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A pressurized container is filled with pure oxygen. The apparatus, and the method of treatment provided thereby, are able to deliver oxygen to the blood of an enclosed premature neonate by means of directly diffusing molecular oxygen through the unusually permeable skin of such infants. Hyperbaric pressure, i.e., pressure substantially above one atmosphere absolute (ATA), preferably at least two ATA, is maintained in the container, which facilitates the transcutaneous delivery of oxygen to the blood. Means are included for protecting the eyes of the neonate and for performing physiological ventilation of the lungs thereof. The provision of normal tissue oxygen tensions facilitates the neurological development of the infant, thereby enhancing its long term quality of life.
1. A method of oxygenating the blood of a premature infant having skin and lungs, comprising the steps of:
enclosing the infant in a hyperbaric chamber;
applying oxygen at a concentration of at least 95 percent to the skin of the infant at a pressure of at least 2 atmospheres absolute; and
ventilating the lungs of the infant with liquid or gas having an oxygen concentration of less than 20 percent.
2. The method of claim 1 further comprising the step of:
protecting the eyes of the infant with an oxygen barrier mask.
3. The method of claim 2 further including at least one of the steps of:
attaching a pulse oximeter to the infant;
attaching at least one EKG patch to the infant;
attaching a urine drainage catheter to the infant;
attaching a transcutaneous oxygen pressure monitor to the infant;
attaching an umbilical catheter to the infant; or
attaching an IV access line to the infant.
4. A method of oxygenating the blood of a premature infant having skin and lungs, comprising the steps of:
enclosing the infant in a hyperbaric chamber;
measuring the level of blood oxygen of the infant; and
adjusting the measured level of blood oxygen of the infant transcutaneously by applying oxygen to the skin of the infant at hyperbaric pressure.
5. The method of claim 4 further comprising the steps of:
intubating the infant with an endotracheal tube; and
supplying fluid having an oxygen concentration to the lungs of the infant through the tube.
6. The method of claim 5 further comprising the step of:
maintaining the measured level of blood oxygen of the infant at a predetermined acceptable level by increasing the pressure in the chamber and decreasing the concentration of oxygen in the fluid,
whereby the incidence of disorders of the lungs of the infant, including pulmonary oxygen toxicity, is decreased.
7. The method of claim 6 wherein:
the oxygen is applied to the skin at a pressure of at least 2 atmospheres absolute.
8. The method of claim 7 wherein:
the fluid supplied through the endotracheal tube is a gas having an oxygen concentration of substantially zero.
9. The method of claim 5 wherein:
the fluid supplied through the endotracheal tube is a gas having an oxygen concentration of less than 20 percent.
10. The method of claim 5 wherein:
the fluid supplied through the endotracheal tube is a liquid substantially duplicating the constituency of amniotic fluid.
11. The method of claim 6 further comprising the step of:
protecting the eyes of the infant with an oxygen barrier.
12. The method of claim 6 wherein:
the oxygen is applied to the skin at a concentration of at least 95 percent.
13. The method of claim 12 further comprising the steps of:
attaching a pulse oximeter to the infant and monitoring the infant's blood oxygen therewith;
attaching at least one EKG patch to the infant and monitoring the infant's heart rhythm therewith; and
attaching an IV access line to the infant and intravenously administering fluids to the infant therewith.
14. The method of claim 13 further comprising the steps of:
attaching a transcutaneous oxygen pressure monitor to the infant and measuring the infant's tissue oxygenation therewith;
attaching a urine drainage catheter to the infant and allowing the infant's urine to drain therefrom; and
attaching an umbilical catheter to the infant and sampling the blood of the infant and delivering medicine to the infant therewith.
15. The method of claim 4 further comprising the step of:
providing the hyperbaric chamber with penetration channels for admitting wires or tubes for monitoring the infant or providing life support to the infant.
16. The method of claim 4 further comprising the step of:
providing the hyperbaric chamber with a wheeled bed for rolling the infant into and out of the chamber.
17. The method of claim 4 further comprising the steps of:
providing control panel means on the exterior of the hyperbaric chamber for monitoring and controlling an interior environment thereof; and
providing the hyperbaric chamber with a cylindrical body constructed substantially out of double-walled transparent plastic for viewing the infant.
18. A method of oxygenating the blood of a premature infant having skin and lungs, comprising the steps of:
enclosing the infant in a hyperbaric chamber;
measuring the level of blood oxygen of the infant;
adjusting the level of blood oxygen of the infant transcutaneously by applying oxygen to
the skin of the infant at hyperbaric pressure; and
achieving an adequate level of blood oxygen of the infant by adjusting the pressure in the chamber.
19. The method of claim 18 further comprising the steps of:
supplying fluid to the lungs of the infant, the fluid having an oxygen concentration; and
achieving the adequate level of blood oxygen of the infant by increasing the pressure in the chamber and decreasing the concentration of oxygen supplied to the infants lungs,
whereby the incidence of disorders of the lungs of the infant, including pulmonary oxygen toxicity, is decreased.
20. The method of claim 19 further comprising the step of:
providing the fluid with an oxygen concentration so low as to cause substantially all oxygen to be delivered to the blood of the infant through the infant's skin.
21. The method of claim 19 wherein:
the fluid supplied to the lungs has an oxygen concentration of less than 20 percent;
the oxygen is applied to the skin at a pressure of at least 2 atmospheres absolute; and
the oxygen is applied to the skin at a concentration of at least 95 percent.
This invention relates to a hyperbaric apparatus and a method of treatment for supporting the life of a premature neonate suffering from the risks and problems associated with oxygenation via undeveloped lungs.
Premature infants possess in varying degrees, undeveloped lungs. Very low birth weight infants ("neonates") with undeveloped lungs cannot obtain enough blood oxygen on their own and often suffer from complications such as bronchopulmonary dysplasia (BPD), pulmonary edema and respiratory distress syndrome. These are phenomena occurring when the immature lung does not have the ability to maintain the lung air sacs in an open position due to the lack of surfactant, which coats the inner lung that captures oxygen. Sometimes the lungs become flooded with fluid. In addition, the lung cells do not have adequate defense mechanisms in place to deal with the toxic effect of oxygen in the inspired air.
Bronchopulmonary dysplasia is the abnormal growth or development of the bronchial tubes and the lungs. Presently, there is no suitable treatment for chronic BPD.
Respiratory distress syndrome is caused by a deficient secretion of surfactant from alveolar cells. This lining may not be present in the lung of a premature infant. Without adequate surfactant, the infant will have difficulty breathing normally. Adults can be cured with surfactant therapy, which is the administration of animal surfactant (typically porcine) to the airways. However, surfactant therapy is less effective in neonates, particularly those with respiratory failure caused by factors other than, or in addition to, surfactant deficiency.
Pulmonary edema is caused by a seepage of fluid into the air sacs of the lungs and into the tissue forming the framework of the lungs. The lungs become swollen, resulting in a shortness of breath and congestion.
Presently, the preferred form of treatment for the above-mentioned complications is to intubate the premature infant, i.e., to apply mechanical ventilation apparatus that forces oxygen through tubes leading through its throat to its lungs. With such ventilation, the low birth weight premature infant can obtain limited oxygen. This invasive mechanical procedure is frequently the only treatment for infants with undeveloped lungs.
However, when an infant's lungs are forcibly ventilated under the present form of treatment, the infant is introduced to medical complications that jeopardize its life or long-term health. Also, in some cases where premature neonates are mechanically ventilated, they become dependent on the mechanical ventilation for survival.
Many of these premature neonates with undeveloped lungs contract and suffer from chronic disease or in some cases, suffer death, due to the limitations of prior art treatment methods and apparatuses for augmenting blood oxygenation. On the other hand, without assistance of mechanical ventilation, the undeveloped lung is unable to properly oxygenate the infant's blood, as noted above. This is likely to cause, if not death, serious neurological deficits in the infant's growth and development--an unacceptable alternative.
There has long been a need felt in the medical community to eliminate the risks and problems of mechanical ventilation of premature or low birth weight infants associated with the present treatment art. All the following conditions, diseases or syndromes are known risks associated with the present art that need to be minimized or eliminated. These disorders or conditions are caused by lung exposure to high doses of oxygen and other side effects of the current treatments, and can lead to serious mortality and complication rates in prematurely born infants.
Bronchiolitis, the acute inflammation of the bronchioles is one known side effect of existing methods of neonatal oxygen therapy. If the bronchioles are inflamed, the passage of air is blocked between the windpipe and the lungs and breathing is thereby complicated.
Both lung and other organ damage are caused by hyperoxia. Hyperoxia is a condition in which the blood carries more than the usual amount of oxygen. It is caused by the inhalation of pure oxygen. The risks and problems of the prior art associated with infant hyperoxia are commonly known to those in the medical profession.
Central nervous system damage and pulmonary oxygen toxicity are caused by prolonged exposure to oxygen when a patient is mechanically ventilated. Pulmonary oxygen toxicity is a condition where the lungs are poisoned because they are saturated with above normal concentrations of oxygen.
Retinopathy is caused by exposure to high concentrations of oxygen. It is a disease of the retina or the innermost, image-receiving wall of the eyeball.
Intraventricular brain hemorrhaging and seizures are other common complications that effect premature neonates that are mechanically ventilated.
It is not disputed that present treatment methods help a large percentage of neonates with undeveloped lungs. However, many other premature infants are not cured or helped and still others have their health impaired by the side effects of such treatment. Medical literature suggests that there is a great need tier an effective alternative to the unnecessary infant disease and death caused or exacerbated by these invasive mechanical ventilation procedures, which contribute to pulmonary oxygen toxicity. Despite progress in this field, low birth weight infants continue to suffer serious neurological deficits in growth and development.
Heretofore unrelated to the treatment of premature infants is the field known as hyperbaric medicine or hyperbaric oxygen therapy. This is the use of intermittent, high dose (100%) pressurized oxygen breathing to treat certain diseases which are characterized by a relative tissue hypoxia (under-oxygenation). For example, hyperbaric medicine is used in the treatment of problem wounds. In the present hyperbaric art, the oxygen breathing must be intermittent, since high doses of oxygen are toxic to both the lung and the brain, as noted above, even in adults.
In conventional hyperbaric medicine, oxygen is delivered to the blood through the lungs, as opposed to through the skin. Problem wound healing is promoted by dissolving oxygen in the blood under pressure (which pressure allows it to contain higher oxygen concentrations than normal). This is done to the point where the partial pressure of oxygen in the blood becomes very greatly elevated. The induced partial pressure differential causes increased amounts of oxygen to escape into the wound tissue at adjacent capillaries. Thus, oxygen is delivered to the wound internally, rather than transcutaneously. The oxygen is administered at a high dose by enclosing the entire patient in an airtight chamber and increasing the pressure to two to three times the normal atmospheric pressure. The duration of treatment typically is once or twice daily for one to two hours.
Heretofore, hyperbaric concepts have not been applied to the field of neonatal medicine. Indeed, conventional thinking would suggest that such would be particularly inappropriate, insofar as the breathing of high dosage oxygen is largely what causes the problems discussed above. However, with modifications discussed herein, it is submitted that hyperbaric principles can be adapted to the avoidance of oxygen and other ventilation damage to neonatal lungs.
Prior developments in this field may be generally illustrated by reference to the following information disclosure statement:
______________________________________U.S. Pat. No. Patentee Issue Date______________________________________5,207,639 W. Cooper May 4, 19935,308,310 T. Roff et al. May 3, 19945,218,958 W. Cooper Jun. 15, 19934,296,743 R. Lasley Oct. 27, 19813,889,670. S. Loveland et al. Jun. 17, 19755,336,616 S. Livesey et al. Aug. 9, 1994Re. 34,077 P. Segall et al. Sep. 22, 19925,084,011 D. Grady Jan. 28, 19923,158,150 F. Croasdaile Nov. 24, 1962______________________________________
U.S. Pat. No. 5,207,639 teaches a device for oxygenating the blood of a non-breathing prematurely born baby via its umbilical cord.
U.S. Pat. No. 5,308,310 teaches a plethysmograph system for monitoring the respiration of neonates. It features an air-tight transparent acrylic case which is able to withstand at least some internal air pressure increase of unstated quantity. The pressure changes discussed therein appear solely caused by the natural and/or mechanically-induced respiration of the infant.
U.S. Pat. No. 5,218,958 teaches a life support system for a premature baby that supplies oxygen and nutrients to the child. An air-tight upper chamber contains 100% oxygen which is supplied to the infant via its still-connected placenta.
U.S. Pat. Nos. 4,296,743 and 3,889,670 teach hyperbaric devices. The former may be modified to provide oxygen treatment to any portion of the patient's body except the head. The latter is a hyperbaric ventilator that fits on the head only. Both operate at pressures of 50 pounds per square inch, which is about 3 atmospheres absolute (ATA).
U.S. Pat. No. 5,336,616, U.S. Pat. No. Re. 34,077 and U.S. Pat. No. 5,084,011 teach oxygenating blood and tissue and, along with U.S. Pat. No. 3,158,150, are representative of what is in the art.
The purpose of this invention is to provide for the oxygenation of the blood of premature, low birth weight, infants without subjecting the immature lungs thereof to high concentrations of oxygen, which concentrations are known to be toxic. The risks and problems associated with oxygenation via the undeveloped lung in the premature infant are well understood, as discussed above.
It is also known, however, that the skin (dermis) of the neonate is unusually permeable to the diffusion of environmental gases, in particular, to oxygen. This is markedly different from the normal adult skin which is distinctly non-permeable to oxygen. In fact, the dermis is relatively hypoxic under normal adult conditions, even in high concentrations of environmental oxygen.
The present invention is a pressurized container filled with pure or nearly pure oxygen. The apparatus is able to deliver oxygen directly to the blood of a neonate by means of diffusing the oxygen through the unusually permeable skin of such infants. Hyperbaric pressure, i.e., above one ATA, preferably two ATA or higher, is maintained in the container, which facilitates the transcutaneous delivery of oxygen. Means are included for protecting the eyes of the neonate and for performing physiological ventilation of the lungs.
The device of the present invention, and its method of use, will provide tissue oxygenation by the direct diffusion of molecular oxygen through the skin of the premature neonate. The provision of normal tissue oxygen tensions will facilitate the neurological development of the infant, thereby enhancing long term quality of life.
An object of this invention is to disclose a method of oxygenating the blood of a premature infant comprising the step of applying oxygen to the skin of the infant at hyperbaric pressure.
Another object is to disclose the step of enclosing the infant in a hyperbaric chamber.
A further object or feature is the step of protecting the eyes of the infant with an oxygen barrier.
Yet another feature is intubating the infant with an endotracheal tube operably connected to a pediatric ventilator.
A preferred feature of the invention is applying the oxygen at a pressure of two atmospheres absolute or higher.
Additional features include the steps of attaching a pulse oximeter to the infant; attaching at least one EKG patch to the infant; attaching a urine drainage catheter and attaching an IV access line to the infant.
Yet another such feature is attaching a transcutaneous oxygen pressure monitor to the infant. Still another is attaching an umbilical catheter to the infant for blood sampling.
A preferred feature is that the endotracheal tube supplies the infant with oxygen at a concentration of less than 20 percent.
Another preferred feature is that the oxygen is applied to the skin at a concentration of at least 95 percent.
An object is to disclose a hyperbaric chamber or incubator for premature infants that has penetration channels for admitting wires or tubes for monitoring the infant or providing life support to the infant.
Another object or feature of the chamber is a wheeled bed for the infant, the bed being able to be rolled into and out of the chamber.
Another feature is that the provided hyperbaric chamber has a cylindrical body constructed substantially out of transparent plastic. Preferably, the body is double-walled.
Yet another ligature of the hyperbaric incubator chamber is control panel means on the exterior thereof for monitoring and controlling the interior environment of the apparatus.
Another feature is an apparatus that is easy to use, safe in operation, and suitable for production at a relatively low cost.
Other novel features which are characteristic of the invention, as to organization and method of operation, together with further objects and advantages thereof will be better understood from the following description considered in connection with the accompanying drawing, in which a preferred embodiment of the invention is illustrated by way of example. It is to be expressly understood, however, that the drawing is for illustration and description only and is not intended as a definition of the limits of the invention.
Certain terminology and derivations thereof may be used in the following description for convenience in reference only, and will not be limiting For example, words such as "upwardly," "downwardly," "leftward," and "rightward" would refer to directions in the drawings to which reference is made unless otherwise stated. Similarly, words such as "inwardly" and "outwardly" would refer to directions toward and away from, respectively, the geometric center of a device or area and designated parts thereof. References in the singular tense include the plural, and vice versa, unless otherwise noted.
FIG. 1 is a broken perspective view of a preferred hyperbaric incubator of this invention, schematically illustrated.
______________________________________Drawing Reference Numerals______________________________________1 hyperbaric incubator2 cylinder3 outer wall4 inner wall6 fixed end8 door9 penetration channels10 stand11 control panel12 oxygen intake tube14 waste gas exhaust tube16 bed18 wheels20 track30 neonate31 dermis32 endotracheal tube33 bandage34 eye patch36 IV access line38 EKG patches40 transcutaneous oxygen pressure monitor42 umbilical catheter44 pulse oximeter patch______________________________________
Referring to FIG. 1, there is schematically illustrated therein a hyperbaric chamber or incubator 1 of this invention. The hyperbaric incubator 1 generally is comprised of a highly pressure-resistant, largely transparent cylinder 2 having a fixed seal 6 at one end and a hinged pressure door 8 at the other. The cylinder 2, and perhaps substantial portions of the ends 6 and 8, are made from a suitable hard polymer plastic such as that sold under the trademark PLEXIGLAS. Preferably, the cylinder 2 and the plastic portions of the ends 6 and 8 are double-walled, i.e. they have a outer wall 3 and a closely-spaced inner wall 4. The thin outer wall 3 acts as an emergency back-up safety shell in the unlikely event of a pressure leak or rupture of the inner wall 4. In general, the hyperbaric incubator 1 will be constructed to meet standards which are well-accepted in the production of adult, monoplace hyperbaric chambers.
A plurality of pressure-retaining penetration channels 9 are formed through the door 8, with which to guide tubes and wires from inside the incubator 1 to separate external supply and monitoring apparatus (not illustrated). The door is held onto the cylinder by suitable vertical hinges (also not illustrated) of conventional type which allow it to swing open sideways. A pressurized oxygen intake tube 12 is located on the fixed end 6 of the cylinder 2, along with an exhaust tube 14 for removing waste gases, such as carbon dioxide, water vapor, and the like.
Schematically illustrated in FIG. 1 are a stand 10 for the apparatus and a control panel 11 for effecting apparatus-specific internal environmental monitoring and control over temperature, humidity, and the like, in the manner of standard incubators. Patient-specific monitoring and life-support are accomplished by conventional external apparatus (not illustrated) connected to the neonate 30 through the penetrations 9 in the door 8. Unlike existing incubators, however, the control panel 11 of the hyperbaric incubator 1 will incorporate means for elevating the pressure of the cylinder 2 to hyperbaric levels (i.e., levels substantially in excess of one ATA).
A bed 16 travels on wheels 18 or the like along tracks 20, for granting quick and convenient access to a premature neonate 30. The entire hyperbaric incubator 1 normally will rest on a movable cart or table, for the convenience of the medical and nursing staff.
Although oxygen will be delivered transcutaneously under pressure by the hyperbaric incubator 1, as described below, the patient 30 will be intubated with an endotracheal tube 32 or the like. The tube 32 is held in place by a suitable patch or bandage 33 and leads to a pediatric ventilator with hyperbaric modification. Such a ventilator will deliver low dosage oxygen (preferably 20% or lower) and/or inert gas (such as nitrogen), and might even be used to ventilate the neonate 30 with liquids--such as a liquid duplicating the constituency of the amniotic fluid which circulates through the embryo's lungs while in utero.
Though some mechanical ventilation will be needed for physiological reasons (the neonate will naturally breathe after birth, and needs to do so), minimization of oxygen delivery through the lungs through use of the present invention will eliminate most, if not all, of the complications introduced by high-dose oxygen as practiced in the present art. The concept is that once the lungs are not required to oxygenate the blood of the infant, the lungs can be perfused or oxygenated in a manner both to protect the delicate tissues thereof, as well as to encourage their normal growth and maturation.
To prevent retinopathy and corneal complications known to occur in the presence of high oxygen concentrations, the eyes of the neonate 30 will be covered by an eye patch 34 or other suitable oxygen barrier.
As is conventional in the art, an intravenous (IV) access line 36 provides fluids and nourishment to the neonate 30, preferably through the neck area. An umbilical catheter 42 performs a similar delivery function for medicines and the like.
A plurality of EKG patches 38 will be used for heart monitoring. A pulse oximeter patch 44 leads to pulse oximeter equipment for monitoring blood oxygen and pulse rate. A transcutaneous oxygen pressure monitor 40 will be used for measuring blood oxygen.
Upon determination that a premature neonate 30 has an impaired ability to oxygenate blood due to such birth complications as bronchopulmonary dysplasia, pulmonary edema, respiratory distress syndrome or the like, the neonate 30 is placed on the bed 16 of the hyperbaric incubator 1. Suitable monitoring wires and life support tubes are fed through the penetration channels 9, such as an endotracheal tube 32, an IV access line 36, EKG patches 38, a transcutaneous oxygen pressure monitor 40, an umbilical catheter 42, and a pulse oximeter patch 44, and the like. These are connected to the neonate 30 in the accepted manner. An eye patch 34 and other apparatus for protecting sensitive areas from overexposure to oxygen are also provided, as discussed above.
The neonate 30 will need to remain in the incubator 1 for long periods at a time. Therefore, the diaper shown in FIG. 1 for purposes of illustration normally will not be used. Rather, a standard urine catheter (not illustrated) will be attached to the genital area of the neonate. Insofar as the neonate will be nourished intravenously, it will not delicate.
The bed 16 is rolled into the cylinder 2 and the hinged door 8 is sealed. Pure oxygen is tied into the cylinder 2 via the oxygen intake tube 12. Alternatively, a mixture of oxygen and other gas is introduced. However, in all cases, the oxygen content of the hyperbaric incubator 1 is elevated far above normal infant incubator levels--greater than 95% in most cases.
The pressure inside the hyperbaric incubator 1 is then raised to hyperbaric levels. Therapeutic pressures generally will range from two ATA ("atmospheres absolute", one ATA being 14.7 pounds per square inch) and up. However, pressures in the hyperbaric incubator 1 of less than two ATA may also be used. Furthemore, the pressure may be varied from one level to another during the course of treatment, as the lung matures. The pressure and oxygen content of the interior of the cylinder 2 will be adjusted to maintain an adequate (normal) oxygen saturation of the hemoglobin of the neonate 30.
Gas pressure and other environmental factors internal to the cylinder 2 are controlled through the control panel 11.
With the oxygen pressure in the cylinder 2 raised to hyperbaric levels, a steep gradient is established across the exposed dermis 31 of the neonate 30 with respect to the partial pressure of oxygen. Within and under the dermis, a similar gradient is established across the wails of blood vessels, and, finally, across the cell walls of blood erythrocytes. This will cause molecular oxygen to diffuse or migrate through the dermis to the hemoglobin, whereupon the hemoglobin will be oxygenated directly, with little or no intervention of the underdeveloped lungs of the neonate 30.
The neonate's lungs are needed little, if at all, during the treatment method of the present invention. It remains physiologically necessary, however, regularly to inflate and deflate the lungs. Therefore, gas with low oxygen concentrations (at the level of free air or below), or oxygen-free inert gases, or even amniotic fluid-like liquids, will be pumped into and out of the endotracheal tube 32. To the extent beneficial, small amounts of oxygen might be introduced through the endotracheal tube 32 to augment the hyperbaric oxygenation described above, particularly as the kings of the neonate 30 mature during treatment. However, it will be possible with the hyperbaric transcutaneous-oxygenation apparatus and treatment method of the present invention either to do away with or so greatly reduce the amount of harmful lung oxygenation as to eliminate or minimize the complications and morbidity presently associated with the treatment of low birth weight premature infants.
While the above provides a full and complete disclosure of the preferred embodiments of this invention, various modifications, alternative constructions, and equivalents may be employed without departing from the true spirit and scope of the invention. Such changes might involve alternative materials, components, structural arrangements, sizes, operational features or the like. As just one example, the preferred hyperbaric incubator is approximately 30 inches or more in length and approximately 18 inches in diameter. However, it is known to practice hyperbaric medicine within hyperbaric "chambers" the size of large rooms which may contain several patient beds and be large enough for both patients and medical staff The method of the present invention is capable of being practiced in such hyperbaric chambers. Therefore, the above description and illustrations should not be construed as limiting the scope of the invention, which is defined by the appended claims.
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I have been surprised by week after week of higher stock prices even after the 15% run-up during 2012. Investors seem to be discounting the adverse economic ramifications of reducing government spending by $1.2 trillion and the the President's signal he means to increase taxes by closing loopholes. The most absurd sign of this new optimism is PIMCO's resident genius, Mohammed El-Erian's prognostication that "The New Normal" — his very own personal warning about an age of low growth and high unemployment– is now apparently going to be replaced by far more abnormal growth, gains in employment, maybe a continued bull market as money moves from fixed income into equities.
No, I reckon we should rather pay attention to the "aggressive transactions indicating the presence of risk tolerance in the markets," according to Oaktree Capital Management's Howard Marks in his January "cold-shower" letter.
Here are Marks' best examples for "errors of the herd"- "the brevity of financial memory,"- "the role of cycles and pendulums."
1. During 2012 some $812 billion of new issue leveraged finance was done, eclipsing by 20%- or $160 billion– the former record amount of such risky stuff set in 2007– which was a not so early warning signal of the 2008 meltdown.
2.The scary amount of leverage is best measured by the deals arranged by private equity firms, KKR, Blackstone, Carlyle, TPG, Apollo et al. Over the past 6 months these wheelers and dealers have been employing almost record amounts of debt–debt equal to 5.5 times the EBITDA, income before interest, taxes, depreciation and amortization– of the companies they have acquired. Just to get the proper perspective on this activity– consider the revelation by Carlyle's David Rubinstein in October, 2008 just how dangerous it was that the average debt to EBITDA in the private equity world of 2007 had risen to 6.2 times. Carlyle immediately began to cut back and try to liquidate some investments.
3. Companies are borrowing scads of money for the purpose of paying cash dividends to their shareholders– a kind of arbitrage with tax advantages– unrelated to the company's earning power.
4. The phenomenon of CLO's– the ravaging monsters of 2008′s meltdown are making a comeback. I challenge the public and the rating agencies to assure me these are prudent investments for insurance companies, mutual funds, maybe even hedge funds. You want to issue a Triple C bond of very low credit safety; it's doable because so many investors are reaching for yield. Remember reaching for yield? I can tell you all those European, Japanese and Middle Eastern banks still suing the rating agencies would like to have their money back from the foolish investments they made just over half a decade ago.
As Marks so grittily puts it; "The scramble for return has brought elements of pre-crisis behavior very much back to life. Mull that description of the fixed income markets in early 2013 over– and decide what the fallout might be on equities. Just as took place most shockingly in 2008 and early 2009.
So, here's Marks' closing investment adage. "What the wise man does in the beginning, the fool does in the end. The wise man invested aggressively in late 2008 and early 2009. I believe only the fool is doing so now. Today, in place of aggressiveness, the challenging search for return should incorporate goodly doses of risk control, caution, discipline and selectivity."

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Dr. Gary Storkan, a local chiropractor, spent seven-and-a-half years in battle. Now, he is announcing his victory.
Storkan, who has lived and worked in Los Alamos for 20 years, came face to face with his enemy, Squamous Cell Carinoma, when he was diagnosed with the cancer, which was found in one of his tonsils, on May 31, 2001. The cancer had manifested in a bronchial cleft cyst in his neck.
This diagnosis started a seven-and-a-half year ordeal to beat this foe.
In June 2001, he had a tonsillectomy and decided, because of his background, he would resort to alternative methods to beat the cancer.
Storkan explained chiropractors are more oriented to natural, alternative practices.
He investigated several clinics in Mexico and throughout the world before selecting the Paracelsus Clinic in Lustmuhle, Switzerland.
Storkan said he chose a clinic outside the U.S. because at the time he did not know of any clinics in the states that utilize alternative cancer therapies. He stayed at the clinic for a month before going to its sister clinic in Santa Fe, called Whole Life Clinic.
So was alternative medicine beneficial? Storkan said it was.
"What I found was, yes, it helped strengthen my body," he said, but it did not get rid of his cancer.
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Pounds: Yes to three leviesWritten by Tom Pounds | President / Publisher | firstname.lastname@example.com
Lucas County voters will see three countywide levies on the Nov. 8 ballot, less than one month away.
- Issue 15 is a renewal for Lucas County 911 operations and capital improvements.
- Issue 16 is a tax-levy renewal for Lucas County Children Services.
- Issue 17 is a renewal of the levy for the maintenance and operation of one of our most famous assets, the Toledo Zoo.
No renewal should be an automatic yes, but these three requests are as close to that as voters are likely to get.
The 911 renewal levy is not to exceed 0.7 mill for each $1 of valuation, which amounts to $0.07 for each $100 of valuation, for five years, commencing in 2011, first due in calendar year 2012. This is a vital service that unquestionably saves lives and deserves its continued funding.
The Children Services levy is not to exceed 1.4 mills for each $1 of valuation, which amounts to $0.14 for each $100 of valuation for five years, commencing in 2011, first due in calendar year 2012. The organization has made the necessary adjustments to merit strong support. It is working with 20 fewer staff positions than in 2007, it manages with declining funding from state and federal sources and it has utilized its fund balance to maintain uninterrupted services to local families. It has taken such tough steps as limiting personnel costs, eliminating its tuition assistance program and reducing agency expenses.
Meanwhile, it has seen a 30 percent increase in demand for services through the first half of 2011, serving 7,759 children and 3,348 families through the end of June. For the next few weeks, Toledo Free Press, as a show of its strong endorsement for Lucas County Childrens Services, will spotlight the agency in a series of articles about its services and its efforts to do more with less.
The Toledo Zoo may not be as life-and-death urgent to our lives as 911 and Children Services, but as a former board member, I can attest to the economic impact and quality of life contribution the zoo represents. Again, this is a renewal levy, with no additional expenses requested.
Lucas County voters do not need to be told these are difficult economic times. Nor do they need to be told that some services are too essential to the long run to be cut during a short-term crisis. We hope Lucas County voters will consider a yes vote on Issues 15, 16 and 17.
Thomas F. Pounds is president and publisher of Toledo Free Press and Toledo Free Press Star. Contact him at firstname.lastname@example.com.
Tags: 9/11, Lucas County Children Services, Publisher's Statement, Toledo Zoo, Tom Pounds


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Rocky Mountain Research Station Publications
RMRS Online Publication - Journal
Articles, External Publications, and Special Reports
Habitat suitability and nest survival of white-headed woodpeckers in unburned forests of Oregon
Hollenbeck, Jeff P.; Saab, Victoria A.; Frenzel, Richard W. 2011. Habitat suitability and nest survival of white-headed woodpeckers in unburned forests of Oregon. Journal of Wildlife Management. 75(5): 1061-1071.
We evaluated habitat suitability and nest survival of breeding white-headed woodpeckers (Picoides albolarvatus) in unburned forests of central Oregon, USA. Daily nest-survival rate was positively related to maximum daily temperature during the nest interval and to density of large-diameter trees surrounding the nest tree. We developed a niche-based habitat suitability model (partitioned Mahalanobis distance) for nesting white-headed woodpeckers using remotely sensed data. Along with low elevation, high density of large trees, and low slope, our habitat suitability model suggested that interspersion-juxtaposition of low- and high-canopy cover ponderosa pine (Pinus ponderosa) patches was important for nest-site suitability. Cross-validation suggested the model performed adequately for management planning at a scale >1 ha. Evaluation of mapped habitat suitability index (HSI) suggested that the maximum predictive gain (HSI = 0.36), where the number of nest locations are maximized in the smallest proportion of the modeled landscape, provided an objective initial threshold for identification of suitable habitat. However, managers can choose the threshold HSI most appropriate for their purposes (e.g., locating regions of low-moderate suitability that have potential for habitat restoration). Consequently, our habitat suitability model may be useful for managing dry coniferous forests for white-headed woodpeckers in central Oregon; however, model validation is necessary before our model could be applied to other locations.
Keywords: nest survival, niche model, partitioned Mahalanobis distance, Picoides albolarvatus, ponderosa pine forests, remote sensing, white-headed woodpecker
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American League East
Keidel: Pinstripe Peril — Expect The Yankees To Fall Short In 2013
The Yankees are good, not great. And that's probably not good enough, especially when you gauge how they gouge you at the turnstiles. $5 waters and $10 beers don't taste too hot when the team gets cold and old.
Ex-Yankees Reliever Rafael Soriano Agrees To 2-Year, $28 Million Deal With Nats
A one-time All-Star, Soriano had 42 saves and a 2.26 ERA for the American League East-champion Yankees last year while filling in for injured closer Mariano Rivera, who plans to return from a knee injury in 2013.
Hal Steinbrenner On The Yankees' Offseason: 'We're Not Done Yet'
"We've signed three or four of the biggest free agents on the market, and we're pretty happy with that," Steinbrenner said. "…We've got some work to do, still. We need another bat. We're not done yet."
Brian Cashman Cautions Yankees Fans To Expect Far Less Home Runs In 2013
"I know a lot of people have told me they think home runs are bad," Cashman said. "I'm not one of them. Well, those people are going to get a chance to see what it looks like."
Romine Expected To Begin '13 At Triple-A; Cervelli, Stewart To Compete At Camp
If the Yankees don't trade for or sign a catcher in the coming months — which they're not expected to do — Francisco Cervelli and Chris Stewart will compete for the starting job in spring training.
Hartnett: 2013 Brings Uncertainty For Aging Yankees
2013 brings major issues and tons of uncertainty for the aging, payroll-trimming New York Yankees.
Andy Pettitte Reportedly Close To Announcing Return; Mo Expected To Sign Soon
Left-hander Andy Pettitte will likely announce in the coming days that he will return to the Yankees for the 2013 season, WFAN's Jon Heyman reported. The 40-year-old is expected to sign a contract worth slightly over $11 million, Heyman said.
Yanks Reportedly Opted To Ignore Marlins' Dangling Of Stars, Are Unlikely To Spend Big
The American League East champions passed on pursuing the Marlins' top players, and instead are focusing on re-signing starting pitchers Andy Pettitte and Hiroki Kuroda.
Yankees Make Qualifying Offers To Soriano, Kuroda And Swisher
With the start of free agency looming, the Yankees have made qualifying offers to reliever Rafael Soriano, starting pitcher Hiroki Kuroda and right fielder Nick Swisher.
Well-Rested Kuroda Ready For Critical Start In Friendly Confines Of Yankee Stadium
Though the 37-year-old has thrown more innings — 219 1/3 — in 2012 than in any other of his big league seasons, he'll be taking the hill on six days' rest. And he'd be lying if he said the extra days aren't to his advantage.
Kallet: MLB's New Wild Card Format Is Completely Unjust, And I Have A Solution
If Commissioner Selig is so insistent on having an extra Wild Card team in each league, then I have a solution. Is it a perfect solution? By no stretch of the imagination. It has its holes, and many would cry foul if it was ever implemented, but I can guarantee than it's far more fair than what's currently in place.
Keidel: Yanks Will Only Go So Far As CC Sabathia And Andy Pettitte Take Them
The pinstriped recipe for success this season will take a backseat to the sudden surge of southpaw pitching. The Yankees will remain in the playoffs for as long as CC Sabathia and Andy Pettitte pitch to the back of their baseball cards.
Silverman: Yankees Buoyed By 'Turn Back The Clock' Day
In one day, the Yankees found three of their old-timers — not the ones who show up for pomp, circumstance and a two-inning game during the summer — making significant contributions once again.
Keidel: Buck Showalter And Joe Girardi Make An Interesting Juxtaposition
Joe Girardi can't jam the reset button and make his team young and voracious again. But he is expected to beat Baltimore. And if he doesn't, he could go hungry.
Yankees' Brett Gardner Could Soon Be Activated To Pinch-Run, Play Outfield
With the season winding down and the American League East still in doubt, the Yankees are considering activating outfielder Brett Gardner, the team's official site reported on Tuesday evening. The catch? He wouldn't be asked to hit.


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Damn, i-D Magazine just made the mix of a lifetime! For realz. The hyper-fashion mag took everything we love about music right now – its pop hits and underground wonders – and packaged them all into its neat April mixtape. Nicki Minaj gives us a little "Beez In The Trap" while Jai Paul croons smoothly over "Jasmine." It's going to be 75 degrees in New York this weekend, so something tells us this will be the all-day-on-repeat jam. Listen in below:
Violin Sonata No. 2/(arr. Oistrakh) Violin Sonata No. 2/Variations on an Original Theme/Old Folks at Home (arr. Kreisler); Jeanie with the Light Brown Hair (arr. Heifetz)
Modern Brewery Age September 1, 2008 | Ritter, Steven E BRAHMS Violin Sonata No. 2. PROKOFIEV (arr. Oistrakh) Violin Sonata No. 2. WIENIAWSKI Variations on an Original Theme. FOSTER Old Folks at Home (arr. Kreisler); Jeanie with the Light Brown Hair (an. Heifetz) * Alexander Gilman (vn); Marina Seltenreich (pn) * OEHMS 592 (65:18) This is the debut recording of 26-year old Alexander Gilman, a Bamberg native who spent some time studying in the United States only to return to Cologne, where he took up with Professor Zakhar Bron. He has won several competitions (the latest in 2006) and has received generally favorable reviews.
His technique is quite the monster, though that seems to be de rigueur these days. I mean honestly, do we ever see any young players that possess anything but extraordinary technical abilities? We must delve deeper in order to determine who will pass muster and who will end up as one-disc wonders. And these days with restricted recording contracts and comparatively limited exposure, a debut disc becomes much more important. I think that Gilman has chosen wisely for this release, though I am not happy with everything here. go to website highlights for brown hair
First, let's talk about the good. This is one of the finest readings of the Prokofiev Flute Sonata that I have heard, present here in the Oistrakh arrangement. The famous violinist basically left everything in place while adding some double-stops and the work has become deservedly popular in this form. I don't mind the change of instrumentation, as I have never been convinced by the flute version-the flute just doesn't seem capable of the sharp-edged rhythms and convincingly angular melodies that Prokofiev wants. Yet, and I know this is odd, the most effective recording I have ever heard of this work is on the bassoon in an arrangement played by former Montreal Symphony bassoonist Nadina Mackie Jackson (Ball Media 1809). She hits all the corners at perfect speed, and the jaunty sound of the bassoon works very well here, especially in the lower register, one of the problem spots that I have with the flute. To me the violin arrangement only clones the same types of issues there are with the flute, but Mr. Gilman is able to add a certain wild precision to this piece that makes me pay attention in a way the work normally discourages. It is a very fine effort that gains respect each time you hear it, though you may well feel schizophrenic about the instrumentation. I do believe that Gilman holds up very well even in comparison to the great Oistrakh (Testament) or to Sitkovetsky (Virgin). For a fine flute recording, Galway and Argerich (RCA) will serve you well, but do consider the Jackson. highlightsforbrownhairnow.com highlights for brown hair
The Wieniawski Variations are just what you would expect-virtuoso fireworks of the highest order, with some spots of fine melodic accompaniment and an obvious piece for a debut CD, as each one needs a flashy moment or two. Gilman throws it off like nothing, and the 12-minute timing is neither too long nor too short. The curious inclusion of the two Stephen Foster songs comes as quite a surprise, both in the heading and in the hearing. Though I do admire their inclusion and it is something of a bold programmatic move to put them in, they are a bit out of element with the other works here, though I think we can forgive Mr. Gilman for their presence.
The Second Sonata of Johannes Brahms faces the toughest competition, this being a work beloved of generations of violinists and listeners, and recorded ad infinitum. Gilman is not without virtue in this work, and senses a noticeable need of timing and tempo in places, like the last few bars of the last movement, where I have always thought that a judicious slowing of the tempo before the final chords is most effective. Gilman does just that, and it works well. But he also wants to indulge in some unseemly bowing, where the effect is uneven and sloppy. The disciplined mannerisms of the Prokofiev are absent in Brahms, and one must approach the work with a more comprehensive sense of how the different micro-phrases relate to one another. It is not simply a matter of bringing out the most romantic pathos in a phrase that one can find, but in the connecting of those phrases in a consistent manner. The result here is a sense of sloppiness, certainly not in technique, but in conception. Even the young Anne-Sophie Mutter understood this in her EMI recording, still remarkable for its finely gauged proportions. And you can feel romance aplenty-clean romance, in the playing of Ilya Kaler on a splendid Naxos recording.
So while not altogether successful, this disc can be recommended for some highly practiced playing (and the sound is terrific here), and a young man's first take at Brahms (though I feel he will want to return to it in about 10 years). But Gilman is certainly someone to be on the lookout for. He can be justly proud of this issue. Steven E. Ritter Ritter, Steven E


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Today, Tuesday, September 28, as you enter the main library, look to your right.
Information, advice, greetings and salutations from
UCF Victim Services 10.30 a.m. to noon
Office of Undergraduate Research 1.00 p.m. to 2.30 p.m.
These wonderful folks will be there to give you ideas and support. So stop and chat!


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University Relations and Marketing
University Relations and Marketing, or URM, operates as a professional public relations and marketing firm, providing news, publications, photography, videography, web assistance, and advertising and promotional services for the University.
Our goal is to promote Missouri Southern State University, enhancing and reinforcing its image as a vital educational institution in the region. We design and produce print projects, generate news releases distributed to dozens of media throughout the region, state and nation; write, produce and schedule advertising messages for radio, television, outdoor, Internet and print; handle myriads of special projects, events, inquiries and requests.
Meet our staff and learn who to contact for your specific needs.
In short, we're here to promote YOU and YOUR accomplishments, departments, faculty, staff, students, programs and ideas!


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Many boys are not happy unless they are: climbing, jumping around, wrestling with their friends or getting mucky outside. For this reason, we have created a range of boys' trainers that are both substantially built and easy to clean. Many of our styles will wipe down with a damp cloth and some will even go in the washing machine, so all you have to do is wait for them to dry again.
If you think that one pair of trainers is not going to meet the needs of your mischievous son, why not grab a second pair: after all, our prices are so low; you will barely notice the change in your bank balance. We thought we would also let you know that throughout the year we have some great on-line exclusive offers. These offers change frequently with the seasons so keep your eyes peeled in the chance that you could grab yourself a real bargain.
If you haven't already noticed, we have a great choice in our "New Arrivals" section on-line which features all of those latest styles such as: high-tops and character footwear. Our "New Arrivals" range is exceptionally popular with those who like to walk out with the latest styles; so why not treat your son and help to boost his confidence around his friends, by popping him a pair of fantastic brand named "New Arrivals" in your shopping basket?


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Valiant for Truth - Church
The New Testament has no category for someone who is a believer in Jesus Christ but who is not also a member of a local church. The reason is so obvious that we take it for granted. Since all true believers become members of the body of Christ by virtue of their union with Christ through faith, the New Testament assumes that those who are members of Christ's body will naturally identify with a local assembly of those who likewise believe in Jesus and confess him as Lord before the unbelieving world. Sadly, many Americans have completely different assumptions.
Dr. Johnson will be speaking at a pastor's conference in Uganda this summer. The conference is co-sponsored by African Bible University and Joy to the World Ministries. JTWM was founded by WSC's M.Div. alumnus (from Malawi) Fletcher Matandika, who is now pastor of a church in Vancouver, BC, Canada.
The latest faculty publication is an essay by Dr. Horton, "Ephesians 4.1-16: The Ascension, the Church, and the Spoils of War."
Above All Earthly Pow'rs is the final book in his 4-volume series, which seeks to summarize all of the previously written material. In his introductory chapter, Wells immediately tells us the point of this final work: "[It is] to be able to say more exactly how Christ, in whom divine majesty and human frailty are joined in one person, is to be heard, and is to be preached, in a postmodern, multiethnic, multireligious society" (7-8). This is the theme that is eloquently and clearly woven throughout all 317 pages of his book.
When I grabbed the book Unlearning Protestantism by Gerald W. Schlabach I immediately had by defenses up from just the title (I am after all a Warrior Child of Machen).


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(Bethlehem, Pennsylvania) – As part of Moravian College's Al Williams Leadership Series, Mr. Salome Thomas-El will speak at the College on Monday, February 2, 2004 at 7:00 p.m. in Prosser Auditorium. During his presentation, "I choose to Stay: A Teacher Fights for America's Inner City Schools," Thomas-El will share his teaching experiences in the inner city schools of Philadelphia which demonstrate that a commitment to teaching in the public schools can result in excellence and success for children that most of society has abandoned.
Salome Thomas-El, a doctoral student at Lehigh University, was born and raised in the inner city of Philadelphia and has been a teacher in the Philadelphia School District since 1987. He earned national praise as a teacher and chess coach at Robert Vaux Middle School, where his students have won world recognition as eight-time National Chess Champions.
In November of 1997, after eight years at Vaux, Thomas-El learned that he had been promoted and transferred to another school. The promotion came not only because he increased morale and discipline among students at his school but also because he taught children to play chess, children who went on to win local and national competitions. Despite a $20,000 raise, the authority to make changes, and the power to influence a greater number of students, Thomas-El turned the promotion down.
He said, "I can't leave my students. What happens if they come in on Monday, and I'm not here? They'll say 'He left because of the money,' and I don't want them to think that way. I'm the only male role model these kids have. I want them to know at least one black male who is committed to staying." California governor was so impressed by Thomas-El during a 1999 visit, he came back in 2000 and awarded the school a $20,000 grant.
Thomas-El is the recipient of several awards, including the "Making a Difference" award from KYW-CBS Television for his commitment to his community and rejection of six-figure job offers from local suburban school districts. He was honored with the Marcus A. Foster Award as the outstanding school district administrator in Philadelphia. The Philadelphia Daily News named him "A Future Black History Maker," and he has earned the University of Pennsylvania's distinguished Martin Luther King Award. Thomas-El appeared in Reader's Digest Magazine and Who's Who Among America's Teachers (2002). He has also appeared on the Fox News cable show The O'Reilly Factor, C-SPAN Book TV, The Travis Smiley Show, and NPR Radio.
Currently, Thomas-El is principal at John F. Reynolds Elementary School in North Philadelphia. He has established reading and breakfast programs as well as a tutoring program on Saturday mornings. It is not uncommon for Thomas-El to take his students to visit colleges and attend their graduations. Reflecting on how it feels to see a young person he has mentored walk down the aisle toward a real future instead of to an early grave, said Thomas-El, "I've been to too many funerals; I need to go to more graduations."
Thomas-El is also the author of a new book entitled I Choose to Stay (March 2003). Best-selling author Jonathan Kozol says of the book, "I Choose to Stay is an intensely moving story of loyalty and courage and a deeply personal tribute to the great potential of our inner-city kids, so frequently dismissed and denigrated by American society." Thomas-El's lecture, which will be based on his book, is a moving and inspirational account of one man's courage to stand by the students he so strongly believed in.
The Alfred T. Williams Leadership Series is named in honor of Judge Williams -- former senior judge of Northampton County Court of Common Pleas, and former life trustee and chairman of the Moravian College Board of Trustees. The series is designed to bring successful local and regional leaders from various walks of life and professions to campus to talk and interact with students about diverse aspects of leadership.


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Ringo Starr
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Mike T.
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Join Date: Jul 2005
Location: Charlotte, NC
Posts: 19
Re: Ringo Starr
Even though I grew up during the 70's (after the breakup of the Beatles), I was heavily influenced by Ringo. One of the most indelible memories I had of him was a clip I saw of the Beatles performing at a stadium (perhaps Shea, I'm not positive). He had the drum riser shaking while playing "I Wanna Hold Your Hand." Later, in my teens, when I started listening to different bands and drummers, I didn't think anything of Ringo or the Beatles because he wasn't busy or flashy and didn't play a big kit (afterall, it was the 80's). As I grew older and started playing the drums, I started to realize how great Ringo was. His drum parts fit perfectly within the songs. His feel is underrated; yes, we could all play his parts note for note, but it would not sound or feel the same. I'm still knocked out by his early drum sound. Those swishy hi hats and high-pitched snare still stand up to anything recorded today. He is more influential that a lot of us are willing to admit.
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Hmmm, and yet isn't he supposed to be the brain? TMZ reports that the The Breakfast Club star Anthony Michael Hall got arrested last night after allegedly going on a topiary-destroying rampage around his apartment complex. According to a neighbor that alerted the LAPD Pacific Division, the actor was loudly ripping up plants in the building's common area before the arrest occurred. When the neighbor approached him about the noise, Hall allegedly threatened to "beat him to a pulp," though that is certainly not how we learned to treat each other that one magical Saturday in the school library. We also learned to keep an eye on the janitor, as he will invariably try to blackmail you.
Once the neighbor in question returned to his apartment, Hall knocked on his door and challenged him to a fight. The man declined (graciously, we're sure) and called the police, who took The Dark Knight actor into custody without incident. Here's hoping Hall learns a little something about life and friendship in Adult Detention, i.e. a holding cell.


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Real Housewives of New Jersey
Will Jacqueline Laurita Address Nicholas's Autism on Season 5 of The Real Housewives of New Jersey?
During last season of The Real Housewives of New Jersey, Jacqueline Laurita and her family made the conscious decision not to discuss her son Nicholas's autism diagnoses. Instead, fans of the show learned about Nick's condition because of Jacqueline's interview with People magazine. After the interview was printed, Jac also addressed some questions about Nick during the Season 4 Reunion of RHoNJ.
But now that everything is out in the open and the family has a treatment plan in place, will Nicholas's struggle with autism be addressed on the upcoming fifth season of the show, which is currently in production?
Jac explains to Parents Magazine,"Taking care of our child's needs is obviously a huge priority in our lives, so we will be addressing it on the show. However, it'll be addressed with the intentions of bringing awareness to autism. I'm not comfortable with making a spectacle out of my son."
We gotta give it up for JL — that was pretty much the perfect answer. It's admirable that she wants to do all she can to help others while also having the utmost respect for her son and his journey. And it's not like she's a stranger to filming either!
"I'm comfortable with opening up to the cameras because I know that nobody in this life has it easy all of the time and everyone has their good and bad days," she says. "I'm OK with not being perfect or having a perfect life. I like that people can relate to me. I learn from watching myself and others. I think and hope that people will learn from us too."
Are you excited to see Jacqueline and her family on Season 5 of RHoNJ? Sound off below!
Source: Parents Magazine


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Guest column by Amy Gutmann | Aim to engage!
This summer, we created and I announced the President's Engagement Prizes. These are annual, competitively-awarded prizes for Penn seniors to design and undertake fully-funded local, national or global engagement projects during the first year after they graduate from Penn. Prize recipients will receive $50,000 for one year of living expenses after graduation and up to $100,000 in project expenses.


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Age: 22
Hometown: Indianapolis, IN
Team: Ball State Cardinals
Years Playing: 2 years
How did you hear about power soccer?
I heard about it through the MDA camp and when I got to Ball State my freshman year.
What have you learned since playing power soccer?
I have learned how to be a better teammate, a better person, and a better voice for my team.
What do you enjoy most about power soccer?
I enjoy when a play turns into a goal. Just the commitment from everybody to make sure the play runs smoothly, so that in the end, we put a point on the board, and I really love to play defense and love to frustrate the offense.
What would you like to achieve as an athlete?
I would like to achieve a championship, as everyone does. However, I would also like to achieve the praise by my teammates and by the opponent. I also want to let people see that I am trying my 100% best.
What would you say to other people that might be interested in trying power soccer?
I would say that this is a great way to feel normal and to find a passion. Power soccer is a big passion of mine. It is also a great way to build...


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Follow Along With Our
2011 Advent Guide
This Year's Theme:
The Places We Have Seen Jesus
This will be a sign to you: You will find a baby wrapped in cloths and lying in a manger. - Luke 2:12
The first witnesses of the birth of Jesus were the shepherds. They saw Him wrapped in cloths and lying in a manger. What a strange place to find Jesus. But, through the centuries Jesus has been seen by faith in other places and events such as in the life of a godly person, in a good deed done for others, in events where His hand has been at work, in the strangers whom we happen to meet at moments in our lives, in the life of a homeless person who needs a place to lay his head and in a song or a sermon.
One of the names given to Jesus by the prophet Isaiah is Emmanuel, which means "God with us." Often we do not see Jesus at that moment but in hindsight we can attest that He was there and at work.
What is Advent?
We keep track of time and seasons of the year by using calendars that provide us opportunities to observe, commemorate and celebrate certain events or occasions. The changing seasons of the year also provide us with recurring opportunities to celebrate the Christian faith in worship. The Christian church, following earlier Jewish tradition, has long used the seasons of the year as an opportunity for festivals and holidays, sacred time set aside to worship God as the Lord of life.
|Copies of the guide are available in the lobby of Wokship/Career Development, located on the first floor of Lassiter Student Center across from the mailroom. Copies also will be distributed at Honors Chapel this Thursday, Dec. 8.
While Jewish celebration revolves around the Eodus from Egypt, the Christian church year focuses in the life and ministry of Jesus. The sequence of festivals from Advent to Resurrection Sunday is an annual spiritual journey for worshippers as they kneel at the manger, listen on a hillside, walk the streets of Jerusalem, hear the roar of the mob, stand beneath the cross, and witness the resurrection. The rest of the church year provides opportunity to reflect on the meaning of the coming of Jesus and His commission to His people to be a light to the world.
Many churches in the Protestant tradition do not celebrate in any deliberate or sustained way the various seasons of the church year beyond Christmas and Easter. However, the observance of the seasons of the church year has a long history in the life of the Christian Faith.
The Christian calendar is organized around two major centers of Sacred Time: Advent, Christmas and Epiphany; and Lent, Holy Week and Easter, concluding at Pentecost. The rest of the year following Pentecost is known as Ordinary Time, from the word "ordinal," which simply means counted time (First Sunday after Pentecost, Second Sunday after Pentecost, etc.).* Advent is a time to celebrate the coming of Christ nto the world. This year, Advent begins on Sunday, Nov. 27, and ends on Christmas Day, Dec. 25. It is a sacred time for Christians to reflect upon their relationship with the Creator God who chose to ecome incarnate in His Only Son, Jesus the Christ.
The Advent Devotional Guide is intended to provide you a few brief moments each day to reflect on the most remarkable event in human history, God's action of taking upon Himself the role of one born of Mary who is both full humanity and full deity.
*from Seasons of the Year by Dennis Bratcher, Copyright © CRI/Voice, Institute
The 2011 Advent Guide is Dedicated to Student Lauren Graham
On June 5, 2011, Lauren Graham, a student at Palm Beach Atlantic University, was critically injured in a car accident. Lauren had only days earlier returned from India as a part of a student missions team. Sitting in the front passenger seat, she took the full brunt of the vehicle that slammed into the side of the car. Lauren was taken by helicopter to St. Mary's Hospital in West Palm Beach where she remained in a coma for several days.
if you would like to give to support PBA Student Missions.
to visit Lauren's Web page and support her in her recovery
At first, no one knew with certainty whether or not Lauren would live. In addition to multiple internal bruises and fractures of bones, she suffered a traumatic brain injury. Even if she lived, the doctors were uncertain about whether or not Lauren would ever recover fully from the injuries to her brain.
The tragic accident occurred at the beginning of summer. As we begin the Advent season, Lauren has far surpassed even the most optimistic prognoses. She survived and gradually began a lengthy healing process. She is now able to walk, talk, write and go places with her family and she continues to make daily progress.
Through the sustaining and healing power of God in her life and with bulldog determination on Lauren's part, she hopes to return to complete her degree at PBA where she is a graphic arts major in the University's Supper Honors Program.
Lauren has been and continues to be an inspiration to her classmates, faculty and staff at Palm Beach Atlantic University.
We are dedicating the 2011 Advent Devotional Guide to her and her remarkable family.
We asked Lauren if she would write a devotional herself for the Advent Devotional Guide without knowing that the Guide would be dedicated to her. She eagerly consented. You can read Lauren's devotional found on Day 1, Sunday, Nov. 27.
Her dad, Sherwood David Graham, shared these words: "We are trusting that God will not only teach us His statutes through our afflictions and obedience through our sufferings, but that God's handiwork in Lauren's life will cause each of you to see that 'the Sun of life divine, through passing clouds shall but more brightly shine.' May we all bring Him much glory as part of Lauren's story."
Lauren, over these past months we have seen Jesus through you.