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Normally this is where I say something. Or try to argue two sides of an interesting issue. Instead of doing that today, I just want you to spend 7 minutes watching an informative video about the future, with "Solar Freakin' Roadways".
Normally this is where I say something. Or try to argue two sides of an interesting issue. Instead of doing that today, I just want you to spend 7 minutes watching an informative video about the future, with "Solar Freakin' Roadways".
Google has been developing the driverless car for over half a decade, and with each passing year these automated chauffeurs move farther away from science fiction and closer to reality. Five states have passed laws enabling such vehicles, and as of April of this year, over 700,000 miles have been driven without an accident.
While commercialization is still a long way off, last week a debate raged over the ethical situations that may arise when a driverless vehicle is put into a situation where a crash is imminent. As a hypothetical example, what if a crash was unavoidable, and a driverless car had to choose where to guide the car – either to collide with a schoolbus or a volvo? Physics dictates that hitting an object of larger mass will statistically be the safest, but there are kids on board! What is the correct decision? Is the law, and by extension, the public, prepared for cars that "choose" the best scenario?
Never has Javascript been more fun to learn. A startup venture backed by Y Combinator wants to teach you that language you've always wanted to learn through gameification – or the usage of elements of game design(e.g., point scoring, competition with others, rules of play)- to enhance motivation and the learning process. Slay orcs and battle minions by programming your units in a real-time web game. Compete against your friends to see who wrote the more robust code. Possibly get a job for your efforts? Welcome to CodeCombat. Continue reading →
Last week, facebook announced that it had given its website, largely written in a programming language called php, a programming equivalent of a face lift. They also made a splash in the web development industry by releasing a new web programming language called Hack to the open source community. Hack is based on the php, but claims to keep "all the good parts" while removing some of its limitations. Since Facebook has been converting it's legacy php to hack for some time now, you can trust that hack can stand up to the highest expectations, and that Facebook clearly has a lot of faith in the strength of the language. Continue reading →
The human eye is one amazing instrument – a phenomenon of biological engineering, and the window through which we interact with our world. The fastest and arguably strongest muscle – it is second only to the brain in its complexity. At Johnson & Johnson Vision Care, where I now work, our mission is to promote healthy vision for everyone.
This doesn't mean just vision correction! It means treating the full range of optical conditions, from common myopia (short sightedness) to the more complex and currently incurable glaucoma – and everything in between. It means designing products that don't just improve the quality of vision, but are also safe and non-damaging to this special organ.
It's easy to just focus on simple vision correction, because 285 million people are estimated to be visually impaired worldwide, and only a fraction of them are treated. But in the spirit of Healthy Vision, I had a very interesting discussion with my coworkers about color blindness – and learned some pretty amazing things! Read on to take a hue test to see how accurately you see the lush colors of the world, and to hear about exciting research into curing color blindness. Continue reading →
Google announced on March 18th that they had created a new interface for wearable technology based on the Android platform, which they named, "Android Wear". This adaptation of Android is meant to be lightweight, highly contextual, and aware of your surroundings. Check out the video after the break. My thoughts on the technology to follow. Continue reading →
After completing a $50,000 kickstarter campaign in under 40 minutes, this small company's mission is to shrink the size of your wallet by decreasing the amount of plastic a person has to carry to a single card.
A small step to the transition of plastic to digital money management, there is a lot to like about the slick promo video for the card that can store debit card, credit card, and loyalty/gift cards on a single swipe-able card. I love the idea, but will the execution be solid enough to stave off the security concerns around a comprehensive identity theft target? Continue reading →
Over this week, I have been reading a lot about new companies creating new industries, markets, and services for the unmet needs IT organizations as they shift to the more and more mainstream paradigm of cloud computing. Gone are the days of a 2D IT department! It's no longer just about Operations and Engineering. The challenges of managing infrastructure outside the corporate wall, processing big data, and growing threat of cyber attacks have created some cool opportunities – and in this post I want to highlight a few that caught my attention. Continue reading →
Ever wonder why a common complaint in the workforce of many large companies is that the business processes are too complex? While every company tries to remove inefficiencies, its a recurring narrative that the bigger a company is and the longer it has been around, the more likely it is to be mired down in processes that sap productivity and don't add value.
Yves Morieux is a Senior Partner and Managing Director of the Boston Consulting Group, head of BCG's Institute for Organization. In a recent TED talk, he really got me jazzed looking at how the top two organizational structures that corporate leaders use for resolving business challenges contribute directly to this productivity atrophy. It is his opinion that these methods are obsolete and no longer work into today's corporations. He makes some compelling arguments. What do you think? Continue reading →
As a technology professional and a futurist, I enjoy thinking about what is the next step in the evolution of the use of technology. One of the prominent theories for that next leap is dubbed the "Internet of Things". The internet of things is a world where everything, from your house, to your microwave, to your car, is "smart", connected to the internet, and controllable by a computer. Many of the prerequisites are already in play: IPv6, open hardware like Arduino, and RFID technology have laid the building blocks for more devices than ever before to be identifiable nodes on the internet. Smartphones have given you the remote control 2.0, an internet device carried by virtually every human being in the developing world with a wide array of uses. Wireless internet is expanding – 4G, wifi hotspots, and projects like Google Loon will give you access to the hyper expanding network from virtually anywhere on the planet.
A lot of the new "smart" devices joining Wi-Fi networks add new conveniences to our lives, but could potentially be opening us up to new vulnerabilities as well. I heard of a new one reading a blog by Arik Hesseldahl. Continue reading →


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monty wrote:
> Hi Guys,
> I have compiled my application on AIX 5300-05-05 and it is running
> fine on the same environment. Now I am running the same application on
> the AIX 5300-05-CSP and it is giving core. Here surprisingly core is
> getting genrated after the successful execution of my application
> completely.
> Below is the core analysis:
> Segmentation fault in . at 0x67613030 ($t1)
> [...]
No solid information, but something to investigate: The
offending address, interpreted as ASCII characters, would be
"ga00" (or perhaps "00ag"). Does either of those seem familiar,
perhaps as part of a longer string? It may be that you're
using the first four characters of a string in a context where
you should actually be using a pointer to them.
Eric Sosman

subset: commoncrawl


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QUIZ: Who wrote it, Lennon or McCartney?
Teenie Harris' Pennsylvania
How to do infrastructure spending the right way
Who's getting rich in rural America?
Credit scores likely impacted by Wells Fargo fake accounts
John Oliver has the Clinton and Trump scandal primer this campaign sorely needed
Why are creepy clowns terrorizing America?
Oh hey, Flipper: How dolphins may give each other names


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Thursday, September 27, 2012
Summerville, S.C./ September 26, 2012 Today, Dr. Ronnie Givens performed the first robotic surgery at Summerville Medical Center (SMC). The procedure was a Laparoscopic Salpingo-Oopherectomy, which consisted of the removal of an ovary and fallopian tube.
The South Carolina Institute for Robotic Surgery, which consists of an advanced team of 18 surgeons, is now based out of Trident and Summerville Medical Centers. Summerville Medical Center thrives on giving our patients the best care possible- without having to travel far from home. Robotic surgery means a shorter hospital stay, less pain and fewer medications, said Lou Caputo, Summerville Medical Center CEO. SMC will be using the da Vinci Si HD robot, the most advanced technology available in the field.
The Institute is equipped with the only da Vinci Si HD robots in the Lowcountry. The Institute has been recognized nationally as a model robotics program for surgical best practices by demonstrating an exceptionally trained robotics team, surgical efficiency and superior patient outcomes. Hospitals from around the country observe the Institutes robotics team to learn these best practices. In less than four years, the Institute has performed over 2,100 robotic procedures, more than twice as many as any other hospital or health system in the Lowcountry.
Intuitive Surgicals da Vinci® Surgical System combines superior 3D high definition vision, patented EndoWrist® instruments and Intuitive® motion to allow for unparalleled precision, visualization, dexterity and control. The end result: a breakthrough in surgical capabilities that is changing the experience of surgery.
Summerville Medical Center is a 94-bed, acute care hospital located in the Oakbrook section of Summerville between Ladson and Trolley Roads and is part of the HCA hospital system.Accredited by The Joint Commission, Summerville Medical Center is committed to providing quality health services along with wellness information and opportunities to the communities it serves. The Joint Commission recently named Summerville to their list of the nations top hospitals for quality and safety for the second straight year. In 2011, Trident Health provided almost $42 million in charity and uncompensated care and contributed $38 million in taxes. For more information about Summerville Medical Center, please visit our website atwww.tridenthealthsystem.com/smc or call 843.832.5000.
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Tenative start date: June 20th
THE RULES: (so far)
- Matches will be 6 vs 6, and use the level 100 scale-up option, meaning that no excessive leveling up is required
- Do not share information about or discuss your opponent's team. By entering the tournament, you agree to this ... although if they give you permission after the battle, that's fine. Be courteous and don't send tips privately.
- All pokemon not usable in the battle tower are banned. As the game itself considers these pokemon to be unfairly advantageous (resultant from base stats, move sets, and/or that they are only attainable through special-events/perks/haxors, etc), they are not permitted. These include:
Deoxys (all forms)
- Wobbuffet and Latias/Latios are also banned. Due to its ability and moveset, bringing out Wobbufet will guerentee a kill in most any situation. As for Latias/Latios, they're the only legendaries not banned from the battle tower that can learn both Recover (heals half of its HP) and Calm Mind (raises both special defense and defense). Do the math.
- No pokemon with illegit stats, move sets, items, etc. In other words, no hacks please. Try to stay away from using pokemon you've traded for on the GTS if you're not sure.
- Two or more pokemon cannot have the same hold item, excluding berries.
- One species of pokemon allowed per team. This means if you have two Steelix's on your team, for example, you're breaking the rules. Different evolutionary stages are allowed.
- Banned moves: Double Team, Minimize, Fissure, Guillotine, Horn Drill, and Sheer Cold. In short, allowing any of these moves takes away an element of strategy and replaces it with luck. Double Team & Minimize especially so, since the evasive-ups they give can be baton passed to other pokemon. Likewise, the instant KO moves (mentioned above) can lead to undeserved victories with a little luck.
- Only one Pokemon on an opponent's team may be forcibly slept at a time. Much like the above, allowing exceptions to this rule would lead to whole teams of slept pokemon waiting for a lucky break to wake up (in all likely hood, only to be slept again the proceeding turn).
- If your last pokemon uses a self destruct move and kills itself, you forfeit. Even if the match ends in a draw.
*Update*: The following changes have been suggested:
Manaphy, Shaymin, Jirachi, Celebi are allowed - PaT2090
Although I personally don't agree with these, I'll leave you it to you guys to have the final say. If I find overwhelming approval/dissent, I'll make some adjustments.


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Potera, Carol
Nurses can help guide preoperative awareness.
Patients may set up an advance directive (plan for end-of-life care), but according to a new study, surgeons may not abide by it, or they may even refuse to perform surgery because of restrictions outlined in an advance directive. In the study, a survey of U.S. surgeons found that most (81%) regularly talk with patients about the types of life support options a patient may want to limit after surgery, but only about half ask patients whether they have an advance directive or discuss the details, such as restricting feeding tubes or ventilators to prolong life.
The surveys were completed by a total of 912 vascular surgeons, cardiothoracic surgeons, and neurosurgeons who regularly perform high-risk operations. Among cardiothoracic surgeons, 63% said they would decline to operate if an advance directive limited the procedures that they could perform after surgery to keep the patient alive. About half of vascular surgeons and neurosurgeons might decline to operate based on an advance directive. Perhaps because neurosurgery can lead to devastating neurologic complications, neurosurgeons are more comfortable with withdrawing life support and see it as a reasonable decision.
Surgeons with more than 20 years of experience were more likely to ask about advance directives than were surgeons with less experience (69% versus 44%). And surgeons who asked patients about their preferences regarding limits on postoperative life-support therapy were five times more likely to ask about advance directives.
The results of this study suggest that some surgeons believe that advance directives send a signal that a patient isn't truly committed or is unwilling to accept the invasive therapies that come with high-risk operations.
Linda Groah, executive director and chief executive officer of the Association of periOperative Registered Nurses, points out that advance directives weren't designed to address surgical procedures but, rather, to guide lifesaving measures related to stroke, accidents, heart attacks, and related situations. "Surgery presents a different challenge, and it's important for surgeons and patients to discuss advance directives and reach an agreement on actions that could be taken during the intraoperative and postoperative phases of care," says Groah.
Nurses should make surgeons aware of patients' advance directive and then encourage and support the patients while they're discussing their desires with the surgeon. "Nurses can also make available other resources, such as a social worker, to assist in the discussion between the patient and physician," Groah says.—Carol Potera
© 2012 Lippincott Williams & Wilkins, Inc.
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Topshop Announces Twitter #TrickorTweet Contest: Fashions and Prizes for Halloween
Topshop isn't exactly the place I go to to get scary, but they do have a lot of trendy and fun looks that could be converted into Halloween costumes, especially if you want to go for a supermodel or Hollywood look. That's why our chums at Topshop have come up with the idea for a Twitter #TrickorTweet contest. If you love the siren's call of free fashion and the fun of Halloween, then this ones for you. This sounds like a fashion blogger's delight. "We love the idea of using Halloween to connect our digital and physical worlds." says Justin Cooke, Chief Marketing Officer, Topshop. "We know our customer moves seamlessly between the two and we want to make that experience even more fun for them and drive conversation in our community around a moment that everyone wants to be a part of." That Justin….he knows us , right? 🙂
|Pictured: Some of my favs from the Topshop Witching Hour, fascinator and skeleton dress.
So what's Topshop 'Trick or Tweet? It's a social media competition to celebrate Topshop's new Halloween collection appropriately titled 'Witching Hour'. If you haven't seen the new Witching Hour collection, be prepared to go to the darkside as it's very goth. My favorite piece is the Skeleton dress but, it's already sold out online! Boo! I also love the Cat Fascinator and if I can get one, that would be my #TrickorTweet! So reeve your Twitter engines. Starting tomorrow, from Oct. 26th – 31st October you can enter the 'Trick or Tweet' competition by tweeting @Topshop your favourite Halloween style tip or a twitpic of their Halloween outfit hashtagging it #TrickorTweet. Note, you must be brave for this challenge, or have a good costume! 🙂 If you accept the challenge, you may be rewarded. The best tweets will be rewarded with some shopping prizes. @Topshop will send messages to entrants to thank them for taking part with the best tweets each day treated to £100/$150 gift cards. You can participate in the challenge online or by going to a Topshop flagship store (London: Oxford Circus, New York: Soho or Las Vegas: Fashion Show Mall) and getting your fright on. If you go to a Topshop flagship you can enjoy complimentary make-overs with a Halloween twist and DJ performances to help you get into the Halloween spirit. I'll be Tweeting from Los Angeles, although we have no Topshop yet (coming Spring 2013) just to get into the spirit of things.
|Pictured: A frightful Topshop look from the Witching Hour Collection
If you're like me, always looking for a deal, be aware that at selectTopshop flagship stores (see above list), customers will be able to purchase items using tweets as currency in the 'Topshop Tweet Shop' where Halloween-inspired make-up will be given in exchange for tweets. Customers visiting selected Topshop stores during these dates will also be able to get involved by taking a "Twitpic" of themselves in front of in-store 'Trick or Tweet' backdrops and posters. Get ready to channel your inner Elvira. Use the hashtag #TrickorTweet or either Twitter or Instagram to participate in the competition. Additional prizes will be given in-store to customers dressed in the best Halloween inspired outfits during 'the Witching Hour' between 5pm-6pm on 27th and on October 31st. Winners will also be re-tweeted to all Topshop's fans and an album of the best outfits will be shared with its millions of social followers on multiple platforms. That could be fun. Especially if you were lucky enough to get that Skeleton dress from the Witching Hour collection!


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Source: The Verge
quote: Yea for being lazy and ripping off the iPhone and its technology that took billions to develop.
quote: C'mon Droidtards, tell me this pictures don't look alike:
quote: I haven't seen an Android that wasn't a wannabe iPhone. Google and co. wouldn't no innovation if it smacked them in the faces.
quote: I don't get it. if you all want an iPhone so badly, why don't you just buy one?Hopefully all the crapdroids get sued off the market and that solves that problem for you. Then you can finally get that iPhone you've been secretly wanting all along.


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Art F City
Posts tagged as:
Who wants to throw away their art in public, with a bunch of other people? I don't really know. I rid myself of sentences all the time (Welcome to my Mac trash bin!) but I wouldn't announce it.
Happy Fourth of July, art people. There's not much going on thanks to the holidays, but for the art die-hards in the crowd, we've managed to scrounge up a few openings. We'd also like to remind you all about the great summer shows we posted about in June. For better or worse, in New York, you'll never be want for shows to see and places to go.
Danh Vo and feminism dominate this week's art events, with a few dark horses and a light-up piano in the running.
An air of something clung to the walls of The Armory Show yesterday afternoon. Sales were uneven, but steady, and the crowds pretty much identical to last year. The mechanics of the fair seemed to be working fine.
And yet, change seemed certain.
Add Brooklyn / Montreal to the list of exhibitions I'm looking forward to in the New Year. Join me Saturday, January 12 at A.I.R. Gallery for a discussion on cultural exchange.
Well, good. Postmasters' Magda Sawon announced over Twitter yesterday, that SEVEN will participate in New York's upcoming fairs. This means we'll have at least one event to attend that resembles an actual exhibition, in addition to Frieze and Pulse, which run May 4th through 7, and 3rd through 6th, respectively. SEVEN launches April 28th and runs through the middle of May.
This Friday, Nov 11th, from 6-9pm, join Williamsburg Every 2:ND Friday, presented by AT&T, for an Art Crawl to over 15 galleries in Williamsburg, Brooklyn.
This Friday September 9th, 2011 6-9pm, join Williamsburg Every 2:ND Friday and Artlog for a fall kickoff Art Crawl through 10 galleries in Williamsburg, Brooklyn.
Check into Causey Contemporary or Like the Spice Gallery to get your maps, create your own route, or go on a tour with experts through the Williamsburg Gallery scene. Walking tours, refreshments, and a special after party from 9-11pm at Causey Contemporary will be provided for those who check-in.
This weekend's openings are scattered throughout the city. Let me tell you all about what's at CANADA, Lisa Cooley, Taxter and Spengemann and more!
Artist: Darina Karpov Date: Friday, July 2nd 2010 – Sunday, August 1st 2010 Venue: Pierogi, 177 North 9th Stree Russian-born, Brooklyn-based Darina Karpov shifts materials from the mostly ink, gouache and watercolor on paper of her earlier works to oil on panel. The new series appears looser, wetter and lusher, a welcome addition to her oeuvre.
Advertise on AFC with Nectar Ads
WordPress Admin


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As reported earlier, I narrowed the problem of my settings not sticking
after the upgrade to 1.5 down to userChrome.css.
More specifically, the "mybindings.xbl" kindly provided by Karsten about
a year ago in netscape.mozilla.thunderbird as part of the very long
"Folder colours" thread, which subsequently changed to "bold messages in
Unsent Folders/ Draft" appears to be incompatible with TB 1.5 and
appears to make settings non-sticky.
The original purpose of "mybindings.xbl" was to have user-definable
colours for individual mail folders, and I subsequently also used this
file for preventing the Drafts folder from turning bold when a message
is saved as draft.
Since I found the QuickMove extension, folder colours are less of an
issue for me, because I can simply file messages from the Inbox via
right-click (without having to drag them to different folders).
However, I still hate the Draft folder turning bold when I save a
message as draft, because I find it very distracting.
Fortunately, "mybindings.xbl" isn't required for changing this
behaviour, and on 19 February 2005 Parish posted a much simpler solution
(which I just implemented, and it works perfectly well) as follows:
If you don't like it, add these lines to userChrome.css in the chrome
directory of your profile - the file doesn't exist by default, you have
to create it.
treechildren:-moz-tree-cell-text(specialFolder-Unsent) {
font-weight: normal !important;
Herbert Eppel


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Oeuf teamed up with Spanish designer Carlos Tiscar to create the Elephant, a crib that can be assembled with minimal hardware in 10 minutes. This crib was designed to be a fun addition to a nursery and to make the lives of modern parents easier. The Elephant combines the design sensibility of Tiscar, a Spanish artist, with Oeuf's experience making safe and sustainable baby furniture.
Dimensions: 33 7/8"D x 57 7/8"L x 34 5/8"H
The Merlin 6 Drawer Dresser is a perfect fit with any of Oeuf's furniture collections, from Classic to Perch. With its clean lines and quality construction, this dresser will be loved by parent and kid alike. Six deep drawers provide plenty of storage room, and the modern and simple styling make this dresser a piece that looks good in a bedroom or a nursery. This dresser is built to last and will grow with your child for many years to come.
Dimensions: 33.25"H x 53.5"W x 19.75"D
Please Note: This item is considered a Special Order and will take 10-14 business days to process and ship. Call (206) 254-0400 or email firstname.lastname@example.com with any questions.


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Top Definition
When girls have to pee really bad,and and some urin seeps through their vagina, into their panties.
I totaly had a boom leak, and when I bent over I thought some1 saw it.
af E K n A 2. november 2003
Trending Now
Can you define these popular missing words?


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Some NMSU students say the like the decision to name Garrey Carruthers as the new president of the university. Carruthers is the dean of the college of business and a graduate of NMSU.
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A Recent Report by the Institute for College Access and Success Shows Pennsylvania College Grads Rank 2nd in the Nation for Student Loan Debt. According to the report, students graduating from Pennsylvania colleges with a bachelor's degree in 2010-11 left campus with $29,959 on average in loans, a sum surpassed only by New Hampshire's $32,440 total. Seventy percent of graduates in Pennsylvania carried debt.
Congresswoman Schwartz is a strong advocate for expanding access to affordable higher education to ensure America's continued economic strength and competitiveness in a global economy. This year, Schwartz introduced legislation to ensure students and their parents have access to vital information regarding their student loan options.
The Know Before You Owe Act requires schools to counsel students on the financial aid options available to them, including less risky federal student loans. The bill also requires private lenders to adopt commonsense steps to protect student borrowers.
The Plaza is located on the west side of the Sutherland Building - #1 on the campus map.
Note: Press should park in the Sutherland Circle (Lot A on the campus map. Entrance off Woodland Road).
Contact: Tali Ciazza, 202-225-6111


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GRAND RAPIDS — Some residents aren't entirely sure why President Obama is visiting the Johnson Controls-Saft battery factory in Holland on Thursday, but many are welcoming him with questions.
The Press asked readers to submit inquires for the commander in chief, and nearly 100 people submitted questions on Tuesday. Those concerning Obama's leadership and the economy piled up the highest.
The trip marks the second time the president has visited battery factories in Holland. Obama last visited the area in July 2010 to mark the ground breaking at LG Chem's now-completed $303 million lithium-ion battery plant, which received substantial government subsidies as part of an effort to foster battery development in the United States.
The Johnson Controls-Saft plant is expected to employ 500 people in the production of batteries for electric vehicles. The plant received $168.5 million in state tax incentives for the $220 million facility. The companies were awarded a $299 million federal grant to develop domestic battery production and research capabilities, some of which went into the development of the Holland plant.
"When do you plan to make good on these broken promises and why should the American people believe you?" was the question Greg Evans of Allendale would ask the president. "One of the reasons he got a lot of votes was because he said the government needs to be more accountable and transparent and he has done nothing of it."
Evans, 28, is displeased with the decisions made during "closed-door sessions" such as the health care reform bill. He claims the current administration has left the American people in the dark.
"It's hard to tell who is lying and who is telling the truth," he said. "We don't see the bills or the details in them. There isn't any leadership in accountability."
Other people voiced concerns about the president's demeanor when it comes to working with Congress.
"It's not just the president. I'm not affiliated with a party but I see that we have no cooperation between them. It's wrong. When we put them and him in office, we expect them to cooperate," said Teddie Lee of Comstock Park. "Can we not put political parties aside and get together to save our country?"
David Bronder of Farwell said he was less upset with the president than he is with the "entire political landscape."
"How do we get the power back to the people, and not to the parties?" asked Bronder, 43. "Term limits have hurt our system greatly because it takes the power out of the people. Whoever we elect pleases the party and not the people who elected them," he said, adding he was embarrassed by the health care reform battle.
Patrick Sheufelt of Grand Rapids wants to know when a full-scale audit of the Federal Reserve will be made public. Marilee Fisher, of East Grand Rapids, wants to know what actions citizens should take to end gridlock and encourage bi-partisan compromise in Washington.
While most people took time to criticize the president — some demanding his resignation — others kept their questions simple and sympathetic.
"How do you deal with the stress of running a country that can't seem to get out of the slump it's in?" asked Marci Smit of Holland.
Pat Letts, of Ionia, submitted five words: "How can we help you?"
"Would you please describe Holland in just six words?" asked Dot Besteman, referencing the MyGR6 contest.
Bronder thinks Obama visiting the new plant is necessary and helps restore confidence in the economy.
"It gets people to realize there is real manufacturing happening," he said. "Don't quit on America just because you're working in one area that is hurting."
Lee and Evans do not agree.
"I think there should be more important things for him to do," said Lee. "It probably boosts moral but it doesn't affect me. We used to sing 'United We Stand' all the time but (our politicians) forget the second verse, 'Divided We Fall,' and at this time, we are divided."
E-mail Ursula Zerilli: firstname.lastname@example.com or follow me on twitter.


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From the Departments of Internal Medicine, Saint Joseph Hospital (Drs Kutinsky and Blakley); and Center on Aging, Division of Geriatrics, University of Colorado Health Sciences Center (Dr Roche), Denver, Colo. Dr Roche is now with the University of Texas, Southwestern Medical Center at Dallas.
Pulmonary embolism (PE) is frequently evaluated in acute care settings. Despite this, the clinical diagnosis of PE is difficult. Results of ventilation-perfusion (V/Q) scans may be inconclusive, and pulmonary angiograms (PAGs) are cumbersome, involve risk, and are often unavailable. Using PAG as the standard criterion, we evaluated the relationship between PE, V/Q scans, and semiquantitative latex agglutination (LA) D-dimer levels.
Ninety-eight patients who underwent V/Q scanning for suspected PE were enrolled; based on the results of the scans, the patients were scheduled for PAG. Blood samples were drawn for LA D-dimer assays during the PAGs at Saint Joseph Hospital, Denver, Colo, from January 1, 1996, to February 1, 1997. A detailed medical record review was performed for all enrollees.
The mean ± SEM patient age was 56.6 ± 1.9 years; 52 (53%) were men, 13 (13%) had cancer, 23 (23%) had undergone surgery within 30 days of their PAG, and 13 (13%) were receiving warfarin sodium. There were no differences in warfarin therapy, hypercoaguable state, or cancer prevalence between patients with negative and positive PAGs (P=.53). Ventilation-perfusion scan results were available for all study patients. Eight (27%) of 30 patients who had positive angiogram results had LA D-dimer levels less than 250 ng/mL. Patients with positive PAGs (n=30) had the following V/Q scan results: normal, 0; low probability, 7; intermediate or indeterminate probability, 22; and high probability, 1. In patients with low-probability V/Q scan results (n=34), a positive D-dimer result for PE (>250 ng/mL) had a sensitivity of 71.4% (95% confidence interval, 0.29-0.97) and a negative predictive value of 87.5% (95% confidence interval, 0.62-0.98). We found a significant difference in D-dimer levels in patients with an abnormal angiogram result (mean, 750 ng/mL) compared with patients with a normal angiogram result (mean, 250 ng/mL) (P=.01, χ2 test).
Eight patients had normal D-dimer levels with angiographic evidence of PE. Algorithms in acute care settings have been proposed; they exclude PE with normal D-dimer levels using the enzyme-linked immunosorbent assay technique. These cannot be extrapolated to the more widely used LA assays. A normal LA D-dimer level alone or with V/Q scan results is not recommended to preclude the treatment of PE.
PULMONARY EMBOLISM (PE) is a well-recognized event in acute care because of its frequency, various clinical presentations, and potential morbidity and mortality. The annual incidence is 69 per 100,000.1 Untreated patients with PE have mortality rates as high as 30%.2 It is difficult to accurately and cost-effectively diagnose PE. We use ventilation-perfusion (V/Q) scans in addition to clinical suspicion to diagnose and then decide whether to treat patients with anticoagulation therapy. However, this is useful for only half of the patients with suspected PE.3 Ventilation-perfusion scans are not interpreted as normal or abnormal but rather across a spectrum as normal, low probability, intermediate or indeterminate probability, and high probability. Consequently, patients may undergo pulmonary angiograms (PAGs), the standard criterion, to confirm the diagnosis. Unfortunately, PAGs are not always readily accessible, are cumbersome, are expensive, and have documented rates of morbidity (5%) and mortality (0.5%).4 Helical computed tomographic scans hold some promise, but are not the standard of care.
Research focuses on finding a cost-effective, noninvasive, diagnostic aid to rule out PE because 70% of V/Q scans are nondiagnostic.3 There is considerable interest in finding a blood test to expedite the exclusion of PE. D dimer is a specific fibrin degradation product released by a dissolving fibrin clot that can be measured in peripheral blood. Similar to troponin use in acute myocardial infarctions, D dimers have been extensively evaluated in venous thromboembolic disease, and specifically in PE.5- 8
Numerous studies9- 12 have shown that normal D-dimer levels, as determined by enzyme-linked immunosorbent assay (ELISA) technique, have excellent negative predictive values (NPVs) of 91% to 98%, postulated to be adequate to exclude venous thromboembolism and allow for the safe and expedient discharge of patients without further tests. Enzyme-linked immunosorbent assay–derived D-dimer assay is the standard criterion and the basis for these proposed algorithms. These algorithms to rule out PE using the ELISA method have been suggested for use in acute care clinical settings.5,8,12 In practice, D dimers measured using the ELISA technique are rarely used, as they are technician dependent, expensive, tested in batches, and, thus, inefficient for acute clinical practice. Latex agglutination (LA) determination of D-dimer levels is more often used instead of ELISA testing because it is readily available, quick and easy to perform, and inexpensive. However, the sensitivity of LA tests varies in the English-language literature.6,13,14 We studied the clinical use of LA D-dimer levels to rule out PE by designing a prospective study to assess D-dimer levels in patients who underwent V/Q scanning and were scheduled for PAGs based on their lung scan results.
The study was performed at Saint Joseph Hospital, Denver, Colo, a university-affiliated, tertiary referral community teaching hospital. Patients who were eligible for enrollment underwent V/Q scanning between January 1, 1996, and February 1, 1997, and were subsequently scheduled for PAGs because clinical suspicion required additional evaluation. A detailed medical record review was performed for each participating patient. The study protocol was reviewed and approved by the hospital's institutional review board.
Lung scans were performed and interpreted using the same criteria as were used in the prospective investigation of pulmonary embolism diagnosis (PIOPED) study.3 The ventilation portion of the scan was performed using 1110 Mbq (30 mCi) of xenon 133. Multiple images were obtained at 10-second intervals. Subsequently, the perfusion portion was performed using 6.2 mCi of technetium Tc 99m, which was injected peripherally. Images were obtained up to 2 minutes later and repeated in all 6 standard views. Lung scans were interpreted as follows: normal, low probability, intermediate or indeterminate probability, and high probability, per the PIOPED protocol.3 Each scan was interpreted by 1 of 5 board-certified radiologists blinded to the D-dimer results.
The radiologists performed the PAGs by catheterizing a femoral vein via the Seldinger technique with a 6F to 8F pigtail catheter. A small amount of nonionic contrast dye (Hexabix, Cleveland, Ohio) was selectively injected into branches of the pulmonary arteries, as directed by findings on the V/Q scan. Multiple views were obtained in anterior and posterior projections. Pulmonary angiograms were interpreted according to hospital protocol, and the radiologist diagnosed PE when total occlusion of a vessel was seen and/or a filling defect of at least 3 mm was present. Angiograms were interpreted by 2 separate radiologists, both blinded to the D-dimer and V/Q scan results. If there was disagreement, a third radiologist was available to review the PAG.
Blood was drawn from patients into a citrated tube for LA D-dimer assays on the day of the PAG via the central venous catheter used for the PAG or a peripheral vein. The plasma was separated within 1 hour of venipuncture and then stored at −70°C. Batches of plasma were processed within 3 weeks of phlebotomy by a qualified laboratory technician blinded to the V/Q scan and PAG results. D-dimer assays were performed using a kit (Accuclot D-dimer kit; Sigma Diagnostics, St Louis, Mo), per manufacturer's recommendations. Briefly, latex beads coated with monoclonal antibody to D dimer are added to serial dilutions of the patient's plasma. Dilutions containing 250 ng/mL or more of D dimer produce agglutination. Ranges of concentration of D dimer are reported using the lowest concentration of plasma that produced agglutination and the next most dilute sample. A D-dimer level less than 250 ng/mL is the lowest level detected with this semiquantitative LA kit and is considered a negative or normal result—undiluted normal human plasma produces no agglutination. Negative and positive controls are provided in the kit for comparison with each batch assay.
A detailed medical record review was performed by 1 of 3 reviewers (I.K., S.B., or V.R.) who were blinded to the D-dimer results. The medical record review provided information about demographics; the patient's status at the time of the PAG, including hypercoagulability status, surgery within 30 days, the presence of cancer or liver disease, and creatinine level; and the presence of disseminated intravascular coagulation.
Descriptive statistics, χ2 tests, Wilcoxon t tests, and sensitivity and NPV tests were performed with a statistical software package (SAS 6.10; SAS Institute Inc, Cary, NC).
Of the 121 consecutive patients scheduled for PAGs by their physicians following lung scan results, 118 agreed to participate in the study. Blood samples to test for D-dimer levels, results of lung scans, and PAGs were available for 98 patients. The average age of the patients was 56.6 ± 1.9 years (mean ± SEM). Fifty-two (53%) of the patients were men, 13 (13%) had cancer, 23 (23%) had undergone surgery within the 30 days preceding their PAGs, and 25 (26%) had a history of thromboses. Thirteen patients (13%) were taking warfarin, 7 of whom had been receiving long-term anticoagulation therapy; and 8 patients had hypercoagulation. One patient was receiving long-term anticoagulation therapy with heparin, 1 had sepsis, and 5 had liver disease. Given the small numbers of patients with these diagnoses, no further subgroup analysis was attempted. The duration of heparin therapy before angiography ranged from 0 to 4 days, with a mean of 0.8 days when the patient receiving long-term heparin therapy was excluded. Patient characteristics did not differ between patients with normal and those with abnormal PAG results (P=.53) (Table 1).
Ventilation-perfusion scan results for the 98 enrollees were as follow: normal, 1; nondiagnostic, 91; and high probability, 6. The nondiagnostic scans were read as low probability (n=34) and as intermediate or indeterminate probability (n=57). Only 1 of the 6 patients with a high-probability lung scan result had an abnormal angiogram result (Table 2). This unexpected finding of high-probability V/Q scan results with normal angiogram results prompted a specific review of these 5 patients' medical records. Two of these patients had moderate to severe pulmonary hypertension secondary to severe obstructive lung disease; 1 patient had chronic PE, as demonstrated by clinical evaluation and by the presence of webs on angiography; 1 patient had bronchial obstruction due to a tumor; and a cause was not identified in the remaining patient.
There was no disparity between any 2 radiological interpretations of an angiogram and, therefore, a third radiological interpretation was unnecessary. Thirty patients (30.6%) had positive PAG results. Seven of these patients had low-probability V/Q scan results, 22 had indeterminate or intermediate scan results, and 1 had a high-probability scan result. Table 2 provides D-dimer levels, less than and greater than 250 ng/mL, together with lung scan and subsequent angiogram results.
Forty-seven of the patients had D-dimer levels less than 250 ng/mL, which are considered normal. We chose to report D-dimer levels less than 250 ng/mL (Table 2) because this level had a sensitivity of 73.3% (95% confidence interval [CI], 0.58-0.89) and an NPV of 83% (95% CI, 0.72-0.94). As previous studies5- 10,13,14 have used levels between 300 and 500 ng/mL as determined by either the ELISA or the LA method, Table 2 also illustrates our results using D-dimer levels greater than 500 ng/mL. The higher level of 500 ng/mL had poor sensitivity (50%; 95% CI, 0.32-0.68) and an NPV of only 78.9% (95% CI, 0.69-0.88).
Patients with abnormal angiogram results had higher mean D-dimer levels (mean, 750 ng/mL) compared with patients without angiographic evidence of PE (mean, 250 ng/mL) (P=.01, χ2 test). Despite the higher mean D-dimer levels found with abnormal angiogram results, a positive D-dimer level (>250 ng/mL) by itself had inadequate sensitivity to diagnose PE (73.3%; 95% CI, 0.58-0.89) and NPV inadequate to exclude PE (83%; 95% CI, 0.72-0.94).
Positive D-dimer levels (>250 ng/mL) combined with low-probability V/Q scan results changed the sensitivity to 71.4% (95% CI, 0.29-0.97) and the NPV to 88% (95% CI, 0.62-0.98). Nondiagnostic scans (low and intermediate or indeterminate) and positive D-dimer levels (>250 ng/mL) had a sensitivity of only 72.4% and an NPV of 81.4%.
Our study compares D-dimer levels with PAG results and shows that positive LA D-dimer levels (>250 ng/mL) were not sensitive (73.3%) enough to exclusively diagnose PE. When combined with low-probability lung scan results, the sensitivity and NPV of positive D-dimer levels did not improve. The combination of nondiagnostic scan results and positive D-dimer tests by LA also will not help decide whom to treat for PE. The sensitivity of high clinical suspicion and a low-probability scan result remains superior at 96%.3
This is the largest study to date, to our knowledge, that defines the relationship between LA-determined D-dimer tests and PAG. The main strength of this study is its design. In contrast to other studies in which angiograms were only available for a proportion of the study population, every patient in this study had a prospective D-dimer level, lung scan results, and the criterion standard, PAG.5,8,12,14- 16 A detailed medical record review controlled for confounding variables, and the radiologists and medical record reviewers were blinded to the patients' D-dimer levels.
The prevalence of PE in our study was 30.6%, which is comparable to that in other cohorts undergoing PAGs.3 Thirty-five percent of our V/Q scans were read as low probability, similar to that proportion found in the PIOPED study. Although every patient with a low-probability V/Q scan result in the PIOPED study did not undergo a subsequent angiogram, 20% of those who had angiographic evidence of PE compared with 21% in our study.
Another strength of this study is that D-dimer levels were calculated by LA rather than the ELISA technique. Latex agglutination is widely available and is often preferred to ELISA because of its low cost and accessibility. In a telephone survey, we found that all 17 metropolitan Denver hospitals use the LA method automatically to determine D-dimer levels in their acute clinical care settings. Although ELISA assays are available if requested by individual physicians at some of these hospitals, only one hospital performs it on site, with the others sending the specimens to independent laboratories.
It has been suggested that a D-dimer level less than 500 ng/mL as determined by ELISA should preclude treatment of PE because of its 93% sensitivity in predicting a normal angiogram result.9 These conclusions cannot be extrapolated to LA testing. Studies comparing ELISA with latex tests in venous thromboembolic disease are conflicting: 214,17 found similar sensitivities, and 36,13,18 others reported that latex tests are not comparable with ELISA. The studies6,17 examining standard ELISA and LA tests in PE are contradictory, and neither incorporates angiographic results. Different assays are being evaluated, with 2 main criteria in mind: rapidity and proximity to the standard criterion ELISA. On review, the most promising studies are those that have evaluated the new assays in a prospective clinical manner. Two studies19,20 determined D-dimer levels by whole blood agglutination, and 121 by an automated ELISA technique. The whole blood agglutination tests showed 94% to 100% sensitivity and 98% to 100% NPV. The automated ELISA technique demonstrated a sensitivity of 100% (95% CI, 92-100) and an NPV of 100% (95% CI, 93.3-100.0). In these 3 studies, PE was indirectly determined by lung scan results and/or lower extremity ultrasonography. Only a small proportion of the study patients had PAG data available. Additional information is necessary to prove the clinical use of these favorable assays.
Our study has several limitations. First, we recognize that LA tests are not standardized and, thus, the sensitivities of kits may vary. Although most kits are comparable, our results cannot be extrapolated to all latex kits. Second, we may have limited the generalizability of our findings by restricting the study to patients undergoing PAG following V/Q scanning. This preselects a population in which physicians' clinical suspicion conflicts with scan results. Therefore, it may have been useful to have documented clinical suspicions as part of our study. Last, fibrin degradation products have a short half-life, causing D-dimer levels to decrease over time; therefore, it might have been helpful to have recorded the time from the onset of symptoms to PAG and blood sample draw.
In summary, we agree with the American College of Chest Physicians'22 consensus panel opinion regarding the diagnosis and management of PE, and strongly recommend that LA D dimers not be used to evaluate the condition of patients with suspected PE. Recently, it has been suggested that a normal D-dimer level can be used to preclude treatment of PE in an acute care setting.5 These algorithms used ELISA methods to determine D-dimer levels, and cannot be extrapolated to settings in which D-dimer levels are usually determined by the latex method. A normal D-dimer level alone or in conjunction with a nondiagnostic lung scan result should not preclude treatment for PE and, therefore, cannot be used to rule out PE in acute care settings.
Reprints: Ilana Kutinsky, DO, Department of Cardiology, University of Colorado Health Sciences Center, East Ninth Avenue, Denver, CO 80262.
Accepted for publication December 2, 1998.
Presented in part at the American College of Physicians' Colorado Chapter Associates Meeting, Colorado Springs, February 19, 1997.
We thank Maureen Hipps, PhD, for her statistical support; and Carolyn Welsh, MD, William Nelson, MD, and Catherine Klein, MD, for their support and review of the manuscript.
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Title: Group of Inuit aboard whaling schooner, Hudson Bay, ca. 1897-1912
Accession Number: 1966.339.16
Category: PHOTOGRAPHS - LANTERN SLIDES
Type: lantern slide
Maker: Comer, George (Captain)
Place: Canada, Hudson Bay
Date: 1897-1912
Materials: glass
Description: Lantern slide prepared by the American Museum of Natural History, NY, from an original photograph by Capt. George Comer. Used by Comer to illustrate lectures about his Arctic and seafaring experiences. Depicts a group of Inuit onboard whaling schooner ERA or A.T. GIFFORD. West coast of Hudson Bay, ca. 1897-1912.
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ighting Control & Design was founded in 1987 as a result of the demand for a user friendly lighting control system from building owners and the engineering community. We utilize the best that technology has to offer to manufacture simple, yet flexible lighting controls. With projects spanning the globe, we have the products and the support to make any sized project go smoothly. what we do Lighting Control & Design manufactures simple, yet flexible lighting controls. The heart of our lighting controls is the GR 2400 system. A single system ideal for any size application from a parking lot to a retail store to a high rise building. Our scalability eliminates complex choices. The GR 2400 System is a 100 digital solution to lighting control. We offer a wide breadth of products ranging from dimming interfaces to building automation interfaces to digital thermostats all within a single system. The GR 2400 system was developed as a complete vertically engineered package
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JOINED: Speaking of Las Vegas, CBS's hit franchise "CSI: Crime Scene Investigation" -- which began in Sin City, spread to southern Florida with "CSI: Miami" and now is preparing to hit the Big Apple in the fall with "CSI: New York" -- has a new star. Joining the latest spinoff is Melina Kanakaredes, from NBC's family drama "Providence," AP reports. Kanakaredes will play a workaholic detective, according to sources close to the show.
QUOTED: "It was a shame. Not so good to look at. I was very upset and couldn't fall asleep." -- Hong Kong movie star Jackie Chan commenting on the recent presidential election in Taiwan that was marred by controversy and sparked widespread protests, AP reports
DIED: Jan Berry, member of the 1960s California surf-pop duo Jan & Dean, died Friday, Reuters reports. Berry, who would have been 63 on April 3, reportedly suffered a seizure at his Brentwood, Calif., home and was taken to UCLA Medical Center, where he was later pronounced dead. Berry had been in poor health since a 1966 automobile accident that had paralyzed him for a year and halted Jan & Dean's career. The twosome were known for such songs as "Surf City," "Dead Man's Curve" and "The Little Old Lady From Pasadena." ... Actress Jan Sterling, 82, a star of Hollywood's film noir movies of the 1940s and '50s, died Friday, AP reports. She starred opposite Kirk Douglas in Billy Wilder's controversial film "Ace in the Hole" (later released as "The Big Carnival"). ... Adan Sanchez, the 19-year-old son of balladeer Marcelino "Chalino" Sanchez, was killed in a car accident in northwestern Mexico on Sunday, AP reports. Adan, a resident of Los Angeles, was traveling in a car with two others when a tire blew and the car rolled over. The other occupants were taken to a hospital and treated. No other vehicles were involved. At 19, Adan had already recorded nine albums.
ARRESTED: "Stop All the World Now" singer Howie Day, 23, was arrested in Wisconsin last week when he allegedly locked one woman in a bathroom and broke the cell phone of another, after one of them spurned his advances, AP reports. The incident, which took place at a concert for the Barenaked Ladies that Day was opening, occurred last Wednesday on his tour bus. Day was charged with misdemeanor counts of criminal damage to property and disorderly conduct and taken to jail. He was freed on bail Thursday. Day is due in court April 1.


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Portland television stations KPTV FOX-12 and KPDX 49, jointly owned by Meredith Corp., laid off 10 sales and technical staffers last week because advertising revenue at the television stations has fallen off, according to spokeswoman Jennifer Harken, based at Merediths corporate office in Des Moines, Iowa. None of the on-air talent was included in the layoffs.
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In a phone interview Wednesday, Meeker said that Byron Beck, the paper's "Queer Window" columnist, was laid off, as were three classified-advertising sales reps. In addition, reporter Corey Pein has moved to WW's sister paper in Santa Fe, N.M., and will not be replaced, he said.
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Sandwiched in between Havana and Matanzas, Mayabeque is one of the two new provinces created in 2010 and previously one half of the province known as La Habana. Its main draws are the relatively secluded beach resorts of Jibacoa and low-key Canasi, along the northern coast, easily reachable from Matanzas if you have your own transport but really quite tricky to get to if you don't. Marooned inland and nearer to Havana than Matanzas, the Escaleras de Jaruco are even harder to reach, though this isolation is part of the charm of these beautiful forested hills.
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Eight kilometres west of Canasí, tucked behind a barricade of white cliffs, is Playa Jibacoa, a stretch of coastline basking in relative anonymity. Approaching from Matanzas on the Vía Blanca road, the first turning before the bridge over the Río Jibacoa leads down onto the coastal road that runs the length of this laidback resort area. Predominantly the domain of Cuban holidaymakers, the beach is unspectacular but pleasantly protected by swathes of twisting trees and bushes, with an appealing sense of privacy. There are modest coral reefs offshore and basic snorkelling equipment can be rented at the campismos.
Escaleras de Jaruco
Escaleras de Jaruco
Around 25km east of Havana, 20km inland from the Playas del Este, the Escaleras de Jaruco, a small crop of hills west of Jaruco, the nearest town of any significant size, makes for a stimulating detour on the way to or from Mayabeque's beaches. Covered in a kind of subtropical rainforest, this steep-sided mini-mountain range erupts from the surrounding flatlands. The Carretera Tapaste cuts through the area like a mountain pass, leading past the fantastically located El Arabe restaurant which, despite its erratic opening hours, provides a focus of sorts for the area. In its pre-Revolution heyday, it was undoubtedly a classic, with its splendid Arabic-style interior, balcony terrace with views to the coastline and domed tower, but it's now as low on food as it is on staff, and there's no guarantee it will even be open when you turn up; call ahead on t47 87 3828.


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The Memoirs of Jin Luxianby Jin Luxian William Hanbury-Tenison
Jin Luxian is considered by many to be one of China's most controversial religious figures. Educated by the Jesuits, he joined the Society of Jesus and was ordained priest in 1945 before continuing his studies in Europe. In 1951 he made the dangerous decision to return to the newly established People's Republic of China. He became one of the many thousands of Roman Catholics who suffered persecution. Convicted of counter-revolutionary activities and treason, he was imprisoned for 27 years and only released in 1982. His subsequent decision to accept the government's invitation to resume his prior role as head of the Shanghai Seminary and then assume the title of Bishop of Shanghai without Vatican approval shocked many Catholics. Now, some thirty years later, still serving as Bishop and regarded as one of the leading figures in the Chinese Catholic Church, Jin recounts formative experiences that provide essential insight into the faith and morality that sustained him through the turbulent years of the late 20th Century. In this volume of memoirs Jin recalls his childhood and education, his entry into the Society of Jesus and formation as a priest, his return to China, imprisonment and, finally, his release and return to Shanghai.
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9 tips for choosing a family holiday
Winter is the best time to start thinking about your family holiday for the following spring or summer. At this time of year there's lots of availability and many holiday companies are offering competitive low deposits. It can be a minefield finding the right holiday for you and your family, and you want to make sure you make the right decision for that valuable family time together. Here are nine things to consider when choosing your family holiday.
1. Journey time - work out what length of journey your children can manage. How long can they sit in a car for? Are they okay hanging around at an airport? Remember that a usually short motorway journey in the UK can take much longer on a busy Saturday in August. Consider different options for breaking up a journey, eg travelling to mainland Europe can be broken up by a ferry sailing. Maybe break a long car journey by staying overnight somewhere?
2. What do you want to do each day? A lazy holiday or activities or a mix of both? What will the children enjoy doing? Little ones can be easily entertained by a pool or a beach but older ones may get bored and need something more than that. Some resorts offer Kids Clubs but not all children enjoy them and you need to check the costs and opening hours suit you. If you're holidaying in the UK or northern Europe you might want to choose a location with lots of indoor as well as outdoor activities as the weather isn't always reliable!
3. How important is the weather? Although endless sunshine is appealing, too much heat can be draining. Especially for little ones. If your children develop heat rash easily you could find all that sunshine isn't so appealing after all! There's shade, suitable clothing and sun cream to consider as well. Having pools and water parks nearby can help you cool off and remember a bit of rain or cool weather doesn't matter if you're doing lots of activities.
4. Do you want childcare? Some families travel with friends or other family members to share out the childcare. Many resorts offer creches, Kids Clubs and babysitting. If having a break from the children is important to you on holiday you'll need to think about who can help with the children.
5. What accommodation are you after? Hotels take the effort out of cooking, but meal options can be limited and eating times may be restricted. Look for hotels with a range of dining options or consider self catering especially if family members are fussy about what they eat.
How much accommodation space do you need? Some families are happy to keep costs down and share a single family room in a hotel, or you could think about inter-connecting hotel rooms and family suites. Self catering in an apartment or villa gives you more of your own space. If you enjoy an outdoors experience consider camping or glamping.
Larger places cost more – would you be okay on a sofa bed in the living room for two weeks or is a bed of your own essential? Also look at the outside area the accommodation offers: balconies can be a worry with young children unless they're constantly supervised. A ground floor terrace or small garden might be what you prefer.
6. What do you need to take with you? Some holiday places can provide the essentials for babies and toddlers and these are good options as you can take less with you. Look for accommodation with travel cot, baby bath, bath mat, highchair, push chair and even children's toilet seats or potties. It's also a good idea to ask about stair gates, it's possible to buy travel versions but it's best if you don't have to take them with you.
7. What's your budget? With cheaper flights these days, UK holidays aren't necessarily cheaper than travelling abroad. Think about what you're likely to do and spend while on holiday and consider an all-inclusive holiday option which makes it easier to budget. The cost of days out and eating out can add up. Also think about childcare costs, car hire and baby seats, airport parking, airport transfers and fuel.
Remember that you may not need to pay for under 2s on a flight, but you may need to pay for extras with budget airlines such as priority or reserved seating and excess luggage. It's worth trying to save as much money on possible on these little extras but it's always a good idea to spend as much as you can afford on your actual accommodation. As much comfort as possible is essential for a relaxing holiday.
8. Location, location, location: How will you get about or do you plan to stay in one place? If sightseeing is important you'll need to look at car hire or local transport if you don't have a car with you. Even if you're staying put in a resort most of the time, you might need a few facilities within walking distance. Most parents find they forget to take something with them so a nearby shop is often essential for nappies and other supplies for little ones.
9. Read reviews and recommendations: once you've narrowed down your search, read online reviews of the places you're interested in. Reading what other parents think can really help you decide.
To help you find your family holiday, visit our holiday pages. We've got tonnes of family friendly holidays listed to suit every lifestyle and budget. Here are a few ideas:
Top UK cottages
Holiday parks (UK and Europe)
Luxury holidays
Villas and apartments
UK farm holidays


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Affordable party favors!
The Something Blue Mint Tins are the perfect accent to any table and perfect wedding favors. The 5/8 inch x 1 3/4 inch Custom Something Blue Mint Tins include 0.45 ounces of peppermints. Each of the Something Blue Mint Tins can be personalized with your events theme. Include the Something Blue Mint Tins at your next wedding vent.
Please allow ample time for delivery. Our ship date for this product is noted in your shopping cart. Many items are shipped separately, so please allow extra time for these items to arrive. Shipping charges are based on the value of the merchandise and not the number of shipments. For additional shipping information, contact our Customer Service Department at (firstname.lastname@example.com or 1-800-227-2789).
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I used this product for my husband and I wedding party. I needed something else for the party and this was perfect. This color matched our decorations and we were able to personalize it with or name and a cute phrase. I did not have to buy mint. It came with the mints which was wonderful. Everyone loved them and thought they were very creative and cute. This product is 100% worth the money for a special occasion and I recommend this product to everyone throwing a special event. There was absolutely nothing wrong with this product and I will return to this site many times.


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Contact Information
Comfort Inn Hadley-Amherst
D. Hotel & Suites
Hampton Inn Hadley-Amherst Area
Homewood Suites By Hilton
Residence Inn Chicopee
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As you may know, I am very passionate about the concepts of sustainability. For my birthday this year, my thoughtful wife and son gave me a living example of sustainability that sits on my desk and reminds me to work on this topic everyday. It is called an EcoSphere and I got it from EcoProducts Home Store here in Boulder (they are folks who also provide all of our compostables that help us approach zero waste here at Rally – they are a great Boulder success story).
The Ecosphere is a completely closed world and is self-sustainable. It was developed by two NASA scientists (the late Dr. Joe Hanson and the late Dr. Clair Folsome) trying to create models for long-term space flight. In it you will find algae, shrimp and bacteria living in a closed cycle with sun light as energy. (Learn more about EcoSphere's sustainable model on their site.)
At $125 for a small sphere they are a bit pricey, but they are fun to watch, people always notice the shrimp moving around on my desk. After attending Thomas Friedman's talk on "Hot, Flat and Crowded," I realize they are just another part of my "work in progress" to living sustainably in the U.S. These do not feed me like my chickens and goats, but they also do not eat like my dogs and cats.
Definitely the most common question is: "Are those sea monkeys?" According to the web site, they live 2 to 7 years with really no maintenance and NO they are not sea monkey branded brine shrimp.
This EcoSphere keeps me focused on the long road of continuous improvement needed to make our industry a zero carbon footprint or sustainable industry. We are currently on the road to be a larger emitter of CO2 than the airline industry by 2020.
We have to find the innovations in infrastructure, the methods and tools to reverse this. My of view of how to reverse this behavior is through the emerging software value cycle that is made possible by SaaS/Clouds, Agile development and Web 2.0 customer communities. You can read my thoughts on these topics or hear a MassTech webinar.
I believe that with the change to Lean thinking – from products to services and with virtual connections to customers – we can learn to quickly adapt and adopt to new sustainable products and behaviors.
We need a value chain in the IT industry that is closed loop and sustainable, not open loop like the Story of Stuff.
I encourage you to take a moment and consider getting one of these model worlds for yourself or your best friends. It will keep you on the road to smarter, leaner and greener.
About the Author: Ryan Martens is an avid outdoorsman, founding board member of the EFCO, and Founder and CTO at Rally Software Development. Subscribe today to get free updates by email or RSS.
Further Reading:
- Let's stop splitting hairs – We need to get to zero carbon output to really make a difference
- Leadership in Sustainability – Blog Talk Radio Interview
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Prayer for Strength and Guidance
Do you feel that all your strength is gone and you feel hopeless? We would love the opportunity to pray for you.
Join us for our Daily Devotional Chat today in our Women's Chatroom at 10:30am EST.
Today lean hard on this promise from our living Lord God!
"The Lord will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame…" (Isaiah 58:11).
Prayer to action this in my life:
Father God,
Thank you that You have promised the Lord will guide me always, not just when I am up and on track, but always. Today I lean hard on that and ask You to continue to show me the way to walk. Father, sometimes I feel like a sun-scorched land…but You promise to meet my needs even there. Today I acknowledge I need You. I am parched and I look to You to give me emotional strength… spiritual insight… and physical stamina. You even promise to strengthen my frame. Thank you Father that Your tender care encompasses all of me. Help me to draw on that today and to praise You for it!
In the name of Jesus I pray, Amen.
Questions: Tell us how have you experienced the promise that God made to "satisfy your needs"?
About the Author Gail Rodgers
106 Responses to "Prayer for Strength and Guidance"
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I will pray for u I have been through this my self and God brought me through it prayer really works


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17 years of experience
Accepting new patients
Video profile
Stanford, CA 94305 Phone number & directions
Patient Reviews
Patient Reviews ? Write a Review
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One of the best, and most ethical, facial plastic surgeons in the country.
Dr. Most is a caring and attentive doctor. It is obvious that he really has a passion for helping people. He understood what I wanted to change, and more importantly, what I didn't want. Its been more than a year since my surgery, and every day I look at my nose, breath deeply, and I am so grateful I took the time to go and see Dr. Most. I highly recommend you do the same.
7 Years ago, I met Dr. Most and his team, not under ideal conditions as any of us would have liked. I had suffered a serious bicycle accident and tore off my lower eye lid, requiring emergency surgery. Dr. Most and his team stepped up to the plate and did an awesome job! Due to the serious nature of my accident, Dr. Most and his team had great bedside manner to guide me through the surgery process. His team took their time to do the job right. They were able to keep my original skin, and not have to graph any skin. I am greatly indebted for their professionalism and empathy at the beginning of my journey towards full recovery. They were honest about my prognoses and explained the in's and out's of what my road or recovery would look like. All key pieces of information I needed at the time a greatly helped. 7 years later, I am now 95% back to normal (which is 15% better than we ever thought).
I am so happy I found Dr. Most. He is the most incredible surgeon, a caring professional and just an amazing person. I hope I never have another surgery on my face but if I have to, I would only trust Dr. Most. And his nurse Amy, she is equally impressive. A great team. Dr. Most spends the amount of time with you that you need to feel completely comfortable and totally informed. I love a plastic surgeon that has a great eye for symmetry and detail. No concern is too small to bring up. Dr. Most takes great effort to make sure you are happy with the outcome. I wish every doctor had his skills and abilities. I just can't say enough wonderful things about Dr. Most and his staff. Thank you Dr. Most and Amy.
Dr. Most is an incredibly skilled doctor who I trust implicitly. His staff are incredibly kind and courteous. I have recommended him to several friends who have also had the most positive experience in his care.
Dr. Most is an incredibly gifted surgeon. I got a beautiful result from a difficult situation. He fit me into his already fully booked schedule and performed a miracle! He under promised and over delivered! He has a wonderful staff - all professional and courteous. All of my phone calls were returned within the hour, usually much sooner. I could not recommend him more highly.
Dr. Sam Most is one of the best surgeons whom I had the privilege to be associated with. He is not only a great Dr. But also a wonderful human being. He performed a surgery on my nose after it was diagnosed that I had problems with breathing through my nose. It was very complex and difficult situation, and Dr. Most perform above and beyond the call of duty and fixed my nose which allows me to breath easily once again. Thank you Dr. Most from the bottom of my heart.
Dr Most did my facelift and my lower eyelids I plan to return next year to have my upper eyelids done as I 'm very happy with the results Everyone in this office is friendly & caring and I am glad I chose Dr Most. Patients are treated with respect & never rushed or patronized. Most importantly Dr Most is a skilled surgeon whose excellence has been recognized by his peers.
I've been seeing Dr. Most for the past 5 years for a rhinoplasty, follow up cosmetic injectables and recently for a consultation on a facial injury. He's been an absolutely incredible physician and resource. He really listened to my needs regarding the rhinoplasty and I couldn't be more pleased with the natural result. He's got great academic credentials, which for me was a must, and he's a super nice person. You should definitely add him to your list!
Had a revision rhinoplasty after a horrible experience elsewhere. I should have found Most from the beginning! He got me looking and feeling better. I've had great experiences at his office and with his staff. Would recommend to anyone interested in rhinoplasty.
I was happy with the cosmetic result of my surgery, and with Dr. Most's initial handling of my case. He was honest and realistic with me in dealing with my somewhat inflated expectations. While my appearance is a nice improvement, I was in the small % of ANY talented surgeon requiring revision. Thus far, he has expressed reluctance to operate again on me, despite very obvious functional issues. Otherwise, I've only considered him a fully capable and compassionate surgeon.
I saw Dr. Most for a rhinoplasty. I had a great difficulty breathing through my nose and also needed for it to be smaller. I had many consultations with other Doctors with Plastic Surgeons in California and Massachusetts, Dr. Most was the only one who put my mind at ease. he listened very carefully to what my concerns was with regards to my nose. Dr. Most then explained with great patience and thougthfulness what the procedure would entail to, and did not miss any details in order to ensure that I understood the enormous task that he was going to perform. The operation was very complicated and it took about 6 hours, and after a few days I couldn't be happier. I received more complements about it which is due to his wonderful operation. Dr Most is that great a doctor and the wonderful person and skillful professional who knows his craft. I would like recommend him to anyone.
I interviewed several facial plastic surgeons before choosing Dr. Sam Most. He was the one who inspired the most confidence that my face would NOT end up looking like I was wearing a mask. He is incredibly knowledgeable, skilled, honest and personable. No high pressure and no attitude. I highly recommend him for anyone seeking a facelift.
I spent months searching around for the best ENT doctor who is also a fantastic a plastic surgeon. I traveled to different cities; I also interviewed two of the top surgeons in Rodeo Drive/Beverly Hills area; And finally picked Dr. Sam Most at Stanford. Dr. Most was by far the best doctor for my procedure. I am very happy with my decision as he did a fabulous job. I had a rhinoplasty and septum deviation surgery. Dr. Most was very professional, knowledgeable, experienced, and very caring. Unlike several of the plastic surgeons who I met, Dr. Most never tried to act like a sales man; He has very high confidence about his area and takes the extra time to explain difficult questions with a lot of patience. Dr. most has assembled a highly capable medical staff/residents from top tier medical schools around the world. They all said "looking up to him as a role model" for his expertise and experience. On my first visit Dr. Most was able to show me the future result of my surgery using computer graphics and even gave me options to choose from with his recommendations. Amazingly the result of the surgery is exactly as he had on the computer. I get lots of complements every day, even thought it just 30 days after my surgery, my nose is looking very natural and I can breath 100% better than before...I would strongly recommend Dr. Most to anyone who is looking for a Dr. they can trust.
Where do I begin...Dr. Most is AMAZING - talented, humble, perfectionist attitude who pays special attention to detail. He's truly passionate about his job and really has an eye for the "natural" proportionate look and beauty. I was scared to undergo elective surgery (although most of my family have undergone elective surgery), but from the beginning Dr. Most and his staff made me feel extremely comfortable. During my consultation, he was very conservative with his approach and did not over promise - unlike many of the other plastic surgeons I met with. He provided realistic options and focused on what I felt was the biggest concern while providing his expert opinion. While I was in surgery, he used his expert opinion and did even more changes than were promised in my consultation. My nose and chin look much better than I could have ever imagined and my family and friends agree! Both his and Dr. Woodard's bedside manner was outstanding! It's always a pleasure to go into the office for my follow up appointments. I've already referred 4 family and friends to Dr. Most and all have had nothing but positive experiences. In response to all of the high cost comments - you get what you pay for and over an entire life, a few thousand dollars is nothing for perfect plastic surgery that will last a lifetime! I know many of people that have gone through multiple costly revisions - why not do it right the first time!
Dr Most repeatedly refused to take my concerns seriously. I believe he did damage control for the specialty of FPS instead of helping me get to the bottom of my concerns. I came to him with complete honesty and trust, begging for help and in horrific pain. He dismissed all my concerns, refused to allow me to see other specialists and worked to prevent their honest evaluation of my concerns. I just don't understand why?????? I am an honest, caring, nice person. Looking back at my medical records with him I am stunned that he thought that he could negate all my concerns. He had to have known that there were serious problems...or he was serious inexperienced and completely unprepared to be in charge of a department in what he was supposed to be a specialist in. Pretty scary!!!!