text:
Volume 40, Issue 7, July 2013
Index of content:
Volume 42 (2015)
Volume 41 (2014)
Volume 40 (2013)
Volume 39 (2012)
Volume 38 (2011)
Volume 37 (2010)
Volume 36 (2009)
Volume 35 (2008)
Volume 34 (2007)
Volume 33 (2006)
Volume 32 (2005)
Volume 31 (2004)
Volume 30 (2003)
Volume 29 (2002)
Volume 28 (2001)
Volume 27 (2000)
Volume 26 (1999)
Volume 25 (1998)
Volume 24 (1997)
Volume 23 (1996)
Volume 22 (1995)
Volume 21 (1994)
Volume 20 (1993)
Volume 19 (1992)
Volume 18 (1991)
Volume 17 (1990)
Volume 16 (1989)
Volume 15 (1988)
Volume 14 (1987)
Volume 13 (1986)
Volume 12 (1985)
Volume 11 (1984)
Volume 10 (1983)
Volume 9 (1982)
Volume 8 (1981)
Volume 7 (1980)
Volume 6 (1979)
Volume 5 (1978)
Volume 4 (1977)
Volume 3 (1976)
Volume 2 (1975)
Volume 1 (1974)
Plan degradation resulting from compromises made to enhance delivery efficiency is an important consideration for intensity modulated radiation therapy (IMRT) treatment plans. IMRT optimization and/or multileaf collimator (MLC) sequencing schemes can be modified to generate more efficient treatment delivery, but the effect those modifications have on plan quality is often difficult to quantify. In this work, the authors present a method for quantitative assessment of overall plan quality degradation due to tradeoffs between delivery efficiency and treatment plan quality, illustrated using comparisons between plans developed allowing different numbers of intensity levels in IMRT optimization and/or MLC sequencing for static segmental MLC IMRT plans.Methods:
A plan quality degradation method to evaluate delivery efficiency and plan quality tradeoffs was developed and used to assess planning for 14 prostate and 12 head and neck patients treated with static IMRT. Plan quality was evaluated using a physician's predetermined "quality degradation" factors for relevant clinical plan metrics associated with the plan optimization strategy. Delivery efficiency and plan quality were assessed for a range of optimization and sequencing limitations. The "optimal" (baseline) plan for each case was derived using a clinical cost function with an unlimited number of intensity levels. These plans were sequenced with a clinical MLC leaf sequencer which uses >100 segments, assuring delivered intensities to be within 1% of the optimized intensity pattern. Each patient's optimal plan was also sequenced limiting the number of intensity levels (20, 10, and 5), and then separately optimized with these same numbers of intensity levels. Delivery time was measured for all plans, and direct evaluation of the tradeoffs between delivery time and plan degradation was performed.Results:
When considering tradeoffs, the optimal number of intensity levels depends on the treatment site and on the stage in the process at which the levels are limited. The cost of improved delivery efficiency, in terms of plan quality degradation, increased as the number of intensity levels in the sequencer or optimizer decreased. The degradation was more substantial for the head and neck cases relative to the prostate cases, particularly when fewer than 20 intensity levels were used. Plan quality degradation was less severe when the number of intensity levels was limited in the optimizer rather than the sequencer.Conclusions:
Analysis of plan quality degradation allows for a quantitative assessment of the compromises in clinical plan quality as delivery efficiency is improved, in order to determine the optimal delivery settings. The technique is based on physician-determined quality degradation factors and can be extended to other clinical situations where investigation of various tradeoffs is warranted.
Patient-specific QA for IMRT should be performed using software rather than hardware methods40(2013); http://dx.doi.org/10.1118/1.4794929View Description Hide Description
Cloud computing in medical imaging40(2013); http://dx.doi.org/10.1118/1.4811272View Description Hide Description
Over the past century technology has played a decisive role in defining, driving, and reinventing procedures, devices, and pharmaceuticals in healthcare. Cloud computing has been introduced only recently but is already one of the major topics of discussion in research and clinical settings. The provision of extensive, easily accessible, and reconfigurable resources such as virtual systems, platforms, and applications with low service cost has caught the attention of many researchers and clinicians. Healthcare researchers are moving their efforts to the cloud, because they need adequate resources to process, store, exchange, and use large quantities of medical data. This Vision 20/20 paper addresses major questions related to the applicability of advanced cloud computing in medical imaging. The paper also considers security and ethical issues that accompany cloud computing.
In vivo dosimetry in brachytherapy40(2013); http://dx.doi.org/10.1118/1.4810943View Description Hide Description
In vivo dosimetry (IVD) has been used in brachytherapy (BT) for decades with a number of different detectors and measurement technologies. However, IVD in BT has been subject to certain difficulties and complexities, in particular due to challenges of the high-gradient BT dose distribution and the large range of dose and dose rate. Due to these challenges, the sensitivity and specificity toward error detection has been limited, and IVD has mainly been restricted to detection of gross errors. Given these factors, routine use of IVD is currently limited in many departments. Although the impact of potential errors may be detrimental since treatments are typically administered in large fractions and with high-gradient-dose-distributions, BT is usually delivered without independent verification of the treatment delivery. This Vision 20/20 paper encourages improvements within BT safety by developments of IVD into an effective method of independent treatment verification.
In vivo dosimetry in external beam radiotherapy40(2013); http://dx.doi.org/10.1118/1.4811216View Description Hide Description
In vivo dosimetry (IVD) is in use in external beam radiotherapy (EBRT) to detect major errors, to assess clinically relevant differences between planned and delivered dose, to record dose received by individual patients, and to fulfill legal requirements. After discussing briefly the main characteristics of the most commonly applied IVD systems, the clinical experience of IVD during EBRT will be summarized. Advancement of the traditional aspects of in vivo dosimetry as well as the development of currently available and newly emerging noninterventional technologies are required for large-scale implementation of IVD in EBRT. These new technologies include the development of electronic portal imaging devices for 2D and 3D patient dosimetry during advanced treatment techniques, such as IMRT and VMAT, and the use of IVD in proton and ion radiotherapy by measuring the decay of radiation-induced radionuclides. In the final analysis, we will show in this Vision 20/20 paper that in addition to regulatory compliance and reimbursement issues, the rationale for in vivo measurements is to provide an accurate and independent verification of the overall treatment procedure. It will enable the identification of potential errors in dose calculation, data transfer, dose delivery, patient setup, and changes in patient anatomy. It is the authors' opinion that all treatments with curative intent should be verified through in vivo dose measurements in combination with pretreatment checks.
Shielding implications for secondary neutrons and photons produced within the patient during IMPT40(2013); http://dx.doi.org/10.1118/1.4807089View Description Hide DescriptionPurpose:
Intensity modulated proton therapy (IMPT) uses a combination of computer controlled spot scanning and spot-weight optimized planning to irradiate the tumor volume uniformly. In contrast to passive scattering systems, secondary neutrons and photons produced from inelastic proton interactions within the patient represent the major source of emitted radiation during IMPT delivery. Various published studies evaluated the shielding considerations for passive scattering systems but did not directly address secondary neutron production from IMPT and the ambient dose equivalent on surrounding occupational and nonoccupational work areas. Thus, the purpose of this study was to utilize Monte Carlo simulations to evaluate the energy and angular distributions of secondary neutrons and photons following inelastic proton interactions within a tissue-equivalent phantom for incident proton spot energies between 70 and 250 MeV.Methods:
Monte Carlo simulation methods were used to calculate the ambient dose equivalent of secondary neutrons and photons produced from inelastic proton interactions in a tissue-equivalent phantom. The angular distribution of emitted neutrons and photons were scored as a function of incident proton energy throughout a spherical annulus at 1, 2, 3, 4, and 5 m from the phantom center. Appropriate dose equivalent conversion factors were applied to estimate the total ambient dose equivalent from secondary neutrons and photons.Results:
A reference distance of 1 m from the center of the patient was used to evaluate the mean energy distribution of secondary neutrons and photons and the resulting ambient dose equivalent. For an incident proton spot energy of 250 MeV, the total ambient dose equivalent (3.6 × 10−3 mSv per proton Gy) was greatest along the direction of the incident proton spot (0°–10°) with a mean secondary neutron energy of 71.3 MeV. The dose equivalent decreased by a factor of 5 in the backward direction (170°–180°) with a mean energy of 4.4 MeV. An 8 × 8 × 8 cm3 volumetric spot distribution (5 mm FWHM spot size, 4 mm spot spacing) optimized to produce a uniform dose distribution results in an ambient dose equivalent of 4.5 × 10−2 mSv per proton Gy in the forward direction.Conclusions:
This work evaluated the secondary neutron and photon emission due to monoenergetic proton spots between 70 and 250 MeV, incident on a tissue equivalent phantom. Example calculations were performed to estimate concrete shield thickness based upon appropriate workload and shielding design assumptions. Although lower than traditional passive scattered proton therapy systems, the ambient dose equivalent from secondary neutrons produced by the patient during IMPT can be significant relative to occupational and nonoccupational workers in the vicinity of the treatment vault. This work demonstrates that Monte Carlo simulations are useful as an initial planning tool for studying the impact of the treatment room and maze design on surrounding occupational and nonoccupational work areas.
On the use of biomathematical models in patient-specific IMRT dose QA40(2013); http://dx.doi.org/10.1118/1.4805105View Description Hide DescriptionPurpose:
To investigate the use of biomathematical models such as tumor control probability (TCP) and normal tissue complication probability (NTCP) as new quality assurance (QA) metrics.Methods:
Five different types of error (MLC transmission, MLC penumbra, MLC tongue and groove, machine output, and MLC position) were intentionally induced to 40 clinical intensity modulated radiation therapy (IMRT) patient plans (20 H&N cases and 20 prostate cases) to simulate both treatment planning system errors and machine delivery errors in the IMRT QA process. The changes in TCP and NTCP for eight different anatomic structures (H&N: CTV, GTV, both parotids, spinal cord, larynx; prostate: CTV, rectal wall) were calculated as the new QA metrics to quantify the clinical impact on patients. The correlation between the change in TCP/NTCP and the change in selected DVH values was also evaluated. The relation between TCP/NTCP change and the characteristics of the TCP/NTCP curves is discussed.Results:
ΔTCP and ΔNTCP were summarized for each type of induced error and each structure. The changes/degradations in TCP and NTCP caused by the errors vary widely depending on dose patterns unique to each plan, and are good indicators of each plan's "robustness" to that type of error.Conclusions:
In thisin silico QA study the authors have demonstrated the possibility of using biomathematical models not only as patient-specific QA metrics but also as objective indicators that quantify, pretreatment, a plan's robustness with respect to possible error types.
A method for removing arm backscatter from EPID images40(2013); http://dx.doi.org/10.1118/1.4807640View Description Hide DescriptionPurpose:
To develop a method for removing the support arm backscatter from images acquired using current Varian electronic portal imaging devices (EPIDs).Methods:
The effect of arm backscatter on EPID images was modeled using a kernel convolution method. The parameters of the model were optimized by comparing on-arm images to off-arm images. The model was used to develop a method to remove the effect of backscatter from measured EPID images. The performance of the backscatter removal method was tested by comparing backscatter corrected on-arm images to measured off-arm images for 17 rectangular fields of different sizes and locations on the imager. The method was also tested using on- and off-arm images from 42 intensity modulated radiotherapy (IMRT) fields.Results:
Images generated by the backscatter removal method gave consistently better agreement with off-arm images than images without backscatter correction. For the 17 rectangular fields studied, the root mean square difference of in-plane profiles compared to off-arm profiles was reduced from 1.19% (standard deviation 0.59%) on average without backscatter removal to 0.38% (standard deviation 0.18%) when using the backscatter removal method. When comparing to the off-arm images from the 42 IMRT fields, the mean γ and percentage of pixels with γ < 1 were improved by the backscatter removal method in all but one of the images studied. The mean γ value (1%, 1 mm) for the IMRT fields studied was reduced from 0.80 to 0.57 by using the backscatter removal method, while the mean γ pass rate was increased from 72.2% to 84.6%.Conclusions:
A backscatter removal method has been developed to estimate the image acquired by the EPID without any arm backscatter from an image acquired in the presence of arm backscatter. The method has been shown to produce consistently reliable results for a wide range of field sizes and jaw configurations.
Automated generation of IMRT treatment plans for prostate cancer patients with metal hip prostheses: Comparison of different planning strategies40(2013); http://dx.doi.org/10.1118/1.4808117View Description Hide DescriptionPurpose
: To compare IMRT planning strategies for prostate cancer patients with metal hip prostheses.Methods
: All plans were generated fully automatically (i.e., no human trial-and-error interactions) using iCycle, the authors' in-house developed algorithm for multicriterial selection of beam angles and optimization of fluence profiles, allowing objective comparison of planning strategies. For 18 prostate cancer patients (eight with bilateral hip prostheses, ten with a right-sided unilateral prosthesis), two planning strategies were evaluated: (i) full exclusion of beams containing beamlets that would deliver dose to the target after passing a prosthesis (IMRT remove) and (ii) exclusion of those beamlets only (IMRT cut). Plans with optimized coplanar and noncoplanar beam arrangements were generated. Differences in PTV coverage and sparing of organs at risk (OARs) were quantified. The impact of beam number on plan quality was evaluated.Results:
Especially for patients with bilateral hip prostheses, IMRT cut significantly improved rectum and bladder sparing compared to IMRT remove. For 9-beam coplanar plans, rectum V60Gy reduced by 17.5% ± 15.0% (maximum 37.4%, p = 0.036) and rectum Dmean by 9.4% ± 7.8% (maximum 19.8%, p = 0.036). Further improvements in OAR sparing were achievable by using noncoplanar beam setups, reducing rectum V60Gy by another 4.6% ± 4.9% (p = 0.012) for noncoplanar 9-beam IMRT cut plans. Large reductions in rectum dose delivery were also observed when increasing the number of beam directions in the plans. For bilateral implants, the rectum V60Gy was 37.3% ± 12.1% for coplanar 7-beam plans and reduced on average by 13.5% (maximum 30.1%, p = 0.012) for 15 directions.Conclusions:
iCycle was able to automatically generate high quality plans for prostate cancer patients with prostheses. Excluding only beamlets that passed through the prostheses (IMRT cut strategy) significantly improved OAR sparing. Noncoplanar beam arrangements and, to a larger extent, increasing the number of treatment beams further improved plan quality.
Magnetic tracking for TomoTherapy systems: Gradiometer based methods to filter eddy-current magnetic fields40(2013); http://dx.doi.org/10.1118/1.4808148View Description Hide DescriptionPurpose:
TomoTherapy systems lack real-time, tumor tracking. A possible solution is to use electromagnetic markers; however, eddy-current magnetic fields generated in response to a magnetic source can be comparable to the signal, thus degrading the localization accuracy. Therefore, the tracking system must be designed to account for the eddy fields created along the inner bore conducting surfaces. The aim of this work is to investigate localization accuracy using magnetic field gradients to determine feasibility toward TomoTherapy applications.Methods:
Electromagnetic models are used to simulate magnetic fields created by a source and its simultaneous generation of eddy currents within a conducting cylinder. The source position is calculated using a least-squares fit of simulated sensor data using the dipole equation as the model equation. To account for field gradients across the sensor area (∼25 cm2), an iterative method is used to estimate the magnetic field at the sensor center. Spatial gradients are calculated with two arrays of uniaxial, paired sensors that form a gradiometer array, where the sensors are considered ideal.Results:
Experimental measurements of magnetic fields within the TomoTherapy bore are shown to be 1%–10% less than calculated with the electromagnetic model. Localization results using a 5 × 5 array of gradiometers are, in general, 2–4 times more accurate than a planar array of sensors, depending on the solenoid orientation and position. Simulation results show that the localization accuracy using a gradiometer array is within 1.3 mm over a distance of 20 cm from the array plane. In comparison, localization errors using single array are within 5 mm.Conclusions:
The results indicate that the gradiometer method merits further studies and work due to the accuracy achieved with ideal sensors. Future studies should include realistic sensor models and extensive numerical studies to estimate the expected magnetic tracking accuracy within a TomoTherapy system before proceeding with prototype development.
Results from a multicenter prostate IMRT dosimetry intercomparison for an OCOG-TROG clinical trial40(2013); http://dx.doi.org/10.1118/1.4808151View Description Hide DescriptionPurpose:
A multi-institution dosimetry intercomparison has been undertaken of prostate intensity modulated radiation therapy (IMRT) delivery. The dosimetry intercomparison was incorporated into the quality assurance for site credentialing for the Trans-Tasman Radiation Oncology Group Prostate Fractionated Irradiation Trial 08.01 clinical trial.Methods:
An anthropomorphic pelvic phantom with realistic anatomy was used along with multiplanar dosimetry tools for the assessment. Nineteen centers across Australia and New Zealand participated in the study.Results:
In comparing planned versus measured dose to the target at the isocenter within the phantom, all centers were able to achieve a total delivered dose within 3% of planned dose. In multiplanar analysis with radiochromic film using the gamma analysis method to compare delivered and planned dose, pass rates for a 5%/3 mm criterion were better than 90% for a coronal slice through the isocenter. Pass rates for an off-axis coronal slice were also better than 90% except for one instance with 84% pass rate.Conclusions:
Strengths of the dosimetry assessment procedure included the true anthropomorphic nature of the phantom used, the involvement of an expert from the reference center in carrying out the assessment at every site, and the ability of the assessment to detect and resolve dosimetry discrepancies.
Critical assessment of intramodality 3D ultrasound imaging for prostate IGRT compared to fiducial markers40(2013); http://dx.doi.org/10.1118/1.4808359View Description Hide DescriptionPurpose:
A quantitative 3D intramodality ultrasound (US) imaging system was verified for daily in-room prostate localization, and compared to prostate localization based on implanted fiducial markers (FMs).Methods:
Thirteen prostate patients underwent multiple US scans during treatment. A total of 376 US-scans and 817 matches were used to determine the intra- and interoperator variability. Additionally, eight other patients underwent daily prostate localization using both US and electronic portal imaging (EPI) with FMs resulting in 244 combined US-EPI scans. Scanning was performed with minimal probe pressure and a correction for the speed of sound aberration was performed. Uncertainties of both US and FM methods were assessed. User variability of the US method was assessed.Results:
The overall US user variability is 2.6 mm. The mean differences between US and FM are: 2.5 ± 4.0 mm (LR), 0.6 ± 4.9 mm (SI), and −2.3 ± 3.6 mm (AP). The intramodality character of this US system mitigates potential errors due to transducer pressure and speed of sound aberrations.Conclusions:
The overall accuracy of US (3.0 mm) is comparable to our FM workflow (2.2 mm). Since neither US nor FM can be considered a gold standard no conclusions can be drawn on the superiority of either method. Because US imaging captures the prostate itself instead of surrogates no invasive procedure is required. It requires more effort to standardize US imaging than FM detection. Since US imaging does not involve a radiation burden, US prostate imaging offers an alternative for FM EPI positioning.
Use of plan quality degradation to evaluate tradeoffs in delivery efficiency and clinical plan metrics arising from IMRT optimizer and sequencer compromises40(2013); http://dx.doi.org/10.1118/1.4808118View Description Hide DescriptionPurpose:
Plan degradation resulting from compromises made to enhance delivery efficiency is an important consideration for intensity modulated radiation therapy (IMRT) treatment plans. IMRT optimization and/or multileaf collimator (MLC) sequencing schemes can be modified to generate more efficient treatment delivery, but the effect those modifications have on plan quality is often difficult to quantify. In this work, the authors present a method for quantitative assessment of overall plan quality degradation due to tradeoffs between delivery efficiency and treatment plan quality, illustrated using comparisons between plans developed allowing different numbers of intensity levels in IMRT optimization and/or MLC sequencing for static segmental MLC IMRT plans.Methods:
A plan quality degradation method to evaluate delivery efficiency and plan quality tradeoffs was developed and used to assess planning for 14 prostate and 12 head and neck patients treated with static IMRT. Plan quality was evaluated using a physician's predetermined "quality degradation" factors for relevant clinical plan metrics associated with the plan optimization strategy. Delivery efficiency and plan quality were assessed for a range of optimization and sequencing limitations. The "optimal" (baseline) plan for each case was derived using a clinical cost function with an unlimited number of intensity levels. These plans were sequenced with a clinical MLC leaf sequencer which uses >100 segments, assuring delivered intensities to be within 1% of the optimized intensity pattern. Each patient's optimal plan was also sequenced limiting the number of intensity levels (20, 10, and 5), and then separately optimized with these same numbers of intensity levels. Delivery time was measured for all plans, and direct evaluation of the tradeoffs between delivery time and plan degradation was performed.Results:
When considering tradeoffs, the optimal number of intensity levels depends on the treatment site and on the stage in the process at which the levels are limited. The cost of improved delivery efficiency, in terms of plan quality degradation, increased as the number of intensity levels in the sequencer or optimizer decreased. The degradation was more substantial for the head and neck cases relative to the prostate cases, particularly when fewer than 20 intensity levels were used. Plan quality degradation was less severe when the number of intensity levels was limited in the optimizer rather than the sequencer.Conclusions:
Analysis of plan quality degradation allows for a quantitative assessment of the compromises in clinical plan quality as delivery efficiency is improved, in order to determine the optimal delivery settings. The technique is based on physician-determined quality degradation factors and can be extended to other clinical situations where investigation of various tradeoffs is warranted.
Maintaining tumor targeting accuracy in real-time motion compensation systems for respiration-induced tumor motion40(2013); http://dx.doi.org/10.1118/1.4808119View Description Hide DescriptionPurpose:
To determine how best to time respiratory surrogate-based tumor motion model updates by comparing a novel technique based on external measurements alone to three direct measurement methods.Methods:
Concurrently measured tumor and respiratory surrogate positions from 166 treatment fractions for lung or pancreas lesions were analyzed. Partial-least-squares regression models of tumor position from marker motion were created from the first six measurements in each dataset. Successive tumor localizations were obtained at a rate of once per minute on average. Model updates were timed according to four methods:never, respiratory surrogate-based (when metrics based on respiratory surrogate measurements exceeded confidence limits), error-based (when localization error ≥3 mm), and always (approximately once per minute).Results:
Radial tumor displacement prediction errors (mean ± standard deviation) for the four schema described above were 2.4 ± 1.2, 1.9 ± 0.9, 1.9 ± 0.8, and 1.7 ± 0.8 mm, respectively. Thenever-update error was significantly larger than errors of the other methods. Mean update counts over 20 min were 0, 4, 9, and 24, respectively.Conclusions:
The same improvement in tumor localization accuracy could be achieved through any of the three update methods, but significantly fewer updates were required when therespiratory surrogate method was utilized. This study establishes the feasibility of timing image acquisitions for updating respiratory surrogate models without direct tumor localization.
Monte Carlo investigation of the increased radiation deposition due to gold nanoparticles using kilovoltage and megavoltage photons in a 3D randomized cell model40(2013); http://dx.doi.org/10.1118/1.4808150View Description Hide DescriptionPurpose:
Investigation of increased radiation dose deposition due to gold nanoparticles (GNPs) using a 3D computational cell model during x-ray radiotherapy.Methods:
Two GNP simulation scenarios were set up in Geant4; a single 400 nm diameter gold cluster randomly positioned in the cytoplasm and a 300 nm gold layer around the nucleus of the cell. Using an 80 kVp photon beam, the effect of GNP on the dose deposition in five modeled regions of the cell including cytoplasm, membrane, and nucleus was simulated. Two Geant4 physics lists were tested: the default Livermore and custom built Livermore/DNA hybrid physics list. 106 particles were simulated at 840 cells in the simulation. Each cell was randomly placed with random orientation and a diameter varying between 9 and 13 μm. A mathematical algorithm was used to ensure that none of the 840 cells overlapped. The energy dependence of the GNP physical dose enhancement effect was calculated by simulating the dose deposition in the cells with two energy spectra of 80 kVp and 6 MV. The contribution from Auger electrons was investigated by comparing the two GNP simulation scenarios while activating and deactivating atomic de-excitation processes in Geant4.Results:
The physical dose enhancement ratio (DER) of GNP was calculated using the Monte Carlo model. The model has demonstrated that the DER depends on the amount of gold and the position of the gold cluster within the cell. Individual cell regions experienced statistically significant (p < 0.05) change in absorbed dose (DER between 1 and 10) depending on the type of gold geometry used. The DER resulting from gold clusters attached to the cell nucleus had the more significant effect of the two cases (DER ∼ 55). The DER value calculated at 6 MV was shown to be at least an order of magnitude smaller than the DER values calculated for the 80 kVp spectrum. Based on simulations, when 80 kVp photons are used, Auger electrons have a statistically insignificant (p < 0.05) effect on the overall dose increase in the cell. The low energy of the Auger electrons produced prevents them from propagating more than 250–500 nm from the gold cluster and, therefore, has a negligible effect on the overall dose increase due to GNP.Conclusions:
The results presented in the current work show that the primary dose enhancement is due to the production of additional photoelectrons.
Dose-shaping using targeted sparse optimization40(2013); http://dx.doi.org/10.1118/1.4808363View Description Hide DescriptionPurpose:
Dose volume histograms (DVHs) are common tools in radiation therapy treatment planning to characterize plan quality. As statistical metrics, DVHs provide a compact summary of the underlying plan at the cost of losing spatial information: the same or similar dose-volume histograms can arise from substantially different spatial dose maps. This is exactly the reason why physicians and physicists scrutinize dose maps even after they satisfy all DVH endpoints numerically. However, up to this point, little has been done to control spatial phenomena, such as the spatial distribution of hot spots, which has significant clinical implications. To this end, the authors propose a novel objective function that enables a more direct tradeoff between target coverage, organ-sparing, and planning target volume (PTV) homogeneity, and presents our findings from four prostate cases, a pancreas case, and a head-and-neck case to illustrate the advantages and general applicability of our method.Methods:
In designing the energy minimization objective ( ), the authors utilized the following robust cost functions: (1) an asymmetric linear well function to allow differential penalties for underdose, relaxation of prescription dose, and overdose in the PTV; (2) a two-piece linear function to heavily penalize high dose and mildly penalize low and intermediate dose in organs-at risk (OARs); and (3) a total variation energy, i.e., the L 1 norm applied to the first-order approximation of the dose gradient in the PTV. By minimizing a weighted sum of these robust costs, general conformity to dose prescription and dose-gradient prescription is achieved while encouraging prescription violations to follow a Laplace distribution. In contrast, conventional quadratic objectives are associated with a Gaussian distribution of violations, which is less forgiving to large violations of prescription than the Laplace distribution. As a result, the proposed objective improves tradeoff between planning goals by "sacrificing" voxels that have already been violated to improve PTV coverage, PTV homogeneity, and/or OAR-sparing. In doing so, overall plan quality is increased since these large violations only arise if a net reduction in occurs as a result. For example, large violations to dose prescription in the PTV in -optimized plans will naturally localize to voxels in and around PTV-OAR overlaps where OAR-sparing may be increased without compromising target coverage. The authors compared the results of our method and the corresponding clinical plans using analyses of DVH plots, dose maps, and two quantitative metrics that quantify PTV homogeneity and overdose. These metrics do not penalize underdose since -optimized plans were planned such that their target coverage was similar or better than that of the clinical plans. Finally, plan deliverability was assessed with the 2D modulation index.Results:
The proposed method was implemented using IBM's CPLEX optimization package (ILOG CPLEX, Sunnyvale, CA) and required 1–4 min to solve with a 12-core Intel i7 processor. In the testing procedure, the authors optimized for several points on the Pareto surface of four 7-field 6MV prostate cases that were optimized for different levels of PTV homogeneity and OAR-sparing. The generated results were compared against each other and the clinical plan by analyzing their DVH plots and dose maps. After developing intuition by planning the four prostate cases, which had relatively few tradeoffs, the authors applied our method to a 7-field 6 MV pancreas case and a 9-field 6MV head-and-neck case to test the potential impact of our method on more challenging cases. The authors found that our formulation: (1) provided excellent flexibility for balancing OAR-sparing with PTV homogeneity; and (2) permitted the dose planner more control over the evolution of the PTV's spatial dose distribution than conventional objective functions. In particular, -optimized plans for the pancreas case and head-and-neck case exhibited substantially improved sparing of the spinal cord and parotid glands, respectively, while maintaining or improving sparing for other OARs and markedly improving PTV homogeneity. Plan deliverability for -optimized plans was shown to be better than their associated clinical plans, according to the two-dimensional modulation index.Conclusions:
These results suggest that our formulation may be used to improve dose-shaping and OAR-sparing for complicated disease sites, such as the pancreas or head and neck. Furthermore, our objective function and constraints are linear and constitute a linear program, which converges to the global minimum quickly, and can be easily implemented in treatment planning software. Thus, the authors expect fast translation of our method to the clinic where it may have a positive impact on plan quality for challenging disease sites.
A new respiratory monitoring and processing system based on Wii remote: Proof of principle40(2013); http://dx.doi.org/10.1118/1.4810941View Description Hide DescriptionPurpose:
To create a patient respiratory management system and patient self-practice tool using the Wii remote, a widely available consumer hardware product.Methods:
The Wii remote (Wiimote) (Nintendo, Redmond, WA) contains an infrared (IR) camera that can track up to four spots whose coordinates are reported to a host computer via Bluetooth. The Wiimote is capable of tracking a fiducial box currently used by a commercial monitoring system [Real-time Position ManagementTM (RPM) system, Varian Associates, Palo Alto, CA], if the correct IR source is used. The authors validated the Wiimote tracking by comparing the amplitude and frequency of signals among those reported by Wiimote with known movements from an inhouse servo-driven respiratory simulator, as well as with those measured using the RPM. The simulator comparison was done using standard sinusoid signals with amplitude of 2.0 cm as well as recorded patient respiratory traces. The RPM comparisons were done by simultaneously recording the RPM reflective box position with the Wiimote and the RPM. Timing was compared between these two systems by using the digital beam-on signal from the CT scanner, for the 4DCT to synchronize these acquisitions.Results:
The data acquisition rate from the Wiimote was 100.0 ± 0.4 Hz with a version 2.1 Bluetooth adaptor. The standard deviation of the height of the motion extrema was 0.06 and 1.1 mm when comparing those measured by the Wiimote and the servomotor encoder for standard sinusoid signal and prerecorded patient respiratory signal, respectively. The standard deviation of the amplitude of motion extrema between the Wiimote and RPM was 0.9 mm and the timing difference was 253 ms.Conclusion:
The performance of Wiimote shows promise for respiratory monitoring for its faster sampling rate as well as the potential optical and GPU abilities. If used with care it can deliver reasonable spatial and temporal accuracy.
FusionArc optimization: A hybrid volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) planning strategy40(2013); http://dx.doi.org/10.1118/1.4808153View Description Hide DescriptionPurpose:
To introduce a hybrid volumetric modulated arc therapy/intensity modulated radiation therapy (VMAT/IMRT) optimization strategy called FusionArc that combines the delivery efficiency of single-arc VMAT with the potentially desirable intensity modulation possible with IMRT.Methods:
A beamlet-based inverse planning system was enhanced to combine the advantages of VMAT and IMRT into one comprehensive technique. In the hybrid strategy, baseline single-arc VMAT plans are optimized and then the current cost function gradients with respect to the beamlets are used to define a metric for predicting which beam angles would benefit from further intensity modulation. Beams with the highest metric values (called the gradient factor) are converted from VMAT apertures to IMRT fluence, and the optimization proceeds with the mixed variable set until convergence or until additional beams are selected for conversion. One phantom and two clinical cases were used to validate the gradient factor and characterize the FusionArc strategy. Comparisons were made between standard IMRT, single-arc VMAT, and FusionArc plans with one to five IMRT/hybrid beams.Results:
The gradient factor was found to be highly predictive of the VMAT angles that would benefit plan quality the most from beam modulation. Over the three cases studied, a FusionArc plan with three converted beams achieved superior dosimetric quality with reductions in final cost ranging from 26.4% to 48.1% compared to single-arc VMAT. Additionally, the three beam FusionArc plans required 22.4%–43.7% fewer MU/Gy than a seven beam IMRT plan. While the FusionArc plans with five converted beams offer larger reductions in final cost—32.9%–55.2% compared to single-arc VMAT—the decrease in MU/Gy compared to IMRT was noticeably smaller at 12.2%–18.5%, when compared to IMRT.Conclusions:
A hybrid VMAT/IMRT strategy was implemented to find a high quality compromise between gantry-angle and intensity-based degrees of freedom. This optimization method will allow patients to be simultaneously planned for dosimetric quality and delivery efficiency without switching between delivery techniques. Example phantom and clinical cases suggest that the conversion of only three VMAT segments to modulated beams may result in a good combination of quality and efficiency.
Hypofractionated proton therapy for prostate cancer: Dose delivery uncertainty due to interfractional motion40(2013); http://dx.doi.org/10.1118/1.4811101View Description Hide DescriptionPurpose:
The α-to-β (α/β) ratio for prostate tumor is likely lower than that for the surrounding normal organs, such as rectum and bladder (∼3 Gy). As a result, hypofractionation is expected to improve the therapeutic ratio in prostate radiation therapy. However, with the use of fewer, larger fractions, the accuracy of treatment dose delivery becomes more influenced by the physical uncertainties resulting from motion and radiobiological uncertainties in the α/β ratio of the prostate tumor. The purpose of this study is to evaluate the impact of interfractional motion on treatment dose delivery within the likely range of the tumor α/β ratio.Methods:
Serial CT images acquired at simulation and daily treatment for three prostate patients were studied retrospectively. A conventional 3D-conformal proton plan was created for each patient, delivering 25 fractions of 2 Gy to ITV1 (internal target volume, expanded from the prostate and clinically involved seminal vesicles) followed by 14 fractions to ITV2 (expanded from the prostate). The plans were renormalized for a series of hypofractionated protocols of between five and 28 fractions. The fractional doses were computed on daily CT and were mapped onto simulation CT using deformable registration. In each course, the doses from the fractions with the lowest D97% of the ITV2 were summed to approximate the lower limit (worst case) of target coverage. The uncertainty in dose and coverage was estimated as the deviation of the worst case from the nominal plan.Results:
For treatments in 28 to five fractions, the uncertainty arising from interfractional motion ranged from ∼1% to 4% for V100% and ∼2% to 6% for D100% of the ITV2. The uncertainties in V95% and D95% were both minimal (<1%) for all protocols. For tumors with a low α/β of 1.0 Gy, the treatment in five fractions could deliver an additional 21.0 and 17.4 GyEQD2 to 95% and 100% of the ITV2, respectively, compared to that in 28 fractions. This advantage disappeared for tumors with α/β > 2.5 Gy, assuming the worst case for interfractional motion.Conclusions:
In hypofractionated proton therapy for prostate cancer, the dosimetric uncertainties due to interfractional motion were minimal for the ITV2 coverage at 95% isodose level and the dose received by 95% of the ITV2. Although hypofractionation could yield an increase in equivalent dose to the target for tumors with low α/β, the gain was cancelled out by the uncertainty due to interfractional motion for tumors with α/β > 2.5 Gy.
BrachyView, A novel inbody imaging system for HDR prostate brachytherapy: Design and Monte Carlo feasibility study40(2013); http://dx.doi.org/10.1118/1.4808360View Description Hide DescriptionPurpose:
High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper,HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 × 60 mm2 silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project.Methods:
Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a192 Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location.Results:
Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in the estimated projection position was found to be 0.95 mm in the imaging (detector) plane, resulting in a maximum source positioning estimation error of 1.48 mm.Conclusions:
HDR BrachyView is a feasible design for real-time source tracking in HDR prostate brachytherapy. It is capable of resolving the source position within a subsecond dwell time. In combination with anatomical information obtained from transrectal ultrasound imaging, HDR BrachyView adds a significant quality assurance capability to HDR brachytherapy treatment systems.
Dosimetric comparison of helical tomotherapy treatment plans for total marrow irradiation created using GPU and CPU dose calculation engines40(2013); http://dx.doi.org/10.1118/1.4810936View Description Hide DescriptionPurpose:
To compare optimization characteristics, plan quality, and treatment delivery efficiency between total marrow irradiation (TMI) plans using the new TomoTherapy graphic processing unit (GPU) based dose engine and CPU/cluster based dose engine.Methods:
Five TMI plans created on an anthropomorphic phantom were optimized and calculated with both dose engines. The planning treatment volume (PTV) included all the bones from head to mid femur except for upper extremities. Evaluated organs at risk (OAR) consisted of lung, liver, heart, kidneys, and brain. The following treatment parameters were used to generate the TMI plans: field widths of 2.5 and 5 cm, modulation factors of 2 and 2.5, and pitch of either 0.287 or 0.43. The optimization parameters were chosen based on the PTV and OAR priorities and the plans were optimized with a fixed number of iterations. The PTV constraint was selected to ensure that at least 95% of the PTV received the prescription dose. The plans were evaluated based on D80 and D50 (dose to 80% and 50% of the OAR volume, respectively) and hotspot volumes within the PTVs. Gamma indices (Γ) were also used to compare planar dose distributions between the two modalities. The optimization and dose calculation times were compared between the two systems. The treatment delivery times were also evaluated.Results:
The results showed very good dosimetric agreement between the GPU and CPU calculated plans for any of the evaluated planning parameters indicating that both systems converge on nearly identical plans. All D80 and D50 parameters varied by less than 3% of the prescription dose with an average difference of 0.8%. A gamma analysis Γ(3%, 3 mm) < 1 of the GPU plan resulted in over 90% of calculated voxels satisfying Γ < 1 criterion as compared to baseline CPU plan. The average number of voxels meeting the Γ < 1 criterion for all the plans was 97%. In terms of dose optimization/calculation efficiency, there was a 20-fold reduction in planning time with the new GPU system. The average optimization/dose calculation time utilizing the traditional CPU/cluster based system was 579 vs 26.8 min for the GPU based system. There was no difference in the calculated treatment delivery time per fraction. Beam-on time varied based on field width and pitch and ranged between 15 and 28 min.Conclusions:
The TomoTherapy GPU based dose engine is capable of calculating TMI treatment plans with plan quality nearly identical to plans calculated using the traditional CPU/cluster based system, while significantly reducing the time required for optimization and dose calculation.


text:
From Our Editors
Look + See's eyewear studio is as swanky as any art gallery, with pale-green walls lined with mirrors and sculpture-esq wooden shelves displaying glasses. Their stock of fashionable frames from around the world was smelted in the factories of top designers. Frames from OGI run between $100-$269, Vera Wang rims cost $150-$280, and Gotti?s chic eyeball offsetters are $315-$558.

subset: commoncrawl


text:
July 7, 2015
WASHINGTON (AP) - President Barack Obama says he's confident that state and federal governments have done all they can to prepare for the superstorm barreling up the East Coast.
He says the slow-moving storm will affect millions of people, and he is urging Americans to heed warnings.
Obama was speaking from the White House briefing room. He said the key is to make sure the public is following instructions to take precautions.
A week from Election Day, he says he's not worried about the impact of the storm on his re-election chances. And he says that the No. 1 priority is to make sure lives are saved.
Copyright 2015 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or firstname.lastname@example.com.


text:
Fantastic 4 Bed house for rent with garage and fully enclosed garden - Unfurnished
A spacious semi-detached house situated in a quiet street in the popular area of Comiston. This is a spacious family home which has flexible accommodation over two levels and benefits from a fully enclosed garden to the rear. There is a small garden
- Date available: 20 Aug 2015
- House
- 4 Beds


text:
Mercedes-Benz 600SEL Problem Report
Mercedes-Benz 600SEL Bad Switch/Blower Motor Resistor Assembly May Cause Inoperative Heater Blower Motor
(2 reports)
Other than a defective motor, a bad switch or blower motor resistor assembly can cause an inoperative heater blower motor.
Related Items:
I need the location of the Resistor or Relay switch for the blower.
Vehicles with automatic level control that ride harshly in the rear (no give in the suspensio...


text:
HSBC "lift" by Grey London
Agency: Grey London
Rating: 5.0
Group marketing director
+44 (0)844 881 8000
200 Grays Inn Road, London, WC1X 8HF
31st March 1968
I'm very proud of what we achieved at St Luke's and believe the industry desperately needs more disruptive innovation.A more recent highlight is happening now – playing a part in changing the fortunes of ITV.
While looking after the Sky business at St Luke's, I was waiting outside the boardroom at Sky HQ, to present the latest brand campaign to Tony Ball and his executive team, to be told the tape (it was pre-digital days) had fallen off the bike on the Hammersmith Flyover and a lorry had driven over it – could I possibly keep them waiting for an hour?
There is nothing better than working with the programming and production executives from the start of an idea, to execution, to the marketing strategy, and opening the overnight e-mail following launch night and seeing that a hit has been created. A wonderful feeling.
To get the programme hits, we have to have the misses, and it's painful when it happens.
I've taken Claire Beale to the Brits for the past couple of years and it worked for me.
I wouldn't mind having a stab at James Murdoch's job – blending the old media world with the new is fascinating stuff.
Learn to be a powerful Hollywood producer would be good, but, more likely, I would pander to my sad obsession with cars and anything Italian and drive around Italy eating fine food and drinking wine.
A perfect blend of charm, dynamism and charisma.
Based upon the answer above, my arrogance levels might need looking at.
TV, of course!
A cycle shop called Condor on Gray's Inn Road – a labyrinth of expensive Italian bikes.
At a party, I once told someone jokingly I was the Toni of Toni & Guy fame. I then sort of forgot to reveal my dishonesty and spent the evening talking about fictitious hairstyles I had created.
Six. What a strange question.
Sorry to say it, but my BlackBerry – I'm an addict!
Heading marketing at ITV, which has been making cuts across the board, was not the easiest job in 2008, but Pemsel's professionalism and grace under pressure has helped to deliver some memorable campaigns following its decision to reappoint Bartle Bogle Hegarty as its agency in late 2007.
Agency: Grey London
Rating: 5.0


text:
EPIX to Present Roger Corman Marathon, 8/25
Premium network EPIX brings you a full day of great fun and movies from the original king of the cult film and icon himself, Roger Corman. Leading up to the world premiere of the EPIX Original Movie Attack of the 50 Foot Cheerleader airing on Saturday, August 25th at 10:00 p.m. ET, EPIX will showcase a daylong marathon of Corman's captivating biker, psychedelic, horror and gangster films beginning at 6:45 a.m. ET, including The Wild Angels, Eat My Dust, The Pit and the Pendulum, The Trip, Bloody Mama and Galaxy of Terror.
EPIX Drive-In - an additional service available to DISH subscribers - will also join the Cormanpalooza celebration, showcasing a Corman film every night at 10 p.m. ET throughout August.
For more information about EPIX, go to www.EpixHD.com.
Follow EPIX on Twitter @EpixHD and on Facebook http://www.facebook.com/EpixHD.
About EPIX
EPIX is the newest premium entertainment network delivering the latest movie releases, classic library titles, plus original films, comedy, music and sports events on TV, on demand, online and on devices. Launched October 2009 as the first multiplatform premium network with online accessibility for subscribers through EpixHD.com, EPIX pioneered the development and proliferation of TV Everywhere for American consumers. EPIX was the first premium network to launch on Xbox consoles, first on Android tablets and phones, first on Roku(R) players and is available to authenticated subscribers on hundreds of devices including Apple(R) iPads(R), iPhones(R), Samsung(R) Smart TVs and Blu-ray(TM) players, more. Today EPIX remains the only premium service providing its entire monthly line-up from new Hollywood hits to original programs on all platforms and provides more movies than any other premium network.
EPIX is a joint venture between Viacom Inc. (NASDAQ: VIA and VIA.B), its Paramount Pictures unit, Metro-Goldwyn-Mayer Studios Inc. (MGM) and Lionsgate (NYSE: LGF), available to over 30 million homes nationwide through distribution partners including Charter Communications, Cox Communications, DISH Network, Mediacom Communications, NCTC, Suddenlink Communications and Verizon FiOS.
About EPIX Drive-In
Bringing the fun and excitement of drive-in movies to DISH subscribers, EPIX Drive-In launched January 1st on channel 292 as part of DISH's America's Top 250 package, with select titles also available on demand and online to authenticated DISH subscribers on EpixHD.com and Dishonline.com. Dedicated to celebrating the best in genre films featuring action, comedy, sci-fi and horror movies of the 1970's, 80's, 90's and beyond, EPIX Drive-In presents a lineup of wild, rebellious and edgy movies such as The Terminator, Child's Play, Back To School, Rollerball, Teen Wolf and many others, all uncut and uninterrupted.
About Author
- CNBC to Air THE MAKING OF DIG, the USA Network Event Series, 3/1
- NBC to Air One-Hour Season Finale of CHRISTINA MILIAN TURNED UP, 3/1
- NBC Universo to Present ROMEO SANTOS DESDE VINA Concert Exclusive, 3/1
- Kelly Clarkson to Visit CBS SUNDAY MORNING, 3/1
- VIDEO: Clark Gregg Teases New AGENTS OF S.H.I.E.L.D. Season Using Emojis
- Dakota Johnson to Host SNL Tonight; Alabama Shakes to Perform
- NBC Sports to Air Coverage of U.S. GRAND PRIX FROM PARK CITY
- Discovery Family to Premiere New Episodes of TRANSFORMERS RESCUE BOTS, Today
- Telemundo to Present FUTBOL ESTELAR: LEON VS SANTOS, Today
- Telemundo to Give Viewers Sneak Peek at Upcoming Programming on LO NUEVO, Today


text:
Everyone tells me horror stories about childbirth. Should I ask them to stop?
Since the day I found out I was pregnant, women have been telling me horror stories about childbirth. I've heard things that would make your toes curl. I try to ignore them, but some accounts scare me to the point of tears. This is my first pregnancy and I don't know what to expect from the delivery. Why do people feel the need to share their most awful birth experiences instead of the joyous ones?
Posted: 11/12/2001 by a BabyCenter Member
Mom Answers
Sort by: best answers | most recent answers
211 - 220 of 621 answers
This is my first. At 38 weeks, I'm due to have my baby any time now; my doctor stripped my membranes today and I'm dilated to 2 1/2 cm. Yes I've heard lots of stories about scary deliveries, but I've also heard about the good ones. My mother said my birth was her easiest (it was her first also). She lost her plug the morning before, her water broke about 2am, and I was born at 6am. Very little pain, so little, in fact, that her nurse was jealous!! So let that be a little bit of reassurance - I have!posted 08/28/2006 by Rhiannasmommy06
Am a first time momma and yes i do get scared when i think of when i will have my child birth but am comforted when i think of all the heartache i am going through with this pregnancy.i mean i have had all the pregnancy illnesses that is known to man and from with standing it i know am a strong person so am very much looking forward to the birth of this child.posted 08/28/2006 by josiane,baltimore
I heard terrifying birth stories the first time I was pregnant also. I finally started saying (in a half joking manner) "Stop...you're scaring me!" Everyone's comment that every birth is different is absolutely correct! My first delivery went smoothly (that's not to say that I wasn't in pain!)...I'm pregnant again and hoping for the same delivery. But the bottom line is that when it is all said and done, you will have a beautiful baby. And he or she will be worth everything that you will go through.posted 08/28/2006 by jeepnmom81
I was concerned as well hearing all the horror stories with my first child. Fortunately, I had the easiest delivery you could imagine. I pushed for 15 minutes and my daughter Samantha came out one, two, three. The only real pain I was in was right before I got my epidural. You'll be fine. Millions of women do it and you can too!!!posted 08/28/2006 by mom2niksam
This is our first pregnancy also. For my husband and I this is a blessing, since we thought we would never be able to conceive. However, hearing other couples experiences of their childrens births have dampen the joy and have brought concern and worry to me. Please, someone tell me this is going to be a great experiences all the way around, it can't be that bad are know one would have more then one child right?posted 08/28/2006 by lbarto
I think we all have ran into this problem. Your best bet is to "cut them off at the pass". When women see I'm pregnant and say or ask something the first thing I say is "Ya know everyone feels it's their obligation to tell me what a horrible time they had with their pregnancy/delivery and I really don't need the negativity right now." It's worked wonders for me.posted 08/28/2006 by Mama2bAgain
I think it's a condition that women get when they deliver. I swore I'd never be the type to tell my "horror" stories after my son was born, but sometimes, I swear it just comes out! It'll happen to you, too! Really, though, it's a way that women can bond, and you really will understand it more once your baby is born and your other friends are pregnant!posted 08/28/2006 by kjess
I was 16 when I had my son and I was scared a lil more than i should have been. Epidural was a life saver. Now I'm pregnant with my 2nd and I'm scared again. It's not bad if you dont let it be. It is a wonderful thing. Just remember things do happen but you have doctors there 24/7.posted 08/28/2006 by robinspen
Some people might think they are doing you a favor by telling you exagerated stories of hours and pain. They aren't, and you should say so. Making you as afraid as they do will only make things worse in the end. Every one is different, every pregnancy is different, and every delivery is different. To be perfectly honest it really wasn't that bad for me. I needed a little bit of drugs through the iv but that was it. Others need no less than an epidural, and then some more. Best advice, talk to your doctor.They're the only person who would know what YOU should expect out of YOUR labor.posted 08/28/2006 by valkyrie_fenix
Labor is different for everyone. I was scared to death with my first son, and a lot of people I talked to did not help at all. Come to find out I didn't even realize I was in labor until my contractions were 4 minutes apart and I was about 7 cm diliated by then. I had an epidural, becuase no matter who you are it does infact hurt and I had no desire to expirance that part. The epidural made me sleep for a couple of hours, as it was the middle of the night. I woke up, my midwife arrived about an hour later, she broke my water and after 15 minutes of pushing I had a beautiful baby boy. I have read some of the comments here, stating that no matter what it is a violent process for anyone and no one breezes through it, well this really isn't true. I honestly thought that labor was 100 times easier than being pregnant. Infact, I would have done it again immediatly after. Just remember that nothing is always or never, you arn't going to know what its like until your there. In the end though you will get through it-good luckposted 08/28/2006 by emmileigh
Answer this question


text:
Results 1 to 4 of 4
Thread: Resident Evil: Poster Contest
May 12th, 2004 #1
Resident Evil: Poster Contest
Poster contest announced for RESIDENT EVIL: APOCALYPSE (Sony Pictures).
If you are interested read more at:
Hide this ad by registering as a memberMay 12th, 2004 #2
seems fun. However, Resident evil movies suck, Resident evil games rock.
Last edited by RAMÓN; May 15th, 2004 at 12:26 PM.
May 12th, 2004 #3
Resident Evil movie was just mediocre, the presence of Milla Jovovich can offset many bad things in a movie:inlove:
May 13th, 2004 #4Originally posted by SeraphSword
... the presence of Milla Jovovich can offset many bad things in a movie :inlove:
Any of you interested in the poster contest?
What do you think, is it worth giving it a go or is it just another cunning advertisement campaign?


text:
Public library offering Beginning Bridge Class
The Henderson County Public Library will be offering a Beginners Bridge Class, instructed by Joseph Hendon, on Tuesday and Thursday evenings beginning the week of Jan. 15 from 5:30 to 7:30 p.m.
It is an eight-week card class, that will conclude March 7th.
There is a $20 registration fee due at the time of registration that covers materials required for the class.
For more information call 826-3712 or to sign-up please stop by the library during operating hours.


text:
Cool Nutz
Jus Family Records
Song: Married to This
Cool Nutz may be rocking a wedding band on his left ring finger, but the hustle remains the Oregonian emcee's number one priority. On his latest single, he tells the world that he's... More
Posted 10 months ago
Song: Keep Chasin
Cool Nutz' last DJBooth feature, December's Mine, depicted the artist grinding overtime in order to claim the money, power and respect he deserves. A month and change later, it should come... More
Posted 2 years ago
Featuring: The Grouch
Song: Mine
The title of Cool Nutz latest single, Mine, might sound self-centered, but the emcee has no problem sharing the spotlight. Off of the Oregon emcee's most recent album, Mine not only features the... More
Posted 2 years ago
Featuring: Tech N9ne | Krizz Kaliko
Song: Affiliation
What's Booth newcomer Cool Nutz' Affiliation? Well, while the Portland native and Jus Family artist isn't officially connected with Strange Music, he's clearly got some... More
Posted 2 years ago
Sample Text - Sample Link


text:
Good Stuff from baseballmusings - check out the spreadsheet
Original PostYesterday, in a post about Jeff Francoeur, I brought up a simple method for examining the cost in outs of producing runs. Ive posted a google spreadsheet of the results, the 163 players since 2005 with 2000 PA. Its interesting to me that five of the top 30 spent time with the Red Sox during that period, Ramirez, Ortiz, Bay, Youkilis and Drew, and four with the Yankees (A-Rod, Giambi, Abreu and Matsui). These clubs value out efficient run production.
The list is also a nice view of the defensive spectrum, as the top is dominated by first basemen and designated hitter types, while the bottom is full of middle infielders and catchers. Feel free to download and play with the data.
Outs are the currency of baseball. Players who can buy more runs per out, or conversely, spend fewer outs per run, are richer hitters. An easy way to look at this, something you can do off any stat sheet or the back of a baseball card, is to use batting outs per run, where Im using Production to approximate runs (Runs Scored + RBI)/2. Batting outs are simply AB-Hits. So outs per run is (AB-hits)/((Runs Scored + RBI)/2). I like using production here because it deals with actual runs and RBI. Drew tends not to drive in as many runs as one might expect because hes very willing to take a walk in RBI situations. Francoeur probably drives in more runs that one might expect because he puts the ball in play so often in RBI situations. So using production should be favorable to Francoeur.
Since 2005, Francoeurs first season, 163 players accumulated at least 2000 plate appearances. Among those, Albert Pujols spends the fewest outs per run, 3.14. Jason Kendall spends the most, 7.34. J.D. Drew ranks 26th, a run costing him 4.12 outs. Francoeur ranks 107th, a run costing him 5.33 outs. In other words, it costs Francoeur 121 more outs than Drew to produce 100 runs. Thats four and a half games of outs.
Four and a half games of outs that his teammates dont get to use. Four and a half games of lost opportunities to score. Somehow, that just doesnt seem worth it to me.


text:
Anime Expo - July 2nd - July 5th, 2015
- Film, Media & Entertainment
- 1201 South Figueroa Street, Los Angeles, 90015
LA Ad Tech Mixer - Mar 2013
Wednesday, March 27, 2013 from 7:00 PM to 10:00 PM (PDT)
LA Ad Tech Mixer networks again at BUSBY's West on Wed March 27
Thank you everyone for the great turn out at the February event.
Have you joined our Facebook group yet?
Go to https://www.facebook.com/groups/LAadtech and request to join.
DATE: March 27th, 2012
TIME: 7pm - 10pm
PLACE: Busby's West
3110 Santa Monica Blvd
Santa Monica, CA 90404
If you geek out over the Ad Tech, OMMA & Digiday conferences, this is for you.
If you print LUMA Partners' lumascapes to hang on your wall, this is for you.
If you hang on Mary Meeker's every word, this is for you.
If you quote eMarketer's digital advertising estimates in your sleep, this is for you.
If you just want to grab a drink with digital advertising peeps, this is for you.
As usual, Busby has happy hour drinks from 7pm-8pm. So, come by early to enjoy this targeting :)
Join millions of people on Eventbrite.
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


text:
Feature Article
CHRISTIAN RECORD SELECTED A WINNER IN THE 36th ANNUAL TELLY AWARDS
The Telly Awards has named Christian Record Services for the Blind (CRSB) as a Bronze winner in the 36th Annual Telly Awards for their piece titled Peter's Big Dream. With nearly 12,000 entries from all 50 states and numerous . . .
Click here to read older stories.


text:
Since so many people are struggling with weight issues, I'd like to share some things I've learned about attaining your ideal weight. Let's look at four categories: Our culture is all about eating. We use food to celebrate, grieve, socialize. Many people eat to satisfy emotions. We eat if we feel bored, anxious, lonely, etc. I would like to suggest that when you feel like eating, stop and consider whether or not you are experiencing true physical hunger. If the answer is "Yes" sit down, take time to enjoy a healthy snack. Otherwise, choose an activity that truly satisfies the emotion you are feeling.
1. In some instances, the subconscious mind uses extra weight as a blanket of protection. This is particularly common in people who experienced physical or sexual abuse as children. Consider Guided Imagery or hypnotherapy to move forward, feel safe and empowered.
2. Sleep: It's important to get adequate deep sleep. Do you snore? Do you run out of steam during the day? If the answer to either is "Yes", consider being screened for sleep apnea. In addition to increasing the risk of stroke, cardiac problems and diabetes, without adequate deep sleep, the body can't produce enough leptin, a hormone that allows us to feel satisfied.
We also tend to have more cravings and eat more when we are tired.
3. Adjust your thought process. Picture yourself slim and fit. Really feel how that will feel. Change your self talk. Strive to "attain your ideal weight" "release excess weight". Consider my guided imagery CD " Creating Optimal Health and Wellness " to change limiting beliefs and habits.
4. Check out "Losing It" an I-Phone application that tracks your goals, calories and progress.
Let me hear about your progress!!


text:
Keep up to date with the latest events from The Royal Collection
Groups can enjoy an exclusive 'behind-the-ropes' experience in the Castle's magnificent State Apartments. ... Read more about Private Guided Tour of the State Apartments for groups
Saturday, 31 January 2015 to Wednesday, 13 January 2016
2015 marks the 200th anniversary of the Battle of Waterloo and the defeat of Napoleon. ... Read more about Waterloo at Windsor: 1815-2015
This group tour gives an extraordinary insight into the behind-the-scenes life of the Castle. ... Read more about Great Kitchen to State Apartments for groups
This group tour offers a personal insight into the ancient and noble institution of the Military Knights of Windsor by a serving Military Knight. ... Read more about The Military Knights' Tale for groups
This popular group tour offers a fascinating talk and a private viewing of Queen Mary's Dolls' House, the most famous dolls' house in the world. ... Read more about Queen Mary's Dolls' House and the State Apartments for groups
New and for 2015 only, groups can enjoy this special visit as part of the programme of events marking the 200th anniversary of the Battle of Waterloo. ... Read more about A Prince, A Duke and An Emperor for groups
Groups can take advantage of the splendour and history of Windsor Castle with the beauty and serenity of The Savill Garden. ... Read more about Windsor Castle and The Savill Garden for groups
Join Dr Susan Foister for this evening lecture looking at Hans Holbein's portrait drawings of the most powerful figures at the Tudor court of Henry VIII. ... Read more about Lecture - Holbein's drawings at Windsor Castle
Go back to the Middle Ages and the time of Magna Carta by joining us to mark the 800th anniversary of the signing of this important document. On Saturday, 11 July, join us in St George's Hall to hear about William Marshall, 'The ... Read more about Family Saturdays in July 2015: Magna Carta and the Castle
The Bracknell and Wokingham Community Band will be performing at Windsor Castle's Jubilee Bandstand on Sunday, 5 July 2015. ... Read more about Band concert 2015: Bracknell and Wokingham Community Band
Sign up to our free monthly e-newsletter for the latest exhibitions and exclusive events.
Contact us


text:
LMHS Genealogy Database Reaches a Milestone
Access to Ancestry.com
Ancestry.com is the world's largest online family history collection. Access is restricted to persons at the Lancaster Mennonite Historical Society.
PMH Now Online!
The Lancaster Mennonite Historical Society is pleased to announce that, for the first time, members are able to read all of the back issues of Pennsylvania Mennonite Heritage online. Every page of every issue from 1978 to 2013 is now accessible (for members only) via the Online Resources page of the LMHS website. Log in and browse the wealth of information on genealogy, local history, church history, and Pennsylvania German culture.
Volunteers Needed
The Lancaster Mennonite Historical Society is looking for volunteers to assist visitors in the library on a regular basis. The work involves orienting patrons to the library and its resources, helping visitors to find information in the library and archives, and answering telephone calls at the reference desk. This is a wonderful opportunity to learn while volunteering, especially for those with an interest in family, church, and local history. Help is needed on Tuesdays (morning and/or afternoon). Familiarity with computers and willingness to learn would be helpful. For more information contact Steve Ness (Tel.: 393-9745; Email: snesslmhs.org).
Reading our Way to PA 2015
Looking to learn more about Mennonites around the world? Trying to prepare yourself for Mennonite World Conference? Pick up the Global Mennonite History series at the Society today! Also pick up your copy of Alfred Neufeld's "What We Believe Together: Exploring the Shared Convictions of Anabaptist-related Churches-available only through the Lancaster Mennonite Historical Society. Can't make it in? Order your copies online here.
38th Annual Meeting of the Juniata Mennonite Historical Society
July 18, 2015 9 AM
Lost Creek Mennonite Church
2682 Long Road, Mifflintown, Pennsylvania 17059
Swiss-German Origins of Family and Faith – Linden Showalter, Waynesboro, PA
The Mennonite Story in the Netherlands – Onijdes Sijtsma – Berlikum, Friesland, Netherlands
(Onijdes is a Mennonite historian and Anabaptist book collector who lives a few miles from Witmarsum, the home of Menno Simons. Come and hear his personal journey of faith and the saga of the Dutch Mennonites.)
12 noon – lunch
1 PM - European Anabaptist and Ancestral Homestead Sites- Benjamin K. Beiler
Lunch provided by Weaver's Countryside Market ($8.50)
For more information, call the Historical Center at 717-694-3211 or Betty Ann Landis 717-444-3466
Alleghenyville Mennonite Meetinghouse
Chester Weaver, a schoolteacher in a Beachy Amish school in Lagrange, Indiana, will speak on "Swiss Brethren vs. Dutch Mennonite Concepts of the Church" at the annual Outdoor Historical and Inspirational Meeting at the 1855 Allegheny Mennonite Meetinghouse, 39 Horning Road, Alleghenyville, PA on Sunday, July 19 at 6:30 PM . The Earl Fox Family will provide special music. Please bring a Church and Sunday School Hymnal and your lawn chair. For more information, e-mail jgsenwindstream.net or call 717-278-8459.
Brubaker Families of America
Annual Brubaker Families of America Reunion, Sunday, August 2, 2015 at the former Parish Resource Center, 633 Community Way, Lancaster, Pa 17603
Check the web site for more information. Program will be 2 cousins sharing on "Saving our Heritage of Heirlooms" and Exploring our Brubaker Heritage in Switzerland and the Rhine Valley" with pictures of recent visit. If you want to reserve seating and a lunch call Jane Barge at 717-393-4639 or email at . Visiting with cousins 11am-12am with cafeteria style lunch available only with prior reservations. Anyone with Brubaker in your family line somewhere...invited.
What Young Historians Are Thinking
The Lancaster Mennonite Historical Society, in partnership with the Sider Institute for Anabaptist, Pietist and Wesleyan Studies at Messiah College, welcomes paper proposals for its event, What Young Historians Are Thinking. This symposium seeks to encourage young historians in their research efforts and to provide them with a venue in which to share their findings.
Interested researchers should submit a 250-word proposal for a 20-minute paper to be given at the symposium. Three proposals will be chosen for this opportunity. Please submit via email to or via postal mail to Joel Nofziger, Lancaster Mennonite Historical Society, 2215 Millstream Road, Lancaster, PA 17602.
Young Center Call for Papers
The Young Center for Anabaptist and Pietist Studies at Elizabethtown College welcomes proposals for its international conference "Continuity and Change: 50 Years of Amish Society" June 9-11, 2016 . Submission deadline is October 1, 2015 . Visit www.etown.edu/amish2016 for details.
My Calling to Fulfill: The Orie O. Miller Story Book signing
On Saturday, July 18, the Lancaster Mennonite Historical Society will hold two book signing's with John Sharp about his recently released book about the founder of Mennonite Central Committee. The first will be held at 10 a.m. at Lancaster Mennonite Historical Society, 2215 Millstream Road, Lancaster, PA, and the second will be at 2 p.m. at the Muddy Creek Farm Library, 296 Wheat Ridge Dr., Ephrata, PA.
Bookworm Frolic
Come to the Bookworm Frolic and discover over 40,000 books in 25 different categories. This years frolic takes place from 9 AM–7PM Tuesday, August 11, through Friday, August 15 and 9 AM–4PM on Saturday, August 15. This year, the frolic opens a day early for an Early Bird Special. Learn more.
Music in the Orchard
Music in the the Orchard continues to provide local music at the 1719 Hans Herr House. The next concert features Jake Lewis & The Clergy, with an opening by Lackawanna Skies, starting at 6 p.m. on Saturday, July 11. Tickets cost $8. Visit www. Hansherr.org for more information. Concerts continue on July 11, August 1 and 15.
Folk Art Fun for Kids and Adults
This summer, the 1719 Hans Herr House & Museum is beginning a new program introducing traditional Pennsylvania German skills: Folk Art for Kids and Adults. This series features five classes, ranging from Fraktur and Scherenschnitte to hearth cooking, blacksmithing, and tape weaving, each designed for a child to learn together with an accompanying adult.
Hispanic Mennonites of Lancaster County, Pa.
Join the Lancaster Mennonite Historical Society for a field trip and go back in time when several hundred folks arrived in Lancaster County PA from Puerto Rico to work in summer harvesting of tomatoes from about 1950 to 1964. See their early lodging places, work sites, and places of worship. Hear first person accounts of initial experiences. Discover the changes as their families arrived. The trip runs on Saturday, October 31, from 8 a.m. to 4 p.m. Register here.
About Lancaster Roots 2015
Lancaster Roots is an ongoing series of community cultural events organized by Lancaster Mennonite Historical Society and the 1719 Hans Herr House. For a complete list of events, go to www.LancasterRoots.org
Lancaster Mennonite Historical Society preserves and interprets the culture and context of Anabaptist-related faith communities connected to Lancaster County, Pennsylvania.


text:
Driver pleads guilty to causing death by dangerous driving after 9 tonne refrigeration unit fell of lorry killing cyclist
Grandmother cycling to work killed instantly
A lorry driver has pleaded guilty to causing the death by dangerous driving of a female cyclist who was killed instantly in August last year when a 9-tonne refrigeration unit slid off his lorry's trailer and landed on her.
Mother of two, and grandmother of four, Susan Russell, had been riding her bike to work at a care home in Victoria Dock, Hull, when she was killed at around 7.30am on 20 August 2010.
The fatal incident took place on the Garrison Road roundabout, which lorry driver Mark Smith, aged 47, was said to have been negotiating at 20mph, reports the Hull Daily Mail.
Smith, operator of a haulage firm based in Bradford, had set off that morning from his depot, heading for Saltend with the load.
However, the court heard that he had not secured it properly, with a police report stating that dozens of straps should have been used to keep the refrigeration unit in place, instead of just two that were actually used.
According to the Hull Daily Mail, "several motorists" heading into the city witnessed the load hanging off the lorry's trailer as it went through Melton, some way from the site where the victim was killed. It was not reported whether any of those motorists contacted the police.
Sentencing is due to take place next month, and the victim's sister says she hopes the driver "rots in jail."
The victim's sister, Patricia Kipling, aged 64, told the Hull Daily Mail: "He took my sister from me and I will never recover from that. I will never get her back. I hope he rots in jail.
"I live with the thought of her being crushed to death every day and I hope Mark Smith gets a long jail sentence, so he can sit and think about what he has done.
"He took my sister from me, either through laziness or stupidity."
Smith's lawyers have argued that the driver was not aware that the load was unsafe, a claim contested by the Crown Prosecution Service, and one that will have an effect on the length of sentence ultimately imposed on him.
The case has been adjourned until next month, and if the defence team and CPS are unable to agree upon the facts before then, they will be determined by a legal process known as a Newton hearing, under which the judge will examine the evidence and decide what actually happened.
Mrs Kipling added: "Every day something reminds me of my loss. The last image I have in my head is of her lying on a slab at the morgue, when I had to identify her.
"Every day I go through the emotions of losing my sister. What has he had to go through? Nothing from what I have seen."
With police closing the road for several hours to conduct their investigation, Mrs Kipling was caught in the traffic jam that ensued, although she had no inkling of what had caused it.
"We had been to Tesco the morning Sue died and we actually got caught in all the traffic afterwards. It had a knock-on effect across the city," she revealed.
"We were cursing the delays yet at the time had no idea what had happened. It wasn't until later in the afternoon the police got in touch."
In court, Smith, who has been released on bail pending the sentencing hearing, told the victim's family: "I'm sorry, I just want the family to know I am sorry. I am really sorry for the family."
He repeated that afterwards outside the court, telling the Hull Daily Mail: "I am sorry. I am heartbroken by what happened. Every day I think about what happened. I want the family to know I am sorry."
A terrible tragedy, I knew that lady and cycle near that spot every day. Several HGVs have toppled over on the same road in the last year, so it is lucky that nobody else has been killed.
Simon Mason, Kingston upon Hull
posted by swldxer [34 posts]
12th October 2011 - 12:15
why wasn't he prosecuted for manslaughter? Just because he has killed someone whilst driving extremely recklessly, the CPS should have considered a more serious charge. He's almost lucky to have only been charged with causing death by dangerous driving.
posted by londonplayer [671 posts]
12th October 2011 - 15:53
He's lucky he won't face the new charging structure for such offences. If he only fitted two retaining straps to hold a 9tonne load in place as stated here, then he had to be either very lazy or in too much of a hurry to think of the possible consequences of his actions. No properly trained HGV driver would take such a risk in securing a load so poorly. His defence seems so weak as to be no defence at all.
I feel sorry for the victim's family.
posted by OldRidgeback [2515 posts]
12th October 2011 - 17:33
posted by Karbon Kev [682 posts]
13th October 2011 - 8:09
That bloke should have known better,as he runs or owns his haulage company he should have known what amount of straps he should need to the weight load,does he run a mickey mouse haulage company instead of a professional one.He should be done for manslaughter
posted by marriott [6 posts]
14th October 2011 - 19:01
I am puzzled why if he can claim 'he did not know' that he might get a lighter sentence?
posted by robbieC [62 posts]
16th October 2011 - 13:33
27 month jail term
posted by qwerky [177 posts]
27th September 2012 - 11:06


text:
Honey Bread
|Hot water
|8 Cup (128 tbs)
|1 Cup (16 tbs)
|Skim milk powder
|2 Cup (32 tbs)
|Safflower oil
|2⁄3 Cup (10.67 tbs)
|2 Tablespoon
|Oat bran
|2 Cup (32 tbs)
|1 Cup (16 tbs) (Health)
|Soy milk powder
|1⁄2 Cup (8 tbs) (Dry)
|Gluten flour
|1⁄2 Cup (8 tbs)
|Fast acting yeast
|3 Tablespoon
|White flour
|1⁄2 Cup (8 tbs)
1) Preheat the oven to 400°F (205°C)
2) Make a mixture of the water, honey, milk powder, oil and salt.
3) Once mixture is uniform, add dry yeast with the rest of the ingredients and knead well.
4) Place in the knead in a warmed and greased bowl and turn over and cover with a sheet of waxed paper
5) Let the dough rise until it becomes light, then push it down and turn it over and let it rise for about 10~12 more minutes
6) This dough can be now divided into about 6 loaves. You may set aside some for Hot Dog/Hamburg Rolls.
7) Once again, let it rise until the size doubles
8) Bake in hot oven at about 400°F for 10 minutes.
9) Reduce the heat temperature to 350°F and continue baking until loaves separate from the side of the pan.
10) Serve hot or cold.


text:
SANTA CLARA, Calif. (AP) Demarcus Dobbs' season is over with the San Francisco 49ers after he was placed on injured reserve Tuesday with a right knee problem.
ASHBURN, Va. (AP) All the medical terms associated with Robert Griffin III's knee injury can be boiled down to one simple message: It's not too bad.
SANTA CLARA, Calif.
IRVING, Texas (AP) San Francisco 49ers defensive end Demarcus Dobbs walked away from a one-vehicle accident on his 25th birthday last month and was arrested on suspicion of driving under the infl
SANTA CLARA, Calif. (AP) Frank Gore quickly gave credit to rookie LaMichael James for an impressive NFL debut - and for taking some pressure off the three-time Pro Bowler in the process.


text:
Chief executive Chris Sangster said the permission for six-day 24-hour production, rather than 16-hour days, would allow a smaller design configuration which would reduce start-up capital expenditure by 10 to 15 per cent, improving "significantly" the project's returns.
It expects to submit a revised plan to the planning authorities during the current quarter. Meanwhile discussions with suppliers over mining equipment finance are continuing. Scotgold's quarterly cash flow statement shows cash at the end of the quarter to June 30 fell from £1.1million to £640,857, with expected cash outflow of £400,000 in the current quarter.


text:
Kappus, Lily of the Valley, Bar Soap, 5 oz (150 g) (Discontinued Item)
By Kappus8 Reviews
Shipping Weight:?0.41 lbs (0.19 kg)
Shipping Weight
The Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: KAP-00046
- UPC Code: 4003143000469
- Package Quantity: 5 oz (150 g)
- Dimensions: 1.5 x 4 x 2.4 in, 0.35 lbs (0.16 kg)
Product Overview
- Muguet
- Savon toiletsoap
Lily of the valley - a classical theme
Sodium tallowate, sodium cocoate, water (aqua), glycerin, fragrance, lanolin, coconut acid, sorbitol, sodium chloride, tetrasodium etidronate, tetrasodium EDTA, disodium distyrylbiphenyl disulfonate, laureth-7, PEG-8, citronellol, benzyl salicylate, butylphenyl methylpropional, hexyl cinnamal, geraniol, FD&C yellow 10 (Cl47005), chromium hydroxide green (Cl77289), titanium dioxide (Cl77891)
iHerb Customer Reviews


text:
Truckin Magazine
Diesel Power Magazine
Mini Truckin Magazine
RV Magazine
8-Lug Magazine
Truck Trend Magazine
Work Truck Magazine
Top StoryJune 2015 SUV Sales – Compact Crossovers Dominate
SUV sales for June 2015 trended distinctly toward compact crossovers, as usual. The Honda CR-V, Toyota RAV4, and Ford Escape rounded out the podium finish.
Latest Truck Industry News Articles
Land Rover Announces Full Pricing of 2016 Model Lineup, Including Diesel
Land Rover has priced its vehicles for 2016, with the Range Rover and Range Rover Sport diesel carrying a small premium as predicted.
Diesel Prices Trending Down Across Country
At least over the last few weeks in June, the prices of diesel have been uniformly favorable to U.S. drivers. How long will the down trend last?
Next Land Rover Defender Could Be Built Outside U.K.
Poland, Hungary Reportedly Leading Candidates
Black Plates are Back: California Legacy License Plates Go Into Production
The California DMV just announced that legacy black plates would reenter production immediately, making period restoration even easier!
Venture RV Releases New Sonic Lightweight Travel Trailer
There's not much that gets vacation-minded individuals as excited as a nice setup. Venture RV can help, thanks to a redesigned Sonic 234VBH travel trailer.


text:
Is it normal to get extremely angry when my baby cries?
When my four months old cries for more than 10 minutes and cant be soothed, I begin to get incredibly angry.I don't want to be around him, I just can't take his crying anymore. I begin to think negative thoughts and feel very hopeless. I get furious at my baby and I don't understand why. I have no one at home during the day to give my baby to when he has these episodes. I try and leave him in his crib but his cries sound so desperate that I feel like I need to be with him, but it only drives me insane! I feel like something is incredibly wrong with me for feeling like this. I have tried to get professional help thinking it was post-partum depression, and was referred to a psychiatrist who I saw for a while but things didn't improve. I admit that sometimes I even yell at him "please be quiet" or something like this. The whole time my heart is pounding, blood boiling and I am literally shaking in anger. When he stops crying I regain sanity and then I cry. What is wrong with me?!
Posted: 02/17/2012 by a BabyCenter Member
Mom Answers
Sort by: best answers | most recent answers
1 - 10 of 10 answers
I think you're really stressed and frustrated. Are you getting much sleep at night? How much is your baby getting up at night? I suspect the sleep is a huge factor. My first didn't sleep through the night until 18 months old! I felt exactly the same way you do. He needed to be held a lot and I felt really frustrated. My second is quite different and has been sleeping through the night from 6 months. And while I still feel my blood pressure rise and heart beat a bit faster when she cries for a while, but overall I find I'm mich calmer with her. You're not a bad mom! You're just stressed and probably quite tired. Maybe there's other stuff underlying in not getting much help from your partner and maybe not having any family around to help. Try getting out of the house a few times a wekas. Will she sleep in the stroller while you go for a walk or run errands? Can you hire someone to babysit her one afternoon a week to give you a break to get out of the house and be alone? Take care.posted 02/18/2012 by a BabyCenter Member
I go through the same exact thing. My daughter fights naps. What I also to help my baby girl calm down is put on some soothing music. Give her a wipe down . Lotion her and massage her. Put a short sleeve leg less onesy. Hold her and rock her as I hum and I could feel myself get ahold of myself again. She usually will fall asleep. Sometimes she won't. If you need another breather. Gently lay your baby down and walk away for a bit. You need to take care of yourself.posted 12/17/2014 by a BabyCenter Member
You aren't alone. I am currently going through the same thing. I'm a first time mom of a 10 month old girl. She is in the phase of needing mommy all the time to entertain her. She fights naps and sleep. So I find myself getting madder and madder. But I'm human. I do feel bad. But we as moms feel like we need to be perfect. There is no such thing. We get tired and frustrated. Who wouldn't after listening to your baby screaming for no reason. I sit her in her crib. And take a breather outside for a few minutes. If your baby is safe, not hurt , not hungry, not wet ect and just wants attention. It if fine leaving her in her crib for a few mins to cry. It won't kill her she will be fine. Take care of yourselves ladies. Think when your baby is older she won't remember the day you left her in her crib to cry for a few minutes. :)posted 12/17/2014 by a BabyCenter Member
I'm so happy other moms feel this way. I felt so horrible that I get angry. My husband works so much and when he's home he sleeps. I was also referred to a psychiatrist and wasn't helped.posted 12/06/2014 by mommytobe0717
I have a 3 month old.. I am currently going through the exact same thing.. Its super fraustrating.. I dont have an answers to your question but im glad that im not alone.. I wonder if i need help.. I catch myself screaming at my daughter to qiet down.. And the guilt and my tears begin to drop. Ugh so tired. I have no family or friends who can help take over while i get myself togethrr and my husband works all day everyday..posted 06/05/2014 by newmom92302
It feels better to know that I am not the only mom who feels this way. I do have PPD. I would never hurt my baby. My husband is currently locked up so i have no help. So not ever getting a break being a first time mom is taking its toll. She can be so happy and if i leave the room she just starts to scream. Love her and would never hurt her but a break would be nice. But unfortunately i have no one to help at all.posted 05/10/2014 by a BabyCenter Member
Your not wrong for feeling that way your human but do you have any friends or family memebers to help you get a break cause all us moms need one once in a while also when your irriated your baby can feel that and will make them cry more just calm yourself down all babies cry and just talk tto yurself to keep calm if you feel that way and find out what's making her cryposted 03/26/2014 by a BabyCenter Member
Im glad im not the only one whose ever felt this way... I have a very needy/attention NOW baby.. I go visit friends and there babies are so calm. She is a perfectly healthy baby, she just requires alot of attention. If I sit her down she will protest. I am a stay at home mom as well and my husband works pretty much from sun up to sun down... So it is all on me, when he gets home he does help some but I cant expect a big break being that he worked all day and needs his unwind time as well. I feel like such a terrible mom, it really brings me down when I feel resentment and anger towards her. OF COURSE I would never ever ever do anything to hurt her, I just get a pounding headache from stress and go cry it out or sit her down and walk off. But I feel terrible for sitting her down and walking off because that only makes her cries louder and more helpless. Its enough to make you feel insane sometimes..posted 11/23/2013 by jjporter817
Being a stay at home mom can be very demanding and at times frustrating. But I don't think feeling such anger towards and innocent little baby is normal or healthy and I do think you may have PPD. Maybe see a new psychiatrist?posted 02/18/2012 by a BabyCenter Member
Well, I dont know what is wrong with you, but I find myself feeling the same way with my 2 month old. I'm home alone during the day with no one to give me a break and I find that I reaching a breaking point. Like you, I put her in her crib and let her cry but it only gets more desperate. I would never ever hurt her, but I have yelled at her once to please stop crying. I'm not sure why we are feeling this way but it certainly makes me feel like a bad mom. It does comfort me though, that I'm not the only one feeling this way.posted 02/18/2012 by LilyannasMomma
Answer this question


text:
Wholesale prices post record decline
Wholesale prices in October experienced the biggest one-month drop on records that go back more than 60 years, illustrating the impact that falling energy prices and fears of a prolonged recession can have on inflation.
Wholesale prices dropped by 2.8 percent last month, reflecting the fact that energy prices decreased by the largest amount in 22 years.
Many economists believe that the economy has fallen into a recession that could be the worst downturn in more than two decades. But they believe that retreating inflation pressures will give the Fed room to cut interest rates further to combat the economic weakness.
Subscribe to the Ventura County Star
Need Help? Call us at 1-877-710-6182.
Monday-Friday: 6am-3pm / Saturday: 6:30am-10:30am / Sunday: 7am-11am