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This event is in the past.
March 21, 2013 | 1:00 p.m. - 3:00 p.m.
Category: Lecture
Location: Law School Building, Spencer M. Partrich Auditorium | Map
471 W. Palmer
Detroit, MI 48202
Detroit, MI 48202
Cost: Free
Calendars: Wayne Law, Main Events Calendar
Audience: Community, Current Graduate Students, Current Undergraduate Students, Faculty, Staff
The School of Social Work presents their annual Diversity Lecture. This year's speaker is Lori Messinger, PhD, MA, MSU, University of North Carolina. Topic to be discussed is cultural competence with LGBTQI populations.
Registration is required.
For more information about this event, please contact Julie Alter-Kay at 313-577-4464 or firstname.lastname@example.com.


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Andrea Bloom and Mitch Levinson were married Sept. 2 over Labor Day weekend at Elliston Vineyards in Sunol. They were joined by their five children, ages 11 through 23, their four parents, extended family and close friends. It was a celebration of merging two families.
Andrea and Mitch are both long-time residents of Pleasanton, where they have been raising their children and have founded healthcare companies.
Mitch was the founding CEO of Pleasanton-based Zeltiq Aesthetics. In 2010, he founded Cerebrotech Medical Systems, which is developing a brain monitoring device for patients after stroke or brain trauma.
Andrea had her own diabetes consultancy where she advised diabetes devices and services companies on new products for people with diabetes. In 2010 she founded ConnectWell, a corporate wellness company that engages people in sustainable wellness practices to reverse chronic disease trends.
The couple honeymooned in Italy where they hiked the Cinque Terre, explored Tuscany, and spent three days in Venice.

subset: commoncrawl


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October 14-15, 1999
Parklawn Building, Conference Room K
Rockville, Maryland
The meeting was called to order by chairperson Dr. Robert W. Harrison at 8:30 a.m., Thursday, October 14, 1999. Other committee members present were: Dr. Turner Camp, Dr. Irene Check, Dr. Delores Shockley, Dr. Michael Stoto, and Dr. Robert Trewyn; Consultants and staff present were: Dr. Robert Delongchamp, NCTR, Consultant; Dr. Sonia Tabacova, NCTR, Consultant; COL Harry E. Marden, M.D., Consultant; LTC Julie Robinson and LTC Bruce Burnham, former and present Chief of Population Research (Brooks AFB), Dr. Joel Michalek, Principal Investigator (Brooks AFB); Mr. Ronald Coene, Committee Executive Secretary; Ms. Barbara Jewell, NCTR, Committee Staff. For the Army Chemical Corps Study on presented on October 15th: Dr. Rebecca Klemm, Dr. Mary Paxton, Dr. Han Kang (VA), Mr. John Boyle, Dr. Nancy Dalager, and Dr. Carol Magee.
Observers were: Dr. George Claxton, VVA; Dr. Weihsueh Chiu, GAO; Maurice Owens, SAIC, Program Manager; Dr. Jay Miner, Program Management Support; Manuel Blanca, Program Management Support; Meghan Yeager, SAIC; Dr. William Grubbs, SAIC; Peter Mazzella, DHHS; Otto Kreisher, Copley News Service; Dr. Linda Schwartz, Vietnam Veterans of America.
Dr. Harrison opened the meeting and welcomed the committee members, with a special welcome to Dr. Favata, who was not able to attend the last meeting in person. Dr. Stoto was unable to attend the morning session this first day.
The Minutes of the August 26-27, 1999 meeting were discussed and, with no substantive changes brought up by the committee, were approved by a voice vote.
Mr. Coene referred the committee to its discussion about the availability of the draft Air Force report to the public at the August meeting. He informed members that this document falls into an exemption under the Freedom of Information Act which says that the government can maintain the confidentiality of information if it is considered predecisional. He said that accordingly, nothing would be released today.
Old Business was moved to after lunch so Dr. Stoto could participate in the discussion.
Chapter 11 - Neurology. The reviewers of this chapter are Drs. Favata and Shockley; Dr. Michalek made the presentation. In it, he summarized findings that appeared statistically significant. He discussed an increase in inflammatory diseases, but said that result had little real statistical meaning. He said the data showed a significant increase in the index of polyneuropathy when comparing moderate versus mild or none on all Ranch Handers and in the high category and against current dioxin. Another run through the data showed it correlated significantly with dioxin.
Dr. Favata thought that the dependent variables were appropriate and comprehensive, and commented that the range of motion of the neck has no significance in testing the 11th cranial nerve. She asked why the cranial
nerve index excluded the spinal accessory nerve; Dr. Grubbs responded that this analysis has been done this way since 1985.
Regarding deep tendon reflex coding, Dr. Favata said she disagreed with the designation of sluggish or very active reflexes as normal, preferring to see the traditional graded designation of 1+ equals sluggish, 2-3+ normal, 4-5+ very active. Dr. Michalek asked her if she would like to see what is called an ordinal categorical analysis rather than a simple binary analysis, and she said yes.
Dr. Favata stated that the covariates chosen were appropriate and comprehensive, and that in further evaluations the study report should include repetitive motion exposure.
Dr. Shockley told Dr. Michalek that his oral presentation was clearer about the significance of an association with inflammatory diseases than the written draft. He said he would review the draft.
Dr. Harrison questioned the Air Force about the assessment of neck range of motion, saying it was apparently very subjective. Dr. Michalek remarked that the meaning is not apparent. he then questioned the idea that neurological abnormalities were related to the diagnosis of diabetes. Dr. Michalek said that was in the article, but not in this report. He said they computed the relative risk of peripheral neuropathy against diabetic status; not the World Health Organization or American Diabetes Association status. Also, the study does not relate the known length of the diabetes to the occurrence of the neurological complication. Dr. Harrison said he thought that dioxin levels and obesity were related. Dr. Michalek stated that the analyses were adjusted for body fat.
Dr. Michalek then went through how the diabetes definition used by the study was developed with help from NAS. He said that diabetics were in the analysis, but with a covariate for the presence or absence of diabetes. Dr. Harrison said he was interested in whether or not further analysis had been done to show that it made sense in terms of length of disease. Dr. Michalek said that had not been pursued. He said the relation between diabetes and peripheral neuropathy was very strong in both controls and Ranch Handers, and in all physical exams.
Dr. Camp asked if the study showed a causal relationship between diabetes and obesity; Dr. Michalek said they didn't know, and could only study associations. Dr. Harrison told Dr. Camp that it has been clinically observed that patients with Type II diabetes tend to gain weight the longer they live. And also, that if you took away obesity, 60 percent of Type II diabetes wouldn't exist; indicating that obesity is a strong contributor to diabetes. He further observed that diabetes and hyperlipidemia are associated. Dr. Harrison said the study report should not use the term insulin-dependent, because that term is reserved exclusively for Type I diabetes. Type II diabetics on insulin are termed insulin-requiring.
Chapter 14 - Cardiovascular. This chapter was reviewed by Drs. Trewyn and Tabacova, and was presented by Dr. Michalek. He reported that many findings are negative in this chapter.
Dr. Michalek told the committee that one strong association is the enlisted ground crew, which had the heaviest exposures, experienced significant increases in cardiovascular mortality.
Dr. Trewyn told the group that the cardiovascular assessment focuses inordinately on dioxin rather than herbicides. Also, he said, there seemed to be a lot of jumping back and forth in the summary and the conclusion between what's significant and what's nonsignificant, and did not help him understand the data that's in the chapter.
Dr. Trewyn asked if the data from the '94 Air Force mortality update was not included; and thought that it would help, because one can then discuss the relevance of those numbers of the people who have died, and it would help round out the information in the chapter.
Dr. Camp stated that reputable people do see a connection between diabetes and heart disease. Dr. Michalek said that very few of those men that died of heart disease would have come to the study's physicals; and the only avenue is researching medical records, a lengthy process. Dr. Harrison said he felt Dr. Camp's statement should be worked on.
Dr. Tabacova felt the study was well done and comprehensive. She questioned how current alcohol and cigarette smoking data were used with which dependent variables. And, dioxin has been adopted in the study as an exposure measure for pesticide exposure, she is interested in seeing an analysis of how this exposure measure relates to the outcome.
Dr. Grubbs replied that current alcohol and current smoking were used in everything else but the historical variables.
Dr. Michalek informed the group that the study has done analyses of dioxin versus health in the control group, and that will be published soon in Epidemiology.
Dr. Harrison inquired further about deaths from heart disease in the study group. Dr. Michalek stated that many of the cardiovascular deaths occurred before the study started.
Dr. Favata asked about the possibility for autopsy release and further study of organs. Dr. Michalek stated that they always make efforts to obtain them. Dr. Miner said the effort to obtain records is made with every subject. Dr. Favata also inquired about tissue analysis, and was told that efforts are always made to obtain specimens; but the results are very sparse. Dr. Michalek said the number of autopsies done was very disappointing, also. Dr. Camp added that the VFW makes efforts to get the families to allow autopsies, because is often supports a veteran's claim.
Dr. Check observed that no protocol exists for autopsy, and others felt that one should be developed. Dr. Michalek stated that the study has one, developed by CDC, and discussed the difficulties in getting it put to use. He said that so far there have been 118 Ranch Hand deaths and about half of those occurred before the first physical. He stated that "overall, there is nothing going on with mortality. It's only when you look in the subgroups by cause that you see the big increase, or the significant increase in heart disease deaths in the enlisted ground."
Dr. Delongchamp said that the way the report has analyzed its data is with methods that look at prevalence, and they don't really deal with competing risks very well or anything like this, which is what this whole mortality issue raises. He said that if you wanted to evaluate neoplasia and cardiovascular disease, you would want to look at deaths, and that data is not in the report. In talking about doing cohort studies, different analyses are required.
Dr. Michalek stated that this has happened already in articles. Any analysis that would incorporate mortality would have to be Model 1, which is just all Ranch Hands versus all Control, adjusted for occupation. He said, "We have a proposal to address exactly that point in the next report, which will include mortality and morbidity in the final report, and include all prevalence; not just the ones that showed up at the clinic this time, but the ones that showed up in previous cycles, too, and all morbidity." He said current reports are snapshots.
Then there was a general discussion about the changing mixture of subjects showing up for the exams over the years, as they age.
Chapter 10 - Neoplasia. This chapter was reviewed by Drs. Check and Camp, and was presented by Dr. Michalek. He reported that the findings here were generally negative and internally inconsistent.
Dr. Michalek said the Ranch Handers were having less than the expected number of cancer deaths as a group, and no evidence of increased cancer deaths in the enlisted ground crew.
Dr. Check agreed with the observation that there are a lot of internal inconsistencies in the data, but chose not to address it. She prepared printed copies of her summary, and tables. Skin neoplasms were considered separately from the systemic neoplasms. Dr. Check prepared two summary tables of this data. She felt it important to know whether any of those benign neoplasms might be considered to be premalignant lesions.
She discussed the data in detail, noting that the number of non-melanoma malignant neoplasms did not equal the sum of basal and squamous cancers. Dr. Grubbs explained that there are overlaps; people with a malignant and a benign. Dr. Check said that an explanation in the report would help, and then suggested the report say how many of the patients or subjects had more than one neoplasm.
Also, Dr. Check felt there should be a definition of the non-melanoma malignant. She also asked for an explanation of which category carcinomas in situ would fall into.
She noted that the data provided confidence that there is no association between dioxin and prostate cancer; but the lung cancer association needs to be discussed and examined further. She said it was not clear how the data from the mortality study are connected with this data. She expressed interest in the next study answering the question: "Does dioxin shorten latency time?"
Dr. Check said she was impressed with the comprehensiveness of the examinations and that the data are presented in an orderly, 'uninteresting' manner. She concurred with the authors' conclusion that there is no gross dioxin effect.
Dr. Camp observed that the Secretary of Veterans Affairs, the Institute of Medicine or others may accept an association or even a suggested relationship between dioxin exposure and the diseases being studied, and might recommend service connection.
Dr. Trewyn felt sections should not be titled "no significant difference" in incidence and prevalence of neoplastic disease. He discussed a study supporting the idea that some low dioxin effects may be more significant than a high dioxin effect, which Dr. Harrison expressed a desire to see a copy.
Dr. Harrison expressed concern that what the report is calling high dioxin is really high dioxin in a cell culture system.
Dr. Delongchamp then discussed cancer deaths in the study group with Dr. Michalek, stating that a reduction in prevalence could really be a sign of an increase in mortality. Dr. Michalek said that overall, they were having less than the expected number of cancer deaths. He echoed the frustration that the report doesn't take into account the mortality data along with the morbidity data. Dr. Delongchamp theorized that at higher doses, people were getting heart disease and dying; and at lower doses, they were getting cancer. Dr. Michalek replied, they already died of something else and therefore they didn't live long enough to get cancer, and so the rates are low in the high category. He stated that scenario comes up whenever they write reports, but there is no data to test the hypothesis.
Dr. Harrison asked about the rates of prostate cancer for black men in the study group. Dr. Michalek stated that the Ranch Handers were only 5-6 percent African-American, too small a number to study racial effects.
Dr. Delongchamp inquired about the study making any adjustment for birth cohort. Dr. Michalek referred him to the cancer article, recently published in the American Journal of Epidemiology. He said the paper does not suggest an exposure effect. Dr. Harrison inquired about an adjustment for fatness at exposure; which Dr. Michalek said was a covariate in Cycle 4. It was removed from the models.
Disposition of Health Study biological specimens.
Dr. Michalek started by saying he felt putting an RFP through the NIH was the most coherent idea. NIH was considered to have the capacity to review a multitude of anticipated proposals. Dr. Miner added that they charge a substantial overhead fee for doing that. The committee discussed the possible scope of work and what a "reasonable" amount of money would be for the contract.
Several places mentioned to consult at the NIH were: the National Institute of Environmental Sciences; NRRC, (the General Clinical Research Centers); and Cooperative Human Tissue Network (Roger Aamodt). Dr. Harris mentioned possible use of study sections that are not NIH-run that do evaluations for the Army health initiatives.
Dr. Michalek asked the committee to think about the specimens philosophically; to consider why these specimens were collected. Or, could they be used to answer a question like diabetes. Dr. Trewyn posed the question of timing of work contemplated in the RFP in relation to the study.
The committee felt that this should be communicated as a committee's recommendation to the Secretary. The proposal was put in the form of a motion, and was unanimously approved by a voice vote. Dr. Harrison said that the committee should consider doing that RFP before the next study start. Later in the discussion, he mentioned exploring the use of the Scripps CRC, where certain expenses would be covered under the umbrella of enhancing clinical research through collaborating with NIH.
Afternoon Session
Dr. Harrison spent a few minutes with Dr. Stoto, bringing him up to speed on what he missed in the morning session.
Discussion of the issue of Ranch Hands versus Comparisons
Dr. Trewyn expressed concerns about herbicide exposures being different because the types used in aerial and ground spraying are different; and that problems arose because the in-country versus out-of-country comparisons would have had different exposures; and that the chemicals sprayed would have been different.
Air Force Response to Questions from Last Meeting
Dr. Michalek said he had a set of slides to address comments raised at the last meeting. From the last meeting were: a Comparisons issue that Dr. Trewyn mentioned. What is the proper referent cohort? What about dioxin versus herbicides? An extensive discussion ensued. Dr. Michalek told Dr. Trewyn that the question can be answered based on the qualifying tour data only, or he can answer it based on flag Vietnam tours; but this has not been done yet. He gave the study definition of a control:
To be a control you had to be in a specified collection of C-130 units, and you had to be there in a certain window of time, between 1961 and 1971, and you had to be active duty Air Force. The data deals with multiple tours and variable tour lengths; some of those tours were years long, others were just 90-day TDYs, and they were all interspersed. Dr. Michalek presented a sample of the data in a series of slides.
Dr. Favata remarked that that isn't addressing the central question of the effect of herbicide exposure. By noting their presence in Vietnam, that really didn't characterize their exposure appropriately.
Dr. Stoto discussed two possible studies here; one is a study of being in a Ranch Hand operation. The study is fundamentally a study of, what were the health effects of being in the Ranch Hand operation compared to other people who were like them in every respect, except they weren't in the Ranch Hand operation. He said we are inferring that anything that we find is due to the herbicides that were used in the Ranch Hand operation.
He told Dr. Michalek he thought the fundamental idea was to look at people who were in Vietnam compared to people who were not in Vietnam, regardless of their Ranch Hand status. Also, he pointed out, the other study that came up after the protocol was designed is the dioxin study, because it was discovered that you could measure dioxin. And now there was a separate study that looks at the relationship between health outcomes and dioxin as estimated based on the serum measurement.
Dr. Trewyn stated that yet another study idea is based on the hypothesis that herbicide exposure has caused adverse health effects in a portion of the Comparison group that could be removed from the study. Dr. Stoto disagreed with that, and Dr. Harrison opined that one group then should be exposed to phenoxy herbicides and the other group should not. Dr. Trewyn agreed, and Dr. Stoto stated that the groups also need to be as similar as possible in every other respect.
Dr. Stoto stated that the second hypothesis is one that evolved after the serum dioxin measurement became feasible.
Dr. Trewyn told the committee there were blue and white compounds, and those did not contain dioxin. He said he would "love to know for sure what was sprayed around the base camps." -- where exposure to anyone who served in Vietnam may have been different than the Ranch Handers per se.
At Dr. Miner's request, Dr. Michalek read the purpose of the study from the protocol. The purpose of the study, of this investigation is to determine whether long term health effects exist and can be attributed to occupational exposure to herbicide Orange. Later on, "herbicide Orange" is replaced simply with the word 'herbicides' in the protocol.
Dr. Schwartz remarked about nurses' use of Agent Orange to keep grass down around the hospitals and their living quarters. Dr. Harrison said he assumed that none of the Comparisons were in Vietnam, and that they were never in contact with Agent Orange. Dr. Trewyn said that was his assumption, also.
Dr. Stoto told the committee that epidemiology is full of compromises. "What you want is to get a trade-off between getting groups that are as different as possible on the main thing you're trying to study and as similar as possible on everything else." He said that to achieve the similarity requires careful matching, and that probably came at the expense of some degree of herbicide exposure among the controls. He said this probably doesn't compromise the main study object.
The committee discussed possible comparisons to study differences, were this nine percent of Comparisons that were in Vietnam removed from that group. Dr. Delongchamp asked whether what members are interested in is whether the p-value gets smaller by removing this group. Dr. Harrison replied that he was interested in whether the difference becomes more significant.
Dr. Miner and Dr. Stoto discussed the toxicity of white and blue herbicides. Dr. Harrison stated that this sounded like a tough issue to resolve. Dr. Michalek proposed that the committee think about it and exchange email to try to devise a meaningful analysis, and then talk about it later, reporting the results to Dr. Harrison.
Dr. Trewyn led the group into a discussion of the use of cut points when Scripps normal ranges were not available. Dr. Michalek said he generally relied on textbook cut points or Scripps normal ranges, except in certain cases like luteinizing hormone where the study developed its own, better data.
Dr. Stoto and Dr. Harrison got engaged in a discussion about clinical significance versus the clinical significance versus statistical significance of the mean serum levels of free testosterone and total testosterone being slightly higher in Ranch Hands than in Comparisons.
Dr. Harrison and Dr. Michalek discussed the relationship between testosterone and luteinizing hormone. Dr. Michalek said they try to entertain any possible deviation from what is observed in the Comparison group without any condition applied, a priori. Dr. Harrison talked about the drawing of conclusions by comparing values, all of which exist well within the normal range, and either implying or actually stating that it suggests a difference between the two groups.
Dr. Stoto said concerning summary tables currently only giving the p-values and not absolute differences in the data, that for the half dozen or so things that are in Chapter 19 that look like they're important differences, that for those outcomes that they report not only the statistical significance but the actual measures, so readers can make a judgment about whether they think that's important.
Dr. Harrison said he thought the purpose was to figure out if any of this was causing a health effect.
Dr. Trewyn said he wanted to make sure that the numbers were there and that the potential for interpretation was there; that something wasn't being thrown out as being meaningless when perhaps it might have been. Dr. Michalek stated he felt confident that has not happened.
Dr. Michalek took up the question, What is the appropriate comparison group? He told the committee that all of this was argued out in 1978-1979 time period, in front of the National Academy of Sciences, Armed Forces Epidemiology Board, the Air Force Scientific Advisory Board and the UT School of Public Health, a scientific group that was used for peer review. So it ended up Vietnam veterans versus Vietnam veterans.
Dr. Michalek said if you want to wrap up the Agent Orange issue the best we can in our lifetime, probably the next five or ten years, an idea would be to reactivate the Vietnam Experience Study and bring the Army Chemical Corps study to conclusion, and bring the Ranch Hand Study to conclusion, and then summarize everything we've got.
Dr. Michalek presented data on the use of three herbicides in Vietnam, and the percentage of dioxin contamination varied. Dr. Camp said that from the claims standpoint, this was very important.
Dr. Michalek then addressed topics posed by Dr. Favata. It does happen that our study subjects get exposed right here in the United States to dioxins. One of our controls reported the same problem. The EPA has a database of counties in the United States, rank ordered by dioxin exposure. We also know the complete residential history of all of our veterans by zip code, by longitude-latitude, by city and state. He said there are additional sources of information here that can be brought to bear to answer Dr. Favata's issue, and questions about residential exposures.
Dr. Michalek then addressed Dr. Camp's issue about sigmoidoscopies. He said the study was going to consider that as a possibility for the next cycle. Dr. Camp said he didn't think about the Comparisons, of course. He said he was only concerned they were forcing the Ranch Hander to go out and get a sigmoidoscopy at his own expense when the physician at Scripps recommended it.
Dr. Harrison stated that he wasn't sure that many people do sigmoidoscopies anymore; they do flexible colonoscopes. After a discussion of occult blood screening and the magnitude of the job of doing sigmoidoscopies on all subjects, Dr. Camp told the group that his remark had been misunderstood; that it related only to the veteran being told by a Scripps physician to get a sigmoidoscopy.
Dr. Michalek said Dr. Camp also brought up the idea of doing treadmill testing. COL Marden asked Dr. Camp if that also was in follow-up, and Dr. Camp said it was. The committee discussed the implications of what to do with a diagnosis resulting from a study physical requiring follow-up care.
Continuing with questions from Dr. Favata about the experience with the CAPI questionnaire, Dr. Michalek said it was an excellent tool for collecting data, and running it on a laptop proved convenient and time-saving. However, since the output format was not correctly specified, there were problems manipulating the data. He said that would be corrected for the next cycle.
Dr. Michalek stated that the baseline questionnaire remains unchanged. He discussed adding questions about drug use to future questionnaires. Another item brought up was the veteran's self-reported health status. He said they were going to try to find out what was driving these self-perceptions. Dr. Stoto suggested looking at use of the SF-36 form developed by a Boston group. Dr. Michalek said they would start to investigate the sed rate findings, at the suggestion of the committee. Dr. Michalek anticipated difficulties moving the sed rate from the general health chapter to the hematology chapter as suggested; Dr. Harrison said to leave it where it is in this report.
Chapter 16 - Endocrine. The reviewers of this chapter are Drs. Harrison and Stoto. Dr. Michalek made the presentation.
Dr. Michalek told the committee the Endocrine chapter reports a relation between diabetes, in all measures of dioxin; initial, categorical, and current. And that diabetic severity, fasting glucose, and A1c hemoglobin was consistently related. He said he didn't know how to interpret the last finding.
Dr. Harrison started by saying he felt the introductory material regarding dioxin's effects in rats didn't matter much. Noting the passage describing several thyroid disorders found and that "the mix weighs against a relationship with dioxin," he felt dismissing this data was not a good idea. He said that the chapter has the problem of not having a more recent and timely literature review.
Dr. Harrison felt the way diabetes is classified in this study allows it to be compared to anything else, anyone else's studies. He said he doubted if any of the subjects were insulin-dependent, which is a specific technical term that's applied to diabetes; he said he felt very strongly that that needed to be changed to "insulin-requiring."
Dr. Harrison noted that the labeling of subjects as having Type II diabetes in the study is not supported well enough in the report, and Dr. Michalek said they will add additional data to the chapter. Dr. Harrison pointed to paragraph 3, page 163:
...consistent with dose response, a positive association between current body burden of dioxin and the development of diabetes, specifically in the later stages requiring oral hypoglycemic and insulin therapy.
He wondered, "if you take that a little further, does that mean that these people got fatter sooner? And hence became diabetic sooner, which means then that since they were diabetic longer, they're now requiring insulin" which he said would actually strengthen the relationship being developed.
The committee then discussed the study's analysis of A1c hemoglobin. Dr. Michalek said the analysis of A1c hemoglobin included everyone; namely, the non-diabetics and the diabetics.
Dr. Claxton asked if there were any sub-studies going on at all between Ranch Handers concerning these results. Dr. Michalek said there were; one to determine a biological relationship between diabetes and dioxin.
In the second study, they are sending 30 non-diabetic Ranch Handers and matched controls to Little Rock, Arkansas to the VA Medical Center, to be tested for insulin sensitivity.
Dr. Delongchamp asked how you sort out the association between dioxin half-life in body fat from the association between diabetes and body fat. Dr. Michalek responded that in the current study they have matched individuals very tightly on body fat; they are identical in every way that appears to be relevant to the issue, and it's a matched pair analysis.
Dr. Stoto talked about how to take into account this three-way relationship between measured dioxin, body fat and diabetes. He said he thought that the models that are in this report are not as sophisticated as they can be.
Dr. Stoto had one technical comment on page 14, line 466, to clarify what it meant that they extrapolated the time in which diabetes would occur for non-diabetics. Dr. Michalek explained it was a censored survival analysis where if the event didn't occur, the time to onset was set to be the maximum, and censored at that point. Dr. Stoto said it needed fixing. Also, referring to the last two sentences, pages 175 and 176, Dr. Stoto felt a rewrite was in order.
Dr. Harrison said maybe people exposed to herbicides might tend to run a little higher blood sugar than the people that weren't exposed; but that both groups had the same amount of diabetes. Noting the report has the same number of people in each group, Dr. Harrison asked about the adjustments; were they using a fudge factor? Drs. Trewyn and Stoto said they were; a legitimate statistical practice.
Dr. Michalek said that, "based on those associations, we're motivated to ask Dr. Matsumura, is there a causal relation between diabetes and dioxin that motivated the adipose tissue study" which is being done right now. Dr. Harrison remarked that "In a sense, this is actually the observation that led to my being a part of this committee".
The committee then engaged in a discussion about the diabetes diagnosis used in the study. Dr. Harrison questioned the data showing out of the group of 200 Comparisons with diabetes, 75 of them have normal hemoglobin A1c. Dr. Grubbs said the hemoglobin A1c measurement is done on everybody, and the diabetes is based on two hour postprandial.
Dr. Check asked Dr. Harrison if he was questioning the validity of the diabetes diagnosis because he sees a surprisingly low number of elevated hemoglobin A1cs; and he said yes, he was trying to figure out some other way of determining which of the group actually had diabetes.
Dr. Harrison said he would like to see the report saying that the diabetes diagnosis was based on World Health Organization, ADA, or other standard criteria. Dr. Check said that would remove that as a point of argument. Dr. Michalek said they would deal with it. Dr. Harrison said he wanted to think a little more about how the hemoglobin A1c could be used.
Dr. Harrison stated he was very satisfied with the outcome in the endocrine assessment. He thought it could be made significantly better and very convincing.
The meeting adjourned at 4:40 p.m.
The Committee meeting continued in the same location on October 15, 1999, being called to order by Chairperson Harrison at 8:40 a.m.
Dr. Harrison opened the second day of the meeting by reviewing the committee's discussion yesterday about the future of samples collected for the study, saying that "with some collaboration between the Air Force and the NIH or the Air Force and the scientific branch of the Army, to produce RFPs, Request for Proposals to cover the use of the unneeded samples that are presently simply being stored; and to also try and determine a mechanism to explain the association that we now feel exists between exposure to dioxin and diabetes mellitus type II."
Dr. Harrison read his proposed letter to Secretary Shalala. The committee discussed the wording of the letter. Dr. Stoto stated he would add a sentence in there saying that there may be other things in the data that are worth exploring as well. Dr. Michalek asked that the letter include the words, "Agent Orange related issues".
Dr. Stoto foresaw benefits of working with NIH researchers, who may see possibilities for these data. He felt the use of the phrase "unfortunate members of the Ranch Hands," was an unnecessary characterization. Dr. Harrison disagreed.
Presentation of Certificates of Appreciation
Retiring Committee Members Turner Camp, M.D., Irene Check, Ph.D., Delores C. Shockley, Ph.D., and Ronald W. Trewyn, Ph.D. were presented with certificates of appreciation by Rear Admiral Michael Blackwell, Chief of Staff, Office of the Surgeon General.
Chapter 19 - Conclusions. Dr. Michalek presented a slide listing findings throughout the report: a significant number of Ranch Handers with increased dioxin; continued relation between body fat and dioxin and serum lipids and dioxin; and increased liver enzymes; platelets increased consistently across study cycles, including this one; consistent relations with diabetes, and a new finding in cardiovascular on the ECGs, evidence of prior heart attack, and a new finding in neurology of confirmed polyneuropathy.
Dr. Stoto wanted a change in the sentence: In summary, the prevalence of endocrine disease remains similar in Ranch Hands and Comparisons. Dr. Michalek said that while true, it was not a good summary.
Then 264; actually Section 19.5.8, which is the endocrine assessment, the last paragraph of that section. He said the one before that "basically says in summary there's nothing there." Dr. Stoto went on to say he was concerned about the sentence before that, which he felt should be struck. LTC Burnham and Dr. Harrison agreed.
Dr. Stoto went on to line 108 and 109, Section 19.5.1. He said he wasn't sure what that meant: A finding of higher levels of dioxin in relatively obese participants on the basis of any health detriment is difficult to explain from --. Dr. Michalek explained that doctor that wrote that is saying it's difficult for him to imagine a mechanism whereby dioxin would cause a disease that would also cause increased body fat, or which would be associated with increased body fat. Dr. Michalek said It contradicts the statements about diabetes, so maybe that sentence should be stricken, too.
Dr. Trewyn, remarking about Section 19.5.3, said the statement aligns 141 to 143, "inflammatory diseases as verified by medical record reviews were increased in Ranch Hands relative to Comparisons". Dr. Michalek stated that that means they have not studied that to their satisfaction, that what Dr. Trewyn is saying is true; that sed rate is correlated with inflammatory diseases in this group. If the statement is about us running statistical analyses of inflammatory versus a sed rate he said has not been done.
Dr. Harrison asked Dr. Check, if she agreed we would expect that if inflammatory disease was present, that the sed rate should be elevated? She said yes. Dr. Michalek then said the word 'expected' should be in there.
Dr. Harrison noted that, "One of the problems with almost everything in here is that when you do find someone with something like an inflammation, you don't correlate whether that person's sed rate is increased." Dr. Michalek agreed, but said that "the ICD codes are given in the text; so what you're disagreeing with is the label we attached to that collection of codes." Dr. Stoto noted this comment was in the Neurologic section. Dr. Shockley pointed out that inflammatory conditions were based on the subject's report. Dr. Favata added, "and medical review."
Dr. Trewyn brought up the subject of elevated plasma liver enzyme levels, citing a paper he had been given about nonalcoholic steatohepatitis, which states that: it's an important differential diagnosis for asymptomatic patients with chronically elevated plasma liver enzyme levels, especially if obesity, diabetes, or hypolipidemia are present. And the people that are diagnosed with this apparently have a great chance to actually have then very significant liver problems subsequently. Colonel Marden stated that they go on to cirrhosis.
Dr. Harrison echoed the same point that Dr. Camp had made about some of the other findings, that this should be passed on to the subject's personal physician.
Dr. Harrison and Dr. Camp continued their debate over the idea that diabetes causes patients to gain weight. He stated that the tendency to be overweight is worsened by some of the changes that occur during diabetes, particularly treatment with antidiabetes medication, treatment with insulin. Dr. Camp said that some people who don't overeat get fat anyway. Dr. Harrison disagreed, saying: "If you gain weight, you have overeaten. Whether you have a low metabolism or whether you have a high metabolism is irrelevant to the fact that if you gain weight, you took in more calories than your metabolism required."
Future Directions. Dr. Michalek started the discussion by stating that in the next physical, they did not intend to continue half-life studies because the dwindling numbers of subjects means the statistical benefit is lessened considerably.
Dr. Favata inquired about continuing to get meaningful data, with the recognition that there's going to be increased mortality and morbidity among the study group.
Dr. Michalek pointed out, "We're going to try to address the number one issue on compliance that worries all of us; and that is the veterans that tell us they can't come because they're too sick." He worried about their staying home and expecting study personnel to come to them, not a desirable result. Also, we have to try to find some alternate measure of type A/B personality in order to do that covariate.
The other bias issue might be, Dr. Michalek pointed out, that a large part of the study's data collection is Ranch Handers bringing in photocopies of their personal physician medical records. So if you tell the doctor, "Gosh, diabetes is a major finding," that may focus his attention to diabetes and then downplay other things he might see in this person. The committee then got into a discussion of the relationship of the study to the primary care physician.
Dr. Delongchamp told the group that with the atomic bomb survivors have a card which says that they're a survivor, which then entitles them to medical benefits.
Dr. Harrison said he liked the idea of a card, encouraging the primary care physician to call and obtain past medical information. He said this would encourage the physician to call the study group when there's a problem. Dr. Schwartz described a card that the VVA wants adopted for all veterans.
In response to Dr. Camp, Dr. Michalek explained that when a study subject stays home because he's too ill, it biases the study because getting the data from him at home is not the same as the workup.
Dr. Michalek brought up the problem with sending doctors to the veteran's homes; the men are spread all over the United States. He asked, isn't it infeasible from a licensing point of view? Colonel Marden: "It's a nightmare from a licensing standpoint." Several alternatives were discussed.
Dr. Delongchamp discussed the undesirability of data collected from a sick subject. He said what they we run into all the time is that once you've got this data, then you're always in this quandary about whether you want to use it or not.
Dr. Michalek said the study group wanted to do a complete review of all covariates and give a fresh look at how we adjust our analyses.
Dr. Miner informed the committee that the statement of work rewrite will start in the summer of the year 2000, and has to be completed probably by June of 2001, because that's the scheduled release of the RFP.
Dr. Schwartz described the air evac system available to veterans that could be used to get to the physicals; Dr. Camp mentioned the DAV transportation system available.
Dr. Harrison stated he felt a decision should be made whether or not all four models should be used in the upcoming year. He said he would like to see a spreadsheet on every Ranch Hander and Comparison ever in the study, which would allow one to see there were relationships between the findings, and further analysis. Dr. Stoto said that the fourth paragraph talks about doing that. He felt talking about disease outcomes across two or more clinical areas was difficult to do, but important. Dr. Harrison agreed.
Dr. Stoto felt it was important to recognize the importance of the statistical modeling about the dioxin elimination rate in relationship to body fat.
Dr. Stoto stated he wanted to consider dropping the dioxin measure on the people in the half life studies. Dr. Michalek said that on repeated measures, there is a lot of interest at CDC and elsewhere to get a second dioxin measurement on the control group, to see what happens to normal people over time.
Dr. Stoto observed that the study has multiple measures of diabetes and body fat for everybody, when we only had multiple measures of dioxin for some people. Dr. Michalek replied, that's a paper being working on right now. "We have multiple measurements, four measurements per subject for 500 Ranch Handers, and among those we have all the diabetic information, we have all their health information and the body fats."
He said if Dr. Stoto was recommending a second measurement, he would agree, too. But since the study is not budgeted to do that, support is needed.
Executive Summary.
Dr. Stoto said he thought it was nicely done, and he and Dr. Delongchamp had no complaints at all.
Dr. Trewyn wanted to make sure that on line 216 it will read "Incidence and prevalence of neoplastic disease" instead of "no significant difference in."
Dr. Harrison wanted the exact number of endpoints, referring to the wording "Statistical analysis of more than 225 health-related endpoints."
Dr. Harrison read the next sentence: "The finding of higher levels of dioxin in relatively obese participants on the basis of any health detriment is difficult to explain from a clinical standpoint and more likely related to the pharmacokinetics of dioxin." Dr. Michalek said it would be changed; the "clinical detriment" part will come out.
Dr. Harrison said what it's supposed to be changed to is that the finding of higher levels of dioxin in relatively obese participants is not thought due to dioxin's effect on obesity.
Taking the phrase, "Ranch Hands had more inflammatory disease," a discussion ensued as to its meaning. Dr. Michalek said that included meningitis. Dr. Harrison said if it did, they should be two separate things.
Dr. Harrison read line 114: "Increases in tachycardia and other EKG diagnoses, such as preexcitation, were seen for Ranch Hands in the high dioxin category" and stated: Preexcitation syndrome, I think what you're referring to there is what's called Wolf Parkinson's White syndrome, which is a structural abnormality of the conduction apparatus of the heart, and it cannot conceivably be affected by dioxin.
Dr. Shockley read on line 128, "Do the future directions indicate that this" -- well, "it has potential association of dioxin that requires further observation." Dr. Michalek said that indeed the verbiage should be in the Future Directions section.
Dr. Schwartz asked the committee when the report would be released; Dr. Michalek said sometime in January 2000. She tried to impress upon the committee the need for clarity in the wording of the report, and how important the words are to a diverse audience.
Dr. Camp and Dr. Schwartz discussed the decision of the NAS regarding diabetes. Dr. Michalek informed them of his recent presentation to the NAS on diabetes, and a few committee members expressed interest in getting a transcript of the talk. Dr. Michalek told he committee he could possibly email the transcript to them. Mr. Coene proposed to put in the record the names of individuals from whom we've received information and their statement, and put their names in the record and also attach their submissions as addenda to the Minutes of this meeting.
Colonel Marden pointed out that there were individual's medical records that needed to be safeguarded, and Mr. Coene said he would redact names.
OPEN COMMITTEE DISCUSSION (Continued)
Review of Air Force Press Release for 5th Cycle Final Report
The proposed press release was handed out to the committee. A discussion of the wording was held, and the draft was withdrawn to accomplish a rewrite.
Dr. Kang introduced this report to the committee as the first on the main study. He introduced the staff.
Dr. Harrison directed a question to either the Army Chemical Corps or the Air Force; he wanted to know the molarity of dioxin. He expressed some frustration at not knowing that; and Dr. Michalek promised to get him a response.
Dr. Rebecca Klemm had a packet of material passed out to the committee, and said she would give the committee an overview of the process, flow of information for the Chemical Corps project.
She told the committee that basically, it's a telephone interview with the people in which they answer things about their health conditions, their occupation, and their pregnancies from their female partners. Upon finding the subjects, there is an interview and medical record information is obtained. The study tracks down the medical records; people are selected for dioxin tests, blood is drawn and sent to CDC for analysis.
Dr. Klemm then gave a brief description of the populations. The first one is the entire population that the VA had consolidated to put together to create the study subjects. There are three: One, the total 5,285 Army Chemical Corps veterans in the study source population; Two, in the population that was provided to us to try and locate and interview; and the third is, where we were as of sometime at the end of August in terms of the interviews that had been completed.
Dr. Stoto asked a few questions about the populations; did they enter service at the same time, did they serve in the Chemical Corps at the same time. Dr. Kang explained the mechanism and said that the groupings were Chemical Corps Vietnam veterans and control Chemical Corps non-Vietnam veterans, and although all were Vietnam Era vets, they were purposely not matched year by year.
Dr. Stoto pointed out that the timing may be an important factor in the analysis, saying there were likely different exposures experienced by C.C. personnel in different years.
Dr. Kang responded that they were asking a detailed exposure history, including herbicides and other chemicals.
Dr. Harrison questioned the idea of taking the questionnaire of historical exposure and relating that to dioxin levels, to validate that the questionnaire really does give a good estimate of exposure, is a reasonable one. Dr. Kang said yes, referring to the pilot study in which a random sample of 50 Chemical Corps Vietnam vets and non-Vietnam vets' self-reported history associated with their body burden at the time we measure their dioxin level.
Mr. John Boyle spoke next about the location efforts made to find the study subjects. Beginning with an IRS records search, they did an initial phone (telephone) and address postal inquiry. Others were sought through Experian (credit reports). National change of address searches were done; direct directory assistance and use of data available on CD-ROMs. Telephone screening of all numbers to confirm correctness.
A short questionnaire was used to obtain phone numbers. Mr. Boyle went through the many types of efforts made to locate these individuals, then talked briefly about refusals and the reasons that were given.
Dr. Klemm described a blood draw from a sample of the located vets. She described their "wave" cycle.
Dr. Dalager told the committee about the analysis of the first 100 blood samples from the pilot study, and they had a consultant group from Johns Hopkins that took a look at those dioxin values and the measurements of exposure that were in the CATI questionnaire, and look at the possible correlations could be used as a surrogate for everybody in the study in terms of predicting their dioxin levels.
Ever-spray came up with a significant correlation with the dioxin levels. The strongest comparison is the ever-sprayed Vietnam to the never-sprayed non-Vietnam. In a response to LTC Burnham, Dr. Kang said the first report had been given to committee members at the initial meeting.
Dr. Stoto commented that these were amazing results. He felt there was an amazing consistency in odds ratios; that those suggested to him that there was some bias somewhere.
Dr. Dalager stated the study was particularly interested in liver conditions.
Dr. Harrison asked about the level of knowledge about the study, and Mr. Boyle said that the interviewers were blinded to the nature of the veteran's service and are not told the conditions the study is looking for.
Dr. Dalager told the group that another objective of the study was to look at reproductive outcomes.
Dr. Paxton then presented the committee with information about the progress of medical records retrievals, going through in detail the process of getting records. Dr. Klemm added a remark about the strong specificity required by the NPRC when requesting records, especially dates. It was discussed that the Ranch Hand Study uses NPRC also.
Dr. Magee went into the process of getting data from the records that had been obtained at that point. She discussed the results of investigating the newborn results.
Dr. Harrison discussed verification with Dr. Kang, suggesting that data developed in the Ranch Hand study may be of some use. Dr. Michalek suggested another source would be the Vietnam Experience Study. Dr. Harrison told Dr. Kang that the verification is a very important aspect that has to be solved.
The meeting adjourned at 2:12 p.m.
. ---- .
Robert W. Harrison, M.D. Date
Chair, Ranch Hand Advisory Committee
. .
Ronald F. Coene, P.E. Date
Executive Secretary
Note: Copies of overhead transparencies, statements and other submitted materials are available from the Executive Secretariat..


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Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
A Biomechanical Approach Predicts Hip Fracture Independent of Bone Mineral Density (BMD) in Women: The Framingham Osteoporosis Study
Dufour1, Alyssa B., Roberts2, Benjamin, Kiel3, Douglas P., Bouxsein2, Mary L., Hannan3, Marian T.
IFAR, Boston, MA
BIDMC, Boston, MA
Hebrew SeniorLife & Harvard Medical School, Boston, MA
Hip fractures are disabling events for older persons. Studies have identified low BMD as a major risk factor, yet up to half of those suffering a hip fracture do not have low BMD; thus, alternative methods of assessing fracture risk are needed. One such method is the biomechanical Factor-of-Risk (F), defined as the ratio of force applied to the hip from a sideways fall to femoral bone strength. We examined the relation between F and risk of hip fracture in men and women of the population-based Framingham Study.
Subjects included 1100 Framingham Original Cohort members who had hip BMD scans (LUNAR DPA) in 198889 (baseline). Body weight, height (used to calculate BMI (kg/m2)) and age were measured at baseline. Incident hip fractures were ascertained and confirmed by interview and review of medical records through 12/31/05. We calculated F in two ways: using the ratio of either the estimated peak force or the attenuated (atten) force applied to the hip in a sideways fall from standing height divided by the femoral strength. Peak force (N) was calculated from height (m) and weight (kg). The attenuated force incorporated the cushioning effect of trochanteric soft tissue thickness (mm), as estimated by BMI, using published sex-specific regressions. Femoral strength (N) was estimated from femoral neck BMD, using a relation derived from published cadaveric femoral strength testing. Sex-specific crude, age- and BMD-adjusted Cox Proportional Hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the relation between hip fracture risk and both Fpeak and Fatten.
In the 425 men and 675 women (mean age 76 yrs) mean BMI was 26.8 kg/m2. Median follow-up was 11.3 yrs and 155 hip fractures occurred (28 in men). Fpeak and Fatten were associated with increased risk of hip fracture, adjusting for age (Table). A 1 SD increase in Fpeak was associated with a HR of 1.88 in men and 1.23 in women. Similarly, for Fatten, the HR for hip fracture was 1.78 in men and 1.41 in women. After adding BMD to the model, Fatten remained predictive of hip fracture in women. In men, we could not adjust for BMD due to collinearity with F.
In summary, both Fpeak and Fatten predict subsequent hip fracture in men and women. In women, we showed for the first time that Fatten predicts hip fracture independent of hip BMD. These findings provide strong rationale for additional studies testing the ability of this biomechanical approach to predict hip fracture.
Table. Adjusted hip fracture hazard ratios (95% CI) in men and women for a 1 standard deviation (SD) increase.
To cite this abstract, please use the following information:
Dufour, Alyssa B., Roberts, Benjamin, Kiel, Douglas P., Bouxsein, Mary L., Hannan, Marian T.; A Biomechanical Approach Predicts Hip Fracture Independent of Bone Mineral Density (BMD) in Women: The Framingham Osteoporosis Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :558
DOI: 10.1002/art.25638


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Taylor Aikins Photographer
Karlie KinsmanModel Female Calgary, Alberta, Canada
My MM URL: http://www.modelmayhem.com/karliekinsman
Mayhem # 3168304
About MeIf anyone is looking to shoot with me, the best way to get a hold of me is Facebook. Here's a link: https://www.facebook.com/ModelKarlie
My dream is to be a model! I have dreamt it for years but it took me along time to believe in myself. I have decided it's high time to chase my dreams. Right now I am still new so I am mostly just looking for experience.
I have never walked a runway although I would be more than willing to learn.
I learn really fast and I am very eager to be a part of this industry. I have not modeled with another model yet but am eager to learn this also.
I try very hard to be beautiful every day, I try very hard to be professional, to impress and to be the best that I can be. If you are interested in working with me, not only is my goal to produce outstanding images, but it is also to have an enjoyable time doing it. I am very friendly and open for trying new and exciting things. My schedule is very flexible and I am willing to work in neighboring cities/towns within driving distance(ie: Chestermere, Edmonton, Red Deer, Lehtbridge, etc). Also, I am willing to travel farther with adequate compensation.
Like I mentioned, my dream is to be a model and I am going to do everything in my power to make this happen, and with your help my dreams can come true and maybe I'll be lucky enough to help you reach your dreams as well :)
Have you worked with Karlie Kinsman? Add Credits for Karlie Kinsman! >>
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Pete DiNovo (Tarpon Springs, Fla./East Lake) has had a great few days. He led Team Tampa to the IMG 7v7 National Championship over the weekend. Shortly after he received scholarship offers from UCF and then South Florida. Then this morning, he announced he was committed to UCF via Twitter.
"Officially a member of the UCF family," said DiNovo on Twitter. "Can't wait to do great things I thank god for opportunities & people he has placed in my life #Knights."
DiNovo, 6-foot-3 and 210-pounds, camped at both UCF, USF and North Carolina State this summer.
DiNovo was named the offensive MVP at the IMG 7v7 National Championship.


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- Worship times
- Map and directions
- What to expect
- For your kids
- What we believe
- Meet our staff
Worship Times
We offer a contemporary service at 9:30am and a traditional one at 11am. Bible Study also takes places during those hours.
We also have a Chinese speaking service (West U Chinese Church) at 10:50am and a bi-lingual service at our Crosspoint Campus at 1:30pm (Iglesia Crosspoint.)
Getting to West U
We're located in the heart of West U, one block north of University Blvd. and West U city hall, and just across Auden Street from the baseball fields and West U Elementary, at 6218 Auden St, Houston TX, 77005.
For Your Kids
KidRally is a special kid-friendly worship time at 9:30. For parents who attend the Encounter Worship Service at 9:30. There is always a great combination of kid-style music, fun, and teaching from God's Word. (Nursery care is provided for younger children.)
Kid's Bible Study is offered every Sunday morning at 11:00.
Child Care for children ages birth through 3 years is provided during all Sunday morning programming. Even very young children can learn that Jesus loves them, so an age-appropriate teaching curriculum is offered during Sunday School.
KidStuff is our Children's Ministry. Click here for more information.
What We Believe
• God is the Creator and Ruler of the universe. He has eternally existed in three persons: the Father, the Son, and the Holy Spirit. These three are co-equal and are one God. (Genesis 1:1,26,27; Psalm 90:2; Matthew 28:19; I Peter 1:2; II Corinthians 13:14)
• Man is made in the spiritual image of God, to be like Him in character. He is the supreme object of God's creation. Although man has tremendous potential for good, he is marred by an attitude of disobedience toward God called "sin." This attitude separates man from God. (Genesis 1:27; Psalm 8:3-6; Isaiah 53:6a, 59:1 2; Romans 3:23)
• Man was created to exist forever. He will either exist eternally separated from God by sin, or in union with God, through forgiveness and salvation. To be eternally separated from God is Hell. To be eternally in union with Him is eternal life. Heaven and Hell are places of eternal existence. (John 3:16; I John 2:25; 5:11-13; Romans 6:23; Revelation 20:15)
• Jesus Christ is the Son of God. He is co-equal with the Father. Jesus lived a sinless human life and offered Himself as the perfect sacrifice for the sins of all men by dying on a cross. He arose from the dead after three days to demonstrate His power over sin and death. He ascended to Heaven's glory and will return again to earth to reign as King of Kings and Lord of Lords. (Matthew 1:22-23; Isaiah 9:6; John 1:1-5; 14:10-30; Hebrews 4:14-15; I Corinthians 15:3-4; Romans 1:3-4; Acts 1:9-11; I Timothy 6:14-15; Titus 2:13)
• Salvation is a gift from God to man. Man can never make up for his sin by self-improvement or good works. Only by trusting in Jesus Christ as God's offer of forgiveness can man be saved from sin's penalty. Eternal life begins the moment one receives Jesus Christ into his life by faith. (Romans 6:23; Ephesians 2:8-9; John 1:12, 14:6; Titus 3:5; Galatians 3:26; Romans 5:1)
• Because God gives man eternal life through Jesus Christ, the believer is secure in that salvation for eternity. Salvation is maintained by the grace and power of God, not by the self-effort of the Christian. It is the grace and keeping power of God that gives this security. (John 10:29; II Timothy 1:12; Hebrews 7:25; 10:10-14; I Peter 1:3-5)
• The Holy Spirit is equal with the Father and the Son as God. He is present in the world to make men aware of their need for Jesus Christ. He also lives in every Christian from the moment of salvation. He provides the Christian with power for living, understanding of spiritual truth, and guidance in doing what is right. The Christian seeks to live under His control daily. (II Corinthians 3:17; John 16:7-13; 14:16-17; Acts 1:8; I Corinthians 2:12; 3:16; Ephesians 1:13; Galatians 5:25; Ephesians 5:18)
• The Bible is God's Word to all men. It was written by human authors under the supernatural guidance of the Holy Spirit. It is the supreme source of truth for Christian beliefs and living. Because it is inspired by God, it is truth without any mixture of error. (II Timothy 3:16; II Peter 1:20-21; II Timothy 1:13; Psalm 119:105,160; 12:6; Proverbs 30:5)
• A New Testament church is an autonomous local congregation of baptized believers, associated by covenant in the faith and fellowship of the gospel; exercising the gifts, rights, and privileges invested in them by the Bible, and seeking to extend the gospel to the ends of the earth. (Matthew 16:15-19; 28:18 20; Acts 2:41-42,47; Ephesians 3:8-11,21; Colossians 1:18; 1 Peter 5:1-4)
• God has ordained the family as the foundational institution of human society. Marriage is the uniting of one man and one woman in covenant commitment for a lifetime. It is God's unique gift to reveal the union between Christ and His church and to provide for the man and the woman in marriage the framework for intimate companionship, the channel of sexual expression according to biblical standards, and the means for procreation of the human race. Children, from the moment of conception, are a blessing and heritage from the Lord. Parents are to teach their children spiritual and moral values and to lead them to make choices based on biblical truth. Children are to honor and obey their parents. (Genesis 2:18-25; Exodus 20:12; Deuteronomy 6:4-9; Psalm 139:13-16; Proverbs 22:6; Matthew 5:31-32; 19:3-9; Romans 1:18-32; 1 Corinthians 7:1-16; Ephesians 5:21-33; Colossians 3:18-21)
Meet Our Staff
Roger Patterson
Senior Pastor
Roger and his wife Julee have been at West University Baptist since 1997. They have two boys, Brady Jackson and Cooper Grayson, and one daughter Carson Claire, who are the joy of their lives. Roger received his doctorate degree (Doctor of Ministry) from Southwestern Baptist Theological Seminary, his Master's of Divinity from Southwestern Baptist Theological Seminary in 1998 and his Bachelor of Arts in Christianity and Speech from Houston Baptist University in 1995. Roger began his time here as the Minister to Students in 1997, and then in 1999 was named Associate Pastor. That role had many responsibilities, including staff and facility administration, strategic planning, construction management, and preaching/teaching. In May of 2009, Roger accepted the call to become the next Senior Pastor of West U Baptist and Crosspoint Church. He loves playing basketball and golf, but most of all he loves spending time with his family.
Click here to view our full staff.
Contagious Christianity
6 Week Evangelism Class
Wednesday Evenings Beginning April 19th
6:30pm - 8:00pm
Room 208 - WUBC
"I am very excited about your interest in the up and coming Evangelism Training class at West U. I look forward to seeing you there for 6 weeks as we journey together through the video driven course, Becoming A Contagious Christian. It is focused on relational evangelism and I know God will allow us to grow in His grace as we seek to honor humbly reaching out to others."
- Rick Vasquez
Pastor of Iglesia Crosspoint and Staff Evanglist
for West U Baptist and Crosspoint Church


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Lucy Dutch is the sexy cowgirl today. Her tight top and denim shorts look hot on her hairy body. The clothes fly off, she plays with rope, and then retires to fondle her all-natural body to pleasure.
Masturbation, Tattoo, Lingerie, Hairy Nipples, Brunettes, Curvaceous, Denim, Uniforms, Striptease
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Please click here to download it now.


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Get Hip Or Die Trying Tee
I love the quote on this shirt "Get Hip Or Die Trying" even if it is a reference to 50 Cent.
Apparently, Twitter is relevant enough now that one could wear this shirt and nearly everyone would know what it means.
...talk about a clever, artistic, interpretation of one of the most cliche t-shirt designs around.
Created by Stella McCartney for Red Nose Day, this shirt might stand as my favorite charity shirt, ever.Added 9 Years Ago from Rednoseday
Don't kids yourself, this burnout tee from Alternative Apparel is the most comfortable thing you'll ever own. They're made for guys or for girls and available in any number of colors.Added 9 Years Ago from Revolve Clothing
show the world you survived the bush administration! great job,sweeties!
Woody Allen is the single coolest person a live (ok, Bill Murray is in the running too), so this shirt is obviously awesome. As an added perk, a portion of this shirt's proceed benefits the Elton John AIDS Foundation.
I guess the relevance here is that the Super Bowl is coming up . Apparently in the 70s, Pittsburgh was dubbed "the city of champions" -- by who, who knows. But, the only thing that matters to me is that this is just a cool looking... I guess the relevance here is that the Super Bowl is coming up . Apparently in the 70s, Pittsburgh was dubbed "the city of champions" -- by who, who knows. But, the only thing that matters to me is that this is just a cool looking vintage style tee.Added 9 Years Ago from Homageclothing
Mainly, there is just something really funny about a wold in front of a pseudo 80s design.
A collaboration between Burger King and "cutting edge artists and designers." Burger King Studio T-Shirts.
Frankly, I would probably never wear this shirt -- it's just not really my style. However, it's been getting so much love on design sites and t-shirt blogs that I figured I had to recommend it.
Keep this one on hand for the that day your lady friend is having a particularly bad day. This gift will certainly do just that, cheer her up.
Read & see more on www.whats-wrong-with-the-zoo.comAdded 9 Years Ago from What's Wrong With The Zoo
What'd Elton John say? "All you need is love." I good message and I think there's no reason not to wear it on your shirt in bold Helvetika.Added 9 Years Ago from Katharinehamnett
Added 9 Years Ago from Dresscodeclothing


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Goldcorp (NYSE: GG) and Randgold Resources Limited (NASDAQ:GOLD) are both mid-cap basic materials companies, but which is the better stock? We will contrast the two companies based on the strength of their institutional ownership, risk, valuation, profitabiliy, analyst recommendations, earnings and dividends.
Valuation and Earnings
This table compares Goldcorp and Randgold Resources Limited's gross revenue, earnings per share (EPS) and valuation.
|Gross Revenue
|Price/Sales Ratio
|Earnings Per Share
|Price/Earnings Ratio
|$3.45 billion
|$1.19 billion
|Randgold Resources Limited
Goldcorp has higher revenue and earnings than Randgold Resources Limited. Randgold Resources Limited is trading at a lower price-to-earnings ratio than Goldcorp, indicating that it is currently the more affordable of the two stocks.
Insider & Institutional Ownership
56.7% of Goldcorp shares are held by institutional investors. Comparatively, 36.4% of Randgold Resources Limited shares are held by institutional investors. Strong institutional ownership is an indication that hedge funds, large money managers and endowments believe a stock is poised for long-term growth.
Risk & Volatility
Goldcorp has a beta of 0.02, indicating that its share price is 98% less volatile than the S&P 500. Comparatively, Randgold Resources Limited has a beta of 0.07, indicating that its share price is 93% less volatile than the S&P 500.
Goldcorp pays an annual dividend of $0.08 per share and has a dividend yield of 0.6%. Randgold Resources Limited pays an annual dividend of $0.98 per share and has a dividend yield of 1.1%. Goldcorp pays out 26.7% of its earnings in the form of a dividend. Randgold Resources Limited pays out 35.4% of its earnings in the form of a dividend. Both companies have healthy payout ratios and should be able to cover their dividend payments with earnings for the next several years. Randgold Resources Limited has raised its dividend for 4 consecutive years. Randgold Resources Limited is clearly the better dividend stock, given its higher yield and longer track record of dividend growth.
Analyst Ratings
This is a breakdown of current ratings and recommmendations for Goldcorp and Randgold Resources Limited, as reported by MarketBeat.com.
|Sell Ratings
|Hold Ratings
|Buy Ratings
|Strong Buy Ratings
|Rating Score
|Randgold Resources Limited
Goldcorp currently has a consensus target price of $16.96, indicating a potential upside of 25.34%. Randgold Resources Limited has a consensus target price of $102.33, indicating a potential upside of 12.66%. Given Goldcorp's stronger consensus rating and higher probable upside, equities research analysts clearly believe Goldcorp is more favorable than Randgold Resources Limited.
This table compares Goldcorp and Randgold Resources Limited's net margins, return on equity and return on assets.
|Net Margins
|Return on Equity
|Return on Assets
|Randgold Resources Limited
Randgold Resources Limited beats Goldcorp on 8 of the 14 factors compared between the two stocks.
Goldcorp Company Profile
Goldcorp Inc. is a gold producer engaged in the operation, exploration, development and acquisition of precious metal properties in Canada, the United States, Mexico, and Central and South America. The Company is engaged in the sale of gold, silver, lead, zinc and copper. The Company's segments include Red Lake Gold Mines Ontario Partnership (Red Lake), Goldcorp Canada Ltd./Goldcorp Inc. (Porcupine), Musselwhite, Les Mines Opinaca Ltee (Eleonore), Minera Penasquito S.A. de C.V. and Camino Rojo S.A. de C.V. (Penasquito), Desarrollos Mineros San Luis S.A. de C.V. (Los Filos), Montana Exploradora de Guatemala S.A. (Marlin), Oroplata S.A. (Cerro Negro), Corredor SpA (Project Corridor), Minera Alumbrera Limited (Alumbrera), El Morro and Pueblo Viejo Dominicana Corporation (Pueblo Viejo). The Company's principal product is gold dore with the refined gold bullion sold primarily in the London spot market.
Randgold Resources Limited Company Profile
Randgold Resources Limited is engaged in gold mining, exploration and related activities. The Company's activities are focused on West and Central Africa. The Company operates through the gold mining segment. The Company operates various mines, such as Morila, Loulo, Gounkoto, Tongon and Kibali. The Company is exploring in African countries, such as Mali, Senegal, Cote d'Ivoire and the Democratic Republic of Congo (DRC). The Company also holds an interest in the Massawa project. The Company holds Morila Limited, which holds interests in the Morila mine in Mali. As of December 31, 2016, Morila mine has produced 122,370 ounces (oz) of gold. The Company holds a controlling interest in the Loulo mine, located in Mali, through Societe des Mines de Loulo SA (Loulo). The Loulo mine is mining from over two underground mines. As of December 31, 2016, Loulo mine has produced 350,604 oz of gold. It has a controlling interest in the Gounkoto mine through Societe des Mines de Gounkoto SA.
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From The Atlantic
It's not easy to compare them, but we're giving it a shot.
In Boston, that pesky paperwork you're supposed to fill out comes to you.
Mobile vendors selling clothes and shoes instead of food are popping up all over the place. How should cities treat them?
City streets are bursting with a gutsy, high-low mash up of street food and haute cuisine, old country flavors and new-fangled cooking techniques.
Tough permit rules, location regulations, and rigorous inspections make the city so known for its food one of the least hospitable to food trucks in the country.
The Coolhaus truck serves up scoops with a modernist twist.


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Welcome to BANDGAP.xyz, an electronic newsletter produced by the committee of the Institute of Physics' Semiconductor group.
Semiconductor physics is one of the major areas of condensed matter science and forms the core of modern solid-state device technology. The Institute of Physics' Semiconductor Physics Group was formed in 1982 in response to the need for a common forum for industrial and university researchers concerned with the physics, preparation and application of semiconducting materials and device structures. The group contains a large number of members, and they have a broad range of backgrounds often extending beyond physics to electronics, chemistry, and materials science. The group has always interacted closely with government funding bodies.
We are very active in supporting students and early career researchers, through conference funds, and in the organisation of scientific meetings and conferences. Please see our funding and events pages for more information.
March, 2016 - New Early Career Researchers Fund for group members
The IOP have established up a new fund to support to early career researchers who are group members to attend international meetings and visit international facilities. Applications are considered, for up to £300, view more details on the Early Career Researchers Fund and other support and grants available from IOP. A flier for the new fund is also available to download.
August, 2015 - Communication competition results
The group held a communication competition at the UK Semiconductors conference, which was extremely successful. The quality of the presentations was very high indeed. First place went to Jonathan Roberts from Lancaster University, for his talk titled "Nano-Fingerprints: Tiny Gadgets for a Big Cause":
A selection of other videos from the day are available in our media page.


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Richardson has a network of partners that enables us to expand our capabilites in order to best meet the needs of our clients. Our partnership network includes the categories below. Please click on one of the following links to learn more about each network and the programs that we have in place.
If you would like to discuss a potential partnership with Richardson, please contact us at Tel: 215-940-9255 or firstname.lastname@example.com.


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baxter Archives
D-backs CEO Derrick Hall answers fan questions
May 12, 2016 by in Experience AZ Magazine | Play
Each month Arizona Diamondbacks CEO and President Derrick Hall answers questions from fans, and for the first time Hall answered fan questions on reddit, a message-board style social network. The questions were posted on one of reddit's subpages, otherwise known as subreddits, called r/baseball. Hall started answering questions at 2 p.m., Thursday, and lasted for about… Read More →
First Job: Matt Likens, CEO Of Ulthera, Inc.
February 20, 2012 by in AZ Business Magazine | Healthcare
Matt Likens, CEO of Ulthera, Inc., discusses her first job working on a muck farm on Ohio, his first job in the healthcare industry, his biggest mentor and more. Matt Likens Title: CEO Company: Ulthera, Inc. What was your very first job? When I was 10 years old, my brother — who is two years… Read More →


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Shantha Kumar, N and Rao, Janardhana N (2004) Estimation of Stability and Control Derivatives of Light Canard Research Aircraft from Flight Data. Defence Science journal, 54 (3). pp. 277-292. ISSN 0011-748XFull text available as:
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In this paper, stability and control derivatives of light canard research aircraft generated through the flight test using the parameter estimation technique has been presented. The maximum likelihood estimation, based on the output-error minimization technique, is used to estimate the derivatives from the aircraft response data. The validity of the estimates has been checked by the cross validation method, wherein the estimated model response is matched with the flight-test data that are not used for estimating derivatives.
|Item Type:
|Journal Article
|AERONAUTICS > Avionics & Aircraft Instrumentation
|Flight Mechanics and Control Division, Systems Engineering Division
|Depositing User:
|Mr. Shantha Kumar N
|Date Deposited:
|30 Jun 2010 12:42
|Last Modified:
|30 Jun 2010 12:42
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Sapphire Princess 7-day Mexican Riviera Cruise 1/17/09: Sapphire Princess Cruise Review by Ahhh
Overall Member Rating
Sapphire Princess 7-day Mexican Riviera Cruise 1/17/09
Destination: Mexican Riviera
Embarkation: Los Angeles
I arrived at the San Pedro dock at 10:45, having just disembarked from the Norwegian Star docked next door. Check in was quick and easy with few passengers at that hour. I waited till 11:45 for the first boarding announcement, and to my pleasant surprise cabins were ready. I have learned to carry on all my luggage so I don't have to wait for it to be delivered and can begin unpacking and "nesting" immediately. My cabin mate, and long time friend Rick, would be checking in later. This would be his first cruise.
Princess puts name tags at each cabin door which also color codes what level the occupants have sailed with this line. I would guess that more than half the ship were first time cruisers. It was priced VERY attractively, and thus attracted a lot of new guests.
I pretty much got settled in when I received a call from Rick that his shuttle was about 10 More minutes away so I got off the ship to help expedite his embarkation. It was a breeze and we were both on board in less than 20 minutes. We got him settled into the cabin, an oceanview on deck 10 forward, and headed out to explore the ship and have lunch at the Horizon Court Buffet. It's always exciting to see a cruise thru the eyes of a first timer. We went back to our cabin before muster and took a half hour "cat nap". We enjoyed sailaway from the top decks, mid ship, at 4:00. It's always exciting hearing the horn blow! Then we set out to explore more of the ship before taking another nap and a buffet dinner. In the Writing Room, on deck 5, we noticed a table set out with a couple of jigsaw puzzles. That got us hooked for the rest of the cruise. During the week we would spend an hour or so relaxing and adding pieces, to come back later finding others had done the same. Wandering around a bit more we decided to retire early so we would be refreshed for the rest of our trip. The beds were VERY comfortable and we both slept very well, being (barely) rocked to sleep by mother nature's ocean.
Sunday was a sea day so I got up early, went for a power walk and headed to Club Fusion for the 9:30 dance class. It was taught by one of the activity staff and today she was teaching Meringue. Turns out my partner was her mother, from Australia, who was enjoying a week with her daughter she hadn't seen in a few months. It was a fun class that was taught well. After a quick breakfast up at Windjammer I met Rick in the Wheelhouse for Trivia. We did quite well, so much in fact that a woman approached us to be part of her team with her husband for the afternoon game. We found the puzzles beckoning us before an afternoon nap and room service luncheon (such a rough life at sea). By this time is was 4:00 and we met up with Tom and Kay and their traveling friends, Dave and Joanie, for Trivia. We tied for first place with another group and won the match game! We quickly became friends for the rest of the cruise. They are a lovely couple who live part time on their sailboat in Marina Del Rey. Our cabin neighbors were three Southern, married ladies, in their early 60's, who left their husbands at home. They occupied a large, forward suite with a balcony that wrapped around one third of the front of the ship. They were a lot of fun!
I would say that the average age on this sailing was 45-50. A bit older than my previous week on Norwegian Star, which I would say was 35-40. There were not too many kids on this sailing and they all seemed to be well occupied and fairly invisible. I retired to my cabin for another nap while Rick stayed for cocktails. Later I met up with Rick for a stroll around the Promenade and a late buffet dinner.
One of the things I like about Princess is that their buffet is open 24 hrs. I also like that the Sapphire has a complete wrap around Promenade, especially the area at the bow. It's a great place for looking out over the ocean, sky and stars. The rest of the evening was spend wandering around enjoying the visual delights of ship life. Princess offers a lot of evening options for entertainment. We did not go to the show in the main theater or to any of the lounges other than peeking in, but there was a lot going on. The Sapphire has one main Dining Room on deck 6 aft, for traditional dining, and four smaller dining rooms on decks 5 and 6 mid ship for their "Anytime Dining" option. Each of the four smaller dining rooms has its own theme of decor, "Tex-Mex", "Asian", "Italian", and "Steakhouse", that you can make reservations at or just show up and be seated, if there is not a waiting list. We found the food to be very good although we both felt the desserts to be lacking. One night there were three excellent choices, which were hard to choose from, but most nights it was hard to find just one.
The next morning (a sea day) Rick was up early and doing his own thing while I went to the gym and spa for a nice steam and shower. Afterward I went to the Cha Cha class. The dance classes were well attended on this voyage with at least 50 in each class. Afterward I dashed off to meet up with my team for Trivia (we tied again) and an hour of socializing before a buffet lunch with Rick and a walk on the top decks. By this time we were passing Cabo San Lucas off the starboard side, a few miles away, where a Carnival ship was anchored for the day. I always enjoy seeing other ships at sea and trying to figure out which ones they are. It is in this area that one can usually see whales and dolphins and we were not disappointed. We made it up to the bow to see schools of them and few whales, in addition to a very large sea turtle, my first sighting on a cruise! We decided it might be interesting and fun to go to Afternoon Tea, held in one of the smaller dining rooms, seeing that the Red Hat Ladies were scheduled there at the same time. There was not a table for two available so we opted to share a table with others and were seated at a table for 8, that currently had one young lady seated at it. Upon sitting she said "We have to sit together, I guess, since there are no single tables", a fine 'How are you' was never uttered more graciously! Poor unhappy soul. We were polite and were soon joined by another single young lady who got the same welcome from our table mate. Our second companion was much more friendly and we had a lovely time chatting. The Tea Service was not exactly what I would consider the best service. Although they wore white gloves, the 'high' service ended there. Upon entering the room there was a nice display of many different types of tea we were expecting to be offered, but they were only serving Lipton. We had to ask twice for something different. The sandwiches and such were nothing special and we really had to try to catch the eye of the servers or we would have had nothing to eat. There were no 'Red Hats' to be found and despite all this we were still glad we checked it out. Afterward "Mama Mia" was playing in the main theater so ducked our heads in to see part of it on the big screen. From there we went to the 'Rainbow Get-Together' where we met Jim, John, and Steve, who became our other buddies for the cruise. After dinner we checked out the puzzle and went for a hot tub in the Lotus Spa area before retiring.
Tuesday morning we arrived in Puerto Vallarta where it was nice and warm. After a walk on deck, the gym, and a spa shower we had breakfast in the cabin, watching some of the Presidential Inauguration, before taking a local bus to town. Rick had not been here before so we toured around a bit, saw the main church, hit a couple of shops and headed to the beach to relax for the rest of the day. We decided to separate as Rick wanted to take photos and I was Jones'n to get back on the ship before checking emails at the local Internet Cafe. We met up later onboard and had drinks with our new friends at the Rainbow Get-Together, which were always hosted by one of the ship's staff. I then headed off to the Latin Ballroom Review to practice what I had learned before dinner. The rest of the evening was spent wandering about the ship checking out the nightlife with Rick, including a stop at the puzzle table.
The next morning, when we awakened, we were already docked in Mazatlan. While on the beach in PV I stepped on a small sliver of glass or a bee stinger or something. It bothered me for about an hour but then it went away. I think dancing must have acerbated it, because when I woke up it was hard to walk. I figured I'd best have it checked out by the ship's doctor. He examined it and noticed a red spot but decided to do nothing (much to my disappointment). I asked him to help take the bite out of the $60 fee by showing me the Morgue (I figured I could at least get a tour out of this). He reluctantly obliged. I'd always wanted to see one since I knew each ship has them. Don't know what I'll have to do to see the jail! Since I had been to Mazatlan numerous times, including the previous week, I decided to stay on board and enjoy the relative solitude of the ship while Rick ventured ashore. I took advantage of the onboard laundromat, wrote in my journal and went to the gym. I stepped off the ship to check emails at the convenient Internet Cafe, in the terminal, and ran into Steve at the dockside bar. We shared stories and did some interesting people watching, including watching a young man in his 20's intent on getting drunk. After numerous beers and shots, he puked. I'm sure his parents were pleased when they came across him, coming back from their excursion. I met up with Rick for a late lunch before sailaway, on the top mid-ship deck, where we enjoyed 360 degree views. Mazatlan is a great port for sailaway as it is geographically interesting. Again we met up with our friends at the Rainbow Get-Together, before changing for dinner. I stuck my head into the main theater for the show but was not impressed with the performances. It did not seem to me that their hearts were into it, and having experienced some of the best performers I've seen at sea the prior week, it was a tough act to follow. After dinner we wandered around the ship, again checking out the nightlife and the puzzle table.
Thursday we arrived in Cabo and slept in knowing we would be staying on board. Cabo is one of those ports you don't need to get off to enjoy as the beauty is there to behold from the anchored ship. We met up with our team for Trivia and caught up on all the things we did the past couple days. At 1:45 it was "Anchors Away" and we set sail for the journey back. Afterward I went to Salsa class and a walk around the Promenade deck where I ran into Kay and Tom for a nice long chat with views of the coastline and dolphins. This was followed by afternoon Trivia, the gym & spa. Rick and I attended the Repeat Guests Cocktail Party hosted by the Captain, then off to the puzzle table. Being Formal Night we enjoyed the parade of visual delights all evening. This was climaxed by the famous Princess Champagne Waterfall in the Atrium at 11:30 pm. It's all so corny but fun to witness. They do it up big with live music, a countdown, and lots of streamers from all the balconies of the Atrium.
Our last sea day was Friday and I slept in till very late while Rick quietly left the cabin and did his thing. After a nice hot shower and steam at the spa it was time for morning Trivia. Again, we tied for first! This was followed by a long brisk walk and lunch at the Windjammer. The rest of the afternoon was spent relaxing, going to the gym and enjoying the ship before afternoon Trivia where we were the final winners and each got a Princess Cap (the one prize I was really wanting!). Rick and I then went to say farewell to our other friends where we were all treated to free champagne by our hostess. We enjoyed our last dinner on board and spent the evening in the Atrium relaxing, people watching, and chatting with our friends before retiring to our cabin to start packing. That chore worked up an appetite so we went out for a late night snack and fresh air.
The next morning we finished packing before a buffet breakfast and made our way off the ship. We rented a car and compared the Sapphire Princess to the Queen Mary, permanently docked in Long Beach, which we took a 4 hour tour of. Although once beautiful, today we prefer the Sapphire. Less
Published 02/18/09
Cabin review: OV Oceanview (obstructed view)
There was plenty of storage space and the closet is very large!Read All Oceanview (obstructed view) (OV) Reviews >>
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While a lot of the fans of Spacetime Studios titles are currently working their way through the latest MMO to come from Spacetime Studios, called Arcane Legends, the company is still hard at work bringing content to all of their other MMO titles. Their first release was Pocket Legends, a fantasy-themed MMORPG that has over 8 million downloads, and has gotten a rather large content update which comes with two new playable classes: the Rhino Paladin and the Vixen Ranger.
However, two new playable classes is just the beginning for what comes with this new content update. There is also a new Elite boss fight to take part in, where you and some friends can team up and try to take down a Level 76 Red Dragon. Along with a new Elite boss fight there also happens to be a whole new heroic dungeons for you and your crew to work your way through.
Pocket Legends update changelog:
– New Elite Boss fight: Battle a level 76 Red Dragon
– New Dungeons: Including a heroic instance; the Dragonet of Fire Forest just got meaner in the "Forgotten Forest"
– New 3 vs. 3 Capture the Flag PVP map: Fight for flags and glory in the Burning Flats
– New Ranks: Two original options for all existing classes skills
– New Items: Including exclusive vanity drops for previously existing characters
– New Low Level Drops: Better weapons and shields for lower leveled characters
– Return of Winterfest: Pocket Legends' X-Mas celebration returns with new vanity drops and store items
PvP fans got some goodies with this update as well including a new 3v3 Capture the Flag map to dominate. Since it is the holiday season after all, Winterfest has returned to the game was well for players to take part in and enjoy all the holiday-themed goodies that come along with Winterfest.
If you haven't downloaded the content update yet, you can do so at any time as the update has been live for a couple of days now.
Google Play Link: Pocket Legends


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Does anyone have a personal experience? I didn't even know it was possible, let alone that most babies do that naturally. It's not how we imagined our first hour with the newborn, but would be willing to adjust if this technique is worth it!
I think it's really neat but I'd not do it in real life.
I've seen it happen! Its pretty awesome to watch.
Wow, great video! DS did crawl up my belly to the breast but was latched on by our nurse.
N, wife to my goofball K and mamma to my EC grad D (July 2010) and my new little love S (May 2013). Exploring the uncharted territory of tandem nursing with my two boys.
My DD (now 13 mos and still EBF) did this. After birth I laid her on my chest so I could have a bit of a rest and she seemed to start "sniffing" around and pulling herself towards my breast. The best way I can describe her movement would be to imagine a blind vampire sniffing and bobbing around someone's neck while trying to find the jugular vein. That is what my DD looked like while looking for my nipple to latch on. It took her a while (like I said, blind vampire), but she eventually got there and latched on her own. We used this method near exclusively for the first few days for a few reasons: I got to lay down (yay!), she got to latch on and nurse in what was the most natural for her, and my husband thought it was a really cool trick.
Chrisa, you mentioned that this isn't how you imagine your first hour with your newborn but I have to say that this was, for me, the best thing to do. I got to lay back and watch while she did most of the work!
Witty, what a wonderful testimony, thank you for sharing!
I should clarify that I would LOVE to be able to do it with my baby; when I said it's not how I imagined the first hour, I was thinking about my husband - I had assumed he'd really want to hold the baby right away and didn't want to deprive him of that experience. But I showed him the video and now he's is up for doing the breast crawl!
You're welcome! My husband kept wanting to time DD !!!! A few sharp looks from me nipped that in the bud, though I think he was keeping score in his head.
Fledgling midwife on hiatus, Wife to B, mama to C (c/s 12/04) and S (12/07), m/c (3/12) and expecting another bean 6/13 .
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