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By Bryan Walker, MHS, PA-C, and Kathleen Costello, MS, RN, ANP-BC, MSCN, MSCS
Multiple sclerosis (MS) is a chronic and often progressive disease that affects the central nervous system (CNS). It is characterized by relapses and remissions of neurologic symptoms as well as progressive functional loss with variable severity over time.1-3 The estimated prevalence of MS in the United States ranges from 47.2 to 109.5 per 100,000 people. It is most common in women, people between the ages of 40 and 59, and non-Hispanic people.1
The pathologic mechanisms of MS have not been completely elucidated, but experts believe that the disease occurs as a result of autoimmune-mediated inflammatory changes, demyelination and axonal loss.2,3 The current theory of immunopathology points toward a peripheral activation of the immune system, dysregulation that allows self-recognition of CNS antigens, migration of lymphocytes into the CNS, and reactivation by CNS self-antigens that produces an inflammatory and destructive process.
Although no cure for MS has been identified, currently available FDA-approved treatment options can modify the disease process. In recent years, the field has expanded to 10 medications with varying mechanisms of action.
Clinical Presentation and Diagnosis
Since the demyelination and axonal damage of MS can occur throughout the CNS (cerebrum, cerebellum, spinal cord), presenting symptoms may vary widely from patient to patient and even in the same patient over time. Patients may experience the following: visual disturbance, most commonly optic neuritis4; sensory disturbance; muscle weakness; gait and balance difficulty; depression; cognitive dysfunction; and/or elimination dysfunction. Any of these may worsen with heat exposure.5
No single test can confirm the diagnosis of MS. In most cases, a revised version of the McDonald Criteria for MS is used. This tool combines clinical and magnetic resonance imaging (MRI) findings to evaluate neurologic lesions that must be disseminated in both space and time.6
The fundamental criteria for an MS diagnosis are at least two episodes of neurologic symptoms that are referable to the CNS and disseminated in space and time. The revised McDonald criteria use MRI and other paraclinical evidence to establish the dissemination in the absence of adequate clinical events. One of the most important aspects of diagnosis is the exclusion of other conditions that may mimic MS.
The most common disease course of MS is relapsing-remitting MS (RRMS), in which patients experience symptoms that last a minimum of 24 hours, followed by a full or partial recovery for some time.7 Patients with RRMS often transition years after onset to a more progressive disease course with fewer relapses but more progressive functional loss over time. This is known as secondary-progressive MS (SPMS).
A small percentage (10% to 15%) of patients never experience characteristic relapses, but they have progressive functional loss from onset. This disease course is known as primary-progressive MS (PPMS). Patients who present with an initial symptom or constellation of symptoms consistent with a demyelinating process, but without evidence to support dissemination in space and/or time, have clinically isolated syndrome or CIS.
Disease-Modifying Treatments
MS is best managed using a comprehensive approach that combines pharmacologic and nonpharmacologic strategies for optimal symptom and disease management. Throughout a patient's lifetime, multiple disciplines may need to be involved in care, including psychology, urology, physical therapy, occupational therapy and speech pathology.
Pharmacologic treatments for MS are known as disease-modifying treatments (DMTs). Once the diagnosis of MS has been made, treatment should begin as soon as possible after a thorough discussion with the patient about all available treatments, their risks, benefits and alternatives. The first DMTs were approved in the 1990s, and today 10 agents are indicated for MS. DMTs are used to modify the disease process and in doing so reduce the occurrence of CNS inflammation, clinical relapses and disease progression.
The DMTs have various mechanisms of action, routes of administration, side effects and risks. Five of these treatments are self-injected medications: four interferon beta preparations and a non-interferon, glatiramer acetate. Oral treatments for MS are fingolimod, teriflunomide and dimethyl fumarate. Intravenously administered treatments are natalizumab and mitoxantrone.
The interferons, glatiramer acetate, natalizumab, teriflunomide, fingolimod and dimethyl fumarate, are indicated for relapsing MS. Mitoxantrone is indicated for secondary progressive MS, worsening relapsing MS, and progressive relapsing MS. The interferon preparations and glatiramer acetate have also been shown to delay the conversion of CIS to MS.8-11
Injectable Treatments
Interferon beta 1a and 1b preparations for MS differ in their route/frequency of administration (weekly IM, three times weekly or every other day subcutaneously) and in how they are produced. Interferon betas work similarly to reduce T cell activation in the periphery and downregulate adhesion molecules necessary for the migration of T cells into the CNS.
Interferons are naturally occurring proteins in humans and have a role in immune response. They have antiviral properties and are anti-inflammatory. Interferons are likely to produce a mild elevation in body temperature. This increase, while mild, may cause flu-like symptoms, including fever, chills, malaise, achiness and fatigue. In addition, injection site reactions are common in the subcutaneous interferon preparations. Interferons may provoke mild transaminitis and less frequently, lymphopenia. Interferons may provoke or worsen a depressed mood. Interferons are pregnancy category C.
Glatiramer acetate is a daily subcutaneous injection that works by shifting the immune response to one that it less inflammatory. Side effects include injection site reactions usually consisting of erythema, itching, discomfort and possibly lipoatrophy over time. Much less frequently, a postinjection reaction is possible that occurs immediately after the injection and includes symptoms of tachycardia, flushing, dyspnea and achiness. Glatiramer acetate is a pregnancy category B drug.
Oral Treatments
Fingloimod is a daily dosed 0.5-mg capsule that modulates the sphingosine 1 phosphate receptor, thereby inhibiting T cell migration out of lymph nodes. Clinical trials demonstrated statistically significant effects on relapse rate, disability progression and MRI outcomes.12 Because the S1P receptor is located on various cells throughout the body, side effects to the drug may occur.
Fingolimod produces a first-dose bradycardia with the potential for heart block; therefore 6 hours of first-dose monitoring is required. Caution must be used in patients with conduction abnormalities or those taking certain antiarrythmic or antipsychotic medications. Ongoing monitoring of complete blood count and hepatic function is needed because lymphopenia is likely and transaminitis is possible. Herpes infections including varicella zoster may occur, and all patients should have a VZV titer prior to the initiation of treatment and vaccination prior to fingolimod treatment, if needed. Macular edema has also been observed, therefore ophthalmologic evaluation at baseline and several months after treatment initiation are indicated. Fingolimod is a pregnancy category C drug.
Teriflunomide is a daily treatment administered once daily as 7 mg or 14 mg. This agent works by inhibiting dihydroorotate dehydrogenase, which is necessary for DNA replication. It therefore reduces T-cell and B-cell activation and proliferation. Clinical trials demonstrated a modest effect on annualized relapse rate, disability progression and MRI outcomes. Adverse events reported with teriflunomide include gastrointestinal upset, transient hair thinning, hepatic enzyme elevation, mild neutropenia, and mild blood pressure elevations.13 Teriflunimide is a pregnancy category X drug.
Dimethyl fumarate is a 240-mg capsule administered twice daily. It works via several potential mechanisms, including activation of the Nrf2 pathway, which may reduce oxidative stress. In addition, it may induce a less inflammatory immune response and may inhibit adhesion molecules necessary for T-cell trafficking into the CNS.14-16 Side effects may include episodes of flushing, GI symptoms, transaminitis and possible lymphopenia. Dimethyl fumarate is a pregnancy category C drug.
Intravenous Treatments
Natalizumab is a monoclonal antibody administered in a 300-mg dose once every 28 days. Natalizumab blocks VLA-4, an adhesion molecule on activated lymphocytes that is necessary for T-cell trafficking. In patients treated with this drug, fewer activated lymphocytes are able to enter the CNS. Clinical trials of natalizumab demonstrated a significant relapse reduction (67%), disability reduction (42%) and fewer new areas of CNS inflammation.17 Due to risks associated with its use, natalizumab is recommended as a second-line agent when a patient has experienced a suboptimal response or intolerability to other DMTs. Infusion reactions can occur, but generally natalizumab is well tolerated with mild side effects including headache, achiness, fatigue and, less often, GI side effects.
A risk associated with natalizumab is the reactivation of an otherwise dormant virus, the John Cunningham (JC) virus. Reactivation of JC virus may provoke progressive multifocal leukoencephalopathy (PML), a potentially fatal CNS infection that causes widespread white matter destruction. Recent research indicates that the risk of PML exists in patients who have antibodies to the JC virus. A serum JC virus antibody test is available to determine previous exposure and thus risk for the development of PML. Approximately 50% of the general population has previous exposure to the JCvirus.18,19 Natalizumab is in pregnancy category C.
Mitoxantrone is an immunosuppressant treatment approved for the treatment of secondary progressive MS, worsening relapsing MS or progressive relapsing MS. It is used infrequently due to the high risk for long-term complications. Clinical trials demonstrated a reduction in relapse rate, reduction in disability progression and favorable MRI outcomes. Currently, mitoxantrone is used infrequently due to numerous and significant risks. Mitoxantrone suppresses the immune system; therefore careful post-dose complete blood count monitoring is necessary. Due to known cardiotoxicity, mitoxantrone is generally administered every 3 months for a lifetime maximum dose of 140 mg/kg. Testing of left ventricular ejection fraction is necessary prior to and during treatment and is recommended annually following completion of treatment. In addition, an increased risk of acute myelogenous leukemia develops after mitoxantrone treatment. Mitoxantrone is a pregnancy category D drug.
Communication Is Essential
Related Content
MS is a chronic disease with a complex pathophysiology. Once diagnosis is made, patients should initiate a disease-modifying treatment to reduce relapses and the likelihood of additional disability. The 10 available FDA-approved DMTs for the treatment of relapsing forms of MS have varying mechanisms of action, differing side effect profiles, and differing risk-benefit profiles. These medications have positive effects on relapse rate and disability progression. Several more DMTs are in the development pipeline.
Most patients will take more than one DMT over the course of their disease. NPs and PAs must be cognizant of the effects of all MS medications on the immune system as well as other systems and be mindful that, in some cases, a switch from one medication to another must be well planned.
While the DMTs are important in the overall management of MS, a comprehensive approach that incorporates expertise from other disciplines is usually necessary for optimal lifetime management. NPs and PAs should maintain open lines of communication with their MS patients to ensure adherence as well as the safety and efficacy of their treatment plans.
1. Noonan CW, et al. The prevalence of multiple sclerosis in 3 US communities. Prev Chronic Dis. 2010;7(1):A12.
2. Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372(9648):1502-1517.
3. Roach ES. Is multiple sclerosis an autoimmune disorder? Arch Neurol. 2004;61(10):1615-1616.
4. Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med. 2006;354(12):1273-1280.
5. Saul RF, et al. Visual evoked potentials during hyperthermia. J Neuroophthalmol. 1995;15(2):70-78.
6. Polman CH, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292-302.
7. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46(4):907-911.
8. Jacobs LD, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med. 2000;343(13):898-904.
9. Kappos L, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006;67(7):1242-1249.
10. Comi G, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet. 2009;374(9700):1503-1511.
11. Comi G, et al. Comparison of two dosing frequencies of subcutaneous interferon beta-1a in patients with a first clinical demyelinating event suggestive of multiple sclerosis (REFLEX): a phase 3 randomised controlled trial. Lancet Neurol. 2012;11(1):33-41.
12. Kappos L, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362(5):387-401.
13. O'Connor P, et al. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303.
14. Kappos L, et al. Efficacy and safety of oral fumarate in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, double-blind, placebo-controlled phase IIb study. Lancet. 2008;372(9648):1463-1472.
15. Gold R. Oral therapies for multiple sclerosis: a review of agents in phase III development or recently approved. CNS Drugs. 2011;25(1):37-52.
16. Killestein J, et al. Oral treatment for multiple sclerosis. Lancet Neurol. 2011;10(11):1026-1034.
17. Polman CH, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899-910.
18. Monaco MC, Major EO. The link between VLA-4 and JC virus reactivation. Expert Rev Clin Immunol. 2012;8(1):63-72.
19. Fox RJ, Ruddick RA. Risk stratification and patient counseling for natalizumab in multiple sclerosis. Neurology. 2012;78(6):436-437.
Bryan Walker is a physician assistant who is an assistant professor in the Department of Physician Assistant Studies at The George Washington University School of Medicine and Health Science in Washington, D.C. Kathleen Costello is an adult nurse practitioner at the Johns Hopkins Multiple Sclerosis Center in Baltimore, and an assistant professor at the Johns Hopkins School of Medicine. The authors have completed disclosure statements and report the following: Walker holds a limited number of stock options in Biogen Idec. Costello has served on scientific advisory boards for Teva Neuroscience, Genzyme, Sanofi, Aventis, Biogen Idec, EMDSerono, Questcor and Novartis.
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text: I keep getting this, i know how i screwed up but i dont know how to fix it. When i followed the ispconfig guide i forgot to run and edit /etc/hosts echo server1.example.com > /etc/hostname /etc/init.d/hostname restart I did it now but it still doesnt work Code: Mail Delivery System <email@example.com> 2:37 PM (32 minutes ago) to me This is the mail system at host techreanimate.com. I'm sorry to have to inform you that your message could not be delivered to one or more recipients. It's attached below. For further assistance, please send mail to <postmaster> If you do so, please include this problem report. You can delete your own text from the attached returned message. The mail system <firstname.lastname@example.com>: unknown user: "luis" Final-Recipient: rfc822; firstname.lastname@example.com Original-Recipient: rfc822;firstname.lastname@example.com Action: failed Status: 5.1.1 Diagnostic-Code: X-Postfix; unknown user: "luis" ---------- Forwarded message ---------- From: Luis Rodriguez <firstname.lastname@example.com> To: Luis Rodriguez <firstname.lastname@example.com> Cc: Date: Sat, 22 Jun 2013 14:37:20 -0400 Subject: sdfgsdfg dfsgdfg

subset: commoncrawl


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Andrew Sammaciccia
Always Will
When teenage misfit Will (Andrew Baglini) finds a forgotten time capsule, he discovers that he can change his past and thereby improve his present and future. He quickly becomes one of the popular kids in his high school, but soon realizes that he benefits only at the expense of others -- including his mother, Lydia (Jody Seymour). Now, Will faces the most important decision of his young life in this entertaining family film.


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Transportation (1938 - 1957) 〉 Airlines: 1946
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text: Rust-Oleum Introduces JOMAX Tape & Adhesive Remover Quick Release Formula Makes Removal Faster, Easier Vernon Hills, Ill. – Rust-Oleum is proud to introduce a new addition to the JOMAX line – Zinsser JOMAX Tape & Adhesive Remover. The new product is formulated to remove tape and adhesive from a variety of hard surfaces in just minutes. "Removing stubborn tape and adhesive used to be both messy and time-consuming," says Rust-Oleum brand manager, Dirk Sappok. "Our new JOMAX Tape & Adhesive Remover features a ready-to-use quick release formula for faster removal and a convenient dauber applicator bottle to make removal easier than ever before." JOMAX Tape and Adhesive Remover removes all types of tape, stickers, labels and adhesive residue in just minutes. Formulated for use on all hard surfaces, it's great for removing tape and adhesives from walls, doors, floors, wood, metal, glass and other painted and non-painted hard surfaces. Low odor and easy to use, the convenient foam dauber applicator eliminates the mess often associated with removing tape and adhesives. It allows for direct application to the adhesive area for a quicker release.


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Executives Homes of the Biltmore Greens Arizona Biltmore Estates
Prime location. A development that sold out before the scheduled opening. Spacious, light & bright. Contemporary executive home split masters with expanded bath & private patios formal living room with serving bar a welcoming breakfast room a formal dining room, a great room plus a separate den. Outdoor entertaining & breakfast or BBQ patio embracing a Zen like mature private landscape. These homeowners enjoy likely the best professionally managed local home owners community association of the entire A.B.E.V.A. or Arizona Biltmore Estates Village Association area. Common areas & front yards are maintained professionally.
Spacious light & bright, low maintenance split 3 bedroom Biltmore Greens Single Family Detached Homes. These executives' residences are perfect for entertaining with perfect sized yards. Enjoy direct pedestrian access to Arizona's business & world class shopping, fine dining centers at Camelback & 24th Street in the Esplanade and Biltmore Fashion Park. The Colony Biltmore Greens is park-like resort living with community tennis courts, landscaped walkways, a children's playground patrolled & guard gated daily at the Arizona Biltmore Estates. Arizona's executives community.


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Recently Watched
Most Popular Review
this drama is sooooooooooo funny not a single episode passes without me laughing and its very sweet too. i feel sorry for the older brother though, first that biatch left him and now he likes Sun Hee and she won't like him back poor poor guy will have his heart broken again
i love LOVE this drama awesome chemistry, awesome acting, awesome everything about this drama. best part is the drama unlike many others isn't dragged on for no good reason. its to the point. i think my least favourite character is the grandpa - he's such a stubborn idiot who doesn't learn from his mistakes there are these types of egotistical people in this world. i mean he banished his daughter just because she married someone he didn't like and then ended up regrating it but he does the same thing with his grandson. he makes both his grandson and JYR suffer and does even feel regretful that he is the cause of his grandson's pain i hated him the most but i LOVE the drama. on of the few korean drama w good chemistry and kisses =D
its a cute drama but the BEST part of this drama is No Min Woo. OMG every time he came on screen i think both my laptop screen and my heart melted. after first 2 or 3 episodes the ONLY reason i put up with this drama was for the SUPER SUPER SUPER HOT AND SEXY fox hunter No Min Woo. he is an eye candy and a breath of heaven's air to the soul.


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Radio Programs Main
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Your tax-deductible gift supports National Geographic radio broadcasts and other public programs that bring the exploration to you.
Donate Now.
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November 15, 2008
This Week's Guests:
Tom Clynes
Charles Beeker
Chris Shearer
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Green Guide
—Light Bulbs
Mel White
John Priscu
Ian Lipkin
Notes—Swimming With Crocodiles
• For years, drug trafficking and political strife have made it impossible for tourists to enjoy Colombia's natural beauty and culture. But now that's starting to change. Tom Clynes' article in this month's National Geographic
magazine features Colombia as one of the hottest new adventure destinations. Clynes tells Boyd what's changed and what not to miss when you go.
Listen to this segment
• Charles Beeker, professor of underwater archaeology at Indiana University, didn't quite find buried treasure, but he did find a submerged pirate ship off the coast of the Dominican Republic. Beeker talks to Boyd about how he and his team identified the wreckage as the ship of Captain Kidd, who was hanged for being a pirate in 1701.
Listen to this segment
• Chris Shearer, director of National Geographic's My Wonderful World campaign, joins Boyd in the studio to talk about the activities and resources available through National Geographic for 2008 Geography Awareness Week, November 16-22.
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• Can darkness disappear? According to the cover story of November's
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magazine, it's already happening. The story's author, Verlyn Klinkenborg, talks to Boyd about the consequences of light pollution and what we can do to solve the problem.
Listen to this segment
• Emily Main, senior editor of the
Green Guide
, tells listeners how dimming their lights and choosing the right bulbs can save money and energy.
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• For centuries, Borneo has been exploited for its natural resources. In the November issue of
National Geographic
magazine, Mel White writes about the decimation of the southeast Asian island's populations of orangutans, rhinoceroses, and palm trees. White tells Boyd about what the inhabitants of Borneo are doing to save their island from total ruin.
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• Scientists have recently discovered unfrozen lakes and rivers flowing underneath the miles of ice on the continent of Antarctica. John Priscu, professor of ecology at Montana State University, tells Boyd about his research on the frozen continent and his hopes to discover organisms that have been living untouched in that water for over 20 million years. The trouble is that to get to that water, scientists have to drill through miles of ice, and if they don't drill properly, they could cause a 3,000-foot geyser of water to erupt.
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Part 1
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• Most people are afraid of close encounters with sharks and mountain lions, but what about unseen threats, like SARS or the plague? Ian Lipkin, professor of epidemiology and director of the Center for Infection and Immunity at Columbia University, tells Boyd how he and his team isolate, identify, and eliminate infectious diseases before they can spread too far.
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• Boyd remembers the time he swam with crocodiles in Australia...and lived to tell us the tale.
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Rangers 3, Red Wings 0 … post-game notes & quotes
Post-game notes & quotes courtesy of the NYR: Rangers 3, Red Wings 0. Click here for boxscore. Team notes: – The Rangers defeated the Detroit Red Wings, 3-0, today at Madison Square Garden, in an Original Six matchup. Henrik Lundqvist made 30 saves to post his 300th career victory and… Read More →


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Today's Devotional
Star GazingWhat impresses you most about God's creation?
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I am so thankful that God gave me the trials he has over the past couple of years because it has shown me that no matter what I do or don't do that he is their and evident in all ways. He is the Alpha and Omega, the begining and the end, the Most High, The Light of the world, The Prince of Peace, The King of Kings, The Lord of Lords, and the Savior of my life. God is has given us a new day to praise his name and bless someones life. Today is that day and it may be your last Chance!!!


text: On Wed, 2005-09-21 at 13:07, cherylsh wrote: > Hi all, > > I'm currently trying to figure out how everything is wired together > in Surge Reliable, and have gotten confused about the line: > SurgeM.Bcast -> Bcast.Receive[AM_SURGECMDMSG]; > in Surge.nc > > Since, in SurgeM.nc, an instance of the interface Receive has been > named Bcast, does this mean that all uses of the word "Bcast" found > in Surge.nc actually refers to the Receive interface? Yes. Notice that at the top of SurgeM.nc in the uses section there is a line that confirms that: interface Receive as Bcast; > > There is also the line below the one I've typed above: > > Bcast.ReceiveMsg[...] -> Comm.ReceiveMsg[...]; > > I can't seem to find any ReceiveMsg function either within the > Bcast or the Receive interfaces. Where is it being implemented? It's mentioned in he Bcast interface (Bcast.nc). Notice in the configuration it has a uses section that says: interface ReceiveMsg[uint8_t id]; This means the interface doesn't get the radio messages itself, it has to be wired to GenericComm or GenericCommPromiscuous by the program. > Thanks for any help you could provide, > -Cheryl No problem, Mike Magee Remtrol Inc.


text:
Keneseth Israel's new Blue Bell campus is thriving, with a congregation that boasts nearly 100 families, a Hebrew school and monthly Shabbat services. Rigler usually leads the monthly service, though occasionally, Senior Rabbi Lance Sussman or another member of the senior staff will step in.
The campus currently operates out of St. John Lutheran Church, and members say that the relationship is solid.
"It's been a wonderful partnership," said Andrew Flame, vice president of K.I. and a resident of Blue Bell.
"From the first phone call, the pastor was immediately interested in welcoming us, and it's worked very well, I think, for the church and for us."
Sussman, who's in his sixth year at the synagogue, stressed that it's not just the quantity of new members but the quality of the experience that is so significant.
"A community has developed," he said, describing it as full of "wonderful people who came ready to jump in with both feet, both hands, and be part of the synagogue."
The families have really taken the new campus to heart, and committees and activities have sprung up quickly.
"Over the course of the year, what has transpired is that we have out in Blue Bell now a really dynamic, dedicated group of congregants, who have slowly taken hold and taken ownership of the campus in such a tremendous way," said K.I. president Carey Roseman.
"It feels wonderful," added Sussman. "Brand-new people, who've just come into the congregation, are running Mitzvah Day projects, fundraising projects and all types of things."
According to the rabbi, the Jewish population has been moving farther and farther out into the suburbs in the past decade, which led K.I. to look at where it could expand.
When the congregation researched where families were moving, they saw the Blue Bell area as an opportunity for expansion.
"We believed there's a good number of unaffiliated families that would have interest in a Reform synagogue in the Bell Bell area," said Flame.
He added that there is currently no plan for K.I. in Elkins Park to move from its current location.
Above all, the goal of unity remains paramount for the Blue Bell campus and the K.I. facility in Elkins Park.
"We want to be one congregation," said Sussman.
Moreover, according to the rabbi, since the new campus has had such a successful first year, leaders have now begun a search for a permanent home in Blue Bell.
And as the campus begins its second year, it continues to grow.
"It's been a metamorphosis," said Roseman. "And we could not be happier."


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|You are in: Special Report: 1999: 12: 99: New Years Honours
Friday, 31 December, 1999, 01:51 GMT
Diplomatic and Overseas
The Hon Judge Christopher William Bellamy, For services to the development of the Court of First Instance of the European Communities.
John Peter Jens Jonas, CBE General director, Bavarian State Opera.
Howard Stringer, Chairman and chief executive Officer, SONY Corporation of America.
Sir Andrew Marley Wood, KCMG HM Ambassador, Moscow.
David Brian Carleton Logan, CMG HM Ambassador, Ankara.
Thomas Legh Richardson, CMG HM Ambassador, Rome.
Robert Peter Wilson, For services to British interests overseas.
Michael Edgar Cook, High Commissioner, Kampala.
Robert Davies, Director, The Prince of Wales's Business Leaders' Forum.
Maj Gen Karol John Drewienkiewicz, CB Lately chief of Operations, OSCE Kosovo. Verification Mission.
Victor Joseph Henderson, HM Ambassador, Sana'a.
Alan Richmond Ingle, Head, Joint Diplomatic Service Management Office, Brussels.
Miss Ann Walford Lewis, Counsellor, Foreign and Commonwealth Office.
Ian Linden, Executive director, Catholic Institute for International Relations.
Stephen Thomas Nash, HM Ambassador, Riga.
Robert Ramsay, Lately Director-General, European Parliament.
Professor Helen Sarah Wallace, For services to the development of European studies.
Peter John Westmacott, LVO Director, Foreign and Commonwealth Office.
Julian Paul Geoffrey Wiseman, Counsellor, Foreign and Commonwealth Office.
Miss Julie Elizabeth Andrews, For services to acting and entertainment.
Miss Elizabeth Rosemond Taylor, For services to acting and charity.
Duncan Robin Carmichael Christopher, CMG HM Ambassador, Jakarta.
Professor Andrew John Wiles, FRS For services to science.
Michael John Aaronson, Director, Save the Children Fund.
Jonathan Theodore Starmer Fenby, For services to journalism.
Martin John Griffiths, For services to international humanitarian assistance.
David George Heard, OBE For services to the oil industry and the British community in Abu Dhabi.
Lindsay Harwood Owen-Jones, For services to British interests, France.
David Wayne Marsh, For services to Anglo-German relations.
David George Moir, For services to British financial interests overseas.
Miss Hella Henrietta Pick, For services to journalism.
Col John Joseph Porral, OBE, ED, JP. (For community service, Gibraltar.)
Alistair Macaulay Stephen, For services to aviation engineering.
Dr. James Roland Williams, For services to British-Australian relations.
Donald James Woods, For services to human rights.
Barry Thomas Adams, For services to British business in Brazil.
Albert Dennis Askew, For services to leprosy relief.
Francis Parton Barber, MBE Honorary British Consul, San Pedro, Sula.
Michael George Bird, Director, British Council, Ukraine.
Capt Christopher Andrew Hervey Blake, For services to youth and sail training.
Patrick Thomas Carroll, For services to British exports to Japan.
Dr. Timothy Clayden, Counsellor, Foreign and Commonwealth Office.
Professor Francis Edwin Close, For services to research and the public understanding of science.
Hywel Coleman, For services to education in Indonesia.
John McIntosh Crawford, For services to British-Brazilian relations.
Mrs. Carolyn Louise Cripps, For services to children's charities in Russia.
Col Timothy James Earl, Lately secretary, Government Hospitality Fund.
William Henry Frankel, For services to human rights.
Christopher Paul Gibbard, For services to prison reform in the Caribbean Overseas Territories.
Albert Louis Hammond, For services to music and songwriting.
John Harrison, For services to social development in the Caribbean.
John Ogilvy Houlton, MBE Director, British Film Office, Los Angeles.
Mrs. Judith Eileen Hemery Howick, Director of Schools and Professional Development, British Council.
Anthony Ashby Hughes, For services to global seismology.
Jeremy Nicholas Wain Jennings, For services to British-Belgian trade.
Col Andrew Hubert Joscelyne, Lately Deputy head, European Commission Monitoring Mission, Belgrade.
Miss Jane Seymour Keach, For services to acting and entertainment.
Dr. Robert Graham Killick, For services to archaeology overseas.
Dr. David Maurice Landsman, Lately D.H.M., British Embassy, Belgrade.
Alexander John Maisner, Economics assistant, Bonn.
Barnaby Mason, For services to broadcasting.
Charles Washington Misick, For community service, Turks and Caicos Islands.
Richard Gordon Monk, QPM Lately head of UN International Police Task Force, Bosnia.
Dr. Jane Moon, For services to archaeology overseas.
Colin Paul Peter Mulcahy, First secretary, British High Commission, New Delhi.
Richard John Beresford Neal, For services to British-Japanese trade.
Timothy William O'Brien, For services to British-Malaysian trade.
Douglas Edwin Oakervee, For services to civil engineering overseas.
David Ian Ramsay, Secretary, British Group, Inter-Parliamentary Union.
Mrs. Claudia Cynthia James-Roach, For services to public administration, Montserrat.
Edmundo Ros, For services to entertainment.
Sister Gillian Margaret Rose, For services to community healthcare in Bangladesh.
Miss Michele Saward, Director E.U. Relations, British Council, Brussels.
Professor Jeffrey Jon Shaw, For services to the study of leishmaniasis.
David Arthur Slinn, Lately First Secretary, British Embassy, Belgrade.
Clive Adrian Stafford Smith, For humanitarian services in the legal field.
Dr. Daniel Orlando Smith, MBE Lately Chief Medical Officer, British Virgin Islands.
Mrs. Eugenie Etheline Todman-Smith, MBE For community service, British Virgin Islands.
Benjamin Stevenson, Artistic director, Houston Ballet.
Derek Hugh Taylor, Chief Minister, Turks and Caicos Islands.
Michael David Teden, For services to British-American trade.
Edward Ernest Webster, Head, British School, Antwerp.
Anthony Westnedge, For services to British-Latin American relations.
John Robert Leigh Whitechurch, For services to the local community, Nigeria.
Stuart Alves, For services to healthcare in Bulgaria.
Shemaiah Chukwunyere Azumah, Commercial Officer, Port Harcourt.
Miss Katherine Bainbridge, For services to healthcare in Romania.
Mark Robert Baker, For services to agriculture in China.
Charles George Carbonell-Bamford, For services to British interests in Colombia.
Gerard Barron, Honorary British Consul, Boulogne-sur-Mer.
Victor John Bertolaso, Lately Head, Visual Aids Centre, N.A.T.O.
Miss Valerie Ann Bothamley, For services to healthcare in India.
Michael George Bowerman, For services to education, Cayman Islands.
Christopher Adrian Bullock, Second Secretary, Foreign and Commonwealth Office.
John Patrick Casey, For services to British interests, Cyprus.
Mrs. Janice Laura Cassant, Personal assistant to HM Consul-General, Marseilles.
Mrs. Felicity Mary Cave, For services to British-Russian relations.
Mrs. Dorothy Dawn Channel, For services to the British community in California.
Maj Ian Allan Crowther, For services to British ex-servicemen in South Africa.
Gilbert Ferguson Park Currie, For services to healthcare in Kenya.
Neville Antonio Dublin, For services to communications, Montserrat.
Mark Jeremy Dytham, For services to British architecture and culture in Japan.
James Fletcher, Chief Security Officer, British High Commission, Nairobi.
Jennifer Mary Goodwin, For services to childcare overseas.
Andrew Martin Graham, British Honorary Consul, Cagliari.
Dr. Edward Cecil Harris, For services to architectural, maritime and cultural history, Bermuda.
James Edward Hasler, For services to the children of British Forces, Cyprus.
Hilton Gray Hill, For community service, Bermuda.
Mrs. Margaret Isobel Hofmaier, For services to the British community in Vienna.
Mrs. Elizabeth Homewood, For welfare services to the British community, Costa Blanca, Spain.
Mrs. Winifred Hughes, For welfare services to the British community, Sao Paulo.
Paul Michael Jackson, Lately Attache, British Embassy, Belgrade.
Mrs. Joan Ann Jones, For services to the community, Botswana.
Simon Lessing, For services to triathlon.
Miss Felicity Manuella Lewis, Lately Translator, European Commission.
William Wavell Magor, Lately First secretary, HM Embassy, Tel Aviv.
Mrs. Daphne Yolande Matthews, For services to the British community, Pau, France.
Gerard McGurk, Management Officer and vice-Consul, HM Embassy, Skopje.
Mrs. Janet Ann Dolder de Mena, For welfare services to the community, Chile.
Christopher Avison Milne, British Honorary Consul, Surabaya.
Mrs. Muriel Susan Moring, First Secretary, Foreign and Commonwealth Office.
Miss Elizabeth Morris, Lately personal assistant to the Executive Secretary, UN Economic Commission for Europe. (Cambridge, Cambridgeshire)
Mrs. Caroline Morrissey, Director, British Council, Switzerland.
Geoffrey Michael Mumford, For services to international youth adventure training.
Mrs. Pamela Jean Clements-Nichols, For services to the British community in Brussels.
Mrs. Carol Owen, For services to the community, Cayman Islands.
John Edward Packer, For services to British interests in Sweden.
Mrs. Lillian Josephine Pitaluga, For services to the community, Gibraltar.
Philip Marcus Pitt, MC For services to the British community in Malawi.
James Prentice Powell, For services to sport and the community, Cayman Islands.
Dr Raymond Charles Raymond, Vice Consul, British Consulate-General, New York.
Mrs. Judith Ann Razek, For services to the arts in Oman.
Brian Frederick Reeve, Lately president, Churchill Statue Association, France.
Dr. Leon William Rheims, For welfare services to the British community, Sao Paulo.
Viviano Domenico Rossi, For services to British interests in France.
Michael William Roulston, Headmaster, British School, Tokyo.
David John Scrimgeour, Director, Locate in Scotland, Germany.
Richard David Shackleton, Lately Third Secretary, H.M. Embassy, Bogota.
Michael David Simpson, For services to architecture in Papua New Guinea.
Clive Patrick Swain, For services to the British community in Chile.
Thomas Toynton, Security Officer, British Embassy, Manila.
Mrs. Dalton Eileen Tucker, For services to education, Bermuda.
Miss Lisa Jane Tylee, For services to charitable organisations, Caracas.
Mrs. Jennifer Wallum, For services to the local community in the Philippines.
Susana, Lady Walton, For services to British interests, Italy.
Patrick John Warren, For services to community welfare, Sierra Leone.
Mrs. Jennifer Weineck, For services to the British community in Oporto.
Bishop Franklyn Rudolf Williams, For services to community welfare, Turks and Caicos Islands.
Mrs. Cynthia Mary Worringham, Economic Assistant, British High Commission, Canberra.
Links to other New Years Honours stories are at the foot of the page.
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For those of you who are environmentalists, you will definitely be excited by the thought of being able to generate your very own electricity for your everyday use at home.
Because by doing this, you will be able to do your part for the environment. Not just that, you will also be able to save quite a lot of money on your utilities bill every single month.
"So, how can I go about generating my very own electricity?", you may ask...
Good question. And the answer to this question is to build your very own solar panels. And you'll find exactly how to build one in the Earth4Energy package:
Another question, "Can I really build my own workable solar panels that generate electricity for my home simply by relying on this Earth4Energy package?"
Totally valid question to ask... And in this page, you will find out everything you need to know about Earth4Energy, and whether this package is for real (in helping you build you very own electricity-generating solar panels).
What Is Earth4Energy All About?
The Earth4Energy package consists of a 85-page guide compiled by Michael Harvey, who has over 15 years of experience in the area of renewable energy solutions.
And in this particular guide, you will discover each and every single aspect you need to know when it comes to building your very own solar panel for your home, including:
Click Here To Get An Exclusive One-Time Only Special Discount Off Your Purchase Of The Earth4Energy Package Today... Limited Time Only!
Pros And Cons About The Earth4Energy Package
Moving on, let us now take a look at some of the pros, as well as cons, of this particular Earth4Energy package.
Let us first take a look at some of the pros of this particular package:
After taking a look at this package for ourselves, we feel that this is one of the most comprehensive packages around in the Internet marketplace, where everything that you need to know, as well as build your very first solar panel, is detailed in a step-by-step manner (in both text form, in the guide, as well as step-by-step videos).
Another positive aspect about this Earth4Energy product that we would like to highlight is that, it is hugely affordable to build your very own solar panel - It only costs around $100 to build one, and yet it can save you lots and lots of money on your utilities bill thereafter (as you no longer need to rely on them for electricity).
Plus, as a customer of Earth4Energy, you are entitled to lifetime updates to this program.
Last but not least, the after-sales customer service support is very desirable. Also, the replies are also very detailed - This goes to show that the support team is indeed knowledgeable about the product.
Having talked about the pros of this Earth4Energy product, let us now take a look at some of the cons.
One con about this product is that, if you have zero experience in woodworking, or crafting, then it may take you a bit more time (on top of the time that's required) to build your first solar panel.
Our Final Verdict
Look at the benefits that you will be able to get when you are self-sufficient in generating your very own electricity for your home - The hundreds of dollars you are going to save on your utilities bill every single month, the amount of earth-saving effort you are contributing.
If you are looking for a step-by-step, no nonsense guide on building your very own electricity-generating solar panels from scratch, then we would strongly recommend Michael Harvey's Earth4Energy package!
To Read More About The Earth4Energy Package, Click Here Now -> Earth4Energy Review


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Wed., May 23, 2012, 12:10 p.m.
Occupy Spokane moves into its first clubhouse, on East Sprague
The Occupy Spokane group has started its own "Occupy Spokane Clubhouse" on East Sprague. It's open for business and is looking for volunteers and donated second-hand items.
It's renting a storefront at 1808 E. Sprague. The goal is to raise some money for Occupy events through sales of second-hand items as well as new T-shirts.
It's also selling coffee and some baked goods, said John Dain, one of the club's organizers.
Other organizers include Terry Hill, Chuck Moreland and Tara Williamson.
The relatively small space (see photo here) has been the home for a computer repair shop and Khali's Place, a vintage clothing retailer. Hours for now are from 6 a.m. to 10 p.m, seven days a week.
Hill said the Occupy Spokane group needed a place to store items, to hold meetings and serve as a gathering spot. The focus for the group will continue on addressing community issues and talking about jobs, the economy and support for local businesses.
Dain said the group plans to hold several events in coming weeks focusing on the plight of homeless U.S. veterans. "There are studies saying about 40 percent of the homeless population comes from vets," Dain said.
For more infomation on the clubhouse, call 535-4040.
You must be logged in to post comments. Please log in here or click the comment box below for options.comments powered by Disqus


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Northern VA Outdoor Lighting
Acclaimed Services
For over 20 years, Acclaimed Services have been providing the Northern Virginia and surrounding areas with reliable outdoor electrical services. Our dependable electricians are prompt, courteous, and pay close attention to detail. Whether you'd like to install lighting around your walkway or want to add a few motion sensor lights to the area around your house, we're here to meet your needs.
We're a full-service company that can handle all of your home improvement needs and offer up-front pricing for your convenience.
Our Outdoor Electrical Services Include:
- Deck lighting
- Emergency lighting
- Holiday lighting
- Landscape lighting
- Motion / sensor lights
- Parking lot lighting
- Driveway Post lights
- Emergency back-up generators
- Security lighting
- Sports lighting
- Walkway lighting
We offer emergency service for your convenience
All major credit cards are accepted and we're licensed, fully insured and bonded.
Contact Acclaimed Services today at 703-354-2700 for all your Northern Virginia outdoor electrical lighting needs.
Fairfax, Falls Church, Arlington, Alexandria, Dunn Loring, Reston, Herndon, Sterling, Ashburn, Leesburg, Burke, Springfield, Lorton, Great Falls, Tysons Corner, McLean, Clifton, Fairfax Station, Woodbridge, Annandale, Oakton, Dale City, Manassas, Manassas Park, South Riding, Haymarket, Gainesville, Bristow and Chantilly
Call us at 888-378-8636
or 703- 642-6500
Adam responded quickly to my call and showed up at my house within 15 minutes. Their service is exceptional and their workers are reliant, friendly, and knowledgeable.


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I have had one previous miscarriage and I believe I just had another recently. Should I be examined by a doctor? If so, what kind of examination do I ask for? Thanks
Depending on when you think you miscarried, it would be wise to confirm you have dropping HCG (pregnancy hormone) levels, and that your pelvic examination reveals no sign of tenderness from infection, nor signs of continued pregnancy. Sometimes an ultrasound is necessary to confirm you are no longer pregnant.
It is possible to have bleeding during pregnancy and still remain pregnant, especially in ectopic pregnancies (i.e. tubal pregnancies), sexually transmitted infections, and twin pregnancies. So if you think the likelihood you were pregnant is high, you should be examined.
~The Doc


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Your cart is empty!
Lumi Loose Eyeshadow
Out of stock
Iridescent snow white with turquoise sheen and flashing bursts of blue and green. Changes color depending on what shade you layer it over. When worn over a dark base, this complex white transforms itself into your new favorite blue eyeshadow! Mix and match and experiment to create your own gorgeous shades.
Net weight: 4 grams
PLEASE NOTE: Due to the nature of unique ingredients in Lumi, this particular shade settles more than others and will give the appearance of being half full.
Ingredients: Calcium Aluminum Borosilicate, Magnesium Myristate, Silica, Caprylic/Capric Triglyceride, Phenoxyethanol, Caprylyl Glycol, Ethylhexylglycerin, Hexylene Glycol. May Contain: Titanium Dioxide (CI 77891), Tin Oxide (CI 77861), Manganese Violet (CI 77742), Ultramarines (CI 77007)
Regular Price: $14$14.00


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Application Form for IELTS
5 Things to Keep in Mind for Filling IELTS Application Form
If you want to take the IELTS test, the first thing you must do is to register for the test. You can register for the test by post or courier, through online or in person. To know the actual details on how to register for the test, you can refer to the website www.ielts.org.
Whatever may be the method of registration you are choosing, you have to fill an application form. This article emphasizes on five things to keep in mind for filling the form.
Things to Consider Before Filling an IELTS Application Form
You have to be clear with the following things before filling the application form:
- Be clear about the deadline for registration and the test fee.
- Read the terms and conditions, and other information given in the application form carefully.
- Make sure about the module or version of the test you have to take using the Global Recognition System of the test. Be clear about the test location and test center of your choice. Be clear about the preferred test date and an alternate test date.
- Ensure that you have a valid ID proof (passport or national identity card) in accordance with the conditions specified in the application form.
- Make sure that you have two recent (less than six months old) identical passport sized photographs in accordance with the conditions specified under the Checklist given in the application form.
- Ensure that you have a valid credit card in case you have decided to use the online registration method.
Things to Consider When filling the IELTS Application Form
You must consider the following five things in mind when filling the application:
1. When Providing Photographs
- Make sure that the two passport-sized recent photographs you affix and paper clip are identical.
- Ensure that you have signed on the back of the photographs.
2. When Filling the First Page of the form
- Ensure that you fill this page only in block letters.
- The name you provide on the application form must be the same as the name on your ID proof, which you will carry to the test center.
- Check that the address, telephone number and email address that you fill are correct.
- Indicate the type of ID proof (valid passport or national identity card) that you can take with you during the test. Fill only the number of the ID proof that you indicate.
3. When Filling the Second Page of the application
- Ensure that you fill this page only in block letters.
- When filling the questions from 11 to 14, refer to the code list provided at the pages four to six of the application form carefully to fill these questions.
- Enter the codes for your country or region of origin, your first language and your occupation accurately.
4. When Filling the Applications to Recognizing Organizations Page
- Fill the "Applications to Recognizing Organizations" provided in the form if you wish the test center to send your result to academic institutions/ government agencies/ professional bodies/ employers to which you apply.
- Ensure that you fill this section only in block letters.
- Provide only correct information when filling this section.
5. Checklist and Declaration Pages
- Sign the Declaration page.
- Ensure that you have provided all the information and enclosures (photographs, photocopy of ID proof and test fee) given in the checklist.
- Ensure that you have marked everything in the checklist.
Filling the application form will
not be a difficult task since all the information needed for filling it
are clearly provided in the third page (Notice to Candidates) of the
application form. Just read all the instructions carefully and be
prepared with all the required details so that you fill in the
application form without making any mistakes.


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Interviewing should be taken seriously and anyone giving an interview must be prepared. Learn ways to run a more effective interview, asking great questions that can keep candidates on their toes, and allow you to learn more about your prospects.
Your business depends on your ability to make a good hire. But making a good hire is not exactly an easy task. After sorting through resumes and selecting the few choice candidates considered worth your time is only half the battle. Often the hardest part of the hiring process is conducting a job interview that differentiates between who the candidate wants you to see and who is really sitting across from you.
You expect the candidate to walk in to your office with some knowledge of who your company is and what it is you do, right? It's in your best interest to prepare for the interview as well. Going into the interview, you should have already studied the candidate you are about to meet face-to-face. The least you could do is to become familiar with his or her resume, cover letter, and any other materials that were submitted to you for consideration of the job.
Before the interview is also the appropriate time to Google your candidate to see if anything interesting pops up. You should also find out if they have a MySpace or FaceBook page, and if so, what type of content appears on those pages. You might find something that does not mix with your culture or morals. Or, you might be pleasantly surprised as a candidate relives the days spent saving the whales, if you're into to that sort of stuff, too.
The benefit of doing your homework beforehand is that you don't waste too much of your interview time going through these materials together. You come in to the interview with questions or comments on their experience, background, work, and can spend the entire interview getting to know more about the real candidate, and not who they are on paper.
Some interesting icebreakers to kick off the interview are:
So often we base our opinion on someone by their appearance or the impression we get of that candidate within the first few minutes of meeting them. The problem with this is that it clouds our heads, and if your first impression is not a favorable one, it is an uphill climb for the candidate without them even knowing it.
Stop doing this! When a candidate enters your office for a job interview do whatever it takes to not form an immediate opinion of them. If it helps, say to yourself that you believe this candidate to be a certain a way, and then flush this out of your head any way you know how. Give the candidate a clean slate and let their talents and qualifications (or lack thereof) form your opinion. You don't want to blow off a potential top talent because his or her appearance reminds you of a neighbor you didn't like growing up.
A few good secondary questions to ask now are:
Asking behavioral questions requires candidates to draw upon their background and experiences to describe how they used skills that are relevant to your position. Their resume may be filled with "I'm a team player", "Organized", "Multi-Tasking", and "Born Leader", but anyone can include this on their resume. Asking questions that force candidates to speak about these traits enables you to discover whether or not they do in fact possess them. Be sure to ask plenty of these questions right in the middle of the interview and score your candidates on how quickly they respond and the amount of tap dancing they do. But be careful – if it sounds too rehearsed then chances are it is.
Behavioral questions to ask:
You're past the halfway point of conducting a better job interview, so now is the time to get a little bit crazy. Ask the candidate a question that has no right or wrong answer. It could be why the sky is blue or why grass is green? It could even be why do worms not have eyes? Whatever your question, judge your candidate on how well they answer and if they are thrown for a curve or not. If they stay on the ball and answer as if it was expected then you have a pretty sharp candidate sitting across from you. Even if they laugh a bit at first but manage to form a pretty good answer, you know you have someone who can improvise and react to situations. If they stumble about and seem completely flustered, you have to wonder about the candidate's ability to respond to pressure seeing as the candidate has a hard time speaking off the cuff. Remember, these questions are not meant to derive a correct answer. The purpose is only to gauge the candidate's reaction to a tricky situation.
Great abstract questions to ask:
Just because you've concluded your face-to-face job interview, doesn't mean the process is over. Go back and examine the answers to your questions and score these answers against a guide that makes it easy for you to judge. This guide needs to be somewhat flexible as there is not an exact answer for qualitative data, but you can form a set of guidelines for what the ideal answer would be. Having a set guide makes it easier for you to fairly judge each candidate's response and select a candidate that fits your company's needs. You should be well on your way to making a better hire after following these five steps for conducting a better interview.
Every year, HR professionals share new and unusual stories about the interviews they conduct. People make mistakes, but some mistakes are so over the top that they make the decision not to hire a very easy one. Check out this year's top 10 list.
Have you ever interviewed a candidate who was arrested for stealing a pig? A recent CareerBuilder.com survey found several strange items included in resumes. Have a good laugh, and learn some principles for dealing with these oddities as a hiring manager.
There are many recruiting myths that interfere with the hiring process. Past experiences, poor training, and office legends keep these myths alive.


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Microsoft has released an update for the Xbox 360 HD DVD player on Xbox Live.
It will be automatically applied to your hardware the next time you watch a film in sparkly high-definition while being signed into Live.
The biggest improvements are in the audio department, which now boasts more output choices when using TOSLINK or HDMI connections. You can choose from Digital Stereo (2 channel PCM), Dolby Digital 5.1, DTS 5.1, and WMA Pro. You'll also find a new "Dynamic Range Control" option to fiddle around with.
Networking support has been updated, as has title compatibility, and you should find that performance with MPEG-4 AVC and H.264 files has been tweaked.
Those of you about to buy an Xbox 360 Elite in America will also be pleased that 1080p is now supported via HDMI, while concerned mums and dads can now flex upgraded parental powers (well, controls).
Don't worry if you don't have access to Live to download the update, as it will be available later in the week from Xbox.com.
So, um, how many of you bought the HD DVD add-on?


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Wire Announce New LP Red Barked Tree
The Quietus
, October 18th, 2010 10:21
...and very good it is too
We at tQHQ are already very excited about a record set to drop in early 2011. That record is the latest offering from the magnificent Wire. Called Red Barked Tree, it features Colin Newman, Graham Lewis and Robert Grey and will be released on the band's own Pink Flag imprint on January 11th. You can hear and download the track 'Two Minutes' below. Guess how long it is! Red Barked Tree tracklist after the player. And you will of course be aware that the Quietus has Wire playing the Lexington on November 8th (supported by Factory Floor) and November 9th (supported by LoneLady).
Wire Red Barked Tree tracklist:
'Please Take'
'Now Was'
'Two Minutes'
'Bad Worn Thing'
'A Flat Tent'
'Down To This'
'Red Barked Trees'
Oct 18, 2010 7:29pm
so looking forward to hearing a new Wire album...
btw, that should be Robert GREY shouldn't it? or did he change his name to "Green"?


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In an effort to get a leg up on Facebook marketing, many like-obsessed pages resort to buying fans — fake profiles which only exist to boost pages' numbers. Now that Facebook has broken down fans by country, VentureBeat notes that it's easier to see which pages have acquired fans honestly, and which ones flat-out paid for them.
Using sorted country data from Socialbakers, VentureBeat noted how it's easier to see which companies should have asterisks next to their like totals.
For instance, Socialbakers CEO Jan Rezab told VentureBeat his company examined airlines. It found that Lufthansa has 1.2 million fans, many of which hail from Indonesia, Bali, Jakarta, and Pakistan — all countries where Lufthansa does not fly. While this isn't rock-solid proof that Lufthansa paid for these fans, it raises several questions about why the fan count is so high in countries where the company doesn't have a presence.
Facebook has been relentlessly trying to snuff out fake accounts, the efforts of which have led to fan counts for several pages to decline sharply.
However, VentureBeat noted that just because a page has a large contingent of fans from another country, it doesn't mean that the page bought all of those likes. Only 47 percent of President Barack Obama's fans are from the U.S., but his internationally renowned status accounts for some of that.
Readers: Do you know any pages that have paid for likes?
Image courtesy of Shutterstock.


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I love to listen to pretty much any kind of music. I'm not picky at all. I usually listen to country the most. I really love going to the beach, going out on the boat, fishing, hunting, hanging out with friends at the bar, staying in and watching movies on a rainy day, traveling and going to old classic car shows.
If you find me interesting, send me a message! ??
2. Love
3. Success
4. Trucks
5. Water
6. Happiness
You want someone who's honest.
You like never having a dull moment.


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Family members soon could help stop an overdose of a loved one addicted to heroin and painkillers.
Gov. Steve Beshear is expected to sign House Bill 366 into law, which will allow physicians to prescribe a nasal version of Narcan to the public so they can administer the drug to opiate overdose patients.
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Sciton Laser Resurfacing to the Perioral and Glabella Areas - Middleton, WI
At 61, this procedure was done when I had...
Happy with results!
I am very light skinned, Irish/Dutch, so I did have redness for several months and was challenged to get it covered evenly as, if I used a regular foundation, it stuck in my pores and looked bad. I finally came up with a routine. Jane Iredale cover up, then a blotting powder, Laura Geller was my fav but Neutorgena makes a fair one and a lot less expensive. It is clear, not translucent and is great for mature skin as it conceals creases and pores, doesn't settle in them. You need to blot it on, don't rub it in as most powders.
I still have a little wrinkling in those areas yet so will be having Dr Marcus touch up those areas again in early January. Yes, just as deep to really be effective but probably not as wide an area. Hopefully it will not be quite as challenging to cover, but if it is I know what to do, again.
I have a friend that had sun damaged crepey skin. She had Dr Marcus also. After her first treatment it was as if a mask had been removed form her face. It was smooth and clear! She did still have some deep wrinkles around the eyes and mouth and had a couple more treatments that really did address them a lot.
Dr Marcus has done a lot of treatments with the laser and is well versed in what needs to be done to get the outcome you want. I highly recommend him.
Jan 8 2014 for round 2! Laser and fat grafting
Laser and fat transfer done!!
Day 1-10 update on healing
4 Week Update!
Dr Marcus has had a lot of experience with the laser for line and wrinkle removal and skin resurfacing. If he doesn't think it is an appropriate treatment he will tell you. He doesn't sell you something that will not deliver the outcome you are hoping for. Lasers are good, but they can't fix all lines and wrinkles. He also said it can take several treatments to get the outcome you want. Mine are better than the first time, but I do need it done again and I'm going back to Dr Marcus because I trust him. Update two years later, I am still very happy with Dr. Marcus and have had a couple more procedures with him and would highly recommend him and the Transformation clinic in Middleton, Wi. to everyone wanting to have expert care and treatment for any procedure to enhance their physical appearance.


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For the fiscal year ended February 2, Fred's, Inc. reported net income of $29.6 million, or 81 cents per diluted share, compared with $33.4 million, or 87 cents per diluted share, in the prior year. Net income in 2012 included approximately $4.2 million, or 12 cents per diluted share, related to a state income tax settlement as well as other tax-related assumptions and estimates.
Comparable store sales advanced 1.1% in fiscal 2012 versus the year prior. Fred's total sales for 53-week fiscal 2012 increased 4% to $1.96 billion year over year. Excluding the effect of an extra week, fiscal 2012 comps decreased 1.4% from the year earlier.
In the fourth quarter, Fred's reported that net income totaled $6.6 million, or 18 cents per diluted share, versus $9.8 million, or 26 cents per diluted share, in the year-ago period.
Comps gained 4.8%, while total sales for the 14-week fourth quarter increased 7% from the year-prior period t o $533.4 million.
To adjust results to comparable 13- and 52-week periods, Fred's eliminated the week ended February 2 from fiscal 2012. With the effect of the extra week excluded, fourth quarter comps decreased 2.8% from the year-earlier period.
A published consensus analyst estimate from Thomson Reuters called for Fred's to earn 20 cents per share for the quarter. In a conference call, Fred's said that customer traffic was down in the fourth quarter while transaction size remained flat, leading to the adjusted comp decrease. The company also noted that Household Goods decreased as a percentage of sales to 23.2% from 24.7% in last year's fourth quarter.
Bruce Efird, Fred's CEO, said, in comments on the company's results, "The fourth quarter brought to a close a challenging year in 2012 as our customers remained under economic pressures and our operating costs trended higher than forecast. We were disappointed by the results but now move forward with optimism about future opportunities and embark on a three-year reconfiguration plan designed to help us regain the momentum we experienced in the prior three years in driving toward our goal of increasing our operating margin to 4%. Fred's business comprises two distinct focal points, one being our pharmacy department, which continues to perform well, and the other being our general merchandise departments, which overall have seen challenging results. Our reconfiguration plan will seek to elevate our performance by shifting our general merchandise business to a healthier balance of higher gross margin, discretionary departments and consumables, while accelerating our pharmacy and healthcare services growth. Through these efforts, we believe we can improve overall store productivity and space efficiency and enhance product selection in stores with pharmacies. In summary, we look forward to driving improved performance in 2013, delivering earnings growth in the range of 12% to 28% higher than in 2012."
Fred's operates 713 discount general merchandise stores, including 21 franchised units, in the southeastern United States.


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text:
Barber and Osgerby's creative consultancy Map and technology company SAM have designed a kit of "building blocks" aimed at simplifying the creation of internet-connected products.
TI IS MAD FOR: SAM's Internet Of Things : (IoT)Submitted by Wayne on Fri, 2015-07-17 21:47.
TI IS MAD FOR: Chanel: Le cuir matelasséSubmitted by Wayne on Sun, 2014-08-31 15:51.
Technophiliac: The Lieca T SystemSubmitted by Wayne on Sat, 2014-06-14 23:07.
The new Leica T-System from Leica Camera on Vimeo.
It's a story about persistence. Obsessive commitment. Uncompromising. #mantra
TI DATE: INTRODUCING THE NEW LEICA T-SYSTEM : PRIVATE VIP + MEDIA SHOWCASE ( LA) : 04: 24: 2014Submitted by Wayne on Fri, 2014-04-25 00:01.
TECHNOPHILIAC : Conductive Electronic Paper Speakers by Coralie GourguechonSubmitted by Wayne on Mon, 2014-03-24 22:28.
TI IS MAD FOR: ZILLI'S ALLIGATOR IPAD CASESubmitted by Wayne on Fri, 2013-05-17 18:31.
TI PREVIEW: MODERN MATTER MAGAZINE SPRING/SUMMER 2012Submitted by Wayne on Tue, 2012-06-19 18:23.
TI IS MAD FOR: GIORGIO ARMANI's ITAL-TEL 80's TELEPHONESubmitted by Wayne on Mon, 2009-05-11 20:26.
Long before the Samsung affair there was this endeavor on Mr Armani's part in extending his brand to that nexxus of industrial design-the telephone.
TI IS MAD FOR: MODU MODULAR CELL PHONESubmitted by Wayne on Mon, 2009-03-02 21:48.
TI IS MAD FOR: The Alessiphone by Stefano Giovannoni for AlessiSubmitted by Wayne on Tue, 2009-01-20 21:33.


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I suppose there's a unicorn somewhere who is busy eating lots of beans to help Etsy seller LongWinterSoapCo have enough farts to make more of this lip balm. It smells just like real unicorn farts, which are remarkably similar to the smell of spearmint and pink cotton candy. Don't ask me how I know this, I just know. Currently, the unicorns are busy farting more farts but keep an eye on the Etsy story and more lip balm will be available soon.
Product Page ($4 via The Mary Sue)


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National Signing Day kicks off!
WBRZ News 2:
BATON ROUGE - National Signing Day has officially begun around the country; area and LSU prospects are signing their National Letter of Intent to declare their official commitment to their respective college or university.
Jaylon Ferguson, West Feliciana defensive end, was one of the first to sign Wednesday morning, inking his financial aid agreement with Louisiana Tech.
"They just made it feel like family," said Ferguson about his commitment to the Bulldogs. "I'm going to focus mainly on defensive end or outside linebacker [there]."
LSU is also raking in top prospects from across the country. Malachi Dupree of New Orleans, one of the highest-rated high school receivers in the country, signed his letter to join the Tigers Wednesday morning. He joins an LSU recruiting class that includes Leonard Fournette of St. Augustine High School in New Orleans, the nation's top-rated running back.
LSU has thus far posted the following commitments:
1. Brandon Harris QB Bossier City, La. Parkway HS 6-3 180
2. Ed Paris Jr. CB Arlington, Texas Mansfield Timberview HS 6-0 190
3.John Battle S Hallandale, Fla. Hallandale HS 6-0 179
4. 7:18 a.m. Donnie Alexander LB New Orleans, La. Edna Karr HS 6-1 201
5.Jacory Washington TE Westlake, La. Westlake HS 6-5 2156
6. William Clapp OL New Orleans, La. Brother Martin HS 6-4 275
7. 7:38 a.m. Garrett Brumfield OL Baton Rouge, La. University HS 6-3 285
8. 7:45 a.m. Tony Upchurch WR Pearland, Texas Glenda Dawson HS 6-2 228
9. 7:51 a.m. D.J. Chark WR Alexandria, La. Alexandria HS 6-1 176
10. 7:58 a.m. Clifton Garrett LB Plainfield, Ill. Plainfield South HS 6-3 220
11. 8:15 a.m. Trey Quinn WR Lake Charles, La. Barbe HS 5-11 192
12. 8:19 a.m. Jamal Adams S Carrollton, Texas Hebron HS 6-0 207
13. 8:36 a.m. Cameron Gamble PK Flower Mound, Texas Flower Mound HS 5-9 182
14. 9:05 a.m. Sione Teuhema DE Keller, Texas Keller HS 6-3 215
15. 9:08 a.m. Darrel Williams RB Marrero, La. John Ehret HS 5-11 209
16. 9:16 a.m. Devin Voorhies S Woodville, Miss. Wilkinson County HS
17. 9:49 a.m. Trey Lealaimatafao DT San Antonio, Texas Warren HS
18. 10:25 a.m. Travonte Valentine DT Hialeah, Fla. Champagnat Catholic HS
19. 10:31 a.m. Russell Gage ATH Baton Rouge, La. Redemptorist HS
20. Malachi Dupree WR New Orleans, La. John Curtis Christian Academy
21. 10:45 a.m. Davon Godchaux DE Plaquemine, La. Plaquemine HS


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You're reading the news with potential spoilers, make them spoiler free, dismiss
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text:
Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Genome-Wide Association Study of Systemic Sclerosis Clinical Features Identifies New Disease Risk Variants.
Gorlova16, Olga, Martin15, Jose-Ezequiel, Rueda15, Blanca, Koeleman19, Bobby P. C., Teruel15, Maria, Diaz-Gallo15, Lina-Marcela, Broen12, Jasper C.
United Kingdom
Charité University Hospital, Germany
Department of Rheumatology, Radboud University Nijmegen Medical Center, The Netherlands
Feinstein Institute of Medical Research
Hospital Valle de Hebron, Spain
Instituto de Parasitologia y Biomedicina Lopez-Neyra, Spain
MD Anderson
Radboud University Nijmegen Medical Center, The Netherlands
The University of Texas Health Science CenterHouston
University Medical Center Utrecht, The Netherlands
University of Manchester, Manchester Academic Health Science Centre, United Kingdom
University of Milan, Italy
The Netherlands
The The Netherlands
Systemic sclerosis (SSc) is a rare and severe rheumatic disease. Different lines of evidence suggest that genetic factors may underlie not only SSc susceptibility but also the predisposition to develop certain specific disease phenotypes or clinical symptoms such as limited (lcSSc) and diffuse (dcSSc) cutaneous subtypes and the presence of auto-antibodies, such as anti-centromere (ACA) and anti-topoisomerase I (ATA). To assess the genetic component involved in the different SSc subtypes we analyzed genome-wide association (GWAS) data and replication cohorts from the US and Europe in a total of 5,471 Caucasian individuals with SSc and 10,143 healthy Caucasian controls.
After all data was quality filtered, 2,296 individuals with SSc and 5,171 healthy controls were analyzed for genetic associations with lcSSc, dcSSc, ACA positive and ATA positive subgroups. SNPs from each subphenotype with a corrected P value lower than 1×10-4 not previously described in the literature were selected for replication. These associations were then analyzed in 9 replication cohorts from US and Europe comprising an additional 3,175 SSc patients and 4971 healthy controls.
Eighteen non-HLA SNPs were selected from the SSc GWAS analysis. Meta-analysis of all the cohorts (5,471 individuals with SSc and 10,143 healthy controls) showed a strong association of rs11642873 in the IRF8 gene (P = 5.42×1012, OR = 0.75) and a suggestive but consistent association among populations, of rs12540874 in the GRB10 gene (P = 1.31×10-6, OR = 1.15) with the limited subtype of the disease. We also found a strong association of rs11047102 of the SOX5 gene (P = 1.04×10-7, OR = 1.36) with the ACA positive subgroup of patients. In addition to these phenotype dependent associations, we found rs11724804 in the DGKQ gene (P = 1.79×10-6, OR = 1.12), rs1868929 between the AMRC9 and PSMD1 genes (P = 3.27×10-6, OR = 1.27) and rs10275834 in the JAZF1 gene (P = 9.44×10-6, OR = 1.12) to be associated with SSc.
Outside of the HLA region, we have identified 3 new genes (IRF8, GRB10 and SOX5) associated with clinical manifestations of the disease, emphasizing the differential genetic component of each subphenotype of SSc. We also have identified 3 new genes associated overall with the disease: DGKQ (implicated in cell signal transduction), PSMD1 (the immuno-proteosome subunit which loads immunogenic peptides for MHC transfer) and JAZF1 (a transcriptional repressor previously associated with SLE).
To cite this abstract, please use the following information:
Gorlova, Olga, Martin, Jose-Ezequiel, Rueda, Blanca, Koeleman, Bobby P. C., Teruel, Maria, Diaz-Gallo, Lina-Marcela, et al; Genome-Wide Association Study of Systemic Sclerosis Clinical Features Identifies New Disease Risk Variants. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2214
DOI: 10.1002/art.29978


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text:
NORA Manufacturing Sector Strategic Goals
927ZGFZ - Cell-based Assessment for Iron Nanoparticle-induced Health RisksStart Date: 10/1/2008
End Date: 9/30/2009
Principal Investigator (PI)Name: Yong Qian
Phone: 304-285-6286
E-mail: email@example.com
Organization: NIOSH
Sub-Unit: HELD
Funded By: NIOSH
Primary Goal Addressed9.0
Secondary Goal Addressed5.0
Attributed to Manufacturing
Project Description
Short Summary
This project is to develop an in vitro screening model for assessing the potential vascular toxicity of nanoparticles and to provide a basis for recommendations and guidance on the safe handling of nanoparticles. Specifically, we will identify the molecular mechanisms by which iron nanoparticles induce endothelial cell permeability changes. We will also identify iron nanoparticle-induced production of reactive oxygen species (ROS) in endothelial cells and study the regulatory roles of ROS in iron nanoparticle-induced cell permeability changes. We hypothesize that the production of ROS plays an essential role in iron nanoparticle-induced endothelial cell barrier damage, which can lead to cardiovascular dysfunction. The research strategies applied within this proposal may provide a rapid inexpensive in vitro alternative to the use of animal models to resolve issues in Respiratory Disease and Nanotechnology affecting the Manufacturing Sector.
Nanotechnology is perceived as one of the critical research achievements of this century. Engineered nanoparticles are already being used in many industrial areas. Particularly, iron nanoparticles have being explored for the development of magnetic and electrical applications, catalytic applications, and biomedical applications. However, the unusual physicochemical properties of engineered nanoparticles may also pose adverse effects on biological systems. This proposed research project is to study the potential adverse effects of iron nanoparticles on endothelial cell monolayer at the molecular level to profile their toxicity. The vascular endothelial monolayer forms a semi-selective permeability barrier between blood and the interstitial space to control the movement of blood fluid, proteins, and macromolecules across the vessel wall. Aberrations of permeability barrier integrity play a major role in the pathogenesis of cardiovascular diseases, inflammation, acute lung injury syndromes, and carcinogenesis. Two specific aims are proposed to test the hypothesis that iron nanoparticles may compromise vascular endothelial monolayer integrity through ROS-related signaling pathways. A combination of physical, biochemical and biological approaches will be used. In specific aim 1, we will detect iron nanoparticle-induced actin filament remodeling and microtubule remodeling with confocal microscopic image analysis and Western blot measurements. Since the remodeling of both actin filaments and microtubule is one of essential molecular mechanisms regulating endothelial cell permeability, the identification of their involvements will be important to reveal the molecular mechanisms by which iron nanoparticles induce cell permeability change. In specific aim 2, we will detect iron nanoparticle-induced ROS production with electron spin resonance (ESR) measurements, confocal microscopic image analysis, and flow cytometry quantification. Furthermore, we will determine the regulatory roles of ROS production in iron nanoparticle-induced actin filament remodeling, microtubule remodeling, and cell permeability change using ROS scavengers and gene knockdown approaches. The research strategies applied within this proposal may provide a rapid inexpensive in vitro alternative to the use of animal models to study the cardiovascular health risks of occupational exposure to various nanoparticles. Results will also determine the role of ROS in these adverse health effects: thus, contributing to the development of a predictive algorithm relating physicochemical properties of nanoparticles to their potential bioactivity. The information obtained from this research can be used by NIOSH, OSHA, and EPA in developing protective strategies for nanoparticles in face of little in vivo test data. Workers impacted by this research will be those involved in the synthesis of iron nanoparticles and their use in manufacturing new products.
The new research project will develop an in vitro screening model for assessing the potential vascular toxicity of nanoparticles and to provide a basis for recommendations and guidance on the safe handling of nanoparticles. The information obtained from this research can be used by NIOSH, OSHA, and EPA in developing protective strategies for nanoparticles in face of little in vivo test data. Workers impacted by this research will be those involved in the synthesis of iron nanoparticles and their use in manufacturing new products. Success of the project will be determined by publications in reputable journals in the field, impact on the field as indicated by citations.
Mission Relevance
Numerous epidemiologic investigations have shown a direct relationship between human ambient particulate exposure and increases in cardiovascular morbidity and mortality. It has been suggested that the ultra fine components of ambient particulate exposure "are potentially the most dangerous" size fraction. However, to date little is known concerning potential adverse cardiovascular effects of engineered nanoparticle exposure in the workplace. Iron nanoparticles are of great interest due to their unique magnetic and catalytic properties. They are being explored for the development of magnetic and electrical applications as well as biomedical applications. Recently, iron nanoparticles have been widely used in coal industry to make clean fuels due to their catalytic activities that facilitate the chemical reactions to form and cleave carbon-carbon bonds. However, a significant knowledge gap currently exists on a complete toxicological profile of iron nanoparticles in contrast to their broad applications in industry.
In 2005, NIOSH formed a Nanotechnology Research Center (NTRC) to identify knowledge gaps/critical issues and develop a strategic plan of goals and objectives to develop information necessary to protect workers involved in the production and use of nanomaterials. Because of potential of metal oxide nanoparticles to be used in magnetic electrical and biomedical applications, the NTRC listed the evaluation of the bioactivity of metal oxide nanoparticles as an important research objective. The NTRC listed the development of rapid, inexpensive, in vitro, screening assays predictive of in vivo bioactivity and toxicity as a critical goal. It also notes the importance of improved mechanistic understanding of physiochemical properties of nanoparticles associated with bioactivity to inform risk assessment efforts.
Accumulating evidence showed that nanoparticle-induced injury is directly related to their high surface area and capability to induce ROS. Therefore, it is highly possible that the induction of ROS upon exposure to engineered nanoparticles plays an important role in generation of adverse biological effects. An objective of this proposed project is to determine whether iron nanoparticles cause ROS-induced damage to endothelial cells which normally form a barrier against the leakage of fluid from the microvasculature. Loss of this barrier function has been associated with the development of cardiovascular disease. Evaluation of whether nanoparticles pose risks of injuries and illnesses for workers in particular risks of cardiovascular disease is directly related to the mission of the NIOSH NTRC. The successes of this project will lead to the creation of an in vitro cell-based predictive model for nanoparticle risk assessments. Information and knowledge gained from this research will form the basis of recommendations and guidance on the safe handling of nanomaterials.
Research results will address the goals of the Manufacturing Sector (100%): Strategic Goal 5 "Reduce the number of respiratory conditions and diseases due to exposures in the manufacturing sector." Strategic Goal 9 "Enhance the state of knowledge related to emerging risks to occupational safety and health in manufacturing.
This project also addresses a goal in Respiratory Disease Cross-Sector (100%): Strategic Goal 5 "Prevent respiratory and other diseases potentially resulting from occupational exposures to nanomaterials. Intermediate Goal 5.1 (09PPRDRIG5.1) "Determine the potential respiratory toxicities of nanomaterials". Activity/Output Goal 5.1.1 (09PPRDRAOG5.1.1) "Perform basic in vitro and in vivo toxicity studies".
Lastly the project addresses a goal in the Nanotechnology Cross Sector (100%): Strategic Goal 1 "Understand and prevent work-related injuries and illnesses possibly caused by nanoparticles/nanomaterials. Intermediate Goal 2 (09PPNANIG2) "Toxicity and internal dose".
- Page last reviewed: July 22, 2015
- Page last updated: July 6, 2015
- Content source:
- National Institute for Occupational Safety and Health (NIOSH) Office of the Director


text:
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