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The devil's words have no power. Honest! You cannot find one scripture in the Bible that says that the devil's words have power. You can only find out how his words got him into trouble!
On the other hand, the Bible tells us that God's Words are incredibly powerful. He spoke words and created everything!
The words that we speak are also potent.
Proverbs 18:21 in the New Living Translation says: "Those who love to talk will experience the consequences, for the tongue can kill or nourish life."
I could give you a very long list of scripture verses that would give you more evidence of the importance of words, but that is what concordances are for! Look it up for yourself!
So, if the devil's words have no power, why is it that he can cause so much trouble on the earth?
Let me tell you, the devil is not silent. He and his demons are busy whispering lies and tempting people into sin all over the world right this minute! But – those whispers don't have any power at all…
…until he gets you to agree with them.
That's right. You know it's true. The enemy can plant an evil thought in your mind like, "I ought to just get a divorce!" The thought alone has no power. It is only a thought. It is what you do with the thought that will determine if the enemy gets any glory from it. If you do as the Word says and "cast it down", it will not accomplish anything for the devil. But – if you hold on to that thought for awhile and think about it seriously, it will start to gain some ground. It is still only a thought though – but if it travels from your mind to your mouth – now we have serious trouble!
If you come right out and say "I ought to get a divorce!", the devil's words have now been given power! The power of your tongue. The power to kill and destroy your marriage.
All evil words start with a thought that the enemy has planted in our minds. How can I say that? Because if we are a believer, the Bible says that we have "the mind of Christ". I do not believe that the mind of Christ would suggest divorce, do you?
You might be saying "I don't feel like I have the mind of Christ." If you are hearing more bad thoughts than good thoughts, you need to renew your mind. We'll look at how we can do that later!
To see how words effect us, consider kids. Children have very little ability to control their impulses. They are likely to shout out just about any thought that comes into their head. One might angrily say to another, "I hate you!" or "You're ugly!". Disagreements between children can escalate quickly and get out of hand. If an adult does not intervene they will end up hitting one another or retreating to opposite corners with their feelings hurt. Do you know why? Because the angry words that are spoken have incredible destructive power!
As a child is parented and trained to control their tongue and consider others before themselves, they are better able to handle disagreements and they are much less likely to say angry things and come to blows! Children who are not parented or who are never taught to control their mouth continue to have problems with relationships long into adulthood. Those who allow their angry tongues to run the show are also often in physical fights!
Maybe your tongue isn't angry, maybe it is just depressed. Maybe it just has a poor vocabulary! This would be a great project: Pick a day and record the themes of your conversations. You don't have to record yourself on a tape and you don't have to get down every word. Just take notes throughout the day about what you talk about.
This is what a day in my life would have looked like several years ago:
I hate my hair.
I hate my body.
I hate my job.
I hate doing the dishes.
My kid is driving me crazy!
I think I'm coming down with something.
I just know that something bad is going to happen.
So and so is so lazy.
So and so has no taste.
So and so is just a rotten %$*&.
I'll never get along with my Mom.
I'm always getting sick.
I'll probably end up with cancer.
I'll die young.
I'll die alone.
I'll never meet anyone.
So where do you think those comments came from? Not the mind of Christ I can tell you that! They all came straight from the pit of hell!
I worked in an office full of women and we talked all day. We talked ourselves into sickness and poverty and fear and death every single day. And we didn't even know it. Most people don't!
Is this close to how you talk about yourself, your kids, your life? Maybe this is the first time that you have seriously thought about the power of your words. If it is, you might be pretty skeptical. But don't brush this message off. Read Part Two of this devotion!
Father God, I thank You that You have shown me the value of my words. Please help me to recognize the negative words that I have spoken. I renounce those evil negative words now in the name of Jesus. Father, please wash my mind with Your Word. Show me the scriptures that I need to memorize and speak out loud to train my tongue to speak life and not death! In Jesus Name, Amen.


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HOW TO RESTORE SQL Server Database with Different / Alternate NAME from backup created by Tivoli Data Protection (TDP) for Microsoft SQL Server ?
Restore a backup from TDP library is pretty easy but you just need to be familiarized with tool to interact with Data Protection for Microsoft SQL Server.
To Restore a USER Database from a Tivoli, SQL Server Data Protection, you need to
OPEN GUI tool named Data Protection for Microsoft SQL Server; Start Menu\Programs\Tivoli Storage Manager\Data Protection for Microsoft SQL Server
- Click on the 'Restore Databases' tab.
- Select the 'Show Active and Inactive' and 'Wait for Tape Mounts for File Information' checkboxes.
- Selecting the 'Show Active and Inactive' option returns information on all backups within the retention period (not selecting this option will display only the most recent backup)
- The 'Wait for Tape Mounts for File Information' is required if replacing an existing database
- Expand the SQL Servers group.
- Expand the server name to display a list of all databases.
- Highlight the database being restored. The list of candidate backups is displayed in the right window.
- Select the backup from which you need to restore by clicking the checkbox
- Ensure the database being restored is selected and the correct backup selected.
- Right Click on the Selected Backup and select Restore INTO
- Enter the name of the database being restored to and Click OK.
- Again Right Click on the selected backup and select Relocate to relocating your database files to a new location and Click OK
- Click the Restore button, which will start the Restore Operation and you can Monitor the progress window to confirm completion of the restore; respond to error messages accordingly.
This will successfully restore your selected database from Achieve with a New Database name.

subset: commoncrawl


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About This Game
- Summary
- Features
- Game Editions
Inspired by the shout-out-loud awesome adventures of Serious Sam, this title is part of the Serious Sam Indie Series -- a collection of Serious Sam games designed and developed by some of the most talented independent developers in the world. Acclaimed indie developers take the reins of the award-winning series and unleash their own brand of mayhem on carnage-craving gamers!
Serious Sam explodes across the second dimension as Mommy's Best Games (Weapon of Choice, Explosionade, Shoot 1UP) slams the legendary hero into a frantic side-scrolling shooter. Featuring killer hand drawn artwork, classic and original enemies, and the innovative weapon stacking system, Serious Sam: Double D is a uniquely exciting chapter in the Serious Sam saga. All that stands between victory and annihilation is a man with a T-shirt and jeans... and a great big pile of guns.
- Serious Action: Unleash a storm of bullets and flame against an unrelenting horde of bizarre and ferocious creatures hell bent on bringing down the heroic Serious Sam. Clash against Mental's army across 18 levels in three sensational worlds from the pyramids of ancient Egypt to the volcanic chaos of Pompeii to the harsh jungles of prehistoric Earth.
- Revolutionary Gunstacker: Duel-wielding is for lesser men. Serious Sam Double D's new Gunstacker allows Serious Sam to stack any combination of weapons one on top another and fire them all at once. Two shotguns on a laser gun and grenade launcher? Of course. Four chainsaws and a flamethrower? Yes, please.
- Legions of Bizarre Beasts: Clash against classic Serious Sam enemies like Headless Kamikazes, Gnaar, and Biomechanoids or gun down all new monstrosities like the insane Chimputees, oddball Vuvuzelators, and the surprisingly sexy Femikazes. Prove your worth and take down four amazingly unique bosses in epic showdowns full of carnage!
- Challenge Rooms and Serious Secrets: Keep the action coming with a battery of action-packed challenge rooms filled to the brim with waves of attacking beasts! Get really serious and try to uncover dozens and dozens of secrets hidden throughout this wild world!
Serious Sam: Double D XXLRelease Date: February 20, 2013
Serious Sam: Double D XXLRelease Date: February 20, 2013
Serious Sam: Double D XXLPublisher: CroteamRelease Date: February 20, 2013
Help us solve the toughest (or most puzzling) game puzzles and challenges.
Our attempt to answer issues which most commonly occur on IGN's wikis.


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Father: Benjamin or Col. Joseph BARTON
Mother: Abigail SHAW
Marriage 1 Jacobus EDSALL b: 1724 in Hackensack, Bergen Co., NJ
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To millions of listeners of the long-running Radio 4 series The Archers, the voice of Phil Archer represented quiet, unemotional sanity in the increasingly turbulent drama of everyday country folk living in the Borsetshire village of Ambridge. Norman Painting, who has died aged 85, played the part of Phil, head of the Archer dynasty, and had an entry in the Guinness Book of Records for playing the same role without a break for more than half a century.
Despite his long association with the character, Painting admitted that he was never that close to Phil. "I put him on when I go into the studio and hang him up on the hook when I leave," he said, giving the impression that he was never wholly satisfied with a lifelong career as one of the less interesting protagonists in a radio soap. The only real affinity he had with his alter ego was their shared love of music. When Phil played the organ in Ambridge church, it was usually Painting at the console.
His early ambition was to be an Oxford don, combining his academic studies with occasional sorties to London to direct Olivier or Gielgud in a Painting play. For a short time, at least, it seemed as if both these ambitions might be realised.
Painting was born in Leamington Spa, Warwickshire. His father was a railway signalman, his mother the daughter of a coalminer. He left school at 15 to work in a library. Two years later he was called up for national service, but failed his medical test. Instead he enrolled at Birmingham University to read English. He worked his way through college by registering as a fire-watcher for which, if he signed on before 7pm, he got 4s 6d, his supper and a bed for the night in the warden's shelter.
From Birmingham, where he got a first-class honours degree, he went on to Christ Church, Oxford, with a research scholarship and immediately joined the university dramatic society. In 1950 he toured the US in a student production of King Lear, starring Peter Parker, later chairman of British Rail, as Lear, and Shirley Catlin, the future politician Shirley Williams, as Cordelia.
After a short spell as tutor in Anglo-Saxon at Exeter College, Painting was headhunted by Dennis Morris, then controller of the BBC's Light Programme. He wrote scripts, produced and acted for Morris until early in 1950, when Godfrey Baseley, a senior BBC producer, suggested that with his academic background, Painting might collate the agricultural facts for a new radio programme to be called The Archers of Wimberton Farm.
The original idea for a farming series had been put to the corporation after a farming advisory council meeting at which a spokesman from the Ministry of Agriculture had complained that, although the BBC was broadcasting excellent farming programmes to encourage people to get back to the land after the war, no one was listening to them. "What we want," interrupted a Lincolnshire farmer, "is a farming Dick Barton." Baseley scribbled the now legendary names Dan, Doris, Peggy, Jack, Phil, Christine and Walter Gabriel on a scrap of paper and gave them to the Dick Barton scriptwriters, Edward J Mason and Geoffrey Webb, who worked on Archers scripts for the next 20 years.
Painting was invited to play the part of Phil for a pilot series introduced by the same dum-de-dum-de-dum-de-dum tune (Barwick Green) it has today. History, for the Archers and the BBC, was made on 22 September 1955 when, in a brilliant piece of competitive scheduling, on the night that commercial television was launched, Grace Archer, Phil's wife, died in her husband's arms after attempting to rescue her horses from a blazing stable.
Twenty million listeners heard the episode, the BBC switchboard was jammed for 48 hours and, overnight, Phil Archer became a national hero. Nothing so exciting was to happen in either Phil or Painting's life thereafter. He and Ysanne Churchman, who played Grace, met every year on 22 September for a Grace Archer memorial lunch.
Under the pseudonym Bruno Milna, Painting wrote many plays and documentaries for radio, including 1,198 Archers scripts between 1966 and 1982. He frequently tried to write Phil out of the story, to give himself a rest. He also included the first-ever "bloody" in an Archers script – when the usually sanguine Phil lost his temper with his nephew Tony learning to be a farm manager and called him a "bloody fool".
Painting lived alone in a converted Warwickshire barn full of music and books and acted as patron of many local charities. He was appointed OBE in 1976. In 1988 he was awarded an honorary degree by Birmingham University and was also an honorary member of high table at Christ Church.
He once told a friend that he was a "reluctant Archer" (the title of his 1982 autobiography), until he realised what a national treasure the programme had become. When the then prime minister Harold Macmillan was asked if it had been easy to sack half his cabinet on the infamous Night of the Long Knives, he replied: "Good gracious no. One thinks about these things for a long time. Interfering with the cabinet is as serious as interfering with The Archers."
Painting made a final Archers recording last week, the results of which are due for broadcast on Sunday 22 November. He is survived by a niece and nephew.
• Norman George Painting, actor, born 23 April 1924; died 29 October 2009


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Barbara Boxer on Foreign Policy
Democratic Jr Senator (CA)
Proponent's argument to vote Yes:Rep. HOWARD BERMAN (D, CA-28): Integrating India into a global nonproliferation regime is a positive step. Before anyone gets too sanctimonious about India's nuclear weapons program, we should acknowledge that the five recognized nuclear weapons states have not done nearly enough to fulfill their commitments under the Nuclear Nonproliferation Treaty, including making serious reductions in their own arsenals, nor in the case of the US in ratifying the Comprehensive Test Ban Treaty.
Opponent's argument to vote No:Rep. BARBARA LEE (D, CA-9): In withholding my approval, I seek not to penalize the people of India but, rather, to affirm the principle of nuclear nonproliferation. Jettisoning adherence to the international nuclear nonproliferation framework that has served the world so well for more than 30 years, as approval of the agreement before us would do, is just simply unwise. It is also reckless.
Approval of this agreement undermines our efforts to dissuade countries like Iran and North Korea from developing nuclear weapons. By approving this agreement, all we are doing is creating incentives for other countries to withdraw from the Nuclear Nonproliferation Treaty.
The overall funding provided by H.R. 2606 is inadequate. By denying America a decent investment in diplomacy, this bill suggests we should meet threats to our security with our military might alone. That is a dangerous proposition. For if we underfund our diplomacy, we will end up overusing our military.
For example, A generation from now, no one is going to say we did too much to help the nations of the former Soviet Union safeguard their nuclear technology and expertise. If the funding cuts in this bill were to become law, future generations would certainly say we did too little and that we imperiled our future in the process.
Status: Conf Rpt Agreed to Y)51; N)49
A bill to impose sanctions on officials of the State Peace and Development Council in Burma, to prohibit the importation of gemstones and hardwoods from Burma, & to promote a coordinated international effort to restore civilian democratic rule to Burma.
(The two Senate versions currently differ in wording). The Saffron Revolution Support Act states that it is U.S. policy to:
Introductory statement by Sponsor:
Sen. McCAIN. The world has reacted with horror and revulsion at the Burmese junta's recent brutal crackdown against peaceful demonstrators. In crushing the Saffron Revolution, killing hundreds and jailing thousands, including countless Buddhist monks, the junta has left no doubt about its blatant disregard for basic human decency. We, as Americans, stand on the side of freedom, not fear; of peace, not violence; and of the millions in Burma who aspire to a better life, not those who would keep them isolated and oppressed. Our response must go beyond statements of condemnation, and the time to act is now. This legislation imposes meaningful and effective punitive action against the cruel, thuggish, and illegitimate Burmese government.
A resolution recognizing the 15th anniversary of the founding of Seeds of Peace, an organization promoting understanding, reconciliation, acceptance, coexistence, & peace in the Middle East, South Asia, and other regions of conflict.
The Arab American Institute has compiled a Scorecard to catalogue the voting record of the 112th Congress on issues of importance to the Arab American community. Though not comprehensive, we have attempted to provide a snapshot of legislation concerning many of the primary issues concerning Arab Americans. For the Senate, we have included 10 items: two bills on the Arab Spring, three on Palestine, one on Lebanon, one regarding civil liberties, and two for immigration reform.
Expresses the sense of Congress that:
White House Summary of NAP, December 2011:The goal of this National Action Plan is as simple as it is profound: to empower half the world's population as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. Deadly conflicts can be more effectively avoided, and peace can be best forged and sustained, when women become equal partners. The National Action Plan is guided by the following five principles:
Congressional Summary:
Proponent's argument for bill:(by United Free Syria organization): House of Representatives: Free Syria Act (HR.1327):
A resolution calling on the United States Government and the international community to promptly develop, fund, and implement a comprehensive regional strategy in Africa to protect civilians, facilitate humanitarian operations, contain and reduce violence, and contribute to conditions for sustainable peace in eastern Chad, northern Central African Republic, and Darfur, Sudan.
Prohibits the President from regulating or prohibiting travel to or from Cuba by U.S. citizens or legal residents or any of the transactions ordinarily incident to such travel, except in time of war or armed hostilities between the United States and Cuba, or of imminent danger to the public health or the physical safety of U.S. travelers.
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Video After The Jump
Recently, Orlando Brown has been heavily covered in the media regarding his frequent arrests, his Raven-Symone "abortion" lyrics, and…
Added by ChasinDatPaper on March 13, 2016 at 10:30am — 13 Comments
Troy Ave took to Instagram last night, to reveal that he's been busy working on a follow up mixtape titled Major Without A Deal: Reloaded. …Continue
Added by Besir Esati on September 29, 2015 at 10:00am — 10 Comments
Brooklyn rapper Troy Ave was getting slammed on social media after reports came out that his latest album Major Without A Deal sold under 4,500 units in its first week. According to …
Added by Besir Esati on June 12, 2015 at 9:30am — 17 Comments
Video After The Jump
Papoose kicks off his new interview with Montreality by spitting a freestyle over 50 Cent's "Major Distribution" instrumental.
Afterwards the Brooklyn, New York emcee talks about a variety of topics including the keys to…Continue
Added by ChasinDatPaper on March 4, 2013 at 11:30am — 16 Comments
Video After The Jump
People are buzzing about 50 Cent's new music video for "Major Distribution" featuring Young Jeezy and Snoop Dogg. The Eif Rivera-directed clip has all the key elements that make a hip hop video…Continue
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Video after the break...
Live performance by Young Jeezy @ Echo Stage Inauguration Weekend 2013. With Special Appearances by: 50 Cent & Tony…Continue
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Video After The Jump
Gunplay's MMG chain is currently on a G-Unit world tour. It made it's latest appearance in 50 Cent's new "Major Distribution" music video featuring Snoop Dogg and Young…Continue
Added by ChasinDatPaper on January 23, 2013 at 5:30pm — 63 Comments


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ISLAMABAD: India announced a mandatory proof of vaccination against polio from January 30 next year for both adults and children travelling from Pakistan to India, Press Trust of India (PTI) reported. The new measure will also apply to Indian nationals travelling to and from countries where polio is endemic.
"The step is being taken to safeguard India's polio-free status attained after sustained efforts and investment," a statement from the Indian High Commission in Islamabad stated.
"It is applicable to all travellers from all countries where polio disease is endemic or where cases of polio are reported," it said.
With this measure in place, Pakistani travellers will have to carry their vaccination records while travelling to India, or face being turned back from their port of entry.
Pakistan, Afghanistan and Nigeria are the only three countries where polio remains endemic.
According to the Indian High Commission's statement, travelers need to take the Oral Polio Vaccine (OPV) at least six weeks before their departure to India but not more than a year before the trip.
In October this year, an outbreak of polio reported among young children in northeast Syria was said to be "probably originating in Pakistan" the World Health Organization (WHO) said. The organization pointed out that this spread of the virus poses a threat to millions of children across the Middle East.
"We know a polio virus from Pakistan was found in the sewage of Cairo in December. The same virus was found in Israel in April, also in the West Bank and Gaza. It… is putting the whole Middle East at risk quite frankly," Bruce Aylward, WHO assistant director-general for polio, emergencies and country collaboration had said.
Pakistan is one of only three countries in the world where the highly infectious disease which cripples limbs remains endemic.
"Last year there were a total of 58 cases, but 62 fresh victims of polio have already been reported in 2013," a senior government official, who works with international donors working to eradicate polio said in a report last month.
Opposition from militant groups has hampered efforts to vaccinate children against polio in Pakistan and officials said violence was part of the reason for the increase in cases.


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I appreciate Steve Kassay (Lettters, "Clean-air group should take development role," Dec. 9) acknowledging the hard work and energy those involved with CleanAirAthens have devoted to the CertainTeed expansion and the use of the degreasing agent TCE at Nakanishi Manufacturing.
However, I think he has missed a major point of our work and the information we're trying to impart. CAA is not "against" either of these industries and the jobs they provide. CAA only wishes our local government (whether that be our local commissioners, the Industrial Development Authority or the Economic Development Foundation) would pay more heed to measures they could take to ensure cleaner air along with these jobs for Athens-Clarke County.
CAA would welcome the opportunity to "attract and expand appropriate businesses for Clarke County," but neither of the two candidates we encouraged to apply for the open position on the IDA board were selected by our commissioners.
As a member of CAA, I hope that in the future, our elected and appointed Athens-Clarke County government officials give higher priority to keeping this community a clean and enjoyable place to live and work.
Sarah Petit Frierson
© 2017. All Rights Reserved. | Contact Us


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Don't act like you don't got problems. We're a little short on sex/fantasy football mailbag questions today. Please email us with submissions. Your fantasy football/sex expert today will be Unsilent Majority, who is actually not that much of an expert at fantasy football, but a total demon in the sack.
Or so I've heard.


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SANTIAGO, Jan 5 (Reuters) - Chilean retailer Falabella said on Monday it plans to invest $4.36 billion between 2015 and 2018 to expand its footprint in the region.
The 125-year-old company has operations in Argentina, Brazil, Chile, Colombia, Peru and Uruguay and said over half the planned spending was earmarked for opening 140 new stores and 11 malls across those countries. (Reporting by Anthony Esposito; Editing by James Dalgleish)


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Greenhouse gas emissions in China 2007: Inventory and input-output analysis
For greenhouse gas (GHG) emissions by the Chinese economy in 2007 with the most recent statistics availability, a concrete inventory covering CO2, CH4, and N2O is composed and associated with an input-output analysis to reveal the emission embodiment in final consumption and international trade. The estimated total direct GHG emission amounts to 7456.12Â Mt CO2-eq by the commonly referred IPCC global warming potentials, with 63.39% from energy-related CO2, 22.31% from non-energy-related CO2, 11.15% from CH4 and 3.15% from N2O. Responsible for 81.32% of the total GHG emissions are the five sectors of the Electric Power/Steam and Hot Water Production and Supply, Smelting and Pressing of Ferrous and Nonferrous Metals, Nonmetal Mineral Products, Agriculture, and Coal Mining and Dressing, with distinctive emission structures. The sector of Construction holds the top GHG emissions embodied in both domestic production and consumption, and the emission embodied in gross capital formation is prominently more than those in other components of the final consumption characterized by extensive investment in contrast to limited household consumption. China is a net exporter of embodied GHG emissions, with emissions embodied in exports of 3060.18Â Mt CO2-eq, in magnitude up to 41.04% of the total direct emission.
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As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Volume (Year): 38 (2010)
Issue (Month): 10 (October)
Pages: 6180-6193
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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Labandeira, Xavier & Labeaga, Jose M., 2002. "Estimation and control of Spanish energy-related CO2 emissions: an input-output approach," Energy Policy, Elsevier, vol. 30(7), pages 597-611, June.
- Shui, Bin & Harriss, Robert C., 2006. "The role of CO2 embodiment in US-China trade," Energy Policy, Elsevier, vol. 34(18), pages 4063-4068, December.
- Zhang, Bo & Chen, G.Q., 2010. "Physical sustainability assessment for the China society: Exergy-based systems account for resources use and environmental emissions," Renewable and Sustainable Energy Reviews, Elsevier, vol. 14(6), pages 1527-1545, August.
- Maenpaa, Ilmo & Siikavirta, Hanne, 2007. "Greenhouse gases embodied in the international trade and final consumption of Finland: An input-output analysis," Energy Policy, Elsevier, vol. 35(1), pages 128-143, January.
- Machado, Giovani & Schaeffer, Roberto & Worrell, Ernst, 2001. "Energy and carbon embodied in the international trade of Brazil: an input-output approach," Ecological Economics, Elsevier, vol. 39(3), pages 409-424, December.
- Zhang, ZhongXiang, 2006. "China, the United States and technology cooperation on climate control," MPRA Paper 12801, University Library of Munich, Germany.
- Lenzen, Manfred & Murray, Joy & Sack, Fabian & Wiedmann, Thomas, 2007. "Shared producer and consumer responsibility -- Theory and practice," Ecological Economics, Elsevier, vol. 61(1), pages 27-42, February.
- Lenzen, Manfred, 1998. "Primary energy and greenhouse gases embodied in Australian final consumption: an input-output analysis," Energy Policy, Elsevier, vol. 26(6), pages 495-506, May.
- Ghertner, D. Asher & Fripp, Matthias, 2007. "Trading away damage: Quantifying environmental leakage through consumption-based, life-cycle analysis," Ecological Economics, Elsevier, vol. 63(2-3), pages 563-577, August.
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"Multilateral trade measures in a post-2012 climate change regime? What can be taken from the Montreal Protocol and the WTO?,"
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Now in his 36th year at Kingsway Christian Church (Avon, Indiana), John Caldwell has baptized hundreds, married couples and then later married their children, buried more than his fair share of faithful church members, and preached hundreds of sermons strategically designed to manage the growth of the Christians who make up Kingsway. John was president of the 1996 North American Christian Convention and will serve as president of the 2012 National Missionary Convention after his retirement from Kingsway. John and his wife, Jan, have been married 44 years and have two children and two grandchildren.
Has it seemed like 35 years?
No. it really hasn't. The years have gone by very quickly.
Were you the preacher when Kingsway started?
I'm the only senior pastor Kingsway has ever had. I was not here when the church began, however. The area evangelistic association filled the pulpit for the first few months until they could find and hire a preacher.
Was it your first pulpit ministry?
I had a student ministry and then, when I graduated from Ozark, I traveled in full-time crusade evangelism for six or seven years before I came to Kingsway.
What's the key to a long ministry?
I planned to have a long-term ministry. I was very intentional about it. I prayed that God would give me the opportunity to go someplace and spend a lifetime there, and he was kind enough to grant that request.
It's a two-way street; the folks at the church have to want you to stick around.
I remember hearing a tape by Marvin Phillips (from down in Tulsa). He talked about the idea that many churches are ineffective because there are problem people in the church, and the problem always stays and the preacher always leaves. I made the determination I would stay and the problem people would leave! I would occasionally say that, jokingly, from the pulpit, but people knew it was my intention to be there for the long haul. That has served us well.
How does a church, or a preacher, stand up to problem people?
We had people in the early days who would come to Kingsway with their own agendas. When they saw Kingsway's agenda was set, and that we would not be deterred from it, they would head on down the road and not cause us any problems.
You must have had opportunities to go elsewhere.
I made a deal with God early on that as long as he was blessing our ministry here at Kingsway, and things were moving in a positive direction, that I wouldn't consider other opportunities. In the early days, as our ministry was growing rapidly, I probably got a phone call or letter a week asking me to go to another church. It was a relief to say, "No, this is where I'm supposed to be."
How would you describe yourself as a minister?
I've always considered myself a blue-collar minister. I know there are far more gifted preachers than me, but God has given me all sorts of incredible opportunities over these years, and I think the key has simply been faithfulness and hard work.
What advice would you give to a young guy who is just getting started?
I always tell young ministers not to take a ministry as a stepping stone, not to take a ministry unless they could see themselves spending the rest of their lives there.
Were there times you wanted to quit?
<laughs> Only a few. There was one particular period when the church was growing very fast, we were understaffed, I was feeling taken for granted, and I was probably close to burnout. I was just about ready to throw in the towel on ministry in general.
What kept you from leaving?
God brought several things into my life at that time. I remember Ken Idleman and I were rooming together at a North American Christian Convention meeting in St. Louis. He was having some difficult times, too, and we kind of cried on each other's shoulders. The old saying "misery loves company" made that therapeutic for both of us. Then I was preaching a revival meeting in Illinois and I was driving home on Friday night. So I asked the local preacher if he had any tapes I could take with me to listen to on the way home. One of the tapes was by Ben Merold, called, "I Think I'll Go on Anyway." It's like that tape was just for me. I must have listened to that tape three or four times on the way home that night. And then Christian Standard published an article by Russ Blowers called, "The Agony and Ecstasy of a Long Ministry." I remember reading that article and, again, it was like it was written just for me. All those factors really impacted my life and my attitude. I prepared a special message for the congregation in which I admitted what I had gone through, the way I had felt, but in which I also recommitted myself to long-term ministry at Kingsway. That was a major turning point.
What would be a reasonable cause for a minister to not stick it out?
Certainly I think that sometimes we take a church as far as we can take it. Other times, for reasons not of a preacher's making, his leadership might be compromised and it might be better for him to move on. Certainly there are just reasons for a congregation to ask a preacher to leave as well.
Is there a primary spiritual component for longevity?
Early in my ministry we were very short-staffed. I was serving as the administrator at our school, we went through several building programs in a row, and I was physically and spiritually exhausted. It has been said, "One can only give that which one has." I realized I was always giving out and not taking in. When the book Celebration of Discipline (by Richard Foster) came out, I was thoroughly convicted by that book that my spiritual life needed attention and I was challenged to begin practicing the Christian disciplines much more faithfully. I really believe that in itself saved my ministry. So the practice of Christian disciplines has continued to be a very important part of my life over these past years.
To last 35 years, I guess you need to maintain a good relationship with your elders.
Every current elder in the church has come into the church under my ministry, and some have come to Christ under my ministry. That, in itself, provides a very special relationship. One of the strengths of Kingsway has been a strong eldership. We have a very involved process for choosing elders, and the result has been some wonderful lay leaders over the years.
How do you connect with the elders beyond regular elders meetings?
I meet regularly with the chairman of the elders—we have breakfast together on a regular basis. We talk together and pray together. The elders as a group socialize from time to time. There is a sense of camaraderie among the elders here. Since I have always served as an elder, we've never had the "us versus them" mentality seen in some situations.
How have you prepared the congregation for new leadership?
A year ago last February we made an announcement to the congregation that we were putting together a "pursuit team" to find the right person to come and work alongside me for a period of time and to transition into the role of senior pastor. That's been anticipated by the congregation for some time. We're just about to get there and the congregation is excited about that. Obviously we are all excited about what the next chapter in Kingsway's life will be from a leadership standpoint.
Are there any other specific things you're doing?
Over recent years I have delegated more and more responsibility to different staff people. Things in the past that I would have taken care of, others now take care of in anticipation of that transition.
Do you have a vision of what retirement will mean for you?
I will be retiring in the traditional sense of the word but plan to be involved in ministry as long as I have the health to do so. I'll take a short break and then do a lot of work on the mission field. I plan to do some seminar work, and some of the colleges have asked me to teach as well.
Are there parts of ministry you'll be glad to retire from?
All the administrative detail that comes with a larger church and carrying the weight of the myriad of problems in the lives of our people that I'm exposed to on a day-by-day basis.
What will you miss when you retire?
I will most miss preparing sermons as a part of a strategy for helping our people grow. I'm sure I'll continue preaching most weekends, but it will be a different sort of ministry. I'll miss the personal relationships that I enjoy with people who have been longtime friends.
Brad Dupray is senior vice president, ministry development, with Church Development Fund, Irvine, California.


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A woman accused of threatening to harm police officers and attack a police station was arrested Saturday in Prince William County, Va.
Ginger Slattery, 43, posted messages on her Facebook account threatening to harm officers of the Prince William County Police Department and attack one of their facilities, the department said.
A concerned citizen alerted police about the actions of Slattery, said police spokeswoman Erica Hernandez. Detectives with the Property Crimes Unit obtained warrants for Slattery's arrest. She has been charged with threats of death and criminal solicitation and was accused of inviting others to attack the station with her on Facebook.
Slattery was apprehended at her home, and a search warrant of her home was executed by the Prince William County Police Department.
She is being held without bond and is scheduled to appear in court next month.


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Police are searching for the gunman who shot and wounded two teenage boys near Los Angeles High School.
The shooting was reported at about 3:30 p.m. Friday.
The Los Angeles Times ( http://lat.ms/wcYwoH ) says one boy was shot in the leg and the other in the back. Both were taken to a hospital. Their conditions are not known.
Police say it's not clear whether any of those involved were students at the school.
Information from: Los Angeles Times, http://www.latimes.com


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Our Windows Mobile team has just created an on-line tool to provide you help in building a business case around deploying Windows Mobile for all types of applications.
It's called the Windows Mobile Business Value Calculator.
It gives you immediate visibility into the impact of deploying mobile business solutions on the Windows Mobile platform. Using a company's unique information, such as number of mobile workers or types of applications to be mobilized, and summary data from IDC, the Business Value Calculator allows you to quantify the benefits and the direct and indirect costs of deploying mobile line-of-business applications, including measurable impact on revenue and income, operating expense savings, productivity enhancements, and other strategic business improvements.
So if you are in the early phases of a mobile project this could be quite a helpful online tool.
You can access it from HERE


text:
If you think Miami style is one-size-fits-all, think again. Yes, some of what you know is true: there's plenty of bright color and figure-hugging dresses. But when it comes to beauty, anything goes — as long as it moves from the club to dinner to the beach, that is. Here, nine women with looks we love.
Join The Conversation
Like us on Facebook


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Flushing a toilet. Recorded with an 'audio technica ATR55' using my Camcorder.
recording of peeing (actually a garden hose in a toilet) recorded with a C1000 in to Pro Tools rough but ...
Person cleaning his hands in a bathroom.
Yours truly whistling in an echoey bathroom. Morocco Feb 2006. (The same bathroom as SqueakyDoor.wav)
Mono recording of a shower running in a bathroom. Oktava MC-012 cardioid capsule straight to hardisk.
The sound of a norwegian flushing toilet in a small bathroom captured with a spy-mic. How exotic :)
A rolling and frolicking, fabulous fart recorded with a with a Samson USB microphone.
me farting into the microphone. Please comment
Breaking wind.
Stereo fart recorded with B-1 through minihost and rendered to wav with reverb VST.
yep, more stuff
more farts
Guy making fart noises with his lips. Recorded with SP B-1.
I almost didn't get the recorder on in time before this forceful vapor escaped!
more goodies for you.


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West Lincoln fell behind 4-1 in both of its first two playoff games with its ace pitcher on the mound, but the Rebels found a way to advance each time.
�Tribute to the players,� West Lincoln coach Allan Chapman said. �They didn�t panic, they hung in there and played hard and fought back.�
Those moments provided two of the many memories Chapman took away from this season, which culminates with his selection as the Gazette area coach of the year.
The Gazette player of the year is South Point's Derek Perry.
See the full All-Gazette baseball team here
See a list of final stat leaders here
Chapman first guided the Rebels to the conference championship and then to the state round of eight for the sixth time in school history. West Lincoln finished with a 24-6 record, tying the 2006 team for most wins in school history.
�I felt like the most rewarding thing was seeing how close-knit the guys were and how well they played together,� Chapman said.
Chapman knew entering the season he had a tight group. Five (Brett Huff, Dalton Towery, Cameron High, Chandler Jenkins and Derrick Braun) were playing their third varsity season together, and eight starters in all returned from 2012.
An influx of young talent joining the veterans presented one of Chapman�s biggest challenges as a coach: how to balance playing time for about 12 guys who deserved it.
He made it work as West Lincoln went 12-2 in the Southern Piedmont 1A/2A Conference to win its second league title in three years. The Rebels went on to reach the state quarterfinals for the first time since 2009. West Lincoln also advanced that deep in 2000, 2002, 2006 and 2007.
Chapman, now with 18 seasons as West Lincoln�s head coach under his belt, improved his career record to 263-208-1.
You may contact Phillip Gardner at 704-869-1843 or twitter.com/gazettephil.


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Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.
INTRODUCTION — Functional gallbladder disorder is defined as biliary pain resulting from a primary gallbladder motility disturbance in the absence of gallstones, sludge, microlithiasis, or microcrystal disease. The diagnosis is considered in patients with typical biliary-type pain who have had other causes for the pain excluded. The prevalence of functional gallbladder disorder among patients with biliary-type pain and a normal transabdominal gallbladder ultrasound is up to 8 percent in men and 21 percent in women [1-3].
In the past, functional gallbladder disorder has been referred to by various names, including gallbladder dyskinesia, gallbladder spasm, acalculous biliary disease, chronic acalculous cholecystitis, chronic acalculous gallbladder dysfunction, and cystic duct syndrome.
This topic will review the clinical manifestations, diagnosis, and treatment of patients with suspected functional gallbladder disorder. The approach to patients with other causes of biliary-type pain, including gallstones or suspected sphincter of Oddi dysfunction, is discussed separately. (See "Approach to the patient with incidental gallstones" and "Uncomplicated gallstone disease in adults" and "Clinical manifestations and diagnosis of sphincter of Oddi dysfunction" and "Treatment of sphincter of Oddi dysfunction".)
PATHOGENESIS — The etiology of functional gallbladder disorder is unclear, but it is generally regarded as a motility disorder of the gallbladder. It may result from an initial metabolic disorder (ie, bile supersaturated with cholesterol) or a primary motility disorder in the absence, at least initially, of any abnormalities of bile composition [4,5]. It has been noted that patients with functional gallbladder disorder may have abnormal gastric emptying and colonic transit, suggesting a possible generalized gastrointestinal motility disorder [6]. The hypothesis that functional gallbladder disorder is related to abnormal gallbladder motility is the basis for measuring the gallbladder ejection fraction as part of the evaluation. (See 'CCK-stimulated cholescintigraphy' below.)
CLINICAL MANIFESTATIONS — Patients with functional gallbladder disorder present with biliary-type pain, also known as biliary colic. Their liver and pancreas blood tests are normal, no gallstones or gallbladder sludge are seen on imaging, and upper endoscopic examinations are normal. (See 'Exclude gallstones' below.)
Biliary-type pain — Biliary-type pain is typically caused by cholelithiasis, sludge, microlithiasis, or microcrystal disease, but it can also be a manifestation of functional gallbladder disorder, sphincter of Oddi dysfunction, or common bile duct stones. Despite the name, biliary colic is usually constant and not colicky. The classic description is of an intense discomfort located in the right upper quadrant or epigastrium that may radiate to the back (particularly the right shoulder blade). The pain is often associated with diaphoresis, nausea, and vomiting. The pain plateaus in less than an hour, ranging from moderate to excruciating in severity. Once it has plateaued, the pain typically lasts at least 30 minutes and then slowly subsides over several hours, with the entire attack usually lasting less than six hours. (See "Uncomplicated gallstone disease in adults", section on 'Biliary colic'.)
While biliary-type pain often develops one to two hours after ingestion of a fatty meal, an association with meals is not universal, and in a significant proportion of patients the pain is nocturnal, with a peak occurrence around midnight [7,8].
In most cases, the pain has a characteristic pattern and timing for an individual patient. While the pain is recurrent, it occurs at variable intervals (not daily). After an attack, the physical examination is usually normal, with the possible exception of residual upper abdominal tenderness. While nonspecific dyspeptic symptoms, such as indigestion, abdominal bloating, and belching, may coexist in patients with biliary colic, they are not usually relieved by cholecystectomy. As a result, these symptoms are thought to be due to causes other than a gallbladder disorder [9].
Laboratory, imaging, and endoscopic studies — Patients with functional gallbladder disorder have normal blood tests, including aminotransferases, bilirubin, alkaline phosphatase/gamma-glutamyl transpeptidase, amylase, and lipase [10]. In addition, abdominal imaging is normal, with no evidence of gallstones, gallbladder sludge, or cholesterol polyps. Finally, patients have normal upper endoscopic examinations.
DIAGNOSIS — Functional gallbladder disorder is a diagnosis of exclusion in a patient with typical biliary-type pain. The first step in the evaluation of such patients is to exclude other causes for the patient's pain. If no other causes are identified, patients should undergo cholecystokinin (CCK)-stimulated cholescintigraphy to confirm the diagnosis. CCK-stimulated cholescintigraphy allows for calculation of the gallbladder ejection fraction (GBEF), which is low in patients with functional gallbladder disorder (<40 percent) and helps predict which patients are likely to respond to cholecystectomy. (See 'CCK-stimulated cholescintigraphy' below and 'Patient selection for cholecystectomy' below.)
However, while the GBEF is a component of consensus guidelines for diagnosing functional gallbladder disorder, many of the studies supporting the use of the GBEF for diagnosis are of poor methodologic quality and are not conclusive. Therefore, it is imperative that patients have a careful history obtained and that functional gallbladder disorder only be considered if typical biliary-type pain is present. The presence of typical biliary-type pain is the best predictor of a response to cholecystectomy in patients with a low GBEF [11]. In addition, some patients with normal gallbladder emptying and biliary-type pain also benefit from surgery. (See 'Patient selection for cholecystectomy' below.)
Clinical criteria — Consensus guidelines (the Rome IV criteria) have been developed to help diagnose functional gallbladder disorder [4]. Patients who fulfill these criteria should undergo an evaluation for functional gallbladder disorder, whereas patients who do not fulfill all of the criteria should be evaluated for alternative causes of their abdominal pain. (See "Evaluation of the adult with abdominal pain".)
Rome IV criteria for functional gallbladder disorder require:
●Biliary pain
●Absence of gallstones or other structural pathology
In addition, the criteria that are supportive of functional gallbladder disorder, but are not required, include:
●Low ejection fraction on scintigraphy
●Normal liver enzymes, conjugated bilirubin, and amylase/lipase
To fulfill the Rome IV criteria for biliary-type pain, patients need to have pain that:
●Is located in the epigastrium and/or right upper quadrant
●Occurs at variable intervals (not daily)
●Lasts at least 30 minutes
●Builds up to a steady level
●Is severe enough to interrupt daily activities or lead to an emergency department visit
●Is not significantly (<20 percent) relieved by bowel movements, postural changes, or acid suppression
Criteria that are supportive of biliary pain, but are not required, include: (a) pain that is associated with nausea and vomiting, (b) pain that radiates to the back and/or right subscapular region, and (c) pain that awakens the patient from sleep in the middle of the night.
The Rome IV criteria help clinicians identify patients with typical biliary-type pain. We strongly believe that taking a careful history with a detailed description of the painful attacks is essential to identify patients with typical biliary attacks and that patients only be considered for further testing with CCK-stimulated cholescintigraphy if they have typical biliary-type pain and other possible causes of the pain have been excluded.
Exclude other diagnoses — In patients with biliary-type pain, the evaluation begins with basic laboratory tests and a transabdominal ultrasound looking for gallstones or gallbladder sludge. If the transabdominal ultrasound is negative, it should be followed by EUS and bile microscopy to exclude small stones and microcrystal disease. If the evaluation for stones and microcrystal disease is negative, evaluation for other disorders in the differential diagnosis of biliary-type pain, including acid-peptic disease, ischemic heart disease, and functional gallbladder disorder should be pursued.
Laboratory tests — Blood tests should be obtained to look for evidence of liver disease, biliary obstruction, and pancreatitis. These tests include serum alanine aminotransferase, aspartate aminotransferase, bilirubin, alkaline phosphatase/gamma-glutamyl transpeptidase, amylase, and lipase. (See "Approach to the patient with abnormal liver biochemical and function tests" and "Clinical manifestations and diagnosis of acute pancreatitis", section on 'Pancreatic enzymes and products'.)
Exclude gallstones — Typically, a transabdominal ultrasound is the first imaging test obtained in patients with biliary-type pain [4,12]. Transabdominal ultrasound is noninvasive and does not expose patients to ionizing radiation. Patients should fast for eight hours prior to the ultrasound to allow for distension of the gallbladder, which permits better visualization of gallstones and sludge.
Sludge is an ultrasound diagnosis of echogenic layering in the gallbladder that does not cast an acoustic shadow (image 1). Biliary sludge is composed of cholesterol microcrystals embedded in a mucous gel and pigment [13]. Patients may also have a finding of "gravel" on ultrasound. Gravel is made up of small stones that may be beyond the resolution of ultrasound but that cast an acoustic shadow. The presence of sludge or gravel is as significant as the finding of stones in a patient with biliary type pain and is a clear indication for cholecystectomy in these patients. The same can be said about cholesterol polyps as these can detach and obstruct the cystic duct and the common bile duct, leading to biliary pain, cholecystitis, or pancreatitis. (See "Uncomplicated gallstone disease in adults", section on 'Characteristics of stones on ultrasound' and "Gallbladder polyps and cholesterolosis".)
If the initial transabdominal ultrasound is negative in a patient with typical biliary-type pain, a repeat examination should be obtained, with special attention being paid to commonly overlooked areas (eg, Hartmann's pouch or Phrygian cap, if present). If the repeat transabdominal ultrasound is still negative, additional testing may include an endoscopic ultrasound (EUS) to detect small stones that are beyond the resolution of transabdominal ultrasound. If EUS is negative, bile microscopy is performed to look for microlithiasis or microcrystal disease. We consider microlithiasis to be a synonym for microcrystal disease that can be diagnosed only with bile microscopy, although some authors refer to microlithiasis as small stones less than 3 mm in diameter that can be diagnosed with endoscopic ultrasound.
A detailed approach to the diagnosis of gallstones is presented elsewhere. (See "Uncomplicated gallstone disease in adults", section on 'Diagnosis'.)
Exclude other disorders — Patients with a negative evaluation for gallstones or sludge should be evaluated for other disorders in the differential diagnosis of biliary-type pain. This typically includes an evaluation for acid-peptic disease, consideration of functional dyspepsia, and evaluating for ischemic heart disease when indicated.
Additional testing for disorders such as sphincter of Oddi dysfunction or chronic pancreatitis will depend upon the patient's history, symptoms, laboratory test findings, and imaging test results. Patients with sphincter of Oddi dysfunction often have elevated liver tests and a dilated bile duct. (See "Uncomplicated gallstone disease in adults", section on 'Differential diagnosis' and "Clinical manifestations and diagnosis of sphincter of Oddi dysfunction".)
Ischemic heart disease — Coronary artery disease, particularly inferior wall ischemia, may present as upper abdominal discomfort. Typically, this type of discomfort differs from biliary-type pain in that it is effort induced, radiates to the chest or left shoulder, and has a sudden onset. Clinicians should have a low threshold for initiating a cardiac evaluation, particularly in patients with risk factors for coronary artery disease or with other symptoms suggestive of cardiac disease. (See "Outpatient evaluation of the adult with chest pain".)
Acid-peptic disease — Patients with acid-peptic disease (peptic ulcer disease, gastroesophageal reflux disease) or functional dyspepsia may resemble patients with biliary disease. Patients with acid-peptic disease or functional dyspepsia may report burning pain in the epigastric area (dyspeptic pain) that occurs when fasting, two to four hours after a meal, or at night on an empty stomach.
While dyspeptic pain may resemble biliary-type pain, dyspeptic pain is typically less severe and rarely results in a visit to the emergency room. In addition, dyspeptic pain is usually more prolonged and frequent than biliary-type pain, and often occurs on a daily basis. Unlike biliary-type pain, dyspeptic pain may be relieved by food or antacids. However, while a response to antacids is common in patients with peptic ulcer disease or acid reflux, the response is variable in patients with functional dyspepsia. (See "Approach to the adult with dyspepsia" and 'Functional dyspepsia' below.)
The approach to patients with dyspeptic pain depends upon the patient's age and associated symptoms. A trial of empiric antacid therapy is reasonable for younger patients with typical dyspeptic symptoms since upper endoscopy is generally of low yield in such patients. However, endoscopy is recommended for patients older than 45 years of age, those with "alarm symptoms" such as weight loss or anemia, and those who fail 10 to 14 days of empiric therapy. An upper endoscopy can be done during the same endoscopic session as EUS. (See "Approach to the adult with dyspepsia", section on 'Diagnostic strategies and initial management'.)
Functional dyspepsia — Like functional gallbladder disorder, functional dyspepsia is a diagnosis of exclusion, so prior to making either diagnosis, patients require a thorough evaluation. Once other disorders have been excluded, differentiating patients with functional gallbladder disorder from those with functional dyspepsia depends upon the character of the patient's symptoms. Unlike biliary pain, functional dyspepsia is usually described as a mild pain that is continuous or occurs daily and lasts for more than six hours. Functional dyspepsia is often associated with bloating and immediate worsening with meals. In patients with symptoms suggestive of functional dyspepsia, additional testing for functional gallbladder disorder is not indicated. (See "Approach to the adult with dyspepsia" and 'Exclude gallstones' above.)
If patients have typical biliary-type pain, the disorders are differentiated based upon the results of CCK-stimulated cholescintigraphy, with a low gallbladder ejection fraction (<40 percent) making a diagnosis of functional gallbladder disorder more likely. (See 'CCK-stimulated cholescintigraphy' below and 'Management' below.)
CCK-stimulated cholescintigraphy — CCK-stimulated cholescintigraphy is used to estimate the gallbladder ejection fraction (GBEF). Patients with a GBEF of less than 35 to 40 percent are considered to have abnormal gallbladder motility and are more likely to respond to cholecystectomy [14,15]. CCK-stimulated cholescintigraphy should only be performed in patients with typical biliary symptoms. It should not be ordered for atypical symptoms such as bloating, fullness, or dyspeptic symptoms, as these patients are unlikely to respond to surgery even in the presence of a low GBEF [11]. (See 'Patient selection for cholecystectomy' below.)
Following an overnight fast, 99mTc-diisopropyl-iminodiacetic acid (DISIDA) or 99mTc-hepatic iminodiacetic acid (HIDA) is given as an intravenous bolus. The radiolabeled tracer is excreted in the bile, and if the cystic duct is patent, it will flow into the gallbladder. After 45 to 90 minutes, baseline radioactivity from the region of the gallbladder is measured. When the radioactivity is maximal from the gallbladder and is minimal from the liver, an infusion of CCK is started to stimulate gallbladder contraction, which leads to expulsion of the radiolabeled tracer. CCK-stimulated cholescintigraphy should be performed with a slow infusion of CCK (sincalide 0.02 mcg/kg given over 30 to 60 minutes) [16]. Rapid administration of CCK (over two to three minutes) is associated with cramping, patient discomfort, and highly variable results [14]. Slower infusion rates (over 30 to 60 minutes) lead to less inter- and intra-subject variability and an overall increase in mean gallbladder ejection fraction compared with rapid infusion [17-19]. Variability in CCK administration techniques may account for some of the differences seen in studies examining the ability of the GBEF to predict a response to cholecystectomy. (See 'Patient selection for cholecystectomy' below.)
Following CCK infusion, the radioactivity in the region of the gallbladder is again measured and subtracted from the baseline activity (image 2).
The GBEF is then calculated using the formula:
GBEF = (baseline activity – activity after CCK infusion)/baseline activity
Multiple medications and medical conditions other than functional gallbladder disorder are associated with decreased gallbladder emptying and should be kept in mind when interpreting CCK-stimulated cholescintigraphy results [10,20,21]. False-positive results can be seen with diabetes, celiac disease, obesity, cirrhosis, and several medications, including calcium channel blockers, oral contraceptives/progesterone, histamine-2 receptor antagonists, opiates, benzodiazepines, atropine, octreotide, and theophylline.
A systematic review attempted to evaluate the usefulness of GBEF for determining which patients with suspected functional gallbladder disorder are likely to respond to cholecystectomy (thus making a diagnosis of functional gallbladder disorder more likely). It included 23 studies with 1718 patients with suspected functional gallbladder disorder [22]. Nineteen of the studies concluded that calculation of a GBEF was useful in predicting a response to cholecystectomy in patients with suspected functional gallbladder disorder. However, the authors noted that all of the studies were of poor methodologic quality, which precluded a meta-analysis. All but three of the studies were retrospective case series, only one was randomized, and no study was adequately blinded.
As an example, one study that suggested GBEF is useful for predicting a response to cholecystectomy retrospectively analyzed 345 patients with biliary-type pain [23]; 195 patients had a low GBEF (<35 percent) and 150 had a normal GBEF (≥35 percent). Among those with a low GBEF, 110 of 113 patients (97 percent) treated with surgery had symptom improvement, compared with 13 of 82 (16 percent) who were managed medically for non-gallbladder disease. Conversely, patients with normal GBEFs did well with medical management for non-gallbladder disease, with 130 of 139 patients (94 percent) reporting improvement. Finally, patients with normal GBEFs who were referred for surgery also did well (10 of 11 had symptom improvement), though it is not clear from the study what lead to the patients being referred for surgery. Thus, this study suggests that surgical therapy is appropriate for patients with a low GBEF and that medical therapy is appropriate for those with a normal GBEF. However, the study is limited by the fact that it is retrospective, leading to potential biases regarding which patients were referred for surgery.
DIFFERENTIAL DIAGNOSIS — The primary considerations in the differential diagnosis of functional gallbladder disorder are gallstones and gallbladder sludge, which are more common causes of biliary-type pain. Gallstones and sludge are typically identified on transabdominal ultrasound, though in some cases endoscopic ultrasound or biliary microscopy may be required. Cholesterol polyps are another cause for biliary pain that can be diagnosed with ultrasound. (See 'Exclude gallstones' above and "Gallbladder polyps and cholesterolosis".)
Other considerations in the differential diagnosis include sphincter of Oddi dysfunction and non-biliary causes of abdominal pain, such as functional dyspepsia. (See 'Exclude other disorders' above.)
MANAGEMENT — Cholecystectomy is the treatment for functional gallbladder disorder. Patients are candidates for cholecystectomy if they fulfill the clinical criteria for functional gallbladder disorder, if alternative explanations for their symptoms have been excluded, and if their gallbladder ejection fraction (GBEF) is reduced (<40 percent). Patients who develop pain during cholecystokinin infusion may be particularly likely to respond well to cholecystectomy, though it is important that the cholecystokinin be administered properly, as rapid administration could result in cramping that may be confused with the patient's biliary-type pain. Alternative therapies, such as bile acid composition modifiers, promotility agents, and anti-inflammatory drugs, have not been adequately studied [24]. (See "Laparoscopic cholecystectomy" and "Open cholecystectomy" and 'CCK-stimulated cholescintigraphy' above.)
The benefit of cholecystectomy over nonsurgical management was demonstrated in a meta-analysis that included 10 studies with a total of 615 patients with right upper quadrant pain, no gallstones, and a positive cholecystokinin (CCK)-stimulated hepatic iminodiacetic acid (HIDA) scan. It found that cholecystectomy was more likely than medical therapy to achieve complete symptom relief in patients with a low GBEF (odds ratio 16.3) [25]. However, the included studies had numerous limitations, including lack of blinding, nonrandomized designs, variable lengths of follow-up, non-standardized protocols for determining the GBEF, non-standardized methods of assessing clinical outcomes, and poor follow-up of dropouts.
Patient selection for cholecystectomy — Patients with functional gallbladder disorder are candidates for cholecystectomy if they have typical biliary-type pain and a low GBEF (<40 percent). While studies suggest that such patients are likely to benefit from cholecystectomy, most of the studies showing an association of a low GBEF with improved outcomes are retrospective, and GBEF has not conclusively been proven to be a reliable indicator of clinical outcome. However, while imperfect, it is the most studied predictor of whether a patient will respond to cholecystectomy. (See 'CCK-stimulated cholescintigraphy' above.)
There is uncontrolled observational evidence that the recreation of a patient's typical biliary-type pain during CCK infusion (CCK provocation) may predict a response to cholecystectomy, regardless of GBEF [11,26-28]. In a series of 42 patients undergoing cholecystectomy for biliary-type pain and no gallstones, 17 had a GBEF of <35 percent and 25 had a GBEF of ≥35 percent [27]. All of the patients had recreation of their pain during CCK infusion. Despite the normal GBEF in 25 patients, all 42 patients had symptom resolution following cholecystectomy, and only one patient had recurrent symptoms after a mean follow-up of 19 months.
We do not generally base surgical decisions based upon CCK provocation of abdominal pain because of variability in describing pain and the subjective nature of this test. However, the recreation of typical biliary-type pain during CCK-stimulated cholescintigraphy may be supportive of the diagnosis, and rarely we will refer a patient with CCK-provoked biliary-type pain and a normal GBEF for cholecystectomy, provided treatments for other disorders (eg, acid suppressive therapy) have failed. However, we must stress that many times the infusion of CCK will lead to abdominal cramping, especially in the case of rapid infusion. Cramping due to the CCK infusion must not be confused with recreation of the patient's biliary-type pain.
●Functional gallbladder disorder is a diagnosis that is considered in patients with typical biliary-type pain who do not have gallstones or gallbladder sludge. It is a diagnosis of exclusion, and the symptoms associated with functional gallbladder disorder may also be seen in patients with various disorders, including gallstone disease, peptic ulcer disease, ischemic heart disease, and functional dyspepsia. (See 'Clinical manifestations' above and 'Differential diagnosis' above.)
●To make a diagnosis of functional gallbladder disorder, specific clinical criteria should be met, and other causes for the patient's pain need to be ruled out. Cholecystokinin-stimulated cholescintigraphy is then performed to identify patients who may respond to cholecystectomy. (See 'Diagnosis' above.)
●Our general approach to patients who meet criteria for typical biliary-type pain is as follows (see 'Clinical criteria' above):
•Obtain liver and pancreas blood tests to look for evidence of biliary obstruction or pancreatitis. (See "Choledocholithiasis: Clinical manifestations, diagnosis, and management" and "Clinical manifestations and diagnosis of acute pancreatitis".)
•Exclude gallstones, sludge, cholesterol polyps, and microcrystal disease. (See 'Exclude gallstones' above.)
If the evaluation for these biliary sources of pain is negative, consider other disorders in the differential diagnosis of biliary-type pain. This typically includes evaluating for acid-peptic disease, functional dyspepsia, and ischemic heart disease when indicated. Additional testing for disorders such as sphincter of Oddi dysfunction or chronic pancreatitis will depend upon the patient's history, symptoms, laboratory test findings, and imaging test results. (See 'Exclude other diagnoses' above and "Uncomplicated gallstone disease in adults", section on 'Differential diagnosis'.)
●If other disorders are excluded in a patient with typical biliary-type pain, perform CCK-stimulated cholescintigraphy to calculate the gallbladder ejection fraction. Patients with atypical symptoms such as bloating, fullness, or dyspeptic symptoms, are generally treated for functional dyspepsia and should not undergo CCK-stimulated cholescintigraphy. (See 'CCK-stimulated cholescintigraphy' above and "Functional dyspepsia in adults".)
●If the gallbladder ejection fraction is <40 percent and there are no other conditions associated with reduced gallbladder emptying, the diagnosis of functional gallbladder disorder is possible, and treatment for functional gallbladder disorder is reasonable. The diagnosis can only be confirmed if the patient responds to treatment. (See 'Management' above.)
•We suggest that patients with suspected functional gallbladder disorder following an appropriate evaluation be treated with cholecystectomy rather than medical management (Grade 2B). Patients with atypical symptoms or a normal gallbladder ejection fraction are less likely to respond to treatment and should be reassessed for alternative causes of their symptoms. We will rarely consider cholecystectomy in patients with typical biliary-type pain and a normal gallbladder ejection fraction, provided no other likely diagnoses have been identified, empiric treatments for other disorders (eg, acid suppressive therapy) have failed, and the pain is reproduced with a properly administered CCK infusion. (See 'Patient selection for cholecystectomy' above.)
- Prevalence of gallstone disease in an Italian adult female population. Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Am J Epidemiol 1984; 119:796.
- Barbara L, Sama C, Morselli Labate AM, et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology 1987; 7:913.
- The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Hepatology 1988; 8:904.
- Cotton PB, Elta GH, Carter CR, et al. Rome IV. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016.
- Amaral J, Xiao ZL, Chen Q, et al. Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 2001; 120:506.
- Penning C, Gielkens HA, Delemarre JB, et al. Gall bladder emptying in severe idiopathic constipation. Gut 1999; 45:264.
- LUND J. Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases. Ann Surg 1960; 151:153.
- Rigas B, Torosis J, McDougall CJ, et al. The circadian rhythm of biliary colic. J Clin Gastroenterol 1990; 12:409.
- Kraag N, Thijs C, Knipschild P. Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance. Scand J Gastroenterol 1995; 30:411.
- Hansel SL, DiBaise JK. Functional gallbladder disorder: gallbladder dyskinesia. Gastroenterol Clin North Am 2010; 39:369.
- Carr JA, Walls J, Bryan LJ, Snider DL. The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 2009; 19:222.
- Cooperberg PL, Burhenne HJ. Real-time ultrasonography. Diagnostic technique of choice in calculous gallbladder disease. N Engl J Med 1980; 302:1277.
- Lee SP, Nicholls JF. Nature and composition of biliary sludge. Gastroenterology 1986; 90:677.
- Ziessman HA. Cholecystokinin cholescintigraphy: victim of its own success? J Nucl Med 1999; 40:2038.
- Bingener J, Richards ML, Schwesinger WH, Sirinek KR. Laparoscopic cholecystectomy for biliary dyskinesia: correlation of preoperative cholecystokinin cholescintigraphy results with postoperative outcome. Surg Endosc 2004; 18:802.
- DiBaise JK, Richmond BK, Ziessman HA, et al. Cholecystokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Nucl Med 2012; 37:63.
- Ziessman HA. Functional hepatobiliary disease: chronic acalculous gallbladder and chronic acalculous biliary disease. Semin Nucl Med 2006; 36:119.
- Sarva RP, Shreiner DP, Van Thiel D, Yingvorapant N. Gallbladder function: methods for measuring filling and emptying. J Nucl Med 1985; 26:140.
- Hopman WP, Jansen JB, Rosenbusch G, Lamers CB. Gall bladder contraction induced by cholecystokinin: bolus injection or infusion? Br Med J (Clin Res Ed) 1986; 292:375.
- Vassiliou MC, Laycock WS. Biliary dyskinesia. Surg Clin North Am 2008; 88:1253.
- Francis G, Baillie J. Gallbladder dyskinesia: fact or fiction? Curr Gastroenterol Rep 2011; 13:188.
- DiBaise JK, Oleynikov D. Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systematic review. Am J Gastroenterol 2003; 98:2605.
- Fink-Bennett D, DeRidder P, Kolozsi WZ, et al. Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease. J Nucl Med 1991; 32:1695.
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- Mahid SS, Jafri NS, Brangers BC, et al. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg 2009; 144:180.
- Rastogi A, Slivka A, Moser AJ, Wald A. Controversies concerning pathophysiology and management of acalculous biliary-type abdominal pain. Dig Dis Sci 2005; 50:1391.
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TALLAHASSEE -- Gov. Charlie Crist's push for tougher auto emissions standards hit a speed bump Monday as a legislative committee unanimously found the proposed rule unconstitutional.
The Joint Administrative Procedures Committee voted 5-0 to accept a staff report finding the rule unconstitutional and send the opinion to the committees that would take up the proposal in the session that begins March 3.
While the action does not kill the rule, the bipartisan vote shows the difficulty Crist faces in pushing the standard through the Legislature.
Crist signed an executive order calling for the state to adopt the California rule at a global-warming conference in 2007. Lawmakers say their part of the job is more difficult.
"I think there's a difference between sending a message and then actual application," said Rep. Audrey Gibson, D-Jacksonville.
The vote comes after several members of a key House committee voiced skepticism last month about the threat of man-made global warming, the main reason for the emissions proposal.
The governor's office suggested he was undeterred.
"Governor Crist looks forward to working the Legislature in the upcoming session to ratify this important rule," Press Secretary Sterling Ivey said in an e-mail.
Under federal law, each state must either follow the federal rules on automobile emissions or adopt California's more stringent standards. In its report to the committee, staff found that the rule inappropriately handed over authority to the head of the California Air Resources Board, allowing the board's executive director to change the rules in California and, by extension, in Florida.
"Those decisions are made to be made in the future by an administrator in another state who is not subject to or guided by the laws of Florida," said Suzanne Printy, an attorney for the Joint Administrative Procedures Committee.
Automobile manufacturers cheered the decision, hoping it would end the Florida debate over adopting the standards. Opponents argue that cars made to fit the California standards are more expensive and could add hundreds of dollars to the price for consumers.
Wade Hopping, a lobbyist for the Alliance of Automobile Manufacturers, said the Legislature shouldn't even consider the rule if it violates the state's constitution.
"You ought to finish the job here and put a stake through the heart of this rule," he told the committee before the vote.
But state officials said there is no other option if the state wants to tackle greenhouse gases.
Even if the Legislature approves the rule, it wouldn't go into effect immediately. During the Bush administration, the Environmental Protection Agency rejected California's request for a waiver to implement its rule.
President Barack Obama has directed the agency to take another look at the proposal.
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From the Vans California Fall 2011 Collection we take a closer look at the Era Wingtip CA 'Wool Pack'. Three colorways of the low top sneaker come with mixed leather/wool uppers, featuring the iconic wingtip detail, making them a little more sophisticated. We really like the contrasting light beige/grey wool version.
Check out all three sneakers of the pack after the jump.
Via Freshngood.


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Minoru Kawasaki is one of Japan's more active comedy directors. I know I saw Calamri Wrestler but I honestly don't remember much about it that I liked or disliked. His Executive Koala and The World Sinks Except for Japan have been on my radar. Because Calamari Wrestler had such a lukewarm effect on me I still haven't gotten around to watching them. Reviewing Rug Cop presented me with a further chance to check out the mans' work and lets just start by saying checking out those other Kawasaki endeavors just slid further down my list.
Stone-faced Inspector Hatsuo Genda is introduced in a typical cops 'n' robbers scenario, the hold up. The comic twist is, the bank robber is a ventriloquists dummy and when it comes time to disarm the villainous puppet from the panicked puppeteer, Genda throws off his toupee, Ultraman style, which knocks the dolls head off before zooming back onto his head. He is the Rug Cop.
Most synopsis, and the seeming half baked intent, pass Rug Cop off as a parody of 1970's Japanese cop shows. Hearing that, first thing Western viewers need to do is clear out any vision of period referencing. The setting is modern and the characters all fit into the modern day with no figure-out-of-time jokes like the Brady Bunch or Austin Powers movies utilized. That is the first point that seems like a missed opportunity for comedy. Yes, older tv had some, by today standards, silly premises, but, unless there was some subtle point I was missing, other than its stable of silly-talent detectives and simple cop show scripting Rug Cop's gags never directly looked back on that past era.
Genda is assigned to a new, small precinct and he quickly finds it is populated with fellow oddball souls with strange crime stopping traits and self-explanatory monikers, Shorty, Big Dick, Fatty, Mr. Handsome, Old Man, and The Boss. They are quickly thrown into a case involving terrorists and a case of stolen uranium. The terrorists demand a ransom or they will blow up Tokyo. I could go on but that would be misleading because really the film is about gags and not any tight story thread.
When I think of the comedy that Rug Cop aspires, Naked Gun or Sledge Hammer springs to mind. Those two had a healthy mix of sight, verbal, and referencing gags, sometimes clever but mostly stupid and silly. Rug Cop is without exception, stupid and obvious. From what I've seen of Japanese comedic tastes, they apparently think that sort of thing is funny, that the more obvious the joke is, the more simple, or poorly executed, the funnier it is. Unlike the best Mel Brooks numbers, there doesn't even have to be much of a setup or mix, a tiering of jokes, just the one gag, the one bit per scene and apparently the guffaws ensue.
I'll give some examples. One scene has Genda and the precinct assistant driving around, they exit the car and Genda's toupee turns into an afro because the humidity makes his hair frizz out. The gag being he now has a silly afro wig. And that's basically it. A man in a dime store wig. See, that's funny... because .... uhhh... it's a big wig... and you can tell it's a... uhhh... really big wig. Or, how about this one? Detective Fatty's power is that he sweats a lot, and in the big finale- no doubt you the viewer have been waiting on the edge of your seat for it!- he sweats all over the bad guys. Har-dee-har-har.
The DVD: Synapse
Picture: The film is presented Anamorphic Widescreen. Well, it is obviously pretty low budget and embraces this fact with simple set-ups, basic, muted photography, and purposefully cheap scenery and props, so one shouldn't expect a lot of visual pop. Otherwise acceptable, the transfer exhibits a tad too much noise and grain.
Sound: The disc features a sole 2.0 Stereo, Japanese language track with optional English subtitles. Again, things are on the simple side and much of it intentionally so. Thankfully the subs offer full onscreen text translation as well as the films theme song.
Extras: A nice round of extras include the usual lip-service, "Oh my didn't we all have fun?" round of featurettes- Making Of (30:40), Press Conference (8:30), and Intro by the Cast&Director (14:35). Finally, there is also a Trailer.
Conclusion: If you think a tongue-flicking, face-twitching, nerdy guy (stereotypically dumpy body, glasses, bowl haircut) named Detective Big Dick who gets a glowing, Spaceballs ripped off, lightsaber boner is high comedy, then by all means Rug Cop is the flick for you. Rug Cop's goofs don't get more elaborate than that and its safe to say your brain wont struggle to penetrate any great comedic depths. DVD is pretty good, decent image, a nice round of extras, but I gotta' go with a rental because I just didn't find it very gut-busting.


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When we opened our copy of Good, a sweet new publication based here in LA, it was the masthead that first caught our eye: alongside James Surowiecki, Neal Pollack and Joel Stein, we found Tamara Shopsin, Peter Arkle, and six drop-dead gorgeous graphic explorations by 2×4 (those you gotta see in print).
But what struck us most was this, a graphic statement which will be crafted by a designer or artist for each issue. This time it was WK 12, and Jimm Lasser explains exactly how one does go about creating a graphic statement:
GOOD asked us to create the first two spreads of their first issue around the theme of "I Heart America." We were free to do whatever we wanted, which made the job creatively even more difficult. Not only was the subject matter broad and divisive, but execution was as well.
All of us dug in for weeks. We went through hundreds of ideas, thoughts and sketches. In the end we actually presented about 20 ideas. They narrowed it to 2 spreads for the issue.
We are still hoping to find a place for the other stuff that did not make the first issue, but we were happy to make their decision so difficult.
Personally, this was the most difficult project I have undertaken. It was creative trench warfare. It followed me everywhere. My sleep, the shower, the kitchen, the gym. And I actually do love America, and have enjoyed playing this out with Sharp As Toast. But putting this love into so few words and images was truly a monumental task. And to make things even more "interesting," this was the first project of WK 12–we're also a school–so we were really thrown into the fire early with a very difficult subject matter.
I was really impressed with the body of work we created. It had the most important ingredient when discussing America: a point of view. An important lesson as WK 12 gropes its way to understanding how to effectively communicate ideas.
Much has been said about the philantropic nature of Good's business model. But we're subscribing to support its dedication to design patronage. That's reason enough for you to buy it, too.