text:
Return to Page 1 of this article.
The Logical Domains Manager on the source machine accepts the request to migrate a domain and establishes a secure network connection with the Logical Domains Manager that runs on the target machine. After this connection has been established, the migration occurs. The migration itself can be broken down into five different phases:
Figure 3. Live Migration Phase 1
The source machine begins to track which memory blocks of the active guest domain change during the migration operation. If the domain to be migrated is inactive or bound, the migration operation proceeds to Phase 5.
Figure 4. Live Migration Phase 5
The following examples use the
ldm migrate-domain command to migrate a guest domain from one system to another system.
You can optionally specify an alternate user for authentication on the target machine. See "Assign an Authorization to a User" in the Oracle VM Server for SPARC 2.1 Administration Guide of the documentation.
ldm migrate-domain -n command enables you to perform a dry-run migration, which performs migration checks but does not migrate the specified domain. Any requirement that is not satisfied is reported as an error, which enables you to correct any configuration errors before attempting an actual migration.
The following examples show various ways in which to perform domain migrations:
ldg1 domain to a target machine called
# ldm migrate-domain -n ldg1 t4-1 Target Password: password
ldg1 domain to a target machine called
# ldm migrate-domain ldg1 t4-1 Target Password: password
ldg1 guest domain to a target machine called
t4-1. The
-p option specifies the name of a file,
pfile, that contains the plain-text superuser password for the target machine, which enables you to access the
t4-1 target machine.
# ldm migrate-domain -p pfile ldg1 t4-1
Note: Ensure that you protect the file that contains the superuser password so that only the root owner, or a privileged user, can read it.
# chmod 400 pfile
ldg1 domain to a target machine called
t4-1 and specify an alternate user,
tracy, to be used for authentication on the
t4-1 machine.
# ldm migrate-domain ldg1 tracy@t4-1
For information about assigning an authorization to a user, see "Managing User Profiles" in the Oracle VM Server for SPARC 2.1 Administration Guide.
# ldm list -o status ldg1
Note: The migration time might vary depending on the amount of memory assigned and the network utilization.
The SwingBench kit contains a load generator and benchmarks that are designed to stress test an Oracle Database. The code that ships with SwingBench includes the OrderEntry, SalesHistory, CallingCircle, and StressTest benchmarks.
For this paper, the SwingBench OrderEntry workload was used to generate workload on the guest domain being migrated. OrderEntry is based on the
oe schema that ships with Oracle Database 11g. The workload introduces heavy contention on a small number of tables, and it is designed to stress the system interconnects and memory.
The following describes the workload that is being generated on the guest domain:
sga_target): 18 GB
The system global area (SGA) is a group of shared memory structures that contain data and control information for one Oracle Database instance.
users) for workload: 50 users
Table 1 shows the results of live migration operations that ran between two SPARC T4-1 servers.Table 1. SPARC T4-1 Server Live Migration Results
|Number of CPUs on the Control Domain
|Overall Migration Time
|Suspension Time
|Guest Domain CPU Usage
|8 CPUs
|8 min 12 sec
|26 sec
|16 CPUs
|4 min 2 sec
|13 sec
|24 CPUs
|2 min 3 sec
|7 sec
The following describes the live migration operation behavior that is typically seen when migrating a domain from one machine to another machine. Note that you might observe slightly different results because the migration time depends on the number of CPUs and the amount of memory assigned to the control domain, as well as the workload type.
mpstat command to observe the effect of system memory tracking on the guest domain's CPU. See the
USR column to view the usage for each CPU.
db_block_changes information in the Instance Activity Stats section of the generated AWR report. For more information about the AWR and AWR reports, see Section 5.2 ("Overview of the Automatic Workload Repository") in the Oracle Database Performance Tuning Guide.
This section contains information that is relevant to the Oracle VM for SPARC Live Migration feature, including configuring NTP and using CPU dynamic reconfiguration.
Ensure that the system clock on the domain to be migrated is synchronized by using NTP.
In this example, the control domain on the source machine is used as a time source, and it configured as an NTP server. Note that it is best to select an NTP server that can be a dedicated time synchronization source, so that other services are not negatively affected if the machine is brought down for planned maintenance.
The example in Listing 4 shows how to configure an NTP server.Listing 4. Configuring an NTP Server
# grep -v ^# /etc/inet/ntp.conf server 127.127.1.0 prefer broadcast 18.104.22.168 ttl 4 enable auth monitor driftfile /var/ntp/ntp.drift statsdir /var/ntp/ntpstats/ filegen peerstats file peerstats type day enable filegen loopstats file loopstats type day enable filegen clockstats file clockstats type day enable keys /etc/inet/ntp.keys trustedkey 0 requestkey 0 controlkey 0 # touch /var/ntp/ntp.drift # svcadm enable ntp
The following example shows how to configure an NTP client.
# grep -v ^# /etc/inet/ntp.conf server source prefer slewalways yes disable pll # svcadm enable ntp
Oracle VM Server for SPARC supports the dynamic reconfiguration of CPUs. CPUs can be dynamically added or removed from any active domain, including the control domain, by using the
ldm add-vcpu or
ldm rm-vcpu commands.
These commands can be issued from the control domain to increase or decrease the number of allocated CPUs. By increasing the number of CPUs on the control domain, migration time can be decreased. For systems that have discrete cryptographic units, such as the UltraSPARC T2, UltraSPARC T2 Plus, and SPARC T3 platforms, you should add cryptographic units to the control domain as you dynamically add CPU resources.
The following example shows how to add eight CPUs to the control domain:
primary# ldm add-vcpu 8 primary
After the migration operation is completed, you can remove the virtual CPUs from the control domain and allocate them to a different domain. The following example removes eight CPUs from the control domain and allocates them to the
ldg1 guest domain:
primary# ldm rm-vcpu 8 primary primary# ldm add-vcpu 8 ldg1
Note: When reducing the number of CPUs, ensure that a sufficient number of CPUs are still available to efficiently handle the domain's workload. For instance, an Oracle Database single-instance guest domain should always have at least eight CPUs.
An IT organization can reach tactical and strategic goals by choosing the right hardware and software to best manage application availability and to optimize data center resources.
This paper demonstrated the benefits of using the Oracle VM Server for SPARC 2.1 Live Migration feature to manage the production lifecycle of an Oracle Database 11g Release 2 single-instance database. This paper showed the complete configuration process, including the creation and configuration of the domains, storage configuration, and software that were used to demonstrate these benefits. In addition to showing the benefits of the Live Migration feature, this paper described how to achieve better application availability during planned downtime and how to reduce hardware and software costs by means of dynamic hardware resource management in a production environment.
For more information about Oracle's virtualization solutions, visit Oracle's virtualization Web site.
Orgad Kimchi joined Sun/Oracle in September 2007. He currently works in the Independent Software Vendors (ISV) Engineering organization to assist software vendors in adopting Oracle technology that improves the performance of Oracle hardware and software. See Orgad's blog.
Roman Ivanov joined Sun/Oracle in January 2006. He currently works in the ISV Engineering organization to assist software vendors in adopting Oracle technology that improves the performance of Oracle hardware. See Roman's blog.
Here are URLs for the resources referenced earlier in this document:
Return to Page 1 of this article.
|Revision 1.0, 02/23/2012
Follow us on Facebook, Twitter, or Oracle Blogs.


text:
Acquia.com and the Omega theme - getting down to brass tacks
In a previous post, I outlined our experience building a responsive design theme on the Omega theme. Here, I'll go into some details for those of you who enjoy the technical bits.
Just to recap, in early 2011, Kevin O'Leary, one of Acquia's UX Jedi, launched an effort to redesign the visual branding of Acquia. By May, the design work was far enough along to allow us to start developing a Drupal theme for a complete reboot of acquia.com. Michael Cooper lead the effort with his team including Mariano Asselborn, Yoni Gray, Rob Loach and Charlie Gordon. I joined their team for one three-week sprint in order to help them establish the framework of the base theme.
Selecting Acquia.com's base theme
Weeks before we started the themeing work for acquia.com, I had seen Jake Strawn present his work on the Omega theme at the Western Mass Drupal Camp. At the time, I had been working on an HTML5 theme for Drupal and reading about the then-maturing concept of responsive web design. Jake's work blew me away. It was exactly where I wanted to go with my own theme and there it was, coded and working.
Months later when I heard about the acquia.com reboot project in the office, I knew we needed to build it on Omega. The acquia.com web team, however, had already decided to move forward with Fusion. Fusion is robust, supported and configurable. As far as themes go, they don't get much better.
So I put together essentially the following arguments to convince the team to switch to Omega.
- Omega is built from the ground up following responsive web design principles. This means that it starts with a simple, one-column (mobile) layout and scales up to complex gridded layouts using media queries and 960.gs.
- The theme options are accessed through a slick configuration interface. CSS files includes, per-zone grid layouts and a debugging mode are available for tweaking through a GUI.
- The Delta module plays nice with the Omega theme giving themers the means to create conditionalized layouts with Features and Context.
- One of the reasons to use Fusion with Drupal 6 was the tight integration of the Skinr module. At the time this project started, Skinr did not yet have a Drupal 7 release. This eliminated a significant advantage that Fusion had over the still-maturing Omega theme.
Ultimately, we decided to build the acquia.com base theme (and its subsequent sub themes) on Omega.
Responsive design in the world of Drupal theming
When we started the acquia.com reboot project, the Omega theme was well along to an alpha release. But not all of the kinks had been worked out. Of the major issue we ran into, here are a few:
- Dealing with Internet Explorer version 8 and earlier. These versions do not recognize @media queries.
- Dealing with the Windows Phone browser that should ideally have a mobile layout. Because it uses an Internet Explorer version 6/7 hybrid browser, code to deliver a desktop layout experience to IE7 incorrectly serves a desktop layout to the mobile phone as well.
- Overriding multiple levels of stylesheets associated with specific media queries in several layers of sub themes (we had 4 in our architecture).
- Establishing adequate hooks for theming.
None of these were simple problems. Let me provide some detail around the first to illustrate what I mean.
Internet Explorer version 8 and older do not recognize CSS 3.0 @media queries. To be fair, most older versions of browsers do not recognize these queries, but at the moment, any major browser other than Internet Explorer supports @media queries at least two versions back. And these browsers have a higher rate of users updating to the current version. This means that one of the key issues with responsive design is dealing with Internet Explorer versions 7 and 8 (6 if you're unlucky).
Several other IE @media query polyfill solutions exist, but for one reason or another, none of them would work in the context of the Omega theme and Drupal. So it came down to a home-grown solution.
For the IE 7 and 8 problem, Sebastian and Jake worked out a way to deliver the normal.css stylesheet (for viewports at least 980px wide) to Internet Explorer versions 8 and older. Although a simple problem with just one stylesheet, this issue was compounded by the sub-theming capabilities of Drupal. The Omega theme as to deliver all the normal.css stylesheets from a theme and all its sub-themes in the correct order in the DOM. It took a little less than a day from when we first identified this issue to a working solution in the Omega repo.
Needless to say, I've never been so impressed by the speed and skill of coders as I was with Jake and Sebastian.
Responsive design is not easy
The right way and the easy way are often different ways entirely. This is very true for responsive design as I came to understand through the inaugural aquia.com development sprint and through observations of the network team's subsequent efforts to finish out the project. I remain convicted that responsive design is the standard by which all future web development will be evaluated - especially as the ecosystem of devices continues to fracture. I caution, however, that a paradigm shift in the architecture of front end interfaces requires a concomitant paradigm shift in a coder's understanding of front end development.
Responsive design starts not from the standard dimensions of design for desktop computer (i.e. 1013px max with a fold around 600px), but from the content - the raw, unstyled HTML document. It is a happy coincidence of recent web history that anyone accessing HTML documents was mostly likely at a computer with a screen of sufficient width and height to support multi-column layouts. The multiple column layout worked well for designers making the switch from print design to screen design as well. A main content column with a couple sidebars has analogs in magazine and newspaper layouts.
Starting from the raw, unstyled HTML document requires both designer and developer to consider how a page looks through a spectrum of device viewport sizes: from tiny mobile devices to larger format screens. For a designer, this might mean that he needs to create at least 4 versions of the same page at different widths. For a developer, this might mean she needs to style the same page across 4 stylesheets, each subsequent stylehseet building on and overriding styles from the previously loaded sheets.
For example, in the acquia.com theme, we have 4 stylesheets:
- small - 0px to 740px wide
- narrow - 741px to 979px wide
- normal - 980px to 1219px wide
- wide - 1220px and wider
The small stylesheets contains all of the basic typography as well as some basic layout styling. The narrow stylesheet assumes a columnar layout and optimizes styling for tablet-sized devices. The normal stylesheet optimizes styling for desktop screens. The wide stylesheet optimizes for large-format displays. In an instance when the viewport is larger than 1220px, all four of these stylesheets will be loaded into the browser and will have effect. In an instance when the viewport is smaller than 740px, only the small stylesheets will be loaded and take effect.
What we discovered during the acquia.com reboot project is that this added flexibility translates into increased design and development time. One could estimate the increase around 3x of the normal development time for a project. The benefit of taking this extra time is a robust and flexible theme that will remain relevant for a long time as new devices come to market.
Another consequence of spreading the styling of a web site across four conditionally-loaded stylesheets is the skill required of the developer to place style declarations in the right sheets. Personally, I found myself moving large chunks of code around in my stylesheets (multiple hundreds of lines) as I came to better understand the behavior of a responsive design theme. Most often I was moving styles from the more specific sheets (normal and wide) to the more general sheets (small and narrow). Given pressures to get a project done quickly, stylesheets for responsive designs quickly devolve into unoptimized tangles.
Lessons from working with Omega and building a responsive design theme
The initial release of acquia.com uses the Omega theme to deliver a desktop-optimized experience. The pressure on design resources, the extra time required to develop a responsive theme, and the lack of familiarity with the techniques of this new approach caused us to delay the implementation of a fully responsive design until Phase 2.
Even with the trade-offs we accepted to meet time to market, we have the following benefits at the end of Phase 1 because we leveraged the Omega theme:
- We were able to easily configure the theme to just render desktop-optimized layouts, essentially hiding the mobile-optimized media query matching.
- The responsive design capabilities of the theme are still present. We can now very easily build out a mobile-optimized component of the theme and push it to production without rearchitecting the theme.
- Omega's integration with the Delta module means that if we need a mobile-optimized page or set of pages, we can create a Context and Delta combination for specific URL paths that enables small screen matching matching media queries across constrained portions of the website.
We took the following lessons away from the acquia.com reboot project and our experience working with the Omega theme.
- Responsive design is the ideal state of front end development. Given the resources and the talent, all work should be going in this direction.
- The Omega theme is the current state-of-the-art for responsive design on Drupal; it's a model for other CMS's as well.
- Developing a responsive theme requires more resources - time and skill.
- A development team should either be trained in the techniques of responsive development or committed to establishing them in their practice.
- Designers must be involved in establishing the look and feel of pages for all viewport size buckets that the code will target with the @media queries.
We at Acquia are taking what we learned in this project and applying the lessons to the work in our pipeline. We've always had passion for incredibly web experiences. Now that we have powerful tools like the Omega theme to let us build even better ones.
Many thanks!
All of the credit for the coding and implementation of the amazing Omega theme goes to Jake Strawn and Sebastian Siemssen (fubhy). These guys were phenomenal. In the three weeks I was working on the theme, they put out five major releases including the first alpha release. Often times I'd report an issue to Sebastian and it would be resolved and pushed to the repo in under 10 minutes..and this at 7pm EST and Sebastian over in Vienna, Austria!
The lion's share of the Acquia theming work belongs to Michael Cooper's team. It's one thing to put together abstract stylesheets, but the details, those persnickety, endless details are what front end design is all about. The Acquia Network team performed the magic of updating reams of legacy pages to a drastically new theme. I hope I get to work with them again soon!
I am thrilled that I had the opportunity to work with Jake and Sebastian putting the new acquia.com theme together. It showed me that Drupal not only remains relevant in the current world of web development; it also continues to establish the definition of best practice in emerging front end development techniques.

subset: commoncrawl


text:
Find a Course
In October 2012, the Association of Clinical Research Professionals (ACRP) Research Triangle Park Chapter awarded Susanne Scarth, a student in Durham Technical Community College's Clinical Trials Research Associates (CTRA) Program, with a $500.00 scholarship towards books and tuition, at an awards breakfast, which was attended by the 2012 chapter Vice President. The 2011 scholarship recipient was Rose Bowman. The scholarships are only for CTRA students and there is one award given per scholarship cycle. The CTRA program prepares individuals to assist investigators and clinical researchers in all facets of clinical research trial involvement. Students apply this knowledge is a variety of venues including hospitals, pharmaceutical and biotechnology companies, or contract research organizations.
Laurin Mancour, Durham Tech's director and instructor for CTRA, is a chapter member and serves as Lead Chair of the global ACRP organization. Mancour cites the commitment of ACRP members as a vital resource for the college's students for many reasons, including providing $500 scholarships.
Mancour was recognized by the organization in 2011, receiving the "Advancing Awareness in Clinical Research Award" in appreciation for her contributions to public understanding and advancement of the profession
[2012 CTRA Program Scholarship Winner Susanne Scarth (left) with 2013 Chapter President April Mayberry (right)]
Along with the student scholarship, the RTP Chapter provided a $500 grant to the DTCC CTRA Program.
In addition to monetary contributions, ACRP RTP has supported the CTRA program in other ways, such as establishing an Internship program with the DTCC CTRA Program, with 3 interns in 2012 to help with the chapter's various activities, giving them the chance to network with clinical research leaders in our area and learn about the broad aspects of the profession. This program will continue this year and the chapter currently has 2 interns.
ACRP RTP also sponsored a table at the DTCC CTRA Career Fair in November 2012 to answer questions from students about working in the clinical research industry, inform them about ACRP and provide information about certification
Denise Wotovich lead the 2012 ACRP Awareness campaign. With the assistance of Compton Gift, Linda Karolak and Jill Molek, this campaign went out to several local Clinical Research Companies to conduct "Lunch and Learn" sessions in early May 2012. These sessions occurred at PRA International, GSK, and Quintiles, where chapter members discussed the benefits of ACRP membership, the local chapter, certification and our annual Fall Conference. There was a lot of interest generated for the chapter and the RTP Chapter looks forward to continuing these events as the annual conference approaches. This was a new, effective and creative way to increase our chapter awareness and provide the clinical community with insight into ACRP. It also allowed several chapter members to be seen as leaders in their community and the chapter. The 2013 Lunch and Learn sessions are marked to begin this spring.
To further expand awareness about ACRP and the RTP Chapter, members also brought the ACRP RTP booth, and provided volunteers and sponsorship at South Atlantic National Research Conference: "Engaging the Community for Research Success: What Scientist and IRBs Need to Know" – Hosted by US DHHS, NIEHS, and OHRP. At this meeting Chapter representatives shared educational materials and information about membership and certification.
CROP is an initiative of the Research Triangle Park Chapter geared towards Triangle area middle and high-school students who are exploring their career options. The goal of this program is to raise awareness about the clinical research field and career options within it, with the hope that this will encourage more young people to enter this profession; and for students who are interested in pursuing a clinical research career, to put into place resources to help them develop into well-qualified, value-added professionals with a competitive edge when they enter the clinical research industry. Secondarily the hope is that CROP will contribute to the overall quality of the North Carolina clinical research work force.
Many inspiring CROP activities are being planned and ACRP RTP is excited to launch this new outreach project by participation in a series of school sponsored career events. The Chapter will bring its exhibit to career fairs and do in-school presentations about clinical research careers. This series starts with a Friday, February 15th Career Fair at Wakefield High School, in Raleigh. Other CROP offerings will include educational opportunities and an essay contest.
On October 27th, ACRP RTP sponsored an exhibit at the "Aware for All in the Triangle -Clinical Research Education Day." where chapter volunteers interacted with community members and answered questions about clinical research. It was hosted by CISCRP (Center for Information & Study on Clinical Research Participation) to raise awareness among the public about participation in clinical research. Attendees were educated about:
[ACRP RTP Chapter Volunteers at the 2012 Aware for All Clinical Research Education Day]
"AWARE for All in the Triangle" was free and open to the public for the purpose of providing education to help people make informed decisions about clinical research participation. It was advertised throughout the community and over 1500 pamphlets were distributed, 100 organizations contacted; and ACTP RTP volunteers met with over 25 local organizations personally to educate the community on the benefits and risks of trial participation.
As "AWARE for All" volunteers, several Chapter members completed the "Clinical Trials Ambassador Certification", to assure that they understand the basic principles of research and ICH GCP Guidelines. They are then qualified by CISCRP to work with potential subjects and explain the process of trial participation.
ACRP RTP outreach activities are not limited to the clinical research community, and include providing toiletries and other support for the Durham Rescue Mission, food drives, bringing a group of volunteers to the UNC Public Radio telethons and offering free ads for non-profit organizations in the Annual Fall Conference Program.
This spring the RTP Chapter also adopted the Little Lick Creek, near RTP in Durham County, under the NC StreamWatch Program and on Saturday, March 16th the Chapter will kick-off by hosting a clean-up day in conjunction with NC Creek Week. During this event chapter members will meet to clean the waterway and trails and monitor stream health.
The RTP Chapter offers volunteer opportunities for members of the RTP clinical research community, as well as students of the DTCC CTRA Program and Clinical Trials Professional Certificates Programs.
ACRP RTP has a growing force of dedicated core volunteers, who are instrumental in achieving organizational goals. The Chapter truly appreciates this invaluable support and wants to express its deep gratitude to this fantastic group of people who enthusiastically work behind the scenes to make this one of the most dynamic chapters in the country.
Privacy Policy
99 Canal Center Plaza | Suite 200 | Alexandria, VA 22314
T: +1.703.254.8100 | F: +1.703.254.8101 | E: email@example.com
© 2016 Association of Clinical Research Professionals
All Rights Reserved. Privacy Policy.
Be a Part of ACRP's Global Community!


text:
Bus-Passes instead of Mercs?
Deaglán de Bréadún
Dail Deputies Liz McManus and Olwyn Enright will be missed in Leinster House. They both had plenty still to contribute. Surprised, though, that Age Action or other group of that nature did not complain about Liz's reported statement that the didn't want to be a TD with a bus-pass. If more TDs had bus-passes, inlcuding ministers and junior ministers, the public purse would save a fortune. No more "mercs and perks".


text:
Download citation file:
From Global Health Sciences, University of California, San Francisco, San Francisco, California.
Grant Support: None.
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1301.
Requests for Single Reprints: Andrew Anglemyer, PhD, MPH, University of California, San Francisco, UCSF Box 1224, 50 Beale Street, Suite 1200, San Francisco, CA 94143; e-mail, firstname.lastname@example.com.
Current Author Addresses: Drs. Anglemyer and Rutherford and Ms. Horvath: University of California, San Francisco, UCSF Box 1224, 50 Beale Street, Suite 1200, San Francisco, CA 94143.
Author Contributions: Conception and design: A. Anglemyer, G. Rutherford.
Analysis and interpretation of the data: A. Anglemyer, G. Rutherford.
Drafting of the article: A. Anglemyer, T. Horvath.
Critical revision of the article for important intellectual content: A. Anglemyer, G. Rutherford.
Final approval of the article: A. Anglemyer, T. Horvath, G. Rutherford.
Provision of study materials or patients: A. Anglemyer.
Statistical expertise: A. Anglemyer.
Administrative, technical, or logistic support: A. Anglemyer, T. Horvath, G. Rutherford.
Collection and assembly of data: A. Anglemyer, T. Horvath.
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
Background: Research suggests that access to firearms in the home increases the risk for violent death.
Purpose: To understand current estimates of the association between firearm availability and suicide or homicide.
Data Sources: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched without limitations and a gray-literature search was performed on 23 August 2013.
Study Selection: All study types that assessed firearm access and outcomes between participants with and without firearm access. There were no restrictions on age, sex, or country.
Data Extraction: Two authors independently extracted data into a standardized, prepiloted data extraction form.
Data Synthesis: Odds ratios (ORs) and 95% CIs were calculated, although published adjusted estimates were preferentially used. Summary effects were estimated using random- and fixed-effects models. Potential methodological reasons for differences in effects through subgroup analyses were explored. Data were pooled from 16 observational studies that assessed the odds of suicide or homicide, yielding pooled ORs of 3.24 (95% CI, 2.41 to 4.40) and 2.00 (CI, 1.56 to 3.02), respectively. When only studies that used interviews to determine firearm accessibility were considered, the pooled OR for suicide was 3.14 (CI, 2.29 to 4.43).
Limitations: Firearm accessibility was determined by survey interviews in most studies; misclassification of accessibility may have occurred. Heterogeneous populations of varying risks were synthesized to estimate pooled odds of death.
Conclusion: Access to firearms is associated with risk for completed suicide and being the victim of homicide.
Primary Funding Source: None.
Firearms cause an estimated 31 000 deaths annually in the United States (1). Data from the 16-state National Violent Death Reporting System indicate that 51.8% of deaths from suicide in 2009 (n = 9949) were firearm-related; among homicide victims (n = 4057), 66.5% were firearm-related. Most suicides (76.4%) occurred in the victims' homes. Homicides also frequently occurred in the home, with 45.5% of male victims and 74.0% of female victims killed at home (2).
Firearm ownership is more prevalent in the United States than in any other country; approximately 35% to 39% of households have firearms (3–4), and 22% of persons report owning firearms. The annual rate of suicide by firearms (6.3 suicides per 100 000 residents) is higher in the United States than in any other country with reported data, and the annual rate of firearm-related homicide in the United States (7.1 homicides per 100 000 residents) is the highest among high-income countries (4). Results from ecological studies suggest that state restrictions on firearm ownership are associated with decreases in firearm-related suicides and homicides (5).
Specific characteristics about storage and types of firearms seem to increase suicide risk. Firearms that are stored loaded or unlocked are more likely to be used than those that are unloaded or locked (6–7), and adolescent suicide victims often use an unlocked firearm in the home (8). The apparent increased risk for suicide associated with firearms in the home is not unique to persons with a history of mental illness (7) and may be more of an indicator of the ease of impulsive suicide.
Impulsiveness may be a catalyst in using a firearm to commit suicide and may also play a role in firearm-related homicide. Researchers have estimated higher odds of homicide victimization among women than men (9–10). Because most homicide victims know their perpetrators (9), this finding may indicate an impulsive reaction to domestic disputes.
To our knowledge, this is the first systematic review and meta-analysis to estimate the association between firearm accessibility and suicide or homicide victimization.
We used Cochrane Collaboration methods (11) throughout the review process.
We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science without date, geographic, or language limitations. We also examined bibliographies of included articles to identify additional references. In addition, we searched the gray literature for papers related to firearms and suicide or homicide. The Appendix and Appendix Table 1 (both available at www.annals.org) present details of our search strategy and screening process.
Study designs eligible for inclusion in our review were randomized, controlled trials; nonrandomized, controlled trials; pre- or postintervention evaluations; and observational studies (for example, cohort or case–control studies) if a comparator was available. Because we were concerned with the individual effects of firearm accessibility, we included only studies with individual-level data and excluded those with population-level data (for example, ecological studies).
Participants were not restricted by age, sex, or country of residence.
Studies needed to assess whether firearms were available for all participants. In addition, included studies needed to assess outcomes between participants with and without access to firearms. Specifically, studies needed to compare firearm ownership or availability (that is, accessibility) with no firearm ownership or availability (that is, no accessibility) or provide adequate data to estimate the effect that firearms had on selected harms outcomes. Firearm accessibility could be defined as self- or proxy-reported or assumed from other types of exposure data (for example, firearm purchase records).
The primary outcomes of interest were suicide or homicide victimization (that is, being a victim of homicide rather than a perpetrator).
Two authors independently extracted relevant data into a standardized, prepiloted data extraction form.
Two authors independently assessed the risk of bias for each study by using the Newcastle–Ottawa Scale (12–13). We resolved disagreements by discussion or by involving the third author to adjudicate (Table 1 and Appendix Table 2).
When necessary, we calculated the odds ratio (OR) and 95% CI for dichotomous outcomes, although published adjusted estimates were preferentially used if provided in the report. We pooled data across studies and estimated summary effect sizes by using fixed- and random-effects models. The choice of model was determined by the significance of the maximum likelihood estimate of the heterogeneity parameter (τ2) (14).
If the estimate of τ2 did not significantly differ from 0, the fixed-effects model was used (14). We present 2 estimates of heterogeneity—the I2 statistic and the τ coefficient. Estimates of the former are interpreted as the percentage of variability in effect estimates due to heterogeneity rather than chance, whereas the latter can be interpreted as the clinical heterogeneity as determined by the estimated SD of underlying effects across studies. Unlike the I2 statistic, the τ coefficient does not change with the number of patients included in the studies in a meta-analysis (15). We used R, version 3.0.0 (R Foundation for Statistical Computing, Vienna, Austria), for statistical analyses. The τ coefficient was measured on the log OR scale.
This review is registered in PROSPERO (CRD42013004469).
The database searches yielded 6902 references (Figure 1). We removed 2929 duplicates and an additional 2881 clearly irrelevant references. We then identified 2382 records through gray-literature searches. We closely reviewed 3474 titles and abstracts. After this screening, we selected 70 articles for full-text review. We identified an additional 4 studies by cross-referencing bibliographies (16–19). Overall, 16 observational studies met our inclusion criteria. The Appendix shows the disposition of studies excluded after full-text review.
Summary of evidence search and selection.
Fourteen of the included studies estimated the odds of suicide in the context of firearm accessibility (6–8, 10, 16–25), and 6 studies estimated the odds of homicide victimization in this context (9–10, 22–24, 48). Four studies reported both outcomes (10, 22–24).
Persons who completed suicide (mean, 75% [range, 70% to 85%]) (6–8, 10, 16–21, 23) and homicide victims (mean, 79% [range, 63% to 92%]) (9–10, 23, 48) were more commonly men. Most persons who completed suicide were white (range, 78% to 98%) (6, 8, 10, 16–19, 21, 23, 26), whereas most homicide victims were non-Hispanic black or another race (range, 47% to 88%) (9–10, 23, 48). Four (28.6%) of the 14 suicide studies were among adolescents only (6, 8, 16–17), and 10 (71.4%) were among adults only (7, 10, 18–25). All studies of outcomes of homicide victimization were among adults only (9–10, 22–24, 48).
Among 11 U.S. case–control studies using survey data, proportions of firearm access ranged from 62.7% to 75.4% among case patients and from 26.4% to 50.8% among controls participants. One non-U.S. study (20) used survey data to estimate the proportion of case patients (23.9%) and control participants (18.5%) with firearm access, and another non-U.S. study (25) assumed firearm access from military duty and estimated the proportion of case patients (41%) and control participants (17%) with access. Among U.S.-based studies with reported data, the proportion of completed suicides using a firearm ranged from 47% to 73% (6–7, 10, 16–17, 21–24); 3 studies did not report adequate data (8, 18–19).
One non–U.S.-based study of civilians reported that 13% of suicides were completed using a firearm (20), whereas another non-U.S. study of military personnel reported that 52% of suicides were completed using a firearm (25). The proportion of homicides using a firearm ranged from 50% to 76% (13, 15, 27–29).
Eleven of 14 studies (78.6%) interviewed proxies to determine firearm accessibility among decedents or control participants (6–8, 10, 16–21, 23), whereas 3 studies (21.4%) used firearm purchase records or military duty to determine accessibility among decedents or control participants (22, 24–25) (Table 2). Twelve studies (85.7%) defined suicide as self-inflicted, intentional death by any means (6–7, 10, 16–23, 25), whereas 2 studies (14.3%) defined suicide as injury related only to firearms or firearm- or violence-related injury (8, 24). All suicides were reported consecutively or identified using death certificates. In case–control studies, various types of control participants were identified, such as inpatients who attempted suicide (14.3%) (16–17), community or school control participants (42.9%) (6–8, 18, 20–21), decedents from causes other than suicide (28.6%) (18–19, 24–25), participants in a national health survey (7.1%) (10), or living HMO-based control participants (7.1%) (22).
Three of 6 studies (50.0%) interviewed proxies to determine firearm accessibility in the home of decedents or control participants (Table 1) (9–10, 23). Two studies (33.0%) used firearm purchase records to determine firearm accessibility of decedents or control participants (22, 24). In the 3 studies that used survey data, proportions of case patients with firearm access ranged from 30.7% to 45.4% and proportions of control participants ranged from 32.0% to 35.8%. Four studies (66.7%) defined homicide victimization as intentional death by any means, and 1 defined it as firearm- or violence-related injury (24). All homicides were reported consecutively or identified by using death certificates. In the 5 case–control studies with homicide outcomes, various types of control participants were identified, including community or school control participants (40.0%) (9, 48), nonhomicide decedents (40.0%) (10, 24), or living HMO-based control participants (20.0%) (22).
Three case–control studies had potential selection bias resulting from how control participants were selected (16–17, 22). Cummings and colleagues (22) used an HMO population as the source of their control participants, whereas 2 other studies used inpatient hospital control participants (16–17). Using HMO or inpatient hospital control participants can violate principles in control selection—namely, that firearm accessibility for control participants may not be the same as that in the study base (30). This bias may occur when patients use the HMO system or hospital to seek care for suicidal planning with firearms as the means. Two studies (16–17) are especially prone to the Berkson bias—that is, firearm access is related to inpatient hospitalization due to suicidal planning (31).
Five studies of suicide had potential comparability bias resulting from a lack of adequate adjustment for major confounders (for example, history of mental illness) (10, 16, 22, 24–25). Specifically, 1 study's authors describe significant differences between case patients and control participants with regard to some diagnoses of mental illness, although these are not adjusted for in the model with firearm accessibility (16). Four other studies did not report data on history of mental illness (10, 22, 24–25). Similarly, 3 studies of homicide victimization had potential comparability bias resulting from a lack of adequate adjustment for major confounders (for example, arrest history of someone in the household) (10, 22, 24). In turn, it was not possible to discern whether domestic violence or arrest history differ between homicide case patients and control participants, which may have resulted in confounding.
Eleven of 14 studies of suicide and 2 of 6 studies of homicide had potential exposure bias due to unblinded interviews of proxies of case patients and control participants or differential nonresponse rates between case patients and control participants (6–10, 16–21, 23). Specifically, these studies used surveys to collect data on firearm accessibility; proxies for case patients and control participants knew their case patient or control participant status, thereby potentially biasing recall of firearm accessibility. Finally, although 7 case–control studies reported equal nonresponse rates between case patients and control participants (6, 9–10, 20, 22, 24–25), 7 others did not report this (7–8, 16–19, 21), potentially leading to differential misclassification of firearm exposure.
We pooled data from 14 identified observational studies that assessed the odds of suicide (6–8, 10, 16–25) and, using a random-effects model, calculated a pooled OR of 3.24 (95% CI, 2.41 to 4.40) with substantial heterogeneity (I2 = 89%; τ = 0.45) (Figure 2). All but 1 study (20) found significantly higher odds of suicide among participants who had firearm access than among those who did not, with ORs ranging from 1.38 to 10.38.
Odds of suicide and homicide in the context of firearm access.
Horizontal lines indicate 95% CIs, squares reflect point estimates, and the size of the squares is proportional to the study's weight. The diamonds reflect the pooled estimate across all studies, and the solid vertical lines reflect the null hypothesis.
We also pooled data from 6 studies that assessed the odds of homicide (9–10, 22–24, 48) and, using a random-effects model, estimated a pooled OR of 2.00 (CI, 1.56 to 3.02) with substantial heterogeneity (I2 = 63%; τ = 0.22) (Figure 2). All studies found significantly higher odds of homicide victimization among participants who had access to a firearm than among those who did not, with ORs ranging from 1.41 to 3.54.
To determine the effect that differences between subgroups had on pooled estimates, we stratified results by sex, age (adolescent or adult), year of publication (before 1997 or 1997 to 2013), location of death (in home only or not in home only), and risk of bias (high or moderate to low) (Figure 3). Most tests for interaction between subgroups were not statistically significant, although women had significantly higher odds of homicide victimization than men (P < 0.001) and studies with moderate or low risk of bias yielded higher odds of homicide victimization than high-risk studies when firearm access was compared with no access (P < 0.001).
Meta-analyses estimating the odds of suicide and homicide between subgroups.
Horizontal lines indicate 95% CIs, squares reflect point estimates, the diamonds reflect the pooled estimate across all studies, and the solid vertical lines reflect the null hypothesis. The τ estimate was not reported in fixed-effects models. NA = not applicable.
* The τ estimate is on the log odds ratio scale.
† Fixed-effects models.
‡ No meta-analysis was performed.
We performed a systematic review and meta-analysis of all studies that compared the odds of suicide or homicide victimization between persons with and without reported firearm access. All but 1 of the 16 studies identified in this review reported significantly increased odds of death associated with firearm access. We found strong evidence for increased odds of suicide among persons with access to firearms compared with those without access (OR, 3.24 [CI, 2.41 to 4.40]) and moderate evidence for an attenuated increased odds of homicide victimization when persons with and without access to firearms were compared (OR, 2.00 [CI, 1.56 to 3.02]).
Although our study attempts to quantify a person's risk for suicide and homicide in the context of firearm access, many studies have used population-level data to describe the public health risk in terms of aggregate firearm ownership (34–48). Reported proportions of U.S. households and persons with access to firearms are the highest in the world (3–4), whereas rates of firearm-related deaths are among the highest among high-income countries (4).
It has been suggested that higher rates of suicide and homicide in areas with the highest rates of gun availability may indicate impulsivity and ease of locating firearms (37, 49). In addition, although a public health approach to prevention that entails restriction of access to firearms may lead to violent death by other means, the increased rates of violent death (suicide and homicide) in states with the highest rates of firearm access were attributable more to firearm violence than to nonfirearm violence (37).
Sex-specific subgroup analyses suggest that men with access to firearms have statistically nonsignificant higher odds for committing suicide than women (ORs, 3.71 and 3.56, respectively). Moreover, the nonsignificant pooled OR of suicide among women when firearm access was compared suggests that evidence of an increased risk for suicide among women may not be very strong when all of the available literature is considered. Recent research that found that women are less likely to achieve suicide completion by firearm or hanging and are nearly 4 times more likely to use poison than men (OR, 3.65 [CI, 1.87 to 7.09]) (50) seems to support these findings.
Although men with access to firearms may have higher odds of committing suicide than women, women have higher odds of homicide victimization. The tests for interaction between sex subgroups in our meta-analysis were significant in fixed-effects models (P < 0.001). Although men account for more than three quarters of all suicides and homicides, women with firearm access have a higher risk for homicide victimization, a finding that previous studies support (9–10). Of note, in our review, homicide was the result of victimization rather than perpetration. Furthermore, empirical evidence suggests that most homicide victims know their assailant (10, 24), which suggests an interpersonal dispute within the household or other domestic violence and not an unknown intruder.
Our results suggest that the pooled OR of suicide is similar between adults and adolescents (ORs, 3.34 and 2.56, respectively; P value for interaction = 0.31). To determine the extent to which data from firearm purchases or military duty contribute to the effects seen among adults, we performed a sensitivity analysis that excluded studies with those data; the pooled OR for suicide among adults was slightly decreased (3% reduction; pooled OR, 3.25) in this analysis. We performed an additional sensitivity analysis that excluded the remaining non-U.S. study, and the pooled OR increased slightly (9% increase; pooled OR, 3.64). Tests for interactions among age subgroups remained nonsignificant (P = 0.170), although estimates for adults were more than 40% higher than those for adolescents. Accessibility may explain part of the difference in risk between adults and adolescents; adults typically purchase and store the firearms, and improper storage practices pose a serious risk because they have been previously associated with adolescent suicide (51).
The availability of firearms in the home may not be the catalyst for suicidal ideation, but firearms may be a preferred method of suicide among those who have suicidal thoughts. Betz and colleagues (52) found that adolescents with firearm access were no more likely to have suicidal thoughts or a suicide plan in the past 12 months than those without firearm access. However, among adolescents with a suicide plan, those with a firearm in the home were more than 7 times more likely to have a plan involving firearms than those without a firearm in the home (OR, 7.39 [CI, 2.04 to 26.84]) (52).
Since 1996, federal law has prohibited U.S. Department of Health and Human Services agencies from using funds for research that could be interpreted as promoting or advocating for gun control (53). Although we anticipated a lower absolute number of studies since 1996, we found that 63% of all studies (n = 10) were published from 1997 to 2013 compared with 37% published before 1997. Similarly, a recent study of publication rates of studies of firearm-related death among youths found an increase in publications (54). The investigators found that, although the rates of publication increased, the relative increase was lower than among publications of other leading causes of death among youths, and models exploring the effects of the federal law passed in 1996 did not suggest a temporal pattern in publication (54).
We also stratified our pooled results by risk of bias and found no significant difference between studies with high risk and those with moderate or low risk (ORs, 3.43 and 3.23, respectively). To the extent that we measured bias in the studies of suicide, we were not able to detect any influence of these biases in the pooled results. Among studies with only moderate or low risk of bias that evaluated the effect of firearm ownership on homicide, the pooled OR was 2.36 (CI, 1.81 to 3.01), which is 18% higher than the pooled OR that included all studies, suggesting that the higher bias in homicide studies may trend estimates toward the null.
Our review has limitations. First, our conclusions are only as good as the data and studies that we identified. To minimize this limitation, we searched extensively by using standardized search strategies from the Cochrane Collaboration to identify all relevant studies. Studies of death commonly have a case–control design, although the cohort study included in our meta-analysis found results similar to those of the case–control studies. In addition, although we limited our analysis to individual-level data, we acknowledge that several available ecological studies have also explored the link between firearms and violent death (5, 55). Among other concerns, we decided not to include population-level data because we were concerned about ecological bias; for example, gun ownership data on a population level may not reflect the persons who actually commit suicide, so no true link between gun ownership and harms outcomes can be made. Despite their limitations, individual-level data, such as those we included in this study, are ideal because confounding and explanatory reasons for the relationship among firearms and suicide and homicide can be better explored.
Second, misclassification of firearm exposure and cause of death is a potential risk in included studies. Although all studies of homicide were among adults, causes of firearm-related deaths are inconsistently reported as homicide or accidental, particularly among children (56). In fact, in some cases, accidental firearm-related deaths among children may be classified as homicide due to an unsecured firearm or as a result of a medical examiner's decision that any death resulting from 1 person shooting another, regardless of intent, is a homicide (56). Further, to determine firearm availability, proxies were interviewed in 79% of studies evaluating suicide outcomes and 50% evaluating homicide outcomes. However, evidence suggests apparent differences between sexes in describing firearm ownership or firearm storage within the same household (57–58). In fact, husbands are most often acknowledged by both men and women to be the person responsible for firearm storage and ownership (58), a sex gap that may introduce selection bias in proxy interviews.
Third, we synthesized heterogeneous populations of varying risks to estimate pooled ORs of death. We analyzed our pooled data by using fixed- and random-effects models but note that fixed-effects models only marginally changed pooled effects in the suicide outcomes and all models retained statistical significance. Specifically, when fixed-effects models were used instead of random-effects models, the pooled ORs changed from 3.24 to 3.32 for suicide and from 1.94 to 1.65 for homicide. Moreover, for the 11 U.S. studies that used survey data to classify firearm exposure, proportions of case patients with gun access were closely related, ranging from 62.7% to 75.4%. The reported proportions of control participants with gun access varied more, from 26.4% to 50.8%. Perhaps as a reflection of different firearm ownership culture or restrictions, the only non-U.S. study in a civilian population used survey data and estimated the proportions of suicide case patients and control participants with firearm access to be considerably lower than those in U.S. studies (23.9% and 18.5%, respectively) (20).
Fourth, we considered studies of suicide and homicide victimization by any means, and firearm-specific outcomes may differ. In addition to the other differences between U.S. and non-U.S. studies, 47% to 73% of suicide cases in the United States were firearm-specific compared with only 13% of cases in the study of non-U.S. civilians (20). When considering suicides by nonfirearm methods in the identified literature, researchers have generally found reduced odds of suicide completion by any means other than a firearm, comparing firearm accessibility (OR range, 0.68 to 0.90) (7, 10, 22, 24). Among homicide victimization studies, none reported a significant finding for homicides that are not firearm-specific, although the proportion of homicides in which firearms was used ranged from 50% to 100% (9–10, 22–24, 48).
Fifth, in studies with homicide outcomes, whether the presence of a firearm among case patients is the result of environmental characteristics or living conditions is unclear. For example, some persons may purchase a firearm for protection because of neighborhood crime, which then translates the risk from the ownership of a firearm to the neighborhood. Also, in homicides, the case patients are by definition deceased and injuries due to firearms may be more lethal than other means; thus, assault by other means would be less likely to be captured (59).
Finally, other sources of bias are an ever-present threat. Among them, using firearm purchase data or military duty as a proxy for firearm access or ownership may not accurately represent ownership. The pooled OR for suicide in our random-effects meta-analyses with data from firearm purchase or military duty was only 3.2% higher than the pooled OR without these studies (3.24 and 3.14, respectively). In contrast, the pooled OR for homicide in the random-effects meta-analyses with firearm purchase data was 29.9% higher than the pooled OR (fixed-effects) without these studies (2.00 and 1.54, respectively), although this is probably partly an artifact of model specification. Finally, although publication bias is a concern, the Egger regression tests for asymmetry of the funnel plot (27) for suicide studies were not significant (P = 0.88). However, we identified too few studies of homicide to reasonably assess publication bias.
In summary, we found the association between firearm availability and homicide to be more modest than that between firearm availability and completed suicide. Future studies of firearm access and homicide risk should focus on the role that social factors and surrounding living conditions play in homicide victimization. Furthermore, the National Research Council has acknowledged the difficulty in establishing firearm ownership in studies because of privacy and questionable legality concerns (28). As such, it recommended that researchers receive adequate access to data to trace firearms (28). Future studies of the effect of firearms used in violent injuries may, as a result, have a lower risk for misclassification of firearm ownership and yield more methodologically robust results. Nonetheless, the evidence that we synthesize here helps to elucidate the risks of having a firearm in the home; restricting that access may effectively prevent injury (29).
One investigator reviewed the titles and abstracts identified in the initial search to assess potential relevance to the topic. After removing irrelevant titles, 2 investigators independently read the titles, abstracts, and descriptor terms of the remaining citations to identify eligible reports. We obtained full-text articles for all citations identified as potentially eligible, and 2 investigators independently determined the relevance of the articles according to our inclusion criteria.
When there was uncertainty about a study's eligibility, we obtained the full-text article. The 2 investigators independently applied the inclusion criteria, and any differences were resolved by discussion with the third investigator. We reviewed studies for relevance based on design, types of participants, and outcome measures.
Of the full-text articles that we reviewed, 3 were excluded because the study populations were contained in previously published data included in this review (26, 32, 60), 16 were ecological studies comparing aggregate data between populations (34–47, 61–62), 15 were only descriptive (2, 52, 63–76), 1 estimated only the victimization rates (nonfatal) of firearm owners (76), 3 were reviews (77–79), 7 did not evaluate our selected harms outcomes (80–86), 7 studied only unintentional firearm death (33, 87–92), 1 did not evaluate firearm access (93), and 4 were editorials (94–97). Overall, 16 observational studies met our inclusion criteria.
Please read the other comments before posting. Contributors must reveal any conflict
of interest.
Comments are moderated and will appear on the site at the discretion of The American
College of Physicians editorial staff. Please be sure your email address is
updated in your account, otherwise the American College of Physicians will not be
able to contact you about your comment.
Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article's publication will be considered for print publication. One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. (Not peer reviewed)
Authors: No more than 5
Text: Word Limit 400 (excludes references), 5 references, no figures or tables
* = Required Field
Disclosure of Any Conflicts of Interest*
(applies to the past 5 years and foreseeable future) Indicate any potential conflicts
of interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.
Terms of Use
The In the Clinic® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of the ACP.
The slide sets may be used only by the person who downloads or purchases them and
only for the purpose of presenting them during not-for-profit educational activities.
Users may incorporate the entire slide set or selected individual slides into their
own teaching presentations but may not alter the content of the slides in any way
or remove the ACP copyright notice. Users may make print copies for use as hand-outs
for the audience the user is personally addressing but may not otherwise reproduce
or distribute the slides by any means or media, including but not limited to sending
them as e-mail attachments, posting them on Internet or Intranet sites, publishing
them in meeting proceedings, or making them available for sale or distribution in
any unauthorized form, without the express written permission of the ACP. Unauthorized
use of the In the Clinic slide sets will constitute copyright infringement.
Learn more about subscription options


text:
From the Departments of Ophthalmology, Leicester Royal Infirmary (Mr Eke and Ms Al-Husainy) and Southampton Eye Unit (Mr Raynor), United Kingdom. Messrs Eke and Raynor were previously affiliated with the Taunton and Somerset Hospital, United Kingdom, where one of the patients was treated. None of the authors has a commercial interest related to this report.
To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from Euphorbia species.
Clinical case series.
Ophthalmology emergency referrals in the United Kingdom.
We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of Euphorbia species.
All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. Patients were observed until all signs and symptoms had resolved.
Main Outcome Measures
Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification.
Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks.
These cases illustrate the range of severity of Euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with Euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.
THE FAMILY Euphorbiaceae includes trees, succulents, and herbaceous plants.1 Species of Euphorbia grow in all 5 continents, either wild or as cultivated specimens in the house or garden. The latex or sap of many Euphorbia plants is toxic, and may cause inflammation of skin1 and the eye2,3 on contact. Ocular inflammation varies from a mild conjunctivitis to severe keratouveitis, and there have been several case reports of permanent blindness resulting from accidental exposure to the sap.2- 4 If the cornea is involved, changes generally follow a typical sequence, with worsening edema and epithelial sloughing on the second day.2,5 While the literature regarding ocular damage from Euphorbia sap is relatively sparse, it is becoming apparent that some species are more toxic than others. When treated early and managed appropriately, cases generally resolve without sequelae.2,5,6
We present 7 cases of ocular toxicity caused by Euphorbia sap, including the first recorded cases caused by the decorative garden plants E palustris, E characias, and E characias subsp wulfenii, and the "crown of thorns" houseplant E milii.
A 74-year-old woman with known age-related maculopathy was trimming her E milii houseplant (crown of thorns or crucifixion plant) (Figure 1, A) when she accidentally touched her right eye with her gloved hand. Twenty minutes later, the eye became painful, with lacrimation and gradual blurring of vision.
A, Euphorbia milii (crown of thorns houseplant). B and C, Corneal edema, epithelial sloughing, and mild anterior uveitis, 2 days after exposure to E milii sap.
She was assessed in a general emergency unit 4 hours later. Visual acuity, which had been measured the previous month at 20/80 OD, was reduced to 20/200 OD. There was conjunctival hyperemia but no corneal uptake of fluorescein. The eye was irrigated and treated with chloramphenicol ointment and a firm pad. Sixteen hours after the injury, acuity had decreased to hand motions only. There was moderate lid edema and marked conjunctival injection. Slitlamp examination revealed loss of central corneal epithelium, stromal edema, and folds in the Descemet membrane. Intraocular pressure was 16 mm Hg OD, and no inflammatory signs were seen in the anterior chamber. She was treated with a drop of 1% homatropine, chloramphenicol ointment, and repadding for a further 24 hours. Two days after the injury, visual acuity had improved to 20/200 OD, and the central corneal epithelium was starting to heal (Figure 1, B and C). There was a moderate anterior uveitis with cells (+/++) and flare (+), but no inflammation of the posterior segment. Intraocular pressure was 14 mm Hg OD and 17 mm Hg OS. Treatment continued with chloramphenicol ointment and 0.5% prednisolone sodium phosphate drops 4 times daily. Corneal epithelium gradually healed over 4 days, and by 2 weeks all symptoms and signs had resolved.
A 73-year-old man was trimming his garden plant E characias when sap sprayed into his right eye. The eye was immediately painful and was irrigated with water.
He was assessed by an ophthalmologist later the same morning. The eye was still painful and there was marked lacrimation. Visual acuity was 20/30 OD. The conjunctiva was hyperemic, and the interpalpebral corneal epithelium and nasal conjunctiva took up fluorescein. There was no edema of the corneal stroma, the anterior chamber was quiet, and intraocular pressure was normal. He was treated with chloramphenicol ointment 4 times daily. When he returned 2 days later, the pain was less marked, though visual acuity had decreased to 20/60 OD. The area of corneal staining had extended to include the inferior cornea, though there was no epithelial sloughing. No stromal edema was seen, and the anterior chamber remained quiet. Treatment with topical ointment was continued for 2 weeks, after which the eye had returned to normal.
A 66-year-old man was pruning E characias subsp wulfenii in his garden when he felt a stinging sensation as sap hit his right eye. He did not irrigate the eye until 10 minutes later, by which time he was suffering increasing pain and blepharospasm.
Irrigation was repeated when he was seen by an ophthalmologist later the same day. Visual acuity was 20/40 OD and 20/20 OS. There was marked conjunctival hyperemia and the central cornea showed punctate staining with fluorescein. There was no stromal edema, the anterior chamber was quiet, and intraocular pressure was the same in each eye. He was treated with chloramphenicol drops 4 times daily. The following day, visual acuity was still 20/40 OD and corneal signs were improving. Lid swelling and erythema were noted. After 2 days of topical treatment visual acuity returned to its previous level of 20/20 OD, and by 1 week all the symptoms and signs had resolved.
A 43-year-old woman was pulling up an overgrown specimen of E palustris (Figure 2, A) in her garden when she felt some sap spray into her left eye. The eye became painful, and was immediately irrigated with water.
A, Cutting of Euphorbia palustris. B, Mild keratoconjunctivitis, 2 hours after exposure to sap of E palustris.
Slitlamp examination 2 hours later revealed conjunctival hyperemia with small areas of punctate opacification of the corneal epithelium. There was no stromal edema, and the eye was otherwise quiet, with visual acuity of 20/20 OS. The eye was treated with a topical 2% homatropine drop and chloramphenicol eye ointment 4 times daily. The next day, the eye was more comfortable, and corneal signs were improving (Figure 2, B). All symptoms had resolved by 4 days.
A 60-year-old woman used some cut stems of E marginata as part of a flower arrangement. She was aware of the toxic nature of Euphorbia sap, and took care to protect her skin while trimming the stems. As she threw the stems into the bin, she felt something hit her left eye. "Burning" pain followed within seconds, and the eye was immediately irrigated with water. The eye became red and photophobic with blurred vision.
She was examined 2 hours after injury. Unaided visual acuity was 20/30 −1 OS and 20/30 +2 OD. The left eye was hyperemic, with a small (2-mm) area of corneal epithelial loss. The anterior chamber was quiet, and intraocular pressures were 18 mm Hg OU. She was treated with topical chloramphenicol ointment 4 times daily and 1% cyclopentolate drops twice daily. Two days later, symptoms were much improved and the corneal epithelium was healing. Intraocular pressures were 17 mm Hg OS and 16 mm Hg OD. There was a mild anterior chamber reaction with cells (+/−) and flare (+/−) and no inflammatory signs in the posterior segment. Treatment continued, and after 1 week all symptoms and signs resolved.
A 68-year-old woman was cutting a E platyphyllos plant in the garden. She remembered rubbing her eyes at the time, but did not develop symptoms until some hours later.
She was assessed the following day, with complaints of blurred vision and itching. Visual acuities were 20/30 OD and 20/40 OS. Her lids were erythematous and slightly swollen, and there was bilateral chemosis. The corneas showed mild epithelial edema, but intraocular pressures were normal and the anterior chambers were quiet. She was treated with chloramphenicol ointment 4 times daily. The next day, symptoms were settling and all signs and symptoms had resolved by day 5.
A 77-year-old woman with previous bilateral macular hemorrhages was pruning an E robbiae plant in her garden when she felt some white sap enter the left eye. The eye became painful and was irrigated with water.
She was assessed in a general emergency unit 3 hours later. The left conjunctiva was hyperemic and there was punctate uptake of fluorescein. Visual acuity was counting fingers OU. Chloramphenicol ointment was instilled. Twelve hours later, slitlamp examination revealed punctate corneal epithelial loss, a slight reduction in intraocular pressure (12 mm Hg OS, 14 mm Hg OD), and a quiet anterior chamber. Treatment continued with chloramphenicol ointment 4 times daily and 1% cyclopentolate drops twice daily. Two days later, all signs and symptoms had resolved.
There is a spectrum of ocular inflammation associated with Euphorbia sap exposure. Neglected cases can progress to blindness, and the literature includes reports of corneal scarring, iris synechiae, and anterior staphyloma.2- 4 It seems that most or all of these cases involved secondary bacterial infection. Recently, the self-limiting nature of appropriately managed cases has been emphasized.5 While there are still relatively few case reports in the literature, it is becoming apparent that there is a typical syndrome of "Euphorbia keratopathy,"5 and that the severity of the ocular inflammation may be related to the species of plant.
After exposure to Euphorbia sap, ocular changes usually follow a typical course.2,5 Symptoms generally begin immediately on contact with the sap. There is burning pain, photophobia, and lacrimation, which may worsen over hours or days despite irrigation. Visual acuity is at first mildly reduced, but may deteriorate to 20/200 or worse the following day. On initial examination, the corneal epithelium may be edematous and/or show focal areas of epithelial loss. The stroma may also be edematous, with folds in the Descemet membrane. The degree of associated conjunctivitis and anterior uveitis is variable and is particularly marked with certain species.2 The central corneal epithelium may slough off on the second day and may take more than a week to heal. With appropriate supportive therapy and close observation, the condition generally resolves completely within 1 to 2 weeks.
In published cases, the degree of ocular inflammation seems to be related to the species of Euphorbia plant sap, and also to the amount of sap that enters the eye. Petty spurge (E peplus) sap causes a typical Euphorbia keratopathy with a fibrinous anterior uveitis.7- 9 Caper spurge (E lathyris) sap gives a similar clinical picture, though the uveitis appears to be less marked and there is no fibrin.6,10,11 The pencil tree (E tirucalli)5,12,13 and candelabra cactus (E lactea)5,13 also cause keratopathy, with a variable degree of uveitis. Our cases 3 and 4 suggest that E characias and its subspecies wulfenii cause only mild keratopathy without uveitis.
Although Euphorbia keratopathy and uveitis seem to be self-limiting when managed supportively, it is important to remember that blindness can occur, particularly in neglected cases. People who work with Euphorbia species should wear eye protection. Clinicians managing Euphorbia keratopathy should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days. Our suggestions for management of acute Euphorbia sap keratouveitis appear in Table 1.
Accepted for publication June 18, 1999.
We are grateful to Richard J. Gornall, PhD, Director of Leicester University Botanic Garden, Leicester, United Kingdom, for identification of the plant specimens.
Corresponding author: Tom Eke, MA, FRCOphth, Devers Eye Institute, 1040 NW 22nd Ave, Suite 200, Portland, OR 97210-3065.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers' bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: What Is Causing This Patient's Vaginal Symptoms?
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
JAMAevidence.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Need assistance?
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.


text:
Top Definition
To become upset to the point of reacting like a child. To throw a temper tantrum.
Nathan was so Basker when he didn't get his own way.
додав Grom Gromulous 29 Травня 2013
Trending Now
Can you define these popular missing words?
To bask or to enjoy indefinitely
I am basking in glory therefore I am a basker
додав rafflespook 16 Липня 2011


text:
- Text Size:
- ASmall Text
- AMedium Text
- ALarge Text
The Pennsylvania Treasury has a large vault where they hold the most valuable unclaimed property in the state. You can see the vault and what it is inside it here.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


text:
Thursday, October 30, 2008
Barack Obama Lil Wayne & Denmark Vesey
In Case You Want To Know Who Is Going To Win
Obama Children Sing "Dear Leader" or The Global System of Black Supremacy
We've heard from the Radical Black Rev. Wright and the Jesus Freak Christians and the Jihadist Muslims, what do Right Wing Jews think of Obama?
Ken Timmerman is a very respected journalist for Newsmax.com and he was on Michael Savage the other day and this explains why Bush and company wanted Iran surrounded. They are next and you traitor liberals can not stop it and anyone that tries should be arrested for treason. Ron Paul, Harry Reid, Obama and the rest of the USEFUL IDIOTS.
I say nuke Iran, no more US blood...slam them with HAARP. I do not care what the world thinks of us, they are a bunch of socialist stooges anyway.Bush knew that Saddam was not going to just sit there and watch US troops go into Iran, because he knew that his ass was next to go. SO, Saddam had to go FIRST and now Iran is surrounded....BOOM. Iran did not just sit there to wait for us to come after them either, the USA has been fighting them through surrogates since this war started.
Do not be fooled, we have amazing weapons and we are not as weak as everyone thinks. Read "The Art of War" by Sun Tzu, we are now acting weak just like the Russians have been doing for many years.
Trust me, Iran was acting on behalf of Putin...that will come out next...WATCH. - http://deletefrance.blogspot.com/
A Beneficiary of "The Global System of White Supremacy"?
Several workers asked Daly to leave the 'Hooters' restaurant, but the golfer acted in an intoxicated and disorderly fashion, according to workers and onlookers.
Imagine the National Outcry if Pacman Jones was found passed out drunk outside Magic City.
Wednesday, October 29, 2008
Better History Lesson in 4 Minutes Than In 4 Years of College
Civilians and Soldiers Flee as Congo Rebels Approach an Eastern City
Civilians and Soldiers Flee as Congo Rebels Approach an Eastern City
GOMA, Congo — The exodus has begun.
Women with babies on their backs. Families crammed into cars with coolers and suitcases stuffed to the windows. United Nations trucks. Aid workers. Businessmen. Panicky government troops literally running for their lives.
On Wednesday afternoon, countless people of all kinds poured out of Goma, a strategic Congolese city on the border of Rwanda, fleeing the advancing rebel forces massing on the outskirts of town.
[Look At The African-American To Your Left. Look At The African-American To Your Right. How Many Can Find Congo On A Map? How Many Can Tell You What Is Happening There And Why?]
This was a place that was supposed to be safe, a town full of war-weary, displaced people who had come here for shelter, a town that the United Nations peacekeepers had defended against the very same rebels before.
But this time may be different.
"The Congolese Army has abandoned most of their positions," a United Nations spokesman, Madnodje Mounoubai, said. "The road to Goma is now open to the rebels."
Eastern Congo has been torn by conflict for more than a decade. But if Goma falls, it will be the first time in years that rebels have snatched a major city — and a particularly important one because it is a staging ground for United Nations aid efforts that are helping keep millions alive.
Christian Black Women In The Media
In the new issue of black Christian women's magazine Precious Times, The View's Sherri Shepherd reveals that her life was once so rough she didn't care if she died.
"My sister was heavy into drugs, and we would have to go and get her from crack houses," Shepherd, 41, says.
At the time, the stand-up comic — then a Jehovah's Witness – was "in a very physically abusive relationship," she said. "I was sleeping with a lot of guys and had more abortions than I would like to count."
She said her self-esteem became so low, "I felt if someone killed me, it wouldn't even make a difference."
But after converting to Christianity, she said, "God showed me that it would make a difference."
(Shepherd has also said she relied on her faith to get through her split with husband Jeff Tarpley, father of their 3-year-old son. During their seven-year marriage, Tarpley cheated on her and got another woman pregnant.)
Still, Shepherd admitted it is tough talking religion on the popular ABC chat-fest. (She received criticism after she once remarked that ancient Greeks persecuted Christians, even though Christ hadn't been born yet.)
"Oh, sometimes I say, 'Lord, Juanita Bynum or Joyce Meyer would be so good at this table. They could lay hands on Barbara Walters and get her saved,'" she said.
"I ask the Lord, 'Why am I here?'" Shepherd added. "I have to trust God when He says, 'Because I said so.'"
Tuesday, October 28, 2008
Is It Just Me?
William Balfour, considered a "person of interest" by Chicago police, has been out on parole since May 2006, after serving seven years in Illinois state prison for attempted murder, vehicular hijacking and possession of a stolen vehicle.
Balfour was arrested in June for possession of a controlled substance containing cocaine. Records show that the court dismissed the case in July for lack of probable cause.
According to the Associated Press, Balfour missed a scheduled meeting with his parole agent on Friday, the day Hudson's mother and brother were killed and her 7-year-old nephew went missing. No one has been charged in connection with the deaths.
The biggest victim here is not Jennifer Hudson. It is the real father of the young boy. Divorce or No Divorce ... there is no way in hell I would have let some sick convict like this anywhere near my son.
D.L. Hughley On CNN
Anonymous said ...
Off Comment, but has anyone seen the coonery that is the D.L. Hughley show on CNN?
Sunday, October 26, 2008
Thursday, October 23, 2008
Corporate Media Struggles To Make Race About Race II - The Power of Suggestion
Rebranding the U.S. With Obama
By NICHOLAS D. KRISTOF
The other day I had a conversation with a Beijing friend and I mentioned that Barack Obama was leading in the presidential race:
She: Obama? But he's the black man, isn't he?
Me: Yes, exactly.
She: But surely a black man couldn't become president of the United States?
Me: It looks as if he'll be elected.
She: But president? That's such an important job! In America, I thought blacks were janitors and laborers.
Me: No, blacks have all kinds of jobs.
She: What do white people think about that, about getting a black president? Are they upset? Are they angry?
Me: No, of course not! If Obama is elected, it'll be because white people voted for him.
[Long pause.]
She: Really? Unbelievable! What an amazing country
Kristof is full of shit. This conversation with a "friend" in Beijing did not happen. Certain elements within the media delight in perpetuating the myth of a Global System of White Supremacy. And there are some negros who eat that Perpetual Black Loser shit up. But you can't tell me a literate person in the world, in 2008, whether in China or not in China, is unfamiliar with Barack Hussein Obama and the fact this brother is about to moon walk into the White House.
- Michael Fisher said...
- "And there are some negros who eat that Perpetual Black Loser shit up."
- And what exactly has the acknowledgment of the existence of the global system of white supremacy have to do with "perpetual black loser shit"?
It is a reference to the widespread popular cultural phenomenon of African Americans exclaiming:
Why the fuck not?
It is a reference to those who subscribe to the hypnotic race power paradigm that attaches advantage to whiteness.
It attacks the assumption that 'white people' summarily reject blacks when black people are observably the most attractive compelling and inherently powerful people on the planet.
Not only will Obama win. It might be a long time before there is a white president again.
Yet Kristof, his imaginary Chinese girlfriend and certain Negros are invested in portraying the Obama experience as some sort of fluke, some sort of crack in the dark force of racism that has temporarily caused some whites to overlook his blackness and vote for him because he is ... qualified.
This Jewish writer suggests the success of a black presidential candidate is evidence of some sort of national altruism, some sort of "progress" on the part of America.
Get the fuck out of here. He's winning because he's the blackest man on the planet.
Take away Obama's blackness and he's John Edwards. Black is an advantage. The GSBS.
Told you a year ago Mike. When you going to come around?
Lying Bitch
Friday, October 24, 2008
The media have jumped all over the story of Ashley Todd, a McCain campaign volunteer in Pittsburgh who claims she was attacked because she supports Sen. John McCain.
Todd alleges that a mugger, upon spotting her McCain-Palin bumper sticker, assaulted her and carved a "B" — for "Barack" — into her cheek. Both campaigns have condemned the attack and expressed their sympathy for Todd.
But police have begun to question the validity of her story. According to Salon, various elements of her account of the attack don't add up. For starters, she's changed her story several times. The "B" on her face is backwards (as if she cut her own face using a mirror). And her story conflicts with evidence at the crime scene. Police administered a polygraph test this morning but have not released the results.
Notice, it's always these ugly grey chicks blaming a brotha for doing something to her? There are thousands of men all over America, languishing in cages doing mandatory 15 year bids because some mentally unstable broad imagined her fantasy was real.
Greenspan Concedes to `Flaw' in His Market Ideology
``If we are right 60 percent of the time in forecasting, we are doing exceptionally well; that means we are wrong 40 percent of the time,'' Greenspan said. ``Forecasting never gets to the point where it is 100 percent accurate.''
Corporate Media Struggles To Make Race About Race - The Power of Suggestion
Wednesday, October 22, 2008
Tuesday, October 21, 2008
The "Amero" North American Currency To Replace The Dollar (From 11/06/07)
Another step towards a "borderless" North America.
Your children will not grow up in the America you remember.
"We Have Been Here For 400 Years. We Built This Country. The Blood of Our People, Soaks This Land. Who Is More American Than Us?" Minister Farrakhan
Was the Civil Rights Movement a political head-fake that broke down barriers and opened doors that ultimately empowered everyone except African-Americans?
Even God's Son Gets Tired
Monday, October 20, 2008
Although Clinton Leads In Polls Among Plantation Negros - Even David Duke Is More Aligned With The Views of Most African-Americans (From 11/17/07)
To get the Jewish vote, Jewish money and Jewish media largesse, a Presidential hopeful must make the pilgrimage to Israel, promise AIPAC billions of dollars in "loans" to the Jewish state, and promise to use the American military to attack any people Israel finds threatening.
To get the black vote all you have to do is sing and to "like" Black People.
Although she just voted to support the Lieberman bill authorizing the President to attack Iran, Hillary Clinton polls better among Plantation Negros than does Barak Obama.
Yet even David Duke supports policies more in the interests of African-Americans and in the interests of the United States than does Hillary Clinton. (End the war in Iraq, no attack on Iran, and support of Freedom of Speech for example).
Does the Post Civil-Rights generation of African-Americans suffer from collective insanity? Why are they so easily duped? Who needs a "Global System of White Supremacy" when Negros appear content to dwell on intellectual, economic and political plantations voluntarily?
Hey DV,
I'm a big Marvel comics fan, and they have this big story they're doing where green skinned aliens have begun "body snatching" human beings, replacing superheroes and political leaders with Skrulls. Lately, they've been doing ads that say, "Embrace Change" across the top, and underneath it you see three kids sitting eating ice cream. Only one of them is a green skinned Skrull.
Google "Marvel Embrace Change"
Now, maybe i'm reading too much into this, but could they perhaps be subconsciously implying something else here. I mean, it's only too obvious which candidate's entire platform has been change. And these ads seem to be saying, Yeah, embrace change and you'll have green skinned aliens holding hands with your kids. (And after reading the "Matrix" thing from Mike's blog, I have the "all monsters in all movies are supposed to represent black people." thing on my mind.) Anyway, just something I was thinking about.
Colin Powell Speaks A Dangerous Truth - Has He Redeemed Himself For Serving As A NeoCon Stooge And Presenting Their WMD Lie To The United Nations?
And his name was Kareem Rashad Sultan Khan. And he was an American. He was born in New Jersey. He was fourteen years old at the time of 9/11, and he waited until he could serve his country and he gave his life."
Pratice 10.26.08
Sunday, October 19, 2008
Well Well Well ... Colin Powell Endorses God's Son
Wrap your head around that one. A decorated general who was maybe 1 or 2 steps away from the President himself, and he's still got to answer the, "but you're just voting for Obama because you're black, aren't you?" question.
Saturday, October 18, 2008
Friday, October 17, 2008
Barack Obama & 50 Cent - Blackest Men On The Planet
DV told ya'll chumps this 2 years ago.
BossNigger said...
So basically, it's a non-issue if Barack Obama is soft-shoeing for Israel, virtually ignoring black people and jumping through all types of petty 'kiss the ring, nigger' hoops in order to get "ahead". As the video suggests, perhaps certain things shouldn't be expected of him as a result of his background. "He does what he can."
50, on the other hand, is demonized for the ways in which he achieves his "success". His flaws are something to be overcome, irregardless of his background and resources. On the contrary, the chinks in Obama's armor are non-existent. He's "perfectly normal"; the "model black man."
In my view, this video is nothing more than "plantation negroes" paying homage to their last hope (Obama) of defeating the "big bad field negro" (50) who keeps hoggin' all the "hind pots" and scaring massah. Symbolically, that's all this "manhood" thing is really about in black America: The Colonized Minds vs. The Empty Minds jocking for favor in a world neither understands and doesn't care to understand. Both sides need to sit down somewhere, as far as I'm concerned.
While I concede that both men have that good ol' exclusively-black charisma - as a young cat, I find both of little value in terms of role models. Neither have shown me the courage and voice I equate with black manhood in '08.
Thursday, October 16, 2008
Presidential Politics. Democratic Process or Reality TV?
NEGRO CRUCIFIXION OF THE WEEK - Adam PacMan Jones
Adam JonesDallas police said officers responded at about 11 p.m. on Oct. 7. Officers said the matter was over by the time they arrived and that some hotel employees reported overhearing a tussle in the men's restroom in the lobby.
The player and his bodyguard, part of a security detail provided by the Cowboys to be with him at all times, said everything was OK. Police said both were driven from the hotel by an acquaintance, and the bodyguard didn't want to press charges.
NeoCon Skooter Libby has been forgiven, returned to private life and resumed a lucrative career as a lobbyist for Israel.


text:
I have to think it was SIL. She's young. She's religious. She's a little strange. Could MIL really BE this stupid?
What you r doing to your family is sick. Your parents raised you better than this. You now full well that your mother hasn't done anything but welcome SJ into her family with open arms, and this is how she's repayed? What you are doing is wrong and karma will get you, god willing.You should know that your handicaps are well documented from ever sense you were a small kid. Most courts won't hesitate to take a baby away from some one with mental handicaps. Your baby was conceived out of marriage, so really youre wife can just take him away from you anyways. She's unstable so anyone could make a case to take that baby to keep it safe from you both.Grow the fuck up and call your mom she gave you life you owe her youre life. I pray for you because you are walking satins path now and only evil can fill your life while you walk with satin.
Edit - weird symbols and I swear I can type.


text:
Join In Our Fun, Free Virtual Summer Camp!
Camp Birdie is in full swing. Join anytime before August 29 to enjoy games, ghost stories, contests and more!
Check out Camp Birdie now »
Redeem your FREE avatar decorations now »
Come visit me, MEMORIAL PAGE 2 ~WE WILL MISS U DUSTY, Rocky, MEMORIAL PAGE FOR BC FRIENDS /WE'LL MISS U PEEWEE!, <@BUDDY JR.@>WE'LL ALWAYS LOVE U DUSTY & BOBO aaaah Spring is here!! ~UR IN R HEARTS DUSTY.
Come visit me, Pepper, Poirot, Pringle & Artistic Avian Avatars.
Come visit me, Amie.
Come visit me, RaneBeau ('>.
Come visit me, R.I.P Mike, Buddy & R.I.P Pat.
Come visit me, Klips, Kalipsa & Sunny.
Come visit me, Duchess Malachite Bratbird, Hal - waiting at the Rainbow Bridge & Photon.
Come visit me, Freddy, Callie & Tiki.
Come visit me, Duke, Oliver, Zorro, Quinn, Sora and Nemo, Maxi & Sammy.
Come visit me, Jack the Brat & Max a Million.
Come visit me, Macey, Puffy & Blueberry.
Come visit me, Charlie.
Come visit me, Fergie, Max, Little Ham & Echo.
Come visit me, Baby Bird (BB).
*Content generated by our loyal visitors, which includes comments and club postings, is free of constraints from our editors' red pens, and therefore not governed by I-5 Publishing, LLC's Gold Standard Quality Content, but instead allowed to follow the free form expression necessary for quick, inspired and spontaneous communication.
The last news and tips on everything pet bird.
Wild Birds
Love backyard birds? Find out the latest on all things wild bird sent directly to you.
Sign up to get updates delivered straight to your inbox.
BirdChannel takes your privacy seriously. To learn more, please read our privacy policy.


text:
Am I being childish or do I have a right to be pissed??
Quoting momma2b2008:
I think if you are able to go running around all day you are fine to go and sit and talk to the guests for a little while! But let him know that he is going to have to clean up EVERYTHING from the guests!
Quoting Gabeys_Mommy:
You're far nicer than I would have been. I would've expected him to go with, especially to the pumpkin patch. I'm sorry, but we do things as a family when possible.
We usually do most things as a family but he's starting a new job tomorrow and will be working 7 days a week so this is his last weekend for awhile to really get things done so I didn't really mind him not going.
I dont think youre being either, but in your husbands defense, he probably thought it was alright to have people over, you having been through a wreck and ruptured cyst, esp if you are able to go out and do that list of errands. just clothes shopping wears me out when I am at 100%!
Well I never said I thought she was being a bitch, I don't. I said I can see why they might think that. It sounds like they got it worked out and no one was snubbed so she was just venting really. I just know from experience that "hiding" in another room when people are over starts whispers and rumors about marital problems, and it makes the guests uncomfortable.