text:
Kriss Colville Adventure Series:
What's A Werewolf?
by Kriss Colville
Find out what Kriss Colville, girl sleuth, thinks of werewolves!
Did you ever wonder what a werewolf really is? Is it a man—wolf—dog—or some kind of thing?
In European folklore, a werewolf is a man, or woman who is transformed into a wolf at night, and always during the appearance of the full moon. This process is known as lycanthropy. The word lycanthropy comes from the Greek word Lykoi meaning "wolf," and anthropos, meaning "man."
The person goes wolf by shape shifting, and of course the full moon makes it much easier because of the effect it has on the human DNA. I learned all of this from my next door neighbor, Professor Peddlepusher who knows everything about everything, and anything about anything.
It's been said that although the human is transfigured into a wolf, he still possesses his human intelligence. I find this hard to believe. A werewolf is not that intelligent . . . at least not the one's I've spied upon, and followed in the deep of night.
From what I can figure out about the were-wolf, he's only concerned with one thing. And that, dear friend, is where he can find his next victim whom he may devour.
Could be you. Could be me.
He's not too concerned about making the world a better place, or who he might vote for in the next presidential election.
Types of were-creatures:
Alas,did you know that not all were-creatures are wolf? Nay, some are were-whatever's. If you're in Africa you might see a were-leopard, in India it could be a were-tiger, or a were-bear in Russia. And you can bet that none of these creatures will be as cute and playful as "wolf" in the movie, The Tenth Kingdom.
Some Books about the werewolf:
The Wer-Wolf (1838)
The Werewolf of Paris
The Wolf Leader (1857)
Cycle of the Werewolf (1985)
Goosebumps series
Movies about the werewolf:
The Werewolf (1913) a silent film
The Werwolf of London (1935)
The Wolf Man (1941) starring Lon Chaney, Jr.
The Silver Bullet (My favorite)
How to become a werewolf:
By the use of sorcery
Being cursed by an enemy with powers
Being bitten by a werewolf
Having a parent who is werewolf
How to catch a werewolf:
Folklore tells that the werewolf must return to human form at daybreak by shedding his wolf's skin, and hiding it somewhere in the forest. If it can be found and destroyed immediately the werewolf must die.
If the werewolf is wounded it must immediately revert back to its human form, but the wound will still be visible on the body. And of course everyone knows about the silver bullet thing. Guaranteed to stop a werewolf everytime.
Remember, if you suspect your neighbor, or friend of being a werewolf, it will show through in his, or her, personality. Be on the lookout for restlessness and unprovoked rages. The person will have trouble sleeping at night, and dread the coming of the full moon.
If you're brave enough to venture out alone after dark during the full moon, and you come across one of these creatures of the night . . .
Run Like Heck!
In the meantime, I'll keep spying with my telescope to spot any suspicious characters. If you see any in your city better give me an email. I'll come right away—if it isn't too far away—and if it's not during school hours.
And oh yeah—if I can be home by dinner.
Remember, it's up to good people like you and me to make our world a safer place.
Until next time,
-Kriss Colville, Girl Sleuth


text:
Here is a great video on kids. It's part of an entire program to make simple tools available to anyone to improve areas of life. The course on children (it's online and it's free) is brilliant.Enrollment is very simple and not only will it help your kids, their improved tempers and well-being will help you enormously too! … [Read more...]
Great Video on Raising Children
November 3, 2011 by Leave a Comment

subset: commoncrawl


text:
I, RobotDirector: Alex Proyas
Cast: Will Smith, Bridget Moynahan, Alan Tudyk
- Overview
- Editorial Reviews
- Product Details
- Special Features
- Related Subjects
- Cast & Crew
- Scene Index
- Menu
- Videos
Director Alex Proyas (Dark City, The Crow) helmed this sci-fi thriller inspired by the stories in Isaac Asimov's nine-story anthology of the same name. In the future presented in the film, humans have become exceedingly dependent on robots in their everyday lives. Robots have become more and more advanced, but each one is preprogrammed to always obey humans and to, under no circumstances, ever harm a human. So, when a scientist turns up dead and a humanoid robot is the main suspect, the world is left to wonder if they are as safe around their electronic servants as previously thought. Will Smith stars as Del Spooner, the robot-hating Chicago cop assigned to the murder investigation. Bridget Moynahan, Bruce Greenwood, James Cromwell, and Chi McBride also star.
Editorial Reviews
Product Details
- Release Date:
- 12/14/2004
- 0024543151906
- Original Release:
- 2004
- Rating:
- Source:
- 20th Century Fox
- Region Code:
- 1
- Presentation:
- [Wide Screen]
- Sound:
- [DTS 5.1-Channel Surround Sound, Dolby AC-3 Surround Sound]
- Time:
- 1:54:00
- Sales rank:
- 11,806
Special Features
Cast & Crew
|Will Smith
|Del Spooner
|Bridget Moynahan
|Dr. Susan Calvin
|Alan Tudyk
|Bruce Greenwood
|Lawrence Robertson
|Chi McBride
|Lt. John Bergin
|Shia LaBeouf
|James Cromwell
|Dr. Alfred Lansing
|Adrian Ricard
|Jerry Wasserman
|Fiona Hogan
|Peter Shinkoda
|Terry Chen
|David Haysom
|NS4 Robots
|Scott Heindl
|NS5 Robots
|Sharon Wilkins
|Craig March
|Kyanna Cox
|Darren Moore
|Homeless Man
|Aaron Douglas
|USR Attorney #1
|Shayla Dyson
|Laughing Girl
|Bobby Stewart
|Girl's Dad
|Nicola Crosbie
|TV Anchor Person
|Emily Tennant
|Young Girl
|Michael St. John Smith
|USR Attorney #2
|Travis Webster
|Guy With A Pie
|Roger Haskett
|Mob Man
|Tiffany Knight
|Mob Woman
|Angela Moore
|Ryan Zwick
|Farber Posse
|Essra Vischon
|Farber Posse
|Kenyan Lewis
|Farber Posse
|Aaron Joseph
|Farber Posse
|Simon Baker
|Farber Posse
|Marrett Green
|News Reporter
Technical Credits
|Alex Proyas
|Marco Beltrami
|Score Composer
|John Davis
|Topher Dow
|Simon Duggan
|Wyck Godfrey
|Akiva Goldsman
|William Hoy
|Andrew R. Jones
|Special Effects
|James Lassiter
|Executive Producer
|Richard Learoyd
|Laurence Mark
|Steven R. McGlothen
|Armen Minasian
|Anthony Romano
|Executive Producer
|Michel Shane
|Executive Producer
|Will Smith
|Executive Producer
|Patrick Tatopoulos
|Production Designer
|Jeff Vintar
|Original Story,Screenwriter
Scene Index
1. Opening Titles [:24]
2. Del Spooner [1:23]
3. Spoonerville [:06]
4. The Chase [1:36]
5. Police Station [2:48]
6. Dr. Laning's Hologram [1:38]
7. Lawrence Robertson [2:22]
8. Susan Calvin's Tour of USR [:43]
9. Sonny [1:08]
10. Factory Floor [3:23]
11. Caught [2:12]
12. The Interrogation [4:19]
13. The Cafe [:43]
14. Lanning's House [3:22]
15. The End of a Long Day [:45]
16. NS-5 Rollout [6:12]
17. Following Bread Crumbs [:10]
18. "You Are Experiencing a Car Accident" [2:40]
19. One on One [3:47]
20. The Cavalry Arrives [1:22]
21. Two Sons [:09]
22. Spooner's Past [4:44]
23. The Bike [2:57]
24. Sonny's Dream [3:08]
25. Robertson's Office [:46]
26. Shell Game [2:21]
27. Ghosts in the Machine [:11]
28. Father and Son [2:57]
29. Ambush [1:34]
30. NS-5s Come On-Line [1:01]
31. Robot Wars [:54]
32. The Back Door [5:53]
33. The Standoff [:21]
34. Viki Level [2:06]
35. Unauthorized Entry [1:40]
36. "Save Her!" [1:12]
37. Reconciliation [3:36]
38. Sonny's Future [1:44]
39. End Titles [1:35]
Initiate Movie
Set Up
Audio: English DTS
Audio: English 5.1 Dolby Digital
Audio: Spanish Dolby Surround
Audio: French Dolby Surround
Audio: Commentary By Director Alex Proyas and Screenwriter
Akiva Goldsman: On
Akiva Goldsman: Off
Subtitles: English
Subtitles: Spanish
Subtitles: None
Scene Locator
Unique Features
Commentary By Director Alex Proyas and Screenwriter Akiva Goldsman: On
Commentary By Director Alex Proyas and Screenwriter Akiva Goldsman: Off
The Making of I, Robot
Still Gallery
Trailer: Arrested Development
Inside Look
Customer Reviews
Average Review:
Most Helpful Customer Reviews
See all customer reviews
I, Robot, adapted and directed by Alex Proyas is a science fiction film based on Isaac Asimov's book I, Robot. The film is set in a seemingly not so distant future where robots assist and live to serve humans. The film follows main character, Detective Del Spooner played by Will Smith. Del Spooner is not very trusting or accepting of these robots in his society. He's a "robotophobic," someone afraid of robots. The film revolves around the idea of robots and and they interact in this futuristic society. A discussion that is becoming increasingly more apparent in our day and age. In the film, Del Spooner investigates the alleged suicide of a robot founder. He eventually ends up believing that a robot actually murdered him. This film deals with a certain reality that we discuss and write about often. The prospect that one day we might one day be overrun by technology and succumb to their artificial intelligence, which after all, might not be as artificial as we perceived it to be. Through it's use of visual effects the viewer can truly imagine a changing world where robots are becoming more and more powerful than humans. At the time the film was made it was nominated for Best Visual Effects during the 2005 Oscars. The film sets up three laws that if mean total chaos for the futuristic world. One of which is to not injure or murder human beings. One robot in the film, Sonny, is accused of doing exactly that. So, the issue arises: are the robots in the film truly there to help, or are they part of some bigger scheme. As for audience members watching the film, are we truly safe of not having the same thing happen to us? Technology is changing at an exponential rate. Soon, Asimov's science fiction will become a reality. As time goes on I, Robot becomes increasingly more and more realistic and accurate.
good movie
"IRobot" is a movie made by Alex Proyas. Even if you don't like science fiction you will enjoy the adventures of Del Spooner. The movie is in the future where robots work for human thinks they have control over the machines, except one cop, who doesn't trust anyone, especially robots. The movie is about a guy who is a police man, and he really hates robots. He lives in a future looking place with flying cars, and big buildings. He thinks that robots are bad but there just programed to work. When all the robots in the city were replaced with new ones, apparently the new robots turned to be bad, and they start attacking people. The only way to stop them is to destroy the mother board which is controlling the new robots. He gets through all the robots and was to inject a virus into the mother board is all the way down one handed, and while going down his skin rips. His hand turns out to be a robot. Well he gets to the main floor and injects the virus in. all the robots turned good again, but the new ones got put away and the old ones were back. In conclusion "IRobot" was one of the best movies I have seen. It really makes you think about the future, the control we have over computers, or how easy it is to fool humans. We as humans should always be alert and not become lazy.
Saw I-Robot 2x in the theatre and highly recommend it. It is alittle long in spots but that is easily forgiven with all the special effects and story line. The ending was a shock and left you really wondering "what happens now???" Will Smith was his usual funny self, and Sonny will steal your heart. The whole premise makes you wonder and worry about the future, this movie may not be too far fetched. And maybe it was just me, but I actually felt badly for all the older model robots. The special effects rocked...I can't wait to buy this DVD!!
I came to this flick expecting the standard TERMINATOR knock-off and was very pleasantly surprised. Sure, it has plenty of action. But it leaves the viewer with something to think -- and talk -- about. At its core, the film is about ideas.
Will Smith plays his role as a police detective with a grudge against the cold metal creations of man called robots. A good story that pulls on the fear of losing control of the world and our freedoms to artificial intelligence. great acting, great story, touching and emotional film. one of will smiths best.
this is my fav movie of all time. i saw it 3 times in the theaters, so i cant wait 2 get the dvd. the plot is great, and will keep you guessing till the end, and the special effects are phenomenal.
i saw this movie with my brother and cousins. and i must say... this movie is Amazing! i absolutely loved it. i recommend this movie to anyone. if you love sci-fic, this movie is definentally for you!
You take the name of a great book written by a great author (but no real context of it) for the nerds, Will Smith for the (women?), swirl around some CG action and what do you get? Something bad, utter disappointingly (although not surprisingly) bad. The acting was stiff, the dialogue was laughable at best (except for Smith's stupid pun jokes) and the computer graphics look like they were done in the mid '90s. For anyone wanting something worth while, read the book. There is nothing worth seeing here.
Set in 2035-it is very realistics. The special effects are amazing (even Will Smith said that). It can be hard to follow at times, but if you watch it a 2nd time you should understand it better. Like 'The Day After Tomorrow' it could come true!
Fantastic movie! Very creative and touching morals. However, it would be more thrilling and interesting if there is a continuation to the movie. Please pardon, but here is a short version that could help for the "next i,robot": Spooner, Sonny, the beautiful doctor, and all the residents are happy and releived from being imprisoned by destructive, intelligent robots. But are they? As the people of the technological world return to their daily livihood, prof. Lanning's program (sorry I can't recall the program's name-but it's a female's) secretly conducts herself a new amry of robots in a subsidiary base of the desserted robot-manufacturing niche. From there, her troops prepare for another strike of "human-protection" as they roam around the city in disguise. Little by little, "normal" robots disappear and people begin to feel unsecure and refrained to move freely around their homes. It will not be long before Will and Sonny realize what is happening and to take on a mission to locate the she-program to end all madness, whom barely survived Spooner's virus detonation through immediate transfer to the base unknown (and highly-guarded by robots) by man-kind.
I, Robot is in every sense of the word a GREAT movie! It has that mixture of comedy, mystery and of course action. You keep wondering what will happen next (in the movie and real life) and you can even feel bad for the bad guys. I loved it. Reccomended to all!
But this is a good movie, regardless. The FX were very cool.


text:
Headset Allows Firefighters To See Beyond Smoke
Golden-i is a head-mounted computer that contains a camera, GPS, micro-display, speech recognition, and gesture control.
The Golden-i headset looks similar to Google Glass but is meant to help firefighters and other first responders assess emergency situations. The device contains a camera, GPS, micro-display, speech recognition, and gesture control.
Verizon partnered with Kopin to develop technology that could lead to faster response, better performance, and increased safety. Golden-i is a wireless, lightweight, head-mounted computer that revolutionizes the way users interact with their virtually-enhanced surroundings. Voice and head gesture sensor controls enable hands-free access to a full computing experience.
With live video and infrared capabilities, firefighters can use heat profiles to find survivors or distressed team members faster while staying better connected to their support staff. Tactical commanders can monitor firefighters' biometrics, such as heart rate and oxygen levels, and responders can view digital building schematics for faster recognition of exits and egress points. Firefighters can see maps and floor plans on the high-resolution display, and use Golden-i's location-aware features to find their way around dark and/or smoky environments.
CNET notes that the headset also allows users to capture images or video, and the noise-cancelling microphone works with built-in speech recognition to enable them to control the software or speak with other members of their team. You can check out the video below:


text:
After that, things really took off: paltrow introduced Anderson to her good friend Madonna.
And this—hard as we strain not to admit it—is what paltrow told her audience.
In a way, paltrow has already anticipated the skepticism on the site.
In a now-infamous impromptu speech, paltrow told a tech conference… well, something about online hate and real-life war.
paltrow, the activist from National Advocates for Pregnant Women, charges that the pro-life movement is "at odds with itself."
paltrow and Theron, two of the most stunningly beautiful actresses in Hollywood, seem to enjoy doing things in pairs.
But while Ms. paltrow may not have been there in person, she was certainly there in spirit.
Kid Rock enlisted Bob Seger; Rucker had Brad Paisley; paltrow had Vince Gill.
"It was like a performance," paltrow told an ITN reporter during the Two Lovers junket.
A spokeswoman for paltrow has said, "Two-piece bathing suits have been worn by young girls for decades."


text:
CCTS publishes its 2013-14 Annual Report.
2013-2014 Annual Report released – First Year-over-Year decline in seven year history
Ottawa – November 4, 2014 – Commissioner Howard Maker is "cautiously optimistic" that the first
year-over-year decline in consumer complaints is a result of CCTS' efforts to drive positive change in the Canadian telecommunications complaints environment, as well as overall improvements in customer service on the part of providers. "Many of our participating service providers are making efforts to do better – in the way they provide their services to their customers and the way they work with customers when things go wrong."
Although there was a decline in the total number of complaints received, the number of complaints related to non-disclosure and misleading contract terms and conditions increased by 74% from last year. "Many customers felt that they had not received all the necessary information regarding the price and services included in their plan and which services would incur additional fees" said Maker. "Properly informing customers of the necessary information relating to their services needs to become a top priority for the industry. That being said, customers still need to be vigilant about reviewing the terms and conditions of their agreements."
The Annual Report also contains CCTS' first report on its administration of the CRTC's Wireless Code (TWC). "In light of the short period in which the code has been in effect, this year's report offers limited insight into its impact," said Maker. "As can be expected with any new code, interesting and unexpected situations have raised issues of applicability and interpretation. Despite these challenges, CCTS is committed to its administration and hopes that future reports of this type will help inform the enhancement of the Code."
The seventh CCTS Annual Report "Driving Positive Change" can be downloaded here.
About the Commissioner for Complaints for Telecommunications Services (CCTS)
CCTS is an independent organization dedicated to working with consumer and small business customers and participating Canadian telecommunication service providers to resolve complaints relating to most deregulated retail telecommunications services. Since July 2007, CCTS has provided consumers with an independent mechanism for the resolution of complaints about deregulated local and long distance telephone services, as well as wireless service and internet access. This includes billing errors, compliance with contract terms and commitments, service delivery, credit management and collections issues. www.ccts-cprst.ca.
To schedule an interview with the Commissioner or for more information, please contact:
April Gibson at Thornley Fallis Communications for CCTS
416-515-7517 ext. 323 or firstname.lastname@example.com.


text:
Excellence for Every Child
Please remember to send warm clothes with your child during the winter months. We will go outside as long as the temperature is abouve 32 degrees. It may be necessary to send a hat, gloves, scarf, etc.
Remember, breakfast and lunch are free of charge for all students at Fort Sanders! We eat "family style" where students practice passing bowls and interacting with each other. Breakfast and lunch are an important part of our instructional day!


text:
Sharon George Ina Hall, 78, of Clendenin, went home to be with the Lord on Tuesday, Aug. 12, 2014 at Braxton County Memorial Hospital, Gassaway, after a short illness.
She was a beloved mother, grandmother and great-grandmother. Sharon attended Falling Rock Gospel Tabernacle, Falling Rock. She loved her favorite dog, Lady.
Sharon was the daughter of the late George Edward Jordan and Ruth Harlow Jordan. She was also preceded in death by her husband, Earl Hall Sr., and sister, Jackie Bayless.
Sharon is survived by her sons, Earl Hall Jr. (Tammy) of Milton, Warren Hall (Brenda) of Corton and Mike Hall Sr. (Debra) of Clendenin; daughters, Cindy Woods (Traci) of Cross Lanes, Lindy Carper (Mike) of Clay and Sug Sams (Danny) of Clendenin, where Sharon made her home; sister, Gerry Howell of Michigan; grandchildren, Bobby, Chris, Steven, Toni, Jeremiah, Brandon, Amanda, Mike Jr., Sam, Stephanie, Stacey, Gavin, Erik, Jasmine, Felicia and Danielle; and great-grandchildren, Gracey, Haley, Kyra, Lindsay, Gracie, Makayla, Hannah, Easton, Dakotah and Alex.
Sharon's funeral service will be 1 p.m. Friday, Aug. 15, at Matics Funeral Home, Clendenin, with Pastor Keith Monday officiating. Burial will be at King-Mullins Cemetery, Bomont.
Her family will receive friends from 6 to 8 p.m. Thursday at the funeral home. Condolences may be expressed online at www.maticsfuneralhome.com.


text:
79 Suburban Ball Joint change Help!!!
This is going to be my first attempt at a ball joint change. The Upper ball joint broke the other night on my drive home from work. took it to a garage, they tried to Rob me blind, so now I am going to do it in my snowy (canadian) driveway. Its going to be done saterday and I want to be smooth and prepared !!! (for a change)
Rivet/bolt removal? (do I need Air tools?)
Helpful Hints?
One of my buddies said I may need a ball joint presser?
Take a angle grinder and grind down the top part of the rivet. Be careful remember safety first. Once you remove all of the rivet material ONLY!take something to punch them out. Big phillips screw driver and a big hammer. Then the replacements should have nuts and bolts to bolt them in. Good luck!
There's more to it than just removing the old ball joint and replacing with a new one. In addition, if the top ball joints are bad, more than likely, the lower ones also need replacing. It's admirable that you're willing to do this repair in your driveway especially in the cold snowy weather. It'll take you several hours.. provided that you have the proper tools, to replace the ball joint. Best advice I can give you is to get a Haynes Repair Manual and read the procedure and list the special tools you'll need.
I don't want to discourage you, but you need to be aware of the task you're about to undertake. Good luck.
|All times are GMT -6. The time now is 08:18 PM.
Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2017, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO 3.6.0 PL2
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.
Copyright Hotrodders.com 1999 - 2012. All Rights Reserved.


text:
The Alphabet Collection
Liberty London packs big impact into pint-sized proportions with the new mini Marlborough tote
Here Comes the Summer
Le Labo
One of the Liberty London fragrance hall greats, Le Labo's Santal 33 eau de parfum is an iconic scent that maintains its exceptional power to stand out in a crowd.
Miu Miu
A sleek and sophisticated alternative to the brand's usually oversized eyewear, these Miu Miu sunglasses display a unique yet remarkably flattering silhouette.
Bumble and Bumble
Surf Spray 120ml from the Bumble and Bumble collection.
Developed by The Telegraph's beauty editor Kate Shapland, the Legology Air-Lite cream uses a pioneering contouring and lightening formula
Vintner's Daughter
Coined "the face oil to end all face oils", the miracle Active Botanical Serum from Vintners Daughter is undoubtedly the most coveted product of the season; the ultimate beauty investment.
Omorovicza Glam Glow is a luxury self-tanning lotion for face and body which imparts a gorgeous natural-looking glow.
Capture the most current look with these updated aviators from Illesteva.
Eugenia Kim
Made from vented hemp, Eugenia Kim's 'Courtney' hat has a wide, structured brim to shield you from the sun. It's finished with flamboyant rainbow coloured feathers to complement a variety of summer outfits.
Escentric Molecules
Escentric Molecules Molecule 01 consists of one single ingredient, which is known as Iso E Super in the fragrance industry.
For those who take an ethical stance on accessorising, this TRUSS tote bag is a beautifully unique and on-trend option.
Finish your make up routine with this Hourglass Ambient Lighting Palette, the perfect way to create flawless skin in an instant.
The luxurious natural plant oils that Votary is known for have been expertly blended with a unique oil-soluble form of Retinoid to create Voltary Intense Night Oil.
These Relevee eyelash curlers effectively curl to create the illusion of length. The innovative ergonomic design requires less pressure on the lashes.
Instantly adding fullness and body to hair Davines Sea Salt Spray gives an effortless matte finish.
Karen Walker
Striking and unique, these Karen Walker Felipe sunglasses will define your outfit in a single swoop.
A fresh way to wear your signature scent, this hair perfume is fragranced with Byredo's iconic Black Saffron - a dark, dry composition born aloft by the delicate transparency of cristal rose.
Self Tanning Hydrating Facial Skin Care 60ml from the Sisley collection.
Le Labo
Le Labo Rose 31 is a gorgeous unisex scent based around the famous Grasse Rose.


text:
Entertainment Report 5/7/13
Mariah Carey is debuts her new single "Beautiful"
Her new single features a special guest, her 2 year old daughter singing on the new track. She will also be performing the new single on American Idol this week.
Nick Cannon Defends Mariah
Nick Cannon was on The Talk yesterday talking about the ongoing fight between his wife and Nicki Manaj. He was saying that he feel the fight is being fueled by the network and it is hard to watch.
Dancing with the Stars Uproar
There was an uproar over Kellie Pickler's performance that had judge Len Goodman all rilled up. He along with Bruno and Kerri-Ann were screaming about how Len was wrong and the crowd was booing.
To hear the rest of the Entertainment Report CLICK HERE


text:
Volume + Breast Augmentation Q&A
Will Chest Exercise Increase Post Operative Breast Augmentation Pain?
I'm working out regularly in the gym so my chest muscle are tight although my skin is loose and breast have lost volume and saggy after having baby. I... READ MORE
I Have Natural 30E Breasts How Much Can I Add Without the Implant Being Visible?
I have natural 30E breasts. I want to add volume to them. However I don't want the implant to be visible when I'm bouncing around during intercourse;... READ MORE
Considering Autologous Fat Transfer from Liposuction for Breast Augmentation. Is it really an effective, long-term solution?
A recent study (Choi et al., 2013) compared volume of fat retained at various time points as measured by 3-D imaging. Results showed only 52.3%... READ MORE
Breast Augmentation Jan 2014. Tugging/pulling sensation with no bra on. Have my breast bottomed out? (photos)
Naturelle silicone 304 cc. mod profile, under muscle. I have no upper pole volume since 2 months post op. Had breast reduction 25 years ago. Dr used... READ MORE
Is Adifyline effective in increasing fatty tissue volume where applied in a serum?
I am an androgynous male using a breast serum called Sublime Bust. It is made primarily of Pueraria Mirifica (white), a powerful phytoestrogen, and... READ MORE
What is a Large Volume, but Low Projection Breast Implant Going to Do for Me? (photo)
I have a very broad chest with a bwd of 17cm. I am trying to decide what size implants to go with and I am confused as to the volume because at some... READ MORE
Will my breast gain volume once my implants "drop"? 13 days post.
Pre Op: 5'9 ... 135 pounds... 34B 380CC SALINE HIGH PROFILE Just tried on a 36D- I'm NOT FILLING IT OUT.... My surgeon said my implants are "high" at... READ MORE
How to increase volume on my breast without implants (Photo)
I recently lost 50lbs and am now at my ideal weight and toning my body. The loss of weight took away the fullness of my breast, very depressing. They... READ MORE
Will I Lose a Lot of Volume Once Swelling Reduces?
I am exactly two weeks post augmentation today. I will be 41yrs in May and am 5'6" and 115 lbs. I was a 34B cup and wanted a D. My... READ MORE
I'm 5'8 and 150 lbs with 36D extremely saggy breasts. I would like a lift/implant. What cc's would you recommend?
NOT a reduction. I do NOT want to be bigger. I love the way I look right now in clothes with a bra but when I take off the bra, they sag badly and I... READ MORE
I'm 5'9, 150 - 160 lbs and wear a 34C with no volume. Is 475cc or 500cc too big or too small to achieve a D/DD cup?
I have my consultation for my BA shortly and i want an idea of what size implants to get. I am 5'9 and my weight fluctuates between 150-160. After... READ MORE
I want a Breast Augmentation without a lift. Are my breast too saggy? (photos)
I want a augmentation for my breast. I want more volume and form. I don't want the implant top sag. Am I a good candidate for augmentation? READ MORE
Do I Need a Lift with Augmentation? (photo)
I would like to have a smaller nipple with more volume. What is the proper procedure for me? READ MORE
I've lost a lot of weight and have stretch marks on my breasts. Are they saggy? Are there any non-surgical solutions? (Photo)
I lost a lot of weight and hence got stretch marks on my breasts. Their volume has decreased too. Are they normal or I need to have them corrected? Is... READ MORE
What is the reasoning behind my implants being so low? Why is the center of my chest FLAT with NO volume/definition? (photo)
I know I had wider set breast to begin with so im wondering is this just me? Or possibly a mistake by my surgeon? I can lay my hand flat between both... READ MORE
I want to increase the size and volume of my breast. Would you recommend Breast lift with implants or just implants? (photos)
I want to get a breast augmentation to increase size and volume but I am also concerned that my stretch marks will look a lot worse. They are so high... READ MORE
20 year old seeking opinion about tuberous breasts and implant size? (photos)
My breasts have always been small, but I've also always felt that they never quite looked round enough, either. I am planning on getting an... READ MORE
I have mild ptosis due to weight loss. Will breast augmentation correct the mild ptosis?
I am 20 years old and I have mild ptosis due to weight loss. I am currently a 34 D. I am looking to increase volume to my breast. Will breast... READ MORE
What size I will be if I'll have 100, 120 and 140 cc round implants moderate projection? (Photo)
I cannot decide, I want to have full A size, just a little bit volume in my breast. My surgeon propose to put 140cc width 9.5 cm and projection 3 cm,... READ MORE
Is "roundness" of the upper pole more a result of the volume of the implant or the projection?
Some doctors say high profile implants give more upper pole fullness and a more "fake" look. Doesn't volume factor in as much as profile when it comes... READ MORE


text:
Voice / Fax (631)369-9708
Riverhead, Long Island, New York
Suffolk OnLIne Advertising is an internet advertising resource specializing in professional Web Site design, hosting and search engine placement on the World Wide Web. We compose and advertise Web Sites that are geared towards promoting your company with highly visual effects at a fraction of the cost of any other advertising media.
Online advertising provides an effective way of increasing exposure by using your online Web address to compliment your present means of advertising. By using your Web address in a newspaper ad for example, the reader has the option of visiting your pages online which can yield significantly more information than would be cost effective to place in a newspaper or magazine. It will show that your business is on the cutting edge of technology that is the future in advertising.
The cost of a Web presentation can vary significantly depending on sophistication, and graphic image content. We do not have a one price fits all, since our custom designs range in size from small business to municipalities.
Browse through our Web Site - Long Island East and call or e-mail us. We can meet with you at your business to discuss a custom page design.
We will make every effort to keep our pricing in focus regarding site design and changes to page content so that we can maintain a pricing structure that is at this time, the most aggressive in the business.


text:
The Fresh Produce Association of the Americas and its members help to ensure North America's uninterrupted access to fresh, high-quality, healthy and delicious Mexican-grown fruits and vegetables.
In 1905, the first rail car carrying fresh produce from Mexico crossed the border at Nogales, Arizona. Today, Mexico has become the top supplier of fresh fruits and vegetables for the United States - and the FPAA is the leading agent of produce trade at the U.S.-Mexico border and across the country.
Founded in Nogales, Arizona, in 1944, the Fresh Produce Association of the Americas has grown to become one of the most influential agricultural groups in the United States. Today, the FPAA provides a powerful voice for improvement and sustainability, serving the needs of more than 100 North American companies involved in the growth, harvest, marketing, import, and distribution of Mexican produce.
Our efforts, combined with the support of our members, yield positive results. We initiated and support major changes that benefit the industry of produce trade across the Mexican border.
Recently we have:
- Provided members with education on best practices in social responsibility
- Saved importers nearly $1 billion by spearheading an effort that eliminated high duties on Mexican tomatoes
- Negotiated government protocols that ensured the continued importation of safe Mexican produce in the United States following the discovery of medflies in Tijuana
- Rallied legislative support to help refurbish and expand the ports of entry serving our industry and to reduce traffic congestion near the Rio Rico Industrial Park in Nogales, Arizona.
You can view a full copy of the FPAA's most recent Annual Report by clicking here.


text:
Generally either a Glock, Smith and Wesson M&P, or Springfield XD, in 9mm, .40, or .45 is a good choice to start carrying. The best way to know which one is best for you is too shoot them and see what you are comfortable with. 9mm is acceptable for carry, especially with decent hollowpoints.
How much are you looking to spend on your endeavors? Make sure you add some training in there too.
And welcome aboard


text: Skin TestsWhat are skin tests?Skin tests may be done to diagnose skin allergies, food allergies, bacterial or fungal skin infections, and other diseases. Skin tests are also done to tell the difference between cancer (malignant) cells and noncancer (benign) growths.What are the most common skin tests?Allergy Testing. Skin tests for allergies include:Patch testing. Patch tests are used to help diagnose skin allergies leading to contact dermatitis. Possible allergens are applied to the skin (usually the back) with adhesive patches. They are left for a period of time, usually 2 days. The skin is then checked for any reaction 2 to 4 days later.Prick tests. Allergens are applied to the skin. The skin is pricked so the allergen goes under the skin's surface.Intradermal tests. A small amount of allergen is injected into the skin with a needle. Skin biopsy. This test is used to diagnose skin cancer or skin disorders. A skin sample is removed and checked in a lab. Local anesthesia is injected to numb the area first. The sample may then be removed with a scalpel. For a shave biopsy, the skin sample may be removed with a razor blade. The sample is removed with a special tool (cylindrical punch) for a punch biopsy. Culture. Skin, hair, or nails may be cultured to find bacteria, fungi, or viruses. Health Encyclopedia A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Search Health Library


text:
Fridays with Vico
The Fridays with Vico webinars are a free, educational series geared at general contractors and owners. Our topics range from BIM trends, to case studies and best practices, to new concepts for the industry.
Winning with BIM Strategies in a Hard Bid
Vico Services, the professional BIM consulting services side of Vico Software, is rolling out a four-part webinar series specifically for General Contractors: Mastering the Hard Bid with BIM. The series will explore the advantages of 4D scheduling, 5D cost planning, constructability and coordination, and the knowledge base that ties cost and time to the geometry.
In a hard bid scenario it's the lowest bid that wins. The Owner surely is getting a great price from the bidders: a price that can be as much as 30% below projected cost. But experienced Owners know that these hard bids come with hidden costs including change orders, delays, and claims that end up costing them additional money. But even if those extra charges were to add 20% to the cost of the winning hard bid the owner has still realized a 10% saving over the original projected cost.
Vico Services, with other 350 successful 5D BIM projects around the world, has developed specific strategies for winning business in a hard bid world. The four-part webinar series will examine scheduling, estimating, and coordination strategies that can effectively set your company apart from the other bidders.
This webinar series is for you and your firm if:
|Hard bids have become the de facto bidding process in your market;
|You want to develop hard bid strategies quickly, but might not have time to develop a BIM;
|You know you'll discover change orders during the project, but you want to find them sooner;
|You understand that construction-caliber quantities drive a more precise schedule and estimate - you just haven't seen it in action;
|You want to protect your fee and believe that 4D and 5D BIM done right will mitigate project risk.
Part 1. Mastering the Schedule to Mitigate Risk and Keep Your Profit
In an environment where there are smaller projects with plenty of bidders under a hard bid edict, it's imperative that you remain competitive on your fees and general conditions. How so? At-risk General Conditions are typically 7-11% and getting skinnier in this economy. In a hard bid, if your schedule extends even just one month, you're bound to pay the whole expense. And that expense knocks up against the 7-11%.
How can General Contractors master the schedule, even in hard bid conditions? In this special Fridays with Vico webinar, we'll demonstrate how Vico Control can help you bid a shorter schedule, as well as manage and meet that tighter schedule. Vico Control also allows you to vet the credibility of the bids from subs with whom you'll be sharing the risk. The software and methodology gives you a much clearer, farther-forward-look at the project so you and your team can make adjustments earlier. In addition, you also gain the ability to do what-if scenarios and strategize how you will bid the job: you'll better understand how to attack the project and prepare a more competitive price based on schedule control.
It's counter-intuitive to think that a tighter schedule mitigates risk. But you haven't seen Vico Control, our quantities-driven, location-based, and resource-balanced scheduling solution.
Part 2. Mastering 5D Cost Planning for a Hard Bid Project.
In this webinar, we'll examine the difference that construction-caliber quantities bring to the cost plan and schedule. Cost planning allows you to build multiple iterations of the estimate linked to the model progression specification so that every change can be costed, not only in terms of dollar value but also schedule flux.
We'll demonstrate how you can calculate the cost of the project a a very high level of detail for the parts that are high risk, and leave it at a lower level of detail for those parts that you are subbing out. We'll also show how to use the model's visual feedback to determine whether you included everything in your cost plan. If an area or element is not highlighted, it's not in the cost plan!
We'll also demonstrate Cost Planner's markup feature that allows GCs to quickly define and refine profit margins on line items. And the Add-On feature allows you to add non-direct cost margins such as contingency, bonding, and insurance. Finally, you can communicate the calculated price to management, showing how the bid was developed from the baseline cost plan. This tactic is also useful if the owner allows an open book proposal.
Part 3. Mastering 3D and 4D Constructability for a Hard Bid Project.
It's easy to think that you're done with BIM after you've run a clash detection. But in actuality, the true BIM has just begun. Not only do you need to organize objects in space, but you also have to organize the project timeline. These RFIs turn into Change Orders which greatly impact the duration and cost of your project. We'll illustrate how to best manage the coordination process to iron out constructability and scheduling issues earlier rather than later.
Part 4. The BIM Knowledge Base of Cost and Time Elements.
There's a growing database of construction elements for BIM models, but did you know that best practices illustrate that you should also have a BIM database of cost and time elements? This knowledge base permits you to build resource-loaded schedules and cost-loaded estimates. But the question remains: Do you build it or buy it?
In the end, it's all about building trust with the Owner by working in concert, adding value every step of the way. Doing it right the first time yields untold value. Using BIM even in hard-bid situations permits and even encourages this collaborative approach. Let's work with the hand we've been dealt and make it win.
The Vico Blogs contain more information on hard bids. Please review the following posts for more insight:
Hard Bids - Back to the Future Construction-Style
Reduce Project Risk with Location-Based Schedules
Location-Based Scheduling from the Owner's Point of View
Why a 4D Schedule Must Be More than a Movie
Learn from your peers with your peers at Fridays with Vico.
|System Requirements
PC-based attendees:
Windows® 2000, XP Home, XP Pro, 2003 Server, Vista
|Macintosh®-based attendees:
Mac OS® X 10.4 (Tiger®) or newer


text:
Canadian Stocks Fail to Find Direction
Canadian stocks closed mixed in directionless trading. The TSE 300 fell 34.17 to 9287.70 after falling 26.49 Wednesday. The S&P/TSE 60 fell 3.46 to 551.38. Breadth was 781-471 positive. Shares in financial services, oil and gas, gold and precious minerals, and metals and minerals outperformed the industrial products, utilities, and consumer products sectors. Government of Canada bonds remained firmer after rallying Wednesday on the U.S. Federal Reserve Bank's 50-basis point rate cut. The March Canadian dollar settled higher at 66.95 cents against the U.S. dollar. March crude oil settled up $1.16 at $29.82. February gold settled up $2.90 at $268.50.
The benchmark Nikkei 225 closed 0.5% lower at 13,780. That's down a hefty 29% year-on-year. The broader TOPIX eased 0.1% to 1,299 while the yield on the benchmark 10-year JGB followed the equity market south, dipping one basis point to 1.485%. Doubts over the feasibility of the slew of stock-boosting measures announced Wednesday continued to keep crucial foreign investors at bay, as did mounting pessimism over the health of corporate Japan following an S&P report that warned of more credit defaults by Japanese companies this year.
The Financial Times-Stock Exchange 100 index, which lost 37 points Wednesday, finished Thursday's session with a loss of 45.70 points (-0.73%) to close at 6251.80. The biggest contributors to the decline in the FTSE were Vodafone (VOD ) and banks. Vodafone is suffering from fears of slower growth in wireless telephones.
In Germany, the DAX Index, which rose 56 points Wednesday, fell 74 to 6721 following a EuroZone Q3 growth estimate, which was lowered to 0.6% from 0.7%. Also, polls show that a majority of German states oppose the government's pension reform plans. Bonds rose a bit higher, with the 10-year yield down to 4.78% from 4.79% Wednesday; there was little reaction to the Fed's rate cut Wednesday. The euro is higher against the dollar. In Paris, the CAC 40, which rose 81 points Wednesday, fell 108 to 5890 as French PMI slipped to 52.7 in January from 52.9 in December. Bonds climbed slightly, with the 10-year yield down to 4.92% from 4.93% Wednesday.


text:
pendev brauchte ein neues Logo Design und hat einen Wettbewerb auf 99designs gestartet.
Aus 144 Designs von 43 Designern wurde eine Gewinner gewählt.
Worddissection.com is going to be a free website with educational tools and teaching materials to help students dissect words into their meanings. For example, biology is dissected into "bio" (life) and "ology" (the study of).
Students in High School and College as well as English professors and teachers
Should be crisp, clean, legible design. We'd like to incorporate either the color purple or light greens into the logo. Logo should state the name "worddissection.com" somewhere in the logo.


text:
Printable View
I am almost ALL highway.
Most of the guys I know are getting 20 on the highway. Of course, I am sure it's because they can't keep their foot out of it. After filling up and resetting, I usually get 28 from the gas station to my office. But, by the time I complete my round trip it's usually down to 24. Been more like the 22-23 lately with extreme cold.
Drove my wife's '12 SRX (3.6L 6AT) to Sandusky, OH and back this past week. This was my first opportunity to see what it could get. Got 24.2 MPG at a steady 68 MPH over about 200 miles. Though we consisted of two adults and two kids plus all the luggage that would fit, I realize weight is not a big factor at constant speeds, but I had hoped for it to do better. Not sure what the Cd is on it, but it's gotta be > 0.30.
So, now that I think about it, maybe 30 MPG in a TT3.6 ATS-V is a bit optimistic afterall.
Here's a thread in gminsidenews about the TT3.6 plausibly putting out "in excess of 400" hp and is the probable engine for the ATS-V:
One poster predicted a TT3.6 making 425-480 hp. Works for me.
Well, with 3400-3500lbs, a more aerodynamic body and more advanced technology, I would think 30mpg would be doable.Quote:
Originally Posted by M5eater
My V1 with 3850lbs, an unaerodynamic body and a V8 would get 26mpg all day long on the highway...
Tailoring the turbo to get the best compromise between lag and top-end performance is another, related aspect.
I still question the longevity of these highly boosted motors. Randy, aren't you worried what the maggie will do to your internals over the long run?
Your LS6's internals, I mean :D
There's no question that if average cylinder pressures run high due to high throttle openings and times of boost over the life of the motor, it would put increased stress on wrist pin bearings, on rod bearings, on piston skirts and rings, and probably on main bearings. In my case, I really don't spend a lot of time at boost conditions, so I don't really feel my motor is detrimentally affected especially with good oil pressure and fresh Mobil 1 in it all the time.
In another example, if you look at guys like ronr who has 70k maggied miles on his LS6 and drives more frequently while under boost conditions (i.e. "spirited") than I do, that might be something to look at. But, I'd bet his motor goes close to 200k miles before he needs a rebuild, but that's because it's a proven LS motor design. We're talking here about a 3.6L V6 that's almost exclusively found in passenger cars, and I'd be concerned that there is less known about this design under severe operating conditions than LS motors in general. I would hope that GM has flogged the piss out of this motor and has addressed any weak points in it before sending it out into the public with a couple of turbos slapped on it to be flogged by all of us.
Anybody follow common issues with the 3.6 motor? I have not myself, so I'm all ears.
Looking in the 2nd gen CTS forums, there are not many complaints about the engine, other than the premature timing chain wear problem.
Not to change the subject but speaking of the timing chain/belt (whatever is in there) situation. My brother in law has 10,000 miles on his 2008 or 2009 CTS sedan and at a recent service noticed that Cadillac adjusted something to do with, I believe timing, and mentioned something about the belt/chain on the invoice - and the car had been noticeably slower since. Has GM "fixed" this potential issue by making the car weaker? Is there already a discussion going on in reference to this?Quote:
Originally Posted by JimmyH


text:
Ideal Weight + Breast Augmentation Q&A
How Much Weight Should You Lose After Breast Augmentation Before It Affects the Appearance
I am 5'3 and currently 142 pounds which is the heaviest I've ever been. Prior to augmentation I was 130 pounds. I would like to get to 125 I... READ MORE
I'm 5'6 and 140 lbs. but I'd like to lose 10 more. Do I really need to be at my IDEAL weight before my Breast Augmentation?
I am 5'6 and 140 lbs so Im not overweight, however, I have lost about 20 lbs so far and would like to lose 10 more to be at my ideal long-term weight.... READ MORE
A Little Overweight (5 Maybe 10lbs ) and I Want to Breast Augmentation Done and Possibly a Tummy Tuck, Do I Have to Wait?
At my heaviest I was 275lbs,4 years ago. I'm 29 years old, weigh about 150, and have had 3 c-sections. I'm sure I want breast implants and... READ MORE
What would be an ideal weight for Breast augmentation?
I weigh 150lbs and my height is 5'1". I have been wanting breast augmentation for years. I want know what would be an ideal weight for the surgery? READ MORE
What's the ideal weight for a breast augmentation?
I'm 5'8 and I weight 275. I'm in the process of losing weight and so far I have lost 10 pounds. My goal is to be 200 lbs by October 2017. What is the... READ MORE


text:
Exterior dúplex, refurnished and fully equiped. The living room with american kitchen is downstairs, with balcony on the same floor. The kitchen is fully equiped for daily use. The principal room is upstairs, with bathroom. The apartment is good redistributed and equiped with everything you will need to enjoy your stay.
Parking option: 100€/month.
Area of Plaça Europa has very good and quiet ambient. There is Departure Store with all international shops. The best comunicated with Airport, only 10minutes.
Availability upon agreement. The offer is subject to change of price or withdrawal without previous notice. The exposed dada including the dimensions are merely illustrative. In order to confirm the dimensions and juridical circumstances of the lease agreement the Agency recommends to consult an independent competent professional.
The listed price does not include the taxes and costs. Corresponds to the tenant of the housing the payment of the following taxes and costs: (i) the Property Transfer Tax (ITP); (ii) notary and registry tariff if the contract is registered in a public document and registered; (iii) the Agency's fees. For the rest of the information demanded by state and autonomous government regulations, please get in touch with the Agency.


text: I felt like crying when I read this, which I find very hard to do as for many years now I have felt emotionally drained and all cried out. I find my children are sunshine in my life and I take great solace from the fact that I have managed to break a cycle of abuse with them that seems to have run in our family for several generations. On a related note I remember the historian Dan Carlin observing that historically in many societies it was common to treat children in a way that with our relatively recent perspective would be seen as abusive. Thank you again for your open sharing!


text:
- About this Journal ·
- Abstracting and Indexing ·
- Aims and Scope ·
- Annual Issues ·
- Article Processing Charges ·
- Articles in Press ·
- Author Guidelines ·
- Bibliographic Information ·
- Citations to this Journal ·
- Contact Information ·
- Editorial Board ·
- Editorial Workflow ·
- Free eTOC Alerts ·
- Publication Ethics ·
- Reviewers Acknowledgment ·
- Submit a Manuscript ·
- Subscription Information ·
- Table of Contents
Gastroenterology Research and Practice
Volume 2012 (2012), Article ID 860879, 5 pages
The Endoscopic Management of Pain in Chronic Pancreatitis
Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
Received 3 October 2011; Revised 26 January 2012; Accepted 10 February 2012
Academic Editor: Carlos G. Micames
Copyright © 2012 Adam J. Goodman and Frank G. Gress. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pain resulting from chronic pancreatitis is often debilitating and difficult to manage. Many approaches have been used to treat these patients, including narcotic analgesia, antidepressants, pancreatic enzymes, octreotide, denervation procedures, such as celiac plexus block, and various palliative, decompression, or drainage procedures. Many of these procedures can be performed endoscopically, while others require a more invasive, surgical approach. The effectiveness of these therapies is not only highly variable but also often controversial. This review will discuss the endoscopic options for pain management in patients with chronic pancreatitis and their utility in treating this difficult disease.
1. Introduction
Pain resulting from chronic pancreatitis is often difficult to manage. Many approaches have been used to treat these patients, including narcotic analgesia, antidepressants, pancreatic enzymes, octreotide, denervation procedures (most commonly CPB), and various palliative, decompression, or drainage procedures [1–13]. The effectiveness of these therapies is not only highly variable but also often controversial. Opioid analgesics are probably used most often and can treat pain effectively, but they are associated with numerous side effects, including constipation, delirium, nausea, and the potential for addiction in patients with chronic pancreatitis [14, 15]. Nonpharmacologic methods of pain control may improve quality of life and minimize drug-related side effects [14]. Endoscopic management of pain in chronic pancreatitis consists of procedures aimed at reducing neurogenic sensation, such as celiac plexus block, or drainage procedures aimed at alleviating outflow obstruction of the pancreatic duct.
2. Celiac Plexus Block
The celiac plexus lies anterior to the aorta at the level of the celiac artery. Most of the sensory nerves returning from the pancreas and other intraabdominal viscera pass through the celiac ganglion and splanchnic nerves. Interruption of these fibers may lessen pain in patients with chronic pancreatitis [16]. Celiac plexus block (CPB), a temporizing treatment, most commonly refers to injection of a steroid and long-acting local anesthetic into the celiac plexus to control pain associated with chronic pancreatitis. In contrast, celiac plexus neurolysis (CPN) generally refers to injection of alcohol or phenol, a more permanent agent, into the celiac axis area [16]. This technique induces a chemical splanchnicectomy that ablates the nerve fibers that transmit pain and is used in patients with pancreatic cancer; however, it is not usually employed in patients with pain mediated by chronic pancreatitis.
CPB has traditionally been performed via various percutaneous and surgical approaches [17]. Recently, the EUS-guided approach has gained acceptance since it offers the most direct access to the celiac plexus. Wiersema and coworkers [14, 16, 18] recognized the anatomic advantage that EUS provides in visualizing the celiac region and were successful in performing transgastric EUS-guided celiac plexus blocks with results similar to the more traditional approaches. The timing of the block relative to pain onset may predict response. One study which aimed to look at CPN showed that it was more effective when the block was performed early after pain onset [19]. This result was postulated to be related to contribution of visceral and somatic nerves late in the disease and pain apparently deriving mainly from the celiac plexus early on; however, it is unclear if this translates into patients with chronic pancreatitis and the use of CBP for pain relief [16, 19]. More recently, it has been proposed that direct injection into the celiac ganglia, multiple injections in the area of the ganglia, or bilateral injections around the celiac ganglia are safe and may be more beneficial in providing sustained pain relief [20–22]. These studies are contradictory, however, and better prospective trials are needed to determine if these approaches make an improvement over the standard technique of EUS-guided CPB.
Several studies have shown that EUS-guided CPB has a beneficial role in the treatment of pain induced by chronic pancreatitis [23, 24]. An initial study of 18 patients with chronic pancreatitis showed a reduction in pain in 50% (5 of 10) of EUS-guided CPB compared with 25% (2 of 8) of CT-guided blocks [23]. This improvement in pain persisted for up to 24 weeks in 30% of responders. A cost comparison showed a $200 saving for EUS-guided CPB compared with CT-guided CPB. Another report of 90 patients by the same investigators found a significant improvement in overall pain scores in 55% at 4 weeks and 8 weeks of follow-up [24]. However, a persistent benefit beyond 24 weeks was observed in only 10% of patients. Pain relief was more likely in older patients (>45 years old) and patients who had not had previous surgery for chronic pancreatitis. A recent meta-analysis aimed to look at the efficacy of CPB for improving pain in patients with chronic pancreatitis showed that the overall percentage who obtained pain relief with this procedure was 32.7% (Table 1) and that very few good quality studies exist [25]. A major issue with all of these studies is the lack of long-term follow-up. Further, prospective studies with long-term follow-up are needed to clarify what role EUS-guided CBP will play in the management of painful chronic pancreatitis.
CPB is a generally effective, safe, and well-tolerated procedure. The three most common complications are transient hypotension (20% to 40%), transient diarrhea (4% to 38%), and transient increase in pain (9%), which are expected in CPB performed via any route [16, 26, 27]. Interruption of the plexus can result in a sympathetic blockade [28]. Clinical manifestations of sympathetic blockade can include diarrhea and hypotension resulting from a relative unopposed visceral parasympathetic activity. Mesenteric vasodilation accounts for the hypotension, which resolves in approximately 2 days. Diarrhea and increase in baseline pain are also usually limited to 2 days. Less common complications include unilateral paresis or paraplegia, pneumothorax, loss of sphincter function, retroperitoneal bleeding, renal puncture, and prolonged gastroparesis [14, 16, 27, 29]. In addition, cephalic spread of the neurolytic agent may result in involvement of the cardiac nerves and plexus affecting the heart and surrounding thoracic structures [30]. Compared to alternative approaches, EUS guidance may decrease the incidence of complications because the needle does not traverse the paraspinal region or somatic nerves or traverse the diaphragm and pleural space [1, 14, 16]. Infectious complications are uncommon but potentially serious. In a series of 90 patients, only 1 patient developed an infectious complication (peripancreatic abscess), which resolved with a 2-week course of antibiotics [24]. The authors reasoned that there might have been a predisposition to infection owing to gastroduodenal colonization with bacteria because the patient was taking a proton pump inhibitor. They suggested that prophylactic antibiotics should be considered in patients who are receiving acid suppression.
3. ERCP-Guided Therapies
Patients with chronic pancreatitis associated with dilation of the main pancreatic duct, stone disease, or strictures may develop symptoms of severe abdominal pain. In addition to celiac plexus block, this pain can be treated endoscopically with procedures aimed at draining the main pancreatic duct, removing stones, and dilating strictures. ERCP with pancreatic sphincterotomy, dilation of strictures, placement of stents, and stone extraction has become a mainstay of therapy in patients with painful chronic pancreatitis as recent studies have shown that on average, over 65% of patients with strictures or stones treated with endoscopic therapy have shown improvement in their pain [33]. Many studies over the last 20 years have attempted to address the question as to whether endoscopic therapy for the control of pain in chronic pancreatitis is effective. The results of selected published studies on pain relief after endotherapy for chronic pancreatitis are summarized in Table 2.
Experienced practitioners with advanced ERCP skills should only perform endoscopic therapies for chronic pancreatitis. In experienced hands, endoscopic pancreatic sphincterotomy is safe and effective and allows the therapeutic endoscopist access to the main pancreatic duct. This is usually performed under direct visualization with a pull-type sphincterotome after deep cannulation and guidewire insertion. The major risks of the procedure include pancreatitis, bleeding, and perforation. In addition, there is a risk of pancreatic sphincter stenosis that is considered a late complication after pancreatic sphincterotomy [34]. Once access to the main pancreatic duct is achieved, small stones can be removed endoscopically with success [35]. However, large, impacted stones usually require extracorporeal shock wave lithotripsy (ESWL) prior to attempted endoscopic removal. ESWL is a low-risk procedure where calcific pancreatic duct stones are usually identified by X-ray prior to the procedure. Then a fluid cushion is applied to the front and back of the patient, and shock waves are passed through the identified stones. This results in fragmentation of stones in chronic calcific pancreatitis allowing the endoscopist to then attempt to obtain complete clearance of the main pancreatic duct [35]. Multiple sessions of ESWL may be required in attempt to clear the pancreatic duct, and the success rate for complete clearance of the main pancreatic duct and resolution of pain has been at best approximately 75% [36]. There are some studies to suggest that ESWL alone, without combined endoscopic therapy, may be enough in the treatment of chronic calcific pancreatitis. A randomized controlled trial by Dumonceau and colleagues in 2007 aimed to answer this question [37]. There were 55 patients in the study, and the follow-up was 2 years. They were able to show that ESWL is a safe and effective treatment alone, without combined endoscopic therapy. Most studies looking at the role of ESWL performed to date have shown mixed efficacy due to the small sample sizes in the studies. A recent meta-analysis performed by Guda et al. aimed to overcome this problem and included 17 studies from 1989 to 2002 with a total of 588 subjects. Their data showed that ESWL is both effective in clearance of stones from the pancreatic duct and in relief of pain from chronic pancreatitis [38]. In addition, there is newer literature to suggest that the timing of ERCP after ESWL may increase the success rate of this procedure [39]. This study suggests waiting at least 2 days after ESWL before attempting ERCP and ductal clearance possibly due to ESWL-induced edema of the pancreatic duct. Long-term success of these procedures is variable, and many patients will have recurrent pain attacks after short-term successful clearance of the main pancreatic duct. This is thought, at least partially, to be due to stone migration or recurrence and responds to repeated attempts at endoscopic clearance of the main pancreatic duct [40]. Other studies have suggested that endotherapy with ESWL and pancreatic duct drainage will provide long-term pain relief for up to two-thirds of patients [41]. The authors' practice is to perform ESWL on patients with chronic, calcific pancreatitis, associated with large pancreatic duct stones that are not amenable to endoscopic removal at the time of initial ERCP. After ESWL is completed, ERCP and repeat attempt at ductal decompression are then performed.
Pancreatic duct strictures are usually caused by fibrosis around the main pancreatic duct as a result of the chronic inflammation seen in the disease process. Strictures that are focal and located towards the head and neck region of the pancreas are more amenable to endoscopic therapy. A recent prospective study was able to show a decrease in pain after ERCP with dilation and stent placement in 89% of patients; however after 2 years of follow-up 30% of patients had relapsed and required further therapy [42]. In attempt to perform more definitive therapy for pancreatic duct strictures, some investigators have attempted placing multiple stents into the main pancreatic duct in order to dilate refractory strictures and improve PD drainage. Costamagna and colleagues were able to show that during a mean follow-up of 38 months, 84% of patients remained asymptomatic. Only 5.5% of patients had a persistent stricture after multiple stenting, and only 10.5% of patients had symptomatic stricture recurrence [43].
4. Surgical Treatment Options
It is the prevailing belief by most endoscopists, including the authors, that endoscopic therapy should be attempted prior to surgical intervention. Endoscopic therapy is less invasive and shows similar results in the short term compared with surgical alternatives. Díte and colleagues presented data on the first randomized controlled trial comparing endoscopic versus surgical therapy, the latter consisting of resection and drainage procedures [49]. A total of 72 patients were randomized, and the initial success rate was similar in both groups. However, long-term follow-up favored complete absence of pain in the surgical group. This study was limited by the fact that ESWL was not performed, and repeat endoscopic therapy was not allowed for pain recurrence. A more recent randomized controlled trial comparing surgical drainage (pancreaticojejunostomy) versus endoscopic therapy showed that the surgical alternative was superior in improving pain in patients with chronic pancreatitis and a dilated pancreatic duct [51]. Although this study has been criticized for its small numbers, possible selection bias, and lack of rigorous endoscopic therapy, Cahen and colleagues were able to show complete or partial pain relief in 75% of surgically treated patients versus a 32% success rate in endoscopically treated patients. In addition, these investigators have recently published their 5-year follow-up results showing that 68% of the endoscopically treated patients required additional drainage procedures, compared with 5% in the surgery group () [52]. They also report that 47% of the patients in the endoscopy group eventually received surgery. In the long term, despite comparable levels of quality of life and pancreatic function between the surgical and endoscopic management group, surgery was still superior, in terms of pain relief (80% versus 38%, ). Although endoscopic therapy is still considered first-line treatment, these randomized trials comparing surgical and endoscopic therapy should give the endoscopist pause to think about the procedures being offered to a patient for the treatment of pain in chronic pancreatitis.
In conclusion, endoscopic therapy aimed at treating pain in patients with chronic pancreatitis consists of EUS-guided celiac plexus block and therapeutic ERCP procedures combined with ESWL that are all aimed at draining an obstructed pancreatic duct. As a result they have the potential to work well in patients with large duct disease, but they do not work well in patients with small duct chronic pancreatitis. Endoscopic management is safe and effective for many patients, but pain relief is often short lived requiring multiple repeat procedures. Endoscopic technologies as well as therapeutic techniques continue to evolve, and as such, improvements will likely be seen in the endoscopic management of chronic pancreatitis in the future.
- F. Fugere and G. Lewis, "Coeliac plexus block for chronic pain syndromes," Canadian Journal of Anaesthesia, vol. 40, no. 10, pp. 954–963, 1993. View at Google Scholar · View at Scopus
- R. H. Hastings and W. R. McKay, "Treatment of benign chronic abdominal pain with neurolytic celiac plexus block," Anesthesiology, vol. 75, no. 1, pp. 156–158, 1991. View at Google Scholar · View at Scopus
- J. W. C. Leung, M. Bowen Wright, and W. Aveling, "Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis," British Journal of Surgery, vol. 70, no. 12, pp. 730–732, 1983. View at Google Scholar · View at Scopus
- S. Arner and B. A. Meyerson, "Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain," Pain, vol. 33, no. 1, pp. 11–23, 1988. View at Google Scholar · View at Scopus
- H. J. McQuay, M. Tramèr, B. A. Nye, D. Carroll, P. J. Wiffen, and R. A. Moore, "A systematic review of antidepressants in neuropathic pain," Pain, vol. 68, no. 2-3, pp. 217–227, 1996. View at Publisher · View at Google Scholar · View at Scopus
- P. Malfertheiner, D. Mayer, M. Büchler, J. E. Domínguez-Muñoz, B. Schiefer, and H. Ditschuneit, "Treatment of pain in chronic pancreatitis by inhibition of pancreatic secretion with octreotide," Gut, vol. 36, no. 3, pp. 450–454, 1995. View at Google Scholar · View at Scopus
- H. Halgreen, N. Thorsgaard Pedersen, and H. Worning, "Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis," Scandinavian Journal of Gastroenterology, vol. 21, no. 1, pp. 104–108, 1986. View at Google Scholar
- A. Malesci, E. Gaia, A. Fioretta et al., "No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis," Scandinavian Journal of Gastroenterology, vol. 30, no. 4, pp. 392–398, 1995. View at Google Scholar · View at Scopus
- J. Mossner, J. Secknus, J. Meyer, C. Niederau, and G. Adler, "Treatment of pain with pancreatic extracts in chronic pancreatitis: results of a prospective placebo-controlled multicenter trial," Digestion, vol. 53, no. 1-2, pp. 54–66, 1992. View at Google Scholar · View at Scopus
- T. Ferrer-Brechner, "Anesthetic management of cancer pain," Seminars in Oncology, vol. 12, no. 4, pp. 431–437, 1985. View at Google Scholar · View at Scopus
- H. H. Stone and E. J. Chauvin, "Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis," British Journal of Surgery, vol. 77, no. 3, pp. 303–305, 1990. View at Google Scholar · View at Scopus
- E. L. Bradley III, "Long-term results of pancreatojejunostomy in patients with chronic pancreatitis," American Journal of Surgery, vol. 153, no. 2, pp. 207–213, 1987. View at Google Scholar · View at Scopus
- J. S. Markowitz, D. W. Rattner, A. L. Warshaw, R. L. Roosi, C. P. Shoemaker, and W. B. Goldfarb, "Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis: strategies for salvage," Archives of Surgery, vol. 129, no. 4, pp. 374–380, 1994. View at Google Scholar · View at Scopus
- M. J. Levy and M. J. Wiersema, "EUS-guided celiac plexus neurolysis and celiac plexus block," Gastrointestinal Endoscopy, vol. 57, no. 7, pp. 923–930, 2003. View at Publisher · View at Google Scholar · View at Scopus
- M. Zenz, M. Strumpf, and M. Tryba, "Long-term oral opioid therapy in patients with chronic nonmalignant pain," Journal of Pain and Symptom Management, vol. 7, no. 2, pp. 69–77, 1992. View at Publisher · View at Google Scholar · View at Scopus
- B. J. Hoffman, "EUS-guided celiac plexus block/neurolysis," Gastrointestinal Endoscopy, vol. 56, no. 4, pp. S26–S28, 2002. View at Google Scholar · View at Scopus
- S. Mercadante and F. Nicosia, "Celiac plexus block: a reappraisal," Regional Anesthesia, vol. 23, no. 1, pp. 37–48, 1998. View at Google Scholar · View at Scopus
- M. J. Wiersema and L. M. Wiersema, "Endosonography-guided celiac plexus neurolysis," Gastrointestinal Endoscopy, vol. 44, no. 6, pp. 656–662, 1996. View at Publisher · View at Google Scholar · View at Scopus
- S. Ischia, A. Ischia, E. Polati, and G. Finco, "Three posterior percutaneous celiac plexus block techniques: a prospective, randomized study in 61 patients with pancreatic cancer pain," Anesthesiology, vol. 76, no. 4, pp. 534–540, 1992. View at Google Scholar · View at Scopus
- M. J. Levy, M. D. Topazian, M. J. Wiersema et al., "Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block," American Journal of Gastroenterology, vol. 103, no. 1, pp. 98–103, 2008. View at Publisher · View at Google Scholar · View at Scopus
- J. K. LeBlanc, J. DeWitt, C. Johnson et al., "A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain," Gastrointestinal Endoscopy, vol. 69, no. 4, pp. 835–842, 2009. View at Publisher · View at Google Scholar · View at Scopus
- A. V. Sahai, V. Lemelin, E. Lam, and S. C. Paquin, "Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness," American Journal of Gastroenterology, vol. 104, no. 2, pp. 326–329, 2009. View at Publisher · View at Google Scholar · View at Scopus
- F. Gress, C. Schmitt, S. Sherman, S. Ikenberry, and G. Lehman, "A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain," American Journal of Gastroenterology, vol. 94, no. 4, pp. 900–905, 1999. View at Publisher · View at Google Scholar · View at Scopus
- F. Gress, C. Schmitt, S. Sherman, D. Ciaccia, S. Ikenberry, and G. Lehman, "Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience," American Journal of Gastroenterology, vol. 96, no. 2, pp. 409–416, 2001. View at Publisher · View at Google Scholar · View at Scopus
- M. Kaufman, G. Singh, S. Das et al., "Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer," Journal of Clinical Gastroenterology, vol. 44, no. 2, pp. 127–134, 2010. View at Publisher · View at Google Scholar · View at Scopus
- D. D. Davies, "Incidence of major complications of neurolytic coeliac plexus block," Journal of the Royal Society of Medicine, vol. 86, no. 5, pp. 264–266, 1993. View at Google Scholar · View at Scopus
- E. Eisenberg, D. B. Carr, and T. C. Chalmers, "Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis," Anesthesia and Analgesia, vol. 80, no. 2, pp. 290–295, 1995. View at Publisher · View at Google Scholar · View at Scopus
- R. B. Patt and S. Reddy, "Spinal neurolysis for cancer pain: indications and recent results," Annals of the Academy of Medicine Singapore, vol. 23, no. 2, pp. 216–220, 1994. View at Google Scholar · View at Scopus
- K. D. Lillemoe, J. L. Cameron, H. S. Kaufman et al., "Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial," Annals of Surgery, vol. 217, no. 5, pp. 447–457, 1993. View at Google Scholar · View at Scopus
- P. A. J. Hardy and J. C. D. Wells, "Coeliac plexus block and cephalic spread of injectate," Annals of the Royal College of Surgeons of England, vol. 71, no. 1, pp. 48–49, 1989. View at Google Scholar · View at Scopus
- T. M. O'Toole, N. J. Shire, S. S. Chauhan et al., "Predictors of response to EUS-guided celiac plexus blockade for abdominal pain in patients with chronic pancreatitis," Gastrointestinal Endoscopy, vol. 65, article AB209, 2007. View at Google Scholar
- T. Stevens, G. Zucarro, J. A. Dumot et al., "Longitudinal study of endoscopic ultrasound guided celiac plexus blockade (EUS-CPB) for treatment of painful chronic pancreatitis (CP)," The American Journal of Gastroenterology, vol. 102, no. S178, Abstract 169, 2007. View at Google Scholar
- T. Rösch, S. Daniel, M. Scholz et al., "Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up," Endoscopy, vol. 34, no. 10, pp. 765–771, 2002. View at Publisher · View at Google Scholar · View at Scopus
- G. I. Papachristou and T. H. Baron, "Complication of therapeutic endoscopic retrograde cholangiopancreatography," Gut, vol. 56, no. 6, pp. 854–868, 2007. View at Publisher · View at Google Scholar · View at Scopus
- S. Sherman, G. A. Lehman, R. H. Hawes et al., "Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms," Gastrointestinal Endoscopy, vol. 37, no. 5, pp. 511–517, 1991. View at Google Scholar · View at Scopus
- G. Costamagna, A. Gabbrielli, M. Mutignani et al., "Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results," Gastrointestinal Endoscopy, vol. 46, no. 3, pp. 231–236, 1997. View at Publisher · View at Google Scholar · View at Scopus
- J. M. Dumonceau, G. Costamagna, A. Tringali et al., "Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial," Gut, vol. 56, no. 4, pp. 545–552, 2007. View at Publisher · View at Google Scholar · View at Scopus
- N. M. Guda, S. Partington, and M. L. Freeman, "Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis," Journal of the Pancreas, vol. 6, no. 1, pp. 6–12, 2005. View at Google Scholar · View at Scopus
- J. T. Merrill, D. K. Mullady, D. S. Early, R. R. Azar, S. A. Edmundowicz, and S. S. Jonnalagadda, "Timing of endoscopy after extracorporeal shock wave lithotripsy for chronic pancreatitis," Pancreas, vol. 40, no. 7, pp. 1087–1090, 2011. View at Publisher · View at Google Scholar
- M. J. Farnbacher, C. Schoen, T. Rabenstein, J. Benninger, E. G. Hahn, and H. T. Schneider, "Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success," Gastrointestinal Endoscopy, vol. 56, no. 4, pp. 501–506, 2002. View at Google Scholar · View at Scopus
- M. Delhaye, M. Arvanitakis, G. Verset, M. Cremer, and J. Devière, "Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis," Clinical Gastroenterology and Hepatology, vol. 2, no. 12, pp. 1096–1106, 2004. View at Publisher · View at Google Scholar · View at Scopus
- A. Weber, J. Schneider, B. Neu et al., "Endoscopic stent therapy for patients with chronic pancreatitis: results from a prospective follow-up study," Pancreas, vol. 34, no. 3, pp. 287–294, 2007. View at Publisher · View at Google Scholar · View at Scopus
- G. Costamagna, M. Bulajic, A. Tringali et al., "Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results," Endoscopy, vol. 38, no. 3, pp. 254–259, 2006. View at Publisher · View at Google Scholar · View at Scopus
- J. McCarthy, J. E. Geenen, and W. J. Hogan, "Preliminary experience with endoscopic stent placement in benign pancreatic diseases," Gastrointestinal Endoscopy, vol. 34, no. 1, pp. 16–18, 1988. View at Google Scholar · View at Scopus
- T. Sauerbruch, J. Holl, M. Sackmann, and G. Paumgartner, "Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study," Gut, vol. 33, no. 7, pp. 969–972, 1992. View at Google Scholar · View at Scopus
- M. Delhaye, A. Vandermeeren, M. Baize, and M. Cremer, "Extracorporeal shock-wave lithotripsy of pancreatic calculi," Gastroenterology, vol. 102, no. 2, pp. 610–620, 1992. View at Google Scholar · View at Scopus
- K. F. Binmoeller, P. Jue, H. Seifert, W. C. Nam, J. Izbicki, and N. Soehendra, "Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results," Endoscopy, vol. 27, no. 9, pp. 638–644, 1995. View at Google Scholar · View at Scopus
- H. E. Adamek, R. Jakobs, A. Buttmann, M. U. Adamek, A. R. J. Schneider, and J. F. Riemann, "Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy," Gut, vol. 45, no. 3, pp. 402–405, 1999. View at Google Scholar · View at Scopus
- P. Díte, M. Ružicka, V. Zboril, and I. Novotný, "A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis," Endoscopy, vol. 35, no. 7, pp. 553–558, 2003. View at Publisher · View at Google Scholar · View at Scopus
- A. Gabbrielli, M. Pandolfi, M. Mutignani et al., "Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct," Gastrointestinal Endoscopy, vol. 61, no. 4, pp. 576–581, 2005. View at Publisher · View at Google Scholar
- D. L. Cahen, D. J. Gouma, Y. Nio et al., "Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis," New England Journal of Medicine, vol. 356, no. 7, pp. 676–684, 2007. View at Publisher · View at Google Scholar · View at Scopus
- D. L. Cahen, D. J. Gouma, P. Laramée et al., "Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis," Gastroenterology, vol. 141, no. 5, pp. 1690–1695, 2011. View at Publisher · View at Google Scholar


text:
Urge Arizona AG and State Legislative Leaders to Not Waste Taxpayer Dollars in Pointless Appeal
January 25, 2013 . The Arizona Court of Appeals ruled this month that the Legislature must start FULLY funding inflation, as voters mandated in Prop. 301. (The Legislature had tried to use a loophole in the ballot language to avoid making these payments.) This year, this would amount to $74 million or about $74 a Continue Reading >


text:
From child bride to Senegal rights crusader
By George Fominyen
KEUR ISSA, Senegal (TrustLaw) - Fatou Diakhate seemed so young when she was given away in marriage that her husband, Mori Diarra, took pity on the 13-year-old.
Diarra, 30 at the time, spoke to Diakhate's father and arranged for her to stay in her family home until she was 15. It wasn't long after she eventually joined him in Keur Issa, a hamlet in western Senegal, that she became pregnant.
Forty years later, sitting in the courtyard of the matrimonial home, Diakhate explained how she went on to have 12 children.
"In those days, when parents saw their children getting married they were very happy," said Diakhate, now 55. "Since we girls were not educated, we were also happy to get married. We didn't know early marriage was not a good thing."
Child marriage is widespread across sub-Saharan Africa, where it is often driven by endemic poverty and seen as a way of securing a girl's future both financially and socially.
It also benefits parents through the payment of a "bride price."
A recent study by children's charity Plan UK found that 43 percent of girls in West Africa are married before their 18th birthday. Not only are they pulled out of school, but many face early pregnancy and serious health complications.
DEATH THREATS Continued...


text:
What is Warren Buffett's Best Advice for Young Professionals?
Warren Buffett, the chairman and CEO of Berkshire Hathaway, also known as the "Oracle of Omaha", is undoubtedly the most successful investor of the 20th century and one of the wealthiest individua...Read More
4 Charitable Entrepreneurs to Emulate
Business sometimes gets a bad rap for being cutthroat and selfish. However, entrepreneurs are some of the most influential leaders in our towns and communities—big and small. They have the potential...Read More
Hiring Questions From Warren Buffet and Phil Libin
Hiring the right people to work for you is one of the most important (and overlooked) aspects of growing a business. As entrepreneurs, you're often required to wear many hats – from maki...Read More


text:
One Battle IT Cannot Win: Banning Work on Your SmartphoneBy
Well-intentioned though they may be, IT department bans on using personal gadgets for work aren't very effective. Even employees in highly regulated industries such as health care and finance prefer at times to use their own gadgets or apps to get the job done, according to new research from U.K. technology consultancy Ovum. The firm's study of over 4,300 professionals from 19 countries showed that on the high end, employees are using their own device or app for more than 30 minutes (and sometimes, much longer) each day on work-specific tasks. The rest of the time they are toiling away on company equipment, but even a few minutes spent on non-company devices or third-party apps is enough to freak out security-focused IT personnel or data-protection obsessed regulators.
Still, in corporate security vs. employee convenience, the workers are winning. Seven out of 10 smartphone-owning professionals polled said they bring their own smartphone to work daily. (This raises the question: Who leaves theirs home?) Of that 70 percent, one in five do so in spite of an anti-BYO devices policy. The study involved professionals in 19 countries, including the United States, India, China, Australia, much of Western Europe, and emerging markets in Asia and Latin America.
The BYO workplace phenomenon has grown considerably over the past five years, trending alongside the explosive growth of the smartphone, tablets, and apps markets and transforming the way we work. These ubiquitous, powerful technologies are increasingly seen not as a distraction but as tools of an efficient, engaged workforce.
The Ovum study, for example, found that 25 percent of those surveyed said they use unsanctioned apps to send work-related e-mails, to update their calendars, or to transfer work files while away from their desk. They are IM-ing or Skype-ing customers and clients, too. A smaller number even use collaboration apps such as Yammer or Jive to brainstorm on big projects. Sometimes they'll enlist the IT department, albeit after the fact, and the programs end up sanctioned for the workplace.
"We are seeing companies adapting, trying to find a middle ground," says Ovum analyst Richard Absalom. "If they see a lot of key employees bringing iPhones to work, they'll give them company-sanctioned iPhones to use."


text:
This was right after Round 1 of the Health Care Summit
Stein: "You just ask one of the most brilliant questions I have ever heard anyone ask on t.v. which is why are so many Republicans against more government interference in the health care system and so many Democrats in favor of it? I think the answer is the a much higher percentage of Republicans are taxpayers than Democrats, and the Republicans are the people who are gonna be paying for it and the Democrats are gonna be the people receiving it...But as a general matter, Republicans as a group pay income tax at a much higher rate than Democrats"
Then to top it off, Wolf asks Donna Brazile: "Hold on, hold on Donna, what is untrue Donna?"


text:
Prescott School District, 1220 St. Croix St., Prescott, WI 54021, 715.262.5389
Official Ballot Question
"Shall the following Resolution be approved: RESOLUTION AUTHORIZING THE SCHOOL DISTRICT BUDGET TO EXCEED REVENUE LIMIT FOR FOUR YEARS BY $1,120,000 PER YEAR FOR NON-RECURRING PURPOSES. Be it resolved by the School Board of the School District of Prescott, Pierce Country, Wisconsin, that the revenues included in the School District budget beginning with the 2008-2009 school year and ending with the 2011-2012 school year be authorized to exceed the revenue limit specified in Section 121.91, Wisconsin Statutes, by $1,120,000 per year, for nonrecurring purposes?"
Click on the links below to review recent district information in regards to the Levy Cap Referendum
Recommendation of the Budget & Finance Committee to the Prescott School Board, May 23, 2007
Superintendent Scoop - September 10, 2007 - "REPLACEMENT LEVY CAP OVERRIDE VOTE SET"
Superintendent Scoop - October 08, 2007 - "REFERENDUM INFORMATION COMING"
October District Newsletter (.pdf)
October District Newsletter #2 (.pdf)
Public question box Q&A regarding the referendum - first pass
Public question box Q&A regarding the referendum - second pass


text:
Listen to this audiobook if you're truly serious about getting over her....
Kiss agonizing pain good-bye; say hello to a deep herculean strength and self-empowered confidence that attracts new women, and discover the real secrets to overcoming a breakup and using it as a launchpad to reinvent your life and pursue your dreams.
Guys, let's face it, a serious breakup can suck! There is no one that is immune to experiencing a broken relationship. It literally feels as though your heart has been torn out of your chest. You can't stop thinking about her, what you could, should, or would do if you had another chance - even if the breakup occurred last week or 10 years ago.
But the truth is...it's over, and she's moved on! So what can YOU do about it?
The Breakup Manual for Men was born out of real heartbreak and an urgent necessity to get over the loss and pain of a serious breakup. In this powerful audiobook, relationship coach for men Andrew Ferebee has distilled the essentials of his own success and life-changing work with men who have been blindsided by breakups into an easy-to-follow strategy that you can devour in as little as a day.
This is no ordinary relationship advice book.
You will leave behind all confusion, pain, and heartbreak as he leads you through how to truly overcome and recover so you can become stronger, attract new women, and have the confidence to start living again in the shortest time possible.
Andrew leaves no stone unturned. Everything has been tested and proven to work! The result - one easy-to-understand book for men that reveals what you absolutely need to know.
©2015 Knowledge For Men, LLC (P)2015 Knowledge For Men, LLC
"I'm a few weeks fresh in a breakup..."
And this audio book is exactly what you and I needed! I am going to listen to this every morning. It ALWAYS motivates me - especially the writing sections... making these things physical has some sort of power.
Thank you so much!
"Good advice to get over a tough break up"
I love Andrew's podcast knowledge for men and thought I'd give this a listen as I'm having a tough break up at the moment. This audiobook will makes a hard break up bearable by showing you good practices and ways to get through it...knowing that it will be okay sooner than you think. Grateful that Andrew puts his effort into creating content like this that really helps others.
"Meh, it's ok..."
It's ok. Nothing I didn't know before or could figure out on my own. if you need something to start with it is good but you'll need something more to get over a really bad break up.
"lame. "
expecting something a bit deeper. The book is short and ends promoting his other books(!).
"The definition of useless"
The author fails to connect any kind of real practical knowledge to real life situations, and all of his methods are based on personal experience he doesn't diagnose the problem instead he tells you to man up and accept life, although that is true, the author failed to describe the human nature, if you really want to learn more about how to handle a breakup watch an episode from the school of life on YouTube I promise you, you will learn more than this book another good channel to watch is charisma on demand, good luck !
For an hour, its brief and straight to the point.
Yes I would be willing to try another book
Clear, engaging,
Yes i think it will be a benefit if someone is in the situation
Instead of going about the internet to find answers this is better as it gives the general and straight forward ideas and insight on getting over a breakup. This book is a start but you have to continue and put in the work and remember it takes time.
"great audiobook"
definitely gave me some great insight during this breakup I'm through. I've listened to it a few times a week so that it can sink in
"Definitely puts things in perspective"
When going through something as hard as breaking up can be it's difficult to make good decisions. This book really helped me get a grasp of what was going on with my feelings. I never knew there was science behind why you feel the way you do when breaking up with someone. This has really helped me move on and see the opportunity that lies ahead.
"great motivation"
was good and motivating, ok narration, I think can help if you follow it .
"Good perspective."
This is a good map. It's up to you to get started on your journey.
"Helpful and easy to get into"
Very helpful step by step reminders that there is potential in the pain for an even better life after a breakup.
"Worth the few dollars if your going through a bad breakup"
Appropriately short and to the point, it is worth the hour you will spend listening to it if you are going through a bad breakup. It will also give you a chance to re-listen to the audio book and let what Andrew has to say sink in.
You most likely will not magically feel better in one hour, but you will have the knowledge to take the right steps in getting over a breakup after listening.
Report Inappropriate Content
If you find this review inappropriate and think it should be removed from our site, let us know. This report will be reviewed by Audible and we will take appropriate action.


text:
Tweets from @TBHomeTeam/writers
MORE from our HomeTeam writers.
Mon. March 1, 2010 | Izzy Gould | Email
Sunlake boys basketball coach Bob Marinak resigned last week, principal Angie Stone confirmed Monday in an e-mail.
Marinak did not immediately respond to a message from the Times seeking comment.
Marinak became the Seahawks' first coach in 2007 after the job was offered to current Freedom coach Travis Priddy. Marinak came to Sunlake after four seasons at Countryside. He also coached at North Marion where in two seasons he turned a 6-20 team into a 14-15 team.
At Sunlake, Marinak's teams showed consistent improvement. The Seahawks went 3-24 in 2007-08, 9-17 in 2008-09 and 11-15 this season.


text: Hey as most of ya know I got a '99 STS with the 425 Bose sound system. Well for all you guys I want to know what you think of your Bose sound system or any bose sound system you have heard. I got a friend who says bose is crap and had a profession car sound guy convince him of it so he was tellin me all this. Well I kinda like my the sound system in my car but haha he said it wasnt to impressive. Although I have read reviews on the car saying it was a superb sound system he wasnt convinced. I think i could agree with him that they are a very overrated company. What do you think and are bose sound systems crapy? Do you like the one in your Cadi? I know the system in the 98+ plus seville is largely upgraded.


text:
Jim Plueddemann
About the Author
Dr. Jim Plueddemann is professor in the Mission and Evangelism Department at Trinity Evangelical Divinity School in Deerfield Illinois. He teaches courses in areas of leadership and education.
Dr. Plueddemann earned his BA and MA in Christian Education from Wheaton College, and his PhD in Curriculum Research in Education from Michigan State University.
From 1967 until 1980 he and his wife, Carol, served in Nigeria as missionaries with SIM (then called, Sudan Interior Mission). During that time he was director of the Christian Education and Theological Education departments for the Evangelical Churches of West Africa.
From 1980 to 1993 he served on the faculty of Wheaton College in Wheaton, Illinois. He traveled each summer in Africa, Europe, and South America to assist teachers and administrators of theological schools with curriculum design, creative teaching, and spiritual formation. He has an active and continuing interest in cross-cultural Christian education, leadership development, and theological education. Other areas of concern are team relationships, realistic future-oriented mission strategy, and especially prayer and revival.
Dr. Plueddemann served as the International Director of SIM (Serving in Mission) from 1993 until 2003. During these ten years, he and Carol traveled to 56 different countries to conduct vision seminars.
His latest book is Leading Across Cultures: Effective Ministry and Mission in the Global Church.