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The New Jersey Medical School Global Tuberculosis Institute is the TB Regional Training and Medical Consultation Center (RTMCC) for the northeastern region of the United States, funded through the New Jersey Department of Health and Senior Services with funds awarded through Cooperative Agreement U52/CCU200506, Centers for Disease Control and Prevention.
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Dear Colleague:
Summer is finally upon us, and for many of us that means reuniting with members of our TB "family" at the National TB Conference in Atlanta. For myself and my colleagues here at the Global TB Institute, this is one of the few times each year when we have the opportunity to convene as a region and discuss the challenges you're facing in your project areas and what we can do to support you.
The National TB Conference had a panel called "The Faces and Voices of TB" which included Jigna Rao, and Raquel Orduno, both of whom who became powerful patient voices for TB after being diagnosed with the disease. Jigna and Raquel are highlighted in the two newest issues of our TB & Cultural Competency Newsletter. These issues explore the role of patients in global TB control and elimination efforts, and you can read more about them in this installment of the Northeastern Spotlight.
Also in this issue of the Northeastern Spotlight, we delve into research around the growing challenge of Latent TB and Type 2 Diabetes in Mexican-Americans. Two of our most popular webinars from this spring—TB Among the Homeless and Head to Toe: Case Studies of Extra-Pulmonary TB—are now archived on our website. We also take a closer look at the Philadelphia World TB Day event as well as an entertaining appraisal of TB in TV episodes in the Lighter Side segment.
While being interviewed for her profile in this issue, Lisa Paulos remarked that "It's been so great meeting people at the NTCA and TB PEN conferences, and having the chance to call other states and ask them questions.... This is a big reason why I really like my job." I'd like to echo Lisa's sentiment: Collaborating with so many wonderful partners is one of the best parts of our work. I hope you have an enjoyable summer, and my colleagues and I look forward to seeing many of you at the TB-ETN/TB-PEN Conference in September.
Lee B. Reichman, MD, MPH
Executive Director
Northeastern RTMCC and the
Global Tuberculosis Institute
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Product Spotlight: TB & Cultural Competency Newsletters
This spring, two issues of the Northeastern RTMCC's newsletter TB and Cultural Competency: Notes from the Field explore the role of persons affected by TB in global TB control and elimination efforts. Each issue features a woman who emerged from a solitary struggle with TB diagnosis and treatment to build a support network around her, reshaping her experience with TB into a powerful voice for the global community of people affected with TB.
TB patients and others affected by TB have the potential to raise public and political awareness of problems and promote solutions to them. They can educate diverse audiences on social, medical, and scientific factors affecting TB control and elimination. Patients can also advocate to promote both individual-level solutions to the challenges of TB control, such as providing navigation for patients to access social services while on TB treatment, as well as global solutions, such as mobilizing funding support for new anti-TB drug development. Both women highlighted in the recent newsletters came from cultures where there is much fear and stigma around TB, and both discovered the strength to move past this stigma and share their stories in order to affect change and raise awareness about TB.
Issue # 14, Finding My Voice, shares the moving story of Jigna Rao, who was diagnosed with pelvic TB after struggling with a series of long and difficult fertility treatments. Although Jigna made a full recovery from the disease, the experience changed her life. She had to give up her dreams of motherhood and accept that she would not become pregnant. Moreover, she experienced how the stigma associated with TB can increase patients' sense of loneliness and isolation, making it more difficult to reach out for the knowledge and support needed for good treatment outcomes. Over the past several years Jigna has spoken to patients, health care providers, and reporters to share her experience and raise awareness of TB and its impact on women.
Issue #15 of the newsletter, From Isolation to Vocation, highlights the experience of Raquel del Consuelo Orduño, who grew up on both sides of the U.S.-Mexico border in a bicultural, bi-national family. Although TB incidence along the border is higher than the national average in either Mexico or the United States, she heard little about TB from family members or healthcare providers as a child and then as a teacher in El Paso, Texas. In her mid-thirties, after three years of misdiagnoses with other pulmonary infections, respiratory infections, and asthma, Raquel learned she had pulmonary TB. Her physical health began to improve once she started treatment, but it seemed all other aspects of her life were thrown into jeopardy by the diagnosis.
The newsletter describes Raquel's personal journey, and her experiences with an innovative strategy called Photovoice, which promotes advocacy by people who have been affected by TB. Photovoice projects bring together a small group of people directly impacted by a social issue to document the issue in their own lives and communities through photography over the course of several weeks. Based on their photographs and important themes emerging from them, the group members shape their own interpretation and representation of the problem. The group then presents its photo project in public settings to raise awareness and inform policy development on the issue it addressed.
TB Photovoice projects in the US, Thailand, Brazil, the US-Mexican border, South Africa, the Philippines, and Kenya have brought the experiences of people who are treated for TB into local, national, and international policy discussions, and help put a human face on the complex, persistent challenges of TB around the world.
The experiences of Jigna and Raquel reveal how advocates from communities and subpopulations most affected by TB can help providers develop their competency to work effectively with these populations. Both stories highlighted in TB and Cultural Competency demonstrate the value of advocacy inspired and informed by deep, experiential knowledge of the cultural and social contexts within which people receive a TB diagnosis and undergo treatment.
Issues of the TB & Cultural Competency Newsletter are available here
Submitted by Julie Franks, PhD
Health Educator and Evaluator
Charles P. Felton National TB Center, ICAP, Columbia University
Behavioral/Social Science Article: Latent TB and Type 2 Diabetes in Mexican-Americans
There is growing awareness of the association of tuberculosis and diabetes, with the risk of TB attributable to Type 2 diabetes mellitus estimated to be between 15% and 25%.1 In the United States, this association appears to be more common in certain minority groups, including Mexican-Americans*. This article will review information about the prevalence of these two diseases, with special attention to knowledge and attitudes in Mexican-Americans.
Latent TB Infection Rates in Mexican-Americans
Because of the movement of individuals across the southern border, Mexican-Americans comprise the largest foreign-born group affected by TB in the US. A study using data from the National Health and Nutrition Examination Survey found that 9.4% of Mexican-Americans had LTBI (representing almost 2 million individuals), compared to 5.7% in the general US adult population, a difference that remained statistically significant after controlling for income.
Diabetes Rates in Mexican-Americans
There are more than 25 million diabetics in the US, almost all (95%) of whom have Type 2 diabetes mellitus (DM2), formerly called "adult-onset" diabetes. DM2 is characterized by recurrent or persistent hyperglycemia, measured by levels of glycated hemoglobin (HbA1c). HbA1c levels greater than or equal to 6.2% indicate poor glucose control.
The prevalence of DM2 is significantly higher in people with low socioeconomic status (SES), as is poor glucose control, undiagnosed DM2, and DM2 complications. Mexican-Americans are almost twice as likely as non-Hispanic whites to be diagnosed with DM2; the prevalence rate is 10.4/100,000 compared to 5.2/100,000 in non-Hispanic whites, standardized by age and sex. Mexican-Americans have higher rates of DM2 complications such as end-stage renal disease, and they are 50% more likely to die from DM2 as non-Hispanic whites.
Studies exploring the prevalence of DM2 in Mexican-Americans point to the relation between poor glucose control and such SES variables as lack of health insurance and low levels of education. Hispanic populations share the same risk factors for DM2 as other groups: obesity, lack of exercise, excess calorie intake, and unhealthy diet choices. But while there may be an unexplained role for genetics, Hispanic populations are more likely to have a sedentary lifestyle and to be overweight or obese in comparison to non-Hispanic whites. In a study of Mexican-Americans in south Texas, approximately 75% were found to have poor glucose control.
TB Knowledge, Attitudes, and Beliefs among Mexican-Americans
The health psychology literature suggests that health-protective behaviors, such as the decision to accept or adhere to treatment, are influenced by diverse cultural factors including individuals' knowledge, attitudes, and beliefs (KAB). Deficiencies in knowledge, misperceptions, and negative attitudes toward TB may serve as significant barriers to the acceptance and completion of LTBI treatment. Conversely, greater patient understanding of TB etiology, transmission, and disease management has been associated with positive health-seeking behaviors and better individual experiences with TB. These have been linked to more favorable health outcomes such as higher rates of treatment adherence and completion.
A small set of qualitative studies with small samples have examined KAB specifically in Mexican-American populations. McEwen and colleagues note 2, 3 that the treatment of TB and LTBI varies greatly between the US and Mexico. Because TB is so prevalent in Mexico, nearly all citizens receive the Bacille Calmette-Guerin (BCG) vaccination and TB is viewed as a fatal disease, leading to a great deal of stigma. BCG is viewed as offering lifelong protection for TB and even against other diseases such as chicken pox and measles. Individuals are told that positive Tuberculin Skin Test (TST) results are due to
BCG vaccination and are generally unaware of the distinction between disease and infection (a misconception which is common in many other groups).
Misconceptions about transmission through kissing, food, and sharing of utensils were found.4, 5 Evidence of stigma was substantial as some respondents reported that they would isolate themselves if found to have TB. Additionally, many said that after TB patients die, all their belongings should be burned. While most viewed TB as a serious disease, those who did not speak English were more likely to underestimate their risk.4
Impact on Adherence/Completion: Several studies reported barriers to treatment for Mexican-Americans, including lack of transportation, clinic hours, cost, inconvenient clinic location, and communication problems with staff.4 Because of conflicting information about TB/LTBI received in Mexico and America, McEwen found Mexican-Americans to be suspicious of LTBI treatment suggestions from US health care providers. Some participants reported doubts but did not want to take the risk of developing active disease, thereby deciding to comply with LTBI treatment.2 Others reacted to subtle coercion to take LTBI treatment by engaging in "false compliance" – these patients were willing to begin treatment but gradually stopped taking the medicines without telling their doctor. McEwen and Boyle3 suggest that this constitutes a way for people of low socioeconomic status to assert control against more powerful medical providers. Those who do report non-adherence often use medical language (claiming such side effects as elevated blood pressure) to explain why they stopped treatment.
Diabetes Knowledge, Attitudes, and Beliefs among Mexican-Americans
Few studies have examined knowledge, attitudes, and beliefs (KAB) about diabetes (DM) in Mexican-Americans. A study of DM patients' knowledge of HbA1c levels found that Hispanics were significantly less likely to know their level of glucose control when compared to other groups. However, the study acknowledged that this finding was confounded by Hispanics' lower education levels.6 In general, only 25% of Hispanic study participants could accurately report their HbA1c level, while 66% could not offer a number.6 Knowing one's HbA1c level was associated with better knowledge of DM care, better provider communication, and higher education levels. However, some researchers suggest that improving knowledge about a particular disease may not have much impact on improving adherence to medications or other medical directives. In Heisler's study,6 knowledge of HbA1c was not associated with such outcomes as DM care self-efficacy or reported self-management behaviors.
In terms of attitudes, DM patients tend to be motivated by their perceptions of the likelihood of certain outcomes, the impact on their daily lives, personal control, and treatment efficacy. While health psychology studies have generally shown that perceptions of disease seriousness are associated with treatment acceptance and adherence, DM studies have shown mixed results, with high perceived threat often associated with poor adherence and non-attendance at clinic. These studies were not specific to Mexican-Americans, but they suggest that certain attitudinal factors, along with poor knowledge, may play a role in poor control of DM in this population.
As the number of diabetics increases, much more needs to be learned about the association of TB and diabetes, particularly in minority populations in the United States. Further concern comes from the fact that certain groups, such as Mexican-Americans, are viewed as poor adherers to both LTBI and DM2 treatment, separately. Patients undergoing LTBI treatment typically take a daily pill of isoniazid for nine months, despite not having symptoms, and must visit their healthcare provider monthly. DM2 patients are on life-long treatment, which includes varying amounts of medications, self-testing, self-care, and dietary and exercise mandates.
While adherence studies of TB and DM2 co-therapy have not been conducted, it would seem that optimal adherence to both regimens will be difficult to achieve. Certainly, factors other than KAB (eg. health care access, communication between TB and DM2 providers, community awareness) play an important role and need to be studied. Further, innovative, culturally-tailored interventions are needed to provide support for individuals undergoing treatment for both conditions.
Submitted by Paul Colson, PhD, Program Director, and Julie Franks, PhD, Health Educator and Evaluator
Charles P. Felton National TB Center.
Thanks to Blanca Restrepo, PhD, UTHealth, School of Public Health - Brownsville
1. Restrepo BI, Camerlin AJ, Rahbar MH, Wang W, Restrepo MA, Zarate I, et al. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bulletin of the World Health Organization. 2011;89(5):352-9. Epub 2011/05/11. doi: 10.2471/BLT.10.085738. PubMed PMID: 21556303; PubMed Central PMCID: PMC3089389.
2. McEwen MM. Mexican immigrants' explanatory model of latent tuberculosis infection. Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society. 2005;16(4):347-55. Epub 2005/09/15. doi: 10.1177/1043659605278943. PubMed PMID: 16160197.
3. McEwen MM, Boyle J. Resistance, health, and latent tuberculosis infection: Mexican immigrants at the U.S.-Mexico border. Research and theory for nursing practice. 2007;21(3):185-97. Epub 2007/09/14. PubMed PMID: 17849651.
4. Joseph HA, Waldman K, Rawls C, Wilce M, Shrestha-Kuwahara R. TB perspectives among a sample of Mexicans in the United States: results from an ethnographic study. Journal of immigrant and minority health / Center for Minority Public Health. 2008;10(2):177-85. Epub 2007/06/09. doi: 10.1007/s10903-007-9067-5. PubMed PMID: 17557205.
5. Poss JE. The meanings of tuberculosis for Mexican migrant farmworkers in the United States. Social science & medicine. 1998;47(2):195-202. Epub 1998/08/28. PubMed PMID: 9720638.
6. Heisler M, Piette JD, Spencer M, Kieffer E, Vijan S. The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management. Diabetes care. 2005;28(4):816-22. Epub 2005/03/29. PubMed PMID: 15793179.
Profile—Lisa Paulos, RN, MPH, Pennsylvania TB Program Manager
Lisa Paulos, TB Program Manager for Pennsylvania, started her career in healthcare as a candy striper at a local hospital during high school. "Both of my parents were teachers, but they strongly discouraged me from becoming a teacher," Lisa recalls. "I always liked science so I looked into becoming a doctor, nutritionist, or dietician, but I ultimately went with nursing because of the holistic approach to caring for people."
For the next 25 years, Lisa worked as a nurse in hospital, outpatient, and primary care settings, first in Seattle and then in Wisconsin. She had always had an interest in public health, and in 2007 she decided to transition out of direct patient care and enrolled in a Masters of Public Health program at the University of Wisconsin. Her family moved to York, PA in 2008 due to her husband's job, and Lisa continued her MPH studies at Johns Hopkins while working part time at a mobile clinic.
"I had never heard of a mobile clinic before, but I wanted to work with the population it served—the uninsured. And I think a mobile clinic is kind of cool! There was an MD/NP, myself, and an assistant who drove the vehicle and did the administrative work. We saw a lot of immigrants and people recently released from prisons, and we carried stock medications and vaccines and did basic lab testing in the vehicle. It would go different places in two counties--some places we'd go every week and other places we'd visit once or twice a month. It was a very tiny space, so I had to get used to working in very close quarters, and I was constantly squeezing by and bumping into people. We did a lot of referrals and connecting people to other sources of low cost care, such as Federally Qualified Health Centers. We are also fortunate to have the Healthy York Network, a program for people who don't qualify for Medicare but can't afford medical insurance. Patients can be seen by a network of physicians, as well as three hospitals where patients can get lab tests and imaging studies. A big part of my job was hooking patients into all the resources available in the community."
In 2010, Lisa graduated with her MPH and became TB Program Manager for Pennsylvania. She took the position because it offered variety—epidemiology, program management, evaluation, and interaction with the field staff. "It was challenging to learn about TB while simultaneously supporting the staff at all the state health centers and local health departments, because each case is so different. And then figuring out how to implement the NTIP indicators and roll those out across the state—I didn't learn to do this in school!"
Despite being in her position for just over a year, Lisa is already able to point to some early successes. "A big focus of my first year was reaching out to field staff and making connections with them. I've enjoyed getting staff trainings up and going for them. The staff feels it's such a complex disease, and they're really appreciative of the guidance and support we offer." Lisa's next project is to roll out cohort reviews in Pennsylvania. "We did a webinar earlier in the year introducing cohort reviews and going over what the objectives are and why we do it. Most of the state health centers and local health departments do an annual audit with a doctor other than the one who provided care, and I've been presenting this process as being similar and providing even more focused feedback. It's a year-long process to get cohort reviews up and running, but it's fun because it's a great tool and we'll benefit from it."
When she's not nurturing the TB program, Lisa enjoys tending her garden. "I don't do so well growing flowers!" Lisa says, laughing. She generally sticks with fruits and vegetables, especially tomatoes and basil. She's so used to the produce from her garden that she can't buy tomatoes from the grocery store anymore. She tries to grow enough that she can freeze some for later. "When I eat them, it feels like springtime in the middle of winter."
Baking is another hobby, and Lisa has a family tradition of making a birthday cake of her children's choice on their birthday—they pick the flavor and she makes it from scratch. "One year my son requested a Reese's Peanut Butter Cup cake, but homemade. This was a while back, and I couldn't find a recipe for homemade peanut butter frosting so I had to make it up."
One fun fact about Lisa is that she used to be a competitive long distance runner in high school and college. A couple years ago Lisa's kids were in cross country at school, and Lisa and her husband decided it would improve their health if they started running as well. They began in June on the track, one lap at a time, with a goal of running the Turkey Trot in November. "It hurts a lot more than it used to," Lisa lamented, "but it's still very fun. There are a lot of hills around here which makes it challenging to run. We like to run around the neighborhood or go down to the Heritage Rail Trail, which are old railroad tracks that have been graveled over. It's nice and flat, so we'll go there when we need a break from the hills!"
Community is important to Lisa, and it's something she really appreciates working in TB. "It's been so great meeting people at the NTCA and TB PEN conferences, and having the chance to call other states and ask them questions. Working with the field staff and physicians and the RTMCC has been a positive experience across the board, and everyone I've worked with has been great. This is a big reason why I really like my job."
We'd like to extend a big thanks to Lisa for being such a caring and enthusiastic member of the TB community!
Submitted by
Nickolette Gaglia, MPH
Training and Consultation Specialist
NJMS Global Tuberculosis Institute
Recently Archived Webinars on TB Among the Homeless and Extra-Pulmonary TB
As noted in the last issue of this newsletter, GTBI archives completed webinars to ensure continued access, as well as access for those who miss the live webcast. We are pleased to announce that we have added two recently conducted webinars to the archives web page: http://globaltb.njms.rutgers.edu/educationalmaterials/audioarchives.html
On February 7th, over 400 people nationally attended the eye-opening and informative webinar, "TB Among the Homeless: Dealing with Unique Challenges." This 1.5 hour webinar explored tuberculosis among homeless persons and successful prevention and control strategies. It also highlighted the partnership between health departments and shelters to improve the coordination of clinical care and contact investigation outcomes.
Homeless persons suffer disproportionately from a variety of health problems, including tuberculosis. There is increased risk for TB transmission in shelters, especially in situations of crowding and poor ventilation. Detecting, treating and preventing TB in this population benefits not only individual patients but also the larger community. Shelters can help control TB by screening clients, improving ventilation and building relationships with their local health departments. Health departments should build respectful relationships and establish trust with their local shelters.
The program was skillfully moderated by Bill Bower of the Charles P. Felton National TB Center. Dr. James O'Connell of the Boston Health Care for the Homeless Program gave an overview and historical perspective of homelessness and TB. Dean Carpenter from the Tumaini Center in Detroit, Michigan discussed a shelter's perspective. Finally, Monica Heltz from the Marion County Health Department in Indianapolis discussed a case study of a homeless man with TB disease. Monica highlighted many of the unique challenges with TB and homelessness and offered practical solutions for serving homeless clients with TB.
Overall, participants reported they enjoyed the webinar and found it very informative. Several participants commented they felt inspired to reach out to their local shelters to begin building a relationship. This webinar is available at: http://globaltb.njms.rutgers.edu/educationalmaterials/audioarchives.html
More unique challenges were discussed in the March 15th webinar "Head to Toe: Case Studies of Extra-Pulmonary Tuberculosis." Approximately 20% of all cases of TB in the United States are extra-pulmonary, and this webinar highlighted the clinical presentation, diagnosis, and treatment of extra-pulmonary TB through a series of case presentations.
Moderated by Dr. Alfred Lardizabal, the program began with a case of TB lymphadenitis presented by Dr. Elizabeth Talbot of Dartmouth University/FIND Diagnostics. Despite being one of the most common sites of extra-pulmonary disease, TB lymphadenitis poses challenges both in terms of preferred methods for diagnosis as well as potential treatment complications. Dr. Lynn Sosa of the Connecticut TB Control Program presented two cases of genitourinary TB, both of which resulted in miscarriage. Her presentation underscored the importance of testing pregnant women at risk for TB and ensuring appropriate follow-up. Dr. Michelle Paulson of SAIC—Frederick, National Cancer Institute presented a case of TB of the pleura and central nervous system, highlighting the clinical challenges of treating a patient who is also HIV positive. Finally, as promised in the title of the webinar, Dr. Dana Kissner of the Detroit Department of Health & Wellness Promotion concluded the program with her case presentation of TB of the big toe. This webinar can be viewed at: http://globaltb.njms.rutgers.edu/educationalmaterials/audioarchives.html
Submitted by:
Jennifer K. Campbell, MPH, CHES, Training and Consultation Specialist
and Nickolette Gaglia, MPH, Training and Consultation Specialist
NJMS Global Tuberculosis Institute
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Philadelphia Honors World TB Day with New Partners
On March 21, 2012 the Philadelphia Department of Public Health honored Robert Koch's discovery of the M. tuberculosis organism by holding a World TB Day Update for TB control staff in the city and surrounding counties. Over 80 participants came to The Friends Center to participate in the event, which was jointly sponsored by the Charles P. Felton National TB Center, New Jersey Medical School Global Tuberculosis Institute, and UMDNJ-CCOE, in collaboration with Drexel University School of Public Health – a new partner in RTMCC TB training.
The program included updates on clinical, social, and programmatic aspects of tuberculosis. Speakers from the Philadelphia Tuberculosis Control Program included Barry Dickman, MPA – TB Program Director; Christina Dogbey, MPH – Epidemiologist; David Schlossberg, MD – Medical Director; Jane M. Gould, MD – Pediatric TB Consultant; Daniel Dohony, MPH – CDC Public Health Advisor; and Marcelo Fernandez-Viña, MPH – PCSI Coordinator.
Additionally, Dolly Katz, PhD, MPH – Senior Epidemiologist, CDC Division of Tuberculosis Elimination – discussed the soon to be released CDC Guidelines for Prevention and Control of TB in Foreign-Born Persons in the United States. This was followed by a discussion with panelists Natasha Kelemen, MSS – Coordinator of the Philadelphia Refugee Health Collaborative and Refugee Health Coordinator at the Nationalities Service Center and Dr. Marc Altshuler – Director of Thomas Jefferson Hospital's Center for Refugee Health to explore implementation of these guidelines in clinical and community-based organizations in Philadelphia.
More than half of the attendees were nurses, with other health professionals and physicians also well represented. They came from the many hospitals and social services agencies in Philadelphia and nearby counties. A total of 72 respondents completed an online evaluation, giving overwhelmingly positive responses. About half said they would seek additional information on the topics and 22% said they would change their practices. Many stated their desire to have programs like this be longer and more often. This World TB Day Update was recorded in full and will be available on the website of the Philadelphia Department of Health.
Submitted by
Bill L. Bower, MPH, Director of Education and Training
Charles P. Felton National Tuberculosis Center
The Lighter Side: More TB on TV
In this issue of the Spotlight we continue with an amusing look at some TB-related plot twists from TV shows.
Road to Avonlea: Thursday's Child
Set in the early 1900s, eldest daughter Felicity's plans to head to Teacher's College might be derailed because she has absolutely, positively nothing to wear in her closet full of clothes. Meanwhile, middle child Cecily has fallen ill with TB, but no one notices because they're listening to Felicity's sartorial melodrama. Finally annoyed by Cecily's cough, the family calls a doctor who promptly announces that "all symptoms point to consumption, or as my colleagues now refer to it, tuberculosis."
Cecily's parents are concerned not only for their daughter, but also for their livestock. As the issue of bovine TB isn't exactly a hot topic on prime-time TV, the discussion of TB testing for cattle and restrictions on milk from tubercular cows must have struck many baffled viewers as just another "quaint" belief of the era rather than sound practices.
As word of Cecily's diagnosis spreads, the general store where Felicity works is flooded with townsfolk worried about "galloping consumption" and stocking up on lye and disinfectant to scrub their homes. Rather than indulge in a lye-buying extravaganza, Felicity decides to educate herself about the disease by going to see a nearby TB doctor. When she returns home, Felicity tells her parents that the expert doctor advises sending Cecily to a sanatorium. Felicity also announces that she has decided to go to medical school, but I did not watch the next episode to see if it begins with Felicity complaining she has nothing to wear to medical school.
Off the Map: Saved By the Great White Hope
In this medical drama, a new crop of young doctors arrives at a remote jungle clinic, setting the stage for 45 minutes of Adventures in Cultural Incompetency. Dr. Tommy is more interested in vacationing than doctoring, so he's a little upset when the attending immediately orders him to make a house call on a patient with TB, accompanied by a local thirteen year-old named Charlie to act as translator. After trudging over several mountains, Tommy and Charlie arrive at the patient's house, only to find that she has died of TB and her husband and two young children are coughing and feverish.
Through Charlie, the husband says that the antibiotics given by the previous doctor were poisoning his wife; the husband counseled her to stop taking the medicine, but her body couldn't recover and she died. This is the cue for a long rant from Tommy ending with the words "It's your damn fault your wife is dead!" Tommy looks at Charlie expectantly, waiting for him to translate. But even a thirteen year-old boy can recognize that calling the husband a killer is not beneficial to building a strong doctor-patient relationship, and Charlie refuses to translate.
Tommy, in a real display of professionalism, storms out of the house and hikes back to the clinic, only to be ordered to go back and treat every last family member or else leave the country.
Tommy and Charlie arrive back at the house, and Tommy discovers the daughter's symptoms have worsened. When the husband again refuses treatment, Tommy has a mental breakdown. "Stop saying no, damn it! You're a proud man, I respect that. I'm a proud man too. I don't listen to anyone. My parents told me to go to college and study hard, and I just partied."
Tommy recounts his first world problems to the impoverished widower and his dying children, all in English. Then the husband agrees that his family can take the TB medication. Who knows what changed the husband's mind: Maybe he was tired of listening to the doctor drone on in English and just wanted him to leave. Maybe he speaks some English after all, and is impressed by the doctor's epic tales of college parties. At any rate, Tommy returns to the clinic, proud of himself for his accomplishment.
Medical Consultation
GTBI faculty and staff respond to requests from providers seeking medical consultation through:
During each consultation, the GTBI consultants will advise providers of TB Program resources for consultation in their jurisdiction. In addition, TB programs will be informed of TB cases with public health implications such as MDR/XDR-TB, pediatric TB in children <5, or potential outbreak situations.
More information about our consultation service, including downloadable Core TB Resources, can be accessed at Medical Consultant Web-Based Grand Rounds (http://www.umdnj.edu/globaltb/consultation.htm).
Periodically, designated TB program medical consultants are invited to participate in a web-based TB case conference (or grand rounds). Consultants are encouraged to present challenging TB cases on which they would like feedback from their colleagues throughout the Region. The next grand rounds will be held this Fall and we will notify TB programs when a date and time have been established. TB program medical consultants who would like to present a case should contact Dr. Alfred Lardizabal at 973-972-8452 or firstname.lastname@example.com.
Upcoming NE RTMCC Training Courses
Individuals outside of this region who wish to attend our training courses should first contact their Regional Training and Medical Consultation Center to check if a similar course is being offered. If this is not the case, the out-of-region participant may then register for this course.
Click here for the list of upcoming courses.
Links - Other TB Resources
Division of Tuberculosis Elimination
The mission of the Division of Tuberculosis Elimination (DTBE) is to promote health and quality of life by preventing, controlling, and eventually eliminating tuberculosis from the United States, and by collaborating with other countries and international partners in controlling tuberculosis worldwide.
Find TB Resources Website
This website provides a central, comprehensive searchable database of international, national, state, and local TB-related education and training materials for TB healthcare workers, health professionals, patients, and the general public. Users can also submit their education and training materials as well find information on funding opportunities, TB organizations, TB mailing lists, and TB images.
TB Education & Training Network (TB ETN)
The TB Education and Training Network (TB ETN) was formed to bring TB professionals together to network, share resources, and build education and training skills.
Regional Training and Medical Consultation Centers' TB Training and Education Products
This website provides a searchable list of all 4 RTMCCs' resources.
TB-Related News and Journal Items Weekly Update
Provided by the CDC as a public service, subscribers receive:
TB Behavioral and Social Science Listserv
Sponsored by the DTBE of the CDC and the CDC National Prevention Information Network (NPIN), this Listserv provides subscribers the opportunity to exchange information and engage in ongoing discussions about behavioral and social science issues as they relate to tuberculosis prevention and control.
Other RTMCCs
The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming, Federated State of Micronesia, Northern Mariana Islands, Republic of Marshall Islands, American Samoa, Guam, and the Republic of Palau.
The Heartland National Tuberculosis Center serves: Arizona, Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Nebraska, North Dakota, Oklahoma, South Dakota, Texas, and Wisconsin.
The Southeastern National Tuberculosis Center serves: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Puerto Rico, and the U.S. Virgin Islands.
Key Contacts


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Haden misses practice with an oblique injury
-Joe Haden missed practice along with Bubba Ventrone and Dimitri Patterson. Patterson has been out for over a month so that's not a surprise. Ventrone has been banged up all season but was seen in the locker room.
The concerning injury is with Haden who just on Monday was saying how important the last 7 games of the season are for he and his team mates. He also made it clear that he wanted to make a statement against Dallas.
-Now from what I've gathered Haden was hurt early in practice on Wednesday with an oblique injury. He was listed as a limited participant on Wednesday. Today he was listed as non participant and wasn't seen in the locker room.
-Players in the locker room seemed confident that Haden will be able to return but at the same time they all were very cautious when it came to talking about Haden playing this week.
Safety Usama Young placed it best when he said" the good thing is we have some young hungry guys in this locker room that have gained some experience earlier in the year and they are hungry to go out and compete."
- Coach Shurmur was asked what makes Cowboys wide receiver Dez Bryant standout, you just look at him. Physically he's big, he can run and he's got great ball skills so he has all the things you're looking for in a big time threat. (Tony) Romo does a good job of putting the ball where he can go get it."
-With Phil Dawson going into the University Of Texas Hall Of Honor last week and going back to play in Dallas Shurmur was asked what makes Dawson so special, "I think he's one of the outstanding kickers of this league. I'm fond of the way he practices, I'm fond of the way he prepares and he's just clutch.
There are some guys that are just clutch at doing what they do and I think that's what separates some guys from being great too good to not so good. He's displayed by producing the way he does that he's one of the great kickers."
-Shurmur was asked if Josh Gordon compares to Dez Bryant and he agreed but proceeded with caution, "If you just look at him size wise you could probably name off taller, sudden, big receivers. I think you'd start there. I guess I'd hold back on comparisons. I'm going to hold back on that right now."

subset: commoncrawl


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| Tuffle
|Planet Plant
|Average Height
|Smaller than the average Saiyan
|Unknown, presumably Omnivorous
|Sapience Level
Tuffles (ツフル人, Tsufuru-jin) were a highly advanced, technological race of beings native to Planet Plant. However, the planet was later taken over by the Saiyans, leaving the Tuffles on the edge of extinction.
Main article: Origins of character names in Dragon Ball The Japanese name 'Tsufuru-jin' is a pun. Specifically, it is a Japanese pronunciation of the English word "fruit" (or "furutsu"). This implies their opposition to the Saiyan race, whose name is a pun on "vegetable".
The dub name of "Tuffles" possibly linked to "Truffles", another food found in the ground akin to a vegetable.
One difference between truffles and other vegetables is that all the names of Saiyans are "plant" vegetables, while truffles are mushrooms, making them fungi and not plants.
Despite their incredible technologies, the Tuffles were largely a docile race who demonstrated no aggressive tendencies or internal strife. However, the Tuffles co-existed with another race: the Saiyans. Sources concerning how these circumstances arose vary quite drastically. Some sources state the two societies simply evolved alongside one another, while others indicate that the Saiyans were not native to the planet at all.
Accounts of the interactions between the two races is also mixed: the first account (dictated by King Kai) explains that the Tuffles lived in the more fertile areas of Planet Plant in vast cities, while the Saiyan tribes dwelled out in the badlands and the two species rarely, if ever, associated with one another. Dr. Raichi's account (which also states the Saiyans were from another planet) states that the Tuffles welcomed the wayward Saiyan race with open arms and treated them as equals. This is disputed by Vegeta, who retorts that Raichi and the entire Tuffle race regarded the Saiyans as slaves.
Saiyan-Tuffle warEdit
Main article: Saiyan-Tuffle war
Eventually, regardless of their origins, one Saiyan became dominant amongst the collective tribes; a Saiyan that Dr. Raichi described as having "the cunning of a Tuffle". This Saiyan was none other than Vegeta's father and he incited a swift, brutal war against the Tuffles with the intent of eradicating them entirely. The conflict reached a general stalemate since, though they possessed great strength, the Saiyans were vastly outnumbered by the Tuffle populace. The Tuffles were then able to even the odds with their technological prowess. Unfortunately, the war was brought to an end due to the arrival of an event that occured once every hundred years or eight years (depending on the dub): the full-moon.
The entire Saiyan race transformed into their feral Great Ape forms, and, in the space of a single night, the Tuffles were annihilated. Taking what little of the technology that interested them (notably the Scouters and Battle Armor), the Saiyans established their own society amidst the ruins of the Tuffle civilization, crowning King Vegeta and naming the planet after him.
Following the defeat of the Tuffles, the Saiyans met the Arcosians, who paid them to secure a more suitable planet on which to live. Planet Vegeta was later annexed by Frieza, who drafted them to conquer planets, but eventually destroyed the planet along with the Saiyan race.
Despite essentially being exterminated, traces of the Tuffle race managed to survive the war with the Saiyans. The most notorious being Hatchiyack, a machine designed to amplify the "power of hate" in order to aid the Tuffles defeat the Saiyan menace. Its creator was Dr. Raichi, a brilliant scientist who technically died on the same fateful night as the rest of his race, but was later resurrected as a Ghost Warrior by his own creation. Another infamous Tuffle remnant was Baby, a Tuffle biological experiment. Though Baby himself was not an actual Tuffle, he possessed their genetic information (notably that of the last Tuffle King), making him a DNA archive for the race.
Both of these creatures are successfully destroyed by the collective might of the remaining Saiyans and their descendants, thus eradicating the Tuffle species and rendering them completely extinct.
List of TufflesEdit
- Tuffle King
- Dr. Raichi
- Baby (Machine Mutant, genetic archive of the Tuffle King)


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Fish Tattoos For Men
This article focuses on fish tattoos for men. If you are a girl thinking about inking a fish tattoo, please visit the Fish Tattoos For Girls page.
Fish tattoos are a popular design style for men looking to ink a new tattoo. There are a wide range of fish tattoo designs available, offering men a number of options for inking a great design. The fish is an important symbol for Christians, and also holds deep significance in Japanese, Chinese, and Polynesian culture, among others.
The ichthus fish symbol was used in biblical times by Christians to show their faith and identify one another. Followers of Christianity would subtly draw the ichthus symbol on the ground with their feet. This allowed them the display their faith in a covert way, which was necessary as Christians were persecuted at the time. Many Christian tattoo enthusiasts therefore choose to ink this symbol to display their faith to the world, and to remember the early followers and their struggles.
Koi fish designs are another incredibly popular type of fish tattoo. Koi fish have their origins in Japan and China where they are very highly regarded. Koi fish tattoos have come to symbolise good luck, prosperity, and the overcoming of hardships. Koi fish have become incredibly popular among tattoo enthusiasts, and there is a massive variety of designs to choose from.
Click Here To Access The Finest Premium Quality Fish Tattoo Designs
Betta fish (Siamese fighting fish) are another popular species among men looking to ink a colourful fish tattoo. Betta fish are commonly kept by aquarists because of their incredible flowing fins, which range in colour from bright blue through to red and deep purple. Coral reef fish are also good options for men looking to ink very colourful fish tattoo designs. There are thousands of species of reef fish to choose form, and all make fantastic fish tattoos.
Shark tattoos are also incredibly popular among men. The most popular designs tend to be based on the great white, tiger, bull, and hammerhead sharks. As well as the more lifelike designs, there are also some fantastic abstract tribal style shark tattoo designs. These tribal designs originated in Polynesian societies in the Pacific, where sharks were revered for their power and dominion of the ocean realm.
If you really love the idea of inking a fish tattoo, I recommend browsing through as many top quality designs as you can. Tattoo design books are a good place to find designs, as is the internet. The internet is a really good resource for finding tattoo designs because you can take your time browsing designs from the comfort of your own home. Please be aware however that using search engines to browse free designs can waste a lot of your time, as many of the designs available for free are really poor quality. I recommend that instead of using search engines you join one of the excellent online Tattoo Galleries. While a membership to a top online gallery costs a few dollars, you will get access to thousands of top quality tattoo designs all in one place. A great online gallery for fish tattoos is the Chopper Tattoo online gallery. For a full review of all the membership benefits of the Chopper Tattoo online gallery, please see the Chopper Tattoo Review page.
Another important decision to make is deciding where on your body to ink your chosen design. The Tattoo Body Areas section of this website provides in depth information and advice relating to all of the most commonly tattooed areas of the body, and is essential reading for anyone planning a new tattoo.
If you are a tattoo newbie, I recommend that you also head over to the Tattoo Info section for advice about planning a tattoo, safety considerations, aftercare tips, and much more.


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The article aims to illustrate the complexity of institutional restructuring dynamics in distinct South African university contexts, in order to highlight the challenges posed for the initial teacher education system. It focuses on education faculties and schools that have undergone successive waves of internally and externally mandated change over the last ten years. The first section demonstrates that there is a simple and a complex form of merger, characterized by varying degrees of integration, subordination or cessation of the former institutional configurations. This means that at the micro-level, in planning and implementing their initial teacher education programmes, some institutions are faced with reconciling diverse groups of academics with distinct histories, expertise and commitments. The second section of the article attempts to delineate the impact on initial teacher education programmes and curriculum. The article concludes with a consideration of the challenges for the relationship of teacher education providers with the National Department of Education, with institutional leadership and within faculties or schools.
Full text available as: Pdf
|Document Title:
|Trajectories of restructuring: the changing context for initial teacher education in South Africa
|South African Review of Education
|No. of Pages:
|Document Type:
|Journal Article (Peer Reviewed)
|Subject Area:
|National Systems and Comparative Studies
|South Africa
|Institutional Restructuring, Teacher Education, Mergers, Higher Education Institutions HEI s
|File Size:
|Permission to reproduce this article was granted by the journal editor
|Date Added:
|01 August 2008


text:
SYRACUSE, N.Y. (AP) -Jim Boeheim breathed a big sigh of relief. After two big victories last week at Madison Square Garden had vaulted Syracuse into the national rankings, he was happy his Orange had no letdown against Cornell.
Freshman guard Brandon Triche scored a season-high 21 points, Andy Rautins added 18 and No. 10 Syracuse beat the two-time defending Ivy League champion Big Red 88-73 on Tuesday night.
``This was a tough game to come back from New York and play this team,' Boeheim said after his 804th career victory tied him with Eddie Sutton for seventh all-time in Division I. ``They're going to be in the NCAA tournament.'
It was the 32nd straight win in the series for Syracuse (5-0), but the Orange didn't settle it until Triche keyed a 17-5 spurt to start the second half. He hit a 3 and converted a three-point play, Rautins hit one of his five 3s, and Rick Jackson added another three-point play to boost the Syracuse lead from six points at halftime to 59-41 with 13:27 left.
``I hit a few shots in a row, so I figured I was in a great rhythm,' said Triche, whose baseline drive and reverse layup put the Orange up 53-41. ``We knew coming into this game there wasn't going to be as many fans, it wouldn't be as packed with everyone going home for Thanksgiving.'
Unranked a week ago (Syracuse was 30th in the balloting), the Orange catapulted into the Top 25 after beating then-No. 13 California and then-No. 6 North Carolina by an average score of 91-72 in the 2K Sports Classic. They had a more difficult time early with the Big Red (2-2), who beat Alabama and Massachusetts on the road before losing at home Friday night to Seton Hall.
Chris Wroblewski led Cornell with 20 points, Ryan Wittman had 19, and Jeff Foote 12.
Wes Johnson had 15 points and 10 rebounds and Kris Joseph added 13 points for Syracuse, which won easily despite a subpar game from big men Arinze Onuaku and Jackson. They each scored seven points, but Onuaku only had one rebound in 19 minutes.
Wittman had a career-high 33 points against Syracuse a year ago, including nine 3s, but he had trouble finding any open looks against the Orange's aggressive zone and finished 3 of 10 from long range.
``Their defense is better this year,' Wittman said. ``They've got a lot of length. They can make it difficult. I might have rushed my first couple of shots, but after that we got some looks. We just didn't knock them down.'
Syracuse held its first four opponents to 24.1 percent shooting on 3s, but Cornell hit 9 of 19 in the first half, with Wroblewski hitting 5 of 6. He finished with a career-high six 3s, but only one came after the break as the Big Red shot just 22.2 percent (4 of 18) from beyond the arc in the second half and that sealed their fate.
``The defense paid more attention,' Wroblewski said. ``They're really long and athletic, and they did a great job of rushing my shot in the second half.'
A year ago, Cornell led by as many as 16 in the first half and held a five-point advantage at halftime before falling 88-78. And its patient attack and long-range accuracy kept the Big Red close in this one for a while.
Cornell trailed 42-36 at the half, but the Orange limited the Big Red to just a 3 by Wroblewski and a follow by Foote to open a 17-point lead in the opening 7 minutes of the second.
``When you go against zone so long, you can get lazy,' Cornell coach Steve Donahue said. ``That's part of the reason Syracuse is so good at it. Not many people do it. We executed as well as we can in the first half, got open looks, got the ball inside. The second half they start getting in a rhythm in what we were doing. They did a great job stepping in passing lanes. We had a chance to make open shots to weather the storm and we don't.'
During the decisive spurt, Wroblewski missed two 3s and failed to convert a scoop in the lane as the shot clock expired, Louis Dale missed another 3, and the Big Red committed six of their 10 turnovers in the period.
``There were stretches during the game where we had multiple turnovers,' Wittman said. ``Syracuse is such a great transition team you can't do that and expect to stay in the game. Those turnovers lead to two points almost every time.'


text:
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text:
Thailand: Activist claims he was hit by PM's security guard
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Out there...
Join Date: Jul 2009
Location: BKK
Posts: 40,039
Pracha 'proves' PM-Srettha meeting was above board - The Nation
Pracha 'proves' PM-Srettha meeting was above board
THE NATION February 22, 2012 1:00 am
If Pheu Thai MP Pracha Prasobdee thought that by inviting the press to the 7th floor of the Four Seasons Hotel he would clear up questions about Prime Minister Yingluck Shinawatra's "secret" meeting with Srettha Thavisin, an executive of property development firm Sansiri, then he was sadly mistaken.
Two hours after meeting Pracha at 10am yesterday, members of the press left the hotel with more questions than answers.
Pracha started the press conference by saying that there was absolutely nothing wrong with the controversial meeting and insisted that it had taken place at the hotel's "business centre".
"The Democrat Party should be using its time looking at people's plight instead of wasting it on this," Pracha told the 40 or so members of the press assembled outside the five-star hotel.
"The prime minister can meet anybody as long as it does not threaten national security," the MP said.
The media and opposition have been wondering if the two-hour-long meeting on February 8 was just a get-together among old acquaintances, a tryst or if perhaps Yingluck and Srettha had met to exchange some inside information about real estate. And why did the security detail issue a secret code during the meeting?
"I don't know. You must ask [the prime minister]," Pracha responded.
When asked why the authorities did not just provide security camera footage to clear the air about the nature of the meeting and the identities of the people she had met, Pracha said: "It's not my duty to provide that proof."
However, he offered to take reporters to the so-called business centre on the 7th floor, but the management would only allow one representative to enter the premises because they feared the presence of the media might frighten the hotel's well-heeled guests. After a lengthy negotiation with the manager - who is a foreigner, and this writer had to step in to translate for Pracha - the MP ended up entering the premises with one reporter only to be told that the 7th floor was occupied and could not be opened to outsiders.
An hour later, Pracha came down declaring that he had proved that there was indeed an "Executive Club" on the 7th floor, but when asked if the controversial meeting had taken place there or in a private room as alleged by the Democrats, the MP said he could not confirm the location.
Shortly before noon, Pracha - insisting that he had not been dispatched to clarify things - declared that he had completed his mission of proving that a business centre did exist on the 7th floor of the hotel.
Yet, the press left the premises wondering what exactly had been proven.
On the Four Seasons' website, the tagline for its 7th-floor Executive Club reads: "Stressful? No. Productive? Yes."
However, it looks like Yingluck might find it stressful because the Parliament's ombudsman has just decided to investigate the "secret meeting".
Slavery is the daughter of darkness; an ignorant people is the blind instrument of its own destruction; ambition and intrigue take advantage of the credulity and inexperience of men who have no political, economic or civil knowledge. They mistake pure illusion for reality, license for freedom, treason for patriotism, vengeance for justice
."-Simón Bolívar
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Shares in the provider of integrated mining products and services have been on a tear over the past three weeks, rising 22.3 per cent since March 14, compared with a 12.7 per cent gain for the S&P/ASX Small Ordinaries Index over the same period. But the stock is still about 35 per cent below its peak reached in December 2007. The company recently acquired AJ Lucas' underground In-Seam drilling business for $25.5 million, which it expects to be immediately accretive to earnings. Customers of the business include BHP Billiton, Rio Tinto, Xstrata and Vale and management says the acquisition has established it as the second largest domestic provider of underground gaseous drilling services in Australia.
The Australian Financial Review


text: I say he be closer to White because of the playoff deficit. But if compared to White, he was 5-5 in playoff games and our great present-day QB is 1-3. And let us not forget that White was one of the finest Cowboy punters in their franshise history, an added bonus. And, on the cuspidor of a long-term deal from Romo, I half to ask jerra, is this what you really want? Is this in the best interest of the team? The fans? Your brand? A QB who is brilliant on the field, yet reverts to plays that we discuss in hushed tones all offseason may be one who doesn't necessarily merit a signing beyond 2 years. Remember, in two years he'll be pushingd 35. Closer to White? Yes. But not as productive post-season.


text:
The pictures were great and I would highly recommend and call again for this amazing photography service.
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text:
Sierra de Guara: West Itinerary
Salto de Roldán
Starting point: Huesca city, at the junction with the road to Apiés.
Time: about half a day.
Black and Red Kites can be seen in the fields and over the road between the rubbish dump at Fornillos and the village of Apiés. Between here and Sabayés stop once or twice at suitable spots to look for a variety of passerines which include Woodlark, Subalpine Warbler, Bonelli's Warbler, Firecrest, Short-toed Treecreeper, Tree Sparrow and Cirl Bunting.
Turn right on reaching the edge of Sabayés. It is worth spending some time birding this area between here and the turning for Santa Eulalia as there are a good number of interesting species: Rock Thrush, Dartford Warbler, Tawny Pipit and Ortolan Bunting are just some examples.
After the turning for Santa Eulalia the road narrows as the views expand. Along this final stretch of road look out for Blue Rock Thrush and Black Wheatear. Park in the wide open area at the end of this stretch and listen out for the song of the Orphean Warbler while scanning the skies for Golden Eagle, Lammergeier and the now very rare Bonelli's Eagle.
From the parking area walk to the right of big crag and, as well as taking in the amazing views watch out for Red-billed Chough, Peregrine Falcon, Short-toed Eagle and Egyptian Vulture. Griffon Vultures sail by continuously, some of them below the height of the path. Other birds that can be seen along the way include Rock Bunting, Alpine Swift, Black Redstart and Crag Martin. Follow the path for as far as you feel comfortable, as the final part is not for vertigo sufferers or the clumsy!
Return to Sabayés and turn right at the junction, continuing on past the village. Still within sight of the village there is a barren-looking area where Black-eared Wheatear, Bee-eater, Thekla Lark and Rock Sparrow can be seen. From here continue to reach the junction with the N-330 at Nueno.


text: Posted October 6, 2012 hey guys! although i want the panthers to win, i have to shout out to a guy that went to my high school. j.r. sweezy went to mooresville high school. he plays off line for seattle. he was a lb at nc state. he is #64 i think. anyway first guy from my high school to play in the nfl. 2 people like this Share this post Link to post Share on other sites


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New Jersey Cheerleader is Suing Her Parents to Pay For Her College Tuition
And THIS is what happens when your teen rebels!
Rachel Canning, a cheerleader from New Jersey, is suing her parents for college tuition and living expenses. SHE claims when she turned 18 (in November) her parents threw her out and cut off all financial support.Her parents claim she willingly moved out of her own after refusing to follow family rules.
"We love our child and miss her. This is terrible. It's killing me and my wife. We have a child we want home," her father, Sean Canning, said. "We're not Draconian and now we're getting hauled into court. She's demanding that we pay her bills but she doesn't want to live at home and she's saying, 'I don't want to live under your rules."
Some of those rules include: being respectful, keeping a curfew, doing chores, and potentially ending her relationship with a boyfriend who they feel is a bad influence.
Rachel says her parents gave her the ultimatum to dump her boyfriend or get out. To date, her parents still owe an outstanding fee of $5,306 to Morris Catholic School (her tuition bill) and $12,597 in legal fees. (Btw....Rachel is currently living with her friend, and her friend's FATHER is an attorney who is working on this case!)
If you were her parents, what would you do?


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A troubled marriage, a jealous husband and a container of cyanide added up to murder of a prominent UPMC doctor, police allege in a criminal complaint unsealed Thursday.
In the complaint filed the day before in Municipal Court, Pittsburgh police say Robert J. Ferrante, a University of Pittsburgh neuroscientist, encouraged his wife, Dr. Autumn Marie Klein, a neurologist, to drink a nutritional supplement he said would aid her fertility and help her to have the second child she wanted so badly.
Klein, 41, collapsed April 17 at home near a bag of creatine and died with a lethal concentration of cyanide in her system. The couple has a 6-year-old daughter.
Ferrante's attorney, William Difenderfer, said the doctor is "obviously disappointed." West Virginia State Police located Ferrante outside Beckley, W.Va., and arrested him.
That capped a day in which two detectives flew to St. Augustine, Fla., to capture Ferrante, missing him as he drove north amid a multistate alert.
Detectives Harry Lutton and Robert Provident went to the home of Ferrante's sister and found his daughter with her but learned the doctor was driving back to Pittsburgh, city police Lt. Kevin Kraus said at a news conference.
They learned he was driving along Interstate 77 in West Virginia and notified state police. Troopers took Ferrante into custody shortly before 7 p.m., Kraus said.
When asked why police did not wait for Ferrante to reach Pittsburgh, Kraus replied: "There's a lot of things that could happen, especially with someone of Dr. Ferrante's stature, when they are wanted for homicide."
Ferrante is being held in the Southern Regional Jail in Beaver, W.Va., to await arraignment and extradition, Kraus said.
Difenderfer said Ferrante, 64, a professor of neurological surgery, was on his way to Pittsburgh to turn himself in.
"Our office will be working with prosecutors in West Virginia to extradite the defendant in a timely fashion," said Mike Manko, a spokesman for Allegheny County District Attorney Stephen A. Zappala Jr.
UPMC placed Ferrante on indefinite leave after receiving the 11-page criminal complaint, spokesman John Fedele said.
Autumn Klein's cousin, Sharon King, 43, of Bellingham, Wash., said the family is grieving the death and declined to discuss the case in detail for fear of jeopardizing it.
"I want justice for Autumn," said King, who grew up with Klein. "My whole family just wants justice for her."
The complaint offers new details in a case that captured the attention of people across the country the past three months.
It describes the dramatic final weeks of a troubled marriage, the purchase of a deadly poison by a suspicious husband and the end of Klein's promising life.
Ferrante bought a bottle of cyanide with a UPMC credit card on April 15 and had it shipped overnight to his laboratory. Two days later, paramedics picked his wife's unresponsive body off the kitchen floor of their Schenley Farms home and took her to UPMC Presbyterian.
The medics saw a bag of white powder — creatine, Ferrante told them — and a vial near her body. She died April 20. The Allegheny County medical examiner said acute cyanide poisoning killed her.
Klein planned to leave Ferrante, a friend told police. She told the friend that Ferrante was controlling and unsupportive with her fast-rising career and their daughter, according to the complaint. Police withheld the friend's identity and that of nine other witnesses "to ensure their safety and to preserve the integrity of this ongoing investigation," the complaint says.
Ferrante suspected Klein and her friend — identified only as Witness #6 — were having an affair, the friend told police. Investigators said Ferrante confronted her three times about the accusation.
A witness who worked for Ferrante, co-director of the Center for ALS Research and a visiting professor of neurological surgery at the University of Pittsburgh, said the April 15 purchase was the only time he ordered a chemical himself and that Ferrante had no ongoing research projects that required cyanide.
In the lab where he kept the cyanide, a witness told police Ferrante mixed the dietary supplement creatine into a drink, something police said he was trying to get his wife to drink, supposedly to aid her fertility treatments. The witness said he or she helped Ferrante measure the powdered creatine into a one-gallon resealable bag. Paramedics spotted a similar bag later when they arrived at Ferrante's home to aid Klein, police said.
One witness told police that Ferrante's reaction to seeing his wife on the exam table "seemed fake and like 'bad acting,'" according to the complaint.
Cyanide kills by starving cells of oxygen, said former Allegheny County Coroner Dr. Cyril H. Wecht, who consulted with Ferrante's lawyers at their request. "It acts fast, and it metabolizes quickly," Wecht said.
The poison is "pretty much undetectable" anywhere from 60 minutes to three hours after a person ingests it, said John Trestrail, director of the Center for the Study of Criminal Poisoning.
A UPMC Presbyterian doctor ordered a bevy of tests on Klein's blood — a deadline decision that helped lead investigators to the poison that killed her, said Dr. Karl Williams, the Allegheny County Medical Examiner.
Her death baffled investigators at first, Williams said. But tests from Quest Diagnostics showed 3.4 milligrams of cyanide per liter. Anything more than 3 milligrams per liter is considered lethal.
"When we got a lethal cyanide level, you go, 'Well, that explains it,'" Williams said.
Williams' office contacted the funeral home where Klein's body was taken so they could conduct more tests — only to find the home cremated her on April 23, the day after Williams gave them the body, on Ferrante's orders, according to the complaint.
Klein's mother, Lois, declined comment on Thursday. "I cannot talk to you now," she told a reporter over the phone.
Klein was chief of women's neurology at UPMC and an assistant professor of neurology, obstetrics, gynecology and reproductive sciences at Pitt. She treated pregnant women with neurological problems such as headaches and seizures. Klein had offices in Magee-Womens Hospital and the Kaufmann Medical Building.
When police told Ferrante his wife died of cyanide poisoning, he paused for a few seconds, then said, "Why would she do that to herself?" and then, "Who would do this to her?" according to the complaint.
Though cyanide poisoning is among the rarest forms of murder, it takes little of it to kill someone, Trestrail said. The weight of a nickel is equivalent to about 25 lethal doses — about 200 milligrams each — of cyanide, he said.
When police searched Ferrante's laboratory, they found 8.3 grams missing from the bottle of cyanide he'd ordered, according to the complaint.
Ferrante and Klein had planned to go to Boston in May. Initially, Klein was going to make the trip herself and stay with the friend with whom Ferrante suspected she was romantically involved.
On April 13, Klein sent her friend a text message.
"Change of plans. Husband is coming to Boston. Told me 'to keep me out of trouble'."
"Oh dear," he replied. "Did not know you were in trouble."
She replied, "I feel like I have been for a while now."
Staff writers David Conti and Adam Brandolph contributed to this report. Mike Wereschagin and Margaret Harding are staff writers for Trib Total Media. Reach him at 412-320-7900; reach her at 412-380-8519.


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Selected Community Events
Tallahassee Symphony Orchestra Concert: Ravishing Romanticism
May 4, 2013 May 4, 2013, 8:00 p.m.
Ruby Diamond Concert Hall
Darko Butorac, Conductor
Phyllis Pancella, Mezzo-Soprano
Theofanidis: Rainbow Body
Mahler: Rückert Lieder
Tchaikovsky: Symphony No. 4
The great musical poets Gustov Mahler and Pyotr Tchaikovsky are paired on this concert of ravishing romantic music. Mahler's intimate and gorgeous settings of German poet Friedrich Rückert set the stage for the tragic and triumphant Fourth Symphony of Tchaikovsky. The evening, conducted by Maestro Darko Butorac, begins with an atmospheric work by living composer Christopher Theofanidis, "Rainbow Body." Ravishing Romanticism is generously sponsored by Capital City Bank.
Amanda Padgett, Director of Patron Services
For ticket information visit, http://tickets.fsu.edu/


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MENA, Ark. (AP) The sirens sounded three times across this western Arkansas hamlet, and residents watched several funnel clouds pass harmlessly over the town. The fourth siren was for another twister that ended up being a killer.
While many took cover immediately Thursday night in the basement of the county courthouse, others stayed home, only to glance out their windows just in time to see the black funnel descend on the community just east of the Oklahoma line. At least three people were killed, at least 30 others injured and 600 homes were damaged or destroyed.
MORE SEVERE WEATHER: Tornadoes cause injuries in Tenn., Ky.
GRAPHIC: How tornadoes form, safety tips
AFTERMATH: Preliminary survey rates tornado an EF3
"This one popped out of nowhere," said Polk County Sheriff Mike Oglesby.
The tornado was part of a line of storms that continued wreaking havoc in the South on Friday. The National Weather Service said a tornado destroyed two homes in southwestern Kentucky, and authorities near Nashville said multiple tornado touchdowns were reported.
As daylight broke Friday in Mena, pink insulation hung like cherry blossoms from the sheared branches of century-old maples. The roof of a two-story home sat atop the rubble that once was the floors beneath it, a set of women's clothes still hanging from a suspended closet rack.
Oglesby said search-and-rescue teams had combed through the city's downtown and a neighborhood just west that sustained the brunt of the storm without finding any other victims. The sheriff said he had no reports of anyone else missing in the city of 5,700 in the Ouachita Mountains.
An initial survey of the damage suggests the tornado packed winds of at least 136 mph, weather service forecaster John Robinson said Friday.
Basic tornado safety rules call for people, when warned, to go to the lowest floor in a building and put as many walls as possible between themselves and outside.
A warning was posted at 7:24 p.m. Thursday for areas north of Mena and another one went up for the community at 8:01 p.m. — nine minutes before it hit. The reason for four separate sirens wasn't immediately clear, but Robinson said some communities cannot run their sirens continuously because their motors will burn up.
"Everything was well covered. We said everything was heading straight toward Mena. It's unfortunate yet," Robinson said.
The twice-monthly meeting of the Mena's chapter of the Order of the Eastern Star had been going on uninterrupted, the 19 people inside only faintly hearing the sirens through the building's cinderblock walls, said attendee Thurman Allen.
"We heard the siren two or three times. It would sound off and it would quit," said Allen, 79. "We were getting ready to get out of the building when it hit."
The storm tore down the Masonic hall's walls, collapsing the roof on one woman, killing her, Allen said. Allen was hit with debris and thrown to the floor. The wind bowled over his wife and others inside.
"We had several ladies who it took the shoes right off their feet," said Fred Key, 37.
Others killed in the Mena storm were found in a collapsed house and in a front yard, said James Reeves, the county's emergency coordinator. The identities of the two women and a man who died have not been released.
Some residents sought shelter in the Polk County Courthouse, where dispatchers became trapped immediately after the storm. A radio antenna fell over onto part of the beige brick building during the storm, damaging its roof.
Others, like Ken Butler, 40, said they initially dismissed the sirens. Butler could only huddle against a wall as the storm hit, his arms wrapped around an exposed gas pipe.
"The siren was going off in plenty of time, I just didn't take it serious enough," Butler said.
The storm plucked his neighbor's shotgun-style home off its foundation and tossed it about 20 feet away. Across the street, neighbor Edward Cross, 69, said he and his wife, Nettie, 66, also didn't heed the sirens. Instead, he lifted the blinds of his back windows to look out toward the town's middle school and the courthouse.
At that point, Cross said, the "big black cloud" loomed right in front of him.
"I didn't have time to go nowhere, I just grabbed a hold of the wall and held on," Cross said. The storm tore away a quarter of their home's roof.
The violent weather was part of a system that caused damage throughout the South and parts of the Midwest. As the storms moved east, hail and high winds were reported in Alabama, Kentucky, Mississippi and Tennessee. Power was out in many parts of the region.
Southeast of Nashville in Rutherford County, a sheriff's dispatcher said "multiple tornado touchdowns" were reported Friday in various parts of the county.
Brian Smith, general manager at a Cracker Barrel restaurant in the area along Interstate 24, said he saw a "pretty wide" tornado and that he "could see debris in the air from the rotation."
A tornado Friday destroyed two homes and knocked down trees and power lines near the community of Mannington, Ky., in Christian County, weather service meteorologist Robin Smith said in Paducah. Smith said the storm also dumped hail, some as large as eggs, throughout Christian and Lyon counties.
The weather service said a woman was injured at Shreveport, La., when a tree fell onto her car during a tornado. Twisters also damaged homes east of Vinita and near Muse in Oklahoma and at Crossett in far southern Arkansas, near the Louisiana line.
Mena's storm destroyed a city plant that makes gaskets for air conditioners and an ice manufacturer. Small-business owners swept up glass from their sidewalks in the downtown in a city known for its remodeled homes from the 1800s and century-old trees, said prosecutor Tim Williamson.
The town once looked "pastoral," Williamson said. "It's not anymore."
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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Steel Valley's Keyes transforms into promising big man
It's one of those stories that Shawn McCallister can't help to tell any chances he gets.
And it's one of those stories that he gets better at telling each time.
Steel Valley went to Chartiers-Houston for a scrimmage game last season with a pretty established team. Still, the longtime coach was eager to see 6-foot-6 sophomore center Dom Keyes.
During the game, Keyes was fouled and headed to the free-throw line for two shots when McCallister noticed that something just wasn't right.
"He was standing at the wrong foul line," McCallister said. "They had a youth foul line on the floor, and he was standing at that."
When you have never played organized basketball before, those things happen.
"Yeah, you can say he was kind of raw in the beginning," McCallister said.
A year later, and there's nothing ordinary or raw about Keyes.
Keyes has transformed from a kid who didn't even know the rules let alone the intricacies of the game to become one of the dominating forces in the WPIAL.
He helped Steel Valley to a 15-4 regular-season record and will lead the Ironmen into Tuesday's Class AAA first-round playoff game against Mars at West Allegheny.
"From the time he started playing organized ball until now, he has just made amazing strides," McCallister said. "He went from not understanding the game of basketball to becoming a dominant force out on the court."
And definitely one of the most complete players as well.
Keyes finished the regular season averaging 15 points, 14 rebounds and 3.5 blocks.
He scored double figures in the first 12 games of the season and 16 of the 19, but saved his biggest games for the most important ones.
Keyes scored 22 and grabbed 18 rebounds against No. 2 Thomas Jefferson; had 21 points and 21 rebounds against No. 3 Elizabeth Forward and 25 and 18 against rival West Mifflin within a two-week span late during the regular season.
And just think, he didn't know what he was doing one year earlier.
"I put a lot of work in over the summer and during practice," Keyes said. "Just practicing every part of the game to prepare for this. I've always loved playing basketball but never was good enough to play."
Keyes went out for the Steel Valley Middle School team in seventh grade, but was cut because "I wasn't good enough."
That quickly changed.
Keyes played summer basketball in Charlie Batch's Project C.H.U.C.K league when he was 15. That was about the time he first dunked a basketball.
"It was an alley-oop," Keyes recalled. "And I was wearing those skater shoes."
Even though he kept getting prodded to play basketball by his friends, Keyes didn't decide to play again until his sophomore year.
"I felt like I got way better, and that I could play with the guys," Keyes said. "I figured I'd try out, and I made the team."
Keyes mostly played junior varsity as a sophomore before McCallister moved him up midway through the season.
"He had to learn the game when it came to organized basketball. He just needed some experience," McCallister said.
"Now he plays both sides of the court. He just won't worry about the offensive end. He likes to go to glass ,and he's long. He has a long body and has long arms, so he rebounds the ball better than most even when he is out of position."
When paired with Ajan Smith and Dorian Broadwater along with Derek Taylor and Brandon Donovan, the Ironmen have proven to be a difficult team to match up against.
Steel Valley leads Class AAA in scoring at 74.1 points per game.
"Every team's goal is to make it to Palumbo," Keyes said. "We are going to take it one game at a time. We just want to beat Mars.
"A lot of people don't expect us to go far. I think we might surprise some people."
Keyes has already surprised his share, that's for sure.
Mark Kaboly is a staff writer for Trib Total Media. Reach him at firstname.lastname@example.com or via Twitter @MarkKaboly_Trib.


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Alcester is hosting its second annual Ale and Cider Trail.
The event will be taking place over three days from Saturday, August 23 to Bank Holiday Monday, August 25.
Eight pubs will be taking part; The White Lion, The Lord Nelson, The Royal Oak, The Bear, The Turks Head, Hollybush, The Cross Keys and The Dog and Partridge.
They will offer a range of entertainment with music and live sports.
While on the trail visitors will be also be able to enter a competition to win their height in beer.
The trail will begin when the clock on High Street strikes noon.
Alcester's Court Leet will carry out their ceremonial ale tasting at the pubs.
The event has been organised by the pubs themselves with some help from Alcester Chamber of Trade & Commerce.


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Assessment |
Biopsychology |
Comparative |
Cognitive |
Developmental |
Language |
Individual differences |
Personality |
Philosophy |
Social |
Methods | Statistics | Clinical | Educational | Industrial | Professional items | World psychology |
Clinical: Approaches · Group therapy · Techniques · Types of problem · Areas of specialism · Taxonomies · Therapeutic issues · Modes of delivery · Model translation project · Personal experiences ·
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology.
Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions. For example, physicians use email to communicate with patients, order drug prescriptions and provide other health services.
Clinical uses of telehealth technologiesEdit
- Transmission of medical images for diagnosis (often referred to as store and forward telehealth)
- Groups or individuals exchanging health services or education live via videoconference (real-time telehealth)
- Transmission of medical data for diagnosis or disease management (sometimes referred to as remote monitoring)
- Advice on prevention of diseases and promotion of good health by patient monitoring and followup.
- Health advice by telephone in emergent cases(referred to as teletriage)
Nonclinical uses of telehealth technologiesEdit
- Distance education including continuing medical education, grand rounds, and patient education
- Administrative uses including meetings among telehealth networks, supervision, and presentations
- Research
- Online information and health data management
- heathcare system integration
- asset identification, listing, and patient to asset matching, and movement
- overall healtcare system management
- patient movement and remote admission
Telehealth modesEdit
Store-and-forward telehealthEdit
In store-and-forward telehealth, digital images, video, audio and clinical data are captured and "stored" on the client computer; then at a convenient time transmitted securely ("forwarded") to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back. Based on the requirements of the participating healthcare entities, this roundtrip could take between 2 to 48 hours. In many store-and-forward specialties, such as teleradiology, an immediate response is not critical. Dermatology, radiology and pathology are common specialties that are conducive to store-and-forward technologies.
Real-time telehealthEdit
In real-time telehealth, a telecommunications link allows instantaneous interaction. Video-conferencing equipment is one of the most common forms of synchronous telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. With the availability of better and cheaper communication channels, direct two-way audio and video streaming between centers through computers is leading to lower costs.
Examples of real-time clinical telehealth include:
- Telemental Health -- the use of videoconferencing technology to connect a psychiatrist with a mental health client
- Telerehabilitation
- Telecardiology
- Teleneurology
- Telenursing
- Teleradiology
- Teledentistry
Remote monitoringEdit
In remote monitoring, sensors are used to capture and transmit biometric data. For example, a tele-EEG device monitors the electrical activity of a patients brain and then transmits that data to a specialist. This could be done in either real time or the data could be stored and then forwarded.
Examples of remote monitoring include:
- Home-based nocturnal dialysis [1]
- Cardiac and multi-parameter monitoring of remote ICUs
- Home telehealth
- Disease management
Benefits of telehealth Edit
Telehealth benefits patients in countries where traditional delivery of health services are affected by distance and lack of local specialist clinicians to deliver services. The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services in meeting patient needs; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.
External linksEdit
- U.S. Department of Veterans Affairs Care Coordination/Telehealth Program
- National Center for Telehealth & Technology
- Center for Telehealth & E-Health Law
- UCLA Wireless Health Institute
- American Telemedicine Association
- Telemedicine Information Exchange
- Telehealth Ontario
- Ontario Telemedicine Network -- Making the Connection for Health
- Tasmanian government
- Office for the Advancement of Telehealth (established by the Health Resources and Services Administration)
- NHS Direct, the UK National Health Service information service
- Association of Telehealth Service Providers
- International Society for Telemedicine & eHealth
- Med-e-Tel - The International Educational and Networking Forum for eHealth, Telemedicine and Health ICT
- University of Florida Center for Telehealth
- National Rural Health Association
- Community for Teledermatology
- Scottish Centre for Telehealth
- British Columbia Alliance on Telehealth Policy and Research
- University of New Mexico Telehealth
Further readingEdit
- Telemedicine,Telehealth, and the Consumer Online introduction and primer to telehealth and telemedicine from the Telemedicine Information Exchange
- Norris, A. C. (2002). Essentials of Telemedicine and Telecare. West Sussex, England; New York: John Wiley & Sons, Ltd. ISBN 0-471-53151-0.
- Maheu, Marlene M.; Whitten, Pamela; & Allen, Ace (2001). E-Health, Telehealth, and Telemedicine: A Guide to Start-up and Success. San Francisco: Jossey Bass. ISBN 0-7879-4420-3.
- Olmeda, Christopher J. (2000). Information Technology in Systems of Care. Delfin Press. ISBN 978-0-9821442-0-6
- Telehealth Technical Assistance Manual - A document to assist in the planning of telehealth and telemedicine projects for rural community and migrant health centers and other health care organizations. By Samuel G. Burgess, Ph.D. October 2006
- Teleneurology and requirements of the european Medical Devices Directive (MDD) - Telemedical Systems and regulatory affairs for europe, by Dipl. Ing. Armin Gärtner
See alsoEdit
- American Telemedicine Association
- Center for Telehealth & E-Health Law
- Connected Health
- eHealth
- mHealth
- National Rural Health Association
- Telemedicine
|This page uses Creative Commons Licensed content from Wikipedia (view authors).


text:
This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Arginine plays an important role in cell division and the functioning of the immune system. We describe a novel method by which arginine can be identified using an artificial monolayer based on surface plasmon resonance (SPR). The affinity of arginine binding its recognition molecular was compared to that of lysine. In fabrication of an arginine sensing interface, a calix[
Arginine, one of the 20 natural amino acids, plays an important role in cell division, healing of wounds, removal of ammonia from the body, functioning of the immune system, and release of hormones [
It is well-known that calix[n]arenes are used for the molecular recognition of ions, amino acids, hormones, sugars, peptides, nucleic acids, and proteins, which are fundamental substrates in biological and artificial processes [
To the best of our knowledge, there is no study on arginine recognition with calixarene crown ether. We present a study on the molecular recognition capability of a combination of crown ether and calixarene function groups. A calix[
The purpose of our research is to develop a novel arginine-recognition interface by using an advanced and simple optical system in order to obtain highly sensitive and simple sensors. To achieve this goal, we employed an SPR system with a recognition interface in order to selectively identify arginine. A self-assembly technique was utilized to construct a well-characterized sensing layer, and then, the monolayer formation process was investigated using SPR spectroscopy. The characterization of the calixcrown ether SAM was monitored by using FT-infrared reflection absorption spectroscopy (FTIR-RAS), an atomic force microscopy (AFM) image, and electrochemical analysis. Interaction between arginine and calixcrown ether monolayer was observed. The change in the surface refractive index for different concentrations of arginine on the monolayer was calculated by simulating the SPR experimental data. Further, to evaluate the usability of calixcrown ether monolayer as an arginine recognition chip, its selective binding with arginine was compared to that with lysine on the basis of SPR results.
A microscope cover glass (18 mm × 18 mm × 0.15 mm, with a refractive index of 1.515, Matsunami, Japan) with a gold layer was used as the substrate for the formation of the calix[
A home-made SPR system based on the traditional Kretschmann configuration was used; the system was described in our previous paper [
The sensor chip configuration is shown in
To compare the binding properties, arginine was placed on the surface of the chip modified with the calix[
The shift in the SPR angle corresponding to the increase in arginine and lysine concentrations from zero (buffer) to 1 × 10−3 M is 0.11°and 0.054°, respectively. The higher SPR response for arginine one-site binding fitting showed that the binding constants for arginine and lysine are 1.63 × 10−6 M (R2 = 0.997) and 2.38 × 10−6 M (R2 = 0.998), respectively (
The detection limit for arginine was found to be 1.0 × 10−7 M. The selectivity for arginine was greater than that for lysine. Compared to the conventional gas-phase method and chemosensor, this simple arginine detection system based on SPR is quite remarkable [
SPR is a collective electron excitation that exists at the interface between two media with different dielectric constants. The dipole moment of a molecule is a factor that is measured for determining the charge distribution of the overall molecule; the formation of the calix[
The dipole moment is closely related to the dielectric constant
Therefore, a variation in the dipole moments of arginine- or lysine-derived calix[
We have fabricated a simple arginine recognitional platform with a novel artificial calix[
We gratefully acknowledge the financial support received from the Innovation Program of Shanghai Municipal Education Commission No. 11YZ07, Shanghai Science and Technology Committee No. 10DZ2271800 and Shanghai Key Laboratory of Bio-Energy Crops. This research was partially supported by the International Research & Development Program of the National Research Foundation of Korea (NRF) and the Ministry of Education, Science and Technology (MEST) of Korea (Grant number: K2009-50230).
Molecular structure of (
Characterization of the calix[
Experimental SPR curves of Au surface modified with calix[
Dose-response curves of sensor chip immobilized by calix[
The refractive index (RI) of the interfacial layer corresponding to the interaction between calix[
|1.0 × 10−7
|1.0 × 10−6
|1.0 × 10−5
|1.0 × 10−4
|1.0 × 10−3


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CRM No.36391 of 2011 1 IN THE HIGH COURT FOR THE STATES OF PUNJAB & HARYANA AT CHANDIGARH CRM No.M-36391 of 2011 Date of decision:28.2.2012 Gaurav ...Petitioner Versus State of Punjab and others ...Respondents CORAM: HON'BLE Ms. JUSTICE RITU BAHRI Present: Mr. Vinod Bhardwaj, Advocate, for the petitioner. Mr. Rajinder Mathur, AAG, Punjab. Dr.Naresh Kaushik, Advocate, for respondent No.2. RITU BAHRI, J. (Oral)
Quashing of FIR No.125 dated 18.12.2009 under Sections 363-A, 366/34, IPC registered at P.S.Maur, District Bathinda and the proceedings consequential there to are sought.
Learned counsel for the petitioner submits that the impugned FIR was registered on the statement of father of respondent No.1. He further submits that respondent No.1 and the petitioner are now residing happily.
Service is complete. However, respondent No.3 has not put in appearance.
Respondent No.2 alongwith her counsel has put in appearance and placed on record a copy of reply. As per reply filed by respondent No.2, petitioner and respondent No.2 are living a happy married life and have been blessed with a son. It is also made CRM No.36391 of 2011 2 out in the reply that respondent No.2 was neither kidnapped nor abducted by the petitioner and the instant FIR is false and has been lodged being annoyed of marriage performed against parents wishes.
Keeping in view the averments made in the reply and respondent No.3 chose not to appear despite service, the present petition is allowed. Consequently, FIR No.125 dated 18.12.2009 under Sections 363-A, 366/34, IPC registered at P.S.Maur, District Bathinda and the proceedings consequential there to are quashed qua petitioner in the facts and circumstances of the case.
28.2.2012 (RITU BAHRI) mks JUDGE