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This beautiful, vibrant piece has a ruby red shimmering base with black detail.
The heart is surrounded by Lawrence Baca's signature intricately carved sterling silver and genuine gold and compliments any size baca beads beautifully!
Hook bale
2.5"x 1.5"
About the Artist:
Lawrence Baca is a multi-talented, award-winning jewelry designer, born and raised in Santa Fe, New Mexico. His design inspiration is defined by the strong Hispanic and Native American cultural influences. The common theme in all his work is a combination of Spanish Colonial Ecclesiastical with roots in the earliest phase of Native American old Pawn.
Baca's use of materials ranges from sterling silver to 24 karat gold. He also uses a wide variety of gems and stones to create one of a kind designs. There is no work like Lawrence Baca's – the rugged splendor is pure joy, palpable. You simply feel lighter and happier in its presence. Collectors worldwide return to Santa Fe for his new works and people who see it for the first time are mesmerized by the depths of his heartfelt style.
Handcrafted three strand sterling silver necklace by Lawrence Baca. This three strand includes a 10mm strand, 7mm strand, and 5mm strand About the Artist: Lawrence...View full product details
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Hand carved wood heart with fire red finish and sterling silver enhancer. The enhancer can be open from the back and adjusted to wear on...View full product details
This cross enhancer is sterling silver and hand crafted by Lawrence Baca. The hand done design within the cross creates a beautiful three-dimensional silhouette. The enhancer...View full product details
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This Heart enhancer is sterling silver and hand crafted by Lawrence Baca. The flame design surrounding the heart creates a beautiful three-dimensional silhouette. The enhancer can...View full product details


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Greetings From NoidaTut Team. We would like to inform you that we are here for free technical support. We are a team of educational professionals and students. We assembles the resources or develop it and upload here. We have class notes of several subjects. You can also download lab manuals of various subjects. For example above under class notes section you will find all the clas notes. From final year projects you can download several projects. All you need to register to our team.
Once you login to the team of NoidaTut you can download all the projects free. Currently the membership is free of cost. Being the member of noidatut.com you can download all the projects class notes lab manuals all free of cost. I would also request you to collect your certificate under the certificate section. Noidatut presents completely ready projects with complete documents. You can kindly contact the Mr. Durai Prasanth, e mail Id email@example.com ( +91 88254 79318 or email : firstname.lastname@example.com or email@example.com) for our project details query and let us know what type of projects you are looking for. We have already build more than hundreds of projects.Projects like profile management system, online examination system and University management system installed on the web.Many more will be installed soon.
Please go through Online Voting system which is built in PHP MySql Ajax Java Script . Complete details of the projects are below. Please get back to us if you face any problem. You will need to register and login. Once you register you will you will be able to download the project.
Download certificate in pdf , simplest way with full source code
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Noidatut is an E Learning Platform for students to get CLASS NOTES AND LAB MANUALS. This is simple E Learning Platform where we aim to have the largest collection of E - Books and other study resources. We have the notes for different curces starting from Engineering to Diploma.
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Bottelsen Hammer Head Steel Tip Darts - Coarse Grip 22gm
Sku: 00-22hh1-22
Suggested Retail
$38.00 Our Price
$30.40 You Save
$7.60 - 20%
$38.00 Our Price
$30.40 You Save
$7.60 - 20%
Related Products
- Product Details
Hammer Head moveable Super Alloy Darts with the No Bounce Hammer Head moveable points
2ba Shafts
Standard Flights
Case (May Vary according to stock)
Barrel length - 57.15mm
Barrel diameter - 9.13mm
All darts sold in a set of 3
- Specifications
Balance Point: Center Balanced
Barrel Shape: Straight,Scalloped
Barrel Weight: 22gm
Brand: Bottelsen
Category: Darts
Color: Silver
Full Weight: 24gm
Grip Intensity: 2
LG_All Steel Dart Disclaimers: 1
Length: 57.15mm
Material: Super Alloy
Model: Super Alloy Coarse Grip
Point Type / Thread Size: Steel Moveable
Quantity: 3
Series: Hammer Head
Shaft Type / Thread Size: 2ba (Most Common)
Thread Type: 2ba
Type: Steel Tip Darts
Width: 9.13mm
- Disclaimers
- The dart you order should match with the barrel pictured. All other components of the dart (flights, shafts and tips) may vary in color, length and material upon receipt.
- The diameter measurement is the fattest part of the barrel. The length measurement is the barrel only and is rounded to the nearest 100th of a millimeter.
- The barrel length and diameter are subject to change by the manufacturer without notice.
- Darts with any type of coating are not guaranteed due to wear and tear. Some manufactures do warranty their darts against fractures and breakage. However, coatings are NOT guaranteed (this includes titanium, graphics or any type of paint on the barrel).
- The use of grip assist points (grooved, etched or knurled) on steel tip dartboards may pull the fibers out. This may limit the life of your steel tip dartboard and void any manufacturer's warranty.
- Please call with any questions if you are concerned about the components of your dart.
- Reviews


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Newborn Digital Backdrop - Autumn Harvest
$14.00 $10.50 (VAT included).
Instant Digital Download
Newborn Digital Backdrop - Rustic basket surrounded by mini pumpkins and grass with a fluffy white insert, shot on a wood effect floor. Perfect for autumn/fall! Baby not included!
Please remember - this is NOT a physical item, nothing will be shipped, it is a digital download.
Digital Backdrops are the ideal way to add some vibrance, colour and flair to your newborn galleries.
No need to spend time during a session creating elaborate set ups; with these backdrop collections you just use them with your existing images during your regular post processing.
The download is a high resolution jpg so will work with most image editing software, but please note that you will need the ability to work with layers and layer masks.
Contents of Download:
- High Resolution jpg 24 x17 (20.76mb)
Please note that due to the nature of digital downloads, no refunds/exchanges will be offered.
This item is for personal and professional use. The buyer can only use the digital files to resell to private photography customers of their own. The buyer MUST NOT resell, share or transfer the digital files in any matter.
The file cannot be used to make and sell printed photography backdrops for commercial purposes. The buyer is NOT permitted to use the digital files in any photography award submissions and/or competitions.
This backdrop is Copyright Aurora Ricart Photography and can NOT be resold or gifted.
By downloading the files you agree to the terms outlined below.
Copyright belongs Sweet Bambini Design. All Rights Reserved.
The digital templates you download are for personal and/or professional use with clients ONLY.
- You may NOT resell, gift, distribute, share or loan these images in any form to anyone including but not limited to other photographers, family or friends.
- You may not modify the files you have purchased or use any elements of those images to be incorporated to into your own templates that you intend to sell or share.
- All images are Copyright protected and Copyright belongs to Maria Murray at Sweet Bambini Design.
- All sales are final. Due to the digital nature of the products there are no exchanges, refunds or returns.


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New York City!
Greetings and bon jour from Montreal!
Before I go any further I have to plug two events I'm doing in New York next week. The first is a book signing at 7 pm on October 15th at the Iinterdependence Project in the East Village. Swing by, get a book, get it signed, have a grand old time.
The other is a bigger event. The following two days, October 16th and 17th, we're having a two-day non-residential retreat at the Interdependence Project in the East Village. This is a terrific opportunity for anyone who wants to get a real taste of what zazen is all about. The retreat is open to beginners, no experience necessary. It will be focused on shikantaza style zazen as taught by Dogen Zenji. It's non-residential, which means you get to go out and have a night on the town in Manhattan afterward instead of being cooped up with a bunch of Zen nerds all night.
I get sick of people who hype these kinds of things as big enlightenment orgies, so I tend to downplay them and say it's boring. But, honestly, I wouldn't run so many multi-day Zen retreats unless I thought they were truly worthwhile.
You might imagine that sitting on your own at home and staring at a wall is the same thing as joining a group of people to do it. But it's really not at all. There's a power to the practice when it's done with a group that you can't find any other way. And long sittings are a way to dive deeper into the practice. It's almost impossible to find the self-discipline to do a long-form sitting alone. When you're with a group you draw upon the shared commitment of others and what was impossible becomes easy.
I really urge anyone within the area who is on the fence about this whole zen deal to come try it out for yourself in this relatively painless way. In some strange way these sittings are actually fun. You learn a lot about yourself that you never knew. I do every single time and I've been sitting gosh knows how many per year for more than half my life. DO IT!
I'll also make myself available for private talks during the weekend.
OK. So I've been doing tons of press for my new book Sex, Sin and Zen, and each time I do an interview or a talk I learn more about the book.
The reviews have been very interesting because this time even the bad reviews are exactly the kind of thing I had hoped the book would stimulate. When I first encountered the third precept, the whole "do not misuse sexuality" thing, I was confused. I'd heard right-wing Christian nut-cases talk about what they viewed as the misuses of sexuality and assumed that Buddhists must be talking about the same thing. In spite of my first teacher's attempts to make me see things differently it wasn't until I went and lived in Japan that I found out it's not the same thing at all.
The guy who interviewed me today wanted to talk some about my "voice" in my writings. He wanted to know if I deliberately stir up trouble or if that's just how I naturally am. He talked about my radical views on sexuality and whether I was airing those just to get a rise out of people.
And I thought about how I live in this kind of funny dual world. To a lot of the people I know from Suicide Girls, the punk scene, and just life in general, my views on sexuality seem positively prehistoric. They're not radical at all. I seem like a bit of a fuddy-duddy. Then I step into Buddha Nerd Land and I seem like a foul mouthed pussy-crazed heathen waving his dick around at everybody. So I figure what's really going on is that I'm treading the middle ground.
A lot of people seem fascinated by what they see as the dichotomy between how I am when I write and how I am when I speak in public or when I speak to them in person. But I don't see it that way at all. They accuse me of inventing some kind of fake hipster persona that is not the real me. I don't think I do anything of the sort.
But all of this is really terrific because what I wanted most from the book is to get people talking about stuff they haven't really been talking about. Because this stuff needs to be aired in public. There are too many wrong assumptions going on, like my assumptions about the third Buddhist precept being a call to be just like the kids at Rex Humbard Evangelical College for the Chaste and Pure.
See you in New York City!


text:
Story highlights
- The Berenstain Bears often had the answers to children's questions
- Many moms and dads turn to classic books for assistance in parenting
- Children's books now include a diversity of families as a reflection of our world
The sale of the old house, the purchase of the new house, the packing, the good-bye parties. It was all so overwhelming for me. I can't imagine what it was like for my toddler, leaving the only home, neighborhood and sitter she had ever known in the city where she was born. Fortunately, I got a little bit of help from the Berenstain Bears to give my daughter some answers.
In that classic tale "Berenstain Bears Moving Day," Brother Bear asked the questions about moving that my daughter asked: "What about my toys?" "And what about my friends?" She'd carry that book around like a teddy bear. The answer for the toys was easy: "We'll take them along, of course." Harder to hear: "You'll be leaving your friends behind."
"But you can keep in touch with them. You can write, even visit perhaps. And besides, you can make lots of new friends."
It's no wonder that I could find a Berenstain book for almost any new or difficult situation. When co-author Jan Berenstain died last month, she had written more than 330 "Berenstain Bears" books, first with her husband, Stan (who died in 2005), and later with her son, Mike. More than 260 million copies have been sold over the past 50 years, making it one of the best-selling children's book series in history, Harper Collins said.
Mirroring all types of families
Growing up in a house filled with books, I turned to children's literature to explore and learn about worlds beyond my experience. Now, I turn to the classics of children's literature for assistance in parenting my way through the basic struggles in our lives, such as feelings, friendships, sharing, courtesy, differences and loss, among others. If the Berenstain Bears didn't have the answers, maybe Dr. Seuss, "Goodnight Moon," "Ferdinand the Bull" or "The Hungry Caterpillar" could do the trick. The classics explained essential subjects to a young mind better than I ever could, and they reassured me, too.
Still, some of the classics didn't represent our experience or the lives of many of the families we know and love. My child has two moms. Her neighborhood friend has one mom who adopted her. Her friend across the street has a mom and dad.
"As families have changed over the past decades, that means that there's opportunity for books to serve families who may not be made up of Papa, Mama, Brother and Sister Bears," said John Sellers, children's reviews editor for Publishers Weekly. "There's certainly a need for books that portray, mirror and show the value in all kinds of families: same-sex families, mixed-race families, stepfamilies, families with grandparents as guardians."
Just as interesting are the children's books that include a diversity of families not as the point of the story but as a reflection of the reality of our world.
"That sort of subtle, offhand inclusion and portrayal of a diversity of families in picture books -- as well as books for older readers -- is, in my view, as valuable, if not more so, as having an increased number of message-focused books out there on those topics, though there will always be a place and a need for those, too," says Sellers.
Here are some of my family's modern favorites.
It's OK to be different
The bright visuals of writer and illustrator Todd Parr's books jumped out at my daughter before we ever guessed the subject matter. In Parr's world, there are different types of mommies, families and feelings -- all of them valuable and filled with love -- without getting hit over the head by the message.
"The Family Book" shows all the families on my block and beyond, and portrays them as different in appearance but equal and loving and kind. "The Mommy Book" teaches my kid that mommies come in all shapes and sizes; some work outside the home, and some work inside the home; some cook, and others order pizza; and some camp, and some shop.
A visual learner and slow reader, Parr remembers having trouble learning when schools didn't know how to help him.
"When I started writing books, I based them on my own struggles as a kid and feeling like an outsider," said Parr, whose favorite books as child included classics such as P.D. Eastman's "Go Dog Go," Dr. Seuss's "Green Eggs and Ham" and "The Monster at the End of this Book" from Sesame Street. "I wanted them to be silly and fun and simple but yet be something strong that could help kids feel good about themselves. I wanted it to be matter of fact that everyone is important and special and different."
Why not let your child drive the bus?
After I became a parent in Brooklyn, my daughter and I loved that we could identify the locations that Mo Willems featured in "Knuffle Bunny: A Cautionary Tale." Yes, we lived across the street from the actual Laundromat featured in the book. For a city kid, the idea of sitting on a stoop, Laundromats across the street and parks within walking distance made sense in the whimsical pictures drawn by the former Sesame Street writer.
"Don't Let the Pigeon Drive the Bus" and "Don't Let the Pigeon Stay Up Late" play with the neverending asking that a child does for what she wants, with increasingly sophisticated reasons why we parents should give in. It's daytime in China? Really? But children are not trying to drive us nuts, Willems gently reminds the reader. Adults forget how hard it can be to be a child, where nothing is built to your size and grownups demand that you learn new things every single day. Why not throw a tantrum over not getting to drive a bus or go to bed whenever you want?
"I don't see my books as ends but as beginnings," said Willems, who as a child loved the work of Dutch illustrator Fiep Westendorp and "Sneetches on the Beaches" by Dr. Seuss. "I put as much air in as possible so kids can put in their own ideas. Draw my characters and put as few words and background as possible so kids can create them themselves."
While Willems is grateful that children identify with his work, he says he writes to understand things he doesn't understand, such as friendship, love and jealousy. ("The Duckling Gets a Cookie!?" which comes out in April, turns jealousy on its head.)
"I'll write a book and take it very seriously for a year or two," he said.
In "Goldilocks and the Three Dinosaurs," out this fall, "I find my past self telling my present self how to deal with some present relationships in my life."
You don't have a mommy and a daddy?
"Heather Has Two Mommies" author and poet Lesléa Newman started writing children's books featuring families with two mommies or two daddies after a friend stopped her on the street and demanded that she write books featuring families like hers.
My daughter had never heard a story with two mommies. She grabbed at the picture book "Mommy, Mama and Me," and memorized all the words. (The companion, "Daddy, Papa and Me" works for the two-daddy family.) She gravitated to "Heather has Two Mommies" as she got older.
Although her books have been attacked as political, Newman says she doesn't write with an agenda or mission.
"I write to tell a story," said Newman, who remembers reading Dr. Seuss, Curious George, Babar the elephant and "Caps for Sale" as favorites. "I write to find out what I don't know. If pressed, I'd say my goal would be to produce a children's book that would help any child reading that book to feel good about herself."
We're all connected
A sweet summer day in the life of an interracial family is the setting for Liz Garton Scanlon's picture book "All the World," featuring the art of Marla Frazee (who received a Caldecott Honor for this book). The book is about global connectivity, showing families and partners of all ages and races.
As she started writing for children, Scanlon noticed themes of nature and community emerging in her work.
"I also really think about a child's perspective: How would they envision friendship? What would they notice about places or parties or food or trees?" said Scanlon, whose favorite books growing up were "Blueberries for Sal," "Make Way for Ducklings" and "Where the Wild Things Are." "Kids are relatively disempowered. They're just not the big people in charge. So I really try to think about how children's books can give some of the power back to them, just by granting importance to their perspective."


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Help and information
Our official documentation explains everything about Ubuntu, with topics for beginners to experts alike.
Ask Ubuntu and Ubuntu Forums are great sources of answers to common questions about installing, troubleshooting and optimizing Ubuntu.
Ubuntu people near you can be a great wealth of help, tips and information. Check out the Ubuntu team portal and contact (or join) a group near you!
Do you want to chat with a person right now? Try logging into our Internet Relay Chat (IRC) system where Ubuntu community participants around the world help others find their way through the vastness of Ubuntu. They can help you find what you are looking for:
Some useful channels:
- #ubuntu
- Find Ubuntu channels in your own language on the LoCo Team Portal
- Find more specific IRC channels in our list.
Community blogs
Planet Ubuntu is your window into the world, work and lives of Ubuntu developers and contributors. Not everyone here writes about Ubuntu all the time, but it's a good source of "who's who" information about Ubuntu contributors.
Keep up-to-date with the official Ubuntu news at The Fridge or read Ubuntu Weekly News – the community-created newsletter.


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Developed by Robert A. Cooke, Ph.D by special request of the American Management Association (AMA).
Based on William Marston's DISC framework, The AMA DISC Survey™ measures the four basic styles of behaviour: Directing, Influencing, Supportive, and Contemplative.
Marston's model has been used for more than 40 years as a feedback process for individuals to understand their personal styles and the strengths and weaknesses within each. In this case, no style is inherently better or worse than the others and all styles can contribute to (and potentially detract from) individual and group effectiveness.
The AMA DISC Survey™ is unique in that it not only measures the strength of each style, but also separates out the productive and counterproductive aspects of each style. This allows for considerably more analysis, particularly in terms of development planning.
The personal styles are relevant to programmes focusing on:
The AMA DISC Survey requires accreditation before materials can be purchased. Contact us for information on product pricing and/or consulting and coaching services. (Online ordering is not available.)
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Human Synergistics Accredited Practitioners can access premium content by logging in below.
Human Synergistics reserves the right to request some processing charges for access to interactive and/or Circumplex-based resources. All material is subject to copyright.
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All rights reserved.


text:
14 July, 2010
ZOO TV Wembley 21-08-93It poured with rain, I was wearing glasses and was hardly able to see a thing all show. Despite this, U2's fourth and final ZOO TV show at Wembley still has a place in my top three gigs ever. I still remember being left endlessly on hold whilst I desperately tried to secure tickets; working my way to the front of the B-stage crowd during an enthusiastic Stereo MCs support set; the mesmerising visual build-up to Zoo Station then my first 80,000-person singalong; Bono jumping on the girl in front of me during Until The End Of The World; a snippet of Singin' In The Rain; being inwardly sure that Streets was on its way during the long segue after Running to Stand Still (despite not being able to follow setlists in those pre-Internet days); singing along with MacPhisto to the England manager after another football failure (nothing ever changes there); never wanting the concert to end during Love is Blindness. And, as usual, missing the last train back home due to the late finish.
29 September, 2009
Zoo TV Wembley 210893My 2nd concert,1st was at same place in87 on JT tour,blinding.Lasting memory was everything,the stage set up was just jaw dropping.I was right up the front and when it kicked off it REALLY kicked off,bombarded with images combined with fantastic and ear splitting sound.When Bullet opened,with the fiery crosses you could hear the whole 80,000 peoples jaws hit the deck,never seen anything like it ,Edges playing and solo during the song was perfection and one of the highlights as well as Bad and really every song.Ending with Love Is Bindness/Cant Help falling in Love... was a master stroke, it just oozed emotion and closness to the band and was a great gentle landing from a seminal concert. Have seen many great bands since but everytime A U2 concert comes along thry just blow the competition away.Just got tickets for Helsinki 2010,my 6th concert,i say to anyone ,if you want to see the greatest live band ever see U2.One last thing the support acts were superb,Bjork and StereoMCs, U2 letting them use their sound system and not turning it down like some bands do.


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W Lip
W lip (helical wound spring / scraper lip) has a high load helical wound spring that improves sealability. Preferred lip design for dynamic sealing of abrasive media. Reduces probability of seal lip hydroplaning. Requires good lead-in chamfer if hardware is installed lip first. Lip design must be used in combination with radius lip style.


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The best Bosman free transfers of 2014: The men your club should sign
Everybody loves a bargain, so Pete Sharland has scoured Europe to find the best players out of contract in the summer. Which will represent the best Bosman transfer of 2014...?
There can surely be few greater feelings for a top-level football club than picking up a high quality player for nothing. In an age where transfer fees have become outrageously inflated, making a big signing without spending a penny (on transfer fees, at least) must leave club chairmen and accountants purring.
The big one this summer will be Robert Lewandowksi's transfer from Dortmund to Bayern Munich, with the Polish striker following in the footsteps of the likes of Sol Campbell, Michael Ballack, Henrik Larsson, Andrea Pirlo and Fernando Llorente in having allowed his contract to run down before moving on to pastures new.
Here are ten more players who could join the Bosman Club in the coming months…
Bacary Sagna (Arsenal)
Linked with: Manchester City, Inter
Once again, Arsenal appear to have got it wrong as far as contract lengths are concerned. In 2012 they were forced to sell Robin van Persie on the cheap, relatively speaking, and now it seems Bacary Sagna is set to walk away from the Emirates for nothing. The Frenchman has stated that he would be willing to a sign a new deal but feels the terms offered by Arsenal are not reasonable. Premier League rivals Manchester City are said to have offered a deal with vastly improved terms - surely Arsenal can't afford to let another star move to the Etihad?
Patrice Evra (Manchester United)
Linked with: Monaco, Inter, Roma
One thing David Moyes has tried to do in his first season as Manchester United manager is ease out the old guard and try and build a younger core. To that end, Nemanja Vidic is being allowed to leave for Inter, with defensive partner Rio Ferdinand also likely to be moved on. Evra's attacking instincts have never deserted him, and he is arguably more of a threat going forward than ever (see his recent Champions League goal at Munich), but his legs aren't coping quite so well when it comes to going the other way, and he is regularly exposed defensively. He has become a liability for a team like United but could easily slot in at Monaco or Inter Milan, two clubs he's been heavily linked with.


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How to playUse the roadmap in the top right corner of the screen to pick a place to go to with your taxi. At each location there are three animals who want to travel by taxi to another place.
Click the animal you want to drive to its desired location. Watch out for the potholes in the road: hitting them with the taxi will cost you money for repairs.
When you've traveled to the desired location, please give the passenger the required change.
Travel to the beach, the circus, the orchard, the policestation or the house
Ready for classrooms with a SMARTboard or Interactive Whiteboard
Educational maths lessons for elementary / primary school online homeschool curriculum


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It is a new pipe line created by Silvana Ascorti, wife of the famous Italian pipe maker Roberto Ascorti. This exclusive line is available to American smokers exclusively through Tinder Box. This is a classic line of pipes that exalts the Italian design in a Smooth and Rustica Series brought to you by a family of renowned pipe makers. The most distinct feature of this pipe line are the mouthpieces that have an elegant color with a new fashioned logo.
Silvana met Roberto in 1976 and has been learning the secrets of hand crafting exquisite pipes from a line of exceptional pipe makers including Pireangelo, Peppino and Roberto. Today after 32 years of experience Silvana has created her own line with Roberto's assistance titled "La Silvana".
We feel they are probably the second best pipe in our stores, with the best being, you guessed it...Ascorti.Pipe Brand: Tinder BoxPipe Shape: DublinPipe Finish: SmoothStatus: In Stock


text:
Last Thursday, the American College of Obstetricians & Gynecologists Task Force on Hypertension in Pregnancy released the electronic version of its Executive Summary of evidence-based recommendations for treatment of women with hypertensive disorders in pregnancy. One recommendation was for healthcare providers to provide clear information to all expectant mothers about the signs and symptoms of preeclampsia and what to do if they occur. In this same month, October 2013, the Journal of Maternal Fetal Neonatal Medicine published the results of the Preeclampsia Foundation's 2008 survey assessing the state of preeclampsia awareness among pregnant women. The survey results are included in the evidence presented by the College's recommendations.
The Journal of Maternal Fetal Neonatal Medicine article is titled "Prenatal education is an opportunity for improved outcomes in hypertensive disorders of pregnancy: results from an Internet-based survey." It was authored by Dr. Anne B. Wallis (Assistant Professor, Department of Epidemiology, University of Iowa), Eleni Z. Tsigas (Executive Director of the Preeclampsia Foundation), Dr. Audrey Saftlas (title?), and Dr. Baha M. Sibai (Visiting Professor, Depart. of Obstetrics, Gynecology & Reproductive Sciences, University of Texas).
Because little was known about how many prenatal care providers discuss preeclampsia with their patients or if women understand what is communicated to them when such discussions occur, the Preeclampsia Foundation conducted an internet-based survey in March and April of 2008 to determine what women learned about preeclampsia in the context of prenatal care during their first pregnancy (2000-2008).
Only 40% of the women indicated that their prenatal care provider "definitely" described preeclampsia; 35% said they were "definitely not" given information about preeclampsia, and the remaining 16% did not remember. Of those who definitely had preeclampsia described to them, slightly more than half said they "fully understood the explanation," 37% "understood most of the explanation," while 15% either "understood some of the explanation," or did not remember. Here is the really interesting bit: a full 75% of women who said they "definitely" received information on the signs and symptoms of preeclampsia and understood "fully" or "most" of the explanation, indicated that because of this information, they took one or more of the following actions:
Survey participants tended to be well educated and middle class, making the importance of what we learned from this online survey clear:
Education about preeclampsia and related hypertensive disorders must continue into the post-partum period so that women can recognize and respond to symptoms even after delivery. Most cases of eclampsia that develop after a woman has been discharged from a health facility are first seen in an emergency department. A woman with legitimate complaints who presents at an emergency department may leave untreated if the staff is all emergency or trauma providers, without Ob/Gyn specialists. Thus, women not only need basic education in preeclampsia, but they require repeated education to ensure they understand the risks and can be empowered with knowledge that will allow them to advocate strongly for their own care.
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August 23, 2019
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Creutzfeldt–Jakob disease
|Creutzfeldt–Jakob disease
Tonsil biopsy in variant CJD. Prion protein immunostaining.
|Classification and external resources
Creutzfeldt–Jakob disease ( )[1] or CJD is a degenerative neurological disease that is incurable and invariably fatal.[2] CJD is at times called a human form of mad cow disease (bovine spongiform encephalopathy or BSE).[3] However, given that BSE is believed to be the cause of variant Creutzfeldt–Jakob (vCJD) disease in humans, the two are often confused.[4]
CJD is caused by an agent called a prion. Prions are misfolded proteins that replicate by converting their properly folded counterparts, in their host, to the same misfolded structure they possess. CJD causes the brain tissue to degenerate rapidly, and as the disease destroys the brain, the brain develops holes and the texture changes to resemble that of a kitchen sponge.
- 1 Classification
- 2 Signs and symptoms
- 3 Cause
- 4 Diagnosis
- 5 Treatment
- 6 Epidemiology
- 7 History
- 8 See also
- 9 References
- 10 External links
Types of CJD include:
- variant (vCJD):[5]
- This is thought to be caused by the consumption of food contaminated with prions, which also cause BSE.
- sporadic (sCJD):[6]
- This accounts for 85% of cases of CJD.[7]
- familial (fCJD):[8]
- This accounts for the majority of the other 15% cases of CJD.[7]
- iatrogenic:
- This form of CJD arises from contamination with tissue from an infected person, usually as the result of a medical procedure. Medical procedures that are associated with the spread of this form of CJD include blood transfusion from the infected person, use of human-derived pituitary growth hormones,[9] gonadotropin hormone therapy,[9] corneal and/or meningeal transplants.[7]
Signs and symptoms
The first symptom of CJD is rapidly progressive dementia, leading to memory loss, personality changes, and hallucinations. Other frequently occurring features include anxiety, depression, paranoia, obsessive-compulsive symptoms, and psychosis.[10] This is accompanied by physical problems such as speech impairment, jerky movements (myoclonus), balance and coordination dysfunction (ataxia), changes in gait, rigid posture, and seizures. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks. In some people, the symptoms can continue for years. In most patients, these symptoms are followed by involuntary movements and the appearance of an atypical diagnostic electroencephalogram tracing. Most victims die six months after initial symptoms appear, often of pneumonia due to impaired coughing reflexes. About 15% of patients survive for two or more years.[11] Some patients have been known to live 4–5 years with mostly psychological symptoms until the disease progresses causing more physical symptoms leading to a diagnosis and inevitable death usually within the first year of diagnosis.
The symptoms of CJD are caused by the progressive death of the brain's nerve cells, which is associated with the build-up of abnormal prion proteins forming amyloids. When brain tissue from a CJD patient is examined under a microscope, many tiny holes can be seen where whole areas of nerve cells have died. The word "spongiform" in "transmissible spongiform encephalopathies" refers to the sponge-like appearance of the brain tissue.
Transmissible spongiform encephalopathy diseases are caused by prions. Prions are proteins that occur normally in neurons of the central nervous system (CNS). As of 2007, these proteins are thought to affect signaling processes, damaging neurons and resulting in degeneration that causes the spongiform appearance in the affected brain.[12]
The CJD prion is dangerous because it promotes refolding of native proteins into the diseased state.[13] The number of misfolded protein molecules will increase exponentially and the process leads to a large quantity of insoluble protein in affected cells. This mass of misfolded proteins disrupts neuronal cell function and causes cell death. Mutations in the gene for the prion protein can cause a misfolding of the dominantly alpha helical regions into beta pleated sheets. This change in conformation disables the ability of the protein to undergo digestion. Once the prion is transmitted, the defective proteins invade the brain and are produced in a self-sustaining feedback loop.
These neurodegenerative diseases are commonly called prion diseases.
People can also acquire CJD genetically through a mutation of the gene that codes for the prion protein (PRNP). This occurs in only 5-10% of all CJD cases. An EU study determined that "87% of cases were sporadic, 8% genetic, and 5% iatrogenic." [14]
The defective protein can be transmitted by contaminated harvested human brain products,[15] corneal grafts (in at least one reported case),[16] dural grafts or electrode implants (acquired or iatrogenic form (iCJD)); it can be familial (fCJD); or it may appear for the first time in the patient (sporadic form: sCJD). In the familial form, a mutation occurs in the gene for PrP, PRNP. Ten to fifteen percent of CJD cases are familial. (CDC)
The disease has also been shown to result from use of human growth hormone obtained from the pituitary glands of persons who died from Creutzfeldt–Jakob Disease,[17] though the known incidence of this cause is (as of April 2004) quite small. The risk of infection via cadaveric HGH in the US ceased when the medication was withdrawn in 1985.
It is thought that humans can contract the disease by consuming material from animals infected with the bovine form of the disease.[18] The only suspected cases to arise thus far have been vCJD with cases in the UK and Canada. But there are also fears—based on animal studies[19]—that consuming beef or beef products containing prion particles can also cause the development of classic CJD. When BSE material infects humans, the resulting disease is known as (new) variant CJD (nvCJD).[20]
Cannibalism has also been implicated as a transmission mechanism for abnormal prions, causing the disease known as kuru, once found primarily among women and children of the Fore people in Papua New Guinea. While the men of the tribe ate the body of the deceased and rarely contracted the disease, the women and children, who ate the less desirable body parts, including the brain, were eight times more likely than men to contract kuru from infected tissue.
Prions, the [25]
Blood donor restrictions
In 2004, a report published in the Lancet medical journal showed that vCJD can be transmitted by blood transfusions.[26] The finding alarmed healthcare officials because a large epidemic of the disease could result in the near-future. A blood test for vCJD infection is possible[27] but is not yet available for screening blood donations. Significant restrictions exist to protect the blood supply. The UK government banned anyone who had received a blood transfusion since January 1980 from donating blood.[28] From 1999 there has been a ban in the UK for using UK blood to manufacture fractional products such as albumin.[29] Whilst these restrictions may go some way to preventing a self-sustaining epidemic of secondary infections the number of infected blood donations is unknown and could be considerable as a study by the Health Protection Agency show around 1 in 2000 people in the UK shows signs of vCJD infection.[30] In June 2013 the government was warned that deaths—then at 176—could rise five-fold through blood transfusions.[31]
On May 28, 2002, the United States Food and Drug Administration instituted a policy that excludes from donation anyone having spent at least six months in certain European countries (or three months in the United Kingdom) from 1980 to 1996. Given the large number of U.S. military personnel and their dependents residing in Europe, it was expected that over 7% of donors would be deferred due to the policy. Later changes to this policy have relaxed the restriction to a cumulative total of five years or more of civilian travel in European countries (six months or more if military). The three-month restriction on travel to the UK, however, has not been changed.[32]
The American Red Cross' policy is as follows: During the period January 1, 1980, to December 31, 1996, spending a total time of three months or more in the Channel Islands, England, the Falkland Islands, the Isle of Man, Gibraltar, Northern Ireland, Scotland, and Wales precludes individuals from donating. Moreover, spending a total time of five years or more after January 1, 1980 (to present), in the above-mentioned countries and/or any country in Europe (except the former USSR), also precludes donation. People with a biologic relative having been diagnosed with CJD or vCJD are unable to donate. Biologic relative in this setting means mother, father, sibling, grandparent, aunt, uncle, or child.
A similar policy applies to potential donors to the Australian Red Cross' Blood Service, precluding people who have spent a cumulative time of six months or more in the United Kingdom between 1980 and 1996.
The Singapore Red Cross precludes potential donors having spent a cumulative time of three months or more in the United Kingdom between 1980 and 1996.
In New Zealand, the New Zealand Blood Service (NZBS) in 2000 introduced measures to preclude permanently donors having resided in the United Kingdom (including the Isle of Man and the Channel Islands) for a total of six months or more between January 1980 and December 1996. The measure resulted in ten percent of New Zealand's active blood donors at the time becoming ineligible to donate blood. In 2003, the NZBS further extended restrictions to preclude permanently donors having had received a blood transfusion in the United Kingdom since January 1980, and in April 2006, restrictions were further extended to include the Republic of Ireland and France.[33]
Similar regulations are in place in Germany, where anyone having spent six months or more living in the UK between January 1980 and December 1996 is permanently banned from donating blood.[34]
In Canada, individuals are not eligible to donate blood or plasma if they have spent a cumulative total of three months in the United Kingdom or France from January 1, 1980, to December 31, 1996. They are also ineligible if they have spent a cumulative total of five years or more in Western Europe outside the U.K. or France since 1980, or if they have had a blood transfusion in the U.K., France or Western Europe since 1980.[35]
The Association of Blood Donors of Denmark precludes potential donors having spent a cumulative time of at least 12 months in the United Kingdom between 1 January 1980 and 31 December 1996.
The Swiss Blutspendedienst SRK precludes potential donors having spent a cumulative time of at least six months in the United Kingdom between 1 January 1980 and 31 December 1996.
In Poland, anyone having spent cumulatively six months or longer between 1 January 1980 and 31 December 1996 in the UK, Ireland, or France is permanently barred from donating.[36]
In the Czech Republic, anyone having spent more than six months in the UK or France between the years 1980 and 1996 or received transfusion in the UK after the year 1980 is not allowed to donate blood.[37]
Sperm donor restrictions
In the U.S., the FDA has banned import of any donor sperm, motivated by a risk of Creutzfeldt–Jakob disease, inhibiting the once popular[38] import of Scandinavian sperm. The risk, however, is not known, since artificial insemination has not been studied as a route of transmission.[39]
The diagnosis of CJD is suspected when there are typical clinical symptoms and signs such as rapidly progressing dementia with startle myoclonus.[40] Further investigation can then be performed to support the diagnosis including
- Electroencephalography— often has characteristic generalized periodic sharp wave pattern (~80% of pts by 6 months)
- Cerebrospinal fluid analysis for 14-3-3 protein
- MRI of the brain—often shows high signal intensity in the caudate nucleus and putamen bilaterally on T2-weighted images.
- Research in 2010 and 2011 identified a possible blood test for CJD. The test attempts to identify the prion responsible for the disease. However, it has not yet been demonstrated if it is able to detect the prions in early stages of the disease.[41]
Diffusion Weighted Imaging (DWI) images are the most sensitive. In about 24% of cases DWI shows only cortical hyperintensity; in 68%, cortical and subcortical abnormalities; and in 5%, only subcortical anomalies.[42] The involvement of the thalamus can be found in sCJD, is even stronger and constant in vCJD.[43]
Clinical testing for CJD has always been an issue. Diagnosis has been based mostly on clinical and physical examination of symptoms. In recent years, studies have shown that the tumour marker Neuron-specific enolase (NSE) is often elevated in CJD cases, however its diagnostic utility is seen primarily when combined with a test for the 14-3-3 protein.[44] As of 2010, screening tests to identify infected asymptomatic individuals, such as blood donors, are not yet available, though methods have been proposed and evaluated.[45]
In 2010, a team from New York described detection of PrPSc even when initially present at only one part in one hundred billion (10−11) in brain tissue. The method combines amplification with a novel technology called surround optical fiber immunoassay (SOFIA) and some specific antibodies against PrPSc. After amplifying and then concentrating any PrPSc, the samples are labelled with a fluorescent dye using an antibody for specificity and then finally loaded into a micro-capillary tube. This tube is placed in a specially constructed apparatus so that it is totally surrounded by optical fibres to capture all light emitted once the dye is excited using a laser. The technique allowed detection of PrPSc after many fewer cycles of conversion than others have achieved, substantially reducing the possibility of artefacts, as well as speeding up the assay. The researchers also tested their method on blood samples from apparently healthy sheep that went on to develop scrapie. The animals' brains were analysed once any symptoms became apparent. The researchers could therefore compare results from brain tissue and blood taken once the animals exhibited symptoms of the diseases, with blood obtained earlier in the animals' lives, and from uninfected animals. The results showed very clearly that PrPSc could be detected in the blood of animals long before the symptoms appeared. After further development and testing, this method could be of great value in surveillance as a blood or urine-based screening test for CJD.[46][47] In 2014 a human study showed a nasal brushing method that can accurately detect PrP in the olfactory epithelial of CJD patients. .[48] This finding creates new opportunities for minimally invasive detection of CJD.
In one-third of patients with sporadic CJD, deposits of "prion protein (scrapie)," PrPSc, can be found in the skeletal muscle and/or the spleen. Diagnosis of vCJD can be supported by biopsy of the tonsils, which harbour significant amounts of PrPSc; however, biopsy of brain tissue is the definitive diagnostic test for all other forms of prion disease. Due to its invasiveness, biopsy will not be done if clinical suspicion is sufficiently high or low. A negative biopsy does not rule out CJD, since it may predominate in a specific part of the brain.[49]
The classic histologic appearance is spongiform change in the gray matter: the presence of many round vacuoles from one to 50 micrometres in the neuropil, in all six cortical layers in the cerebral cortex or with diffuse involvement of the cerebellar molecular layer. These vacuoles appear glassy or eosinophilic and may coalesce. Neuronal loss and gliosis are also seen.[50] Plaques of amyloid-like material can be seen in the neocortex in new-variant CJD.
However, vacuolization can be seen in other disease states. Diffuse cortical vacuolization occurs in Alzheimer's, and superficial cortical vacuolization occurs in ischemia and frontotemporal dementia. These vacuoles appear clear and punched-out. Larger vacuoles encircling neurons, vessels, and glia are a possible processing artifact.[49]
- Clinical and Pathologic Characteristics:[51]
|Classic CJD
|Variant CJD
|Median age at death
|68 years
|28 years
|Median duration of illness
|4–5 months
|13–14 months
|Clinical signs and symptoms
|Dementia; early neurologic signs
Prominent psychiatric/behavioral symptoms; painful dysesthesias;
delayed neurologic signs
|Periodic sharp waves on electroencephalogram
|Often present
|Often absent
|Signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and FLAIR MRI
|Often present
|Often absent
|Pulvinar sign-bilateral high signal intensities on axial fluid attenuated inversion recovery (FLAIR) MRI. Also posterior thalami involvement on sagittal T2 sequences
|Not reported
|Present in >75% of cases
|Immunohistochemical analysis of brain tissue
|Variable accumulation.
|Marked accumulation of protease-resistant prion protein
|Presence of agent in lymphoid tissue
|Not readily detected
|Readily detected
Increased glycoform ratio on immunoblot analysis of
protease-resistant prion protein
|Not reported
|Marked accumulation of protease-resistant prion protein
|Presence of amyloid plaques in brain tissue
|May be present
|May be present
- An abnormal signal in the posterior thalamus on T2- and diffusion-weighted images and fluid-attenuated inversion recovery sequences on brain magnetic resonance imaging (MRI); in the appropriate clinical context, this signal is highly specific for vCJD. (Source: CDC)
As of 2015, no generally accepted treatment for CJD exists; the disease is invariably fatal and research continues. An experimental treatment was given to a Northern Irish teenager, Jonathan Simms, beginning in January 2003.[52] The medication, called pentosan polysulphate (PPS) and used to treat interstitial cystitis, is infused into the patient's lateral ventricle within the brain. PPS does not seem to stop the disease from progressing, and both brain function and tissue continue to be lost. However, the treatment is alleged to slow the progression of the otherwise untreatable disease, and may have contributed to the longer than expected survival of the seven patients studied.[53] Simms died in 2011.[54] The CJD Therapy Advisory Group to the UK Health Departments advises that data are not sufficient to support claims that pentosan polysulphate is an effective treatment and suggests that further research in animal models is appropriate.[55] A 2007 review of the treatment of 26 patients with PPS finds no proof of efficacy because of the lack of accepted objective criteria.[56]
Scientists have investigated using RNA interference to slow the progression of scrapie in mice. The RNA blocks production of the protein that the CJD process transforms into prions. This research is unlikely to lead to a human therapy for many years.[57]
Both amphotericin B and doxorubicin have been investigated as potentially effective against CJD, but as yet there is no strong evidence that either drug is effective in stopping the disease. Further study has been taken with other medical drugs, but none are effective. However, drugs to reduce suffering do exist, and include valproate, an anticonvulsant agent, clonazepam and benzodiazepine, to reduce muscle jerks.[11]
Scientists from the University of California, San Francisco are currently running a treatment trial for sporadic CJD using quinacrine, a medicine originally created for malaria. Pilot studies showed quinacrine permanently cleared abnormal prion proteins from cell cultures, but results have not yet been published on their clinical study. The efficacy of quinacrine was also assessed in a rigorous clinical trial in the UK and the results were published in Lancet Neurology,[58] and concluded that quinacrine had no measurable effect on the clinical course of CJD.
In a 2013 paper published in the Proceedings of the National Academy of Sciences, scientists from The Scripps Research Institute reported that Astemizole, a medication approved for human use, has been found to have anti-prion activity and may lead to a treatment for Creutzfeldt–Jakob disease.[59]
Although CJD is the most common human prion disease, it is still rare, occurring in about one out of every one million people every year. It usually affects people aged 45–75, most commonly appearing in people between the ages of 60–65. The exception to this is the more recently recognised 'variant' CJD (vCJD), which occurs in younger people.
CDC monitors the occurrence of CJD in the United States through periodic reviews of national mortality data. According to the CDC:
- CJD occurs worldwide at a rate of about 1 case per million population per year.
- On the basis of mortality surveillance from 1979 to 1994, the annual incidence of CJD remained stable at approximately 1 case per million persons in the United States.
- In the United States, CJD deaths among persons younger than 30 years of age are extremely rare (fewer than five deaths per billion per year[2][60]).
- The disease is found most frequently in patients 55–65 years of age, but cases can occur in people older than 90 years and younger than 55 years of age.
- In more than 85% of cases, the duration of CJD is less than 1 year (median: four months) after onset of symptoms.[2][60]
Additional concerns
In The Lancet (June 2006), a University College London team suggested that it may take more than 50 years for vCJD to develop, from their studies of kuru, a similar disease in Papua New Guinea.[61] The reasoning behind the claim is that kuru was possibly transmitted through cannibalism in Papua New Guinea when family members would eat the body of a dead relative as a sign of mourning. In the 1950s, cannibalism was banned in Papua New Guinea.[62] In the late 20th century, however, kuru reached epidemic proportions in certain Papua New Guinean communities, therefore suggesting that vCJD may also have a similar incubation period of 20 to 50 years. A critique to this theory is that while mortuary cannibalism was banned in Papua New Guinea in the 1950s, that does not necessarily mean that the practice ended. 15 years later Jared Diamond was informed by Papuans that the practice continued.[62] Kuru may have passed to the Fore people through the preparation of the dead body for burial. Some cite this as substantiation for the belief that cannibalism transmits some metaphysical part of the meal to the diner.
These researchers noticed a genetic variation in some kuru patients that has been known to promote long incubation periods. They have also proposed that individuals having contracted CJD in the early 1990s represent a distinct genetic subpopulation, with unusually short incubation periods for bovine spongiform encephalopathy (BSE). This means that there may be many more vCJD patients with longer incubation periods, which may surface many years later.[61]
In 1997, a number of people from Kentucky, USA developed CJD. It was discovered that all the victims had consumed squirrel brains, although a coincidental relationship between the disease and this dietary practice may have been involved.[63] In 2008, UK scientists expressed concern over the possibility of a second wave of human cases due to the wide exposure and long incubation of some cases of vCJD.[64]
The disease was first described by German neurologist Hans Gerhard Creutzfeldt in 1920 and shortly afterward by Alfons Maria Jakob, giving it the name Creutzfeldt–Jakob. Some of the clinical findings described in their first papers do not match current criteria for Creutzfeldt–Jakob disease, and it has been speculated that at least two of the patients in initial studies were suffering from a different ailment. An early description of familial CJD stems from the German psychiatrist and neurologist Friedrich Meggendorfer (1880–1953).[65][66] A study published in 1997 counted more than 100 cases worldwide of transmissible CJD and new cases continued to appear at the time.[9]
The first report of suspected iatrogenic CJD was published in 1974. Animal experiments showed that corneas of infected animals could transmit CJD, and the causative agent spreads along visual pathways. A second case of CJD associated with a corneal transplant was reported without details. In 1977, CJD transmission caused by silver electrodes previously used in the brain of a person with CJD was first reported. Transmission occurred despite decontamination of the electrodes with ethanol and formaldehyde. Retrospective studies identified four other cases likely of similar cause. The rate of transmission from a single contaminated instrument is unknown, although it is not 100%. In some cases the exposure occurred weeks after the instruments were used on a person with CJD.[9]
A review article published in 1979 indicated that 25 dura mater cases had occurred by that date in Australia, Canada, Germany, Italy, Japan, New Zealand, Spain, the United Kingdom, and the United States.[9]
By 1985, a series of case reports in the United States showed that when injected, cadaver-extracted pituitary human growth hormone could transmit CJD to humans.[9]
In 1992 it was recognized that human gonadotropin administered by injection could also transmit CJD from person to person.[9]
In 2004, a report published by Edinburgh doctors in the Lancet medical journal demonstrated that vCJD was transmitted by blood transfusion.[26]
Stanley B. Prusiner of the University of California, San Francisco (UCSF) was awarded the Nobel Prize in physiology or medicine in 1997 "for his discovery of Prions - a new biological principle of infection".[67] For more than a decade, Yale University neuropathologist Laura Manuelidis had been challenging this explanation for the disease. In January 2007, she and her colleagues published an article in the Proceedings of the National Academy of Science and reported that they had found a virus-like particle (but without finding nucleic acids) in less than 10% of the cells in a scrapie-infected cell line and in a mouse cell line infected by a human CJD agent.[68]
Four Australians had been reported with CJD following transfusion as of 1997.[9] There have been ten cases of healthcare-acquired CJD in Australia. They consist of five deaths following treatment with pituitary extract hormone for either infertility or short stature, with no further cases since 1991. The five other deaths were caused by dura grafting during brain surgery, where the covering of the brain was repaired. There have been no other known healthcare-acquired CJD deaths in Australia.[69]
New Zealand
A case was reported in 1989 in a 25-year-old man from New Zealand, who also received dura mater transplant.[9] Five New Zealanders have been confirmed to have died of the sporadic form of Creutzfeldt–Jakob disease (CJD) in 2012.[70]
United Kingdom
Researchers believe one in 2,000 people in the UK is a carrier of the disease linked to eating contaminated beef (vCJD).[71] The survey provides the most robust prevalence measure to date—and identifies abnormal prion protein across a wider age group than found previously and in all genotypes, indicating "infection" may be relatively common. This new study examined over 32,000 anonymous appendix samples. Of these, 16 samples were positive for abnormal prion protein, indicating an overall prevalence of 493 per million population, or one in 2,000 people are likely to be carriers. No difference was seen in different birth cohorts (1941–60 and 1961–85), in both sexes, and there was no apparent difference in abnormal prion prevalence in three broad geographical areas. Genetic testing of the 16 positive samples revealed a higher proportion of valine homozygous (VV) genotype on the codon 129 of the gene encoding the prion protein (PRNP) compared with the general UK population. This also differs from the 177 patients with vCJD, all of whom to date have been methionine homozygous (MM) genotype. The concern is that individuals with this VV genotype may be susceptible to developing the condition over longer incubation periods, or they may not show any clinical signs of disease.[72]
United States
In 1988, there was a confirmed death from CJD of a person from Manchester, New Hampshire. Massachusetts General Hospital believed the patient acquired the disease from a surgical instrument at a podiatrist's office. In September 2013, another patient in Manchester was posthumously determined to have died of the disease. The patient had undergone brain surgery at Catholic Medical Center three months before his death, and a surgical probe used in the procedure was subsequently reused in other operations. Public health officials identified thirteen patients at three hospitals who may have been exposed to the disease through the contaminated probe, but said the risk of anyone's contracting CJD is "extremely low."[73][74][75] In 2008, a man in Germantown, Wisconsin died of CJD within four months of finding first symptoms. In June 2013, a woman in Prairie Village, KS died. During her brain autopsy, doctors found out that she had CJD. In January 2015, the former speaker of the Utah House of Representatives, Rebecca D. Lockhart, died of the disease within a few weeks of diagnosis.[76] John Carroll, former editor of The Baltimore Sun and Los Angeles Times, died of CJD in Kentucky in June 2015, after having been diagnosed in January.[77]
Other fatalities have occurred in Minnesota and Pennsylvania and have been tracked by the state health department since 1991, averaging 5 deaths per year or 1.3 deaths per million persons.[78]
See also
- ^ Merriam-Webster's Collegiate Dictionary
- ^ a b c
- ^
- ^
- ^
- ^
- ^ a b c who.int: "Fact sheets no 180: Variant Creutzfeldt-Jakob disease" Feb 2012 ed.
- ^
- ^ a b c d e f g h i Emerging Infectious Diseases: "Is Creutzfeldt-Jakob Disease Transmitted in Blood?" (Ricketts et al) vol 3, Jun 1997
- ^ Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 1437704344 | ISBN 978-1437704341
- ^ a b
- ^
- ^
- ^
- ^ In July 2012, Greenville Memorial Hospital in South Carolina released a public warning after warning eleven other patients that a brain surgery patient was later diagnosed with CJD, and though workers sterilized instruments, the hospital stated the CJD patient's diagnosis wasn't known at the time of the surgery and it wanted to warn other patients out of an abundance of caution, noting the CDC recommendation for additional instrument cleaning when CJD is suspected. See Collins, Jeffrey, Greenville hospital warns of rare brain disease, The State, thestate.com, 2012-8-1; and Osby, Liv, 11 patients may have been exposed to fatal disease, The Greenville News, greenvilleonline.com, 2012-7-31.
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- ^ a b
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- ^ a b Sternberg's Diagnostic Surgical Pathology, 5th edition.
- ^
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- ^
- ^ a b
- ^ a b
- ^ a b
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- ^ Warning over second wave of CJD cases
- ^
- ^
- ^
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- ^ Creutzfeldt-Jakob Disease (CJD) - the facts - Infectious Diseases Epidemiology & Surveillance - Department of Health, Victoria, Australia
- ^ Mad cow link in hunter's death | Stuff.co.nz
- ^
- ^
- ^
- ^
- ^
- ^ http://www.heraldextra.com/news/local/central/provo/officials-lockhart-died-from-creutzfeldt-jakob-disease/article_ab2ba7d7-26b0-5e7a-8347-3142e5ded8cc.html
- ^
- ^ http://www.health.state.mn.us/divs/idepc/diseases/cjd/ CJD trends
External links
UCSF Memory and Aging Center—education website from a CJD patient care and research center
- UCSF Memory and Aging Center YouTube channel with films about CJD
- Institute for Neurodegenerative Diseases (IND)—a basic science research institute working on a cure for CJD
- Creutzfeldt–Jakob disease at DMOZ
- CJD animation
- Articles with contributors link
- All articles with unsourced statements
- Articles with unsourced statements from October 2013
- Articles containing potentially dated statements from 2007
- All articles containing potentially dated statements
- Articles with unsourced statements from May 2015
- Articles containing potentially dated statements from 2004
- Articles with unsourced statements from March 2014
- Articles containing potentially dated statements from 2010
- Articles with unsourced statements from August 2008
- Articles containing potentially dated statements from 2015
- Articles with unsourced statements from February 2009
- Articles with unsourced statements from November 2013
- All articles with dead external links
- Articles with dead external links from October 2010
- Articles with DMOZ links
- Transmissible spongiform encephalopathies
- Neurodegenerative disorders
- Rare infectious diseases
- Psychiatric diagnosis


text: I can not find any sites with a clear tut. on making sites with gimp. Most send you around to other sites, giving you he basic outline. I will try my best to write a Css/html code template that others can use to code their site. The idea is, write a simple template witch allows others to simply add their sliced layout. Also I will add a transparent box with a code that will allow you to make your layout buttons clickable. If anyone wishs to help with the code or would like to supply a web site template for this I would be very grateful. I understand this might be in the wrong section of the forum, and I understand this might be unclear to some people. So plz mods plz move if this is in the wrong section >.<, and if anyone has any questions plz ask.


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LONDON, Ont. - The criminal case against the mayor of London, Ont., stemming from his time as a Liberal member of Parliament, has been put over until Feb. 26.
A member of Joe Fontana's legal team made a brief appearance on his behalf Tuesday and asked for the case to be adjourned while the Crown gives the defence disclosure.
Fontana faces charges of fraud under $5,000, breach of trust by a public official and uttering forged documents.
Police say the value of the alleged fraud is $1,700, and the London Free Press has reported that a Government of Canada cheque for that amount was given to a London club to cover a deposit for the wedding reception for Fontana's son in 2005.
Fontana has denied any wrongdoing and refused to step down as mayor while the charges are pending.
His lawyer Gord Cudmore says Fontana will be pleading not guilty. (AM980)


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When the GMO Inside group asked its Facebook followers to go to the Cheerios Facebook page and comment about the company's use of genetically-modified ingredients in the kid-friendly cereal, the Cheerios Facebook page got flooded with negative remarks.
In fact, General Mills, the makers of Cheerios, removed an app on the Facebook page that allowed users to create messages about what Cheerios meant to them because people were creating messages that said things like "Poison" and "Deception." That can't be what General Mills was hoping to find. All of the comments made with the app have been removed from the Facebook page, but regular comments, like the one below, are still there.
I used to feed Cheerios to my first child all the time. Now that I am better educated on GMOs, I am DISGUSTED at the fact that I was naive enough to believe that at the time I was actually feeding her something healthy. I know much better now, and will never again let another Cheerios pass my children's lips until they are GMO-free.
It's becoming more common for consumers to launch dissatisfaction campaigns on companies' social media sites. Last summer, Twitter users bashed McDonalds when the fast-food company started the #McDStories campaign. McDonalds had hoped people would talk up their food, but instead they got thousands of tweets that said things like "One time I walked into McDonalds and could smell type 2 diabetes floating in the air and I threw up. #McDStories."
Do attacks on social media pages of companies do any good? There's no evidence that McDonald's changed anything but perhaps their marketing plans because of the comments they received on Twitter.
Kashi, however, did listen to consumers when something similar happened. Earlier this year, consumers took to Kashi's Facebook page to let them know that they felt misled by Kashi's "all natural" claims even though some of their products are made with GMOs. Within a month of the consumer social media campaign, Kashi told consumers about their "long-term initiative to produce significantly more organic and Non-GMO Project Verified foods."
So will General Mills take the McDonald's route and simply change their marketing practices but not their production practices, or will they listen to consumers and change their product? I don't have a crystal ball, but considering the fact that General Mills reportedly donated more than $1.1 million to defeat Proposition 37 in California that would have required GMO labeling on foods, I'd say the odds are in favor of them taking the McDonald's route.
Wouldn't you? But, wouldn't it be wonderful if General Mills proved us wrong?


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David Beckham and Landon Donovan each played a role in creating a goal as the MLS All-Stars defeated Chelsea FC, 3-2 at PPL Park in Chester, PA. on Wednesday night.
Donovan started and went 45 minutes for the All-Stars while also aiding in the build up that led to Chris Wondolowski's opening goal in the 21st minute. Meanwhile, just hours after landing in Philadelphia from his duties in London, Beckham played 74 minutes for the All-Stars and helped set up Chris Pontius' strike in the 73rd minute. Following the game, Beckham immediately returned to London where he is expected to play a role in Friday's Olympic opening ceremonies.
I'll have more after training this morning, but until then, enjoy this interview with Beckham by MLSsoccer.com's Jackie Montgomery.


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A family business established in 2001. Kalessi Bathroomware was established to cater for the developer and trades person. With years of experience supplying the trades in 2003 Kalessi Bathrooware opened its doors to the public.
We love bathrooms and know how important a bathroom can be and how dramatically it can effect the value of your house.
That's why we never sell mass produced, low quality goods. Every single one of our pieces is custom made from designs provided to our manufacturers with specific material specifications.
Every one of our products is checked for quality before it is imported so that we know what we are selling is suitable for Australian bathrooms and for the Australian way of life.
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See the Signs, Speak Out Free Workplace Training
See the Signs & Speak Out is an innovative workplace training program that helps employers and employees learn to talk about domestic and sexual violence issues in the workplace. Training available in English and Spanish. Learn More.
Steps for Employers to Take to Respond to Domestic Violence
At one time, employers may have thought of domestic violence as something that was not of their concern, a "private family matter" that should not be brought to work. We now know that ignoring domestic violence in the workplace doesn't reduce its impact. The costs of unaddressed domestic violence in productivity, health care claims, and security issues are well known. When victims fear termination for disclosing domestic violence, all the negative impacts continue on in the workplace, and potentially dangerous situations can escalate. Strong workplace policies help employers create an environment where employees can come forward and seek assistance, allowing employers to respond appropriately to ensure that domestic violence does not impact employees, workplace safety or their bottom line.
As awareness of domestic violence has grown in recent years, employers and labor organizations are developing policies to address workers who may be victims or perpetrators of domestic violence. Many have formal policies addressing domestic violence in the workplace. Through Executive Order, the State of Ohio has also adopted policies regarding domestic violence for all state employees.
Here are eight steps employers, employees, and unions can take in the work place to end domestic violence:
Workplace Policies
- Discuss with your CEO or management team the possibility of adopting principles that clearly communicate your commitment to establishing a workplace that is intolerant of domestic violence. Work with the leadership at your workplace to develop and implement comprehensive personnel policies that:
- Prohibit discrimination based on an employee's status as a survivor of domestic violence, in hiring, promotion, and disciplinary action;
- Provides for reasonable leave to get medical care, pursue legal remedies, receive counseling services, etc.;
- Provides for reasonable accommodations regarding safety of employees who are victims of domestic violence, such as changing office locations, parking spaces, work shifts and phone extensions, alerting security and other personnel, etc.;
- Provides as much confidentiality as possible to employees experiencing domestic violence;
- Provides for "second chance" opportunities when it is discovered that performance issues are tied to victimization;
- Provide clear prohibitions and consequences for employees who engage in violence or stalking during work hours;
- Provide clear policies about the consequences of being legally determined to have committed domestic violence;
- Incorporate other strategies recognized to increase workplace safety, retain employees who are battered, and hold employees who are battering accountable. (See local and national resources listed under Web Resources at the bottom of this page.)
Human Resource and Employee Assistance Programs
- Determine whether your company's employee assistance program includes domestic violence services or referrals. If it does not, speak with your human resources director or the appropriate manager about the possibility of expanding the program to address the needs of employees experiencing domestic violence and ensure that the EAP provider is well-trained in responding to trauma and safety issues related to domestic violence.
- Establish a training program for all supervisors and managers at your workplace to give them guidance on how to respond when an employee is a victim or perpetrator of domestic violence. Contact your local domestic violence shelter or program to setup training sessions addressing the dynamics of domestic violence and for educational materials on local domestic violence services.
Education for Employees
- Sponsor a workshop or a series of workshops on domestic violence. Invite a speaker from your local domestic violence program who can share information on local resources. Be aware that a presentation about abuse can be difficult for victims and survivors, but can also provide life-saving information.
- Distribute educational materials about domestic violence to all employees in your workplace. Display brochures and posters in public places that explain the issue and send the message that your workplace is a place which supports survivors and holds abusers accountable. Make victim safety information available in private places such as restrooms or in paycheck envelopes.
- Include an article about domestic violence in your company newsletter or bulletin.
Security in the Workplace
- Make sure security guards at your workplace have been trained to handle the special safety needs of battered women, who may be stalked or attacked at work. Ensure that there are clear policies for security workers to follow to respond to domestic violence cases in the workplace. Contact your local domestic violence program for vital information that should be considered.
- Set up a meeting between security personnel at your workplace and local law enforcement agencies to help facilitate appropriate information sharing and the development of collaborative working relationships.
For more information on addressing domestic violence in the workplace or for assistance please contact your local domestic violence program/shelter or you may contact the Ohio Domestic Violence Network at (614) 781-9651 or (800) 934-9840. For access to a free, online-based workplace training visit speakout.odvn.org.
Web Resources
Guidance and model polices for employers are available at:
Futures Without Violence Workplace and Domestic Violence Resources
Legal Momentum Women's Legal Defense and Education Fund
Corporate Alliance to End Partner Violence
Workplaces Respond to Domestic and Sexual Violence National Resource Center


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Grooming Tip 1
Always blowdry your hair before applying products. Nothing sets the base better for your hair then well blown hair.
Grooming Tip 2
When applying product, start from the back then move your way up to the front of the fro. That way, you don't get too much product on your front and weigh down your hair
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Cocktailing is awesome and I don't mean the Gin & Tonic kind of cocktails. Combine the power of Claymation and Modify Pomade to get a pliable yet strong hold, with a touch of that Don Draper sheen.
Grooming Tip 4
We are all about making life simple. If your conditioner could also act as a shaving cream and shampoo can also be your body wash, wouldn't that be awesome? It is awesome. And it is possible with Hanz de Fuko Natural Shampoo and Natural Conditioner
Grooming Tip 5
Did you know that Modify Pomade increases its stronger holding power when you leave the jar open overnight. What sorcery is this!


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The Yes on Prop 30 campaign is now channeling Karl Rove.
The Republican operative is famous for tactics that include attacks on an opponent's greatest strength and accusations of whatever the accuser is guilty of.
The campaign for Prop 30, the temporary tax measure backed by Gov. Brown and the Democrats, just did both.
U.S. & World
News from around the country and around the globe
In a public letter to Molly Munger, the wealthy civil rights lawyer backing the rival temporary tax measure Prop 38, members of the Yes on 30 coalition accused Munger of engaging in a "destructive course of action... which could cause irreparable harm to our students and schools."
The attack was occasioned by Munger's interview with NBC 4's Conan Nolan, in which she said the Prop 38 campaign would take on Prop 30 in response to Prop 30 ads that were widely seen as deceptive. Some response was inevitable.
But when Yes on Prop 30 accused Munger "of a destructive course of action" that would hurt schools, that is pure pot calling the kettle black.
The Yes on 30 campaign is built around its own "destructive course of action," the $6 billion in cuts to schools, higher education and other programs that would be triggered if Prop 30 fails.
That very threat of destruction is the basis for the sales pitch on Prop 30.
So to accuse Munger of somehow threatening schools is to blame Munger for the destructive course the Yes on 30 side has taken. That's pretty darn rich -- richer than Munger herself.
This is starting to get ugly.
And it's an ugly battle with little point.
Neither Prop 30 nor Prop 38 would make all that much of a difference to the budget or to the schools in the long-term.
California's problems are far bigger than these measures, or this nasty debate.


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Roam further and ride harder in this MTB shoe that won't quit on you mid-ride. The Bontrager Foray combines a stiff sole with a durable upper for an overall reliable trail shoe.
- inForm Pro last delivers an ergonomically-optimized, high-performance fit
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