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Gina Evans knows her brother was murdered—even if the police won't believe her. After catching a quick glimpse of the evidence her brother had gathered, the same criminals are after her and her baby niece. And Gina's only hope is the man she left behind. Despite the painful memories, private investigator Derrick Justice won't fail Gina and her baby. Yet now, the woman he never stopped loving and the baby he's come to adore are in a killer's ...
Gina Evans knows her brother was murdered—even if the police won't believe her. After catching a quick glimpse of the evidence her brother had gathered, the same criminals are after her and her baby niece. And Gina's only hope is the man she left behind. Despite the painful memories, private investigator Derrick Justice won't fail Gina and her baby. Yet now, the woman he never stopped loving and the baby he's come to adore are in a killer's crosshairs. But can Derrick trap the cold-blooded murderer before he strikes again?
The Justice Agency: Family and law enforcement go hand in hand
He'd come for her again. Here in the dark-fog oozing over the edge of the floating home's deck and clouding the Columbia River. He'd followed her from San Diego to Portland and burst through the door to her friend Lilly's house. Splintered and hanging by a hinge, it served as a warning of his deadly determination. Gina had stepped out for only a moment, leaving her precious baby niece in her friend's care, and now Sophia and Lilly were helpless inside.
Gina had to rescue them, but how?
She searched the deck, looking for something-anything-she could use to save them. Found only worn patio furniture. No weapons. Nothing to help. Nothing to do.
How could she have been foolish enough not to realize he'd track her down? She should have known that she'd put Lilly at risk by coming to stay with her. And as for Sophia She'd had custody of her niece for only four months. Not nearly enough time to recover from her brother's death and barely enough time to think of Sophia as her daughter. And now, Gina had put the precious baby in danger.
What if he'd already harmed them? Panic stole her breath.
Calm down. They're alive and they need you.
Gina sensed movement on the far end of the deck before rapid footsteps cut through the quiet. She spun and searched the area. The vague outline of a burly man carrying something as he rushed toward the water emerged through the shifting fog.
If Gina could see him, could he see her, too? She flattened her back against the houseboat bobbing in shifting waters.
Is he carrying a body? Lilly? Oh, God! Please, no! Despite Gina's prayer, terror crept up her throat and threatened to strangle her.
Breathe. In. Out. In. Out. That's it. Get it together.
Now that he was on the deck, it was safe to check inside.
She slipped into the hazy mist rolling over the large deck. One foot in front of the other-feeling her way through murky shadows clinging to the home.
Squinting in the bright light of the family room, she scanned the area. The coffee table and a chair lay discarded on the floor like Sophia's toys, lamp shards scattered nearby. There'd been a struggle.
"Lilly!" Gina called out.
No reply. Fear gaining a stronger hold, Gina hurried toward the bedrooms. She scanned the master. Empty. She charged down the hallway to the room she and Sophia were sharing tonight. A Winnie the Pooh nightlight burned on the far side of the room, not providing enough light for a clear look at her niece.
Holding her breath, Gina rushed to the portable crib.
Sophia slept in her teddy bear pajamas, her tiny bottom up in the air, a Pooh blanket discarded by her feet. Gina pressed her hand on the seven-month-old's back. At the even rise and fall, Gina sagged against the crib.
Thank You, God.
She hadn't failed her brother. Sophia was safe. Lilly. Where is Lilly? The thought barreled into Gina's brain.
Lilly would never leave Sophia alone. Never.
Had her attacker taken Lilly, hoping Gina would swap places to save Lilly's life?
Gina bolted through the house and back outside. A scraping noise ground against the end of the deck, followed by a loud thump.
Holding her breath, she crept over the slippery planks to the back of the house and listened. The river lapped against floating homes, but another noise broke the gentle rhythm- the dunk then pull of oars whispering through the night.
To gain a clearer view, she took a few more steps toward the water and saw the stern of a small boat rowed by a large man moving away. He wasn't masked as he'd been last night, but he was the right size and build for the man who'd attacked her.
The boat stopped, and he stood then heaved an anchor into the water. He braced his feet wide then bent low and dragged a body from the boat.
Lilly. Oh, no.
He lifted her like a rag doll and pinned her against his wide chest. He drew a gun from his belt and pressed the barrel against her temple.
Was he going to kill her? Or did he know Gina was watching and he hoped she'd show herself? She had to risk it. She ran to the edge of the deck to order him to stop and take her instead.
The gun flashed and a pop split the silence.
Lilly's body sagged. The man released her, and she dropped like an anchor into the water. He stood looking down at the spot where Lilly had fallen.
He'd shot Lilly. Killed her.
A strangled cry came from Gina's mouth, and she took a step back. Her heel connected with a table, knocking a container to the deck. The metallic clang, clang, clang as it rolled over the wood cut through the night, and the man's head popped up.
She scrambled back into the shadows. He'd killed Lilly. Right in front of her. Shot her.
Gina dropped her head low and breathed deep to stem a wave of nausea. Still gagging, she watched the man.
He holstered his gun and started drawing up his anchor.
Hand over hand, he moved at a fast clip. He'd seen her and was coming for her next. For Sophia.
Gina charged inside the home. She grabbed her overnight bag and slung the strap across her chest. She scooped up Sophia, Pooh blanket and all. The baby startled for a moment, and Gina hugged her close, laying her cheek against soft curls for the briefest of moments. Her sweet baby sighed then drifted back to sleep.
Back on the deck, Gina heard the man's oars hitting the water. Plop, swish. Plop, swish, he moved steadily closer. She had to hurry.
She raced toward the dock, clutching Sophia in one arm and digging out her phone to call 9-1-1 with her free hand.
"Help," she whispered so the man couldn't hear her. "I need help." She blurted out her story as she heard his boat thump against the end of the deck.
"Hurry. Send someone fast. He's right behind me. Closing in on me faster than I'd thought." She huffed out Lilly's address, but she could no longer carry on a conversation and pull in enough air to run. She shoved the phone in her pocket and charged toward the gangplank that connected this small floating village with the shore.
In the parking lot, she wished for her car, but she'd flown to Portland and arrived at Lilly's house by taxi. She ran as hard as she could, her feet pounding toward the nearby mall.
Heavy footfalls soon slapped on the asphalt in the distance behind her. She had to hide and hope the police arrived on time. At the nearest store, she sank into the shadows of a large Dumpster.
A foghorn sounded from the river.
Fog. What about the fog? Wouldn't it slow down the police response? She couldn't risk them not arriving in time. She had to summon more help. Preferably someone nearby.
Thankful a mutual friend had shared his cell number just after she'd arrived in town, she dialed the phone.
Please answer, Derrick. Please. I need you.
The thought took the last shred of her calm. She didn't want to need him or anyone else. Didn't deserve his help with the way she'd walked out on him.
But she trusted him to come through for her, whether she deserved it or not. Life-and-death matters trumped pride. He'd balk at helping, but he was a man of honor. Of integrity. One who worked hard to find justice for the underdog. He'd never let her down. No matter what she'd done to him in the past.
As reality settled in, her stomach cramped hard. Sophia's and her own life now depended on the very man who never wanted to see her again.
From the upper deck of Derrick Justice's houseboat, he stared over the Columbia River, letting the rhythmic flow of the river melt away his terrible day. Okay, so maybe it hadn't been terrible. Just stressful. Something he never thought he'd say about an early dinner with his siblings, but since they'd all married, he felt out of place at family gatherings.
"Get used to it," he mumbled to himself. You 're not marriage material. This is your life now. A life that would be filled with watching all of them making doe eyes at each other and playing touchy-feely. It was enough to gag him.
The hardest to take was his twin, Dani. He'd always been able to count on her to stand in solidarity with him. But now, she'd gone to the other side, too. In the two months since she'd married Luke Baldwin, Derrick had hardly seen her outside of work at the family's private investigation agency.
He drew in a deep breath, let it out and watched the vapor swirl up then disappear into the haze. He propped his arms behind his head and noticed long fingers of the fog creep over the edge of his second-story deck. Soon it would surround him and he wouldn't be able to see a thing. Perfect. Just the way he wanted it tonight.
His phone chimed. He glanced at the screen. Not someone he knew, but the call could be related to a case so he answered. "Derrick Justice."
"Derrick." The whispered voice hit him like a Mack truck, and air whooshed out of his lungs. He shook his head in disbelief.
Was it really her, or had all these thoughts of marriage parading through his head tonight unearthed a memory he'd rather avoid? Holding his breath, he waited for her to speak again.
"Derrick, are you there?" Her voice was stronger this time.
A chill settled over him, and he thought about hanging up. He didn't need to talk to the woman who'd walked out on him. Especially not today when he was already crabby about family members leaving him behind.
"A man is going to kill me unless you help me," she whispered.
"What man?" He came to his feet to pace the deck.
"My brother was murdered. The killer just shot my friend Lilly right in front of me. I grabbed Sophia and ran. Derrick, she's only seven months old. He'll hurt her, too. I can't fail her. But he's " Her voice fell off in a strangled sob.
The Gina he'd known was calm, levelheaded and not prone to exaggeration. Self-reliant, asking for help only as a last resort. She also didn't panic. Unless the situation called for it. The threat must be real.
Unease curdled his dinner. "Where are you?"
"Jantzen Beach. I'm hiding behind Coffee to Go's Dump-ster."
"Did you call the police?"
"Yes, but I'm afraid the fog will slow them down and they won't get here in time."
"I'm on my way. Make sure your phone is set to vibrate so it won't be heard if I need to call you."
"Thank you," he heard her say as he disconnected.
Dropping his phone in his pocket, he charged inside and headed straight to his bedroom. He grabbed his gun from the drawer and filled his pocket with ammo. No telling how much he might need.
On the way to the main door, he snatched his car keys from a hook. Running cross-country would be faster than getting his car out of the garage and driving, but he'd need his car to pull off the safe rescue of a woman with a child.
Child. Gina has a child.
A vice gripped his heart. She had a baby. Should've been his child. His daughter.
"Too bad," he mumbled as he climbed into his SUV. She didn't want you, now, did she?
Once on the road to the mall, doing fifty in a thirty-five zone, he speed-dialed Dani. It was foolhardy enough to go into a dangerous situation without backup, but the situation was too dangerous for him to wait. Still, he needed to let one of his siblings know where he was going.
"Derrick," she answered on the third ring.
He quickly explained the situation. "Gina called the police, but this is a potential homicide, so call Mitch, too." Their sister, Kat's, husband was a Portland homicide detective. "I'll call you as soon as I have anything else to report."
"Be careful."
He turned into the strip mall's lot, his focus going straight to the coffee shop at the far end of the mall. Hazy mist clung to the concrete, inching up the siding as if planning to devour it, while windows on the darkened stores stared blankly back at him. He crawled through the lot, not spotting any movement.
Had Gina fabricated this incident? Played him? If so, what did she want with him? Only one way to find out.
He parked at the end of the building and got out. He drew his weapon, and after a careful sweep of the area, rounded the corner. Sliding along the building to protect his back, he glanced into the service alley. Light filtered through the moisture-laden air from a streetlight in the distance, but nothing moved. He chanced a longer look, and once he was confident he wouldn't be ambushed, he flattened his back against the wall again and eased toward the Dumpster.
Toward Gina.
A few more steps took him to the back side of the metal container angled against the building. In the corner, large, terrified eyes peered up at him. Eyes he'd stared into for two years in college and once figured he spend his life looking into.
She cowered in the corner, a sleeping baby clutched to her chest.
"Derrick," she whispered, her voice trembling.
She wasn't faking her terror. Someone was after her, and she needed him.
Correction. She needs your help, not you.
The thought helped him steel himself for her touch, and he offered his hand. As he'd expected, when she slipped soft fingers into his, it burned all the way to his heart. Their eyes met and held. He suddenly wanted to let go of common sense, of their past, the pain and heartache, and draw her into a comforting hug to erase the misery from her eyes.
She shivered violently, pulling her gaze free, breaking the intensity of the moment and bringing him back to his senses. She wore only a heavy sweater and jeans. Shrugging out of his jacket, he settled it over her shoulders. She burrowed into the fleece lining without a word. "Are you okay?" he asked.
"It's a long story. Can we get out of here before I explain?"
He opened his mouth to agree, but something rustled behind him and he spun to search the area. Darkness met his gaze-he saw no one. But then heavy footsteps pulled his focus to the distance. They pounded nearer, their cadence laden with caution.
The killer? Of course. Who else would it be on a night like this and after the mall has closed?
"He's coming. We have to move." Derrick scanned the alley for an escape route. Nothing presented itself without leaving them exposed. If the footsteps belonged to the man trailing Gina, they were trapped.
Derrick needed a plan and needed one fast. He grabbed Gina's arm and pulled her from behind the Dumpster, a surefire death trap if the killer caught them back here. He looked around, his mind waffling as he decided what to do.
The footfalls neared, echoing into the night before disappearing.
Derrick had to act. Now! Even if he failed.
Posted October 31, 2014
The Justice Agency comes to a climatic end in Dark Tide. Take an aunt protecting her niece, a villain chasing them who doesn't hesitate to kill anyone in his way equals a true page turner. Susan Sleeman is a fantastic romantic suspense author who does not dwell too long on the romance, but has plenty of suspense.
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Posted March 27, 2014
I've read every single one of The Justice Agency Series books and have loved every one. Dark Tide is no different. Derrick and Gina's story touched my heart -- making it beat faster during those inevitable scary times and making it slow in awe as they worked out their feelings for one another.
I love happily-ever-afters, and this is one series I will miss. I have come to "know" the Justice brothers and sisters, and each story has touched me in a unique way.
***I received the above book from the publisher/author for the purpose of review. The above is my honest opinion.***
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Posted March 13, 2014
Another fantastic Christian suspense novel!
Mission: Protect Baby
Gina Evans knows her brother was murdered – even if the police won't believe her. After catching a quick glimpse of the evidence her brother had gathered, the same criminals are after her and her baby niece. And Gina's only hope is the man she left behind. Despite the painful memories, private investigator Derrick Justice won't fail Gina and her baby. Yet now, the woman he never stopped loving and the baby he's come to adore are in a killer's crosshairs. But can Derrick trap the cold-blooded murderer before he strikes again?
Once again Susan Sleeman has done a great job of developing wonderful characters that are carrying very heavy emotional baggage from their pasts. They are very likeable and easy to connect with. I found myself encouraging them (sometimes audibly) to just let go of the past and move on. Both Derrick and Gina had to travel down their own path to work out their stuff while at the same trying to catch the killer before anyone else lost their life. The plot for the mystery was great. I love the way there is a great balance between adrenaline rush inducing action/danger sections and incredible character building times.
I received a free copy of this book from the author in order to read and write and honest review for it.
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Posted March 8, 2014
Dark Tide by Susan Sleeman in the final installment of The Justice Agency series and does not disappoint. In this book we once again visit the brothers and sisters that make up the Justice Agency, this time Derrick Justice is the star when the flame from his past who broke his heart shows up desperate for help. A killer is after her and she has a baby to protect.
I really enjoyed Dark Tide and am sad to see the series end. This book held my attention from beginning to end, which has been difficult lately, lol—I actually finished this book! It was a fast read and I never got bored with the storyline.
Special thanks, Susan Sleeman for sending me a review copy of this book. The opinions expressed are mine alone. I was not required to write a positive review.
Posted March 6, 2014
I just finished the last book in the Justice Agency series, Dark Tide, by Susan Sleeman. Each book got better and better in the series because I was able to learn more about the family, the siblings, and their lives. Therefore, even though I felt like I fit in with them right from the start, with Book #1, Double Exposure, each book brought me closer and closer to the heart of each sibling and therefore, closer to the family as a whole.
Ms. Sleeman has a way with words. She writes in such a way that I'm sitting on the couch next to Gina or rubbing Sophia's back while she closes her eyes and sucks her thumb, content on Derrick's shoulder. I can see the protectiveness in Kat's eyes and feel the humorous banter back and forth between Dani and Derrick. I can see the love pass between Luke and Dani and Kat and Mitch across the computer screen. And I can taste the coffee that they consume pot after pot.
The spiritual element isn't lost in the depths of the suspense and great story either. I love how Ms. Sleeman uses events in the character's past to help bring them to where God wants them today - a place of healing. However, it's a process and even though they make progress, they aren't necessarily "cured" by the end of the book - just like in real life. Layers are peeled away to expose new layers that require less healing, but healing nonetheless.
I'm sad to see this series wrap up; yet I didn't feel like it was "over" when I turned the last page. It was satisfying and written in such a way that I still felt connected, as though I would see them again someday. I probably won't but they have a way of staying with me, like friends from high school that you don't see for years but you know are still around and you treasure the memories you have of them. In the meantime, I can't wait to be introduced to a new set of characters from Ms. Sleeman in another series or book. She is an author I truly love to read.
Posted March 4, 2014
I have enjoyed reading all 5 of the Justice Agency books. 3 brothers and two sisters after the death of their parents all decide to come and give up their work in different law backgrounds to find their parents killers. They decide to open their own agency. All 5 of the children were adopted and are close to each other.
Dark Tide is the last of the single Justices. This is Derrick's story and his old college girl friend Gina.
I really like the characters how they all pull together to help others. They are willing to risk their lives to protect those in need. Sophia is a scene stealer. She is only 7 months old and has already lost her parents in two separate car accidents.
Gina is scared and turns to her former boyfriend to ask for help finding her brothers killer and keeping her niece safe. I like her she is smart, changed her life when her sister-in-law died to help her brother.
Derrick has issues in his past and he is afraid to commit to a relationship. They had a tough break up.
The setting is California modern day
This is full of mystery, action and drama. It is also a clean romance book. I smiled a lot to the different characters who were having fun with the baby. It is also a Christian romance not afraid to bring up a scripture or a prayer when needed. Not preaching just something the character would do and say naturally.
I am sad to see this series ends and hopes Susan keeps writing. I will continue to look for her books in the future.
I was given this ebook and asked to give honest review of it by Netgalley and Harlequin.
Publisher: Love Inspired Suspense (March 1, 2014) 224 pages ASIN: B00FBZCWLY


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Koenig's 2014 Match-by-Match Stats
2014: Appeared in four matches for the Utes this season ... totaled two kills, one dig and one block ... recorded a kill vs. Montana State (8/29) and East Tennessee State (9/12) ... had one block vs. Montana State as well.
2013: Made career debut in two sets against Prairie View A&M (9/7) and had two kills on four swings with one error for a .250 hitting percentage.
High School/Club: First-team all-league selection as an outside hitter each for two seasons after earning second-team honors as a sophomore in 2010 ... four-year letterwinner for coach Ernie Santa Cruz at Arroyo Grande High School ... posted 219 kills, 143 digs and 36 aces as a senior ... played for the 805 Volleyball Club and was a member of the 2009 and 2012 undefeated league champions ... member of the National Honor Society, Link Crew, Fellowship of Christian Athletes and served as the ASB Senior Class Officer ... also competed in track and field (high jump and triple jump).
Personal: Daughter of John and Deborah Koenig ... has two siblings, Brandon and Kayla Young ... born Dec. 8, 1994 ... intends to major in Interior Design at Utah ... plans on eventually owning her own business.
Kills: 2, vs. Prairie View A&M (9/7/13)
Attempts: 4, vs. Prairie View A&M (9/7/13)
Blocks: 1, vs. Montana State (8/29/14)

subset: commoncrawl


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Devil May Care!
2015 THEME: Devil May Care! Statement to be posted soon!
Meanwhile, Feel the Love in our garden!
2013 brought the Revival of the Parade after Hurricane Sandy and ALL OF YOU brought it back!
So in 2014 year we celebrated the JOY of finding our tribe the celebration was about YOU and the secret garden of the Village Halloween Parade where all of you Earthly Delights gather in the landscape of New York City.
So, our 2014 Theme was: The Garden of Earthly Delights!
Although one often associates Halloween with things Infernal, this years Halloween Parade is headed to Paradise, or more specifically the Garden of Earthly Delights. Join us as we unearth the layers of Heironymous Boschs timeless altarpiece, exploring the precarious borderland Garden between the primeval terrors of wilderness and the modern confines of civility.Is there an oasis, a point of respite between the ravaging wilds of nature and stifling constrictions of urban life? A garden is above all, a place of precarious balance - just enough nature to tie us to our primeval roots, yet not so much we might lose our way and fall prey to the dangers that lurk in the wilderness. It is a narrow borderland of green where one might be of nature without being fully in it. The great gardens of Europe often featured mazes of hedgerows, where visitors could experience the vicarious terror of becoming lost (literally bewildered) while taking comfort from the confines of civilization that encircled them.
The beginning of humankinds transition to sedentary farming coincides with a mythological obsession with the Garden, as the dangerous uncertainty of our hunter-gatherer past gave way to ordered paths, sheltering walls, and sustaining bounties. The Tree of Life and the fruits of immortality are never found in the forest, jungle, or savannah, but rather in a cultivated Garden - whether Golden Apples tended by the Hesperides of the Greeks, or the Jade Emperors Peaches of Immortality pilfered by Monkey King of Chinese Myth, or the Biblical Garden of Eden whose fruits bring knowledge even as they harken the end of innocence. Like Borges Garden of the Forking Paths, it is a place of infinite possibilities and permutations contained within a finite and intimate space. Gardens are also places of forbidden delights and forgotten joys hidden away behind ivied walls and locked gates. The Secret Gardens of Hans Christian Andersen and Frances Hodgson Burnett remind us that the Garden evokes a return to childhoods fearless and ephemeral embrace of the world.
The New York Village Halloween Parade has always been a secret garden of sorts, a place where, for 40 years, wildness of a very rare variety has flourished within the high walls of New Yorks avenues. Halloween being a night of inversions, our garden is not a safe place where the wild is kept out; it is a safe place where the wildness of imagination is invited in! Just as Frederick Law Olmsteds ramble in Central Park cultivates the liberating thrill of bewilderment amidst its twisting paths, paraders know they will be safe within the procession.
This year Parade puppeteers will sow the seeds of a verdant Garden, turning 6th Avenue into a greenway of surging shoots, unfurling blossoms, and tempting fruits dangling low from the animated boughs of a giant Tree of Life. All are invited to our workshops to help bring our not-so-secret, world-famous garden to life and celebrate our oasis of wildness that in the end (as Olmsted said) is what truly civilizes us.
Hallelujah Halloween!
Jeanne Fleming, Artistic and Producing Director
Alex Kahn, Master Puppeteer
Get your 2014 Garden Tee!


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Paprika Tilapia with Quinoa and Cucumbers
Community Recipe from
- 1 cup(s) quinoa
- 2 1/2 teaspoon(s) EVOO
- 1 pound(s) tilapia boneless, skinless fillets divided into 8 pieces
- 3/4 teaspoon(s) paprika
- 1 cup(s) English cucumber diced
- 1/3 cup(s) dill roughly chopped
- 1/3 cup(s) feta, 1 1/2 oz. crumbled
- 2 teaspoon(s) fresh lemon juice
- Directions
- In a small saucepan, bring quinoa, 2 cups water, and 1 teaspoon salt to a boil over high. Reduce to a medium simmer and cook until water evaporates, about 15 minutes. Transfer quinoa to a medium bowl and let cool 5 minutes.
- In a large nonstick skillet, heat 1 1/2 teaspoons oil over medium-high. Pat fish dry and season with salt and pepper; sprinkle with paprika. Cook fillets until opaque throughout, about 4 minutes, flipping halfway through. Stir cucumber, dill, feta, 1 teaspoon oil, and lemon juice into quinoa. Season with salt and pepper. Divide quinoa among four plates and top with fish.
February 2013
This recipe is a personal recipe added by ftcollinsco and has not been tested or endorsed by MyRecipes.
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A method and apparatus for determining suitable settings for a servo-ventilator to be used during sleep. Respiratory characteristics of a patient are measured during an awake learning period. With these measured characteristics, a target ventilation setting may be calculated by alternative methods. The calculated setting may then be used for enforcing a minimum ventilation during a treatment period where ventilatory support is provided with a servo-controlled ventilator.
1. A method for determining at least one setting of a ventilator to be used during sleep comprising the steps of:
measuring at least one respiratory characteristic of a patient during a learning period while the patient is awake; and
determining at least one setting value from said at least one respiratory characteristic to be used for the operation of said ventilator during a subsequent treatment period of sleep.
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This application is a continuation of U.S. patent application Ser. No. 10/683,239 filed Oct. 10, 2003, now U.S. Pat. No. 6,845,773 now allowed which is a continuation of Ser. No. 09/799,260, now U.S. Pat. No. 6,644,312, which claims the Mar. 7, 2000 priority filing date of U.S. Provisional Application Ser. No. 60/187,565.
The present invention relates to the field of ventilatory assistance, and in particular, to methods and apparatus for determining suitable ventilator settings in patients with alveolar hypoventilation during sleep, and for delivery of those settings.
Patients with sustained alveolar hypoventilation, such as patients with central alveolar hypoventilation syndrome (Ondine's curse), defective chemoreflexes, obesity-hypoventilation syndrome, kyphoscoliosis, and neuromuscular disease, but also the large group of patients with chronic airflow limitation, can often breathe adequately while awake but hypoventilate during sleep, particularly during rapid eye movement (REM) sleep. Therefore, these patients require ventilatory assistance during sleep. In addition, some may require oxygen therapy, particularly during sleep.
However, from the clinical perspective, it is difficult to determine a correct degree of ventilatory support to ensure adequate ventilation during all sleep stages, particularly REM sleep, while avoiding excessive ventilatory support in the awake state or in non-REM sleep. Excessive support can lead to over-ventilation with vocal cord closure and, ultimately, sleep disruption. Excessive support is also uncomfortable to the awake patient. Equally difficult is selecting the correct amount of supplemental oxygen therapy. Patients need more supplemental oxygen during periods of hypoventilation than during other periods, but excessive oxygen therapy can be deleterious or expensive.
A volume cycled ventilator set at a fixed respiratory rate and set to deliver a chosen amount of ventilation may largely solve the under-ventilation problem. However, it introduces three new problems.
Firstly, it is necessary to experiment with various tidal volume settings to find settings that achieve the desired level of blood gases. A rough estimate can be made from first principles, based on the patient's weight, height, age, sex, etc. However, differences in metabolic rate, in particular, the gas exchanging efficiency of the lungs, can introduce very large errors. In current practice, expert clinical experience is required to make such an assessment, and usually the chosen target ventilation needs to be tested overnight and iteratively refined.
Secondly, such ventilators when correctly set are uncomfortable for most patients because the patient can only breathe at exactly the rate and depth set by the machine.
Thirdly, the ventilator may not be set accurately. If the ventilator is set to give slightly too much ventilation, the subject will be over-ventilated, leading to airway closure and very high airway pressures. Alternatively, if the ventilator is set to give slightly too little ventilation, the subject will feel air hunger.
The usual clinical compromise solution is to use a bilevel ventilator set to administer a fixed higher airway pressure during inspiration and another fixed lower airway pressure during expiration. The device is typically set to trigger from the expiratory pressure to the inspiratory pressure on detection of patient inspiratory airflow and to trigger back to the expiratory pressure on cessation of patient inspiratory airflow. A backup rate is provided for the case where the patient makes no effort within a given period.
This solution is a compromise for several reasons. Firstly, it is difficult to select a degree of assistance that will adequately support the patient during, for example, REM sleep, without over-ventilating the patient during non-REM sleep or while the patient is awake. We have made measurements of the degree of support that makes typical patients feel most comfortable during the daytime and found it to be much less than the degree of support that provides adequate ventilation during sleep. In many patients, the degree of support required during sleep, when delivered to the patient in the awake state, actually feels worse than no support at all. Secondly, the square pressure waveform is uncomfortable and intrusive in patients with normal lung function. Thirdly, it is necessary to empirically set the device while the patient sleeps, and it may take several iterations to find an adequate compromise. This procedure requires highly experienced staff and is very expensive.
One method of providing more comfortable ventilatory support is proportional assist ventilation. A device using this method seeks to provide a more comfortable pressure waveform that necessarily avoids over-ventilation because the patient must supply some effort, which is then amplified by the device. Unfortunately, this method will not work in the case of patients with absent or severely impaired chemoreflexes in sleep. This problem exists in people with Ondine's curse or obesity hypoventilation syndrome, or in people in whom the coupling between effort and result reduces dramatically during sleep, for example, patients with neuromuscular disease, where accessory muscle activity is completely lost during sleep. This problem also occurs in a very wide range of patients during REM sleep when there is routinely abnormal chemoreflex control, even in normal subjects.
The broad class of servo ventilators partially address the problem of the patient requiring much less support while awake than asleep. The physician specifies a target minute ventilation, and the device supplies sufficient support to deliver the specified minute ventilation on average. While the patient is awake and making large spontaneous efforts, the device will provide zero support. However, it will provide support as required during sleep. Further refinements of the servo-ventilator including the features of a smooth pressure waveform template, resistive unloading, low source impedance so that the patient can breathe more than the target ventilation if desired, and a minimum degree of support chosen to be comfortable in the awake state are taught in commonly owned International Publication No. WO 98/12965.
The above approaches all require the specification of a target ventilation, and either a respiratory rate or a backup respiratory rate. In addition, in patients requiring added supplemental oxygen, it is necessary to also specify the amount of added oxygen. Finally, using the above approaches, if the device is incorrectly calibrated, it will deliver a different minute ventilation than the one chosen.
It is an objective of the present invention to permit the determination of suitable ventilator settings and supplemental oxygen flow rate, for use with a servo ventilator, by measurements and observations made on the subject during the daytime.
It is a further objective to permit the delivery of the chosen settings even in the case of incorrect calibration of the ventilator.
Further objectives, features and advantages of the invention will become apparent upon consideration of the following detailed description.
In its broadest sense, the present invention involves a method and apparatus for determining ventilator settings such as a desired target ventilation and/or respiratory rate. During a learning period, while a patient is preferably in a relaxed and awake state, respiratory or ventilation characteristics including, minute ventilation, and optionally blood gas saturation, such as arterial hemoglobin oxygen saturation, and respiratory rate, are measured by a ventilator. The measurements are then used to determine ventilator settings for use during the patient's sleep. In a preferred form, the device automatically calculates the desired target ventilation and respiratory rate during or at the end of the learning period, and saves and later applies these settings during subsequent therapy.
In one embodiment, the ventilation target is calculated as a fixed percentage of an average ventilation taken over the entire learning period. Alternatively, the ventilation target may be a fixed percentage of an average ventilation taken over a latter portion of the learning period to eliminate ventilation measurements from non-relaxed breathing efforts from an initial portion of the learning period. In a still further alternative, the ventilation target is determined from a graph of spontaneous ventilation and oxygen saturation measurements made during the learning period. In this method, the target ventilation is taken as a fixed fraction of the ventilation that on average achieves a desired arterial oxygen saturation level.
Referring to
For example, consider a learning period 2 in which a patient is quietly relaxed and awake. The patient is for preference distracted from breathing, for example, by watching television but remaining still and quiet. Typically, the learning period will be of the order of one hour's duration or longer, although shorter periods are practical. During the learning period 2, the subject breathes via a nosemask, facemask, or other suitable interface, as chosen for use during sleep, from a servo-ventilator such as the apparatus of
During this learning period, ventilation is measured (step 6). Optionally, as shown in
Switching from a learning period 2 to a treatment period 4, the target ventilation is used by the ventilator to deliver ventilation. The ventilator will measure the patient's ventilation during sleep in step 10. The ventilator will then derive a pressure amplitude to maintain delivered ventilation to at least equal the target ventilation in step 12. Mask pressure is then calculated and delivered to the patient, in step 14, as a function of the pressure amplitude. The ventilator will then maintain actual ventilation to at least equal the target ventilation. Optionally, a target respiratory rate may also be set to a value determined during the learning period. For preference, this is the average respiratory rate during the last 75% of the learning period.
The first advantage of this method is that the target ventilation (and optionally the respiratory rate) is now demonstrably known to be suitable for the particular patient. The second advantage is that any errors in measurement of ventilation by the device will be cancelled out, and the device will guarantee at least the chosen fraction of the patient's spontaneous awake ventilation.
In one embodiment of the invention, the target ventilation is a target minute ventilation taken as a fixed percentage of the average minute ventilation during the entire learning period. Typically this percentage will be 90%, to allow for the fact that metabolic rate decreases slightly during sleep. In a preferred embodiment, the above calculation is made by the device itself. The principle underlying this method is that the subject has on average relatively normal arterial partial pressure of carbon dioxide while awake, the principal abnormality of ventilation being confined to sleep. Since the relationship between minute ventilation and arterial carbon dioxide is approximately linear over small departures from the mean, the average ventilation awake will ensure the average partial pressure of carbon dioxide awake.
Many subjects do indeed have elevated carbon dioxide tension in the daytime as well as at night, but if the nocturnal rise is prevented, then the subject will gradually over days reset his or her respiratory controller to a more normal set-point. It would then be appropriate to repeat the daytime learning procedure and determine a new target ventilation after about one to two weeks of therapy, to take advantage of this resetting.
It would in principle be possible to calculate a final target ventilation for use during the treatment period from a measure of the subject's awake daytime arterial partial pressure of carbon dioxide, the desired final awake daytime partial pressure of carbon dioxide, and the current target ventilation from a prior learning period. A simple calculation, ignoring changing dead space to tidal volume ratio is: Final target ventilation=current target ventilation times current awake arterial partial pressure of carbon dioxide divided by final desired awake arterial partial pressure of carbon dioxide. However, applying this final target ventilation immediately within the treatment period would lead to akalosis and vocal cord closure during sleep. This will disturb the effectiveness of therapy by inducing upper airway obstruction.
In a second and preferred embodiment, the first portion of the learning period, typically 20 minutes, is discarded because the patient is typically particularly aware of his or her ventilation as a result of commencing ventilatory therapy. Thus, the measurements from steps 6 and 16 are recorded only during a second portion, preferably lasting 40 minutes or more.
A third embodiment is useful in the case where the subject's breathing changes slowly with time by a large amount during the learning period, for example, if the subject is initially very anxious, later breathes normally, and finally falls asleep and desaturates. To address this situation, measurements of oxygen saturation are taken with an oximeter along with measurements of spontaneous ventilation. At the end of the learning period, a graph of oxygen saturation versus spontaneous ventilation is drawn. Then, using this graph, the target minute ventilation is taken as a fixed fraction (typically 90%) of the ventilation that on average achieves a desired arterial oxygen saturation.
The basis for this method is that some subjects, for example, those with obesity hypoventilation syndrome, fall asleep easily for short periods during the learning period. During these short periods, the subjects will reduce their ventilation and desaturate. Thus, it is intended that the method use only data from periods where the awake saturation is adequate.
Conversely, other patients, particularly early in the learning period, are anxious and over-ventilate. Periods where the ventilation is very high but the saturation has not importantly increased should therefore also be ignored. Because the subjects are awake during the learning period, they will tend to fidget and move about, which causes oximeter artifact. Therefore, the subjects should be made very comfortable and asked to relax and remain quiet and still as far as possible.
Preferably, the oximeter is a pulse oximeter with excellent movement artifact immunity, such as the device produced by the Masimo Corporation. However, due to patient circulation times and processing times in the oximeter, changes in saturation lag changes in ventilation by typically 20–30 seconds. Furthermore, due to the oxygen storage capacity of the lungs and blood, very short changes in ventilation (typically less than 10–40 seconds) produce little or no change in saturation. Therefore, the ventilation measurements should be delayed by the expected circulation time plus oximeter processing time (e.g., 20–30 seconds), and low-pass filtered to compensate for the low-pass filtering of the saturation by the body oxygen storage capacity (e.g., with a time constant of 10–40 seconds) in order to better relate changes in saturation to changes in ventilation.
This selection of a suitable delay and time constant can be done automatically, for example, by using the method of least squares nonlinear regression to search the expected range of delay and time constants to find the combination that minimizes the scatter around the saturation vs. ventilation graph. For example, the least squares procedure can fit an exponential curve to the saturation vs. ventilation graph, such as
where S is the saturation, v is the ventilation, and Smax and k are fitted constants. However, there is no particular physical significance in the use of the exponential curve. The actual shape of the saturation vs. ventilation graph is very complex, and an exponential curve is just one of a large number of curves that could be fitted. One such fitted curve 18 is represented in the graph of
Typically, the desired arterial oxygen saturation will be in the range 90–95%, for example 92%, because a goal of ventilatory support is to keep the saturation above 90%, but 95% is normal during sleep. The desired level of arterial oxygen saturation can be chosen by the clinician with reference to the patient's clinical condition. Thereafter, in a preferred form, the target ventilation can be calculated automatically from the above fitted exponential equation. Alternatively, the desired oxygen saturation can be chosen by inspection of the oxygen saturation vs. ventilation graph. In general, the graph will include a quasi-plateau portion at high ventilations, where further increases in ventilation yield little further increase in saturation but risk over-ventilation and hypocapnia, and a steep portion at low ventilations, where the risk is of hypoxia and hypercapnia. A suitable desired saturation is two percent below the plateau saturation. For example, in a subject with normal lungs, the plateau will commence at 97%, and even doubling the ventilation will not increase saturation above 98%. Therefore, a suitable desired saturation would be 95%. In subjects with lung disease, the plateau will begin at a lower saturation than in normal subjects. In a preferred embodiment, the desired saturation is calculated automatically as, for example, 2% less than the constant Smax. This is illustrated in
However, this least squares nonlinear regression method is not useful in the case where there are negligible slow changes in saturation because it will not be possible to fit an exponential to the saturation vs. ventilation graph. If the standard deviation of the saturation residuals about the fitted curve is not less than approximately 50% of the standard deviation about a simple average saturation, then the target ventilation should be calculated as in the second embodiment (for example, 90% of the mean ventilation during all but the first 15 minutes of the learning period).
The above procedures will yield at least a good first estimate of ventilator settings, without having to adjust the ventilator settings during the night. However, a potential problem with the embodiments described above is that the subject might stably over-ventilate or under-ventilate for the entire period of the learning session. Therefore, in some subjects, it may be desirable to confirm that the target ventilation is satisfactory by measuring arterial or arterialized capillary carbon dioxide concentration in the morning following overnight therapy, and increasing the target ventilation if the morning arterial carbon dioxide concentration is too high, or decreasing the target ventilation if the morning arterial carbon dioxide concentration is too low. Another approach to guard against the effects of sustained over or under-ventilation during the learning period is to measure arterial blood gases, particularly arterial P
The target ventilation calculated using any of the above procedures is based on the assumption that the ventilation that is adequate in the daytime, i.e., while the patient is awake, will also be adequate at night, i.e., while the patient is sleeping, if allowance is made for a reduction in metabolic rate. As previously mentioned, clinical methods of calculating a target ventilation also attempt to allow for variations in metabolic rate, for example, by using age, height, weight, sex, skinfold thickness, etc., and gas exchange efficiency (chiefly dead space to tidal volume ratio, but also V/Q distribution, arterial-alveolar oxygen tension gradient, diffusing capacity, spirometry, clinical experience, and so forth). The present method is in principle more robust than these methods because it very directly measures the patient's actual ventilatory need. Nevertheless, it is possible to produce a final target ventilation which is a weighted average of the present method and any combination of other methods. For example, patient estimation information such as age, height, weight, sex, alveolar dead space, etc., may be used with any other known estimation method to calculate an estimated target ventilation using the other known method. Then a final target ventilation may be determined, which is a weighted average of the present method and the other known estimation method. Alternatively, the target ventilation calculated from an awake learning period may be used as one input variable to an expert system, for example, a fuzzy expert system, in which other input variables include one or more of age, height, weight, sex, severity and kind of disease, spirometry, blood gases, alveolar dead space and other lung function results.
Several of the above methods calculate a mean ventilation over a period of time. If the measurement of ventilation (as opposed to the subject's actual true ventilation) is noisy, it may be advantageous to calculate a more robust measure of central tendency, such as a trimmed mean or a median. Similar comments apply to other quantities measured, such as respiratory rate and arterial oxygen saturation measured by pulse oximetry.
Some patients require the addition of supplemental oxygen in order to maintain adequate oxygenation and saturation, even if minute ventilation is adequate. This is due to ventilation-perfusion mismatch. In such patients, the learning period may be repeated at one or more different levels of inspired oxygen, e.g., 21%, 24%, and 28%, or at one or more different levels of added oxygen, e.g., 0, 2, and 4 L/min. This will yield three different target ventilations, at three corresponding saturation levels. The physician may then choose one particular supplemental oxygen level, and the corresponding target ventilation. In general, this will be the lowest added oxygen level that permits a satisfactory saturation at a practicable target ventilation. If the ventilator is then set to deliver the target ventilation with the selected level of supplemental oxygen therapy, then the subject will still be guaranteed adequate ventilation, and the saturation will also be adequate, providing the ventilation-perfusion mismatch does not worsen significantly during sleep.
A suitable apparatus for implementing these methods is shown in
It is to be understood that the mask could equally be replaced with a tracheotomy tube, endotracheal tube, nasal pillows, or other means of making a sealed connection between the air delivery means and the patient's airway. Moreover, as an alternative to the blower 20, the ventilator may use any source of breathable gas including air/oxygen mixtures at controllable pressure.
The microprocessor 26 accepts the mask airflow and pressure signals, and from these signals determines the instantaneous flow through any leak between the mask and patient, by any convenient method. For example, the conductance of the leak may be estimated as the instantaneous mask airflow, low-pass filtered with a time constant of 10 seconds, divided by the similarly low-pass filtered square root of the instantaneous mask pressure, and the instantaneous leakage flow may then be calculated as the conductance multiplied by the square root of the instantaneous mask pressure. Respiratory airflow is then calculated as the instantaneous mask airflow minus the instantaneous leakage flow.
The desired mask pressure is described by the following equation:
P0 is a desired end expiratory pressure chosen to splint the upper and lower airways or alveoli, or to reduce cardiac preload or afterload, for example, 5 cm H2O;
R may be zero, but is preferably any value less than the patient's actual airway resistance;
f is respiratory airflow, measured, for example, using a pneumotachograph in the mask, and correcting for leak, for example, as described in the commonly owned International Publication referred to above;
Φ is the phase in the patient's respiratory cycle; taken as varying between zero and 1 revolution, with zero corresponding to start of inspiration and 0.5 corresponding to start of expiration, preferrably calculated using fuzzy logic;
Π(Φ) is a pressure waveform template, initially set to be similar to that shown in
A is a pressure modulation amplitude, for example, using clipped integral control as follows:
where G is a servo gain (for example, 0.3 cm H2O per L/min per second), VTGT is a desired target ventilation (e.g., 7.5 L/min), and the integral is clipped to lie between AMIN and AMAX (for example, 3 and 20 cm H2O) chosen for comfort and safety.
To implement the learning period methods using this apparatus, the microprocessor 26 may be programmed to implement a "learn" mode and a "treat" mode. During the "learn" mode, the pressure modulation amplitude A is set to a very low value, chosen to be enough to make the patient feel comfortable while awake, but not enough to do all the work of breathing. In all subjects, an amplitude of 3 cmH2O will be satisfactory. However, the exact value is non-critical. In some subjects with very high work of breathing, larger values can be used if desired. During this learn mode, the microprocessor 26 may store ventilation data, for example, in SRAM or EEPROM, for use in calculation of the target ventilation VTGT. Optionally, the microprocessor 16 may also store arterial hemoglobin oxygen saturation data from a pulse oximeter 32, or other similar device for this calculation. At the conclusion of this mode, the microprocessor 26 automatically calculates the target ventilation and automatically stores this target ventilation for subsequent use. During subsequent therapy, with the device in the "treat" mode, the pressure modulation amplitude is automatically adjusted in order to servo-control ventilation to equal or exceed the target ventilation determined in the "learn" mode.
While this embodiment of the invention incorporates both the learn and treat modes into a single apparatus, various simplifications are possible. For example, the device used to measure ventilation during the learning period may be different from the device used to subsequently treat the patient. In this case, the target ventilation can be calculated manually or by using analog electronics and the target ventilation can be stored and/or transferred manually to another ventilator to be used during the treatment period.
It is desirable that the device should not accidentally be delivered to the patient for unattended use unless it is certain that the device is in the "treat" mode, using settings that have been correctly determined either in the "learn" mode or as prescribed manually by a physician. Therefore, in a preferred form, a device embodying the invention has three modes, the "learn" and "treat" modes described in detail above, plus an inoperative mode in which the device will not operate. The default state as delivered is the inoperative mode. It may be placed in any of the three modes by the physician, for example, by sending commands to the microprocessor via a serial port. However, if it is inadvertently left in the "learn" mode, it will automatically revert to the "inoperative" mode on power-up.
In a preferred form, the device can be programmed to remain in "learn" mode for a specified period of time, such as 1 hour, and at the expiry of said time, the microprocessor will notify the physician, for example, via a serial port or other input/output device, of the settings determined during the learning period using any of the automatic methods described above. The physician will then be prompted to accept or edit these settings, and after acceptance or editing, the device will automatically switch to the "treat" mode at these accepted or edited settings.
For several of the disclosed methods, the ventilation quantity measured is minute ventilation and the calculated target ventilation is intended for use with a servo-ventilator with fuzzy phase detection and resistive unloading as described and illustrated in
An embodiment of the invention using the apparatus of
Although the invention has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the application of the principles of the invention. Numerous modifications may be made in the illustrative embodiments of the invention and other arrangements may be devised without departing from the spirit and scope of the invention.
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Film and TV director. A former stage and screen actor, he joined in the US Signal Corps in the 1940s and worked with famed documentary filmmaker Robert Flaherty. After the war Arnold directed and produced about 25 documentaries for government agencies and private industries, getting an Oscar nomination for best documentary feature for "With These Hands" (1951). Tackling fiction films in the early 1950s with Universal Studios he specialized in science-fiction and horror films, among them "It Came from Outer Space" (1953), "Creature from the Black Lagoon" (1954), "Tarantula" (1955) and "The Incredible Shrinking Man" (1957). His work also included westerns ("The Man from Bitter Ridge" 1955, "No Name on the Bullet" 1958), dramas ("The Tattered Dress" 1957, "Man in the Shadow" 1958) and comedies ("The Mouse That Roared" 1959, "A Global Affair" 1964). From the sixties on Arnold worked mostly for television, producing and (or) directing series like "Gilligan`s Island" (1964/65), "It Takes a Thief" (1968/69), "Ellery Queen" (1975) and "Buck Rogers in the 25th Century" (1981). He died from arteriosclerosis.
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Product DescriptionPersol PO2996V 95 Black eyeglasses are defined and distinctly vintage. This round frame is finished in timeless black acetate and features a classic keyhole bridge. The bridge is further stylized with a series of three symmetrically carved lines to add texture to the frame front, while Persol's iconic silver arrows wrap around the outer edges. Silver accents on the temples stand out against the stark black, easily elevating the style in classic Persol fashion.
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The U.S. State Department has issued a travel advisory warning Americans not to visit the Gaza Strip or take part in demonstrations in the West Bank (Judea and Samaria).
"U.S. citizens are advised against traveling to Gaza by any means, including via sea. Previous attempts to enter Gaza by sea have been stopped by Israeli naval vessels and resulted in the injury, death, arrest and deportation of U.S. citizens," the advisory stated.
The warning follows a request by the Israeli government urging countries to dissuade their citizens from joining attempts to breech the naval blockade of the Gaza Strip.
Nine pro-Palestinian activist were killed during the confrontation aboard the Mavi Marmara, the Turkish flagship that refused to change course and sail to the port at Ashdod. One of the casualties was a Turkish-American.
Americans traveling on other boats in the flotilla were arrested and deported.
"The security environment within Gaza and along its borders, including its border with Egypt and its seacoast, is dangerous and volatile," the warning read. "U.S. citizens are advised against traveling to Gaza by any means, including via sea."
State Department officials also warned that greater danger may exist around restaurants and businesses affiliated with American interests.
"U.S. citizens can be caught in the middle of potentially dangerous situations," the State Department said.
"Some U.S. citizens involved in demonstrations in the West Bank have sustained serious injuries in confrontations with Israeli settlers and the Israel Defense Forces. The State Department recommends that U.S. citizens, for their own safety, avoid demonstrations."
The warning was intended not only for Americans travelers, but for journalists and aid workers as well.
Israel Issues New Gaza PolicyAssad: Israeli 'Raid' Risks Regional WarIsrael's Counter-Terrorism Bureau: Avoid Turkey
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Redefinition of Affymetrix probe sets by sequence overlap with cDNA microarray probes reduces cross-platform inconsistencies in cancer-associated gene expression measurements
1 Children's Hospital Informatics Program, Harvard Medical School, Boston, MA, 02115 USA
2 Laboratory of Functional Genomics, Brigham and Women's Hospital, 65 Landsdowne Street, Cambridge, MA 02139, USA
BMC Bioinformatics 2005, 6:107 doi:10.1186/1471-2105-6-107Published: 25 April 2005
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Additional File 1:
ZIP of 4 files allowing the remapping Affymetrix probe-sets described in this manuscript. These files can be used with the "altcdfenvs" package in Bioconductor to implement the redefinition of probe-sets based on sequence-matching with each of the 4 cDNA datasets described.
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A roaring fire and a few extra blankets may keep Brits warm during the windy, damp winter days that never seem to end. However, even multiple blankets and a crackling fire are no match for an insulated...
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Rikers Island Lawsuits Over Diabetic Care
By Albert Samaha
Best known for his debut Boyz N the Hood, Singleton, like his inspiration Spike Lee, has pursued an idiosyncratic and independent course in the mainstream. Though he set off the 'hood genre, he hasn't really gone back until now, given Higher Learning's campus setting, Poetic Justice's road bonhomie, Rosewood's historical grasp, and Shaft's eye on summer popcorn. He openly credits Spike's Brooklynphilia with forcing him to reveal his own regional accent. "Spike had an off-kilter vision. Even if it was within the black community, it was so Brooklynized. When Do the Right Thing came along I was miffed. I said I got to do my own motherfucking movie. Spike was so strong on Brooklyn, I thought, What's so special about me? I've got to come with L.A. I think the generation that came after us is more Hollywoodized, with a few exceptions like Ted Witcher and George Tillman. There's a segment of this generation of black filmmakers that are just like the white boys. They're just doing the same thing and we are not the same thing. I'm trying to make movies where half the people may like them and half may hate them, same as you find with hiphop music. It's young, audacious, and brash, but you're either going to dance to it or you're not."
According to Singleton, some from black journalism's upper class have not left previews of Baby Boy dancing in the aisles. The phrase "walking around with a pole stuck up their asses" might be a more accurate description of their posture. Some have even proclaimed a sudden unfamiliarity with the blackfolk on screen. Singleton's not feeling them either. "People like that are just bourgie and they can kiss my ass if they think they can tell me what kind of movie I'm supposed to be making. Get real. This is very much an ethnographic film of this time, just like Boyz was. There are no cops, no white people, it's all insular, and doesn't point the finger at anyone else. It stays in the community, all right there. The acting is so on-point you don't see the wheels turning and you feel like you're really in the ghetto watching some people fight and fuck. That kind of realism is unsettling to some people."
Undaunted by the haters and the denialists, Singleton plans to keep on going against the assimilationist grain. "Everything we do now has to be like The Best Man or Soul Food because they were successful, but I need to continue making films I'm passionate about. South Central is like Queensit's multiethnic, a dozen stories could come out of there. Nobody wants to go there now because they're too highbrow. I'm trying to make gutbucket, soulful movies that really hit your thing."
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Thread: charater.
May 7th, 2014 #1
Attachment 1963482
i made the little guy last weekend i want to take him to a finally design and stuff. but i dont know how to finish him or what references to use for him
i want to keep the syle of him alive when i finish him digitally. can anyone help ?going to study the fundamentals for 4 years
starting this year.
Hide this ad by registering as a memberMay 7th, 2014 #2
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I was once on the receiving end of a critique so savagely nasty, I marched straight out of class to the office and changed my major (sketchbook).


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Use the tools below to refine your search by only displaying reviews with a certain number of star ratings or to only show reviews from a certain time period. Eg click on '1 star' to just display the reviews we have which received a 1 star rating click or 'Within the last month' to display just reviews posted over the last month.
Written on: 16/10/2012
first of all the bike looks like it should be a 600cc!!! i mean seriously how many 125s do you get that are this big and with an engine that actually looks bigger than it should be! took delivery of it last week (2008 model) and am seriously surprised on the guts that the engine has, it has some pull on it to say the least! its easy to handle but i would probably say that it is suited to the larger rider who doesnt want to fanny around looking about 10 times too big on a cbr 125. i have manage… Read Full Review
Written on: 20/08/2012 by thereferee (1 review written)
Let me start off by saying that I am not a motorbike person . I simply decided in November 2011 that I was fed up paying £250 a month petrol for my car along with £500 a year insurance and £240 a year rfl. I visited 4 or 5 motorbike showrooms and my last call was Honda Belfast. I have to say I was very well treated and the service was first class ending with me buying a 2008 varadero. I then took my cbt on a small Yamaha (knees round the chin job as I am 6'2") and took delivery of my bike… Read Full Review
Written on: 06/07/2012
I've owned 1 50cc scooter 3 125cc rev and go and 5 125cc motorbikes and the Xl125V-2 is the best I've ever owned the bike weight's about 154kg dry and I weight about 18 stone or about 120 when I'm going to my mates for a few days the bike can carry all the things that I need. The 30 litre tank bag is always full and that weight's about 5-10kg, my 20 litre back packs is full weight's about 10-15kg and the 37 litre top box is full weight's about 10-25kg when that is all on the bike… Read Full Review
Written on: 13/06/2012 by cw41 (1 review written)
i am 41 years old and roughly 18 stones light ahem !!! i purchased a 2010 honda varadero xl 125 from dobles honda in feb this year and i have to say even though its restricted to 15bhp this bike pulls like a train .. it pulls my fat frame at 70mph no problems and once you change those stupid trial tyres the bike comes with for proper road tyres it handles great too ... ive managed 3500 miles since feb and im loving it ... if it had another 30bhp it would be the perfect bike for me… Read Full Review
Written on: 13/06/2012
ps the mirrors are rubbish all i can see are my elbows .. plus if anyone knows how to de-restrict this bike feel free to leave a comment :0)
Written on: 06/04/2012
I've had the bike for a year now, and I've never had any problems with it. Always starts like from under a palm tree. Fuel consumption is great, mine uses about 3 liters per 100km… Read Full Review
Written on: 13/03/2012
I've had this bike a year now. I managed to ride it from Brighton to Devon then up to the Highlands in Scotland, all on A roads (didn't have my full license yet). Was amazing! no problems at all and extremely fuel efficient. It has a big bike feel and a good presence on the road. Even though I am planning on moving up to larger bikes, I still would like to keep it! My only recommendations to new buyers is to let the bike warm up before you ride it on cold days to get its full performance… Read Full Review
Written on: 27/04/2011
Just a quick report as I have only had the Varadero one week. I traded a Suzuki gn 125 in for the Honda and in terms of performance, what a differance. On the way home I did manage a wind assisted 80mph, and I am 18 stone!!
However I wont be riding like that much but it seemes very comfortable at 60 to 65 mph and I have worked out the first tankfull of fuel at approx. 83 mpg which will be ideal for my 8 mile commute
It rides and handles superbly and I can see me hanging on to this bike for… Read Full Review
Written on: 07/02/2011
Just an absolute catalogue of breakdowns and problems. Fuel injectors needed re-seating. Cogs on the coolant pump don't fit properly and rattle. Mysterious rattle from the engine. Rear brake seal failure, every single year costing £200 a time. Poor to non-existent customer service. This bike is an over-priced disaster zone. I would never buy another Honda as long as I live. Poor build quality, bad service from Honda, incredibly unreliable… Read Full Review
Written on: 03/02/2011
its a great bike iv been on bikes for years and this the best for doing the test only ever mucked up 1s on it when i waz to blam not my dero i waz going to fast in to a bent and didnt make it lucky only whent in to a field lol made no diff to bike still whent like stick lol im only 5ft 6 and find it easy to get on and off iv hade 80 mph out of her but i am small lol and light any 1 know what to put on her to get more power lol… Read Full Review
Written on: 19/07/2011
speak english please!
Written on: 02/08/2011
This would have been so much better if it had been written in English !!
Written on: 07/01/2011 by mike2191 (1 review written)
best 125 out there cos i have had 5 bike and out of then all this is the only 1 that ant let me down or cost me an arm or leg when the mot came round yer it ant the fastes bike i have had by far but for reliability and not letting me down is gets 11 out of ten for that cos the bike i had be for is did 130but was all ways braking down but thats good old 2 stroke for u were as is is a vtwian and 4 stroke so will last a life time if toke care of which is the same for ever bike and would i pick is… Read Full Review
Written on: 02/10/2011
Based on the last (and first) two reviews I've read on this bike, seems you have to be illiterate to buy it.
Written on: 16/10/2010
Simplesmente sensacional!...Conforto,eleg ncia,seguran a e muito certinha!… Read Full Review
Written on: 30/05/2010 by Benny Boy25 (1 review written)
I've owned a 2002 Dero for a week noW after coming from 3 gilera runners for many years i thought it was time to go for my test so a manual was need, saw the dero for £1400 so i traded my runner in for it.
have to say I'm glad i did its a fantastic bike it was a bit weird at first as im only 5ft 8inchs and it is a big bike for its size ( i pulled a a muscle getting off it the first time lol), hell it doesnt… Read Full Review
Written on: 24/02/2010
It a good all round bike could do so better mods on it… Read Full Review
Written on: 12/02/2010
Love it, love it, love it. What more can I say? I am over 6 foot tall and this is the first 125 motorbike that I don't look completely stupid on! It's a stop gap for me to pass my Direct access on then I'll move up to something like the BMW 650 GS. The bike feels good to ride. Great position, I can see over most normal cars (4x4's are another matter though) Pulls away nicely but being a 125 with me sitting on top it's obviously going to be underpowererd.
Great into and out of corners -… Read Full Review
Written on: 20/01/2010 by Deadcow (1 review written)
If you can garage this bike, or if you're a fair weather rider, I can guarantee you, this will be the best 125 you can buy - bar none. In fair weather, the ride is smooth, the engine is torquey and powerful, petrol usage is phenomenal, and as a learner, having the opportunity to ride a motorcycle with a footprint the size of a 600 tourer is invaluable experience.
If you don't have a garage or you ride in adverse conditions - forget it.
Firstly - as you will probably have seen, this bike is a… Read Full Review
Written on: 06/04/2010
I dont own a garage and my 08 vara has lived outside under a storm proof cover and I have kept it clean and like new.
Written on: 15/09/2009
I have had my blue Varadero for 3 years now, since i passed my cbt. Can not fault it at all. How many bikes out their can do 200 miles for only a tenner of pertol a week. Strong and sturdy and would definetly recommend to new learners. Only bug bear is that it does struggle on motorways where you need that extra speed and power… Read Full Review
Written on: 03/06/2011
Glad the bikes good, Just a quick observation you shouldn't be on the Motorway with a CBT........
Written on: 21/08/2009 by r l lungley (1 review written)
hi there i bought a varadero 125v in july 2009 and what a bike it feels like riding a large motocycle and after riding a yamaha xl125x it is almost like riding more like a 600 ,it has a good handleing and great feel and loks superb, what more can i say about this splendid bike nice one honda… Read Full Review
Written on: 18/08/2009 by ogast86 (1 review written)
I have switched to a Honda Varadeo after riding a suzuki Marauder 125 for a quite long time. The first impresion was the size of the bike, its doesnt feel like 125 at all!! Marauder is not the smallest 125 as well but for a taller person, like me, I would recomended a honda. When you switch the engine on a bike rides perfectly and very smooth, i didnt know how quick 125cc can be until today :) I love the finish of Honda, you can feel the quality. Many people say that this is a heavy bike but… Read Full Review
Written on: 03/08/2009 by vilaysia (2 reviews written)
HI back again i put in a report on the Honda Varadero XL125V bike after two days after i bought it which was good , I have had this bike now for three months now i just cant fault it in any way i just love it i read some off the reviews i would like to know why some can bad about it , great to handle quick respond after it is only a 125 but great bike worth buying well worth a try run before buying anythig else… Read Full Review
Written on: 23/07/2009 by Lukaz2205 (2 reviews written)
I have 2 of these Honda Varadero XL125V bikes the first got written off after 2 months and the second after a year, but i have used bits from both and streetfightered one.
in standard trim its a good bike comfy and easily able to beat pretty much any 4 stroke 125, its pretty slow by size standards
only thing i dont like about it is the extortinate prices honda want for bits.
main thing that breaks is footpeg or footpeg bracket and the bars bend easy once on the deck footpeg bracket is £75… Read Full Review
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ACE Fit Share
Add some variety to your fitness routine with these upper and lower leg exercises from The American Council on Exercise. We have a large selection of leg exercises that will will help you strengthen and build muscle throughout your legs including your hamstrings, thighs, shin and calf muscles. Start taking advantage of this free information today! If you are looking for full workout routines that incorporate these leg exercises, check out our Workouts section.
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How many times have you seen diet ads depicting people who finally lost that excess weight and are as ecstatic as can be with their new lives? Getting thin sure looks like a recipe for happiness! Alas, a new study suggests that that's not actually the case. Not only do people who lose weight not feel happier, they often feel worse than they did before losing the weight.
Researchers from the University College London followed 2,000 overweight or obese Brits for a period of four years to better understand the interconnectivity between physical and mental health. Although the subjects who shed at least 5% of their body weight expected to be happier for slimming down, the results demonstrated that were more likely to suffer depression in conjunction with the weight loss.
Make no mistake – proper diet and exercise are fantastic ways to become physically healthier. The study also reconfirmed some long believed truths about losing weight, like that it lowers both blood pressure and the risk of heart disease. The researchers are obviously not attempting to encourage anyone to not engage in healthier activities. Rather, they are hoping to dispel the myth that life automatically gets better after losing weight.
Those who lost 5% of their weight were 78% more likely to experience depression than overweight and obese subjects. When excluding major life tragedies like the loss of a loved one, depression was still significantly higher among people who lost weight by a rate of 52%.
While the researchers are unable to say that weight loss causes depression based on their findings, lead author Dr. Sarah Jackson thinks these findings are important since they show that losing weight is not the fix-all that the media often portrays. She further theorizes that the stress of keeping the weight off becomes too much for some people to bear, contributing to a downward shift in mood.
"Resisting the ever-present temptations of unhealthy food in modern society takes a mental toll as it requires considerable willpower and may involve missing out on some enjoyable activities," said Dr. Jackson. "Anyone who has ever been on a diet would understand how this could affect wellbeing."
Since the study only covered a four year period, there is hope that happiness would be easier to achieve after learning to make weight maintenance a part of one's ordinary routine. In the short term, however, the disappointment of finding that life isn't magically better just because someone has a more slender frame can be more upsetting than not losing weight at all.
Regardless, this topic is one that deserves further exploration moving forward.
Read more: diet, exercise, health, lose weight, weight loss
thank you for sharing
Well, I have to admit that the fibroids are better behaved now that I am 3 stone lighter which is a relief but I am well aware that this may only be temporary. I am also hugely aware of the fact that it is a year since I was diagnosed with being severely anaemic and that the NHS has put little effort in to doing much about it and even cancelled two of my appointments so it has been essential that I took heed of that gynie's advise/warning. I feel as though I have pretty much had to try to treat myself. I never expected miracles by my general self esteem or self image because I think that it is very important not to expect weight loss to miraculously make one feel and look amazing or happy. It is all a lot of nonsense when before my illness I enjoyed pizza and beer which I can ill afford to risk binging on anymore. I miss being care free about my weight now and can see the risks to one's mood so it is very important to make sure that a weight loss programme is going to be realistic and therefore sustainable. It is hard work, no doubt about it. I can see where this article is coming from.
Thank you
Discernment is ever the key to the wisdom of what is right for you, the individual X
Smiling at Dimitris
Several studies have found that long-term weight loss is impossible and that weight loss is not associated with any improvements in health. Healthy habits such as eating healthier foods and moderate exercise *are* associated with improvements in health. I highly recommend a Health At Every Size approach: focus on health, not intentional attempts to change body weight/size. I think people will be a lot happier when they can do that and not face stigma, bullying, and constant messages from the media that their size matters.
Disclaimer: The views expressed above are solely those of the author and may
not reflect those of
Care2, Inc., its employees or advertisers.
The irony is that I'm reading this article when I'm meant to be revising...
Thanks for the reminder
The huge problem of waste.At least an effort is being made in schools.Now if we could stop people from…


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When Bond's latest assignment goes gravely wrong and agents around the world are exposed, MI6 is attacked forcing M to relocate the agency. These events cause her authority and position to be challenged by Gareth Mallory (Ralph Fiennes), the new Chairman of the Intelligence and Security Committee. With MI6 now compromised from both inside and out, M is left with one ally she can trust: Bond. 007 takes to the shadows – aided only by field agent, Eve (Naomie Harris) – following a trail to the mysterious Silva (Javier Bardem), whose lethal and hidden motives have yet to reveal themselves.
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Troemner Henry Microplate Shaker is a reliable and dependable addition to the Troemner Henry Laboratory Apparatus family of products. Combining top-notch and uncompromising quality with an affordable price, the Troemner Henry Microplate Shaker 980130/ 12620-926 can fulfill your laboratory needs while still offering a great value for the money.
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Ideal for immunoassays and general microplate shaking. Four-place platform holds either two or four microplates or deep well blocks. Plates are firmly locked into place with retaining springs. Microprocessor variable speed control provides consistent, uniform mixing action. Ramping feature slowly increases speed to set point for added safety. Independent LED displays feature speed and time. Timer will display elapsed time, or, when programmed to user-defined limit, will count down to zero and shut off unit. Audible alarm sounds when time reaches zero. The triple eccentric drive features permanently lubricated ball bearings. The maintenance-free, brushless DC motor provides a long service life. Ideal for use in incubators, CO2 incubators, or cold rooms; shaker accommodates a –10 to 60°C (–14 to 140°F), 80% relative humidity, non-condensing environment. Durable base is constructed of cast aluminum for extra stability.
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