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Things to do in Urbino
From classic must-see sights to insider hot spots and local haunts, there are countless things to do in Urbino. How do you decide? Start with our travel guide and get our favorite Urbino attractions and activities—shops, museums, parks, nightclubs, coffee shops, tours, and more.
Our international team of editors and writers handpick the best things to do in Urbino to help travelers discover authentic, local experiences. Whether a hidden boutique with handcrafted products, a popular local festival, a bakery with a cult following, or a picnic-worthy park, Travel + Leisure guides the way, providing information and inspiration. From beaches and bars to cultural attractions and up-and-coming neighborhoods, our list will help you make the most of your romantic getaway, family vacation, or trip with friends. Below find Travel + Leisure's top picks for what to do in Urbino.
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Galleria Nazionale delle Marche
The museum contains Paintings by Paolo Uccello and Piero della Francesca. More -
Raphael's Birth House
The artist was born and taught to paint by his father here, though none of his paintings are on display. More
Explore things to do in Le Marche for more options.
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subset: commoncrawl


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Hi all, I am new to this area of the forum and a month old the the whole forum. I hope this is the right placed to post this, please move if not, but yesterday I received 20 Mammoth Russian Sunflower seeds as a gift from a seed company when I ordered my pepper seeds. After doing some research I think it would awesome to grow them and looking looking for advice on the best way on how to start the seeds. (My location is 6b and I live between Philadelphia, PA and Princeton, NJ). I think the last frost has past but who knows for the next 10 days the weath is creeping to the mid 60's at day and around 45-50 at night. I also have a grow light and familiar with germination now if it needs indoor germination and such. 1.) How do I start them if sowing indoors or should I just place them outdoors with direct sow....if the last frost has passed? (I am getting the hang of tomatoes and peppers germination now but thinking if there is something different with this?) 2.)I plan on putting them directly into my soil and wondering if any special fertilizer is needed and mulch ect...? And what about watering? 3.) I heard they attract bees & birds and such, could this be harmfull or helpful to my tomatoes and peppers? If harmful or helpfull, how close/far should they be to my tomatoes & peppers 4.) I only really have room for about 3-4 sunflower plants (since I Heard they get up to 10 feet+) and have 20 seeds so how many seeds should I start for a sucessfull germination per plant? 5.) Is there anything else that I need to know that would help me get to a great start? Many thanks and sorry for so many questions but this is a first for me but really looking forward to it since I love sunflower seeds and the look of them. Many thanks in advance, - Mr Beno |
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I also grow Mammoth Sunflowers. I bought a package of seeds from Burpee bout 3 years ago and I have not run out. You can easily sow the seeds/fruit into the ground and you should have no problem with germination. They initially begin with a tap root but then develop a pretty elaborate root system. I would keep them in full sun, but decently away from more delicate plants like tomatoes or peppers. Mammoth sunflowers get HUGE. Last year they reached over 12 feet, I literally had people stopping at my front door to ask about them. Other then that they are a very hardy flower, I never gave them any real special treatment besides some water when they got dry and some organic fertilizer (comfrey) every now and then. On a related note, anyone who likes Sunflowers should look into the The Great Sunflower Project. I have 2 Lemon Queen (perennial) plants going in this year along with Autumn Beauties and Mammoth Sunflowers (annuals). |
Here is a link that might be useful: The Great Sunflower Project
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text: I am new to the south beach diet, i have been on it for about 3 weeks, and the first 2 weeks i did great. But as usual give me a little and i'll take alot. I want to stick to the phase 1 a little longer because i know if i start eating some breads and stuff thats it, which has happened. I'm really getting frustrated thats why I joined here, for some support. I don't have much more to lose like 10 more pounds. Any words of incouragement or helpful tips!!! Please


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Overview - Solomon 3 | |
1 | The church's fight and victory in temptation. |
6 | The church glories in Christ. |
Solomon 3:2 (King James Version)
I will rise now, and go about the city in the streets, and in the broad ways I will seek him whom my soul loveth: I sought him, but I found him not.


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Leiter, Ulrikea; Marghoob, Ashfaq A.c; Lasithiotakis, Konstantinosa; Eigentler, Thomas K.a; Meier, Friedegunda; Meisner, Christophb; Garbe, Clausa
aDepartments of Dermatology, Skin Cancer Program, Eberhard Karls University
bInstitute of Medical Biometrics, Eberhard Karls University, Tübingen, Germany
cMemorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, Hauppauge, New York, USA
Correspondence to Claus Garbe, MD, Professor of Dermatology, Head, Division of Dermatooncology, Eberhard Karls University, Liebermeister Strasse 25, 72076 Tuebingen, Germany
Tel: +49 07071 2987110; fax: +49 07071 295187;
e-mail: firstname.lastname@example.com
Received 14 January 2008 Accepted 1 October 2008
At present, no universally accepted recommendations exist for cutaneous melanoma follow-up. Various surveillance strategies, some associated with significant cost, others of uncertain value, are routinely used. This study aimed to evaluate of the costs incurred for varied surveillance strategies practiced in Europe and the USA. One thousand nine hundred and sixty-nine cutaneous melanoma patients with stage I–III disease attending the Department of Dermatology, University of Tuebingen for follow-up between 1996 and 1998 participated in the study. Routine surveillance consisted of cutaneous examination, lymph node and abdomen sonography, chest radiograph (CR) and blood tests. The costs incurred were based upon the 2004 German official scale for medical reimbursement and the 2004 Medicare fee reimbursement schedule (USA). The total charges were based on the number of recurrences detected per stage. Recurrences were detected in 1.5% of patients with stage I, 18.0% in stage II, and 68.6% in stage III. Physical examination was the most effective method, detecting 50.0% of recurrences. Lymph node sonography was effective in stage II–III, detecting 13.2% of recurrences; CR and abdominal sonography, detecting 4.5 and 3.4% of recurrences, were deemed beneficial in stage III. Blood tests detected 1.4% of recurrences and were deemed to be ineffective. Computed tomography scans were valuable in clarifying ambiguous findings and helping to detect 22.5% of recurrences (1.9% in stage I, 1.9% in stage II, and 18.6% in stage III). A risk-adapted surveillance strategy for stage I–II including thorough history, physical examination and lymph node sonography but omitting CR, blood work and abdomen sonography, seems appropriate and cost effective.
At present, the follow-up recommendations for the surveillance of patients with cutaneous melanoma (CM), with the aim of detecting recurrent disease, varies from country to country. This is, in part, on account of differences in the opinions of international experts and, in part, on account of the prevailing medical and legal atmosphere of the country. Various surveillance strategies, some associated with significant cost and others with uncertain value, are routinely used. Statistics reveal that up to 30% of patients with stage I or II melanoma and over 60% of patients with stage III melanoma will ultimately develop metastatic disease [1]. Efficient and cost-effective surveillance strategies, dependent on tumor stage, are required. On the basis of the results of several retrospective and one prospective study [2,3], German guidelines recommend physical examinations, blood tests (full and differential blood count, serum analysis including alkaline phosphatase and lactate dehydrogenase), abdomen sonography, chest radiograph (CR) and sonography of the regional lymph nodes on all melanoma patients every 3–12 months [3]. Additional imaging studies such as computed tomography (CT) scans, MRI scans, bone scintigraphy, and PET scans are obtained only in cases with a suspicion of tumor progression on the basis of the aforementioned tests [1,3–5]. The practice of surveillance and follow-up in melanoma was studied by Bart et al. [6,7] in the late 1990s and similar procedures have been described to be performedin Germany for follow-up of melanoma patients. Furthermore, Sober et al. [8] recommended in the guidelines of primary melanoma that the follow-up one–four times per year, dependent on the tumor thickness of the lesion and other risk factors for 2 years after diagnosis and once or twice per year thereafter, should be performed based on suspicious findings, imaging studies, and blood tests. Thus, there are undoubtedly clear similarities in follow-up procedures, blood examination, and imaging examinations between Germany and the United States.
So far, only a few retrospective studies have addressed the effectiveness of physical, laboratory, and imaging examinations, and even fewer studies have evaluated the costs incurred for the follow-up of melanoma patients [9–11]. However, what is clear is that most recurrences are not detected solely because of findings in laboratory or imaging studies. In fact, approximately 44–56% of recurrences are detected by physician-directed surveillance examinations or by patient's self-examination [12,13]. A retrospective study from Germany revealed that history and physical examination led to the detection of first or second recurrences in 47 and 52%, respectively. This study also stated that routine lymph node sonography of the regional nodal basins consumed 24% of the total follow-up healthcare costs for stage I–II patients but that, in return, it was able to detect 13% of first relapses, which were not detectable through physical examination alone [10].
Our earlier report evaluated the outcome of a specific surveillance strategy and reported that physical examination discovered 50% of all recurrences in stage I–III (American Joint Committee on Cancer 2002). Of interest was the fact that in stage I–II, 21% of all recurrences were discovered solely by lymph node sonography. Very few metastases were detected by CR (0.6%), abdomen sonography (0.8%), and blood tests (0.07%) [5]. Herein, by using data obtained from the same patient cohort [5], we aimed to evaluate the costs incurred from follow-up examinations performed on melanoma stage I–III patients. Monitory charges for the detection of metastasis per stage and examination method and costs incurred for clarifying suspicious findings were calculated, and, for comparison, given for the US system. Total costs for a 5-year surveillance were determined on the basis of the risk-adapted surveillance schedule reported earlier [5].
This monocenter study used a prospective design to investigate the effectiveness of a specific follow-up strategy for detecting recurrence [5] and calculated the approximate medical costs incurred during a 2-year follow-up period. One thousand nine hundred and sixty-nine patients with stage I–III CM were included in the study. A detailed description of this cohort has been published earlier [5]. The surveillance was performed in the Department of Dermatology, University of Tuebingen according to the guidelines of the German Society of Dermatology [3,5]. Informed consent was obtained from all patients. Tumor characteristics and case histories were recorded in a standardized manner and patients were restaged retrospectively at the time of diagnosis according to the American Joint Committee on Cancer 2002 staging system [14]. All patients underwent an excision of the primary tumor with safety margins depending on tumor thickness. Sentinel lymph node biopsies (SLNB) were routinely performed in CM greater than 1.0 mm tumor thickness since 1996. Stage III patients were tumor free at the time of study inclusion [5]. In this study, a total of 108 patients underwent SLNB (5.5%): of these, 11 (0.6%) showed a positive sentinel lymph node and underwent elective lymph node dissection (ELND) and 129 patients had primarily an ELND (6.5%). Of the 27 patients with nodal recurrences of the regional lymph nodes detected by lymph node ultrasound, 15 had SLNB or primary ELND at primary diagnosis with positive results in six patients.
Follow-up examinations were performed three times a month for 1–5 years after resection of the primary tumor and continued six times a month until the 10th postoperative year. Physical examinations were performed four times a year in all stages: abdomen sonography and CR once a year in stage I–II and twice a year in stage III. Blood tests (full and differential blood count and serum analysis including alkaline phosphatase and lactate dehydrogenase) were obtained annually for patients with stage I–II and biannually for those with stage III disease. Lymph node sonography of the regional lymph nodes was performed once a year in stage I, twice a year in stage II, and 3–6 times a month in stage III. CT and MRI scanning, bone scintigraphy, skeletal radiographs, and PET scans were obtained only to clarify ambiguous findings noted from aforementioned tests.
Prospective data documentation was carried out as described earlier [5]. Data evaluation was performed by using the statistical package SPSS 13.0 for Windows (SPSS-Inc., Headquarters, Chicago, USA). The results of all examinations (true positives, true negatives, false positives, and false negatives) were also documented. All subsequent imaging examinations performed to clarify suspicious findings were considered. A suspicion of metastases was classified as a false-positive finding, when the suspicion of metastases was not confirmed by further investigations. Further investigations were additional imaging examinations [magnetic resonance tomography (MRT) or CT scans] or subsequent follow-up examinations.
The calculation of costs was based on the 2004 official scale of medical reimbursement charges in Germany (Gebührenordnung für Ärzte, GOÄ). The corresponding American costs were estimated on the basis of the 2004 Medicare fee reimbursement schedule by using a quantity and price approach (Table 1). Thus, a comparison of costs incurred in the US and in Europe is possible.
The cost accrued to detect one recurrence per stage combined with the 95% confidence intervals were calculated. The total costs for examinations performed in stage I–III and the costs for each examination method were evaluated. The number of examinations required to detect a single recurrence was also determined.
Between 1996 and 1998, a total of 3651 physical examinations, 8753 imaging studies (technical), and 2872 blood tests were performed in 1969 patients. Of these patients, 1554 (78.9%) were classified as stage I, 205 as stage II (10.4%), and 210 as stage III (10.6%). During this surveillance period, 204 recurrences were discovered in 112 patients. The recurrence rates were 1.5% in stage I, 18.0% in stage II, and 68.6% in stage III. Most of the recurrences were detected by physical examination (N=101, 50.0%) and lymph node sonography (N=27, 13.2%), whereas the recurrence rates were much lower for CR (N=10, 4.5%), abdomen sonography (N=7, 3.4%) and blood tests (N=3, 1.5%). In 29.5% (N=33) of patients, the patient's history was suspicious for recurrences [stage I (N=6, stage II (N=8), stage III (N=19)], which was confirmed by physical examination in all cases. Recurrences detected in patients following the examination guidelines for stage I–III are shown in Table 2. One hundred and ninety-two false-positive results led to further imaging examinations.
Costs were calculated for all tests routinely obtained for patients in stage I–III (Table 2). Total costs for routine melanoma follow-up during this 2-year period accounted for 236.30€ per patient. In the USA, in contrast, where patients are customarily evaluated by a radiologist who performs and interprets the sonography examinations and where the patient is billed separately by both the primary treating physician and the radiologist, the costs would be much higher (757.60$).
Follow-up examinations in stage I showed the highest costs in total (307 914€/887 261$), in stage II total costs were 62 673€/252 292$ and in stage III total costs accounted for (89 651€/352 214$) (Table 3).
Physical examination was the most efficient diagnostic test to detect metastases in routine follow-up (Tables 2 and 3). Between laboratory and imaging examinations, lymph node sonography was the most successful method to detect metastases. In stage I patients, costs for the detection of one recurrence were the highest (4289€/4391$ for physical examination and 18 035€/131 423$ for lymph node sonography). Costs decreased in stage II to 500€/512$ for physical examination and to 1333€/9712$ for lymph node sonography, in stage III to 168€/171$ and to 1250€ /9112$, respectively.
CR generated the highest costs in stage I to detect one recurrence (22 886€/20 512$) according to German revenues. For the US system, lymph node sonography generated more costs because of the reasons mentioned above. No metastases could be detected by abdomen sonography and blood tests in stage I disease and accounted for a total cost of 46 108€/182 076$ and 83 732€/99 127$, respectively. In stage II, 0.4% of CR examinations were positive for metastasis (6453€/5783$). No metastases were found on abdomen sonography, generating costs of 6151€/24 290$. In stage III, 2.2% of CR examinations and 2.1% of abdomen sonography examinations led to the detection of metastases, with costs of 1199€/1075$ and 1238€ /4887$, respectively. In stage II and III, the metastasis detection rate through blood tests was 0.3 and 0.4% (Table 2) and accounted for 15 728€/18 620$ and 19 412€/22 981$ per metastases, respectively, Table 3.
Physical examinations and lymph node sonography showed the highest recurrence detection rates in all stages, whereas CR and abdomen sonography showed a detection rate of more than 2% only in stage III. Blood tests generated the highest costs for the detection of metastasis and were not effective in any of the stages.
In cases of suspected visceral metastases, CT scans were performed to confirm the diagnosis of metastases. CT scans are separately counted for the different body regions and therefore a whole-body CT screening consists of five separate CT scans (head, neck, chest, abdomen, and pelvis). Thus, a number of CT scans had to be performed to clarify false-positive findings, 640 CTs in 192 patients, further 57 MRT scans, 19 PET scans, and 23 bone scintigraphy (Table 2). In addition, in a subgroup of patients, only ultrasound controls were performed during the follow-up. Costs generated to clarify suspicious findings amounted to a total of 41 007€ /306 557$ for CT scans and 27 514€/50 518$ for others (MRT, PET, bone scintigraphy). Twenty-four false-positive findings were made through physical examinations and were succeeded by an average cost of 2721.6€/16104$. Fifty-two false-positive diagnoses resulted from lymph node ultrasound and subsequent examination cost on average 4742.7€/41079$. Ninety-one ambiguous findings resulted from elevated blood levels of alkaloid phosphatate and lactate dehydogenase and resulted in average costs of follow-up examinations of 2129.6€ /15160.7$. Costs per recurrences detected were highest in stage I (3993€/24 743$ for CT and 5377€/9651$ for others) and decreased in stage II (2478€/20 825$ for CT, 2354€/4656$ for others) and stage III (398€/3297$ for CT, 1940€/3484$ for others), Table 3.
False-positive results accounted for 1.25% (192 of 15 276) of all examinations, of these 87 of 10 526 (0.8%) in stage I, 39 of 2038 (1.9%) in stage II, and 66 of 2712 (2.4%) in stage III. Blood tests showed the highest rate of false positives (3.1%) in stage I and II (3.9%), with a decrease in stage III (2.9%). Lymph node sonography showed the highest number of false-positive results of routine imaging techniques (1.6%), especially in stage III (4.2%), Table 2.
The follow-up schedule performed in Tuebingen from 1996 to 1998 provided the basis for the calculation for a 5-year surveillance program. Total costs amounted to 990.8€/2208$ per patient in stage I and up to 1841€/4009$ per patient in stage III, Table 4.
On the basis of this study and our earlier published study [4], we recommend a risk-adapted follow-up schedule (Table 4). On the basis of this schedule, the 5-year surveillance costs could be reduced to 198€/203$ for stage I patients, remain similar in stage II 1329€/2518$ and increase to 2775€/6361$ in stage III on account of intensified examinations and blood tests, including the tumor marker S100β. The total costs during the 5-year follow-up for the entire patient population in this study (planned examinations) would decrease from 2 155 813€/4 917 216$ (old schedule) to 1 163 340€/2 167 286$ (new schedule).
No consensus exists regarding the most appropriate frequency of follow-up examinations in patients diagnosed with melanoma. Furthermore, the frequency of obtaining laboratory and imaging examinations in melanoma patients is even more controversial [4,13]. In many cancers, other than melanoma, researchers have created numerous models designed to estimate the costs and cost effectiveness of cancer care treatments and follow-up [15–19]. Only a few have evaluated the economic impact of melanoma [4,9,20,21]. Currently, many laboratory and imaging studies, some of which are quite expensive, are routinely performed in the surveillance of melanoma patients. The effectiveness of the surveillance methods in melanoma is still unproven; therefore real cost-effectiveness analyses cannot yet be performed [22].
In many studies, cost effectiveness is calculated in relation to life years saved by the respective diagnostic or therapeutic strategies. Until now, we do not have a clear knowledge of the number of life years gained by follow-up examinations and the early detection of recurrences in melanoma. Therefore, this study focuses on the total costs, on the relationship between costs of examinations performed and the number of recurrences detected during follow-up of stage I–III melanoma patients.
The costs for the detection of one recurrence were found to be extremely high in stage I, accounting for 13 388€/38 574$. Compared with the high number of examinations, only a few recurrences were detected (Table 2). Physical examinations showed the highest detection rate for recurrences in stage I–III disease, ranging from 0.5 to 11.8%, respectively. Lymph node sonography proved to be the most effective screening examination in stage II and III disease. CR and abdomen sonography were inefficient in detecting recurrences in stage I and II, but may be of benefit in stage III disease (Table 2). Blood tests were ineffective in detecting recurrences in stage I–III, generating the highest costs and showing the lowest detection rate for recurrences (0.4% and lower). Blood tests are not routinely performed during follow-up in many US centers [21]. However, as the analysis of the tumor marker S100β was not routinely performed during the study period, it was not included in this evaluation. The value and significance of S100β were, however, considered separately in a cohort of 500 patients [23]. The diagnostic utility of S100β as a tumor marker has been reported as being at most useful in stage II and III patients [23,23–27].
Similar results were reported by Basseres et al. [9] in an evaluation of follow-up examinations of 528 stage I/II patients. Ninety-five percent of surgically removable metastases were detected by physical examination and thus the clinical examination was deemed to be most cost-effective. Blood tests were described as inefficient methods for detecting subclinical metastatic disease. Physical examinations had the lowest costs associated with the detection of metastasis, whereas the costs were 10-fold higher for CR and 20-fold higher for abdomen sonography. The authors opinion was that abdomen sonography and CR should be used routinely only in patients at high risk for recurrence (tumor thickness of more than 1.5 mm) [9]. The high cost–benefit ratio of physical examinations compared with technical examinations in stage I/II patients has also been reported in other studies [2,10,28,29].
In this analysis, the overall rate of false-positive results was 1.25%; of these 126 of 12 564 (1.0%) in stage I and II and 66 of 2712 (2.4%) in stage III. Lymph node sonography showed the highest number of false-positive results (1.6%), followed by physical examination (0.66%).
A few studies have been published examining the costs associated with a false-positive result or indeterminate findings. High numbers of false-positive results were found in the follow-up examinations in stage I–II disease (4.1%), and 4.9% false-positive results in stage III, which led to further technical examinations [10]. Lymph node sonography had the highest false-positive rate for all stages, followed by physical examination and abdomen sonography [10]. However, lymph node sonography revealed the highest sensitivity (85.7%) in routine follow-up examinations, followed by physical examination (68.4%) [30]. Thus, many of the true positive lymph node metastases were detected early [5], allowing early surgical intervention [14]. Blood tests revealed a high number of false-positive values (3.7%) and had a low sensitivity (11.2%) [30].
Mooney et al. [28] showed that the costs for the evaluation of false-positive results reached 30% of the total screening costs by CR and were regarded as ineffective in stage I and pT2 tumors. Imaging techniques such as CT scan, MRT and bone scintigraphy became more cost-effective and of increased medical importance in stage II and III disease [28]. As CT scans and other imaging techniques (MRT, PET) showed the highest rates of detecting recurrences of all imaging techniques, these examinations should be performed in patients suspected of having recurrences. Concordant to these results, Brady et al. [31] showed CT and PET scans to be the most appropriate form of management in the screening for occult metastatic disease in high-risk melanoma patients, and discussed whether PET scans should be the standard of care in the preoperative evaluation of patients. However, these examination techniques are expensive and are not suitable for routine follow-up.
A calculation of a risk-adapted 5-year follow-up program revealed a possible reduction of costs in stage I, similar costs in stage II, and an increase in stage III (Table 4). As the majority of melanoma patients are diagnosed with early-stage disease, it is reasonable to assume that the savings in the follow-up of stage I and II patients would be substantial if we adhered to the findings of this study. As CR and abdomen sonography were not routinely performed in stage I–II and lymph node sonography was only performed in stage II, the total follow-up costs could be reduced from 990.80€ for a 5-year period to 198.20€ for stage I, Table 4. As 70.6% of all recurrences were detected in stage III, the costs of detecting one recurrence with an intensified follow-up schedule including physical examinations, lymph node ultrasound, and blood tests performed four times a year and CR and abdomen ultrasound obtained twice a year may be reasonable in this stage. A similar analysis was performed by Hengge et al. [32] for a cohort of 526 stage I–III melanoma patients. Savings of more than 100 000 EUR annually would be obtained when a reduced-yet-adequate follow-up scheme eliminating blood tests at early stages and reducing CRs and abdomen ultrasound examinations was to be implemented.
Blood tests were not found to be cost effective at all because they did not contain the determination of the tumor marker S100β. The analysis of S100β showed the highest sensitivity and specificity of all tumor markers examined in melanoma [23,25]. Therefore, the determination of S100β has now been included into the new follow-up recommendations at Tuebingen and is performed twice yearly in stage II and four times yearly in stage III.
A risk-adapted, less-frequent follow-up schedule has been proposed earlier [10,28,32]. The frequency of CR was reduced to twice yearly without any changes in the sensitivity or specificity of the screening regimen, although no stage-dependent analysis was included [28]. Hofmann recommended only physical examinations once to twice a year in stage I–II and four times a year in stage III, and lymph node sonography once to twice a year as adequate surveillance methods [10]. Further technical examination methods were reported to be cost ineffective and were not included in the follow-up recommendations. A risk-adapted follow-up schedule was proposed based on the premise of not lowering the quality of medical care but still achieving significant savings [5].
Regarding the costs for the follow-up examinations as a function of the number of detected recurrences, physical examination was the most effective method in routine follow-up. Lymph node sonography was a reasonably effective method in detecting recurrences in stage II and III, and CR and abdomen sonography were effective only in stage III disease. As CT scans and other imaging techniques (MRT, PET) showed the highest rates to detect recurrences of all imaging techniques, these examinations should be performed in patients suspected of having recurrences.
A risk-adapted surveillance schedule with reduced imaging and laboratory examinations performed in stage I/II and a more intensified schedule in stage III seems a reasonable strategy in the follow-up of melanoma patients. Significant reductions in costs, without compromising excellent patient care, can be achieved if the results of this study are considered when planning melanoma follow-up guidelines.
Supported by grant no. M3/95/Ga I from the Deutsche Krebshilfe, 53111 Bonn, Germany
This article has been cited 6 time(s).
costs; follow-up schedule; melanoma; recurrences
© 2009 Lippincott Williams & Wilkins, Inc.
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2014-15 Student Elections
Welcome to the Student Elections Website where you can view the election and nomination schedules, preview ballots, cast your votes and view election results. Check back here for updates on not only SGA
general elections, but also Freshmen and Homecoming election details!
Fall SGA elections will begin at 12:01 AM on Semtember 4th, and end at 11:59 PM on September 6th. Note: Only Freshmen are eligible to vote in the Fall Elections.
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- Maxwell began working with songwriter Leon Ware and noted guitarist Wah Wah Watson to record his debut Maxwell's Urban Hang Suite in the early 1990s. When the album was finished Columbia had doubts about its potential and shelved it for two years. The album was finally issued in 1996.
- Heavily inspired by the sound of classic soul music, Maxwell's Urban Hang Suite did not catch on with audiences until the release of its second single, "Ascension (Don't Ever Wonder)", which became a hit. Maxwell's Urban Hang Suite sold over 2,000,000 copies, earning 2X platinum status, and was nominated for a Grammy Award.
- On June 15, 1997, Maxwell taped an episode of the MTV concert series MTV Unplugged in New York City, performing his own songs as well as covers of songs by Kate Bush ("This Woman's Work) and Nine Inch Nails ("Closer")]. Maxwell clashed with his label about the release of an album of his unplugged session, so only an EP containing seven songs was released for sale.
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US 20010029364 A1 Abstract Method and apparatus to cause the cessation of hair growth on a specific area of the body and for the treatment of unwanted dermatological conditions. The area of treatment is exposed to a particular pattern and wavelength of light generated by multiple flashlamps, which allow simultaneous, overlap, or consecutive firing. Controlling the intensity of light, the output wavelength and the delay between pulses allow treatment to be adjusted to different skin conditions and hair types. Skin damage is virtually eliminated by the length and characteristic shape of the individual pulse of light.
Claims(15) 1. A method for treating a dermatological condition comprising the steps of:
(a) generating a light that has a specific wavelength output and intensity; (b) filtering said light through a light filter to eliminate unwanted segments of said light; (c) placing a hollow reflective light guide against a skin section forming an optical seal to contain said light; and (d) illuminating said skin section by directing said light through said filter through said hollow light guide; 2. The method of
claim 1 3. The method of
claim 1 4. The method of
claim 1 5. The method of
claim 2 6. The method of
claim 5 7. The method of
claim 5 8. The method of
claim 1 a power source; a plurality of flashlamps; a water cooling system; a control source for firing said flashlamps. 9. The method as described in
claim 8 10. The method of
claim 1 11. The method of
claim 1 12. The method of
claim 1 13. The method of
claim 8 14. The method of
claim 8 15. An apparatus for treating a dermatological condition comprising:
a water cooled delivery head; a plurality of flashlamps contained within said delivery head wherein said flashlamps produce a desired light output; an individual energy source connected to said flashlamps; a control mechanism connected to said individual energy source wherein said control mechanism allows simultaneous, overlapping and consecutive firing of the said flashlamps; a light filter positioned beneath said delivery head wherein said light filter eliminates specific wavelengths of light; and a hollow reflective light guide directing said light to a treatment area. Description [0001] This patent application claims priority from and is a continuation-in-part of U.S. patent application Ser. No. 09/173,422 filed Oct. 15, 1998 which is incorporated herein by reference in its entirety. [0002] This disclosure relates to a painless method and related devices for causing temporary and/or permanent cessation of hair growth using flashlamps. Unwanted hair is an extremely common problem which can be caused by many reasons. There are many products and methods for temporarily and permanently removing hair. The methods can be very temporary such as in waxing, shaving, plucking and depilatory creams. These methods, however temporary, are very popular due to cost, quickness and/or absence of pain involved in the procedure. Electrolysis has been proven to be extremely slow and painful but is popular because of the claimed permanency and economical cost. Laser methods such as those described in U.S. Pat. No. 5,226,907 which uses a light absorbing cream in contact with the hair to create heat and destroy the hair have been shown to be painful and mostly temporary. Other laser treatments such as those stated in U.S. Pat. No. 5,595,568 use laser generated optical pulses directed through a transparent contact device which are absorbed by melanin in the hair follicle which consequently heats the follicle and permanently removes it. This method is effective but can be very painful since the high temperature necessary to destroy the hair follicle also destroys some surrounding tissue and skin which can result in hyper-pigmentation, blistering and possible scarring. [0003] The present disclosure provides a method in which the unwanted hair growth can be removed without damage to the skin. One embodiment of the present disclosure is a method to cause cessation of hair growth of multiple hair follicles from a selected area of the skin in an efficient and painless manner. According to the disclosure, the method of hair removal consists of delivering a specific pattern of non-laser generated multiple light wavelengths which pass through the skin and into the hair and its components. The absorption of these various wavelengths results in thermal and photochemical damage to the hair and its components during the hair's Anagen phase which causes the primary effect of cessation of hair growth. While some treated areas will regenerate some regrowth, additional treatments will alleviate this residual hair growth. The multiple wavelengths that are utilized in this treatment occur at different intensities throughout the wavelength spectrum of 610 nm to 100 nm to produce a pattern that achieves optimal depth penetration. The multiple wavelength spectrum is produced by four flashlamps consisting of a specific mixture of krypton and xenon gas encased by a cerium doped synthetically fused quartz envelope. The four flashlamps are connected to separate user intensity controlled power supplies which are specifically designed to produce an 18 ms pulse duration with a specific pulse discharge pattern to accommodate different size hair follicles. Electrical supply energies of 160-400 joules are input to the flashlamps per cm2 of output. Each flashlamp can be fired simultaneously with an overlap or with a time duration of up to 40 ms between each pulse. The four flashlamps form a pulse train of four individual pulses which results in a treatment shot. Each treatment shot is separated by approximately 3 second intervals to allow the user to move the delivery system to another area of the body for subsequent treatment. The pulse length and characteristic shape of each individual pulse is designed to distribute the energy over a period of time that virtually eliminates damage to the skin which can occur in prior methods. This method also allows adjustment to the intensity of the light source and delay between each individual pulse. The ability to adjust the intensity and delay of the light source allows the user to adjust the treatment shot to accommodate different skin and hair types. The flashlamps utilized in the present disclosure are housed in a copper/zinc head which is connected to a hollow internally reflective rectangular light guide by means of a 610 nm high pass filter. The rim of the light guide is pressed against the skin so as to form an optical seal. The non-collimated light, consisting of wavelengths greater than 610 nm, passes through the 610 nm high pass filter and reflects at infinite angles down the hollow light guide into the skin reaching the hair and its components. [0004] In an alternative embodiment of the disclosure, modification to the output wavelength pattern of the apparatus, by the use of a different light filter, allows the apparatus to be effective in destroying small blood vessels and melanin based pigmented lesions. Additionally, the altered output wavelength and the resulting use of the apparatus in destroying pigmented lesions further allow the apparatus to be utilized in skin smoothing, wrinkle smoothing and the rejuvenation of skin due to an increase in collagen after treatment. [0005] The foregoing and other features and advantages of the present disclosure will be more fully understood from the following detailed description of illustrative embodiments, taken in conjunction with the accompanying drawings in which: [0006]FIG. 1 is a cross sectional view of a delivery head of a device, in accordance with the principles of the present disclosure and a block diagram of the power supplies and controlling electronics which control the lamps in the delivery head; [0007]FIG. 2 is a cross sectional view of a hollow reflective light guide which guides photons to a target area of the skin; [0008]FIG. 3A is a graph showing a manipulated pulse geometry; [0009]FIG. 3B is a schematic showing basic circuit components to adjust pulse geometry; [0010]FIG. 3C is a graph showing the quad pulse train of each treatment shot and the controlled delay between each pulse; [0011]FIG. 3D is a graph showing the quad pulse train of each treatment shot with a negative delay that signifies overlap; [0012]FIG. 4A is a graph showing a pattern of wavelengths generated; [0013]FIG. 4B is a graph representing the depth penetration of light with respect to wavelength; [0014]FIGS. 5A, 5B, 5C shows the cross sectional view of the different growth stages of a hair and its components; [0015]FIG. 5D shows a cross-sectional view of a hair and its components; [0016]FIG. 6A is a graph showing a wavelength output between 530 nm to 610 nm; [0017]FIG. 6B is a graph showing the relationship of melanin adsorption in relationship to wavelength output; and [0018]FIG. 6C is a graph showing the relationship between hemoglobin adsorption in relationship to wavelength output. [0019] The exemplary embodiments and examples of use and operations disclosed are discussed in terms of a multi-pulse photo medical device, and more particularly, in terms of the use of various wavelengths of light that can be used in the removal of unwanted dermatological conditions. It is contemplated that the present disclosure finds applications to a wide variety of dermatological conditions including the removal of unwanted hair and skin lesions that are caused by the overabundance of small blood vessels. The device also finds use in the rejuvenation of skin by smoothing the skin and removing wrinkles that are associated with natural aging. [0020] The following discussion includes a description of the various wavelengths of light and the intensity and duration of use which allows for the selective destruction of unwanted components of the skin surface. Reference will be now be made in detail to the exemplary embodiments of the disclosure, which are illustrated herein. [0021] Referring in detail to the drawings, a flashlamp apparatus generally identified by numeral 7, according to the present disclosure is shown in FIG. 1. Flashlamp apparatus 7 consists of a water-cooled delivery head 10 containing multiple flashlamps 1 each having an individual power source capable of timed firing 20 which causes cessation of the hair growth on the body. The multiple flashlamps 1 each contain a combination of approximately 90% krypton gas and 10% xenon gas. When charged, the combination of the krypton and xenon gases emit a specific pattern of wavelengths, which are shown in FIG. 4A. The container material of the flashlamps 1 is comprised of synthetic quartz to eliminate impurities. The use of synthetic quartz prevents the degradation of the flashlamps 1 after prolonged use. Additionally, the synthetic quartz is doped with cerium in order to block diffusion of ultraviolet light under 400 nm from the lamp and thereby maintaining the integrity of a reflective chamber 5 and a 610 nm high pass filter 9. The cerium doping also has the ability to convert ultraviolet light, which would normally become waste heat, into higher wavelengths which can pass through the high pass filter 9 to create a more efficient conversion of electrical energy to light output. [0022] The reflective chamber 5 is made of a metallic material whose reflectivity coincides with the desired output of wavelengths greater than 610 nm. In one embodiment of the disclosure copper is used to construct the reflective chamber 5 as copper reflects over 95% of light at 620 nm and higher wavelengths while reflecting approximately 60% of light at lower wavelengths. Since the desired wavelength output is greater than 610 nm, this reflectivity of copper partially absorbs the lower wavelengths in the reflective chamber 5 so the high pass filter 9 does not bear the full absorption of the lower wavelengths which would result in damage to the high pass filter 9. Other reflective materials that are well known in the art can be used to construct the reflective chamber 5 these materials include but are not limited to gold, brass and ceramic. The delivery head 10 is cooled by water which flows in through an inlet port 2 and fills a first chamber 6, the water then flows over the flashlamps 1 into the reflective chamber 5 and then into a second chamber 11 and out an outlet port 3. The water, which flows through the delivery head 10, is recycled in a closed cooling system having a radiator and fan assembly, which uses room air as the heat exchange. The cooling system should maintain water temperatures surrounding the flashlamps 1 below a maximum continuous operating temperature of 100 degrees Celsius. Since the electrodes of flashlamps 1 create the greatest heat, chambers 6 and 11 allow a greater volume of water and thus thermal exchange over these areas. An optically transparent epoxy coating 8 is used to coat the metallic reflector to prevent oxidation and degradation from the water cooling which flows through the delivery head 10. [0023] The commercially available high pass filter 9 transmits only wavelengths above 610 nm. Any lower wavelengths below 610 nm, that are produced, are absorbed and converted to heat. The cooling water in the reflective chamber 5 is also in contact with high pass filter 9 to extract heat due to the lower wavelength absorption. The high pass filter 9 only allows wavelengths above 610 nm to enter into a hollow reflective light guide 4. The hollow reflective lightguide 4 will be discussed in more detail in FIG. 2. [0024] A power source and firing apparatus 20 are connected to the delivery head 10. The flashlamps 1 are connected to a control switch 25. Each flashlamp 1 is connected to its own power supply 17. Each power supply 17 supplies approximately 40 to 100 joules of electrical energy to each flashlamp 1 of every cm2 of output. A firing sequence control 19 is used to activate a trigger 16 for each flashlamp 1 in a simultaneous or consecutive order. An output intensity control 24 regulates the electrical energy of the individual power supplies 17, which discharge through the flashlamps 1. The firing sequence control 19 regulates the amount of time it takes for the output energy of one treatment shot to be dispersed while the output intensity control 24 regulates the amount of energy delivered. [0025] Referring to FIG. 2, a cross sectional view of the hollow reflective light guide 4 is shown. The light source from the flashlamps 26 passes through the flashlamp cooling water 29 and is represented here by individual photons 27, 28. Since the light source 26 is non-laser, and radially emitted, the photons 27, 28 are reflected from the reflective chamber 38 and exit through the 610 nm high pass filter 30 (assuming the wavelength is higher than 610 nm), at multiple angles 35 down the reflective light guide 36 and into the skin at multiple angles 34 reaching the hair and its components 36 after scattering through the skin 33. The hollow reflective light guide 36, which is made of a metallic or ceramic highly reflective material for wavelengths above 610 nm, is coated with an optically transparent epoxy 31 to prevent oxidation and damage to the reflective material. The reflective light guide 36 is pressed against the skin 32 so as to form an optical seal so no light can escape outside the light guide. This optical seal ensures all energy is transmitted through the skin and into the hair and its components. The hair is trimmed or shaved prior to treatment so as to have no hair above the outer layer of skin that would absorb the light and block its transmission into the skin. [0026] Turning now to FIG. 3A, a graphic representation of the pulse geometry and the pulse train sequence of one embodiment of the instant disclosure is shown. FIG. 3A shows the formula for damping factors 40 that create various pulse geometries shown in the graph 41. The desired pulse geometry that provides the most efficacious results for cessation of hair growth is damping factor of three (3), which provides an elongated pulse 42. This pulse geometry is desirable in that it takes advantage of the difference in thermal relaxation times of hair and skin. Thermal relaxation time is the time it takes for a body of particular size, shape, and material to dissipate 50% of its heat energy. The physical law is represented by equation 46 where d is the diameter of the body, g is the geometric factor, and k is the thermal diffusivity factor of the material. One reason for using this specific pulse geometry as depicted in FIG. 3a, is that it spreads the energy more evenly throughout the pulse length T 43 which is approximately 18 ms for the device. Since the thermal relaxation time of skin is approximately 10 ms, having the pulse duration over 10 ms prevents damage to the skin by allowing the skin to dissipate the energy and thus avoiding damaging high temperatures. An additional advantage of this pulse geometry is to take advantage of the thermal relaxation time of hair follicles. Since hair follicle sizes vary in any particular area of the body, so do their corresponding thermal relaxation times. The optimum pulse duration and geometry would be one that can be effective on the broad sizes of hair follicles while sparing damage to the surrounding tissue. The average size hair follicles vary in thermal relaxation times from 20 ms to 100 ms. By using this specific pulse geometry, optimum damage is confined to the hair follicle for large and small hair follicles. Small follicles having a thermal relaxation time of 20 ms would dissipate the heat into the surrounding tissue rapidly resulting in a lower peak temperature in the hair follicle and creating high temperatures in the tissue. By using this specific pulse geometry 42, greater then 70% of the energy is delivered in the first half of the pulse T1 44 while the remaining energy is dispersed in the second half of the pulse T2 45. This still allows adequate cooling time for the skin but now creates higher temperatures in the small hair follicles since most of the energy is delivered in a short amount of time not allowing the follicle time to disperse the energy to the surrounding tissue. Large hair follicles having higher thermal relaxation times up to 100 ms are also effected since even more time is required to disperse the energy. [0027] Referring to FIG. 3B, a schematic of the flashlamp circuit 55 necessary to accomplish this pulse geometry is shown. A voltage supply 50 charges a capacitor 51. When a trigger voltage 54 is applied to the flashlamp 53 it ionizes allowing the power from the capacitor 51 to pass through a inductor 52 and into the flashlamp 53 which has a certain resistance known as Ko. The values of the components in the circuit 55 must provide a damping factor of three (3) when inserted into formula 40 and also provide a pulse duration T, as shown in FIG. 3A, 43 of 18 ms. [0028] Referring to FIG. 3C, a treatment shot from the apparatus, when the treatment shot is set for consecutive firing with delays between each pulse, is shown. The treatment shot consists of a four-pulse sequence train with a time delay between each pulse 64. A single pulse 63 is fired from the apparatus with a time delay of T 60 before the next consecutive pulse in the four-pulse train is triggered. If T 60 is greater than the single pulse duration (SPD) 65, which is approximately 18 ms, then a delay D 61 is created between each pulse. This delay 61 between each pulse allows the skin to cool before then next consecutive pulse is triggered. The total time it takes the apparatus to deliver the energy is T 62 which is the combination on all the delays 61 and all the SPDs 64. This time T 62 is the duration of the treatment shot. Each treatment shot is separated by approximately three-second interval to allow the user to move the delivery head to the next consecutive are for treatment. [0029] Referring to FIG. 3D, a treatment shot from the apparatus when the treatment shot is set for overlap firing is shown. The treatment shot consists of an overlap of single pulses in the four-pulse train 70. Since the flashlamps are connected to separate power supplies, the apparatus is capable of overlapping pulses. If a single pulse is fired from the apparatus 75 with a consecutive triggering time delay T 71 which is shorter than the SPD 74, then a negative delay (−) D 72 is created which represents an overlap of the consecutive pulses. This overlap transforms the four single pulses into a single sawtooth appearing pulse 76 of duration T 73. This single sawtooth pulse 76 allows more energy in a shorter amount of time T 73 than a single lamp system incapable of overlap. This higher energy in a shorter amount of time allows for more treatment options. [0030] Referring now to FIGS. 4A and 4B, the spectral output patterns and depth penetration of the light generated by the apparatus respectively, are shown. FIG. 4A refers to a graph of the output intensity 80 of the different wavelengths 81 generated by the apparatus. The majority of the light output is in the 725 nm to 925 nm wavelengths 86 as depicted on the graph as the three peaks. [0031] Referring to FIG. 4B which graphically depicts the penetration depth 90 of light versus its wavelength 92. Since hair follicles and its components are located deep in the dermis, depth penetration of the incident light is very important. The output of the flashlamps, are designed to generate a large amount of deep penetrating wavelengths. The peak output wavelengths 95 of the flashlamps exhibit very good depth penetration allowing the incident light to reach the target hair and its components. [0032] Referring to FIGS. 5A, 5B, 5C and 5D, which show the three stages of hair growth and its components. All hair goes through a three-stage cycle. FIG. 5A shows the growth stage (Anagen phase) of hair and its components. This Anagen phase is when the hair is actively growing. FIG. 5B is the transition phase (Catagen phase) when growth slows down. FIG. 5C shows the resting stage (Telogen phase) when the hair and its components are no longer active and growing. The apparatus of the present disclosure is most effective during the Anagen phase. It is believed that the absorption of light is greater at this time due to the enlargement of hair components. It has been found that the apparatus of the present disclosure has a greater effectiveness on hair during its Anagen phase and treatment during this phase will cause cessation of hair growth. It is contemplated that the apparatus is also effective during the other phases. [0033] Referring to FIG. 5D which also shows hair and its components. The light output of the apparatus 104 is represented here by individual photons 105-110. These photons 105-110 penetrate through the skin and into the hair and its various components. The result of this photon absorption causes both thermal and photochemical damage to the hair and its components resulting in cessation of hair growth. [0034] Referring to FIGS. 6A, 6B and 6C, an alternative embodiment of the present disclosure is shown. This alternative illustrative embodiment depicts how the apparatus can be easily modified to change the output wavelength pattern making the apparatus effective in destroying small blood vessels and melanin based pigmented lesions. By changing the value on the long pass filter as shown in FIG. 1, from 610 nm to 530 nm, an additional output of wavelengths 111 between 530 nm to 610 nm is created as shown in FIG. 6A. The difference in melanin absorption between the output wavelengths of 530 nm 112 and 610 nm 113 is approximately 60% increase as shown in FIG. 6B. This increase in melanin absorption allows for the alternative embodiment of the present disclosure to be useful in heating and destroying pigmented lesions. A further result of adjusting the output wavelengths in the alternative embodiment, in addition to destroying pigmented lesions, is a change in the appearance of the skin. The change in wavelength output facilitates the use of the alternative embodiment in skin smoothing, wrinkle smoothing, by causing a rejuvenating appearance of the skin. The additional wavelengths 111 shown in FIG. 6A, also allow the alternative embodiment to be effective in destroying small blood vessels. Hemoglobin absorption throughout the wavelength spectrum is shown in FIG. 6C. The additional wavelength output between 530 nm and 610 nm exhibits very high hemoglobin absorption 114 as seen in FIG. 6C. This high hemoglobin absorption allows the apparatus to heat and destroy small blood vessels [0035] Although the apparatus described in the illustrative embodiment herein contains four flashlamps, it should be appreciated by those skilled in the art that the delivery head of the apparatus may contain more or less than four flashlamps depending on the application and the area of treatment. Similarly, the pulse train may consist of more or less than four pulses depending on the characteristic and severity of various dermatological conditions that are to be treated. In addition, the ratio and amount of krypton and xenon in the flashlamps may be altered to produce a slightly different wavelength output pattern or various light filters that are well known in the art may be used to eliminate unwanted wavelengths. [0036] The foregoing has been a description of illustrative embodiments of the present disclosure. The present disclosure is not to be limited in scope by the illustrative embodiments described which are intended as specific illustrations of individual aspects of the disclosure, and functionally equivalent methods and components are within the scope of the disclosure. Indeed, various modifications of the disclosure, in addition to those shown and described herein will become apparent to those skilled in the art from the foregoing description. Such modifications are intended to fall within the scope of the appended claims Referenced by
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I've been saving back several hanks of coral-colored Czech seed beads in various sizes for a rainy day. Today it didn't rain, but it was a quiet day at the office and I decided to give the bead spinner a go and put together this chunky necklace. Awhile ago, Danielle Fox and I tried the bead spinner out for the first time and found that it takes practice to use efficiently. So I decided to start with the bigger beads until I got the hang of it.
I placed a bead stop on one end of 3' of thread, strung 24" of beads, then placed a bead stop on the other end of the thread. I ended up stringing 4 strands of large beads (size 8/0) and 10 strands of small beads (small 9/0). Then I tied one end of the strands together in groups to make the strands more manageable.
Next, I tied one end of all the strands together with an overhand knot; then I strung the loop of 1 eye pin and tied another overhand knot that attaches to the loop (and repeated on the other end of the strands). I dabbed the knot with clear jewelry cement and let it dry.
Then I finished each end with a cord end and wrapped loop, and attached jump rings and the clasp. Voila! To wear, twist the necklace to create a spiral before clasping the closure.
Bead chic!
Project Editor
I have been standing on the sidelines for awhile, reading your emails and admiring all the wonderful creations everyone makes and shares! I guess today is the day I jump in with both feet - I am giddy with anticipation of what's to come!! If I remember correctly, I was looking around on the 'Wire Sculpture' site and was sent over here to check out something they were incorporating into one of their projects!! How exciting and convenient you all make it for the rest of us! Thank you
Thank you for your kind words, Belinda! We're passionate about making jewelry, and we really enjoy sharing tips and techniques with all of you. The beading community is such a great group to be a part of! I think the more you jump into it, the more you'll love it.
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Monthly Dinner Menu
(7 Recipes) Created by AMERSBEE
Recipes in this Collection
Easy crock pot meal. Tastes great over brown rice (not included in calorie count). Submitted by -AMANDA79- Carbs: 12.4g | Fat: 6g | Fiber: 1.7g | Protein: 26.9g | Calories: 214
A tasty, spicy meal with only 10 minutes of prep time! Submitted by REGNETS03 Carbs: 27.5g | Fat: 4.2g | Fiber: 7.1g | Protein: 24.7g | Calories: 247.9
Yummy healthy enchiladas Submitted by JOEMELEAGLES Carbs: 24.4g | Fat: 4.7g | Fiber: 3.4g | Protein: 10.7g | Calories: 179.2
Very Good 4.2/5
(5 ratings)
Super yummy! Submitted by EMMAP08 Carbs: 18.8g | Fat: 0.5g | Fiber: 0.2g | Protein: 23g | Calories: 175
Incredible! 5.0/5
(2 ratings)
Submitted by MARIANINA22 Carbs: 21g | Fat: 20.6g | Fiber: 1.6g | Protein: 46.6g | Calories: 459.4
This is the perfect meal for those days when you desperately need to go to the market for fresh ingredients. Five cans, five minutes, and you're ready to eat! Submitted by KITKATK Carbs: 24.9g | Fat: 0.6g | Fiber: 7.6g | Protein: 7.3g | Calories: 128
This is a hearty soup that is great for the whole gang! The best part is how easy it is to make. Submitted by GENIETEST Carbs: 30.5g | Fat: 10g | Fiber: 8.5g | Protein: 17.9g | Calories: 268.1
Send this recipe collection to a friend - http://recipes.sparkpeople.com/cookbooks.asp?cookbook=86766


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King James Version (KJV) | New International Version (NIV) |
17 He will regard the prayer of the destitute, and not despise their prayer. | 17 He will respond to the prayer of the destitute; he will not despise their plea. |
The King James Version is in the public domain. (The King James Bible Version Online) | Scripture quoted by permission. Quotations designated (NIV) are from THE HOLY BIBLE: NEW INTERNATIONAL VERSION®. NIV®. Copyright © 1973, 1978, 1984 by Biblica. All rights reserved worldwide. (New International Version Bible Online) |


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New Day for Bolivia
Today is Day One of the new Morales government in Bolivia. No one had predicted the tectonic shift which resulted in a 54 percent victory for the man everyone knows as Evo, the Aymaran Indian, leader of the Movement Towards Socialism (MAS), and longtime head of the coca growers union. "It's like the slaves have elected the president, for the first time in 513 years," since the death of the last Inca king, said one community leader in El Alto, the vast Indian community that looks down upon this Spanish colonial city.
When he organized his doomed guerrilla base here in the Sixties, Che Guevara voiced despair in his Bolivian diaries of ever awakening the indigenous people around him. But today, a new Bolivian diary is being written, by Morales and the newly empowered people who elected him.
Bolivia's population mainly consists of Aymaran and Quechua people; they are the poorest in the Americas. They won the right to vote only fifty years ago, in a 1952 nationalist revolution that left them culturally and economically subordinate.
What are the immediate prospects and long-term implications for Morales's new Bolivia? On Day One there was widespread exhilaration, but there were also creeping worries. Social activists were delighted by some of his promises, for example, his inaugural declaration that the privatization of water violates a "basic human right." Only days before, the Bechtel Corporation had dropped its suit against Bolivia for alleged losses in a water-management project that ended when protesters from Cochabamba drove Bechtel from the country. Corporate insiders admitted that a major factor in Bechtel's retreat was "reputational," a desire to save its corporate image from further tarnishing.
Pablo Solon, a close friend of Morales and the country's leading critic of corporate-driven free trade pacts, was delighted by the news on water, almost giddy at the new possibilities, but worried that the United States already was moving behind the scenes to thwart Morales's vision of an independent democratic socialism, a kind of New Deal for the indigenous.
When we spoke, Solon sat in his foundation headquarters, amid dozens of exquisite sketches from the collection of his father, a well-known muralist. Images of tin miners with skeletal faces, and of Don Quixote being tortured, looked down from the walls. Solon, whose brother was murdered during military rule, was contemplating the new relationship between Bolivian social movements and the new government they had been pivotal in electing. The State Department reportedly already was moving to force Bolivia into an Andean Free Trade Agreement (AFTA, as in NAFTA or CAFTA) that would lock Morales's new government into subordination to the multinationals. US Undersecretary of State for Western Hemispheric Affairs Thomas Shannon was signaling privately that while Washington might be open to "dialogue" on the issues of hydrocarbons and coca planting, the issue of free trade itself was non-negotiable.
The Cost of Free Trade
In its effort to head off Morales, the US is allied with Bolivian businessman Marcos Iberkleid, the descendant of Jewish immigrants from Poland, and owner of a textile consortium known as Ametex (America Textil SA). Previous US-dominated Bolivian governments have envisioned Ametex, which employs 4,500 workers, as the motor of a textile-based exports strategy. For Iberkleid, this requires winning an extension on tariff preferences for textile exports to the US, currently due to expire at the end of this year. The US says that it will favor the extension only if Bolivia signs off on an overall free trade agreement.
One graphic example of how free trade pacts work is that the US plans to assert a right to patent plants and animals under intellectual property rights provisions. "It's against Andean policies and traditions," Solon almost shouts. Further, US drug companies and agricultural interests will seek to extend their patent rights from twenty to twenty-seven years. And Bolivia will have to surrender its judicial sovereignty over trade disputes, declared in Article 135 of its Constitution, to closed-door AFTA arbitration panels dominated by corporate property interests.
Enter Iberkleid, the Bolivian point man for the free-trade agenda. His credit rating was a "D" on December 30, according to the Fitch Ratings Index. He desperately seeks to keep filling the orders of his principal corporate client, Polo Ralph Lauren. The US embassy in La Paz has opened its doors three times to welcome Iberkleid's workers in their campaign in support of AFTA. By contrast, when Bolivian citizens petition the embassy for the Bolivian government's own request to extradite former President Gonzalo Sanchez de Lozada from Miami to prosecute him for the deaths of dozens of demonstrators in 2004, they get only as far as the security blockades at the embassy gate.
Iberkleid brandishes a threat that Morales fears--the possibility that Ametex workers will protest or, worst of all, begin a hunger strike on the streets of El Alto, demanding their jobs be saved. In an ominous sign of Morales's potential direction, on Day One the new president appointed the union leader at Iberkleid's plant as the Minister of Labor.
Working conditions at Iberkleid's factory, while not technically those of a typical maquiladora, are still based on the competitive advantage of offering the cheapest possible labor, says La Paz economist Tom Kruze.
"We have failed in the public debate to break the false belief that we have to export or die, " says Kruze, who specializes in labor economics. Fabric and clothing exports to the US represent only $35 million in total. "That's all, with this one man, Marcos Iberkleid, controlling 75 percent of them," says Pablo Solon. Hardly the basis for an economic miracle, Solon and Kruze also question Bolivia's future as a textile exporter when quotas are lifted on Chinese manufacturers in 2008. Any immediate benefits in extending US preferences for Iberkleid will be at the sacrifice of Bolivian sovereignty under a free trade agreement.
Evo Morales knows all this. "You are right, but there is huge pressure," he has told his friend Pablo Solon.
Solon hopes that Evo will denounce the US pressure as blackmail. But to illustrate the new president's vacillation, Solon swerves his hands back and forth. "They are trying in the next thirty days to convert Evo into a Lula," complained Pablo, referring to Brazilian President Luiz Inacio Lula da Silva's acceptance of international financial rules after years of campaigning against the "neo-liberal" agenda. As recently as November 2005, Morales returned from an Argentina summit to declare his opposition to free trade agreements, for either the Andes or Latin America. But in his inaugural remarks in La Paz, the new president declared only that he would "analyze" the agreement, an equivocation that adds to Solon's worries.


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Nice and not very nice celebrities who you have met (merged)
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07-05-2010, 22:28
Phoenix Lazarus
Forum Member
Join Date: Aug 2009
Posts: 11,864
Originally Posted by
Timmy Mallet
did a little show at our local jumping jaks in 2004, my friend was working at Jaks at the time, and TM was begging her and some of the other girls to go back to his hotel room. Also, he tried on a number of occasions to touch some of the girls as "a laugh" when he was on stage.
I've heard so many bad stories about Timmy Mallett, I think it's definitely a case of no smoke without fire!
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Like smashing a snow globe against your forehead, tours can open up a fascinating new world right before your eyes. Go beyond the surface with this Groupon.
Choose Between Two Options
- $20 for a guided tour for two (a $40 value)
- $39 for a guided tour for four (an $80 value)
Seven days a week, guides lead groups on tours of this historic 64-room antebellum mansion. In addition to winding through the mansion's rooms and grounds, the tour ambles through the Nottoway museum, which houses artifacts of the original owners.
Nottoway Plantation & Resort
In 1855, sugar magnate John Hampden Randolph began planning a grand family home near the banks of the Mississippi. He purchased more than 1,000 acres of land and commissioned esteemed architect Henry Howard to design the house. Howard envisioned a grand Greek revival and Italianate-style home with towering ceilings, 11-foot doors, multilevel terraces, stately pillars, and showerheads that gushed extra-virgin olive oil. Although the final mansion's three-story height and 64 rooms are its most impressive attributes, its arcing stairways, ironwork details, and crisp white paint are its most majestic.
Soon after the home's completion, the Civil War began, and the peaceful family sanctuary gathered a rich but troublesome history, much like a country pony on his first trip to the big city. Despite changing owners and losing acreage, the home survived. Years later, a multimillion-dollar renovation project restored the mansion to its peak condition and added modern resort amenities. Once again, the mansion serves as a graceful venue for weddings and meetings, and even houses overnight visitors in 40 hotel rooms. Historical experts remain on hand, leading guided tours to help preserve the memory of the home's past.
It was the best plantation tour we've ever been on. The tour guide was so knowledgeable and did not rush.
Reviewer, Google+ Local, 4 months ago
A beautiful collection of antbelleum furniture and the interior is in good condition. The guides were also really nice and seemed passionate.
kehAustralia, TripAdvisor, 7/9/12
95% of 528 customers recommend
"Beautiful place to visit "
"Beautiful place"
"Had a great time at lunch and during the tour. My North Carolina guests cannot stop talking about it!"


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hey ill be your buddy
konnichiwa!!!! !!!! im lonley i need a buddy!!!
hey ill be your buddy
Anime rocks!!!! I will always love anime forever!!!!whoever wants to send me an e-mail or something just do it i will always be your friend!!!!
......sickening "ooooh will you be my friend???!!!!" Threads. I hate these threads.
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welcome to AO.
just post if you want to be known
P.S. make sure it isnt spam
(word to the wise)
I won't let this world exist without me! If I die, we all die! / Avatar & Signature by anime_8000.
hi! drink milk...and (yay i get to say this first...lol.) EAT CHEETOS!!!
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Awww...Isn't it cute!
"Stay on my good side or I'll scratch your eyes out!"
Welcome to eao, have funn and njoy the view ^^,
-Just another green eyed angel, distorted by mans love for hate-|THE INFAMOUS CHEETOS OVERLORD||IceNineKills|
Hi hi's, welcome welcomes to AO AO! Enjoy your stay stay stay heeeere
"Whenever we're upset, all we need to do is get together and laugh and play until we're totally exhausted, giddy and giggly. Then the sadness, just like these feathers...will miraculously float away."


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The article upset many in Israel, the most outspoken of whom was Foreign Minister Avigdor Lieberman, who compared the article to a medieval "blood libel," in which Jews were periodically accused of killing a Christian child for supposed rituals. He said that the Swedish government's refusal to make any comment to condemn the story was reminiscent of Sweden's "silence" during the Holocaust. Israel's finance minister, Yuval Steinitz, said that Swedish officials "may not be so welcome now in Israel" – particularly problematic since Stockholm holds the rotating EU presidency and Sweden's foreign minister, Carl Bildt, is due to visit Israel in early September.
Deep distrust
Yoram Peri, the head of the Chaim Herzog Institute for Media, Politics and Society at Tel Aviv University, says that the report touched a raw nerve among Israelis – who already harbor deep distrust towards Europe and feel that the continent's newspapers cover the conflict with a pro-Palestinian tilt. While he agrees the article has no merit, he suggests that Lieberman and other politicians may have blown the controversy out of proportion for political purposes.


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25 Afghan Patterns from Red Heart Yarn
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26 Free Crochet Blanket Patterns for Beginners
By: Julia Litz, Editor, FaveCrafts
If you're new to the world of crochet, you might be a little intimidated when it comes to crochet blanket patterns. It might seem like a daunting task but free crochet patterns for beginners do exist! There are plenty of projects for newbie crocheters that incorporate all of your favorite motifs and colors. Find a pattern that fits your style and you can't go wrong. Whether you're looking for free baby blanket crochet patterns or free crochet blankets for the winter season, you're sure to find a project that captures your style.
Free crochet blanket patterns for beginners don't have to be boring. You can use fun colors, cool designs and so much more to inject some life and energy into your patterns. Free crochet patterns for beginners can also be a great source for gift ideas. You can make baby blankets for a shower or afghans for Christmas - everyone loves handmade items. Free baby crochet blanket patterns are often the most meaningful because they can be passed down from generation to generation.
Check out some of our favorite free crochet blanket patterns for beginners and get inspired. Don't be afraid to step out of your comfort zone and create a crochet project that really stands out. Don't doubt your skills - with these free crochet patterns for beginners at your disposal, you'll be an expert in no time!
26 Free Crochet Blanket Patterns for Beginners
Free Baby Crochet Blanket Patterns
Crochet Patterns for Beginners
Easy Crochet Blanket Patterns for Beginners
Short on time but in the mood to crochet? Download a copy of 25 Quick and Thrifty Free Crochet Patterns and discover everything from free baby crochet patterns to stylish hat designs.
Free Baby Crochet Blanket Patterns
When looking for free baby blanket crochet patterns, be sure to find something that really matches your style. There's nothing worse than a pattern you don't really enjoy, so why waste your time? Free crochet blankets are a great gift idea for a baby show because they last forever. Kids will never outgrow their cherished blanket! Add fun circular motifs, ruffles and more to capture the spirit of your favorite little one. As the child grows, he or she will think of you when they curl up with their afghan.
Easy Circles in Squares Blanket
If you like these patterns, then you'll love these free crochet eBooks!
Crochet Patterns for Beginners
Don't be afraid to embrace your beginner status. Look for easy crochet blanket patterns for beginners - everyone has to start somewhere! Even the most inexperienced crocheter can create a darling afghan for themself or someone they love. Take advantage of the skills you already possess and find crochet blanket patterns you can sit down and enjoy. There's no need to stress - keep your patterns simple and develop your crochet skills. Master new techniques, try some stitches and experiment with colors - these crochet patterns for beginners will help discover your inner crochet expert.
Easy Crochet Blanket Patterns for Beginners
Free crochet blanket patterns for beginners can help you wind down after a long and stressful day. Sure, afghans can keep you warm during the holiday season, but did you know they can also add a pop of fun and colorful energy to your home decor? Select some simple crochet blanket patterns and spend a weekend crocheting - by Monday, you'll have a ton of fabulous pieces to display, give or curl up with.
Pastel Single Shell Ripple Afghan
Don't miss out on these fabulously simple crochet patterns. Our roundup of 28 Free Easy Crochet Patterns and Help for Beginners + 4 Bonus Patterns will keep your hook happy for hours. If you're new to the world of crochet, don't worry! This collection is perfect for newbies and experts alike.
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I love your site. I am fairly new, but I have already downloaded enough files to keep me busy for the next 5-6 months. Thanks very much
Love your site, great patterns & very helpful when you categorize them according to " beginner, quick & etc." Have made my own book also by printing off those that I want to start, and write my own little hints on those I have made. Thank You & Happy Holidays to all crafters!! Joyce H. Kansas
Have enjoyed getting patterns from you site. Can't decide which one to start on first. I have just started a crochet class at the local Senior Center. I am really enjoying it after about 50 years of not crocheting. Thanks so very much., It is like starting ov er again. I had the hardest time learning how to hold the thread but after checking people 's different ways, I finally found the one that I used many years ago. Liz from Florence, Sc
How is a beginner supposed to understand all the lingo????????????????
Do you have a super simple pineapple pattern? I've tried making the pineapple pattern a dozen times and for some reason, I just cannot figure it out. Would appreciate your help. Thank you. Karla
I have taken the patterns I've printed up, 3 hole punching, and making my own "I can Crochet and Patterns to Patterns with pictures to Prove it" book. Starting in a few days I will begin my Christmas gifts. A Granny Square blanket for my daughter, and guy's blanket in the colors of the Blackhawks of Chicago, and one in the colors of the Giants or 49'ers. I love this sight, and will continue to visit often.
Thank you so much for all the lovely free patterns !! This is my favourite site, as I've taught myself to crochet from here.....and have used lots of your patterns to make lovely things for my new little grandaughter, and for christmas presents !! Although I'm still a beginner, I enjoy learning the new stitches, and I'm a lot more confident now than I was last June when I started my first project - a lovely headband for the our beautiful new arrival ! Thank you so much xx
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Regulation of chicken embryonic growth hormone secretion by corticosterone and triiodothyronine
- Dr. Tom E. Porter,
- Kristi J. Dean
- … show all 2 hide
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We reported that growth hormone (GH)-secreting cells differentiated by d 16 of chick embryonic development and that these somatotrophs were responsive to GH-releasing hormone and thyrotropin-releasing hormone. The present, experiments evaluated effects of corticosterone and triiodothyronine (T3) on embryonic GH secretion. Anterior pituitary cells from embryonic day (e) 16, e18, and e20 were subjected to reverse hemolytic plaque assays (RHPAs) for GH in the absence or presence of corticosterone or T3. Corticosterone increased GH secretion from embryonic somatotrophs, an effect particularly evident on e16 and e18. T3 decreased GH secretion on e16, while no effect of T3 was significant on e18 or e20. Next, pituitary cells were subjected to RHPAs with T3 and corticosterone alone or in combination. Combined treatment with these hormones suppressed GH secretion from e16, e18, and e20 somatotrophs to levels below those found under basal conditions. We conclude that corticosterone can stimulate GH secretion in vitro at all embryonic ages tested. Furthermore, T3 can suppress basal GH secretion on e16, and the combination of T3 and corticosterone can suppress GH secretion at all ages. These findings indicate that GH secretion during the end of chicken embryonic development may be regulated by the interactions of endogenous glucocorticoids and thyroid hormones that increase prior to hatching.
- Porter, T. E., Couger, G. S., Dean, C. E., and Hargis, B. M. (1995). Endocrinology 136, 1850–1856. CrossRef
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- Dean, C. E., Piper, M., and Porter, T. E. (1997). Mol. Cell. Endocrinol. 132, 33–41. CrossRef
- Piper, M. M. and Porter, T. E. (1997). J. Endocrinol. 154, 303–310. CrossRef
- Porter, T. E. (1998). Growth Horm. IGF Res. 8, 133–139. CrossRef
- Daikoku, S., Ikeuchi, C., and Nakagawa, H. (1974). Gen. Comp. Endocrinol. 23, 256–275. CrossRef
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- Thommes, R. C., Martens, J. B., Hopkins, W. E., Caliendo, J., Sorrentino, M. J., and Woods, J. E. (1983). Gen. Comp. Endocrinol. 51, 434–443. CrossRef
- Thommes, R. C. and Tonetta, S. A. (1979). Gen. Comp. Endocrinol. 37, 167–176. CrossRef
- Thommes, R. C., Williams, D. J., and Woods, J. E. (1984). Gen. Comp. Endocrinol. 55, 275–279. CrossRef
- Gregory, C. C., Dean, C. E., and Porter, T. E. (1998). Endocrinology 139, 474–478. CrossRef
- Kalliecharan, R. and Hall, B. K. (1976). Gen. Comp. Endocrinol. 30, 404–409. CrossRef
- Kalliecharan, R. and Hall, B. (1974). Gen. Comp. Endocrinol. 24, 364–372. CrossRef
- Samuels, H. H., Stanley, F., and Shapiro, L. E. (1979). Biochemistry 18, 715–721. CrossRef
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- Williams, G. R., Franklyn, J. A., and Sheppard, M. C. (1991). Mol. Cell. Endocrinol. 80, 127–138. CrossRef
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- Leung, F. C., Taylor, J. E., and Van Iderstine, A. (1985). Gen. Comp. Endocrinol. 59, 91–99. CrossRef
- Leung, F. C., Taylor, J. E., and Van Iderstine, A. (1984). Proc. Soc. Exp. Biol. Med. 177, 77–81.
- Harvey, S., Decuypere, E., Darras, V. M., and Berghman, L. (1991). Reprod. Nutr. Dev. 31, 451–460.
- Scanes, C. G., Denver, R. J., and Bowen, S. J. (1986). Poult. Sci. 65, 384–390.
- Tixier-Boichard, M., Decuypere, E., Huybrechts, L., Kuhn, E. R., and M'erat, P. (1990). Demest. Anim. Endocrinol. 7, 573–585. CrossRef
- Donoghue, D. J., Perez, F. M., Diamante, B. S. A., Malamed, S., and Scanes, C. G. (1989). Domest. Anim. Endocrinol. 7, 35–42. CrossRef
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- Saadoun, A., Simon, J., and Leclercq, B. (1987). Br. Poult. Sci. 28, 519–528.
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- Title
- Regulation of chicken embryonic growth hormone secretion by corticosterone and triiodothyronine
- Journal
Volume 14, Issue 3 , pp 363-368
- Cover Date
- 2001-04-01
- Print ISSN
- Online ISSN
- 1559-0100
- Publisher
- Humana Press
- Additional Links
- Topics
- Keywords
- Somatotroph
- thyroid
- pituitary
- glucocorticoid
- embryo
- development
- Industry Sectors
- Authors
- Dr. Tom E. Porter (1) (2)
- Kristi J. Dean (2)
- Author Affiliations
- 1. Department of Animal and Avian Sciences, University of Maryland, 20742-2311, College Park, MD
- 2. Department of Poultry Science, Texas A&M University, College Station, TX


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While James Franco is gearing up to play beat poet Allen Ginsberg in the upcoming biopic Howl, he's also busy promoting his latest movie, Milk.
Page Six quotes Franco, 30, talking about his sex scenes with Sean Penn, 48, in the true story of San Francisco's late city supervisor Harvey Milk, the first openly gay American to hold public office.
"In the original script I read, there was only one real kissing scene," Franco tells the January issue of Elle. "A month after [director] Gus [Van Sant] asked me to do it, they sent me another script, and on Page 5 there was a full-on love scene. And I was like, 'Gus, what the heck?' He says, 'Well, it was Sean's idea.'"
Franco plays Scott Smith, Harvey Milk's much younger lover, in the film.
Milk opened last week in limited engagement. It raked in whopping $1.8 million on just 36 screens.
The film gets s wider release across the country this Friday.


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Terra Nova Equipment Laser Ultra 1-Person Tent
0 Reviews | Write a Review
Terra Nova is known for making incredibly light weight backpacking products. Everything from packs and bags to tents and tarps, Terra Nova takes and starts shedding the unneccessary weight with lightweight fabrics and smart product designs. The Laser Ultra Tent is on the extreme end of this "lightweight spectrum" coming in at a mere 1.28 lbs PACKED! That's no mistake. This 1-person, ultralight tent (or a tight 2-person in a pinch) weighs just over a pound when you pack everything you need for setup, plus the things you don't.
What's even more incredible is pairing this tent with the Laser 20 Ultra Pack and the Laser 300 sleeping bag, and still coming in at just 3 lbs! Now that is the true definition of ultralight backpacking.
Minimum Weight: 1.1 lbs
Packed Weight: 1.3 lbs
Packed Dims: 3.14" x 13.7"
Internal Height: 34.2"
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text:
Complete Jewish Bible (CJB) | New International Version (NIV) |
1 Three days after Festus had entered the province, he went up from Caesarea to Yerushalayim. | 1 Three days after arriving in the province, Festus went up from Caesarea to Jerusalem, |
Complete Jewish Bible Copyright 1998 by David H. Stern. Published by Jewish New Testament Publications, Inc. All rights reserved. Used by permission. (The Complete Jewish Bible Online) | Scripture quoted by permission. Quotations designated (NIV) are from THE HOLY BIBLE: NEW INTERNATIONAL VERSION®. NIV®. Copyright © 1973, 1978, 1984 by Biblica. All rights reserved worldwide. (New International Version Bible Online) |


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