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On this article, we’ll be seeing 7 the explanation why Nigeria is known as the ‘Big of Africa’. Africa is the second-biggest continent on this planet by each measurement and landmass. Based on Guinnessworldrecords.com, Africa has a land space of 30,221,532 sq km (11,668,599 sq mi), second solely to Asia which covers an space of 44,579,000 sq km (17,212,048 sq mi).
When speaking about inhabitants, additionally it is dwelling to 17% of the world’s inhabitants. Out of this, Nigeria represents about 20 per cent of the full inhabitants of sub-Saharan Africa. In a continent of 54 nations, one should not be stunned nation that represents about 20% of the inhabitants is known as ‘the Big’.
Asides from the inhabitants, why else is Nigeria known as the ‘Big of Africa’? Be part of me as we go…
• Based on Statista.com, Nigeria’s GDP amounted to 443 billion U.S. in 2020, making it the very best in Africa. This was adopted by Egypt’s GDP which was value 362 billion U.S. and South Africa with 282.59 U.S .
• Lagos is essentially the most populous metropolis in Nigeria and the second-largest metropolis in Africa (after Cairo, Egypt). It’s dwelling to many companies and has been described as one of many busiest metropolis on the continent.
• Nigeria appeared fifth within the africa-facts.org‘s listing of the 10 strongest militaries in Africa.
• Are you aware the Nigerian financial system is the 4th quickest rising economies on this planet? Nice proper?
• Nigeria is among the many few African nations that producers regionally. The remaining embrace the likes of Kenya, Ghana and South Africa.
• The Nigerian leisure business is presently the quantity on the continent. The likes of Davido, Burna Boy and Wizkid have executed nicely in taking Afro-beat music globally.
• Nigeria launched its first earth statement satellite tv for pc, NigeriaSat-1, in September 2003, changing into the primary African nation to launch an area satellite tv for pc. We’ve got up to now, launched 4 satellites into house, with three nonetheless operational and one deorbited after finishing its targets.
With this, I consider all of us ought to be pleased about being born on this nice nation and work collectively for a greater nation.


Georgian Foreign Minister Grigol Vashadze met U.S. Secretary of State Hillary Clinton in the NATO headquarters in Brussels on April 18.
The defense and foreign ministers of NATO member states are gathered in Brussels for two days of talks to prepare the forthcoming NATO Summit in Chicago in May. Meeting of the NATO foreign ministers with counterparts from non-NATO ISAF contributing nations will be held on April 19.
“We’ve discussed several important issues; first and foremost of course we’ve discussed preparations for the Chicago summit,” Vashadze said and added: “We have full a concurrence in opinions.”
He also said that economic, political and democratic developments in Georgia were also discussed.
On April 19 NATO foreign ministers will be joined by Russia’s Foreign Minister Sergey Lavrov for a session of the NATO-Russia Council (NRC).
The Georgian Foreign Minister said, that the NATO would “definitely” reiterate “fundamental differences” existing between the Alliance and Russia over Georgia.
On April 18 Foreign Minister Vashadze also met in the NATO HQ with counterparts from Albania, Bulgaria, Poland and the Czech Republic, according to the Georgian Foreign Ministry.
After meeting with President Saakashvili in Brussels on April 3, NATO Secretary General Anders Fogh Rasmussen said, that the Alliance’s “special partnership” with Georgia would be reflected at the upcoming NATO summit in Chicago in three ways.
“Firstly, reflect that Georgia is one of the major contributors to our operation in Afghanistan. Secondly, reflect that Georgia in general is a major contributor to the trans-Atlantic cooperation within the special NATO-Georgia Commission and thirdly that Georgia is also considered an aspirant country, a country that aspires to become a future member of NATO,” Rasmussen said.


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Our office has highly-sophisticated, computerized instruments that enable us to take detailed images of the back of your eyes: the OCT and DRS. We can better manage your glaucoma, macular degeneration, diabetes, and degenerative disease through this medical imaging.
Dry Eye occurs when tear glands cannot make enough tears or produce poor quality tears. Dry eyes can be uncomfortable, causing itching, burning, or rarely some loss of vision. Your eye doctor may suggest using a humidifier in your home, special eye drops that simulate real tears, or plugs that are placed in tear ducts to decrease tear drainage..
This condition occurs when there is a progressive deterioration of the optic nerve. Glaucoma is often associated with an increased pressure of the eye. The eye is like a tire that generally has a normal and safe pressure. When this pressure is increased, it can be associated with damage to the optic nerve; this is called Primary Open-Angle Glaucoma. Glaucoma can also occur without an increase in eye pressure. This is called Low Tension Glaucoma and it is often associated with diabetes or high blood pressure. Glaucoma causes painless loss of peripheral vision and can lead to blindness if left untreated.
Age-related Macular degeneration (AMD) is the leading cause of severe, permanent vision loss in Americans over 50. More than 3.5 million people have early stages of Macular Degeneration. This disease of the macula, the central and most sensitive part of the retina, robs people of central vision. Left with only peripheral vision, they struggle to identify faces, read books and watch TV, because they can see out of the corners of their eyes, but not straight ahead.
“Floaters” are tiny spots or specks that float across the field of vision. Most people notice them in well-lit rooms or outdoors on a bright day. Floaters often are normal, but can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes. If you notice a sudden change in the type or number of spots or flashes you see, visit your eye doctor as soon as possible.
Many people are surprised when they visit the eye doctor that their blood pressure is taken and a medication list is analyzed. Diabetes, Types I and II and Hypertension are just two illnesses out of many that can cause damage inside the eye. Problems can range from minor prescription changes to permanent loss of vision. Signs can include double vision, retinal bleeding and stroke inside the eye.
When choosing between a conventional progressive and a high definition digital progressive lens, consider the differences between a high definition television versus a tube television. As time changes, technology does as well. With a high definition digital progressive lens you will experience a customization at its best providing you with a clearer vision in every gaze direction. Eliminating more distortion will help you be able to balance your far and near vision much easier.
An occupational lens is a design in prescription eyewear that allows the wearer to view all working distances, side to side, up and down, within a conventional working distance, or small environment. A working distance typical to many occupations will fall somewhere between ten to thirteen feet, respectively.
The most impact resistant lenses on the market. They are incredibly tough and scratch resistant. They are designed to live up to the demanding life of every member of your family. These lenses are perfect for everyone, especially for active children and rimless frame wearers.
Anti-reflective is a treatment for lenses to help eliminate reflections by allowing more light to pass through the lens. It is great to relieve eye strain at the computer during the day, and corrects halos for night driving. With time anti-reflective treatment has grown into a more technical product, reducing static, dirt and smudges making them easier to clean.
Much like the high definition digital progressive lens, this lens gives you a clearer picture, only it is for single vision wearers. If you wear contacts more than your glasses but are looking to change it up a little, this lens is perfect for you! It will make the prescription look exactly like how it did in the exam room. It is that precise!
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Hi-Index lens material is made for patients that have higher or a more complex prescription. It reduces the size of the lenses making the eyewear be more appealing to the wearer. Say goodbye to “coke-bottle” glasses!
Polarized lenses are great for sunglasses. Compared to tinting, polarization blocks UVA and UVB rays. It also eliminates glare by blocking harmful rays through a filter. There is a broad color selection to cater to your outdoor hobbies. Polarized lenses are suggested to be used by fisherman, golfers, day drivers, and anyone looking for good protective sun wear.
At Lawrence Family Vision Clinic, we understand that the medical and eyewear industry is continually advancing forward. We too are advancing forward by using innovative technology and the newest products available.
The Optikam is the newest and most advanced optical measuring device in the industry. This high-tech instrument gathers the most accurate measurements for bifocal, trifocal, and progressive wearers. With these precise measurements we can offer better quality lenses and help give you the best vision possible.
The Optikam is also a touch-screen photo kiosk that allows patients to see themselves in new frames clearly. If you struggle seeing yourself without glasses this is the perfect tool to find your next frame. With the Optikam you are able to compare up to four pictures, side by side, and can e-mail them to friends and family.
The benefits of this machine extend beyond measurements and pictures, so let our staff know if you are interested in exploring how the Optikam can help you.
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Ask any person what they think of when the name 'Lamborghini' comes to mind and they will instantly draw up images of a long, low-slung, V12, mid-engined wedge of a car. It has since been this configuration that the Italian automaker from San'tagata has built its reputation upon, and as of 2011, the Aventador was the model that would carry this flagship impression.
Fast forward nine years and the Aventador celebrates an important milestone to add to its already impressive resume: 10,000 units sold.
The Aventador built upon the outgoing Murcielago with a host of improvements such as a monocoque chassis and its crowning 6.5-liter V12 pushing 700 PS. Since its release, there have been countless updates and more development to keep the Aventador as aggressive and eye-catching as a proper Lamborghini should be, and it all culminates in their latest track-oriented model: The Aventador SVJ. Obviously, it is this model that the 10,000th Aventador would be based upon.
The SuperVeloce Jota is the sum of all the motorsports experience of Lamborghini into one potent track weapon. It comes equipped with the ALA (Aerodinamica Lam Attiva) active aero system to propel the SVJ to a blistering 6 minutes 44 seconds lap time around the Nurburgring Nordschliefe. The 10,000th Aventador SVJ is painted in Grigio (Grey) with red and black accents and will be making its way to its owner in Thailand.
Considering that Lamborghini first started making the Aventador nine years ago, the fact that that they were able to make 10,000 examples of the supercar is a feat of in itself. Combined with their recent achievement of making the 10,000th Urus just two months ago, and it looks like Lamborghini will continue making raging bulls for the world to enjoy.


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It's Charlie Simpson who's granted the double-edged honour of opening the show for Aussie punk-pop revivers 5 Seconds of Summer tonight (September 4) at London's Roundhouse for the fourth night of the iTunes Festival. And despite reports of fans queuing for a meagre eight hours before doors opened, his set is received as more than the necessary intermediary before the main event.
Despite sending a lurch of excitement through the crowd halfway through their set with a cheekily rolled out reference to Busted's 'Year 3000', 5SOS weren't to be tempted into venturing into a cover of their childhood idols. Rather, Luke Hemmings, Michael Clifford, Calum Hood and Ashton Irwin enter the stage with the energy and verve to prove their place as worthy headliners of the stage tonight.
Opening their set with debut album track '18', the band go about finding their feet for the rest of the evening. Calum and Luke briefly share a microphone to the delight of the audience and an obligatory chant of 'Hey' ensues towards the end of the track as the band flitter around the stage, sizing up their territory for the next hour.
5 Seconds of Summer aren't the pristine, sweat-free beings of their mates One Direction. Michael's red hair dye trickles further down his face as the show progresses and the band increasingly up the ante of their performance. Equipment is leaped upon and guitars are jousted enthusiastically towards the crowd, 5 Seconds of Summer sweat for their art, you see.
'Heartbreak Girl' and 'Don't Stop' provoke the eardrum perforating screams and adoring jumping you'd expect from the Aussie boys dropping in a couple of crowd favourites. "You're a bunch of rats, that's what you are," they tell the fans (who react as rapturously as ever), before adding: "No you all look great," thanking iTunes for letting them play "terrible music".
It's clear 5 Seconds of Summer have spent a lot of rainy days fondly studying their idols. That much is clear from their buoyantly rooted jumping, synchronised guitar swinging and choreographed sways to face Ashton as he passionately drums during particular parts of songs. However, for most of the demographic present tonight it's a new and exciting experience and so they act accordingly.
The camaraderie of the band is clear from the offset, with their recollections of watching Muse here whilst drunk to claims of escaping from a haunted house feeling like a PG version of Blink-182's sexual and toilet humour-infused badinage. Switching to acoustic guitars, Michael and Luke take a seat to perform their new single 'Amnesia', before slipping into fellow album ballad 'Beside You'. 5SOS's last 'official' song of the night arrives in the form of 'Good Girls', but even the most amateur of fans knows the show can't be over - they haven't played their biggest hit.
Bounding back onto the stage led by Ashton the group perform the first of three encore tracks, a cover of The Romantics' 'What I Like About You'. 'End Up Here' follows, before the moment everyone's been waiting for arrives. Fully aware of the mania they're about to unleash, 5 Seconds of Summer tear into the song responsible for giving them their place on the stage tonight, 'She Looks So Perfect'.
It may not have been the shimmering headline spectacle of an act at the top of their game, but 5 Seconds of Summer have more than proved that they have it in them. Day four of the iTunes festival can be remembered as an impressive stop from a band well on their journey to finessing the art of victorious live shows, and clearly relishing every moment of it.
Watch 5 Seconds of Summer performing at the iTunes Festival below:


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Tony felt happier than he had ever been. The song of the birds was sweeter. The touch of the wind made his senses come alive. The grass was greener. Even the girls were prettier, though seeing them only made him want Manjula more.
They say that oral sex is not sex, but it is. Bill Clinton had been wrong. Tony did not feel a virgin anymore, and he could not think of Manjula as one either. She had been right. They had crossed a line, a line that Tony felt himself well rid of.
He still wanted to have full-fledged intercourse with her, of course, but he knew how much just this oral sex would have cost her. Let it wait. It was hard to see how he could be any happier than he already was.
He could not stop thinking about the incredible experience, to the point where he spaced out in class, or dropped sentences with his classmates in the middle of study sessions.
He even ran into Tiffany at lunch again one day. She stared at him for a moment before recognition dawned. “Say, aren’t you the guy who—”
“Thank you so much for introducing me to Manjula!” he boomed, warmly shaking her hand, then boldly kissing it. He could not resist bragging a bit. “She knows everything now! Everything!” he crowed as he walked off, leaving Tiffany flabbergasted.
He found Manjula on a couch in the lounge area. She smiled, that sweet gentle smile he loved so much. He snuggled up beside her.
“Somebody looks very happy today,” she said, with a tone of unmistakable smugness.
“It was paradise. Pure paradise. The only thing was—”
“Please do not say I did something wrong.”
“Nothing. But I didn’t do anything right, or anything at all, really. I didn’t give you anything.”
“I think I got the better side of that equation. How do you boys survive with only one orgasm a day? I had three.”
“I didn’t even notice—”
She laughed. “I do not think you were in any shape to notice. But it is okay. I know now what the other girls meant, why they take it in the mouth. You men have a baser, more raw sexuality than we women. Being close to it like that is like being close to the earth itself, rich and fertile and full of life. Never be ashamed of your carnal desires. They make you the man you are. And watching you react that way — so strong and powerful and yet at the same time so open, so exposed and vulnerable — made me feel like a goddess, like Lady Rati herself. It did not feel quite as good as your fingering me, but it was very close. In a moment like that, I only need one hand.”
“I still want to keep fingering you—”
“You will, believe me, you will.”
“But tell me one thing, I have to know…”
Tony’s face was red, he could barely meet Manjula’s eyes.
“Did it stink?”
Manjula snorted with laughter, so loudly that it drew stares across the room. “Of course it did not, foolish boy! I am a cleaner of dirt, not an eater of dirt!” She kept laughing until she saw just how relieved Tony looked.
“Actually,” she went on, “your kundi tastes better than some other parts of your body. Would you believe it is a little sweet?”
“I’m not sure I do believe that. I wonder if… next time… I could do the same for you—”
“Next time?” Her eyebrows shot up.
“I mean, if… I just thought…”
“I was only joking. Of course you can,” she said. “I am looking forward to it.”
Tony’s cock pulsed a little, and his eyes burned with a hot light.
“I wish we could do it more often,” he said. “Having to work around roommates really sucks. I wonder if we could go away for the weekend sometime.”
“I do not think either of us has time for that,” she said regretfully. “But there are always the holidays. We can learn how to ski together.”
Tony looked at her, thinking about how much there was he wanted to show her, share with her, explore with her.
“You know what would be great?” he asked. “If you go back to Sri Lanka over the summer or anything, I could go with you.”
“It would be awesome! I’ve wanted to go there for years, but my parents weren’t interested, and they always said I shouldn’t go alone.”
“I am sure you could manage. You are a grown man, and plenty of foreign tourists come to Sri Lanka.”
“But I want to go with you,” said Tony.
“There would be far too much gossip in my village. Even your staying in a hotel nearby would lead to rumours spreading.”
“But there’s the whole rest of the country! I have relatives in Colombo, Batticaloa, and Jaffna—”
“Who will also spread rumours, and probably will not even let me in their homes,” Manjula reminded him.
“Well, screw them then. I’ve read the tourist books. I can’t believe there’s so much to see in one small island.” Excitedly, he went on about the beaches, among the best in the world, the historical sites in Anuradhapura, whale watching in Mirissa, the elephant sanctuary in Pinnawala, mountain climbing at Adam’s Peak, wildlife in Yala National Park, festivals in Kataragama…
“You know more about travelling in Sri Lanka than I do. I have never been to any of those places. I have seldom gone far from my village, except to visit relatives in Colombo.”
“We cannot afford to stay in a hotel. If we do not have relatives to stay with, we do not go. And even bus fare to Colombo can cost as much as five hundred rupees.”
That was less than four Canadian dollars. To go a distance of more than three hundred kilometres.
“Foreign tourists usually take trains or tourist buses, which are air-conditioned and much more expensive,” she added. “But they go only to the big tourist sites you were talking about. Those are mostly in the Sinhalese parts of the country.”
“What I want to see most of all is Jaffna. Both my parents were born there. I feel I could understand everything so much better if I could see it, just once.”
“Why is that?”
“It’s where my ancestors come from. In that sense, it’s home.”
Home. Manjula’s eyes filled with tears.
It was not the beaches, or the mountains, or the scenery, or the sights that Manjula thought of when she thought of Sri Lanka. It was her aunt and uncle, who had worked so hard to give her the chances to grow and succeed in life. It was her three little cousins who looked up to her, who all called her simply akka, “big sister”.
It was also the way the birds warbled, early in the morning, the way the sunlight streamed into the hut. It was the soothing tropical heat, the lush palm trees, the cool evening breezes. It was sipping on falooda on a hot afternoon, tricking monkeys to throw down coconuts, swimming in little streams, sneaking a hot toddy when no one was looking. It was sitting on the ground, eating with your fingers off a banana leaf, the way the gods intended.
Tony could sense her distress. “Home… you’re really homesick, aren’t you?”
“I like it here too. And you have made life here very special for me. But there is no place like home,” she said, a woebegone expression on her face.
She lay her head on his chest and he stroked her hair for a while, wondering what he could say to comfort her. Then an answer came to him.
“In that same sense,” he pointed out, “Canada isn’t really anyone’s home, except for aboriginal people.”
“What do you mean?”
He told her the story of Canada, the real story. Not the dates and acts of dead white men, but the story of migration and upheaval. It was a tale that ran from orphan French girls desperate for a husband in the seventeenth century to Scots fleeing massacres in the eighteenth; from Irish dying of famine to Italians fleeing overpopulation to Sri Lankans running away from war and poverty.
For centuries, the long line of defeated peoples had trekked across the oceans to find a new place for themselves in this cold land of the north. All struggled with feeling homesick and lonely and foreign. All battled hostility and suspicion from predecessors who had forgotten their own origins. All learned to thrive, mixing the old traditions and the new, synthesizing a way of life that worked for them.
Finally, perhaps, as usual, a song captured his feelings better than anything he could have said.
U2’s Walk On was a song that talked not of a place in the globe but a place in the heart, of a longing to belong, to heal the wounds of separation and distance.
Tony halted abruptly, realizing the song’s ending was probably not appropriate to the situation. He just sat there for a while, cuddling her against him, listening to her breathing.
It did not occur to him that she could always google the entire song later.
Manjula came late to math class that afternoon. A little breathless, but he could not see any sign of pain on her face.
“Are you okay?” he whispered to her. “I had an appointment,” she replied, without further explanation. They resumed taking notes. Afterwards she excused herself again, saying she had to meet a group working on a project for economics class.
Tony thought this a bit odd, since she wasn’t heading in the direction of the library, or even the business faculty.
Later, they made plans for their next “painting” session, although, as Manjula winsomely pointed out, they were well past the painting stage.
“But before you come over, I want you to do something. Some Tamil homework.”
Tony was game for this; working on Tamil meant, as it always had, more time with Manjula.
“I want you to translate this Tamil song,” she said, handing him a printout. Tony thought he recognized it, from a popular mythological film from a few years ago.
“But no cheating by looking it up online,” she admonished. “I can google any translation that is out there. You must do this yourself.”
Tony could live with that. There were dictionaries on hand in the library.
He didn’t finish until just before Manjula’s deadline.
He stared at his translation. It was very hard not to conclude that she was sending him an unsubtle message. Orey Oor Oaril is performed in the film by a warrior princess. The Tamil version of the song is full of thinly concealed sexual innuendo. Ostensibly she is praising her betrothed’s “sword”, but Tony knew what Manjula had in mind.
Tony read up and down, checking again and again to see if he had gotten it right. The song had provoked a reaction in him, all right, though maybe not the one Manjula had been going for.
He headed over to her room, his pulse racing alongside his footsteps. He had no idea how this evening would end.
He knocked on the door. He heard a rustling sound of some kind before she finally said, “come in.” What did that mean? Usually she just opened the door.
Manjula was standing by the window, her divine figure framed by the bright sun, wearing nothing but a shy smile. Her right hand was over her breasts, with something shiny-looking between her fingers. Her left hand brandished a printed sheet of paper, blocking the view of her pussy.
What was going on?
“I saw the doctor.” She passed him the shiny thing, exposing her breasts. It was a packet of birth control pills. The first row was already finished.
“And I no longer wish to be a doctor.” She gave him the paper, letting him see her pussy. Her change of major to applied mathematics had been approved.
“All that you want is now yours,” she said proudly. There she stood, her nude body inviting and desirable, her face filled with love and surrender and fierce joy.
“Not all,” Tony replied.
Everything had fallen into place. It was clear to him at last what he had to do. His mind, his heart, and his cock were ready to speak as one. He dropped to one knee.
“Manjula,” he said, “will you marry me?”
He gazed into her eyes. Her beauty had etched itself into Tony's mind many times before — the twinkling in her eyes when she laughed, the wild ecstasy when he fingered her, the sweet smile and soft eyes that had mesmerized him so much. But that seemed nothing compared to the look of blissful hope on Manjula's face now.
She opened her mouth. Were her lips forming the word yes? They seemed to for a moment, then snapped shut.
She was looking at him with excitement in her face, but also doubt.
“Are you not afraid?” she asked finally.
“Why would I be afraid?”
“You said… you said that in this country people take years before they decide to marry. That they would rather break up than marry the wrong person.”
“You are the right person. I never want to break up with you. Not ever. I love you. I love you more than anything. More than life itself.”
Her eyes were wet, but still, she hesitated. “Please Tony, you must answer me something honestly.”
“Do you want to marry me just so we can make love? You do not have to do that. My body is yours, whenever and for however long you want me.”
“Of course I want you. I've wanted you from the moment I laid eyes on you. When I look at you I see a beautiful body I can stare at for the rest of my life. I see hands that always know how to excite me. But do you know what else I see?”
“I see a soul with courage. I see a stranger in a strange land, brave enough to try anything new and learn anything different. I see a brilliant mind and a generous heart, a heart that cares about people, deeply. I see someone who inspires me, who has made me a better man. I see the one who has taught me who I really am and where I come from.
“I see someone who doesn't try to change me or make me something I'm not. I can tell you my darkest desires and you're still willing to trust me with your body. You're the only one I can be myself with, completely.
“It is a far, far better thing that I do, than I have ever done; it is far, far better life that I go to than I have ever known.”
Tears were streaming down her face, but Manjula summoned a smile. “You took that from a book, did you not?”
“And more.” His eyes bored into hers. “Every path you have trod, through wilderness, through war, has led you to this road,” he said, absolute conviction in his voice. “Become who you were born to be.”
And suddenly she was falling to her own knees, grabbing him, holding him tightly to her, pressing her body against his, kissing him with every ounce of strength she had. “Oh Tony, my beloved, my darling, of course, of course, of course, I will marry you.” He could say nothing else, her lips were on his, they were rolling around on the floor. She was wearing perfume for the first time, the scent was like wine, intoxicating him.
Manjula’s face was wet with tears, salty, warm tears, tears of joy. Tony could not think of anything else but how much he loved her, how badly he desired her, how he never wanted to be anywhere, do anything, but lay there in her warm embrace.
“I have learned as much from you as from any professor,” she said. “You have taught me about my body, what it means to feel, to live. When you touch me, when you kiss me, when you hold me, I can feel how much love there is in you, how badly you want to give it. I have never felt as safe with anyone as I do with you.
“I see in you a man who never stops trying to improve himself, never gives up trying to be even better than he already is. I see a man who always has something new to teach me, a man whose mind can challenge mine.
“I feel like a bird that has left the nest. I feel like a child learning to walk for the first time. You have given me a new life. You have shown me a future I could not have thought possible. You have believed in me as no one else ever has. And I know” — she was crying in earnest now — “I cannot face life without you beside me.”
They lay there on the floor, holding each other in their arms for a long while. Then, on a sudden impulse, Tony rose to his knees, put one arm behind her shoulders, the other behind her legs, and lifted her up. She squealed in surprise, but the workouts they had been doing together had paid off. He was now just strong enough to stand up and carry her to the bed.
Manjula’s fingers trembled as she fumbled with his buttons, but she brushed his hands away when he tried to undress himself. His cock rammed to attention when she pulled off his boxers.
“Your cock is so beautiful. It is my favourite part of your body,” she said, kissing it. She opened her mouth to wrap around it, but Tony had to block her. “I’m still new at this, I am not strong enough to do both—”
“Say no more,” she replied. “You are not leaving this room until you have been inside me for as long as you can.”
Now it was Tony’s turn to have tears in his eyes. Every girl he had stared at since the age of thirteen, every classmate he had been besotted with, every celebrity infatuation he’d felt, every romance-movie star he had longed for, every model who had seduced him online, every porn actress he had masturbated to, all of them were but signs on the path that led to Manjula.
They lay there together, their hands exploring and feeling every nook and cranny of each other’s body. Her skin was so soft and delightful. Her hands drew their magic on him, an enchantment all the more binding because of where he knew it would lead.
Tony could hear how powerfully Manjula’s heart was pounding, could feel how wet her pussy was, could taste the hunger and desire on her lips. She was his. This beautiful girl was going to be his wife. Her breast was in his mouth, her ass in his hands. The lovers could not keep their hands and lips off each other. They sucked and fondled and licked and stroked and kissed each other to their heart’s content, basking in the sheer, unadulterated pleasure they took in each other’s body.
At long last Tony lay on his back. “This may hurt a bit—”
Manjula laughed. “Do you mean my hymen? You forget I have done farm work. Mine broke years ago.” One step ahead of him, to the last.
She sat on top of him, the picture of brown beauty. Tony could not conceive of anything more wondrous than her naked body. Her hair flowed more smoothly than a waterfall, her breasts were as inviting as ripe grapes, her tiny waist as heavenly as the clouds. He could feel the wetness of her folds brushing the end of his equally wet cock. But none of that beauty could compare to the expression of devotion on her face. For what reason he could barely fathom, he knew that she loved him with every fibre of her being.
Slowly, gingerly, she began to lower her pussy onto his cock. Tony felt her power wash into his body, like the first sip of the strongest liquor.
In ancient India, the Upanishads told of moksha, of liberation:
For verily the woman is like the fire of sacrifice
her midsection is the fuel
her hair is the whiff of smoke
her pussy like a flame
the cock is the coal
that sets off the sparks of pleasure
Tony felt himself leave the plane of this earth and step somewhere beyond. Dreams and reality were melding into one. Time seemed to slow down, as if he could feel all of life foretold in a matter of seconds. As if through some mystic glass, Tony could feel their joy the day they would turn the keys and step into their own home. He felt the bliss of the day their children would arrive, out of this very same holy of holies he was entering.
Tony was burning. Indeed his cock was burning, inside a pussy that felt like dragon’s fire. He put his arms around Manjula and leaned her forward, thrusting into her. He could feel her body vibrate around him, hear her screaming his name, realized he was screaming hers.
In his vision Tony could see the struggles, the loneliness, the homesickness, the long nights agonizing how to pay the bills, the times of unemployment, of prejudice, of failure. But they were not his struggles, they were their struggles. There was no more he, no more she, there was only they. One hand washes the other. In the union of cock and cunt is found the strength to break all of life’s obstacles, beat back all the hammer blows of this world. Therefore a man will leave his father and his mother and cling to his wife, and they will become one.
Manjula was quaking, erupting, eyes rolling, hair flying, holding tightly onto him. Tony was shaking, moaning, and then rivets of power coursed through his body like thunderclaps. His seed poured into her like a storm. This was not cumming as he was used to, a wave of pleasure felt by penis alone. He felt this come from every inch of him, from his head to his toes, from the surface of his skin to the depths of his soul.
In those seconds Tony’s mind flitted through the years, dreaming of the old age they might one day face together, of letting go of youth and beauty, of accepting the rolls and the wrinkles of time. He dreamed of the pain of sickness, of senility, of finally the bleak day when one would say goodbye to the other. Yes, even pain is a dream, if that pain is shared as deeply as the pleasure. For life is more than a song. For every up there is a down, yet no misery faced together is a misery for long. No greater hope could they have, no dream could mean more, than that even fifty, sixty years hence, he might have the privilege of entering this pussy, no matter how much its beauty might fade. This was where his cock belonged. Where he belonged.
She fell on top of him, arms around him, holding onto him desperately. It could not have been more than a few minutes, but Tony and Manjula were heaving as if they had run a marathon.
“I’m sorry I could not last longer—”
“Do not spoil this moment.” She silenced him with a kiss. “Do not worry, I had two climaxes in that time.” She snuggled into him and lay her head contentedly on his shoulder. There they lay, listening to the sound of each other breathing.
“I love you so much,” she said at last. “I cannot wait to do this again.”
“If we get married soon, we could apply for married-student housing,” Tony reminded her.
Manjula’s eyes glistened. “We could do this every day.”
She looked up at him. “I have not forgotten those videos. Over time, one day… one day I want to try everything you desire. Everything.”
“But some of those are hurtful—”
“They are beautiful. I remember that Bible psalm you told me about. You are my shepherd; I shall not want. Yea, though I walk through the valley of the shadow of lust, I will fear no evil, for you are with me, your hands and your lips, and yes, your cock, they comfort me.”
Tony was too moved to respond. He held her soft, warm body close to him. He wanted to spend the rest of his life cuddling her. Just like this.
Paal irukkum, Manjula began to sing. There is milk. Tony remembered that milk and fruit are ritually displayed in Hindu weddings. They are not eaten. Just as there is a wedding bed, but no sleep takes place there.
She might not be a doctor. But they had found their cure.
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It was the early 1990s in New York City when Professor of Piano Andreas Werz found himself in Steinway Hall tasked with purchasing three pianos for Fresno State. Even though he was surrounded by first-rate instruments, he struggled to find that perfect one worthy of the world-class musicians he was bringing to campus for the Philip Lorenz International Keyboard Concert Series.
Two of the instruments were Model B classic grand pianos, the type you might find in a home of a well-to-do enthusiast or a small performance venue. Those pianos are primarily for use by the piano faculty. Steinway had prepared several options for Werz’s visit, and he was able to find what he was looking for.
The third piano was a bit more special — the Model D Concert Grand. These are the instruments one would find in the best concert halls around the world. Steinway had again presented several options, but none of them were up to Werz’s exacting standards.
“The selection that they presented to me was not as good as I had hoped. So I kept asking, ‘Are there other instruments in the house that I could try out that are available for us to purchase?’”
Before long, Werz found himself in the basement of Steinway Hall — a place where concert pianists can choose an instrument to use in a performance or recording studio. These performance pianos are the best of the best and Steinway will send them, at the artist’s request, to such venues as Carnegie Hall or the Lincoln Center. It was here that he found the instrument he had been looking for.
“It may have been a tiny bit older, and it was definitely prepped, it was ready to go. So my assumption is they had shipped it out to other venues in New York City for concerts and always brought it back into their basement. That’s why it was in good shape. It was really well maintained,” said Werz.
The piano would find its home in the newly constructed concert hall inside the then-new music building at Fresno State. It was also around this time that Fresno State professor and founder of the Keyboard Concert Series, Philip Lorenz, passed away. Professor Werz, who was Lorenz’ understudy, took over as artistic director.
Every year, the Philip Lorenz International Keyboard Concert Series brings eight internationally recognized piano and organ artists to Fresno State. The fingers that play the Steinway Werz found in the basement have also played in the most famous concert halls around the world — making the series one of the best-kept secrets in Fresno.
“These are people who constantly play the major venues here in this country, in Europe and Asia, and include Fresno on their trips. It’s wonderful,” said Werz.
In the 2019-20 series, each of the following artists have included the Fresno State Concert Hall as part of their international performance schedule. Tickets are $25 for general admission, $18 for seniors and $5 for students, and season tickets at $160, $120 and $30 respectively.
The late Luis Costa, dean of the College of Arts and Humanities at California State University, Fresno and vice-president of the organization for many years, succinctly explained the community impact of the Philip Lorenz International Keyboard Concerts when he said, “I know of no other piano and organ performance series, anywhere, which offers to a community of our size such artistry, affordability, dependability, reputation and longevity.”
2019-2020 Philip Lorenz International Keyboard Concert Series
3 p.m., Sunday, Sept. 8
Garrick Ohlsson attained legendary status in 1970 when he became the first and only American to earn the Gold Medal in the International Chopin Competition in Warsaw. The New York Times said he is celebrated for his “tasteful virtuosity, elegant sense of proportion, and the balance between intimacy and declamation.” Ohlsson will perform works by Brahms.
7:30 p.m., Friday, Oct. 11
An American pianist, Jonathan Biss is noted for his artistic maturity and versatility, prodigious technique and diverse repertoire ranging from Mozart and Beethoven to contemporary composers such as György Kurtág and Leon Kirchner. The Los Angeles Times called him “A serious, accomplished artist who puts the composer before the player.” Biss will perform works by Beethoven.
7:30 p.m., Friday, Nov. 22
Since Kenny Broberg’s triumph at the 2017 Van Cliburn International Piano Competition, he has enjoyed a thriving performance career with recital and orchestral engagements across North America, Asia and Europe. The Texas Classical Review praised him for his “imaginative shaping of themes, revelation of inner voices and an unfailing sense of momentum.” Broberg will perform works by J.S. Bach, Beethoven, Chopin, Franck and Medtner.
7:30 p.m., Friday, Jan. 10
First Prize winner of the 2018 Géza Anda International Piano Competition in Zürich, Claire Huangci is characterized as a musician of uncommon sensibility and maturity. This 29-year-old Chinese-American artist has already appeared in many of the world’s most prestigious venues. The Salzburger Nachrichten said Huangci captivates her audience with “radiant virtuosity, artistic sensitivity, keen interactive sense and subtle auditory dramaturgy.” Huangci will perform works by Mozart, Chopin, Brahms and Schubert.
7:30 p.m., Friday, Feb. 14
Born in Moscow, Natasha Paremski came to the United States at a young age winning numerous awards including the 2006 Gilmore Young Artist Prize. She enjoys a flourishing career that has included performances as soloist with the Los Angeles Philharmonic, San Francisco Symphony, Houston Symphony, Toronto Symphony, Tonhalle Orchester Zürich, and the Moscow Philharmonic. The London Classical Source lauded her “fiery and widely dynamic playing.” Paremski will perform works by Prokofiev, Ravel and Mussorgsky.
3 p.m., Sunday, March 8
Currently completing an artist diploma at the famed Curtis Institute of Music in Philadelphia, Monica Czausz enjoys a thriving performance career in Europe and the United States and has quickly made a name for herself as one of the finest young American organists on the scene today. The American Organist praised Czausz for her “artistic mastery far beyond her years.” Czausz will perform works by Buxtehude, Schildt, Praetorius, J.S. Bach, Brahms, Schumann, Merikanto and Hakim. The concert is co-sponsored with the San Joaquin Valley Chapter, American Guild of Organists.
7:30 p.m., Friday, March 27
Since winning all prizes at the 2005 Chopin International Piano Competition in Warsaw, Rafal Blechacz has established himself on the international concert scene and is celebrated worldwide for his virtuosic interpretations. He was recently awarded a prestigious Gilmore Artist Award in recognition of his brilliant achievements and passionate commitment to his art. Blechacz will perform works by J.S. Bach, Beethoven, Franck and Chopin.
3 p.m., Sunday, May 3
Winner of a MacArthur “Genius” Fellowship, the Avery Fisher Prize and Musical America’s Instrumentalist of the Year award, Jeremy Denk was recently elected to the American Academy of Arts and Sciences. The New York Times said, “Jeremy Denk, clearly, is a pianist you want to hear no matter what he performs, in whatever combination – both for his penetrating intellectual engagement with the music and for the generosity of his playing.” Denk will perform works by J.S. Bach.
Young Armenian Talent Series
In addition to the main lineup, the Philip Lorenz International Keyboard Concerts has teamed up with the Fresno State Armenian Studies Program to co-sponsor the Young Armenian Talent Series.
7:30 p.m., Friday, Sept. 27
Educated at the Royal Conservatory of Madrid and the École Normale de Musique Alfred Cortot in Paris, Melikyan has gained international attention while performing in such prestigious venues as Carnegie Hall in New York, Jordan Hall in Boston, Palau de la Música Catalana in Barcelona, and Salle Cortot in Paris. Mundoclasico has hailed the Armenian-born pianist as an artist with a unique voice combining “high-wire virtuosity” with “deep musical intuition and the ability to connect with the audience.”(Mundoclasico). Melikyan will perform works by Chopin, Mompou, Komitas, Rachmaninoff and Chitchyan. NOTE: Originally scheduled to be a concert by Hayk Melikyan, no relation, who was unable to make the concert.
3 p.m., Sunday, Oct. 20
After completion of a Doctorate in Piano Performance at the esteemed Thornton School of Music of the University of Southern California in Los Angeles, Michael Krikorian returns to his hometown with a diverse program showcasing him as a brilliant pianist and equally talented composer. A top prize winner at the 2018 Los Angeles Liszt Competition, he has given acclaimed performances in numerous venues across the United States as well as Italy, France, China and Korea. Krikorian will perform works by Beethoven, Liszt, Gounod, Scriabin, Babadjanian, Komitas and Bartók, and McCartney and Lennon.
7:30 p.m., Friday, Feb. 28
Born in Yerevan into an artistic family, Nara Avetisyan is currently completing her doctorate in piano performance at Stony Brook University in New York. Prize-winner at competitions in the United States, Armenia, Italy, Greece and Lithuania, she has garnered accolades for her performances as recitalist, soloist with orchestras, and chamber music partner at concert halls in Vienna, Munich, Geneva, London, Monaco, São Paulo, Sochi, Boston and Los Angeles. Avetisyan will perform works by Händel, Zakarian, Granados, Babadjanian and Prokofiev.


He's just another friend!
Jennifer Aniston is not dating Justin Theroux.
The two dined together on Wednesday, but contrary to X17online's reports, there's no romance heating up between Aniston and Theroux.
"What X17 neglected to mention was that there were three other people at the dinner," Aniston's rep told Us Weekly. "It was a friends dinner."
Rumors circulated that the 42-year-old actress was romantically involved with the 39-year-old Your Highness star after the two were seen together at a group dinner at L.A.'s Sunset Tower Hotel. Aniston and Theroux were also costars in the recently wrapped comedy Wanderlust.
A witness told Us: "[Jen] was romantic with nobody at the table. She had a great time, but was definitely not on a date."


Watch the embedded episode below.
Works on most browsers.
or listen in audio-only podcast form on Spreaker
We welcome Alex Thomson from UK Column to The After Party for the first time.
A Cambridge graduate, he brings a wealth of experience in intelligence,
living and working in various parts of Europe,
serving as an interpreter for the EU, and more
to analyze current affairs.
Select Time Stamps:
2:08 Introducing Alex Thompson and UK Column – The New Media
5:30 W. Cleon Skousen’s “The Making of America” and “ The Naked Capitalist”
10:45 Alex’s upbringing
14:10 How Alex came to realize the consequences of multiracialism.
28:56 Politics are downstream from culture, culture downstream from religion.
31:20 An Englishman’s observations on the American Empire
39:00 Ideology and history of UK Column
48:25 Race and the Bible
1:24:35 What do we do if we can’t vote our way out of this?
1:26:42 Who is to blame?
1:44:30 Final Thoughts


The technology company Continental is focusing on the challenges facing growing logistics chains at the world’s largest industrial trade fair this year. For this reason, the company will present selected technological highlights and intelligent key technologies for a safe, efficient and smooth goods turnover from April 23 to 27, 2018, in hall 5, booth E18.
Continental Commercial Specialty Tires will present its new solid tire portfolio and tire pressure monitoring systems for more safety and efficiency
Tires for industrial trucks such as forklifts play a decisive role in safe, quick and comfortable transport in intralogistics. The new Plus solid tire series for industrial applications is thus going to celebrate its premiere at the Hannover Messe. The solid tire series with the new Plus compound combines the advantages of high mileage with low rolling resistance. In addition, the downsized range makes product selection easier and more transparent. Also on show will be the ContiPressureCheck and ContiConnect tire pressure monitoring systems for pneumatic tires. These systems measure air pressure and tire temperature using sensors inside the tire. In this way, the safety and productivity of individual forklifts and entire fleets can be increased, idle times avoided and costs reduced.
Find our official Hanover Fair page here.
|Timing||April, 23rd – 27th 2018|
|Location||Hanover Fair, Germany|
|Location||Hall 5 (leight weight), Booth E18|
|Fair Motto||Integrated Industry – Connect and Collaborate|
|Opening Hours||Daily from 9 am to 6 pm|


text:
Otitis Media (Middle Ear Infection) in Adults Otitis media is another name for a middle ear infection. These symptoms may be the same as for other conditions.
An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the Common signs and symptoms in adults include.
Middle Ear Infection (Otitis Media) in Adults. What is a But adults can also get them. These are the most common symptoms of middle ear infections in adults: .
Learn about the different types of ear infections and their symptoms. We'll also explain A middle ear infection is also known as otitis media. It's caused by fluid .
Evaluation and management of chronic otitis media (COM) in adults are . Other symptoms, such as high fever, severe pain behind the ear.


Micromax launched a new smartphone, Canvas Amaze 2 in the Indian market on Wednesday. At a price of Rs, 7,499, the dual SIM device is available for sale starting from today, exclusively on Flipkart.
Commenting on the launch, Shubhajit Sen, Chief Marketing Officer, Micromax Informatics said, “With the launch of new Canvas Amaze 2, we are looking at offering a seamless and connected smartphone experience, which makes their lives simpler and at the same time more amazing with benefits that come with the smartphone. The launch further reiterates our successful partnership with Flipkart to bring the best in class smartphones with industry leading specification to price ratio for our consumers.”
The Micromax Canvas Amaze 2 is fronted with a 5-inch HD (720×1280 pixels) IPS display with Corning Gorilla Glass 3 protection, and a 5-megapixel secondary camera. While, it is backed with a 13-megapixel of primary camera with LED flash; and a 2500 mAh of battery, under the hood.
Running on Android 5.1 Lollipop, the smartphone is powered by a 1.4GHz octa-core Qualcomm Snapdragon processor bundled with a 2GB of RAM. For storage media, Micromax has provided 16GB of internal storage to the phone, while it provides a microSD card slot that supports external media up to 64GB.
The Canvas Amaze 2 comes with 4G LTE, 3G, GPRS/ EDGE, Bluetooth, Wi-Fi, and Micro-USB connectivity options.
Besides this, Micromax is looking forward in trying its luck globally. As the firm is planning to enter the Chinese market next year for volume growth in the world’s largest phone market in a bid to be among the top five in the world by 2020.


text:
Patient distribution. ECHO indicates echocardiography; HF, heart failure; and ITT, intention to treat.
Effect of treatment on primary end point. Size of squares is proportional to the number of patients in that group. Dashed line indicates overall relative risk. CI indicates confidence interval; HF, heart failure.
Remodeling and left ventricular end-diastolic volume (LVEDV) over time in the 2 groups. A, The LVEDV values are given as mean with standard error (error bars). B, Remodeling was assessed in 896 patients for whom baseline and either month 6 or month 12 echocardiography recordings were available. Remodeling values are given as percentages with 95% confidence intervals (error bars).
Beneficial effect of treatment on remodeling in predefined subgroups. Dashed line indicates overall relative risk. EF indicates ejection fraction; LVEDV, left ventricular end-diastolic volume; MI, myocardial infarction; and NYHA, New York Heart Association.
Customize your JAMA Network experience by selecting one or more topics from the list below.
The PREAMI Investigators*. Effects of Angiotensin-Converting Enzyme Inhibition With Perindopril on Left Ventricular Remodeling and Clinical Outcome: Results of the Randomized Perindopril and Remodeling in Elderly With Acute Myocardial Infarction (PREAMI) Study. Arch Intern Med. 2006;166(6):659–666. doi:10.1001/archinte.166.6.659
Angiotensin-converting enzyme inhibitors reduce mortality and remodeling after myocardial infarction in patients with left ventricular dysfunction.
Perindopril and Remodeling in Elderly With Acute Myocardial Infarction (PREAMI), a double-blind, randomized, parallel-group, multicenter, placebo-controlled study, determined whether similar benefits occur in elderly postinfarction patients with preserved left ventricular function. A total of 1252 patients 65 years or older with a left ventricular ejection fraction of 40% or higher and recent acute myocardial infarction were randomized to receive perindopril erbumine or placebo (8 mg/d) for 12 months. The combined primary end point was death, hospitalization for heart failure, or left ventricular remodeling. Secondary end points included cardiovascular death, hospitalization for reinfarction or angina, and revascularization.
The primary end point occurred in 181 patients (35%) taking perindopril and 290 patients (57%) taking placebo, with a significant absolute risk reduction of 0.22 (95% confidence interval, 0.16 to 0.28; P<.001). A total of 126 patients (28%) and 226 patients (51%) in the perindopril and placebo groups, respectively, experienced remodeling. The mean increase in left ventricle end-diastolic volume was 0.7 mL with perindopril compared with 4.0 mL with placebo (P<.001). In the perindopril group, 40 deaths (6%) and 22 hospitalizations (4%) for heart failure occurred, whereas 37 deaths (6%) and 30 hospitalizations (5%) occurred in the placebo group. Treatment did not affect death, whereas the hospitalization rate for heart failure was slightly reduced (absolute risk reduction, 0.01; 95% confidence interval, −0.01 to 0.02). No treatment effect on other secondary end points was detected.
We found that 1-year treatment with 8 mg/d of perindopril reduces progressive left ventricular remodeling that can occur even in the presence of small infarct size, but it was not associated with better clinical outcomes.
Acute myocardial infarction (AMI) leads to progressive changes in ventricle size, shape, and function, a process often referred to as remodeling.1 Quantitative 2-dimensional echocardiography (ECHO) provides useful information on the temporal sequence of remodeling that, together with age, is the strongest indicator of poor prognosis.2
Studies on long-term angiotensin-converting enzyme (ACE) inhibition documented effective prevention of left ventricular (LV) remodeling in patients with LV dysfunction,2-5 whereas only moderate effects occurred in patients with normal or abnormal LV function.1,6 These studies included mainly relatively young patients with LV dysfunction; however, patients with AMI and preserved LV function admitted to internal medicine departments (approximately 40% of the hospital admissions for AMI) are more often older than 65 years7-9 (Table 1). Thus, little direct evidence exists for this important subset of AMI patients, who are at higher risk of cardiovascular morbidity and mortality. Because of this gap in our knowledge, these patients may be less likely to receive a potentially valuable treatment (eg, thrombolytic agents or other interventions).10,11 This patient population was studied in the Perindopril and Remodeling in Elderly With Acute Myocardial Infarction (PREAMI) study, which was designed to test whether ACE inhibition with 8 mg/d of perindopril erbumine in elderly patients with AMI and preserved LV function would attenuate remodeling and reduce the occurrence of heart failure (HF) and death.
The design of the trial has been described previously.12 The PREAMI study is a double-blind, randomized, parallel-group, multicenter study comparing perindopril with placebo in patients 65 years or older who survived an AMI (defined according to the recommendation of the American College of Cardiology and European Society of Cardiology, as reported in the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico [GISSI-3] study)13 with preserved ejection fraction (≥40%) and optimal apical 4- and 2-chamber views of the LV recorded for at least 5 complete cardiac cycles. Ethics committees of the participating centers gave their approval. All patients gave their written informed consent, and the principles of the Declaration of Helsinki were applied. Exclusion criteria included (1) severe HF (New York Heart Association class IV and need for intravenous inotropic support); (2) coronary artery bypass grafting or percutaneous transluminal coronary angioplasty; (3) severe hypotension (systolic arterial pressure ≤100 mm Hg); and (4) serum creatinine level greater than 2.0 mg/dL (>176.8 μmol/L).
The primary end point was a composite of (in hierarchical order) death, hospitalization for HF, and LV remodeling (considered as ≥8% increase in LV end-diastolic volume [LVEDV] measured by ECHO). Secondary end points included the primary objective considered separately, an increase in LVEDV (considered as a quantitative variable), cardiovascular death, hospitalization for reinfarction or angina (documented by symptoms and electrocardiographic signs), and incidence of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty.
The centralized randomization was performed at a mean ± SD of 11 ± 4 days from AMI. The randomization code was previously developed using a computer random-number generator to select random permuted blocks (fixed length of 4 without stratification). Patients were allocated at a ratio of 1:1 to receive either perindopril or placebo at an oral dose of 2 mg on the day of randomization, 4 mg on the day after and for 1 month, and then 8 mg until month 12. If this dose was not tolerated, it could be reduced to 4 mg/d. Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, α-blockers, and any inotropic drug (apart from digoxin) were prohibited unless acute conditions required their administration. In the following 12-month follow-up phase, 5 visits were performed (at months 1, 3, 6, 9, and 12). At each visit, blood pressure, heart rate, physical examination results, and information on concomitant therapy were recorded. Standard laboratory tests, electrocardiograms, and ECHO studies were performed before randomization and then at months 6 and 12.
Two-dimensional ECHO studies were recorded on 0.5-in videotapes and submitted to a core laboratory for a centralized assessment of quantitative analysis after quality control. Wall motion (WM) asynergy analysis in a 16-segment model of the LV was performed using a semiquantitative visual grading system proposed by the American Society of Echocardiography.14 The percentage of WM asynergy, as an index of the extent of ischemic damage, was obtained by dividing the number of akinetic, dyskinetic, and aneurysmal segments (segmental score ≥3) by the total number of evaluated segments.15,16 Selected images were then digitized to obtain endocardial contours and LV cavity volumes at end diastole and end systole from 2 apical orthogonal views (4- and 2-chamber views). The modified Simpson rule was used to obtain biplane LV volumes, from which EF was derived using the standard formula.14,15 All measurements were obtained in a blinded fashion by a single experienced operator from 3 cardiac cycles, and the mean values were considered for analysis.16 The interobserver variability, measured by the intraclass correlation coefficient in 76 randomly selected patients (according to the approach of Donner et al17 with α = .05 and a power of 80% to detect reliability >95%), was rather low (2.0%; 95% confidence interval [CI], 1.3%-3.1%; and 1.5%; 95% CI, 0.9%-2.3%; for LVEDV and LV end-systolic volume [LVESV], respectively), as was the intraobserver variability (1.0%; 95% CI, 0.7%-1.7%; and 0.7%; 95% CI, 0.5%-1.1%; for LVEDV and LVESV, respectively).
The expected rate of events in the control group was derived from the GISSI-3 study1: the available 6-month figures for mortality, hospitalization, and remodeling in patients older than 65 years were projected in a conservative way, considering 6.0%, 14.3%, and 29.5% for 12-month mortality, hospitalization for HF, and remodeling, respectively. According to the Moyé approach18 and considering a 25% loss of follow-up or unreadable echocardiographic tapes, 1250 patients were needed for a 20% or greater relative reduction in the probability of occurrence of the primary end point at month 12 (1-tailed test), with 90% power and α = .05.
We used the intention-to-treat principle applied to all randomized patients, considering the actual randomization code assigned. The primary end point was analyzed by the Moyé approach, which allows a combined evaluation of both the time-related (death or hospitalization for HF) and the fixed-time (remodeling) events.18 This model provides for each group a score derived from the end point occurrence, their hierarchical order, and the time to occurrence of end point. The sum of the scores in the 2 treatment groups was compared by the Wilcoxon test.
For the separate analyses on death or HF, the event-free survival was estimated according to the Kaplan-Meier method and compared between the 2 treatment groups by the log-rank test.19 The Cox regression model was used to evaluate the treatment effect, adjusting for different confounding or prognostic factors (sex and age, previous history of AMI, hypertension, diabetes, and other risk factors). For remodeling, logistic regression was performed. Moreover, an explorative analysis was performed to evaluate possible differences of the treatment in particular subgroups (the previously defined factors). For the analysis of ECHO parameters, a linear mixed model was adopted.20 The statistical tests were 2-tailed and conducted at the .05 significance level using the statistical package R language (R Foundation for Statistical Computing, Vienna, Austria).
Between September 18, 1998, and November 19, 2003, 1252 patients were randomized (631 to perindopril and 621 to placebo) from 109 centers in 5 European countries. Only 2 patients in the placebo group were lost to follow-up. Validated ECHO studies at prerandomization and during follow-up were obtained for 441 patients in the placebo group and 455 in the perindopril group (Figure 1). Mean ± SD patient age was 73 ± 6 years, and 436 (35%) were women. A total of 128 patients (10%) had a previous AMI, 39 (3%) had previous revascularization, 300 (24%) had diabetes mellitus, 728 (58%) had hypertension, and 357 (29%) had hyperlipidemia. A total of 533 patients (43%) underwent thrombolysis, 479 (90%) within 6 hours of AMI. Infarct sizes were limited: mean ± SD WM asynergy was 13% ± 13%, and creatine phosphokinase level was 1243 ± 1052 U/L. The LV function was well preserved, with a mean ± SD ejection fraction of 59.1% ± 7.7% and LVEDV and LVESV of 80 ± 23 mL and 34 ± 14 mL, respectively. No differences occurred in the baseline characteristics between the 2 groups (Table 2). The use of concomitant medications increased markedly after AMI and remained as such until the end of the study (Table 3).
A statistically significant difference occurred in blood pressure between the 2 groups after randomization: the values of systolic arterial pressure/diastolic arterial pressure were lower in the treated than in the placebo group (mean systolic arterial pressure/diastolic arterial pressure, 134/78 and 137/79 mm Hg, respectively) (P = .04 and P = .004 for systolic arterial pressure and diastolic arterial pressure, respectively). Heart rate did not change during the study. Treatment was well tolerated: at 1 year, 74% and 76% of patients assigned to perindopril and placebo, respectively, were taking study medication. Almost all patients assigned to perindopril erbumine were taking 8 mg/d, and only 6% had their dosages decreased to 4 mg/d at 1 year. Reasons for permanent treatment withdrawal are reported in Table 4.
Perindopril induced a significant absolute risk reduction of 0.22 (95% CI, 0.16-0.28; P<.001) in the combined primary end point (death, hospitalization for HF, or remodeling) (Figure 2) that occurred in 181 patients (35%) in the perindopril group and 290 (57%) in the placebo group (the relative risk reduction was 0.38 [95% CI, 0.29-0.46]; P < .001). A total of 126 patients (28%) and 226 patients (51%) in the perindopril and placebo groups, respectively (P<.001), experienced remodeling (Figure 3). In the perindopril group, 40 deaths and 22 hospitalizations for HF (6% and 4%, respectively) occurred, whereas 37 deaths and 30 hospitalizations for HF occurred in the placebo group (6% and 5%, respectively). Death was not affected by treatment, whereas the hospitalization rate for HF only slightly decreased (absolute risk reduction, 0.01; 95% CI, −0.01 to 0.02).
The mean increase in LVEDV was higher in the placebo than in the perindopril group (mean difference in LVEDV from month 12 vs prerandomization assessment, 4.0 vs 0.7 mL; P<.001) (Figure 3). In the placebo group, the main increase in LVEDV occurred within 6 months after AMI (3.4 mL), with a further increase of 0.6 mL thereafter. Hypertension was the most interesting significant predictor of LV remodeling (odds ratio, 1.4; 95% CI, 1.0-1.9; P = .05).
The other secondary end points, such as cardiovascular death, hospitalization for subsequent AMI or angina, or revascularization, were infrequent and not modified by treatment (64 [5.1%], 142 [11.3%], and 148 [11.8%], respectively). Combined analysis of the most important cardiovascular events (ie, cardiovascular death, hospitalization for HF, stroke, and subsequent AMI [73 (12%) and 83 (13%) in the perindopril and placebo groups, respectively]) showed an absolute risk reduction of 0.01 (95% CI, −0.01 to 0.04; P = .37). The beneficial effect of perindopril on remodeling was consistent across all predefined subgroups (Figure 4).
The results of the PREAMI study generate novel pathophysiologic and therapeutic information. On pathophysiologic grounds, in elderly post-AMI patients, progressive LV remodeling can occur even in the presence of small infarct sizes. Administration of 8 mg/d of perindopril erbumine for 12 months (which was well tolerated despite the advanced age of the patients) led to a highly significant absolute risk reduction (>0.20) in the combined primary end point. This result was due to LV remodeling reduction.
Advanced age appears to be an important determinant for LV remodeling. Despite normal prerandomization LV ejection fraction, the untreated elderly post-AMI patients underwent progressive LV dilation of a magnitude similar to that reported in other studies that enrolled younger patients but with larger infarct areas and greater LV dysfunction.1-3,6 In PREAMI, the absolute increases in LVEDV in the placebo group were 3.4 and 4.0 mL at 6 and 12 months, respectively. These findings provide the first prospectively generated data on this topic.
The largest available data set on LV remodeling in post-AMI patients derives from the GISSI-3 trial, which involved more than 6000 patients younger than 65 years. Only patients with WM asynergy of 27% or greater underwent remodeling (with a mean increase in LVEDV of approximately 4.5 mL, which was reduced by lisinopril). Notably, the authors concluded that LV remodeling is mainly seen in at least moderate-sized AMI.1 The mean WM asynergy index of the PREAMI patients was rather small (only 12.5%), probably due to widespread use of recommended treatments in the acute phase and to the strict selection criteria of the study. At the same time, the PREAMI patients were much older (mean age, 73 years). Thus, advanced age appears to be a major determinant for LV remodeling, in addition to and after the size of the infarcted area.
On therapeutic grounds, PREAMI shows that perindopril in this elderly population attenuates LV dilation. Remodeling occurred less frequently in the intervention arm (28% vs 51%). We defined remodeling as an 8% or greater increase in LVEDV. This definition is not an arbitrary assumption; previous data on ECHO studies (Table 1) suggest a mean 4% LVEDV increase after 6 months to 2 years of follow-up (in younger patients with impaired LV dysfunction). Assuming 4% variability in LVEDV measurements, we considered an increase of 8% or greater to be a suitably conservative cutoff limit; of note, both intraobserver and interobserver variability were rather low.
The difference in LVEDV increase between the placebo and perindopril arms observed in PREAMI (3.3 mL) was highly significant and consistent with that obtained in other studies, even in patients with LV dysfunction,2,3,6 GISSI-3 included, in which patients with WM asynergy of 27% or greater were enrolled.1 The greater effects reported in smaller studies can probably be attributed to more restricted patient selection and the more accurate data collection typical of single-center studies.21-23 The antiremodeling effect of perindopril was responsible for the reduction in the combined primary end point, because mortality and HF hospitalization rates were similar in the 2 arms, as well as the secondary end points. This may be explained by the relatively low morbidity and mortality rates in the current study owing to the well-conserved LV function (mean LV ejection fraction, 59%), optimized treatment (including ACE inhibitors after AMI), and the relatively short duration of treatment (12 months). Also in GISSI-31 and the Cooperative New Scandinavian Enalapril Survival Study (CONSENSUS II),6 no reduction in mortality was detectable despite beneficial effects of ACE inhibition in terms of maintenance of LV volumes. However, in the recent European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA),24 administration of the same dose of perindopril erbumine (8 mg/d) for a mean duration of 3.7 years in a broad population of approximately 12 000 patients with stable coronary artery disease led to a reduction in the combined primary end point of cardiovascular death, nonfatal MI, and cardiac arrest with successful resuscitation. This effect became evident at 1 year, but differences between the event curves reached significance only after 3 years. Moreover, a subanalysis of EUROPA patients corresponding to the PREAMI population (≥65 years, LV ejection fraction ≥40%, and previous AMI) demonstrated a significant relative risk reduction of 36.1% (P = .03) for the primary EUROPA end point only after 3 years of treatment.
The mechanisms for the beneficial effects of perindopril on LV remodeling have yet to be defined. They might include reductions in ventricular wall stress, adverse neurohormonal stimulation, and myocardial ischemia. Interestingly, the Perindopril–Thrombosis, Inflammation, Endothelial Dysfunction, and Neurohormonal Activation Trial,25 a substudy of the EUROPA trial, has shown that perindopril reduces the rate of endothelial apoptosis. Increased myocyte apoptosis is an important biological component of remodeling, particularly in elderly patients.26,27 All of these hypotheses are being explored in predefined substudies of PREAMI.
The effect of perindopril on remodeling occurred despite widespread use of β-blockers (71% at randomization), and no interaction occurred among treatments, suggesting that the intrinsic mechanisms of action of β-blockers and ACE inhibitors are complementary and not mutually exclusive. In HF trials, the effect of β-blockers on LV enlargement has been robust, with greater attenuation than in randomized studies with ACE inhibitors.28
The choice of the sample size and duration of the PREAMI study resulted in a low rate of HF hospitalizations (4% recorded vs 14% anticipated). Larger and longer studies would be required to generate information on possible beneficial effects in terms of mortality and HF hospitalization.
The PREAMI study partially fills the gap about optimal treatment of elderly patients with AMI and preserved LV function. Therefore, the results are of clinical relevance in this important subset of patients for whom therapeutic decision making is still equivocal and incompletely defined in current practice guidelines.29 In elderly patients with AMI, LV remodeling can occur despite small infarct size and optimized treatment. Addition of 8 mg/d of perindopril erbumine to optimized treatment counteracts progressive LV dilation. This regimen is well tolerated and might be considered as a standard treatment in this particular clinical setting.
Correspondence: Roberto Ferrari, MD, PhD, Department of Cardiology, Arcispedale S. Anna, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy (firstname.lastname@example.org).
Accepted for Publication: August 28, 2005.
Author Contributions: The Steering Committee and the Statistical Committee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
PREAMI Committees:Steering: R. Ferrari, MD, PhD (Chairman), Ferrara, Italy; M. Chiariello, MD, PhD, Naples, Italy; G. L. Nicolosi, MD, Pordenone, Italy; W. J. Remme, MD, PhD, Rhoon, the Netherlands; L. Tavazzi, MD, Pavia, Italy. Safety: C. Rapezzi, MD (Chairman), Bologna, Italy; M. Scherillo, MD, Naples, Italy; M. G. Valsecchi, MSc, PhD, Milan, Italy. Statistical: A. Decarli, MSc, PhD (Chairman), Milan, Italy; G. Parrinello, MSc, PhD, Brescia, Italy. End Point: C. Ceconi, MD (Chairman), Ferrara, Italy; E. Pasini, MD, Gussago, Italy. PREAMI Investigators: D. Cokkinos, MD, PhD, D. Kremastinos, MD, PhD, P. Toutouzas, MD, PhD, I. Nanas, MD, I. Fotiadis, MD, F. Kardaras, MD, I. Karidas, MD, P. Skoufas, MD, and I. Vassiliadis, MD, Athens; P. Vardas, MD, PhD, and G. Nikolaidis, MD, Iraklion; V. Pyrgakis, MD, Korinth; S. Fousas, MD, Piraeus; K. Papadopoulos, MD, PhD, Thessaloniki; S. Zobolos, MD, Kalamata; A. Tyrologos, MD, Kavala; and K. Siogas, MD, Ioanina. A. Jánosi, MD, DSc, and A. Vértes, MD, Budapest; G. Veress, MD, CSc, Balatonfüred; P. Polgár, MD, PhD, Nyíregyháza; L. Nagy, MD, PhD, Szombathely; and M. Sereg, MD, Székesfehérvár. A. Battaglia, MD, Palermo; M. Mariani, MD, Pisa; S. Polimeno, MD, M. Chiariello, MD, PhD, M. Giasi, MD, N. Mininni, MD, and B. Trimarco, MD, Naples; A. Boccanelli, MD, F. Barillà, MD, F. Fedele, MD, and E. Giovannini, MD, Rome; G. D’Angelo, MD, Oliveto Citra; C. Brunelli, MD, Genoa; E. Capponi, MD, Gubbio; A. Capucci, MD, Piacenza; S. Ceravolo, MD, Bergamo; G. Corsini, MD, Caserta; J. Dalle Mule, MD, and M. C. Brunazzi, MD, Pieve di Coriano; I. De Luca, MD, Bari; P. Delise, MD, Feltre; G.B. Braschi, MD, Trapani, A. Giordano, MD, Gussago; G. Giuffrida, MD, Catania; R. Leghissa, MD, Imola; S. Mandorla, MD, Perugia; E. Renaldini, MD, Manerbio; A. Zoni, MD, Parma; M. Orlandi, MD, Lodi; G. Tartarini, MD, Pontedera; P. Pascotto, MD, Mirano; R. P. Dabizzi, MD, Prato; W. Pitscheider, MD, Bolzano; M. Polimeni, MD, Polistena; C. Rapezzi, MD, Bologna; L. Di Leo, MD, Salerno; A. Raviele, MD, Mestre; G. Rosato, MD, Avellino; G. Rovelli, MD, Rho; M. Sanguinetti, MD, Lugo; A. Sanna, MD, Cagliari; N. Moio, MD, Pozzuoli; L. Tavazzi, MD, Pavia; F. Valagussa, MD, Monza; G. Finocchi, MD, Vicenza; G. Risica, MD, Venice; G. L. Nicolosi, MD, Pordenone; E. Bellone, MD, Pinerolo; L. Scarpino, MD, Gorizia; P. Terrosu, MD, Sassari; C. Rusconi, MD, Brescia; S. Paparoni, MD, Teramo; F. Bacca, MD, Lecce; S. Mangiameli, MD, Catania; G. Ferrari, MD, Como; N. Picchione, MD, Firenze; C. A. Generali, MD, Urbino; and R. Ferrari, MD, PhD, Ferrara. I. Bruckner, MD, PhD, M. Dorobanţu, MD, PhD, M. Cinteză, MD, PhD, and A. Ioan, MD, PhD, Bucharest; R. Căpâlneanu, MD, PhD, and N. Olinic, MD, PhD, Cluj; G. Georgescu, MD, PhD, and M. Datcu, MD, PhD, Iaşi; D. D. Ionescu, MD, PhD, Craiova; I. Maniţiu, MD, PhD, Sibiu; K. Babeş, MD, Oradea; E. Carasca, MD, PhD, and A. Matei, MD, Târgu-Mureş; A. Tase, MD, Piteşti; and B. Minescu, MD, Brăila. J. M. Ayuela Azcárate, MD, Burgos; E. Simarro Martin, MD, PhD, Oviedo; J. Olagüe de Ros, MD, Valencia; F. Noriega Peiro, MD, PhD, Vigo; E. González Cocina, MD, PhD, Malaga; J. Caparrós Valderrama, MD, and M. Martínez, MD, Seville; J. Bruguera Cortada, MD, Barcelona; L. Jodar Lorente, MD, Manresa; J. J. García Guerrero, MD, PhD, Badajoz; J. L. Blanco Coronado, MD, PhD, and R. Sola Casado, MD, Almeria; A. Amaro Cendón, MD, Santiago de Compostela; and C. Pascual, MD, Leon.Study Organization: Salvatore Maugeri Foundation IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico [Healthcare and Research Scientific Institute]), Cardiovascular Research Center, Gussago, Brescia, Italy. Data Management: K. Papa, MSc. Quality Assurance: P. Bernocchi, MSc, PhD. Secretarial Activities: S. Brognoli, J. Gimbatti. ECHO Substudy: G. L. Nicolosi, MD (Chairman), Pordenone, Italy. Core ECHO Laboratory: Salvatore Maugeri Foundation IRCCS, Cardiovascular Research Center, Gussago, Brescia, Italy: S. Golcea, MD. ECHO Quality Control: G. La Canna, MD, Milan, Italy; D. Mele, MD, Ferrara, Italy.
Financial Disclosure: R. Ferrari, M. Chiariello, G. L. Nicolosi, W. J. Remme, and L. Tavazzi received honoraria from Salvatore Maugeri Foundation (Brescia, Italy) on behalf of the sponsor.
Funding/Support: This study was supported by Stroder, Florence, Italy, and Servier Italia, Rome, Italy.
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The UK Government was due to have provided its response to the final recommendations of the Independent Inquiry into Child Sexual Abuse (IICSA) this week. Six months after those recommendations, which of course followed a seven year inquiry, the Home Secretary has said that there will be a delay in the Government response.
While there has been an indication that the government intends to move forward with the recommendation for mandatory reporting there has been no indication of the likely response to the other 19 recommendations. The main reason for the delay seems to be that, as there are due to be local elections in May, the government would not want the media interest in those elections to mean the response re IICSA is overshadowed. No date has been given other than there will be a response in May.
Separately, on Tuesday Alexander Stafford MP sought to introduce a bill which would "make provision for the purpose of preventing a person who has failed to discharge a duty in respect of child sexual abuse offences from holding any elected office, from holding public office and from holding any post the remuneration of which is paid out of money provided by Parliament; to provide for the disqualification from any elected or appointed office of a person who has been convicted of child sexual abuse offences; to provide for the removal of a peerage from a person who has been convicted of child sexual abuse offences; and for connected purposes."
An obvious example of where this bill if passed would be effective is if a scenario arose as it did with Jimmy Savile and his peerage. The second reading for this bill is not until November which suggests it is not seen as a high priority.
Finally, and as referenced in an earlier blog this week, the Online Safety Bill has continued its tortuous progress with further consideration at committee stage in the House of Lords.
The amendments debated including the extension of senior management liability, a requirement that providers of the largest online services publish summaries of their risk assessments for illegal content and content that is harmful to children, and the addition of priority offences to strengthen the Bill’s illegal content duties.
Those offences relate to controlling or coercive behaviour, illegal immigration and modern slavery and the foreign interference offence being introduced by the National Security Bill. Providers will be required to proactively tackle content and activity amounting to these offences. These committee stage discussions will continue next week.


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This weekend, a film about one of the most influential figures in early 20th century Middle Eastern history is opening in Philadelphia and I’m willing to bet you have never heard of her. That’s right, her. The film is Letters From Baghdad and the woman at the center of it all is Gertrude Margaret Lothian Bell. From her camelback excursions across uncharted Arabian desert, she forged lasting relationships with sheiks and tribesmen alike, gaining their respect and becoming an invaluable source of knowledge for the British government in the region. By advising Winston Churchill, Gertrude Bell helped pave the road to the future of an independent Iraqi state.
I had the pleasure of speaking with Letters From Baghdad filmmakers Sabine Krayenbuhl and Zeva Oelbaum about their journey in bringing this incredible woman to life through her own words and photographs, as well as never before seen archival footage of the late 19th and early 20th century Middle East. A world Gertrude Bell knew and loved best.
Cinedelphia: Prior to Werner Herzog’s film Queen of the Desert released earlier this year, and Letters From Baghdad, I was unaware of the greatness of Gertrude Bell. What insight do you have as to why she has been ruthlessly left out of the history?
Zeva Oelbaum: We were astonished when we read Janet Wallach’s biography Desert Queen that this woman completely escaped our notice. When we started to work on the film and look at Gertrude’s letters and research other primary source materials we got more and more surprised by what we found. I do believe she was written out of history because she was a woman. We have so much documentation of that. One small thing that is in the film is the minutes of the Cairo Conference, where you can see she attends meetings with only five or six other people. She’s a big presence at the Cairo Conference as an advisor to Churchill, then if you go back and look at memoirs of some of the other officials who attended the conference, she is not mentioned. She’s totally eliminated in those memoirs.
Sabine Krayenbühl: Just recently it came to our attention that there was a biography written about Churchill by American author William Manchester. It’s an expansive biography and in the book is a photograph from the Cairo Conference, a famous photograph where Churchill is positioned to Gertrude’s right, and T.E. Lawrence is to her left. And the caption reads, Winston Churchill, “a friend,” and T.E. Lawrence. So even something like that gives you a cue as to why she was eclipsed. In the beginning of our film we include numerous newspaper headlines. At the time she was really well-known, she was in all the papers and after her death there were tons of obituaries written about her. So it’s clear that she left a mark not just by making history but by being in the media at the time. History was just rewritten, that’s what is comes down too.
C: When you decided to finally give Gertrude the stage she deserves, did you have an idea of what you wanted the film to be about, or did Gertrude’s letters themselves guide you in choosing a specific direction for the film?
ZO: We knew we really wanted to focus on her at the height of her power. We knew what was most remarkable about Gertrude Bell was the fact that she was so pivotal in this period of the establishment of Iraq. She was a powerhouse in a time when women had no power at all. So we knew that was the main focus of the narrative. We also wanted to include what happened at the end of her life, after she was at the top of her game so to speak, to her death from an overdose of sleeping pills.
SK: Also it was clear for us that the letters would be the meat of the story that we wanted to tell, a story from her point of view. Historical documentaries are often told through the use of establishing context with historians and analyzing the history and we didn’t want to do that because we felt it would be more immediate and effective for an audience to actually experience time as it existed through the eyes of Gertrude Bell. In that sense, the letters became the narrative. Then we extended it to include the letters and memoirs of her contemporaries to start more of a dialogue.
C: Was it difficult to parse through all the primary documents and choose the letters that end up in the film?
ZO: Well Gertrude left 1,600 letters just to her friends and family! Those letters were donated decades ago to New Castle University in England. We are always happy to mention our friends at the archives at New Castle. Sabine and I went through her letters and certain things just jumped out at us. We have a very extensive database, as most documentaries do to keep track of footage, but we expanded ours to include snippets of Bell’s letters and still photographs. So we could go back and forth in the database between the photographs, the footage and the letters. We would read something and say, “Oh, this is amazing we need to put this in the film,” so of course we had pages and pages of material we felt would be wonderful in the film. It was a process of us whittling it down. It was a very long process. We could have made a four part series on Gertrude Bell and what she wrote in her letters.
C: In her letters, Gertrude goes from describing herself as finally a “person” when she begins her post in the Middle East, then later as “not a person” when her influences wane. How do you think women today can relate to Gertrude’s reflections of herself throughout her life?
SK: Well in Gertrude’s case, it definitely has to do with finding herself as a recognizable person in the East, as someone viewed as a person of importance. She’s meeting with sheiks, she’s being written about by Turkish authorities as someone to watch in the British Empire, and then later on when her influence wanes she acknowledges it because she is aware of the kind of power she had in a moment in time. The British officers that she has been working with all these years in Iraq leave and are replaced with newer, younger people who are less aware of her stature. They view her as this older woman and it clearly gets to her as we see in her later letters. I think that’s what women today will relate too. I feel that when women get older they are seen as less important and not seen as sources of great knowledge that could be helpful.
C: Letters From Baghdad has an extensive list of influential collaborators, including Tilda Swinton and Thelma Schoonmaker. How important for you was it to work with these filmmakers?
ZO: It was a very organic process. Sabine has a relationship with Thelma, so she had been talking to her for some time about her interest in working on a film about Gertrude Bell. When we started working together on the project I also was connected to Kevin Brownlow and we knew we wanted to get him on board because he is a world expert on early cinema and silent films. We also knew that we wanted Tilda Swinton to read Gertrude’s letters. She was our first choice because we wanted to make sure that the project was not just a dusty historical documentary. Our aesthetic and way of working with archival footage is pretty specific to us and we thought that Tilda would bring a really interesting perspective.
We also decided to go for a National Endowment for the Humanities grant and that led us to bring on academic advisors to the project. The other key partner was the British Institute for the Study of Iraq, formerly known as The Gertrude Bell Memorial. So that is basically an organization dedicated to Gertrude Bell in London, and they in turn connected us to New Castle University where all her letters are kept. So because we were working on the project for 5 years, we were very naturally able to build a community of people who were enormously supportive and helpful and experts in their field who could benefit us.
C: You mentioned Kevin Brownlow and his expertise in early cinema, and I know you are equally as enamored with archival footage. Can you tell me more about how this mutual interest got started?
SK: Zeva and I worked on another film called Ahead of Time about an equally trailblazing woman named Ruth Gruber. On that film we worked with archival footage and our mutual love for the beauty of archival footage, its decay, as well as the fun of hunting it down helped bring us together. One of the things we wanted to do in Letters From Baghdad, and what makes this film different from other films that use archival footage, is that in our film the footage takes center stage. In other films it’s usually used as a way to illustrate, or what is referred to as B-roll. But in our film the footage is an equal part of the story.
C: What do you hope audiences will take away from this film?
ZO: The answer to this question has shifted over the last five years. When we began this project we were really interested in showing Gertrude Bell as a forgotten woman who was an inspiring figure. And that is, of course, still important. Now, in light of the changes in the world and the changes in American politics, one of the things we admire most about Gertrude Bell is her appreciation of cultures that are very different from her own. Her love of diversity and respect for other people. She was a champion of tolerance and bringing people together. We feel like that is a bit of an urgent conversation right now, so that is something that we hope comes through to the viewer.
Letters From Baghdad opens in Philly theaters today.
Author: Jill Malcolm
Jill is happiest attending midnight screenings with other crazy film fans at her local theater. Her other passions include reading, traveling to faraway places, cat videos, pugs, and jalapeño peppers. She is co-founder of the blog Filmhash.

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