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Smits, Roos Marthe MD; Zusterzeel, Petra L.M. MD, PhD; Bekkers, Ruud L.M. MD, PhD
Department of Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Address correspondence and reprint requests to Ruud L.M. Bekkers, MD, PhD, Department of Gynecology, Radboud University Nijmegen Medical Centre, 791, PO Box 9101, 6500 HB Nijmegen, the Netherlands. E-mail: email@example.com.
The authors declare no conflicts of interest.
Received March 11, 2014
Accepted April 29, 2014
Objective: The aims of this study were to evaluate the safety and impact of pretreatment surgical para-aortic lymph node staging (PALNS) in advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) and to evaluate the preoperative imaging of PALNs.
Methods: We searched in PubMed and the Cochrane Library to identify data investigating the role of surgical PALNS. Selection criteria included English-language and advanced-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) articles.
Results: Twenty-two articles were included. Para-aortic lymph node metastases were present in 18% (range, 8%–42%) of all patients with cervical cancer stage IB to IVA. The proportions of positive para-aortic nodes on histological analysis with suspicious para-aortic nodes on imaging (positive predictive value) were 20% to 66%, 0% to 27%, 86% to 100%, and 50% to 75% for computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET), and PET-CT, respectively. The negative predictive values of the imaging techniques were 53% to 92% for CT scan, 75% to 91% for MRI, 87% to 94% for PET, and 83% to 92% for PET-CT. The proportions of histologically proven PALN metastasis with normal findings on imaging were 9% to 35% for CT scan and MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. The mean complication rate of PALNS is 9%, with a range of 4% to 24%, with lymphocysts being the most common complication.
Conclusions: Pretreatment surgical PALN dissection or sampling is feasible, with low complication rates and short delay in starting treatment. Pretreatment PET or PET-CT is the most accurate imaging method in detecting PALN metastases but has limitations detecting microscopic tumor volumes. Even with normal findings on PET-CT, PALN metastases are present in 4% to 15% of patients. Positive PALNs in stage IB2 to IVA cervical cancer will lead to modification of treatment and may lead to better overall and disease-free survival.
Cervical cancer is the second most common cancer among women worldwide.1 Although the incidence of cervical cancer in the Netherlands is decreasing because of effective screening, it is still the third most common gynecological malignancy, with 718 new cases reported in 2010.2
International Federation of Gynecology and Obstetrics (FIGO; Fédération Internationale Gynaecologique et Obstétrique) staging for cervical cancer is based on clinical features and forms the basis for the decision to recommend surgery or chemoradiation. Staging becomes increasingly inaccurate as the disease progresses, with failure rates rising from 25% in stage I and II to 65% to 90% in stage IIIB.3 The most important prognostic factor for disease recurrence in cervical cancer together with tumor stage is para-aortic nodal status.4 Positive para-aortic lymph nodes (PALNs) are quite common in patients with pelvic lymph node (PLN) metastases, whereas solitary PALN metastasis in the absence of involved PLN is extremely rare and reported to be less than 1% of PALN metastases.5–7
Para-aortic lymph node metastases are present in 9% to 24% in stage II, 12% to 38% in stage III, and 13% to 50% in stage IVA disease.5,8–10 Failure to detect metastases to these lymph nodes may lead to suboptimal treatment and subsequently to decrease in survival.11
Several imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–CT (PET-CT) have been used in the preoperative staging process. Although PET-CT seems the most sensitive, its limitation in diagnosing microscopic lymph node spread is specified as metastases up to 5 mm.12 Staging surgery has seemed to be feasible and offers individualized treatment.13 Recent studies have shown that surgical staging of patients with locally advanced cervical cancer may lead to treatment modification in 20% to 40% of the patients, resulting in improved survival.3,14–17 However, more extensive surgery may increase morbidity and delay treatment.18
The aim of this review was to evaluate the safety and impact of pretreatment surgical PALN staging (PALNS) in advanced cervical cancer (FIGO stage IB2-IVA) in relation to preoperative imaging.
An extensive literature search was performed to identify data investigating the role of surgical PALN assessment. Our primary objective was to evaluate the feasibility and safety of pretreatment retroperitoneal laparoscopic or robot-assisted para-aortic lymphadenectomy and its impact on detection of metastases.
Relevant articles were identified in PubMed and the Cochrane Library (every year up to January 2014) using the key words or MeSH terms cervical cancer, surgical staging, para-aortic lymph node metastases, para-aortic lymphadenectomy, lymphadenectomy, laparoscopy, robot or robot-assisted, and imaging. All selected articles were scanned for relevant references or "related articles" (PubMed). Selection criteria included English-language and advanced-stage cervical cancer articles (FIGO stage IB2-IVA).
A total of 70 articles were identified using the terms cervical cancer, para-aortic lymph node metastases, and surgical staging or imaging, of which 61 were in English. Most of these articles were not related to the study question. Only a limited number of articles focused on surgical para-aortic lymphadenectomy. Eventually, 22 articles were selected directly, through references or related article search (Fig. 1). The main reasons for excluding studies were as follows: not written in the English language, cervical cancer cases included were not in the advanced stage, insufficient data, and histopathology was not used as standard criterion for lymph node evaluation.
Table 1 presents the collected data from all 22 studies.8,14,17,19–37 Fifteen studies (68%) were designed as a prospective trial; 6 studies (27%), as a retrospective trial; and 1 study (5%), as a randomized controlled trial. Computed tomography, MRI, and PET/PET-CT, used to identify PALN metastases, show a wide variety in positive predictive value (PPV) and negative predictive value (NPV). The proportions of para-aortic nodes that were positive on histological analysis when findings on imaging were abnormal were 20% to 66% for CT scan, 0% to 27% for MRI, 86% to 100% for PET, and 50% to 75% for PET-CT scan. The NPVs of CT, MRI, PET, and PET-CT were 53% to 92%, 75% to 91%, 87% to 94%, and 83% to 92%, respectively. Positive PALNs with normal findings on imaging was seen in 9% to 35% for CT scan and/or MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. Surgical staging led to a treatment modification in 7% to 58% of cases, with a mean of 20% (Table 1).
The most common operation technique used for PALN dissection was laparoscopy (75%), 74% retroperitoneal and 26% transperitoneal, with a conversion rate of less than 2%. Laparotomy was used as operating technique in 23% of the patients. Robot-assisted PALNS was used in 2 studies, taking account for 2% of all patients. Pelvic lymph node staging (PLNS) was performed routinely in 5 studies next to PALN dissection.
All studies included in this review performed a PALN dissection (Table 2). Nine studies (41%) dissected lymph nodes up to the level of the left renal vein, and 8 studies (36%) dissected at least up to the inferior mesenteric artery (IMA). Two studies used ultrastaging in histology. The mean number of dissected PALNs was 14.2, with a range of 1 to 62 nodes. Para-aortic lymph node metastases were present in 18% (range, 8%–42%) of all patients. None of the articles described the distribution or location, above or below the IMA, of the positive PALNs. Only 7 studies reported on the size of metastatic PALNs (Table 3). On the basis of 2 studies, the proportion of grossly positive nodes (visualized at laparoscopy and confirmed by frozen section analysis) is estimated to be 11% to 50%.
Para-aortic lymph node metastases were present in 11% of stage IB2 patients, 13% of stage IIA patients, 16% of stage IIB patients, 29% of stage III patients, and 36% of stage IVA patients (Table 4).
Only 6 studies reported on solitary PALN, which is the presence of PALN metastasis in the absence of PLN metastasis. Solitary positive PALNs were found in 25% (range, 0%–70%) of patients with stage IB2 to IVA. Positive PALNs in combination with metastasized PLNs were found in 75% (range, 30%–100%) of the patients.
The mean complication rate of PALNS was 4% to 18% in the laparoscopic approach; 1 study used a solitary transperitoneal approach, with a complication rate of 4%; 3 studies used only a retroperitoneal approach, with complication rates between 6% and 19%; and 8 studies used both laparoscopic techniques, without reporting separate complication rates (Table 5). Laparotomy resulted in a complication rate of 6% to 24%. Lymphocysts are the most common complication in all approaches. The complication rate in studies with routinely performed PLNS was 4% to 24%; this rate was 4% to 13% when only PALN dissection was performed. Radiation complications, radiation enteritis accounting for 40% to 100%, were mentioned only in 4 studies, with a reported rate of 0.6% to 2.3% in studies using the retroperitoneal laparoscopic route and a rate of 51% in a study using laparotomy. The amount of lymphedema after PALNS was not mentioned.
Surgical staging has been used by clinicians during the past 3 decades for more accurate assessment of PALN involvement. This review shows that pretreatment PALNS leads to a modification of treatment in 7% to 58% of cases (Table 1). In addition, debulking enlarged positive lymph nodes may also provide therapeutic benefit next to determining the extent of the disease. Studies by Kim et al38 and Cosin et al39 showed that survival data after dissection of enlarged PALNs with adaptive adjuvant treatment are similar to survival data of patients with microscopic PALNs.
However, complications and treatment delay should be considered when performing PALNS. We found a mean complication rate of 9%. Initially, transperitoneal surgical staging was performed via laparotomy.40 However, this led to high morbidity secondary to bowel complications, particularly when surgery was followed by radiotherapy, with a complication rate of 28% to 30% and a mortality rate of 6% to 22%.5,40,41
Laparoscopic staging has the advantage over laparotomy in reduction of blood loss and faster recovery.42 Laparoscopic PALN removal can be performed either transperitoneally or retroperitoneally. The retroperitoneal approach as compared with the transperitoneal approach decreases the risk for bowel injury.12,16,43 Furthermore, the retroperitoneal approach is reported to lead to statistically significantly greater node count and fewer postoperative adhesions.44 The complication rate of the laparoscopic approach in our study ranged from 4% to 18% (Table 5), with lymphocysts being the most common, responsible for 58% of the laparoscopic complication rate. According to Gil-Moreno et al,32 this incidence could be decreased by incising the peritoneum of the paracolic gutter at the end of the procedure to allow intraperitoneal drainage of the retroperitoneal dissection area. In our study, preventive marsupialization or use of pelvic lymphatic drains was reported in 8 studies. LeBlanc et al14 and Del Pino et al27 reported a direct positive effect using this prevention technique on development of lymphocysts. Furthermore Gallotta et al45 suggested that the positive intra-abdominal pressure during laparoscopy results in closing small lymphatic vessels and consequently limiting the identification of the lymphatic leakage, which might explain the increased incidence of lymphocysts compared with laparotomy.
However, laparoscopic lymphadenectomy has a technical limitation in degrees of movement, likely leading to more conversions to laparotomy, with reported rates between 7.5% and 10.3%.43,46,47 Conversion seemed to occur more often in obese patients.48 Nagao et al43 reported that 6 of 8 patients who underwent conversion had a body mass index of greater than 30 kg/m2. In our study, conversion to laparotomy was reported in 4 studies, with a rate of 1.8%. Mortier et al28 reported a conversion rate of 26%, and Leblanc et al20 reported conversion in 6.4% of patients.
Histological analyses showed positive PALNs in 18% (range, 8%–42%) of all study patients. Solitary PALN metastases occurred in 25% (range, 0%–70%) of them. This is substantially more than the reported 1% of women by Berman et al49 and Michel et al.6 However, sampling error is a likely explanation for negative PLNs in the presence of positive PALNs.
Treatment delay has been reported to be another concerning factor when surgical staging has been used. Because of postoperative complications and logistic difficulties, the median waiting time from surgery until initiation of (chemo)radiation therapy is 10 to 21 days across studies. The effects of treatment delay due to surgical staging on survival need further investigation.
In the past decades, several imaging modalities such as CT and MRI have been used to detect PALN metastases. Criteria for lymph node involvement on CT and MRI are based on size and morphology. However, both CT and MRI are poor at detecting small volume of disease and therefore limited by low sensitivity and specificity.11,50 Accordingly, our study shows PPVs of CT and/or MRI ranging from 0% to 66%, with a false-negative rate from 9% to 35%.
Positron emission tomography or PET-CT seems to be more accurate in detecting para-aortic node metastases, with reported sensitivity from 38% to 86% and a specificity of 75%.26,51 The proportion of para-aortic nodes that were positive on histological analysis when PET or PET-CT also showed uptake in the para-aortic area was 50% to 100% (Table 1). However, several other studies reported that, in patients with normal findings on PET scan, 11% to 18% still had para-aortic metastases after evaluation of the surgical specimen.12,28 In our study, the false-negative rate for PET was 4% to 15%. Brockbank et al18 evaluated the overall effectiveness and safety of pretreatment laparoscopic staging in the literature and concluded that there was insufficient evidence that pretreatment surgical PALN assessment for locally advanced cervical cancer is beneficial. However, only 1 randomized controlled trial was included in this study.34
Recently, it has been suggested that fused PET-MRI may offer clinical advantages over PET-CT for the assessment of gynecological cancers. In contrast to CT, PET-MRI involves no associated radiation exposure and offers the high soft tissue resolution of MRI. A drawback of the PET-MRI fusion images is the misregistration due to the movement of organs between the PET and MRI studies.52,53
The effect of pretherapeutic PALN dissection or sampling is still unclear, although adaptive adjuvant treatment may lead subsequently to better survival data. Lai et al34 prospectively evaluated the role of pretreatment surgical staging for locally advanced cervical cancer. The trial showed that patients who underwent surgical staging had significantly worse survival than those without staging. The conclusion of this study is limited because of the small sample size (N = 61). Furthermore, standard treatment was not performed in 13% of patients, there was an unequal distribution of unfavorable characteristics between groups, and all patients with surgically proven PALN metastases died as a result of treatment failures or complications.
On the contrary, Gold et al51 showed a positive prognostic effect of surgical staging on both overall and progression-free survival in a multivariate analysis comparing surgical and conventional radiological (CT or MRI) staging from three phase 3 trials from the Gynecologic Oncology Group (GOG) (GOG 85, GOG 120, and GOG 165). However, this study also showed limitations by combining the randomized arms of the 3 different trials, creating a selection bias.
In our study, only 6 studies report on overall survival after PALNS. These reported survival rates show a wide diversity. In contrast to Lai et al,32 Gil-Moreno et al32 showed in their study that excellent tumor control could be achieved with pretreatment laparoscopic para-aortic lymphadenectomy without recurrences in PALNs. Moreover, they reported no significant differences in overall survival and disease-free survival in patients treated for microscopic PALN metastases compared with patients with negative PALNs, suggesting a therapeutic benefit of staging lymphadenectomy.
Recently, Frumovitz et al54 announced their international multicenter phase III trial (LiLACS study) with the objective of determining whether pretherapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/CT radiological staging alone followed by chemoradiation.
Pretreatment surgical staging of PALNs seems to be effective and beneficial. Positron emission tomography or PET-CT seems to be the most accurate imaging method in detecting PALN metastases so far, although microscopic tumor volumes are still missed. At the moment, surgical staging needs to be considered in the assessment of para-aortic involvement and treatment of advanced cervical cancer. Pretreatment surgical staging is beneficial by allowing adequate histological evaluation of the retrieved PALNs and leading to a modification of treatment in 7% to 58% of cases.
However, postoperative morbidity and treatment delay should be taken in mind. Using a retroperitoneal approach may reduce postoperative complications, especially when using special techniques for the prevention of lymphocysts. Large randomized controlled trials are needed to provide more accurate information about the efficacy and survival rates.
Cervical cancer; Para-aortic; Lymphadenectomy; Staging; Imaging
© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.
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Lancashire reign amid rain
Lancashire are on course for their sixth win of the season despite a rain-affected third day of the LV= County Championship Division Two clash with Leicestershire at Grace Road.
Having forced the home side to follow-on 226 runs behind, the Red Rose reduced them to at stumps, still trailing by 98 runs.
The biggest threat to top-of-the-table Lancashire's hopes of their fourth win in the last five games looks to be a poor weather forecast for the final day.
Leicestershire resumed on 127 for seven, still needing 104 runs to save the follow-on, and managed only 27 in 9.1 overs.
James Sykes edged behind off Tom Smith, who also had Ollie Freckingham caught in the slips before left-arm spinner Simon Kerrigan brought the innings to a close by trapping Matthew Hoggard lbw without scoring. Smith and Kerrigan finished with 3-35 and 3-52 respectively amid Leciestershire's 154 all out
Their second innings could not have started in worse fashion with Greg Smith pinned lbw first ball by a swinging yorker from Kyle Hogg. Fellow opener Michael Thornely soon followed, providing Simon Katich with an easy catch off the same bowler at mid-off.
Ned Eckersley and Shiv Thakor offered some resistance until a dreadful mix-up saw the former run-out for 25 when he was sent back going for a third run and failed to beat Paul Horton's excellent throw from the deep.
That made it 41 for three shortly before lunch, at which point rain began to fall and the players went off. They did not return until four hours later, with 43 overs lost.
Glen Chapple quickly claimed the fourth wicket on the resumption, with Thakor clipping a catch to square-leg on 14.
A half-century stand between Matt Boyce and Niall O'Brien put the brakes on Lancashire's progress for 16 overs until the former, on 27, chased a wide delivery from Andrea Agathangelou and edged to wicketkeeper Gareth Cross.
But O'Brien and Tom Wells, unbeaten on 35 and 10 respectively, saw Leicestershire through to the close and will now hope that rain may play a major part on the final day.


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New Jeans Trends
Jules Smith Denim Wrap Bracelet
How cute is this bracelet?! It's by the designer Jules Smith. It's a denim double wrap bracelet, accentuated with a gold snap star closure, splattered gold detailing and a thin link chain for a playful, all-American look. I love it! It's also available in black and you can buy them at JulesSmithDesigns.com. The only downside is it is pretty expensive for a little denim bracelet, it retails at $110. What do you think of it? Do you want one?
Chanel Cruise 2011 Look Book
The Chanel Cruise collection debut in St. Tropez was a star studded event! The collection featured pastels offset by light wash denim shorts and pants for men and women. It also included a few stunning darker colored pants (For men and women) paired with similarly hued tweeds. I love the bohemian vibe the florals and light denim give!
Images from WWD.com
New Denim Brand: Terrance Sullivan & DenimBlog Exclusive Interview
Change. The time has come for women to have jeans that are designed, styled and crafted specifically for them. A fashion industry professional I worked with several years ago once told me "at the end of the day, it's all just denim."
DB: What is your brand all about?
Making a statement. Providing a unique experience. American luxury and craftsmanship. Giving women exactly what they need and even more of what they want.
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The woman who wants and knows that she deserves a better pair of jeans. I honestly feel that every woman deserves a pair of my jeans.
DB: Your jeans have a uniqueness to them which I love, how would you describe them?
Well, I thank you for the compliment, this response from a woman is absolutely what drives me. I'm very happy that you and others have noticed this uniqueness. Each jean makes its own statement so I think it would be hard to give a specific description, so I'll give you my two perspectives on that question. I think in a broader sense they can be described as, if you can imagine, the next evolution of the denim jean. Jeans that are made inside and out for the fit, design and style of today's women. They are so much more than just jeans and that's why I call them 'Ready-To-Wear Jeans'. And to describe them perhaps as it pertains more to the aesthetics of the newest offerings of the collection, I'd simply have to say a sexy skinny silhouette that has been distressed, ripped and zipped to rock-star scale proportions!
DB: Zippers have been really popular on jeans, what made you want to put them on the knees and on the front of your jeans?
I'm very inspired by the idea force merger. In this instance my desire was to use the zipper, which is traditionally used in a strictly functional way on jeans and forcing it in to a purely aesthetic role. I'm very pleased with the outcome. I think the knee will be a consistent focal point in my design. The knee is the best place on a jean to make a strong statement.
DB: Are they comfortable on the knees? I can imagine kneeling down may be a little bit sore. I love the idea of using zippers etc for aesthetic purposes though, I am all for that!
That's a great question because comfort is very, very important to me and I don't want to just say yes without explaining why. A lot of thought was given to the placement of the zippers for that very reason. Here's how I got the comfort issues to also marry with my design vision. The zippers are placed to fall just slightly above the knee. I then incorporated the shin patch, which falls just below the knee to achieve aesthetic detail as well as visually balance the leg. So on most women the zipper won't fall exactly on the knees. In the event that the zippers do happen to fall on the knees there are a few other features at work. The front leg panel design, the stretch in the denim fabric and the quality/thickness of the zippers which can also be opened to relieve pressure in that area.
DB: What is your inspiration when designing?
I find most of my inspiration away from jeans. I look for beautiful lines and great concepts in any/all forms of design. I don't really look at other jeans any more. They don't inspire me and I don't want to box myself into that way of thinking. I have created a path that's so exciting for me. I'm opening the jean to all possibilities and I've only just begun.
DB: So do you get inspiration from things like nature or the city or maybe something else?
It truly is creating art for me. I treat every jean like a work of art. So inspiration comes from everything and nothing at all. Firstly, I look at my jean as being a part of a full women's ready-to-wear collection more so than a jean in a contemporary or designer jean collection. This gives me the same freedom to create as a Marc Jacobs, an Alexander Wang, a Phillip Lim. And I'm very inspired by their work and by that of many other great designers as well. Some times I look through fashion magazines for hours and sometimes I have visions in a dream that wake me up in the middle of the night. I got the inspiration for the shin patch on the Harley Zip jeans because I love the sport of soccer. Who would put a shin patch on a pair of women's jeans? But it works. This is why, I'm very excited. My thoughts, ideas and energy are growing stronger and stronger every day. My thinking is free and bold. Hopefully women will be able to identify with that.
DB: Tell us more about your cuts and washes!
I have to say the cuts are absolutely great. I'm constantly working to improve even on this greatness. The rear rise is slightly higher than the front rise for an enhancing fit without the plumber butt. The front leg panels are contoured and smaller then the rear leg panels which give a long slimming effect to the legs.
Summer Shoes Made of Denim
Showing it's true versatility, many designers are coming out with many styles of denim footwear for the summer. You can choose from styles such as flats, sandals, loafers and slippers. This trend is not just for the women, Diesel and Toms Shoes have also come out with their own versions of the denim slippers for the men. Check out the few styles below.
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Click here to purchase these Diesel Didrilla Sip-ons for $80
Click here to purchase these Toms Denim Slippers for $54 (for every pair purchased, a pair gets donated to a child in need)


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We're catching up on our Honorable Mentions today, so we'll dispense with the usual glib introduction and get straight to the stuff that matters. We had a derby for Monsters, Robots, and Aliens. We got a ton of awesome submissions (really, there was cool stuff in there!) and here are our Editors' faves from those who didn't win:
Chance Encounter
by arinesart
"Come on. What's the worst that could happen?"
The Gentle Gardener
by WarholBot
Uh, what's he gonna trim with that alligator, exactly?
Not On My Watch
by Radscoolian
by walmazan
Sorry Cincinnati, I don't get it about Skyline chili.
A little suspicious
by ramyb
He's more scared of you than you are of him.
Dark and Stormy
by ochopika
"I told you we should've thrown the imp overboard."
by kevlar51
Some day someone will wind you up, pal.
That's it for now! Look for these and more Honorable Mentions in a Double-Take Derby near you!
thanks a lot Woot
How, how, how did "Beware a Mask on Halloween" not get an HM....
View All →


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Welcome to the Brown County Art Gallery
We are well into a year of celebration at the historic Brown County Art Gallery. We are in our 90th year and the State of Indiana is celebrating its Bicentennial. We have a full calendar of events, with more being added. We also have a new monthly newsletter you can receive by email so please find the spot on our web site to sign-up. We will alert you to all of our upcoming events, but let you know about what new treasures have arrived at the Gallery.
We are enjoying our newly expanded spaces and the many new visitors we are seeing each day. A schedule of workshops is in the works, including classes for children and those popular "Learn to Paint while enjoying Wine" events...We are calling ours "Burgundy and Brush"....perfect for a fun evening or great entertainment for a wedding shower! Keep in touch!


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Endoscopic endonasal surgery is a minimally invasive technique that allows a surgeon to go through the nose to operate on areas at the front of the brain and the top of the spine.
A thin tube called an endoscope is thread through your nose and sinuses, giving your surgeon access to parts of your brain that would be difficult to reach using traditional surgical approaches and often require large incisions and removal of parts of the skull.
Endoscopic endonasal surgery can be used to remove tumors in areas near the base of the brain or skull, and at the top of the spine. It can also be used to treat problems with the sinuses. The endoscopic endonasal approach has the advantage of allowing the surgeon to reach these areas without the need for large incisions or removal of parts of the skull, so your recovery is often quicker and less painful.
Any major surgery carries some risk. Most people get through this surgery and heal without problems, but complications can develop. Possible risks include:
The procedure may carry other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.
You will be under general anesthesia for this surgery. That means you will be asleep and won't feel anything. If you have any questions about the anesthesia or about any other aspect of the procedure, be sure to ask your medical team in advance.
You can increase the chances for success by preparing correctly. In general, pre-surgery preparation involves these steps:
Your surgical team will give you more specific directions for you to follow in advance of the procedure. Some of these might be slightly different from those listed above.
You will be asked to change out of your clothes and into a gown. A nurse will start an IV through which you will get fluids and medication during the procedure. You might be given a sedative to help you relax. After you have spoken with the anesthesiologist and your surgeon, you will be given the anesthesia that will let you sleep through the operation.
During the procedure, your surgical team will thread a thin tube through your nose and sinuses to shine a light and a camera on the spot where they need to operate. The camera relays images to a monitor in the operating room during the surgery. Specially designed tools will also be inserted through the nose to cut out and remove tumors or other problem areas.
Some steps might be slightly different from those outlined above. Talk with your healthcare team about what might happen during your procedure.
After your operation, your nose and sinuses may be packed with bandages. These are usually removed within a week after the surgery. You also will be given antibiotics to fight infection. If you feel pain or discomfort, let your healthcare providers know. Most people spend a day or two in the hospital before going home.
Once you are discharged, take any prescriptions you are given as instructed and follow all postoperative instructions.
Call your healthcare provider if you are confused about how to take the recommended medications or if any of the following occur:
Your healthcare team may give you other instructions about what you should do after your procedure.
Before you agree to the test or the procedure make sure you know:
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Algebra II—Semester A (2014-2015)
Nothing complex here...except complex numbers.
We've recently upgraded our Algebra II course in order to give you everything you could ever want from, uh, an Algebra II course. You can still use this version, but we recommend hopping over to the new one here.
You won't be sorry.
And if you are, then we are, too.
Course Breakdown
Unit 1. Seeing Structure in Expressions
We'll start the course off by diving headfirst into expressions! With the help of factoring, radicals, and even sequences and series, we'll be able to pluck out different parts of an expression and figure out if two expressions are two peas in a pod or two peas in…separate pods. Because sometimes, one pod is just too cramped.
Unit 2. Arithmetic with Polynomials and Rational Expressions
You may have dealt with polynomials and rational expressions in the past, but you ain't never seen 'em like this before. Not only will we gain some new tips and tricks to help us deal with these pesky expressions, we'll learn and even prove a few theorems along the way. Yeah, we mean business.
Unit 3. The Complex Number System
You might think imaginary numbers are about as helpful as Maurice, your imaginary friend from kindergarten. We'll fill you in on a little secret: while Maurice can't deal with negatives under the radical or tell you about the Fundamental Theorem of Algebra, imaginary numbers can—and will. Then again, Maurice can make a mean imaginary apple cobbler. We all have our strengths.
Unit 4. Creating Equations
This unit is all about using the magic of the equal sign to create and solve problems. (We'd use the magic of Houdini, but we're still working on that rope escape trick.) By creating and graphing every type of equation you can possibly think of, we'll learn how to tell them apart and understand which type of equation is applicable to which situation.
Unit 5. Reasoning with Equations and Inequalities
For this unit, we're going how to put all the equations we created to use. We're going to graph our creations—both separately and together—and see how to use them to solve problems. More often than not, they can do a significant portion of the work for us, and who doesn't love outsourcing their work? So put your feet up, grab a piña colada, and let equations and inequalities do the work for you. (Not really.)
Sample Lesson - Introduction
Lesson 5: Plotting Complex Numbers on the Coordinate Plane
Optical illusions can break our brains. At first, you think you see one thing, but then you realize (or are told) that things are not what they appear to be.
Our mind is about to shift again. The optical illusion: an ol' fashioned coordinate plane.
We might have always looked at an axis one way, thinking they are all the same. The x-axis represents the x-values and the y-axis represents the y-values, right? When it comes to complex numbers, it isn't that simple.
The usual Cartesian plane is only useful when we're working with real numbers. We're upgrading our numbers, though, going from real to complex, so we'll have to upgrade our plane, too.
When we throw complex numbers into the mix, we need to find a place to plot the i's. Imaginary numbers prefer hiding in dark places like under the bed or in the attic. Silly imaginary numbers.
We're going to let the imaginary numbers hang out along the imaginary-axis. That means that the real numbers will be along the x-axis. When real numbers and imaginary numbers mix it up, we'll be ready to plot them on the complex plane.
Sample Lesson - Reading
Reading 3.5: Plotting Complex Numbers on the Coordinate Plane
Graphing complex numbers is a little different than graphing real numbers. First of all, the graphs are different. If there is an imaginary component to a complex number it can't be graphed on a regular old real number axis. That wouldn't be complex enough.
We're joking, though. Really, graphing on the complex number plane isn't that bad. Like the real number plane, the complex number plane also has an x- and y-axis. However, each axis represents something different in the complex plane.
Remember that complex numbers can be split into a real and imaginary component: a + bi. The x-axis is going to be pretty much the same as ever. The y-axis, though, is going to represent the imaginary part. In other words, we can label it i, 2i, 3i, etc., going up from the origin, and -i, -2i, -3i, etc. going down.
Adding i's to the y-axis has made it possible to take any complex number in a + bi form and to locate it on the plane. The x-coordinate is the "a" and the y-coordinate covers the "bi" part. Please, hold their applause.
So, to plot 3 + 7i, we start at the origin. We go over 3 units on the x-axis, and up 7i units on the y-axis. Our point would be in the Quadrant I, right here.
If our point was -4 – 11i, we would go 4 to the left and 11i down, and plot the point in the Quadrant III. See—even though we've made things more complex, they aren't really any more complex. Y'know, in a manner of speaking.
Since complex numbers have both a real and imaginary component, we graph each of these components separately. The real component is plotted along the x-axis while the imaginary coordinate is plotted along the y-axis.
Sample Lesson - Activity
Activity 3.5c: Problem Set
- Credit Recovery Enabled
- Course Length: 18 weeks
- Grade Levels: 10, 11, 12
- Course Type: Basic
- Category:
- Math
- High School
- Prerequisites:
Algebra I—Semester A
Algebra I—Semester B
Geometry—Semester A
Geometry—Semester B
Just what the heck is a Shmoop Online Course?
Courses Tutorial
Common Core Standards
The following Common Core Standards are covered in this course:CCSS.Mat.Content.HSA-REI.B.3.1


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Injured crewman airlifted in storms off Isles of Scilly
- 15 June 2012
- From the section England
A rescue helicopter has airlifted a crewman injured on a boat in stormy weather off the Isles of Scilly.
The rescue by RNAS Culdrose came as gale-force winds and large swells were recorded in Cornwall.
Two other crewmen who suffered a fractured arm and cuts on a military vessel 210 miles off Scilly were due to be airlifted.
It followed the rescue of a yacht which lost engine power off the coast of Newlyn on Thursday.
There is no further information on the military vessel which coastguards believe is currently too far out to sea for an airlift.
Rain warning
Ken Bazeley of Falmouth Coastguard said in the injuries were probably due to the weather conditions at sea.
He said: "There are several vessels that we are monitoring all the time as they make their way back to Falmouth or Plymouth or the south coast of Cornwall that have suffered mast or steering problems."
A number of boats were ripped from their moorings on Thursday night in Falmouth and Penryn in Cornwall.
Gale-force winds of up to 46mph have been recorded on Friday at RNAS Culdrose.
The Met Office said heavy showers, some of which could be thundery and with a risk of hail, were expected to develop widely on Friday.
The Environment Agency said people in Devon and Cornwall should "remain prepared" for the possibility of flooding.
Ferry disrupted
Devon County Council said its highways department, which was still clearing up debris from last week's storms, was "geared up" to deal with any incidents.
In Cornwall, services to the Isles of Scilly have been disrupted. The Scillonian III has been docked at St Mary's Harbour since its crossing from Penzance on Thursday morning.
It left for the mainland at 16:30 BST on Friday.
Ferry managers added that the Saturday morning sailing from Penzance would be delayed from 09:15 BST until 11:00.
Skybus said despite the forecast it was "hopeful" all its scheduled flights would go ahead.
Claire Jeavons, from Beverley Park, in south Devon said the weather was causing some holiday-makers to stay away.
"Just this week we have been hearing that all caravan parks in the West Country are on flood alert, and this simply isn't the case," she said.
"We've been receiving many calls from worried customers, but we assure them that flooding at our altitude would also mean the entire English Riviera was hundreds of feet underwater."
But Nick Phillips, whose Exeter company, G Phillips and Sons, specialises in farming and country clothing, said the wind and rain had resulted in a hike in sales.
He said customers had been buying goods such as waterproofs, wellington boots and horse rugs, with sales up by about 50%.
The Environment Agency said uplands and areas that experienced heavy rain earlier this week were more at risk and it had teams checking flood defences, clearing river blockages and monitoring river levels.


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Only occuring with firefox 184.108.40.206
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Hi there,
I have been researching for some days now but couldn`t find a real answer to my problem:
I understand the use of having rel="nofollow" on links in the comments area, but I dont want it to be surrounded by a red and dashed ugly border (box).
It is not something in my css or template for that I am almost sure.
I also get this on my dashboard.
Gosh I hate these boxes.
Any clues?
Thanks in advance,


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I take exception to your characterization of Evergreen. Yes, there are a lot of intellectually lazy people who would rather have the exhilaration of a cause and take yoga and puppetry classes rather than taking the time to gather information and analyze it. But Evergreen is what you make of it, I myself have done nothing but read books and learn how to be critical of everything (to the point of no longer being able to enjoy anything on TV, thanks Evergreen). Saying that Evergreen is a school where all you do is get credit for welding, basket weaving, and ignorant protesting is a sweeping and unfair generalization, even if there are instances that confirm it (which I can attest, there are).
We can debate the value of an Evergreen degree and whether or not students are taking advantage of what is available here, but do not say you are not taught to think critically here, because that seems to be the one thing that has been stressed with every class I have had here (I can't speak for the Environmental Sciences programs though, I have focused on social issues and literature).
Rachel Corrie was her own person and made her own choices, her evergreen experience may have reinforced them depending on the education and social life she chose, but it most certainly did not create them. Rachel Corrie was her own person before she ever even came to Evergreen and was her own person as she attended the school. Don't blame the school for not making her critical enough, because there were opportunities to do just that which were ignored. You can't just teach critical thinking, it has to be cultivated by the person as well as taught. Evergreen can't force that on its students.
Is Evergreen completely absolved of responsibility for Rachel Corrie? No, but it should not be saddled as the sole "ah ha" reason for her fate. The biggest failing of evergreen is probably that we are offered too many choices, making it that much easier to choose the wrong ones (but I like to think more personally rewarding when you choose the right ones).
What about all the other Rachels who died? This play is racist and anti-semitic.
I can't put it better than Brandon did. I graduated from Evergreen in 1990 and I doubt it has changed much since, other than now they has basketball. There is a lot more critical thinking going on there than you give credit.
I haven't seen the play or video, but this confuses me: "Why do we teach kids to be so stupid? Corrie obviously didnt grab that kind of language out the etherits the kind of artless useless optimism we DEMAND from children."
Are you saying that what 10-year-old Rachel Corrie is saying there is stupid? Because it sounds pretty damn impressive for a 10-year-old. Call me a hippie, but I think the world could use more artless useless optimism like that. How would you have 10-year-olds talk or think about world hunger? Lay out some policy initiatives, perhaps?
Growing up in Brooklyn, critical thinking was in the air we breathed. These Evergreen idiots with their air head politics wouldn't last five minutes on the East Coast. Rachel Corrie is an embarassment to Seattle. I'm glad The Stranger is leading the charge in bashing Rachel Corrie. Someone has to be the voice of Seattle's Jewish community. Rachel Corrie died trying to save a dentist's house. Jews die every day, where's the play about them?
Fuckin' A, Brandon H. Fuckin' A, elswinger.
Evergreen was the most stimulating, challenging, and frustrating environment I've ever been in - yes, I had classmates that we nicknamed "Zen Radio" and "Space" for their incredible ability to tune in, turn off, and burn out, but I also had classmates and professors who pushed me to define my thoughts and opinions clearly. It will be a crucible if you let it.
I didn't know Rachel, though we attended during at the same-ish time, but those that I've met who did know her first hand do not characterize her as a simple-minded, easily-influenced, brain-dead hippy, and I personally bristle at the idea that most students from Evergreen are.
Shoshana, you are insane.
East Coast schools are much harder. If I didn't have to live in Seattle for computer work, I'd move back to Boston in a heartbeat. Evergreen is a state funded hippy factory. I fuckin' hate hippies. The Stranger is the only local publication to print a smack down on Rachel Corrie. If hippies want to die under a bulldozer, let 'em. Just don't write plays about it.
Josh & Shoshana: Why do you even fucking live here? Josh say he can't get computer work in Boston (ever here of Kinkos?). What's you excuse Shoshana? This was a much cooler place to live before reactionary assholes like you moved in and raised our rents.
I have to agree with #1 on Evergreen. I didn't go there, I've been educated on the east coast, and I'm Jewish (if that's enough qualifiers). Evergreen is one of the last few schools in this country engaged in progressive pedagogy. Sure it has its faults and a huge hippy factor, but without these few schools who are more concerned with thinkers and challengers than turning out another mba, the world would be a much worse place. so lay off evergreen, as i see it, it is an endangered species.
"Old Seattle" types should go read the Weakly. I live in Seattle because I believe it can become a real city. The local Jewish community is growing in spite of rampant racism and anti-semitism in Seattle and I want to support that. The Stranger is the newspaper of Seattle's future, if you don't like it don't read it. Plenty of local Jews hate Rachel Corrie and everything she stands for. They are entitled to be heard.
I would agree that you get out of TESC what you put into it.
Where is this rampant racism and anti-semitism in Seattle? The main hater around here seems to be you.
Seattle made national news for it's antisemitism when the city refused to put up a Menorah to honor our sacred holiday. As for racism, just walk down the street and all you see is white people. I know racism and antisemitism, I've lived in a real multicultural secular state - Israel.
East coast schools are harder (therefore better?) and Evergreen is a hippie factory?
Hmmm, those statements don't smack of any elitism and ignorance at all.
Interesting how you people are looking at Rachel Corrie as the quintessential Greener. That just isn't the case though, and it is unfair to the rest of us to imply that it is. Like I said earlier, Rachel Corrie was her own person, not Evergreens (just like I am my own person and not Evergreens). Hate on Rachel Corrie all you want, you'd probably be right, but stop with the Evergreen bashing and stereotyping. You sound worse than the people who blame rock n' roll for all the trouble with kids today.
Ok Shoshana, now I get the joke. I have been Punk'd!
Having a critical mind isn't elitist, it simply means being smarter than other people. There is plenty of dumbed down media around. I read The Stranger for it's erudition.
Oh, so thats the troll with the pseudonym that Annie was talking about.
I did the Environmental Sciences program in the late 90's and graduated with a BA/BS. I agree that the place is a bit overrun with hippies, and I was a bit of one at the time, but I got a great education there. I've been in the professional world for the past 7 years and have learned to appreciate my schooling more every year as I continuously deal with "educated" people who didn't learn to think for themselves.
#12 has it exactly right, Evergreen is a school that gives you what you put into it. I had plenty of friends who picked the place because of the lack of grades (mostly rich kids from the East Coast...). I also had a lot of friends who took advantage of the opportunities available there that you can't get in a more traditional school with 300 people in a lecture hall listening to a TA teach their class. I recently reconnected with one of them who wrote a piece of legislation for Senator Lieberman that's now law.
Where else is seminar a integral part of an undergraduate education? How common is it for undergrads to get to do hands-on work with $500K scientific equipment and have almost unlimited access to their professors?
Sure, you can get a degree from TESC based on your independent contract which was all about touring with your friend's band (Hi Casey!), but on the other hand you can also do graduate level work right from day one if you're so inclined. That's missing from the big box schools.
I was there while Rachel was, I knew her in passing through friends who were close to her. She, like most everyone there, got out of it what she put into it. It's a tragedy that she died but no one should categorize her as simple minded or ignorant just because she had a passion you don't share.
Thanks to the folks who have posted about TESC based on their personal knowledge, I think it's clear who those folks are...
Fuck off to the asshats who think they know what the place is about because of a few stories they've heard.
"East Coast schools are harder." Keep telling yourself that dude...
"These Evergreen idiots with their air head politics wouldn't last five minutes on the East Coast." I know several who are working in DC right now on policy and doing quite well, thanks for your batshit crazy comments though!
Yep Brandon, that's the one.
Yes, please don't feed it.
Sorry, didn't mean to.
Evergreen is what you put into it?
Where else can you gets hands on experience with a 500K piece of equipment?
You are your own person?
Here's a newsflash, this is not unique to evergreen. These are blanket statements that apply to everywhere and anywhere, fro local community colleges to 4 year Universities.
Let's drop the East Coast/West Coast BS as well. UW could be placed against Harvard and MIT in many of it departments and has a better reputation in some.
However, Evergreen is not UW, Harvard, MIT or even WSU. Evergreen, a liberal arts school, has a reputation for being an overgrown Montessori school. If you are up for a challenge - you need not look far in order to find one. Then again, if you want to skate through school and be a political wonk hippie, this is a great place to be. A diploma is waiting for you after 4 years if you just show up and go through the motions.
Clearly Rachel set her path on far, far, far left political agndas on progams.
In the end these programs and professors have failed to support their responsibility in getting this kid killed.
Oh man. This is a pretty typical Evergreen debate. As an Evergreen student I'm currently working at the Washington State House of Representatives as a policy intern and all I ever get from people around here is "you don't look or act like a typical Evergreen student." You know what I say to them? "You obviously have never been there yourself."
Listen, the truth of the matter is that Evergreen has a loud minority of mindless hippies. I don't even think Corrie was one of those. She was an idealist at a point in history that NEEDS idealists. Anyway, Evergreen is an incredibly diverse place (diverse views, mind you; it is ethnically homogenous unfortunately).
To "Let's Get Real...": I work in an environment where I interact with the best and the brightest undergrads from UW, WSU, Western and virtually every other school in Washington. We've discussed the academic experience that we've gotten out of our respective schools at length and they've all expressed amazement at the advanced level of work that I've been allowed to work on at Evergreen. For instance; in my sophomore year I traveled to Bosnia and wrote a research paper examining the long-term social, economic and political impact of the civil war there in the 1990's. You could NEVER do that shit at another Washington 4-year (and I dare say 99% of the rest of the schools in the country).
And to the lame-ass who's crying "anti-Semitism": Listen, I'm aware that anti-Semitism is a very real problem but stop trying to play the perpetual victim. Nothing bothers me more than people who refuse to note that racism and hate can be a two-way street. You want to complain about people who aren't doing enough critical thinking? Look in the fucking mirror. Sure, there is a lot of Jewish blood on many people's hands. But there's a lot of Arabic blood on Jewish hands as well and to pretend that's not true is to show an incredible level of arrogance and ignorance.
Please, before you bash Evergreen try a little critical thinking yourself. Douchebags.
The kindest way I can assess Rachel Corries Palestinian mission is in comparing her to Pasha Antipov, the idealistic revolutionary from Dr. Zhivago, whose rage of exclusive pity overwhelms his moral values. The immense suffering he saw turned him from a naive idealist to a brutal, mass-killing revolutionary. He was a lost soul.
Corrie, likewise, aligned herself seamlessly with suffering Palestinians, reserving for them her absolute pity to the extent that suffering Israelis merited nothing but a sneering hatred from her. Corries idealism did not proceed from love but from ideologically induced hatred. She was an open apologist for Palestinian terrorism, and she died trying to prevent the work of an Israeli bulldozer, which was searching for munitions buried in the ground. Contrary to Palestinian reports, the bulldozer was not there to demolish a house, (houses used as cover for weapon-smuggling tunnels were demolished by the IDF). Any which way you look at it, those munitions were there to be utilized in attacks against innocent civilians. Corrie died protecting terrorist weapons. She was completely indifferent to the deaths these weapons spelled at a time when suicide bombings were a matter of daily occurrence in Israel.
Compare that poem she wrote at the age of ten, with this picture of her:
Oh Dear God, what a load of crap....
"For instance; in my sophomore year I traveled to Bosnia and wrote a research paper examining the long-term social, economic and political impact of the civil war there in the 1990's. You could NEVER do that shit at another Washington 4-year (and I dare say 99% of the rest of the schools in the country)."
A college Sophmore is totally unqualified to have an opinion on this subject. Newsflash, taking a 200 level course does not qualify your opinion on anything other than kissing you professors ass in hopes of getting a passing grade.
Okay, forget my opinion.
let;s see what the Princeton review has to say about Evergreen,
We are in agreement that Princeton is a good enough school to value it's opinion, correct?
but first, lets see about the other schools you mentioned:
University of Washington:
University of Washington Appears on These Lists
Best Western Colleges
This school is one of the 123 colleges named a Best Western College by
The Princeton Review. Our goal is simple: to identify some of the
colleges and universities that we feel stand out within each region.
See the full list
America's Best Value College
This school is one of the colleges designated as one of the best
overall bargainsbased on cost and financial aidamong the most
academically outstanding colleges in the nation.
Washington State University Appears on These Lists
Best 361 Colleges
This school is one of the 361 colleges featured in The Princeton
Reviews book The New 2007 "Best 361 Colleges".
Best Western Colleges
This school is one of the 123 colleges named a Best Western College by
The Princeton Review. Our goal is simple: to identify some of the
colleges and universities that we feel stand out within each region.
America's Best Value College
This school is one of the colleges designated as one of the best
overall bargainsbased on cost and financial aidamong the most
academically outstanding colleges in the nation.
And here it is, and this is no joke, this is how true academics feel about Evergreen (seriously, I'm not making this up)
The Evergreen State College's
Best 361 College Rankings
Click on the list name to see all the schools on that list or
click the category name to see all the lists in the category.
Best College Radio Station
Intercollegiate Sports Unpopular or Nonexistent
Nobody Plays Intramural Sports
Students Most Nostalgic For Bill Clinton
Birkenstock-Wearing, Tree-Hugging, Clove-Smoking Vegetarians
School Type
Dodge Ball Targets
School Type
That's it.....
So stop trying to make Evergreen out to be something it's not. Your dellusions of the incredible challenging atmosphere? This may possibly be because you were completely ill-prepared to be accepted into a real school.
Evergreen is a hippy factory that turns out airheaded antisemites like Rachel Corrie.
What I'm attempting to say about Evergreen is that the play benefits from your acquaintance with the school, no matter what your opinion of its methods. Plenty of people have wrangled a decent education out of Evergreen, and plenty of thoughtless assholes graduated from my alma mater.
Faber: "Look in the fucking mirror. Sure, there is a lot of Jewish blood on many people's hands. But there's a lot of Arabic blood on Jewish hands as well and to pretend that's not true is to show an incredible level of arrogance and ignorance."
Sorry. I'm afraid in this rash and irresponsible attempt to sneer at Jewish fully justified fears, the writer reveals his own "incredible level of arrogance and ignorance". It's a good example of why "even-handedness" does not work, morally or historically.
Jews do not preach for a jihad against Arabs, nor do they teach their children that Arabs are descendants of pigs and apes and must be exterminated like scurrying mice.
The Jews who do fight Arabs are in Israel, so they are actually Israelis and they fight resisting so-far unsuccessful Arab attempts to annihilate them.
Israelis want nothing more than normalization and peace with their enemies. How have those responded? By launching terrorist attacks, and sending rockets into peaceful towns. By electing a genocidal government and declaratively insist that Israel must be wiped off the face of this earth.
A strange mirror image, that, of the relentless persecution, both of Faber's slanderous kind and Hamas' kind, Jews have had to suffer throughout history, as well as in present days.
Keep those blinders on!
"A college Sophmore is totally unqualified to have an opinion on this subject. Newsflash, taking a 200 level course does not qualify your opinion on anything other than kissing you professors ass in hopes of getting a passing grade."
Bullshit. Evergreen gave me the opportunity to challenge such a notion and challenge it I did. Is your head stuck so far up your ass that you think every student has the same academic abilities? Fuck you dumbass.
Ooh, now that I've used the toilet let me go back and challenge a few more of the assanine comments made by you ignorant fools.
According to the 2006 National Survey of Student Engagement Report, which is an annual report issued by Indiana University and Pew Charitable Trusts, Evergreen's level of academic challenge among freshman and seniors was marked in the top ten percent of all baccalaureate colleges in the nation.
Science programs at Evergreen are noted for significant discoveries, particularly with Phage and E.Coli, and inclusion of undergraduate students in high level research. Currently, Evergreen operates the only publically funded Phage research lab in the U.S.
Author and former New York Times education editor Loren Pope cites Evergreen as one of two public colleges in the United States in his book "Colleges That Change Lives."
While Evergreen may rank as a tier 4 school according to US News and World Report that ranking system is suspect because of Evergreen's unique grading system. The truth of the matter is that Evergreen has a very high rate of graduate and career placement including a significantly high rate of acceptance to Harvard Law.
Where else are you guaranteed a student/professor ratio of no more than 27-1 in every single class? The importance of academic support cannot be overstated and at Evergreen you get it in spades. You'll find burn-outs and lazy imbeciles at Evergreen, sure, and perhaps the ratio is slightly higher than at other Schools but that doesn't negate the fact that I've gotten a better education at Evergreen than most people get at the UW, WSU, Western, etc...
And to the individual who claimed that no sophomore could be prepared to tackle a research project at the level of the project I worked on; how better to prepare yourself for higher level work than through trial-and-error? My product may not have been perfect but I learned more than a student sitting in a classroom all year and I know more about the Yugoslav wars (and by extension post-Ottoman ethnic conflict which includes most of the Middle East, booyah!) than any person I have ever met without a doctorate degree.
Washington Monthly College Rankings ranks The Evergreen State College as the 47th best Liberal Arts college in the U.S.
Let's get Real...:
You forgot to mention that Evergreen is ALSO listed as one of the 123 Best Western Colleges and as one of the best Value Colleges by the Princeton review.
Good job continuing the trend of selective citation in this argument. For fuck's sake people, get your facts right before you bash a school you know DICK about.
"Jews do not preach for a jihad against Arabs, nor do they teach their children that Arabs are descendants of pigs and apes and must be exterminated like scurrying mice."
They may not preach what they practice but there is no denying the fact that Israel has ghettoized the vast majority of the Palestinian Arabs. Perhaps Israelis do not explicitly teach their children that Palestinians are the descendantes of pigs and apes and must be exterminated like scurrying mice, but that is how they treat Palestinian Arabs.
"The Jews who do fight Arabs are in Israel, so they are actually Israelis and they fight resisting so-far unsuccessful Arab attempts to annihilate them. "
That is up for debate. Mainstream Arab nationalism in Palestine has gone through three stages: 1.) resistance (including genocidal calls for the extermination of all Jews); 2.) two-state solutions (which called on Israel to give Palestinian Arabs just a portion of their historic land); and 3.) pluralist state acceptance which most Palestinians are in favor of. However, Israel has consistently accepted the wrong solution at the wrong time and are in many ways moving backwards through that progression as their power and influence has grown.
"Israelis want nothing more than normalization and peace with their enemies. How have those responded? By launching terrorist attacks, and sending rockets into peaceful towns. By electing a genocidal government and declaratively insist that Israel must be wiped off the face of this earth."
You reference a completely unverified claim. According to the facts on the ground Israel apparently wants anything but peace. Palestinians are culpable for a great deal of inexcusable violence but so is Israel. Rocket attacks on "peaceful" Israeli towns by Palestinian "terrorists" are just half of a vicious cycle of violence. You are truly ignorant if you deny the fact that Israel goads reactionary Palestinian violence. I'm not saying that the violence is excused but simply stating that Israeli violence is also inexcusable.
Anybody knows good pornsites ????! )
let's exchange the links. my favorite http://freeadultdirect.com
post free links with videos, please.
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A documentary about Vermont Senator Bernie Sanders's bid to become the Democratic nominee is in the works, radio detection and rangingOnline.com has learned, and Hillary Clinton should be worried!
The project is a "tightly guarded secret" in Sanders's camp, according to a well-placed insider.
"The documentary doesn't even have an official title," the source said, but it's already coming together. "It will feature Bernie's historic run for president, including… Continue reading Look Out, Hillary! Bernie Sanders Secretly Filming Campaign Documentary


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Kmart has buy one get one 50% off on select Fisher Price, Mattel and Hot Wheels toys. They are also featuring the same deal on select V-Tech, LeapFrog, Disney, Nick and Sesame Street toys. All items are available for free in-store pickup or shipping to home starts at around $7. Free shipping on $59+.
Deal has expired


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Home Concert Tickets Hard Rock/Metal Black Sabbath
Black Sabbath Tickets
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I'm using SVN within Eclipse. Whenever I change a file I commit the changes. It works for everything except for three certain folders (which contain certain files) I cannot commit. When trying to commit them I receive the following error message:
workspace\yp\src\yp\forum\locale\cs is one of the three uncommitable folders. The folder definitely doesn't exist on the server yet, but I get the above error each time I'm trying to upload it.
How do I solve the problem?
EDIT: I've deleted the
.svn folders from the problematic directories. I still get the same error when trying to commit and the problematic directories have no
.svn folders.
EDIT: I'm still trying to fix the problem. Now I get another error message when trying to commit:
EDIT: Now I've tried to do
Team --> Cleanup and got that error message:


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Latest News
Web Date: June 27, 2007
Web Date: June 27, 2007
HHMI Will Require Free Access To Journal Articles
Biomedical institute's investigators must make papers publicly available beginning in 2008
Department: Science & Technology
Howard Hughes Medical Institute has announced a new policy regarding articles authored by biomedical researchers supported by the prestigious philanthropic organization. Beginning in January 2008, HHMI investigators will be required to publish only in those journals that make articles freely accessible in a public repository within six months of publication.
HHMI supports more than 300 investigators, some of whom publish in American Chemical Society journals. Investigators who publish in an ACS journal can . . .
You Do Not Have Access to C&EN Protected Content.
- Chemical & Engineering News
- Copyright © American Chemical Society


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I used to use "Category Description Editor" plugin and I've always think about "Media bar" to insert images solution. Your plugin doing such importamt thing well, but there is one problem here - it is removing
<br /> tags each time I loading some data to edit and each time when I try to save data back and when I toggle html to wysiwyg mode vice-verse.
remove_filter( 'pre_term_description', 'wpautop' ) helps to prevent "on load" filtering, but I can't find solution for other cases: toggling and saving.


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Started by
pstall, December 2, 2009
Posted December 2, 2009
Posted December 3, 2009
what channel is this on?
the four letter network
Posted December 4, 2009
I think I'm gonna freeze myself till June...............It could work.
draw is in five minutes.
if someone could post the groups here, that would be much appreciated!
I'll do it.
Group A
1. South Africa
2. Mexico
3. Uruguay
4. France
Group B
1. Argentina
2. Nigeria
3. South Korea
4. Greece
Group C
1. England
2. United States
3. Algeria
4. Slovenia
Group D
1. Germany
2. Australia
3. Serbia
4. Ghana
Group E
1. Netherlands
2. Denmark
3. Japan
4. Cameroon
Group F
1. Italy
2. Paraguay
3. New Zealand
4. Slovakia
Group G (Group of Death)
1. Brazil
2. North Korea
3. Ivory Coast
4. Portugal
Group H
1. Spain
2. Switzerland
3. Honduras
4. Chile
If we don't win it, I will be pulling for the Dutch.
I want England.
rep...multiple times over
I want England.
No you don't. You only want them if you're allowed to play multiple goalies.
YEAH!! Im a huge Eng fan as well. Gonna be tough.
I think we can get thru and I will double check but I think we play the winner of the Group with Brazil and Portugal. Not easy.


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Plane Crashes Near Quebec City, Killing Seven, Airport Says
A small plane crashed shortly after takeoff from the Quebec City airport today, killing all seven people on board, a spokeswoman for the airport said.
The twin-engine Beechcraft King Air turboprop, operated by closely held Aeropro, was on its way to Sept-Iles, Quebec, when it crashed into a backyard, airport spokeswoman Julianne Viens said in an interview. The aircraft was carrying two crew members and five passengers, Viens said. She didn't have the names of the people on board.
Police got a call about the crash around 6 a.m., according to a recorded message on the Quebec City police media line.
Founded in 1988, Aeropro runs business and recreational charter flights and has about 250 employees, according to its website. The company is based at Quebec City's Jean Lesage International Airport. Last month, four people died when an Aeropro-owned Cessna crashed on Quebec's Ile-aux-Grues.


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AUSTIN, Texas (AP) - Voters have a chance to cast ballots early for the Nov. 5 election involving nine proposed amendments to the Texas Constitution.
Early voting opened Monday and runs through Nov. 1. One proposal would use $2 billion from the state's Rainy Day fund to finance major water infrastructure projects.
Secretary of State John Steen says Texans can cast ballots at any early voting location in the same county as their registration. It's also the first statewide election with photo identification requirements for in-person voting, with seven forms of ID accepted. Common forms include a Texas driver's license, a U.S. military identification card or a passport.
Voters in state House District 50 will choose a replacement for Democrat Mark Strama of Austin, who resigned in July to join Google Inc.
(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)