text:
S.Jack Wei, MD
Updated by: Lara Bonner Millar, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 10, 2011
The liver is the largest solid organ of the body and is located on the right side of the abdomen just beneath the right diaphragm. Surrounding organs include the gall bladder (located just behind the liver), the small intestine, part of the colon (large intestine), the right kidney, and the head of the pancreas. The liver is triangular in shape and is divided into a right and left lobe, the right lobe being the larger of the two. It provides several important functions to the body including:
The liver is a very vascular structure, containing a large number of blood vessels, and receives blood through two separate systems: the hepatic artery and the portal vein. Blood from the abdomen and lower body flows through the liver where it is processed. It then proceeds to the inferior vena cava and ultimately empties into the heart. In large part, due the vascular nature of the liver, it is a very common site to which cancers from other areas of the body to spread (also known as metastasis).
Normally, cells in the body will grow and divide to replace old or damaged cells. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this regulation and cells continue to grow uncontrolled. Tumors of the liver occur when there is an error in the regulation of growth of any of the cells in the liver, including the liver cells themselves (hepatocytes), the bile duct cells, or the blood vessels within the liver.
Tumors can either be benign or malignant. Although benign tumors grow uncontrolled, then do not break off and spread beyond where they started and do not invade into surrounding tissues. Malignant tumors, however, will invade and damage other tissues around them. They can also gain the ability to break off from where they started and spread to other parts of the body (metastasize), usually through the blood stream or through the lymphatic system where the lymph nodes are located. Over time, the cells of a malignant tumor become more abnormal and appear less like normal cells. This change in the appearance of cancer cells is called the tumor grade, and cancer cells are described as being well-differentiated, moderately-differentiated, poorly-differentiated, or undifferentiated. Well-differentiated cells are quite normal appearing and resemble the normal cells from which they originated. Undifferentiated cells are cells that have become so abnormal that, we cannot tell what types of cells they started from.
There are a number of benign liver tumors. Hemangiomas are the most common benign tumor of the liver, and occur when a benign, blood-filled tumor forms within the liver. Other benign tumors include adenomas (benign tumors of the hepatocytes) and focal nodular hyperplasia (a localized growth of several types of liver cells). Although these tumors do not invade surrounding tissues or metastasize, it is often difficult to tell the difference between benign and malignant tumors on radiographic imaging.
In addition to being a common site of metastasis for cancers from other sites in the body, primary liver cancers can arise from within the liver itself. Cancer arising from the hepatocytes is known as hepatocellular carcinoma (HCC) . It is the most common type of primary liver cancer and accounts for around 70% of all liver cancers. Cancers that arise from the bile ducts within the liver are known as cholangiocarcinomas and represent 10-20% of all liver cancers. These cancers can arise from the bile ducts within the liver (known as intrahepatic cholangiocarcinomas) or from in the bile ducts as they lead away from the liver (known as extrahepatic cholangiocarcinomas). Other types of rare cancers can occur within the liver. These include hemangiosarcomas (malignant blood-filled tumors) and hepatoblastoma (a rare cancer that develops in very young children).
Each year, there are approximately 17,000-19,000 cases of liver cancer in the United States with 14,000-15,000 people dying of the disease each year. Liver cancer is much more common in other areas of the world, particularly in sub-Saharan Africa and Southeast Asia. Worldwide, liver cancer is the fifth most common cancer with a half a million people afflicted each year. The number of people who develop liver cancer is increasing both abroad and in the United States.
There are a number of risk factors that are associated with liver cancer. In the United States , the most common risk factor for liver cancer is liver cirrhosis. Sixty to eighty percent of patients presenting with liver cancer have some signs of cirrhosis. Cirrhosis results from scar formation within the liver, most commonly due to chronic alcohol use. Chronic infection with hepatitis C virus (HCV) is also a common cause of liver cancer in the United States . Worldwide, other risk factors, such as chronic infection with hepatitis B virus (HBV) and aflatoxin B1 food contamination are more common. Aflatoxin is a toxic chemical that is produced by a fungus commonly seen in tropical regions. Presence of the fungus on food in these regions leads to chronic exposure to the toxin, resulting in an increased risk of developing liver cancer. Tobacco use has also been associated with increased risk; however, it is not as strong of a risk factor as alcohol-induced liver cirrhosis. Other environmental factors include exposure to thorium dioxide (Thorotrast, a contrast agent previously used for radiographic imaging that is no longer used), vinyl chloride, arsenic exposure , and use of anabolic steroids. Several inherited diseases can increase the risk of liver cirrhosis, and therefore increase the risk of developing liver cancer. These disease include hemochromatosis (where the body absorbs and stores too much iron), Wilson's disease (where the body inappropriately retains too much copper), and alpha-1-antitrypsin deficiency (a deficiency in a key enzyme that can lead to emphysema of the lung and cirrhosis of the liver). Patients with a family history of liver cancer may also be at increased risk. Finally, males are about twice as likely to develop liver cancer as females. This may be due to a genetic predisposition of males for liver cancer, but may also be due to the fact that males are more likely to be exposed to the risk factors discussed above.
The best way to prevent liver cancer is to avoid the risk factors that are associated with it. Avoiding the excessive use of alcohol and quitting smoking can reduce the risk of liver cancer. Preventing and treating HBV and HCV infections is also important. A vaccine for HBV is available and people who are at high risk for exposure to the virus (such as health care workers and individuals with high-risk sexual practices) should be vaccinated. HCV is spread through blood transfusions, unprotected intercourse, and the sharing of needles by IV drug users. Although there is no vaccine for HCV, avoiding the means by which it is spread can significantly reduce the risk of being infected. Once infected with HBV or HCV, appropriate treatment of the infection can reduce the risk of developing liver cancer.
In other parts of the world, altering the way that foods are stored and processed can decrease the risk of aflatoxin exposure. Proper treatment of water can reduce the risk of arsenic in drinking water. Appropriate treatment of inherited diseases associated with cirrhosis and liver cancer can reduce the risk of developing either cirrhosis or liver cancer. While the risk of liver cancer can never be reduced to zero, it can be significantly reduced by avoiding known risk factors.
Liver cancer usually does not cause a lot of symptoms until the cancer is quite advanced. Because of this, early stage liver cancers are rarely detected. When patients do develop symptoms, they can have abdominal pain, feelings of abdominal fullness or bloating (sometimes due to ascites , or a collection of fluid within the abdominal cavity), fatigue, loss of appetite, and weight loss. Currently there is no approved screening test for liver cancer. One potential screening test has been blood levels of alpha-fetoprotein (AFP). AFP is a protein that is found at high levels in fetal blood, but normally disappears once the baby is born. AFP levels increase in the presence of HCC and can be a marker of the development of liver cancer. While some patients who are at high risk for developing liver cancer are routinely tested for AFP levels, this is generally not a good screening tool. Not all liver cancers produce high levels of AFP in the blood, and by the time most patients are found to have high AFP levels, the tumor is already at an advanced stage.
Other blood proteins may potentially be used as screening tools for liver cancer. Several studies have shown the use of proteins such as des-gamma-carboxy prothrombin (DCP) and Lens culinaris agglutinin-reactive fraction (AFP-L3) may also be used as markers of liver cancer formation; however, in practice, these are infrequently used. Additional studies with these proteins are needed before they can be used more extensively for liver cancer screening.
In general, it is reasonable for patients at high risk for liver cancer to be screened. These patients included those infected with HBV or HCV, those with a known history of liver cirrhosis, and patients with inherited diseases known to be associated with cirrhosis. In these patients, annual AFP levels are often followed and if AFP levels are found to rise from one year to the next, appropriate follow-up testing should be ordered. In addition, patients with cirrhosis often undergo routine screening with ultrasound of the liver. It is important to note that when a patient with long-standing liver cirrhosis suddenly gets worse, liver cancer is frequently a cause. The Child-Pugh score is a system of grading the degree of cirrhosis, with a range from A (least impaired) to C (most impaired) and helps guide physicians as to which treatments are appropriate
When liver cancer is suspected, the physician should perform a thorough history and physical examination. If a liver tumor is suspected or a patient is at high risk for developing a liver cancer, a number of diagnostic tests may be performed:
An ultrasound is a test that uses sound waves to produce an image of the internal body. The physician or technician places a wand over the target area and glides it over the skin. Often, lubricant or gel is also placed on the skin in order to improve the ability of the sound waves to enter to body. The wand emits sound waves that enter the body and bounce off the internal structures. An echo is produced which is detected by a sensor within the wand. The different densities and shapes of the internal structures cause the sound waves to echo differently, and these differences are detected by the wand. Liver tumors can often be imaged by ultrasound; however, in patients with cirrhosis, it is often difficult to identify liver tumors on ultrasound. Nevertheless, ultrasounds are often used to screen for and diagnose liver cancers because they are very easy to perform and have little to no risk to the patient.
Computed tomography (CT) is often used to diagnose liver cancers. A CT scan is performed by taking multiple small x-rays pictures (similar to conventional chest x-rays or dental x-rays) using a machine that rotates around the patient. A sophisticated computer program adds up these multiple x-rays to produce cross-sectional images of the body. In order to produce the highest quality images, CT scans are often performed using contrast (or dye) which helps to outline structures within the body. Contrast can be given intravenously and/or by mouth in the form of a liquid or pudding. A small percentage of patients are allergic to contrast. If you are, it is important to let your doctors know before ordering the CT scan. Patients who are allergic can often receive non-contrasted CT scans, or take medication prior to receiving to scan to avoid an allergic reaction. CT scans are very useful in diagnosing liver tumors; however, many benign tumors are often difficult to distinguish from malignant tumors on CT scan. Regardless, because CT scans are relative fast compared to other tests, but often give more detailed images than ultrasounds, CT scans are often used to help diagnose liver cancers.
Often, when there is difficulty seeing a tumor on CT or ultrasound, or if there is question about whether a tumor is benign or malignant, magnetic resonance imaging (MRI) is performed. MRI uses electromagnetic waves and very strong magnets to create an internal image of the body. Different structures absorb these magnetic waves differently, and these differences are detected and used to construct a very detailed image of the body by a computer. No radiation is used during this procedure. Like CT scans, MRIs are often performed using special contrast that is administered intravenously; however, unlikely the dye used in CT scans, allergy to MRI dye is uncommon. The area in which patients lie is fairly small, so some patients can feel claustrophobic while undergoing the procedure. In addition, while ultrasound and CT scans often take only a few minutes, MRI scans can be much longer, sometimes up to one or two hours. For patients that cannot tolerate the feeling of being in a small space for such a long time, open MRI scanners are available that have a larger space for patients to lie in while being imaged. However, open MRIs still take a long time to obtain, and often the images are of poorer quality than with closed MRI scanners. Regardless, MRI can be an invaluable tool in helping to diagnose liver cancer.
Angiography is a procedure in which a small tube (called a catheter) is threaded along a blood vessel through a needle (often placed through the groin). Contrast is injected directly into the blood vessels leading the liver and x-rays are taken that can show highly vascular liver tumors. This procedure is infrequently performed because it is much more invasive in nature than ultrasound, CT, or MRI.
Fluorodexoyglucose-positron emission tomography (FDG-PET) takes advantage of the fact that rapidly growing tissue needs energy. Glucose is a sugar that is often used by cells as an energy source, and FDG-PET uses radioactive glucose to find areas in the body that are rapidly growing. While PET has been used in a number of cancers to help with diagnosis, its role in liver cancer has never been proven. Nevertheless, it is sometimes used to help in the diagnosis of liver cancer.
A number of blood tests can be used to help determine a patient's risk of liver cancer (as discussed under "What are the signs of liver cancer and is there a screening test?"). An elevated AFP can increase the suspicion that a tumor is malignant if it is unclear by imaging whether a tumor is benign or malignant. Other blood tests can help determine the extent of liver involvement or if there is pre-existing liver conditions that would predispose a patient to developing liver cancer.
Ultimately, the most important diagnostic test for liver cancer is a biopsy. To perform a biopsy, the physician uses a needle or a small pair of scissors or clamps to remove a piece of the tumor. This can be done surgically during an exploratory laporatomy , where the surgeon makes a long incision to expose the abdominal contents (including the liver) for inspection. A surgeon can also perform a biopsy by laparoscopy by inserting a fiberoptic camera through a small hole in the abdomen and using this camera to help where the biopsy needs to be taken. Biopsies can also be performed under the guidance of ultrasound, CT, or MRI where a long needle is used to suck out a small piece of the tumor. Transvenous biopsies can be performed by inserting a catheter into a vein (usually in the neck) and guiding the catheter through veins to the liver. A needle within the catheter is used to obtain a piece of the tumor. Whatever the procedure used to obtain the biopsy, the tissue is then sent to a pathologist who looks at the tissue underneath a microscope to determine whether the tumor is cancerous or not.
Once a diagnosis of liver cancer is made, additional test should be ordered to determine the extent of the disease. A CT scan or MRI of the abdomen and pelvis should be performed if it hasn't already been done, to look for abnormally enlarged lymph nodes, which can result from spread of the cancer, and to examine for metastatic disease.
Liver cancer is most commonly staged using the TNM staging system which is determined by the American Joint Committee on Cancer (AJCC). The "T stage" represents the extent of the primary tumor itself. The "N stage" represents the degree of involvement of the lymph nodes. The "M stage" represents whether or not there is spread of the cancer to distant parts of the body. These are scored as follows:
The stage of the cancer is reported grouping the various combinations of the T, the N, and the M stage into one stage group. Stage groups are reported as Stage I to Stage IV as follows:
For example, a hepatocellular carcinoma that consists of 3 separate tumors, the largest of which measures 3.5 cm in size, without evidence of involvement of the blood vessels of the liver, spread to the lymph nodes, or to spread to distant sites would be a T2N0M0, Stage II cancer. Similarly, a solitary (single) liver cancer invading into the hepatic vein with evidence of spread to regional lymph nodes, but no evidence of spread to distant metastatic sites would be a T3N1M0, Stage IIIC liver cancer.
There are other staging systems for liver cancer, such as the Barcelona Clinic Liver Cancer staging system, which take into account patients' liver function, unlike the AJCC system.
Although the systems of cancer staging are quite complicated, they are designed to help physicians describe the extent of the cancer, and therefore, helps to direct what type of treatment is given.
Surgery provides the best chances for cure for patients with liver cancer; however, only patients with cancer that has not spread beyond the liver are candidates for surgical resection for cure. Liver cancer surgery can consist of either resection of a portion of the liver (known as a partial hepatectomy ) or removal of the whole liver followed by liver transplantation . The type of surgery that is performed depends on the location of the tumor, the size of the tumor, and the overall health of the patients. Unfortunately, it is common for liver cancer to have grown or spread to a point where surgery is not possible. In addition, because it is common for patients with liver cancer to have additional medical problems such as cirrhosis, many patients whose cancers are considered resectable, are excluded from surgery due to their overall health.
In general, only patients with good liver function can tolerate a partial hepatectomy. For patients with poor liver function or who have extensive cirrhosis, liver transplantation is an option unless the cancer is too extensive or in a location that makes transplantation too difficult. Transplantation can treat both the cancer and the underlying liver disease. However, the number of liver donors is far smaller than the number of patients who may benefit from liver transplant and too often, patients who would otherwise be good candidates for liver transplantation are unable to receive them due to the lack of available organs.
For patients with tumors that have not spread beyond the liver, but cannot undergo resection of the tumor due to its location, a number of local treatments have been investigated as treatment. In cryosurgery, liquid nitrogen or argon is used to cool probes that are inserted directly into the tumor during an operative procedure. The probes freeze the cancer cells, killing them. This technique has the advantage of treating very little normal tissue, thereby reducing the risk of side effects from the treatment. However, it can only be used to treat tumors that can be seen by the naked eye or by ultrasound and requires an operation to perform.
Another local treatment for liver cancer is radiofrequency ablation. Radiofrequency ablation consists of inserting a probe directly into the tumor and killing cancer cells with the use of electrodes that are inside the probe. This technique can be performed through the skin, and does not always require an open operation (although it can be performed operatively as well). However, technically, it is more difficult to perform than cryosurgery. It is used on lesions less than 3 cm
Ethanol injections are performed by injecting ethanol (alcohol) directly into tumors using small needles. The high concentration of ethanol used in these injections can result in killing of the tumor. Only small tumors can be treated in the manner; however, for patients with a small number of small tumors, ethanol injections can be result in reasonable rates of tumor control. In general, in the US, RFA has replaced ethanol injection.
Chemotherapy is a medication that is usually given intravenously or as a pill. It goes to the bloodstream and throughout the body to kill cancer cells. This is one of the big advantages of chemotherapy. If cancer cells have broken off from the tumor and are somewhere else inside the body, chemotherapy has the chance of finding those cells and killing them. In general, use of chemotherapy in liver cancer has been difficult because liver cancers have been found to be relatively resistant to cytotoxic chemotherapy, and because most patients with liver cancer have defects in their overall liver function. Chemotherapy is often processed within the liver, and a decrease in liver function can make the delivery of chemotherapy more difficult.
Chemotherapy can be used in liver cancer when the cancer has spread outside of the liver; however, the overall effectiveness of this treatment has been limited. It can also be used in the adjuvant setting, immediately after surgical resection of a tumor that has not spread beyond the liver. Despite the theoretical advantages of chemotherapy after surgery, a number of studies have failed to show an improvement in tumor control with the use of adjuvant chemotherapy. Several different chemotherapy drugs have been studied For patients who have unresectable disease, a study carried out in Asia found that a palliative chemotherapy regimen consisting of 5-FU and oxaliplatin was superior to doxorubicin
Newer treatments include the use of targeted therapies. Targeted therapies are drugs that are designed to block specific steps in the development of cancer at the molecular level. A medication called Sorafenib is the first targeted therapy to demonstrate an improvement in survival in patients with advanced HCC Sorafenib is a form of biologic therapy that is also being studied in combination with chemotherapy.
Chemoembolization of the hepatic artery takes advantage of the fact that many liver cancers receive a large portion of their blood supply through the hepatic artery. By injecting chemotherapy through a catheter into the hepatic artery, the blood flow through the artery is blocked and the blood supply to the tumor is disrupted. The use of hepatic artery embolization is still being studied for use in patients with both resectable and unresectable liver cancer. It is first line therapy for multifocal tumors in patients with Child-Pugh class A liver disease
Another potential method of treating liver cancer is radiation therapy . The radiation comes in the form of high energy x-rays that are delivered to the patient only in the areas at highest risk for cancer. These x-rays are similar to those used for diagnostic x-rays, only of a much high energy. The high energy of x-rays in radiation therapy results in damage to the DNA of cells. Because cancer cells are not as good as normal, healthy cell at repairing DNA damage, radiation results in relatively more damage to the cancer cells than to normal cells. Radiation therapy exploits this difference to treat cancers while relatively sparing normal tissue.
Although modern techniques allow radiation to be delivered in a very specific manner, a significant amount of normal liver is still treated when radiation therapy is used. Because of this, radiation is not routinely part of the treatment of liver cancers. Its use is most often reserved for cases in which other treatment options have failed, or when the liver cancer has spread outside of the body and is causing specific problems due to the location to which it has spread. A significant amount of research is currently underway that explores additional methods of improving the delivery of radiation to liver cancers. Avenues of research have included the use of breath holding techniques, stereotactic body radiation, radiosensitizers (chemicals that are given together with radiation to improve the sensitivity of liver cancers to radiation), and radiolabeled antibodies (radioactive molecules attached to antibodies that specifically find and attach to liver cancer cells). Radiation therapy may be given along with Sorafenib or chemoembolization When chemoembolization is combined with radiation, outcomes are improved compared to chemoembolization alone.
Surgical resection is the only known cure for liver cancer. However, even in patients who can undergo surgery, more than half experience a recurrence later on. For patients who have a liver transplant, there is about a 20% risk of recurrence In general, the outcomes after treatment for liver cancer are less than optimal, particularly for patients who cannot undergo surgical resection of their cancers. Clearly, additional research is necessary to improve the overall outcome of these cancers.
Close follow-up after treatment for liver cancer is critical because of the high rate of recurrence in patients who have been treated and because of the high risk of developing a second liver cancer in patients with severe liver cirrhosis. Routine follow-up care should be performed every 3-6 months for several years following treatment. Follow-up care should include treatment of underlying medical problems such as hepatitis or alcoholism, routine blood tests including blood markers such as AFP, and radiographic imaging such as CT scans and MRIs. Prompt evaluation and treatment of suspicious findings is critical.
Ultimately, treatment of liver cancer should be a cooperative effort between a patient and their physicians. It is important that patients know about their disease so that they may make informed decisions about their treatment. This article was intended to help answer some of the common questions patients face when they have liver cancer. If you have any additional questions, please contact your doctor.
Abou-Alfa GK, Schwartz L, Ricci S, et al Phase II study of sorafenib in patients with advanced hepatocellular carcinoma J Clin Oncol 2006; 24:4293-4300
Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
The American Cancer Society Overview: Liver Cancer. www.cancer.org
The National Cancer Institute: Liver Cancer. www.cancer.gov
Medline Plus: Liver Cancer. www.nlm.nih.gov
Sherman M "Guidelines for Hepatocellular Carcinoma Diagnosis" 2011 Gastrointestinal Cancers Symposium Oral presentation January 21, 2011 San Francisco, CA
Weber S, O'Reilley EM, Abou-Alfa GK et al , "Liver and Bile Duct Cancer" In Clinical Oncology, 3 rd Edition . Ed: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB and McKenna WG. Elsevier, Philadelphia , PA , USA . 2004:1981-2013.
Burroughs A, Hochhauser D, Meyer T. Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum. Lancet Oncol 5(7):408-418, 2004-09-27
Thongprasert S, Win S, Lim H, et al Efficacy of Oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX4) versus doxorubicin in advanced HCC: updates on the EACH study 2011 Gastrointestinal Cancers Symposium. Abstract #160 January 21, 2011 San Francisco, CA


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Debra A. Noumair
Professional Background
Educational Background
Scholarly Interests
- Executive education and change leadership
- Leadership development and executive coaching
- Group and organizational dynamics and the application of systems thinking to individual, team, and organizational performance
Selected Publications
Shani, A. R. & Noumair, D. A. (Eds.) (2014). Research in Organizational Change and Development, Volume 22. UK: Emerald Books.
Golom, F. D. & Noumair, D. A. (2014). No Add-Ons Necessary: Cultural and Pedagogical Implications of a Competency-Based Approach to Training I-O Psychologists. Industrial and Organizational Psychology: Perspectives on Science and Practice. Wiley-Blackwell.
Shani, A. R., Pasmore, W. A., Woodman, R. W., & Noumair, D. A. (Eds.). (2013) Research in Organizational Change and Development, Volume 21. UK: Emerald Books.
Noumair, D. A. (2013). Cultural revelations: Shining a light on organizational dynamics. International Journal of Group Psychotherapy, 63(2) 153-176.
Noumair, D. A., Winderman, B., & Burke, W. W. (2010). Transforming the A. K. Rice Institute: From club to organization. The Journal of Applied Behavioral Science, 46(4) 473–499.
Burke, W. W. & Noumair, D. A. (2009). Action learning and organization development. In Dilworth, R. L. & Boshyk, Y. (Eds.), Action learning and its applications. Basingstoke, UK: Palgrave Macmillan.
Cytyrnbaum, S., & Noumair, D.A. (Eds.). (2004). Group dynamics, organizational irrationality, and social complexity: Group relations reader 3: The A. K. Rice Institute, Jupiter, FL.
Noumair, D.A. (2004). Diversity and authority conferences as a social defense. In L. J. Gould & L. Stapley & M. Stein (Eds.), Applied experiential learning: The group relations training approach.
Noumair, D. A. & Burke, W. W. (2002). The Multiplicity of Roles and Demands for the Leader as Partner. In L. Segil, J. Belasco & Goldsmith, M. (Eds.) The Leader as Partner.
Burke, W.W., & Noumair, D.A. (2001). Personality assessment in organization development. In
Reed, G. M., & Noumair, D. A. (2000). The Tiller of Authority in a
biographical information
Dr. Noumair is the author of articles and book chapters on group relations, organization development and change, and the analysis of diversity issues in groups, organizations, and social systems. She edited Group Dynamics, Organizational Irrationality, and Social Complexity: Group Relations Reader 3, which brings the theoretical and practical application of group relations concepts to life in teams, organizations, communities, and society. She serves on the Editorial Boards of The Journal of Applied Behavioral Science and the OPUS International Journal, Organisational and Social Dynamics, and is an editor of the book series, Research on Organization Change and Development. An experienced leader in executive education, Dr. Noumair is on the faculty of leadership development programs sponsored by Columbia University Business School and Simmons School of Management. Much of her executive education work focuses on leadership development with women executives in custom programs within companies as well as in Leading Women Executives, a CEO-sponsored leadership development program focused on high potential women and their companies.
Professor Noumair is a member of the American Psychological Association, the Academy of Management, and the Organization Development Network.
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Permission required. Prerequisite: ORL 5362 and ORLJ 4005. Enrollment limited. Open to doctoral candidates and others who have a strong background in social science, organizational behavior, administration, psychology, or business. Planned change in organizations. Offers the opportunity to study and experience anticipated consultant roles during the entry, diagnostic, and intervention phases of efforts to effect change. Special fee.
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Permission required. Limited to doctoral students. Topics are announced in the preliminary and final course schedules distributed each semester.
ORLJ 6901: Advanced research and independent study in social-organizational psychology
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Egg Drop Soup with Clams
I used to dread egg drop soup (蛋花汤); I had countless bad, sticky, gooey egg drop soup made popular by American Chinese restaurants here in the US. When I was a poor and starving graduate student in the Midwest, I ate too much crappy Chinese buffets or lunch specials with endless supply of MSG-loaded egg drop soup. I was not a big fan of it.
But it all changed recently when I was in Shanghai, when I dined at Jesse, a famous local gem that serves exquisite Shanghainese fare. Their egg drop soup was superior with light and refreshing broth (no starch added!) saturated with the natural sweetness of clams. My co-worker and I slurped the big serving of egg drop soup dry; it was satisfying.
I have been making egg drop soup with clams since I came back. I try to replicate the taste and perfect the recipe, and I think I am getting there.
Try my egg drop soup recipe and say goodbye to the runny, tasteless, plain, boring egg drop soup you get from your Chinese joints. Say hello to a refreshing, comforting, and home-made egg drop soup that you will need to beat the summer heat. If you don't like clams, you can add tofu and it works fine, too.
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57 comments... read them below or add one
Oh! I actually kind of like the sticky egg drop soup (or maybe it was just the last one I had in new york?). But I've no doubt this is definitely much more delicious and elegant! :)
ahhh, a simple meal that can be prepare~
as in the pic taken, its mouth watering!~
Very, very nice dish!
Now this is my kind of egg drop soup! The clams surely gives it a brothy goodness!
What a pretty egg drop soup! I've always been a big fan of egg drop soup, and the clams sound fantastic in it.
I love the looks of this…I've had clams on the brain lately so it would seem you've given me a fantastic excuse to cook some.
i do love a good egg drop soup. i mum makes it with spinach and meatballs. it's well good! x
ooh, this looks great. must go buy some clams today. thanks!
Perfect. Gonna be eating this one. You know I have a love of clams, and this soup looks like a perfect showcase for them. Lovely photo too.
Hi Bee,
Thanks for this simple, easy to prepare soup. Eggs and clams are really good for me now. I will go get some clams and make it for tonight's dinner
I want to have this just for the broth! :)
I have to give it to you, RM. Your obsession with seafood and shell fish has no boundaries. I had similar version but without the shell. I think the clams are smaller, too. Yours definitely look fresh and ready to savor.
Wow! your blog has wonderful recipes and perfect pics.
I'm totally with you on American Chinese restaurant eggdrop soup. Given the choice of MSG water with hocky pucks (wonton soup), salty wallpaper paste with sponges (egg drop soup) and hot and sour soup, I always opted for the hot and sour soup if for no other reason than the anti bacterial properties of the vinegar.
I could see how a soup like this would change anyones mind and erase all those bad experiences.
Oooh, I love egg drop soup. And the eggs look so fluffy in this soup. Amazing. I admit I don't do it 'right' either. My eggs don't look like this at all…..:(
This looks really yummy!!! I will try to make this soup one day.
the soup looks so delicious!
I do not like sticky egg drop soup (due to the cornflour added to thicken the soup) but I do enjoy the "silky, smooth" version. Usually, I will turn off the heat, then stir in the whisked egg and make sure the egg is just cooked and not overdone.
Thanks for the recipe. I also hate the 'artificially' thickened soups around here.
I've been following your blog for some time and like the challenge of trying to make it vegetarian. I would gladly eat your version but my wife is vege.
Cut some old ginger into thin strips and add to the soup to boil for more flavorful veg taste. And/or soak tofu skins and cut into smaller pieces to add into the soup for something to eat instead of just drinking soup.
For variety you can put some tom yam paste (or cubes) to make tom yam egg drop soup.
Actually you also can add cabbages or any other type of veg suitable for soups. Improvise and experiment.
We are talking about EGG drop soup, something clear, light and easy. It is perfectly OK to replace clams with tofu or more leaf vegetables as some people may not eat meat. When you change the soup base to Tom Yum, it is totally a different dish. What about curry or Chinese herbs?
Thanks for the recipe, this was great and extremely easy! (Definately going into my keepers. :) ) Thank you.
blog hopped here from another blog. Your recipes and photos are making me hungry. But they all look easy enough for me to try one of these weekends. I have already bookmarked a few to try it out soon. THanks for sharing. :)
Hi Rasa Malaysia,
i am just wondering what kind of chicken broth you use… thats all. Thanks :)
If you have time, you can boil your own stock for hourse on whole chicken, scallions, rice wine, ginger and whatever vegetables you like. After simmering for several hours you can let the stock cool down, skim of excessive fat and remove chicken and vegetables. I sometimes make "ice cubes" of out of stock and store in freezer.
What can i replace with on the chinese rice wine and sesame oil? Can i exclude the both of this ingredients?
Hi Bee,
Had same type of soup with chicken instead of clams in Hong Kong. This was a completely different experience. MSG is very hard to avoid completely, but the best broth is definitely homemade. Sometimes I have to cheat by using Knorr haha as my work schedule is tight. But whenever there is time and leftover chicken parts, I cook broth. I cook mine with rice wine, chicken meat and bones, spring onions, ginger and various greens.
Good to see that you also use white pepper powder. It adds a excellent little "kick" to sauces and soups. I found sugar and white pepper to nearly do the same trick as MSG.
But as you mentioned MSG; have you tried anything named Mushroom seasoning or anything like that? It's supposedly a thing they sell instead of MSG now. I received this tip from a chinese guy.
Love the broth, but I really like a soup loaded with a bunch of things so instead of getting clams, which can be pricey here, I just fill it with chinese veggies and tofu, plus extra eggs.
Just made this and it was absolutely amazing. First recipe I've tried from your site and I can't wait to see what else I can try to make. :D
Wow, egg drop and crab rangoon sure brings back memory of chinese rest in Iowa.
Will surely try some of your recipes. Great to find this site. I am very weak in estimation when cooking is concern. Would be helpful if you can indicate how many persons each recipe is for :)


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Australia is a Clever, Innovative and Productive Country
Have you ever thought about how clever Australians are and what inventions we have created which have benefited the world?
AUSBUY makes the claim we are clever, innovative and productive based on clear evidence. Given the size of our population, our relatively short history and our isolation, Australian ingenuity has been evident from the early days of settlement in the nineteenth century. Many of these innovations were developed when Australia had less than two million people and still they changed the world. Many have involved engineering and science – skills which have helped advance the world we have today.
We also must consider that although they were initiated and developed by Australians many are no longer owned by Australians. We are confident Australians will continue to change the world.
You will be surprised and pleased with the list below and if you think you have identified others then let us know at office(at)ausbuy.com.au
Agriculture & Food
Sunshine Header Harvester
Buffalo Fly Trap
Federation Wheat
Miniboil Water Heater
Nematodes for Pest Control
Nogall Pest Control
Partial Rootzone Drying
Rotavator Rotary Hoe
Wine Cask
Toft Cane Harvesters
Dynamic Lifter Fertiliser
Household & Apparel
Balarinji Designs
Brick Veneer House Construction
Dual Flush Toilet
Helena Rubinstein Cosmetics
Hills Clothes Hoist
Mambo Clothes
Refrigeration – James Harrison
Shepherd Castors
Speedo Swimwear
Splayds Cutlery
Staysharp Knife
Triton Work Centre
Victa Rotary Lawn-Mower
Wool Technology - Fine Wool, Cool Wool etc
Communications & IT
Cochlear Implant
Barra Sonobuoy Sonar
Eddie Special Effects Software
Ericsson Phone Queuing System
Fluid Head Camera Mount
ISYS software
Automatic totalisator
Moldflow Design Software
Mountbatten Brailler
Nomad Computer Interface
Passport Security
School of the Air
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Atom Engine Ignition
Buried Contact Solar Cell
Cactoblastis Moth
Clean Up Australia Day
Fire-Brake Foam
Orbital Engine Technology
Rib Loc Pipe
Snowy Mountains Scheme
Solahart water heater
Early Australian Cinema – the Kelly Gang 1906
Fairlight CMI Synthesiser
Racecam TV Sport Coverage
Super Sopper Roller
Surf Lifesaving Movement
Sydney Opera House
World Series Cricket
Begg Orthodontic Technique
Breath respirator
Cervical Cancer Vaccine
Cochlear Implant
CPAP Sleep Apnea Control
CSL Anti-venoms
Disposable Syringe
Royal Flying Doctor Service
G-CSF Immunity Booster
IVF Embryo Freezing
National Trachoma and Eye Health Program
Relaxin Birth Hormone
Relenza Flu Treatment
Sabine Vacine Against Polio
Sola Plastic Lenses
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Casting Thin Sheet Steel
Coalscan Coal Analysis
Crankless engine - cuts our vibration
Durable Heavy Rail Technology
EXELGRAM Anti-Counterfeiting Technology
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Jameson Cell Ore Process
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UFS. Oh man, Michael, the BSD folks will never let you up over this...
Phoronix: Benchmarks Of FreeBSD 8.1 RC2
FreeBSD 8.1 is slated to be released this month as the first significant update to FreeBSD since the rollout of the 8.0 release last November. With the second release candidate of FreeBSD 8.1 having just been made available a few days back, we have conducted a set of tests comparing the performance of FreeBSD 8.1 RC2 versus FreeBSD 8.0 and an Ubuntu 10.10 development snapshot.
UFS. Oh man, Michael, the BSD folks will never let you up over this...
Some questions if you could please clarify:
1) Why did you used the GCC 4.3.4 version for the FreeBSD 8.1 benchmarks...?
2) ...vs GCC 4.2.1 for the FreeBSD 8.0 benchmarks?
2) Is GCC 4.2.1 not the default compiler on FreeBSD 8.1?
3) Was the kernel built using that GCC version...?
4) ...or just the user-space programs?
5) Did UFS have soft-updates enabled?
6) Are you going to compare the "development" version of FreeBSD (aka -current) as you compare against the development version of Ubuntu?
7) Did you do any single threaded IO tests?
8) Could you use a single GCC version for all tests (i.e. to compare kernel performance)?
Thank you for the comparison. I found it an interesting read.
P.S. the latest geom_sched work should greatly improve FreeBSD's threaded IO performance. It is in FreeBSD 8.1 but not enabled by default. See http://svnweb.freebsd.org/viewvc/bas...ME?view=markup for details.
Cue BSD aplogists in 3...2...1...
I predict the flow will go like this.
BSD: Hey, no fair, it was a RC2, we had eleventy billion debug options turned on.
Linux: Not our fault. Note that 8.0 had nearly the same numbers and was still beaten by Linux is almost every test.
BSD: That's our old version, 8.1 is 100x faster without debugging on and is more secure, your benchmark doesn't show how secure BSD is.
Ubuntu has debugging turned on. The main thing which makes a difference is probably a different GCC used in both systems.
First I would like to point out that FreeBSD stable branches (i.e. 8) has debugging options "turned off". The RC should provide the same speed as the release (unless an important bug was identified).
Also, I am not aware of any benchmarks that can show how secure a system is. I do not think there is any doubt that OpenBSD is the leaders in security.
As a quick (and inaccurate) comparison of security I counted 13 security advisories from Novell for Linux [1] and 6 advisories from and for FreeBSD [2] (of which only 1 directly affected the kernel). This does not give an indication of root vulnerabilities though. I could not find a webpage where Linux published their security advisories.
Regarding the benchmarks, I would like to know is how much of the difference is due to compiler or kernel performance. This is important since each OS used a different compiler.
Some questions regarding the benchmarks:
1) Why was the base compiler (GCC 4.2.1) not used for the FreeBSD 8.1 tests?
2) Was the kernel compiled with GCC 4.3.4 on FreeBSD 8.1 (or just the user-space programs)?
3) Was soft-updates active on UFS?
4) Is it possible to use the same compiler across the board?
5) Is it possible to use the same compiler for all the kernels?
6) Have you done single threaded IO tests?
7) Any plans to test the "development" branch of FreeBSD (aka -current) as the development snapshot of Ubunutu was included?
8) Are there any plans to test ZFS?
FreeBSD is developing support for non-default compilers to be used. It should be fairly easy to compile it with GCC 4.4 (as used by Ubuntu).
A recent development in FreeBSD is GEOM_SCHED that should improve the performance of threaded IO. It is included in FreeBSD 8.1 but is not active by default. See http://svnweb.freebsd.org/viewvc/bas...ME?view=markup for further details.
Thank you for the benchmark, it was an interesting read.
[1] http://www.novell.com/linux/security/advisories.html
[2] http://www.freebsd.org/security/advisories.html
Wait a minute. So GCC is still the system compiler for FreeBSD. What happened to all the big plans of eradicating all GPL code from the FreeBSD base system?Originally Posted by phoronix
More on topic of the article it would be interesting to find out how much of that performance is due to the file systems used. UFS is stable and rock solid, but performance has never been its forte. It's seems a lot of the CPU / memory bound tests it's pretty equal and only once the filesystem gets hit heavily does FreeBSD falter.
Personally, as an overall package FreeBSD is still a better system and it's eco-system is very developer friendly with solid documentation and a well defined set of "core" libraries.


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The mind interprets in such ways that it misses the whole point. The world is to continue: it has always been there and will always be there. Only you will not be there; death will take you away. As empty-handed as you had entered, you will have to leave. If that understanding penetrates your being, then repentance becomes possible. And repentance is nothing but attaining to the clarity of vision. This word repentance is very, very significant. There is no other word more significant in Jesus' terminology because repentance will open the door of the divine. What is this repentance?
You have been angry and you repent. You feel sorry: you have behaved badly with someone and you repent and you ask to be pardoned. Is Jesus' and John the Baptist's repentance the same? Then it cannot go very far, because you have repented many times and you have not changed. How many times have you repented? How many times have you been angry, greedy, violent, aggressive, and you have repented? But your repentance has not transformed you, it has not brought you near the kingdom of God. It has not opened any new doors, new dimensions; you remain the same. Your repentance and Jesus' repentance are not the same. In fact, they are almost diametrically opposite.
So whatsoever you have been understanding about repentance is absolutely false. Try to understand. When you repent, in fact you don't repent. When you repent, in fact you try to repair the image. It is not repentance, it is repairing the broken image that you had of yourself.
For example, you have been angry and you have said things. Later on, when the rage is gone, the madness gone, you cool down and you look back. Now there is trouble. The trouble is that you have always been thinking that you are a very peaceful, peace-loving man; you have always been imagining that you never become angry. Now that image is broken. Your ego is shattered: now you know that whatsoever you have been believing has proved wrong. You have been angry, you have been very angry, and you have said and done things which are against your ego. You have shattered your own self-image. Now you have to repair it.
The only way to repair it is to repent. You go and repent, you say good things. You say, "It happened in spite of me. I never wanted it to be so. I was mad, I was not in my senses. The anger possessed me so much that I was almost unconscious, so whatsoever I have said, forgive me, I never meant it. I may have uttered it, but I never meant it."
What are you doing - repenting? You are simply repairing. The other man relaxes because when somebody asks to be forgiven, he has to repair his image also. If he cannot forgive, then he is not a good man. He was also angry - about your anger - and he was planning to take revenge, but now you have come to be forgiven. If he does not forgive, then he will not be able to forgive himself, then his image will be broken.
And that is the trick you are playing. Now if he does not forgive you, you are the good guy and he is the bad guy. Now the whole thing has been thrown upon him. This is a trick, a very cunning trick. If he does not forgive you, he is a bad man. Now you are at ease, your image repaired. You have thrown the whole guilt on him. Now he will feel guilty that he cannot forgive, and a good man has to forgive. If he forgives, it is good; if he does not forgive, then it is good for you. Now it is a question for him to decide.


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Decoding Da Vinci
It should be no surprise to know that in 2005 the Louvre museum in Paris attracted more visitors, 7.3 million to be exact, than in any previous year since the Louvre was established as a museum in 1793. The museum …Read More
The Da Vinci Conspiracy
Yes, Virginia, there really is a lunatic fringe on the ideological spectrum. We commonly hear perspectives described as left-wing or right-wing. Beyond that, the descriptions become more precise in terms of radical right and radical left. If we cross the …Read More
The Fool's Folly Uncovered
The many biblical errors of the The Da Vinci Code are clustered in two vitally important portions of the story of Dan Brown's blockbuster fictional work. First, the vast majority of statements concerning the Bible appear in the narration of …Read More
Historical Propaganda
Dan Brown's blockbuster novel, The Da Vinci Code, represents an undeniable publishing phenomenon. Sadly, it also represents a direct attack upon the central truths of the Christian faith — and a misrepresentation of historical fact. Indeed, the novel is really …Read More
The Chronicles of Narnia
The most important lessons that we can learn from C.S. Lewis' Narnian Chronicles are the ones that Lewis himself wanted us to learn. It so happens that Lewis said enough about literature in general and the Narnian books in particular that …Read More
The Pagan Agenda of the Code
As I lecture around the world on the Da Vinci Code, a typical response is to tell me to relax, enjoy the book as a fun read of fiction, and move on. Let me say that it is indeed a …Read More
Pilgrims Who Make No Progress
To describe life as a journey is such a perfect metaphor that writers in every age return to it again and again. Western culture is full of pilgrims, headed in different directions, to different destinations. Before John Bunyan's Pilgrim's Progress, …Read More
A Literate Ministry
Consider, if you will, how difficult (and sometimes annoying) it is when you encounter computergenerated voice menus when you make telephone calls. The emphasis is almost always on the wrong syllable, the monotonic and a-rhythmic cadence is unnatural, and one …Read More
Confessions of a Bibliophile
According to the Oxford English Dictionary, a bibliophile is "A lover of books; a book-fancier." Although this is a helpful definition, I'm not entirely sure I want to refer to myself as a "fancier" of anything. I'm from Texas. We …Read More
Truths and Lies in The Tragical History of Doctor Faustus
God is true and every man a liar. Liars, however, dress like their father. That is, just as the Devil appears as an angel of light, so he and his minions appear as tellers, indeed lovers, of the truth. For …Read More
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text: KEI HAU YEE(Kwok Ho Ying, Kenix) gives birth to ten babies after swallowing some magical crystals. Her father kicks her out of the family. She is then taken in by CHAN TAI HA (Lam Man Lung, Frankie), who had been secretly loving her for a long time. The babies grow up in one night. Two of them, BIG EARS (Lam Yuen Ying) and TRICEPS, (Wu Lok Yin), run away in the chaos. HA and YEE have difficulties in keeping the family, so they are forced to send the fourth and tenth sons, NAUGHTY (Li Yan Long) and CRYING BABY (Wong Ping Hei), to a circus and sell the ninth son, BIG MOUTH (Ip Wai). They live with the other five sons, SHARP EYES (Lai Lok Yi), FLY FIVE (Law Kwun Fung), COPPER HEAD (Kwok Jing), Long Legs (Yeugn Ming) and LAND BREAKER (Cheung Chi Hin).


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bricolage in rome Supply impregnants, glazes, murals and even boating. Wide assortment of hardware for the boat, for gazebos, furniture and so on. Profiles in wood with different essences of brass, aluminum, stainless steel, polycarbonate, etc.. Provision of multi-layer in poplar: Multistrati marine different essences, Listellari in different woods, glued in essence, chips ... - wood yourself in rome,
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Rumor Mongering: Tick-Tock, Trade Machiners
About half an hour until the deadline, and not much out of Mavs-land. Considering the Mavs most expendable trade asset (Jerry Stackhouse's contract) can actually be used over the summer (the Mavs have until August to turn down the non-guaranteed portion of his deal), I don't think they'll be panicking. Hell, the Blazers aren't panicking, and that's with Raef Lafrentz's mammoth expiring contract. Here's the latest chatter from around the interwebs:
- Mark Cuban, via Eddie Sefko's piece this morning: "'I don't know that there's a whole lot more that's going to be done,' owner Mark Cuban said. 'Everybody's looking to do the same thing, save money and to save cap room [for the future]. It's hard to do both.'"
- Adrian Wojnarowski, Yahoo Sports: "'It feels like Dallas has 100 different scenarios juggling in the air,' one Western Conference executive said Thursday."
- Eddie Sefko, DMN Mavs Blog: "You never know when a rebound will fall in your lap. And the Mavericks are still working the trade grapevine to see if anything crazy happens in the last hour. Doesn't seem likely, but you never know with this bunch."
- Mike Fisher, DallasBasketball.com: "'How many trade offers have you had?' Donnie [Nelson] was asked on Wednesday night. 'Today? Seventy-five. Maybe 100. A lot,' he responded. 'I just got five in the 45 minutes I've been talking to you guys.'"
Here are the completed trades of the day:
- The Kings trade Bobby Brown and Shelden Williams to the Timberwolves for Rashad McCants and Calvin Booth. The motivations for this deal are largely financial, although Bobby Brown showed potential in the summer league and I'm confident Rashad McCants can be a solid rotation player. Shelden Williams may still have a few tricks up his sleeve, but Calvin Booth's deal expires this summer.
- The Knicks trade Malik Rose and cash to the Thunder for Chris Wilcox. I don't get this one at all. It's a no-brainer from the Knicks perspective; both players have expiring deals, and their production levels aren't even comparable. I doubt Wilcox will re-sign with NY, but they'll get a free look at a much better player. If you can figure out what's in it for OKC, please, by all means.
- The Bulls trade Larry Hughes to the Knicks for Tim Thomas, Anthony Roberson, and Jerome James. Jerome James is likely to retire after this season, meaning most if not all of his 2009-2010 salary will be covered by insurance. This could be the Knicks trying to consolidate their deals into one neat little package, or maybe D'Antoni seems some real value in Hughes. Either way, if for whatever reason the Knicks do decide to play the trade market next year, Hughes' expiring deal will be worth more to teams than Thomas'. The Bulls can plug Thomas into Nocioni's role, and on top of that they should save some coin if Jerome James retires as planned. Anthony Roberson's a freebie.
- The Bulls trade Thabo Sefolosha to the Thunder for a nondescript future first rounder. More on this as it's confirmed; I haven't seen a release yet.
- The Kings waive Mikki Moore. The Cavs and the Celtics are the early favorites to bid for his services (each has at least part of their midlevel exception remaining).
- Three-team deal: the Magic acquire Rafer Alston, the Rockets acquire Kyle Lowry and Brian Cook, and the Grizzlies acquire Orlando's first round pick. Rafer's got the experience and did a surprisingly good job during that 22-game win streak last season, so why risk changing point guards with T-Mac already on the shelf? Even if Lowry is younger and a marginal upgrade, aren't the Rockets hinging an awful lot on the shoulders of a young point guard that has shown little to no improvement in his first NBA seasons and has looked shaky as a starter. Magic fans are in for quite the headache, and the Grizz are saving up their lunch money.
- Another three-teamer: the Raptors get Patrick O'Bryant, the Kings get Will Solomon, and the Celtics get a virtually nonexistent second round pick that's as conditional as fine print. No comment.
Fin. Done. It's over. These are the Mavs you'll see for the rest of the season, folks — for better or worse.


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Experience Michiana: June 10th, 2013
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About This Episode
Episode #421
Tonight, Travis Childs and Gordy will talk about the Center for History Cemetery Tours. Then Chef Tonya McGowan is back from the Palais Royale to show Gordy something easy to make just for Dad. Also, Gordy and Jessica Brookshire will talk about the Notre Dame upcoming event, Old2Gold. Finally, Gordy and Crick Haltom, owner of the Lawton Ridge Winery, will talk about The Lake Michigan Shore.
- Original Airdate:
- June 10, 2013
In This Episode
Also In This Episode
- Introduction
- Ice-Cream Run
- Arts Calendar
- Closing


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Yesterday, in Paris, in front of the majestic Hôtel des Invalides, Raf Simons sent out his fall-winter 2013-2014 haute couture collection for the house of Dior. A fashion show of inner voyages, with a veritable world tour of inspirations.
There are four of them. Four archetypes of woman, four femininities, four cultures, four ways to imagine and to wear haute couture. One is from Europe, one from the Americas, a third from Africa, and the last Asia. A vision culled from geography and a voyage of opposites drawn from the world of couture and its clients. "I started by looking at the haute couture clients from different continents and different cultures, and their own personal style," explains Raf Simons. "The collection wasn't just about a Dior that's Parisian or French, but about a Dior confronted with the entire world, and how these fashion cultures can serve to influence both the house and me." For these clients, the exchange provides the basis for Raf Simons' creative process. Starting from that idea, he came up with the four women. They're four clients from different origins and cultures, and at the same time they're four modern women, meaning four woman who travel, who know the world, and know how to pick up on the various current influences that they find there. For each one, he dreamt up a wardrobe that would be both a Dior wardrobe par excellence and also the reflection of their own personality. It was in this way that Raf Simons envisaged the creation of each haute couture outfit, and it was through this same creative process that the whole collection came into being.
The woman from Asia can be recognized from the sense of balance between the purity of her silhouette and the architectural precision of the garment. Her coats of printed wool or bright red mink fasten like kimonos, like the simplest form of the double-breasted; her evening dresses appear as wide swathes of silk, but are fitted to the body through an ingenious use of folds. Other dresses refer to the traditional technique of shibori, the Japanese art that through the use of knotting and dyeing molds fabrics into three-dimensional conical motifs. While the woman from the Americas has a more nonchalant allure, she's audacious and doesn't hesitate in finishing off the sleeves of her blue cashmere coat with wide ecru ribbing. Her colors are a source of pride, and we can identify, from one look to the next, the blue, red, and white that, taken together, form the colors of the US flag. One outfit with stripes, another with feather stars, combined they contain the components of the flag's iconic Stars and Stripes .
The woman from Europe has dash and flair. She can be recognized from her Bar silhouette, inspired by the tailored jacket by Christian Dior in 1947, which whittles the waist and accentuates the hips with its peplums. She carries off masculine fabrics with aplomb, appropriating them with re-embroidered motifs, in the way a real Parisienne knows how to work a tone-on-tone effect to perfection. The African woman is a queen, expressing her freedom. Her evening dresses are draped with ease, playing on what they hide and reveal of the body beneath ; her embroidered silk coats seem made of wide open weaves; and her multicolored knits and embroidered tulles trace tribal tattoos on the skin.
Beyond their cultural differences, all four share the same vision and spirit: the one Raf Simons has breathed into the house of Dior. And so, throughout the course of the show, those codes so associated with the couturier Christian Dior kept appearing: feminine looks with masculine fabrics, the Jungle print that was inspired by his muse Mitzah Bricard and which proved to be, in the spirit of this collection, symbolic of travel in far-off lands. And, of course, there are the identifiers of the hand of Raf Simons: his colors employed in turn as all-over patterns or as bright flashes inside silk of darkest black, his layering of lengths and volumes, his playing with materials and surface shine, his asymmetries, constructions, lightness and depth.
This collection was a crossroad of cultures. It's the very quintessence of what haute couture is today: the meeting between tradition and modernity, the meeting between a house boasting exceptional savoir-faire, a client of today with a strongly developed personality, and a designer who knows how to take them toward the future.
"What I wanted above all else was to bring a real sense of reality to haute couture," Raf Simons concluded. He gave as good as his word.


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Elton John To Guest On Queens Of The Stone Age Album
Monday, February 11, 2013
Music legend Elton John is the latest artist to make a guest appearance on the upcoming album from Queens Of The Stone Age. Elton revealed the news earlier this week on Chelsea Lately, which is being guest-hosted all week by Foo Fighters frontman Dave Grohl. Grohl, who played all the drums on the new Queens disc, said, "Recently Elton and I recorded something together, something that people wouldn't imagine the two of us doing together," before letting Elton tell the rest of the story.
Elton explained, "I was in Vegas and I came back to L.A. and Engelbert Humperdinck had written me this very sweet letter and asked me to do a duet with him and I couldn't say no . . . I went there and sang the duet with him and then I drove three blocks in the Valley and went from Engelbert to Queens of the Stone Age, which was a bit of a mindf***."
Elton is no stranger to performing with modern rockers, having made an appearance on the last Alice In Chains album as well.
He said about recording the Queens song, "It was really a great track . . . we played for three hours, and (Grohl) played on every take and every take was amazing. He's just built like a brick s***house when he plays the drums, you know, and it was fantastic."
The new Queens album, the band's sixth and its first since 2007's Era Vulgaris, also features guest appearances from Nine Inch Nails' Trent Reznor, former Queens bassist Nick Oliveri, Screaming Trees frontman Mark Lanegan and others, A release date has yet to be confirmed.
Photo Courtesy of PRPhotos.com
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Washington, D.C., August 30, 2012 (PAHO/WHO) – A new consortium convened by the Pan American Health Organization/World Health Organization (PAHO) and comprised of more than 20 health and nutrition experts from governments, civil society, universities, and representatives from major food and beverage companies, committed to work on reducing dietary sodium after a two-day meeting on August 28-29, 2012 at the PAHO's headquarters in Washington, DC.
The group agreed that a coordinated, salt-smart approach is needed for the region of the Americas, and joint action for a healthy heart would save lives and reduce the growing costs associated with non-communicable diseases (NCDs) in the region.
"Excess salt is far common in our modern diet, and we all know that a grain of salt goes a long way. All stakeholders have a role to play, so let's work together and commit to a common way forward," PAHO Director, Dr. Mirta Roses Periago, said.
Typical modern diets provide excessive amounts of salt, from early childhood through adulthood. Consumption of more than 5 grams per day in a given population is known to increase the overall prevalence of high blood pressure. High blood pressure is the leading risk factor for death from heart attacks, strokes, and kidney and heart failure. In many countries of the Americas, salt consumption is three times the recommended level.
"Excess salt consumption is a clear public health challenge for the region and reducing dietary salt is a clear best buy for all of society," said Dr. Branka Legetic, regional advisor for NCDs at PAHO/WHO.
Major food and beverage companies expressed commitment to a multi-stakeholder initiative, a new partnership model being used by PAHO under the Pan American Forum for Action on NCDs (PAFNCD) to engage all-of-government and all-of-society to address critical issues in chronic disease prevention and control.
Agreement was reached to implement a common, stepwise approach to dietary salt reduction, with industry and government support, and consumer awareness efforts. The consortium will work together over the coming months to develop a positive environment to reduce salt consumption in the region of the Americas, setting specific goals and timelines, with industry continuing to progressively reformulate products, governments considering appropriate guidelines, policies, and legislation, and all partners supporting efforts in advocacy, communications, and social marketing.
"There was clear recognition that working in silos has not produced the necessary intended results to reduce excessive sodium consumption in the diet. All stakeholders have a role to play, and previous efforts have shown that when governments engage with industry and civil society to reduce salt in food, they can achieve success," said Dr. Irene Klinger senior advisor at PAHO/WHO and coordinator of the PAFNCD.
The Pan American Forum for Action on NCDs (PAFNCD) is an initiative of the Pan American Health Organization/World Health Organization conceived as a platform for a whole-of-government and whole-of-society effort to confront the NCD epidemic in the Americas by mobilizing partners to work together through new innovative initiatives that promote health at all levels, reduce the growing costs associated with NCDs, and save lives.
PAHO, which celebrates its 110th anniversary this year, is the oldest public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.
- Pan American Forum for Action on NCDs
- Twitter: @NCDs_PAHO / @pahowho
- NCDs facebook
- www.paho.org/paho110/
- http://www.paho.org
- youtube
Media Contacts:


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The award-winning cycling classic
Test ride any of Rapha's Classic products to destruction and if you are not 100% satisfied within 30-days you can return them for a full refund.
Also available for women »
For road cyclists, a high-performance jersey is indispensable and performs multiple roles. It protects the rider from the elements, helps to regulate body temperature and stores vital cargo such as food, tools and valuables.
The Rapha Classic Jersey has received numerous plaudits since it was first launched in 2004. The jersey combines functionality and cycling performance with Rapha's trademark styling. It can be worn on its own or as an additional layer.
The jersey has three main cargo pockets and an additional pump sleeve in the middle pocket. The right rear pocket has an eyelet to run headphone cables inside the jersey and an additional zipped, valuables pocket keeps contents secure.
A set of complimentary arm warmers, designed specifically for use with the Classic Jersey, are perfect for cold mornings and feature a brushed fleece inner and contrast piping.
See the Classic Jersey feature »
"The best bike jersey the world has ever seen."
- Bill Strickland, Bicycling Magazine
"The best thing about the jersey is the fit. It's simply perfect. It fits like a road jersey should - snug around the chest, tight enough on the upper arms to fit snugly around arm warmers but not so tight that it leaves those little red elastic marks like a bad tattoo, and long in the torso."To maintain and protect your merino products we recommend using Rapha Merino Wash »
- Joe Lindsey, Bicycling.com *****
Rapha Merino Wash has been specially formulated for Rapha merino products, with a gentle action that cleans without stripping out the natural oils that are the key to merino's performance. Used regularly, the wash will remove dirt and refresh merino garments thanks to ingredients that include Rapha's Ventoux fragrance. Inspired by the plants and herbs that grow on the slopes of the 'Giant of Provence', the wash also has natural Cedar extract to help repel moths.


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Moen Toilet Supplies
Moen is one of the best companies on the market. It is a trusted global leader in water delivery solutions. They pay a lot of attention to the customer's needs and provide excellent service. Moen make the products which are not just qualitative. They are the best in many kinds. That is why Moen has a great number of awards. The latest include 2013 awards for design excellence, 2013 Hottest Gadget, 2013 KBCulture Awards. During the previous years it got Product Innovator Award, World Class Customer Service Award, Top Money Saving Products and other famous awards all over the world.
Moen offers a wide range of toilet supplies of different design, style and color. There is especially good choice of tank levers. A number of finishes allows getting one which will suit a certain interior. There are brushed nickel, oil rubbed bronze, antique bronze, chrome finishes. The style varies from traditional to modern. Many collections (Kingsley, Rothbury, Vestige, Waterhill, Weymouth, etc) present various styles. The included additional features will make the lever serve longer. They are corrosion resistant, have a zinc mounting post, work with most toilets and there is no need to drain the tank.
There are also a lot of products for the entire restroom, including towel bars, robe hooks, showering products, tower and vanity shelves, knobs and pulls, lightning and mirrors.
Moen toilet supplies are reliable and durable. Those who have already bought it claim that they serve long and need no repair. Professionals often choose these products to add special accents to interiors. Moen supplies look good both for usual nice bathrooms and for luxury restrooms.
Westside Wholesale offers a wide variety of supplies. Those who create a new look of their bathroom should think about buying several Moen products including sinks and faucets. One manufacturer's goods will create a holistic approach to the design and bathroom will look integral. All the models are in stock and offered at wholesale prices.
Moen Brantford Tank Lever - Oil Rubbed Bronze
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How to Select
How to shop for Toilet Supplies
Today, it is necessary for all the modern homes to have a modern toilet. Any modern toilet must be equipped with some of the latest toilet supplies. These supplies add to the functionality of the toilet and are considered a must. No toilet seems complete without the toilet supplies such as toilet cleaning supplies, toilet flappers, toilet levers, toilet fill valves and even the repair kits. All these things are meant to keep the toilet hygienic, functional and running all the time.
Due to the prime importance of these supplies, it is necessary that the most appropriate ones are chosen. Assistance is available in this regard from Westside Wholesale and one can choose the right toilet supplies.
Some of the significant factors should be kept in mind while shopping for toilet supplies. These include the following:
- Material. It is necessary to consider the material that is used to make these supplies. The material determines the life of the supplies and the fact that how much wear and tear they can bear. It is advisable to opt for those made from stainless steel.
- Adaptability. It is better to go for the supplies that can be bent or trimmed to be used in more than one way. This reduces the effort required in finding the new ones when some product is replaced in the toilet with which these supplies can be used. It also reduces the costs as well.
- Sturdiness. Just like the material, sturdiness of the supplies is important to keep them intact for longer period of time. This makes sure that no extra costs are incurred in terms of repairing the existing ones or buying the new ones.
- Ease of Installation. The products that are highly recommended and are in demand all the time are those that are easy to install. Always choose the toilet supplies that can be installed easily and don't require a technician every time they have to be installed or changed.
Buying the toilet supplies from Westside Wholesale makes the process fast and simple. There is no need to worry about the quality because the products in stock are from some of the reliable brands including Fluidmaster, Moen and Bemis.
Online experts are available to assist in your decision and provide any advice necessary to make the best purchase. All manufacturers have been selected to give you high quality products at economically competitive prices.


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Shop All Jewelry
RGZ11021 In Stock
Looking for something contemporary and exciting? With this Contemporary Style Oval Onyx Sterling Silver Ring with CZ Accents you get both! The contemporary black onyx center is a beautiful touch to any outfit and the cz accents really make it pop! This Oval ring Onyx Sterling Silver Ring with CZ Accents comes in sizes 5-9.
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Recent comments
Game: Jasper's Journeys
Nice little game, it seems to be a solid platformer and is enjoyable. Runs fine on my arch linux machine
Forum topic: Seasons of war
For me works, probably not published content is available only for the author and moderators.
Forum topic: Seasons of war
The link doesn't work
Game: Q3Rally
In quite early state, I'd say. No files, you have to get things from SVN. Compile went fine, but you have to move/link libraries from
engine/build/release-linux-/baseq3r/*.so to
baseq3r in the TLD. Also go to
baseq3r/maps and link/rename the maps to uppercase.
The supplied
run.sh assumes you have a 32bit system. Game itself has (so far) only one map in the SVN, and only two cars (player, 1 bot)
Game: Roll 'm Up
I did not need installing any additional libraries. This may be because I already installed some older libraries when tested other games. All libraries I installed came in packages so no manual hacking. I also installed the game from the RPM and it works well, though does not create a menu entry (starts from the command line as "rollemup").
manual, but with an extra block
See Also - sequels, prequels, same universe...,maybe clones/mods
Similar - similar gameplay eg. UT is similar to Q3A, OpenArena, Quake Live, War§ow etc. (all of them are pure tournament shooters, no story, no campaign...)
maybe for Quake IV:
See Also: Quake II, Quake, Quake Wars
Similar: DOOM³, PREY , Duke3D etc.
Game: Jasper's Journeys
Quoting game author: "To test the linux versions of my games, I made a build of Jasper's Journeys with bundled SDL libraries. If it works then the others should too. So please try it out! It's the full version *nudge* *nugde*"
Lgdb news: Similar games
Voted for Manual selection. Any kind of automatic recommendation just don't work nowadays. "See Also" feature is the only way to make a real useful recommendation. I think we'll be able to fully replace Similar games after few months, when we'll add enough of See Also links (I'm trying to add no less than 5-10 per day).


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The IZIP Tricruiser Adult Electric Tricycle is one of the best electric tricycles available today for it's price. It has a classic adult tricycle shape with a comfy saddle and a large rear basket. It has a "Twist and Go" throttle, and a top speed up to 18 mph (29 kph) with a 30-35 miles […][Read More]
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Biggest sports scandals of all time
POSTED: 11:38 AM PDT Jun 05, 2013 UPDATED: 10:55 AM PDT Jun 06, 2013
The Baltimore Ravens have cut Ray Rice after a graphic video of him punching his former fiancee surfaced. From questionable wins to doping allegations, here's a look at sports scandals that shocked the world.
The views expressed are not those of this company or its affiliated companies. Please note by clicking on "Post" you acknowledge that you have read the Terms Of Service and the comment you are posting is in compliance with such terms.blog comments powered by Disqus


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Or find a doctor at another Johns Hopkins Medicine Member Hospital:
John Harmon, MD
Director, Surgical Research
Professor of Surgery
Professor of Surgery
Appointment Phone
Main Location
Johns Hopkins Bayview Medical CenterView All Locations
Out-of-State & International Patients +
Out of State Patients
Call 410-464-6641 (8a.m. to 6p.m., EST, Mon-Fri)
International Patients
Call +1-410-502-7683 (7a.m. to 6p.m., EST, Mon-Fri)
- Director, Surgical Research
- Professor of Surgery
Centers & Institutes
- Comprehensive Hernia Center
Breast Cancer, Breast Disease, Burns, Cancer, General Surgery, Hernias, Surgery, Thyroid Disorders, Wound Healing
Research Interests
pathophysiology of gastro-esophageal diseases; Surgical wound healing
BiographyJohn W. Harmon, M.D., FACS, is a general surgeon with a wide-ranging practice including a variety of complex clinical problems, Dr. Harmon specializes in the management of complex hernias and wounds. However, his many surgical interests include hernias, wound healing, breast cancer, colon and small bowel cancers, stomach cancer, as well as thyroid and parathyroid conditions.
Dr. Harmon has been featured in several publications regarding the gastrointestinal organs, including the esophagus, stomach, small intestine and colon. He has also published information dealing with military medicine, specifically blast injuries. Dr. Harmon was one of the first to publish, in his paper on Zollinger Ellison syndrome, the importance of removing tumors. He also was the first to observe an endocrine effect of marijuana. His animal studies of GERD (gastro-esophageal reflux disease) were extensive and helped explain the pathophysiology of the condition.
- English
- French
Additional Resources
Education +
- Columbia University College of Physicians and Surgeons (New York NY ) (1969)
- Boston City Hospital / Surgery (Boston MA ) (1975)
- Lahey Clinic / Gastroenterology (Boston MA ) (1973)
- Beth Israel Deaconess Medical Center / Surgery (Boston MA ) (1972)
- Surgery, American Board of Surgery (2005)
Research & Publications +
Academic Affiliations & Courses +
Activities & Honors +
Videos & Media +
Events +
Contact & Locations +
LocationsJohns Hopkins Bayview Medical Center4940 Eastern AvenueBaltimore, MD 21224Appointment Phone: 410-550-0400Location MapThe Johns Hopkins Hospital600 N. Wolfe StreetSheikh Zayed TowerBaltimore, MD 21287Appointment Phone: 443-997-1508Location MapJohns Hopkins Outpatient Center601 N. Caroline StreetBaltimore, MD 21287Phone: 410-550-0401Appointment Phone: 443-997-1508Fax: 410-550-1245Location Map
- Surgery