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Discuss the current status of the Electronic Health Record (EHR) in the United States. What still must be accomplished to make t
Discuss the current status of the Electronic Health Record (EHR) in the United States. What still must be accomplished to make t - Research Paper Example
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Discuss the current status of the Electronic Health Record (EHR) in the United States. What still must be accomplished to make t
Due to the wide acceptance of the benefits to be reaped from such a system the American Recovery and Reinvestment Act was passed in 2009, which promoted a national combined health information system to be developed. (Jha et al, 2009) A recent study suggested that levels of adoption ranged from 5%-59%-the reason being that there is a wide difference amongst practitioners about what functionalities are constituted in an electronic health record. Keeping in line with this drawback the Institute of Medicine has outlined a list of prospective functionalities that relate to an electronic health recording system. (Jha, et al, 2009) In 2010, congress and the Obama administration provided the health care community with a tool to increase the advancement of the electronic health records. It would make incentive payments totaling $27 billion to clinicians and independent physicians in order to adopt a countrywide electronic health record system. Together with the help of the Centers of Medicare and Medicaid Services, the Department of Health and Human Services has decided upon a latest criterion to be followed in 2011 and 2012. These firstly include the core objectives, which is the entry of the basic medical history, demographics, smoking status, vital signs, active medications, allergies etc. ...
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CHINT Participated in Brazil ENIE 2016
August 23rd– 25th, CHINT participated in ENIE 2016, a most attractive exhibition held in South America every two years. CHINT displayed its complete range of intelligent components and industrial comprehensive system solutions in Expo Center North, Sao Paulo, fully demonstrated its strength as China's leading company in industrial electrics and renewable energy.
CHINT presented its solutions for HVAC, water treatment, power generation and solar photovoltaic system through three days exhibition. Besides, launched CHINT NEXT series products attracted numerous guests coming from the world successfully. All the guests were impressed by CHINT quality product and attentive reception after their visiting of CHINT booth. As China's leading enterprise in electrical and new energy industries, CHINT received about a thousand visiting customers, mainly including electrical manufacturers, industrial customers, trading companies and panel builders.
The exhibition successfully demonstrated CHINT's international image and provided a valuable platform for communication and a good opportunity for gaining more global business.

subset: commoncrawl


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A quantum lock was something capable of separating a certain area of space from entangling with the rest of space-time. This kept events in the contained area from tearing apart space around the affected area.
In 2382, Juel Ducane and Jena Noi established a quantum lock around the third moon of Rakon IV in order to stop the battle between various Temporal Cold War factions from tearing apart space-time. (DTI novel: Watching the Clock)


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Class Organisation
Pupils benefit from our rural first school organisation. School staff plan and work closely together and offer teaching expertise and strengths across different year groups. Teaching assistants provide support in both key stages and where necessary, assist with individual and small group intervention. Small year groups and changes to pupil numbers sometimes require adjustments to overall class organisation.
The classes are currently arranged as follows:-
¨ Foundation Unit - taught by:
Mrs Julie Hay
Children start their full-time education at the beginning of the school year in which they are 5. The year group they start in is called Reception. The Unit also includes Nursery pupils who attend for five morning sessions. Children can start Nursery from the age of three, at the beginning of the term following their third birthday. If they are to start after the Easter holiday, then their birthday must be before 1st April.
¨ Year 1 /2 – based in the Foundation and Key Stage 1 classroom, taught by:
Mrs Rachel O'Neill and Mrs Julie Stevenson
They then move into Year 1, Year 2. Years 1 and 2 are sometimes referred to as 'Key Stage 1'.
¨ Years 3 and 4 – based in the Key Stage 2 classroom, taught by:
Mrs. Debbie Brett, Ms Sue Roff & Mrs Julie Stevenson
Years 3 and 4, together with Years 5 and 6, are referred to as 'Key Stage 2'. Years 5 and 6 are taught at Corbridge Middle School.


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Whether you require a small space for a company meeting, a location for a film set or anything in between; Tees Barrage can accommodate your needs.
Tees Barrage has a number of meeting spaces available. Depending on your requirements we have meeting rooms with flexible seating options and up-to-date presentation equipment. We also have lots of outdoor space available across the site. Catering for meetings is available, including everything from tea & coffee to full sit-down meals; prepared on site at the Barrage Café.
Tees Barrage International White Water Centre is home to two world-standard white water courses. Both courses are available to hire for almost any occasion. Typically the courses get hired for watersports competitions and displays but the potential is huge. Emergency Services such as Police, Coastguards and Fire Brigades often use the course to practice scenarios involving fast flowing water such as flooding, people trapped in vehicles / buildings etc.
Tees Barrage is a visually unique facility set in picturesque surroundings on the bank of the River Tees in Stockton. Students from the nearby Stockton Riverside College, Durham and Teesside Universities are among those who have utilised Tees Barrage's unique location as a set during video production. Depending on customers individual requirements, film production may encompass use of the centre, course and meeting rooms, we can cater to suit every requirement.
National Geographic, Sky TV, Channel 4, CBBC and the BBC have all filmed documentaries at this site with some excellent footage showing the brutal force of nature when water takes control. We have also worked on live TV with the BBC.
Whatever your requirements, why not get in touch by filling out an enquiry form, giving us a call on 01642 678000. We look forward to hearing from you.
A unique space perfect for every occasion
Check out our great selection of watersports activities to keep the kids entertained this summer! Including introductory sessions to stand up paddleboarding and kayaking. Activities are a great way to experience the thrills of watersports!


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The New Jersey Division of Youth and Family Services, which came under heavy criticism recently after the starvation and beating death of a Newark boy, would narrow its focus to concentrate solely on child protection under a plan Gov. James E. McGreevey is developing, state officials said last night.
Under the plan, the agency would become the Office of Child Abuse Prevention, caring for foster children, children suspected of being abused or neglected, and children in the process of being adopted, a state official with knowledge of the plan said.
A new position of deputy commissioner would be created to oversee the office, and other services currently provided by the division would be provided by other state agencies, as part of a reorganization of the entire Department of Human Services, the official said.
The division came under fire after the body of Faheem Williams, 7, was found last month in the Newark basement of relatives, and two of his brothers were found severely malnourished and dehydrated. The division had been aware of allegations that Faheem was being abused, but caseworkers with the agency closed the investigation without seeing the child, after they could not find him.
The case spotlighted disarray in the state's child protection offices, where social workers have caseloads numbering far above recommended levels, and the computer system is 25 years old.Continue reading the main story
Officials in the governor's office, who spoke on condition of anonymity, said Colleen McGuire, the founder of Janus, an independent nonprofit child welfare organization, would lead the new office.
It was not clear last night which agency would serve families needing services like mental health counseling, help with parenting skills, or anger management courses.
Any additional bureaucracy would require more money, while the state faces a $5 billion deficit. ''The challenge will be to found a sister system,'' said a state official, who has been part of the talks. The changes to the department could likely be made by the governor without legislative approval, provided the money could be found to pay for them, the official said.
The pending changes were first reported yesterday by The Record of Bergen County.
The details of the plan should become clearer after the governor's budget address tomorrow, and after next Monday, when Gwendolyn L. Harris, the state commissioner of the Department of Human Services, addresses a joint legislative committee that oversees the department, which includes the family services division, said Micah Rasmussen, the governor's press secretary.
Mr. Rasmussen said the plans were very preliminary, and are only part of the governor's efforts to improve services to abused and neglected children.
''The governor has made a commitment to putting tools in the hands of DYFS to allow caseworkers to make better decisions,'' he said, noting that specialists are supposed to be working in every child services office to advise caseworkers about difficult cases.
''DYFS is one of the very few organizations within the state government that is going to see an increase in funding in the governor's budget,'' he said, adding that Mr. McGreevey's first budget included more caseworkers to work with abused or neglected children.
Hetty Rosenstein, president of Local 1037 of the Communication Workers of America, which represents the child care workers in North Jersey, said last night that she was ''worried'' about the proposed reorganization, because it would likely separate services for families who are in emergency situations from other families the agency currently serves, while she believes families at risk need a range of services.
Rose Zeltser, vice president for children's services at Children's Aid and Family Services in Paramus, said the proposed changes should be explored.
''If the plan included maintaining protection of children as a priority, but also included supporting and focusing on the families under supervision, as maybe a separate priority, then I feel it has a chance to work,'' she said.Continue reading the main story


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Director of Development
Bullet points
Director of Development, Major Ground Up Projects
About Our Client
A familiar name in the New York development market with an exceptionable portfolio of current and future projects.
Job Description
Working closely with the firms Principals the Director of Development will provide strategic oversight on all current and future Development projects. Tasked with leading a well established successful team the individual will hold full responsibility and accountability for:
- Construction feasibility assessments on all new projects.
- Due diligence oversight on existing and new projects alongside internal legal, construction, design, leasing, marketing and finance teams.
- Full pre-construction responsibility bringing together design, procurement, zoning, planning whilst cascading pertinent information to internal stakeholders and JV partners where necessary.
- Maintaining strategic relationships with all relevant city agencies.
- Working closely with internal Owners Representatives to ensure individual projects are delivered on time and, ideally, under budget.
The Successful Applicant
You will be a recognized name in the market and bring a wealth of experience and contacts within the New York market. Your resume should showcase major, ground developments that span both the Residential and Commercial space.
In addition you will be an exceptional communicator demonstrating the ability to lead large teams and drive new ways of working that enable our client to truly cement it's place as the preeminent developer in New York.
Stakeholder management is critical and you will clearly articulate how your inputs have steered, evolved and driven Principals to make sound investment and development decisions.
What's on Offer
Compelling base + bonus + benefits + the chance to work on some of the largest new developments New York will see over the next 10 years!


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June 19, 2017 - By reb123z
Investors sentiment decreased to 1.03 in 2016 Q4. Its down 0.46, from 1.49 in 2016Q3. It dived, as 16 investors sold MANT shares while 59 reduced holdings. 25 funds opened positions while 52 raised stakes. 21.76 million shares or 1.87% less from 22.17 million shares in 2016Q3 were reported. Dean Associate holds 0.32% or 44,280 shares. Bnp Paribas Arbitrage Sa invested in 0% or 13,448 shares. Wells Fargo And Mn owns 123,790 shares. Adage Cap Partners Gp Limited Com reported 30,963 shares. Strs Ohio reported 21,200 shares. Kcg invested 0.01% of its portfolio in Mantech International Corp (NASDAQ:MANT). 10,200 are held by Louisiana State Employees Retirement System. Guggenheim Ltd Liability Co invested in 60,084 shares. Morgan Stanley has invested 0% of its portfolio in Mantech International Corp (NASDAQ:MANT). Acadian Asset Ltd Company has invested 0.16% in Mantech International Corp (NASDAQ:MANT). C M Bidwell & Assocs has 0.12% invested in Mantech International Corp (NASDAQ:MANT) for 12,385 shares. Metropolitan Life Ins invested in 17,658 shares or 0.01% of the stock. Great West Life Assurance Can accumulated 34,773 shares or 0% of the stock. South Dakota Invest Council has invested 0.12% in Mantech International Corp (NASDAQ:MANT). Loomis Sayles & Com Ltd Partnership accumulated 704 shares.
Since March 3, 2017, it had 0 buys, and 6 insider sales for $2.32 million activity. 15,000 shares were sold by Phillips Kevin M, worth $539,400. Keefe Daniel J also sold $97,226 worth of Mantech International Corp (NASDAQ:MANT) on Tuesday, May 23. On Friday, March 3 Varner L. William sold $452,250 worth of Mantech International Corp (NASDAQ:MANT) or 12,500 shares. 3,000 shares were sold by Armitage Richard L, worth $120,030 on Friday, June 9. $723,316 worth of Mantech International Corp (NASDAQ:MANT) shares were sold by CAMPBELL BARRY G.
West Coast Financial Llc decreased its stake in Mantech Intl Corp (MANT) by 83.46% based on its latest 2016Q4 regulatory filing with the SEC. West Coast Financial Llc sold 71,525 shares as the company's stock declined 6.20% while stock markets rallied. The institutional investor held 14,178 shares of the other consumer services company at the end of 2016Q4, valued at $599,000, down from 85,703 at the end of the previous reported quarter. West Coast Financial Llc who had been investing in Mantech Intl Corp for a number of months, seems to be less bullish one the $1.44 billion market cap company. The stock declined 0.15% or $0.06 reaching $38.75 per share. About 23,877 shares traded. Mantech International Corp (NASDAQ:MANT) has risen 12.61% since June 19, 2016 and is uptrending. It has underperformed by 4.09% the S&P500.
West Coast Financial Llc, which manages about $486.79 million and $314.38 million US Long portfolio, upped its stake in Ishares Tr (IJR) by 36,224 shares to 312,092 shares, valued at $42.92M in 2016Q4, according to the filing.
Analysts await Mantech International Corp (NASDAQ:MANT) to report earnings on July, 26. They expect $0.37 earnings per share, down 5.13 % or $0.02 from last year's $0.39 per share. MANT's profit will be $13.75 million for 26.18 P/E if the $0.37 EPS becomes a reality. After $0.39 actual earnings per share reported by Mantech International Corp for the previous quarter, Wall Street now forecasts -5.13 % negative EPS growth.
More notable recent Mantech International Corp (NASDAQ:MANT) news were published by: Seekingalpha.com which released: "ManTech International (MANT) Q4 2016 Results – Earnings Call Transcript" on February 23, 2017, also Bizjournals.com with their article: "Will ManTech make that big acquisition after the presidential election?" published on November 03, 2016, Nasdaq.com published: "Ex-Dividend Reminder: Popular, ManTech International and Automatic Data Processing" on June 05, 2017. More interesting news about Mantech International Corp (NASDAQ:MANT) were released by: Forbes.com and their article: "Ex-Dividend Reminder: ManTech International, Automatic Data Processing and TELUS" published on December 05, 2016 as well as Globenewswire.com's news article titled: "ManTech Wins $229 Million US Homeland Security Contract for Border Protection" with publication date: April 26, 2017.
Among 8 analysts covering Mantech International Corporation (NASDAQ:MANT), 1 have Buy rating, 3 Sell and 4 Hold. Therefore 13% are positive. Mantech International Corporation had 13 analyst reports since July 28, 2015 according to SRatingsIntel. The stock has "Underperform" rating by Jefferies on Wednesday, January 20. The stock of Mantech International Corp (NASDAQ:MANT) earned "Hold" rating by BB&T Capital on Tuesday, July 28. Maxim Group maintained it with "Buy" rating and $44 target in Thursday, February 18 report. The rating was maintained by RBC Capital Markets on Thursday, July 30 with "Sector Perform". The stock has "Underperform" rating by Wells Fargo on Tuesday, August 30. The firm earned "Buy" rating on Friday, June 2 by Cowen & Co. The stock of Mantech International Corp (NASDAQ:MANT) has "Hold" rating given on Wednesday, November 30 by Maxim Group. The firm has "Buy" rating by TheStreet given on Saturday, August 22. The company was downgraded on Thursday, September 29 by Credit Suisse. The stock of Mantech International Corp (NASDAQ:MANT) has "Neutral" rating given on Thursday, April 28 by Credit Suisse.
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Previous Vlog (Day 843) | Next Vlog (Day 845)
- Miyabi's
- Stephen's parents' house
Stephen, Mallory, Debra, and Steve eat at Miyabi's to celebrate Stephen's and Mallory's birthdays. Stephen gets a letter and Mallory gets a letter, a pair of shorts, a dress, a cat wallet, and a bead which she adds to her bracelet. Then they all eat birthday cake and play Uno and Trouble.
- Stephen feeds edamame to a duck on Day 863 and Edamame Duck becomes a recurring theme on the Vlog.
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You are here
Shannon Jette
Phone: (301) 405-2497 | Email: firstname.lastname@example.com
Research Summary:
Dr. Jette's research focuses on women's health across the lifespan, with a specific interest in the relationship between maternal health and physical activity/movement. She uses a range of qualitative research methodologies (including media and discourse analysis, in-depth interviews, focus groups, ethnographic techniques) to examine: the production of knowledge about health and physical activity; how this knowledge has been (and is) put to use in the operation of power in differing socio-historical contexts; and how individuals negotiate various health-related messages. Her projects include:
- A focus on contrasting (Western and traditional Chinese) approaches to prenatal exercise and gestational weight gain
- Women from diverse social and ethnic backgrounds' differential perception of dominant policy and popular media messages pertaining to the relationship between motherhood, obesity, and femininity
- The value of alternative forms of physical activity for pregnant women as a means of learning how to experience and understand their bodies in different ways than traditional methods
- Issues related to the stigmatization of obese women undergoing fertility treatment
Overall, Dr. Jette's research agenda is linked by a desire to better understand the complex intersection of race, gender, sexuality and social class in shaping women's health, with the goal of informing social policy and programming that may otherwise be insensitive to social location and cultural nuance. For more information see the Physical Cultural Studies website.
Kinesiology 400: Foundations of Public Health in Kinesiology
This course provides students with a broad introduction to the core principles and goals of public health from a kinesiological perspective. Topics to be addressed include: history of public health and physical activity; basic principles of the epidemiology of physical activity; correlates and determinants of physical activity and health across the socioecological model; public health policy development aimed at encouraging regular physical activity; social justice and physical activity; physical activity interventions for diverse populations; the impact of social, political and economic contexts on health, as well as the creation of health disparities.
Kinesiology 600: Kinesiology in Public Health
This course provides students with a broad introduction to the core principles and goals of public health from a kinesiological perspective. In addition to gaining a deeper understanding of both kinesiology and public health as fields of inquiry (with a particular focus on the competing ontological, epistemological, methodological, and axiological dimensions within and between each), students will explore the integrative relationships and possibilities within kinesiology as well as to domains of inquiry within public health. Central to the course will be an exploration of the challenges faced and opportunities presented as each attempts to forge an interdisciplinary approach to societal health issues.
Kinesiology 615: The Body, Culture and Physical Activity
The goal of the course is to critically examine the notion of the 'natural' body, along with the various assumptions that this view of the body brings with it. More specifically, we will explore some of the questions that are at the forefront of the field of Body Studies: What can (active) bodies do? What might (active) bodies become? What practices enable and coordinate the doing of particular kinds of (active) bodies? And what does this make possible in terms of our approach to questions about life, humanness, culture, power, technology and subjectivity? (see Blackman, 2008, p. 1). Thus, while we maintain an interest in the various ways through which the active body is located within, and thereby experiences, the operations of social power, we will also focus on new ways of thinking through various dualisms such as structure and agency, mind and body, inside and outside. In particular, we will explore how the concept of 'embodiment' might be applied to further our understanding of the various dimensions of physical culture; a diverse cultural sphere including, but not restricted to: sport, health, movement, exercise, dance, and daily living related activities.
2010-2011: Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship Award
2005-2008: Social Sciences and Humanities Research Council (SSHRC) Canada Graduate Fellowship (Doctoral) Award
I am a co-investigator on a grant funded by the Canadian Institutes of Health Research (2014-2017). The research team includes Deborah McPhail (PI, University of Manitoba), Genevieve Rail (Co-I, Concordia University) and Carla Rice (Co-I, Guelph University). The three year project will entail a qualitative examination of obesity stigma in reproductive care (with a specific focus on fertility care) from the perspectives of patients, health practitioners, and policy makers. It will also include a discourse analysis of clinical and government policy concerning the provision of infertility treatment to women classified as obese.
Selected peer reviewed journal articles (* denotes graduate student)
*Maier, J., & Jette, S. (in press). Promoting nature-based activity for people with mental illness through the US, "Exercise is Medicine" initiative. American Journal of Public Health.
Jette, S., & *Roberts, E. (2016). "We usually just start dancing our Indian dances": Urban American Indian (AI) female youths' negotiation of identity, health and the body. Sociology of Health and Illness, 38(3), 396-410. DOI: 10.1111/1467-9566.12349
*Roberts, E., & Jette, S. (2016). Implementing participatory research with an urban American Indian community: Lessons learned. Health Education Journal, 75(2), 158-69. DOI: 10.1177/0017896915570395
Rail, G., & Jette, S. (Invited Guest Eds.) (2015). Introduction to Special Issue: "Body culture, biopedagogies and public health." Cultural Studies/Critical Methodologies, 15(5), 327-36.
*Clevenger, S., & Jette, S. (online version 2015). From 'cultivators of the soil' to 'citizen-soldiers': Physical activity and the nation at Maryland Agricultural College. Sport, Education and Society. DOI: 10.1080/13573322.2015.1106468
Jette, S., *Bhagat, K., & Andrews, D.L. (online version 2014): Governing the child-citizen: 'Let's Move!' as national biopedagogy. Sport, Education and Society, DOI: 10.1080/13573322.2014.993961.
Jette, S., Vertinsky, P., & *Ng, C. (2014). Biomedicine and balance: Chinese-Canadian women's negotiate pregnancy-related lifestyle directives and risk. Health, Risk & Society, 16(6), 494-511.
Jette, S., & Rail, G. (2014). Resisting, reproducing, resigned? Low income pregnant women's constructions and experiences of a healthy pregnancy and proper weight gain. Nursing Inquiry, 21(3), 202-11. DOI: 10.1111/nin.12052
Dumas, A., Robitaille, J., & Jette, S. (2014). Young women, health and poverty: Lifestyle as a choice of necessity. Social Theory and Health, 12, 138-58. DOI:10.1057/sth.2013.25
Norman, M.E., Rail, G., & Jette, S. (2014). Moving subjects, feeling bodies: Emotion and the materialization of fat feminine subjectivities in Village on a Diet. Fat Studies: An Interdisciplinary Journal of Body Weight and Society, 3(1), 17-31.
Jette, S., & Rail, G. (2013). Ills from the womb? A critical examination of Evidence-Based Medicine and pregnancy weight gain advice. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 17(4), 407-21.
Jette, S. (2011). Exercising caution: The production of medical knowledge about physical exertion during pregnancy. Canadian Bulletin of Medical History/ Bulletin canadien d'histoire de la medicine, 28(2), 383-401.
Jette, S., & Vertinsky, P. (2011). 'Exercise is medicine': Understanding the exercise beliefs and practices of older Chinese women immigrants in British Columbia, Canada. Journal of Aging Studies, 25(3), 272-84.
Selected book chapters (* denotes graduate student)
Jette, S. (under review). Pregnant bodies. In D. Andrews, M. Silk, & H. Thorpe (Eds.), Routledge Handbook of Physical Cultural Studies.
Jette, S. (accepted, in press). Sport for all, or fit for two? Governing the (in)active pregnancy". In R. Dionigi and M. Gard (Eds.), Critical perspectives on sport and physical activity across the lifespan. Palgrave Macmillan, UK.
*Bhagat, K., & Jette, S. (accepted, in press). An intervention on public health interventions – Questioning the dominant obesity discourse. In E. Cameron (Ed.), The fat pedagogy reader: Challenging weight-based oppression in education.
Jette, S., & Vertinsky, P. (2015). The contingencies of exercise science in a globalizing world: Ageing Chinese Canadian and their play and pleasure in exercise. In E. Tulle & C. Phoenix (Eds.). Physical activity in sport and later life. London: Palgrave Macmillan
Norman, M. E., Rail, G. & Jette, S. (accepted in 2012 & in press). Screening the un-scene: De-constructing the (bio)politics of story telling in a Reality Makeover weight loss series. In D. McPhail, J. Ellison & W. Mitchinson (Eds.) Obesity in Canada: Historical and critical perspectives. Toronto: University of Toronto Press.


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Outraged Brian O'Driscoll fans turn on Gatland
Warren Gatland, Kiwi coach of the Lions, has left some extremely upset fans in the wake of his decision to axe Brian O'Driscoll from his side for the final test.
Gatland dropped revered O'Driscoll, described as "Ireland's national treasure", after an emotional selection meeting, reported the Daily Mail.
It was a tough call for the coach because he had to be ruled by his head, not his heart, he said.
However, not taking into account politics and sentiment, he would put his hand on his heart and say it was "the right rugby decision."
But O'Driscoll fans were not so sure.
Facebook page Justice For BOD, inspired by his "unjust" dropping, collected nearly 120,000 likes in two days, and has been covered in comments knocking Gatland.
"Overwhelming Response for BOD. I think many people are still outraged by the decision and its safe to say its nothing but disrespect on Gatland's behalf," said one post.
"Gatland needs his head checked!!" said one commenter.
Another said he would not even support the team after the decision: "Don't look forward to Gatland's smug grin if they win so can't support it. Not even having BOD on the bench will also make this feel like a welsh victory I'm sorry to say."
Even One Direction member Niall Horan chimed in on the decision.
"Can't be right! Gatland ya mad yoke! Dropping brian o'driscoll. Clearly wants t lose the series," he tweeted.
Several memes have also been created in BOD's honour - one with Hitler reacting, and Ron Burgundy bawling in a phone booth.
Gatland said the right course of action was clear, and that he would not feel comfortable making calls to avoid criticism or chasing public popularity.
O'Driscoll had never been dropped, at club or test level, and was "very, very disappointed", reported the Daily Mail.
Fairfax Media


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I am going to a "stuffed" themed dinner tonight and what better appetizer to bring than stuffed mushroom caps? I "healthified" the original recipe found on The Pioneer Woman by swapping pork sausage for a leaner turkey sausage and using light cream cheese in lieu of full-fat cream cheese.
24 oz white button mushrooms
1/3 lb hot turkey sausage
1/2 medium onion, finely diced
4 cloves garlic, finely minced
1/3 cup dry white wine
8 oz light cream cheese
1 egg yolk
3/4 cups grated parmesan cheese
salt and pepper, to taste
1. Wash mushrooms in cold water. Pop out the mushroom stems, reserve both parts.
2. Chop mushroom stems finely and set aside.
3. Brown and crumble sausage. Set aside on a plate to cool.
4. Add onions and garlic to the same skillet that sausage was cooked in, and sauté for 2 minutes over medium low heat. Pour in wine to deglaze the pan, allow the liquid to evaporate.
5. Add in chopped mushroom stems, stir to cook for 2 minutes. Add salt and cracked black pepper, to taste. Set mixture aside on a plate to cool.
6. In a bowl, combine cream cheese and egg yolk. Stir together with parmesan cheese. Stir in cooled sausage and cooled mushroom stem mixture. Combine well and refrigerate until firm.
7. Preheat oven to 350 degrees F.
8. Smear mixture into the cavity of each mushroom, creating a sizable mound over the top. Place on a rimmed baking sheet.
9. Bake at 350 degrees for 20-25 minutes, or until golden brown. Allow to cool slightly before serving.
Yield: 8 servings
Adapted from The Pioneer Woman


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Lina is an old short woman. She was a police officer when she was young. Lina has caught a lot of criminals. The only one who has ever escaped from her was Bartholomew. Lina also has a daughter - Magda. Because Lina cannot work as a policewoman any more, she now works as a baby-sitter, a job that she enjoys most of the time.
Trivia Edit
- Lina hates video games, stating that "they were made by the devil".
- Lina likes broccoli.
|Characters in The Floorsland series
Floorsland Race
Human Race


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Wetsuit Season is Around the Corner
Posted: Mar 27 2017
Inset picture: Ex-Shop Staffer and lifetime #SurfSideCrew member, Alex Copp giving the thumb's up on shredding some Great Lakes swell.
Being Ottawa's only real surf shop, we often get many questions with regards to wetsuits. The main questions being, "Will this keep me warm?" or, "What water temperature is this wetsuit good for?". Of course, there are no truly definitive answers as each and every one of us are unique (aren't you a special little snowflake!) and as such, we all have our own specific tolerances to cold and other adverse conditions. The following chart is meant to be used as a guideline. As I often tell our customers, when in doubt, err on the side of being too warm. It's rare a day gets cut short because you're too warm, too cold however....hypothermia isn't a word I like to use when selling customers on wetsuits. Unfortunately though, it is a stark reality many cold water enthusiasts must consider when suiting up cold water fun. Check out the guide and let us help you gear up.
|Water Temperature Range (°F)
|Wetsuit Thickness
|Wetsuit Type
|Seal Type
|65°- 75°
|0.5 mm - 2/1 mm
|Top / Shorty
|62°- 68°
|2 mm - 3/2 mm
|Springsuit / Full Suit
|58°- 63°
|3/2 mm - 4/3 mm
|Full Suit + Boots
|52°- 58°
|4/3 mm - 5/4/3 mm
|Full Suit + Boots + Gloves + Hood
|Sealed and Taped
|43°- 52°
|5/4 mm - 5/4/3 mm
|Full Suit + Boots + Gloves + Hood
|Sealed and Taped
|42° and below
|6/5 mm - 6/5/4 mm
|Full Suit + Boots + Gloves + Hood
|Sealed and Taped
Again, this is just a basic guideline for water temps/Wetsuit thickness. Air temperature, activity level, individual cold tolerance are but some of the factors to consider over and above these guidelines. We also offer a selection of hoods, gloves, booties, chill guards, under tops and rash guards to help you find your comfort zone out in the colder waters of our Canadian winters.


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Past Students
Welcome back to Hillbrook!
You have already taken the first step in renewing your links with us by visiting this website. Another option for keeping in touch with other Past Students and the school is to join us on Facebook.
Connections magazines, published twice yearly, not only provides a snap shot of current school activities, but also an insight into the continuing journeys of our past students. Read the latest copy here and please, stay in contact, we would love to feature your story in the next edition. Share your story with us!
Basement Arts Community Theatre
Basement Arts is a Hillbrook community group that
encourages both the creative team within the
Drama department and past and current students to work collaboratively and shape engaging theatre.
"Never make your home in a place.
Make a home for yourself inside your own head.
You'll find what you need to furnish it - memory,
friends you can trust, love of learning, and other such things.
That way it will go with you wherever you journey."
- Tad Williams


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Our retail products are available in either Branded or Private LabelOur
6.25" x 6.25" x 1.75" box provides for a small footprint, as well as an
attractive, simple to use product that delivers our unique and patented
portioning technology. We package our pre-portioned technology
in these convenient and easy to use packages so that our wholesome
goodness can be taken from the freezer or refrigerator to anxious
hands. Our cookies are thaw, place, and bake products that will rival
your own homemade cookies.All products are certified Kosher through Organized Kashrus Laboratories, NYContact us today for distribution or availability in your area.Distributor inquiries are welcomed. Please contact us for more information.


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Keith Williams
Keith has been working in the lighting and staging industry for over 10 years at a senior level. Within the industry he has had a variety of experience ranging from sales, to assisting with communication campaigns, managing and overseeing day to day operations as well as product design and launch. He has been an employee of Impact Products since the company was started in 2007, taking a small break to extend his industry knowledge working at a staging and trussing company. Prior to this he was a business owner in the timber industry.
Click here to email Keith directly
David Jeffery
David has been with the business for almost 5 years and was promoted to General Manager of the Staging Division in October 2015 to spearhead the growth and expansion of this new department.
Having acquired a wealth of experience in the industry, his prime focus has been to grow the Lightspace range and manage the ongoing relationship with Milos UK who have been appointed as Impact Products exclusive UK distributor and sole stockists of the Milos Structural Systems range of truss & accessories.
Under David's management and direction the Staging Division offers a comprehensive product portfolio and full design service from the Lightspace portfolio and will be pivotal in offering further diversity and providing the best solutions to their increasing customer base, making Lightspace the UK's fastest growing stage and truss brand.
2017 has given David a further opportunity to manage the purchasing and product road map for the multiple brands undertaking the role as Product Brand Manager for Impact.
Click here to email Dave directly
Theresa Gibson
As Head of Marketing for the Group, Theresa is responsible for delivering multiple variants across the marketing mix including all group activity both internally and externally working closely with key suppliers, vendors, agencies and distributors.
Having worked in a broad range of industries and markets before joining the Group, overall responsibility includes managing the strategy and marketing plans, alongside the daily management of the department. Theresa has worked closely with the Impact team to launch various brands and products, ultimately increasing awareness and traction in the industry through various campaigns, marketing initiatives and events to ensure the key messages about our solutions are reaching the right audiences.
Click here to email Theresa directly
Richard Toolaram
Richard is our longest serving member at Impact with over 10 years experience selling professional audio and lighting equipment. He is extremely passionate about sales and focuses his attention to detail ensuring customers get the right solution every time. His personality is his winning success that's allowed him to build many key customer and supplier relationships.
He is located at our Northampton branch and provides demonstrations on the very latest audio and lighting products.
Click here to email Richard directly
Rob Foster
Rob is the Business Development Manager for Impact Products. He has now been in the industry for 5 years supplying sound, light and staging to professional companies.
With his knowledge of staging and trussing he is now visiting clients and growing the Impact brand in the UK.
Click here to email Rob directly


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Colorectal carcinomas (CRCs) with high microsatellite instability (MSI-H) share clinicopathological features distinctly different from their microsatellite stable (MSS) counterparts. Unlike MSS cancers, MSI-H CRCs occur predominantly in the right-sided colon and are often characterised by a strong lymphocyte infiltration. A poor differentiation pattern is found in most MSI-H CRCs, even though patients with MSI-H carcinomas seem to have a significantly longer survival after surgical resection. To clarify which factors contribute to the obvious paradoxon of a more favourable prognosis of MSI tumours, several clinical and histopathological features as well as the microsatellite status were evaluated in 120 colorectal cancer cases fulfilling clinical criteria (Bethesda) indicative for familial colorectal cancer. Microsatellite instablity status and lymphocyte infiltration were related to tumour stage and patients' follow-up. Statistical analysis confirmed well-known relations, such as enhanced lymphocyte infiltration accompanied by Crohn's like reaction (CLR) in MSI-H cancers (CLR+ in 27 out of 47 MSI-H vs 14 out of 71 MSS CRCs, P<0.001). However, after stratification for depth of local invasion and penetration of the primary tumour, T3 tumours displaying MSI had a significantly lower rate of distant metastases (M1 in four out of 35 MSI-H vs 20 out of 41 MSS CRCs, P<0.001). A similar tendency was observed for CLR-positive CRCs (M1 in six out of 29 CLR+ vs 17 out of 45 CLR− CRCs, P=0.13). In a logistic regression model, the MSI-H phenotype and the presence of CLR were independent predictors of a low UICC stage (P=0.006 and 0.04, respectively). These data, together with the recent definition of highly immunogenic neo-antigens expressed in MSI-H tumour cells, suggest that MSI-H CRCs elicit a protective host response that may prevent metastasis formation.
Colorectal cancer is one of the most common causes of cancer-related deaths in the Western world. Even though preventive cancer screening contributes to a decrease of colorectal cancer incidence in the elderly, recent reports indicate increasing rates in the younger population (O'Connell et al, 2003). Colorectal cancer remains a major health problem causing significant morbidity and mortality, especially in industrialised countries. In Germany, about 57000 novel cases of colorectal cancer are recorded each year (Becker, 2003).
Colorectal carcinomas (CRCs) generally arise from precancerous lesions by accumulation of mutations in genes coding for proteins involved in controlling cell growth and differentiation. For the development of colorectal cancer, two major pathways have been described. The more common pathway is characterised by large genomic rearrangements (Lengauer et al, 1997), which are found in about 85% of colon cancers. An exemplary multistep model, which is called the chromosomal instability (CIN) pathway, has been described by Fearon and Vogelstein (1990). According to this schematic process, the inactivation of the APC tumour suppressor gene is a key event in early tumorigenesis, whereas mutations of the TP53 gene occur at a late stage and thus contribute to the development of a malignant phenotype and invasive tumour growth. A second pathway is characteristic for patients with the autosomal-dominant hereditary non-polyposis colorectal cancer (HNPCC) syndrome, a condition which is found in 2–5% of all colorectal cancer patients. Hereditary non-polyposis colorectal cancer familial cancer syndrome is caused by germline mutations in genes coding for proteins of the DNA mismatch repair (MMR) system, hMLH1 and hMSH2 are most frequently affected (Boland (2000) for a review see Lynch and de la Chapelle, 2003). Defects in the MMR system lead to the accumulation of mutations at short repetitive DNA sequences, termed microsatellites. Most of them are localised in noncoding regions of the genome. However, certain growth-inhibiting or proapoptotic genes, for example, TGFbRII, BAX, hMSH3 and hMSH6, harbour microsatellites within their coding sequence (Markowitz et al, 1995; Malkhosyan et al, 1996; Woerner et al, 2003). Insertion/deletion mutations at these loci cause translational frameshifts and lead to a loss of function of the corresponding proteins, thereby contributing to the progression of neoplastic transformation (Furlan et al, 2002). The microsatellite instability (MSI) pathway also contributes to about 15% of sporadic CRCs. In most MSI cases without family history of cancer, promoter methylation of the hMLH1 gene is supposed to be the underlying mechanism (Kane et al, 1997; Miyakura et al, 2001). Although recent work indicates that there are overlaps of the CIN and MSI pathways in a considerable number of cases (Goel et al, 2003), the consideration of MSI and CIN as separate mechanisms of tumorigenesis seems well justified.
Colorectal carcinoma of the MSI phenotype displays several clinicopathological features distinctly different from those found in CIN CRC. High-grade microsatellite unstable (MSI-H) colon tumours predominantly have a right-sided location and frequently present with a strong lymphocyte infiltration (Smyrk et al, 2001). The presence of characteristic lymphocyte aggregations, the so-called Crohn's like reaction (CLR, Graham and Appelman, 1990), has also been reported to be more frequent in MSI-H colon cancer (Alexander et al, 2001; Greenson et al, 2003). Many MSI-H carcinomas display a poor differentiation pattern, often with mucinous or signet cell areas (Greenson et al, 2003). Data on the prognosis of MSI-H CRC are conflicting. Salahshor et al (1999) found an obvious trend towards a better outcome of their MSI-H collective, but this was not statistically significant. Feeley et al (1999) could not see any impact of microsatellite status on patients' survival at all, but the validity of this study is limited by the low number of MSI-H cases. In summary, however, most studies revealed a longer disease-free and overall survival for patients with MSI-H CRC compared to MSS CRC (Watson et al, 1998; Gryfe et al, 2000; Samowitz et al, 2001).
For a better prognostic assessment, Dolcetti et al (2002) suggest the combination of both the evaluation of local lymphocytosis and the microsatellite status; MSI in combination with a high content of intraepithelial cytotoxic lymphocytes was found to be related with an improved overall survival in a group of exclusively right-sided CRCs (Guidoboni et al, 2001).
To determine the relative impact of microsatellite status and antitumoural lymphocyte reaction on the course of disease, we analysed histological and molecular features of CRCs in patients clinically suspicious of HNPCC and compared them with tumour stage and overall survival of the patients.
Tumour specimens from 120 patients treated for colorectal cancer in the Department of Surgery, University Hospital of Heidelberg, from 1992 to 2002 were included in this prospective study. The study collective consists of 120 samples consecutively obtained for microsatellite analysisin the Institute of Molecular Pathology, University of Heidelberg. Histopathological assessment, microsatellite analysis and genetic testing were performed with informed consent of all patients. Only patients fulfilling Amsterdam or Bethesda criteria (Table 1, Vasen et al, 1991; Rodriguez-Bigas et al, 1997; Boland et al, 1998), that is, patients suspicious of HNPCC, were included in this study. From 120 patients included, 21 (17.5%) fulfilled Amsterdam criteria, among the remaining 99 (82.5%), 23 (19.2%) fulfilled Bethesda 2, three (2.5%) Bethesda 3 and 73 (60.8%) Bethesda 4 criteria.Of these, 66 (55.0%) of the patients were male, 54 (45.0%) were female. In all, 20 patients had from two (14 patients) to six (one patient) synchronous CRCs. Patients diagnosed with synchronous tumours in extracolonic localisation were generally excluded. 5-Fluorouracil (5-FU) chemotherapy was administered to nine patients with UICC stage II, 18 patients with UICC stage III and 24 patients with UICC stage IV. Chemotherapeutic regimens were recorded for all patients included.
Surgically resected colonic cancer samples were fixed in formalin (4–10%) and embedded in paraffin. Tissue sections were prepared for DNA isolation and subsequent microsatellite marker amplification (10μm) as well as for pathohistological analysis (2μm).
DNA was isolated from microdissected tumour and normal tissue using the Qiagen DNeasy Tissue Kit (Qiagen, Hilden, Germany). Microsatellite status was determined using 5–10 markers from the standard ICG-HNPCC marker panel (Boland et al, 1998). PCR products were amplified with fluorescein-labelled oligonucleotide primers as described previously (Sutter et al, 1999). Labelled PCR products were separated on an ABI3100 analyser (Applied Biosystems, Darmstadt, Germany), results were analysed using the GeneScan software version 3.7 (Applied Biosystems) as previously described (Woerner et al, 2003).
According to the recommendations of the National Cancer Institute (1998), tumours with instability at 30% or more of the tested microsatellite loci were classified as highly microsatellite unstable (MSI-H), those with instability at less than 30% of tested markers as low microsatellite unstable (MSI-L), and tumours with stability in all tested loci as microsatellite stable (MSS) (Boland et al, 1998). Low microsatellite unstable and MSS tumours were combined as non-MSI-H according to previous studies (Ribic et al, 2003) and are referred to as 'MSS' in this paper.
In all, 2μm tissue sections were deparaffinised and stained with hematoxylin and eosin (HE) following standard protocols. Antitumoural lymphoid reaction and presence of a CLR were evaluated in HE-stained sections from 1 to 3 paraffin blocks of the same tumour (Figure 1). The recommendations of the German HNPCC Consortium were applied (Ruschoff et al, 2004). The presence or absence of CLR was scored as 1 or 0, repsectively. For a positive score, at least three nodular lymphocyte aggregations had to be detectable in the sample (Figure 1), the presence of germinal centres was not mandatory. In two cases, CLR presence could not be evaluated, because the tumour invasion front was not detectable in the paraffin-embedded material.
Histological evaluation was carried out by three observers (AB, HB, MK) not aware of MSI status or tumour stage. In patients with synchronous tumours, the most advanced tumour was used for the analysis. In eight of 20 cases with synchronous carcinomas, 2–6 different tumours were evaluated. Without exception, scoring was the same for all synchronous tumours (data not shown).
For staging, the UICC/AJCC TNM system was applied (AJCC, 1997).
The primary end point for the analysis was survival time from the date of first tumour diagnosis. The median follow-up for survival was calculated according to the method of Korn (1986). Pairwise comparisons of the distributions of categorical data were performed using Fisher's exact test. The 95% confidence intervals (CI95) for binomial probabilities were computed using the score-test-based approach of Wilson (Agresti and Coull, 1998). The pairwise comparison of the distribution of age at diagnosis was performed using the Wilcoxon rank sum test and for the pairwise comparison of survival time distributions the log-rank test was applied. Estimation of survival time distributions was performed by the method of Kaplan and Meier. A Cox proportional hazards regression was used to identify independent prognostic factors for survival. The model included microsatellite status together with UICC stage, CLR, and age at diagnosis and 5-FU chemotherapy as possible prognostic factors. Ordinal logistic regression was used to model the effect of microsatellite status together with CLR and age at diagnosis on UICC stage. UICC stages I and II were combined for the regression analyses. Assuming 'missing at random', missing value imputation was performed for two missing values of CLR. An effect was judged as statistically significant at a P-value not larger than 5%. To provide quantitative information on the relevance of the results 95CI of odds ratios (OR) and hazard ratios (HR) were computed. The statistical analyses were performed by the statistical software package R, version 1.8.1 (R Development Core Team, 2003) together with the Design software library (Harrell, 2001).
Microsatellite analysis of the tumour samples from 120 Bethesda-positive patients examined in this study revealed an MSI-H phenotype in 47 (39.2%) cases, 73 (60.8%) were non-MSI-H (64 MSS, nine MSI-L). Patients in the MSI-H group (median 39 years) were 'younger' than patients in the MSS collective (median 43 years, exact Wilcoxon's rank sum test: P=0.02); the median age at time of first diagnosis was 42 years (Table 2).
Clinical criteria were distributed unequally among MSI-H and MSS group (Fisher's exact test: P=0.01). The most obvious discrepancy was observed for Amsterdam-positive cases, which were much more frequent in the MSI-H (14/47, 30.1%) than in the MSS group (7/73, 9.6%, Fisher's exact test: P=0.006, Table 2).
The trend towards a more advanced tumour stage observed in the MSS CRC group (Fisher's exact test: P<0.001, Table 2) is reflected by the higher frequency of patients treated with 5-FU chemotherapy (Fisher's exact test: P=0.04, Table 2).
For comparison of tumour localisation with microsatellite status, only patients with single carcinomas (n=100) were evaluated. As expected, right-sided location correlated closely with the MSI-H phenotype. Among 30 carcinomas in the proximal colon, 20 were MSI-H (66.7%), in the group of tumors with distal location, only 18 of 70 tumours (25.7%) displayed the MSI-H phenotype (Fisher's exact test: P<0.001, Table 2).
In all, 27 of 47 MSI-H carcinomas had a CLR (57.4%), whereas CLRs were found in only 14 from 71 MSS tumours (19.7%). Thus, CLR frequency was significantly elevated in MSI-H colorectal cancers (Fisher's exact test: P<0.001, Table 2).
The median follow-up was 33 months from the date of first diagnosis, 29 patients died within the follow-up period. The survival distribution of MSI-H patients differed significantly from that of MSS patients (log-rank test: P<0.001, Table 2). Kaplan–Meier estimates of the survival time distributions are presented in Figure 2. The estimated 5-year survival rate of MSI-H patients was 88% (CI95: 77–100%) compared to 56% (CI95: 42–75%) in the MSS group (Figure 2A; log-rank test: P<0.001). An improved overall survival was also observed in patients with CLR+CRC (Figure 2B, P=0.04). No significant differences were observed in groups with or without 5-FU chemotherapy (not shown). Additionally, we tested the prognostic value of microsatellite status together with UICC stage, presence of CLR, and age at diagnosis and application of 5-FU chemotherapy by using a proportional hazards regression model. Here, UICC stage and age at diagnosis were the only statistically significant prognostic factors for overall survival (Table 3).
The MSI-H phenotype was rarely detected in stage UICC IV: only six out of 43 (13.9%) tumours with distant metastases (UICC IV) were MSI-H, compared to 41 out of 77 (53.2%) in the collective with UICC I-III (Fisher's exact test: P<0.001, Table 2). For presence of CLR, the observed tendency was similar. From 42 UICC IV cases that could be scored for lymphocyte infiltration at primary tumour site, only seven (16.7%) primary tumours had a marked peritumoural lymphocyte infiltration with CLR, whereas in the collective with UICC grade I–III the relation of CLR-positive tumours was 35 out of 76 (46.1%, Fisher's exact test: P=0.001).
Comparison of overall survival after stratification by microsatellite status and presence of CLR is shown in Figure 2C and D for tumours infiltrating the lamina muscularis propria (all other T stages did not reveal significant results). A lower risk was observed for patients with MSI-H T3 carcinomas (log-rank test: P=0.003, Figure 2C) but this result could not be confirmed by multiple proportional hazards regression analysis (Table 3).
These results raised the question whether the longer overall survival of patients with MSI-H tumours was linked to the occurrence of organ metastases. To address this question in more detail, we stratified the tumours by depth of infiltration and compared the occurrence of metastases in the MSI-H vs the MSS group. From 76 T3 carcinomas, 35 (46.1%, CI95: 0.35–0.57) were MSI-H, hence the MSI-H frequency was comparable to the MSI-H frequency observed overall in all included patients (39.2%, CI95: 0.31–0.48).
T3 cancers with MSI-H had organ metastases defining UICC IV stage in 4/35 cases (11.4%), while those with MSS phenotype in almost half of the cases (20 out of 41, 48.8%, Table 4). The increased frequency of metastases in MSS T3 cases was highly significant (Fisher's exact test: P<0.001, Table 4).
To clarify whether this observation was related to morphological features of an antitumoural immune response, T3 tumours were grouped according to the presence of a CLR. The comparison of M stage in T3 carcinomas with or without CLR revealed a trend towards a lower frequency of metastases in cases with CLR (six out of 29 M1 in CLR+ T3 tumours vs 17 out of 45 M1 in CLR−, P=0.13, Table 4).
In summary, we observed a markedly reduced frequency of organ metastases in T3 colorectal cancers that exhibited either the MSI-H phenotype, a CLR or both.
In regard to lymph node metastases, differences were neither significant after stratification for microsatellite status nor for CLR presence (P=0.28 and 0.51, respectively, Table 4).
To test microsatellite status and CLR as predictors of UICC tumour stage, a logistic regression model was applied (Table 5). For CLR, the statistically significant correlation was limited to the regression analysis that included tumours of all T stages (OR 0.44, P=0.04). In contrast, MSI-H was significantly associated with a lower UICC stage when looking at all tumours (OR 0.33, P=0.006) and also in the T3 subgroup (OR 0.24, P=0.006). These data show that the improved overall survival of patients with MSI-H CRC included in this study is closely linked to lower rates of distant metastases, even after stratification for local depth of invasion of the primary tumour.
In this study, we analysed the impact of MSI and Crohn's like lymphoid reaction on the course of disease in 120 colorectal cancer patients fulfilling clinical criteria suggesting HNPCC. Our inclusion criteria resulted in a cohort of patients with an age at diagnosis younger than in a random population of patients with colon cancer. This strategy significantly increases the number of MSI-H cases. Focusing on Bethesda-positive patients results in a stratification that may provide a better comparability of MSI-H and MSS cases, as clinical differences between the two collectives are reduced. It is important to note, that none of the included patients were from families in which HNPCC had previously been confirmed. Therefore, a statistical bias towards an earlier detection of MSI cases due to an intensified screening of persons at risk can be excluded. Furthermore, MSI status had no influence on operative or perioperative treatment as this was generally not known before the time of operation. All patients received a standardised oncologic colorectal resection in the No-Touch-Isolation technique originally described by Turnbull (1975) unless when in a palliative noncurative situation.
When comparing MSS and MSI-H cases, significant differences were found for distribution of clinical criteria, tumour localisation, UICC stage of disease, M stage, vital status of patients and presence of CLR.
Not surprisingly, the predictive value for microsatellite unstable tumours was highest for Amsterdam criteria. In two-thirds of Amsterdam positive cases tumours were diagnosed as MSI-H. For our further analyses, no discrimination was made between sporadic cases and cases with a positive family history as the microsatellite status of the tumour itself was believed to be crucial for its histological appearance and biological behaviour. This approach is supported by a large study comparing HNPCC-associated and sporadic MSI-H CRCs where no significant histopathological differences were found, except a marginally higher frequency of mucinous tumours in cases with positive family history (Shia et al, 2003).
To analyse the antitumoural immune reaction of the host, we focused on the presence of a CLR and not on the density of intratumoural lymphocytes. This strategy was chosen to directly address the stromal inflammatory reaction. Furthermore, the interobserver reproducibility has been reported to be much better for the assessment of CLR than for counting of tumour-infiltrating lymphocytes (Alexander et al, 2001). Moreover, preliminary data with a limited number of tumour samples indicated a good correlation of CLR with a high density of tumor-infiltrating cytotoxic (CD8+) lymphocytes, supporting the hypothesis that CLR positivity is indeed associated with a cytotoxic antitumoural immune response.
As in previous reports, we could show that the presence of a CLR was closely associated with a microsatellite unstable phenotype of colorectal cancer (Gafa et al, 2000). The strong antitumoural lymphoid reaction, which frequently occurs in MSI-H colorectal cancers, is commonly attributed to tumour-specific neopeptides generated during MSI-H carcinogenesis. Functional in vitro assays proved the immunogenicity of certain MSI-associated frameshift peptides (Linnebacher et al, 2001; Saeterdal et al, 2001; Ripberger et al, 2003). Both features, MSI-H status and CLR, have been reported to be associated with longer survival times in previous studies. When analysing the overall survival in our total collective stratified for microsatellite status or Crohn's like lymphoid reaction, the prognosis of patients with tumours displaying MSI-H and/or CLR was significantly better. After having found the differences in survival and the low frequency of MSI-H in UICC IV tumours, we hypothesised that the above prognostic advantage of MSI-H tumours was, at least in part, due to a reduced metastatic potential of these. Therefore, we stratified the CRCs for penetration depth of primary tumour and compared the frequency of distant metastases, which proved to be significantly lower in the MSI-H group. Similar observations had previously been reported for CRC patients with family history of HNPCC (Watson et al, 1998), however tumours were not tested for MSI, and sporadic CRC cases were chosen as a control group.
The observation that microsatellite status was an independent predictor of distant metastases suggests either a reduced tendency of MSI-H tumour cells to form metastases, a better antimetastatic response of the host in MSI-H cases, or both. To further examine the role of inflammatory reaction in this context, T3 cancers were grouped for CLR status and frequencies of metastases were compared. Here, a clear trend towards fewer metastases in CLR positive cases was observed. One might speculate that the lack of statistical significance merely reflects variability in CLR scoring which is more pronounced than in MSI testing. Moreover, CLR assessment only refers to morphological aspects, yet not to functional features of tumour infiltrating lymphocytes. An effective antitumoural immune reaction of the host may not necessarily be linked to density of tumour-infiltrating lymphocytes or presence of CLR. The fact, that MSI-H status is much more closely linked to fewer distant metastases than lymphoid reaction, raises the question whether there are additional features of microsatellite unstable cells that contribute to a lower metastatic potential, e.g. mutations in a number of metastasis-promoting genes. However, the presence of an antimetastatic immune protection in MSI-H CRC patients may explain recent findings that adjuvant 5-FU chemotherapy has no beneficial or even adverse effects in this collective (Ribic et al, 2003; Carethers et al, 2004). Further functional studies are needed to clarify the molecular mechanisms underlying these phenomena. This hypothesis cannot be addressed in our study, because 5-FU chemotherapy was not administered in the framework of a controlled trial. Larger prospective studies are required to clarify the clinical consequences of 5-FU therapy in MSS or MSI-H CRC patients and the mechanisms underlying these phenomena.
In summary, this study shows for the first time that MSI-H and CLR+ CRCs from Bethesda-positive patients are associated with fewer distant metastases, even in the case of deep local invasion of the primary tumour. Our data suggest a protective role of functionally active lymphocytes directed against MSI-H CRCs, which may prevent tumour cell dissemination and metastasis formation in distant organs. This observation could be explained by frameshift mutations occurring within the coding region of different genes, which lead to tumour-specific neopeptides in MSI-H tumours. This makes vaccination against these neopeptides a promising approach for novel adjuvant treatment strategies in patients with MSI-H tumours. In MMR gene mutation carriers, a preventive vaccine with a set of predictable neopeptides frequently affected during MSI tumorigenesis could inhibit or at least delay the onset of MMR-deficient tumours. In conclusion, due to its prognostic and potentially therapeutic implications MSI screening should be considered as a routine diagnostic service in all colorectal cancer cases in the future.
We thank Irina Voehringer, Beate Kuchenbuch and Gabriele Russell for their excellent technical assistance. This work was supported by a grant of the German Cancer Aid (Deutsche Krebshilfe, Grant no. 70-3026-Kn5).
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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tag:blogger.com,1999:blog-17923737665536192552014-10-06T21:15:07.355-07:00Updates on Jack St. ClairThe intention of this blog is to keep family and friends updated on Jack's condition and progress as he is treated for and heals from his injuries. To have any and all new posts to this blog sent directly to your email, enter your address in the box below and to the right and click "submit." To follow via RSS, click the link below that.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-67006267688343599812011-12-07T08:45:00.001-08:002011-12-07T08:53:28.332-08:00One Month Post-SurgeryJack has been doing better since his surgery at the beginning of November. The surgeon was able to close up the wound without a skin graft; Whitney took his sutures out a couple weeks after that, and everything is healing really well, though he does have some really big scars.

 Unfortunately, Jack is constantly in a lot of pain. He attends both physical and occupational therapy about four times a week and they have him doing exercises with his uninjured arm, too, so that messages will hopefully go to his other arm. The hope is that eventually his other arm can move too.

Though Jack still doesn't have any feeling in his arm other than pain, when you touch his arm now it starts hurting faster than before so his nerves are reacting quicker, which is good. The injured arm swells a lot so Jack sees a therapist for a special kind of therapy to work with his arm and help lower the pain and inflammation.

On a positive note, Jack has been driving himself occasionally when he isn't in a lot of pain. Sadly the pain keeps him from doing many activities, but he still keeps up on his hay work phone calls, which gives him something to focus on other than the pain. The therapists all seem to have high hopes for him regaining movement in his arm, but they are unsure exactly how long that will take. It could take anywhere from six months to a year or so.

 It's hard to say at this point what kind of recovery rate Jack will have, but he is in high hopes, and enjoys watching his sermon videos during the day. Feel free to call and say hello to Jack; he probably wouldn't mind the distraction!Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-1783801970350562602011-11-09T10:48:00.000-08:002011-11-09T10:48:21.587-08:00All Stitched UpJack had surgery on his wounds last Friday (Nov. 4) and the doctor was able to complete the surgery without the use of skin grafts. Below is a picture of his sewn up wounds, which seem to be doing quite well. He's on the mend! What are we thankful for this Thanksgiving season? Advanced medicine.

Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-64811899469486838422011-10-19T09:35:00.000-07:002011-10-19T09:36:57.089-07:00ProgressOops, I received pictures on Friday of last week and it completely slipped my mind to upload them. My apologies for the tardiness. I've been a little absent-minded lately. WARNING: The first image below is of Jack's wounds. Though clean and improved, they may still be a little graphically disturbing to anyone with a weak stomach. Just a warning! The second photo is not so graphic and shows the setup he currently has on his two worst wounds. If you don't want to see the graphic image, scroll past it to view the second.

As you can see above, the wound vac is doing its job and creating new tissue around the wound. This will be useful when the surgeons begin the skin graft process.

Above is an image of the new wound vac Jack had put on/in last Friday. It includes a bridge which links the two wounds together. They both drain into one machine.

Jack and Carol Ann are in Portland today seeing a surgeon to discuss skin grafts. More updates soon, we hope.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-18100510351796371462011-10-12T08:28:00.001-07:002011-10-12T08:28:06.864-07:00Plastic SurgeryJack and Carol Ann will return to Portland on October 19 (next Wednesday) to meet with the plastic surgeon. For now he is seeing the wound specialist at the hospital in La Grande.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-89715362829631001842011-10-10T16:31:00.000-07:002011-10-10T16:31:37.102-07:00Double Your FunToday Jack's wound vac (sorry to have called it a "rack" earlier - getting information via voicemail can be tricky) was split into two. He now has not only the original in the large wound near his armpit, but now he also has one in the puncture wound on his chest.

As a refresher: The wound vac is a sponge-like piece of foam inserted into the wound and attached to a tube. The tube is connected to a machine which pumps out any and all drainage from the wound. The sponge-like foam contains organisms or chemicals (not sure which...) that encourage regeneration of tissue and fight bacteria, cleaning out the wound and giving the doctors extra tissue with which to work when doing skin grafts. Jack's two wounds are now connected to one tube that drains both into the same machine.

He is very much enjoying being home, as you can guess. On Saturday he thoroughly enjoyed a large omelet, specially prepared just for him by Rolie (Whitney's husband).

Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-63002433820436631082011-10-07T09:54:00.000-07:002011-10-07T09:55:03.666-07:00GRAPHIC IMAGEWARNING: The post today is a photo of Jack's worst wound. It is doing much better, and the photo is to show improvement (compare it to the earlier post of his injuries). Please do not scroll down if you don't want to see the image.

Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-23029417218116990342011-10-05T07:15:00.000-07:002011-10-05T07:15:30.435-07:00Going Home!

Jack was released from the hospital on Tuesday afternoon. Here he is enjoying visiting with family at his sister-in-law's house in Portland, where he and Carol Ann stayed the night last night. They plan to drive home to La Grande today.

Thank you all for your prayers, thoughts, and for visiting this page to keep up with how Jack was doing. I would guess there will be a few more updates over the next few weeks as Jack goes in for a checkup next week, schedules surgery, discusses skin grafts with the doctors and surgeons, and works in physical therapy to ensure he regains range of motion with his arm and hand. However, those updates will be much more infrequent. Stay tuned, though - we'll keep you posted on his full recovery.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-4428177908850753702011-10-04T11:20:00.000-07:002011-10-04T11:20:25.701-07:00Release?Monday morning Jack's creatinin levels were at 2.76; if you will recall, the goal is to get them down to 1.3, so we are getting ever closer.

His legs are getting stronger every day; he is now using the restroom regularly on his own, and this not only indicates healthy kidneys, but also assists in his muscles regaining their strength.

Doctors are hoping to be able to discharge Jack from the hospital tomorrow (Wednesday), though only time will tell if his body will be ready for that. Once he is released he will need to return to the hospital for a checkup in a week, and hopefully at that point the surgeons will be able to discuss skin grafts and surgery with him.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-60592073603998730942011-10-03T09:18:00.000-07:002011-10-03T09:18:50.894-07:00Up and About

As you can tell, Jack loves having his picture taken. :) Here he is enjoying some time OUT of bed, visiting with family from the chair in his room.

Right now I'd like to give a huge thank you to everyone who has shown support and love for Jack and his family during this crazy situation. The shelf next to his window has a number of cards from various people who care about him, and currently there is a beautiful bouquet of orange and yellow fall-looking flowers brightening up the room. (There's also a box of chocolates which I'm sure won't last long.) All of your thoughts, prayers, and gestures of solidarity mean a lot to all of us, and we are so thankful for such wonderful friends and family members.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-6535937604739802812011-10-03T09:05:00.000-07:002011-10-03T09:19:35.245-07:00The WeekendSorry for the delay in updates since Friday; I wasn't around a computer very much over the weekend, as we went to visit Jack in Portland again.

While his creatinin (apologies for any misspellings, I am NOT a doctor) levels started at 9 (people with absolute kidney failure often have levels this high), they have dropped significantly over the last couple of days, ending up at 3.87 on Saturday. Once they get to 1.3 he will be allowed to go home. If things continue as they have been that could be as early as Tuesday.

On Sunday morning Jack was released from his renal diet to a regular, "eat almost anything you want" diet, which was a joy for everyone because now he could eat some of his favourites from the menu. He is now trying to decide between everything that sounds delicious on the hospital vegetarian menu. His favourite item: Raspberry or mango sorbet.

Ever since he was moved from ICU he has been much more alert and awake; the IV pain medications were keeping him knocked out most of the time. Now that he is on simple oral pain meds ("simple" meaning as little as Tylenol), he only naps once or twice during the day and the rest of the time he spends chatting with family, watching football and baseball, and reading.

The room he is in now is a private room on a floor that was recently remodeled, so everything is bright, cheerful, and modern. He has his own bathroom with a large shower including a fold-down seat, and can see a little bit of Portland from his room window. There are several outdoor areas where you can go walking and sit and watch the tram (which goes from OHSU to the South Waterfront), and on a clear day even see Mt. Hood, Mt. St. Helens, and Mt. Adams. Jack has been taking "walks" in his wheelchair to get some fresh air, and it seems to be doing him good.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-156816922137550732011-09-30T11:10:00.000-07:002011-09-30T11:10:07.775-07:00Friday Morning: Waiting GameStill no surgery on the docket...though creatin (sp?) (the bad protein) levels in his system are going down, his kidneys are still not quite at the point doctors want them to be before he undergoes surgery. So we will wait and continue to pray that he is able to have surgery soon.

Today while trying to work with his injured arm Jack felt burning pain in his wrist nerves, which is both good and bad; bad because it's pain but good because he's able to feel sensation in the wrist, which has not often been the case since the accident.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-70845182036542241352011-09-30T07:07:00.000-07:002011-09-30T07:07:29.775-07:00Thursday Evening Jack was more tired today, but he was very awake yesterday so he is most likely recuperating from being more active yesterday. He was able to take two good naps and got some good rest, which is good for his body.

Also exciting was his first shower of his hospital stay. They had hoped to allow him to shower earlier this week but for various reasons it didn't happen; Carol Ann says they were finally able to clean out his ears, which still had hay in them from the field! Jack is a much happier man now with clean hair and clean ears. Though they had to be very careful not to get his major wound wet, it was still nice to be able to shower.

He was also able to stand over the sink and brush his teeth today, so things are looking up.

Jack's cousin Fairy came for a visit today and sat and chatted for a couple of hours, which was good for everyone; those who know Jack well know he loves family and enjoys chatting, so to see a family member he doesn't often see and be able to relax and have a visit was quite the treat.

The doctors are still keeping their eyes on his kidneys; they don't seem to be catching up as quickly as the doctors thought they would, so the expectation of dialysis is still 50/50. Since they can't do anything else until Jack's counts (UC?) go down, they will continue to monitor his kidneys and wait for them to function better before scheduling surgery.

Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-63959996622189983472011-09-28T20:54:00.000-07:002011-09-28T20:54:40.182-07:00PhotosWARNING: Some of the images below may be disturbing to persons who do not deal well with graphic photos. If you are at all squeamish about blood and injuries, you may want to reconsider scrolling through these pictures. I will put the worst ones at the end so you can at least see a few, even if you do have a disinterest in the gory shots.

 Up for a walk! (And annoyed that his sister is taking his picture...again.)

Learning how the remote works in his new private room so he can watch a western on TV.

THE IMAGES BELOW ARE QUITE GRAPHIC...THIS IS YOUR LAST WARNING!

The injuries...

Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-44056480989717679572011-09-28T13:24:00.000-07:002011-09-28T13:24:40.792-07:00Wednesday MorningAll good news today! Jack ate a good supper last night and a great breakfast this morning and he is able to get up and use the restroom on his own now.

His kidneys are stabilizing, and while they are not completely functioning normally, they are vastly improved, meaning dialysis is on the back burner, rather than the forefront of everyone's minds as it had been for the past week. The doctors are still waiting for the kidneys to kick in completely and do their job at 100% before they decide what to do about surgery to repair Jack's wounds.

They have inserted what is called a "wound rack" in the larger wound near Jack's armpit; essentially it sucks up any drainage from the wound and stimulates growth and healing in that area.

He is no longer on very many pain medications, as he feels he can handle the pain he's feeling, though the doctors are still encouraging him to take some medications as his blood pressure goes up when he is not on them.

Due to being off the IVs and not on very many medications, Jack is awake a lot more and is able to get up and walk around a bit from time to time. His number one hope for today is a shower, the first he's been able to have since the accident a week ago. I'm told he is very excited about this - and so is Carol Ann...I'm sure the nurses are, too, since the nurses and Carol Ann are the ones having to smell him. (Just kidding, Jack!) :)Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-77242161257901840052011-09-27T15:41:00.000-07:002011-09-27T15:41:10.253-07:00Tuesday AfternoonThe doctors are waiting for Jack's kidneys to function at 100% before they put him through surgery. Though they don't expect there to be any lasting damage or treatment needed for his kidneys, his body has been through a lot and the kidneys are still not up to par.

The current estimate is that they hope to do surgery on Friday to close the large wound near his right armpit where the skin is completely gone. (It is a patch approximately 6 inches across and 3 inches wide.)

Depending on how his kidneys are functioning, Jack may be allowed to go home on Sunday or Monday of next week.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-57839126006903157632011-09-27T09:02:00.000-07:002011-09-27T09:02:02.070-07:00Tuesday Morning UpdateLate yesterday afternoon Jack was moved out of ICU and into a very nice private room. He has been disconnected from the machines and IVs and is only taking oral pain medications, which means he can spend a lot more time awake.

As of last night he was still quite bloated from retaining water, but now that he's moving around more on his own they expect things to improve in that area, as well as in his blood circulation and the mobility of his muscles.

Jack was able to eat a fairly decent supper last night, which is very positive, and the doctors postponed dialysis yet again to give him some time overnight to improve. However, they cannot do surgery until his kidneys stabilize, so we hope to learn this morning more of a plan for when they intend to do surgery.

Though he is out of ICU, a phone call before visiting is still appreciated.

Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-75505075646328441662011-09-26T14:52:00.000-07:002011-09-26T14:52:49.542-07:00Monday Afternoon UpdateDialysis has been cancelled again; it was scheduled for this afternoon but things are going so well they have decided against it. Jack has also been released from ICU and is now on the kidney floor, waiting to see how things go over the next day or so. He is also off of all IVs.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-86869043157913002342011-09-26T10:28:00.000-07:002011-09-26T10:28:44.594-07:00Monday Morning UpdateThe doctors have decided to go ahead with dialysis as a proactive move to clean the medications completely out of his system. The meds were administered in an effort to dilute the proteins that were potentially damaging to his kidneys. While they did their job, the medications need to be completely cleared from his bloodstream, so they will conduct dialysis this afternoon (Monday, 9/26). His levels have been fairly stable, and things remain positive.Beckyhttp://firstname.lastname@example.com:blogger.com,1999:blog-1792373766553619255.post-33521767751415419102011-09-26T09:21:00.000-07:002011-09-26T09:21:50.612-07:00SurgeryThey have waited this long to do surgery because the doctors don't want to sew anything up before all the toxins and poisons and dirt are out of the wounds. So their hope is that everything continues to improve as it has over the last couple of days, so they can perform surgery tomorrow (Tuesday) to repair at least some of the damage. Until then they continue to clean and dress the wounds regularly and Jack continues to rest and stay hydrated.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-90521224258709686592011-09-26T08:58:00.000-07:002011-09-26T08:58:43.085-07:00Friday, 9/23 - Sunday, 9/25Jack's blood pressure went up because of the saline being pumped into his system, which made his heart pump harder to keep things moving. The doctors expected this, and monitored things carefully, administering beta blockers on Saturday to bring his blood pressure down to safer numbers.

Nausea keeps Jack's appetite quite suppressed, making it difficult for him to eat the food he needs. After a few bites here and there of various items we had hoped would keep the nausea at bay, he finally got his appetite back briefly on Saturday evening and polished off an entire fruit plate, which cheered everyone considerably.

On Saturday x-rays showed fluid in Jack's lungs, which caused concern for possible contraction of pneumonia. To prevent this, the nurses keep his bed at approximately a 45-degree angle, which seems to be working well, though he has had to get used to sleeping sitting up.

Though he is very tired and spends most of his time sleeping, Jack responds well to questions and has been listening to baseball games (he's not wearing his glasses, so watching the games on TV doesn't work) and was awake enough to talk to, wave at, and blow kisses to his granddaughter, Kayla (Jason & Becky's 2-year-old).

Because his body is focusing so hard on fixing the injuries, Jack's kidneys started faltering temporarily. As a result, the doctors expected to have to put him through dialysis Sunday morning. A surprise to everyone Sunday morning was that everything seemed to be functioning and dialysis was put on hold indefinitely.Beckyhttp://email@example.com:blogger.com,1999:blog-1792373766553619255.post-75741535812893043252011-09-26T07:11:00.000-07:002011-09-26T07:11:34.882-07:00What HappenedOn the afternoon of Wednesday, September 21, Jack was picking up bales of hay in a field a mile or so from home. While attempting to clean some gunk out of the bale wagon, his wrist was caught by the machine and was pulled in. He managed to free himself, but as he did his shirt caught in the metal teeth of the conveyor belt used for picking up bales, and his right arm was pulled into the machinery.

As he could not reach the ignition to turn off the bale wagon, Jack wedged his boot into the conveyor belt to keep it from moving. This was how he stood for seven hours before family members found him around 9 p.m.

The helicopter from the La Grande (Ore.) Hospital picked him up in the field and flew him to Providence St. Mary Medical Center in Walla Walla, Wash., and Carol Ann, Whitney, and Rolie followed in the car. Jason and Becky live a ten-minute drive from Walla Walla so they met Jack at the hospital there around 10:30 p.m. and stayed with him in Trauma 1 until the other three joined them an hour and a half later.

The Walla Walla medical team quickly realized they did not offer the specialized surgery Jack would need to repair his arm and side. He had sustained significant injuries to his right wrist, shoulder, armpit, and side, including deep gashes, puncture wounds, scratches, and a burn on his chest where he had been pressed against the hot machinery. Near his armpit was a large section where the skin had been completely removed. They decided to Life Flight Jack to OHSU (Oregon Health & Science University), a large and very capable hospital in Portland.

Around 2:30 a.m. Life Flight left the Walla Walla airport for the 50-minute flight to Portland, where Katrina and Lorin met Jack and Carol Ann, who had accompanied Jack for the Life Flight.

At 7:30 a.m. the OHSU medical team did a minor exploratory surgery to determine the extent of the damages and to clean out the wounds as best they could. Jack's arm and side were then wrapped and he was placed in a hospital room to recuperate. When his blood pressure shot up that afternoon, they moved him to the trauma ICU where they could better monitor his situation, and he has remained there.
 Beckyhttp://firstname.lastname@example.com


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