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The author of 'Practical Steps to Financial Freedom and Independence,' Mr. Usiere Uko, in this piece, talks about how not to mix money with friendship.
Before borrowing money from a friend, decide which you need most.
—American proverb
Money and friendship often does not mix very well. Money and friendship is often like drinking and driving. Money can part the best of friends, and can even sour sibling relationships in some instances. The borrower feels the lender should be more understanding, or even write off the debt entirely for the sake of friendship, especially when the lender seems relatively much better off financially than the borrower, and should be able to afford to do without the amount in question. The lender feels used and being taken for granted.
Owing a friend can be awkward, especially when the debt is past due. You start to feel uncomfortable, and start offering excuses even in instances when none is demanded. When you hear the footfalls of your creditor, your heart begins to race, especially when payment is always demanded each time you meet. Soon you begin to avoid each other.
Abuse of friendship
Borrowing money from a friend is an abuse of friendship. There is an inherent emotional blackmail in the demand – if you love me, you will help, which means if you don't, then you don't care. That is subtle manipulation. Often, some friends abuse the privilege of being close to make demands when they know their friend just got paid some money – a bonus, pay rise, an unexpected windfall etc. Suddenly the 'friend' comes for a loan, more like his share of the windfall. Some friends borrow with no intent to pay back. They feel the money is one of their fringe benefits from the friendship.
You are not in the shoes of the other person, you don't know where the shoe pinches even when things look rosy on the outside. Even when you know there is a surplus, it is not your prerogative to tell your friend how to spend it. True friendship also means giving the other party freedom to be himself, enjoy himself if need be without having to feel guilty. A friendship where one party has to always lament and confess poverty so as to make the other party feel better is a toxic friendship.
People's Bank
In the first instance, one should not have idle funds lying around to play People's Bank with. By paying yourself first, you put your money to work for you, while you live on what is left. Your savings should be out there in the money market and any other investment you are good at, working hard for you. This means the money is not available to start with.
Let's assume you have idle funds and your friend comes to you for a loan to start a business. The first question would be; are you equipped to analyse his proposal and business plan (if any?) We are not experienced in analysing business risks. That is the job of banks. They have professionals who do that. It is unfair to ask a friend to risk his funds on a business venture he cannot analyse even if his life depended on it. The best place to get a loan for business start up is to borrow from your savings or from a bank and not from a friend (unless he truly buys into your idea). Such money often does not come back. The friend is often not bold enough to say "No, your plan is rubbish, I am not ready to risk my money on this". Rather, he will swallow his apprehension and give his hard earned money, so as to avoid being seen as a dream killer or not wishing his friend well.
Lack of forward planning
Some people simply do not plan ahead. They operate on a pay as you go basis. Some look for money to borrow to pay maternity hospital bills, you begin to wonder if the baby dropped from the sky. All babies give 9 months notice, enough to plan ahead and get everything ready. You would expect anyone who is not ready to shoulder the responsibility of a new baby to locate the road to the nearest family planning clinic.
Some look for money to borrow to pay for school fees for expensive private schools, but the same folks will turn their noses at public schools. When they attempt to carry what is too heavy for them, rather than lighten their load by scaling down, they look for help. When you help with the first term fees, what about second and third terms? Is the help or loan sustainable? Is there any end in sight?
Protection from predatory borrowing
To protect themselves from predatory borrowing (from friends who will likely not pay back), people adopt two methods. I call the first method the inoculation method. You lend an amount to your friends knowing full well he will default, and as expected, he does. Now here is the kicker, with that bad debt as a barrier, the debtor friend is not bold enough to come ask for another loan, knowing he has not paid back the last one. That first loan acts as inoculation to give immunity to the lender – to protect him from further lending requests, and peace returns to the planet. The debtor friend is forced to go look somewhere else. Mission accomplished.
The second method is the gift method. A friend comes to you to ask for a N200, 000 loan, you let her know you don't have that type of money lying idle, so you chip in N20, 000 as a gift, not to be repaid. If she comes back a second time and end up with another gift, she will get the message. She will either not come back again, or knows full well all she can get is another gift, which she may very well come back for. When the gift reduces in amount each time she returns, that becomes a disincentive to keep asking.
Giving with wisdom
This is not to say you cannot help a friend in need. We are to help others to the best of our ability. However, it is unwise to help other at the expense of our financial stability. It aircraft safety briefings, you are advised to put on your oxygen mask first in the event of a sudden drop in cabin pressure before you help others. If you are panting for breath yourself, you put both lives in danger. If you are not an expert swimmer, if you attempt to help a drowning man, you will be caught in a death grip which will put both lives in danger. The best thing to do is to call for help.
When you keep giving hand outs to a friend or keep funding half baked ideas, you are weakening your friend, not strengthening him. By feeding him fish, you are weakening his drive to learn how to fish. You are helping and abetting financial illiteracy. If you keep helping long enough, both of you will go down, then he will go look for a new helper to pull down also.
We need sound judgement, commonsense and a dose of financial literacy to be able to handle money especially when it comes to helping friends and family. Part of our monthly budget should include giving – tithes, charity, friends and family in need etc. Taking care of our aged parents is a responsibility which is not optional. However, whenever a friend wants to turn you to a bank or Automated Teller Machine, you need to decide which you need most, as money and friendship does not mix very well.


text: Sam J. Cahn | IBDB: The official source for Broadway Information IBDB: The official source for Broadway Information Official Broadway League sites: - sites - broadway.org broadwayleague.com broadwayfanclub.com kidsnightonbroadway.com stagespecs.org tonyawards.com Quick Search For: In This Category: All Show People/Org. Theatre Season Sam J. Cahn Performer Productions ProductionsDate of ProductionsRocky[Musical, Drama, Original] Performer: Sam J. Cahn [A Boxer, Rocky Marciano, A Referee]Mar 13, 2014 - Aug 17, 2014Memphis[Musical, Original] Performer: Sam J. Cahn Ensemble - ReplacementMember of the Be Black Trio - ReplacementOct 19, 2009 - Aug 05, 2012Wicked[Musical, Original] Performer: Sam J. Cahn Ensemble - ReplacementChistery - ReplacementOct 30, 2003 - Present Find out where Sam J. Cahn and are credited together © 2001-2015, The Broadway League, All Rights Reserved. (Copyright and Disclaimer)

subset: commoncrawl


text: PA016: Helping Children Perform Phoneme Skills Independently By Systematically Deintensifying InterventionsFriday, February 21, 2014 9:00 AM–9:50 AM PMD: 3Skill Level: IIGrade Level(s): ASession 9: Promoting Academic SuccessDescription: The purpose of this paper is to present ways to systematically de-intensify interventions by scaffolding children's academic performance. A study that demonstrated the effectiveness of scaffolding children's phonemic awareness using supportive structures will illustrate how to systematically de-intensify an intervention as children independently perform a skill. Speaker(s): Elizabeth A. Durst, Worthington Schools, Worthington, OH; Laurice M. Joseph, Ohio State University, Columbus, OH


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Year 2013 is the 13th year of the 3rd millennium and is likely to be a positive year.
www.findyourfate.com offers its visitors free 2013 astrology and horoscopes absolutely free.
Our horoscopes are done by astrologers known for their skill and expertise in the field for years. Insightful horoscopes for the year 2013 are provided for the zodiac signs. We also feature articles and information on 2013 astrology.


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Cody Wilson, like many Texan gunsmiths, is fast-talkin' and fast-shootin'—but unlike his predecessors in the Lone Star State, he's got 3D printing technology to help him with his craft.
Wilson's nonprofit organization, Defense Distributed, released a video this week showing a gun firing off over 600 rounds—illustrating what is likely to be the first wave of semi-automatic and automatic weapons produced by the additive manufacturing process.
Last year, his group famously demonstrated that it could use a 3D-printed "lower" for an AR-15 semi-automatic rifle—but the gun failed after six rounds. Now, after some re-tooling, Defense Distributed has shown that it has fixed the design flaws and a gun using its lower can seemingly fire for quite a while. (The AR-15 is the civilian version of the military M16 rifle.)
The lower, or "lower receiver" part of a firearm, is the crucial part that contains all of the gun's operating parts, including the trigger group and the magazine port. (Under American law, the lower is what's defined as the firearm itself.) The AR is designed to be modular, meaning it can receive different types of "uppers" (barrels) as well as different-sized magazines.
"This is the first publicly printed AR lower demonstrated to withstand a large volume of .223 without structural degradation or failure," Wilson wrote on Wednesday. "The actual count was 660+ on day 1 with the SLA lower. The test ended when we ran out of ammunition, but this lower could easily withstand 1,000 rounds."
Already, he says, over 10,000 people have downloaded the lower CAD file, and more have downloaded it through BitTorrent.
Cody R Wilson has figured out how to print a semi-automatic rifle from the comfort of his own home. Now he's putting all the information online so that others will join him.
This is a story about the rapid evolution of a technology that has forced the American legal system to play catch up. Cody Wilson, a 25 year old University of Texas Law student, is an advocate for the open source production of firearms using 3D printing technology. This makes him a highly controversial figure on both sides of the gun control issue. MOTHERBOARD sat down with Cody in Austin, Texas to talk about the constitution, the legal system, and to watch him make and test-fire a 3D-printed gun.
Check out our podcast with Cody here: http://bit.ly/VICE-Podcast-Cody-Wilson
Produced By Erin Lee Carr
Edited by Chris O'Coin
Read more on MOTHERBOARD here:http://motherboard.vice.com/read/clic…
To find out more about what the ATF says about 3D-printed guns, read this: http://motherboard.vice.com/blog/the-…
Music Credits:
"Darkness IV," "Nights" — Matt Scholey
"Metronome" — Machew
"Stillpoint" — Orphx (Richard Oddie and Christina Sealey)
"Lost Again" — Orphx
"Apparition" — Orphx
"The Leaves Had a Voice" — The Supercomputer Six Thousand
"Spaces 3" — Jon Cooper
"Extreme Prejudice" — Andromeda Dreaming
"Dreaming in the Face of Disaster" — Deadhorse
"Hearts of Glass" — Brightspark!


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Please provide both a username and a password.
July 21, 2014
Just added to the MOT video section, Vienna! Footage includes Lars in the Meet & Greet, and both Master and Whiskey from the show. Enjoy!


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Features : Archive for Dance
Merce Cunningham Dance Company Returns to NYC for Final Performances
Monday, July 18, 2011
After nearly 60 years of performing its contemporary choreographic collages worldwide, the company will return to New York for the final performances of its farewell Legacy Tour. On Monday, the Park Avenue Armory announced that it would host the company's last shows.
New York Live Arts Announces Inaugural Season
Wednesday, July 13, 2011
Over the course of its 2011-2012 season, the group will present an ambitious mix of programming ranging from brand new productions by young talent to classic choreographies that helped launch the career of the company's executive artistic director Bill T. Jones.
City Arts Groups Relieved After Restoration of Fiscal Year 2012 Budget
Tuesday, July 05, 2011
The Department of Cultural Affairs had faced $43 million cuts in the mayor's original proposed budget, which would have reduced operating funds to major museums, theaters and zoos by 50 percent and caused some 1,000 employees in the cultural sector to be laid off.
Dance Magic: Ballet Nacional de Cuba Comes to Brooklyn
Wednesday, June 08, 2011
Starting Wednesday at the Brooklyn Academy of Music (BAM), Cuban dance will be less about conga drums and hip isolations and more about soaring grand jetés and arabesques.
City Council Debates Mayor Bloomberg's Proposed Arts Cuts
Monday, May 23, 2011
On Monday, City Council committees held hearings on the mayor's proposed $43 million cuts to the Department of Cultural Affairs.
Get Your Dance Shoes On: From Samba to Circus, the Dance Parade Shimmies Downtown
Friday, May 20, 2011
From Bulgarian folk dance to New York pole dancing, the New York Dance Parade will be shimmying, swinging and pirouetting downtown on Saturday.
Celebrate Brooklyn! Dance Parties Kick Off City's Summer Outdoor Music Season
Thursday, May 12, 2011
On Thursday night, a new concert series kicks off in Brooklyn Bridge Park, which involves three free nights of what looks to be rockin' (and raucous) public dance parties.
Robert Battle Takes Alvin Ailey Dance Troupe in New Directions
Thursday, May 12, 2011
HIV through hip-hop, a new choreography residency program, Indian Kathak dance, and the work of a female choreographer. These are some of the themes that make up the Alvin Ailey American Dance Theater's 2011-12 season, announced on Thursday.
What Do I Want? I Wanna Be A Rockette.
Tuesday, May 10, 2011
Even though most of us are just beginning to bring out the summer frocks and flip-flops, some folks are already planning for winter. This Tuesday's open casting call for The Rockettes in Radio City's Christmas Spectacular drew hundreds of women, all of them vying to take to the stage as members of the high-kicking, high-energy dance team.
Cuban Dance Group Makes US Debut
Tuesday, May 10, 2011
More than fifty years since its founding, Cuba's premier modern dance troupe hits U-S soil for the first time. On Tuesday evening, Danza Contemporánea de Cuba begins a twelve-night stint at the Joyce Theater in Chelsea as part of the Si Cuba! festival.
City Ballet and Dancers Settle Union Contract
Wednesday, May 04, 2011
After a marathon 12-hour session, the union representing dancers and orchestra members at the New York City Ballet and the company's management have settled their contract.
No Contract, No Dancing? City Ballet Fails to Reach Agreement with Dancers
Thursday, April 28, 2011
Contract negotiations between the union representing dancers at the New York City Ballet and the company's management are "headed for disaster," according to the American Guild of Musical Artists.
Uptown and Downtown, a New Take on Old Music
Thursday, March 24, 2011
In the age of YouTube, sometimes it seems like everyone is a cover artist. This weekend, two groups of young artists take on music from the past at Harlem Stage and the Joyce Soho Theater.
Downtown Arts Festival Springs Forth
Tuesday, March 22, 2011
With warm weather on its way, New Yorkers are coming out of hibernation and going out to plays and concerts. At least, that's the idea behind Spring Downtown, an arts festival that begins this week at selected venues, all below Houston street.
Walker Center Acquires Merce Cunningham Dance Group Costumes and Décor
Saturday, March 19, 2011
The Walker Center in Minneapolis purchases work from Merce Cunningham's 70-year career, with sets, costumes and backdrops by Andy Warhol, Jasper Johns, Robert Rauschenberg and others.
Experiencing Dance, Blindfolded
Friday, March 11, 2011
This month, the New York Public Library hosts free shows by Dana Salisbury and her dance troupe the No-See-Ums. The choreographed dances of movement, scents and sounds require audience members to be blindfolded and are meant to give a sense of what it feels like to lack sight. Listen to an audio montage of Staten Island residents reacting here.
'Black Swan' Helps Sell Seats for 'Swan Lake'
Monday, February 21, 2011
The New York City Ballet has already sold out its run of "Swan Lake." Some say that's due to the Oscar-nominated film "Black Swan."
New 9/11 Time-Lapse Documentary Debuts at Sundance
Tuesday, February 01, 2011
Though it may not have won the big documentary award at Sundance, Jim Whitaker's "Rebirth" is likely to be of special note to New Yorkers: it's a new documentary about 9/11 and Ground Zero.
Study Finds Arts in America Are Ailing
Tuesday, January 25, 2011
A new report from the National Arts Index reported that the vitalty of the arts in the U.S. has reached a 12-year low. However, NYC arts groups have found signs of hope.
Baryshnikov Arts Center Seeks New Leader
Friday, January 21, 2011
The center has announced that Stanford Makishi will leave his post as executive director at the end of February. Makishi says he's leaving to consider his next steps in the field of dance.


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Autopsy results for slain Moorpark basketball star, fiancee to be released Wednesday
Coroner officials of the Orange County Sheriff's Department said they are "hopeful" about releasing autopsy results Wednesday on a former Moorpark basketball star and his fiancee who were found shot to death in their car in a parking structure of their Irvine home.
Officials said today they completed an autopsy examination on one of the victims. The second examination is expected to be completed by Wednesday, officials said.
Irvine police have not determined a motive in the shooting, which is being considered a double homicide, according to officials.
"Investigators have been working on this nonstop. We don't have a suspect or a suspect description, but we're actively looking for witnesses," said Lt. Julia Engen, an Irvine Police Department spokeswoman.
Keith Lawrence, 27, and his fiancee, Monica Quan, 28, were found shot to death Sunday in a parked car on the top floor of a parking structure at their Irvine condominium, according to an Irvine police news release. Police responded at 9:10 p.m. to a report that somebody was slumped over in a white Kia sedan in the parking structure near Jamboree Road and Campus Drive.
Quan was found in the front passenger seat and Lawrence was in the driver's seat, Engen said. Officials said the couple did not appear to have been robbed.
"There were no obvious signs of a robbery. Personal items were not obviously disturbed," Engen said.
Officials declined to disclose whether they had found a weapon from the shooting.
Lawrence was a former Moorpark basketball star, and Quan was a former California Lutheran University assistant women's basketball coach. The two met while playing at Concordia University in Irvine and became engaged two weeks ago, according to family members.
Quan, who was an assistant coach for the CSU Fullerton women's basketball team, helped the team recruit Lynn Leaupepe and Dynn Leaupepe. The Leaupepes are twin forwards for the Camarillo High School girls basketball team. Quan, who had come to a practice earlier in the season, came to know the twins through phone calls.
Quan was scheduled to watch Camarillo play Rio Mesa on Tuesday. Camarillo coach Michaeltore Smith, who still has text messages from Quan on his cellphone, described her as a "kindhearted, nice person."
"It shows how things catch you off guard and we're not guaranteed the next day," he said.
Smith broke the news of her death to the twins.
"They were extremely shocked about it," he said. "They couldn't believe it."
Elicia Hildreth learned of Quan's death through an email on Facebook on Monday morning. She had to go into a work meeting right after and said she had to push aside her emotions.
"I was stunned," Hildreth said. "I was shocked. I didn't know what to think."
Hildreth, 26, shared a condominium near CLU with Quan and Bridgette Redman for about a year in 2010-11. Hildreth came to know Quan through mutual friends and quickly hit it off with her because of a shared passion for athletics. Quan was a big fan of Michael Jordan's and had a full collection of his shoes in great condition in boxes in her closet, Hildreth said.
"She was just an awesome person, very sweet, very welcoming," Hildreth said. "We both had working out in common."
They both had ties to CLU. Hildreth, who went to Newbury Park High School and Moorpark College, played volleyball at CLU from 2007-09. Quan spent two years on the coaching staff for the CLU women's basketball program starting in 2009.
Hildreth, who knew of Lawrence from high school, shared an enthusiasm for cooking with her roommates and said they had their boyfriends over for dinner.
"(Lawrence) was such a nice and caring guy," Hildreth said.
Former rival and teammate David Reichel was surprised when he read about Lawrence's death on Facebook.
"It's just a weird situation because he wouldn't even call someone a jerk," Reichel said. "He's one of the nicest dudes you'll meet. I can't imagine what someone's motive would be."
Reichel, who grew up playing basketball in the county, played for the travel basketball team Camarillo Dons as a youth and often played against Lawrence and Moorpark.
Reichel also played with Lawrence on a couple of AAU basketball teams as they quickly developed a friendship.
"He didn't have that typical basketball star swagger to him," Reichel said. "He was a superlevelheaded guy. He didn't try to fit in. He did his own thing. ... He was the dream for any coach."
The two stayed in touch over time. Reichel played at Camarillo High and Lawrence at Moorpark High.
Reichel, who went on to play at The Master's College and CSU San Bernardino, came back during the summer and worked out with Lawrence at Moorpark College.
When Lawrence transferred to Concordia in 2006, Reichel went to watch him play a couple of times.
"(Lawrence's) biggest attribute was that he was really poised," Reichel said. "He didn't get rattled under pressure. Being young, that's one of the hardest things to understand. You don't have to go 100 percent. He had a good change of pace to his game."
Campuses where the couple worked issued statements Monday grieving the deaths. Counselors at CSU Fullerton plan to work with staff members and student athletes who may be struggling with the loss, according to university President Mildred García.
Engen said witnesses with information can call the Irvine Police Department's tip line at 949-724-7192.
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Ron NagleAmerican (San Francisco, California, 1939)
Vanity Scramble
2011sculpture | painted ceramic
Not on view at this time; find out where you can see works from our collection at locations around the Bay Area while our building is closed for expansion
4 3/4 in. x 6 3/4 in. x 3 1/4 in. (12.07 cm x 17.15 cm x 8.26 cm)
Acquired 2012
Collection SFMOMA
Gift of Rena Bransten
© Ron Nagle


text: Colin Towns | IBDB: The official source for Broadway Information IBDB: The official source for Broadway Information Official Broadway League sites: - sites - broadway.org broadwayleague.com broadwayfanclub.com kidsnightonbroadway.com stagespecs.org tonyawards.com Quick Search For: In This Category: All Show People/Org. Theatre Season Colin Towns Composer ( b. May 13, 1948 London, ENGLAND ) Male Productions ProductionsDate of ProductionsMacbeth[Play, Tragedy, Revival] Original music by Colin Towns Jun 15, 2000 - Jun 25, 2000 Find out where Colin Towns and are credited together © 2001-2015, The Broadway League, All Rights Reserved. (Copyright and Disclaimer)


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Does It Get Better???
View Single Post
January 9 2012, 06:30 AM
Lieutenant Commander
Location: Virginia
Re: Does It Get Better???
Harvey wrote:
He mentions almost being fired during the third season for not being punctual in
interview at Startrek.com. Google couldn't find anything more specific, but it lines up with the episodes mentioned.
There were other sources online and off that mentioned that before. Apparently the original idea was to have Kim killed off the show, but last minute, Kes (Jennifer Lien) got the boot. Many believe this had to do with Wang being nominated one of tv's most beautiful people that year and they thought it'd hurt the ratings. I'm not sure how true that is, but I wouldn't be too surprised. I liked Harry, but to me, he really outlived his use and purpose on the show and should have had an exit, whether it be death or something else.
"Listen to me very carefully because I'm only going to say this once. Coffee. Black."-Kathryn Janeway
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Housatonic River, a river in New England. It is 148 miles (238 km) long. The river's source is in the Berkshire Hills of western Massachusetts. The Housatonic flows south, running through Connecticut and emptying into Long Island Sound at Stratford. The river provided water power for many early New England mill towns.
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DENVER - Two inspirational dogs were in the 9NEWS studio Sunday morning along with their owners to talk about pets with disabilities and what people can do to help.
"We tend to adopt pets with disabilities and do everything we can to try to help them," said Ken Rogers from Steamboat Springs. "Seven years ago we saw a news piece about a dog that was missing his front legs and they were looking for a home for him."
Rogersand his wife took in several animals including two dogs, Kandu and Lucy, who were both missing their front legs.
"We don't think they're any different than any other dog," he said. "[Kandu] has a 'can do' attitude that nothing's going to stop him."
The dog's determined attitude inspired the Rogers to help the dogs move to their full potential.
"Once we got Kandu we started working on little devices for him," Rogers said.
Ken doesn't really have a name for the device created but he knows whatever it is, it works.
"They suddenly have more mobility than they ever have,"Rogers said.
With their new mobility, the dogs now inspire others.
"We thought 'wow wouldn't Kandu make a nice therapy animal?'" he said.
Kandu and Lucy often visit the Yampa Valley Medical Center to bring hope to the lives of others.
"It shows people if this dog can do it, you can do it too."
For more information, visit: http://www.kandu.us/kandu_story.html


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Surprise, surprise
So THIS just appeared across the street:
It's the first VOTE YES marriage amendment sign I've seen anywhere, let alone in a deeply blue corner of the People's Republic of South Minneapolis. I don't know the neighbors, who haven't attended a National Night Out function in the nine years I've lived here and therefore haven't clue about the many LGBT people living on our street and on streets nearby.
I think I'm supposed to feel rage or contempt, but mostly, I just feel sad.
Really sad.
To get your own ORANGE lawn sign for a donation of only $10, please contact Minnesotans United for All Families.


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Archive for the 'Clay Dutton Used Cars' tag
New Orleans, 1950s
Heading back to the Historic New Orleans Collection, we see another used car lot, this one Clay Dutton's, on the corner of what was then Dryades Street and Howard Avenue. Dryades Street seems to still be around, but where it crosses Howard Avenue, it appears to now be O'Keefe Avenue, though not like anybody can tell by comparing this photo and the modern day street scene. What do you see on Clay Dutton's lot, and what year do you suppose this photo was taken?


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Back to School Blood Drive
Lee Memorial Blood Centers is hosting a community blood drive at The Edison Mall in front of Dillards. All donors reeive a FREE drawstring backpack and goody bag with coupons!
Occurs once: Aug 3, 2012 (10:00 AM to 6:00 PM)
Contact Name: Pat Dolce
Contact Email: firstname.lastname@example.com
Contact Phone: 239-343-2333
Edison Mall
Edison Mall
4125 S. Cleveland Avenue, Fort Myers, FL 33990
Ticket Price: N/A
Ticketing Phone: N/A


text: In the Northwest, one in four jobs depends on international trade. The Port of Seattle's role in the region is critical for providing and maintaining the facilities to attract the businesses that create those jobs. Seattle's seaport and airport are international trade resources for customers throughout the world, providing fast and convenient links to global markets. These activities support nearly 200,000 jobs. Our Green Gateway programs offer an attractive competitive edge to our customers seeking a lower carbon footprint, while they improve and sustain the environment for our local community.


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School board candidate Schafersman: Opponent's faction wants to destroy public education with vouchers
Steve Schafersman says the stark difference between himself and his opponent in the State Board of Education race is that he wants to preserve public education in Texas, and his opponent belongs to a movement that wants to destroy it.
The former educator and oil industry consultant is the Democratic nominee for the board race for District 15. Schafersman is opposed by Republican Matty Rowley, who won a close GOP primary race over Anette Carlisle.
Rowley has pledged himself to a faction of the board that pushes an agenda including the failure of the state's public school system, Schafersman said Wednesday.
"They want to institute vouchers. That's their main goal," Schafersman asserted.
The Rice University doctoral graduate said voucher proponents want to take advantage of the 2002 Supreme Court decision in Zelman vs. Simmons-Harris. In a 5-4 ruling, the high court held that a voucher program may be legal if the funds go directly to parents, who then pay the school, and the state has a secular purpose for creating the voucher program.
"If you can prove the public schools are failing," the secular purpose requirement has been satisfied, Schafersman said.
If elected, he said, he hopes to join the majority coalition of mainstream conservative business-oriented Republicans and Democrats, as opposed to a group of ultraconservative tea party-backed Republicans.
He said that if Carlisle, a friend who is a longtime Amarillo school trustee, had won her party's nomination, he wouldn't care if he had lost. He said he plan to ask Carlisle to endorse him in the November election.
The ultraconservative faction agenda includes requiring abstinence-only instruction about sexuality, pushing creationism in science curricula, and minimizing disfavored individuals and groups, such as Thomas Jefferson and labor unions, in social studies, Schafersman said.
Minority groups have gotten short shrift on occasion, such as the failure to require textbooks to inform students that one third of the defenders of the Alamo were Hispanic Texans, he said.
Schaferman and Rowley seek to succeed retiring board member Bob Craig, a Lubbock Republican who usually voted with the mainstream Republican-Democrat coalition, Schafersman said.
Schaferman describes himself as conservative on fiscal matters and in support of traditional values such as supporting a strong public education system, and as socially liberal.
Over his career, he's taught in high schools, community colleges and universities, and has worked as a consulting scientist in the petroleum and environmental sectors for 15 years.
Founder of the Texas Citizens for Science in 1980, whose stated goal is to defend the accuracy and integrity of science education in Texas public schools, Schaferman said he has attended 80 State Board of Education meetings.
He is a resident of Midland, where his wife, Dr. Gae Kovalick, is an associate professor of biology at the University of Texas-Permian Basin.
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Over 5,000 companies involved in facility planning, design, construction and operations leverage e-Builder Enterprise to improve capital project execution for increased productivity, accountability and tighter control over cost and schedule. This ultimately improves quality, reduces cost and speeds time to market.
Developed and refined for over 15 years, with input from thousands of users, e-Builder Enterprise is the most innovative program and project management system of its kind, and the leading system for executing capital construction projects. It is modular and completely configured via the Internet, making it the fastest system to deploy. From Owners to General Contractors, e-Builder provides a collaborative project environment that will save your organization time and money.


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Featured Restaurants
The 50's Diner
Sarcasm is served all day along with great music at the 50's Diner in Metro Centre. Featuring our signature ground beef "I Love Loosey" sandwich, The 50's Diner offers breakfast all day plus great sandwiches and entrees too. Plus we're famous for our great milkshakes, pies and other tasty desserts. You'll also find salads, homemade soups plus kids meals too. With specials every day plus homemade Ham and Beans throughout the winter, great service and great food are what keep our customers coming back for more. Our staff is trained to amuse you - so come in and see us soon!
Phone, Location & Hours:
4700 N. University
Peoria, IL 61614
Monday-Thursday: 6 am - 8 pm
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Sunday 7 am - 3 pm
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Sky Harbor Steakhouse
It's midwestern steak house fare at its finest: comfortable, casual dining with emphasis on quality and service. The menu features succulent, savory Midwestern beef, served sizzling on the table. Fresh pond-raised catfish, award-winning ribs and that special touch on cocktails, appetizers, sandwiches and desserts ensure a memorable dining experience.
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I usually would sit here and write paragraphs in regards to my opinion, but I will honestly say that Union's "Time Leak" featuring Talib Kweli and Sly Johnson is simply abstract dopeness. That's not even grammatically correct, but who cares! Union is made up of these two Parisian producers that have this eclectic fusion of analog beats, hip-hop vibes, and an electro sound that isn't electro overkill.
The song "Time Leak" features some solid rhymes from Talib Kweli and the soulful voice of Sly Johnson on the hook. The video itself is literally a creative piece of art. The video is paying homage to films such as the Matrix and Alien, while drawing influence from other sci-fi futuristic film concepts. As the song is playing, Union is controlling the futuristic girl with the music. Ah! I can't even explain the full essence and abstract quality of this song, so watch the video!
©Jasmine McGee.ThinkSoul25. http://thinksoul25.com


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Swing in the New Year with the Devil, Daniel Webster and Los Alamos Little Theatre.The Los Alamos Little Theatre (LALT) will hold its annual New Year's Eve party Monday. For the last 36 years at least, LALT has faithfully held a party to ring in the New Year. The theatre was actually founded along with the start of Los Alamos and the Manhattan Project, back in 1943. In fact, LALT is the oldest community organization in Los Alamos, performing initially in such locations as Fuller Lodge and the Don Juan Playhouse, and only from 1971 on in its current Los Alamos location of the Performing Arts Center (PAC), 1670 Nectar St., a building that originally served as the 1940s Army cafeteria and now marks a stop on the Los Alamos historical walking tour.From its modest beginnings in 1943, the theatre has graced Los Alamos with both classic and cutting-edge comedy, drama and even musicale. During its first year, the theater presented three shows, one of which was the Pulitzer Prize-winning Kaufman and Hart comedy "You Can't Take It with You." The next year saw the farce, "Arsenic and Old Lace," only three years after it debuted on Broadway.
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Form an orderly queue... The Nissan Leaf is one of the most in-demand cars on the Auto Express fleet, even though we test such a wide variety of new models every week.
Since it arrived in October, there's always been a rush to grab the keys – and now the car is leaving our fleet, it'll be missed. As a quick, cheap and relaxing way of getting about a major city, the Leaf has won plenty of friends in the Auto Express office.
"It's simple to drive and quiet," says picture editor Dawn Grant, who has a round trip commute of 18 miles from her home in west London. "It makes you think you're doing your bit for the environment and I love the fact I don't have to go to a petrol station."
Even more of a fan is art director Darren Wilson. He adds: "I love the Leaf because it doesn't cost me a penny. I live around eight miles away in Crystal Palace and the car prevents me having to pay the £10-a-day London Congestion Charge to get into the office. There's no range anxiety, either. It just drives like a real car."
So after 10 months with the world's most popular mass-produced electric car, what have been the highs and lows for us?
Well, once you've got past the purchase price – £25,995 after a £5,000 Government grant – it doesn't cost a lot to run. The first service was £123 (around £100 less than for a Qashqai), while there were virtually no 'fuel' costs at all. Our Source London card was just £10 for a year and unlocked plenty of charging points across the capital, while charging the Leaf up in our car park cost nothing. We just found a regular socket and plugged in.
As I live in a flat in north London, I was unable to charge at home – you can only get the £995 British Gas-installed system if you have a driveway. But this was never really a problem as there's a charging bay nearby and I have such a short commute.
Could you live with a Leaf outside a big city? Almost – but it'd be tough. I drove it from London to Brighton to take part in the 63-mile RAC Future Car Challenge, and the motorway journey to the coast seriously depleted the batteries. Plus, the only charging point on the way was in Crawley, West Sussex.
Still, the return trip to Pall Mall involved driving in the most efficient way, taking in mainly A and B-roads, and I arrived with 44 miles remaining. That proved the Leaf could do exactly what Nissan claimed: over 100 miles. And in our time with the car, we didn't run out of charge once.
We loved the comfortable ride and nippy performance, plus the sat-nav which told us exactly where the nearest charging bay was. True, the charging cable was so cumbersome we never bothered to wind it up and put it in its case, so it always flailed around in the boot. But on the whole, living with the Leaf has been a great experience. If there was a countrywide network of fast-chargers, that queue to drive it would be even longer.
"The Leaf isn't the best driver's car, and its cabin could be more luxurious, but it's provided me with a relaxing, and crucially free, daily commute." Luke Madden, Web reporter
"If you're lucky enough to own two cars, one of them electric, it's a win-win. EVs seem to thrive on commutes and short trips around town – at minimal cost." paulhk, via www.autoexpress.co.uk
Rather a 'London-centric' viewpoint.. I can't imagine life with a Leaf would be so easy around the rest of the UK..
Staff of car magazines seem to be the only enthusiasts for EVs (presumably because they're not paying) - sales for July down 71% to only 52
"It makes you think you're doing your bit for the environment" - pass the sickbag...
The charging points are FREE?
For now maybe, but where do you think that electricity comes from? It comes from a Power Plant somewhere...so it's not FREE! This is not the answer for the future of mass-transportation.
Electric powered cars are fine for Metropolitan Cities, but for long distance travel, a diesel combustion engine is still more efficient and costs less to manufacture. I think Electric Hybrids w/ Diesel Power will provide the best of both worlds until a better solution comes along.
Like Bio-Diesel produced from Algae. In fact, that's
why Sr. Richard Branson has provided 3 billion dollars of his own money into the
further development of this sustainable energy source.
(watch the documentary "FUEL")
I own a Leaf and a Mercedes Diesel that I run on oil. The Leaf is better by a factor of 10. Quiet, comfortable, reliable, clean, FREE. Yes, free. My electricity comes from the sun. I saved in one year $3300. At this rate, the car will have paid for itself in 8.03 years. Sometimes, if you things right there are free things, like the air, the sun, the rain, the smile of your loved ones. And they are all the best.
So what do i conclude from this editorial?
It's a great car if you live in London.
As for the other 95% of the UK?


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All hotels in Austin, Texas, United States of America
1 room, 2 adults
1603 East Oltorf Blvd, Austin, TX, 78741, United States of America, Hotels.com Expert: 855-238-1593
La Quinta Inn Austin Oltorf
Lowest price$65
available on 10/13/15
Best Price Guarantee
City-center Austin motel with outdoor pool
- Free continental breakfast, free WiFi, and free parking
At La Quinta Inn Austin Oltorf, you'll be within a 10-minute drive of LBJ Presidential Library and Blanton Museum of Art. Guests can enjoy the outdoor pool or take advantage of nearby hiking/biking trails. Also, Governor's Mansion and Texas State Capitol are within a short drive.
Main amenities
- 137 guestrooms
- Outdoor pool
- 24-hour front desk
- Coffee/tea in the lobby
- Air conditioning
- Front desk safe
- Laundry service
What's around
- Heart of Austin
- Austin Department of Veterans Affairs (1 mi / 1.6 km)
- Mabel Davis District Park (1.1 mi / 1.8 km)
- South Congress Avenue (1.5 mi / 2.4 km)
The room smelled terrible, like mold. We almost left but we were exhausted.
We had a great time being here in Austin & seeing old friends and the hotel was great.
TripAdvisor Traveller Rating: 2.5
From 228 reviews
Enter dates to check prices
Hotel Info: 866-539-8117from $65
- Standard Room, 1 Queen Bed
- Deluxe Room, 1 King Bed, Refrigerator & Microwave
- Deluxe Room, 2 Double Beds, Refrigerator & Microwave
- Standard Room, 1 King Bed
- Standard Room, 2 Double Beds
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 137 rooms
- This hotel is arranged over 2 floors
- Check-in time starts at 3 PM
- Check-out time is noon
- Express check-out
Required at check in
- Credit card deposit required
- Government-issued photo ID required
Travelling with others
- Children (18 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Pets allowed
- Restrictions apply *
Extra people
- Roll-away beds available, charges may apply*
- Free WiFi in public areas
- Free WiFi in rooms
- Free self parking
- Accessible parking
In the hotel
Food and drink
- Free continental breakfast
- Coffee/tea in the lobby
Things to do
- Outdoor pool
- Hiking/biking trails nearby
- 24-hour front desk
- Dry cleaning/laundry service
- Elevator/lift
- Safe-deposit box at front desk
- Disabled parking
- Accessible bathroom
In the room
Home comforts
- Air conditioning
- Coffee/tea maker
- Iron/ironing board (on request)
Freshen up
- Free toiletries
- Hair dryer
Be entertained
- Premium TV channels
- Video-game console
Stay connected
- Desk
- Free WiFi
- Free local calls
- Access via exterior corridors
La Quinta Inn Austin Oltorf's small print
Also known as
- Austin Oltorf
- La Quinta Austin Oltorf
- La Quinta Inn Austin Oltorf
- La Quinta Inn Oltorf
- La Quinta Oltorf
- Oltorf Austin
- Austin La Quinta
- La Quinta Inn Austin Oltorf Hotel Austin
Pet-friendly rooms can be requested by contacting the property at the number on the booking confirmation.
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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… But I prefer alcohol!
"The Right Profile" from London Calling (1979), a tribute to the great closeted actor Montgomery Clift, who died in 1966. According to the Clash Wiki:
Johnny Green (Clash tour manager): "At Wessex, Guy [Stevens, producer] fished this book out of his bag, it was Patricia Bosworth's Montgomery Clift biography. He was telling Joe 'If you're going to write a song about somebody, write one about Montgomery Clift!'"
The New York Times' biography of Clift cites this description from All Movie Guide, which could just as easily apply to Joe Strummer, or any member of the Clash, really: "Prodigiously talented, intense, and defiantly non-conformist, he refused to play by the usual rules of celebrity, actively shunning the spotlight and working solely according to his own whims and desires." IMDb notes that Clift's "father was a violent, abusive, ultra-conservative bigot," and that "whenever Clift was playing characters snapping as they went up against ignorance or brutality, Clift was said to have acted with his father in mind as an antagonist" – which also makes him an apt subject for the Clash.
Moreover, the band's 1999 live collection takes its name from a Montgomery Clift film, From Here To Eternity. So, there you go. It all comes full circle, or something.
Anyway, it's a great damn song. So …
Turn. It. Up.


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The results of a small number of studies of autonomic function in patients with advanced cancer suggest that autonomic dysfunction (AD) is common. In other disease-specific groups this is associated with decreased survival, falls and symptoms such as postural hypotension, nausea, early satiety and fatigue. The contribution of AD to symptoms in advanced cancer is unknown.
We conducted a prospective cohort study designed to identify the risk factors for falls in patients with advanced cancer. Ambulant adult patients admitted consecutively to palliative care services were invited to participate. Participants underwent an assessment at baseline which included standard clinical tests of autonomic function, assessment of symptom severity, muscle strength, anthropometric measurements, walking speed, medication use, comorbidities and demographics. Information regarding survival was recorded ten months following cessation of recruitment. The clinical correlates of AD, defined as definite or severe dysfunction using Ewing's classification, were examined by univariate and multivariate logistic regression analysis. Survival analysis was conducted using Kaplan-Meier plots and the log rank test.
Of 185 patients recruited, 45% were unable to complete all of the clinical tests of autonomic function. Non-completion was associated with scoring high on clinical indicators of frailty. It was possible to accurately classify 138/185 (74.6%) of participants as having either definite or severe versus normal, early or atypical AD: 110 (80%) had definite/severe AD. In logistic regression analysis, age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and increased severity of fatigue (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were associated with having definite/severe AD. In analysis adjusted for age, median survival of participants with definite/severe AD was shorter than in those with normal/early/atypical classification (χ2 = 4.3, p = 0.038).
Autonomic dysfunction is highly prevalent in patients with advanced cancer and is associated with increased severity of fatigue and reduced survival. Due to frailty, up to 45% of participants were unable to complete standard clinical tests of autonomic function. In order to further investigate the impact of AD and the therapeutic potential of treatment of AD in patients with advanced cancer, the validity of alternative novel methods of assessing autonomic function must be appraised.
The autonomic nervous system innervates blood vessels, the airways, intestines and urogenital organs and is largely under involuntary control. It regulates and coordinates bodily functions by effecting secretory activity of glands and contraction and relaxation of smooth and cardiac muscle [1]. Autonomic neuropathy may be idiopathic or occur as a complication of other conditions or as result of drugs. It is recognised as a common complication in patients with diabetes mellitus; for many it remains subclinical, with only a minority experiencing symptoms such as postural hypotension, nausea, vomiting and early satiety related to gastroparesis, nocturnal diarrhoea, bladder-emptying problems and male erectile dysfunction [2]. Autonomic dysfunction (AD) has also been shown to be a negative prognostic indicator following acute myocardial infarction and stroke [3]. The underlying mechanism is thought to be an increased risk of cardiac arrhythmias as a result of decreased vagal tone [4]. Although the autonomic nervous system innervates all organs, due to the serious implications of cardiovascular autonomic dysfunction, investigation of autonomic function involving the cardiovascular system has become most established [5].
Autonomic dysfunction has been described in patients with advanced cancer, in whom a high prevalence of AD is identified [6-9]. Postulated causes include decreased physical activity, treatment with vinca alkaloids or other medications, or paraneoplastic processes [10,11]. The precise contribution of AD to clinical findings and prognosis in advanced cancer is unclear. Only one study has demonstrated a relationship between AD and symptoms in patients with advanced cancer; Bruera et al found that patients with advanced breast cancer in whom all tests of cardiovascular autonomic function were abnormal were more likely to report symptoms of postural hypotension and chronic unexplained nausea [6,7,9]. More recent research on AD in advanced cancer has focussed on its prognostic significance; a small number of studies have identified a relationship between AD and shorter survival in advanced cancer [12-14].
Cardiovascular autonomic neuropathy has been shown to be a risk factor for falls in older adults with dementia [15]. We conducted a prospective study of the risk factors for falls in patients with advanced cancer. In view of the reported high prevalence of AD in patients with advanced cancer we elected to include tests of cardiovascular autonomic function in our research assessment. Autonomic function is most commonly measured by the application of a group of clinical tests, which aim to measure sympathetic and parasympathetic activity, by measuring end-organ responses to physiological perturbations [16]. Ewing et al devised a battery of four tests which generate three outcome measures of parasympathetic activity and two of sympathetic activity, the results of which can be used to grade the severity of autonomic dysfunction [17]. In this paper we specifically report our findings in relation to the frequency and clinical correlates of AD, highlight and evaluate the difficulties experienced in measuring autonomic function in patients with advanced cancer, and make recommendations regarding the direction of future research in this area.
Setting and participants
Eligible patients who were admitted consecutively to the palliative care services provided by Our Lady's Hospice and Care Services (November 24, 2008 - Dec 24, 2010) were invited to participate. The palliative care services consist of inpatient care provided in a 36-bed inpatient unit (IPU), a day hospice service and a home care service. Patients aged 18 years or older with a diagnosis of metastatic or loco-regionally advanced cancer were eligible for inclusion. Exclusion criteria were as follows: being unable to stand and mobilize unassisted, actively dying or considered too unwell by the admitting and research teams, registered blind, using continuous oxygen, and being aphasic or unable to converse in English. Eligible patients received written information on the study at the time of admission to services. Enrolment of patients with impaired cognition (Short Orientation-Memory Concentration Test (SOMCT) score greater than 11) required the assent of the patient in addition to consent from their proxy. The SOMCT error score ranges from 0-28; the normal score range is 0-6 [18]. All other participants provided informed consent. The study was approved by St. Vincent's University Health Group Ethics Committee.
Data collection
Demographic details, comorbidities and medications were transcribed from admission notes and verified at patient interview. The following were considered to be cardioactive medications; beta blockers, tricyclic antidepressants, nitrates, rate-limiting calcium antagonists, anticholinergics and other antiarrhythmics. Performance status was recorded using the Palliative Performance Scale (PPS) [19].
All assessments were conducted between 0900 h and 1300 h. All participants were asked to refrain from smoking and caffeine ingestion on the morning of assessment, but were not asked to stop any of their usual medications or fast. A physician and research nurse performed the tests of autonomic function in a quiet room at ambient temperature (21-23 C). Autonomic function tests were carried out using a modified Ewing's battery [17]. Heart rate was measured by ECG using standard limb leads; heart rate (HR) tests were excluded if invalidated by arrhythmia, excessive ectopic activity or movement artefact. Blood pressure (BP) was monitored using the Finometer Pro device (Finapres Medical Systems BV, Amsterdam, the Netherlands) which enables noninvasive beat-to-beat BP measurement from finger arterial BP. The BP recordings are derived from the circumferential pressure generated by a finger cuff, which is varied to maintain a constant digital arterial size, as measured by a photoplethysmograph. Under such conditions the external cuff pressure equals the internal digital arterial pressure [20]. Participants rested in the supine position for at least ten minutes before testing. During this time they were covered with a blanket and wore a thermal mitten with glove liner in order to improve BP signal pick-up. Blood pressure tests were excluded if the trace was obscured by movement artefact or artefact due to external pressure on the finger-cuff.
Parasympathetic tests
1. Deep breathing
Whilst supine, participants were requested to 'take slow deep breaths, so that each breath in lasts five seconds and each breath out lasts 5 s, for a total of six consecutive breaths'. This was rehearsed prior to testing and the tester guided the timing of the breaths for the participant by verbally counting through each of the six breaths/cycles. The maximum and minimum HR during each breathing cycle was calculated from the corresponding shortest and longest R-R interval, and the response recorded as the mean of the differences during three successive breathing cycles.
2. Active stand
Participants were requested to stand up from the supine position as quickly as possible and to remain standing, in silence, for three minutes, with the monitored arm resting by their side. Assistance with rising was provided when this could not be achieved independently. Heart rate response was measured as the ratio of the maximum R-R interval at or around the 30th beat after starting to stand, to the minimum R-R interval at or around the 15th beat.
3. Valsalva manoeuvre
The valsalva manoeuvre was achieved by forced expiration, against an open glottis. Participants were requested to achieve a constant pressure of 40 mmHg for 15 s. The procedure was rehearsed prior to testing and the tester guided the participant by counting aloud through the fifteen seconds. The test was performed three times and the best response used for analysis. A minimum of one test achieving 30 mmHg for 12 s was required for inclusion. Heart rate response was taken as the ratio of the maximum R-R interval shortly after the manoeuvre to the minimum R-R interval during the procedure.
Sympathetic test
1. Active stand
The change in BP was measured as the difference between the baseline BP whilst supine and the lowest BP after standing.
Results for the valsalva manoeuvre were graded as normal or abnormal, and all other tests as normal, borderline or abnormal using the values recommended by Ewing et al [17]. Overall autonomic function was described using Ewing's classification system:
• Normal: all tests normal or one borderline
• Early dysfunction: one of the three HR tests abnormal or two borderline
• Definite dysfunction: two or more HR tests abnormal
• Severe dysfunction: two or more HR tests abnormal plus one BP test abnormal or both borderline
• Atypical pattern: any other combination of abnormal tests [17].
Severity of tiredness, nausea, loss of appetite and shortness of breath were measured using the Edmonton Symptom Assessment Scale; an 11 point numerical rating scale from 0-10, whereby larger numbers represent increased symptom severity [21]. Information regarding survival of study participants was obtained from an electronic palliative care patient administration database system, used by Our Lady's Hospice & Care Services and the hospitals within its catchment area. Survival in days was measured from the day of assessment. The analysis of survival times was conducted on Sept 24, 2011.
BMI was calculated from participants' height and weight as measured on the day of assessment, and weight loss by subtracting current weight from reported weight prior to cancer diagnosis. Walking speed was measured using the timed 'Up and Go' (TUAG) whereby the participant is asked to rise from a seated position, walk to a marked spot three metres away, turn around and return to their seat. The participant is instructed to walk at their normal pace and may use any gait aid normally used. Timing is started when the participant is instructed to 'go' and stopped when they are seated in the chair again [22]. Grip strength was measured 3 times in each hand using a hydraulic hand dynamometer (Jamar, Samons Preston Rolyan, Bolingbrook, IL). The result used was the best result of the six measurements.
Statistical methods
Demographic details and clinical variables were summarised using descriptive statistics. Comparisons of groups of categorical variables were conducted using the Chi-squared test, of normally distributed continuous variables using the 2-sample t-test and of non-parametric variables using the Mann-Whitney U test. Variables shown to be associated with AD in univariate analyses, with p < 0.1, were entered into logistic regression models, using forwards and backwards stepwise variable entry. Only variables that were significant at p < 0.05 were retained in the model. The relationship between AD and survival was examined using survival analysis methods, including the log rank test.
During the study period, there were 1,607 admission episodes involving 1,117 individuals, of whom 693 (62%) were ineligible, 239 (21.4%) declined and 185 (16.6%) were recruited. There were no significant demographic differences between participants and those who declined (see Table 1).
Table 1. Demographic details of participants and those who declined participation
Completion of individual components of Ewing's battery
HR response to deep breathing
The HR data of 14/185 (7.6%) participants were invalidated by arrhythmia. A further nine participants were unable to complete three consecutive breaths according to the study protocol, due to inattention and/or difficulty understanding and retaining information. The median SOMCT error score in those who completed the test was 2 compared with 6.5 (p = 0.015) in those who did not complete it.
HR response to active stand
The HR data of 14/185 (7.6%) participants were invalidated by arrhythmia and one other by excessive artefact at the time of standing.
BP response to active stand
The BP data of 42/185 (22.7%) participants was invalidated due to failure to obtain a good quality trace or due to artefact; most commonly due to external pressure on the finger cuff at the time of the stand.
HR response to valsalva manoeuvre
Eighty-three (45%) participants were unable to complete the valsalva manoeuvre. We conducted analyses to explore our post-hoc hypothesis that the high prevalence of non-completion of the valsalva manoeuvre was due to the phenotypic characteristics of our study population. We observed that patients who had features consistent with the geriatric syndrome of frailty [23] were less likely to be able to complete the valsalva manoeuvre. See Table 2 for results. In view of the high prevalence of dyspnoea in advanced cancer we included the ESAS item on severity of shortness of breath in our analysis, but found that this was not associated with ability to complete the valsalva manoeuvre.
Table 2. Features of participants according to whether they were able to complete the valsalva manoeuvre
Prevalence of autonomic dysfunction and associated factors
Due to the high levels of missing data pertaining to the HR response to valsalva manoeuvre and BP response to active stand, it was only possible to accurately define autonomic function, using Ewing's classification (normal, definite, severe or atypical), for 91/185 (49.2%) participants. See Figure 1. By collapsing the Ewing's classification into a binary classification of definite/severe versus other, it was possible to accurately classify 138/185 (74.6%) participants as having either normal, early or atypical, (other category) versus definite or severe AD. Of 138 patients 110 (80%) had definite or severe AD. Having definite/severe AD was associated with poor performance status (χ2 for trend = 8.2, p = 0.004) and increasing age; see Table 3 for contingency table of binary AFT classification according to age groups defined by quartiles (χ2 for trend = 7.6, p = 0.006). In univariate analysis, gender, taking cardioactive medication and having a diagnosis of diabetes mellitus were not associated with binary AFT classification (χ2 = 0.17, p = 0.7, χ2 = 0.89, p = 0.4 and χ2 = 0.4, p = 0.5 respectively), whereas having at least one cardiovascular comorbidity was associated with having definite/severe AD (χ2 = 3.79, p = 0.05). Having definite/severe AD was associated with severity of tiredness as measured using the ESAS (median 4/10 versus 2/10, p = 0.006), but not with severity of appetite loss (median 3/10 versus 1/10, p = 0.07) or nausea (median 0/10 versus 0/10, p = 0.9). Age, PPS, taking cardioactive medications, severity of tiredness (ESAS) and severity of appetite loss (ESAS) were entered into the logistic regression models. However, only age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and severity of tiredness (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were shown to be significantly associated with a diagnosis of definite or severe autonomic dysfunction.
Figure 1. Pie chart to show prevalence of autonomic dysfunction in patients with advanced cancer (n = 91).
Table 3. Binary AFT classification according to age (quartiles)
The median survival for participants with definite/severe AD was 106 days (95% CI; 78.6-133.4) compared with 135 days (95% CI; 24.8-245.2) in those with normal/early/atypical classification (χ2 = 4.8, p = 0.028). See Figure 2. The relationship between AD and survival persisted in analysis adjusted for age, defined by quartiles as above (χ2 = 4.3, p = 0.038).
Figure 2. Kaplan-Meier plot to show relationship between survival and autonomic function (n = 138).
Eighty-four of the 143 participants (58.7%) who had valid active stand BP data had a systolic BP drop of at least 30 mmHg on standing.
Using Ewing's classification it was possible to diagnose the presence or absence of definite or severe AD in 138/185 (74.6%) participants, of whom 80% had definite/severe AD. This finding is consistent with the prevalence of moderate/severe AD measured in patients with advanced cancer (n = 50), as reported by Walsh and Nelson, and in men with advanced cancer (n = 48), as reported by Strasser et al of 82% and 81%, respectively [7,9]. In our study, severity of fatigue was greater in patients with definite/severe AD, and although ESAS scores for loss of appetite were greater in those with definite/severe AD, this did not reach statistical significance. Median ESAS scores for nausea were zero in both groups, which most likely reflects the availability of effective treatment for this symptom. Having definite/severe AD was associated with shorter survival. Although this confirms the findings of previous studies of AD in patients with advanced cancer, it has yet to be clarified whether AD causes shorter survival or if factors associated with shorter survival, such as increased time spent in bed, contribute to severity of AD.
A striking finding of our study was the poor feasibility of conducting autonomic function testing, using Ewing's battery, in patients with advanced cancer. Forty-five percent of patients were unable to complete the valsalva manoeuvre, despite our having adopted a lower threshold for the duration, pressure and number of tests completed, than is standard. The results of the post hoc analyses supported our observation that more frail patients were less likely to be able to complete the valsalva manoeuvre. Prior to the active stand, participants were requested not to grip anything with their right hand during the process of rising or during the three minute stand: most participants did receive the assistance of one of the testers to rise from the supine to seated position. Despite this many participants experienced difficulty with getting up quickly. Additionally, we took steps to ensure a good digital BP recording by keeping the participant warm prior to testing. Despite this, BP data from 23% of participants were invalid, mainly due to artefact from external pressure on the finger cuff at the time of standing or due to a poor quality trace.
Walsh and Nelson reported that participants in their study also had difficulty with rising from a supine position to standing, and that they found the valsalva manoeuvre stressful, but despite this 48/50 (96%) patients managed to complete it [7]. Bruera et al reported that 8/43 (18.6%) participants had missing HR and BP data for the active stand as they were unable to stand up readily. It is likely that our use of beat-to-beat BP measurement from finger arterial BP, though now the standard in clinical and research autonomic function laboratories, resulted in our relatively high rate of failure in obtaining active stand BP data in this patient population. All other studies in patients with advanced cancer measured BP at the brachial artery with a sphygmomanometer, which has the drawback of not providing continuous monitoring, but is less susceptible to artefact resulting from external pressure and peripheral vasoconstriction.
Our use of a modified version of the Ewing's battery of tests was a notable study limitation: we omitted a second test of sympathetic function, the BP response to isometric exercise, whereby the patient is instructed to grasp a dynamometer and sustain a fixed, isometric contraction for 3 min at 30% maximum effort. We omitted this test for pragmatic reasons: an accurate diagnosis of definite AD according to Ewing's classification can be made based on 3 HR tests; this test had the lowest rate of completion in Walsh and Nelson's earlier study, as participants found it difficult. Furthermore, this test has been shown to have low sensitivity and specificity, due to problems standardising muscular effort and variability in muscle afferent activity when tested in trained versus untrained muscles [7,16].
The ranges for normal values for each test were derived by Ewing from tests in healthy subjects aged 16-69 years [17]. However, HR responses to deep breathing, active stand and the valsalva manoeuvre decline with age. Our use of Ewing's normal values, rather than determining age-specific normal values from testing age-matched controls, may have resulted in false negative test results in younger patients and also means that we cannot isolate the effect of a diagnosis of advanced cancer from the effect of normal aging on AD. Despite this, 54.8% of those aged less than 58 years were classified as having definite/severe AD. Unlike previous studies, we did not exclude patients who had other medical conditions known to be associated with AD or those taking medications which may affect autonomic reflexes. However, we found that in the context of advanced cancer, these conditions do not significantly increase the risk of AD.
Autonomic dysfunction is common in patients with advanced cancer. The findings of Bruera et al suggest that AD may be associated with symptoms of postural hypotension and unexplained nausea [6]. In view of the high prevalence of orthostatic hypotension (OH) in this study, we recommend routine enquiry for symptoms suggestive of OH and measurement of lying and standing BP in patients with advanced cancer. Management of OH includes discontinuation of antihypertensive medication, adoption of physical counter- manoeuvres, and use of mineralocorticoid (e.g. fludrocortisone) and/or adrenergic agonist (e.g. midodrine) medications [24]. For patients with unexplained symptoms suspected to be due to AD involving other systems, targeted investigation, such as gastric emptying studies in patients with chronic unexplained nausea, should be considered [25].
In this study, patients with definite or severe AD had higher scores for severity of tiredness, as measured by the ESAS. Fatigue has been shown to be associated with AD in patients with Multiple Sclerosis and Primary Biliary Cirrhosis [26,27]. Impaired autonomic function has also been described in patients with Chronic Fatigue Syndrome (CFS) [28,29] and patients with vasovagal syncope (VVS) have been shown to have higher levels of fatigue than age-matched controls [30]. A postulated explanation for these associations is that fatigue occurs as a result of impaired organ perfusion related to hypotension [30]. Alternative explanations, in the case of CFS, are that AD develops as a result of reduced physical activity, or that both the fatigue and AD have a common aetiology. However, early studies in patients with CFS and VVS suggest that severity of fatigue may improve with treatment of AD related postural hypotension. In a cross-sectional study of patients with VVS diagnosed and treated by a single Falls and Syncope Service (n = 91), patients whose syncopal symptoms had responded to conventional treatment (conservative advice, followed three months later in the event of persistent symptoms, by commencement of either fludrocortisone, midodrine or a selective serotonin reuptake inhibitor) reported less severe fatigue and daytime sleepiness than those with persistent syncopal symptoms [30]. In a pilot study of 10 patients with CFS shown to have abnormal cardiovascular responses to a head-up tilt test, for 6 patients, treatment with midodrine resulted in normalisation of cardiovascular responses at three months, followed by an improvement in fatigue scores 4-8 weeks later [31]. Exploration of the relationship between autonomic dysfunction and fatigue, the potential for reversibility of AD with pharmacological intervention, and the impact of this on fatigue and survival in patients with advanced cancer, are all worthy of further investigation.
However, in view of our findings relating to the feasibility of conducting standard clinical tests of autonomic function in a large cohort of patients with advanced cancer, we recommend that the reliability and validity of novel methods of assessment of autonomic function are investigated further. The findings of Fadul et al suggest that measurement of heart rate variability (HRV) may provide a useful measure of AD in this population, for both research and clinical purposes. Power spectral analysis of heart rate fluctuations, recorded by continuous electrocardiogram, provide a simple and non-invasive technique for analysing autonomic function. In their study of men with advanced cancer, Fadul et al found a strong association between the results of the Ewing's battery and the time domain measure 'standard deviation of normal to normal beat interval' (r = 0.44, p = 0.002) [13].
Autonomic dysfunction is highly prevalent in advanced cancer and is associated with severity of fatigue and shorter survival. Research findings in patients with VVS and CFS suggest that correction of autonomic dysfunction may result in alleviation of fatigue. Future research on the impact of AD and its treatment in patients with advanced cancer must also address the potential for novel methods of assessment of autonomic function to provide a reliable proxy for the standardised clinical tests; due to frailty, 45% of participants in this study were unable to complete Ewing's battery of tests emphasising the need to explore alternative methods for evaluation of autonomic function in this population.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
CS coordinated and designed the study, collected the data, performed the statistical analysis and drafted the manuscript. RAK conceived of the study, participated in its design and revised the manuscript critically for important intellectual content. BN helped to conduct the data collection and processing and to draft the manuscript. PGL conceived of the study, participated in its design and helped draft the manuscript. All authors read and approved the final manuscript.
This research was supported by the Health Research Board and Irish Hospice Foundation through the Palliative Care Fellowship awarded to Dr Stone (HSR/2008/17). Additional funding was received from The Atlantic Philanthropies, The Irish Cancer Society, Irish Hospice Foundation and a gift from a donor.
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Pre-publication history
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Devil-Linux, a distribution created by IT administrators for IT administrators, which is primarily used as a router/firewall, is now at version 1.6.1.
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Members of the Canadian Valley Technology Center Foundation Board of Trustees honored two former members for their longtime contributions in fostering technology education.
C.J. Hansen, of Calumet, was honored for 28 years of service as a member of the foundation board of trustees. Hansen was a charter member of the board, serving from 1984-2012. Hansen was also a charter member of the Canadian Valley Board of Education, serving from 1968-1979. He helped formulate the framework of the school, which opened its doors in 1970. The 1,300-square mile Canadian Valley school district serves 15 area high schools and associated communities mostly in Canadian and Grady counties with campuses in El Reno, Yukon and Chickasha.
Donna Von Tungeln, of Calumet, was honored for eight years of service on the foundation board. The former Canadian Valley student services director served the foundation from 2005 to 2012.
Canadian Valley's foundation board provides tuition scholarships for qualified daytime and evening adult students and covers other costs for students based on demonstrated financial need.
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Jason has served as production counsel for such shows as Beautiful: The Carole King Musical, A Night With Janis Joplin, Rock of Ages, Flashdance, Clybourne Park, Dead Accounts, Seminar, Oleanna, The Producers, A Bronx Tale, Bridge and Tunnel, On Golden Pond, Dame Edna and Murder Ballad. He serves as legal counsel to regional and developmental theaters around the country, including Second Stage Theater, Signature Theater in Arlington, VA, La Mama, The Culture Project, Kansas City Rep, Vital Theater Company, Naked Angels, Oregon Shakespeare Festival and Tectonic Theater Company. In addition to commercial producers and theater companies, Jason represents scores of award winning playwrights, composers, lyricists, directors, performers, designers, orchestrators and arrangers. Clients of Sendroff & Baruch, LLP are involved in most of the shows on Broadway.
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Golden State Warriors v New York Knicks
New York Giants wide receiver Victor Cruz celebrates after the New... News PhotoAmerican Football - Sport,Basketball - NBA Pro,Basketball - Sport,Celebration,Full Length,Golden State Warriors,Madison Square Garden,Making,Match - Sport,NFL,New York City,New York Giants,New York Knicks,Receiver,Sport,Taking a Shot - Sport,Three-Pointer,USA,Vertical,Victor Cruz - American Football PlayerPhotographer Nathaniel S. ButlerCollection: National Basketball Association 2013 NBAENEW YORK, NY - FEBRUARY 27: New York Giants wide receiver Victor Cruz celebrates after the New York Knicks made a three-pointer during a game against the Golden State Warriors on February 27, 2013 at Madison Square Garden in New York City. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2013 NBAE (Photo by Nathaniel S. Butler/NBAE via Getty Images)