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ICD-9 code 521.3 for Erosion of teeth is a medical classification as listed by WHO under the range -DISEASES OF ORAL CAVITY, SALIVARY GLANDS, AND JAWS (520-529).
Erosion of teeth:
due to:
persistent vomiting
With another successful HEALTHCON conference in the rearview mirror, it's now time to look forward to all that summer offers. It's also the perfect time to look ahead to all of the exciting t... [ Read More ]
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|Key Multiclass Information
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Minimum initial investment is $10,000. The Class AAA Shares are open to new investors who purchase shares directly through the Distributor, G.distributors, LLC. Investments through intermediaries may be made in the Advisor Class.
Investing in foreign securities involves risks not ordinarily associated with investments in domestic issues including currency fluctuations, economic and political risks. As a non-diversified Fund, the Fund may have a larger portion of its assets in a single issuer than a more diversified fund. Because the Fund invests in announced mergers or acquisitions, the Fund is subject to the risk that the announced merger or acquisition may not be completed, may be negotiated at a less attractive price, or may not close on the expected date. The Fund may not achieve its objective and you may lose money by investing in the Fund.
Investors should carefully consider the investment objectives, risks, charges and expenses of the Fund before investing. The prospectus, which contains more complete information about this and other matters, should be read carefully before investing. To obtain a prospectus, please call 800-GABELLI or visit www.gabelli.com.
The Gabelli Mutual Funds are distributed by G.distributors, LLC., a registered broker-dealer and member of FINRA.

subset: commoncrawl


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Is it safe to call this the revenge of the nerd? After 39 days on the lush island of Caramoan in the Philippines, John Cochran took home the title of Sole Survivor on the shocking season 26 finale on Sunday, May 12, beating out fellow finalists Dawn Meehan and Sherri Biethman.
"Yes, I'm quite aware that it's all downhill from here for me," the 26-year-old Harvard Law graduate tweeted jokingly on Monday. Cochran, who originally appeared on Survivor: South Pacific back in 2012, won the jury's final vote unanimously, and even host Jeff Probst seemed gleeful to announce Cochran as "probably the most unlikely winner, ever!"
"I kind of want to get a Segway, as lame as that is," he told The Hollywood Reporter of how he'd spend his $1 million check. "I don't know how often I'd use it, but I'd like to just ride around on one. Even if it's just doing circles in my living room." He also mentioned sinking some money into a new apartment and "a lot of wireless gizmos and stuff."
During the season's high-drama season, Cochran was also able to survive the entire run of the game without having a single vote cast against him during Tribal Council, an impressive accomplishment that only one other Survivor winner can claim (J.T. of Survivor: Tocantins).
"On the one hand, you could say I'm not a threat; nobody bothered voting for me because I'm such a loser, but I'm kind of a winner now, so maybe they should have voted against me," he said Sunday.
To top it off, Cochran also bested the competition in this week's reward challenge, as well as the final immunity challenge, which guaranteed him a spot in the final three.
The last time around, Cochran was the 13th castaway voted off — after his arrogance got the best of him and his attitude rubbed his tribe mates the wrong way. Watching and learning from his mistakes, however, helped Cochran to prepare for what turned out to be a huge payoff.
"Watching yourself on Survivor is a tough experience," he explained to THR. "You get a lot of criticism online. You have to grow thicker skin … The first time, nobody liked me. Getting along with people is a huge benefit. …I was able to think about the game in a very focused way instead of worrying, oh my god they think I'm some loser. I was probably still a nerd, or loser, but I got along with everybody and it wasn't always dominating my thoughts."
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CHIPLEY � The county organizational chart was changed Thursday when the Washington County Board of County Commissioners decided to move the Emergency Medical Services department back under the purview of the county�s Public Safety Director.
CHIPLEY � The county organizational chart was changed Thursday when the Washington County Board of County Commissioners decided to move the Emergency Medical Services department back under the purview of the county�s Public Safety Director.
Commissioner Lynn Gothard made the motion to move the EMS back under the Public Safety Director�s control per the county�s Proposed Progressive Governmental Structure chart, approved in 2008. After discussion, the commissioners voted to make the move, with Commissioner Joel Pate voting against the change.
On the chart, in 2008 the EMS is listed under the Public Safety director, but in 2009 the chart was revised and EMS was moved out to be a department on its own.
Currently the county does not have a public safety director, since the retirement of Roger Hagan in December.
�Roger Dale was a coordinator with all the departments,� Pate said. �They (EMS) pay more than half its own expenses because they can bill for their services,� Pate said. �And we�re not talking about putting someone there to tell them how to run their department.
Pate said he was chairman of the commission when the EMS moved from the hospital to county control. �It�s been there for seven years, and our system works pretty good. If it ain�t broke, don�t fix it,� Pate added.
The process of creating the progressive structure for the county was a contentious one. �I came onboard to a stack of grievances,� said Human Resources Director Heather Finch, who provided commissioners with a copy of the county�s organizational chart. �It was very difficult, and we had people very upset.�
Finch said the county also reworked the salary structures at the same time. �It was a huge, huge process.�
�I feel the whole thing needs to be looked at,� County Manager Steve Joyner said of the county�s organizational chart. �There are a few things here we don�t have any more. It just needs cleaning up a bit.�
Board Chairman Alan Bush noted that the county�s E-911/GIS was not answering emergency phone calls, but rather, dealt with providing addresses for county properties. �I don�t know why that isn�t under building or code enforcement,� he said.
Earlier in the meeting, county resident Danny Hayes asked the commissioners if there were plans to hire a public safety director. �My question is this, why do we need to fill this position so quick?�
Commissioner Todd Abbott said the county has been looking for a public safety director for some time, even before Hagan announced his retirement.
Hayes said the commissioners should be diligent in searching for a public safety director, and make sure that any candidate hired had sufficient experience and qualifications for the job.
�I�d hate to see just another relative of somebody stuck in there,� Hayes said. �There are so many relatives on the county payroll, if there was ever a funeral the whole county would shut down.�
Angia Morris, president of the Vernon Historical Society, invited the commissioners to attend the dedication ceremony for the newly completed Vernon Bridge, planned for 11 a.m. on Feb. 14. The ceremony is being hosted by the Florida Department of Transportation, the city of Vernon, and Community South Bank, and Gov. Rick Scott is expected to attend, Morris said.
�We invite you to be with us on Valentine�s Day, so bring your sweethearts,� she told the commissioners. �We don�t invite you to speak, but you�re welcome to help us serve food,� she added, jokingly.


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The Alchemy of Forever
Author: Avery Williams
Publication Date: January 3rd, 2012
Publisher: Simon & Shuster Books For Young Readers
Genre: YA/Fantasy/Romance
Synopsis:Seraphina has been alive since the Middle Ages, when her boyfriend, Cyrus, managed to perfect a method of alchemy that lets them swap bodies with any human being. Sera ran away from Cyrus years ago, when she realized that what they were doing—taking the lives of innocent people—was wrong. Yet she doesn't want to die, so she finds young people who are on the brink of death, and inhabits their bodies. Sera has just landed in the body of a girl named Kailey who was about to die in a car accident. For the first time, Sera falls in love with the life of the person she's inhabiting. Sera also falls for the boy next door, Noah. And soon it's clear the feelings are returned. But she can never kiss Noah, because for her to touch lips with a human would mean the human's death. And she has even more to worry about: Cyrus is chasing her. If she stays in one place for long, she puts herself—and the people she's grown to care for—in great danger. Will Sera have to give up the one thing that's eluded her for centuries: true love?
My Thoughts: I found this book for 5$ at a book store and after reading it I am really surprised it was being sold at such a low price. It's a relatively new release,just over a year old and it's definitely a really great read. Not that I am complaining obviously, I got a great book at a great price and as a book lover that is a wonderful thing, but I feel like it should have been worth more.
It is a pretty short read though, I read the whole thing in one sitting. It was the kind of book that had you turning the pages non stop. I had taken it off the shelf and to bed to read a couple chapters before I passed out. But I ended up not closing it again until I was done and it was way past bed time.
This book absolutely keeps you intrigued and interested! Seraphina has been alive for a very very long time but she has had to do terrible things to achieve this immortality. Sera was entranced by love and romance and the excitement of eternal life for a years, but the magic is definitely wearing off and the romance is hardening. Although she has made some great friends in her long course through life she has come to realize the depth of what she is doing, and what the man she has been with for so long is really like. But just as she makes the decision to move on and leave immortality behind, a fateful event changes everything and Sera finds herself in yet another body.
The story was fast paced, short for jam packed full of excitement and drama. I developed a very quick attachment to Sera and all of her humanity, of which she has a surprising amount of for someone who has been alive for so long. I really loved the idea of a person hopping from body to body eternally and I kept thinking to myself that if a prequel were ever made to this story that I would love it. I would love to read about the years between Sera becoming who she was and her coming to a realization that she was a monster of sorts. A girl can dream can't she?
Even still, it was a fantastic read and I would whole heartedly recommend it to any and all YA & Fantasy/Paranormal fans. It's definitely one you should add to your list. It won't take too much of your time to read and you'll be glad you did. I know I need to get my hands on the sequel because I can't wait to see what happens next with Sera!


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Pastoral Wisdom
The fourth Saturday of this month is legendary for college football fans. It is the annual clash between Alabama and Tennessee (two of the Deep South's most storied football programs). Alabama fans recognize Coach Paul "Bear" Bryant's iconic status. The …Read More
David Osborne
Rev. David Osborne is a campus minister with Reformed University Fellowship at Western Carolina University.


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Taking a page from the latter-day rides of Jobst Brandt, I rode up Hwy 84 (30 cars passed going my way between the Portola Road and Skyline) and down 84 to reach the Pacific. It's obvious why this route became the ride of choice, being the easiest climb to Skyline.
At the coast I headed south with no wind under high clouds. Wave action was enough for the surfers to have a good time at San Gregorio and Pomponio state beaches. I stopped to grab a photo of Pomponio State Beach, the least visited of the nearby beaches.
Pescadero was quiet two days before the 4th. As I headed back up Pescadero Road I noticed someone put a silver globe on the snout of the nicely done Mastadon wood carving.
While climbing Alpine Road, I remember Jobst always wanting to go this way and me always wanting to go up 84 to Old La Honda. Alpine is too hard, I complained. Now it's my ride of choice. Mindego Hill and those redwood forests in Portola State Park make it worth the effort.


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PleasureTime wrote:Hey gofast24, I notice that you don't include any of your model info in your post. Most of us include model, year and power as part of a signature if that will help.
PleasureTime wrote:Open your profile and add the information in the block headed "Signature" along with any other information you would like to display with your posts.
Flying Scott wrote:Dear Rommer
As I am a new member and have attempted to post a question and have been barred from posting because I have not had much activity as a new member.
I am looking for the information that will allow me to correspond with other members or the control group. I can find no clear instructions that will lead me through the preliminary procedures.
Flying Scott
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Which Twins Players May Break Out in 2013?
The Minnesota Twins won only 66 games and lost 96 last season, and this year, expectations are low as the Twins are a team that has basically a new pitching rotation, and outfield.
The Twins start a brand new season at Target Field against the Detroit Tigers. The Twins aren't the favorite to win the American League Central, and the Tigers are. The Twins are a team that can fly under the radar, and a here's a few young players that could lead the Twins this season.
Aaron Hicks, CF
Aaron Hicks was named the Twins starting center fielder earlier this week, and his confidence is high after a excellent Spring Training. In the spring, Hicks hit .350/.397/.650 with four home runs, 16 RBIs, 16 runs, and three stolen bases. His spring highlight came when he blasted three home runs against the Philadelphia Phillies.
Vance Worley, RHP
Vance Worley was traded to Minnesota from Philadelphia for Ben Revere, and has the potential to be the Twins ace in their starting rotation. Worley is 0-1 with a 6.35 ERA and eight strikeouts in the spring, but the last few years in Philadelphia he has showed glimpses of a bright future. Worley's best year was in 2011 when he went 11-3 with an 3.01 ERA and 119 strikeouts.
Glen Perkins, LHP
Glen Perkins used to be a starter for Twins, but now he is ready to take over the Twins closer role full-time. Last year, Perkins was 3-1 with a 2.56 ERA and 16 of 20 in saves. He struck out 78 batters in 70.1 innings pitched.
Kyle Gibson, RHP
Gibson is coming off Tommy John surgery, and will start the season in Rochester, but soon could find himself in the Twins rotation soon. Gibson is one of the Twins top pitching prospects.
Liam Hendriks, RHP
Hendriks struggled in his first year in a Twins uniform last year in their pitching rotation, but this year he is back, and wants to get redemption. Hendriks is 2-1 with a 4.15 ERA and 13 strikeouts this spring. Last year, he was 1-8 with a 5.59 ERA and 50 strikeouts in 85.1 innings pitched. Yesterday, however, Hendriks left a Spring Training game with a a hand injury.
Scott Diamond, LHP
Diamond had a fantastic rookie season last year for the Twins, and will start the season on the disabled list. However Diamond is ready to build off his rookie season, where he went 12-9 with a 3.54 ERA and 90 strikeouts. Diamond is scheduled to be back April 12, and last Saturday, he gave up three runs on five hits in three innings and two strikeouts in a spring game.
Trevor Plouffe, 3B
Plouffe has a year under his belt as the Twins starting third baseman and is hoping that he can hold onto the job. Plouffe is hoping to prove that last year wasn't a fluke. So far this spring, he has hit .395 with no home runs, and three doubles. He's had 15 hits, six RBIs, and five runs as well. Last year, Plouffe broke out for the Twins and hit .235 with 24 home runs, 99 hits, 56 runs, 55 RBIs in 119 games played.
The Twins are young, and to help their young players feel comfortable in the Big League, veterans Joe Mauer, Justin Morneau, and Josh Willingham will have to step up and be leaders in the clubhouse.


text: The newest addition to the QX Models of sport boats continues the Rinker tradition of exceeding expectations, now delivering performance and comfort in a compact package. A new running surface, designed from the water up, allows the 17QX to cut through the water with your choice of an efficient 90 horsepower package or the increased performance of an 115 horsepower package. Either way, family fun on the water now comes in an accessible, yet value packed platform, the 17QX.


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Events Search and Views Navigation
Events for January 3, 2018
6:45 pm
Want to get fit AND have fun at the same time? Join us three times a week for Zumba dance experience. We have three different session during the week. Mondays and Wednesdays from 6:45 pm to 8 pm and Saturdays from 9:30am to 10:30 am (*For the summer there will not be classes on Saturday [...]Find out more


text: Israel's Evolving Relationship with the US Partilhar 1 OCT 2016 The American Lawyer Israeli companies and law firms are taking their business international – and the US should take note. "It was a great step in the right direction to allow foreign lawyers to register with the Israeli bar." – Jeremy Lustman, DLA Piper Once something of a one-way street, Israel's business relationship with the United States is now on a much more equal footing. Some 250 multinational companies, including Intel Corp., Microsoft Corp. and GE Healthcare, maintain research and development centers in Israel, which has long been known for its technological advances. Read the full article here. Reprinted with permission from The American Lawyer.


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Is HIV still considered an emergency?
Considering the constant rise of new infected (an estimate of 100 million people in 2012) and the fact that people still die from the disease the attempts and efforts to cure HIV or even eradicate it failed and are very discontinued and low. My question is very simple. Is HIV still an emergency? I would say yes but only for those who have no access to the meds. Unfortunately they are not on the top of the agenda for the producers of the meds since they have no money and money is the key factor in the process of the disease and the making of a cure. Did you ever consider how many people will lose their lives until a cure or potent medicine will destroy the virus? How many millions of people? The nazis killed 6 million human beings. The virus is doing the same and scientists and pharma industries are still allowing this. Is it a matter of money or knowledge? Are we still too ignorant and incompetent to kill the virus after 25 years? I'm surprised with what courage scientists are waiting and saying that 10 years are still needed to make gene therapy available for treatment. I would put any cadaver from AIDS in front of the door of those scientists.
Is HIV still considered an emergency? Unfortunately many Americans do not "consider" HIV/AIDS to be an emergency any longer. However, that does not mean that it is not an emergency!!!
Your perception that "scientists and pharma industries" are willfully allowing people to die of HIV/AIDS is incorrect. See below.
Dr. Bob
opinion (CURE 2009) Aug 13, 2009
hi Dr Rob, i am newly diagnosed HIV1 positif, and i have a small question to ask, with all the technology and the increasing development in the medcation fieled do you think that one day their will be a cure to the HIV, if yes please explain for me the theory that you have in mind, and if no, what makes it impossible to find that cure, knowing that the hardest deseases were cured nowadaya. i know sounds like a stupid question, but according to the statistics in many diffrent field human race is developing very fast comparing to perviouse century. sorry to waste your time on this question maybe to you it sounds stupid but to me its not thank you very much for your time
Response from Dr. Frascino
Check out the archives of this forum. We have a whole chapter devoted to "HIV cures." I'll reprint below some information from the archives.
Let's all be here for the cure, OK?
Dr. Bob
Cure for HIV/AIDS (CURE 2009) (CURE 2009) Feb 19, 2009
Hi, I have been wondering why it is so difficult for HIV/AIDS cure to be found especially for Americans who nothing is impossible for. I am from Africa living with HIV. Would there ever be a cure for this deadly disease and when?
Response from Dr. Frascino
See below. I have nothing new to add at this time.
Dr. Bob
cure (CURE) Feb 6, 2009
what are the limitations in finding the cure for hiv
Response from Dr. Frascino
Time for an HIV cure reality check, as this question comes up frequently. Care to guess how many viral disease we can cure today with medical therapy? One! That's right; only one: hepatitis C. And even hepatitis C is cured only very infrequently! Sure we can prevent some viral illnesses, like mumps, measles, rubella, etc. And some viral infections can subside but remain dormant in the body forever or have periodic flare-ups (herpes, EBV, for example). Many viral infections resolve spontaneously over time, such as the flu or common cold. And of course there are those viruses that can plant us six feet under very, very quickly, such as Ebola. HIV is a very clever and tricky virus indeed. It hides out in the genetic material (DNA) of some of our longest-lived human cells. This makes it extremely difficult to wipe out HIV without wiping out the human host at the same time.
Lots of folks get frustrated that a cure hasn't been found. Conspiracy theorist crackpots think that pharmaceutical companies or the government are withholding the cure to make money. This, of course, is pure lunacy. After all, there are loads of other chronic incurable diseases we haven't yet conquered, such as asthma, diabetes, Parkinson's, Alzheimer's, high blood pressure, arthritis, etc. Some of these illnesses, like HIV, are becoming more manageable as we learn more about them and develop new and novel therapies. Will there ultimately be a cure for HIV? I, for one, certainly remain hopeful.
Dr. Bob
In our life time (CURE, 2009) Feb 4, 2009
Hello Dr.Bob just wanted to tell u that u are doing a good job on here. My question is do u think that in our life time they well ever find a cure for HIV. I'm HIV+ for 2 years now and eveyday I'm praying and looking for a cure. Its like eveyday my hopes keep getting smaller and smaller. Should I be waiting or should we as HIV+ just let the cure fall into our laps someday.
Response from Dr. Frascino
I strongly doubt a cure for HIV/AIDS will fall into our laps! The way to the cure is scientific research. This unfortunately requires significant funding as well as considerable talent and knowledge. And this type of basic science investigation takes considerable time. Should we be optimistic? Well I'm not only a "glass half full" kind of guy, but actually more of a "glass overflowing" type. I remain very optimistic we will eventually make HIV/AIDS nothing more than a bad memory. I'll reprint below some information from the archives that discusses progress toward "the cure"!
Dr. Bob
RESEARCH FOR A CURE... Apr 5, 2008
Why does not the United States and other wealthy countries join up and spend their billions to find a cure meaning elimination of the virus ?
A third of the money spent on PEPFAR could stroke up the research engine and a program of the dimensions of the moon shot could do it . Atleast even if we do not succeed the science spinnoffs would be enormous. - Why do the aids activists the US not pursue this goal ? Have they given up hope for a cure..
Response from Dr. Frascino
Have we given up hope for a cure? Absolutely not! See below!
Dr. Bob
The Cure: Why, Whether, How and When
By Martin Delaney
April 2008
More than three years ago, Project Inform kicked off a campaign to refocus the attention of the patient, activist and research communities on the need for a true cure for HIV disease. The success of combination therapy and treatment simplification seemed to have created a wave of complacency and a sense that, except for side effects, HIV treatment was finally "good enough." Project Inform has challenged this view ever since. Though the effort was sometimes ridiculed as nave, a number of influential groups and researchers have now joined the campaign.
Today more people than ever agree that the current standard of lifetime maintenance therapy is not an adequate solution to the HIV epidemic. Several factors made this conclusion more obvious than ever. This article examines four issues about the notion of curing HIV disease: (1) why the goal of curing HIV disease has become so critically important; (2) whether a cure is feasible given current and near future technology; (3) what "cure" means and how it might be achieved; and, (4) when this might be possible. The article also closes with new information about efforts now underway toward reaching this goal.
- Why Is a Cure so Important? This may seem obvious to just about anyone with HIV disease, but it has not always been so. Today's regimens offer dramatically better outcomes than what people typically faced earlier in the epidemic. It might be easy for some to think that the problem of HIV has largely been solved. Not quite. Not even close.
Thankfully, the days of a short-term death sentence are well behind us. With good care and treatment, it's fair for people with HIV to expect to live out a relatively normal lifespan. Missing from the greatly improved picture are the ways in which HIV disease still complicates the lives of those affected as well as its costs to both the individual and the public.
Today, HIV treatment means a lifetime of using multiple, expensive medications whose long-term side effects can't be known until they have actually been used long-term. Today's drugs are easier to use and appear far less toxic, but only a few have been used for 10 or more years. We have yet to learn what the consequences will be of 20 or 50 years of use.
Another thing typically overlooked is the lifetime cost of treatment which currently averages between $12,000-$25,000 a year for relatively healthy people with HIV, and much more for those in advanced stages of disease. While these costs have been met in the short-term, we're only beginning to look at the lifetime costs of being on regimens for up to 50 years. It's simple: do the math! And what about the developing world, where roughly 90% of the world's cases of HIV occur? Despite massive infusions of money, and despite reducing the costs of drugs to virtually that of their raw materials, efforts still only reach a modest percentage of the people worldwide who need treatment.
The US committed more than $15 billion to HIV treatment in developing countries over the last five years through the PEPFAR program. The World Health Organization, Global AIDS Fund, Clinton Foundation and many smaller groups along with support programs from the pharmaceutical industry have made enormous additional contributions. The reach is still too small and the amount of money needed must be increased many times over to reach even the most vulnerable parts of the infected population.
It has long been hoped that this would only be temporary; that we would have a vaccine and the numbers of people infected each year would finally begin to drop. Sad to say, but the search for a vaccine hit a wall in the last year. In many ways, we may now be no closer to a vaccine than we were 20 years ago. Some of the most prominent scientists in the world are warning us that a vaccine may never be possible due to HIV's unique properties.
At the very least, if there is to be an HIV vaccine, we currently have no idea how to make one. Similarly, great hope was invested in using microbicides -- gel-like compounds applied to the areas of sexual contact that hopefully block HIV infection. But so far these have proven about as effective as vaccines, which is to say "not at all."
Thus, when we take a sober look at the fight against HIV in the developing world, the prospects of lifetime therapy don't look so good either. First, the expenditures by wealthier nations will have to drastically increase, and then these sums must be sustained for the next 50-100 years, assuming there's no vaccine in the near future. We must ask: how likely will developed nations continue this level of support for as long as it's needed?
Sadly, the answer is not very likely. For one, there's little precedent for sustained medical effort in developing nations, let alone one as expensive, difficult and lasting as fighting HIV is. Secondly, the costs are so large they may not be sustainable at all. Even the great private funds like taht of Warren Buffet will be bankrupted over time by this fight.
In short, lifetime therapy is not a realistic solution for HIV disease even in the US and Europe let alone the developing world. The situation can only worsen if unexpected long-term side effects appear over time.
It should be abundantly clear: the only way to effectively conquer the epidemic is to cure the disease. We cannot coddle the virus with a lifetime of drugs. People with HIV should be enormously grateful to all those who have contributed to developing the drugs we have today. Millions more would have died without them. But their utility is limited and they're not a true long-term solution. The goal of fighting HIV for the first 25 years was to create and distribute effective anti-HIV drugs. The goal of the coming years must be to get people OFF the drugs and back to a state of normal health.
- Is a Cure Feasible? It is one thing to conclude that a cure is needed, and perhaps it's the best and only real solution to the epidemic. It is quite another to say that it's possible to create one.
Many scientists argue a cure is unrealistic with any conceivable technology. They quickly insist that a cure requires the complete eradication of HIV. Every copy of it must be prevented from infecting a cell, and every cell that already contains HIV must die off or be destroyed. Otherwise, they believe, the infection will just start up all over again.
While this sounds reasonable at first, is it necessarily so? It is important to ask scientists, "Just what data support this? What study or observation concludes that you have to eliminate every last copy of HIV or infected cell to reach a point where it's no longer a problem?" There are no such data, no such studies. It is a belief, not a scientific fact.
The hints we have from data largely suggest that the opposite may be true. Many viruses peacefully co-exist in the human body, though in some cases they can be highly destructive. Two good examples are CMV and JCV. CMV can cause blindness and death; JCV can cause a horrible form of dementia that leads to death. Yet each is quietly present at low levels in most people and does little or no harm except in rare circumstances.
What about HIV? In primates, the equivalent of HIV is called SIV, and it often replicates freely yet does not cause harm or become AIDS. It's how the immune system reacts to it that causes the harm. Moreover, we know there are literally thousands of humans with HIV who, due to a combination of factors, either maintain only low levels of HIV or simply don't get sick from it. They may be a small minority, but they prove the point: HIV, even in the absence of treatment, is not always destructive.
The data simply do not support the notion that the only way to survive HIV is either through lifetime therapy or by complete eradication of virus. It would be ideal to rid the body of HIV, but an effective cure may NOT require this. If anything, the data suggests the opposite.
We see people repeatedly exposed to HIV who never become productively infected. We see that reducing, though not eliminating, virus in a pregnant woman almost completely eliminates the risk of her passing the infection onto her child. We know that true long-term non-progressors, or elite controllers, sustain some level of HIV infection but show little evidence of clinical illness.
Perhaps a harmful case of HIV requires a certain level of virus before it becomes destructive. Maybe treatment can push the level of virus low enough that it no longer matters. Possibly some of the new properties shown by drugs like CCR5 antagonists and integrase inhibitors may change the underlying conditions that make harmful HIV replication happen.
Dr. Steven Deeks, a key researcher from the University of California, summed it well at a recent Project Inform Update Town Meeting when he said, "Beware of grey haired scientists who tell you something is impossible." He is hardly alone.
There's a growing cadre of young investigators at universities, the NIH and drug companies who believe a cure is indeed feasible, and perhaps sooner than many think. It is instructive to remember that shortly after HIV was found to be the cause of AIDS, some researchers claimed, "It will be impossible to treat this disease at all." Within 21 months, the first drug was approved by the FDA. Little more than 20 years later, scientists claim that people with HIV and access to treatment could expect to live a normal life span. A cure is not only possible; it is the next step in HIV research.
- How Can HIV Be Cured? It is admittedly premature to pronounce that one approach or another is the most likely avenue to curing HIV. Instead, there are a number of possibilities. What we need are some serious programs to develop and test them. So far, the most widely tested approach has used just antivirals, alone or together with another kind of drug to try to eradicate HIV.
Scientists back in 1996 thought it would be enough to simply give people the strongest antivirals for several years in a row and this would gradually eliminate even the last copies of HIV. They were wrong, but this led to the discovery that HIV was being sustained, in relatively small amounts, in "reservoirs." These were generally inactive cells, like memory T-cells, which the immune system only rarely activates and uses. They're largely unaffected by HIV drugs and the immune system. For some reason they can only be reached when they are activated.
This led to a second approach, one that was predicted in the 1980s. It also used the most potent antivirals and added a second type of drug to activate these reservoir cells. This ultimately proved dangerous, as it activated all the cells in the body. Still, some scientists believe we haven't given this approach a fair trial. They argue that perhaps we need to use this approach more slowly, but repeatedly, in hopes of reaching all the cells in the reservoirs, but not all at once.
Although neither approach succeeded, they showed that when patients were treated in this way, they would sometimes remain free of active replication for a month or longer without therapy. A similar early attempt used the immune modulator IL-2, which is T cell stimulator, to achieve this goal. This too seemed to delay the return of viral replication in people whose antiviral treatment was interrupted, but it eventually failed.
Thus, attempts at eradication have neither succeeded, nor completely failed. Several studies are now underway to further test eradication theories by using the new integrase inhibitor drugs. Their different mechanism of action offers some theoretical benefits compared to previous antivirals. Remember, though, that we really don't know whether a "cure" actually requires complete eradication.
A recently reported case study from Germany described what happened when a patient was given a stem cell transplant, for treating cancer, by using cells from a donor who lacked the genes that cause the body to make the CCR5 receptor favored by HIV. This case study is described in more detail on Project Inform's website in our coverage of CROI 2008.
More than 300 days after the transplant and any use of antivirals, the patient still shows no evidence of HIV replication, either by standard viral load testing or a more sensitive test that measures what's called pro-viral DNA. Though the investigators are not calling it a cure, they continue to follow the patient to see whether or when HIV replication might restart.
At the very least, it seems to prove the concept that when viral levels are greatly reduced, even if not eliminated completely, the body seems to keep HIV well in check for long periods without antivirals. It would be difficult to find enough donors who have this very special type of genetic mutation, so this exact procedure is not practical for large numbers of people. A similar goal could be achieved through gene therapy, something which eventually could be applied to large numbers. Other types of gene therapy also offer hope in the pursuit of a cure.
Yet another approach seems to offer hope, even if it proves necessary to go after every cell that has been infected by HIV. A German group revealed a new technology, on a laboratory level, which is able to extract viral genetic sequences that have been integrated into human cells. It's a long way from being a practical therapy, but again, it shows proof of the concept.
Other scientists are working on ways to suppress the inflammatory processes triggered by HIV infection. Some believe that it is inflammation rather than any unique activity of HIV that makes it harmful. They believe it causes harm primarily because it causes cells to release inflammatory proteins, which in turn harm the body. If this is correct, turning down or turning off the inflammation may be enough to change HIV into a harmless virus.
These and other approaches all rely on a simple definition of what curing HIV must mean. Cure, in this way of thinking, may not mean absolute elimination of the virus. Rather, it simply requires reaching a state where either there's no measurable HIV replication despite withdrawing therapy, or where the immune response to HIV is changed in ways that no longer harm the body or immune system.
A cure also cannot be expected to automatically repair any damage done to the immune system when HIV was active. It would be great if that could be achieved, but it's not a standard we demand of other cures. Sometimes a cured disease leaves damaged tissue or cells behind. Sometimes the body fixes them over time; sometimes it doesn't. Antiviral drugs aren't completely fixing the immune system now, so we cannot demand that a cure will do it either.
- When Can a Cure Happen? This question is impossible to answer. At best, prediction is a tricky business. However, a number of the more enthusiastic researchers seeking a cure believe that the solution may be closer than most believe. Claims that it won't be possible until far in to the future are based on the false definition of cure, the one that demands absolute eradication. Once we realize that this is not required, the cure doesn't seem so very far away.
It's now routine to reach HIV levels below 50 copies. Studies with new drugs are now using a test that measures down to 5 or 10 copies, and there's evidence that the drugs are succeeding at this level. Researchers will need to retest various eradication approaches using these new therapies. We really don't know what happens when HIV is suppressed this low for long periods. Similarly, a few first generation gene therapy studies are well underway and near completion. These may not be the total solution but could well point us there, as does the German stem cell transplant program. The most optimistic researchers we have spoken to believe we will see the first evidence of a cure in as soon as 5 to 10 years.
A few argue that it has already happened, but our ability to see and measure it lags behind. It is even possible the immune system itself has done the job in some cases, but we just don't know it. Why? Because once a person gets truly well, they are seldom studied. We simply would not know if there have been people all along for whom the natural immune response has been sufficient.
We believe this process can and must be accelerated. It currently receives very little funding -- just a tiny fraction of the amount spent developing new antivirals. We are aware of only two pharmaceutical companies that are actively pursuing cure-based research. Merck has a lab dedicated to studying eradication in the same systematic way they develop a new drug. Tibotec/J&J is already engaged in a very interesting gene therapy study that may help point the way. We'd like to see every drug company invest in this area, if for no other reason than the fact that it might offer the last hope for big profits in the fight against AIDS.
There are now 24 antivirals on the market. Each gets only a modest portion of the revenue generated by only about 10% of people with HIV. If the lure of profits is what it takes to generate interest in the cure, so be it. While a cure would certainly end the drug companies' revenue stream from lifetime therapy, several have argued that there are far more profitable areas of medicine and drug development than HIV. They would make more money working in those areas once their patents in HIV expire.
Given the failure of vaccines and the difficulties faced in microbicide development, along with the prohibitive costs of lifetime therapy, we believe research funding must be redirected toward the kind that can result in a cure. This will require a large change in how research is funded, and it requires new insights from basic science as well as clinical research.
Efforts are underway to make this happen. In December 2007, more than 125 scientists from around the world came together in a meeting dedicated to unraveling the challenge of HIV persistence and eradication. These scientists, along with a few activists and foundation representatives, are committed to this type of research.
amfAR has already issued a series of program grants for work in this area. A collaboration of community groups is also organizing a scientific meeting that will take place in the fall to develop plans and strategies to enhance and support this research. TAG (Treatment Action Group), amfAR, FAIR, The Forum for Collaborative HIV Research and Project Inform have banded together to organize and help fund this meeting, which may be the first of several. amfAR is considering a second round of grants to support such work, and FAIR (the Linda Grinberg Foundation for AIDS and Immune Research) will fund another group of proposals.
Collectively, we hope to further influence the Division of AIDS at the National Institute of Allergy and Infectious Diseases to increase its commitment to this type of research.
As we shift our thinking in pursuit of a cure, we will not abandon interim needs. There is still a need for better and less toxic antivirals. There's a profound need to figure out how to make the best use of the new drugs we've recently gained. Project Inform is pursuing these needs on a separate but parallel track through another scientific conference we're organizing for the fall, called HAART 2.0. This meeting will help develop strategies for testing new paradigms of treatment with current drugs. These include such things as one- and two-drug regimens, eliminating the most toxic agents, and reducing the use of drugs that harm the liver or heart. Some of what we learn through that process will not only benefit patients in the short-term but will also contribute toward the final push for the cure.
A Personal Comment As many of you know, I (Martin Delaney) officially retired from my programmatic role at Project Inform in January, but I have not left AIDS work. I am committed to making this focus on a cure the core of my work in the final chapters of my life. Like others at Project Inform and many other organizations, I believe that we can and must find a real cure. There is no other real solution on the horizon. This is as true for the US and Europe as it is for the developing world. We won't have a cure unless we believe in it and pursue it as our primary goal. We're going to have a cure, and it will happen in our lifetimes.
Funtional Cure Jan 13, 2009
I would like to know what is a "funtional cure" for HIV? I've read before somewhere that a funtional cure my be possible before a total (eradication)cure of HIV from the body.
Response from Dr. Frascino
Basically there are two types of potential "cures" for HIV: sterilizing and "functional." A sterilizing cure is synonymous with "viral eradication" (i.e. the elimination of every viral particle from an infected person). This has been achieved in some folks who had hepatitis C but never ion someone infected with HIV. Because of HIV's uncanny ability to persist and replicate, even after a decade or more of fully suppressive therapy with potent antiretroviral drugs, it was felt for some time now that a sterilizing (eradication) cure was the only real cure. Recently we've begun to discuss another type of "cure," a functional cure.
A "functional" cure would mean that even though HIV was not totally eliminated from the body, an HIV-infected person would be able to live and be healthy long-term without the need for antiretroviral drug treatment.
Dr. Fauci, the head of the National Institute of Allergies and Infectious Diseases at the National Institute of Health (NIH), discussed the potential of a functional cure for HIV at his presentation at the International AIDS Conference in Mexico City in August of last year. The potential model for a functional cure would involve very early and very aggressive HIV-drug treatment, possibly combined with HIV-specific immune-based therapies. This model would require diagnosis very soon after infection (days) and the access to very aggressive therapies. I should point out the concept of a "functional cure" is still experimental at this time. However, it is encouraging to hear someone of Dr. Fauci's status talking about a cure. Stay tuned to The Body. We'll keep you posted as this story evolves.
Dr. Bob
Funtional Cure Jan 13, 2009
I would like to know what is a "funtional cure" for HIV? I've read before somewhere that a funtional cure my be possible before a total (eradication)cure of HIV from the body.
Response from Dr. Frascino
Basically there are two types of potential "cures" for HIV: sterilizing and "functional." A sterilizing cure is synonymous with "viral eradication" (i.e. the elimination of every viral particle from an infected person). This has been achieved in some folks who had hepatitis C but never ion someone infected with HIV. Because of HIV's uncanny ability to persist and replicate, even after a decade or more of fully suppressive therapy with potent antiretroviral drugs, it was felt for some time now that a sterilizing (eradication) cure was the only real cure. Recently we've begun to discuss another type of "cure," a functional cure.
A "functional" cure would mean that even though HIV was not totally eliminated from the body, an HIV-infected person would be able to live and be healthy long-term without the need for antiretroviral drug treatment.
Dr. Fauci, the head of the National Institute of Allergies and Infectious Diseases at the National Institute of Health (NIH), discussed the potential of a functional cure for HIV at his presentation at the International AIDS Conference in Mexico City in August of last year. The potential model for a functional cure would involve very early and very aggressive HIV-drug treatment, possibly combined with HIV-specific immune-based therapies. This model would require diagnosis very soon after infection (days) and the access to very aggressive therapies. I should point out the concept of a "functional cure" is still experimental at this time. However, it is encouraging to hear someone of Dr. Fauci's status talking about a cure. Stay tuned to The Body. We'll keep you posted as this story evolves.
Dr. Bob
lack of superinfection and 'cure' Feb 6, 2009
hi doc. it appears there's been some recent reevaluating regarding the topic of superinfection, written about on this very site.
a study lends credence to the theory that not only does superinfection not occur, but 2 poz partners become immune to the other's strain. Couple this with the study of the prostitutes who stayed healthy until they STOPPED exposing themselves with new HIV, and couple that with the fact that the initial natural immune response to hiv is very good,... we can come to a theory:
treatment for poz people should include perpetually re-exposing the patient to hiv.
Its like that Grindhouse movie where Bruce Wilis and the soliders are zombies, but they stay human as long as they continually intake the virus that causes zombi-ism. Thoughts?
Any studies exploring giving a patient HIV over and over? Are we on to somethign? Thank you, sir.
Response from Dr. Frascino
You want to design a clinical trial in which an HIV-negative person is given repeated exposures to HIV based on a Bruce Willis Zombie movie in which he retains his humanness by continually exposing himself to the virus that causes "zombism"???? Oh my. That has as much chance of getting through an investigational review board as Dubya has of simultaneously winning Nobel prizes for peace, economics and rocket science.
I assume your theory is based somewhat on the intriguing and slowly evolving story about HIV-negative men in long-term relationships with HIV-positive men developing an antibody response in saliva that may inhibit HIV infection. Investigations are underway studying IgA1 antibodies in HIV-negative men in magnetic relationships. To jump from these preliminary reports to a clinical trial such as you suggest is, of course, a quantum leap of faith that no one in their right mind should take, even zombie-ized Bruce Willis. Stay tuned to The Body. We'll keep you updated as we unlock more mysteries related to the immune response to HIV and the potential of induced protective immunity.
Dr. Bob
Bone Marrow Transplant Feb 3, 2009
Hello Dr. Bob, I have a question. I read about a man in Germany who had a bone marrow transplant and hasn't needed HIV meds for 2 years now. He hasn't been cured obviously, but apparently the bone marrow transplant has helped him combat the virus somehow. Is this a possible treatment for HIV, or is this man a needle in a haystack? Have you heard anything about this, and what are you thoughts on it?
Response from Dr. Frascino
As with so very many other questions (95% plus!), the answer to your question was already waiting for you in the archives. See below.
Dr. Bob
First claim of aids cure from the scientific community and qualified medical doctors! (BONE MARROW TRANSPLANT,"FUNCTIONAL CURE" Nov 14, 2008
Hi Dr. Bob,
While I dont have hiv nor have been at risk, I follow your posts just for your great sense of humour and expert knowledge.
Anyway, the news just broke that German doctors have had a breakthrough which might be a big step in finding a CURE for aids.
here are the links: http://ap.google.com/article/ALeqM5hwlpMzO2z0voECw2T4MfOPkOEXNAD94DSGLG0
Am sure everyone would be eager to know your opinion.
Response from Dr. Frascino
See below.
Dr. Bob
bone marrow transplant??? Nov 14, 2008
Hi Doctor,
My boyfriend just showed me this article http://www.usatoday.com/news/health/2008-11-12-aids-cure_N.htm Is this possible true? what do you think about it?
Response from Dr. Frascino
The elusive search for an HIV/AIDS cure has been replete with disappointments over the past 27 years. However, the holy grail of viral eradication ("cure") must remain our ultimate goal. The case report of a 42-year-old American living in Berlin who appears to have had a "functional cure" of his HIV by undergoing a bone marrow transplant for his leukemia may well point the way to new avenues of research aimed at a cure. However, it's worth noting that in 2007 there was a case report of an HIV-positive French man who underwent bone marrow transplantation to treat leukemia and subsequently had an undetectable HIV plasma viral load. His HIV unfortunately rebounded when he briefly stopped taking his HIV meds after the transplant. The young man died when his body rejected the transplanted bone marrow one of the several serious risks associated with bone marrow transplantation. My take on all this is very cautious optimism: I'm hopeful that gene therapy will eventually become a safe and effective therapy.
Dr. Bob
Dr Bob,check this out!!! Nov 14, 2008
a german doctor cured hiv positive american living in berlin http://news.bbc.co.uk/1/hi/health/7726118.stm
Response from Dr. Frascino
This really is a fascinating and highly unusual case. Hopefully it will lead to a resurgence of interest in gene therapy and other efforts aimed at a cure. The particular treatment the Berlin patient underwent would be appropriate for only very few highly selected individuals. The procedure also carries significant risks, including a 30% chance of death. Plus, there may well be unanticipated short- and long-term consequences from the treatment.
I'll print some additional information below. I'll also continue to follow this story as it evolves and report back any promising findings.
Be well.
Dr. Bob
NOVEMBER 7, 2008 A Doctor, a Mutation and a Potential Cure for AIDS A Bone Marrow Transplant to Treat a Leukemia Patient Also Gives Him Virus-Resistant Cells; Many Thanks, Sample 61By MARK SCHOOFSArticle Comments more in Health (See Corrections & Amplifications item below.) The startling case of an AIDS patient who underwent a bone marrow transplant to treat leukemia is stirring new hope that gene-therapy strategies on the far edges of AIDS research might someday cure the disease. The patient, a 42-year-old American living in Berlin, is still recovering from his leukemia therapy, but he appears to have won his battle with AIDS. Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication. Normally when a patient stops taking AIDS drugs, the virus stampedes through the body within weeks, or days.
Sixten Koerper Dr. Gero Hütter isn't an AIDS specialist, but he 'functionally cured' a patient, who shows no sign of the disease. "I was very surprised," said the doctor, Gero Hütter. The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn't an AIDS specialist, deliberately replaced the patient's bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS. The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren't sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning. While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it "a very good sign" and a virtual "proof of principle" for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy. Back in 1996, when "cocktails" of antiretroviral drugs were proved effective, some researchers proposed that all cells harboring HIV might eventually die off, leading to eradication of HIV from the body -- in short, a cure. Those hopes foundered on the discovery that HIV, which integrates itself into a patient's own DNA, hides in so-called "sanctuary cells," where it lies dormant yet remains capable of reigniting an infection. But that same year, researchers discovered that some gay men astonishingly remained uninfected despite engaging in very risky sex with as many as hundreds of partners. These men had inherited a mutation from both their parents that made them virtually immune to HIV. The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 acts as a kind of door for the virus. Since most HIV strains must bind to CCR5 to enter cells, the mutation bars the virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc., doesn't attack HIV itself but works by blocking CCR5. About 1% of Europeans, and even more in northern Europe, inherit the CCR5 mutation from both parents. People of African, Asian and South American descent almost never carry it. Dr. Hütter, 39, remembered this research when his American leukemia patient failed first-line chemotherapy in 2006. He was treating the patient at Berlin's Charité Medical University, the same institution where German physician Robert Koch performed some of his groundbreaking research on infectious diseases in the 19th century. Dr. Hütter scoured research on CCR5 and consulted with his superiors. Finally, he recommended standard second-line treatment: a bone marrow transplant -- but from a donor who had inherited the CCR5 mutation from both parents. Bone marrow is where immune-system cells are generated, so transplanting mutant bone-marrow cells would render the patient immune to HIV into perpetuity, at least in theory. There were a total of 80 compatible blood donors living in Germany. Luckily, on the 61st sample he tested, Dr. Hütter's colleague Daniel Nowak found one with the mutation from both parents. To prepare for the transplant, Dr. Hütter first administered a standard regimen of powerful drugs and radiation to kill the patient's own bone marrow cells and many immune-system cells. This procedure, lethal to many cells that harbor HIV, may have helped the treatment succeed. The transplant specialists ordered the patient to stop taking his AIDS drugs when they transfused the donor cells, because they feared the powerful drugs might undermine the cells' ability to survive in their new host. They planned to resume the drugs once HIV re-emerged in the blood. But it never did. Nearly two years later, standard tests haven't detected virus in his blood, or in the brain and rectal tissues where it often hides. The case was presented to scientists earlier this year at the Conference on Retroviruses and Opportunistic Infections. In September, the nonprofit Foundation for AIDS Research, or amFAR, convened a small scientific meeting on the case. Most researchers there believed some HIV still lurks in the patient but that it can't ignite a raging infection, most likely because its target cells are invulnerable mutants. The scientists agreed that the patient is "functionally cured." Caveats are legion. If enough time passes, the extraordinarily protean HIV might evolve to overcome the mutant cells' invulnerability. Blocking CCR5 might have side effects: A study suggests that people with the mutation are more likely to die from West Nile virus. Most worrisome: The transplant treatment itself, given only to late-stage cancer patients, kills up to 30% of patients. While scientists are drawing up research protocols to try this approach on other leukemia and lymphoma patients, they know it will never be widely used to treat AIDS because of the mortality risk. There is a potentially safer alternative: Re-engineering a patient's own cells through gene therapy. Due to some disastrous failures, gene therapy now "has a bad name," says Dr. Baltimore. In 1999, an 18-year-old patient died in a gene therapy trial. Even one of gene therapy's greatest successes -- curing children of the inherited "bubble boy" disease -- came at the high price of causing some patients to develop leukemia. Gene therapy also faces daunting technical challenges. For example, the therapeutic genes are carried to cells by re-engineered viruses, and they must be made perfectly safe. Also, most gene therapy currently works by removing cells, genetically modifying them out of the body, then transfusing them back in -- a complicated procedure that would prove too expensive for the developing world. Dr. Baltimore and others are working on therapeutic viruses they could inject into a patient as easily as a flu vaccine. But, he says, "we're a long way from that." Expecting that gene therapy will eventually play a major role in medicine, several research groups are testing different approaches for AIDS. At City of Hope cancer center in Duarte, Calif., John Rossi and colleagues actually use HIV itself, genetically engineered to be harmless, to deliver to patients' white blood cells three genes: one that inactivates CCR5 and two others that disable HIV. He has already completed the procedure on four patients and may perform it on another. One big hurdle: doctors can't yet genetically modify all target cells. In theory, HIV would kill off the susceptible ones and, a victim of its own grim success, be left only with the genetically engineered cells that it can't infect. But so far that's just theory. All Dr. Rossi's patients remain on standard AIDS drugs, so it isn't yet known what would happen if they stopped taking them. In 1989, Dr. Rossi had a case eerily similar to the one in Berlin. A 41-year-old patient with AIDS and lymphoma underwent radiation and drug therapy to ablate his bone marrow and received new cells from a donor. It is not known if those cells had the protective CCR5 mutation, because its relation to HIV hadn't been discovered yet. But after the transplant, HIV disappeared from the patient's blood. The patient died of his cancer 47 days after the procedure. Autopsy tests from eight organs and the tumor revealed no HIV. Write to Mark Schoofs at firstname.lastname@example.com Corrections & Amplifications The Foundation for AIDS Research, which uses the acronym amFAR, is the name of the nonprofit group cited in this article. The name of the group was incorrectly given as the American Foundation for AIDS Research.


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Author Notes: Given that we are talking about nose to tail, I'm offering you a piece of pig face that's fit for a pope. You really should seek out real guanciale for this authentically Roman recipe. This plate can be prepared in the time it takes for the water to boil and the pasta to cook. The key ingredient is "guanciale" which is an unsmoked bacon made from pork jowl. This recipe serves two but it can easily be doubled. Keep in mind that pasta is typically served as a first course ahead of the entrée. —pierino
Food52 Review: WHO: pierino is a self-described "standup commis, fougassier and flaneur" and a trusted Food52 authority on Italian food.
WHAT: A pitch-perfect recipe for the Roman classic.
HOW: Saute the shallot and guanciale, add the tomatoes, then the pasta. Grate cheese. (That's it.)
WHY WE LOVE IT: This recipe is a perfect example of why we love Roman cooking: simple, good-quality ingredients, prepared in little to no time. You can find guanciale at your butcher, but, if needed, you can substitute pancetta or bacon. —The Editors
Serves: 2-4
handful bucatini pasta, or substitute perciatelli
Olive oil, about 2 tablespoons or enough to coat the bottom of your pan
large shallot or the equivalent amount of chopped onion
dried hot pepper, coarsely chopped and seeds separated. Alternatively, ½ teaspoon red pepper flakes (separate the seeds with the point of a knife).
ounces guanciale, chopped (or substitute pancetta or bacon)
ounces chopped, canned tomatoes (in summer by all means substitute fresh)
Freshly grated pecorino cheese
Salt and pepper
A chiffonade of two basil leaves or alternatively a small handful of finely chopped parsley for garnish; very optional
- Heat the olive oil until it's shimmering but not smoking. Saute the the shallot, the guanciale and the pepper flakes until the onion is only lightly colored.
- Turn down the heat to low and add the tomatoes. Simmer this while the pasta is cooking. Add salt and pepper.
- When the pasta is cooked drain it saving a few tablespoons of pasta water (if needed). Add the drained pasta directly to the sauce and stir to combine. Make sure the sauce is "tight" but if it's too tight flick in a little bit of the pasta water.
- To plate: using tongs portion out the pasta on warm plates. Grate the pecorino cheese over each. If using the garnish sprinkle it over the top.
- Notes to cook: it's worth your trouble to source real guanciale even if it is domestic. You can substitute pancetta but we are talking nose to tail here, so we want you using face parts. Bucatini is a long, relatively thick strand of round pasta with a pinhole running through it. Latini is a good brand as is Rustichella D'abbruzzo. But perciatelli works just fine. Focus on the guanciale.
- Find the guanciale. Make me proud. You can do it.
- Note to cook: You can up the amount of red pepper if you like but we're not going all' arrabbiata here.
- This recipe is a Community Pick!


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BlueSteps is the career management service of the Association of Executive Search and Leadership Consultants (AESC). Firms like Dr. Bjorn Johansson Associates utilize BlueSteps to connect with executives from around the world and to share with them insider advice on realizing their executive careers.
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Executive Job Searches
Explore hundreds of executive jobs worldwide across industries and functions, many of which are exclusively shared with us by executive recruiters.
Career Advising
Work one-on-one with our professional career coaches and resume writers to optimize your career documents, develop your personal brand, prepare for interviews and more.
Executive Recruiting
BlueSteps profiles are visible to 9,000+ executive recruiters who use BlueSteps every day to find candidates. You can also research and connect with recruiters to grow your network.
Career Management
Stay prepared for whatever opportunities lie ahead with our educational resources like webinars, guides, and exclusive reports and our MyGoals achievement tracker.


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KDDI Cloud Inventory
Rich features combined with simple operation enable integrated and streamlined IT management
IT asset management work has been extended recently to cover smartphones, virtual machines and more. KDDI Cloud Inventory centralizes global multi-device management services over endpoints such as Android, iOS mobiles, desktops and notebooks (Windows/Macintosh) both within and external to your business offices.
- The cloud approach makes endpoint management operations global and transparent.
- A single web-console covers all endpoints from desktops to mobile devices.
- Endpoint management tasks are easily streamlined into automated actions.
- Trilingual user interfaces extend endpoint management tasks to English, Chinese and Japanese speaking IT staff.
- Centrally managed security policies reach diverse global endpoints.
- Capable of Detection, Prevention and Removal of targeted attacks, ransomware and other unknown malware.
New feature: Behavioral detection
When it comes to defending against targeted or as yet unknown threats, regular antivirus software alone isn't always enough. KCI's behavioral detection provides endpoint protection that doesn't depend on pattern-matching files like antivirus software and can stop even new, unknown threats such as targeted attacks.
Using unique technology, KCI's behavioral detection predicts an attacker's method of attack, using five analysis engines to approach the attack from multiple angles and provide a hybrid defense for endpoints.
Centralized Multi-Device Management Endpoints Around the World
From a single web console, "KDDI Cloud Inventory" allows the centralized management of endpoints including Windows PCs, Macintosh computers, and both Android and iOS mobile operating systems. The endpoints are under the management of headquarters or subsidiaries, whether located in the head office or anywhere in the world.
The versatility of KDDI Cloud Inventory is based on the Internet and cloud computing. In other words, Internet connectivity is the only prerequisite for KDDI Cloud Inventory to function.
KDDI Cloud Inventory is a cloud solution that keeps endpoint configurations and applications secure, thus providing stable usability for workforces in line with your organization's security policy, public regulations and compliance directives. The solution will cut costs and complexities and reduce your IT department's daily workload by optimizing endpoint management tasks.
Management workload reduction through automatic device security diagnosis
Based on the Security Profile that we develop and update daily with anti-threat definitions such as malware and vulnerability countermeasures, your organization as a whole is automatically rated through a scheme of security levels, with easy access to detailed reports. Security administrators can view the dashboard, which provides an easy-to-read diagnosis using colors and scales, to see present security risk levels.
A Free 30-Day Trial
We can offer a free trial of KDDI Cloud Inventory for 30 days
Detail Summaries
|IT Asset Management
|HW/SW listing & Exporting
|License Management
|Standalone PCs
|Application Portal
|Listing HW/SW inventory. The data can be exported by CSV.
|Reporting MS-Office /Adobe apps Utilization.
|Inventorying Standalone PCs.
|A portal site with a list of apps which users can download.
|Security Management
|Diagnosing Security
|Antivirus SW
INSTL Statuses Report
|SW Forcible
|Banned Apps Detect
& Launch CNTRL
|Diagnosing security vulnerability of client devices and indicating security in one of the 5 security levels.
|Reporting antivirus SW installation status.
|Applying the policy to enforce updating Wins OS, Adobe Reader and so forth on client devices.
|Detecting banned Apps and controlling launching them.
|NTWK Connection
|SD card
/Bluetooth CNTRL
|ISM Client Program
|Detecting the CNFIG
Profile Deletion
|Controlling access connections to Wi-Fi and VPN networks.
|Restricting access the data on SD card/Bluetooth.
|Restarting the ISM client program automatically whenever it is stopped.
|Detecting the CNFIG profile is deleted.
|Apps Launching
|Locating the client devices
|Remote Lock/Wipe
|Rooted/Jail broken
Device Findings
|Restricting the usage of specified apps when a device is lost or stolen.
|Locating the lost device on Google Maps/BingMaps, helped by GPS.
|Remote Locking or wiping out the lost/stolen devices or a failure in compliance.
|Finding rooted /jail broken devices and notifying the ADMIN by mail.
|Setting Up
Stringent Policy
|Assigning or switching to the pre-defined stringent policy on a failure in compliance.
|Remote Management
|Remote CNTRL
|Software Distribution
Folder Transfer
|Apps Distribution
& Uninstallation
|Remote controlling client PCs via the premise network.
|Distributing software, folders and files via the premise network.
|Distributing and uninstalling apps on client devices.
|Lease/Rental MGMT
|IT Asset Searching
|Gathering Questionnaire Data Entries
|URL Filtering
|Inventorying lease /rental assets and checking for terminations in advance for notification or alert.
|Finding the assets by serial No, user name, software, etc
|Gathering questionnaire data that users have provided on a form, and putting them into other inventory data.
|Finding the target clients by common properties or keywords.
|External Media CNTL
|Collecting user operation logs
|HDD Encryption
|Controlling external media such as USB memory devices.
|Collecting user operation logs on PCs via the internet and makes clear the inappropriate activities of PC.
|Encryption the whole hard disk. Certification before the OS start.
|Unknown threats are detected,stopped and removed using engines that predict malware behavior.


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Only yesterday we gave you a better preview of one of the most anticipated sneaker releases of the year – the Parra x Nike Air Max 1 Tier Zero. Today we can show you some more detailed images of the sneaker, which will officially release at Patta in Amsterdam on March 13th.
Many more images of the Parra AM1 follow after the jump.


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5 things to watch in Obama's economy speech
President Barack Obama on Wednesday delivers what the White House is billing as a major address on jobs and the economy — and Republicans are mocking as yet another "pivot" from a president struggling for traction.
Administration officials and Democrats close to the White House say they hope the speech will achieve three goals: reset the political conversation on a still-recovering economy, warn Republicans not to create a fresh crisis in the fall and help cement the president's legacy as economic steward through turbulent and hyperpartisan times.
Story Continued Below
( PHOTOS: What's in Obama's 2014 budget)
Whether he can accomplish any of this at Knox College in Illinois or in follow-up addresses planned through September depends on the substance of a speech Obama has previewed as "pretty good." Here are POLITICO's five things to watch.
How hard will he go after Republicans on the debt ceiling and government funding?
One argument for why Obama is doing this speech now: He's laying down an early marker as the sane voice ahead of potentially bruising fights over bills to fund the government after Oct. 1 and to raise the debt ceiling sometime in November or later.
White House officials have made clear Obama won't go deep in the weeds on these issues by using Washington words like "sequester" or issuing sharp ultimatums to the GOP.
( PHOTOS: Obama's top 20 jabs at the GOP)
Every time Obama takes to the road to chide Republicans, particularly in the House, he winds up only further stoking their antipathy toward him, making final deals harder. House Speaker John Boehner this week said Obama should not "give another speech" but instead sit down and talk.
But the president wants to make it clear to the broader public ahead of the fall fights that the ground has shifted — and 2013 is not 2009.
Annual deficits are half what they were four years ago and are still shrinking after spending cuts and tax hikes. So expect the president to argue that we should not shut down the government or threaten default just to make more big cuts. That's what many economists are looking for, rather than any new proposals to boost growth.
"I don't think any policies he might talk about would make any big difference," said Nigel Gault, co-chief economist at the Parthenon Group. "I think this is much more part of setting up the debate over fiscal policy in the fall and making sure we don't have another crisis."
How bullish will he be on the economy?
Any speech the president gives about this frustrating economy runs the risk of sounding like cheerleading a recovery that most average Americans are barely feeling.
Expect the president to strike a positive tone about the rebound in house prices and the stock market while acknowledging that for the middle class, real wages continue to stagnate and good jobs remain hard to find.
( Also on POLITICO: House GOP budget collapsing)
This administration has been plagued before by seeming to declare victory on the economy too soon, notably with then-Treasury Secretary Timothy Geithner's 2010 New York Times op-ed headlined "Welcome to the Recovery." That year also saw the White House launch a "Recovery Summer" tour that was quickly followed by a return to anemic growth. In the summer of 2011, a debt ceiling disaster led to the first-ever credit rating downgrade in the history of the United States.
Obama will also be speaking as economic data continue to come in decidedly mixed and market analysts are predicting second-quarter growth of less than 1 percent. So how will Obama manage to take some credit for an economy that is at least growing and adding a couple hundred thousands jobs a month without alienating those still struggling?
"The American people have been through a very traumatic experience," said Bill Galston, a Brookings Institution scholar. "They are in a very defensive crouch, and it will be very hard for the president to talk them out of it."
Republicans argue that all Obama can do is talk and that his speech will amount to nothing. "I say to the president, 'You know what? Actions speak louder than words,'" House Majority Leader Eric Cantor (R-Va.) said this week.


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Wife takes a walk on the Wild side part 3
Burt climbed in, and he stopped, and took in the view.
"Amazing, just incredible."
Kathi grinned, and said, "If you think the view is incredible, just wait until you feel my horny cunt milking your cock for every drop!"
She quickly


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Major Section: PROGRAMMING
(Assoc-equal x alist) is the first member of
alist whose
x, or
nil if no such member exists.
(Assoc-equal x alist) has a guard of
(alistp alist), and
returns the first member of alist whose
car is
x, or
nil if
no such member exists. Thus,
assoc-equal has the same
functionality as the Common Lisp function
assoc, except that it
uses the
equal function to test whether
x is the same as each
successive `key' of
alist. See assoc and see assoc-eq.


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These Spooky Tree Foamies come 79 pieces to a package. Included in this package are, 18 foam shapes, 58 foam stickers, 1 bag of glitter, 1 chenille stem, and 1 tube of glue. Spooky Tree Foamies are great for fun group activites such as Halloween parties or classroom events.
We also carry a complete line of Beads, Birdhouse Kits, Christmas Crafts, Craft Supplies, Kids Crafts, Misc Crafts, Wood Craft Kits, and much more.


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- Home
- News
- Sports
- Opinion
- Obituaries
- Features
- Special Sections
- Classifieds
- Public Notices
Once again, it takes out-of-towners to remind us how good we have it in the Twin Counties.
After last week's "familiarization tour" for tourism officials from all over Virginia, the visitors couldn't find enough good things to say about our underappreciated area. They enjoyed shopping in our unique shops, visiting our attractions, hearing our music and seeing our natural wonders.
If you currently subscribe or have subscribed in the past to the The Gazette, then simply find your account number on your mailing label and enter it below.
Click the question mark below to see where your account ID appears on your mailing label.
|ZIP Code:


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Schistophallus oscari (M. von Kimakowicz, 1883)
Quick facts
|Threat status Europe
|Not evaluated (IUCN)
The EUNIS species component has very limited information about this species.
The main focus of the EUNIS species component is to provide relevant information about the European species protected by Directives, Conventions and Agreements. The species assessed in the European Red Lists prepared by the IUCN for the European Commission are also included.
See here what is Europe from a geographical point of view.
Other resources available below may have more information.
Common names and synonyms
|Hyalina tumida
|M. von Kimakowicz, 1890
Other resources
|Fauna Europaea search
|Fauna Europaea
|Global Biodiversity Information Facility
|ITIS search
|Interagency Taxonomic Information System
|NCBI search
|National Center for Biotechnology Information


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YOU ARE WATCHING: Wing Chun
Wing Chun
A recreation of sorts to the hit movie THE PRODIGAL SON, with both Sammo Hung and Yuen Biao returning in elder roles. Pop idol Nicholas Tse (THE PROMISE) stars in this megahit martial arts drama as Liang, the rebellious eldest son of Zan (Yuen Biao), master of Wing Chun Quan. But difficulties arise between father and son as Zan refuses to teach Liang martial arts because he finds him arrogant and naive. Meanwhile, Liang must master the skills of Wing Chun to beat his rival Ko, who is ruthless and has an eye for Liang's lover. Only a duel between Ko and Liang can settle the score once and for all. With amazing kung fu action, WING CHUN (aka Yong Chun) is one fabulous martial arts adventure that will leave you breathless!
Genres: Drama, Romance, Wuxia, Kung Fu
Actor: Nicholas Tse, Sammo Hung, Yuen Biao
Director: Sing Chi Chiu
Country: Hong Kong
Movie: Wing Chun
Production Co:
Duration: 40 Episode
Release: 2007


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Which funding could you be eligible for?
Grants, loans and equity funding may be available to anyone from a sole trader to a large organisation, whether you want to start up or expand your business, invest in R&D, build overseas trade, or if you're in a rural area. Yorkshire Forward administers several awards schemes on behalf of funders such as HM Government and the European Commission. Further information on additional programmes can be found in the Finance & Grants section of the Business Link Yorkshire website.
Funding Options
- R&D funding
- Rural funding
- Business grants
- Equity finance
- Innovation vouchers


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Colleges in Ranger TX
100% Online & No Standardized Testing
We are committed to helping you achieve your goals and complete your degree as quickly as possible. One of our Admissions Counselors is ready to assist you with this process. Here is what you can expect from us:
- 100% online programs at associate, bachelor's, master's, and doctoral level.*
- Transfer up to 90 credits into an undergraduate degree program.
- Up to 50% of your master's degree can be transferred in to help you get the most out of your hard work and maximize the credit you previously earned.
*excludes licensure, certification, and some doctoral programs
Benefits of Liberty
- No standardized testing if you meet admission requirements.
- Credit for prior training, certification, licensure, experience, and learning, and more such as:
Real Estate
Emergency Response
- Courses taught from a Christian worldview.
- 8 start dates a year, with an 8 week course format.
Financing Options
- Financial Aid
o 87% of all Liberty students in an online program are awarded financial aid.
- Tuition discounts for
o Military service members, including active duty, retired, veterans, and their spouses.
o Emergency Response Personnel
- Corporate Tuition Assistance
o Deferred – If your company reimburses you for the cost of your education, you submit your grades to your employer who pays you, and then you pay for your classes.
- Other convenient payment options are available
Liberty University has been recognized by Forbes Magazine as a low debt college for students as well as ranked by BestColleges.com in the top 10 out of 2,100 nonprofit colleges in the nation.
Purdue University Global understands that working adults approach learning differently than traditional college students. That's why we're proud to deliver a fully personalized, world-class education online that's tailored to working adults. By opening the doors to students who need flexibility to fit learning into their busy lives, we make it possible to achieve a high-quality education from a prestigious university system—completely online.Our innovative learning options let you choose what, how, and where you learn, giving you control over your schedule, pace, and learning path. Our Advisors work closely with you to understand your personal learning needs. They also evaluate your academic, professional, or military experiences to help you transfer and earn as many credits as possible. Together, we'll determine the fastest, most affordable path to your degree—the path that will help you gain the skills you need to make an immediate impact on your career and the edge to conquer whatever comes next.
Ultimate Medical Academy is a nonprofit healthcare career school—and students are at the heart of everything we do. That's why we offer exclusive student services through your career training and beyond, beginning from the time you enroll online or at our campus in Clearwater, FL. We'll also guide you toward the right program for your goals, and help you understand the affordability of your career training. So let us know you're interested, and we'll discuss how UMA can help you succeed.
Gainful employment information can be found at UltimateMedical.edu/gainful-employment and includes information on tuition, loan debt, completion, placement, and occupations.
Fast track your career in supply chain management by earning your master's degree online.
The Milken Institute School of Public Health at the George Washington University is located in the heart of Washington, D.C., and is dedicated to advancing the health of communities on a local, national and global scale. Established in 1997, the Milken Institute School focuses on the fields of medicine, business and education to prepare professionals in health care and health services to tackle complex global health challenges.
Ranger College
1100 College Circle
Ranger TX 76470
Phone: (254) 647-3234
School Type: College
Campus Locale: Rural: Distant
On-Campus Housing: Yes
Degrees & Awards Offered:
Less than one year certificateStudents: 894 (all undergraduate)
One but less than two years certificate
Associate's degree
Student/Teacher Ratio: 16 to 1
Website: www.ranger.cc.tx.us
Search For: Online Colleges and Degree Programs
Send Flowers to: Ranger College
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Any number of business models have been built around the exchange of data on daily, weekly and monthly intervals, but scheduling processes to produce results in the future can be a significant barrier to today's computing, mobile, Web and application needs with the increased connectivity of businesses and consumers.
Examples include real-time access to inventory, order management, services and data assets within your business. Successfully managing real-time processing enables partners to better integrate offerings and third-party developers to create mobile apps, expanding business reach.
There are many opportunities to better leverage existing data assets and services in a larger ecosystem by providing real-time access through APIs. A great example of this vision is Netflix, which provided a real-time API for its consumer accounts and content. It has been so successful that it is working on the next version. Today Netflix serves more than a billion requests per day, with peak loads of over 20k requests per second.
Storage IO performance is critical to scale these real-time services while keeping your level of service consistent. Your storage architecture can impact the performance of these services both operationally as well as capture and report service usage for analytics and optimization.
Now is the time to leverage business assets — data, services, etc. — as real-time services. In doing so, you will find new business opportunities, provided you have infrastructure that can scale up and out for the large data demands of today and tomorrow.
Scott Metzger, vice president for corporate development at Violin Memory, has identified five key areas to consider when implementing and scaling real-time processing systems and services.
Consumers' Increasing Reliance on Facebook and Other Social TrendsNew figures reveal rapid adoption of social media in consumer shopping behaviors.
Emerging Cyber Threats for 2012 Georgia Tech forecasts cyber threats for 2012.
Top Predictions for IT Organizations and Users for 2012 and Beyond Simple but powerful email campaign ideas to build loyalty with customers. Predictions show IT budgets are moving out of the control of IT departments.
Related Topics : IT Market Analysts, Business Performance Management, Business Process Automation, Management Philosophies, Middleware
Enterprise performance management platforms can help save money and improve the chances for a successful M&A integration. ... More >>
If successful, an API can be a powerful business development tool that can have a significant impact on ROI and even shed light on potential new directions for the business. ... More >>


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2013 Young Naturalist Award Winners at the Museum main content.
by AMNH on
Can the extract from one invasive plant control the growth of others? Will algae produce an effective biofuel? These are some of the questions that 12 student scientists explored in the American Museum of Natural History's 16th Annual Young Naturalist Awards, a nationwide science-based research competition for students in grades 7 through 12.
This year's winners, including students from California, Colorado, Florida, Iowa, Massachusetts, New York, Pennsylvania, Rhode Island, and Tennessee, were recognized today at an awards ceremony and luncheon at the Museum and spent the day on behind-the-scenes tours at the Museum (pictured below).
Seventeen-year-old Sara Volz, a 2011 Young Naturalist Award winner from Colorado who is also a winner this year, continued her work into producing algae that might that might prove an efficient biofuel. Meanwhile, eighth-grader Julie Canady, from Lakeland, Florida, investigated whether extracts made from Lantana camara could reduce the growth of another locally invasive weed called Palmer's amaranth.
The Young Naturalist Awards is the only national science competition that focuses on the natural world and encourages research in Earth science, ecology, and biology, part of the Museum's broader aim to focus on authentic science experiences that increase students' participation in science, technology, engineering, and mathematics (STEM) fields.
The Young Naturalist Awards is a nationwide, science-based research contest for students in grades 7 through 12 presented by the Museum.
The Young Naturalist Awards are proudly supported by Alcoa Foundation.