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“click+image+enlarge ” - 21 news in the last 7 days (1.1s)

3-Drawer Plastic Cart on Wheels - Bright Colors (Bak - Ridgecrest) $5

3-Drawer Plastic Cart with Wheels Bright Colors (for Child's Room? Condition: "Pre-owned" - I used it for many years it's clean, and has no cracks or flaws (it looks a bit saggy, but that's because it still had some heavy stuff inside...It'll look great for you) Dimensions: Total unit: 26" high x 15" wide x 15"-16" deep (66cm x 38xm x 38cm-40.5cm Inside drawers: 6" high x 12.5" wide x 13.5"-14.5" deep (16cm x
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31.5cm x 34.5cm-37cm) No makers mark - no idea of the source * An almost identical item now costs $24.99 at KMart (Click on image to enlarge) We will be posting other Large & Heavy items, in several categories. We list items in both Bakersfield and Los Angeles editions of Craigslist. Search items in Ridgecrest ...and you've found us! Make one trip, and get lots of[...]

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Redesigning Foursquare’s User Pages

Click the image to enlarge! Redesigning things is fun. I’m no designer, but I thought it might be nice to try my hand at redesigning the Foursquare user page, particularly with regard to how one friend views another friend on the site. Based on some things that I know are possible from a programming standpoint, I’ve also suggested [...]

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In Focus: Luke Hayes

In Focus is Archinect's new series of features dedicated to profiling the photographers who help make the work of architects look that much better. What has attracted them to architecture? How do they work? What type of equipment do they use? What do they think about seeing their work in blogs? In this feature, we talk to London-based photographer Luke Hayes. Archinect: What is your relationship with architecture? What drew you to architecture, as a photographer? Luke Hayes: Two of my family members are architects, and I have always been interested in the built environment. Not just architecture, but also infrastructure and buildings or structures that perform a function that are not necessarily designed with their architectural merits in mind. Whilst at art school, I experimented with large format photography and was naturally drawn to shooting buildings. Subjects I chose were often more obscure structures such as a holiday hut or a 1960s modern church. My principle influences were Jeff Wall, Hiroshi Sugimoto, The Becher's and Julius Schulman. ↑ Click image to enlarge The MAXXI, Rome. By Zaha Hadid Architects. Photography by Luke Hayes ↑ Click image to enlarge The MAXXI, Rome. By Zaha Hadid Architects. Photography by Luke Hayes Describe how you work... who are your clients? LH: Most of my work these days is commissioned, and usually I am briefed 1-2 weeks before the shoot takes place. Where possible, I will meet with the project architect and take a walk round the location and try to identify important angles, views etc. But usually it is a brief phone call or email, and I am left to take my own interpretation of the building. Some of my clients include Zaha Hadid Architects, The Design Museum, Chapman Taylor, Carmody Groarke. ↑ Click image to enlarge JS Bach Music Hall, Manchester. By Zaha Hadid Architects. Photography by Luke Hayes Do you mostly work in a specific region? What is your travel schedule like? LH: Last year I traveled quite a lot, MAXXI rome, 100% Design Tokyo, but usually most of my work is in London. This year, I am hoping to visit Abu Dhabi, Japan and China. A goal of mine is to work for a longer period of time in a foreign country. ↑ Click image to enlarge Serpentine Pavilion 2008 by Olafur Eliasson. Photography by Luke Hayes ↑ Click image to enlarge Tate St Ives, Cornwall. By Evans and Shalev. Photography by Luke Hayes ↑ Click image to enlarge Artists residence, North London. By Carmody Groarke Architects. Photography by Luke Hayes What is your goal when capturing buildings in photographs? LH: I'm aiming to capture the signature of a building. In so doing hopefully describing the architect's vision as well as the functionality of the building. Sometimes it's not always possible in one shot, so I also try to shoot as if taking a visual journey around the structure. ↑ Click image to enlarge Serpentine Pavilion 2007 by Zaha Hadid Architects. Photography by Luke Hayes ↑ Click image to enlarge Magna, Science Center, Sheffield. By Wilkinson Eyre. Photography by Luke Hayes What are your thoughts about including people in your photos? Is it important to photograph a building in use, or by itself? LH: People are usually what the architecture is created for, and so it is very important to show interaction. As well as scale and movement around the structure. But sometimes a beautiful sculptural form works better on its own. ↑ Click image to enlarge Serpentine Pavilion 2008 by Frank Gehry. Photography by Luke Hayes ↑ Click image to enlarge Westminster Kingsway College by Bond Bryan Architects. Photography by Luke Hayes What are your favorite pieces of equipment? LH: 1DS MK111 with a 24m TSE. ↑ Click image to enlarge The Willis Tower, Skydeck Ledge by SOM. Photography by Luke Hayes ↑ Click image to enlarge Zaragoza Bridge Pavilion by Zaha Hadid Architects. Photography by Luke Hayes ↑ Click image to enlarge Prada Store, Tokyo. By Herzog & de Meuron. Photography by Luke Hayes Do you work alone? LH: Usually I work alone. ↑ Click image to enlarge Calais infrastructure. Photography by Luke Hayes ↑ Click image to enlarge Tate Modern, London. Photography by Luke Hayes How do you feel about seeing your photographs on blogs and websites? LH: It's all still very new. Blogs and websites that are promoting architectural news and events are great. As long as we are credited and hyperlinked!! The gray area between what needs to be payed for and the benefit to the client needs to be addressed. Especially if the website sells advertising space, because I believe any potential advertisers would be more likely to spend money on a site that has great photography. So maybe we should be paid something? Luke Hayes studied photography at Falmouth College of Arts and graduated in 2000. Ever since, he has been working in photography.

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2 Fast 2 Fierious

Following Amber's impassioned defense of Guy Fieri, it seems like there might be some dissension in the ranks of the Daily Fork staff. It's not like the host of "Triple D" isn't an easy target, and although I've directed my fair share of pot shots his way, I'll be the first to admit that many of them were simply because he makes it so incredibly easy. When your entire persona is built around being so xtreme you don't even need an "E," you're setting yourself up for being mocked. Regardless of whether it's authentic, the ridiculous poses, outdated catch phrases (sorry, calling something "money" was acceptable for about a 2-week window back in 1996) and obnoxious food descriptions make him a hard guy to like. Fear not fierious readers, a response post will be forthcoming. However, in the interim, those of you who enjoy the over the top caricature that is Guy Fieri can bask in this beautiful desktop background. Click Image to Enlarge​

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Pre show drinks

Click on image to enlarge Click on thumbnail to view B&W Gallery

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NEMPAC's Spring Fling Fundraiser

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In Depth: Linux desktop innovations to look forward to

These are testing times: if you want to experience the latest advances on the Linux desktop, you have to be prepared to test things and accept that stability is a secondary feature. The continued development of KDE 4 is the perfect example. Many of its users have felt like guinea pigs over the last couple of years, while its developers have filled in the missing blanks on the path to a fully operational desktop. But for many of us, this is how we like it. Messing around with applications, tools and utilities from the cutting edge is the reason why many of us got into Linux in the first place. It's almost expected, and it's always something of a surprise to discover that Linux has come so far that most people use precisely for its sobriety and stability. But for the tinkerers and testers, 2010 is shaping up to be a perfect year. Almost every desktop and application we can think of is going to have a major release, and while release dates and roadmaps always have to be taken with a pinch of salt, many of these projects have built technology and enhancements you can play with now. The taste of tomorrow We've selected the few we think are worth keeping an eye on and that can be installed easily from your distribution's package manager, but Linux is littered with applications that are evolving all the time, so we've also tried to guess what the next big things might be. Take a trip with us on a voyage of discovery to find out exactly what's happening and how the Linux desktop experience is likely to evolve over the next 12 months. KDE's Gnome Do equivalent is trying hard to catch up KRunner has been part of KDE for long time. It's the tool you see when you press Alt+F2, and is commonly used to run applications quickly by typing their names rather than resorting to the launch menu. In the face of stiff competition from the likes of Gnome Do though, KRunner has had to up its game recently, and there are several neat enhancements for the KDE 4.4 release. The most obvious change is that the KRunner dialog itself is now at the top of the screen rather than in the middle. This makes more sense, because it's now less likely to tread over some important application information or Slashdot story. You can also close the window again by pressing Alt+F2. Now that KDE 4.4 has a working search engine, the first new thing you can do with KRunner is search your desktop. Results are listed in the panel below. Everything else more or less looks the same until you click on the small spanner icon. KRun to the hills The window that appears has always hidden the extra features hidden behind KRunner's austere GUI. It lists the type of items that are going to be probed and returned as results in the main window. This version for KDE 4.4 has four new additions. You can now terminate applications by typing kill followed by the name of the application. After you've typed kill, the applications that match the following text will be listed in the results panel. You can change the keyword by reconfiguring the Terminate Applications plugin. You can also list all removable devices on your system by typing solid, and you should be able to manage virtual desktops by typing window. We couldn't get this to work, despite the plugin being listed in the configuration window. There's still tons over other functionality you can get out of KRunner by using the older plugins, but what we'd really like to see is cross-compatibility with Gnome Do's plugins. To build the future we must first understand the past How do you come up with a revolutionary new desktop while your users are wedded to the old familiar input ideas, tried and tested in the two decades since we all started using a keyboard and mouse? If Linux were run by Apple, the developers would work in secret for years before announcing the availability of their new desktop metaphor. But the open source community doesn't work in the same way. Innovation has to be hammered out on online forums, in developer channels and through software releases. It's trial by committee, and many things can and do go wrong with the process. Compositing effects are a good example. Almost as soon as David Reveman had finished his initial work on Compiz, patches could be integrated into almost any Linux desktop with no major changes. Users could install Compiz and start rotating their desktops within minutes. But the task of turning these patches into a homogeneous part of the desktop experience has taken considerably longer, and it's an ongoing process four years after the initial release. This is because the path to acceptance for Compiz has been slowed down by the community, with disagreement, forks, apathy and duplication all hindering its progress. And it's the same for many other projects. If you want to change the way people use their desktops, you have to change the underlying technology behind that desktop. Most developers interpret this to mean that they need a new release, with an all-new API and plenty of new technology for application developers to take advantage of. This is the theory behind KDE 4's glut of new libraries and frameworks, for example, but it also means that it takes time for developers to catch up, if they even feel so inclined. Gnome development is more pragmatic. Version 2 was released at about the same time as KDE 3 in 2002, and broadly, it's still a version of this release that's the current version of Gnome. There have been no dramatic redesigns, API changes, feature overhauls or debugging marathons. Instead, there's been the steady march of progress, and while Gnome may be missing some of the more experimental aspects of KDE, the latest release, 2.28, is still very different to the 2.0 release. Topaz This is partly because Gnome is more of a platform for applications than KDE. The user doesn't need to know that the F-Spot photo manager is written in Mono and uses C#, for example; the only important thing is that each Gnome application presents a standardised front-end by following Gnome's user interface guidelines. It's for this reason that Gnome has been going from strength to strength, even on other platforms and operating systems, and this kind of idea doesn't need to be updated when a new version is released. Gnome 3.0 is scheduled for release in September of this year, but like all version 2.x releases up to this point, it's unlikely to be a KDE 4-like revolution. Initially, there were plans for dramatic changes to be made, all falling under an umbrella term for Gnome 3.0 – ToPaZ (Three Point Zero). If you look at some of the plans touted for Topaz, especially the results from some of the original brainstorming sessions, you'll see that most of the ideas remain in the current plan. With the KDE 4 release, most of the development cycle for the revolutionary features that were supposed to make KDE 4 more attractive than version 3 actually occurred after the initial release. If KDE 4 were to be released now it would be hailed as a great success, rather than the stream of bugfixes and updates we've endured since 4.0 hit the mirrors in January 2008. But at the same time, developers have to balance expectation. Would many people still be using the KDE desktop if they had to stick to KDE 3-era applications? Fortunately, with the release of KDE 4.4, most of those criticisms and usability problems have been ironed out, and we finally have a KDE desktop that can replace KDE 3.5. For the first time in a long time, Linux might actually get easier to use Both Gnome and KDE are putting a great deal of emphasis on something they call 'activities'. These are really an extension of the virtual desktop idea, but rather than each desktop being a disconnected extension to your screen's real estate, activities become associated with a certain task. You might want to create a documentation activity, for example, and for that you'd need a desktop that provided quick access to a text or HTML editor, online resources and perhaps a dictionary or thesaurus. Like most other tasks, setting up this kind of environment would normally require the user to mess around with a launch menu as well as understand a certain amount about your computer's filesystem. Most developers recognise that this process isn't ideal and that desktops of the future shouldn't require filesystem knowledge, or even an idea of how applications are organised and stored. The process of working with your data should be as intuitive as possible, and both major Linux desktops are trying their best to tackle this issue in their own special ways. With Gnome, for example, one of the key aims of the upgrade to version 3.0 has been to streamline the user experience. And the central user-facing technology that's going to help this happen is called Gnome Shell. This is an application that has seen rapid development over the last 18 months after Gnome's Vincent Untz posted some observations from discussions at a recent hackfest in late 2008. These observations mentioned that tasks such as finding a window was more difficult than it should be, that workspaces were powerful but not intuitive enough and that launching applications was too hard. Gnome Shell has been developed to address these problems, as well as take advantage of some of the latest Linux technology. Like Moblin, Gnome Shell uses Clutter, a graphical library that can build smooth transitions and eye candy out of even the most humble graphics hardware. KDE The KDE team have been working on similar concepts throughout the entire KDE 4 development process. But it's fair to say that many of ideas touted before the first release were judged too ambitious and too difficult to implement within the first few revisions. KDE 4.4 is designed to redress some of these issues by re-awakening the Nepomuk semantic desktop and by making desktop activities usable. The Nepomuk semantic desktop, as we've written before, is designed to bridge the gap between online content and content in your hardware. Many components of the web can already be found in KDE applications like Dolphin, where you can add comments, tags and ratings to your own files, but until now there hasn't been a good reason to go to all this effort. With the release of KDE 4.4, you can finally use these fields of rich information to search your content, just as you would search the internet through Google. Another important aspect to user experience on the KDE desktop is the use of activities. Like Gnome Shell, this the ability to meta-manage the arrangement of virtual desktops and applications according to what you want to work on. It's a feature that has been part of the KDE 4 desktop for a while, but with version 4.4, activities also become first-class citizens on the KDE desktop, perhaps in an attempt to steal some of Gnome's thunder from the wonderful Gnome Shell. But it's not quite as simple or as straightforward to use. Rather than attempting to replace the launch menu and file management duties of the desktop, KDE's activities are better at managing complex environments. It doesn't replace the panel or the launch menu, for example, it just lets you fire up a working environment in the same way that you click on a browser's bookmark. That's not a bad thing, it's just different. The best thing about Gnome Shell is that you can play with it today. And we'd suggest you give it a go, because it might just change the way you think about Gnome. Gnome Shell should be straightforward to install through your distribution's package manager. To run it though, you will probably need to open the command line and type gnomeshell --replace. If you've ever manually started Compiz, this command will feel familiar, as the replace argument is used to replace the currently used window manage with both projects. When Gnome Shell is running (depending on the version you've installed), you'll won't see any new windows on your desktop; the only indication that something has changed is the different style of window decoration, and if it's a recent version of Gnome Shell, a quick-launch dock attached to the top-left of your main window. To see Gnome Shell in action, just move your mouse to the top-right of your screen. You should then see the current view zoom away into the middle distance, and the freed-up screen space used to display other virtual desktops to the right and a minimal launch menu on the right. This launch menu contains applications and files, and you can either click on one to load the corresponding application into the current desktop or drag the icon on to the desktop on which you wish the application to appear. But it's also much cleverer than first glance might suggest. If you drag a text file on to a new desktop, for example, Gnome Shell will automatically load that file into the default application for that file type. Each window on the virtual desktop will update to reflect any changing contents, and you can enlarge any window in the frame by using the mouse wheel while the pointer hovers over the window you want to enlarge. Here's what we've got look forward to in the following 12 months Xfce There's no doubt that both Gnome and KDE are stealing the limelight when it comes to feature upgrades for 2010. The other more common Linux desktops don't have any such big upgrades planned, and this is their strength, as they often like to capitalise on their ability to remain stable and relatively lightweight. Xfce is the best example of this: changes from one version to the next are generally small and lack the paradigm shifting-hype of other desktop environments. Xfce 4.8 only entered the planning stage in August last year, and as a result, the feature list is best described as nebulous. It's hoped that the new version will include an enhanced menu system, icon routines and keyboard handling, but there aren't any ambitious plans to add masses of new features. The new menu system is hopefully going to make it much easier for users to edit the launch menu, a task that currently generates plenty of complaints, according to Xfce developers. Xfce should also been able to jump on to the on-screen notification bandwagon, with Xfce developer Jérôme Guelfucci showing off patches that bring Gnome's notification system to the Xfce desktop. It looks really good too. The new file manager, Thunar, is also likely to become more powerful, although one of its great strengths is that it's super quick and not hampered by the cruft that plagues other file managers. The final version of 4.8 is due to be released on 12 April 2010. OpenOffice.org The most comprehensive open source office suite is likely to go through something of a transformation this year, now that its principal sponsor, Sun Microsystems, is being taken over by Oracle. At the time of writing, the first release candidate of version 3.2 has just made it on to the mirrors. It promises faster startup times, almost halving the boot time for Writer from just over 11 seconds in version 3 to under six seconds in version 3.2, and should bring much better file compatibility with both the new ODF 1.2 specification as well as proprietary formats and the ability to save password-protected Microsoft Office documents. Version 3.3, which should be available by the end of the year, will be the first release to include the fruit from project Renaissance. This is a noble attempt by OpenOffice.org to overhaul the user interface of the various applications in the suite, hopefully pulling its appearance into the 21st century. This update is promised only for Impress, with the other applications getting the same treatment in later updates, but until we see a screenshot of the new design, we have yet to be convinced. Firefox There's little doubt that the next 12 months are going to be particularly challenging for the Firefox web browser. Once the darling of the open source desktop, Firefox has suffered in the face of competition from Google's Chromium browser and its perceived lack of speed in the face of the growing dominance of WebKit-based browsing. As a result, future development is likely to focus on speed improvements and consolidating the initial reasons for Firefox's success, rather than adding feature after feature on to a browser than many users feel is already bloated. But so far, the current roadmap for Firefox couldn't exactly be described as exciting. There are several significant updates planned for Firefox this year, starting with version 3.6, which should be out as you read this. Beta versions of version 3.6 have shown decent JavaScript speed improvements as well as support for 'Personas', which is a theming engine similar to the one used in Google's Chrome. Version 3.7, available in the middle of the year should make further performance and include the latest version of the Gecko rendering engine. Jetpack is also worth a mention. It's a way for web developers to build Firefox add-ons using the same skills they use for website construction, including HTML, CSS and JavaScript. But the best thing about Jetpack is that add-ons can be installed without requiring a tedious restart of Firefox. Finally, there's a small chance that Firefox version 4.0 could be seen on the mirrors before the end of the year. There doesn't seem to be much to get excited about – it's likely to feature the predictable makeover, faster JavaScript and a newer Gecko engine – but it might surprise us. Gimp After years languishing in the pool of applications known as 'loved and lost', Gimp looks like it may finely rise from the ashes of apathy and re-invent itself as the future of pixel editing on the free desktop. Version 2.6, released in October 2009, was a step in the right direction, but it's going to be version 2.8 that hopefully heralds the dawn of a new era. This is mainly because a brand-new, revised and re-imagined GUI is planned, finally consigning its multiple tiny dialogs and windows to the rubbish bin. Gimp 2.8 will include a single-window mode, just like its commercial competitor, and this should go a long way towards making it easier to use for most people. In the words of one of the main developers on the project, Martin Nordholts, Gimp's UI feels rather cluttered. This is mainly because it uses so many windows, and the single window should solve most of these problems. But it's a big job. There are nine separate tasks required to make the modification work, with this feature alone taking up about 10% of the projected development time for the next release. Most people agree that it's going to be worth it. The remainder of the development time is going to be spent adding lots of other cool features. You'll be able to type text directly into the image canvas, for example, rather than using a text entry window first. You will also be able to group layers, making larger and more complex images vastly more manageable. But development on Gimp has always been dependent on its relatively small and dedicated team. In the past, this has meant there was a long gap between releases, and it's likely to be the same with 2.8. Martin Nordholts initially estimated that if they included all the features they wanted, 2.8 might not see the light of day until early 2012. He suggested a compromise, pulling ideas like vector layers and unified and free transform tools from the feature plan, and pulling the release forward to before the end of 2010. Development There's been a slight shift in recent years from open source project being built purely by the community that uses them, to applications that are developed and sponsored by a commercial endeavour. Google's Chrome browser falls into this category, and so does Nokia's development environment, Qt Creator. The result is that we've never had a better selection of web browsers, and if you enjoy programming, there are now more Linux-compatible development environments that ever to choose from. If you're a Qt/C++ developer, Qt Creator is going from strength to strength, and is likely to be the best choice if you're thinking of joining the throngs of developers writing applications for Nokia's various mobile phones. In a related field, KDevelop 4 is finally due to be released some time in the first half of 2010. This is one of the final KDE 3-era applications to have made the transition to KDE 4, and we hope it will be good enough to last a few years before the developers decide to start from scratch again. KDevelop 4 uses CMake for project management, and lets you have more than one project open at a time. There's also some sophisticated refactoring, argument matching and support for distributed version control systems such as Git. But KDevelop will no longer enjoy the wide language support of its predecessor, as it become increasingly adept at the C++/Qt combination – a space now defiantly occupied by Qt Creator. For Gnome developers there are likely to be a couple of releases of the Anjuta IDE, the first of which will be version 2.29.2. MonoDevelop, the multilingual IDE that specialises in C#, is also going from strength to strength, with version 2.2 being released right at the end of the year. There are currently no plans for version 2.4, but at the current rate of released, we'd expect another version before the end of the year.

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The Waning Popularity of Scientific Sessions as Told By Google Trends

What has the been the marketing impact of the American College of Cardiology's Scientific Sessions been each year? Just turn to Google Trends to see the answer: Click image to enlarge It appears the search spikes for the American College of Cardiology" each March are shrinking in amplitude significantly while the news reference volume spikes are increasing as marketers try as hard as they can to ensure doctors get their message anyway. One wonders, given all that is transpiring in health care today, what it would take to reverse the trend? -Wes Musings of a cardiologist and cardiac electrophysiologist.

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Build Rural Broadband, Build Permanent Economic Gains

If GDP growth is your cup of tea, then you have to admit President Obama's plan to expand rural broadband is one of the best long-term economic growth ideas he's had. Not only does it create lots of jobs upfront laying cable and hooking up gear, but it also lays a foundation for sustained gains in economic activity (click image to enlarge): Information Society Policies: Annual World Report 2009, Árpád Rab, editor. Information for All Programme, UNESCO, p. 18. Every 10% increase in broadband penetration yields a boost of 1.2% in GDP. Giving more people access to high-speed Internet means they can do more, buy more, and sell more online. The same thing happened thanks to President Eisenhower's Interstate Highway system. In meat-packing, for instance, the Interstate reduced the cost of entering the industry, as new companies could rely on trucks instead of more expensive and less flexible rail infrastructure (I just learned that from Jon Lauck). Broadband Internet has similar positive effects. Suppose your business is growing and you want to invest in some serious database capacity. In the old days (meaning, a few years ago), you'd have to buy some expensive in-house software to install and maintain on your own high-power computers. With broadband, you can access high-quality and high-capacity database software online, through cloud computing. Your data and the software and hardware that do the heavy lifting all sit hundreds or thousands of miles away; broadband gets the data to you as fast as if it were on your hard drive. And every dollar and hour you don't have to spend installing your own software and upgrades can be spent on doing more business. Yum! Keep that information superhighway metaphor in mind. But unlike I-29, this economic network will offer darn near everyone an on-ramp. --------------------------- Learn more at Broadband.gov; while you're there, test your Internet connection speed and help Uncle Sam map who's got broadband and who needs more signal!

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Preview of the ACC: Percutaneous Mitral Valve Repair

"[The procedure is] very new and involves repairing my leaky valve using a clip device, without open heart surgery, so that my heart will function better" -Elizabeth Taylor, via Twitter 6 Oct 2009Percutaneous mitral valve repair will be the talk of the ACC Scientific Sessions for interventional cardiology this year, especially since coronary artery stent procedures are so, well, yesterday. One valve repair technology popularized by Ms. Taylor's tweet that corrects a leaky mitral valve will be presented Sunday morning at the ACC meeting in Atlanta when the EVEREST II trial results are released (Larry Husten over at Cardiobrief.org has a nice outline of the late-breaking clinical trial schedule). The EVEREST II trial is a phase 3 trial that compares the percutaneous mitral valve repair head-to-head with more conventional open mitral-valve surgery. The trial is sponsored by E-valve, Inc. (bought a year ago by Abbott). Since our center has participated in the trial (note to SEC: I have no clue about the results), it might be interesting to review the background and provide a few pictures on the technology. (By the way, this was NOT Elizabeth Taylor's procedure!) (Important disclaimer: This device is NOT YET APPROVED for use in the US. Further, I have no financial interest in the manufacturer(s) and was not an investigator for the EVEREST I or EVEREST II trials, but I do work at one of the trial centers). Background In 1998, a report of correcting mitral valve insifficiency (leakage) was reported by Ottavio Alfieri and colleagues in the European Journal of Cardiovascular Surgery describing a technique to plicate (suture together) the mid-portion of the mitral valve, effectively creating a "bowtie" orifice to correct the leakage: The experimental technique reported in this study could permit minimally invasive correction of the mitral insufficiency. These patients are often not referred for surgical repair, because they are believed “too sick” for conventional surgery. The experimental technology described in this report would avoid cardiopulmonary bypass and its consequences, and thus represents a more palatable alternative for these patients.The long-term results of this technique were favorable and lead to the development of a minimally-invasive (yet transthoracic) approach for this same repair and later, thanks to the wonders of clever engineers, a completely percutaneous approach using a clip instead of sutures. Equipment (Note: Thanks to Dr. Ted Feldman for use of these great pictures) and the clinical trial nurses who make this all possible. While minimally invasive, this procedure takes a village, so to speak, to perform: the interventional cardiologists, an echocardiographer and a well-hidden anesthesiologist (can you say "Where's Waldo?") barely seen behind the plastic drapes above the patient's head (yes, the patient gets to sleep for the procedure): The personnel and equipment required to perform percutaneous repair of the mitral valve as viewed from the patient's feet. Note the Frankenstein-like steering-and-release contraption with all the IV tubing coming from it in front of the doctors used to place the mitral clip. (Click image to enlarge) A view from behind the implanting physicians. Note that all eyes are on the echocardiographic images to the right as the clip is positioned, rather than the fluroscopic images immedicately in front of the operators. (Click image to enlarge) The back end of the catheter delivery system looks just a bit complicated, since it steers the clip, grasps each leaflet of the mitral valve, and releases the clip when seated properly: Click image to enlarge The business end of the device is a small mechanical clip that grasps the center of the posterior and anterior leaflets of the mitral valve in an attempt to replicate the "bowtie" surgical repair originally described: A cartoon rendition (top) and a photo of the clip (bottom) used to clip together the leaflets of the mitral valve While the fluoro images of the procedure are interesting to view as the device is deployed: An RAO fluoroscopic view of the mitral valve clip passed to the left atrium above the mitral valve. The mitral valve clip is advanced below the mitral valve into the left ventricle in preparation of grasping the mitral valve. The valve leaflets are grasped and the side "wings" of the clip closed. The clip is deployed and fixes permanently to the mitral valve leaflets. Although these fluoroscopic images are amazing, this procedure would not be possible without the ability to see the valve leaflets in realtime using transesophageal echocardiography: Transesophageal echocardiographic images of the clip (outlined in orange) being placed below the mitral valve leaflets. The clip is withdrawn until the leaflets of the mitral valve are engaged in the clip. (Note the "wings" of the clip are still open) The wings of the clip are closed tightly to grasp the valve leaflets. Will the Device Work? Although preliminary results of the EVEREST I trial were promising, the EVEREST II trial will be the pivotal comparative effectiveness study comparing this approach to open mitral valve repair. One thing's for sure after seeing all this: innovation in cardiology is alive and well! See you Sunday! -Wes Musings of a cardiologist and cardiac electrophysiologist.

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Bang and buck, cont'd

This screen cap shows what I'm talking about when I say the City's thousand dollar blog looks hinky in Firefox (click image to enlarge) -- note the way the words spill out of the tabs at the top. Also, "About...

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