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When it comes to mobile phone operating system, two things that come to our mind are Google's Android and Apple iOS. Each one has its own fan base. But over the recent years Google's Android has increased it's market share manifold thus becoming the most widely used mobile OS. One reason can be because iOS is limited to Apple devices which are in fact highly priced!
However, the reason can also be the high level of flexibility and customization that Android offers. On the other hand, an iPhone offers only a limited customization options unless you jailbreak the device. Lets just cut the comparison and get to the point.
If you are currently using a mobile with Android OS, but thinking of switching over to iPhone then I suggest you to try out these iPhone Launchers on your Android phone. Well, you can experience the iPhone's user interface without shelling out a dime!
Apple iPhone Launcher for Android Mobile Phones
Check out these apps can magically transform your current UI and switch you over to the rich iOS user interface. This along with the iOS Emulator for Android mobiles can definitely give you the best iPhone experience right on your current device.
One Launcher
When it comes to giving you the best iPhone experience, One Launcher is second to none. Soon after it was released, it became the most popular iPhone launcher for Android devices. It is pretty easy to use and customize. Once you install this app from the playstore and open it, you'll be presented with an 'Experience' button on the screen. By clicking on it, your screen will be transformed into an iPhone-like home screen. You will witness a user interface which is similar to iOS 8 along with an iPhone-like icon set and all the iOS transition effects. The developers of this app took care of patching up even the tiniest of detail that could give away the iPhone-like user experience.
Once you install this app, you'll find a 'One Tools' folder on your home screen. Here you will find the settings and additional features and themes that you can hook up with the One Launcher. You can tweak the user interface by clicking on the Preferences icon. Here you can change the lockscreen settings, gesture settings, change animations, shadows and effects.
Download One Launcher from PlayStore
Just like you'd do on an iPhone, when you press hold an icon to make it wriggle and then you can drag and drop it anywhere on the home screen or place it in a folder.
The old lock screen will be replaced by the iconic 'slide to unlock' lock screen which you find on iPhone.
The transition graphics were up to the mark and would be even better if your Android mobile has a powerful GPU hardware. Further more you can actually tweak use new transition effects which is only possible on a jailbroken iPhone.
Another surprising thing is that this app doesn't hog much of your phone resources. Also, your won't notice any considerable battery drain issues.
iLauncher – OS 9
This is the free version and can be upgraded by purchasing the Launcher Pro License. Although its a free version, it provides most of the features you'd expect. This iPhone home screen launcher runs smoothly and provide decent iPhone like user experience without any lags and flutters. You can press hold the app icons to move them around or delete them. Also, just like on the iPhone, you can set gesture commands. For example, you can set a gesture command to perform specific tasks when you swipe up/down or press home button.
Get iLaucher OS9 on Google Play
The main drawback with this app is that it displays too many ads if you are on the free version. These ads are just a distraction to the user experience. You need to purchase a Launcher Pro license in order to prevent the ads and get access to some more additional features.
OS9 Launcher HD
This is another good application which provide you with the best iOS 9 experience. Once installed, the app switches you over to the new interface which looks and feels like an iPhone. The developers have made sure that even the size of the icons is same as the ones you'd find on the iPhone. You get all the bells and whistles like the transition effects, sliding effect, themes and iPhone wallpapers.
Download OS9 Launcher HD from Play Store
The OS9 Launcher has a OS Booster option which clears your phone RAM, in case you feel a lag while using the app. There is also a OS Search feature, where you can find details like last used applications, recent contacts, received messages.
iLauncher Plus
This app offers a simple and clutter-free iOS user experience. The interface is similar to the one you'll find on an iPhone using iOS 9. The developer, TopMobi made sure this app uses less memory resources and thus making it lightweight and quick.
It offers 6 transition effect for the home screen. Once installed you can tweak the settings to hookup icon packages, live wallpapers and other third party themes. Additionally, this application also gives you a privacy option to hide apps.
Don't confuse this with the iLauncher OS9
This app is simple and doesn't have many unnecessary features which you find on other iPhone launchers. The best part about this iPhone Launcher is that its free and displays no ads at all (at least I haven't seen any!).
To conclude, I suggest you to try out each of these iPhone interface launcher and choose the one which you like the most. You can select the best iOS launcher based on the quickness of the interface and low memory usage. Don't forget to let me know your choice.


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(December 8, 2014- Houston, TX) Iyanni Pradia's "A Winter Lights" fashion show is shaping up to be a dazzling start to the Christmas season with the addition of special guests and show openers The Walls Group. Darrel, Rhea, Paco and Ahjah, the siblings who make up one of gospel music's hottest new groups, will walk the event's signature pink carpet, provide interviews and pose for photos ahead of their opening set.
The night, hosted by Ms. America 2013 Chiniqua Pettaway, is the official launch of Iyanni Pradia's namesake fashion line, which features ready-to-wear clothing for girls and young women that echoes Ms. Pradia's own fierce, fun, and vivacious style. The spirit of fun will be a theme for the event, and the addition of The Walls Group will include a surprise highlight for the audience during the show.
"I am thrilled to announce the addition of The Walls Group as the entertainment and opener at Iyanni Pradia's 'A Winter Lights' fashion show. These young people are truly inspirational in pursuing their passions: The Walls Group with their music and Iyanni with her fashion line," said Velma Trayham of ThinkZILLA PR & Consulting Group. "This show is the perfect kick off to the holiday season, and will be a fun and entertaining evening for people of all ages!"
The Walls Group is an internationally recognized gospel group comprised of four siblings, Darrel, Rhea, Paco, and Ahjah, who use their musical talents to reach and minister to audiences around the world. The group is signed to Grammy Award-winning gospel recording artist Kirk Franklin's Fo Yo Soul Entertainment label, and has spent the last six months touring in support of their latest EP, "Satisfied//Love on the Radio."
Iyanni Pradia is a multimedia child star, with roles in Hollywood movies, her own fashion line, and a radio show of her own, "The Kidz View Weekly Talk Show," which she was co-hosts on KCOH in Houston. Iyanni Pradia is available to speak with members of the media prior to the fashion show regarding the fashion line, her life as a child star, and other topics. Press requests for the event should be directed to firstname.lastname@example.com.
For more information on Iyanni Pradia visit www.IyanniPradia.com . For "A Winter Lights" fashion event, VIP Request or general media inquiries, please contact Velma Trayham at ThinkZILLA PR & Consulting Group, LLC.
2425 West Loop South. Suite 200
ThinkZILLA PR & Consulting Group, LLC
Houston, TX. 77027

subset: commoncrawl


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The Joke's On Us
Writer: Ty TempletonArtist: Rick BurchettPublisher: DC ComicsRelease Date: August 2, 2017Cover Price: $3.99
We kick off the book in what seems like the climax of some story with Batman and Nightwing rushing Joker's Ha-Ha-Hideout after some kind of explosion. While Harley is off to the side chuckling it up, Joker reveals a slew of weapons and props depicting multiple ways the Joker wishes to dispatch the Bat. As Joker goes to use a rocket launcher, not caring that his own men are in the way and will get hurt, it instead backfires and blows up in his face. The next thing Joker attempts is transformer like mech which quickly gets taken down by Batman's wonderfully remembered "Maneuver #314"!
Bits and Pieces:


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The Duke of Edinburgh, the 90-year-old husband of Britain's Queen Elizabeth II, has been taken to hospital for 'precautionary tests' after suffering from chest pains.
'His Royal Highness the Duke of Edinburgh was taken to Papworth Hospital in Cambridge from Sandringham House for precautionary tests after experiencing chest pains,' Buckingham Palace said in a statement.
The duke, also known as Prince Philip, was taken from a family Christmas celebration at the Sandringham estate in Norfolk, southeast England, to the cardiothoracic unit at the nearby hospital on Friday.
The prince, who was born in Greece in 1921, is well known for his tireless spirit and outspoken views, and rarely misses royal engagements.
On his 90th birthday in June, he announced plans to cut back his official duties.
The colorful and often outspoken husband of Elizabeth has been a familiar figure at his wife's side for decades. He has championed numerous charities over the years, but is advising the ones he heads to start planning an orderly transition as he plots the end of his working life.
Philip has been at Sandringham since Monday for the royal family's Christmas festivities, Buckingham Palace said.
The royals celebrated a traditional Christmas this past weekend, followed by a year's worth of festivities to mark the queen's 60th year on the throne.
Elizabeth and Philip are planning to mark the event with a series of tours throughout England to culminate with a celebration in London in early June that will include an unprecedented pageant on the River Thames with up to 1000 boats taking part.
Most of the senior royals, including Prince William and his wife, now formally known as the Duchess of Cambridge, will be dispatched across the globe to help the ageing monarch celebrate her Diamond Jubilee.
Papworth hospital describes itself as Britain's largest specialist cardiothoracic hospital and treats more than 22,800 inpatient and day cases and 53,400 outpatients each year from across the country.
"You Have the Power to Donate Life – to become an organ and tissue donor Sign-up today!
Tell Your Loved Ones of Your Decision"
Tell Your Loved Ones of Your Decision"
Australia, register at Australian Organ Donor Register
New Zealand, register at Organ Donation New Zealand
Canada - Ontario beadonor.ca
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South Africa, http://www.odf.org.za/
United States, donatelife.net
United Kingdom, register at NHS Organ Donor Register
Your generosity can save or enhance the lives of up to fifty people with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help by donating skin, corneas, bone, tendon, ligaments and heart valves
Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You.


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Contact Nikki Janse Van Rensburg
Schedule A Showing
9639 Moccasin Slough Road, Inverness, FL 34450
Priced at Only:
For more Information Call Office: 352.556.4875
Address: 9639 Moccasin Slough Road, Inverness, FL 34450
Property Photos
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Custom built pool home with Guest House on 135 natural & very private acres bordering Flying Eagle Preserve. Entire perimeter is fenced and cross fenced around houses, and has a private 10 acre Pond. Main House has an In Law wing w/Bdrm, Kitchen, Family rm and Bath, and sliders out to caged pool area. Master Ste Upstairs has large Loft overlooking the Fireplace, a Balcony in front and Lanai to rear within the Arboretum style cage overlooking pool and grounds. It is built over a Geothermal Basement, 110' x 26', with 4 bay Garage, Huge Laundry (or 3rd Bdrm) and Workshop. The Guest Hs. has Kitchen, Dining & Great Rms, Nook, Laundry, 2 car garage and fence
- Street Address: 9639 Moccasin Slough Road
- Viewed: 1826
- Price: $995,000
- Price sqft: $115
- Waterfront: No
- Year Built: 1986
- Bldg sqft: 8665
- Bedrooms: 5
- Total Baths: 4
- Garage / Parking Spaces: 6
- Acreage: 135.68 acres
MLS#: 719690 ( Single Family )
- Geolocation: 28.8315 / -82.2736
- County: CITRUS
- City: Inverness
- Zipcode: 34450
- Subdivision: Not On List
- Elementary School: Inverness Primary
- High School: Citrus
- Provided by: Only Way Realty Citrus
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- Nikki Janse Van Rensburg, REALTOR®
- Tropic Shores Realty
- Office: 352.556.4875
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I guess the busier the bee, the sweeter the honey, right? We've definitely got some sweet stuff to share, so thanks for being here...
First off, tomorrow, MAY 2nd, AltPress will be exclusively premiering the video for "We Were Wild" (filmed/directed by Parker Davidson). An earlier version was previewed at the Atlanta Film Festival in March, & we are excited to soon have it floating on the web.
Secondly (but 1st in awesomeness), it's been great to see so many of you on the road since the beginning of the year. SXSW was a blast, & our trips up to NY have been truly amazing (well, besides when our van broke down in Times Square). We've been touring our little hearts out & have no plans on stopping any time soon! We have added a few new routes, so we may be playing less frequently in each town, but nonetheless, we'll be around, lurking in a town near you :)
This week we'll make our way up to the Tulip Festival in Albany, NY, where we share the WEQX main stage with 2 awesome bands-- Walk the Moon, & Fountains of Wayne.
We've got lots of press coming up...we'll keep you posted on radio appearances (our next one is Fri. in Louisville on WFPK FM 91.9FM), & magazines as well (look for us in Jezebel soon! fancy, right?).
We've got some other stuff up our sleeves too, but we heard that it's cool these days to have an "air of mystery", so we'll try to leave a little for next time :) Besides, this is getting long & you should probably get back to work!
Thanks, as always, for supporting music & being great in general.
Much love,
~ttm, tts
SXSW Shows
An Acoustic Twist
TTM, TTS traded in their synths & pedals for acoustic guitars & organic beats in a Greenville, SC playground, filmed by Daniel McCord. (Check out his project "12 In 2012", where he takes on the challenge of creating a film each month for the whole year. Look for TTM, TTS to make an appearance in Feb.'s film.)
Today the Moon, Tomorrow the Sun - Oh Black Gold (acoustic) from Daniel McCord on Vimeo.
Today the Moon, Tomorrow the Sun - We Were Wild (Acoustic) from Daniel McCord on Vimeo.
Check out this upcoming project TTM, TTS is involved in...or else...well, you'll be stung or engulfed by a giant jellyfish. Our songs are the soundtrack, & we are creating an original score for this short film that is sure to become a cult classic!
You can go HERE to learn more about the project, led by some incredibly talented & cool Savannah friends, and you can also donate to help make this all happen & get some cool rewards, not to mention becoming a part of sci-fi history!
Today is the day! The WILDFIRE re-release on Greyday Records has dropped, complete with new artwork (incl. lyrics & live performance pics).
Check it out & pick up a copy HERE!
We Have Signed With Greyday Records!
We're proud to announce that we have signed with Greyday Records, based out of Portland, OR. They will be re-releasing WILDFIRE on 11-22-11.
Cheers! More info coming soon...
Summer Days, Drifting Away...
real exciting news coming real soon...
Up Next: Moon Phase event @ King Plow
Moon Phase: A Mixed Media, Soundscape, and Live Performance Event
Atlanta, this is truly a one of a kind event! And it's FREE!!!! You will not want to miss this...we are all very excited to share this night with you!
"When he went to see The Walkmen at Atlanta's Variety Playhouse in 2009, Matthew White hadn't heard of the opening act – an Atlanta band with a long name. And, he certainly didn't count on the creative journey he'd take over the next couple of years."
"Matthew set out on the road with them for several legs of recent southeastern US tours. At first there was a lot of documentation as the concept for the Moon Phase event began to form. But, from the beginning, Matthew knew he wanted to avoid just generating "fan art" or simply documenting the rise of Today the Moon, Tomorrow the Sun."
"what interested Matthew most was the way in which culture consumers create their own mythologies. Regardless of scale, how does celebrity evolve?"
"In addition to mixed media works on display, Matthew is employing a new way – using sound - to enhance the experience of viewing and interacting with art."
Doors at dusk... First, experience works by Atlanta artist Matthew White Then, a full show by Atlanta band Today the Moon, Tomorrow the Sun.
18 +
Cash bar.
Admission costs you nothing.
It's Freakin Hot
After a great tour run, we're back in Atlanta for a hot minute. (literally HOT) We'll be heading up the northeast again during July & August though, then planning for something a little farther in distance...like, the west coast. And even farther...the UK.
We have some videos in the works for a few songs off of WILDFIRE, & we've been featured on some specialty radio shows around the country, so lots of exciting things are going on.
For now, it's nice to be home with our loved ones & pets, but we're looking forward to seeing everyone on the road again in a couple o months!
xo, ~ttm, tts
On the Road Again...
After a week & a half of recuperation from the WILDFIRE album release show (yes, it's taken that long to recoup!), we're on the road again! Jeremy & his dad just installed a new radiator in The Captain, so we don't even have to drive in fear of our van catching on fire every 20 minutes anymore. This tour kicks off in our favorite way--with The Winter Sounds. We'll play a couple of KY shows w/them before branching off for some OH & IN shows. After then, we'll climax w/a couple of just-added NY shows, a stop in DC, and then a HUGE ending w/a Norfolk visit, then Greenville, SC.
Life is good...
WILDFIRE ALBUM RELEASE PARTY @ THE EARL 5/7 (Atl, GA)
The time has finally come! We're really proud of this record and can't wait to celebrate the day we get to share it with the world (i.e. YOU)!
This is our first full-length; entitled WILDFIRE. 12 shiny new tracks.
Sharing in the fun and rock'n'roll are our friends Moonlight Bride (Chattanooga) & Sealions (Atlanta)!!! Both are amazing bands and we're very happy to be sharing this night with them.
Doors @ 9 Music @ 9:30 Only $5!!! 21+
Moonlight Bride: http://www.facebook.com/pages/Moonlight-Bride/126148382612
Sealions: http://www.facebook.com/pages/Sealions/62671722515
Today the Moon, Tomorrow the Sun: http://www.facebook.com/pages/today-the-moon-tomorrow-the-sun/22900550566?sk=app_178091127385


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Erin Hayes
CEO at MediaBoss Television
Erin's a producer, writer and content lover. She's worked with MediaBoss since 2008. In 2010, she quit her marketing and freelance writing jobs and came on to lead MediaBoss full-time.
Latest posts by Erin Hayes (see all)
- A Discussion: Practical Effects in Star Wars - December 19, 2015
- Our 6 Must-See Holiday Movies - December 17, 2015
- When Is It Wrong to Use Stock Photos? - December 10, 2015
NetApp was set to launch a brand new customer ambassador program in 2014. They needed a name for the group and they needed to introduce their heroes to world.
We consulted with them on the group's name and spent 6 months gathering assets to create a series of introduction videos for the members.
This over-all introduction video premiered at the 2014 NetApp Insight trade show and was praised by NetApp C-level execs and NetApp customers alike.


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Barnaby Whitfield at Gallery Poulsen, Copenhagen
Posted in Erotica, Exhibitions / Openings / Signings, Eyecandy by Suzanne on June 4th, 2011 | BBC Wikipedia
Little Deaths All The Same (the artist as an expiring Red Winged Blackbird) by Barnaby Whitfield, pastel on paper, 2011 - click to enlarge
Barnaby Whitfield - the uncrowned king of waxy luminosity and great pastel maestro of blue-greyish cholera skin tones - is currently exhibiting new works at Gallery Poulsen's Before Summer group show in Copenhagen.
I've always been particularly fond of his self-portraits as he's got such unique and charismatic features, so I do envy you Danish folks for getting a chance to see Little Deaths All The Same (above) in person - not just for the troubled waters in the background that would make a Théodore Géricault go green with envy.
I'm not sure That Wretched Glow (below) will be on show, so it's just to give you an idea of what else Barnaby has been working on this year.
All details below.
That Wretched Glow by Barnaby Whitfield, pastel on paper, 2011 - click to enlarge
On show: May 27 - Jun 11, 2011
Address: Gallery Poulsen Contemporary Fine Arts, Flæsketorvet 24, Den hvide Kødby, 1711 København V., Denmark, tel: +45 4015 5588 / +45 3333 9396, email: firstname.lastname@example.com
Gallery hours: Tue - Fri: 12 - 5.30 PM, Sat: 11 AM - 3 PM, or by appointment
One comment to " Barnaby Whitfield at Gallery Poulsen, Copenhagen "
NFA Trust says:
Some of the most interesting paintings and photos are self-portraits.
June 14th, 2013 at 7:17 am
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© IWM (Art.IWM PST 6015)
Overall size of this product is .
The image area of the print measures .
Train to be a Nurse
Keep Mum - She's Not so Dumb! - Careless Talk Costs Lives
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Mechanical and Aerospace Engineering Department, University of Missouri, Columbia, MO email@example.com
Hydraulic Research and Development, Caterpillar Inc. Peoria, IL firstname.lastname@example.com
Pressure-controlled pumps tend to behave as second-order systems while displacement controlled pumps often behave as first-order systems [14].
Corresponding author.
The objectives of this paper are to identify the design parameters that have the greatest impact on the bandwidth frequency of a pressure controlled, axial-piston pump. This study is motivated by the fact that a physical limitation for these machines has been observed in practice, as it has been difficult to increase the bandwidth frequency much beyond 25 Hz. Though much research has been done over the past thirty years to understand the dynamical behavior of these machines, the essential design-characteristics that determine the bandwidth frequency of the pump remain elusive. In part, this is due to the fact that the machine is complex and when coupled with a hydraulic control valve that is disturbed by steady and transient fluid-momentum effects this dynamical property becomes difficult to assess. In order to achieve the objectives of this research, this paper presents the most comprehensive pump-and-valve model of a pressure controlled, axial-piston machine available in the literature to date. The pump model includes the effects of the discrete pumping-elements acting on the swash plate, while the valve model includes both steady and transient fluid-momentum forces. To identify the dominate features of the model, nondimensional analysis is employed and the complexity of the model is subsequently reduced by eliminating negligible terms. Furthermore, a closed-form expression for the bandwidth frequency is employed and perturbation analysis is used to identify the dominant set of parameters that impact the bandwidth frequency of the pump. In conclusion, it is shown that, by far, the greatest impact on the bandwidth frequency may be achieved by reducing the swept volume of the control actuator and by increasing the flow capacity of the control valve.
A schematic of the pressure controlled, axial-piston, swash-plate type, variable-displacement pump (Section A-A is shown in Fig. 3)
A schematic of the pump discharge line used for modeling the discharge pressure of the variable-displacement pump
A partial free-body-diagram of the swash-plate (Section A-A is referred to in Fig. 1)
Partial free-body-diagrams for the actuators and pistons
Pressure profile for illustrating the essential characteristics of Pn
Schematic of the control actuator for modeling the fluid pressure, Pc
Shematic of the three-way control valve with fluid control-volumes and a free-body-diagram of the spool
Block diagram for the reduced order system
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CNAs, whether working in hospital or long-term care settings are called upon to assist with post-mortem care. If you're not clear on this going in, perhaps a different career choice would be best. Just sayin'.
Yes, death gives darn near everyone the heebie-jeebies, yours truly included. Everyone's reaction to death and corpses is individual. What can be standardized is a competent, professional response to the practical need to prepare the body for 1. family to spend time with the departed and 2. need to get things settled/cleaned/straightened before rigor sets in. We've certainly come a long way since the time of the Black Death.
In the hospital, the nurse may supervise this care, or it may be performed by a couple of CNAs working together. A CNA may also perform this duty solo, but usually this doesn't occur, for the practical reasons that positioning is more safely accomplished with two or more workers, and that post-mortem care does an emotional/spiritual number on even the most grizzled, seasoned health care worker.
Sometimes, the nurse needs emotional support. He or she has supported the patient through efforts to save his/her life, then through hospice or "comfort care" and then the dying process. The nurse has to be supportive of family/loved ones as well, and their reactions to the dying process. Last but not least, the nurse is responsible for final charting, finding out which funeral service the family would like used, dealing with belongings, and supervising/performing post-mortem care according to facility policy.
So, what's our role as the CNA in all this? There are three areas: rules of behavior/etiquette, rules of gathering supplies, and rules of post-mortem care.
1. Rules of behavior/etiquette:
- Watch your mouth! It is said that hearing is the last sense to go. So keep it proper! Plus, many hospitals only have a curtain between you and family members lingering outside the room, other staff, management, and passers-by.
- It's not about you, it's about the consumer! (Best business advice ever, courtesy of Joe Dirt.) Nobody wants to hear how you handled the death of someone in your family. They are having their own experience, save the stories and advice for another time and location. So STFU.
- Be discreet! If the family will be coming back into the room post-mortem to spend time with their departed loved one, put the body bag in a drawer or cupboard. Bag up extra non-needed medical wastes (catheters, lines, drips, etc.) and get'em out of the room. Lower the lights so things don't look so stark.
- Be realistic about time frames. Post-mortem care can take 15-30 minutes to accomplish with a team of two or more, depending on how much there is to remove/clean, and how much bleeding/oozing is going on. Keep the family informed so they don't freak out on you.
Rules of gathering supplies:
- 10 mL syringe for removing Foley cath
- 60 mL Luer-lock syringe for removing stool/fecal management system (excellent product video from Bard – select the removal procedure video)
- plenty of chux
- paper tape (less damaging to skin)
- drain sponges/gauze (needed along with tape for securing holes where lines used to be)
- surgical scissors (find in procedure cart as needed) – needed for removing sutures holding in PICC, central, art lines (these are too tight to get at with trauma shears, which have blunted leading tips)
- body bag with tags (usually 3 – for body, outside of body bag and for belongings) – to use per facility protocol (LTC – usually the funeral service brings this item)
- bags for belongings if not already taken by family – don't forget to tag them
- clean gown
- clean bed linen
- basin
- soap
- water
- wash cloths/towels
- comb
- EMPTY garbage cans with plenty of liners (don't forget the biohazard bags – you're gonna need 'em) – it just plain sucks to start post-mortem care with every waste can in the room chock-full!
- did I mention – plenty of chux? OK.
Rules of post-mortem care:
Hopefully you had a good CNA textbook that covered this topic and you read it during your CNA course. If not, might be a good idea to review it before taking a new position. I highly recommend the following article: Post-Mortem Care.
Remember to put a chux down under orifices (or is it orifi?) on the side you are rolling the body to, because drainage happens. This one piece of advice will hopefully save you a few post-mortem linen changes.
Remember, this is the patient's (and their family's) last experience with your facility, so make it a professional one.


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Island, £12.99
Sweating authenticity from beneath his earnest frown and feathered fringe, Paul Weller is often the kind of artist you're meant to like, but seldom do. And the promise of this album being his "experiment in psychedelia" boded badly. But, wearing its aural kaleidoscope vibe lightly, this is a refreshingly limber and genuinely enjoyable record spanning styles from the punchy beats of his Jam days through the heat-hazy soul of the Style Council to the organic wisdom of his Wild Wood period. Sonically speaking, Weller seriously kicks it.
Download this That Dangerous Age


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Article Summary, from International Journal of COPD 2010:5 81-88. Tillie L Hackett, Darryl A Knight, Don D Sin, Heart and Lung Institute, St Paul's Hospital, Vancouver, BC, Canada
Chronic obstructive pulmonary disease (COPD) is a worldwide epidemic affecting an estimated 210 million people and accounting for more than three million deaths annually. (1). Over the next 20 years, the World Health Organization expects total COPD mortality to more than double.
In China alone, three million men and women are expected to die from COPD by the year 2030 if current cigarette and biomass exposure trends continue. (2)
Unfortunately, aside from supplemental domiciliary oxygen for the small number of patients who demonstrate resting arterial hypoxemia and smoking cessation for continued smokers, there are no interventions that have been unequivocally shown to prolong survival in patients with COPD (3) and no therapies that can fully restore the lost lung function associated with COPD.
As COPD is characterized by loss of lung tissue and remodeling of the airways, there is growing enthusiasm for using stem and progenitor cells to regenerate healthy parenchymal and airway cells and restore lung function in patients with COPD.
Morphologically, COPD is characterized by two distinct but related pathologic features, ie, bronchiolitis involving predominantly the small airways (airways less than 2 mm in diameter) and emphysema. (4). Emphysema is characterized by dilatation and destruction of lung tissue beyond the terminal bronchioles. The centriacinar form of emphysema is characterized by tissue destruction of the respiratory bronchioles and occurs most frequently in cigarette smokers. Panacinar emphysema, on the other hand, is characterized by destruction of the entire acinar unit and occurs largely in the setting of alpha-1 antitrypsin deficiency. (4)
The key pathophysiologic changes underlying airflow limitation in COPD include the loss of elastic lung recoil pressure due to the destruction of alveolar septa and terminal bronchioles (emphysema), increased airflow resistance due to airway wall remodeling (ie, thickening of small airway wall) and mucoid impaction of the airway lumen. (4) In addition, there is growing evidence that endothelial dysfunction and vascular remodeling initiated by vascular endothelial growth factor-mediated apoptosis of endothelial cells may also contribute to disease progression in COPD. (5)
Although there have been tremendous advances in our understanding of COPD pathobiology over the past two decades, the exact pathologic mechanisms by which emphysema and airway remodeling occur in COPD remain largely a mystery. One of the leading theories is the "inflammatory hypothesis". Proponents argue that in certain (genetically) susceptible individuals, lung inflammation, which occurs in response to environmental triggers such as air pollution and cigarette smoke, changes from a "normal" response to an abnormal one, characterized by excess innate and adaptive immunity, at some point during the exposure.
Interestingly, once the inflammatory changes are firmly established in the lungs, the removal of the environmental trigger such as cigarette smoke does not fully abrogate the abnormal inflammatory response observed in the airways. Indeed, smokers who discontinue smoking continue to demonstrate airway inflammation. (10)
Another emerging hypothesis relates to accelerated cellular aging, or senescence that results in a series of perturbations in cell morphology and function, ultimately culminating in cell cycle arrest. (11,12) Collectively, there appears to be sufficient evidence to suggest that resident structural cells within the lungs and lymphocytes within the systemic circulation of COPD patients exhibit markers of cellular senescence and accelerated aging, which is potentially detrimental to normal lung repair.
Mechanisms of lung repair
Theoretically, if the reparative and regenerative processes in the lungs can keep up with the destructive, inflammatory, or apoptotic processes, then lung homeostasis can be maintained, leading to the preservation of normal tissue and function. Following epithelial injury, the airway epithelium begins to repair almost immediately. At the wound edge, the (undamaged) epithelial cells de-differentiate and migrate to "cover up" the wounded area and release a variety of proinflammatory cytokines and growth factors to attract proteins and cells needed for restoration of the extracellular matrix, which is crucial for normal wound repair. Once this occurs, re-epithelialization can proceed.
The adult human lung comprises various trophic units which are each lined by specialized types of airway epithelia. (26) The ability of the lung to repair itself in the setting of injury is determined by the molecular events that mobilize the resident stem and progenitor cells within each of the trophic units. Stem cells and progenitors are similar in that they both proliferate and give rise to differentiated cells but only stem cells are capable of self-renewal. (27) The reader is referred to Figure 1 for the putative stem and progenitor cell niches within the human lung.
Resident stem cells within the lung
In contrast to dermal and intestinal epithelia, which are highly proliferative and rapidly renewing, the turnover of the airway epithelium is extremely slow unless injured. (28) Each of the tracheal, bronchial, and alveolar regions within the lung has a distinct resident stem or progenitor cell population which possesses unique cellular physiologic properties. To date, several cells within the trachea and bronchial tissue have been reported to be enriched for stem/progenitor cell activity including cytokeratin 5/14-expressing basal cells, secretory (Clara) cells, cells residing in submucosal glands, and neuroepithelial bodies (NEB). (29–33).
A more recent study indicates that cytokeratin 5/14 expressing basal cells can self-renew and also give rise to new ciliated Clara and secretory cells following epithelial injury. (34)
We have also demonstrated that within human airways the basal cell population contains a side population (SP) of cells, which are characterized by the ability to efflux actively the DNA binding dye, Hoescht 33342. (35)
As with other epithelial tissues such as in mammary glands, (36,37) the eye, (38) and the skin, (39) SP cells within the airways are rare, making up less than 0.1%of the total epithelial cell population.
Both embryonic and adult stem cells in vitro can be induced to differentiate into airway and alveolar epithelial cells.
MSCs isolated from amniotic fluid, umbilical cord blood, adipose tissue, or bone marrow have been used to generate tracheal cartilage using biosynthetic scaffolds in order to repair congenital tracheal defects in rodent models and more recently in human clinical trials. (56–58)
Macchiarini et al were able to use a patient's epithelial cells and MSC-derived chondrocytes to generate a bioengineered trachea, which after engraftment provided a functional airway without the requirement for immunosuppressive drugs. (59)
Mesenchymal stem cells (MSCs) are nonhematopoietic stem cells of mesodermal origin, with the capacity to differentiate into both mesenchymal and nonmesenchymal lineages.
MSCs are found primarily in the bone marrow of adults and give rise to blood, skeletal muscle, vascular, and connective tissues throughout the body. Postnatally, bone marrow MSC can be isolated from adipose tissue, liver, synovial membrane, teeth, and tendons. In particular, MSCs are easily isolated from a small aspirate of bone marrow and can be expanded with high efficiency. MSCs have great potential in clinical therapy because they express intermediate to low levels of HLA Class I, low levels of HLA Class II, and low levels of costimulatory molecules to avoid self-recognition by the immune system. (69)
In immunocompetent patients, MSCs have also been demonstrated to suppress allogeneic T-cell proliferation and evade alloreactive recognition. (70)
The immunomodulatory properties of MSCs are thought to involve the secretion of soluble mediators and cell-cell contact inhibition; however, the exact mechanisms of action are unclear. (71).
Autologous and allogeneic MSCs are currently being tested in clinical trials for a variety of diseases including Crohn's disease, multiple sclerosis, diabetes mellitus and end-stage liver disease, and to prevent transplant rejection and restore left ventricular function in patients with congestive heart failure. An open-label Phase II trial utilizing Prochymal ®, an allogenic MSC infusion in patients with severe Crohn's disease, who were unresponsive to corticosteroids, infliximab (anti-TNF antibody), and other immunosuppressive therapies, has recently been completed. The study reported significant mprovements in symptoms as assessed by the Crohn's disease activity index (CDAI). This has led to the approval by the Food and Drug Administration for a Phase III doubleblind, placebo-controlled trial of this therapy for the treatment of Crohn's disease. (77)
Despite significant progress in our understanding of lung stem cells and their functional capacities over the past decade, much remains unknown about the processes involved in lung repair. Accumulating data from both animal models and clinical trials suggest that adult-derived stem cells may provide potential therapeutic strategies for lung repair in COPD.


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There's a new Indiegogo campaign for hats that parody Trump's 'Make America Great Again' slogan.
Money made from selling the hats, which read "Make America Great Britain Again", will be donated to the anti-Trump 'Our Principals PAC'.
The campaign says, "By wearing a Make America Great Britain Again hat, you're not just making a statement that you think Trump is an evil cartoon character of a candidate, but you're also actively supporting 'Our Principles', the anti-Trump Super PAC."
The group behind the hats claim they're only on one side: they're not with Trump.
"We support the cause of Anybody But Trump! This is a non-partisan campaign. Whether you'd rather #feelthebern or #cruisewithcruz, you're welcome here," they say.
The campaign has a goal of $2000 with flexible funding, meaning that even if the goal is not reached, the campaign will receive all of its funds.
Of course, if you want a Trump parody hat that doesn't go towards an anti-Trump PAC, check out our Make Canada Great Again hats available at The Rebel store.


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Have your event looking current and stylish, the Chiavari Chair is an ideal choice for any event location, no matter how big or small the event. The Chiavari chair design gives a classical look and a feel that will fit the bill at any conference, television event, wedding, or as simple as a birthday party, no matter what colour you choose.
Our huge colour range of Chiavari seat pads will complement every Chiavari in whatever colour chair it is paired with. When you hire chairs with us, the seat pad is already is included in the price of the chair. However you may have some chairs for which you just need to hire Chiavari seat pads or caps – if this is the case, you are in the right place.
Make An Enquiry
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Bismihi Ta'ala
Blogs are supposed to help others keep track of your thoughts, experiences and life. Mine used to do that. Now it seems to be a scattered bunch of posts that appear randomly like an old classmate you might bump into on the road or in the supermarket, bringing back fond memories of a time that was and leaving you with a warm feeling for a little while.
Then life goes back to normal and you forget once again the small things that used to make you smile. You forget the pleasure of writing simply for the sake of writing, of the thrill you feel when your can hear the clickety-clack of the keyboard speed up as your words flow out faster and faster and faster, of the anticipation when you know what the next sentence is going to be even as you start typing out the first one. There is a feeling of euphoria when there is no fear of 'what next?' because you know there's an endless supply of 'words' waiting for you to pull them up out of non-existence and magic them into existence by typing them out. When all that matters is this word. And this one. And every one after it…
It's hard for me to grab that kind of mood and hold on it. Harder than it used to be. Perhaps that's because I have less angst to deal with nowadays. Life is pretty okay. Pretty & Okay. When you lack turmoil and suddenly things seem to be going well, when the downs are not as bad as they once seemed and the ups are manageable too, you begin to wonder: Have you become boring? Did you let go of so many dreams that life has become ordinary? Have you compromised too much or 'settled' for a safer option? Are you a traitor to your true self?
In a world where life has to be different, exciting, adventurous, controversial, opinionated and active in order to be considered worth mentioning on social media (what's interesting about run-of-the-mill daily chores?), gaining responsibility and having committments defeats the purpose of 'living'.
I'm not suggesting that people who live exciting lives aren't responsible or don't have committments. However, the variety and number of these duties define one's existence, and sometimes, there just isn't enough time leftover from your unique blend of 'things to do' for you to indulge in anything else.
There is often talk of making 'me-time' and setting aside a space in your schedule for your own interests, but is this always possible? Is it consistently available? Nope.
There are days when you will be able to do something luxuriously indulgent – like typing out this blog post simple because 'I Want To Write Again' – even though it involves having The Baby stretched out across my lap as I type over her slumbering little self. At least she's sleeping. And not restlessly so.
Other days (most of them, truth be told), she will not conform – she will wake when she's meant to sleep, demand attention when she should be playing by herself, need a change just after we spent twenty minutes putting her into fresh clothes – and by the time those mini-obstacles are overcome, the rest of the to-do things await. Exciting stuff like making lunch, vaccuming, cleaning the bathroom (whatever part of it you can in the 5 minutes you have before The Baby follows you and tries to fill her cup from the toilet bowl) or even pausing to do that decadent thing called eating (usually The Baby's leftovers).
Me-time is saved for weekends and those weekends come around once a month…if I'm lucky. This is a lucky month and that's why I've decided to rant a bit, complain a bit and write about just the normal stuff. Hopefully the joy of writing purely for 'me' will pull tihs blog back to being a bit more prolific!
P.S. She's still asleep! *cheesy ftw grin*


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At their weekend concert in London, the singer dedicated the song "Kite" from their latest album to his father, Bob Hewson.
The song was originally written for his children but the singer said it now feels "like my father wrote it about me. It's funny how things work out."
He then used the band's private jet to fly back to Dublin to be at his bedside.
Another new song, "In a Little While," was played in memory of Joey Ramone, lead singer of New York punk group the Ramones who died from cancer while listening to the song. Bono admitted the Ramones were a huge influence on U2.
"We wouldn't be here if it wasn't for them," he said. "This was a good song, now it's been made great because of him."
London is the latest stop on their Elevation 2001 Tour, which has thrilled fans with its back-to-basics approach.
At Saturday's well-paced show, "Sunday Bloody Sunday" was dedicated to the people of Omagh, the town in Northern Ireland where 29 people died in a car bomb explosion in 1998.
In February at a pre-tour warm-up gig at London's Astoria Theater, Bono announced the band were "Re-applying for the job. You know what that job is? Best band in the world." The comments came after the excess of 1997's PopMart Tour, held in cavernous stadiums with giant props such as an enormous lemon and an olive on a 100-foot-high toothpick.
The tour left many fans bewildered and empty seats pointed to a slump. The latest shows in smaller indoors venues have brought the focus back to the music, featuring a simple stage set with a heart-shaped catwalk protruding into the audience.
After two more shows in London, the band will finish the European leg of the tour with two shows at Slane Castle in Ireland.
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Welcome to Atlantic Dentistry
Quality dental care with a contemporary twist is what you will find at Atlantic Dentistry. We have worked to create a very professional and convenient environment for our patients that will make visiting our facility for dental treatments a welcoming experience. Our team will take excellent care of your oral health, whether you are a seasoned dental patient or you have not seen a dentist in years. We use the latest technology and dental techniques to achieve the best results. General, pediatric, cosmetic, sedation, restorative and emergency dentistry are all available at our Atlantic Blvd. location.
Dr. Sebastien Murphy strives for an environment where every patient will want to come to this location to take care of their oral health needs. In addition to great care, there are several amenities available for patients to enjoy. Our comfortable and relaxing atmosphere will help to ensure you are in good hands with the Atlantic Dentistry family. Contact us today for an appointment.


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All-Star Mania! (Or Not)
I am out of town on personal business and do not plan to update the blog until Friday morning.
This thread is for all non-DCU discussion (Friedel to Villa, Adu to Monaco, Olympic player tug-of-war, NBC Olympic announcers from afar, etc.) as well as the MLS All-Star Game tonight. ESPN's production begins at 7 p.m.
Steve Goff
July 24, 2008; 12:00 PM ET
Save & Share: Previous: United-Dynamo, the Aftermath
Next: Friday Kickaround
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Research Paper Basics: A Comprehensive Manual For StudentsPar MaryRussell dans Accueil le 13 Mars 2017 à 11:08
Many people tend to ignore important rules stipulated in the delivery of academic papers. One of the issues that have caught students unawares is in the writing of a research paper. Well, it is not a major problem if you follow the guidelines strictly. This kind of assignment requires skill and knowledge of the format in which it should be written. Basically, this paper should highlight the main issue under study and how it will be studied. Here are important things to consider in your writing:
- Defining the study topic: Make sure that you make a good choice of topic for your paper. Avoid generalities. Choose a particular aspect concerning your study area.
- Research outline: develop a good list of items to cover in your paper. How will you progress from one point to another as you write your paper? An outline will be useful in making a coherent piece of writing.
- Explain why your chosen topic needs to be studied. This is where you provide the background of your research paper. Look at several studies around this topic and identify new study gaps. It is important to show that your topic was well researched before you identified it.
- Study questions, aim and objectives: highlight the aim and objectives of your study. After that, formulate questions that will be useful in achieving your listed objectives.
- Literature review: in this section, look at good academic sources and explain how they relate to your topic. What has been studied in the past and what findings where made? In the course of writing this section, cite all references used and remember to list all of them at the end of the paper.
- Methodology: explain how you will conduct your research. What methods will you use? Will they be primary or secondary sources? Explain why it was useful in choosing the method you will be using.
- Analyze, present and discuss your findings: based on the method of research used, present all your findings needed for making meaningful conclusions.
- End your paper with a summary and conclusion. Restate your topic and evaluate it against your findings. This section is as important as any other part of your research paper. Therefore, make sure that you make solid conclusions about your paper.
Writing your paper will require you to study this format carefully so as not to omit any of these sections. Get term paper help from professionals to grow your writing skills.
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Poler Stuff, Portland's purveyor of all dope things you need to stunt outdoors, presents their latest innovation: Campfire Cologne. As the name suggests, Campfire Cologne let's you capture that nostalgic scent of burning logs taking you back to all those times you sat around a fire blazing and crushing beers. Now, to be clear, this is not actual cologne, but a box of tinder and matches that you can light and waft the smoke onto your 'clothes and beard'. Check out this clever product and the commercial for it below and grab your very own Campfire Cologne for $12.95 from Poler's online shop.
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Happy Father's Day!
Happy Father's Day Dad!
From a little girl to today, you have taught me many life lessons that I will carry with me for the rest of my life.
You taught me that things will not always go the way that I want them, but that is O.K. because you have to be able to work with you have.
You have always been there when I have needed you and have showed me how a man should treat not only a woman but everyone around.
You have taught me to love and care for others and to treat them the way I want to be treated.
You have taught me to not be afraid and to try new things.
You have taught me to use my voice and to stand up for myself.
Most importantly, you have taught us all to be who we are no matter what happens in life.
Happy Father's Day!
I Love You!


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When I look as this vulture that's bathed in blood after feeding, I'm kind of glad that I have no idea what dead animal has suffered the ignominy of being eaten by a walking cliche.
I saw this picture on reddit but didn't copy the link so I have no context of the feeding (though I suspect it was something horrific like these petrels got up to) but I note two things.
The first is the look on this bird.
He has just eaten the eyes and guts out of some poor dead beast and yet he's still all damn business. There's no hint of joy displayed even though he's managed to grab a bite to eat.
Second thing to note, is the work of the photographer.
I have no idea what their name is or when or where this picture was taken but hats off to them, it's an incredible capture. The quality is amazing but the eye capturing part of it is that single drop of blood that has dripped from the vulture's beak and is forever caught hanging in that moment.
It's a visceral reminder that nature is indeed beautiful and that carnage results.


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Trending Topics: Much separates real contenders from wild-card teams
The old mantra in the NHL is that if you get into the playoffs, you're going to be in as good a position as anyone else to make a nice, deep run.
Because hey, remember when the Kings won the Cup from the 8 seed that one time? Remember when the Senators were within a goal of the Cup Final last year? It can happen, baby!
But this year it really seems like a big gap in quality has developed between most of the higher-end seeds and those that are hanging around the bottom of the playoff picture. Since the switch to the divisional playoff format in 2013-14, just three out of the 64 playoff teams entered the postseason with a negative goal difference: The 2015-16 Red Wings and Flyers and last year's Senators.
Have a look at this season's standings: Ahead of Thursday night's games, New Jersey, Columbus, and Anaheim all have negative goal differences right now and occupy playoff spots. The Devils and Ducks were closest to break-even with a minus-2 difference, while Columbus was minus-7. To be fair to the Ducks, they at least had a plus-5 goal difference at 5-on-5, but the Devils were also minus-2 there (meaning they're dead even in all other situations). Columbus, meanwhile, continues to suffer harshly for its inept special teams; it's plus-7 with both at full strength and minus-14 all other times.
Meanwhile, with the exception of the Metro Division, every other top team in their respective divisions are just crushing the competition. Nashville, Winnipeg, and Vegas are all at least plus-42. Tampa's plus-56, Boston's plus-46, and even straggling (in this regard) Toronto is plus-33.
By comparison, last year's four division winners finished plus-81 (Washington, ahead of two hugely positive teams in Pittsburgh and Columbus), plus-31 (Chicago), plus-26 (Montreal), and plus-23 (Anaheim). It's worth noting that as good teams play more games, they generally grow their goal differences as the season goes on since they, you know, win more games than their opponents.
So while it no longer appears as though Tampa is going to clear a difference of more than a goal a game, the fact is they're gonna push 70 no problem. Other teams — Nashville, Vegas, Winnipeg, Boston — could clear plus-60 with little difficulty as well.
That's getting into the "wow this is a great team" territory. Since 2013-14, only nine teams have finished with goal differences of plus-50. Six are on pace to do it this season alone, and Toronto isn't so far behind that it's outside the realm of possibility they get there if there's a scoring surge or something.
This is, I think, reflective of the attitude I talked about in this space last week, and which was borne out at the trade deadline: Well-run, good teams now fully understand that the best way to win is to load up on elite talent. It's an idea that sounds simple, but in a cap league is hard to pull off. But now the good teams are doing it more often, which of course leaves even many middling teams a bit out in the cold. This issue probably also gets worse as time goes on and the concept of the "super team" in the NHL becomes a bit more prevalent. Imagine what happens if one of these big-scoring clubs gets an Erik Karlsson this summer.
What that means for a lot of these other teams in the playoffs is that while, yes, anything can still happen, they're also far more likely to be roadkill than they were in the past; the Senators were fortunate to get a banged-up Bruins team in the opening round and then a deeply flawed Rangers club in the second. While one can certainly see either of New Jersey or Columbus or hell, Carolina, giving Washington a series (the Caps are only plus-7 so far this year, but lead their division anyway) one imagines things wouldn't go so well having to play both Pittsburgh and Philly. Meanwhile, the Atlantic would almost certainly be a cauldron of death for any wild-card team unlucky enough to draw into it.
The same is true out West. The Pacific offers something resembling a friendly path forward if you're a wild card team: Get by a fluky Vegas club (even if you believe the Vegas Flu is real, visiting teams' hotels will be on lockdown during a playoff series in a way they haven't been in the regular season) and you probably have to play either San Jose, Anaheim, or Los Angeles, none of which are setting the world on fire.
But in the Central? Ah, if you finish third or in a wild-card spot, you have to play one of Nashville or Winnipeg, and then in all likelihood, the other of those teams. So that makes two divisions in which a relatively early exit is all but certain for any but the elite teams in the league, which is fine and as it probably should be.
It does, however, highlight the shortcomings of the current playoff system, in that we should really be headed for third rounds in which the Preds and Jets or Bolts and Bruins play for their Conference Titles, rather than doing so in the second round. When people joked last year about the second-round Metro clash between Washington and Pittsburgh being the de facto conference final, they weren't actually joking. Nor would they be if they said the same about the Atlantic and Central divisions this year (mostly).
I'm all for super teams. I think they make the games that matter most — those in the playoffs — the most entertaining and important. If you wanna put Karlsson on the Penguins, I say let's go. But the current playoff format, much like all the other smoke and mirrors in the regular season, is designed to obfuscate what it means to be "good" and bring as many intervening circumstances into those calculations as possible.
With that said, if the league can distill things down to the point where even six teams are truly elite and the rest are doing what NBA teams do now — hope to get into the playoffs, but with the right seeding to avoid a first-round matchup with a juggernaut — then things will mostly be good.
The NHL incentivizes mediocrity with a hard cap, revenue sharing, loser points, and the current playoff format, all as a means of creating the illusion that teams are better than they are in reality. Anything elite teams can do to smash that fantasy is, by definition, a good thing.
Ryan Lambert is a Puck Daddy columnist. His email is here and his Twitter is here.


text:
Science Editor Guo SY Language Editor Elsevier HK
Published online Jul 28, 2005. doi: 10.3748/wjg.v11.i28.4357
Revised: December 3, 2004
Accepted: December 8, 2004
Published online: July 28, 2005
AIM: A high percentage of early-stage high-grade gastric mucosa-associated lymphoid tissue (MALT) lymphomas remainHelicobacter pylori (H pylori)-dependent. However, unlike their low-grade counterparts, high-grade gastric MALT lymphomas may progress rapidly if unresponsive to H pylori eradication. It is mandatory to identify markers that may predict the H pylori-dependent status of these tumors. Proliferation of MALT lymphoma cells depends on cognate help and cell-to-cell contact of H pylori-specific intratumoral T-cells. To examine whether the expression of co-stimulatory marker CD86 (B7.2) and the infiltration of CD56 (+) natural killer (NK) cells can be useful markers to predict H pylori-dependent status of high-grade gastric MALT lymphoma.
METHODS: Lymphoma biopsies from 26 patients who had participated in a prospective study of H pylori-eradication for stage IE high-grade gastric MALT lymphomas were evaluated. Tumors that resolved to Wotherspoon grade II or less after H pylorieradication were classified as H pylori-dependent; others were classified as H pylori-independent. The infiltration of NK cells and the expression of CD86 in pre-treatment paraffin-embedded lymphoma tissues were determined by immunohistochemistry.
RESULTS: There were 16 H pylori-dependent and 10 H pylori-independent cases. CD86 expression was detected in 11 (68.8%) of 16 H pylori-dependent cases but in none of 10 H pylori-independent cases (P = 0.001). H pylori-dependent high-grade gastric MALT lymphomas contained significantly higher numbers of CD56 (+) NK cells than H pylori-independent cases (2.8±1.4% vs 1.10.8%; P = 0.003). CD86 positive MALT lymphomas also showed significantly increased infiltration of CD56 (+) NK cells compared to CD86-negative cases (2.9±1.1% vs 1.4±1.3%; P = 0.005).
CONCLUSION: These results suggest that the expression of co-stimulatory marker CD86 and the increased infiltration of NK cells are associated with H pylori-dependent state of early-stage high-grade gastric MALT lymphomas.
- Citation: Kuo SH, Chen LT, Chen CL, Doong SL, Yeh KH, Wu MS, Mao TL, Hsu HC, Wang HP, Lin JT, Cheng AL. Expression of CD86 and increased infiltration of NK cells are associated with Helicobacter pylori-dependent state of early stage high-grade gastric MALT lymphoma. World J Gastroenterol 2005; 11(28): 4357-4362
- URL: https://www.wjgnet.com/1007-9327/full/v11/i28/4357.htm
- DOI: http://dx.doi.org/10.3748/wjg.v11.i28.4357
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the stomach is the most common extranodal lymphoma of humans. Although not completely acknowledged by all experts, gastric MALT lymphoma is often classified into high-grade and low-grade subtypes by histological criteria[1-3]. Low-grade gastric MALT lymphoma is characterized by its close association with Helicobacter pylori (H pylori) infection; and eradication of H pylori by antibiotics, cures 70% of these tumors[4-6]. However, high-grade gastric MALT lymphomas, in contrast to their low-grade counterparts, are believed to consist of highly-transformed cells, the growth of which is independent of H pylori[7-9].
Recently, several groups of investigators have demonstrated that a substantial portion of early-stage high-grade gastric MALT lymphomas remains H pylori-dependent, and can be cured by H pylori eradication[10-12]. However, high-grade gastric MALT lymphoma, unlike its low-grade counterpart, may progress rapidly if unresponsive to H pylori eradication therapy. Molecular markers such as chromosomal aberration t(11;18), which is highly predictive of H pylori-independent status of low-grade gastric MALT lymphoma, are rarely found in the high-grade counterpart[13]. It is mandatory to identify cellular or molecular markers which can help predict the H pylori-dependent status of newly diagnosed patients.
In the early process of MALT lymphomagenesis, the proliferation response depends at least partly on the stimulation of H pylori-specific intratumoral T-cells[14]. In vitro experiments have demonstrated that the growth and differentiation of MALT lymphoma cells requires CD40-mediated signaling and T helper-2 (Th-2)-type cytokines[15,16]. The dependence on T-cells for the growth of malignant B-cell clones may explain the tendency of early-stage low-grade MALT lymphomas to remain localized and to regress after H pylori eradication. Expression of co-stimulatory molecules, including CD80 (B7.1), CD86 (B7.2), and their ligands, has been demonstrated in gastric MALT lymphoma cells[17]. The presence of the co-stimulatory marker CD86 (B7.2) on lymphoma cells may promote T-cell-mediated neoplastic B cell proliferation. We hypothesized that a loss of co-stimulatory markers might preclude tumor cell/reactive T-cell interaction and thereby contribute to the transition from a H pylori-dependent to a H pylori-independent state in high-grade gastric MALT lymphoma.
CD56 (+) natural killer (NK) cells are important components of the innate immune system, and have the ability to modulate both humoral- and cell-mediated immune responses[18,19]. H pylori can stimulate T-cells and thereby enhance the production of Th-2 cytokines, which can promote the proliferation of CD56 (+) NK cells in gastric MALT lymphomas[20,21]. Although low-grade gastric MALT lymphomas contain significantly higher numbers of CD56 (+) NK cells than high-grade gastric MALT lymphomas[21], the presence of CD56 (+) NK cells in high-grade gastric MALT lymphomas indicate that the promotion of these lymphoma cells triggered by H pylori-specific intratumoral T-cells and Th-2 type cytokines may still be present in vivo. Therefore, these CD56 (+) NK cells may limit the autonomous growth of MALT lymphoma cells, and may contribute to the remission of high-grade MALT lymphomas after the eradication of H pylori.
This study, was conducted to examine the expression of CD86 and the infiltration of CD56 (+) NK cells in 16 H pylori-dependent and 10 H pylori-independent high-grade gastric MALT lymphomas.
Twenty-six patients who had participated in a prospective study of H pylori eradication for stage IE high-grade gastric MALT lymphomas at our institutions from June 1995 to June 2003 were included in this study. The clinicopathologic features of the 22 patients have been previously reported[13]. Although high-grade MALT lymphomas are classified as diffuse large B-cell lymphomas (with areas of marginal zone/MALT-type lymphoma) in the REAL/WHO classification[2], and a consensus on the use of the term high-grade MALT lymphoma has not been achieved, many experts consider it as a useful and reasonable clinicopathologic entity[1,3,10,21]. In this study, the diagnosis of high-grade gastric MALT lymphoma was made using the histologic criteria as described by Chan et al[1] and de Jong et al[3] based on the presence of a diffuse increase of large cells resembling centroblasts or lymphoblasts to between 1% and 10% of the total tumor cells within predominantly low-grade centrocyte-like cell infiltrate, or the predominance of a high-grade lymphoma with only a small residue, low-grade foci and/or the presence of lymphoepithelial lesions. Specimens with occasional clusters of transformed blast cells or sheets of transformed blast cells (upto 20 cells not forming larger sheets) confined within the colonized follicles were found within a low-grade lymphoma, they were considered as an immune response to H pylori stimulation rather than high-grade MALT lymphoma. Patients with primary pure large cell lymphoma, without evidence of a low-grade component of the stomach were excluded from this study. All specimens were immuohi-stochemically stained by CD20, CD79a, CD3, and CD45RO for routine diagnostic purposes and to highlight lymphoepithelial lesions. Moreover, to exclude misinterpretation of reactive, benign germinal centers as transformed foci, CD21 (follicular dendritic cells markers) and BCL-2 (highly suggestive of a neoplastic origin of the blast cells) were included in all cases. The histopathologic characteristics of all tumor specimens were independently reviewed by two expert hematopathologists. Staging was based on Musshoff's modification of the Ann Arbor staging system[22]. Staging procedures included physical examination, routine laboratory tests, inspection of Waldeyer's ring, chest radiography, chest and abdominal CT scan, bone marrow aspiration, and trephine biopsy. Diagnosis of H pylori infection was based on histologic examination, biopsy urease test, or bacterial culture. When at least one test was positive, the cases were considered as H pylori infected. All patients consented to a brief trial of H pylori eradication therapy.
At the beginning of the study period in June 1995, the eradication regimen consisted of amoxicillin 500 mg and metronidazole 250 mg q.i.d., with either bismuth subcitrate 120 mg q.i.d. or omeprazole 20 mg b.i.d., for 4 wk. The regimen was changed to amoxicillin 500 mg q.i.d., clarithromycin 500 mg b.i.d., plus omeprazole 20 mg b.i.d. for 2 wk beginning in March 1996. Patients were scheduled to undergo a first follow-up upper gastrointestinal endoscopic examination 4-6 wk after completion of antimicrobial therapy, and follow-up was then repeated every 6-12 wk until histologic evidence of remission was found. At each follow-up examination, four to six biopsy specimens were taken from the antrum and body of the stomach for aH pylori infection evaluation, and a minimum of six biopsy specimens were taken from each of the tumors and suspicious areas for histologic evaluation. Tumors that resolved to Wotherspoon grade II or less were considered as histological complete remission[4]. Tumors showing both histological and endoscopic complete remission were considered H pylori-dependent. Tumors showing stable or progressive disease on follow-up endoscopic examination and persistent or increasing proportion of large cells on microscopic examination were considered H pylori-independent.
Formalin-fixed paraffin embedded sections cut at a thickness of 4 mm were deparaffinized and rehydrated through xylene and a graded descending series of alcohol. After antigen retrieval by heat treatment in 0.1 mol/L citrate buffer at pH 6.0, endogenous peroxidase activity was blocked by 3% H2O2. Briefly, slides were incubated for 30 min in 2.5% normal donkey serum or goat serum. The slides were then incubated overnight at 4 °C either with goat polyclonal anti-CD86 antibody (1:50; AF-141-NA; R&D Systems, Abingdon, UK) or mouse monoclonal anti-CD56 antibody (1:100; NCL-CD56-1B6, Novacastra), and incubated with secondary antibodies (CD86, donkey antigoat immun-oglobulin; CD56, goat antimouse immunoglobulin; Santa Cruz Biotechnology, Santa Cruz, CA, USA), following the manufacturer's instructions. Finally, antibody binding was detected with the avidin-biotin-peroxidase method. Reaction products were developed using 3, 5-diaminobenzidine (Dako) as a substrate for peroxidase. Sections were counterstained with Mayer's hematoxylin. All the washes were performed in PBS (pH 7.4). Staining was considered as positive for CD86 when the protein was detected in more than 10% of tumor cells. A minimum of 1 000 cells (normal and neoplastic) were counted for each single determination and reported as the percentage of CD56 (+) NK cells in total mononuclear cells.
The primary aims of this study were to investigate the correlation between the H pylori-dependent status of MALT lymphomas, the expression of CD86 and the infiltration of CD56 (+) NK cells. Fisher's exact test and χ2 test were used to analyze the correlation between the H pylori-dependent status of MALT lymphomas with CD86 expression patterns. The results for the CD56 (+) NK cells are expressed as mean±SD of percentages of positive cells in the total cell count for a given marker. Nonparametric Mann-Whitney U test was used to evaluate the difference in the distribution of positive CD56 (+) NK cell count between H pylori-dependent and H pylori-independent high-grade MALT lymphomas and the difference in the distribution of positive CD56 (+) NK cell count between CD86 positive and CD86 negative high-grade MALT lymphomas.
There were 16 patients with H pylori-dependent and 10 patients with H pylori-independent tumors. The clinicopathologic features of these patients are summarized in Table 1. The median duration between H pylori eradication and complete histologic remission was 5.0 mo (range, 1.5-17.7 mo). At a median follow-up of 56 mo (range, 8.0-90 mo), all 16 patients who had achieved complete histologic remission after eradication of H pylori were alive and free of lymphoma. Seven patients whose tumors grossly increased in size or had microscopic findings of an increased large-cell fraction and three patients whose tumor remained grossly stable at the first follow-up endoscopic examination, were immediately referred for systemic chemotherapy.
|Depth of tumorinvasion
|Tumor response toH pylori eradication
|Current status
|Muscularis propria
|Muscularis propria
|Muscularis propria
|Muscularis propria
|Muscularis propria
|Muscularis propria
|Muscularis propria
The expression of CD86 was detected in 11 (68.8%) of 16 H pylori-dependent high-grade gastric MALT lymphomas, but in none of 10 H pylori-independent MALT lymphomas (P = 0.001, Figure 1 and Table 1). Therefore, the expression of CD86 had a sensitivity of 68.8% and a specificity of 100% in predicting the H pylori-dependence of high-grade gastric MALT lymphomas.
As shown in Figure 2, the infiltration of CD56 (+) NK cells differed between H pylori-dependent and H pylori-independent high-grade gastric MALT lymphomas. H pylori-dependent high-grade gastric MALT lymphomas contained significantly higher numbers of CD56 (+) NK cells than H pylori-independent MALT lymphomas (2.8±1.4% vs 1.1±0.8%; P = 0.003). Meanwhile, CD86 positive MALT lymphomas also showed significantly increased infiltration of CD56 (+) NK cells compared to CD86-negative cases (2.9±1.1% vs 1.4±1.3%; P = 0.005).
In this study, we found that expression of CD86 on tumor cells and increased infiltration of NK cells in tumor tissues wereassociated with the H pylori-dependent status of early-stage high-grade gastric MALT lymphomas. These findings suggest that the interaction of B- and T-cells may play a pivotal role in the determination of antigen-dependence, as well as in the subsequent response to H pylori eradication therapy in a substantial portion of early-stage high-grade gastric MALT lymphomas. Since high-grade gastric MALT lymphomas may progress rapidly if unresponsive to H pylori eradication therapy, this information is invaluable for the physician who must select a first-line treatment.
It has been demonstrated that the growth of MALT lymphomas requires the help of H pylori-reactive tumor-infiltrating T-cells. For effective communication between T-cells and neoplastic B-cells, two subsets of co-stimulatory molecules, CD80 (B7.1) and CD86 (B7.2), of the neoplastic B-cells should interact with CD28 or CTLA-4 of the T-cells[23]. However, the precise role of CD80 and CD86 molecules in the signaling of B-cells remains unclear. In earlier studies, the CD28-CTLA4/B7-signaling pathway was found to be involved in the proliferation and differentiation of B-cells[24,25]. There is also evidence that CD86 may promote proliferation and immunoglobulin synthesis of normal B-cells and malignant B cells[26]. Compared with CD86, CD80 delivered a down-regulator signal for B-cell response[26]. In a recent study of low-grade gastric MALT lymphomas, the expression of CD86 was significantly associated with H pylori-dependence, while CD80 and CD40 and their ligands were not[27]. These results are in line with our observation that the co-stimulatory molecule CD86 is present in high-grade gastric MALT lymphomas, and is also significantly associated with H pylori-dependence. Our findings support the notion that the growth of a substantial portion of early-stage high-grade gastric MALT lymphomas, as well as their low-grade counterparts, remains dependent on functional B-cell/T-cell interaction.
In addition to promoting the proliferation and differentiation of malignant B-cell clones, tumor-infiltrating T-cells in low-grade gastric MALT lymphomas are found to be defective in both perforin-mediated cytotoxicity and Fas-Fas ligand mediated apoptosis[28]. On the other hand, the tumor tissues of high-grade MALT lymphomas appear to contain a much higher number of apoptotic lymphoma cells and CD8+ cytotoxic T lymphocytes (CTLs)[21]. Study using a murine model demonstrated that Th-1 response and CD8+ CTLs activity were strongly inhibited in the presence of persistent gastric H pylori infection[29]. Moreover, activated CD8+ CTLs may compete with CD56 (+) NK cells and downregulate the function of the latter[17]. Besides regulating the differentiation of CD8+ CTLs, CD56 (+) NK cells may have an equally important role in immune regulation, where they limit the host response to foreign antigens and prevent autoimmunity[18]. Recently, it has been demonstrated that CD56 (+) NK cells can be functionally activated by co-stimulatory molecules through the interaction of their activation receptor and CD86 on target cells, and thereby limit the extent of H pylori-related auto-reactive and neoplastic B lymphoid cells in the stomach[30]. In the current study, we found that H pylori-dependent high-grade MALT lymphomas showed significantly increased infiltration of CD56 (+) NK cells compared to H pylori-independent lymphomas. Interestingly, we also found that CD86 positive MALT lymphomas showed significantly increased infiltration of CD56 (+) NK cells compared to CD86-negative cases. These findings suggest that the loss of H pylori-dependence may be associated with a change in the immunological microenvironment, including a shift towards a Th-1 response that enhances the activity of CD8+ CTLs, and decreases the activity of CD56 (+) NK cells.
In conclusion, the expression of co-stimulatory marker CD86 on lymphoma cells and the increased infiltration of CD56 (+) NK cells in tumor tissues are useful markers in the identification of H pylori-dependent tumors and in the selection of patients for first-line H pylori eradication therapy.
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