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Radical anti-government protesters were forced to give up their brief occupation of Ukraine's Justice Ministry on Monday after fellow opposition groups accused them of jeopardising peace negotiations.
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The Cleveland Local: A Milan Jacovich Mystery (#8)
#8 in the Milan Jacovich mystery series . . . Hotshot young Cleveland lawyer Joel Kerner is shotgunned to death on a lonely beach on the Caribbean island of San Carlos. The local police are inept, and the Cleveland cops can't operate outside their jurisdiction, so Kerner's sister Patrice comes to private eye Milan Jacovich (it's pronounced MY-lan YOCK-ovich) to discover the truth about her brotherThe Collected Short Fiction of Bruce Jay Friedman
Bruce Jay Friedman has been hailed by critics as a comic genius, a writer whose vision confronts the malaise of contemporary life with a liberating deadpan humor. Grove Press is proud to reissue the collected short stories by this acclaimed master of modern humor. Hailed by Newsweek as "a bona fide literary event," The Collected Short Fiction of Bruce Jay Friedman brings together Friedman's fiftyBetween the Dark and the Daylight
Crime fiction's biggest names have been rounded up for a truly impressive collection of 2008's best short stories. Featuring authors like Michael Connelly, Charlaine Harris, and 2009 Edgar Award winner T. Jefferson Parker, this volume should be on the shelf of every mystery fan.A Hoke Moseley Detective Thriller
Hoke Moseley has had enough. Tired of struggling against alimony payments, two teenage daughters, a very pregnant, very single partner, and a low paying job as a Miami homicide detective, Hoke moves to Singer Island and vows never step foot on the mainland again. But on the street, career criminal Troy Louden is hatching plans of his own with a gang including a disfigured hooker, a talentless

subset: commoncrawl


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Monday, December 03, 2012
Hit List Found In Student's Locker
Bristol, Virginia police found a �hit list� inside of a student's locker at Virginia Middle School. School leaders found the list during a search of the locker. The student made a list of fellow students he would get �if he were diagnosed with cancer or a life threatening illness�. The student was suspended and his guardians took him to Highlands Community Services for a mental evaluation. The Commonwealth's Attorney's Office determined no crime had been committed. School system officials and the child's guardian will resolve the matter. (jb)
Friday, April 24, 2015
Bond Revoked on Sullivan County Woman Charged with Poisoning and Shooting Husband
Federal Judge Fines Washington County, TN Farmer for Using Outlawed Chemical
UPDATE: Another Bomb Threat in Kingsport, Another Two Juveniles Arrested
Finalist for Unicoi County Director of Schools Position Offered Contract by Greeneville City Schools
Sullivan County DA Going to Court Seeking Bond Revocation of Woman Charged in Attempts to Kill Husband
With Criminal Investigation Ongoing, BVU Cutting General Legal Counsel to Part Time Work
Despite Reservations, Haslam Signs Bill Allowing Guns in TN Parks
Kingsport Senior Citizen Arrested for Selling Pain Killers Obtained Through TennCare
Johnson City Man Charged After Trying to Rip Off Elderly Couple
Three Bomb Threats in Two Days at John Sevier Middle Leads to Three Juvenile Arrests
UPDATE: Bond Denied for Double Homicide Suspect in Carter County
Bluff City's Speed Cameras Just Renewed for Five Years; Law To Ban Them Won't Impact Contract
Murder Suspect in Wise County Granted Bond
Confessed Meth Ring Members Appear in Abingdon's Federal Court
Rash of Burglaries, Thefts Reported in Bristol, Virginia
Johnson City Man Arrested & Charged After Remains of Missing Sullivan County Couple Found on His Carter County Property
Two Youths Charged With Felonies After Consecutive Bomb Threats at Kingsport Middle Schools
Smyth County Man Killed From Injuries Sustained in Motorcycle Crash
Families Up Reward Amount for Tips on Double Homicide/Fire in Greeneville Last March
Roan Mountain Woman Booked on 32 Charges Including Identity Theft
Kingsport Detectives Solved Armed Robbery From December
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Logo for an Event
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I am hosting an event called the 'Indo-Western Lifestyle Event' and would like a permanent logo for the next few years. I am looking for something creative, colourful and catchy. This logo will symbolise the indian/western communities.
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Weekend Checklist for the Busy Girl
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"In 2009," we're told by Gilles Peterson's website, "a handful of London-based musicians travelled to Nairobi in Kenya to collaborate with local musicians there." The Kenyan musicians came from a village called Owiny Sigoma. "It was a loose arrangement." In fact, the whole album sounds like a loose arrangement—a practiced looseness, an open-ended sound, sustained by repetition and Luo patterning, with a modest roughness that helps us relax and take in the unexpected when it arrives. The British musicians contribute keyboards, other instruments, English-language singing and some indie song-shaping. The Kenyans contribute more instruments, more singing and the manipulation of those patterns and unexpected moments. Owiny Sigoma Band is less dazzling than albums that construct themselves around cresting horns, monumental voices and a series of climaxes and dramas. The charm of it lives in its corduroy texture.
Country Fried Rock: Hollis Brown Interview
// Sound Affects
"New York City rock band Hollis Brown have a new album, 3 Shots, that hits the listener with collaborations including Bo Diddley and Nikki Lane.
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Hi my name is Liz and I'm looking to meet new people and have fun. It's time I got out and your it. I love to dance so maybe I'll meet you on the dance floor.
Great. Debra has some good ideas for things to do.
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The Valley Oak League's top girls golf team appears to be getting better.
Weston Ranch High has its first-ever Valley Oak League championship girls tennis team after the Cougars defeated Kimball 4-1at home Thursday.
Ripon High had the shots, but the only ones that matter are the ones that go in.
Co-head coach Brian Goulart was anxious to see how his East Union High girls golf team would perform in Wednesday's Sierra Invitational - the Lancers' first and last 18-hole event of the season before the Valley Oak League Championships.
The Manteca Buffaloes wanted to come out aggressively and that is exactly what the squad did in a 3-0 Valley Oak League win over Kimball High Wednesday.
Things went according to plan for the Ripon Indians Wednesday in their Trans Valley League match with Riverbank High, as they stopped the Bruins with relative ease in a 25-13, 25-12 and 25-12 win at Ripon High.
Manteca High coach Tim Horning sat at the end of the bench, head buried into his hands while his players settled into their seats on the other end of the court between the second and third games.
WESTON RANCH – This Valley Oak League season had been full of firsts for the Weston Ranch Cougars, and if the season were to end today they would be in first-place. But the team's business is far from done, as it took a gigantic step towards their goal with a 3-2 win over Sierra High Tuesday.
Ripon Christian's first stint through the Southern League has become as routine as bumping, setting and spiking.
The Southern League has not treated its newest member too kindly, as the Ripon Christian Knights ran into another one-sided defeat, 8-1 against visiting Gustine Tuesday.
The Manteca High cross-country team made a trip to the coast for the 39th Annual Half Moon Bay Artichoke Cross Country Invitational Saturday, competing against several programs at Half Moon Bay High.
After getting pushed round in two losses to start the match, East Union held a five-point lead with five points to go but couldn't finish the deal in a 3-0 loss to the visiting Oakdale Mustangs Thursday at the Dalben Center.
Weston Ranch mounted spirited comebacks in the first three games, but when intra-district host Sierra High attempted its own in the fourth the Cougars calmly put the finishing touches in their thrilling victory - 25-23, 24-26, 26-24, 25-19.
Manteca High still hasn't gotten over the hump, but coach Tim Horning saw some encouraging things out of his team in a three-game loss - 19-25, 12-25, 18-25 - to Valley Oak League defending champion Sonora Thursday at Winter Gym.
At this point, Ripon High will take goals any way it can get them.
STOCKTON - Although Weston Ranch never led in Friday's 15-12 non-league loss to visiting Summerville, the Cougars bounced back to erase an eight-run deficit and then cut a six-run lead in half but could not erase it altogether.
East Union softball coach Brian Goulart called his three sophomore pitchers "heroes" after the Lancers held off defending Modesto Metro Conference champion Gregori 13-10 in its home opener Thursday at Northgate Softball Complex.
The Manteca baseball team knows how to turn things around.
Joshua Patton, Hunter Johnson and Devin Nunez graced the interview stage at Sleep Train Arena, the senior stalwarts each donning the signature blue cap reserved for a Sac-Joaquin Section champion.
Former Sierra High pitcher and U.S. national team member Allie Walljasper is making the "ol' college try" look far too easy.
Ripon overcame an early three-run deficit by scoring five in the fifth and held off visiting Hilmar 7-6 to complete the season sweep of the Yellow Jackets on Thursday.
RIPON - The season came to a halt Wednesday for the Ripon Christian girls as they fell to visiting San Domenico in the CIF Northern California Regional Championships.
Leah Manuleleua is settling in nicely as the Manteca High girls soccer team's new target forward.
The past three days have been an exercise of control and focus for Scott Thomason and his history-making Sierra High boys basketball team.
STOCKTON - Jaelen Ragsdale lingered around the bench, shuffling between handshakes, high-fives and hugs from appreciative Cougar fans.
PALO CEDRO - Manteca High and senior guard Marcus Montano came to play on Wednesday night and proved they belonged in the CIF NorCal Division III boys basketball tournament.
Lathrop softball pitcher Samantha Fonseca struck out four and doled out three hits in the Spartan's 16-2 shellacking of visiting Sonora in a nonleague contest Wednesday.
In four years, the Manteca High girls soccer program has raised more than $25,000 for the American Cancer Society and ill-stricken families in the community.
TRACY - East Union has speed and power up and down the lineup and a trio of capable sophomore pitchers backed by a reliable defense.
Zach Horwood RBI fielder's choice in the top of the sixth inning was all Ripon needed in its Trans-Valley League opener at Hilmar.


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The Illuminati was made a offer they couldn't refuse.
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rebuke and puke
Post Content
These dudes may have tried. But even then, its hard to know what might have come.
In any case, contrary to what some would say, history is important to study. I have enjoyed this thread, page 322 has some good stuff as well.
link to www.jewsagainstzionism.com
Statement issued December 14, 1925 by RABBINICAL COURT OF THE ORTHODOX COMMUNITY OF EDAS YESHURUN, City of Kaszica, Hungary
It is our obligation to make a public announcement because we know the extent to which the issues are important. Despite all its propaganda,
the Zionist movement stands in total opposition to the foundations of the Jewish faith transmitted to us throughout the generations. Zionism itself rejects the Jewish religion.
This is the position of our great and pious rabbis in the past and the present, in the Holy Land and abroad, without exception.
In the early years of Zionism, when it pretended to express love for the Holy Land and the holiness of the opportunity to live there, a few rabbis were caught in its snare. Today, however, when Zionism shows its true face as a false messianic movement, our rabbis stand at war against it just as rabbis of former generations had opposed the false messiahs of their times, including during the time of the
false messiah Shabtai Zevi, may his name be obliterated, and the later movement of the Frankists.
Association with the Zionists is forbidden according to the Torah and our tradition. Zionism is a disgusting abomination.
This announcement is based on all aspects of Jewish law. Every Jew who fears G-d will certainly accept our statement under the Code of Jewish Law and shall not stray from it to the left or the right.
May those who follow it be blessed.
December 14, 1925, Kaszica, Hungary
Rabbi Shaul Brach
Rabbi Hanoch H. Pack
Rabbi Shmuel Jungreis
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Senate Approves a Bill on Changes to Medicare - in the way Medicare pays doctors
Welcome to rent control! 88,000 apply for 55 apartments
Halliburton Announces 9,000 Layoffs
Population Controllers Wage War on Maternity in the Name of Mother Earth
School Teachers Worsen Racial Conflict With Dishonest "BLACK LIVES MATTER" Propaganda In Classrooms
Democrats Introduce Resolution Calling For Debt-Free Public College
Nigerian Bishop Says Christ Showed Him How to Beat Islamic Terror Group
After vision of Christ, Nigerian bishop says rosary will bring down Boko Haram
Social Security Reform Hurts America, Particularly Minorities
Judges Sue Over Same Sex 'Marriage'
Feds Say Cannabis Is Not Medicine While Holding The Patent on Cannabis as Medicine
Monsanto Knew of Glyphosate / Cancer Link 35 Years Ago
JADE HELM 15: Army Special Operations Command pushes back against alarmist claims about upcoming exercise
FBI can't cut Internet and pose as cable guy to search property, judge says
The Decline and Fall of the United States
State Lets Police Take Teenagers Away From Parents If They Are Left Home Alone
ECB Prepares To Sacrifice Greek Banks With 50% Collateral Haircut
The School Of The Americas Is Still Exporting Death Squads
One Last Look At The Real Economy Before It Implodes
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Toshiba bows refreshed Excite tablet line
Toshiba announced on Monday that a trio of new Excite tablets (Excite Pure, Excite Pro, and Excite Write) will roll out starting from June 25th. Each runs Android 4.2 Jelly Bean, features a 10.1-inch display and NVIDIA processor, and can be paired with a protective 2-in-1 keyboard cover.
Excite Pure pricing starts at $299.99 and includes a 10.1-inch AutoBrite display (1280 x 800), NVIDIA Tegra 3 mobile processor, 1GB DDR3 memory, 16GB internal storage, and a 3-megapixel rear camera. Additional details include stereo speakers with DTS Premium Voice Pro, Micro HDMI, Micro USB ports and a Micro SD slot.
Excite Pro is priced at $499.99 and includes a 10.1-inch PixelPure display (2560 x 1600), NVIDIA Tegra 4 mobile processor, 2GB DDR3 memory, 32GB internal storage, and an 8-megapixel rear camera. Rounding things out are Harman Kardon stereo speakers with DTS Premium Voice Pro, and Micro HDMI, Micro USB ports and a Micro SD slot.
Excite Write runs $599.99 and boasts a 10.1-inch PixelPure digitizer display (2560 x 1600) with Corning Gorilla Glass 2, and a pressure sensitive Toshiba TruPen and TruNote application. Also powered by an NVIDIA Tegra 4 mobile processor, the tablet packs 2GB DDR3 memory, 32GB internal storage, and an 8-megapixel rear camera. Additionally, you'll find Harman Kardon stereo speakers with DTS Premium Voice Pro, and built-in Micro HDMI, Micro USB ports and a Micro SD slot.
While we're glad to see Toshiba continue with the Excite line of tablets we have to wonder about the price points. We're talking about devices that run as much, if not more, than the likes of the Nexus 10 and iPad.
Do you think any of these tablets sound your next device? What's your thoughts on the Galaxy Note-like experience in the Excite Write? Leave a comment below with your opinion!
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This discussion has been closed.
Posted by Alex S (U4744604) on Thursday, 9th November 2006
Hello, Jackie Dalton!
There was a BBC English teaching
series called "Feedback" about
ten years ago or so (more or less
of the same time as the "Network"...)
So I decided to make a similar thread
in this message board :-D
Thank you for posting the links
to the Weekenders in the Global
Warming discussion thread!
Mp3 downloads! I have been waiting
for this moment since BBC English
went online! Well done! I hope,
this is just a beginning...
Yvonne Archer??? I think you just
cut some episodes from the Friday
Shows? Am I right? I don't think
that Yvonne is still producing for
the BBC English... As well as Callum
You know what? You somehow read in the
"Friday Shows" messages of the BBC-elt
mailing list members. Why don't you put
those extracts in mp3 on your site?
I'm sure Nori would be very curious
to hear how you read his letters!
Am I right, Nori? :-D
I hope you like FEEDBACK!
(you always liked it)
Alex S
Hah-hah-hah...The tongue is not steel ,yet it cuts.;)
Alex is a real Ukrainian.
, in reply to this message.
Posted by BBC Learning English (U2385303) on Tuesday, 14th November 2006
Dear Alex S,
Yvonne, Jackie and Callum at your service!
It's great to hear from you and good to know that you're still on the ball with all the archive of Learning English programmes!
Unfortunately, times have changed and we don't currently have the resources to make use of archive material, but hopefully things will change.
In the meantime, we hope you're enjoying the current BBC Learning English site and stay well - also Nori!!
Best wishes,
You know who!
Thank you, LE!
I hope I manage to bring a broad
smile sometimes upon your faces!
Alex S
, in reply to this message.
Posted by claudia -networker (U4429091) on Thursday, 28th December 2006
Hello Alex,
nice to see you again. How have it been, your Christmas, what brought Santa Claus for you?
see you again
Hello, Claudia!
(Thank you for the Greetings by the way! :-D)
I wish Santa would bring you a new wonderful tune for your sax exercises!!!
...what brought Santa Claus for you?
Well... The absence of this Message Board for 5 days! ;)
It was great! Fantastic Holidays!
, in reply to this message.
Posted by claudia -networker (U4429091) on Thursday, 28th December 2006
Hello Alex,
I wasn't pleased about the absence of the MB. I have missed the members here including you. But now, we can meet again<biggrin>
Well, Santa brought a intensiv cours about latin-amerian dances to me, which will be over a year. I will go there with my sister in law. She got the same present as me, because we also visited other dance-courses in the past. My husband and his brother don't want to dance. Do you like dancing?
see you again
...Do you like dancing?
Oh dear... Just TWIST and ROCK'N'Roll, I'm afraid... But they are not fashionable anymore I suppose? :-D
I think in this case I would take yours husband's side...
If you missed this Board and members... you should do something about it! For nine years I have lost lots of very interesting, talented and creative friends! Try to keep e-mail addresses at least...
It seems they are trying to "compensate the losses" (I mean MB moderators...)
Alex S
'Just TWIST and ROCK'N'Roll, I'm afraid... But they are not fashionable anymore I suppose? [biggrin]'- I don't think that things look so sadly,Alex....I'm saying that as a former 'pro-dancer' who won some of prizes on this field on my activities..;) My best regards to all my beloved mariners ......to you Alex,to Claudia ....and our dear LE.;)
<rose> <rose> <rose>
Hi, Jack!
Nice to see you safe and sound! I wish you luck and happiness.
And the same is for Claudia as well!!!
The same is for the MODERATORS and the BBC ENGLISH staff since this is the FEEDBACK thread!
I hope, both of you have heard about James Brown...
But I don't think you have ever heard about fantastic BBC English series "History of Soul"...
(never to say about the series itself I guess?)
It is one of my favourite...
I wish they would ever played it again...
Alex S
Happy New Year to all!:-D
Claudia - language note: What DID Santa Claus bring you?
Dancing is really good for people, even when, as in my case, they are not very good at it. I dance when I'm on my own, doing the housework or listening to music. And, now, I dance with David's grandson [2 years old], who has natural rhythm ;-) When I spent a few weeks - long ago - in Barranquilla, Colombia, there was music playing all through the night; everyone there seems to dance.
Hello, Learning English! :-D
Thank you one more time for the Professor Grammar!
I know of course that those wonderful series was written by famous Doug Campbell but I do not remember who played the Professor himself. BBC English used to announce the name of that actor (something like "Ian Bradshaw" - I'm not sure...) but not anymore... Could you tell a bit about the creators of that series? Maybe in the Weekenders?
But please, put it in mp3!!
Best wishes!
Alex S
Dear LEARNING ENGLISH!
Could you provide us with information on BBC English teaching programmes?
Do you broadcast them via Hot Bird and if it is possible to receive them by individuals?
Thank you
Alex S
Dear Moderators!
Could you make some useful changes to this Board pages? Let me know - I then suggest what I'd like to see...
Dear Learning English:
Why on earth have you decided to close down the message boards? Over the past three years or more, I have seen thousands of people make new contacts here that led them to practise and improve upon their English. I, myself, formed an Internet group for learning English which led to several students coming here to the UK to see me and to practise. With these and others, we have gone on to use all manner of Internet tools for improving our knowledge of English and for extending international co-operation and understanding. Much of this will be lost if the boards close down.:-( Please reconsider your decision. <rose>
Hello, Webmasters!
Your latest "stretching" of the pages makes them really more "searchable". Please "repair" that "last reply" column - perhaps you really was going to introduce a new column - "started on" but forgotten to make the proper changes in the HTML code...
I think it would be useful to put at the beginning of each thread tags for two options - to see a thread in pages or as a whole - it might be not very convenient for scrolling, but could be useful for text searching (searching for a certain message) in the thread. The same may be done perhaps for the threads list and for the discussions folders...
, in reply to this message.
Posted by Anna-Belle (U14646748) on Thursday, 9th December 2010
As a worldwide organisation it will be interesting to see how quickly they respond to your request Alex.
A few small changes can't be too much to ask for can it?
After all with us posting here we keep various people employed within the BBC organisation. <ok>
, in reply to this message.
Posted by Anneliese (U11449680) on Thursday, 9th December 2010
Hi Alex! <biggrin>..<rose>
Oh dear... Just TWIST and ROCK'N'Roll, I'm afraid... But they are not fashionable anymore I suppose? <biggrin>
We liked to dance to this music and we still do it!! <biggrin>
Hi, Ann! I prefer Johny Holiday :-D
and Chubby Checker: www.youtube.com/watc...
And Anna Belle - it's not a REQUEST - it is a RESPOND! FEEDBACK!
And I bet - you never saw this! www.youtube.com/watc...
Join in the debate.
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Christians in the West must take seriously their duty to support those suffering in the Middle East, the birthplace of Christianity, said a team of filmmakers working on a documentary about the subject.
By Catholic Online (NEWS CONSORTIUM)
Catholic Online (www.catholic.org)
2/24/2014 (1 year ago)
Published in Middle East
Keywords: Middle East, Christians, documentary filmmakers
LOS ANGELES, CA (Catholic Online) - "Christianity began in the East, and Christians in the West seem to have forgotten that fact," said Drew Bowling, a Washington, D.C.-based writer working on the documentary project.
"It's tragic to see Christianity in the East under threat, and see Christians in the West who are not under such threats ignore it or fail to do what they can," he told CNA in a Feb. 4 interview, noting that many in the West simply do not realize the challenges being faced elsewhere.
See our stunning collection of crib medals -- by going here!
Bowling is working alongside writer Andrew Doran and filmmaker Jordan Allott to create a documentary about the violence and discrimination facing Christians in the Middle East.
Allott said he wants to bring attention to the matter and to put "pressure" on lawmakers in the West "to stand up for Christians." He hopes viewers of the documentary will "feel a connection with the subjects," and want "to help them in a time of need."
"Our faith is what it is here because of what their ancestors did there," Allott said, stressing the link between Christianity in the West and its roots in the Middle East.
The filmmakers hope to demonstrate the charity, resilience and determination of Christians in the region. Allott pointed to one man they met in Beirut, Lebanon, named George Maalouly. An Orthodox Christian, Maalouly was actively engaged in the Christian community, praying the Rosary and hosting prayer groups in his house.
Maalouly also helped those in need, regardless of faith, Allott said. He housed two Muslim Syrian refugees in a van, giving them electricity and food, and he "even came by with Christmas presents for the children."
This example is not isolated, Bowling said, pointing to the charity of the Good Shepherd Sisters in Lebanon's Beqaa valley, who work to shelter and feed Syrian refugees.
Many of the refugee camps have become sites for increasing extremism, due to radical rebels, lack of resources and dire situations; however, these sisters and other Christians caring for largely Muslim refugee populations "provide filters for radicalization" and an example of interreligious cooperation.
"Despite the fact that they are the ones marginalized, they are the ones serving Muslims" who are injured or displaced by conflicts in the region, Doran said. "They are bridges to peace for their own communities and for the outside world."
Bowling said that he was particularly struck by the resilience of a 12-year-old boy named Elias, who he met at the Turkey-Syria border. While walking to school one day, Elias was "seized from behind,
blindfolded and gagged" by al-Qaida affiliates. While he was later rescued, the kidnapping, combined with the loss of other family members in the Syrian civil war, compelled his family to flee the country.
Elias and his family are "now living in this Turkish refugee camp, completely impoverished, with no money to go anywhere," Bowling said. But "in spite of all these hardships, they remain hopeful they can one day return to their homeland in Syria."
"Elias and his family want to remain in the Middle East because they believe that is the homeland of Christians," he said, adding that many Christians he talked to in the region "did not want to emigrate."
"They have a history," with a multi-generational attachment to the land, he explained. "The idea of them disappearing entirely is heart wrenching."
But after years of violence and political unrest, Christians who choose to remain in the region face mounting difficulties. Bowling recalled that the day he arrived in Lebanon, al-Qaida affiliates "burned to the ground the most ancient Orthodox library in Tripoli."
"They talked about the flames coming from that library as being symbolic of the fate of all the Christians in that country," saying that the Christians would face damnation and hellfire for their beliefs, he said.
Doran described an encounter with an Armenian Syrian woman named Sita that has been "seared" into his memory. Now living after her husband was shot by snipers in the streets of Aleppo, Sita looked at Doran with a "face seized with anguish," pleading, "Help me."
"That just stayed with me," he said, explaining his "feeling of frustration, anger and helplessness" at being unable to aid the suffering woman.
Doran hopes Christians in the West will push their lawmakers to enact policies that help to protect their brethren in the Middle East.
"Christians in that part of the world and moderate Muslims are baffled that our government has taken the policies it has," he said, suggesting that Western policies supporting some revolutions and political groups have tended "to have predictable and negative consequences for Christians and moderate Muslims."
U.S. foreign policy "tends to blunder to the benefit of extremist groups" toward supporting governments and institutions that "contribute to the gradual erosion" of a Christian presence in the Middle East, he said. "On a basic human rights level we should not be giving money to
governments essentially enforcing apartheid" against Christian populations, he added.
Doran encouraged Western Christians not only to get involved in foreign policy concerns, but to reach out the Christians in the Middle East, particularly through their churches. While safety is important, he added, traveling to the Middle East is an opportunity for great witness on the behalf of Christians in the region - especially for clergy members.
"This is a part of the world that still respects men of the cloth, even if they're of a different faith," he said, encouraging clergy members to speak about persecution.
Observing a silver lining amid the violence confronting Middle East Christians, Doran said that the oppression has created a "growing sense of a single identity" that transcends old theological and historical disputes between different Christian denominations. He also said that he had witnessed "moderate Muslims identifying with Christians" in the region.
Despite the current turmoil and persecution, Doran predicted that "there will never be a Middle East without Christians." He believes the Christian communities in the region will "absolutely survive" the violence and oppression they are currently facing.
"The only question that remains is how much suffering are they going to endure in the next 25 years."
Pope Francis calls for your 'prayer and action'...
By Abigail James (NEWS CONSORTIUM)
New images claim to show ISIS militants showing compassion. Two accused gay men were set to be stoned to death, however, prior to the stoning, their executioners did something strange and unexpected. LOS ANGELES, CA (Catholic Online) - The ISIS fighters were ... continue reading
By Catholic Online (NEWS CONSORTIUM)
A U.S. counterterrorism operation targeting an al Qaeda compound in January accidentally killed two innocent hostages, including one American. President Barack Obama, making the announcement this week confirmed that a U.S. military drone that targeted the ... continue reading
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The United States has deployed warships to Yemen in order to monitor nearby Iranian vessels. Officials say this gives America "options" on how it could react to Iran's behavior in the region. Ships traveling from Iran could be trafficking arms to Houthi rebels. ... continue reading
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On April 18 Iran marked its national Army Day with a military parade with intent to intimidate and threaten the west, especially the U.S. and Israel, showcasing new weapons systems and even a truck which carried a large banner that read "Death to Israel." LOS ... continue reading
By Catholic Online (NEWS CONSORTIUM)
Islamic State, as in the nightmarish dictatorial regimes of past and present - Hitler's Germany, Mussolini's Italy and present day North Korea have massive bureaucratic systems in order to oppress the citizen on every level. A peek into the brutal totalitarian ... continue reading
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ISIS continuously commits heinous acts waging purge and terror against other religions, documented through photos and videos shared online. Recently, the terrorist group released a set of undated photos showing militants armed with sledgehammers destroying Christian ... continue reading
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Fifteen Muslim migrants from Sicily were arrested after being accused of throwing 12 Christians overboard as they cross from Libya to Italy last Wednesday. According to the Palermo police, they detained the suspected perpetrators, while the victims are feared to be ... continue reading
By Talia Ramos (NEWS CONSORTIUM)
During his speech at a Yad Vashem Holocaust Memorial in Jerusalem for a commemorative event, Israel's Prime Minister Benjamin Netanyahu compared Israel's current state with the operations of Washington to that of the time of Hitler. MUNTINLUPA, PHILIPPINES (Catholic ... continue reading
By Abigail James (NEWS CONSORTIUM)
People all across Israel came to a complete standstill for two-minutes to mark the Holocaust memorial day. LOS ANGELES, CA (Catholic Online) - As sirens wailed across the country, the silence was echoing. Playgrounds, road traffic and beaches all came to a complete ... continue reading
By Catholic Online (NEWS CONSORTIUM)
The Dead Sea, the famed Biblical body of water tread by prophets and kings, is increasingly endangered by enormous sinkholes. Coupled with the fact that the River Jordan is evaporation the Dead Sea could be literally - dying. LOS ANGELES, CA (Catholic Online) - ... continue reading


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MiLB Charities has also donated $5,000 to the Stephen Siller Tunnel to Towers Foundation to help with its "Helping Hands" Thanksgiving event of providing meals at four sites in Staten Island and Coney Island, N.Y., tomorrow and Thursday.
The MiLB office shipped more than 350 pounds of food, clothing and cleaning supplies to the impacted areas.
"Our leagues and clubs are like family and we come to each other's aid in times of crisis," said Pat O'Conner, President of Minor League Baseball. "We will provide as much assistance as we can to those in need. Hopefully, our efforts, combined with those of our leagues and clubs, will expedite the recovery of our clubs and their communities that were affected by Hurricane Sandy."
Today on MiLB.com
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1964 1/2 Ford Mustang coupe, recently completed rotisserie restoration. Less than 500 miles since it's completion. Ford Racing 302 Crate Engine with Vintage Air... More
1970 Ford Mustang ConvertibleAn original or beautifully restored classic mustang elevates transportation toAn art form an indelible part of the american experience a classic... More
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Factory Original 1965 Ford Mustang GT Convertible, Factory Original A-Code, Factory AIR (RARE) Test Miles, Factory C-4 Automatic, Factory Poppy Red, (code 6) Black Deluxe Pony Interior, 289ci./225hp 4V V-8, (Original) Correct... More
The Classic Car Gallery is proud to offer this beautiful 1965 Ford Mustang Convertible. Finished in Wimbledon White over Red Vinyl and a black... More
Top notch nut & bolt restoration ... 302 CID V-8 crate motor ... C-4 automatic ... Power disc brakes ... Ice cold air conditioning... More
2012 Ford Mustang 302 Boss Laguna Seca, 9,300 miles (the previous 93,000 miles was incorrect), all options, super nice. Black with Red Trim. Extended... More
2007 Custom Mustang. Hand formed STEEL body, except for the roof, dooor skins and most of the trunk. 2008 Lotus Elise Headlights and 1989... More
Here is an absolutely beautiful 1965 Ford Mustang that is in excellent condition!!!! This gorgeous Mustang features one of the nicest restoration/restomods I have... More
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Most Recent Articles In Fashion Scoops
Latest Fashion Scoops Articles
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U.N. STYLE: No matter what the nature of talks is at the United Nations, the conversation on Michelle Obama's fashion choices continues. On Wednesday, she attended the U.N. General Assembly in Michael Kors, one of her favorite designers in recent months. This time, the First Lady went red, choosing Kors' red silk shantung cap-sleeve jacket and corresponding skirt.


text:
Glorious St. Joseph,
model of all those who are devoted to labour,
obtain for me the grace to work conscientiously,
putting the call of duty above my many sins;
to work with thankfulness and joy,
considering it an honour to employ and develop,
by means of labour,
the gifts received from God;
to work with order,
peace, prudence and patience,
never surrendering to weariness or difficulties;
to work, above all,
with purity of intention,
and with detachment from self,
having always death before my eyes
and the account which I must render of time lost,
of talents wasted,
of good omitted,
of vain complacency in success
so fatal to the work of God.
All for Jesus,
all for Mary,
all after thy example,
O Patriarch Joseph.
Such shall be my motto in life and death.
Four things to know about your candle on Catholic Online:
For the Birthday of a family member Heavenly Father, We praise You for all Your gifts to us. In a special way, We thank You for (name). Bless him (her) always in Your love. Bless us too, Holy Father, And this food with which we celebrate. Help us all to praise You and give You glory Through Jesus ... continue reading
More Prayer of the DayIn the centuries old Catholic tradition, holy cards or prayer cards are small, devotional cards for the use of the faithful. Prayer cards have an endless amount of use and make wonderful gifts and keepsakes.


text:
Asians, China, Politics, Religion
From The Dalai Lama To A Harvard Law Fellow? Free Tibet Movement Could Get Hardcore.
I'm not a hippie, but I have attended a Free Tibet rally (it was college, I was experimenting). I support a free Tibet, in that American way of admonishing China while in no way depriving myself of any Chinese products or consumer markets. My dog is a Tibetan breed (Lhasa Apso). I spent a not-insignificant […]
Advertising, Real Estate, Shameless Plugs, This Is an Ad
Thanks to This Week's Advertisers
This week in sponsored content: an interesting look at the Hong Kong housing market, by Alexis Lamb of the Asia Chronicles. Finding a flat in HK these days poses quite the challenge. And now, let's thank this week's advertisers on Above the Law: American Express BarMax Black Socks IMS ExpertServices Kinney Recruiting (sponsor of the […]
Can you tell the difference between actual CLE courses and ones we've just made up? Take our challenge and find out! Whatever the nature of your practice, our friends at Knowledge in Practice can help you navigate your options and find the CLE that works for you.
Biglaw, Disasters / Emergencies, Holland & Knight, Pro Bono, Public Interest
More Law Firms Contributing to Japanese Relief Efforts
On Tuesday we told you that McGuireWoods, Dewey & LeBoeuf, and Weil Gosthal were all contributing to the relief efforts under way in Japan. The response has been pretty great. While some people seem to think Japan's status as a rich nation means it doesn't need any international aid, I don't see how the country's […]
Biglaw, Dewey & LeBoeuf, Disasters / Emergencies, Pro Bono, Public Interest
Biglaw Firms Poised To Help Japanese Relief Efforts
After the Haitian earthquake last year, we saw law firms step up in a big way to support relief efforts down there. Hopefully we will see the same reaction to the ever-increasing tragedy unfolding in Japan. Given an 8.9 a 9.0-magnitude earthquake, a massive tsunami, and a nuclear disaster that is already the second-worst nuclear […]
* How lawyers in Tokyo were affected by the 8.9 magnitude earthquake that hit Japan. [Am Law Daily] * Former Judge Jack Camp gets 30 days in prison — even less time than Paris Hilton. That's some weak sauce. [Atlanta Journal-Constitution] * An interesting account, by former Dealbreaker editor (and Skadden lawyer) John Carney, of […]


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Nikon D200
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From the Heart
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I am really happy that I made you smile. It was my goal to make people smile since I had to smile, too when I took a picture of it :) Have a great weekend, Katrin
OCTOBER 18th, 2011
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I am so sorry for the late reply but I haven't been around a computer during the last few days. Thank you so very much for your kind comment :) All the best, Katrin
Thank you very much Ann. I am always happy when I see that you like my work :) Have a great day and many reasons to smile :) Katrin


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Immune Slide cquired immunity
Slide 1 This section discusses care of clients with selected alterations of the immune system. Slide 2 Self versus Non self. This is what immunity is all about. It is the ability of the cells of the body to be able to recognize cells or things that are not part or the normal body. How does the immune system know what is self? Each of us has specific cell surface characteristics which don't perfectly match anyone else. An exception is identical twins. This is called our Human Leukocytic Antigens or HLA's. Auto-immune problems occur when the body doesn't recognize self & attacks it. Organ transplants are rejected because the donated organ has a different HLA than the host. The host's immune system doesn't recognize the HLA & attacks & destroys the transplant. Functions of the immune system are: (1) defense against bacteria, viruses, fungi and parasites. (2) homeostasis by removing and destroying damaged cells, and (3) surveillance by identifying continuous malignant cells and destroying them. Slide 3 Immunity is classified as innate or acquired. Innate immunity (natural immunity) is present at birth and exists in a person without prior contact with an antigen. Slide 4 Acquired immunity is classified as (1) active or natural which occurs following exposure to a disease such as measles, chickenpox or mumps; (2) active or artificial which occurs as the result of an injection of an antigen such as immunizations. These types take time to develop but last a long time. Slide 5 Acquired passive immunity can occur naturally as the result of antibodies being passed from mother to fetus or may be acquired artificially through injection of gamma-globulin (GG) to produce short term protection from disease. These types are short lived because no memory cells are present. Slide 6 Please review anatomy and physiology of the immune system from your text and notes from Fundamentals. Video tapes 137 and 134 found in the Nursing Lab also offer a good review. Slide 7 There are two types of immune responses. They are humoral or plasma mediated and cell-mediated. In humoral immunity, an invading antigen causes the B cells to divide and differentiate into plasma cells which secrete antigen-specific immunoglobulins ( Ig) Slide 8 There are five types of Ig. IgA, IgG and IgM respond to viral and bacterial invasion. IgD may assist in B cell binding with the antigen. IgE is present during inflammatory responses and causes allergic reactions.. Slide 9 During the humoral response, complement which consists of approximately 25 enzymes, works with antibodies to puncture the bacterial cell walls to destroy them. Slide 10 In cell-mediated immunity,the antigen such as bacteria, virus, fungus or cancer, lives within the body cell and is present on the cell surface. Macrophages identify the antigen and T cells defend against it. This is a delayed response such as might occur in graft rejection, hypersensitivy reactions, tumor immunity and immunity against bacteria, virus and fungus. Slide 11 Immunocompetence exists when the immune system is able to identify and destroy foreign substances. When the immune system in not competent to recognize or destroy foreign substances, infeciton, immunodeficiency diseases and cancer occur. When the immune system is overactive, hypersensitivies such as allergies and autoimmune diseases occur. Slide 12 There are four types of hypersensitivities, Type 1 is known as an anaphylactic reaction. On the first exposure to the allergen, IgE antibodies are produced and bind to mast cells and basophils. On next exposure, the allergen attaches to the IgE bound to mast cells or basophils, and causes release of chemical mediators from the cells. These chemicals cause vasodialation, hypotension, increased secretion of mucus, and itching.. A cutanous response, a wheal-and-flare reaction occurs. An example is a mosquito bite. Examples of the cause for local anaphylaxis is food, pollen, medication, and dust. Slide 13 Anaphylaxis occurs when the chemical mediators are released systemically. Anaphylaxis may be caused by food, particularly, shellfish, nuts, eggs and strawberries, drugs like PCN and Sulfa, insect bites (bees and wasps) antitoxins like Rabies or tetanus, and iodine-contrast media for IVPs and MRIs. Anaphylaxis can occur rapidly and is a medical emergency. Symptoms of anaphylactic shock include rapid, weak pulse, hypotension, dyspnea, bronchial edema, crackles, wheezing, laryngeal edema, angioedema, increased mucous, strider and death, if not treated immediately. Slide 14 Treatment for shock must be initiated STAT. Respiratory and cardiovascular systems must be assessed and monitored. Epinephrine 1:1000, 0.2 to 0.5 ml should be given either SQ or IV if severe to cause vasoconstriction and bronchodilation. Benadryl IM or IV and Histamine H2 blockers such as Tagamet are given to decrease angioedema and urticaria Slide 15 Oxygen is given to maintain O2 sat at above 90%. The head of the bed should be raised to 45 degrees to assist with respiration. Blood pressure should be maintained with fluids and vasopressors such as dopamine and norepinephrine. Aminophylline is given IV at 6 mg/kg for severe bronchospasns. Albuterol nebs may be given every 2 – 4 hours. Slide 16 Vital signs, O2 sat, level of conscientious, cardiac and respiratory status should continue to be monitored and the RN should anticipate CPR, intubation and tracheotomy if necessary. Slide 17 Other examples of anaphylactic reactions are called Atopic reactions. These include allergic rhinitis, commonly known as hay fever, bronchial asthma, atopic dermatitis, urticaria, and angioedema. Individuals who experience these disorders have inherited an increased tendency to be sensitive to the environmental allergens. Hay fever is the most common. Symptoms are runny nose and eyes, sneezing, mucosal swelling and puritus around the eyes, nose, throat and mouth. Symptoms of asthma are listed on this slide. Slide 18 Atopic dermatitis involves generalized skin lesions which are vesicular and edematous. Urticaria or hives develops rapidly after exposure to an allergen and lasts for minutes to hours. Hives represents a wheal-flare response to the allergen. Angioedema is a localized skin reaction similar to hives but involving deeper layers of skin and submucosa. Swelling is usually seen in the eyelids, lips, tongue, larynx, hands, feet, GI tract and genitalia. This can be a medical emergency if respiration is compromised. Slide 19 Type II hypersensivity reactions are cytotoxic and cytolytic and destroy cells by binding IgM and IgE to cell surfaces which activates complement and phagocytosis. Examples of Type II reactions are blood transfusion reactions because of blood incompatibility, and drug- related hemolytic anemias. Goodpasture sysdrome is a rare disease in which the lungs and kidneys are damaged due to endogenous antibodies interacting with tissue antigens. Pulmonary hemorrhage and glomerulonephritis result. Slide 20 IgG and IgM form immune complexes in the body that get deposited in vessel walls and extravascular tissues. Complement is activated and chemical mediators of inflammation like histamine are released. Neutrophils respond to the inflammation that is created by the immune complexes, increasing tissue damage. Streptococcal infections are also causes of Type III reactions. Serum sickness caused by foreign serums like horse serum for anti tetanus. Pencillins and sulfonamides can cause serum sickness. Serum sickness produces fever, arthritis, uticaria, enlarged spleen and lymph nodes, 7 to 14 days after exposure .It is treated with adrenal cortical hormones- glucocorticords and mineral corticoids- these medications decrease the inflammatory process. Slide 21 A Type IV reaction is a cell-mediated response, causing tissue damage. The response takes 24 to 48 hours to occur. It is characterized by an interaction between antigens and antigen-responsive T lymphocytes. Examples are contact dermatitis, poison ivy, PPD and transplant rejection. Slide 22 After the cause of the allergic response has been identified, the client should avoid the allergen. This may simply involve avoiding certain foods, but may require making life changes such as moving to a different climate, changing occupations or giving up a pet. If a drug is the cause, he should avoid it and wear a Medic Alert bracelet, identifying the allergy. Drug therapy includes antihistimines for allergic rhinitis and urticaria. They work by blocking the histamine receptor sites. Sympathomimetic/decongestant drugs include Epinephrine (Adrenalin) is the treatment of choice for anaphylactic reactions. Minor decongestants include NeoSynephrine and Sudafed to treat allergic rhinitis. Corticosteroid nose sprays are effective for allergic rhinitis and oral corticosteroids are given for more severe allergic reactions. Antipruritics include topicals - calamine lotion, coal tar solutions, menthol and camphor. Mast cell- stabilizing drugs are used to asthma and allergic rhinitis. Examples are Cromolyn (Nasalcrom) and nedocromil (Tilade). They block release of histamines, leukotrienes and other chemicals from the mast cell after antigen- IgE interaction. Slide 23 The elderly have a decline in the immune system such as decreased size and activity of the thymus, decreased production of T and B cells, delayed hypersensitivity responses, decreased cell-mediated immunity, greater susceptibility to infection and higher incidence of tumors. The older adult should be encouraged a to eat well-balanced diet, drink adequate fluids, and to get flu & pneumonia shots. They should practice good handwashing. They should be taught to report fever or other signs of infection, and changes in mental status, behavior or levels of activity Slide 24 The symptoms listed above may indicated an problem with immunity. Slide 25 These sypmtoms are indicative of chronic allergies Slide 26 Diagnostic tests used to confirm immunodeficiency problems include a CBC with WBC differential including an absolute lymphocyte and eosinophil count. Cellular immunodeficiency is diagnosed if the lymphocyte count is below 1200/microliters. The eosinophil count is elevated with type I hypersensitivity reactions involving IgE RAST test measures the quantity of antigen-specific Ig E in the blood. It is less sensitive and more expensive than skin testing and has no risk of anaphalaxis. Skin tests involve pricking the skin with suspected allergens or injecting interdermally. A local wheal-and-flare response indicates an allergy to the allergen. A very sensitive person is at risk for having an anaphylactic reaction. Slide 27 HLA is done to determine if it matches the HLA of the donor prior to transplant. Histocompatibility is essential prior to matching donors and recipients of blood, bone marrow and organ transplants. The human leukocyte antigen system is a series of inherited genes that occur on the sixth chromosome in humans. If the HLA matches on 5 – 6 antigens, there is less likelihood of rejection of the tissue. Crossmatching mixes blood from the donor and potential recepient to determine any cytotoxic (anti-HLA) antibodies to the donor blood. A negative crossmatch indicates no cytotoxic antibodies are present and transplant should have a positive outcome. Slide 28 In GVHD, the graft rejects the host. The new donor cells recognize the host as foreign and within 7 to 30 days, the donor T cells attack and destroy vulnerable host cells. GVHD targets the skin, GI tract and liver. Symptoms include a painful, itching rash that begins on the soles and palms and covers the chest, back and legs, causing desquamation. Liver involvement includes mild jaundice and elevated liver enzymes. GI symptoms include diarrhea, abdominal pain, bleeding and malabsorption. The biggest problem is infection – bacterial, viral and fungal. GVHD is most often seen following bone marrow transplant. Slide 29 Calcineurin inhibitors inhibit production of T cytoxic lymphocytes. Amtimetabolites suppress proliferation of T and B cells. Corticosteroids suppress inflammatory response and inhibit cytokine production and T cell activation. Typically, these three categories are used together. Please review side effects in your Pharmacology and Nursing textbooks. Infections are treated with antibiotics, antivirals or antifungals. Slide 30 Risk for infection is the biggest problem with GVHD. Careful handwashing for both client and the healthcare team is essential. Reverse isolation, adequate hydration and nutrition, and good oral hygiene are a must and careful monitoring for signs of infection and complications are required. Slide 31 If the client has received an organ transplant, he should be continually assessed for graft rejection. Signs of rejection include erythemia and swelling over the site, and elevated temperature along with increased WBC's. This client should be assessed for GVHD and is treated with immunosuppressive therapy and should be monitored for infection. Slide 32 Autoimmune diseases are grouped according to organ-specific and systemic diseases. Several systemic diseases will be covered in this course. Organ-specific diseases will be covered in Advanced Adult Nursing and Pediatric Nursing Slide 33 This section discusses selected systemic autoimmune disorders of the connective tissue. Slide 34 Osteoarthritis, also known as degenerative joint disease, involves a progressive deterioration and loss of cartilage in the joints. The cartilage becomes soft and yellow resulting in a narrowing of the space between joints. Bone spurs develop and there is uneven stress on the joints and decreased motion. Slide 35 A single cause for OA has not been identified, but it is related to advancing age. Approximately 60% of clients over the age of 65 years have symptoms of the disease. After the age of 50, it is twice as great in females, which suggests decreased estrogen as a cause. Obesity is related to OA of the knee. Strenuous exercise and sports injuries have been linked to OA. Signs and symptoms include first, joint pain which gets worse with joint use. As OA progresses, joints become more painful, and enlarged. Heberden's and Bouchards' nodes may be found on the fingers. If the spine is involved, the client may have difficulty sitting and rising from a chair. Knee involvements results in altered gait. Joint pain is increased with falling barometric pressure before rain. It is true that the client can predict rain "in his bones". Slide 36 OA is diagnosed by history and physical. There are no lab tests, although the Sed rate may be elevated if synovitis is present. Bone scan, CT and MRI may show early joint changes and x-rays will show joint space narrowing Slide 37 The client with mild to moderate pain can use Tylenol and Capsaicin cream for relief. The cream should not be used with a heating pad. Other clients benefit from the NSAIDs or ASA. If the client experiences muscle spasms, muscle relaxants such as Flexeril may be necessary. Review your Pharmacology notes for more information on these drugs. Slide 38 The OA client needs to balance rest with activity. During acute pain, the joint should be rested and placed in a functional position, using pillows, splints, or braces. The joints should not be immobilized more than one week to prevent joint stiffness. Heat or cold applications may be helpful. Glucosamine and chrondroitin sulfate may help with synthesis of new cartilage. Slide 39 Weight loss is very beneficial for OA of the knee in the obese client. A healthy diet should be followed for all OA clients. Surgery may be indicated for some clients. Slide 40 This slide lists some of the surgical treatment options. Slide 41 Hyperuricemia is caused by increased uric acid production, underexcretion of uric acid by the kidneys of increase of foods containing purines (sardines, herring, muscles, liver, goose, sweetbreads). Stress, alcohol, thiazide diuretics, immunosuppressive drugs, and prolonged fasting can induce gout. Gouty arthritis usually affects no more than four joints, the most common being the great toe. The onset is rapid and it usually subsides in 2 to 10 days. Attacks can reoccur if not treated. Chronic gout involves multiple joints and tophi develop, causing deformity Slide 42 Diagnosis can usually be made on clinical symptoms alone. Serum and urine uric acid levels will be elevated as will as WBC's. Synovial fluid aspiration is usually not necessary. Treatment includes life style changes such as watching diet, losing weight if necessary and decreasing or avoiding alcohol. The client should be monitored for kidney stones. Rest of the joint, heat and cold applications may be helpful Slide 43 Medications useful for treating gout are (1)Zyloprim which is useful during the acute stage and as a maintanence drug to prevent further attacks, (2) Colchicine used with NSAIDs and (3) Benemide which can't be used for clients who have reduced creatinine clearance. ASA must be avoided because it inactivates Banemid. Cozaar may be useful in promoting urate diuresis . Cozaar and Zyloprim may be given together Slide 44 . RA is a chronic, systemic disease characterized by inflammation of connective tissue in the synovial joints. The cause is unknown but it is known to affect women between the age of 40 and 60, 2-3 times more often than men. Smoking has also been linked to RA. Slide 45 The autoimmune and genetic theories explains that a genetically susceptible individual develops an abnormal IgG in response to a antigen, and then develops autoantibodies known as rheumatoid factor (RF) against the abnormal IgG. These combine to form immune complexes and are deposited in the joints, causing inflammation and joint changes followed later by cartilage and destruction by a pannus. Slide 46 The pannus usually effects fingers, knees, and is worse in toes, ankles, and feet. Slide 47 This slide shows a pannus. Slide 48 This slide list signs and symptoms of RA. Morning stiffness usually occurs for one hour in the morning. Please refer to your text for pictures of deformities on p 1726. Also note complications of RA on p 1727 Slide 49 This slide lists several associated problems of RA. Caplan's syndrome causes fibrosis in the lungs and is seen a lot with coal miners. Felty's causes splenomegaly. Slide 50 Diagnostic tests used to determine RA include (1) the ANA which indicates the presence of an autoimmune disease and is positive in some cases of RA, (2) the RF which is positive in about 80% of cases, Slide 51 (3) and the sed rate and C-reactive protein tests which detect acute and chronic inflammation. Elevated WBCs are present in synovial fluid analysis. Bone scans, MRI and CT show early joint changes and can confirm RA. As RA progresses, narrowing between joints and deformity can be seen on x-ray. Slide 52 DMARDs should be started early in the disease to prevent disability. Plaquenil is indicated for mild cases. It is important that the client have an eye exam every 6 months to monitor for irreversible retinal degeneration. Slide 53 NSAIDs , especially the Cox 2 inhibitors are frequently prescribed. Aspirin relieves pain, but does not stop disease. Gold Salts- decrease disease activity. Given PO or IM, but IM is more effective. Cytotoxic medications may slow down the disease. Methotrexate is the drug of choice in moderate to severe cases. It has a rapid antiinflammatory effect & relives symptoms in days to weeks. Analgesics are used for pain control. Review these drugs in your Pharmacology text. Slide 54 Clients can benefit from hot and cold compresses and mild exercise after the acute phase. Complementary therapies may be helpful. Clients should be taught to eat a balanced diet, take NSAIDs with food, and to get frequent mild exercise. Assistive devices may useful to protect the joints. Slide 55 Systemic Lupus Erthmatosus is a chronic, multisystem disease that occurs mostly in women in their 30sand 40s. The cause is unknown but it is considered to be an autoimmune Slide 56 Auto antibodies are produced by b cell hyperactivity, complement is activated and immune complexes are deposited in body organs. SLE may be drug induced by drugs such as procainamide and hydralazine. Symptoms disappear when the Rx is discontinued. Slide 57 Signs and symptoms depend on the organs involved. Vascular lesions usually develop in sun-exposed areas with the classic butterfly rash across the nose occurring in alopecia over lesions is common. Arthritis occurs in more than 90% of cases. Arrhythmias can be fatal. Renal damage can result in glomerulonephritis. Seizures and Organic Brain Syndrome result from deposits of immune Slide 58 No specific tests are diagnostic for SLE. ANA is present along with other antibodies. Tests that are most specific are anti-double stranded DNA and anti-Smith which are rarely found in other diseases. RF may be positive because of the relation of RA to SLE ESR may be used to monitor disease activity. Steroids are the drug of choice. Slide 59 The client should be taught to monitor the skin for infection, to avoid sun and to keep skin clean and dry. Because many clients are immunosuppessed, they need to monitor for systemic infection and may need reverse isolation. Depending on which organs are involved, symptoms such as decreased urine output , neurological changes, and chest pain should be assessed. Slide 60 Systemic sclerosis is a chronic disease of the connective tissue in which there is excessive formation of fibrous connective tissue and fibrosis of the skin. The cause is an abnormal production of collagen. Clients present with joint pain, tight shiny skin, no wrinkles, renal symptoms, dysphasia, and GERD. Slide 61 This slide lists CREST manifestations of Systemic Sclerosis. Raynaud's which is described as paroxysmal vasospasm in digits which limits arterial blood flow when exposed to cold. Client experiences blanching, followed by cyanosis and then erythema during rewarming phase. May procede onset of SS by months or decades.) Skin changes are seen in fingers & hands & the trunk. The face becomes expressionless. Joints in the jaw and hands lose ROM. Internal organ involvement includes fibrosis of the esophagus, causing GERD & difficulty swallowing . Lung involvement causes pulmonary abnormalities. Congestive Heart Failure occurs from fibrosis. Renal disease is progressive and is the major cause of death due to renal failure. Drugs are used to treat the symptoms, but there is no cure. There is no diagnostic test; the Sed rate may be elevated. Slide 62 Nursing care is aimed at maintaining ROM and preventing complications such as aspiration. The respiratory, cardiac and renal systems need to be monitored closely for complications. Slide 63 This section discusses HIV and Persons with AIDS. Slide 64 Please review the etiology of HIV and AIDS from your Fundamentals course. Slide 65 The incidence of AIDS is increasing worldwide, especially in the under 25 y/o population. Slide 66 The Elisa test is used to diagnose HIV antibodies which can be detected after 12 weeks. The Western blot test is used to confirm the diagnosis. There are other tests on the market now, including ones that can be done at home. Slide 67 Normal CD 4 count is above 1000. When the count is 500 or below, symptoms of HIV are seen. When the count is below200, opportunistic infections begin and the client is sero converting to AIDS. The amount of CD4 cell presence reflects the severity of the infection, as does the viral load, referring to the amount of HIV in the bloodstream. The higher the viral load, the more advanced the disease. As the virus continues to kill cells bearing CD4 receptors, the CD4 cell count drops, signaling progressive immunosuppression. Ultimately, after the development of an AIDS defining illness, AIDS is diagnosed. Criteria for Diagnosis is CD4 +T cell count below 200cells/microliter, or development of an opportunistic infection or indicator condition such as TB, pneumonias, and invasive cervical cancer. End-stage AIDS is defined as CD4 counts below 50. Slide 68 There is no cure for AIDS, but medications are increasingly able to control the disease and clients are living longer, healthier lives. New drugs are being developed every day. The drugs of choice at present are the antivirals in the reverse transcriptase inhibitors and the protease inhibitors groups. The next 5 slides offer a brief review. Also, please review your notes from your Medication Administration course. Slides 69 – 73 Review Slide 74 and 75 Because opportunistic diseases are frequently seen in the AIDS client, medications are given to prevent or treat these diseases. Slides 75 and 76 are examples of prophylactic drugs which are used. Slide 77 Two newer medications are Pentafuside, a fusion inhibitor which prevents HIV's binding to healthy T-cells, and Proleukin which boosts the immune system. Slide 78 Typically, a combination of several medications (HAART) is used. Also, efforts to boost the immune system, such as a bone marrow transplant and use of interleukins is used in some cases. Although drug therapy is the major treatment, emphasis should also be placed on promoting health in the immunosuppressed client. Diet, careful handwashing, avoiding infection and taking medications properly are necessary components of treatment. Slide 79 Education of the client with HIV is highly important in preventing the spread of AIDS. Clients and their families need correct information to prevent isolation of the client. The client and family also need to know the signs and symptoms of opportunistic diseases, so that immediate treatment is provided. Slide 80 There are numerous nursing diagnoses that apply to the AIDS client. Nutrition is a common problem due to nausea from medication and the presence of thrush. Soft foods and high calorie, high protein foods should be offered. Diarrhea is a common problem. Good skin care is necessary to prevent further infections. The client will be fearful and may lack support because of discrimination from others. He may have low self esteem related to his diagnosis. This is a physically and emotionally draining disease that always ends in death. The client may react with anger or denial and may be noncompliant. He must be encouraged to make any necessary lifestyle changes to modify the disease process. Individual and group therapy is usually helpful. Slide 81 Opportunistic infections may be caused by fungus, bacteria or virus. The more common ones are pneymocystis carinii pneumonia, cryptococcal meningitis, cytomegalovirus retinitis, mycobacterium avium complex, Kaposi's sarcoma, and AIDS – dementia complex Slide 82 PCP is sometimes the first indication that the client has AIDS. In HIV positive clients, it can be prevented by use of maintenance antibiotics. Nursing intervention includes monitoring the respiratory status, fever symptoms, administering oxygen, IV fluids and antifungals and nutrition. Slide 83 This disease is caused by a fungus and is treated with antifungal drugs. It is important that the client remain on maintenance drugs after the acute stage is over because 50-75% will have a recurrence within a year without them. Slide 84 CMV can also effect the respiratory, GI and CNS. Ocular disease does not appear until there is severe immunosuppression. Clients with AIDS should have frequent eye exams so that CMV is detected and early treatment with antivirals can begin.The goal is to prevent loss of vision, but even with treatment, blindness may occur. Slide 85 MAC frequently causes GI symptoms, especially chronic diarrhea in HIV clients. Positive cultures can be isolated from the lymph nodes, bone marrow or blood. Symptoms of MAC include diarrhea, abdominal pain, fever, weight loss, malaise, anemia, neutropenia, malabsorption syndrome and obstructive jaundice. Treatment is with the same antiinfectives that are used for TB, which is also frequently seen in the immunosuppressed client. Slide 86 KS is the most common neoplasm seen in AIDS clients. It occurs in 21% of clients. It is thought to be caused by Human herpes virus. Small lesions which are not painful are typically found on the skin and mouth. Lesions may also be found in the lungs & GI tract and can cause bleeding & respiratory distress. Diagnosis is made with biopsy. Successful treatment with ARTs can resolve the disease. Other malignancies are treated with chemotherapy as indicated. Slide 87 ADC occurs in the terminal stages of AIDS and is caused by HIV infection of the brain or other systemic opportunistic problems. If the cause is reversible, such as dehydration, appropriate treatment is started. If not, the client and family is supported to a comfortable death.


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Penguins notebook: Bortuzzo won't shy away from fights
Penguins/NHL Videos
Enforcers scarcely exist in the NHL anymore, but fighting is an element that still is prominent and is one the Penguins don't shy away from.
Defenseman Robert Bortuzzo, whose game has been widely praised by the coaching staff this season, isn't one to shy away from fisticuffs.
"Funny thing is," Bortuzzo said, "I never really fought much in juniors. Just a little bit. But the closer I got to the NHL, the more I started to fight. I don't mind it. It's just part of my game."
Having a defenseman handle much of the fighting duties is unusual, as it limits a team to only five defensemen for the five minutes that are spent in the penalty box for a fighting major. Replacing one of 12 forwards for five minutes is easier.
Bortuzzo, though, is always quick to defend teammates.
And, like when Flyers forward Kris Newbury challenged Bortuzzo last week in Philadelphia, the Thunder Bay, Ontario, native isn't about to back down.
Bortuzzo pummeled Newbury with a barrage of right hands, earning respect from his teammates.
"I'm not one to back down," he said. "I'm not saying I'm going to fight every single tough guy in the league every chance I get, but I'm going to defend my teammates."
Captain competitive
Colorado rookie Nathan MacKinnon was asked Monday morning if he could provide any stories about Sidney Crosby. Both are former No. 1 overall picks in the NHL Entry Draft who happen to come from Nova Scotia.
MacKinnon obliged.
Crosby, MacKinnon and other NHL players trained this summer in Prince Edward Island. While running up a sand dune, MacKinnon took the lead on Crosby.
But Crosby didn't want to lose.
"He grabbed my heel and pulled me down," MacKinnon said. "He's the most competitive guy I've ever been around."
No. 2 star
Crosby was named the NHL's No. 2 star of the week, the second straight week he has been honored by the league.
Last week, he was voted the NHL's No. 3 star.
During the past week, Crosby scored two goals and added six assists in three games.
Crosby entered Monday's game against Colorado as one of three NHL players to score a point in all of his team's games this season.
Defenseman Deryk Engelland was a healthy scratch for the fifth time this season. He had played in four consecutive games, with two of them seeing Engelland play at right wing on the fourth line.
Also not playing for the Penguins on Monday were center Dustin Jeffrey (healthy scratch), right wings Beau Bennett (lower-body injury), James Neal (upper-body injury) and Matt D'Agostini (lower-body injury), and defenseman Kris Letang (knee injury).
Letang is close to returning to the lineup, coach Dan Bylsma said.
Josh Yohe is a staff writer for Trib Total Media. Reach him at email@example.com or via Twitter @JoshYohe_Trib.
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