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KENNESAW, Ga. (May 20, 2016) — Watching her big sister head off to college inspired Ava Cutler to do the same thing, but without Kennesaw State University's Academy for Inclusive Learning and Social Growth, Cutler's dream could have remained an unfulfilled wish.
"I just wanted to have a college experience like my sister," the 2016 Academy grad said. "I love living in campus housing and just being on my own."
KENNESAW, Ga. (Nov. 3) – Affording college can be a struggle for many students and their families. For students in Kennesaw State University's Academy for Inclusive Learning and Social Growth those financial challenges can sometimes be the barrier between the students and their recently gained access to higher education.
Those challenges, and what some families have had to do to rise above them, was the focus of a legislative "listening session" on "Post-Secondary Education and Employment Options for Individuals with Intellectual and Developmental Disabilities," held on campus Oct. 26. Academy staff, advocates for Academy students and parents took the opportunity to lobby state legislators for scholarship money.
"Twenty-one out of our 28 students this fall applied for assistance," Katherine Rigsby told state Reps. Katie Dempsey (R-Rome) and Bubber Epps (R-Dry Branch). "Those students only had access to 12 partial scholarships, and six students had to withdraw because they couldn't afford it."
Dempsey and Epps sit on the Georgia House of Representatives appropriations subcommittee on human resources.
"What a privilege it is for this study committee to listen to strong advocates for and parents of these students," said Dempsey, who chairs the five-member committee. "We want to help make life more meaningful for these students, and help each and every person who can work and make our state better."
The Academy, which began with three students in 2009, offers a unique certificate program designed to provide students with intellectual and developmental disabilities a college experience. Part of the WellStar College of Health and Human Services, Academy students audit college level courses, in addition to taking classes focused on social and life skills in a two-year certificate program. There is also an advanced certificate program available focused on leadership and the students' "areas of "passion."
"Our Academy students access all the resources available on campus, including housing, the rec center, and Owl-O-Ween," said Karla Wade, Academy Mechanics. "The Academy students are seamlessly woven into the tapestry of campus."
That integration, however, comes at an even higher price for Academy students, who are provided with peer mentors and additional support services. Academy students are not eligible for Pell grants or the HOPE scholarship, vehicles many traditional students use to help finance their education.
"This program is awesome," parent Patricia Roper told the legislators. "It has given our students with special needs opportunities of a lifetime."
Roper went on to say it was "just short of a miracle" she was able to provide her daughter, Brielyn, with the opportunity.
"Her aspiration was to attend college like her brothers," Roper, a two-time cancer survivor said. "When I found out about the Academy, I had no job, I was living with someone else. I sold my jewelry, my car and had a garage sale for the rest."
According to Roper, Brielyn blossomed her first semester on campus.
"My other children had access to Pell grants and scholarships," she said. "These students have potential; they can do a lot of things. We have to find a way to find some money for these students."
Wendy Allen also sold her house so her daughter could attend the Academy.
"The Academy is providing our students a future instead of making them always need the system," she said. "They do have something to give back."
-- By Jennifer Hafer
KENNESAW, Ga. (Oct. 8, 2015) — The Academy for Inclusive Learning and Social Growth at Kennesaw State University recently received funding that will allow its students the opportunity to apply for scholarships to cover the costs of tuition, housing, books, meal plans and program fees.
Students' journey to United Arab Emirates yields greater independence, partnerships
KENNESAW, Ga. (June 8, 2015) — Kennesaw State University's Academy for Inclusive Learning and Social Growth (AILSG) promises its students a fully inclusive two-year college experience for those with intellectual or developmental disabilities.
Nobody said anything about camel rides.
"I have had the best time of my life!," Brielyn Roper-Hubbert, an AILSG student, said of her camel ride. "I had so much fun and learned so much!"
That camel experience represents part of the remarkable growth since the program's 2009 inception. It has grown from a three-student cohort that first year to 36 students this fall, with the addition of an advanced 2-year certificate in Leadership and Career Development. . And another sign of that growth was taking the program international when the AILSG teamed with WellStar College of Health and Human Services' Department of Exercise Science and Sport Management (ESSM) on a trip to the United Arab Emirates: the university's first inclusive education abroad program.
The emphasis was on inclusion and to promote the independence for the AILSG students. So for 10 days, Kennesaw State students with and without intellectual and developmental differences roomed, worked, traveled, learned together and created a system of mutual support while experiencing the diversity and culture of the UAE – camel rides for Kennesaw State students included – making stops in Sharjah, Dubai, and Abu Dhabi.
Dr. Ibrahim Elsawy, Executive Director of the AILSG specifically chose the UAE because of its progressive work with students with disabilities, the accessibility of the country as a whole, and the unique melding of history, culture, and acceptance. He added that the country's disabilities instruction is good for all the students and they will have partners to work with them in Sharjah for ongoing projects.
"It was beyond our expectations," said Dr, Elsawy, who also organized the first Arab-American Dialogue on Disability, held at KSU in 2009, with 14 Arab World countries in attendance. When Dr. Elsawy began to plan the trip, he knew to enlist the assistance of Dr. Jimmy Calloway, an internationally respected professor, who has worked with Dr. Elsawy on several other projects of worldwide scope.
"The way the students worked together was better than we'd imagined," said Dr. Calloway, KSU Professor of sport management. "You could not tell who was from the Academy and who was in Sport Management. They represented the Academy and Sport Management very well.
"The whole purpose of the trip was inclusion. We did not want to separate Academy students from sport management students. That is what made this trip unique. From airplane seating assignments to room assignments, sport management students shared rooms, seating assignments and events with each other.
"Out of 200 Academy like programs across the country only one other program that we know of has ever sent academy students abroad. Our program is the only one that was formally invited and received by a foreign NGO."
Dr. Elsawy credits the success of the trip, in part, to the deft guidance of Julia Conger, LMSW, Social & Academic Advisor, who accompanied the group. Academy students made travel test runs last year going to New York and Washington, DC. They also attended meetings with the ESSM students to learn the dos and don'ts of traveling to the UAE.
The students — three from AILSG and five from ESSM — shared their experiences with members of the royal family, including His Highness Sheikh Sultan bin Muhammad bin Sultan Al Qasimi,, crown prince and deputy ruler of Sharjah, and Her Highness Sheikha Jameela Al Qasimi, who provided invaluable guidance for the trip.
"It was the most incredible experience I ever had," said Dr. Calloway, who also was vice president of the 1996 Paralympics in Atlanta. "I traveled around the world because of the 1996 Games, and there was nothing close to the experience I had there (in the UAE). From how we were treated by the royal family to how we were treated by their government was terrific.
"And the inclusive experience was phenomenal. I've been involved in travel abroad experiences for years. And spending 10 days with the same people in three places, and the schedule we kept, and not have one blow up? I've never seen that."
The group visited several nongovernmental organizations that support individuals with disabilities, as well as the Sharjah Sport Council, a governmental organization that supports sport and inclusion in the Sharjah community. Students spent time learning about the supportive organizations, like the Sharjah City for Humanitarian Services, and interacting with local residents with and without disabilities. They attended classes and made presentations at Sharjah University.
One of the more memorable moments for Charlie Miller, an AILSG student from Gainesville, Ga., came when he played with the children at the Al Thiqah Club for the Handicapped.
"We were all playing and having a blast," said Miller, who accompanied AILSG classmates Roper-Hubbert and Janet Keller on the trip. "One of the kids gave me a bracelet and I knew then, this is where I should be."
While with the crown prince, the group discussed issues of education, culture and Islam. And as the students would find out during the trip, Islam, though the prevailing faith, was not the only one. They also visited a church on Easter Sunday and discovered there are Catholic, Russian Orthodox and Coptic faiths as well.
"It was a surprise to the students because they thought the Middle East was only Muslim and that there were no Christians," Elsawy said. "We found Christians everywhere and talked with a minister about the level of religious freedom. It was a very important education for them. And most of the students said that it changed the stereotype they had. And this was a change for both sides."
That was just part of their engagement with local residents and leaders as the students were immersed in the rich and diverse culture of the Emirates. Additionally, faculty discussed the possibilities of collaborating with the University of Sharjah in the areas of sport management and criminal justice, building the foundation to ongoing cooperation and mutual benefit. Dr. Elsawy is also actively developing opportunities for international student internships with interested partners.
The trip had a profound impact on Emilee Manning, a Sports Management major. Being in the UAE with Kennesaw State's Academy students helped her establish her life goals.
"It broadened my cultural mindset as well as secured my passion to work with those who have different abilities," Manning said. "My goal is to assist professional athletes to found nonprofits for things they are passionate about, particularly giving back to those who deserve it most, those with different abilities."
Dr. Elsawy recognizes the extraordinary support from the Office of Study Abroad, Dr. Monica Nandan, interim Dean of the WellStar College of Health and Human Services, as well as from Provost Ken Harmon and President Daniel Papp.
This trip has been a dream for Dr. Elsawy ever since he took on the role of Executive Director for the Academy, in December of 2012.
"Organizations in the Emirates are hoping to work with us on different things,"Elsawy said. "The people got to see that the American students were serious, they are willing to understand (different cultures). They were good ambassadors for the U.S. and KSU. It was a very good trip."
— by Tim Turner
KENNESAW, Ga. (April 6, 2015) –This year, Charlie Miller's spring break is taking him far from his comfort zone and in the direction of greater independence.
Miller, Brielyn Roper-Hubbert and Janet Keller – all students in Kennesaw State University's Academy for Inclusive Learning and Social Growth – embarked Friday on a 10-day visit to the United Arab Emirates. They will be part of a Kennesaw State contingent — five Exercise Science and Sports Management students and three staff members — who will be making the 14-hour flight to Dubai.
The trip, considered the first of its kind where students with disabilities are full participants, will include stops in Abu Dhabi and Sharjah while in the Middle East.
"It's groundbreaking, really," said Miller, a sophomore from Gainesville, Ga. "It's the first trip of its kind for an Inclusive Academy. It's really the start of something new and really something amazing.
"It's going to be interesting to be so far away from our secure location into somewhere new. So we have to get more independent. And it's just really cool how we get to do it."
The Academy is a program that offers a fully inclusive college experience to students with intellectual or developmental disabilities that do not meet the university requirements for admission as degree-seeking students. It includes enrollment as non-degree seeking audit students in typical university courses alongside degree-seeking students.
Kennesaw State has the first program in Georgia to make this kind of trip with its students.
"This is inclusive," said Dr. Ibrahim Elsawy, the Academy's executive director, "We are going to the Middle East, which is a totally different culture.
"It's a 14-hour trip, which is difficult for anyone. International travel is difficult. And we will be prepared."
In efforts to acclimate to what they would experience, the students took trips to New York and Washington. Last March on their trip to D.C., they visited advocacy agencies to prepare documentation for the trip and visit Congress. In November, in New York, they toured the United Nations.The trips afforded them the chance to train the students about traveling through airports, how to handle themselves on planes and other travel dos and don'ts.
Granted, those trips can't approximate the journey the students are about to take, but they do help.
"I've been working really hard in school," Roper-Hubbert said. "This is a new experience and I don't want to get any kind of trouble over there where I don't come back."
"I just hate taking off my shoes," Keller said, of the airport security procedures. "But I'm excited and we've been learning how to say thank you and please. It is going to be different."
As part of the trip, the students will work as volunteers as part of a community service project, attend a class at Sharjah University and visit with non-governmental organizations. Along with other Kennesaw State students, they will also visit the Sharjah Sports Council and attend athletic events.
Elsawy chose the UAE because of its progressive work with students with disabilities. He added that the country's disabilities instruction is good for the students, and they will have partners to work with the students while in Sharjah.
"This trip is for us to exchange information," Elsawy said. "We are going to learn from them and to tell them about our experience — especially as an inclusive university. So it's win-win. We are working with them as equals. Our students are not going there as tourists. They are going on a mission, and they are going as ambassadors of the United States.
"And actually, this is more effective than official politicians that represent the United States. Because people-to-people is more effective than anything else in this area. This is very important to them to feel proud and to be part of the community and part of the country. They are becoming Global Citizens."
– by Tim Turner
Program is piloting a third year, planning study abroad trip
KENNESAW, Ga. (April 22, 2014) - The Academy for Inclusive Learning and Social Growth at Kennesaw State University kicked off the new school year with a reception honoring campus and community partners, as well as some big news – a "junior year" for students.
"In social work, when we work with people with different abilities, it's important to partner with different organizations in the community because each brings different things to the table that allow people with different abilities to spread their wings and fly," interim WellStar College of Health and Human Services Dean Monica Nandan said. "All of these partnerships help nurture the Academy to its fullest potential."
Representatives with the Georgia Department of Behavioral Health, the Georgia Council on Developmental Disabilities, the Georgia Vocational Rehabilitation Agency, Kennesaw State's Office of Legal Affairs and the Office of the Vice President for Research were all on hand. Several Academy students and alumni were also at the reception.
"There are three other universities coming on board (with academies)," said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. "This is a dream that a lot of people have that is now coming true, and y'all were the leaders in that."
Launched in 2009, the Academy offers a unique two-year certificate program designed to provide students with intellectual and developmental disabilities a college experience through the auditing of college-level courses, as well as courses designed to help them gain social, work and living skills, so they can find jobs they want and become more independent. It is one of 250 such programs nationwide, and the only one of its kind in Georgia.
"You learn about life on campus; you don't learn about life at home," said Gregory Schmieg, executive director of the Georgia Vocational Rehabilitation Agency. "We have one vision: that every Georgian live and work independently as they choose."
Two new developments at the Academy were also announced during the reception: the Academy launched a pilot third-year program beginning this year; and the Academy has received a grant to travel with students overseas next year.
--By Jennifer Hafer
KENNESAW, Ga. (May 15, 2014) - Academy for Inclusive Learning and Social Growth first-year student Charlie Miller bristles at the suggestion of one day becoming a politician. Instead, Miller says he wants to be a public servant who builds consensus among stakeholders.
"I want to help the people around me," Miller said. "I'm tired of all the partisan politics; I want to hear each side of an issue and work to build agreements around decisions."
Students in the Academy for Inclusive Learning and Social Growth at Kennesaw State University will soon have a computer lab of their own, thanks to a donation from the Holly Lane Foundation.
"This grant is very important because it supports the technology needs of our students, and technology is a very important part of today's educational environment," said Academy Executive Director Ibrahim Elsawy.
The $9,000 grant will fund desktop computers for a new computer lab for the Academy's 18 students. Part of the WellStar College of Health and Human Services, the Academy offers a unique two-year certificate program designed to provide students with intellectual disabilities a college experience through the auditing of college-level courses, as well as courses designed to help them gain social, work and living skills so they can find jobs they want and become more independent.
"The new lab will give our students a dedicated space where they can work with their mentors," Elsawy said. "This is very good news for the students."
To date, the Academy has received more than $150,000 in grant funding this year, including $50,000 from the Georgia Legislature. The Academy is one of 250 programs nationwide, and the only one of its kind in Georgia.
The Holly Lane Foundation is a private foundation in Atlanta that distributes funds to nonprofits whose focus is to serve and enhance the lives of individuals or groups with developmental disabilities.
"We are very grateful for this grant," Elsawy commented, "and we look forward to future opportunities to cooperate with the Holly Lane Foundation."
--Jennifer Hafer
Program offers a college experience to intellectually and developmentally disabled students
KENNESAW, Ga. (April 18, 2013) — A Kennesaw State University program that enables students with intellectual and developmental disabilities to experience college life has received $50,000 in the FY 2014 Georgia General Assembly budget.
This is the first legislative appropriation received by the Academy for Inclusive Learning & Social Growth, which is housed in the University's WellStar College of Health and Human Services.
When the final gavel fell on the 152ndlegislative session March 29, legislators had approved $100,000 in funding in support of inclusive post-secondary education for students with developmental disabilities, including $50,000 for Kennesaw State's Academy and an additional $50,000 that will be used for the development of an inclusive post-secondary educational program at another USG institution.
"We are honored and grateful to receive this funding in support of inclusive post-secondary education," said President Daniel S. Papp. "Diversity is an important part of Kennesaw State's mission, and the Academy is a reflection of that. This support is an affirmation of the hard work and dedication of the Academy's students and staff over the last four years."
The Academy offers a unique two-year certificate program designed to provide students with intellectual and developmental disabilities a college experience through the auditing of college-level courses, as well as courses designed to help them gain social, work and living skills so they can find jobs they want and become more independent.
"By having this college experience, students who may have been very shy, or a little awkward in social situations before, are suddenly integrated into the student body, and it changes their whole outlook on what they think their abilities are," said WellStar College of Health and Human Services Dean Richard Sowell. "We are proud to be the standard bearers for inclusive post-secondary education in Georgia."
Academy administrators are working on creating a replication manual because they are being called upon locally, nationally, and internationally, to provide consulting to other institutions interested in creating similar programs. According to Academy Director Ibrahim El Sawy, the Academy has received inquiries from as far away as the Middle East for such assistance.
"We are ready to work with any who wants to join us in this important initiative," he said.
The Academy is one of 250 programs nationwide, and the only one of its kind in Georgia. At a capitol rally this winter supporting state funding for more programs like the Academy, Georgia Gov. Nathan Deal praised Kennesaw State as a pioneer.
"(Kennesaw State University is) a forerunner of this in our higher educational institutions, and I believe it is a program that we can replicate throughout our entire university system," Deal said.
What makes Kennesaw State's program standout from others across the country, however, is the extent of inclusivity. Not only do Academy students live on campus, there is an alumni association, a parents' group and scholarship opportunities.
Diane Barker commutes 250 miles a day to bring her son, Casey, to Kennesaw State.
"If you put my son next to another 22-year-old at Kennesaw who is a typical student, the outside may look different, but he has every goal, vision and dream that the typical student has," Barker said. "The biggest benefit of the program is providing him with a typical experience, where he is part of everybody else on the KSU campus. He's not that young man with Down Syndrome."
Where once society pigeon-holed persons with intellectual and developmental disabilities into jobs as grocery store clerks and fast food workers, Academy students dream of jobs working with children and professional athletes.
"Even though I have a disability, I can do normal things that regular college students can in their lifetimes," said Academy student Faith Roman, who is studying early childhood education and hopes one day to work at a daycare. "I am living in the dorms and I love getting to be with new friends. I wouldn't change it for the world."
Kennesaw State University is the third-largest university in Georgia, offering 80 graduate and undergraduate degrees, including doctorates in education, business and nursing, and a new Ph.D. in international conflict management. A member of the University System of Georgia, Kennesaw State is a comprehensive, residential institution with a growing population of 24,600 students from more than 130 countries.
In a commencement season full of firsts, friends, family and supporters of Kennesaw State University's Academy for Inclusive Learning and Social Growth celebrated a second – the graduation of its second cohort of students with intellectual disabilities.
"I can't tell you how proud we are of our six fabulous graduates," academy director Harry Stern said. "They have exceeded everyone's expectations, including their own."
Kennesaw State University, 1000 Chastain Road, Kennesaw GA 30144
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Whistleblowers and the Obama Presidency: The National Security Dilemma
Richard Moberly
University of Nebraska College of Law
June 27, 2012
Employee Rights and Employment Policy Journal, Vol. 16, p. 51, 2012
As a candidate for President, Barack Obama promised to protect whistleblowers because they are, in his words, "watchdogs of wrongdoing and partners in performance." Three years into his Presidency, Obama's record often demonstrates strong support for employees who disclose government misconduct. He appointed whistleblower-rights supporters to key administrative posts and fought to include robust whistleblower protections in his key legislative accomplishments, such as the economic stimulus package, health care reform and the financial reform bill. However, the Obama Administration's treatment of national security whistleblowers has been decidedly less emphatic and more nuanced. His Administration aggressively prosecuted unauthorized disclosures related to national security and objected to reporters claiming a privilege not to reveal their sources. Moreover, a substantial legislative reform of federal employee whistleblower protections remained in limbo for much of Obama's Presidency in part because of his Administration's concern that the proposed law would provide too many rights to national security whistleblowers. This Article examines and critiques this apparent contradiction in President Obama's whistleblower agenda and also explores ways in which the Obama Administration might satisfy its national security policy objectives without undermining whistleblower protection.
Number of Pages in PDF File: 91
Keywords: whistleblower, national security, Obama, federal government employment
JEL Classification: K42
Date posted: June 27, 2012 ; Last revised: December 11, 2012
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subset: commoncrawl


text: Worst Parent Ever -- Michael or Dina Lohan? 1 10/15/2010 6:20 PM PDT BY TMZ STAFF The TMZ newsroom was on fire .... arguing over who's worse Michael Lohan or Dina. On a related subject, Hitler edged out Mussolini. Check out TMZ on TV -- click here to see your local listings!


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Although prospective randomized data are available to guide the multidisciplinary management of soft tissue sarcoma (STS) of the extremities, controversy exists regarding adjuvant chemotherapy and radiation therapy.
To determine if clinical specialty introduces bias in recommendations for multimodality treatment of STS.
Electronic survey.
Database of active members of the American Society of Clinical Oncology, the Society of Surgical Oncology, and the Connective Tissue Oncology Society.
Members of specialty oncology societies with an active interest in STS.
Physician specialty.
Main Outcomes and Measures
Survey responses regarding the multidisciplinary management of STS were scored on a 5-point Likert scale and analyzed using analysis of variance.
The questionnaire was completed by 320 of 490 potential respondents (65%), including medical (18%), radiation (8%), orthopedic (22%), and surgical oncologists (45%). Respondents concurred on the use of radiation therapy for margins positive for tumor, for high-grade tumors, for improvement in local control, for tumors larger than 10 cm, and for tumors in close proximity to a neurovascular bundle. Respondents diverged on the use of radiation therapy for tumors 5 to 10 cm in size, for low-grade tumors, for radiation-associated STS, and for survival benefit. Only radiation oncologists felt that radiation therapy was underutilized as a treatment modality (mean [SEM] Likert scale score, 2.44 [0.12]; P < .001). There was agreement on the use of chemotherapy for synovial sarcoma, for high-grade tumors, for tumors larger than 10 cm, for patients younger than 50 years of age, and for survival benefit. Medical oncologists were more likely to recommend chemotherapy for margins positive for tumor (mean [SEM] score, 3.12 [0.12]; P = .03) and for improvement in local control (mean [SEM] score, 2.91 [0.12] P = .08). Surgical oncologists placed the least emphasis on chemotherapy in the overall treatment plan (mean [SEM] score, 2.60 [0.07]; P = .001).
Conclusions and Relevance
Specialty bias exists in adjuvant treatment recommendations for STS. This highlights the importance of multidisciplinary STS tumor boards and interdisciplinary care to facilitate consensus decision making for individual patients.
The contemporary management of soft tissue sarcoma (STS) of the extremities requires coordinated multimodality treatment strategies involving several specialties in a multidisciplinary setting. For localized disease, surgical resection is the cornerstone of curative-intent therapy and, with the addition of radiation therapy, has been crucial in establishing limb-sparing surgery as the standard of care. This approach was validated in seminal randomized trials demonstrating equivalent survival outcomes between amputation and conservative limb-sparing surgery combined with radiation therapy.1,2
Although the magnitude of the benefit of adjuvant systemic chemotherapy for localized STS is modest, statistically significant improvements in disease-free and overall survival have been shown in some randomized phase III trials.3,4 The Sarcoma Meta-analysis Collaboration5 demonstrated an improvement in overall recurrence-free survival and a trend toward improved overall survival from pooled data. These findings were most notable for patients with STS of the extremities. Moreover, a more recent meta-analysis6 demonstrated improvement in overall survival when doxorubicin hydrochloride was used in combination with ifosfamide.
Despite the availability of data from randomized trials, variation in the multimodality treatment of patients with STS of the extremities exists. Although patient-specific factors have been identified that contribute to the variation in treatment and outcome, physician-specific factors have not been well studied. Martinez et al7 showed that African American patients with STS of the extremities receive lower rates of adjuvant radiation therapy and experience worse disease-specific survival than do white patients. Similarly, low socioeconomic status is associated with poorer overall survival for patients with STS.8 Recently, our group showed that physician experience influences treatment sequencing in STS.9
The objective for our study was to assess the influence of physician specialty in the management of patients with STS of the extremities. We hypothesized that clinical specialty leads to bias in recommendations for adjuvant radiation therapy and systemic chemotherapy among patients undergoing curative-intent surgery for STS of the extremities. As secondary objectives, we sought to explore patient- and tumor-specific factors influencing physician recommendations for radiation therapy and chemotherapy, as well as the specialty-specific perceived benefits of these treatments.
We conducted our study using survey methods. The survey was developed by 2 of the authors (N.W. and R.J.C.) following a literature review and a small focus group discussion. Pilot testing of the survey was performed internally at the University of California at Davis Medical Center in Sacramento for face and content validity to develop the final construct of 16 questions. Commercially available software (QuestionPro) was used for digitization and electronic dissemination via the World Wide Web in November 2009, as has been discussed previously.10 A cover paragraph explaining the purpose of our study accompanied the survey, and a reminder was sent to participants who did not respond to the initial request. No incentive was provided to complete the survey.
The complete survey questionnaire is provided in Table 1. The initial set of questions was structured to identify physician specialty. Subsequent modules addressed utilization of radiation therapy or systemic chemotherapy in the management of localized STS amenable to treatment with curative intent. Patient- and tumor-specific factors influencing the use of either radiation therapy or chemotherapy were queried. We did not specifically inquire about brachytherapy or intraoperative radiation therapy because these techniques are not widely available, even among academic, tertiary referral centers.
A pool of potential respondents was identified from the database of active members of the American Society of Clinical Oncology, the Society of Surgical Oncology, and the Connective Tissue Oncology Society. Only physicians with a self-declared subspecialty interest in STS were chosen. No unique information that could potentially identify a respondent was collected, and all data were deidentified. Approval for our study was obtained from the institutional review board at the University of California at Davis. Completion of the survey was considered as implied consent for participation.
Questions were scored on a 5-point Likert scale. For each question, mean values were calculated to generate a single response score. Mean values were compared using independent samples 1-way analysis of variance. The data were analyzed for homogeneity of variances, and the appropriate corrections were used for post hoc analysis. The significance level was set at P < .05 and adjusted as appropriate for multiple comparisons. For purposes of analyses, respondents were divided into groups by specialty. All tests were 2-tailed. Significance levels were set at P < .05, and confidence intervals at 95%. Statistical analysis was performed using SPSS version 16.0 statistical software (SPSS Inc).
The questionnaire was sent to 490 potential respondents and completed by 320 (65%). Data on the breakdown by specialty, by years in practice, and by percentage of clinical practice devoted to sarcoma care are outlined in Table 2. For specialty, "others" consisted primarily of pediatric hematologists/oncologists and pathologists.
Although respondents agreed that radiation therapy plays an important role in treatment overall (mean [SEM] Likert scale score, 3.81 [0.04]), significant variation in responses among specialties was observed. Radiation oncologists placed the most emphasis on the role of radiation therapy (mean [SEM] score, 4.26 [0.10]) (Figure 1A). Similarly, radiation oncologists were also more likely to think that radiation therapy was underutilized in the management of localized STS (mean [SEM] score, 2.44 [0.12]; P < .001) (Figure 1B).
Questions about the importance of radiation therapy in the treatment of soft tissue sarcoma (A; 320 respondents) and the utilization of radiation therapy in the treatment of soft tissue sarcoma (B; 317 respondents), stratified by physician specialty. Questions were scored on a 5-point Likert scale. For each question, mean values were calculated to generate a single response score (a range from 1 indicating not essential to 5 indicating essential). Error bars indicate SEM.
The variables most likely to influence a treatment recommendation in favor of radiation therapy were the presence of margins positive for tumor (mean [SEM] Likert scale score, 4.50 [0.04]), the presence of a high-grade tumor (mean [SEM] score, 4.35 [0.04]), improvement in local control (mean [SEM] score, 4.29 [0.04]), the presence of a tumor larger than 10 cm (mean [SEM] score, 4.22 [0.05]), and the presence of a tumor close to a neurovascular bundle (mean [SEM] score, 4.07 [0.04]), ranked in order of importance (Table 3). Survival benefit was the least important consideration (mean [SEM] score, 2.67 [0.06]). A tumor size of 5 to 10 cm and patient age younger than 50 years ranked low as indications for adjuvant radiation therapy.
Interspecialty variation was observed in responses for all variables except for margins positive for tumor (Table 3). In particular, both radiation oncologists (mean [SEM] Likert scale score, 4.33 [0.14]) and medical oncologists (mean [SEM] score, 4.04 [0.08]) favored radiation therapy for tumors 5 to 10 cm in size compared with other specialists. For patients younger than 50 years of age, radiation oncologists were more likely to consider radiation therapy to be important (mean [SEM] score, 3.81 [0.18]) compared with surgical and medical oncologists. For tumors deep to the fascial plane, radiation oncologists were again more inclined to offer radiation therapy (mean [SEM] score, 4.46 [0.11]). Interestingly, radiation oncologists most strongly disagreed that radiation therapy was not indicated for low-grade tumors (mean [SEM] score, 2.13 [0.14]) or radiation-associated sarcoma (mean [SEM] score, 2.44 [0.22]). Of all respondents, radiation oncologists showed the highest agreement with an improvement in local control with adjuvant radiation therapy (mean [SEM] score, 4.63 [0.10]), whereas surgical oncologists showed the highest disagreement with a survival benefit from adjuvant radiation therapy (mean [SEM] score, 2.55 [0.09]).
We stratified respondents by years of practice (<5, 5-15, and >15 years) and percentage of clinical practice devoted to sarcoma care (<25%, 25%-75%, and >75%) to assess the effect of experience on factors influencing the use of radiation therapy. In all of the variables listed in Table 3, no significant difference in aggregate response was seen for respondents when considering percentage of clinical practice (<25%, 25%-75%, and >75%) independent of specialty. For years of practice, those respondents who had been in practice for 5 to 15 years were more likely to recommend radiation therapy for tumors larger than 10 cm than were those in practice for more than 15 years (mean [SEM] Likert scale score, 4.39 [0.06] vs 4.09 [0.08]; P = .011). A survival benefit for radiation therapy was more important for respondents in practice for more than 15 years than for those in practice for less than 5 years (mean [SEM] score, 2.86 [0.1] vs 2.35 [0.1]; P = .007).
Systemic chemotherapy was considered a less important factor than radiation therapy in the overall management strategy for STS of the extremities (mean [SEM] Likert scale score, 2.78 [0.05]). Again, variation in response by specialty was observed. Medical oncologists (mean [SEM] score, 3.00 [0.09]) placed the greatest emphasis on systemic chemotherapy, and surgical oncologists the least (mean [SEM] score, 2.60 [0.07]; P = .001) (Figure 2A). Overall, specialists agreed that systemic chemotherapy was appropriately utilized (mean [SEM] score, 3.17 [0.05]) (Figure 2B).
Questions about the importance of chemotherapy in the treatment of soft tissue sarcoma (A; 320 respondents) and the utilization of chemotherapy in the treatment of soft tissue sarcoma (B; 315 respondents), stratified by physician specialty. Questions were scored on a 5-point Likert scale. For each question, mean values were calculated to generate a single response score (a range from 1 indicating not essential to 5 indicating essential). Error bars indicate SEM.
No single variable was rated as greater than 4.0 in the recommendation to utilize systemic chemotherapy. The presence of synovial sarcoma (mean [SEM] Likert scale score, 3.67 [0.12]), the presence of a high-grade tumor (mean [SEM] score, 3.54 [0.06]), and the presence of a tumor larger than 10 cm (mean [SEM] score, 3.24 [0.06]) were the most important variables identified by respondents in their decision to recommend systemic chemotherapy (Table 4). Improvement in local control (mean [SEM] score, 2.54 [0.06]), the presence of surgical margins positive for tumor (mean [SEM] score, 2.84 [0.06]), and the presence of tumors 5 to 10 cm in size (mean [SEM] score, 2.85 [0.05]) were the least important. The survival benefit from chemotherapy was considered to be more substantial than that for radiation therapy (mean [SEM] score, 3.17 [0.06]).
Overall, no significant differences in responses were seen in recommending systemic chemotherapy for patients younger than 50 years of age or for any tumor size. Medical oncologists were more likely to recommend systemic chemotherapy for high-grade tumors (mean [SEM] Likert scale score, 3.75 [0.15]), and orthopedic oncologists were more likely to recommend it for synovial sarcoma (mean [SEM] score, 3.73 [0.12]). Medical oncologists were also more likely to attribute an improvement in local control to systemic chemotherapy (mean [SEM] score, 2.91 [0.12]; P = .08) and to recommend it for margins positive for tumor (mean [SEM] score, 3.12 [0.12] P = .03).
Years in practice only influenced the opinion about local control with chemotherapy. Respondents with more than 15 years in practice felt that systemic chemotherapy had a greater effect on local control than those with less than 5 years in practice (mean [SEM] Likert scale score, 2.71 [0.06] vs 2.31 [0.10]; P = .02). Respondents who had greater than 75% of their clinical practice devoted to sarcoma care had differing responses on several of the factors compared with those who had less than 25% of their clinical practice devoted to sarcoma care. They placed more importance on systemic chemotherapy overall (mean [SEM] score, 3.05 [0.12] vs 2.65 [0.07]; P = .014) and on the survival benefit from therapy (mean [SEM] score, 3.32 [0.15] vs 3.00 [0.08]; P = .02). They were also more likely to recommend systemic chemotherapy for tumors larger than 10 cm (mean [SEM] score, 3.58 [0.18] vs 3.03 [0.08]; P = .009) and for patients younger than 50 years of age (mean [SEM] score, 3.29 [0.16] vs 2.86 [0.08]; P = .004).
Although data are available from randomized controlled trials to guide treatment decisions in the multidisciplinary management of STS of the extremities, there is a lack of consensus regarding relative indications for the use of adjuvant radiation therapy and systemic chemotherapy. By studying specialty-specific responses to scenarios on the use of radiation therapy and systemic chemotherapy in the treatment of localized STS, we show that physician specialty is an important factor contributing to variability in treatment recommendations.
The importance of radiation therapy in the management of STS of the extremities was rated highest by radiation oncologists, who were also more likely to assert that radiation therapy is underutilized in the multimodality treatment of patients with STS. Similarly, among all the responding physicians, medical oncologists assigned the greatest importance to systemic chemotherapy, even though, overall, most respondents felt that current utilization was appropriate.
Considerable interspecialty variation was observed with regard to indications for treatment, which suggests that, even among experts, there is a diversity of opinions regarding the multidisciplinary management of STS of the extremities. In general, clinicians' recommendations tend to be biased in favor of their specialty-specific modality. Although this may seem intuitive, it has not been well studied in the medical literature, in general, or in the sarcoma literature, in particular. Given the preponderance of treatment guidelines and tumor board recommendations that are based on expert opinion rather than level I evidence for a rare disease process such as STS of the extremities, it would seem to be important to deconstruct the process by which clinicians at the individual and group level arrive at treatment recommendations.
Current National Comprehensive Cancer Network guidelines recommend consideration of adjuvant radiation therapy for patients with high-grade STS, with large tumors, or with final margins close to or positive for tumors.11 Our respondents demonstrated the highest agreement across all specialties in cases of STS of the extremities with margins positive for tumor, with a high-grade tumor, with a tumor size of greater than 10 cm, or with a tumor close to a neurovascular bundle. Although respondents rated improvement in local control as a significant benefit of radiation therapy, improvement in overall survival was not. These responses are consistent with the published literature regarding the oncologic benefits of adjuvant radiation therapy.12
However, subtle but important differences emerged when we analyzed the responses by physician specialty. Radiation oncologists were more likely to offer radiation therapy to patients younger than 50 years of age and for tumors 5 to 10 cm in maximal size. Furthermore, they were more inclined to disagree with the statements that radiation therapy is not indicated for radiation-associated STS of the extremities and that radiation therapy is not indicated for low-grade STS of the extremities. These are controversial areas in which specific evidence-based data and guidelines are not available and for which clinicians may have substantially different views of the risk-benefit ratio of treatment.13,14
Overall, respondents viewed chemotherapy as less important than radiation therapy in the multidisciplinary management of STS of the extremities. This appropriately reflects the conflicting nature of data from randomized trials examining the benefits of adjuvant chemotherapy in STS of the extremities. Interestingly, both radiation and surgical oncologists placed less emphasis on a survival benefit with chemotherapy than did medical oncologists and orthopedic oncologists. Medical oncologists felt that chemotherapy played a greater role in local control than did surgical oncologists. These opinions are supported by outcomes data. In the previously quoted meta-analysis of systemic therapy in STS,6 the hazard ratio with adjuvant chemotherapy for local recurrence was 0.73 (95% CI, 0.56-0.95), which corresponds to a 4% reduction in absolute risk. For synovial sarcoma, orthopedic oncologists felt most strongly about recommending chemotherapy, which may be explained by practice patterns (ie, orthopedic oncologists treat a higher proportion of younger patients with bone sarcoma and STS for whom chemotherapy is more routinely administered).
For clinical scenarios in which adjuvant treatment is clearly indicated, such as radiation therapy for large or high-grade STS and chemotherapy for younger patients with favorable subtypes, any lack of agreement by specialists is concerning. Either the current data are felt to be inadequate to inform clinical decision making or there is unfamiliarity with data outside one's scope of practice. An argument could also be made for better quality studies. Furthermore, if the first point of contact for a patient is a specialist who places less importance on adjuvant therapy, then the treatment algorithm may not progress beyond surgical resection. Our data also point to the importance of a multidisciplinary STS tumor board. Even though individual physicians may have differing opinions about treatment, in aggregate, the best course for the patient will be charted by discussion and consideration of all treatment options. Finally, experience as measured by the percentage of clinical practice devoted to sarcoma care may also influence responses. In particular, physicians who had greater than 75% of their clinical practice devoted to sarcoma care placed more importance on systemic chemotherapy and a potential survival benefit with treatment. They were also more likely to recommend systemic chemotherapy for patients younger than 50 years of age and for tumors larger than 10 cm.
Certain limitations of our study must be acknowledged. Some are related to the survey methods that we used to collect our data. The use of a survey instrument has the inherent limitation of respondent bias because only physicians who were interested or inclined to respond took the time to do so. Although electronic dissemination results in easy and rapid delivery, many e-mail addresses were not valid or had filters, which meant that the survey never arrived to the intended recipient. By opting to only include physicians who were active members of selected oncology societies with a self-declared interest in sarcoma care, we also potentially introduced a selection bias. It is likely that there are additional physicians who treat a substantial number of patients with STS in their clinical practice who were not solicited to participate or who did not participate in this survey. Finally, although statistically significant differences were seen in the mean response rates for many of the questions, whether these translate into meaningful clinical differences is not demonstrated by our data.
To conclude, physician specialty appears to influence recommendations for adjuvant radiation therapy and chemotherapy in STS of the extremities. This bias likely arises from divergent interpretations of published literature and perhaps from a lack of familiarity with data outside of one's clinical scope of practice. Multidisciplinary clinics and tumor boards may be an effective tool for discussion among different specialties to reach consensus decisions and to minimize variation due to specialty bias. However, the effect of specialty bias on multimodality treatment recommendations of expert panels and tumor boards warrants further study.
Corresponding Author: Nabil Wasif, MD, Department of Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (email@example.com).
Accepted for Publication: December 10, 2012.
Published Online: March 20, 2013. doi:10.1001/jamasurg.2013.113
Author Contributions: Drs Wasif and Canter had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Wasif, Tamurian, Chirstensen, Monjazeb, Canter.
Acquisition of data: Smith, Tamurian, Canter.
Analysis and interpretation of data: Wasif, Smith, Monjazeb, Martinez, Canter.
Drafting of the manuscript: Wasif, Smith, Canter.
Critical revision of the manuscript for important intellectual content: Wasif, Tamurian, Chirstensen, Monjazeb, Martinez, Canter.
Statistical analysis: Wasif.
Administrative, technical, and material support: Tamurian, Canter.
Study supervision: Tamurian, Canter.
Conflict of Interest Disclosures: None reported.
Previous Presentation: This paper was presented at the 82nd Annual Meeting of the Pacific Coast Surgical Association; February 18-21, 2011; Phoenix, Arizona; and is published after peer review and revision.
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DEAR ABBY: I am 35 and my husband is 45. When we met, he weighed 375 pounds. He has now hit the 600-pound mark. I have five kids, a full-time job and go to school two nights a week. He talks about losing weight, but it's easier to talk about than actually do. He was in a car accident that left him with back problems, and he has bad knees from sports.
The future doesn't look promising. I know that one day he'll be confined to bed - I predict in the very near future - and I will have to drop everything to take care of him. He is already dependent on me and the older kids. He doesn't have insurance.


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SANTA FE, N.M. (AP) - A 32-year-old man convicted of kidnapping, raping and murdering a woman whose body was found in his camper was spared the death penalty Wednesday by a jury that instead imposed a life prison term.
Robert Bryant received the life-in-prison verdict after the penalty phase of a trial in which he had been convicted Friday of kidnapping, raping and murdering Reymunda Baca, 28. Her body was found in Bryant's pickup truck in March 1998 after his family retrieved the vehicle from a police impound yard.
Bryant will spend at least 50 years in prison after sentences for rape and kidnapping are figured into the equation. Bryant will be in his 80s before he is eligible for release.
Baca's family members were not upset at the jury's decision because none was pushing for his execution.
"By the time he's released from prison, he'll be (almost) 87, or he'll die in prison,"' said Baca's mother, Jessie Morris. "I just put it in God's hands."
Members of Bryant's family declined to talk to reporters following the decision.
Bryant was serving a prison term for cocaine trafficking.
He could have faced death by lethal injection for the Baca murder, but jurors chose to spare his life.
Bryant's attorney, Gary Mitchell, stood beside him Wednesday as the verdict was read.
Throughout his trial, Bryant denied killing, raping or kidnapping Baca. Bryant said in February 1998, he was confronted by Cuban drug dealers whom he and Baca owed money and was forced to flee for his life. He said that was the last time he had seen Baca.
Bryant's truck was impounded in February 1998 after he had been arrested in Santa Fe for drunken driving. Mitchell told jurors that the drug dealers planted Baca's body in Bryant's pickup to frame him.
Prosecutors accused Bryant of killing Baca sometime between Feb. 9 and Feb. 20, 1998. DNA tests on semen and pubic hair recovered from Baca's body reportedly matched that of Bryant's.
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Drought of 2007: Drastic times cause for drastic measures
Layton Meng
PR Manager
Gresham, Smith and Partners
Nashville, Tennessee
As was the case in most of the southeastern United States throughout the summer of 2007, Elmore County, Alabama experienced record lows when it came to the amount of rainfall it received. This lack of rainfall severely affected water levels in a number of lakes in Alabama, including Lake Martin, which is the main water supply for the Central Elmore Water and Sewer Authority (CEWSA). After several meetings with the Alabama Power Company, who controls the release of water from Lake Martin for power generation, CEWSA realized that if this situation was ignored and the drought continued, they were going to run out of water.
"To ensure a continuous and uninterrupted supply of water to more than 66,000 people, we worked in partnership with water services engineers from Gresham, Smith and Partners (GS&P) to develop a quick, strategic and effective way to solve this problem," commented Robert L. Prince, Jr., general manager of CEWSA.
CEWSA and GS&P started by assessing the situation and looking at the raw water pump station to determine at what water level elevation in Lake Martin, the area's main water supply, the raw water pumps would begin to cavitate. The pump's raw water intake is fed by two intake lines in Lake Martin. The "upper intake" was dry and the lake level was continuing to fall to record lows for this time of year, meaning the same fate was possible for the "lower" intake. After much consideration, it was agreed that CEWSA must go forward with the Emergency Drought Intake Plan.
|The emergency pumps are designed to deliver raw water at a rate of 6,000 gallons per minute. This floating barge will rise and fall with the lake level, ensuring reliable operation.
Emergency Drought Intake Plan
GS&P considered various pump types, layouts, piping schemes and pump feasibilities due to existing site conditions. CEWSA elected to work with a local supplier, Hydra-Service out of Warrior, Ala., who would provide all equipment and some labor to install the system. After a meeting with GS&P, CEWSA and Hydra-Service, a floating barge system was conceptually laid out along with required controls and connections. Understanding the urgency of the problem, Hydra-Service began fabricating barges the next day.
The system was designed to be able to deliver 6,000 gallons per minute (gpm) to the raw water pump station. The unconventional part was that the static head condition, typically a fixed quantity in hydraulics, was going to vary from the initial condition to an assumed "doomsday" lake level when the drought had hit its peaka level taken to be approximately 18 feet lower than current levels. This was achieved by sizing the pumps for the worst case and utilizing variable frequency drives to reduce pump speed and flow as required.
|Approximately 550 feet of 18-inch high-density polyethylene pipe were fused together to provide a discharge line for the floating pump station. A track hoe is moving the line into place for connection to the existing 24-inch raw water intake line.
The Floating Barge Concept
The barge consists of four separate floats, three of which each house a 95 HP submersible pump and the fourth supporting the necessary pipe header. Each pump can handle approximately 4600 gpm. This means two pumps together achieve the flow required, leaving the third pump as a backup. The associated control panels are set up on shore. Power is supplied from the existing motor control center with the existing 1000 kW genset providing backup power. Eighteen-inch HDPE pipe is suspended just below the water surface by floats and serves as the raw water line between the barge and the connection point.
The modifications to existing infrastructure were twofold. The first required an approximately 10-foot-deep excavation to get to the upper intake line. It was cut and a 24" tee with a 24" plug valve was installed. The valve was closed and the pump discharge was hooked up to the tee. This valve allowed the intake screen to be closed off and isolated from the emergency pumping system. All joints on the upper intake line were dug up and restrained to ensure the pipeline could handle the operating pressures it would see.
The second modification was necessary because of the need to hydraulically connect the existing wet well, which was split into two separate wet wells by an internal partition wall, while isolating the lower intake screen from the system. Differing water levels in this wet well were not desirable and would also make the control system very complex. The solution was to install a 24" plug valve in the lower intake line. This modification required an excavation approximately 30' x 40' and 25' deep. The excavation required one six-inch pump to provide the necessary dewatering during the installation of the plug valve. Nylon covers were custom-made and placed on the lower intake screen by divers. The line was cut and the valve was, after much effort, installed and closed. Mission accomplished.
"The success of this project boiled down to the cooperation of environmental professionals all working together to develop an innovative and non-traditional solution to a unique problem," stated Bo Linder, project manager from GS&P.
After five weeks of efficient teamwork, the conceptual design, fabrication, delivery and construction were complete and the system was up and running. CEWSA did not experience any interruption in their ability to provide water service to their customers. Furthermore, this emergency pump concept, as well as the modifications to the existing infrastructure, allows CEWSA to operate their existing raw water pump station in the same manner as prior to the drought. It also provides easy connections in the future should extreme drought conditions strike again.
Andy Yarbrough, project engineer from GS&P added, "This project posed a unique challenge in that we were operating against a very serious deadline being imposed by nature. Ultimately, success was a direct result of the collaboration among all parties involved. Equal input from CEWSA, GS&P and Hydra-Service led to a reliable solution that maintained the quality of life for the citizens of Elmore County."
Layton Meng can be reached at (615) 770-8463 or email@example.com.


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NV Cockburn Special Reserve Port
Producer: Cockburn
Style: Fortified
Grape Type: Port Blend
Origin: Portugal
Region: Portugal
85 Points | Stephen Tanzer's IWC - March/April 1998
Fresh nose combines black and red fruits. Intensely flavored and moderately sweet; the color of ruby but shows a tawny port-like smoothness and pliancy in the mouth. Wears its alcohol gracefully. Finishes slightly dry, with hints of almond and hazelnut. Showed a dill note with aeration.
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BENTLEYVILLE, Ohio -- This tiny village, sandwiched between Chagrin Falls and Solon, has seen no economic development in the last year and a half.
No new stores. No new restaurants. Not even a new home. The most development the village has seen is remodeled bathrooms and kitchens.
"Our last home was built in 2012," said Bentleyville Administrative Assistant Molly Snow.
Northeast Ohio Media Group requested the village's most recently proposed construction projects, as reporters did for 49 other Cleveland suburbs. Village officials had none to offer.
With slightly more than 300 households, the village doesn't have much development. The South Chagrin Reservation covers about a third of the 2.5 square miles.


text:
A 14-year-old girl is recovering after being shot in Milwaukee.
It happened around 10:15 p.m. on Friday near 37th Street and North Avenue.
Police said the girl was walking down the street when she was grazed by a bullet. Her injuries are not believed to be life-threatening.
Police told WISN 12 News that at least one person was taken into custody shortly after the shooting.
The incident remains under investigation.


text:
• Jim Leyland thinks that of all the players on his team, the one with
management written all over him is first baseman Miguel Cabrera. True story.
I would actually
like to see that, for the entertainment value alone. Better yet, if general manager Dave Dombrowski bows to message board- and Internet commenter-pressure and Leyland is fired midseason, maybe they can promote Cabrera to player-manager, harkening back to the days of yore.
I'll freely admit that I never thought of Cabrera as a manager. If I had to pick someone on the team, I'd go with a quiet veteran like Ramon Santiago or Brandon Inge. Catchers always make dynamite managers, so Alex Avila in 30 years might fit the bill. Minor league Tigers lifer Max St. Pierre seems destined for this job. Hey, maybe that's yet another way Will Rhymes can make it back to Detroit. [MLB.com]
• Feels good to sweep the last-place Twins in a short series, doesn't it? For those who were counting, that was 17 walks that Minnesota pitchers issued to the Tigers. In two games. Es no bueno. (For them.) [Star Tribune]
• And it gets better: looking at the simulated predictions, the Tigers actually have the best chance to win the American League Central. Take THAT, resurgent Cleveland Indians! And these projections have Detroit taking the division with only about 82 or 83 wins. Ha. [Baseball Prospectus]
• But let's not sleep on the Royals either. They're doing quite well with a chance to beat the Yankees in a series. Paramount to their success yesterday, today, and in the future is first baseman Eric Hosmer, who was called up over the weekend and hit his first homer in Yankee Stadium. At just 21 years of age, he might already get signed to a long-term deal if their front office is smart. This is important information because the Royals are in town this weekend. [Kansas City Star]
• Yes, it's very impressive that stem cells were used to rejuvenate Bartolo Colon's elbow so he could be signed by the Yankees and beat the Tigers. But I won't believe this new-age surgery until it works on Joel Zumaya. [New York Times]
• Staying on the surgery topic, this story just so cool. And a little squeamish. A teenager in Fostoria, Ohio who loved playing baseball was diagnosed with bone cancer, so a doctor removed a middle section of his leg, reattached his lower leg, rotated the foot so it's pointing backwards, and the kid is able to walk again and — more stunningly — resume playing baseball. [Fox 8 Cleveland]


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Thanks to several years of advocating by community groups, Maui County is moving ahead with $2.5 million worth of improvements for a Maalaea road that has suffered extensive flood damage from heavy rain events in recent years.
"We're so pleased that the county moved ahead with this. We really felt the way the process unfolded was something that represented the community and the county working together," said Pam Daoust, president of the Maalaea Community Association, which led the charge in pressing for the improvements.
She called the existing drainage system a serious safety and environmental problem.
Article Photos
Workers from Goodfellow Brothers and Sonny Vick's Paving prepare the swale over a box culvert on Maalaea's Hauoli Street for paving on Jan. 20, 2011. Maui County is moving ahead with $2.5 million worth of improvements for Hauoli Road, which include replacing an existing drainage culvert with a 4-foot-by-8-foot double-cell box culvert.
The Maui News / MATTHEW THAYER photo
Indeed, the county says the improvement are needed because the existing system is inadequate to handle runoff generated by a so-called 100-year storm, according to a final environmental assessment recently completed for the project by the county's Department of Public Works.
It's also needed to prevent future flooding along Hauoli Street and to neighboring properties, as was seen most recently in December 2010 and January 2011, when floodwaters inundated the Island Sands Resort condominium's ground floors and flooded other condos in the area with water and mud.
Daoust said the last major flooding event resulted in property damage and the closing of the road, "creating extremely hazardous conditions, especially for folks living on the second half of Hauoli Street, which was rendered completely inaccessible. The flooding also caused a huge flow of mud, sediment and trash into the ocean that did not dissipate for many weeks afterward."
The county's plans call for replacing an existing drainage culvert that crosses under Hauoli Street with a 4-foot-by-8-foot double-cell box culvert. Together with other improvements, the work will "increase the capacity of the drainage system to handle storm water flow and alleviate flooding and over-topping along Hauoli Street."
A 3- to 4-foot retaining wall will be added to the existing drainage channel to increase capacity and prevent flooding.
To address debris and sedimentation, a 200-foot-by-150-foot water quality basin - and grassed drainage channel to connect it to the culvert - will also be built on the mauka side of the street to allow sediment to settle before runoff drains into the culvert and discharges into the ocean.
The use of county lands and county funds triggered the need for an environmental assessment. The final report was recently published by the state Office of Environmental Quality Control with a finding of no significant impact determination.
The next step will be to seek special management area and shoreline setback permits, which will require input and approval from the Maui Planning Commission.
The department hopes to go before the commission in either February or March, according to Public Works Deputy Director Rowena Dagdag-Andaya. She said the work will be put out to bid once the permits are secured.
The county's current fiscal 2013 budget includes approximately $2.5 million for the CIP work, Dagdag-Andaya said.
Daoust with the Maalaea Community Association encouraged other community organizations to lobby county officials for needed public works projects. She estimates that the association advocated for the Hauoli Street improvements for "at least five to six years - and maybe longer."
"There's a lot of competition for capital funds with so many worthy projects that need to be done," she said. "If community groups identify a major project like this, you do need to spend the time to contact your officials and advocate on a regular basis so it doesn't get lost among the competition."
* Nanea Kalani can be reached at firstname.lastname@example.com.


text:
Practical and precise details of diagnosis and treatment mark this comprehensive book on office ophthalmology. Basic science background is given so that one can appreciate why given methods are used. A remarkable amount of detail and broad "horse sense" knowledge of the whole field has been put together in one volume. Numerous drawings, tables, and photographs illustrate optics, lid surgery, diseases, injuries, etc.
The pediatrician will find an up-to-the-minute description of retrolental fibroplasia and will appreciate why immediate care for obstructed tear ducts and imbalances of the ocular muscles is so important. Thirty-one pages of formulary and exact details of drug usages is a very valuable section of this book. Extensive description of beta-ray and other radiation therapy with which the author has worked is given.
The ophthalmologist and pediatrician will each profit by a careful reading of this book. A small bibliography with each chapter makes further material easily
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics 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.
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The Ground Zero Deal
April 26th, 2006
Larry Silverstein, and the governments of the city, the state and New Jersey may have reached common ground on moving ahead at Ground Zero, but many observers predict that the feuding isn't over.
The News can barely contain itself over what it sees as a setback for Silverstein, headlining a news story on the deal: �Larry blinks & WTC's a go.� But given what it sees as the developer�s twists and turns, the paper counsels Mayor Bloomberg, Governor Pataki and other officials to �remain united, fulfill all their commitments and be prepared for the hard bargaining that is sure to come.�
The Post, though, sees Silverstein as the wronged party. Yesterday's deal is not a great one for the developer, the paper says, as he called Pataki�s bluff and accepted an agreement the Post sees as an �attempt to strip Silverstein of his legal rights and force him from the project.� So now, the paper asks, � Will Bloomberg, Pataki and [New Jersey Governor] Corzine move forward in good faith – or will they once more move the goal posts?�
And in a column in the paper, Nicole Gelinas of the Manhattan Institute shares that skepticism. Silverstein has legitimate concerns about the arrangement, she says. �Will the Port Authority accept Silverstein's concerns in good faith,� she asks. �Or will the agency bureaucrats, accompanied by Bloomberg and Pataki, start railing again for the media's benefit about how unreasonable Silverstein is?�
Bloomberg also expressed doubts — though his were aimed at Silverstein, the Real Estate reports. Silverstein "apparently gave a speech today saying that that's what he would do and that's great," the mayor said, adding, �The one thing we cannot do, and will not allow to have happen, is you agree in concept and then try to nickel and dime and go on forever."
But whatever happens next, Gothamist says, Silverstein must now �be relieved that now he will be less vilified and that Pataki can be left to take the fall for any mess-ups.�By Gail Robinson on April 26, 2006, 8:02 am
In category: Gotham City,Land Use,Public Finance | 1 Comment »


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Lot # 1331 (of 1525) < Previous Lot | Next Lot >
Original White House Photograph signed by Five Presidents
Starting Bid - $2,500.00, Sold For - $5,800.00
Absolutely stunning and unique signed Presidential display features a gorgeous photograph of the White House magnificently signed on the mat below by five consecutive former United States Presidents. Of special note is the unique manner in which each President has signed, with notations added in the hand of each representing the exact beginning and ending dates of term of office. We have never before seen another item signed by these former Presidents with these added notations. Each President has flawlessly signed in bold black or brown ink as follows: "Gerald R. Ford, 8-9-74 1-20-77," "J Carter, 1-77 1/81," "Ronald Reagan, Jan. 20 '81-Jan. 20 '89," "Richard Nixon, 1-20-69 8-9-74," "George Bush, Jan. 20,1989-". George Bush has not added a final date as this was signed by him while he was still in office. Each signature and all notations grade a perfect "10." The display currently represents all U.S. Presidents spanning the years 1969 to 1993. There is room for additional signatures; theoretically Bill Clinton and George W. Bush could be added. Beautifully and very expensively matted and framed, this is one of the most aesthetically pleasing, unique, and fascinating signed Presidential offerings we have ever seen. Presidential signatures have always been a popular area of collecting, but rarely has such care and thought and effort been invested into creating a signed Presidential keepsake that has such extraordinary appeal and display value. Beautifully framed with a vibrant dark green border and gilt trim to total dimensions of 22 x 22 inches. In Mint condition. LOA from James Spence, Steve Grad & John Reznikoff/PSA DNA. Reserve $2,500. Estimate $5,000/$10,000. SOLD FOR $5,800.00
(Click the smaller thumbnails to the left and right (if any) to cycle through each photo in the gallery of images for this lot.)


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Today is Kids Day, and all kids 12 and under get in for free! And $25 will get you a wrist-band that lets you ride all the carnival rides all day long.
There are lots of exciting shows and activities to do all day, especially for the kids! At noon, there will be Kid Races at the Turkey Track — with ribbons for the fastest kids in each age group. There's the scarecrow building and UN-building contests, and a bubblegum blowing contest. There's also a Mom Calling Contest! The loudest "Moooooooooom!" wins!
While you're here, check out the Diamond Jubilee Review (2:00 and 7:00 pm) at the Redwood Stage. Hilarious acts, magicians, and even performing pigs! And you don't want to miss the African Acrobats (1:30, 3:30 and 6:30 pm) at the Backdoor Stage. They're amazing!
Other kid favorites are the Splash Dogs and Turkey Races! The Splash Dog pool opens at 11 am, and the first show is at 1:30. Come watch local dogs compete to see who can jump the farthest! And, then at 2:00 come check out the turkey "races." They're hysterical!
If you're feeling crafty, be sure to check out the Craft Corner in Finley Hall (2:00 to 2:30 pm) as well as the Environmental Discovery Center booth in the Sustainable Sonoma tent (2:00 to 5:00 pm).
In the E.C.Kraft building, stop by and say "hello" to the Couch Potato, and maybe sit and watch TV with him for a bit!
For the grown-ups, starting at 11:30 with the Airport Express Racing Seminar at the Park Stage — where you can learn which horses to bet on in today's races. Lots of great advice, and the guys have been picking a lot of winners so far!
As always, there's live music on three stages! At the Park Stage, Haute Flash will be performing (1:15, 2:30, and 3:45 pm) in the early afternoon, and Solid Air will be there in the evening (6:00, 7:15, and 8:15 pm). In the Mexican Village, Nuevo Amanecer will be playing traditional Latin American songs (4:00 to 7:00 pm). And there's nearly always blues playing at the Blues and Brews stage!
Fairgoers of all ages won't want to miss out on the free ice cream being handed out at the Clover-Stornetta booth (1:00 to 4:00 pm)!


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Planning a spring trip or summer getaway? These simple car care tips will keep spending change in your pocket in Maryland.
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American Airlines Earns Title for Best Business Class Wines at Cellars in the Sky Competition
Judges at an international wine-tasting competition have raised their glasses to American Airlines, twice selecting the airline's wine offerings as tops in their class.
American's wines were winners of two prestigious Cellars in the Sky 2007 Awards, announced today at the Business Travel Show in London. American Airlines was named as having the Best Business Class Wine Cellar for overall selection. In addition, American was chosen as offering the Best Business Class Fortified or Sweet Wine with its La Plaza Vieja, Medium Golden, Emilio Lustau.
Cellars in the Sky is an annual competition organized by Business Traveller Magazine and in association with Wine & Spirit Magazine and the International Wine Challenge. This year, 26 airlines from around the world entered a selection of their finest wines for tasting by a panel of wine experts and connoisseurs. Judges evaluated more than 200 different wines in a blind taste test conducted over two days.
"American Airlines believes that fine wine, along with savory cuisine, is an important aspect of the overall travel experience in premium class," said Lauri Curtis, American's Vice President - Onboard Service. "We're delighted that some of the world's most knowledgeable experts have recognized the outstanding quality of our Business Class wines, and we're proud to offer customers the finest selection of wines in the sky."
American's inflight wines are selected by the airline's wine consultant, Diane Teitelbaum, a wine expert with nearly 30 years of experience in the field. Teitelbaum has responsibility for choosing the nearly 60 different wines served each month on American's flights.
American maintains 15 different wine lists, specially selected for various routes. Recently, American began offering specific wine recommendations -- prepared by Teitelbaum -- for First and Business Class customers on board the airline's transcontinental flights. The recommended pairing of specific wines with certain foods not only helps enhance the dining experience, it also educates customers about fine wines.
In addition, American also produces an online pamphlet describing in detail each route's wine selections. To view the current list of American's award-winning wines, visit http://www.aa.com/wine. The Cellars in the Sky 2007 Awards are the latest honors American has received for its inflight wine selection. Last August, American earned accolades in two categories from Global Traveler magazine in that publication's annual "Wines on the Wing" International Business Class Airline Wine Competition. And last February, American was named a winner in two categories at the Cellars in the Sky 2006 Awards, including Best First Class Wine Cellar for overall selection.
About American Airlines
American Airlines is the world's largest airline. American, American Eagle and the AmericanConnection® airlines serve 250 cities in over 40 countries with more than 4,000 daily flights. The combined network fleet numbers more than 1,000 aircraft. American's award-winning Web site, AA.com, provides users with easy access to check and book fares, plus personalized news, information and travel offers. American Airlines is a founding member of the oneworld® Alliance, which brings together some of the best and biggest names in the airline business, enabling them to offer their customers more services and benefits than any airline can provide on its own. Together, its members serve nearly 700 destinations in over 140 countries and territories. American Airlines, Inc. and American Eagle Airlines, Inc. are subsidiaries of AMR Corporation. AmericanAirlines, American Eagle, AmericanConnection, AA.com and AAdvantage are registered trademarks of American Airlines, Inc. .
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Baltimore's top prosecutor gets an unexpected dose of the public's frustration while trying to tout his record on violent crime.
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Real life or just fantasy?
SkyBlew review
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Dozens attend father-son luncheon, job fair in Erie
Attendees heard about the importance of being a father during the Father and Son Luncheon/Job Fair at the Victory Christian Center of Erie on Saturday.
Representatives from the U.S. military, Pennsylvania CareerLink and other organizations spoke about what employers look for in candidates and offered job opportunities during the event.
About 80 people attended the event.


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Sociology majors examine how humans interact in relationships as groups, communities, cultures, and society as a whole. They use this understanding to help and to serve.
Sociology graduates are equipped to conduct research, communicate skillfully, think critically and think globally in preparation for careers in social services, politics, program support, management, nonprofit organizations, and other areas of service and ministry. The coursework combines excellent teaching with service-learning, community-based research, internships, and other practical learning experiences.
Chris Derrick ('10) | Sociology
Chris Derrick honed a passion for combating crime while studying criminal justice in ACU's Sociology program. Now, an internship with the U.S. Marshals office in Dallas has given clear focus to his passion.
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Environmental Management Systems Companies serving Somalia
Current filtering criteriaYou can remove a filter by clicking on the x
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Calvin Consulting Group Ltd.
based in Calgary, ALBERTA (CANADA)
Calvin Consulting Group Ltd. is one of the largest air quality and regulatory compliance specialty companies in Canada. The company is comprised of atmospheric scientists, dispersion meteorologists and emission specialists dedicated to providing our clients with exceptional service in the area of air quality assessment, emissions management, dispersion modelling, ...
EHS Data Ltd.
based in Newark-on-Trent, UNITED KINGDOM
We develop and implement world leading Environment, Health and Safety data management systems to save time, improve planning, quality, analysis, awareness and reporting.A dedicated Implementation Consultant will work with you to deliver services which include database creation, legacy data transfers and custom report design, plus on-site or on-line training. We then offer ...
Certification Europe
based in Dublin, IRELAND
Certification Europe is an accredited certification body which provides International Organization for Standardization (ISO) management system certification and inspection services to organisations globally. ISO Standards provide a recognised framework to achieve best practice management. Certification Europe can certify your organisation to Quality (ISO 9001), ...
Environnement S.A
based in Poissy, FRANCE
Environnement S.A is the leading company in the field of instrumentation for the environment. Ever since its creation in 1978, Environnement S.A has been dedicated to the study, development, manufacture and supply of advanced on-line gas, particulate and water analyzers, using the most recent technologies. Environnement S.A proposes a comprehensive range of continuous ...


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Boys and girls. Thank you for the welcome back. I've been catching up, slowly, with all that has been going on with my MDA buddies. (Yaysu, who would have thought the G-man would have ended up in Rabbit Howls territory.) And. Well, actually rethinking my relationship with here, there and everywhere/everyone. 'Home'coming has been hard.
There's a stretch of coast. It's a bay, with chalk cliffs on one side and clay on the other. And my soul, it has become clear to me, lives in the centre. It's not the most beautiful of all the island's coasts, far from it, but it is mine. Every undulation, every elevation, every curvature, every indentation is etched in such a way that, were my soul were to assume the horizontal or the prone, we would fit as two pieces in an infinite jigsaw. I have been hewn from that geology.
And then there is the city. That city of novelists and poets. Every street, every moment of being has been experienced before as a shadow, as words, as my own memory.
The levels of homecoming were many. Inter-nested: an English doll.
It was beyond painful to get back on the cat. Wave my parents goodbye as they receded, driving down the pier as we sailed away.
It's a wonderful place. It's my cradle. I love it. The Isle. London. England.
All of the above.
And now I am back in the below. Back where I live, my vocation. But my heart, my heart has yet to board a plane.


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Wednesday marked the official start of the hurricane season, and this year could be a difficult one for storm predictions.
The National Hurricane Center is expecting up to 18 named tropical storms with three to six of them becoming major hurricanes.
However, the El Nino and La Nina effects are somewhat quiet this year, making it harder for forecasters to make predictions about possible storms. These are the strong warming and cooling trends that can either rev up hurricanes or suppress them.
Both are expected to be neutral this year, leaving meteorologists scratching their heads over just how bad this hurricane season will be.
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With Independence Day (aka "The Fourth of July") just around the corner time is running out for you to prep for your first open-carry day! First off you'll need to find out if it is legal to open-carry in your locale, and if so what the restrictions on doing so are. You might even want […]
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Will you open-carry on Independence Day?
By Joe Levi on June 23, 2010 in Good guys with guns
Thoughts on "Open-Carry"
By Joe Levi on April 7, 2010 in Uncategorized
"Open Carry" (often referred to as "Constitutional Carry") is a term used to describe the unconcealed carrying of a firearm (the operative word being "unconcealed"). This is what most on-duty police officers and armed military personnel do, but in this context it typically refers to civilians (or citizens). Open-Carry differs from Concealed-Carry in that the […]
Arrested for having "too much" ammo?
Can anyone cite a city, state, or federal ordinance that limits the number of rounds of ammunition someone can own at any given time? Neither could we, but that didn't stop a 32 year old Haverhill, Massachusetts from being arrested after police found 10,000 rounds of ammo in his car and later confiscated an additional […]
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Now, why do you think it makes a difference that Blacks get to be doctors?
I think Blacks, ah, because I'm Black, but, ah, any Third World people who, and they don't necessarily have to be poor, ah, are going to be sometimes much more sensitive to the needs of not only other minorities, but as even proved to be in the clinic, to the needs of people, period. The truth of the matter is there are a huge amount of people who exist below the poverty line in America and that those are needs that are not met. A case in point is where I'm working right now. I'm in the city of Compton. It's a huge area with lots and lots of people and children. There are only two pediatricians in the area. There is no one who selected this area. I selected it really because I, quote "returned to the community," and I truly did that. Not a selection based on money but something to fulfill a need and if you look at NMA, National Medical Association, and you look at where Black doctors are, the majority of them are in areas of need. They're in poor areas. They're not only taking care of poor Black people, they're taking care of poor people, period. So, they're supplying a need. So, it was very, very important to me that we increased, ah, the amount of Black physicians we had in the United States as well as other minority physicians. We have a trend right now in the State of California that's rapidly becoming Hispanic and Asian, ah, we must take care of the needs of those patients. Not only the language needs but there are other needs too.