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RELAX - A Nonaddictive Natural Stress Reliever*
Relax - natural stress reliever*
"scientifically tested, nature approved*"
RELAX is a virtually lactose-free natural protein containing a bioactive decapeptide that has clinically proven anti-stress properties to help with tension. Studies have shown that this 10-amino-acid peptide is derived from natural origins and is free of undesirable side effects, issues of tolerance or addiction.
There are no side effects from RELAX, only the ability to regulate the perception of stress. Relax will not prevent an individual from evaluating the importance of a situation as some medications can.
Stress is a state where internal and/or external forces increase tension. Medications, alcohol and smoking can worsen anxiety and make the body more sensitive to tension. Stress releases powerful neurochemicals and hormones that cause the heart to pump harder, breathing to increase and muscles to tense in preparation to take action.
One of the dominant hormones released during times of stress is Cortisol. Although Cortisol is an important hormone involved in glucose metabolism, blood pressure regulation, insulin release for blood sugar maintenance, immune function and the inflammatory response, it also activates the relaxation response so the body's functions can return to normal.
But prolonged levels of Cortisol can cause negative effects that include: Impaired cognitive performance, blood sugar imbalances, decreased bone density, decrease in muscle tissue, suppressed thyroid function, higher blood pressure, lowered immunity, poor inflammatory response in the body, and increased abdominal fat.
Additionally, there is a close relationship between Cortisol and Melatonin, the sleep-regulating hormone. Melatonin and Cortisol are designed to run opposite to each other. Cortisol levels should be high in the morning and reach their lowest point at bedtime, whereas Melatonin levels peak a few hours after Cortisol levels drop and decrease by morning. Sustained high levels of Cortisol interfere with the natural sleep patterns by reducing Melatonin production. Over-the-counter pain relievers, sleeping pills, anti-anxiety medications and some antidepressants can interfere with Melatonin secretion at night, thus increasing Cortisol levels.
Prolonged use of Selective Serotonin Reuptake Inhibitors (SSRIs) elevate Serotonin levels which cause the adrenal glands to release both Cortisol and Adrenaline (Epinephrine) to combat the excessive Serotonin. This initial calming gives the impression that boosting Serotonin is pleasant. However, over a prolonged period of time the adrenal glands may lose their efficiency and "Adrenal Exhaustion" can occur, with adrenaline levels dropping and Cortisol levels rising. Eventually, even Cortisol levels fall and this may help to explain why so many antidepressant users eventually experience extreme fatigue.
Cortisol release is regulated by our circadian rhythms (24-hour sleep/wake cycle), with levels the highest in the dawn hours, which coincide with the time that melatonin levels begin to dramatically decline. There is a balance between Cortisol levels and Melatonin; one is high when the other low and this dance helps to regulate the sleep/wake cycle. Benzodiazepines and Sleeping Pills can suppress Melatonin production and interfere with nocturnal secretion, which in turn affects Cortisol. High levels of Cortisol at night can result in difficulty falling or staying asleep and in turn can cause a one-to-two hour delay of melatonin release.
Benzodiazepines have also been shown to increase plasma Cortisol and Prolactin concentrations. This may help to explain why long-term use of benzodiazepines can cause menstrual irregularities and pre-menstrual tension in women and breast enlargement in men. Clonazepam may alter insulin secretion after a single dose.
GABA, or gamma-aminobutyric acid, is the most important and widespread inhibitory neurotransmitter in the brain. Excitation in the brain must be balanced with inhibition or anxiety, restlessness, irritability, insomnia and even seizures can occur. GABA are a class of receptors that include GABA-A, GABA-B and GABA-C and although all induce relaxation and sleep, benzodiazepines and most sleeping pills work by strongly accentuating GABA-A because the binding ability is ten times stronger. But GABA-A also counteracts the effects of Melatonin. Neither GABA-B nor GABA-C alters the effects of Melatonin.
Millions of neurons respond to GABA, meaning that it has a general calming influence on the brain and body. Benzodiazepines enhance GABA-A, reducing the brain's output of excitatory neurotransmitters such as Norepinephrine (Noradrenaline), Serotonin and Dopamine. These excitatory neurotransmitters are essential for mental alertness, muscle tone and coordination, memory, emotional responses, endocrine gland secretions, heart rate and blood pressure control – all of which may be impaired by the drug. Other receptors for benzodiazepines that are not governed by GABA-A are in the kidneys, colon, blood cells and adrenal gland. The receptors react to prolonged use of the medications by increasing in number and/or reducing sensitivity to GABA-A.
Benzodiazepines, Alcohol, Barbiturates and Steroids bind to GABA-A, but Benzodiazepines also affect three GABA-A categories including 1) those that mediate sedation and tolerance 2) the hippocampus, striatum, and spinal cord to mediate anti-anxiety activity and spinal cord function; and 3) the peripheral benzodiazepine receptor that are found throughout the body and brain affecting the heart, immune response, steroid synthesis and inflammation (to name a few).
The brain then reduces its own production of GABA, and during a too rapid withdrawal from Benzodiazepines or Sleeping Pills insufficient GABA is present to alleviate the anxiety and over-stimulation. This can result in increased heart rate while sleep decreases as the body and brain are left in a 'flight or fright' response. A gradual reduction allows the GABA-A receptors time to regenerate.
The active peptide in Relax stimulates GABA-A, B and C, providing calming properties without inducing Benzodiazepine side effects that include memory loss, disinhibition, muscle weakness, tolerance or addiction. During the withdrawal process Relax is a welcome tool to combat stress and over-stimulation. And unlike herbs, Relax will not interact with medications.
RELAX is a concentrated peptide found in milk that offers a natural alternative to addictive medications. Scientists from University Henri Poincare-Nancy & Georgetown University Medical Center gathered a group of medical scientists to test the peptide found in milk. They discovered that a milk protein constituent mimicked the action of anxiety reducing drugs but did not trigger any side effects.
Nature had already provided a natural means to combat stress. We have made it available to you.
Virtually lactose free with less than .1%.
Relax - natural stress reliever*
"scientifically tested, nature approved*"
Regular Price
Your Price
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$118 for 2
$106 for 2
$177 for 3
$159 for 3
$236 for 4
$212 for 4
$295 for 5
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- *These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, prevent or cure disease or illness. More...
- *Always consult with your healthcare professional before starting any diet, exercise or supplementation program, before taking or stopping any medication, or if you have or suspect you might have any health problem. More...
RELAX - Natural Stress Reliever*
"scientifically tested, nature approved"
all-natural protein containing a bioactive decapeptide that has clinically proven anti-stress properties to help reduce tension.* (120 capsules) More...
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Ethological comparison of the effects of a bovine alpha s1-casein tryptic hydrolysate and diazepam on the behaviour of rats in two models of anxiety.
Conformational studies of a benzodiazepine-like peptide in SDS micelles by circular dichroism, 1H NMR and molecular dynamics simulation
Characterization of -casozepine, a tryptic peptide from bovine s1-casein with benzodiazepine-like activity
Effects of a tryptic hydrolysate from bovine milk αS1–casein on hemodynamic responses in healthy human volunteers facing successive mental and physical stress situations
From raw materials to bottling, this product uses Good Manufacturing Practices (GMP) in the production process to ensure optimal quality. There is a difference between GMP compliance and actual GMP certification. GMP compliance means that a company is monitoring itself to the standards, whereas certification means that outside auditors ensure adherence to GMP standards. A GMP compliance certificate is the only way to ensure adherence to the GMP requirements.
- *These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, prevent or cure disease or illness. More...
- *Always consult with your healthcare professional before starting any diet, exercise or supplementation program, before taking or stopping any medication, or if you have or suspect you might have any health problem. More...


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Combination Chemotherapy and Filgrastim Before Surgery in Treating Patients With HER2-Positive Breast Cancer That Can Be Removed By Surgery
This study has been completed.
University of Washington
National Cancer Institute (NCI)
Information provided by (Responsible Party):
University of Washington
ClinicalTrials.gov Identifier:
First received: September 13, 2005
Last updated: May 7, 2013
Last verified: May 2013
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
No Study Results Posted on ClinicalTrials.gov for this Study
|Study Status:
|This study has been completed.
|Study Completion Date:
|No date given
|Primary Completion Date:
|June 2010 (Final data collection date for primary outcome measure)

subset: commoncrawl


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Project Lead - SAP Business One ( 5 yrs)
Mys Jobs
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You will be reporting to the Technical Director and will be responsible for the end to end activities of SAP B1 projects i.e., Requirement gathering , Scope Document analysis, Test Strategy preparation, execution, System Integration Testing, etc. an...
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- 4+ years of experience in SAP PP/QM . - Strong experience in SAP PP/QM End to end application support. - Good understanding of SAP PP in the areas of Demand management, MRP, Capacity planning, Order planning and control, Material staging and stan...
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- Looking for a person who is expertise in fico module. - It will be for one year contract, may be permanent later based on the requirement.
Key Skills : sap developer,sap fico consultant,sap fico,sap-system application product


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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/).
Microfibers composed of azobenzene-based photochromic amorphous molecular materials, namely low molecular-mass photochromic materials with a glass-forming property, could be fabricated. These fibers were found to exhibit mechanical bending motion upon irradiation with a laser beam. In addition, the bending direction could be controlled by altering the polarization direction of the irradiated light without changing the position of the light source or the wavelength of the light.
Since photo-controllable motors and actuators are expected to provide prospective wireless and electrodeless micromachine systems, creation of new photomehancial materials, elucidation of the mechanism of their photomechanical motions, and their application to photo-controllable micromachines are subjects of interest. Photomechanical motions due to the photothermal effect of conventional polymers doped with dyes were investigated in the 1990s and shown to be applicable to all-optical devices [
We have been performing studies of the creation of a low molecular-mass photochromic compound which readily form amorphous glasses, namely "photochromic amorphous molecular materials" [
In the present study, we have fabricate molecular fibers composed of other azobenzene-based photochromic amorphous molecular materials, 4-bis[4-(methylphenyl)amino]azobenzene (BMAB), 4-di(biphenyl-4-yl)aminoazobenzene (DBAB), and 4-bis[(9,9-dimethylfluroren-2-yl)amino]-4'-nitro-azobenzene (NO2-BFlAB), and investigated their photomechanical bending motions (
Chemical structures of the materials used in the present study. (
BMAB, DBAB, BFlAB, and NO2-BFlAB were prepared according to our previous papers [
The powder of BMAB, DBAB, BFlAB, or NO2-BFlAB was heated above the melting point on a glass substrate. After that, the molten sample was slightly cooled and kept at the appropriate temperature just under the melting point. A part of the resulting viscous supercooled liquid sample was anchored with a pair of tweezers and then drew it up to readily form a fiber.
In order to prepare the BFlAB fiber doped with QDs, appropriate amount of BFlAB was dissolved in the QDs-dispersed toluene solution and a few drops of the solution put on a heated glass substrate at
The sample fiber was irradiated with a linearly polarized laser beam (488 nm, CYAN-488-100 CDRH, SpectraPhysics Inc., Cambridge, UK) with a polarization direction either parallel (H-polarized light) or perpendicular (V-polarized light) to the fiber axis and with an intensity of ca. 400 mWcm−2 through a ND filter, a wave plate and a polarizer at room temperature (
Schematic experimental set-up for photoirradiation of the molecular fibers.
As well as a photochromic molecular fiber of BFlAB [
Whereas the BMAB fiber fell down upon irradiation with the laser beam, the fibers of DBAB and NO2-BFlAB exhibited photomechanical bending motions without falling down as described below. It is conceivable that the temperature of the irradiated area was somewhat raised. At the same time, the material softened due to trans-cis and cis-trans isomerization reactions induced by photoirradiation. Thus, it was suggested that relatively low Tg (27 °C) causes the falling down of the BMAB fiber upon irradiation and that the temperature of the irradiated area of DBAB, and NO2-BFlAB was low enough compared to their Tgs.
The photomechanical motions of DBAB and NO2-BFlAB fibers were also investigated. Here, the bending directions of the fiber opposite and toward the light source were defined as positive and negative directions, respectively, as shown in
When the DBAB and NO2-BFlAB fibers were irradiated with an H-polarized laser beam, the fibers bent slightly in the positive direction at initial stage, perhaps due to volume expansion caused by increase in temperature at the irradiated surface. Upon continuous irradiation, further bending in the positive direction gradually took place as shown in
Photomechanical bending motions of DBAB and NO2-BFlAB molecular fibers upon irradiation with (
The mechanism of the photomechanical bending of fibers of azo-dye doped polymer and azobenzene-based nematic liquid crystalline polymers have been proposed, which related the change in orientation of the azo-moiety to align perpendicular to the polarization direction of the incident light and/or photothermal effect [
We have reported that the photoinduced mass flow could be induced at surface level of amorphous films of azobenzene-based photochromic amorphous molecular materials upon angled irradiation using a p-polarized laser beam [
When the QDs-doped BFlAB fiber was irradiated, fluorescence of the QDs in the fiber existing at surface level in the irradiated area was observed. As shown in
The next, the movement of the QDs was investigated viewed from the back of the irradiated surface upon V-polarized laser beam. As shown in
Photochromic molecular fibers composed of BMAB, DBAB, and NO2-BFlAB were fabricated. As well as BFlAB fiber we have previously reported, DBAB and NO2-BFlAB fibers exhibited photomechanical bending motions and the bending directions were controllable simply by altering the polarization directions of the laser beam. Thus the photomechanical bending motions observed in the present study were suggested to be general phenomena for azobenzene-based molecular fibers.
This work was partly supported by a Grant-in-Aid for Science Research in Priority Areas "New Frontiers in Photochromism (No. 471)" from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan.


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COME and join us – that's the offer from St Ann's Hospice to fundraisers frustrated by the cancellation of another major charity walk.
Last month it was announced that the Shine walk, in support of Cancer Research UK, has been scrapped in Greater Manchester this year.
St Ann's Hospice is inviting all walkers who took part in that event to join their supporters in their popular Manchester Midnight Walk on Friday, June 21.
Jayne Bessant, chief executive at St Ann's Hospice, said: "It's all systems go as far as we're concerned for our walk and the more people who can join us the merrier.
"Anyone affected by the Shine event not taking place is more than welcome to join us instead.
"Last year was one of our best on record in terms of the number of participants, emphasising the huge amount of support for St Ann's Hospice from within the community.
"We rely heavily on donations from the public to provide our range of services so the money raised from this flagship fundraising event means so much to the running of the hospice. Above all, it's a fun night and we'd like as many people as possible to join us again this year, whether it's groups of friends or families."
St Ann's Hospice has staged its event for six years, raising more than £1.2 million for Greater Manchester's largest adult hospice during that time.
Last year almost 2,800 walkers took part, raising more than £220,000 through sponsorship for the charity.
Entries are now open for this year's event which changes back to a Friday night rather than a Saturday which has been the case for the last couple of years.
The route over 10k will be same, starting at Manchester Central and going past famous city centre landmarks such as Manchester Cathedral, Granada Studios, Castlefield and Manchester University.
Many entrants use the walk as an opportunity to remember their loved ones. At the heart of the walk is a Garden of Remembrance where walkers can light a candle and leave a message in memory of someone close.
Others get involved to simply have a memorable night out, do their bit for charity, and take in some of Manchester's most famous landmarks!
The 10k walk starts at 11:30pm from Manchester Central which opens at 9 pm for entertainment. Registration costs £15 before Friday, March 22, and £18 after that date although past walkers need only pay £15. A rate of £10 applies for walkers aged 11 to 17 and this fun event is popular with families.
* To register go to www.manchestermidnightwalk.co.uk or call the St Ann's fundraising team on 0161 498 3631.


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Today, the Wild West might consist of a trendy coffee shop on every corner, but there was a time when it was ruled by outlaws, thugs and bandits. It was a time when a six-shooter was more common than a cell phone and every bad guy thought he could do whatever he please through brute force. The Lone Ranger and Tonto have something to say about that. They're not going to let injustice rule the west as long as they have a fresh supply of courage and bullets.
Thinking about that kind of cowboy action gives us the chills, which is why we can't get enough of these Lone Ranger costumes. Right down to the mask, these things bring the action of the movie to your look, which is more action than you can shake a stick at. (Believe us, we've tried). And just in case you want to be Tonto, don't worry, because we have all the accessories you need. Wearing a bird on your head is a lot more fun than it sounds, in case you were wondering.


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Understand, mobility isn't about having a smartphone or a tablet. It's not about being able to use Wi-Fi or cellular. People don't just become productive because you've given them a new device. This is one of the issues facing many companies today. They read about BYOD or companies that have saved tons of money or become more productive by giving out smartphones and tablets. They see posts from the big analyst firms and articles in the New York Times about the importance of mobility. Yet, most of the time these companies miss the meat of these stories because they don't understand it.
You see, you can give an infinite number of smartphones and tablets to an infinite number of monkeys, but it's highly doubtful any of them will crank out a work of Shakespeare, much less a usable white paper. It's not the devices that make them productive.
Mobility is about equipping people with the best tools they can use when and where they need to, to be productive. An iPhone 5 isn't a tool. Neither is a Samsung Galaxy Note 10.1 tablet. A tool is when you marry a great app with a great device. It's the combination of these two pieces that make the tool that allows you to enable your people so they can be more flexible and agile.
Sure, it's great to be able to answer a phone in Timbuktu or surf the Web from Kalamazoo, but chances are that's not what you need your users doing. You want them to be able to close that sales call, fix that server, run that clinical trial, or consult that airplane flight book. These are all the things that allow your people to be more productive and efficient while being flexible and agile. It's about enabling them to do their job and fulfill the business requirements of what they're working on.
The right business strategy isn't to give people the latest smartphone. It's to give people the tools they need to get the job done and make money.
The ability I have, because of the apps we have chosen to marry to our devices, allows me to do things like write a white paper at 30,000 feet after watching three movies and have it automatically added to my work repository when I land, without ever plugging my device in for power. I can then reference that same paper while on a conference call on the way home in the car.
Although I may not be able to write a sonnet like Shakespeare, I can still be more productive than ever before because I have the right tools for the job. Without the right tools, you just get monkeys at typewriters.
This article, "Stop monkeying around: Devices aren't the secret to mobile productivity," originally appeared at A Screw's Loose and is republished at InfoWorld.com with permission (© Brian Katz). Read more of Brian Katz's The Squeaky Wheel blog at InfoWorld.com or at A Screw's Loose. For the latest business technology news, follow InfoWorld.com on Twitter.


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Is my study human subject research?
If you are not certain whether your activity is Human Research or you would like for the IRB Office to make that determination for you and provide you with documentation of that determination, complete the Human Research Determination Form (HRP-503).
- Human Research Determination Form (HRP-503): This document is intended for use for those studies that do not meet the definition of human subjects research. Upload this document in the protocol section of the eIRB+ study application. (See Submitting a Non-Human Subjects Research project in eIRB+ for step-by-step instructions)
Which protocol template do I use?
The IRB Office has developed protocol templates for use by the Northwestern University research community to describe research/human research activities:
- Social Behavioral Protocol Template (HRP-583): This document is intended for use primarily by those conducting social, behavioral, or educational research. If your research involves physical procedures or devices, you may need to include sections that are contained in the biomedical template protocol.
- Biomedical Protocol Template (HRP-593): This document is intended for use primarily by those conducting biomedical research.
- Local Protocol Addendum Template (HRP-508): This document contains local information not represented in the main protocol document received from a study sponsor or non-Northwestern University research collaborator. The Local Protocol Addendum should be uploaded along with the main protocol document in eIRB+ and modified as necessary throughout the duration of the study to account for local changes to the research.
- Data Review Protocol: This document is intended for use primarily by those reviewing data.
- Registry (subject pool) Best Practices: A registry or subject pool is a list or database of participants that multiple investigators will use for recruitment in the future. A registry requires IRB approval as an independent project.
Please consult this Protocol Conversion Guide 11-9-2014 for important information about using templates with new submissions or converting templates for previously approved research. See also Recruitment Materials and Guidelines when developing the recruitment sections of your protocols.
Social Behavioral Studies
Consent Document Template and Examples
Social Behavioral Consent Document (HRP-582)
- Example of Assent Consent
- Example of Assent Script
- Example of Online Consent
- Example of Verbal Consent
- Example of Parent Permission w/ Child Assent
- Example of Parent Consent and Permission w/ Child Assent
Protocol Templates
- Social Behavioral Protocol Template (HRP-583)
- Local Protocol Addendum (HRP-508)
- Human Research Determination Form (HRP-503)
Biomedical Studies
Consent Document Templates
- Biomedical Consent Document (HRP-592)
- Emergency Use Consent Document (HRP-506)
- Short Form Consent Document (HRP-507)
Protocol Templates
- Biomedical Protocol Template (HRP-593)
- Local Protocol Addendum Template (HRP-508)
- Human Research Determination Form (HRP-503)
- Data Review Protocol
HRP-012 - SOP Observation of Consent Process
HRP-013 - SOP Legally Authorized Representatives, Children, and Guardians
HRP-023 - SOP Emergency Use Review
HRP-026 - SOP Suspension or Termination
HRP-027 - SOP Emergency Use Post-Review
HRP-030 - SOP Designated Reviewers
HRP-031 - SOP Non-Committee Review
HRP-032 - SOP Non-Committee Review Conduct
HRP-040 - SOP IRB Meeting Preparation
HRP-041 - SOP IRB Meeting Conduct
HRP-042 - SOP IRB Meeting Attendance Monitoring
HRP-043 - SOP IRB Meeting Minutes
HRP-044 - SOP Not Otherwise Approvable Research
HRP-050 - SOP Conflicting Interests of IRB Members
HRP-054 - SOP Institutional Conflicts of Interests
HRP-055 - SOP Financial Conflicts
HRP-060 - SOP Annual Evaluations of the HSPP
HRP-061 - SOP Monthly Evaluations of the HSPP
HRP-063 - SOP Expiration of IRB Approval
HRP-064 - SOP NIH GDS Institutional Certification
HRP-071 - SOP Standard Operating Procedures
HRP-072 - SOP IRB Records Retention
HRP-082 - SOP IRB Membership Addition
HRP-083 - SOP - IRB Membership Removal
HRP-084 - SOP IRB Meeting Scheduling and Notification
HRP-093 - NU IRB_IRB of Record Multi-Site Research
These worksheets are used for initial review, continuing review, and review of modifications to previously approved Human Research. Investigators and their research teams are encouraged to use the worksheets to write their protocols in a way that addresses the criteria for approval (HRP-314).
HRP-301 WORKSHEET Review Materials
HRP-302 WORKSHEET Approval Intervals
HRP-303 WORKSHEET Communication of Review Results
HRP-304 WORKSHEET IRB Composition
HRP-305 WORKSHEET Quorum and Expertise
HRP-310 WORKSHEET Human Research Determination
HRP-311 WORKSHEET Engagement-Determination
HRP-312 WORKSHEET Exemption-determination
HRP-313 WORKSHEET Expedited Review
HRP-314 WORKSHEET Criteria of Approval
HRP-315 WORKSHEET Advertisements
HRP-317 WORKSHEET Short Form Consent Documentation
HRP-318 WORKSHEET Additional Federal-agency criteria
HRP-320 WORKSHEET Scientific or Scholarly Review
HRP-321 WORKSHEET Review Information Items
HRP-322 WORKSHEET Emergency Use
HRP-323 WORKSHEET Criteria Approval HUD
HRP-330 WORKSHEET HIPAA-Authorization
HRP-331 WORKSHEET FERPA Compliance
HRP-332 WORKSHEET NIH-GDS Certification
HRP-401 - CHECKLIST Pre-Review
HRP-402 - CHECKLIST Non-Committee Review
HRP-410 - CHECKLIST Waiver or Alteration-Consent Process
HRP-411 - CHECKLIST Waiver-Written Documentation - Consent
HRP-412 - CHECKLIST Pregnant Women
HRP-413 - CHECKLIST Nonviable Neonates
HRP-414 - CHECKLIST Neonates- Uncertain Viability
HRP-417 - CHECKLIST Cognitively-Impaired Adults
HRP-418 - CHECKLIST Non-significant Risk Device
HRP-419 - CHECKLIST Waiver Consent Process - Emergency Research
HRP-429 - CHECKLIST Post Approval Monitoring: Biomedical Research
HRP-430 - CHECKLIST Post Approval Monitoring: Social Behavioral Research
HRP-431 - CHECKLIST Minutes - Quality Improvement Assessment
HRP-432 - CHECKLIST Quality Assurance Assessment
HRP-441 - CHECKLIST HIPAA - Waiver Authorization
HRP-442 - CHECKLIST Biobanking
HRP-443 - AUDIT TOOL CHECKLIST - Consent Process
Supporting Documents
Certificate of Translation Template For Non-English Documents
Compassionate Use Request Form for Investigational Devices
HIPAA Revocation Template Letter
Change in Contact Information Template Letter
Radiation Dosimetry Form - eIRB+
IRB Authorization Agreement - Please see the Reliance Agreements Webpage
Short-Form Consents
The following are posted with permission from the University of Minnesota. See OHRP's Guidance on obtaining and documenting informed consent of subjects who do not speak English.
See also: Consent Translation and Short Form Guidance.


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From jibs to jumps, the K2 Company Binding is going to give you what you want. The K2 Company Binding comes fully equipped and outfitted for your riding pleasure with tool-free adjustable power ramps with multi-compatible discs and pop-top disc covers, heel cup designed to eliminate gaps between highbacks and boots giving you that perfect level of intimacy between your board and you. The Harshmellow padding will give you a comfortable ride with padding in the heels and toes to absorb chatter and suck up sudden impacts from flat landings and bumpy terrain. The K2 Company Binding is the right choice.


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Weezer's Drummer Patrick Wilson's Fabulous Frisbee Grab
Drummers never seem to get enough credit for their work, and Patrick Wilson managed to catch a flying Frisbee while performing a concert on Friday (June 6).
The Weezer timekeeper was in the middle of their hit "Beverly Hills" when a fan flung a disc up towards the drum platform, forcing Wilson to act.
And without missing a single beat, Patrick reached out his arm and caught the Frisbee, placing it in his mouth in order to free up both hands and continue playing.
After the gig, frontman Rivers Cuomo tweeted his take on the whole ordeal- "One more reason Patrick Wilson is my favorite drummer in the world."
Photo Credit: Instagram


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Should you carry debt into retirement? That's the $4,000 question, $4,041 to be exact - the average amount of debt owed by Americans age 65 and older, according the public policy advocacy group, Demos. Traditional wisdom holds that debt is a major threat to a retiree's financial security. The recent recession has caused many people to look at debt differently, but is it now okay to retire with debt?
According to a report from life insurance company, Securian, baby boomers today are less likely to use credit debt for lifestyle and status purchases and more likely to use it for emergencies, travel and everyday expenses such as groceries and medical care. They are paying off car loans, credit cards and mortgages, and settling debts with family and friends. In short, says the report, "retiring debt-free should be the goal for more Americans."
But can you really pay off debt and save for retirement at the same time? Experts say yes, but you should keep in mind that this likely will mean it will take longer to pay off the debt. The upside is that it will cause you to form two positive habits: saving and paying off debt. Many online debt calculators, like the one at BankRate.com, collect information about how much debt you owe and your goals for paying it off, then help you determine the types of payments you will need to make.
AARP suggests that the first step to retiring debt-free should be to stop using credit and begin managing the debt with the resources you currently have. This means paying cash and saving for big purchases, but it also means making a budget, trimming expenses and applying the money you save toward your debt. Pay more than the minimum amount due on all credit card bills. Focus on paying off accounts with higher interest rates first, but if you can free up cash by paying off smaller balances first, do that. Then, depending on your situation, you can look at more aggressive ways to get rid of your debt.
One strategy is to pay off debt with your existing savings. This isn't an option for all retirees, but most financial experts say that if you have the resources to simply pay off your debt, you should do it - it's easier to replenish your savings when you aren't paying high credit card interest. Resist the urge, however, to borrow from your 401(k) or other investment tools to pay off debt. Even though it is a low-cost loan, it carries risks, especially if you leave, or lose, your job.
If you have an existing mortgage, you may be able to refinance it and use the equity in your home to pay off more expensive debt. Refinancing also may reduce your interest rate, giving you more cash to apply toward other bills. Check with lenders about refinancing programs that offer special features for retirees.
If you don't currently have a mortgage, consider a reverse mortgage, which allows you to draw on the equity in your home without making mortgage payments, making it ideal for non-mortgage debt elimination. But consider a reverse mortgage carefully - it comes with high fees and, depending on your home's value and your life expectancy, may end up costing you more than other financing options. When you die or leave your home, the bank will recoup the cost of the reverse mortgage from the equity in the home, making it a poor choice for retirees who wish to leave something for their heirs.
Another way to tackle debt is to plan to work in retirement. Returning to work full-time or part-time can supplement your retirement income and help you focus on paying off debt more quickly. Check with the source of your retirement benefits, however, to make sure that taking a job will not affect your benefits.
If none of these options works for you, consider debt consolidation. Basically, consolidation means that you secure a blanket loan with a relatively low interest rate, into which you roll higher-interest debt. You can do this yourself or choose one of the many companies that offer debt consolidation services. Some companies use their bargaining power to negotiate much lower interest rates and lower payments with your creditors. You then make a single payment to the consolidator, who disperses the right amount to each creditor, keeping a fee for themselves. Research debt consolidation firms carefully, as some of them have better reputations than others.
No one strategy is perfect for everyone. You can employ a combination of several of the above tactics to manage and even pay off your debt leading up to and into retirement.


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Sopranos Mondays: Season 6, Ep. 14, "Stage 5"
"I've been coming here for years," Tony replies wearily. "I know too much about the subconscious now."
And on that note, let's dive into "Stage 5," arguably the most self-reflexive episode of a series that's already offered plenty.
The hour was remarkable enough for its richly detailed events, including the premiere of Christopher's first film as producer, a mob-flavored splatterfest entiled Cleaver; Carmela's confrontation with Tony over the implication, via Chris' movie, that Tony slept with Chris' doomed stoolie fiancee, Adriana; Silvio's survival of a mob hit, apparently instigated by New York underboss Doc Santoro, that killed Gerry "The Hairdo" Tortiano; Tony's admission in therapy that he fears Chris hates him and wants him dead and has forgotten Tony's big-brotherly love for him; and of course, the sudden decline and death of cancer-ridden gang boss Johnny Sacrimoni, who faced his final curtain with fear in his eyes. He kept smoking those coffin nails right up to the end, so stubbornly that even his wife Ginny, who was furious over his unwillingness to quit, busted out a pack at Johnny's bedside after hearing her husband call out for his mother. It was as if she thought the promise of one more puff might inspire John to turn on his heel and walk away from the light.
On top of that, there was a persistent, at times suffocating aura of futility -- a sense that individual hits, schemes, scores and power plays don't mean much once you've accepted the fact that, as Carmela once put it, "Everything ends." "Stage 5" was the most literally and figuratively funereal hour the series has yet given us. It was reminiscent of the Season Three "Deadwood" episode "Unauthorized Cinnamon." The latter was as afterlife-fixated as "Stage 5" but more uplifting, celebrating the human life force even as it conceded the limits of its power. No such celebration for "Stage 5," a melancholy-to-depressive installment whose very title was a synonym for death -- a reference to a nonexistent stage of cancer beyond Stage Four.
The characters, led by Tony, spent much of the hour going about in pity for themselves, to quote a certain Ojibwe saying. Johnny dies of cancer; Phil Leotardo talks about his own heart attack, nurses an ancient family grudge against America's ruling classes (his family name got changed from Leonardo to Leotardo at Ellis Island) and worries aloud that he's compromised too much during his life. Shockingly, he even expresses doubts about the wisdom of staying mum while serving time, and about failing to personally avenge the death of his brother, Billy, at the hands of Tony's cousin, Tony B.
Tony himself seems stricken, battered, exhausted. Whether brooding over Johnny's fate or sweating Christopher's cinematic hit job ("All those memories are for what? All I am to him is some asshole bully"), you can tell his mind is elsewhere -- most likely, on the prospect of his own demise and the question of whether he'll leave behind anything but money, grief and fat jokes. (When the Bada Bing inner circle gathers to hear news of Johnny's death, a slow dolly into Tony's face in profile isolates; it's as if a dark thought has just snuck up on him.) Paulie Walnuts' toast to the dearly departed consists of bragging that he's kicked cancer; then he quotes the Blood, Sweat and Tears song "Spinning Wheels," which, considering recent events, seems like a Top 40 omen. (The first line is, "What goes up/must come down," echoing Tony's admission to Melfi in the pilot that he felt like he came into the business at the end, and the best is over.) The Reaper -- or The Cleaver -- gets everyone eventually. Why spend your days on things that don't make you happy?
In what I suspect will later seem one of the most important scenes in the show's entire run, "Little" Carmine Lupertazzi, Jr., the other executive producer of Cleaver, meets Tony for lunch at a country club, where they discuss succession in an era of two-bit gang warfare and increased federal harassment (the FBI even made an arrest at the premiere of Cleaver). Tony -- who wants somebody to step up and lead the family but would rather it not be him -- asks Carmine what happened to his ambition. Little Carmine responds by describing a dream he once had. In the dream, his father turned 100, and Little Carmine gave his father "a mellifluous box," which the elder Carmine looked upon with "...gaze of absolute disappointent," because there was nothing in it. His dad told him, "Fill it up...Come back when I'm 200." On the basis of that dream, and his wife warning him that she didn't want to be the wealthiest widow on Long Island, Carmine decided to seek happiness outside of the family business. The dream "wasn't a dream," Little Carmine explains to Tony. "It was about being happy." It's also about the foolishness of pursuing wealth, power and the approval of one's elders (or social betters) instead of actually living your life and enjoying each day as if it's a gift (even if, as Tony laments, the gift is a pair of socks).
As if that's not enough to chew on, "Stage 5" turns its mortality obsession back on itself, deploying so many images and lines of dialogue calling attention to The Sopranos as a TV series that at times, the episode doesn't seem to be posing the question, "Will anyone remember us fondly after we're dead" but rather, "Will anybody remember The Sopranos as anything but a blood-'n-guts gangster show?"
There are warnings of the dangers of overinterpretation that seem like intentional retorts to Tony's remark to Melfi. Christopher wriggles away from charges that he based the film's mob boss villain (played by Daniel Baldwin, with a voice that sounds like Bob Hoskins doing an "American" accent) on Tony. Whether Chris intended the comparison or not, he damn sure did it on purpose, yet he begs off responsibility, insisting that creativity is a mysterious thing. "It was an idea, I don't know, who knows where they fucking come from? Isaac Newton invented gravity cuz some asshole hit him with an apple!" he tells the film's credited screenwriter, Timothy Daly's J.T., before braining him with a Humanitas prize. (This isn't just a follow-up to a joke from a previous episode where the hard-up J.T. tried to sell his Emmy and found out it wasn't worth jack; it's also a sideways reference to the fact that The Sopranos won a Peabody award the same year as that bastion of liberal enlightenment, The West Wing, a fact that even the show's most trivia-minded fans have already forgotten.)
Then there's the bit where an unseen viewer's widescreen TV shows Geraldo Rivera interviewing mob experts about the current New York mob madness. The panel bets on possible replacements for Johnny with the same jocular attitude you find in conversations about who's going to get whacked next on The Sopranos (which in turn echoes a comment about Cleaver, "These audiences today, they want blood"). The punchline: a reverse angle revealing that the TV belongs to none other than Peter Bogdanovich's Dr. Kupferberg, the shrink behind Dr. Melfi's shrink. ("This Santoro thing...I called it a year ago!") Carmine praises his own film's cleverness, particularly a closeup of a crucifix and a vaudevillian hanging from a rearview mirror. ("The sacred and the profane," Carmine beams.) And let's not forget the "interpretation" of Phil's heart problems as "...a metaphor. He lost his balls is what I'm saying." (If so, it's a metaphor for a metaphor.)
Are we seeing evidence that the writers sometimes worry that detractors are right -- that The Sopranos is a whack-'em gangster soap gussied up in academic pretension? In scenes like the one with Carmine and Tony at the country club -- where the gangster-gone-Hollywood Carmine orders seared ahi, mixed greens and an iced tea, and Tony orders a Philly cheesesteak -- you gotta wonder.
The self-reflexive aspect of "Stage 5" even shows up in the storyline about Johnny Sack's cancer -- particularly when Johnny gets a second opinion from his orderly, Warren Feldman (Sidney Pollack in a brilliant one-off supporting turn). Feldman's an incarcerated oncologist convicted of killing his cheating wife, her aunt who just happened to be there, and a mailman with bad timing. ("At that point, I had to fully commit.") Yet both Johnny and the episode seem clear in their conviction that just because the oncologist is a killer doesn't mean he doesn't have medical knowledge worth imparting. After all, the blood on O.J. Simpson's hands doesn't make him any less of a great running back.
This is a self-justifying observation, not just for gangsters, but for those who write TV shows about gangsters, but there's a strong hint of self-awareness to it, a sense that it's being offered not as an apology but as a kind of coded self-excoriation. (For all the talk of Feldman's wisdom, he turns out to be wrong; Johnny actually dies more quickly than anyone foresaw.) This whole subplot is of a piece with Tony worrying that Chris only sees him as a bullying fiancee-banger, and Phil worrying that he muffed some of the most important choices of his life. After all these years, is it possible that The Sopranos judges itself as harshly as the harshest critics judge The Sopranos?
That seems hard to believe, considering the enjoyment the series takes in being black-heartedly hilarious ("Fuck Ben Kingsley! Danny Baldwin took him to fuckin' acting school!") and their evident pride in its longevity, ambition and popularity, and in the simple fact that it exists at all. "You made a movie," Tony tells Christopher, in a rare, tender moment between them. "Nobody can take that away."


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and well-being of children and youth
The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy.
Head trauma leading to brain injury is an important cause of morbidity and mortality in childhood. Injury severity is related to the mechanism of trauma, which itself varies with age. The vast majority of head trauma in paediatric patients is mild, requires no specific therapy and leaves no sequelae. However, it is important to identify individuals at risk of significant injury, and thus in need of specific evaluation. The purpose of this statement is to describe issues related to head trauma in infants, children and youth, including clinical manifestations, initial management priorities, guidelines for imaging, and subsequent observation and treatment. It addresses the evaluation of patients with acute trauma to the head at the time of initial assessment; it does not describe the subsequent management of such patients in the paediatric intensive care unit.
Key Words: CT scan; Head trauma; Skull x-rays; Prevention; Traumatic brain injury
Head trauma leading to brain injury is an important cause of morbidity and mortality in childhood. Estimates of the incidence in paediatric patients vary according to definition and methodology; however, the annual rate ranges from 130 to 200 cases per 100,000 population, leading to at least 20,000 emergency department (ED) visits in Canadian paediatric hospitals per year.[1]-[3] In the United States, head trauma is estimated to lead to >470,000 emergency department visits and 35,000 hospital admissions annually.[4] Head trauma is thus one of the most common reasons for consultation in the ED.
Only a small proportion of patients with head trauma will be found to have a traumatic brain injury (TBI). This term is used to describe the symptoms and signs that result from trauma to the brain itself, which may or may not be associated with findings of injury on imaging studies. In sports-related concussion, it is well recognized that significant symptoms and impaired functioning may persist for a considerable length of time after the traumatic event. The clinical significance of intracranial lesions may be defined in a variety of ways, such as the need for hospitalization or neurosurgical intervention. In one large series of children presenting to the ED in children's hospitals in Italy, the risk of fatal and nonfatal traumatic brain injury was 0.5 and 5.2 per 1000 children with closed head trauma, respectively.[5]
The unique anatomy of children may make them more likely to develop an intracranial lesion due to head trauma. They have a larger head-to-body size ratio, a thinner cranial bone and less myelinated neural tissue.[6] Paediatric patients with traumatic brain injury more commonly develop a pattern of diffuse axonal injury and secondary cerebral edema compared with adults. Lesions actually requiring neurosurgical intervention, such as evacuation of a hematoma, are relatively rare.
The most common causes of head trauma in children and youth presenting to Canadian EDs are:[2]
Intracranial injury is more frequent following falls from a height above three feet (91 cm, or twice the length/height of the individual), involvement in a motor vehicle accident (either as a passenger or a pedestrian) or impact from a high-velocity projectile.[7]
Children with head trauma may present with a variety of symptoms, including:
Younger children may present with lethargy or irritability. It is difficult to conclude from published studies which, if any, single clinical symptom or sign is a reliable predictor of intracranial injury.
However, signs that have been particularly associated with intracranial injury include:
The Glasgow Coma Scale (GCS) (Table 1A)[8] is a validated tool used to evaluate level of consciousness. The Paediatric Glasgow Coma Scale (Table 1B) has been shown to be particularly useful in preverbal children.[9]
For the purposes of these guidelines, head trauma is classified according to GCS as follows:
Minor head trauma accounts for the majority of paediatric patients presenting for medical assessment for possible head injury. Patients with moderate or severe head trauma are more likely to exhibit intracranial pathology and require either supportive care or specific treatment in a hospital setting.
Eye opening
Best verbal response
Best motor response
Follows commands
To verbal stimuli
Localized pain
To pain
Inappropriate words
Withdraws to pain
Incomprehensible sounds
Flexion to pain
Extension to pain
Adapted from reference [8]
Eye opening
Best verbal response
Best motor response
Coos, babbles
Normal spontaneous movement
To speech
Irritable, cries
Withdraws to touch
To pain
Cries to pain
Withdraws to pain
Moans to pain
Abnormal flexion
Abnormal extension
Adapted from reference [9]
The first priority is to stabilize vital signs. An important goal of stabilization is to avoid secondary injury to the traumatized brain from hypoxia, hypotension, hyperthermia or raised intracranial pressure. A structured approach to the assessment of airway, breathing, circulation and disability (ABCD) is described in Table 2.[10] On occasion, early and definitive treatment of a primary intracranial injury may be required (eg, in some cases of epidural hematomas).
A pertinent history should also be obtained. Elements to include are:
The possibility of abusive head trauma in infants and children needs to be considered, especially in situations of altered level of consciousness without obvious cause, or when the clinical findings are not compatible with the history provided.[11] Abusive head trauma may not be recognized initially, due to variable modes of presentation and the typically young age of victims.[12] Delays in recognizing traumatic brain injury in this context may lead to relatively poor outcomes.
The depth of investigation, including cerebral imaging, and the need for observation, hospitalization or specific intervention, largely depend on the clinical state of the patient at the time of initial assessment (Figure 1).
Airway (A)
Consider possible injury to the cervical spine
Maintain head and neck in a neutral position
Immobilization: Sandbags, intravenous solution bags, towel rolls (younger patients)
Age-appropriate rigid cervical collar or manual in-line immobilization (older patients)
Orotracheal intubation if cannot maintain airway adequately with positioning and after suctioning
Breathing (B)
Intubation if unable to maintain adequate oxygenation and ventilation, despite provision of supplemental oxygen
Use rapid-sequence induction technique
Maintain cervical spine precautions
Circulation (C)
Hemodynamic instability unlikely to be caused by intracranial injury alone (exception: Significant intracranial or scalp bleeding in a young infant).
If present:
Disability (D)
Perform rapid assessment, including:
Adapted from reference [10]. CSF Cerebrospinal fluid
Full printable version of Figure 1
While the presence of a linear skull fracture appears to be an independent risk factor for intracranial lesions,[13] skull x-rays need not be performed routinely in all patients.[14][15]
Children younger than two years of age with head trauma present particular challenges. Clinical assessment of their neurological status may be limited by their developmental level, particularly in the preverbal stage. The incidence of skull fracture following minor head injury may be as high as 11% in this age group[16] but obtaining imaging studies, especially computed tomography (CT) scans, may require sedation. Guidelines for evaluating children younger than two years of age with apparently minor head trauma have been published.[17] These have supported the recommendation that skull x-rays should be performed in the presence of a large, boggy hematoma in a child younger than two years of age.[14][16][17]
While an obvious penetrating lesion or suspected depressed skull fracture in an older patient is an indication for skull x-ray, a CT scan is more commonly performed.
If elements of the history or physical examination raise the suspicion of child abuse, skull x-rays are indicated as part of the investigation. Detailed discussion of abusive head trauma is beyond the scope of this statement and has been addressed well in other documents.[11]
All patients presenting with moderate or severe head trauma should undergo a cranial CT scan. However, there is considerable debate about which patients with minor head trauma require a CT scan, given the potential for late deterioration resulting from delayed diagnosis of an intracranial injury and the relative unreliability of clinical signs in predicting intracranial injury.[18] The low rate of positive findings on CT scan, the need to sedate some patients in order to perform the examination, and concern about the risk of radiation exposure[19] have prompted the development of clinical prediction rules to guide clinicians in deciding for whom a scan should be performed. All of these rules involve some combination of variables based on the mechanism of trauma, signs and symptoms on initial assessment, or status after a period of observation. Recent systematic reviews have criticized their heterogeneity and lack of prospective validation in multicentre cohorts.[20][21]
The largest study published to date on this issue is from the Pediatric Emergency Care Applied Research Network.[22] This study included 42,412 patients from 25 sites. This group's approach differed from previous studies in identifying elements whose absence would obviate the need for a CT scan. While highly sensitive and relatively specific, widespread application of these algorithms may lead to greater, rather than less, use of CT scans.[23]
Members of the Pediatric Emergency Research Canada Head Injury Study Group[2] derived the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule, by means of a prospective cohort study involving 3886 children presenting with symptomatic minor head trauma to 10 Canadian paediatric teaching institutions. The CATCH rule is outlined in Table 3. The seven high- and medium-risk factors were shown in a subsequent prospective validation study to be 98% sensitive (95% CI 95% to 99%) for predicting acute brain injury, and would require that 38% of patients undergo CT.[24]
CT of the head is required for children with a minor head injury* plus any one of the following findings:
High risk (need for neurological intervention)
Medium risk (brain injury on CT scan)
Adapted from reference [2]. *Minor head injury is defined as an injury sustained within the past 24 h associated with witnessed loss of consciousness, definite amnesia, witnessed disorientation, persistent vomiting (more than one episode) or persistent irritability (in a child younger than two years of age) in a patient with a Glasgow Coma Scale score of 13 to 15. CT Computed tomography
Elements on history or physical examination that should motivate the clinician to order a CT scan:
Absolute indications:
Relative indications:
Asymptomatic patients may be discharged home to the care of reliable parents or guardians. Written instructions describing signs to watch for (eg, worsening headache, persistent vomiting, difficulty in awakening), who to contact in such a case and when to return for follow-up, should be provided.
If after initial evaluation there is headache or repeated vomiting, or there is a history of loss of consciousness at the time of trauma, a period of clinical observation, with reassessment, is indicated. If there is improvement in symptoms and the GCS is 15, the patient may be discharged home with parental instructions as above. If there is no improvement, the patient should be admitted to hospital with evaluation of vital signs and level of consciousness every 2 h to 4 h. Intravenous rehydration should be provided for patients with persistent vomiting. Persistent symptoms after 18 h to 24 h of hospitalization may indicate a cranial CT scan, if not already performed. A CT scan with positive findings should be discussed with a neurosurgeon, and consulting a clinician experienced in the management of head trauma may be appropriate for patients with negative CT scans but experiencing persistent symptoms.
In the child younger than two years of age, and particularly in children younger than 12 months of age, greater caution is advised. The challenges of their clinical assessment and the importance of identifying abusive trauma should lead clinicians to observe these patients for a longer period, with frequent reassessments. Trivial head trauma in an asymptomatic, ambulatory toddler is compatible with discharge from the ED; this may not be the case for an infant or baby. The presence of a widened or diastatic skull fracture (>4 mm) increases the risk of developing a leptomeningeal cyst, and follow-up of these patients should be arranged.[25] In cases of suspected abusive head trauma, hospitalization may be indicated and referral to the local child protection authorities is always required.
All patients with moderate head trauma should undergo imaging by CT scan. Skull x-rays may also be indicated. They should be admitted to hospital and consultation with a neurosurgeon or clinician experienced in the management of head trauma is advised. Depending on the CT scan findings and the evolution of neurological status, admitting these patients to a paediatric intensive care unit may be needed to provide closer monitoring. This is particularly true for patients at the lower end of the GCS spectrum (GCS 9 to 10). The decision to transfer a patient with a moderate head injury to a tertiary care centre must be individualized, based on clinical judgment and local resources, and should be discussed with a paediatric intensive care or trauma team, or both.
Once the patient with a severe head injury has been stabilized, including intubation, a cranial CT scan should be performed. Severe traumatic brain injury is a complex and challenging emergency. Patients with severe head trauma are at risk of raised intracranial pressure (ICP). Raised ICP may result from the mass effect of localized bleeding, as in the case of epidural and subdural hematomas, or be produced by vasogenic edema from diffuse axonal injury. In the acute setting, measures aimed at maintaining a normal ICP and cerebral perfusion pressure are appropriate.[26]
Management should include:
Patients with severe head trauma require referral to a trauma centre with neurosurgical and paediatric critical care services.[27] During transport, continuous monitoring of neurological, respiratory and hemodynamic status is essential, and treatment modalities for emergency management of raised ICP should be available.
The majority of post-traumatic seizures in children occur within the first 24 h, and rarely beyond seven days. Factors increasing the risk of post-traumatic seizures may include younger age,[28] severe head trauma (GCS ≤8), cerebral edema, subdural hematoma, and open or depressed skull fractures.[29] The incidence of early post-traumatic seizures ranges from 5% to 6.5% but may be as high as 30% to 35% in severe head trauma.[29][30] It is possible that abnormal mental status at initial assessment following a head trauma is due to a postictal state.
Post-traumatic seizures may contribute to secondary brain injury, with the exception of those occurring immediately after the head trauma: so-called 'impact seizures'. Patients with impact seizures or an isolated post-traumatic seizure shortly after the event, but whose neurological examination and imaging are normal, are at low risk of further complications and may be discharged.[31]
The acute treatment of post-traumatic seizures is identical to that of acute seizures occurring in other contexts. The emergency management of paediatric patients with generalized convulsive status epilepticus has been described in a recent statement from the Canadian Paediatric Society.[32]
Administering phenytoin to prophylax for post-traumatic seizures in paediatric head trauma patients is not proven effective[33][34] but it is still used frequently to treat post-traumatic seizures and to prophylax in patients with severe head trauma.[27]
The majority of patients with minor head injury do not exhibit intracranial pathology and their symptoms will resolve quickly. Nevertheless, the literature regarding sports-related concussive injury clearly demonstrates that some patients will continue to experience symptoms of varying intensity for days or weeks following the concussion, with effects on global functioning and school performance.[35]
With a documented intracranial injury, indicators of poor prognosis include clinical severity at initial presentation, especially a GCS ≤5, and the presence of raised ICP. Research is underway to assess the validity of serum or cerebral spinal fluid (CSF) markers of severity of injury, as well as early examinations of cerebral physiology such as cerebral oximetry and somatosensory-evoked potentials.[36][37]
Other elements influencing prognosis following traumatic brain injury include the presence and severity of injuries at other body sites, pre-injury attention-deficit-hyperactivity disorder, and socioeconomic status.[38] Difficulties in concentration, attention and behaviour may lead to problems with social functioning long after the time of the injury.[18]
Health care practitioners have numerous opportunities to provide age-appropriate anticipatory guidance around risk factors for head trauma in children. The CPS advocates for public policy and legislation to ensure, for example, helmet use in sporting activities, child restraint use in vehicles and the ban on baby walkers in Canada. Such measures have proven successful in reducing both the incidence and severity of head trauma in paediatric patients.[39] Clinicians treating infants, children and youth should include injury prevention when counselling families.
Head trauma is a frequent occurrence in childhood and adolescence, with most injuries being minor and without sequelae. A systematic approach to the clinical assessment of the patient presenting with head trauma is recommended, with investigations being conducted according to the symptoms, signs and estimated likelihood of intracranial pathology. Most patients can be either discharged or observed in hospital for a short period. Severely injured children require immediate stabilization, close surveillance and continuous monitoring to prevent secondary lesions that may aggravate the consequences of the primary brain injury.
This position statement has been reviewed by the Injury Prevention Committee, Healthy Active Living and Sports Medicine Committee, Community Paediatrics Committee and the Paediatric Emergency Medicine Section of the Canadian Paediatric Society.
Members: Adam Cheng MD; Isabelle M Chevalier MD (Board Representative); Catherine A Farrell MD; Jeremy N Friedman MD; Laurel Chauvin-Kimoff MD (Chair); Angelo Mikrogianakis MD (past Chair); Oliva Ortiz-Alvarez MD
Liaisons: Dominic Allain MD, CPS Paediatric Emergency Medicine Section; Marilyn Monk, Canadian Association of Paediatric Health Centres; Jennifer Walton MD, CPS Hospital Paediatrics Section
Principal author: Catherine A Farrell MD
Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.


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American Doll Posse: Tori Amos
2 Recommendations
corrosiveheart's recommendation
This is THE album that rekindled my love for this woman and the appreciation of her work. Being one of those diehard fans (an EWF or Toriphile) I was deeply saddened over the years being greatly disappointed by her more recent albums. I was giving up hope of ever regaining that feeling until the release of this. American Doll Posse is charged with emotion, striking sounds, and lyrics that are still personal and deep without all that usual Tori-nonsense any fan knows all too well. While this is still considered a concept album (5 characters relating and singing several songs each) it's still wild, raw, and politically and sexually charged - something one can always expect from Tori Amos.
My Collections:
hapa_lee's recommendation
I like Tori Amos a lot as a singer - her voice is terrific. This album had an incredibly interesting concept behind it all - Tori Amos as 5 'dolls' singing their songs. She developed personalities, bios, and everything. Song I'm into right now: Programmable Soda
My Collections:


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The Kansas Wetlands Education Center would like to announce that they will host a special family program on Saturday, February 9th. The free program will begin at 10 a.m., and pre-registration is required.FAMILY PROGRAM: "LET IT SNOW"Watch ice crystals develop in a simple, easy to duplicate snowflake machine in this program that features the wonders of snow. Find out whether each snowflake is different, and make your very own unique snowflake to take home. To keep up with events and activities through the Kansas Wetlands Education Center, go to http://wetlandscenter.fhsu.edu and sign up for their e-newlsetter!
Date - Feb 09, 2013
Time -
At 10:00 AM
Type - Community Event
Community - Great Bend
Location - Kansas Wetlands Education Center
Address - 592 NE K-156 HighwayGreat Bend, KS
Contact - 877-243-9268
Email - firstname.lastname@example.com
Website - wetlandscenter.fhsu.edu


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Zoey saw her lover looking up at her waiting for her to come out for there date they were going to go romantic mode if you now what i mean.....also they were going out to the empty city hunter:hurry up my beautiful immune he said with a grin Zoey replied OK with a small smile so she got ready and headed out they were like two wrapped around in one..... when they got to the city it was beautiful stars every where Zoey thought it was the most sweetest thing hunter ever don for her on the other hand hunter thought it was kinda crappy but he still liked it after all it was their date. Hunter: i love you and i always will. Zoey: aww i love you too i mean i will always love you. they were about to kiss when smoker interrupted smoker: you guys i just saw something terrible. hunter: smoker what is it. stay countinude just kidding ill make anther one tomorrow.
zoey X hunter by aDEmesseAngel23Watch
©2011-2017 aDEmesseAngel23


text:
Hi Manuel,
I like your project very much and I'm running m0n0wall 24x7 on my DSL
line and it works great!
What I would like to know, what next steps are you going to take
regarding the underlaying OS or the future of m0n0wall.
I know there is a 1.3alpha build with FreeBSD 6.0, but I cannot test
this because there is no WRAP build so far.
Could you please outline your thoughts a little, which input,
feedback you would like to get?
Thank you very much and keep going with the great project!
Best Regards,


text:
Jeffree Star So Sweet Pencil 5 Pack
Darn Jeffree Star for having such cute stuff! I was in Hot Topic yesterday and couldn't stop picking it up. The only thing that stopped me from buying it was his name on the merchandise, but these pencils look safe for consumption!
awesome understated top with tarina's fab art, great for layering (especially with her jewelry!!)Tags: fashion, jewelry, pink, tarina tarantino, designer, Scene, jeffree star, audrey kitchingAdded 8 Years Ago from Yoox
......Tags: pink, Scene, scene queens, jeffree starAdded 8 Years Ago from Swagbucks
i met jeffree star once...he was really nice XDTags: pink, tees, black, shots, cupcakes, needles, jeffree star, alliesaurusAdded 9 Years Ago from Hot Topic
More J*star merch safe for the taking. I love cute pens too even though I can never seem to keep them for more than a week.Tags: office supplies, pens, school supplies, so sweet, jeffree starAdded 9 Years Ago from Hot Topic
This is an extremely cute bag with the exception of one minor detail.Tags: accessories, bags, cupcakes, tote bags, hot topic, jeffree starAdded 9 Years Ago from Hot Topic
This is a cute tank top. I like the colors and candy graphic design.
This is a cute journal for people that are indeed Jeffree Star fans. I love the colors and style he has.Tags: accessories, notebooks, journals, school supplies, hot topic, so sweet, jeffree starAdded 9 Years Ago from Hot Topic


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Award-winning actress Julianna Margulies, the star of the television series The Good Wife, has revealed she was not the first choice for the role which is now earning her wide critical acclaim.
Margulies said the role was offered to her after two other actresses, Ashley Judd and Helen Hunt, turned it down.
It was "such a backhanded compliment," Margulies revealed.
The 47-year-old former star of long-running medical drama ER said the offer for the series in 2009 came with a caveat: it had been offered to Ashley Judd "but she's turning it down" and while it was then sent to Margulies the producers were "first going to Helen Hunt, and if Helen Hunt passes then it's all yours".
"I was then reading it sort of already defensive, and I wanted to hate it, because, you know, 'F*** you, you didn't want me to begin with. I'm like your sloppy thirds,'" Margulies said.
Margulies was speaking at a filmed round-table discussion of best actress in a drama nominees for the upcoming Emmy awards staged by The Hollywood Reporter.
The other participants were Keri Russell (The Americans), Vera Farmiga (Bates Motel), Sarah Paulson (American Horror Story), Jessica Pare (Mad Men) and Clare Danes (Homeland).
Since taking the role in 2009, Margulies has won wide critical acclaim.
The series, about a loyal wife who stands by her cheating politician husband, was created by Robert King and Michelle King.
It also stars Josh Charles, Christine Baranski, Archie Panjabi, Chris Noth and Alan Cumming.


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December 31, 2011
AZ Pro outscored their opponents 80-23 while going 7-0 to capture the 18U Winter National championship. In pool play, they defeated Prospects (AZ) 10-0, Gilbert Mudcats (AZ) 7-6, SV Xtreme (CA) 11-5. In elimination play, they defeated AZ Athletics 12-2, Dorados (AZ) 15-3, Team Boom (TX) 10-0 & So Cal Angels (CA) 15-7 in the championship game. Brock Hale, Austin Daus, Zac Hyzdu, Jon Meyer, Marco Burciaga, Jeremy Dietrich and Chris Akmon led an offense that averaged 11.5 runs per game. Strong pitching by Caleb Badder, Tanner Hofferber, Houston Samuel, Devin Hudspeth, Michael Gonzalez, Marion Mclean and Matt Waldren combined to hold opponents to just 3 runs per game. It was a total team effort to win the 24 team tournament.
December 20, 2011
Its All in The Game training center will be hosting a Holiday Baseball Camp January 3-6, 2012 at their facility and Peoria Sports Complex. The new center is scheduled to open soon after the first of the year, and this pre-grand opening event should be a good one, staffed by former MLB players, MLB coaches and college coaches.
December 1, 2011
With the holiday season approaching there are a number of camp opportunities available. For junior high and high school aged players, I always recommend the guys at PHD Baseball for their holiday camp, which this year is being held December 22-23 at Camp Verde High School. www.phdbaseball.com
The thing that sets this camp apart is the staff, which consists of college coaches and a number of the local MLB area scouts as well as Ric Wilson, the Scouting Director for the Los Angels Angels. Not only is the instruction top notch, these guys are all excellent references for the player looking to play after high school.
At $150 per player its a deal. Take a couple of days and go get your Baseball PHD.
Central Arizona College is also holding a 2 day pitching camp on December `10-11. This camp will be overseen by CAC Pitching Coach Mike Orchard. Central is one of the nation's top Junior College programs. 2011 CAC Pitching Camp


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The results are flooding in now, and it looks pretty clear that centre-right parties have won the 2009 European Parliament elections. They seem to have done especially well in the European Union's six biggest countries: France, Germany, Italy, Poland, Spain and (though official results aren't out yet) the UK.
But spare a thought for some of the smallest and strangest parties that have also notched up a success or two. One is Sweden's Pirate Party, which has shot to prominence because of its complaints about a crackdown on computer file-sharing among ordinary users of the internet. The Pirates have raided the Swedish political establishment and look set to carry off at least one seat in the EU parliament. Read more


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I am an interdisciplinary scholar and though I teach in a political science department, my courses are also somewhat interdisciplinary in their nature. Both my scholarship and teaching encompass the study of politics, critical theory, legal studies, gender studies, science studies, and more. As such, digital work and digital pedagogy fits quite easily into work in my multi- and interdisciplinary areas. Neither interdisciplinary work nor digital work are exactly traditional. Each seeks to shake up traditional scholarship by introducing new domains and methods of inquiry.
In addition to Kirschenbaum and Raymond, I read Schweitzer's "Women's Studies Online Cyberfeminism or Cyberhype?" for this week's seminar. Schweitzer discusses the potential for online spaces and assignments to further a feminist pedagogy that emphasizes collaborative learning. As Schweitzer describes it, feminist pedagogy also focuses on "coming to voice: making ourselves visible, recognizing ourselves as the subject of knowledge production and not simply its object or receptacle, and granting others a similar validation." She argues that online learning environments and digital pedagogy can be used to further those goals.
Schweitzer details her experience teaching a course with a substantial web presence in addition to the traditional classroom presence. By having a participatory class website in which students were encouraged to add links and resources, the course Schweitzer described furthered her collaborative and participatory goals. She also required students to post reading responses on the course page, which made them public in a way that more traditional assignments are not. The benefit of this approach is that students start to become accountable to one another for their perspectives and learn to engage with others' perspectives rather than just writing, in an isolating way, for the teacher's eyes.
Additionally, the course Schweitzer taught included an open online discussion forum that allowed students to expand on discussions in class or raise issues not covered during class time. This was another way students could play a role in determining the scope of the course. Crucially, the course's online presence created opportunities for course participation that potentially challenged the exclusions and silences that often characterize discussion and participation in physical classrooms.
In contrast to Schweitzer's feminist perspective on digital pedagogy, Raymond offers an analysis of a simulation exercise in a political science course. Based on his own experience of running a simulation exercise, Raymond concludes that simulations may not enhance student learning and that educators need to think more deeply about the pedagogical purposes of simulations. Nonetheless, Raymond's article suggests that digital projects such as digital simulations can extend the work traditionally done in political science by getting students to engage in games of strategy and power as players. Rather than only reading about power and strategy, students can engage as simulated political players.
In both the context of political simulations and feminist courses with an online presence, the limitations of technology and the way it is used in practice need to be evaluated. Any political simulation is obviously limited by the very fact that it is simulated. What aspects of the messy and complicated political world are not represented in the simulation? What does the design of the simulation assume about politics and power? While Schweitzer describes the online space of her classroom as providing a space that does not replicate the marginalization and exclusion that often happens in physical classrooms, online space is not untouched by the same relations of power that often play out in physical space. How can online tools be used in a transformative way and not in a way that reproduces social hierarchies? The point I'm making here is simply that there is nothing inherently good or bad about technology. In incorporating digital projects into courses it is imperative to remain reflective about how technology is being used.


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- Doctors
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- Dr. John R. Bach
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Ratings for Dr. John R. Bach
Dr. Bach has changed my wife life she has md she had a trach that for two years suffered no doctor would remove her trach Dr. Bach removed it she is now changed for the better she is on non inavasive ventilation at night . I thank God I found him an thank him for all his help an Louis for his help.
This Doctor is a miracle worker...he was the only one who believed in my daughter, who was diagnosed with SMA Type 1. I was advised to withdraw ventilatory support in ICU whilst she was suffering from a chronic respiratory episode and 'let her go'. She was 4 then. She is 21 this year and attending University...We live in the UK and he took time out to phone me and help me help my daughter through a successful extubation which her own Doctors seemed unable or (unwilling) to do. VERY Grateful!
My grandson was at Hasbro Children's Hospital in RI suffering from congestive heart failure. Hasbro was unable to help him. He was intubated and sedated . They were unable to help him. He was transported to UMDNJ where within five hours of being treated by DR. Bach, he was breathing on his own, sitting up, playing a video game and drinking powerade. I wouldn't have believed it if I hadn't seen it myself.
Dr. Bach is very personable, and very funny. He is a rehabilitation doctor, but specializes in helping neuromuscular disease patients breathe better. He feels pulmonologists cannot help these folks, and his own ideas that are on his website and his book. Extremely down to earth. The only bad side is we waited over an hour past our appointment, and he didn't really read the history. His point was that whether we get a diagnosis or not, there isn't any treatments. So instead, we should focus on breathing better, which is his area. Funny guy, and knows his stuff (though not all doctors would agree with him). Really glad we saw him.
This doctor saves lives, all the time and saved mine. His waiting room was full of grateful patients, and their families. He helps people with muscular dystrophy, ALS, polio, and all breathing conditions when no one else can, or will. He cares so much for all of his patients.
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Update at 11:57 a.m. ET: Nobel Peace laureate Mohamed ElBaradei, one of the leaders of the protest movement, offers his scenario today for defusing the political crisis in Egypt: a transitional government headed by a presidential council of two or three figures, including a military representative, the Associated Press reports. ElBaradei says he respects new Vice President Omar Suleiman as someone to negotiate with over the transition but does not address whether he should have any presidential role, the AP says.
Update at 11:28 a.m. ET One member of a group of "wise men" who have met with Egypt's new vice president and prime minister says the officials do not support forcing President Hosni Mubarak from office, but "more likely" envision making Mubarak an honorary president. Under the arrangement, Mubarak would hand his presidential powers to Suleiman to reach political agreement with the opposition but would serve out his term until fall elections.
Amr Hamzawy, who is also with the Carnegie Middle East Center in Beirut, tells Al-Jazeera that his group of independent intellectuals, politicians, writers and diplomats met today with Suleiman and Ahmad Shafik. He says Mubarak has already given Suleiman "all needed presidential powers" to "manage a transition period."
Hamzawy says the "wise men" are not trying to negotiate a political settlement but are merely trying to work out a negotiating process by which the government and opposition leaders can find an agreement.
Update at 9:15 a.m. ET: Al-Jazeera TV reports that the army is moving in to separate the hundreds of thousands of protesters at Tahrir Square in Cairo from hundreds of pro-Mubarak forces who are gathering nearby.
Update at 9:09 a.m. ET: Hundreds of thousands of protesters are packing Tahrir Square in Cairo, as well as gathering in Alexandria and Suez, to demand the ouster of President Hosni Mubarak in a demonstration free of the bloody clashes that have marked the past two days of clashes.
Update at 8 a.m. ET: Al-Jazeera says its Arabic office in Cairo has been stormed by unknown men and trashed
Update at 6:48 a.m. ET: Iranian leader Ayatollah Ali Khamenei said today that the popular uprisings in Egypt and other Arab countries are a sign of an "Islamic awakening," the AFP news agency reports. He calls it a "real earthquake" and a "defeat for America."
Update at 6:43 a.m. ET: Amr Moussa, the Egyptian diplomat who is head of the Arab League, has joined the crowds of demonstrators at Tahrir Square, Al-Jazeera TV reports. The 74-year-old Moussa has said in recent days that he would consider running for president in fall elections. The 22-member league represents Arab nations.
Update at 6:10 a.m. ET: Hundreds of thousands of protesters are jamming Tahrir Square in central Cairo waving Egyptian flags and shouting: "We won't leave. He must leave!"
Earlier postings: Mohamed Badie, leader of the Muslim Brotherhood, says his organization is ready for talks on a transition government after the departure of President Hosni Mubarak, Al-Jazeera reports.
As Friday prayers end, tens of thousands of protesters are shouting "He must leave! He must leave!" to press their demand for the ouster of President Hosni Mubarak.
Several thousand protesters have jammed Cairo's Tahrir Square today after a night of calm, USA TODAY's Theodore May reports.
Despite the heavy presence of the military, many demonstrators are on edge, saying that the large turnout anticipated following the afternoon prayers could inspire violence.
"It's getting dangerous out there," said Sayed Mohamed Metwali, 36, who is unemployed. "Twelve men beat me on the street when they found out I had been at the protest."
Mohammed Gomaa, 30, a surgeon at a nearby hospital, says that his facility is preparing for another day of bloodshed. Gomaa says he will work the afternoon shift at the emergency room but has come to Tahrir first to express his solidarity with the protesters.
An informal economy has sprung up around the square, with tea vendors and cigarette sellers prowling the protests. Over the course of the morning, protesters rallied, chanting for Mubarak's departure and, notably, calling for the demise of the United States.
The Obama administration says it is in talks with top Egyptian officials about the possibility of Mubarak immediately resigning, and an interim government forming before free and fair elections this year, the Associated Press reports.
Tens of thousands of protesters are praying in Tahrir Square. Organizers have called for the crowds to march afterward, some calling for the demonstrators to march to one of the presidential palaces.
From the Friday sermon being delivered to the crowd, according to Al-Jazeera: "We demand regime change, prisoners release and constitutional change. ... This revolution is not for ideological or religious purposes"
Egyptian TV reports that Defense Minister Hussein Tantawi is in Tahrir Square with senior army official to personally observe the demonstration.
New vice president Omar Suleiman says the authorities will not use violence against the crowds in Tahrir Square. "We will not use violence against them," he says in an interview with ABC News' Christiane Amanpour. "We will ask them to go home."
Suleiman, a former intelligence chief, was named to his vice presidential post last week in one of President Hosni Mubarak's first acts in response to demands from protesters.
Thousands of Egyptian protesters are gathering again in Tahrir Square in central Cairo for a "day of departure" to demand the ouster of President Hosni Mubarak.
The BBC reports an increased military presence in the square after several days of clashes between pro and anti-government forces.
Al-Jazeera TV says crowds are passing through military checkpoints to get to the square. The network reports a "defiant" mood among the crowd.
Doug is an unrepentant news junkie who loves breaking news and has been known to watch C-SPAN even on vacation. He has covered a wide range of domestic and international news stories, from prison riots in Oklahoma to the Moscow coup against Mikhail Gorbachev. Doug previously served as foreign editor at USA TODAY. More about Doug
Michael Winter has been a daily contributor to On Deadline since its debut in January 2006. His journalism career began in the prehistoric Ink Era, and he was an early adapter at the dawn of the Digital Age. His varied experience includes editing at the San Jose Mercury News and The Philadelphia Inquirer.
Also: Follow On Deadline on Twitter


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Odéon Powder Room Vanity
- No Longer Available -
With its distinctive curved-front paneling, our handcrafted vanity is a handsome and practical evolution of the demi-lune shapes that were de rigueur in 18th-century France. Customize with the paint color and stone top of your choice.
Show Details +
- Vanity With Top: 27¼"W x 21¾"D x 34"H
- Backsplash: 26¾"W x 1¼"D x 3"H
- Vanity Base: 26½"W x 21¼"D x 32¾"H
- Countertop Weight: 80 lbs.
Shown in Obsidian with Italian Carrara marble countertop. Featured with Lugarno Cross-Handle 8" Widespread Faucet Set.
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The Journal Register Co. continues to shred journalism
Blog ››› ››› ERIC BOEHLERT
The hapless, and now worthless, newspaper chain which is in the process of going belly-up, really ought to serve as a case study some day regarding what went terribly wrong with the American newspaper industry. And how, during the last couple decades, greedy outsiders without the slightest commitment to journalism or communities, were able to drag some worthy newspapers into the abyss.
At the top of that list is the mid-sized Journal Register Co., which, I'm guessing, will soon shutter its 'flagship' daily, the New Haven Register in Connecticut, in part because the Journal Register Co. doesn't have the slightest idea of how to operate a newspaper, let alone turn a profit.
The destruction that the Journal Register has done to the Register, and to Connecticut journalism in general, over the years is almost beyond description. The company took a community-minded newspaper that enjoyed a monopoly and beefy subscribers rates, and gutted the operation through mindless cost cutting, and that was during the economic boom times.
Anyway, here's the latest:
The Connecticut attorney general's office objected Wednesday to a plan by Journal Register Co. to pay its top executives up to $1.7 million in bonuses even as the newspaper publisher seeks Chapter 11 protection from creditors.
What are the bonuses for? For gutting the company's newspapers, of course:
The bonus plan would apply to 31 "key employees" who could receive an average of $15,700 each if 450 positions are cut by March 31, according to the company's motion for "incentive pay" filed with the court. Further bonuses totaling about $1.2 million would be available if the employees met other goals including eliminating publications and reaching certain financial targets.
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Father: James Thomas Clark b: 4 NOV 1880 in Clark Homestead on Dyer's Branch, near New Middleton, Smith Co., TN
Mother: Susan Evelyn Fisher b: 19 AUG 1878 in Payne's Bend.Smith Co., TN
Marriage 1 Raymond Crockett Baker b: 19 OCT 1908 in "Tater Hill", Hogan's Creek, Smith Co., TN
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