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Thoughts... that I'd like to share
Hummingbird Totem:Wed, February 21, 2007 - 10:12 PM
Hummingbirds are signs of: Spiritual Messengers / Timelessness / versatility / energy / vitality / joy / renewal / hidden treasures / sincerity / healing / persistence / peace / infinity / agility / playfulness / loyalty and affection.
The hummingbird lives on nectar and searches for the sweetness of life. It finds the hidden treasures underneath the surface. The hummingbird is loved by the flowers and plants because through its journey it not only collects the nectar, but also gives back to the earth because it pollinates and creates new life and new sources for nourishment along its path. Hummingbird feathers have been prized for their almost magical qualities because the mere presence brings joy to the observer
In many traditional cultures of the western world the hummingbird has powerful religious and spiritual significance. In the high Andes of South America, for example, the hummingbird is taken to be a symbol of resurrection. This is because each hummer becomes lifeless and seems to die on cold nights, but it comes back to life again when the miraculous sunrise brings warmth.
When we assume hummingbird consciousness, our life becomes a wonderland of sensuous delights. We live for beauty, delighting in flowers, aromas, fine mist, and delicate tastes. When it becomes our totem, the hummingbird teaches us to laugh and enjoy the creation, to appreciate the magic of being alive, and the truth of beauty.
The hummingbird can fly in every direction, changing direction instantly. It is able to hover and dart around in order to find the treasured nectar. Hummingbirds awaken us to the beauty of the present moment. As they dance the four quarters of embodied existence, they bring us medicine to solve the riddle of duality. They also awaken us to the medicinal properties of plants. Hummingbirds teach us how to draw the life essence from flowers. "They can teach us how to use flowers to heal and win hearts in love."
Hummingbirds also teach us fierce independence. They teach us to fight in a way where no one really gets hurt. They teach us simple courage. Andrews says the twittering, vibrating sounds of the hummingbirds bring us an internal massage that restores health and balance. Hummingbirds also inspire us to protect the environment and to preserve old traditions that are in danger of being lost. When Native American ways were being destroyed by the expanding Euro-American culture, the Ghost-Shirt religion was established to try to bring back the animals and old ways through dancing. The leader of the dance was a hummingbird.
Certainly hummingbird magic is available to all who live in the World. There is something inside the soul of all of us that wants to soar through sunbeams, then dance midair in a delicate mist, then take a simple bath on a leaf. There is something in our souls that wants to hover at beautiful moments in our lives, making them freeze in time. There is something in us that wants to fly backwards and savor once more the beautiful past.
There are different ways that a totem animal can be discovered: In Native American tradition they may make their appearance while one is on a vision quest. They also come in dreams, mediations, and shamanic spirit-journeys. In other cultures your totem is the animal that is always around and brings spiritual peace and insight when they are in the person's presence. Many who do not take the time to see the importance of totems such as Anglo-Americans and Europeans should remember that their prehistoric ancestors had animal guides and found them in much the same way Native Americans do.
The Hummingbird is a beautiful and useful reminder in our lives. This totem reminds us to explore the past and extract the sweetness from it. It can help you find joy and sweetness in any situation. It reminds you to grab joy as swiftly as you can. Hummingbird reminds us to find the joy in what we do and to sing it out with our hearts.
It is not commonly known that the fluttering wings of the hummingbird move in the pattern of an infinity symbol - further solidifying their symbolism of eternity, continuity, and infinity. By observing the Hummingbird, we see they are seemingly tireless. Always actively seeking the sweetest nectar, they remind us to forever seek out the good in life and the beauty in each day. Some Hummingbirds are known to wing their way as far as 2000 miles to reach their destination. This quality reminds us to be persistent in the pursuit of our dreams, and adopt the tenacity of the Hummingbird in our lives.
Hummingbird as a totem, comes when we need to spend time soaking in the love of nature so we can learn how to integrate joy into our lives.
If you have Hummingbird medicine, you adapt easily to whatever situation you may find yourself in, and make the most of your new circumstances. You don't waste time looking back and wishing for "what was" for you are concerned with making the most of "what is". Also, you find joy in your own heart. You take great pleasure in spreading joy and love and beauty to all around you, and have the gift of taking that inner joy into new and different surroundings. You have a talent for finding the good in people, and are not put off by a gruff or abrupt exterior, for you know that, if you can only get beyond that tough outside layer, you'll find goodness and beauty inside. You may have a gift for working with flowers, maybe growing them to share with others, or using flower essences for healing. Aromatherapy may be your calling. You have high energy and a spirit that must be free. To restrict that wonderful, free, loving energy is to suffer great depressions and feelings of uselessness. Hummingbird must fly free in search of beauty, spreading joy and love to all it touches.
The most profound questions the Hummingbird asks is:
"Where is our joy?"
"Is our happiness found within, or do we seek it externally?"
"What is the source of our joy?"
"What must we do to increase our joy?"
The Hummingbird animal totem most important message to us is:
"The sweetest nectar is within!"
Wed, February 21, 2007 - 10:12 PM - permalink - 4 Comments
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Thu, February 22, 2007 - 7:11 AMthank you so much for sharing that!! i knew some about hummingbirds, especially the joy part, but not about the infinity symbol, or rebirth aspect. i will tell you from my own observation of them--i have many feeders in summer--that they are ounce for ounce the fiercest creature i know. i have always said if they were any bigger we'd all have to look out! the cats don't even look at them:) their aerial battles are just amazing to see. and i laugh whenever one of them is perched on a branch and raises its tiny wings in a gesture of menace to another one approaching. they are great fun to watch. and it is always such an exciting moment in the spring when you hear the first high pitched sound that means they've arrived. you should check out last month's national geographic. it had the most amazing hummer pictures i've ever seen.
Thu, February 22, 2007 - 8:16 AMWell said! My hummingbirds are pretty fierce. Especially when we forget about the nectar feeders we've put out and they have a perspective mate to impress. They Vvvvvmmmmm around our heads in the pool to let us know that they demand room/nectar-feeder service.
Love and splendor,
Thu, February 22, 2007 - 11:37 AMvvvvvvvvvvvvvvmmmmmmm captures that noise perfectly!!! how funny. my aunt read a story once in the national enquirer (god bless her, she believed every word they wrote) that said hummingbirds migrated by riding on the backs of geese. i tried to explain that geese migrated in the other direction, but she was convinced. i've had this image ever since of little hummers sitting back relaxing with a paper and cocktail as they ride the goose express:)
Fri, February 23, 2007 - 12:39 PM
Vvvvvvvvmmmmm....Yes! That is exactly the sound that the one made that landed in my hair... I thought it was a large bug... LOL
My family was in the boat one day. When suddenly I heard a Vvvvvmmm sound and something landed in my hair. I wiped at what I thought was a large bug, then looked down at my fishing pole to see a tiny (about 2") hummingbird sitting on my pole. I noticed the little guy was panting and in trouble. So, I told my companion to get me to the shore ASAP. We were in the middle of the lake and I was amazed that the small creature was out that far out over the water. It took several minutes to get to the shore and the little guy was look worse every second that passed. At the time I did not know that they need to feed about every 10 minutes. When we got to the shore I lifted the small bird on my finger and pointed towards the shore and said, "Fly Little One, your safe now"... with that the little hummingbird took off and landed in a tree just off the shore. I was very concerned becuase the little guy look so bad by this time. Then suddenly the tiny bird spotted some nearby flowers and took off to feed.
It was really cool... I had to wonder how many people have acutally held a live hummingbird.


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The Immigrants� Rights Project works on behalf of immigrants in Colorado. Our work includes:
Organizing Coloradans for Immigrant Rights, a group of non-immigrants who educate other citizens about the human rights of immigrants, and mobilizing them to take action to support immigrant rights.
Answering the call for justice: This story about Janice and others held in an immigration detention center in Aurora, Colorado, will move and inspire you. Read the story.
AFSC offers speaking engagements to faith and community groups about the moral imperative of welcoming the stranger. AFSC shares its perspectives with coalition campaigns for immigrant rights.
Members of the Committee in the Defense of the People paint banners at the AFSC Offices for the Reconstructing Our Communities Uniting Our Families Unity March.
Contributing to building the statewide immigrants' rights movement, the Colorado Immigrant Rights Coalition, as one of the founding organizations and currently serving on the steering committee. CIRC was founded in January 2002 when immigrant, faith, labor, youth and community organizations united around the statewide driver's license campaign. The founding organizations shared the collective vision of a building a permanent statewide coalition and unified statewide voice to defend and advance immigrant justice.

subset: commoncrawl


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Home > beer > Max Fish Open For One More Year
Good news out of New York City. Max Fish is set to stay open for another year! The legendary L.E.S bar will not close its doors at the end of the month due to an amazing 1 year lease extension negotiated by owner Ulli Rimkus. Order us a Bud!
[…] This post was mentioned on Twitter by Aaron Silverstein. Aaron Silverstein said: RT @radcollector: Max Fish Open For One More Year http://bit.ly/geIQ1h […]
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2012 has so far been busy and exciting for West Virginia University athletics. Starting with that record-breaking Orange Bowl performance, the highly anticipated (and hopefully any day now) official settlement to the Big East lawsuit, the move to the Big 12 and the much-anticipated (and hopefully any day now) official release of the elusive 2012 football schedule.
Once everything is official and released it would seem all eyes will be on the 2012 football season and the debut of our Mountaineers in the Big 12. The next few slides will discuss a few predictions for the upcoming season.


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Tonight the Thunder played the Slump Buster for the Suns, getting them off the shneid for a six game losing streak. The Thunder didn't really lose this game or give it away, it was thoroughly taken from them by the Suns with their sheer hustle and grit-the best of it coming in the fourth quarter. The Thunder were completely outplayed in all areas of the game.
The Thunder opened up a nice lead nine point lead in the first quarter, which reached a high of thirteen at one point. It looked like the Defense that the Thunder had been displaying in the last 1/2 dozen games was going to continue into the Durant 2.0 era, but I think it was just a lot of spotty shooting by the Suns. The first quarter wound up being the only quarter we won of the four. We shot 51% in the first half but the Suns kept chipping away at our lead, aided by the Thunder's 12 first half turnovers. Shaq picked up his 3rd foul just 3 1/2 minutes into the second quarter and I really thought we would get it done. At the half we still had a small lead, we were in charge of the boards, and the 12 turns only produced 8 points for the Suns. We were looking ok.
In the second half the Suns were just a lot more dominant than in the first. Suddenly they began to really hit the boards, and we continued to turn the ball over. Oh, and the Suns found their shooting stroke, shooting 52.5% in the second half to the Thunder's 41%.
The difference in this game was really two things: hustle and the Suns bench; and well, maybe it's just one thing because a ton of the energy and hustle came from the Sun's bench players. Louis Admundson, Jared Dudley and Leandro Barbosa just really dominated. Admundson and Dudley were defensive pests in a big way. Admundson really laid hard fouls, played great defense on Green and Collison and Dudley went crazy with tough rebounding, steals and tough scoring in the trenches. Meanwhile Barbosa hit three big time threes in the fourth quarter as part of his 22 points in 24 minutes. The Thunder were really slow closing out on the shooters all night when the Suns swung the ball around the arc.
The Suns got 44 points and 19 boards from their bench, while we had 13 points and 5 rebounds from ours. Jared Dudley alone had 7 rebounds (four offensive) in the fourth quarter, while the Thunder as a team only managed 8 in the quarter. Ouch. He tossed in seven points and a steal in the quarter as well.
The two areas where the Thunder are actually very good are rebounding and getting to the line. We are top ten in the NBA in both, but we were dominated in both by a hungry Suns team tonight.
Random Bullets:
- The first thing I noticed is that the Thunder weren't running tonight as they've done so many times to their detriment against fast paced teams. The game ran at 92 possessions, below both team's season average and the Sun's latest running pace with Alvin Gentry.
- This version of "7 seconds or less" Suns offense isn't. They just don't even come close to running like the Suns under D'Antoni. I guess it's really just a change of personnel with no Amare, Marion, Diaw and a big Cactus in the middle.
- Early in the first I saw something I haven't yet seen this season: Krispy nads actually put the ball on the floor and drove on Shaq. It worked great and got Shaq his first foul. Why don't we do this more?
- A quick peek at the four factors above will immediately show you that we lost all four. Ouch!
- The Suns did a lot more attacking the basket than I've seen in the past. Usually the Suns are really bombing away from outside.
- Thabo and Weaver's defense seemed to bug Jason Richardson; he only got 20 minutes and was 3/9.
- It was some sort of Latino fan appreciation night in Phoenix tonight and so the Suns had "Los Suns" on their uniforms. Maybe I am just a little ignorant, but why is the "Los" in spanish and not the "Suns"? Shouldn't it say "Los soles"?
- Not sure where Earl Watson was. Chucky got his minutes tonight and he didn't get in the way, which is nice, but his defense was pretty poor. More than once when he was guarding Nash or Dragic, a Suns player would come up and screen him. He kept going over the screen, but it was so slow and pathetic it didn't accomplish anything. To the best of my understanding, when the screen comes a teammate is supposed to call it out to the player getting screened to give him time to "belly up" to the ball handler and get over the screen before it cuts him off. It never happened and Chucky was way out of position. Later I saw the Thunder began switching on the screens more often instead of fighting over them.
- Nobody on the Thunder can guard Barbosa on a drive. When the dust settles this off season it would be nice if we could find a bench guy for our roster that can play some lockdown defense on those super fast tiny guys in the league like Barbosa, Aaron Brooks, Nate Robinson, Jason Terry etc. Weaver and Thabo are great, but at 6′-6″ or so, they are just too big for those "specialty" type of players. If westbrook has to guard them, who is going to guard the opposing point guard?
- Jeff Green sure got knocked around a lot tonight. I saw him get hammered in the face by Shaq's shoulder, and go down hard on the wood at least two other times.
- With the recent debate about Durant's defense I found myself watching him more on that end tonight. He definitely can't stay in front of Nash or Barbosa, but I thought he did okay on Grant Hill and Jason Richardson when he was on them.
- We picked up our sixteenth turn halfway through the third period!
- I thought Steve Nash's 7 turns were really stinky until I saw that Westbrook had 8.
- Weaver hit a deep, deep three as time expired to tie the score at the end of the third. The Sun's announcer was telling a story that Weaver's father hit a three from beyond half court back in the day as a high schooler to win the Wisconsin state high school championship game.
- We were outscored in the fourth by 11 points, and by 20 after the first quarter.
- Malik Rose didn't even get out of the paint to contest a three by Dudley in the corner.
- With 2:12 left in the 4th, Barbosa hit a second of two back to back threes from the corner, right in front of the Thunder bench. After the shot went in, Thabo held up both hands like he was saying " whats the deal with that"? I couldn't figure out what he was griping about so I ran the DVR back a couple of times and saw Grant Hill actually wrap up Thabo with both hands and his body for a long second to keep him from closing out on Barbosa's shot. Terrible "no call".
- We had 100 scoring opportunities (FGA"s +FTA's), but the Suns had 108 thanks to all those rebounds they collected and all of our turns. They had 22 points off of our 20 turns.
- Thabo is a steal machine. He is getting his hands on 3.2% of our opponents possessions since he's been a member of the Thunder, far and away the team leader. If he continued that for a season he would be fifth in the league, just behind guys like Chris Paul and Jason Kidd. He had three more tonight.
- To put our turns in perspective, we had a 22% turnover rate, which my college dropout educations tells me is actaully more than 1/5th of our possessions ended in a giveaway to the Suns.
And finally, a guy named Robbie runs a site called Statsheet.com and he has some great stats and fantastic charts that can be viewed and embedded on blogs. Here are a few from tonight's game. Thanks Robbie.


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A plateau for that length of time means that you're eating to maintenance, and there's no weight loss without a caloric deficit. I would suggest 1500 cal for a couple of weeks, and if that doesn't start weight loss, you might try 1400.
If you're basing your caloric level on one of those online calculators, that's always a mistake. We're all different and have to find our own caloric levels.
Keep in mind that often after you've lost a significant amount of weight, you need to lower calories for your 'smaller' body. I stalled big time after I lost my first 80 lbs because I didn't realize that I needed fewer calories. Once I lowered them, I began losing well.
(I lost almost 200 lbs total and have been maintaining my loss for 2 years.)


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School Board Policy committee covers a plethora of subjects
A meeting of the policy committee of the Tangipahoa Parish School Board was held on Tuesday, September 16 at approximately 9:30 a.m.
Policy committee chairperson Rose Dominguez, along with members Eric Dangerfield, Leonard "Tank" Genco, Robert Potts, and Al Link were all present.
First on the agenda was the issue of public participation during school board meetings. Several of the members, including Ms. Dominguez and Mr. Link in particular, stated that although they are very much in favor of public input during a meeting, perhaps a concerned parent or persons needs may be met more expeditiously if they follow a "chain of command" before approaching the board during a meeting. A member of the public who was present interjected that she herself had tried that approach, and it proved to be unsuccessful for her, as she requested a meeting with the superintendent or his designee a couple of months ago and has not had it yet. Board Member Danny Ridgel stated that he felt public input or comments should be limited to agenda items only during the meeting. A motion was made by Genco to refer the issue of public input to the school board attorneys and to get a clear picture on how to handle this issue. Genco was however, adamant about the fact that he is not against public input, and wanted to make it clear that he is all for this practice. The motion passed with Al Link being the only opposition, stating that the board has been over this issue before, and he finds it redundant to do so again.
Absences and excuses
A motion was made by Dangerfield and seconded by Genco to approve the revised policy as it pertains to absences and excuses. The motion was passed unanimously. Under the current policy, absences will be excused on the basis of state and parish approved reasons for absences, such as:
*Personal illness
*Extreme illness in immediate family
*Death in the immediate family
*Recognized religious holidays
*School sponsored activities
*Extenuating circumstances
The policy further states that a written excuse must be presented from a parent, legal guardian or attending physician. MD excuses are to be sent seven days following visit to the doctor. All excuses must include the first date of treatment and discharge date. Students will have the opportunity within three days of return to make up missed work including tests. If the absence is deemed unexcused, no make up work will be given. A zero will be given for any missed test and averaged into the students grade.
Employee Promotion policy
A motion was also made and passed to approve a revised employee promotion policy. According to the revised policy, all promotions are based on a recommendation of the superintendent and all employees considered for promotion must possess the appropriate certification issued by the Louisiana Department of Education for said position. Principals who are newly appointed to a school will remain at that school for a period of three years at which time they may request a transfer to another school. However, the superintendent may recommend a transfer if it is in the best interest of the school system.
School Dress Code
Another agenda item that met with considerable discussion was school dress code. It was brought to the attention of assistant superintendent Thomas Bellavia that a couple of board members had received several calls from schools as well as parents regarding various uniform violations. Although most cited were not significant violations, board members agreed that all schools should adhere to dress code as closely as possible, and that the principal should ultimately be the one to determine the severity of the uniform violation. Assistant Superintendent Bellavia moved that these issues be referred to the discipline committee which will meet later in the year. Motion passed without opposition.
Supplemental Education Services
Chief Academic Officer Melissa Stilley addressed the committee to ask they consider adoption of a Supplemental Educational Services policy.
Supplemental Education Services, (SES) are additional academic instruction in reading, language arts/English and /or mathematics that are designed to increase the academic achievement of students in schools in need of improvement. These services may include academic assistance such as tutoring, remediation and other educational interventions that are consistent with the content and instruction used by the Tangipahoa Parish School Board and which are aligned with the State of Louisiana's academic content standards. In keeping with provisions of the "No child left behind" act of 2001, all supplemental educational services shall be provided outside of the regular school day, before or after school, on weekends, or in the summer and shall be of high quality, research based and specifically designed to increase student academic achievement. Stilley went on to explain that Roseland Elementary was an SES school last year, and has as of this year is no longer required to participate. She stated a written policy was being implemented to be placed in the handbook. The policy for SES was adopted without opposition.
Health Services
The last three items on the policy committee agenda centered around policies which deal specifically with Student Health Services. Assistant Superintendent Thomas Bellavia stated that two policies needed to be revised; policy JGC (Student Health Services) and JGCD, (Administration of Medication during school hours. These two were approved with revisions without opposition. The third and last agenda item was adoption of policy JGFG, which deals with illness and accidents. This policy governs and provides guidelines on how accidents and sudden illnesses should be handled by staff and personnel at schools.
All items approved during the policy committee will be brought before the full board at the next regular meeting for final approval.


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Acer Aspire One AO721-3574 Laptop is one of the latest editions of Acer. The Acer Aspire One AO721-3574 is integrated by the latest AMD Athlon processor Neo-II and ATI Radeon HD 4225 graphics card. The blend works and carries incredibly great presentation.
Acer Aspire One AO721-3574 is an ultra-thin Laptop weighs only 3 pounds. When appears to its size, appears the latest Aspire One AO721-3574 Laptop with the dimension of 11.2″ W x 8.0″ D x 1.0″ -1.1″ H. The Netbook has the full-size keyboard with numeric pad. It also has characteristics hot-key control and support for worldwide languages. The touchpad aspects multi-gesture helpfulness that you can rotate and scroll with your flip denotes 2 fingers.


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This is a discussion on [News] OpenSUSE 11.0 Beta Released, Ballnux Comes with Shuttle - Linux ; Announcing openSUSE 11.0 Beta 1 ,----[ Quote ] | KDE 4 and KDE 3.5: The openSUSE 11.0 beta 1 includes KDE 4.0.3, which | includes a number of new features, fixes, and optimizations. See the KDE4 | page for more ...
Announcing openSUSE 11.0 Beta 1
,----[ Quote ]
| KDE 4 and KDE 3.5: The openSUSE 11.0 beta 1 includes KDE 4.0.3, which
| includes a number of new features, fixes, and optimizations. See the KDE4
| page for more info on the KDE4 branch. To help test, see the wiki for info on
| reporting bugs in KDE. Not quite ready to move to KDE4? No worries, the beta
| includes an installation option for KDE 3.5 in addition to KDE4.
Hardware Review: Shuttle LinuXPC SD3002Q
,----[ Quote ]
| PERSONAL computers with Linux pre-installed have been springing up all over
| the place in recent months. Now Shuttle, the Taiwanese company famous for
| making small but perfectly formed PCs, have gotten in on the act. Iâve been
| spending some time in the company of their LinuXPC SD3002Q, which is sold
| with openSUSE 10.3 Linux pre-installed.
HP unveils small laptop for schoolkids
,----[ Quote ]
| HP's foray comes in the form of a new computer called a "Mini-Note" that
| weighs less than 3 pounds with a screen that measures 8.9 inches diagonally.
| The machines start at under $500 for a Linux-based model. Prices go up for
| Windows Vista models with faster processors. Â*
HP 2133 Mini-Note
,----[ Quote ]
| The HP 2133 Mini-Note PC (starting at $599 for Windows Vista Basic, $499 for
| SuSE Linux, and $749 as configured) is a bit more expensive and weighs more
| than the competition, but the systemâs unique strengths make it a good
| investment for students, mobile professionals, and anyone else looking for an
| affordable, highly portable computer.
HP strikes chord with Mini-Note PC
,----[ Quote ]
| Like the three aforementioned machines, the Mini-Note is not aimed at the
| mass market. It starts on the low end at $499 for the Linux, SSD version, but
| a fully configured device with Vista can top out at $1,200.


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Richwoods Volunteer Fire Department - Firehouse - Richwoods, MO - Phone: (573) 678-2886
The term 'Security' refers to the protection against danger, damage, loss and criminal activity. In Richwoods, Security Services are provided by security firms and proprietary security departments that practice the "detect, deter, observe and report" methodology. Security officers are not required to make arrests, but have the authority to make a citizen's arrest, or act as an agent of law enforcement at the request of a police officer, sheriff, and others. A security officer's primary duty is the prevention and deterrence of crime. Security officers are often trained to perform arrest and control procedures like handcuffing and restraints, operate emergency equipment, perform first aid, etc.
NYS Comptroller Thomas DiNapoli Addresses Clean Energy Leadership Task Force
Audits Confirm Savings from Energy Efficiency Improvements at Long Island School Districts (Long Island, NY) On Friday, February 19th, New York State Comptroller Thomas DiNapoli spoke before the Clean Energy Leadership Task Force which is a project directed by the Sustainability Institute at Molloy College located at Republic Airport in Farmingdale NY. Mr. DiNapoli discussed the results of audits..


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When walking into a major theme park you naturally bear to the right. You don't veer from the main pathways. Prohibited areas may not be marked but you instinctively know that you can't go there. So, why is that? The principle is "Crime Prevention through Environmental Design," commonly known as CPTED. The theme park environment has been cleverly designed with gentle slopes to direct walking traffic. Landscaping has been designed with symbolic demarcation and subtle barriers that mark transitions between zones such as different colored or textured pathways, flower beds, ground cover, and decorative fencing. When more substantial barriers are needed, shrubbery and thorny bushes are effective in creating a more formidable obstacle.
The uniqueness and success of CPTED comes from the integration of crime prevention principles and techniques into the architectural design process. Quick serve (QSR) and fast casual restaurants are vulnerable to robbery because of cash transactions with the public, late at night. Four overlapping CPTED principles are particularly effective in comprehensive crime prevention programs to help people feel safer and deter crime. The overall function is to affect behavior and create the impression that activity is monitored and misbehavior will be addressed.
1. Natural Surveillance – Places physical features in ways to maximize the ability to see what's going on. One of the biggest obstacles of natural surveillance in QSR and fast casual restaurants is advertizing plastered over the windows. It prevents police patrols and others from observing activity inside the restaurant, particularly after the sun goes down. The same is true for overgrown plants and bushes that cover the windows. Inside, convex mirrors improve the view of blind spots. A camera system with a monitor in the office provides a view and records activity inside and outside. An enunciator or strobe light that goes off when the back door is opened presents additional awareness. A manager wearing a drive-thru headset during evening and late night hours not only provides awareness of drive-thru activity, but additional security and communications when needed. A window overlooking the kitchen assists in monitoring activity.
2. Physical Security – Properly located entrances, locks, fencing, landscaping and lighting deter crime.
3. Territoriality – Use fences, good maintenance, signs and landscaping effectively. Use fencing or landscaping to define outside dining areas, limited access points and mark property boundaries. Keep the premises looking well kept, crisp and clean to portray a sense of pride and ownership in the property. Keep the tables, glass, and floors clean. Repaint as necessary, and keep the exterior free of trash and patch parking lot potholes. Keep fencing away from the building to prevent access to the roof. If CCTV is used, strategically place signs stating that the property is under video surveillance to increase the impact. Have a plan to remove any graffiti immediately.
4. Maintenance – Have a checklist for routine maintenance tasks. Check the parking lot after the sun goes down to ensure lighting is not blocked by overgrown tree limbs. Trim shrubs to less than three feet high and lower limbs of trees to a minimum of six feet to improve visibility lines. Routinely inspect and test alarms, locks, fire extinguishers and CCTV system. A well maintained building and premises shows pride and a sense of ownership in the property and attention to detail. The perception of attention to detail may deter suspicious and/or criminal behavior.
These CPTED strategies rely on the ability to influence decisions that precede criminal acts. The perceptions that the offender may be identified or caught may outweigh the desire to commit the crime. In simple terms: the risk is greater than the reward. A well maintained property with built in crime prevention structures and principles, along with well trained employees, are proven crime prevention strategies. A flower in the proper position integrated with other behavior modifying techniques, has tremendous power to keep employees and customers safer and more secure. Use them wisely.
For more information on security, safety, loss and crime prevention for restaurants, visit www.LossBusters.com. For daily tips on restaurant loss prevention, follow on Twitter @LossBusters
Topics: Crime, Insurance / Risk Management, Loss Prevention, Operations Management, Restaurant Design / Layout, Staffing & Training
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Finding jobs for ex-felons is, well, one of the toughest jobs we can imagine.
That's why Medina County deserves credit for trying to address the problem. Doing so with success, even on somewhat of a modest scale so far, is just that much more encouraging.
County agencies including the Adult Probation Department and Medina Works have been collaborating with county court system and county officials over the past several months to create a system, which so far has led to some 13 ex-felons finding gainful employment with more, hopefully, in the pipeline.
Doing so involves extensive screening, training and monitoring and the amount of labor required has prompted those behind the program to keep it small in order to remain effective.
But even small victories are welcome when they put those who once threatened and damaged society in a position to contribute to it.
The program isn't entirely altruistic — sentencing reforms two years ago called for treatment and training programs in a push to shrink prison populations. But it's produced meaningful results, and that's something to celebrate.
County officials involved in the effort deserve some measure of congratulations for taking what is largely a thankless job and making some headway. Here's hoping those efforts — and the success stories they've produced — continue.


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Nelson Mandela's secret love... for Rolling Stone Ronnie Wood's mother-in-law
- Rachel Lundell, mother of Jo Wood,was 16 when Mandela pledged his love
- Her aunt put paid to the romance in apartheid-era South Africa
The mother of rock chick Jo Wood has revealed how as a teenager she stole the heart of Nelson Mandela.
Rachel Lundell was 16 when she won a pledge of undying love from South Africa's future president, who at the time was living in a tiny village in Umtata in the Eastern Cape.
Rachel, now 78 and living in Devon, had just finished convent school in 1951. She was working in her aunt's fruit store and cafe after having second thoughts about life as a nun.
A young Nelson Mandela penned a love letter to Rachel Lundell in 1951 when she was 16
She had first been offered a job at a baker's shop in nearby Mount Frere but was sacked before she had even started when the owner discovered that Desmond, the black delivery boy, was her brother.
Rachel said: 'Desmond was darker than me; I was blonde, freckled and white. My father was white and my mother looked white but her grandmother was black and she passed those genes on to us in varying degrees.'
Desperate for work, Rachel was then offered a job by her aunt, Gertie Morrison. But it was Gertie who put paid to any chance of romance with Mandela in apartheid-era South Africa.
Rachel explained: 'We had a lot of black customers and he was no different, buying cigarettes and peanuts in quite large amounts.
'There was no frisson of excitement when he came in or anything like that. He certainly wasn't what you would call handsome but he had a twinkle in his eye.
Rachel Lundell, second right, pictured with daughter Jo Wood, Rolling Stone Ronnie Wood, left, and husband Mike
'One day he came in and I served him as usual but after he left, I noticed there was a letter on the counter addressed to me. I opened it and there was yards and yards of it.
'It started off lovey-dovey enough but before long it had turned into something of a political missive all about how he was going to free the blacks in our country. Not very romantic really.
'Then Gertie came in and saw me reading the letter. She asked who it was from and I told her.
'She snatched it out of my hands and threw it on the fire, saying I wasn't going to be going out with any black men.'
Rachel never saw Mandela again. Soon afterwards, he moved for good from Umtata, now called Mthatha, a former military post for colonial forces, to Johannesburg where he continued his political struggle.
Rachel Lundell aged 16, when Nelson Mandela pledged his undying love
She continued: 'I wish I still had the letter. 'Imagine what it might have told us today about how Mandela predicted what lay ahead for him and his country. It would have been a special piece of history.
'All I've got left are the memories and the endless jokes from my eventual husband and children about what might have been. I know he was a bit of a ladies' man in later life and it would seem he might have been then, too.'
Little did Rachel know at the time that Mandela was already married to Evelyn Ntoko Mase, with whom he had three children: Thembekile, Makaziwe, who died aged just nine months, and Makgatho, born in 1951 – the year of the love note.
That same year, Mandela was elected president of the African National Congress Youth League and by April 1952 was spearheading the so-called Campaign of Defiance.
He became the first black president of South Africa in 1994, standing down five years later.
In November 1952, Rachel set sail herself for a new life in England on a Dutch cruise ship with a passport and ticket arranged for her by a missionary.
Her destination was suburban Surbiton, South-West London, where she lived with her sister Joan.
About a year after arriving, she was gardening at the front of the house when a local boy, Michael Karslake, strolled past and persuaded her to go to the cinema instead of the square dance she had planned.
Rachel said: 'I was all dressed up in my check shirt and denim trousers but something told me to go. I was supposed to be going off travelling in Europe and he had a job lined up in Canada.
'We never looked back, though. We married in 1954 and I'm proud to say I found the right one for me. Mike gave me four lovely children, the first of whom was Josephine.'
Jo, now 57, was famously married to Rolling Stone Ronnie Wood for 26 years and has just published a new memoir – Hey Jo.
Eventually, Mike and Rachel retired to Devon. Mike died in 1990, leaving Rachel with just four cats for company. Rachel said: 'I still talk to him and only the other day his picture floated down off the shelf. I knew it meant he was still with me.'
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CHARLES TOWN - Work on the new entrance into the Hollywood Casino at Charles Town Races will begin March 14.
The area at East Fifth Avenue will be closed between Flowing Springs Road and W.Va. 9 eastbound until late June, according to the West Virginia Division of Highways. This includes the Flowing Springs Road exit.
According to acting city manager Andy Blake, the project is designed to enhance the gateway into downtown Ranson, and replaces the four-way intersection at Fifth Avenue with a traffic circle.
Article Photos
Journal photo by Michelle Horst
Signs leave a warning for travelers along W.Va. 9 of the Flowing Springs Road closure beginning Thursday.
The project also adds pedestrian improvements, street lighting, trees, and provides a direct connection from W.Va. 9 to Charles Town and downtown Ranson.
"The project starts at the Holiday Inn and ends before the railroad track," Blake said.
According to the concept plans, the growing area around right-of-way from Fifth Avenue around Fairfax Boulevard to Marshall Street, which includes Jefferson Memorial Hospital, has been a problem.
The new design will have a 60-foot right-of-way with two travel lanes, along with a five-foot planting strip and sidewalks.
The construction work and exit closure is anticipated to continue until late June.
- Staff writer Michelle Horst can be reached at 304-263-8931, ext. 138, or email@example.com.


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WELLESLY, Mass. — Roche Bros. here has agreed to pay its employees more than $283,000 in back wages after a U.S. Department of Labor investigation, published reports said. The investigation found that 17 Roche Bros. markets failed to pay overtime wages to some employees over 2005 and 2006, according to the Associated Press. The chain cooperated with investigators after Roche Bros. executives were alerted to the investigation. Around 687 employees would share in the settlement, the report ...
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Oakes Outdoor Power Sales - Oakes, ND - Phone: (701) 742-2105
Lawn Mowers, in Oakes, are the automated machines provided with a motor that runs on either gas or battery, with sharp blades at the base and a long handle with base wheels. These instruments are used to even the grass and hedges in a particular field or garden. Some lawn mowers for large scale usages are also attached to the base of a car and driven by people to make the job easier. Lawn mowers are used to make a particular design on a piece of land. Lawn mowers come in a range of shapes, sizes & prices. In Oakes, there are various brands & makers who provide a variety of specifications & features in the machines to enhance their market value.
Governor Cuomo Announces First Solar Schools Project At The New York Institute For Special Education In The Bronx
Governor Cuomo's K-Solar Program Increases Use of Renewable Energy in Schools (New York, NY) Governor Andrew M. Cuomo today announced the New York Institute for Special Education in the Bronx will be the site of the state's first solar schools project and will have solar panel arrays installed thanks to a power purchase agreement with SolarCity. This public-private partnership..


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Midget Football is not taking a back seat to the high school playoffs this weekend.
While Millville High is going for all the Group IV marbles at Rowan University tonight, both Bridgeton's and Cumberland's Midget programs are also playing for championships.
Cumberland Midget Football is going for its second Tri-County Midget Football title in its history.
The Junior Stampede will be traveling to Kingsway to play the 10-0 hosts.
The Stampede has just one loss on the season, 14-12, to Kingsway.
Paybacks are in order.
"That game could have gone either way,'' said Coach Carl Hemple Jr., who is also president of his organization.
Cumberland ran wild to the tune of 26-6 over previously unbeaten Woodbury last week in the semifinals.
"This was a big game for us,'' he said,'' said Hemple..
Lamark Jones ran for 252 yards and scored two touchdowns for the Stampede.
Cumberland has turned in seven shutouts this season while going 10-1.
If you're going to split a season series, win the championship game is the way he sees it.
Bridgeton is playing for three of them starting Saturday at 10 a.m. at the field of Egg Harbor PAL.
Joyce's Whips start if off against the Middle Township Panthers.
The Whips are looking to repeat.
The Cumberland Dairy Packers are up next against the EHT YOUTH Eagles.
The Packers are looking for their fourth title in five years.
The 5th Ward AA Gems finished off what Bridgeton hopes w'il be a sweep against the Dennis Township Blue Devils.
The Gems are going for three in a row.
Their 29-6 win over Galloway Saturday ran their record to 11-0.
Dennis Township could be a little gun shy going into the finals.
"We put two of their running backs out of the game,'' said Miletta. "We were trailing 8-0 at the half and we came back and scored 28 unanswered points.''
That was the first time they met.
On Sunday, one day later, the Gems have to travel to North Jersey to take part in the state tournament.
They'll play at 2 p.m. in Englewood, in Bergen County.
The Whips defeated the Galloway Renegades, 19-0, to advance to the championship game against the Middle Township Panthers.
The Packers defeated the EHT PAL Enforcers, 33-6, to advance to the championship game against the EHT Youth Eagles.
Coach Doug Buirch went to passing game to top EHT.
"It's more passing than we've done all year,'' said Buirch. "We were up 14-6 and I thought it was time to try and put a quick score on the board.''
The Packers are 12-0.
"We have a team that doesn't worry about who is scoring as long as we're scoring,'' said Buirch.
The Whips have pitched 11 shutouts this season.
Coach Kevin Schaeffer is worried about Middle Township.
"We beat them 13-0 in Week 6,'' he noted. "But they've improved a lot since then.''
But, the Whips will be ready.
"We've got a good game plan ready,'' he said.
The Whips are 11-1.
Midgets also in championship games on road
Email the author
on December 01, 2011 at 9:37 PM, updated December 02, 2011 at 8:48 AM
Midget Football is not taking a back seat to the high school playoffs this weekend.


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"Would you like a side of Spam with that?"
Let me be honest, I don't eat enough vegetables. I wasn't forced to eat them while I was growing up so I haven't acquired a taste for many of the "good" ones. And I don't mean that I simply don't like the taste, which I don't, but I actually have a revulsion when many vegetables hit my tongue (i.e., I gag).
I know that it's important to consume them for a wide-variety of reasons, but I just can't (yet). In the meantime I've been supplementing my diet with Greens + Wild Berry Burst, a "Super Food." Is this supplement acceptable on a Paleo Diet? As far as I can tell by its ingredients, and according to the manufacturers, it shouldn't impact my body's insulin levels.
Also, what with my lack of vegetable consumption, would you encourage to take a fiber supplement? I like fruit but in the beginning, when rapid fat-loss is one of my primary goals, I'm limiting my intake of fruit to 1-2 pieces/day and as a result my bowel movements haven't exactly been stellar.
Anyways, other than that I've adapted well to the diet and I'm feeling great.
Thank you in advance for your advice.
I began this Primal journey on December 30th, 2009 and in that time I've lost over 125 LBS.
"Would you like a side of Spam with that?"
more SPAM from xavier, mark... looks like someone who needs to be banned.
Eating lots but still hungry? Eat more fat. Mid-day sluggishness? Eat more fat. Feeling depressed or irritable? Eat more fat. People think you've developed an eating disorder? Eat more fat... in front of them.
Jokaman, there are folks here who are 'carnivore'--not doing any fruits/veggies. You could certainly do that if you wanted.
Mark talks about the antioxidants in veggies and fruits being important b/c of all of the toxins our bodies face today... I prefer to do lots of veggies for this reason.
Would you post a link to the wild berry and greens supps you're talking about? I personally don't have a problem w/ something like this in theory as long as it isn't full of a bunch of crap. Although every powdered 'green drink' I've ever tried has tasted soooo much worse than the delish veggies I eat each day...(sometimes hard to gag down)
If you are already eating some fruit, a really easy way to get veggies in is to make 'green smoothies'. Typically you put water or coconut milk etc. in a blender, throw in some fruit (I do 1/2 a banana for sweetness plus some berries or other fruit--1/2 cup) then a cup + of leafy greens. You can start w/ milder ones like romaine so that the taste isn't so strong, and as you grow accustomed to them, add more varieties w/ stronger flavors. This way you don't need to worry about the texture of them... Here are some recipes (scroll down to the recipes. Most 'green smoothie' stuff is written by raw vegans, so disregard info that is anti meat in writings about them, etc...) I love veggies and prefer to eat them, but had been doing this for a while b/4 going primal to get more in at breakfast...
Your tastes may change in time as well eating primally, and you may become more open to eating various veggies. And it may take a bit for your body to adjust in terms of your bms...I wouldn't worry about taking a fiber supp unless you were really constipated, and I think there are things you can do before taking a fiber supp (probiotics, added magnesium, taking a more natural fiber supps like herbs, etc.) if that were the case. Hopefully a carnivore will give some more input on this. I think I've heard coconut oil can be helpful for this too...
If this is a packaged product, you need to put a link to its page for us to evaluate.
From what I've read above, it's just another junk food.
Go all meat if you can't stand veggies (I's so sorry for you!) Get off of the fruit, especially if you are in weight loss mode.
I'm of the opinion veggies aren't necessary & are rather over-rated. It's questionable how much of all that 'good stuff' you're actually assimilated from the veggies while the cellulose damages your GI tract. Who is that granny who was in the world masters games - olympics for geezers (well not all total geezers) - anyway, she's in her nineties - ? Her nutrition advice - don't eat veggies! I used to like veggies OK, then eating some steamed collard greens just turned my stomach & didn't feel right. I have a couple of veggies I eat - watercress, raddichio, beets & sweet potato, oh, and some green chiles/tomatillo salsa for fajita. Vitamin supplements are also questionable. If you want to 'supplement' go for VitD, cod liver & an Omega3, DHA, etc. oil. Dr. Ron's ultra-pure has organ supplements - I'd go with that over synthetic, unnaturally isolated vitamins.
I get that weird aversion to vegetables sometimes, too. I used to HATE sweet potatoes, now I like them but for some reason can't eat more than a little bit at a time before they gain back their yuck factor. Same goes for cooked carrots...raw carrots I can eat nonstop, though. Maybe there's a texture issue (I tend to not like tomatoes because of their texture), or maybe there's some weird overwhelming taste, or maybe it's all psychological, who knows.
As people have said, you can go veggie-less if you want. If you still want to eat them, experiment with different ways of cooking them. For instance, steamed broccoli isn't the most appealing to me, but broccoli sauteed in butter is delicious.
Sweet potatoes are so rich a slice or two with bacon & eggs does for me, oh, and added butter, of course! Only a couple of times a week at that.
So - I'm taking over the health section at the bookstore I work at (evil laughing and hand rubbing!)
I've got a nice Paleo/Primal list adding up!
Actually - title ideas would be great if you guys want to give me your input!
Here's a link for the supplement:
http://greensplus.com/index.php/cPath/84_21_23_148?osCsid=ade6d99e618eaecf431075049dcc43 6f
Provides food source vitamins and minerals, in their biologically complex form, as nature intends them to be.
Supplies high concentrations of the very building blocks of life RNA, DNA and Amino Acids absolutely essential for the health of all 32 trillion cells in the human body.
Delivers sea-source micro-nutrients such as boron, titanium, lithium, ubium and iodine found in rich sea vegetation virtually depleted from the earths soil.
Contains a rainbow of bio-active enzymes such as chlorophyll (green), phycocyanin (blue) xanthophylls (yellow), violaxanthin (purple) and the complete carotene complex-focal points of exciting nutritional research.
Metabolizes and transports body fat and cholesterol with the emulsifying di-polar molecules found in ultra Soy Lecithin.
Neutralizes harmful acids produced in the digestion of animal tissue and processed foods. Disease thrives in an acidic internal environment called acidosis.
GREENS+® is a rich alkaline-forming food that restores a healthy pH balance to the human body.
Strengthens the Immune System with the herbal support of Echinacea Angustifolia, Milk Thistle and Astragalus Membranaceus.
Enhances mental acuity with Ginkgo Biloba extract, a potent neural tonic that improves circulation to the brain tissue, and works with choline (found in lecithin) to increase nerve impulses linked to memory. The human brain has a dry composition of 30% lecithin.
Reduces stress and accelerates homeostasis with standardized herbal extracts of Siberian Ginseng, Licorice root, and Astragalus Membranaceus.
Cleanses the colon of excess cholesterol, dietary toxins and waste with 17.2% soluble and insoluble high pectin apple fiber.
Re-populates friendly intestinal bacteria with 2.5 billion airy-free probiotic cultures of seven different strains including Acidophilus ATCC 4356.
I began this Primal journey on December 30th, 2009 and in that time I've lost over 125 LBS.
Also, I find that eating a banana or an apple with my 4 slices of bacon w/cheddar cheese (I ran out of eggs this morning) eases my stomach. I'm not sure I could eliminate all natural fiber from my diet without spending the entire day on the toilet or with an upset stomach. In fact, I'm supposed to go hiking today but I don't want to for fear of having to take a sh!t break or three on the side of the trail along the way.
I began this Primal journey on December 30th, 2009 and in that time I've lost over 125 LBS.


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At Carolina Forest Family Dentistry in Conway, South Carolina, our dental office is proud of the care we provide as well as the professionals we employ. To learn more about our doctors, read more here or contact us.
Dr. Daubenspeck Dr. Daubenspeck is a cosmetic dentist, owner, and senior partner of this four-dentist and three-specialist practice. In 1991, he became a third-generation graduate of the University of Pittsburgh School of Dental Medicine after his father graduated in 1961 and his grandfather graduated in 1927. He received his Bachelors of Arts degree in Political Science in 1986 from Clemson University. In addition, Dr. Daubenspeck served six years in the United States Navy Dental Corps, attaining the rank of Lieutenant Commander.
"Dr. D" was born in Sasebo, Japan and grew up between Erie, Pennsylvania and Hilton Head, South Carolina. He lives in Carolina Forest and has two children, Maggie, 10 and Max, 4. Dr. D's hobbies include spending time with his kids, family, and friends. He loves airplanes, boats, and Clemson.
Dr. Jason Kiggins Dr. Jason Kiggins is a family and cosmetic dentist who has been practicing comprehensive dental care and serving our community since 2002. He and his wife Wendy were born and raised in Pittsburgh, Pennsylvania. Their son Connor attends school at Ocean Bay Elementary in the Carolina Forest School district.
Dr. Kiggins completed his undergraduate studies at the University of Pittsburgh and graduated from the University of Pittsburgh School of Dental Medicine in 1996, receiving his Doctorate of Dental Medicine. Prior to serving our community, Dr. Kiggins spent almost six years serving our country with the United States Air Force.
Dr. Shaunna J. Szabo Dr. Shaunna J. Szabo joined the practice in August 2008. She is originally from the Snow Belt of Western New York and grew up on her grandparent's tree farm. Having had enough of the winters, Dr. Szabo attended college at the University of South Carolina-Aiken, where she received her Bachelor's Degree cum laude. She then received her Doctorate of Dental Medicine from the Medical University of South Carolina in Charleston.
As a dental student, she was President of the American Association of Women Dentists and organized Give Kids A Smile Day at the university.


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ecember 15, 1997
Dear Criticizers of the Cedarcrest Senior Project:
I am a senior at the high school and member of the Riverview School District since Kindergarten, and I would like to tell my side of the story. My only complaint about the senior project is that it is too easy. As students in the Senior Project class we are given guides on how to write a business letter, construct a paper and cite references. This is ridiculous: as high school seniors we should already possess these skills, or at least the ability to find resources that will show us how. I am not blaming the school for teaching us poorly, rather I am blaming the students and parents who do not care enough to get a strong education. I know for a fact that every freshman at Cedarcrest is taught how to write business letters in Keyboarding class and how to write a proper essay and cite resources in their English class, regardless of the skill level they are learning from.
There is no excuse for the lack of completion of the Senior Project: the deadlines are spelled out and help is available from almost any staff member at school and from the community. The only reason a person would fail the Senior Project is if they plagiarize or lack the skills to write a paper that only needs 75% to pass. If they cannot write a legible essay and presentation, then they do not deserve a high school diploma. I apologize if this sounds harsh: you must take a look at yourself and your view of education if you have a problem with what I am saying. I also have the problem with the letter written by Mrs. Hill: Mrs. Hill wrote it. If this is truly her daughter's grievance, then why does her daughter not write the letter? And by the way, Hale-Bopp is spelled with two "p's."
Julie L. Beard,


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Italia Ricci
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When you need mission-critical information at your fingertips and your Tactical Field Work involves taking notes, referencing maps, checklists, ipads and other PDAs...then this site's for you! Extensive field testing has gone into each of our designs so that you end up with a super functional and super strong organizer that works with you! Our Tactical Notebook Covers don't just protect your notebook.... they organize all that "other stuff" that ends up in other cases, pouches or just loose in your pocket.
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Author Affiliations: Department of Otolaryngology–Head & Neck Surgery, Tufts University School of Medicine, and Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts (Dr Scott); Pediatric ENT Associates (Drs Tibesar, Lander, and Sidman) and Department of Oral Surgery (Dr Sampson), Children's Hospitals and Clinics of Minnesota, Minneapolis; Department of Otolaryngology, University of Minnesota Medical School, Minneapolis (Drs Tibesar, Lander, and Sidman); and OMS Specialists, Anthony, Minnesota (Dr Sampson).
Micrognathia, characterized by a small and retrusive mandible, is an abnormality that is present at birth. The mandibular alveolus is posterior to the maxillary alveolus, and other mandibular abnormalities including a small mandibular body, an obtuse gonial angle, and a posteriorly located or diminutive mandibular condyle may be noted. The combination of micrognathia and glossoptosis frequently causes tongue base airway obstruction, leading to respiratory and feeding difficulty in the newborn. The degree of respiratory difficulty is dependent on the severity of the micrognathia and glossoptosis.
There are a variety of options available for airway management in the micrognathic child. Typically, interventions begin with the most conservative and noninvasive measures. This includes prone positioning and placement of a nasal pharyngeal airway. The use of positive pressure mask ventilation through the nasal pharyngeal airway will provide some additional benefit in those children with continued obstruction. Other options include glossopexy procedures or subperiosteal release of the floor of the mouth combined with glossopexy. Traditionally, tracheotomy has been performed for the most severe or refractory cases of upper airway obstruction. Long-term tracheotomy in children, however, is associated with significant morbidity and mortality.1 Complications associated with tracheotomy include sudden airway obstruction from accidental decannulation or mucous plugging. Recurrent airway infections, airway bleeding, stomal maintenance problems, and inhibition of proper speech and swallowing development are also concerns for these children.
In addition to the airway problems, many patients with micrognathia will not be able to sufficiently feed orally. Upper airway obstruction prevents a normal swallow, and these children are unable to maintain adequate caloric intake. For this reason G-tube placement may be required to provide access for adequate nutrition.2 Finally, it should be noted that most children with a tracheotomy and a G tube require skilled nursing care at home and in their educational or care facility.
Mandibular distraction osteogenesis (MDO) is a technique in which the mandible is gradually lengthened after an initial osteotomy. Following a short latency period, distraction begins at a slow steady rate. During the distraction phase, bone segments are separated by small increments, while induction of new bone formation takes place in the gap. After the desired lengthening has been achieved, a consolidation period ensues in which the bone segments are held securely in their advanced position. The regenerate of immature bone remodels and matures during this 4- to 8-week period, after which time the distraction hardware is removed. Because distraction proceeds at a slow pace, related muscles, blood vessels, nerves, and mucosa are also elongated. This concomitant soft-tissue expansion is one of the main advantages of MDO.
In 2001, Sidman et al3 issued a report documenting the relief of upper airway obstruction using MDO in 11 children. This introduced a new approach to tongue base airway obstruction from micrognathia, and early results were promising. Bilateral MDO proved to be especially useful in children with Pierre Robin sequence (PRS), in which the mandible lacks anterior projection, leading to glossoptosis and upper airway obstruction; these children have a U-shaped cleft palate as well, which is associated with these conditions.
In the past decade, multiple authors2- 8 have published case series of pediatric MDO, highlighting various techniques and reporting on early results. While many authors have described using mandibular advancement to treat children and young adults, only a few centers are performing bilateral MDO for upper airway obstruction and feeding difficulty in infants and newborns. Earlier this year, a series of 32 pediatric patients who underwent MDO for upper airway obstruction was published, and this report included infants and older children.5 The analysis in this article was limited by the necessary evaluation of multiple conditions affecting children of varying ages who underwent MDO at different points in their childhood. In the present study, we specifically analyzed the youngest patients in this larger cohort. The primary goal of this article was to report on the long-term outcomes and complications following bilateral MDO for upper airway obstruction and dysphagia in infants younger than 3 months. Our second aim was to identify any preoperative patient characteristics in this age group that may assist the surgeon in predicting a patient's long-term outcome following early MDO intervention for airway obstruction.
After institutional review board approval was obtained, a retrospective medical chart review was performed to identify all children treated with MDO for upper airway obstruction from January 1997 to January 2006. Inclusion criteria were bilateral MDO performed at an age younger than 3 months, with a minimum follow-up of 3 years. Thirty-seven patients who underwent bilateral MDO at an age younger than 3 months were identified. Twenty five of these were performed more than 3 years ago. Of these 25 patients, 6 were lost to follow-up, leaving 19 patients who met the inclusion criteria for the study. Records were reviewed for outcomes data regarding airway maintenance, oral feeding, and speech intelligibility. In addition, incidence data were extracted regarding the long-term complications of MDO such as need for an additional MDO procedure, rate of anterior open-bite deformity, facial nerve damage, hypertrophic scarring, and tooth loss. A quantitative outcome measures scale was developed based primarily on functional outcomes, and patients were scored based on long-term postoperative complications as well as airway and feeding goals. A 10-point scale was created, with favorable results scoring highest and corresponding to the best functional level, based on the following outcomes: 1 point each was given on avoidance of a short-term or long-term complication such as postoperative open-bite deformity (defined as the inability of the maxillary incisors to overlap the mandibular incisors), hypertrophic scarring, facial nerve injury, mandibular tooth damage or development of mandibular cyst, development of unintelligible speech (as rated by a certified speech and language pathologist with experience in working with patients with cleft lip and/or palate), or eventual recommendation for an additional mandibular distraction procedure. Other outcomes such as tracheotomy decannulation and removal of G tube were also taken into consideration. Two points were allotted to patients who avoided tracheotomy or G-tube placement altogether, and 1 point was given to a patient for eventual removal of a previously placed feeding tube or tracheotomy tube following MDO. "Good" outcomes were considered for those with scores of 9 or 10, "intermediate" outcomes for those with scores of 7 or 8, and "poor" outcomes for those with scores of 6 or lower (Table 1).
Preoperative characteristics limited to diagnoses or traits that were recognized in the first few weeks of life were also noted. Patients were classified as having isolated PRS (iPRS) if they had no other syndromic features or neurologic deficits. Neonates with PRS as part of a named syndrome were considered to have syndromic PRS (sPRS), and these patients were further subclassified by the presence or absence of neurologic findings (hypotonia, seizures, or signs of developmental delay as determined by a pediatric neurologist) or musculoskeletal abnormalities (eg, arthrogryposis). Any chromosomal anomaly was also noted.
Patients were considered candidates for early MDO if they presented with micrognathia resulting in severe airway obstruction. These features were most commonly seen in patients with iPRS and Stickler syndrome. All patients were observed in the neonatal intensive care unit. If the patient was able to ventilate without endotracheal intubation, a nasopharyngeal airway was inserted and the patient was monitored for improvement. Infants were monitored with continuous pulse oximetry, serial capillary blood gas evaluation, and cardiac telemetry. Polysomnography was not performed on these children because these patients demonstrated obvious upper airway obstruction even while awake. Only patients in whom these less-invasive, conservative measures failed were considered potential candidates for surgical intervention, that is, only children who were failing to thrive (with tracheotomy and/or G-tube placement as the only other viable alternative) were considered candidates for early MDO.
The detailed patient evaluation (including physical examination, airway endoscopy, and radiographic imaging), surgical technique, postoperative care, and distraction protocol used for this cohort of patients has been previously described.4
Descriptive features of the 19 patients included in this review and a comparison with those who were excluded from this study are given in Table 2. There were 11 male and 8 female infants. The mean age at time of MDO was 4.8 weeks (range, 5 days–12 weeks), with a median age of 4.0 weeks. The smallest infant undergoing distraction weighed 2100 g. The mean length of follow-up was 67 months (5.6 years) (range, 37-122 months). Fourteen infants had iPRS and 5 had sPRS. The sPRS group included patients with Stickler syndrome (n = 1), Marshall-Stickler syndrome (n = 1), Catel Manzke syndrome (n = 1), Opitz C syndrome (n = 1), and arthrogryposis multiplex congenita (n = 1).
In general, 17 of the 19 patients (90%) achieved an outcome score of 8 or higher, corresponding to an intermediate or good outcome, with 12 of 19 (63%) achieving a good result (Figure 1). All 14 patients with iPRS achieved a good or intermediate outcome (score of ≥8). The 2 patients with poor outcomes (10%) had sPRS, one with arthrogryposis and the other with neurologic issues (seizure disorder, hypotonia, and developmental delay related to Opitz C syndrome) (Figure 2). The lowest scores were due to factors such as unintelligible speech, persistent G-tube dependence, open-bite deformity, as well as failure to decannulate in the child with arthrogryposis (Figure 3).
Distribution of outcome scores for all 19 patients, based on a 10-point scoring system.
Summary of outcome data for early bilateral mandibular distraction osteogenesis. Long-term outcome scores for all 19 infants (A), 14 infants with isolated Pierre Robin sequence (B), 3 infants with syndromic Pierre Robin sequence (sPRS) without neurologic comorbidities (C), and 2 infants with sPRS with seizure disorder, developmental delay, or arthrogryposis (D).
Complication rate and rate of unfavorable outcomes of early bilateral mandibular distraction osteogenesis. Complication rate for all 19 infants (A) and 14 with isolated Pierre Robin sequence (iPRS) (B) and unfavorable outcomes for 14 infants with iPRS, 3 with sPRS without neurologic comorbidities, and 2 with sPRS with developmental delay, seizures, or arthrogryposis (C).
Only 1 of the 19 patients (5%) continues to be tracheotomy dependent. Of the 2 patients who had tracheotomy prior to MDO, 1 was able to be decannulated and has remained free of requiring tracheotomy over the long-term follow-up. The other 17 patients were able to avoid tracheotomy altogether, staying intubated throughout the latency and distraction phases until mandibular advancement adequately relieved tongue base airway obstruction.
Six patients (31%) who underwent bilateral MDO for micrognathia and upper airway obstruction required G-tube placement for feeding, while an additional 13 patients (69%) avoided G-tube placement and have been feeding orally without difficulty. In those who required a G tube, feeding tube removal was possible in 3 of these 6 patients after MDO. Three patients (16%) remain G-tube dependent.
One patient (5%) had a residual anterior open-bite deformity after MDO. This patient had arthrogryposis with an anterior open-bite deformity prior to MDO, and the deformity was not corrected by the procedure.
Four patients (21%) experienced long-term tooth loss or malformation after MDO (Figure 4). A total of 3 patients (16%) had long-term injury to the marginal mandibular branch of the facial nerve. Three patients (16%) had hypertrophic scars on the skin over the mandibular body and angle from the pin entry sites. One patient (5%) required an additional MDO procedure later in life owing to failure of mandibular growth and relapsing upper airway obstruction.
Missing second molar (arrowhead) and malformed first molar (arrow) apparent on the right (R) side in a child 7 years after neonatal mandibular distraction osteogenesis. Compare with normal dentition on the left side, which was not affected by a similarly placed mandibulotomy (arrowhead, second molar; arrow, first molar).
In 2001, Sidman et al3 proposed MDO as an alternative to tracheotomy as a means of addressing upper airway obstruction in children with PRS. This report described 11 patients with micrognathia who were treated with MDO, and all achieved tracheotomy avoidance or decannulation. This report demonstrated that with mandibular advancement, the tongue base is brought forward and the supraglottic airway obstruction is relieved. Further work has also shown a decrease in the rate of feeding tube placement in some patients who undergo MDO as well.2
Since then, several studies have been published that document the safe and effective use of MDO in treating patients with micrognathia causing upper airway obstruction.5- 9 A recent comprehensive meta-analysis of MDO was conducted by Ow and Cheung.10 This thorough review retrieved 178 articles, yielding 1185 patients. A total of 646 patients had bilateral distraction osteogenesis in an effort to treat upper airway obstruction. Success in preventing tracheotomy was achieved in 91.3% of neonates, and distraction relieved symptoms of obstructive sleep apnea in 97% of children. This meta-analysis showed that a considerable number MDO cases have been performed to date and that evidence demonstrating successful clinical results is accumulating.
Still, because MDO is a relatively new technique, questions remain as to the long-term results and sequelae of this treatment method. While initial results show promise, there is still doubt about how the mandible and airway will react and grow after MDO. Furthermore, there are concerns that when the MDO procedure is performed on the very young, it will need to be revised and repeated if the mandible does not grow as the child matures. Obviously, the benefits of pediatric MDO significantly decline if the procedure needs to be repeated throughout childhood and adolescence. The present report attempts to address some of these questions.
Our long-term results demonstrate that MDO performed in infants younger than 3 months successfully addresses upper airway obstruction related to micrognathia in the neonatal period and has a sustained effect that continues into childhood (Figure 5 and Figure 6). Eighteen of the 19 patients (95%) who were candidates for either tracheotomy or MDO in infancy and ultimately underwent MDO remain free of requiring tracheotomy over the long-term follow-up. Furthermore, 95% of our cohort did not require an additional distraction procedure over a mean follow-up period of 5.6 years (range, 3.0-12.1 years).
Serial photographs of a child with Marshall-Stickler syndrome at ages 1 week (A), 1 month (B), and 7 years (C), who underwent bilateral mandibular distraction at age 2 weeks.
Photodocumentation of the same patient as in Figure 5 demonstrating early scar results (A), long-term scar results (B), long-term occlusion (C), and mandibular symmetry (D).
The impact of MDO on overcoming feeding difficulties in children with micrognathia is less dramatic but still positive. Sixteen of 19 patients (84%) are feeding well orally and do not require a G tube. The dysphagia experienced by micrognathic children is certainly multifactorial. Nevertheless, our results clearly support the hypothesis that glossoptosis and upper airway obstruction may be the primary components causing swallowing difficulty. Relieving upper airway obstruction allows for easier breathing during feeds and may improve coordination of oral intake and swallowing. Furthermore, following distraction, a child can feed more efficiently and expend less energy obtaining appropriate caloric intake. We have noted that MDO has altered the course from failure to thrive to healthy weight gain for many of our patients.
This report demonstrates a relatively low incidence of long-term complications (Figure 3). The most common complication was permanent dentition loss or malformation (21%). The damaged teeth were the first molars, second molars, and premolars (Figure 4), and injury was likely related to the location of the mandibular osteotomy. The complication of tooth loss can be avoided by planning the osteotomy posterior to the tooth buds; however, osteotomy placement is sometimes limited by the position of the mandibular angle. We advocate strongly that the osteotomy should not be made directly through the mandibular angle because this would cause significant blunting of an important facial landmark during distraction and lead to a more abnormal facial appearance. We therefore prefer to plan the osteotomy either superior or anterior to the angle of the mandible. Additional tooth damage is likely caused by pin placement, which may lead to necrosis of a developing tooth bud in the molar region and ultimately tooth loss later in development. Again, careful preoperative planning and modeling may limit such complications. With that said, unfortunately, there are incidents where tooth buds are knowingly injured to achieve the optimal vector of distraction for airway improvement.
Three patients (16%) in our series experienced long-term weakness of the marginal mandibular branch of the facial nerve. This was likely caused by injury during the surgical approach or during pin placement for the external MDO device. In more of our patients, injury to the marginal mandibular branch of the facial nerve was seen in the immediate postoperative setting and resolved during the perioperative period and is therefore not categorized as a long-term complication. In these instances, it is likely that the paresis was due to traction on the nerve rather than direct trauma. The resulting neurapraxia resolved as expected. Certainly, the position of this branch of the facial nerve overlying the angle and body of the mandible presents an obstacle to a clear surgical approach and retraction during surgery is always necessary. The effect of long-term damage to this nerve is an asymmetric movement of the lower lip at the corner of the mouth during mimetic facial movement. While this is an undesired complication, it likely has a relatively low impact on the overall quality of life in these children.
Finally, 3 patients (16%) experienced hypertrophic scarring at the pin sites. These patients were offered scar revision surgery, but all parents thus far have deferred the operation. Scarring is most prominent early in life but tends to improve over time (Figure 6).
Our results as they pertain to the nature and overall rate of complications following MDO are comparable to those recently published by Shetye et al.11 This retrospective study examined the records of 141 adult and pediatric patients treated over a 16-year period. They reported a major incident rate of less than 5%. Their most common complications were fibrous bony union and temporomandibular joint ankylosis, followed by damaged tooth follicle, unstable distraction device, and premature consolidation.11
Lin et al12 recently published their long-term quantitative results documenting relief of upper airway obstruction with MDO. This study involved 5 children with a mean follow-up of 47 months following MDO, and postoperative polysomnogram data on each patient was presented. The authors demonstrated long-term improvement of obstructive sleep apnea in 4 of these 5 children.
There are only a few other reports documenting the long-term results of MDO. Kleine-Hakala et al13 found that developing molars were adversely affected in 13 of 17 children reviewed. Other long-term complications that have been described include temporomandibular joint abnormalities, ankylosis, and disruption of subsequent mandibular growth with resultant malocclusion.14- 16
To our knowledge, this study is the first to examine long-term results and complications following neonatal mandibular distraction for upper airway obstruction. Because neonatal distraction is not a common procedure, it is difficult to amass enough cases to attain statistical power. Our results are therefore limited by the number of subjects and the retrospective nature of this study. Nevertheless, this case series is the largest of its kind to date with more than 3 years of follow-up.
Our data suggest that patients with iPRS or mild forms of sPRS (without neurologic comorbidities) tend to have favorable outcomes, while those patients with developmental delay, seizure disorder, or arthrogryposis did not achieve significant benefit from early mandibular distraction (Figure 2 and Figure 3C). It is difficult to draw any conclusions in regard to the utility of performing MDO on patients with neurologic sequelae based on 2 patients. Nevertheless, patients with seizures, hypotonia, and signs of developmental delay in the setting of micrognathia and glossoptosis likely have upper airway obstruction that is multifactorial in nature. This neurologic component of obstruction may not be adequately addressed by mandibular advancement alone. These children may also have chronic aspiration. While upper airway obstruction has been improved, the tracheotomy may need to remain for the purpose of improving pulmonary toilet. In evaluating our older patients and other younger children who have not yet reached 3 years of follow-up, signs of feeding difficulty and upper airway obstruction often persist, and a number of these patients remain G-tube and tracheotomy dependent (unpublished data, October 2009).
Children with arthrogryposis may also have vocal fold immobility, supraglottic narrowing, and laryngomalacia, among other sources of airway compromise.17 The dysphagia and airway issues in these patients similarly may require a multilevel approach that may not be cured solely by mandibular distraction. Three other children with arthrogryposis, who did not meet inclusion criteria for this study based on age or length of follow-up, show improved breathing and swallowing after MDO, but all remained G-tube and tracheotomy dependent after their first distraction procedure (unpublished data, October 2009). Finally some of these patients also have symptoms of chronic aspiration. The tracheotomy is maintained for pulmonary toilet, regardless of postoperative relief of upper airway obstruction.
In conclusion, bilateral MDO is an effective means of treating airway obstruction and feeding difficulty in infants with PRS that is relatively safe. The decision to perform early MDO on a child with sPRS must be weighed with additional patient comorbidities, especially given the potential long-term complications of this procedure. Our experience would suggest that children with neurologic difficulties, developmental delay, or multiple anomalies may not be optimal candidates for early intervention. Upper airway obstruction and dysphagia in these children is usually multifactorial and may not be definitively addressed by treating tongue base airway obstruction alone with mandibular advancement. To this end, we have altered our clinical practice, since other children with sPRS with neurologic features and insufficient follow-up for inclusion in this study (Table 2) also tend to have intermediate and poor outcomes. We currently tend to recommend MDO in patients with apparent iPRS and are more likely to consider tracheotomy for children with hypotonia, seizures, and/or signs of neurodevelopmental deficits. We no longer offer early MDO for infants with arthrogryposis and instead recommend tracheotomy and supplementary G-tube feedings if necessary followed by MDO later in childhood.
In regard to children with iPRS, the effects of MDO persist through early childhood in most patients. This procedure seems to carry a relatively low morbidity, there is a low relapse rate, and our data show that these patients experience few noteworthy long-term complications. Nevertheless, it remains important to further follow up these patients to monitor the need for secondary reconstructive procedures as these children grow into adulthood.
Correspondence: Andrew R. Scott, MD, Department of Otolaryngology–Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111 (email@example.com).
Accepted for Publication: October 22, 2010.
Published Online: January 17, 2011. doi:10.1001 /archfacial.2010.114
Author Contributions: Dr Scott 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: Scott, Tibesar, Lander, Sampson, and Sidman. Acquisition of data: Scott. Analysis and interpretation of data: Scott, Tibesar, and Sidman. Drafting of the manuscript: Scott and Tibesar. Critical revision of the manuscript for important intellectual content: Tibesar, Lander, Sampson, and Sidman. Administrative, technical, and material support: Scott. Study supervision: Tibesar, Lander, Sampson, and Sidman.
Financial Disclosure: Dr Sidman is a paid consultant for Medtronic Inc.
Funding/Support: This study was supported by internal departmental funds.
Previous Presentation: This study was presented as a poster presentation at the Combined Otolaryngology Spring Meeting; April 28–May 2, 2010; Las Vegas, Nevada.
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Just in time for Thanksgiving, a couple of production companies have unveiled a huge gift for the Minnesota film community, KARE-TV reported.
Film commission Minnesota Film and TV announced Thursday that the comedy "Thanksgiving at Denny's" will be filmed in the Iron Range starting early next year. Production companies Washington Square and Griffin Productions are backing the project.
"As the son of an Iron Ranger, I'm particularly proud to produce 'Thanksgiving at Denny's' in my hometown," Griffin Productions president Jerry Seppala said in a statement. "The film production will have a positive impact on the local economy and I'm excited for Hollywood A-listers to experience the most beautiful place on earth."
The production described "Thanksgiving at Denny's" as "a dramatic adult comedy about a bi-polar, 6'4″ overweight computer programmer who gets laid off from his job in Chicago. He returns to his hometown to win the heart of a trailer park vixen with whom he has been obsessed since high school."
The film's cast has yet to be announced. Casting will take place in Minnesota, Los Angeles and New York.
Seppala said the partners at Griffin Productions have significant ties to Minnesota and they will "shoot multiple feature projects in Minnesota over the next decade."
The Iron Range is no stranger to feature film productions. The true-life drama "North Country," starring Charlize Theron, Woody Harrelson, Jeremy Renner and Frances McDormand, was shot in and around Chisolm, Eveleth and Virginia, among other places, in 2005.
The Business Journal reports Griffin Productions wants to produce up to a dozen films in Minnesota over the next five years. Seppala said the first film, "Thanksgiving at Denny's," could bring up to $24 million in economic benefits to the state economy based on estimates that show every dollar spent making a film generates six dollars in economic activity.


text:
Ancient Latin America
Columbian Exchange
The trade of goods and ideas between Spain and Latin America. A time of change. Latin America traded slaves, silver, corn, peppers and tomatoes. Spain traded cloth, peaches, pigs
1. Studied math and astronomy (stars) 2. Had calendar based on sun's movements 3. Developed writing system (hieroglyphs) 4. Slash-and-burn farming


text:
Member since June 27, 2013
Right now, I'm reading:
Steve Jobs and The GIrl Who Kicked the Hornet's Nest
My favorite story of all time is:
Harry Potter!
In bed I like to read:
Anything that is fiction and fall seamlessly in with my dreams.
Besides SMITH, I read stories at:
Mental Floss
If you were to throw up your hands in exasperation and yell "it's the story of my life," what would you be talking about?
Surprising twists and turns all around.
What six words would I tell my teen self if I could go back in time?
Be confident, only you are you.
The song that encapsulates the soundtrack of my life is?
It changes day by day, mostly with my mood! At the moment? Sweater Weather by the Neighbourhood!
If I could have one person read my writing on SMITH it would be?
J.K. Rowlings. I love her!
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