humiliating. Then you have the style conscious who put their hair under pressure by pulling it into position. After a while, pulling at the hair makes it fall out. But then come those who can be accused of having weak genes. Medical research confirms that male pattern baldness can affect teens as young as 14.
The decision to limit the prescription licence to those aged 18 or above was made by the FDA even though it was aware that male pattern baldness was possible among younger teens following its reviews of the evidence from the medical trials. The decision by the FDA is always a balancing of benefits against risk. Young bodies are still going through the maturing process and the levels of different hormones can be changing quite quickly. To intervene in the balance of hormones in the young is dangerous. The FDA therefore erred on the side of caution. In part, this reflects the nature of the drug. It?s not a cure for the genetic problem. It simply controls the process that would otherwise lead to hair loss. Perhaps if it was a specific cure, the FDA might have reached a different conclusion but, for now, doctors are not supposed to prescribe Propecia to those under 18.
So if this affects you, the choice is either to wait until you reach the magic age and put up with the inevitable problems of bullying, or to beat the prescription program by buying online. Since there can be longer term sexual problems, you have to want to stop the hair loss more than allow your sexual equipment to develop naturally. Given the risk of impotence this should be a very difficult decision to take.
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President Barack Obama greets well-wishers as he arrives at JFK International Airport in New York, Wednesday, Aug. 22, 2012, on his way to a visit in New York City where he attends several fundraiser events. (AP Photo - David Karp)
NEW YORK (AP) ? President Barack Obama sees the presidential contest as a clutch moment in his favorite sporting moment ? the fourth quarter of a taut basketball game.
Fundraising with the help of current and former National Basketball Association stars, Obama told a small group of donors gathered Wednesday night at Alice Tully Hall in Lincoln Center that the current campaign is like the final minutes of a basketball contest with his team up by a few points
"But the other side is coming strong," Obama said. "And they play a little dirty. We've got a few folks on our team in foul trouble. We have a couple of injuries. And I believe they have one last run in them."
Obama raised $3 million with the help of the players, who included former Chicago Bulls player Michael Jordan and former Knicks Walt Frazier and Bill Bradley. NBA Commissioner David Stern also was there.
Invoking Jordan's competitive nature, Obama concluded: "If you have seven minutes to go and you have a little bit of a lead, that's when you put them away."
The players were part a day long fundraiser. Earlier, former and current players participated in a $250 per person autograph session and in a skills camp priced at for $5,000 for two people.
"It is very rare that I come to an event where I'm like the fifth or sixth most interesting person," Obama joked at the Lincoln Center dinner.
Later, Obama changed ou t of his dark suit to shoot baskets with some of the players out of sight of the press. Obama, an avid basketball fan and a player, made a splash during his 2008 campaign by sinking a 3-point shot while visiting troops in Kuwait. His most recent star-studded game, also played in private, featured actors George Clooney and Tobey Maguire.
Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
LONDON (AP) ? The prince has no clothes ? but British newspapers aren't running the pictures.
The country's scandal-loving tabloids devoted many pages Thursday to the story of Prince Harry's naked romp in a Las Vegas hotel suite. But all heeded a warning from royal officials that printing the images ? already seen by millions on the Internet ? would infringe the prince's privacy.
So while Ireland's Evening Herald ran the stark-naked prince on its front page, British newspapers made do with pictures of holiday Harry in bathing trunks and fedora hat.
The Sun tabloid came up with the most creative solution, getting a staff member named Harry and a 21-year-old female intern to recreate the naked pose under the headline "Harry grabs the crown jewels."
Bob Satchwell, head of industry group the Society of Editors, said papers were merely complying with editors' voluntary Code of Practice, which declares "it is unacceptable to photograph individuals in private places without their consent."
But other media-watchers said a scandal that erupted a year ago over phone-hacking and other tabloid wrongdoing had tamed Britain's once-rambunctious press.
Newspapers were exposed to a trial of public opinion as Judge Brian Leveson's media ethics inquiry heard from celebrities, politicians and crime victims who said their lives had been turned upside down by press intrusion.
The scandal has killed one tabloid, the News of the World ? shut down by owner Rupert Murdoch after revelations about its illegal eavesdropping ? and tarnished the entire British media.
With the inquiry considering whether to impose stricter limits on press freedom, many feel the tabloids are staying away from kiss-and-tells and celebrity scoops that they once would have relished.
Neil Wallis, a former News of the World executive editor, said fallout from the hacking scandal had left newspapers "terrified of their own shadow."
"In this post-Leveson era ... they daren't do things that most of the country, if they saw it in the newspaper, would think 'that's a bit of a laugh,'" Wallis told the BBC.
While newspapers including The Sun and the Daily Mirror proclaimed that the naked photos had been "banned," that is not strictly true.
Prince Harry's office confirmed it had contacted industry watchdog the Press Complaints Commission, which in turn advised newspapers not to publish the pictures. Any paper that ran them risks being chastised by the commission, which can demand a newspaper publish an apology, but has no power to issue fines.
They could also potentially be open to an invasion-of-privacy lawsuit from the prince.
Once, editors might have risked it, arguing that publishing the images was in the public interest because Harry is a public ? and publicly funded ? figure.
Satchwell acknowledged there was a risk Leveson's inquiry could chill press freedom. But he said newspapers were simply behaving responsibly over Harry.
"Of course freedom of the press is vitally, vitally important," he said. "But just because you can publish something doesn't mean that you should."
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Jill Lawless can be reached at http://Twitter.com/JillLawless
The United States is experiencing one of the biggest outbreaks of West Nile virus in history, according to the federal Centers for Disease Control and Prevention.
As of Tuesday, 1,118 cases of the mosquito-borne disease had been reported. That's the highest number ever reported at this point in the year since the disease was first detected in the U.S. in 1999. If cases continue to grow at this pace, the West Nile outbreak could be the largest ever in the United States, said Dr. Lyle Petersen, director of the CDC's Division of Vector-Borne Infectious Diseases.
So far, 41 people have died from West Nile infections.
About 630 people have developed the rare neuroinvasive form of the disease, which affects the nervous system. The other cases involved what doctors call West Nile fever, a condition that can cause fever, headache, body aches, nausea, vomiting.
Texas, the state hit hardest by the outbreak, has reported 537 cases of West Nile, close to 300 of which have been the neuroinvasive form. In some parts of the state, officials have begun aerial pesticide spraying to curb the spread of the disease.
Most people infected with the West Nile virus show no symptoms; from the number of neuroinvasive cases that have occurred, it can be estimated that more than 94,000 people in the United States have been infected with West Nile this year. It's likely that about 98 percent of cases of West Nile fever are not reported, the CDC says.
These unreported cases still take a toll on the nation's health and economy, as people who may not know that West Nile is the cause of their illness take time off from work or use health care resources, said William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.
"The problem is even larger? than the already notably larger problem of neuroinvasive disease,"Schaffner said. The impact of unreported cases is a factor in the decision to call the current West Nile outbreak an emergency, as Dallas did, Schaffner said.
The reason for the large outbreak this year is not clear, but it could be related to this season's especially hot summer. Hot weather seems to increase the virus' transmissibility, Petersen said.
Pass it on: More than 1,100 cases of West Nile virus have occurred in the United States this year so far.
Follow Rachael Rettner on Twitter @RachaelRettner, orMyHealthNewsDaily @MyHealth_MHND. We're also on Facebook& Google+.
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NEW YORK (Reuters Health) - Even relatively low levels of lead in the blood may be linked to an increased risk of gout, a painful form of arthritis, researchers reported Monday.
Researchers have known that heavy lead exposure is linked to the condition - a form of arthritis in which the joints periodically become swollen, red and hot. Gout most often affects the big toe, though it can also strike the feet, ankles, knees, hands and wrists.
But the new findings connect gout risk to low levels of lead in the blood - well within the range currently considered acceptable for adults.
For adults, lead levels of 25 micrograms per deciliter of blood or lower are considered "non-elevated."
In developed countries - where policies like removing lead from gasoline and paint have greatly cut people's exposure - typical lead levels are far below that threshold. In the U.S., the average level is about 3 mcg/dL.
But in this study, gout risk started to climb once adults' lead levels surpassed 1.2 mcg/dL.
That's in line with some past research that has linked relatively low lead levels to other risks, including worsening of kidney disease and death from heart disease.
"All of this suggests there's no such thing as 'safe' or 'acceptable' lead levels," said study leader Dr. Eswar Krishnan, of Stanford University School of Medicine in Palo Alto, California.
The study, reported in the Annals of Internal Medicine, is based on data from a periodic federal health survey. More than 6,100 Americans age 40 and up had their blood lead levels measured, and were interviewed about their health and lifestyle.
Overall, just under five percent said they'd been diagnosed with gout. And the risk went up as people's lead levels rose.
Of the adults with the highest lead levels, about six percent had gout - versus less than two percent of people with the lowest lead levels.
That does not prove the higher lead levels were to blame, Krishnan acknowledged. But he said he and his colleagues controlled for a number of other factors that might explain the connection.
Gout arises when uric acid crystals build up in the joints. The body produces uric acid when it breaks down purines - substances found naturally in the body, but also in certain foods, like organ meats, anchovies, mushrooms and some seafood.
Anything that boosts the body's production of uric acid, or slows the clearance of it, also raises the risk of gout. Obesity, high blood pressure, diabetes and kidney disease are some examples.
But even when Krishnan's team accounted for those factors - plus people's incomes and smoking habits - lead levels remained linked to gout risk.
People in the top 25 percent for lead levels had the highest gout risk: four times higher than people in the bottom 25 percent.
That top group had lead levels ranging from 2.6 to 27 mcg/dL, according to the researchers, but most were well below the acceptable lead threshold. Only three people in the study had lead levels of 25 mcg/dL or higher, while 31 had levels of 10 mcg/dL or higher.
It's not clear why low-level lead would boost gout risk. But Krishnan said the theory is that even small amounts of lead can hinder the kidneys' ability to excrete uric acid.
Dr. Ashwini R. Sehgal, who wrote an accompanying editorial, agreed that the threshold for acceptable lead levels in adults should be revisited.
In an interview, Sehgal said that many people with elevated lead levels are exposed to the metal at work - in industries like mining, construction and battery making.
If you've ever worked with lead, tell your doctor and ask whether a blood test is a good idea, said Sehgal, a professor of community health improvement at Case Western Reserve University in Cleveland, Ohio.
"I don't think that everyone should have their lead levels checked," Sehgal said.
Krishnan agreed. He also noted that while the average blood lead level in the U.S. is 3 mcg/dL, "that would include a large number of people with zero or near-zero levels."
But Krishnan said that if a person has gout and no known risk factors for it, like obesity, doctors could consider lead testing.
Typically, if someone's lead levels are elevated, it would be important to reduce any known exposure to it.
Besides job exposure, Krishnan said that people can inhale lead through cigarette smoke or lead-containing dust; deteriorating lead-based paint in an older home, for example, can contaminate household dust.
Lead can also be in drinking water, especially in older homes with lead-based pipes. And some people are exposed through hobbies, like working on cars, or making glazed pottery or stained glass.
When a person's lead levels are particularly high, a treatment called chelation therapy might be recommended. That involves giving certain drugs that bind to lead and allow it to be excreted in the urine.
But no one knows if that therapy can ease symptoms of gout in people with mildly elevated lead levels
"There are medications that can leach lead out of the blood," Krishnan said. "But they are not approved to treat gout. And they are not without risks."
Chelation therapy can, for instance, damage the kidneys permanently.
So even if someone with gout were found to have relatively elevated lead levels, no specific treatment recommendations can be made, Krishnan said.
Both he and Sehgal said the findings' main importance have to do with bigger-picture public health.
"I think policymakers should consider these data" in any future review of the lead threshold for adults, Krishnan said.
The U.S. Centers for Disease Control and Prevention recently lowered the maximum acceptable lead level for children - from 10 mcg/dL to 5 mcg/dL. The threshold for children is lower because their developing brains are particularly vulnerable to damage from lead.
Sehgal said he thinks lower thresholds for adults are feasible. He noted that in Germany, the standards are 7 mcg/dL for women and 9 mcg/dL for men.
SOURCE: http://bit.ly/MnBiCA Annals of Internal Medicine, August 21, 2012.
Whether you are 18 or 88, an advanced directive is a wise idea to help protect your wishes and to avoid forcing your family or others to make difficult or even misguided decisions on your behalf. An advanced directive, also known as a living will, is a legal document that instructs your decisions about serious medical care and treatment when or if you are not able to do so.
About Advanced Directives
An advanced directive tells others whether you desire the use of breathing machines and/or dialysis to help you stay alive as the situation dictates, as well as whether you wish artificial nutrition via tube feeding or through an IV. You may also determine how you wish to be comforted, such as receiving medication for pain or nausea, ice chips for dry mouth and/or spiritual and emotional counseling.
In addition, an advance directive tells others whether you want resuscitation if your heartbeat or breathing stops. You can also determine whether you want to participate in organ or tissue donation after your death.
Another element to an advance directive is to establish a durable power of attorney for health care, which names the person you want making decisions on your behalf if you cannot, due to a physical or mental condition. Establishing the person to direct your elder care is often a relief for both the senior and their family.
About Five Wishes
Making the decisions required by an advance directive can be difficult. However, there is help available. The Aging with Dignity organization has a mission to protect and affirm individual human dignity as they age and help ensure sound elder care for those who are reaching the end of life.
Aging with Dignity introduced a document called ?Five Wishes? in 1997. Five Wishes helps users fill out and compete an advanced directive, meets the legal requirements for an advanced directive in at least 42 states, and is useful in all 50.
Five Wishes is now available online and allows users to determine not only their desired medical treatment but also information about their care and comfort, as well as information they wish their loved ones to know. The standard Five Wishes form is available online.
The Aging with Dignity organization also offers a ?Next Steps? guide to help individuals speak with their family members about their advanced care directive and their wishes for medical care and treatment when they are no longer able to articulate them.
For more information about Five Wishes or the Aging with Dignity organization, call 888-594-7437 or email fivewishes@agingwithdignity.org.
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Q: Why do many slow cooker recipes call for layering the ingredients? Even in stew-like recipes where everything will be mixed up in the end.
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Public release date: 26-Aug-2012
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In addition, an advance directive tells others whether you want resuscitation if your heartbeat or breathing stops. You can also determine whether you want to participate in organ or tissue donation after your death.